Road To Deceased Donor Transplantation in Egypt.

In Egypt, there is presently a growing need to have a deceased donor transplant program. Egypt conducted its first kidney transplant from a living donor in 1976 and a first partial liver transplant in 2001. Since 2009, the Egyptian Health Authorities Combat Transplant Tourism in concordance with ethics codes and the Declaration of Istanbul Custodian Group has been in place. The Egyptian Transplantation Law of 2011 mentions that organs could be procured from deceased donors based on a will and on family consent. This law has had many critics, including religious authorities who have stressed that organs cannot be taken from a person with brain death because, in their view, life ends with death of all organs. Many intensivists disagree over the definition of death. In addition, the media has communicated contradicting and sometimes misleading health care information. Mummification is rooted in pharos practice and linked to religious beliefs. The ancient Egyptians believed that, by burying the deceased with their organs, they may rejoin with them in the afterlife. Since 2019, the transplant community in Egypt has started collaborations with international transplant organizations and campaigns with doctors and celebrities to donate their organs after death, which have stressed that a deceased donor program could help against end-stage organ mortality. In November 2022, after communications with politicians, President Abdelfattah El Sisi directed the government to establish a regional center for organ transplantation, which aimed to be the biggest in the Middle East and North Africa region. The new center will be part of a new medical city that would replace Nasser Medical Institution in Cairo, Egypt. The Ministry of Health issued an official form to be signed by a person before his death, accepting use of organs, to give hope and support to other patients in need.

Evolution of the Concept of Death.

The definition of death remains unresolved. To define death, one has to define the characteristics of a living person and to confirm whether an individual with brain death fulfils any of these characteristics. Although the concept of irreversible cessation of brain function is clear, controversy remains on the treatment of individuals with brain death and beating hearts. An individual with brain death but a beating heart is not breathing on his own and is dependent on medications and machines to maintain respiration, heartbeat, and blood pressure. Muslim scholars remain divided over the issue of whether death also means irreversible cessation of brain function. Questions remain on when it is permissible to remove vital organs for organ transplant. Groups have advocated for uniformity in law and medical practice on the definition of brain death.

Organ Donation in Syria.

The first living donor kidney transplant in Syria was performed 44 years ago; by the end of 2022, 6265 renal transplants had been performed in Syria. Kidney, bone marrow, cornea, and stem cells are the only organs or tissues that can be transplanted in Syria. Although 3 heart transplants from deceased donors were performed in the late 1980s, cardiac transplant activities have since discontinued. In 2003, national Syrian legislation was enacted authorizing the use of organs from living unrelated and deceased donors. This important law was preceded by another big stride: the acceptance by the higher Islamic religious authorities in Syria in 2001 of the principle of procurement of organs from deceased donors, provided that consent is given by a first- or second-degree relative. After the law was enacted, kidney transplant rates increased from 7 per million population in 2002 to 17 per million population in 2007. Kidney transplants performed abroad for Syrian patients declined from 25% in 2002 to <2% in 2007. Rates plateaued through 2010, before the political crisis started in 2011. Forty-four years after the first successful kidney transplant in Syria, patients needing an organ transplant rely on living donors only. Moreover, 20 years after the law authorizing use of organs from deceased donors, a program is still not in place in Syria. The war, limited resources, and lack of public awareness about the importance of organ donation and transplant appear to be factors inhibiting initiation of a deceased donor program in Syria. A concerted and ongoing education campaign is needed to increase awareness of organ donation, change negative public attitudes, and gain societal acceptance. Every effort must be made to initiate a deceased donor program to lessen the burden on living donors and to enable national self-sufficiency in organs for transplant.

Lived Religion in Religious Vaccine Exemptions.

This essay explores a more inclusive and equitable interpretation of "religion" within the context of religious vaccine exemptions. The existing literature critiques the prevalent interpretation of the meaning of religion in religious exemption cases, but frequently overlooks the importance of incorporating the concept of "lived religion." This essay introduces the concept of lived religion from religious studies, elucidates why this lived religion approach is crucial for redefining "religion," and illustrates its application in the domain of religious vaccine exemptions. The author contends that broadening the meaning of religion by employing the concept of lived religion would promote a more inclusive and equitable implementation of religious vaccine exemptions.

Nurses, Clergy, Chaplains, Parkinson's Disease, Workplace Religiosity, Women's Health and Family Issues.

This issue of JORH explores a broad range of topics looking at the professions of nursing, clergy and chaplains. This issue also concludes the series on Parkinson's disease (Part 2), and for the first time, JORH presents a collation of articles relating to workplace religiosity. Finally, this issue revisits the topics of women's health and family issues in relation to religiosity and spirituality.

Impact of Ramadan fasting on lipid profile, uric acid, and HbA1c in CKD: A systematic review and meta-analysis.

Studies have shown that fasting during Ramadan has different effects on circulating levels of several biochemical markers. This study aims to conduct a comprehensive evaluation of studies related to the effect of fasting in the holy month of Ramadan on lipid profile, uric acid, and HbA1c in CKD patients. Studies were systematically searched and collected from three databases (PubMed, Scopus, and Web of Science). After screening, the quality and risk of bias assessment of the selected articles were evaluated. Study heterogeneity was assessed using the Cochrane test and I² statistic. In case of any heterogeneity random effects model with the inverse-variance method was applied. All analyses were performed using STATA software version 16. Four observational studies were included in this study. The results of this meta-analysis were that cholesterol (Weighted mean differences (WMD):0.21 with 95% CI:-0.09-0.51 (P-value=:0.18)), LDL (WMD:0.06 with 95% CI -0.24-0.36 (P-value:0.69)), triglyceride (WMD:0.05 with 95% CI:-0.25-0.35 (P-value:0.73)) had not-significant increase. Uric acid (WMD: -0.11 with 95% CI: -0.42-0.21 (P-value:0.51)) and HbA1c (WMD: -0.22 with 95% CI: -0.79-0.36 (P-value: 0.46)) show a non-significant decrease. The results of the analyses did not report significant changes in the lipid profile, uric acid, and HbA1c in CKD patients after Ramadan fasting.

Arguments for a ban on pediatric intersex surgery: A dis/analogy with Jehovah witness blood transfusion.

This article argues for a ban on the performance of medically unnecessary genital normalizing surgeries as part of assigning a binary sex/gender to infants with intersex conditions on the basis of autonomy, regardless of etiology. It does this via a dis/analogy with the classic case in bioethics of Jehovah Witness (JW) parents' inability to refuse life-saving blood transfusions for their minor children. Both cases address ethical medical practice in situations where parents are making irreversible medical decisions on the basis of values strongly held, identity, and relationship-shaping values-such as religious beliefs or beliefs regarding the inherent value of binary sex/gender-amidst ethical pluralism. Furthermore, it takes seriously-as we must in the intersex case-that the restriction of parents' right to choose will likely result in serious harms to potentially large percentage of patients, their families, and their larger communities. I address the objection that parents' capacity to choose is restricted in the JW case on the basis of the harm principle or a duty to nonmaleficence, given that the result of parent choice would be death. I provide evidence that this is mistaken from how we treat epistemic uncertainty in the JW case and from cases in which clinicians are ethically obligated to restrict the autonomy of nonminor patients. I conclude that we restrict the parents' right to choose in the JW case-and should in the case of pediatric intersex surgery-to secure patient's future autonomy.

Digitising diabetes education for a safer Ramadan: Design, delivery, and evaluation of massive open online courses in Ramadan-focused diabetes education.

AIMS: Ramadan-focused diabetes education is critical to facilitate safer Ramadan fasting amongst Muslim people living with diabetes. We present the design, delivery, and evaluation of two parallel massive open online courses (MOOCs) in Ramadan-focused diabetes education for people with diabetes and HCPs. METHODS: Two Ramadan-focused diabetes education MOOCs were developed and delivered for Ramadan 2023: one for HCPs in English, and another for people with diabetes in English, Arabic and Malay. A user-centred iterative design process was adopted, informed by user feedback from a 2022 pilot MOOC. Evaluation comprised a mixed-methods evaluation of pre- and post-course user surveys. RESULTS: The platform was utilised by people with diabetes and their family, friends and healthcare professionals. Overall, a total of 1531 users registered for the platform from 50 countries, 809 started a course with a 48% subsequent completion rate among course starters. Qualitative analysis showed users found the course a user-friendly and authoritative information source. In the HCP MOOC, users reported improved post-MOOC Ramadan awareness, associated diabetes knowledge and ability to assess and advise patients in relation to their diabetes during Ramadan (p<0.01). CONCLUSIONS: We demonstrate the potential of MOOCs to deliver culturally tailored, high-quality, scalable, multilingual Ramadan-focused diabetes education to HCPs and people with diabetes.

"I Would Consult a Doctor, But What the Rabbi Says Goes": Ultra-Orthodox Jews' Relationships with Rabbis and Doctors in Israel.

We examine relationships among ultra-Orthodox Israeli Jews, their doctors, and rabbis when medical decisions are made. Analyzing excerpts from sixteen focus groups with 128 ultra-Orthodox Jews, we determine how their belief system affects their decisions about whom to trust and follow when the doctor's instructions contradict the rabbi's advice. We argue that the strict behaviors described here with regard to relations among doctors, rabbis, and patients, function as social capital that raises the status of ultra-Orthodox Jews as members of an exclusive club that balances health decisions with the social demand to obey their religious leaders.

A Glimpse into Gynecologic Practice During the Islamic Golden Age.

The Islamic Golden Age was the time in history from eighth to fourteenth century. This era was marked by expansion of Islamic world to all the Middle East, North Africa, South and East Europe, and Central Asia. The Islamic world was the wealthiest region in the world at that time and that wealth was utilized to promote great flourishing in the arts, philosophy, science, and medicine. The practice of healing was considered the most noble of human undertakings by Islamic scholars. In this era, many great physician-scientists emerged in the Islamic world, albeit several were not Muslims, who examined prior writings, corrected many, and proceeded to produce their own observations and innovations. This article highlights some of the most important contributions to gynecology of some prominent scholars during this shining phase of medical history.

A Framework for Examining Bioethical Issues from a Sunni Perspective: Maslaha.

All religions should develop convincing responses to emerging bioethical problems stemming from medical and technological advancements. Additionally, believers need to know their faiths' interpretations of bioethical issues to be able to make medical decisions in line with their religious values. Therefore, Islamic bioethics should provide Muslims with conclusive and credible answers regarding newly rising problems in health care by revisiting the religious norms and decrees. However, the diversity in the Islamic denominations, the traditionalist aspect of the Sunni jurisprudence demanding strict compliance with the scriptural texts, the lack of unanimously accepted authority, and the limited number of academic works in Islamic bioethics (at least in English) complicate exploring new standards or rules for new ethical matters. In this view, the present paper aims to delineate two primary Islamic theological schools and propose al-Ghazali's maslaha as a general framework to analyze bioethical issues in the Sunni tradition. Maslaha allows exercising discretion in light of the protection of five fundamental values: religion, life, reason, lineage, and property. Maslaha has the potential to enable Sunni Muslims to appraise contemporary ethical questions, concerns, and dilemmas through an Islamic view and make more autonomous decisions by having religious guidelines.

Mental Health During Crisis: Development and Evaluation of the Post-disaster Spiritual Coping Scale in Turkey.

This research presents the detailed development of the post-disaster spiritual coping scale, which aims to evaluate post-disaster spiritual coping processes. The study's first step in developing the scale has been to review the literature on the effects disasters have on the lives of individuals alongside spiritual coping's role in this process. The study has also taken into account the steps required when developing a scale. Data were initially collected from individuals who'd experienced the February 6 Kahramanmaras earthquake, after which the scale items were created. In line with expert opinions, a pilot application of the scale was applied before the items took their final form. During the data collection phase, data were collected three times (N1 = 388, N2 = 194, N3 = 94). Exploratory factor analysis (EFA) was then performed, and the scale was concluded to consist of one dimension and 13 items. Afterward, confirmatory factor analysis (CFA) was performed over the 13-item scale, confirming the results from the previous analysis. The CFA results also showed acceptable goodness-of-fit values to have been obtained (χ2/df = 2.200; RMSEA = 0.061; SRMR = 0.024; CFI = 0.933; GFI = 0.908). At the same time, each item in the scale was concluded to have a sufficient loading value. As a result of the analysis of internal consistency for the scale, Cronbach's alpha was found to be 0.950. Significant values were also obtained as a result of the criterion validity analysis for the developed scale. In conclusion, the final version of the post-disaster spiritual coping scale has been developed and validated, with the reliability and validity coefficients of the scale being found sufficient. This scale can be used as a powerful tool for evaluating the spiritual coping mechanisms of individuals who are being affected by disaster.

Spiritual Coping in Family Caregivers of Patients With Advanced Cancer: A Cross-Sectional Study.

CONTEXT: Family caregivers face significant challenges when providing care to individuals with advanced cancer. Spiritual coping strategies may support caregivers in addressing these challenges. OBJECTIVES: We evaluated spiritual coping levels among Chinese family caregivers of patients with advanced cancer and explored associated factors. METHODS: This cross-sectional study recruited 358 family caregivers of patients with advanced cancer. The Spiritual Coping Scale was used to evaluate spiritual coping levels, while various scales, including the Caregiver Reaction Assessment Scale, General Self-Efficacy Scale-Schwarzer, and Perceived Social Support Scale, were used to identify influencing factors. T-tests and analysis of variance were used for group comparisons. Pearson's correlation and multivariate linear regression were used to analyze the associated factors. RESULTS: Chinese family caregivers of patients with advanced cancer had moderate spiritual coping levels. Differences in spiritual coping levels were observed in sex, religion, and the presence or absence of anxiety and depression (p < 0.05). Women and caregivers who identified as religious had higher levels, while those with anxiety or depression had lower levels. Spiritual coping was positively correlated with self-efficacy and spiritual health (p < 0.01). Multiple linear regression analysis revealed that religion, anxiety, depression, self-efficacy, and spiritual health were statistically significant associated factors for spiritual coping scores, explaining 43.3% of the variance in scores (F = 53.769, p < 0.001). CONCLUSION: The spiritual coping of Chinese family caregivers should be considered by health care providers, who should focus on alleviating their anxiety and depression while improving self-efficacy and spiritual health, especially among nonreligious caregivers.

Aporte espiritual/religioso pela enfermagem no tratamento do câncer de mama: revisão integrativa / Spiritual/religious support for nursing in the treatment of breast cancer: integrative review / Apoyo espiritual/religioso de la enfermería en el tratamiento del cáncer de mama: revisión integrativa

Objetivo: analisar na literatura científica a importância da abordagem espiritual/religiosa pela equipe de enfermagem no tratamento do câncer de mama. Método: revisão integrativa, realizada na BDENF, LILACS e SCOPUS. Resultados: foram selecionados seis estudos, evidenciou-se que a abordagem espiritual/religiosa pelos profissionais de enfermagem auxilia para o enfrentamento positivo do câncer de mama. Assim, emergiu a categoria.: Abordagem espiritual/religiosa na assistência de enfermagem e suas repercussões positivas para o enfrentamento do câncer de mama. Conclusão: a categoria da enfermagem integra a rede de apoio social para o alívio do sofrimento, por meio do aporte espiritual/religioso, auxiliando para a minimização de sentimentos negativos associados ao diagnóstico e aos eventos adversos dos tratamentos, sendo importante incluir discussões acerca desta temática na formação de nível técnico e graduação em enfermagem.

Objective: to analyze in the scientific literature the importance of the spiritual/religious approach by the nursing team in the treatment of breast cancer. Method: integrative review, carried out in BDENF, LILACS and SCOPUS. Results: six studies were selected, showing that the spiritual/religious approach by nursing professionals helps to cope positively with breast cancer. Thus, the following category emerged: Spiritual/religious approach in nursing care and its positive repercussions for coping with breast cancer. Conclusion: the nursing category is part of the social support network for relieving suffering, through spiritual/religious support, helping to minimize negative feelings associated with the diagnosis and adverse treatment events, and it is important to include discussions on this topic in technical and undergraduate nursing training.

Objetivos:analizar la importancia del abordaje espiritual/religioso por el equipo de enfermería en el tratamiento del cáncer de mama en la literatura científica. Método: revisión integradora, realizada en BDENF, LILACS y SCOPUS. Resultados: fueron seleccionados seis estudios que demuestran que el abordaje espiritual/religioso por profesionales de enfermería ayuda a enfrentar positivamente el cáncer de mama. Surgió la siguiente categoría: Enfoque espiritual/religioso en los cuidados de enfermería y sus repercusiones positivas para el afrontamiento del cáncer de mama. Conclusión: la categoría de enfermería forma parte de la red de apoyo social para aliviar el sufrimiento, a través del apoyo espiritual/religioso, ayudando a minimizar los sentimientos negativos asociados al diagnóstico y a los eventos adversos de los tratamientos, siendo importante incluir discusiones sobre este tema en la formación técnica y de pregrado de enfermería.

Psychological disorders and coping strategies in patients with inflammatory bowel disease. Their impact on health-related quality of life

Background and objectives: inflammatory bowel disease (IBD) has a major impact on psychological well-being. This condition is associated with a high level of anxiety and mood disorders, but stress prevalence and how an individual copes with IBD have not been sufficiently explored. The objective of this study was to assess the impact of the disease on psychological disorders and to identify coping strategies used by patients with IBD, as well as to analyze the relationship between these variables and sociodemographic and clinical variables. Methods: a cross-sectional prospective study was performed including 126 consecutive patients. Those with psychiatric conditions prior to the onset of the IBD were excluded. Independent variables were measured using a sociodemographic and clinical questionnaire. The patients completed the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale (PSS) and the BRIEF COPE questionnaire. Quality of life was measured using the nine-item IBD Quality of Life (IBDQ-9). Results: the final cohort comprised 100 patients (37 with ulcerative colitis and 63 with Crohn’s disease). The prevalence rates of the variables of stress, anxiety and depression were high (44 %, 24 % and 14 %, respectively). Stress and depression were higher in females (p < 0.05), without differences regarding other sociodemographic and clinical variables. Moreover, higher levels of anxiety and depression were found to be associated with stress and dysfunctional coping strategies (p < 0.01). Conclusions: patients with IBD, particularly women, have high rates of psychological disorders. Those with anxiety and depression presented more stress and used more dysfunctional strategies. These conditions must be considered for a multidisciplinary management. (AU)

¿Dios mío, por qué me has abandonado? Estrés, ansiedad, depresión y afrontamiento religioso en los estudiantes de Medicina / God, why have you forsaken me? Stress, anxiety, depression and religious-coping in medical students

Antecedentes: los estudiantes de Medicina presentan niveles elevados de estrés, ansiedad y depresión. El afrontamiento religioso es una vía para entender y enfrentarse a eventos negativos en la vida que están relacionados con lo sagrado. Existen diversos estudios de asociación entre el afrontamiento religioso y los niveles de estrés, ansiedad y depresión. El objetivo del estudio fue determinar la influencia del afrontamiento religioso sobre el estrés, ansiedad y depresión en los estudiantes de Medicina de la Universidad Andina del Cusco. Métodos: estudio transversal analítico, en 317 estudiantes de Medicina de la Universidad Andina del Cusco. Se utilizó la Escala de depresión, ansiedad y estrés (DASS-21) para medir los estados estresantes y la Escala abreviada de afrontamiento religioso (Brief RCOPE), para determinar niveles de afrontamiento religioso positivo y negativo. Para la expresión de los resultados se calcularon prevalencias y frecuencias, correlación de Spearman y chi cuadrado, valor de p y el IC al 95%. Se incluyó a todos los estudiantes de Medicina que dieron su consentimiento informado y que cursaron de manera regular el ciclo académico 2020-I. Resultados: el 51,5% fueron del sexo femenino. El promedio de edad fue de 21,31 años. El 66,2% obtuvieron puntajes de depresión-moderada, severa o extremadamente-severa, el 70,9% obtuvo puntajes de ansiedad-moderada, severa o extremadamente-severa y el 42,3% presentó estrés-moderado, severo o extremadamente-severo. El afrontamiento religioso negativo tuvo una relación positiva muy significativa con el estrés, ansiedad y depresión. Interpretación: el afrontamiento religioso negativo se asoció significativa (<0,001) y positivamente con el estrés (0,252), ansiedad (0,304) y depresión (0,357), con una potencia alta (>0,5). El estudio tiene implicaciones clínicas y de salud pública.(AU)

Background: Medical students present with elevated levels of stress, anxiety, and depression. Religious coping is an avenue for understanding and coping with negative life events that are related to the sacred. There are several studies of association between religious coping and levels of stress, anxiety and depression. The aim of the study was to determine the influence of religious coping on stress, anxiety and depression in medical students of the Universidad Andina del Cusco. Methods: Analytical cross-sectional study in 317 medical students of the Universidad Andina del Cusco. The Depression, Anxiety and Stress Scale (DASS-21) was used to measure stressful states and the Abbreviated Religious Coping Scale (Brief RCOPE) to determine levels of positive and negative religious coping. For the expression of the results, prevalence and frequencies, Spearman's correlation and chi-square, p-value and 95% CI were calculated. All medical students who gave their informed consent and who regularly attended the 2020-I academic year were included. Results: Of the participants, 51.5% were female. Mean age was 21.31 years. The 66.2% obtained scores of depression-moderate, severe or extremely-severe, 70.9% obtained scores of anxiety-moderate, severe or extremely-severe and 42.3% presented stress-moderate, severe or extremely-severe. Negative religious coping had a highly significant positive relationship with stress, anxiety and depression. Interpretation: Negative religious coping was significantly (<0.001) and positively associated with stress (0.252), anxiety (0.304) and depression (0.357), with high power (>0.5). The study has clinical and public health implications.(AU)

[Islam and assisted reproduction treatments: an empirical study on the relationship between science and religion in Tangier and Barcelona.] / El islam ante los tratamientos de reproducción asistida: un estudio empírico sobre la relación entre ciencia y religión en Tánger y Barcelona.

In recent decades there have been significant developments in assisted reproduction techniques, which have aided couples with difficulties in having children. These techniques have been well received in different parts of the world, and Muslim countries have been no exception. Adopting sociologist Michèle Lamont's theoretical perspective on "boundaries", semi-structured interviews were conducted with 20 health professionals and Islamic community leaders in the cities of Tangier and Barcelona during 2022. The aim of this article is twofold: first, to analyze how key actors in the Muslim community conceive of the relationship between Islam and science; second, to explain how this understanding is negotiated in relation to assisted reproduction treatments. The article concludes with a consideration of the complexities related to drawing the line between the positions of science and religion, and emphasized the importance of examining empirical cases in order to better capture the complex relationship between these two spheres and gain a deeper understanding of existing bioethical debates.

En las últimas décadas hubo un desarrollo significativo de técnicas de reproducción asistida que ayudaron a parejas con dificultades a tener hijos. Estas técnicas han sido bien recibidas en diferentes partes del mundo, y los países musulmanes no han sido una excepción. Desde la perspectiva teórica de la socióloga Michèle Lamont basada en las fronteras o "boundaries", en el año 2022 se realizaron entrevistas semiestructuradas a 20 profesionales de la salud y líderes de asociaciones musulmanes de Tánger y Barcelona, con el objetivo de analizar, en primer lugar, cómo actores claves musulmanes conciben la relación entre islam y ciencia y; en segundo lugar, cómo se negocia esta comprensión en el caso de los tratamientos de reproducción asistida. Se concluye sobre la complejidad de la delimitación de fronteras en las definiciones de ciencia y religión, y se destaca la importancia de centrarse en casos empíricos para comprender mejor la compleja relación entre los dos ámbitos y entender los debates bioéticos existentes.