Journals
2026 EN
Khayat Naser · Daraqel Baraa · Baker Muath Abu
+4 more
ABSTRACT Background Temporomandibular disorders (TMD) and orofacial pain (OFP) are influenced by behavioural and psychosocial stressors. The Gaza Strip's prolonged conflict provides a critical context for estimating burden and correlates. Objectives To estimate the prevalence of self‐reported TMD/OFP symptoms and identify independent risk factors among adults in Gaza during wartime. Methods Cross‐sectional survey of 1000 adults (500 women, 500 men) equally allocated across five governorates. A structured questionnaire captured self‐reported facial/TMJ/ear pain, jaw function, parafunctional behaviours (e.g., bruxism, oral habits) and psychological symptoms (tension, mood, sleep) was used. Analyses used descriptive statistics, chi‐square tests and multivariable logistic regression adjusted for sex. Results TMD‐related pain was reported by 33.1% ( n = 331). Neck pain occurred in 41.0% and morning facial stiffness in 28.2%. In bivariate analyses, men more often reported jaw dysfunction (limited opening, chewing difficulty, joint sounds), while women more often reported psychological symptoms; sex was not an independent predictor. Independent predictors were morning facial stiffness (AOR 2.57–5.27 across frequency categories), limited mouth opening (AOR 3.03; 95% CI 1.75–5.28), joint noises (AOR 3.13; 95% CI 2.08–4.72), sleep bruxism (AOR 2.33; 95% CI 1.51–3.60) and daily somatic pain elsewhere (AOR 2.99; 95% CI 1.53–5.84). Gum chewing showed an inverse association (AOR 0.62–0.31). Tension, sadness, global sleep disturbance, daytime bruxism, smoking, alcohol use, orthodontic history and governorate were not independent predictors. The multivariable model showed good performance (AUC = 0.882; Nagelkerke's R 2 = 0.519). Conclusions During active war, self‐reported TMD and OFP symptoms are prevalent among adults in Gaza and are strongly associated with parafunctional habits and psychological distress, both potentially intensified by war‐related stress. These findings underscore the need for integrated dental and mental health interventions in conflict‐affected populations.
Journals
2026 EN
Stephenson Anya · AlBusaidi Ibrahim S. · Williman Jonathan
+3 more
ABSTRACT Aim To analyse trends in community systemic antibiotic dispensing to children and young people (0–14 years) in New Zealand between 2010 and 2019. Methods Dispensing data were retrieved from the National Pharmaceuticals Collection and population data from the Te Whatu Ora Populations Web Tool. Dispensing rates were described using the number of defined daily doses/1000 inhabitants per day (DID) and courses dispensed/1000 inhabitants/year. Results Total antibiotic dispensing declined over the study period, both in terms of courses dispensed (annual percentage change [APC] −3.4% per year) and DIDs (APC −0.67% per year). Amoxicillin/clavulanic acid showed the greatest decline in dispensing (APC −9.5% per year), while cefalexin had the most significant increase (APC +53.7% per year). The highest dispensing rates were observed among children aged 0–4 years, Pacific patients and those in the lowest socioeconomic quintile. Counties Manukau had the highest regional dispensing rates. Antibiotic stewardship, as per the WHO AWaRe guidelines, improved: Access antibiotics increased from 83% to 91%, while Watch antibiotics decreased from 17% to 9% of total dispensing. Conclusions These findings suggest an overall improvement in prescribing practices, likely due to the adoption of antimicrobial stewardship programmes. Further study is under way to understand the reasons for and any risks associated with, high community rates of cefalexin dispensing.
John Wiley & Sons Australia
Journals
2026 EN
Hafeez Abdul · Akram Wasim · Naz Shabana
+5 more
ABSTRACT This study evaluated the effects of enzyme supplementation and microbial fermentation of guar meal (GM) on broiler performance, nutrient digestibility, bone characteristics, blood biochemistry, and gut health. A total of 900 1‐day‐old male Hubbard broiler chicks were randomly assigned to nine finisher‐phase dietary treatments in a 3 × 3 factorial design, including untreated (UG), enzyme‐treated (EG), and fermented (FG) GM at 3%, 6% and 9% inclusion levels. Results revealed that fermentation significantly high feed intake, weight gain, and feed conversion ratio (FCR), with the FG3 group showing the best performance. Apparent ileal digestibility of crude protein, fibre, calcium, and phosphorus was significantly enhanced in EG and FG groups, especially at 3% inclusion, compared to untreated diets. Bone weight and tibio‐tarsal index improved with processing, indicating enhanced skeletal development, while robusticity index was highest in the 9% UG group, suggesting altered bone remodelling under anti‐nutritional stress. Serum HDL levels increased and LDL levels decreased significantly in birds fed processed GM, indicating higher lipid metabolism. Furthermore, processed GM diets enhanced apparent metabolisable energy and reduced intestinal viscosity. Overall, dietary inclusion of 3% fermented or enzyme‐treated guar meal improved broiler growth, nutrient utilisation, and health parameters, offering a promising strategy to optimise alternative protein use in poultry nutrition.
Journals
2026 EN
Zhou Jiahua · Liu Kuan · Boor Patrick P. C.
+2 more
ABSTRACT Organ transplant recipients are at high risk of developing chronic infection when exposed to hepatitis E virus (HEV), which can rapidly progress to liver fibrosis and cirrhosis. Macrophages play a key role in the response to the infection and disease progression. However, the interactions amongst immunosuppressants, macrophages, the course of HEV infection and activation of inflammatory response remain unclear. In this study, we generated M0, M1 and M2 macrophages from the human THP‐1 cell line. These macrophages were then infected with HEV and treated with different immunosuppressants. We visualised viral infection using laser confocal microscopy, and quantitatively analysed viral replication and inflammatory responses by bulk sequencing, RT‐qPCR, ELISA and Western blotting. We found that the M1 inflammatory macrophages exhibited the highest, while M2 macrophages had the lowest levels of viral RNA. Genome‐wide transcriptome analysis indicated that viral, inflammation and immunity‐related pathways were predominantly upregulated by HEV infection. Dexamethasone exerted potent inhibitory effects on inflammatory response in macrophages. Mycophenolic acid (MPA) demonstrated inhibitory effects on viral replication, IL‐1β and TNF‐α expression, whereas mTOR inhibitors had the opposite effects, and tacrolimus showed no clear effect. In conclusion, immunosuppressants can differentially affect HEV replication and the subsequent inflammatory responses in macrophages.
Journals
2026 EN
Barakat Eman M. F. · Kohla Mohamed · Tawheed Ahmed
+36 more
ABSTRACT Hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC) poses significant health challenges globally, particularly in regions with considerable HBV prevalence such as Egypt. Despite immunisation programmes, HBV remains a leading cause of liver cancer in Egypt, often diagnosed at advanced stages, complicating management and worsening prognosis. This retrospective multicentre study included 365 Egyptian patients diagnosed with HBV‐related HCC between February 2007 and July 2023 from six tertiary care centres across Egypt. Clinical, laboratory, tumour characteristics, treatment outcomes and overall survival were collected and analysed. Diagnosis was confirmed according to international guidelines using triphasic CT or dynamic MRI. Treatment responses were assessed using modified RECIST criteria, and survival was analysed using Kaplan–Meier curves. Patients had a median age of 59 years, predominantly male (76.4%), and most (98.4%) presented with cirrhosis at diagnosis. The majority were not receiving antiviral treatment (76.71%) at presentation. Intermediate and advanced BCLC stages (B‐D) comprised over 75% of cases. Trans‐arterial chemoembolization was the primary treatment modality (34.5%), followed by sorafenib (24.1%) and best supportive care (28.8%). Median overall survival was 13.1 months. Independent factors associated with mortality included high ALBI score, positive HBV DNA at diagnosis, and advanced Child–Pugh classification. In conclusion: this study underscores the advanced stage at which HBV‐related HCC is typically diagnosed in Egypt and the resulting poor survival outcomes. Strengthening early detection through surveillance programmes, increasing antiviral therapy coverage and adherence to treatment protocols are critical strategies to enhance patient prognosis.
Journals
2026 EN
Zahran Eman · Elbahnaswy Samia · Abdelhamid Fatma
+10 more
Abstract Aflatoxin B1 (AFB1) contamination of aquaculture feed poses serious health risks to fish and consumers. In this study, the efficacy of a novel anti‐mycotoxin agent specific for aquatic species (AM‐AQ) containing bentonite, sepiolite, and orange peel meal ( Citrus Sinensis ) in alleviating AFB1 toxicity in Nile tilapia ( Oreochromis niloticus ) was evaluated. Fish were fed a basal diet as a control group and diets containing AFB1 (50 μg/kg), AM‐AQ (3 g/kg), or a combination of both for 6 weeks. AFB1 exposure significantly reduced growth, altered hematological parameters, protein profile, and digestive enzyme activities ( p < 0.05), and suppressed respiratory burst activity ( p < 0.001). It also altered the expression of liver and kidney function enzymes, lysozyme, and pro‐inflammatory cytokines and generated oxidative stress ( p < 0.05, p < 0.01). AM‐AQ supplementation effectively counteracted these adverse effects by restoring these parameters to control levels. Notably, AM‐AQ reduced AFB1 residues in the musculature by 99.6% after 6 weeks ( p < 0.001). Histopathological analysis revealed severe liver, spleen, and intestinal damage in the group exposed to AFB1, which was markedly ameliorated by AM‐AQ treatment ( p < 0.05). These results demonstrate that the AM‐AQ is a promising feed additive for protecting Nile tilapia against AFB1 toxicity and for reducing AFB1 transfer to edible tissues. Further research is required to optimize its application in aquaculture.
Wiley Subscription Services
Journals
2026 EN
Danpanichkul Pojsakorn · Pang Yanfang · Inggriani Maria
+10 more
ABSTRACT Background Social determinants of health (SDoH), including poverty and social isolation, have emerged as important contributors to adverse outcomes of chronic diseases. However, their impact on patients with metabolic dysfunction‐associated steatotic liver disease (MASLD) remains poorly characterised. This study aimed to assess the association between social vulnerability in MASLD and liver‐related and cardiovascular outcomes. Methods We conducted a population‐based retrospective cohort study using the TriNetX network, which aggregates de‐identified electronic health records from healthcare systems across the U.S. Patients with MASLD and at least one International Classification of Diseases, Tenth Revision (ICD‐10) code for documented social vulnerability (Z59.5, Z59.6, Z56.0 and Z60.2) were compared to non‐socially vulnerable individuals. Outcomes, including major adverse liver outcomes (MALO), major adverse cardiovascular events (MACE), hepatocellular carcinoma (HCC) and other cardiovascular complications, were assessed over a 5‐year follow‐up using Cox proportional hazards models. Results Individuals with MASLD and documented social vulnerability were at higher risk of MALO (8.3% vs. 4.4%; HR 1.69, 95% CI: 1.42–2.01). Cardiovascular morbidity was consistently elevated including MACE (22.7% vs. 12.5%; HR 1.64, 95% CI: 1.46–1.83), arrhythmias (34.4% vs. 17.8%; HR 1.81, 95% CI: 1.64–2.00) and heart failure (12.4% vs. 6.7%; HR 1.64, 95% CI: 1.42–1.89). The incidence of HCC did not differ between documented socially vulnerable and non‐socially vulnerable individuals with MASLD. Conclusions Documented social vulnerability is independently associated with higher risks of liver and cardiovascular complications in MASLD. These findings underscore the importance of integrating SDoH into MASLD management and risk prediction models to address disparities in long‐term outcomes.
Journals
2026 EN
Amin Shaimaa Mohamed · Hamad Nagwa Ibrahim Mohamed · Elsheikh Mahmoud Ahmed
+9 more
ABSTRACT The postpartum period is a critical stage where maternal confidence and self‐efficacy significantly influence breastfeeding success and overall adjustment. Cyberchondria refers to the repetitive searching for health‐related information online, which can lead mothers to doubt their caregiving abilities, lower their confidence, and negatively impact their perceived competence in breastfeeding and infant care. This study explored the relationship between cyberchondria, maternal self‐efficacy, and breastfeeding perceived competency among postpartum mothers. A cross‐sectional survey was conducted with 300 mothers within 2 months of childbirth, recruited through a two‐stage random sampling method from primary health care facilities in Zagazig district, Egypt. Participants completed validated Arabic versions of the Cyberchondria Scale (CS), the Perceived Maternal Parenting Self‐Efficacy Scale, and the breastfeeding competency scale (BCS). Findings revealed that higher cyberchondria levels were linked with lower maternal self‐efficacy and diminished breastfeeding competency. Maternal self‐efficacy demonstrated a significant positive association with breastfeeding perceived competency and partially mediated the relationship between cyberchondria and breastfeeding competency. These results suggest that online health‐seeking behaviors may undermine maternal confidence and skills, highlighting the importance of incorporating digital health literacy interventions into postpartum care. Supporting mothers in navigating online health information effectively may enhance self‐efficacy and improve breastfeeding outcomes.
Journals
2026 EN
Abdallah Haitham Mokhtar Mohamed · Zaky Mohammed ElSayed · Amin Shaimaa Mohamed
+5 more
ABSTRACT Background Critical care nurses face persistent high‐stress conditions that can compromise their mental health and job performance. In response, there is growing recognition of the value of a Trauma‐Informed Climate (TIC), which provides a framework that promotes psychological safety by acknowledging the impact of trauma and fostering supportive practices to enhance emotional resilience, well‐being and job functioning in this demanding field. Aim This study aimed to examine the mediating role of emotional resilience in the relationship between trauma‐informed climate, psychological well‐being and job performance among critical care nurses. Study Design A cross‐sectional descriptive design was employed in Egypt, adhering to the STROBE checklist. Results A total of 368 registered critical care nurses completed the Connor‐Davidson Resilience Scale (CD‐RISC), the Swedish version of Ryff‘s Psychological Well‐Being Scale, the Job Performance Scale and the Trauma‐Informed Climate Scale. Data were analysed using SPSS and AMOS version 24.0. The mean scores were 43.11 ± 9.29 for emotional resilience, 76.41 ± 8.54 for psychological well‐being, 47.40 ± 5.12 for job performance and 29.58 ± 4.68 for trauma‐informed climate. Emotional resilience showed significant positive correlations with psychological well‐being ( r = 0.432, p < 0.001), job performance ( r = 0.413, p < 0.001) and trauma‐informed climate ( r = 0.195, p < 0.001). Path analysis revealed that emotional resilience mediated the relationship between trauma‐informed climate and both job performance ( β = 0.159, p < 0.001) and psychological well‐being ( β = 0.319, p < 0.001). Trauma‐informed climate had a significant direct effect on job performance ( β = 0.162, p = 0.003) and psychological well‐being ( β = 0.662, p < 0.001), with total effects of β = −0.321 and β = −0.981, respectively ( p < 0.001). Conclusions Emotional resilience significantly mediates the effect of trauma‐informed climate on psychological well‐being and job performance among critical care nurses. Promoting a trauma‐informed work climate and resilience‐building strategies may enhance nurses' well‐being and professional outcomes. Relevance to Clinical Practice This study underscores the importance of fostering trauma‐informed climates and resilience development in clinical settings. By equipping critical care nurses with emotional resilience and creating psychologically safe environments, healthcare institutions can support improved mental health and performance outcomes. These efforts can lead to better patient care, lower staff burnout and enhanced workforce sustainability.
Journals
2026 EN
Mahran Ghada Shalaby Khalaf · Aldalaeen Muamar · Mahdy Magdy
+4 more
ABSTRACT Background Venous catheter selection is a crucial aspect of patient care, impacting treatment outcomes, patient safety and healthcare sustainability performance. While central venous catheters (CVCs) offer advantages for certain clinical situations, their safety profile compared to peripheral venous catheters (PVCs) remains a subject of debate. Aim This study aimed to compare the safety profiles of CVCs and PVCs to inform evidence‐based practice and improve sustainability performance in venous catheter selection. Study Design A two‐group, prospective observational cohort study included adult patients (≥ 18 years) admitted to the emergency department and intensive care units of a university hospital in Assiut, Egypt. The safety profile was assessed using three key metrics: the Infection Probability Score (IPS), rates of Healthcare‐Associated Infections and Sepsis (HAIS) and in‐hospital mortality. Results While all 200 enrolled patients completed the study (160 ICU, 40 ED), the subgroup analysis was limited to 160 ICU patients due to the smaller ED group size. Central venous catheters were associated with a higher rate of catheter occlusion (40.0% ( n =32) vs. 31.3% ( n =25), p =0.248), while peripheral venous catheters were predominantly associated with phlebitis (18.8% ( n =15) vs. 27.5% ( n =22), p =0.189) and extravasation (0.0% ( n =0) vs. 3.8% ( n =3), p =0.080, OR = 7.2, 95% CI 2.7–140.2). Furthermore, patients with central venous catheters had a higher mean infection prevention score (17.6 ± 2.4 vs. 12.7 ± 5.1, p < 0.001, r = 0.520) and a significantly greater likelihood of healthcare‐associated infections (91.3% ( n =73) vs. 25.0% ( n =29), p < 0.001, OR = 31.3, 95% CI 12.4–79.0). Notably, mortality was significantly higher among patients with central venous catheters (71.3% ( n =57) vs. 6.3% ( n =5), p < 0.001, OR = 37.2, 95% CI 13.3–103.8). Conclusion These findings suggest that, despite the potential benefits of central venous catheters, the presence of a CVC is associated with a higher risk of severe complications, including infection, healthcare‐associated infections, and mortality, compared to peripheral venous catheters in this observational cohort. This elevated risk profile may negatively impact sustainability performance by increasing resource utilization, treatment costs, and the burden of harm. The large observed effect sizes, supported by high post‐hoc power, strengthen the evidence for this association within the study population. However, as this was an observational study without adjustment for potential confounding factors such as severity of illness or indication for catheter type, these results demonstrate association and cannot infer causation. The findings highlight the complex risk‐benefit assessment required in clinical decision‐making. Relevance to Clinical Practice These findings highlight the importance of a meticulous assessment of patient needs and risk factors when selecting a venous catheter. Clinicians should carefully weigh the potential benefits of central venous catheters against the increased risk of complications, particularly in patients with heightened susceptibility to infection or those requiring shorter‐term intravenous access. Prioritising peripheral venous catheters whenever feasible may contribute to improved patient safety, outcomes and overall sustainability performance of healthcare delivery by preventing costly complications and enhancing resource efficiency.