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Background: Pediatric patients infected with coronavirus disease 2019 (COVID-19) have unique clinical characteristics. Tumor necrosis factor (TNF) is a proinflammatory cytokine that greatly contributes to tumor pathogenesis.Purpose: To describe the presenting characteristics of COVID-19 infection among pediatric patients, and investigate the possible role of the TNF-α signaling pathway.Methods: This prospective case-control study included 50 Egyptian pediatric patients with COVID-19 and 50 healthy controls. Clinical, laboratory, and radiological assessments were performed. Serum TNF-alpha (TNF-α), TNF-α-converting enzyme (TACE), and angiotensin-converting enzyme 2 (ACE2) were measured using enzyme-linked immunosorbent assay. ACE (I/D) (rs4646994), ACE2 rs2285666, and TNF-α-308G/A single nucleotide polymorphisms (SNPs) were performed using conventional polymerase chain reaction techniques with or without restriction fragment length polymorphism.Results: The median age was 1 year (interquartile range [IQR], 0.31–2.50 years) in the case group and 1.45 years (IQR, 1.00–3.00) in the control group. The main presenting symptoms were fever (92%), dry cough (74%), and dyspnea (72%). The lymphocytic count was normal in 14 patients (28%), decreased in 16 patients (32%), and increased in 20 patients (40%) of the case group. Positive chest computed tomography finding of COVID-19 infection were demonstrated among 40% of patients using COVID-19 Reporting and Data System categories (ground-glass opacity with or without consolidations in the lungs). There were significant increased serum TACE and TNF-α with decreased ACE2 levels among cases versus controls (P< 0.001). The GG genotype and G allele of the TNF-α-308G/A SNP were significantly higher in patients than in controls (P<0.05 for both), with insignificant differences in genotype and allelic frequencies in the ACE (I/D) (rs4646994) and ACE2 rs2285666 SNPs.Conclusion: The TNF signaling pathway was significantly activated in pediatric COVID-19 infection. Only the TNF-α-308G/A SNP was significantly associated with pediatric COVID-19 infection.

To assess the knowledge and attitudes of the general public in Jordan towards autism. In addition, we aimed to assess their awareness of various treatment options for autism, and their attentiveness and willingness to assist. A cross-sectional survey was conducted in Jordan for the period between April and May 2022 using an online questionnaire developed based on a literature review. A total of 833 individuals in Amman city completed the questionnaires assessing participant demographics, knowledge of and attitude towards ADS, awareness of management options, perception, and ability to help. Using logistic regression, the odds ratios (ORs) and 95% confidence intervals (CIs) for those who are more likely to be informed about autism were determined. The participants' overall understanding of autism spectrum disorder was poor, with a mean score of 6.2 (SD: 3.1) out of 17, or 36.5%. The participants showed a moderately positive attitude towards autism, with an average agreement of 60.9% for government support for ADS children. The items about management options auditory integration training therapy had the highest level (50.1%). Additionally, the participants showed a moderate to high level of attention and ability to help people with autism. The majority confirmed that they see the need to implement changes in public facilities to meet the needs of autistic patients (71.8%). When compared to others, females, aged below 30, single, with family income less than 500 JD, holding a bachelor's degree, and working outside the healthcare field had a higher likelihood of knowing more about the autism spectrum condition (p ≤ 0.05). Our research illustrates the lack of awareness and knowledge among the Jordanian population regarding autism. To fill this gap, educational awareness programs should be conducted to promote Jordanian knowledge regarding autism and find ways in which communities, organisations, and governments can support so as to allow for early diagnoses and an appropriate treatment plan and therapy for autistic children.

Background Addiction to smart phones is classified clinically as behavioral addiction resulted from an excessive problematic usage of smart phones that effect the daily life of the users. Therefore, this study aims to explore the prevalence of smart phone addiction, its associated psychological distress risk, and its associated predictors among university students in Jordan. Methods Between November 2022 and January 2023, a cross-sectional online survey study was conducted in Jordan. In this study, we used previously developed questionnaire instruments, the psychological Distress scale of Kessler and the Smartphone Addiction Scale. A score of 30 was used to identify the dummy variable in the binary logistic regression analysis to identify predictors of severe psychological distress, and smartphone addiction score of 38.7 was used to to identify predictors of smartphone addiction. Results A total of 2337 university students participated in this study. The mean psychological distress score for the study participants was 30.0 (SD: 8.9). More than half of the study participants (59.1%) had a psychological distress score of 30 and above, which indicates a severe mental disorder state. More than half of the study participants (56.7%) had a smartphone addiction score of 30 and above, which reflects a smartphone addiction state. Females, divorced, those who feel that their mental abilities have been negatively affected by the use of smart phones, those who feel that using smartphones has affected their sleep and made it harder to fall asleep, and those feel that everything requires effort and fatigue, and they do not want to do any activity that requires effort were more likely to have severe psychological distress compared to others (p < 0.05). Females, those who feel that using smartphones has affected their sleep and made it harder to fall asleep, and those feel that everything requires effort and fatigue, and they do not want to do any activity that requires effort were more likely to be smartphone addicted compared to others (p < 0.05). Conclusion Mental diseases are a major public health concern in Jordan, especially among university students. Females, those who thought smartphone usage hurt their mental capacities, and those who had trouble sleeping and fatigue were more likely to develop serious psychological discomfort and smartphone addiction. Smartphones are indispensable, but excessive use can lead to addiction and harm university students’ mental health.

The prevalence of Metabolic-associated fatty liver disease (MAFLD) has been steadily increasing worldwide, paralleling the global epidemic of obesity and diabetes. It is estimated that approximately one-quarter of the global population is affected by MAFLD. Despite its high prevalence, MAFLD often goes undiagnosed due to the lack of specific symptoms in its early stages. However, as the disease progresses, it can lead to more severe liver-related complications such as fibrosis, cirrhosis, and hepatocellular carcinoma. Therefore, we aimed to investigate the expression levels of the nucleotide-binding oligomerization domain, leucine-rich repeat (LRR)—containing proteins (NLR) family pyrin domain-containing protein 3 [NLRP3] inflammasome pathway components, NLRP3 and interleukin 1β (IL-1β) genes in patients with MAFLD with various degrees of steatosis and fibrosis. Participants were classified into two equal groups; MAFLD group: consisted of 120 patients with different degrees of hepatic fibrosis and steatosis based on fibro scan results. The non-MAFLD group was comprised of 107 participants. Molecular analysis of pyrin domain-containing protein 3 and IL-1β relative gene expressions was performed in the blood of all participants, using Real-time quantitative polymerase chain reaction (RT-qPCR). Patients with post-MAFLD hepatic fibrosis had significantly higher relative gene expression levels of IL-1β and NLRP3; with IL-1β > 1.1 had AUC of 0.919, sensitivity of 88.33, specificity of 96.26, PPV of 96.4, and NPV of 88 and 92.3 accuracy ( p value < 0.001). NLRP3 > 1.33 had a sensitivity of 97.5, specificity of 99.07, PPV of 99.2, NPV of 97.2, and 98.3 accuracy with an AUC of 0.991 ( p value < 0.001) as predictors of post-MAFLD hepatic fibrosis.. A significant increase in the mean relative gene expression levels of both IL-1β and NLRP3 found in patients with early fibrosis (F0-F1-2); 31.97 ± 11.8 and 6.76 ± 2.18, respectively; compared with patients with advanced hepatic fibrosis stages (F2-F3); 2.62 ± 3.71 and 4.27 ± 2.99 ( p  < 0.001 each). The present study provides novel evidence for the possible involvement of IL-1β and NLRP3 inflammasome in metabolic-associated fatty liver disease pathogenesis and could be valid markers for the early detection of post-MAFLD hepatic fibrosis. 

Objectives: To examine the prevalence of mental distress among university students in Jordan. Methods: An online cross-sectional study using a self-administered questionnaire was conducted between 12th of June and the 4th of August 2021 in Jordan to measure student mental stress using Self-Reporting Questionnaire-20 (SRQ-20). Results: A total of 1063 university students participated in the study. One-third of the participating students reported that they had a history of COVID-19 infection. More than half of the participating university students (65.7%) were found to have mental distress (measured symptomatically by the SRQ-20 with a score of eight or more). The average mental distress score was 9.8 (SD: 5.5) out of 20. Female students, students from non-medical colleges, students in their last years of study, students with chronic diseases and those with low income were associated with high levels of mental distress (p < 0.05). With regards to social support, a moderate level of social support was received from three sources: persons considered as significant others, family members, and friends. The average social support score for the participating university students was 41.9 (SD: 10.3) out of 60 (equivalent to 69.8%). Conclusions: Mental distress is prevalent among university students in Jordan. There is a need for evidence-based governmental strategies and interventions that provide social support at universities such as self-help measures and professional mental health services as part of student health services that would be helpful to reduce the burden of mental distress of students and promote the mission of the integration of mental health in all university policies.

Cardiovascular diseases have become a leading global health burden, with rising mortality worldwide. WNT and JAK/STAT have been highlighted as emerging biomarkers in cardiovascular disease pathogenesis. This study assessed the Wnt/JAK-STAT signaling pathway in relation to SFRP5 and genetic polymorphisms in cardiac patients. This prospective case-control study included 100 patients with various cardiac diseases (IHD, valvular heart disease, HF, cardiomyopathy, and arrhythmia) and 50 matched healthy controls. Clinical and echocardiographic assessments were performed. Plasma SFRP5, Wnt5a, and JAK levels were measured using ELISA; STAT5A expression by flow cytometry; and SFRP5 (rs780369540) gene polymorphism by TaqMan real-time PCR were also performed in all participants. Cardiac patients showed significantly higher median BMI (33 vs. 28.5 kg/m , = 0.001) and markedly increased median value of each Wnt5a (16.85 vs. 5.6 pg/mL, < 0.001), median JAK (9.45 vs. 2.4 pg/mL, < 0.001), and STAT5A expression (87.55% vs. 33%, < 0.001), with lower SFRP5 levels (4 vs. 6.7 ng/L, < 0.001) compared to control. The SFRP5 (rs780369540) T allele was more frequent in patients (51.5% vs. 32%, = 0.001), and dominant TT + TC genotypes were higher (66% vs. 42%, = 0.005) compared to the control group. TT carriers showed higher median Wnt5a, lower median SFRP5, and reduced ejection fraction compared to other genotypes (TC, CC) carriers. Multivariate analysis identified elevated Wnt5a, JAK, and decreased SFRP5 as independent predictors of cardiovascular disease ( < 0.05). Cardiac patients showed altered WNT5a, JAK, and SFRP5 levels. SFRP5 polymorphism predicted cardiovascular risk independently.

ObjectiveThe burden of neurological disease-related disabilities and deaths is one of the most serious issues globally. We aimed to examine the hospitalisation profile related to nervous system diseases in Australia for the duration between 1998 and 2019.DesignA secular trend analysis using a population-based dataset.SettingThis analysis used a population-based study of hospitalised patients in Australia. Hospitalisation data were extracted from the National Hospital Morbidity Database, which collects sets of episode-level information for Australian patients admitted to all private and public hospitals.ParticipantsAll patients who were hospitalised in all private and public hospitalisations.Primary outcome measureHospitalisation rates related to nervous system diseases.ResultsHospitalisation rates increased by 1.04 times (from 650.36 (95% CI 646.73 to 654.00) in 1998 to 1328.90 (95% CI 1324.44 to 1333.35) in 2019 per 100 000 persons, p<0.01). Overnight-stay episodes accounted for 57.0% of the total number of hospitalisations. Rates of the same-day hospitalisation for diseases of the nervous system increased by 2.10-fold (from 219.74 (95% CI 217.63 to 221.86) in 1998 to 680.23 (95% CI 677.03 to 683.43) in 2019 per 100 000 persons). Rates of overnight-stay hospital admission increased by 42.7% (from 430.62 (95% CI 427.66 to 433.58) in 1998 to 614.70 (95% CI 611.66 to 617.75) in 2019 per 100 000 persons). ‘Episodic and paroxysmal disorders’ were the most prevalent reason for hospitalisation, which accounted for 49.0% of the total number of episodes. Female hospitalisation rates increased by 1.13-fold (from 618.23 (95% CI 613.24 to 623.22) in 1998 to 1316.33 (95% CI 1310.07 to 1322.58) in 2019 per 100 000 persons). Male hospitalisation rates increased by 86.4% (from 682.95 (95% CI 677.67 to 688.23) in 1998 to 1273.18 (95% CI 1266.98 to 1279.37) in 2019 per 100 000 persons).ConclusionHospitalisation rates for neurological disorders in Australia are high, potentially owing to the ageing of the population. Males had greater rates of hospitalisation than females.

Background: Epilepsy is a disorder characterized by recurring seizures that do not have an immediate identifiable cause. It is a disorder with complex symptoms and a wide range of risk factors, with age, genetics, and origin being the most prevalent variations. This study aimed to evaluate the knowledge of and attitude towards epilepsy among the Jordanian community. Method: An online cross-sectional study using a self-administered questionnaire was conducted between 29 March and 15 May 2022 in Jordan. In this study, three previously validated questionnaire items were adapted and employed. Binary logistic regression was applied to identify predictors of good knowledge and a positive attitude. Results: A total of 689 participants were involved in this study. A weak level of knowledge about epilepsy was observed among the study participants (35.3%). The participants showed a moderately positive attitude towards epilepsy (63.3%). Being female, holding a bachelor’s degree, knowing anyone who had epilepsy and seeing anyone having an epileptic seizure were factors that positively affected participants’ knowledge about epilepsy. Being aged between 24 and 29 years or being divorced were factors that affected the participants’ attitudes negatively towards epilepsy. Conclusion: The study’s participants had limited knowledge of epilepsy and a favorable attitude toward it. The community’s understanding of epilepsy and attitude toward epilepsy patients should be improved by an informed educational effort on the part of various media platforms. All facets of the community, including parents, should be the focus of these initiatives.

Gephyrin ( ) is an essential protein in the regulation of inhibitory postsynaptic density and polymorphism in the corresponding gene may have a role in the development of pharmacoresistant epilepsy (PRE). For the first time, we aimed to evaluate the association of rs928553T/C variants with PRE susceptibility. Moreover, we have analyzed the genetic polymorphism affecting \"rs12782374G/A\" in the same population to detect the effect of SNP on the drug-metabolizing ability of patients with PRE. This case-control study enrolled 100 patients (group A) and 100 healthy, age and sex-matched controls, unrelated to patients (group B). TaqMan™ assays using real-time PCR were run for genotyping of rs928553T/C and rs12782374G/A in all participants. T>C polymorphism revealed significant risk association with occurrence of PRE using dominant, recessive and codominant models as follows: TT vs (TC+CC): OR 0.23, 95%CI: 0.13-0.43, <0.001. In addition, (TT+TC vs CC): OR 0.38, 95%CI: 0.18-0.77, <0.001. Also, T vs C (OR 0.34, 95%CI: 0.22-0.51, =<0.001). Similarly, G>A polymorphism showed a significant increased risk of PRE (GG vs (GA+AA): OR 0.11, 95%CI: 0.05-0.23, <0.001). Furthermore, (GG+GA vs AA): OR 0.18, 95%CI: 0.084-0.39, <0.001. Also, G vs A (OR 0.24, 95%CI: 0.15-0.366, =<0.001). Mutation of both (rs928553) and (rs1278237) genes may be implicated as a genetic mediators of resistance in patients with PRE.