Efficacy and safety of etrolizumab in treatment of moderate to severe ulcerative colitis: A systematic review and meta-analysis.

Background: Etrolizumab is a promising drug for treating moderate to severe ulcerative colitis. Aim: The aim of this study was to assess the efficacy and safety of etrolizumab for induction and maintenance of remission in moderate to severe ulcerative colitis. Methods: We searched the following databases: PUBMED, Web of Science, OVID, and SCOPUS from inception to January 15. Inclusion criteria were any phase 2 and 3 clinical trials that compared etrolizumab with a placebo in treating moderate to severe ulcerative colitis, excluding case reports, animal studies, phase 1 trials, and conference abstracts due to duplication. We used RevMan software (5.4) for the meta-analysis. Results: Five clinical trials were included in our meta-analysis. The total number of patients included in the study is 1248 patients, 860 patients in the etrolizumab group and 388 patients in the placebo group. In the induction phase, the pooled analyses showed a statistically significant association between etrolizumab and increased clinical remission, and endoscopic remission compared with placebo (risk ratio [RR] = 2.66, 95% confidence interval [CI] = 1.69-4.19, p < 0.0001), and (RR = 2.35, 95% CI = 1.52-3.65, p = 0.0001), respectively. In the maintenance phase, the pooled analyses showed a statistically significant association between etrolizumab and increased histologic remission and endoscopic remission (RR = 2.04, 95% CI = 1.40-2.98, p = 0.0002) and (RR = 1.92, 95% CI = 1.29-2.85, p = 0.001), respectively. No statistically significant difference was observed in adverse events between etrolizumab and placebo in the induction and maintenance phases. Conclusion: Our results show that etrolizumab is an effective and safe drug for the induction and maintenance of clinical remission in moderate to severe ulcerative colitis patients, as proved by histologic and endoscopic findings. Future randomized trials are still needed to compare etrolizumab to the other agents and further establish its value for the practice.

Prevalence and knowledge of polycystic ovary syndrome (PCOS) and health-related practices among women of Syria: a cross-sectional study.

Polycystic Ovarian Syndrome (PCOS) is a prevalent metabolic and hormonal disorder affecting women of reproductive age. Limited data exists on Syrian women's PCOS awareness and health behaviors. This study aimed to gauge PCOS prevalence, knowledge, awareness, and health-related practices among Syrian women. A cross-sectional online survey was conducted from 11 February to 27 October 2022, targeting Syrian women aged 18-45. Collaborators from specific medical universities distributed a questionnaire adapted from a Malaysian paper through social media platforms. Out of 1840 surveyed Syrian women, 64.2% were aged 21-29, and 69.6% held bachelor's degrees. Those with a bachelor's degree exhibited the highest mean knowledge score (12.86), and women previously diagnosed with PCOS had a higher mean knowledge score (13.74) than those without. Approximately 27.4% were confirmed PCOS cases, and 38.9% had possible cases. Women with PCOS were 3.41 times more likely to possess knowledge about the condition. The findings suggest a moderate level of PCOS knowledge and health-related practices among Syrian women, emphasizing the need for increased awareness. Consistent local PCOS screening programs, in collaboration with obstetrics and gynecology professionals, are crucial for improving understanding and clinical symptom recognition of this condition among Syrian women.

Rhinovirus infection presenting with symptomatic hyponatremia-Atypical presentation of a common infection.

Key Clinical Message: Rhinovirus infection has the potential to exhibit unconventional symptoms like symptomatic hyponatremia. Health care professionals should remain vigilant about this potential complication, especially in cases with uncommon presentations. Timely identification and effective management of hyponatremia can mitigate potential complications and enhance patient prognosis. Abstract: The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a prominent contributor to low sodium levels. Various factors can contribute to hyponatremia, affecting the diagnosis and treatment of the condition. Of note, some infections have been identified as potential causes of SIADH. Although rhinovirus infection has been linked to SIADH, it is usually associated with severe respiratory infections. Herein, we present a distinctive case where rhinovirus caused significant hyponatremia symptoms, even in the absence of typical respiratory symptoms or fever.

Esophageal Ulceration Following the Ingestion of a Single Dose of Doxycycline: A Case Report.

Doxycycline is one of the medications that cause drug-induced esophagitis. This condition occurs due to prolonged contact of the medications with the esophageal mucosa, leading to erosion, ulcers, and, in some cases, stricture of the esophagus. Chest pain, dysphagia, and odynophagia are the most common symptoms. Endoscopy is the gold standard for confirming the diagnosis. The treatment consists of stopping the offending medication and starting proton pump inhibitors (PPIs) and sucralfate. Herein, we describe a middle-aged man who presented with severe chest pain, odynophagia, and dysphagia that started two hours after ingesting the first doxycycline pill. An endoscopy showed multiple longitudinal ulcers in the distal esophagus. Symptoms significantly improved after starting a PPI and sucralfate, and feeding was resumed two days later. A follow-up with endoscopy after two months reported completely healed esophageal ulcers. In conclusion, doxycycline-induced esophageal injury is often an underdiagnosed and underreported condition. Physicians and patients should be more aware of doxycycline's detrimental effect on the esophagus, as it can induce esophageal ulceration even after a single dose if not administered properly. Therefore, all patients prescribed oral doxycycline should receive appropriate instructions to minimize this side effect.

Iron deficiency-induced thrombocytosis presenting with blue toe syndrome.

Although the etiology of blue toe syndrome is varied, the association between blue toe syndrome and iron deficiency-induced thrombocytosis (IDIT) has not been well established. We report the case of a 38-year-old Saudi male who presented with blue toe syndrome and laboratory investigations revealed severe thrombocytosis secondary to iron deficiency. The patient was managed with analgesics, antiplatelets, anticoagulation, intravenous fluids, and iron supplementation. Subsequently, his symptoms resolved within a few days. IDIT is crucial to consider as a possible cause of microvascular thrombosis disorders, especially in patients with severe thrombocytosis.

Assessment the awareness of vitamin D deficiency among the general population in Syria: an online cross-sectional study.

BACKGROUND: Vitamin D deficiency is an importance preventable problem in the global and associates with lack levels of awareness about vitamin D. According to prior studies, in the Arab world, there is low of knowledge and awareness toward vitamin D deficiency. The target of our study is evaluating the knowledge level about vitamin D deficiency and determining the associated factors with levels of awareness of its. METHOD: This online cross-sectional study was performed in Syria between 25 February to 29 March 2023 to assess the levels of knowledge about vitamin D deficiency among general Syrian population. The study's survey was obtained from previously published research and we conducted a pilot study to assure the validity and clarity questionnaire. All Syrian individuals aged 18 or older who were able to read and write and willing to participate were included, while, non-Syrian nationality individuals and all medical staff (doctors, nurses, and medical students…), as well, those under 18 age were excluded. The questionnaire consisted of 23 questions separated into four categories. The first section was sociodemographic information of the study population. The second section measured the level awareness of the study population regarding the benefits of vitamin D. In addition, the third and fourth part evaluated knowing of the respondents about sources of and toxicity consequences of vitamin D. The data were analyzed by utilizing multivariate logistic regression in IBM, SPSS V.28 version. RESULTS: Overall, 3172 of the study population accepted to participate in this research and 57.9% the majority of them were aged in the range among 18 and 28. While, the average age of the respondents were 30.80 ± 11.957. Regarding with the awareness toward knowledge of advantages and source of vitamin D and outcomes of vitamin D toxicity. Most of the participants mentioned that vitamin D is used to treat bone disease and rickets and contributes in maintaining calcium and phosphates (91.4% and 84.6%, respectively). Whereas, more than half of them reported that sun exposure does not cause vitamin D poisoning and that vegetarians are more likelihood to have vitamin D than non-vegetarians, (54.1% and 54.9%, respectively). Only, age and occupation out of nine predictors variables were significantly correlated with adequate knowledge of Vitamin D (p-value < 0.05). The respondents aged more than 60 years were high probability to have good recognition of Vitamin D than participants aged between 18 and 28 years. (OR = 7.95). Retired participants have shown lower aware of Vitamin D 0.38 times than students. CONCLUSION: Our research revealed that most of the participated individuals have sufficient comprehension about vitamin D, despite, there were significant gap. Health education via programs by government health-care agencies, NGOs and social workers is necessary to increase the awareness and knowledge toward benefits, source, deficiency and toxicity of vitamin D to avoid injury several diseases such as rickets.

Asthma prevalence among United States population insights from NHANES data analysis.

Asthma is a prevalent respiratory condition that poses a substantial burden on public health in the United States. Understanding its prevalence and associated risk factors is vital for informed policymaking and public health interventions. This study aims to examine asthma prevalence and identify major risk factors in the U.S. POPULATION: Our study utilized NHANES data between 1999 and 2020 to investigate asthma prevalence and associated risk factors within the U.S. POPULATION: We analyzed a dataset of 64,222 participants, excluding those under 20 years old. We performed binary regression analysis to examine the relationship of demographic and health related covariates with the prevalence of asthma. The study found that asthma affected 8.7% of the U.S. POPULATION: Gender emerged as a significant factor, with 36.0% of asthma patients being male and 64.0% female (p < 0.001). Individuals aged 60 and older having the highest asthma prevalence at 34.0%. Non-Hispanic whites had the highest prevalence at 46.4%, followed by non-hispanic blacks at 26.0%. In contrast, Mexican Americans and other hispanic individuals had lower rates, at 9.6% and 9.0%, respectively. Females were 1.76 times more likely to have asthma than males (p < 0.001). Obese individuals had a 1.74 times higher likelihood of current asthma compared to underweight individuals (p < 0.001). Notably, both Non-Hispanic Whites and Non-Hispanic Blacks showed higher odds of current asthma compared to Mexican Americans (with adjusted odds ratios of 2.084 and 2.096, respectively, p < 0.001). The research findings indicate that asthma is prevalent in 8.7% of the U.S. POPULATION: Our study highlights that individuals who are female, have low income, are obese, and smoke have the highest likelihood of being affected by asthma. Therefore, public health policies should prioritize addressing these risk factors in their preventive strategies.

Knowledge and Attitude of Healthcare Providers Regarding Palliative Care and Related Factors: An Online Cross-Sectional Study.

BACKGROUND: Palliative care alleviates pain and enhances the quality of life of patients with life-threatening illnesses. Training programs are required to provide patients with proper care and advance their health because the expertise of healthcare personnel in palliative care is inadequate. AIM: We aimed to assess healthcare professionals' knowledge of palliative care because palliative care programs are infrequently used in Syria. METHODS: An online cross-sectional study was conducted between July 24, 2022, and August 28, 2022, to assess palliative care knowledge and applications among Syrian healthcare workers. The study questionnaire was designed in accordance with a previous study, and the inclusion criteria included Syrian healthcare workers, physicians, and nurses, as well as medical and nursing students. The first section of the questionnaire included sociodemographic information, while the second, third, and fourth sections assessed healthcare workers' experiences, knowledge, and attitudes toward palliative care, respectively. RESULTS: Of the 602 participants, 66.2% of the sample study were females. The majority of the respondents (72.9%) were medical students, with 18.8% residents and 8.3% nurses or nursing students. The majority of the participants (84%) correctly answered the question about pain treatment goals, while only a small percentage (5.3%) correctly answered the question about whether long-term opioid use was addictive. There were no statistically significant differences in the overall knowledge levels across demographic areas, genders, or specialties. Only 14 participants were considered knowledgeable about palliative care. Regarding attitudes toward palliative care, the three responses that received the greatest degree of agreement were "Pain relievers should be given as needed to terminally ill patients" (89.7%) and "Patients have the right to determine their own degree of psychosocial intervention" (81%). Residents in urban and rural areas scored markedly different in their attitudes. Students in their fifth year were 8.06 times more likely to have a positive attitude when compared to those in their first year. CONCLUSIONS: Our findings show that Syrian healthcare providers lack knowledge of palliative care. It is important to integrate palliative care into Syria's healthcare system to enhance the quality of life of patients who are approaching the end of their lives and to provide care for those who require it.

Emergency Contraception Knowledge, Attitudes, and Barriers Among Men: A Cross-Sectional Study.

Background Emergency contraception (EC) plays a pivotal role in the prevention of unintended pregnancies following unprotected sexual intercourse. Men's awareness regarding emergency contraception is pivotal for informed decision-making and for enhancing reproductive health in this context. This study investigated Syrian men's awareness and perspectives on emergency contraception to inform diverse reproductive health initiatives. Methods We conducted a cross-sectional study in Syria, from June 2022 and April 2023. Our study included male participants aged 18 years or older who held Syrian nationality and volunteered to participate. The data collection involved administering a questionnaire comprising three sections (knowledge, attitude, and barrier assessment), encompassing a total of 30 questions. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY). Results Most participants were aged 18-25 (65.7%) and single (75.4%) and held a university degree (79.3%). The knowledge of emergency contraception was low (36.1%), with the Internet and social media (77.5%) being the primary sources of information. While 89% held positive attitudes toward emergency contraception, only 37.3% supported nonprescription availability. Age, income, and desire for children were associated with knowledge, attitudes, and the use of emergency contraception. Men aged 26-35 exhibited the highest positive attitude (8.11±1.83). Those desiring no children showed higher attitude scores (7.42±2.04). Income was positively associated with knowledge (adjusted odds ratio {AOR}=1.75 and confidence interval {CI}=1.02-2.99) and emergency contraception use (AOR=2.87 and CI=1.27-6.48). Conclusion This study underscores the knowledge gap regarding emergency contraception in Syrian men. Despite positive attitudes, awareness remains limited, particularly among those of childbearing age. Targeted education and improved accessibility to emergency contraception can enhance its use among men, particularly in those with low socioeconomic status and younger age groups.

Assessing social accountability perspectives among Syrian medical students: a cross-sectional study.

BACKGROUND: Social accountability (SA) within medical education signifies a commitment to address critical regional, societal, and national issues through educational, research, and service activities. In resource-limited regions, marginalized communities face barriers to accessing quality healthcare, and the concept of SA is often poorly understood by students. This study aims to investigate the perspectives, awareness, and comprehension of Syrian medical students regarding the concepts and principles of SA. METHODS: This cross-sectional online study was conducted in Syria from June 1st to July 25th, 2023, to assess the perspectives on SA among medical students enrolled in pre-clinical and clinical phases from the 3rd to the 6th year, encompassing both stream I and stream II. The questionnaire included three parts: consent and introduction, socio-demographic data, and a 12-item survey assessing social accountability. Data were analyzed using Statistical Package for the Social Sciences software version 24 (SPSS 24). RESULTS: A total of 1312 medical students (62.3% females vs. 37.7% males) participated in our analysis. Less than half of the participants (45.7%) reported that their institution had a limited social mission statement regarding the communities they serve. However, only 39.6% reported that their curriculum partially reflected the needs of the population they serve. A mere 7.5% and 6.8% of respondents indicated that their school had excellent community partners and stakeholders shaping their institution, and they learned significantly about other cultures and social circumstances in the medical context through their curriculum. About 24.1% reported that their institution required them to engage in a substantial amount of community-based learning, and 37.4% believed that their class reflected a good representation of socio-demographic characteristics of the reference population. A significant portion of the participants (44.3%) stated that their school did not encourage them to pursue generalist specialties, and 12.7% felt that their institution did not have a positive impact on the community. Among the included participants, 45.8% had some level of SA status, while 37.7% indicated good SA status. Age, gender, and the phase of study were the only sociodemographic characteristics statistically associated with SA status (p-value < 0.05). The association between the 12 items determining SA and the year of study was statistically significant for seven items (p-value < 0.05). However, adjusted logistic regression revealed no significant correlation between predicting SA status and sociodemographic factors (p-value > 0.05). CONCLUSION: This study underscores the significant influence of clinical experience and gender on Syrian medical students' perceptions of SA. To enhance these perceptions, medical institutions should tailor support services for different stages of training and target initiatives to engage male students.

Awareness, knowledge, attitude, and skills regarding telemedicine among Syrian healthcare providers: A cross-sectional study.

Background: After the widespread of coronavirus disease (COVID-19) around the globe, it was imperative to establish preventative measures to restrict the virus's transmission. The purpose of this research was to present an overview of the awareness, knowledge, attitude, and abilities of Syrian physicians about telemedicine technology. Methods: An online cross-sectional study was conducted from April 1 to May 15, 2022. The questionnaire was taken from published study, and the inclusion criteria consist the Syrian doctors who worked in hospitals during the COVID-19 pandemic, mainly those who had direct contact with patients. Results: Among 385 responses, 52.72% of them were females, 83.9% of them were aged less than 30 years old, and 66% were working in the governmental sector; 66% of participants have moderate knowledge about using computers and the internet, 80% have heard about telemedicine. Despite that, 95.1% of participants have not attended any training workshop on telemedicine, and most of them have reported no availability of a telemedicine unit in their department. Only 31.7% participants have shown high awareness of telemedicine. Furthermore, no significant correlation was identified between the academic level with the age and telemedicine awareness, knowledge, attitude, or computer skills. Despite that, there was an obvious correlation between age and computer skills (P-value < 0.05). There was a significant correlation between the medical specialty and awareness, and computer abilities, especially the anesthesiology (88.5 ± 5.2), (84 ± 8.7), respectively. Spearman's rho test showed mild positive significant association in various subscales (awareness and experience, experience and skills, knowledge and attitude, knowledge and skills, and attitude and skills). Conclusion: The study results demonstrate that most of the participating clinical doctors have a neutral view of telemedicine, even though they do not know much about it and do not have considerable experience with it. It is practical to educate and train academic staff, practicing physicians, residents and medical students within the clinical stages about telemedicine.

Knowledge, attitudes and intentions of the Syrian pregnant women toward labour analgesia, and its associated factors: a cross sectional study in Syria (2022).

BACKGROUND: During the reproductive period among pregnant women, the worst pain a woman can experience is labour pain. Untreated labour pain has many detrimental effects on the mother and the fetus. Then, the inadequate levels of awareness and attitudes toward labour analgesia among pregnant women are considered a serious concern that influences no-healthy results for both the mother and the baby. Therefore, this research aimed to define the degree of Awareness, Attitude, and intent to use labour analgesia among pregnant women in Syria. METHODS: We conducted a cross-sectional study from 7 September to 23 October 2022, in which we included Pregnant Syrian women aged 18 and above. The questionnaire was based on a prior study that included verified and validated scales, which consisted of 23 questions separated into four sections. The sample size was calculated using Fisher's formula; however, our study included 638 participants. The data was analyzed using IBM SPSS Version 28.0, using descriptive and binary logistic regression methods. RESULTS: Among those who had previous deliveries, 39.4% performed a caesarian delivery, and only 1.9% had a delivery at home. Nearly half of the study participants (50.4%) reported adequate knowledge about analgesia for obstetric pain. The inquired pregnant women who had children had more odds of knowledge than participants who had not. Respondents who were childbearing at the health center were more likely to have a good attitude (Adjusted Odds ratio = 4.728, P-value < 0.05, 95%CI: 1.035-21.589) than those who were childbearing at a national referral hospital. Also, the respondents above 31 years were less likely to desire labour analgesia than those aged 18-24. CONCLUSION: Our results revealed that Syrian pregnant women have a moderated awareness, attitudes, and desire regarding labour analgesia, indicating a serious health problem among this population group. It is recommended that local and global health organizations address the current condition relevant to this issue by implementing healthy educational programmes for Syrian women through coordination with obstetric and gynaecological professionals.

Evaluating physicians' awareness and prescribing trends regarding proton pump inhibitors: a cross-sectional study.

Introduction: Proton pump inhibitors (PPIs) are commonly used to treat acid-related disorders. Their appropriate use depends on the correct indications from the clinician. Owing to the high incidence of use and misuse, PPIs have been identified as an essential pharmacological class for developing deprescribing recommendations. Therefore, assessing physicians' knowledge and practice regarding PPI usage is critical for paving the way toward targeted recommendations and efforts. Objective: This study aimed to assess Syrian physicians' perceptions of proton pump inhibitors adverse effects, their benefit in upper gastrointestinal bleeding (UGIB) prophylaxis, and how these perceptions are related to PPI prescription practice. Methods: A cross-sectional study was performed using a web-based questionnaire distributed among Syrian physicians in internal medicine between 28 November and 23 December 2022. The questionnaire assessed perceptions and experiences of PPIs, concerns about specific adverse effects, and their effectiveness for UGIB prophylaxis, in addition to the different scenarios used to determine the best practice for appropriate treatment to manage minimal, mild, moderate, and high-risk UGIB patients. Results: A total of 473 participants completed the questionnaire, with median age ±SD was (28.46 ± 4.58), and most participants (83.3%) were residents. Approximately half of the participants (45.5%) agreed that discussion assistance was provided to continue or terminate PPIs properly. Only 8.9% were very familiar with published evidence of PPI adverse effects. Bone weakening and vitamin B12 deficiency were the most frequently reported side effects (81.8% and 79.7%, respectively). However, dementia (0.4%) and mortality (1.9%) were the least reported adverse effects. More than half of the participants (64%) perceived using PPIs to prevent upper GI bleeding. Non-trainee physicians were less knowledgeable about appropriate GERD management than resident physicians (p < 0.001). Conclusion: The study showed a gap between Syrian physicians' perceptions and practices regarding PPI use, which necessitates spreading awareness of updated guidelines for PPI usage and their side effects.

Correction: Stigmatizing attitudes towards depression among university students in Syria.

[This corrects the article DOI: 10.1371/journal.pone.0273483.].

Large Ascites in a Cirrhotic Patient Reveal an Isolated and Late Metastasis of Ductal Breast Cancer: A Case Study.

Breast cancer is the most prevalent cancer in women worldwide, and its prevalence has increased since the introduction of screening programs. Most cases are discovered at an early stage; however, despite effective treatment, some cases progress to metastasis. The most common breast cancer metastatic locations are the bone, liver, and lungs. Ascites malignant due to peritoneal involvement is a rare manifestation of metastatic breast cancer. After 8 years of well-controlled breast cancer, we report a 54-year-old woman who presents with malignant ascites and is known to have cirrhosis of the liver.

Case report: Severe sinus tachycardia as a leading manifestation of systemic lupus erythematosus flare.

Systemic lupus erythematosus (SLE) is known to have various cardiac manifestations, including arrhythmias and tachycardia. However, it is rare to encounter severe sinus tachycardia as a presenting feature in patients with SLE. Herein, we present a case of a 32-year-old Filipino female with a history of recurrent hospital admissions due to palpitations and uncontrolled tachycardia. Despite trying various symptomatic treatments, her symptoms remained persistent. Ultimately, the patient was diagnosed with SLE during her hospital stay. Eventually, her symptoms improved after initiating steroids. In conclusion, severe sinus tachycardia could be an unusual presentation of SLE that physicians should consider.

Knowledge toward ovarian cancer symptoms among women in Syria: Cross-sectional study.

BACKGROUND: Ovarian cancer is the second most prevalent malignancy in women over 40, especially in low-income nations. For every 100,000 women in Syria, 473 new cases of ovarian cancer are diagnosed. This study aims to investigate the knowledge of ovarian cancer symptoms among Syrian women and determine the factors associated with good knowledge. METHODS: An online cross-sectional was performed between July 29 and August 17, 2022. The inquired participants in the study were Syrian females above 18 years. The questionnaire consists of 41 questions organized into three sections: sociodemographic information, Confidence in recognizing ovarian cancer symptoms, and women's Awareness of the symptoms of ovarian cancer. RESULTS: This research included 557 Syrian women, and the average age was 23. Only 20.5% of involved women demonstrated a good knowledge of the symptoms of ovarian cancer. The participants who agreed that abdominal pain and pelvic pain are ovarian cancer symptoms formed (36.8%), and (63.9%), respectively. Regarding the additional presenting symptoms of ovarian cancer, "extreme generalized fatigue" was the most often reported symptom (66.1%). Divorced women showed greater knowledge scores than other marital status groups (7.13 ± 3.31, P-value<0.05), while public sector participants scored higher than other occupational groups (6.38 ± 2.5, P-value<0.05). CONCLUSION: Our findings indicate that Syrian females have inadequate knowledge regarding ovarian cancer symptoms. More ovarian cancer awareness programs for Syrian women of all ages are needed to increase the early identification of this illness.

Attitude of Syrian medical specialty trainees toward providing health care services to patients with mental disorders.

BACKGROUND: The stigma associated with mental diseases in the healthcare system and among healthcare professionals has been identified as a significant barrier to treatment and rehabilitation and to the provision of substandard physical care for persons with mental illnesses. The goal of this study is to assess the attitude of physicians in Syria towards individuals with mental health disorders. METHODS: An online cross-sectional survey was conducted among phyisicians in Syria to evaluate their attitudes toward patients with mental health disorders and their provided treatment in the time period between August 16 and October 1, 2022. The questionnaire for the study was developed based on previous research, and the inclusion criteria for the sample were all medical specialist trainees from all specialties and residents who had direct contact with people suffering from mental health disorders. The questionnaire was divided into two sections; the first included sociodemographic data on the participants and the second assessed physician's attitudes toward mental illness patients. With the IBM SPSS V. 28.0 package tool (IBM Corporation, Armonk, NY, USA), descriptive and multivariate logistic regression analyses were used to analyze the data. RESULTS: 539 medical residents participated in this research; their average age was 26.11 (+- 1.74) years, and 50.27% were males. City residents had the highest stigma score on the third question (2.66 ± 1.06, P value < 0.05) in the 'social distance' domain. The mean stigma scores for these three items in the recovery area were (2.76 ± 1.15, 2.51 ± 0.92, and 3.73 ± 0.83), respectively, for city residents. In the 'social distance' domain, the stigma score of two questions (the first and fourth questions) was associated with the resident's specialty, with dermatology residents having the highest mean score in both questions (mean = 3.6 ± 1.12, 3.43 ± 1.19, respectively). Only the second item in the 'Detection' domain was scored higher (mean = 3.850.81) by surgery residents than other residents. The stigma in the 'Recovery' domain was greatest among dermatology residents (mean = 3.710.94) than among other residents. There was a statistically significant relationship between residency and the Detection stigma scale (p = 0.03, Adj R2 = 0.008). There was a moderate correlation (Adj R2 = 0.048) between the Recovery scale and three of the six predictors (location, marital status, and the number of years living in the current residence). Two demographic factors (country of residence and marital status) were significantly correlated (p0.05) with the Social Responsibility Scale, and the Adjusted R-Squared Value was 0.006. CONCLUSION: Our findings indicate substantial stigma among resident physicians who treat patients with mental illnesses, which might negatively impact both the efficacy of therapy and the phyisician's mental health. It is important to educate medical residents on mental health issues so that they can treat their patients appropriately. It is suggested that mental health concerns be included in the curriculum of residency programs for physicians so that they have adequate perspectives and attitudes about treating these patients.

Comparison of monocyte distribution width and Procalcitonin as diagnostic markers for sepsis: Meta-analysis of diagnostic test accuracy studies.

AIM: We aimed to perform a meta-analysis to find out whether PCT and MDW could be used as accurate diagnostic markers for sepsis. METHODS: We searched PUBMED, WOS, and SCOPUS databases. Inclusion criteria were any observational or clinical trials that compared monocyte Distribution Width [MDW] with Procalcitonin [PCT] as diagnostic markers in a patient with sepsis. Case reports, editorials, conference abstracts, and animal studies were excluded. RevMan software [5.4] was used to perform the meta-analysis. RESULTS: After the complete screening, 5 observational studies were included in the meta-analysis. The total number of patients included in the meta-analysis in the sepsis group is 565 and 781 in the control group. The pooled analysis between the sepsis group and controls showed a statistically significant association between sepsis and increased levels of MDW and PCT [MD = 3.94, 95% CI = 2.53 to 5.36, p-value < 0.00001] and [MD = 9.29, 95% CI = 0.67 to 17.91, p-value = 0.03] respectively. Moreover, the subgroup analysis showed that the p-value of MDW levels [< 0.00001] is more significant than the p-value of PCT levels = 0.03, the p-value between the two subgroups [< 0.00001]. Additionally, the overall ROC Area for MDW [0.790] > the overall ROC Area for PCT [0.760]. CONCLUSION: Our study revealed a statistically significant association between sepsis and increased MDW and PCT levels compared with controls and the overall ROC Area for MDW is higher than the overall ROC Area for PCT, indicating that the diagnostic accuracy of MDW is higher than PCT.MDW can be used as a diagnostic marker for sepsis patients in the emergency department. More multicenter studies are needed to support our findings.