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Abstract Background Dipyrone (Metamizole) is a potent pain reliever and fever reducer with muscle relaxant properties, most commonly used as an analgesic and antipyretic agent. Despite the fact that it has been banned in many high-income countries following confirmed studies of fatal agranulocytosis and adverse drug reactions, it is still widely used in various countries of the world. However, the antipyretic therapeutic indications of dipyrone in febrile children are currently unknown, and there is little information on the advantages and disadvantages of using dipyrone in febrile children. In febrile children, we expected that dipyrone’s antipyretic effectiveness wouldn’t be any more effective than ibuprofen. Therefore, the purpose of this research is to evaluate the effectiveness of oral dipyrone and oral ibuprofen as antipyretics in febrile children. Methods Several databases, including PubMed, Scopus, Web of Science, and Cochrane Library, were searched thoroughly using a pre-established search strategy for potential research. The studies included in this analysis comprised randomized controlled trials that compared the antipyretic effects of oral ibuprofen and oral dipyrone in febrile children. Data analysis was carried out using RevMan 5.4 software. Results Three studies were selected among the 27 publications we discovered to be applicable, and they underwent qualitative and quantitative analysis. The pooled analysis revealed no discernible difference between oral dipyrone and oral ibuprofen in terms of their antipyretic effects (Mean difference (MD) = 0.06; 95% confidence interval (CI): -0.08, 0.20). Conclusion Both oral dipyrone and ibuprofen are effective in reducing high-temperature levels in febrile children without any significant difference.

This study aims to reconstruct the adoption of the theory of planned behaviour for predicting entrepreneurial intentions by examining moral judgement as an intervening variable. This study is significant in the present times since there is flawed reasoning when analysing entrepreneurial intentions. Most people believe that entrepreneurial intention is a manifestation of social aspects or favourable or unfavourable evaluation of the behaviour of interest. As such, they formulate that those aspects directly affect entrepreneurial intentions. Within the current study, our analyses do not provide strong empirical evidence for such claims. It is documented that moral judgment becomes a mediator for the use of social aspects to predict entrepreneurial intentions. Then, this study also found that moral judgment is the best and closest predictor of entrepreneurial intentions. Therefore, our study proposes different directions to understand and predict entrepreneurial intentions.

Abstract Dyskeratosis congenita (DC) is a rare inherited bone marrow failure syndrome, caused by genetic mutations that principally affect telomere biology. Approximately 35% of cases remain uncharacterised at the genetic level. To explore the genetic landscape, we conducted genetic studies on a large collection of clinically diagnosed cases of DC as well as cases exhibiting features resembling DC, referred to as ‘DC-like’ (DCL). This led us to identify several novel pathogenic variants within known genetic loci and in the novel X-linked gene, POLA1. In addition, we have also identified several novel variants in POT1 and ZCCHC8 in multiple cases from different families expanding the allelic series of DC and DCL phenotypes. Functional characterisation of novel POLA1 and POT1 variants, revealed pathogenic effects on protein-protein interactions with primase, CTC1-STN1-TEN1 (CST) and shelterin subunit complexes, that are critical for telomere maintenance. ZCCHC8 variants demonstrated ZCCHC8 deficiency and signs of pervasive transcription, triggering inflammation in patients’ blood. In conclusion, our studies expand the current genetic architecture and broaden our understanding of disease mechanisms underlying DC and DCL disorders.

Objective: Isolated tricuspid valve surgery is uncommon and associated with high perioperative morbidity and mortality. We aimed to study the overall outcomes of patients who underwent minimally invasive right thoracotomy tricuspid valve surgery (Mini-TVS), consisting of either tricuspid valve repair (TVre) or replacement (TVR). Methods: We performed a retrospective analysis of all Mini-TVS procedures (2017-2022), through which we identified isolated tricuspid valve surgeries. We examined in-hospital outcomes, survival analysis over a 4-year period, and competing risk analysis for reoperative surgery. Results: Among a total of 51 patients, the average age was 60 ± 16 years, and 67% (n = 34) were female. Severe tricuspid regurgitation was present in all cases. Infective endocarditis was noted in 7.8% (n = 4), and 24% (n = 12) had preexisting pacemakers. Mini-TVS included TVre in 18 patients (35%) and TVR in 33 patients (65%). The in-hospital and 30-day mortality rates were 4% (n = 2) and 6% (n = 3), respectively. At 4 years, the overall TVS survival was 76% (confidence interval, 62-93%), with no significant difference between TVre and TVR (91% vs 69%, P = .16). At follow-up, 3 patients required repeat surgery for recurrent regurgitation after 2.6, 3.3, and 11 months, with a reoperation rate of 7.3% (confidence interval, 2.4-22%) at 2 years. Factors associated with worse overall survival included nonelective surgery, right ventricular dysfunction, serum creatinine >2 g/dL, and concomitant left-sided valve disease. Conclusions: A nonsternotomy minimally invasive approach is a feasible option for high-risk patients. Midterm outcomes were similar in repair or replacement. Patients with right ventricular dysfunction and left-sided disease had worse outcomes.

Objective: Implementation and continuing optimization of enhanced recovery protocol after thoracic surgery results in significant improvement of postoperative outcomes. We observed a 10-fold increase in the rate of postoperative day (POD) 1 discharges following robotic thoracoscopic anatomic resections over time. We aimed to determine factors associated with safe POD1 discharges. Methods: We performed a retrospective analysis of a prospectively maintained database of robotic anatomic pulmonary resections between July 1, 2012, and June 30, 2022, with patients of the last 2.5 years forming the basis of this study. Data collected included demographics, insurance types, Area Deprivation Index (indicator of poverty), and operative and postoperative variables including length of stay, opioid use, daily pain levels, readmissions, and outpatient interventions. Factors associated with POD1 were analyzed using a logistic regression module. Result: In total, 279 patients met inclusion criteria (91 POD1 discharges, 32.6%; none discharged with a pleural catheter). There was neither an increase of postdischarge interventions for pleural complications nor readmission in early discharge patients. After adjusting for relevant factors, younger age, right middle lobectomy, lower opioid use on POD1, operating room finish before 4 PM, and low Area Deprivation Index were significantly associated with POD1 discharge. A subanalysis of 49 patients, who could have been discharged on POD1, identified hypoxemia requiring home oxygen, atrial fibrillation, and poorly controlled pain being common mitigatable clinical factors delaying POD1 discharge. Conclusions: Safe POD1 discharge following robotic thoracoscopic anatomic resection was achieved in 32% of cases. Identification of positive and negative factors affecting early discharge provides guidance for further modifications to increase the number of POD1 discharges.

Objectives: Textbook oncological outcome (TOO) is a composite metric for surgical outcomes, including non–small cell lung cancer (NSCLC). We hypothesized that social determinants of health (SDH) can affect both the attainment of TOO and the overall survival (OS) in surgically resected NSCLC patients with pathological nodal disease. Methods: We queried the National Cancer Database (2010-2017) for preoperative therapy-naïve lobectomies for NSCLC with tumor size

Within the scope of this research, we introduce a novel category of bi-univalent functions. Horadam polynomials are utilized to characterize these functions by utilizing series from the Poisson distribution of the Miller-Ross type. Functions from these new categories have been used to construct estimates for the Fekete-Szego functional, as well as estimates of the Taylor-Maclaurin coefficients |l2| and |l3|. These projections were created for the methods in each of these brand-new subclasses. We made some additional discoveries after, focusing on the traits that contributed to our initial findings.

Abstract Aim To assess the social cognitive elements of the stigma of mental illness (knowledge, attitudes and behaviours) among healthcare professionals (HCPs) in Jordan. Design A cross‐sectional descriptive design. Methods A total of 206 HCPs were conveniently recruited from general hospitals in Jordan. The mental attitude, knowledge and intended behaviours scales were used to measure stigma elements. Results Participants reported a moderate level of knowledge, a moderate negative attitude and a moderate or not greater interest to deal with people with mental health illnesses. The bivariate correlation revealed a negative significant correlation between HCPs' knowledge and attitude, indicating that HCPs with more knowledge significantly have more positive attitude (lower average score) towards those suffering from the illness. A more significant correlation was found between HCPs' knowledge and behaviour. The HCPs who had more knowledge were holding more interest and willingness towards dealing with persons with mental illness. Patient or Public Contribution Negative attitudes among HCPs demand awareness programmes pertaining to the stigma of mental illness to afford higher standards of practice for patients with mental problems.

Objective: Few studies have assessed the outcomes of mitral valve surgery in patients with obesity. We sought to study factors that determine the in-hospital outcomes of this population to help clinicians provide optimal care. Methods: A retrospective analysis of adult patients with obesity who underwent open mitral valve replacement or repair between January 1, 2012, and December 31, 2020, was conducted using the National Inpatient Sample. Weighted logistic regression and random forest analyses were performed to assess factors associated with mortality and the interaction of each variable. Results: Of the 48,775 patients with obesity, 34% had morbid obesity (body mass index ≥40), 55% were women, 66% underwent elective surgery, and 55% received isolated open mitral valve replacement or repair. In-hospital mortality was 5.0% (n = 2430). After adjusting for important covariates, a greater risk of mortality was associated with older patients (adjusted odds ratio [aOR], 1.24; 95% CI, 1.08-1.43), higher Elixhauser comorbidity score (aOR, 2.10; 95% CI, 1.87-2.36), prior valve surgery (aOR, 1.63; 95% CI, 1.01-2.63), and more than 2 concomitant procedures (aOR, 2.83; 95% CI, 2.07-3.85). Lower mortality was associated with elective admissions (aOR, 0.70; 95% CI, 0.56-0.87) and valve repair (aOR, 0.58; 95% CI, 0.46-0.73). Machine learning identified several interactions associated with early mortality, such as Elixhauser score, female sex, body mass index ≥40, and kidney failure. Conclusions: The complexity of presentation, comorbidities in older and female patients, and morbid obesity are independently associated with an increased risk of mortality in patients undergoing open mitral valve replacement or repair. Morbid obesity and sex disparity should be recognized in this population, and physicians should consider older patients and females with multiple comorbidities for earlier and more opportune treatment windows.

Objectives: Enhanced recovery after thoracic surgery (ERATS) protocols use a combination of analgesics for pain control and have been associated with decreased opioid requirements. We investigated the impact of continual ERATS refinement on the incidence of opioid-free discharge. Methods: We retrospectively analyzed our prospectively maintained institutional database for elective, opioid-naive robotic thoracoscopic procedures. Demographics, operative outcomes, postoperative opioid dispensed (morphine milligram equivalent), and opioid discharge status were collected. Our primary outcome of interest was factors associated with opioid-free discharge; our secondary objective was to determine the incidence of new persistent opioid users. Results: In total, 466 patients from our optimized ERATS protocol were included; 309 (66%) were discharged without opioids. However, 34 (11%) of patients discharged without opioids required a prescription postdischarge. Conversely, 7 of 157 patients (11%), never filled their opioid prescriptions given at discharge. Factors associated with opioid-free discharges were nonanatomic resections, mediastinal procedures, minimal pain, and lack of opioid usage on the day of discharge. More importantly, 3.2% of opioid-free discharge patients became new persistent opioid users versus 10.8% of patients filling opioid prescriptions after discharges (P = .0013). Finally, only 2.3% of opioid-naive patients of the entire cohort became chronic opioid users; there was no difference in the incidence of chronic use by opioid discharge status. Conclusions: Optimized opioid-sparing ERATS protocols are highly effective in reducing opioid prescription on the day of discharge. We observed a very low rate of new persistent or chronic opioid use in our cohort, further highlighting the role ERATS protocols in combating the opioid epidemic.

Despite the importance of tourism investment in maximizing the imports of countries that have the ingredients for its existence, including Iraq (which is characterized by the diversity of its sources of tourism and the role of this sector has been strengthened after the inclusion of the marshlands in southern Iraq within the World Heritage areas in 2016), it is an inexhaustible resource if it is properly exploited. Through the great economic resources and returns it achieves, the Iraqi legislator and other legislation, including the legislation under comparison, neglected to organize its provisions in special legislation, which means referring to the general provisions regulating investment and legislation related to tourism work, researching the provisions of tourism investment in terms of emerging rights About him and the obligations incumbent on the tourist investor is what we will discuss in this research, in which we reached a number of results, perhaps the most prominent of which is the legislative shortcoming in the provisions of tourism investment despite the practical need for its existence and what this shortcoming left obstacles and difficulties that led to the delay in tourism investments, which prompted us to inviting the Iraqi legislator to issue a legal regulation for tourism investment.

The availability of digital infrastructures and the fast-paced development of accompanying revolutionary technologies have triggered an unprecedented reliance on Artificial intelligence (AI) techniques both in theory and practice. Within the AI domain, Machine Learning (ML) techniques stand out as essential facilitator largely enabling machines to possess human-like cognitive and decision making capabilities. This paper provides a focused review of the literature addressing applications of emerging ML tools to solve various Project Scheduling Problems (PSPs). In particular, it employs bibliometric and network analysis tools along with a systematic literature review to analyze a pool of 104 papers published between 1985 and August 2021. The conducted analysis unveiled the top contributing authors, the most influential papers as well as the existing research tendencies and thematic research topics within this field of study. A noticeable growth in the number of relevant studies is seen recently with a steady increase as of the year 2018. Most of the studies adopted Artificial Neural Networks, Bayesian Network and Reinforcement Learning techniques to tackle PSPs under a stochastic environment, where these techniques are frequently hybridized with classical metaheuristics. The majority of works (57%) addressed basic Resource Constrained PSPs and only 15% are devoted to the project portfolio management problem. Furthermore, this study clearly indicates that the application of AI techniques to efficiently handle PSPs is still in its infancy stage bringing out the need for further research in this area. This work also identifies current research gaps and highlights a multitude of promising avenues for future research.

The study aimed to identify the level of self-regulation skills and the level of academic integration, as well as to identify the level of motivation to learn among students of the Faculty of Science in Palestinian universities, and to identify the nature of the relationship between self-regulation skills and academic integration and motivation to learn among the study sample. The study sample consisted of (250) male and female students from College of Science in Palestinian universities, and the researcher used the scale of self-regulation skills, academic integration and learning motivation scale, all of which were prepared by the researcher. A statistic between academic engagement and motivation to learn.

Objective: In this study we aimed to determine the effect of the COVID-19 pandemic on the delivery of care for thoracic surgical patients at an urban medical center. Methods: A retrospective analysis of all thoracic surgical cases from May 1, 2019, to December 31, 2020, was conducted. Demographic characteristics, preoperative surgical indications, procedures, final pathologic diagnoses, and perioperative outcomes were recorded. A census of operative cases, relevant ancillary services, and outpatient thoracic clinics were obtained from our institutional database. Results: Six hundred nineteen cases were included in this study (329 pre-COVID-19 and 290 COVID-19, representing an 11.8% reduction). There were no differences in type of thoracic procedures or perioperative outcomes among the 2 cohorts. Prolonged reduction of thoracic surgical cases (50% of baseline) during the first half of the COVID-19 period was followed by a resurgence of surgical volumes to 110% of baseline in the second half. A similar incidence of cases were performed for oncologic indications during the first half whereas more benign cases were performed in the second half, coinciding with the launch of our robotic foregut surgery program. After undergoing surgery during the pandemic, none of our patients reported COVID-19 symptoms within 14 days of discharge. Conclusions: During the initial surge of COVID-19, while there was temporary closure of operative services, our health care system continued to provide safe care for thoracic surgery patients, particularly those with oncologic indications. Since phased reopening, we have experienced a rebound of surgical volume and case mix, ultimately mitigating the initial negative effect of the pandemic on delivery of thoracic surgical care.

Abstract Background The rapid shift to online education due to COVID-19 quarantine challenged students’ ability to accept pure online learning without negative consequences for their physical, emotional and mental health. Some educational institutions introduced new strategies to reduce the psychosocial burden associated with online learning during home confinement. Thus, the primary aims were to determine the consequences of COVID-19 for the psychological well-being and fatigue levels of higher education students and to explore the effects of a new academic assessment approach in reducing home confinement stress. Method A cross-sectional online survey was conducted among students, from 30 August to 30 September 2020, of 7 disciplines in all 16 higher colleges of technology in the United Arab Emirates (UAE). The Mental Well-being and Learning Behaviours Scale and the modified Copenhagen Burnout Inventory were used to evaluate students’ psychological well-being and fatigue levels. A Welch t-test and Welch ANOVA were performed to determine the differences in perceived psychological well-being associated with students’ characteristics. Second, Kruskal_Wallis and Mann_Whitney were performed to determine the differences in fatigue level based on students’ characteristics. Results One thousand four hundred students participated. The majority were female (78.5%) and aged from 21–25 years (58.1%). Around 14% of respondents were married with children. Nearly 40% were satisfied with the new assessment approach introduced during the COVID pandemic and 45.5% perceived it as having reduced their home confinement stress. The mean psychological distress score of 3.00 (SD ± 0.71) indicates a moderate impact of COVID-19 on psychological well-being. Students’ psychological distress was positively correlated with fatigue level (0.256, p

Objectives: Our Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid consumption. We sought to evaluate the influence of such efforts on clinical outcomes and the use of both schedule II and schedule IV opioids following robotic thoracoscopic procedures. Methods: A retrospective study of patients undergoing elective robotic procedures between September 1, 2018, and December 31, 2020, was conducted. Essential components of pain management in the original protocol included nonopioid analgesics, intercostal nerve blocks with long-acting liposomal bupivacaine diluted with normal saline, and opioids (ie, scheduled tramadol administration and as-needed schedule II narcotics). Protocol optimization included replacing saline diluent with 0.25% bupivacaine and switching tramadol to as needed, keeping other aspects unchanged. Demographic characteristics, type of robotic procedures, postoperative outcomes, and in-hospital and postdischarge opioids prescribed (ie, milligrams of morphine equivalent [MME]) were extracted from electronic medical records. Results: Three hundred twenty-four patients met the inclusion criteria (159 in the original and 183 in the optimized protocol). There was no difference in postoperative outcomes or acute postoperative pain; there was a significant reduction of in-hospital and postdischarge opioid requirements in the optimized cohort. For anatomic resections: mean, 60.0 MME (range, 0-60.0 MME) versus mean, 105.0 MME (range, 60.0-150.0 MME), and other procedures: mean, 0 MME (range, 0-60 MME) versus mean, 140.0 (range, 60.0-150.0 MME) (P

Background: Depression and anxiety are prevalent psychological comorbidities within the patient group with AMI (acute myocardial infarction) and correlate with harmful effects. This research aimed to examine the predictive value of anxiety and depression on HRQoL (health-related quality of life) and prolonged cardiovascular outcomes within individuals with AMI in Baghdad, Iraq. Methods: This study, designed as a prospective cohort, enrolled 1,000 AMI patients from three tertiary care hospitals in Baghdad. Anxiety and depression were evaluated through the use of the PHQ-9 (Patient Health Questionnaire-9) and HADS (Hospital Anxiety and Depression Scale) at baseline. Over a 5-year follow-up period, the main endpoint was a composite of cardiovascular events, including recurrent AMI, cardiovascular mortality, and heart failure. Secondary outcomes included HRQoL, which was evaluated using the SF-36 (Short Form-36) questionnaire. Data analysis was performed employing linear mixed-effects models and Cox proportional hazards regression. Results: At baseline, the prevalence of depression and anxiety was 42.6% (95% Cl: 39.5-45.7) and 38.4% (95% Cl: 35.4-41.4) (HADS) or 35.2% (95% Cl: 32.2-38.2) (PHQ-9), respectively. After adjusting for confounders, baseline HADS-Anxiety (adjusted HR: 1.08, 95% Cl: 1.04-1.12), HADS-Depression (adjusted HR: 1.06, 95% Cl: 1.02-1.10), and PHQ-9 scores (adjusted HR: 1.05, 95% Cl: 1.02-1.08) were significant predictors of cardiovascular events. Higher levels of depression and anxiety were additionally linked with lower SF-36 Mental and Physical Component Summary scores within the 5-year follow-up timeframe. Conclusion: Anxiety and depression are highly prevalent among AMI patients in Baghdad and are significant predictors of reduced QoL and adverse cardiovascular events over five years. The results highlight the importance of comprehensive management and regular evaluation to identify depression and anxiety in individuals with AMI to improve outcomes and QoL. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a major contributor to the global burden of cardiovascular diseases, affecting over 1.28 billion adults worldwide. One of the primary contributors to the progression of cardiovascular diseases is hypertension, influenced by various psychosocial factors, including personality traits. The distinguishing attributes of Type D personality (TDP) are linked to adverse cardiovascular outcomes; however, its influence on the progression of hypertension is less understood. This investigation endeavored to analyze the affiliation between the onset of hypertension and TDP during five years in a sample of initially normotensive adults. Methods: A prospective cohort study included 500 initially normotensive participants in Baghdad, Iraq. The DS14 scale was used at baseline to assess TDP, and blood pressure was measured annually for five years. Cox proportional hazard regression models were employed to examine the association between TDP and incident hypertension, adjusting for traditional risk factors. Path analysis explored potential mediators, including physiological reactivity and health behaviors. Results: The incidence of hypertension was significantly higher among participants with TDP compared to non-type D participants (22.4% vs. 12.9%, P = 0.007). Individuals with TDP had a 1.63-fold increased risk of hypertension (95% Cl: 1.02-2.60; P = 0.040) after adjusting for age, sex, BMI, smoking, physical activity, and family history of hypertension. Path analysis revealed that physiological reactivity and health behaviors partially mediated the association between TDP and incident hypertension. Conclusion: TDP is independently associated with the development of hypertension in initially normotensive adults. Physiological reactivity and health behaviors partially explain the relationship between TDP and incident hypertension. Assessing the presence of TDP and implementing targeted interventions could help prevent the onset of hypertension and improve cardiovascular health. [ABSTRACT FROM AUTHOR]