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    Effect of Perioperative Supplementation with Arginine and Omega-3 on Postoperative Complications in Patients Undergoing Gastrointestinal Cancer Surgery: A Pilot Open-Label Randomized Controlled Trial
    (MDPI, 2026) Sakhri, Saida; Othman, Rym Ben; Jerbi, Chaima; Ceylan, Halil Ibrahim; Naija, Lamia; Zemni, Ines; Dergaa, Ismail
    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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    High Prevalence of Malnutrition and Sarcopenia with Inadequate Nutritional Support in Intensive Care Unit Patients: A Prospective Observational Study of Clinical Outcomes
    (MDPI, 2026) Ben Othman, Rym; Cherni, Asma; Dergaa, Ismail; Ceylan, Halil Ibrahim; Ceylan, Nagihan Burcak; Stefanica, Valentina; 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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    Mindfulness-Acceptance-Commitment Intervention Effects on Athletic Performance, Passion, and Psychological Well-being in Competitive Tennis Players: A Randomized Controlled Trial
    (Romanian Association of Balneology, 2026) Abidi, Wafa; Fall, Estelle; Chalghaf, Nasr; Ceylan, Halil İbrahim; Muntean, Raul Ioan; Dergaa, Ismail; Jarraya, Mohamed
    While traditional psychological skills training focuses on cognitive control, mindfulness-based approaches emphasize acceptance and present-moment awareness. The Mindfulness-Acceptance-Commitment (MAC) protocol shows promise for enhancing athletic performance; however, limited research has examined its effects on passion and well-being in tennis players. Forty-four competitive male tennis players (M age = 18.1 ± 1.1 years) were randomly assigned to either a MAC intervention group (n = 22) or a passive control group (n = 22). The MAC protocol consisted of seven weekly 45-minute sessions focusing on mindfulness, acceptance, and values-driven behavior. Primary outcomes included tennis serve performance assessed by certified coaches using a standardized 16-serve protocol. Secondary outcomes included mindfulness skills (Mindful Attention Awareness Scale), subjective well-being (Positive and Negative Affect Schedule, Satisfaction with Life Scale), harmonious passion, and obsessive passion (Passion Scale). Intention-to-treat analyses with 44 participants revealed significant improvements in the MAC group compared to controls. Tennis serve performance improved significantly in the MAC group (pre: 13.18 ± 2.19 to post: 15.09 ± 2.45, t(21) = 7.54, p < .001, d = 0.87) but not in the control group (pre: 13.05 ± 2.33 to post: 12.86 ± 2.41, t(21) = 0.78, p = .442, d = 0.08), with a significant between-group difference at post-test (t(42) = 3.71, p = .001, d = 1.12). Mindfulness skills improved substantially in the MAC group (pre: 39.00 ± 4.18 to post: 52.73 ± 3.65, t(21) = 13.76, p < .001, d = 3.28) compared to controls (pre: 43.55 ± 4.75 to post: 44.32 ± 4.12, t(21) = 1.31, p = .203, d = 0.16), with a significant between-group difference (t(42) = 7.16, p < .001, d = 2.16). Harmonious passion increased significantly in the MAC group (pre: 17.27 ± 2.64 to post: 24.05 ± 4.16, t(21) = 6.15, p < .001, d = 2.57) while remaining stable in controls (pre: 17.86 ± 3.75 to post: 16.91 ± 3.61, t(21) = 1.65, p = .114, d = 0.25), with a significant between-group difference (t(42) = 6.40, p < .001, d = 1.93). Obsessive passion decreased in the MAC group (pre: 23.73 ± 3.66 to post: 16.27 ± 2.86, t(21) = 7.54, p < .001, d = 2.04) while remaining unchanged in controls (pre: 18.00 ± 3.85 to post: 18.41 ± 4.04, t(21) = 0.85, p = .406, d = 0.11), with a significant between-group difference (t(42) =-2.02, p = .050, d =-0.61). Subjective well-being improved markedly in the MAC group (pre: 9.00 ± 7.37 to post: 27.09 ± 7.47, t(21) = 8.37, p < .001, d = 2.45) compared to controls (pre: 4.54 ± 5.85 to post: 8.72 ± 6.08, t(21) = 0.65, p = .526, d = 0.71), with a significant between-group difference (t(42) = 6.85, p < .001, d = 2.07). MAC training represents an effective intervention for enhancing tennis performance, psychological well-being, and adaptive passion while reducing maladaptive passion. These findings support the clinical utility of mindfulness-based approaches in tennis psychology and warrant further investigation on a larger scale. © 2026 by the authors.
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    Ramadan intermittent fasting alters cardiac autonomic modulation, neuromuscular performance, and recovery in adolescent tennis players: a within-subject repeated-measures design
    (Taylor & Francis Ltd, 2026) Lakhdar, Nadia; Landolsi, Mounir; Ghouili, Hatem; Ceylan, Halil Ibrahim; Ceylan, Nagihan Burcak; Muntean, Raul Ioan; Dergaa, Ismail
    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.