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BACKGROUND: The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patients directives, family feelings and representatives desires, and all decisions should be shared. CONCLUSIONS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.

BACKGROUND: Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS: A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS: The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.

Abstract Introduction and aim External validations of the Good Outcome Following Attempted Resuscitation (GO-FAR) score have been in populations where Do Not Attempt Resuscitation (DNAR) is practised. We aim to externally validate the GO-FAR score in a population without a DNAR order. Methods We studied patients ≥ 18 years old who had an In-hospital cardiac arrest (IHCA) with known outcomes at Al Ain Hospital from January 2017 to December 2019, excluding those who died in the emergency department. Studied variables included demography, location, response time, code duration, initial rhythm, primary diagnosis, admission vital signs, GO FAR score variables, discharge status, and functional outcomes as determined by the cerebral performance category score ranging from 1 (good cerebral performance) to 5 (brain death). Results 366 patients were studied; 66.7% were males. The median (IQR) age was 70 (55–81) years. Cardiac and respiratory causes were the primary diagnoses in 89 (24.6%) and 67 (18.5%), respectively. IHCA occurred in critical areas such as the intensive care unit, high dependency unit and coronary care unit in 206 (80.8%) patients. The majority, 308 (91.8%), had a non-shockable rhythm, and a return of spontaneous circulation was achieved in 159 (43.4%) of the patients. Thirty-one (8.5%) patients survived to hospital discharge, and 20 (5.5%) patients had cerebral performance category scores of 1 and 2. The area under the curve of the ROC for survival to discharge with good functional outcome was 0.74 (95% CI 0.59–0.88). The best cut-off point for predicting survival with a good neurological outcome was a GO-FAR score of

Abstract Background Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. Methods This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. Results A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. Conclusion This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.

Abstract Early detection of COVID-19 improves the chance of recovery and helps identify high-risk patients. Our study aimed to statistically predict the time to improvement with the admission data of COVID-19 patients. Methods: Our prospective cohort study occurred between January and September 2022 at Alexandria University Hospital’s outpatient clinic and isolation department. We enrolled 43 patients after assessing their eligibility and collecting their baseline data. Results: The mean age was 34.8 years (± 12.3). Most of them were females (65.1%). The mean of oxygen saturation was 95.2% (± 2.8). We used linear regression to predict how long it would take to improve [time to improvement (days) = 1.186*P (mmol/L) + 0.010*IL-10 (pg/mL)]. Its diagnostic performance was 0.723 (95% CI: 0.552–0.894), and it was accurate at predicting improvement within a week but not at longer delays; additionally, its positive and negative predictive values were 56.3% and 85.2%, respectively. Conclusion: We recommend monitoring phosphorus and interleukin-10 levels. The time-to-improvement delay negatively correlated with a reduction in baseline oxygen saturation upon admission. Additionally, for every 0.84 meq/L increase in phosphorus or 100 pg/mL increase in interleukin-10, there was a 1-day delay provided that the other was constant, with a coefficient of determination of 85.9%.

The generated nonlocal correlations of two superconducting-charge (SCC) qubits including uncertainty-induced nonlocality (UIN), Bell-Horodecki nonlocality, and negativity’s entanglement have been explored by intrinsic decoherence model. An initial separable two SCC-qubits state to study the generation of nonlocal correlations. By adjusting the intrinsic decoherence intensity and the two superconducting-qubits interaction parameters (of Josephson energies, the mutual two SCC-qubits coupling energy, and the difference between the Josephson SCC-qubit energies), we can control the produced maximum Bell-Horodecki nonlocality, UIN, and entanglement, which their dynamics align with the hierarchy principle. It is found that the generations of two-qubit states, having Bell-Horodecki nonlocality, UIN, and negativity entanglement, by the interactions of two SCC-qubits depend on their interaction parameters and intrinsic decoherence. For weak mutual two SCC-qubits coupling energy and the Josephson SCC-qubit energies with a slight difference between the Josephson SCC-qubit energies, the generated two SCC-qubit state has strong nonlocal correlation dynamics. The mutual coupling energy for two SCC-qubits can enhance the generation of weak nonlocal correlation dynamics when there is a significant difference between the Josephson SCC-qubit energies. Controlling Josephson energy, mutual coupling, and the energy difference of SCC-qubits can improve nonlocal correlations’ robustness against intrinsic decoherence.

The study aimed to evaluate the relationship between physical activity, psychological well-being, and Health-Related Quality of Life (HRQoL) among adults within the academic community of Universitas Pendidikan Indonesia. This research was designed to inform policymakers on the importance of implementing needs-based health services and improving overall health status.A total of 201 employees were selected as the sample population. To collect data, the researchers used the Global Physical Activity Questionnaire (GPAQ) and the Short Form Health Survey (SF-36). The results indicated that the data followed a normal distribution, with Kolmogorov-Smirnov test results for GPAQ = 0.82 and HRQoL = 0.83.The correlation test revealed a significant relationship between physical activity levels and HRQoL, with a significance value of Sig. = 0.000, which is less than 0.05, indicating statistical significance. The R-Square value of 0.694 suggests that a substantial portion of the variance in HRQoL can be explained by the level of physical activity.The study underscores the critical role of developing effective physical activity programs to influence and predict physical activity behaviors positively. The findings align with existing research that demonstrates the benefits of physical activity in enhancing HRQoL, improving mood, and reducing symptoms of depression. This highlights the importance of physical activity as a key factor in promoting psychological well-being and overall quality of life.

Abstract :The cessation of Internet services for only a few hours creates clear confusion, and members of society become living in a state of “social alienation.” This indicates the depth of the psychological and social integration of individuals with this virtual network, which has drawn the attention of many researchers and those interested in researching the phenomenon and revealing its social, political, and media dimensions. The use of social media is no longer limited to urban communities only, but has become widespread even in remote areas with a rural Bedouin character. Our approach to this phenomenon, in its various dimensions, comes as a serious attempt to examine the functional relationship between the status of the virtual world and its outcomes in reshaping the Algerian social reality, by presenting a general problem that states:How did social media contribute to reproducing the representations of members of the Algerian tribal community towards their social reality? Keywords : Social media, Social change, Nomadism, The tribe, Identity.

Abstract Wet Age-related Macular Degeneration (wet AMD) is a common ophthalmic disease that significantly impacts patients’ vision. Optical coherence tomography (OCT) examination has been widely utilized for diagnosing, treating, and monitoring wet AMD due to its cost-effectiveness, non-invasiveness, and repeatability, positioning it as the most valuable tool for diagnosis and tracking. OCT can provide clear visualization of retinal layers and precise segmentation of lesion areas, facilitating the identification and quantitative analysis of abnormalities. However, the lack of high-quality datasets for assessing wet AMD has impeded the advancement of related algorithms. To address this issue, we have curated a comprehensive wet AMD OCT Segmentation Dataset (AMD-SD), comprising 3049 B-scan images from 138 patients, each annotated with five segmentation labels: subretinal fluid, intraretinal fluid, ellipsoid zone continuity, subretinal hyperreflective material, and pigment epithelial detachment. This dataset presents a valuable opportunity to investigate the accuracy and reliability of various segmentation algorithms for wet AMD, offering essential data support for developing AI-assisted clinical applications targeting wet AMD.

Abstract : This article examines the use of religious education in Algerian schools to facilitate the social integration of youth. Religious education in schools plays a critical role as a prominent social institution. The political authorities view it as a means to shape religious values and ensure the state's involvement in cultural matters. They believe that religion, being culturally significant, must be cultivated and preserved. The study found that the Islamic sciences curriculum supports religious education in schools, which is essential for social integration. This support is considered in the context of various social, health, economic, and political values. Keywords: Islamic sciences, religious education, schools, secondary education, social integration

Abstract Background Magnetic resonance imaging (MRI) is a noninvasive diagnostic tool that is commonly used to visualize soft tissues and anatomical structures. Many patients who undergo MRI scans experience anxiety. This multicenter study was conducted to assess anxiety levels experienced by patients who underwent MRI scans in the Palestinian radiology departments and identify the risk factors associated with higher levels of anxiety experienced by the patients. Methods This multicenter cross-sectional study was conducted in the radiology departments of different hospitals in the West Bank of Palestine using a questionnaire. The questionnaire collected different demographic data of the patients. A 100-mm visual analog scale (VAS) was used to assess the level of anxiety experienced by the patients who received MRI scans. The data were analyzed using SPSS version 28. Results A total of 383 patients participated in this study. Of the patients, 255 (66.6%) reported experiencing low, moderate, or high anxiety levels during the MRI scan. The median anxiety was 20.0 with an interquartile range (IQR) of 0.0–50.0 as measured using the 100-mm VAS. Higher anxiety levels were reported by the patients who were female (p-value

This article presents the usage of Integrated Course Design (ICD) in the design and evaluation of applying agile methodologies within an undergraduate module of study to foster the development of computer science students employability skills. Undergraduate programs of computer science typically follow traditional educational methods which can lead to students unable to connect knowledge learned in class to actual situations and students are often assessed individually, whereas collaborative group projects are more akin to industry practice. The teaching experience reported gives students the opportunity to relate concepts learnt in class to a practical group-based project. Students must meet the requirements of a 'client' who will provide feedback and additional challenges for students while following the Agile framework SCRUM. Positive student feedback and module grades 7.70% higher than the department average over a four year period indicates the teaching structure and assessment presented is an effective method to foster the development of technical and soft skills of undergraduate computer science students.

Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.

ABSTRACTIntroduction Lower respiratory tract infection is one of the leading causes of morbidity and mortality all over the world, with a substantial impact on healthcare costs. In Egypt, local consensus on its burden, diagnosis, and vaccination is scarce. This expert opinion is the first to address the local recommendations for vaccinating adults against respiratory infection. It sheds light on the growing need to understand the barriers and underpublicized concept of adult vaccination in Egypt.Areas covered A collaborative multidisciplinary panel from Egypt developed an expert opinion-based suggestions/points, including epidemiology, microbiology, and highlights on vaccination in Egypt, as well as challenges and recommendations regarding adult vaccination.Expert opinion Adult vaccinations against respiratory infections are now recommended for high-risk people by all healthcare regulatory bodies. However, it was acknowledged that there may be hesitancy and concerns among patients; in addition, healthcare professionals’ awareness about vaccination guidelines and benefits needs improvement. There are several strategies that could be implemented to enhance vaccine adherence in Egypt. These approaches encompass conducting community education programs, addressing the concerns of patients, and enhancing awareness among healthcare professionals through education, policy changes, and periodical reminders in each healthcare setting.

ABSTRACTObjectives Coronary artery thrombus burden (TB) is one of the risk factors for major adverse cardiovascular events (MACE) in patients with acute ST segment elevation myocardial infarction (STEMI). It was discovered that there is a strong relationship between epicardial adipose tissue (EAT) thickness and the incidence of coronary atherosclerosis. The aim of our study is to evaluate the relationship between EAT thickness and coronary TB in patients with STEMI treated with primary percutaneous coronary interventions (PPCI).Methods The study included 80 patients presented with acute STEMI and treated by PPCI; their mean age was 54.35 ± 8.80 years, and 70 (87.5%) were males. Patients were divided into 2 groups according to the degree of TB: group I (25 patients) with low TB and group II (55 patients) with high TB. The EAT thickness was measured by 2D-echocardiography in all patients.Results We found that EAT thickness was significantly higher in group II compared to group I (p