Ahmad Aldardour

Background: Cardiovascular manifestations, such as pericarditis, myocarditis, and thromboembolic events, are well-documented complications in patients with systemic autoimmune diseases that significantly contribute to morbidity and mortality. Nonetheless, early or atypical presentations of cardiac tamponade in patients with overlapping autoimmune conditions remain diagnostically challenging and underreported. Case Presentation: We present the case of a 47-year-old woman diagnosed with rheumatoid arthritis (RA), Sjögren’s syndrome (SS), and antiphospholipid syndrome (APS), who was admitted to the emergency department with acute-onset pleuritic chest pain, tachypnea, and hypoxemia. Initial clinical evaluation raised suspicion of pulmonary embolism (PE) due to her prothrombotic risk factors and an elevated D-dimer level of 5 µg/ ml. However, bedside echocardiography identified a moderate-to-large circumferential pericardial effusion with early tamponade physiology, evidenced by respiratory inflow variation and right atrial collapse, despite maintained blood pressure and the absence of classical hemodynamic collapse. Electrocardiography (ECG) revealed sinus tachycardia with electrical alternans. The patient received medical management with high-dose corticosteroids, hydroxychloroquine, and colchicine, along with close hemodynamic monitoring. The patient demonstrated clinical improvement without the need for pericardiocentesis. This case underscores the diagnostic complexities in patients with autoimmune diseases presenting with atypical cardiopulmonary symptoms and highlights the essential role of rapid bedside imaging in detecting occult yet potentially life-threatening complications. Conclusion: Early identification of tamponade physiology, even at low pressure, through point-of-care echocardiography, coupled with targeted anti-inflammatory treatment, is crucial for improving clinical outcomes in patients with systemic autoimmune diseases. Clinicians should maintain a high level of vigilance for cardiac involvement, even in the absence of classical tamponade signs, particularly in patients with multiple, overlapping autoimmune conditions.

Background: Dentists are at an increased risk of developing musculoskeletal disorders, particularly carpal tunnel syndrome (CTS), due to repetitive hand movements, awkward postures, and sustained grip forces. This study aimed to investigate the prevalence and risk factors of self-reported wrist and hand symptoms and clinically relevant CTS indicators among dentists in Jordan. Methods: A cross-sectional study was conducted among 201 licensed dentists in Jordan. Participants completed demographic questionnaires and the Valid Arabic version Boston Carpal Tunnel Questionnaire (BCTQ) to assess their symptom severity and hand function. Data was analyzed using STATA version 17, applying descriptive statistics, chi-squared tests, t-tests, ANOVA, and multivariable linear regression to evaluate association between sociodemographic factors and BCTQ scores. Results: Of the 201 participants, 64.2% were female and 35.8% were male. Female dentists were significantly younger (median age 31 vs. 39 years, p < 0.001), reported higher symptom severity (median score 18.0 vs. 16.0, p = 0.019), and experienced greater functional limitations (median score 15 vs. 9, p < 0.001) than male dentists. The overall mean symptom severity score was 19.12 (SD = 7.82), and the functional impairment score was 14.20 (SD = 6.37), indicating mild pain and functional limitation. Multivariable regression revealed that male sex was associated with significantly lower symptom scores (β = 0.7, p = 0.001) and better function (β = 0.722, p = 0.002). Geographic location, higher education level (PhD), and full-time employment were associated with higher symptom scores in the study. Conclusions: Wrist and hand symptoms are prevalent among dentists in Jordan, with significant sex differences in symptom severity and functional impairment. Geographic location, academic degree, and working hours were significant predictors of CTS-related symptoms. These findings underscore the need for ergonomic interventions and targeted preventive strategies, especially for high-risk groups, such as female and full-time practitioners.

Background: Resistance exercise has shown effectiveness in reducing various risk factors related to sarcopenic obesity (SO) compared to other types of exercise, e.g., aerobic exercise. Objective: This systematic review evaluates the effect of resistance exercise on body composition, muscular strength, and functional capacity among older women with sarcopenic obesity aged ≥ 60 years. Methods: This systematic review is registered on PROSPERO (registration No. CRD42023394603) and follows the PRISMA guidelines. The following electronic databases were used to search the literature: Pedro, Cochrane Central Register of Controlled Trials, Embase, PubMed, and Web of Science. We included only RCTs that investigated the effect of resistance exercise on body composition and functional capacity. Two independent reviewers conducted the process of study selection and data extraction. Results: The search strategy retrieved 687 results. One hundred and twenty-six records were deleted as duplicates. Consequently, 534 studies were excluded after the title/abstract assessment. After further detailed evaluation of twenty-seven full texts, seven RCTs were included; all the RCTs examined the isolated effect of resistance exercise in women with sarcopenic obesity. The included studies comprised 306 participants, with an average age of 64 to 72 years. We noticed a trend of improvement in the included studies among the intervention groups compared to the control groups among the different outcomes. The study protocol was inconsistent for the intervention settings, duration, and outcomes. Including a modest number of trials made it impossible to perform data meta-analysis. Conclusions: Heterogeneity among studies regarding training protocols and the outcome measures reported limited robust conclusions. Still, resistance exercise intervention can improve body composition and functional capacity among elderly women with sarcopenic obesity.

Background: Human cognitive processing speed is known to decline with age. Human cognitive processing speed refers to the time that an individual takes from receiving a stimulus to reacting to it. Serious games, which are video games used for training and educational purposes, have the potential to improve processing speed. Numerous systematic reviews have summarized the evidence regarding the effectiveness of serious games in improving processing speed, but they are undermined by some limitations. Objective: This study aimed to examine the effectiveness of serious games on the cognitive processing speed of an older adult population living with cognitive impairment. Methods: A systematic review of randomized controlled trials (RCTs) was conducted. Two search sources were used in this review: 8 electronic databases and backward and forward reference list checking. A total of 2 reviewers independently checked the eligibility of the studies, extracted data from the included studies, and appraised the risk of bias and quality of the evidence. Evidence from the included studies was synthesized using a narrative and statistical approach (ie, meta-analysis), as appropriate. Results: Of the 548 publications identified, 16 (2.9%) RCTs eventually met all eligibility criteria. Very-low-quality evidence from 50% (8/16) and 38% (6/16) of the RCTs showed no statistically significant effect of serious games on processing speed compared with no or passive intervention groups (P=.77) and conventional exercises (P=.58), respectively. A subgroup analysis showed that both types of serious games (cognitive training games: P=.26; exergames: P=.88) were as effective as conventional exercises in improving processing speed. Conclusions: There is no superiority of serious games over no or passive interventions and conventional exercises in improving processing speed among older adults with cognitive impairment. However, our findings remain inconclusive because of the low quality of the evidence, the small sample size in most of the included studies, and the paucity of studies included in the meta-analyses. Therefore, until more robust evidence is published, serious games should be offered or used as an adjunct to existing interventions. Further trials should be undertaken to investigate the effect of serious games that specifically target processing speed rather than cognitive abilities in general. Trial Registration: PROSPERO CRD42022301667; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=301667

BACKGROUND Cognitive processing speed is known to decline by age. Processing speed refers to the time that an individual takes from receiving a stimulus to reacting to it. Serious games, which are video games employed for training and educational purposes, have the potential in improving processing speed. Numerous systematic reviews have summarized the evidence about the effectiveness of serious games in improving processing speed, but they are undermined by some limitations. OBJECTIVE This study aims to pool the evidence about the effectiveness of serious games in improving processing speed among elderly people with cognitive impairment. METHODS A systematic review of randomized controlled trials (RCTs) was undertaken. Two search sources were used in this review: 8 electronic databases as well as backward and forward reference list checking. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, and appraised the risk of bias and quality of the evidence. Evidence from the included studies was synthesized using a narrative and statistical approach (i.e., meta-analysis), as appropriate. RESULTS Out of 548 publications identified, 16 RCTs eventually met all eligibility criteria. Very low-quality evidence from 8 RCTs and 6 RCTs showed no statistically significant effect of serious games on the processing speed as compared with no or passive interventions groups (P=0.77) and conventional exercises (P=0.58), respectively. A subgroup analysis showed that both types of serious games (cognitive training games (P=0.26) and exergames (P=0.88)) are as effective as conventional exercises in improving processing speed. CONCLUSIONS There is no superiority of serious games over no or passive interventions and conventional exercises in improving processing speed among older adults with cognitive impairment. Yet, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Therefore, until more robust evidence is published, serious games should be offered or used as an adjunct to existing interventions. Further trials should be undertaken to investigate the effect of serious games that target specifically processing speed rather than cognitive abilities in general.