Manar Ahmed Kamal

Chronic pain is a major cause of disability worldwide, impacting around 20% of adults globally. Conventional mu-opioid peptide (MOP) receptor agonists provide effective analgesia; however, their prolonged use is restricted by severe dose-limiting toxicities such as opioid-induced respiratory depression, analgesic tolerance, hyperalgesia, physical dependence, and addiction. The goal of this narrative literature review was to compile the available data on NOP receptor-targeted analgesics, with a focus on dual NOP/MOP agonists and cebranopadol. The pharmacological mechanisms, preclinical and clinical evidence, safety profile, and potential therapeutic role in pain management were all highlighted. The nociceptin/orphanin FQ (N/OFQ) peptide (NOP) receptor system has been identified as a new pathway for managing pain through mechanisms that differ from those of classical opioid signaling. The NOP receptor is a Class A G-protein-coupled receptor (GPCR) that preferentially couples to inhibitory G(i/o) proteins. Upon activation, it suppresses adenylyl cyclase activity, lowers intracellular cyclic adenosine monophosphate (cAMP) levels, blocks voltage-gated calcium channels, and activates G-protein-gated inwardly rectifying potassium channels, thereby hyperpolarizing neurons and decreasing excitatory neurotransmitter release. NOP receptors are anatomically distributed throughout the peripheral and central nervous systems, including primary afferent sensory neurons, dorsal root ganglia, spinal dorsal horn, periaqueductal gray, rostral ventromedial medulla, central amygdala, ventral tegmental area, and nucleus accumbens. NOP activation via these pathways offers significant pain relief in acute nociception, as well as in chronic inflammatory and neuropathic pain conditions. Supraspinal activation of NOP within the mesocorticolimbic pathway influences the emotional aspect of pain by reducing corticotropin-releasing factor signaling and decreasing mesolimbic dopamine release. NOP agonism effectively provides analgesia while also attenuating drug reward and reinforcement. The development of pharmaceuticals utilizing NOP agonism has progressed from endogenous peptide analogues to selective non-peptide agonists, and more recently to bifunctional NOP/MOP (dual NMR) agonists, such as the dual NOP/MOP agonist cebranopadol, which has passed Phase I–III clinical testing. There are still significant questions about long-term safety, comparative efficacy, and the interpretation of unpublished or preliminary Phase III results, despite the fact that available clinical trials indicate analgesic efficacy with perhaps decreased respiratory and abuse-related effects. This drug achieves equianalgesic efficacy through potent dual NOP/MOP activation while significantly reducing the risk of respiratory depression and drug-liking. However, clinical translation of NOP receptor agonism is hindered by several challenges, including supraspinal pronociceptive paradoxes, species-specific pharmacology, dose-dependent sedation, and regulatory complexities associated with mixed-mechanism ligands. NOP-targeted therapies represent a promising approach for the development of next-generation, opioid-sparing analgesics in pain medicine.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare and potentially lethal complication of blood transfusion. It occurs when transfused immune cells, such as lymphocytes, elicit an immune response against the recipient’s tissues, including the skin, bone marrow, and gastrointestinal tract. TA-GVHD leads to severe pancytopenia, resulting in increased vulnerability to severe, often untreatable infections. Although the pathogenesis of TA-GVHD is fairly well understood, management remains challenging given the paucity of successful outcomes. We present a case of an immunocompetent 40-year-old Yemeni male who developed TA-GVHD after receiving a single unit of irradiated blood from his brother. The transfusion was done prior to an upper endoscopy procedure that confirmed the diagnosis of a peptic ulcer disease after which the patient was treated appropriately. He presented later with severe dyspnea and productive cough, necessitating oxygen support via face mask. The patient rapidly deteriorated with unstable vitals and was subsequently intubated and mechanically ventilated. Unfortunately, the patient died later due to cardiopulmonary compromise despite appropriate resuscitative measures. In summary, TA-GVHD is a serious condition that attacks the recipient’s tissues and results in severe pancytopenia.

Fatigue has the potential to alter how impact forces are absorbed during running, heightening the risk of injury. Conflicting findings exist regarding alterations in both kinematics and plantar pressure. Thus, this systematic review and subsequent meta-analysis were conducted to investigate the impact of general and localized muscle fatigue on kinematics and plantar pressure distribution during running. Initial searches were executed on 30 November 2021 and updated on 29 April 2023, encompassing PubMed, The Cochrane Library, SPORTDiscus, and Web of Science without imposing any restrictions on publication dates or employing additional filters. Our PECOS criteria included cross-sectional studies on healthy adults during their treadmill running to mainly evaluate local muscle fatigue, plantar pressure distribution, biomechanics of running (kinematics, kinetics, and EMG results), and temporospatial parameters. The literature search identified 6626 records, with 4626 studies removed for titles and abstract screening. Two hundred and one articles were selected for full-text screening, and 20 studies were included in qualitative data synthesis. The pooled analysis showed a non-significant decrease in maximum pressure under the right forefoot’s metatarsus, which was more than the left rearfoot after local muscle fatigue at a velocity of 15 km/h (p-values = 0.48 and 0.62). The results were homogeneous and showed that local muscle fatigue did not significantly affect the right forefoot’s stride frequency and length (p-values = 0.75 and 0.38). Strength training for the foot muscles, mainly focusing on the dorsiflexors, is recommended to prevent running-related injuries. Utilizing a standardized knee and ankle joint muscle fatigue assessment protocol is advised. Future experiments should focus on various shoes for running and varying foot strike patterns for injury prevention.

Introduction and importance: Right atrial myxoma is rarely associated with Budd–Chiari syndrome (BCS). In this paper, we present a case of a young patient with a giant right atrial myxoma complicated by the development of BCS. Case presentation: A 26-year-old female presented to the emergency room with persistent abdominal pain, ascites, lower limb edema, and an acute episode of dyspnea. Abdominal computed tomography revealed a lesion in the right cardiac cavity that resembled an intracardiac thrombus. Transthoracic echocardiography showed a large heterogeneous mass in the right atrium protruding into the right ventricle and a large thrombus interfering with inferior vena cava flow. The patient underwent cardiac surgery to remove the atrial mass, and histopathologic examinations confirmed the diagnosis of atrial myxoma. Clinical discussion: The right atrial myxoma is relatively rare, especially the giant ones. Rarely have intracardiac tumors such as giant right atrial myxoma been identified as a risk factor for the onset of BCS. Conclusion: In the differential diagnosis of BCS, right atrial tumors, including myxomas, should be considered, especially when other explanations are absent.

Background: In medical practice, it is common to see patients who present with physical symptoms for which no disease pathology can be found. The presence of neurological symptoms that are shown to be incompatible with neurological pathophysiology is classically known as “conversion disorder” or “Functional Neurological Symptom Disorder” (FND). While FND is common in Egypt as in the rest of the world, few scientific studies systematically evaluate the degree of knowledge, attitude, and care provided by health care professionals to FND patients. We aimed to assess Egyptian physicians’ perspectives on FND.Results: A cross-sectional study has been conducted on 152 physicians dealing with FND practicing in Egypt from specialties of psychiatry, neurology, and other specialties. We found that for 45% of the participants, disordered functioning of the nervous system plus psychogenesis was the accepted etiology behind FND. Most participants were significantly not satisfied with their education about FND (p-value 0.01). Psychiatrists and neurologists significantly preferred to use the term “conversion disorder” while other specialties mainly used “psychic” and “Somatization/Somatoform Disorder” (p-value 0.001). Forty-four percent of the participants think they have a good knowledge of functional neurological disorders (FND), while the majority (86.8%) were worried about missing an organic disorder. Psychiatrists were the most confident in diagnosing FND and the most comfortable discussing it with patients (p-values 0.055 and 0.007, respectively).Conclusion: Here we highlight the common theme of worry about FND patients prevailing among healthcare professionals who are mostly perplexed about the mechanisms behind FND, and how to communicate these symptoms to other professionals and patients themselves. Future directions need to be devoted to minimizing the gap between the research finding and the currently applied care. Better education and teaching about FND may improve patient care.

Telemedicine, telehealth, and E-health all offer significant benefits for pain management and healthcare services by fostering the physician–patient relationship in otherwise challenging circumstances. A critical component of these artificial-intelligence-based health systems is the “agent-based system”, which is rapidly evolving as a means of resolving complicated or straightforward problems. Multi-Agent Systems (MAS) are well-established modeling and problem-solving modalities that model and solve real-world problems. MAS’s core concept is to foster communication and cooperation among agents, which are broadly considered intelligent autonomous factors, to address diverse challenges. MAS are used in various telecommunications applications, including the internet, robotics, healthcare, and medicine. Furthermore, MAS and information technology are utilized to enhance patient-centered palliative care. While telemedicine, E-health, and MAS all play critical roles in managing chronic pain, the published research on their use in treating chronic pain is currently limited. This paper discusses why telemedicine, E-health, and MAS are the most critical novel technologies for providing healthcare and managing chronic pain. This review also provides context for identifying the advantages and disadvantages of each application’s features, which may serve as a useful tool for researchers.

Background: Coronavirus disease-19 emerged in December 2019. Healthcare workers were exposed to this highly infectious virus during the pandemic and suffered several social and psychological consequences, such as anxiety, psychological distress, and burnout. Objectives: To assess the psychological distress, anxiety, depression, coping strategies, risk perception, and attitude toward interprofessional teamwork among Egyptian healthcare workers during the COVID-19 pandemic. Methods: We conducted a cross-sectional online survey which consisted of five sections. The primary outcomes were anxiety (GAD-7), depression (PHQ-9), risk perception towards COVID-19, interprofessional teamwork attitude, and coping strategies during the Coronavirus disease-19 pandemic. The web-based questionnaire was distributed to Egyptian healthcare workers from the 20^th of April 2020 to the 20^th of May 2020. A snowball sampling method was used. Regression analysis was conducted to test the relationship between the socioeconomic characteristics and the previously mentioned outcomes. Results: A total of 403 participants responded to the online questionnaire. The majority were females (70.5%) and within the age group of 26–40 years (77.7%), with 2–5 years of work experience (43.2%). Most participants were pharmacists (33%) and physicians (22.1%). Eighty-two participants (21%) reported moderate to severe anxiety, and 79 participants reported (19.4%) moderate to severe depressive symptoms. In the univariate model, the marital status was associated with depression (OR 0.47, 95% CI 0.28–0.78), anxiety (OR 0.52, 95% CI 0.32–0.85), and an attitude toward interprofessional teamwork (β = -1.96 95% CI -2.72 to -1.2). Providing direct care to the patients was associated with lower anxiety symptoms (AOR 0.256, 95% CI 0.094–0.697). More severe anxiety and depressive symptoms were associated with difficulties in everyday life and the professional work environment (AOR 4.246 and 3.3, P = 0.003 and 0.01, respectively). Availability of mental health facilities at the workplace was associated with a lower risk perception towards COVID-19 (β = -0.79, 95% CI -1.24 to -0.34) and a more positive attitude towards teamwork (β = 2.77 95% CI 1.38–4.15). Conclusions: According to our results, the COVID-19 pandemic was associated with mild anxiety and depression among healthcare workers in Egypt, especially pharmacists and physicians. We recommend more research targeting the mental health of healthcare workers in Egypt. If proven cost-effective and needed, wide-scale mental health screening and public health campaigns can facilitate effective prevention and treatment strategies. In addition, the availability of mental health facilities at the workplace could alleviate some of the risk perception associated with health emergencies and improve interprofessional teamwork.

Background: Spiritual leadership is the most positive leadership style accepted by positive organizational behavior scholars that contributes to psychological capital. Spiritual leadership could be a critical organizational resource for followers. The study aims to examine the levels of spiritual leadership and psychological capital among nursing educators and determine the relationship between spiritual leadership and psychological capital among nurse educators. Methods: A cross-sectional design was applied using two tools: spiritual leadership and psychological capital scales. Over 3 months, data were collected from 213 nursing educators. Results: The spiritual leadership level is moderate to high (49.8 and 38.5%). The psychological capital level is high (63.4%). The association between spiritual leadership and psychological capital is a strong, positive, and highly significant correlation (R-value = 0.63, P = 0.001). The regression analysis predicted that male participants were expected to have more spiritual leadership and psychological capital than females. Conclusion: It can be concluded and validated how important it is to develop and practice spiritual leadership to foster followers’ psychological capital. Implications of nursing management: as nursing leaders must have spiritual competencies to promote workplace spirituality on the daily agenda as a foundational area in management.

Ramadan is the ninth month of the Islamic lunar calendar in which it is compulsory for Muslims to abstain from eating and drinking during the daytime. The COVID‐19 pandemic posed additional challenges for Muslims as the crowded religious gatherings could give a new breath to the spread of the virus. Similar measures were adopted during Ramadan in 2021. The initiation of COVID‐19 vaccination across the globe in combination with the need to maintain personal protective measures against COVID‐19, result in new needs and challenges. At this juncture, Ramadan 2022 offers a growing opportunity to unite a global voice for solidarity, equal distribution of COVID‐19 vaccines, and tackling the challenge of vaccine hesitancy.

Endoscopic retrograde cholangiopancreatography (ERCP) identifies and treats pancreatic and biliary diseases. We conducted a systematic review and meta-analysis examining relevant papers in five databases to examine the frequency of hypoxia throughout the surgery and the lowest oxygen saturation level in patients under sedation. Our meta-analysis included three randomized controlled trials with 390 participants, 196 in the high-flow oxygen (HFNC) group and 194 in the low-flow oxygen (LFNC) group. Their ages ranged from 65.3 to 79 years. The pooled effect estimate showed that HFNC decreased the incidence of hypoxia during the procedure when compared to LFNC (odds ratio −0.84; 95% confidence interval [CI] −1.65, −0.02; P = 0.04), and the mean of lowest oxygen saturation in patients during sedation was significantly lower in LFNC compared to HFNC (mean difference 2.34; 95% CI 1.35, 3.32; P = 0.001). The pooled effect estimate showed that the HFNC group had a lower incidence rate of jaw thrusting adverse events during anesthesia than the LFNC group (risk difference −0.12; 95% CI −0.21, −0.04; P = 0.001). In summary, HFNC systems reduced the incidence of hypoxia for patients undergoing ERCP and had a higher mean lowest oxygen saturation during sedation.