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Beate C Sydora,1 Lindsay Jane Whelan,1,2 Benjamin Abelseth,2 Gurpreet Brar,3 Sumera Idris,3 Rachel Zhao,4 Ashley Jane Leonard,4 Brittany N Rosenbloom,5 Hance Clarke,6 Joel Katz,6,7 Sanjay Beesoon,1 Nivez Rasic2,8 1Department of Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada; 2Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; 3Health Systems Knowledge and Evaluation, Alberta Health Services, Edmonton, AB, Canada; 4Knowledge Resource Service, Alberta Health Services, Edmonton, AB, Canada; 5Toronto Academic Pain Medicine Institute, Toronto, ON, Canada; 6Department of Anesthesia and Pain Management, Toronto General Hospital, UHN, Toronto, ON, Canada; 7Department of Psychology, York University, Toronto, ON, Canada; 8Department of Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB, CanadaCorrespondence: Nivez Rasic, Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Medical Lead, Vi Riddell Pain & Rehabilitation Program, Acute Pain Lead, Alberta Pain Strategy, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada, Tel +403-955-7810, Email Nivez.Rasic@albertahealthservices.ca Sanjay Beesoon, Assistant Scientific Director, Surgery Strategic Clinical Network, Alberta Health Services, 02-048 South Tower, Seventh Street Plaza, 10030 107 St NW, Edmonton, AB, T5J 3E4, Canada, Tel +780-735-1682 ; +780-218-4786, Email Sanjay.Beesoon@albertahealthservices.caPurpose: Risk factors for the development of chronic postsurgical pain (CPSP) have been reported in primary studies and an increasing number of reviews. The objective of this umbrella review was to compile and understand the published presurgical risk factors associated with the development of CPSP for various surgery types.Methods: Six databases were searched from January 2000 to June 2023 to identify meta-analyses, scoping studies, and systematic reviews investigating presurgical CPSP predictors in adult patients. Articles were screened by title/abstract and subsequently by full text by two independent reviewers. The selected papers were appraised for their scientific quality and validity. Data were extracted and descriptively analyzed.Results: Of the 2344 retrieved articles, 36 reviews were selected for in-depth scrutiny. The number of primary studies in these reviews ranged from 4 to 317. The surgery types assessed were arthroplasty (n = 13), spine surgery (n = 8), breast surgery (n = 4), shoulder surgery (n = 2), thoracic surgery (n = 2), and carpal tunnel syndrome (n = 1). One review included a range of orthopedic surgeries; six reviews included a variety of surgeries. A total of 39 presurgical risk factors were identified, some of which shared the same defining tool. Risk factors were themed into six broad categories: psychological, pain-related, health-related, social/lifestyle-related, demographic, and genetic. The strength of evidence for risk factors was inconsistent across different reviews and, in some cases, conflicting. A consistently high level of evidence was found for preoperative pain, depression, anxiety, and pain catastrophizing.Conclusion: This umbrella review identified a large number of presurgical risk factors which have been suggested to be associated with the development of CPSP after various surgeries. The identification of presurgical risk factors is crucial for the development of screening tools to predict CPSP. Our findings will aid in designing screening tools to better identify patients at risk of developing CPSP and inform strategies for prevention and treatment.Plain Language Summary: Chronic postsurgical pain (CPSP) is pain experienced predominantly at the surgical site for longer than 3 months after a surgical procedure. Depending on surgery type, it can affect between 10 and 80% of people undergoing major surgeries, which may have negative effects such as a lower quality of life, disability, and persistent opioid use. Targeted identification and management of at risk patients in the presurgical phase may decrease the risk of CPSP. This umbrella review generated a list of potential risk factors for CPSP from evidence-based reviews of the current literature.Thirty-nine presurgical risk factors were identified in this review. Risk factors are divided into six broad categories: psychological, pain-related, health-related, demographic, genetic, and social/lifestyle-related. Although the strength of evidence for individual risk factors varied across reviews, risk factors in the psychological category consistently showed a strong impact on the development of CPSP.It is vital to understand which individuals are vulnerable and at risk for CPSP. The findings of this umbrella review will aid in designing screening tools to identify surgical candidates at risk. Some risk factors, such as genetics, cannot be altered. However, many identified risk factors are modifiable and may inform strategies for the prevention and treatment of CPSP using screening tools. Our findings may guide future research to consider an in-depth analysis of risk factor characterization to group modifiable presurgical risk factors. At risk patients will be offered psychological, physical, and pharmacological treatments accordingly to mitigate their risk of developing CPSP and ultimately improve patient outcomes in surgery.Keywords: chronic postsurgical pain, risk factors, predictors, umbrella review, surgery

Nigeria, with a population of over 190 million people, is rated among the 10 countries with the highest burden of infectious and zoonotic diseases globally. In Nigeria, there exist a sub-optimal surveillance system to monitor and track priority zoonoses. We therefore conducted a prioritization of zoonotic diseases for the first time in Nigeria to guide prevention and control efforts. Towards this, a two-day in-country consultative meeting involving experts from the human, animal, and environmental health backgrounds prioritized zoonotic diseases using a modified semi-quantitative One Health Zoonotic Disease Prioritization tool in July 2017. Overall, 36 of 52 previously selected zoonoses were identified for prioritization. Five selection criteria were used to arrive at the relative importance of prioritized diseases based on their weighted score. Overall, this zoonotic disease prioritization process marks the first major step of bringing together experts from the human-animal-environment health spectrum in Nigeria. Importantly, the country ranked rabies, avian influenza, Ebola Virus Disease, swine influenza and anthrax as the first five priority zoonoses in Nigeria. Finally, this One Health approach to prioritizing important zoonoses is a step that will help to guide future tracking and monitoring of diseases of grave public health importance in Nigeria.

Epidemiological data on acute otitis media (AOM), an infectious disease frequently affecting children, are lacking in some countries. This study was undertaken to assess the incidence of AOM in children ≤5 years in Saudi Arabia, Oman, Pakistan, and Turkey, as well as the economic burden from a parent/caregiver perspective. Medical records of 4043 children (Saudi Arabia = 1023, Oman = 998, Pakistan = 1022, Turkey = 1000) were retrospectively reviewed and the incidence of AOM episodes calculated from suspected and confirmed cases. Using a standardized Health Economics Questionnaire, parents recorded resource use and expenses incurred per AOM episode [in local currency and converted to US dollars (USD)]. The overall incidence of AOM episodes per 1000 person–years was: Saudi Arabia, 207 [95% confidence interval (CI): 178–238]; Oman, 105 (95% CI: 85–127); Pakistan, 138 (95% CI: 116–163); and Turkey, 99 (95% CI: 79–123). The mean total out-of-pocket healthcare expense incurred by parents/caregivers per episode was: Saudi Arabia USD67.1 [standard deviation (SD) = 93.0], Oman USD16.1 (SD = 16.4), Pakistan USD22.1 (SD = 20.5), and Turkey USD33.6 (SD = 44.9). The incidence of AOM episodes varied across all four countries, probably due to different diagnostic and management practices. Nevertheless, our results confirm that AOM causes a substantial burden to public health, reinforcing the need for cost-effective prevention strategies.

Although the majority of travel-associated communicable diseases can be prevented, the public health burden of these diseases remains significant. Relatively little is known about how travelers know and perceive the health risks associated with travel and how they utilize preventive measures before and while traveling abroad. This study was conducted to determine the level of the knowledge, attitudes, and practices (KAP) of Muscat International Airport travelers about travel health in order to assess the knowledge gap and the need for travel health services in Oman. A cross-sectional study was conducted over a period of 1 week using a self-administered questionnaire. The overall level of knowledge about vaccine-preventable diseases, food safety, and preventive measures against insect bites of the participants was inadequate. The practice concerning preventive travel health measures, such as the use of specific immunizations and antimalarial prophylaxis, was very limited, and influenced by some personal and travel-related factors. The inadequate level of travelers’ knowledge and poor utilization of travel medicine services highlights the need for the provisions of specialized travel medicine services at the national level and to develop educational materials promoting the importance of pre-travel health advice.

Osama Adnan Kensara,1,* Adel Galal El-Shemi,2,3,* Amr Mohamed Mohamed,2,4 Bassem Refaat,2 Shakir Idris,2 Jawwad Ahmad2 1Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia; 2Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia; 3Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt; 4Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt *These authors contributed equally to this work Abstract: Colorectal cancer (CRC) is one of the most prevalent cancers and has a high mortality rate. Insensitivity and the limited therapeutic efficacy of its standard chemotherapeutic drug, 5-fluorouracil (5-FU), represents an important challenge in CRC treatment. The robust antitumor properties of thymoquinone (TQ), the main bioactive constituent of Nigella sativa, have recently been demonstrated on different cancers. We investigated whether TQ could potentiate the chemopreventive effect of 5-FU to eradicate the early stages of CRC and elucidated its underlying mechanisms. An intermediate-term (15 weeks) model of colorectal tumorigenesis was induced in male Wistar rats by azoxymethane (AOM), and the animals were randomly and equally divided into five groups: control, AOM, AOM/5-FU, AOM/TQ, and AOM/5-FU/TQ. TQ (35 mg/kg/d; 3 d/wk) was given during the seventh and 15th weeks post-AOM injection, while 5-FU was given during the ninth and tenth weeks (12 mg/kg/d for 4 days; then 6 mg/kg every other day for another four doses). At week 15, the resected colons were subjected to macroscopic, histopathological, molecular, and immunohistochemical examinations. Interestingly, 5-FU/TQ combination therapy resulted in a more significant reduction on AOM-induced colorectal tumors and large aberrant crypts foci than treatment with the individual drugs. Mechanistically, 5-FU and TQ remarkably cooperated to repress the expression of procancerous Wnt, β-catenin, NF-κB, COX-2, iNOS, VEGF, and TBRAS and upregulate the expression of anti-tumorigenesis DKK-1, CDNK-1A, TGF-β1, TGF-βRII, Smad4, and GPx. Overall, our findings present the first report describing the in vivo enhancement effect of combined TQ and 5-FU against early stages of CRC; however, further studies are required to determine the value of this combination therapy in an advanced long-term model of CRC and also to realize its clinical potential. Keywords: colorectal tumors, thymoquinone, 5-fluorouracil, combination therapy, rats

الحمدلله الذي أرشد قاصده إلى مقاصده، وأطلعنا على مراكز كتابه ومراصده، والصلاة والسلام على سيدنا محمد وآله وصحبه ومعاضده، وبعد: فإنَّ هذا البحث يهدفُ إلى بيان دلالة التعريف والتنكير في القرآن الكريم عبر ورودهما فيه ، والكشف عن فحوى تلوّن هذا الأسلوب بين المُصطلحين. ويسعى البحث كذلك إلى دراستهما وبيان مفهومهما وطريقة صياغتهما والاختلاف بين سياقيهما في القرآن الكريم إذ يأتي اللفظ تارة نكرة في موضع، وتارة يكون معرفة. وفي كُلِّ موضع -مما سيُذكر- قد أتى التعريف والتنكير بما يناسب سياقه. ويُعدَّ التعريف والتنكير مظهراً لغوياً أسلوبياً ، يوفر للمنشئ نوعاً من المرونة في الصياغة ، وفي التعامل مع المفردة في الجملة .

Zishan Haider1, Muhammad Idris1, Wasim A Memon1, Nazia Kashif1, Sidra Idris1, Zafar Sajjad1, Saeed Akram21Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan; 2Medicine Department, Aga Khan University Hospital, Karachi, PakistanObjectives: To evaluate (1) whether or not the addition of computer-assisted diagnosis (CAD) to 64-slice multidetector computed tomography (CT) can be used as a screening tool for detection of pulmonary nodules in routine CT chest examinations and (2) whether or not to advocate the incorporation of CAD as a screening tool into our daily practice.Materials and methods: A retrospective cross-sectional analysis of 109 consecutive patients who had all undergone routine contrast-enhanced CT chest examinations for indications other than lung cancer at the Radiology Department of Aga Khan University Hospital, Karachi, between November 2010 and January 2011. All examinations were evaluated in terms of the detection of pulmonary nodules by a consultant radiologist and CAD (ImageChecker CT Algorithm R2 Technology) software. The ability of CAD software to detect pulmonary nodules was evaluated against the reference standard. In addition, a chest radiologist also calculated the number of pulmonary nodules. The sensitivity and specificity of the CAD software were calculated against the reference standard by using a 2 × 2 table. The Mann-Whitney U test was applied to compare the performances of CAD and the radiologist.Results: CAD detected 610 pulmonary nodules while the radiologist detected only 113. The reference standard declared 198 pulmonary nodules to be true nodules. CAD detected 95% of all true nodules (189/198), whereas the radiologist detected only 57% (113/198). In the detection of true pulmonary nodules, CAD had 98% sensitivity compared with the radiologist who had 57% sensitivity; the statistical difference between their performances had a P value

Wasim A Memon, Zishan Haider, Mirza Amanullah Beg, Muhammad Idris, Tanveer-ul-Haq, Waseem Akhtar, Sidra IdrisRadiology Department, Aga Khan University Hospital, Karachi, Pakistan Every author contributed equally to the workObjective: To determine the diagnostic accuracy of liver ultrasound for the detection of hepatoma in chronic liver disease (CLD) patients by either taking histopathology or serum α-fetoprotein levels or a biphasic computed tomography (CT) scan (whichever is available) as the gold standard.Study design: Cross-sectional.Place and duration of study: Radiology Department, The Aga Khan University Hospital, Karachi, Pakistan, from January 2007 to January 2010.Methods: A total of 239 patients (156 males and 83 females) with clinical suspicion or surveillance of hepatoma in CLD referred to the radiology department for ultrasound evaluation followed by either liver biopsy and histopathology or serum α-fetoprotein level or biphasic CT scan.Results: The sensitivity of ultrasound for hepatoma detection in CLD was 65%, specificity was 85%, and accuracy was 70%, and positive predictive value and negative predictive value were 92% and 45%, respectively.Conclusion: Ultrasound is a relatively quick, safe, reasonably accurate, and noninvasive imaging modality for the detection of hepatoma in CLD and can be complemented with clinical assessment of screening high-risk patients.Keywords: hepatoma, ultrasound, radiology, chronic liver disease

Ilyas S Aleem1, Hamza Jalal2, Idris S Aleem3, Adeel A Sheikh1, Mohit Bhandari11Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; 2The University of Calgary, Calgary, Alberta, Canada; 3Carleton University, Ottawa, Ontario, CanadaAbstract: Decision analysis has become an increasingly popular decision-making tool with a multitude of clinical applications. Incorporating patient and expert preferences with available literature, it allows users to apply evidence-based medicine to make informed decisions when confronted with difficult clinical scenarios. A decision tree depicts potential alternatives and outcomes involved with a given decision. Probabilities and utilities are used to quantify the various options and help determine the best course of action. Sensitivity analysis allows users to explore the uncertainty of data on expected clinical outcomes. The decision maker can thereafter establish a preferred method of treatment and explore variables which influence the final clinical outcome. The present paper reviews the technique of decision analysis with particular focus on its application to clinical decision making.Keywords: decision analysis, patient preference, game theory, evidence-based medicine

A novel incoherent OCDMA receiver with incorporated all-optical clock recovery for self-synchronization of a time gate for the multi access interferences (MAI) suppression and minimizing the effect of data time jitter in incoherent OCDMA system was successfully developed and demonstrated. The solution was implemented and tested in a multiuser environment in an out of the laboratory OCDMA testbed with two-dimensional wavelength-hopping time-spreading coding scheme and OC-48 (2.5 Gbp/s) data rate. The self-clocked all-optical time gate uses SOA-based fibre ring laser optical clock, recovered all-optically from the received OCDMA traffic to control its switching window for cleaning the autocorrelation peak from the surrounding MAI. A wider eye opening was achieved when the all-optically recovered clock from received data was used for synchronization if compared to a static approach with the RF clock being generated by a RF synthesizer. Clean eye diagram was also achieved when recovered clock is used to drive time gating.

Microwave hybrid heating (MHH) has become soldering's alternative method for lead-free solder alloys due to its benefits towards modern microtechnology, such as shorter processing time, lower energy consumption and lower defect rate. Nonetheless, it still requires susceptors to improve its heating performance, such as SiC, which is known for its high loss factor under low microwave frequencies. In this study, the effect of microwave hybrid heating on mechanical properties, as well as the microstructure of solder joint between Sn3.0Ag0.5Cu (SAC305) solder alloy and Cu substrate was investigated. Solder joint was created using MHH with different soldering parameters (amount of SiC in a range of 3-7g and exposure time in a range of 7-10min) between SAC305 solder alloy (in the form of wire and paste) and Cu substrate. Then, a lap shear test was carried out following a standard of ASTM D1002 to determine solder joint strength. Characterization was made using an optical microscope and scanning electron microscopy. Results showed that solder wire produced the highest solder joint strength with the value of 115.45 MPa when using 3.05g of SiC for 8.92min soldering time. Meanwhile, the solder paste produced 109.76MPa solder joint strength when using 3.03 g of SiC for 9.39 min soldering time. The intermetallic compound (IMC) form was scallop-like Cu6Sn5, both solder/substrate joints with a thickness of 2.87 μm for solder wire and 3.62 μm for solder paste. Nonetheless, an excessive amount of SiC would generate more heat in MHH and increase the IMC thickness as well as reduce shear strength, which eventually decreases the solder joint stability. [ABSTRACT FROM AUTHOR]

Background and aims – Climate change induces increasing temperatures and drought, with possible profound shifts in species’ presence and distribution. Ecological niche models are widely used to assess plant species responses to climate change. However, such data are scarce for West Africa, particularly for vulnerable multipurpose species. This study focuses on modelling the ecological niche and the conservation status of the multipurpose tree Detarium senegalense to improve insights into its habitat suitability in West Africa under past, present, and future climatic conditions. This will provide an essential basis for setting up global management plans through efficient conservation and ecological restoration policies. Material and methods – The potential distribution of D. senegalense under past, current, and future climate scenarios were assessed using four algorithms including generalized additive models (GAM), generalized linear models (GLM), random forest (RF), and Maximum Entropy (MaxEnt). We also assessed the shift direction of suitable habitats and the conservation status of the species based on IUCN criteria. Overall, 220 occurrences were combined with a set of five bioclimatic variables to run the models. Key results – Models performed well with good values of AUC (0.92) and TSS (0.73). Isothermality (41.10%) and Precipitation of Wettest Month (21.50%) contributed most to the distribution of the species. The distribution of D. senegalense was relatively constant from the past to the present but could decrease in the next decades. In the future, only 17.70% and 13.98% of the areas were predicted to be suitable under respectively ssp245 and ssp585. In protected areas, the suitable areas under ssp245 were estimated at 21.01% with a decrease of 2.50% and 14.60% with a decrease of 8.61% under ssp585 by 2050. The direction of the distribution shifted to the south-east under future climate scenarios. The conservation status assessment of the species is Least Concern (LC). Conclusion – This study improves our understanding of the past, present-day, and future distribution of the species and provides support to better manage the conservation of D. senegalense in West Africa.

Objectives: Cupping therapy is a widely used complementary medicine for the treatment of migraine headaches globally. However, conflicting evidence exists on its effectiveness. To evaluate the safety and efficacy of cupping therapy in treating migraine headache disorder.Methods: Seven databases were systematically searched: PubMed/MEDLINE, Clinicaltrials. gov, Cochrane CENTRAL, ScienceDirect, ProQuest, SinoMed, and the National Science and Technology Library. The primary endpoints are the treatment success and the pain intensity reduction. The secondary endpoints were adverse events (AEs) risk and improvement in quality of life (QoL), which was based on the Migraine Disability Scale (MIDAS). Subgroup analyses were performed based on the cupping techniques (wet and dry cupping) and adjunctive complementary treatments (i.e. acupuncture and/or collateral pricking).Results: Eighteen trials out of 348 records were included, pooling 1,446 participants (n = 797 received cupping therapy). Treatment success was significantly higher among those with cupping therapy (risk ratio [RR] [95% CI] = 1.83 [1.52-2.21]); with significant improvement observed only with wet cupping (RR [95% CI] = 1.88 [1.53-2.30]). The adjunctive complementary therapy did not achieve a greater amplitude of treatment success compared to cupping therapy alone. Furthermore, cupping therapy showed significant pain reduction compared to baseline (standardized mean difference [SMD] [95% CI] = 0.55 [0.39-0.70]) and achieved fewer risks of AEs (RR [95% CI] = 1.88 [1.53-2.30]). However, cupping did not improve the overall QoL (MIDAS SMD [95% CI] = –0.79 [–3.55-1.98]).Conclusion: Cupping therapy was an effective complementary modality to treat migraine headaches. However, it did not demonstrate improvement in QoL (PROSPERO: CRD42024514509).

Bandr Hafedh, Sarah Mohammed Idris, Farah Nadreen, Abdulrhman M Banasser, Radiah Iskandarani, Saeed Baradwan Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi ArabiaCorrespondence: Saeed Baradwan, Email dr.saeed_bardwan@yahoo.comBackground: Laparoscopic sacrohysteropexy is an emerging uterine-preserving strategy for management of uterovaginal prolapse (UVP). The literature on laparoscopic sacrohysteropexy for management of UVP is very scarce from Saudi Arabia. This research examined the feasibility, clinical utility, and safety of laparoscopic sacrohysteropexy in a Saudi setting.Methods: A retrospective study was conducted, including all patients who met the inclusion criteria. The laparoscopic sacrohysteropexy technique was adapted with modifications from the “Oxford hysteropexy”. The primary endpoint was overall success, defined as anatomical success in all vaginal compartments (UVP grade 0 or 1 postoperatively). The secondary endpoint was the mean change in point C. Descriptive data were summarized with numbers and percentages, while numerical data used means ± standard deviations. Fisher’s exact and Student’s t tests were used for univariate analyses. Significant surgical outcome predictors were identified via logistic regression, with p < 0.05 considered statistically significant.Results: Overall, 21 patients met the inclusion criteria. The most frequent indication for laparoscopic sacrohysteropexy was UVP without anterior or posterior wall prolapse (n = 15, 71.4%), whereas the most frequent grade of UVP was grade III (n = 13, 61.9%). One patient (4.8%) required switch to laparotomy due to severe adhesions. No perioperative complications were recorded. The mean change in point C and hospital stay were 5.8 ± 2.1 (range: 0– 8) and 1.4 ± 0.6 days (range: 1– 3), respectively. Surgical success was achieved in 18 patients (85.7%). Only three patients experienced recurrences (one, two, and six months postoperatively). The mean change in point C was significantly higher in successful cases contrasted with the failed cases (6.5 versus 1.3).Conclusion: Laparoscopic sacrohysteropexy for management of uterovaginal prolapse revealed technical feasibility, safety, and beneficial utility of the procedure. Further large-sized and multicentric investigations are important to gather additional pertinent information on laparoscopic sacrohysteropexy.Keywords: pelvic organ prolapse, uterovaginal prolapse, sacrohysteropexy, surgical failure, success rate