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Volume 2 (2023)

Short Commentary

Targeting DNA Methylation Rewires Drug Responses of RB1-Deficient and Neuroendocrine Prostate Cancer

Jiawei Guo*

A commentary on Targeting DNA methylation and B7-H3 in RB1-deficient and neuroendocrine prostate cancer by Yasutaka Yamada, Varadha Balaji Venkadakrishnan, Kei Mizuno, Martin Bakht, Sheng-Yu Ku, Maria Mica Garcia, Himisha Beltran (2023). Sci Transl Med. 15(722): eadf6732. doi: 10.1126/scitranslmed. adf6732.


Research Article

Borrelia Burgdorferi Basic Membrane Protein A Initiates Arthritis in Tree Shrews

Bingxue Li; Hanxin Wu; Weijie Ma; Lei Zhong; Bingxue Li; Li Peng; Li Gao; Xinya Wu; Weijiang Ma; Liangyu Zhu; Jieqin Song; Suyi Luo; Fukai Bao*; Aihua Liu*

Borrelia burgdorferi Basic membrane protein A (BmpA) plays a crucial role in mediating immune responses to Lyme arthritis. The aim of this study was to describe manifestations and the main evaluation method on recombinant BmpA (rBmpA) - induced arthritis in tree shrews. We used rBmpA to stimulate knee joint in vivo in tree shrew animals.


Review Article

Regulation of Stem Cell Proliferation by p38 MAPK Signaling

Alexandre Clouet; Patrick Narbonne*

The p38 Mitogen Activated Protein Kinase (MAPK) is a key member of a highly conserved superfamily of protein kinases. Mostly sensitive to inflammatory cytokines and stress signals, p38 activation leads to a variety of cellular responses, including proinflammatory cytokines secretion, cell survival, apoptosis induction and the regulation of cell proliferation.


Research Article

The Impact of Intensive Care Unit-Acquired Weakness on Patients with Septic Shock

Ling Wang*; Dengyan Long

The study aimed to investigate the impact of Intensive Care Unit-Acquired Weakness (ICU-AW) on patients with septic shock. Patients with pneumonia-induced septic shock admitted to our ICU were categorized into ICU-AW and non-ICU-AW groups based on the presence of ICU-AW during their ICU stay.


Research Article

Computational Biology Approach Exploring Morbific and Control Strategies to Cure Typhoid

Daksh Kumar; Shweta Mishra; Annie Jessica Toppo; MD Mahfooz Khan; Pramod Kumar; Aditi Kumari; Priyangulta Beck; Dipanjali Sharma; Kajal Kumari; Pinki Raj Sahu; Dinesh Kumar; Sanyukta Kumar; Mukesh Nitin*

Typhoid is a life threatening disorder caused by Salmonella enterica typhi has been a crucial topic of study in developing and underdeveloped countries especially India, some Asian, African and Middle Eastern countries which are reported to be affected with this bacteria.


Research Article

Identification of Comparative Collagen Fibril Associated Changes in Normal and Keratoconus Corneas using Vibrational Optical Coherence Tomography and Machine Learning

Frederick H Silver*; Dominick Benedetto; Tanmay Deshmukh; Nathalie A Daher

Vibrational Optical Coherence Tomography (VOCT) is a non-invasive technique that uses infrared light and audible sound to characterize tissues noninvasively. We have used VOCT in vivo to characterize the differences between control corneas and corneas with stages I, II, III and IV Keratoconus (KC).


Review Article

Bradycardia Concomitant with Hypertension

Michał Zwoliński; Katarzyna Zemsta; Bartłomiej Kulesza*; Ryszard Tomasiuk

Bradycardia is defined as a Heart Rate (HR) <60 beats per minute (bpm) in adults, except for well-trained athletes (studies often use a lower cut-off of 50 bpm) [1]. Multiple potential causes of bradycardia include atrioventricular block, conduction tissue disease, sick node disease.


Short Commentary

Biochemical Screening and Pregnancy Outcome after Assisted Reproduction

Jyotsna Verma*; Geetu Jhingan; Divya C Thomas; Sunita Bijarnia-Mahay; Ratna D Puri

Women conceived using Artificial Reproduction Technology (ART) are more likely to have a high risk of Down's Syndrome (DS) compared with the women who conceived naturally. On comparison with naturally conceived pregnancies, ART pregnancies show significant differences in the levels.


Clinical Image

Catastrophic APS

Farzaneh Futuhi*; Mohammad Javanbakht

In this case report, a 20-year-old male patient was admitted to the hospital suffering from nausea and vomiting after drinking alcohol and after two rounds of hemodialysis, he is discharged by the poisoning service.


Research Article

Risk Factor Analysis of Twin Pregnancy and its Relationship with Delivery Mode in 1,494 Clinical Cases: A Retrospective Study

Ting Huang#; Yuanyuan Zhu#; Nana Yang; Lizhou Sun; Yetao Xu*;Yi Pan*

To explore the relationship between the risk factors of twin pregnancy and delivery mode. Clinical data of 1,494 women with twin pregnancies delivered in our hospital from June 2006 to October 2019 were retrospectively analyzed. According to the delivery mode, 1,355 cases were divided into the cesarean section group and 139 into the natural delivery group.


Research Article

Can Brief Illness Perception Predict Pain Related Outcomes for People with Chronic Low Back Pain?

Thomas Elsborg*; Jeanette Birkedal Kühnel; Anja Geisler

Treating patients with complex chronic non-malignant pain can be complicated by psychological and/or social factors. A vital importance for recovery is how the patient copes with pain and the emotional suffering that accompanies it. Patients´ Illness Perception (IP) and expectations towards the treatment has proven to play an important role for the treatment response.


Short Commentary

Whether is the Logic of Russian Roulette Appropriate for Assessing Individual Cancer Risks of Breast Cancer Mutation Carriers among their Clusters?

Sven Kurbel*; Nika Ćurković; Kristijan Dinjar

Breast and ovarian cancers can result from an inherited mutation that runs in the family. An unsolved question is the individual risk for a mutation carrier within her family cluster at some point in time. This question is here interpreted using logic of the Russian roulette in which the revolver is spun only once.


Research Article

Cellular Viability and Nitric Oxide Detection in Response to Maraviroc Incubations with Axenic C6 Glioma and PC-12 Neuronal Cells in Vitro

Shariq M Zaman; David C Platt; Marjorie A Jones*

Brain cancers, such as Glioblastoma Multiforme (GBM), exploit the body's own immune system to support tumor growth within their microenvironment. GBM, an incurable cancer known for its highly invasive characteristics, utilizes various pro-inflammatory pathways to mediate the body's response, one of them being the CCR5 signaling pathway.


Research Article

The Efficacy of Slow-Release Copper Capsule Administration on Postpartum Anestrus in Dairy Cows

Hossein Hamali*; Mohammadreza Nikan; Hossein Navaee

Deficiency of single or multiple minerals or their imbalances may cause various reproductive failures, such as infertility, poor conception, and anestrus. Copper deficiency is related to reproductive disorders. This study investigated the effects of slow-release copper bolus administration in postpartum anestrus cows.


Research Article

The Role of Service Quality in Developing the Medical Tourism Sector in Qatar: An End User Survey

Asrar M AlBaz*, Claire Haven-Tang; Caroline Ritchie

SERVQUAL is used for evaluating service quality by finding out the gaps between anticipation and observations of clients' viewpoint. To ensure better insight on how service quality theory can help enhancing medical tourism in Qatar. Cross sectional survey using SERVQUAL questionnaire involving a total of 350 HMC service users.


Research Article

Impact of COVID-19 Infection on Patients with Parkinson's Disease: A Cross-Sectional Study

Xinyao Liu#; Jing Bai#; Xiaobing Li; Xin Guo; Yaqian Mu; Yan Shi; Ya Bai*; Xuedong Liu*

Background: The coronavirus disease 2019 (COVID-19) pandemic seriously threatened global public health. Patients with Parkinson's disease (PwP) may also have been affected to different degrees in terms of symptoms, medication, medical treatment, and rehabilitation exercise.


Case Report

Paroxysmal Throbbing Pain Precipitated by Swallowing, Followed by Syncope, are Fatal Processes of Glossopharyngeal Neuralgia

Hai-Ping Xia; Biao Jin; Hui Zhou; Cen Su; Kang-Ren Zhao; Shao-Xia Dong; Rui Ma*

Glossopharyngeal neuralgia is not a simple disease with just sensory neurodynia, which could be followed by fatal cardiac syncope. We report a rare case, female, 46-year-old, married, paroxysmal throbbing pain in right auricle for 5 year, followed by syncope for 10 days.


Research Article

A Comparative Study of Cognitive Behavioral Therapy and Mindfulness-Based Cognitive Therapy for Weight Reduction and Activity Increase in Obese Individuals with Coronary Artery Disease

Fateme Dehghani-Arani*; Arash Lotfi Kangarshahi

Objective: Obesity is a metabolic disorder and is often the cause of health problems such as cardiovascular diseases. The purpose of this preliminary study was to compare the efficacy of Cognitive Behavioral Therapy (CBT) with Mindfulness-Based Cognitive Therapy (MBCT) on activity and weight in obese people who have Coronary Artery Disease (CAD).


Case Series

Clinical Features and Genetic Analysis on 2 Cases and their Families with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy

Hai-Ping Xia; Biao Jin; Hui Zhou; Cen Su; Kang-Ren Zhao; Shao-Xia Dong; Rui Ma*

Objective: To accumulate clinical features and clinical laboratory data about cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy. In this study, 2 cases and their families with cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy admitted to our hospital were engaged for retrospective study.


Review Article

Advances in the Application of 6-Gingerol in Diseases of the Central Nervous System

Wenhua Li*; Min Li; Suya Ma; Yunong Tian

6-Gingerol is the main active component of ginger, which is widely used in traditional Chinese medicine. 6-Gingerol has a variety of pharmacological effects, including anti-apoptosis, antiviral, immune protection, antibacterial, anti-inflammatory, antioxidant and anti-tumor.


Research Article

Depression as a Predictor for Rehospitalization in Schizophrenia Spectrum Disorders

Onwuameze O*; Scaife S; Chakrabarty A; Incandela F; Keck-Flory S; Olagunju A; Botchway A

Purpose: Depression is known to impact the clinical course, outcome and prognosis of Schizophrenia spectrum disorder (SSD), however, this association is still not well established in the literature. We aimed at assessing whether presence of depression and depression with suicidal ideation is associated with rehospitalization in SSD patients.


Short Commentary

Recent Trends in Cycling Behaviour in Older Males: An Analysis and Plea for Therapeutic Options

Roger W Byard*

In recent years there has been an increase in middle-aged and older males riding bicycles along city streets. While this in itself would not seem to represent a problem, a number of issues arise. Firstly, these riders do not seem to venture outdoors unless they are surrounded by a pack of like-minded individuals-presumably they only feel safe in large numbers, which probably makes good sense given the consistency with which they seem to disobey basic road rules.


Review Article

Homeostasis of Circadian Rhythm and Therapeutic Approaches to Manage its Related-Disorders: The Case of Medicinal Mushrooms Rich in Melatonin

George D Tselepis; Ioannis S Palamiotis; Sofia K Georgiou-Siafis*

Circadian rhythm consists of complicated molecular mechanisms to orchestrate environmental stimuli to intrinsic molecular clocks. However, circadian rhythm is frequently deregulated in modern society by both extrinsic and biological factors leading to Circadian Rhythm Sleep Disorders (CRSD).


Review Article

Obesity Paradox and Critical Covid -19 Disease: Debunking a Myth

Susanne M Lang*; Helmut Schiffl

Introduction: Short-and long-term morbidity and mortality associated with Covid-19 disease remains high. Obesity is a recognized risk factor for symptomatic Covid-19, disease, hospitalization, critical Covid-19 disease, and fatal organ dysfunctions. Whether obesity is causally linked with mortality of critically ill Covid-19 patients is an unresolved question.


Review Article

Disease and Circulating miRs: Updated in the Medical World

Elham Ghazizadeh*; Zahra Nasery

The abundance of circulating miRNAs-small non-coding RNAs involved in posttranscriptional regulation of gene expression- in body fluids of cancer patients holds great promise to identify stable and specific biomarkers, which may be useful for early diagnosis as well as to predict the clinical outcome and treatment response.


Case Report

Case Report: Etoposide Induced Skin Rash in Small Cell Lung Carcinoma

Juan Carlos Fuentes Rosales, MD; Karandip Bains, MD; Kennedy Aikins, MD*

Introduction: Etoposide is a semisynthetic podophyllotoxin derivative that is active against several solid and hematologic malignancies. The adverse effect of this chemotherapeutic agent includes nausea, vomiting, abdominal pain, hair loss, and dizziness [3-7].


Research Article

Risk Factors for Blindness and Partial Blindness in the Amhara Region of Ethiopia: Spatial and Regression Analyses

Hailu Shifarew*; Legesse Negash

Background: Seeing difficulties like blindness and partial blindness are affected by a number of intrinsic and extrinsic factors. The objective of this study is to evaluate whether seeing difficulties are associated with extrinsic (external) factors like environmental, educational, and socioeconomic status of people.


Research Article

Virtual Screening and Binding Mode Analysis of Selected FDA Approved Drugs Against PLpro Target: An Effort to Identify Therapeutics to Combat COVID-19

Mitra Ashouri*; Rohoullah Firouzi*

Papain-like protease (PLpro) is one of the most promising targets for anti-SARS-CoV drugs because it is an essential multifunctional cysteine protease for corona viral replication. In this study, an unbiased existing bioactive library containing 1916 FDA-approved drugs has virtually been screened using a new successful computational pipeline in the framework of the ensemble docking strategy to identify potential binding molecules of SARS-CoV-2 PLpro.


Review Article

Insights into the Endogenous Opioid System: An Overview

Priscila BIM do Couto; Rayla Leandra Oliveira dos Santos; Nelson CR Filho; Thalya Cristina Silva Cardoso; Luiza HB Caval-cante; Isadora S Oliveira; Felipe A Cerni; Luis E Bermejo Galan; Manuela B Pucca*

Pain is a leading cause of medical complaints worldwide, underscoring the essential role of knowledge and use of opioids. Opioids are drugs that directly impact pain processing, immune functions, stress regulation, and more. They originate from opium, which is extracted from Papaver somniferum, a plant native to the Mediterranean region.


Short Commentary

Long COVID-19

Leonor Chacin-Bonilla*

COVID-19 may lead to a perseverance of symptoms after recovery from the disease, a condition known as long COVID, characterized by continual cognitive, somatic and behavioral symptoms. SARS-CoV-2 infection triggers different molecular to tissue level events, given by the inherent features of each patient.


Case Report

Inducible Laryngeal Obstruction (ILO) Coexisting with COPD can Fatally Influence the Course of COPD Exacerbation

Wlodzimierz Mierzwa; Wlodzimierz Wróbel W; Lech Polewiak; Anita Krzywańska-Ferens; Sandra Kucięba; Dariusz Ziora*

An intermittent extrathoracic airway obstruction due to adduction of vocal cords, formerly referred to as Vocal Cord Dysfunction (VCD) and now as ILO or VCD/ILO, can lead to sudden dyspnoea of varying intensity mimicking asthma attacks. VCD/ILO may often coexist with asthma, but only few reports mention VCD/ILO coexisting with COPD.


Review Article

Gastric X/A-Like Cell-Derived Peptides Participate Global Lipid Metabolism Regulation

Ruili Yu*; Lingfei Kong

The X/A-like cell is an enteroendocrine cell that was initially poorly understood but has gained significant attention due to its peptide products, including ghrelin, desacyl-ghrelin, obestatin and nesfatin-1. While these peptides are primarily known for their roles in controlling food intake, they also play various roles in gastrointestinal motility, mood, sleep, cardiovascular function, immunity, inflammation, and more.


Research Article

Metabolic Syndrome and Breast Cancer Development: A Durable Friendship

Stan Mihai Cosmin*; Mireștean Camil; Badulescu Florinel

Introduction: Breast cancer is the most common type of cancer in women; the incidence increases by 20% when associated with diabetes. Over the last decade, both the incidence and mortality through the neoplasm of the mammary gland or diabetes are constantly growing, and the links between the two are not completely clarified.


Research Article

Identification of Key Genes and Pathways in Metastatic Hepatocellular Carcinoma by Integrated Analysis

Yanzhi Qian; Fengchao Liu*

Hepatocellular Carcinoma (HCC) metastasis is the main cause of death in HCC patients, and clarifying the regulatory molecular mechanism of HCC metastatic progression will improve the therapies for HCC patients. The aim of this study was to identify hub genes and related signaling pathways involved in HCC metastasis. A total of 143 Differentially Expressed Genes (DEGs) were identified between primary and metastasis HCC samples using GSE40367 from the Gene Expression Omnibus (GEO) database.


Short Commentary

Development Status of Internet Hospitals in China

Liang Licheng*

Internet hospitals are the deep integration of Internet, information technology and medical services. Driven by new technologies such as mobile Internet, cloud computing, big data, and the Internet of Things, the era of "Internet plus+medical care" is emerging. In December 2015, the first Chinese Internet hospital, Wuzhen Internet Hospital, was launched, and public health emergencies have catalyzed the development of "Internet plus medicine".


Review Article

Microbiologic Therapy of Tuberculosis: Bacterium termo to Streptomyces griseus

H Bradford Hawley*; John D Bullock

Tuberculosis in the 19th century resulted in 1,000 deaths per 100,000 population per year in European and American cities. There was no effective treatment. In 1885 Professor Arnaldo Cantani of Naples successfully treated a patient with pulmonary tuberculosis using an inhaled spray made from a culture of Bacterium termo.


Research Article

The Efficiencies of Erythrocyte Indices in Differential Diagnosis of Beta Thalassemia Minor and Iron Deficiency Anemia

Zeynep Yildiz*; Abdulkadir Deniz; Asuman Orcun

Background: The most common causes of microcytic anemias are Iron Deficiency Anemia (IDA) and Beta Thalassemia minor (BTm). Correct diagnosis is important to prevent unnecessary iron loading and to manage thalassemia states. In this study, we aimed to evaluate the performances of erythrocyte indices to support the differential diagnosis in a practical, quick and economic way.


Case Report

Stent Implantation in One Case of Atherosclerotic Vertebrobasilar Artery Stenosis and Literature

Jing-Gang Bao; Feng-Fan Bai; Chen He; Xiang-Ji Lu; Jian-Ping Zhang; Gang Yang; Xin-Wei Zhu; Xiao-Dong Wang; Ri-Le Wu

Intracranial Atheromatous Disease (ICAD) accumulates intracranial large vessels, which is one of the most common causes of ischemic stroke. The risk factors for ICAD include advanced age, smoking, hypertension, hypercholesterolemia and insulin-dependent diabetes mellitus [1-3]. The mechanisms of stroke caused by stenosis of vascular lumen caused by intracranial atherosclerotic disease include: 1) Hypoperfusion.


Review Article

Amyotrophic Lateral Sclerosis: From Mechanisms to Current, Emerging, and Alternative Therapeutics

Ivelina P Kioutchoukova*; Devon Foster; Rajvi N Thakkar; Hayley N Kurz; Brandon Lucke-Wold*

Amyotrophic Lateral Sclerosis (ALS) is a severe neurodegenerative disease affecting the motor neurons. Although the etiology remains unknown, mutations in superoxide dismutase 1 have been observed in patients with familial ALS, resulting in increased calcium in the cells and leading to cell death.


Research Article

The Virtual Medical Care of Heart Failure, An Overview

Jose Ferrer Costa*; Leomar Colmenares Hernandez

We're currently witnessing an exponential surge in technological advancements, especially in the fields of Virtual Reality (VR) and Artificial Intelligence (AI). These technologies have found a dynamic role within the medical and healthcare sector, expanding the boundaries of patient care, diagnosis, treatment, and even medical education.


Research Article

Cost-Effectiveness Analysis of Tiotropium + Olodaterol Fixed-Dose Combination for Patients with Moderate-to-Very Severe Chronic Obstructive Pulmonary Disease in China

Yajie Gu; Zhuolin Zhang3; Xin Li*; Junrong Zhu*

Chronic Obstructive Pulmonary Disease (COPD) is a kind of chronic progressive respiratory disease with considerable effect on patients and society. The launch of tiotropium + olodaterol Fixed-Dose Combination (FDC) provides a new choice for patients with moderate-to-very severe COPD in China. The purpose of this study is to evaluate the cost-effectiveness of tiotropium + olodaterol FDC compared with tiotropium for the treatment of patients with moderate-to-very severe COPD from the perspective of the Chinese healthcare system.


Short Commentary

On the Mechanism of Alcoholysis between Fatty Acid Methyl Esters and Trimethylolpropane

Ilona S Kozeeva*; Valentin N Sapunov; Michial S Voronov

This paper reports on a previously undescribed mechanism of the alcoholysis of fatty acid methyl esters with a polyol, in particular, with trimethylolpropane. The chromatographic data of the reaction products are illustrated by calculations of the mass and molar concentrations of all participating components of the system. Some observable phenomena have been noted. The authors propose an extended mechanism of the alcoholysis process.


Case Report

Statin Therapy and Tendon Rupture in High ASCVD Score Patient: A Comprehensive Case Report and Literature Review

Mahsa Fadaei*; Mehrdad Jafari Tadi; Seyyed Taher Seyyed Mahmoudi; Parisa Kianpour; Sina Ghobadi; Mohommad Rasekhi Siahkal Mahalleh; Shima Rafie; Seyyed Mahdi Seyyed Mahmoudi; Reza Mourtami

Statin-induced tendon rupture is a rare clinical manifestation that warrants attention, especially in patients with a high 10-year atherosclerotic cardiovascular disease (ASCVD) risk score. This case report presents the unique scenario of a 58-year-old male with a history of ischemic heart disease and previous percutaneous coronary intervention who experienced tendon rupture following minor traumas while on long-term statin therapy.


Research Article

Accuracy of Pulse Oximeter at Different Sensor Locations in Patients with Viral Pneumonia: Comparison of Finger and Earlobe

Farzan Vahedifard; Zahra Rezaei; Mehrdad Jafari Tadi*; Mahsa Fadaei; Mehdi Kashani

Since the advent of the COVID-19 pandemic, there has been a significant surge in patients admitted to emergency departments exhibiting hypoxemia yet showing no signs of dyspnea. This intriguing presentation sparked our hypothesis that SpO2 measurements derived from the index finger may not reliably estimate the actual peripheral blood oxygen saturation.


Review Article

The Effects of COVID-19 on the Compliance of Dental Operators with Infection Control in Saudi Arabia: A Review

Muhannad Q Alanazi*; Abdulhameed G Albeshr; Yazeed A Alhabdan; Abdullah F Alhussain; Setah Alanazi; Hanan Abdullah Alshahrani; Alanoud M Alanazi

Background: The COVID-19 pandemic shocked the world by its fast and massive spread, morbidity and mortality. This pandemic has had a significant impact on infection control practices among dental operators as well as other specialties; dental operators are at the highest level of being more prone to infections, due to their direct exposure to the patients. Furthermore, routine dental treatment includes the use of some instruments that stimulate the infection chain, such as air-turbine handpieces and ultrasonic scalers.


Research Article

Protective Effects of Silymarin against Chronic Exposure to Manganese-Induced Hematological Alterations, Biochemical Perturbations and Genotoxicity in Rats

Khadija Boukholda; Yassine Chtourou; Fatma Makni-Ayadi; Choumous Kallel; Fatiha Chigr; Hamadi Fetoui*

Manganese (Mn), a trace metal, is essential for maintaining the normal regulation of many biochemical and cellular processes. However, accumulation of Mn due to excessive environmental exposure leads to neurological impairment, biochemical lesions, and genotoxic effects which results in a sequalae of physiologic and pathologic responses. Natural compounds such as silymarin, a bioactive flavonoid present in Milk Thistle (Silybum marianum L.), might be beneficial for the treatment of those disorders.


Review Article

Circulating Particles and Related Nucleic Acid as Highlighted Biomarker in Prostate Cancer

Elham Ghazizadeh*; Mahya Sadeghi; Elham mehri

Since prostate cancer (PC) is the second most malignancy in men, the accurate and timely detection is crucial. Presently the gold standard test in prostate cancer detection is about Prostate-specific antigen (PSA) screening. Although PSA monitoring correlated with reduction of PC mortality, but it is not accurate enough because of high false positive rate. Detection of circulating biomarkers as a novel approach have significantly advanced the diagnosis and also prognostic screening of PC.


Research Article

Epidemiological Aspects, Clinical, Echographic and Bacteriological Aspects of Tuberculous Pericarditis in the Mohammed VI University Hospital of Marrakech

Rocyr Junior Ibara-Onguema*; Salma Nafidi; Tibou Camara; Sanae Nehame; Mohammed El Jamili; Saloua El Karimi; Mustapha El Hattaoui

Introduction: Tuberculosis is a major public health problem and one of the leading causes of pericarditis. Its prevalence is still high in developing countries. This is a serious condition that can be complicated by tamponade and pericardial constriction. The objective of our study was to describe the epidemiological, clinical and evolutionary characteristics of tuberculous pericarditis cases.


Research Article

Visceral Adiposity and Lipid Accumulation Product Indices as Valuable Predictors of Metabolic Syndrome in the Elderly: Bushehr Elderly Health (BEH) Program

Maryam Marzban; Kamyar Asadipooya; Mohamad Gholizade; Iraj Nabipour; Afshin Ostovar; Bagher Larijani; Akram Farhadi; Amir Hossein Darabi; Mohamad Hadi Emamat; Fateme Mozafari; Mohammdreza Kalantarhormozi*

Metabolic Syndrome (MetS) encompasses a cluster of cardiometabolic risk factors and plays a significant role in elderly patients' long-term complications. Herein, we studied the association of Lipid Accumulation Product (LAP) and Visceral Adiposity Index (VAI) with MetS to assess their validity for diagnosing and predicting MetS. In this cross-sectional study based on Bushehr elderly health program, data of 3000 old (more than 60) enrollees of phase 1 and 2426 of phase 2 of this cohort were evaluated.


Research Article

Hydrogen Gas Device has Therapeutic Effect on Skin Damage and Alleviates Dermatitis in Mice

Vladimir I Klichko; Daniel H Crow; Svetlana N Radyuk*

Molecular hydrogen (H2) emerged a decade ago as a potent therapeutic and is attracting more and more attention. The beneficial effects of H2 are ascribed to its antioxidant and anti-inflammatory function, as well as its ability to induce defense responses and confer protective effects. Remarkably, H2 has no known adverse effects on cell function.


Case Report

Nursing Care for a Patient with Severe Traumatic Brain Injury: A Case Report

Qiu Chen; Ying Gao*; Ke Wang; Jun Shen; XinXia Wang; Miao Li

Introduction: Summarizing the intensive care experience and lessons learned in a patient with severe traumatic brain injury. Case Report: This paper describes a 52-year-old female patient who presented as severe traumatic brain injury. The key points of nursing were early and rapid identification and opening of the green channel, giving mild hypothermia therapy, and Continuous Renal Replacement Therapy (CRRT) by the neurological care team during the critical period.


Review Article

UHRF1: A Diagnostic and Prognostic Marker of Cancer

Qurat-ul-Ain; Mehak Nimra; Areej Ghouri; Shafaq Zahoor; Asma Sarfraz; Faiza Naseer*

There are many members of the UHRF family including UHRF1, UHRF2, UHRF3, and UHRF4 having different functions. In this review, we mainly study the activity of UHRF1. It is a multi-domain protein associated with epigenetic mechanisms of cell regulation and proliferation.


Review Article

Mitochondrial Respiration and Molecular Markers for its Study

Bon EI*; Maksimovich NYE; Dremza IK; Gaiko DV; Bakush UA

Mitochondria play a key role in providing energy for cellular functions, and on the other hand, they are a target, decoder and switch of intracellular signals, generator of secondary messengers and proapoptotic factors. Modern ideas about the mechanisms of energy transduction in the mitochondrial membrane were formed after Peter Mitchell created the chemiosmotic theory of ATP synthesis. The data presented in the article can serve as a fundamental basis for further study of the brain in normal and pathological conditions with further extrapolation of the obtained data to humans.


Case Series

Cecal Bascule-An Unusual Cause of Intestinal Obstruction. 2 Unique Case Reports with Different Outcome

D Hazan*; D Shamir; K Dayan

Objective: A cecal bascule is a rare type of cecal volvulus occurring in the elderly population with a male predominance. It is a condition where the cecum folds upward upon itself. There are only a handful of case reports published on a cecal bascule. This is the first case being reported from Israel. Case presentation: This case discusses a 73 year old male with hypertension, ischemic heart disease, diabetes mellitus, chronic renal failure, and osteoporosis.


Research Article

Rate of Same-Day Antiretroviral Therapy Initiation and its Predictors among Newly-Diagnosed HIV-Positive Patients in a District Hospital in Douala, Cameroon

Derrick T Efie; Nsagha Dickson; Denis Zofou; Calson Ambomatei*; Fatimatou M Efie

Aim: The fight against HIV/AIDS remains a global health priority. In 2015, in a bid to control the pandemic, the World Health Organization adopted the "Treatment for All" strategy aimed at guaranteeing the placement of all persons living with HIV (PLWHIV) on Antiretroviral Therapy (ART). ART, especially when started early following diagnosis, decreases the number of AIDS-related deaths and allows PLWHIV to lead healthy lives. This paper aims to determine the rate of same-day ART initiation, assess the factors that favor same-day initiation, and identify the reasons for delayed initiation among people newly diagnosed with HIV in a District Hospital in Douala, Cameroon.


Research Article

Appraisal to Prenatal Ovarian Traits in Morph-Metric Aspects of Nili-Ravi Buffalo Bovine Fetus

Momen Khan; Muhammad Saleem; Farman Ullah*; Zohaib Ahmed Bhutto; Sami Ullah Khan; Muhammad Altaf Hussain; Mohammad Salim

This study aimed to evaluate the Nili-Ravi buffalo changes in fetal growth relationship with crown rump length (C-R) ovarian at fetal ages from 51 to 290 days. In the methods, the weight, size, and other proximate measurements were compared with the ovarian histology of female sex were externally differentiated up to 56 days.


Review Article

Biomaterials Surface Engineering Towards Anti-Adhesive Urinary Catheters

Tugce Caykara; Ligia R Rodrigues; Carla Silva*

Hospital Associated Infections (HAI) have been growing in number over the years, representing a concern that requires attention. The most frequent infections are observed in the urinary tract and 80% of them are catheter related. These infections cause problems ranging from mild discomfort to severe implications and even death.


Research Article

Repurposing of Some VEGFR-2 Inhibitors: In Silico Molecular Dynamics Simulation (at 200 ns), Docking Based on the SARS-CoV-2-Main-Protease Inhibitor N3

Sanadelaslam SA El-Hddad; Mohamed H Sobhy; Hamada S Abulkhair; Khaled El-Adl*

The present study suggests the potential anti-SARS-CoV-2 activities of thirty five reported VEGFR-2 inhibitors containing the amide and urea linkers. Nineteen members revealed the best in silico results and hence, were subjected to further MD simulation for their inhibitory activities against SARS-CoV-2 Mpro across the 200 ns.


Short Commentary

Smart Cures - They Can Contribute to the Prevention of Cancer

Manfred Doepp*

It is phenomenal what plants and nature as a whole achieve in terms of synthesis. They are not inferior to a chemical laboratory. After all, this is how mankind has managed to live and survive even under adverse conditions. Plants and animals, for example, defend themselves against enemies with the help of molecules that have a deterrent or even a killing effect. It therefore makes sense to make use of this experience of nature and to use therapeutically those plants that prevent cells from dividing uncontrollably. A list of plants that possess such abilities is presented here. Predominantly they are food, especially spices. They can be integrated into the daily food intake without any problems. It is logical to achieve prevention of cancer.


Research Article

Methylation Analysis of Promoter Region of ETS-1 Gene in Human Breast Cancer Patients

D Hai Zhiqin; Peng Juanxia; Ma Tao; Liu Qilun*; He Shulan*

This study aimed to compare the methylation status of ETS1 between 18 cancerous and cancer-side tissues in breast cancer patients using matrix-assisted laser ionization-time flight mass spectrometry. A total of 46 CpG sites on FJ-1, FJ-3, and FJ-5 fragments from the promoter region of the ETS1 gene were detected for methylation levels.


Case Report

Drug-Induced Liver Injury due to Tofacitinib: A Case Report

Dan Dima*

The liver plays an essential role in concentrating and metabolizing drugs. Many synthetic drugs, herbals, toxins, and even food supplements can lead to liver damage. This damage can occur immediately or months or years after taking the drug.


Research article

Cytotoxic and Antimicrobial Efficacy of Alhagi maurorum

Sobia Gilani; Yamin Bibi*; Tayyiba Afzal; Rimsha Baloch

Medicinal plants have long been studied due to their anticancer effects and use of them is commonly increased as a complementary and alternative medicine among patients with cancer. As drugs obtained from plants are cheap, safe to use, available without any difficulty, more effective, easy to store, and rarely have side effects.


Short Commentary

Bioactive Compounds of Exotic Tropical Camu-Camu (Myrciaria Dubia) in the Seed, Ripe Fruit and Freeze-Dried

Jeff Moats; Jaime Paiva Lopes Aguiar*; Francisca das Chagas do Amaral Souza

Camu-camu (Myrciaria dubia) fruits are promising sources of various bioactive compounds such as vitamin C, phenolic compounds and carotenoids. Camu-camu is a fruit native to the Amazon region and is considered the greatest natural source of vitamin C worldwide are also good sources of dietary fiber, minerals, polyphenols and antioxidants.


Research Article

Monitoring Important Phenological Stages of Rice with Multi-Season Rice Crop Profile Using Indian SCATSAT-1 Data

Dipanwita Haldar*; Ashutosh Panda; Suresh Kumar; Prakash Chauhan

Use of SCATSAT-1 Ku-band scatterometer data and Sentinel-1A IW Level 1 (L1) GHDH (ground-range detected, high resolution) product for monitoring rice crop phenology in Mekong Delta region of Vietnam. Five-day composite data was used covering a part of Mekong Delta in Vietnam for multiple season in year 2018-19 spanning over 10 months covering three crops of rice.


Research Article

The Effect of Polysaccharide Extracted from Raw Atractylodes Macrocephala on Loperamide-Induced Constipation in Rats

Wenli Zhu; Xiaoqing Chi*

Objective: To explore the effect and mechanism of Polysaccharide extracted from raw Atractylodes Macrocephala on Loperamide-induced constipation in rats. Methods: The rats were given Loperamide (3 mg/kg) by intragastric to induce constipation, after that, the rats were administrated the water, ethanol extract and polysaccharides extracted from raw Atractylodes Macrocephala.


Research Article

Treatment of Melanoma Metastasis: Surgical, Chemotherapy, and Innovation

Chelsea Rosen; Taeya Mayes; Claire Overholt; Brandon Lucke-Wold*

Melanoma is a form of skin cancer with an increased ability to metastasis to organs such as the brain and other visceral organs, contributing to its aggressiveness and seriousness. Melanoma's prevalence around the globe rapidly continues to rise. Melanoma development is a complex process often depicted as a step-wise process with the potential to end in metastatic disease. Recent studies suggest that the process could be non-linear. Melanoma has many risk factors including genetics, UV exposure, or exposure to carcinogens.


Review article

Advancing Analytics of EEG Signals

Fnu Ruchika*; Durga Neupane; Siddharth Shah; Maliya Delawan; Brandon Lucke-Wold

Electro Encephalo Graphy (EEG) is a non-invasive diagnostic tool that is widely used in the field of neurosurgery. The EEG measures the electrical activity of the brain, which provides essential information about brain function and can help diagnose various neurological conditions. In neurosurgery, EEG monitors the brain during surgery to ensure that the patient's brain function remains stable and minimize the risk of neurological complications.


Research article

Feasibility Analysis of Planned Coronary Rotational Atherectomy Guided by Coronary Angiography for Severe Calcified Coronary Lesions in Grass-Roots Hospitals

Chen Jinling*; Yu Yang; Zhang Wenguang; Zhao Chunyong

With the improvement of people's living standard and the progress of aging, the frequency of complex coronary artery lesions, including severe coronary artery calcification, is getting higher and higher. Epidemiological data show that coronary artery calcification occurs in 50% of the population


Research article

Current Treatment of Depression in Children with Autism and Intellectual and Developmental Disabilities

J Nikki Steinsiek*; Aaron L Fox; Jessica LC Blanks; Gabrielle E Hodgins; Juliana W Stone; James E Bedford

There are no evidence-based guidelines for the treatment of depression in Autism Spectrum Disorder (ASD). We describe prescribing practices for youth with depression and ASD and/or Intellectual and Developmental Disabilities (IDDs). Data was queried for youth with ASD and/or IDDs ages 10-18 with diagnoses of depression seen in an academic outpatient psychiatry clinic between 2015 and 2020.



Morphological Changes in the After Birth Tissues in Intrauterine Chlamydial Infection

Natalia А Tatarnikova*

Bovine chlamydia causes great economic damage to agriculture due to the fact that the pathogen is widespread in the population, is extremely virulent and pathogenic for fetal intrauterine development, while in adults the disease has little symptomatic or latent course. Intrauterine infection is characterized by a vertical route of infection


Short Report

An Unusual Case of Neisseria Meningitidis Infection in Elderly Revealing a Primary Classic Pathway Complements Deficiency

Nadir Abdelhameed*; Michail Kaklamanos

Primary classic pathway complement deficiencies in older people are rarely reported in the literature. The link between classical pathway complement deficiencies and Neisseria Meningitidis infections is not clearly understood. We are reporting a case of Neisseria meningitis with persistent C4 deficiency over a longer than 18-week period despite a complete clinical recovery. Uncommon infections, such as Neisseria Meningitidis infections, should prompt clinicians to consider an underlying complement deficiency.


Research Article

Influence of General Anesthetics at Periodontium of Pediatric Patients

Samir Heta; Ilma Robo*; Spiro Sila; Dariel Thereska

According to a study by Kubo S. et al, intravenous anesthesia with propofol, if compared to inhaled anesthesia, sevoflurane, also used for procedural sedation, provides a slower release and less agitation [1]. It is preferred as a general anesthetic for due to the rapid induction and duration of adequate anesthesia, this is sufficient for surgical intervention.


Research Article

Online Family Intervention for Caregivers of People with Severe Mental Disorders in Psychosocial Rehabilitation Centers

Ernesto Baena Ruiz*; Cristina Abelleira Vidal; Mónica García Ortega; José A Sánchez Padilla; Fátima C Quintana Castellano; Sofía A Díaz Garrido; Alba Giráldez Castro; Natalia Benítez Zarza

In order to contextualize the origin of this new intervention format, it is necessary to briefly describe the context in which it arose. For more than two decades, the Mental Health Network (MHN) of Gran Canaria (Spain) has been developing a program of care for family members of people with SMD, called the "Family Support and Collaboration


Research Article

Difficulties, Problems, Limitations, Challenges, and Corruption Facing Cancer Patients in the Occupied Palestinian Territories: The West Bank, Including East Jerusalem, and the Gaza Strip

Hilmi S. Salem*

This research was conducted in relation to the cancer status in the Occupied Palestinian Territories (OPT): The West Bank, including East Jerusalem, and the Gaza Strip, with a total population of about 5.4 million and an area of about 6,000 km2. The mortality rate from several types of cancer was 14% in 2016, representing the second cause of death after cardiovascular diseases which account for 30.6% of all causes of death in the OPT.


Review article

Long Covid & Antidepressants

Rafael Rivas-Vázquez; Enrique J Carrazana; Mark A Blais; Gustavo J Rey; Emma Rivas-Vázquez; Alan A Quintana

Three years into this historic pandemic, the scientific and healthcare communities continue to learn a great deal regarding COVID-19, the disease that is produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The most urgent and immediate focus has been on vaccine development for disease prevention/mitigation and on identification of effective therapeutic interventions for acute phase of illness. However, attention is increasingly being placed on formulating treatment strategies for individuals who are post-COVID-19 and experiencing a syndrome of persistent cognitive, somatic and behavioral symptoms that is being referred to as long COVID.


Research Article

Methodology for Predicting Time Processes using Neural Technologies on the example of the Spread of Covid-19 in the Russian Federation and Moscow

Aduard Dadyan

This paper solves the problem of predicting Covid-19 diseases in Moscow and the Russian Federation using neural networks. This approach is useful in cases where it is necessary to overcome difficulties related to non-stationarity, incompleteness, unknown distribution of data, or when statistical methods are not completely satisfactory. The problem of forecasting is solved using the analytical platform Deductor Studio, developed by specialists of Intersoft Lab of the Russian Federation.


Research Article

Subjective and Objective Physical Activity Measurement Methods for the Prediction of Possible Sarcopenia

Cheng Zhu; Ying Du; Yanan Zhao

Early detection and prevention of sarcopenia are essential for maintaining the functional health of older adults. There is a close association between sarcopenia and physical activity levels. Possible sarcopenia is a precursor to sarcopenia, which can accurately predict sarcopenia. According to the tertiary prevention system, the diagnosis of possible sarcopenia has significant implications for the early detection of sarcopenia and the reduction of its Prevalence.


Research Article

Uncovering the ceRNA Network Related to the Prognosis of Stomach Adenocarcinoma among 898 Patient Samples

Zhe LIU; Fang LIU; Olutomilayo Olayemi PETINRIN; Yu ZHANG; Hiu-Man WONG; Ka-Chun WONG

Stomach adenocarcinoma (STAD) patients are often associated with significantly high mortality rates and poor prognoses worldwide. Among the STAD patients, competing endogenous RNAs (ceRNAs) play key roles in regulating one another at the post-transcriptional stage by competing for shared miRNAs.


Opinion Article

Aspirin, the Feasibility as a Binding Inhibitor

Toshihiko Hanai

Aspirin is a popular flu medicine and trying to use in curing Covid-19 patients; however, the effectiveness was mixed results, and the variant types were not provided in the reports [1-3]. In silico analysis demonstrated that it did not inhibit the binding of Delta S-RBD with ACE-2. Rather, it bridges the binding of Delta S-RBD K478 with ACE-2 R317 (Figure 1A) [4]. The binding affinity of current spreading


Case Report

Successful Conservative Management of Dysfunctional Elimination Syndrome Associated with Micronutrient Deficiencies, Recurrent Juvenile Allergic Urethritis and Penoscrotal Edema

Govani DJ; Govani ND; Govani DR; Panchasara NG; Patel RR; Midha PK; Correia RC; Patel RV*

Dysfunctional elimination syndrome is a constellation of symptoms related to the urinary, genital and colorectal dysfunction of the psycho-neuro-endocrine-target organs axis origin secondary to congenital and acquired disorders characterized by functional partial silent chronic pelvic outlet obstruction in the absence of any somatic neurologic deficits. We wish to report a toddler boy with a bowel dysfunction in the form of chronic refractory constipation and voiding dysfunction leading to recurrent genital symptoms in the form of juvenile allergic urethritis


Letter to Editor

You will be better soon: Manipulating Patients to Continue Psychotherapy Treatment

Kadir Uludag

Psychotherapy is demonstrated to be beneficial for most patients with minor and major psychological problems such as depression, schizophrenia, mood disorder, and anxiety. Patients may not respond to psychotherapy. However, how to deal with such clients is decided by their psychotherapists, and it is unclear when they should terminate the psychotherapy session.


Short Commentary

Retinal Toxicity of Silicone Oil

Mehrdad Motamed Shariati*; Arash Darvish

Polydimethylsiloxane, known as silicone oil, belongs to a group of polymeric organosilicon compounds and is widely used in vitreoretinal surgery. The five physical properties of silicone oil (SO) that make it valuable in vitreoretinal surgeries include transparency, viscosity (1000-5000 centistoke), biocompatibility, high interfacial surface tension in aqueous solution, and positive buoyancy.


Short Commentary

Virtual Reality and the Future of Anxiety Disorders Treatment

Aria Elahi; Parker Alan Maddox; Hassan Khuram; Ali Issani; Rahim Hirani*

Virtual Reality is a recent innovation that has made preliminary forays into many different fields including medicine. Recent research on VR indicates that it is an effective and accessible treatment for anxiety disorders. The literature demonstrates that compared to standard en-vivo therapy it is as effective, more accessible and provides therapists with a significantly greater degree of control and analysis. In this opinion article, we discuss VR used for treating phobia, generalized anxiety disorder, and social anxiety disorder.


Short Commentary

Potential of Stem Cell Transplantation for Huntington's Disease

Laikang Yu

Neurodegenerative diseases, such as Alzheimer's disease (AD), Huntington's disease (HD), and Parkinson's disease (PD), are highly disabling and fatal disorders affecting millions of people worldwide and are defined as progressive and uncontrolled progressive loss of motor neuron function or neuronal cell death. Chronic neurodegeneration may develop for a long time and lead to the loss of specific neuronal subtypes or the general loss of neuronal populations.


Case Report

Identification of Non-Polio Enterovirus in an Infant with Impaired Immunity in Sri Lanka

Pattiyakumbura TT; Lankapriya KR; Karunarathne K; Godakanda PGGAN; Abeynayake JI*

Enteroviruses are a group of small RNA viruses. With their ubiquitous nature, they cause a wide spectrum of diseases worldwide. The majority of infections can be seen in the pediatric age group. Enteroviruses usually cause mild infections but also cause severe infections including encephalitis, acute flaccid paralysis, myopericarditis, acute respiratory and gastrointestinal infection, and sepsis. Patients with impaired immunity often have severe enteroviral infections with a high case fatality rate.


Short Commentary

Powerful SEM: An Easy and Powerful Auxiliary for Structural Equation Modelling Analysis

Zhenwei Dai*

Powerful SEM is a free R package that addresses some important issues in structural equation modelling. It can calculate sample size and statistical power of structural equation modeling (SEM) more easily, and provide adjusted model fit indices (Bollen-Stine P correction), to make it more convenient to conduct SEM analysis. Currently, it has 2 versions: v0.1.0, and v0.2.0. The latest version (v0.2.0) has three functions: semsample(), sempower(), and BSfit(). This paper will introduce the functions of powerfulSEM to you.


Clinical Image

"Full-House" Nephropathy in a ANA Negative Patient

Aysa Cesar Pinheiro*; Andrade CAAC; Gomes HODM; Siqueira MAFM; Araújo JS; Campos PF; Cecilia Livia De Oliveira Martins

Antinuclear antibody (ANA) is considered a constant in the diagnosis of systemic lupus erythematosus (SLE), mainly due to its high sensitivity. However, a few recent studies have suggested that ANA may be negative in patients with established SLE, partly because of the variation in immunofluorescence assays that may influence its outcome. The frequency of test negativity ranged from 4.9% to 22.3% in some studies.


Research Article

Outbreak Investigation of Acute Watery Diarrhea with Flu Like Symptoms in Pediatric Unit in a Peripheral Hospital in Sri Lanka

Abeynayake JI*; Ruwanpathirana T; Madarasinghe S; Jayarathne U; Liyanage G; Samaraweera B

Acute watery diarrhea outbreaks are common in children and Rotavirus is the leading cause which cannot be clinically differentiated from other pathogens and confirmation needs specific laboratory diagnosis. This brief report is on small-scale outbreak of rotavirus infection at a pediatric unit in a peripheral hospital in Sri Lanka. The aim is to describe the investigation of children with acute watery diarrhea admitted to a pediatric unit in a peripheral hospital in low resource setting country.


Research Article

Evaluation of the Earliest Time for Induction of Abortion and Progesterone Profile Changes by Dexamethasone Injection in the Pregnant Heifers

Hossein Hamali; Javad Jafari; Ezzatullah Fathi

The use of dexamethasone in many diseases such as ketosis, drug and food allergies and septic shock is pointed out in cows. Dexamethasone use in pregnant cows is limited due to it, s abortive effect. On the other hand, dexamethasone does not always cause abortion. So the aim of our study was to detect the exact period that we can use dexamethasone in pregnant heifers. To achieve this purpose, we selected 40 Holstein heifers from farms with the same nutritional and welfare systems.


Research Article

Role of Referral System in Provision of Health Service to the Patients: A Prospective Study in South Punjab, Pakistan

Waseem Akram; Mujahid Hussain; Anosh Sana; Muhammad Sultan; Sameen Abbas*; Mishal Bajwa

A referral can be defined as a process in which a doctor or hospital does not possess sufficient resources (drugs, equipment, skills) to manage a clinical condition and it seeks for the assistance of a better or differently resourced facility at the same or higher level to assist the patient or take over the management of, the client's case, which is not possible for the first hospital or doctor. All the Rural residence deserve access to health care services regardless of their place of residence with no exception.


Research Article

Perceptions of COVID 19 Vaccine in Rural Cameroon

Elit L; Ngalla C; Afungchwi G; Tum E; Fokom-Domgue J; Nouvet E

To compare and contrast responses of parents of 9-14 year old girls concerning vaccines for human papillomavirus (HPV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, which causes a disease called COVID). One on one interviews of 45 parents of 9-14 yo old girls from Mbingo to Fundong, Cameroon. Parents had to speak in English or Pidgin English. They could not be health workers. Qualitative analysis of the transcribed interviews using ATLAS.ti 9. We used a thematic analysis and a theoretical framework of acceptability.