Background: The complications of prolonged immobilization cause many adverse outcomes, including increased morbidity and mortality, prolonged hospitalization, increased hospitalization costs, and lead to a global burden of disease. The aim of this study is to investigate the correlation between the severity of immobilization and the risk of deep vein thrombosis (DVT) in hospitalized elderly patients. Materials and Methods: This research is a cross sectional analytic study using medical record data. The population is immobilized elderly patients who were hospitalized at Wahidin Sudirohusodo Hospital from November 2024 to April 2025. The statistical test was chi-square test. Results: In the mild to moderate immobilization group, most patients were in the low to moderate DVT risk category, totaling 33 patients (94.3%). Conversely, in the severe immobilization group, almost all patients were in the high DVT risk category, totaling 43 patients (95.6%). The test results showed a P-value of 0.000 (P < 0.05). Conclusions: There is a significant correlation between the severity of immobilization and the risk of DVT in elderly patients

Background: Hypertension is a majot public health concern and a leading contributor cerebrovascular morbidity worldwide. Hypertension also has been increasingly linked to cognitive decline and dementia, yet most studied focused on elderly populations. This study aims to identify factors that influence cognitive function in patients with hypertension. Methods A cross-sectional study was carried out at Dr. Wahidin Sudirohusodo Hospital and Hasanuddin University Hospital, Makassar, from May to July 2025. A total of 317 hypertensive patients aged 18–60 years were enrolled, and cognitive function was assessed using the MoCA-INA. Result Bivariate tests showed that age, education, and marital status were significantly associated with cognitive dysfunction in hypertensive patients (p < 0.05). Multivariate tests showed that age, education, and marital status were significantly associated with cognitive dysfunction in hypertensive patients. Age ≥ 50 years was a significant risk factor for cognitive impairment in hypertensive patients (OR 2.86; 95% CI: 1.12–7.31; p = 0.029). Low education was a significant risk factor for cognitive impairment in hypertensive patients (OR 3.06; 95% CI: 1.59–5.90; p = 0.001). Conclusions Age greater than or equal to 50 years and low education increase the risk of cognitive dysfunction in hypertensive patients.

Uterine Inflammatory Myofibroblastic Tumor (IMT) is rare. It might closely mimic other more common mesenchymal uterine neoplasms, mainly leiomyoma and leiomyosarcoma. Accurate diagnosis and distinction from other uterine mesenchymal neoplasms are crucial for treatment and prognostication purposes We report a case of Uterine IMT in a 45 year old woman. Ultrasonographically and macroscopically, the tumor mimicked a submucosal leiomyoma. It measured 8.5cm, displayed myxoid areas, infiltrative borders, no necrosis and a maximal mitotic count of 4 Mitotic Figures per 10 High Power Fields (4MF /10HPF). The degree of cytological atypia was mild. It expressed ALK-1 and showed ALK gene rearrangement by FISH  We review the histologic, immunohistochemical and cytogenetic features of Inflammatory Myofibroblastic Tumor in general and we discuss the differential diagnosis in the uterus. We also review the published criteria that are currently used in order to predict the biological behavior.

Background: An increasingly large number of Lebanese citizens has been travelling each year. Little is known about the extent to which Lebanese travellers seek travel advice, and vaccination before their departures. This study aims to determine the level of knowledge, attitudes, and practices (KAP) of Lebanese travellers towards travel health to assess the knowledge gap and the need for travel health services in Lebanon.    Methods: A cross-sectional study was conducted over a period of 1 week using a self-administered questionnaire at Rafic Hariri International Airport in Beirut. It included 615 travellers. Results: Travellers were predominantly men (68%), and 80% had a high educational level. The majority were travelling to the Middle East/Gulf countries (36%) and sub-Saharan Africa (35%). More than half (57%) were travelling alone, mostly for work (68%). The big majority (75%) sought general information about their travel destination, and the sources of information were mainly family and friends (44%), and the internet (36.7%). Around the third (33%) sought medical advice, mostly from physicians (19%). Only 2.4% sought it from travel clinics. The absence of medical concerns was the main reason not to get medical advice (42.9%). Almost half were not vaccinated to flu (49%). Approximately the third of all participants (32%) received/purchased medications before travel: flu vaccine (7.8%), OTC drugs (19.02%), and antimalarials (12.68%). Half of travellers were planning to participate in outdoor activities, but most won’t use protection to bugs/mosquitoes. Only 15.8%of all travellers sought pre-travel medical advice at least one month prior to the trip, and this behaviour was found to be associated with high-risk destinations, stay length, travelling for religion/mission purpose, participating in outdoor activities, visiting rural areas, and health insurance status.  Conclusion: In our study, Lebanese travellers, although mostly highly educated, had less than optimal travel health perceptions and practices. The lack of awareness and initiative exhibited by Lebanese travellers towards travel health brings to light a growing need for specialized travel medicine services at the national level and educational programs that publicly highlight the importance of pre-travel medical guidance.

Background: This study evaluates the knowledge, attitudes, and readiness to practice of Lebanese healthcare workers regarding disaster preparedness and crisis response using validated scales, as Lebanon becomes increasingly vulnerable to humanitarian crises. Methods: A descriptive, cross-sectional, survey-based study was conducted in Lebanon over 3 months in 2022 using a self-reported online questionnaire. Data analysis was performed with SPSS 26.00. Factor analyses checked reliability and validated the KArP scales. Descriptive statistics, bivariate analysis, and multivariable analysis were performed, with normality checks and non-parametric tests when necessary. Results: A total of 265 respondents participated, equally distributed between physicians, nurses, and pharmacists. The mean age was 35.8 ± 9.3 years, and the mean work experience was 11.43 ± 8.3 years. Nearly all (91.3%) had prior exposure to hazards and training (95.1%). A large majority (83.8%) expressed the need for mental health support. Knowledge scores were poor, while attitude and readiness scores were relatively good. Most respondents (84.2%) found local governance support insufficient, and 60.8% were unfamiliar with the logistics of disaster response. Almost all (95.4%) called for more relevant workshops. Nurses (b=2.44), previous disaster experience (b=2.34), and past training (b=4.07) were predictors of higher knowledge scores. Higher attitude scores were linked to better knowledge scores (b=2.19) and the need for mental health counseling (b=13.51). Greater knowledge (b=0.43) and attitude scores (b=0.24), older age (b=0.21), and being a nurse (b=3.60) predicted better readiness to practice. Conclusions: Lebanese healthcare workers show inadequate disaster preparedness, particularly in knowledge. This underscores the need for more educational resources, training, and improved mental health support to prevent burnout.

Background: Road traffic crashes constitute a major preventable cause of mortality and injury worldwide, particularly in low- and middle-income countries. Increasing motorization, population growth, urban expansion, road infrastructure limitations and unsafe road-user behavior may contribute substantially to the burden of traffic-related mortality. Objective: To evaluate the temporal trends, demographic characteristics and mechanisms of road traffic-related deaths recorded in Kirkuk Governorate, Iraq, between 2016 and 2025. Methods: A retrospective descriptive analytical study was conducted using records from the Injury Surveillance Program of the Forensic Medicine Department in Kirkuk. All registered road traffic fatalities from January 1, 2016, to December 31, 2025, were included. Variables included year of death, sex, age group and road-user or vehicle category. Frequencies, percentages, temporal changes and simple linear regression were used for statistical analysis. Results: During the 10-year study period, 8,046 deaths were registered, of which 2,377 (29.5%) were attributable to road traffic accidents. Road traffic deaths increased from 205 in 2016 to 339 in 2025, representing a 65.4% increase. Linear trend analysis demonstrated an average increase of approximately 19.7 deaths per year (R²=0.788; p<0.001). Automobile-related incidents accounted for 1,115 deaths (46.9%), followed by pedestrians 750 (31.6%), motorcycles 435 (18.3%), bicycles 50 (2.1%) and other mechanisms 27 (1.1%). Males accounted for 1,918 deaths (80.7%), whereas females accounted for 459 (19.3%). A total of 445 fatalities (18.7%) occurred among persons aged <15 years. Conclusion: Road traffic mortality represents a substantial and increasing public-health problem in Kirkuk. Automobile occupants, pedestrians and motorcyclists represent the main fatality groups. Integrated preventive strategies involving enforcement, safer road infrastructure, vehicle inspection, injury surveillance and protection of vulnerable road users are urgently required.

Background:  Cytomegalovirus (CMV) is a common opportunistic infection in individuals with Human Immunodeficiency Virus (HIV). CMV infection can affect various organs, such as the retina, gastrointestinal tract, lungs, and central nervous system, and contributes to increased morbidity and mortality in HIV patients. The aim of this study is to determine the factors that contribute to the clinical manifestations of CMV in HIV patients. Methods: This study is an analytic observational study with cross sectional method. This study involved 160 patients diagnosed with HIV and CMV with age more than 18 years at Wahidin Sudirohusodo Hospital during the period February - July 2025. CMV-infected patients were categorized into two groups based on the presence or absence of clinical manifestations of CMV. Results: This study included 160 patients diagnosed with HIV. Patients with clinical manifestations of CMV were found in 80 patients. Male patients were 7.2-fold more likely to have clinical manifestations (OR = 7.2, 95% CI = (2.35 - 22.10) p=0.000), age <45 years 2.2-fold (OR = 2.2, 95% CI = (0.99 - 5.01) p=0.048). Disease duration <1 year had 4.4-fold and 1- 5 years had 2.8-fold (OR = 4.4, CI 95% = (1.88 - 10.71) p=0.001) and (OR = 2.8, CI 95% = (1.35 - 5.78) p=0.001). Patients receiving the telado therapy regimen had 0.5-fold (OR = 0.5 CI 95% = (0.26 - 0.99) p = 0.045). CD4 < 200 cells/µL were 10-fold (OR = 10.10 CI 95% = (4.76 - 21.49) p= 0.000). Multivariate analysis showed that CD4 <200 cells/µL had a risk of 10.2-fold and male had a risk of 7.4-fold. Conclusion: This study shows that male gender, age less than 45 years, length of illness less than 5 years, type of therapy, and CD4 count are associated with clinical manifestations of CMV in HIV patients.

Introduction:  Knee osteoarthritis (OA) is a major cause of chronic pain, functional disability, and poor quality of life in elderly populations. Factors such as pain, limited mobility, and psychosocial impairment due to OA can affect patients' daily activities, independence, and mental health. In addition, comorbidities such as obesity, diabetes, and hypertension can also contribute to worsening the conditions of OA patients, which in turn affects their quality of life (QoL). Pain is a major cause of functional disability and negatively impacts various aspects of QoL, including activity, mood, and sleep quality. This study aims to investigate the effects of age, body weight, and comorbidities with quality of life (QoL) of knee osteoarthritis patients Materials and methods: An observational study involving 51 patients over the age of 50 with knee OA. The diagnosis of OA was based on the 1990 American College of Rheumatology (ACR) criteria. Patients' QoL was measured based on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Results:  Subjects aged > 60 years had a risk of QoL 5.3-fold (RR: 5.375; 95% CI: 2.877-10.044; p<0.05) compared to subjects with knee OA aged < 60 years. Subjects with overweight had a risk of impaired QoL 4.6-fold (RR: 4.675; 95% CI: 2.257-9.685; p<0.05) compared to subjects with normal weight. Subjects with >2 comorbidities had a risk of impaired QoL 8-fold (RR: 8.000; 95% CI: 3.524-18.162; p<0.05) compared to subjects with <2 comorbidities. Conclusions: Advanced age, overweight, and comorbidities are significantly associated with reduced QoL in knee OA patients. Multifactorial interventions are needed to improve QoL in this population.

Immune Thrombocytopenia Purpura (ITP) is a disease characterized by thrombocytopenia, which is diagnosed by excluding other causes of thrombocytopenia. In recent years, there have been many studies on the association between Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) values with ITP, but the results have not been consistent. This study aims to determine the association between mean MPV and PDW with the severity of ITP. Materials and methods: a cross-sectional study involving 100 ITP patients aged more than 18 years at Dr. Wahidin Sudirohusodo Hospital Makassar, Indonesia. The diagnosis of ITP was established by excluding all causes of thrombocytopenia. MPV and PDW values were obtained from the patient's complete blood test results. Data were analyzed using Statistical Packages for Social Science (SPSS) statistical software version 26. Results:  This study included 100 ITP patients. It was found that MPV was significantly high (p = <0.001) in severe ITP compared to mild and moderate (1.8% vs 17.5% vs 80.7%). PDW was significantly high (p = <0.001) in severe ITP compared to mild and moderate (9.5% vs 15.9% vs 74.6%). MPV value of 13.65 fL was predictive of severe ITP with a sensitivity of 72.40% and specificity of 83.30% and PDW value of 18.8 fL was predictive of severe ITP with a sensitivity of 79.30% and specificity of 76.20%. Conclusions: High values of MPV and PDW were more common in patients with severe ITP. In addition, the mean of MPV and PDW were also found to be higher along with the severity of ITP

Hepatitis B and Metabolic Associated Fatty Liver Disease (MAFLD) are conditions that can contribute to the development of liver fibrosis. Hepatitis B triggers long-term liver inflammation and activates stellate cells, which play a role in the formation of fibrotic tissue. On the other hand, MAFLD is closely associated with metabolic syndrome, including obesity, dyslipidemia, and insulin resistance. When both conditions coexist, the risk of fibrosis progression increases, accelerating the transition to cirrhosis and other hepatic complications. The aim of this study is to determine the effect of hepatitis B and MAFLD on the occurrence of liver fibrosis. Materials and Methods: a descriptive study using a cross-sectional design. The study involved all patients diagnosed with hepatitis B at Wahidin Sudirohusodo General Hospital in Makassar between August 2024 and February 2025. Hepatitis B diagnosed based on serum hepatitis B antigen. The criteria of MAFLD based on the presence of hepatic steatosis accompanied by obesity, type 2 diabetes mellitus, or metabolic syndrome. Patients are categorized into Group 1: patients with hepatitis B and Group 2: patients with hepatitis B and MALFD. Liver fibrosis assessed using transient elastography (FibroScan), categorized into non-advanced fibrosis (F2-F3) and advanced fibrosis (>F4). Results: Among 98 patients with hepatitis B, 43 patients (43.9%) had MAFLD. Group 2 had significantly higher liver stiffness (p<0.05) compared to group 1 (11.19 kPa vs 17.1 kPa). Group 2 had a significantly higher incidence of advanced fibrosis compared to Group 1 (60.6% vs 39.4%) and 2.8-fold more likely to develop advanced liver fibrosis (OR: 2.809; 95% CI 1.184–6.664; p = 0.017). HBeAg-negative was significantly associated with more advanced fibrosis compared to HBeAg-positive (OR: 11.610; 95% CI 3.766–35.791; p < 0.05). Conclusion: Patients with hepatitis B accompanied by MALFD have a higher average liver stiffness compared to patients with hepatitis B alone. HBeAg-negative status is the most significant factor contributing to the occurrence of liver fibrosis.

Background: Increasing  parental  vaccination  hesitancy  is  fueled  by  concerns  of  vaccination  safety  and effectiveness, widespread misinformation, and barriers to vaccines availability and accessibility. Vaccination uptake against rotavirus remains suboptimal in low-middle income countries. We aimed  to  study  the  knowledge,  attitude,  and  practice  (KAP)  of  Lebanese  parents  towards vaccination with a focus on Rotavirus vaccine. Methods: A cross-sectional study was conducted in 2 public and 2 private schools in the greater Beirut area in 2017-2018 school year. A questionnaire assessing KAP of vaccination in general and rotavirus vaccine in specific was shared with Lebanese parents of school children between aged 3 to 18 years. Results: The overall response rate was 76.5% (306 out of 400 questionnaires) out of which 221 respondents answered the rotavirus questions. Only 45.25% respondents reported vaccinating their children against rotavirus. Factors associated with higher vaccine uptake included younger parent’s age, higher level of parent’s education, children’s mothers being employed, and higher household incomes (p-values <0.005). Respondents vaccinating against Rotavirus have a more positive attitude towards vaccines in general and 96% reported their child’s pediatrician to be their primary source of information. Lack of pediatrician’s recommendation was the most common reason (55%) for not vaccinating against rotavirus. Conclusion: Vaccination against rotavirus among Lebanese children remains low but increases with higher parental age, education, and income. Cost and lack of awareness were the most significant barriers for vaccination while pediatricians’ recommendation was the most trusted and influential source on parent’s decision to vaccinate. More efforts are needed to disseminate vaccination information through pediatricians’ recommendations and other means and increase vaccine availability and accessibility.