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Introduction: Polycystic ovary syndrome (PCOS) is a complex endocrine condition affecting women of reproductive age. It is characterised by insulin resistance and is a risk for type 2 diabetes mellitus (T2DM). The aim of this study was to review the literature on the effect of pioglitazone and rosiglitazone in women with PCOS., Methods: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane Library and the Web of Science in April 2020 and updated in March 2023. Studies were deemed eligible if they were randomised controlled trials (RCTs) reporting the effect of pioglitazone and rosiglitazone in PCOS. The study follows the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently extracted data and assessed the risk of bias using the Cochrane risk of bias tool., Results: Out of 814 initially retrieved citations, 24 randomised clinical trials (RCTs) involving 976 participants were deemed eligible. Among women with PCOS, treatment with rosiglitazone compared to metformin resulted in a significant increase in the mean body weight (mean difference (MD) 1.95 kg; 95% CI 0.03-3.87, p = 0.05). Metformin treatment was associated with a reduction in mean body mass index (BMI) compared to pioglitazone (MD 0.85 kg/m 2 ; 95% CI 0.13-1.57, p = 0.02). Both pioglitazone compared to placebo (MD 2.56 kg/m 2 ; 95% CI 1.77-3.34, p < 0.00001) and rosiglitazone compared to metformin (MD 0.74 kg/m 2 ; 95% CI 0.07-1.41, p = 0.03) were associated with a significant increase in BMI. Treatment with pioglitazone compared to placebo showed a significant reduction in triglycerides (MD - 0.20 mmol/L; 95% CI - 0.38 to - 0.03, p = 0.02) and fasting insulin levels (MD - 11.47 mmol/L; 95% CI - 20.20, - 2.27, p = 0.01). Rosiglitazone compared to metformin was marginally significantly associated with a reduction in the luteinising hormone (LH) (MD - 0.62; 95% CI - 1.25-0.00, p = 0.05)., Conclusion: Both pioglitazone and rosiglitazone were associated with significant increases in body weight and BMI when compared with metformin or placebo. Pioglitazone significantly reduced triglycerides and fasting insulin when compared with placebo while rosiglitazone showed a modest reduction of LH when compared with metformin., Prospero Registration No: CRD42020178783., (© 2024. The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature.)

Abstract Background: While treating patients during a pandemic, nurses are at risk of mental health issues caused by the stress they face. This study aimed to examine the degree of anxiety and depression among Sudanese nurses throughout the coronavirus disease 2019 (COVID-19) pandemic and demographic features and their association with depression and anxiety. Methods: An online-based cross-sectional study was conducted on Sudanese nurses. Data were collected from eligible nurses using a three-part questionnaire: demographic questions, the generalized anxiety disorder-7 (GAD-7), and the major depression index (MDI). We used the Chi-square test and Spearman or point biserial correlation to assess the association between demographics, anxiety, and depression. Results: Two hundred and forty-six nurses from Sudan participated in this study. Around 69.5% of participants experienced mild to severe anxiety, while26.4% revealed mild to severe depression. We found a significant association between depression and anxiety (P < 0.001). However, we did not find a significant association between depression or anxiety categories and the baseline characteristics of participants. Conclusion: Our study demonstrates high rates of anxiety and depression among Sudanese nurses throughout the COVID-19 pandemic. As we found no association between anxiety and depression with personal characteristics, psychological support should be given to all nurses' categories as all of them nearly have the same risk for anxiety and depression.

The vitiligo is a cutaneous pigmentary disease. It is one of the most common skin conditions challenging most dermatologists all over the world. The purpose of the study is to shed a light on available data of this skin lesion regarding its epidemiology, pathogenesis, etiology and genetic causes. Additionally theories and hypotheses related to its occurrence and clinical characteristics of various distinguishable types are considered. The diagnosis and treatment of this skin disorder using different medications and management lines or procedures, particularly recently discovered ones, may positively input into treatment of these skin disorders. The article is based on comprehensive data obtained from such well-known scientific databases as Web of Science, Medline, EMBASE, Pubmed Central, PubMed, Scopus, and Cochrane Library.

Malnutrition and pain are common in patients with chronic kidney disease who undergo hemodialysis. Although both pain and malnutrition are associated with increased morbidity and mortality, few studies have explored the correlation between pain and nutritional status. This study aimed to investigate the factors associated with pain intensity in patients undergoing hemodialysis, focusing on the risk of malnutrition. This was a cross-sectional study conducted at a regional dialysis center in a large tertiary hospital. Convenience sampling was used to recruit adult patients who had undergone hemodialysis for more than three months. An interviewer-administered questionnaire was used to gather sociodemographic and clinical data related to dialysis status, comorbidities, and body mass index (BMI). Pain severity and pain interference with functioning domains of the Brief Pain Index (BPI) were used to assess pain, and the malnutrition inflammation score (MIS) was used to assess nutritional status. Descriptive and inferential statistics were used to report the findings. The data were analyzed using the 25th version of the Statistical Package for the Social Sciences (IBM-SPSS) software. Of the final sample of 230 patients, 63.0% were males and 37.0% were females, with an average age of 58.3 years. Almost one-third of the participants had a BMI within the normal range (33.9%), and nearly one-third had a BMI within the underweight range (33.9%). Slightly more than half had a normal nutritional status or mild malnutrition (54.8%), while just under half had moderate or severe malnutrition (45.2%). The prevalence of pain was 47.0%. At the multivariate level, the severity of pain was associated with malnutrition (p < 0.001). Pain interference with function was associated with marital status (p = 0.045), number of comorbidities (p = 0.012), and malnutrition (p < 0.001). The MIS was positively correlated with both the severity of pain and the interference score. Pain and malnutrition were found to be prevalent in patients undergoing hemodialysis. Pain severity was associated with malnutrition, and pain interference was associated with malnutrition, marital status, and the number of comorbidities. Hemodialysis treatment should follow a patient-tailored approach that addresses pain, nutritional status, and associated chronic conditions. In addition, pain assessment and management should be included in the curriculum of nephrology training programs., (© 2024. The Author(s).)

This in vitro study assessed the effect of different primers on the shear bond strength (SBS) and adhesive remnant index (ARI) of orthodontic brackets bonded to reinforced polyetheretherketone (PEEK) substrate. A total of 40 specimens were randomly distributed to two groups based on the primer used for orthodontic bonding: group 1 (control)-Transbond XT adhesive with Visio.link primer and group 2 (test)-orthodontic adhesive (Transbond XT) with traditional orthodontic primer. After bonding, specimens were thermocycled followed by SBS testing and ARI scoring of debonded specimens. Data were analyzed using the unpaired independent t -test and the Chi-square test. Group 1 specimens showed significantly higher SBS values (21.38 ± 1.48 MPa) compared to group 2 specimens (18.63 ± 1.29 MPa) ( p < 0.0001). Adhesive remnant index scores showed no significant variations in bond failure modes and distributions between groups. The SBS obtained by the tested primers exceeded the clinically recommended value. Consequently, there is a comparable clinical application for both tested primers in orthodontic bonding, especially the traditional orthodontic primer, where the availability of Visio.link in clinical practice is not ensured.

This case report describes the presentation, diagnosis, and surgical management of a rare vesical ectopic pregnancy in a 36-year-old woman with a history of multiple cesarean sections. The patient presented with symptoms of suprapubic pain, fever, and amenorrhea. An initial ultrasound indicated retained products of conception, leading to a preliminary diagnosis of septic miscarriage. However, subsequent rescanning revealed an empty uterus and a non-viable fetus within the bladder, connected to the uterine cavity. Cystoscopy confirmed the presence of fetal parts inside the bladder. Finally, a laparotomy was performed and the fetus was removed from the bladder with repair of the underlying uterovesical fistula. An uneventful postoperative period ensued. The literature review revealed only four previously reported cases with similar overall presentations. This case highlights the importance of considering vesical ectopic pregnancies in patients with a history of cesarean sections and unusual symptoms, as prompt surgical intervention is crucial for ensuring successful management of the condition., (© 2023 International Federation of Gynecology and Obstetrics.)

Context: Polycystic ovary syndrome (PCOS) is a complex endocrine disease that affects women of reproductive age and is characterised by biochemical and clinical androgen excess., Aim: To evaluate the efficacy of pharmacological interventions used to decrease androgen hormones in women with PCOS., Data Source: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science from inception up to March 2021., Data Synthesis: Two reviewers selected eligible studies and extracted data, and the review is reported according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)., Results: Of the 814 randomised clinical trials (RCTs) located in the search, 92 met the eligibility criteria. There were significant reductions in total testosterone level with metformin versus (vs) placebo (SMD: - 0.33; 95% CI  - 0.49 to  - 0.17, p < 0.0001, moderate grade evidence) and dexamethasone vs placebo (MD:-0.86 nmol/L; 95% CI  - 1.34 to  - 0.39, p = 0.0004, very low-grade evidence). Significant reductions in the free testosterone with sitagliptin vs placebo (SMD:  - 0.47; 95% CI  - 0.97 to 0.04, p = 0.07, very low-grade evidence), in dehydroepiandrosterone sulphate (DHEAS) with flutamide vs finasteride (MD:  - 0.37 µg/dL; 95% CI  - 0.05 to  - 0.58, p = 0.02, very low-grade evidence), a significant reduction in androstenedione (A4) with rosiglitazone vs placebo (SMD:  - 1.67; 95% CI  - 2.27 to  - 1.06; 59 participants, p < 0.00001, very low-grade evidence), and a significant increase in sex hormone-binding globulin (SHBG) with oral contraceptive pill (OCP) (35 µg Ethinyl Estradiol (EE)/2 mg cyproterone acetate (CPA)) vs placebo (MD: 103.30 nmol/L; 95% CI 55.54-151.05, p < 0.0001, very low-grade evidence) were observed., Conclusion: Metformin, OCP, dexamethasone, flutamide, and rosiglitazone use were associated with a significant reduction in biochemical hyperandrogenemia in women with PCOS, though their individual use may be limited due to their side effects., Prospero Registration No: CRD42020178783., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Obesity has become a global epidemic in the modern world, significantly impacting the global healthcare economy. Lifestyle interventions remain the primary approach to managing obesity, with medical therapy considered a secondary option, often used in conjunction with lifestyle modifications. In recent years, there has been a proliferation of newer therapeutic agents, revolutionizing the treatment landscape for obesity. Notably, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide, liraglutide, and the recently approved dual GLP-1/GIP RAs agonist tirzepatide, have emerged as effective medications for managing obesity, resulting in significant weight loss. These agents not only promote weight reduction but also improve metabolic parameters, including lipid profiles, glucose levels, and central adiposity. On the other hand, bariatric surgery has demonstrated superior efficacy in achieving weight reduction and addressing overall metabolic imbalances. However, with ongoing technological advancements, there is an ongoing debate regarding whether personalized medicine, targeting specific components, will shape the future of developing novel therapeutic agents for obesity management., 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. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Roomy, Hussain, Behbehani, Abu-Farha, Al-Harris, Ambi, Abdalla, Al-Mulla, Abu-Farha and Abubaker.)

Adipocyte P2 (aP2), also known as FABP4, is an adipokine that adipose tissue produces and expresses in macrophages. Its primary role is to facilitate the transportation of fatty acids across cell membranes. Numerous studies have reported associations between FABP4 and the development of metabolic disorders. However, there is limited knowledge regarding FABP4 expression in diabetes and obesity, especially about different age groups, genders, and ethnicities. This study aims to investigate the association between FABP4 levels, diabetes mellitus, and obesity within various ethnic groups. We measured plasma FABP4 concentrations in a cohort of 2083 patients from the KDEP study and gathered anthropometric data. Additionally, we collected and analyzed clinical, biochemical, and glycemic markers using multivariate regression analysis. The average FABP4 concentration was significantly higher in female participants than in males (18.8 ng/mL vs. 14.4 ng/mL, p < 0.001, respectively), and in those over 50 years old compared to those under 50 years of age (19.3 ng/mL vs. 16.2 ng/mL, p < 0.001, respectively). In this study, significant positive associations were found between the plasma level of FABP4 and obesity markers: BMI (r = 0.496, p < 0.001), hip circumference (r = 0.463, p < 0.001), and waist circumference (WC) (r = 0.436, p < 0.001). Similar observations were also seen with glycemic markers, which included HbA1c (r = 0.126, p < 0.001), fasting blood glucose (FBG) (r = 0.184, p < 0.001), fasting insulin (r = 0.326, p < 0.001), and HOMA-IR (r = 0.333, p < 0.001). Importantly, these associations remained significant even after adjusting for age, gender, and ethnicity. Furthermore, FABP4 levels were negatively associated with male gender (β: -3.85, 95% CI: -4.92, -2.77, p < 0.001), and positively associated with age (β: 0.14, 95% CI: 0.096, 0.183, p < 0.001), BMI (β: 0.74, 95% CI: 0.644, 0.836, p < 0.001), and fasting insulin (β: 0.115, 95% CI: 0.091, 0.138, p < 0.001). In this study, plasma FABP4 levels were significantly higher in diabetic and obese participants, and they were strongly influenced by age, gender, and ethnicity. These findings suggest that FABP4 may serve as a valuable prognostic and diagnostic marker for obesity and diabetes, particularly among female patients, individuals over 50 years old, and specific ethnic groups.

Objective: To assess the efficacy of primary urethral realignment in the prevention of urethral stenosis and in simplifying delayed urethroplasty after complete pelvic fracture urethral injury in male children., Methods: This randomized comparative trial included 40 boys <18 years with complete pelvic fracture urethral injury. The initial management was a primary urethral realignment in 20 boys and suprapubic cystostomy alone in the remaining 20 boys. The boys who underwent primary urethral realignment were assessed regarding the development of urethral stenosis. Boys who needed to be delayed urethroplasty in the two groups were compared regarding urethral defect length, intraoperative details, postoperative outcomes, number of procedures, and time to achieve normal voiding., Results: Although 14 (70%) patients were able to void after primary urethral realignment, all of them developed urethral stenosis and needed delayed urethroplasty. No statistically significant difference between the two groups was found regarding urethral defect length, intraoperative details, and postoperative outcomes. Patients in the primary urethral realignment group underwent significantly more procedures (p < 0.001) and took a significantly longer time to achieve normal voiding (p = 0.002)., Conclusion: Primary urethral realignment is neither able to prevent urethral stenosis nor effective in simplifying later urethroplasty after complete pelvic fracture urethral injury in male children. It exposes the patients to more surgical procedures and a prolonged clinical course., (© 2023 The Japanese Urological Association.)

Purpose: To investigate the influence of immediate dentin sealing (IDS) vs delayed dentin sealing (DDS) on the marginal gaps of machinable monolithic zirconia (MMZ) vs pressable lithium disilicate (PLD) laminate veneers., Materials and Methods: A total of 40 maxillary lateral incisors were used and received butt-joint laminate veneer preparation. The samples were divided into two groups (n = 20 each) according to ceramic material: PLD ceramic was used in the first group, and MMZ was used in the second. Each group was then divided into two subgroups according to the bonding protocol: IDS was employed in one, and DDS in the other (n = 10 each). The marginal gap widths were measured using digital microscopy and statistically analyzed., Results: The smallest marginal gaps were observed in MMZ-DDS (57.2 ± 8.4 μm), followed by PLD-DDS (62.4 ± 2.7 μm) and MMZ-IDS (63.5 ± 1.9 μm). The largest marginal gaps were observed in PLD-IDS (81.5 ± 6.3 μm). Two-way ANOVA revealed that the bonding technique (P < .001) and ceramic material (P < .001) both showed significant differences., Conclusions: MMZ produced beIer marginal accuracy than PLD. IDS seems to have a predisposition to significantly wider marginal gaps than DDS, but these gaps are within the clinically acceptable range. The marginal accuracy of ceramic veneers appears to be related to the bonding technique as well as the material of construction.

Nutrition plays a critical and crucial role in addressing neglected tropical diseases (NTDs) and their complications, as they often contribute to malnutrition, which can worsen the impact of these conditions. Therefore, it is necessary to investigate the nutritional status of mycetoma patients, which has not been explored previously. This descriptive cross-sectional hospital-based study was conducted at the Mycetoma Research Center (MRC), University of Khartoum, Sudan. The study included 179 confirmed mycetoma patients and an equal number of age- and sex-matched normal controls. The nutritional status of the mycetoma patients was assessed and compared with that of the control group. The majority of the patients were young adults with varying educational levels, predominantly from Central Sudan. The foot was the most commonly affected part; most patients had lesions more than 10 cm in diameter. The Body Mass Index (BMI) was calculated for both study groups, revealing that 43.5% of the patients and 53.6% of controls had a normal BMI. Furthermore, 36% of patients were underweight, contrasting with only 11% in the control group. Correlation analyses indicated no significant associations between BMI and age groups, educational levels, daily meals, food quantity, and appetite in the study population (p > 0.05). Similarly, no significant differences were observed in BMI concerning disease duration and affected sites (p = 0.0577). The Kruskal-Wallis test did not reveal significant differences in BMI means among the groups. The study revealed that most participants consumed three meals daily, and the control group showed a more robust appetite and consumed more food than the patient group (p = 0.005). Nevertheless, there were no significant differences in the consumption of different food types between the patient and control groups and among different BMI categories (p = 0.025 and 0.040, respectively)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Gabani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Cadmium (Cd), being a highly toxic heavy metal, significantly impacts plant growth and development by altering nutrient uptake and causing oxidative and structural damage, resulting in reduced yield. To combat Cd toxicity and accumulation in wheat, it was hypothesized that co-application of Selenium (Se) and Silicon (Si) can reduce the adverse effect of Cd and regulate Cd resistance while improving Se fortification in wheat. Therefore, this study evaluated the comparative effect of Se and Si on the growth and antioxidant defense systems of wheat plants grown in a hydroponic setup. Briefly, the plants were acclimatized to the hydroponic solution for 1 week and then exposed to 10 µmol Cd. Afterwards, the treatments, including 0.2 mmol Si and 1.5 µmol Se, were applied as a root and foliar application, respectively. Plants supplemented with both Se and Si showed improved biomass and other physiological growth attributes, and this response was associated with improved activity/contents of antioxidants, including glutathione (GSH) content, glutathione reductase (GR), ascorbate peroxidase (APX), and catalase (CAT), with related lowering of hydrogen peroxide, malondialdehyde content, and structural damages. Moreover, by Se + Si supplementation, a decrease in total S levels in plant tissues was observed, whereas an increase in total protein concentration and GSH indicated a different and novel mechanism of Cd tolerance and S homeostasis in the plant. It was observed that Si was more involved in significantly reducing Cd translocation by stabilizing Cd in the root and reducing its content in the soluble fraction in both the root and shoot. Whereas Se was found to play the main role in reducing the oxidative damage caused by Cd, and the effect was more profound in the shoot. In addition, this study also observed a positive correlation between Si and Se for relative uptake, which had not been reported earlier. Our findings show that the Se and Si doses together benefit growth regulation and nutrient uptake; additionally, their combinations support the Cd resistance mechanism in wheat through upregulation of the antioxidant system and control of Cd translocation and subcellular distribution, ultimately contributing to the nutritional quality of wheat produced. Thus, it is concluded that the co-application of Se and Si has improved the nutritional quality while reducing the Cd risk in wheat and therefore needs to be employed as a potential strategy to ensure food safety in a Cd-contaminated environment.

We present a case of extradural hematoma resulting from a relatively minor closed injury over the vertex where a plasma cell tumour had invaded the superior sagittal sinus. The patient underwent an emergency craniotomy and evacuation of the hematoma. Hemostasis and prevention of recollection of the hematoma were hampered by the erosion of the sagittal sinus making its direct repair impossible. This was achieved by hitching up the dura lateral to the sinus to become its lateral wall reinforced by hemostatic agents. The patient made a full recovery. Malignant tumours invading the dural venous sinuses and eroding the skull can cause life-threatening intracranial bleeding after relatively minor trauma.

Aside from its importance in human and animal health, low levels of foliar-applied selenate (SeO 4 ) can be advantageous in the presence of sulfur (S), contributing to improved growth, nutrient uptake, and crop quality. A hydroponic experiment in a growth chamber explored the interactive influence of Se and S on micronutrients and several quality indices, such as soluble sugars, organic acids, and total protein concentrations in spinach ( Spinacia oleracea L.). Three levels of S (deprivation, adequate, and excessive) with varying quantities of Se (deficient, moderate, and higher) were examined in combination. Under S starvation and along with S nourishment in plant parts, Se treatments were found to cause noticeable variations in plant biomass and the concentrations of the examined elements and other quality parameters. Both Se levels promoted S accumulation in S-treated plants. Although the Se treatment had the opposite effect in shoots, it had a favorable impact on minerals (apart from Mn) in roots grown under S-limiting conditions. The S and Se relationship highlighted beneficial and/or synergistic effects for Mn and Fe in edible spinach portions. Reducing sugars were synergistically boosted by adequate S and moderate Se levels in roots, while in shoots, they were accumulated under moderate-or-higher Se and excessive S. Furthermore, the concentration of the quantified organic acids under S-deficient conditions was aided by various Se levels. In roots, moderate Se under high S application enhanced both malic acid and citric acid, while in the edible parts, higher Se under both adequate and elevated S levels were found to be advantageous in malic acid accumulation. Moreover, by elevating S levels in plant tissues, total protein concentration increased, whereas both moderate and high Se levels (Se1 and Se2) did not alter total protein accumulation in high S-applied roots and shoots. Our findings show that the high S and medium Se dose together benefit nutrient uptake; additionally, their combinations support soluble sugars and organic acids accumulation, contributing ultimately to the nutritional quality of spinach plants. Moreover, consuming 100 g of fresh red spinach shoot enriched with different Se and S levels can contribute to humans' daily micronutrients intake.

Tuberculosis (TB) is currently rated as the 13th leading cause of mortality and the second leading cause of death after COVID-19, and above AIDS. Existing challenges relating to the development of multidrug-resistant strains and dangerous side effects of currently used drugs add impetus to the search for additional TB treatments. Hence, interest has grown in the use of medicinal plants as a source of bioactive preparations with efficacy against TB-causing organisms, and also with the ability to ameliorate the negative effects of TB drugs. This study aimed to evaluate the antimycobacterial and hepatoprotective potentials of extracts and isolated flavonoid compounds from invasive Chromolaena odorata. Test organisms used were pathogenic Mycobacterium bovis and M. tuberculosis H37RV, and the fast-growing M. aurum, M. fortuitum and M. smegmatis . The selectivity index (SI) values of the test substances were determined through cytotoxicity assays to promote these extracts and compounds as leads for the development of effective and safe anti-tubercular drugs. The antimycobacterial activity was evaluated using a serial microdilution method, and the SI was calculated from the 50% lethal concentrations calculated from cytotoxicity tests. Hepatoprotective activity was determined using HepG2 liver cells treated with rifampicin as a toxin. The extracts and compounds had a range of antimycobacterial activity with minimum inhibitory concentration (MIC) values ranging from 0.031 to 2.5 mg/mL. Two flavonoid compounds, 5,7,4'-trimethoxy flavanone and 5‑hydroxy-3,7,4'-trimethoxyflavone showed promising antimycobacterial potential, and minimal toxicity was observed, as most SI values were higher than 1. The flavonoid compound 5,7,4'-trimethoxy flavanone had the highest SI (6.452), which was against M. tuberculosis H37RV. The HepG2 cells were reduced to 65% due to toxicity by rifampicin, however, the flavonoid compounds were able to improve cell viability to between 81 and 89% at different concentrations tested. Results obtained indicate that C. odorata may serve as a lead for the development of safe and effective antimycobacterial and hepatoprotective drugs., 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., (© 2023 SAAB. Published by Elsevier B.V. All rights reserved.)

Background: While treating patients during a pandemic, nurses are at risk of mental health issues caused by the stress they face. This study aimed to examine the degree of anxiety and depression among Sudanese nurses throughout the coronavirus disease 2019 (COVID-19) pandemic and demographic features and their association with depression and anxiety. Methods: An online-based cross-sectional study was conducted on Sudanese nurses. Data were collected from eligible nurses using a three-part questionnaire: demographic questions, the generalized anxiety disorder-7 (GAD-7), and the major depression index (MDI). We used the Chi-square test and Spearman or point biserial correlation to assess the association between demographics, anxiety, and depression. Results: Two hundred and forty-six nurses from Sudan participated in this study. Around 69.5% of participants experienced mild to severe anxiety, while 26.4% revealed mild to severe depression. We found a significant association between depression and anxiety (P < 0.001). However, we did not find a significant association between depression or anxiety categories and the baseline characteristics of participants. Conclusion: Our study demonstrates high rates of anxiety and depression among Sudanese nurses throughout the COVID-19 pandemic. As we found no association between anxiety and depression with personal characteristics, psychological support should be given to all nurses' categories as all of them nearly have the same risk for anxiety and depression. [ABSTRACT FROM AUTHOR]

Context: Polycystic ovary syndrome (PCOS) is a heterogeneous condition affecting women of reproductive age and is associated with increased body weight., Objective: To review the literature on the effect of different pharmacological interventions on the anthropometric indices in women with PCOS., Data Sources: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library, and the Web of Science in April 2020 with an update in PubMed in March 2021., Study Selection: The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)2020., Data Extraction: Reviewers extracted data and assessed the risk of bias using the Cochrane risk of bias tool., Results: 80 RCTs were included in the meta-analysis. Metformin vs placebo showed significant reduction in the mean body weight (MD: -3.13 kg; 95% confidence interval [CI]: -5.33 to -0.93, I² = 5%) and the mean body mass index (BMI) (MD: -0.75 kg/m 2 ; 95% CI: -1.15 to -0.36, I² = 0%). There was a significant reduction in the mean BMI with orlistat versus placebo (MD: -1.33 kg/m²; 95% CI: -2.16 to -0.66, I² = 0.0%), acarbose versus metformin (MD: -1.26 kg/m²; 95% CI: -2.13 to -0.38, I² = 0%), and metformin versus pioglitazone (MD: -0.91 kg/m²; 95% CI: -1.62 to -0.19, I² = 0%). A significant increase in the mean BMI was also observed in pioglitazone versus placebo (MD: + 2.59 kg/m²; 95% CI: 1.78-3.38, I² = 0%) and in rosiglitazone versus metformin (MD: + 0.80 kg/m²; 95% CI: 0.32-1.27, I² = 3%). There was a significant reduction in the mean waist circumference (WC) with metformin versus placebo (MD: -1.21 cm; 95% CI: -3.71 to 1.29, I² = 0%) while a significant increase in the mean WC with pioglitazone versus placebo (MD: + 5.45 cm; 95% CI: 2.18-8.71, I² = 0%)., Conclusion: Pharmacological interventions including metformin, sitagliptin, pioglitazone, rosiglitazone orlistat, and acarbose have significant effects on the anthropometric indices in women with PCOS., (© 2021 John Wiley & Sons Ltd.)

End-stage renal disease (ESRD) is a common chronic disease worldwide that requires hemodialysis. Patients may face chronic pain and poor quality of life. Therefore, a better understanding of these variables in hemodialysis patients is essential to provide a good intervention. We aim to determine how common chronic pain is in hemodialysis patients and its correlation with sociodemographics, C-reactive protein (CRP), calcium, phosphorus, albumin, and parathyroid hormone. A cross-sectional study of hemodialysis patients was conducted in Palestine. Data collection took place between November 2020 and May 2021. We used the brief pain inventory score to assess chronic pain, and lab tests detected CRP levels. Data were collected using a convenience sampling technique. There were two hundred sixty-one patients in the present study. The mean age of the patients was 51 years, with 63.6% being men. 47.1% of them reported having chronic pain. Gender (p = 0.011), social status (p = 0.003), educational status (p = 0.010), and number of chronic diseases (p = 0.004) indicated a significant relationship with the severity score of pain. Furthermore, sex (p = 0.011), social status (p = 0.003), and number of chronic diseases (p = 0.002) were significantly associated with the pain interference score. Additionally, Person's test indicated significant correlations between CRP and pain severity (p < 0.001) and with pain interference (p < 0.001). Albumin was significantly and negatively correlated with pain severity (p = 0.001) and pain interference (p < 0.001). Multiple linear regression analysis revealed that patients who had a higher CRP level and many chronic diseases were more likely to have a higher pain severity score. However, pain severity was the only predictor for pain interference. Our results suggest that there is a significant correlation between the existence of chronic pain in hemodialysis patients and increased CRP levels. However, further investigations are needed with a larger number of patients in more than one dialysis unit to confirm this correlation and management of chronic pain in patients with HD., (© 2023. The Author(s).)

Context: Polycystic ovary syndrome (PCOS) is a heterogeneous condition affecting women of reproductive age. It is associated with dyslipidaemia and elevated plasma C-reactive protein (CRP), which increase the risks of cardiovascular disease (CVD)., Objective: To review the existing evidence on the effects of different pharmacological interventions on lipid profiles and CRP of women with PCOS., Data Sources: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane Library, and Web of Science in April 2020 and updated the results in March 2021., Study Selection: The study included randomized controlled trials (RCTs) and follows the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)., Data Extraction: Two independent researchers extracted data and assessed for risk of bias using the Cochrane risk of bias tool. Covidence systematic review software were used for blinded screening and study selection., Data Synthesis: In 29 RCTs, there were significant reductions in triglycerides with atorvastatin versus placebo [mean difference (MD): -0.21 mmol/L; 95% confidence interval (CI): -0.39, -0.03, I 2  = 0%, moderate grade evidence]. Significant reductions were seen for low-density lipoprotein cholesterol (LDL-C) with metformin versus placebo [standardized mean difference (SMD): -0.41; 95% CI: -0.85, 0.02, I 2  = 59%, low grade evidence]. Significant reductions were also seen for total cholesterol with saxagliptin versus metformin (MD: -0.15 mmol/L; 95% CI: -0.23, -0.08, I 2  = 0%, very low grade evidence). Significant reductions in C-reactive protein (CRP) were seen for atorvastatin versus placebo (MD: -1.51 mmol/L; 95% CI: -3.26 to 0.24, I 2  = 75%, very low-grade evidence)., Conclusion: There were significant reductions in the lipid parameters when metformin, atorvastatin, saxagliptin, rosiglitazone and pioglitazone were compared with placebo or other agents. There was also a significant reduction of CRP with atorvastatin., (© 2021 John Wiley & Sons Ltd.)

Objective: Polycystic ovary syndrome (PCOS) is a complex endocrine condition affecting women of reproductive age. It is characterized by insulin resistance and is a major risk factor for type 2 diabetes mellitus (T2DM). The objective was to review the literature on the effect of different pharmacological interventions on insulin resistance in women with PCOS., Design: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science in April 2020 and updated in March 2021. The study follows the 2020 Preferred Reporting Items for Systematic reviews and Meta-ana. Reviwers extracted data and assessed the risk of bias using the Cochrane risk of bias tool., Results: In 58 randomized controlled trials there were significant reductions in the fasting blood glucose (FBG) with metformin versus placebo (standardized mean difference [SMD]: -0.23; 95% confidence interval [CI]: -0.40, -0.06; I² = 0%, low-grade evidence), and acarbose versus metformin (mean difference [MD]: -10.50 mg/dl; 95% CI: -15.76, -5.24; I² = 0%, low-grade evidence). Significant reductions in fasting insulin (FI) with pioglitazone versus placebo (SMD: -0.55; 95% CI: -1.03, -0.07; I² = 37%; p = .02, very-low-grade evidence). A significant reduction in homoeostatic model assessment of insulin resistance (HOMA-IR) was seen with exenatide versus metformin (MD: -0.34; 95% CI: -0.65, -0.03; I² = 0%, low-grade evidence). No effect on homoeostatic model assessment of beta cells (HOMA-B) was observed., Conclusions: Pharmacological interventions, including metformin, acarbose, pioglitazone and exenatide have significant effects on FBG, FI, HOMA-IR but not on HOMA-B., (© 2021 John Wiley & Sons Ltd.)

Sulfur (S) deprivation leads to abiotic stress in plants. This can have a significant impact on membrane lipids, illustrated by a change in either the lipid class and/or the fatty acid distribution. Three different levels of S (deprivation, adequate, and excess) in the form of potassium sulfate were used to identify individual thylakoid membrane lipids, which might act as markers in S nutrition (especially under stress conditions). The thylakoid membrane consists of the three glycolipid classes: monogalactosyl- (MGDG), digalactosyl- (DGDG), and sulfoquinovosyl diacylglycerols (SQDG). All of them have two fatty acids linked, differing in chain length and degree of saturation. LC-ESI-MS/MS served as a powerful method to identify trends in the change in individual lipids and to understand strategies of the plant responding to stress. Being a good model plant, but also one of the most important fresh-cut vegetables in the world, lettuce ( Lactuca sativa L.) has already been shown to respond significantly to different states of sulfur supply. The results showed a transformation of the glycolipids in lettuce plants and trends towards a higher degree of saturation of the lipids and an increased level of oxidized SQDG under S-limiting conditions. Changes in individual MGDG, DGDG, and oxidized SQDG were associated to S-related stress for the first time. Promisingly, oxidized SQDG might even serve as markers for further abiotic stress factors.

Background: The current hepatocellular carcinoma (HCC) diagnostic approaches lack adequate sensitivity and specificity. So, this study was performed to develop an innovative model of surface-enhanced Raman spectroscopy (SERS) that can detect HCC patients by identifying the circulating tumor-derived exosomes., Methodology: Sixty participants, including normal controls, hepatitis C virus (HCV)-infected patients, and HCV-associated HCC patients, had their whole blood samples and exosomes separated from these samples analyzed using Raman spectroscopy (RS). A revolutionary model of SERS, based on an innovative glass and nano-gold, was designed to directly identify exosomes. Its measurements were simulated by Comsol Multiphysics (5.6)., Results: The RS examination of the whole blood samples revealed no Raman peaks. Yet, the isolated exosomes from these samples generated Raman peaks at 400 and 1000 cm -1 wavenumbers in the HCV group. A Raman shift was detected in HCC patients at 812, 852, and 878 cm -1 wavenumbers with intensity ratios of 120, 130, and 60, respectively. The RS had a sensitivity and specificity of 95 % and 100 %, respectively, for detecting HCC. However, the newly-designed SERS was able to identify the HCC-derived exosomes, at 812 and 878 cm -1 wavenumbers, with boosted intensity ratios of 9*10 6 and 4*10 6 , respectively, in the whole blood samples., Conclusion: The newly-developed SERS model has the potential to detect HCC patients through recognizing the tumor-derived exosomes non-invasively, with high accuracy, and without the need for laborious exosomal separation. Nonetheless, bringing this technology into the clinic demands the establishment of spectral databases and their validation using the current gold standards., 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 © 2023 Elsevier B.V. All rights reserved.)

Background: Type 4 osteoporotic fracture (OF4), according to the classification system of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU), is unstable and requires fixation as per the guidelines of the same group. We evaluated the use of stand-alone vertebral body augmentation (VBA) in pain control of OF4., Methods: This is a single-centre, in two hospitals, comparative study to evaluate the effectiveness of percutaneous vertebroplasty (PVP) and kyphoplasty (KP) in pain control of OF4. OF4 patients treated with VBA were compared to a conservatively treated control group. The two groups of OF4 were then compared to similar cohort of OF2 and OF3 patients who were treated by either VBA or expectantly., Results: A total of 78 cases were studied. VBA of OF4 showed a statistically significant better pain control than conservative treatment. The response of this group of fractures to VBA was similar to that of OF2 and 3., Conclusion: VBA can provide satisfactory pain control for OF4 patients., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Mohamed Abdelrahman Abdalla et al.)

Background: Polycystic ovarian syndrome, a common endocrine disorder, is an important cause of infertility among women of reproductive age. Within the Gulf Cooperation Council countries, polycystic ovarian syndrome is found to affect women increasingly. No study has been carried out to critically summarize the evidence on the prevalence of polycystic ovarian syndrome among women suffering from infertility in these countries., Objective: This protocol aims to conduct a systematic review and meta-analysis of the studies reporting the prevalence of polycystic ovarian syndrome among women seeking infertility treatment in the six Gulf Cooperation Council countries (Bahrain, Kuwait, Oman, Saudi Arabia, Qatar, and United Arab Emirates)., Design/methods and Analysis: The systematic review and meta-analysis will follow the following method., Data Source: Five databases, including PubMed, Embase, CINAHL, Web of Science, and SCOPUS, will be searched for observational studies using a combination of relevant keywords and Medical Subject Headings from inception of databases., Data Extraction: Two reviewers will screen titles and abstracts, followed by a full-text search based on the eligibility criteria. The main outcome is to measure the proportion of women who have polycystic ovarian syndrome among infertility-diagnosed patients. In addition, the risk of bias in the included studies will be assessed using the national institute of health quality assessment tool for observational studies., Data Synthesis: The random-effects method of the analysis with the inverse variance will be used to calculate the pooled prevalence of polycystic ovarian syndrome-attributed infertility. Variation in prevalence estimates will be calculated using subgroup analysis based on study and patients' characteristics and publication bias will be assessed via funnel plot inspection and Eggar's test., Discussion: A critical assessment of evidence on the prevalence of polycystic ovarian syndrome in women attending fertility clinics is helpful in risk quantification, enabling better planning for managing infertility in women with polycystic ovarian syndrome., Registration: This protocol has been registered with PROSPERO, protocol registration number (CRD42022355087).

This study aimed to determine in vitro anthelmintic activity of plant extracts of eleven plant species used traditionally in South Africa to treat various disorders including symptoms related to nematode infections, and to isolate bioactive compounds from the most active plant extract. Crude plant extracts were tested on different life-cycle stages of Haemonchus contortus. The cytotoxicity of the most active extracts, fractions and compounds was evaluated on Vero cells and the most potent extract, fractions and compounds were tested for their ability to kill the parasitic H. contortus and the free-living nematode Caenorhabditis elegans. Typha capensis acetone extract had the strongest egg hatching inhibitory effect with an EC 50 of 184.94 μg/mL, and this extract also halted larval development of H. contortus with an EC 50 of 83.30 μg/mL compared to the positive control (albendazole) with an EC 50 of 2.66 μg/mL. Typha capensis crude extract and its butanol fraction had promising anthelmintic activity against both parasitic H. contortus and free-living C. elegans. Two compounds isolated from T. capensis, namely, isorhamnetin-3-O-β-D-glucoside and isorhamnetin 3-O-rutinoside, had antioxidant activity with IC 50 values of 3.16 μg/mL and 0.96 μg/mL respectively, and good anthelmintic activity against H. contortus with IC 50 values of 55.61 μg/mL and 145.17 μg/mL respectively. Identification of bioactive compounds from the T. capensis crude extract supports development of this extract as a complementary or alternative treatment against haemonchosis. However, further research is necessary to confirm the anthelmintic efficacy of the plant, including in vivo studies., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This review addresses the rationale of recurrent and/or residual caries associated with resin composite restorations alongside current strategies and evidence-based recommendations to arrest residual caries and restrain recurrent caries. The PubMed and MEDLINE databases were searched for composite-associated recurrent/residual caries focusing on predisposing factors related to materials and operator's skills; patient-related factors were out of scope. Recurrent caries and fractures are the main reasons for the failure of resin composites. Recurrent and residual caries are evaluated differently with no exact distinguishment, especially for wall lesions. Recurrent caries correlates to patient factors, the operator's skills of cavity preparation, and material selection and insertion. Material-related factors are significant. Strong evidence validates the minimally invasive management of deep caries, with concerns regarding residual infected dentin. Promising technologies promote resin composites with antibacterial and remineralizing potentials. Insertion techniques influence adaptation, marginal seal, and proximal contact tightness. A reliable diagnostic method for recurrent or residual caries is urgently required. Ongoing endeavors cannot eliminate recurrent caries or precisely validate residual caries. The operator's responsibility to precisely diagnose original caries and remaining tooth structure, consider oral environmental conditions, accurately prepare cavities, and select and apply restorative materials are integral aspects. Recurrent caries around composites requires a triad of attention where the operator's skills are cornerstones., Competing Interests: The authors declare no conflicts of interest.

Background: Secondary bacterial and fungal coinfections have been reported among critically ill coronavirus disease-19 (COVID-19) patients and are associated with increased disease severity and mortality incidence (MI) rates., Aims: This study aimed to track bacterial and fungal coinfections among COVID-19 patients in the intensive care unit (ICU) and to assess the impact of these infections on disease prognosis and patient outcomes in Jordan., Materials and Methods: This was a single-center study that enrolled 46 ICU patients diagnosed with COVID-19. Microbiological and antimicrobial susceptibility results and inflammatory biomarker data were retrospectively analyzed., Results: The MI rate attributed to bacterial and fungal coinfections was 84.8%, and the highest rate was reported among patients older than 70 years (66.7%). The MI rate related to bacterial coinfections was 95.2%, whereas that of fungal coinfections was 4.8%. The most commonly isolated bacterium in the blood was a coagulase-negative staphylococcus (41%), followed by Klebsiella pneumoniae in nasopharyngeal swabs (34%) and Acinetobacter baumannii in sputum samples (31%). Candida species were the sole cause of fungal coinfections in the studied population. In particular, Candida albicans was isolated from 3% of patients with bacteremia, whereas Candida glabrata was isolated from 8% of nasopharyngeal swabs. Klebsiella pneumoniae was considered the major cause of upper respiratory tract infections (34%). Multifactorial infection was significantly associated with increased MI ( p value <0.001)., Conclusion: COVID-19 MI is associated with respiratory bacterial/fungal coinfections. The ability to predict bacterial and fungal coinfections in ICU patients may be crucial to their survival and prognosis., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Ayman Daifallah Alsheikh et al.)

Selenium (Se) is an essential trace nutrient for humans and animals owing to its role in redox regulation, thyroid hormone control factors, immunity, inflammatory reactions, brain activities, and carbohydrate regulation. It is also important to support muscle development, as well as for reproductive and cardiovascular well-being. Furthermore, sulfur is known to be a healing element, due to the remarkable function of specialized and secondary S-containing compounds. The scope of the current study was to determine the impact of Se and S enrichment on the secondary metabolite accumulation and antibacterial and NO inhibition activities in green and red leaf lettuce (V1 and V2, respectively). The plants were grown in a hydroponic system supplied with different S concentrations (S0: 0, S1: 1 mM and S2: 1.5 mM K 2 SO 4 ) via the nutrient solution and foliar-applied varying levels of Se (0, 0.2 and 2.6 µM). Electrospray ionization-quadrupole time-of-flight mass spectrometry (ESI-QTOF/MS) combined with ultra-performance liquid chromatography (UPLC) was used to identify the secondary metabolites in green and red lettuce. The results indicated that extracts of the biofortified lettuce were not cytotoxic to Vero kidney cells at the highest concentration tested of 1 mg/mL. The ESI/MS of the tentatively identified metabolites showed that the response values of 5- O -caffeoylquinic acid, cyanidin 3- O -galactoside, quercetin 3- O -(6''-acetyl-glucoside) and quercetin 3- O -malonylglucoside were induced synergistically under higher Se and S levels in red lettuce plants. The acetone extract of red lettuce had antibacterial activity against Pseudomonas aeruginosa , with a minimum inhibitory concentration (MIC) of 0.156 and 0.625 μg/mL under S2/Se1 and S2/Se2 treatments, respectively. As with antibacterial activity, the acetone extract of green (V1) lettuce treated with adequate (S1) and higher S (S2) under Se-limiting conditions showed the ability to inhibit nitric oxide (NO) release from macrophages. NO production by macrophages was inhibited by 50% at respective concentrations of 106.1 ± 2.4 and 101.0 ± 0.6 μg/mL with no toxic effect on the cells, in response to S1 and S2, respectively, under Se-deficient conditions (Se0). Furthermore, the red cultivar (V2) exhibited the same effect as the green cultivar (V1) regarding NO inhibition, with IC 50 = 113.0 ± 4.2 μg/mL, in response to S1/Se2 treatments. Collectively, the promising NO inhibitory effect and antibacterial activity of red lettuce under the above-mentioned conditions might be attributed to the production of flavonoid glycosides and phenylpropanoic acid esters under the same condition. To the best of our knowledge, this is the first report to show the novel approach of the NO inhibitory effect of Se and S enrichment in food crops, as an indicator for the potential of Se and S as natural anti-inflammatory agents.

Context: Polycystic ovary syndrome (PCOS) is one of the commonest endocrine disorders affecting women of reproductive age, and metformin is a widely used medication in managing this condition., Aim: To review the available literature comprehensively on the therapeutic impact of metformin on the clinical and metabolic parameters of women with PCOS., Data Source: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane Library and the Web of Science and selected sources for grey literature from their inception to April 2020. An updated search in PubMed was performed in June 2022., Data Synthesis: Two reviewers selected eligible studies and extracted data, and the review is reported following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)., Results: In 24 eligible randomised controlled trials (RCTs) involving 564 participants who received metformin therapy, metformin was associated with significant reduction in body weight by 3.13 kg (95% CI: -5.33, -0.93), body mass index (BMI) by 0.82 kg/m² (95% CI: -1.22, -0.41), fasting blood glucose [standardised mean difference (SMD): -0.23; 95% CI: -0.40, -0.06], low-density lipoprotein cholesterol (LDL-C) (SMD: -0.41; 95% CI: -0.85, 0.03), total testosterone (SMD: -0.33; 95% CI: -0.49, -0.17), androstenedione (SMD: -0.45; 95% CI: -0.70, -0.20), 17-hydroxyprogesterone (17-OHP) (SMD: -0.58; 95% CI: -1.16, 0.00) and increase the likelihood of clinical pregnancy rate [odds ratio (OR): 3.00; 95% CI: 1.95, 4.59] compared with placebo., Conclusion: In women with PCOS, metformin use has shown a positive impact in reducing body weight, BMI, total testosterone, androstenedione, 17-OHP, LDL-C, fasting blood glucose and increasing the likelihood of pregnancy in women with PCOS., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s), 2022.)

Background: Heart failure (HF) is considered one of the main causes of morbidity and death among chronic diseases worldwide. Patients have increasingly reported chronic pain in long-standing heart failure as a disturbing symptom. Its unknown etiology and mechanism, in addition to its insidious progressive nature, made both the doctor and the patient not notice it until it affects the quality of life (QoL) and general health status. The primary objective of this study is to find the prevalence of pain in chronic heart failure patients and its impact on their QoL. The secondary objective is to determine the predictors of QoL in HF patients., Methods: A multicenter cross-sectional design was used. The European Quality of Life scale five dimensions scale and the Brief Pain Inventory were adopted to evaluate QoL and pain, respectively. The Statistical Package for the Social Sciences version 25 was applied to present the data. The Mann-Whitney U, Kruskal-Wallis, and Cronbach alpha tests were used., Results: The final study had a total of 142 individuals. The prevalence of pain among HF patients was 84.5%. Knee pain was the main complaint among patients. Our patients' median pain severity score was 18 [5.00-25.00], while the median pain interference score was 39 [24.75-53.00]. They had a median EQ-5D score of 0.34 [0.0-0.6] and an EQ-VAS score of 50 [30-70]. Pain severity (p = 0.004 and p < 0.001, respectively) and pain interference (p < 0.001 and p = 0.001, respectively) were found to significantly associated with both QoL scores; the visual analogue scale (EQ-VAS) and EQ-5D-5L. In multivariate analysis, monthly income was the only variable significantly correlated with EQ-VAS and EQ-5D-5L, along with pain variables., Conclusions: Pain is a common symptom among patients with HF and is significantly associated with their QoL. Low income is also highly associated with poor QoL. Definitive guidelines should be achieved to increase awareness and understanding of the importance of pain management, reaching a higher QoL level, less pain, and good adherence to HF medications., (© 2022. The Author(s).)

The aim of this review is to focus light on the history of the human vermiform appendix from the morphological, anatomical, surgical, classification of the origin, types, blood supply aspects in order to understand the real function and summarized this information that positively impacts the clinical decision in case of appendicitis, the most popular surgical condition. Although the characteristic features of the normal and diseased appendix had been reported for many previous centuries, it was still the most common challenge facing every single day in the operation room. The appendectomy, the commonest surgical emergency procedure, may cause little confusion for the surgeons due to highly variable situations of inside the abdominal cavity. However, the recent imaging techniques have increased the surgeon's ability for crucial diagnosis of the diseased appendix. Besides the above-mentioned criteria, with its clinical features diagnosis and management, the author was deeply searched in many scientific databases including EMBASE, Cochrane Library, PubMed, Pubmed Central (PMC), Medline, Web of Science, and Scopus.

Objectives: This review article aims to describe some of the roles of Matrix metalloproteinases (MMPs) in enamel, dentine, dental caries, hybrid layer degradation, pulp and periodontal tissues, throwing light on their current inhibitors. The article addresses the potential of MMPs to serve as biomarkers with diagnostic and therapeutic value., Design: The sections of this review discuss MMPs' involvement in developmental, remodeling, degradational and turnover aspects of dental and periodontal tissues as well as their signals in the pathogenesis, progress of different lesions and wound healing of these tissues. The literature was searched for original research articles, review articles and theses. The literature search was conducted in PubMed and MEDLINE for articles published in the last 20 years., Results: 119 published papers, two textbooks and two doctoral theses were selected for preparing the current review., Conclusions: MMPs are significant proteases, of evident contribution in dental and periapical tissue development, health and disease processes, with promising potential for use as diagnostic and prognostic disease biomarkers. Continuing understanding of their role in pathogenesis and progress of different dental, periapical and periodontal lesions, as well as in dentine-pulp wound healing could be a keystone to future diagnostic and therapeutic regimens.

Alterations of chloroplast membrane lipids might serve as indicators of eco-physiologically induced and plant nutrition-induced changes during plant growth. The change in the degree of fatty acid saturation in the membranes is in particular a strategy of plants to adapt to abiotic stress conditions. Green multi-leaf lettuce plants ( Lactuca sativa L.) were subjected to three different sulfur (S) levels. Sulfoquinovosyl diacylglycerol derivatives (SQDG) might be affected by S nutrition. Therefore, the present study was conducted to investigate the impact of S fertilization on the content and composition of individual SQDG. In addition to a change in the SQDG composition, a general change in the total lipid composition of the chloroplast membrane was observed. A significant increase in total SQDG content and doubling of the galactolipid content and significant alterations of individual SQDG were observed at elevated levels of S fertilization. High levels of S supply demonstrated a clear trend of increasing total chloroplast lipid content and concentrations of linolenic acid, in addition to a further decline in palmitic acid. The study opens perspectives on S supply and its crucial role in the build-up of photosynthetic apparatus. Moreover, it emphasizes the role of S-containing compounds, including sulfolipids, in modulating physiological adjustment mechanisms to improve tolerance ability to various abiotic stresses in plants and, consequently, plant food quality.

The facile and environmentally friendly synthesis of porous organic polymers with designed polar functionalities decorating the interior frameworks as an excellent adsorbent for selective carbon dioxide capture and metal ion removal is a target worth pursuing for environmental applications. In this regard, two azo-linked porous organic polymers denoted man-Azo-P1 and man-Azo-P2 were synthesized in water by the azo-linking of 4,4'-diaminobiphenyl (benzidine) and 4,4'-methylenedianiline, respectively, with 1,3,5-trihydroxybenzene. The resulting polymers showed good BET surface areas of 290 and 78 m 2 g -1 for man-Azo-P1 and man-Azo-P2, respectively. Due to the enriched core functionality of the azo (-N=N-) and hydroxyl groups along with the porous frameworks, man-Azo-P1 exhibited a good CO 2 uptake capacity of 32 cm 3 g -1 at 273 K and 1 bar, in addition to the remarkable removal of lead (Pd), chromium (Cr), arsenic (As), nickel (Ni), copper (Cu), and mercury (Hg) ions. This performance of the synthesized man-Azo-P1 and man-Azo-P2 in the dual application of CO 2 capture and heavy metal ion removal highlights the unique properties of azo-linked POPs as excellent and stable sorbent materials for the current challenging environmental applications., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Purpose: To investigate the difference in mechanical thrombectomy (MT) outcomes between vertebrobasilar tandem occlusion (VBTO) and isolated basilar artery (BA) occlusion (non-VBTO) and the difference in rates of successful recanalization between the clean-road and dirty-road pathways, in VBTO., Methods: We conducted a meta-analysis after searching PubMed, EMBASE, and Google Scholar databases as of April 2021. We only included adult patients who underwent MT to treat acute ischemic stroke (AIS) due to VBTO, and the following outcomes should be reported: successful recanalization, functional outcome at 90 days, and symptomatic intracerebral hemorrhage (sICH). The main effect size measures were odds ratio and risk difference, and the software used was RevMan 5.4., Results: The analysis included 81 VBTO and 324 non-VBTO patients (seven studies). We found no significant difference regarding 3 m functional independence [4 studies: OR = 1.71 (95% CI, 0.54, 5.43), I 2  = 75%], 3 m mortality [4 studies: OR = 1.62 (95% CI, 0.62, 4.25), I 2  = 66%], sICH [4 studies: OR = 1.71 (95% CI, 0.67, 4.39), I 2  = 0%], and successful recanalization [3 studies: OR = 0.81 (95% CI, 0.12, 5.57), I 2  = 80%]. A subgroup analysis of 118 VBTO patients (five studies) showed no significant difference in successful recanalization between clean-road and dirty-road pathways [RD = 0.07 (95% CI, - 0.09, 0.24), I 2  = 40%]., Conclusion: The results of this meta-analysis support the use of MT for AIS patients with VBTO. In VBTO patients, none of the clean-road or dirty-road pathways proved to be superior to the other., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study investigated the beneficial effects of selenium (Se) and sulfur (S) enrichment on the primary metabolism in butterhead lettuce. The plants were treated with three levels of Se via foliar application in the presence of two S levels in the nutrient solution under greenhouse conditions. The lettuce plants that were exposed to the lower selenate level (1.3 μM) in combination with the adequate and high S supplies (1 and 2 mM, respectively) accumulated 38.25 ± 0.38 µg Se g -1 DM and 47.98 ± 0.68 µg Se g -1 DM, respectively. However, a dramatic increase in the Se concentration (122.38 ± 5.07 µg Se g -1 DM, and 146.71 ± 5.43 µg Se g -1 DM, respectively) was observed in the lettuce heads that were exposed to the higher selenate foliar application (3.8 μM) in response to the varied sulfate concentrations (S1 and S2, respectively). Under higher Se and S supplies in the lettuce plants, the levels of organic acids, including malic acid and citric acid, decreased therein to 25.7 ± 0.5 and 3.9 ± 0.3 mg g -1 DM, respectively, whereas, in the plants that were subjected to adequate S and lower Se fertilization, the malic acid, and citric acid levels significantly increased to 47.3 ± 0.4 and 11.8 ± 0.4 mg g -1 DM, respectively. The two Se levels (1.3 and 3.8 μM) under the S1 conditions also showed higher concentrations of water-soluble sugars, including glucose and fructose (70.8.4 ± 1.1 and 115.0 ± 2.1 mg g -1 DM; and 109.4 ± 2.1 and 161.1 ± 1.0 mg g -1 DM, respectively), compared to the control. As with the glucose and fructose, the amino acids (Asn, Glu, and Gln) exhibited strikingly higher levels (48.7 ± 1.1 μmol g -1 DM) under higher S and Se conditions. The results presented in this report reveal that the "crosstalk" between Se and S exhibited a unique synergistic effect on the responses to the amino acids and the soluble sugar biosynthesis under Se and S enrichment. Additionally, the Se-and-S crosstalk could have an important implication on the final nutritional value and quality of lettuce plants.

Background: Osteoarthritis is one of the most common musculoskeletal problems. Pain is the most common complaint and the most significant cause of decreased health-related quality of life (HRQOL) among osteoarthritic patients. The objectives of this study were to assess the impact of pain on quality of life among patients with osteoarthritis and to assess the association of sociodemographic and clinical factors with HRQOL., Methods: Using a cross-sectional study design, we collected data from osteoarthritis patients in orthopedic outpatient clinics from four hospitals in the Palestine-West bank between November 2020 and March 2021. We used the Brief Pain Inventory (BPI) scale to assess pain and the Quality of Life scale five dimensions (EQ-5D) with the visual analog scale of the European Quality of Life (EQ-VAS) to assess HRQOL., Results: In our study, 196 patients composed the final sample, with an average of 60.12 ± 13.63 years. The medians for the EQ-5D score and EQ-VAS score were 0.72 (0.508-0.796) and 70 (55-85), respectively. The pain severity score was found to have a significant negative association with both the EQ-5D and EQ-VAS scores with r of - 0.620, p <  0.001, and - 0.554, p <  0.001, respectively. Similar associations were found between pain interference score and both EQ-5D (r = - 0.822, p <  0.001) and EQ-VAS scores (r = - 0.609, p <  0.001). Multiple regression analysis showed that participants with higher educational level (p = 0.028), less diseased joints (p = 0.01), shorter duration of disease (p = 0.04), and lesser pain severity and interference scores (both with p < 0.001) had significantly higher HRQOL scores., Conclusions: We found that many variables have a significant negative impact on HRQOL among patients with osteoarthritis. Our finding provides a well-founded database to use by clinicians and healthcare professionals who work with patients with osteoarthritis, as well as educational and academic institutions., (© 2022. The Author(s).)

Background: Non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and hepatic fibrosis are the most detrimental hepatic abnormalities associated with increased body weight with devastating clinical outcomes. Therefore, there is a substantial necessity for efficient management strategies, including significant weight reduction. Bariatric surgery has been used as a therapeutic approach in a selected obese patient with NAFLD/NASH and other cardiometabolic comorbidities., Purpose: The study is focused on the predictive role of PTH with the indices of hepatic steatosis/NAFLD and NASH based on liver biopsy, elastography, and sonography in morbidly obese patients., Methods: Ninety patients with BMI between 35 and 40 kg/m 2 with more than two comorbidities who referred to Imam Reza outpatient clinic from December 2016 to September 2017 were recruited and underwent initial assessments, including demographic profiles, psychological assessment, anthropometric measurements, hepatic biopsy, and basic laboratory tests. Liver stiffness was evaluated using two-dimensional shear wave elastography (2D-SWE) at least two weeks before liver biopsy. The histological analysis of the liver was performed using biopsy samples which obtained from left hepatic lobe during bariatric surgery under direct surgeon observation using a 16-gauge Tru-cut needle. The study was approved by the ethical committee (IR.MUMS.fm.REC.1396.312)., Results: The level of PTH was significantly high in patients with positive histology for hepatic fibrosis, steatosis, and NASH/NAFLD compared to patients with negative histology (p = 0.005, p = 0.009, and p = 0.013, respectively). Also, patients with liver fibrosis confirmed by elastography had significantly higher serum PTH concentration than patients without fibrosis (p = 0.011). PTH was also positively correlated with hepatic fibrosis, NASH, and steatosis (p = 0.007, p = 0.012, p = 0.023, respectively)., Conclusion: High levels of PTH was significantly associated with histological indices of (hepatic fibrosis, steatosis, NAFLD and NASH) and elasticity indices. Therefore, it is imperative to assess for high levels of PTH in the morbidly obese population pre-and post-bariatric surgery. However, for a more robust and comprehensive assessment, a randomized controlled trial is needed. The study was conducted in accordance with the practice guidance in the diagnosis and management of NAFLD from the American association for the study of liver disease (AASLD) 2018., Level Iii: Evidence obtained from well-designed cohort or case-control analytic studies., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Contrast-induced acute kidney injury (CI-AKI) has been reported to be the third most common cause of hospital-acquired acute kidney injury (AKI) and is associated with significant morbidity and mortality., Objectives: This study aimed to assess the incidence and risk factors of CI-AKI in Sudanese patients undergoing coronary angiography., Methods: The study was a descriptive, prospective, hospital-based study conducted at Alshaab Hospital between January and April 2019. A total of 163 patients undergoing coronary angiography were enrolled, and a checklist was used to collect data. Chi-square and regression analyses were performed to identify the risk factors of CI‑AKI. CI‑AKI was defined as a rise in serum creatinine ≥25% above baseline within three days after percutaneous coronary angiography (PCA)., Results: CI‑AKI incidence in patients undergoing coronary angiography was 31.9% (52/163). Among independent variables, diabetes mellitus, the type of coronary angiography, and the volume of contrast medium were statistically significantly (p-value ˂ 0.05) associated with CI-AKI development. Logistic analysis showed that diabetes (odds ratio (OR): 15.2; 95% CI: 6.771-33.974; p = 0.001), percutaneous coronary intervention (PCI) (OR: 2.4; 95% CI: 1.168-4.901; p = 0.017), and the volume of contrast medium (OR 2.1; 95% CI: 1.440-3.054; p = 0.001) were independent predictors correlated to CI‑AKI development., Conclusion: The incidence of CI-AKI is 31.9%, and diabetes mellitus, PCI, and high volume of contrast medium are associated with a higher risk of CI-AKI in patients undergoing coronary angiography., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Abdalla et al.)

Introduction: There is conflicting data on the effect of polycystic ovary syndrome (PCOS) on bone mineral density (BMD) and fracture risk. Recent genetic data suggest that men may also carry genetic risk factors for PCOS; the associations of these factors with parameters of bone health remains unknown. We aimed to investigate if the genetic risk of PCOS is associated with BMD and fracture risk in women and men in the UK Biobank dataset., Methods: We used Mendelian randomisation (MR) analysis to test the association of genetic risk of excess testosterone in PCOS with BMD and fractures in the UK biobank study. The MR analysis was performed using linear regression analysis with the weighted genetic risk score (wGRS) as an independent variable adjusting for age, BMI and population eigenvectors. The horizontal pleiotropy in the MR analysis was tested using MR-Egger regression analysis., Results: The study consisted of 221,086 Caucasian women (mean age ± SD: 56.7 ± 7.9 years, mean body mass index [BMI] ± SD: 27.0 ± 5.1 kg/m 2 , mean BMD ± SD: 0.50 ± 0.11 g/cm 2 ) and 187,816 Caucasian men (mean age ± SD: 57.1 ± 8.1 years, mean BMI ± SD: 27.7 ± 4.1 kg/m 2 and mean BMD ± SD: 0.56 ± 0.12 g/cm 2 ). Women and men self-reported 24,797 (11%) and 17,076 (10%) fractures over the last 5 years, respectively. The MR analysis showed that one SD increase in the wGRS for clinical or biochemical hyperandrogenism in PCOS was associated with significantly higher heel BMD (Beta = 0.0007 [±0.0002], P-value = 0.001) and a significantly reduced risk of fractures (OR = 0.97, P-value = 0.003) in women. A similar wGRS in men was not associated with BMD or risk of fractures., Conclusion: In this study, we showed that the excess genetic risk for hyperandrogenism in women with PCOS is associated with a higher BMD and reduced risk of fractures., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Kidney failure is common in patients with Coronavirus Disease-19 (COVID-19), resulting in increased morbidity and mortality. In an international collaboration, 284 kidney biopsies were evaluated to improve understanding of kidney disease in COVID-19. Diagnoses were compared to five years of 63,575 native biopsies prior to the pandemic and 13,955 allograft biopsies to identify diseases that have increased in patients with COVID-19. Genotyping for APOL1 G1 and G2 alleles was performed in 107 African American and Hispanic patients. Immunohistochemistry for SARS-CoV-2 was utilized to assess direct viral infection in 273 cases along with clinical information at the time of biopsy. The leading indication for native biopsy was acute kidney injury (45.4%), followed by proteinuria with or without concurrent acute kidney injury (42.6%). There were more African American patients (44.6%) than patients of other ethnicities. The most common diagnosis in native biopsies was collapsing glomerulopathy (25.8%), which was associated with high-risk APOL1 genotypes in 91.7% of cases. Compared to the five-year biopsy database, the frequency of myoglobin cast nephropathy and proliferative glomerulonephritis with monoclonal IgG deposits was also increased in patients with COVID-19 (3.3% and 1.7%, respectively), while there was a reduced frequency of chronic conditions (including diabetes mellitus, IgA nephropathy, and arterionephrosclerosis) as the primary diagnosis. In transplants, the leading indication was acute kidney injury (86.4%), for which rejection was the predominant diagnosis (61.4%). Direct SARS-CoV-2 viral infection was not identified. Thus, our multi-center large case series identified kidney diseases that disproportionately affect patients with COVID-19 and demonstrated a high frequency of APOL1 high-risk genotypes within this group, with no evidence of direct viral infection within the kidney., (Copyright © 2021 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)