An-Najah National University

Conduction abnormalities are common long-term sequelae after the Senning procedure for dextro-transposition of the great arteries (d-TGA), often requiring permanent pacing. Infection or lead malfunction may necessitate system extraction. Leadless pacemakers offer a promising alternative option. We present a 30-year-old man with d-TGA who previously underwent a Senning procedure. He had an infected pacemaker with lead extrusion. A combined procedure was performed, including complete system extraction and implantation of a leadless VDD pacemaker (Micra AV2). The procedure achieved atrioventricular (AV) synchrony and rapid recovery. This case highlights the viability of integrating leadless VDD pacemaker implantation with lead extraction in post-Senning d-TGA patients for efficient AV synchrony. It supports leadless pacing as practical solution for complex congenital cardiac anatomy. Leadless pacemakers represent a promising alternative pacing strategy for patients with d-TGA post-Senning procedure. Micra VDD pacing with AV synchrony represents an innovative and effective approach in this setting.

Autologous bone marrow transplantation (auto-BMT) is frequently complicated by febrile episodes and systemic inflammation, particularly during the neutropenic phase, making inflammatory markers such as C-reactive protein (CRP) valuable for monitoring recovery and guiding clinical decisions. In this descriptive, retrospective study of 244 febrile auto-BMT patients in the West Bank, data on demographics, CRP levels (days 1–14), fever onset and duration, and white blood cell (WBC) engraftment were analyzed using non-parametric tests and Spearman correlation. Fever typically began around day 6.7, lasted 6.5 days, and was accompanied by a CRP peak on day 8 (mean 104.8 mg/L) before gradually declining, while WBC engraftment occurred on day 12.96 (SD ± 5.29). CRP levels significantly differed by cancer type and conditioning regimen (p < .001), but not by gender, age, or comorbidities, and were weakly correlated with fever duration and negatively with fever onset. WBC engraftment day showed moderate correlations with fever duration and end. These findings suggest that CRP and fever patterns follow a predictable inflammatory course peaking around day 8, with engraftment timing significantly affecting fever duration, underscoring CRP’s potential as a supportive biomarker for post-transplant monitoring.

Cognitive health in the elderly is linked to modifiable factors, including nutrition-related elements such as obesity, eating habits, and micronutrient deficiencies. The purpose of this study is to determine the association between serum magnesium levels and cognitive function among Palestinian elderly. A total of 200 older adults were included in the study (36.5% men and 63.5% women); the mean age was 64.6 ± 3.3 years. The mean cognitive function, as measured by the MoCA score, was 24.5 ± 3.66, whereas the average scores were 5.4 ± 1.19 for ADL and 6.2 ± 3.2 for IADL. The results indicated a substantial correlation between serum magnesium levels, IADL, smoking status, and cognitive performance. Sociodemographic characteristics, sleep quality, physical activity, body mass index, malnutrition, and adherence to the Mediterranean diet exhibited no significant correlation with serum magnesium levels. To conclude, serum magnesium levels were associated with smoking, cognitive function, and instrumental activities of daily living (IADL). Magnesium did not significantly correlate with Activities of Daily Living (ADL). These associations should be interpreted cautiously, as cognitive function is influenced by multiple additional factors not captured in this study.

The round sardinella (Sardinella aurita Valenciennes, 1847) is a widely distributed migratory pelagic fish inhabiting the Mediterranean Sea and the eastern Atlantic coasts. The species is heavily exploited and represents a valuable resource for global fisheries. In the Mediterranean area, uptakes of round sardinella are particularly high in the Ionian and Levant regions, where landings have shown fluctuating yet significant peaks in recent decades. Given its migratory nature, understanding the connectivity among populations is crucial for delineating appropriate fishery management units. Previous studies employing morphometric, meristic, and molecular analyses have yielded mixed results regarding population structuring. Here, the genetic differentiation among Eastern Mediterranean S. aurita populations was investigated using a multi-marker approach: the mitochondrial cytochrome c oxidase subunit I (COI), cytochrome b (CytB), control region (CR), and 16S ribosomal RNA (16S rRNA), and seven species-specific nuclear simple sequence repeats (SSRs). Overall, the results indicate high genetic diversity coupled with weak population structuring across the Eastern Mediterranean. These analyses aim at clarifying stock boundaries towards supporting sustainable management strategies at a regional scale for this ecologically and economically important species.

The present study integrated supramolecular analysis with a range of in silico approaches, including crystal structure determination, target prediction, ADMET (absorption, distribution, metabolism, and excretion) profiling, network pharmacology, and molecular docking to investigate the anticancer potential of compound 3 (tetrabromothia-bridged diquinoline). In the solid state, Compound 3 was found to incorporate p-xylene, yielding a stable inclusion complex [(3)2. (p-xylene)], the structure of which was elucidated and interpreted through the lenses of crystal engineering and supramolecular chemistry. Moreover, compound 3 exhibited favourable drug-likeness and strong predicted binding affinity for EGFR and ERBB2 (HER2), suggesting that modulation of EGFR tyrosine kinase inhibitor resistance, along with ERBB signalling pathways, may underpin its potential anticancer activity.

Abstract Background Hepatitis B virus (HBV) infection is a primary global public health concern since it is commonly recognized as the primary risk factor for cirrhosis and liver cancer globally. This study aims to evaluate the level of knowledge and the prevailing attitudes of Jordanian nursing students toward hepatitis B, with a particular focus on identifying knowledge gaps and factors influencing their understanding and perceptions. Materials and methods A descriptive design was employed to collect data from December 1, 2023, to April 1, 2024. A self-administered questionnaire was used to conduct convenience sampling among senior Jordanian nurses. Result A total of 455 participants were analyzed, revealing a young cohort with a mean age of 22.5 years. The participants demonstrated moderate knowledge of hepatitis B, with specific misconceptions identified. Besides, participants demonstrated a moderately positive attitude toward hepatitis B. However, demographic characteristics showed significant differences in knowledge by sex, whereas certain factors did not. Still, attitudes significantly differed based on those infected with hepatitis B and family members infected with hepatitis B. Conclusion This study focused on training and awareness programs to enhance knowledge and foster a positive attitude towards hepatitis B amongst nursing students. Moreover, combining these training and awareness activities would help improve hospital safety protocols in Jordan and ensure that a hepatitis B virus outbreak is averted.

BackgroundTinnitus is a prevalent condition worldwide, particularly among adolescents, that has a substantial impact on quality of life, yet it remains an understudied issue.ObjectivesThis study aims to determine the prevalence of tinnitus and its associated risk factors among Palestinian adolescents aged 15–18.MethodsA cross-sectional study was conducted from January to March 2025. A convenience sample of participants was recruited. The study utilized the European School for the Interdisciplinary Tinnitus Research Screening Questionnaire.ResultsA total of 1,131 participants were enrolled in the study, with 64.5% being females. The prevalence of tinnitus among the study sample was 532, representing 47% of the population. Females had a higher prevalence of tinnitus, with 370 affected (50.7%) compared to males (40.4%). Significant associations were found between tinnitus and several factors: age, positive family history of tinnitus (threefold increased risk), sensitivity to external sounds (2.7 times higher likelihood), slight hearing difficulty in noisy environments (1.7 times higher risk), pain symptoms (double the risk), and difficulty falling asleep (1.8 times higher risk). Notably, the majority of affected participants (71.5%) had never sought professional care for their tinnitus.ConclusionAlthough Tinnitus is common among Palestinian adolescents aged 15–18 years, the majority of affected participants did not seek professional care for tinnitus. These findings highlight the importance of conducting further research to shed insight into this prevalent and neglected health priority.

Dynamic Message Signs (DMSs) play a critical role in conveying real-time traffic information to drivers; however, their effectiveness heavily relies on how messages are structured and displayed, particularly regarding phasing duration and content length. This study examines the influence of these two factors on driver readability, comprehension, and gaze behavior using an advanced virtual reality (VR) driving simulator. Controlled experiments simulated four DMS scenarios, combining two phasing intervals (2.5 and 4 s) with short and long message formats, adhering to Michigan Department of Transportation (MDOT) guidelines. The experiment integrated eye-tracking technology to measure fixation duration and frequency, while statistical methods, including survival analysis and LASSO regression, were employed to identify significant predictors of message readability. Results revealed that shorter messages with shorter phasing intervals led to the highest comprehension rates and reduced cognitive strain. Furthermore, individual characteristics such as gender, driving speed, and highway driving experience significantly affected how drivers engaged with DMS messages. These findings contribute to the development of more effective DMS deployment strategies and provide practical design recommendations to enhance traffic safety and information delivery on high-speed roadways.

Regional anesthesia, while offering numerous clinical advantages, can paradoxically heighten intraoperative anxiety and stress due to patients remaining conscious throughout surgical procedures. This study aimed to evaluate the impact of immersive virtual reality (VR) on intraoperative anxiety, stress markers, and patient satisfaction in patients undergoing elective surgery under regional anesthesia. A prospective, randomized controlled trial was conducted from 20 July to 20 September 2024 at Rafidia Governmental Surgical Hospital, Nablus, Palestine. A total of 145 patients undergoing elective surgery under regional anesthesia were randomly assigned to either a VR group (n = 72) receiving immersive VR therapy using VR headset devices with standardized nature-based environments during intraoperative period, or a control group (n = 73) receiving standard hospital protocol care. Outcomes included anxiety assessed via State-Trait Anxiety Inventory (STAI) and stress levels measured using Perceived Stress Scale (PSS-10). A per-protocol analysis was conducted for the primary outcomes. The VR group demonstrated significantly reduced postoperative state anxiety scores (37.2 ± 15.3 vs. 52.9 ± 15.7, p < 0.001; Cohen's d = 1.01) and sustained trait anxiety reduction (40.1 ± 13.5 vs. 53.3 ± 15.0, p < 0.001; Cohen's d = 0.94). Perceived stress levels were significantly lower in the VR group postoperatively (21.1 ± 5.3 vs. 25.9 ± 5.8, p < 0.001; Cohen's d = 0.87). Patient satisfaction scores were substantially higher in VR group (8.6 ± 1.2 vs. 6.1 ± 1.7, p < 0.001; Cohen's d = 1.73). Postoperatively, a significantly higher proportion of patients using VR experienced mild state anxiety (77.8%) and mild trait anxiety (70.8%) compared to control group. Immersive VR is a safe and effective non-pharmacological intervention that significantly reduces intraoperative anxiety and stress while enhancing patient satisfaction during regional anesthesia in this study population. Given its safety profile, efficacy, and favorable economic profile, VR should be considered for integration into standard intraoperative care protocols, though further research is needed to confirm generalizability and cost-effectiveness. This study was retrospectively registered at ClinicalTrials.gov with the identifier NCT07132216 on 20 August 2025. The trial protocol is available at https://clinicaltrials.gov/study/NCT07132216?id=NCT07132216&rank=1.