To explore the relationship between serum levels of midkine and omentin-1 and the severity of sepsis in patients, and their prognostic value. A retrospective analysis was conducted on the clinical data of 180 sepsis patients. According to the severity of the patient's condition, they were separated into sepsis group (n = 76), severe sepsis group (n = 59), and sepsis shock group (n = 45). Based on the survival within 28 days of admission, they were grouped into survivors group (n = 128) and nonsurvivors group (n = 52). The serum Midkine level and APACHE II score in the sepsis shock group were higher than those in the severe sepsis group and sepsis group, while the Omentin-1 level was lower than that in the severe sepsis group and sepsis group (p < 0.05). The serum Midkine level and APACHE II score in the severe sepsis group were higher than those in the sepsis group, while the Omentin-1 level was lower than that in the sepsis group (p < 0.05). The Midkine and APACHE II score in the nonsurvivors group was higher than those in the survivors group, while the Omentin-1 score was lower than that in the survivors group (p < 0.05). Midkine and APACHE II score were independent risk factors for the prognosis of sepsis patients, while Omentin-1 was a protective factor for the prognosis of sepsis patients (p < 0.05). The AUC of the combined prediction of serum Midkine and Ommentin-1 for the prognosis of sepsis patients was 0.880, with a sensitivity of 90.38% and a specificity of 72.66%. The combined prediction of serum Midkine and Ommentin-1 was better than that of individual prediction of Midkine and Ommentin-1. Serum Midkine is highly expressed and Omentin-1 is lowly expressed in sepsis patients, and the combination of the two has a high predictive power for the prognosis of sepsis patients.
The Republic of Srpska (RS), as a part of the Western Balkans (WB) region, has a higher diabetes prevalence than the EU. This study aims to assess the cost-effectiveness of early treatment of high-risk patients with pre-diabetes and undiagnosed diabetes in our setting. We designed a Markov chain Monte Carlo (MCMC) model which reflects the current International Diabetes Federation (IDF) three-step plan for the prevention of T2DM in those at increased risk. The model captures the evolution of the disease in FINDRISC high-risk patients from normal glucose tolerance (NGT) to impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) and then to T2DM and its complications. We developed two MCMC models, in order to follow the progression of the disease in high-risk cases, ie, when early treatment is undertaken or when it is not undertaken. The health costs and quality adjusted life years (QALY) were discounted at an annual rate of 3%. The key model parameters were varied in one-way and probabilistic sensitivity analysis. Early treatment resulted in increased life expectancy, postponement of the onset of diabetes and increased QALY for all patients. The discounted incremental cost-effectiveness-ratios (ICER) in NGT, IFG, IGT, and T2DM patients were -289.9, 9724.03, -1478.59 and 4084.67 €. In high-risk IGT patients, ICER was the most favorable, being both a cost saving and QALY gaining, with the consistent results confirmed by the sensitivity analysis. The results recommend the acceptance of a new health policy of identifying IGT patients with the use of FINDRISC questionnaire and plasma glucose measurements; providing them with a lifestyle change program; and implementing intensive diabetes treatment, as their disease progresses. Our results are especially significant for the Western Balkan countries, since this was the first cost-effectiveness study of T2DM prevention in this region.
Work-related musculoskeletal disorders (WRMSDs) refer to injuries or conditions that affect the muscles, tendons, nerves, and other components of the musculoskeletal system, often resulting from repetitive movements, sustained static postures, or prolonged periods of sitting and standing. Dental professionals and students are particularly susceptible due to the physically demanding nature of clinical practice. These disorders can adversely affect professional performance, productivity, and overall quality of life. The present study aimed to determine the prevalence, associated risk factors, and potential consequences of WRMSDs among dental students and professionals at Umm Al-Qura University, Makkah, Saudi Arabia. A cross-sectional survey was conducted among dental students and professionals at Umm Al-Qura University. Data were collected using a self-administered, structured online questionnaire designed to assess the prevalence of WRMSDs, associated risk factors, and management strategies. Statistical analysis was performed using IBM SPSS Statistics software, with the level of significance set at p < 0.05. Among the respondents, 67.8% were under 25 years of age, and 59.8% were female. More than half (55.6%) reported experiencing WRMSD symptoms in at least one body region during the past year, with 36.8% indicating chronic pain. The most commonly affected areas were the neck (56.9%), and lower back (52.3%). The leading contributing factors were inappropriate posture (44.8%) and prolonged sitting (29.7%). The most affected quality-of-life domains included increased stress and anxiety (33.1%), sleep disturbances (30.0%), and reduced academic or occupational performance (25.0%). Despite the high prevalence, 77% of participants did not seek professional care. The most frequently reported pain management strategies were the use of analgesics (31.4%) and engagement in physical activity (29.3%). This study demonstrates a high burden of WRMSDs among dental students and professionals, with symptoms primarily affecting the neck and lower back. Incorporating ergonomic training and structured occupational health programs into dental education and clinical practice may reduce long-term functional impairment and improve overall well-being.
Assessment of risk factors of breast cancer in the general population provides insightful information towards prevention of breast cancer. This study aimed to assess the risk factors of breast cancer among women in a community from a resource-limited setting in sub-Saharan Africa. This descriptive community-based cross-sectional study was conducted in Dodoma, Tanzania, from July to December 2020. The study included women aged between 18 and 70 years. The data were analyzed using SPSS program version 25.0. Independent t-test was used to compare the mean age of the participants for the availability of risk factors of breast cancer. A two-tailed p < 0.05 was considered significant. A total of 354 women were analyzed, and the median age was 27.0 (23.0-35.3) years. Only 11.8% (n = 18) of all the participants did not have any of the risk factors examined. Not engaging in physical activity was the most frequent risk factor which accounted for 68.2% (n = 242) of all the participants. There were more 60.7% (n = 215) of the study participants with a low mean age (22.9 ± 3.5) who had more than 5 risk factors compared to 39.3% (n = 139) of the participants with a high mean age (25.3 ± 9.4) who had more than 5 risk factors, with no statistically significant difference (95% CI = 0.91-2.22, p = 0.31). There is a large proportion of women younger than 40 years in the population of Tanzanian women with many risk factors of breast cancer. This may contribute to the currently observed increase in the incidence of breast cancer in Tanzania for women aged less than 40 years. Therefore, there is an urgency for targeted awareness and screening for breast cancer among younger women in Tanzania so as to increase early detection and diagnosis.
Background: Telemedicine became a fundamental part of healthcare provision during COVID-19 pandemic. An evaluation of telemedicine-associated satisfaction helps the service develop more viable applications. This review evaluated the satisfaction of healthcare users and providers and their willingness to use this modality in future.Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search on empirical articles published between March 2020 and December 2022 was performed on 'PubMed' and 'Scopus' databases. Findings that reported on satisfaction of patients, families and caregivers as well as clinicians were extracted and analysed. Quality of included studies was assessed. After applying inclusion and exclusion criteria, the review included 27 eligible studies.Results: Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare. Almost all studies were undertaken within the NHS. There were many tools that measured satisfaction. Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%. Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information. Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people. In general, willingness to use telemedicine in future was high in the recipients as well as the providers of healthcare.Conclusion: COVID-19 pandemic has transformed healthcare in the UK and promoted a revolution in telemedicine applications. Satisfaction was high among both recipient and provider of healthcare. Telemedicine managed to provide a continued care throughout the pandemic while maintaining social distance. The current review presented commendable evidence to encourage different specialities to engage in telemedicine application.
Fasting during Ramadan involves abstaining from food and drink from dawn to sunset, potentially influencing cognitive functions essential for the intellectual development of the youth. Therefore, understanding the effects of fasting on these functions in children/adolescents provides valuable perspectives to enhance education and promote mental well-being. However, studies on children/adolescents in this context are still limited. To evaluate the impact of Ramadan fasting on cognitive functions, including information processing speed, inhibition, decision-making, and auditory attention processes among children and adolescents aged 11 to 15 years. This study was conducted with 24 healthy children/adolescents (aged 12.84 ± 0.69 years). The experimental protocol consisted of two sessions: Before-Ramadan (BR) and at the beginning of the second week of Ramadan (R2). At each session, the boys were randomly tested on simple reaction time (SRT), choice reaction time (CRT), negative priming reaction time (NPRT), and auditory discrimination (P300). The tests were administered and scored by the same person in the different sessions. The study found that Ramadan fasting did not have an effect on various reaction times or on electro-physiological data, including P300 amplitude and latency. The current study, conducted with healthy children/adolescents, indicates that Ramadan fasting had no impact on various reaction times (SRT, CRT, NPRT), suggesting the preservation of information processing speed and decision-making, even in the face of increased task complexity. This is evident, on the one hand, through the maintenance of the ability to react to unexpected events, and, on the other hand, through the mastery of resistance to automatism, thus reflecting the preservation of inhibitory function (NPRT). Regarding P300 data, the absence of changes in latencies and amplitudes suggests that Ramadan fasting did not alter either the evaluation time of auditory stimuli or auditory attention processes.
Electronic Health Records (EHR) have been adopted to improve the quality of care. Despite the growing use of health information technology, nursing documentation remains a challenge. In Tunisia, the implementation of the Electronic Medical Record (EMR) system is gaining momentum as part of national initiatives to modernize healthcare. However, nursing documentation is still largely paper-based, and no studies in Tunisia have adressed this topic. This research aims to assess the effect of the Electronic Nursing Record (ENR) on the quality and safety of care indicators (QSCI). This is an interventional study structured in four phases: development, pre-implementation, implementation, and evaluation, integrating the principles of the 'Standards for Reporting Implementation Studies' (StaRI). A list of QSCI was defined and validated through a literature review and Delphi consensus. The impact of the ENR on these indicators was evaluated in a Tunisian university hospital through a quasi-experimental study. Indicators were measured before ENR, one month after, and six months after. Data analyses was conducted using SPSS with statistical tests. Initially, the study led to the identification and validation of seventeen QSCI. Subsequently, a quasi-experimental study was conducted to evaluate the impact of ENR implementation on these indicators. The results revealed a significant improvement in the intervention group (using ENR), particularly in the traceability of vital signs (p < 10⁻3) and infusion administration (p = 0.027). Conversely, the control group (using paper-based documentation) performed better in terms of traceability of inter-team handovers (95.1% compared to 71.9% for the intervention group). The electronic documentation system is seen as a major transformation in healthcare in many hospitals worldwide. Moreover, electronic nursing documentation is crucial for patient safety. Its implementation in our hospital revealed a positive impact of the ENR on certain aspects of care quality while highlighting gaps in inter-team handovers.
The ratio of fibrinogen to albumin (FAR) is considered a new inflammatory biomarker and a predictor of cardiovascular disease risk. However, its prognostic value for patients with chronic heart failure (CHF) with different ejection fractions (EFs) remains unclear. A total of 916 hospitalized patients with CHF from January 2017 to October 2021 in the First Affiliated Hospital of Kunming Medical University were included in the study. Death occurred in 417 (45.5%) patients out of 916 patients during a median follow-up time of 750 days. Among these patients, 381 patients suffered from HFrEF (LVEF <40%) and 535 patients suffered from HFpEF or HFmrEF (HFpEF plus HFmrEF, LVEF ≥ 40%). Patients were categorized into high-level FAR (FAR-H) and low-level FAR (FAR-L) groups based on the optimal cut-off value of FAR (9.06) obtained from receiver operating characteristic (ROC) curve analysis. Upon analysing the Kaplan - Meier plots, the incidence of death was significantly higher in all patients with FAR-H and patients in both HF subgroups (p < 0.001). The multivariate Cox proportional hazard analyses indicated that the FAR was an independent predictor of all-cause mortality, regardless of heart failure subtype. (HR 1.115, 95% CI 1.089-1.142, p < 0.001; HFpEF plus HFmrEF, HR 1.109, 95% CI 1.074-1.146, p < 0.0001; HFrEF, HR 1.138, 95% CI 1.094-1.183, p < 0.0001) The optimal cut-off value of FAR in predicting all-cause mortality was 9.06 with an area under the curve value of 0.720 (95% CI: 0.687-0.753, p < 0.001), a sensitivity of 68.8% and a specificity of 65.6%. After adjusting for the traditional indicators (LVEF, Lg BNP, etc.), the new model with the FAR had better prediction ability in patients with CHF. Elevated FAR is an independent predictor of death in CHF and is not related to the HF subtype.
Clostridium difficile (Clostridioides difficile) is a leading cause of nosocomial infections in hospitalized patients worldwide. Stool samples were collected from 112 inpatients admitted to different hospitals and were screened for C. difficile GDH + toxin A + B by immunoassay, and all positive samples by immunoassay were processed for molecular detection of C. difficile using the GeneXpert assay. C. difficile strains were detected in 12 (10.71%) out of 112 stool samples using the GDH + toxin A + B immunoassay method and toxigenic C. difficile was confirmed in 5 stool samples using the GeneXpert molecular assay. C. difficile strains were also detected in 7 (8.97%) out of 78 stool samples from intensive care unit patients, 3 (25%) out of 12 stool samples from internal medicine ward patients, 1 (11.11%) out of 9 stool samples from surgery ward patients, and 1 (10%) out of 10 stool samples from isolation ward patients using the GDH + toxin A + B immunoassay method and the toxigenic C. difficile strain was confirmed in 1, 2, 1, and 1 stool samples, respectively, using the GeneXpert molecular assay. Toxigenic C. difficile was confirmed in patients at 4 (51.14%) out of 7 hospitals. In the present study, we also analyzed the clinical information of patients with C. difficile-positive stool samples who were receiving one or more antibiotics during hospitalization. The binary toxin gene (cdt), the tcdC gene, and the C. difficile strain polymerase chain reaction (PCR) ribotype 027 were not detected using the GeneXpert molecular assay among 12 C. difficile-positive samples by immunoassay. This study should aid in the prevention of unnecessary empiric therapy and increase the understanding of the toxigenic C. difficile burden on the healthcare system in the southwestern province of Saudi Arabia.
This study aimed to describe the molecular epidemiology and seasonality of human rhinovirus (HRV) in chronic obstructive pulmonary disease (COPD) and its association with COPD exacerbations in Abu Dhabi, the United Arab Emirates (UAE). Sputum specimens were collected for analysis from all COPD patients who visited a medical center from November 2021 to October 2022. The real-time quantitative polymerase chain reaction (qPCR) test was used to detect HRV. Of the 78 COPD patients included in the study, 58 (74%) patients presented with one or more exacerbation episodes. The incidence of COPD exacerbation peaked over the winter and substantially decreased during the summer. HRV positivity in patients during exacerbation (E1) was 11/58 (19%) and 15/58 (26%) two weeks after the exacerbation episode (E2). There was no significant difference in the HRV load in these patients. No statistically significant difference was observed in the detection of HRV during exacerbation compared to patients with stable COPD. This is the first study to assess the association between HRV detection by qPCR and COPD exacerbations in the UAE. The high sensitivity of the detection technology helped collect reliable epidemiologic data. Few studies have provided similar Middle East data. This study's pattern of COPD exacerbations and HRV detection parallels that of temperate countries. This information can help with future, more extensive surveillance of respiratory viruses in the UAE and the Middle East and their association with COPD exacerbations.
Pyrazole derivatives are a class of heterocyclic compounds known to have broad pharmacological effects. This study aimed to synthesize and characterize a new series of pyrazole derivatives and investigate their effects on a series of in vitro assays. Five synthesized compounds were confirmed structurally using standard spectroscopic techniques, and their cytotoxic activity was evaluated against HeLa cells using MTT assay and morphological examination of viability. DNA damage and fragmentation were analyzed using a comet assay, agarose gel electrophoresis, and diphenylamine reaction. Antioxidant properties were evaluated with radical scavenging assays, and anti-inflammatory potential was assessed with in vitro inhibition assays (COX-1/2). Pyrazolethione 5 showed antiproliferative effects at all concentrations, with preserved cell confluence at ≤62.5 µg/mL. It also demonstrates DPPH scavenging activity similar to that of ascorbic acid in a dose-dependent manner, reaching a maximum activity of 85.9% with an IC₅₀ of 48.77. In addition, it demonstrated antioxidant activity, although significantly lower than that of gallic acid, with a maximum scavenging percentage of 83.9% at 1000 μg/mL and an IC50 of 54.97 μg/mL. In the comet assay, the treatment significantly increased DNA fragmentation to 26.2% ± 0.88% from 12.8% ± 0.77% in the control cells (p < 0.01), representing a two-fold induction of apoptosis. The test compound inhibited COX-1 in a dose-dependent manner (86.29% inhibition at 1000 µg/mL), producing an IC50 value of 29.14 ± 0.97 µg/mL, while it produced moderate inhibition of COX-2, 82.03% inhibition at 1000 µg/mL, and had an IC50 value of 51.49 ± 2.13 µg/mL. According to flow cytometry analysis, untreated HeLa cells were mainly in G1 (54.56%) and G0 (34.86%), with fewer cells in S (9.63%), and G2-M (0.94%). In pyrazolethione-treated HeLa cells, G0 accumulation (73.57%) and fewer proliferative phases (S 3.10% and G2-M 2.78%) indicated substantial alteration to the cell cycle. Pyrazolethione 5 demonstrates a favorable safety profile, with minimal cytotoxicity at lower concentrations, and impressive antioxidant and anti-inflammatory activities. The DPPH and gallic acid-like radical scavenging activities, moderate COX-1 and COX-2 inhibition, and DNA fragmentation suggest multiple bioactivities. Furthermore, the compound significantly altered cell cycle progression in HeLa cells, leading to G0/G1 arrest and reduced proliferation. Taken together, the data indicate pyrazolethione 5 is a potential lead compound for further development/investigation as an anticancer and anti-inflammatory agent with low toxicity.
We aim to study the characteristics and outcomes of patients with a Do-Not-Attempt Resuscitation and to determine its impact on the Cost of In-Hospital Cardiac Arrest. A retrospective study of all adult patients admitted to the hospital from June 2021 to May 2022 who had a Do-Not-Resuscitate order. We abstracted patients' socio-demographics, physiologic parameters, primary diagnosis, and comorbidities from the electronic medical records. We calculated the potential economic cost using the median ICU length of stay for the admitted IHCA patients during the study period. There were 28,866 acute admissions over the study period, and 788 patients had DNR orders. The median (IQR) age was 71 (55-82) years, and 50.3% were males. The most prevalent primary diagnosis was sepsis, 426 (54.3%), and cancer was the most common comorbidity. More than one comorbidities were present in 642 (80%) of the cohort. Of the DNR patients, 492 (62.4%) died, while 296 (37.6%) survived to discharge. Cancer was the primary diagnosis in 65 (22.2%) of those who survived, compared with 154 (31.3%) of those who died (P = 0.002). Over the study period, 153 patients had IHCA and underwent CPR, with an IHCA rate of 5.3 per 1,000 hospital admissions. Without a DNR policy, an additional 492 patients with cardiac arrest would have had CPR, resulting in an IHCA rate of 22.3 per 1000 hospital admissions. Most DNR patients in our setting had sepsis complicated by multiple comorbidities. The DNR policy reduced our IHCA incidence by 76% and prevented unnecessary post-resuscitation ICU care.
Folk medicine remains an important component of health practices in Saudi Arabia and continues to attract growing scholarly attention. This study maps the scholarly landscape of folk medicine research related to Saudi Arabia by examining publication trends, author keywords, collaboration among institutions and countries, and the impact of authors and sources. Publications were retrieved from the Scopus and Web of Science databases using Saudi Arabia as the country affiliation. After PRISMA-guided identification, screening, deduplication, and eligibility assessment, 2527 publications published between 1989 and 2024 were retained for analysis. Bibliometrix was used for bibliometric computation and visualization, and VOSviewer was used to map country co-authorship and keyword co-occurrence networks. The results show sustained growth in publication output, strong participation by Saudi institutions, and broad international collaboration. The most prominent research themes were antioxidant activity, antimicrobial properties, herbal medicine, and traditional medicine. These findings provide a bibliometric overview of knowledge production in this area and may inform future systematic, clinical, and policy-oriented research on traditional medicine in Saudi Arabia.
Aim: Functional gastrointestinal (GI) disorders are recognized as a major public health concern worldwide. These disorders involve persistent digestive symptoms indicative of digestive tract dysfunction.Materials and Methods: A survey examining the utilisation of probiotics and medicinal plants as supplementary treatments was conducted on 160 patients with GI disorders at healthcare institutions in Saïda from March to April 2023 using questionnaires that had been previously adapted and tested for reliability with Cronbach's alpha test. Raw data collected through the questionnaires were transferred to a database and analysed using SPSS software.Results: Overall, 49.38% of participants possessed knowledge of or actively utilised probiotics; such awareness was strongly associated with the participants' educational attainment (p = 0.029). The noteworthy probiotic supplements were Biocharbon (36.09%), Lactocil (15.38%), Smebiocta (13.61%), Ultrabiotic Adult (12.43%), Effidigest (12.43%), and Ultralevure (7.69%). During crisis, individuals tended to consume natural goods rich in probiotics, including yoghurt (13.26%) and fermented milk (8.60%), as well as foods rich in prebiotic fibre, including vegetables (18.99%), fruits (13.26%), wheat (9.67%), bran (7.52%), rye (6.81%), and oat flakes (6.45%). Additionally, 77.56% of patients used medicinal plants during crises, with Mentha spicata (12.2%), Thymus vulgaris (11.3%), Pimpinella anisum (8.5%), Cuminum cyminum (8.0%), Punica granatum (7.8%), Trachyspermum ammi (7.5%), and Senna acutifolia (7.0%) being the more commonly favoured options in phytotherapy. The main focus of these herbs was to alleviate bloating (57%), constipation (30.12%), and diarrhoea (12.87%) (p < 0.001). The most frequently utilised plant parts were leaves (47.30%), seeds (25.21%), and bark (13.21%). Most patients (82.91%) favoured infusion as their preferred consumption method, and approximately 85.43% believed in phytotherapy's ability to extend symptomatic relief.Conclusion: The understanding of probiotics is still in its infancy, whereas phytotherapy is more widely accepted by patients. Nonetheless, patients are open to the exploration of natural alternatives to conventional medicines.
Cryopreservation of sperm is routinely used in assisted reproduction technology (ART) for male fertility preservation. However, this method has been associated with oxidative stress and DNA fragmentation that may impair sperm quality. Additionally, antioxidant interventions such as melatonin supplementation have not been thoroughly explored in this setting. Although Libya is reported to have one of the highest global prevalence rates of male infertility, Libya-specific data remain limited. This study aimed to determine the effect of a single freeze-thaw cycle on sperm DNA fragmentation and oxidative stress markers, and to evaluate whether melatonin has an impact on post-thaw oxidation profiles. This prospective cohort study was conducted at the Fertility and Reproductive Medicine Center, Beirut Hospital, Benghazi. Semen samples of 104 normozoospermic Libyans were evaluated before and after freezing. DNA fragmentation index (DFI) was measured by sperm chromatin dispersion (SCD) test, and reactive oxygen species (ROS) were quantified by using luminol-enhanced chemiluminescence. In a subset of ejaculates, aliquots were supplemented with 2 mM of melatonin prior to cryopreservation. Cryopreservation was associated with a statistically significant increase in DFI (46.3 ± 18.3% to 60.0 ± 23.0%; p < 0.001) and ROS levels (3.2 × 10³ to 14.7 × 10³ RLU/s; p < 0.001). Smokers presented significantly higher DFI at both pre-freeze and post-thaw evaluations (p < 0.001). We detected a positive correlation between ROS and post-thaw DFI (r = 0.68; p < 0.001). Melatonin-treated samples exhibited moderate but significant differences in ROS (12%, p = 0.045) and DFI (11%, p = 0.004) compared to untreated aliquots. These findings suggested that the freeze-thaw process may contribute to oxidative and genomic stress in spermatozoa, while melatonin supplementation appears to provide limited protection. Larger, multicenter studies incorporating ART endpoints are required to determine the potential translational relevance of these findings.
Intracytoplasmic sperm injection (ICSI) has become an integral practice in assisted reproduction technology (ART), but the optimal time interval between oocyte denudation (DN) and ICSI is still not well defined. Libya remains underrepresented in global fertility estimates, and prospective paired data on DN-to-ICSI timing from Libyan IVF practice are limited. We aimed to investigate whether performing ICSI immediately after DN, compared with an intended four-hour delay, affects pregnancy outcomes and early embryology yield. This prospective cohort study was conducted at the Fertility and Reproductive Medicine Center, Beirut Hospital, Benghazi and included 88 Libyan ICSI cycles. After enzymatic-mechanical DN using hyaluronidase, mature metaphase II (MII) oocytes were injected with selected sperm. Within each cycle, sibling MII oocytes were allocated in a 1:1 ratio to immediate ICSI or delayed ICSI after an intended interval of about four hours, using a computer-generated within-cycle allocation sequence. For clinical comparison, cycles were allocated by pre-generated permuted-block randomization to transfer blastocysts under one timing condition (44 cycles/arm). The primary outcome was normal fertilization (two pronuclei); secondary outcomes included cleavage (Day 3), blastulation and blastocyst quality (Day 5/6; Gardner-Schoolcraft), biochemical pregnancy and clinical pregnancy. Immediate DN-ICSI was significantly associated with higher fertilization rates than delayed injection (80.07% ± 17.09% vs 70.80% ± 17.37%; mean difference: 9.26, 95% CI 4.40-14.12; p = 0.0003) and a higher cleavage rate (76.89% ± 17.03% vs 67.97% ± 18.47%; mean difference 8.93 points, 95% CI 3.59-14.26; p = 0.0013). Biochemical pregnancy (40.9% vs 54.5%; p = 0.200) and clinical pregnancy (29.5% vs 27.3%; p = 0.813) did not differ significantly. These results suggest that a shorter DN-to-ICSI interval may improve fertilization and early embryo development, with no observed differences in blastulation or early pregnancy outcomes. Larger multicenter studies with cumulative live births are required to determine clinical relevance.Intracytoplasmic sperm injection (ICSI) has become an integral practice in assisted reproduction technology (ART), but the optimal time interval between oocyte denudation (DN) and ICSI is still not well defined. Libya remains underrepresented in global fertility estimates, and prospective paired data on DN-to-ICSI timing from Libyan IVF practice are limited. We aimed to investigate whether performing ICSI immediately after DN, compared with an intended four-hour delay, affects pregnancy outcomes and early embryology yield. This prospective cohort study was conducted at the Fertility and Reproductive Medicine Center, Beirut Hospital, Benghazi and included 88 Libyan ICSI cycles. After enzymatic-mechanical DN using hyaluronidase, mature metaphase II (MII) oocytes were injected with selected sperm. Within each cycle, sibling MII oocytes were allocated in a 1:1 ratio to immediate ICSI or delayed ICSI after an intended interval of about four hours, using a computer-generated within-cycle allocation sequence. For clinical comparison, cycles were allocated by pre-generated permuted-block randomization to transfer blastocysts under one timing condition (44 cycles/arm). The primary outcome was normal fertilization (two pronuclei); secondary outcomes included cleavage (Day 3), blastulation and blastocyst quality (Day 5/6; Gardner-Schoolcraft), biochemical pregnancy and clinical pregnancy. Immediate DN-ICSI was significantly associated with higher fertilization rates than delayed injection (80.07% ± 17.09% vs 70.80% ± 17.37%; mean difference: 9.26, 95% CI 4.40-14.12; p = 0.0003) and a higher cleavage rate (76.89% ± 17.03% vs 67.97% ± 18.47%; mean difference 8.93 points, 95% CI 3.59-14.26; p = 0.0013). Biochemical pregnancy (40.9% vs 54.5%; p = 0.200) and clinical pregnancy (29.5% vs 27.3%; p = 0.813) did not differ significantly. These results suggest that a shorter DN-to-ICSI interval may improve fertilization and early embryo development, with no observed differences in blastulation or early pregnancy outcomes. Larger multicenter studies with cumulative live births are required to determine clinical relevance.Intracytoplasmic sperm injection (ICSI) has become an integral practice in assisted reproduction technology (ART), but the optimal time interval between oocyte denudation (DN) and ICSI is still not well defined. Libya remains underrepresented in global fertility estimates, and prospective paired data on DN-to-ICSI timing from Libyan IVF practice are limited. We aimed to investigate whether performing ICSI immediately after DN, compared with an intended four-hour delay, affects pregnancy outcomes and early embryology yield. This prospective cohort study was conducted at the Fertility and Reproductive Medicine Center, Beirut Hospital, Benghazi and included 88 Libyan ICSI cycles. After enzymatic-mechanical DN using hyaluronidase, mature metaphase II (MII) oocytes were injected with selected sperm. Within each cycle, sibling MII oocytes were allocated in a 1:1 ratio to immediate ICSI or delayed ICSI after an intended interval of about four hours, using a computer-generated within-cycle allocation sequence. For clinical comparison, cycles were allocated by pre-generated permuted-block randomization to transfer blastocysts under one timing condition (44 cycles/arm). The primary outcome was normal fertilization (two pronuclei); secondary outcomes included cleavage (Day 3), blastulation and blastocyst quality (Day 5/6; Gardner-Schoolcraft), biochemical pregnancy and clinical pregnancy. Immediate DN-ICSI was significantly associated with higher fertilization rates than delayed injection (80.07% ± 17.09% vs 70.80% ± 17.37%; mean difference: 9.26, 95% CI 4.40-14.12; p = 0.0003) and a higher cleavage rate (76.89% ± 17.03% vs 67.97% ± 18.47%; mean difference 8.93 points, 95% CI 3.59-14.26; p = 0.0013). Biochemical pregnancy (40.9% vs 54.5%; p = 0.200) and clinical pregnancy (29.5% vs 27.3%; p = 0.813) did not differ significantly. These results suggest that a shorter DN-to-ICSI interval may improve fertilization and early embryo development, with no observed differences in blastulation or early pregnancy outcomes. Larger multicenter studies with cumulative live births are required to determine clinical relevance.
To evaluate the predictive role of serum amyloid A (SAA) levels and their association with antiphospholipid antibodies (APA) and coagulation markers such as lupus anticoagulants (LA), anti-cardiolipin (ACA), protein C (PC) deficiency, protein S (PS) deficiency, and antithrombin III (ATIII) deficiency in recurrent pregnancy loss (RPL). This prospective case-control study comprised two groups: the study group (n = 88) included women with recurrent pregnancy loss at Mansoura University Hospital between January 2019 and December 2020, and the control group (n = 52) included women without obstetric or medical complications. Demographic, clinical, and laboratory data, including serum samples collected at 10 weeks of gestation, were collected from all participants. The study measured SAA levels, lupus anticoagulants, anti-cardiolipin, protein C, protein S, and antithrombin III levels. The SAA level was significantly elevated in the recurrent pregnancy loss group compared to that in the control group. Lupus anticoagulant positive, anti-cardiolipin positive Immunoglobulin M (IgM), and deficiencies in protein C, protein S, and antithrombin III were significantly observed in patients with RPL (p < 0.05). The SAA levels were significantly elevated in both LA-positive and ACA-positive IgM patients. The receiver operating characteristic (ROC) curve analysis demonstrated that at SAA > 24.8 for the prediction of recurrent pregnancy loss, sensitivity was 98.86%, and specificity was 92.31%. Positive and negative predictive values were 95.6% and 98.0%, respectively. The area under the curve = 0.971 (0.927-0.992). SAA is associated with recurrent pregnancy loss and may therefore serve as a potential predictor of this condition. The observed elevation in SAA levels could be primary or secondary to the inflammatory response that promotes thrombotic activity in RPL patients at risk of APA, Protein S, Protein C, and ATIII deficiencies. Implementing SAA screening during pregnancy may facilitate the identification of individuals who could potentially benefit from novel treatment strategies.
Asthma is a prevalent chronic respiratory disease associated with significant morbidity and mortality globally. Effective self-management of asthma depends on adequate numeracy skills, which are essential components of health literacy (HL). Although the Asthma Numeracy Questionnaire (ANQ) has been validated among parents of asthmatic children, no previous studies have specifically validated the tool among adult patients with asthma. Therefore, this study aimed to validate the Arabic version of the Ar-ANQ among adult patients with asthma in Jordan, assess their asthma-related numeracy skills, and identify demographic and clinical factors associated with numeracy. A cross-sectional study was conducted with 398 adult patients with asthma attending the Respiratory Therapy Unit at the University of Jordan Hospital (JHU) from November 2024 to April 2025. Participants completed the Arabic Ar-ANQ and provided demographic information. The questionnaire's validity and reliability were evaluated using Confirmatory Factor Analysis (CFA) and Rasch analysis. Associations between Ar-ANQ scores and sociodemographic variables were analyzed using quantile regression. Confirmatory Factor Analysis (CFA) confirmed the unidimensional structure of the Ar-ANQ (SRMR = 0.02, CFI = 0.98, GFI = 0.99, TLI = 0.95), demonstrating high internal consistency (Cronbach's α = 0.80). Rasch analysis further supported the instrument's reliability, with acceptable infit and outfit statistics, as well as item and person separation reliability indices. Numeracy skills varied significantly among participants, influenced by education level and income, with higher Ar-ANQ scores observed among those with higher educational attainment and income levels. The Ar-ANQ is a valid and reliable instrument for evaluating numeracy skills essential for effective asthma self-management among adult asthmatic patients. Its use can facilitate targeted educational interventions and improved asthma control.
Preoperative anxiety is a feeling of insecurity, physical and psychological discomfort that arises from the prospect of undergoing surgery. Managing anxiety is a therapeutic cornerstone in anesthetic care. Virtual reality has shown a significant effect on managing anxiety and pain by leveraging the principle of distraction, hypnosis, or a combination of distraction and relaxation. We aim to study the impact of virtual reality on perioperative anxiety during surgeries performed under regional anesthesia. This was a monocentric, prospective, randomized study conducted over a three-month period from March 2023 to May 2023 in the anesthesia and resuscitation department of Taher Sfar Hospital in Mahdia. A total of 72 patients scheduled for orthopedic surgeries were included. Patients were randomized to be allocated to: VR+ group (n = 36), who experienced virtual reality during the operation, or the VR- group (n = 36), who did not experience virtual reality. The consumption of anxiolytics (Midazolam) was evaluated intraoperatively along with perioperative anxiety levels (ICD-11 code MB24.6). Anxiety levels were assessed using the STAI-6, and LIKERT scales. Patient satisfaction was measured using the LIKERT scale. Data from 68 patients were analyzed, with 34 patients in each group. Our study showed that there were no significant differences in preoperative anxiety levels between the groups (average STAI-6 score: VR- = 43.2 vs. VR+ = 44.8). Virtual reality reduced the frequency of anxiolytic use intraoperatively: 61.7% in the VR- group vs. 5.8% in the VR+ group (p < 0.001), as well as the quantity used. Postoperative anxiety reduction was comparable between groups. All patients included in the study exhibited very low anxiety levels according to the STAI-6 score, taking preoperative anxiety levels into account. Virtual reality can be considered an effective method for managing perioperative anxiety during surgeries under regional anesthesia and helps prevent postoperative complications.
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a growing public health concern because of its increasing prevalence and harmful effects on physical and mental health. This disorder leads to disruptive symptoms such as daytime sleepiness and fatigue, which negatively affect vigilance, productivity, and quality of life. To investigate the impact of OSAHS severity on quality of life, productivity, and anxiety disorders in an active population. This cross-sectional study was conducted from January 2018 to June 2023 at Sahloul University Hospital among patients diagnosed with OSAHS. Excessive daytime sleepiness was assessed via the Epworth Sleepiness Scale, quality of life via the SF-12 Health Survey, mental health via the Hospital Anxiety and Depression Scale (HAD), and work productivity via the Work Productivity and Activity Impairment (WPAI) questionnaire. During the study period, 93 active patients diagnosed with OSAHS were included. Severe OSAHS was identified in 35 patients (37.6%). Male sex and tobacco smoking were associated with increased severity of OSAHS (p = 0.002 and 0.005, respectively). Patients with severe OSAHS had a higher body mass index (BMI) (p = 0.043). A significant association was observed between depression and anxiety scores and the severity of OSAHS (p = 0.018 and 0.025, respectively). An alteration in quality of life was more pronounced in patients with severe OSAHS (p < 0.001). In terms of productivity, the severity of OSAHS was correlated with alterations in the four dimensions of the WPAI. After binary logistic regression, the severity of OSAHS was associated with BMI (p = 0.005; aOR = 1.16; 95% CI [1.04-1.29]) and presenteeism (p < 0.001, aOR = 1.08; 95% CI [1.04-1.11]). OSAHS has substantial professional repercussions and negative impacts on patients' quality of life. As this is a cross-sectional study, only statistical associations can be inferred. Nonetheless, promoting screening and access to care is crucial at both the individual and organizational levels.