War-related trauma and posttraumatic stress disorder in refugees, displaced, and nondisplaced people during armed conflict in Sudan: a cross-sectional study.

BACKGROUND: The ongoing armed conflict in Sudan has caused mass displacement, affecting mental health. This study aimed to assess the prevalence of posttraumatic stress disorder (PTSD) and trauma among refugees, internally displaced, and nondisplaced people, while also examining the link between displacement type, PTSD severity, and associated factors. METHODS: This cross-sectional study used the Posttraumatic Stress Disorder Checklist for DSM-5 to assess PTSD symptoms and the General Health Questionnaire-28 to evaluate depression. Data were collected from 642 participants, targeting general social media groups for those within Sudan and specific groups for refugees outside the country. Sociodemographic and trauma event data were also gathered. Data analysis was conducted using SPSS, applying one-way ANOVA and independent t-tests to compare PTSD and depression. Binary logistic regression identified associations between sociodemographic factors and PTSD symptoms. RESULTS: Among the 642 participants, 46.3% were internally displaced people (IDP), 42.1% were refugees, and 11.7% were non-displaced individuals. Clinically significant PTSD symptoms were identified in 36.6% of the participants. Refugees had a significantly greater percentage of traumatic events (M = 4.31, SD = 2.605, p < .01). Depression symptoms were found to be strongly associated with clinically significant PTSD (p < .001). Factors significantly linked to depression symptoms included female gender (p = 0.015), being single (p = 0.048), younger age (p = 0.036), dissatisfaction with living conditions (p < 0.001), and unemployment (p = 0.021). Dissatisfaction with living conditions also significantly influenced the likelihood of developing PTSD (p < .001). CONCLUSION: The study found that 36.6% of participants experienced PTSD, with refugees having a 1.4 times greater risk of developing PTSD compared to IDP and non-displaced individuals. Traumatic events were moderately correlated with PTSD symptoms, though non-displaced individuals had higher exposure to such events. These findings highlight the need for targeted mental health interventions, particularly for refugees and those affected by traumatic events. Further research using probability sampling is necessary to confirm these results and inform more effective mental health policies and programs for displaced populations.

Evaluation of the therapeutic potential of novel nanoparticle formulations of glutathione and virgin coconut oil in an experimental model of carbon tetrachloride-induced liver failure.

BACKGROUND: Acute liver failure (ALF) is a critical condition characterized by rapid liver dysfunction, leading to high mortality rates. Current treatments are limited, primarily supportive, and often require liver transplantation. This study investigates the potential of a novel nanoparticle formulation of glutathione (GSH) and virgin coconut oil (VCO) alone and in combination to enhance therapeutic outcomes in a rat model of ALF induced by orogastric carbon tetrachloride (CCl4). METHODS: The study employed adult male Albino rats divided into ten groups, with ALF induced via a single oral dose of CCl4. Various treatment regimens were administered over seven days, including conventional and nanoparticle forms of GSH and VCO and their combinations. The efficacy of treatments was evaluated through biochemical analysis of liver function markers, oxidative stress indicators, inflammatory biomarkers, and histopathological examinations. Nanoparticles were synthesized using established methods, and characterization techniques were employed to ensure their quality and properties. RESULTS: The nanoparticle formulations significantly improved liver function, as indicated by reduced serum levels of alanine aminotransferase and aspartate aminotransferase, alongside decreased oxidative stress markers such as malondialdehyde. Furthermore, they reduced tumor necrosis factor alpha and interleukin-1 beta inflammatory markers. Histological analysis revealed reduced hepatocellular necrosis and inflammation in treated groups compared to controls. Also, decreased nuclear factor-kappa B was detected by immunohistochemical analysis. CONCLUSION: The findings show that the nanoparticle mixture of GSH and VCO effectively reduces liver damage in ALF. This suggests a promising drug-based approach for improving liver regeneration and protection. This innovative strategy may pave the way for new therapeutic interventions in the management of ALF.

The Role of Oral Nutritional Supplements in Head and Neck Cancer Patients Undergoing Chemoradiotherapy.

PURPOSE: This study aimed to assess the impact of oral nutritional supplements (ONS) on nutritional intake, body weight, and body composition in head and neck cancer (HNC) patients undergoing chemoradiotherapy. The study evaluated whether ONS could prevent treatment-related nutritional deterioration. METHODS: This prospective observational pilot study included 30 HNC patients randomized into two groups: ONS (n = 15) and No ONS (n = 15). All participants underwent chemoradiotherapy, with the ONS group receiving 200 mL of a high-calorie, high-protein supplement twice daily. Nutritional status, including body weight, BMI, fat mass, fat-free mass, and bone mass, was assessed at three time points: baseline, mid-treatment, and end of treatment. Data were analyzed using the Mann-Whitney U test, with a p-value of ≤0.05 considered statistically significant. RESULTS: At baseline, there were no significant differences between the two groups in body weight, BMI, or body composition. By the end of radiotherapy, the No ONS group showed significant reductions in body weight (p < 0.001), BMI (p < 0.001), fat mass (p < 0.001), and fat-free mass (p < 0.001), while the ONS group maintained more stable nutritional parameters. Acute radiotherapy toxicities, including nausea, dysphagia, and oral mucositis, were not significantly different between the two groups. CONCLUSION: ONS effectively mitigates weight loss and preserves body composition in HNC patients undergoing chemoradiotherapy. While no significant reduction in radiation-induced toxicities was observed, the nutritional benefits of ONS support its use in preventing malnutrition in this patient population. Larger studies are needed to further validate these findings.

The effect of probiotic supplementation on non-alcoholic fatty liver disease (NAFLD) fibrosis score in patients attending a tertiary hospital clinic in Cairo, Egypt.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic fat accumulation (> 5% of liver tissue) in the absence of alcohol abuse or other chronic liver diseases. NAFLD can progress to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). This study aimed to assess the efficacy of probiotic (lactobacillus) supplementation on NAFLD fibrosis score. METHODOLOGY: A double-arm randomized controlled trial was conducted in the family medicine clinic of a tertiary hospital, enrolling patients with sonographic evidence of NAFLD. Fifty patients were divided into two groups: the Probiotic group received lifestyle modification instructions along with daily probiotic supplementation for twelve weeks, with regular monthly follow-up visits. The Standard Treatment group received low-fat diet and lifestyle modification instructions only. RESULTS: The mean age of participants was 46.10 years (SD 10.11), with 70% females and 30% males. The study found a statistically significant difference in liver enzymes (ALT and AST) and BMI in the probiotic group before and after intervention. However, there was no significant difference in NAFLD fibrosis score between the two groups. CONCLUSION: Short-term probiotic treatment resulted in improvements in ALT, AST, and BMI in the probiotic group, but did not significantly affect NAFLD fibrosis score. Further research with larger sample sizes and longer follow-up periods is warranted. TRIAL REGISTRATION: The clinical trial was registered at Protocol Registration and Results System with number NCT06074094 (12/09/2021).

Baseline optical coherence tomography angiography biomarkers predict visual outcomes in treatment-naïve neovascular age-related macular degeneration patients.

This retrospective study aimed to assess different macular neovascular network characteristics in relation to changes in best corrected visual acuity (BCVA) over 3 and 12 months following treatment. Using optical coherence tomography angiography, we reviewed the medical records of 46 treatment-naïve patients with neovascular age-related macular degeneration (nAMD) who received intravitreal aflibercept injections. The change in BCVA from baseline to 3 months and 12 months after treatment was recorded. The mean vessels percentage area, junctions density, lacunarity, and fractal dimension were significantly correlated with the change of BCVA from baseline to month 3 (P = 0.003, 0.046, 0.007, and 0.005 respectively). Fractal dimension and vessels percentage area were correlated with the change of BCVA from baseline to month 12 (P = 0.023 and 0.023 respectively). The findings suggest that baseline characteristics of macular neovascular complexes may serve as predictors for BCVA changes following treatment with aflibercept in nAMD patients.

Determinants of hepatitis B virus infection among pregnant women in Bench Sheko zone, Southwest Ethiopia: a case-control study.

Background: Hepatitis B Virus (HBV) infection during pregnancy poses serious risks by raising the likelihood of chronic infection in newborns by 90% and the risk of cirrhosis and liver cancer by 25% in chronic infections. This study aimed to identify determinants of HBV infection among pregnant women in the Bench Sheko zone, Southwest Ethiopia. Methods: An unmatched case-control study was conducted from May 15 to July 15, 2022, in selected health facilities of the Bench Sheko zone, Southwest Ethiopia. Medical charts were reviewed to collect the HBsAg status of participants, as all pregnant women attending antenatal care underwent routine screening. It involved 228 pregnant women (76 HBV-positive cases and 152 HBV-negative controls). Data were collected using structured questionnaires, and analyzed using SPSS 21. A multivariable logistic regression was performed to identify significant determinants of HBV infection, and statistical significance was declared at p-value <0.05. Results: After controlling potential confounders, having no formal education (AOR = 4.94, 95% CI: 2.01, 8.29; P = 0.007), urban residency (AOR = 2.56, 95% CI: 1.43, 6.86; P = 0.010), history of unsafe abortion (AOR = 3.87, 95% CI: 2.17, 6.98; P < 0.001), sharing sharp materials (AOR = 8.43, 95% CI: 5.54, 10.9; P < 0.001), contact with HBV-infected persons in the family (AOR = 2.18, 95% CI: 1.72, 4.87; P < 0.001), tribal scarification (AOR = 3.23, 95% CI: 1.24, 8.91; P = 0.017), and history of unsafe tooth extraction (AOR = 4.52, 95% CI: 2.18, 9.76; P = 0.039) were identified as significant predictors of HBV infection. Conclusion: The study identifies multiple factors contributing to HBV infection in pregnant women. Therefore, it is crucial to promote safe abortion practices and the responsible use of sharp materials, avoid high-risk contact with infected individuals within the family, raise awareness about the risks associated with tribal scarification while advocating for safer practices, and offer education on safe tooth extraction methods to reduce the risk of HBV.

E-SAT: An extreme learning machine based self attention approach for decoding motor imagery EEG in subject-specific tasks.

The advancements in Brain-Computer Interface (BCI) have substantially evolved people's lives by enabling direct communication between the human brain and external peripheral devices. In recent years, the integration of machine larning (ML) and deep learning (DL) models have considerably imrpoved the performances of BCIs for decoding the motor imagery (MI) tasks. However, there still exist several limitations, e.g., extensive training time and high sensitivity to noises or outliers with those existing models, which largely hinder the rapid developments of BCIs. To address such issues, this paper proposes a novel extreme learning machine (ELM) based self-attention (E-SAT) mechanism to enhance subject-specific classification performances. Specifically, for E-SAT, ELM is employed both to imrpove self-attention module generalization ability for feature extraction and to optimize the model's parameter initialization process. Meanwhile, the extracted features are also classified using ELM, and the end-to-end ELM based setup is used to evaluate E-SAT performances on different MI EEG signals. Extensive experiments with different datasets, such as BCI Competition III Dataset IV-a, IV-b and BCI Competition IV Datasets 1,2a,2b,3, are conducted to verify the effectiveness of proposed E-SAT strategy. Results show that E-SAT outperforms several state-of-the-art (SOTA) existing methods in subject-specific classification on all the datasets, with an average classification accuracy of 99.8%,99.1%,98.9%,75.8%, 90.8%, and 95.4%, being achieved for each datasets, respectively. The experimental results not only show outstanding performance of E-SAT in feature extractions, but also demonstrate that it helps achieves the best results among nine other robust ones. In addition, results in this study also demonstrate that E-SAT achieves exceptional performance in both binary and multi-class classification tasks, as well as for noisy and non-noisy datatsets. .

Formulation of Microemulsion-Based Gels for Enhanced Topical Administration of Nonsteroidal Anti-Inflammatory Drugs.

Nonsteroidal anti-inflammatory drugs are commonly administered orally to manage pain and inflammation, but they can have negative gastrointestinal side effects. Topical delivery is an alternative, and microemulsions (µEs) have been shown to be effective in facilitating, but they suffer from a liquid nature and low long-term retention on the skin. Hence, microemulsified gels (µEGs) have been developed, and in this study, we explored certain µEGs with diclofenac sodium (DF-Na) and naproxen sodium (NP-Na) with the hypothesis to ensure a slower and more sustained delivery of NSAIDs through the skin. The µEGs comprised castor oil (∼8%), water (∼12%), Tween-20 (∼72%), Span-20 (∼8%), poloxamer 407, and DF-Na or NP-Na. Optical microscopy was used to study the microstructures in the µEs and µEGs, and phase transitions from water-in-oil (w/o) to oil-in-water (o/w) with continuous networks were observed. Based on studies with dynamic light scattering and analyses of electron micrographs, it was observed that the µEs and µEGs loaded with DF-Na and NP-Na comprised monomodal nanodroplets. The average sizes of the droplets were (∼35 nm) and (∼60 nm) for the µEGs, without and with drugs. Fluorescence spectroscopy was used to ensure that the drugs were more likely to be present in the hydrophobic microenvironment of the formulations. Moreover, ex vivo permeation studies were conducted at pH values of 5.5 and 7.4 across rabbit skin. The release rates of DF-Na (>99 ± 1.5%, P < 0.07) and NP-Na (>89 ± 1.1%, P < 0.01) were slower for the µEGs within 8-10 h than for the µEs at the low pH, which is of relevance to the optimal pH of the skin. It was observed that µEGs with high viscosities are effective and may have potential for use in topical drug delivery applications.

Respiratory and functional benefits of manual diaphragmatic release for cleaning-laborers exposed to occupational hazards.

BACKGROUND AND PURPOSE: To examine the respiratory and functional benefits of manual diaphragmatic release for Cleaning-Laborers Exposed to Occupational Hazards. METHODS: A randomized controlled trial of 36 participants aged 35-45 years was randomly allocated into two groups. The experimental group (n = 18); received manual diaphragm release along with respiratory training exercises, and the control group (n = 18); received respiratory training exercises only. Three times/week for 12 consecutive weeks. The serum immunoglobulin E level, pulmonary functions [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow (PEF) rate (PEF)], chest wall mobility, and 6 min walk-test performance were assessed pre- and post-intervention. RESULTS: There was a greater decline in serum immunoglobulin levels (p = 0.003; Partial η2 = 0.23) and enhancement in pulmonary functions [FEV1 (p = 0.025, Partial η2 = 0.14), FVC (p = 0.017, Partial η2 = 0.16), FEV1/FVC (p = 0.028, Partial η2 = 0.13), and PEF (p = 0.012, Partial η2 = 0.17) in the experimental group. Further, there was a greater increase in chest mobility at the xiphoid level (p = 0.002, Partial η2 = 0.25) in the experimental group, but this was not the case at the axillary level (p = 0.29, Partial η2 = 0.03). Still, the 6 min walk-test performance improved more significantly in the experimental group (p = 0.002, Partial η2 = 0.24). CONCLUSION: The diaphragmatic release technique may offer a promising approach for mitigating distressing respiratory symptoms, enhancing immune function, and improving 6 min walk-test performance among cleaning laborers with work-related respiratory hazards. TRIAL REGISTRATION: The study was retrospectively registered at XXX (ID: NCT05802355).

The surgical, histopathological characteristics, and survival outcome of ovarian clear cell carcinoma: a retrospective case series sharing the experience of a tertiary cancer centre.

Background: Ovarian clear cell carcinoma (OCCC) is a rare and distinct subtype of epithelial ovarian cancer (EOC). It is unique in several biological aspects. This study analyzes the clinicopathological features and survival outcome of patients with OCCC, aiming to identify factors affecting recurrence, progression-free survival (PFS) and overall survival (OS). Methods: A retrospective study included 49 women with OCCC between January 2009 and December 2021 at Oxford Cancer Center. All demographic and pathological characteristics, pre-operative biomarkers, surgical procedure, complications, hospital stay, chemotherapy regimen, and disease status on follow-up, were collected from electronic medical records. Results: No residual disease (R0) was achieved in 39 out of 49 women who underwent cytoreductive surgery. The follow-up time had a mean of 8.75 years. The 3-year OS was 73.4%, and the 3-year PFS was 81.3% [95% confidence interval (CI): 84.63-118.93]. Women with stage 1 disease had the best outcome. There was a marked difference (P<0.001) in OS in the presence of residual disease. No residual disease conferred a 3-year OS of 88.6% (95% CI: 108.6-141.8), compared to only 12.5% in the presence of residual disease (95% CI: 4.48-32.11). In multivariant analysis, the International Federation of Gynecology and Obstetrics (FIGO) stage was the only independent prognostic indicator of OS with (P<0.05), including carbohydrate antigen (CA) 125, hemoglobin, albumin, associated endometriosis, ascites, residual disease and FIGO staging. Conclusions: Surgery to achieve no residual disease is necessary to improve the prognosis in advanced OCCC. The true challenge is to predict which patients with early-stage disease at higher risk of recurrence and would most benefit from adjuvant treatments.

Interventional approaches to treatment resistant depression (DTR) in children and adolescents: A systematic review and meta-analysis.

BACKGROUND: Major depressive disorder (MDD) is highly prevalent in youth. Conventional treatment paradigms primarily involve selective serotonin reuptake inhibitors (SSRIs) and psychotherapy, yet a significant proportion of this population exhibits treatment-resistant depression (TRD). In adults, interventional therapies like Electroconvulsive Therapy (ECT), repetitive Transcranial Magnetic Stimulation (rTMS), and ketamine have shown promise for TRD, but their comparative efficacy remains underexplored in Adolescent and pediatric population. This systematic review and meta-analysis aims to assess the relative effectiveness of ECT, rTMS, and ketamine in treating TRD among adolescents. METHODS: Following PRISMA guidelines, we systematically searched databases for studies of ECT, rTMS, or ketamine for treatment-resistant depression in youth ages 10-24. Three reviewers independently screened for inclusion based on predefined criteria. Included observational and randomized controlled trials reported depression symptoms with measures like HDRS and MADRS in youth treated with ECT, rTMS, or ketamine. Two reviewers extracted data on interventions, patients, and depression symptom outcomes. Chance-adjusted inter-reviewer agreement was calculated. For meta-analysis, we pooled standardized mean differences (SMDs) in depression scores using random effects models and assessed heterogeneity with I2 statistics. RESULTS: Meta-analysis of 10 observational studies examined SMD in depression scores for treatment resistant depression patients treated with ECT, ketamine, or rTMS. Patients treated with ECT had a significantly lower SMD of 1.99 (95 % CI 0.92-3.05, p < 0.001) compared to baseline. Patients treated with ketamine also had a significantly lower SMD of 1.58 (95 % CI 1.04-2.12, p < 0.001). Patients treated with rTMS had the lowest SMD of 2.79 (95 % CI 0.79-4.80, p = 0.006). There was no significant difference between the three groups overall (p > 0.05). Comparative analysis between ECT and ketamine found no significant difference in SMD (p = 0.387). Comparison of ECT versus rTMS found a significant difference in SMD favoring rTMS (p = 0.004). Comparison of ketamine versus rTMS suggested a potential difference in SMD favoring rTMS (p = 0.058). In summary, rTMS resulted in significantly larger reductions in depression scores than ECT, and potentially larger reductions than ketamine. CONCLUSIONS: This meta-analysis illustrates the ability of rTMS, ECT, and ketamine to improve depression in youth. rTMS resulted in the largest improvements, highlighting its potential as a first-line treatment for pediatric treatment-resistant depression given its favorable side effect profile compared to ECT. Further research directly comparing these modalities is needed.

Nutritional status and extended metabolic screening in Egyptian children with uncomplicated type 1 diabetes.

Nutritional status assessment, including amino acids, carnitine, and acylcarnitine profile, is an important component of diabetes care management, influencing growth and metabolic regulation. A designed case-control research included 100 Egyptian participants (50 T1DM and 50 healthy controls) aged 6 to 18 years old. The participants' nutritional status was assessed using the Body Mass Index (BMI) Z-score. Extended metabolic screening (EMS) was performed using a high-performance liquid chromatography-electrospray ionization-mass spectroscopy system to evaluate the levels of 14 amino acids, free carnitine, and 27 carnitine esters. T1DM children had considerably lower anthropometric Z-scores than the control group, with 16% undernutrition and 32% short stature. Total aromatic amino acids, phenylalanine, phenylalanine/tyrosine ratio, proline, arginine, leucine, isoleucine, free carnitine, and carnitine esters levels were considerably lower in the diabetic group, suggesting an altered amino acid and carnitine metabolism in type 1 diabetes. BMI Z-score showed a significant positive correlation with Leucine, Isoleucine, Phenylalanine, Citrulline, Tyrosine, Arginine, Proline, free carnitine, and some carnitine esters (Acetylcarnitine, Hydroxy-Isovalerylcarnitine, Hexanoylcarnitine, Methylglutarylcarnitine, Dodecanoylcarnitine, Tetradecanoylcarnitine, and Hexadecanoylcarnitine). HbA1c% had a significant negative correlation with Total aromatic amino acids, Branched-chain amino acid/Total aromatic amino acids ratio, Glutamic Acid, Citrulline, Tyrosine, Arginine, Proline, and certain carnitine esters (Propionylcarnitine, Methylglutarylcarnitine, Decanoylcarnitine, Octadecanoylcarnitine and Octadecenoylcarnitine), suggest that dysregulated amino acid and carnitine metabolism may be negatively affect the glycaemic control in children with TIDM. In conclusion, regular nutritional assessments including EMS of T1DM patients are critical in terms of diet quality and protein content for improved growth and glycemic management.

Promoting strategies for biological stability in drinking water distribution system from the perspective of micro-nano bubbles.

Microorganisms thriving in drinking water distribution system (DWDS) reduces biological stability of water, causing numerous threats to residents' drinking water safety. Traditional disinfection methods have intrinsic drawbacks, including microbial reactivation and byproduct formation, leading to waterborne diseases. Thus, effective disinfection techniques are required to ensure the microorganism's inactivation and enhance biological stability. Micro-nano bubbles (MNB) provide a promising result to these issues. This study simulates the hydraulic conditions of the tank of DWDS to investigate the enhancement of biological stability in the tank using MNBs with distinct gas sources. The analysis focused on water quality characteristics, biological stability indicators, and microbial community composition. The results showed that the dissolved gas method could generate abundant bubbles with a particle size below 1000 nm, with a concentration exceeding 106/mL in water. The particle size and Zeta potential of bubbles were crucial factors influencing in situ the ·OH generation; hence, the ·OH concentration was highly sensitive to changes in bubble size. In addition, MNBs inhibited the growth of target bacteria in water, degraded organic matter, and improved the biological stability of drinking water, reaching significant degradation rates for biodegradable dissolved organic carbon (42.74 %), assimilable organic carbon (49.49 %), and total bacteria (51.32 %). MNBs directly degraded organic matter in water by ·OH generation in situ, reducing the microbial nutrient source, thereby inhibiting microbial metabolism and activity, which induced optimum disinfection effects on Proteobacteria, Cyanobacteria, and Planctomycetota in water. In particular, the proposed experiment achieved a 100 % disinfection rate for Acinetobacter in Proteobacteria, disrupting metabolic intermediate functions with the microbial community after MNB treatment. Therefore, this study has demonstrated the potential of MNBs to enhance the biological stability of drinking water, improve water quality, and ensure residents' water health, providing valuable technical support for drinking water safety.

Exploring cardiopulmonary rehabilitation in the middle east and North Africa region: A narrative review of challenges and opportunities.

BACKGROUND AND OBJECTIVES: Cardiopulmonary Rehabilitation (CR) is crucial for managing conditions like congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and post-COVID-19 complications. This review examines CR practices in the Middle East and North Africa (MENA) region, exploring challenges, disparities, and emerging trends. METHODS: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science to identify studies published between date of inception and April 24th, 2024, focusing on CR programs, outcomes, challenges, and strategies specific to the MENA region. Data extraction included study design, population characteristics, CR interventions, and key findings. RESULTS: CR programs in the MENA region vary widely in scope and execution. While efforts are underway to integrate CR services into national healthcare policies, significant challenges persist, including limited infrastructure, shortages of trained professionals, and cultural barriers. Emerging trends include the use of telehealth and digital monitoring tools to expand access to CR services and policy reforms aimed at improving service delivery and patient access. CONCLUSION: CR plays a crucial role in improving the quality of life and health outcomes for cardiopulmonary patients, including those in the MENA region. However, significant challenges hinder the widespread adoption and effectiveness of CR programs. Addressing these challenges requires efforts to increase public education, reduce costs, expand funding, and enhance interprofessional collaboration. Future research should assess virtual rehabilitation, cultural adjustments, and long-term outcomes to tailor interventions to MENA's needs, ultimately enhancing CR accessibility and patient outcomes.

Development and validation of a machine learning model to predict myocardial blood flow and clinical outcomes from patients' electrocardiograms.

We develop a machine learning (ML) model using electrocardiography (ECG) to predict myocardial blood flow reserve (MFR) and assess its prognostic value for major adverse cardiovascular events (MACEs). Using 3,639 ECG-positron emission tomography (PET) and 17,649 ECG-single-photon emission computed tomography (SPECT) data pairs, the ML model is trained with a swarm intelligence approach and support vector regression (SVR). The model achieves a receiver-operator curve (ROC) area under the curve (AUC) of 0.83, with a sensitivity and specificity of 0.75. An ECG-MFR value below 2 is significantly associated with MACE, with hazard ratios (HRs) of 3.85 and 3.70 in the discovery and validation phases, respectively. The model's C-statistic is 0.76, with a net reclassification improvement (NRI) of 0.35. Validated in an independent cohort, the ML model using ECG data offers superior MACE prediction compared to baseline clinical models, highlighting its potential for risk stratification in patients with coronary artery disease (CAD) using the accessible 12-lead ECG.

Evaluating the effectiveness of citation count as a measure of methodological quality in esophagogastric surgery research: a comparative analysis with the MINORS score and levels of evidence.

Aim: The primary objective was to assess the relationship between the citation number and the quality of the articles, as compared with the level of evidence and the MINORS score. This study's secondary objective was to characterize the 50 most cited articles in the field of oesophagectomy research. Background: There has been an increased need for an evaluation tool to indicate research quality. Available quality assessment tools include the Level of Evidence, the MINORS score, the Cochrane Risk of Bias 2.0 Tool, the Newcastle Ottawa Scale, CASP Appraisal Checklists, and Legend Evidence Evaluation tools. Methods: The Web of Science allowed evaluating and comparing articles on oesophagectomy research. The quality of the 50 most cited articles was assessed using the Oxford Centre level of evidence classification and the methodological index for non-randomized studies (MINORS). Results: Level of evidence II studies were cited more than level IV (P=0.008). There was a significant positive correlation between citation number and MINORS score (P=0.002). The median MINORS score was highest amongst level II studies, followed by levels III, IV, and I. The median MINORS score for level II evidence was significantly higher than for level IV (P=0.001). The study sample size is associated with higher levels of evidence but does not correlate with the citation number. Female authors contributed to 4 out of 50 articles. Recently published articles tended to be cited more frequently. More authors equated to more citations. Prospective studies are more likely to be cited. Conclusion: Citation analysis can be used as an indicator of quality when assessing articles. It should, however, be used with caution as highly cited work, famous authors, and journals are all more likely to be cited. Citation analysis should be used alongside other well-established tools.

Monitoring the prevalence of Pseudomonas fluorescens as a spoilage indicator in cow raw milk, teat surfaces, and milk tanks.

Background: Milk and its products are very sensitive to spoilage if they are kept under unsuitable conditions which may provide favorable circumstances for the growth of specific spoilage organisms, Pseudomonas fluorescens accounted as the most dominant indicator for milk spoilage. Aim: This study highlights monitoring the prevalence of P. fluorescens as a spoilage indicator organism in cow raw milk and its contact surfaces represented by teat surfaces and milk tanks in Nineveh province. Methods: A total of 150 samples from cows' raw milk, teat surfaces, and milk tank swabs were collected from different locations in Nineveh province from October 2023 till February 2024. The Pseudomonas fluorescens were detected by using conventional cultivation methods supported by molecular detection of the target pathogen using the polymerase chain reaction technique. Results: Out of 150 samples, 48 (32%) were positive for the prevalence of P. fluorescens by traditional methods, and 39 (26%) were positive using PCR assay according to the 16SPflu gene yielded a band at 850 bp. The P. fluorescens was recovered at 19 (38%) from raw milk. Teat surfaces revealed a higher isolation rate 11 (22%) compared to milk tanks 9 (18%). The mean counts of Pseudomonas in cows raw milk revealed 4.38, 6.29, and 7.37 log CFU/ml for the 0, 3, and 6 days of storage at chilling temperature. Results of DNA sequencing of the 16SrRNA gene revealed 12 strains recorded in the GenBank nucleotide sequence database. Conclusion: Our results shed light on the risk of P. fluorescens prevalence as a spoilage indicator in raw milk and surrounding surfaces which is inevitable to apply hygienic procedures during milk collecting, processing, and preservation to increase the shelf life of the products and ensure milk safety and consumer health.

Nonoperative Management of a Spontaneous Perforation of Neobladder Secondary to Blackout From Solitary Binge Drinking: A Case Report and Current Literature Review.

The orthotopic ileal neobladder is becoming a popular technique of urinary diversion after radical cystectomy (RC) for localized muscle-invasive bladder cancer (MIBC), allowing patient continence, with a more desirable body image and good quality of life. Minimally invasive robot-assisted RC and neobladder have the potential to minimize physical and psychological trauma and are increasingly being adopted for patients with MIBC worldwide. Spontaneous perforation of orthotopic neobladder is uncommon;however, it represents serious complications. Solitary binge drinking can be dangerous in a patient with a neobladder because of reduced level of consciousness and overdistension of the neobladder. We report a case of spontaneous ileal neobladder perforations one year post-robotic RC secondary to blackouts from binge drinking. We also describe nonoperative active management and review the literature. A 66-year-old gentleman was brought by ambulance to our emergency department with a reduced level of consciousness, vomiting, and abdominal pain in the early hours of the morning. Collateral history revealed that he had drunk alcohol alone the night before at his home where he lives alone. Initial examination revealed tachycardia and hypotension. Immediate resuscitation using the sepsis six protocol included intravenous normal saline, blood culture, broad-spectrum antibiotic, lactate measurement, and insertion of a urethral catheter to monitor urine output. Following contrast-enhanced computed tomography (CECT) of the abdomen and pelvis, the patient was referred to a urologist. A diagnosis of spontaneous perforation of the neobladder was made. A nonoperative or 'conservative' management approach was adopted with careful active monitoring at the intensive care unit (ICU) involving a multidisciplinary team. Follow-up CT was performed to assess radiological recovery. The patient recovered successfully and was discharged home five weeks post-admission with an indwelling urethral catheter. The catheter was removed 10 weeks post-admission following a cystogram confirming the integrity of the neobladder. The patient has preserved neobladder function and continence and is doing well until the last follow-up at six months post-discharge. Patients with neobladder should be rigorously counseled about the importance of timed voiding, intermittent self-catheter, serious consequences of solitary binge drinking, and urinary retention.

Temporal trends in lower extremity amputation in Middle East and North Africa (MENA) region: analysis of the GBD dataset 1990-2019.

BACKGROUND: Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. METHODS: The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. RESULTS: From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. CONCLUSION: The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.