Systemic lupus erythematosus (SLE) is an autoimmune illness caused by a malfunctioning immunomodulatory system. China has the second highest prevalence of SLE in the world, from 0.03% to 0.07%. SLE is diagnosed using a combination of immunological markers, clinical symptoms, and even invasive biopsy. As a result, genetic diagnostic biomarkers for SLE diagnosis are desperately needed.SLE = 1315, nnormal = 122), and pooled four data sets  as the validate data set . We screened the differentially expressed genes (DEGs) between the SLE and control samples, and employed the least absolute shrinkage and selection operator (LASSO) regression, and support vector machine recursive feature elimination (SVM-RFE) analyze to discover possible diagnostic biomarkers. The candidate markers’ diagnostic efficacy was assessed using the receiver operating characteristic (ROC) curve. The reverse transcription quantitative polymerase chain reaction (RT-qPCR) was utilized to confirm the expression of the putative biomarkers using our own Chinese cohort . Finally, the proportion of 22 immune cells in SLE patients was determined using the CIBERSORT algorithm, and the correlations between the biomarkers’ expression and immune cell ratios were also investigated.From the Gene Expression Omnibus (GEO) database, we downloaded three array data sets of SLE patients’ and healthy people’s peripheral blood mononuclear cells (PBMC)  as the discovery metadata  values of these six genes reached to 0.96 and 0.913, respectively, in the discovery and validation data sets. After that, we checked to see if the expression of ABCB1, IFI27, and PLSCR1 in our own Chinese cohort matched that of the discovery and validation sets. Subsequently, we revealed the potentially disturbed immune cell types in SLE patients using the CIBERSORT analysis, and uncovered the most relevant immune cells with the expression of ABCB1, IFI27, and PLSCR1.Our study identified ABCB1, IFI27, and PLSCR1 as potential diagnostic genes for Chinese SLE patients, and uncovered their most relevant immune cells. The findings in this paper provide possible biomarkers for diagnosing Chinese SLE patients. Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects the adolescent and menopausal women . The cliNowadays, the diagnosis of SLE is primarily based on a series of clinical manifestations and laboratory indicators, such as skin erythema, arthralgia, complement C3, C4, and anti-dsDNA antibodies, etc. –11. SLE Until now, immune cells such as lymphocytes, dendritic cells, macrophages, basophils, and neutrophils have been identified to be disrupted in the course of SLE –17. TherSLE = 1315, nnormal = 122) and looked for the differentially expressed genes (DEGs) between SLE and controls. Next, we identified the diagnostic biomarkers of SLE using different machine learning algorithms. Following that, we merged four GEO data sets as the validation data  and confirmed the expression of the identified diagnostic biomarkers, then used logistic regression to develop a diagnostic prediction model. Furthermore, we validated the expression of the candidate biomarkers using our own Chinese cohort . Moreover, we used the CIBERSORT algorithm to quantify the proportion of 22 immune cells in PBMC of SLE patients and healthy people. Finally, we explored the relationship between the expression of the identified biomarkers and the ratios of immune cells in PBMC of SLE patients.In this study, we used the Gene Expression Omnibus (GEO) database to obtain three expression microarray datasets of SLE patients’ and healthy people’s peripheral blood mononuclear cells (PBMC). Then, we pooled the three datasets as a metadata cohort  were also merged as the verification data after normalization.The DEGs were screened out using the R package “limma” based on the metadata cohort’s data set. The heat map showing the expression of DEGs was depicted using the R package. Next, the DAVID database was used to analysis the functions of the DEGs based on gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway. In addition, the R package “clusterProfiler” and “DOSE” were used for the Disease ontology (DO) enrichment analyses. The gene set enrichment analysis (GSEA) was used to distinguish the most significant functional items between SLE and controls. The gene set “c2.cp.kegg.v7.0.symbols.gmt” from the Molecular Signatures Database (MSigDB)  was seleTwo algorithms, namely least absolute shrinkage and selection operator (LASSO) logistic regression and support vector machine-recursive feature elimination (SVM-RFE), were used to screen the potential SLE diagnostic markers. The “glmnet” R package was used to perform the LASSO analysis to identify the optimal diagnostic markers in SLE, and the SVM-RFE was used to find the optimal variables. The candidate diagnostic markers were picked by intersecting the markers identified by these two algorithms. Then, the expression of the candidate diagnostic biomarkers were verified based on the merged dataset containing GSE4588, GSE50772, GSE99967, and GSE24706.To examine the diagnostic efficacy of the candidate markers, the receiver operating characteristic (ROC) curves were drawn based on the discovery metadata and the validation data set.A total of 23 whole blood samples (including 13 SLE samples and 10 control samples) were collected from Shenzhen People’s Hospital. Patients diagnosed as SLE, with a SLE disease activity index (SLEDAI) score more than 5 were included. The clinical manifestations of all patients were shown in The total RNA was isolated from the PBMC according to the manufacturer’s instructions. The transScript all-in-one first-strand cDNA synthesis superMix for qPCR  kit  was used for the reverse transcription of mRNA. After that, the qPCR assays were conducted out with the PerfectStart Green qPCR SuperMix kit , with the following primers: GAPDH (Forward: 5-TGACTTCAACAGCGACACCCA-3. Reverse: 5-CACCCTGTTGCTGTAGCCAAA-3). ABCB1 (Forward: 5-GTCTGGACAAGCACTGAAAGATAAGA-3. Reverse: 5- CAACGGTTCGGAAGTTTTCTATTGC-3). EIF2AK2 (Forward: 5- AGAAGGCGGAGCGTGAAGTAAAAG-3. Reverse: 5- ATCCATCCCAACAGCCATTGTAGTG-3). HERC6 (Forward: 5- CCTGCCAAGCCTAAACCTGAGAAG-3. Reverse: 5- TACAGAGCCAGTGGGAAAGGAAGG-3). ID3 (Forward: 5-GGACGACATGAACCACTGCT-3. Reverse: 5-TCAGTGGCAAAAGCTCCTTT-3). IFI27 (Forward: 5-TCTGCAGTCACTGGGAGCAA-3. Reverse: 5-CCCAATGGAGCCCAGGAT-3), PLSCR1 (Forward: 5-CCTCAGTATCCACCGACAGCATTC-3. Reverse: 5-ACTGGCTGATTTGGGACAGGAAAG-3). All the primers were synthesized by the Sangon Biotech Company. Among them, GAPDH was an internal reference gene. The gene relative expressions were calculated by the 2-ΔΔCT method. A p value < 0.05 was considered statistically significant.The CIBERSORT algorithm  was usedAfter batch effects were removed using the R package “SVA,” we combined three expression array data sets collected from the GEO database  into one discovery data set, which included data from 1315 SLE patients and 122 healthy people. We used principal component analysis (PCA) to cluster all of the samples and discovered that each sample’s point was randomly distributed, indicating that the normalization was done correctly . The result showed that 10 genes harbored the similar expression trend with statistical significance in both discovery and validation data sets, including ABCB1, EIF2AK2, HERC6, PLSCR1, ID3, IFI27, SCRN1, CD160, HSP90AB1, and PCYOX1. Among these 10 genes, we selected ABCB1, EIF2AK2, HERC6, PLSCR1, ID3, and IFI27 for the following study because the statistical differences of their expression was most significant in both the discovery and validation sets  cells in SLE were significantly lower, while monocytes, macrophages M0, activated dendritic cells, neutrophils were higher –27.Following that, we investigated the correlation between the ratios of the 22 types of immune cells in SLE patients, and discovered that the degrees of memory B cells and activated dendritic cells, the levels of regulatory T cells (Tregs) and memory B cells, the levels of Tregs and activated dendritic cells all had a strong positive link, respectively. Furthermore, the ratio of CD8 T cells was adversely linked with that of neutrophils, memory B cells, and monocytes . Among the six putative biomarkers, we confirmed their expression using our own Chinese cohort , and three of them were statistically significant, while the other three genes showed the same expression trend to the machine learning results. The reason for this phenomenon could be due to the small sample size and the racial heterogeneity. Thus, a bigger cohort may be necessary for the further validation in future research.In this study, we screened the putative diagnostic biomarkers of SLE using machine learning. We all know that the conclusions drawn from a single data set are typically limited, unrepeatable, or inconsistent. To ensure the correctness of our findings, we retrieved three cohorts from the GEO database  to ensure that the markers screened out are more universal and accurate. Second, we used two machine learning methods, LASSO and SVM, to screen diagnostic markers, whereas Zhao X’s work screened biomarkers through overlapping the DEGs of six independent data sets. Compared with the intersection method, LASSO and SVM have stronger power in identifying biomarkers with higher distinguishing efficacy. Third, we validated the screened markers using our own Chinese cohort, thereby the markers had potential application for Chinese patients.In 2021, Zhao X’s team has revealed several potential SLE biomarkers based on a comprehensive bioinformatics analysis . CompareWe also observed a link between the infiltration of certain immune cells and the expression of biomarker genes. However, more evidence is needed to support the link in a wider range of situations, and the relevance of this correlation is unknown at this time. Furthermore, immune cell infiltration and marker gene expression may not be causally related. The systemic inflammation that occurs in lupus may cause changes in immune cell ratio, and the marker gene expression may be linked to that inflammation.Among the six SLE candidate markers, ABCB1, HERC6 and ID3 are identified for the first time. Furthermore, we confirmed the expression of ABCB1 in the Chinese population using our own cohort. ABCB1, also known as P-glycoprotein (P-GP), is a multidrug resistance protein mainly expressing in barrier organs such as brain, liver, kidney, and skin –32. ReceMachine learning, on the other hand, detected three recognized SLE biomarkers, including EIF2AK2, IFI27, and PLSCR1, confirming the algorithms’ accuracy. The protein encoded by EIF2AK2, as one key component of the innate immune system, is increasingly expressed in T cells of SLE patients, and is likely to be associated with cellular translation and proliferation . BesidesSLE = 1315, nnormal =122), including ABCB1, EIF2AK2, HERC6, ID3, IFI27, and PLSCR1, and demonstrated that ABCB1, EIFI27, and PLSCR1 might be suitable for the Chinese population. Meanwhile, we discovered the quantitative changes of 13 types of immune cells in SLE patients, as well as the link between the expression of ABCB1, IFI27, and PLSCR1 and the ratios of different immune cells. Our findings provide potential biomarkers for Chinese SLE patients, and give the insight into the relationship between gene expression and immune cell ratios.Generally speaking, we identified six genes as prospective SLE biomarkers (nThe datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/The studies involving human participants were reviewed and approved by the Ethics Committee of Shenzhen People’s Hospital (LL-KY-2021393). Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.WZ conceived and designed the project. YZ wrote the manuscript. SL provided data analysis support. XH and DL contributed to clinical sample collection. YC, ZZ, and WC performed the experiments. YX and GW provided conceptual guidance. DT and YD supervised the study. All authors read, revised and approved the final manuscript.This study was supported by grants from the Key Research and Development Program of Guangdong Province (No. 2019B020229001), the science and technology plan of Shenzhen (No. JCYJ20200109144218597), Shenzhen Guangming District Science and Technology Innovation Bureau (No. 2021R01020), Shenzhen Key Medical Discipline Construction Fund (No. SZXK011), and the Guangdong Basic and Applied Basic Research Foundation (No. 2021A1515111071).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Anterior laryngeal webs (ALWs) are uncommon abnormalities consisting of membranous tissues on the supraglottic, glottis, and/or subglottis at birth.3OMIM 188400/192430).This paper presents a case report of a patient with an ALW and the 22q11 deletion syndrome (SD22q11), also known as the velocardiofacial syndrome or DiGeorge syndrome , measuring 50 cm (P25-50), with a 35 mm cephalic perimeter (P50-98). The baby was cyanotic and did not cry during birth. Oxygen therapy was required, and the patient remained in hospital for 15 days after birth. At the age of 3 months, a laser laryngeal procedure was done to remove a subglottic membrane; at this point the patient had episodes of hypocalcemia that required treatment with calcium gluconate.pectus carinatum, protruding navel, right cryptorchidism, and thin fingers of the hand. The palate was ogival, but there were no associated abnormalities such as velopharyngeal insufficiency. Neuropsychomotor, behavioral, and speech development was compromised as the patient grew, requiring drug therapy - haloperidol and biperiden. The physical examination at age 12 years and 2 months was as follows: weight - 47 kg (P75-90), height - 147 cm (P50), cephalic perimeter - 53 cm (P2-50), elongated face, narrow palpebral fissures, bilateral epicanthic folds, hypoplasic nasal alae, dental malocclusion, prognathism, overfolded helices , ALWs are a mild form of laryngeal atresia (type III).The SD22q11 is a relatively common genetic disease; it is caused by a deficiency in region 11 in the long arm of the chromosome 22. Although most cases of the SD22q11 are sporadic (because of new mutations), patients with this deletion have a 50% chance of passing it onto their offspring. The clinical features of this syndrome are varied; the phenotype includes several types of otorhinolaryngeal alterations. These changes have been given several names given before the syndrome was described in the beginning of the 1990s, such as the DiGeorge syndrome, the velocardiofacial syndrome, and Shprintzen's syndrome. These names reflect the perception of different specialists about the same disease.It should be noted that in some cases these features may not be so evident, especially younger children, making it more difficult to raise the possibility of this syndromeAs has been reported in the literature,


Clinical, educational, and research interest in telerehabilitation has not been widely explored until the COVID-19 pandemic. Amid the enduring pandemic, telerehabilitation remains part of the daily service, academic, and research responsibilities of residents in various training institutions worldwide.To determine the Rehabilitation Medicine residents' current levels of telerehabilitation readiness, knowledge, and acceptance, their pattern of beliefs about telerehabilitation, and the factors affecting their readiness.All bona fide residents from all training institutions in the Philippines were invited to participate in an online survey evaluating the following constructs: technological readiness ; telerehabilitation knowledge ; and telerehabilitation acceptance (using the Unified Theory of Acceptance and Use of Technology questionnaire). A pre-test and pilot test were conducted. The TRI responses were classified according to technology adoption segments to determine the respondents' pattern of beliefs about telerehabilitation.p < 0.05).Sixty-two residents participated (86.1% response rate). They had good telerehabilitation readiness (3.3 ± 0.4 out of 5), fair telerehabilitation knowledge (2.1 ± 1.1 out of 5), and excellent telerehabilitation acceptance (4.5 ± 0.6 out of 5). The majority were classified either as telerehabilitation skeptics (38.7%), pioneers (19.4%), or explorers (19.4%). The factors that significantly influenced telerehabilitation readiness were optimism, innovativeness, discomfort, and insecurity (Despite having favorable levels of telerehabilitation readiness and acceptance, the Rehabilitation Medicine residents showed fair telerehabilitation knowledge. Our results suggest the need for formal education and training on virtual rehabilitation care during residency. Telerehabilitation, a branch of telemedicine, is an emerging method of delivering rehabilitation services through information and communications technology to connect patients and clinicians and minimize the barriers of distance, time, and cost . SpecifiWith the rise of new technologies and “overcoming of the initial skepticism to which every new technology is subjected” , there hOne way to prepare for a telerehabilitation program is to understand the readiness of potential target-users  for the technology . The uptHence, the present study aimed to determine the Rehabilitation Medicine residents' baseline levels of telerehabilitation readiness, knowledge, and acceptance, their pattern of beliefs about telerehabilitation, and the factors affecting their readiness for telerehabilitation. The results of our study may serve as basis for program development or evaluation and capacity-building interventions related to improving telerehabilitation-related teaching and learning programs, research, and service delivery.This study is founded on well-established concepts embedded in the Technology Readiness Index (TRI) version 2.0 questionnaire  and the st-3rd year and chief residents) training in all of the six Rehabilitation Medicine residency programs in the Philippines during the period of data collection (September to November 2020). Based on the census of residents  recognized by the PBRM, the sample size was computed at 62 with 0.05 margin of error. The eligibility criteria included access to stable Wi-Fi broadband and ability to provide full voluntary informed consent.This was a cross-sectional study approved by the institutional research board and the Philippine Board of Rehabilitation Medicine (PBRM). We employed total enumeration of all bona fide residents across all year levels  the 16-item TRI version 2.0 to evaluate technology readiness; (2) an original 5-item multiple-choice test to evaluate telerehabilitation knowledge; and (3) the 31-item UTAUT questionnaire to evaluate telerehabilitation acceptance.The validity and reliability of the survey were established through a pre-test. In addition, a pilot test involving 12 residents randomly selected from different training institutions was conducted prior to data collection to obtain feedback on how the wording of the survey and study implementation could be improved. During the actual data collection, respondents were given up to 3 months to complete the survey at their most convenient time. All data gathered remained anonymous and confidential. Descriptive  and inferential statistics  were used to analyze the results with 95% confidence interval.The modified version of the TRI, also known as the Abbreviated Technology Readiness Index by Parasuraman and Colby, is a valid and reliable tool  that measures overall technological readiness . PermissThree professors in the study institution, who are considered early adopters of the technology and have delivered local and international talks on telerehabilitation, convened to come up with 5 original multiple-choice questions to evaluate the residents' basic telerehabilitation knowledge. They considered the questions as must-knows in providing a quality telerehabilitation service. The questions were subjected to a pre-test and modified accordingly to achieve an acceptable Cronbach's alpha of at least 0.70. To ensure understandability of the questions, a pilot test was also done. Each correct answer was given 1 point, and the sum of scores was computed for each respondent and interpreted as follows: 1.00−1.80 = poor, 1.81−2.60 = fair, 2.61−3.40 = good, 3.41−4.20 = very good, 4.21−5.00 = excellent telerehabilitation knowledge.Telerehabilitation acceptance was evaluated using the validated 31-item UTAUT questionnaire, which consists of the following constructs: performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), attitude (AT), anxiety (AX), self-efficacy (SE), and behavioral intention (BI) to use the technology –18. EachLastly, to determine the factors that influenced the respondents' readiness for telerehabilitation, the mean TRI scores were used. Since data indicating telerehabilitation readiness were in ratio-continuous form, linear regression was done. Tests of assumption  were performed beforehand to ensure that the regression model test statistics were applicable. Wherever data were not suitable for such tests, non-parametric test statistics were conducted.A total of 62 out of 72 residents participated (86.1% response rate). The demographic characteristics of the respondents are presented in n = 24, 38.7%), followed by pioneers , explorers , hesitators , and avoiders .The overall TRI score of the respondents was 3.3 ± 0.4 out of 5, interpreted as good telerehabilitation readiness. The TR dimension with the highest mean score was optimism, while the one with the lowest score was discomfort . Based oThe respondents had a mean telerehabilitation knowledge score of 2.1 ± 1.1 out of 5, interpreted as fair. Each item was correctly answered by <50% of the respondents, except for item number 2 in which almost 60% correctly identified the principles of informed consent . On the The overall UTAUT score of the respondents was 4.5 ± 0.6 out of 5, interpreted as excellent telerehabilitation acceptance. The UTAUT constructs with the highest mean scores were: (1) behavioral intention (4.9 ± 0.9); (2) self-efficacy (4.7 ± 0.8); and (3) facilitating conditions (4.6 ± 0.8) .p < 0.05], with an R2 of 1.000. On the other hand, the rest of the variables  did not reach statistical significance (p > 0.05).Based on linear regression, the following factors showed significant associations with telerehabilitation readiness: optimism, innovativeness, discomfort, and insecurity [F  = 0.000, p < 0.05), while telerehabilitation knowledge and UTAUT scores were not found to be statistically associated with readiness.Our study showed that the Rehabilitation Medicine residents in the Philippines have good telerehabilitation readiness, fair telerehabilitation knowledge, and excellent telerehabilitation acceptance. Although the majority were classified as telerehabilitation skeptics (38.7%), combining telerehabilitation explorers (19.4%) and pioneers (19.4%), the two highest levels of technology adopters, comprised an almost equal percentage (38.8%). The factors that significantly influenced telerehabilitation readiness were the respondents' optimism, innovativeness, discomfort, and insecurity , would have adapted to the sudden shift to virtual care and training, evidenced by their favorable telerehabilitation readiness and acceptance. However, their theoretical knowledge of telerehabilitation neither seemed adequate nor congruent with their readiness and acceptance.It is established that many factors like knowledge, skills, attitude, and working environment contribute to the success of any new technology or its adoption . TelerehTraditionally, telehealth or telemedicine, let alone telerehabilitation, was not included in the curriculum of most, if not all, premedical, medical, and/or residency training programs in the Philippines , 20. In Our study showed that almost half of the respondents did not have any telerehabilitation experience at the time of data collection. With the intermittent suspensions of outpatient rehabilitation services in Metro Manila and the prevailing apprehension of patients about in-person consultations and therapy sessions because of the unpredictable COVID-19 situation, the Rehabilitation Medicine residents encounter a significant decline of cases and, therefore, learning opportunities . Hence, Research interest in telerehabilitation has not been widely explored around the world until recently . ConsideOur study focused only on the current Rehabilitation Medicine residents. However, there are many other stakeholders that have to be evaluated as well, such as the patients and primary caregivers, consultant physiatrists, administrative staff, therapists, nurses, rural clinicians, and medical students. They could be potential targets of future research in order to determine their telerehabilitation perceptions. Exploratory qualitative studies about factors that could affect their telerehabilitation readiness, knowledge, and acceptance are recommended. Nonetheless to our knowledge, our study was the first in local and international literature to provide baseline data on the perceptions of physiatrists in-training regarding telerehabilitation. The design of our study and data may serve as benchmark for potential research on telerehabilitation education and training in the future.The Rehabilitation Medicine residents in the Philippines had mixed levels of telerehabilitation adoption, which ranged from being skeptics to pioneers and explorers. Although it seemed that despite their relatively low telerehabilitation knowledge and high telerehabilitation acceptance, their optimism and innovativeness seemed to be significant facilitators of telerehabilitation readiness. A call to action is warranted for incorporating telerehabilitation in the curriculum of Rehabilitation Medicine residency training to ensure quality of virtual care.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.This study was reviewed and approved by the University of the Philippines Manila-Research Ethics Board (UPM-REB). The participants provided their voluntary informed consent to participate in the study.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This study is a recipient of the Residents' Research Grant given by the Expanded Hospital Research Office of the Philippine General Hospital, University of the Philippines Manila.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The nearly dormant field of persistent luminescence has gained fresh impetus after the discovery of strontium aluminate persistent luminescence phosphor in 1996. Several efforts have been put in to prepare efficient, long decay, persistent luminescent materials which can be used for different applications. The most explored among all are the materials which emit in the visible wavelength region, 400–650 nm, of the electromagnetic spectrum. However, since 2014, the wavelength range is extended further above 650 nm for biological applications due to easily distinguishable signal between luminescent probe and the auto-fluorescence. Recently, UV-emitting persistent materials have gained interest among researchers’ due to their possible application in information storage, phototherapy and photocatalysis. In the present review, we summarize these recent developments on the UV-emitting persistent luminescent materials to motivate young minds working in the field of luminescent materials. Luminescence or the emission of light is an old phenomenon. The first report of light emission from fireflies and glowworms can be dated back to the period, 1500–1000 B.C., in the Indian holy scriptures “Vedas” and also in Chinese Book of Odes (the Shih Ching). The word for “glowworm” in sanskrit language is “Khadyota” ,3,4. TheThe beginning of modern era can be dated back to the discovery of man-made ZnS:Cu,Co material by Hoogenstraaten and Klasens in the year 1953 . Howeverscovered . Matsuzah 520 nm . Upon seh 520 nm ,11,12. Th 520 nm . Among on et al. . These mn et al. . Hereaftn et al. ,16.As shown in Trap depth: The trap (defect) depth within the host lattice is the first and foremost important parameter for a good PersL material. When the trap depth energies are between 0.5–0.6 eV, the material can be effectively charged (trapping) and discharged (detrapping) at room temperature. In fact, instead of intentional defects (0.5–0.6 eV), materials containing unintended defects with trap depth between 1.0–2.0 eV can be utilized for de-trapping under the influence of thermal or optical energy addressed as thermoluminescence (TL) and optically stimulated luminescence (OSL) respectively. The more details on these aspects can be found in Refs. [in Refs. ,22.Minimum light output: PersL is the light output that is observed when an initial excitation is seized. Hence, the two important parameters that prevail after such seizure of excitation energy are: (a) light output, and (b) its duration. Usually in most of the materials, the light intensity decreases by almost 90 % of the initial value in the initial few minutes limiting their commercial aspects. However, a good PersL material is the one in which the duration below which the photopic intensity decreases to an eye perceivable intensity value of 0.32 mcd/mFrequency factor (s): When the charges are detrapped from defects at room temperature, there exists a competition between re-trapping and detrapping processes leading to the delay in phosphorescence. The charges once trapped are released very slowly from traps at room temperature delaying the overall recombination process at the luminescence center. Due to this competition between the trapping–detrapping–retrapping processes, multi-exponential or hyperbolic decay curve is obtained. The frequency factor (s) is an important parameter and its value depends upon the competition between these different processes. The typical value of ‘s’ is between 101014 s−1 . HoweverThe type (nature) of defect, their number and energetics within the host band gap are important for a good PersL material. One can engineer new materials by modulating the host bandgap itself or by changing the defect scenario in the host lattice. The PersL materials are expected to possess following important parameters to get required emission color, efficiency and the long lasting luminance:Overall, the key engineering aspect to prepare new/existing PersL materials is the creation of luminescence centers intentionally having a trap depth between energies, 0.5–0.6 eV, which can be effectively charged and/or discharged at the room temperature.New PersL materials are researched frequently leading to important ideas and innovative applications. In these developments, materials chemistry plays an important role . For exaSolid-State synthesis: The synthesis method is one of the widely used technique to prepare PersL materials. For example, AO- and Bompounds ,24. SuchNon-conventional techniques for the synthesis of PersL materials are defined as those techniques which do not comprise steps such as continuous grinding and/or heating at elevated temperatures. These techniques are also called wet-chemical routes. Some of these routes are:Sol-gel synthesis method comprises of atleast six different steps which includes hydrolysis, polymerization, gelation, drying, dehydration and densification. The product formed in sol-gel method is uniform and possesses better control over the crystallite size, dimensions, shape and morphology of the final product. The method involves both the physical and chemical processes. The process can prepare different oxide-based host matrices with ease. The synthesis of PersL materials, CdSiO3 , Sr2SiO43 [2SiO4 , Y3Al5O1[3Al5O12 , and LaAl5O12 [3 , are notThe method involves primarily two important hydrolysis and condensation reactions and the final output depends on the nature of precursor, solvents, reaction temperature and pH of the sol. In literature, from the synthesis point-of-view, Lue3+,Cr3+ , Gd3Al5−e3+,Pr3+ , CaAl2O4 [2O4:Yb , Sr2MgSiu3+,Dy3+ , SrAl2O4nO3:Pr3+ , Y2O3:Dyd3+/Sm3+ , Li6CaLaO12:Eu3+ , are impSiO2)6O2 , Lu2SiO5iO5:Pr3+ , CaMgSi2r3+ [2O6 , could bCombustion method is another interesting technique to prepare nanoparticles of PersL materials. This technique was developed in late 1990s. In this method, the use of a fuel, either of urea, hydrazine or glycine, is preferred. Fuel plays crucial role in propagation of the reaction via layer by layer heat transfer. The final product in combustion synthesis is mostly powders while some other forms like foam and conglomerates are also reported in the literature. As the reaction in combustion synthesis is highly exothermic, the temperature during such heat release is ∼2500 K. The method is mostly used to prepare oxides and thus require water soluble precursors (mostly nitrates). The method was modified in later stages to use either heated wire, electric spark or laser beams to provide initial temperature for reaction to initiate. Once initiated, the reaction continues on its own due to the presence of fuel.The final product in this reaction is obtained within 5 min of the initiation of the reaction. Apart from the use of a fuel for reaction, there are two more important parameters that should be fulfilled: (a) the product to be formed should be refractory in nature, and (b) the solution prepared from precursors should be well dispersed and should possess high chemical energy so that the combustion reaction can initiate. The reaction is initiated at temperature ∼500 K in an appropriate atmosphere which is mostly dominant by oxygen gas  to promote exothermic reaction. Combustion synthesis is characterized by several benefits such as the low reaction duration, low desired initial temperature for reaction initiation, quick synthesis and high final product yield. Moreover, in this method, there is no need for high temperature furnaces as is the case with solid-state synthesis method. Some of the interesting articles in this domain are Refs. ,40,41.The method is another important non-conventional method to prepare nanoparticles of PersL materials. The method is even capable of preparing nanomaterials which are unstable at high temperatures. The solution of either oxides, hydrides, or metal powders is prepared in the suspension form for an initiation of the reaction. The important parameters, temperature (around 573 K) and pressure (around 100 MPa), are controlled to control the shape and size of the final product (nanoparticles). The reaction starts with a nucleation step followed by the growth under controlled conditions of temperature and pressure. All the type of final products, oxides, metal nanoparticles and non-oxides can be prepared using hydrothermal method. The relevant synthesis process to prepare PersL materials can be obtained from Refs. ,43,44.The co-precipitation is a non-conventional method of preparing PersL materials. The main achievement of this synthesis type is that there is a better control over size of the nanoparticles via control over pH, temperature and concentration of the reactants. The nanoparticles prepared are homogeneous and no agglomeration is obtained for the final product. This method has been applied to synthesize variety of PersL materials, for example SrEu2+Dy3+ . The metEu2+Dy3+ , and othEu2+Dy3+ ,48.Marcilly and coworkers developed this technique in the year 1970 . The pH The above mentioned conventional and non-conventional synthesis procedures show great potential to prepare nanoparticles with reasonable control of the as-prepared PersL materials ,54.The most promising application of PersL materials is in bio–imaging as discussed by Maldiney et al. in the year 2014 . Thus, rThe rays coming from the sun are another important source of UV-radiations especially that of UV-A and UV-B radiations. The amount of UV radiations received on earth from the sun vary from altitude, weather, season of the year, time of the day and latitude. These UV-radiations cause pigmentation or tanning in humans. UV-A and UV-B induces tanning in the basal cell layer and upper layers of the epidermis, respectively ,59. The Almost 95% of the emitted UV-radiations from the sun contain UV-A radiations in the wavelength region 315–400 nm. These radiations are capable of affecting the top layer of skin and can cause premature ageing, wrinkles and some skin cancers. There are two important components to consider while thinking about the existing or new UV-emitting PersL materials: (a) the choice of the host lattice, and/or (b) the choice of the dopant ions. The prominent hosts used by materials scientists to prepare PersL materials are garnets, silicates, phosphates and perovskites, as has been summarized recently by Wang and Mao . On the and Tb3+ ,64.2+, 3+ or 4+, with respective loss of 6sWhile Pbm 1 → 14 . Due to Among different 14 lanthanoids, the most promising is Ceorbitals . The 4f1nsitions ,69,70,71ver 10 h ,73.Apart from CeThe UV-emitting PersL materials are promising for diverse applications as discussed in previous sections. The literature published on PersL materials emitting in the three different UV domains, UV-A, UV-B, and UV-C, is compiled in From the data, three different rare earth–based dopant ions, CeA region , while lor 300 h  The excior 300 h ,22 and tor 300 h . In the or 300 h .The mechanism of charge trapping and detrapping is simple, yet complicated. In general, when a sample is excited using an appropriate excitation energy, the electrons move from valence band to the conduction band followed by their trapping at the defect sites. These charges upon trapping require some external stimulation such as heat or optical energy, to get out from such defects. There can be two different ways of charge trapping: (a) one related to electrons (electron trapping), and (b) related to holes (hole trapping), as shown in MAlM = Ca and Sr) material, as shown in Among the most studied mechanisms of charge recombination (which produces luminescence) is delocalized mechanism. Matsuzawa was the first person to explain the mechanism in After the initial work of Matsuzawa, further work in this direction was perfomed by Aitasalo in the year 2003 . In Aitaperature ,104. In observed . Both DoA and B ions in the spinel structure Step 1: the excitation of the CrStep 2: the excitation is dissociated by the local electric field into an electron and a hole.Step 3: The excitation is thus trapped in the vicinity of CrStep 4: the reverse reaction  or for only few, is still unknown. The pathways to solve such issues require immediate attention of the scientific community. Another area of immense interest for researchers’ working on PersL, is to prepare good, efficient phosphors for security and surveillance purposes.The recent developments on PersL materials especially those emitting UV radiation have found applications in photodynamic therapy, information storage, anticounterfeiting, photocatalysis, etc. To prepare UV-emitting materials, which can be divided into UV-A, UV-B and UV-C regions, one needs to follow smart techniques  rather than physical efforts. While VRBE gives us information about the exact location of rare earth ions in individual hosts, the options to prepare UV-emitting materials is limited as the transitions in lanthanoids are restricted because of their f–f nature (for Ln


Objective To investigate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in university students, the factors associated with PMS, the most prevalent symptoms, and the interference of symptoms in academic, family, social, and work activities.Methods This cross-sectional study included 1,115 university students aged ≥ 18 years from the University of Rio Verde, Goiás. Premenstrual syndrome and PMDD were identified using the Premenstrual Symptoms Screening Tool. Associations with sociodemographic, behavioral, reproductive, nutritional, and health factors were investigated using the Poisson regression.Results The prevalence of PMS was 46.9% , and of PMDD, 11.1% (95% CI 9.3–13.0). The most prevalent symptoms were physical, such as breast tenderness, bloating, e weight gain (73%); followed by psychological ones such as overeating/food cravings, tearful/more sensitive to rejection (> 60%). More than 30% of the patients reported that the symptoms interfered in a moderate-to-severe way in their social and academic activities. After adjusted analysis, PMS was more prevalent in those who were attending the 1st/2ndsemester of college , those who consumed alcohol in the last 30 days , and those who had depression .Conclusion Almost half of the university students had PMS and ∼ 11%, PMDD. Physical symptoms were the most common and interfered in a moderate-to-severe way in various aspects of life. Attending the first semesters, consuming alcohol, and having depression were risk factors for PMS. The identification of risk factors for PMS is essential to prevent symptoms and reduce the impact of the syndrome. Premenstrual syndrome (PMS) is characterized by a set of physical and psychological symptoms, which start 1 to 2 weeks before menstruation, subside with the onset of menstrual flow, and are cyclical and recurrent. In addition to premenstrual tension, PMS can be severe enough to impact some aspects of a woman's life.The etiology of PMS remains unknown, but the source of symptoms is associated with the susceptibility of some women to normal hormonal changes that occur during the menstrual cycle. Premenstrual symptoms often improve with the use of ovulation inhibitors during pregnancy and after menopause, which provides strong evidence of their relationship with cyclic ovarian function. In addition, the stabilization of neurotransmitters, such as serotonin, and changes in the effect of gamma-aminobutyric acid (GABA) through the use of antidepressant or anxiolytic drugs can improve the symptoms of PMS. Therefore, it appears that these neurotransmitters play an important role in the development of premenstrual symptoms.The main symptoms observed in women with PMS are increased breast size and sensitivity, swelling, weight gain, headache, acne, anxiety, irritability, depression, mood swings, and changes in appetite. The intensity of symptoms varies among women. Many women have mild symptoms in their reproductive years, such as breast engorgement and edema, but do not perceive these symptoms as distressing or debilitating. However, other women may have intense and disabling symptoms, which may lead to the more severe form of PMS, that is, premenstrual dysphoric disorder (PMDD),Confirming the diagnosis of PMS is important to differentiate it from other diseases, determine its prevalence, and define an effective treatment.In the available literature, variations in prevalence can be found. A review study found that the prevalence of physiological premenstrual symptoms varied between 50 and 85% , PMS varied between 30 and 40%, and PMDD varied between 3 and 8%. The absence of diagnostic consensus, differences in the interpretation of symptoms to define PMS, and the different populations investigated justify, at least in part, the inconsistencies in the prevalence of PMS between the studies of the review.Some sociodemographic, reproductive, and behavioral characteristics are associated with the occurrence of PMS. Studies have shown that the prevalence of premenstrual symptoms is high in younger, black, and obese women; those with unhealthy eating habits; those who consume alcohol; and those who smoke.Regarding the impact of PMS symptoms, the literature shows that it can be severe enough to interfere with the relationships and daily activities of women of reproductive age.Therefore, the present study aimed to investigate the prevalence of PMS and PMDD in university students, the factors associated with PMS, the most prevalent symptoms, and the interference of symptoms in academic, family, social, and work activities.This was a cross-sectional university-based study performed with students of courses in the area of health from a university in the Midwest Brazil. The study is part of a larger project that evaluated the epidemiological profile of university students in the health field at Universidade de Rio Verde, Goiás, in 2018. The larger study included all university students (men and women) aged ≥ 18 years, from the courses of nursing, dentistry, medicine, physiotherapy, pharmacy, and physical education, from three campuses, who were attending the university from November 2018 and who agreed to participate in the research. The present study included female university students aged ≥ 18 years. University students who did not menstruate  and those with irregular menstrual cycles  were excluded because the instrument used to measure PMS has not been validated for this population.To achieve the objectives of this study, the sample size was calculated adopting 40% prevalence for PMS and 16% for PMDD, with a margin of error of 3 percentage points, and a 95% confidence level,The fieldwork was performed by a trained field team, who approached the students on campuses. After receiving explanation of the nature of the study and having granted informed consent, the participants filled out a standardized, self-administered, and pretested questionnaire in a pilot study.nddomain consists of 5 items that assess the functional impact of premenstrual symptoms. Each item is classified according to severity as “absent,” “mild,” “moderate,” or “severe.” The symptoms included were as follows: 1) anger/irritability, 2) anxiety/tension, 3) tearful/sensitive to rejection, 4) depressed/hopeless mood, 5) lack of interest in activities at work, 6) lack of interest in homework, 7) lack of interest in social activities, 8) difficulty concentrating, 9) fatigue/lack of energy, 10) overeating/food cravings, 11) insomnia, 12) hypersomnia (too much sleep), 13) feeling overwhelmed or out of control, and 14) physical symptoms . The second domain included the impact of these symptoms on A) work/college efficiency or productivity, B) relationships with coworkers/colleagues, C) relationships with family, D) social life activities, and E) home responsibilities. In items A and B, the words “college” and “colleagues” were added to suit the reality of the population studied. To confirm the presence of PMS, the following criteria were established: the presence of 1) at least 5 symptoms (1–14), rated as moderate or severe; 2) at least 1 of the first 4 symptoms (1–4), rated as moderate or severe, and 3) at least 1 item from A to E, rated as moderate or severe. For PMDD, the following criteria were established: the presence of 1) at least 5 symptoms (1–14) rated as moderate or severe, 2) at least 1 of the first 4 symptoms (1–4) rated as severe, 3) and at least 1 item from A to E, rated as severe.The study outcome was the prevalence of PMS and PMDD, measured by the Premenstrual Symptoms Screening Tool (PSST), which was validated for the Brazilian population.st–2nd, 3rd–4th, 5th–6th, 7th–8th, or ≥ 9th), and economic class .2]) and classified as normal weight (BMI < 25 kg/m2), overweight (BMI ≥ 25 kg/m2and < 30 kg/m2), and obesity (BMI ≥ 30 kg/m2).The sociodemographic characteristics assessed were age , self-reported skin color (white or non-white), course period  was used to describe the study population, the premenstrual symptoms investigated in the two PSST domains, and to calculate the prevalence of PMS and PMDD. The hierarchical approachThis study was approved by the Research Ethics Committee at Universidade do Vale do Rio dos Sinos (UNISINOS), Protocol 2.892.764, which hosted the study's coordination, and Universidade de Rio Verde, Protocol 2.905.704, which hosted the study's data collection, in accordance with the National Health Council Resolution 466/12. All participants signed a consent form, guaranteeing confidentiality of information and the right to withdraw participation at any time.rd/4thsemester of college, and economic class B. Regarding behavioral characteristics, 62.7% were physically active, less than half had healthy eating habits (43.9%), more than 90% did not smoke, and 74% had consumed alcohol in the last 30 days. About two-thirds of the group used hormonal contraceptives, and more than 70% had menarche at age ≥ 12 years. Approximately 15% had BMI > 25 kg/m2, 7.9% had hypothyroidism or hyperthyroidism, and 20.6% were diagnosed with depression , white skin color, attending the 3ression .The prevalences of PMS and PMDD were 46.9%  and 11.1% , respectively, according to the PSST criteria. The physical symptoms  were present in 73% of university students, and the most prevalent psychological symptoms were overeating/food cravings, tearfulness/sensitivity to rejection, anxiety/tension, and anger/irritability; in more than 60% of the cases in moderate or severe way. In more than 30%, these symptoms interfered with their efficiency and productivity at work/college, relationships with colleagues, family relationships, activities, and social life, in moderate-to-severe ways. Difficulty concentrating and feeling under pressure or severely out of control were reported by ∼ 8.5% and 8.4% of the students, respectively .stand 2ndcourse periods (54.6%), had unhealthy eating habits (49.6%), were smokers (62.2%), and who consumed alcohol in the last month (49.4%). It was also prevalent in those who used one or more hormonal contraception methods  and in those with depression (65%)  .After adjusting for confounding factors, being in the first periods of the academic course , alcohol consumption , and medical diagnosis of depression  remained associated with PMS. . The usThe present study found a high and consistent prevalence of PMS among university students in the health field. The main complaints reported were physical  and psychological symptoms . These symptoms interfered in moderate-to-severe ways in the academic, family, and social activities of this population. After adjustment, the highest PMS probability occurred for university students who were attending the first periods of the course, who had consumed alcoholic beverages in the last 30 days, and who were diagnosed with depression.The prevalence of PMS (46.9%) identified in the present study is consistent with that in the literature. One systematic review identified a combined prevalence of PMS of 47.8% ,In relation to symptoms, the most prevalent ones found in this study were physical symptoms , followed by desire for overeating/food cravings, tearfulness/sensitivity to rejection, anxiety/tension, and anger/irritability, which is consistent with the literature. A prospective, observational study involving 60 university students from Centro Universitário São Camilo, in São Paulo, with a mean age of 24.6 ± 4.7 years, identified the following main symptoms of PMS: irritability (76.6%), swelling (65%), and anxiety 58.3%).%.3dataUpon analyzing the associated factors, a high prevalence of PMS was found among university students in the initial periods of the course compared with those attending the final semesters. The association between lower educational levels and PMS has been described previously. In a population study performed in the United Kingdom, an inverse linear association was found in which the lowest level of education was associated with a high occurrence of PMS.In relation to behavioral variables, an association was also found between alcohol consumption and PMS, which has already been evidenced. In a systematic review, 19 studies were evaluated, and it was found that alcohol consumption was associated with a 50% increase in the likelihood of developing PMS .Regarding the morbidities assessed, depression was associated with PMS after adjusting for possible confounding factors. This finding is consistent with another study that shows that university students with depressive symptoms are more likely to have symptoms of PMS and its most severe form, PMDD, which has already been classified as a depressive disorder.Contrary to what would be expected in relation to the use of hormonal contraceptive, there was no dose-response effect between the categories of this variable and PMS, through adequate statistical test. However, it was observed that women who reported using 2 or more hormonal contraceptives showed 22% more probability of having PMS than those who did not, even after adjustment for confounding factors. As there is no knowledge of a medical recommendation for the use of an overlap of hormonal contraceptive methods, a possible explanation for the association found for this category would be that women who present premenstrual symptoms replace hormonal methods more frequently during life, in search of a pharmacotherapy that fulfills the contraceptive function and reduces the premenstrual symptoms. Thus, it cannot be said that the use of a combination of hormonal contraceptives occurred, but that the woman experienced the use of more than one hormonal method.p-value. Smoking was associated with PMS only in the crude analysis, probably because of the low prevalence of university smokers (4%), which gave little power to this analysis.In the present study, no association was found between smoking, eating habits, physical activity, and PMS, which was also demonstrated by other authors.One of the main limitations of this study was its cross-sectional design since the association between PMS and some associated factors, such as depression, may have been affected by reverse causality as exposure and outcome were measured at the same time. Another limitation was the use of an instrument with retrospective information. There is evidence that data collected prospectively show a prevalence different from that of data obtained retrospectively.This study has several strengths. First, this is one of the few Brazilian studies that, in addition to determining the prevalence of PMS and PMDD in a population of young university students, evaluated the association of PMS with sociodemographic, reproductive, behavioral, nutritional, and health variables. Thus, this study expands the knowledge on PMS and the associated factors in Brazilian university students. Second, the significant sample size added power to the investigated associations. Third, the rigorous application of the methodology, using a validated instrument for the diagnosis of PMS, and controlling possible confounding factors, made it possible to analyze the independent effects of the variables.In conclusion, the study identified that almost half of the university students had PMS, and ∼ 11% had PMDD. Physical symptoms were more prevalent than psychological ones. These symptoms interfered in a moderate-to-severe manner in their social and academic activities. The university students who were at the beginning of the course, who consumed alcohol as well as those who had a diagnosis of depression had a higher prevalence of premenstrual symptoms; therefore, this population should be better monitored. The identification of risk factors for PMS is essential to prevent symptoms and reduce the impact of the syndrome. However, longitudinal studies are necessary to better elucidate the associations described here.


The overuse of antibiotics in food animals has led to the development of bacterial resistance and the widespread of resistant bacteria in the world. Antibiotic-resistant bacteria (ARB) and antibiotic-resistant genes (ARGs) in food animals are currently considered emerging contaminants, which are a serious threat to public health globally. The current situation of ARB and ARGs from food animal farms, manure, and the wastewater was firstly covered in this review. Potential risks to public health were also highlighted, as well as strategies  to fight against bacterial resistance. This review can provide an avenue for further research, development, and application of novel antibacterial agents to reduce the adverse effects of antibiotic resistance in food animal farms. Meanwhile, these shared ARGs between animals and humans confer resistance to bla, aac, tet, chloramphenicol, MLSB, and sul; humans shared more ARGs with the chicken than other animals (such as pigs and cattle) from different countries  and ARGs can be transferred to humans by direct contact with animals, exposure to animal feces or wastewater, and consumption of contaminated animal food products  in farm bioaerosols are up to 2.3∼10.6 log copies/m3  were dispersed from the animal farms to a distance of 10 km. Multidrug-resistant (MDR) bacteria  and ARGs were transferred to workers and residents in the surrounding environment via inhalation, thus, posing the risk of diseases  in pigs and chickens than that in cattle (5.2∼30.4%); bacterial resistance to van and tigecycline was absent or low; other strains of E. hirae, E. durans, and E. caaeliflavus had no or low resistance to daptomycin, linezolid, tigecycline, and vancomycin. This pan-European Union survey indicated that bacterial clinical resistance to critically important antibiotics commonly used in human medicine was absent or low, except for erythromycin , macrolides, fluoroquinolones, and trimethoprim mainly originated from oral and injection. Moreover, the daily excretion of antibiotics was 1.47∼48.3 mg/d per pig, which is associated with the growth stage of pigs, and chlortetracycline and bacitracin are major contributors. However, simple waste treatments such as anaerobic digesters or lagoons did not effectively remove antibiotics  are a reservoir of zoonotic pathogens and ARGs from feces, which may cause a high incidence of respiratory infections in pig farmers . MeanwhiPenaeus vannamei by PCR; 62 different ARGs, which were classified into 21 types , were identified in the shrimp gut by the plasmid metagenomic method. These ARGs are from Vibrio (accounted for 2.8∼51%) and Aeromonas (16∼55%) plasmids; especially Vibrio may be major bacterial pathogens in shrimp. Notably, the plasmid metagenomic focusing on the mobile genetic elements (MGEs) may have great potential to identify ARGs in complex environments  by the PCR method , and tetM (12.7%) and ermB (1.8%), respectively. It is favorable to improve the knowledge of the diseases infected with Streptococcus sp. and to efficiently prevent and control these pathogens in tilapia farming worldwide  used in the animals are not absorbed by them and are excreted from their bodies . A totalaac, macrolides, fluoroquinolones, tetracvclines, sulfonamides, phenicols, and glycopeptides, respectively,  and two fosfomycin-resistant genes (such as fosA-like1 and fosA-like2). These novel ARGs were related to either hydrolyzation of both penicillins and cephalosporins or MGEs. Noticeably, the MICs of E. coli carrying fosA-like genes increased by 128-fold, indicating a key resistome reservoir in duck farms and posing a high spread risk  markedly increased. Additionally, chlortetracycline residues and ARGs abundance in feces and manure gradually decreased with fermentation time, and aerobic composting more potently reduced ARGs abundance (by 84.4%) than anaerobic digestion (79.4%), indicating that fermentation could remove most of the antibiotic residues. The results suggest that although chlortetracycline can reduce the diversity of the gut microbiota in pigs and increase the abundance of ARGs in feces, fermentation may be a common effective method of waste recycling  in swine manure wastewater by using the qPCR method. Nearly all tested ARGs were found in sow, nursery, and finisher farms; the highest levels of tetracycline- and macrolide-resistant tetA and ermF genes were approximately 109 and 6 × 108 GU/100 mL in nursery farm lagoon effluent. Other ARGs, including ermA, tetB, and intI, ranged from 106 to 107 GU/100 mL. However, finisher farms had less diversity of microbes and fewer ARGs than others, which may be related to the continuous application of antibiotics in feed. Noticeably, it was found to reduce the methicillin-resistant mecA gene as the pigs aged. This result implied that microbial populations and ARGs in swine farm wastewater may be influenced by farm management systems , and β-lactam, sulfonamide, and tetracycline resistance genes ; both sul1and sul2 genes were the most abundant and the most detected ARGs. Contamination sources mainly originated from pigs and anthropogenic activities, and animal farming wastewaters did not exclusively lead to antibiotic resistance profiles. This serves as a very valuable tool to evaluate antibiotic resistance contaminants in aquatic ecosystems  mainly confer resistance to rifampin, trimethoprim, aminocoumarin, lipopeptide, fluoroquinolone, and pyrazinamide. Acidovorax and Prymnesiovirus are the dominant hosts of ARGs. Noticeably, bacteriophages, as a reservoir of ARGs, are also involved in the dissemination of ARGs  and ARGs , which may be related to direct contact with animals. The resistant genes-blaCTX–M–15 (48.5∼64.3%), blaCTX–M–14 (7.1∼18.2%), and blaDHA–1 (12.1%) were the most prevalent ESBL ones in workers. Additionally, 17.4% of household members had ESBL-producing E. coli and K. pneumonia and 13% of members carried the same ESBL gene as workers. The data indicated that direct or indirect contact with animals is a potential source of ARB and ARGs - and AmpC β-lactamase (AmpC)-producing and ARGs .E. coli can be transferred from broilers to farmers. The result showed that the prevalence of ESBL- and AmpC-producing E. coli among people on farms was up to 14.3∼27.1% after contact with infectious live broilers, higher than those among partners and family members who are not living on farms (11.4∼15.7%). This result was consistent with that of previous studies, in which direct contact with broilers may have a high risk for ESBL- and AmpC-producing E. coli among humans (S. aureus (MRSA) and AmpC-producing E. coli among broilers at different ages and workers. No MRSA isolates were found in broilers and workers; the prevalence of ESBL- and AmpC-producing E. coli in farms was 87.5 (34 day-age) and 100% (68 day-age), higher than that of workers (18.5%). Meanwhile, both blaCTX–M–1 and blaCMY–2 resistant genes were detected in broilers and workers, which may be associated with contact with live animals. This result stated that direct contact with animals is a high-risk factor for the carriage of ARB and ARGs  and 33 virulence factors. Moreover, the mcr-1 gene was transferred from the calf to the farmer, posing the risk of a farm as a reservoir of ARB with zoonotic potential , and the transposon IS613 had the highest abundance of 4.9 log copies/m3. Additionally, the wind speed and high temperature could increase the spread of ARGs in bioaerosols. Noticeably, fecal contribution to ARB in bioaerosols accounted for 59.4% in winter, higher than that in summer (19.9%). Horizontal gene transfer of ARGs in bioaerosol exhibited a higher possibility in winter (77.8%) than that in summer  was also observed than other antibiotics (28.9∼10.5%), including amoxicillin, ampicillin, levofloxacin, ciprofloxacin, and gentamicin, respectively, while both blaTEM and tetA genes occupied 44.7%. Additionally, tet and sul genes were closely related to disinfectant or heavy metal resistance genes . This result indicated that retail meat may be a reservoir for the transmission of antibiotic-resistant Salmonella  in healthy chickens. Among 926 E. coli isolates, there were 22 ExPEC ones (accounting for 2.4%), and most of them carried both blaCTX–M and fosA3 resistance genes, conferring resistance to β-lactam and fosfomycin, respectively. E. coli O78 was found to be the most predominant one of six serogroups, which commonly occurred in humans. It suggested that these ExPEC may be transmitted to humans by food supply , S. aureus (17.2%), S. hyicus (14.1%), S. intermedius (9.4%), and E. coli (9.4%) were major pathogens; E. coli isolates from both cows and goats were resistant to vancomycin, ceftriaxone, spectinomycin, and doxycycline, and they were intrinsically resistant to penicillin; S. aureus isolates from all animals were resistant to spectinomycin, penicillin G, and clindamycin, indicating a public health risk of infection with MDR bacteria due to regular consumption of raw milk  by π-stacking interactions, and approximately 80% of ARGs can be removed from water by GO. The removal efficacy of GO nanosheet for ARGs reduced by <40% after 5 regeneration cycles, indicating excellent stability and reusability of GO nanosheet. GO nanosheet may be a desirable candidate for the efficient treatment of ARGs in animal wastewater or other water  were detected in six livestock farms, indicating that resistance to tetracyclines, sulfonamide, and β-lactams is prevalent in the wastewater treatment of livestock farming. The highest levels of five ARGs were found in the anaerobic treatment tank and the lowest in the activated sludge unit and the effluents. The removal efficiency of these ARGs ranged from 33.30 to 97.56% in influx and efflux samples. It suggested that anaerobic treatment of livestock farming wastewater may reduce the dissemination of ARB (n of ARB .°C) was more efficient at reducing ARGs, MGEs, and their associated bacteria than that of conventional composting , indicating their different removal rates. This may be associated with the compost’s physico-chemical parameters, such as temperature, moisture, and the ratio of total organic carbon and Kjeldahl nitrogen. During composting, low moisture and pile turning frequency could inhibit further dissipation of antibiotics (Phanerochaete chrysosporium (p), Bacillus licheniformis (b), and Aspergillus niger (a), respectively. There were four composting piles of A (p:b:a = 1:0:0), B (control), D (p:b:a = 1:5:5), and G (p:b:a = 1:4:0), respectively. The best removal effect of tetracycline (93.7%) and oxytetracycline (87.8%) was found in composting pile D, higher than that in pile B ; the highest removal of doxycycline (98.6%) and enrofloxacin (89%) existed in pile A, higher than that in pile B . This result is superior to a previous study in which the removal rate of antibiotics ranged from 28.8 to 77.8%  from swine wastewater by using volcanic- and zeolite-medium system treatment. The qPCR results showed that antibiotic concentrations significantly decreased in two vertical flow constructed wetlands, and oxytetracycline HCl had the highest removal rate, superior to ciprofloxacin HCl and sulfamethazine. The absolute abundance of tetO, tetM, and tetW declined by 50%, as well as one order of magnitude in volcanic and zeolite systems. Meanwhile, the zeolite-medium system more efficiently eliminated antibiotics from wastewater than the volcanic-medium one, which may be related to different pH and average pore sizes of media. More antibiotics were adsorbed in the soil, higher than that in the media and vegetation. This implied that soil is responsible for antibiotic removal from wastewater in constructed wetlands, which can adsorb all almost antibiotics (>90%) from the aqueous phase  used in diverse environmental samples can be potentially applied for the degradation of antibiotics and ARGs in animal farms due to excellent stability and recyclability .Some effective or commercially viable alternatives have been implemented by animal farmers or are under development; various alternatives  to antibiotics are available to reduce antibiotic use in food animals in farms . Among tE. coli, MRSA, Shigella flexneri, and others  are considered effective and safe alternatives to antibiotics for animal production due to their high stability in vivo  existed in more than 11 bacterial species and it has been disseminated to over 40 countries , alternatives to antibiotics , and antibiotic administration to reduce ARB and ARGs in animal farms, which may help us address the issues of antibiotic resistance.CX helped to investigate, supervise, and wrote the manuscript. LK wrote the manuscript and prepared the figures. HG and XC helped to investigate and review the manuscript. XW conceptualized and wrote the manuscript. All authors read and approved the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


IgA vasculitis  is a vasculitis of small vessels involving multiple organs, particularly of the joints, gastrointestinal tract, skin, and kidneys. Growing laboratory evidence has shown that complement plays a key role in the pathogenesis of IgAV, although direct evidence of this association in patients is lacking. We report a child with IgAV associated with clinical features of hypertension, nephrotic range proteinuria, acute kidney injury, and low serum C3, with histopathologic findings on renal biopsy of membranoproliferative glomerulonephritis with C3 and IgA co-dominance, and extensive complement derangements. This case report suggests that complement modifies the pathogenesis of IgAV, and further investigation into complement-targeted therapy in cases of refractory IgAV may be beneficial. IgA vasculitis  is a vasculitis of small vessels involving multiple organs, particularly of the joints, gastrointestinal tract, skin, and kidneys. The diagnostic criteria for IgAV is the presence of palpable purpura with at least one of the following clinical features: abdominal pain, arthralgia/arthritis, renal involvement with glomerulonephritis; or skin biopsy of the purpuric lesion demonstrating leukocytoclastic vasculitis with predominant deposition of IgA. Renal involvement  occurs in 20 to 55% of patients within 3 months after the development of purpura, with 85% of nephritis cases presenting within the first month , 2. BiopIgA immune complexes are hypothesized to play a central role in the pathophysiology of IgAV. These immune complexes are formed following an antigenic exposure and deposit in small blood vessels including the glomerular capillaries and mesangium, resulting in recruitment of inflammatory cells. Aberrant glycosylation of IgA in the hinge region has been demonstrated in both IgAVN as well as IgA nephropathy , 7. The We report a child with IgAV associated with clinical features of hypertension, nephrotic range proteinuria, acute kidney injury, low serum C3, and normal serum C4, with histopathologic finding on renal biopsy of membranoproliferative glomerulonephritis with C3/IgA co-dominance by immunofluorescence, and extensive characterization of the complement system revealing activation of the alternative pathway, without clear activation of the terminal pathway. To our knowledge, there are few case reports of similar presentation in the literature , none ofA 5-year-old previously healthy Native American boy presented to a local emergency room with pruritic palpable rash in the lower and upper extremities, associated with abdominal pain and hand swelling. His family medical history was negative for autoimmune disease or renal disease. Blood pressure was 90/60 . Initial examination revealed a purpuric rash more prominent on the lower extremities than the upper extremities with mild tenderness to palpation of the abdomen. Laboratory values revealed a c-reactive protein (CRP) 30 mg/L, prothrombin time 11.4 s, international normalized ratio (INR) 1.1, partial thromboplastin time (PTT) 29 s, white blood cell count (WBC) 10,200/μL , hemoglobin 12.3 g/dL, platelet count 261,000/μL, blood urea nitrogen (BUN) 10 mg/dL, creatinine 0.29 mg/dL, albumin 2.9 g/dL, and normal liver enzymes. A skin biopsy was not undertaken, but based on the features of his clinical presentation, he was diagnosed with IgAV. The patient was discharged home and instructed to follow-up with his pediatrician.At a follow-up visit with his pediatrician 2 weeks later, his symptoms had resolved with the exception of his abdominal pain. His blood pressure was then noted to be 130/80 with mild edema of his extremities on examination. The purpuric rash had resolved. Laboratory investigation on Day 18 of illness revealed BUN 62 mg/dL, creatinine 0.57 mg/dL, albumin 1.8 g/dL, and urine protein to creatinine ratio (UPC) >19.8 mg/mg. Urine microscopy showed 50–100 red blood cells per high power field. Serum complement levels demonstrated mildly decreased level of C3  and normal level of C4 , also noted in 2/dose twice daily, and lisinopril. In addition, comprehensive quantitative and functional complement testing were performed, which revealed low levels of Factor B, Factor H, and Factor I suggesting activation of the alternative pathway, but with normal levels of Bb, Ba, and properdin which in contrast would be inconsistent with alternative pathway activation. Additionally, the level of C5 was slightly low but sC5b-9 was normal, indicating quiescence of the terminal pathway. No acquired factors of complement dysregulation  were noted. Genetic testing has not been pursued to date.Upon admission, given the clinical constellation of nephrotic syndrome, the patient underwent percutaneous renal biopsy on Day 22 of his disease course. Light microscopy demonstrated a membranoproliferative pattern of glomerular injury including mesangial and endocapillary hypercellularity, inflammatory cell infiltration, and crescent formation  was not identified in this patient, pathogenic variants in complement regulatory genes or a risk haplotype as seen in C3G and IC-MPGN may still be present and warrant exploration . The speAfter discharge from the hospital, my son had to see his pediatrician weekly. For four months, we struggled with swelling of his eyes, leg, and scrotum and his blood pressure. His symptoms eventually improved, and we were able to go down on his medications. Now, he is off of his steroids and is only on one blood pressure medication.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. Written informed consent was obtained from the individual(s), and minor(s)' legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Background: Corticosteroids play a significant role in managing the vast majority of inflammatory and immunologic conditions. To date, population-based studies on knowledge and attitudes concerning corticosteroids are scarce. This study aims to comprehensively assess knowledge, perception, experience and phobia toward corticosteroid use among the general population in the era of COVID-19. Methods: A cross-sectional self-administrated questionnaire was used to collect the data from 6 countries. Knowledge and corticophobia scores, descriptive statistics and logistic regression were computed. Results: A total of 2354 participants were enrolled in this study; the majority were females (61.6%) with an average age of 30. Around 61.9% had been infected previously with COVID-19, and about one-third of the participants had experience with corticosteroid use. The mean knowledge score was relatively satisfactory (8.7 ± 4.5 out of 14), and Corticophobia ranked a high score in all countries. Age, female gender, and history of COVID-19 were positively correlated with developing corticophobia. Conclusion: Our study highlights that the general knowledge about steroids was satisfactory. However, the phobia toward its use upon indication is high. Therefore, enhancing awareness and providing essential counseling regarding the rational use of corticosteroids may reduce corticophobia. COVID-19 is a rapidly spreading infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is characterized by a hyperinflammatory response; severe cases develop acute respiratory distress syndrome (ARDS), the most severe form of acute respiratory failure. Although many Arab countries applied early serious preventive measures to control the infection of COVID-19, the total number of confirmed COVID-19 cases in the Arab world ranked fourth among the top 15 most affected countries .Corticosteroids play a significant role in managing the vast majority of inflammatory and immunologic disorders . They gaConcerns regarding corticosteroid use, broadly known as “corticophobia” . CorticoUnderstanding basic principles about important drug categories, like corticosteroids, is essential to health literacy. This knowledge enables individuals to comprehend better the information that they are likely to receive about those drugs . StudiesPopulation-based studies on knowledge and attitudes concerning corticosteroids are scarce, and the results are strongly limited by the small sample size and investigation of a single dosage form . AnotherThis descriptive cross-sectional study was conducted between March and July 2022 among the general population from 6 Arab countries including Egypt, Iraq, Jordan, Saudi Arabia, Sudan, and Syria. A self-administered, online questionnaire was delivered to the participants in two languages (English and Arabic) using Google Forms. In addition, 89 participants responded to the questionnaire from other Arab countries such as Kuwait, Lebanon, Palestine, Qatar, and Yemen, which were categorized in the study as “others”. Regarding the inclusion criteria, the eligible participants include any adult (age > 18 years) who was able to read and respond to the questionnaire. The data recruitment process was accomplished through the co-investigators in each country.n = 9) and the number of 10 subjects per predictor level, a minimum sample size of 90 or higher from each country was considered suitable.This was a multinational study with high variability in the number of populations. Accordingly, based on Tabachnick and Fidell’s recommendation for sample size calculation in analysis, 5–20 subjects per predictor are suggested to be preferable . Based oParticipation in this study was voluntary and anonymous. Informed consent was obtained from each participant. A written participant consent statement, “Your participation in completing this questionnaire is highly appreciated”, was given to the participants at the beginning of the survey. Consent approval was achieved if the participants were willing to proceed with the survey.The study questionnaire was developed after reviewing related validated surveys in the literature ,30,31 anInitially, the tool was developed in English and evaluated by five academics in the pharmacy field for content and face validity. Then, it was translated into Arabic by two independent academic translators using translation and back-translation techniques. For the sake of clarity and understandability of the questionnaire’s items among the study-eligible population, it was piloted on 30 participants from various backgrounds , and linguistic refinements were made as needed based on the feedback from the pilot-testing phase. The pilot responses were not included in the final analyses. The final version of the questionnaire was distributed through online media, mainly social media, e.g., Facebook , WhatsApThe total knowledge score was calculated by giving the participants a list of 14 knowledge items. Each item had two response choices, either yes or no, which were scored based on whether they were correct (score of 1) or incorrect (score of 0); thus, the overall knowledge score ranges between (0 and 14). There was no cut-off score value that identified the acceptable level of knowledge; however, this study summed up the total correct answers and considered a good level of knowledge above 50%. In addition, a higher score in each category represents a higher knowledge level.Regarding the corticophobia score, the responses for the listed statements were recorded using a 5-point Likert scale . Through Cronbach’s alphas, the reliability of the scale was determined, and it showed that the alpha was 0.83, which indicated that the items would form a scale of high internal consistency. The results of the 5-point Likert type scale were analyzed and ranked between 1–5 have been divided into three ranks: a low score is between 1.00–1.66, a moderate score between 1.67–3.32, and a high score between 3.33 and 5.00.®). The mean ± standard deviation (S.D.) and frequency (or percentages) were used for continuous and categorical variables, respectively. The Chi-square and Kruskal–Wallis tests were used to identify a significant difference in sociodemographic variables between countries, and for frequencies < 5, Fisher’s exact test was used. Binary logistic regression analyses were used to test the predictors for corticophobia. Univariate logistic regression was carried out to initially screen the independent variables associated with high scores (3.33–5.00) on the Likert scale for corticophobia, including age, gender, major, education level, residential area, presence of chronic diseases, history of COVID-19 infection, experience with corticosteroid use, experience with side effects from corticosteroids and knowledge score about corticosteroids. Using univariate regression analysis, predictors with p-value < 0.25 were entered into multivariable regression analysis. Predictors were selected after checking their independence, where Spearman’s correlation coefficient (r) of less than 0.4 indicates the absence of multicollinearity between the independent predictors in multivariable regression analysis. The multivariable regression analysis identified independent variables associated with high scores. Statistical significance was set at a p-value of test ≤ 0.05.Study data was analyzed using the 24th version of the statistical package for social science , with an average age of 30 years. Almost two-thirds of the participants were bachelor’s degree holders (63.5%), and a majority reported living in urban areas (83.6%). Approximately one-third of the sample (29.3%) were students, (29.1%) worked in the healthcare sector, and (18.7%) were unemployed or retired. Regarding the health status of the participants, the majority did not report having any chronic disorder (81.7%). Of those with chronic conditions, the most prevalent were cardiovascular diseases (9.6%) or obesity/overweight (8.4%). Around (61.9%) of the total study subjects had been infected previously with COVID-19, where 21.5% rated that the infection was mild. Across all participating countries, almost a quarter of the involved individuals have been infected once only with COVID-19 (26%). Exactly one-third of the total sample admitted receiving the COVID-19 vaccine (33.3%). Around (31.6%) of the subjects reported using corticosteroids themselves or having relatives or friends who do. Among those who had previous exposure to corticosteroid usage, the majority (36.7%) had continuously used the corticosteroid medication for less than 7 days. The most commonly utilized dosage form (62.1%) was the tablet. More than half of the participants (51.5%) used corticosteroids for the treatment of dermatologic disorders, 26.1% for infection with COVID-19, and 41% for the treatment of respiratory disorders . The most commonly reported side effects among study respondents were increased appetite leading to weight gain (45%) followed by mood changes, swings, and depression (34.1%). Also, more than a quarter of the participants who used corticosteroids reported acne or easily bruised thin skin (27.8% and 26.1%), respectively. Participants from different countries showed relatively satisfactory knowledge (mean > 7 out of 14) about corticosteroids. Participants scored a total of (8.7 ± 4.5) out of (14) where each correct answer scored 1 and 0 for the incorrect answer. The highest knowledge score was reported from Egypt and Iraq (10.5), while the lowest was from Saudi Arabia (7.5). Regarding the information sources from which most participants generated their knowledge about corticosteroids, social media platforms appeared to be one of the most utilized sources to acquire information about corticosteroids (66.8%), followed by books (59.6%). In countries like Egypt, Jordan, and Sudan, healthcare workers were the least preferred source of information accessibility about corticosteroids. Fear of corticosteroid use (corticophobia) scores were assessed among the study participants from different countries. Overall, corticophobia scores appeared high (3.33–5.00) on the Likert scale among all participants on all assessed corticophobia aspects, as shown in Regression results at 95% confidence interval revealed that a high Corticophobia score was positively correlated with female gender, age, and history of COVID-19 infection. In addition, participants’ educational level and knowledge scores were negatively correlated with developing corticophobia. Corticosteroids can be prescribed as powerful anti-inflammatory therapeutic medications used for the treatment of a wide variety of disorders. Nevertheless, they are associated with some side effects that are mostly related to the dose used and duration of treatment. During the COVID-19 pandemic, many reported behaviors were reported regarding medications use among different countries including Middle East ,37,38. FPrevious studies were conducted to assess knowledge and awareness regarding corticosteroids ,42,43,44On the other hand, low levels of knowledge regarding corticosteroid side effects among study participants were found. A nationwide survey in south Korea reported similar findings on the general public knowledge regarding topical corticosteroids. Fear of side effects is a major limiting factor for the use of steroids. Hence, the role of health care providers is crucial in appropriately counseling patients on the correct use of corticosteroids and preventing hesitation, misuse, and abuse of corticosteroids.The present study showed that most participants generated their knowledge about corticosteroids mainly from social media platforms (66.8%). Internet accessibility, mainly social media, is reported to be one of the most feasible and accessible sources of health information nowadays ,49,50. SDuring the COVID-19 pandemic, social media platforms have been crucial in transmitting health information between people . A previSteroid phobia is a critical hurdle that affects the acceptability of treatment, and adherence to it eventually worsens disease progression . SeveralSeveral studies investigated associations with developing corticosteroid phobia. In our study, age and gender were positively correlated with developing corticophobia. Several studies reported similar findings, as females were more prone to convey a steroid phobia, especially if they have experienced any side effects from corticosteroid use ,65,66. OParticipants’ educational level and knowledge scores were significantly negatively correlated with developing corticophobia. As a person would expect, education usually improves people’s general knowledge and awareness, which might explain this association of steroid phobia with educational level and knowledge scores. Nevertheless, another study highlighted that steroid phobia might be associated with having a higher university degree .Several factors might contribute to corticophobia among people. These factors might include the fear of side effects, lack of education, lack of counseling, and misinformation from social media. The fears of side effects such as increased appetite and weight gain, as reported by this study and others, indicate that fear of adverse effects and lack of appropriate knowledge about steroid treatment are the most important reasons for developing corticophobia ,68. TherSeveral limitations can be identified in this study. First, the representation of each participating population could be compromised, as the study tool warrants computer literacy, internet availability, an enhanced level of education to access and complete the online survey, which might affect the generalizability of our study findings. Second, information bias related to the accessibility of resources on demand can compromise response credibility. Third, selection bias related to the data collection  might be an issue, with no random selection warranted. Residual confounding bias could arise from possible un-measured variables or responses to variables directly or indirectly related to corticosteroids. Moreover, an online survey instead of a face-to-face meeting poses reliability and authenticity risks to the study data. The online survey included country-specific questions for each population to complete, with a full description of the target population and inclusion criteria in the title and the invitation message. Considering the restriction measures during the COVID-19 pandemic, such a methodology was the best option.With corticosteroids being used extensively, it is imperative to control the use of these medications in the proper way. In our study, while the general level of knowledge was satisfactory about steroid usage, indications, and dosage regimen, there is still a need to strengthen the knowledge and understanding regarding their possible side effects at a deeper level. In addition, this study revealed that the corticophobia level was high; therefore, enhancing awareness and providing essential counseling regarding the rational use of corticosteroids may reduce corticophobia.