Eastern Countries Research Articles

Getting sincere and efficient support: A grounded theory study of older spousal caregivers of people with alzheimer's disease

Despite the importance of supporting older spousal caregivers (OSCs) of people with Alzheimer's Disease (PWAD), little evidence is available about the process of its occurrence in Middle Eastern countries, such as Iran. Understanding this process will help support more effectively. This study explored the support process for OSCs of PWAD using the grounded theory approach of Corbin and Strauss (2015). A total of 16 participants (10 caregivers, six formal and informal resources) were recruited using purposive and theoretical sampling methods, and in-depth interviews were conducted with them. Getting sincere and efficient support was the core category and was achieved through four strategies, which were thoughtful support-seeking, informal support-getting, formal seasonal support-getting, and informal support-devoting. Despite OSCs' vital need for multiple support, specific factors and conditions impair the support process. Healthcare providers and policymakers can use the results to make informed decisions and provide more practical support for these older caregivers.

Comparison of the Diagnostic Performance of Antigen B Purified from Sheep Hydatid Cyst Fluid (HCF) with Commercial ELISA Kit.

Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the metacestode of Echinococcus granulosus. CE is a health problem in Middle Eastern countries, such as Iran. The purpose of this study was to purify subunit 8 KDa antigen B from crude sheep hydatid cyst fluid (HCF) and compare its sensitivity and specificity with a commercial human ELISA kit (PT-Hydatid-96). 28 sera samples were collected from hydatid cyst patients who had surgery for a hydatid cyst and had their disease confirmed by pathology after the surgery. Furthermore, 35 samples of healthy individuals with no history of hydatid cysts were collected, as were nine serum samples from parasite-infected non-CE patients. HCF was obtained from sheep fertile cysts at a Sari slaughterhouse and used as an antigen. In an indirect ELISA test, the B antigen was employed, and the results were compared to those from a commercial ELISA kit. The results of this study were analyzed using the Kappa test. The commercial ELISA kit showed 17 cases (23.6%) positive, 44 cases (61.1%) negative, and 11 cases (15.3%) borderline. B antigen showed that 18 (25%), 43 (59.7 %), and 11 (15.3%) were positive, negative, and borderline, respectively. One sample (1.4% of 72 total samples) of 35 serum samples from healthy individuals was positive using B antigen-based ELISA. In addition, all nine serum samples from parasite-infected non-CE patients were negative for both tests. The sensitivity and specificity of the commercial ELISA kit have been evaluated at 60.7% and 100%, respectively. For B antigenbased ELISA, these values are 64.3 and 97.7%, respectively. Antigen B produced from hydatid cyst fluid is a promising option for serological identification of hydatid cysts in both infected and healthy individuals. In an indirect ELISA test, hydatid fluid antigen could be used as a precise source of detection.

POST‐UK (Adjunctive Intra‐Arterial Urokinase After Successful Endovascular Thrombectomy in Patients With Large‐Vessel Occlusion Stroke): Study Protocol of a Multicenter, Prospective, Randomized, Open‐Label, Blinded‐End Point Trial

BACKGROUND Intra‐arterial infusion of an adjunctive thrombolytic agent after macrovascular recanalization by endovascular thrombectomy was regarded as a promising strategy to promote outcomes of patients with stroke. Given the characteristics of urokinase as an affordable, available, and widely applied medication, especially in Eastern countries, this trial aims to assess the safety and efficacy of intra‐arterial urokinase as adjunct to endovascular thrombectomy in improving outcomes among patients with anterior large‐vessel occlusion stroke after excellent to complete reperfusion. METHODS The POST‐UK (Adjunctive Intra‐Arterial Urokinase After Successful Endovascular Thrombectomy in Patients With Large Vessel Occlusion Stroke) trial is a multicenter, prospective, randomized, open‐label, blinded‐end point trial conducted in China. The planned sample size is 498. Those eligible patients with anterior circulation large‐vessel occlusion stroke and achieving excellent to complete reperfusion by endovascular thrombectomy are planned to be consecutively randomized in a 1:1 ratio to the experimental group (a single dose of intra‐arterial urokinase) or to standard of care. RESULTS The primary outcome is a freedom from disability (modified Rankin Scale score of 0–1) at 90±7 days. The safety outcomes are mortality within 90±7 days and symptomatic intracranial hemorrhage within 48 hours. CONCLUSION The POST‐UK trial will provide valuable insight of efficacy and safety of intra‐arterial urokinase in patients with large‐vessel occlusion stroke after achieving excellent to complete reperfusion by endovascular thrombectomy.

Climate Change Implications on Middle Eastern Geography and Stability – A Case Studies of GCC- with a Focus on the Kingdom of Saudi Arabia

The environment constitutes the natural setting where humans reside, secure food sources, and utilize natural resources to fulfill their material and life necessities. Unlike other creatures, humans have not adapted to nature and the surrounding environment; instead, they have manipulated it to their advantage, disrupting the ecological balance. The primary catalyst for this disruption was the Industrial Revolution, which significantly increased pollution rates, harmful emissions, and the extraction of raw materials, thereby intensifying the exploitation of natural resources. The gravest concern is that the damage inflicted upon nature may reach a point of no return, with catastrophic and enduring consequences, such as global warming, ice melting, rising sea levels, and escalation in greenhouse gases, along with severe repercussions of these events, including an increase in mortality rates due to natural disasters. Effective responses necessitate actions at various levels, including cultural and educational initiatives and international measures, particularly in legislation. Such laws must enforce stringent controls on emissions from industrial and automotive sources. Individuals are called upon to conserve electricity and water, and adopting renewable energy sources, such as solar, hydro, wind, and tidal energy, that do not rely on fuel combustion is encouraged. Planting trees, which absorb carbon dioxide as a primary contributor to global warming, is among the most critical measures we can undertake. The Gulf Cooperation Council (GCC) is essential in combating climate change in this arena, and the Kingdom of Saudi Arabia is leading in this. This paper elaborates on the impact of climate change in Middle Eastern countries using a brief case study of the Saudi Green Initiatives. The paper also presents the policy recommendations to the concerned stakeholders of the GCC and the government of Saidi Arabia.

Hikikomori in the Middle East: The role of problematic gaming, social media use, and loneliness

Hikikomori, a form of severe social withdrawal has been found to be associated with behavioral addictions such as gaming addiction and problematic social media use (PSMU). Since literature related to hikikomori is lacking in the Middle East, this study aimed to determine whether there are significant differences in hikikomori-like traits between two different types of social media users and gamers and investigate loneliness as a potential mediator between hikikomori and the two types of problematic behaviors. A cross-sectional, correlational design was employed, collecting a final sample of 220 participants residing in Middle Eastern countries using a mixture of convenience and snowball sampling. Results showed that passive social media users demonstrated significantly greater hikikomori-like traits compared to active users. Furthermore, hikikomori-like traits exhibited significant positive associations with problematic gaming, PSMU, and loneliness. Two separate mediation analyses, the first with PSMU and a second with problematic gaming as predictors, revealed that loneliness acted as a significant mediator between both these problematic behaviors and hikikomori-like traits.

Blood pressure control and cardiovascular risk assessment in patients with hypertension: a pooled analysis of 6 countries in Eastern and Southern Europe (SNAPSHOT study)

Abstract Background Recent guidelines of the European Society of Cardiology (ESC) introduced stricter recommendations regarding blood pressure (BP) control, based on recommended levels following an assessment of cardiovascular (CV) risk. However, data are lacking on perception and actual BP control, and CV risk assessment. Purpose To assess BP control and CV risk assessment in patients with hypertension. Methods This is a cross-sectional multicentre study (SNAPSHOT) including pooled data from 6 countries in Europe. 9466 patients with hypertension were included from 513 participating investigators (69.6% general practitioners [GPs], 17.4% cardiologists, 6.2% endocrinologists). BP control and CV risk were assessed by investigators and compared to the re-assessment based on current ESC guidelines (SCORE1 and SCORE2&2-OP). Results 9443 patients with complete data (65.6±10.7 years, 57.0% female) were analysed from Bulgaria (35.6%), Romania (26.8%), Croatia (13.8%), Serbia (12.5%), Georgia (6.4%), and Spain (4.9%). Most patients had additional risk factors, such as overweight/obesity (81.6%), dyslipidaemia (80.8%), type 2 diabetes (32.8%) or current/former smoking (29.5%). Two or more risk factors (male gender, age ≥65 years, obesity, smoking) were more frequent in patients with very high calculated CV risk (60.9% by SCORE1, 57.7% by SCORE2&2-OP). Systolic and diastolic BPs were 139.3±17.3 mmHg and 82.3±10.9 mmHg, respectively. Almost all patients (98.5%) had their hypertension treated, 54.5% taking a single-pill combination (SPC). The most used drug classes were diuretics (59.6%), angiotensin-converting enzyme inhibitors (59.4%), and beta-blockers (57.0%). Combination therapy of 2 or 3 drug classes (SPC or not) was used in 33.2% and 34.4% of patients, respectively. According to investigators, BP was considered controlled in 75.0% of patients, whereas 48.0% of patients had BP <140/90 mmHg, and only 24.4% of patients were controlled at BP target according to guidelines (Figure 1). CV risk was estimated by investigators as low, moderate, high or very high for 10.1%, 34.9%, 32.0% and 23.0% of patients, respectively, whereas calculated CV risk was very high in most patients (59.1% by SCORE1, 86.8% by SCORE2&2-OP). CV risk estimated by investigators varied by country and by speciality, being high (29.4%, 35.0% and 32.0%) and very high (32.4%, 49.8% and 18.6%) for cardiologists, endocrinologists and GPs, respectively. Compared to calculated CV risk, CV risk estimated by investigators was frequently underestimated (54.4% by SCORE1, 67.6% by SCORE2&2-OP), varying between 30.8% in Spain and 68.2% in Bulgaria for SCORE1, and between 42.1% in Spain and 84.8% in Serbia for SCORE2&2-OP (Figure 2). Conclusion Physicians across 6 European countries tended to overestimate control of BP and underestimate CV risk in patients with hypertension. Our findings highlight the need for better assessment and management of patients according to the latest ESC guidelines.

Transregional Cooperation of German Federal States with Eastern Regions and Countries (Late 20th — 21st Century)

This study examines the formation and development of transregional relations between the federal states of Germany (Bundesländer) and Eastern countries and regions. It presents the findings of a normative-legal analysis of the foundations of international and foreign policy activities of German federal states, based on national legislation. The focus is on the institutional framework for cross-border interactions between individual administrative units of the Federal Republic of Germany and their foreign partners. The research explores partnerships with both neighboring Middle Eastern territories and more distant Eastern regions. The findings indicate that the international and foreign economic activities of the German states are extensive, aligning with the opportunities outlined in Germany’s constitutional documents, and are significantly broader and more diverse compared to similar activities in the regions of France and Italy. It has been identified that German states engage in a system of “horizontal partnerships” primarily with provinces of the People’s Republic of China. Additionally, it is reported that a principle of “network cooperation” is applied to most other Eastern countries, encompassing not only economic but also scientific, cultural, and humanitarian ties. The study demonstrates that among the examined EU countries at the regional level, German federal states lead in establishing the most successful and effective partnerships with regions in Eastern countries.

Kuwaiti Teachers’ Classroom Behavior Management Practices, Experiences, and Beliefs

Recent statistics suggest that student externalizing behaviors are increasing in Western and Asian countries; however, there is a paucity of research on teachers’ perspectives of these behaviors in Middle Eastern countries. A mixed-methods research design was used to investigate Kuwaiti public elementary and middle school teachers’ perceptions of their classroom behavior management (CBM) experiences, including their (a) academic preparation; (b) use of CBM practices to support students with externalizing behaviors; (c) observations of student externalizing behaviors; and (d) perceptions on administrative support and family involvement. Participants included 2,140 general and special education teachers randomly recruited from 45 schools. Results indicated that fewer than half of the teachers surveyed had prior instruction in CBM, reported using a wide variety of CBM practices in response to student behavior problems, and perceived higher levels of administrative support than family involvement. Implications of the study’s findings and suggestions for further research were discussed

Flexible bronchoscopy-assisted removal of aspirated scarf pins from the tracheobronchial tree: the experience of 146 subjects.

Aspiration of scarf pins is a common problem in specific geographical locations where the Muslim population is high, especially in countries like Egypt, Bangladesh, Middle Eastern countries, and certain regions in India. This condition is also referred to as hijab-pin syndrome. We discuss the largest experience of flexible bronchoscopic extraction of aspirated scarf pins from the tracheobronchial tree. A multicenter retrospective observational study was conducted on 146 patients from 4 different centers in Egypt, Bangladesh, India, and Germany. Flexible bronchoscopy was successful in the extraction of aspirated scarf pins in all 146/146 patients with a 100% success rate. 136/146 (93.15%) patients were females, with the most common age group between 12 and 18 years (34.24%). 132/146 (90.4%) remembered the aspiration event before coming to the hospital. Cough was the predominant presenting symptom. (71.22%). In all 146 cases, the foreign body was identified on a standard chest X-ray. The left main bronchus was the most common site of aspiration, 67/146 (45.89%), followed by the right main bronchus, 56/146 (38.35%). 14 patients (9.58%) had a history of unsuccessful attempts to remove by rigid bronchoscopy, and flexible bronchoscopy was successful in these 14 (100%) patients who had a prior unsuccessful attempt to remove. The current series is the largest in literature and demonstrated an excellent success rate in the removal of the aspirated scarf pin.

Enhancing Sustainable Communities through the Protection of Natural Buffer Zones

Certain regions within Middle Eastern countries are vulnerable to climate-related hazards, including floods and dust storms, resulting in adverse consequences for these nations and hindering the sustainable development of urban communities. The preservation and development of natural buffer zones, such as green spaces and surface waters, offer nature-based solutions to shield urban areas from the impacts of these hazards. This article examines the significance and legal protection of these buffer zones and concludes that, despite their effectiveness in mitigating floods and dust storms, natural buffer zones have not received distinct recognition as protective zones for urban areas in international and national legal frameworks. The study recommends the integration of natural buffer zones preservation and development into national and regional urban planning and disaster risk management policies and strategies, highlighting their role as nature-based solutions for enhancing urban sustainability in the Middle East, especially Iran.

Variables influencing students' learning motivation: critical literature review

This study presents a critical literature review exploring the variables influencing student learning motivation between 2017 and 2023. The study analyzes 84 empirical studies to identify trends and patterns across diverse demographics, including varied age groups and cultural backgrounds, focusing on contrasting Eastern and Western educational contexts. This study aims to fill the existing gap by examining a wider range of populations in recent years to assess the relationship between learning motivation and the factors that influence it. Six pivotal factors influencing learning motivation were identified: psychological values, cognitive factors, social and environmental influences, demographic factors, academic background and study habits, and interventions and programs, each contributing uniquely to the understanding of student motivation. Moreover, the findings underscore the predominance of psychological values in Eastern countries, whereas the Western literature focuses on social and environmental influences. This review acknowledges the nuanced relationship between cultural constructs and learning motivation research, emphasizing the need for culturally sensitive educational policies and practices. Additionally, by taking into account the recent advancements in technology and the effects of global events such as the COVID-19 pandemic, this study considers additional motivational factors, presenting a holistic view that could inform future educational interventions and academic policies. For example, the revised categorization in our study emphasizes the complex and interconnected nature of the factors affecting learning motivation, highlighting the interaction among psychological, social, cognitive, and demographic dimensions.

Knowledge, Attitudes, and Practices Toward Breast Cancer and Breast Cancer Screening Among Arab Females in the Middle East: A Literature Review.

Breast cancer is one of the most diagnosed cancers in Arab countries. Lack of knowledge and awareness regarding breast cancer screening has increased the breast cancer-related morbidity and mortality. This literature review aimed to assess published research papers with a focus on the levels of knowledge, attitude, practice, and barriers of women in Arab countries of the Middle East toward breast cancer and its screening. SCOPUS, MEDLINE, and Google Scholar were searched using specific terms for relevant, quantitative, original studies published between 2017 and 2022. All English articles that matched the inclusion criteria were included in this review. Fourteen studies focusing on knowledge, attitudes, and barriers regarding breast cancer were included. Two independent reviewers performed screening and extraction. Among the reviewed studies, a range from 19.6% in Oman to 67% in Saudi Arabia had poor knowledge of breast cancer. Past personal or family history was a well-recognized risk factor (n=5), and being worried about the results was the most common barrier to screening. Although most women were aware of screening methods, the majority did not practice screening. Social media and the internet were the most used sources of information used by women to obtain knowledge regarding breast cancer and its screening (n=6). Most of the Arab female population had low levels of knowledge, attitudes, and practices regarding breast cancer and its screening. Programs designed to raise awareness are necessary, and more policy changes must take place on the national level in Arab, Middle Eastern countries to address the low knowledge, the negative attitudes, and the limited access to breast cancer screening.

Evaluation of a distribution, education and awareness intervention for child passenger safety in Lebanon: a low-income and middle-income country setting

BackgroundThe Eastern Mediterranean Region suffers disproportionately from paediatric traffic-related injuries. Despite governmental laws, Lebanon—an eastern Mediterranean country—has low child restraint (CR) use prevalence. This study examined the impact of using...

Progress of nations in the organisation of, and structures for, kidney care delivery between 2019 and 2023: cross sectional survey in 148 countries

ObjectiveTo assess changes in key measures of kidney care using data reported in 2019 and 2023.DesignCross sectional survey in 148 countries.SettingSurveys from International Society of Nephrology Global Kidney Health Atlas...

Exploring the Nexus between Greenhouse Emissions, Environmental Degradation and Green Energy in Europe: A Critique of the Environmental Kuznets Curve

This study examines the intricate relationship between economic growth and European environmental degradation via the Environmental Kuznets Curve (EKC). Our results contest the traditional inverted U-shape model of the Environmental Kuznets Curve, indicating that the theory may not be consistently applicable across European countries. Utilizing CS-ARDL and MMQR modelling, we reveal substantial regional disparities. Western European nations demonstrate a typical Environmental Kuznets Curve (EKC) pattern in the short term, characterized by an initial increase in emissions alongside GDP development, followed by a subsequent fall. Conversely, Eastern and Balkan nations exhibit a U-shaped connection, described by an early decline in emissions followed by a subsequent increase as their development levels increase. The influence of renewable energy differs, as it decreases emissions in the short term in Western Europe. However, its long-term impacts are variable, especially when contrasted with its more pronounced effect on emissions in Eastern and Balkan countries. Furthermore, trade openness intensifies environmental degradation in the short-term across all regions, although its long-term impact diminishes, particularly concerning greenhouse gases (GHG). The relationship between renewable energy and trade openness is substantial for the short-term reduction of carbon dioxide emissions, but this effect declines with time. The results indicate that a uniform environmental policy throughout Europe may lack efficacy. Customized strategies to expedite the transition in Western Europe and more specific interventions in Eastern Europe are essential to harmonize economic progress with environmental sustainability. Future research should examine the determinants of the diminishing long-term effects of renewable energy and the interplay between trade and environmental policies.

It’s not just about jobs: The significance of employment quality for participation in political violence and protests in selected Arab Mediterranean countries

It is often proposed that the young unemployed are more likely to engage in political violence, conflicts, and protests. One problem in studying the unemployed – especially in the Global South – are the blurred lines between the unemployed, the employed, and those working in the informal sector. Further, the employed are a heterogeneous group so employment quality might also play an important role. To tackle these issues, this study uses a new quantitative dataset, which covers youth in five Middle Eastern and North African countries: Algeria, Egypt, Lebanon, Morocco, and Tunisia. These data provide considerably more fine-grained information about the employment situations of the respondents than the datasets previously used. The study investigates separately two forms of political participation: in political violence and in demonstrations. The regression analyses show that there is no clear difference between the young unemployed and the young employed in their likelihood to participate in the studied political activities. However, some features related to employment matter. Those whose employment status is ambiguous are substantially more likely to participate in demonstrations and political violence than the employed. Among those who work, those who are dissatisfied with their work and those who work fewer hours participate more often in these activities. Income on its own does not seem to have an effect; however, those who have more assets are more likely to participate, and compared to those who feel themselves middle income, those feeling rich or poor are more likely to engage in political violence and demonstrations. The results suggest that instead of thinking in terms of a dichotomy of the employed and unemployed, more emphasis should be placed on understanding the variety of employment situations and employment quality and their impact on political instability.

Military System Culture Archetype and Humanistic Thinking-In Sunzibingfa, Focusing on the Practical Will of Military System and Strengthening of Discipline

Regardless of the time and space differences between eastern and western countries before and after their origin, the improvement of military systems and solutions to problems all reflect the practical will of national defense strategic responsibility and tactics. From the anthropological point of view, no matter the development of the xianqin civilization and the victory or defeat of the war history, the establishment, development and changes of the system and discipline are discussed as the boundary and module of historical dialectics. This is a myth of the victory of the country's social and political diplomacy, a basic sanction of the security strategy, and a specific matter for the interpretation of the structural and institutional principles. Then, as a cultural prototype, can the other appearance and symbolic significance of this military system, as the AI social language view in the 21st century, become another status and security awareness of dominating the world? The positive answer to this is that as an individual country, its multiple roles are sufficient to enhance political strategies, diplomatic security, social tranquility and individual spirit of challenge. This issue actually plays a role as the boundary and module of the historical dialectics of military system through the changing process of the history of the times before discussing the concept and essence of a liberal democratic society.

Interplay of Cardiometabolic Syndrome and Biliary Tract Cancer: A Comprehensive Analysis with Gender-Specific Insights.

BTC overall incidence is globally increasing. CCA, including its subtypes, is a form of BTC. MetS, obesity, MASLD, and diabetes are all linked to CCA in interconnected ways. The link between obesity and CCA is less well-defined in Eastern countries as compared to Western. Although more research is needed to determine the relationship between MASLD and extrahepatic CCA (eCCA), MASLD may be a concurrent risk factor for intrahepatic CCA, particularly in populations with established or unidentified underlying liver disease. Interestingly, the risk of biliary tract cancer (BTC) seemed to be higher in patients with shorter diabetes durations who were not treated with insulin. Therefore, early detection and prevention of chronic liver disease, as well as additional intervention studies, will undoubtedly be required to determine whether improvements to MetS, weight loss, and diabetes therapy can reduce the risk and progression of BTC. However, further studies are needed to understand how reproductive hormones are involved in causing BTC and to develop consistent treatment for patients. Finally, it is critical to carefully assess the cardiological risk in BTC patients due to their increased intrinsic cardiovascular risk, putting them at risk for thrombotic complications, cardiovascular death, cardiac metastasis, and nonbacterial thrombotic endocarditis. This review aimed to provide an updated summary of the relation between the abovementioned cardio-metabolic conditions and BTC.

The Palestinian Diaspora: Status and Rights in Middle East and North African Countries

The Palestinian diaspora, beginning with a mass exodus following the establishment of Israel in 1948, has faced diverse and evolving challenges in Middle Eastern and North African host countries. This paper explores the historical and contemporary status of Palestinian refugees in these regions, examining the legal, social, and economic conditions they endure. While neighboring Arab states initially supported Palestinian refugees, their experiences have since been defined by prolonged refugee status and fluctuating levels of hostility. In Lebanon, Jordan, Syria, Egypt, and the Gulf countries, policies have fluctuated based on geopolitical interests and local dynamics. North African countries, while offering some support, also reflect the complexities of Palestinian integration. The ongoing refugee crisis underscores the need for international efforts to address the root causes and ensure the rights and welfare of Palestinian refugees.

The validity and reliability of the Arabic version of the EQ-5D in atrial fibrillation patients in a conflict country: a study from Syria

BackgroundThe EQ-5D is one of the most commonly used tools to establish health-related quality of life (QoL). EQ-5D data in atrial fibrillation (AF) patients in the Middle East are lacking.ObjectivesThis study aims to evaluate the reliability and validity of the Arabic version of the EQ-5D in AF inpatients in Syria.MethodsThe study involved patients admitted to the emergency department of Tishreen’s University Hospital in Latakia with AF as the primary diagnosis between the 1st of June 2021 and the 1st of June 2023. Arabic versions of the EQ-5D, EQ-VAS and SF36 questionnaires were administered to patients. Validation was done using convergent, discriminant, and known-groups validity, while reliability was conducted using EQ-5D retesting within 2–4 weeks.Results432 participants were included in the study with a mean ± standard deviation of 63 ± 15. Males represented 242 (56%) of the participants. All hypotheses relating EQ-5D responses to external variables were satisfied. All three validation hypotheses demonstrated that the EQ-5D had the convergent, discriminant and known group validity to assess QoL in this cohort. The intraclass correlation coefficient (ICC) for test-retest reliability ranged between 0.74 and 0.88, while Cohen’s κ ranged between 0.72 and 0.86. Cronbach’s α value for internal consistency was 0.73.ConclusionThe Arabic version of EQ-5D was valid and reliable in measuring QoL in AF inpatients in Syria. This validation opens the door for more widespread use of the EQ-5D in Arabic-speaking regions, facilitating better-informed healthcare decisions and improving patient care strategies in Syria and other Middle Eastern countries.