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Background Migraine is a disabling disorder characterized by recurrent severe headache attacks. Non-invasive neuromodulation can be employed in the prevention and/or acute treatment of migraine. Remote electrical neuromodulation (REN), a type of non-invasive neuromodulation, is an effective and safe at-home treatment for migraine. It stimulates peripheral nerves in the upper arm to trigger conditioned pain modulation. Methods We searched PubMed, Web of Science, Scopus, and the Cochrane Library for clinical trials and observational studies that assess the efficacy of REN in patients with migraine attacks. Statistical analysis was performed using Review Manager version 5.4.1 and Open Meta Analyst software. Results Our study included 12 studies with 9912 migraine patients. In the single-arm meta-analysis, 64% (95% CI: 0.62 to 0.65), and 22% (95% CI: 0.213 to 0.237) of patients experienced a reduction in pain and pain-free status at 2 h, respectively. Additionally, 59% (95% CI: 0.548 to 0.637), and 54% (95% CI: 0.471 to 0.609) of patients reported sustained pain relief and sustained pain-free status at 24 h, respectively. Marked functional improvement was achieved in 59% (95% CI: 0.577–0.607) of patients within 2 h post-treatment with REN, and 54.6% (95% CI: [0.519 to 0.574]) reported the disappearance of their most bothersome symptom (MBS). Device-related adverse events were reported in 0.4% (95% CI: 0.003 to 0.005) of patients. In double arm meta-analysis, pain-free status at 2 h had an odds ratio (OR) of 2.77 (95% CI: 1.63 to 4.71). While device-related adverse events had an OR of 1.45 (95%CI: 0.42 to 4.94). Trial registration CRD42024596712

Background Dementia is a growing public health concern, affecting over 55 million people worldwide, with Alzheimer’s disease (AD) being the most prevalent cause. Cholinesterase inhibitors (ChEIs) and memantine remain the mainstay pharmacological treatment for AD and other dementias, despite their modest benefits and potential adverse effects. The safety profiles of these medications, particularly at different doses and formulations, remain inadequately explored, necessitating a comprehensive evaluation. Methods This systematic review and network meta-analysis (NMA) will assess the safety of ChEIs (donepezil, galantamine, rivastigmine) and memantine in dementia treatment. We will include randomized controlled trials (RCTs) with ≥ 3 months of follow-up, evaluating adverse events (AEs), serious adverse events (SAEs), and treatment discontinuation rates. A comprehensive literature search will be conducted in PubMed, Scopus, Web of Science, and Cochrane Library, with additional searches in Google Scholar and reference lists of included studies. Data extraction will follow a standardized approach, and study quality will be assessed using the Cochrane risk-of-bias tool-2. A Frequentist or Bayesian NMA framework will be used to compare safety profiles, with heterogeneity assessed using the I 2 test. Discussion By addressing gaps in prior NMAs, this study aims to provide an in-depth evaluation of safety outcomes associated with different ChEI and memantine doses and formulations across various dementia types. The findings will support clinicians in making informed treatment decisions and guide future research and policy development for dementia management. Systematic review registration PROSPERO (CRD42025642902).

Background Dealing with death and dying patients is one of the most challenging aspects of medical practice. The purpose of this study was to assess the attitude of medical interns toward death and dying patients as well as their level of death anxiety. Methods This cross-sectional study was conducted on medical interns across three countries—Egypt, Jordan, and Palestine—using an online survey created with Google Forms. The survey included sociodemographic information, the Approach to Death and Dying Patients Attitude Scale (ADDPAS), and Templer's Death Anxiety Scale (DAS). The sample size was calculated using OpenEpi, aiming for minimum 466 from Egypt, 273 from Jordan, and 348 from Palestine. Data were analyzed using SPSS version 27. Kruskal–Wallis and Mann–Whitney U tests were used to evaluate significant associations between demographic variables and the outcomes of the scales. Spearman’s correlation coefficients and simple linear regression analysis assessed the relationship between the scales. A p -value of ≤ 0.05 was considered statistically significant. Results This cross-sectional study analysis was done on 1156 participants. The median age was 24 years (interquartile range “IQR”: 24–25), with most living in urban areas (74.6%). Females comprised 53.6%. The median score on the DAS was 8.00 (IQR: 6–11). Hardness in communicating with the dying and their relatives and avoidance of death and dying patients subscales median scores were 2.22 (IQR: 1.89–2.44) and 2.54 (IQR: 2.18–2.81), respectively. Females had higher death anxiety and a less positive attitude toward communicating with dying patients and their relatives. Egypt scored lower on the ADDPAS subscales but higher than Palestine and Jordan on the DAS. DAS had a significant indirect relationship with hardness in communicating with the dying patients and their relatives ( r  = -.384; p  < 0.001) and avoiding death and dying patients ( r  = -.123; p  < 0.001). Simple linear regression showed that the DAS significantly predicts both subscales. Conclusions Medical interns showed moderate death anxiety and a positive attitude toward communication and avoidance of death and dying patients. Those with a higher level of death anxiety demonstrated a greater tendency to avoid dealing with dying patients and had more difficulties with communication. End-of-life training is recommended.

Strawberries are rich in antioxidants and plant components to enhance cardiac health and regulate blood sugar. This experiment investigates the effects of N fertilization and foliar spraying with calcium (Ca) and boron (B) on growth, chemical composition of plant foliage, fruit yield, and quality of strawberry plants (Fragaria × ananassa Duch. cv. Fortuna). This experiment includes 12 treatments from the combination between four N fertilizers treatments (combinations of mineral and organic fertilizers) and three foliar spraying treatments with Ca+B at 2 and 4 mL/L in addition to the control treatment (spraying with tap water). Results show that the treatment where 50% of the recommended dose of N (50% RDN) was applied with mineral fertilizer + 100% organic N was the most effective one since it induced the highest values of plant height, number of crowns per plant, number of leaves per plant, fresh and dry weight per plant, especially when combined with the foliar application of Ca+B at the highest tested rate (4 mL/L). The highest values of N, P, K, Ca, B, and total carbohydrate contents were also scored for the combination of 50% RDN + 100% organic N and the foliar spraying with Ca+B at 4 mL/L in both growing seasons. In addition, the highest values of fruit yield per plant and per hectare, exportable fruit yield/ha, fruit firmness, fruit TSS, Vitamin C, total sugars, and anthocyanin, as well as the lowest values of total acidity were recorded for the combined treatment of 50% RDN + 100% organic and Ca+B at the highest rate (4 mL/L). The highest recorded value of length, diameter, and weight of fruit were scored by fertilizing strawberry plants with the recommended dose of mineral N (100% RDN) and spraying with Ca+B at the highest rate in both growing seasons. In conclusion, it could be suggested that fertilization of strawberry plants with half the recommended dose with mineral N fertilizer + 100% organic fertilizer and foliar spraying with Ca+B at 4 mL/L increases plant growth and improve yield parameters and fruit quality of the strawberry plants.

This work investigated the effects of potassium mineral fertilizers, combined with biofertilizers (T1–T4 treatments) and the foliar spraying of seaweed extract (at 1 g/L, 2 g/L, and 3 g/L) on the vegetative growth characters, chemical constituents of foliage, and the yield and quality parameters of globe artichoke. The maximum height, and the fresh and dry weight of the leaves, was recorded in plants that received only soil with added potassium (T1 treatment) and sprayed with seaweed extract at 3 g/L. Furthermore, the highest number of offshoots per plant was registered in the T2 treatment combined with seaweed extract (3 g/L). T1 and T2 treatments resulted in the highest values of leaf N, P, K, and total carbohydrate content when combined with seaweed extract (3 g/L). The highest numbers of early, late, and total heads per plant were obtained for the T1 treatment and seaweed extract (3 g/L). Similarly, most of the head quality parameters were beneficially affected by the T2 treatment and seaweed extract (3 g/L). In conclusion, it is suggested that soil application of mineral potassium fertilizer (75% of RD) combined with biofertilizer (25% of RD) and the foliar spraying of seaweed extracts at 3 g/L, was most beneficial for the yield and quality parameters of globe artichoke plants.

Broccoli is a popular vegetable throughout the world and contains important nutritional features. This study was conducted to evaluate the effect the fertilization with different phosphorus sources (i.e., soil application of rock phosphate (RP) at 428 kg ha−1, calcium superphosphate (CSP) at 670 kg ha−1, phosphoric acid (PA) at 126 L ha−1 and monoammonium phosphate (MAP) at 334 kg ha−1) combined with biofertilizers (i.e., inoculation with phosphorin or mycorrhiza) on plant growth aspects, antioxidants enzyme activity, chemical constituents, yield and quality of broccoli leaves and heads (Brassica oleracea var. italica Plenck). The experiment was performed according to the randomized complete block design with three replications (n = 3), for two growing seasons (2018–2019) at the experimental farm of Benha University, Egypt. The obtained results showed that the highest values of plant height, leaf area, fresh and dry weight of leaves/plant, head weight and diameter, and the highest yield of heads ha−1 were recorded in plants that received MAP fertilizer and were inoculated with mycorrhiza. On the other hand, the highest value of head length, total carbohydrate and total soluble solids (TSS) content were observed in plants fertilized with PA and inoculated with mycorrhiza. The highest leaf nitrogen % and head ascorbic acid content, as well as the lowest head total phenol content were recorded in plants supplemented with MAP fertilizer and inoculated with mycorrhiza. Moreover, broccoli plants fertilized with PA and inoculated with mycorrhiza showed promising results in terms of phosphorus, potassium and total carbohydrate content, antioxidant activity and dehydrogenase activity. In conclusion, phosphorus may affect plant growth, yield and chemical parameters in broccoli plants depending on the fertilizer source, while inoculation with mycorrhiza may also have a beneficial impact on these parameters.

Epilepsy is one of the most common neurological diseases with unclear etiology where its genetic background and treatment regime still need further exploration. This study designed to evaluate the pharmacogenomics of and genes, and their association with epilepsy susceptibility among Jordanian population. A case-control study was conducted on Jordanian cohort of 296 epileptic patients and 299 healthy individuals. Custom platform array was used to genotype the genetic polymorphisms within (rs1801133) and rs717620, rs3740066, rs2273697) genes. This study revealed a significant genetic association of MTHFR rs1801133 polymorphism with susceptibility to generalized in general and generalized tonic-clonic epilepsy (GTCE)( =0.018 and 0.01, respectively). Regarding gene, rs717620 was of linkage with generalized and GTCE subtypes ( =0.045 and 0.048, respectively), while rs717620 was associated with poor responder patients ( =0.036) with no linkage of the ABCC2 haplotypes. MTHFR and ABCC2 polymorphisms showed an association with either epilepsy types in general or subtypes and treatment response among Jordanian population. This study also suggested that these gene polymorphisms have an important role in epilepsy development and drug effectiveness and could be of a great impact in the era of epilepsy diagnosis and treatment.

A total of 50 million persons were diagnosed worldwide with epilepsy. One-third of them are experiencing debilitating seizures despite optimum anti-epileptic drugs (AEDs) treatment. Several studies have suggested that CYP3A5, CHRM2, and ZNF498 influence the pharmacokinetics of AEDs. Therefore, the severity of the disease as well as the degree of response to the AEDs could be affected by the genetic polymorphisms within these genes. In this study, we assessed the effect of certain single nucleotide polymorphisms (SNPs) within , and genes on the susceptibility to develop epilepsy and the responsiveness to AEDs treatment. A case-control and pharmacogenetic study was conducted on samples of 299 healthy individuals in addition to 296 epileptic patients. Genotypic, allelic, and clinical data association were performed for the selected polymorphisms within the (rs324649, rs420817, rs15524, and rs1859690) in the Jordanian population. The analysis revealed no significant association of the investigated SNPs with epilepsy in general, partial and generalized epilepsy as well as drug responsiveness. and were associated with family history ( =0.003 and =0.002, respectively) and the classification of epilepsy for the variant =0.009). On the other hand, was not linked to either disease severity or treatment responsiveness. Our results failed to confirm the association of , and variants with either disease development or treatment response. Clinical pharmacogenetic studies may contribute to treatment personalization, appropriate drug dose selection, minimizing drug adverse reactions, increasing drug efficacy, and reducing the costive burdens.

This review evaluated recent clinical evidence on the management of sympathetic crashing acute pulmonary edema (SCAPE) with high-dose nitroglycerin (HDN) therapy. Several recent studies, including randomized controlled trials and cohort studies, were analyzed to assess the efficacy and safety of HDN compared with low-dose nitroglycerin (LDN). Across studies, HDN was associated with improved clinical outcomes, including reduced rates of ICU admission, intubation, and acute kidney injury; shorter hospital stays; a lower incidence of major adverse cardiac events; and more rapid achievement of blood pressure targets. Symptom resolution within six hours was consistently reported, and most patients were discharged without complications. Adverse effects, such as hypotension, were infrequent. Collectively, these findings support the use of HDN as a safe and effective intervention for SCAPE, warranting further large-scale randomized trials to confirm these promising results.

Purpose: To evaluate vitamin D levels among adult Sudanese RA patients and identify its correlation with RA disease activity. Patients and Methods: A bicentric cross-sectional analytical hospital-based study was performed in two Khartoum State Hospitals between October 2019 and January 2020, enrolling 90 Sudanese patients with RA. Serum vitamin D levels were measured with a standard reference level of 30ng/mL-100ng/mL. A detailed interview-based questionnaire was used to collect the patient's information, clinical data and lab results--disease activity was assessed via the DAS-28 score. The data was then analyzed using SPSS v-24. Results: Vitamin D levels were low in 79 candidates (87.8%), 53 of which (67.1%) showed moderate insufficiency (10- 30ng/mL), and 26 candidates (32.9%) had severe deficiency (less than 10 ng/mL). Regarding the disease activity, 57 participants (63.3%) had moderate disease activity (DAS-28=3.2-5.1), and 22 participants (24.4%) had high disease activity (DAS-28 >5.1). A significant negative correlation was reported between high DAS-28 scores and low vitamin D levels with p-value = <0.001 (95% CI: - 0.8591 to 0.0015) and r = -0.44. Conclusion: Most adult Sudanese rheumatoid arthritis patients showed low vitamin D levels (87.8%), which was also significantly correlated with increased disease activity (P-value <0.05). Moreover, the prevalence of low vitamin D levels was significantly higher than in numerous countries worldwide. Keywords: vitamin D, rheumatoid arthritis, DAS-28 score, Sudan