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Asthma and chronic obstructive pulmonary disease (COPD) are prevalent chronic respiratory disorders that cause significant morbidity and mortality. Some studies evaluated the use of inhaled unfractionated heparin (UFH) in the treatment of asthma and COPD. We aimed to synthesize the available evidence for the efficacy and safety of inhaled heparin in improving lung functions among asthmatic and COPD patients. A comprehensive search was performed using Pubmed, Embase, EBSCO, Scopus, Web of Science, Cochrane CENTRAL, WHO Clinical trials, clinicaltrials.gov, Iranian Clinical trials, Google Scholar, Research Gate, ProQuest Thesis, OVID, and medRxiv databases. Two independent reviewers included all pertinent articles according to PRISMA guidelines, and extract data independently. The two reviewers checked the quality of studies using the ROB2 tool. To determine the pooled effect estimate of the efficacy and safety of inhaled heparin, a meta-analysis was carried out using the R programming language. Publication bias was evaluated using Egger’s regression test. The heterogeneity was explained using a meta-regression, and the quality of evidence was assessed by the GRADE approach. Twenty-six studies with a total of 581 patients were included in the qualitative analysis and 16 in the meta-analysis. The primary outcome was treatment success (improvement of lung function) that was measured by standardized mean differences (SMD) of the forced expiratory volume per second (FEV1) either per ml or percentage. Heparin has a large effect on both FEV1% and FEV1 ml when compared to the control group (SMD 2.7, 95% CI 1.00; 4.39; GRADE high, SMD 2.12, 95% CI − 1.49; 5.72: GRADE moderate, respectively). Secondary outcomes are other lung functions improving parameters such as PC20 (SMD 0.91, 95% CI − 0.15; 1.96). Meta-regression and subgroup analysis show that heparin type, dose, year of publication, study design, and quality of studies had a substantial effect. Regarding safety, inhaled heparin showed a good coagulation profile and mild tolerable side effects. Inhaled heparin showed improvement in lung functions either alone or when added to standard care. More large parallel RCTs are needed including COPD patients, children, and other types, and stages of asthmatic patients.

Background Assessing quality of life (QoL) of caregivers of patients with tuberculosis (TB) highlights their unseen sacrifices. This study aimed to address the domains of QoL of TB caregivers and to estimate their possible determinants in Alexandria, Egypt. Methods This cross-sectional survey was conducted in the chest clinics and the main chest hospital in Alexandria, Egypt. From May to September 2023, data were collected through structured, face-to-face interviews using the World Health Organization Quality of Life– BREF (WHOQOL-BREF) questionnaire. The findings were compared to those of published results from tuberculosis patients and the general population. Multivariate regression analysis was conducted to identify the key predictors influencing the QoL of TB caregivers. Results In total, 149 caregivers participated in the study; 83.9% of them were females, and 76.5% were married. Caregivers showed QoL scores similar to TB patients in most domains ( p  > 0.05), except for the social domain, where they scored significantly lower (39.7 ± 20.2 vs. 50.3 ± 20.6; p  < 0.001). Compared to the general population, caregivers had significantly lower QoL across all domains. In the physical domain, older age (≥ 65 years) predicted lower QoL ( β = −16.45, p  = 0.022), while male gender and the absence of chronic disease were associated with higher scores ( β  = 10.48, p  = 0.022 and β  = 15.51, p  < 0.001, respectively). The psychological domain was positively affected by the absence of chronic disease ( β  = 8.23, p  = 0.015). For social relations, single and widowed/divorced individuals reported markedly lower QoL than married participants ( β = −20.96, p  = 0.003 and β = −20.18, p  < 0.001, respectively). Lastly, in the environmental domain, receiving additional caregiving support predicted improved QoL ( β  = 5.42, p  = 0.039). Conclusion TB significantly impaired the QoL of the caregivers. These findings highlight the need for the targeted interventions to improve their well-being.

Background Mental disorders are currently a global public health concern, particularly after the coronavirus disease 2019 (COVID-19) pandemic. Mental health services gradually transitioned to teleservices, employing various methods like texting and videoconferencing. This meta-analysis aimed mainly to quantify the acceptability of tele-mental health services among both beneficiaries and providers. Secondary objectives included quantifying the usability of and satisfaction with these services. Methods We conducted a systematic search of the following databases PubMed Central, SAGE, Google Scholar, Scopus, Web of Science, PubMed Medline, and EBSCO according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022. Results Out of 3366 search results, 39 studies fully met the inclusion criteria. The pooled acceptability of tele-mental health services among beneficiaries was [71.0% with a 95% confidence interval (CI) of 63.0 − 78.5%, I 2  = 98%]. Using meta-regression, four key factors contributed to this heterogeneity (R 2  = 99.75%), namely, year of publication, type of mental disorder, participant category, and the quality of included studies. While acceptability among providers was [66.0% (95%CI, 52.0 − 78.0%), I 2  = 95%]. The pooled usability of tele-mental health services among participants was [66.0% (95%CI, 50.0 − 80.0%), I 2  = 83%]. Subgroup analysis revealed statistically significant results ( p  = 0.003), indicating that usability was higher among beneficiaries compared to providers. Conclusions The study highlighted a high acceptability of tele-mental health services. These findings suggest a promising outlook for the integration and adoption of tele-mental health services and emphasize the importance of considering user perspectives and addressing provider-specific challenges to enhance overall service delivery and effectiveness.

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in severe consequences worldwide. Our study aims to assess the quality of life (QoL) domains and its determinants among the general population in Arab countries after two years of the COVID-19 pandemic. Methods: An anonymous online cross-sectional survey using the short version of World Health Organization QoL (WHOQOL-BREF) instrument was distributed among Arab adults in 15 Arab Countries. Results A total of 2008 individuals completed the survey. Amongst them, 63.2% were 18–40 years and 63.2% were females, 26.4% had chronic disease, 39.7% confirmed having contracted COVID-19, and 31.5% had experienced the unfortunate loss of relatives due to COVID-19. The survey revealed that 42.7% reported good physical QoL, 28.6% were satisfied with psychological QoL, 32.9% had a sense of well-being in the social domain, and 14.3% had good QoL in the environmental domain. The predictors of physical domains were as follows: being a male (β = 4.23 [95%CI 2.71, 5.82]), being from low-middle income country (β = -3.79 [95%CI -5.92, -1.73]) or being from high-middle-income country (β = -2.95 [95%CI -4.93, -0.92]), having a a chronic disease (β = -9.02 [95%CI -10.62,-7.44]) having a primary/secondary education (β = -2.38 [95%CI -4.41, -0.054]), number of years of work experience ≥ 15 years (β = 3.25 [95%CI 0.83, 5.73]), income-per-capita [ranged from (β = 4.16 [95%CI -5.91, -2.40]) to (β = -11.10 [95CI%, -14.22, -8.11])], a previous COVID-19 infection (β = -2.98 [95%CI -4.41, -1.60]), and having relative died from COVID-19 (β = -1.56 [95%CI -3.01, -0.12]). The predictors of psychological domain were having a chronic disease (β = -3.15 [95%CI -4.52, -1.82]), a postgraduate education (β = 2.57 [95% CI 0.41, 4.82]), number of years of work experience ≥ 15 years (β = 3.19 [95%CI 1.14, 5.33]), income-per-capita [ranged from (β = -3.52 [95%CI -4.91, -1.92]) to (β = -10.31 [95%CI -13.22, -7.44])], and a previous COVID-19 infection (β = -1.65 [95%CI -2.83, -0.41]). The predictors of social domain were being a male (β = 2.78 [95%CI 0.93, 4.73]),  being single, (β =-26.21 [-28.21, -24.32]), being from a low-income country (β = 5.85 [95%CI 2.62, 9.13]), or from a high - middle-income country (β = -3.57 [95%CI -6.10, -2.12]), having a chronic disease (β = -4.11 [95%CI -6.13, -1.11]), and income-per-capita [ranged from (β = -3.62 [95%CI -5.80, -1.41]) to (β = -11.17 [95%CI -15.41, -6.92])]. The predictors of environmental domain were being from a low-middle-income country (β = -4.14 [95%CI -6.90, -1.31), from a high-middle-income country (β = -12.46 [95%CI -14.61, -10.30]), or from a low-income-country (β = -4.14 [95%CI, -6.90, -1.32]), having a chronic disease (β = -3.66 [95%CI -5.30, -1.91]), having a primary/secondary education (β = -3.43 [95%CI -5.71, -1.13]), being not working (β = -2.88 [95%CI -5.61, -0.22]), income-per-capita [ranged from (β = -9.11 [95%CI -11.03, -7.21] to (β = -27.39 [95%CI -31.00, -23.84])], a previous COVID-19 infection (β = -1.67 [95%CI -3.22, -0.21]), and having a relative who died from COVID-19 (β = -1.60 [95%CI -3.12, -0.06]. Conclusion The study highlights the need for public health interventions to support the general population in the Arab countries and mitigate its impact on their QoL.

Bedaquiline (BDQ), an innovative anti-tuberculous (TB) agent, has attracted attention for its potential effectiveness against drug-resistant TB. This study investigated the impact of BDQ-containing regimens on treatment success rates among multi-drug resistant tuberculosis (MDR-TB) patients in Egypt. We conducted a prospective cohort study that included all adult non-pregnant patients treated in MDR-TB centers in Egypt from April 1, 2020, to June 30, 2021, with follow-up extended until December 31, 2022. The study compared patients prescribed BDQ according to national protocols with those receiving conventional treatments for MDR-TB. Treatment success rates, mortality rates, and adverse events were analyzed using descriptive statistics, chi-square tests, logistic regression, and Kaplan–Meier survival curves. Adjustment for potential confounders was conducted using propensity score matching and Cox-hazard regressions. A total of 84 patients were included in this study. The median age of the study participants was 39 years; 22.6% were women, 57.1% were unemployed or housewives, and 1.2% had human immunodeficiency virus (HIV). Regarding the treatment regimen, 67.8% were exposed to BDQ-based treatment. Among the 55 patients (65.5%) with treatment success, a significantly higher success rate was observed in the BDQ group (73.7%) compared to the conventional group (48.1%), P = 0.042. Additionally, the incidence of skin discoloration was significantly higher in the BDQ group compared to the conventional group (38.6% versus 0.0%, P < 0.001). Despite the lower mortality incidence in the BDQ-group (14.0% versus 22.2% in the conventional group), the Kaplan–Meier survival analysis revealed no excess mortality associated with the BDQ-group, with a hazard ratio (HR) of 0.62 (95% CI 0.21–1.78, P = 0.372). Propensity score matching, while considering factors such as lesion site, diabetes mellitus, hepatitis C virus, and smoking, revealed a significant increase in the success rate associated with BDQ inclusion, with an HR of 6.79 (95% CI 1.8–25.8). In conclusion, BDQ is an effective and tolerable medication for treating MDR-TB, associated with lower mortality rates compared to conventional treatment.

Recent Mpox outbreaks in non-endemic countries have highlighted the importance of global health preparedness. Combined national survey and pooled analysis were conducted to assess the knowledge and attitudes of healthcare workers (HCWs) toward Mpox in Egypt and the Arab region. An online survey was distributed to HCWs in Egypt, and a literature search of PubMed and other sources was performed to identify relevant studies from Arab countries. Descriptive statistics were utilized for all variables, with chi-square and t-tests used for comparisons. A random-effects meta-analysis was performed, with heterogeneity assessed using the I 2 statistic. Subgroup analyses were conducted to explore factors of heterogeneity. A total of 399 eligible HCWs from various Egyptian health facilities were included. The mean age of participants was 35.6 ± 7.1 years; the majority were female, married, pharmacists, and had at least five years of experience. The survey revealed that only 37.6% of Egyptian HCWs had good knowledge of Mpox, while 97.9% held positive attitudes. The meta-analysis of 30 studies from Arab countries including both HCWs and the general population, showed a pooled proportion of 35% (95% CI: 31%–39%) for good knowledge and 48% (95% CI: 37%–59%) for positive attitude. A higher positive attitude was significantly associated with female gender and HCWs. Significant knowledge gaps regarding Mpox exist among HCWs in Egypt and the wider Arab region, despite generally positive attitudes. This underscores an urgent need to update medical curricula, implement continuous educational programs and launch nationwide awareness campaigns.

Large, high-quality patient datasets are essential for applications like economic modeling and patient simulation. However, real-world data is often inaccessible or incomplete. Synthetic patient data offers an alternative, and current methods often fail to preserve clinical plausibility, real-world correlations, and logical consistency. This study presents a patient cohort generator designed to produce realistic, statistically valid synthetic datasets. The generator uses predefined probability distributions and Cholesky decomposition to reflect real-world correlations. A dependency matrix handles variable relationships in the right order. Hard limits block unrealistic values, and binary variables are set using percentiles to match expected rates. Validation used two datasets, NHANES (2021–2023) and the Framingham Heart Study, evaluating cohort diversity (general, cardiac, low-dimensional), data sparsity (five correlation scenarios), and model performance (MSE, RMSE, R2, SSE, correlation plots). Results demonstrated strong alignment with real-world data in central tendency, dispersion, and correlation structures. Scenario A (empirical correlations) performed best (R2 = 86.8–99.6%, lowest SSE and MAE). Scenario B (physician-estimated correlations) also performed well, especially in a low-dimensions population (R2 = 80.7%). Scenario E (no correlation) performed worst. Overall, the proposed model provides a scalable, customizable solution for generating synthetic patient cohorts, supporting reliable simulations and research when real-world data is limited. While deep learning approaches have been proposed for this task, they require access to large-scale real datasets and offer limited control over statistical dependencies or clinical logic. Our approach addresses this gap.

Background Assessment of quality of life (QoL) in patients with tuberculosis (TB) may improve healthcare providers’ understanding of the disease burden. This study aimed to investigate the QoL of patients with TB in Alexandria, Egypt. Methods This cross-sectional study was conducted in chest clinics and main chest hospitals in Alexandria, Egypt. A structured interview questionnaire was used to collect data from participants through face-to-face interviews from November 20, 2021, until the June 30, 2022. We included all adult patients aged 18 years or above during the intensive or continuation phase of treatment. The World Health Organization (WHO) WHOQOL-BREF instrument was used to measure QoL, which includes the physical, psychological, social relationships, and environmental health domains. Using propensity score matching, a group of TB free population was recruited from the same setting and completed the questionnaire. Results A total of 180 patients participated in the study: 74.4% were males, 54.4% were married, 60.0% were 18–40 years old, 83.3% lived in urban areas, 31.7% were illiterate, 69.5% reported insufficient income, and 10.0% had multidrug-resistant TB. The TB-free population group had higher QoL scores than the TB patients’ group: (65.0 ± 17.5 vs. 42.4 ± 17.8) for the physical domain, (59.2 ± 13.6 vs. 41.9 ± 15.1) for the psychological domain, (61.8 ± 19.9 vs. 50.3 ± 20.6) for the social domain, (56.3 ± 19.3 vs. 44.5 ± 12.8) for the environment domain, (4.0(3.0–4.0) vs. 3.0(2.0–4.0)) for general health, and (4.0(3.0–4.0) vs. 2.0(2.0–3.0)) for the general QoL, P  < 0.0001. Patients with TB aged 18–30 years had the highest environmental score compared with the other age groups ( P  = 0.021). Conclusions TB had a significant negative impact on QoL, with the physical and psychological domains being the most affected. This finding necessitates strategies to improve QoL of patients with to enhance their compliance to treatment.

Tuberculosis (TB) is a significant global public health concern. The incidence of extrapulmonary tuberculosis (EPTB) is increasing; however, comprehensive data on its epidemiological and clinical characteristics remain limited, especially among populations who are co-infected with human immunodeficiency virus (HIV) or hepatitis C virus (HCV). This study aimed to assess the incidence and predictors of EPTB in patients co-infected with HIV or HCV in Egypt. We conducted a retrospective cohort study on patients infected with TB who are treated in Egyptian chest hospitals from January 1 to December 31, 2023. Patients were categorized into pulmonary TB (PTB) and EPTB. Clinical data, including HIV or HCV co-infection status, were analyzed to identify risk factors and comorbidities associated with EPTB. Multilevel logistic regression was employed to examine predictors of EPTB. Among 7,245 TB patients, 42.5% were diagnosed with EPTB. Determinant of EPTB were HIV-positive (OR = 0.46, 95% CI: 0.30–0.71, p  < 0.001), being male (OR = 0.31, 95% CI: 0.27–0.35, p  < 0.001 ), age (particularly children under 5 years) (OR = 4.75, 95% CI: 2.29–9.84, p  < 0.001 ), urban residency (OR = 1.05, 95% CI: 0.87–1.27, p  < 0.05), and comorbidities (OR = 0.59, 95% CI: 0.35–0.98, p  < 0.05). The most common sites for EPTB were the lymph nodes (27.10%) and pleural cavity/effusion (24.60%). EPTB represents a substantial proportion of TB cases in Egypt, particularly among younger individuals and females. Despite the low percentage of HIV or HCV co-infection in EPTB cases, further analysis and diagnostic testing of undiagnosed patients are required. These findings underscore the need for targeted interventions and comprehensive care models for TB patients, especially in the context of HIV co-infection.

Background Geriatric dentistry is an understudied area in dental schools in Egypt. Our study aimed to assess the knowledge and attitudes of Egyptian dentists regarding geriatric oral health and identify barriers to delivering dental care to geriatric patients. Methods We conducted an anonymous online cross-sectional study in November and December 2022, targeting dentists with varying levels of experience working in different Egyptian institutions. A 30-item questionnaire assessed the respondent’s views on geriatric oral health, perceived knowledge, attitudes, and barriers. The Google form was distributed through emails and commonly used social media platforms. Results A total of 421 dentists responded to this online questionnaire. Of the respondents, 44.9% were male, 45.0% were between 20 and 29 years old, and 31.5% worked in more than one dental setting. Multivariate analysis revealed that female sex negatively affected attitude β = -1.72 [95%CI,-2.43 – -1.11]. The proportion of older patients who visited the respondents’ clinics per day (11–30%) and more than 30% increased perceived knowledge [β = 1.01 (95%CI, 0.41 –1.62), β = 1.50 (95%CI, 0.71–2.22)] and attitude [β = 0.70 (95%CI, 0.06–1.40), β = 0.73 (95%, 0.13–1.61)] while decreased the perceived barriers [β = -1.10 (95%CI, -1.91 – -0.32)] respectively. On the other hand, years of experience increased perceived knowledge only after 5–10 years [β = 1.02 (95%CI, 0.04–2.10)] and after more than 10 years [β = 1.30 (95%CI, 0.21–2.70)]. Governmental work only increased perceived barriers [β = 1.33 (95%CI, 0.10–2.54)], while living in the middle and west delta decreased perceived barriers [β = -0.91 (95%CI, -2.12 – -0.01 and β = -1.33, (95%CI, -2.22 – -0.40) respectively]. Conclusions Our study highlights the need to improve the knowledge and attitudes of young dentists towards geriatric dentistry. Furthermore, working conditions in dental facilities, particularly in the government sector and Upper Egypt, need to be improved to reduce barriers to delivering dental care to geriatric patients.