Wasef Na’amnih

Background/Objectives: Xenotransplantation with genetically modified pig organs offers a potential response to the global shortage of donor organs. Although both Islam and Judaism may permit exceptions when treatment is medically necessary, public awareness of these rulings remains limited. This study examined knowledge and attitudes among Muslim and Jewish adults regarding the medical use of porcine-derived organs. Methods: A cross-sectional study was conducted among 884 Muslims and 916 Jews aged 18–81 years. Participants completed an anonymous online questionnaire distributed through convenience and snowball sampling. Six organ-specific items assessed perceived religious knowledge using six ordered permissibility categories and a separate “I don’t know” option, and attitudes using a 7-point Likert scale. Results: Across the six knowledge items, 15.08% of Muslim responses and 9.83% of Jewish responses were “I don’t know.” Mean composite Knowledge scores were 2.69 and 2.49, respectively (p = 0.025; d = −0.113, Jewish minus Muslim). Composite Opinion means were 3.04 and 2.87 (p = 0.092; d = −0.080). The mediation model included 772 Muslims and 846 Jews; adjusted Knowledge–Opinion coefficients were β = 0.95 and 0.79. The free model was saturated (df = 0); constraining all 13 structural coefficients to equality across groups worsened fit (Δχ²(13) = 2718.19, p < 0.001). Conclusions: Public awareness of religious considerations surrounding porcine-derived transplantation was limited. The findings support culturally sensitive education and informed-consent processes while respecting individual autonomy and variation within religious communities. Strong Knowledge–Opinion associations require caution about common-method effects and do not establish causal mediation or actual treatment choices.

Background and objective: Evidence regarding dietary intake of specific macronutrients, dietary fiber, and fatty acids in relation to cognitive performance during school age remains limited. We examined these associations among healthy Arab children in Israel. Methods: This cross-sectional analysis included 146 children aged 10–12 years from a prospective cohort. Dietary intake was assessed using a single 24 h dietary recall. Cognitive performance was assessed using the Arabic version of the Wechsler Intelligence Scale for Children, Fourth Edition. Full-scale intelligence quotient (FSIQ) was the primary outcome, whereas verbal comprehension (VCI), perceptual reasoning (PRI), working memory (WMI), and processing speed (PSI) indices were exploratory secondary outcomes. Multivariable linear regression models adjusted for age, sex, village, socioeconomic status, and total energy intake. Results: No statistically significant associations were found between the examined dietary exposures and FSIQ scores. Among 48 exploratory comparisons involving 12 dietary exposures and four specific cognitive domains, higher dietary fiber intake was associated with higher WMI (B = 0.430, 95% CI 0.067–0.794), and this association remained consistent across sensitivity analyses. Higher polyunsaturated fatty acid intake was associated with higher PRI (B = 0.312, 95% CI 0.021 to 0.604), and higher linolenic acid intake with higher PSI (B = 3.325, 95% CI 0.081 to 6.569). However, both findings were sensitive to alternative exposure specifications. In a sensitivity analysis, any calculated trans-fat intake versus zero calculated intake was associated with lower PRI (B = −6.290, 95% CI −10.766 to −1.814). Conclusions: We found no evidence of associations between the examined nutrient intakes and FSIQ, the primary outcome for overall intellectual functioning. Exploratory analyses identified domain-specific associations, particularly a consistent positive association between dietary fiber intake and working memory. These findings provide new evidence on nutrient intake and cognitive performance among healthy school-aged children from an underrepresented population. Given the study limitations, these associations should be interpreted cautiously and confirmed in larger prospective studies using repeated dietary assessments.

Cultural and religious norms significantly influence reproductive decisions, including prenatal testing and pregnancy termination. We conducted a cross-sectional study among Muslim women living in mixed Jewish-Arab cities compared to those in predominantly Arab cities in Israel. Data for all co-variates were obtained through participants’ self-reports by an online questionnaire of 36 items for adequate content validity between July 2022 and June 2023. In total, 1081 Israeli Muslim women aged 18–49 years were enrolled. Religious affiliation has been shown to influence individuals’ attitudes toward abortion, with members of religious communities often holding more restrictive or negative views on the subject. Muslim women residing in mixed Jewish-Arab cities demonstrate significantly higher uptake of both non-invasive and invasive prenatal testing, as well as pregnancy terminations following abnormal diagnoses, compared to those in predominantly Arab cities (p < 0.001), which indicates that proximity to Jewish communities, greater availability of health services, and exposure to more permissive social norms in mixed cities may reduce religious and cultural barriers, thereby facilitating more informed reproductive decisions. Older women (≥35) in mixed cities had a higher tendency to birth a child with abnormalities in the past than Arab cities (80.9% vs. 70.0%, respectively), However, women who lived in mixed cities underwent more non-invasive (87.2% vs. 64.8%, respectively), invasive prenatal tests (85.1% vs. 69.7%, respectively), and pregnancy termination (88.3% vs. 64.1%, respectively) than those in Arab cities, p < 0.001. Our findings indicate the importance of gaining a deeper understanding of the relations between religious convictions, cultural standards, and medical practices that should contribute to reducing the prevalence of genetic disorders with their associated adverse impact on families, communities, and healthcare systems.

Porcine-derived organ transplants may arouse resistance due to Muslim religious prohibitions against consuming pork products. However, according to Sharia, pork is permitted for life-saving purposes. We performed a cross-sectional study among 884 Israeli Muslims aged 18–81 years with different levels of religious observance, socioeconomic status, and education to assess the knowledge and attitudes of Muslims regarding porcine xenotransplantation according to the Islamic perspective. We used an online questionnaire that was posted on social media. Our findings demonstrated that Muslims were unaware of what is permitted by Islam. Thus, we offer recommendations for improving the informed consent process with Muslim patients. We believe that the findings of our study will be used as an evidence-based source for deliberations among physicians, religious leaders, and theologians to promote knowledge in members of their religions and, no less importantly, the cultural competence of medical and nursing staff with respect for the autonomy of any patient.

Background: Xenotransplantation from genetically modified pigs is emerging as a potential solution to organ shortages, yet, faces religious and cultural barriers, particularly, in the Muslim and Jewish communities whose religions prohibit using pigs for consumption, commerce, and medical treatment. While exceptions exist for life-saving cases, research addressing public perceptions and religious concerns remains limited, obstructing medically informed decisions by these populations. Objectives: The primary research aim was to assess the level of knowledge among Muslim and Jewish individuals regarding religious rulings on the use of porcine organs in medical situations. Additionally, the study evaluated participants’ personal attitudes toward the acceptability of such use. Methods: A cross-sectional survey was conducted using a structured questionnaire completed by 884 Muslim and 916 Jewish participants. The questionnaire examined two main domains: (1) knowledge of religious doctrines concerning the permissibility of pig-derived organ transplantation, and (2) personal attitudes toward the ethical and religious acceptability of such procedures. Results: The results demonstrated a low level of awareness among both Muslim and Jewish participants regarding the religious permissions for medical use of porcine organs. A majority in both groups expressed opposition to pig-derived xenotransplantation. Importantly, the data revealed a strong association between the participants’ knowledge of religious rulings and their attitudes toward such medical interventions. Conclusion: This study reveals a critical gap in public understanding about religious exemptions for life-saving porcine organ transplantation within Muslim and Jewish communities. The findings emphasize the need for better education and culturally sensitive informed consent to support ethically grounded medical decisions regarding xenotransplantation.

Transport by unmanned aerial systems (UASs) (e.g., drones) could save time and personnel. Our study aimed to assess the effect of drone transportation on the clinical laboratory results of biological samples by examining its impact on pre-analytical and analytical processes. We performed a cross-sectional study of healthy volunteers from Sha’ar Menashe Mental Health Center between July and November 2022. Blood and urine samples were transferred to the central laboratory at Hillel Yaffe Medical Center. Overall, 40 healthcare workers aged 21–67 years (57.5% females) with a mean age of 45.8 (SD = 11.3) years from Sha’ar Menashe Mental Health Center were recruited in the study. There were no significant differences between transportation modes in the complete blood count levels. We found a significant difference between the transportation modes for GGT (p = 0.01) and PT (p = 0.04), despite the very similar mean results of these tests. In Bland–Altman plots, GGT and PT samples fell within the 95% limits of agreement and were indicated as not clinically relevant; however, glucose and LDH did not meet the 95% acceptance criterion and showed a potential clinical effect. There was full agreement between the two types of transportation for urine glucose, nitrites, and urine cultures. UAS transport is an appropriate method for maintaining the quality of most routine clinical laboratory specimens, similar to the routine procedure of using a vehicle. For the 34 biochemistry, hematology, and coagulation assay parameters, only glucose and LDH did not meet the 95% acceptance criterion and showed a potential clinical effect.

Summary: Hepatitis E virus (HEV) is one of the most common causes of viral hepatitis. We examined HEV seroprevalence and associations of sociodemographic and lifestyle characteristics with HEV immunoglobulin G (IgG) seropositivity in the Arab population. A cross-sectional single-centre study was conducted among adults in the Nazareth area during 2022. Blood samples were tested using the Altona Real-Star HEV-RNA and the Wantai IgG assays. Data on sociodemographics, health status, and lifestyle were collected using structured questionnaires. Overall, 490 individuals (55.9% males) aged 18 − 96 (mean = 53.2, SD = 28.0) were enrolled. HEV IgG seropositivity was estimated at 21.4% (95% CI 17.9–25.3). No samples were HEV-RNA positive. The correlates of HEV IgG seropositivity were older age (prevalence ratio (PR) 1.07, 95% CI 1.04–1.09, P < 0.001) and consuming beef frequently (PR 2.81, 95% CI 1.40–5.63, P = 0.003). No associations were found between Arab religious groups (Muslim, Christian or Druze, representing different socioeconomic status and dietary habits) or pork consumption and HEV IgG seropositivity. In conclusion, HEV seropositivity was high in the Arab population, and assessing HEV in Ruminants, particularly cows, is warranted.

Background A comprehensive evaluation of potential living kidney donors is crucial to ensure their short and long-term safety. We explored differences in kidney biochemical indicators, blood pressure measurements, and glucose control pre- and post-kidney donation between women with pre-diabetes and those with normal glucose levels. Methods We performed a prospective cohort study at West Bank and Gaza University hospitals between 2016 and 2022. Differences in sociodemographic and clinical factors that were collected from the participants’ medical records between women with pre-diabetes and without diabetes, pre- and post-donation, were assessed using the chi-square test for categorical variables and the Mann–Whitney U test for variables with skewed distribution. Trained nurses performed anthropometric measurements and drew fasting blood samples at various time points from one year before donation to five years after donation. Results Altogether, 114 female kidney donors (57 with pre-diabetes) aged 27–45 years (median = 35.7, IQR = 5.6) were included in the study. The post-donation median Body Mass Index (BMI) remained higher in women with pre-diabetes (35.02) than in those without diabetes (29.34) five years after donation, (P < 0.001). The 24 h protein, diastolic, and systolic blood pressure levels were significantly higher among women with pre-diabetes than among those without diabetes five years after donation, (P < 0.001). The median estimated glomerular filtration rate (eGFR) was significantly lower in pre-diabetic women (78.2 ml/min/1.73 m²) compared with the non-diabetic participants (87.9 ml/min/1.73 m²) five years after donation, (P < 0.001). Conclusions Pre-diabetic donors showed an increased risk of adverse outcomes, including hypertension, impaired oral glucose tolerance test, worsening kidney function, and proteinuria. Our findings underscore the importance of maintaining regular check-ups and follow-ups in particular in pre-diabetic kidney donors. Graphical abstract

Background: Early risk stratification tools for COVID-19 patients have been indicated yet there are few data about their ability to effectively detect clinical deterioration among COVID-19 patients. Objectives: To evaluate the NEWS-2 to predict severe morbidity and mortality for COVID-19 patients admitted to hospitals. Methods: We conducted a prospective cohort study among adult COVID-19 patients with a confirmed diagnosis who were admitted to the inpatient units at COVID-19 Martyrs Medical Military Complex Hospital, from 1 March 2022, until 29 February 2023. NEWS-2 scores were measured at admission and 6, 12, 24, and 48 h after their admission to the hospital using receiver operating characteristic (ROC) curves. Results: Overall, 192 adult COVID-19 patients aged 25–94 years (mean = 62.1, SD = 13.9) were enrolled. Of those, 49.0% were males, 47.4% were vaccinated, and 53.6% had diabetes. The 192 enrolled patients were classified into NEWS-2 score categories, with almost 13% (12.5%) falling into the high-risk category already upon admission. The mean NEWS-2 scores were excellent predictors of mechanical ventilation, admission to the ICU, and mortality, as indicated by an AUROC of 0.94 (95% CI: 0.88–1.00, p < 0.001), 0.91 (95% CI: 0.87–0.96, p < 0.001), and 0.96 (95% CI: 0.92–1.00, p < 0.001), respectively. Significant differences in mean NEWS-2 scores were found between the participating patients, both with and without comorbidity in the course of the patient’s stay in the ICU, and mortality (p = 0.004, p = 0.043, respectively). Positive correlations of the high NEWS-2 scores were revealed using a multiple linear regression model, indicating the necessity of administering non-invasive ventilatory assistance (p = 0.013), hospitalization for a minimum of six days (p = 0.013), and admission to the ICU (p = 0.006). Nonetheless, there was a negative association between mortality and the NEWS-2 score (p < 0.001). Conclusions: The NEWS-2 had moderate sensitivity and specificity in predicting the deterioration of patients with COVID-19 whereas there was high sensitivity and specificity in predicting the mortality for patients with COVID-19, both with and without comorbidity. Our findings support the utility of NEWS-2 monitoring as a sensitive approach for initially assessing COVID-19 patients. It could be helpful to enhance the accuracy of predictive performance by supplementing the score parameters by adding biological parameters in addition to clinical judgment.