Emotional Intelligence Among Medical Students in Palestine A Cross-Sectional Study

Background: Emotional intelligence (EI) is defined as a pro-social behavior that deals with recognizing, understanding, influencing and managing our own and other’s emotions. In medical education and clinical practice, EI has been related to improves the doctor-patient relationship. Objectives: Measure EI among Palestinian medical students in two stages of their studies, clinical and basic sciences, and assessing the factors that may affect it. Moreover, compare medical students of Al-Quds and Al-Najah Universities regarding EI score and detect possible differences. Methods: A quantitative, cross-sectional, questionnaire-based, online survey was conducted among 692 medical students in Al-Quds and Al-Najah universities in Palestine. Emotional intelligence was evaluated using a 33-item scale as an index introduced by Schutte et al. (1998). Data was analyzed in a quantitative manner using SPSS (VER.20). Results: 745 students filled the questionnaire with a response rate of 92.88%. A total of 692 were sampled which were representative of the student population. The mean score of EI is 3.83 (SD=0.41) out of a maximum possible score of 5 with 69.1% of the sample having high EI. Statistics showed that EI decreased significantly at α≤0.05 among basic and clinical stages of study with a negative correlation between EI and academic year (PCC= -0.086). This indicates that as the academic year increases, EI decreases (p=0.023). Moreover, EI is affected significantly at α≤0.05 in a positive manner by having a hobby or doing extracurricular activities. In addition, students who indicate they always regret studying medicine tend to relate to lower EI, this may reflect the lack of interest to study this field. Conclusion: Medical students, both male and female, have a relatively high level of emotional intelligence in the universities that were studied. Students in the clinical stage have lower EI than basic sciences medical students, which indicates that students have a conflict between objectivity and humanity while training clinically. Therefore, emotional support during clinical years would serve in improving EI. Moreover, EI is affected by having a hobby or extracurricular activities, indicating that EI can be modulated through the encouragement of such activities

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Effectiveness of Low Copper-Containing Chemicals against Olive Leaf Spot Disease Caused by Venturia oleaginea

The high level of copper (Cu) accumulation in the soil, the risk of surface water contamination, and the potential public health problems due to Cu entering the food chain have raised concerns on the use of Cu compounds in agriculture, including olive growing. As a consequence, there is worldwide regulatory pressure on agricultural systems to limit the use of Cu compounds. Hence, a field trial was carried out to evaluate the effectiveness of low copper containing chemicals to control olive leaf spot (OLS) disease caused by Venturia oleaginea. The trial was conducted in 2021 in an olive (cv. Nabali Baladi) grove in Palestine. Copper complexed with lignosulphonate and gluconate (Disper Cu Max&reg;) and the self-defense inducer Disper Broton GS&reg; were evaluated and compared to dodine and the traditionally and frequently used copper hydroxide. In addition, untreated trees were used as the control. Treatments were made in March, July, and August. In March 2021, leaves grown in 2020 were present and 100% infected. V. oleaginea infections caused defoliation in untreated and treated olive trees with varying degrees of intensity: the Control had the most defoliation, followed by copper hydroxide and Disper Cu Max&reg;, whereas dodine and, in particular, Disper Broton GS&reg; had the least. All treatments reduced symptomatic leaves but their efficacy varied significantly: copper hydroxide was the least effective, Disper Cu Max&reg; was intermediate, dodine and, mainly, Disper Broton GS&reg; were the most effective. Overall, the results are promising since Disper Cu Max&reg; and Disper Broton GS&reg; were able to significantly reduce OLS damage and the amount of copper used for treatments

Emotional Intelligence Among Medical Students in Palestine A Cross-Sectional Study

Background: Emotional intelligence (EI) is defined as a pro-social behavior that deals with recognizing, understanding, influencing and managing our own and other’s emotions. In medical education and clinical practice, EI has been related to improves the doctor-patient relationship. Objectives: Measure EI among Palestinian medical students in two stages of their studies, clinical and basic sciences, and assessing the factors that may affect it. Moreover, compare medical students of Al-Quds and Al-Najah Universities regarding EI score and detect possible differences. Methods: A quantitative, cross-sectional, questionnaire-based, online survey was conducted among 692 medical students in Al-Quds and Al-Najah universities in Palestine. Emotional intelligence was evaluated using a 33-item scale as an index introduced by Schutte et al. (1998). Data was analyzed in a quantitative manner using SPSS (VER.20). Results: 745 students filled the questionnaire with a response rate of 92.88%. A total of 692 were sampled which were representative of the student population. The mean score of EI is 3.83 PalStudent Journal Correspondence concerning this article should be addressed tothe mentioned authors at the mentioned institutes. Copyright © 2020 Al-Quds University, Deanship of Scientific Research. All rights reserved. E-mail: [email protected] Palestine, Abu Dis, Al-Quds University (SD=0.41) out of a maximum possible score of 5 with 69.1% of the sample having high EI. Statistics showed that EI decreased significantly at α≤0.05 among basic and clinical stages of study with a negative correlation between EI and academic year (PCC= -0.086). This indicates that as the academic year increases, EI decreases (p=0.023). Moreover, EI is affected significantly at α≤0.05 in a positive manner by having a hobby or doing extracurricular activities. In addition, students who indicate they always regret studying medicine tend to relate to lower EI, this may reflect the lack of interest to study this field. Conclusion: Medical students, both male and female, have a relatively high level of emotional intelligence in the universities that were studied. Students in the clinical stage have lower EI than basic sciences medical students, which indicates that students have a conflict between objectivity and humanity while training clinically. Therefore, emotional support during clinical years would serve in improving EI. Moreover, EI is affected by having a hobby or extracurricular activities, indicating that EI can be modulated through the encouragement of such activities

Emotional Intelligence Among Medical Students in Palestine A Cross-Sectional Study

Background: Emotional intelligence (EI) is defined as a pro-social behavior that deals with recognizing, understanding, influencing and managing our own and other’s emotions. In medical education and clinical practice, EI has been related to improves the doctor-patient relationship. Objectives: Measure EI among Palestinian medical students in two stages of their studies, clinical and basic sciences, and assessing the factors that may affect it. Moreover, compare medical students of Al-Quds and Al-Najah Universities regarding EI score and detect possible differences. Methods: A quantitative, cross-sectional, questionnaire-based, online survey was conducted among 692 medical students in Al-Quds and Al-Najah universities in Palestine. Emotional intelligence was evaluated using a 33-item scale as an index introduced by Schutte et al. (1998). Data was analyzed in a quantitative manner using SPSS (VER.20). Results: 745 students filled the questionnaire with a response rate of 92.88%. A total of 692 were sampled which were representative of the student population. The mean score of EI is 3.83 (SD=0.41) out of a maximum possible score of 5 with 69.1% of the sample having high EI. Statistics showed that EI decreased significantly at α≤0.05 among basic and clinical stages of study with a negative correlation between EI and academic year (PCC= -0.086). This indicates that as the academic year increases, EI decreases (p=0.023). Moreover, EI is affected significantly at α≤0.05 in a positive manner by having a hobby or doing extracurricular activities. In addition, students who indicate they always regret studying medicine tend to relate to lower EI, this may reflect the lack of interest to study this field. Conclusion: Medical students, both male and female, have a relatively high level of emotional intelligence in the universities that were studied. Students in the clinical stage have lower EI than basic sciences medical students, which indicates that students have a conflict between objectivity and humanity while training clinically. Therefore, emotional support during clinical years would serve in improving EI. Moreover, EI is affected by having a hobby or extracurricular activities, indicating that EI can be modulated through the encouragement of such activities

Emotional Intelligence Among Medical Students in Palestine A Cross-Sectional Study

Background: Emotional intelligence (EI) is defined as a pro-social behavior that deals with recognizing, understanding, influencing and managing our own and other’s emotions. In medical education and clinical practice, EI has been related to improves the doctor-patient relationship. Objectives: Measure EI among Palestinian medical students in two stages of their studies, clinical and basic sciences, and assessing the factors that may affect it. Moreover, compare medical students of Al-Quds and Al-Najah Universities regarding EI score and detect possible differences. Methods: A quantitative, cross-sectional, questionnaire-based, online survey was conducted among 692 medical students in Al-Quds and Al-Najah universities in Palestine. Emotional intelligence was evaluated using a 33-item scale as an index introduced by Schutte et al. (1998). Data was analyzed in a quantitative manner using SPSS (VER.20). Results: 745 students filled the questionnaire with a response rate of 92.88%. A total of 692 were sampled which were representative of the student population. The mean score of EI is 3.83 PalStudent Journal Correspondence concerning this article should be addressed tothe mentioned authors at the mentioned institutes. Copyright © 2020 Al-Quds University, Deanship of Scientific Research. All rights reserved. E-mail: [email protected] Palestine, Abu Dis, Al-Quds University (SD=0.41) out of a maximum possible score of 5 with 69.1% of the sample having high EI. Statistics showed that EI decreased significantly at α≤0.05 among basic and clinical stages of study with a negative correlation between EI and academic year (PCC= -0.086). This indicates that as the academic year increases, EI decreases (p=0.023). Moreover, EI is affected significantly at α≤0.05 in a positive manner by having a hobby or doing extracurricular activities. In addition, students who indicate they always regret studying medicine tend to relate to lower EI, this may reflect the lack of interest to study this field. Conclusion: Medical students, both male and female, have a relatively high level of emotional intelligence in the universities that were studied. Students in the clinical stage have lower EI than basic sciences medical students, which indicates that students have a conflict between objectivity and humanity while training clinically. Therefore, emotional support during clinical years would serve in improving EI. Moreover, EI is affected by having a hobby or extracurricular activities, indicating that EI can be modulated through the encouragement of such activities

Efficacy and safety of dapagliflozin in patients with inadequately controlled type 1 diabetes (DEPICT-1):24 week results from a multicentre, double-blind, phase 3, randomised controlled trial

Background Dapagliflozin is a sodium-glucose cotransporter-2 inhibitor approved for the treatment of type 2 diabetes. We aimed to assess the efficacy and safety of dapagliflozin as an add-on to adjustable insulin in patients with inadequately controlled type 1 diabetes. Methods DEPICT-1 was a double-blind, randomised, parallel-controlled, three-arm, phase 3, multicentre study done at 143 sites in 17 countries. Eligible patients were aged 18–75 years and had inadequately controlled type 1 diabetes (HbA1cbetween ≥7·7% and ≤11·0% [≥61·0 mmol/mol and ≤97·0 mmol/mol]) and had been prescribed insulin for at least 12 months before enrolment. After an 8 week lead-in period to optimise diabetes management, patients were randomly assigned (1:1:1) using an interactive voice response system to dapagliflozin 5 mg or 10 mg once daily, given orally, or matched placebo. Randomisation was stratified by current use of continuous glucose monitoring, method of insulin administration, and baseline HbA1c. The primary efficacy outcome was the change from baseline in HbA1cafter 24 weeks of treatment in the full analysis set, which consisted of all randomly assigned patients who received at least one dose of study drug. An additional 55 patients who were incorrectly and non-randomly allocated to only dapagliflozin treatment groups were included in the safety analysis set. This study was registered with ClinicalTrials.gov, number NCT02268214; data collection for the present analysis was completed on Jan 4, 2017, and a 28 week extension phase is ongoing. Findings Between Nov 11, 2014, and April 16, 2016, 833 patients were assigned to treatment groups and included in safety analyses (dapagliflozin 5 mg [n=277] vs dapagliflozin 10 mg [n=296] vs placebo [n=260]; 778 of these patients were randomly assigned and included in the full analysis set for efficacy analyses (259 vs 259 vs 260; difference due to randomisation error affecting 55 patients). Mean baseline HbA1cwas 8·53% (70 mmol/mol; SD 0·67% [7·3 mmol/mol]). At week 24, both doses of dapagliflozin significantly reduced HbA1ccompared with placebo (mean difference from baseline to week 24 for dapagliflozin 5 mg vs placebo was −0·42% [95% CI −0·56 to −0·28; p&lt;0·0001] and for dapagliflozin 10 mg vs placebo was −0·45% [−0·58 to −0·31; p&lt;0·0001]). Among patients in the dapagliflozin 5 mg (n=277), dapagliflozin 10 mg (n=296), and placebo (n=260) groups, the most common adverse events were nasopharyngitis (38 [14%] vs 36 [12%] vs 39 [15%]), urinary tract infection (19 [7%] vs 11 [4%] vs 13 [5%]), upper respiratory tract infection (15 [5%] vs 15 [5%] vs 11 [4%]), and headache (12 [4%] vs 17 [6%] vs 11 [4%]). Hypoglycaemia occurred in 220 (79%), 235 (79%), and 207 (80%) patients in the dapagliflozin 5 mg, dapagliflozin 10 mg, and placebo groups, respectively; severe hypoglycaemia occurred in 21 (8%), 19 (6%), and 19 (7%) patients, respectively. Adjudicated definite diabetic ketoacidosis occurred in four (1%) patients in the dapagliflozin 5 mg group, five (2%) in the dapagliflozin 10 mg group, and three (1%) in the placebo group. Interpretation Our results suggest that dapagliflozin is a promising adjunct treatment to insulin to improve glycaemic control in patients with inadequately controlled type 1 diabetes. Funding AstraZeneca and Bristol-Myers Squibb

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk