Physical properties and thermodynamic characteristics of hydrogen.

This paper discusses the use of hydrogen in various industries and energy sectors. It focuses on studying the properties and characteristics of hydrogen, which serves as a key factor in determining its potential in various applications. Such aspects of hydrogen application as environmental friendliness as well as utilization efficiency and safety are considered. The widespread use of hydrogen as a universal environmentally friendly energy carrier, raw material and fuel will successfully solve many significant ecological, energy and technological problems. The most important physical and chemical properties and thermodynamic characteristics of hydrogen described in the paper make it possible to choose among existing technologies or focus on developing new ones that will ensure high efficiency of its utilization not only at present but also in future. The information presented in the paper can be used for reference.

Effects of Intrahypothalamic Administration of microRNA Inhibitors and Mimetics on Blood Plasma Biomarkers in the Rat Aging.

The effect of let-7a-5p, miR-9a-3p, miR-132-3p, miR-218a-5p microRNA inhibitors and mimetics, when administered into the dorsomedial nucleus of the hypothalamus (DMN), on the markers of age-related changes in blood plasma in 3-month-old and 24-month-old male rats was studied. In the 24-month-old control rats, the content of C-reactive protein (CRP) increased, and the level of myoglobin decreased compared to the 3-month-old animals. After te administration of miRNA inhibitors, the level of CRP significantly increased, and the content of myoglobin decreased, and after the administration of miRNA mimetics, opposite changes were observed. We found no significant differences in the content of somatotropic hormone and testosterone between the control and experimental groups, as well as between the 3-month-old and 24-month-old animals.

Perceptions of burnout among public sector physicians in Sierra Leone: A qualitative study.

In Sierra Leone, physicians face a high risk of burnout due to systemic challenges, with studies suggesting a gap in recognizing and addressing this condition. We explored public-sector physicians' experiences and perceptions of the organizational structures and characteristics needed to help them thrive in a resource-limited practice setting. We conducted in-depth, semi-structured interviews with 24 public sector physicians across Western Area Urban (Freetown), Bo, Kono, and Kambia districts in Sierra Leone. Thematic content analysis was carried out using both deductive and inductive techniques to generate codes and identify key themes. Physicians in Sierra Leone face multifaceted challenges that significantly impact both healthcare delivery and personal well-being. Our findings reveal that overwhelming workload and stringent schedules contribute to burnout, directly compromising patient care quality. The emotional burden of caring for patients with economic constraints in accessing treatment further exacerbates physician stress. Limited resources, such as insufficient medical supplies and personnel, foster a sense of helplessness among clinicians, leading to detachment and cynicism towards their ability to effect change. In the absence of formal institutional support, physicians often rely on peer support to manage burnout. These challenges collectively undermine physicians' ability to provide optimal care, as the emotional and physical toll affects their decision-making and engagement with patients. Within Sierra Leone's resource-constrained healthcare context, systemic reforms are necessary to address the root causes of physician burnout, and to improve patient care. Our findings suggest that implementing formal support structures, including counselling services and mentorship programs, is crucial. Improving working conditions through better resource allocation and infrastructure development is essential. Developing strategies to address the emotional burden of care, including robust training programs, could enhance physician well-being, reduce burnout, and consequently improve the overall quality of patient care in Sierra Leone's public health sector.

MRSA Inhibitory Activity of Some New Pyrazolo[1,5-a]pyrimidines Linked to Arene and/or Furan or Thiophene Units.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major contributor to hospital-acquired infections and is highly resistant to treatment. Ongoing research focuses on developing new antimicrobial medications to prevent the spread of resistance. A facile method was employed to efficiently synthesize new pyrazolo[1,5-a]pyrimidines in 84-93% yields by reacting 4-benzyl-1H-pyrazole-3,5-diamine with the respective α,ß-unsaturated ketones. The reaction was carried out in ethanol containing 1.2 equivalents of potassium hydroxide at reflux for 5-6 h. The new products are attached to a para-substituted aryl group with variable electronic properties at pyrazolopyrimidine-C5, in addition to one of three units at C7, namely phenyl, thiophen-2-yl, or furan-2-yl units. A wide spectrum of antibacterial activity was displayed by the new pyrimidines against six different bacterial strains. In general, pyrimidines attached to furan-2-yl units at C7, in addition to another aryl unit at C5, attached to 4-Me or 4-OMe groups, demonstrate significant antibacterial activity, particularly against S. aureus strain. They had MIC/MBC of 2.5/5.1 and 2.4/4.9 µM, respectively, which exceeded that of ciprofloxacin. Moreover, they demonstrate more effective MRSA inhibitory activity than linezolid, with MIC/MBC values up to 4.9/19.7 and 2.4/19.7 µM against MRSA ATCC:33591 and ATCC:43300 strains, respectively.

PBPK modeling of recombinant factor IX Fc fusion protein (rFIXFc) and rFIX to characterize the binding to type 4 collagen in the extravascular space.

Patients with severe and sometimes moderate hemophilia B are prophylactically treated with factor IX concentrates to prevent bleeding. For some time now, various extended terminal half-life (EHL) recombinant factor IX concentrates are available allowing less frequent administration during prophylaxis in comparison to standard half-life recombinant FIX (rFIX). Especially, recombinant FIX-Fc fusion protein (rFIXFc; Alprolix®) exhibits a rapid distribution phase, potentially due to binding to type IV collagen (Col4) in the extravascular space. Studies suggest that the presence of extravascular rFIXFc is protective against bleeding as without measurable FIX activity in plasma, and no extra bleeding seems to occur. The physiologically based pharmacokinetic (PBPK) model for rFIXFc which we describe in this study, is able to accurately predict the observed concentration-time profiles of rFIXFc in plasma and is able to quantify the binding of rFIXFc to Col4 in the extravascular space after an intravenous dose of 50 IU/kg rFIXFc in a male population. Our model predicts that the total AUC of rFIXFc bound to Col4 in the extravascular space is approximately 19 times higher compared to the AUC of rFIXFc in plasma. This suggests that rFIXFc present in the extravascular compartment may play an important role in achieving hemostasis after rFIXFc administration. Further studies on extravascular distribution of rFIXFc and the distribution profile of other EHL-FIX concentrates are needed to evaluate the predictions of our PBPK model and to investigate its clinical relevance.

Distribution and species composition of potato viruses in the Novosibirsk region.

Among the many diseases that affect potato plants, viral infections are the most common and cause significant damage to farms, affecting both the yield and quality of potatoes. In this regard, an important condition for preserving the potato seed fund in Russia is systematic monitoring and early highly specific detection of potato viral infections. The purpose of the work is to study samples of potato varieties collected in the Novosibirsk region for the presence of viral infections using RT-PCR. 130 potato plants from three districts of the Novosibirsk region (NR) were studied. As a result of monitoring, the following viruses were identified: PVY (potato virus Y), PVS (potato virus S), PVM (potato virus M) and PVX (potato virus X). The quarantine pathogen potato spindle tuber viroid (PSTVd) was not detected in any of the samples analyzed. The maximum frequency of occurrence in the region was noted for three viruses: PVY, PVM and PVS. A significant proportion of the samples were mixed viral infections: the occurrence of the combination of infection PVY + PVM in plants was 25.0 %, and PVY + PVS, 22.6 %. To develop methods for determining the strain affiliation of the studied samples, the nucleotide sequences of the capsid protein genes of 10 Y-virus isolates were sequenced. Phylogenetic analysis of the studied sequences of NR isolates was carried out with a set of sequences of reference strains 261-4, Eu-N, N:O, NE-11, NTNa, NTNb, N-Wi, O, O5, SYR_I, SYR_II and SYR_III retrieved from GenBank. As a result of phylogenetic analysis, it was established that NR viral samples fell into two groups of strains: group 1, which also includes isolates of the reference strains 261-4/SYR_III, and group 2, NTNa. The obtained results of the strain affiliation of NR samples lay the basis for the development of DNA and immunodiagnostic systems for identifying PVY circulating in NR, as well as for elucidating the source and routes of entry of specific virus strains.Key words: Solanum tuberosum; viral infections; RT-PCR; potato Y virus; phylogenetic analysis.

Wear characteristics of zirconia-toughened epoxy/Kevlar-honeycomb composite lining for drilling casing.

Casing wear is a persistent issue in oil and gas drilling facilities that call for innovative more wear-resistant materials to mitigate casing failures. The present work examines the tribological performance of a novel composite lining comprised of Kevlar honeycomb in a matrix of epoxy reinforced with Zirconia particles against hardband drillpipe tooljoint (DP-TJ). Three side loads (1000, 1200, and 1400 N) and three DP-TJ speeds (0.43, 0.76, and 1.02 m/s) were considered under dry sliding conditions. The results showed that the specific wear rate (K) increased with speed at all side loads. However, K value was found to reach a maximum, reaching 20.3*10-8 MPa-1 at 1200 N before dropping to about 8.5*10-8 MPa-1 when the load is increased to 1400 N. This decline in specific wear rate at the load of 1400 N was attributed to the growth of a double transfer layer through the alignment of zirconia particles in the lining. The scanning electron microscope (SEM) images of worn surfaces revealed that higher K values are associated with more adhesion, delamination, and fiber breakage. Energy dispersive spectroscopy (EDS) and X-ray diffraction (XRD) analysis of the worn surface and the debris collected after the wear test reveals minimal wear of DP-TJ. The epoxy/Kevlar-honeycomb composite lining demonstrated appreciable wear resistance even under dry sliding conditions.

Risk factors and outcome of hepatitis C infection among patients in a secondary care hospital: A 5-year retrospective study.

BACKGROUND: Hepatitis C virus (HCV) infection, predominantly transmitted by exposure to infected blood, remains one of the major public health problems worldwide. This study aims to identify the risk factors of HCV transmission and its chronic complications among the study group. MATERIALS AND METHODS: This retrospective study was approved by the Research and Ethical Review and Approve Committee (RERAC) of Oman and conducted at a secondary-care hospital situated in the North Batinah region of Oman. The study population included all HCV cases confirmed by positive serology and reverse-transcription polymerase chain reaction tests during their presence at the hospital between January 2017 and December 2022. The relevant data of the study population were retrieved from the hospital electronic health record system. The data were analyzed using the Statistical Package for the Social Sciences (SPSS), Version 26.0. RESULTS: A total of 177 HCV confirmed cases were included in the study. HCV infection was predominant among males (74%) and individuals of the age group of 21-60 years (74.6%). Genotyping was possible only in 107 cases. Among HCV genotypes, genotype 3 (58.9%) was the most frequently identified, followed by genotype 1 (34.6%). Hemodialysis (21.5%), history of blood transfusion (16.4%), and injection drug use (11.9%) were the major risk factors for HCV infection, while cirrhosis (7.3%) and fatty liver disease (4%) were the most frequently observed chronic HCV complications. HCV infection in the spouse/partner (21.5%), alcohol use (7.3%), and co-infection with hepatitis B virus (2.3%) and human immunodeficiency virus (1.7%) were the other significant factors detected in our study population. CONCLUSIONS: HCV is a multi-factorial disease leading to severe chronic complications, thus representing a public health threat. This clearly emphasizes the cruciality of HCV community awareness campaigns and enhancement of Omani national guidelines for early screening of high-risk groups as well as effective management of HCV-infected cases to reduce the substantial burden of the disease on patients as well as the healthcare system.

A systematic review of recent advances in urinary tract infection interventions and treatment technology.

OBJECTIVE: Urinary tract infection is one of the most common extraintestinal infectious diseases encountered in clinics. It affects both genders and all age groups and constitutes a major health issue in clinical practice worldwide. Uropathogens often develop resistance to therapeutic agents, creating a formidable challenge for physicians to treat these infections. The goal of the current review is to provide current information on therapeutic advancements and interventions in the treatment of urinary tract infections. MATERIALS AND METHODS: Databases like MEDLINE, PubMed, and ClinicalTrials.gov were used as search engines to collect the relevant articles, and the required information was extracted. RESULTS: Research data suggest an increasing prevalence of pathogenic strains that are resistant to standard antimicrobial regimens recommended for the treatment of urinary tract infections. Targeted therapies for urinary tract infections, such as mannosides and pilicides, as well as vaccinations against uropathogenic Escherichia coli, have been developed recently. The efficacy of other strategies like iontophoresis, hydrogel-coated catheters, and antibiofilm therapy is also investigated. Clinical trials conducted between 2014 and 2019 show a rise in interest in a variety of therapies, highlighting the need for a thorough strategy to treat urinary tract infections, particularly in populations of women. CONCLUSIONS: Antimicrobial-resistant strains of Escherichia coli are becoming more common in urinary tract infections, which have led to the development of targeted medicines such as mannosides and pilicides, as well as immunizations against the pathogenic Escherichia coli strains. There is continuing research into alternate approaches, such as hydrogel-coated catheters, antibiofilm therapy, and iontophoresis. Clinical trials conducted between 2014 and 2019 showed a rise in interest in these different treatment approaches.

Ebi3 Binding to IFN-γ and IL-10 Limits Their Function.

EBV-induced gene 3 (Ebi3) is a ß subunit within the IL-12 cytokine family that canonically binds to α subunits p19, p28, or p35 to form the heterodimeric cytokines IL-39, IL-27, and IL-35, respectively. In the last decade, the binding partners for Ebi3 have continued to expand to include IL-6 and the other IL-12 family ß subunit p40, revealing the possibility that Ebi3 may be able to bind to other cytokines and have distinct functions. We first explored this possibility utilizing an in vivo mouse model of regulatory T cell-restricted deletions of the subunits composing the cytokine IL-35, p35, and Ebi3, and we observed a differential impact on CD8+ T cell inhibitory receptor expression despite comparable reduction in tumor growth. We then screened the ability of Ebi3 to bind to different cytokines with varying structural resemblance to the IL-12 family α subunits. These in vitro screens revealed extracellular binding of Ebi3 to both IFN-γ and IL-10. Ebi3 bound to IFN-γ and IL-10 abrogated signal transduction and downstream functions of both cytokines. Lastly, we validated that extracellular complex formation after mixing native proteins resulted in loss of function. These data suggest that secreted partnerless Ebi3 may bind to cytokines within the extracellular microenvironment and act as a cytokine sink, further expanding the potential immunological impact of Ebi3.

Periprocedural Assessment of Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement Using Diastolic Delta and Videodensitometry.

BACKGROUND: Paravalvular regurgitation (PVR) is a common complication after transcatheter aortic valve replacement, posing an increased risk of heart failure and mortality. Accurate intraprocedural quantification of PVR is challenging. Both hemodynamic indices and videodensitometry can be used for intraprocedural assessment of PVR. We compared the predictive value of the isolated versus combined use of the hemodynamic index diastolic delta (DD) and videodensitometry for the incidence of relevant PVR 1 month after transcatheter aortic valve replacement. METHODS AND RESULTS: In this prospective cohort study, patients underwent periprocedural PVR assessment by DD and videodensitometry (using left ventricular outflow tract-aortic regurgitation [LVOT-AR]). Cardiac magnetic resonance served as reference modality for PVR assessment. Relevant PVR was defined as cardiac magnetic resonance-regurgitant fraction >20%. Fifty-one patients were enrolled in this study. Mean age was 80.6±5.2 years and 45.1% of patients were men. Mean LVOT-AR and cardiac magnetic resonance-regurgitant fraction were 8.2%±7.8% and 11.7%±9.6%, respectively. The correlation between DD and LVOT-AR was weak (r=-0.36). DD and LVOT-AR showed a comparable accuracy to predict relevant PVR (area under the curve 0.82, 95% CI: 0.69-0.95 versus area area under the time-density curve 0.80, 95% CI: 0.62-0.99). The combination of DD and LVOT-AR improved the prediction of relevant PVR (area under the time-density curve, 0.90, 95% CI: 0.81-0.99), and resulted in an increased concordance (86.3%) and positive predictive value (75%) compared with DD alone (76.5% and 40%, respectively), or LVOT-AR alone (82.3% and 50%, respectively). CONCLUSIONS: DD and videodensitometry are both accurate and feasible modalities for the assessment of PVR after transcatheter aortic valve replacement. The synergistic use of both techniques increases the predictive value for relevant PVR after transcatheter aortic valve replacement. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04281771.

Synthesis and evaluation of nanosized aluminum MOF encapsulating Umbelliferon: assessing antioxidant, anti-inflammatory, and wound healing potential in an earthworm model.

Nanoporous aluminum metal-organic framework (Al-MOF) was synthesized via solvothermal methods and employed as a carrier matrix for in vitro drug delivery of Umbelliferon (Um). The encapsulated Um was gradually released over seven days at 37 °C, using simulated body fluid phosphate-buffered saline (PBS) at pH 7.4 as the release medium. The drug release profile suggests the potential of Al-MOF nanoparticles as effective drug delivery carriers. Structural and chemical analyses of Um-loaded Al-MOF nanoparticles (Um-Al MOF) were conducted using Fourier-transform infrared (FTIR) spectroscopy, X-ray diffractometry (XRD), and ultraviolet-visible (UV-Vis) spectroscopy. Thermal gravimetric analysis (TGA) was employed to investigate the thermal stability of the Al-MOF nanoparticles, while Transmission Electron Microscopy (TEM) was utilized to assess their morphological features. Um-Al MOF nanoparticles demonstrated notable antioxidant and anti-inflammatory properties compared to Um and Al-MOF nanoparticles individually. Moreover, they exhibited significant enhancement in wound healing in an earthworm model. These findings underscore the potential of Al-MOF nanoparticles as a promising drug delivery system, necessitating further investigations to explore their clinical applicability.

[Palliative care in practice]. / Palliatieve zorg in de praktijk.

In palliative care patient problems often are complex and have elements that relate to more than one dimension and therefore require a multidisciplinary approach.In this article the methodical approach of "palliative reasoning" is described, which helps to analyse, treat and follow up complex patient problems in the palliative phase. Furthermore, tips, general recommendations and treatment options are described based on existing Dutch clinical practice palliative care guidelines, literature and expert opinion.

Adaptive Deep Brain Stimulation in Parkinson's Disease: A Delphi Consensus Study.

Importance: If history teaches, as cardiac pacing moved from fixed-rate to on-demand delivery in in 80s of the last century, there are high probabilities that closed-loop and adaptive approaches will become, in the next decade, the natural evolution of conventional Deep Brain Stimulation (cDBS). However, while devices for aDBS are already available for clinical use, few data on their clinical application and technological limitations are available so far. In such scenario, gathering the opinion and expertise of leading investigators worldwide would boost and guide practice and research, thus grounding the clinical development of aDBS. Observations: We identified clinical and academically experienced DBS clinicians (n=21) to discuss the challenges related to aDBS. A 5-point Likert scale questionnaire along with a Delphi method was employed. 42 questions were submitted to the panel, half of them being related to technical aspects while the other half to clinical aspects of aDBS. Experts agreed that aDBS will become clinical practice in 10 years. In the present scenario, although the panel agreed that aDBS applications require skilled clinicians and that algorithms need to be further optimized to manage complex PD symptoms, consensus was reached on aDBS safety and its ability to provide a faster and more stable treatment response than cDBS, also for tremor-dominant Parkinson's disease patients and for those with motor fluctuations and dyskinesias. Conclusions and Relevance: Despite the need of further research, the panel concluded that aDBS is safe, promises to be maximally effective in PD patients with motor fluctuation and dyskinesias and therefore will enter into the clinical practice in the next years, with further research focused on algorithms and markers for complex symptoms.

Acutely blocking excessive mitochondrial fission prevents chronic neurodegeneration after traumatic brain injury.

Progression of acute traumatic brain injury (TBI) into chronic neurodegeneration is a major health problem with no protective treatments. Here, we report that acutely elevated mitochondrial fission after TBI in mice triggers chronic neurodegeneration persisting 17 months later, equivalent to many human decades. We show that increased mitochondrial fission after mouse TBI is related to increased brain levels of mitochondrial fission 1 protein (Fis1) and that brain Fis1 is also elevated in human TBI. Pharmacologically preventing Fis1 from binding its mitochondrial partner, dynamin-related protein 1 (Drp1), for 2 weeks after TBI normalizes the balance of mitochondrial fission/fusion and prevents chronically impaired mitochondrial bioenergetics, oxidative damage, microglial activation and lipid droplet formation, blood-brain barrier deterioration, neurodegeneration, and cognitive impairment. Delaying treatment until 8 months after TBI offers no protection. Thus, time-sensitive inhibition of acutely elevated mitochondrial fission may represent a strategy to protect human TBI patients from chronic neurodegeneration.

Advances and challenges in the fractionation of edible oils and fats through supercritical fluid processing.

Petrochemical solvents are widely used for the extraction and fractionation of biomolecules from edible oils and fats at an industrial scale. However, owing to its safety concerns, toxicity, price fluctuations, and sustainability, alternative solvents and technologies have been actively explored in recent years. Technologies, such as ultrasound and microwave-assisted extraction, supercritical carbon dioxide extraction, supercritical fluid fractionation, and sub-critical water extraction, and solvents, like ionic liquids and deep eutectic solvents, are reported for extraction and fractionation of biomolecules. Among them, supercritical carbon dioxide extraction and fractionation are some of the most promising green technologies with the potential to replace petrochemical-based conventional techniques. The addition of cosolvents, such as water, ethanol, and acetone, improves the extraction of amphiphilic and polar compounds from edible oils and fats. Supercritical fluid processing has diverse applications, including concentration of solutes, selective separation of desired molecules, and separation of undesirable compounds from the feed material. Temperature, pressure, particle size, porosity, flow rate, solvent-to-feed ratio, density, viscosity, diffusivity, solubility, partition coefficient, and separation factor are the fundamental factors governing the extraction and fractionation of desired biomolecules from lipids. Supercritical fluids stand alone compared to conventional fluids, because of their tunable solvent properties. Overall, it is to be noted that supercritical fluid-based methods have lots of scope to replace conventional solvent-based methods and progress toward the creation of sustainable food-processing techniques. This review critically evaluates the parameters responsible for the extraction and fractionation of biomolecules from edible oils and fats under supercritical conditions.

Family strategies for managing childhood cancer: Using traditional and complementary medicine in Southern Egypt.

BACKGROUND AND PURPOSE: The use of traditional and complementary medicine (T&CM) is common in children with cancer globally. We aimed to assess the prevalence, types, reasons, perceived effectiveness, and disclosure rate of T&CM use among children with cancer in Southern Egypt. We also investigated whether T&CM use contributed to delays in initial presentation and treatment. MATERIALS AND METHODS: A cross-sectional design was utilized. Data were collected via an interviewer-administered questionnaire. Eligible children and their caregivers at the South Egypt Cancer Institute were invited to participate. RESULTS: Eighty-six children completed the study (response rate = 86%). T&CM use was reported by 52 (60.5%) patients, with six (11.5%) experienced delayed presentation. The reasons for T&CM use were complementary for 37 (71%) and alternative for 15 (29%) of the participants. The types of T&CM used included herbal (63%), nutritional (33%), witchcraft (29%), and religious (19%) therapies. Approximately 48% of users employed multiple T&CM types. Family members recommended T&CM for 60% of the users. Most patients (65%) perceived T&CM as effective, with 71% initiating its use during the early phases of treatment. Almost all participants (98%) reported that healthcare providers did not inquire about T&CM use. T&CM usage was more prevalent among wealthier families (p = .023). There was no significant relationship between T&CM use and patient gender, diagnosis, residence, or paternal educational level. CONCLUSIONS: The significant utilization of T&CM among children with cancer highlights the need for healthcare providers to engage in open and early discussions with families regarding T&CM use.

Healing of leprosy-associated chronic plantar wounds with a novel biomembrane containing latex proteins from Calotropis procera.

Pre-clinical assays demonstrated that a 1% polyvinyl alcohol biomembrane containing latex proteins (10%) from the medicinal plant Calotropis procera was biocompatible and stimulated healing of incisional and excisional wounds in murine models, and the mechanistic aspects were established. The efficacy of the biomembrane (BioMemCpLP) to promote healing of chronic ulcers in leprosy patients was investigated. The study started with 28 volunteers. Five were excluded later due to different disconformities. Ulcers from 15 patients were continuously treated with BioMemCpLP for 56 days. Five patients were treated only with silver sulfadiazine and three patients received plain hydrocolloid wound dressings with high absorption capacity. In all cases, wound dressings were renewed three times a week for 56 days and ulcers were evaluated weekly for contraction and healing progress. The extent of the healed area in the ulcers treated with BioMemCpLP was greater than in the control groups. Approximately 88% of ulcers treated with BioMemCpLP were fully healed before day 56, against 6% in both control groups. This result was not correlated with age/gender, duration or location of ulcers, deformity or whether or not the patient was cured of leprosy. The results showed that BioMemCpLP was beneficial for treatment of ulcers suffered by leprosy patients without noticeable side effects.

Health professionals' views and experiences of breaking bad news in the Eastern Mediterranean Region: a scoping review.

Introduction: Breaking bad news is a critical yet challenging aspect of healthcare that requires effective communication skills, empathy, and cultural sensitivity. Health professionals in the World Health Organization's (WHO) Eastern Mediterranean Region face unique cultural and social factors distinct from other parts of the world. This scoping review aims to comprehensively explore the peer-reviewed literature on the health professionals' experiences in delivering bad news within the WHO's Eastern Mediterranean Region. Methods: This scoping review was conducted according to the Joanna Brigg Institute's scoping review methodology and reported utilizing the Preferred Reporting Items for Systematic Reviews extension for scoping review (PRISMA-ScR) guidelines. A search using a combination of keywords and MeSH terms related to "breaking bad news" and "health professionals" was performed in PubMed, Scopus, CINAHL, EBSCO, ERIC via Embase, and Dar Almandumah (Arabic) databases. Common themes were synthesized from studies conducted in the WHO's Eastern Mediterranean Region. Results: Out of 4,883 studies initially identified in the databases, 24 studies met the inclusion criteria, involving a total of 4,710 participants, including physicians, nurses, and residents. The studies were published between 2006 and 2022, predominantly from Iran (n = 12). The majority employed a cross-sectional design (n = 21) or mixed methods (n = 3), with a notable absence of qualitative studies. No studies used theoretical frameworks. More than half of the studies (n = 14) reported that participants had positive attitudes toward breaking bad news. This positivity was evident in their willingness to share bad news, perceived possession of adequate knowledge, positive attitudes, having received training, awareness of accepted approaches, and adherence to protocols. The lack of training and limited awareness of established protocols like SPIKES, ABCDE, and BREAKS for breaking bad news were major concerns among participants. Conclusion: The scoping review reveals both positive and negative experiences of breaking bad news by health professionals in the WHO's Eastern Mediterranean Region. Most studies highlight the need for culturally sensitive targeted education and training programs on breaking bad news. Further research, particularly using qualitative methodologies and theoretical frameworks is warranted.