Saint Joseph University, Lebanon

Background: Acute ischemic stroke is one of the leading causes of disability and mortality globally, with increasing incidence in Africa, as the continent is already burdened with infectious diseases. Rapid diagnosis and efficient treatment are crucial, as even a slight delay to reperfuse the brain significantly affects the recovery outcome. Neuroimaging is vital for optimal care and thrombolytic or endovascular therapy in specialised stroke care units. This review aims to discuss the burden of acute ischemic stroke in Africa and how healthcare systems have tried to reduce the incidence and improve outcomes for the disease. Methodology: Data was collected from online databases and medical journal published on PubMed, Ovid MEDLINE, ScienceDirect and Embase bibliographical data. All articles related to acute ischemic stroke in Africa were considered. Results: The medical care for acute ischemic stroke in Africa is far from optimal with little adherence to recommended protocols. There is a lack of public awareness of the disease, imaging infrastructure, personnel, stroke care units and recovery facilities, due to poor funding. Poor knowledge of stroke signs and symptoms results in delay in treatment and poor prognosis. Conclusion: We urge African leaders and private entities to invest in stroke care by building appropriate infrastructures, providing medical equipments, implementing guidelines, and sustainable follow-up systems. Telehealth is a suggested strategy to mitigate the scarcity of health personnel, and international and national efforts to increase treatment affordability should be doubled. Further extensive research on the impact of acute ischemic stroke on the African continent population is encouraged.

Machine learning has become a key branch in artificial intelligence by providing unique predictive modeling solutions. Predicting the compressive strength of concrete determined using non-destructive test techniques (NDT) includes high levels of uncertainty. This uncertainty directly depends on the repeatability of the measurement and the variability of concrete properties. This study aims to evaluate the effect of mixture composition and age of concrete on the coefficient of variation (CV) of the rebound hammer index applied to various types of concrete. Several supervised machine learning models, including multivariate multiple regression (MMR), support vector machine (SVM), Gaussian process regression (GPR), and Regression tree (RT) were utilized to predict the compressive strength of concrete. A large dataset of 468 cubic concrete specimens was sorted into four categories and employed for simulation. Regardless of the selected dataset, it was concluded that GPR/SVM and RT yielded the most accurate model prediction metrics of compressive strength when using rebound hammer records over MMR model. The results of the adopted models were remarkably better when mixture proportions and age of concrete features (i.e., age and w/p) were considered in the simulation.

Terpenoids (isoprene and monoterpenes) are highly reactive Volatile Organic Compounds (VOCs) known for decades for their biogenic origin. Here, we discuss the nature and magnitude of their anthropogenic emissions. We compiled and re‐analyzed 14 data sets of in situ VOC observations collected over the last decade in contrasting urban areas from mid‐latitudes to subtropical regions. We show the systematic presence of anthropogenic terpenoids in urban ambient air with clear covariations with anthropogenic compounds (R² > 0.50) even during mid‐latitude winters. Despite the emerging importance of monoterpene emissions from consumer products in North American cities, there is some evidence of monoterpene emissions from tailpipe exhaust in cities of the developing world. The traffic‐related fraction of monoterpenes is estimated and can account for up to 40% of their ambient levels. The anthropogenic emission ratios (ER) of some terpenoids (isoprene, α‐pinene and limonene) are estimated and spatially compared. The anthropogenic emissions of terpenoids are indirectly estimated from those ER combined to regional and global emission inventories (CAMS‐GLOB‐ANT_v4.2) at urban and country scale focusing on France, Lebanon, and Vietnam. Those anthropogenic emissions do not represent more than 3% of other anthropogenic VOC emissions. However, they dominate by one to three orders of magnitude the reactivity of other anthropogenic VOCs regarding NO3 oxidation and ozonolysis. This study raises two questions which need further investigations in the future: (a) the significance of terpenoid emissions from traffic, especially in urban areas of the developing world and (b) the role of anthropogenic terpenoids in nighttime and wintertime atmospheric chemistry at mid‐latitudes.

Purpose To assess volumetrically, the impact of vertical facial growth types (VGFT) on the retromolar area as a bone donor site Material and methods 60 cone beam computed tomography (CBCT) scans of adult individuals were classified in three groups according to their SN-GoGn angle: hypodivergent group (hG) (33.33%), normodivergent group (NG) (30%) and hyperdivergent group (HG) (36.67%). Total harvestable bone volume and surface (TBV and TBS respectively), total cortical and cancellous bone volume (TCBV and TcBV respectively) and the percentage of cortical and cancellous bone volume (CBV and cBV respectively) were evaluated. Results The whole sample showed a mean TBV of 1220.99±448.81mm³ and a mean TBS of 940.29±259.93mm². Statistically significant differences were found between the different outcome variables and the vertical growth patterns (p<0.001). TBS differs for the different vertical growth patterns with the highest mean of TBS observed in the hG group. TBV also significantly differs between the different vertical growth patterns (p<0.001) with the highest mean observed for the hG individuals. Significant differences in percentages of cBV and CBV were present between the hyper-divergent groups and the other groups (p<0.001) with the hyper-divergent group having the lowest percentage of CBV and the highest percentage of cBV. Conclusion hypodivergent individuals tend to have thicker bone blocks that can be used in onlay technique while thinner bone blocks harvested from hyperdivergent and normodivergent individuals can be used in three-dimensional grafting approach.

Background: Verbal fluency tasks are frequently used for neuropsychological assessment in clinical practice and research. It consists of two tasks namely category and letter fluency tests. Objective: To determine normative values in category (animals, vegetables, fruits) and letter fluency [Mim () “M”, Alif () “A”, Baa () “B”] tasks in Arabic language in 60 s. Methods: This study was a cross-sectional national survey and included 859 community-dwelling, cognitively intact Lebanese residents aged ≥55 years. Norms were presented according to age (55–64 years, 65–74 years, ≥75 years), sex and level of education (illiterate, no diploma, primary certificate, baccalaureate or higher). Results: Level of education had the most significant positive effect on verbal fluency tasks performance amongst Lebanese older adults. The negative effect of older age was more prominent in the category fluency task compared to the letter fluency task. Women outperformed men in vegetables and fruits categories. Conclusion: This study provides clinicians with normative scores of category and letter fluency tests, which can be used for neuropsychological assessment of older Lebanese patients being evaluated for cognitive disorders.

Objective: Flares of autoimmune rheumatic disease (AIRDs) following COVID-19 vaccination are an outstanding concern in vaccine-hesitant individuals. Therefore, we investigated the incidence, predictors and patterns of flares following vaccination in individuals living with AIRDs using global COVID-19 Vaccination in Autoimmune Diseases (COVAD) surveys. Methods: The COVAD surveys were used to extract data on flare demographics, comorbidities, COVID-19 history, and vaccination details among patients with AIRDs. Flares following vaccination were identified as patient-reported(a), increased immunosuppression(b), clinical exacerbations(c) and worsening of PROMIS scores(d). We studied flare characteristics and used regression models to differentiate flares among various AIRDs. Results: Of 15165 total responses, the incidence of flares in 3453 patients with AIRDs was 11.3%, 14.8%, 9.5%, and 26.7% by definitions a-d, respectively. There was moderate agreement between patient-reported and immunosuppression-defined flares (K = 0.403, p = 0.022). Arthritis (61.6%) and fatigue (58.8%) were the most commonly reported symptoms. Self-reported flares were associated with higher comorbidities (p = 0.013), mental health disorders (MHD) (p < 0.001), and autoimmune multimorbidity (AIDm) (p < 0.001).In regression analysis, the presence of AIDm (OR = 1.4;95%CI:1.1-1.7;p=0.003), MHD (OR = 1.7;95%CI:1.1-2.6;p=0.007), and Moderna vaccine (OR = 1.5;95%CI:1.09-2.2;p=0.014) recipients were predictors of flares. Mycophenolate (OR = 0.5;95%CI:0.3-0.8;p=0.009) and glucocorticoids (OR = 0.6;95%CI:0.5-0.8;p=0.003) were protective.A higher frequency of patients with AIRDs reported overall active disease post-vaccination compared to before vaccination (OR = 1.3;95%CI:1.1-1.5;p<0.001). Conclusion: Flares occur in nearly one in ten individuals with AIRDs after COVID vaccination, with people with comorbidities, especially AID multimorbidity, mental health disorders and use of the Moderna vaccine being particularly vulnerable. Future avenues include exploring flare profiles and optimizing vaccine strategies for this group.

Introduction: Although PSA screening has been rationalized, prostate cancer continues to have the highest incidence rate in 2021, and alone accounts for 26% of cancer diagnoses in men. A thorough review of the medical literature highlights a vast array of approved and investigational treatments for prostate cancer. Thus, selecting the best treatment option for the appropriate patient at the right time is crucial. Hence, biomarkers help in defining optimal patient stratification, revealing potential processes through which a drug might exert its impact and aid in the tailoring of treatments for efficient personalized medicine. Areas covered: This article is a pragmatic review of novel prostate cancer therapies that can help guide clinicians in tackling prostate cancer with the latest treatments. Expert opinion: Local radiotherapy has proven to be a game changer for low burden, de novo metastatic prostate cancer. Androgen deprivation therapy continues to be the ultimate treatment. Delaying resistance to these agents will undoubtedly be a breakthrough in the treatment of prostate cancer. When it comes to metastatic castrate resistant disease, treatment options become narrower. PARP inhibitors and N-terminal domain inhibitors, offer new hope, and have a synergistic effect with immunotherapy adding promising agents to the therapeutic arsenal.

Purpose: To compare pain perception associated with two computer-controlled local anesthesia devices, the WAND™ STA (Milestone Scientific Inc., Livingston, NJ, USA) and the Calaject (Rønvig dental MFG, Daugaard, Denmark) in young children. Methods: A split-mouth randomized clinical trial comprising 30 patients, aged 6-12 years, received randomly, in two separate sessions, a local anesthesia injection in the maxillary using either the wand STA or the Calaject. Pain perception was evaluated using the patient's heart rate, an 11-point numerical scale (NRS), and the Sound, Eye, and Motor (SEM) body movements. Statistical difference was set at p = 0.05. Repeated measures analysis of variance were conducted to compare the mean pulse for Calaject and STA at different times. It was followed by univariate analysis and Bonferroni multiple comparisons tests. Wilcoxon tests were performed to compare NRS, SEM, and injection duration between Calaject and STA. Results: There was no significant statistical difference between Calaject and STA in pulse rate before injection (p = 0.720), during injection (p = 0.767), and after injection (p = 0.757). The mean NRS score was significantly greater with STA in comparison with Calaject (p = 0.017). The mean SEM score was also significantly greater with STA in comparison with Calaject (p = 0.002). However, the mean duration was significantly longer with Calaject (p = 0.001). Conclusions: Calaject was more effective than STA in reducing pain perception associated with periapical injection in young children.

Cancer cells have unique metabolic activity in the glycolysis pathway compared to normal cells, which allows them to sustain their growth and proliferation. Therefore, inhibiting glycolytic pathways may provide a promising therapeutic approach to cancer treatment. In this first-of-its-kind study, we analyzed the genetic responses of cancer cells to stressors, particularly drugs that target the glycolysis pathway. Gene expression data for experiments on different types of cancer cells were retrieved from the Gene Expression Omnibus and fold-change in expression was then clustered after dimensionality reduction. We identified four response clusters, the first and third were affected the most by anti-glycolytic drugs, consisting mainly of squamous and mesenchymal tissues, showing higher mitotic inhibition and apoptosis. Drugs acting on several glycolytic targets at once resulted in such responses. The second and fourth clusters were relatively unaffected by the treatments, succumbing the least to glycolysis inhibitors. These clusters are mainly gynecological and hormone-sensitive, with drugs acting on hexokinases mainly inducing this response. This study highlights the importance of analyzing the molecular states of cancer cells to identify potential targets for personalized cancer treatments and to improve our understanding of the disease.

Cancer cells have unique metabolic activity in the glycolysis pathway compared to normal cells, which allows them to sustain their growth and proliferation. Therefore, inhibiting glycolytic pathways may provide a promising therapeutic approach to cancer treatment. In this first-of-its-kind study, we analyzed the genetic responses of cancer cells to stressors, particularly drugs that target the glycolysis pathway. Gene expression data for experiments on different types of cancer cells were retrieved from the Gene Expression Omnibus and expression fold-change was then clustered after dimensionality reduction. We identified four response clusters, the first and third are affected the most by anti-glycolytic drugs, consisting mainly of squamous and mesenchymal tissues, showing higher mitotic inhibition and apoptosis. Drugs acting on several glycolytic targets at once resulted in such responses. The second and fourth clusters were relatively unaffected by the treatments, succumbing the least to glycolysis inhibitors. These clusters are mainly gynecological and hormone-sensitive, with drugs acting on hexokinases mainly inducing this response. This study highlights the importance of analyzing the molecular states of cancer cells to identify potential targets for personalized cancer treatments and to improve our understanding of the disease.

Cancer cells have unique metabolic activity in the glycolysis pathway compared to normal cells, which allows them to sustain their growth and proliferation. Therefore, inhibiting glycolytic pathways may provide a promising therapeutic approach to cancer treatment. In this first-of-its-kind study, we analyzed the genetic responses of cancer cells to stressors, particularly drugs that target the glycolysis pathway. Gene expression data for experiments on different types of cancer cells were retrieved from the Gene Expression Omnibus and expression fold-change was then clustered after dimensionality reduction. We identified four response clusters, the first and third are affected the most by anti-glycolytic drugs, consisting mainly of squamous and mesenchymal tissues, showing higher mitotic inhibition and apoptosis. Drugs acting on several glycolytic targets at once resulted in such responses. The second and fourth clusters were relatively unaffected by the treatments, succumbing the least to glycolysis inhibitors. These clusters are mainly gynecological and hormone-sensitive, with drugs acting on hexokinases mainly inducing this response. This study highlights the importance of analyzing the molecular states of cancer cells to identify potential targets for personalized cancer treatments and to improve our understanding of the disease.

Consulting the best available evidence is key to successful conservation decision-making. While much scientific evidence on conservation continues to be published in non-English languages, a poor understanding of how non-English-language science contributes to conservation decision-making is causing global assessments and studies to practically ignore non-English-language literature. By investigating the use of scientific literature in biodiversity assessment reports across 37 countries/territories, we have uncovered the established role of non-English-language literature as a major source of information locally. On average, non-English-language literature constituted 65% of the references cited, and these were recognized as relevant knowledge sources by 75% of report authors. This means that by ignoring non-English-language science, international assessments may overlook important information on local and/or regional biodiversity. Furthermore, a quarter of the authors acknowledged the struggles of understanding English-language literature. This points to the need to aid the use of English-language literature in domestic decision-making, for example, by providing non-English-language abstracts or improving and/or implementing machine translation. (This abstract is also avaialble in 21 other languages in Supplementary Data 4).

Peanuts are the seeds of a legume crop grown for nuts and oil production. Peanut allergy has gained significant attention as a public health issue due to its increasing prevalence, high rate of sensitization, severity of the corresponding allergic symptoms, cross-reactivity with other food allergens, and lifelong persistence. Given the importance of peanuts in several sectors, and taking into consideration the criticality of their high allergic potential, strategies aiming at mitigating their allergenicity are urgently needed. In this regard, most of the processing methods used to treat peanuts are categorized as either thermal or thermomechanical techniques. The purpose of this review is to provide the reader with an updated outlook of the peanut’s allergens, their mechanisms of action, the processing methods as applied to whole peanuts, as well as a critical insight on their impact on the allergenicity. The methods discussed include boiling, roasting/baking, microwaving, ultrasonication, frying, and high-pressure steaming/autoclaving. Their effectiveness in alleviating the allergenicity, and their capacity in preserving the structural integrity of the treated peanuts, were thoroughly explored. Research data on this matter may open further perspectives for future relevant investigation ultimately aiming at producing hypoallergenic peanuts.

The use of the Time-Dependent Density-Functional Theory (TDDFT) has increased in the atomic collision field. Calculating the electron-capture cross section (ECCS) for protons is an important question in hadrontherapy and plasma physics, among other areas. In previous studies, it was shown that the approach based on the Local Density Approximation (LDA) fails in the 1-50 keV region, requiring the use of the Optimized Effective Potential (OEP) method. In this work, the ECCS values for 1-50 keV protons impacting on isolated hydrogen, carbon, nitrogen, oxygen, and nitrogenous atoms were determined using the TDDFT. It is shown that adding the Self Interaction Correction to the LDA (LDA-Sic) allows obtaining results close to those provided by the OEP and experiments, with the advantage that the LDA-Sic consumes less computational time. In addition, it was demonstrated that it is imperative to include the spin correction for the specific helium and oxygen cases, in order to get good results for the ECCS using the TDDFT. Theoretical results obtained in this work show excellent agreement with experimental values.

Phosphatidylinositol 3-kinases (PI3Ks) are a family of intracellular signal transducer enzymes that can attach a phosphate group to the 3’-hydroxyl of the inositol moiety of membrane-embedded phosphatidylinositol (PI). PI3Ks have been shown to play important roles in cell proliferation, growth, survival, motility, and metabolism. Nonetheless, the PI3K pathway has also shown to be overactivated in several tumors, particularly B-cell malignancies. In recent years, the PI3K signaling pathway has become the major focus of substantial drug discovery and development efforts. Selective (PI3K) inhibitors have been approved for the treatment of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), and indolent non-Hodgkin lymphomas (iNHL), such as follicular lymphoma and marginal-zone lymphoma. Four selective PI3K inhibitors have received accelerated FDA approvals for the treatment of patients with relapsed/refractory (R/R) CLL and/or iNHL based mainly on single-arm Phase II studies: Idelalisib (PI3K-δ inhibitor), copanlisib (dual PI3K-α and PI3K-δ inhibitor), duvelisib (dual PI3K-γ and PI3K-δ inhibitor), and umbralisib (dual PI3Kδ and CK1ϵ inhibitor). Conversely, recent interim results of randomized control trials (RCTs) involving some of these agents, showed a worrisome trend of decrease in overall survival (OS), and an increase in fatal and severe adverse effects, in comparison with patients in the control arms. Consequently, the class of PI3K inhibitors came under scrutiny, with an FDA expert panel voting on April 21, 2022, recommending that future FDA approvals of PI3K inhibitors be supported by randomized data, rather than single-arm data only, and further discontinuing the use of almost all the PI3K inhibitors in hematologic malignancies. As we believe further research is needed to help potentialize PI3K inhibitors by improving their safety profiles, this mini-review aims at revisiting the clinical successes, the failures, and the promising aspect of this class of drugs, while presenting possible ways that could benefit its successful development.

Background Hypoplastic left heart syndrome (HLHS) is a rare but genetically complex and clinically and anatomically severe form of congenital heart disease (CHD). Case presentation Here, we report on the use of rapid prenatal whole-exome sequencing for the prenatal diagnosis of a severe case of neonatal recurrent HLHS caused by heterozygous compound variants in the MYH6 gene inherited from the (healthy) parents. MYH6 is known to be highly polymorphic; a large number of rare and common variants have variable effects on protein levels. We postulated that two hypomorphic variants led to severe CHD when associated in trans; this was consistent with the autosomal recessive pattern of inheritance. In the literature, dominant transmission of MYH6-related CHD is more frequent and is probably linked to synergistic heterozygosity or the specific combination of a single, pathogenic variant with common MYH6 variants. Conclusions The present report illustrates the major contribution of whole-exome sequencing (WES) in the characterization of an unusually recurrent fetal disorder and considered the role of WES in the prenatal diagnosis of disorders that do not usually have a genetic etiology.

The Mediterranean Basin is one of the World’s plant diversity hotspots and a region prone to several anthropic pressures, besides being one of the World’s areas most susceptible to climate change. In this region, which hosts a high percentage of threatened species, there has been a large increase in practical conservation actions to prevent the extinction of many plants or improve their conservation status. In this framework, plant translocations have become increasingly important. To obtain a picture of the status and to depict possible directions, data on plant translocations was collected through the available databases, national experts, and the grey literature available online. Overall, a list of 836 translocations relating to 572 plant species was found. These actions are mainly concentrated in Spain, France, and Italy (c. 87%) and, except for some pioneering actions, translocations have strongly increased starting from 2010. A subsequent in-depth bibliographic search of the scientific databases was conducted to determine how much information about plant translocations was documented in the scientific literature. This search resulted in a list of 133 peer-reviewed papers, of which only 17 describing one or more translocations and, as a whole, reporting 101 experiences carried out on 56 plant species. Our research highlighted a great discrepancy between the scarce scientific documentation in comparison to the large number of practical conservation actions carried out. The great experience gained in these translocations constitutes an enormous heritage potentially available to implement the necessary conservation actions to preserve the plant diversity of the Mediterranean Basin.

In 2020, fentanyl and its analogs contributed to ~65% of drug-attributed fatalities in the USA, with a threatening increasing trend during the last ten years. These synthetic opioids used as potent analgesics in human and veterinary medicine have been diverted to recreational aims, illegally produced and sold. Like all opioids, central nervous system depression resulting from overdose or misuse of fentanyl analogs is characterized clinically by the onset of consciousness impairment, pinpoint miosis and bradypnea. However, contrasting with what observed with most opioids, thoracic rigidity may occur rapidly with fentanyl analogs, contributing to increasing the risk of death in the absence of immediate life support. Various mechanisms have been proposed to explain this particularity associated with fentanyl analogs, including the activation of noradrenergic and glutamatergic coerulospinal neurons and dopaminergic basal ganglia neurons. Due to the high affinities to the mu-opioid receptor, the need for more elevated naloxone doses than usually required in morphine overdose to reverse the neurorespiratory depression induced by fentanyl analogs has been questioned. This review on the neurorespiratory toxicity of fentanyl and analogs highlights the need for specific research focused on these agents to better understand the involved mechanisms of toxicity and develop dedicated strategies to limit the resulting fatalities.