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Fatma Mahmoud,1 Aiat Ghadban,1 Thana Harhara,2 Halah Ibrahim2 1Education Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; 2Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab EmiratesCorrespondence: Fatma Mahmoud Tel +971555006525Email famahmoud@seha.aeAbstract: Pandemics create unprecedented public health challenges that require comprehensive and coordinated responses from health care systems and can, thereby, cause substantial and prolonged disruption to residency training. The coronavirus 2019 (COVID-19) pandemic has impacted medical education worldwide. Currently, there is a gap in the literature from the trainee’s perspective, and little advice on resuming post-pandemic operations. As internal medicine residents serving on the frontlines of a COVID-19 designated government hospital in the United Arab Emirates, we also faced significant challenges and uncertainties during the pandemic. We are fortunate to have overcome the initial surges and have spent the past 6 months navigating a new reality. We believe that the COVID-19 crisis provides an opportunity for graduate medical education programs worldwide to implement targeted changes that can lead to sustainable improvements in the system. In supporting learning during these times, our residency program has adopted flexible scheduling, focused on frequent and transparent communication, incorporated different strategies to build community and promote psychological wellbeing, and advanced virtual teaching modalities. The aim of this article is to share the strategies that have helped us to move forward in the aftermath of the first phases of the pandemic, whilst we prepare for the uncertainty of the future. We hope that the lessons we have learned can help inform other programs as they react and adapt to the global after-effects of this crisis.Keywords: COVID-19, pandemic, crisis response, medical education, internal medicine, residents

Background: Family medicine (FM) is a medical specialty that provides continuing, comprehensive health care for the individual and the family. This study aimed to describe Lebanese citizens’ knowledge, attitudes, and practices toward FM as a specialty. Methods: This is a national cross-sectional phone-based survey targeting the knowledge of the public about FM and its scope of practice. Questions were asked whether participants had primary health care doctors and their specialties Results: A total of 373 participants were included, with a response rate of 85.2%. Two-thirds were aware of the specialty of FM, while only 16.6% of the participants had previously visited a family physician. Most participants (69.7%) had a doctor they regularly consulted. One-third of participants had a general practitioner as their regular doctor. More than 80% of the participants agreed that FM physicians treat all family members with common and chronic diseases. Around 60% to 75% of participants knew that family physicians provide medical care to children, treat patients with psychiatric impairments, and perform minor surgeries. There was a significant gap in the participants’ knowledge of FM physicians’ role in managing obstetric or gynecologic patients. Conclusion: Despite public awareness of FM, limited understanding and system challenges hinder its utilization in Lebanon. Educational campaigns, government-supported FM practices, and collaborations with public health initiatives are crucial to bridging the knowledge gap and establishing FM as the cornerstone of primary care. This knowledge gap challenges the specialty’s identity and necessitates promoting FM as the cornerstone of primary care, potentially requiring a system-wide endorsement.

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

The research was concerned with studying technical alienation in contemporary global sculpture, as alienation is a concept that gained an important place due to its connection with humans and then moved to different fields, including art. Accordingly, the study was built on four chapters. The first chapter included: the research problem that ended with the following question (What are the uses of technical alienation in contemporary global sculpture)? It also included the importance of research and the need for it, as well as the goal of the research and the limits of the research, and then defining the terms mentioned in the title and defining them linguistically, terminologically and procedurally. As for the second chapter: it included two sections: The first section: by studying the concept of alienation in philosophical thought and what its manifestations are. The second section: was concerned with studying the representations of alienation in contemporary global sculpture. The chapter concluded by reviewing the indicators of the theoretical framework to benefit from them in analyzing the research sample. As for the third section: it included the research community. His sample, the research tool. The fourth chapter: included the results of the research, its discussion, and its conclusions. Among the results reached by the researcher are: 1. The phenomenon of alienation reflected different states of representation depending on the level of alienation, its time, and its social place that did not belong to its paths. It constituted a realistic (material) representation of the sculptor’s state of separation from the surroundings of his community, embodied in the sculptural treatments of his works. 2. The state of alienation for the sculptor was represented by an internal struggle between two active tendencies, the first represented by his desires, while the second was founded on his needs that could not be satisfied, in order to contribute to a creative, sculptural product to bring them out (the state of alienation). Therefore, the state of alienation is considered a type of active orientation (alienation). Positive) It resulted in sculptural works with a creative path.

يهدف البحث إلى الإشارة إلى العوامل المؤثرة على ربحية المصارف بشكل نظري, وإيضاح مفهوم السلاسل المقطعية, ودراسة أثر مؤشرات سياسة إدارة الائتمان المصرفي في معدلات الربحية تم اعتماد المنهج الوصفي التحليلي وتغطي الدراسة الفترة الممتدة من 2011 وحتى 2021, وقد تم الحصول على البيانات الثانوية اللازمة لأغراض الدراسة من القوائم المالية لكافة المصارف الخاصة التقليدية العاملة في سورية كاملة. ومن اهم النتائج يوجد أثر إيجابي ذو دلالة إحصائية لكل من نسبة صافي التسهيلات / إجمالي الودائع ولنسبة حقوق المساهمين / صافي التسهيلات في المصارف السّورية العاملة في معدل العائد على إجمالي الموجودات, بينما يوجد أثر سلبي ذو دلالة إحصائية لنسبة صافي التسهيلات / مجموع الموجودات في المصارف السّورية العاملة في معدل العائد على إجمالي الموجودات, ولكنه لا يوجد أثر إيجابي ذو دلالة إحصائية لنسبة صافي فوائد التسهيلات/ إجمالي الدخل في المصارف السّورية العاملة في معدل العائد على إجمالي الموجودات.

Background: Insufficient remnant liver volume (RLV) after the resection of hepatic malignancy could lead to liver failure and mortality. Portal vein ligation (PVL) prior to hepatectomy is subsequently introduced to increase the remnant liver volume and improve the outcome of hepatic malignancy. IL-22 has previously been reported to promote liver regeneration, while facilitating tumor development in the liver via Steap4 upregulation. Here we performed PVL in mouse models to study the role of IL-22 in liver regeneration post-PVL. Methods: Liver weight and volume was measured via magnetic resonance imaging (MRI). Immunohistochemistry for Ki67 and hepatocyte growth factor (HGF) was performed. IL-22 was analyzed by flow cytometry and quantitative polymerase chain reaction (qPCR) was used for acquisition of Il-33, Steap4, Fga, Fgb and Cebpd. To analyze signaling pathways, mice with deletion of STAT3 and a neutralizing antibody for IL-22 were used. Results: The remnant liver weight and volume increased over time after PVL. Additionally, we found that liver regenerative molecules, including Ki67 and HGF, were significantly increased in remnant liver at day 3 post-PVL, as well as IL-22. Administration of IL-22 neutralizing antibody could reduce Ki67 expression after PVL. The upregulation of IL-22 after PVL was mainly derived from innate cells. IL-22 blockade resulted in lower levels of IL-33 and Steap4 in the remnant liver, which was also the case in mice with deletion of STAT3, the main downstream signaling molecule of IL-22, in hepatocytes. Conclusion: IL-22 promotes liver regeneration after PVL. Thus, a combination of IL-22 supplementation and Steap4 blockade could potentially be applied as a novel therapeutic approach to boost liver regeneration without facilitating tumor progression after PVL.

This study examined the feasibility of producing colored geopolymer concrete using slag as the binder and investigated the effects of pigment on various properties of geopolymer concrete. The geopolymer concrete was supplemented with two varieties of pigment, namely iron oxide hydroxide in the shades of "red" and "yellow", then the following tests of compressive strength, rebound number, density, and ultrasonic pulse velocity were carried out on it. The highest compressive strength value was achieved when adding 1% of pigments, which increased the red and yellow values from the reference value by 2.7 percent and 1.8 percent, respectively. The best rebound number values can be obtained by adding 1% yellow and 3% red, which increased the red and yellow values from the reference value by 8% and 15%, respectively. The density increases as the proportion of the additional pigment rises. The maximum density values were achieved by incorporating 1% of red and yellow pigment, with a respective increase of 1% and 3% for red and yellow. The highest values of ultrasonic pulse velocity when adding 1% of yellow and red color pigments increased by 1.7% for yellow and 2% for red. The optimal addition is 1.2% as it enhances properties and reduces expenses when utilizing smaller pigments.

IntroductionDigital health interventions, particularly mobile health platforms, have shown promise in supporting patients with respiratory conditions, but their application in pulmonary arterial hypertension (PAH) remains limited. We aimed to assess the feasibility, acceptability, and potential clinical benefit of the novel PAHcare™ digital platform as a patient-centred intervention for PAH management through a prospective, single-arm, multicenter pilot study conducted on 53 patients diagnosed with PAH who used the platform for 6 months.MethodsThe primary objective was to assess the impact on Health-Related Quality of Life (HRQoL) through questionnaires. Secondary objectives included evaluating clinical outcomes, including disease progression, PAH signs and symptoms, the 6-min walking test, and the patient’s symptom perception. Additionally, we assessed patient satisfaction and engagement with the PAHcare™ platform, interaction with health coaches, retention, costs and healthcare resource utilisation (HCRU), and safety through monitoring device incidents.ResultsMinimal changes in HRQoL and clinical outcomes were observed over 6 months. A noteworthy 92.4% of patients actively used the platform in the first month, maintaining high usage throughout the study. Patient satisfaction was substantial, with more than half of the patients expressing excellence in service quality, willingness to reuse the platform, and fulfilment of their needs. Health coach interaction was high, with 76% of patients initiating contact within the first week. User retention rates were 70%, with prevalent ongoing usage and interaction with healthcare professionals even after the study. In terms of HCRU and costs, the study showed no significant changes in PAH-related hospital admissions, clinical visits, or tests. Finally, the low number of device-related incidents indicated platform safety.ConclusionThis pilot study provides compelling evidence supporting the feasibility and acceptability of the PAHcare™ digital platform to empower patients to manage their disease and significantly enhance their overall experience with PAH.

تعتبر الحوادث المنزلية أهم سبب لوفيات الأطفال بعمر سنة إلى 5 سنوات, وتعد الإدارة الآمنة والفعالة لبيئة المنزل أمراً حاسماً ومهماً لحماية الطفل من الحوادث المنزلية التي يمكن أن تسبب الإصابات أو العجز أو الوفاة, لذلك يتوجب على الأمهات أن تتوفر لديهن المعلومات والممارسات حول اتخاذ التدابير الوقائية وتوفير البيئة الآمنة لضمان سلامة أطفالهن في المنزل, لذلك هدفت تلك الدراسة إلى تقييم معلومات وممارسات الأمهات حول الحوادث المنزلية عند الأطفال تحت سن الخمس سنوات على عينة قوامها 100 أم تم اختيارهن بطريقة العينة المتاحة من عيادة الأطفال بمشفى التوليد والأطفال باللاذقية ,وجمعت البيانات باستخدام استبيان مطور لهذا الغرض .أظهرت نتائج الدراسة الحالية أن أكثر من ثلث الأمهات لديهن أطفال تعرضوا للأذيات المنزلية , وكانت غالبية الأذيات الجروح يليها السقوط ثم الحروق, كما بينت النتائج أن غالبية الأمهات لديهن ممارسات صحيحة حول منع الأذيات المنزلية بشكل عام. وقد أوصت الدراسة بضرورة تفعيل البرامج التثقيفية التي تهدف إلى تحسين معلومات وممارسات لدى الأمهات فيما يتعلق بالسلامة المنزلية وطرق حماية الطفل من مخاطر الأذيات ضمن المنزل.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by autoantibody's presence in the circulation and involvement of many systems. The current study aims to study the role of some immunological and non-immunological parameters in SLE development and to illustrate the correlations between these parameters. The current study included 50 blood samples collected from SLE patients and apparently healthy control. The methods of work included Complete Blood Count (CBC) analysis to assess blood components, you mean to analyse Hb, WBC, ESR, ELISA technique to measure serum levels of TLR-7, IL-17, and TNF-γ, antinuclear antibody test (ANA) and double-strand DNA antibody (anti ds DNA). The study results showed a significant increase in serum levels of each WBC (p< 0.005), ESR (p< 0.001), IL17(p< 0.004), TLR7(p< 0.005), IFN-γ (p< 0.001), ANA (p< 0.001), and anti dsDNA (p< 0.001) in SLE patients compared to apparently healthy control but the Hb is decreasing level was low in the SLE patients compared with control. In conclusion, the low hemoglobin, WBC, and ESR are non-specific parameters associated with SLE pathogenesis. ANA, Anti-ds-DNA as excellent biomarkers for the diagnosis of SLE and serum level of TLR-7, TNF-γ, and IL-17 were evaluated in SLE patients compared to healthy people and they may be suggested as a prognostic tool in SLE patients.

Lipedema is a chronic, idiopathic, and painful disease characterized by an excess of adipose tissue in the extremities. The goal of this study is to characterize the gene expression of estrogen receptors (ERα and ERβ), G protein-coupled estrogen receptor (GPER), and ER-metabolizing enzymes: hydroxysteroid 17-beta dehydrogenase (HSD17B1, 7, B12), cytochrome P450 (CYP19A1), hormone-sensitive lipase (LIPE), enzyme steroid sulfatase (STS), and estrogen sulfotransferase (SULT1E1), which are markers in Body Mass Index (BMI) and age-matched non-lipedema (healthy) and lipedema ASCs and spheroids. Flow cytometry and cellular proliferation assays, RT-PCR, and Western Blot techniques were used to determine the expression of ERs and estrogen-metabolizing enzymes. In 2D monolayer culture, estrogen increased the proliferation and the expression of the mesenchymal marker, CD73, in hormone-depleted (HD) healthy ASCs compared to lipedema ASCs. The expression of ERβ was significantly increased in HD lipedema ASCs and spheroids compared to corresponding healthy cells. In contrast, ERα and GPER gene expression was significantly decreased in estrogen-treated lipedema spheroids. CYP19A1 and LIPE gene expressions were significantly increased in estrogen-treated healthy ASCs and spheroids, respectively, while estrogen upregulated the expression of PPAR-ϒ2 and ERα in estrogen-treated lipedema-differentiated adipocytes and spheroids. These results indicate that estrogen may play a role in adipose tissue dysregulation in lipedema.

In this study, the possibility of producing colored geopolymer concrete consisting of slag as a binder and studying the effect of pigment on some properties of geopolymer concrete is discussed. Here two types of pigments (chromium oxide “green” and iron oxide hydroxide “yellow”) were added to the geopolymer concrete and some tests such as slump values, compressive strength, flexural strength, and permeability test were conducted. The results showed that the best percentage of pigment addition was 1% of the weight of the slag, and with increasing addition, the mechanical properties began to deteriorate.

Public reimbursement systems face the challenge of balancing provision of needed treatments and the reality of limited resources. Canada has a complex system for drug approval and public reimbursement, with jurisdiction divided between the federal government and the provinces/territories. A pivotal role is that of health technology assessment (HTA), which relies primarily on health economic principles to analyze the value of drugs on a population health basis and make recommendations about public reimbursement. The Canadian Agency for Drugs and Technologies in Health (CADTH) provides recommendations to all provinces but Quebec. This article provides an overview of Canada’s approval and public reimbursement pathway, including the role of HTA and the economic principles on which it relies. Starting in late 2020, CADTH reduced the cost per quality-adjusted life year (QALY) threshold, the metric relied upon in making recommendations to public payers. An analysis of all 56 oncology drug final recommendations issued from January 2020 to January 2022 was conducted and confirms this reduction in the cost per QALY threshold. As a result of this threshold reduction, recommendations to the provinces include, in a number of cases, substantially greater price reductions. The potential implications for successful price negotiation with the pan-Canadian Pharmaceutical Alliance (pCPA), the public negotiating body for the provinces, are discussed.

BackgroundMethodsResultsDiscussionHigh worldwide estimates of depression and suicidality in patients diagnosed with schizophrenia highlight the importance of understanding their associated factors for designing targeted interventions that can both improve distress symptoms and reduce suicide risk in this vulnerable population. In this regard, our study aims to assess the link between beliefs about voices, self-esteem, depression and suicidality in a sample of Lebanese long-stay patients with auditory hallucinations.This study followed a cross-sectional design. Data has been gathered at the psychiatric hospital of the Cross, Lebanon, during the month of April 2022. Patients diagnosed with schizophrenia, aged >18 years, hospitalized for >1 year, clinically stable, and experiencing persistent auditory verbal hallucinations were included.Sixty-one patients were experiencing auditory hallucinations and were therefore enrolled in the study. Their mean age was 56.05 ± 12.25 years (27.9% females); 42.6% of patients had suicidal ideation, 48.9% had depression. Multivariable analyses models showed that, after adjusting for confounders, higher omnipotence (Beta = .49) and emotional resistance (Beta = .92) remained strongly linked with more depression; while only higher depression (aOR = 1.17) remained significantly linked with increased likelihood of having suicidal ideation.Pending future longitudinal research, findings suggest that mental health professionals should not only assess the presence of auditory hallucinations but also pay attention to the patient’s beliefs about their voices, as they may be determinant in the development of depression. Therapeutic approaches targeting resistant and malevolent beliefs about voices may be highly beneficial as adjuvant to existing pharmacological and psychological interventions. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer is one of the leading causes of cancer-related deaths worldwide. Traditional methods for predicting patient outcomes rely heavily on the physical characteristics of tumors. Our research aims to develop a new, simple risk score that uses three specific molecular markers found in tumor tissues. By examining the presence and levels of these markers, we hope to better predict which patients have a higher risk of poor outcomes. This can help doctors make more informed decisions about treatment options. Our findings may lead to improved survival rates by identifying high-risk patients who need more aggressive treatment and sparing low-risk patients from unnecessary procedures. Introduction: Several new molecular markers in colorectal carcinomas have been discovered; however, classical histopathological predictors are still being used to predict survival in patients. We present a novel risk score, which uses molecular markers, to predict outcomes in patients with colorectal carcinoma. Methods: The immunohistochemistry of tissue micro arrays was used to detect and quantify H2BUB1, RBM3 and Ki-67. Different intensities of staining were categorized for these markers and a score was established. A multivariate analysis was performed and survival curves were established. Results: 1791 patients were evaluated, and multivariate analysis revealed that our risk score, the 3-biomarker classifier, is an independent marker to predict survival. We found a high risk-score to be associated with dismal median survival for the patients. Conclusions: A more personalized score might be able to better discriminate low- and high-risk patients and suggest adjuvant treatment compared to classical pathological staging. Our score can serve as a tool to predict outcomes in patients suffering from colorectal carcinoma. [ABSTRACT FROM AUTHOR]