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Rania Abd El-Hamid El-Kady,1,2 Dania Waggas,2 Ahmed AkL3,4 1Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 2Department of Pathological Sciences, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia; 3Department of Nephrology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; 4Department of Internal Medicine/Adult Nephrology, Dr. Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi ArabiaCorrespondence: Rania Abd El-Hamid El-KadyDepartment of Pathological Sciences, Fakeeh College for Medical Sciences, Jeddah, 2537, Kingdom of Saudi ArabiaTel +966 569849897Email raniael_kady@yahoo.comBackground: Albeit growing technical advances in the design of hemodialysis catheters, intravascular catheter-related bloodstream infection (CRBSI) still represents an utmost clinical challenge to the health-care workers (HCWs). Data regarding the influence of the culprit organism on the scenario of CRBSI in the literature are extremely lacking. Thereby, this research was carried out.Methods: We undertook a retrospective cohort study over an interval of 2 years, involving patients who underwent regular hemodialysis via catheters in the Renal Dialysis Unit (RDU) of Dr. Soliman Fakeeh Hospital (DSFH), Jeddah, Kingdom of Saudi Arabia (KSA). The study enrolled 139 patients (56.8% females and 43.2% males), with mean age of 60.79 ± 11.45 years.Results: The aggregate rate of CRBSI was 5.1/1000 catheter days. Amongst the 139 study candidates confirmed of having CRBSI, while 69.8% of CRBSIs were ascribed to Gram-positive cocci, about one-third of the infectious episodes were secondary to Gram-negative bacilli. Interestingly, fever was the most common presentation of S. aureus CRBSI compared to CoNS and Gram-negative bacilli CRBSIs (20.9% versus 12.9% versus 6.5%, p= 0.0001), whereas CRBSIs due to CoNS were presented mainly with rigors (19.4%). Of note, CRBSIs caused by Gram-negative bacilli had a tendency to manifest with unusual symptoms such as vomiting or hypotension. Besides, they were more prone to involve hospitalization or ICU admission. In this study, no mortality was attributed to CRBSIs.Conclusion: Our study disclosed that the illicit organism has a repercussion on the clinical presentation as well as the fate of CRBSI among hemodialysis patients. This highlights the worth of identifying the infected cases in a periodic manner, to avoid the occurrence of devastating complications. A large body of work from various hemodialysis centers should take place in the near future so as to provide more insight in this perspective.Keywords: hemodialysis, catheter, ESRD, CRBSI, susceptibility

This paper addresses the analysis of textured images using the symmetric positive semi-definite matrix. In particular, a field of symmetric positive semi-definite matrices is used to estimate the structural information represented by the local orientation and the degree of anisotropy in structured and sinusoid-like textured images. In order to ensure faithful local structure estimation, an adaptive algorithm for the regularization of the extent of gradient fields smoothing is proposed. Results obtained on different texture samples show the strength of the proposed method in accurately representing the local variation of orientations in the underlying textured images, which paves the way towards an accurate analysis of the texture structures.

Abstract Wastewater treatment is of utmost importance in providing all equitable and safe drinking water. In the present study, a chitosan impregnated sugarcane bagasse biochar SCNC biocomposite has been synthesized for the removal of Congo red (CR) dye from an aqueous solution. The SCNC biocomposite was thoroughly characterized through Brunauer, Emmett and Teller (BET) and N2 adsorption isotherm, point of zero charge (pHPZC), elemental analysis, Scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR) and Thermogravimetric analysis (TGA) analysis. Moreover, SCNC biocomposite was further employed to remove CR dye from the aqueous solution in batch mode. The SCNC biocomposite could remove more than 95.0% of CR at an initial concentration of (100mgL− 1), adsorbent dosage (0.05 g), time (200 min), pH ~ 3. The SCNC biocomposite achieved maximum adsorption capacity of 170mgg− 1. The equilibrium adsorption data for CR dye were best fitted to the Langmuir isotherm model with R2, 0.999. The kinetic and isotherm were statistically investigated using the chi-square statistic (χ2 ), mean square error (MSE), and the sum of squares error (SSE) Because of the higher correlation coefficient (R2 ≥ 0.999) and lower error functions, the equilibrium CR adsorption isotherms for a single-dye system fit Langmuir and the PSO kinetic model. The thermodynamic studies revealed the spontaneous and endothermic nature of adsorption of CR dye onto SCNC biocomposite. The SCNC biocomposite can be regenerated up to the 5th cycle successfully. The mechanism of CR adsorption onto SCNC was elucidated.

Abstract Objective This study aimed to assess the public’s knowledge of stroke before and after viewing an educational video about stroke risk factors, preventive measures, and alarming signs. Methods A single-arm interventional study was conducted in Lebanon using a 3-minute video-based education about stroke. A pre- and post-structured questionnaire compared the level of knowledge about stroke. Results The study included 685 participants. Knowledge of stroke, risk factors, warning signs, treatment, and preventive measures significantly increased post-educational video sessions. A higher baseline knowledge score was associated with a family history of stroke (Beta = 1.76) and being a healthcare professional (Beta = 3.35). Participants between 25 and 34 years (Beta=-1.39) and those with a high risk of stroke (Beta=-1.03) were significantly associated with a lower knowledge score. Conclusion This study demonstrated the effectiveness of a video-based educational tool to raise awareness about stroke. Short, targeted audio-visual resources using lay language can convey health education messages and influence behavioral changes. The community can benefit from a large-scale educational campaign that targets different socio-economic statuses to enhance knowledge of stroke and save lives.

Abstract Background The carotid artery stenosis (CAS) is a notable risk element for ischemic stroke, accounting for 10 to 20% of such cases. There is a deficiency in research studies exploring the prognostic impact of CAS specifically in the anterior circulation acute ischemic stroke (AIS). Therefore, we conducted this study to evaluate the prognostic impact of CAS in individuals with anterior circulation AIS. Patients were categorized into two groups, patients with both anterior circulation AIS and CAS in comparison to patients with anterior circulation AIS without CAS (control group). We compared patient characteristics, neuroimaging, and outcome evaluations using a modified Rankin Scale (mRS) and the National Institute Health Stroke Scale (NIHSS) in both groups. P-value 0.05. The mean NIHSS was significantly elevated the CAS group compared to the control group (p = 0.037). Our results showed that patients with CAS ≥ 70% were associated with an mRS > 2 and a significantly higher NIHSS compared to control. The regression analysis showed that occlusion > 1/3, CAS ≥ 70%, and higher NIHSS score were considered independent predictors of mRS > 2. The mortality rate was significantly elevated in the CAS group versus the control group (p

Abstract Background A recommendation by the World Health Organization (WHO) was issued about the use of chest imaging to monitor pulmonary sequelae following recovery from COVID-19. This qualitative study aimed to explore the perspective of key stakeholders to understand their valuation of the outcome of the proposition, preferences for the modalities of chest imaging, acceptability, feasibility, impact on equity and practical considerations influencing the implementation of using chest imaging. Methods A qualitative descriptive design using in-depth interviews approach. Key stakeholders included adult patients who recovered from the acute illness of COVID-19, and providers caring for those patients. The Evidence to Decision (EtD) conceptual framework was used to guide data collection of contextual and practical factors related to monitoring using imaging. Data analysis was based on the framework thematic analysis approach. Results 33 respondents, including providers and patients, were recruited from 15 different countries. Participants highly valued the ability to monitor progression and resolution of long-term sequelae but recommended the avoidance of overuse of imaging. Their preferences for the imaging modalities were recorded along with pros and cons. Equity concerns were reported across countries (e.g., access to resources) and within countries (e.g., disadvantaged groups lacked access to insurance). Both providers and patients accepted the use of imaging, some patients were concerned about affordability of the test. Facilitators included post- recovery units and protocols. Barriers to feasibility included low number of specialists in some countries, access to imaging tests among elderly living in nursing homes, experience of poor coordination of care, emotional exhaustion, and transportation challenges driving to a monitoring site. Conclusion We were able to demonstrate that there is a high value and acceptability using imaging but there were factors influencing feasibility, equity and some practical considerations associated with implementation. We had a few suggestions to be considered by the expert panel in the formulation of the guideline to facilitate its implementation such as using validated risk score predictive tools for lung complications to recommend the appropriate imaging modality and complementary pulmonary function test.

Abstract In this research, we reported the synthesis of effective sulphonated sugarcane bagasse (SCB@SA) biosorbent based on agriculture waste materials via a simple diazotization strategy for the removal of methylene blue (MB) and Bismarck Brown R(BB) dyes from waste water samples. First, the sugarcane bagasse (SCB) waste was collected, grinded, and sieved to obtain the desired size. Secondly, the SCB powder is modified with sulfanilinic acid (SA) via the formation of its diazonium salt to introduce sulfonic groups on the SCB surface. Different advanced techniques were applied to characterize the prepared materials before and after the adsorption process viz. Scanning electron microscopy (SEM), transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), Energy-dispersive X-ray spectroscopy (EDS) and Thermogravimetric analysis (TGA). Different parameters affecting the adsorption process of both MB and BB were studied. Because of the higher correlation coefficient (R2 ≥ 0.999) and lower error functions, the equilibrium MB and BB adsorption isotherms for a single-dye system fit Langmuir with maximum adsorption capacity reaching to 127.48 and 166.75 mg/g for MB and BB, respectively. Moreover, the RL values obtained for both dyes lie between 0 and 1, indicating that MB and BB adsorption by SCB@SA is a favorable process. Besides, the error functions’ values of the pseudo-2nd-order are significantly lower than those of the pseudo-1st-order, implying that the adsorption MB and BB onto SCB@SA biosorbent fitted the pseudo-2nd-order kinetic model in a chemosorption manner. In the thermodynamic studies, the adsorption process is spontaneous, exothermic, and has less randomness. In addition, the SCB@SA biosorbent could be reused in five cycles maintaining on suitable adsorption efficiency. Finally, the MB and BB dyes could be adsorbed on the SCB@SA biosorbent via three mechanisms including π-π stacking, columbic attraction, and hydrogen bonding.

Abstract Coronary artery disease (CAD) is the leading cause of death among adults worldwide. Accurate risk stratification can support optimal lifetime prevention. Current methods lack the ability to incorporate new information throughout the life course or to combine innate genetic risk factors with acquired lifetime risk. We designed a general multistate model (MSGene) to estimate age-specific transitions across 10 cardiometabolic states, dependent on clinical covariates and a CAD polygenic risk score. This model is designed to handle longitudinal data over the lifetime to address this unmet need and support clinical decision-making. We analyze longitudinal data from 480,638 UK Biobank participants and compared predicted lifetime risk with the 30-year Framingham risk score. MSGene improves discrimination (C-index 0.71 vs 0.66), age of high-risk detection (C-index 0.73 vs 0.52), and overall prediction (RMSE 1.1% vs 10.9%), in held-out data. We also use MSGene to refine estimates of lifetime absolute risk reduction from statin initiation. Our findings underscore our multistate model’s potential public health value for accurate lifetime CAD risk estimation using clinical factors and increasingly available genetics toward earlier more effective prevention.

IntroductionGreater side-to-side asymmetry can indicate impaired skill, reduced power production, and an increased risk of injury. Bilateral differences highlight the presence of asymmetries that should be assessed to understand their impact on both injury risk and performance enhancement.ObjectiveThis study aimed to assessment muscle activation and bilateral asymmetry in major trunk and shoulder muscles during a two-armed kettlebell swing exercise.MethodsTwenty-seven participants (age: 24.2 ± 2.6 years; body mass: 82.9 ± 7.7 kg; height: 176.9 ± 7.0 cm) were included in the study. Electromyographic (EMG) data were collected bilaterally from twelve muscles (six muscles per side: anterior deltoid [AD], posterior deltoid [PD], erector spinae longissimus [ESL], erector spinae iliocostalis [ESI], external oblique [EO], and rectus abdominis [RA]).ResultsResults indicated that asymmetry indices for the AD, ESL, ESI, and RA muscles during the upward propulsion phase fell within the determined threshold of 15%. However, the asymmetry indices for the PD and EO muscles exceeded this threshold by 3.36% and 2.62%, respectively. The findings suggest that trunk muscle asymmetries during the kettlebell swing are generally less pronounced than those of the shoulder muscles, particularly during the float phase.ConclusionThese results provide valuable insights into bilateral muscle asymmetry during a two-armed kettlebell swing, which can inform the development of targeted training programs. The methods and findings of this study may further contribute to understanding the effects of muscle balance, symmetry, and injury mechanisms in dynamic movements.

Introdução: Segundo a Organização Mundial de Saúde (OMS), o Linfoma de Hodgkin (LH), também denominado de Doença de Hodgkin, é subdividido em 2 categorias, baseadas na morfologia e no imunofenótipo: I - LH Clássico (HLc) compreende 90% dos LH e seus subtipos: Esclerose Nodular; Celularidade Mista; Rico em Linfócitos; Depleção Linfocitária e um segundo subtipo denominado de II - Predominância linfocítica Nodular que corresponde apenas < 05% dos LH com características morfológica e imunofenotípicas distintas do LHc. Objetivos: Este trabalho tem por objetivo analisar o comportamento epidemiológico quanto às características do LH no Brasil, assim como a respectiva distribuição geográfica. Método: Trata-se de um estudo epidemiológico quantitativo, transversal, descritivo e retrospectivo com base nos dados disponibilizados pelo Instituto Nacional de Câncer (INCA) quanto à incidência e à distribuição geográfica do LH no âmbito nacional. Resultados: Quanto aos aspectos analisados, o LH representa 0,5% dos tipos de câncer em geral e 14% de todos os linfomas. De acordo com KENNEDY B J (1998), a incidência do LH nos Estados Unidos da América responde por 0,7% de todos os novos casos de câncer, representando 7.400 novos casos por ano com uma taxa de mortalidade de 0,4 casos/100.000/ano na União Europeia. Conforme IARC 2013, a taxa anual de mortalidade padronizada por 100.000 casos de LH no mundo chegou a ser de 30.000,00, o que parece não ter se modificado até então. Ademais, o LH ocorre em qualquer faixa etária, entretanto, apresenta um predomínio na faixa etária jovem entre 15-35 anos, e cursa com uma curva de incidência bimodal nos países desenvolvidos, com o 1°pico aos 25 e o 2°aos 60 anos. O LH também apresenta discreta predileção pelo sexo masculino. No Brasil, segundo os dados do INCA, o LH ocupa o 20°lugar entre os tipos de cânceres mais comuns com risco estimado de uma taxa bruta de 1,40 novos casos/100 mil homens e 1,41/100 mil mulheres e para cada ano do triênio 2023 a 2025 estima-se um total 3.080 casos novos, 1.500 casos em homens e 1.580 em mulheres. Discussão: Ao se comparar os dados do INCA com os resultados observados na literatura, percebe-se que a maioria dos casos no Brasil são diagnosticados com doença avançada e 75% em estágio clínico EC: II bulky, III or IV, além disso, sabe-se que 20% apresentam comprometimento da medula óssea. Dentre o subtipo histológico mais comum, a esclerose nodular representa 60% dos casos, com uma alta concentração entre as idades de 20-30 anos e tempo entre os primeiros sinais e sintomas de aproximadamente sete meses. Quanto ao tratamento, 65% dos pacientes entram em remissão completa, 15% em remissão parcial e em média de 20% em progressão de doença utilizando regimes padrão de tratamento quimioterápico como o BEACOPP non-escalated ou ABVD. Conclusão: Com base nos dados do INCA e nos dados internacionais, os resultados refletem que a maioria dos casos, no Brasil, tem o seu diagnóstico em estágios avançados, isso altera não apenas o prognóstico da doença, como também impacta na intensificação de tratamentos, assim como na possível recidiva/refratariedade da doença. Os dados apresentados acima evidenciam que a sobrevida global do grupo de pacientes, no Brasil, perfazem um percentual de 70% com uma sobrevida livre de eventos de 55% em uma mediana de dois anos, sendo frequentemente necessário a terapia de salvamento, sublinhando a importância de diagnósticos precoces e tratamentos mais eficazes.

Introdução: De acordo com a classificação da Organização Mundial da Saúde (OMS), os linfomas difusos de grandes células B (LDGCBs) constituem um grupo heterogêneo de doenças dentro dos linfomas não hodgkin (LNH) com alta prevalência. Segundo Swerdlow et al., 2008, algumas categorias passaram a ser reconhecidas como entidades específicas: 1- Linfoma difuso de grandes células B com subgrupos moleculares com respostas variáveis ao tratamento e com características biológicas diferentes. Estudos de expressão gênica têm identificado três subgrupos: a) LDGCB, subgrupo centro germinativo símile (GCB) com expressão de genes relacionados ao centro germinativo, CD10 e bcl-6; b) LDGCB, subgrupo célula B ativada (ABC), caracterizado pela expressão de genes relacionados a células mitoticamente ativas; c) LDGCB primário do mediastino (PMBL); 2- Linfoma de células B com comportamento agressivo e com características intermediárias entre o LDGCB e o Burkitt; 3- LDGCB com imunofenótipo de célula B em estágio final de diferenciação. Essas variantes moleculares podem ser reconhecidas em parte pelo método imunohistoquímico (IMQ) utilizando anticorpos: CD10, bcl-6 e MUM1 e o algoritmo de “Hans” para a subclassificação do LDGCB. Este relato de caso descreve a melhor escolha de tratamento para o LDGCBs. Relato de caso: Paciente S.B., 49 anos, masculino diagnosticado em 2023 com LDGCB e considerado como de alto grau por suas caracteristicas evolutivas de transformação clonal de um Linfoma de Hodgkin (LH) predominância linfocítica nodular. A IMQ evidenciou tripla expressão BCL-2 40%, BCL-6 30%, C-MYC 20% e Ki67 > 90% mas os estudos moleculares “FISH”, entretanto, com negatividade, para BCL2, BCL6 e ausência do rearranjo C-MYC. O estadiamento clínico mostrou IVBXS: envolvimento esplênico, hepatico, sistema nervoso central (SNC), sudorese, febre e massa bulky de 9,6 × 6,7 × 10,3 cm na região mediastinal. Índice Prognóstico Internacional IPI = 5, IPI Revisado = 3, e IPI no SNC = 4, todos de alto risco de recidiva no SNC acima de 10,4% em 2 anos. Assim, optou-se pelo protocolo R-CODOX M/R-IVAC e “involved field radiotherapy” na massa bulky, sendo a melhor escolha para o tratamento. O paciente evoluiu após o terceiro ciclo de tratamento com resposta metabólica completa por PET SCAN em score de Deauville 2. Discussão: O LH predominância linfocitica nodular é uma entidade rara representando cerca < 0,5% dos LH. Considerando a sua evolução clonal para outra doença, o LDGCB foi considerado por si só como um fator de alto grau por suas características de transformação. Conclusão: O caso retrata a complexidade da escolha da melhor terapia para pacientes com LDGCB que, apesar de não apresentarem imunoexpressão para bcl2, bcl-6 e ausência do rearranjo C-MYC aos estudos moleculares, foi considerado como de alto grau por suas caracteristicas evolutivas de transformação clonal e com alto índice de recidiva e refratariedade pós-tratamento.

Introdução: A leucemia linfocítica crônica (LLC) é uma doença linfoproliferativa crônica (DLPC), que afeta principalmente indivíduos adultos e tem crescimento raro e mais lento em crianças. Isso promove o estímulo ao desenvolvimento de novos tratamentos como a imunoterapia com células CAR-T, que utiliza células de defesa geneticamente modificadas e reprogramadas em laboratório para eliminar os tumores. Nesse contexto, faz se necessário maiores investigações da eficácia do uso de célula CAR T frente a LLC, uma vez que é de causa multifatorial. Objetivos: Investigar a eficácia das células de imunoterapia CAR-T como uma abordagem terapêutica para pacientes com leucemia linfoide crônica, com o objetivo de verificar se essa estratégia é eficaz. Materiais e métodos: Trata-se de um estudo descritivo de revisão bibliográfica, feita por meio dos descritores “((Efficacy) AND (Leukemia)) AND (Lymphocytic Chronic)) AND (B-Cell)) AND (Immunotherapy)) AND (Therapy, CAR T-Cell)) AND (Adoptive)) AND (Biomarkers)) NOT (acute)”, resultando em 12 artigos na base de dados PubMed. Utilizamos o filtro de resultados para os 5 últimos anos, resultando em artigos de 2019 a 2023. Foram selecionados os 4 que abordavam o tema e descartados os 11 restantes. Resultados: A terapia com células T CAR anti-CD19 mostrou uma taxa de resposta global (ORR) de 82% no 28° dia, com 64% dos pacientes em remissão completa (CR). A LLC progrediu em quatro de 22 pacientes, e a sobrevida global média foi de 20,3 meses. Infusões com doses superiores a 2,5 × 106 células/kg resultaram em ORR de 88% e CR de 75%, indicando um efeito dose-responsiva. Efeitos adversos incluíram Síndrome de Resposta Citocinética (SRC) e Eventos Neurológicos. A SRC variou de graus 1 a 5, com febre, hipotensão e insuficiência renal. A toxicidade neurológica durou em média 1 dia, com encefalopatia reversível, disfagia, disartria e alucinações. Houve aumento nos níveis de citocinas após a infusão de células CAR-T. Discussão: A eficácia da terapia com células CAR-T na leucemia linfocítica crônica (LLC) revela avanços significativos e desafios persistentes. A partir da revisão dos quatro artigos encontrados, a terapia CAR-T mostrou uma alta taxa de resposta global (82%) e remissão completa (64%) no 28° dia, indicando seu potencial como uma opção eficaz para pacientes com LLC. No entanto, a progressão da doença em alguns pacientes e a mediana de sobrevida global de 20,3 meses destacam a variabilidade da eficácia entre os indivíduos. A análise também mostrou que doses mais altas de células CAR-T podem melhorar os resultados, mas levantam questões sobre a segurança e a relação custo-benefício. Por fim, os efeitos adversos como a Síndrome de Resposta Citocinética e eventos neurológicos sublinham a necessidade de um manejo cuidadoso desses efeitos. Conclusão: O uso terapêutico de células CAR-T frente LLC demonstrou eficácia, com indicadores de CR superiores a 60% nos pacientes. Salienta-se que essa terapia pode ser impactada por fatores intrínsecos das células T, carga tumoral, terapias anteriores e outros coeficientes. A revisão dos estudos recentes reforça a necessidade de mais pesquisas a longo prazo para entender a durabilidade da resposta e a segurança contínua da terapia CAR-T na LLC.

BackgroundThe relationship between salivary α-amylase activity (sAAa) and susceptibility to cardiovascular disorders lacks a definitive consensus in available studies. To fill this knowledge gap, the present study endeavors to investigate this association among overweight/obese otherwise healthy Qatari adults. The study specifically categorizes participants based on their sAAa into high and low subgroups, aiming to provide a more comprehensive understanding of the potential link between sAAa levels and cardiovascular and inflammation markers in this population.MethodsPlasma samples of 264 Qatari overweight/obese (Ow/Ob) participants were used to quantify the sAAa and to profile the proteins germane to cardiovascular, cardiometabolic, metabolism, and organ damage in low sAAa (LsAAa) and high sAAa (HsAAa) subjects using the Olink technology. Comprehensive statistical tools as well as chemometric and enrichments analyses were used to identify differentially expressed proteins (DEPs) and their associated signaling pathways and cellular functions.ResultsA total of ten DEPs were detected, among them five were upregulated (QPCT, LCN2, PON2, DPP7, CRKL) while five were down regulated in the LsAAa subgroup compared to the HsAAa subgroup (ARG1, CTSH, SERPINB6, OSMR, ALDH3A). Functional enrichment analysis highlighted several relevant signaling pathways and cellular functions enriched in the DEPs, including myocardial dysfunction, disorder of blood pressure, myocardial infraction, apoptosis of cardiomyocytes, hypertension, chronic inflammatory disorder, immunes-mediated inflammatory disease, inflammatory response, activation of leukocytes and activation of phagocytes.ConclusionOur study unveils substantial alterations within numerous canonical pathways and cellular or molecular functions that bear relevance to cardiometabolic disorders among Ow/Ob Qatari adults exhibiting LsAAa and HsAAa in the plasma. A more comprehensive exploration of these proteins and their associated pathways and functions offers the prospect of elucidating the mechanistic underpinnings inherent in the documented relationship between sAAa and metabolic disorders.

This work investigates the compositional dependence and thermal annealing of the morphological properties, electrical conductivity mechanisms and Mott's parameters of sprayed MoxW1-xO3 (x = 0, 0.05, 0.10 and 0,20) thin films. The prepared thin films were examined using field emission scanning electron microscopy (FE-SEM), energy dispersive X-ray analysis (EDX) and Fourier transform infrared spectroscopy (FTIR) techniques. In addition, the two-point probe method was used to calculate the electrical properties of MoxW1-xO3 thin films. The FTIR results revealed that; the tungsten hydroxyl bond (W-OH) and the surface hydroxyl group vibrated within the ranges of 1558.62–1645.56 cm−1 and, 3296.76 and 3424.34 cm−1, respectively. Furthermore, a prominent band in the spectrum spanning from 850 to 650 cm−1 represents the W-O-W bridge mode. The FE-SEM investigations found that the molybdenum (Mo) dopant caused significant changes in the surface morphology of the films. The EDX results showed that the percentages of the isotropic elements MoxW1-xO3 agreed well with those obtained by atomic weight. Studies of the conduction mechanism indicate that the transition temperature was approximately 393K. Corresponding to Mott's model, the conduction mechanism below this temperature was across the variable hopping conduction band near the Fermi level. The mechanism exhibited a cycle of localised states through activated thermionic emission above 393K. Mott parameters were also estimated in addition to barrier potential energies, trapping state energies, local state densities, and other variables. The results revealed that both temperature areas had a rise in ρo and ρ1 values during and after annealing. The ΔEo and ΔE1 values in each temperature area decreased as the Mo-ion concentration increased. Furthermore, the conversion temperature gradually reduced as Mo was added. Based on these properties, the study's overall findings indicate that MoxW1-xO3 is suitable for future photonic devices and optoelectronic applications.

Abstract Background Hepatocellular carcinoma (HCC) is the first cause of cancer in Egypt. Recently, HCC developed post direct-acting antivirals (DAAs) differ in some characteristics from those developed without DAAs exposure regarding the biological features and behavior of HCC. We aimed to assess the epidemiological, clinical, laboratory, and radiological findings besides the biological behavior of HCC patients post DAAs in comparison to HCC not exposed to DAAs. An analytic cross-sectional research was performed at the National Liver Institute which is a tertiary multidisciplinary HCC center. Subjects included hepatitis C virus patients and were allocated into two groups: group I included 2036 HCC cases post-DAA treatment and group II included 6338 HCC cases who did not receive DAAs. Subjects were examined to evaluate clinical, laboratory, and radiological findings. Tumor staging was done using the BCLC staging system. Results Group II showed a more advanced Child–Pugh score, FIB-4 index, and MELD score than Group I (P = 0.001). The multiplicity of hepatic focal lesions was elevated in group I than in group II (P = 0.033). AFP level was significantly elevated in group I than in group II (p = 0.012). Portal vein invasion was significantly elevated in group I than in group II patients (P = 0.001). Extrahepatic spread of HCC was significantly elevated in group I than in group II (P = 0.001). Infiltrative lesions were significantly elevated in group I than in group II (P = 0.002). Conclusion Our study detected that the behavior in HCC post DAAs treatment is more aggressive in respect of the number of lesions, PV invasion; local and distant metastasis, and serum AFP level than in patients unexposed to DAAs. Strict surveillance in cirrhotic patients treated with DAA should be followed according to the international guidelines for early diagnosis and treatment of HCC.

Abstract Background Cancer patients are often treated with radiation, therefore increasing their exposure to high energy emissions. In such cases, medical errors may be threatening or fatal, inducing the need to innovate new methods for maximum reduction of irreversible events. Training is an efficient and methodical tool to subject professionals to the real world and heavily educate them on how to perform with minimal errors. An evolving technique for this is Serious Gaming that can fulfill this purpose, especially with the rise of COVID-19 and the shift to the online world, by realistic and visual simulations built to present engaging scenarios. This paper presents the first Serious Game for Lung Cancer Radiotherapy training that embodies Biomedical Engineering principles and clinical experience to create a realistic and precise platform for coherent training. Methods To develop the game, thorough 3D modeling, animation, and gaming fundamentals were utilized to represent the whole clinical process of treatment, along with the scores and progress of every player. The model’s goal is to output coherency and organization for students’ ease of use and progress tracking, and to provide a beneficial educational experience supplementary to the users’ training. It aims to also expand their knowledge and use of skills in critical cases where they must perform crucial decision-making and procedures on patients of different cases. Results At the end of this research, one of the accomplished goals consists of building a realistic model of the different equipment and tools accompanied with the radiotherapy process received by the patient on Maya 2018, including the true beam table, gantry, X-ray tube, CT Scanner, and so on. The serious game itself was then implemented on Unity Scenes with the built models to create a gamified authentic environment that incorporates the 5 main series of steps; Screening, Contouring, External Beam Planning, Plan Evaluation, Treatment, to simulate the practical workflow of an actual Oncology treatment delivery for lung cancer patients. Conclusion This serious game provides an educational and empirical space for training and practice that can be used by students, trainees, and professionals to expand their knowledge and skills in the aim of reducing potential errors.

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare systems globally, particularly in terms of access to medicines. Lebanon has been greatly affected by the pandemic, having faced concomitant financial and economic crises. The objective of the study was to understand the experiences of patients with COVID-19 in Lebanon, as well as those of their families, and healthcare providers, with regards to their treatment decisions and accessibility to COVID-19 medicines. Methods For this qualitative study, we conducted 28 semi-structured interviews. We used purposive sampling to recruit participants with a diverse range of perspectives. The data collection phase spanned from August to November 2021 and was conducted virtually. After transcribing and translating the interviews, we employed thematic analysis to identify recurring themes and patterns. Results In total, 28 individuals participated in this study. Participants highlighted challenges owing to the COVID-19 pandemic and economic crisis. Accessing COVID-19 medicines posed major hurdles for physicians and patients, given limited availability, global shortages, local circumstances, community hoarding and stockpiling by pharmacies. Providers based treatment decisions on research, local and international practice guidelines, experiences and expert feedback. Patients sought information from social media, community members and physicians, as well as through word of mouth. Accessing medicines involved navigating the healthcare system, the black market, charities, personal networks and political parties and sourcing from abroad. The medicines were either free, subsidized or at inflated costs. Conclusions This study highlights the diversity and complexity of factors influencing decision-making and accessing medicines during the COVID-19 pandemic in Lebanon. Future research should explore strategies for ensuring medicine access during crises, drawing insights from comparative studies across different countries.

Abstract Background Ventilator-associated pneumonia (VAP) is one of the leading causes of mortality in patients with critical care illness. Since obesity is highly prevalent, we wanted to study its impact on the outcomes of patients who develop VAP. Methods Using the National Inpatient Sample (NIS) database from 2017 to 2020, we conducted a retrospective study of adult patients with a principal diagnosis of VAP with a secondary diagnosis with or without obesity according to 10th revision of the International Statistical Classification of Diseases (ICD-10) codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included tracheostomy, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a p-value less than 0.05 considered statistically significant. Results The study included 3832 patients with VAP, 395 of whom had obesity. The mean age in both groups was around 58 years, and 68% of the group with obesity were females compared to 40% in females in the group without obesity. Statistically significant comorbidities in the obesity group included a Charlson Comorbidity Index score of three and above, diabetes mellitus, hypertension, chronic kidney disease, and sleep apnea. Rates and odds of mortality were not significantly higher in the collective obesity group 39 (10%) vs. 336 (8.5%), p-value 0.62, adjusted odds ratio 1.2, p-value 0.61). The rates and odds of tracheostomy were higher in the obesity group but not statistically significant. Obese patients were also found to have a longer hospitalization. Upon subanalysis of the data, no evidence of racial disparities was found in the care of VAP for both the obese and control groups. Conclusions Obesity was not found to be an independent risk factor for worse outcomes in patients who develop VAP in the intensive care unit.

The introduction of fluorine in compounds plays a crucial role in drug development as it greatly influences their final pharmacokinetic and dynamic properties. Due to the prevalence of fluorine in FDA-approved drugs in recent years, identifying the mechanisms driving their chemical transformations has become crucial in the drug discovery landscape. 19F NMR spectroscopy is a powerful analytical technique that allows for the examination of fluorine-containing compounds, offering valuable information about their structure, dynamics, and reactivity. NMR spectra can be interpreted through the leveraging of Density Functional Theory (DFT). However, the screening of compounds and discovery of feasible drug candidates is limited due to its computational cost. Here, we present a machine learning approach to accelerate the prediction of DFT-calculated 19F NMR chemical shifts. The fluorine atoms’ features in the models were derived from their local three-dimensional environments, representing their neighboring atoms within a radius of n Å away from the given fluorine atom in the compound. A comparative analysis of thirteen regression models was conducted using features extracted from 501 fluorinated compounds in our laboratory’s chemical inventory. Among the models, Gradient Boosting Regression (GBR) exhibited the highest performance, achieving a mean absolute error of 3.31 ppm with a local environment radius of 3 Å. This demonstrates a comparable accuracy to DFT calculations while reducing computational time from several hundred seconds to milliseconds. 3 Å was also found to be the most optimal radius across all models when encoding features for local atomic environments.

Background: Peanut meal (seeds waste with the red skin) contains antioxidants and anti-inflammatory compounds, which protect cells from oxidative stress and inflammation. Hypothesis: This byproduct can be used to produce nutraceutical and functional food items that may become popular. Methods: Ultrasound-assisted extraction was used to prepare peanut meal extracts at various times and with different solvents of 90 % (acetone, ethanol, methanol, and acetic acid ethyl ester). Acetone peanut meal extracting (for 20 min ) demonstrated the highest total phenolic content (83.78 mg GAE/g meal) and DPPH scavenging activity (95.83 %). Acetone peanut meal extract (PME) was analyzed by HPLC and encapsulated using sodium alginate via the co-extrusion technique. The alginate/PME microbeads were studied for their morphology and release of phenolic compounds. Results: The results of the molecular docking demonstrated a strong binding affinity, implying that the identified compounds in PME may inhibit acetylcholinesterase. Through the in vivo study, it was revealed that PME and PME microbeads demonstrated antioxidant and anti-inflammatory effects in AlCl3-treated rats. Additionally, PME and PME microbeads reduced the acetylcholinesterase activity while elevating the levels of dopamine and serotonin compared to the AlCl3-treated rats. Conclusion: This work provided valuable contributions towards the valorization of peanut byproducts, highlighting their potential neuroprotective effect against aluminum-induced Alzheimer's disease.