Background: Rehabilitation programs for children with cerebral palsy (CP) aim to improve their motor and cognitive skills through repeated and progressively challenging exercises. However, these exercises can be tedious and demotivating, which can affect the effectiveness and feasibility of the programs. To overcome this problem, virtual reality VR-assisted exergaming has emerged as a novel modality of physiotherapy that combines fun and motivation with physical activity. VR exergaming allows children with CP to perform complex movements in a secure and immersive environment, where they can interact with virtual objects and scenarios. This enhances their active engagement and learning, as well as their self-confidence and enjoyment. We aim to provide a comprehensive overview of the current state of research on VR exergaming for CP rehabilitation. The specific objectives are: To identify and describe the existing studies that have investigated the effects of VR exergaming on motor function and participation outcomes in children with CP. In addition, we aim to identify and discuss the main gaps, challenges, and limitations in the current research on VR exergaming for CP rehabilitation. Finally, we aim to provide recommendations and suggestions for future research and practice in this field. Methods: In June 2023, we conducted a systematic search on Scopus, Web of Science, PubMed, Cochrane, and Embase for randomized trials and cohort studies that applied VR-assisted exergaming to rehabilitating patients with CP. The inclusion criteria encompassed the following: (1) Randomized controlled trials (RCTs) and cohort studies involving the rehabilitation of children with CP; (2) the application of VR-based exergaming on the rehabilitation; (3) in comparison with conventional rehabilitation/usual care. The quality of the selected RCTs was evaluated using Cochrane’s tool for risk of bias assessment bias includes. Whereas the quality of cohort studies was assessed using the National Institutes of Health (NIH) tool. Results: The systematic search of databases retrieved a total of 2576 studies. After removing 863 duplicates, 1713 studies underwent title and abstract screening, and 68 studies were then selected as eligible for full-text screening. Finally, 45 studies were involved in this review (n = 1580), and 24 of those were included in the quantitative analysis. The majority of the included RCTs had a low risk of bias regarding study reporting, participants’ attrition, and generating a random sequence. Nearly half of the RCTs ensured good blinding of outcomes assessors. However, almost all the RCTs were unclear regarding the blinding of the participants and the study personnel. The 2020 retrospective cohort study conducted at Samsung Changwon Hospital, investigating the effects of virtual reality-based rehabilitation on upper extremity function in children with cerebral palsy, demonstrated fair quality in its methodology and findings. VR-assisted exergaming was more effective than conventional physiotherapy in improving the Gross Motor Function Measurement (GMFM)-88 score (MD = 0.81; 95% CI [0.15, 1.47], p-value = 0.02) and the GMFM walking and standing dimensions (MD = 1.45; 95% CI [0.48, 2.24], p-value = 0.003 and MD = 3.15; 95% CI [0.87, 5.42], p-value = 0.007), respectively. The mobility and cognitive domains of the Pediatric Evaluation of Disability Inventory score (MD = 1.32; 95% CI [1.11, 1.52], p-value < 0.001) and (MD = 0.81; 95% CI [0.50, 1.13], p-value < 0.0001) were also improved. The Canadian Occupational Performance Measure performance domain (MD = 1.30; 95% CI [1.04, 1.56], p-value < 0.001), the WeeFunctional Independence Measure total score (MD = 6.67; 95% CI [6.36, 6.99], p-value < 0.0001), and the Melbourne Assessment of Unilateral Upper Limb Function-2 score (p-value < 0.001) improved as well. This new intervention is similarly beneficial as conventional therapy in improving other efficacy measures. Conclusions: Our findings suggest that VR-assisted exergaming may have some advantages over conventional rehabilitation in improving CP children’s functioning and performance in daily life activities, upper and lower limb mobility, and cognition. VR-assisted exergaming seems to be as effective as conventional physiotherapy in the other studied function measures. With its potential efficacy, better feasibility, no reported side effects, and entertaining experience, VR-assisted exergaming may be a viable complementary approach to conventional physiotherapy in rehabilitating children with CP.

The use of electronic nicotine delivery systems (ENDS), including e-cigarettes, vape pens, hookah pens, e-cigars, and e-pipes, has grown in popularity worldwide, particularly among young individuals. However, these products are not without risks, as their emissions may contain harmful substances such as diacetyl (a flavoring agent linked to specific pulmonary problems in high concentrations), tobacco-specific nitrosamines, and volatile organic compounds with unknown long-term effects on lung health. This systematic review and meta-analysis aimed to assess the prevalence of ENDS use among school and college students on a global scale. A comprehensive search was conducted in PubMed, Scopus, Cochrane Library, and Web of Science databases. Two researchers independently selected and extracted data from the identified studies. The pooled prevalence of ENDS use among school or college students was calculated using a random-effect meta-analysis. The systematic review encompassed 146 studies with 4,189,145 subjects from 53 countries and six continents. The overall current prevalence of ENDS use was 10.2%, indicating a significant presence of this behavior among students. Moreover, ENDS current use was higher among males (10.2%) than females (7.5%). In comparison, the lifetime prevalence was 22.0%, indicating that a substantial portion of students have tried these products but do not continue to use them regularly. Our meta-analysis reveals a significant prevalence of ENDS use among school and college students globally, with higher rates observed among males than females. The lifetime prevalence of ENDS indicates that many students have tried or are currently using these products. The current prevalence of ENDS use was 10.2%, with notable variations across different continents.

Background: Hypertensive disorders of pregnancy (HDP) can significantly impact maternal, neonatal, and fetal health. For controlling these disorders, frequent blood pressure measurements are required. Home blood pressure monitoring (HBPM) is a suggested alternative to conventional office monitoring that requires frequent visits. This systematic review was conducted to evaluate the efficacy and safety of HBPM in the control of HDP. Methods: We systematically conducted databases search for relevant studies in June 2022. The relevant studies were identified, and qualitative synthesis was performed. An inverse variance quantitative synthesis was conducted using RevMan software. Continuous outcome data were pooled as means differences, whereas dichotomous ones were summarized as risk ratios. The 95% confidence interval was the measure of variance. Results: Fifteen studies were included in our review (n = 5335). Our analysis revealed a superiority of HBPM in reducing the risk of induction of labor, and postpartum readmission (P = 0.02, and 0.01 respectively). Moreover, the comparison of birth weights showed a significant variation in favor of HBPM (P = 0.02). In the analysis of other outcomes, HBPM was equally effective as office monitoring. Furthermore, HBPM did not result in an elevated risk of maternal, neonatal, and fetal adverse outcomes. Conclusion: Home monitoring of blood pressure showed superiority over office monitoring in some outcomes and equal efficacy in other outcomes.

Background: Surgical procedures in the heart requires protection of the heart from ischemia–reperfusion injury. Cardioplegia is the primary myocardial protective method in use. Histidine–tryptophan–ketoglutarate (HTK) solution is an intracellular cardioplegic solution that was initially used to preserve organs for transplantation. Methods: A systematic electronic search was conducted in July 2021, in four databases; PubMed, Scopus, Web of Science, and Cochrane Library for eligible randomized controlled trials. The results were screened and the eligible trials were identified. Thereafter, the relevant data were extracted and pooled as mean difference or risk ratio, and 95% confidence interval in an inverse variance method using RevMan software. Results: This review included 12 trials (n = 1327). HTK solution has resulted significantly in shorter intensive care unit stay (MD = − 0.09; 95% CI [− 0.15, − 0.03], p = 0.006), and shorter hospital stay (MD = − 0.51; 95% CI [− 0.71, − 0.31], p < 0.00001). Moreover, the patients who received the HTK solution had significantly lower levels of creatine kinase (after 4–7 h (MD = − 157.52; 95% CI [− 272.31, − 42.19], p = 0.007), and 24 h (MD = − 136.62; 95% CI [− 267.20, − 6.05], p = 0.04)), as well as creatine kinase muscle brain band (after 44–48 h (MD = − 3.35; 95% CI [− 5.69, − 1.02], p = 0.005)). Conclusion: HTK solution had the same efficacy and safety as other cardioplegic solutions in most of the clinical parameters. Furthermore, the solution showed superiority in fastening the recovery and protecting the myocardium at the biochemical level. HTK solution provides longer myocardial protection; therefore, it limits surgical interruption. HTK solution can be used as an alternative to the currently used cardioplegic solutions.

This study explores an eco-friendly approach to mitigate risks associated with organophosphorus insecticides, particularly Chlorpyrifos, by synthesizing silver nanoparticles (AgNPs) using Psidium guajava leaf extract and preparing a nanocomposite (AgNPs/S18) with Chlorpyrifos pesticide. The green-synthesized AgNPs and AgNPs/S18 nanocomposite were characterized using various analytical techniques, confirming the successful synthesis of AgNPs with an average size of 37 nm and forming a stable nanocomposite. Antibacterial assays demonstrated significant activity against Staphylococcus aureus, with AgNPs showing an 87.8% reduction and the nanocomposite achieving a 72% reduction in bacterial population. Cytotoxicity evaluations on normal liver and liver cancer cell lines revealed enhanced cytotoxicity of the nanocomposite compared to AgNPs alone, suggesting potential applications in targeted therapies. In vivo studies on rats revealed the protective effects of AgNPs and the nanocomposite against Chlorpyrifos-induced toxicity in liver and kidney tissues. Histopathological and ultrastructural analyses showed both treatments, particularly the nanocomposite, significantly mitigated cellular damage caused by Chlorpyrifos exposure. These findings suggest that green-synthesized AgNPs and their nanocomposite with Chlorpyrifos offer a promising approach to reducing pesticide hazards while maintaining efficacy. This research contributes to developing safer alternatives in pest management, addressing the need for more environmentally friendly agricultural practices while protecting human health and ecosystems.

Background: The optimum model of perinatal care for low-risk pregnancies has been a topic of debate. Obstetrician-led care tends to perform unnecessary interventions, whereas the quality of midwife-led care has been subject to debate. This review aimed to assess whether midwife-led care reduces childbirth intervention and whether this comes at the expense of maternal and neonatal wellbeing. Methods: PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for relevant studies. Studies were checked for eligibility by screening the titles, abstracts, and full texts. We performed meta-analyses using the inverse variance method using RevMan software version 5.3. We pooled data using the risk ratio and mean difference with the 95% confidence interval. Results: This review included 44 studies with 1,397,320 women enrolled. Midwife-led care carried a lower risk of unplanned cesarean and instrumental vaginal deliveries, augmentation of labor, epidural/spinal analgesia, episiotomy, and active management of labor third stage. Women who received midwife-led care had shorter hospital stays and lower risks of infection, manual removal of the placenta, blood transfusion, and intensive care unit (ICU) admission. Furthermore, neonates delivered under midwife-led care had lower risks of acidosis, asphyxia, transfer to specialist care, and ICU admission. Postpartum hemorrhage, perineal tears, APGAR score < 7, and other outcomes were comparable between the two models of management. Conclusions: Midwife-led care reduced childbirth interventions with favorable maternal and neonatal outcomes in most cases. We recommend assigning low-risk pregnancies to midwife-led perinatal care in health systems with infrastructure allowing for smooth transfer when complications arise. Further research is needed to reflect the situation in low-resource countries.