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This study examines how digital transformational leadership (DTL) drives superior and enduring organizational performance through the mediating roles of organizational agility (OA) and digital transformation (DT) while assessing the contingent moderating role of digital culture (DC). Anchored in the Resource-Based View (RBV), the study conceptualizes DTL as a strategic intangible capability that enables the orchestration of digital and agile resources into sustained performance outcomes in digitally turbulent environments. Data were collected from 284 senior and middle managers across 13 Palestinian commercial banks—a highly regulated sector undergoing intensive digital pressure in an emerging-economy context—using an online survey. The proposed relationships were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) with SmartPLS 4.0. The results reveal that DTL significantly enhances both OA and DT, which in turn contribute positively to organizational performance. OA and DT operate as both independent and sequential mediators, uncovering a multistage capability-building pathway through which leadership fosters long-term adaptability and resilience. The findings further indicate that digital culture conditions the effectiveness of leadership-driven transformation, shaping how digital initiatives consolidate into enduring organizational routines rather than short-term efficiency gains. By reframing sustainable transformation as the continuity of organizational performance through agility, digital renewal, and cultural alignment—rather than as an ESG outcome alone—this study refines RBV boundary conditions in digital contexts. The study contributes theoretically by clarifying how leadership-enabled capabilities generate sustainable competitive advantage and offers actionable managerial insights for cultivating agility, embedding digital transformation, and strengthening cultural readiness to support long-term organizational resilience.

The combination of ABT-199, a BCL-2 inhibitor, and Vorinostat, a histone deacetylase inhibitor, holds great potential in colorectal cancer therapy due to their synergistic effects. However, their poor solubility and bioavailability present challenges for effective treatment. This study aimed to co-encapsulate these drugs in poly(lactic-co-glycolic acid) nanoparticles to enhance stability, control drug release, and preserve their synergistic anti-proliferative effects in colorectal cancer cells. This study initially focused on evaluating the anti-proliferative activity of free ABT-199 and Vorinostat in HT-29 and HCT116 colorectal cancer cells. The drugs demonstrated potent cytotoxic effects, with Vorinostat exhibiting IC 50 values of 1.32 µM in HT-29 cells and 2.04 µM in HCT116 cells, while ABT-199 displayed IC 50 values of 4.04 µM and 5.49 µM, respectively. To investigate the interaction between ABT-199 and Vorinostat, the combination index was calculated using the Chou-Talalay method. The analysis revealed strong synergism between the drugs in both cell lines, with CI values consistently below 1 across all tested molar ratios. The most pronounced synergy was observed at a 1:1 molar ratio, which exhibited the lowest CI values. Building on these results, ABT-199-loaded nanoparticles (ABT-NPs), Vorinostat-loaded nanoparticles (VOR-NPs), and dual-loaded nanoparticles (DLNPs) were formulated using the nanoprecipitation method. ABT-NPs and VOR-NPs had sizes of 210.6 ± 6.2 nm and 202.5 ± 5.6 nm, with encapsulation efficiencies of 73.2 ± 4.81% and 86.4 ± 5.5%, respectively. The DLNPs, which co-encapsulated both drugs at a 1:2 molar ratio, exhibited a size of 210 ± 7.3 nm and maintained good stability. Cytotoxicity studies revealed that both ABT-NPs and VOR-NPs retained comparable anti-proliferative effects to the free drugs, with IC 50 values close to those of their unencapsulated counterparts. Furthermore, DLNPs enhanced the anti-proliferative effect, significantly increased the apoptotic cells as measured by flow cytometry which was coincided with an increasing caspase-3 activity in both HT-29 and HCT116 cells, indicating an enhanced apoptotic response.

The wide diversity of microbiota at the genera and species levels across sites and individuals is related to various causes and the observed differences between individuals. Efforts are underway to further understand and characterize the human-associated microbiota and its microbiome. Using 16S rDNA as a genetic marker for bacterial identification improved the detection and profiling of qualitative and quantitative changes within a bacterial population. In this light, this review provides a comprehensive overview of the basic concepts and clinical applications of the respiratory microbiome, alongside an in-depth explanation of the molecular targets and the potential relationship between the respiratory microbiome and respiratory disease pathogenesis. The paucity of robust evidence supporting the correlation between the respiratory microbiome and disease pathogenesis is currently the main challenge for not considering the microbiome as a novel druggable target for therapeutic intervention. Therefore, further studies are needed, especially prospective studies, to identify other drivers of microbiome diversity and to better understand the changes in the lung microbiome along with the potential association with disease and medications. Thus, finding a therapeutic target and unfolding its clinical significance would be crucial.

Vitamin B12 deficiency is classically associated with anemia and neurological dysfunction. However, recent studies suggest that elevated plasma vitamin B12 may indicate increased short-term cancer risk. This association remains largely unexplored in Middle Eastern populations, including Jordan, where cancer rates are rising and diagnosis often occurs at advanced stages due to limited screening. This study is aimed at investigating the association between serum vitamin B12 levels and the risk of colorectal, breast, and lung cancers in a Jordanian population, evaluating differences by cancer type and stage. A retrospective case-control study was conducted at King Abdullah University Hospital, Jordan, from January 2018 to December 2022. The study enrolled 260 patients diagnosed with colorectal, breast, or lung cancer and 260 matched healthy controls. Data collected included sociodemographic factors, clinical characteristics, and serum vitamin B12 levels. Serum vitamin B12 levels were significantly higher in cancer patients compared with controls (579.23 ± 468.72 vs. 492.70 ± 174.36 pg/mL; = 0.005). High vitamin B12 levels (> 800 pg/mL) occurred in 15.8% of cancer patients versus 1.5% of controls ( < 0.001). Vitamin B12 levels varied significantly by cancer type, being highest in lung cancer patients (669.53 ± 566.59 pg/mL) compared with breast (594.86 ± 468.9 pg/mL) and colorectal cancer patients (439.62 ± 291.89 pg/mL; = 0.024). There was a strong positive correlation between vitamin B12 levels and cancer stage, peaking in Stage IV cancers, = 0.629, = 0.001. Elevated serum vitamin B12 levels are significantly associated with solid cancers in Jordanian patients, particularly pronounced in lung cancer and advanced stages. These findings do not imply a causal relationship, but rather suggest that serum vitamin B12 may function as a potential biomarker for cancer detection and disease monitoring in resource-limited settings.

Multimorbidity, the coexistence of two or more chronic conditions, is increasingly prevalent in Jordan, a middle-income country with a growing non-communicable disease (NCD) burden and limited data on medication adherence. This study examined adherence prevalence, predictors, and barriers among Jordanians with multimorbidity to inform interventions supporting Sustainable Development Goal 3. A cross-sectional, mixed-methods study was conducted from April to December 2024 in two tertiary Hospitals' outpatient clinics in Amman. Adults (≥18 years) with ≥2 chronic conditions requiring ongoing medication ( = 405) were recruited via convenience sampling. Adherence was assessed using the General Medication Adherence Scale (GMAS, 0-33; high adherence defined as GMAS ≥27) alongside a Self-Administered Comorbidity Questionnaire (SCQ)-like checklist. Qualitative data were collected through an open-ended question and analyzed using thematic analysis. Descriptive statistics, correlation analysis, and logistic regression were used. Qualitative data were analysed using thematic analysis. Of 420 invited participants, 405 completed the survey (response rate: 96.4%). High adherence (GMAS ≥27) was observed in 54.3% of participants. Factors positively associated with medication adherence included older age, higher income, fewer medications, higher health literacy, and social support, while cost, polypharmacy, forgetfulness, rural residence, and low perceived medication necessity were key barriers. Six qualitative themes were identified: economic strain, access gaps, cultural beliefs, religious coping, caregiving burden, and symptom management issues. This first study of medication adherence in Jordanian multimorbidity highlights actionable barriers and facilitators, offering a scalable model for resource-limited settings. Subsidies, mobile pharmacies, and culturally tailored strategies could substantially reduce the non-adherence rates, advancing NCD control regionally and globally.

This study aimed to assess the medical care strategies for primary Hypertension in Iraqi adults through a hospital-based problem-oriented plan to improve patient outcomes by identifying and addressing medical problems. This cross-sectional study was conducted in a hospital setting of Iraqi adults diagnosed with primary hypertension. Data collection involved patient interviews, medical record reviews, and measurements of blood pressure (BP). The assessment of medical problem-oriented plans (MPOPs) was performed using the validated Alsayed_v1 tool, which includes three main components: the assessment of treatments, the MPOP classification system, and the care plan. The study participants of 80 Iraqi patients had a mean age of 52.3 years, with 55% male and 45% female. Common comorbid conditions included diabetes mellitus (40%), chronic kidney disease (30%), and coronary artery disease (20%). The most commonly prescribed antihypertensive medications were angiotensin-converting enzyme inhibitors (ACEI) (75.00%). On average, participants were taking 2.087 antihypertensive medications (SD = 0.60), with the majority (63.75%) using a combination of two medications. However, the average BP among participants was 148/92 mmHg, indicating uncontrolled hypertension in most cases (90%). The study identified an average of 3.2 MPOPs per patient, with the most common being inappropriate drug selection (25%), incorrect dosage regimen (20%), and non-adherence to treatment (15%). The chi-squared analysis revealed a significant association between gender and blood pressure status (Χ² = 4.366, p = 0.037). Additionally, the study identified 233 MPOPs across four categories: Indication (23.18%), Effectiveness (53%), Safety (7%), and Patient-related issues (17%). A multiple regression analysis was performed to identify predictors of the number of MPOPs with which heart failure was a significant predictor (β = 4.931, p = 0.003). The findings highlight the complexity of managing hypertension in Iraqi adults and underscore the need for personalized treatment plans to address the medical problems. Implementing a problem-oriented approach in clinical practice can lead to better BP control and improved health outcomes. This study provides valuable insights for healthcare providers and policymakers to enhance hypertension management strategies in Iraq. However, the study's findings should be interpreted with caution due to limitations such as a relatively small and specific sample, reliance on self-reported data, and the cross-sectional design, which restricts causal inference.

ObjectivesOnline purchasing, including drugs, increased dramatically in the last decade especially through the COVID-19 pandemic. The aim of this study was to investigate the frequency and attitudes of consumers concerning online drug purchasing and assess their perceptions regarding the benefits and disadvantages.DesignA web-based survey conducted through a self-administered questionnaire that was approved by the Institutional Review Board (IRB) committee, ethical approval number: IRB/Al-Ahliyya Amman University/3/13/2021-2022. Cronbach’s alpha for the attributes of benefits and disadvantages was 0.608 and 0.744, respectively. Primary outcome measures were extent of trust of the public in online drug purchasing using Likert scale. Multivariate linear regression was used to assess predictors of the trust score.SettingsHashemite Kingdom of Jordan.ParticipantsInclusion criteria; residents of the Hashemite Kingdom of Jordan 18 years or older. The questionnaire was distributed through snowball effect via different social media.ResultsA total of 428 participants filled the questionnaire, their average age was 29.7±11.2. Almost all participants, 419 (98.6%) use the internet daily but only 79 (18.6%) participants shop online regularly. Fifty participants (11.8%) purchased drugs online and they had higher benefits score of online purchasing compared with those who did not buy drugs online, 12.5±3.7 and 10.9±3.1, respectively, p=0.002. Participant who purchased drugs online had an increase in trust score of 0.847 compared with those who did not purchase drugs online, p<0.001. In the multivariate model, participants with education level of high school or higher than high school, compared with those with education lower than high school had an increase in trust score of 1.336 (p=0.026) and 1.137 (p=0.039), respectively.ConclusionThe public recognises the risks in buying drugs online. Awareness campaigns and regulations that control and monitor online drug purchasing should be implemented.

This study aimed to describe the molecular epidemiology and seasonality of human rhinovirus (HRV) in chronic obstructive pulmonary disease (COPD) and its association with COPD exacerbations in Abu Dhabi, the United Arab Emirates (UAE). Sputum specimens were collected for analysis from all COPD patients who visited a medical center from November 2021 to October 2022. The real-time quantitative polymerase chain reaction (qPCR) test was used to detect HRV. Of the 78 COPD patients included in the study, 58 (74%) patients presented with one or more exacerbation episodes. The incidence of COPD exacerbation peaked over the winter and substantially decreased during the summer. HRV positivity in patients during exacerbation (E1) was 11/58 (19%) and 15/58 (26%) two weeks after the exacerbation episode (E2). There was no significant difference in the HRV load in these patients. No statistically significant difference was observed in the detection of HRV during exacerbation compared to patients with stable COPD. This is the first study to assess the association between HRV detection by qPCR and COPD exacerbations in the UAE. The high sensitivity of the detection technology helped collect reliable epidemiologic data. Few studies have provided similar Middle East data. This study's pattern of COPD exacerbations and HRV detection parallels that of temperate countries. This information can help with future, more extensive surveillance of respiratory viruses in the UAE and the Middle East and their association with COPD exacerbations.

This study aimed to evaluate Jordanian healthcare professionals' knowledge, skills, and experience in dealing with and treating adult asthmatic patients and assess healthcare professionals' compliance with the Global Initiative for Asthma (GINA) guideline recommendations for asthma treatment and management in Jordan. A cross-sectional survey was conducted in Jordan between May and June 2023. This study included physicians, pharmacists, and nurses working in clinical settings and directly interacting with asthma patients in Jordan's private and governmental healthcare facilities who were eligible to participate in this research. Three primary sections of an online survey were constructed using Google Forms and included demographic data, a diagnosis and management of the illness, and a list of worldwide medical references for asthma. A total of 300 healthcare professionals, including pharmacists (103), nurses (87), Doctor of Pharmacy (28), and physicians (82), took part in this research. The survey respondents' general knowledge of the nature and symptoms of asthma is quite high, exceeding 84% and 86%, respectively. The survey also showed a high degree of awareness of asthma diagnosis. It was also revealed that around one-quarter of participants consistently reported the severity of asthma. The most frequent factor influencing the decision to take controller or maintenance medicines is symptom severity (reported from 86% of participants). The GINA guidelines were selected as the asthma information source by almost half of the participants. Finally, 47% of participants were aware of the GINA's 2019 adjustments of the recommendations. This study showed that Jordanian healthcare professionals understand the nature, symptoms, and diagnoses of asthma disease. However, many of the survey participants lack adherence, awareness, and understanding of the GINA recommendations about asthma management. More research is required to assess the adherence to the evidence-based recommendations and evaluate the impact of training courses.