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Abstract Early therapeutic intervention in high-risk smoldering multiple myeloma (HR-SMM) has shown benefits, however, no studies have assessed whether biochemical progression or response depth predicts long-term outcomes. The single-arm I-PRISM phase II trial (NCT02916771) evaluated ixazomib, lenalidomide, and dexamethasone in 55 patients with HR-SMM. The primary endpoint, median progression-free survival (PFS), was not reached (NR) (95% CI: 57.7–NR, median follow-up 50 months). The secondary endpoint, biochemical PFS, was 48.6 months (95% CI: 39.9–NR) and coincided with or preceded SLiM-CRAB in eight patients. For additional secondary objectives, the overall response rate was 93% with 31% achieving complete response (CR) and 45% very good partial response (VGPR) or better. CR correlated strongly with the absence of SLiM-CRAB and biochemical progression. MRD-negativity (10-5 sensitivity) predicted a 5-year biochemical PFS of 100% versus 40% in MRD-positive patients (p = 0.051), demonstrating that deep responses significantly improve time to progression. Exploratory single-cell RNA sequencing linked tumor MHC class I expression to proteasome inhibitor response, and a lower proportion of GZMB+ T cells within clonally expanded CD8+ T cells associated with suboptimal outcomes.

Abstract This review synthesizes 48 academic studies on Initial Coin Offerings (ICOs) from 2018 to 2023, employing bibliometric and content analyses to illuminate their complexities and innovation in entrepreneurial finance. It identifies four key themes: (1) regulatory intricacies, market transformation, and strategic implications for emerging ventures; (2) the opportunities and challenges presented, and key factors influencing the success of ICOs; (3) ICOs and entrepreneurial finance; and finally, (4) review of reviews. By examining the intersection of legal frameworks, disruptive potential, and stakeholder challenges, this interdisciplinary perspective captures the essence of ICOs and charts a course for future inquiry. It serves as a pivotal reference for researchers, practitioners, and regulators to understand the multifaceted ICO landscape and its implications for the future of finance.

Abstract Background Stuttering priapism is characterized by recurrent, self-limited episodes of penile erection lasting from a few minutes to a maximum of three hours, often resolving spontaneously. These episodes can occur with or without sexual stimulation. If not treated promptly and effectively, stuttering priapism can severely impact a patient’s quality of life, leading to significant psychological distress and anxiety related to sexual performance. Although it has been associated with various hematological disorders and pharmacological treatments, many cases of stuttering priapism remain idiopathic, meaning they have no identifiable cause. Currently, no conclusive randomized clinical trials exist on the management of idiopathic stuttering priapism. This study aims to review the existing literature on the pathophysiology and management of idiopathic stuttering priapism and propose an algorithm to assist physicians in its evaluation and treatment. Results A systematic literature review was conducted using the PubMed database, focusing on the terms “idiopathic,” “stuttering,” “ischemic,” and “priapism.” The search identified 23 relevant references published between 1991 and 2022. The selection and analysis of these studies adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and results were described qualitatively. Recent research into the effectiveness, sustainability, tolerability, and side effects of various treatments for idiopathic stuttering priapism has enhanced the understanding of its underlying molecular mechanisms. Various treatments, targeting different mechanisms, have been identified that can potentially reduce the frequency and severity of episodes and improve patient outcomes. Conclusion Current research predominantly addresses the acute treatment of idiopathic stuttering priapism rather than strategies to alter the disease’s overall course. The limited number of treatment reviews, case reports, and the low level of evidence available, combined with the absence of randomized clinical trials, prevent the establishment of a consensus on treatment protocols. As a result, idiopathic stuttering priapism remains under-recognized and under-treated. This review proposes a management framework to help clinicians access and apply the available literature effectively, minimizing the reliance on extensive case reports and review articles.

Abstract Background Unlike eating disorders (ED) that are officially recognized and focusing on the quantity of food, Orthorexia Nervosa (ON) revolves around an unhealthy fixation on the quality of food eaten. Existing ON scales differ in how these conceptualize and define ON, ensuing inconsistency in assessments that not only affects the validity and reliability of ON related research, but also impacts the ability of healthcare professionals to identify and provide support for individuals struggling with ON. Objective Create the first Eastern locally validated tool that considers the cultural nuances and specificity of the Lebanese general population’s eating attitudes and their social context, addresses the limitations of existing scales and thereby provides a valid instrument that can be used in Lebanon and culturally-similar countries. Methods Data were collected between September 2023 and February 2024, enrolling 320 participants for the exploratory factor analysis and 658 for the confirmatory analysis. Results Starting from an initial pool of 25 items, the exploratory-confirmatory (EFA-CFA) factor analyses retained 13 items. The LONI showed a unidimensional factor structure, and satisfactory convergent and concurrent validity with a composite reliability (ω and α) of 0.90 providing clear evidence of its high reliability, supporting the stability and consistency of LONI scores across different subsamples. The structural characteristics, factor loadings, and item intercepts of the LONI remained consistent regardless of gender, affirming the tool’s stability and reliability in measuring ON traits across diverse populations. Conclusion The LONI is a valid tool for assessing ON, particularly in accounting for Lebanese and culturally similar populations. The scale’s unidimensional structure allows for straightforward calculation of the score, making it practical for both clinical and research applications, while offering a unique advantage in considering regional dietary patterns compared with existing ON screening tools due to its cultural specificity and psychometric strengths. The ON prevalence was high in the present sample, underscoring the significance of sociocultural and behavioral factors in its manifestation.

Abstract Background: In patients with eosinophilic esophagitis (EoE), the correlation between symptoms of esophageal dysfunction and endoscopic and histologic disease activity is generally poor and probably related to multiple causes such as esophageal remodeling processes that might go undetected using endoscopy and histology as well as esophageal hypervigilance and symptom-specific anxiety. Hence, there is a need for a holistic management of patients that goes beyond the control of eosinophilia and symptoms. Summary & Key messages: Physiological esophageal testing using high-resolution manometry, functional lumen imaging probe, pH-impedance, wireless pH monitoring and mucosal impedance may unveil the effects of chronic transmural fibro-inflammatory changes of the esophageal wall as well as esophageal hypervigilance, thereby assisting to phenotype patients, predict therapeutic response to therapy and identify motility disorders that may need a specific targeted therapy to ameliorate patients’ outcomes. This article discusses the role of functional esophageal examinations in the diagnosis and management of EoE.

Abstract Background Intravascular papillary endothelial hyperplasia (Masson tumor) is a rare, benign vascular tumor characterized by the proliferation of endothelial cells within blood vessels. While it typically affects the skin and subcutaneous tissues, it can occasionally appear in unusual locations. Case presentation We report a rare case of Masson tumor located in the right atrial appendage of a healthy individual. This case was complicated by atrial wall rupture and subsequent cardiac tamponade. The tumor was successfully resected under cardiopulmonary bypass. Conclusion This case highlights a rare occurrence of Masson tumor in the heart, emphasizing the importance of prompt surgical intervention to prevent life-threatening complications such as cardiac tamponade.

Abstract The continuous growth of biofilm infections and their resilience to conventional cleaning methods and antimicrobial agents pose a worldwide challenge across diverse sectors. This persistent medical, industrial, and environmental issue contributes to treatment challenges and chronic diseases. Lactic acid bacteria have garnered global attention for their substantial antimicrobial effects against pathogens and established beneficial roles. Notably, their biofilms are also predicted to show a promising control strategy against pathogenic biofilm formation. The prevalence of biofilm-related problems underscores the need for extensive research and innovative solutions to tackle this global challenge. This novel study investigates the effect of different extracts (external, internal, and mixed extracts) obtained from Lactobacillus rhamnosus GG biofilm on pathogenic-formed biofilms. Subsequently, external extracts presented an important eradication effectiveness. Furthermore, a 6-fold concentration of these extracts led to eradication percentages of 57%, 67%, and 76% for Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa biofilms, respectively, and around 99.9% bactericidal effect of biofilm cells was observed for the three strains. The results of this research could mark a significant breakthrough in the field of anti-biofilm and antimicrobial strategies. Further studies and molecular research will be necessary to detect the molecules secreted by the biofilm, and their mechanisms of action engaged in new anti-biofilm strategies.

Abstract Background Despite the importance of community involvement in research, little formal training in community outreach and engagement (COE) is offered to cancer research trainees. A collaboration between the Office of COE and the Office of Cancer Research Training and Education Coordination (CRTEC) at the Sidney Kimmel Comprehensive Cancer Center at Jefferson led to the COE-CRTEC Trainee Working Group, a unique program in which trainees in cancer research each created a novel COE initiative. Methods Four cancer research trainees were selected to serve as COE Program Liaisons (CPLs), each aligned with one of the four cancer center research programs. Each CPL developed, implemented, and evaluated a project that enhanced the bidirectional relationship between their research and the community. Trainees were provided a modest budget, support from the Office of COE, and a requirement to complete the project within one academic year. Results Projects included a cancer education seminar for older adults at a senior center, a prostate cancer education and screening event at a predominantly African American church, a video demonstrating a day in the life of a skin cancer researcher, and a podcast that featured SKCCC investigators answering research questions from community members. Conclusion Students who would not typically be exposed to COE training gained experience developing, implementing, and evaluating community-based initiatives. Projects were diverse in topic and approach, reflecting the diversity of the trainees and the community. Allowing trainees, those who are the next generation of cancer researchers, to design community-based research may lead to more patient-centered research in the future.

Abstract Background Disparities in health outcomes among persons with disabilities (PWD) are influenced by preventable factors including negative attitudes and discriminatory practices of healthcare professionals and the limited training of medical students in working with PWD. Objective The purpose of this study was to validate the “Medical Students’ Attitudes Towards Patients with Disabilities” (MSA-PWD) scale among Lebanese medical students and identify associated factors. Method A scale validation study was conducted as part of the standard internal evaluation process at the medical school, using a cross-sectional design based on a qualitative content validity process, involving students from years 1 to 4. The study included questions from previous tools, and others encouraging students to reflect on their encounters with PWD and share their insights. Statistical procedures were applied to assess the reliability and validity of the tool, including construct validity, convergent validity, known-group validity, and trend analysis. Results After a careful selection of the related items, the MSA-PWD scale demonstrated high construct validity and internal consistency, along with good convergent validity and known-group validity. Factor 1 of the scale was able to differentiate between different enrollment years of medical students, correlating with the self-assessment tool for confidence in dealing with PWD and clinical experience scenarios. Conclusion The “Medical Students’ Attitudes Towards Patients with Disabilities” scale validated in this study is a comprehensive instrument that can distinguish between different medical school enrollment classes. The newly developed scale was valid, and reliable.

Abstract Background Obsessive-compulsive disorder (OCD) and eating disorders (ED) share common features, including the presence of obsessions and compulsions, and they often co-occur. Additionally, there is a significant comorbidity between ED and childhood traumatic experiences (CTE), as well as between CTE and OCD. Various biological and environmental factors have been proposed to explain the connection between ED, OCD, and CTE. This study explores the link between CTE and the comorbidity of ED and OCD, with the hypothesis that specific types of CTE may increase the risk of developing OCD in individuals with ED. Methods Participants (N = 562) were enrolled at an eating disorder unit in Montpellier, France, between March 2013 and January 2020. The Childhood Trauma Questionnaire (CTQ), Eating Disorder Examination Questionnaire (EDE-Q), and Mini International Neuropsychiatric Interview (MINI) were used to evaluate childhood maltreatment, assess clinical characteristics associated with ED, and categorize participants into two groups: patients with and without OCD. Results Bivariate analysis revealed that patients with comorbid ED and OCD had higher EDE-Q scores (p

Abstract Background Obstetric anesthesia guidelines are essential for standardizing obstetric anesthesia practices globally and ensuring high-quality patient care. However, practices may vary across different settings, and there are limited data from Arab countries. This study aims to gain insights into obstetric anesthesia practices in several major hospitals across Arab countries. Methods A questionnaire was emailed to 85 obstetric anesthesiologists/anesthesia chairpersons in major hospitals, including academic medical institutions and central hospitals, across 11/22 Arab countries. This survey gathered data on key structural and process-related obstetric anesthesia indicators. Results Out of 85 contacted, we had 56 responses (65.8%), with 41 being fully completed, providing insights into obstetric anesthesia indicators. Regarding structure: 31 (76%) hospitals had an operating room adjacent to the delivery room, all had intensive care units, and 22 (54%) had a lead obstetric anesthesiologist. For equipment, 19 (46%) had a video laryngoscope in the delivery suite, and 20 (49%) occasionally used ultrasound for epidurals. Regarding process: 33 (81%) held regular meetings, and 21 (51%) conducted research. Before epidural and spinal procedures, 26 (63%) and 28 (68%) required coagulation studies for patients without a history of hemorrhagic complications, while 38 (93%) and 36 (88%) mandated a platelet count, respectively. For labor analgesia, 34 (83%) primarily used epidurals, and 15 (37%) placed preemptive catheters in high-risk pregnancies. For cesarean delivery, 40 (98%) used spinals, with 16 (39%) using intrathecal morphine and 22 (54%) administering aspiration prophylaxis before general anesthesia. Regarding spinal-induced hypotension, 6 (15%) used prophylactic phenylephrine infusion. Conclusion This survey highlights variations in obstetric anesthesia practices among various major hospitals in several Arab countries, compared to international recommendations. It emphasizes the need for obstetric anesthesia registries in the Arab world for future research. Further studies are required to outline country-specific practices, improve resource allocation, and enhance obstetric population safety and satisfaction.

Abstract Background Diabetes is associated with impairments in muscle mass and quality increasing the risk of sarcopenia. Thus, this study aimed to investigate the odds of sarcopenia and its associated risk factors among Qatari adults (> 18 years), while exploring the modulating effects of health and lifestyle factors. Methods Using a case–control design, data from 767 participants (481 cases with diabetes and 286 controls without diabetes) was collected from Qatar Biobank (QBB). Sociodemographic, lifestyle factors including dietary intake, anthropometric and biochemical measures were analyzed. Handgrip strength, Dual X-ray absorptiometry (DXA), and Bio-impedance were used to assess muscle strength, muscle mass and muscle quality, respectively. The risk of sarcopenia was estimated using the European consensus on definition and diagnosis of sarcopenia. Results Cases with diabetes were older (55 vs. 36 years; P

This study investigates the changes and persistence in dynamic connectedness between stock market performance and exchange rate fluctuations, comparing conventional and Islamic financial systems. With an eye on a global financial landscape characterized by the integration of capital markets and the adoption of floating exchange rate regimes, it examines the effects of exchange rate variations on the dynamics of the stock market in nine different countries - the United Kingdom, Australia, Japan, Singapore, Canada, China, India, Korea, and South Africa. The study employs daily data spanning from November 2015 to July 2023 and uses a comprehensive analysis of three-step methodology, including nonparametric causality-in-quantiles tests, asymmetric slope Conditional Autoregressive Value-at-Risk (CAViaR), and Time-Varying Parameter Vector Autoregressive (TVP-VAR) Connectedness measure. Our results underline the asymmetric impact of exchange rate fluctuations on stock markets and highlights the distinctive characteristics of Islamic financial markets. Comparing Islamic and conventional stock markets in the context of exchange rate fluctuations, this study not only serves to fill a gap in the existing literature but also emphasizes the significance of currency exchange rate swings for global investors, policymakers, and practitioners trying to understand the intricacies of global financial markets.

This paper investigates the potential that mediated text can have on expanding Lebanese young people's notions and understandings of sexuality beyond their personal boundaries and the immediate local context to uncover the portrayal of these notions within a global mediated space. It specifically seeks to examine the intersection between Lebanese youth media practices and sexual learning by identifying the extent to which watching the hit Netflix series "Sex Education," affected young people's sexual identities, knowledge and practices. Four focus groups, each comprised of six respondents, described the importance of the series in influencing young people's sexual learning and thoughts in a society where sexuality and sexual subjects are taboo. The four main discussion themes that were developed -- namely, Open Mindedness: transgression, acceptance and respect; Transformation: life skills and right choices; Gender Equality, Well-being and Health; Reliability/identification and the Need for Trustworthy Connections; and the Need to Re-educate Family and Society about Sex -- underscore the importance of the series as a learning tool, the need for the re-introduction of sexual education as part of school curricula in Lebanon, and the re-education of society more generally to help foster healthier sexual lives among young people.

Many mothers do not communicate with their adolescent about sexual health topics due to perceived barriers. Our goal in this study was to shed light on the activities mothers engage in to prepare for sexual health discussions with their young adolescents. We also examined the extent to which mothers' past sexual communication behaviour and intentions were associated with engaging in these activities and perceptions of their helpfulness. Participants were 244 mothers of young adolescents who completed surveys at two points in time separated by 6 months. Overall, 64% of the mothers had engaged in one or more preparatory activity but found doing so only somewhat helpful. More extensive past sexual communication and higher sexual communication intentions were associated with engaging in preparation activities and finding them more helpful. However, past communication was significantly associated with the likelihood of engaging in preparatory behaviours for mothers with low, average, but not high sexual communication intentions. The results point to the importance of strengthening mothers' sexual communication intentions and providing them with information about high-quality resources and/or a resource package as means to increase the likelihood that they will engage in activities that prepare them to discuss sexual health topics with their adolescent.

Infant formula milk (IFM) is increasingly utilized as a substitute for natural breastfeeding despite the fact that breast milk has been always recognized as the optimal nourishment method. While IFMs are fortified with essential nutrients that are crucial for proper growth, they can also harbor non-essential toxic metal contaminants from various sources during the production process. Given the heightened vulnerability of newborns to such contaminants, it is imperative to thoroughly analyze, evaluate, and minimize the toxicity associated with the consumption of such IFMs. However, classical approaches to date, have been always adopted for assessing such risks by finding first the analytical concentration of metals in the IFMs followed by multiplying it by the average daily powder intake (ADI) then dividing by the average infant weight. The outcome is then compared to an established standard such a PTWI to assess the extent of toxicity. The drawback with such studies is the use of a fixed ADI for all samples as if all samples have the same and exact preparation directions while using somewhat different infant masses.Accordingly, this study aims at assessing the toxic risk amongst newborns from IFM consumption through the identification and application of various highly important and toxicity-contributing parameters from each IFM and its directions of preparation label separately which are discussed here for the first time while providing comparisons between the classical approach versus our new approach to highlight its importance.Seventy-three IFMs (0–6 months) were analyzed for lead (Pb), cadmium (Cd), arsenic (As), and aluminum (Al) levels and unlike previous studies, this work incorporated various feeding parameters from each IFM for calculating the intakes thus, revealing potential toxicity risks even in IFMs that are considered safe by the classical approach. Metal contamination was significant, with 97.3 % of samples containing detectable Pb, 41.1 % Cd, 16.4 % As, and 93.2 % Al while highlighting Pb in exceeding its maximum allowable level (MAL). This novel approach, which considers new diverse feeding schedules/parameters that are ironically suggested by manufacturers that have been previously overlooked elsewhere, emphasized IFMs' potential as sources of heightened metal toxicity in comparison to classical approaches. Results highlighted Pb and Al as major concerns, with As and Cd of lesser concern. Findings also emphasized the importance of such new parameters for safeguarding newborn health and should be payed attention to by caregivers. The study strongly and highly recommends adherence to minimum feeding schedules (MFS) and proper scooping techniques to reduce newborn exposure to toxic metals. It also suggests continuous monitoring and stricter regulations by health authorities at the production level of such products so as to provide a safer commodity in the first degree and to also provide better and somewhat uniform and specific feeding labels and precautions on such products.

Background Urinary tract infections (UTIs) are among the most common bacterial infections, and appropriate antimicrobial therapy with agents that minimise resistance is crucial. Despite international concern, adherence to guidelines is still suboptimal. This study aims to determine the effect of the absence of national guidelines and the rate of conformity to international guidelines among physicians in antibiotic (ATB) prescriptions for the treatment of UTIs in adults and detect the factors that are associated with a higher rate of non-compliance.Methods Patient-related characteristics and the prescribed ATBs were gathered from patients' medical files, and a questionnaire was directed to physicians to elicit the factors involved in decision-making. Four criteria were evaluated: molecule conformity, daily dose conformity, duration conformity and global conformity.Results 37 Lebanese physicians and 185 prescriptions were included. The most prevalent class of ATBs was fluoroquinolones (30.3%). Global conformity to guidelines was 31.4%, while conformity on drug choice, daily dose and duration of treatment was 83.2%, 74.7% and 41.6%, respectively. There were no differences in conformity rates according to the physician’s specialty (p=0.135). Physicians who studied in an American-system university had an increased risk of non-conformity (adjusted OR (aOR=2.107, p=0.018). Patients with higher education levels, or presenting with fever or chills, were more likely to get a non-compliant prescription (aOR=2.140, p=0.032 and aOR=4.947, p=0.033, respectively).Conclusion In a country with no local guidelines, non-conformity to international guidelines is high. Larger national studies are needed with immediate interventions to enhance physicians’ prescribing practices. After local guidelines were established, it would be interesting to compare the rate of adherence to these guidelines.

This research explores the interdependence within the international logistics sector among 17 nations, utilizing a quantile-based technique to assess the transmission of returns. By analyzing daily data from DataStream spanning from 1 June 2016, to 12 August 2024, we apply the Quantile Vector Autoregression framework to examine the synchronous behavior of variables, considering the magnitude of shocks. Our findings reveal varying degrees of linkage at the lower, median, and upper quantiles of the conditional distribution. The results show that extreme events, such as the COVID-19 pandemic and the Russia-Ukraine war, significantly amplified spillovers across logistics markets, while the impact of the Israel-Hamas conflict was more regionally contained. Regional clustering and geographical proximity play a crucial role, with stronger interconnections observed among neighboring countries, such as the US and Canada, and Germany and France. The US stands out as a dominant transmitter of shocks, while countries in Asia and Oceania tend to be net receivers, highlighting their vulnerability to external disruptions. These results underscore the need for quantile-based risk assessments in regulatory frameworks and risk management strategies to better manage asymmetric risk transmissions during global crises.

Background and objectives Violence against women (VAW) is widespread and can have serious physical and mental health consequences, including post-traumatic stress disorder (PTSD) and sleep disorders. Victim-survivors often face barriers in accessing specialised care, highlighting the need for a multidisciplinary response, especially in healthcare settings. The Maison des Femmes (MdF) model provides holistic support to women experiencing VAW, including medical, psychological, social and legal support. The aim of this study is to examine whether the MdF’s comprehensive intervention programme offers advantages over standard care in improving mental health indicators, such as PTSD.Method and analysis Our pragmatic quasi-experimental study uses a non-randomised controlled cluster design. The intervention group comprises women enrolled in MdFs in five French cities, while the comparison group includes women receiving usual care in sociomedical structures located geographically close to MdF centres. Our study aims to recruit 360 women (180 per group), aged 18 years or older, who have experienced intimate partner violence or sexual violence and who seek care at the study centres. The primary analysis will compare the change in PTSD Checklist for DSM-5 (PCL-5) scores over 6 months in the two groups using multivariable linear regression with propensity score adjustment. Secondary outcomes include sleep disorders, quality of life, symptoms of anxiety and depression, self-esteem, sense of safety and well-being, initiation of legal and socioprofessional proceedings, and healthcare utilisation.Ethics and dissemination The study was approved by the ‘Comité de protection des personnes Ile de France III’ (CPP Committee for the Protection of Persons Ile de France III; institutional review board on 20 December 2023; Ref no. (Numéro SI): 23.04197.000491).The results of the study will be communicated via academic publications; easily understandable briefs for a broader public; and proactive involvement with medical institutions, journalists and advocacy groups.Trial registration number NCT06226818. Version Number 1- february2024.

Objectives The primary aim of this research is to uncover the underlying factors that shape hospital selection criteria among individuals in Lebanon.Design Cross-sectional study.Setting A survey was circulated across social media platforms and messaging applications in Lebanon from February to May 2023. This questionnaire aimed to gauge participants’ opinions on the importance of various factors in their hospital selection process.Participants A total of 746 participants filled out the survey. We targeted Lebanese adults who were not hospitalised at the time of survey submission.Main outcome measures We performed an exploratory factor analysis to examine the underlying structure of our 70-question survey. Reliability analysis was conducted using Cronbach’s alpha and McDonald’s omega. Factor scores were derived by aggregating raw scores and computing the mean.Results The survey results identified eight key factors that accounted for 58.02% of the total variance, with excellent sampling adequacy (Kaiser-Meyer-Olkin=0.921, Bartlett’s p