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Abstract Background Techniques in endovascular therapy have evolved to offer a promising alternative to medical therapy alone for Type B aortic dissections (TBADs). Aim The aim of this meta-analysis was to compare mortality and overall complications between thoracic endovascular aortic repair (TEVAR) and best medical therapy (BMT) in patients with TBADs. Methods We included randomized control trials and prospective or retrospective cohort studies that compared TEVAR and BMT for the treatment of type B aortic dissection. Multiple electronic databases were searched. Results Thirty-two cohort studies including 150,836 patients were included. TEVAR was associated with a significantly lower 30-day mortality rate than BMT (RR = 0.79, CI = 0.63, 0.99, P = 0.04), notably in patients ≥ 65 years of age (RR = 0.78, CI = 0.64, 0.95, P = 0.01). The TEVAR group had a significantly prolonged hospital stay (MD = 3.42, CI = 1.69, 5.13, P = 0.0001) and ICU stay (MD = 3.18, CI = 1.48, 4.89, P = 0.0003) compared to the BMT. BMT was associated with increased stroke risk (RR = 1.52, CI = 1.29, 1.79, P

Abstract Background Aspirin has been proven to be effective in preventing preeclampsia (PE) in singleton pregnancies. However, the use of aspirin for women with twin pregnancies is still debatable. The purpose of our meta‐analysis is to evaluate the effectiveness of aspirin for preventing preeclampsia in twin pregnancies. Methods We searched the following databases: PubMed, Scopus, Cochrane Library and Web of Science. Twelve studies were included in the meta‐analysis. The quality assessment and ROB were executed using NOS and ROB 2 respectively. RevMan software 5.4 was used for performing the analysis. Results The pooled analysis showed no significant difference between the administration of aspirin and the control group in decreased incidence of PE, hypertensive disorders, IUGR or twin‐to‐twin discordance (RR = 0.73, CI = 0.43–1.24, p = 0.24), (RR = 0.60, CI = 0.34–1.07, p = 0.08), (RR = 0.90, CI = 0.45–1.82, p = 0.77) and (RR = 1.76, CI = 0.83–3.73, p = 0.14), respectively. However, the pooled analysis showed a statistically significant association between aspirin and decreased incidence of preterm birth (PTB) (RR = 0.58, CI = 0.39–0.86, p = 0.006). Subgroup analysis of the dose revealed a significant association between 100 mg of aspirin and decreased PE incidence compared with the control group (RR = 0.44, CI = 0.23–0.84, p = 0.01). Conclusion The overall analysis showed no significant role of Aspirin in reducing the incidence of PE. The dose subgroup analysis revealed that only 100 mg of Aspirin is effective in decreasing PE. Future multicentre randomized control trials are warranted to give us conclusive results.

Abstract Adherence to antihypertensives is crucial for control of blood pressure. This study analyzed factors and interventions that could affect adherence to antihypertensives in the US. PubMed, Scopus, Web of Science, and Embase were searched on January 21, 2022 and December 25, 2023 for studies on the adherence to antihypertensives in the US. Nineteen studies and 23 545 747 patients were included in the analysis, which showed that adherence to antihypertensives was the highest among Whites (OR: 1.47, 95% CI 1.34–1.61 compared to African Americans). Employment status and sex were associated with insignificant differences in adherence rates. In contrast, marital status yielded a significant difference where unmarried patients demonstrated low adherence rates compared to married ones (OR: 0.8, 95% CI 0.67–0.95). On analysis of comorbidities, diabetic patients reported lower adherence to antihypertensives (OR: 0.95, 95% CI 0.92–0.97); furthermore, patients who did not have Alzheimer showed higher adherence rates. Different BMIs did not significantly affect the adherence rates. Patients without insurance reported significantly lower adherence rates than insured patients (OR: 3.93, 95% CI 3.43–4.51). Polypill users had higher adherence rates compared with the free‐dose combination (OR: 1.21, 95% CI 1.2–1.21), while telepharmacy did not prove to be as effective. Lower adherence rates were seen among African Americans, uninsured, or younger patients. Accordingly, interventions such as fixed‐dose combinations should be targeted at susceptible groups. Obesity and overweight did not affect the adherence to antihypertensives.

Abstract Background Early oral feeding has been previously postulated to contribute to developing postoperative complications following head and neck reconstructive surgeries using free flaps. This study assessed the association between the timing of oral feeding (early vs. late) and postoperative complications and length of hospital stay among these patients. Method PubMed, Scopus, Cochrane, and Web of Science were searched using terms such as “oral feeding” and “head or neck cancer.” We utilized RevMan software version 5.4 for the analysis. The study defined early oral feeding as feeding within 5-day post-operation, while late oral feeding was defined as feeding after the fifth postoperative day. Five papers that met the inclusion criteria were included in the analysis, with 1097 patients. Results The results showed that early feeding was not significantly associated with postoperative fistulas (RR 0.49, 95% CI 0.23 to 1.05, p-value = 0.07), hematoma/seroma (RR 0.71, 95% CI 0.33 to 1.51, p-value = 0.38), or flap failure (RR 0.84, 95% CI = 0.38 to 1.87, p-value = 0.67). However, early oral feeding was significantly associated with shorter hospital stays than late oral feeding (MD −3.18, 95% CI −4.90 to −1.46, p-value = 0.0003). Conclusion No significant difference exists between early and late oral feeding regarding the risk of postoperative complications in head and neck cancer (HNC) patients who underwent free flap reconstruction surgery. However, early oral feeding is significantly associated with a shorter hospital stay than late oral feeding. Thus, surgeons should consider implementing early oral feeding after free flap reconstruction in HNC patients.

Abstract Background Etrolizumab is a promising drug for treating moderate to severe ulcerative colitis. Aim The aim of this study was to assess the efficacy and safety of etrolizumab for induction and maintenance of remission in moderate to severe ulcerative colitis. Methods We searched the following databases: PUBMED, Web of Science, OVID, and SCOPUS from inception to January 15. Inclusion criteria were any phase 2 and 3 clinical trials that compared etrolizumab with a placebo in treating moderate to severe ulcerative colitis, excluding case reports, animal studies, phase 1 trials, and conference abstracts due to duplication. We used RevMan software (5.4) for the meta‐analysis. Results Five clinical trials were included in our meta‐analysis. The total number of patients included in the study is 1248 patients, 860 patients in the etrolizumab group and 388 patients in the placebo group. In the induction phase, the pooled analyses showed a statistically significant association between etrolizumab and increased clinical remission, and endoscopic remission compared with placebo (risk ratio [RR] = 2.66, 95% confidence interval [CI] = 1.69–4.19, p

ABSTRACT Background Previous meta‐analyses have shown mixed results regarding the association between eating disorders (EDs) and type 1 diabetes mellitus (T1DM). Our paper aimed to analyse different EDs and disordered eating behaviours that may be practiced by patients with T1DM. Methods A literature search of PubMed, Scopus and Web of Science was conducted on 17 January 2023, using the key terms “T1DM,” “Eating Disorders” and “Bulimia.” Only observational controlled studies were included. The Revman software (version 5.4) was used for the analysis. Results T1DM was associated with increased risk of ED compared with nondiabetic individuals (RR = 2.47, 95% CI = 1.84–3.32, p‐value

Background and aim: Recent studies reported a significant association between enteric dysmotility and GnRH antibodies, other studies reported no significant association. Therefore, we aimed to perform a meta-analysis to investigate and clarify the exact association between enteric dysmotility and GnRH antibodies. Methods: PubMed, Web of Science, and Scopus databases were searched. The inclusion criteria were any randomized control trials or observational studies that reported the level or prevalence of GnRH IgM or GnRH IgG antibodies in patients with enteric dysmotility matched with healthy controls. Exclusion criteria: Case reports, case series, reviews, editorials, and animal studies. RevMan software 5.4 was used to perform the meta-analysis. Results: After search of the literature, 4 studies were included in the meta-analysis with a total number of 469 individuals included in the study. The pooled analysis showed a statistically significant association between enteric dysmotility and increased prevalence of GnRH IgM antibodies compared with controls (RR ​= ​4.47, 95% CI ​= ​1.17 to 17.06, p-value ​= ​0.03). Contrarily, no statistically significant association between enteric dysmotility and the levels of IgM antibodies as well as the prevalence of IgG antibodies was found compared with controls, (MD ​= ​0.92, 95% CI ​= ​-1.01 to 2.86, p-value ​= ​0.35) and (RR ​= ​1.84, 95% CI ​= ​0.09 to 35.86, p-value ​= ​0.69), respectively. Conclusion: Our study detected a significant association between intestinal dysmotility and high prevalence of GnRH IgM antibodies when matched with controls. Conversely, we found no statistically significant association between enteric dysmotility and IgG antibodies. Further research is warranted to support our results and clarify the exact association between enteric dysmotility and GnRH antibodies.

Background After the widespread of coronavirus disease (COVID-19) around the globe, it was imperative to establish preventative measures to restrict the virus's transmission. The purpose of this research was to present an overview of the awareness, knowledge, attitude, and abilities of Syrian physicians about telemedicine technology. Methods An online cross-sectional study was conducted from April 1 to May 15, 2022. The questionnaire was taken from published study, and the inclusion criteria consist the Syrian doctors who worked in hospitals during the COVID-19 pandemic, mainly those who had direct contact with patients. Results Among 385 responses, 52.72% of them were females, 83.9% of them were aged less than 30 years old, and 66% were working in the governmental sector; 66% of participants have moderate knowledge about using computers and the internet, 80% have heard about telemedicine. Despite that, 95.1% of participants have not attended any training workshop on telemedicine, and most of them have reported no availability of a telemedicine unit in their department. Only 31.7% participants have shown high awareness of telemedicine. Furthermore, no significant correlation was identified between the academic level with the age and telemedicine awareness, knowledge, attitude, or computer skills. Despite that, there was an obvious correlation between age and computer skills ( P -value

Abstract Introduction The Mycobacterium abscessus complex is a nontuberculous mycobacteria species that is pervasive in soil and water. Various medical equipment malfunctions, infected surfaces, and patient transmission are potential causes of Mycobacterium abscessus infection in the hospital environment. These cases have an annual prevalence that ranges from 1.4 to 6.6 per 100,000 infections, mainly increasing. Case presentation We present the case of a 23-year-old American female patient who presented to the emergency room with significant abdominal pain between low pelvic sutures and the umbilicus. She reported abdominal pain, pruritus, and boils on her back preventing her from standing upright. The symptoms occurred in the liposuction area after cosmetic surgery in the Dominican Republic. The clinical, radiological, and cultural findings helped diagnose Mycobacterium abscessus infection. We conducted a mini literature review on the published reports of Mycobacterium abscessus. Conclusion Mycobacterium abscessus infection may occur due to surgical procedures abroad. Measures are required to combat Mycobacterium abscessus and reduce its prevalence in hospital settings.

Key Clinical Message Guillain‐Barré syndrome (GBS) is a rare but possible complication that may occur after COVID‐19 vaccination. In this systematic review, we found that GBS presented in patients with an average age of 58. The average time for symptoms to appear was 14.4 days. Health care providers should be aware of this potential complication. Abstract Most instances of Guillain‐Barré syndrome (GBS) are caused by immunological stimulation and are discovered after vaccinations for tetanus toxoid, oral polio, and swine influenza. In this systematic study, we investigated at GBS cases that were reported after receiving the COVID‐19 vaccination. Based on PRISMA guidelines, we searched five databases (PubMed, Google Scholar, Ovid, Web of Science, and Scopus databases) for studies on COVID‐19 vaccination and GBS on August 7, 2021. To conduct our analysis, we divided the GBS variants into two groups, acute inflammatory demyelinating polyneuropathy and non‐acute inflammatory demyelinating polyneuropathy (AIDP and non‐AIDP), and compared the two groups with mEGOS and other clinical presentation In this systematic review, 29 cases were included in 14 studies. Ten cases belonged to the AIDP variant, 17 were non‐AIDP (one case had the MFS variant, one AMAN variant, and 15 cases had the BFP variant), and the two remaining cases were not mentioned. Following COVID‐19 vaccination, GBS cases were, on average, 58 years of age. The average time it took for GBS symptoms to appear was 14.4 days. About 56 percent of the cases (56%) were classified as Brighton Level 1 or 2, which defines the highest level of diagnostic certainty for patients with GBS. This systematic review reports 29 cases of GBS following COVID‐19 vaccination, particularly those following the AstraZeneca/Oxford vaccine. Further research is needed to assess all COVID‐19 vaccines' side effects, including GBS.

Abstract Background Urinary tract tuberculosis (UTTB) is a common form of extrapulmonary tuberculosis (TB) which can infrequently present as renal carcinoma, leading to serious errors in the diagnosis and treatment of UTTB. Case presentation A 76-year-old Syrian man presented with gross hematuria as the main symptom. A urinary endoscopic examination and pelvic multi-slice computed tomography imaging increased the suspicion of a speared renal mass in the right urinary tract. The patient was treated for renal cancer. After nephrectomy and ureterctomy, the histopathology of the resected mass confirmed the diagnosis of UTTB and interstitial nephritis. Conclusion This case should serve to increase the attention of clinicians to perform an accurate diagnosis step by step. This is especially important if they have a patient similar to the case described here who presents with a renal mass, to avoid serious results such as the loss of an essential organ system.

Several reports showed the likelihood of a relationship between COVID-19 infection and the onset and prognosis of diabetes mellitus (DM) of all types. A 73-year-old female patient who presented to the clinic with respiratory symptoms and was tested positive for COVID-19 and treated for the next three days. Despite having neither a known history of hyperglycemia nor a family history of diabetes, she was unconscious and suffering from polyuria and polydipsia when she was brought to the emergency department. Once her condition was successfully stabilized, she was sent home with COVID-19 medications and oral anti-diabetic therapy. After subsequent viral recovery and continued anti-diabetic medication, the patient was monitored for the following seven months. DM might be linked to the SARS-CoV-2 infection. Further research is necessary to prove a relationship between COVID-19 and newly-onset diabetes.

Background and aimRecent studies evaluated the role of vamorolone in treating Duchenne muscular dystrophy (DMD), so we aimed in our Meta-analysis to assess the efficacy of vamorolone in comparison with placebo and corticosteroids for treating DMD patients.MethodsWe searched PubMed, Web of Science, Scopus, and Cochrane library databases. We included any randomized control trials and controlled observational studies that investigated the role of vamorolone in treating DMD patients. We used RevMan software, version 5.4. to perform our meta-analysis.ResultsAfter a search of the literature, 4 studies were included in the meta-analysis; the total number of patients included in the study is 277 patients, 125 patients in the vamorolone group, 106 in the glucocorticoids group, and 46 in placebo (steroid naïve) group. The pooled analysis showed a statistically significant association between the vamorolone group and increased TTSTAND velocity, TTRW velocity and TTCLIMB velocity compared with the placebo group (MD = 0.04, 95% CI = 0.02–0.07, p = 0.002), (MD = 0.24, 95% CI = 0.11–0.37, p = 0.0003), and (MD = 0.06, 95% CI = 0.05–0.06, p < 0.00001), respectively. Also, the analysis showed a statistically significant association between vamorolone and increased TTRW velocity and increased Height percentile for age compared with the glucocorticoid group (MD = −0.14, 95% CI = −0.26 to −0.01, p = 0.03) and (MD = 17.82, 95% CI = 3.89–31.75, p = 0.01), respectively.ConclusionOur study revealed a significant association between vamorolone and increased TTSTAND velocity, TTRW velocity, and TTCLIMB velocity compared with the placebo (steroid naïve), also showed a statistically significant association between increased TTRW velocity and increased Height percentile for age compared with the glucocorticoid that enhances the privilege of vamorolone over glucocorticoid in treating DMD patients. More multicenter randomized studies are needed to support our results.

Generalized Anxiety Disorder (GAD) is a prevalent condition and a significant cause of mental disability and poor quality of life. People with GAD have chronic worrying, restlessness, and discrimination from the general public; Little is known about the stigmatizing attitudes toward people with GAD among Syrian students. The questionnaires contained demographic data about age, gender, social status, personal stigma toward GAD scale, perceived stigma toward GAD scale, social distance with those with GAD, the participants' usual source of their knowledge about GAD, helpful interventions, and supporting information. A total of 1,370 replies were collected, but only 1,358 were used for analysis as 12 participants declined to complete the survey. About 44.1% of participants agreed that people with GAD could snap out of the problem, most of them being females (32.4% of the total population). Compared to medical students, more non-medical students (7.1% of the total population) believed that anxiety is a sign of personal weakness. This study demonstrated that Syrian college students showed a high level of stigmatizing and socially distancing attitudes toward people with GAD, particularly female and non-medical students.

Abstract Background and Aims Antibiotic resistance is seen as a worldwide health risk as a result of the overuse of antibiotics. Many countries noted that antibiotic usage was high during the COVID‐19 pandemic. The purpose of this study is to evaluate Syrians' knowledge, attitudes, and practice about the use of antibiotics and antibiotic resistance during the COVID‐19 epidemic. Methods A cross‐sectional study was conducted using an online questionnaire to collect the data from the Syrian population from February 5 to March 4, 2022. Syrians 18 years or older all over the world were able to participate in this study. A convenience snowball sampling method was used. SPSS version 20.0 was used to analyze the data. To examine the results, binominal logistic regression was used. Statistical significance was defined as a p

After the widespread of COVID-19 virus worldwide, vaccination targeted reducing spread of cases and mortality rates. However, vaccination hesitancy was observed among the communities worldwide. Vaccination hesitancy involved parents regarding the decision of vaccinating their children- After obtaining ethical approval, an online cross-sectional study was conducted from 1 March to 22 April 2021 to evaluate the parents' acceptance of vaccinating their children against the COVID-19 virus in Syria. Data were analyzed using descriptive and multivariate logistic regression analysis in IBM, SPSS V. 28.0 package program (IBM Corporation, Armonk, NY, USA). Among 283 participants, 105 participants agreed to vaccinate their children, and 178 were not. A significant correlation between age and vaccine willingness was found (P-value < 0.0001*), especially in the age group between 18 and 30 years old (45.2%). Parents who accepted vaccinating themselves were more willing to vaccinate their children (34.6%). According to our results, there is a greater need to enhance awareness and knowledge programs about the vaccine's effectiveness and encourage parents to accept giving the vaccine to their children.

Abstract We report a rare case of a 50‐year‐old female patient with COVID‐19 presented to the emergency department where supplementary oxygen is delivered via noninvasive face mask ventilation. X‐ray imaging confirmed the existence of pneumoperitoneum. CT scan was not applicable due to the advanced status of the patient.

Abstract Similar to bronchiectasis, Turner syndrome is possible to have more pathological manifestations or etiologies than what has already been documented. Slower recovery process is expected when treating a patient with several comorbidities like Turner syndrome. Turner syndrome patients are vulnerable and should be extensively monitored to lower late presentation rates.

Abstract Background and Aims Fecal microbiota transfer (FMT) is a potential treatment for irritable bowel syndrome (IBS). Several randomized trials have tested FMT effects using different routes of administration, doses, and sample sizes. We aim to assess the overall efficacy of FMT for IBS patients and the safety of the intervention. Methods We systematically searched four databases for randomized control trials that studied the efficacy and safety of FMT in IBS patients. Results We included 8 randomized trials (472 patients) that compared FMT with placebo in IBS patients. Pooled results showed no statistically significant difference between FMT and control groups in the overall change in IBS symptom severity (IBS‐SSS) at 1 month (p = 0.94), 3/4 months (p = 0.82), and at the end of trials (p = 0.67). No significant difference in the total number of respondents between the FMT and control groups (risk ratios = 1.84, [95% confidence interval (CI) = 0.82–2.65], p = 0.19). Although the oral route of administration showed a significant difference in the number of respondents (p = 0.004), there was no statistically significant difference in the IBS‐SSS when subgrouping the oral route of administration (mean difference = 47.57, [95% CI = −8.74–103.87], p = 0.10). Conclusion FMT is not an effective treatment to relieve all the symptoms of IBS. Even in the groups that showed relatively significant improvement after FMT, the effect was proven to wear off over time and the re‐administration carries a low success rate. Future research should consider different bacterial‐based interventions such as probiotics or specific antibiotics.

Bullying is defined as unpleasant behavior that causes someone to feel disturbed or embarrassed, affecting their self-esteem. Based on this premise, we set out to investigate bullying among Syrian graduate medical education residents and fellows, estimate its prevalence among specific subgroups, and give recommendations to help validate the findings and enhance the graduate medical education training experience. A sample of 278 residents and fellows in Syrian graduate medical school were recruited for the study in a national cross-sectional survey, with 276 participants completing a Bullying survey in 2021 and two people refusing to participate. Participants in the survey were asked to provide basic demographic and programming information and three general Bullying and 20 specific bullying behavior items. Differences across groups were compared for demographic and programmatic stratifications. About 51% of participants had experienced one or more bullying behaviors, 69% said they had been bullied, and 87% said they had witnessed Bullying. Residents and supervisor-attendings were the most common sources of perceived Bullying (~67 and 62%, respectively), followed by patients (58%), nurses (46%), and pharmacists (46%) (33%). More specific bullying behaviors have been recorded by female Arabic Syrians who are shorter than 5'8, have a body mass index (BMI) of 25, and are 30 years old or younger who were -compared to males- more likely to report attempts to minimize and devalue work (55 vs. 34%, P ≤ 0.01) and criticism and work monitoring (56 vs. 33%, P ≤ 0.01). In addition, general medical graduates and PGY-2-PGY-6 respondents reported more specific bullying behaviors than private medical graduates and post-graduate participants in the first year (PGY 1), respectively. For example, a significant difference is noticed when reporting unreasonable pressure to perform work (83 vs. 6%, P ≤ 0.01). Except for physical violence, which does not differ statistically between groups, most bullying behaviors were reported by participants with statistically significant differences between study groups—many residents and fellows in Syria's graduate medical school system report being bullied. Anti-bullying rules and a multidisciplinary strategy including all players in the medical system are essential to eradicating these pervasive practices in healthcare.

Abstract Background and Aim Some studies reported a positive link between familial Mediterranean fever (FMF) and epicardial adipose tissue. Our meta‐analysis aimed to evaluate whether there is a significant association between FMF and increased epicardial adipose tissue thickness. Methods We searched the following databases: PUBMED, WOS, OVID, SCOPUS, and EMBASE. Inclusion criteria were any original articles that reported epicardial adipose tissue in FMF patients with no age restriction, excluding reviews, case reports, editorials, animal studies, and non‐English studies. Thirty eligible studies were screened full text but only five studies were suitable. We used RevMan software (5.4) for the meta‐analysis. Results The total number of patients included in the meta‐analysis in the FMF patients group is 256 (mean age = 24.3), and the total number in the control group is 188 (mean age = 24.98). The pooled analysis between FMF patients and controls was [mean difference = 0.82 (95% CI = 0.25–1.39), p‐value = 0.005]. We observed heterogeneity that was not solved by random effects (p > 0.00001). We performed leave one out test by removing the Kozan et al. study, and the heterogeneity was solved (p = 0.07), and the results were (MD = 0.98, 95% CI = 0.52–1.43, p‐value

PurposeTo evaluate the effect of polypills on the primary prevention of cardiovascular (CV) events using data from clinical trials.MethodsWe searched PubMed, Web of Science, EBSCO, and SCOPUS throughout May 2021. Two authors independently screened articles for the fulfillment of inclusion criteria. The RevMan software (version 5.4) was used to calculate the pooled risk ratios (RRs) and mean differences (MDs), along with their associated confidence intervals (95% CI).ResultsEight trials with a total of 20653 patients were included. There was a significant reduction in the total number of fatal and non-fatal CV events among the polypill group [RR (95% CI) = 0.71 (0.63, 0.80); P-value < 0.001]. This reduction was observed in both the intermediate-risk [RR (95% CI) = 0.76 (0.65, 0.89); P-value < 0.001] and high-risk [RR (95% CI) = 0.63 (0.52, 0.76); P-value < 0.001] groups of patients. Subgroup analysis was performed based on the follow-up duration of each study, and benefits were only evident in the five-year follow-up duration group [RR (95% CI) = 0.70 (0.62, 0.79); P-value < 0.001]. Benefits were absent in the one-year-or-less interval group [RR (95% CI) = 0.77 (0.47, 1.29); P-value = 0.330]. Additionally, there was a significant reduction in the 10-year predicted cardiovascular risk in the polypill group [MD (95% CI) = −3.74 (−5.96, −1.51); P-value < 0.001], as compared to controls.ConclusionA polypill regimen decreases the incidence of fatal and non-fatal CV events in patients with intermediate- and high- cardiovascular risk, and therefore may be an effective treatment for these patients.

Hanine Abbas,1– 3 Mazen Kurdi,1 Frank de Vries,2– 4 Hein AW van Onzenoort,2,5 Johanna HM Driessen,2– 4,6 Myriam Watfa,7 Rita Karam1,7,8 1Department of Chemistry and Biochemistry, Faculty of Sciences, Lebanese University, Beirut, Lebanon; 2Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands; 3Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands; 4Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, the Netherlands; 5Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands; 6NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; 7Quality Assurance of Pharmaceutical Products Department, Lebanese Ministry of Public Health, Beirut, Lebanon; 8Pharmacology Department, Faculty of Medical Sciences, Lebanese University, Beirut, LebanonCorrespondence: Rita KaramFaculty of Sciences, Lebanese University, Section 1, Beirut, LebanonTel +961 3 77 5061Email ritakmouawad@hotmail.comBackground: Poor adherence to antihypertensives is associated with negative outcome of the disease as well as loss of health-care resources. Addressing the epidemic of poor adherence requires identifying factors associated with this behaviour. The aim of this study is to describe adherence to antihypertensive medication among Lebanese hypertensive patients and to evaluate the association between socio-economic, patient- and conditions-related factors and non-adherence.Methods: A cross-sectional study was carried out on adherence to antihypertensive medications covering all governorates of Lebanon. This study was conducted between February 2018 and January 2019 on a random sample of 1497 hypertensive patients. A face-to-face questionnaire was used to assess adherence to antihypertensive medication and its determinants according to the five World Health Organization (WHO) main categories. Logistic regression analysis was performed to test the adjusted association between the multiple exposure factors, and drug adherence data were collected by trained interviewers.Results: Adherence to antihypertensive medications was reported by 1253 (83.7%) of the patients. After multivariate analysis, patients who tried to control their stress level (OR =  0.77, 95% CI [0.38– 0.95]), those who had normal BP readings (OR =0.49, 95% CI [0.18– 0.97]), and those who believed in the effectiveness of their treatment (OR =  0.31, 95% CI [0.14– 0.76]) had a significantly lower chance to exhibit non-adherence to their treatment. However, older patients (OR= 1.87, 95% CI [1.23– 2.21]), divorced/separated patients (OR= 2.14, 95% CI [1.31– 5.48]), married (OR=1.96, 95% CI [1.27– 3.90]), widowed (OR=2.11, 95% CI [1.62– 6.50]), obese patients (OR = 1.76, 95% CI [1.21– 1.94]), and patients who smoked hookah and cigarettes (OR = 2.62, 95% CI [1.17– 6.76]) were more likely to exhibit non-adherence.Conclusion: Our study highlights the influence of factors such as old age, marital status, BMI and high level of emotional stress on non-adherence to medication in hypertensive patients. These determinants should be incorporated into adherence improving strategies.Keywords: non-adherence, antihypertensive medications, patient-related factors, condition-related factor, Lebanon

Background After the COVID-19 pandemic, anxiety and depression have reached high levels, especially after the last wave, Omicron. Healthcare workers in contact with COVID-19 patients or those who come in contact with them may exhibit high levels of anxiety and depression. Therefore, we aimed to assess anxiety and depression symptoms among ICU companions of COVID-19 patients. Methods From 30 November 2021 to 1 March 2022, sixth-year medical students at Aleppo University Hospital conducted interviews with the companions of COVID-19 patients who they brought their patient to the ICU centre as part of a cross-sectional quantitative study using the PHQ-9 and GAD-7 tools to gauge their level of anxiety and depression among companions of COVID-19 patients. The data were analyzed using the SPSS program. In addition, logistic regression models were used to study possible factors of anxiety and depression symptoms during COVID-19. Results The total number was 997 participants in contact with COVID-19 patients. The mean score of the depression assessment tool (PHQ-9) in our questionnaire was 9.5 with a range of 0 to 27. At the same time, the anxiety assessment tool (GAD-7) had a mean score of 9.1, ranging from 0 to 21. A binary logistic regression was used to predict the relationship between depression and anxiety and various factors. We found that the companions with medical specialties were substantially less likely to develop anxiety than other companions [AOR = 0.459; 95%CI (0.23–0.9)], in addition females were substantially higher likely to develop depression than males [AOR = 1.322; 95%CI (0.992–1.762)]. 45.4% of companions had moderate to severe anxiety, in additon 50.8% of companions had moderate to severe depression. Conclusion Our research reveals that moderate to severe anxiety and sadness are present in roughly half of the COVID19 patients’ companions. Females, people with children, and hard workers were more inclined to feel anxious than others, and those who are not in the medical field were more likely to suffer from depression than others, thus it is critical to assist these groups during the present outbreaks (Omicron and Monkeybox).

Background and Aim Chronic alcoholism and nutrition play an important role in liver and pancreatic diseases. To compare drinking habits and nutritional data in patients with alcoholic liver disease (ALD) and alcoholic pancreatitis (ALP). Methods Clinical, anthropometric, dietary intake, laboratory, and imaging data were recorded in consecutive patients of ALD and ALP. Results In 150 patients of ALP (n = 76) and ALD (n = 74), the age of starting alcohol consumption (19.03 ± 3.78 vs 18.0 ± 2.59 years) and the mean amount of alcohol consumed per day (165.63 ± 87.99 vs 185.50 ± 113.54 g; P = 0.230) were similar. Patients with ALD consumed alcohol on a daily basis more frequently (90.5 vs 72.3%; P = 0.003) and had a longer duration of alcohol intake (21.6 + 0.2 vs 14.5 + 6.9 years; P

Hanine Abbas,1 Mazen Kurdi,1 Myriam Watfa,2 Rita Karam1–3 1Department of Chemistry and Biochemistry, Faculty of Science, Lebanese University, 2Quality Assurance of Pharmaceutical Products Department, Lebanese Ministry of Public Health, 3Pharmacology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon Background: Adherence to treatment, healthy lifestyle, physical activities, smoking, diet, and salt intake are important factors to control for an effective decrease in blood pressure (BP) values for patients diagnosed with essential hypertension (HT). The aim of this work was to study the adherence to antihypertensive treatment and factors predicting this behavior in Lebanese patients. In addition, we evaluated the extent of patient’s knowledge and perceptions about HT, risk factors, and medication side effects.Methods: The cross-sectional study was conducted between May and September 2015 among 249 participants randomly recruited from community and hospital pharmacies (56.6%), private cardiology clinics (37%), and outpatient clinics located in hospitals (6.4%) in Baabda region of Lebanon. The questionnaire was prepared after reviewing published literature. Data were collected by trained and certified interviewers and analyzed by Statistical Package for the Social Sciences program. p-value less than 0.05 was considered to determine the statistical significance.Results: Among the 249 patients interviewed, 48% were females with a mean age of 62±17.2 years. Overweight and obesity was declared in 42.2% and 35.3%, respectively. Only 52.6% of participants reported visiting their physicians for regular checkups, and 72% claimed checking their BP routinely at home. Awareness of complications related to HT was very high (97%). However, our results showed that 89.2% of the participants were found to be adherent to treatment, and forgetfulness was cited as the main reason for non-adherence to therapy. Only health coverage showed statistical significance (p=0.01) between adherent and non-adherent participants.Conclusion: A better communication between patients and their physicians, the use of a special container for medication packaging, and reminder to refill prescriptions are important parameters to enhance adherence to treatment. HT can be better managed if an educational system is implemented to increase awareness. Keywords: Lebanon, hypertension, treatment, compliance, adherence, awareness

This study was conducted in one of the unheated plastic house at the Department of Horticulture and Landscape design, College of Agriculture and Forestry, University of Mosul during spring season 2018 to study the impact of two factors, the first: Tuber depth , 10 and 15 cm, the second: Zinc sulphate spraying on potato plants Actrice variety, 0, 150, 300 and 450 mg. l-1, the experiment was designed in the Split Plot system within a Randomized Complete Block Design (RCBD) with three replicates. The results could be summarized as: Tuber planted at 15 cm depth and spraying with zinc sulphate 450 mg. l-1 increased plant higher, number of stems per plant, leaf area per plant, whole dry matter percentage, number of tubers per plant, plant yield and total mg. l-1 .

Endoplasmic reticulum (ER) stress induces the unfolded protein response (UPR), an essential adaptive intracellular pathway that relieves the stress. Although the UPR is an evolutionarily conserved and beneficial pathway, its chronic activation contributes to the pathogenesis of a wide variety of human disorders. The fidelity of UPR activation must thus be tightly regulated to prevent inappropriate signaling. The nonsense-mediated RNA decay (NMD) pathway has long been known to function in RNA quality control, rapidly degrading aberrant mRNAs, and has been suggested to regulate subsets of normal mRNAs. Here, we report that the NMD pathway regulates the UPR. NMD increases the threshold for triggering the UPR in vitro and in vivo, thereby preventing UPR activation in response to normally innocuous levels of ER stress. NMD also promotes the timely termination of the UPR. We demonstrate that NMD directly targets the mRNAs encoding several UPR components, including the highly conserved UPR sensor, IRE1α, whose NMD-dependent degradation partly underpins this process. Our work not only sheds light on UPR regulation, but demonstrates the physiological relevance of NMD's ability to regulate normal mRNAs.