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Despite the availability and benefits of the Human papillomavirus (HPV) vaccine, parental acceptance remains low in the eastern mediterranean region (EMR). Therefore, this meta-analysis aimed to estimate the pooled proportion of parental uptake and willingness to vaccinate their children with the HPV vaccine and their determinants in the EMR. We searched PubMed Central, PubMed Medline, Scopus, Web of Science, ProQuest, Google Scholar, and medRxiv according to PRISMA guidelines until the 5th of April 2024. We included all papers discussing parental uptake and willingness to vaccinate their children with the HPV vaccine in EMR without time or language limitations. The study risk of bias was assessed using the Newcastle–Ottawa Scale quality assessment tool. We pooled data using the random effect model. Leave one sensitivity analysis, subgroup analysis, and meta-regression were used to address heterogeneity. Out of 1551 screened studies, thirty-three studies of 18,455 parents from 12 countries fully met the inclusion criteria and were eligible for meta-analysis. The pooled proportion of parental willingness for future HPV vaccination, based on 32 studies involving 17,815 parents was 61 % (95 % CI: 54–68 %, I2 = 99 %). Using meta-regression, the proportion of working parents, study quality, and geographical region explained approximately 52.46% of the observed heterogeneity. In contrast, based on 9 studies involving 5029 parents, the pooled proportion of parental uptake was 7 % (95 % CI: 5–10 %, I2 = 91 %). Using meta-regression, study quality and geographical region explained 71.42% of the observed heterogeneity. Despite the high parental willingness for HPV vaccination, the uptake of the vaccine in EMR remains critically suboptimal and far behind the goal of the World Health Organization's cervical cancer elimination strategy. Urgent interventions are needed, including adding the vaccine to the national vaccination programs (NVPs) and tailoring parents–targeted awareness campaigns to improve knowledge and address barriers to vaccine uptake.

Metabolic dysfunction-associated steatotic liver disease (MASLD), is a common liver disorder, predicted to increase globally. Currently, non-invasive methods are proposed for the assessment of (MASLD). This study aimed to investigate the use of serum Liver Type Fatty Acid Binding Protein (L-FABP) concentration as a diagnostic and prognostic biomarker in pediatric MASLD patients and to evaluate its relationship with steatosis and fibrosis. An observational, cross-sectional study on paediatric MASLD patients. Serum levels of L-FABP and hepatic biochemical markers were measured and analyzed. Statistical analyses evaluated the association between L-FABP and other markers, while logistic regression and ROC curves assessed its diagnostic accuracy. Serum L-FABP levels showed a significant difference between the MASLD and control groups (P < 0.0001). The results of logistic regression revealed that each one-unit elevation of L-FABP level was associated with 144.5% higher odds of being MASLD (95% CI: 129.3% - 167.8%). A receiver operating characteristics (ROC) curve was constructed to assess the diagnostic accuracy of L-FABP. The resulted area under the ROC curve (AUC) was 0.885. The cutoff value was 5.7 ng/ mL, with sensitivity of 72.73%, and a specificity of 93.62%. The results also showed that the odds ratio of progressing from stage F2 to F3 increases by 108.9% (95% CI: 87.2% - 141.4%) for each one-unit increase in serum L-FABP level. L-FABP shows promise as a non-invasive biomarker for diagnosing and monitoring MASLD in pediatric patients. Its association with disease stages suggests its utility in assessing disease progression, particularly in advanced stages.

Background Stroke is a major public health burden, with high mortality and long-term disability, particularly in low-resource and conflict-affected settings. In Sudan, the ongoing armed conflict since April 2023 has critically impacted healthcare delivery, yet its effects on stroke care remain underexplored. Methods A descriptive cross-sectional survey was conducted among 431 physicians managing stroke cases during the 2024 Sudan conflict. Data were collected through a self-administered questionnaire distributed via medical networks. Descriptive statistics summarized the findings, and Kruskal-Wallis tests assessed associations. Results Most respondents were general practitioners (49.2%), with over 80% having ≤ 5 years’ experience and working in public hospitals. Nearly 49% reported significantly worsened stroke outcomes since the war, and 58% noted increases in both incidence and severity. Key barriers included delayed hospital arrival (38.5%), lack of neuroimaging (28.8%), and financial constraints. Over 70% cited shortages in supplies; rehabilitation was disrupted by facility loss, displacement, and inadequate follow-up. Complications such as recurrent strokes (57.5%) and infections (53.4%) were common. No significant associations were found between demographic factors and responses patterns to stroke management services. Conclusion The war has led to a systemic collapse in stroke management in Sudan. A coordinated response is urgently needed to address diagnostic limitations, security risks, and rehabilitation gaps. Strengthening training, infrastructure, and resource delivery must be prioritized in future recovery strategies.

Background Since the outbreak of armed conflict in Sudan on April 13, 2023, 13 million have been displaced, with young people bearing a significant share of the psychological burden. Despite growing awareness, the mental health impact of this crisis remains underexplored, especially among internally displaced persons (IDPs) and refugees aged 15 to 35. Methods This cross-sectional study assessed the prevalence and associated factors of depression, anxiety, and post-traumatic stress disorder (PTSD) among the displaced Sudanese youth, using validated screening tools (PHQ-9, GAD-7, and PC-PTSD-5). Participants were reached via an online questionnaire between September 2024 and January 2025. Multivariate logistic regression was conducted to identify key predictors for each mental health condition. Results Depression and anxiety were widespread, affecting over half the respondents, while PTSD symptoms were present in 19%. Financial loss, bereavement, job loss, and disruption of education were significantly associated with both depression and anxiety. PTSD was more likely among individuals displaced for over two years, those who experienced personal loss, and those whose education was interrupted. Females were disproportionately affected across all mental health outcomes. Conclusion The mental health toll of the ongoing conflict in Sudan is severe among displaced youth, with a high prevalence of depression and anxiety driven by financial insecurity, loss, and disrupted life trajectories. These findings underscore the urgent need for integrated mental health services within humanitarian responses. Addressing trauma through community-based interventions and psychosocial support is critical to prevent long-term harm.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease (NAFLD), often coexists with type 2 diabetes mellitus (T2DM) due to shared metabolic pathways such as insulin resistance. Empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, may provide hepatic and metabolic benefits. This study evaluated its effects on liver fat, enzymes, fibrosis, metabolic parameters, and inflammation in T2DM with MASLD. A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed according to PRISMA guidelines. Primary outcomes included liver fat content, enzymes, and fibrosis markers. Secondary outcomes were metabolic and inflammatory parameters. Eleven RCTs (n = 3077) were included. Empagliflozin significantly reduced liver fat (MD = -3.11%; 95% CI: -4.12 to -2.11; p < 0.00001) and liver stiffness (MD = -0.43 kPa; p = 0.003), but had no significant effect on AST (-0.27 IU/L; p = 0.89) or GGT (-9.25 IU/L; p = 0.14). It significantly lowered HbA1c (-0.54%; p < 0.0001), fasting glucose (-20.89 mg/dL; p < 0.0001), weight (-2.04 kg; p < 0.0001), and waist circumference (-3.47 cm; p < 0.0001), with a nonsignificant reduction in BMI (-0.77 kg/m²; p = 0.09).Uric acid decreased (-0.41 mg/dL; p < 0.00001), but IL-6 and fibrosis scores (FIB-4, NFS) remained unchanged. Empagliflozin improves liver fat, stiffness, glycemic control, body weight, and uric acid in T2DM with MASLD, but its effects on fibrosis and inflammation remain uncertain. Larger, long-term histologic trials are needed to confirm these outcomes.

Background Anorectal hemorrhoids are a common condition that frequently needs surgery in more challenging situations. Both stapled hemorrhoidectomy and conventional hemorrhoidectomy are standard surgical procedures, each one with various advantages and disadvantages as well. The purpose of this study is to compare the outcomes of these two operations concerning patient satisfaction, complications, recovery time and postoperative pain. Method This retrospective cohort analysis was conducted in Karbala, Iraq, at AL-Kafeel Hospital and AL-Safeer Hospital. Information has been collected from patients who had stapled hemorrhoidectomy in 2023–2024 and those who had conventional hemorrhoidectomy from 2015–2018. To account for baseline variations, especially those related to the kind of anesthetic and extent of hemorrhoids, propensity score matching (caliper = 0.05) was employed. SPSS version 29.0 was used for statistical analysis, and comparisons were made by using t-tests, chi-square tests, and correlation analyses. Statistical significance was defined as a p-value of less than 0.05. Results Out of 114 patients (50 conventional, 64 stapled), the stapled group had a higher percentage of fourth-degree hemorrhoids, postoperative pain and bleeding were significantly lower in the stapled group (p < 0.001), and only the conventional group had wound infections and anal stenosis (p < 0.05). The stapled group also showed better postoperative outcomes. Conclusion Stapled hemorrhoidectomy is linked to less pain, fewer complications, and faster recovery than conventional hemorrhoidectomy, but the risk of recurrent hemorrhoidectomy is still a concern. These findings support that surgical decision-making in hemorrhoid management can be optimized.