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Background: Use of extended pharmacologic thromboprophylaxis after major abdominopelvic cancer surgery should depend on best-available scientific evidence and patients&apos; informed preferences. We developed a risk-stratified patient decision aid to facilitate shared decision-making and sought to evaluate its effect on decision-making quality regarding use of extended thromboprophylaxis. Methods: We enrolled patients undergoing major abdominopelvic cancer surgery at an acad mie tertiary care centre in this pre-post study. We evaluated change in decisional conflict, readiness to decide, decision-making confidence, and change in patient knowledge. Participants were provided the appropriate risk-stratified decision aid (according to their Caprini score) in either the preoperative or postoperative setting. A sample size calculation determined that we required 17 patients to demonstrate whether the decision aid meaningfully reduced decisional conflict. We used the Wilcoxon matched-pairs signed ranks test for interval scaled measures. Results: We included 17 participants. The decision aid significantly reduced decisional conflict (median decisional conflict score 2.37 [range 1.00-3.81] v. 1.3 [range 1.00-3.25], p < 0.01). With the decision aid, participants had high confidence (median 86.4 [range 15.91-100]) and felt highly prepared to make a decision (median 90 [range 55-100]). Median knowledge scores increased from 50% (range 0%-100%) to 75% (range 25%-100%). Conclusion: Our risk-stratified, evidence-based decision aid on extended thromboprophylaxis after major abdominopelvic surgery significantly improved decision-making quality. Further research is needed to evaluate the usability and feasibility of this decision aid in the perioperative setting. Contexte: L&apos;utilisation d&apos;une thromboprophylaxie pharmacologique prolong e apr s une chirurgie majeure pour cancer abdomino-pelvien doit reposer sur les meilleures donn es scientifiques existantes et les pr f rences des malades bien renseign s. Nous avons con u un outil d cisionnel stratifi selon le risque pour faciliter les prises de d cision partag es et nous avons voulu en mesurer l&apos;effet sur la qualit des prises de d cision relatives l&apos;utilisation de la thromboprophylaxie prolong e. M thodes: Pour cette tude avant-apr s, nous avons inscrit des malades soumis une chirurgie majeure pour cancer abdomino-pelvien dans un centre universitaire de soins tertiaires. Nous avons valu les diff rences aux plans du conflit d cisionnel, de l&apos; tat de pr paration la prise de d cision, du degr de confiance envers le processus d cisionnel, et du niveau de connaissances des malades. On a remis aux personnes participantes l&apos;outil d cisionnel appropri (selon leur score de risque de Caprini) l&apos; tape pr - ou postop ratoire. Un calcul de la taille de l&apos; chantillon a permis de d terminer qu&apos;il nous fallait 17 personnes pour d montrer que l&apos;outil d cisionnel r duisait significativement le conflit d cisionnel. Nous avons utilis le test des rangs sign s de Wilcoxon pour paires appari es et mesures par chelle d&apos;intervalles. R sultats: Nous avons inclus 17 personnes. L&apos;outil d cisionnel a significativement r duit le conflit d cisionnel (indice m dian de conflit d cisionnel 2,37 [ ventail 1,00-3,81] c. 1,3 [ ventail 1,00-3,25], p < 0,01). Avec l&apos;outil d cisionnel, les personnes se sentaient tr s en confiance (m diane 86,4 [ ventail 15,91-100]) et se sentaient pr tes prendre leur d cision (m diane 90 [ ventail 55-100]). Les scores m dians de connaissances sont pass s de 50% ( ventail 0%-100%) 75% ( ventail 25%-100%). Conclusion: Notre outil d cisionnel stratifi selon le risque et fond sur des donn es probantes concernant l&apos;utilisation de la thromboprophylaxie prolong e apr s une chirurgie majeure pour cancer abdomino-pelvien a significativement am lior la qualit des prises de d cision. Il faudra approfondir la recherche pour valuer l&apos;applicabilit de cet outil d cisionnel en contexte p riop ratoire., Venous thromboembolism (VTE) is an important cause of perioperative morbidity and death among patients with cancer. (1,2) Beginning pharmacologic thromboprophylaxis at the time of surgery and continuing until hospital discharge [...]

Abstract Introduction Kuwait has a large expatriate community who experience both restricted access to public health services and lower income than Kuwaiti citizens. Given these conditions, we examined differences in characteristics and management of chronic kidney disease (CKD) between Kuwaitis and expatriates. Methods Clinical and laboratory data for adult CKD Stages 3–5 not on dialysis (CKD 3–5 ND) patients with native kidneys attending nephrology clinics in all Ministry of Health hospitals collected from January 1, 2022, to December 31, 2022. Cohort was then divided into Kuwaiti patients and expatriates patients for comparison. Results We collected data from 2,610 patients (eGFR: 30.8 ml/min/1.73m2; age: 62.6 years; males: 56.7%; Kuwaitis: 62.1%). Kuwaitis were older (63.94 vs. 60.3 years, p

Abstract Cardiovascular diseases, especially hypertension, stand as prominent contributors to global mortality. Hypertension, often referred to as a silent killer syndrome, necessitates the use of multiple medications for effective control and management. A new environmentally friendly HPLC–DAD method is introduced in this study for the concurrent analysis of telmisartan (TEL), chlorthalidone (CHT) and amlodipine besylate (AML), in both pure forms and combined pharmaceutical dosage form. An isocratic elution mode was employed to achieve chromatographic separation, utilizing an Inertsil C18 column (250 × 4.6 mm, 5.0 µm) and a mobile phase mixture of acetonitrile and phosphate buffer (pH 3.0 ± 0.1) with ratio of 35:65, v/v. The separation was achieved within 10 min at a flow rate of 1.0 mL/min. The proposed method's validation was carried out following the guidelines outlined by the International Council for Harmonisation (ICH). The achieved linearity range was 1.0–140.0 μg/mL for TEL and 1.0–100.0 μg/mL for CHT and AML with quantification limits of 0.061, 0.177, and 0.313 μg/mL for TEL, CHT, and AML, respectively. The fixed combination tablet dosage form demonstrated acceptable release profile, as indicated by the in-vitro dissolution studies. The studied dissolution media were phosphate buffer pH 7.5, 0.01 N HCl, and water, utilizing a USP type II apparatus at 37 ± 0.5 °C with a stirring rate of 75 rpm. The proposed method was applied successfully for the quality assessment of Telma-ACT® Tablets with good precision and accuracy. Various tools were used for evaluating the level of greenness, including Green Analytical Procedure Index (GAPI), Analytical Greenness Metric for Sample Preparation (AGREEprep), Analytical Eco-Scale (AES), and Analytical Method Greenness Score (AMGS). These tools had confirmed the eco-friendliness of the proposed method. Additionally, the newly introduced White Analytical Chemistry (WAC), and the Blue Applicability Grade Index (BAGI) have been specifically developed to evaluate the sustainability and the applicability of the method.

Abstract Background Diabetic nephropathy (DN) is a frequent and long-lasting microvascular consequence that has an established connection with diabetes. It serves as the primary etiological agent of end-stage renal disease, a critical renal disorder that develops on a worldwide level. The molecular pathophysiology of DN is multifactorial, such as transforming growth factor-beta [TGF-β] which affects the expression of miRNAs such as miRNA-21 and miRNA-192 during renal fibrosis. However, to date, the clinical application is inadequate due to discrepancies observed in the published data. This cross-sectional investigation aimed to assess the correlation between serum TGF-β1, miRNA-21 and 192, and glycemic control, metabolic abnormalities, and renal function in patients with type II diabetes. Methods Based on the albumin/creatinine ratio (ACR), fifty subjects with type II diabetes were divided into three categories: Group I consisted of individuals with normoalbuminuria (n = 16), Group II of microalbuminuria (n = 16), and Group III of overt proteinuria (n = 18). All participants were subjected to the estimation of mature miRNA-21 and miRNA-192 by TaqMan two-step stem loop qRT-PCR and serum TGFβ1 level by ELISA. Results There was an upregulation in miRNA-21 expression in the 3 different groups of patients (p value = 0.043). The serum fold change (FC) of miRNA-21 showed significantly greater median values in patients with overt proteinuria compared to those with normoalbuminuria (5.57 FC versus 1.11 FC, p = 0.017). A positive correlation (r = 0.343) (p = 0.013) was observed between the ACR and the median levels of miRNA-21, which was statistically significant. No statistically significant distinctions were detected in the concentrations of serum TGF-β1 or miRNA-192 among the three patient groups (p values of 0.234 and 0.225, respectively). Conclusion The findings of the present research implied that miRNA-21 might function as an early indicator of renal pathology associated with diabetes mellitus (DM).

Museums environment is complicated and defined by indoor air quality, thermal and lighting comfort. Artifacts deterioration is factored by extreme conditions of thermal exposure or excessive lighting. With high control required for exposed old monuments and visitor comfort, museums energy systems reach extreme levels. In this paper, we aim to find the gap in museums high energy loads and reach solutions through architectural design. The paper studies comparison results for different techniques in fifty recent case studies to identify the specific factors that matter most to museum buildings. These factors are implemented simultaneously on one base model in three climatic states by multi-objective optimization. The best option will showcase each climate optimum conditions. The paper introduces optimum architectural procedures optimizing sDA and ASE to minimum 70% and maximum 10% respectively while decreasing thermal load. The results help architects and policy makers achieve daylighting and energy optimization in museums through architecture.

Introducción: el síndrome autoinmune a la insulina, previamente conocido como síndrome de Hirata, es un proceso que condiciona la presencia de anticuerpos endógenos contra esta hormona en pacientes sin exposición previa a insulina exógena y con páncreas anatómicamente normal, que se caracteriza por la aparición espontánea de episodios de hipoglicemia hiperinsulinémica. Objetivo: concientizar sobre este efecto adverso a medicamentos, con el fin de informar sobre su existencia y lograr un diagnóstico temprano. Presentación del caso: presentamos el caso de un paciente joven de 34 años que tenía enfermedad de Graves y con quien se instauró manejo con metimazol, con posterior desarrollo de episodios de hipoglucemia hiperinsulinémica, asociados a la presencia de autoanticuerpos contra insulina, los cuales se resolvieron de manera espontánea con manejo esteroideo. Discusión y conclusión: el diagnóstico de este síndrome se basa en la presencia de autoanticuerpos contra la insulina. Se han descrito casos asociados a la ingesta de medicamentos cuyo componente químico tiene presencia de grupos sulfidrilo, como el metimazol, y donde su evolución normal es hacia la resolución espontánea. Actualmente no hay claridad respecto a la mejor aproximación terapéutica, debido a su baja frecuencia y a los pocos datos registrados al respecto. Es por ello que se requiere de una alta sospecha clínica y que en lo posible se intente la identificación de un agente desencadenante.

Rationale & Objectives: Acute kidney injury (AKI) incidence and outcome in Kuwait are unknown. Moreover, non-Kuwaitis, who represent 66% of the population, have lower income, and their access to public health services is restricted compared with Kuwaitis who have free full access. Study Design: Observational prospective multicenter cohort study. Setting & Participants: Adult inpatients with AKI in 7 public hospitals from January 1 to December 31, 2021. Exposure: AKI identified using Kidney Disease: Improving Global Outcomes serum creatinine-based criteria. Outcomes: For hospitalized patients with AKI, the outcomes included 30-day outcomes of mortality, need for dialysis, kidney recovery rates, and differences in outcomes between Kuwaitis and non-Kuwaitis. Analytical Approach: A backward stepwise multiple logistic regression analysis was performed to assess possible independent risk factors for the outcomes. Results: We recruited 3,744 patients (mean age: 63 years; mean baseline estimated glomerular filtration rate [eGFR]: 66.7 mL/min; non-Kuwaitis: 42.3%), representing 3.2% of hospitalizations and 19.5% of intensive care unit (ICU) admissions. Non-Kuwaitis were significantly younger (57.6 vs 66.9 years), with higher baseline eGFR (73.1 vs. 62 mL/min), more frequent community acquired AKI (53.8% vs 46.7%), and AKI in summer (34.7% vs 26.9%). Dialysis was provided to 33.5% of patients, with a higher need for non-Kuwaitis (35.5% vs 32.1%). At 30 days, 34.4% of patients died, representing 24.8% of hospital mortality and 59.8% of ICU mortality. No differences in mortality or kidney recovery were noted between Kuwaitis and non-Kuwaitis. Low eGFR did not affect the mortality rate. Limitations: Observational nature and short follow-up period of 30 days only. Conclusions: AKI was associated with high dialysis need and mortality. Non-Kuwaitis accounted for less cases despite representing 66% of the population because they were younger with higher baseline eGFR and fewer comorbid conditions. Non-Kuwaitis had higher rates of community acquired AKI and AKI in summer and a higher need for dialysis but had similar mortality and complete kidney recovery rates. Plain-Language Summary: Incidences of acute kidney injury (AKI), its management, and its outcomes are unknown in Kuwait. In addition, Kuwait has a large population of ethnically diverse expatriates who have lower income and do not enjoy the same level of access to public hospital services. We recruited hospitalized adults who have a diagnosis of AKI in several public hospitals in Kuwait. We analyzed characteristics, management, and outcomes data for more than 3,700 patients and found that AKI affects 3.2% of hospitalized patients. AKI leads to high dialysis utilization rates and causes high mortality rates. Although more Kuwaitis were affected by AKI, the mortality rates for Kuwaitis and non-Kuwaitis were similar. Non-Kuwaitis were younger with better baseline kidney function and fewer chronic diseases than Kuwaitis.

The risk for cardiovascular disease (CVD) is higher for individuals with a first-degree relative who developed premature CVD (with a threshold at age 55 years for a male or 65 years for a female). However, little is known about the effect that each unit increase or decrease of maternal or paternal age of onset of CVD has on offspring age of onset of CVD. We hypothesized that there is an association between maternal and paternal age of onset of CVD and offspring age of onset of CVD.We used the Framingham Heart Study database and performed conditional imputation for CVD-censored parental age (i.e. parents that didn't experience onset of CVD) and Cox proportional regression analysis, with offspring's age of onset of CVD as the dependent variable and parental age of onset of CVD as the primary predictor. Modifiable risk factors in offspring, such as cigarette smoking, body mass index (BMI), diabetes mellitus, systolic blood pressure (SBP), high-density lipoprotein (HDL) level, and low-density lipoprotein (LDL) level, were controlled for. Separate analyses were performed for the association between maternal age of onset of CVD and offspring age of onset of CVD and the association between paternal age of onset of CVD and offspring age of onset of CVD.Parental age of onset of CVD was predictive of offspring age of onset of CVD for maternal age of onset of CVD (P < .0001; N = 1401) and for paternal age of onset of CVD (P = 0.0134; N = 1221). A negative estimate of the coefficient of interest signifies that late onset of cardiovascular events in parents is protective of onset of CVD in offspring. Cigarette smoking and HDL level were important associated confounders.Offspring age of onset of cardiovascular disease is significantly associated with both maternal and paternal age of onset CVD. The incorporation of the parameters, maternal or paternal age of onset of CVD, into risk estimate calculators may improve accuracy of identification of high-risk patients in clinical settings.

Abstract The challenge of corrosion posed as a result of acidic sittings is considered as a major industrial concern, wherein ionic liquids serve as crucial in addressing the corrosive impacts on metals. In this study, five selected cyclic ammonium based ionic liquids were synthesized; IL-1MPyrBr, IL-1MPipBr, IL-2PyBr, IL-3MPyBr and IL-4MPyBr and their chemical structures were characterized using a variety of spectroscopic techniques (FT-IR, IH-NMR, 13C-NMR, Elemental analysis and thermal gravimetric analysis (TGA). Their corrosion inhibition efficiency was studied on carbon steel in 1 M HCl via different concentrations at 298 K using chemical and electrochemical parameters (PDP and EIS). DFT quantum parameters were computed, and the noted results were in complete compatible with the experimental. The synthesized ILs recorded excellent inhibition on the carbon steel corrosion in acidic media with increasing efficiency by increasing the inhibitor concentrations from 20 to 100 ppm. Different cations in the synthesized ILs affect the anti-corrosion effect and IL-3MPyBr showed the highest inhibition (ηR); 96.12% using the lowest concentration. Kinetic and thermodynamic considerations were studied and illustrated.

IntroductionPeritoneal dialysis (PD)-related peritonitis is one of the leading causes of discontinuation of PD and is considered a critically important outcome for patients on PD. However, there is no universally accepted method of measuring this outcome in clinical trials.MethodsWe convened an online consensus workshop to establish a core outcome measure for PD-related peritonitis in clinical trials.ResultsA total of 53 participants, including 18 patients and caregivers, from 12 countries engaged in breakout discussions in this workshop. Transcripts were analyzed thematically. We identified the following 3 themes: (i) feasibility and applicability across diverse settings, which reflected the difficulty with implementing laboratory-based measures in resource-limited environments; (ii) ensuring validity, which included minimizing false positives and considering the specificity of symptoms; and (iii) being meaningful and tangible to patients, which meant that the measure should be easy to interpret, reflect the impact that symptoms have on patients, and promote transparency by standardizing the reporting of peritonitis among dialysis units.ConclusionA core outcome measure for PD-related peritonitis should include both symptom-based and laboratory-based criteria. Thus, the International Society for Peritoneal Dialysis (ISPD) definition of peritonitis is acceptable. However, there should be consideration of reporting suspected peritonitis in cases where laboratory confirmation is not possible. The measure should include all infections from the time of catheter insertion and capture both the rate of infection and the number of patients who remain peritonitis free. A core outcome measure with these features would increase the impact of clinical trials on the care and decision-making of patients receiving PD.

The electrocatalytic oxygen evolution reaction (OER) is an arduous step in water splitting due to its slow reaction rate and large overpotential. Herein, we synthesized glycerate-anion-intercalated nickel–iron glycerates (NiFeGs) using a one-step solvothermal reaction. We designed various NiFeGs by tuning the molar ratio between Ni and Fe to obtain Ni4Fe1G, Ni3Fe1G, Ni3Fe2G, and Ni1Fe1G, which we tested for their OER performance. We initially analyzed the catalytic performance of powder samples immobilized on glassy carbon electrodes using a binder. Ni3Fe2G outperformed the other NiFeG compositions, including NiFe layered double hydroxide (LDH). It exhibited an overpotential of 320 mV at a current density of 10 mA cm–2 in an electrolytic solution of pH 14. We then synthesized carbon paper (CP)-modified Ni3Fe2G as a self-supported electrode (Ni3Fe2G/CP), and it exhibited a high current density (100 mA cm−2) at a low overpotential of 300 mV. The redox peak analysis for the NiFeGs revealed that the initial step of the OER is the formation of γ-NiOOH, which was further confirmed by a post-Raman analysis. We extensively analyzed the catalyst’s stability and lifetime, the nature of the active sites, and the role of the Fe content to enhance the OER performance. This work may provide the motivation to study metal-alkoxide-based efficient OER electrocatalysts that can be used for alkaline water electrolyzer applications.

Abstract The features of this work on corrosion inhibition have been investigated based on the ecological awareness and according to the strict environmental legislations. This was done by studying how different imidazolium derivatives ionic liquids containing different alkyl chains R8, R10 and R12 affected the corrosion reaction of carbon steel specimen immersed in 1 M hydrochloric acid at various temperatures. Weight loss, potentiodynamic polarization and electrochemical impedance spectroscopy were utilized to examine the corrosion inhibition behavior on carbon steel. In addition, FT-IR spectroscopy was used to analyze the coated film that has been formed on the metal surface. The prepared ionic liquids showed effective inhibition efficiency, where the corrosion rate after the using of 100 ppm of R8-IL, R10-IL and R12-IL was decreased from 5.95 (µg cm−2 min−1) to 0.66, 0.56, and 0.44 (µg cm−2 min−1), respectively at 20 °C. In the polarization curves, the corrosion current, Icorr, decreases by ILs addition and suggest that ILs act as mixed type inhibitors. From EIS findings, the increase in Rct and decrease in Cdl values proves the adherence of inhibitor molecules on carbon steel surface. The temperature effect was also studied on the film formed, where increasing the temperature from 20 to 50 °C, the corrosion rate increased and the inhibitors efficacy decreased. The increasing in the length of the attached alkyl chain, the efficacies of the prepared inhibitors increases. Various thermodynamic parameters such as the reaction activation free energy (ΔG*), the entropy of activation (ΔS*), and the enthalpy of activation (ΔH*), as well as the adsorption isotherm were investigated in order to interpret the mechanism and obtain the most accurate perception.

ABSTRACTBackground Patients undergoing heart surgery with a midline sternotomy typically get intravenous opioids as their primary form of post-operative pain management. Due to its possible drawbacks, regional neuraxial anesthesia is still controversial. There have been reports on the impact of rectus sheath plane (RSP) block in conjunction with ultrasound-guided transverse thoracic muscle plane (TTP) block on postoperative pain following sternotomy.Aim Of The Study The efficiency of combining TTP and RSP blocks in lowering the targeted patients’ perioperative requirement for opioids, minimizing opioid adverse effects, and attaining a potential Fast-Tract Extubation.Patients And Methods 50 patients undergoing open cardiac surgery via median sternotomy were randomly assigned to one of two groups in this randomized, prospective, comparative trial. Group (B) got combined ultrasound-guided TTP and RSP blocks, while Group (S) received saline in the same planes before to the incision.Results There was no significant difference between the groups for the demographic information, postoperative opioid consumption, or VAS pain scores, however there was a very significant difference between the groups for intraoperative opioid intake and time to extubation.Conclusion Combining TTP and RSP blocks has improved fast-track extubation, decreased hemodynamic changes in response to surgical stress, and decreased intraoperative opioid usage. The blocks directed by routine pain score evaluation did not, however, have a significant impact on postoperative opioid use.

Abstract Deposition of asphaltene aggregates can easily depress the oil production, because it may clog the wellbores, annulus, pipelines, and surface facilities. Moreover, asphaltene molecules have a negative effect on the catalytic reactions in the refinery process. Therefore, in this work, three different ionic liquids (IL-H, IL-CH3, and IL-NO2) were synthesized, and characterized using FT-IR and NMR spectroscopy to evaluate their efficiency as asphaltene dispersants. The thermal gravimetric analysis of the prepared ILs showed that IL-H, IL-NO2, and IL-CH3 were thermally stable up to 280 °C. The ILs showed good dispersion activity of the petroleum asphaltenes, where the asphaltene onset precipitation (AOP) was changed from 7.5 to 10.5, 11, and 13.5 ml added n-heptane after the use of IL-H, IL-NO2, and IL-CH3, respectively. Moreover, the colloidal instability index of crude oil was changed from 0.92 (unstable asphaltene) to 0.69 (stable asphaltene). It is noted during the experiments that the presence of an alkyl chain attached to the ionic liquid moiety increases the efficiency of the dispersant. This may be owing to the formation of π–π* with asphaltene molecules due to the presence of electron donating group. Quantum chemical parameters were calculated for the prepared ILs, and the theoretical data confirmed the experimental results.

Prompt diagnosis and surgical management of melanoma strongly impact prognosis. Considering the limited resources, emergency closures, and staffing shortages during the COVID-19 pandemic in Canada, our institution implemented a dedicated care pathway to prioritize cancer surgeries. We aim to assess whether this strategy was effective at preventing surgical wait time delays and upstaging of melanoma. We retrospectively collected data of patients aged ≥18 years with biopsy-proven primary melanoma who underwent wide local excision (WLE) ± sentinel lymph node biopsy (SLNB) between 1 March 2018–29 February 2020 (pre-pandemic) and 1 March 2020–22 March 2022 (pandemic). Patients with distant metastasis, recurrence, in situ disease, and unknown primary were excluded. Wait time from consult to surgery, tumour (T) and nodal (N) stage, and overall stage were collected. Results: We included 419 patients [pre-pandemic (n = 204) and pandemic (n = 215)]. Median wait time (days) [interquartile range] to surgery was 36 [22–48] pre-pandemic and 35 [24–49] during the pandemic (p = 0.888). There were no differences found in T stage (p = 0.060), N stage (p = 0.214), or overall melanoma stage (p = 0.192). We highlight the importance of streamlining melanoma surgery during a pandemic. As the need arises to meet surgical backlogs including benign surgery, dedicated cancer surgery should maintain a priority to not negatively affect cancer outcomes.

Abstract Background Epidemiological studies on the prevalence and management of chronic low back pain (CLBP), osteoarthritis (OA), and diabetic peripheral neuropathy (DPN) are limited in Egypt. This review aimed to map and identify data gaps in the patient journey touchpoints for CLBP, OA, and DPN. Main body of the abstract An evidence-based mapping approach using MEDLINE, Embase, and Biosis databases were used to identify records between January 2010 and December 2019. Quantitative data synthesis was performed using simple mean or weighted mean, whereas qualitative information was synthesized using a narrative summary. For CLBP, of the 79 records retrieved, 11 were eligible for final analysis (7 CLBP and 4 OA records), and for DPN, of 42 records identified, 13 studies were eligible. For CLBP, data available for prevalence, awareness, and treatment were 34.3%, 39.5%, and 70.0%, respectively. The prevalence of OA was 43.0%. The majority (98.6%) of patients with OA adhered to the treatment, and in 96.2% of the patients’ symptoms were controlled. The prevalence of DPN was estimated to be 42.7%, synthesized evidence indicated that 14.1% of patients were aware of DPN and 22.7% underwent screening. Conclusion As the existing literature is limited, further evidence-based studies are required to accurately understand the complexity of patient journey touchpoints in Egypt. Although the studies on musculoskeletal chronic pain syndrome are limited, the high prevalence of chronic low back pain, osteoarthritis and peripheral neuropathy should urge the health care system to organize the research groups and health care facilities to focus on these disorders and to consider them in the global health care plans.

Climate change is the most critical global challenge countering today; therefore, the impacts of climate change require an urgent and collective response where building and construction industry is regarded as one of the highest contributors to many issues that the world is encountering today, especially in a country undergoing rapid urbanization and industrialization such as Egypt. The primary objective of this paper is to promote the use of regenerative design to develop buildings intended to restore and improve the surrounding natural environment by aiming to leave a positive impact instead of harm reduction and participation in Egypt's plan for encountering climate change through a theoretical study for regenerative design and the Living Building Challenge (LBC) as a supporting tool to simplify the regenerative approach for discussing Net-Positive Energy Buildings, where the buildings aim not simply to generate energy but to identify the purpose and the way to handle resources to provide more than the building requires. Then the paper summarized two office buildings that achieved the Living Building Challenge certification, which provides using different architectural and mechanical systems working in concert to perform better, and this could be a reference repeated in developing countries such as Egypt. The study found that regenerative buildings offer an exceptional opportunity to effectively solve current environmental problems and achieve Net-Positive impacts on buildings to “add value” and be designed and operated to generate more than is needed.

Consensus guidelines call for complete resection of retroperitoneal sarcoma with consideration of neoadjuvant radiation for curative-intent treatment. The 15-month delay from the initial presentation of an abstract to the final publication of the STRASS trial results assessing the impact of neoadjuvant radiation led to a dilemma of how patients should be managed in the interim. This study aims to (1) understand perspectives regarding neoadjuvant radiation for RPS during this period; and (2) assess the process of integrating data into practice. A survey was distributed to international organizations including all specialties treating RPS. Eighty clinicians responded, including surgical (60.5%), radiation (21.0%) and medical oncologists (18.5%). Low kappa correlation coefficients on a series of clinical scenarios querying individual recommendations before and after initial presentation as an abstract indicate considerable change. Over 62% of respondents identified a practice change; however, most also noted discomfort in adopting changes without a manuscript available. Of the 45 respondents indicating discomfort with practice changes without a full manuscript, 28 (62%) indicated that their practice changed in response to the abstract. There was substantial variability in recommendations for neoadjuvant radiation between the presentation of the abstract and the publication of trial results. The difference in the proportion of clinicians describing comfort with changing practice based on the presentation of the abstract versus those that had done so shows that indications for proper integration of data into practice are not clear. Endeavors to resolve this ambiguity and expedite availability of practice-changing data are warranted.

Biophilic design is a new approach that can enhance human psychological well-being. Most recent studies focus on applying biophilic design to hospitals or office buildings, not academic buildings. While usually ignored, students' level of satisfaction is one of the most important key indicators for a successful learning environment. This paper aims to identify the biophilic design attributes that can potentially contribute to enhancing the students' level of satisfaction. This will be done through an experimental research design using virtual reality in a design studio at The British University in Egypt. Each participant (N = 52) was exposed to the existing condition and then the virtual experience. Before and following each exposure, cognitive and performance assessments were administered, this assessment was analyzed with the use of SPSS. Results show a highly positive impact of Natural Lighting, Natural Ventilation Greenery, Large Windows, Indirect Connection to Nature, and Natural Finishing Material on the student’s level of satisfaction.