Avicenna - Current Issue

Background: The humanitarian crisis in Gaza has escalated to unprecedented levels as of late September 2024, with devastating impacts on civilians and the healthcare infrastructure. Years of the blockade, exacerbated by ongoing military aggression, have led to the collapse of Gaza's health system anddeepened the region's public health crisis.

Objective: The aim of this study was to examine the far-reaching public health consequences of the Gaza conflict, with a focus on the destruction of healthcare infrastructure, the rise in communicable diseases, and the psychological trauma affecting the population.

Methods: A qualitative analysis was conducted using secondary data from peer-reviewed journal articles, reports from international humanitarian organizations, and official statistics. Thematic analysis identified key challenges, including the impact of infrastructural collapse, barriers to medical care, and the consequences of prolonged conflict on mental and physical health.

Results: The findings indicate over 41,615 deaths, including approximately 16,500 children,and thousands are still missing. The destruction of hospitals, roads, and ambulances has severely disrupted medical services andleft tens of thousands without medical care. Chronic lack of medical supplies, clean water, and electricity further aggravates the crisis. Additionally, communicable diseases and psychological trauma have reached critical levels, disproportionately affecting children and vulnerable populations.

Conclusions: The findings highlight the urgent need for a coordinated international response to address the healthcare crisis in Gaza. Emergency measures should include curbing military aggression, providing humanitarian aid, and rebuilding healthcare systems. Long-term efforts must focus on building resilient health infrastructure, ensuring access to essential medical care, and addressing the mental health needs of the population. Future research should explore the long-term public health outcomes of conflict and strategies to enhance healthcare resilience in similar settings.

Background: In 2022, 4.9 million children died worldwide before the age of five years. The UN General Assembly has set the target to reduce under-five child mortality rate (U5MR) to 25 deaths per 1,000 live births by 2030. However, the UN Inter-Agency Group for Child Mortality Estimation highlights that, without rapid action, many low and lower middle-income countries may fall short of this target, resulting in the loss of 35 million children under five years of age before 2030. In such a scenario, it is crucial to understand the determinants that contribute to the reduction of preventable child deaths.

Design: Anonymized and publicly accessible data from the Indian National Family Health Survey (NFHS-5) were used. The sample consisted of 724,115 women aged 15–49 years, categorized into urban and rural groups. Data on the number of community daycare centers, or Anganwadi centers, per state were obtained from the Ministry of Women and Child Development. For better analysis of data, the country was divided into regions, with union territories classified according to their geographical locations. Various statistical methods such as descriptive statistical analysis, correlation coefficient, and linear regression analysis were used.

Results: Descriptive analysis showed that Central India had the highest U5MR (49.8%), despite having the second highest number of community daycare centers (74,510) in the country. The Spearman rank correlation analysis showed a significantly large positive relationship between community daycare centers (%) and U5MR (r = 0.521, p < 0. 001). Conversely, there was a significantly large negative relationship between women with internet access (%) and U5MR (r = -0.6908, p < 0. 001). The results from multiple linear regression showed b0 = 53.6807, b1 = -0.58788, and b2 = 0.77266, with an R² value of 0.5616 (p = 0). Additionally, simple linear regression analysis for the percentage of community daycare centers along with U5MR in children showed a beta coefficient (b) of 2.5767 (p < 0. 001), with an R² value of 0.2938. For the data on internet access to women (%) and U5MR, the beta coefficient (b) was -0.6759, the p value was 0, and the R² value was 0.5444.

Conclusion: In comparison to the data from NFHS-4 (2015–16), there was a notable decrease in the U5MR in almost all states in the country. The study showed that urban women had greater access to the Internet than rural women. Furthermore, child mortality rates were higher in rural areas than in urban areas in every state. The enhanced access to health information through the Internet for urban women may have contributed to the lower child mortality rates observed in urban settings. Internet access for women at the individual level is significantly more effective in reducing the U5MR than the community-level approach of daycare centers.

Artificial intelligence (AI) is revolutionizing the field of neuro-oncology, especially in the context of astrocytoma detection and management. AI and deep learning techniques have significantly advanced the diagnostic process, enabling more accurate tumor grading and classification through comprehensive analysis of histopathological images. AI-powered tools, such as convolutional neural networks, assist in distinguishing between tumor subtypes, while radiomics and computer vision improve real-time intraoperative decision-making, thereby aiding neurosurgeons to optimize surgical resections with greater precision.

In terms of treatment, AI facilitates personalized therapy by integrating genomic, radiological, and clinical data to tailor treatment strategies based on individual tumor profiles. Prognostic models using AI have demonstrated up to 80% accuracy in predicting patient outcomes, guiding oncologists in selecting the most effective interventions. AI-driven tumor segmentation enhances radiotherapy precision by accurately identifying organs at risk, thereby reducing radiation exposure to healthy tissues. Moreover, AI contributes to drug discovery by accelerating the identification of novel therapeutic compounds with high blood–brain barrier permeability.

Despite these advancements, several challenges hinder AI’s clinical integration, including data privacy concerns, algorithmic bias, and the need for regulatory frameworks to ensure equitable and ethical AI applications in healthcare. To bridge this gap, the health sector must establish standardized AI protocols, invest in AI-compatible infrastructure, and integrate AI-driven decision support systems into clinical workflows. Additionally, interdisciplinary collaboration between AI specialists, radiologists, and oncologists is essential to validate AI models through large-scale multicenter studies and randomized controlled trials.

Future research should focus on expanding AI accessibility in resource-limited settings and addressing ethical concerns through transparent AI governance. By implementing structured mechanisms for AI adoption, the healthcare sector can harness its full potential to revolutionize astrocytoma management, ultimately improving diagnostic accuracy, treatment efficacy, and patient outcomes.

The aim of our cross-sectional study was to evaluate the reliability of videos uploaded on YouTube demonstrating the Heimlich maneuver. We searched for the terms “Heimlich maneuver”, “abdominal thrust”, “abdominal thrust maneuver”, “foreign body airway obstruction”, or “subdiaphragmatic abdominal thrusts” to find videos uploaded on YouTube from 2020 to 2023. We analyzed the source of the upload, the time duration, the viewership, and the use of mannequins or performance on humans or neither. Of the 1,008 videos uploaded, 106 videos met the inclusion criteria. The median score for the included videos was 2.5. There was no statistical difference in the scores between the professional videos compared to non-professional videos. However, videos uploaded by professionals had a higher viewership and median score than those uploaded by non-medical sources (median scores 3 and 2, respectively). The results of our study indicate that the videos uploaded by medical professionals were viewed more frequently than unidentified sources, although they were not comparatively more reliable.

Background: Autonomic dysfunction, characterized by heightened sympathetic and diminished parasympathetic activity, is increasingly recognized as a significant factor in the pathophysiology and therapeutic management of bipolar disorder (BD). The aim of this study is to investigate the changes in sympathetic skin response (SSR) among BD type 1 patients during the manic phase compared to their state after clinical remission.

Methods: This retrospective cross-sectional study enrolled 17 patients who were newly diagnosed with BD type 1 in the manic phase, adhering to DSM V criteria, over 4 years from January 2018 to December 2022. All subjects received treatment with sodium valproate, and SSR testing was performed during both the manic phase and following a washout period. The latency and amplitude of bilateral palmar and plantar SSRs were examined using electrical stimulation of the median and tibial nerves. Statistical analyses were conducted using paired T-tests and Mann–Whitney U tests to assess the mean differences in SSR latency and amplitude pre- and post-treatment.

Results: The treatment led to a statistically significant reduction in SSR latency for the right tibial nerve (from 2.380 ± 0.370 to 2.126 ± 0.241 seconds, p = 0.014) and the left median nerve (from 1.829 ± 0.410 to 1.600 ± 0.217 seconds, p = 0.033), indicating moderate effect sizes. In contrast, SSR amplitude demonstrated minimal variation across all examined nerves, with no statistically significant increase observed following treatment (all p-values = 0.05).

Limitations: The small number of participants in the study could affect the reliability of the results.

Conclusion: The results of the study indicate that SSR latency may serve as a promising biomarker for evaluating autonomic function in patients experiencing manic and euthymic phases of BD following mood stabilizer treatment. Nonetheless, further validation through larger cohort studies with long-term follow-up is essential to corroborate these preliminary findings and better understand the implications for clinical practice.

Background: Video gaming has become a primary form of entertainment worldwide, offering recreational benefits while simultaneously raising concerns about its physical and psychosocial impacts on children. These concerns include mental health, academic performance, and social interactions. The aim of this study was to evaluate parental awareness of these effects in order to identify knowledge gaps and support the development of targeted interventions.

Methods: A descriptive cross-sectional hospital-based study included 411 students aged 13–28 years and their parents at Punjab and the ICT (Islamabad Capital Territory) region from July to September 2022. The study design enables concurrent data collection, providing a comprehensive overview of parents’ knowledge, perceptions, and concerns about the effects of video games on their children’s mental health, social behavior, academic performance, and overall well-being. The collected data were subsequently analyzed and interpreted using both descriptive and inferential statistics. Data were analyzed using SPSS version 20.

Results: Among the 411 participants, a majority, 251 (61.8%), of students reported that they did not feel themselves addicted to video games, while 233 (56.7%) parents believed that their children were addicted and observed signs of depression, anger, and social phobia. Of the 98 (23.8%) students who admitted to being addicted, many indicated that it started during the COVID-19 quarantine.

Conclusion: The study suggests that, although students spend long periods playing video games, they do not perceive any symptoms of addiction. In contrast, parents generally find video games unbeneficial, noting a decline in interactive time with their children. They observed behavioral changes, although there were no signs of loss in academic performance. Notably, the results indicate that COVID-19 may have played a role in the onset of video game addiction. It is essential to implement educational initiatives focused on responsible gaming in schools. Parents require assistance in setting healthy gaming boundaries and monitoring screen usage. Policymakers should consider enforcing stricter regulations on child-oriented gaming advertisements. Further research is necessary to evaluate the long-term behavioral effects and intervention techniques.

Background: Diabetic nephropathy (DN) represents one of the most severe complications associated with type 2 diabetes (T2D), often leading to kidney failure and significantly affecting patients’ quality of life. Early detection and monitoring of DN are essential to prevent its progression. Midkine and copeptin, two biomarkers associated with inflammatory and metabolic processes, have shown promise in reflecting the underlying changes associated with DN, thus offering hope for improved diagnosis and management. The objective of this study was to investigate the clinical relevance of midkine and copeptin levels in T2D patients and their associations with insulin resistance and albuminuria status, evaluating their potential as predictive tools to detect the progression of DN.

Methods: A case–control study was carried out with 360 participants, grouped into 90 healthy controls and T2D patients categorized by different stages of albuminuria (normoalbuminuric, microalbuminuric, and macroalbuminuric, with 90 individuals in each category). Serum levels of midkine, copeptin, fasting insulin, and other biochemical analytes were measured. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR), while renal function was evaluated using the albumin–creatinine ratio (ACR) and the estimated glomerular filtration rate (eGFR).

Results: Elevated levels of midkine and copeptin were found in T2D patients, with the highest levels observed in the macroalbuminuric group (p < 0.001). Both biomarkers were positively correlated with glycemic parameters (fasting glucose, HbA1c), insulin resistance (HOMA-IR), and markers of DN (ACR, eGFR) (p < 0.001). ROC (receiver operating characteristic) analysis showed strong diagnostic performance for both biomarkers, with midkine yielding an area under the curve (AUC) of 0.96 (95% CI: 0.94–0.99, sensitivity: 96.7%, specificity: 91.1%) and copeptin yielding an AUC of 0.98 (95% CI: 0.97–1.0, sensitivity: 97.8%, specificity: 88.9%). Multivariate linear regression analysis identified midkine (p = 0.039) and copeptin (p = 0.027) as significant predictors of albuminuria.

Conclusion: Serum levels of midkine and copeptin are elevated in T2D patients, with a strong association with the onset and progression of DN. These biomarkers may serve as early indicators for diabetic kidney disease, facilitating timely detection and management of renal complications. Their role in predicting insulin resistance and cardiovascular risk further underscores their potential as clinical tools for managing DN.