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Background Human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) can cause severe and fatal complications; knowledge about these diseases is essential for promoting safe sex practices and modifying behaviours that are harmful to one’s health. This study investigates Syrian people’s understanding, attitudes, and behaviors towards HIV/AIDS and STIs, aiming to identify factors promoting safe sex practices and modifying harmful behaviors. Methods This online cross-sectional study was conducted in Syria between 3 September and 23 November 2022, involving all 18+ individuals. The questionnaire was adapted from a previous study containing 74 questions from five sections: socio-demographic information, knowledge and practice regarding STIs, knowledge and practice regarding HIV/AIDS, attitude towards HIV/AIDS, and attitude regarding STIs and analyzed using descriptive and multivariate logistic regression. Results The study involved 1073 participants mostly aged between 18–30, with 55.3% females. Over half had good awareness of STIs and HIV/AIDS, with 55% and 63% respectively. Specifically, the overall knowledge level of STI type, signs/symptoms, risks of transmission, preventive methods, and complications for untreated STIs were (45.7%), (52.9%), (58.1%), (66.1%), and (59.6%), respectively. Medical field respondents had higher knowledge of HIV (P-value < 0.05, OR = 2). Conclusion Our results show that Syrian people have a knowledge level of STIs and HIV was moderate. However, the attitude toward STIs was negative, as less than half of the participants had a good attitude. It is essential to solve these knowledge gaps, especially in low-income countries such as Syria.

Background: Problematic internet use (PIU) or internet addiction has become increasingly prevalent, and concerns about its impact on mental health and social functioning have grown. This study aimed to investigate the prevalence of PIU among Syrian university students and its relationship with their demographics, internet user behavior, and mental health. Methods: A cross-sectional study was conducted among undergraduate medical students in Syrian government universities between 12 April and 29 May 2022. The survey included the Beck Depression Inventory and the Internet Addiction Scale. Results: Out of 2891 participants, 75.2% were female, with an average age of 21.87. The average Internet Addiction Test (IAT) score was 49.4, and the overall prevalence of PIU was 89%. Furthermore, 93.0% of participants displayed possible signs and symptoms of depression. PIU was significantly linked with physical abuse (p = 0.001) and mental stress (p = 0.0001). Internet addiction is (AOR:1.723, COR:2.289) fold more likely to occur in those with more than 8 h of sleep per night than in those who sleep for less than 6 h (p-value < 0.05). Unadjusted regression analysis showed that 13 predictors of the independent variables were statistically significant in predicting the presence of internet addiction, such as participants who suffered from a breakup (COR:2.039), domestic violence (COR:2.136), physical abuse (COR:2.190), or mental stress (COR:2.621) were more likely to be affected by internet addiction than those who did not (p-value < 0.05). Conclusions: The study found a high rate of internet addiction among Syrian medical students, with those experiencing mental health problems and depression symptoms more likely to be internet addicts. To prevent PIU, students should be encouraged to participate in extracurricular activities, such as sports, and awareness programs should be enhanced to highlight the negative effects of internet addiction.

Abstract Background Vietnam and Saudi Arabia have high disease burden of primary hepatocellular carcinoma (HCC). Early detection in asymptomatic patients at risk for HCC is a strategy to improve survival outcomes in HCC management. GALAD score, a serum-based panel, has demonstrated promising clinical utility in HCC management. However, in order to ascertain its potential role in the surveillance of the early detection of HCC, GALAD needs to be validated prospectively for clinical surveillance of HCC (i.e., phase IV biomarker validation study). Thus, we propose to conduct a phase IV biomarker validation study to prospectively survey a cohort of patients with advanced fibrosis or compensated cirrhosis, irrespective of etiologies, using semi-annual abdominal ultrasound and GALAD score for five years. Methods We plan to recruit a cohort of 1,600 patients, male or female, with advanced fibrosis or cirrhosis (i.e., F3 or F4) and MELD ≤ 15, in Vietnam and Saudi Arabia (n = 800 each). Individuals with a liver mass ≥ 1 cm in diameter, elevated alpha-fetoprotein (AFP) (≥ 9 ng/mL), and/or elevated GALAD score (≥ -0.63) will be scanned with dynamic contrast-enhanced magnetic resonance imaging (MRI), and a diagnosis of HCC will be made by Liver Imaging Reporting and Data System (LiRADS) assessment (LiRADS-5). Additionally, those who do not exhibit abnormal imaging findings, elevated AFP titer, and/or elevated GALAD score will obtain a dynamic contrast-enhanced MRI annually for five years to assess for HCC. Only MRI nearest to the time of GALAD score measurement, ultrasound and/or AFP evaluation will be included in the diagnostic validation analysis. MRI will be replaced with an abdominal computed tomography scan when MRI results are poor due to patient conditions such as movement etc. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MRI will not be carried out in study sites in both countries. Bootstrap resampling technique will be used to account for repeated measures to estimate standard errors and confidence intervals. Additionally, we will use the Cox proportional hazards regression model with covariates tailored to the hypothesis under investigation for time-to-HCC data as predicted by time-varying biomarker data. Discussion The present work will evaluate the performance of GALAD score in early detection of liver cancer. Furthermore, by leveraging the prospective cohort, we will establish a biorepository of longitudinally collected biospecimens from patients with advanced fibrosis or cirrhosis to be used as a reference set for future research in early detection of HCC in the two countries. Trial registration Name of the registry: ClinicalTrials.gov Registration date: 22 April 2022 Trial registration number: NCT05342350 URL of trial registry record

Abstract The awareness of cardiovascular diseases (CVDs) contributes to the complications and fatality rates from these diseases among individuals; however, no previous study in Syria was conducted on this topic; thus, this study aims to assess Syrians' awareness of CVDs warning symptoms and risk factors. This online cross-sectional study was performed in Syria between the 1st and 25th of August 2022. The inclusion criteria for the sample were citizens of Syria over 18 who currently reside in Syria. The questionnaire included open- and closed-ended questions to assess the awareness of CVDs. A total of 1201 participants enrolled in the study with a response rate of 97.2%; more than half of the participants (61.4%) were aged 18–24. The most recognizable risk factors and warning signs when asking close-ended and open-ended questions were smoking (95.2%, 37.1%) and chest pain (87.8%, 24.8%), respectively. Overall knowledge scores for risk factors and warning signs were (61.5%). Regarding knowledge score of CVDs risk factors and warning signs, participants aged 45–54 scored higher than other age groups, and respondents with a university education level had a higher score than other educational levels (15.7 ± 0.3), (14.5 ± 0.1), respectively. Participants aged 45–54 have a higher probability of good knowledge of CVDs risk factors and warning signs than participants aged 18–24 (OR = 4.8, P value

Abstract Background Diabetes and arterial hypertension are the two most common types of non-communicable diseases (NCDs) impacting people globally. There is no prior research on the Syrian population’s knowledge and treatment of hypertension and diabetes. It is crucial to investigate how the Syrian public understands and perceives these disorders in order to address the increased incidence and prevalence of hypertension and diabetes. This research intends to assess the level of hypertension and diabetes-related awareness, knowledge, attitude, and practices among Syrian individuals. Methods A cross-sectional survey was conducted online between 1 August and 25 August 2022. The questionnaire for the study was developed based on previous research, and the inclusion criteria for the sample were Syrian residents older than 18 who presently live in Syria. The survey consisted four sections: sociodemographics information, WHO STEPS survey instrument on knowledge of and lifestyle determinants for hypertension and diabetes, respondents’ knowledge of and comprehension of hypertension and diabetes, and respondents’ awareness of these disorders. Results Among 976 participants, 65.8% were females. the most common causes for hypertension from the perspective of participants were (90.1%) for stress, (87%) High salt consumption, (82.1%) genetics, (78.2%) old age, (78%) obesity (69%) anxiety, and (38.6%) for drug usage. Primary and middle school educational status participants had greater hypertension knowledge (92.3%) than other educational levels. There was a statistical significant difference between the knowledge toward the hypertension and the drinking alcohol, which the nonalcoholic knowledgeable persons were the most common (819 / 976)(P

Objective To provide insights into the nature, risk factors, impact and existing measures for reporting and preventing violence in the healthcare system. The under-reporting of violence against healthcare workers (HCWs) globally highlights the need for increased public awareness and education.Methods The Violence Study of Healthcare Workers and Systems study used a survey questionnaire created using Research Electronic Data Capture (REDCap) forms and distributed from 6 June to 9 August 2022. Logistic regression analysis evaluated violence predictors, including gender, age, years of experience, institution type, respondent profession and night shift frequency. A χ2 test was performed to determine the association between gender and different violence forms.Results A total of 5405 responses from 79 countries were analysed. India, the USA and Venezuela were the top three contributors. Female respondents comprised 53%. The majority (45%) fell within the 26–35 age group. Medical students (21%), consultants (20%), residents/fellows (15%) and nurses (10%) constituted highest responders. Nearly 55% HCWs reported firsthand violence experience, and 16% reported violence against their colleagues. Perpetrators were identified as patients or family members in over 50% of cases, while supervisor-incited violence accounted for 16%. Around 80% stated that violence incidence either remained constant or increased during the COVID-19 pandemic. Among HCWs who experienced violence, 55% felt less motivated or more dissatisfied with their jobs afterward, and 25% expressed willingness to quit. Univariate analysis revealed that HCWs aged 26–65 years, nurses, physicians, ancillary staff, those working in public settings, with >1 year of experience, and frequent night shift workers were at significantly higher risk of experiencing violence. These results remained significant in multivariate analysis, except for the 55–65 age group, which lost statistical significance.Conclusion This global cross-sectional study highlights that a majority of HCWs have experienced violence, and the incidence either increased or remained the same during the COVID-19 pandemic. This has resulted in decreased job satisfaction.

BackgroundThe aim of this study was to explore potential healthcare workers' (HCWs) concerns about the monkeypox virus in order to create practical solutions to manage this disease.MethodsOnline cross-sectional research was conducted in 11 Arabic countries (Egypt, Saudi Arabia, Yemen, Syria, Libya, Algeria, Tunisia, Iraq, Palestine, Jordan, and Sudan) from 2 August 2022 to 28 December 2022.ResultsApproximately 82% of respondents felt the need to acquire further information. The acceptability of the vaccine against monkeypox has been indicated by more than half of the participants (54.5%). Furthermore, we state that 45% of the participants are knowledgeable about the monkeypox virus, and 53.1% of the participants have never been affected with COVID-19 before are more worried about COVID-19 than about monkeypox. Participants diagnosed with COVID-19 were 0.63 times less likely to worry about monkeypox than those who were not diagnosed with COVID-19. A greater willingness to get the monkeypox vaccination was seen among the age group 21–30 years (42.4%) compared to the other age groups.ConclusionMost healthcare professionals have a moderate knowledge of the monkeypox virus. Furthermore, they demonstrated a low willingness to get the vaccination against the monkeypox virus.

Objective: The study aimed to investigate the pharmacist interventions in minimizing drug-related problems in diabetes with co-existing hypertension.Methods: Prospective observational study.Results: Overall, a total of 628 interventions were recommended for 1,914 patients during the 5-year period of study. Among all the interventions, the majority were suggested regarding “substituting the drug” (39%), change in frequency of administration (25%), and addition of drug (14%). Patient compliance status was found significant (p = 0.29 ± 0.07).Conclusion: Clinical pharmacists have a crucial role in minimizing drug related problems. Particularly, there should be a greater emphasis on patient counselling and patient follow-up.

IntroductionCOVID-19, is one of the biggest challenges facing humanity in the 21st century (1). The pandemic outbreak as affected all human activities, starting with healthcare and medical service passing with economy and social relationships, as well as political, religious and cultural enactments (2). The healthcare workers were the most affected fighting in the frontline working longer hours under a high risk of being infected (3). This study aims to assess the depression, anxiety and stress levels of the healthcare workforce (physicians, nurses, pharmacists and dentists) in the Middle East and North Africa—MENA–region.MethodsWe invited healthcare workers in the Middle East to participate in our cross-sectional survey by answering to the DASS-21 questionnaire.ResultsA total of 4,845 healthcare workers participated in the study. The participants were from 11 countries as follows: 436 from Egypt, 430 from Algeria, 458 from Iraq, 453 from Jordan, 473 from Libya, 428 from Palestine, 419 from Saudi Arabia, 452 from Sudan, 451 from Syria, 424 from Tunisia, and 421 from Yemen. The doctors among the healthcare workers were 51.7%, 19.0% were from the nursing staff, 16.8% were pharmacists, and 12.5% were from dentists. The depression level among the healthcare workers was as follows: 29.1% were normal, 13.7% were mildly depressed, 26.9% were moderately depressed, 14.4% were suffering from severe depression, and the depression state was extremely severe for the last 15.9%. At the same time, 29.1% were suffering from no anxiety, while 6.9% were at a mild level, 22.3% were at a moderate level, 13.4% were at a severe level, and 28.3% were at an extremely severe level. For the stress levels, 38.6% were normal, 14.9% were suffering from mild stress, 20.3% were moderate, 17.4% were severe, and the stress level was extremely severe for the other 8.9%.DiscussionThis study indicates that in the Middle East and North Africa—MENA—region, the prevalence of depression, anxiety, and stress among the healthcare workforce during the COVID-19 pandemic was 70.9, 70.9, 61.4, respectively.

Abstract Background For patients undergoing noncardiac surgery, bleeding and hypotension are frequent and associated with increased mortality and cardiovascular complications. Tranexamic acid (TXA) is an antifibrinolytic agent with the potential to reduce surgical bleeding; however, there is uncertainty about its efficacy and safety in noncardiac surgery. Although usual perioperative care is commonly consistent with a hypertension-avoidance strategy (i.e., most patients continue their antihypertensive medications throughout the perioperative period and intraoperative mean arterial pressures of 60 mmHg are commonly accepted), a hypotension-avoidance strategy may improve perioperative outcomes. Methods The PeriOperative Ischemic Evaluation (POISE)-3 Trial is a large international randomized controlled trial designed to determine if TXA is superior to placebo for the composite outcome of life-threatening, major, and critical organ bleeding, and non-inferior to placebo for the occurrence of major arterial and venous thrombotic events, at 30 days after randomization. Using a partial factorial design, POISE-3 will additionally determine the effect of a hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of major cardiovascular events, at 30 days after randomization. The target sample size is 10,000 participants. Patients ≥45 years of age undergoing noncardiac surgery, with or at risk of cardiovascular and bleeding complications, are randomized to receive a TXA 1 g intravenous bolus or matching placebo at the start and at the end of surgery. Patients, health care providers, data collectors, outcome adjudicators, and investigators are blinded to the treatment allocation. Patients on ≥ 1 chronic antihypertensive medication are also randomized to either of the two blood pressure management strategies, which differ in the management of patient antihypertensive medications on the morning of surgery and on the first 2 days after surgery, and in the target mean arterial pressure during surgery. Outcome adjudicators are blinded to the blood pressure treatment allocation. Patients are followed up at 30 days and 1 year after randomization. Discussion Bleeding and hypotension in noncardiac surgery are common and have a substantial impact on patient prognosis. The POISE-3 trial will evaluate two interventions to determine their impact on bleeding, cardiovascular complications, and mortality. Trial registration ClinicalTrials.gov NCT03505723. Registered on 23 April 2018.

• Background Globally many studies have reported on violence faced by healthcare workers. However, there is still a lack of homogeneous data to give us a concrete understanding of the present scenario on a global scale. Conducting a global survey required a robust team organization structure, unique dissemination strategies accounting for the regional limitations, and continual networking to maintain and propagate the pool of survey collaborators and responders. This study aims to describe the strategies that helped carry out a global survey- based study, the lessons learned, and recommendations for future studies. • Methods This cross-sectional survey-based study was based on methodology of the “Hub and Spoke” model with the core team and sub-groups about different regions and managing country leads. The study was conducted across eight weeks from 6th June 2022 to 8th August 2022. The key steps included team organization, strategy formulation for survey dissemination and data collection, launching the project on social media, and conducting a post-survey amongst the collaborators. The Core Team convened weekly via video conference platforms to discuss the modus operandi, including the responsibilities of team members in communicating with HCWs from each country; strategies for data extraction and analysis. A standard message was created for the survey in English, which was spread via text, audio and video messages; the message was tailored according to the target region and population. The language barrier was managed by creating an audio translation or shifting to “an interviewer-administered” questionnaire. Call for leads and collaborators was organized through social media platforms and incentivized by proposing collaborative authorship • Results A core team of 11 members from 7 countries was assembled, which expanded to 40 country leads from around 110 countries. We also amassed more than 75 regional collaborators who worked to provide feedback and spread the message. The “Violence Study of Healthcare Workers and Systems” (VISHWAS) amassed 5500 responses across the world. A weekly alternating trend in the number of survey responses was observed for eight weeks. Guiding principles garnered through this collaborative project include focusing on 1. Effective team organization, 2. Ensuring external validation of survey tool, 3. Personalized communication, 4. Global networking, 5. Timely communication for maintaining momentum, and 6. Addressing regional limitations. The post-survey analysis showed that WhatsApp messaging was the most common modality used for survey dissemination, followed by in-person meetings and text messaging. The successful techniques were noted to be 1. Direct communication with respondents, 2. Regular progress updates, 3. Responsiveness for regional and country lead’s needs 4. Timely troubleshooting. The most common barriers for the respondents were limitations in language proficiency, technical fallouts, lack of compliance with, and difficulty understanding the questionnaire. • Conclusion In this global survey-based study of more than 5500 responses from over 110 countries, valuable lessons in team management, survey dissemination, and addressing barriers to collaborative research. We thereby recommend incorporating the guiding principles from this study to design future surveys on a global scale.

Background: World Health Organization (WHO) verified 780 cases of monkeypox across 27 countries between 13 May 2022 and 2 June 2022. The World Health Organization (WHO) classified the growing worldwide monkeypox epidemic a PHEIC on July 23; the bulk of confirmed cases have been found in European locations. The purpose of this research is to assess the level of awareness toward human monkeypox virus among the Syrian medical students, general practitioners (GPs), medical residents, and specialists. Methods: We performed a cross-sectional online survey in Syria between 2 may and 8 September, 2022 to assess medical students', general practitioners', residents', and specialists' knowledge about the monkeypox virus. The utilized tool was developed with input from the World Health Organization, the Centers for Disease Control and Prevention, and cross-sectional studies conducted in Indonesia. The survey has 53 questions divided into three groups: demographic information, work-related details, and monkeypox knowledge. The time-efficient and simple snowball method of sampling was used. Version 28.0 of SPSS was used to analyze the data. Results: A total of 1257 healthcare workers and medical students throughout all of Syria's governorates took part in the research. The percentage of responders who learned anything about monkeypox in medical school was just 6.2% (n = 78). As a whole, students scored 10.23 out of a possible 15, with 11 being the adequate level for knowledge. About half of the participants (n = 700) are familiar with the term "monkeypox." As well, half of the respondents (n = 663) just learned about monkeypox during the last few days, while almost half (n = 530) only learned about it within the past month. Almost participants didn't know adequately about monkeypox. The natural host and incubation time for monkeypox were correctly identified by just 2.7% of responders and 33.3% of the whole population, respectively. 1.8% of participants gave the right response when asked about the symptoms of monkeypox. Sixty percent of the study sample think the symptoms of monkeypox and smallpox are identical. The females had higher knowledge toward monkeypox (aOR = 1.5, 95% CI = 1.26-1.80, p

Background: An estimated 17.8 million lives were lost in 2017 due to cardiovascular disease (CVD), resulting in a total of 330 million years of life lost and an additional 35.6 million years of disability. Numerous studies have shown the importance of education and awareness in promoting positive and long-lasting behavioral changes. This study aims to assess Syrians' awareness of cardiovascular disease (CVD) warning symptoms and risk factors and investigate further into the variables that contribute to this awareness. Methods: A cross-sectional survey was undertaken online between August 1 and 25, 2022, to examine Syrian individuals' awareness of cardiovascular disease risk factors and early warning signs. The study's questionnaire was constructed based on prior research, and the inclusion criteria for the sample were citizens of Syria over the age of 18 who currently reside in Syria. There were three categories of questions on the questionnaire: sociodemographics, an evaluation of CVD knowledge using both open- and closed-ended inquiries, and medical history and behavioral risk factors. Results: There were 1201 inquired participants; 728 (60.6%) were males, and 473 (39.5%) were females. Concerns about developing diabetes were reported by 45.8% (n=550), hypertension was feared by 54.0% (n=540), and 43.9% (n=572) of individuals, and heart disease was feared by 45.9% (n=572). The internet and social media platforms were the most common ways they learned about it. Closed-ended questions indicated that the majority of participants (n=1164, 94.9%) had recognized CVD risk factors, with smoking (95.2%), obesity (93.6%), cholesterol (91%), and hypertension (90.3%) being the most often reported risk factors. Close-ended questions regarding CVD warning indicators revealed that most participants (n=897, 74.7%) correctly identified the warning symptoms. However, in response to open-ended questions, most participants (n=478, 39.8%) did not identify CVD risk factors, as well only (n=291, 24.2%) did. In addition, open-ended questions concerning CVD warning signs indicated that more than half of the participants (n=680, 56.6%) had poor identification of the warning symptoms. The age group between 55 and 64 years had the greatest CVD risk factors, and education was related to greater knowledge of CVD risk factors (P-value

The gut microbiome is intricately coupled with immune regulation and metabolism, but its role in Coronavirus Disease 2019 (COVID-19) is not fully understood. Severe and fatal COVID-19 is characterized by poor anti-viral immunity and hypercoagulation, particularly in males. Here, we define multiple pathways by which the gut microbiome protects mammalian hosts from SARS-CoV-2 intranasal infection, both locally and systemically, via production of short-chain fatty acids (SCFAs). SCFAs reduced viral burdens in the airways and intestines by downregulating the SARS-CoV-2 entry receptor, angiotensin-converting enzyme 2 (ACE2), and enhancing adaptive immunity via GPR41 and 43 in male animals. We further identify a novel role for the gut microbiome in regulating systemic coagulation response by limiting megakaryocyte proliferation and platelet turnover via the Sh2b3-Mpl axis. Taken together, our findings have unraveled novel functions of SCFAs and fiber-fermenting gut bacteria to dampen viral entry and hypercoagulation and promote adaptive antiviral immunity.

Background: Diabetes and hypertension are the two most common types of non-communicable diseases (NCDs) impacting people globally. There is no prior research on the Syrian population's knowledge and treatment of hypertension and diabetes, so it is crucial to assess how the Syrian population acknowledges and perceives these illnesses. This research intends to assess the level of hypertension and diabetes-related awareness, knowledge, attitude, and practices among Syrian individuals. Methods: A cross-sectional study was conducted between 1 August and 25 August 2022 to assess adult awareness, knowledge, attitude, and behavior about hypertension and diabetes. The questionnaire for the study was developed based on previous research, and the inclusion criteria for the sample were Syrian residents older than 18 who presently live in Syria. On the questionnaire, there were four sections: sociodemographics information, WHO STEPS survey instrument on knowledge of and lifestyle determinants for hypertension and diabetes, respondents' knowledge of and comprehension of hypertension and diabetes, and respondents' awareness of these disorders. Results: Among 976 participants, (65.8%) were females. Participants reported hypertension caused by (90.1%) stress, (78.2%) old age, (69%) anxiety, and (38.6%) drug usage. High salt consumption (87%), genetics (82.1%), and obesity (78%) are all risk factors for hypertension. In addition, minimizing salt consumption (92.4%), regular exercise (87.2%), and avoiding anxiety (85%) are preventative measures for hypertension. Participant answers to hypertension consequences were (75.8%) foot ulcer and (74%) eyesight loss. Primary and middle school educational status participants had greater hypertension knowledge (92.3%) than other educational levels. Alcohol use was linked to hypertension knowledge (P < 0.05). Participants whose lifestyles did not include alcohol use had a higher hypertension knowledge level (90.3%). Participants with a family history of diabetes have a greater knowledge of hypertension (92%) than those without (66.9%). Almost age groups have shown good knowledge of diabetes, especially participants aged above 55 (93.8%). However, most individuals have examined blood pressure (82.3%), whereas fewer than half had screened for blood sugar (64.4%). 82.2% of individuals check their blood pressure frequently, whereas 6.2% monitor their blood sugar. Men have a higher hypertension knowledge than females (mean=8.39, SD=2.02), P-value< 0.05, and knowledge of hypertension among participants was shown to be higher among those in good income status than other economic levels (mean=8.34, SD=1.98), P-value< 0.05. Participants between the ages of 40 and 55 showed better knowledge of diabetes compared to other age groups (mean=11.32, SD=2.54), P-value< 0.05; as well, men demonstrated greater knowledge of diabetes than females (mean=10.76, SD=2.79), P-value< 0.05. Conclusion: Our results demonstrated that the Syrian population has a good to moderate understanding of hypertension and diabetes. However, there is still a shortage of standardized, regular screening practices. Since individuals remain involved in unhealthy lifestyle habits, it is vital to provide accurate information about hypertension and diabetes.

Artificial intelligence has been prevalent recently as its use in the medical field is noticed to be increased. However, middle east countries like Syria are deficient in multiple AI implementation methods in the field of medicine. So, holding these AI implementation methods in the medical field is necessary, which may be incredibly beneficial for making diagnosis more accessible and help in the treatment. This paper intends to determine AI's knowledge, attitude, and practice among doctors and medical students in Syria. A questionnaire conducted an online cross-sectional study on the google form website consisting of demographic data, knowledge, and perception of AI. There were 1,494 responses from both doctors and medical students. We included Syrian medical students and doctors who are currently residing in Syria. Of the 1,494 participants, 255 (16.9%) are doctors, while the other 1,252 (83.1%) are undergraduate medical students. About 1,055 (70%) participants have previous knowledge about AI. However, only 357 (23.7%) participants know about its application in the medical field. Most have shown positive attitudes toward its necessity in the medical field; 689 (45.7%) individuals strongly agree, and 628 (41.7%) agree. The undergraduate students had 3.327 times more adequate knowledge of AI than students in the first year. In contrast, the undergraduate 6th-year students had 2.868 times the attitude toward AI higher than students in the first year. The residents and assistant professors had 2.371 and 4.422 times the practice of AI higher than students, respectively. Although most physicians and medical students do not sufficiently understand AI and its significance in the medical field, they have favorable views regarding using AI in the medical field. Syrian medical authorities and international organizations should suggest including artificial intelligence in the medical field, particularly when training residents and fellowship physicians.

Healthcare workers were prioritized in vaccination campaigns globally because they are exposed to the highest risk of contamination by SARS-CoV-2. This study evaluated the self-reported post-vaccination side effects of inactivated (BBIBP-CorV and CoronaVac) and adenoviral vector-based (AZD1222, Gam-COVID-Vac and Ad26.COV2.S) vaccines among Algerian healthcare workers using a validated questionnaire. The final analysis included 721 healthcare workers, with a predominance of females (59.1%) and younger individuals 20–30 years old (39.4%). Less than half (49.1%) of the respondents reported at least one local side effect, while 53.8% reported at least one systemic side effect. These side effects were more prevalent among viral vector vaccinees than inactivated virus vaccinees. The most common local side effects were injection site pain (39%) and arm pain (25.4%), while fatigue (34.4%), fever (28.4%), headache (24.8%) and myalgia (22.7%) were the most prevalent systemic side effects. The side effects appeared earlier among inactivated virus vaccines recipients and generally lasted for 2 to 3 days for the two vaccinated groups. The risk factors associated with a higher prevalence of side effects included female gender, allergic individuals, individuals with regular medication, those who contracted the COVID-19 disease and those who received two doses for both inactivated and viral-based vaccines groups. Despite the higher prevalence of post-vaccination side effects among adenoviral vector vaccines recipients, both vaccines groups were equally effective in preventing symptomatic infections, and no life-threatening side effects were reported in either vaccine group.

During aging, changes in gene expression are associated with a decline in physical and cognitive abilities. Here, we investigate the connection between changes in mRNA and protein expression in the brain by comparing the transcriptome and proteome of the mouse cortex during aging. Our transcriptomic analysis revealed that aging mainly triggers gene activation in the cortex. We showed that an increase in mRNA expression correlates with protein expression, specifically in the anterior cingulate cortex, where we also observed an increase in cortical thickness during aging. Genes exhibiting an aging-dependent increase of mRNA and protein levels are involved in sensory perception and immune functions. Our proteomic analysis also identified changes in protein abundance in the aging cortex and highlighted a subset of proteins that were differentially enriched but exhibited stable mRNA levels during aging, implying the contribution of aging-related post- transcriptional and post-translational mechanisms. These specific genes were associated with general biological processes such as translation, ribosome assembly and protein degradation, and also important brain functions related to neuroplasticity. By decoupling mRNA and protein expression, we have thus characterized distinct subsets of genes that differentially adjust to cellular aging in the cerebral cortex.

Unlike RORα, which has been thought to be somewhat redundant, RORγt has been well characterized in its function and contribution to the development of Th17 cells. Here the authors show that RORα is important in Th17 differentiation and that RORα deletion or a small molecule inhibitor of RORα can reduce disease in EAE and colitis mouse models.

Background: Most patients who take antihypertensive medications continue taking them on the morning of surgery and during the perioperative period. However, growing evidence suggests this practice may contribute to perioperative hypotension and a higher risk of complications. This protocol describes an acute kidney injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial, which is testing the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy in patients undergoing noncardiac surgery. Objective: To conduct a substudy of POISE-3 to determine whether a perioperative hypotension-avoidance strategy reduces the risk of acute kidney injury compared with a hypertension-avoidance strategy. Design: Randomized clinical trial with 1:1 randomization to the intervention (a perioperative hypotension-avoidance strategy) or control (a hypertension-avoidance strategy). Intervention: If the presurgery systolic blood pressure (SBP) is

Globally, the novel corona virus infection has continued to witness a growing number of cases since December 2019 when the outbreak was discovered and noted in China. Despite this has not been well studied for the case of COVID-19, human contact, public moveableness and environmental variables could have an impact onairborne’spropagation and virus continuance, such as influenza virus. This study aimed to determine the seasonal variation and geographical distribution of COVID-19 across Nigeria. An internet based archival research design was employed for this study on the seasonal variation and geographical distribution of COVID-19 across Nigeria. This involved the use of goggle mobility data and world map on Corona Virus Infection (COVID-19). The search strategy for getting information for this research was done electronically. The keywords in the case search using the goggle mobility software was “COVID-19 Update”, “COVID-19 Update in Nigeria”, ‘COVID-19 Winter Report’, “COVID-19 Case Fatality March 2020–July 2021”, “COVID-19 Case Fatality in Nigeria”. The data gotten from the goggle motor updates were entered into Statistical Package for the Social Sciences (SPSS) which was used in the analysis of the study. Results from the study, reported that official COVID-19 cases number was significantly higher in the Dry season (October 2020–April 2021) with 59.0% (127,213) compared to 41.0% (85,176) in the wet/rainy season (May–September) it revealed that the dry and rainy seasons had a COVID-19 prevalence of 0.063 and 0.041 respectively. Further results from the study showed that the prevalence of COVID-19 was 0.07% in the North-Central, 0.04% in both the North-East and North-West, 0.03% in the South-West, 0.09% in the South-South, and the highest prevalence of 0.16% in the South-East. Considering the case Fatality rate of COVID-19 during the Dry and Wet Seasons. The study revealed that North-Central had a death toll of 196 (10.4%) out of 9457 confirmed COVID-19 cases hence a fatality of 2.07. Fatality rate of 1.49% in South western Nigeria, South-South Nigeria, 1.49%, South-East accounted to a fatality rate of 1.25%. Nigeria based on the finding of this study records increased fatality in Dry season over wet seasons. The study concluded that prevalence of COVID-19 varies in seasons in Nigeria Hence; further Data and Meteorological analysis on weather variations towards the SARS-CoV-2 Virus spread should be evaluated by future researchers. It is imperative to ensure strict and controlled application of social measures, such as social distancing, mandatory wearing of non-medical masks to prevent droplets from entering the respiratory tract, screening of affected patients along with quarantine is essential to defeat and improve infection control.

COVID-19 booster vaccines have been adopted in almost all countries to enhance the immune response and combat the emergence of new variants. Algeria adopted this strategy in November 2021. This study was conducted to consider the self-reported side effects of COVID-19 booster vaccines by Algerians who were vaccinated with a booster dose of one of the approved inactivated-virus vaccines, such as BBIBP-CorV and CoronaVac, or one of the adenoviral-vector-based vaccines, such as Gam-COVID-Vac, AZD1222 and Ad26.COV2.S, and to determine the eventual risk factors. A cross-sectional study using an online self-administered questionnaire (SAQ) was conducted in Algeria between 28 April 2022, and 20 July 2022. A descriptive analysis of the 196 individuals who were included showed a nearly equal distribution of adenoviral- (52%) and inactivated-virus vaccines (48%) and of males (49.5%) and females (50.5%). The results showed that 74.7% of the studied population reported at least one local or systemic side effect. These side effects were more frequent among adenoviral-vector vaccinees (87.3%) than inactivated-virus vaccinees (60.6%) (sig. < 0.001). Injection site pain (40.3%), heat at the injection site (21.4%), and arm pain (16.3%) were the most common local side effects. These signs generally appeared in the first 12 h (73.3%) and generally lasted less than 24 h (32.8%). More interestingly, these signs differed from those that followed the administration of primer doses (48.5%) and were generally more severe (37%). The same observation was reported for systemic side effects, where the signs were especially most severe in the adenoviral-vaccinated group (49.4% vs. 20.8%; sig. = 0.001). These signs generally appeared within the first day (63.6%) and mostly disappeared before two days (50.8%), with fatigue (41.8%), fever (41.3%), and headache (30.1%) being the most common. Adenoviral-vector vaccinees (62.7%) were more likely to use medications to manage these side effects than were inactivated-virus vaccinees (45.7%) (sig. = 0.035) and paracetamol (48.5%) was the most used medication. Adenoviral-based vaccines were the types of vaccines that were most likely to cause side effects. In addition, being female increased the risk of developing side effects; regular medication was associated with local side effects among inactivated-virus vaccinees; and previous infection with COVID-19 was associated with systemic and local side effects among adenovirus-based vaccinees. These results support the short-term safety of booster vaccines, as has been reported for primer doses.

For a long time, tuberculosis (TB) has been inflicting mankind with the highest morbidity and mortality. Although the current treatment is extremely potent, a few bacilli can still hide inside the host mesenchymal stem cells (MSC). The functional capabilities of MSCs are known to be modulated by TLRs, NOD-2, and RIG-1 signaling. Therefore, we hypothesize that modulating the MSC activity through TLR-4 and NOD-2 can be an attractive immunotherapeutic strategy to eliminate the Mtb hiding inside these cells. In our current study, we observed that MSC stimulated through TLR-4 and NOD-2 (N2.T4) i) activated MSC and augmented the secretion of pro-inflammatory cytokines; ii) co-localized Mtb in the lysosomes; iii) induced autophagy; iv) enhanced NF-κB activity via p38 MAPK signaling pathway; and v) significantly reduced the intracellular survival of Mtb in the MSC. Overall, the results suggest that the triggering through N2.T4 can be a future method of immunotherapy to eliminate the Mtb concealed inside the MSC.

Alzheimer’s disease (AD) is a devastating neurodegenerative disorder characterized by extracellular amyloid β (Aβ) and intraneuronal tau protein aggregations. One risk factor for developing AD is the APOE gene coding for the apolipoprotein E protein (apoE). Humans have three versions of APOE gene: ε2, ε3, and ε4 allele. Carrying the ε4 allele is an AD risk factor while carrying the ε2 allele is protective. ApoE is a component of lipoprotein particles in the plasma at the periphery, as well as in the cerebrospinal fluid (CSF) and in the interstitial fluid (ISF) of brain parenchyma in the central nervous system (CNS). ApoE is a major lipid transporter that plays a pivotal role in the development, maintenance, and repair of the CNS, and that regulates multiple important signaling pathways. This review will focus on the critical role of apoE in AD pathogenesis and some of the currently apoE-based therapeutics developed in the treatment of AD.

Due to the emergence of various highly contagious variants of SARS-CoV-2, vaccine boosters were adopted as a complementary strategy in different countries. This strategy has, however, posed another challenge for the national authorities to convince their population to receive the booster after the first challenge of COVID-19 primer dose vaccines. This study was conducted to determine COVID-19 vaccine booster acceptance and its associated factors in the general population in Algeria. Using social media platforms, an online self-administered questionnaire was distributed between 28 January and 5 March 2022 for all Algerian citizens who received COVID-19 vaccines. Overall, 787 respondents were included in this study. Among them, 51.6%, 25%, and 23.8% accepted, rejected, or were hesitant about the COVID-19 vaccine booster, respectively. However, only 13.2% declared receiving the booster dose. Additionally, while 58.2% of the respondents declared being relieved after primer vaccination, 11.4% among them declared that they regretted being vaccinated. The most common reasons for acceptance were experts’ recommendations (24.6%) and the belief that COVID-19 vaccine boosters were necessary and efficient, while rejection was mainly due to the belief that primer doses are sufficient (15.5%), or that vaccination in general is inefficient (8%). Males, older individuals, those with chronic comorbidities or a history of COVID-19 infection, non-healthcare workers, and those with low educational levels were associated with significantly higher odds for booster acceptance. Moreover, belief that booster doses were necessary and efficient, disagreeing with the notion that primer doses were not sufficient, experts’ recommendations, and the desire to travel abroad were significantly associated with higher odds of COVID-19 vaccine booster acceptance.

Summary: RORγt is well recognized as the lineage-defining transcription factor for T helper 17 (TH17) cell development. However, the cell-intrinsic mechanisms that negatively regulate TH17 cell development and autoimmunity remain poorly understood. Here, we demonstrate that the transcriptional repressor REV-ERBα is exclusively expressed in TH17 cells, competes with RORγt for their shared DNA consensus sequence, and negatively regulates TH17 cell development via repression of genes traditionally characterized as RORγt dependent, including Il17a. Deletion of REV-ERBα enhanced TH17-mediated pro-inflammatory cytokine expression, exacerbating experimental autoimmune encephalomyelitis (EAE) and colitis. Treatment with REV-ERB-specific synthetic ligands, which have similar phenotypic properties as RORγ modulators, suppressed TH17 cell development, was effective in colitis intervention studies, and significantly decreased the onset, severity, and relapse rate in several models of EAE without affecting thymic cellularity. Our results establish that REV-ERBα negatively regulates pro-inflammatory TH17 responses in vivo and identifies the REV-ERBs as potential targets for the treatment of TH17-mediated autoimmune diseases. : Roles for the circadian protein REV-ERBα have not been extensively explored in the immune system. Amir et al. demonstrate that REV-ERBα acts as a negative regulator of pro-inflammatory TH17 cell development and function, and REV-ERBα ligands are efficacious in mouse models of autoimmunity. Keywords: Th17, RORγt, IL-17A, REV-ERB, SR9009, T cells, autoimmunity, circadian

Pregnancy induces unique changes in maternal immune responses and metabolism. Drastic physiologic adaptations, in an intricately coordinated fashion, allow the maternal body to support the healthy growth of the fetus. The gut microbiome plays a central role in the regulation of the immune system, metabolism, and resistance to infections. Studies have reported changes in the maternal microbiome in the gut, vagina, and oral cavity during pregnancy; it remains unclear whether/how these changes might be related to maternal immune responses, metabolism, and susceptibility to infections during pregnancy. Our understanding of the concerted adaption of these different aspects of the human physiology to promote a successful pregnant remains limited. Here, we provide a comprehensive documentation and discussion of changes in the maternal microbiome in the gut, oral cavity, and vagina during pregnancy, metabolic changes and complications in the mother and newborn that may be, in part, driven by maternal gut dysbiosis, and, lastly, common infections in pregnancy. This review aims to shed light on how dysregulation of the maternal microbiome may underlie obstetrical metabolic complications and infections.

A case study was conducted to investigate situational inhibitors to informal learning activities amongst accountants in a public firm in Malaysia. Four situational inhibitors emerged from the data analysis. The accountants reported that lack of time, lack of proximity to colleagues’ working areas, lack of support from others and structural inhibitor as the inhibitors to the learning. The paper proceeds to outline the theoretical and practical implications as well as suggestions for future research.

It is instrumental for the Mycobacterium tuberculosis (Mtb) to persist within its host in dormancy. Mtb represses most of its metabolic machinery during latency, but upregulates the expression of latency-associated protein alpha-crystallin protein (Acr1). Therefore, it is imperative to understand how throughout dormancy, Mtb employs Acr1 to regulate the host immunity. This study reveals that Acr1 exhibits divergent effect on the pre- and post-maturation stages of dendritic cells (DCs). In the current study, we demonstrate that early encounter of bone marrow cells with Acr1 while differentiating into DCs (AcrDCpre), leads to impairment in their maturation. In contrast, when exposed to Acr1 after maturation (AcrDCpost), DCs show augmentation in their activity, secretion of TNF-α, IL-12, IL-6, and activation of T cells. Additionally, AcrDCpost promoted the polarization of naïve CD4 T cells to Th1 cells and Th17 cells and restricted the intracellular growth of Mtb. Furthermore, these DCs upregulated the expression of CCR7 and exhibited enhanced migratory capabilities. The discrete impact of Acr1 on DCs is mediated through a mechanism involving STAT-1, SOCS-3, ERK, TLR-4, and NF-κB signaling pathways. This study reveals the unprecedented role of Acr1 in distinctly modulating the function of DCs at different stages of maturation.

Introduction: Autonomic Nervous System (ANS) imbalance may trigger or enhance pathology in different organ systems that varies in different age groups hence objective of present study was to evaluate association of different Age-groups with autonomic functions. Materials and Methods: A cross-sectional study was conducted in 62 healthy volunteers in Department of Physiology LLRM Medical College Meerut, India. Volunteers were divided into three groups as younger (15-45 years), middle (45-60) and elder age (above 60), Autonomic functions were tested in three domains viz. Cardio-vagal, adrenergic and sudomotor functions. Numerical data was summarized as mean and standard deviation and categorical data as count and percentage. ANOVA and Chisquare test were used to find difference among groups, p

Background & Objective: Health literacy is defined as the degree to which individuals have the capacity to obtain process and understand basic health information and services required for making appropriate health decisions The aim of this study was to estimate the level of health literacy and to determine the factors influencing it using valid instrument Methods: In a Populationbased household survey in 5 cities and 5 villages of Boushehr Mazandaran Kermanshah Ghazvin and Tehran provinces 1086 adults aged 18 and older were enrolled into the study Health literacy was measured by the questionnaire designed for test of Functional Health Literacy in Adults (TOFHLA) after validation Regression analysis was used to determine the association of demographic factors and level of health literacy Results: The average response rate was 708% in the studied clusters From all participants 614% were female and the rest were male Mean age of participants was 381 years Seventeen percent of the study population was illiterate and 36% had diploma or higher education The level of health literacy was adequate in 281% borderline in 15 3% and inadequate in 565% of the subjects Mean score of health literacy was 453 in males and 411 in females (P=0057) However after adjustment for educational level in the regression model health literacy was found to be higher in females (P=014) Limited health literacy was also associated with lower economic status (P=0004) Conclusion: This study indicates that the level of health literacy is low in Iran Educational level was the most important determinant of health literacy and the most increase was seen in subjects with more than 8 years education Lower health literacy in women older people and rural inhabitants was mainly due to lower educational levels in these groups

DNA is one of the major intracellular targets for a wide range of anticancer and antibiotic drugs. Elucidating the binding between small molecules and DNA provides great help in understanding drug-DNA interactions and in designing of new and promising drugs for clinical use. The ability of small molecules to bind and interfere with DNA replication and transcription provides further insight into how the drugs control the expression of genes. Interaction of an antimetabolite anticancer drug 6 mercaptopurine (6MP) with calf thymus DNA was studied using various approaches like UV-visible spectroscopy, fluorescence spectroscopy, CD, viscosity and molecular docking. UV-visible spectroscopy confirmed 6MP-DNA interaction. Steady state fluorescence experiments revealed a moderate binding constant of 7.48 × 10(3) M(-1) which was consistent with an external binding mode. Competitive displacement assays further confirmed a non-intercalative binding mode of 6MP which was further confirmed by CD and viscosity experiments. Molecular docking further revealed the minimum energy conformation (-119.67 kJ/mole) of the complex formed between DNA and 6MP. Hence, the biophysical techniques and in-silico molecular docking approaches confirmed the groove binding/electrostatic mode of interaction between 6MP and DNA. Further, photo induced generation of ROS by 6MP was studied spectrophotometrically and DNA damage was assessed by plasmid nicking and comet assay. There was a significant increase in ROS generation and consequent DNA damage in the presence of light.

Connected and autonomous vehicles (CAVs) are considered a hot area of research in the field of intelligent transportation systems. However, over the past few years, cybersecurity threats have posed significant challenges to such systems, given the ever-evolving automotive industry. Thus, there is a growing need to design resilient control strategies to address the issue of cyberattacks. This article proposes the design of a distributed multiagent expert control scheme for cyberattack-resilient control of CAVs. The study implemented an event-triggered consensus-based attack detection scheme capable of distinguishing between replay (RA), denial-of-service (DoS), and false data injection (FDI) attacks. The attacks in this study occur randomly, are bounded and time-varying, and can overlap with each other. It was demonstrated that by considering an estimator error bound ε for the attacked signal reconstruction, the SMC controller in feedback with a vehicle remains stable in the sense of Lyapunov. Conditions were then provided that guarantee global asymptotic stability for a minimum dwell-time constraint T, and the platoon was shown to be string stable for the minimum distance between vehicles, denoted as dˇ[sub.cth]. Finally, the performance of the control strategy was evaluated using multiple performance indices, considering platoons of varying sizes., Author(s): Amir Mohammed (corresponding author) [1]; Craig Ramlal [1]; Lincoln Marine [1]; Fasil Muddeen [1] 1. Introduction Connected and autonomous vehicles can be regarded as automotive entities outfitted with advanced [...]

Objectives: We aimed to assess undergraduate medical students' knowledge, attitude, and perception regarding artificial intelligence (AI) in medicine. Methods: A multi-national, multi-center cross-sectional study was conducted from March to April 2022, targeting undergraduate medical students in nine Arab countries. The study utilized a web-based questionnaire, with data collection carried out with the help of national leaders and local collaborators. Logistic regression analysis was performed to identify predictors of knowledge, attitude, and perception among the participants. Additionally, cluster analysis was employed to identify shared patterns within their responses. Results: Of the 4492 students surveyed, 92.4% had not received formal AI training. Regarding AI and deep learning (DL), 87.1% exhibited a low level of knowledge. Most students (84.9%) believed AI would revolutionize medicine and radiology, with 48.9% agreeing that it could reduce the need for radiologists. Students with high/moderate AI knowledge and training had higher odds of agreeing to endorse AI replacing radiologists, reducing their numbers, and being less likely to consider radiology as a career compared to those with low knowledge/no AI training. Additionally, the majority agreed that AI would aid in the automated detection and diagnosis of pathologies. Conclusions: Arab medical students exhibit a notable deficit in their knowledge and training pertaining to AI. Despite this, they hold a positive perception of AI implementation in medicine and radiology, demonstrating a clear understanding of its significance for the healthcare system and medical curriculum. Clinical relevance statement: This study highlights the need for widespread education and training in artificial intelligence for Arab medical students, indicating its significance for healthcare systems and medical curricula. Key Points: • Arab medical students demonstrate a significant knowledge and training gap when it comes to using AI in the fields of medicine and radiology. • Arab medical students recognize the importance of integrating AI into the medical curriculum. Students with a deeper understanding of AI were more likely to agree that all medical students should receive AI education. However, those with previous AI training were less supportive of this idea. • Students with moderate/high AI knowledge and training displayed increased odds of agreeing that AI has the potential to replace radiologists, reduce the demand for their services, and were less inclined to pursue a career in radiology, when compared to students with low knowledge/no AI training. [ABSTRACT FROM AUTHOR]