Energy drink consumption among medical students in Jordan - prevalence, attitudes, and associated factors: a cross-sectional study.

Background: Energy drinks (ED) are popular beverages that contain high levels of caffeine, sugar, and other supplements, such as vitamins, which are marketed to enhance mental alertness and physical performance. Studies have shown that energy drink consumption is prevalent among medical students. Therefore, this study aimed to assess the prevalence, attitudes, and factors associated with energy drink consumption among medical students in Jordan. Materials and methods: A cross-sectional study was conducted among medical students from six public universities in Jordan. A total of 307 students were included in the study, and data were collected using an expert-validated questionnaire. The collected data were analyzed using SPSS version 25. Results: The study found that 50% of the sample had consumed ED, half of them started consuming them at the age of 16-18, and learned about them from friends. The primary reasons for consuming ED were to stay awake at night and the majority of them increase their consumption during exams to increase alertness. Regular energy drink consumption was significantly associated with being a student at the university located in the south governorate of Jordan (P=0.021), living alone (P=0.000), drinking alcohol (P=0.049), drinking coffee daily (P=0.043), and consuming more than 10 cans of soft drinks weekly (P=0.001). However, sex, age, academic achievement, and smoking status had no significant association with regular energy drink consumption. Students with regular energy drink consumption experienced daytime sleepiness, decreased concentration, fatigue, and reduced performance more than students with no regular energy drink consumption. Conclusion: The prevalence of energy drink consumption among medical students in Jordan is high, with factors such as social influences, lifestyle behaviors, and academic pressure being significant contributors. This study highlights the need for interventions to promote healthy behaviors and raise awareness about the potential harms of ED among medical students.

Increased Expression of Neprilysin Is Associated with Inflammation in Preeclampsia.

Preeclampsia (PE) is associated with a finely tuned equilibrium between trophoblast cell invasion and fetal-maternal immunological tolerance. An imbalance between proinflammatory (IL-6) and anti-inflammatory (IL-10) cytokines is a hallmark of PE. Neprilysin (NEP), a membrane-bound metalloprotease, is vulnerable to the inflammatory environment and plays a significant role in modulating vascular tone. The aim of this study was to determine the correlation between NEP (mRNA and protein) levels and the inflammatory status in PE patients compared to healthy pregnant women and to identify the role of NEP in evaluating the severity of preeclampsia. The study group comprised 52 pregnant women with PE while the control group comprised 47 normotensive pregnant women. After a caesarean section, placental tissue samples from patients and controls were collected to measure the expression levels of IL-6, TGF-ß, IL-10, and NEP mRNA. In addition, an enzyme-linked immunosorbent assay was used to assess the quantity of NEP protein in blood samples. Our results revealed a significant positive correlation between NEP (mRNA and protein) and proinflammatory markers IL-6 and TGF-ß levels in patients compared to controls and a significant inverse correlation between NEP and anti-inflammatory cytokine IL-10. Moreover, this is the first study to find a strong positive correlation between NEP level and PE severity. In conclusion, in PE patients, there is a substantial relationship between NEP, the degree of inflammation, and PE severity. NEP could act as a potential biomarker for diagnosis and prognosis of PE.

Ergonomics and musculoskeletal symptoms in surgeons performing endoscopic procedures for benign prostatic hyperplasia.

BACKGROUND AND PURPOSE: Benign prostatic hyperplasia (BPH) is the most common urologic disorder affecting older men, necessitating medical or surgical intervention. Limited data exists regarding the effect these surgeries have on the endourologist's musculoskeletal system following the surgery because of the required difficult posture, prolonged procedures, repetitive movements, and the settings of an adjustable visual display terminal workstation. The aim of our study was to survey the prevalence and possible causes of musculoskeletal disorders among endourologists performing transurethral resection of the prostate (TURP) or laser prostatectomy using either holmium laser enucleation or thulium laser enucleation. MATERIALS AND METHODS: An email inviting all members of the Endourological Society to participate in the survey was sent. The questionnaire included different demographic and practice characteristics, with concern regarding performing either TURP or laser prostatectomy and the incidence and type of musculoskeletal incidents following these surgeries. All responses were collected by a commercially available internet based survey host (www.surveymonkey.com) over a period of 6 weeks. RESULTS: Of the 121 complete responses, 84 (69%) of endourologists complained of a musculoskeletal disorder following TURP or laser prostatectomy. The most frequent complaint was for neck (64%), followed by back (57%), shoulder (48%), hand (40%), and elbow (18%). The average prostate volume turned out to be the most compelling predictor for musculoskeletal disorder occurrence with an average prostate volume of 76 g operated on by the complaining group compared with 59 g in the noncomplaining group. Those with more severe symptoms were linked to a mean prostate size of 80 g (60-146) and constantly complained of shoulder, neck, or back trouble compared with the less-severely complaining group. CONCLUSIONS: A high prevalence of musculoskeletal complaints among urologists performing endourologic prostatectomy was confirmed and was found to be proportionally related to the size of the prostate. The integration of an ergonomic specialist inside the operation room to watch and correct the surgeon's position during endourologic procedures may reduce the endourologist's exposure to these occupational hazards.

Design, Synthesis, Anticancer Evaluation and Molecular Modeling of Novel Estrogen Derivatives.

A series of estrone derivatives 3⁻8 was designed and synthesized using estrone arylmethylenes 2a,b as starting materials and their structures were confirmed by different spectral data and elemental analyses. All the newly synthesized compounds exhibited potent in vitro and in vivo cytotoxic activities against breast cancer cell lines. In addition, all compounds were subjected to in vitro and in vivo inhibition assays for EGFR and VEGFR-2 kinases as well as p53 ubiquitination activity to obtain more details about their mechanism of action. Based on the promising results, a molecular docking study was investigated for the most representative compound 5a against the two targets, EGFR and VEGFR-2 kinases, to assess its binding affinity, hoping to rationalize and obtain potent anticancer agents in the future.

Bakri balloon versus condom-loaded Foley's catheter for treatment of atonic postpartum hemorrhage secondary to vaginal delivery: a randomized controlled trial.

OBJECTIVE: To assess the efficacy and safety of condom-loaded Foley's catheter versus Bakri Balloon in the management of primary atonic post partum hemorrhage (PPH) secondary to vaginal delivery. STUDY DESIGN: This study was single blinded randomized controlled trial conducted at Assiut Woman's Health Hospital, Egypt in the period between October 2014 and December 2015. It Comprised 66 women with primary atonic PPH following vaginal delivery. Eligible participants were randomly assigned to Bakri balloon (group A) or condom-loaded Foley's catheter (group B). The primary outcome was the success of tamponade to stop the uterine bleeding without additional surgical interventions. Secondary outcomes included time between insertion and stoppage of the bleeding, the amount of blood transfusion and maternal complications. RESULTS: Both treatment modalities successfully controlled the primary atonic PPH without a statistically significant difference [30/33(91.0%) and 28/33(84.84%), p = .199; respectively]. However; Bakri balloon required shorter time to stop the uterine bleeding (9.09 min vs. 11.76 min, p = .042; respectively). There was no statistically significant difference between both groups regarding postpartum maternal complications, the vital signs, urine output, hemoglobin and hematocrit levels from before to after tamponade insertion. CONCLUSIONS: Condom-loaded Foley's catheter is as effective as Bakri balloon in the management of primary atonic PPH following vaginal delivery but requires a significant bit longer time to stop the attack.

A short-term evaluation of the safety and the efficacy of bipolar transurethral resection of the prostate in patients with a large prostate (>90 g).

OBJECTIVE: To evaluate the efficacy and safety of bipolar transurethral resection of the prostate (TURP) in patients with a large prostate (>90 g), as a significant recent modification of TURP is the incorporation of bipolar technology, which uses the same technique as monopolar TURP but with normal saline as the irrigant. PATIENTS AND METHODS: Forty patients with a prostate of >90 g and who were considered at risk for monopolar TURP were treated by bipolar TURP. The operative duration, resection time, resected tissue weight, resection rate, resection ratio, amount of irrigation fluid used, the decrease in intraoperative haemoglobin level, haematocrit and serum sodium levels, and the blood loss were recorded. The follow-up data were analysed. RESULTS: The mean (SD) operative duration was 116.3 (25.52) min, the resection time was 106.5 (25.69) min, the resected volume was 78.9 (20.58) g, the decrease in haemoglobin levels was 1.67 (0.46) g/dL, the mean serum sodium decline was 2.60 (0.68) mmol/L, and the blood loss was 532 (101.2) mL. The blood loss/g of resected tissue was 6.85 (0.70) mL. The mean (SD) postoperative bladder irrigation time was 2.0 (0.32) days, the catheterisation time was 3.25 (0.55) days and the postoperative hospital stay was 3.25 (0.55) days. CONCLUSION: Bipolar technology makes it possible to use TURP to treat patients with very large prostates and who are at risk when treated by the standard monopolar technology, with a satisfactory safety profile and with favourable efficacy.

Analgesic and anticonvulsant activities of some newly synthesized trisubstituted pyridine derivatives.

A series of novel pyridine carbohydrazide derivatives were synthesized from the reaction of 2-chloro-6-hydrazino-isonicotinic acid hydrazide with selected active reagents. All prepared compounds were tested as analgesic and anticonvulsant agents. The pharmacological screening showed that many of these compounds have good activities comparable to those of valdecoxib and carbamazepine as reference drugs.

Synthesis, Structural Elucidation, and In Vitro Antitumor Activities of Some Pyrazolopyrimidines and Schiff Bases Derived from 5-Amino-3-(arylamino)-1H-pyrazole-4-carboxamides.

The reaction of 5-amino-3-(arylamino)-1H-pyrazole-4-carboxamides 1a,b with acetylacetone 2 and arylidenemalononitriles 5a-c yielded the pyrazolo[1,5-a]-pyrimidine derivatives 4a,b and 7a-f respectively. On the other hand, Schiff bases 9a,b and 12a-j were obtained upon treatment of carboxamides 1a,b with isatin 8 and some selected aldehydes 11a-e. The newly synthesized compounds were characterized by analytical and spectroscopic data. Representative examples of the synthesized products 4a,b, 7e, 7f, 9b, 12b-f, 12h, and 12j were screened for their in vitro antitumor activities against different human cancer cell lines and the structure-activity relationship (SAR) was discussed.

The use of a biological model for comparing two techniques of fluoroscopy-guided percutaneous puncture: A randomised cross-over study.

OBJECTIVES: To develop a new and inexpensive model for training in fluoroscopic puncture into the pelvicalyceal system, and to use this model to compare the learning curve of two fluoroscopic techniques, the 'eye of the needle' (EN) and triangulation techniques. MATERIALS AND METHODS: For the trial we used a commercial plastic model (a shop-window mannequin) in which a bovine kidney, embedded in sponge with a spatial orientation similar to the human, was inserted into the model. The ureter of the animal kidney was connected to contrast fluid. Ten residents and interns were randomised into two groups; group A started the puncture using the EN technique, each member making five attempts, and then five attempts using the triangulation technique, and group B started with triangulation and then used the EN technique. RESULTS: There was no statistically significant difference between the techniques for the mean (SD) number of trials to make a correct puncture, at 2.68 (1.00) in the EN technique and 2.86 (1.05) in the triangulation technique, or for the duration of each trial, at 523 (189) s for the EN technique and 578 (175) s for the triangulation technique. The fluoroscopy time was less in the EN technique, at 113.9 (48.9) s than for the triangulation method, at 135.8 (42.4) (P < 0.005). CONCLUSIONS: The model was easy to construct and feasible for training. Both techniques had a similar learning curve, with higher fluoroscopy exposure for the triangulation technique.

Thermo-expandable metallic urethral stents for managing recurrent bulbar urethral strictures: To use or not?

OBJECTIVES: To assess the role of temporary thermally expandable urethral stents in maintaining urethral patency in patients with a recurrent bulbar urethral stricture. PATIENTS AND METHODS: Twenty-three men with a recurrent bulbar urethral stricture after several attempts at direct visual internal urethrotomy (DVIU) and/or failed urethroplasty were managed with a thermally expandable, biocompatible nickel-titanium alloy urethral stent (Memokath® MK044, Pnn Medical, Kvistgaard, Denmark). The stents were applied by a special mounting device via a rigid urethroscope after DVIU. All patients were followed using plain radiography, uroflowmetry and urine analysis every 3 months for 1 year, and then every 6 months. RESULTS: The mean (SD) age of the patients was 55.4 (7.3) years and the mean (SD) stricture length was 3.6 (1.2) cm. All patients tolerated the stent, with minimal discomfort in some patients. Four patients (17%) had urinary tract infections, three (13%) had haematuria, three (13%) had obstructed stents due to encrustation, in five (22%) the stent migrated, and two patients had no delayed complications. The mean (SD) follow-up was 17.4 (6.1) months. CONCLUSION: Urethral stenting with nickel-titanium alloy thermally expandable stents can be an acceptable temporary procedure for patients with recurrent bulbar urethral strictures who are unfit for or who refuse urethroplasty. However, they have limitations; the search for an ideal urethral stent continues.

Synthesis of potent antitumor and antiviral benzofuran derivatives.

A new series of potent antitumor and antiviral benzofuran derivatives was synthesized by the reaction of the furochromone-6-carboxaldehydes 1 and 2 with different heterocyclic amines to yield the benzofuran-5-carbonyl derivatives 4-11. The synthesized compounds 1, 3-11 were tested against twelve different human cancer cell lines and all of the compounds were more potent than the comparative standards. The HIV inhibitory activity of the tested compounds 1, 3-11 showed that they have higher potency than Atevirdine. Moreover, compound 6 was significantly potent with wider therapeutic index. The HIV-1 RT inhibitory activity showed that compounds 10, 11, 3 and 4 were notably potent but with lower therapeutic index than Atevirdine. The HCV NS3-4A protease inhibitor activity of the tested compounds revealed that they have weaker potency and less therapeutic index than VX-950, although compounds 1, 4, 9 and 6, respectively exhibited significant activity.

Modified ileal conduit stoma: safety of freeing the mesenteric edge of the distal part of ileal conduits.

PURPOSE: An ileal conduit is created in about half of all urinary diversions. Difficulties in constructing an abdominal stoma in morbidly obese patients can be challenging, especially if the patient has a short mesentery. Excessive traction on the mesentery in an attempt to pass the distal segment of ileum through the thick abdominal wall may result in ischemia of the whole segment blood supply. We evaluated the safety of freeing the terminal portion of the conduit from its mesentery to facilitate easy passage of the conduit through the abdominal wall and decrease the incidence of parastomal hernia. MATERIALS AND METHODS: Five domestic pigs were used for this study. In each subject a 10 cm segment of ileum was isolated to form the ileal loop and bowel continuity was established. A 3 to 4 cm segment of the distal ileal loop was freed from its mesenteric blood supply. This segment of the loop was passed through the appropriate defect in the abdominal wall to the skin and an everted stoma was constructed. Postoperatively the animals were followed for 1 month and then sacrificed. The ileal loop with its mesentery and surrounding skin were harvested en bloc and sent for gross and histological examination. RESULTS: Mean postoperative time was 30 days (range 29 to 32). No mortality or perioperative complications were recorded. All animals had an uneventful postoperative course until the scheduled time for specimen collection. At harvesting the stoma remained pink in all animals. Gross examination and calibration demonstrated no evidence of narrowing or stenosis. Histological examination revealed no ischemic changes. The mucosa of the entire ileal loop was uniform and healthy. CONCLUSIONS: Freeing the mesenteric edge of the ileal loop is safe. This finding has an important application for allowing easy construction of an ileal loop or continent cutaneous diversion stoma in morbidly obese patients. This finding is also applicable when constructing terminal ileostomy or colostomy stoma in select patients.