New Emirates Medical Journal - Volume 5, Issue 1, 2024

A wide variety of tumors affect the pleura, both primary and secondary. The most common are metastatic carcinomas, usually of pulmonary origin. They manifest as malignant pleural effusion or multifocal pleural lesions. The extrapulmonary source of metastasis is mentioned but occurs less frequently. Pleural primary tumors other than diffuse malignant mesothelioma are either uncommon or rare and have received less attention. The World Health Organization (WHO) classified primary tumors of the pleura into three broad histogenetic classes of neoplasms, namely mesothelial tumors, mesenchymal tumors, and lymphoproliferative disorders.

A 41-year-old male patient was referred to our facility from the prevention medicine department with consolidation in the right lower zone of the chest, diagnosed as a case of encysted pleural effusion to rule out TB. This was discovered during a routine health examination for residency visa renewal. After laps and imaging workup, it was diagnosed as Solitary Fibrous Pleural Tumor (SFPT). The first surgical intervention was hampered by bleeding from the mass itself. Therefore, the patient underwent a second intervention after successful embolization of the arterial supply of the tumor by the interventional radiologist.

Primary pleural neoplasms represent a small but significant group of heterogeneous tumors, many of which may mimic each other. Modern imaging modalities permit diagnosis and play a major role in staging and assessing surgical respectability. Novel molecular and immunohistochemical markers now allow confirmation of diagnosis and potentially form the basis for future targeted therapies. Embolization of tumor perfusion has a lifesaving role when needed.

Caffeine, a stimulant for the central nervous system, is extensively consumed worldwide and can be found in various items such as coffee, tea, chocolate, and energy beverages. In addition to its stimulating properties, caffeine has been shown to provide numerous health advantages, including relief from migraines, treatment for neonatal apnea, and possible protective effects against neurodegenerative diseases and metabolic disorders. Despite its widespread use, the understanding of caffeine's therapeutic uses among healthcare professionals is still quite limited.

This study was conducted to measure the awareness and knowledge regarding the health impacts of caffeine among medical students and interns at RAKMHSU.

A cross-sectional study was carried out over six months (September 2023–April 2024) involving 190 participants selected through purposive sampling. Data were gathered using a structured, pretested questionnaire and analyzed with SPSS v29. Both descriptive and inferential statistical methods, including chi-square and independent t-tests, were employed.

The majority (70.5%) of the participants were female, with an average age of 20.52 years. Although 67.4% acknowledged caffeine's efficacy in migraine management, awareness of its neuroprotective properties (Parkinson's: 22.6%; Alzheimer's: 28.4%) and metabolic advantages was notably low. Students in clinical years exhibited significantly higher knowledge scores compared to their preclinical peers (p = 0.041). However, no significant differences were found based on gender, college affiliation, or residential status.

There are evident gaps in knowledge regarding caffeine’s health benefits among healthcare students, especially concerning its emerging therapeutic roles. These results highlight the necessity for focused educational initiatives within health sciences programs to improve the understanding and application of evidence-based dietary practices.

Cardiac amyloidosis, characterized by amyloid fibril deposition in the heart, often leads to heart failure and has a high mortality rate. The early detection of cardiac amyloidosis is critical for improving patient prognosis; however, the subtle and variable presentations of this condition can make early diagnosis challenging. Echocardiography is pivotal for diagnosing this condition. Through this study, we aim to improve the understanding of the echocardiographic features of cardiac amyloidosis.

This retrospective case series was based on the data of patients diagnosed with amyloid transthyretin-related cardiac amyloidosis (ATTR cardiac amyloidosis) from 2020 to 2024 at the Prince Sultan Cardiac Center in Riyadh, Saudi Arabia. The collected data included demographic characteristics, medical history, laboratory results, medication use, 12-lead electrocardiography results, and echocardiographic parameters.

Fifteen patients (11 males and four females, aged 41–88 years) were included in the analysis. The most common comorbidities were hypertension (seven patients) and atrial fibrillation (nine patients). The key echocardiographic characteristics were increased left ventricular (LV) wall thickness (mean: 19.9 mm), reduced global longitudinal strain (mean: −10%), and apical sparing. Six patients were positive for the 5-5-5 sign and pericardial effusion.

Recognizing echocardiographic features, such as apical sparing and increased LV wall thickness, is essential for the early diagnosis of cardiac amyloidosis. Improved clinical awareness and diagnostic protocols could enhance early detection and patient outcomes.

Coronary artery disease (CAD) is a significant contributor to 50%-70% of cardiac failure cases. Successful reperfusion is linked to improved systolic and diastolic functions.

This study aimed to detect the correlation between ECG parameters (QRS duration and fragmentation, QTc, Tpe, and Tpe / QTc ratio), which were proved to be correlated with improved reperfusion post-PCI and associated with the improvement in systolic and diastolic function.

This prospective research was performed on 54 ischemic cardiomyopathic cases from March 2019 to September 2022. All patients with Ischemic cardiomyopathy (ICM) and an EF less than 40%, along with viable myocardium determined by Dobutamine stress Echocardiography, underwent Complete revascularization of PCI amenable vessels.

There was a statistically significant positive correlation between the QTc interval and EF% after 1 month (r=0.29) and between the QTc interval and the percentage of improvement in both systolic and diastolic functions (EF& E/é) with a more positive correlation with improvement in EF (r=0.35 and 0.27 respectively). A stronger positive and significant correlation between the percentage of improvement in EF% with both Tpe interval, Tpe/QTc ratio, and QRS duration (r= 0.57, 0.50, and 0.58, respectively) was found. Also, there was a positive significant correlation between the percentage of improvement in E/é with both Tpe interval, Tpe/QTc ratio, and QRS duration (r= 0.37, 0.26, and 0.32 respectively)

ECG parameters are capable of predicting improvement of systolic and diastolic functions in ischemic cardiomyopathic patients as observed by improvement in ejection fraction and E/é after PCI compared to before PCI.

With the spread of COVID-19 around the world, this disease became a serious threat to global health and exposed people to coronavirus anxiety and death. Hospitalized patients have faced more anxiety about coronavirus and death, which can affect both the experiences and satisfaction of patients.

The present study investigated the relationship between death anxiety, COVID-19 anxiety, experiences, and satisfaction of patients during the COVID-19 outbreak.

This correlational study was performed on 239 patients admitted to Ali-Ibn Abi-Talib Hospital of Rafsanjani, southern Iran, during the COVID-19 outbreak. The socio-demographic characteristics, Templer death anxiety scale (DAS), Corona disease anxiety scale (CDAS), short-form of the Hong Kong inpatient experience questionnaire (SF-HKIEQ), and patient satisfaction instrument (PSI) were used to collect data. The data were then analyzed using SPSS 25.

10.9% of participants had high COVID-19 anxiety, and 69.0% had high death anxiety. 77.8% of the participants had problems in the inpatient experience. 69.9% of participants were dissatisfied, and 30.1% had moderate satisfaction. A significant negative correlation between death anxiety and COVID-19 anxiety (r = -0.13; p = 0.04) was observed. Death anxiety hurt experiences, and COVID-19 anxiety had a positive impact on patients' experiences. Also, we found a significant positive correlation between experiences and patients' satisfaction. COVID-19 anxiety, age, death anxiety, and infection with COVID-19 predicted 37% of the variance of patients' experiences. COVID-19 anxiety, inpatient experience, and marital status predicted 14% of the variance in patient satisfaction (p < 0.05).

Patients have experienced high levels of death anxiety and moderate levels of COVID-19 anxiety during the outbreak of the COVID-19 pandemic, which has affected their experiences and satisfaction. Professional assistance is needed to improve patient experience and satisfaction during pandemics such as COVID-19 disease. The results of this study may help to prepare suitable future interventions and programs to increase patient satisfaction in hospitals.

Hemolacria, the presence of blood in tears, is an uncommon condition with various underlying etiologies. Although it can be alarming, its occurrence is often linked to a range of medical conditions, particularly in pediatric patients.

We present two pediatric cases involving hematological diseases who developed hemolacria as a manifestation of their underlying conditions. Case 1 includes that of an eight-year-old girl with chronic immune thrombocytopenia (ITP) who developed hemolacria during an episode of epistaxis. Case 2 is of a seven-year-old girl with acute lymphoblastic leukemia (ALL) who presented with hemolacria during maintenance chemotherapy. Both cases illustrate the importance of considering hematological disorders in the differential diagnosis of pediatric hemolacria. 
Both cases were managed using a multidisciplinary strategy tailored to their underlying conditions. Systemic treatments, including intravenous immunoglobulin, thrombopoietin receptor agonists, and chemotherapy, addressed the primary hematological disorders. Localized ocular therapies, such as artificial tears, topical steroids, and antihistamines, were employed to manage symptoms and prevent complications. Supportive care measures, including patient education and infection prevention protocols, were integral to both management plans.

These two cases underscore the importance of recognizing hematological diseases as potential causes of hemolacria in children. Effective management requires a comprehensive, multidisciplinary approach that combines systemic treatment of the underlying disease with targeted local therapies and supportive care. Timely intervention is critical to ensuring favorable outcomes in these rare but significant presentations.

Emotional intelligence (EI) plays a pivotal role in the effectiveness and efficiency of nursing students in their academic and professional pursuits. EI levels differ across academic years and tend to increase with age, often being higher in female students.

This study aimed to assess the EI of RAKMHSU nursing students in the UAE.

This descriptive cross-sectional study used the Schutte EI Scale to assess the EI of 214 undergraduate nursing students. The Schutte EI Scale is a five-point Likert scale comprising 33 questions that yields scores between 33 and 165, including reverse scoring for three questions. Data were analysed using IBM SPSS Version 25.

Approximately 82.7% of the study participants were female and 91.6% were unmarried. The age range of the participants was 18–22 years. Scores of 33–77, 78–121, and >122 on the Schutte EI Scale were considered low, moderate, and high, respectively. No differences were found in the average EI scores of nursing students by academic year. Overall, 68.15% of the students had high EI, 23.83% had moderate EI, and 7% had low EI. The study found no correlation between the EI scores and demographic factors. All EI domain scores except those for emotion perception were consistent between first- and final-year nursing students.

The study showed that many of the nursing students exhibited high EI, which is essential for communication, patient care, and professional development. Further, demographic parameters, including age, gender, and academic year, did not significantly affect the EI scores, suggesting that EI in this cohort of students was stable. Most students demonstrated strong EI, although the perception of the cohort could be improved. These findings highlight the need to integrate EI training in nursing universities to improve students’ emotional abilities, thereby improving patient outcomes and the nursing profession.

Entry-level physiotherapists function as autonomous healthcare practitioners within a complex healthcare system, requiring professional competence in the clinical domain. Physiotherapy (PT) educational programs typically emphasize onsite teaching and use summative assessments to evaluate students' achievement of program objectives and learning outcomes. However, possessing knowledge and skills does not guarantee efficacy or confidence in clinical practice. This study aimed to assess the impact of online teaching approaches (TAs) during the COVID-19 era on the physiotherapy self-efficacy (PSE) of senior FCHS physiotherapy students across three clinical areas: musculoskeletal (MSK), neurological (N), and cardiorespiratory (CR), and to explore the influence of academic factors on PSE scores.

Researchers collected data for this cross-sectional study using a four-section questionnaire. One section specifically addressed the PSE. The study focused on three cohorts of pre-graduation senior PT students at Fatima College of Health Sciences (FCHS) who encountered a combination of onsite, online, and blended TAs due to COVID-19. Nonparametric statistical analysis was employed to analyze the data.

Of the seventeen participating students (68% participation rate, median age 22), the results indicate a statistically significant decrease in self-efficacy from MSK to N and CR clinical areas. The impact of online TAs on PSE varied by course specialty; TAs related to CR specialty courses significantly correlated with PSE scores, showing a preference for onsite TA to enhance self-efficacy over blended and online TAs. Furthermore, greater exposure to clinical cases and verbal encouragement from clinical educators were associated with higher self-efficacy. Physiological reactions, such as body pain, were also found to be influenced by the specific clinical area.

The impact of online TAs, implemented during the COVID-19 pandemic, on the self-efficacy of senior PT students is dependent on the specialty of the courses. This impact was most significant in CR specialty courses. Moreover, other factors, such as the sufficiency of exposure to clinical cases and clinical educators’ verbal encouragement, significantly contributed to students' self-efficacy.

The traditional methods are mostly used to detect tracheal localization and to exclude esophageal localization. Therefore, the aim of this study was to investigate the usefulness of epigastric manual compression in the confirmation of esophageal placement of the tube.

Out-of-hospital ETE was performed by experienced paramedics working in the emergency ambulance service, while ETE in the emergency department was performed by emergency medicine residents or emergency medicine specialists with at least 2 years of emergency department experience. Epigastric compression was performed by applying pressure to the epigastric region at least three times (in 5 sec) with the volar side of the intubated patient while the patient was ventilated with a balloon-valved mask. Immediately after ETI was performed, Ultrasonography (USG) was performed as the gold standard confirmation method. If a double path sign was observed and the pleural sliding motion was not seen, it was considered unsuccessful.

A total of 78 patients were included in the study (an equal number of successful and unsuccessful ETE applications). Approximately 59% (n=46) of the patients were female, median age was 73 years (64-80), and 22(28.2%) patients were intubated due to traumatic etiology. The specificity and sensitivity of epigastric fluctuation for esophageal intubations were 83.33% and 60%, respectively. The positive predictive value was 92.31%, and the negative predictive value was 38.46%. Epigastric auscultation airflow sound had a specificity of 86.96% and a sensitivity of 65.45% for esophageal intubation.

Although the fluctuation that occurs in the tube with epigastric compression is not as sensitive and specific as USG, it is a better method than lung auscultation.

Pediatric inflammatory bowel disease [IBD] impacts affected children with many diagnostic, therapeutic, and life challenges. The traditional drugs used for induction and maintenance of remission had many unwanted side effects. Therefore, there was an urgent need for safer, more effective therapeutic strategies. Hence, modifying the gut microbiota [GM] was proposed as an innovative approach based on the theory that restoring the disturbed GM harmony will have a positive impact on IBD activity and remission.

This review aimed to examine each modality used to modify the gut microbiota in children with IBD, addressing their action mode, effectiveness, limitations, and side effects for a more holistic approach to children with IBD.

Four electronic databases were searched, including WOS, Cochrane Library, PubMed, and Scopus, for articles that investigated modulating GM via exclusive enteral nutrition, prebiotics, dietary fiber, probiotics, fecal microbiota transplantation, and antibiotics.

The available evidence was encouraging regarding their effectiveness and safety; however, those studies were hindered by their small sampling size and inconsistency in recruiting cases.

Further work should identify other therapeutic and prognostic avenues for modulating GM for these vulnerable groups.

Ankylosing spondylitis (AS), also known as rheumatic pelvic spondylitis, is considered the primary condition in a group of chronic inflammatory rheumatic diseases collectively referred to as spondyloarthropathies.

This study aimed to explore the association between ABCB1 C3435T polymorphism and the predisposition to ankylosing spondylitis (AS) in the Algerian population. The frequency of this polymorphism was compared between the group of AS and healthy subjects.

A case-control study involving 81 AS patients and 98 controls was conducted. DNA genotyping was done using predesigned probe-based allelic discrimination TaqMan® assays. Allele and genotype frequencies were compared between cases and controls, and statistical analyses were executed using SAS software (version 9.1, SAS Institute Inc., Cary, NC).

No statistically significant differences were observed in the frequencies of ABCB1 genotypes and alleles between AS cases and the control group. In contrast, the recessive model (CC+CT/TT) (OR = 8.99 [11.97-40.99], p = 0.004) was significantly associated with the mixed form of the disease, while the heterozygous 3435CT genotype provided protection against the axial form. Moreover, a positive association was also found between the ABCB1 C3435T polymorphism and BMI (OR: 5.19 [1.41-19.9], p = 0.01).

This is the first study to explore the association of ABCB1 polymorphisms with susceptibility to ankylosing spondylitis in an Algerian population. It was determined that the ABCB1 C3435T SNP does not influence the risk of AS but rather affects the disease phenotype and body mass index (BMI).

Iron-Deficiency Anemia (IDA) is a global burden affecting more than a billion individuals. It is most prevalent due to nutritional deficiencies. Researchers have linked Selenium (Se) to anemia and erythropoiesis.

This interventional-study was designed to investigate the plasma Se concentration and its supplementation impact in IDA patients receiving standard treatment.

In the present study, a total of 215 IDA patients were enrolled from different departments of AIIMS, New Delhi, after getting ethical authorization from the Institutional-Ethical Committee. Iron supplements were administered to patients with only IDA, while a combination of iron and selenium supplements was given to patients with selenium-deficient IDA for 90 days. Parameters such as hemoglobin, hematocrit, RBC count, serum ferritin, transferrin, TIBC, and plasma Se levels were measured on the baseline and the 90th day.

All blood parameters were significantly below the normal reference range on the 0th day. Se levels were found to be higher in the study population {57% (122/215) in IDA}. Further, in low plasma Se IDA patients 26% (55/215), treatment with iron and Se supplements for 90 days significantly improved all blood parameters and led to a subjective improvement of the patient’s well-being.

Selenium levels are variable in patients with IDA, and no correlation can be drawn for the benefit of selenium in the IDA. Further, the high prevalence of nutrition-related disorders such as IDA highlights the need to avoid blind Se supplementation along with iron. These combination in the form of nutritional supplements having Se are rampantly available and sold over the counter. So, supplements with Se shouldn’t be generalized to IDA patients..

CTRI/2023/04/051405

Polycystic Ovary Syndrome (PCOS) is one of the most prevalent endocrinal disorders in the reproductive age of women and is, therefore, a risk factor for Gestational Diabetes Mellitus (GDM). One of the medications used in the management of PCOS is metformin and its use has been proposed to decrease the occurrence of GDM. The purpose of this study focuses on the effects of the dose and duration of metformin treatment on the prevalence of GDM among pregnant women affected by PCOS.

A cross-sectional survey was carried out on 112 pregnant women diagnosed with PCOS in tertiary care hospitals in Karachi. Data were collected through a structured questionnaire, in which 55 patients received metformin and others did not receive metformin. Both groups were compared for the prevalence of GDM. Chi-square test was used in data analysis at a significance level of p < 0. 05.

GDM was found to be significantly higher in non-metformin group than metformin group (60% vs 40%, P=0.03). The data analysis extended this finding, which concluded that metformin use is inversely related to GDM risk (p = 0.02).

This study shows that metformin therapy reduces the incidence of GDM in pregnant PCOS patients and may be used to prevent GDM in such patients. Such outcomes indicate the possibility of the use of metformin as a means of preventing GDM in this group of patients.

The healthcare sector plays a significant role in the control and mitigation of plastic pollution-associated threats to the environment and human health.

This study aimed to investigate the awareness, pro-environmental behaviors, and strategies for mitigating plastic pollution among nursing students.

A cross-sectional survey was conducted with 210 undergraduate nursing students using a structured questionnaire. Convenience sampling was used to recruit study participants. Data were analyzed using the Statistical Package for the Social Sciences version 26.

The results of the study revealed that the majority of nursing students (71%) had moderately adequate levels of awareness regarding plastic pollution, whereas 70.48% of the students engaged in inadequate levels of pro-environmental behaviors.

The present findings demonstrate the necessity of reinforcing nursing students regarding the reduction of plastic pollution through specific policies and educational involvement. These measures would contribute to further initiatives and encouragement of their student period, future nursing practice, and patient safety at all levels.

Globally, urinary tract infections (UTIs) have attracted the attention of clinicians and have become a serious public health threat. Management of UTIs has become a growing concern for clinicians due to increased antimicrobial resistance (AMR). The present study was conducted to identify the most diagnosed uropathogens causing UTIs among Inpatient Department (IPD) and Outpatient Department (OPD) patients visiting a tertiary care health centre and also to analyse the patterns of prescribed antibiotics based on physicians’ empirical and urine culture-based approach. Furthermore, this study sought to evaluate the sensitivity patterns of selected bacteria against antibiotics used to treat UTIs among patients.

This study was undertaken for a period of three years at the Department of Medicine in collaboration with the Department of Microbiology. Mid-stream clean catch urine samples were collected from UTI suspects from both IPD and OPD patients and processed for culture and susceptibility testing as per standard guidelines. Univariate and bi-variate descriptive statistical techniques were used to analyse the data.

A total of 2400 urine samples were processed for culture and sensitivity testing, out of which 200 samples were found positive. Escherichia coli was the most frequently isolated urinary pathogen in both OPD and IPD patients (55.3% and 74.4%, respectively). Empirically, the most commonly prescribed antibiotic was piperacillin/tazobactam (13%), while the culture-based antibiotic was nitrofurantoin (20%). The findings highlight that more than 95% of isolates of the most prevalent uropathogen E. coli were sensitive to amikacin, ciprofloxacin, imipenem, and nitrofurantoin, whereas more than 90% were sensitive to ceftazidime, cefoperazone sulbactam, and piperacillin/tazobactam.

Increasing resistance to common antibiotics necessitates a reevaluation of both empirical and culture-based antibiotic approaches. The findings of this study are of significant importance and highlight the need to develop a targeted antibiogram for UTI, understand the trends in antimicrobial resistance (AMR), and ensure the rational selection and antibiogram both in empirical and culture-based approaches.

Incidental gastric tumours, including benign gastric adenomyoma (GA) during bariatric surgery, can pose diagnostic and management dilemmas, resulting in misdiagnosis, inappropriate procedures, or even abandoning the procedure.

We report a rare case of an incidental prepyloric GA discovered during a one-anastomosis gastric bypass performed for diabetes management. Preoperative gastroscopy was unremarkable, but intraoperative laparoscopy revealed a mass near the pylorus resembling a gastrointestinal stromal tumour (GIST). An initial histopathological examination was non-confirmatory. However, subsequently, it was confirmed to be a GA. The patient underwent a staged surgical approach, achieving diabetic control during the primary procedure and tumour excision subsequently. This is the first documented case of GA discovered during bariatric surgery.

Gastric tumours identified during bariatric procedures necessitate an individualized approach considering the procedure planned, tumour characteristics, and anatomical location, to achieve the best clinical outcomes.

Digital eye strain (DES), also known as computer vision syndrome (CVS), is a common condition affecting individuals who spend prolonged periods focusing on screens, leading to symptoms, such as dry eyes, eye strain, headaches, and blurred vision. University students, including medical students, increasingly spend more time staring at screens for study and research. Therefore, this study assesses the prevalence and impact of DES among medical students, a group increasingly dependent on digital resources for their studies.

This cross-sectional study was conducted from November 2023 to February 2024 at RAK Medical and Health Sciences University, UAE. A sample of 209 undergraduate medical students was recruited using non-probability convenience sampling. The sample size was calculated based on a 95% confidence level and a ±5% margin of error, representing 46.4% of the eligible population. Data were collected through a validated electronic questionnaire and analyzed using SPSS version 29, employing descriptive and inferential statistics to explore associations between visual symptoms and factors, such as refractive errors, study duration, and ergonomic practices.

Among respondents, 69.9% were female, with a mean age of 19.87 ± 1.58 years. The prevalence of myopia was 49.7%, while hypermetropia and astigmatism were reported at 2.9% and 6.7%, respectively. A striking 92.8% experienced at least one DES symptom, with tired eyes (71.3%) and eye strain (58.9%) being the most common symptoms. Significant correlations were observed, including dry eyes associated with myopia (p = 0.002) and difficulty refocusing linked to hypermetropia (p = 0.029). Ergonomic practices revealed that 80.4% of students used screens closer than recommended, which correlated with increased eye strain (p = 0.001) and tired eyes (p = 0.044). Moreover, adherence to the 20-20-20 rule was low (3.8%), associated with heightened symptoms.

This study highlights a high prevalence of DES symptoms among medical students, related to inadequate ergonomic practices. These findings emphasize the necessity for targeted interventions to enhance eye health and ergonomic awareness in this population. Future research should evaluate the effectiveness of such interventions.

ADHD (attention-deficit hyperactivity disorder) is a developmental disorder characterized by inattention and distractibility, as well as hyperactivity.

This study investigated the prevalence of ADHD in male and female students of primary school in Babol (Iran).

This study was a cross-sectional study. The studied population was school-aged children (7-12 years old) in the urban areas of Babol city. A total of 1469 primary school students were included in the study during 2021-2022. In this research, the Revised Conners' Parent Rating Scale (CPRS-R) was used to investigate ADHD disorder.

The prevalence of ADHD in the present study was 9.9% (146 people). ADHD subgroups, in the order of prevalence, included mixed type (67 people, 4.6%), hyperactivity-impulsive type (43 people, 2.9%), and then inattentive type (36 people, 2.5%). ADHD prevalence among males and females was 13.4% and 7%, respectively. This was 1.9 times higher in male students than in female students. ADHD subgroups in male students, in order of prevalence, included mixed type (44 people, 50%), impulsive hyperactivity type (32 people, 36.36%), and inattentive type (12 people, 13.63%), and in female students, ADHD subgroups were inattentive type (24 people, 41.37%), mixed type (23 people, 39.65%), and hyperactivity-impulsive type (11 people, 18.96%). ADHD was seen mostly in students with illiterate parents (p≤0.001).

It seems that the prevalence of ADHD in children of elementary schools in Babol was not significantly different from the prevalence reported in other cities of Iran and globally.

Medically-complicated obesity, a major public health issue due to the ineffectiveness of traditional treatments, is increasingly managed through bariatric surgery. This study investigates the knowledge of clinical year students about bariatric surgery at RAKMHSU. It aims to assess their awareness and understanding of this crucial intervention for severe obesity and its related health risks.

This cross-sectional study was conducted over three months at RAK Medical and Health Sciences University (RAKMHSU) and utilized a survey to assess perception regarding bariatric surgery among clinical year students from RAK College of Medical Sciences (RAKCOMS) and RAK College of Nursing (RAKCONS). A pre-validated questionnaire was employed, and participants were randomly selected. Data analysis focused on the reliability of the tool and the student’s perception.

The study included 197 participants, comprising 162 medical and 35 nursing students. Significant differences emerged in three areas: nursing students preferred daily exercise more (Q6), believed in the greater likelihood of weight regain post-surgery (Q9), and were more aware of disease susceptibility (Q13) compared to medical students. Correlation analysis revealed that students who felt body shape affected self-confidence had better bariatric surgery knowledge and BMI calculation experience. Notable correlations were found between specific questions, with significant positive correlations observed among nursing students but not medical students.

Obesity is a global epidemic with rising prevalence, including in the UAE, where 43% of expatriates are overweight and 32.3% obese. Environmental factors, such as low physical activity due to climate and cultural norms, exacerbate the issue. Our study revealed good knowledge of BMI among participants, reflecting awareness of obesity's risks. However, concerns about bariatric surgery safety persist, with 32% of participants wary of complications. Despite this, the most recognized bariatric surgery is a viable option for medical conditions like PCOS. Educational interventions are essential to address misconceptions, promote informed decisions, and bridge gaps in exercise habits and referral practices.

In conclusion, while many medical and nursing students demonstrate a solid understanding of bariatric surgery, hesitations and misconceptions persist. Continuous education is essential to address these concerns, enhance knowledge, and align perceptions with clinical advancements. By doing so, future healthcare professionals can make informed decisions and provide better care for patients with severe obesity, ultimately improving outcomes and fostering greater acceptance of evidence-based surgical interventions.

Prediabetes is associated with an increased risk of diabetes. However, there is currently no cohesive picture of the prevalence of prediabetes and its risk factors in Afghanistan. Therefore, we conducted a study to examine the prevalence of prediabetes and its risk factors among adult outpatients in Afghanistan.

We conducted a cross-sectional study on outpatients aged 18 years or over (n=1766) from April 2023 to October 2023. The sociodemographic characteristics and clinical variables of the patients were collected through an interview-based survey. Regression analysis was used to examine the association between prediabetes and its risk factors.

The study included 54.6% females and 45.4% males, with a mean age of 48.9 (±10.8). The prevalence of prediabetes was 27.9%. Males were more likely to have prediabetes with increased odds (OR = 1.48; 95% CI: 1.17–1.89; p < 0.001) compared with females. There were higher odds of having prediabetes for overweight or obese (OR = 2.10; 95% CI 1.15-3.84; P = 0.016), smoking (OR = 7.26; 95% CI 3.00-11.05; p < 0.001), hypertension (OR = 2.76; 95% CI 2.00-3.81; p < 0.001), and high cholesterol levels (OR = 1.48; 95% CI 1.16-1.90; P = 0.002), compared to participants without prediabetes.

The prevalence of prediabetes in our study was high. Risk factors that were related to prediabetes included male gender, obesity or overweight, smoking, hypertension, and high cholesterol levels. Focusing control and prevention efforts on these risk factors linked to prediabetes can significantly reduce its prevalence and mitigate future consequences.

Nasopharyngeal carcinoma (NPC) is a prevalent cancer in Algeria, where it ranks as the most common cancer of the aerodigestive tract in men, with an incidence rate of 5.1 cases per 100,000 persons per year. The etiology of NPC is multifactorial. Thus, this research aims to identify specific dietary risk factors prevalent in the western Algerian region.

We conducted a case-control study comprising 120 incident cases of histologically confirmed nasopharyngeal carcinoma, carefully matched with 120 controls.

Nasopharyngeal cancer, more common in males (average age 45.2 ± 2.5 years), is linked to consuming traditionally preserved foods (khlii, salted fats, boiled milk, processed meats), elevating NPC risk. Significant associations include hot chili peppers, citrus fruits, and dried vegetables, while increased fruit and coffee intake reduces risk. High-temperature cooking and fried food show a strong link. Multivariate analysis identifies hot chilli, citrus fruits, fresh fruits, and coffee as the key factors significantly associated with NPC.

This research provides essential insights for implementing primary prevention measures to combat nasopharyngeal carcinoma effectively. By identifying specific dietary risk factors prevalent in the western Algerian region, healthcare authorities can focus on targeted interventions to reduce the burden of NPC in this population.

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive treatment modality that is gaining prominence due to the limitations of existing pharmacotherapy approaches. To date, there is a paucity of research examining the awareness of rTMS among psychiatrists in the Arabian Gulf region. In this region, treatment resistance is prevalent due to the cultural attribution of psychological distress to somatic factors and the stigma associated with pharmacotherapy.

This study aims to assess the comprehension and attitudes of psychiatrists towards rTMS and determine the factors that contribute to their knowledge of rTMS in Oman.

A quantitative, observational, cross-sectional study was conducted utilizing an online survey. The survey collected demographic information, and a validated measure was used to assess variations in knowledge and attitudes towards rTMS. Univariate analysis and multiple linear regression were performed to identify risk factors associated with knowledge levels.

Fifty psychiatrists participated in this study, resulting in a response rate of 53%. The mean age of the participants was 32.7±4.3 years (range: 26.0–41.0), with more than half being female (n=28, 56.0%) and classified as residents (junior/senior) (n=25, 50.0%). Most of the sample was Omani (n=45, 90.0%) and were employed in tertiary hospitals (n=38, 76.0%). The mean scores for knowledge and attitudes towards rTMS in this sample were 14.5±3.8 and 22.5±6.3, respectively. The linear model indicated that senior residents and older participants had a higher level of knowledge than junior residents (β=4.65, p<.001). Furthermore, participants who had access to an rTMS device at work demonstrated a higher level of knowledge than those who did not (β=1.88, p=0.027).

Three factors significantly influence the knowledge of psychiatrists about rTMS: their educational level, access to an rTMS device at work, and the availability of standardized training in rTMS.

Bronchial asthma, a chronic inflammatory condition, poses significant health challenges for children. Proper management of childhood asthma requires the knowledge, attitudes, and practices (KAP) of the caregivers. This study assesses the KAP of caregivers in the management of asthmatic and non-asthmatic children in the UAE.

A cross-sectional study was conducted in Ras Al Khaimah over four months, involving 182 children aged 6-16 years. Data were collected through a pre-validated KAP questionnaire distributed to caregivers of asthmatic and non-asthmatic children across schools, parks, and private clinics. Descriptive statistics were used to analyze the responses.

Among caregivers of asthmatic children, 77.1% demonstrated adequate knowledge, while 45.83% held a positive attitude towards asthma. In contrast, caregivers of non-asthmatic children had lower knowledge (37%) and attitudes (26.88%). Lack of adequate knowledge led to poor asthma management practices, with only 75% of caregivers conducting regular follow-ups. Better caregiver knowledge was associated with improved asthma control, while misconceptions and negative attitudes led to suboptimal care.

Significant gaps in caregiver KAP were identified, with a need for targeted educational programs to enhance asthma management. Improving caregiver understanding and attitudes through regular physician visits and educational initiatives is crucial for optimizing asthma outcomes in children.

Social anxiety disorder (SAD) is an excessive and irrational fear of social situations, leading to an avoidance of those situations. Individuals with SAD may fear acting in a certain way or exhibiting anxiety symptoms in front of others, which can significantly impact their daily functioning and quality of life. Among medical students, SAD can negatively influence academic performance, particularly in exams, and lead to employment difficulties. The COVID-19 pandemic introduced unique stressors, including social isolation and the transition to online learning, which may have exacerbated anxiety-related conditions. Understanding the prevalence and associated factors of SAD during this period is essential to develop targeted interventions for students. Thus, this work aimed to assess the prevalence and demographic correlates of SAD among medical students at the College of Medicine and Health Sciences at Sultan Qaboos University (SQU) in Oman during the pandemic.

A questionnaire-based cross-sectional study was conducted from September to October 2020 in SQU, College of Medicine and Health Sciences. Medical students from all academic years were invited to complete demographic data and the Liebowitz social anxiety scale (LSAS). The LSAS is a 24-item self-rating scale to assess SAD. An analysis using a Chi-square test was performed to obtain the factors associated with SAD.

A total of 558 students completed the questionnaire, of which 348 were female (62%). The total prevalence of SAD was 64%, whereas moderate grade SAD accounted for 27% of the participants, marked grade 19%, severe grade 11%, and very severe grade 7%. Among the students who had the disorder, 71% suffered a generalized subtype of SAD. A significant association between SAD and phase of study (p<0.001), age group (p<0.001), and gender (p<0.001) was found. Phase 1 (69%) exhibited the highest prevalence, followed by phase 2 (66%) and phase 3 (48%). Among the age groups, 17-19 years group (67%) demonstrated the highest prevalence, followed by age groups 20-22 (64%) and 23-25 (46%). In terms of gender, females (70%) were more likely to display SAD symptoms than males (52%).

The results of this study indicated a high prevalence of SAD among medical students and showed a significant association between SAD and the phase of study, age group, and gender. These results could help justify the establishment of targeted mental health interventions to support medical students in managing their anxiety, which can ultimately result in an improvement in their academic performance and overall quality of life. University administrators and psychologists should aim to develop supportive programs for students.

Integration of research into medical education is crucial for cultivating physician-scientists capable of advancing medical breakthroughs. It is imperative to take these measures for early medical students to establish a strong research foundation for future healthcare professionals.

This study investigated the impact of early research exposure on pre-clinical medical students at Gulf Medical University (GMU). A sample size of 85 MD students participated in the study, which spanned six months. In GMU, early exposure to research begins with sessions integrated into the Medical Education and Lifelong Learning (MEL) course during the first year, covering the structure and function of different sections of a research paper and practical application through Journal Article Discussions (JADs) in journal clubs in the 2nd year.

The intervention involved the evaluation of these measures through pre-validated MCQs and a self-administered questionnaire. MCQ results revealed that over 70% of students scored above 40% on research knowledge assessments. Additionally, a questionnaire comprising open and close-ended questions revealed that most of the students reported a positive agreement in understanding research structures.

The findings underscored the necessity of incorporating research into medical curricula to enhance students' research competencies and foster a positive attitude toward research. This study highlighted the importance of early research exposure in developing future physician-scientists.

Crush syndrome is the second most common cause of death in earthquakes, following direct trauma. Crush syndrome develops when toxic substances released after tissue injury or crushing reach the bloodstream. The aim of this study was to investigate factors associated with morbidity and mortality in patients rescued from the rubble after the February 6 earthquake and admitted to our hospital who had crush syndrome by retrospectively analyzing their data.

Hemodialysis, fasciotomy, and other parameters during hospitalization and time to transfer to a ward or death of 36 adult patients with crush syndrome who were rescued from the rubble and hospitalized after the February 6 earthquake were retrospectively analyzed.

Thirty-six patients were included in the study. There was no significant correlation between the mortality of patients according to their time of rescue or need for fasciotomy, dialysis, or inotropes (p=0.767, p=0.294, p=0.625, p=0.865, respectively). There was a high inverse correlation between the time of rescue and time to death. There was a weak inverse correlation between the time of rescue and hospitalization duration (r=-0.767 and r=-0.341, respectively). There was a significant correlation between the need for inotropes and mortality (p<0.001). No one who didn't need dialysis passed away. Dialysis was necessary for all six of the deceased individuals. We can conclude that one significant factor in predicting death in CS patients is the requirement for dialysis.

Crush syndrome, which develops in patients rescued from the rubble alive, is a life-threatening condition. It is an important syndrome and an important cause of mortality for earthquake victims. Further large-scale studies are needed to elucidate the association of time of rescue, the need for fasciotomy and hemodialysis, and other factors with mortality.

Despite significant advancements in COVID-19 treatment and prevention, immunocompromised individuals, particularly those with hematological malignancies, remain at high risk for severe infection and suboptimal vaccine response. Pre-exposure prophylaxis strategies for these vulnerable populations have been limited. Monoclonal antibodies, proteins designed to target specific antigens, offer a promising preventive solution for individuals unable to mount a sufficient immune response to vaccination. However, there is a critical unmet need to establish clear patient selection criteria for pre-exposure prophylaxis with monoclonal antibodies in these groups. This consensus statement explores recent research to address this gap, outlining profiles of patients most likely to benefit from monoclonal antibody-based prophylaxis.

The consensus statement was developed through a rigorous process, utilizing a pre-Delphi search method and a modified Delphi technique to gather expert opinions. This approach ensured a comprehensive and informed consensus among experts in the field. Initially, nine distinct patient categories requiring pre-exposure prophylaxis with monoclonal antibodies were identified. Through iterative rounds of expert feedback, discussion, and refinement, these nine categories were expanded and subdivided into twelve more specific groups of hematological malignancies and immunocompromised disorders. This refinement aimed to better capture the diverse patient profiles requiring prophylaxis, providing a more detailed framework for the targeted administration of monoclonal antibodies.

The study resulted in the panel members agreeing on nine categories for the use of monoclonal antibodies in COVID-19 prevention for high-risk patients. Achieving consensus among experts is crucial as it reflects the collective validation of evidence-based recommendations that can be reliably applied in clinical practice. A 100% agreement was reached for HIV and AIDS, underscoring the unanimous recognition of the vulnerability of this group to severe COVID-19 outcomes. Similarly, 96% agreement was reached for patients on immunomodulatory drugs (IMiDs), and 90.5% for those with hematological diseases, highlighting strong expert support for prophylaxis in these categories. Immunodeficiencies and renal conditions garnered 86% agreement, indicating broad, although slightly more varied, expert consensus on these groups. Lastly, 80% of the panel supported patients with solid organ cancer, liver conditions, rare neurological disorders, and severe life-limiting neuro-disabilities, reflecting recognition of their elevated risk despite more diverse opinions for these categories.

This consensus statement offers healthcare professionals in the UAE a clear, evidence-based framework for the use of monoclonal antibodies in preventing COVID-19 among patients with hematological malignancies and immunocompromised conditions. By outlining specific patient categories, the statement provides a practical guide that enables clinicians to make informed decisions about pre-exposure prophylaxis, ensuring that high-risk individuals receive timely and appropriate protection. The consensus not only enhances the ability of healthcare providers to identify and prioritize at-risk populations, but also optimizes patient outcomes by streamlining preventive measures in clinical practice. In addition, these findings lay the groundwork for future research and the development of standardized protocols, ultimately improving the management of vulnerable populations in the ongoing fight against COVID-19.

Among women of reproductive age, Polycystic Ovarian Syndrome (PCOS) is a common endocrine condition marked by insulin resistance, metabolic abnormalities, and hormonal imbalances. Infertility, irregular menstrual periods, acne, hirsutism, and obesity are among the symptoms that this illness frequently causes. Traditional PCOS therapies usually include drugs like insulin sensitizers and oral contraceptives, which can have negative side effects and might not deal with the underlying causes of the condition. This study aims to examine the etiology of PCOS and the effectiveness of natural management techniques in reducing symptoms and enhancing general health outcomes.

The objective of this study is to comprehend the pathophysiology and underlying mechanisms of PCOS, including hormonal and metabolic factors, assess the effectiveness of natural management strategies, such as dietary changes, herbal supplements, physical activity, and lifestyle interventions, in managing symptoms, investigate the effects of particular diets and lifestyle changes on insulin sensitivity, inflammation, and hormonal balance in PCOS patients, compare natural strategies with conventional treatments to determine the advantages and disadvantages of each treatment, identify research gaps, and suggest areas for future study.

A thorough examination of pertinent literature, including clinical studies, randomized controlled trials, and meta-analyses published in peer-reviewed journals, was a part of the search approach. Studies on the pathophysiology of PCOS, traditional therapies, and natural management strategies were found using databases like PubMed, Scopus, and Web of Science.

The review concentrated on studies conducted within the last 15 years to guarantee that the most recent findings were included. This study intends to shed light on the possible advantages of incorporating natural methods into PCOS care by combining the available data and comprehensive treatment choices.

In summary, PCOS is a common and complex disorder that affects women's health worldwide. Effective management requires knowledge of its symptoms, risk factors, and underlying mechanisms. Women can be empowered to manage PCOS better and enhance their general well-being by emphasizing a holistic approach that incorporates lifestyle changes and natural therapies.

The study investigated the impact of incorporating fruits or fruit juices into the diets of prediabetic individuals to mitigate oxidative stress. Previous research presented divergent approaches, making replication of findings challenging. This study aimed to evaluate whether advising the consumption of two low-calorie fruits daily could improve oxidative stress, glycemic control, and anthropometric measurements in prediabetic individuals.

An open-label, parallel, randomized controlled trial was conducted at a medical college hospital in Mangalore, Karnataka, India. Thirty participants, aged 40-70 years, with impaired fasting glucose or impaired glucose tolerance, were recruited through screening of first-degree relatives of patients with type 2 diabetes. Participants were randomly allocated in a 1:1 ratio to either the intervention group, which consumed two low-calorie fruits daily or a wait-list control group. The inclusion criteria were adults aged 40-70 years with prediabetes. Exclusion criteria included a history of diabetes, chronic diseases, normal glucose tolerance, smoking, alcohol use, recent antioxidant/vitamin use, and participation in dietary trials within the past year. Outcomes included plasma vitamin C levels and blood pressure, oxidative stress markers, glycemic parameters, and anthropometric measures. Over three months, measurements were taken at the beginning and end of the study. Statistical analysis was performed using the Wilcoxon signed-rank test and Mann-Whitney U test, with a significance level set at p < 0.05.

The mean age of participants was 43.1 ± 10.1 years in the intervention group and 44.7 ± 9.6 years in the control group. The intervention group demonstrated a significant 15% increase in plasma vitamin C levels (mean change: 4.0 µmol/L; p = 0.021; 95% CI: 1.2–6.8), whereas the control group experienced a 9% decrease. Systolic blood pressure decreased significantly in the intervention group (mean change: -3.0 mmHg; p = 0.04; 95% CI: -4.5 to -1.5), while the control group showed an increase. No significant differences were observed between groups in terms of oxidative stress markers, glycemic parameters, or anthropometric measures.

Overall, our study provided insights into the effects of incorporating low-calorie fruits into the diet of individuals with prediabetes. While improvements in vitamin C levels and systolic blood pressure were observed, there were no significant changes in oxidative stress, glycemic status, anthropometry, and other antioxidant measures. These findings contribute to the existing literature on the potential benefits of fruit consumption in individuals with prediabetes, highlighting the importance of vitamin C as a biomarker and its potential role in blood pressure regulation and cardiovascular benefits. This study also highlights plasma vitamin C as a promising biomarker for assessing the effects of fruit supplementation. Additionally, this study suggests that broader dietary and lifestyle modifications may be necessary to achieve comprehensive metabolic improvements, particularly in prediabetic individuals.

(CTRI/2011/05/001739).

The global impact of COVID-19 resulted in widespread illness and death. The rapid evolution of SARS-CoV-2, accompanied by increased transmission caused by Variants of Concern (VOC), became a significant concern in the post-pandemic.

This study has been conducted to evaluate the performance of multiplexed real-time reverse transcription-PCR (RT-PCR) assays for COVID-19 detection and the use of specific mutation RT-PCR-based approach to identify VOC in SARS-CoV-2 positive samples in the northern part of the UAE.

We selected 200 respiratory specimens tested between October 2022 to January 2023, at the Pure Lab, COVID Screening Lab, Al Qassimi Women's and Children's Hospital, Sharjah, UAE. We evaluated the performance of four commercially available RT-PCR kits for COVID-19 detection. Further, the positive samples were used to identify variants by variant detection kit as required for mutations in Spike protein (HV 69-70 DEL, N501Y, E484K, K417N) to identify Omicron, British and SARS-CoV-2 wild type (WT) E Gene variants, respectively.

In the post-pandemic period, 153/200 (76.5%) positivity was observed. There was a higher prevalence of COVID-19 among males, accounting for 52% of the cases, in comparison to females 48% aged between 20-40 years. Variant analysis showed that 50 samples were detected for the SARS-CoV-2 OMICRON variant (B.1.1.529), 4 samples were detected for the SARS-CoV-2 British variant (B.1.1.7), however, 99 samples were detected for SARS-CoV-2 wild type (WT) E gene with no mutation.

This study demonstrates the efficacy of a rapid and cost-effective RT-PCR assay designed to detect spike mutations to effectively contribute to public health response efforts. Additionally, by performance evaluation of PCR kits for COVID-19 detection with the Cycle Threshold (CT) values obtained from diagnostic PCR, we can gather valuable insights into the viral load of samples. This information helps us gauge the extent of transmission and assess the severity of the disease within the population.

This study examines the factors contributing to the shortage of medical doctors teaching medical students despite their crucial role in training the future medical workforce.

To analyze the factors behind the lack of medical doctors in the training of medical students, we used ‘phenomenology’ to understand clinical educators' lived experiences and their constructed meanings. Within the domain of phenomenology, we applied hermeneutic (interpretive) phenomenology. The experiences of eight clinical educators at the Gulf Medical University were explored through interviews and analyzed using Interpretative Phenomenological Analysis (IPA) and Socio-Cognitive Career Theory (SCCT).

The findings revealed that entry into medical education often occurred serendipitously due to inadequate career counseling and the undervaluation of the field. Acquiring a postgraduate qualification in medical education contributed to professional growth of the participants by enhancing expertise and fostering a stronger professional identity. Key motivators included a passion for the field, student interaction, support from colleagues, and an encouraging working environment. Clinical educators faced challenges, particularly when they compared their careers to those of practicing clinicians. These challenges included perceived undervaluing of their field, an unclear professional identity, slower career progression (notably in the UAE) and low income. Furthermore, clinicians who serve as educators as well, often struggle with insufficient time dedicated to teaching responsibilities. Coping strategies involved cultivating a positive work environment and maintaining optimism. Growing awareness and a positive outlook for medical education were noted.

This study uncovered the underlying issues faced by clinical educators through their lived experiences. To change the status quo, we propose facilitating medical students and young doctors in joining the field of Medical Education early in their careers. This can be achieved by providing strong career counseling and establishing clear entry and progression pathways in the field of Medical Education, through medical universities and health centers. Medical educators should be facilitated by providing an encouraging environment, acknowledging their medical education-related qualifications, and improving remuneration.

Olanzapine is an atypical antipsychotic drug for treating bipolar disorders and Schizophrenia. Regardless of being used as a common antipsychotic drug, there are reports of hepatic abnormalities caused by using Olanzapine. Silymarin and Vitamin C have been shown to have hepatoprotective effects.

The purpose of the present study was to study the hepatotoxic effects of Olanzapine and the hepatoprotective role of Silymarin and Vitamin C on the Liver of Albino rats.

The study was conducted on 24 albino rats. The animals were randomly divided into four groups of six rats each: Group A consisted of six rats and served as the control group; Group B consisted of six rats who received orally 4mg/kg of Olanzapine daily; Group C consisted of six rats who received 4mg/kg of Olanzapine plus 200mg/kg of Silymarin daily and Group D consisted of six rats which received orally 4mg/kg of Olanzapine plus 15mg/kg of Vitamin C daily. The animals were sacrificed in two sittings at four and eight weeks, and tissues were processed by routine histopathological technique. The liver enzymes (AST, ALP, ALT) were calculated and analyzed statistically using one-way ANOVA.

It was found that the liver of rats treated with Olanzapine showed sinusoidal dilatation, sinusoidal congestion, central venous congestion, central venous dilatation, cellular infiltration, and portal triaditis. The liver enzymes (AST, ALP, ALT) were markedly raised in the drug-treated rats, showing Olanzapine as a hepatotoxic agent. On the other hand, Silymarin and Vitamin C) both proved to show an excellent hepatoprotective effect.

Olanzapine administration causes histopathological and biochemical abnormalities in the liver. Vitamin C and Silymarin are both potent hepatoprotective agents against Olanzapine-induced hepatic toxicity.

Cardiomyopathies are a broad range of cardiac illnesses defined by mechanical and/or electrical dysfunction and abnormal ventricular hypertrophy or dilatation. Cardiomyopathies are classified into two categories: either primarily related to myocardial disease or secondary to other systemic or organ disorders, including the thyroid gland. Thyroid hormones have been linked to a wide range of significant effects on the cardiovascular system.

We experienced a case of a 37-year-old male who presented with symptoms of heart failure and was discovered to have dilated cardiomyopathy. The echocardiography study revealed significant left ventricular global hypokinesia and severely depressed left ventricular systolic function. The laboratory testing confirms the presence of severe normocytic, normochromic anemia with severe hypothyroidism.

The present case illustrates that hypothyroidism should be addressed systematically by healthcare providers when dilated cardiomyopathy is identified, and thyroid function testing should be regularly performed.

The Enhanced Recovery After Surgery (ERAS) program is a multidisciplinary approach aimed at minimizing postoperative complications, shortening hospital stays, and improving clinical outcomes. The current study assesses the knowledge, attitudes, and practices (KAP) of nurses and anesthesia technicians regarding the ERAS program, which is essential for evaluating their understanding and readiness to implement the program, as well as identifying factors influencing the successful adoption of ERAS in clinical practice.

The cross-sectional study involved nurses and anesthesia technicians with at least two months of experience at the University Medical Center in Ho Chi Minh City, Vietnam. A validated questionnaire assessed their KAP regarding the ERAS program. Data were collected via electronic surveys during ERAS group meetings and analyzed with Stata 16.0. The Wilcoxon and Kruskal-Wallis tests compared qualitative variables, while Spearman regression identified relationships between quantitative variables.

Among the 193 nurses and anesthesia technicians, knowledge and attitude scores towards the ERAS program were highly rated, with mean scores of 7.66 ± 1.46 and 40.10 ± 5.24, respectively. Their mean practice score was 6.51 ± 1.26. Age, work experience, and educational level significantly influenced the participant's knowledge, attitudes, and practices. Additionally, there was a positive correlation between attitude and practice (p < 0.001).

This study shows that nurses and anesthesia technicians possess the knowledge and a positive attitude toward the ERAS program; however, their practices remain limited. These results highlight the importance of continuous training and professional development to enhance the effectiveness of ERAS implementation in clinical practice.

Helicobacter pylori (H. pylori) is the most prevalent chronic bacterial infection in humans. Limited research has been conducted both internationally and locally to evaluate the general community’s collective understanding of H. pylori infection, its diagnosis, and its management.

This study aims to evaluate the level of understanding of H. pylori infection, its diagnosis, and management among the general population residing in the western region of Saudi Arabia.

The study employed a cross-sectional online survey method to gather data from a sample of 1,025 of the general population. Four major cities were selected for this study: Makkah, Madinah, Jeddah, and Taif. The knowledge scores were classified into three categories: low, fair, and good.

63.5% of participants had a fair knowledge of H. pylori infection. A statistically significant difference was observed between regions, with a P value of 0.022. Furthermore, there was a strong correlation between the respondents' degree of knowledge and age (p < 0.001), education level (p < 0.001), number of family members at home (p < 000.1), monthly income (p < 0.001), and previous exposure to H. pylori infection (p < 000.1).

Most participants know about H. pylori However, its transmission, link with stomach cancer, diagnosis, and treatment are had low level of knowledge. Several additional educational and policy interventions are recommended to enhance public knowledge of H. pylori To address the identified gaps in understanding, targeted educational campaigns should be developed.

Intestinal malrotation in adults is more common in chronic, insidious patterns, reported to be around 88% in the literature, with features ranging from intermittent abdominal pain and vomiting to food intolerance, malabsorption, and motility disorders. This clinical spectrum can be debilitating for the patient in terms of morbidity and mortality, especially in the context of acute presentation in the background of chronic features.

We present a 26-year-old male with a history of over 10 hospital admissions since childhood with intermittent abdominal pain and vomiting labeled as cyclic vomiting syndrome. He was in distress regarding the chronicity of his symptoms and presented with an acute abdomen due to acute small bowel intestinal obstruction. He underwent diagnostic laparoscopy and reduction of internal hernia followed by exploratory laparotomy and division of Ladd’s band and realignment of bowel. Postoperatively, he recovered and recuperated well.

Intestinal malrotation should be in the routine differential diagnosis of acute abdomen, especially with the history of nonspecific abdominal symptomatology, so that diagnosis can be made early to prevent morbidity and mortality in this age group.

This study focuses on the mental health and resilience of migrant students at RAK Medical and Health Sciences University (RAKMHSU) in the UAE, who often face unique challenges such as cultural adjustment, language barriers, and separation from family and friends.

This study aimed to evaluate the resilience levels of RAKMHSU's migrant students, identify their challenges, and provide evidence-based recommendations to enhance their mental health and resilience.

A total of 206 university students who migrated participated in the study. The study analyzed the resilience-mental health relationship using the Positive Mental Health Scale and the Brief Resilience Scale.

The study found that most students, 92.23%, had normal levels of resilience. A smaller proportion, 1.46%, exhibited high resilience. The mental health assessment revealed that 84.95% of students had high positive mental health scores. Furthermore, the study found a significant positive correlation (r = 0.188, p = 0.007) between mental health and resilience scores.

Migrant students face academic and migratory challenges. However, the student body at RAKMHSU exhibits high levels of mental health resilience. Tailored support programs can strengthen this resilience for better mental health and academic outcomes in the multicultural educational setting.

To evaluate the suitability of commercially available glucometers in the UAE in terms of accurate and reliable blood glucose measurements.

Portable glucometers are employed for measuring blood glucose levels, offering distinct advantages such as providing instant results and being user-friendly when compared to laboratory reference analyzers. However, certain molecules, such as those found in medications, can interfere with the accuracy of glucometer readings.

To evaluate the precision and interference in the presence of maltose and vitamin C of three glucometers commercially available in the UAE.

We utilized plasma samples to conduct two types of experiments: a precision experiment and an interference experiment. We compared the precision of three glucometer brands available in the United Arab Emirates [Accu-Chek Instant^TM, One Touch Select Plus Flex^TM, and Trister GlucoScan^TM] in the presence or not of various interfering molecules, such as Maltose and Ascorbic Acid (Vitamin C).

Accu-Chek Instant^TM demonstrated the highest precision among the glucometers tested, with a coefficient of variation of less than 5% for all measured glucose values. In contrast, OneTouch Select Plus Flex^TM and Trister Glucoscan^TM exhibited higher variability in precision, with coefficients of variation of 11.4% and 11%, respectively. Accu-Chek Instant^TM consistently performed well in terms of bias and precision in the presence of interferences, and does not display glucose readings above 50mg/dL of Vitamin C. Notably, Ascorbic acid induced a greater bias compared to Maltose for all three glucometers.

The performance of the glucometer is affected by its testing methodology. Accu-Chek Instant^TM shows improved precision and is able to detect the presence of Vitamin C. When it comes to Maltose interference, it results in a higher bias change but lower variability, which can be addressed by applying a correction factor.

Mobile health interventions showcase effectiveness for improving treatment adherence among Latent TB Infection (LTBI) patients. However, there is a paucity of evidence regarding their acceptability and usability. This study aimed to assess the initial acceptability and usability of a mobile health application that has been designed to ensure treatment adherence in LTBI patients.

A descriptive study was conducted to assess the acceptability and usability of a mobile health application, “My Treatment Friend”. A total of 82 LTBI patients were selected, and access to the application was given to them. This application provides support to LTBI patients in reporting daily medication and side effects. The basic demographic characteristics of the participants were collected through a Google form-based questionnaire. The acceptability and usability of the application were assessed using the likert scale questionnaire and SUS tool, with samples of n=44 and n=20 participants, respectively.

LTBI patients found the mobile application acceptable and feasible, with an SUS score of 73, which comes under Grade B as per the SUS score sheet. The majority believed that the app was very simple to use and easy to understand. However, there is a requirement to add more features that can enhance the acceptability and usability of the application.

The study showed the importance and usefulness of mobile applications to assist LTBI patients in finishing their prescribed treatment courses of action. Additionally, it highlights how crucial it is to build future applications using user-centered design. User-centered design may play an important role in designing mobile applications and ensuring effective engagement and satisfaction among users.

A significant risk factor for cardiovascular disease, hypertension, affects more than a billion people globally. Numerous non-pharmacological methods work well to lower blood pressure. The objective of this study was to assess the short-term effect of green tea supplementation on blood pressure among people with hypertension.

This community-based randomized controlled trial was conducted among people with hypertension recruited using a purposive sampling technique from the village of Lakhnaur, Mohali, Punjab, India. Sixty patients were randomly assigned to receive either supplementation with green tea beverage (one cup/day) or no intervention. The primary outcome measure was systolic and diastolic blood pressure. Blood pressure was measured at the baseline and 15 days after the intervention using a standard calibrated digital sphygmomanometer.

Post-intervention, the decrease in the mean systolic blood pressure was significantly greater (p <0.01) in the experimental group (129.83±6.497) than in the control group (135.0±6.433).

Green tea supplementation significantly lowered the systolic blood pressure among study participants. Green tea may be included as part of a lifestyle intervention to manage and control systolic blood pressure in hypertensive patients.

BFUHS/2K22/p-TH/12888 8/12/22.

The coverage of immunization amongst adults in India remains low; a lack of nationally endorsed guidelines and implementation policies is a contributing factor. There is a paucity of tools available to assess knowledge, attitude, and practices (KAP) regarding adult immunization. Hence, we attempted to develop a KAP questionnaire to evaluate the existing expertise regarding adult immunization among medicine and infectious diseases resident doctors in an apex medical institute in India.

A two-stage scheme for the development and validation of the questionnaire was followed. The first step involved an exhaustive literature review, focused group discussion, and in-depth interviews. The prepared draft was reviewed by experts in the field of infectious diseases and adult immunization across the domains of necessity, relevance, and clarity. ‘Item-level content validity indices’ (I-CVI) and ‘Scale-level content validity indices’ (S-CVI) were then calculated. Brennan and Prediger's AC (Agreement Coefficient) and Gwet’s AC (Agreement Coefficient) were used to establish inter-rater agreement on the obtained expert reviews.

A 57-item KAP questionnaire was developed and was reviewed by a total of 11 experts. The questionnaire had satisfactory I-CVI (>0.6 for all the items) and S-CVI Ave (>0.9 for each of the domains). The questionnaire had a strong inter-rater agreement as assessed by both Brennan and Prediger AC (> 0.6, p<0.001) and Gwet’s AC (>0.8, p<0.001).

The developed tool was scientifically validated following a staged process. We propose that this questionnaire can hence be used to evaluate the knowledge, attitude, and practices regarding adult immunization amongst medical practitioners across medical colleges and hospitals in India. This may be instrumental in developing programmatic interventions and major policy changes to enhance the practice of adult immunization amongst healthcare providers.

This study aimed to evaluate the effect of ameliorated insulin injection site rotation on the incidence of Lipohypertrophy (LH) and glycemic control in patients with diabetes.

A quasi-experimental design involving a pretest-posttest with a control group was utilized at the medical outpatients’ clinic of Sohag University Hospital. The participants were divided into two groups (30 in the study group and 30 in the control group). Two instruments were utilized to collect the data, i.e., a sociodemographic and clinical data sheet and a lipohypertrophy assessment sheet.

The majority have been found to suffer from type I DM with an insulin injection duration from one to less than 6 months. A significant reduction has been noticed in the lipohypertrophy incidence and grade during the 6-month assessment compared to the pre-intervention assessment.

A marked reduction in the incidence of LH and improved glycemic control have been noted in the study group, indicating the clinical significance of the anti-clockwise insulin site rotation technique.

Overweight and obesity are growing problems worldwide, along with a decrease in physical activity. This trend is also seen in the United Arab Emirates, including insufficient exercise among university students. This study aimed to evaluate the physical activity level, weight categories, and fat distribution among female college students and determine the correlations and associations between these factors and demographic factors.

A cross-sectional study was conducted among 204 female undergraduate health profession students recruited through a convenience sampling technique. Data were collected using anthropometric measurements and a self-administered International Physical Activity Questionnaire (IPAQ). The relationships between weight categories (Body Mass Index, BMI), fat distribution (Waist-to-Hip Ratio, WHR), and levels of physical activity, as well as the relationship between BMI and WHR, were analyzed using the PSPP statistical program.

The mean age of the students was 20.5 ± 1.9 years, with an average BMI of 25.4 ± 6.6 kg/m². About 60.3% of the students were moderately active. Physical activity levels were significantly associated with BMI categories (P= 0.008). BMI and WHR categories were also significantly associated (P= 0.012). There was a strong association between students' perceived physical activity levels and their actual activity, as measured by the IPAQ short form (P= 0.001). No significant relationships were found between physical activity, anthropometrics, and demographic characteristics.

Female college students demonstrated moderate levels of physical activity, and a negative correlation was detected between their physical activity levels and weight categories. None of the studied demographics showed a correlation or association.

Normal circadian blood pressure response includes a nocturnal fall in BP by 10 to 20% of the average daytime BP. Many diseases, including diabetes mellitus, alter these normal circadian BP changes. DM, through its long-term microvascular and macrovascular complications, such as autonomic neuropathy, affects BP dipping patterns by decreasing dipping (non-dipper), exaggerating dipping (nocturnal hypotension), or causing an actual increase in BP (reverse dipping). These altered dipping patterns are likely to be more common in those with long-standing hyperglycemia, poor glycemic control, and concurrent renal dysfunction. Abnormal dipping patterns (non-dipping and reverse dipping) are associated with increased target organ damage and cardiovascular risk among diabetic patients. The BP variation and dipping patterns are best studied using ambulatory blood pressure monitoring. This study has compared BP dipping patterns in patients with T2DM and healthy controls and evaluated their correlation with the duration of diabetes, glycemic status, and renal status by employing Ambulatory Blood Pressure Monitoring (ABPM).

50 patients with T2DM for more than 5 years have been compared with 50 normal subjects (controls) for alteration in the circadian BP pattern and its relationship with the patients’ duration of diabetes, glycemic status, and renal status.

This study has revealed statistically significant findings concerning abnormal dipping patterns (non-dipping and reverse dipping) between diabetic and non-diabetic patients (56% vs. 24%, p-value=0.001), between the duration of diabetes for more than 10 years and 5-10 years (77.8% vs. 43.8%, P=0.02), between higher HbA1c of more than 9% and 7-9% (34.5% vs. 4.8%, P=0.0001), between patients with proteinuria and those without proteinuria (p=0.045), and between patients with microalbuminuria and those with no microalbuminuria (87.5% vs. 41.2%, p=0.002).

Compared to normal subjects, most patients with T2DM had an abnormal BP dipping pattern. The duration of DM, poor glycemic control, and renal dysfunction (proteinuria and microalbuminuria) were positively correlated with nocturnal BP dipping pattern abnormalities.

An adverse drug reaction is defined as “an appreciably harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product, which warrants prevention or specific treatment, alteration of the dosage regimen, or withdrawal of the product, as it predicts hazard from future administration.”

Currently used to report such responses, the International Classification of Diseases will soon incorporate WHO's Adverse Reaction Terminology. A medication's bad effects can fall into one of six types, each having its own mnemonic: withdrawal, therapeutic failure, dose-and time-related, non-dose-related, weird, increased withdrawal, and withdrawal overall (time-related). Factors such as timing, illness pattern, investigation findings, and retesting the medicine could be useful in pinpointing the reason for a suspected adverse drug reaction. Management includes treating the effects of the medication specifically as well as, if feasible, stopping it altogether.

Reporting suspected adverse medication reactions is important. Monitoring techniques are able to identify responses and establish connections. There is many software that is used to report and monitor adverse drug reaction responses. Various Pharmacovigilance companies use AI technology to utilize this method to record signals, communicate, and solve new issues in order to limit or avoid harm because of large data size.

Osteoporosis is a bone condition that disrupts bone structure, reduces its strength, and increases the risk of fractures. While osteoporosis is commonly recognized as a disorder affecting the elderly, it can also develop in younger adults and be accompanied by other disorders. Screening individuals and diagnosing those at higher risk of osteoporosis early may significantly reduce the likelihood of complications and associated costs.

Serum biochemical factors are rather easily measured and accessible, making them valuable as predictive indicators for the prognosis and early diagnosis of osteoporosis. However, there is not enough evidence about possible relationships between these factors and osteoporosis in different bones.

In this descriptive cross-sectional study, we analyzed osteoporotic indices, including bone marrow density (BMD), T-score, Z-score, and standardized BMD, in a large population of individuals at risk of osteoporosis. We then investigated potential relationships between biochemical values and osteoporosis indices in the evaluated subjects. The collected data were analyzed using the Kruskal-Wallis test and Spearman correlation coefficient methods.

A total of 1104 patients were enrolled, with 87.7% being female and 12.3% male. The mean age of the patients was 56.48 ± 11.62 ( ± SE) years. Among them, 251 patients had normal bone density, while 556 patients had osteopenia, and 270 patients had osteoporosis. The Kruskal-Wallis analysis demonstrated that serum levels of Calcium (p=0.014), Phosphorus (p =0.002), and Vitamin D3 (p =0.045) were positively associated with the risk of osteoporosis, whereas serum albumin (p =0.005) and Alkaline phosphatase (p =0.002) levels were negatively associated. Additionally, the Spearman correlation coefficient showed a negative association between hemoglobin levels and BMD in both the spine (p =0.046) and femur (p =0.049).

Serum levels of biochemical factors may serve as primary predictive markers for the early diagnosis of individuals at higher risk of osteoporosis and bone fractures. In addition to factors involved in calcium homeostasis, serum levels of albumin and hemoglobin are also associated with BMD scores and the development of osteoporosis.

The study sought to quantify the frequency and categorize the types of prescribing errors occurring in outpatient settings while evaluating the efficacy of pharmacist interventions in mitigating such errors.

This study was a cross-sectional, retrospective interventional study conducted over a one-year period from September 1, 2017, to August 31, 2018, at the outpatient departments of one government and one private tertiary care hospital in Hyderabad, Pakistan. A total of 2,552 outpatient prescriptions were randomly collected and evaluated by the researchers to identify prescribing errors, using the British National Formulary (BNF) as a reference guide. The study rigorously adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, ensuring comprehensive reporting, transparency in methodology, analysis, and interpretation of the observational research findings.

The collected data were analyzed using chi-square tests in SPSS version 25 to assess statistical significance. Among the 2,552 outpatient prescriptions examined, 12,501 (40.4%) prescribing errors were identified. The error rate was higher in the government hospital (6,672; 42.8%) compared to the private hospital (5,829; 38.0%). The most prevalent errors occurred during the subscription stage (2,302; 45.1%), with 1,245 (48.1%) and 1,057 (42.0%) errors in the government and private hospitals, respectively. This was followed by errors in the inscription (3,447; 45.0%), superscription (5,156; 40.4%), and transcription (1,596; 31.3%) stages. Common interventions during the subscription stage addressed incomplete patient information (age, weight, etc.), missing consultant signatures, and stamps. For the inscription stage, frequent interventions involved incorrect drug doses and strengths.Typical interventions for the subscription and inscription stages included adding missing therapy durations and usage instructions, respectively. Pharmacist interventions were accepted at a higher rate in private hospitals (3,669; 62.9%) compared to government hospitals (3,675; 55.1%), with a total of 7,344 (58.7%) interventions accepted.

The study revealed a high prevalence of prescribing errors across all stages of the outpatient prescription process, with the subscription stage being the most error-prone. The findings highlight the critical role of pharmacist-led prescription interventions in mitigating prescribing errors, thereby enhancing prescribing practices, optimizing therapeutic outcomes, and safeguarding patient safety.

Type 2 diabetes is a heterogeneous disease characterized by high blood glucose levels. Its prevalence is increasing as a result of lifestyle, related genes expression, and insufficient insulin signaling. The activation or inhibition of some proteins in the insulin signaling pathway play a vital role in glucose uptake into the cells and in maintaining serum glucose homeostasis. Phosphoinositide-3-kinase (PI3K), 3-phosphoinositide-dependent protein kinase-1 (PDK1), Protein kinase B [PKB, also known as the serine and threonine kinase (AKT)], and Rac family small GTPase 1 (RAC1) are key proteins that play important roles in the liberation of Glucose Transported-4 (GLUT4) vesicle, and consequently the uptake of glucose in response to the insulin signal of hyperglycemia.

In this study, we have focused on the route of targeting insulin signaling proteins for decreasing insulin resistance by targeting the four proteins, PI3K, PDK1, AKT, and RAC1, using in silico studies.

Docking experiments, using AutoDock algorithms, were performed to predict the activity of eight recently purified derivatives of Gundelia tournefortii (GT) and Ocimum basilicum (4-hydroxybenzoic acid, beta-amyrin, beta-sitosterol, chlorogenic acid, lupeol, lupeol-trifluoroacetate, myo-inositol, and stigmasterol) on the insulin signaling proteins. The SwissADME website was used to predict ADMEtox properties for the eight derivatives of the above-mentioned medicinal plants.

Most of the Gundelia tournefortii and Ocimum basilicum derivatives have shown variable levels of activation, mainly on the PDK1 and AKT pathways, and to a much lesser extent on the PI3K and RAC1 pathways.

The results have indicated that Gundelia tournefortii and Ocimum basilicum derivatives can be potent anti-diabetic drugs, namely in targeting PDK1 and AKT pathways.

Valvular heart diseases are some of the most common causes of cardiovascular morbidity and mortality worldwide. The mitral valve is estimated to be the cause of 15% of deaths in heart valve disease. Mitral valve dysfunction can be treated with a variety of operative options, one of which is mitral valve replacement. Although it is less desirable than repair, in some situations, it is the only viable option. Thus, we conducted this systematic review to help guide future risk assessment for mitral valve replacement patients and help in the construction of pre-operative risk assessment tools.

This is a systematic review of original articles discussing the topic of predictors of mortality for patients undergoing mitral valve replacement surgery. A systematic search was conducted via independent researchers across a number of databases, starting with PubMed databases utilizing its MeSH database, followed by a complementary search through Google Scholar.

In total, 27 original articles were included in a collective cohort of 145005 patients. Older age was the most commonly cited variable as a mortality predictor, followed by decreased left ventricular ejection fraction. EuroSCORE is a well-known scoring system that predicts in-hospital mortality following major cardiac surgeries. It was found that it overestimated mortality greatly, while another study found that the revised EuroSCORE II system was a better predictor of mortality. Overall, we note that both versions usually overestimate mortality.

There seems to be an overall agreement over several factors, including older age, decreased ejection fraction, and the expertise of the surgeon and the institution on being clear predictors of postoperative mortality. There is also an obvious need for new tools to better predict mortality rates preoperatively, as the currently used scores often result in greatly inaccurate predictions.

A lack of proper anti-malarial medication use can lead to drug resistance, failed therapy, and even death. It is unclear how widespread the use of fake anti-malarial medications is in India. Better malaria treatment and the execution of regulatory initiatives to improve anti-malarial drug quality necessitate regional research into the quality of available anti-malarial pharmaceuticals. This study aimed to look into the quality of anti-malarial drugs in regions of India where malaria is common. Conclusions about the prevalence of substandard anti-malarial medications in Indian communities can be drawn from the findings.

Samples of anti-malarial pills were bought from stores in five different Indian areas. One hundred and fifty anti-malarial drug samples were gathered. Using a GPHF minilab lab kit, the quality of the following samples was determined: chloroquine (n=50), artemether lumefantrine (n=50), artesunate sulphadoxine-pyrimethamine (n=14), and primaquine (n=31).

This research confirmed that 98% of the tablets disintegrated properly in a minilab disintegration test. As a result, when compared to both the full set of standards and 80% of the samples, 99% of the samples passed the preliminary qualitative TLC test. Only 4% of samples (those with insufficient amounts of the active medicinal component) failed the quantitative HPLC test.

Anti-malarial medicine counterfeiting has been found to be quite uncommon in India compared to other countries. However, further research is needed, such as post-marketing surveillance, to ensure that effective anti-malarials are distributed to the public.

The normal anatomy of the coronary arteries consists of the right coronary artery and the left main coronary artery, which originate from the right and left sinuses of Valsalva in the aortic root separately. In general, congenital anomalies of the coronary artery are uncommon in adults. The ectopic origin of a coronary artery from the pulmonary trunk is part of a group of infrequent coronary artery anomalies. The Anomalous origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) is thought to be an extremely rare congenital coronary artery anomaly. Most of our knowledge and experience about this congenital coronary malformation is derived from published case reports and series.

We have, herein, reported the case of a 68-year-old male who was discovered to have ARCAPA after he presented to our center with chest pain. The patient underwent multiple invasive and non-invasive diagnostic imaging modalities, including an echocardiogram, a coronary angiogram, a multislice-gated coronary computed tomographic angiogram, and stress perfusion cardiovascular magnetic resonance imaging. The clinical decision was to continue with conservative non-surgical management along with close follow-up.

The ARCAPA anomaly is considered to be one of the rare congenital coronary artery variances that can be discovered in late adulthood as a patient may remain asymptomatic for many decades.

Identifying the preferred learning modalities of students is crucial for a comprehensive understanding of the content of the study, and this can be achieved by employing the VARK inventory developed by Neil D. Fleming. The preferred learning modality of students significantly influences their learning outcomes.

This study aimed to identify the preferred learning modalities among health professional students.

Using a cross-sectional survey study design, we surveyed a consecutive sample of 351 students from three health professional programs: Nursing, Medical, and Pharmacy. After obtaining institutional board approval, a standardized self-administered VARK inventory (Visual, Aural, Read/write, Kinaesthetic), version 7.8, was employed. VARK scores were computed for each respondent and sent to the publisher for interpretation and categorization of learning preferences. Data were analyzed using SPSS version 28.0 and 29.0.

The findings revealed that 35.9% of participants were between 18-20 years old and identified as unimodal learners, with 19.09% preferring kinaesthetic learning. In the bimodal and trimodal categories, 5.98% exhibited preferences for AK (Aural, Kinaesthetic) and VAK (Visual, Aural, and Kinaesthetic). Only seventy students (19.9%) preferred multimodal learning patterns. Notably, all the college students were identified as unimodal learners.

Understanding these diverse learning preferences empowers students to employ appropriate learning methods, enhancing their overall learning experience. Faculty members can leverage this data to tailor teaching styles, thereby optimizing the learning environment. Further research across different universities can contribute to broader knowledge and informed strategies that promote effective learning processes.

Nowadays, the resistance to available antibiotics could be mentioned as a global threat to public health. The aim of this preliminary study was to conduct a retrospective survey associated with the prevalence of Nosocomial Infections (NIs) and the pattern of microbial resistance in a tertiary care referral hospital (Alzahra), Isfahan, Iran.

The data between the years 2016 to 2022 were extracted from the official database of hospital NI records. The microbiological culture results, represented by non-repetitive specimens, were further analyzed for pathogens and the pattern of antibiotic resistance. Then antibiotic susceptibility testing was done using standard methods of disk diffusion or Phoenix M50. The recorded variables have been presented as mean ± standard deviation, prevalence, and percentage. Data were analyzed using SPSS version 20.

For a duration of 5.5 years, the period prevalence of NIs was recorded as 2%, with more than 50% associated with ventilator-associated events and urinary tract infections. Klebsiella pneumonia, Acinetobacter baumannii, and Staphylococcus were the main pathogens. Further study of specimens from the year 2022 (n= 898) confirmed the most isolated bacteria as Klebsiella pneumonia (n = 290, 32%), Acinetobacter baumannii (n= 206, 23%), Enterococcus (faecium-fecalis n=125, 14%), Escherichia coli (n = 116, 13%), Staphylococcus aureus (n = 95, 11%), and Pseudomonas aeruginosa (n = 66, 7%). Resistance (R%) in Isfahan versus the whole country was confirmed for Klebsiella pneumonia (third or fourth generation of cephalosporins: R = 80.9 vs. 82%), fluoroquinolones (R = 76.6 vs. 73%), beta-lactamase inhibitors (R = 75 vs. 79%), carbapenems (R = 65.7 vs. 66%), and so on, respectively.

There has been reported an increase in the proportion of isolates resistant to cephalosporins, fluoroquinolones, and others. The variety of latent pathogens resistant to frequently administered antibiotics highlights the significance of continued and homogenous antimicrobial evidence-based pharmacotherapy investigations in Isfahan, Iran. Further studies in this direction are recommended.

Sickle cell anemia (SCA) poses significant metabolic challenges in affected individuals, yet the relationship between resting metabolic rate (RMR) and disease severity remains underexplored, particularly in Sudanese pediatric populations.

The aim of this study is to investigate the RMR and its correlation with disease severity scores and treatment with hydroxyurea in Sudanese patients with sickle cell disease.

We conducted a case-control study on 100 individuals aged 3-18 years, with 50 having SCA and 50 forming the healthy control group. RMR was computed using the Harris-Benedict formula, the World Health Organization equation, and the Buchowski formula. Severity scores were determined using a SCA Scoring System.

The mean age for the control group (9.52 ± 4.35 y) was similar to that of the SCA group, whether receiving or not receiving hydroxyl-urea (9.44 ± 4.164 and 9.68 ± 4.534, respectively (p=0.980). The resting metabolic rate (RMR) in the case group was significantly lower compared to the control group when using the Harris-Benedict and WHO equations (p = 0.004 and 0.001, respectively). A notable difference in RMR was observed between the case group (using the Buchowski formula) and the control group (using the Harris-Benedict equation) (p = 0.006), but not with the WHO equation (p = 0.054). Treatment with hydroxyl-urea was significantly associated with low severity scores among the SCA patients (p< 0.001).

The elevated RMR levels among Sudanese SCA patients compared to healthy subjects can be shown when calculated with the Buchowski formula but not with the other standard equations designed for healthy individuals.

Non-resolving pneumonia after antibiotic treatment is encountered on quite a few occasions in clinical practice and is estimated to account for approximately 15 percent of inpatient pulmonary consultations and 8 percent of bronchoscopies. This is more frequently seen in intensive care/ ventilated patient-associated pneumonia compared to community-acquired pneumonia. Treatment failures are mostly due to infectious causes, and only 20% of the cases are due to noninfectious causes.

We present here an interesting case of non-resolving pneumonia. Our patient was a 58-year-old Middle Eastern descendant male who presented with a cough with excessive mucoid sputum for 6 months. Chest radiology showed patchy consolidation in the right lower lobe, which gradually progressed to multilobar consolidation over several months despite treatment with antibiotic antifungal and steroids. Extensive evaluation was done with laboratory microbiological studies and bronchoscopy, but it was negative for tuberculosis and malignancy. So, the patient underwent an open lung biopsy. Histopathology and immunohistochemical staining were suggestive of adenocarcinoma of the lung, predominant lepidic pattern, with papillary, acinar patterns, and foci of invasion.

This case is interesting because of its unique clinical presentation with bronchorrhea and progressive pneumonia. Also, it reveals the role of surgical lung biopsy in navigating cases of difficult non-resolving pneumonia.

In the year 2009, Remdesivir or Veklury was discovered by Gilead Sciences for the management of hepatitis C, Ebola and Marburg virus disease through injection into a vein and then a few years later, 22nd Oct 2020 (United States), the drug was recommended for the management of COVID-19 under a provisional guideline.

The aim of this systematic review was to address pharmacotherapy approaches associated with the efficacy and side effects of remdesivir for the treatment of viral infections.

This is a focused, in-depth consequent guide approach and literature search, with a methodical assessment associated with the terms “Remdesivir,” “ Remdesivir Bioavailability,” “Remdesivir and Disease,” “ Remdesivir and COVID-19” that was done through Pubmed, Scopus, and Web of Science from their inception to 29 Oct 2023.

101 studies included in silico, in-vivo, and in-vitro experiments to test remdesivir therapeutic efficacy were selected based on the current, knowledgeable, and high-quality topics of manuscripts. Regarding efficacy, in addition to COVID-19, remdesivir shows therapeutic efficacy in other virus infections, such as hepatitis C, Ebola, and Marburg. In patients with COVID-19, remdesivir shortens the time to recovery, lowering progression to mechanical ventilation and decreasing hospital resources. Combination with dexamethasone in selected patients who need minimal conventional oxygen but are at high risk of severe COVID-19 was reported beneficial. Combination with chloroquine or hydroxychloroquine may cause a decrease in the antiviral activity of remdesivir, but dexamatason reported minimal or no reduction in drug exposure. However, synergistic effects were reported in combination with favipiravir, but methotrexate toxicity needs to be evaluated. Significant improvement in 'patients' conditions was reported in combination with methylprednisolone pulse therapy. Infusion-related reactions such as nausea, elevated liver enzymes, sweating, and hypotension are the most common side effects.

Different studies showed that with remdesivir pharmacotherapy, in addition to significant improvement in the recovery rate in those with COVID-19, the risk of adverse effects was significantly lower than in the control groups. To verify efficacy and side effects, besides attentive consideration of kidney and liver function, further evidence-based pharmacotherapy studies of remdesivir seem advantageous.

Although most cases of choriocarcinoma are of gestational origin, rare cases of extrauterine origin (such as pulmonary) have been reported, which have a poor prognosis.

We present one such rare case involving a 35-year-old female patient who initially presented to the emergency department with hemothorax and was found to have primary lung choriocarcinoma after multiple biopsies. The patient was properly managed and discharged in a healthy condition. However, she subsequently returned to the hospital with an intracranial haemorrhage and, unfortunately, passed away despite all efforts.

Due to the life-threatening initial presentations of primary pulmonary choriocarcinoma, it is essential to conduct an intensive work-up and maintain close observation when a patient initially presents with such symptoms. Early diagnosis is crucial to initiate appropriate treatment and prevent further complications. Therefore, we aimed to discuss and establish an emergency medicine department-based diagnostic pathway to contribute to the early diagnosis of this deadly malignancy.

Dermatoglyphics is the study of dermal ridge configuration on the skin of the fingers and palms, which can be used to diagnose chromosomal disorders and individual identification. Stress is characterized by feeling overwhelmed with mental or emotional pressure and evokes a biological response when any intrinsic or extrinsic stimulus is applied. Stress can cause acute effects and disorders that can trigger structural changes like atrophy and decrement in weight in different brain parts with long-term effects on the nervous system.

In this cross-sectional study, fingerprints of 150 participants of Gulf Medical University with an equal number of students and faculty/ staff were obtained by fingerprint scanner. Participants were classified into low, moderate, and high-stress levels by questionnaire. Collected data were statistically analyzed to find any association between dermatoglyphics and perceived stress levels.

Radial Loop was found to have the highest frequency as a percentage in all three groups. Plain whorl was the pattern with the second-highest percentage of occurrences. A notable observation was the lack of plain arch and low frequency of accidental whorl in the high-stress group.

The findings contribute to our understanding of the potential of dermatoglyphics as an indicator of perceived stress, opening up avenues for further research in utilizing these patterns as a non-invasive tool for assessing stress levels.

The association between visceral obesity and insulin resistance establishes an alternative risk for the onset of type 2 diabetes mellitus. The infiltration of macrophages in the visceral fatty tissue and the unreliable generation of adipokines are associated with mechanisms directing the progress of insulin resistance.

The objective of the study was to observe the relationship between visceral fat-associated adipokines and biochemical variables in central obese type 2 diabetic patients.

This study included 100 central obese subjects (both genders) aged 30-60 years newly diagnosed with type 2 diabetes mellitus. Out of the 100 participants, 73 were male and 27 were female. Serum adipokines were analyzed using an enzyme-linked immunosorbent assay. Biochemical parameters were assessed using the Cobas^® 6000 analyzer, while HbA1c levels were determined through high-performance liquid chromatography.

The results showed a significant relationship (p < 0.05) between the adipokines and HbA1c, fasting, and postprandial blood glucose levels. The results indicated a significant association (p < 0.05) between the adipokines and lipid profile with varying degrees in central obese type 2 diabetic subjects.

The relationship between visceral fat-associated adipokines and metabolic variables may influence the metabolic pathways in central obese type 2 diabetic patients. The adipokines are strong predictors for the intensification of diabetic risk and can be used as a diagnostic tool for risk assessment in the central obese population.

It is known that attitudes towards the elderly are an important variable affecting healthcare services. Considering the increasing trends of the population over 65 years in countries, it is important to determine the attitudes of future healthcare workers towards the elderly and to prepare them to serve in the health sector with activities that will lead to positive changes. In this direction, it is important to determine the effect of personality traits of prospective healthcare workers on their attitudes toward the elderly.

The research was conducted using the “relational survey model”. The study was conducted with 581 prospective healthcare workers. Personal Information Form, Eysenck Personality Questionnaire, and Kogan's Scale of Attitudes towards the Elderly were used as data collection tools. Data were obtained and analyzed using the online data collection method.

According to the results of the study, it was found that the attitudes of students who were healthcare candidates for older adults were generally positive (= 63.46±13.42). While there was a positive yet moderate and statistically significant correlation between attitudes towards the elderly and scores on the Extraversion subscale (r= 0.634, p<0.01) and a negative yet moderate and statistically significant correlation with scores on the Neuroticism (r= -0.568, p<0.01) and Psychoticism (r= -0.602, p<0.01) subscales. The personality traits extraversion, neuroticism, and psychoticism explained 58.6% of the attitude towards the elderly. According to the regression results, extraversion (β= 0.358; p<0.001) positively affected attitudes towards the elderly, whereas neuroticism (β= -0.310; p<0.001) and psychoticism (β= -0.307; p<0.001) negatively affected attitudes towards the elderly.

Given the important role of healthcare professionals in improving the care and quality of life of the elderly, it is necessary to develop strategies to improve the attitudes of future healthcare professionals towards the elderly. Consideration of personality traits in determining these strategies may contribute to the development of effective and personalized approaches.

The relationship between ECG changes in dilated nonischemic cardiomyopathy and ejection fraction (EF) is complex and poorly understood. Thus, this study aimed to identify the most common patterns of ECG associated with dilated nonischemic cardiomyopathy and their relationship to EF.

A retrospective cross-sectional study was conducted between 2019 and 2022, including 100 consecutive patients with nonischemic dilated cardiomyopathy. ECG data were rate, axis, left (LBBB) and right bundle branch block (RBBB), first-degree heart block, premature ventricular contractions, depth of S wave in leads V1 and V2, length of R wave in leads V2 and V6, the ratio of R/S in the lead V4, left ventricular hypertrophy (LVH), maximum R wave length in leads I, II, and III, poor R wave progression, ST-segment elevation, and T wave inversion.

The most common ECG pattern associated with cardiomyopathy was T-wave inversion (47%). The EF was 23.9± 8.87% in patients with LBBB and 25.5± 8.07% in patients without LBBB (P= 0.361). In patients with T-wave inversion, the EF was 23.4± 8.21%, and it was 26.28± 8.35% in patients without T-wave inversion (P= 0.086). In patients with LVH, the EF was 23.89± 7.84%, and it was 25.5± 8.66% in patients without LVH (P= 0.354). A negative nonsignificant correlation existed between SV1, SV2, RV2, RV6, R/S V4, and maximum R in I, II, III, and EF.

The study showed that T-wave inversion was the most common pattern associated with dilated nonischemic cardiomyopathy. The study provided insight into the negative correlation between EF and SV1, SV2, RV2, RV6, R/S V4, and maximum R in I, II, and III, although it did not reach a significant level.

Acceptance of COVID-19 vaccination of medical personnel reduces the spread of infection the research aimed to evaluate healthcare professionals' attitudes toward vaccination by the health belief model.

A quantitative, cross-sectional research design was used for the study.

Most medical personnel agreed to get the COVID-19 vaccination (84%; n=384). Medical workers over 45 (90%) showed more readiness for vaccination. The main pushbacks against the vaccination included the development of a vaccine in a short period (n=56; 73.7%), fear of side effects (n=49; 64.5%), lack of reliable information about vaccination (n=35; 46.1%), negative information spread by the media (n=26, 34.2%). Recommendations by healthcare workers (63.9%), health authorities (73.1), media (70%), large number of people being vaccinated (72.6%), and provision of trustworthy information (71.3%) facilitate vaccination.

The high rate of COVID-19 vaccination among medical personnel shows that they have a high risk perception of infection. Among Health Belief Model components, cues to actions were most important in willingness to carry out vaccination. Recommendations of the WHO and scientists significantly influence the willingness to carry out vaccination. The regulatory responsibilities of the state and the public's trust in it play a crucial role in raising the population's awareness about the vaccine.

The study investigated the relationship between Determining the Factors Related to Maternal-Fetal Attachment in Pregnant Mothers with Maternal-Fetal Attachment.

Demographic policies in Iran emphasize population, fertility, and maternal health. Maternal-fetal attachment (MFA) is a term used to describe conditions that help the mother cope with the physiological changes during pregnancy. MFA contributes significantly to the future health of mother and child. Thus, it is essential to identify the nature of maternal-fetal attachment during pregnancy, when women need to prepare for and adapt to childbirth. The present study was conducted to determine the factors related to maternal-fetal attachment in pregnant mothers of Arak City.

The study investigated the relationship between obstetric-demographic factors, emotional intelligence, marital satisfaction, and domestic violence with maternal-fetal attachment.

The present cross-sectional study was conducted on 177 pregnant mothers with a gestational age of 37-40 who were referred to health centers in Arak, Iran, for pregnancy care in 2022. Five questionnaires, including an obstetric-demographic questionnaire, Cranley's Standard Mother-Fetal Attachment Scale, Schutte Self-Report Emotional Intelligence Test, ENRICH marital satisfaction scale, and HITS domestic violence questionnaire, were used to measure the factors related to maternal-fetal attachment. Data were analyzed using SPSS21 software and descriptive and analytical statistics, including frequency distribution, Pearson correlation, t-test, Chi-square, Analysis of variance (ANOVA), and Multiple Logistic Regression model.

The mean of age women and age of husbands was 29.07± 5.88 years and 32.93± 5.28 years, respectively. The mean maternal-fetal attachment score was 88.12± 15.76. The mean of the emotional intelligence, the marital satisfaction and, the domestic violence was 4.71± 2.81, 121.88± 17.30, 37.86± 7.25, 6.54± 3.35, respectively. The interval between the current and the previous pregnancy had a range of 1-7 years and a mean of 4.71± 2.8 years.

There was a positive significant correlation between the maternal-fetal attachment score and the interval between the current and the previous pregnancy (r=0.22, p=0.02),

There was a positive significant correlation between the maternal-fetal attachment score and the emotional intelligence (r=0.31, p=0.001) the marital satisfaction (r=0.25, P=0.001). There was a negative significant correlation between the maternal-fetal attachment score and the domestic violence (r=-0.26, p=0.001

Identifying attachment-related factors helps the health staff carry out the necessary training and preventive measures to increase maternal-fetal attachment, especially in high-risk parents who need more care.

Aphasia, also known as language impairment, is a condition that affects the ability to express and understand language, as well as the ability to communicate. Crossed Aphasia in Dextral (CAD) is defined as aphasia after a right hemispheric stroke. Usually, aphasia is caused by a left-sided stroke in right-handed individuals. The prevalence of crossed aphasia in right-handed individuals is 0.38% to 3%. CAD is diagnosed when the following factors are present: aphasia, right-handed patient, no family h/o left-handedness, the structural integrity of the left hemisphere, and absence of brain damage in childhood. Another entity, Global Aphasia Without Hemiparesis (GAWH), is a rare stroke syndrome presenting with global aphasia without any weakness and occurs in the lesion of the left-sided peri-sylvian region.

A 56-year-old female with a known case of severe mitral stenosis with chronic AF on warfarin and not on regular medications was brought to our hospital as she had not communicated for the past day. On initial examination, the patient was conscious, globally aphasic, with left facial lag and no weakness of limbs. Her initial Computed Tomography (CT) brain scan was normal. She was not thrombolysed as she was out of the window. Brain Magnetic Resonance Imaging (MRI) showed right frontal, temporal, and parietal infarct in middle cerebral artery territory. She was treated conservatively with full-dose anticoagulation and, upon discharge, was started on oral anticoagulants. At the time of discharge, the patient was able to understand a few commands and was having echolalia with non-fluent speech. She was reviewed again at 3 months, and she had a full recovery of her speech.

CAD is a rare stroke syndrome with low prevalence. Even though all subtypes of aphasic syndromes are seen in CAD, Broca's aphasia is the common subtype, and men are affected commonly. Most patients also present with apraxia and visuospatial neglect. Our patient had all the criteria for the diagnosis of CAD and also had GAWH and showed rapid recovery. The cause of the disease in this patient was considered to be two different lesions involving language areas due to an embolism in her heart.

This case has been presented for its rarity due to the occurrence of both CAD and GAWH in the same patient in a right-sided infarct.

The WHO Emergency Committee advocates preventive strategies for COVID-19 management, emphasising vaccines as highly effective but acknowledging their limitations. Chloroquine and hydroxychloroquine, initially effective against COVID-19, were discontinued due to severe side effects. Further clinical trials are imperative to establish the safety and efficacy of new antiviral agents, some of which may have harmful effects on human development.

The shortcomings of various conventional treatments have prompted urgent efforts to discover safe, natural compounds that may be useful in combating COVID-19. This study aims to review research that has investigated the potential of traditional phytotherapies used by different populations for the prevention and symptomatic treatment of COVID-19 infection.

This paper reviewed scientific studies published through searching on search engines such as PubMed, Scopus, Google Scholar, ScienceDirect and Elsevier from May until October 2023.

The preventive and anti-COVID-19 attributes of Traditional Chinese Medicine, Ayurvedic formulations and African medicinal plants have been substantiated in research. In Nepal, recommendations endorse the utilisation of medicinal plants for herbal teas and homemade sanitizers. Zingiber officinale, Curcuma longa L. and Curcuma xanthorriza Roxb., along with Camellia sinensis are crucial Indonesian medicinal plants with potential for treating COVID-19. Z. officinale was predominantly chosen for relieving coughs and sore throats associated with COVID-19 in Saudi Arabia.

The immunomodulatory properties of medicinal plants, which may prove useful in combating COVID-19, have been verified via elevation of the level of peripheral WBCs, IgM, IgG; inhibition of leukotrienes and prostaglandins, maintenance of the integrity of intestinal mucosal barrier and regulation of HMGB1. The antiviral effects of herbs, including the inhibition of viral DNA and RNA replication, down-regulation of oxidative stress, and the impediment of SARS-CoV-2 access to vascular endothelial cells, suggest their potential to facilitate earlier recovery from COVID-19 infection.

Advancing scientific research in phytotherapy promises the possibility of novel approaches for effectively managing future infectious diseases and pandemics.

Vancomycin, used to treat severe gram-positive infections, can induce acute kidney injury. Some evidence introduced Interleukin-18 (IL-18) as an inflammatory mediator of ischemic damage to many organs and urinary IL-18 as a diagnostic biomarker of acute tubular necrosis.

The current study aimed to evaluate the urinary level of IL-18 after vancomycin therapy.

This cross-sectional study was conducted on patients under treatment with vancomycin selected from those referred to Dr. Sheikh Hospital, Mashhad, Iran, from 2018-2019. Urinary IL-18 was measured based on nanograms per milliliter using a human IL-18 enzyme-linked immunosorbent assay kit about this cytokine before vancomycin administration and then two days later. All the analyses were performed in SPSS software (version 25), and a P-value less than 0.05 was considered statistically significant.

A total of 36 patients with a mean age of 40.06±36.67 months were included in the study. The mean scores of IL-18 before and after taking vancomycin were 1453.00±555.01 and 1713.00±660.98, respectively. The IL-18 was significantly lower before vancomycin consumption than the level reported after 48 h (P<0.05).

The present study highlighted a higher level of urinary IL-18 after vancomycin treatment, which may indicate kidney injuries. Therefore, it may be considered a potential biomarker of acute tubular necrosis in patients under vancomycin therapy.

Over the last half-century, the treatment and management of autoimmune rheumatic diseases have progressively improved, particularly with the contribution of immunobiological or biological therapies known as disease-modifying antirheumatic drugs. Although these agents have been generally efficient in the management of rheumatoid arthritis (RA), some patients experience limited efficacy and non-responsiveness to treatment. In addition, they may cause adverse clinical effects, further aggravating the disease.

Despite advancements in biological therapies, significant clinical needs persist. This review aims to discuss novel treatments, guiding future guidelines and drug discoveries for rheumatoid arthritis.

This review follows the 2020 PRISMA statement, utilising PubMed and Google Scholar for literature search and emphasizing recent meta-analyses on the safety and efficacy of targeted immunobiological medications.

Small molecule inhibitors, whether utilised independently or in conjunction with Methotrexate, have been shown to contribute to effective disease management and have the potential for better adherence to the American College of Rheumatology criteria. Tocilizumab therapy demonstrates a significant reduction in disease activity and improves rates of disease remission when combined with Methotrexate. Investigations of mesenchymal stromal cell therapies have had promising outcomes, improving both cartilage quality (as evaluated by Macroscopic Cartilage Repair Assessment) and joint tenderness and swelling in clinical joint counts. Intra-articular administration of tolerogenic dendritic cells has displayed a capacity to alleviate pain, as measured by Visual Analog Scale scores, and enhance the Disease Activity Score across 28 joints. Resveratrol capsules supplemented with allopathic therapy show potential in reducing TNF-α and interleukin-6 serum levels.

More investigations and their analysis will improve patient outcomes and reduce adverse effects and the costs involved in developing and obtaining immunobiological drugs. Moreover, assessing the safety and efficacy of anti-RA properties of the bioactive compounds could offer less toxic and more cost-effective natural treatment options.