Afnan W. M. Jobran

Cancer remains a leading cause of mortality globally, while hypertension is the primary contributor to cardiovascular disease and premature death. These conditions frequently coexist; hypertension may precede cancer due to shared risk factors or arise during or after cancer treatment, partly as a result of the hypertensive effects of antineoplastic therapies. As cancer survival rates improve, effective management of comorbid hypertension has become increasingly important. In this study we analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database, which includes 17 registries and cover approximately 34.6% of the U.S. population, this study evaluated hypertension-related mortality among cancer patients diagnosed between 2000 and 2021. Causes of death were stratified by demographic, clinical, treatment, and cancer-specific characteristics. Standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated across survival intervals. Among 6,891,191 patients with malignant disease, 17,780 deaths (0.26%) were attributed to hypertension. Hypertension-related mortality was 24% higher than in the general population (SMR 1.24, 95% CI 1.22–1.26), with the greatest excess observed within the first year after diagnosis (SMR 2.04, 95% CI 1.97–2.11). Elevated risk was identified among patients younger than 40 years, racial minorities, unmarried individuals, those with regional or distant disease, and those who did not receive surgery, radiotherapy, or chemotherapy, particularly during the first year after diagnosis. No improvement in hypertension mortality was observed during 2010–2021, and females exhibited a slightly higher risk than males. SMRs did not decrease over time, and females exhibited a slightly higher risk than males. These findings support the consideration of early and sustained onco-hypertension management and coordinated care among oncologists, cardiologists, and primary care physicians. Further research examining patient-level risk factors, comorbidities, treatment strategies, and socioeconomic determinants is essential to improve survival outcomes among cancer survivors.

Diabetic foot complications are a major cause of morbidity and disability yet are largely preventable through proper self-care. This cross-sectional study assessed foot self-care practices among adults with diabetes in the West Bank, Palestine, and identified factors associated with adherence. We interviewed 300 adults attending diabetes clinics at four sites using a structured questionnaire adapted from a published foot-care instrument. Foot self-care was measured using an 11-item frequency scale (score range 0–44), with higher scores indicating better adherence; the scale showed acceptable internal consistency (Cronbach’s alpha = 0.81). Overall adherence was suboptimal: although 80.9% reported washing their feet daily, only 33.1% inspected their feet daily, 45.1% dried between toes, and 40.3% inspected shoes. Risky behaviors were common, including soaking feet (28.6%), walking barefoot (20.2%), and wearing shoes without socks (15.9%). Only 13% reported performing all recommended behaviors daily. In multivariable analysis, higher income, higher educational attainment, and longer diabetes duration were associated with better adherence, and male sex was associated with lower adherence in the ordinal logistic model. These findings highlight important gaps in preventive foot self-care in the West Bank, driven by socioeconomic and educational disparities and limited clinical reinforcement, underscoring the need for culturally tailored education and routine provider-led counseling and screening to reduce diabetic foot complications.

Synovial sarcoma is a high‐grade soft‐tissue sarcoma that commonly affects adolescents and young adults. Involvement of the head and neck region is rare, and tumors arising from the sinonasal tract are particularly uncommon and diagnostically challenging. We report the case of a 38‐year‐old male who presented with head trauma and decreased consciousness following a transient neurological episode while driving. Brain computed tomography revealed a lesion involving the left anterior ethmoidal air cells with associated old cerebral infarctions. Further magnetic resonance imaging demonstrated an aggressive enhancing sinonasal mass with limited intracranial extension, associated with radiologic findings suggestive of vasculitis and acute‐on‐chronic ischemic insults. Histopathological evaluation showed a spindle‐cell neoplasm considered most consistent with synovial sarcoma based on morphology and available immunohistochemical findings. The patient was started on neoadjuvant chemotherapy, after which the vasculitic findings showed regression, suggesting a probable paraneoplastic vasculitic association. Due to the complex anatomical location and local extension of the tumor, complete surgical resection was not initially feasible. Planned management included combined chemoradiotherapy with consideration of future surgical intervention. This case highlights the diagnostic and therapeutic challenges of sinonasal synovial sarcoma and emphasizes the importance of multidisciplinary evaluation, particularly in cases associated with unusual vasculitic and ischemic manifestations.

Cardiovascular diseases (CVD) are the leading global cause of mortality, projected to account for 23.3 million deaths annually by 2030, presenting

Background: Diabetic foot complications are a leading cause of morbidity, disability, and healthcare costs worldwide, yet they are largely preventable through proper self-care. In Palestine, evidence on patient adherence to recommended practices is scarce. This study aimed to assess the knowledge, attitudes, and practices of foot self-care among adults with diabetes in the West Bank and to identify factors associated with adherence. Methods: A cross-sectional study was conducted among 300 diabetic patients attending primary care clinics across the West Bank. Data were collected using a structured and validated questionnaire covering knowledge, attitudes, and practices. Statistical analyses included reliability testing, factor analysis, bivariate correlations, and multivariable regression models to identify independent predictors of adherence. Results: Adherence to recommended foot care practices was generally low, with only 13% of participants reporting daily engagement in all recommended behaviors. While daily foot washing was widely practiced (80.9%), preventive measures were less consistent: 33.1% inspected their feet daily, 45.1% dried between toes, and 40.3% inspected shoes. Risky practices were also common, including foot soaking (28.6%), barefoot walking (20.2%), and wearing shoes without socks (15.9%). Reliability testing of the foot care scale revealed poor internal consistency (Cronbach’s alpha = 0.39), suggesting a multidimensional structure. Multivariable regression showed that higher education (adjusted B = –4.05 for no schooling vs. undergraduate, p = 0.049), higher income (B = +3.91, p = 0.028), and longer diabetes duration (B = +1.02 per 5 years, p = 0.035) were associated with better adherence. Male sex was linked to lower adherence (OR 0.46, p = 0.017). Exposure to structured education and professional foot examinations also strongly predicted improved practices. Conclusion: Adherence to preventive foot self-care among diabetic patients in the West Bank is suboptimal, particularly in practices directly related to ulcer prevention. Socioeconomic disparities, health literacy, and limited clinical reinforcement emerged as key barriers. Culturally tailored education, structured provider counseling, and policy-level interventions are urgently needed to reduce the burden of diabetic foot disease in Palestine.

Introduction and importance: Intussusception is the most frequent cause of bowel obstruction in infants. Most cases are managed nonsurgically with liquid or enema reduction. Our study aims to evaluate the efficacy and safety of air versus liquid enema reduction for the treatment of intussusception in pediatric patients. Materials and methods: A literature search was conducted on electronic databases, and the references of all included studies were searched to identify additional relevant studies meeting our inclusion criteria. Our meta-analysis included studies that compared the use of air and liquid enemas in pediatric patients with intussusception. The primary outcomes assessed were reduction success, perforation, and recurrence rates. Secondary outcomes included hospital stay duration, reduction time, reduction pressure, and fluoroscopy time. Meta-analysis was performed using RevMan 5.4. Results: Twenty-nine studies were included in the analysis, encompassing 9281 patients. The pneumatic reduction was significantly associated with a higher success rate (risk ratio: 1.22, 95% confidence interval [CI]: {1.12, 1.34}) and a shorter reduction time (mean difference [MD]: −2.64, 95% CI: [−4.73, −0.55]). No significant difference was found between the two procedures in terms of perforation rate, recurrence rate, length of hospital stays, reduction pressure, and fluoroscopy. Subgroup analysis revealed that pneumatic reduction had higher success rates in both RCTs and cohort studies and was superior to liquid reduction before the year 2011. After 2011, both techniques had similar success rates. Pneumatic reduction also showed higher success rates in both children’s and non-children’s hospitals and among the general radiologists’ subgroup, though pediatric radiologists achieved similar success rates with both techniques. Conclusions: Pneumatic enema reduction offers higher success and faster treatment for pediatric intussusception, with comparable safety to hydrostatic methods, supporting its use as the preferred nonsurgical approach. Further comparative studies are recommended to examine radiation dose and fluoroscopy time.

Although nutritionally beneficial, honey may harbor Clostridium botulinum spores, posing risks to infant botulism (IB). Infants under one year are vulnerable due to immature gut flora, with IB potentially causing severe symptoms, such as respiratory failure. Despite global awareness, cultural beliefs influenced caregivers' practices in Palestine. This study evaluated Palestinian parents' knowledge, beliefs, and feeding practices regarding honey to guide targeted interventions. This cross-sectional study (August-September 2024) surveyed 469 Palestinian parents (aged ≥18 years) from 10 West Bank cities, excluding 88 ineligible responses. A validated questionnaire assessed their knowledge, attitudes, and practices. Data were analyzed using the R software (frequency, Chi-squared/Fisher's tests; p < 0.05). Most participants were female (89%), under 30 years old (53%), and highly educated (77%). While 58% knew of honey-linked IB, only 32% identified C. botulinum as the causative agent. Notably, 15.8% fed honey to infants aged <12 months and 62.5% introduced complementary feeding at 6-12 months. Age and income-influenced practices, with many believing that honey aids digestion or supplements nutrition. The findings reveal gaps in knowledge and widespread cultural beliefs about the benefits of honey, which contribute to unsafe feeding practices. Health interventions in Palestine should incorporate these insights to improve awareness and to prevent IB.

The rare condition known as HELLP syndrome is typified by hemolysis, low platelet counts, and high liver enzymes. We report a case of a 25-year-old primigravida who presented at a previable gestational age with nonspecific symptoms. She was diagnosed with hepatic infarction, a rare but severe complication of HELLP syndrome, and was managed promptly to prevent maternal morbidity and mortality.