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Abdullah M Alzahrani,1– 3,&ast; Razan Rambo,1– 3 Fahad Alotain,1– 3 Anjum Naeem,1– 3 Rami M Alzhrani,4 Mohammad A Albaradi,1– 3 Shoeb Althubiani,1– 3 Shahd E Sharaf,1– 3 Ali F Alwadie,1– 3 Mohammad S Alzahrani,5 Noor T AlSebaih,6 Randa H Ainosah,7 Yahya A Alzahrani7,&ast; 1Pharmaceutical Care Department, Ministry of National Guard—Health Affairs, Jeddah, 22384, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, 21423, Saudi Arabia; 3College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, 22384, Saudi Arabia; 4Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif, 21944, Saudi Arabia; 5Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, 21944, Saudi Arabia; 6Pharmaceutical Care Department, King Fahad Armed Forces Hospital, Jeddah, 23311, Saudi Arabia; 7Department of Pharmacy, East Jeddah Hospital, Ministry of Health, Jeddah, 23816, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Yahya A Alzahrani, Department of Pharmacy, East Jeddah Hospital, Ministry of Health, Jeddah, 23816, Saudi Arabia, Tel +966557700178, Email yalzahrani5@moh.gov.saPurpose: Patient satisfaction with pharmacy services, particularly in outpatient and discharge pharmacy settings, has become a vital metric for assessing medical quality. However, there’s limited research on patient satisfaction in discharge pharmacy services in the Kingdom of Saudi Arabia (KSA). This study aims to systematically investigate and delineate the various patient-related and non-patient-related factors that significantly impact patient satisfaction in the realm of discharge pharmacy services.Patients and Methods: This cross-sectional study was conducted over three months at King Abdulaziz Medical City in Jeddah (KAMC-J). The sample size was determined using a single population proportion formula, which resulted in a required sample size of 384 patients. A validated questionnaire with a five-point Likert scale evaluated satisfaction from “Strongly Dissatisfied” (1 point) to “Very Satisfied” (5 points) has been used. Data collectors underwent training and obtained written consent from participants, with questionnaire completion taking 5– 10 minutes face to face.Results: The study encompassed 437 participants, primarily male (59%) with a college education (45.3%), residing mostly in Jeddah (67.3%). Notably, 84.4% were not healthcare providers, and most visited the pharmacy every six months (44.6%). The patient satisfaction survey revealed high scores for counseling understanding, pharmacist courtesy, and the way the pharmacist answered questions (4.94± 0.31, 4.94± 0.27, 4.94± 0.32; respectively), but lower for understanding possible side effects (4.30± 1.30) and pharmacy location (4.57± 0.99). In logistic regression, visits lasting 10– 15 minutes, and less than 10 minutes were significantly (p< 0.05) associated with increased odds of patient satisfaction (OR=6.39, OR=9.45; respectively) Moreover, the medium length hospital stay was associated with decreased odds of patient satisfaction (OR=0.31, p=0.026).Conclusion: In conclusion, the study determined a significant proportion of patients are satisfied with discharge pharmacy services at KAMC-J, with the length of consultation and hospital stay being pivotal to their satisfaction. Addressing these factors, alongside optimizing pharmacist-patient communication and pharmacy service efficiency, can substantially elevate the quality of pharmaceutical care and patient experience.Keywords: King Abdulaziz medical city, KAMC-J, Discharge pharmacy, Patient Satisfaction, Counseling Services, Pharmacist-Patient Relationship, Pharmacy Location and Environment

Background: Several studies examined the reciprocal relationship between knee osteoarthritis (KOA), depression, and postural balance separately; however, few studies have investigated the relationship between them. Therefore, this study aimed to identify the relationship between postural balance and depression among patients with KOA in Saudi Arabia. Methods and Results: A total of 71 patients with KOA were recruited (36 males, 35 females) with a mean age of 55.0±8.6 years, mean knee pain of 7.2±1.0, and mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) of 44.9±11.6. Depression was measured using the Hospital Anxiety and Depression Scale (HADS). The participants were asked to complete the HADS, rate their pain in both knees using the Visual Analogue Scale (VAS) and the WOMAC, and undergo the Berg Balance Scale (BBS) to assess the postural balance. A significantly strong negative correlation was observed between postural balance and anxiety and depression in all the participants (BBS and HADS: r= −0.920, P

Perilunate dislocation is a rare carpal dislocation, which are predominantly trans-styloid and trans-scaphoid. This type of fracture dislocation is seen due to axial loading of a hyperextended ulnar-deviated wrist. This can result in the disruption of the scapholunate, lunocapitate, and lunotriquetral ligaments. The lunate may dislocate volar or dorsal to the other carpal bones. Herein, we have reported a case of trans-styloid, trans-scaphoid perilunate fracture dislocation with carpal tunnel syndrome, which has never been reported in the literature. A 38-year-old construction worker presented with a swollen hand and signs of carpal tunnel syndrome. The patient was diagnosed with perilunate fracture dislocation after a through clinical and radiological assessment. The scaphoid had invaginated into the radial styloid and demonstrated a comminuted fracture pattern. Volar lunate displacement was identified, and the patient demonstrated signs of carpal tunnel syndrome, which is not a common presentation. Open reduction with ligament repair was performed to minimize jeopardizing the hand function. Spelt tea cup sign is a diagnostic for perilunate dislocation. Operative exploration and reduction is imperative for failed closed lunate dislocation reduction to minimizes ongoing soft tissue jeopardy. Moreover, carpal tunnel release is indicated in the present of symptomatic carpal tunnel syndrome. To our knowledge, only a few cases of trans-styloid, trans-scaphoid perilunate dislocation with neurological deficit have been reported.

Helalah Alenizy,1 Nouran Aleyeidi,2 Reema Almutairi,3 Leen Khosyfan,3 Raghad Bedaiwi,3 Leen Alowaidah,3 Hissah Alrushud,3 Khawla Alfadda,3 Lujain A Alshamekh,3 Najd Al Anazi,3 Shuruq Alshammari,3 Amal Alzahrani,3 Hanin Alomar3 1Obstetrics and Gynecology, Department of Obstetrics and Gynecology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 2Community Medicine, Department of Family and Community Medicine, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 3College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi ArabiaCorrespondence: Nouran Aleyeidi, Department of Family and Community Medicine, College of Medicine, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Tel +966 504304577, Email naaleyeidi@pnu.edu.saBackground: Menstruation is a natural process that occurs monthly in women. Although menstruation is a fundamental aspect of women’s lives, their readiness for and beliefs about menstruation vary. Moreover, their practices during menstruation can be influenced by various factors, including age, education level, mother’s education, and field of specialty. This study aimed to explore menstruation-related readiness, beliefs, and practices among women who had experienced menstruation in Saudi Arabia. In addition, the study aimed to evaluate the factors affecting these women’s readiness, beliefs, and practices regarding menstruation.Patients and Methods: This cross-sectional online questionnaire-based study included 3471 women of different ages who had experienced menstruation. The participants were selected using convenience sampling from all regions of Saudi Arabia. The questionnaire was distributed between late December 2022 and March 2023 and included questions on demographics and menstruation-related readiness, beliefs, and practices.Results: Of the 3471 participants, 1627 (46.8%) were well prepared for menstruation. In addition, most of the study participants (80.2%) had positive beliefs about menstruation. However, the participants’ menstrual practices varied. Over half of the participants (63%) used painkillers and approximately half (54.4%) used herbal medicine during menstruation.Conclusion: This study found that less than half of the participants were ready for menarche. In contrast, most participants displayed positive beliefs concerning menstruation. In terms of practices, the women exhibited certain dietary restrictions during their menstrual period and predominantly favored herbal remedies for pain relief over conventional painkillers. Implementing awareness campaigns and incorporating school education on menstrual readiness and hygiene is needed.Keywords: women’s health, gynecology, menarche, hygiene, herbal medicine, menstrual pain

Uncommon genetic illnesses pose significant challenges for detection due to their low occurrence and intricate genetic makeup. Traditional targeted genetic testing methods are often limited, missing rare or unidentified genetic variations. This project proposes a novel strategy that leverages Whole-Genome Sequencing (WGS) data and Random Forest (RF) analysis to overcome these limitations. WGS provides a comprehensive view of an individual's genetic profile, capturing a wide array of genetic variations that targeted approaches might overlook. By employing the RF method, which excels at handling complex datasets and detecting non-linear interactions, this project aims to uncover intricate links between rare genetic diseases and gene variations. The Swedish Genome Reference dataset will serve as the foundation for this research. RF analysis will be applied to this extensive dataset to identify patterns and connections that might reveal new genetic markers and previously unknown risk factors for these illnesses. This approach allows for exploring vast genetic datasets to detect structures and associations, providing deeper insights into the genetic underpinnings of rare diseases. Combining WGS with RF analysis offers a powerful tool for discovering genetic indicators and risk factors contributing to rare genetic disorders, achieving an accuracy rate of 97 %. This innovative approach can significantly enhance understanding, diagnosis, and treatment of these conditions. By highlighting the value of advanced computational techniques and comprehensive WGS databases, the project aims to pave the way for more personalized and specialized medical treatments, ultimately improving patient outcomes for those affected by rare genetic diseases.

Spontaneous stress fracture of the scapular spine associated with rotator cuff tendinopathy is a rare complication in an elderly patient. Rotator cuff tendinopathy is a common condition characterized by degeneration and inflammation of the rotator cuff tendons. On the other hand, stress fractures are small cracks or breaks in bones that occur in response to repetitive or excessive mechanical loading. We present a rare case of a 79-year-old female patient complaining of persistent right shoulder pain that was unresponsive to medication which worsened in the last week and associated with a limited range of motion and inability to raise her arms above her head. Imaging studies revealed a nondisplaced fracture involving the mid-aspect of the scapular spine with surrounding callus formation and adjacent reactive changes. Stress fractures are often observed in weight-bearing bones, but they can also occur in non-weight bearing bones like the scapular spine. The association between rotator cuff tendinopathy and stress fractures of the scapular spine is uncommon and not well-documented in the literature. The biomechanics of the shoulder joint and altered force transmission due to rotator cuff pathology may contribute to the development of stress fractures. This case highlights the need to consider uncommon complications, such as stress fractures, in patients with shoulder pain. A comprehensive approach and early recognition of rare complications can guide appropriate diagnostic and treatment strategies to prevent potential complications and optimize patient outcomes.

الملخص: أهداف البحث: السكتة الدماغية هي أحد الأسباب الرئيسية للوفاة وضعف الوظيفة الجسدية. أصبحت عملية استئصال الخثرة داخل الأوعية الدموية الآن هي المعيار المعترف به لعلاج السكتة الدماغية الإقفارية الحادة في الدورة الدموية الأمامية مع انسداد الأوعية الدموية الكبيرة، وخاصة عندما تكون صور الدماغ المواتية واضحة في غضون 24 ساعة من ظهور الأعراض. تهدف هذه الدراسة إلى توضيح الخصائص والملامح السريرية ونتائج المرضى الذين خضعوا لاستئصال الخثرة داخل الأوعية الدموية للسكتة الدماغية الإقفارية الحادة. طريقة البحث: في تصميم مجموعة مستندة إلى السجلات بأثر رجعي، قمنا بمراجعة السجلات الطبية للأفراد الذين خضعوا لاستئصال الخثرة داخل الأوعية الدموية بسبب السكتة الدماغية الإقفارية الحادة في مستشفى الملك فهد العام في جدة، المملكة العربية السعودية. شملت الدراسة، التي أجريت من يوليو 2022 إلى نهاية أكتوبر 2023، تحليلا شاملا للعوامل السريرية والإشعاعية والعوامل المرتبطة بالوقت والنتائج المتنوعة. النتائج: في مجموعة مكونة من 117 مريضا بمتوسط عمر 58.5 عاما، كان 81 مريضا (69.2%) من الذكور. كان ارتفاع ضغط الدم والسكري من أكثر عوامل الخطر شيوعا، حيث أثرا على 48.7% و41% من المجموعة على التوالي. كان لدى ما يقرب من نصف المرضى درجة مواتية وفق برنامج ألبرتا للسكتة الدماغية للتصوير المقطعي المبكر (7-10)، وتلقى 45.3% منهم منشط البلازمينوجين عن طريق الوريد. حقق ما يقرب من ثلثي المرضى درجة 2ب في العلاج المعدل للاحتشاء الدماغي أو أعلى، وأظهر 39.3% انسداد الشريان الدماغي الأوسط-إم1. كان معدل حدوث التحول النزفي المصحوب بأعراض حوالي 13%، بينما حقق ثلث المرضى نتيجة مواتية حسب مقياس رانكين المعدل (0-2). ارتبطت عوامل مثل التقدم في السن، وارتفاع درجات مقياس السكتة الدماغية للمعاهد الوطنية للصحة، والإقامة الطويلة في المستشفى بنتائج أسوأ. وعلى العكس من ذلك، فإن غياب ارتفاع ضغط الدم والرجفان الأذيني، إلى جانب ارتفاع مقياس انحلال الخثرة في احتشاء دماغي، زاد بشكل كبير من احتمالية تحقيق نتائج إيجابية. الاستنتاجات: في دراستنا، أظهر مرضى استئصال الخثرة من الأوعية الدموية الذين تم فحصهم فئة عمرية أصغر سنا، حيث أظهرت النتائج السريرية والشعاعية درجة معينة من التشابه مع المنشورات الأخرى. ومن الجدير بالذكر أن غياب ارتفاع ضغط الدم والرجفان الأذيني، جنبا إلى جنب مع درجة أعلى في اختبار انحلال الخثرة في احتشاء دماغي، كان مرتبطا بزيادة احتمالية تحقيق نتيجة إيجابية Abstract: Background: Stroke is a significant contributor to both mortality and compromised physical function. Endovascular thrombectomy (EVT) is now the recognized standard of care for anterior circulation acute ischemic stroke (AIS) with large vessel occlusion (LVO), especially when favorable brain images are evident within 24 h of symptom onset. This study elucidated the characteristics, clinical profiles, and outcomes of patients who underwent EVT for AIS. Methodology: In this retrospective record-based cohort study, we reviewed the medical records of individuals who underwent EVT for AIS at King Fahad General Hospital in Jeddah, Saudi Arabia. The study, conducted from July 2022 through October 2023, encompassed a comprehensive analysis of clinical, radiological, and time-related factors and diverse outcomes. Results: In a cohort of 117 patients with a mean age of 58.5 years, 81 (69.2%) were male. Hypertension and diabetes mellitus were the most common risk factors, affecting 48.7% and 41% of the cohort, respectively. Approximately half of the patients had a favorable ASPECT Score (7–10), and 45.3% received intravenous tissue plasminogen activator (tPA). Nearly two-thirds achieved a modified thrombolysis in cerebral infarction (mTICI) score of 2b or higher, and 39.3% exhibited M1-middle cerebral artery (MCA) occlusion. The incidence of symptomatic hemorrhagic transformation was about 13%, whereas one-third of the patients attained a favorable mRs outcome (0–2). Factors such as advanced age, higher NIH Stroke Scale (NIHSS) scores, and prolonged hospital stays were associated with poorer outcomes. Conversely, the absence of hypertension and atrial fibrillation, along with higher TICI scores, significantly increased the likelihood of favorable outcomes, with P values of 0.015, 0.0490, and 0.025, respectively. Conclusions: In our study, the examined patients who underwent EVT were younger in age, with clinical and radiological outcomes showing some degree of comparability to other publications. Notably, the absence of hypertension and atrial fibrillation, combined with a higher TICI score, was associated with an increased likelihood of achieving a favorable outcome.

CONTEXT Early detection of lung cancer through screening can improve outcomes; yet public knowledge, attitudes, and practices regarding lung cancer screening in Saudi Arabia are limited. AIMS The aim is to assess knowledge, attitudes, and practices toward lung cancer risk factors and screening, and understand the impact of demographic factors on these variables. SETTINGS AND DESIGN An observational cross-sectional study was conducted from October 2023 to March 2024, involving 708 participants. METHODS A validated questionnaire from a previous Malaysian study, translated into Arabic, was distributed to participants. STATISTICAL ANALYSIS USED Descriptive statistics, Shapiro–Wilk test, one-way analysis of variance, Tukey’s test, and logistic regression were used. RESULTS Most participants (95.9%) recognized smoking as a major risk factor. Common misconceptions included viewing lung cancer as infectious (84.0%) or affecting only men (14.4%). Nonetheless, 66.4% expressed willingness for future screening. Younger participants (18–40 years) and those with higher education demonstrated better knowledge scores (mean score: 11.33 ± 2.97 for ages 18–40; 11.42 ± 2.88 for those with master’s or doctorate degrees), with significant differences based on age (P = 0.007) and education level (P = 0.025). No significant differences were observed based on gender, region of residence, or monthly family income. CONCLUSIONS There is a positive inclination toward lung cancer screening among the Saudi public, but there are significant knowledge gaps, particularly regarding nonsmoking-related risk factors and misconceptions, suggesting a need for enhanced public education and screening programs.

Sugarcane peel waste (SPW) modified by combustion was used as a sorbent for methylene blue (MB) in aqueous medium under the influence of parameters such as pH of the medium, initial MB concentrations, contact time, SPW dosage, and temperature using batch experiments. The microstructure of the adsorbent was analyzed using Fourier infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), energy dispersive X-ray analysis (EDX), and X-ray diffractometer (XRD). The quantity (mg/g) of adsorbed MB increased with increased contact time, rise in dye concentration, as well as the solution pH. Similarly, the temperature of the system improved the sorption effectiveness with maximum sorption capacity of 65.4 and 81.2% at 45 °C and 55 °C for USPW and MSPW, respectively. At an initial MB concentration of 100 mg/L, temperature of 45 °C and 55 °C, pH of 4, and reaction times of 80 and 60 min for unmodified sugarcane peel waste (USPW) and modified sugarcane peel waste (MSPW), respectively, optimal MB adsorption of 22.6 and 33.2 mg g-1, respectively, was achieved.

BACKGROUND: Diabetes mellitus (DM) is a primary cause of chronic kidney disease (CKD), a significant and growing global health issue. Primary healthcare physicians (PHPs) are crucial in detecting, managing, and preventing CKD, but many lack the necessary knowledge and skills to effectively diagnose and manage the disease. This study assessed the knowledge and competence of PHPs in managing diabetes-related CKD. MATERIALS AND METHODS: This cross-sectional study was conducted among all Primary Healthcare Physicians (PHPs) working at Primary Healthcare Center (PHC) in King Abdulaziz Medical City of the National Guard, Jeddah, Saudi Arabia. An online questionnaire was sent to all PHPs and data were collected from January 2024 to February 2024. Data analysis performed utilizing RStudio (version 4.3.1). Categorical variables were expressed as frequencies and percentages, whereas mean and standard deviations were computed for continuous variables. Kruskal–Wallis rank sum test was used to determine differences in confidence scores across various demographic and occupational characteristics. A multivariable linear regression analysis was performed to identify factors related to confidence. RESULTS: Of 141 PHPs, 122 filled online questionnaire yielding a response rate of 86.5%. responded. The majority (90.2%) were 18–45 years of age, 68.0% were qualified as family physicians, 38.0% belonged to the specialized poly clinic, and 54.9% had less than 5 years of experience. PHPs showed a varied levels of confidence and knowledge. While 76.2% were confident about the stages of kidney disease and 65.6% acknowledged the importance of the urine albumin-creatinine ratio (uACR) test, 58.1% were uncertain of interpreting uACR results and CKD diagnostic criteria. More than 60.0% were uncertain of the treatment steps postdiagnosis and prediction of CKD prognosis. Age, qualification, specialization in family medicine, and clinic affiliation were significantly related to confidence levels. CONCLUSION: The study underscores notable gaps in PHPs' knowledge and confidence concerning CKD screening, diagnosis, and management. Continuous education and targeted interventions are essential for the improvement of PHPs' competence and patient outcomes in the management of CKD.

Abstract This study evaluated the efficiency of an on-site household greywater treatment system for indirect human reuse and for domestic lawn irrigation. This helps in the reduction in the disparity between water demand and supply that is facing the rapidly increasing global populace. Natural household greywater was settled and then conventionally filtered by using two types of non-woven geotextile media; thermally bonded and needle punched. A third woven cotton textile media was also experimented and all the non-woven geotextile media were tested in single and double layers and combined with the woven cotton textile layer. The different filter media configurations were tested for a period of one year operation (six runs) with two filtration rates of 15.00 and 25.00 m3/m2/day for each run. For all runs, the final treated effluent was disinfected using calcium hypochlorite prior to reuse. The double layer needle punched non-woven geotextile media together with the woven cotton textile media gave the best removal efficiencies; 96.34 ± 1.85% for turbidity 81.87 ± 6.43% for BOD5, 97.49 ± 1.68% for TSS, 75.35 ± 3.99% for CODt, 99.59% for E.coli. The soluble CODs removal efficiencies were negligible (below 3%) in the first four runs with non-woven geotextile media and increased to 28.05 ± 4.29% when the woven cotton textile media was added. In general, the system was found to save about 63% of the daily water consumption reflecting a net 22.50% reduction in the daily water billing costs for the whole household.

Khalid M Alshamrani,1– 3 Dana A Alzahrani,1 Yara S Alghamdi,1 Lama M Aljohani,1 Ziyad F Al Nufaiei1– 3 1College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 3Ministry of the National Guard - Health Affairs, Jeddah, Saudi ArabiaCorrespondence: Khalid M Alshamrani, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, P. O. Box 9515, Internal Mail Code 6610, Jeddah, 21423, Saudi Arabia, Tel +966-12-2266666 Ext 46396, Email alshamranik@ksau-hs.edu.saBackground: Occupational hazards among healthcare workers (HCWs) present serious risks, from infectious diseases to physical and chemical dangers, along with psychological stress, all of which threaten their health and safety. This study aims to identify the unique challenges and hazards encountered by radiology technologists in in Saudi Arabia by assessing the key factors contributing to these risks.Methods: A descriptive questionnaire study was conducted in January-February 2023, targeting 75 radiology technologists at King Abdulaziz Medical City (KAMC), Jeddah, with participants recruited via non-probability convenience sampling and invited to complete a widely recognized questionnaire previously used among radiographers. Descriptive statistics were calculated, and the Kruskal–Wallis H-test was conducted to examine the relationships between demographic factors and different aspects of occupational hazards.Results: Of the 75 technologists contacted, 63 responded, resulting in an 84% participation rate. Workload, work shifts, and patient-related factors are major contributors to occupational hazards, surpassing technologist-specific and organizational elements. Additionally, 68.3% cited rigid leadership and unequal treatment as aggravating factors, while insufficient staffing, inadequate protective devices, and patient interaction were also significant concerns. Over 60% identified bending, lifting heavy patients, prolonged radiation exposure, and frequent walking as major hazard sources.Conclusion: Key occupational hazards factors facing radiology technologists include high workloads, work shifts, and patient-related issues, with 68.3% citing rigid leadership and unequal treatment as exacerbating risks. Insufficient staffing and protective devices, along with demanding work conditions, further heighten these hazards. This study emphasizes the need for targeted interventions in staffing, resources, and culture to improve radiology technologists’ safety. Keywords: healthcare workers, Kingdom of Saudi Arabia, occupational health, professional risk, radiologic technology, safety

Basem M Alraddadi,1,2 Emily LG Heaphy,3 Muhannad S Alzahrani,1 Mouad Alqadi,1 Moayad Sami Qashqari,1 Mohammed S Alhuthali,1 Mohammad Kamal Al Hroub,4 Lama Hefni,1 Abeer N Alshukairi,1,2 Yasser Aldabbagh,5 Mohammed Qutub6 1Medicine Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 2Medicine Department, Al Faisal University, Riyadh, Saudi Arabia; 3Research- Jeddah Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 4Infection Control & Hospital Epidemiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 5Department of Medicine, Al-Moosa Health Group, Al-Ahsa, Saudi Arabia; 6Pathology and Laboratory Medicine Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi ArabiaCorrespondence: Emily LG Heaphy, King Faisal Specialist Hospital and Research Center- Jeddah, Al Rawdah Road, P.O. Box 40047, Jeddah, 21499, Saudi Arabia, Email emily.lg.heaphy@gmail.comPurpose: The study aimed to determine the impact of Carbapenem-resistant Enterobacterales (CRE) colonization status on development of CRE infection and 30-day mortality outcomes in high-risk patients.Patients and Methods: This retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia from October 2022 to July 2023. It included all patients aged 14 years and older admitted to the intensive care unit (ICU), the renal transplant unit and the oncology units who were screened for CRE colonization upon hospital admission.Results: Overall, 246 patients comprised the study population and 37 patients (56.8% ICU, 13.5% renal transplant unit, and 29.7% oncology units) had a positive CRE screening test. The majority of the isolates (59.5%) were OXA-48. Almost one-third (32.1%) of the patients had diabetes mellitus and 55.3% had any underlying immunosuppression. Eight (3.3%) patients had a confirmed CRE infection and 35 (14.2%) patients died within 30 days of screening. A positive CRE screening test significantly increased the likelihood of 30-day mortality for this high-risk patient population (adjusted odds ratio [AOR] = 3.06, 95% CI = 1.10– 8.51, p = 0.03).Conclusion: A substantial percentage of the high-risk patients had a positive CRE screening test at the time of hospital admission and CRE-colonization status predicted 30-day mortality. Further studies are needed to determine the best practices for CRE screening as a strategy to prevent infection and mortality.Keywords: carbapenem-resistant enterobacterales, CRE, epidemiology, OXA-48, Saudi Arabia

Abstract Purpose The correlation between body weight and health is a significant public health concern. While the adverse effects of obesity on pulmonary function are well-known, the impact of being underweight remains debated due to limited research. This study aimed to investigate the correlation between Body Mass Index (BMI) categories and lung function parameters. Results A study of 3077 participants found significant differences in gender, age, height, and weight across various Body Mass Index (BMI) categories. The study found non-significant variations in forced expiratory flow (FVC) across BMI categories, with underweight individuals showing lower FVC compared to normal and overweight individuals. BMI significantly impacted mean forced expiratory flow during the middle half of FVC. A significant negative correlation was observed between age and FVC, FEV1, FEV1/FVC ratio, and FEF25-75. A significant positive correlation was observed between weight, height, and lung function parameters. Multiple regression analysis revealed a decrease in lung function with advancing age, while height showed significant positive associations. The study concluded that age, sex, smoking, height, and weight collectively explained 41.0% of the variance in FVC, FEV, and FEF25-75.

Abstract Background Two validated and effective extraction techniques have been developed to ascertain the presence of polycyclic aromatic hydrocarbons (PAHs) in traditional cigarettes and E-cigarettes. PAHs are a class of chemicals that occur naturally, and these contaminants may cause cancer and other harmful effects in human beings. Traditional cigarettes and E-cigarettes contain many PAHs. Method In terms of linearity, limit of detection, limit of quantification, accuracy (%), and precision (%), the two in-house lab setups for 7PAHs extraction from traditional cigarettes and E-cigarette were validated using high-performance liquid chromatography-fluorescence detection. Results The concentration of Σ7PAHs for traditional cigarettes and E-cigarettes ranged from 6.23 ± 0.04 ng/cig to 75.61 ± 0.02 ng/cig, and non-detectable to 3.56 ± 2.71 ng/puff. The PAHs recovery in traditional cigarettes and E-cigarettes ranged from 92.74–110.45%, and 97.20–111.74%. The toxicity of equivalent (TEQs) of carcinogens revealed that traditional cigarettes brands have higher TEQs than E-cigarettes. Conclusion This study highlights the detection of 7PAHs levels and its risk assessment in product brands for traditional cigarettes and E-cigarettes marketed in Saudi Arabia. The results suggested that the developed methods are a precise and versatile approach for measuring 7PAHs in traditional cigarettes and E-cigarettes.

Abstract Povidone-iodine is identified as one of the widely applicable antiseptic reagents for treatment of skin infection and wound healing. Controllable releasing of povidone-iodine is extensively required for healing of chronic wounds. The release of povidone-iodine was systematically studied from the composites based on carboxymethyl starch (CMS). Currently, different ratios from copper precursor and L-aspartic acid (L-AA) were interacted with CMS to obtain Cu-L-AA@CMS composites. Increment the percentage of L-AA was reflected in clustering of dense masses from the desirable composite with highly crystalline/stable structural network. Regardless to pH conditions, Cu-L-AA(30%)@CMS composite showed the highest efficiency for controllable release of povidone-iodine, whereas, the release percentages were estimated to be 58%, 32% and 18% at pH 5, 7 and 9, respectively. The kinetic results revealed the impossibility of povidone-iodine releasing via diffusion/erosion for further support of the hypothesis of releasing via swelling process. Moreover, the release of povidone-iodine using column technique showed that the lowest release was estimated at using high rate of 6 mL/min. Besides the biocompatibility and biodegradability of the prepared Cu-L-AA@CMS composites, it showed the superiority for controllable release of povidone-iodine antiseptic reagent to regulate its beneficial effect in curing of the skin.

Abstract Assessment of side effects associated with COVID-19 vaccination is required to monitor safety issues and acceptance of vaccines in the long term. We found a significant knowledge gap in the safety profile of COVID-19 vaccines in Bangladesh. We enrolled 1805 vaccine recipients from May 5, 2021, to April 4, 2023. Kruskal-Wallis test and χ2 test were performed. Multivariable logistic regression was also performed. First, second and third doses were administered among 1805, 1341, and 923 participants, respectively. Oxford–AstraZeneca (2946 doses) was the highest administered followed by Sinopharm BIBP (551 doses), Sinovac (214 doses), Pfizer-BioNTech (198 doses), and Moderna (160 doses), respectively. Pain at the injection site (80-90%, 3200–3600), swelling (85%, 3458), redness (78%, 3168), and heaviness in hand (65%, 2645) were the most common local effects, and fever (85%, 3458), headache (82%, 3336), myalgia (70%, 2848), chills (67%, 2726), muscle pain (60%, 2441) were the most prevalent systemic side effects reported within 48 h of vaccination. Thrombosis was only reported among the Oxford–AstraZeneca recipients (3.5-5.7%). Both local and systemic effects were significantly associated with the Oxford–AstraZeneca (p-value

Abstract Classification of pathogenic E. coli has been focused either in mammalian host or infection site, which offers limited resolution. This review presents a comprehensive framework for classifying all E. coli branches within a single, unifying figure. This approach integrates established methods based on virulence factors, serotypes and clinical syndromes, offering a more nuanced and informative perspective on E. coli pathogenicity. The presence of the LEE island in pathogenic E. coli is a key genetic marker differentiating EHEC from STEC strains. The coexistence of stx and eae genes within the bacterial genome is a primary characteristic used to distinguish STEC from other pathogenic E. coli strains. The presence of the inv plasmid, Afa/Dr adhesins, CFA-CS-LT-ST and EAST1 are key distinguishing features for identifying pathogenic E. coli strains belonging to EIEC, DAEC, ETEC and EAEC pathotypes respectively. Food microbiological criteria differentiate pathogenic E. coli in food matrices. ‘Zero-tolerance’ applies to most ready-to-eat (RTE) foods due to high illness risk. Non-RTE foods' roles may allow limited E. coli presence, which expose consumers to potential risk; particularly from the concerning Shiga toxin-producing E. coli (STEC) strains, which can lead to life-threatening complications in humans, including haemolytic uremic syndrome (HUS) and even death in susceptible individuals. These findings suggest that decision-makers should consider incorporating the separate detection of STEC serotypes into food microbiological criteria, in addition to existing enumeration methods. Contamination of STEC is mainly linked to food consumption, therefore, outbreaks of E. coli STEC has been reviewed here and showed a link also to water as a potential contamination route. Since their discovery in 1982, over 39,787 STEC cases associated with 1,343 outbreaks have been documented. The majority of these outbreaks occurred in the Americas, followed by Europe, Asia and Africa. The most common serotypes identified among the outbreaks were O157, the ‘Big Six’ (O26, O45, O103, O111, O121, and O145), and other serotypes such as O55, O80, O101, O104, O116, O165, O174 and O183. This review provides valuable insights into the most prevalent serotypes implicated in STEC outbreaks and identifies gaps in microbiological criteria, particularly for E. coli non-O157 and non-Big Six serotypes.

Primary hyperparathyroidism has emerged as a prevalent endocrine disorder in clinical settings, necessitating in most cases, surgical intervention for the removal of the diseased gland. This condition is characterised by overactivity of the parathyroid glands, resulting in excessive parathyroid hormone production and subsequent disturbances in calcium homeostasis. The primary mode of management is surgical treatment, relying on the accurate localisation of the pathological parathyroid gland. Precise identification is paramount to ensuring that the surgical intervention effectively targets and removes the diseased gland, alleviating the hyperfunctioning state. However, localising the gland becomes challenging, as discrepancies between the clinical manifestation of active parathyroid and radiological identification are common. Based on our current knowledge, to date, no comprehensive review has been conducted that considers all factors collectively. This comprehensive review delves into the factors contributing to false-negative 99mTc-Sestamibi scans. Our research involved an exhaustive search in the PubMed database for hyperparathyroidism, with the identified literature meticulously filtered and reviewed by the authors. The results highlighted various factors, including multiple parathyroid diseases, nodular goitre, mild disease, or the presence of an ectopic gland that causes discordance. Hence, a thorough consideration of these factors is crucial during the diagnostic workup of hyperparathyroidism. Employing intraoperative PTH assays can significantly contribute to a successful cure of the disease, thereby providing a more comprehensive approach to managing this prevalent endocrine disorder.

Brain tumors are a significant health concern worldwide, necessitating accurate and timely diagnosis for effective treatment planning and management. However, conventional methods for brain tumor identification through medical imaging analysis often face challenges related to accuracy, efficiency, and privacy concerns. Current approaches may struggle with limited datasets, privacy regulations hindering data sharing, and the need for specialized expertise in interpreting medical images. Accurately identifying brain tumors is pivotal in diagnosis, treatment planning, and patient prognosis. This research proposes a novel approach for advancing brain tumor identification by integrating Synthetic Generative Adversarial Networks with federated convolutional neural Networks in medical imaging analysis. Federated-CNNs are a type of neural network architecture designed for federated learning scenarios. In federated learning, model training occurs locally on data distributed across multiple devices or institutions without exchanging raw data. Federated CNNs allow collaborative model training across these distributed datasets by aggregating local model updates rather than exchanging raw data. This approach ensures that sensitive data remain localized within each participating institution, thus addressing privacy concerns in medical imaging analysis. Our methodology harnesses the power of GANs to generate synthetic brain MRI images, addressing data scarcity issues commonly encountered in medical imaging datasets. These synthetic images are then utilized in conjunction with Federated-CNNs, enabling cooperative model training between many healthcare institutions while maintaining the anonymity and privacy of data. Moreover, integrating Federated CNNs ensures that sensitive medical imaging data remain localized within participating institutions, addressing data privacy concerns and fostering collaboration among medical professionals. The research advances medical imaging analysis by introducing a novel methodology that leverages existing technologies to improve brain tumor identification accuracy. Specifically, the feature extraction phase using DenseNet121, implemented in MATLAB, achieves an outstanding accuracy of 99.82 % and outperforms Various existing methods, including Inception-V3, ResNet-18, and GoogleNet, demonstrating the efficacy of our approach in capturing discriminative features from medical imaging data. This high accuracy underscores the potential of our methodology to enhance diagnostic accuracy and clinical decision-making in neurology and oncology. The research offers a promising avenue for further exploration and innovation in medical imaging analysis, with significant implications for improving patient outcomes and advancing healthcare practices.

Wireless Body Area Networks (WBANs) play a crucial role in healthcare and various other domains by enabling continuous monitoring of vital signs and activities. However, challenges such as low-powered sensors, unstable links, and routing issues hinder their efficiency and reliability. In this paper, we propose the Thermal Aware High Throughput (TAHT) routing protocol to address these challenges. TAHT utilizes a multi-hop topology and prioritizes stable links for efficient routing, considering parameters like energy, link quality, and temperature. Through experimental evaluation, TAHT demonstrates a 10% to 20% improvement in throughput, a 15% reduction in temperature overheads, and enhanced overall performance compared to benchmark protocols. By effectively managing energy consumption, minimizing duplicate data transmissions, and optimizing routing paths, TAHT offers a novel solution to improve the reliability and sustainability of WBANs, thus advancing the field beyond previous efforts in the literature.

Hodgkin’s lymphoma (HL) and autism spectrum disorder (ASD) are a rare combination. Diagnosing and treating patients with this combination is challenging. Here, we report the case of a 19-year-old male with ASD and HL. Upon initial presentation to our clinic, the patient was very active with the clinical features of autism. Pathology confirmed stage IVBs HL of the mixed cellularity subtype. He received six cycles of Adriamycin, bleomycin sulfate, vinblastine sulfate, and dacarbazine and has been in remission for the last 4 years. This report presents the challenges in the diagnosis and treatment of a young patient with ASD and cancer and how to overcome them.

Background and Aim: Many primary care physicians (PCPs) believed that managing overweight and obesity is essential to their jobs, however, many believe that they were doing it ineffectively, unsatisfying, and had negative attitudes. We conducted this study to explore the knowledge, attitudes and adherence to obesity management guidelines, identify potential barriers that may prevent adherence of PCPs to obesity treatment guidelines. Methods: We conducted this cross-sectional study and conducted a questionnaire sent via email to all PCPs in the Ministry of Interior centers in Riyadh, Al-Kharj, AlQassim, Wadi Ad Dawasir, Hail and Tabuk in Saudi Arabia. Results: A total of 119 PCPs participated in the survey, 61 (51.3%) males and 58 (48.7%) females. All respondents (n = 119, 100%) answered correctly that obesity is a disease. Of PCPs surveyed, genetics accounted for 75.6% of the responses as the cause of obesity. 79.8% believed that the best way for patients with obesity to lose weight was to engage in regular physical activity. The majority of PCPs (87.4%) thought that treating obesity should be a top priority, and 88.2% would typically recommend obesity therapy to their patients. Around 68.9% of PCPs thought that it’s their patients’ responsibility to lose weight. The majority will recommend obesity treatment and 75.6% would talk to their patients about weight concerns, while 60.5% would refer their patients to obesity surgery. There was a positive significant association between higher knowledge and better attitude and better adherence to treatment guidelines. More experienced PCPs were more confident. The most common perceived barrier was the patients’ lack of desire to follow obesity treatment. Conclusion: Primary care clinics and PCPs play a crucial role in diagnosing and treating patients with obesity, according to Ministry of Health guidelines on the prevention and management of obesity. PCPs must not only acknowledge obesity as a chronic illness and the possible long-term consequences it may cause, but also provide comprehensive, multi-component interventions that include lifestyle changes, medication, and appropriate referrals for bariatric surgery when needed. Healthcare professionals must form a cooperative relationship with obese patients to ensure that the patients follow treatment protocols.

Ali S Alsudais,1,2 Waleed Mohammed Alshehri,3 Ahmed M Alrehaili,4 Reyadh Khalid Albeladi,5 Mohammed Khoshhal,4,6 Ahmed Albelowi,4 Raghad Saleh Alzahrani,1,2 Ahmed Alnabihi,1,2 Bader Bashrahil,1,2 Omar Alabbasi3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 3Department of Ophthalmology, King Salman Bin Abdulaziz Medical City, Madinah, Saudi Arabia; 4College of Medicine, Taibah University, Madinah, Saudi Arabia; 5College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 6Ohud Hospital, Madinah, Saudi ArabiaCorrespondence: Ahmed Alnabihi, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia, Tel +966569493360, Email Alnabihi.ahmed@gmail.comObjective: This meta-analysis evaluated the efficacy and safety of DEXTENZA, an intracanalicular dexamethasone insert, for the treatment of seasonal/perennial allergic conjunctivitis.Methods: Multiple databases, including PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, the Directory of Open Access Journals, and Scopus, were searched for randomized controlled trials (RCTs) comparing the efficacy of DEXTENZA with a placebo. The primary efficacy endpoint was the change in the conjunctival allergen challenge (CAC) model. The GRADE approach was used to assess the certainty of evidence, and the revised Cochrane risk of bias tool for randomized trials was employed to assess bias.Results: Four RCTs involving 323 participants met the eligibility criteria, and all had a low risk of bias. A meta-analysis revealed a statistically significant increase in the mean CAC change for conjunctival itching, with low heterogeneity among measurements at 3 minutes (P

Introduction: The Oral Health Impact Profile (OHIP) serves as a crucial tool in understanding the intricate relationship between oral health and systemic conditions like type 2 Diabetes. This study delves into the comparative analysis of OHIP in patients with and without type 2 diabetes, shedding light on the nuanced impact of this metabolic disorder on oral health-related quality of life (OHrQoL). By scrutinising factors such as oral discomfort, functional limitations and psychological well-being, this research aims to unearth valuable insights into the unique challenges faced by diabetic individuals in maintaining optimal oral health. Such findings hold immense significance in guiding tailored interventions and enhancing holistic healthcare approaches. Materials and Methods: A cross-sectional study was carried out with 232 diabetic and non-diabetic individuals. Clinical examinations were conducted, and a validated Arabic version of the OHIP-14 instrument was used. Data were analysed using the Statistical Package for the Social Sciences version 20.0. Results: In total, 232 patients with and without diabetes were included in this study. A statistically significant effect was observed amongst diabetic compared to non-diabetic participants (P = 0.015). The overall OHrQoL across the seven domains of participants with diabetes was significantly lower than those without diabetes (P = 0.0001). Oral lesions were more common and showed statistically significant effects amongst diabetic compared to non-diabetic patients (P = 0.0001). Conclusion: Patients with type 2 diabetes have shown undesirable oral health which impacted their quality of life compared to those without diabetes. Future research focusing on developing preventive interventional strategies for diabetic patients, in addition to enhancing the awareness of oral diseases and dental care amongst those patients, is highly encouraged. Developing a standardised protocol with a unified OHrQoL instrument and methodological statistical analysis approaches that could be generalised and used worldwide periodically amongst diabetic patients may also be advocated.

BACKGROUND: Nocturnal enuresis (NE) is defined as any intermittent incontinence while sleeping in a child over the age of 5. This disorder can have emotional and psychological implications. Here, we performed the first meta-analysis to provide an overall assessment of the prevalence of NE and the factors associated with it in Saudi Arabia. We also examined its psychological impact and mothers' behavior in dealing with this disorder. PATIENTS AND METHODS: A thorough search was conducted on PubMed, Scopus, Cochrane, and Web of Science databases for studies assessing the prevalence of NE. Comprehensive Meta-Analysis Version 3.3 was used to conduct the analysis. We evaluated NE prevalence, NE frequencies, NE by time, social shame and embarrassment in children with NE, and mothers seeking medical advice. A meta-regression analysis was performed to determine the correlation between the frequency of NE and NE in parents, NE in siblings, gender, and age. The quality of the included studies was assessed by Newcastle Ottawa Scale. RESULTS: Sixteen cross-sectional studies, totaling 14 284 participants, were included. NE prevalence was 24.8% (95% CI: 17, 34). The prevalence of NE one to two times per week was 26.8% (95% CI: 15.1, 43.0), three to four times was 31.8% (95% CI: 18.5, 48.9), and five to seven times was 33.8% (95% CI: 18.2, 54.1). NE occurring at night was 24.4% (95% CI: 22.8, 26.2) and at day and night was 16.6% (95% CI: 15.3, 17.9). A significant difference was found between the regions of Saudi Arabia in the prevalence of NE, with the southern and eastern regions having the highest prevalence and the central region having the lowest prevalence. The overall pooled prevalence of embarrassment and social shame in children with NE was 63% (95% CI: 46, 77). The percentage of mothers seeking medical advice was 54.4% (95% CI: 39.7, 68.3). The prevalence of NE is positively correlated with the prevalence of NE in parents and siblings, but no association was found with males or age. CONCLUSION: A quarter of Saudi Arabian children suffer from NE, and it is associated with feelings of embarrassment and social shame. Half of the mothers seek medical counseling. Having parents or siblings with NE increases the likelihood of NE in the child. Future research is needed to corroborate the findings of other risk factors, such as age and gender. Future research will also be required to identify the precise causes or effects within each region that contribute to the varying prevalence of NE.

Abstract The Internet of Things (IoT) generates substantial data through sensors for diverse applications, such as healthcare services. This article addresses the challenge of efficiently utilizing resources in resource-scarce IoT-enabled sensors to enhance data collection, transmission, and storage. Redundant data transmission from sensors covering overlapping areas incurs additional communication and storage costs. Existing schemes, namely Asymmetric Extremum (AE) and Rapid Asymmetric Maximum (RAM), employ fixed and variable-sized windows during chunking. However, these schemes face issues while selecting the index value to decide the variable window size, which may remain zero or very low, resulting in poor deduplication. This article resolves this issue in the proposed Controlled Cut-point Identification Algorithm (CCIA), designed to restrict the variable-sized window to a certain threshold. The index value for deciding the threshold will always be larger than the half size of the fixed window. It helps to find more duplicates, but the upper limit offset is also applied to avoid the unnecessarily large-sized window, which may cause extensive computation costs. The extensive simulations are performed by deploying Windows Communication Foundation services in the Azure cloud. The results demonstrate the superiority of CCIA in various metrics, including chunk number, average chunk size, minimum and maximum chunk number, variable chunking size, and probability of failure for cut point identification. In comparison to its competitors, RAM and AE, CCIA exhibits better performance across key parameters. Specifically, CCIA outperforms in total number of chunks (6.81%, 14.17%), average number of chunks (4.39%, 18.45%), and minimum chunk size (153%, 190%). These results highlight the effectiveness of CCIA in optimizing data transmission and storage within IoT systems, showcasing its potential for improved resource utilization and reduced operational costs.

Abstract Introduction Graves’ disease (GD) is an autoimmune disorder characterized by hyperthyroidism due to increased thyroid-stimulating hormone receptor antibodies (TRAb).The treatment of GD often consists of radioactive iodine therapy, anti-thyroid drugs (ATD), or thyroidectomy. Since few studies have collected data on remission rates after treatment with ATD in Saudi Arabia, our study aimed to assess the efficacy and the clinical predictors of GD long-term remission with ATD use. Method We conducted a retrospective chart review study of 189 patients with GD treated with ATD between July 2015 and December 2022 at the endocrine clinics in King Abdulaziz Medical City in Riyadh. All GD patients, adults, and adolescents aged 14 years and older who were treated with ATD during the study period and had at least 18 months of follow-up were included in the study. Patients with insufficient follow-up and those who underwent radioactive iodine (RAI) therapy or thyroidectomy as first-line therapy for GD were excluded from the study. Results The study sample consisted of 189 patients, 72% of whom were female. The patients’ median age was 38years (33, 49). A total of 103 patients (54.5%) achieved remission. The median follow-up period for the patients was 22.0 months (9, 36). Patients who achieved remission had lower mean free T4 levels (25.8pmol/l ± 8.93 versus 28.8pmol/l ± 10.82) (P value = 0.038) and lower median TRAb titer (5.1IU/l (2.9, 10.7)) versus (10.5IU/l (4.2, 22.5)) (P value = 0.001) than patients who did not achieve remission. Thirty-five out of 103 patients who achieved remission (34%) relapsed after ATD discontinuation. The patients who relapsed showed higher median thyroid uptake on 99mTc-pertechnetate scan than patients who did not relapse: 10.3% (5.19, 16.81) versus 6.0% (3.09, 12.38), with a P value of 0.03. They also received ATD for a longer period, 40.0 months (29.00, 58.00) versus 25.0 months (19.00, 32.50), with a P value of

Abdullah R Alzahrani,1 Doaa I Mohamed,2 Hebatallah H Abo Nahas,3 Dalia Alaa El-Din Aly El-Waseef,4 Abdulmalik S Altamimi,5 Ibrahim H Youssef,6 Ibrahim Abdel Aziz Ibrahim,1 Soha MY Mohamed,7 Yasmine Gamal Sabry,7 Alaa H Falemban,1 Nasser Attia Elhawary,8 Ghazi A Bamagous,1 Mariusz Jaremko,9 Essa M Saied10,11 1Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 2Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 3Zoology Department, Faculty of Science, Port Said University, Port Said, Egypt; 4Department of Histology and Cell Biology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 5Department of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia; 6Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 7Physiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 8Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia; 9Smart-Health Initiative and Red Sea Research Center, Division of Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia; 10Chemistry Department, Faculty of Science, Suez Canal University, Ismailia, Egypt; 11Institute for Chemistry, Humboldt Universität Zu Berlin, Berlin, GermanyCorrespondence: Essa M Saied, Institute for Chemistry, Humboldt Universität zu Berlin, Berlin, 12489, Germany, Email saiedess@hu-berlin.deIntroduction: Pulmonary fibrosis (PF) and tissue remodeling can greatly impair pulmonary function and often lead to fatal outcomes.Methodology: In the present study, we explored a novel molecular interplay of long noncoding (Lnc) RNA CBR3-AS1/ miRNA-29/ FIZZ1 axis in moderating the inflammatory processes, immunological responses, and oxidative stress pathways in bleomycin (BLM)-induced lung fibrosis. Furthermore, we investigated the pharmacological potential of Trimetazidine (TMZ) in ameliorating lung fibrosis.Results: Our results revealed that the BLM-treated group exhibited a significant upregulation in the expression of epigenetic regulators, lncRNA CBR3-AS1 and FIZZ1, compared to the control group (P< 0.0001), along with the downregulation of miRNA-29 expression. Furthermore, Correlation analysis showed a significant positive association between lnc CBR3-AS1 and FIZZ1 (R=0.7723, p< 0.05) and a significant negative association between miRNA-29 and FIZZ1 (R=− 0.7535, p< 0.05), suggesting lnc CBR3-AS1 as an epigenetic regulator of FIZZ1 in lung fibrosis. BLM treatment significantly increased the expression of Notch, Jagged1, Smad3, TGFB1, and hydroxyproline. Interestingly, the administration of TMZ demonstrated the ability to attenuate the deterioration effects caused by BLM treatment, as indicated by biochemical and histological analyses. Our investigations revealed that the therapeutic potential of TMZ as an antifibrotic drug could be ascribed to its ability to directly target the epigenetic regulators lncRNA CBR3-AS1/ miRNA-29/ FIZZ1, which in turn resulted in the mitigation of lung fibrosis. Histological and immunohistochemical analyses further validated the potential antifibrotic effects of TMZ by mitigating the structural damage associated with fibrosis.Discussion: Taken together, our study showed for the first time the interplay between epigenetic lncRNAs CBR3-AS1 and miRNA-29 in lung fibrosis and demonstrated that FIZZ1 could be a downregulatory gene for lncRNA CBR3-AS1 and miRNA-29. Our key findings demonstrate that TMZ significantly reduces the expression of fibrotic, oxidative stress, immunomodulatory, and inflammatory markers, along with epigenetic regulators associated with lung fibrosis. This validates its potential as an effective antifibrotic agent by targeting the CBR3-AS1/miRNA-29/FIZZ1 axis. Keywords: lung fibrosis, long noncoding RNA CBR3-AS1, miRNA-29, FIZZ1, trimetazidine, histopathology

Ziyad S Almalki,1 Abdullah M Alrashdi,1 Dalal E AlHuzaimi,2 Joud O Alotaibi,2 Malek M Alqahtani,1 Ruba D Alzahrani,2 Shahad A Alajmi,2 Rami R AlOsaimi,2 Salman M Majrashi,1 Abdullah K Alahmari,1 Ahmed M Alshehri,1 Abdulaziz I Alzarea,3 Mohammad Tarique Imam,1 Areej A Alshlowi2 1Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; 2College of Pharmacy, Almaarefa University, Riyadh, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Aljouf, Saudi ArabiaCorrespondence: Ziyad S Almalki, Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia, Tel +966 11 588 6059, Email z.almalki@psau.edu.saPurpose: This study aimed to explore the Willingness To Pay (WTP) of uninsured individuals in Saudi Arabia and the factors influencing their decisions regarding telemedicine services.Patients and Methods: This study used a cross-sectional survey design and convenience sampling to gather data from respondents aged 18 years or older who had visited healthcare facilities at least once in the past year and were uninsured. WTP was determined using the contingent valuation method, and a two-part regression model was applied to analyze the factors influencing WTP.Results: The study included 4232 participants and discovered that approximately 17.41% were willing to pay for telemedicine services. Those aged 60 and older, employed in the government or private sector, in higher socioeconomic quintiles, and experiencing chronic health issues showed a positive association with their WTP value. Conversely, individuals aged between 30 and 44 years, married, and unemployed exhibited a negative association with a lower WTP value.Conclusion: The findings indicate that most respondents hesitated to pay for telemedicine services, with a significant influence from sociodemographic characteristics, underscoring the need to promote telemedicine use among underserved populations and address health disparities.Keywords: healthcare, sociodemographic, questionnaire, contingent valuation method

The principles of water sustainability are not exclusive to one civilization without the other this make led the research problem to emerge as a question: "What is the methodology of water sustainability in Islamic architecture and how it can be used as a guide-line for achieving water sustainability in contemporary architecture?”. To answer this question the research in its theoretical study demonstrated three points, begun with presenting the functions of water in Islamic architecture, then it explained how Islamic architecture depended on water as a design tool in the process of place making, and it ended with determining the principles and criteria of water sustainability in Islamic architecture. The research determined the methodology of achieving water sustainability in Islamic architecture. Depending on this methodology the research analyzed two case study projects: Alhambra palace in Spain and Al-Ghuri Sabil in Egypt, and then the research applied this methodology in one of contemporary housing projects in Egypt, and this led the research to emphasize its main hypothesis which state “the principles and criteria of water sustainability which preexists in Islamic architecture can be used as a guide-line for achieving water sustainability in contemporary architecture”.

Abdullah Dalboh,1 Walid M Abd El Maksoud,1 Khaled S Abbas,1 Hassan A Alzahrani,1 Mohammed A Bawahab,1 Fahad S Al Amri,1 Marei H Alshandeer,1 Maha A Alghamdi,1 Meshal S Alahmari,2 Abdulaziz M Alqahtani,2 Mansour S Alqahtani,2 Aljohrah M Alqahtani,2 Leinah H Alshahrani2 1Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia; 2College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Walid M Abd El Maksoud, General Surgery Department, Faculty of Medicine, King Khalid University, P. O. 641, Abha, 61421, Saudi Arabia, Tel +966543128555, Email wabdulmksoud@kku.edu.saBackground: The relationship between laparoscopic sleeve gastrectomy (LSG) and gastroesophageal reflux disease (GERD) is intricate. Hiatal hernia repair or gastropexy can have an impact on postoperative GERD.Aim: To assess the effect of the repair of an accidentally discovered HH and/or gastropexy on the development of de novo postoperative GERD symptoms after LSG.Methods: This retrospective study included all obese patients who underwent LSG at our hospital from January 2018 to June 2022. The data retrieved from patients’ files comprised demographic and clinical data, including BMI, GERD symptoms, and comorbidities. Hiatal hernias, surgical technique, gastropexy, duration, and intraoperative complications were recorded. Postoperative data included early and late postoperative complications, weight loss, de novo GERD, and medication use.Results: The study included 253 patients, 89 males (35.2%) and 164 females (64.8%), with a mean age of 33.3± 10.04 years. De novo GERD was detected in 94 individuals (37.15%). HH was accidentally found and repaired in 29 patients (11.5%). Only 10.3% of LSG and HH repair patients had de novo GERD symptoms, compared to 40.6% of non-HH patients. 149 patients (58.9%) had gastropexy with LSG. Postoperative de novo GERD symptoms were comparable for LSG with gastropexy (40.5%) and LSG alone (40.9%).Conclusion: After one year, concurrent hiatal hernia repair and LSG seem to be safe and beneficial in lowering postoperative de novo GERD symptoms. The inclusion of gastropexy with LSG had no significant impact on postoperative de novo GERD. Both HH repair and gastropexy lengthened the operation but did not increase its complications.Keywords: Obesity, Laparoscopic sleeve gastrectomy, Gastroesophageal reflux disease, GERD, Hiatal hernia, Gastropexy

Introduction: Epilepsy is a neurological disorder characterised by recurrent unprovoked episodes of seizures. A seizure is a frightening event, especially when it lasts more than five minutes, known as status epilepticus, which, if not treated promptly, can lead to brain injury. Understanding first aid for a seizure is crucial and may save the patient’s life. Aim: To assess school teachers’ knowledge about epilepsy, their attitudes toward epileptic patients, and the factors that affect teachers’ knowledge in Al-Baha City. Materials and Methods: This cross-sectional study was conducted in Al-Baha City, Saudi Arabia, from November 2021 to May 2022. A total of 305 teachers working in various randomly selected schools, equally distributed between male and female schools, were enrolled. Data were collected through an electronic questionnaire to evaluate teachers’ knowledge and attitudes toward epilepsy. Statistical analysis was performed using the Chi-square test, with data considered statistically significant when the p-value was less than 0.05. Results: In the present study, out of 305 subjects, 167 (54.8%) were male, and the majority, 137 (44.9%), were aged between 35-44 years. Of the participants, 214 (70.2%) were found to have poor knowledge about epilepsy, particularly regarding its etiology, impact on learning, and treatment options. There was a positive attitude among 211 (69.2%) participants toward hiring epileptic patients in their businesses and 240 (78.7%) responded positively to allowing their children to play with epileptic patients. However, 125 (41%) participants had a negative attitude toward allowing their offspring to marry an epileptic patient. Conclusion: The school teachers’ knowledge about epilepsy was poor. While their attitudes were positive regarding hiring epileptic patients and allowing their children to play with them, their attitude was negative regarding allowing their offspring to marry an epileptic patient.

BackgroundThe coronavirus disease (COVID-19) pandemic has presented unprecedented stressors and difficulties for healthcare professionals. This study explored the prevalence of generalized anxiety disorders and burnout among radiology practitioners and interns in various hospitals in Saudi Arabia after the end of the COVID-19 global public health emergency.MethodsA cross-sectional survey of 230 radiology practitioners and interns was conducted between October and November 2023. This study utilized the Generalized Anxiety Disorder 7-item (GAD-7) scale and Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP) 22-item questionnaire, employing a non-probability convenience sampling method. The average scores of the individual components constituting the GAD-7 scale and each burnout scale were calculated, and statistical analyses were conducted using the Mann-Whitney U and Kruskal-Wallis H nonparametric tests.ResultsOf 382 radiology practitioners and interns, 230 (60.2%) responded to the survey. Notably, 42.6% of the participants reported experiencing GAD. Regarding burnout, 82.3% were at moderate-to-high risk for emotional exhaustion, 93.5% for depersonalization, and 52.1% for personal achievement. The 31–40 years age group showed significantly higher burnout rates (p = 0.001) compared with the other age groups. Those with more than three years of experience had notably higher emotional exhaustion scores (p = 0.002) and a nearly significant increase in depersonalization scores (p = 0.051) than those with less experience.DiscussionOur study revealed that 42.6% of radiology practitioners and interns experienced GAD, with the majority facing significant burnout. Furthermore, our research indicates a decline in GAD levels among radiology practitioners and interns compared with the peak COVID-19 pandemic period. It also showed a significant increase in both the incidence and severity of burnout, surpassing pre-pandemic levels in a comparable cohort. These findings emphasize the pressing challenges of GAD and burnout among healthcare workers, especially radiology professionals.

Introduction: The ligamentum arteriosum is a structure that connects the pulmonary artery to the aorta in the developing fetus. After birth it usually undergoes fibrous degenerative changes and calcification. Ligamentum arteriosum calcification (LAC) can be mistaken for an esophageal perforation, especially in patients with suspected esophageal foreign bodies or suspected esophageal injuries. Case presentation: A 16-month-old boy underwent elective surgery for congenital lipomyelomeningocele. The endotracheal intubation was technically difficult due to an anterior position of the larynx. Postoperatively he developed high fever and an elevated white blood cell count, which were concerning for an esophageal perforation. A computerized tomography (CT) scan with oral contrast with the patient in left latera decubitus due to recent lower back surgery was done and showed a hyperdense line near the aortopulmonary window, resembling an esophageal contrast leak. Knowing that LAC was in the differential, and before proceeding with any major interventions for a presumed esophageal injury we did a barium swallow study, which confirmed that there was no esophageal perforation. The patient recovered well. Conclusion: LAC is an uncommon condition that is difficult to distinguish from a contrast leak secondary to an esophageal perforation. A lack of awareness of condition can lead to unnecessary intervention.

Despite the expected direct effects of radiation on DNA through its direct interaction with the biomolecule, research indicates that radiation also interacts with the DNA’s environment, resulting in indirect effects. Therefore, in this study, we explored the feasibility of using the quartz tuning fork (QTF) sensor system in biomedical applications, specifically in detecting DNA damage caused by low doses of gamma radiation, directly and indirectly. We differentiated between direct and indirect damage by analyzing the fork’s resonance frequency changes. This experiment was divided into three stages: before, during, and after irradiation. Each stage involved samples of pure DNA and DNA in a 60-µL aqueous solution, evaluated under identical conditions. Before irradiation, we measured frequency shifts (Δf) over a 20-min period, resulting in values of 19.34, 20.25, and 7.6 Hz for water, DNA, and DNA in water, respectively. Subsequently, the samples were irradiated with cesium-137 for the specified duration, resulting in frequency shifts of ∼ 39.21, 28.37, and 41.23 Hz for the same conditions. Our investigations showed an increase in Δf from 20.25 to 28.3 Hz at doses ranging from 7.5 to 30 µGy for pure DNA. Interestingly, DNA in aqueous solution exhibited hypersensitivity to radiation, with frequency shifts ranging from 7.6 to 41.23 Hz. Furthermore, we observed a significant difference in frequency shift after irradiation between pure DNA and DNA in water, with shifts of ∼ 70.75–98.45 Hz and 56.32–79.28 Hz for DNA and DNA in water, respectively. This result indicates a significant increase in DNA damage in aqueous environments, driven by the generation of active hydroxyl radicals (OH−), resulting in base damage and an associated increase in strand breaks. Consequently, our research indicates a lack of substantial direct impact on DNA repair owing to the absence of a conducive postirradiation environment. Therefore, QTF is a valuable biomarker for radiation sensitivity and is promising for future applications as a mass-sensitive biosensor.

Combining artificial intelligence (AI) and optimization techniques in the quest for environmental sustainability has emerged as a promising strategy. This paper explores the potential of a Federated Long Short-Term Memory (Fed LSTM) model in addressing environmental challenges through decentralized learning and efficient intelligence. Fed LSTM, a model tailored for government curricula, offers a novel method for analyzing and optimizing disaggregated environmental data across multiple sites while preserving data privacy. Its applications in environmental sustainability span various domains. Firstly, energy policy enables the creation of accurate local energy consumption forecasting models by integrating data from diverse sources such as buildings, infrastructure, and renewable energy installations. Secondly, in environmental monitoring, Fed LSTM facilitates the quantification of key parameters like biodiversity levels. Thirdly, resource efficiency optimizes the use of resources in agriculture, water management, and waste management, leading to more efficient resource management and reduced environmental impact. The benefits of Fed LSTM have the potential to significantly enhance environmental sustainability by providing adaptive solutions and new options for managing complex environmental challenges through decentralized and privacy-protected approaches. This paper advocates for further research and effective implementation of Fed LSTM in environmental sustainability initiatives to realize its full potential in promoting positive environmental development. With an accuracy of 99.2 %, surpassing existing methods, this approach is implemented using Python.

This study explored the nutritional qualities of black mash bean flour impacted by fermentation, gelatinization and their combination. Protease activity, in vitro protein digestibility (IVPD), and protein solubility were evaluated for both fermented and unfermented black mash bean flour samples. Interestingly, when compared to fermented samples and gelatinized mash bean flour (GMBF), raw mash bean flour (RMBF) showed the highest protein solubility. Due to enzymatic activity and protein hydrolysis, fermentation with Lactobacillus E14 and Saccharomyces cerevisiae MK-157 enhanced protein solubility. Prolonged fermentation timeframes were positively correlated with protease activity and IVPD, suggesting the degradation of complex proteins. The highest levels of IVPD (90.12%) and protease activity (5546.78 U/g) were detected in GMBF fermented by S. cerevisiae MK-157, indicating the impact of fermentation on protein breakdown. The Lactobacillus E14-fermented RMBF exhibited 5521.45 U/g of protease activity and 87.54% IVPD. The mineral content of the fermented samples was substantially greater than that of the unfermented GMBF. The increased calcium, magnesium, potassium, sodium, iron, zinc, and copper levels for the GMBF fermented by S. cerevisiae MK-157 indicated that fermentation facilitated the release of minerals from chelated compounds. Microscopic examination revealed higher protein quantities in the fermented flour as well as hydrolyzed and broken starch granules embedded in the protein matrix. Large mash bean proteins were shown to be proteolyzed during fermentation into smaller peptides by SDS PAGE. Storage proteins were extensively broken down during fermentation with S. cerevisiae MK-157, whereas Lactobacillus E14 displayed a more focused pattern of hydrolysis. The nutritional profile of black mash bean flour was improved by fermentation with Lactobacillus E14 and S. cerevisiae MK-157.

Faidherbia albida (Delile) A. Chev, a type of tree in the Leguminosae family, has several traditional uses. This study investigates the antioxidant properties, phenolic and flavonoid contents, nitric acid modulatory effects, and cytotoxicity of methanolic and chloroform extracts of the bark and fruits of Faidherbia albida. Various assays were performed to evaluate the antioxidant properties of the extracts, including the Folin-Ciocalteu and AlCl3 tests, the oxygen radical absorbance capacity (ORAC), the purple diphenyl picrylhydrazine (DPPH) scavenging ability, and the Ferric Reducing/Antioxidant Power (FRAP). The ability of the extracts to modulate the production of nitric oxide (NO) was assessed, and the cytotoxicity of the extracts was evaluated in cultured cells. Additionally, a bibliometric analysis was performed on related research documents. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to evaluate the cytotoxicity of the extracts in cultivated RAW 264.7 cells. A bibliometric analysis of 362 research documents related to F. albida published since 1913 was performed to understand the current state of knowledge to identify areas for further research using bibliometric computer packages. The results showed that the bark methanolic extract had the highest phenolic content, while the chloroform extract of the fruits had the highest flavonoid content. The chloroform extract of the fruits exhibited the highest inhibition of NO production. The extracts exhibited low cytotoxicity. The methanolic extract of the bark exhibited the strongest radical scavenging activities for FRAP and DPPH. The ORAC assay revealed that the antioxidant capacity of the methanolic extract of the fruits and the chloroform extract of the bark were approximately four times greater than that of quercetin, which is a known antioxidant compound. F. albida exhibits a significant antioxidant activity, which is influenced by both solvent polarity and specific botanical components.

Madrid–Barajas Airport (MAD) is the fourth-busiest airport in Europe. The aerosol chemical composition and the concentrations of other key pollutants were measured at the airport perimeter during October 2021 to assess the impact of airport emissions on local air quality. A high-fidelity ambient instrumentation system was deployed at Madrid–Barajas Airport to measure the following: concentrations of organic aerosols (with their composition), black carbon (eBC), carbon dioxide (CO2), carbon monoxide (CO), nitrogen dioxide (NOx), sulfur dioxide (SO2), particulate matter (PM2.5, PM10), total hydrocarbon (THC), and total particle number. The average concentrations of eBC, NOx, SO2, PM2.5, PM10, CO, and THC at the airport for the entire campaign were 1.07 µg m−3, 22.7 µg m−3, 4.10 µg m−3, 9.35 µg m−3, 16.43 µg m−3, 0.23 mg m−3, and 2.30 mg m−3, respectively. The source apportionment analysis of the non-refractory organic aerosol (OA) using positive matrix factorisation (PMF) allowed us to discriminate between different sources of pollution, namely less oxidised oxygenated organic aerosol (LO-OOA), alkane organic aerosol (AlkOA), and more oxidised oxygenated organic aerosol (MO-OOA). The results showed that LO-OOA and MO-OOA account for more than 80 % of the total organic particle mass measured near the runway. Trace gases correlate better with the AlkOA factor than LO-OOA and MO-OOA, indicating that AlkOA is mainly related to primary combustion emissions. Bivariate polar plots were used for pollutant source identification. Significantly higher concentrations of the obtained factors were observed at low wind speeds ( m s−1) from the southwest, where two of the runways and all terminals are located. Higher SO2/NOx and CO/eBC ratios were observed when the winds originated from the northeast, where the two northern runways are located. These elevated ratios are attributed to the aircraft activity being the major pollutant source in the northeast area.

Eosinophilic esophagitis is an antigen-mediated chronic inflammatory disorder that has risen in incidence and prevalence over the past 2 decades. The clinical presentation is variable and consists of mainly esophageal symptoms such as dysphagia, heartburn, food impaction, and vomiting. Current management relies on dietary elimination, proton-pump inhibitors, and topical corticosteroids with different response rates and relapses after treatment discontinuation. With a better understanding of the underlying pathophysiology, many molecules emerged recently as targeted treatment including dupilumab (IL4/IL13 blocker), as the first FDA-approved biological treatment, which has changed the management paradigm.

Abstract Background Castanea sativa Mill. is important for ecosystems and societies. Its rich historical and cultural significance, remarkable ecological contributions, and diverse applications have inspired scientific research. This comprehensive review and conceptual mapping of chestnut research consolidates existing knowledge, identifies emerging trends, and highlights untapped potential to inform future investigations. First, the Scopus database was searched to retrieve all data-driven articles in English related to C. sativa published in English from 1951 to 2023. Second, the R language, Scopus Analytics, and VOSviewer were used to analyze the year of publication, authors, countries, affiliations, keywords, and citations. Finally, network analysis was performed to evaluate the hotspots and developmental trends of C. sativa. A total of 1889 research articles were recovered. Results The articles showed an exponential progression, with a regression coefficient of 0.9435 (R2) and an annual growth rate of 6.28%. Italy (19.87%), Spain (15.56%), Portugal (13.39%), Turkey (6.92%), and Switzerland (5.17%) were the most prolific countries. C. sativa (798), sweet chestnut (54), cryphonectria parasitica (44), honey (38), phenolic compounds (35), chestnut blight (33) and antioxidant activity (31) are the keywords that occur the most frequently. The main research groups in the thematic map are "forest management," "Cryphonectria parasitica," "wood," "Spain" and "ethnobotany." Research on C. sativa has all the basic, motor, niche, and emerging or declining themes. Forest management, drought, Gnomoniopsis smithogilvyi, C. sativa shells, amino acids, honey, phenolic compounds, hydrolyzable tannins, antioxidant capacity, antioxidants, and extractives are trending topics. Conclusions This bibliometric analysis highlights the importance of C. sativa research, revealing its ecological contributions, cultural significance, and diverse applications. Future studies should focus on forest management, drought resistance, and bioactive properties to ensure sustainable utilization.

Abstract This paper proposes a total fusion of blockchain and AI tech for tomorrow’s viable, rich in diversity and transparent fisheries. It outlines the main goal of tackling overfishing challenges due to lack of transparency and biodiversity depletion in the fisheries sector. With the use of blockchain technology, we can ensure that all fishery products are safely traced from their harvest up to when they get to the market— at the same time, AI algorithms are used in monitoring fish populations and predicting them plus decision-making processes which should be enhanced thus promoting bio-diversity and ensuring sustainability of fish stocks. Results show promise on using both technologies together: improving sustainability plus transparency in fisheries which would promote more fish biodiversity, while others including using an artificial intelligence system have not been confirmed yet by observations. The conclusion underscores the transformative nature of these technologies as having great implications towards fisheries management; this implies that there is a need for future observational studies aimed at validating such other findings.

Concerns exist regarding increased toxicities, including endocrine therapy toxicity, with concurrent radiation and endocrine therapy in early breast cancer (EBC). We present a pragmatic, randomized trial comparing concurrent versus sequential endocrine and radiotherapy in hormone-responsive EBC. In this multicenter trial, patients were randomized to receive adjuvant endocrine therapy concurrent with, or sequential to, radiotherapy. The primary outcome was change in endocrine therapy toxicity from baseline to 3 months post radiotherapy using the Functional Assessment of Cancer Therapy–Endocrine Symptom (FACT-ES) score. From September 2019 to January 2021, 133 patients were randomized to concurrent endocrine and radiotherapy, and 127 to sequential treatment. Most patients were post-menopausal (72.7%, 189/260) with stage 1 disease (65.8%, 171/260). Tamoxifen was the endocrine therapy of choice for 69.6% (181/260) of patients, and an aromatase inhibitor for the remainder. The median total radiation dose and fractions were 40.1 Gray (range 26–50) and 15 fractions (range 5–25), respectively. For the primary outcome of change in endocrine therapy toxicity per FACT-ES scores from baseline to 3 months post radiotherapy, no significant difference was found between the groups (median [range] = −4.9 (−82, 38.8) for concurrent and −5.1 (−42, 40) for sequential, p = 0.87). This is the first trial to investigate the impact of concurrent versus sequential adjuvant endocrine and radiotherapy on endocrine therapy-related toxicities. The findings provide further support to allow the optimal timing of radiation and endocrine therapy to be tailored for the individual patient.

Background: The COVID-19 pandemic has had a significant impact globally, and understanding the relationship between inflammatory markers and disease progression is crucial for effective management. This retrospective study aimed to examine the association between various inflammatory markers, such as C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), D-dimer, ferritin, and procalcitonin (PCT), and the characteristics of disease progression and outcomes in individuals affected by COVID-19. Methods: This study collected raw data from 470 patients who tested positive for SARS-CoV-2 using RT-PCR. Results: The logistic regression analysis revealed that elevated LDH levels were associated with male gender, ICU admission, low oxygen saturation (O2 < 93%), the need for mechanical ventilation, death, and the presence of lung infiltrates. Higher D-dimer levels were associated with older age, diabetes mellitus, cardiac disease, and low oxygen saturation. Ferritin levels were significantly associated with older age, ICU admission, low oxygen saturation, mechanical ventilation, and lung infiltrates. In contrast, CRP was only significant regarding lung infiltrates and procalcitonin levels were not significantly associated with any of the examined factors. Conclusion: This study highlights the importance of monitoring key inflammatory markers, such as LDH, D-dimer, and ferritin, as they are significantly associated with the severity of COVID-19 illness. These findings can inform clinical decision-making and guide the development of targeted interventions to improve patient outcomes.

Abstract A robust finding in psycholinguistics is that prior language experience influences subsequent language processing. This phenomenon is known as syntactic priming. Most of the empirical support for L2 syntactic priming comes from lab-based experiments. However, this evidence might not reflect how priming occurs in typical language activities in the L2 classroom. As such, we conducted a classroom-based priming study. Using a between-subject design, 52 L2 Arabic speakers read and listened to eight story-reading sessions over two weeks that either included a high proportion of the fronted temporal phrase (TP) structure (experimental group) or included no fronted TPs (controls). The effect of L2 proficiency was also investigated. Results revealed that the experimental group did not significantly increase their use of fronted TPs in the immediate posttest or the one-week delayed posttest relative to the baseline. A null effect of Arabic L2 proficiency was also observed. We discuss our findings in light of related priming theories and previous findings. This study highlights the need for more research on syntactic priming via common language tasks in the L2 classroom.

Abstract Medical image fusion (MIF) techniques are proficient in combining medical images in distinct morphologies to obtain a reliable medical analysis. A single modality image could not offer adequate data for an accurate analysis. Therefore, a novel multimodal MIF-based artificial intelligence (AI) method has been presented. MIF approaches fuse multimodal medical images for exact and reliable medical recognition. Multimodal MIF improves diagnostic accuracy and clinical decision-making by combining complementary data in different imaging modalities. This article presents a new multimodal medical image fusion model utilizing Modified DWT with an Arithmetic Optimization Algorithm (MMIF-MDWTAOA) approach. The MMIF-MDWTAOA approach aims to generate a fused image with the significant details and features from each modality, leading to an elaborated depiction for precise interpretation by medical experts. The bilateral filtering (BF) approach is primarily employed for noise elimination. Next, the image decomposition process uses a modified discrete wavelet transform (MDWT) approach. However, the approximation coefficient of modality_1 and the detailed coefficient of modality_2 can be fused interchangeably. Furthermore, a fusion rule is derived from combining the multimodality data, and the AOA model is enforced to ensure the optimum selection of the fusion rule parameters. A sequence of simulations is accomplished to validate the enhanced output of the MMIF-MDWTAOA technique. The investigational validation of the MMIF-MDWTAOA technique showed the highest entropy values of 7.568 and 7.741 bits/pixel over other approaches.

Abstract Background Countries in the Middle East have some of the lowest rates of physical activity and some of the highest rates of obesity in the world. Policies can influence population levels of physical activity. However, there is a dearth of research on physical activity policies in the Gulf region. This qualitative study analyses cross-sectoral barriers and facilitators for the development, implementation and evaluation of physical activity policies in Saudi Arabia and Oman, two of the largest countries in the region. Methods Semi-structured interviews were conducted with 19 senior policymakers from the Ministries of Health, Education, and Sport in Saudi Arabia and Oman, and were examined using thematic analysis. Results We identified seven themes related to physical activity policies in Saudi Arabia and Oman: leadership; existing policies; physical activity programs related to policies; private sector policies; challenges; data/monitoring; and future opportunities. Both countries have a central document that guides policy-makers in promoting physical activity, and the available policies in both countries are implemented via multiple programs and initiatives to increase physical activity. Compared with Oman, in Saudi Arabia, programs from the non-profit sector, represented by community groups, play a more significant role in promoting physical activity outside the government framework. The private sector has contributed to promoting physical activity in both countries, but interviewees stated that more financial support is required. Policy limitations differ between Saudi Arabia and Oman: intersectoral collaboration in Oman is limited and mainly based on individuals’ own initiative, while the health transformation in Saudi Arabia tends to slow down policy implementation in relevant areas. Physical education in Saudi Arabia and Oman is similar; however, increased support and collaboration between government agencies and the private sector for out-of-school sports academies are needed. Conclusions This study addresses key gaps in analysing physical activity policies in Gulf Cooperation Council countries. Our study highlights the importance of increasing financial support, improving collaboration between governmental agencies and between them and the private sector and consolidating efforts to back physical activity policies and dismantle cross-sectoral barriers in Saudi Arabia and Oman. Educational institutions in Saudi Arabia and Oman play a crucial role in promoting physical activity from early childhood to young adults. Our insights assist policy-makers, public health officials and stakeholders in shaping effective physical activity-promoting policies, programs and interventions to prevent non-communicable diseases. Challenges identified in Saudi Arabia and Oman's policies will inform their future development.

Mazen Alzahrani,1 Omer Alammari,2 Abdulelah Binyamin,3 Raed Alsulami,1 Rawan Hawsawi2 1Department of Anterior Segment, Jeddah Eye Hospital, Jeddah, Saudi Arabia; 2Department of Anterior Segment, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3Department of Ophthalmology, King Fahad Armed Forces Hospital, Jeddah, Saudi ArabiaCorrespondence: Mazen Alzahrani, Email d.mazen@hotmail.comPurpose: The aim of this study was to assess changes in corneal parameters 6 months after corneal cross-linking for progressive keratoconus, using the ABCD system.Patients and Methods: This retrospective study was conducted at the King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia) between January 1 and July 30, 2022. This study included 16 eyes of 16 patients with keratoconus who underwent corneal cross-linking at the same hospital and were at least 18 years old. At least one preoperative (T0) and one postoperative examination was performed for each patient. Six months after the procedure (T1), patients underwent corneal tomography. The parameters A, B, C, and D were also evaluated. Other parameters monitored included maximal keratometry (Kmax) (K1 and K2), Belin/Ambrósio Enhanced Ectasia Display, and index vertical asymmetry. The progression of ectasia was identified by a consistent change in at least two parameters: steepening of the anterior corneal surface or the posterior corneal surface, thinning or an increase in the rate at which the corneal thickness changed from the periphery to the thinnest point, where the magnitude of the change was greater than the normal noise of the testing system.Results: Among the patients, 68.8% were men. The patients’ average age was 25.8± 5 years. Throughout the 6-month postoperative follow-up, parameters A, B, and C exhibited substantial changes (P = 0.000 for parameters A, B, and C). Parameter A increased 6 months after surgery, whereas parameters B and C decreased. Preoperatively and 6 months after surgery, Kmax, K1, and Belin/Ambrosio-enhanced ectasia demonstrated substantial differences. However, parameter D, K2, and the average pachymetric progression index did not change significantly.Conclusion: Anterior and posterior corneal curvatures and corneal thickness profiles can be useful for monitoring the progression of keratoconus and the success of the corneal cross-linking operation.Keywords: corneal cross-linking, keratoconus, ABCD grading system, topography