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Mouna Achoui,1 Karen Heyninck,2 Chung Yeng Looi,1 Ali Mohd Mustafa,1 Guy Haegeman,2 Mohd Rais Mustafa1 1Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 2Department of Physiology, Laboratory of Eukaryotic Gene Expression and Signal Transduction, Ghent, Belgium Abstract: The terpenoid 17-O-acetylacuminolide (AA) was shown to inhibit the production of several inflammatory mediators. However, the mechanisms by which this compound elicited its anti-inflammatory activity remain to be elucidated. In this study, we analyzed the effects of AA on inflammatory gene expression in two different cell types with primordial importance in the inflammatory processes – endothelial cells and macrophages. In human umbilical vein endothelial cells, AA inhibited the expression of inflammatory proteins including the adhesion molecules intercellular adhesion molecule 1; vascular cell adhesion molecule 1; and E-selectin, as well as the release of the chemokine interleukin-8. Additionally, AA hindered the formation of capillary-like tubes in an in vitro model of angiogenesis. AA’s effects in endothelial cells can be attributed at least in part to AA’s inhibition of tumor necrosis factor alpha-induced nuclear factor of kappa light polypeptide gene enhancer in B-cells (NF-κB)’s translocation. Also, in lipopolysaccharide-stimulated macrophage-like RAW264.7 cells, AA was able to downregulate the expression of the genes cyclooxygenase 2, inducible nitric oxide synthase, interleukin-6, and chemokine (C-C motif) ligand 2. Moreover, AA inhibited the phosphorylation of nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor-alpha (IκBα), IκB kinase (IKK), and the mitogen-activated protein kinases JNK, ERK, and p38. In conclusion, the present results further support the anti-inflammatory potential of AA in different models of inflammation. Keywords: 17-O-acetylacuminolide, angiogenesis, HUVEC, MAPK, NF-κB

Galal Faisal Abdulqader Abdulla Albani,1 Widad Ibrahim Abdelgadir,2,3 Amal Abdelgadir Ali Mohamed,4 Magda Yousif,5 Amna Mohammed Ali Mustafa,6 Egbal Abbashar Algmair Almkiy,7,8 Khadiga Z M Mohammed,4,9 Eman Ahmed Saad Mohamed,7 Fahad Abdullah A Alghamdi,10 Raga Gasim Ahmed,11 Manal SA Hakami,10 Niemat A Dinar,10 Amal Alsulami,2 AbdAllah Ibrahim AbdAlrahman Mudawi,12 Waled AM Ahmed10 1Department of Nursing, Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen; 2Department of Community Health Nursing & Mental Nursing Sciences College of Nursing,Taif university, Taif, Saudi Arabia; 3Faculty of Nursing Sciences Bahri University, Sudan; 4Department of Maternal and Child Nursing Sciences College of Nursing,Taif university, Taif, Saudi Arabia; 5Nursing Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia; 6Faculty of Nursing Sciences, Jazan University, Jazan Saudi Arabia; 7Department of Nursing, Faculty of Applied Medical Sciences, Buraydah College, Buraydah, Saudi Arabia; 8Faculty of Nursing Sciences, Alneelain University, Sudan; 9Nursing Faculty, Zagazig University, Zagazig, Egypt; 10Faculty of Nursing, Al-Baha University, Al-Baha, Saudi Arabia; 11Department of Nursing, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia; 12Oral and Dental Health Department, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi ArabiaCorrespondence: Waled AM Ahmed; Amal Abdelgadir Ali Mohamed, Tel +966508245369; +966550367392, Email wahmed@bu.edu.sa; ammohamed@tu.edu.saBackground: Oral health education programs have long been considered an essential part of oral health policies. This is important for reducing the risk of oral diseases through health enhancement and voluntary behavioral changes due to learning opportunities. This study aimed to evaluate the effects of school-based oral health education program on oral health in school children in Sudan.Methods: A quasi-experimental study was conducted at four governmental schools in Khartoum, Sudan, between August 2018, and March 2022. A total of 423 school children were randomly allocated into the control (n = 211) and study (n = 212) groups. An adapted questionnaire was administered to students before and after the intervention to assess their knowledge and practice of oral health. The study group participated in oral health education activities. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 21.Results: The findings revealed that the mean knowledge at the pre-educational program was 9.3066 (SD = 3.91078) and the mean knowledge after the educational program was 21.2736 (SD = 2.13982). The scores indicated that the school children had significantly higher knowledge and practice scores after the oral health education program.Conclusion: The study concluded that education program on oral health improved students’ oral health knowledge and practices. Imposing theoretical and practical lessons on oral and dental health in school curricula can motivate students to maintain oral health care, and this improves oral health status.Keywords: education program, school children, oral health, knowledge, practice, Sudan

Native Americans are the first people to reside in the United States of America, specifically the northern part of it. One of the famous Native American poets is Scott Momaday. Momaday is a Kiowa Native American poet, storywriter, and novelist. The purpose of this research is to explain traditions, and the significance of natural landscape in Scott Momaday's poetry, focused on words, images and metaphors by means of descriptive qualitative method. The researchers endeavor to apply a concept of Shamanism in Momaday's poetry. Shamanism is an ancient healing tradition, and a way of life. It is a way to connect with nature and all the creations. Every plant for native Americans symbolizes a certain thing, cherries symbolize mercy, and they can heal wounds by the ointment. The data are taken from the poems related to nature and tradition as in The Earth, Eagle Feather Fan, The Delight Song of Tsoai-Talee, and Angle of Geese. The results show that natural landscape and traditions are linked to spirituality. For Native Americans, there is no difference between animate and inanimate objects; everything in this life has a soul.

Aim: The number and distribution of health workers per capita are significant factors for countries to achieve their goals in the health sector. However, there is a global shortage of skilled health workers. The immigration of health professionals or their intention to emigrate is a critical problem, especially for source countries. This situation directly affects the access, equity, and quality of necessary health services. In this article, we discussed the intentions of physicians to emigrate and the factors that pull and push physicians, including the methods that can be applied. Method: It was designed as a descriptive and cross-sectional study in accordance with the research problem. A total of 504 physicians from Turkey participated in the study. The data were collected using a personal information form and a scale consisting of "Push Factors, Pull Factors, Negative Impacts of Migration, and Positive Impacts of Migration". Mean and standard deviation were used in the study. Results: The results indicate that physicians in Türkiye intend to emigrate. Also, physicians would prefer to emigrate to developed countries such as Germany, the USA, and England if they have the opportunity to leave Türkiye. Working and living conditions are the first factors pushing them, followed by the phenomenon of violence in healthcare. The participants think that if they emigrate, new physicians in Turkey cannot be replaced quickly, and this will further increase the heavy workload of their colleagues. Conclusion: Considering these results, it is necessary to develop policies for trained healthcare workers to work in source countries and to reduce the level of the emigration tendency of health workers, especially in developing countries such as Türkiye. In particular, these policies should include micro and macro policies related to violence in healthcare and the improvement of working conditions. Otherwise, the effective, efficient, and interrupted delivery of health services may be disrupted.

The European Union has given new impetus to the European Pact on Migration and Asylum, making important progress in trying to adapt the European response to the current migratory reality. The COVID-19 pandemic and the crisis generated by the war in Ukraine have, once again, highlighted the significant challenges faced by the European Union. Ongoing migration flows and rapidly evolving security challenges have resulted in a growing common awareness within the EU of the need to jointly address these new geostrategic challenges. In the Pact, the migration issue is addressed from a comprehensive approach, proposing different measures, and highlighting the role of the European Border and Coast Guard Agency (Frontex) in the management of the EU’s external borders. Regarding the EU’s international cooperation on migration and borders, Frontex emerges as the main player. This paper seeks to elaborate and analyse the legal frameworks enabling the Frontex Agency to implement its external dimension. It also examines the Agency’s international cooperation in the light of the new Frontex regulation and from the perspective of an essential component of European integrated border management (EIBM). Frontex can now provide support through joint operations on the territory of any third country, without the limitation of the neighbourhood tie.

Lactobacilli (n = 24), isolated from human infants and yogurt, showed variable in vitro activity against Salmonella enteritidis (8.0 ± 1.0 to 16.6 ± 0.5 mm) and other gut pathogens (9.0 ± 1.0 to 15.3 ± 0.5 mm), as determined by a well diffusion assay. The isolates were identified as Limosilactobacillus fermentum (FY1, FY3, FY4, IL2, and IL5), Lactobacillus delbrueckii (FY6 and FY7), Lactobacillus sp. (IL7), and Lactobacillus gasseri (IL12). All isolates showed variable in vitro tolerance to acidic pH for 3 h and visible growth at pH 4 and in the presence of 0.3% ox-bile. The antibiotic susceptibility profile of Lactobacillus isolates indicated resistance against vancomycin, ciprofloxacin, streptomycin, and lincomycin. Isolates had variable auto-aggregation and showed variable capabilities to co-aggregate with S. enteritidis. Based on all tested parameters, L. fermentum IL2, L. fermentum IL5, and L. gasseri IL12 were selected for co-culture experiments, followed by in vivo evaluation in Balb/c mice. All the selected isolates resulted in a 100% reduction in S. enteritidis in broth. Lactobacillus isolates efficiently colonized mouse guts and inhibited S. enteritidis colonization. Overall, there was ≥99.06% and ≤4.32 Mean log10 reduction in Salmonella counts in mice feces within 7 days. The study, thus, provided characterized lactobacilli that could be considered as potential ingredients for probiotic formulations intended to prevent S. enteritidis infection in humans.

Evapotranspiration represents one of the main parameters in the hydrological cycle. It is usually expressed by the term Reference evapotranspiration (ETo), that is affected by some meteorological parameters. This study aims to find the difference amount in reference evapotranspiration (ETo) between urban and suburban quarters in Karbala city. Study methodology includes selecting once urban area and four suburban quarters. Two methods of determining the reference evapotranspiration were applied. First, a direct method which measured reference evapotranspiration (ETo) at selected fields by using a hand-held device. Second, an indirect method was used Penman-Montieth equation. The findings showed that magnitudes of reference evapotranspiration (ETo) by Penman-Montieth equation are higher than the values measured by the direct method for urban and suburban quarters. Also, it was found that the absolute percentage of difference in the average amount of reference evapotranspiration (ETo) between urban and suburban quarters is 13% by using the direct method and 61% by using Penman-Montieth equation. Study conclusions are suburban area has higher magnitude of reference evapotranspiration (ETo) than urban quarter by using any of direct method and indirect method (Penman-Montieth equation).

يهدف البحث إلى محاولة تحليل حوكمة النفقات وانعكاسها على مؤشرات الاستدامة المالية في العراق وطرح بعض المتطلبات لتطبيقها، وذلك باستخدام أهم مؤشرات الاستدامة المالية التي يمكن الاعتماد عليها في اتخاذ إجراءات لتفادي ضغوط المالية العامة والاضطرابات والأزمات المالية في المستقبل, وقد تم تحليل البيانات المالية عن طريق التعليق على نتائجها للمدة من (2015-2021) وبالاعتماد على التقارير والنشرات المتوفرة لدا وزارة التخطيط/ الجهاز المركزي للإحصاء والبنك المركزي العراقي/ دائرة الاحصاء والابحاث، وتم التوصل إلى مجموعة من الاستنتاجات أهمها ارتفاع مستوى الديون الداخلية والخارجية في العراق اثر بشكل عكسي على مستويات الاستدامة المالية للدولة نتيجة للأعباء التي تترتب على سداد الديون والفوائد المستحقة عليها التي تتحملها الأجيال الحالية واللاحقة, وتم تقديم مجموعة من التوصيات أهمها تنويع إيرادات الدولة والتقليل من الاعتماد على المورد النفطي ورفع نسبة النفقات الاستثمارية على حساب التشغيلية وتقليل الدين العام الداخلي والخارجي الأمر الذي ينعكس بشكل إيجابي على الاستدامة المالية.

Certain disadvantages could have appeared while using hot mix asphalt (HMA), such as the release of unhealthy gases into the environment (environmental issues), difficulty in sustaining the temperature over long distances (logistical issues), and consuming a sufficient amount of energy while preparing and laying down (practical and economic issues). To overcome the aforementioned issues, this study aimed to develop rapid-curing emulsified asphalt cold mixes (EACM) comprising a cementitious filler made from industrial by-product materials. Paper sludge ash (PSA) is used as an active filler for application in the EACM rather than conventional mineral filler. Additionally, to maximize the effect of PSA’s hydraulic activity, incinerated sewage ash (ISA) is utilized as an activator at a concentration of 0%–4% by mass of the aggregates. The results demonstrate that the use of waste PSA significantly improves the indirect tensile stiffness modulus (ITSM) by around 10 times more after 2 days than the traditional emulsified asphalt cold mixes. In addition, the improvement in ITSM was around 30% and 65% for 6%PSA+1%ISA and 6%PSA+4%ISA mixes, respectively. Furthermore, the rutting for the 6%PSA+1%ISA and 6%PSA+4%ISA mixes decreased to around 19% and 11% in comparison to the traditional 131-pen HMA. The formation of hydration products and rapid demulsification of asphalt emulsion, which results in binding within the mixtures, are responsible for the increased ITSM and rutting resistance. As a result, environmental issues are minimized, and energy preservation may be maintained.

Amaç: Araştırmanın amacı, bireylerin Covid-19 aşı okuryazarlık düzeyini ölçmek için kullanılacak geçerli ve güvenilir bir ölçeği Türkçe’ ye uyarlamaktır. Gereç ve Yöntem: Kronik hastalıklarda sağlık okuryazarlığının değerlendirilmesi için Ishikawa ve meslektaşları tarafından geliştirilen ve Biasio ve meslektaşları tarafından Covid-19 aşı okuryazarlığı olarak uyarlanan ölçek kullanılmıştır. Ölçeğin Türkçe uyarlamasında doğrulayıcı ve keşfedici faktör analizi ve güvenilirlik analizi yapılmıştır. Örneklem seçiminde kolayda örnekleme yöntemi kullanılmıştır. Çalışmanın örneklemini çalışmaya katılmayı kabul eden 596 birey oluşturmaktadır. Bulgular: Araştırma da katılım gösterenlerin, %60,6’sı kadın ve %39,4’ü erkeklerden oluşturmaktadır. Ayrıca, katılımcıların %34,1’ni Y kuşağı, %28,2’sini X kuşağı, %27,9’nu Z kuşağı ve %9,9’nu Bebek Patlaması kuşağı oluşturmaktadır. Kaiser-Meyer-Olkin örneklem yeterliliği test sonucu değeri 0,905 ve Barlett’s testi anlamlıdır. Açıklayıcı faktör analizine göre orijinal ölçekteki gibi iki boyuta ayırılmakta ve toplam açıklanan varyansı %65,970’dir. Ölçeğin uyum iyiliği değerleri, RMSEA= 0,069, NFI= 0,949, CFI= 0,961, GFI= 0,943, AGFI= 0,917, IFI = 0,961, TLI= 0,952, RMR=0,036 olarak tespit edilmiş ve kabul edilen değerlerde olduğu anlaşılmıştır. Son olarak ölçeğin Cronbach alfa değeri 0,868 olarak tespit edilmiştir. Sonuç: Covid-19 aşı okuryazarlığı ölçeğinin kullanılabilecek geçerli ve güvenilir bir araçtır. Aynı zamanda ölçek, bireylerin Covid-19 aşısı ile ilgili ne şekilde bir bilgi elde ettiğini, aşı hakkında bilgi toplama ve anlama yeteneklerini değerlendirmektir.

Abstract Objective Although many bacterial culture media are available commercially, there is a continuous effort to develop better selective media for bacteria, which cannot be grown on existing media. While exploring antibacterial properties of clove, we observed that it has the potential to selectively inhibit growth of certain types of bacteria. This led us to do the experiments, which resulted in developing a new media which selectively allowed the growth of only Gram-negative bacteria, while inhibiting the Gram-positive bacteria. Results Mueller Hinton Agar (MHA) was used as the base media and was modified to develop MHA-C15 (MHA containing 15% volume/volume water extract of clove). Gram-negative bacterial pathogens Escherichia coli, Klebsiella pneumoniae, Salmonella typhimurium and Pseudomonas aeruginosa grew on MHA-C15. However, none of the major Gram-positive bacterial pathogens such as Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus mutans, Bacillus spp. and Enterococcus spp. grew on it. Taken together, these findings show that MHA-C15 is a newly developed selective media for culture of Gram-negative bacteria.

Scientists have effectively demonstrated that the introduction of a waste product comprising cementitious chemical compositions can enhance the mechanical properties and durability of cold bitumen emulsion mixes (CBEMs). On the other hand, the high air void content of the CBEM mix remains a challenge that is considered unsatisfactory by paving engineers. As a result, this investigation highlights two major changes that were made. The first is the use of waste paper sludge ash (PSA) as a filler in CBEM instead of the conventional mineral filler (CMF). The second change was made to further improve the mixture by reducing the amount of CBEM air voids using microwave (MW) heating energy as a post-treatment method. When compared to typical hot mix asphalt (HMA), the new CBEMs showed great mechanical properties and durability. Moreover, the proposed method, using CBEMs, has lower environmental risks, is safer, and is more cost-effective than existing paving mix technologies. This study presents a method for controlling air voids within pavement specifications without affecting mechanical behaviour or generating additional environmental or economic considerations. When compared to typical mixtures, laboratory test results showed that MW-heating can enhance both the stiffness modulus and the air void content. Furthermore, these results revealed a minor reduction in creep stiffness and water sensitivity. Nevertheless, in terms of mechanical, volumetric, and economic properties, the suggested post-mix treatment was comparable to HMA. The findings point to the need to adopt CBEM post-heating approaches, particularly the MW treatment procedure.

Background: The emergence of COVID-19 has been a major challenge to public health and the world economy. During a wave of COVID-19, the usage of widespread vaccination procedures and broader coverage to the whole of humanity will be made possible if the general population has access. An intended effect of vaccination is to provide “herd immunity,” which protects those who have not been vaccinated along with those who have been. However, some concerns regarding the safety and efficacy of COVID-19 vaccines were raised. Aim: This study aims to provide evidence on the short-term safety and efficacy of four types of vaccines that are officially approved by the Ministry of Health in the United Arab Emirates (UAE). These include Sinopharm, Sputnik V, Pfizer, and AstraZeneca. Method: This study utilized a cross-sectional descriptive design. Data on the efficacy and short-term protection of COVID-19 vaccines on vaccinated citizens and residents (n = 764) of the UAE were collected between February and April 2021. Participants were conveniently approached using a Google Forms survey, where they responded to a semi-structured questionnaire pertaining to socio-demographic questions and in-depth questions related to COVID-19, including whether they suffer from any comorbidities, the most commonly encountered post-vaccination side effects, and the severity of their symptoms, using a 5-point Likert scale. Results were analyzed using SPSS version 24, calculations of p-values and descriptive statistics were used for data differentiation. Results: The majority of the participants (n = 612 or 94.4%) stated that they did not become reinfected after receiving two doses of COVID-19 vaccine. In addition, the incidence of being hospitalized after vaccination was negligible. In terms of adverse effects, the most common individually reported side effects, regardless of the vaccination type, included “pain at the site of injection”, followed by “general fatigue”, then “lethargy”. Moreover, most of these side effects occurred after the second dose of the vaccine, irrespective of the type of vaccine. Females were found to be more susceptible to the adversities of COVID-19 vaccination. The occurrence of side effects was not found to be related to the nationality/ethnicity of the vaccine recipient. Furthermore, none of the vaccines affected sleep pattern, since a significant number of respondents reported a regular sleep pattern after being vaccinated. The majority respondents who received two doses of vaccination (n = 585 or 76.6%) reported that they did not become infected post vaccination, regardless the type of vaccine received, whereas only (n = 11 or 1.9%) were reinfected with COVID-19 after 2–4 weeks. Conclusion: The findings of this study suggest that vaccines can offer short-term protection against COVID-19 reinfection. Moreover, both the first- and second-vaccination side effects were described as very mild to moderate, which indicates tolerability. These data may strengthen the public confidence in receiving vaccinations.

Sağlık kurumları emek yoğun hizmet veren kuruluşlardır. Bu kurumların amaçlarının arasında örgüte değer katan, nitelikli ve tecrübeli çalışanları örgüte dâhil edilmesi, örgütte kalmalarını sağlanması ve örgüte olan bağlılıklarını arttırılması gösterilebilir. Örgütsel İklim çalışanların örgütteki mevcut psikolojik durumu algılama biçimleri olarak tanımlanabilir. Çalışmanın amacı sağlık çalışanlarının örgütsel iklimin örgütsel bağlılığa etkisini tespit etmektir. Araştırma İstanbul ilinde faaliyet gösteren 501 çalışanlı bir özel hastanede gerçekleştirilmiştir. Çalışma kapsamında tüm çalışanlara ulaşılmak hedeflenmiş fakat 179 (%35) çalışandan geri dönüş alınabilmiştir. Örgütsel bağlılık ile örgütsel iklim arasında pozitif yönlü güçlü ilişki(r=0,626) bulunmuştur. Örgütsel iklimin örgütsel bağlılığa etkisini ortaya koymak amacıyla oluşturulan regresyon modeli istatistiksel olarak anlamlıdır. Çalışmanın sonuçları örgütsel iklimin örgütsel bağlılığı pozitif yönde etkilediğini (R2=0,392) ortaya koymaktadır. Sağlık kuruluşlarının yoğun rekabet ortamında ayakta kalabilmesi için mevcut çalışanlarının örgütte kalmasını sağlaması ve örgütün çalışanlar tarafından tercih edilen bir kurum haline getirmesine bağlıdır. Bu neden ile örgüt içinde var olan örgütsel iklimi pozitif hale getirmek için çalışmalar yapılması örgütün uzun vadeli hedeflerine ulaşması için önemli görülmektedir.

Çalışmanın amacı, hastane çalışanlarının istihdam şekillerine göre örgütsel adalet algılamalarında farklılık olup olmadığını belirlemektir. Bunun yanında çalışanların sosyo-demografik özelliklerinin örgütsel adalet algılamalarında farklılık oluşturup oluşturmadığının belirlenmesi de hedeflenmektedir. Çalışmanın evrenini Sakarya Üniversitesi Eğitim Araştırma Hastanesi’nde çalışan 3055 sağlık personeli oluşturmaktadır. Çalışmanın örneklemi 405 kişidir. Veri toplama aracı olarak sosyo demografik özellikleri belirlemeye yönelik bir form ile Colquitt (2001) tarafından geliştirilen Örgütsel Adalet Algısı ölçeği kullanılmıştır. Verilerin analizinde; tanımlayıcı istatistiksel metotlar, korelasyon analizi, bağımsız örneklemlerde t-testi ve ANOVA analizlerinden yararlanılmıştır. Çalışmanın bulgularına göre devlet memurlarının örgütsel adalet algısı ortalamaları 3,27; sözleşmeli çalışanların 2,82; taşeron işçilerin ise 2,99’dır. Yapılan analiz sonucunda memurlar, sözleşmeli çalışanlar ve taşeron işçilerin örgütsel adalet algıları arasında anlamlı bir farklılık bulunmuştur. Ayrıca çalışanların yaşları, eğitim durumları, aylık ortalama gelirleri ve idari görevleri örgütsel adalet algılarında anlamlı farklılık oluşturmaktadır. Ancak cinsiyet, medeni durum ve mesleki tecrübe anlamlı bir farklılık oluşturmamaktadır.

Karşılaştırmalı yönetiminin temelinde, diğer ülkelerin deneyimlerinden yararlanma, farklı ülkelerde geliştirilen yönetim tekniklerini ve yenilikleri öğrenme, bunları kendi ülkesinin yönetimine uyarlama düşüncesi yatmaktadır. Çeşitli ülkelerin yönetimlerinin karşılaştırılmasında kullanılan yaklaşımların başında “bürokrasi”yi kullanan yaklaşım gelmektedir. Bu çerçevede yönetimlerin kendi içinde, yönetimin farklı düzeyleri arasında ve farklı yönetimler arasında karşılaştırma yapılmasına imkân sağlayacak şekilde “sağlık sistemleri”nin değerlendirilmesine yönelik yaklaşımlar da uluslararası kuruluşların ve ülkelerin dikkatini çekmektedir. Bu çalışmada sağlık reformları temelinde Türkiye ve Amerika Birleşik Devletleri (ABD) sağlık sistemlerinin incelenmesi ve karşılaştırılması amaçlanmaktadır. Bu kapsamda öncelikle Sağlıkta Dönüşüm Programı sonrası Türkiye sağlık sistemi yönetim, finansman, kaynak temini ve hizmet sunumu boyutlarında değerlendirilecektir. Benzer şekilde ABD sağlık sistemi de sağlık reformları temelinde incelenecektir. Daha sonra 2000-2015 yılları arasında Türkiye İstatistik Kurumu (TÜİK), Ekonomik Kalkınma ve İşbirliği Örgütü (OECD) ve Centers for Medicare and Medicaid Services (CMS) verileri göz önünde bulundurularak Türkiye ve Amerika Birleşik Devletleri sağlık sistemlerinin karşılaştırılması ve değerlendirilmesi yapılacaktır. Sonuç olarak, yürütme organının merkezilik derecesi, yürütme organın yapısı ve idari örgütlenme yapısı açısından Türkiye ve ABD’nin temel farklılıklara sahip olduğu görülmektedir. Bu farklılıklar sağlık sistemlerinin yönetim, finansman, kaynak temini ve hizmet sunumu boyutlarını doğrudan etkilemektedir. Söz konusu farklılıkların temelinde siyasal ve yönetsel farklılıklar, sosyo-ekonomik farklılıklar, sağlık sisteminde kamu ve özel sektörün ağırlığının yer aldığı düşünülmektedir.

Antibiotic resistance toward commonly used medicinal drugs is a dangerously growing threat to our existence. Plants are naturally equipped with a spectrum of biomolecules and metabolites with important biological activities. These natural compounds constitute a treasure in the fight against multidrug-resistant microorganisms. The development of plant-based antimicrobials through green synthesis may deliver alternatives to common drugs. Lepidium sativum L. (LS) is widely available throughout the world as a fast-growing herb known as garden cress. LS seed oil is interesting due to its antimicrobial, antioxidant, and anti-inflammatory activities. Nanotechnology offers a plethora of applications in the health sector. Silver nanoparticles (AgNP) are used due to their antimicrobial properties. We combined LS and AgNP to prevent microbial resistance through plant-based synergistic mechanisms within the nanomaterial. AgNP were prepared by a facile one-pot synthesis through plant-biomolecules-induced reduction of silver nitrate via a green method. The phytochemicals in the aqueous LS extract act as reducing, capping, and stabilizing agents of AgNP. The composition of the LS-AgNP biohybrids was confirmed by analytical methods. Antimicrobial testing against 10 reference strains of pathogens exhibited excellent to intermediate antimicrobial activity. The bio-nanohybrid LS-AgNP has potential uses as a broad-spectrum microbicide, disinfectant, and wound care product.

Thin films of pure copper oxide and doped copper oxide have been prepared by chemical spray pyrolysis. The films were doped with Manganese (Mn) by 2% & 4% ratios. X-ray diffraction show that all prepared films have The two strong peaks of the CuO films appear at 35.74o and 38.95o which correspond to diffraction from planes (-111) and (111) respectively. The absorption coefficient was calculated from transmission spectra range (450 – 950 nm) , the absorption coefficient increase by doping, the allowed direct optical band gab energy has been evaluated from absorption coefficient and the energy band gab increased by doping.

Penile cancer is a relatively uncommon cancer in the United States, spreading locally and through lymphatic channels. Metastatic disease is rare but has been reported in the liver, lungs, bone, brain, heart, and skin. Here we report a case of penile squamous cell carcinoma that had metastasized to the groin and presented as a chronic non-healing wound. [Arch Clin Exp Surg 2014; 3(1.000): 56-58]

Patients with cancer face a significant risk of cardiovascular death, regardless of time since cancer diagnosis. Elderly patients are particularly more susceptible as cancer-associated cardiac complications present in advanced stage cancer. These patients may often present with symptoms observed in chronic heart failure (HF). Cardiac wasting, commonly observed in these patients, is a multifaceted syndrome characterized by systemic metabolic alterations and inflammatory processes that specifically affect cardiac function and structure. Experimental and clinical studies have demonstrated that cancer-associated cardiac wasting is linked with cardiac atrophy and altered cardiac morphology, which impairs cardiac function, particularly pertaining to the left ventricle. Therefore, this review aims to present a summary of epidemiologic data and pathophysiological mechanisms of cardiac wasting due to cancer, and future directions in this field., (© 2024. The Author(s).)

Background: Sarcoidosis is a granulomatous disease with varying courses of disease progression. Environmental exposures are thought to be contributors to disease onset. Exposure to air pollutants such as fine particulate matter (PM 2.5 ) and nitrogen dioxide (NO 2 ) have been identified as contributors to health disparities in lung diseases; little is known about these environmental exposures' associations with disease outcomes in sarcoidosis., Research Question: Is higher exposure to PM 2.5 and NO 2 associated with worse lung function in sarcoidosis?, Study Design and Methods: We conducted a retrospective, cross-sectional study of individuals with pulmonary sarcoidosis seen from 2005-2015. Home addresses at the year of enrollment were geocoded and exposure to PM 2.5 and NO 2 was modeled using high resolution 1 km by 1 km annual surface exposure data during the year of enrollment. Racial and sex differences in exposure were determined. Multivariable linear regression models were used to examine the associations between PM 2.5 and NO 2 and the PFT measures, FVC, FEV 1 and DL CO ., Results: Among the 415 individuals in the analysis, Black individuals had significantly higher exposure to PM 2.5 and NO 2 compared to non-Hispanic White individuals, 12.2 μg/m 3 (SD 2.4) vs 11 μg/m 3 (SD 2.2) and 6.3 ppb (SD 1.9) vs 5.0 ppb (SD 2.0) respectively. Every 1μg/m 3 higher exposure to PM 2.5 was associated with 1.12% lower DL CO % predicted (95% CI: -1.83 to -0.41, p<0.05). Every 1ppb higher exposure to NO 2 was associated with 1.04% lower DL CO % predicted (95% CI: -1.91 to -0.18, p<0.05) in fully adjusted models. There were no significant associations between these pollutants and either FVC or FEV 1 % predicted., Interpretation: Higher exposure to PM 2.5 and NO 2 was associated with worse DL CO % predicted. Black individuals with sarcoidosis were exposed to higher PM 2.5 and NO 2 than non-Hispanic White individuals. Air pollution exposure may be a contributor to reported health disparities in sarcoidosis., (Copyright © 2024. Published by Elsevier Inc.)

Background: The prevalence of hypertension (HTN) has significantly increased among younger adults (15-45 yrs) in the U.S. Despite this, there is limited data on trends of HTN-related mortality within this population., Methods: Data from the CDC WONDER multiple-cause of death database was analyzed from 1999 to 2021, focusing on HTN-related mortality in young adults aged 15 to 45 years. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) were calculated and stratified by year, sex, race/ethnicity, urbanization status, and census region., Results: Between 1999 and 2021, there were 201,860 HTN-related deaths among young adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC 35.3; 95 % CI 20.6 to 44.5) and then to 9.4 in 2019 (APC 3.1; 95 % CI 2.7 to 3.5) before sharply rising to 13.9 in 2021 (APC 22.3; 95 % CI 15.1 to 26.4). Men consistently exhibited higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). In 2020, the highest AAMR was observed among non-Hispanic (NH) Black or African American young adults (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islander (5.0). The Southern region had the highest AAMR (9.3), followed by the Midwest (6.4), West (5.8), and Northeast (5.4). Nonmetropolitan areas consistently had higher AAMR (8.5) than metropolitan areas (7.0). States in the top 90 th percentile for AAMRs included Mississippi, the District of Columbia, Oklahoma, West Virginia, and Arkansas, with these states exhibiting approximately five times the AAMRs of those in the lower 10th percentile., Conclusion: HTN-related mortality among young adults in the U.S. increased steadily until 2019, followed by a sharp rise in 2020 and 2021. The highest AAMRs were observed among men, NH Black young adults, and individuals residing in the Southern and non-metropolitan areas of the U.S. These findings underscore the need for targeted interventions to reduce the burden and address disparities in HTN-related mortality among young adults in the U.S., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: A Urethral diverticulum can be defined as sac-like dilation lined with epithelial tissue, which may be congenital or acquired. It usually develops in the penoscrotal angle region but can also be observed in the penile urethra. It usually occurs in female teenagers. This report aims to discuss a male infant with a large urethral diverticulum., Case Presentation: A 5-month-old male presented to the urological department at Sulaimani Teaching Hospital with a penile swelling that had been noticeable since birth. Clinical examination revealed a ventral cystic penile shaft swelling, which would fill with fluid during urination. A urethrocystoscopy was performed and showed a wide cystic ventral diverticulum. Diverticulectomy was performed as a surgical approach to remove the diverticulum., Discussion: Congenital anterior urethral diverticulum is an uncommon condition that typically begins in early life. It can manifest with various symptoms, like recurrent infections of the urinary tract, painful urination, and post-void urine dribbling. Diagnosis involves imaging, with urethrocystoscopy, to rule out other potential diagnoses. Different surgical techniques exist that show promising results in preventing recurrence. The current case involved diverticulectomy and multi-layered wound closure with a dartos flap., Conclusion: Large anterior diverticulum in early infancy is rare but possible; operation is the preferred intervention method., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Hassan, Bapir, Aghaways, Hama, Raheem, Sabr, Mohammed, Kareem, Mustafa and Kakamad.)

Disease coding is the process of assigning one or more standardized diagnostic codes to clinical notes that are maintained by health practitioners (e.g. clinicians) to track patient condition. Such a coding process is often expensive and error-prone, as human medical coders primarily perform it. Automating diagnostic coding using Artificial Intelligence is seen as an essential solution in Hospital Information Management Systems and approaches built on Convolutional Neural Networks currently perform best. In this work, a neural model built on unstructured clinical text for enabling automatic diagnostic coding for given patient discharge summaries is proposed. We incorporate a structured self-attention mechanism designed to boost learning of label-specific vectors and the significant clinical text snippets associated with a certain label for this purpose. These vectors are then combined with a novel code description pipeline leveraging the descriptions provided for each standardized diagnostic code. The proposed model achieved best performance in terms of standard metrics over the MIMIC-III dataset, outperforming models based on Longformers and Knowledge graphs. Furthermore, to leverage structured clinical data to enhance the proposed model, and to enable improved diagnostic code prediction, model ensembling is considered. A neural model built on structured data by leveraging supervised machine learning algorithms such as random forest and boosting, is designed for multi-class code classification. Experimental results revealed that the proposed ensemble models show promising performance compared to traditional models that rely solely on unstructured or structured clinical data, emphasizing their suitability for real-world deployment., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Giant adrenal myelolipoma (AML) may cause severe symptoms. In contrast to the previous reports, laparoscopy may play a pivotal role in the management of giant AML. This report aims to discuss a case of giant AML managed successfully by laparoscopy. A 63-year-old male was found to have a giant (12 × 10 × 8 cm) left AML during a workup for left lower chest pain on imaging. laparoscopic excision of a left adrenal gland with the lesion was performed under general anesthesia. The patient was discharged from the hospital after 3 days uneventfully. AML is a benign tumor that is characterized by the presence of adipose tissue and hematopoietic elements. Myelolipomas are typically asymptomatic. AML diagnosis is based on imaging and blood workup. Small asymptomatic AML is usually managed conservatively, while symptomatic AML is managed with surgery. Even though an open approach is the standard option, laparoscopy, as a minimally invasive technique, in some centers may replace laparotomy. Laparoscopy can be a successful method for managing AML, even when they are large in size., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

The occurrence of crystals in semen is rare, with spermine phosphate crystals being the only type commonly described. Uric acid crystal formation is significantly influenced by pH levels. The present study reported a rare case of uric acid crystals in the semen of a patient with azoospermia associated with Sertoli cell-only syndrome (SCOS). A 28-year-old male with a four-year history of primary infertility underwent clinical assessment, including a normal physical examination with small testes. Seminal fluid analysis revealed abnormal uric acid crystals. Elevated follicle-stimulating hormone, luteinizing hormone and prolactin levels were observed. The diagnosis of SCOS was confirmed through testicular sperm aspiration. Azoospermia is a medical condition characterized by the absence of sperm in the semen, specifically the absence of sperm in the pellet obtained after centrifugation. It is classified into two primary types: Obstructive and non-obstructive azoospermia. Non-obstructive azoospermia is subdivided into three categories: SCOS, hypospermatogenesis and maturation arrest. The occurrence of SCOS in azoospermic males ranges from 26.3 to 57.8%. The diagnosis of azoospermia with SCOS can be achieved through the analysis of multiple semen samples, medical history, physical examination, hormonal analysis, histopathological examination and genetic testing. The presence of uric acid crystals in seminal fluid was first reported in patients with chronic prostatitis symptoms in 2005. Despite the rarity of crystals in semen, uric acid crystals were found in the semen of an azoospermic male with SCOS., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024, Spandidos Publications.)

Mammalian cells replicate ~ 3 × 10 9 base pairs per cell cycle. One of the key molecules that slows down the cell cycle and prevents excessive DNA damage upon DNA replication stress is the checkpoint kinase ataxia-telangiectasia-and-RAD3-related (ATR). Proteolysis-targeting-chimeras (PROTACs) are an innovative pharmacological invention to molecularly dissect, biologically understand, and therapeutically assess catalytic and non-catalytic functions of enzymes. This work defines the first-in-class ATR PROTAC, Abd110/Ramotac-1. It is derived from the ATR inhibitor VE-821 and recruits the E3 ubiquitin-ligase component cereblon to ATR. Abd110 eliminates ATR rapidly in human leukemic cells. This mechanism provokes DNA replication catastrophe and augments anti-leukemic effects of the clinically used ribonucleotide reductase-2 inhibitor hydroxyurea. Moreover, Abd110 is more effective than VE-821 against human primary leukemic cells but spares normal primary immune cells. CRISPR-Cas9 screens show that ATR is a dependency factor in 116 myeloid and lymphoid leukemia cells. Treatment of wild-type but not of cereblon knockout cells with Abd110 stalls their proliferation which verifies that ATR elimination is the primary mechanism of Abd110. Altogether, our findings demonstrate specific anti-leukemic effects of an ATR PROTAC., (© 2024 The Authors. Molecular Oncology published by John Wiley & Sons Ltd on behalf of Federation of European Biochemical Societies.)

Hyperactive FMS-like receptor tyrosine kinase-3 mutants with internal tandem duplications (FLT3-ITD) are frequent driver mutations of aggressive acute myeloid leukemia (AML). Inhibitors of FLT3 produce promising results in rationally designed cotreatment schemes. Since FLT3-ITD modulates DNA replication and DNA repair, valid anti-leukemia strategies could rely on a combined inhibition of FLT3-ITD and regulators of cell cycle progression and DNA integrity. These include the WEE1 kinase which controls cell cycle progression, nucleotide synthesis, and DNA replication origin firing. We investigated how pharmacological inhibition of FLT3 and WEE1 affected the survival and genomic integrity of AML cell lines and primary AML cells. We reveal that promising clinical grade and preclinical inhibitors of FLT3 and WEE1 synergistically trigger apoptosis in leukemic cells that express FLT3-ITD. An accumulation of single and double strand DNA damage precedes this process. Mass spectrometry-based proteomic analyses show that FLT3-ITD and WEE1 sustain the expression of the ribonucleotide reductase subunit RRM2, which provides dNTPs for DNA replication. Unlike their strong pro-apoptotic effects on leukemia cells with FLT3-ITD, inhibitors of FLT3 and WEE1 do not damage healthy human blood cells and murine hematopoietic stem cells. Thus, pharmacological inhibition of FLT3-ITD and WEE1 might become an improved, rationally designed therapeutic option., Competing Interests: Declaration of Competing Interest OHK declares paid consultant activity for BASF, Ludwigshafen, Germany, and the patent “The use of molecular markers for the preclinical and clinical profiling of inhibitors of enzymes having histone deacetylase activity”. The BASF has not influenced our study and its products are not discussed in the manuscript. SM and OHK declare the patents “Novel HDAC6 inhibitors and their uses”, and “Synthesis, pharmacology and use of new and selective FMS-like tyrosine kinase 3 (FLT3) inhibitors”. All other authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Objective: Despite the historical neurological use of Withania somnifera, limited evidence supports its efficacy for conditions like anxiety and insomnia. Given its known anti-stress properties, this review evaluated its safety and efficacy for anxiety and insomnia., Methods: We searched Medline, Cochrane Library, and Google Scholar until August 2023 for randomized controlled trials (RCTs) comparing W. somnifera to placebo in patients with anxiety and/or insomnia. Outcome measures included changes in anxiety levels via the Hamilton Anxiety Scale (HAM-A), Sleep Onset Latency (SOL), Total Sleep Time (TST), Wake After Sleep Onset (WASO), Total Time in Bed (TIB), Sleep Efficiency (SE), and Pittsburgh Sleep Quality Index (PSQI) score. We utilized a random-effect model for pooling Mean Differences (MD) with a 95% Confidence Interval (CI). Heterogeneity was assessed through sensitivity and subgroup analysis, and the quality of RCTs was evaluated using the Cochrane revised risk of bias tool., Results: Pooled results from five RCTs (n = 254) demonstrated that W. somnifera significantly reduced HAM-A scores (MD = -5.96; [95% CI -10.34, -1.59]; P = 0.008; I 2  = 98%), as well as sleep parameters such as SOL, TST, PSQI, and SE, but not WASO and TIB., Conclusion: While W. somnifera extracts yielded promising results, further research with larger sample sizes is needed to confirm its effects on anxiety and insomnia., (© 2024 John Wiley & Sons Ltd.)

Background: Carotid body tumors are uncommon neuroendocrine growths near the carotid bifurcation. While some advocate preoperative embolization to minimize bleeding, others avoid it due to complications. This study shares the experience of a single center in managing patients with carotid body tumors without practicing preoperative embolization., Methods: This was a cross-sectional study of patients with carotid body tumors managed between 2020 and 2024. Data were collected from the hospital's registry. When necessary, routine blood tests, neck ultrasonography, and computed tomography scans were conducted. The tumors were categorized according to Shamblin's classification. The average duration of follow-up was 20 months., Results: The study involved 25 patients, 22 (88%) females and 3 (12%) males. Their ages ranged from 27 to 85 years old. Twenty (80%) cases presented with neck swelling, and six (24%) had a positive medical history. Tumors were mainly on the right side (52%), with 20 (80%) showing ill-defined neck masses. Tumor sizes ranged from 1.5 to 7 cm, with Shamblin type II tumors being discovered in the majority of cases (72%). Types of tumors were significantly associated with the tumor size (p-value < 0.05). Blood transfusion was required in five cases (20%), three from type III and two from type II, with none from type I (p-value = 0.001). Temporary neurological deficits occurred in 3 cases (12%). No functional impairment or mortality was recorded., Conclusions: Carotid body tumors are rare tumors with an unknown etiology. Operation without practicing preoperative embolization may be feasible with an acceptable outcome., (© 2024. The Author(s).)

Background: The enormous consequences of drugs include suicides, traffic accidents, and violence, affecting the individual, family, society, and country. Therefore, it is necessary to constantly identify and monitor the drug abuse rate among school-going youth. A geospatial dashboard is vital for the monitoring of drug abuse and related crime incidence in a decision support system., Objective: This paper mainly focuses on developing MyAsriGeo, a geospatial drug abuse risk assessment and monitoring dashboard tailored for school students. It introduces innovative functionality, seamlessly orchestrating the assessment of drug abuse usage patterns and risks using multivariate student data., Methods: A geospatial drug abuse dashboard for monitoring and analysis was designed and developed in this study based on agile methodology and prototyping. Using focus group and interviews, we first examined and gathered the requirements, feedback, and user approval of the MyAsriGeo dashboard. Experts and stakeholders such as the National Anti-Drugs Agency, police, the Federal Department of Town and Country Planning, school instructors, students, and researchers were among those who responded. A total of 20 specialists were involved in the requirement analysis and acceptance evaluation of the pilot and final version of the dashboard. The evaluation sought to identify various user acceptance aspects, such as ease of use and usefulness, for both the pilot and final versions, and 2 additional factors based on the Post-Study System Usability Questionnaire and Task-Technology Fit models were enlisted to assess the interface quality and dashboard sufficiency for the final version., Results: The MyAsriGeo geospatial dashboard was designed to meet the needs of all user types, as identified through a requirement gathering process. It includes several key functions, such as a geospatial map that shows the locations of high-risk areas for drug abuse, data on drug abuse among students, tools for assessing the risk of drug abuse in different areas, demographic information, and a self-problem test. It also includes the Alcohol, Smoking, and Substance Involvement Screening Test and its risk assessment to help users understand and interpret the results of student risk. The initial prototype and final version of the dashboard were evaluated by 20 experts, which revealed a significant improvement in the ease of use (P=.047) and usefulness (P=.02) factors and showed a high acceptance mean scores for ease of use (4.2), usefulness (4.46), interface quality (4.29), and sufficiency (4.13)., Conclusions: The MyAsriGeo geospatial dashboard is useful for monitoring and analyzing drug abuse among school-going youth in Malaysia. It was developed based on the needs of various stakeholders and includes a range of functions. The dashboard was evaluated by a group of experts. Overall, the MyAsriGeo geospatial dashboard is a valuable resource for helping stakeholders understand and respond to the issue of drug abuse among youth., (©Ahmad Mustafa Al-Aboosi, Siti Norul Huda Sheikh Abdullah, Rozmi Ismail, Khairul Nizam Abdul Maulud, Lutfun Nahar, Khairul Akram Zainol Ariffin, Meng Chun Lam, Muhamad Lazim bin Talib, Suzaily Wahab, Mahadzir Elias. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 30.07.2024.)

Peripheral artery disease (PAD) is a common condition characterized by atherosclerosis in the peripheral arteries, associated with concomitant coronary and cerebrovascular diseases. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a class of drugs that have shown potential in hypercholesterolemic patients. This review focuses on the efficacy, safety, and clinical outcomes of PCSK9 inhibitors in PAD based on the literature indexed by PubMed. Trials such as FOURIER and ODYSSEY demonstrate the efficacy of evolocumab and alirocumab in reducing cardiovascular events, offering a potential treatment option for PAD patients. Safety evaluations from trials show few adverse events, most of which are injection-site reactions, indicating the overall safety profile of PCSK9 inhibitors. Clinical outcomes show a reduction in cardiovascular events, ischemic strokes, and major adverse limb events. However, despite these positive findings, PCSK9 inhibitors are still underutilized in clinical practice, possibly due to a lack of awareness among care providers and cost concerns. Further research is needed to establish the long-term effects and cost-effectiveness of PCSK9 inhibitors in PAD patients., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Spinal anesthesia is the most preferred method for cesarean section (C-section). This meta-analysis was performed to determine the effect of low and high intrathecal doses of pethidine on the maternal outcomes after C-section., Methods: A systematic search of PubMed, Scopus, Cochrane Library, and Google Scholar was performed. Random-effects meta-analysis was performed to derive odds ratios (ORs) from dichotomous data., Results: Seventeen randomized controlled trials with 1304 C-section patients were included. Patients who had received intrathecal pethidine experienced decreased shivering and intensity of shivering (OR 0.13; P <0.001) and (OR 0.21; P <0.001), respectively. Moreover, vomiting (OR 2.47; P =0.002) and pruritus (OR 5.92; P <0.001) were significantly higher in the pethidine group. There was no statistically significant difference in the incidence of nausea (OR 2.55; P =0.06) and hypotension (OR 0.91; P =0.67)., Conclusions: Intrathecal pethidine can effectively decrease shivering, although it increases the risk of vomiting and pruritus. No significant difference was found both in the maternal hypotension and nausea., Competing Interests: Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Drug-induced liver injury (DILI) represents a significant clinical challenge characterized by hepatic dysfunction following exposure to diverse medications. Methotrexate (MTX) is a cornerstone in treating various cancers and autoimmune disorders. However, the clinical utility of MTX is overshadowed by its ability to induce hepatotoxicity. The current study aims to elucidate the hepatoprotective effect of the alcoholic extract of Egyptian Araucaria heterophylla resin (AHR) on MTX-induced liver injury in rats. AHR (100 and 200 mg/kg) significantly decreased hepatic markers (AST, ALT, and ALP), accompanied by an elevation in the antioxidant's markers (SOD, HO-1, and NQO1). AHR extract also significantly inhibited the TGF-β/NF-κB signaling pathway as well as the downstream cascade (IL-6, JAK, STAT-3, and cyclin D). The extract significantly reduced the expression of VEGF and p38 with an elevation in the BCL2 levels, in addition to a significant decrease in the IL-1β and TNF-α levels, with a prominent effect at a high dose (200 mg/kg). Using LC-HRMS/MS analysis, a total of 43 metabolites were tentatively identified, and diterpenes were the major class. This study presents AHR as a promising hepatoprotective agent through inhibition of the TGF-β/NF-κB and JAK/STAT3 pathways, besides its antioxidant and anti-inflammatory effects.

Introduction: Thoracic outlet syndrome (TOS) typically considered a condition of the adult population; it is often disregarded in children and adolescents due to its limited recognition within the pediatrics. The current study aims to systematically review and provide insights into TOS among pediatric patients., Methods: PubMed, Scopus, Web of Science, and Google Scholar databases were thoroughly searched for English language studies published until March 15th, 2024. The study included those articles focusing on pediatric or adolescent individuals diagnosed with TOS. Data collected from studies encompassed date of publication, number of participants or reported cases, age (years), gender of participants, type of TOS, affected side, type of treatment, surgical approach, bony abnormality, duration of symptoms (months), outcome, and follow-up time duration (months)., Results: The current study comprised 33 articles, 21 of which were case reports, 10 of which were case series, and the remaining were cohort studies. In this study, 356 patients were included. Females constituted 234 (65.73%) of the patient population. Among TOS types, neurogenic TOS was found among 201 (56.5%) patients. Sporting-related activity or physical activity was present in 193 (54%) patients, followed by a history of trauma in 27 (7%) patients., Conclusions: Pediatric patients exhibited a higher percentage of vascular TOS than their adult counterparts, with the supraclavicular approach emerging as the preferred treatment method. Sports-related activities were identified as the primary risk factor associated with pediatric TOS., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Despite the increase in hereditary disease in Arab countries due to the high rates of consanguineous marriages, research on community awareness of premarital screening (PMS) for disease carriers is still scarce., Aim: To investigate knowledge and attitudes toward genetic PMS programs among university students in Libya., Methods: A cross-sectional study was conducted using a self-administered questionnaire distributed to 421 Libyan students aged 18-25 years at the University of Tripoli., Results: Most of the participants (79%, n=316) agreed that a PMS program is important and expressed willingness to have PMS programs if they were advised to do so. Two-thirds of participants (67%, n=268) had heard of PMS programs, of whom (27.2%, n=73) heard of them from social media., Conclusion: Most of the university students had good knowledge of PMS but poor knowledge of the hereditary disease targeted by PMS. Most of them had a positive attitude toward PMS., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Bioethics Committee of Libyan Biotechnology Research Center issued approval BEC-BRTC 18-2019. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shebani et al.)

Background: The importance of including bioethics in the medical curricula has been recognized globally. Certain countries including Pakistan continue to lag behind although some developments have occurred recently., Objectives: The research aimed to provide a snapshot of bioethics education in undergraduate medical colleges in Karachi, Pakistan. The secondary objectives included identifying factors promoting or inhibiting integration of bioethics into the curriculum., Methods: A two-pronged strategy was used to collect data including a website review of medical colleges, in existence for more than ten years, recognized by the Pakistan Medical and Dental Council (PMDC), the regulating body for undergraduate medical education in Pakistan. The other arm employed in-depth interviews with medical educationists in colleges fulfilling inclusion criteria. Data from the website was analyzed and presented as frequencies. Qualitative data was analyzed using content analysis method which involved coding of transcripts, multiple readings and arriving at subthemes and themes iteratively., Results: Thirteen medical colleges were included for the website review, of which four were from public sector. Three medical colleges used the word "ethics" in their vision and mission statement and four had provided a detailed curriculum for ethics on their website. Thematic framework included four broad themes: 1) Need for Bioethics Education, 2) Current Status of Bioethics Education 3) Challenges in integration of bioethics in medical curriculum and 4) Recommendations for integration of bioethics in the Curriculum. Participants were in agreement that bioethics was important in development of future physicians. Participants identified various challenges, foremost being shortage of trained faculty, lack of institutional buy-in and overcrowded curriculum., Conclusion: The study identified sporadic inclusion of bioethics in undergraduate medical curricula, left to the discretion of individual institutions. Since Karachi is a cosmopolitan city, the findings may reasonably reflect the situation in other parts of the country. While bioethics is recognized as an important field, it will continue to remain an orphan subject in the curricula unless the regulatory and accreditation bodies make it compulsory for institutions to include ethics in their curricula., (© 2024. The Author(s).)