Marafi Jammaa Ahmed

Introduction: Mobile phones play a pivotal role in the lives of young adults and medical students, but their problematic use may negatively affect daily functioning. The ongoing armed conflict in Sudan has substantially disrupted daily routines, academic activities, psychological wellbeing, and sleep behaviors among university students. This study aimed to assess the association between problematic smartphone use and sleep quality, sleep patterns, chronotype, and life satisfaction among undergraduate medical students during the conflict period in Sudan. Methods: An analytical cross-sectional study was conducted among 387 undergraduate medical students in Sudan between September 2025 and November 2025, during an ongoing armed conflict. Data were collected using self-administered online questionnaire incorporating validated instruments: the Problematic Use of Mobile Phone (PUMP) Scale, Smartphone Addiction Scale–Short Version (SAS-SV), Pittsburgh Sleep Quality Index (PSQI), Morningness–Eveningness Questionnaire (MEQ), and Satisfaction With Life Scale (SWLS), alongside demographic variables. Descriptive statistics summarized participant characteristics and scale scores. Associations were examined using Spearman correlation analyses. Multivariable logistic regression was performed with poor sleep quality (PSQI >5) as the dependent variable. Independent variables entered simultaneously into the model included PUMP score, SAS-SV score, MEQ score, SWLS score, age, gender, and employment status. Analyses were conducted using R software, with p < 0.05 considered statistically significant. Results: A total of 387 students participated (mean age 22.1 ± 2.3 years; 69% female). Poor sleep quality (PSQI >5) was observed in 71% of participants. Smartphone addiction showed a modest but statistically significant association with poorer sleep quality (ρ =0.22, p < 0.001). In multivariable analysis, higher smartphone addiction scores were associated with increased odds of poor sleep quality (OR = 1.04; 95% CI: 1.00–1.07) and greater morningness preference was associated with lower odds of poor sleep quality (OR = 0.94; 95% CI: 0.91–0.96; p < 0.001). Employment status (OR = 2.34; 95% CI: 1.27–4.56) was independently associated with poor sleep quality (all p < 0.05). Conclusion: Poor sleep quality was highly prevalent among Sudanese medical students and was independently associated with smartphone addiction, evening chronotype, and employment status. These findings highlight important associations between smartphone use behaviors, chronotype, and sleep quality in conflict-affected academic settings and support the need for further longitudinal research, particularly within conflict-affected academic settings.

Background: Breast cancer is one of the most frequent cancers globally, and radiotherapy plays an important key role in reducing the chance of recurrence following breast-conserving surgery. As an alternative to traditional fractionated radiotherapy (CFRT), hypofractionated whole-breast irradiation (HFRT) has gained popularity since it provides similar oncological results over shorter treatment periods. Nevertheless, the comparative effectiveness and safety profile of hypofractionated versus conventional fractionation schedules remains an area of ongoing evaluation. Aim: To compare the efficacy and safety of HFRT versus CFRT in patients with breast cancer, with particular emphasis on disease-free survival and treatment-related toxicity. Methods: A comprehensive search of PubMed, Cochrane Library, Scopus, Web of Science, and Embase was conducted through December 2024. Randomized controlled trials (RCTs) and comparative studies evaluating HFRT versus CFRT in early-stage breast cancer. Key outcomes assessed included disease-free survival (DFS) and treatment-related toxicities, particularly lymphedema and acute radiation dermatitis. The Mantel–Haenszel method to calculate risk ratios (RRs) with 95% confidence intervals (CI) was used. Results: Eight studies comprising 5,495 breast cancer patients were identified. The meta-analysis demonstrated no significant differences in disease-free survival (DFS) in 5 years ( RR = 1.01, 95% CI 0.96–1.06; P = 0.83 ). Similarly, no significant difference was observed in the incidence of lymphedema between HFRT and CFRT (RR = 1.19, 95% CI 0.94–1.51; P = 0.15). Regarding acute radiation dermatitis, a statistically significant difference favoring HFRT was observed under the fixed-effects model (RR = 1.62, 95% CI 1.20–2.18; P = 0.002). However, due to substantial heterogeneity across studies (I² = 90%), a random-effects model was applied, which demonstrated no statistically significant difference between treatment groups (RR = 1.43, 95% CI 0.51–4.01; P = 0.50). These results should be interpreted with caution given the high between-study variability. Conclusion: HFRT demonstrated comparable oncological outcomes to CFRT, with a trend toward reduced acute skin toxicity, indicating that it could be a promising therapy option for early-stage breast cancer. Standardizing radiation treatments and evaluating long-term toxicity and patient-reported results should be the goals of future research. Also, the observed variability across studies warrants cautious interpretation of the pooled estimates, particularly for outcomes demonstrating substantial heterogeneity. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD42025631012.

Background: Ongoing research aims to identify the most effective sedative for procedural sedation. This meta-analysis compares dexmedetomidine with midazolam-fentanyl in surgical patients. Methods: We conducted a search through MEDLINE, EMBASE and CENTERAL to find randomized controlled trials (RCTs) comparing dexmedetomidine and midazolam-fentanyl. Data on participant characteristics, intervention details, and outcomes were extracted, focusing on intraoperative hemodynamic parameters, respiratory safety, and adverse events. Sedative efficacy and recovery profiles were also evaluated and assessed descriptively across included studies. Data were analyzed using RevMan 5.4, applying random effects models for significant heterogeneity (I ² > 50%). Studies with fewer than three data points per group were excluded, and sensitivity analyses were performed. Results: We include 4 RCTs with 259 patients. Dexmedetomidine significantly lowered mean arterial pressure (MAP) by −6.42 mmHg (95% CI: −8.24 to −2.21, p < 0.001). Initially, heart rate differences were not significant, but after excluding an outlier, dexmedetomidine reduced heart rates by 6.71 bpm (95% CI: −10.74 to −2.68, p = 0.001). Respiratory rate and oxygen saturation showed no significant differences between groups, and adverse events were comparable. Conclusion: Dexmedetomidine offers superior blood pressure control compared to midazolam-fentanyl, with similar safety profiles for respiratory parameters. Further research is needed to assess long-term outcomes such as postoperative delirium and residual sedation.

Background: Given the current lack of data from Iraq regarding peritoneal carcinomatosis (PC) management using Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), and the diversity in genetics, environmental conditions, and socioeconomic factors in Iraq, we conducted the first study of PC management using CRS+HIPEC. Methods: This is a retrospective single-center study at Al-Arabi Private Hospital in Baghdad, Iraq, on 61 patients recently diagnosed with peritoneal cancer who have been managed by CRS and HIPEC for the first time in Iraq. Subsequently, the patients were observed for a duration of 4 years throughout the follow-up phase. Results: The study, with an average participant age of 49.15 years and females representing 62%, showed an overall survival rate of 26.2% and a median survival duration of 32.51+/-12.8 months. Colorectal and ovarian cancers were predominant at 49% and 21%, respectively. The closed method of HIPEC was used in 80% of cases. Significant associations were found between Neoadjuvant Chemotherapy (NACT) (p = 0.0001), Cytoreductive Surgery score (CC score) (p = 0.01), Peritoneal Cancer Index (PCI) (p = 0.001), and survival rates. Conclusion: In summary, as Iraq’s first study, our study provides crucial insights into PC management. Highlighting the vital role of NACT in CRT+HIPEC treatment, our study reveals no statistically significant difference between closed and open HIPEC methods. Our study further emphasizes the prognostic value of an elevated PCI and the critical importance of optimal cytoreduction, as reflected in the Completeness of Cytoreduction (CC) score. Our findings call for continued research, collaboration, and practical application to advance PC care.

Background Esophageal cancer (EC) remains a highly aggressive malignancy with a poor prognosis despite advancements in treatment. Toripalimab, a PD-1 inhibitor, has demonstrated the potential to improve clinical outcomes. This systematic review and meta-analysis assess the efficacy and safety of Toripalimab in EC. Methods Following PRISMA 2020 guidelines, we conducted a systematic review and meta-analysis, searching PubMed, Embase, Scopus, ScienceDirect, and Google Scholar up to January 2025. Eligible studies evaluated Toripalimab in esophageal cancer, including randomized controlled trials and non-randomized controlled trials. Primary outcomes included overall survival (OS), progression-free survival (PFS), and objective response rate (ORR), while safety outcomes assessed treatment-related adverse events. Data were synthesized using random-effects models, with heterogeneity evaluated via Cochrane’s Q and I² statistics. Results The pooled analysis included six studies involving 678 patients. Toripalimab demonstrated promising efficacy, with a Complete Response (CR) rate of 33%, Partial Response (PR) rate of 36%, pathological complete response (pCR) rate of 30%, and major pathological response (MPR) rate of 46%. The R0 resection rate was 87%, while OS and PFS rates were reported at 78% and 50%, respectively. Anemia (56%), alopecia (54%), leukopenia (54%), and fatigue (30%) were the most frequently reported adverse effects. Other common adverse effects included nausea (29%), constipation (18%), and vomiting (20%). Conclusions Toripalimab demonstrates significant potential in treating esophageal cancer, with favorable response rates and survival outcomes. However, the high incidence of adverse effects highlights the need for supportive care and ongoing research. While based on limited sample sizes and single-arm studies that may introduce bias and affect generalizability in this review, we provide valuable preliminary insights into toripalimab’s potential, highlighting the need for larger randomized trials to build on these findings.