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Abstract Background COVID-19 preventive measures required a drastic shift to online teaching-learning in most of countries. Institutions used different combinations of live online lectures (synchronous) requiring students to attend the class in real-time, as well as recorded lectures uploaded by the instructors to be accessed by students as per their own convenience (asynchronous). We undertook this study to assess and compare the perceptions of students regarding their learning experiences in the synchronous versus asynchronous mode of instruction using their teaching-learning during the compulsory online mode of instruction at the peak of the COVID-19 pandemic. Methodology This cross-sectional questionnaire-based study received responses from 122 final-year medical students studying at the College of Medicine, King Khalid University, Abha, Saudi Arabia. An online 5-point Likert scale-based questionnaire was used to collect data regarding experience and perception towards synchronous and asynchronous learning. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P-value less than 0.05 was considered significant. Result All the students found both synchronous and asynchronous learning to be equally satisfying, enjoyable and comfortable. No statistically significant difference was found when both the methods were analyzed for enhancement of knowledge. The students opined that asynchronous learning helped them manage their time better whereas synchronous learning encouraged more interaction during the live lectures. Conclusion Overall, the students' perceptions regarding both synchronous and asynchronous online learning were positive. As both methods have their advantages/limitations, a mix of both synchronous and asynchronous methods may be adopted depending upon the content of the topic and the desired learning outcomes.

Background and Objectives: Intragastric balloon (IGB) is a safe option for obesity management. However, studies determining the factors influencing the procedure’s outcomes are scarce. Therefore, our goal was to determine the factors affecting weight reduction after IGB insertion. Materials and Methods: This retrospective study included 126 obese patients who underwent IGB treatment using the ORBERA® Intragastric Balloon System. Patients’ records were retrieved; and demographic data, initial body mass index (BMI), complications, compliance with both diet and exercise programs, and percentage of excess weight reduction were recorded. Results: The study included 108 female (85.7%) and 18 male (14.3%) patients. The mean age was 31.7 ± 8.1 years. The percentage of excess weight loss (EWL) was 55.8 ± 35.7%. The mean weight loss was 13.01 ± 7.51 kg. A significant association was found between EWL and age, initial weight, initial body mass index, and the number of pregnancies. No major complications were observed. However, the balloon had to be removed early in two patients (1.59%) due to its rupture and in two other patients (1.59%) due to severe gastritis. Conclusions: IGB therapy is a safe and effective option for obesity management, associated with low rates of complications. The EWL after IGB insertion is significantly higher among older patients, those with a relatively low initial body mass index, those with a longer duration of IGB insertion, and female patients with less parity. Larger prospective studies are needed to support our results.

Cervical thymic cysts (CTCs) are unusual lesions, representing only 1% of cystic cervical masses. Diagnosis of this condition in adults is even rarer. We report a 34-year-old female who presented with asymptomatic progressively growing left-sided neck swelling. Neck ultrasound (US) showed a large cystic lesion with septation, compressing the ipsilateral vessels. Magnetic resonance imaging (MRI) confirmed the US findings. Surgical excision was performed which subsequently showed findings consistent with CTC. CTC in adult is extremely rare, with few reported cases identified in the literature. Thymic gland anomalies in the neck are the consequences of an arrest in the descent of the gland, sequestration of the thymic tissue, or failure of involution. The diagnosis of this condition is rarely done prior to surgical excision. The clinical presentation, radiologic imaging, surgical findings, and histologic appearance are all essential components to make the correct diagnosis of this very rare differential diagnosis of cystic lateral neck swelling.

Research on cost-effective and efficient technology that can hold enormous amounts of heat or cold in a specific volume has been ongoing for a while. Due to its isothermal behaviour throughout the phase change process and high energy storage density, latent heat storage in phase change materials (PCM) is highly appealing. The incorporation of latent heat of storage in building materials considerably aids in the energy conservation of structures, which is a major role of thermal storage. By reducing the frequency of internal air temperature swings and keeping the indoor air temperature closer to the ideal temperature for longer periods of time, increasing the building's thermal storage capacity can improve human comfort. Nonetheless, a phase change material can be chosen to accommodate every type of weather in a certain area.

In the last decade, the urgent need to explore medicinal plants or drug development has increased enormously around the world to overcome numerous health problems. In the present investigation, HPLC indicated the existence of 18 phenolic and flavonoid compounds in the Cupressus sempervirens extract. Hesperetin represents the greatest concentration (25,579.57 µg/mL), while other compounds, such as pyro catechol, rutin, gallic acid, chlorogenic acid, naringenin, and quercetin, were recognized in concentrations of 2922.53 µg/mL, 1313.26 µg/mL, 1107.26 µg/mL, 389.09 µg/mL, 156.53 µg/mL, and 97.56 µg/mL, respectively. The well diffusion method documented the antibacterial/antifungal activity of C. sempervirens extract against E. faecalis, E. coli, C. albicans, S. typhi, S.aureus, and M. circinelloid with 35, 33, 32, 25, 23, and 21 mm inhibition zones, respectively, more than the standard antibiotic/antifungal agent. Low values ranging from 7.80 to 15.62 µg/mL of MIC and MBC were recorded for E. faecalis, E. coli, and C. albicans. From the 1- diphenyl-2-picryl hydrazyl (DPPH) assay, promising antioxidant activity was recorded for C. sempervirens extract with IC50 of an 8.97 µg/mL. Moreover, ferric reducing antioxidant power (FRAP) and total antioxidant capacity assays (TAC) confirmed the antioxidant activity of the extract, which was expressed as the ascorbic acid equivalent (AAE) of 366.9 ± 0.2 µg/mg and 102 ± 0.2 µg/mg of extracts, respectively. α-amylase and α-glucosidase inhibition % were determined to express the antidiabetic activity of the extract in vitro, with promising IC50 value (27.01 µg/mL) for α-amylase compared to that of acarbose (50.93 µg/mL), while IC50 value of the extract for α-glucosidase was 19.21µg/mL compared to that of acarbose 4.13 µg/mL. Prothrombin time (PT) and activated partial thromboplastin time (APTT) revealed the role of C. sempervirens extract as an anticoagulant agent if compared with the activity of heparin. Binding interactions of hesperetin and gallic acid were examined via the Molecular Operating Environment (MOE) Dock software against E. faecalis (PDB ID: 3CLQ), C. albicans (PDB ID: 7RJC), α-amylase (PDB ID: 4W93), and α-glucosidase (PDB ID: 3TOP). The obtained results shed light on how molecular modeling methods might inhibit the tested compounds, which have the potential to be useful in the treatment of target proteins.

Solar air heaters (SAHs) harness solar radiation to warm the air. This study investigates the efficacy of 3D cylindrical roughness features in enhancing heat transfer and reducing friction losses within SAHs. The configuration involves inline and staggered placement of 3D cylindrical roughness elements beneath the absorber surface. Through ASHRAE standard 93–77 testing, heat transfer and friction factors are examined across various cylinder roughness setups, with parameters such as relative roughness pitch (p/h) and gap (w/h) considered. The channel aspect ratio (W/B) is set at 5, and a relative roughness height (h/D) of 0.06 is maintained and flow Reynolds number (Re) is varied from 3000 to 8000. Regression analysis reveals a significant relationship between heat transfer and friction. Notably, at Re = 7910, p/h = 20, and w/h = 8 for staggered cylinder roughness, average friction factor (fav) increases by 171.3 %, and average nusselt number (Nuav) increases by 69.7 %. Similarly, the efficiency index (η) peaks at 0.8192 with inline roughness at Re = 2969, p/h = 20, and w/h = 8. The introduced 3D cylinder roughness elements disrupt the laminar sub-layer, amplifying convective heat transfer while curbing friction losses. This approach optimizes SAH performance within the studied parameter range, showcasing potential improvements for utilizing solar energy. Experimental results, along with expressions for average friction factor (fav) and average Nusselt number (Nuav), underscore the benefits of cylinder-shaped roughness geometries while maintaining h/D = 0.06. These findings introduce an innovative convective heat transfer method, enhancing SAH efficiency. Furthermore, the anticipated average friction factor (fav) and average Nusselt number (Nuav) values align within error limits of ±6.63 % and ±6.62 %, respectively, with improved regression coefficients indicating the stronger relationship and the influence of independent variables on dependent variables.

The heat transfers and fluid flow features of a Microchannel Heat Sink with Secondary Oblique Channels and Rectangular Ribs (MCHS-SOCRR) were examined by numerical and simulation modelling. The adaptive neuro-fuzzy inference system was utilized to predict the Microchannel Heat Sink with Secondary Oblique Channels and Rectangular Ribs heat transfer properties of above-mentioned model using aluminum oxide nanofluid after the modified Dragonfly optimization algorithm approach method was used to establish the optimal geometric parameters for channel width, and relative rib width. At this phase, a comparison of ideal heat transfer and pressure drop values to the present model was made. The validation of the thermal performance is simulated utilizing MATLAB. The significant outcomes of the current study are that the nanoparticle diameter has a significant impact on the temperature of the coolant and the wall. The Nusselt number rises as a consequence of increasing nanoparticles with high thermal conductivity in the system's heat transfer rate. When comparing the two methods, aluminum oxide nanofluid had a faster rate of heat transfer than water. There is evidence that the flow rate of heat through a microchannel is greatly affected by the thermal conductivity of a nanofluid.

The purpose of this research was to better understand the challenges, as well as ways to overcome the aforementioned challenges, associated with sex and reproductive health education for parents of adolescents with autism spectrum disorder (ASD) from the perspective of parents. A qualitative multiple case study approach, including interviews and document analysis, was conducted to answer the research questions. The participants included 9 parents of adolescents with ASD, including (4) fathers and (5) mothers. Their children’s ages ranged from (13–19) years. Inductive coding was conducted to analyze the data collected. The findings suggested several challenges exist, including parents’ lack of knowledge regarding sex and reproductive health education and training on how to effectively teach their children. This lack of knowledge may contribute to unacceptable social demonstrations of sexuality by individuals with ASD, which creates another challenge for parents. The findings related to the second research question indicated families of individuals with ASD need more awareness and education, particularly on how to effectively educate their children on sexual matters. The importance of education regarding sexual matters for individuals with ASD within the school and community was also realized. The findings could help the Ministry of Education establish educational programs to ensure schools are equipped to educate individuals with ASD on sexual matters. The programs could also be beneficial if they provided training to parents on how to effectively provide sexual education to their adolescent children. The findings of this research could additionally provide insight to parents, general education teachers, and special education teachers on the importance of sex and reproductive health education for children with ASD.

Over the past three decades, minimally invasive robotic technology has evolved substantially in urological practice, replacing many open procedures and becoming part of routine clinical practice. The Health Sector Transformation Program for the Kingdom's Vision 2030 aims to restructure the health sector and optimize its status and prospects as an effective and integrated ecosystem centered on the patient's health. Therefore, this consensus seeks to endorse the clinical practice guidelines for robotic surgery (RS) in the KSA, highlighting its effectiveness, safety, and favorable outcomes compared to open and laparoscopic surgeries in certain procedures when used by trained surgeons in well-structured RS programs.

The influence of geometrical parameters of V-symmetry ribs on heat flow and fluid flow characteristics of solar air heater (SAH) rectangular duct with ribbed absorber is investigated theoretically. Fabrication of ribs in repeated artificial protrusions pattern on the absorber surface appears as a simple approach for increasing the solar collectors radiation harnessing capacity. The various characteristics of artificial roughness protrusions include relative roughness height (e/Dh), relative roughness pitch (p/e), and angle of attack of flow (α), and the span of these parameters is determined based on experimental considerations of the device and working circumstances. To measure the improvement in the coefficient of heat transfer and friction factor, the outcomes were correlated to those of a smooth conduit under identical flow characteristics. The greatest increase in Stanton number and friction factor is 1.13 and 1.19 folds that of the smooth SAH duct, correspondingly.

Adding flow-disturbing components to the absorber plate's effective heat transfer zone is the most efficient Thermo-hydraulic performance enhancement approach for a solar air heater (SAH). Researchers are attempting to decide the best geometrical parameters for a SAH when the turbulent flow has fully established with fabricated roughness protrusions on the absorber surface plate in a cone-shaped contour. The Thermo-hydraulic performance of the proposed SAH design is taken into account throughout the optimization process. Air flow rate and geometrical variables such as the Reynolds number Re=3000 to 8000, relative rib pitch p/e=10 to 20, and relative rib gap w/e=4 to 8 are varied in a series of experiments to assess the SAH's performance. Flow angle of attack (α = 90°), relative roughness height (e/Dh = 0.08), and rectangular flow passage aspect ratio (W/H = 5) are maintained constant in all the trials for inline and staggered configurations. Series of tests are carried out to establish statistical correlations between the average Nusselt number and the average friction factor. Thermo-hydraulic performance is affected by the Reynolds number (Re) as well as relative roughness gaps (w/e) and relative roughness pitch (p/e) of the conical protrusions. There was a 64.5% increase in Nusselt number and a 153.3% increase in friction factor at Re = 8000, p/e = 10 and w/e = 4. Cone-shaped roughness, as suggested, has a Thermo-hydraulic efficiency index of 0.8233, which ocuurs at p/e = 20 and w/e = 8 at Re = 3000.

Background: In the last three eras, the incidence of renal cell carcinoma (RCC) has increased, due to increased radiological studies. The expected 5-year survival rate has become better, associated with the identification of small size renal masses. However, this survival improvement may be secondary to improved surgical techniques and medical therapies for these malignancies. Objectives: The objective was to report the trends of clinical presentation, peri-operative, oncological outcomes, and surgical management trends for RCCs over the period. Methods: After Institutional Review Board approval, a retrospective study for adult patients was conducted, who presented with renal mass and were managed between 2008 and 2019. Variables, including demographics, perioperative and pathological outcomes analyzed using descriptive statistics for continuous variables reported as mean ± standard deviation and categorical variables values compared by Chi-square test. Survival Analysis calculated using the Kaplan-Meier method. The level of significance is set at P-value < 0.05. Results: A total of 588 patients underwent surgical treatment for kidney cancer from January 2008 to January 2019. 237 (40.30%) were females and 351 (59.69%) males. The clinical presentation was higher as an incidental diagnosis of 58.67%. 71.25% of patients were from outside Riyadh city. Pathology was mostly clear cell RCC 61.22% and grade 2 (57.48%). Tumor size, surgery time, and length of hospital stay showed a significant difference between the three periods (both P > 0.05). Robotic surgery performed more than open (P < 0.0001). There was no significant difference in the survival time, when compared to patients by the regions and when compared by the primary tumors (Log-Rank P = 0.4821). Patients from the Riyadh region (median = 54.0) had a significantly higher recurrence time (Log-Rank P < 0.0001). Conclusion: There was a rising trend in the incidence of RCC associated with comorbidities and incidental diagnosis. In our study period we found increase in the trend of minimal invasive approach. The size of the tumor, blood loss and operative time decreases over the period of time. The Robotic assisted nephrectomy approach has become increased over the period of time duration in present study.

Abstract Flexible cystoscopy under local anaesthesia is standard for the surveillance of bladder cancer. Frequently, several reusable cystoscopes fail to reprocess. With the new grasper incorporated single-use cystoscope for retrieval of ureteric stents, we explored the feasibility of using it off-label for diagnosis and the detection of bladder cancer. Consecutive diagnostic flexible cystoscopies between Mar 2016 and Nov 2018 were reviewed comparing the reusable versus the disposable cystoscopes. A total of 390 patients underwent 1211 cystoscopies. Median age was 61.5 years (SD 14.2, 18.8–91.4), males 331 (84.9%) and females 59 (15.1%). Indication for cystoscopy was prior malignancy in 1183 procedures (97.7%), haematuria 19 (1.6%) or bladder mass 7 (0.6%). There were 608 reusable and 603 disposable cystoscopies. There was no significant difference between groups at baseline in age, sex, BMI, smoking status, or prior tumor risk category. There was no significant difference in positive findings (123/608, 20.2% vs 111/603, 18.4%, p = 0.425) or cancer detection rates (95/608, 15.6% vs 88/603, 14.4%, p 0.574) among the two groups, respectively. We conclude that the disposable grasper integrated cystoscope is comparable to reusable cystoscope in the detection of bladder cancer.

Purpose: Data regarding patients' perception and satisfaction about physicians providing the medical care based on their attires in Southern Region of Saudi Arabia are scarce and even lacking. The aim of this study was to assess the patients' opinion regarding the suitable attires of physicians. Materials and Methods: A descriptive cross-sectional survey was performed on a random sample of patients from Aseer Central Hospital, Southern Military Hospital and Abha Maternity Hospital. The questionnaire collected data on their perception of physicians' attire as well as reflection of dress on trust and willingness to discuss personal issues. Results: The study included 248 patients. The majority (81.9%) of the participants agreed on the importance for physicians to wear their medical attires. Also 84.3% of them confirmed that physician's appearance is important source of their confidence. Skirt plus lab coat was the most favored for female physicians (39.3%). As for male physicians, scrub plus lab coat was the most preferred (33.6%) attire. Conclusion: Patients attending hospitals in southwestern Saudi Arabia preferred for their physicians to wear formal attire with white coats, rather than the Saudi national dress. Skirt plus lab coat was the most preferred for female physicians. As for male physicians, scrub plus lab coat was the most preferred attire. Patients approved the importance for physicians to wear their medical attires and confirmed that physician's appearance is important source for their confidence. The study recommends that physicians should adopt formal attire and the institutional dress code policy should be modified to fit these preferences.

The energy/heat and diffusion/mass flux occurred due to chemical potential and temperature gradient, respectively have worth in the areas of electrical power generation, solar power technology, chemical engineering, petrology, nuclear waste disposal, hydrology, high temperature processes and geoscience. In connection to this, Soret and Dufour effects on steady, incompressible, laminar flow of non-Newtonian Casson liquid over a stretching sheet in a porous medium under local thermal non-equilibrium (LTNE) conditions have been theoretically investigated in the presence of Stefan blowing and magnetic effects. The energy equations are formulated by using the LTNE, which establishes the separate temperature profiles for both fluid and solid phases. The governing equations for the flow arguments are reduced by selecting suitable similarity transformations, which are then numerically solved using the traditional Runge-Kutta- 4 (RK-4) with shooting method. The flow features in reply to the impact of the emerging parameters are inspected in detail graphically. The significant outcomes of the current study are that, the rise in values of magnetic and porosity parameters decays the velocity but improves the heat transfer. An upsurge in Dufour number decreases the heat transfer rate of both solid and liquid phases. The upsurge in Soret number diminutions the mass transfer rate.

The present inspection elaborates the thermal distribution through a convective-radiative longitudinal trapezoidal moving fin with an internal heat source by considering the linear and nonlinear temperature-dependent thermal conductivities and heat transfer coefficient. The non-dimensionalization of the energy equation is carried out using dimensionless terms, and the resulting nonlinear ordinary differential equation (ODE) is solved analytically using the differential transform method (DTM) with Pade approximant approach. Furthermore, the consequence of several non-dimensional parameters, namely thermal conductivity parameter, convection-conduction parameter, Peclet number, radiation-conduction parameter, fin taper ratio, temperature ratio parameter, and internal heat generation parameter on temperature gradient and fin efficiency is explained with the help of graphs. The significant primary results of the investigation illustrate that the thermal distribution through the fin gradually decreases as the magnitude of the convection-conduction parameter, temperature ratio parameter, and radiation-conduction parameter rise. In contrast, it upsurges for heat generation and thermal conductivity parameters.

The heat transfer technology is growing significantly for desired solutions as the need for efficient heating and cooling systems in the aerospace, automotive, and chemical sectors. Bearing this in mind the need for effective cooling/heating systems, the steady, two-dimensional Glauert wall jet flow with thermophoretic particle deposition is investigated in the presence of Al2O3 nanoliquid. The Glauert transformations are used to transform the system of partial differential equations (PDEs) that reflect conservation, continuity, temperature, and concentration, as well as boundary conditions. The fourth fifth order Runge-Kutta-Fehlberg (RKF-45) method along with the shooting approach is used to solve the reduced system of ordinary differential equations (ODEs). The role of physical quantities for the parameters in concern are visually depicted and described in depth. Results reveal that, rise in values of velocity slip parameter upsurges the velocity profile away from the wall and declines near the surface. The increase in radiation parameter inclines the heat transfer. The growing values of both radiation parameter and volume fraction advances the heat transfer rate. The growing values of thermophoretic parameter improves the mass transfer rate.

Thermogalvanic systems represent a means to convert a temperature gradient into electricity, using only redox chemistry. However, the kinetics of electron transfer and physical mass transport of the redox couples are known limitations. In this study we present self-contained gelled thermogalvanic cells (or thermocells) containing the ferricyanide/ferrocyanide redox couple, which additionally have gold nanoparticles either immobilised at the gel/electrode interface, or distributed throughout the entire gel. Both methods of introducing the gold nanoparticles result in an apparent electrocatalytic improvement, as demonstrated by significant decreases in the electron transfer resistance. However, when used as thermogalvanic cells, only minor improvements were observed in power generation, and relatively rapid dissolution of the gold nanoparticles was observed, to yield passivating gold analogues of Prussian blue. Therefore successful preparation and short-term improvements have been demonstrated, but are offset by long-term stability issues. The relatively surprising instability of the generally inert gold nanoparticles in the presence of ferricyanide/ferrocyanide, particularly under thermogalvanic conditions, is of particular note. Keywords: Thermoelectrochemistry, Thermogalvanic cells, Gold nanoparticles

Tubulocystic renal cell carcinoma (RCC) is one of the newly recognized subtypes of RCC. It has a unique cystic morphology and indolent behavior. During the last decade, few studies have been published describing tubulocystic RCC with poorly differentiated foci. A subset of these cases are associated with loss of fumarate hydratase which is a characteristic feature of hereditary leiomyomatosis and renal cell carcinoma-associated RCC. However, these two entities represent two distinct subtypes of RCC in the recent WHO Classification of kidney tumors. Herein, we are describing a rare case of tubulocystic renal cell carcinoma with poorly differentiated foci and loss of fumarate hydratase.