Libyan Journal of Medicine最新文献

Metabolically dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading chronic liver disease worldwide, driven primarily by metabolic derangement. The current investigation proposes to elucidate the hepatoprotective mechanisms of telmisartan (TEL) in MASLD. Twenty-four male Wistar rats were allocated to four groups (Control, MASLD, TEL-treated, and MASLD/TEL). Lipid profiles, glycemic markers, liver enzymes, and hepatic markers of oxidative stress (malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), and catalase) were measured. MASLD-associated genes retrieved from GeneCards® were mapped to Rattus norvegicus ortholog genes using the gprofiler2 R package. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Reactome enrichment analyses were subsequently performed using the clusterProfiler R package. Hepatic inflammatory cytokines (TNF-β, IL-6, and NF-κB), mitochondrial respiratory enzymes (Complexes I-IV), and the gene expression of Nrf2, HO-1, MMP-9, and TIMP-1 were evaluated using spectrophotometric assays for mitochondrial respiratory enzymes. Histological assessment was done using Hematoxylin and Eosin (H&E) staining, Masson's trichrome, and TGF-β immunostaining. TEL ameliorates MASLD-associated disturbances in the serum ALT level and lipid profile. It significantly reduces the levels of oxidative stress markers. KEGG and Reactome enrichment highlighted pathways involved in lipid metabolism, insulin resistance, and inflammation, with the peroxisome proliferator-activated receptor (PPAR) and AMP-activated protein kinase (AMPK) signaling pathways being the most enriched. TEL treatment increased the hepatic expression of Nrf2, HO-1, and TIMP-1 while decreasing the expression of MMP-9. The levels of the proinflammatory cytokines TNF-α and IL-6 decreased. The activities of mitochondrial enzymes (citrate synthase and complex I) improved. MASLD induced marked hepatic fibrosis, which was markedly improved following TEL treatment. TEL has notable hepatoprotective properties in MASLD by enhancing metabolic parameters, decreasing oxidative stress, and moderating inflammatory reactions.

Despite the wide availability of contraception, the abortion rate in Serbia remains high. Being in a steady relationship and perceiving low risk to catch sexually transmitted infections have been identified as the most common reason to not use condom, while around 11% of females used oral contraceptive pill. The study aim was to investigate the reasons of Serbian women to seek induced abortion as well as the factors that might impact the decision to terminate pregnancy. A cross-sectional study was conducted at the Clinic for Ob/Gyn, University Clinical Centre of Serbia in Belgrade, which is a referral public tertiary health care institution. Women who underwent induced abortions from 2022 to 2024 filled in a questionnaire on socio-demographic characteristics, life-style and habits, medical history and motives for an induced abortion. Multivariate regression models were used to identify factors associated with each reported abortion motive. The study analyzed 433 women aged 16 to 49 years (mean 32.0 years). The most common motives for abortion were already having enough children (44.3%) and financial difficulties for child upbringing (42.0%). In contrast, gaining weight and concerns about physical changes due to pregnancy was the least endorsed reason for seeking an abortion. The majority of women (52.9%) reported multiple motives for abortion. Motives were generally the same for women who the first and recurrent abortion. Most common factors influencing the decision to terminate pregnancy were not being in a relationship or marriage and vigorous physical activity at workplace. One-half of women had multiple motives for abortion and more than 50% of women sought abortion multiple times. The most important factors associated with voluntary abortion seeking is not having a steady partner and working in a physically demanding job. These findings should be considered in the public health policy agenda.

Formal training for residents-as-teachers is increasingly emphasized in many institutions worldwide. This study investigated 'residents-as-teachers' training, perceptions, and practices at the Faculty of Medicine of Sousse. An online survey was sent to the residents of FMSo (n = 1060). The three assessed areas in the survey were: training and teaching experience, teaching practices used, and attitudes and perceptions. Statistical analyses included descriptive statistics, two-proportion tests, and multivariate logistic regression. One hundred five residents responded (response rate: 9.9%). Although 68.6% reported teaching weekly (often 1-5 hours), and 33.3% found it enjoyable or rewarding, a notable feedback gap existed: 17.1% received no feedback from supervisors, and 15.2% none from learners. Preferred teaching methods included clinical case discussions (40.9%), role-playing (38.0%), brainstorming (37.1%), and workshops (35.2%). Multivariate analysis showed residency year was the only predictor of teaching contribution (OR = 3.72; p< 0.001). Despite limitations like the low response rate, the study concludes that residents value teaching but lack adequate feedback. It underscores the critical need to develop new and refine existing training programs for residents-as-teachers to improve the overall quality of medical education.

The utility of carotid artery Doppler flow velocity (CADFV) over mortality is not well known. This study investigated the utility of bedside ultrasound in assessing volume status and predicting mortality in patients with septic shock with CADFV, the inferior vena cava collapse index, and the central venous pressure (CVP). This prospective observational study included adults admitted to the ED with septic shock, defined by hypotension (SBP < 90 mmHg or MAP < 65 mmHg) and evidence of end-organ hypoperfusion. Patient demographics, CVP, CADFV, inferior vena cava (IVC) diameter, inferior vena cava collapsibility index (IVCCI), and outcomes were recorded. Measurements are compared in terms of mortality. The mean age was 67 years, with a 57% mortality rate. ROC analysis revealed that CADFV predicted mortality with a sensitivity of 72% and a specificity of 68% at a cutoff of 50 cm/s. The IVCCI had 93% sensitivity and 85% specificity at a cutoff of 54.5%. The CVP had 61% sensitivity and 71% specificity at a cutoff of 1.5 mm H₂O. The mean IVCCI was 59%, and the mean CVP was 2.4 mmH₂O. The mean IVCCI was 59%, and the mean CVP was 2.4 mmH₂O. The deceased patients had a mean IVCCI of 63% and a mean CVP of 1.62 mmH₂O, whereas discharged patients had a mean IVCCI of 55% and a mean CVP of 3.45 mmH₂O. CADFV, IVCCI, and CVP can be used in evaluating the volume status and predicting mortality in septic shock. These noninvasive measures provide alternatives to invasive methods and facilitate timely intervention in emergency care.

In-depth knowledge of the anatomical structure of the root canal system is fundamental for successful endodontic treatment. This research aimed to evaluate the root canal structures of lower premolars in the Saudi western demographic via Cone Beam Computed Tomography (CBCT) scans. 760 CBCT scans were reviewed, which incorporated 2747 mandibular premolar teeth. SPSS was employed for descriptive statistics and Pearson chi-square tests. The Kappa tests were executed for intra- and inter-observer consistency. The number of roots, canals, and canal configurations based on Vertucci's classification were assessed. The study further explored the prevalence, patterns, and variations of the root canal systems, considering gender-based variations and bilateral resemblance. Predominantly, mandibular premolars possessed a single root, though a minority displayed two or three roots. The occurrence of multiple canals was also on the lower side, with the type I canal pattern emerging predominantly. Gender-based distinctions were evident, as males exhibited a higher frequency of two-rooted premolars and multiple canals than females. It was noted that the anatomical differences were more in the mandibular first premolars than in the second premolars. A significant bilateral consistency was observed, with most teeth showcasing consistent root and canal numbers. This research offers essential perspectives on the diverse nature and variability of root canal anatomy within the Saudi Western cohort, facilitating better understanding and treatment planning in endodontics.

Balance issues have been reported to be common among females with overweight or obesity with associated fall risks. Despite the increasing reports of the negative impacts of obesity on balance and cognition, there is a scarcity of research aimed at evaluating effective interventions. To examine the effects of rebound exercises on cognition and balance among females with overweight and obesity. This Quasi-experimental study used the purposive sampling method to recruit 20 female students (aged 17-35 years) with overweight and obese at the Evangel University Akaeze, Ebonyi State Nigeria. Rebound exercise intervention was administered to all participants at the gym for 30 minutes in each session, three times a week for six weeks, while their cognitive performances, stationary balance, and dynamic balance were measured pre-and post-trial using Trail Marking Test Apparatuses, Unilateral Pedal Tests, and Meter Backward Walk Test respectively. There was a significant (p < 0.001) difference in the participants' cognition values across weeks 1, 3, and 6 with a progressive improvement over time. There was also a significant (p < 0.05) difference in the participants' static and dynamic balance values across weeks 1, 3, and 6 with a progressive improvement in balance performance over time. Rebound exercise significantly improved the cognition and balance of females with overweight or obese. This finding suggests a promising intervention to improve balance and cognitive-related problems in this population. Registered retrospectively in the Pan African Clinical Trial Registry, identification number for the registry is PACTR202405746557031. Dated 2 May 2024.

The cornerstone of asthma management is the stepwise approach recommended by both national and international guidelines. In this study, we aim to investigate physicians' attitudes and approaches towards step-down treatment in asthma management in Turkey. In this cross-sectional study, questionnaire-based data were gathered from pulmonologists, immunology and allergy specialists and immunology and allergy fellows in November-December 2024. Of the 225 physicians, the median years of service in their speciality was 5 (min1-max51) years. Nearly 35% of survey participants rarely step down asthma medication (12.9% and 52.4% of participants always and frequently, respectively). The two most selected barriers were 'I am afraid the patient will get worse' (50.9%) and 'patients don't want to' (29.9%). Participants whose primary concern regarding step-down asthma treatment was fear of patient deterioration were found to use step-down approaches less frequently (66.7%, p < 0.001). Working in educational and research hospitals, the fear that the patient may worsen, and infrequent adherence to guideline updates were significantly associated with the rare implementation of step-down treatment in asthma management. Our study identified that the fear of potential disease worsening and infrequent adherence to updated guidelines were significantly associated with the limited implementation of step-down treatment in asthma management.

To evaluate the predictive role of serum amyloid A (SAA) levels and their association with antiphospholipid antibodies (APA) and coagulation markers such as lupus anticoagulants (LA), anti-cardiolipin (ACA), protein C (PC) deficiency, protein S (PS) deficiency, and antithrombin III (ATIII) deficiency in recurrent pregnancy loss (RPL). This prospective case-control study comprised two groups: the study group (n = 88) included women with recurrent pregnancy loss at Mansoura University Hospital between January 2019 and December 2020, and the control group (n = 52) included women without obstetric or medical complications. Demographic, clinical, and laboratory data, including serum samples collected at 10 weeks of gestation, were collected from all participants. The study measured SAA levels, lupus anticoagulants, anti-cardiolipin, protein C, protein S, and antithrombin III levels. The SAA level was significantly elevated in the recurrent pregnancy loss group compared to that in the control group. Lupus anticoagulant positive, anti-cardiolipin positive Immunoglobulin M (IgM), and deficiencies in protein C, protein S, and antithrombin III were significantly observed in patients with RPL (p < 0.05). The SAA levels were significantly elevated in both LA-positive and ACA-positive IgM patients. The receiver operating characteristic (ROC) curve analysis demonstrated that at SAA > 24.8 for the prediction of recurrent pregnancy loss, sensitivity was 98.86%, and specificity was 92.31%. Positive and negative predictive values were 95.6% and 98.0%, respectively. The area under the curve = 0.971 (0.927-0.992). SAA is associated with recurrent pregnancy loss and may therefore serve as a potential predictor of this condition. The observed elevation in SAA levels could be primary or secondary to the inflammatory response that promotes thrombotic activity in RPL patients at risk of APA, Protein S, Protein C, and ATIII deficiencies. Implementing SAA screening during pregnancy may facilitate the identification of individuals who could potentially benefit from novel treatment strategies.

Organ donation from brain-dead patients is a major advancement in transplantation medicine. However, challenges remain in identifying and managing potential donors. In Tunisia, low donation rates reflect both medical limitations and significant sociocultural barriers, with limited national data addressing these factors. This study aimed to describe the epidemiological, clinical, and paraclinical profiles of patients with severe coma in Tunisian intensive care units (ICUs), and to identify factors associated with progression to brain death (BD) and subsequent organ donation outcomes. A pilot prospective multicenter study was conducted over one year (November 2022 - October 2023) in three Tunisian university hospitals: Sahloul and Farhat Hached (Sousse), and Mohamed Taher Maamouri (Nabeul). All ICU patients with severe coma (i.e.; Glasgow coma scale≤8) requiring invasive mechanical ventilation were included. Patients were followed until BD confirmation or ICU discharge. The transplant coordination team approached families of confirmed BD patients for donation consent. Among 104 patients (mean age: 47years; 76% male), 26 (25%) progressed to BD, mainly due to haemorrhagic stroke (57.7%) and traumatic brain injury (30.8%). BD was significantly associated with male sex (odds ratio (OR)=2.63; p=0.047), comorbidities such as arterial hypertension and/or diabetes mellitus (OR=2.63; p=0.041), traumatic causes (5.76; p<0.001), haemorrhagic stroke (OR=13.83; p<0.001), and prolonged ICU stay defined as a stay exceeding 14days (OR=12.54; p=0.014). Of the 17 confirmed BD cases, families of 12 were approached, with consent obtained in five (41.6%). Refusals (58.3%) were mainly due to concerns about body integrity, religious beliefs, and family influence. Improved donor management, family communication, and public awareness are crucial to increasing donation rates. Registration. This study protocol was registered on ClinicalTrials.gov (Identifier: NCT06948669).