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Abstract Background Widespread vaccine acceptance is crucial, particularly with emerging infectious diseases like COVID-19. This study assesses COVID-19 vaccine willingness and its influencing factors among healthcare workers (HCWs) and non-HCWs in Lebanon. Methods In November 2020, a web-based survey was conducted among Lebanese adults using snowball sampling. Participants completed an anonymous Arabic questionnaire covering sociodemographics, health status, vaccine intentions, and the Health Belief Model. Multivariable logistic regression was performed to identify factors associated with COVID-19 vaccine acceptance in HCWs and non-HCWs. Results Of 2802 participants, 51.5% intended to receive the COVID-19 vaccine. HCWs (65.8%) were more willing than non-HCWs (47%). Factors positively linked to acceptance included older age, marital status, urban residence, recent influenza vaccination, heightened susceptibility and benefit perception, concerns about vaccine access, and health authority recommendations. Conversely, vaccine refusal history, safety concerns, and side effect worries reduced intention. Among non-HCWs, female gender, religiosity, and manufacturer reliability concerns, negatively affected acceptance. Good knowledge, public vaccine intake, and self-motivation were positive factors. HCWs were unaffected by these factors. Conclusion Addressing the concerns and misconceptions surrounding the COVID-19 vaccine, especially among non-HCWs, while promoting the benefits of vaccination, is essential to enhance COVID-19 vaccine acceptance in Lebanon to achieve broader immunization coverage and pandemic control. in the community.

Abstract The construction industry significantly impacts the environment through natural resource depletion and energy consumption, leading to environmental degradation. Circular Economy (CE) material efficiency strategies—such as material reuse, design for disassembly, prefabrication, and recycling—offer promising solutions for reducing resource consumption and waste. This paper explores stakeholders’ perspectives on the costs and benefits of implementing CE material efficiency strategies in the construction industry, using the 3-R (Reduce, Reuse, Recycle) framework. By analyzing data from 382 participants, it assesses perceptions of costs and benefits, uncovering regional differences. The findings highlight that studied European stakeholders prioritize reuse and design for disassembly, while studied non-European countries focus on offsite production and material reuse optimization. Despite these differences, both groups view waste reduction as a key benefit, due to the cost savings it provides. By highlighting regional drivers and barriers to CE adoption, this research establishes a foundation for developing targeted policies and collaborative strategies to advance CE implementation in construction worldwide.

AbstractThe issue of combating noise and achieving legal protection for public tranquility is vital and important, in light of the modern technology that causes noise, and the increasing violations in using the horn, besides the misunderstanding of the freedom in practicing crafts without respecting others tranquility. The research aims to demonstrate the need of administration's intervene to protect public tranquility through its authority, consistent with the enforced legal legislation, with an indication of shortcomings in those legislations, especially in granting the authority to administration to withdraw the license and grant incentive rewards for environmentally friendly activities to implement thus legislations. Furthermore to insight the administration to its powers in those legislations and protecting public tranquility as one of the elements of the environmental public system, also to grant it more powers in this field.

Abstract Introduction With the upsurge of COVID-19 cases, Lebanese hospitals were overburdened and hospital care was prioritized for COVID-19 patients with the highest probability of poor outcomes. This paper aimed to assess the suitability of residential settings for home isolation and to explore the patient’s ability to adhere to the required precautions measures. Methods All COVID-19 cases reported between February, 21 and the end of June 2020 and who had mild or moderate symptoms, were contacted via phone calls by a healthcare professional to fill out a standardized questionnaire developed to assess the suitability of the residential setting for home care. Inpatient cases were required, before their discharge from the hospitals, to sign consent related to their adherence to the mandatory precautionary measures. They were also asked to complete, on daily basis, the symptoms monitoring log form. A referral system to health facilities was established to manage cases with worsening health status. A collaborative framework to address violations of home isolation rules was also put in place. Results Of the 600 cases assessed, 44.7% of them were isolated in a living building apartment (67.2%) with one entrance (85.5%) including four to eight rooms (71%). Around one-quarter of patients have children (

Abstract Background Hospital cleaners are the unsung heroes in the fight against the COVID-19 pandemic. This study aimed to assess the knowledge, attitudes, and practices (KAP) of hospital cleaners towards COVID-19 and determine factors associated with good practices. Methods A cross-sectional study was conducted in Lebanon between the 1st and 14th November 2020. Using a snowball sampling technique, data were collected through an online survey that was sent to governmental and private hospitals. The questionnaire consisted of socio-demographic characteristics and KAP of hospital cleaners towards COVID-19. Descriptive statistics and logistic regression analysis were performed. Results A total of 453 cleaners completed the survey, of whom 54.3% were females. Most participants had a good level of COVID-19 knowledge (98%) and good preventive practices (89.7%). Regarding attitude, 90.7% had a positive attitude toward health facilities, 78.8% toward cleaning and disinfection, and 73.5% toward health authorities. Sociodemographic characteristics, including younger age, higher levels of education, working in private hospitals, and having more than 3 years of experience, were positively associated with good preventive practices. Our results also showed that participants who had good knowledge about COVID-19, COVID-19 prevention and treatment, cleaning and disinfection processes, and COVID-19 risk factors had a higher likelihood of positive preventive practices. Finally, a positive attitude toward health facilities, health authorities, and cleaning and disinfection was positively associated with good practices. Conclusion The surveyed cleaners have a high level of knowledge and expressed positive attitudes toward health facilities and health authorities, as well as good preventive practices. Understanding the determinants of cleaning performance is critical in tailoring interventions to improve hospital cleaning.

The study aims to assess the health-related Quality of Life (HRQOL) and its association with socio-demographic factors among the Afghan refugees residing in Quetta, Pakistan. For this purpose, a cross-sectional, descriptive study design by adopting Euro QOL five dimensions questionnaire (EQ-5D) for the assessment of HRQOL was conducted by approaching Afghan refugees from the camp and other areas of Quetta, Pakistan. Furthermore, this study also involved descriptive analysis to expound participant's demographic characteristics while inferential statistics (Kruskal-Wallis and Mann-Whitney test, P < 0.05) were used to compare EQ-5D scale scores. All analyses were performed using SPSS v 20. Herein, a total of 729 participants were enrolled and were subsequently (n = 246, 33.7%) categorized based on their age of 22-31 years (31.30 ± 15.40). The results of mean EQ-5D descriptive score (0.85 ± 0.20) and EQ-VAS score (78.60 ± 11.10) indicated better HRQOL in the current study respondents as compared to studies conducted in other refugee camps around the globe. In addition, demographic characteristics including age, marital status, locality, years of living as refugees, life as a refugee residing out of Pakistan, place of residence in Afghanistan, educational qualification, occupation, and arrested for crime were the statistically significant predictors (P < 0.05) of EQ-5D index scores. However, gender, living status, monthly income, preferred place of treatment were non-significant predictors (P > 0.05). The results of current study provided evidence for a model that correlated with participant's socio-demographic information and HRQOL. Moreover, this study also revealed a baseline assessment for the health status of Afghan refugees, interestingly, these results could be applied for improving HRQOL of the given participants. In conclusion, the HRQOL of Afghan refugees residing in Quetta, Pakistan can largely be improved by providing adequate healthcare facilities, education and employment opportunities, mental and social support, and providing adequate housing and basic necessities of life.

Abstract In this paper, we propose a general framework for the reconstruction of the underlying cross-regional transmission network contributing to the spread of an infectious disease. We employ an autoregressive model that allows to decompose the mean number of infections into three components that describe: intra-locality infections, inter-locality infections, and infections from other sources such as travelers arriving to a country from abroad. This model is commonly used in the identification of spatiotemporal patterns in seasonal infectious diseases and thus in forecasting infection counts. However, our contribution lies in identifying the inter-locality term as a time-evolving network, and rather than using the model for forecasting, we focus on the network properties without any assumption on seasonality or recurrence of the disease. The topology of the network is then studied to get insight into the disease dynamics. Building on this, and particularly on the centrality of the nodes of the identified network, a strategy for intervention and disease control is devised.

Abstract Since the beginning of the COVID-19 pandemic, the Epidemiological surveillance program of the Lebanese Ministry of Public Health has launched a rapid surveillance system for collecting COVID-19-related mortality data. In this study, we document the Lebanese experience of COVID-19 mortality surveillance and provide an analysis of the epidemiological characteristics of confirmed deaths. The implementation of the rapid COVID-19 mortality surveillance system, data sources, and data collection were described. A retrospective descriptive analysis of the epidemiological characteristics of confirmed cases occurring in Lebanon between February 20, 2020, and September 15, 2021, was performed. Epidemiological curves of Covid-19 confirmed cases and deaths as well as the geographic distribution map of mortality rates were generated. Between February 21, 2020, and September 15, 2021, a total of 8163 COVID-19-related deaths were reported with a predominance of males (60.4%). More than 60% were aged 70 years or above. Of all deaths, 84% occurred at hospitals and 16% at home. The overall cumulative mortality rate was 119.6 per 100,000. The overall case fatality ratio (CRF) was 1.3%. Of the total deaths, 82.2% had at least one underlying medical condition. The top reported COVID-19 comorbidities associated with COVID-19-related deaths are cardiovascular diseases including hypertension (59.1%), diabetes (37.2%), kidney diseases including dialysis (11%), cancer (6.7%), and lung diseases (6.3%). The CFR was 30.9% for kidney diseases, 20.2% for cancer, 20.2% for lung diseases, 18.1% for liver diseases, 14% for diabetes, and 12.2% for cardiovascular diseases. Considering the limited human and financial resources in Lebanon due to the economic and political crisis, the rapid mortality surveillance system can be considered successful. Improving this system is important and would contribute to better detection of deaths from emerging and re-emerging diseases during health crises.

This research study utilizes four machine learning techniques, i.e., Multi Expression programming (MEP), Artificial Neural Network (ANN), Adaptive Neuro-Fuzzy Inference System (ANFIS), and Ensemble Decision Tree Bagging (DT-Bagging) for the development of new and advanced models for prediction of Marshall Stability (MS), and Marshall Flow (MF) of asphalt mixes. A comprehensive and detailed database of 343 data points was established for both MS and MF. The predicting variables were chosen among the four most influential, and easy-to-determine parameters. The models were trained, tested, validated, and the outcomes of the newly developed models were compared with actual outcomes. The root squared error (RSE), Nash-Sutcliffe efficiency (NSE), mean absolute error (MAE), root mean square error (RMSE), relative root mean square error (RRMSE), regression coefficient (R2), and correlation coefficient (R), were all used to evaluate the performance of models. The sensitivity analysis (SA) revealed that in the case of MS, the rising order of input significance was bulk specific gravity of compacted aggregate, Gmb (38.56 %) > Percentage of Aggregates, Ps (19.84 %) > Bulk Specific Gravity of Aggregate, Gsb (19.43 %) > maximum specific gravity paving mix, Gmm (7.62 %), while in case of MF the order followed was: Ps (36.93 %) > Gsb (14.11 %) > Gmb (10.85 %) > Gmm (10.19 %). The outcomes of parametric analysis (PA) consistency of results in relation to previous research findings. The DT-Bagging model outperformed all other models with values of 0.971 and 0.980 (R), 16.88 and 0.24 (MAE), 28.27 and 0.36 (RMSE), 0.069 and 0.041 (RSE), 0.020 and 0.032 (RRMSE), 0.010 and 0.016 (PI), 0.931 and 0.959 (NSE), for MS and MF, respectively. The results of the comparison analysis showed that ANN, ANFIS, MEP, and DT-Bagging are all effective and reliable approaches for the estimation of MS and MF. The MEP-derived mathematical expressions represent the novelty of MEP and are relatively simple and reliable. Roverall values for MS and MF were in the order of DT-Bagging >MEP >ANFIS >ANN with all values exceeding the permitted range of 0.80 for both MS and MF. Hence, all the modeling approaches showed higher performance, possessed high generalization and predication capabilities, and assess the relative significance of input parameters in the prediction of MS and MF. Hence, the findings of this research study would assist in the safer, faster, and sustainable prediction of MS and MF, from the standpoint of resources and time required to perform the Marshall tests.

Engineered cementitious composite (ECC) is a special material that, when continuously hydrated, can considerably aid in self-healing. It is necessary to look at the capacity of ECC for self-healing – as measured by crack-widthafter (CWA) – when process of healing has completed, gauge the severity of the cracking, and foresee the extent of the healing. However, modeling and forecasting capacity of ECC for self-healing is a challenging task. Prediction of self-healing is a notably uncommon application of machine learning (ML), which has been applied to forecast a range of concrete properties. To estimate the capacity of ECC for self-healing, this study used three different the ensemble ML algorithms namely AdaBoost regressor (AR), decision tree (DT), and bagging regressor (BR). In addition, k-fold cross-validation method is utilized to assess the model effectiveness. With an R2 value of 0.974, the BR model was more successful in predicting outcomes when compared to the DT and AR models. Improved model performance was shown for ensemble models with smaller MAE (AR = 3.40, and BR = 1.89), MSE (AR = 27.09, and BR = 10.40), and RMSE (AR = 5.21, and BR = 3.23) values and larger R2 (AR = 0.933, and BR = 0.974) values as compared to DT (MAE = 4.29, MSE = 43.28, RMSE = 6.58, R2 = 0.894). Eventually this study will lead to savings in time, effort, and money, and the use of ML approaches to predict CWA will advance the field of civil engineering. It is also advised to investigate the crack-healing properties of additional cementitious materials such rice husk ash, wheat straw ash, and pumice powder subject to modeling their crack-healing properties using ML approaches.

There have been extensive experimental studies available on the composition and characteristics of Ultra-High-Performance concrete (UHPC). However, the relation between UHPC characteristics and mixture content, on the other hand, is extremely non-linear and challenging to distinguish utilizing typical statistical approaches. A comprehensive literature research was carried out for this aim to acquire experimental data on the compressive strength of UHPC. The dataset contains 810 experimental values of compressive strength and 15 most influential parameters that include cement, water, nano-silica, quartz powder, limestone powder, gravel, sand, slag, superplasticizer, fiber, temperature, age, fly ash, relative humidity, and silica fume, are considered as input. The suggested gene expression programming (GEP) model can estimate the compressive strength of UHPC by using simple mathematical formulations. There is no predetermined function to evaluate in the GEP technique, and it replicates or eliminates numerous combinations of factors to create the formulation that suits the experimental results. For verification and validation of model performance, various statistical measures, SHAP analysis, external validation checks, and comparing with the regression model, are applied. SHAP analysis provided that age, fiber, silica fume, superplasticizer, cement, sand, and water have a high influence on compressive strength while other input parameters have less influence on compressive strength. The model outcomes indicate the robustness and accuracy of the predictive potential of the proposed model. As a result, the GEP model can be used to give practical insights into the mixture design of UHPC for a variety of construction applications, resulting in better predictive capacity at a cheaper cost and in a considerably shorter period. Also, the present study findings can assist the design engineers and builders to understand the significance of each constituent in UHPC.

Abstract Burnout among physicians is a serious concern that cultivates its seeds during their education. This study assessed the prevalence of burnout among Lebanese physicians and explored its correlates and the combined effects of the pandemic and the economic crisis on burnout. A web-based cross-sectional study was conducted in December 2020 using a snowball sampling technique. Moderate and high levels of burnout hit 90.7% of the physicians where personal, work-related, and client-related burnout were detected among 80.4%, 75.63%, and 69.6% of them respectively. A strong association was found between the higher level of burnout and female gender, younger age, being single, having a dependent child, living with an elderly or a family member with comorbidities, and insufficient sleeping hours. Physicians’ specialties, working in a public health facility, limited years of professional experience, lack of previous experience in a pandemic, and extensive working hours were also associated with increased burnout. Furthermore, low income, working in the frontline, higher threat perception, and fear of COVID-19 were contributing to higher burnout. The combined effect of threat perception and financial hardship significantly increased burnout levels. The alarming burnout level detected among physicians urges health authorities to take prompt actions to enhance the physicians’ well-being.

Abstract Background Lebanon, a small country in the Middle East, remains severely affected by the COVID-19 pandemic. Seroprevalence surveys of anti-SARS-CoV-2 antibodies provide accurate estimates of SARS-CoV-2 infection and hence evaluate the extent of the pandemic. The present study aimed to evaluate the prevalence of SARS-CoV-2 antibodies in Lebanon and to compare the estimated cumulative number of COVID-19 cases with the officially registered number of laboratory-confirmed cases up to January 15, 2021. Methods A nationwide population-based serosurvey study was conducted in Lebanon between December 7, 2020, and January 15, 2021, before the initiation of the national vaccination program. The nCOVID-19 IgG & IgM point-of-care (POCT) rapid test was used to detect the presence of anti-SARS-COV-2 immunoglobulin G (IgG) in the blood. Seroprevalence was estimated after weighting for sex, age, and area of residence and adjusting for the test performance. Results Of the 2058 participants, 329 were positive for IgG SARS-COV-2, resulting in a crude seroprevalence of 16.0% (95% CI 14.4–17.6). The weighed seroprevalence was 15.9% (95% CI of 14.4 and 17.4). After adjusting for test performance, the population weight-adjusted seroprevalence was 18.5% (95% CI 16.8–20.2). This estimate implies that 895,770 individuals of the general population were previously infected by COVID-19 up to January 15, 2021 in Lebanon. The overall estimated number of subjects with previous SARS-CoV-2 infection was three times higher than the officially reported cumulative number of confirmed cases. Seroprevalence was similar across age groups and sexes (p-value > 0.05). However, significant differences were revealed across governorates. Conclusions Our results suggest that the Lebanese population is still susceptible to SARS-CoV-2 infection and far from achieving herd immunity. These findings represent an important contribution to the surveillance of the COVID-19 pandemic in Lebanon and to the understanding of how this virus spreads. Continued surveillance for COVID-19 cases and maintaining effective preventive measures are recommended to control the epidemic spread in conjunction with a national vaccination campaign to achieve the desired level of herd immunity against COVID-19.

Abstract Background The coronavirus disease (COVID-19) pandemic represents a serious worldwide threat. Stranded Lebanese citizens abroad appealed to the Lebanese government to embark on citizen repatriation missions. We aim to document the Lebanese experience in the repatriation of citizens during COVID-19 which allow us to disclose encountered challenges and lessons learned. Methods This is a retrospective description of processes involved in the phased repatriation of Lebanese citizens. The Mission consisted of 4 phases starting, April 5th until June 19th 2020. The prioritization of returnees was based on both medical and social risk assessment. The repatriation team was divided into four groups: the aircraft team, the airport team, the hotel team and the follow up team. On arrival, all returning citizens were tested using Polymerase chain Reaction (PCR) based technique, and were obliged to adhere to a mandatory facility quarantine for 24 to 48 h. Returning travelers who were tested positive for COVID-19 were transferred to the hospital. Those who were tested negative were urged to strictly comply with home-quarantine for a duration of 14 days. They were followed up on a daily basis by the repatriation team. Results Overall, 25,783 Lebanese citizens have returned home during the phased repatriation. The third phase ranked the uppermost in regard of the number of citizens repatriated. The total number of performed PCR tests at the airport upon arrival was 14,893 with an average percentage of around 1% positivity for COVID-19. On the other hand, more than 10,687 repatriates underwent external PCR requisite in the third and fourth phases. Two hundred seventy-two repatriates were tested positive for COVID-19 upon their arrival. Conclusion Considering the limited human and financial resources besides the economic and political crisis, the overall repatriation mission could be considered as a successful experience. Such processes would not have been achieved without the professionalism of all involved stakeholders.

Background The COVID-19 pandemic has harshly burdened the healthcare systems. Health care workers (HCWs) are at substantial risk of infection and confronted several stressors as well leading them to experience burnout. This study aimed to assess the prevalence of burnout among Lebanese health HCWs and to identify its associated factors. Methods A cross-sectional online survey was conducted between the first of November and the end of December 2020 among Lebanese HCWs working in all active hospitals operating across the country. Data were collected using an Arabic, anonymous, self-reported questionnaire comprising four sections: (a) basic sociodemographic characteristics, (b) exposure to COVID-19 covariates, (c) occupational factors, and (d) the measurements including the Copenhagen Burnout Inventory (CBI). CBI subscale cut-off score of 50 was used to assess the prevalence of burnout among HCWs. Multinomial logistic regression analyses were performed to examine the factors associated with the different aspects of burnout. Results Out of the 1751 respondents, personal burnout (PB) was detected in its moderate and high-level aspects among 86.3% of Lebanese HCWs. Moderate and high levels of work-related burnout (WB), and client-related burnout (CB) hit 79.2% and 83.3% of HCWs, respectively. HCWs who were females, married, physicians, having a poor health status and specific living conditions (dependent child, elderly at home, family member with comorbidities, and a low income) were more likely to exhibit a high level of PB compared to no/low burnout level. Moreover, frontline HCWs, those infected by COVID-19 or those having a colleague infected by COVID-19, and those exhibiting a high perception of threat were more prone to experience a high-level PB rather than a low/no burnout. Working in a public hospital, extensive working hours, and insufficient sleeping hours were also found positively associated with high PB. However, older age and altruism were negatively associated with high PB compared to no/low PB among HCWs. As for WB, similar factors were found either positively or negatively associated with a high level of WB except health status and living conditions factors (dependent child or family member). As for CB, older age of HCWs (> 30 years) and altruism were negatively associated with high CB compared to no/low burnout level. However, working in the frontline, high threat perception, extensive working hours, insufficient sleeping hours, and low income were positively associated with high CB among HCWs compared to no/low burnout. Conclusion The prevalence of burnout among Lebanese HCWs during the pandemic was significant and alarming. Enacting and implementing preventive policies and effective interventions are urgently needed to cultivate wellness among HCWs.

Rubber is a waste product produced by the industrial sector in large quantities. Due to its non-degradable nature, it has been a serious threat to the environment. Thus, it is recommended to develop concrete or mortar containing rubber, so that it can save our environment, and it is economical too. Crumb rubber, when incorporated in mortar, reduces its strength, so it can be used along with some fibers to enhance its strength. This study examined the effect of elevated temperatures, i.e., 150, 300, 450, 600, and 750 °C, on mortar samples containing 5% crumb rubber replacement of fine aggregate by volume, and with the incorporation of 1% PPF. The findings indicated a rise in compressive strength up to 300 °C, followed by a subsequent decline. It was also observed that the weight loss of the samples increased with an increase in temperature.

Abstract Background Since the focus of healthcare has shifted toward prevention, pharmacists were highly encouraged to expand their practice to include immunization services. Our study aimed to assess the knowledge, attitudes and beliefs of community-based Lebanese pharmacists, in addition to their willingness to expand their practice scope to include vaccine administration. Methods A cross-sectional study was conducted during the phase preceding the arrival of the COVID-19 vaccine in Lebanon between 1 and 31st December 2020. Using a stratified random sampling method, data were collected from Lebanese community pharmacists (CPs) through an online survey that included information on socio-demographic characteristics, clinical experience, willingness to administer vaccines, knowledge about vaccination, attitudes towards immunization, reasons supporting utilizing pharmacists as immunizers and the requested elements to incorporate immunization in pharmacists’ practice scope. Multivariable analyses were performed to identify the factors associated with knowledge. Results A total of 412 community pharmacists participated in this survey. Of the total, 66.5% of the surveyed CPs are willing to administer vaccines. The majority of them (89.8%) had an overall good level. Out of all, 92.7% showed a positive overall attitude score toward immunization, 95.4% agreed that community pharmacists can play an important role in advertising and promoting vaccination. The main needed elements for implementing immunization services in pharmacies listed by participants were: support of health authorities (99.3%), statutory allowance (82.8%), patient demand (95.4%), pharmacist’s interest (96.1%) and continuous education and training workshops on immunization. Older CPs (50 years and above) [aOR = 0.703, CI 95% (0.598–0.812)] and those working in Bekaa and North have lower knowledge score than their counterparts. High educational level [aOR = 1.891, CI 95% (1.598–2.019)], previous experience in immunization [aOR = 3.123, CI 95% (2.652–4.161)] and working in urban areas [aOR = 3.640, CI 95% (2.544–4.717)] were positively associated with a good knowledge level. Conclusion Most of Lebanese community pharmacists are willing to offer immunizations. The expansion of the pharmacists practice scope to include provision of immunizations required a national plan that encompasses strengthening knowledge, training, certification for eligibility to administer vaccines, enhancing pharmacovigilance and statutory reform.

Background. Lymphocytic infiltration of the pituitary is an unusual inflammatory disorder of the pituitary and indicated to be autoimmune in origin. Presentations depend on the site of involvement and degree of destruction of the cellular population of the pituitary and may range from an asymptomatic state to pan-hypopituitarism with or without mass effects. In the present study, we represent a rare case of lymphocytic infiltration of the pituitary gland who was diagnosed with such condition and the subsequent management. Case presentation. A 22-year-old male who was admitted with symptoms of increased thirst and excessive fatigue. Following a thorough physical, clinical, laboratory, biochemistry, and imaging examinations a timely diagnosis of lymphocytic infiltration of the pituitary was made without using the invasive procedure of pituitary biopsy. In light of the diagnosis prompt management with the mainstay of glucocorticoid was started along with replenishing the other deficient hormones. In this study we describe a rare case of lymphocytic infiltration of the pituitary discussing in terms of epidemiology, sign and symptoms, laboratory evaluation, imaging studies, histopathology, management, and the usual outcome. Conclusion. Lymphocytic infiltration of the pituitary gland can be diagnosed with the clinical presentation along with lab evaluation and imaging but without pituitary biopsy, which could help in an early and accurate diagnosis which is the basis for better management of the rare condition.

Background: Phalsa (Grewia subinequalis L.) is a commercial and nutritionally important berry fruit. It is cultivated in Pakistan as a minor fruit crop without any variety characterization. Therefore, the objective of to assess genetic diversity through ISSR markers and morphological features of wild phalsa genotypes collected from different parts of Punjab, Pakistan. Methods: Morphological characteristics such as plant height, stem circumference, growth habit, leaf length, leaf width, leaf area, leaf color and leaf apex shape showed high variation among genotypes. Results: Among the twenty inter-simple sequence repeats (ISSR) primers, UBC-812 exhibited the highest PIC values of (0.485) and Dj (0.389) compared to other primers, which considered it better for the identification of phalsa genotypes and prediction of diversity. Moreover, the unweighted pair group method with arithmetic mean cluster analysis divided the sampled genotypes into five clusters (clusters A-E) based on morphological analysis, while molecular data divided the genotypes into eight clusters (clusters A-H). Conclusion: This study confirmed the high diversity in wild populations especially 'O1P2” and “O7P3” genotypes, with both DNA-based and morphological descriptors that depict their potential use for future phalsa breeding programs.

Background and Aim: Transfer of antibiotics from raw milk to derived products is directly related to the processes involved in the manufacturing of dairy products, including East Mediterranean cheeses, since these have particular flow diagrams of production. The aim of this study was to assess the effects of skimming, pasteurization, curding, pressing, salting, cheese boiling, and whey acidification/heating on two widely used antibiotics in Lebanon, oxytetracycline (OTC) and tylosin (TYL), in the manufacture of commonly consumed cheeses in the East Mediterranean. Materials and Methods: Four hundred and fifty kilograms of full-fat bovine milk were spiked with OTC and TYL, then skimmed and pasteurized using holder and high-temperature short-time (HTST) methods. Milk was then processed to make cheeses (23 kg Baladi, 20 kg Akkawi, 20 kg Halloum, and 18 kg Double Cream). Liquid chromatography–mass-spectrometry was used to measure antibiotics. Analysis was performed using Statistical Package for the Social Sciences v25. Results: Skimming significantly (p=0.015) decreased TYL concentration by 68.6%. OTC degradation during holder (41- 54%) proved to be significant (p=0.015). HTST had a significant (p=0.012) effect on TYL with 32% degradation. Curding step in making Baladi had a significant (p=0.028) effect on OTC only with the concentration increasing by 1.5-fold. Acidification and heating of whey to produce Double Cream decreased significantly (p=0.037) OTC concentration (14.7- 46.3%), while TYL concentration increased significantly (p=0.000) by 300%. Pressing and salting in making Akkawi did not have any significant effect, while cheese boiling in making Halloum significantly decreased both antibiotics. Conclusion: OTC is transferred to Baladi and Akkawi (curd based) mainly, while double cream (whey based) has a high level of TYL transfer. Hence, people who consume these cheeses excessively could be exposed to high amounts of both antibiotics and thus be prone to their detrimental effect on health.

BackgroundAnaplastic thyroid carcinoma (ATC) is an endocrine tumor with a low incidence but a very poor prognosis. The vast majority of patients have a survival time of only three to six months, but a few survive for two years or more. In recent years, there have been major breakthroughs in targeted and immunotherapy in the field of oncology therapy. Although the preliminary study for ATC showed a promising prospect, more clinical trials are needed. It is the best approach to explore the measures that can improve survival time of ATC from the available clinical data, especially those with long survival.MethodsWe report on an 82-year-old ATC patient who survived for 3 years and systematically review the clinical characteristics of 45 ATC patients with complete data from the two largest centers in northwest China. In particular, factors related to long-term survival were analyzed and summarized.ResultsThree years prior, an 82-year-old woman was diagnosed with ATC by core needle biopsy following a physical examination. The thyroid tumor was resected within one month, and then the patient was treated with radiotherapy. The patient was still healthy after three years of follow-up. Analysis of prognostic factors for the 45 reviewed patients showed that those undergoing radical surgery (median overall survival (OS) = 472 days, p = 0.0261) and radiotherapy (median OS = 220 days, p = 0.0136) had better outcomes. In addition, patients younger than 65 years (median OS = 164.5 days, p = 0.0176) and with a lower tumor stage (IV A, median OS = 633.5 days, p = 0.0191) also had a better outcome.ConclusionATC is a highly malignant tumor, but timely early diagnosis and standardized treatment with radical surgery and radiotherapy as the core can achieve good results. Some patients can achieve long-term survival.

Since Health care workers (HCWs) are at high occupational risk for COVID-19, they are prioritized for immunization. This study aimed to assess the acceptance rate of the COVID-19 vaccine among HCWs and to identify its determinants. A web-based cross-sectional study was conducted between10 and 31 December 2020 among Lebanese HCWs. The Health Belief Model (HBM) was used as a theoretical framework. Multivariable logistic analyses were carried out to identify the factors associated with the acceptance of the COVID-19 vaccine among HCWs. A total of 1800 HCWs have completed the survey. Around half (58.10%) of them were frontline HCWs and aged between (30–49) years old. Over two-thirds (67.33%) of the participants have received the seasonal influenza vaccine. The acceptance rate of the COVID-19 vaccine among surveyed HCWs was 58%. HCWs who were male (aOR = 1.99, 95% CI (1.41–2.80)), working in the frontlines (aOR = 1.61, 95% CI (1.17–2.21), and those who have received influenza vaccination for the current year (aOR = 1.38, 95% CI(0.99–1.92)) were more willing to get the COVID-19 vaccine. However, factors such as living in rural areas (aOR = 0.61, 95% CI (0.44–0.84)), and being previously diagnosed with COVID-19 (aOR = 0.66, 95%CI (0.45–0.96) were found negatively associated with vaccine acceptance. In terms of health beliefs items, concerns related to the novelty of vaccine (aOR = 0.42, 95% CI (0.25–0.71)), side effects/vaccine safety (aOR = 0.41, 95% CI (0.23–0.73), reliability of manufacturer (aOR = 0.43, 95% CI (0.30–0.63)), and the number of required doses (aOR = 0.58, 95% CI (0.40–0.84)) were also negatively associated with the willingness to get vaccinated against COVID-19. Remarkably, concerns such as the limited accessibility (aOR = 1.68, 95% CI (1.14–2.47)), and availability of vaccines (aOR = 2.16, 95% CI (1.46–3.20)) were associated with an increased likelihood of willingness to receive the COVID-19 vaccine. With regards to cues of action, receiving reliable and adequate information about the vaccine (aOR = 1.98, 95% CI (1.36–2.88)), recommendation by health authorities (aOR = 1.93, 95% CI(1.33–2.81)), and recommendations from health facilities (aOR = 2.68, 95% CI(1.80–3.99)) were also positively associated with vaccine acceptance. Lastly, perception of COVID-19 vaccine benefits by HCWs in terms of protecting them and their close contacts (patients, family members, and friends) from COVID-19 infection (aOR = 4.21, 95% CI (2.78–7.11)) was associated with an increased likelihood of vaccine uptake. The moderate acceptance rate of the COVID-19 vaccine among HCWs found in our study could have broader extents. Understanding and pointing out factors impairing vaccine acceptance such as concerns about the novelty of vaccine and manufacturers’ reliability are required to reach a higher vaccination rate.

Background Community pharmacists (CPs) are increasingly facing occupational challenges as a result of the COVID-19 pandemic, putting them at high risk of burnout. This study aimed to assess the prevalence of burnout among Lebanese CPs during the COVID-19 pandemic and to identify its associated factors. Methods An online survey was conducted among Lebanese CPs between February 1st and March 30, 2021. Collected data included information on sociodemographic characteristics, exposure and work-related variables, the Copenhagen burnout inventory (CBI), and the COVID-19 threat perception scale. Prevalence of burnout was calculated. Multiple logistic regressions were performed to identify the factors associated with the three burnout domains. Results A total of 387 CPs participated in the survey. Of the total, 53.7% were females; and 43.2% were aged less than 40 years old. The prevalence of moderate-to-high personal, work-related and client-related burnout was 77.8%, 76.8, and 89.7%, respectively. Younger age, staff pharmacist, working more than 40 h per week, high perceived COVID-19 threat were associated with a moderate-to-high likelihood of burnout in all three domains. However, altruistically accepting the risks of caring for COVID-19 patients was the only variable that was associated with a lower likelihood of burnout in all three domains. Conclusion An alarming prevalence of personal, work-related and client-related burnout was revealed among Lebanese CPs. This study has many implications for practice and provides a framework for establishing policy interventions to reduce burnout levels among Lebanese CPs. Preventive strategies and interventions on individual and organizational basis are recommended.

Background Utilizing community pharmacists (CPs) as immunizers has being adopted in various countries as approach to boost influenza vaccination coverage. Our study aims to explore the Lebanese CPs’ willingness to administer influenza vaccine, and to identify factors associated with this willingness. Methods This is a web-based, cross-sectional study, conducted over 2 months, from the 1st of November to the end of December 2020. Self-reported data were collected electronically from Lebanese CPs through an anonymous, questionnaire using google form. The collected data were analyzed using the statistical software SPSS (Statistical Package for Social Sciences). Bivariate and multivariable analyses were performed to examine factors associated with the willingness of CPs to administer influenza vaccine. Results A total of 412 CPs participated in this survey of which 76.9% are willing to administer influenza vaccines. More than 90% of them had a good overall knowledge score and 88.8% of CPs showed a positive overall attitude score, particularly towards involvement of CPs in influenza vaccine provision. Their willingness to administer vaccine was positively associated with the younger age (aOR = 3.12 with 95% CI (1.597–4.040)), higher education level (aOR = 2.02 with 95% CI (1.093–3.741)), previous experience in immunization (aOR = 2.72 with 95% CI (1.320–5.627)) and urbanicity of pharmacy (aOR = 1.542 with 95% CI (1.219–4.627)). Extensive working hours (aOR = 2.34 with 95% CI (1.131–4.845)), working in pharmacies that are operating round-the-clock, showing positive attitude towards immunization (aOR = 3.01 with 95% CI (1.872–6.422)) and towards provision of influenza vaccines (aOR = 13.72 with 95% CI (13.721–38.507)) were also positively associated to this willingness. Conversely, patient privacy (aOR = 0.55 with 95% CI (0.079–0.983)), time and cost for professional development (aOR = 0.55 with 95% CI (0.172–0.918)), limited patient’s trust (aOR = 0.39 with 95% CI (0.203–0.784)), financial remuneration (aOR = 0.18 with 95% CI (0.088–0.377)), and requirement of formal certification in vaccine administration (aOR = 0.07 with 95% CI (0.020–0.279)) were negatively associated to this willingness. Conclusion Addressing the unearthed concerns related to utilizing CPs as influenza immunizers through a concerted effort is a key to success in any future implementation of vaccination services in pharmacies.

The conventional method for determining the Marshall Stability (MS) and Marshall Flow (MF) of asphalt pavements entails laborious, time-consuming, and expensive laboratory procedures. In order to develop new and advanced prediction models for MS and MF of asphalt pavements the current study applied three soft computing techniques: Artificial Neural Network (ANN), Adaptive Neuro-Fuzzy Inference System (ANFIS), and Multi Expression Programming (MEP). A comprehensive database of 343 data points was established for both MS and MF. The nine most significant and straightforwardly determinable geotechnical factors were chosen as the predictor variables. The root squared error (RSE), Nash–Sutcliffe efficiency (NSE), mean absolute error (MAE), root mean square error (RMSE), relative root mean square error (RRMSE), coefficient of determination (R2), and correlation coefficient (R), were all used to evaluate the performance of models. The sensitivity analysis (SA) revealed the rising order of input significance of MS and MF. The results of parametric analysis (PA) were also found to be consistent with previous research findings. The findings of the comparison showed that ANN, ANFIS, and MEP are all reliable and effective methods for the estimation of MS and MF. The mathematical expressions derived from MEP represent the novelty of MEP and are relatively reliable and simple. Roverall values for MS and MF were in the order of MEP > ANFIS > ANN with all values over the permissible range of 0.80 for both MS and MF. Therefore, all the techniques showed higher performance, possessed high prediction and generalization capabilities, and assessed the relative significance of input parameters in the prediction of MS and MF. In terms of training, testing, and validation data sets and their closeness to the ideal fit, i.e., the slope of 1:1, MEP models outperformed the other two models. The findings of this study will contribute to the choice of an appropriate artificial intelligence strategy to quickly and precisely estimate the Marshall Parameters. Hence, the findings of this research study would assist in safer, faster, and more sustainable predictions of MS and MF, from the standpoint of time and resources required to perform the Marshall tests.

Late in 2020, two genetically-distinct clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with mutations of biological concern were reported, one in the United Kingdom and one in South Africa. Using a combination of data from routine surveillance, genomic sequencing and international travel we track the international dispersal of lineages B.1.1.7 and B.1.351 (variant 501Y-V2). We account for potential biases in genomic surveillance efforts by including passenger volumes from location of where the lineage was first reported, London and South Africa respectively. Using the software tool grinch (global report investigating novel coronavirus haplotypes), we track the international spread of lineages of concern with automated daily reports, Further, we have built a custom tracking website (cov-lineages.org/global_report.html) which hosts this daily report and will continue to include novel SARS-CoV-2 lineages of concern as they are detected.

Late in 2020, two genetically-distinct clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with mutations of biological concern were reported, one in the United Kingdom and one in South Africa. Using a combination of data from routine surveillance, genomic sequencing and international travel we track the international dispersal of lineages B.1.1.7 and B.1.351 (variant 501Y-V2). We account for potential biases in genomic surveillance efforts by including passenger volumes from location of where the lineage was first reported, London and South Africa respectively. Using the software tool grinch (global report investigating novel coronavirus haplotypes), we track the international spread of lineages of concern with automated daily reports, Further, we have built a custom tracking website (cov-lineages.org/global_report.html) which hosts this daily report and will continue to include novel SARS-CoV-2 lineages of concern as they are detected.

In the present study, we provide a retrospective genomic surveillance of the SARS-CoV-2 pandemic in Lebanon; we newly sequence the viral genomes of 200 nasopharyngeal samples collected between July 2020 and February 2021 from patients in different regions of Lebanon and from travelers crossing the Lebanese–Syrian border, and we also analyze the Lebanese genomic dataset available at GISAID. Our results show that SARS-CoV-2 infections in Lebanon during this period were shaped by the turnovers of four dominant SARS-CoV-2 lineages, with B.1.398 being the first to thoroughly dominate. Lebanon acted as a dispersal center of B.1.398 to other countries, with intercontinental transmissions being more common than within-continent. Within the country, the district of Tripoli, which was the source of 43% of the total B.1.398 sequences in our study, was identified as being an important source of dispersal in the country. In conclusion, our findings exemplify the butterfly effect, by which a lineage that emerges in a small area can be spread around the world, and highlight the potential role of developing countries in the emergence of new variants.

We are reporting three cases of gastrointestinal basidiobolomycosis from Tohama (the southern region of Saudi Arabia) during the period from September 2016 to September 2017. Although the cases had different pathological sites and clinical presentations, all were treated successfully with a single oral antifungal therapy (Itraconazole) with no need for surgical excision. The course after treatment was uneventful with complete cure and no relapses. Keywords: Basidiobolus Ranarum, Gastrointestinal basidiobolomycosis, Itraconazole

The traditional method to obtain optimum bitumen content and the relevant parameters of asphalt pavements entails time-consuming, complicated and expensive laboratory procedures and requires skilled personnel. This research study uses innovative and advanced machine learning techniques, i.e., Multi-Expression Programming (MEP), to develop empirical predictive models for the Marshall parameters, i.e., Marshall Stability (MS) and Marshall Flow (MF) for Asphalt Base Course (ABC) and Asphalt Wearing Course (AWC) of flexible pavements. A comprehensive, reliable and wide range of datasets from various road projects in Pakistan were produced. The collected datasets contain 253 and 343 results for ABC and AWC, respectively. Eight input parameters were considered for modeling MS and MF. The overall performance of the developed models was assessed using various statistical measures in conjunction with external validation. The relationship between input and output parameters was determined by performing parametric analysis, and the results of trends were found to be consistent with earlier research findings stating that the developed predicted models are well trained. The results revealed that developed models are superior and efficient in terms of prediction and generalization capability for output parameters, as evident by the correlation coefficient (R) (in this case >0.90) for both ABC and AWC.

The Arabian Tahr Arabitragus jayakari is endemic to the Hajar Mountains of Oman and the United Arab Emirates in the southeast of the Arabian Peninsula and is categorized as Endangered on the IUCN Red List of Threatened Species. Lack of scientific research from areas of its occurrence has been a challenge in determining its basic ecological aspects such as current distribution range, population status, and abundance. In the present study, we report a new distribution record for the Arabian Tahr from the Hatta Mountain Conservation Area in the Dubai Emirate through camera trap images. A total of 442 images (44 events) were obtained using three camera traps on 564 trap nights between March and December 2016. About 90% of the Arabian Tahr captures were recorded between 1100 and 1600 hr, indicating diurnal activity. This new occurrence record of the Arabian Tahr from this area is considered of high significance as it will drive in more studies and incentives towards the conservation and management of the species and the area as a whole.

The journal retracts the article, Effects of a Single Dose of Ivermectin on Viral and Clinical Outcomes in Asymptomatic SARS-CoV-2 Infected Subjects: A Pilot Clinical Trial in Lebanon [...]

The present research aims at evaluating the mechanical performance of untreated and treated crumb rubber concrete (CRC). The study was also conducted to reduce the loss in mechanical properties of CRC. In this study, sand was replaced with crumb rubber (CR) with 0%, 5%, 10%, 15%, and 20% by volume. CR was treated with NaOH, lime, and common detergent for 24 h. Furthermore, water treatment was also carried out. All these treatments were done to enhance the mechanical properties of concrete that are affected by adding CR. The properties that were evaluated are compressive strength, indirect tensile strength, unit weight, ultrasonic pulse velocity, and water absorption. Compressive strength was assessed after 7 and 28 days of curing. The mechanical properties were decreased by increasing the percentage of the CR. The properties were improved after the treatment of CR. Lime treatment was found to be the best treatment of all four treatments followed by NaOH treatment and water treatment. Detergent treatment was found to be the worse treatment of all four methods of treatment. Despite increasing the strength it contributed to strength loss.

Objective: This study was designed to determine the efficacy of ivermectin, an FDA-approved drug, in producing clinical benefits and decreasing the viral load of SARS-CoV-2 among asymptomatic subjects that tested positive for this virus in Lebanon. Methods: A randomized controlled trial was conducted in 100 asymptomatic Lebanese subjects that have tested positive for SARS-CoV2. Fifty patients received standard preventive treatment, mainly supplements, and the experimental group received a single dose (according to body weight) of ivermectin, in addition to the same supplements the control group received. Results: There was no significant difference (p = 0.06) between Ct-values of the two groups before the regimen was started (day zero), indicating that subjects in both groups had similar viral loads. At 72 h after the regimen started, the increase in Ct-values was dramatically higher in the ivermectin than in the control group. In the ivermectin group, Ct increased from 15.13 ± 2.07 (day zero) to 30.14 ± 6.22 (day three; mean ± SD), compared to the control group, where the Ct values increased only from 14.20 ± 2.48 (day zero) to 18.96 ± 3.26 (day three; mean ± SD). Moreover, more subjects in the control group developed clinical symptoms. Three individuals (6%) required hospitalization, compared to the ivermectin group (0%). Conclusion: Ivermectin appears to be efficacious in providing clinical benefits in a randomized treatment of asymptomatic SARS-CoV-2-positive subjects, effectively resulting in fewer symptoms, lower viral load and reduced hospital admissions. However, larger-scale trials are warranted for this conclusion to be further cemented.

Introduction: Among the United Arab Emirates (UAE) population more and more people now consider travelling abroad. This is potentially problematic because travelling enhances exposure between hosts and pathogens and so people that travel are putting their health at risk. This concern makes it necessary that public education is provided to inform people of the risks of travelling abroad so that such risks can be minimized. Guidelines and advice on travelling abroad are available and easily accessible but several studies have shown that travellers do not always follow such advice. In this study, the aim was to look into the practices and attitudes of UAE residents in relation to prevention of travel-related infectious diseases. Methods: A cross-sectional study was conducted from February to April 2015, in different emirates of the UAE. A self-administered anonymous questionnaire was developed based on material acquired from similar studies. The methodology applied quota sampling whereby adults above the age of 18 who’d travelled abroad in the past year were chosen from the seven emirates. The number of participants selected from each emirate was proportionate to the population size of each state. Results: A total of 385 questionnaires were completed. A remarkable 70% of respondents indicated that they had not taken on any precautionary measures prior to travel. Of greater interest was that only 21% of participants had taken advice on health prior to travel, while the outstanding majority 79% reported that they had not taken advice. The most common source of advice had been taken from family and friends among those who had taken advice at 41%, while only 15.4% had acquired it from specialized travel medicine clinics. High risk perception, spending more preparation time and travelling for longer durations were important factors that encouraged pretrial health consultation and undertook preventive measures. Conclusion: This study revealed that UAE residents had not taken adequate measures to prevent travel related infectious diseases. Despite the limitations of this study, it still provides sufficient data to improve public health intervention directed at encouraging travellers to acquire pre travel health consultation.

Palu-Koro fault is a major fault in western neck of Sulawesi Island. It is shown by Mw 7. 5 struck the area in 2018. Its trace can be observed by the appearance of surface ruptures. We recorded their geographic coordinates and observed the geological conditions of the surface such as structures form, properties of rocks, and physical properties of local hot springs. Then we conducted a qualitative interpretation by integrating field observation data on several References related regional geological structure of the area. From the results of the review, we suspect that there is a very close relationship between the activities of the geological structure and the appearance of several hot springs in the neck region of western Sulawesi. This is evidenced by the presence of 7 points of manifestation with the same pattern as the direction of orientation of the main fault, which is relatively north-south. However, one of requirements of the manifestation appearance on the surface is the existence of the fractures as up flow channels of geothermal fluids. Heat source is interpreted to come from intrusive igneous rocks as hot rocks conducting heat to the aquifer which heats the hydrological system around the area. We conclude that geothermal manifestations in the western neck of Sulawesi Island are tectonic geothermal related to the geological structures and not to the volcanic activity.

Resumo: Introdução: Nos doentes admitidos com síndrome coronária aguda (SCA), a presença de anemia é um fator predizente de prognóstico. Contudo, os diversos scores de risco após SCA não incluem este fator. Objetivos: Avaliar se a presença de anemia na admissão em doentes com SCA tem valor acrescido relativamente ao score GRACE na predição de mortalidade a curto e médio prazo. Métodos: Entre janeiro 2005 e dezembro 2008, avaliaram-se os doentes admitidos consecutivamente na nossa Unidade de Cuidados Intensivos por SCA e incluídos no registo de SCA do centro. Em todos os doentes foram colhidos dados demográficos, antropométricos, fatores de risco para doença coronária, dados clínicos e laboratoriais da admissão, incluindo hemoglobina. Foram identificados os doentes com anemia (hemoglobina 154 para o score GRACE, respetivamente.Analisou-se a ocorrência de morte intra-hospitalar, aos 30 dias e ao primeiro ano de seguimento. Resultados: Incluíram-se 1423 doentes, com idade média de 64 ± 13 anos, 69% do sexo masculino, identificando-se a presença de anemia na admissão em 27,7% dos doentes. Estes doentes eram mais idosos, com predomínio do sexo feminino, mais hipertensos e diabéticos, maior número com história prévia de enfarte, com pior classe de Killip na admissão e score GRACE mais alto. Pelo contrário, eram menos fumadores, com menor apresentação como enfarte com supradesnivelamento ST e receberam menos bloqueadores beta, estatinas e angioplastia coronária. Tiveram também mais complicações hemorrágicas durante o internamento. A mortalidade intra-hospitalar (10 versus 4%), aos 30 dias (12 versus 5%) e ao primeiro ano (15 versus 6%) foram superiores no grupo com anemia (p 154, respectively).In-hospital, 30-day and one-year mortality were analyzed. Results: The study population included 1423 patients with a mean age of 64±13 years, 69% male, anemia on admission being present in 27.7%. These patients were older and more often female, with a higher proportion of hypertensives and diabetics, and more often had a history of myocardial infarction, worse Killip class on admission and higher GRACE risk score. On the other hand, fewer were smokers, fewer presented ST-segment elevation myocardial infarction and they were less often treated with beta-blockers, statins and coronary angioplasty. They had more bleeding complications during hospital stay. In-hospital (10% vs. 4%), 30-day (12% vs. 5%) and one-year mortality (15% vs. 6%) were higher in the anemia group (p

Resumo: A eficácia ventilatória, avaliada por prova de esforço cardiorrespiratória (PECR), tem um importante valor prognóstico em doentes (dts) com insuficiência cardíaca crónica (ICC) por disfunção sistólica ventricular esquerda (DSVE). Os seus determinantes mantêm-se, contudo, controversos. Objectivo: Investigar a eventual correlação entre parâmetros de eficácia ventilatória, obtidos por PECR, e o valor do fluido torácico total (FTT), avaliado por bioimpedância eléctrica torácica (BET), em dts com ICC por DSVE. Métodos: Estudámos 120 dts com ICC por DSVE, referenciados ao nosso laboratório para PECR – 76% do sexo masculino, idade 52,1 ± 12,1 anos, 37% de etiologia isquémica, fracção de ejecção ventricular esquerda 27,6 ± 7,9%, 83% em ritmo sinusal, 96% sob iECA e/ou ARAII, 79% sob beta-bloqueante e 20% tratados com dispositivo de ressincronização cardíaca. Os dts efectuaram PECR, em tapete rolante, protocolo de Bruce modificado, sendo considerados para análise, como parâmetro de capacidade funcional, o consumo de oxigénio de pico (VO2p) e, como parâmetros de eficácia ventilatória, o declive (d) da relação entre ventilação minuto (VE) e produção de CO2 (VCO2) e o valor do VE/VCO2 no limiar anaeróbico (LANA). Os estudos por BET, média de 20 minutos de aquisição, foram efectuados após 15 minutos de repouso, em posição supina, imediatamente antes das PECR, sendo analisado o valor do FTT. Resultados: O valor do FTT variou entre 20,6 e 45,8 kOhm−1, média = 32,2, DP = 5,7, mediana = 32,7, o de VO2p entre 8,9 e 40,6 ml/kg/min, média = 21,0, DP = 6,2, mediana = 20,2, o do dVE/VCO2 entre 19,8 e 60,7, média = 30,7, DP = 7,9, mediana = 29,1 e o do VE/VCO2 no LANA entre 21 e 62, média = 33,1, DP = 7,5, mediana = 31,5. Por regressão linear, o FTT não se correlacionou com o VO2p – r = 0,05, p = 0,58 – mas apresentou correlação com os parâmetros de eficácia ventilatória analisados: r = 0,20, p = 0,032, r2 = 0,04 com dVE/VCO2 e r = 0,25, p = 0,009, r2 = 0.06 com VE/VCO2 no LANA. Conclusão: O FTT correlaciona-se com os parâmetros de eficácia ventilatória, avaliados por PECR, em dts com ICC por DSVE, o que indica que poderá ser um dos seus determinantes. Abstract: Ventilatory efficiency, evaluated by cardiopulmonary exercise testing (CPET), has considerable prognostic value in patients with chronic heart failure (CHF) due to left ventricular systolic dysfunction (LVSD). Its determinants nevertheless remain controversial. Aim: To investigate the possible correlation between parameters of ventilatory efficiency obtained by CPET and thoracic fluid content (TFC), assessed by thoracic electrical bioimpedance (TEB), in patients with CHF due to LVSD. Methods: We studied 120 patients with LVSD and CHF, referred to our laboratory for CPET: 76% male, age 52.1±12.1 years, 37% of ischemic etiology, left ventricular ejection fraction 27.6±7.9%, 83% in sinus rhythm, 96% receiving ACEIs and/or ARBs and 79% beta-blockers, and 20% treated with a cardiac resynchronization device. TEB studies were performed after 15 minutes of rest, prior to symptom-limited treadmill CPET, using the modified Bruce protocol. CPET-derived peak oxygen consumption (pVO2), the slope of the relationship between minute ventilation (VE) and carbon dioxide production (VCO2), VE/VCO2 at the anaerobic threshold (AT), and TFC assessed by TEB were considered for analysis. Results: TFC ranged between 20.6 and 45.8 kOhm−1, mean 32.2, SD = 5.7, median 32.7, pVO2 8.9–40.6 ml/kg/min, mean 21.0, SD 6.2, median 20.2, VE/VCO2 slope 19.8–60.7, mean 30.7, SD 7.9, median 29.1 and VE/VCO2 at AT 21–62, mean 33.1, SD 7.5, median 31.5. By linear regression, TFC did not correlate with pVO2 (r = 0.05, p = 0.58), but showed correlation with parameters of ventilatory efficiency: r = 0.20, p = 0.032, r2 = 0.04 for VE/VCO2 slope and r = 0.25, p = 0.009, r2 = 0.06 for VE/VCO2 at AT. Conclusion: TFC correlates with CPET parameters of ventilatory efficiency in patients with CHF due to LVSD, suggesting that it may be one of its determinants. Palavras-chave: Insuficiência cardíaca, Prova de esforço, Eficácia ventilatória, Cardiografia de impedância, Fluido torácico total, Keywords: Heart failure, Exercise testing, Ventilatory efficiency, Impedance cardiography, Thoracic fluid content

Introduction: Corneal confocal microscopy (CCM) detects neurodegeneration in mild cognitive impairment (MCI) and dementia and identifies subjects with MCI who develop dementia. This study assessed whether abnormalities in corneal endothelial cell (CEC) morphology are related to corneal nerve morphology, brain volumetry, cerebral ischemia, and cognitive impairment in MCI and dementia., Methods: Participants with no cognitive impairment (NCI), MCI, and dementia underwent CCM to quantify corneal endothelial cell density (CECD) and area (CECA), corneal nerve fiber morphology, magnetic resonance imaging (MRI) brain volumetry, and severity of brain ischemia., Results: Of the 114 participants, 14 had NCI, 77 had MCI, and 23 had dementia. CECD (1971.3 ± 594.6 vs 2316.1 ± 499.5 cells/mm 2 , p < 0.05) was significantly lower in the dementia compared to the NCI group. CECD and CECA were comparable between the MCI and NCI groups ( p = 0.13-0.65). Corneal nerve fiber density (CNFD) (31.7 ± 5.6 vs 24.5 ± 9.2 and 17.3 ± 5.3 fibers/mm 2 , p < 0.01), corneal nerve branch density (CNBD) (111.8 ± 58.1 vs 50.4 ± 36.4 and 52.7 ± 21.3 branches/mm 2 , p < 0.0001), and corneal nerve fiber length (CNFL) (24.6 ± 6.6 vs 16.5 ± 6.8 and 16.2 ± 5.0 mm/mm 2 , p < 0.0001) were lower in the MCI and dementia groups compared to the NCI group. Lower CECD partially mediated the impact of age and diabetes on CNFL reduction ( p < 0.05), whereas CECA lost its significance after adjustment ( p = 0.20). CEC morphology does not affect the association between corneal nerve fiber loss and MCI/dementia. CECD and CECA had no significant association with cerebral ischemic lesions ( p = 0.21-0.47), dementia ( p = 0.11-0.35), or cognitive decline ( p = 0.37-0.38). However, lower CECD and higher CECA were associated with decreased cortical gray matter volume ( p < 0.05-0.01)., Discussion: CEC loss occurs in patients with dementia, and both endothelial cell loss and hypertrophy are associated with cortical gray matter atrophy. CNF loss occurs in individuals with MCI and dementia. Corneal nerve and endothelial cell abnormalities could act as biomarkers for neurovascular pathology in dementia., Highlights: Corneal endothelial cell density is significantly reduced in patients with dementia.Corneal nerve fiber density, branch density, and length are lower in subjects with mild cognitive impairment (MCI) and dementia.Corneal endothelial cell loss and hypertrophy are associated with cortical gray matter atrophy.Corneal nerve and endothelial cell abnormalities could act as biomarkers for neurovascular pathology in dementia.Reduced corneal endothelial cell density partially mediates the effects of age and diabetes on corneal nerve fiber loss., Competing Interests: We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship and are not listed. We confirm that the order of authors listed in the manuscript has been approved by all authors. None of the other authors have received or anticipate receiving income, goods, or benefit from a company that will influence the design, conduct, or reporting of the study. Author disclosures are available in the supporting information., (© 2025 The Author(s). Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Exosomes are extracellular vesicles with a diameter ranging from 40 to 160 nm. They are produced by hepatocytes, cholangiocytes, hepatic stellate cells (HSCs), liver sinusoidal endothelial cells (LSECs) and Kupffer cells in liver tissue. The secretion of exosomes might vary in quantity and composition in reaction to multiple triggers and various stages of disease. They transport various payloads, such as proteins, DNAs, and RNAs, and enable cell interaction to regulate myriad physiological and pathological processes in liver tissue. Long non-coding RNAs (lncRNAs) are a crucial component of exosomes with an excellent capability to regulate multiple cellular activities such as differentiation, development, metabolism, proliferation, apoptosis, and activation. With the advancements in transcriptomic and genomic study methods and database management technology, the functions and mechanisms of exosomal lncRNAs in liver diseases have been well-studied. This article delves into the detailed role of exosomal lncRNAs in liver disease onset and progression, ranging from hepatocellular carcinoma (HCC) to liver fibrosis drug-induced liver damage (DILI) and steatotic liver diseases., Competing Interests: Compliance with Ethical Standards. Conflict of Interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

PMMA/PEG and PMMA/PEG doped with SiO 2 , TiO 2, and Al 2 O 3 were fabricated using the solution-casting technique. The composites were characterized by X-ray diffraction and scanning electron microscopy (FE-SEM), which revealed that the amorphous nature of PMMA/PEG blend doped with Al 2 O 3 was hindered by the crystalline nature of those doped with SiO 2 and TiO 2 . The absorption of PMMA/PEG blend doped with Al 2 O 3 is higher, band gap energies were decreased from 4.90 eV for PMMA/PEG blend to 4.03 eV, 3.09 eV, and 2.09 eV for SiO 2 , TiO 2 , and Al 2 O 3 doped PMMA/PEG blend, respectively. The dielectric constant, ε' has a high value (2 × 10 4 ) for samples PMMA/PEG and SiO 2 /PMMA/PEG. While dielectric loss ε ″ -values decreased to < 100 for TiO 2 /PMMA/PEG and Al 2 O 3 /PMMA/PEG. Further, the fabricated composite SiO 2 /PMMA/PEG led to improvement the optical and dielectric properties compared with PMMA/PEG for optoelectronic such as manufacturing of optical fiber cables application. The results show TiO 2 /PMMA/PEG and Al 2 O 3 /PMMA/PEG are multifunctional can be used as low-permittivity nanodielectric and substrates to design the next generation of flexible electronic devices., (© 2024. The Author(s).)

Eco-friendly and renewable composite beads were constructed for efficient adsorptive removal of Cr (VI) ions. Attapulgite (ATP) clay decorated with cetylpyridinium bromide (CPBr) was impregnated into cellulose acetate (CA) beads, which were formulated through a simple and cost-effective solvent-exchange approach. FTIR, XRD, SEM, Zeta potential, and XPS characterization tools verified the successful formation of ATP-CPBr@CA beads. The composite beads displayed a spherical and porous shape with a positively charged surface (26.6 mV) at pH 2. In addition, higher adsorption performance was accomplished by ATP-CPBr@CA composite beads with ease of separation compared to their components. Meanwhile, equilibrium isotherms pointed out that the Langmuir model was optimal for describing the adsorption process of Cr (VI) with a maximal adsorption capacity of 302 mg/g. Moreover, the D-R isotherm model verified the physical adsorption process, while adsorption data obeyed the pseudo-second-order kinetic model. Further, XPS results hypothesized that the removal mechanism involves adsorption via electrostatic interactions, redox reaction, and co-precipitation. Interestingly, the ATP-CPBr@CA composite beads reserved tolerable adsorption characteristics with a maximum removal present exceeding 70% after reuse for seven successive cycles, proposing its feasible applicability as a reusable and easy-separable candidate for removing heavy metals from aquatic bodies., (© 2024. The Author(s).)

The COVID-19 pandemic has emerged as a significant event of the current century, introducing substantial transformations in economic and social activities worldwide. The primary objective of this study is to investigate the relationship between daily COVID-19 cases and Pakistan stock market (PSX) return volatility. To assess the relationship between daily COVID-19 cases and the PSX return volatility, we collected secondary data from the World Health Organization (WHO) and the PSX website, specifically focusing on the PSX 100 index, spanning from March 15, 2020, to March 31, 2021. We used the GARCH family models for measuring the volatility and the COVID-19 impact on the stock market performance. Our E-GARCH findings show that there is long-term persistence in the return volatility of the stock market of Pakistan in the period of the COVID-19 timeline because ARCH alpha (ω1) and GARCH beta (ω2) are significant. Moreover, is asymmetrical effect is found in the stock market of Pakistan during the COVID-19 period due to Gamma (ѱ) being significant for PSX. Our DCC-GARCH results show that the COVID-19 active cases have a long-term spillover impact on the Pakistan stock market. Therefore, the need of strong planning and alternative platform should be needed in the distress period to promote the stock market and investor should advised to make diversified international portfolio by investing in high and low volatility stock market to save their income. This study advocated the implications for investors to invest in low volatility stock especially during the period of pandemics to protect their return on investment. Moreover, policy makers and the regulators can make effective policies to maintain financial stability during pandemics that is very important for the country's economic development., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The 'GeriDerm' (geriatric dermatology) clinic, is a new dermatology-based service at Hamad Medical Corporation (HMC), accommodating the needs of our elderly population living in the State of Qatar. Due to the global demographic transition towards an elderly population (≥65 years of age), incidences of chronic diseases, including dermatologic conditions, rise in parallel. Patients of older age are at higher risk of using multiple medications, seeing multiple care providers, often receiving multiple diverging pieces of information, and feeling lost within the system. Taking into consideration the elderly unique characteristics, the Geriatric Dermatology telemedicine clinic is a novel approach to meeting the many challenges our elderly patients face via providing quick, accurate assessments of cognition, functional status, frailty screening, and assessment for polypharmacy. Methods: Data of 1080 elderly patients with various skin disorders from June 2020 to July 2021 was received from the Dermatology Geriatric clinic, and then reviewed. Results: There were 521(48.2%) new cases and 559(51.8%) follow-up cases who attended the clinic either virtually or face to face consultation. A total of 587(54.4%) female and 493(45.6%) male elderly patients attended the clinic. The mean age was 74.6, with a minimum age of 60 and a maximum age of 106 years. 57.9%(625) of GeriDerm patients were Qatari, followed by Palestinian 75(6.9%), Syrian 51(4.7%), Egyptian 46(4.3%), and Indian 44(4.1%); while other nationalities constituted 239(22.1%). The majority of the cases were Contact Dermatitis 146(13%), Bullous Pemphigoid 107 (10%), and Pruritis 101(9.4%). Conclusion: The 'GeriDerm' service at HMC aimed to achieve the best healthcare standards for the elderly population of Qatar during COVID-19 pandemic, and is now established as a continuous advanced technology-based framework facilitating caring for older patients with skin disease via providing a clear pathway for adequate triaging, identification of severe conditions (red flag) requiring in-person clinic visits, while managing non-life threatening dermatoses via a teledermatology based approach., (© 2023 Al-Khawaga, Akram, Hussain, Chandran, Buddenkotte, Joy, Manjooran, Kolaparambath, Mosaad, Al- Naama, AL Hamad, Steinhoff, HBKU Press.)