Search Results (3,499)

Background: Lebanon adopted the World Health Organization (WHO)’s regional strategic plan (2012–2020) to achieve measles elimination. We aimed to analyze WHO measles surveillance performance indicators to identify areas for improvement. Methods: We reviewed suspected measles and rubella cases notified to the national epidemiological surveillance program between January 2013 and December 2024. A suspected case was defined as any patient with a febrile maculopapular rash or considered clinically compatible by physicians. We assessed notification rates of discarded non-measles/rubella suspected cases, timeliness of investigations within 48 h, completeness of case investigations (demographic and vaccination data), and proportion of cases tested for measles/rubella. Mean proportions and standard deviations were calculated across years and provinces. Results: A total of 6581 suspected cases were reported, predominantly from hospitals (66%). Outbreaks occurred in 2013 (n = 1760), 2018–2019 (n = 1984) and 2023–2024 (n = 346). Outside outbreak years, the notification rate ranged between 0.7 and 1.8 per 100,000 population. Timely investigation was achieved in 72% (±30%) of cases, while adequate investigation reached 52% (±19%). Laboratory testing was performed in 62% (±16%) of cases. Conclusions: Surveillance in Lebanon showed suboptimal sensitivity, a high proportion of hospitalized cases, and variability in completeness of epidemiological and laboratory investigations. Strengthening outpatient reporting and continuous training of healthcare professionals are essential to improve surveillance performance. Full article

Background/Objectives: Cancer patterns in low-resource and crisis-affected settings are poorly characterized, particularly among socioeconomically vulnerable populations. This study aimed to describe cancer distribution, age at diagnosis, and barriers to care among patients presenting to a non-governmental organization (NGO) in Tripoli, Lebanon. Methods: We conducted a retrospective analysis of patients with histopathologically confirmed cancers presenting to a single NGO. Sociodemographic, clinical, and behavioral data were extracted from medical records. Socioeconomic status (SES) was assessed using a validated composite scale. Age-standardized proportions (ASPs) were calculated using GLOBOCAN and WHO standard weights. Barriers to care were categorized into financial, geographic, system-level, and sociocultural domains. Associations were assessed using chi-square tests and regression models. Results: Breast cancer was the most common malignancy (32.0%), followed by colorectal (CRC: 9.8%). A total of 440 patients were included. Colorectal cancer (CRC) was the second-most common malignancy, with 37% of cases occurring before age 50. Breast cancer accounted for nearly half of female cancers. Smoking-related malignancies, particularly bladder and lung cancers, were prominent. Sex differences were cancer-specific, with male sex associated with bladder cancer but not overall cancer distribution. Barriers to care were highly prevalent: 97.3% reported at least one financial barrier, 95.4% system-level barriers, and 72.4% geographic barriers. Low SES was significantly associated with geographic barriers (p < 0.001). Conclusions: Cancer patterns in this vulnerable population are characterized by early-onset disease, a high burden of smoking-related cancers, and pervasive barriers to care. These findings highlight the importance of integrating SES and access-related variables into cancer surveillance systems and support the development of targeted, equity-focused interventions. Full article

Creating secondary flows that encourage fluid interchange between hot and cold regions is frequently necessary to improve convective heat transfer in compact channels. A well-known passive method for enhancing mixing and boosting thermal performance in laminar regimes is the use of vortex generators (VGs), which create streamwise and transverse vortices. Laminar forced convection in a rectangular channel with rectangular wing vortex generators with triangular tips is investigated numerically in this work. The primary goal is to assess the impact of the number of tips per wing on pressure drop and heat transfer enhancement at a fixed angle of attack (α). This study examines a single row of rectangular wing vortex generators (VGs) with triangular tips and systematically evaluates how variations in tip number influence not only the global Nusselt number and friction factor but also the three-dimensional vortex structure distribution along the channel. This approach contrasts with many previous studies that primarily focus on global performance indices or on classical delta-type VGs. ANSYS Fluent’s finite volume method is used to solve three-dimensional stable, laminar, incompressible flow and heat transfer. Two Reynolds numbers, Re = 456 and Re = 911, are simulated for different triangular-tip configurations at a fixed angle of attack of α = 30°. To connect flow structures to heat transfer behavior, area-averaged Nusselt numbers and friction factors are calculated for each case, and vortex cores and their spatial locations are examined. The findings demonstrate that heat transfer improvement is directly and significantly impacted by the VG tip arrangement. The trade-off between heat gains and pressure losses is highlighted by the fact that some tip configurations produce stronger, more persistent vortices and higher Nusselt numbers at the expense of an increased friction factor. The conclusions are limited to laminar flow conditions at α = 30°, Reynolds numbers of 456 and 911, and the investigated one-, two-, and three-tip configurations. Full article

This case report describes a digital workflow for the aesthetic rehabilitation of a 30-year-old male patient with unaesthetic anterior teeth. The treatment incorporated AI-assisted smile design software (SmileCloud Biometrics) for 2D/3D digital planning and patient communication. Six lithium disilicate veneers (IPS e.max CAD) were fabricated using CAD/CAM technology following mock-up-guided minimally invasive preparation (0.2–0.9 mm reduction). The restorations were adhesively cemented under rubber dam isolation. One-week follow-up confirmed aesthetic integration, occlusal harmony, and patient satisfaction. This case illustrates how digital workflows with AI-assisted tools can support veneer rehabilitation through data-informed planning and conservative preparation while maintaining aesthetic outcomes. Full article

Background: Antihyperlipidemic medications are widely prescribed for the management of dyslipidemia and prevention of cardiovascular disease and may also influence bone metabolism, formation, and repair. However, their impact on peri-implant bone remodeling and dental implant survival remains insufficiently investigated. Objectives: The aim of this study was to evaluate the influence of antihyperlipidemic therapy on dental implant survival and failure rates over a ten-year period. Methods: A retrospective cohort study included 552 patients receiving 1680 dental implants between 2012 and 2022. Patients were divided into a control group (512 patients; 1581 implants) and a study group receiving antihyperlipidemic monotherapy (40 patients; 99 implants). Clinical, radiographic, and demographic data were collected and analyzed, and implant failure was assessed according to the established clinical criteria of the International Congress of Oral Implantologists. Results: Kaplan–Meier analysis demonstrated significantly better dental implant survival in patients receiving antihyperlipidemic therapy (log-rank p = 0.046). The failure rate was lower in the study group (1.01%) compared with the control group (5.12%). Cox regression analysis, adjusted for age, sex, implant diameter and length, insertion torque, and bone quality, showed that antihyperlipidemic therapy was associated with a markedly reduced risk of implant failure (HR = 0.16). Overall, the use of antihyperlipidemic medications was associated with a significantly lower risk of implant failure (p < 0.05), suggesting a beneficial effect on long-term dental implant survival. Conclusions: The present findings indicate that antihyperlipidemic therapy may be associated with improved dental implant survival and enhanced osseointegration. These results should be interpreted as hypothesis-generating and necessitate confirmation in future prospective randomized controlled studies with expanded and more balanced cohorts. Full article

This study advances understanding of how Catholics and Protestants in the United States reconcile capitalist ideology, religious commitment, and sustainability orientation, a triadic relationship largely unexplored in existing scholarship. By integrating System Justification Theory with multidimensional approaches to religiosity, we demonstrate that Economic System Justification and Fair Market Ideology operate through distinct cognitive and motivational logics with divergent implications for sustainability. Religiosity emerges as a demographically contingent moderator, reshaping how market ideology translates into sustainability attitudes differently across age cohorts and income strata. The study extends System Justification Theory by establishing the theoretical independence of defensive system-preserving motivations from proactive market beliefs, while reconceptualizing religious commitment as a conditional mechanism activated under specific biographical and material circumstances rather than a uniform force. Crucially, spiritual resources retain capacity to reorient believers’ navigation of economic participation and sustainability responsibility, illuminating how moral frameworks rooted in religious tradition counterbalance market logic’s encroachment upon value systems. These insights offer pathways for faith communities, sustainability practitioners, and policymakers seeking to foster sustainable attitudes through demographically calibrated interventions that leverage the ethical scaffolding religious commitment provides. Full article

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by enhancing antitumor immune responses; however, clinical outcomes remain highly variable across patients and tumor types. While tumor-intrinsic factors such as PD-L1 expression and tumor mutational burden provide some predictive value, they do not fully explain response heterogeneity. Increasing evidence highlights the critical role of host-related determinants in modulating ICI efficacy. This review provides a comprehensive overview of key host factors, including baseline immune competence, T-cell repertoire diversity, cytokine profiles, and peripheral biomarkers. It further examines the impact of germline genetics, HLA genotype, and epigenetic regulation on immune responses. The role of the gut microbiome and its metabolites is explored, alongside the impact of metabolic status, obesity, nutrition, and lifestyle behaviors. Additionally, the effects of co-medications and comorbidities are discussed. Integrating these host-related factors may improve patient stratification and support the development of personalized immunotherapy strategies. Full article

The ${\mathrm{N}}^2$,${\mathrm{N}}^2$-dimethylguanosine (${\mathrm{m}}^{2,2}\mathrm{G}$) modification at the G27 nucleotide of transfer RNA (tRNA) is a crucial modification known to impact tRNA folding. Although some functional implications of ${\mathrm{m}}^{2,2}\mathrm{G}$ have been characterized, little is known about the molecular details of the effect of this modification on tRNA folding. In this work, we study folding of a tRNA isodecoder molecule by conducting all-atom structure-based simulations initiated from an ensemble of unfolded configurations. We observed that the folding of the modified tRNA proceeds cooperatively and hierarchically, beginning with the folding of the anticodon stem loop, followed by the folding of the D-stem loop or T-stem loop, and ending with the folding of the acceptor stem, thereby resulting in a fully folded configuration. However, the folding of the unmodified tRNA isodecoder revealed partially-folded intermediate configurations to be more favorable than a fully folded state. These results provide insights into the role of methylation in the folding of the tRNA isodecoder studied here and have broader implications for the folding of other tRNA species. Full article

Background: Basic emergency care is an important component of health system strengthening in resource-limited settings in sub-Saharan Africa. Objectives: This scoping review mapped and synthesised evidence on the implementation, capacity-building approaches, and policy implications of the WHO/ICRC Basic Emergency Care (BEC) course in the region. Methods: Twenty studies from 13 countries were included. Reported facilitators of BEC implementation included perceived relevance to frontline practice, practical and structured course content, contextual adaptation, mentorship, and training-of-trainers or cascade approaches. Reported barriers included time constraints, staffing shortages, limited infrastructure and emergency care resources, and technological challenges affecting digital reinforcement strategies. Across studies, BEC was generally associated with short-term improvements in provider knowledge, confidence, and perceived competence. However, implementation outcomes were reported inconsistently and were largely limited to acceptability, feasibility, and appropriateness, with less evidence on adoption, cost, penetration, and sustainability. Evidence on longer-term retention, practice change, patient outcomes, and broader system-level impact remained limited. Conclusions: Overall, BEC appears to be a potentially useful and context-appropriate approach to strengthening frontline emergency care training, but stronger longitudinal and implementation-focused evaluations are needed. Full article

Lebanon has experienced a prolonged series of crises marked by economic collapse, political instability, institutional failure, and repeated collective trauma. While families are often assumed to serve as key sources of support in such contexts, little is known about how they sustain resilience under conditions of chronic uncertainty. This qualitative study explores how Lebanese families experience hardship, adapt, and strive to remain resilient during the severe cumulative crisis in Lebanon. The study draws on four expert group discussions involving professionals in psychology, social work, community intervention, and social policy (N = 44). Using a systematic thematic analysis, the study developed a conceptual and context-specific model of family resilience shaped by macro-level factors, processes of adaptation and coping, and available support systems. The findings suggest that family resilience in this context is less about recovery and more about endurance and continuous adjustment. Strategies such as migration emerged as central yet emotionally and relationally challenging. Participants also highlighted significant limitations in institutional and policy responses to family needs, particularly the fragmentation of existing initiatives. Preserving the family and its resilience in Lebanon requires targeted and collaborative interventions, especially on the macro level, that extend beyond short-term emergency responses. Full article

Background: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) are characterized by neuropsychiatric symptoms linked to immune dysregulation. Emerging evidence highlights the role of host–microbiome interactions in modulating neuro-immune functions via gut–brain axis signaling; however, its contribution to PANDAS pathophysiology remains poorly understood. Methods: We conducted microbiome analysis from samples collected across multiple sites of PANDAS patients including nasal, throat and stool. We performed an integrated multi-omics analysis of stool samples from pediatric PANDAS cases and healthy controls, including discordant twin pairs. Microbial composition and function were assessed using 16S rRNA gene sequencing, shotgun metagenomics, while untargeted metabolomic profiling was performed using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS). Results: PANDAS cases exhibited reduced alpha diversity and significantly altered beta diversity compared to controls, indicating shifts in gut microbial composition. Shotgun metagenomic analysis revealed differential enrichment of functional pathways, including diminished quorum sensing, altered gamma-aminobutyric acid (GABA) biosynthesis, and microbial degradation processes. Multiple gut–brain modules (GBMs) and gut metabolic modules (GMMs) associated with neurotransmission, transport activities and metabolism were significantly perturbed in PANDAS. Metabolomic profiling showed reduced functional diversity and distinct clustering of metabolic profiles, with differential abundance of amino acids, bile acids, and neuroactive compounds. Integrative analysis further identified disrupted microbe–metabolite networks allied to gut–brain signaling. Conclusions: Our findings reveal significant functional shifts in gut microbiota composition, functional capacity and metabolite profile in PANDAS, suggesting dysregulation of the gut–brain axis signaling. This study provides a foundation for development of microbiome-based biomarkers and therapeutic strategies for pediatric neuropsychiatric disorders. Full article

Retinoblastoma is the most common intraocular malignancy of childhood and is most often driven by loss of the RB1 tumor suppressor gene. While current treatments achieve high survival rates, they are frequently associated with significant morbidity, highlighting the need for more precise, biology-driven therapeutic methods. Increasing evidence suggests that retinoblastoma progression is not dictated by neoplastic cells alone, but rather by complex interactions within the tumor microenvironment, including stromal and immune components. In this review, we examine the cellular and molecular landscape of retinoblastoma with a particular focus on the immune microenvironment, including the spatial distribution and functional roles of innate and adaptive immune cells, as well as immune checkpoint proteins such as PD-1, PD-L1, and CTLA-4. We discuss how tumor- and treatment-induced immune suppression shapes disease progression and therapeutic response, and how chemotherapy alters immune infiltration and checkpoint expression. Finally, we explore emerging immunotherapeutic and cell-based approaches, emphasizing the potential for combination therapies that integrate immune modulation to improve outcomes and reduce long-term toxicity in retinoblastoma. Full article

Parkinson’s disease (PD) and acute kidney injury (AKI) are two conditions with increasing prevalence and severe systemic complications and consequences. This research examines the combined neuroprotective and nephroprotective properties of three medicinal plants, Mucuna pruriens (Muc), Moringa oleifera (Mor), and Silybum marianum (SM), in a murine model of PD, AKI, and their comorbid state (PD–AKI), highlighting the role of the PI3K/AKT/mTOR and Nrf2/NF-κB signaling pathways. The mice were grouped as PD, AKI, or PD-AKI, and with or without the herbal pre-treatment, along with their respective controls. Motor impairments were assessed using the rotarod and pole climb assays. Biochemical indicators of renal function, oxidative stress markers, and inflammatory cytokines were quantified in kidney and brain tissues. Assessment of Nrf2, NF-κB, PI3K, AKT, and mTOR expression levels was performed using qRT-PCR. The AKI groups had significant renal impairment (4-fold increase in creatinine and 7.5-fold increase in BUN), oxidative stress (~5.5-fold increase), and increased cytokine levels (~1.5-fold increase), with downregulation of the PI3K/AKT/mTOR (~2-fold decrease) and Nrf2 signaling pathways (~1.8-fold decrease), alongside upregulation of NF-κB (~2.5-fold increase). The PD and PD-AKI groups exhibited significant neuroinflammation (~1.5-fold increase) and redox imbalance (~6-fold increase) in brain tissue, accompanied by motor impairments (1.6 to 4.6-fold decrease). Pre-treatment with Muc, Mor, and SM significantly ameliorated renal impairments (3.5-fold decrease in creatinine and ~5-fold decrease in BUN) and neurological deficits. These findings establish Muc, Mor, and SM extracts as potent, multi-target interventions capable of disrupting the feed–forward cycle of neuro-renal damage. Full article

Introduction: Recent advancements in genomic technologies have significantly improved the resolution of genetic variants driving rare genodermatoses, a heterogeneous group of inherited skin disorders caused by pathogenic variants affecting skin structure and function. However, many genodermatoses remain molecularly uncharacterized, particularly in Middle Eastern populations. Objectives: This study aimed to evaluate the diagnostic accuracy and inherent challenges of utilizing (WES) for genodermatoses within a Middle Eastern context. Methods: We performed WES on three unrelated Middle Eastern pediatric patients presenting with genodermatoses. Genetic variants were prioritized and adjudicated according to ClinVar and the American College of Medical Genetics and Genomics (ACMG) guidelines. Results: WES identified pathogenic variants in three pediatric cases presenting with genodermatoses. Findings included a GJB2 missense variant (c.148G>T; p.Asp50Asn) associated with keratitis–ichthyosis–deafness (KID) syndrome. This represents one of the first documented cases in a Middle Eastern population. Two additional patients presenting with epidermolysis bullosa harbored truncating variants in COL7A1 (c.497dup; p.Val168Glyfs12) and EXPH5 (c.5786del; p.Pro1929Leufs8), respectively; the latter also carried a KRT5 missense variant (c.1607G>A; p.Ser536Asn). Conclusions: WES is a robust diagnostic adjunct for resolving ambiguity in rare genodermatoses, though its efficacy remains contingent on the availability of regional genomic references. Within pediatric dermatology, systematic exome sequencing serves as a powerful facilitator for transitioning from clinical suspicion to definitive molecular characterization. Collectively, these findings highlight the essential role of regionally representative genomic datasets in the accurate interpretation of novel variants and the advancement of precision dermatology. Full article

We evaluated global radiotherapy practices in the management of early-stage (AJCC/UICC 8th edition stages I-II) glottic cancer (ESGC). A cross-sectional online survey was conducted in March 2025 across centers worldwide. Data was collected on clinical practices, including staging, CT simulation, target volumes delineation, organs-at-risk contouring, radiotherapy techniques, dose and fractionation schedules, treatment delivery techniques, and image guidance practices. A total of 181 responses were received, primarily from Asia (41.4%) and Europe (24.3%). Most respondents were from non-academic public centers (44.2%), with multidisciplinary team involvement reported by 84.5%. Head and neck CT scan was the most used staging modality (80.1%). Intensity-Modulated Radiation Therapy was the most common planning technique (82.9%). Hypofractionated radiotherapy schedules predominated for T1 (84%) and T2 (72.4%) disease. T1a was typically treated with whole-larynx target volume (72.4%). Use of ipsilateral involved vocal cord irradiation varied by geographical region (p = 0.015), being most common in North America (44.8%) and Europe (38.6%). Accelerated fractionation for T2 also differed significantly (p < 0.001), with the highest use reported in North America (41.4%). Daily Cone-Beam Computed Tomography was acquired by (58.2%). In total, 70% of respondents expressed interest in the results of a future phase III randomized trial comparing stereotactic body radiation therapy to conventional radiotherapy. Significant global variations in radiotherapy practices for ESGC were observed, likely reflecting disparities in access and differences in institutional protocols. The development and implementation of standardized, evidence-based global guidelines are essential to harmonize care, minimize toxicity, and improve outcomes for patients with ESGC. Full article