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Abstract Background Artificial intelligence (AI) is transforming health profession education (HPE) through personalized learning technologies. HPE students must also learn about AI to understand its impact on healthcare delivery. We examined HPE students’ AI-related knowledge and attitudes, and perceived challenges in integrating AI in HPE. Methods This cross-sectional included medical, nursing, physiotherapy, and clinical nutrition students from four public universities in Jordan, the Kingdom of Saudi Arabia (KSA), the United Arab Emirates (UAE), and Egypt. Data were collected between February and October 2023 via an online survey that covered five main domains: benefits of AI in healthcare, negative impact on patient trust, negative impact on the future of healthcare professionals, inclusion of AI in HPE curricula, and challenges hindering integration of AI in HPE. Results Of 642 participants, 66.4% reported low AI knowledge levels. The UAE had the largest proportion of students with low knowledge (72.7%). The majority (54.4%) of participants had learned about AI outside their curriculum, mainly through social media (66%). Overall, 51.2% expressed positive attitudes toward AI, with Egypt showing the largest proportion of positive attitudes (59.1%). Although most participants viewed AI in healthcare positively (91%), significant variations were observed in other domains. The majority (77.6%) supported integrating AI in HPE, especially in Egypt (82.3%). A perceived negative impact of AI on patient trust was expressed by 43.5% of participants, particularly in Egypt (54.7%). Only 18.1% of participants were concerned about the impact of AI on future healthcare professionals, with the largest proportion from Egypt (33.0%). Some participants (34.4%) perceived AI integration as challenging, notably in the UAE (47.6%). Common barriers included lack of expert training (53%), awareness (50%), and interest in AI (41%). Conclusion This study clarified key considerations when integrating AI in HPE. Enhancing students’ awareness and fostering innovation in an AI-driven medical landscape are crucial for effectively incorporating AI in HPE curricula.

Abstract Background This study aims to evaluate the microtensile bond strength (µTBS) of different resin composite restorations bonded to mid-coronal dentin and proximal root dentin using light-cured, chemical-cured, and dual-cured adhesives immediately and after aging. Nanoleakage and degree of cure were also assessed. Methods Eighty-four molars were divided into mid-coronal dentin and proximal root dentin. Each group was further subdivided into three subgroups based on the restorative systems used, which involved the utilization of light-cured, chemical-cured, and dual-cured adhesives. Half of the specimens underwent µTBS testing after 24 h, while the other half after aging. Representative specimens were analyzed for nanoleakage. The degree of cure of the tested adhesive systems was also assessed. Results Aging showed a significant negative effect on µTBS results and led to increased nanoleakage (p

Abstract Background The COVID-19 pandemic significantly increased the demand for remote healthcare services delivery, including remote access to medications. This study explored the practices and challenges associated with remote provision of pharmaceutical products and services in Kampala, Uganda. Methods A cross-sectional study was conducted from July to September 2022, enrolling 174 out of 198 sampled retail pharmacies. Data was collected using a pre-tested questionnaire on remote service provision, platforms used, products offered, delivery methods, and challenges faced. Results Over 58% of pharmacies provided remote services, primarily through social media (especially WhatsApp) and phone calls. OTCs and POMs were the most commonly dispensed products remotely. Key challenges identified included high internet costs, labor shortages, poor internet quality, and a lack of specific regulations for remote provision of pharmaceutical products and services. Conclusion The proportion of retail pharmacies providing pharmaceutical products and services remotely is significant in Kampala, but they face challenges that need to be addressed. Regulations are crucial to ensure responsible dispensing practices and rational medicine use. Addressing internet affordability and quality, staffing issues, and delivery logistics is essential for sustainable and effective remote pharmaceutical products and services.

Abstract The ongoing conflict in Gaza has led to severe destruction of the health system and eventually its collapse. Moreover, multiple attacks on health workers were reported which led to obstacles in service delivery. The conflict has led to further humanitarian crises including shortage of food, water sanitation, and hygiene, and outbreaks of infectious diseases. About 2 million of Gaza’s population are internally displaced with the majority in Rafah. Rafah’s population has increased by 500% in less than four months. This has led to acute food severity in Gaza for the whole of the population. Moreover, the cut of UNRWA aid is expected to further expand the humanitarian crisis as over 2 million of the population depends on the aid.

Abstract Background The Geriatrics Health Behavior Questionnaire (GHBQ) is essential for assessing health-related behaviors among older adults populations. This study focuses on the translation, cultural adaptation, and psychometric evaluation of the Arabic version of the GHBQ to ensure its relevance and accuracy for Arabic-speaking older adults individuals. Methods This cross-sectional study was conducted at the Cairo University Educational Hospital’s outpatient clinic. The GHBQ was translated and culturally adapted through a systematic process, including initial translation, back-translation, expert review, and pilot testing. The psychometric properties of the Arabic-translated GHBQ were evaluated using a sample of 200 older adults Arabic-speaking participants. Reliability was assessed using Cronbach’s alpha (α) and Intraclass Correlation Coefficient (ICC). Validity was evaluated through Content Validity Index (CVI), Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA). Results The Arabic GHBQ demonstrated excellent reliability with Cronbach’s alpha values ranging from 0.74 to 0.87 across subscales and ICC values confirming reproducibility (ICC = 0.82). The CVI indicated strong content validity (average CVI = 0.91). EFA revealed a five-factor structure, explaining 72% of the variance, with all factor loadings exceeding 0.60. CFA supported the questionnaire’s structure with fit indices meeting recommended criteria: χ²/df = 2.05, NFI = 0.92, TLI = 0.94, GFI = 0.90, SRMR = 0.05, AIC = 140.35, and BIC = 160.22. Criterion validity was confirmed through significant correlations with established health behavior measures (r = 0.63, p

Abstract Background Female breast cancer stands as the prime type of cancer in the Kingdom of Saudi Arabia (KSA), with a high incidence and mortality rates. This study assessed the burden of female breast cancer in KSA by analyzing and forecasting its incidence, mortality, and disability-adjusted life years (DALYs). Methods We retrieved data from the Global Burden of Disease (GBD) about female breast cancer from 1990 to 2021. Time-series analysis used the autoregressive integrated moving average (ARIMA) model to forecast female breast cancer statistics from 2022 to 2026. Results From 1990 to 2021, KSA reported 77,513 cases of female breast cancer. The age groups with the highest number of cases are 45–49 years, followed by 40–44 years, 50–54 years, and 35–39 years. The analysis also showed fewer cases in the younger age groups, with the lowest number in the less than 20-year-old age group. From 1990 to 2021, KSA reported 19,440 deaths due to breast cancer, increasing from 201 cases in 1990 to 1,190 cases in 2021. The age-standardized incidence rate/100,000 of breast cancer increased from 15.4 (95% confidence interval (CI) 11.2–21.0) in 1990 to 46.0 (95%CI 34.5–61.5) in 2021. The forecasted incidence rate of female breast cancer will be 46.5 (95%CI 45.8–46.5) in 2022 and 49.6 (95%CI 46.8–52.3) in 2026. The age-standardized death rate per 100,000 Saudi women with breast cancer increased from 6.73 (95%CI 6.73–9.03) in 1990 to 9.77 (95%CI 7.63–13.00) in 2021. The forecasted female breast cancer death rate will slightly decrease to 9.67 (95%CI 9.49–9.84) in 2022 and to 9.26 (95%CI 8.37–10.15) in 2026. DALYs increased from 229.2 (95%CI 165.7–313.6) in 1990 to 346.1 (95%CI 253.9–467.2) in 2021. The forecasted DALYs of female breast cancer will slightly decrease to 343.3 (95%CI 337.2–349.5) in 2022 reaching 332.1 (95%CI 301.2–363.1) in 2026. Conclusions Female breast cancer is still a significant public health burden that challenges the health system in KSA, current policies and interventions should be fashioned to alleviate the disease morbidity and mortality and mitigate its future burden.

Abstract Background and objectives Obsessive–compulsive disorder (OCD) is a chronic psychiatric disorder defined by the existence of obsessions and/or compulsive behaviors or mental acts persistently and affects around 1–3% of the population in the world. Multiple studies demonstrated the link of the insight level to how severe was OCD and existence of resistance to both medications and psychotherapy in individuals with OCD. Studying the characteristics associated with poor insight is very important for management of treatment-resistant OCD and development of new therapeutic approaches. The purpose of this work was to assess the level of the insight in Egyptian patients with OCD, identify clinical correlates that could anticipate the degree of insight, and assess the validity and reliability of brown assessment of belief scale after being translated to Arabic version. Methods A comparative cross-sectional study of 96 individuals (male and female aged from 18 to 60) diagnosed with OCD based on the Arabic version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The study excluded any individuals with any coexisting neuro-psychiatric conditions and a history of major medical disease. Severity of OCD was assessed through the Arabic version of the Yale–Brown Obsessive–Compulsive Scale (YBOCS). Subsequently, participants performed the Brown Assessment of Beliefs Scale (BABS) after being translated into Arabic and assessed for reliability, validity and applicability of the translated form. Results Patients with OCD presented with poor insight were associated with more untreated time interval, longer disease duration and more severity that was dramatically differed (p ≤ 0.05, ≤ 0.001, ≤ 0.05 respectively). Also, there was a substantial notable correlation among BABS and YBOCS obsession, compulsion, and total score. Conclusions The existence of good insight in patients diagnosed with OCD was associated with lower severity and less duration of illness compared to patients with poor insight. Also, the more time waited before the intervention the worst the patient scores on the insight scale.

Abstract Background Peripheral insulin resistance and compromised insulin secretion from pancreatic β-cells are significant factors and pathogenic hallmarks of diabetes mellitus (DM). NF-κβ/TLR-4 and SERCA/Ca2+ pathways have been identified as potential pathways regulating insulin synthesis by preserving pancreatic β-cell functioning. The current study aimed to evaluate the therapeutic effect of aged garlic extract (AGE) against DM in a streptozotocin (STZ)-induced rat model with particular emphasis on pancreatic β-cell functioning. Methods AGE was characterized by gas chromatography-mass spectrometry (GC-MS), Fourier-transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM) to evaluate its physio-chemical characteristics followed by in-vitro anti-diabetic and antioxidant potential. This was followed by the induction of DM in laboratory animals for investigating the therapeutic action of AGE by evaluating the role of NF-κβ/TLR-4 and the SERCA/Ca2+ pathway. The parameters assessed in the present experimental setup encompassed antioxidant parameters, metabolic indicators, insulin concentration, intracellular calcium levels, apoptotic markers (CCK-8 and Caspase Glo-8), and protein expression (P-62 and APACHE-II). Results AGE characterization by SEM, GC-MS, and X-ray diffraction (XRD) revealed the presence of phenylalanine, alliin, S-allylmercaptocysteine (SAMC), tryptophan, 1-methyl-1,2,3,4-tetrahydro-β-carboline-3-carboxylic acid as major bioactive constituents of AGE. Metabolic studies, including intraperitoneal glucose tolerance test (IPGTT), revealed significantly lower blood glucose levels in the AGE group compared to the disease control group. In contrast, the intraperitoneal insulin tolerance test (ITT) exhibited no significant difference in insulin sensitivity between the AGE supplementation group and the DM control group. Interestingly, AGE was found to have no significant effect on fasting glucose and serum insulin levels. In contrast, AGE supplementation was found to cause significant hypoglycaemia in postprandial blood glucose and insulin levels. Importantly, AGE causes restoration of intracellular Ca2+ levels by modulation of SERCA/Ca2 functioning and inhibition NF-κB/TLR-4 pathway. AGE was found to interact with and inhibit the DR-5/ caspase-8/3 apoptotic complex. Furthermore, microscopic studies revealed degeneration and apoptotic changes in pancreatic β-cells of the DM control group, while supplementation of AGE resulted in inhibition of apoptotic pathway and regeneration of pancreatic β-cells. Conclusion The current study suggests that AGE enhance glucose homeostasis by exerting their effects on pancreatic β-cells, without ameliorating peripheral sensitivity. Moreover, AGEs promote an increase in β-cell mass by mitigating the apoptosis of pancreatic β-cells. These findings suggest that AGE could aid in developing a viable alternative therapy for diabetes mellitus (DM).

The aim of this research is to identify the effect of the phenomenon of Phubbing on the organizational behavior of administrators working in vocational schools in the light of the variables of appreciation and Provision of Attention to Employees. The research community consisted of (45) administrators, who were selected in a stratified random manner. The descriptive survey method was used in the current research. To achieve the objectives of the research, a questionnaire was developed, and its validity and reliability were confirmed. The results showed that the effect of the phenomenon of Phubbing on the organizational behavior of administrators working in vocational education schools in the light of the variables of appreciation and concern for workers was medium. The results of the research also showed that there were statistically significant differences at the significance level ([alpha] [less than or equal to] 0.05) according to the gender variable in favor of the male category. And there were no statistically significant differences according to the educational qualification variable, and there were no statistically significant differences according to the years of experience variable. In light of these results, the research recommended that the administrations of vocational education schools attach great importance to organizational behavior and work on treating it and alleviating the obstacles it faces and trying to tackle the phenomenon of Phubbing, so that it works to stimulate conducting studies and research from time to time to find out the effects of this phenomenon on organizational behavior in various circumstances and organizational variables in the educational administrative environment.

Ensuring safe and effective blood transfusion is essential for improving healthcare and preventing the spread of blood-borne diseases worldwide. Medical students are a potential key resource for voluntary blood donation, particularly in medical college hospitals, which can help alleviate the shortage of blood products. Additionally, they have the potential to inspire a wider segment of the population to donate blood, thereby narrowing the gap between blood supply and demand. This study aims to evaluate the knowledge, perceptions, and practices related to voluntary blood donation among undergraduate medical students at Gulf Medical University in Ajman, United Arab Emirates, and to identify the factors associated with these aspects. A cross-sectional, institution-based study was conducted among undergraduate medical students at Gulf Medical University. Data were gathered through a self-administered structured questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS) version 27. Knowledge, perceptions, and practices related to blood donation among 301 participants were assessed. The findings revealed no significant association between knowledge levels and demographics such as gender, marital status, residence, college, or academic year. While most participants were aware of blood donation procedures and benefits, actual donation practices were low, with 84.4% rarely donating blood. Key barriers included fear of needle pain and time constraints. Health professionals and social media were the primary sources of information, indicating the need for targeted educational interventions to improve blood donation rates. Students at Gulf Medical University are well-informed about blood donation, with many willing to donate. However, fears like needle pain and time constraints limit participation. Educational efforts could help overcome these barriers.

Aims:Approximately 80-85% of thyroid malignancies are papillary thyroid cancer (PTC). This study evaluated the relationship between thyroid capsule invasion (TCI) in PTC and macroscopic histopathological findings.Methods:A single-center, retrospective study was conducted using the medical records of adult patients who underwent PTC surgery. The patients were classified as TCI (+) or TCI (-) based on the postoperative pathological examination. Tumor localization, calcification, and multifocality were evaluated between the two groups.Results:The study included 236 patients (mean age: 44.3±12.0 years, female sex: 76.7%). Preoperative basic characteristics, comorbidities, thyroid function status, nodule calcification, halo border irregularity, and nodule diameter on ultrasonography were similar between the two groups. However, more TCI (+) patients had positive or suspicious fine needle aspiration biopsy findings preoperatively. The duration of surgery was longer in TCI (+) patients (86 minutes vs. 75 minutes, p1 mm was more common in TCI (+) vs. TCI (-) patients (47.3% vs. 81.8%, p

Abstract Background: Diabetes mellitus is a major noncommunicable disease worldwide, and its prevalence is rapidly increasing. The Finish score helps in the prediction of the risk of future diabetes development, as well as in the identification of undiagnosed diabetes. The current study was conducted to identify people at risk of developing type II diabetes mellitus in River Nile State, Sudan. Methods: This cross-sectional community-based study was conducted in River Nile state between 2019 October and 2020 March. Data were collected using a questionnaire that included the Finnish Diabetes Risk Score variables from 400 participants after an informed consent. Chi-square test was used to test the associations, with the P-value considered significant when < 0.05. Results: The majority of participants (257 [64.3%]) were < 45 years old, and 229 (57.3%) were male. The risk of type II diabetes mellitus was found to be low in 187 (46.8%) people and high in 213 (53.2%). Moreover, 128 (32%) had a body mass index (BMI) between 25and 30 kg/m2, while 46 (11.5%) had > 30 kg/m2. Waist circumference of < 94 cm was found in 147 (36.8%) males, while only 63 females (15.8%) had a waist circumference < 80 cm. Age, gender, BMI, daily activity, history of hypertension, history of hyperglycemia, and family history of diabetes were all significantly associated with the risk of developing diabetes mellitus (P < 0.001). Conclusion: The Finnish Diabetes Risk Score was found to be useful in facilitating wider access to the risk of type II diabetes among the study population. More than half of the study population were at risk of developing diabetes mellitus.

Objective: To assess awareness and attitudes towards folic acid intake before and during early pregnancy. Study Design:A cross-sectional study. Place and Duration of Study: The study was conducted in a primary health polyclinic of King Faisal University in Al Ahsa, Saudi Arabia from 18 December 2022 to 30 March 2023. Materials and Methods: The study employed a 22-item self-constructed questionnaire, developed after a thorough literature review. It encompassed six socio-demographic, two obstetric, four awareness, six knowledge, and three attitudes items. A sample of 385 females participated through systematic randomized sampling. SPSS software version 26.0 was used for data analysis. Results: About 40% (157) of participants were 36-45 years old and the mean age was 33.24 years with an 8.68 SD. While 89.4% (344) were married, 76.4% (294) were Saudi nationals, 51.7% (199) had a monthly income of 5000-10000 riyals, 41.8 % (161) were employed, 62.4% (241) held bachelor's degrees, 58.4% (211) were pregnant, 75.6% (291) had children, 42.9% (165) had heard of NTD and 3.1% (12) had neural tube defects affected children. A good knowledge score was achieved by 72.4% of participants, age 18-25 years, married status, students, and low income showed statistically significant association with knowledge level (p

Abstract Sensors, wearables, mobile devices, and other Internet of Things (IoT) devices are becoming increasingly integrated into all aspects of our lives. They are capable of gathering enormous amounts of data, such as image data, which can then be sent to the cloud for processing. However, this results in an increase in network traffic and latency. To overcome these difficulties, edge computing has been proposed as a paradigm for computing that brings processing closer to the location where data is produced. This paper explores the merging of cloud and edge computing for IoT and investigates approaches using machine learning for dimensionality reduction of images on the edge, employing the autoencoder deep learning-based approach and principal component analysis (PCA). The encoded data is then sent to the cloud server, where it is used directly for any machine learning task without significantly impacting the accuracy of the data processed in the cloud. The proposed approach has been evaluated on an object detection task using a set of 4000 images randomly chosen from three datasets: COCO, human detection, and HDA datasets. Results show that a 77% reduction in data did not have a significant impact on the object detection task’s accuracy.

Abstract Piezoelectric energy harvesting is gaining popularity as an eco-friendly solution to harvest energy from tire deformation for tire condition monitoring systems in vehicles. Traditional piezoelectric harvesters, such as cymbal and bridge structures, cannot be used inside tires due to their design limitations. The wider adoption of renewable energy sources into the energy system is increasing rapidly, reflecting a global attraction toward the utilization of sustainable power sources (Aljendy et al. in Int J Power Energy Convers 12(4): 314–337, 2021; Yesner et al. in Evaluation of a novel piezoelectric bridge transducer. In: 2017 Joint IEEE International Symposium on the Applications of Ferroelectric (ISAF)/International Workshop on Acoustic Transduction Materials and Devices (IWATMD)/Piezoresponse Force Microscopy (PFM). IEEE, 2017). The growing interest in capturing energy from tire deformation for Tire Pressure Monitoring Systems (TPMS) aligns with this trend, providing a promising and self-sustaining alternative to traditional battery-powered systems. This study presents a novel one-end cap tire strain piezoelectric energy harvester (TSPEH) that can be used efficiently and reliably inside a tire. The interaction between the tire and energy harvester was analyzed using a decoupled modeling approach, which showed that stress concentration occurred along the edge of the end cap. The TSPEH generated a maximum voltage of 768 V under 2 MPa of load, resulting in an energy output of 32.645 J/rev under 1 MPa. The computational findings of this study were consistent with previous experimental investigations, confirming the reliability of the numerical simulations. The results suggest that the one-end cap structure can be an effective energy harvester inside vehicle tires, providing a valuable solution for utilizing one-end cap structures in high-deformation environments such as vehicle tires.

Introduction Stress and pain are high among patients undergoing hemodialysis. Benson's Relaxation technique affected a wide range of physical and psychological signs and symptoms among patients undergoing hemodialysis. Objective To evaluate the effectiveness of Benson's Relaxation Technique in reducing stress and pain among patients undergoing maintenance hemodialysis. Materials and Methods A systematic review of randomized controlled trials was conducted. A systematic literature search was carried out from 2000 to 2023. Searched databases included EBSCO-Host “Academic Search, Cochrane, CINAHL, Health Business, MEDLINE, Psychology and Behavioral Sciences, SPORTDiscus”, PubMed, Ovid, and Google Scholar. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were conducted. RCTs were critically appraised using the Cochrane's Risk of Bias Tool. Four RCTs met the inclusion criteria and included in this review since they were applicable to practice. Results Four randomized controlled trials were identified supporting the use of Benson's relaxation technique as a nursing treatment in managing stress and pain among patients undergoing maintenance hemodialysis, as it achieved a significant decrease in stress and pain scores. The overall quality of the randomized controlled trials was judged to be low to relatively moderate. Conclusions Most of the randomized controlled trials lacked details on intervention adherence. It is recommended to conduct additional longitudinal randomized controlled trials in different countries with bigger sample sizes, to provide more evidence for generalizing outcomes.

Bioenergy, or energy derived from biomass, has the potential to displace fossil fuels in the near future due to its abundance, cleanliness, and carbon dioxide neutrality. From biomass thermochemical treatments, the release of syngas, which can be employed in various heat and power generation systems, makes gasification particularly alluring. When a syngas with little tar and impurity is required most of the time downdraft gasifiers are among the first gasification systems that are chosen. Because it requires a lot of time and is impractical to evaluate the performance of a gasification system using all the available biomass kinds under numerous parameters, fast and quick simulation approaches with well-developed mathematical models are required for the efficient and economical utilization of energy resources. The current study aims to investigate the performance of a throated downdraft gasification system by using a model and experiments based on the characterization of pretreated biomass feedstock. Mango seed hull (MSH) a biomass wastes that is readily available locally, was used for the analyses. The producer gas generated with MSH has a composition of 18.34 % H2, 23.87 % CO, 14.83 % CO2, and 1.27 % CH4 in a wet basis. The calorific value was determined to be 4.89 MJ/Nm3. MSH is discovered to be good biomass feedstocks for producing syngas through biomass gasification.

Abstract Background Current guidelines advocate for colorectal cancer (CRC) screening in adults who are at risk by using direct visualization methods such as colonoscopy. However, in Egypt, there is a paucity of data regarding the current practice of colonoscopy screening. Moreover, more information is needed about the knowledge and attitudes of potential participants regarding the procedure and possible barriers that can limit their participation. Methods We conducted a nationwide cross-sectional study using an interview-based survey of patients aged 45 years or above who presented to outpatient clinics of nine university hospitals throughout Egypt. Participants were surveyed to assess their compliance with CRC colonoscopy screening guidelines, their knowledge of and attitude towards colonoscopy screening, and their perspective on potential barriers to colonoscopy screening. Results A total of 1,453 participants responded to our survey in the nine study centers. Only a minority of participants (2.3%) were referred for CRC screening. Referral rates were higher among those who knew someone with a history of CRC (5.3% vs 1.5%, p

Abstract Background Psychiatric comorbidities, and sleep disorders, are prevalent in adults with epilepsy (AWE). Good control of epilepsy can help AWE lead a normal fruitful life and incorporate in daily activities as others. This study aims to assess the frequency, risk factors of depression, and poor sleep quality among patients with epilepsy and examine their relation with epilepsy control. Methods This cross-sectional study was accomplished during the period from January to October 2023 involving 179 AWE. All were exposed to complete history taking: stressing on personal data, evaluation of medication adherence using the modified Morisky scale, sleep quality using the Pittsburgh Sleep Quality Index, and depressive symptoms evaluated by the Zagazig Depression Scale. Results Depression was reported in 22.2% of studied patients; while 44.4% had poorer epilepsy control. Poor sleep quality was reported in 35.2% of epilepsy patients and was associated with non-adherence and poor seizure control. Depression increased the risk of poor control by about 16-folds. Non-adherence was associated with depression and poor sleep quality and was one of the predictors of poor epilepsy control. Conclusion Depression and poor sleep quality can impair the outcome of PWE and also there is a strong association between depression and poor sleep quality among PWE and both impair seizure control.