Background/Aims: Behçet’s disease (BD) is an autoinflammatory disease of unknown etiopathogenesis. Oxylipins i.e., prostaglandins, leukotrienes, lipoxins, resolvins, and protectins are bioactive polyunsaturated fatty acids (PUFAs) derivatives involved in inflammatory response induction and resolution. The study aimed to determine the profile of selected PUFAs and oxylipins and to define a lipidomic signature for BD. Methods: A case-control study was conducted involving thirty-five patients with BD and thirty-five age and sex-matched healthy individuals as a control group. Selected plasma PUFAs and oxylipins were analyzed using a targeted LC-MS/MS method. Results: The lipidomic profile was different between the two groups. BD patients showed higher levels of oxylipins deriving from either the n-6-arachidonic acid (i.e., prostaglandin D2, E2, F2α, and 6-keto-F1α, thromboxane B2, leukotriene B4, E4 and F4, and 6-epi and 15-epi-lipoxin A4) or n-3 PUFAs (i.e., 18-hydroxyeicosapentaenoic acid, 7,17-dihydroxy docosapentaenoic acid, protectin X, and resolvin D5), but decreased levels of both n-3 and n-6 PUFAs. Multivariate analyses selected the combination of four mediators, i.e., docosapentaenoic acid, prostaglandin E2, thromboxane B2, and lipoxin A4 as an accurate lipidomic signature for BD. Conclusions The profile of PUFAs/oxylipins is altered in BD patients, characterized by increased pro-inflammatory and pro-resolving oxylipins. The findings suggest that oxylipin metabolism might be involved in BD pathophysiology and may represent a therapeutic target for the disease. Further research is required to examine the role of lipid mediators in BD.

Background: This study compared the quality and duration of analgesia between the superior trunk (ST) and the clavipectoral fascial plane (CFP) blocks in conjunction with a selective supraclavicular nerve (SCN) block for clavicular surgeries. Methods: Fifty patients undergoing mid-third clavicular procedures were randomly assigned to the ST group (received an SCN block followed by blockage of the ST of the brachial plexus) and the CFP group (received an SCN block followed by the CFP block). The primary outcome was the time until the first rescue analgesia. Secondary outcomes included total nalbuphine dosage and numerical rating scale (NRS) scores within the first 24 hours, the onset of sensory block, as well as deltoid and biceps muscle function using the modified Bromage score (MBS), diaphragmatic excursion, along with satisfaction levels. Results: The ST group exhibited a more prolonged duration until the first request for rescue analgesia compared to the CFP group (18.76 ± 0.89 hours vs. 15.34 ± 1.38 hours), with a mean difference of 3.42 hours (95% confidence interval: 2.76 to 4.08, P < 0.001). The ST group consumed less nalbuphine and reported lower NRS scores at 6, 8, 12, 16, and 24 hours than the CFP group. Additionally, the ST group exhibited a lower MBS and diaphragmatic excursion than the CFP group. However, the differences in the onset of sensory block and satisfaction levels were not statistically significant. Conclusions The ST group demonstrated superior outcomes in pain control with less favorable outcomes concerning diaphragmatic excursion and upper limb motor function.

Purpose: This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines. Materials and Methods: A 39-question survey was developed by senior Global Andrology Forum (GAF) experts to comprehensively cover clinical aspects of RT. This was distributed globally via a secure online Google Form to ED specialists through the GAF website, international professional societies, and social media, the responses were analyzed and presented for frequencies as percentages. Consensus on expert recommendations for RT use was achieved using the Delphi method. Results: Out of 479 respondents from 62 countries, a third reported using RT for ED. The most popular treatment was low-intensity shock wave therapy (54.6%), followed by platelet-rich plasma (24.5%) and their combination (14.7%), with stem cell therapy being the least used (3.7%). The primary indication for RT was the refractory or adverse effects of PDE5 inhibitors, with the best effectiveness reported in middle-aged and mild-to-moderate ED patients. Respondents were confident about its overall safety, with a significant number expressing interest in RT’s future use, despite pending guidelines support. Conclusions This inaugural global survey reveals a growing use of RT in ED treatment, showcasing its diverse clinical applications and potential for future widespread adoption. However, the lack of comprehensive evidence and clear guidelines requires further research to standardize RT practices in ED treatment.

Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12–19 IU/mL by 22.5% of participants and 20–40 IU/mL by 27.8%, while 31.8% reported no upper limit. Conclusions This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.

Quetiapine-induced hypokalemic periodic paralysis (QIHPP) is a rare condition. Herein, we present the case of a 31-year-old pregnant Malay woman diagnosed with bipolar II disorder and QIHPP. She presented to the casualty department with a 2-day history of bilateral lower limb weakness and numbness. Her renal function tests showed moderate hypokalemia (2.5 mmol/L), whereas other investigations were normal. Quetiapine was suspected to be the cause, prompting a psychiatric referral to manage her acute condition. Balancing the risks of untreated QIHPP against the potential relapse of bipolar symptoms from quetiapine discontinuation or dosage reduction poses a significant treatment challenge for pregnant women with QIHPP. Finally, we reduced the quetiapine dosage after careful consideration, leading to the normalization of potassium levels and symptom resolution. Therefore, clinicians should be aware of this side effect when initiating or continuing quetiapine treatment in women of childbearing age or pregnant women with psychiatric disorders. It is crucial to monitor serum electrolytes, especially potassium, following quetiapine administration and warn patients about its potential side effects.

Background: Establishing cost-effective informal care services for lonely older adults living at home in developing countries can be an innovative approach for improving their well-being. This study investigated the effectiveness of an informal home care support intervention program (HoSIP) reducing the loneliness and improving quality of life of lonely community-dwelling older adults. Methods: This quasi-experimental pre-post study employed a non-randomized control group design with a 12-week intervention period and three follow-up points at the end of the HoSIP. Questionnaires were used to measure feelings of loneliness (20-item UCLA Loneliness Scale), quality of life (Control, Autonomy, Self‐Realization and Pleasure Scale), general health (12-item General Health Questionnaire), social network (six-item Lubben Social Network Scale), social support (12-item Multidimensional Scale of Perceived Social Support), and self-care ability (17-item Self-care Ability Scale for the Elderly). Repeated-measures analysis of variance was used to gauge the effect of the intervention program over time and in comparison to the control group. Data analyses were performed using the IBM SPSS Statistics software (IBM Corp., USA). Results: We found a significant relationship between the outcome variables, including feelings of loneliness (P<0.001) and quality of life (P<0.001), at different stages of measurement. Despite the positive feasibility results, the implementation of the HoSIP faced challenges due to a lack of facilities (e.g., place restriction for holding educational classes, educational facilities like computers, video projector, and whiteboard at daycare center) and the absence of supporting organizations. Conclusion Utilizing the existing capabilities of older adults to provide online and face-to-face care services can be a cost-effective way to improve their quality of life and reduce loneliness. The process of facilitating such informal care services for lonely older adults should be managed by either governmental or non-governmental organizations to reduce the rate of social isolation among this vulnerable population.

Objective: The World Health Organization recognized infertility as a disease and emphasized universal access to high-quality treatment. Nevertheless, inequality and inequity in infertility care are pervasive in Morocco, access to care is hindered by multiple potential barriers delaying treatment seeking and management. This study aimed to explore factors and barriers to assisted reproductive technology (ART) among infertile women in Morocco. Methods: This is a cross-sectional analytical study relies on prospective data collected through a standardized questionnaire, was carried out in January-June 2023. The target population concerned 110 infertile women attending a private clinic in Morocco. Results: Women who experienced infertility in Morrocco have demonstrated several barriers including: cost and lack of financial means (90%) and distance from fertility care (80%). On bivariate analysis findings suggest there are multifactorial factors that influence access to ART: the age, marriage span, monthly household income, duration of infertility, and education level and profession. On multivariable logistic analysis, age over 35 years old (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.07-10.65; P=0.004) and the duration of infertility over 10 years (OR, 5.59; 95% CI, 1.24-25.24; P=0.003) remained significantly associated with women who had undergone ART. Conclusion This study has demonstrated that infertile women confront economic barriers, social pressure, and constraints related to health systems. Women over the age of 35 with the duration of infertility exceeding 10 years are certainly making more considerable economic efforts to access ART. Policy-makers must to take into account these barriers and factors to ensure efficient access to ART.

Objectives: The objectives of this review and meta-analysis were twofold: first, to determine theprevalence of substance use among school-going children in Arab and African countries; andsecond, to highlight the considerable influence of variables such as the nation’s region and thetimeframe of the study on the prevalence of substance use. Methods: Research was sourced from Science Direct, Scopus, Web of Science, Google Scholar,and PubMed. Thirty-seven articles were incorporated in accordance with the PRISMA guidelines. This review included studies published from 2013 to 2023. The statistical meta-analysis was performed using Comprehensive Meta-Analysis ver. 3 software. Across 37 studies, the total number of study participants was 73,508. Results: The meta-analysis revealed that tobacco was the most commonly used substance, with a prevalence of 16% (95% confidence interval [CI], 12.7%–20.02%). This was closely followed by alcohol, which had a prevalence of 15% (95% CI, 10.5%–22.8%), stimulants at 11.4% (95% CI, 7.4%– 17%), khat at 10% (95% CI, 5.7%–15%), and cannabis at 8% (95% CI, 3.3%–18.4%). Notably, alcohol was the only substance that showed an increasing trend in prevalence from before to after 2019, rising from 13.3% (95% CI, 6.2%–26.1%) to 17% (95% CI, 10.2%–27%) (p < 0.001). Additionally, the prevalence of substance use varied significantly between Arab and African countries (p < 0.001). Conclusion Although the prevalence of substance use among school-going populations hassignificantly decreased over time, with the exception of alcohol, it is imperative that bothAfrican and Arab countries implement comprehensive measures and stringent laws to addressthe production and marketing of substances.

Child abuse is a widespread global health crisis with longterm implications for children’s physical, psychological, and emotional well-being. Pediatric emergency departments (PEDs) are often the first point of contact for children experiencing abuse, presenting unique diagnostic challenges due to the diverse manifestations of maltreatment. In contrast to physical abuse that often leaves visible markers, nonphysical abuse (e.g., emotional neglect or psychological harm) frequently go undetected, exacerbating underreporting and delayed interventions. This article examines the prevalence, diagnostic challenges, and multidisciplinary strategies for addressing child maltreatment in PEDs. Cultural and systemic barriers, coupled with insufficient training and resource constraints, hinder the recognition of subtle signs of nonphysical abuse. Advances in diagnostic imaging, behavioral assessment tools, and laboratory investigations are discussed as critical components of comprehensive evaluations. Multidisciplinary teams play a pivotal role in addressing the complexity of abuse cases, combining medical, psychological, and legal expertise to provide holistic care while minimizing additional trauma. The integration of artificial intelligence into diagnostic workflows is explored as a transformative innovation, offering potential for early detection of abuse patterns and enhanced decision-making. However, the implementation of artificial intelligence requires careful consideration to ensure that it complements human expertise and aligns with ethical standards. There is a need for standardized protocols, targeted training programs, and supportive systems to empower healthcare professionals in recognizing and reporting all forms of child maltreatment. We propose more research to develop tools capable of detecting nonphysical abuse in PEDs. By combining technological advancements, multidisciplinary collaboration, and educational initiatives, PEDs can improve outcomes for vulnerable children and address the widespread issue of child maltreatment more effectively.

Purpose: Research proved the beneficial effect of Zinc on human health and Gastrointestinal tract inflammatory diseases. We propose that zinc would be of value in children with Hirschsprung’s disease (HD) undergoing elective pull-through surgery. This study was carried out to determine the influence of preoperative zinc intake on postoperative outcomes, especially the hospital length of stay in patients diagnosed with HD as a primary outcome.Other outcomes include identification of the nutritional and inflammatory status including the nutritional and inflammatory markers in children with HD with possible impacts on hospital outcomes. Methods: This is a randomized interventional control study that was applied to 50 children diagnosed with HD who underwent elective pull-through surgery. We randomly allocated 25 diagnosed with HD who underwent elective pull-through surgery. We randomly allocated 25 patients to zinc treatment. Results: The results demonstrated that the interventional group had a lower incidence of complications (20%) when compared to the control group (64%), with a significant p-value of 0.002. In addition, less incidence of Hirschsprung’s associated enterocolitis (HAEC) (12% vs. 40%) and skin excoriation (8% vs. 32%) were documented in the interventional group compared to the controls respectively. Conclusion Pre-operative zinc supplementation may have a beneficial impact on HD children undergoing elective pull-through surgery as regards outcomes such as HAEC and skin excoriation.