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- MakaleAçık Erişim2026Scopus SJRQ1Effect of Perioperative Supplementation with Arginine and Omega-3 on Postoperative Complications in Patients Undergoing Gastrointestinal Cancer Surgery: A Pilot Open-Label Randomized Controlled Trial
Sakhri, Saida; Othman, Rym Ben; Jerbi, Chaima; Ceylan, Halil Ibrahim; Naija, Lamia; Zemni, Ines; Jamoussi, Henda; Dhiab, Tarek Ben; Ceylan, Nagihan Burcak; Stefanica, Valentina
Background: Perioperative immunonutrition, including arginine and omega-3 fatty acids, has been proposed to support postoperative recovery by modulating immune function. Aim: To evaluate the effects of perioperative arginine and omega-3 supplementation on postoperative infectious complications, mortality, hospital length of stay, intensive care unit duration, and inflammatory markers in patients undergoing gastrointestinal cancer surgery. Methods: In this Pilot Open-Label randomized trial, 35 adult patients scheduled for elective gastrointestinal cancer surgery at Salah Azaiez Institute were randomly assigned to receive either perioperative immunonutrition (n = 18; three daily capsules of omega-3 and one sachet of Arginine+ for 7 days preoperatively and 7 days postoperatively) or standard care (n = 17). Primary endpoints were postoperative infectious complications and 1-month mortality. Secondary endpoints included hospital length of stay, ICU duration, and postoperative biochemical markers. Results: No statistically significant differences were observed between groups in 1-month mortality (p = 0.324), hospital length of stay (median 7 vs. 7 days, p = 0.392), or ICU duration (median 5 vs. 6 days, p = 0.601). Urinary tract infection (5.9% vs. 11.1%, p = 0.939) and wound infection rates (5.9% vs. 11.1%, p = 0.581) were comparable. Importantly, postoperative C-reactive protein and other inflammatory markers did not differ significantly between groups (CRP: 165 vs. 175 mg/L; intergroup p = 0.798). Conclusions: In this trial, perioperative immunonutrition with arginine and omega-3 fatty acids did not improve postoperative clinical outcomes or inflammatory markers in patients undergoing gastrointestinal cancer surgery. At the administered dose and within a small, heterogeneous cohort, immunonutrition did not provide additional benefit beyond standard care. Larger, adequately powered multicenter trials with optimized dosing are required to clarify its role in gastrointestinal oncology.
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İncele - MakaleAçık Erişim2026Scopus SJRQ3Ramadan intermittent fasting alters cardiac autonomic modulation, neuromuscular performance, and recovery in adolescent tennis players: a within-subject repeated-measures design
Lakhdar, Nadia; Landolsi, Mounir; Ghouili, Hatem; Ceylan, Halil Ibrahim; Ceylan, Nagihan Burcak; Muntean, Raul Ioan; Alsaeed, Mohammed Issa; Ben Said, Noureddine M.; Zaouali, Monia; Bouhlel, Ezzedine
Background: Tennis requires repeated high-intensity efforts with brief recovery periods, placing significant demands on cardiac autonomic regulation and neuromuscular performance. Ramadan intermittent fasting alters sleep, nutrition, and hydration patterns, potentially affecting match responses, particularly in adolescents. Methods: Sixteen male International Tennis Federation (ITF) junior players completed a within-subject repeated-measures study during mid-Ramadan and 15 days post-Ramadan. Each performed a standardized two-set outdoor match under both conditions. Heart rate variability (HRV), countermovement jump (CMJ), blood glucose, hydration markers, and rating of perceived exertion were assessed at baseline (T0), between sets (T1), and post-match (T2). Sleepiness, chronotype, fatigue, and recovery were evaluated via validated questionnaires. Results: Match play reduced lnRMSSD (p < 0.001, eta p(2 )= 0.775) and increased LF/HF (p < 0.001, eta p(2)= 0.234), indicating sympathetic dominance. During Ramadan, parasympathetic activity was lower (p < 0.001, eta p(2)= 0.269), and CMJ performance was reduced (p = 0.010, eta p(2)= 0.085). Blood glucose showed a Period & times; Set interaction (p = 0.020,eta p(2) = 0.114). Sleepiness, fatigue, and perceived recovery were significantly impaired (p < 0.001). Conclusion: Ramadan intermittent fasting reduces vagal activity and impairs neuromuscular performance in adolescent tennis players. HRV-guided training, optimized nutrition, and sleep management may help mitigate these effects.
- MakaleAçık Erişim2026Scopus SJRQ1Acute Caffeine Ingestion, Calendar-Based Menstrual-Cycle Window, Time of Day, and Match-Induced Fatigue Independently and Interactively Influence Psychophysiological, Cognitive, and Physical Performance in Elite Female Volleyball Players: A Randomized Double-Blind Placebo-Controlled Crossover Design Study
Seddik, Meher; Dhahbi, Wissem; Bessifi, Manel; Moussa-Chamari, Imen; Ceylan, Halil Ibrahim; Ceylan, Nagihan Burcak; Muntean, Raul Ioan; Cular, Drazen; Souissi, Nizar
Aim: Female athletic performance is shaped by the convergence of menstrual-cycle timing, circadian rhythms, fatigue, and ergogenic supplementation; yet no prior study has examined these factors simultaneously in a sport-specific setting. This study investigated the independent and combined effects of acute caffeine ingestion, calendar-based testing window, time of day, and match-induced fatigue on psychophysiological, cognitive, and physical performance in trained female volleyball players. Methods: Thirteen elite eumenorrheic female volleyball players (age: 24.23 +/- 4.06 years) completed a randomized, double-blind, placebo-controlled crossover protocol comprising 12 sessions corresponding to all combinations of testing window (menstrual, follicular, luteal), supplementation (caffeine 6 mg & centerdot;kg(-1) vs. placebo), and time of day (08:00 h vs. 18:00 h). Assessments included the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Spiegel questionnaire, Profile of Mood States, Hooper Index, Stroop task, Countermovement Jump (CMJ), Modified Agility T-Test (MAT), and Reactive Agility Test (RAT), administered before and after a one-hour simulated match. Results: Significant main effects of testing window, caffeine, time of day, and fatigue state were observed across all outcome domains (all p < 0.05). Caffeine reduced daytime sleepiness (F(1,12) = 23.84, p < 0.001, eta p(2) = 0.665), enhanced vigor (F(1,12) = 114.10, p < 0.001, eta p(2) = 0.905), and improved MAT performance (F(1,12) = 33.27, p < 0.001, eta p(2) = 0.735). The follicular window was associated with superior cognitive, neuromuscular, and mood-related outcomes relative to the menstrual and luteal windows. Exploratory higher-order interactions suggested condition-specific caffeine benefits for MAT, RAT, and CMJ, particularly in afternoon post-fatigue conditions; these patterns require replication in larger samples. Conclusions: Acute caffeine ingestion improved several psychophysiological, cognitive, and neuromuscular outcomes in trained female volleyball players, with effects that varied across calendar-based testing windows, time of day, and fatigue state. Individualized supplementation strategies incorporating cycle timing and circadian context remain investigational; prescriptive recommendations require replication in larger, hormonally verified samples before clinical or applied adoption.
AtıfScopus1WoS1OpenAlex2İncele - MakaleAçık Erişim2026Scopus SJRQ2Network comparison methods detect temporal reorganization of psychophysiological integration invisible to conventional univariate analysis: Proof-of-concept using lunar-phase-timed measurements in elite athletes
Yousfi, Narimen; Dhahbi, Wissem; Ghouili, Hatem; Mejri, Mohamed Arbi; Bessifi, Manel; Ceylan, Halil Ibrahim; Valentina, Stefanica; Ceylan, Nagihan Burcak; Chtourou, Hamdi; Dergaa, Ismail
Field studies using conventional univariate methods fail to detect physiological rhythms (melatonin, cortisol, sleep architecture) that are consistently documented under laboratory-controlled conditions, suggesting that temporal factors operate on systemic organization rather than isolated metrics. Network analysis quantifies conditional dependencies among variables simultaneously, enabling the detection of organizational changes independent of mean-level shifts. As an exploratory proof-of-concept, this study examines whether network comparison methods detect temporal reorganization of psychophysiological integration invisible to conventional repeated-measures analysis in elite athletes; no confirmatory causal inference is drawn. Twelve elite male athletes completed psychophysiological assessments (mood states, subjective well-being, neurocognitive performance, postural control, intermittent endurance) at three lunar phases (New Moon, First Quarter, Full Moon) in a counterbalanced design. Conventional repeated-measures ANOVA detected no temporal effects on isolated variables (all F < 2.87, p > 0.05, eta(2)p < 0.21). Network comparison revealed marked organizational differences: New Moon versus Full Moon networks exhibited distinct architecture (M = 0.31, padj = 0.008) and connectivity (S = 8.42, padj = 0.029). Centrality systematically redistributed from capacity and well-being constructs (New Moon: vigour z = 1.82) to recovery markers (Full Moon: stress z = 2.13). Twelve connections differed significantly, including enhanced stress-confusion coupling (Delta r = +0.39, p = 0.003). This proof-of-concept demonstrates that temporal measurements can exhibit systemic reorganization despite stable component means, resolving apparent contradictions between laboratory-detected physiological rhythms and field-based null findings. Temporal control measurements and multi-cycle replication are required to definitively attribute observed reorganization to lunar periodicity rather than generic temporal variation.
- MakaleAçık Erişim2026Scopus SJRQ1High Prevalence of Malnutrition and Sarcopenia with Inadequate Nutritional Support in Intensive Care Unit Patients: A Prospective Observational Study of Clinical Outcomes
Ben Othman, Rym; Cherni, Asma; Dergaa, Ismail; Ceylan, Halil Ibrahim; Ceylan, Nagihan Burcak; Stefanica, Valentina; Sedghiani, Ines; Borsali, Nebiha; Jamoussi, Henda
Background: Malnutrition and sarcopenia are highly prevalent in intensive care settings and are associated with adverse clinical outcomes. Aim: The study aimed to evaluate the association between nutritional care, nutritional status, and patient outcomes in intensive care units. Methods: This prospective observational study at a Tunisian tertiary hospital investigated nutritional status and management of 100 intensive care unit patients, each of whom was followed for seven days after ICU admission. Malnutrition Risk was assessed by NUTRIC and MNA scores. The severity of disease was assessed using the APACHE II and SOFA scores. Malnutrition was diagnosed using body mass index and weight loss. Sarcopenia was assessed through grip strength, calf circumference, and psoas muscle area. Nutritional management was evaluated using calculations of caloric and protein intake. Clinical outcomes included the need for intubation, difficulty with oxygen weaning, healthcare-associated infections, and the development of pressure ulcers. Results: The participants had a mean age of 54.85 +/- 17.25 years, with a slight male predominance (53 males, 47 females). Pre-existing metabolic conditions affected 80% of patients, including hypertension (40 patients), diabetes (36), and obesity (18). The primary reasons for admission were respiratory disorders (25%), infectious diseases (23%), and metabolic disorders (16%). The mean APACHE II score was 15.91 +/- 6.84, and the mean NUTRIC score was 3 +/- 1.66; 27% were classified as at high risk of malnutrition. The prevalence of malnutrition reached 50% (28% moderate, 22% severe). Only 31% received adequate caloric intake, while 84% had insufficient protein intake. Malnourished patients required intubation more frequently (50% versus 22.5%; p = 0.014), experienced greater difficulty with oxygen weaning (78.4% versus 48.6%; p = 0.008), and developed pressure ulcers more often (43.5% versus 6%; p < 0.001). Sarcopenic patients showed similar patterns for intubation (51.4% versus 18.9%, p = 0.003), oxygen weaning difficulty (77.5% versus 46.9%, p = 0.007), and pressure ulcers (39.2% versus 6.7%, p < 0.001). Conclusions: Malnutrition and sarcopenia are highly prevalent in intensive care patients and are associated with severe complications, including prolonged mechanical ventilation and pressure ulcer development. Inadequate nutritional support remains common despite known consequences. Early comprehensive nutritional assessment and appropriate management from admission are essential to improve outcomes in critically ill patients.
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