القدرة التنبؤية للتشوهات المعرفية وقلق الموت في جودة الحياة لدى عينة من كبار السن في فلسطين

الأهداف: هدفت الدراسة التعرف إلى القدرة التنبؤية للتشوهات المعرفية وقلق الموت في جودة الحياة لدى عينة من كبار السن في فلسطين. المنهجية: أجريت الدراسة وفقاً للمنهج الوصفي الارتباطي، من خلال تطبيق مقياس التشوهات المعرفية، ومقياس قلق الموت، ومقياس جودة الحياة، على عينة متيسرة ضمت (108) من كبار السن في فلسطين، وحللت البيانات باستخدم برنامج (SPSS, 28)، من خلال المتوسطات الحسابية، ومعامل ارتباط بيرسون، واختبار معامل الانحدار المتعدد التدريجي باستخدام أسلوب الإدخال (Stepwise). ولغايات تحديد مستوى كل من متغيرات الدراسة، حولت المتوسطات إلى ثلاثة مستويات: مرتفع (3.68-5)، ومتوسط (2.34-67.3)، ومنخفض (2.33 فأقل). النتائج: أظهرت النتائج أن مستوى كل من التشوهات المعرفية، وقلق الموت، وجودة الحياة لدى المسنين، جاءت جميعها بمستوى متوسط، وبلغ المتوسط الحسابي للدرجة الكلية للتشوهات المعرفية (2.79)، بينما بلغ المتوسط لقلق الموت (2.91)، في حين بلغ المتوسط لجودة الحياة (3.55). وبينت النتائج وجود أثر دال إحصائيًا لكل من التشوهات المعرفية وقلق الموت في التنبؤ بجودة الحياة، وأن كل من التشوهات المعرفية وقلق الموت قد وضحا معًا (%41.9) من نسبة التباين في جودة الحياة؛ أي أن متغيري: التشوهات المعرفية وقلق الموت، لهما دور مهم وأساس في التنبؤ بجودة الحياة. وأشارت النتائج إلى عدم وجود فروق دالة إحصائيًا في التشوهات المعرفية، أو قلق الموت، أو جودة الحياة باختلاف الجنس للمسن. الخلاصة: توضح النتائج أهمية الأخذ بالاعتبار التعامل مع التشوهات المعرفية وقلق الموت في بناء البرامج الإرشادية لتحسين الشعور بالرضا عن الحياة لدى المسنين

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

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

Quantitative Assessment of Apically Extruded Debris after Single-Files Supplemental Retreatment considering Apical Patency Influence: In Vitro Study

Objective. This study aims to assess the impact of re-establishing apical patency on the quantity of debris extruded through the apex after three supplementary retreatment files (TruNatomy (TRN), WaveOne Gold (WOG), and XP endo Finisher R (XPFR)). Materials and Methods. Eighty single-rooted mandibular premolars were prepared with ProTaper Universal rotary systems (PTU) up to F3 and obturated. The samples were divided into two main groups according to the presence or absence of the apical patency (n = 40), GI with apical patency and GII without apical patency. Based on the file system, which was adopted to eliminate the previous filling, each group had four subgroups (n = 10). In GI PTUR and GII PTUR, ProTaper Universal retreatment files (PTUR) were utilized only to remove the most primary filling material (control groups). In the other groups (PTUR) used, it was first followed by supplementary files. The quantity of debris extruded by different retreatment file systems was determined and compared to the corresponding control group with or without apical patency. Data were analyzed using a two-way ANOVA with a post hoc Tukey’s multiple comparison test at a 5% significance level. Results. There was a statistically significant difference among the control and experimental groups. XPFR had the least quantity of extruded debris. Apical patency did not affect the debris extrusion. Conclusion. All tested files led to a significant apical debris extrusion regardless of apical patency

AFF1 and STAT4 genes polymorphism in Egyptian systemic lupus erythematosus patients: Association with disease development and activity

Aim of the work: To assess the possible association of ALF transcription elongation factor 1 (AFF1)(rs340630) and signal transducer and activator of transcription 4 (STAT4)(rs7582694) genes polymorphism in Egyptian systemic lupus erythematosus (SLE) cases and their relation with disease activity. Patients and methods: The study included 103 SLE patients and 103 matched controls. SLE disease activity index (SLEDAI-2 K) was assessed. Genotyping was implemented with amplification refractory mutation system polymerase chain reaction (PCR) for AFF1 and allele-specific multiplex PCR for STAT4. Results: The median age of the patients was 38 years, disease duration was 7 years and were 97 females and 6 males (F:M 16.2:1). The median SLEDAI-2 K was 5. AFF1 ‘G’ allele was associated with SLE at 1.52 higher odds ratio (p = 0.042). AFF1 genotypes showed no significant association with existence of SLE (p = 0.08). In SLE patients with A/A genotype, seizures (28.6 %), pleurisy (42.9 %), consumed C3 (85.7 %) and consumed C4 (71.4 %) was significantly more frequent compared to G/A (5.7 %,7.5 %, 56.6 % and 39.6 %) and G/G (0 %, 9.3 %, 39.5 % and 14 % respectively; p = 0.01,p = 0.046,p = 0.04 and p = 0.001). There was a significant association between STAT4 gene polymorphism and the 'C' allele with the occurrence of SLE (p = 0.005 and p < 0.001 respectively). No significant difference was found in clinical manifestations, laboratory investigations or disease activity among STAT4 genotypes. Conclusion: STAT4 polymorphism revealed a significant association with increased SLE risk. However, AFF1 ‘polymorphism showed no significant association with existence of SLE. No significant difference was found in the proportions of AFF1 and STAT4 genotypes among activity grades of SLE

Seed Endophytic <i>Achromobacter</i> sp. F23KW as a Promising Growth Promoter and Biocontrol of Rhizoctonia Root Rot of Fenugreek

Root rot is one of the most significant soil and seed-borne fungal diseases, limiting the cultivation of fenugreek plants. Endophytic bacteria and their natural bioproducts have emerged as growth promoters and disease suppressors in the current era. Despite limited research, seeds are a good funder of endophytic microbiomes, which are transmitted from them to other seedling parts, thereby providing a shield against biotic and abiotic anxiety and promoting the growth at early germination and later stages. The current study evaluated the hypothesis that seed endophytic bacteria and their lytic enzymes, growth promotors, and antifungal molecules can induce growth, and inhibit root rot disease development at the same time. The isolation trial from fenugreek seeds revealed a lytic Achromobacter sp., which produces indole acetic acid, has antifungal compounds (e.g., 2-Butanol, 3,3’-oxybis-), and reduces the growth of Rhizoctonia solani by 43.75%. Under the greenhouse and natural field conditions, bacterial cells and/or supernatant improved the growth, physiology, and yield performance of fenugreek plants, and effectively suppressed the progress of root rot disease; this is the first extensive study that uses a new seed-borne endophytic bacterium as a plant-growth-promoting, and biocontrol tool against the sclerotia-forming; R. solani; the causative of fenugreek root rot

Ginger and Its Derivatives as Promising Alternatives to Antibiotics in Poultry Feed

Poultry enterprises have sustained rapid development through the last three decennaries. For which reason, higher utilization of antibacterial, either as therapeutic or growth promoting agents, has been accepted. Owing to the concern of developing bacterial resistance among populations towards antibiotic generations, accumulation of antibacterial remaining&rsquo;s in chicken products and elevating shopper request for outcomes without antibacterial remaining&rsquo;s, looking for unconventional solutions that could exchange antibacterial without influencing productiveness or product characters. Using natural alternatives including ginger, garlic prebiotics, organic acids, plant extracts, etheric oils and immune stimulants have been applied to advance the performance, hold poultry productiveness, prevent and control the enteric pathogens and minimize the antibacterial utilization in the poultry production in recent years. The use of a single replacement or ideal assemblage of different choices besides good supervision and livestock welfare may play a basic role in maximizing benefits and preserving poultry productiveness. The object of this review was to support an outline of the recent knowledge on the use of the natural replacements (ginger and its derivatives) in poultry feed as feed additives and their effects on poultry performance, egg and meat quality, health as well as the economic efficiency