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The knowledge of eggplant farmers on the proper use of pesticides was evaluated in Khartoum State. Questionnaire was distributed to farmers in North Nile Farms (NN), East Nile Farms (ENF), and West Nile Farms (WNF) to solicit information. Interviews and questionnaires revealed that there is a limited level of awareness among farmers. The majority (94%) of farmers did not abide by recommended disposal procedures, they only damage and bury the containers inside the farms. The majority of farmers (66%) were not aware of the safety period for any given product. The excessive use of pesticides in eggplant production and reliance only on pesticides as a pest management strategy calls for the implementation of IPM programs integrating the use of environmentally soft chemicals with other non-chemical control methods to manage pests and diseases. Safety periods should be carefully watched to reduce the level of residues in eggplant fruits below the acceptable level and to ensure sustainable and safe production.

Kholood M Shalabi,1 Zahra A Alshraif,2 Rawaa Ismail Ismail,3 Kheloud Almubarak,2 Noha Mohmoud,1 Shaffi A Shaik4 1Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 2Rehabilitation Services Department, King Abdullah University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 3College of Medicine, Almaarefa Colleges, Riyadh, Saudi Arabia; 4Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Shaffi A Shaik, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, 11426, Saudi Arabia, Tel +966-11-4671544, Email shaffiahamed786@gmail.com; sshaik@ksu.edu.saPurpose: This study’s objective was to measure secondary traumatic stress disorder among Saudi Arabian physiotherapists employed in the critical care, neurology, cardiology, pulmonology, and mental health fields. Also, to identify the factors related to secondary traumatic stress.Methods: Between July 2021 and June 2022, a cross-sectional study involving physiotherapists from the critical care, emergency, neurology, cardiology, pulmonology, and mental health departments was carried out. Data were collected from the participants by using the validated Secondary Traumatic Stress Scale (STSS). Appropriate Statistical analysis (bivariate and multivariate) was carried using SPSS 21.0 software to analyse the data.Results: We quantified the prevalence of secondary traumatic stress, among 201 healthcare professionals (physiotherapists) in total were assessed; of them, 23.4% worked in the medical/surgical and neurosurgical departments and 5% in the critical care and emergency departments. Twenty-four percent of the participants slept less than five hours each day, and 26.4% worked more than 45 hours per week. Our study subjects had mild STS in 25.4% of cases, moderate stress in 15.9%, high STS in 15.9% and severe STS in 30.9% of cases. The intrusion score (mean = 11.65), avoidance score (mean = 5.5), arousal score (mean = 4.1) and total mean score of 42.50 of the STSS were significantly different across the age groups, marital status and years of experience of study participants. The regression analysis shows age groups and severe stress were independently related to the total STS scores.Conclusion: The study has found out higher level of STS among physiotherapists which highlights the necessity for a variety of interventional programs to be implemented in hospital settings in order to enhance communication abilities, lessen emotional discomfort, and apply relaxing techniques.Keywords: stress, secondary traumatic stress disorder, burnout, healthcare workers, physiotherapists, depression

The study aims to develop and optimize extended-release cinitapride matrix pellets using lipid wax glyceryl monostearate (GMS) and ethyl cellulose (EC) for treating functional dyspepsia and gastrointestinal reflux disease. Pellets were prepared using the extrusion spheronization technique by applying central composite design (CCD), keeping EC-7cps (matrix former), spheronization speed, and time as variables. The drug release, sphericity, and aspect ratio were quality parameters. The predicted optimized formulation was evaluated for chemical interaction, thermal stability, accelerated stability, and surface morphology. EC effectively controlled the overall Cinitapride release for up to 12 h, but burst release was reduced by sintering the matrix pellets. A direct relationship was observed between the sphericity and aspect ratio of the pellets with the spheronization speed and time. F pred followed the Korsmeyer-Peppas model, demonstrating a non-fickian diffusion at all pH levels. The bioavailability of F pred was compared with reference immediate release tablet by applying in silico PBPK modeling and comparable relative bioavailability. The PBPK predicted C max , T max , AUC 0-t , and AUC 0-∞ was 361.93 pg/mL, 6.88 h, 4567.8 pg/mL/h, and 5204.7 pg/mL/h, respectively. Lipid-cellulose-based extended-release Cinitapride matrix pellets were successfully prepared and can be effectively used as a single dose regimen for treating functional dyspepsia and gastrointestinal reflux disease., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Drug abuse poisoning is a significant public health problem in many countries all over the world. The recent study aimed to assess the applicability of NEWS II and APACHE II scores as predictors of the ICU admission of acute intoxication by substance abuse. The study enrolled 98 patients admitted to the Alexandria Poison Center of the Main University Hospital (APC-AMUH) with a history of acute intoxication with substance abuse. Collected data included socio-demographic data, circumstances of exposure, and clinical and laboratory data. These data were employed to calculate NEWS II and APACHE II scores. A total of 98 substance abuse patients were admitted. Morphine constituted the highest percentage of substance intoxication (33.7%), followed by methanol (23.5%) and tramadol (17.3%). About one-third of the patients needed the ICU admission (32.7%). The median of NEWS and APACHE II was 7. The mean values of NEWS II and APACHE II in patients who entered the ICU were significantly higher than in patients who did not enter the ICU. The cut-off value of the ROC curve of NEWS II and APACHE II scores for admission to the ICU was 8 for both. These findings suggest that NEWS II and APACHE II scores are good predictors for the evaluation of patients intoxicated by substance abuse who need ICU admission., (© The Author(s) 2025. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Clozapine is a potent serotonin receptor antagonist and commonly used for the treatment of Schizophrenia. The study aimed to develop and optimize the transdermal matrix patch of clozapine. A 3-level, 3-factor Central Composite Design was applied to examine and validate the impact of various formulation variables, Eudragit, PEG, and oleic acid on in vitro drug release, flux, and tensile strength (TS). Different formulation characteristics were studied in terms of physico-chemical characterization, Fourier Transform Infrared Spectroscopy (FTIR), Differential Scanning Calorimetry (DSC), drug release performance, and in vitro permeability. The numerical and graphical optimization was based on the desirability function and the optimized formulation obtained from the polynomial equation was further validated and evaluated for the targeted critical attributes. The optimized patch was further evaluated for skin irritation, in vivo pharmacodynamics, in silico prediction, and simulation using the GastroPlus TCAT® model and stability. The experimental results of the optimized formulation, such as tensile strength 1.220 kg/cm 2 , flux 147.376 μg/cm 2 /h and Q24 94.874%, showed similarity with the values predicted by numerical and graphical optimization. In vivo Neuro-pharmacological studies showed that the results were comparable to the standard. The C max , T max , AUC t, and AUC inf were predicted as 38.396 ng/mL, 28.960 h, 1625.500 ng-h/mL, and 1175.700 ng-h/mL for a 50 mg patch. No skin irritation was found for the optimized transdermal patch as per the Draize score method. The shelf life of the optimized formulation was 30.41 months under accelerated conditions. The study showed that the matrix-type transdermal patch of clozapine can be used for the management of schizophrenia in terms of improved patient compliance., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Executive function influences children's learning abilities and organizes their cognitive processes, behaviors, and emotions. This cross-sectional study examined whether an Indonesian Computer-Based Game (ICbG) prototype could be used as a Computer-Based Game Inventory for Executive Function (CGIEF) in children and adolescents. The study was conducted with 200 children, adolescents, and their parents. The parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF) questionnaire, and the children and adolescents completed the CGIEF. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were performed using LISREL Version 8.80. The construct of CGIEF was valid/fit with normal theory-weighted least squares = 15.75 ( p > .05). SEM analysis showed that the theoretical construct of the CGIEF was a valid predictor of executive function. The critical t value of the pathway was 2.45, and normal theory-weighted least squares was 5.74 ( p > .05). The construct reliability (CR) for CGIEF was 0.91. Concurrent validity was assessed using the Bland-Altman plot, and the coefficient of repeatability (bias/mean) was nearly zero between the t scores of total executive functions of the CGIEF and BRIEF. This preliminary study showed that the CGIEF can be useful as a screening tool for executive dysfunction, metacognitive deficits, and behavioral regulation problems among children and adolescents in clinical samples., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Metoclopramide is an antiemetic agent prescribed for motion sickness, cancer chemotherapy, and pregnancy. The present work aimed to design a metoclopramide-loaded halloysite nanotubes (HNTs) drug-in-adhesive transdermal drug delivery system. Four formulations F1, F2, and F3 with different ratios of HNTs to metoclopramide and a F4 without HNTs were developed using acrylic adhesive DURO-TAK 387-2510 by the solvent casting method. These formulated patches were thoroughly evaluated and in-vitro release and permeation studies were performed. The optimized formulation was analyzed using skin irritation, SEM, DSC, and FTIR studies. The GASTROPLUS TCAT model was used to predict the in-vivo performance. HNT-based formulations exhibited controlled drug release, achieving approximately 60% in 4 h, compared to over 80% release in the same period from the formulation without HNT. The optimized formulation (F3) demonstrated a lag time of 1.802 h with a flux of 0.103 mg/cm 2 /hr. The shelf life was 19.279 months at 5 ± 3 °C. The C max , T max , AUC t, and AUC inf were predicted as 40.84 ng/mL, 6.32 h, 561.51 ng/mL×h and 599.61 ng/mL×h for a 30 mg patch. The study demonstrated that metoclopramide can be effectively loaded into HNTs and proved safe and effective in drug-in-adhesive type transdermal systems using HNTs as a drug carrier., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Genetic characterization and its association with quantitative traits in local breeds are important tools for the genetic improvement and sustainable management of animal genetic resources. Myogenic regulatory factor 5 (MYf5) and POU class 1 homeobox 1 (POU1F1) are candidate genes which play important roles in growth and development of mammals. The present study aims to detect the genetic diversity of the MYf5 and POU1F1 genes in four local Egyptian rabbit breeds and their association with growth traits, using PCR-restriction enzyme (PCR-RFLP), PCR-single-strand conformational polymorphism (PCR-SSCP), and direct sequencing techniques. The results showed that MYF5 exon 1 was observed with two genotypes in Baladi Black (BB), Gabali (GB) and New Zealand White (NZW) breeds while APRI-line (APRI) presented one genotype. The genetic diversity of Myf5 exon 2 between breeds showed two genotypes in APRI compared to three in NZW and four genotypes in BB and GB breeds. The genetic diversity of the POU1F1 gene (intron 5 and partial cds) in different rabbit breeds was two genotypes in NZW and three genotypes in BB, GB, and APRI breeds with different frequencies for each genotype. Based on the statistically significant difference between genes genotypes and growth weight, the results suggested that the genotypes of Myf5 exon 2 (1 and 2) of the BB breed, Myf5 exon 2 genotype 2 of the APRI breed, and genotype 1 of Myf5 exon 1 and genotype 1 of POU1F1 of the NZW breed compared to genotypes for each gene can be considered candidate molecular markers associated with the improvement of growth traits in these breeds., (© 2023. The Author(s).)

This study aims to design and optimize ondansetron (OND) gastro-retentive floating minitablets for better and prolonged control of postoperative nausea and vomiting (PONV) with improved patient compliance. Minitablets were directly compressed and encapsulated in a size 2 capsule shell with an overall dose of 24 mg. Central composite design (CCD) was applied keeping one cellulose ether derivative HPMC K15M and Carbopol 971 as variable and used as swelling and rate retarding agents. The other cellulose derivative i.e. sodium carboxymethyl cellulose, along with mannitol, sodium bicarbonate, and talc, were used in fixed quantities. The floating lag time, total floating time, swelling index, in-vitro drug release, and zero-order (RSQ value), were critical quality parameters. The optimized formulation (F pred ) was evaluated for all critical parameters, along with surface morphology, thermal stability, chemical interaction, and accelerated stability. The in silico PBPK modeling was applied to compare the bioavailability of F pred with reference OND immediate-release tablets. The numerical optimization model predicted >90 % drug release with zero-order at 12 h. In silico PBPK modeling revealed comparable relative bioavailability of F pred with the reference formulation. The gastroretentive floating minitablets of OND were successfully designed for prolonged emesis control in patients receiving chemotherapeutic agents., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Norethisterone acetate (NETA), also known as norethindrone acetate is a progestogens medication that is widely used in birth control pills, menopausal hormone therapy, and for the treatment of gynecological disorders as abnormal uterine bleeding and endometriosis. There is a lack of detailed histological information regarding the effects of NETA on the uterine structure. So, the present study focuses on the uterine histological, histochemical and ultrastructure changes following the exposure to NETA in the albino rats. To do this aim, fourteen adult female albino rats were used. They were randomly divided into two equally groups: Control group and NETA treated group. Albino rats of control group were administered daily food, water and orally distilled water only, while rats of NETA treated group were administered daily orally 20 µg of NETA dissolved in 2 ml distilled water, food, and water. The experiment was continued for three weeks., Results: The findings of the present work indicated that the use of NETA has negative effects on the endometrial epithelium (proliferation, autophagy and apoptosis), glands (necrotic, apoptotic or pseudosecretory glands) and stromal and myometrial reactions (granulocytes, connective tissue remodeling, apoptosis, myocytes hypertrophy)., Conclusion: This work revealed that NETA has desynchronized progestogenic effect on the uterine tissues of the albino rat and thereby prevent implantation and pregnancy., (© 2024. The Author(s).)

Introduction: Self-care practices among patients with hypertension have been shown to improve blood pressure control. Video-based interventions (VBIs) are helpful in enhancing patients' selfcare practices. However, validated VBIs in the Malay language for patients in primary care settings are scarce. This study aimed to develop and validate a VBI series in the Malay language to educate patients with hypertension on self-care practices in primary care settings., Methods: This study was conducted in three phases: (1) pre-production, (2) production and (3) post-production. The pre-production phase involved designing the storyboard and scripts, which underwent content validation by content experts and subsequently by patients with hypertension. Once the storyboards and scripts achieved acceptable consensus, the videos were recorded (production phase). The post-production phase included video editing and face validation among patients with hypertension. Statistical analysis included the calculation of the item-level content validation index (I-CVI) and item-level face validation index (I-FVI) during content and face validation, respectively., Results: The storyboards and scripts for five videos were developed. The I-CVI of all videos was 1.0 after two rounds of content validation among six content experts. The I-CVI of all videos was 1.0 among five patients with hypertension. Five videos were recorded and edited, achieving an I-FVI of 1.0 during face validation among 10 patients., Conclusion: A VBI series consisting of five videos was developed and validated for use among patients with hypertension in primary care settings to improve their knowledge of self-care practices., Competing Interests: None., (© Academy of Family Physicians of Malaysia.)

This study analyzed physical violence against physicians in Egypt from a medicolegal perspective. 88%, 42%, and 13.2% of participants were exposed to verbal, physical, and sexual violence. Concerning the tools of violence, 75.2% of attackers used their bodies. Blunt objects (29.5%), sharp instruments (7.6%), and firearm weapons (1.9%) were used. The commonest manners of attacks were pushing/pulling (44.8%), throwing objects (38.1%), and fists (30.5%). Stabbing (4.8%) and slashing (2.9%) with sharp instruments were also reported. Traumas were mainly directed towards upper limbs (43.8%), trunks (40%), and heads (28.6%). Considering immediate effects, simple injuries were reported that included contusions (22.9%), abrasions (16.2%), and cut wounds (1.9%). Serious injuries included firearm injuries (4.8%), internal organs injuries (3.8%), fractures (2.9%), and burns (1.9%). Most (90.5%) of injuries healed completely, whereas 7.6% and 1.9% left scars and residual infirmities, respectively. Only 14.3% of physicians proceeded to legal action. The current study reflects high aggression, which is disproportionate to legal actions taken by physicians. This medicolegal analysis could guide protective measures for healthcare providers in Egypt. In addition, a narrative review of studies from 15 countries pointed to violence against physicians as a worldwide problem that deserves future medicolegal analyses., (© 2024. The Author(s).)

Aim: Insulin therapy require self-administration of subcutaneous injection leading to painful and inconvenient drug therapy. The aim is to fabricate nanoemulsion (NE) based insulin loaded microneedles with improved bioavailability and patient compliance. Materials & methods: Different ratios of polyvinyl alcohol and polyvinylpyrrolidone as polymers were prepared through micro-molding technique for microneedles. Characterization of were performed using scanning electron microscope, differential scanning calorimetry, Fourier-transform infrared spectroscopy and circular dichroism. Mechanical strength, hygroscopicity and pain perception of these microneedles were also evaluated. In vitro release, permeation and in vivo PK/PD study of NE-based microneedles were conducted. Results: NE-based microneedles of insulin have improved bioavailability and quick response. Conclusion: Microneedles loaded with insulin can be effectively delivered insulin transdermally to treat diabetes with increased convenience and patient compliance.

This study investigated the ability of natural nanotubular clay mineral (Halloysite) and cellulose ether based biocomposite matrix as a controlled release agent for Verapamil HCl (BCS Class-I). Drug-loaded halloysite was prepared and tablet formulations were designed by varying amount of hydroxy propyl methyl cellulose (HPMC K4M). Physical characterization was carried out using SEM, FTIR, and DSC. Tabletability profiles were evaluated using USP1062 guidelines. Drug release kinetics were studied, and physiologically based pharmacokinetic (PBPK) modeling was performed. Compressed tablets possess satisfactory yield pressure of 625 MPa with adequate hardness and disintegration within 30 min. The initial release of the drug was due to surface drug on tablets, while the prolonged release at later time points (around 80 % drug release at 12 h) were due to halloysite loading. The FTIR spectra exhibited electrostatic attraction between the positively charged drug and the negatively charged Si-O-Si functional group of halloysite, while the thermogram showed Verapamil HCl melting point at ~146 °C with enthalpy change of -126.82 J/g. PBPK modeling exhibited PK parameters of optimized matrix formulation (VER-HNT 3% ) comparable to in vivo data. The study effectively demonstrated the potential of prepared biocomposite matrix as a commercially viable oral release modifying agent for highly soluble drugs., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Salivary glands are highly responsible for maintaining oral tissue homeostasis by secreting saliva. This study was designed to investigate aquaporin 1 and 4, oxidative stress, and autophagy in submandibular and parotid salivary glands of diabetic rats and the possible ameliorative effect of intermittent fasting on these changes. Fifty adult male rats were divided into control and experimental groups. Experimental diabetes was induced by a single intraperitoneal injection of streptozotocin. After induction of diabetics, the experimental group was divided into two groups (diabetic without intermittent fasting and diabetic with intermittent fasting). The animals were sacrificed two and four weeks after induction of diabetes. Intermittent fasting significantly decreased malondialdehyde and significantly elevated reduced glutathione (GSH) in the submandibular and parotid glands compared to those of diabetic rats. The salivary secretions were also significantly histologically spared in diabetics with intermittent fasting groups. Furthermore, intermittent fasting increased aquaporin 1 in both glands, while aquaporin 4 was only elevated in the submandibular gland. The immunolocalization and gene expression of Lc3-II was higher in the diabetic salivary glands than in the fasting glands. In conclusion, these findings highlight the pathological role of autophagy in diabetic submandibular and parotid glands and provide potential target for the therapeutic role of intermittent fasting to ameliorate the dysfunction of the submandibular and parotid glands in type I diabetes mellitus., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could appear to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed the global view of education, including graduate and postgraduate education making the development of an alternative approach in times of social isolation an academic imperative. The present review aims to investigate the challenges experienced among undergraduate and postgraduate education and the strategies adopted to address these challenges during the pandemic., Method: The preferred reporting items for the systematic review and meta-analyses extension for Scoping Reviews (PRISMA-ScR) were followed. The aim was to include journal articles published in the English language that discussed the influence of the pandemic on educational processes and applied innovative approaches as a solution to educational challenges. From January to August 2020, PubMed, EMBASE, and Google Scholar were searched for articles, yielding 10,019 articles. Two groups of authors examined the retrieved articles separately to avoid any risk of bias. The title and abstract of the articles were used for scrutiny, followed by full-text screening based on the established inclusion and exclusion criteria. The facts and findings of the studies were also discussed based on per capita income, literacy rate, and Internet accessibility., Results: Thirty of the obtained articles were included in the study. The selected articles were from North and South/Latin America, Asia & Pacific, South Africa, and Europe regions. Nineteen of the selected articles dealt with undergraduate education, ten with postgraduate, and one with both groups. The affordability of digital devices and the availability of Internet services were the major challenges for low- and middle-income economies. The ZOOM platform has been adopted by more than 90% of the education systems., Conclusion: Means of communication, including visual media, digitized content, and other web-based platforms, have been recognized as efficient learning and training tools, but have not been fully accessible for mass application and use due to the lack of availability of resources, their cost, and insufficient training among the users. In light of this review, it is suggested that harmonized and collaborative efforts should be made to develop cost-effective and user-friendly tools to overcome the current challenges and prevent future educational crises., Systemic Review Registration: The review was not registered., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: Transitional-aged youths (17-to-24-years-old) are prone to mental-health problems. Students in higher education, especially medical students, are more exposed to stressors and thus need training to increase resilience. However, there have been limited mental-health strengthening modules specifically developed for medical students of transitional age, and none in Indonesia. This study intends to test the effectiveness of an online mental-health strengthening module in altering resilience., Methods: A pragmatic randomized trial with repeated measurements was employed to evaluate biopsychosocial outcomes of resilience. The intervention module was delivered in 4 weeks to 105 eligible students. Participants were divided into intervention group ( n  = 52) and control group ( n  = 53). Outcomes were measured in the 4th, 8th, and 12th weeks. Primary outcome was resilience level as measured by Connor-Davidson Resilience Scale (CD-RISC). Perceived Stress Scale (PSS), Depression Anxiety Stress Scale (DASS) were utilized to measure stress, depression and anxiety. Knowledge and attitude toward mental-health were also measured through validated questionnaires. Stress levels of participants were measured biologically by measuring salivary cortisol and alpha-amylase levels at the baseline and 12th-week., Results: Compared to the control group, there were no significant difference in resilience score of the intervention group compared to control group [F(1, 103) = 2.243, P  = .137]; however, there was a significant main effect of time [F(3, 309) = 18.191, P  < .001] and interaction effect between intervention and time in resilience score [F(3, 309) = 5.056, P  = .002]. Additionally, compared to the control group, there were significant increases in knowledge [F(1, 103) = 66.805, P  < .001], attitudes and behavior towards mental-health [F(1, 103) = 5.191, P  = .025], and a significant decrease in stress perception score [F(1, 103) = 27.567, P  < .001]. The mean salivary delta cortisol during pre-test and post-test at week 12 in the intervention group showed significant difference ( P  < .001). However, there was no significant difference in the mean delta salivary alpha-amylase between pre-test and post-test at week 12, both in the intervention and control groups., Conclusion: The mental-health strengthening module was accepted and applicable to first-year medical students and was found to be effective in increasing resilience from various biopsychosocial aspects. It is also advisable to have similar modules throughout the medical school to maintain sustainability., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Kaligis, Ismail, Wiguna, Prasetyo, Gunardi, Indriatmi, Pasaribu, Pandia, Minayati, Magdalena, Nurraga, Pramatirta, Calvin and Sourander.)

Background: COVID-19 can have serious long term health consequences, which is called Post-COVID-19 Syndrome (PCS). Currently, the available evidence and understanding of PCS management is limited. Because one of the symptoms of PCS is associated to psychological symptoms, psychotherapy is believed to have a role in the management of PCS. This study aimed to identify the effectiveness of supportive psychotherapy in PCS patients at Cipto Mangunkusumo National General Hospital., Methods: This study was a single blind randomized clinical trial using a pre-and post-test with control group study design. Participants were randomly divided into two groups: a psychotherapy group with 40 participants and an education group with 37 participants. Each group was given internet-based psychotherapy or education three times a week in a form of group consisting of 6-8 participants. Symptom Checklist-90 questionnaire was used to evaluate somatic and psychological symptoms. Heart rate variability and neutrophil lymphocyte ratio were also investigated. Data analysis was performed using the independent T test., Results: An improvement in the SCL-90 score was found to be 17.51 (SD 30.52) in the psychotherapy group and 19.79 (SD 35.10) in the education group, although there was no significant difference between the two groups (p = 0.771). There was no significant difference between the two groups in decreasing NLR (p = 0.178) and improving HRV (p = 0.560)., Conclusion: Both internet-based group supportive psychotherapy and education improved psychological and somatic symptoms in PCS patients, although there was no significant difference between the two groups. There was no significant difference between the two groups in decreasing NLR and improving HRV. Suggestions for further research regarding adding frequency of internet-based group psychotherapy in PCS patients and held in the morning to achieve more optimal results.

A taste-masked chewable tablet of ciprofloxacin using ion exchange resin Kyron T-134 for enhancing compliance for the paediatric population was developed. The drug-to-resin ratio was optimized for maximum taste masking by studying the effects of soaking time (X1) and mixing time (X2) on complexation (%) using Central Composite Rotatable Design (CCRD). The resin complexes were characterized by bitterness score, DSC, FTIR, and PXRD. The complex was further formulated and optimized into chewable tablets through full factorial design, The optimized formulation was subjected to a bioequivalence study, and a virtual approach of PBPK modelling was adapted to predict the pharmacokinetics of the drug in the paediatric group. The drug resin ratio of 1:1.5 yielded an optimum drug loading of 99.05%. The optimized formulation shows minimum disintegration time with more than 99% drug release within 30 min. The formulation F-9 was found to be bioequivalent with a geometric mean ratio of C max , T max , AUC 0-t , and AUC 0-∞ within 90% CI. It was concluded that quality by design approach can successfully be applied to optimize the drug resin ratio and PBPK modeling is a successful predictive tool for estimating the pharmacokinetics of ciprofloxacin HCl in the paediatric population., (© 2023. Springer Nature Limited.)

The transition of a pregnant woman's role often causes emotional changes that have an impact on marital satisfaction. We develop MIESRA mHealth and evaluate its impact on satisfaction of husband-wife relationship during pregnancy. A quasi-experimental study was conducted on 82 couples of pregnant women and divided into control, single, and paired group. We implemented MIESRA mHealth for four weeks. In the couple group, the wife did mindfulness based on the information in the MIESRA mHealth together with her husband. In a single group, the wife sees the video as an initial guide to doing mindfulness. In the control group, respondents received programme interventions from hospitals which included education and consultation with obstetricians. Husband-wife relationship is evaluated using Compatibility of Husband-and-Wife Relationships / Kesesuaian Hubungan Suami Istri (KHSI) questionnaire and the generalised estimating equations (GEE) was used to analyse the data. The women's KHSI scores in the couple and single intervention groups (β = -7.46, p = 0.002; β = -9.11, p = 0.001) were better than the control group. The husbands' KHSI scores in the paired and individual intervention groups (β = -7.04, p<0.001; β = -3.74, p = 0.024) were better than the control group. Nursing interventions to build emotional bonds between parents and foetuses based on mHealth can be a promising intervention for marital harmony during the perinatal period. MIESRA m-Health is a promising intervention on marital satisfaction during pregnancy and can be implemented as a part of the antenatal care programme to increase marital satisfaction., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Besral et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Adolescents are at risk in experiencing mental health problems if the risk factors owned are more than the protective factors. This study aims to identify the effectiveness of Mental Health nursing promotive and preventive models on protective factors, risk factors and Adolescents' Mental Health. This research was with quasi-experiment, design employed randomization control group pre and post-test design conducted on 240 adolescents, which was divided into both groups equally. The study found that protective factors (self-esteem, family relationship, and prosocial ability) has increased after intervention model by 10.2%; 4.4%; 15.7%, respectively, risk factors (bullying behavior, anxiety, emotional problems, behavioral problems, and peer problems) has decreased after the intervention model by 9.8%; 26.1%; 25.9%; 17.5%; 22.4%, respectively. The model also increased the adolescents' mental health after intervention model by 14.9%. The mental health nursing promotive and preventive model is effective to increase the mental health of adolescents by 21.3%. Mental health nursing' promotive and preventive model could be used as basic needs to implement early detection regarding mental health of adolescents in the UKS scope and involving teachers' role, as well as parents in maintaining mental health.

Introduction: A SeDeM expert tool-driven I-optimal mixture design has been used to develop a directly compressible multiparticulate based extended release minitablets for gastro-retentive drug delivery systems using loxoprofen sodium as a model drug. Methods: Powder blends were subjected to stress drug-excipient compatibility studies using FTIR, thermogravimetric analysis, and DSC. SeDeM diagram expert tool was utilized to assess the suitability of the drug and excipients for direct compression. The formulations were designed using an I-optimal mixture design with proportions of methocel K100M, ethocel 10P and NaHCO 3 as variables. Powder was compressed into minitablets and encapsulated. After physicochemical evaluation lag-time, floating time, and drug release were studied. Heckel analysis for yield pressure and accelerated stability studies were performed as per ICH guidelines. The in silico PBPK Advanced Compartmental and Transit model of GastroPlus™ was used for predicting in vivo pharmacokinetic parameters. Results: Drug release follows first-order kinetics with fickian diffusion as the main mechanism for most of the formulations; however, a few formulations followed anomalous transport as the mechanism of drug release. The in-silico -based pharmacokinetic revealed relative bioavailability of 97.0%. Discussion: SeDeM expert system effectively used in QbD based development of encapsulated multiparticulates for once daily administration of loxoprofen sodium having predictable in-vivo bioavailability., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rauf-ur-Rehman, Shoaib, Ahmed, Yousuf, Siddiqui, Saleem, Qazi, Khan, Irshad, Bashir, Naz, Farooq and Mahmood.)

Background: Mother-infant bonding is an important factor that supports an infant's socio-emotional development. Therefore, every family member should acknowledge these processes, especially in an extended family set-up like in Indonesia. The general study objective was to predict several socio-demographic factors associated with mother-infant bonding in Indonesian samples., Method: This is a cross-sectional study. The participants included 168 mothers who had infants aged 0 to 36 months and willingly joined the study by signing the informed consent form. The Indonesian version of mother-infant bonding scale and a socio-demographic questionnaire were administered to all mothers. Logistic regression was applied to identify the socio-demographic factors that had any association with the mother-infant bonding scale. The data were analyzed using the SPSS program version 21 for Mac., Results: The study showed that 13.1% of the participants were categorized as having a moderate-to-high level of impaired mother-infant bonding. Logistic regression analysis showed that vaginal or normal delivery mode was 4.07 (95% CI [1.27, 13.09]) times more likely to exhibit low levels of impaired mother-infant bonding compared to a cesarean section. The model explained 18.6% (Nagelkerke R 2 ) of the variance in impaired mother-infant bonding and accurately classified 86.9% of cases., Conclusion: The findings support prior studies that have been conducted in several countries. Psychoeducation on supporting mother-infant bonding may consist of several topics, such as the advantages of vaginal delivery mode and the importance of family support. It may be delivered in the early adulthood period and, hopefully, basic knowledge during those periods may help strengthen the understanding of mother-infant dyad issues among all family members.

Background and Aim: Given the rise in stray and imported dogs in Egypt over the past 5 years, it is surprising that no report of Brucella canis infection in dogs or humans has been documented in Egypt's published papers. This study aimed to detect the presence of antibodies against the rough ( B. canis ) and smooth Brucellae among dogs in Egypt and to characterize the Brucella species circulating in dogs., Materials and Methods: Blood samples (n = 449) were collected from owned and stray dogs in the Greater Cairo region (n = 309) and Damietta governorate (n = 140). The apparent, true, and total seroprevalence of canine brucellosis caused by B. canis infection were calculated using the 2-mercaptoethanol tube agglutination test (2-ME TAT) and rapid slide agglutination test (RSAT). We used the rose Bengal test (RBT) and the buffered acidified plate antigen test (BAPAT) to check the serum samples from dogs for the presence of antibodies against smooth Brucellae . Three polymerase chain reaction (PCR) assays - Bruce-ladder PCR, B. canis species-specific PCR (BcSS-PCR), and Abortus Melitensis Ovis Suis (AMOS)-PCR - were used to determine the Brucella species in the buffy coats of the serologically positive dogs., Results: The overall apparent and true prevalence of B. canis infection in dogs were estimated to be 3.8% and 13.2%. The estimated true prevalence in stray dogs (15%) was higher than in owned dogs (12.5%). The BAPAT and the RBT using smooth antigens revealed that 11 (2.4%) and 9 (2%) were positive. Bruce-ladder PCR targeting eryC, ABC , and Polysaccharide deacetylase genes was able to identify B. canis in nine out of 17 buffy coat samples. AMOS-PCR identified the eight undetermined Brucella species by Bruce-ladder PCR as Brucella abortus (n = 4) and Brucella melitensis (n = 4). To exclude the presence of Brucella suis , a one-step species-specific BcSS-PCR was performed and specifically amplified all B. canis DNA (n = 9) the same as did the Bruce-ladder PCR., Conclusion: To the best of our knowledge, this is the first report of B. canis detection in dogs in Egypt. Molecular identification of B. abortus and B. melitensis in the Egyptian canines highlights the role of stray dogs in brucellosis remerging in Brucellosis-free dairy farms. Brucella canis infection can be diagnosed specifically with the one-step BcSS-PCR. The obtained results set-an-alarm to the veterinary authorities to launch plans to control this disease in dogs., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Hamdy, et al.)

Background: Hemorrhagic cystitis often develops in patients treated with cyclophosphamide (CP). Vincamine (vinca alkaloid) is the source of the synthetic derivative vinpocetine (Vinpo). Worldwide, Vinpo is used as a cerebroprotective drug. As it has anti-oxidant, anti-thrombotic and anti-inflammatory effects but the power of Vinpo to prevent CP induced cystitis has not been studied., Aim of Study: This research was planned to explore the effect of Vinpo (10-30 mg/kg, orally) administered 1 or 4 h before inducing cystitis by CP injection (300 mg/kg, i.p.) on the urinary bladder of mice., Results: Administration of Vinpo 30 mg/kg, 4 h before CP injection ameliorated inflammatory markers. It reduced inducible nitric oxide synthase (iNOS), tumor necrosis factor- α (TNF-α), and BCL2 Associated X (Bax) expression in the bladder and increased the total antioxidant capacity level. Histological examination of the bladder has further supported these results. The present study suggests a protective effect of Vinpo (30 mg/kg, 4 h before CP injection) against CP-induced bladder inflammation., Conclusion: This proposes that Vinpo 30 mg/kg may become a promising pharmacological drug to prevent urinary adverse effects in patients treated with chemotherapy using CP., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: People with noncommunicable diseases (NCDs) are at a significantly higher risk of worst outcomes if infected with COVID-19 and thus amongst the main target population for vaccination. Despite prioritizing them for vaccination, the number of vaccinated patients with comorbidities stalled post vaccine introduction. Despite that the government along with partners ran a national awareness campaign to ramp up vaccination coverage, the coverage remained suboptimal. Thus, a one-to-one health counselling initiative was implemented to explore the acceptance of COVID-19 vaccines by the NCDs patients and address the main issues surrounding vaccine hesitancy. This study evaluates the impact of this intervention by analyzing the change in COVID-19 vaccine acceptance., Methods: In this analytical observational study, a random sample of 57,794 people living with NCDs were approached. Out of them, 12,144 received one-to-one counselling by a group of trained health professionals. The counselled group's vaccine acceptance was assessed on a Likert scale from 1 to 5 pre- and post- counselling. Moreover, a random sample was followed up 2 months after initial counselling to measure their vaccine acceptance and update their vaccination status., Results: 44.5% of total respondents were already registered in the vaccination platform. On a scale from 1 to 5, the overall mean confidence significantly increased by 1.63 from 2.48 pre-counselling to 4.11 post-counselling. Two-months post counselling, a random sample was contacted again and had a mean vaccine confidence of 3.71, which is significantly higher than pre-counselling confidence level despite a significant decrease to post-counselling results., Discussion: Implementing an intervention that targets all key factors impacting health decisions, such as health literacy, risk appraisal and response efficacy, helps reach an adaptive response and increase vaccine confidence. Scholars should be cautious when implementing an intervention since it could lead to maladaptive defensive responses. One-to-one interventions are more effective in population when addressing new interventions and vaccines., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The study is based on using SeDeM expert system in developing controlled-release tramadol HCl osmotic tablets and its in-silico physiologically based pharmacokinetic (PBPK) modeling for in-vivo pharmacokinetic evaluation. A Quality by Design (QbD) based approach in developing SeDEM-driven full factorial osmotic drug delivery was applied. A 2 4 Full-factorial design was used to make the trial formulations of tramadol HCl osmotic tablets using NaCl as osmogen, Methocel K4M as rate controlling polymer, and avicel pH 101 as diluent. The preformulation characteristics of formulations (F1-F16) were determined by applying SeDeM Expert Tool. The formulation was optimized followed by in-vivo predictive pharmacokinetic assessment using PBPK "ACAT" model of GastroPlus™. The FTIR results showed no interaction among the ingredients. The index of good compressibility (ICG) values of all trial formulation blends were ≥5, suggesting direct compression is the best-suited method. Formulation F3 and F4 were optimized based on drug release at 2, 10, and 16 h with a zero-order kinetic release ( r 2 = 0.992 and 0.994). The SEM images confirmed micropores formation on the surface of the osmotic tablet after complete drug release. F3 and F4 were also stable (shelf life 29.41 and 23.46 months). The in vivo simulation of the pharmacokinetics of the PBPK in-silico model revealed excellent relative bioavailability of F3 and F4 with reference to tramadol HCl 50 mg IR formulations. The SeDeM expert tool was best utilized to evaluate the compression characteristics of selected formulation excipients and their blends for direct compression method in designing once-daily osmotically controlled-release tramadol HCl tablets. The in-silico GastroPlus™ PBPK modeling provided a thorough pharmacokinetic assessment of the optimized formulation as an alternative to tramadol HCl in vivo studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Saleem, Shoaib, Yousuf, Ahmed, Ahmed, Siddiqui, Mahmood, Sikandar and Imtiaz.)

The traditional diagnosis of Attention Deficits/Hyperactivity Disorder (ADHD) is through parent-child interviews and observations; therefore, innovative ADHD diagnostic tools that represent this digital era are needed. Virtual reality (VR) is a significant technology that can present a virtual immersive environment; it can provide an illusion of participation in an artificial milieu for children with ADHD. This study aimed to develop an ADHD-VR diagnostic tool construct (Research Domain Construct/RDC) based on the DSM5 ADHD diagnostic criteria, and using the RDC to develop a diagnostic tool with a machine learning (ML) application that can produce an intelligent model to receive some complex and multifaceted clinical data (ADHD clinical symptoms). We aimed to expand a model algorithm from the data, and finally make predictions by providing new data (output data) that have more accurate diagnostic value. This was an exploratory qualitative study and consisted of two stages. The first stage of the study applied the Delphi technique, and the goal was to translate ADHD symptoms based on DSM 5 diagnostic criteria into concrete behavior that can be observed among children in a classroom setting. This stage aimed to gather information, perceptions, consensus, and confirmation from experts. In this study, three rounds of Delphi were conducted. The second stage was to finalize the RDC of the ADHD-VR diagnostic tool with ML, based on the first-stage results. The results were transformed into concrete activities that could be applied in the programming of the ADHD-VR diagnostic tool, followed by starting to input data that were required to build the diagnostic tool. The second stage consisted of more than ten focus-group discussions (FGDs) before it could be transformed into the ADHD-VR diagnostic tool with the ML prototype. First-stage data analysis was performed using Microsoft Excel for Mac. Qualitative data were analyzed using conceptual content analysis with a manifest/latent analysis approach. From the first stage of the study, there were 13 examples of student behaviors that received more than 75% totally agreed or agreed from the experts. The RDC of the ADHD-VR diagnostic tool with machine learning application consisted of three domains and was divided into six sub-domains: reward-related processing, emotional lability, inhibitory, sustained attention, specific timing of playing in order, and arousal. In conclusion, the results of this study can be used as a reference for future studies in a similar context and content, that is, the ADHD-VR diagnostic tool with machine learning based on the constructed RDC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wiguna, Bahana, Dirgantoro, Minayati, Teh, Ismail, Kaligis and Wigantara.)

Purpose: Halloysite nanotubes (HNTs) are a versatile and highly investigated clay mineral due to their natural availability, low cost, strong mechanical strength, biocompatibility, and binding properties. The present work explores its role for retarding and controlling the drug release from the composite polymer matrix material., Methods: For this purpose, nanocomposite films comprising propranolol HCl and different concentrations of HNTs were formulated using the "solution casting method". The menthol in a concentration of 1% w/v was used as a permeation enhancer, and its effect on release and permeation was also determined. Quality characteristics of the nanocomposite were determined, and in vitro release and permeation studies were performed using the Franz diffusion system. The data was analyzed using various mathematical models and permeation parameters. Optimized formulation was also subjected to skin irritation test, FTIR, DSC, and SEM study. Systemic absorption and disposition of propranolol HCl from the nanocomposites were predicted using the GastroPlus TCAT® model., Results: The control in drug release rate was associated with the higher concentration of HNTs. F8 released 50% of propranolol within 8 hours (drug, HNTs ratio, 1:2). The optimized formulation (F6) with drug: HNTs (2:1), exhibited drug release 80% in 4 hours, with maximum flux of 145.812 µg/cm 2 hr. The optimized formulation was found to be a non-irritant for skin with a shelf life of 35.46 months (28-30 ℃). The in silico model predicted C max , T max , AUC t , and AUC inf as 32.113 ng/mL, 16.58 h, 942.34 ng/mL×h, and 1102.9 ng/mL×h, respectively., Conclusion: The study demonstrated that HNTs could be effectively used as rate controlling agent in matrix type transdermal formulations., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Sikandar et al.)

Internet gaming disorder (IGD) is a rising health concern. Indonesia has yet to have any validated instrument specifically designed to screen for this disorder. This study aims to validate the Indonesian version of the Ten-item Internet Gaming Disorder Test (IGDT-10) and conduct a latent class analysis of gamers among the youth. An online survey was conducted between October and December 2020 at two universities in Depok and Jakarta, Indonesia. In total, 1233 respondents (62.6% female and 20.3±1.90 years old) gave valid responses and played video games. Confirmatory factor analysis (CFA) confirmed the unidimensional structure of the scale. Cronbach's alpha was 0.72 and composite reliability was 0.92. The latent class analysis yielded three distinct classes of gamers. The continuation and negative consequences were highly distinctive for the group at high risk of IGD (class 3). Deception had the lowest endorsement rate (41.7%); while, the continuation domain had the highest endorsement, 91.2%. The IGD prevalence estimate was 1.90% among the respondents. Approximately 70.2% of the gamers did not show IGD symptoms. The adapted Indonesian IGDT-10 was demonstrated as valid and reliable among Indonesian youths. Consistent with previous studies, the deception domain had a low endorsement rate. The detected IGD rates were comparable to the global range. The majority of the current sample disclosed no symptoms; however, a considerable proportion would benefit from early preventive measures., Competing Interests: The authors have declared that no competing interests exist.

Various factors influence the students' perception of universities and university image. This study explores five factors affecting university image among Graduate Alumni. Surveys, administered to 597 graduate alumni were assessed to determine Graduate Alumni perspectives toward their university. Findings revealed that the key factors that impacted graduate alumni affecting the university's image and reputation were gender, nationality, level of study, and the ability of the institution to equip graduates with certain specific skills. Based on these findings, the university should consider further examining these areas to provide a more in-depth understanding of how these factors work to shape graduate students' perspectives of the university and develop ways to address areas that need to be developed and improved., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors.)

Polypharmacy may be considered as the customary practice to provide optimum care services to patients but inter resulted in augmented probability of multiple drug interaction. Keeping in view the importance of drug interaction possibility, this study was designed to evaluate the effect of ranitidine on pharmacokinetics of amoxicillin in the local population of Karachi, Pakistan. Amoxicillin and ranitidine are the most commonly prescribed drugs to treat duodenal ulcer caused by Helicobacter pylori. The current investigation was carried out as a single center, open label, two phase, single dose, randomized way in cross over manner to evaluate the potential of pharmacokinetic interaction among amoxicillin formulation and ranitidine in adult healthy male volunteers. Post dosing blood samples were collected at multiple time points that are 0.5, 1, 1.5, 2, 3, 4, 6, 8 and 10 hours after administering amoxicillin 250mg capsule with and without ranitidine. For estimation of amoxicillin concentration in plasma, an HPLC method was developed and validated. The solvent system consisted of 0.025M phosphate buffer: acetonitrile (94:6 v/v). C18 column was employed with a flow rate of 1.0 ml/minute and at 230nm. A linear pattern with a correlation coefficient of 0.999 in the concentration ranges of 25μg/mL to 0.097μg/mL for amoxicillin and 25μg/mL to 0.048μg/mL for ranitidine was observed. Amoxicillin retention time was about 8 minutes and ranitidine retention time was around 12 minutes. Amoxicillin levels were computed and the concentrations were applied to calculate the pharmacokinetic parameters. Pharmacokinetic parameters were estimated by Kinetica TM 4.4.1 (Thermo Electron Corp. USA). The analysis of variance (two way) and t test (two one sided) were applied on log transformed pharmacokinetic parameters of amoxicillin. The Tmax was determined between amoxicillin alone and amoxicillin with ranitidine by Friedman test. The 90% confidence interval values for Cmax(calc) (0.687-0.743) and Tmax(calc) (1.148-1.742) for amoxicillin with or without ranitidine were not found within the FDA acceptable limits of 0.8-1.25. Study demonstrated the significant reduction in peak plasma levels of amoxicillin in presence of ranitidine. It is advisable to administer both drugs with time interval to avoid such interactions and increases in the bactericidal efficacy of amoxicillin., Competing Interests: The authors have declared that no competing interests exist.

Background: Supportive psychotherapy (SP) may increase the benefit of acute coronary syndrome (ACS) management, but there is no structured SP as a guideline for healthcare professionals. This study aimed to develop structured SP as a guideline for implementing psychotherapy in the management of ACS patients in intensive cardiac care unit (ICCU)., Methods:  This qualitative study used Delphi technique as a modified Delphi method to reach a consensus among experts of structured SP for healthcare professionals in the management of ACS during hospitalized in ICCU. This was developed using self-reflection, observation, and interview of SP implementation in daily psychosomatic practice, gathering literature reviews, doing focus group discussion (FGD) and interview with ACS survivors. During the Delphi rounds, we interviewed 50 informants as source people using valid questionnaires, to proceed a draft of the SP framework and the structured sessions. The SP framework draft and the structured sessions were evaluated and corrected by experts anonymously until the consensus was reached. The validity of the consensus was tested, using Likert psychometric scale to reach an agreement. Cronbach alpha test was used to assess construct validity with SPSS 20., Results:  All of preparations conducted before the Delphi rounds showed that ACS patients had psychosomatic disorders during in ICCU, that required support. SP is very helpful to reduce the negative impact of this disorders.Off 50 informants answered a valid and reliable questionnaire which supports the above statement. The draft was made based on the above process. The development of SP for healthcare professionals of ACS managements was reached in a consensus of expert panelists in the second round of the Delphi with Cronbach alpha of 0.9., Conclusion: Supportive psychotherapy (SP) for healthcare professionals in the management of ACS in ICCU were developed and may be applied in clinical practice and research.

Background: Inborn errors of metabolism (IEMs) commonly present with pediatric cardiomyopathy. Identification of the underlying cause is necessary as it may lead to improved outcomes., Objectives: We aimed to investigate the diagnostic rate, the clinical, and biochemical spectra of IEMs among Egyptian pediatric patients presenting with cardiomyopathy, and their outcome measures., Methods: We retrospectively analyzed the clinical, biochemical, and radiological data of 1512 children diagnosed with cardiomyopathy at Cairo University Children's Hospital over a 5-year duration., Results: Two hundred twenty-nine children were clinically suspected as IEMs and underwent metabolic workup. Nineteen different IEMs were confirmed in 57 (24.4%) of the suspected children. Their median age at presentation was 2.6 years and the majority had extra-cardiac manifestations. Hypertrophic cardiomyopathy represented 43/57 (75.4%) of confirmed cases, while dilated cardiomyopathy represented 13/57 (22.8%), and one patient presented with a mixed phenotype. Twenty- six patients (45.6%) survived, while 31 patients (54%) either died or were lost to follow up and assumed deceased., Conclusions: We developed for the first time a database and a diagnostic scheme for metabolic cardiomyopathies in Egyptian children. With the recent introduction of enzyme replacement therapy, many metabolic disorders became treatable, thus establishing an early and accurate diagnosis is extremely important., (© 2022 Seliem ZS et al.)

Background and Aim: Mental health is an integral part of adolescent wellbeing. However, only few adolescents understand the importance of mental health and are aware of the right time to seek help. Lack of knowledge and stigma may impede help-seeking behavior. To assess these aspects, three questionnaires have been developed in the English language. This study aims to assess the validity and reliability of an Indonesian version of the Mental Health Literacy and Help-Seeking Behavior set of questionnaires among adolescents in Indonesia. Methods: This is a cross-sectional study that used The Mental Health Literacy and Help-Seeking Behavior set of questionnaires developed by Kutcher and Wei. The set consists of three questionnaires: the Mental Health Knowledge, Attitude Toward Mental Health, and Help-Seeking Behavior questionnaire. The study was conducted between October 2020 and January 2021 with 68 first-year medical students at the University of Indonesia, who represented adolescents in a transitional phase. The questionnaires were translated into the Indonesian language by a bilingual psychiatrist and reviewed by 10 expert psychiatrists to determine content validity [Item-Level Content Validity Index (I-CVI) and Scale-Level Content Validity Index (S-CVI)]. Cronbach's alpha values were used to assess internal consistency (reliability). Results: The content validity test produced positive results with an I-CVI scores of 0.7-1.0 and S-CVI scores of 0.87, 0.90, and 0.99 for the knowledge, attitude, and help-seeking behavior questionnaires, respectively. For the reliability test, Cronbach's alpha values were 0.780 for the attitude questionnaire and 0.852 for the help-seeking behavior questionnaire, while the value for the knowledge questionnaire was 0.521. Conclusion: The ability to properly measure mental health through the availability of accessible, valid, and understandable tools plays an important role in addressing mental health issues among adolescents. In the current study, the Indonesian translations of all three questionnaires examining knowledge, attitude, and help-seeking behavior were considered to be valid and reliable., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kaligis, Ismail, Wiguna, Prasetyo, Indriatmi, Gunardi, Pandia, Minayati, Magdalena, Nurraga, Anggia, Pamungkas, Tran, Kurki, Gilbert and Sourander.)

Increasing evidence has shown an association between periodontitis and cognitive impairment. Subgingival microbiota play a great role in periodontitis pathogenesis. However, the correlation between the subgingival microbiome and cognitive impairment remains unclear. This study aimed to evaluate the red and orange complex subgingival microbiome of cognitively impaired and cognitively normal elderly Indonesian subjects with periodontitis. Twenty-eight elderly subjects diagnosed with periodontitis underwent two cognitive examinations using the Hopkins Verbal Learning Test and the Mini-Mental State Examination. Gingival crevicular fluid taken from the periodontal pocket, at a depth between 5 and 7 mm, using a paper point was used as the subgingival samples. The subgingival microbiome in the cognitive impairment group ( n = 14) and cognitively normal group ( n = 14) was compared using the 16S rRNA Metagenomic iSeq™ 100 Sequencing System. There was β-diversity in the subgingival microbiota between the cognitively impaired and cognitively normal subjects. The metagenomic analysis showed a higher abundance of Porphyromonas and Treponema bacteria in the cognitive impairment group than in the normal cognitive group ( p < 0.05). The abundance of Porphyromonas gingivalis and Treponema denticola was higher in the cognitively impaired elderly subjects. The role of P. gingivalis and T. denticola in the pathogenesis of cognitive impairment needs further investigation.

Adolescence is often a period of turmoil. The COVID-19 pandemic has increased adolescents' difficulty due to mental health consequences that may affect their developmental milestones. This study constructed and empirically tested a theoretical model of three predictive factors (cyberbullying, abuse, and screen time) and stress as the mediating factor in adolescent non-suicidal self-injury (NSSI). Structural equation model (SEM) analysis was applied to investigate stress as a mediating factor in the relationship between adolescent NSSI and cyberbullying, abuse, and screen time. This cross-sectional study used a "crowdsourcing" sample collection method to recruit 464 adolescents aged 11-17 years who were administered a questionnaire comprising scales on cyberbullying, abuse, screen time, stress, and NSSI. All scales had construct reliabilities ranging from 0.759 to 0.958. SEM statistical analysis was performed using Lisrel version 8.8 (Scientific Software International, USA) for Windows (Microsoft Corporation, Redmond, WA, USA). The mean (± SD) age of the cohort was 14.61 ± 1.65 years, and consisted of 66.7% females. Secondary high school was the highest educational background (58%). The study found that cyberbullying and abuse were direct positive predictors (critical t -value for the path > 1.96; p < 0.05) of adolescent NSSI; however, screen time did not have any direct relationship. Furthermore, stress was a significant full mediating factor of screen time and a partial mediating factor of cyberbullying and abuse in the relationship with adolescent NSSI (critical t -value of the path = 5.27; p < 0.05). Cyberbullying, screen time, and abuse with the mediating effect of stress could explain 48% of the variance in adolescent NSSI ( R 2 = 0.48). Adolescent mental health prevention and promotion programs need to be redesigned during the current COVID-19 pandemic to manage their stress and minimize the mental health consequences of cyberbullying, abuse, and inappropriately increased screen time., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wiguna, Minayati, Kaligis, Ismail, Wijaya, Murtani and Pradana.)

Autophagy is a key metabolic process where cells can recycle its proteins and organelles to regenerate its own cellular building blocks. Chemotherapy is indispensable for cancer treatment but associated with various side-effects, including organ damage. Stem cell-based therapy is a promising approach for reducing chemotherapeutic side effects, however, one of its main culprits is the poor survival of transplanted stem cells in damaged tissues. Here, we aimed to test the effects of activating autophagy in adipose-derived mesenchymal stem/stromal cells (ADSCs) on the survival of ADSCs, and their therapeutic value in cisplatin-induced liver injury model. Autophagy was activated in ADSCs by rapamycin (50 nM/L) for two hours before transplantation and were compared to non-preconditioned ADSCs. Rapamycin preconditioning resulted in activated autophagy and improved survival of ADSCs achieved by increased autophagosomes, upregulated autophagy-specific LC3-II gene, decreased protein degradation/ubiquitination by downregulated p62 gene, downregulated mTOR gene, and finally, upregulated antiapoptotic BCL-2 gene. In addition, autophagic ADSCs transplantation in the cisplatin liver injury model, liver biochemical parameters (AST, ALT and albumin), lipid peroxidation (MDA), antioxidant profile (SOD and GPX) and histopathological picture were improved, approaching near-normal conditions. These promising autophagic ADSCs effects were achieved by modulation of components in TGF-β1/Smad and PI3K-AKT signaling pathways, besides reducing NF-κB gene expression (marker for inflammation), reducing TGF-β1 levels (marker for fibrosis) and increasing SDF-1 levels (liver regeneration marker) in liver. Therefore, current results highlight the importance of autophagy in augmenting the therapeutic potential of stem cell therapy in alleviating cisplatin-associated liver damage and opens the path for improved cell-based therapies, in general, and with chemotherapeutics, in particular.

This study compares the Empathy Quotient (EQ) and Systemizing Quotient (SQ) scores of elementary school children with and without ADHD. The study also examined their brain types and, because sex plays a big role in empathy and systemizing ability, compared the results of the boys and girls. This cross-sectional study involved 122 participants, including 61 parents of children with ADHD and 61 parents of children without ADHD. The EQ, SQ and brain types were obtained using the Empathy and Systemizing Quotient in children (EQ-/SQ-C), validated in the Indonesian language. Data was analyzed using the SPSS program version 20 for Windows, with a p -value < 0.05 for statistical significance. There was a significant difference in EQ between children with and without ADHD, the score being lower in children with ADHD. There was also a significant difference in SQ among girls with and without ADHD, but not in boys. The brain types in both groups were not significantly different. The results indicate that children with ADHD have a lower ability to empathize compared to children without ADHD. Systemizing abilities were significantly lower in girls with ADHD than in girls without. Therefore, an intervention program focusing on improving empathy and systemizing ability needs to be developed in the community., Competing Interests: The authors declare no conflict of interest during the preparation, data collection, interpretation of the results, or article writing.

Purpose: The current study proposed the simple, eco-friendly and cost-effective synthesis of carboxymethyl cellulose (CMC) structured silver-based nanocomposite (CMC-AgNPs) using Syzygium aromaticum buds extract., Methods: The CMC-AgNPs were characterized by ultraviolet (UV) spectroscopy, scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction (XRD), Fourier transmission infra-red (FTIR), energy-dispersive X-ray (EDX), and dynamic light scattering (DLS) techniques. The synthesized nanocomposites were evaluated for their bactericidal kinetics, in-vivo anti-inflammatory, anti-leishmaniasis, antioxidant and cytotoxic activities using different in-vitro and in-vivo models., Results: The spherical shape nanocomposite of CMC-AgNPs was synthesized with the mean size range of 20-30 nm, and the average pore diameter is 18.2 nm while the mean zeta potential of -31.6 ± 3.64 mV. The highly significant (P < 0.005) antibacterial activity was found against six bacterial strains with the ZIs of 24.6 to 27.9 mm. More drop counts were observed in Gram-negative strains after 10 min exposure with CMC-AgNPs. Significant damage in bacterial cell membrane was also observed in atomic force microscopy (AFM) after treated with CMC-AgNPs. Nanocomposite showed highly significant anti-inflammatory activity in cotton pellet induced granuloma model (Phase I) in rats with the mean inhibitions of 43.13% and 48.68% at the doses of 0.025 and 0.05 mg/kg, respectively, when compared to control. Reduction in rat paw edema (Phase II) was also highly significant (0.025 mg/kg; 42.39%; 0.05 mg/kg, 47.82%). At dose of 0.05 mg/kg, CMC-AgNPs caused highly significant decrease in leukocyte counts (922 ± 83), levels of CRP (8.4 ± 0.73 mg/mL), IL-1 (177.4 ± 21.3 pg/mL), IL-2 (83.7 ± 11.5 pg/mL), IL-6 (83.7 ± 11.5 pg/mL) and TNF-α (18.3 ± 5.3 pg/mL) as compared to control group. CMC-AgNPs produced highly effective anti-leishmaniasis activity with the viable Leishmania major counts decreased up to 36.7% within 24 h, and the IC 50 was found to be 28.41 μg/mL. The potent DPPH radical scavenging potential was also observed for CMC-AgNPs with the IC 50 value of 112 μg/mL. Furthermore, the cytotoxicity was assessed using HeLa cell lines with the LC 50 of 108.2 μg/mL., Conclusion: The current findings demonstrate positive attributes of CMC fabricated AgNPs as a promising antibacterial, anti-inflammatory, anti-leishmaniasis, and antioxidant agent with low cytotoxic potential., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Asghar et al.)

The aim of this study was to develop an Indonesian computer-based game prototype, including feasibility testing, targeted on attention deficit/hypersensitivity disorder (ADHD) clinical symptoms and executive function. The study comprised five steps. The first to third steps used an exploratory qualitative research design. The Delphi technique with FGD was applied to collect qualitative data. During the study, seven experts participated in ten FGDs. Feasibility testing was conducted as a one group pre- and post-test design that included ten children with drug-naïve ADHD without other mental or physical disorders. Feasibility data were collected before and after 20 training sessions with the Indonesian computer-based game prototype. The framework analysis was performed for qualitative data. Quantitative data were analyzed using the paired t-test, Pearson's correlation and Spearman's rank-order correlation. Outputs of the exploratory qualitative study were the Indonesian computer-based game prototype constructs and general agreements of the prototype,. The Indonesian computer-based game prototype construct comprised six components: reward-related processing, control inhibition, improved sustained attention, specific timing, increased arousal, and improved emotional regulation. After 20 sessions of training, several indicators decreased significantly, such as CATPRS-teacher rating (18.5 [5.31] vs. 12.9 [5.51], p = 0.047), BRIEF-GEC (64.80 [10.21] vs. 57.50 [7.51], p = 0.02), BRIEF-MI (66.1 [7.61] vs. 58.4 [7.56], p = 0.014), BRIEF-Initiate (66.6 [10.15] vs. 54.1 [6.49], p = 0.008), BRIEF-Working Memory (68.0 [6.89] vs. 60.9 [10.05], p = 0.02), and BRIEF-Organization of Material (60.7 [12.88] vs. 49.3 [11.79], p = 0.04). There was a low to moderate correlation between CATPRS-teacher and -parent rating and several BRIEF domains. Feasibility testing output also included the training procedure guideline. The present study indicated that the Indonesian computer-based game prototype could be used as a framework to develop a fixed computer-based game intervention for children with ADHD. However, further randomized controlled studies need to be conducted to show its effectiveness., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Background: Globally, teachers have misconceptions about epilepsy and its management. Little is known about Saudi Teachers' knowledge about epilepsy in Taif City., Method: Descriptive questionnaire-based cross-sectional survey of a sample of schoolteachers in Taif Governate., Results: The study included ( n = 420) schoolteachers. All heard about epilepsy and ( n = 116, 27.6%) knew about epilepsy from an afflicted individual, and ( n = 102, 24.3%) from social media outlets. Most teachers believed that an epileptic fit constitutes seizures ( n = 370, 88.1%). Some ( n = 330, 78.6%) were not satisfied with their knowledge level. Attitudes were positively associated with years of experience, but, generally, were only modest with 50.2% fearful of having an epileptic child in class. The mean practice score was 6.9 (out of 15). Practice was improved by having a pupil with epilepsy in class., Discussion and Conclusion: Schoolteachers in Taif showed excellent crude knowledge about epilepsy. However, knowledge of crucial details of the disorder were poor. This could be due to reliance on social media for information. There was high level of insight among schoolteachers regarding their sub-optimum knowledge levels. Knowledge was much better among experienced schoolteachers. Witnessing an epileptic fit improved knowledge. Teachers' attitudes toward epilepsy were negative, likely because of significant epilepsy-related stigma. Years of experience were significantly associated with increased attitude score. Schoolteachers' actual practice in handling epilepsy cases was below-expectation. There is pressing need for high-quality workshops to address knowledge and practice deficits., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family Medicine and Primary Care.)

Background: COVID-19 is an infectious disease that is easily widespread and has clinical manifestations as mild, moderate, or severe disease. COVID-19 patients are required to be isolated during treatment to reduce transmission. This can cause anxiety and depression, which in turn worsens the patient's illness. Providing supportive psychotherapy can help provide a feeling of safety, comfort and calm for patients. The choice of method in providing supportive psychotherapy can be done online/teleconsultation or internet-based. This clinical review aims to determine the effect of online teleconsultation or internet-based psychotherapy on COVID-19 patients., Methods: A systematic search was performed using online databases, such as PubMed, Cochrane, EBSCO/CINAHL and ProQuest. The identified articles were screened using eligibility criteria. There were 2 studies (Zhou et al, and Wei et al) which were analyzed critically using the Newcastle Ottawa Scale., Results: Both studies showed that management of psychotherapy through teleconsultation or internet-based on COVID-19 patients can help relieve the patient's psychological symptoms. Zhou et al studied 63 suspected COVID-19 with 23.8% (n = 15) having a Hospital Anxiety Depression Scale (HADS) score of 8 or more. There was a significant decrease in HADS-A nxiety (HADS-A) scores (p <0.01) and HADS-Depression (HADS-D) scores (p <0.01) in 15 patients, and from the overall HADS scores (p < 0.01). Wei et al. Showed 17-HAMD and HAMA scores in the online psychological intervention group also showed a significant reduction in symptoms of depression and anxiety compared to controls., Conclusion: Psychotherapy through online teleconsultation or internet-based on COVID-19 patients can help relieve symptoms of anxiety and depression and teleconsultation and also effective in dealing with psychological complications in patients with COVID-19.

Brucellosis is a zoonosis that has a devastating impact on the economy and public health, particularly in the Middle East, including Egypt. This study aimed to define risk factors associated with brucellosis in humans and in their cattle in Fayoum governorate - Upper Egypt. Also, molecular genotyping of recovered Brucella isolates from human cases and their cattle to assess the potential cross-species transmission in the study region. Data were obtained via double matched case-control studies for brucellosis in humans (106 cases and 160 controls) and in their cattle (78 cattle cases and 105 cattle controls). The results of multivariate regression analysis revealed that predictors of human brucellosis were animal-related occupations (OR 2.1, P 0.02), previous infection in other household members (OR 3.2, P 0.007), eating home-made soft cheese (OR 2.3, P 0.03), and exposure to cattle abortions (OR 6.9, P  < 0.001). For cattle, predictors of brucellosis were maturity ≥2 years of age (OR 2.9, P 0.01), ≥2 animals reared by the same household (OR 3.7-6.9, P  ≤ 0.001), and recent abortion (OR 15.2, P 0.01). Twelve Brucella isolates were recovered from eight human cases (7.5%, 8/106) and four cattle cases (6.2%, 4/65). All isolates were B. melitensis biovar 3. Analysis of the IS711 gene sequence revealed complete homology (100%) between isolates. Six virulence genes were utilized for virutyping: virB (100%), omp25 (100%), amiC (100%), ure (91.7%), wbkA (91.7%), and bvfA (75%). Virutyping revealed four virutypes: V1 (lack bvfA , 16.7%), V2 (harbored all genes, 66.7%), V3 (lack wbkA , 8.3%), and V4 (lack wbkA and ure , 8.3%). Repetitive extragenic palindromic PCR (REP-PCR) typing revealed two REP types. Combined REP-PCR/virulence genotyping revealed five different genotypes (G1-G5) for the detected isolates and a unique genotype for the reference strain (G6, B. melitensis bv3 Ether). Human and cattle isolates from the same household had matched genotypes. In conclusion, there were widespread risk factors among the cases studied. Health education for high-risk groups is essential for disease prevention, and combined REP-PCR/virulence genotyping is a quick tool for traceability, particularly in developing countries endemic with brucellosis as Egypt., Competing Interests: None., (© 2021 The Authors.)

Brucellosis is a highly contagious zoonosis that occurs worldwide. Whole-genome sequencing (WGS) has become a widely accepted molecular typing method for outbreak tracing and genomic epidemiology of brucellosis. Twenty-nine Brucella spp. (eight B. abortus biovar 1 and 21 B. melitensis biovar 3) were isolated from lymph nodes, milk, and fetal abomasal contents of infected cattle, buffaloes, sheep, and goats originating from nine districts in Egypt. The isolates were identified by microbiological methods and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Differentiation and genotyping were confirmed using multiplex PCR. Illumina MiSeq ® was used to sequence the 29 Brucella isolates. Using MLST typing, ST11 and ST1 were identified among B. melitensis and B. abortus , respectively. Brucella abortus and B. melitensis isolates were divided into two main clusters (clusters 1 and 2) containing two and nine distinct genotypes by core-genome SNP analysis, respectively. The genotypes were irregularly distributed over time and space in the study area. Both Egyptian B. abortus and B. melitensis isolates proved to be genomically unique upon comparison with publicly available sequencing from strains of neighboring Mediterranean, African, and Asian countries. The antimicrobial resistance mechanism caused by mutations in rpoB, gyrA, and gyrB genes associated with rifampicin and ciprofloxacin resistance were identified. To the best of our knowledge, this is the first study investigating the epidemiology of Brucella isolates from livestock belonging to different localities in Egypt based on whole genome analysis.