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Abstract Background Mitochondrial DNA (mtDNA) copy number is associated with tumor activity and carcinogenesis. This study was undertaken to investigate mtDNA copy number in papillary thyroid cancer (PTC) tissues and to evaluate the risk of PTC development. The clinicopathological features of patients and mtDNA copy number were correlated. The value of mtDNA copy number was evaluated as a biomarker for PTC. Method DNA was extracted from 105 PTC tissues and 67 control thyroid tissues, and mtDNA copy number mtDNA oxidative damage were determined using qPCR techniques. Results Overall, the relative mtDNA copy number was significantly higher in PTC patients (p

Context: Persistent infection with high-risk human papillomavirus (hr-HPV) types is associated with high-grade cervical abnormalities. Aims: The aim of the study was to find most hr-HPV types causing persistent infection in abnormal cytological samples using Aptima HPV testing and discuss the compatibility of the Gardasil 9 vaccine in targeting most types. Settings: The study was conducted in a cytology laboratory in a tertiary hospital. Design: This is a retrospective observational study. Methods and Materials: Cytology and HPV Aptima test reports were obtained for abnormal cervical samples for a 6-year period. Statistical Analysis Used: Pearson Chi-square test. Results: Reports of 2834 abnormal cervical samples were analyzed. Aptima testing was positive in 21% of samples, including 92% of squamous cell carcinoma (SCC), 76.4% of the high-grade squamous intraepithelial lesion (HSIL), 52% of low-grade squamous intraepithelial lesion (LSIL), 40% of adenocarcinoma (ADC), and 21% of atypical squamous cells that cannot exclude HSIL (ASC-H). The Aptima other hr-HPV group was most common (60%), HPV16 was 26%, HPV18/45 was 9.6%, and double HPV infection was 4.3%. HPV16 was the most common infection in HSIL+ cases. HPV infection was most common in age groups (30–39) and (40–49), and a shift to age groups (50–59) and ≥60 was seen in HSIL+ cases. Conclusions: This study is the first of its kind in correlating age with hr-HPV and cytology findings in the Middle East and adds to previous knowledge related to the prevalence and Aptima testing of HPV. The outcome could be used as a baseline for the Gardasil 9 vaccine and for the assessment of its effectiveness after three or five years from initiation.

Ration contamination with cadmium chloride (CdCl2) leads to serious economic loss. The current study aimed to explain the ameliorative effect of grape seed extract (GSE) either alone or in combination with CdCl2. One hundred and fifty chicks were used in the current study. They were equally alienated into 6 groups; group I was kept as control. Group II: given grape seed extract by the first dose (GSE1) of 250 mg/kg; group III: given grape seed extract by the second dose (GSE2) of 500 mg/kg; group IV: given cadmium chloride (CdCl2) to evaluate the undesirable effects of the dose (100 mg/kg diet). Group V: given combination of GSE1+ CdCl2, group VI: given combination of GSE2+ CdCl2. At the end of the 3rd and 5th weeks, the following parameters were measured: Serum oxidants and antioxidants (GSH, SOD, CAT and MDA), brain oxidants and antioxidants (SOD, CAT, MDA, and NO), semi-quantitative RT-PCR detection of brain and liver GST and GPx, as well as serum cytokines (IL-1β, IL-10, and TNF-α), were determined. The results put on display show that GSE extract considerably ameliorated the levels of serum and tissue oxidants and antioxidants, as well as cytokines that ramshackle CdCl2. Histopathological assessment of brain tissue and BAX brain sections was in concurrence with the immunological, oxidant, antioxidant, and RT-PCR results. It is important to take into consideration that the immunostimulant, antioxidative properties of GSE are mechanistically achieved. So, GSE could be used as a protective agent against ration contamination.

BackgroundRheumatoid arthritis (RA) is a common condition treated with biological disease-modifying anti-rheumatic medicines (bDMARDs). However, many patients exhibit resistance, necessitating the use of machine learning models to predict remissions in patients treated with bDMARDs, thereby reducing healthcare costs and minimizing negative effects.ObjectiveThe study aims to develop machine learning models using data from the Kuwait Registry for Rheumatic Diseases (KRRD) to identify clinical characteristics predictive of remission in RA patients treated with biologics.MethodsThe study collected follow-up data from 1,968 patients treated with bDMARDs from four public hospitals in Kuwait from 2013 to 2022. Machine learning techniques like lasso, ridge, support vector machine, random forest, XGBoost, and Shapley additive explanation were used to predict remission at a 1-year follow-up.ResultsThe study used the Shapley plot in explainable Artificial Intelligence (XAI) to analyze the effects of predictors on remission prognosis across different types of bDMARDs. Top clinical features were identified for patients treated with bDMARDs, each associated with specific mean SHAP values. The findings highlight the importance of clinical assessments and specific treatments in shaping treatment outcomes.ConclusionThe proposed machine learning model system effectively identifies clinical features predicting remission in bDMARDs, potentially improving treatment efficacy in rheumatoid arthritis patients.

This study aims to evaluate the performance and effectiveness of six spectral water indices - derived from Multispectral sentinel-2 data - to detect soil moisture and inundated area in arid regions to be used as an indicator of mudflow phenomena to predict high-risk areas. Herein, the validation of the performance of spectral indices was conducted using threshold method, spectral curve performance, and soil-line method. These indirect validation techniques play a key role in saving time, effort, and cost, particularly for large-scale and inaccessible areas. It was observed that the Normalized Difference Water Index (NDWI), Modified Normalized Difference Water Index (mNDWI), and RSWIR indices have the potential to detect soil moisture and inundated areas in arid regions. According to the temporal spectral curve performance, the spectral characteristics of water and soil moisture were distinct in the Near infrared (NIR) and Short-wave Infrared (SWIR1,2) bands. However, the rate and degree differed between these bands, depending on the amount of water in the soil. Furthermore, the soil line method supported the appropriate selection of threshold values to detect soil moisture. However, the threshold values varied with location, time, season, and between indices. We concluded that considering the factors influencing the behavior of water and soil reflectivity could support decision-makers in identifying high-risk mudflow locations.

Background and Aims: Treatments for ulcerative colitis (UC) differ in safety, efficacy, and route of administration; patient preferences for treatment attributes should be considered in treatment decisions. No study to date has explored patient preferences for moderate-to-severe UC treatment in Middle Eastern countries. Methods: A discrete-choice experiment aimed to quantify treatment preferences in patients with moderate-to-severe UC in 5 Middle Eastern countries (Saudi Arabia, Kuwait, Jordan, the United Arab Emirates, and Lebanon). Respondents chose between experimentally designed profiles for hypothetical UC treatments with varying efficacy (time until UC symptoms improve and chance of UC symptom control after 1 year), side effects (annual risk of serious infection, 5-year risk of malignancy), mode and frequency of administration, and need for occasional steroid use. A random-parameters logit model was used to estimate preference weights for these attributes, from which conditional relative importance estimates and maximum acceptable increases in risks of serious infection and malignancy were derived. Results: Among 365 adults with moderate-to-severe UC who completed the survey (mean age, 36 years; 50% female), 5-year risk of malignancy and symptom control after 1 year had the greatest conditional relative importance. Respondents were generally willing to accept statistically significant increases in annual risk of serious infection and 5-year risk of malignancy in exchange for better efficacy, changes in mode of administration and dosing schedule, and avoiding occasional steroid use. Conclusion: Of the attributes evaluated, individuals with UC in Middle Eastern countries most value avoiding 5-year risk of malignancy and a higher probability of symptom control, on average.

Mangrove ecotourism is gaining immense popularity in the Gulf Cooperation Council (GCC) countries as a neoliberal conservation tool, and it has contributed significantly to the growth of the tourism sector in the region over the past two decades. However, there is no comprehensive review on the full extent of mangrove ecotourism activities and the contribution to mangrove conservation/restoration and economic growth in the region. A systematic literature review approach was used to examine the evolution of mangrove ecotourism in the GCC countries from 2010 to 2023. A total of 55 articles were retrieved from the Google and Google Scholar search engines, and the Scopus and Web of Science databases were incorporated. We synthesized the results and provided perspectives on the following: (1) the geographical and temporal distribution of studies in relation to mangrove extent, (2) key sites, attractions, and values for mangrove ecotourism activities, (3) the positive and negative impacts of mangrove ecotourism, and (4) existing mangrove conservation and restoration initiatives for the growth of mangrove ecotourism in the GCC countries. The findings underscore the significance of mangrove ecotourism in supporting economic development, protecting coastal ecosystems, and sustaining local livelihoods in the GCC countries. However, this study highlights the crucial need for sustainable coastal environmental management through integrated land use planning and zoning to address the negative impacts of anthropogenic pressures on mangrove ecosystems and ecotourism attractions. The use of remote sensing tools is invaluable in the monitoring of mangrove ecosystems and associated ecotourism impacts for informing evidence-based conservation and restoration management approaches. Thus, harnessing mangrove ecotourism opportunities can help the GCC countries with balancing economic growth, coastal environmental sustainability, and community well-being.

Screening mammography is considered to be the most effective means for the early detection of breast cancer. However, epidemiological studies suggest that longitudinal exposure to screening mammography may raise breast cancer radiation-induced risk, which begs the need for optimization and internal auditing. The present work aims to establish a comprehensive well-structured Diagnostic Reference Level (DRL) system that can be confidently used to highlight healthcare centers in need of urgent action, as well as cases exceeding the dose notification level. Screening mammographies from a total of 2048 women who underwent screening mammography at seven different healthcare centers were collected and retrospectively analyzed. The typical DRL for each healthcare center was established and defined as per (A) bilateral image view (left craniocaudal (LCC), right craniocaudal (RCC), left mediolateral oblique (LMLO), and right mediolateral oblique (RMLO)) and (B) structured compressed breast thickness (CBT) criteria. Following this, the local DRL value was established per the bilateral image views for each CBT group. Screening mammography data from a total of 8877 images were used to build this comprehensive DRL system (LCC: 2163, RCC: 2206, LMLO: 2288, and RMLO: 2220). CBTs were classified into eight groups of

Background: The non-vitamin K antagonist oral anticoagulants (NOACs) have become the mainstay anticoagulation therapy for patients requiring oral anticoagulants (OACs) in the Gulf Council Cooperation (GCC) countries. The frequency of NOAC-associated major bleeding is expected to increase in the Emergency Department (ED). Nonetheless, we still lack local guidelines and recommendations for bleeding management in the region. The present Delphi-based consensus aims to establish a standardized and evidence-based clinical care pathway for managing NOAC-associated major bleeding in the Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE). Methods: We adopted a three-step modified Delphi method to develop evidence-based recommendations through two voting rounds and an advisory meeting between the two rounds. A panel of 11 experts from the KSA and UAE participated in the consensus development. Results: Twenty-eight statements reached the consensus level. These statements addressed key aspects of managing major bleeding events associated with NOACs, including the increased use of NOAC in clinical practice, clinical care pathways, and treatment options. Conclusion: The present Delphi consensus provides evidence-based recommendations and protocols for the management of NOAC-associated bleeding in the region. Patients with major NOAC-induced bleeding should be referred to a well-equipped ED with standardized management protocols. A multidisciplinary approach is recommended for establishing the association between NOAC use and major bleeding. Treating physicians should have prompt access to specific reversal agents to optimize patient outcomes. Real-world evidence and national guidelines are needed to aid all stakeholders involved in NOAC-induced bleeding management.

In the last few decades, revegetation strategies for ecosystem restoration have received great attention in dryland studies, especially those related to the restoration and revegetation of native desert plants to combat land degradation. Long-term monitoring and assessment are critical for the restoration programs to track the progress of the restoration program goals. The effectiveness and success of monitoring depend on the selected methods with respect to spatial and temporal scales. Traditional methods for vegetation monitoring are time-consuming, expensive, and require considerable labor efforts (manpower) in terms of field measurements, collecting samples, lab analysis, and the difficulty of accessing some study areas. Thus, satellite remote sensing images have been widely used to monitor land degradation and restoration programs using multispectral and hyperspectral sensors and indices such as NDVI, which is the most popular index for vegetation monitoring. However, such techniques showed many limitations when used in arid ecosystems, especially for seasonal vegetation assessments, which could mislead the monitoring and assessment of the restoration projects. This paper discusses lessons learned from previous research work, including the limitations of using satellite remote sensing in arid ecosystems and the use of UAV methods to overcome these issues and challenges to provide more accurate outcomes for seasonal assessment of vegetation in arid landscapes.

Background: A growing body of evidence underscores the beneficial impact of therapeutic drug monitoring (TDM) on the efficacy and cost-effectiveness of anti-tumour necrosis factor (TNF) therapy in patients with inflammatory bowel disease (IBD). Objectives: We surveyed clinician attitudes, perceptions and barriers related to TDM in IBD in the Middle East. Design: A 15-question survey was distributed through national gastroenterological societies in five Middle Eastern countries (UAE, Saudi Arabia, Kuwait, Lebanon and Egypt). Methods: Data on clinician characteristics, demographics, utilization patterns and obstacles related to the adoption of TDM with anti-TNFs were gathered. Logistic regression analysis was used to predict factors influencing the utilization of TDM. Results: Among 211 respondents (82% male), 82% were consultants, 8% were physicians with an interest in gastroenterology (GI), and 6% were GI trainees. Of these, 152 met inclusion criteria, treating >5 IBD patients per month and ⩾1 with an anti-TNF per month. TDM was used in clinical practice by 78% (95% CI: 71–85) of respondents. TDM was utilized following the loss of response (LOR) in 93%, for primary non-response (PNR) in 40% and before restarting anti-TNF therapy after a drug holiday in 33% of respondents, while 34% used TDM proactively. No specific factors were associated with the use of TDM. Barriers to TDM use included cost (85%), time lag to results (71%) and lack of insurance reimbursement (65%). Overall knowledge of TDM (70%), interpretation and actioning of results (76%) or awareness of clinical guidelines (57%) were not perceived as barriers. If barriers were removed, 95% would use TDM more frequently; 93% for LOR, 60% for PNR, 50% when restarting after a drug holiday, and 54% would use TDM proactively. Conclusion: Most gastroenterologists use TDM for LOR, with cost, time lag and insurance reimbursement being significant barriers. Addressing these barriers would increase the judicious use of reactive and proactive TDM to optimize anti-TNF therapy in IBD.

Thrombophilia in venous thromboembolism (VTE) is multifactorial. Von Willebrand factor (vWF) plays a major role in primary hemostasis. While elevated vWF levels are well documented in VTE, findings related to its cleaving protease (ADAMTS-13) are contradicting. The aim of this study was to determine vWF, ADAMTS-13, and the multifactorial Thrombospondin-1 (TSP-1) protein levels in patients after 3-6 months following an unprovoked VTE episode. We also explored a possible association with factor V Leiden (FVL) mutation. vWF, ADAMTS-13 and TSP-1 were analyzed using ELISA kits in 60 VTE patients and 60 controls. Patients had higher levels of vWF antigen ( P = .021), vWF collagen-binding activity ( P = .008), and TSP-1 protein ( P .05). There appears to be an imbalance between vWF and ADAMTS-13 in VTE patients even after 3-6 months following the onset of VTE. We report that the odds of developing VTE in carriers of FVL mutation are 9.672 times those without the mutation, but the presence of this mutation is not associated with the studied proteins.

Introduction: Despite changes in regulations, boxing-related injuries and fatalities are still occurring. The numbers available in the literature regarding mortality and long-term consequences may not accurately represent the actual situation. Indeed, the real extent of this phenomenon remains poorly known. Research question: Delineating the spectrum of acute and chronic consequences of boxing-related traumatic brain injuries (TBI). Material and methods: Narrative review of the literature concerning acute and chronic boxing-related TBI. Keywords such as mortality, boxing, subdural hematoma were used to search in PubMed and Google scholar. An updated analysis of the Velazquez fatalities collection in boxing was undertaken. Results: The Velazquez collection includes 2076 fatalities from 1720 to the present with a death rate of 10 athletes per year. More than half of the deaths (N = 1354, 65.2%) occurred after a knock-out, and nearly 75% happened during professional bouts. In Australia, from 1832 to 2020, 163 fatalities were recorded (75% professional). In Japan, from 1952 to 2016, 38 deaths were recorded with a mean age of 23.9 years. Up to 40% of retired professional boxers in the United States were diagnosed with symptoms of chronic brain injury. Clinical dementia is far more prevalent among professional boxers than in amateurs with an incidence of 20%. Discussion and conclusions: A concerted effort to raise awareness and shed light on boxing-related neuro-trauma is required. Similar considerations can be made for other combat sports or contact sports. A call to action to address this knowledge gap, decrease and prevent this phenomenon is advocated.

Introduction: Artificial Intelligence tools are being introduced in almost every field of human life, including medical sciences and medical education, among scepticism and enthusiasm. Research question: to assess how a generative language tool (Generative Pretrained Transformer 3.5, ChatGPT) performs at both generating questions and answering a neurosurgical residents’ written exam. Namely, to assess how ChatGPT generates questions, how it answers human-generated questions, how residents answer AI-generated questions and how AI answers its self-generated question. Materials and methods: 50 questions were included in the written exam, 46 questions were generated by humans (senior staff members) and 4 were generated by ChatGPT. 11 participants took the exam (ChatGPT and 10 residents). Questions were both open-ended and multiple-choice.8 questions were not submitted to ChatGPT since they contained images or schematic drawings to interpret. Results: formulating requests to ChatGPT required an iterative process to precise both questions and answers. Chat GPT scored among the lowest ranks (9/11) among all the participants). There was no difference in response rate for residents’ between human-generated vs AI-generated questions that could have been attributed to less clarity of the question. ChatGPT answered correctly to all its self-generated questions. Discussion and conclusions: AI is a promising and powerful tool for medical education and for specific medical purposes, which need to be further determined. To request AI to generate logical and sound questions, that request must be formulated as precise as possible, framing the content, the type of question and its correct answers.

One of the major contaminants in aquatic ecosystems is bisphenol A (BPA), a synthetic industrial chemical widely used in the production of epoxy resins and plastics. BPA has negative effects on fish health. Proanthocyanidin, a natural immune stimulant extracted from grape seeds (GR), possesses various biological and antioxidant properties. This study aimed to mitigate the harmful effects of BPA by supplementing the fish diet with GR. Healthy Nile tilapia (120 fish, 14.95±0.10g) were divided into four groups: Group 1 served as the control; group 2 was fed 400mg GR per kg of feed; group 3 was exposed to 3mg of BPA per liter of water without GR supplementation, and group 4 was exposed to 3mg of BPA per liter of water and fed a GR-supplemented diet (400mg GR per kg). After 28 days, blood and tissue samples were collected to assess serum biochemical parameters, cytokines, catalase (CAT) activity, malondialdehyde (MDA) levels, and the histological features of the liver, spleen, and kidney. Co-treatment with GR improved serum protein levels as well as urea and creatinine levels that were previously altered by BPA exposure. BPA exposure elevated serum interleukin (IL)-1β and hepatic MDA levels, which were reduced by GR administration. Additionally, CAT activity decreased in the BPA group but increased in the GR+BPA group. BPA also significantly upregulated the mRNA transcripts of IL-6 and tumor necrosis factor (TNF-α), which may trigger inflammation, while GR significantly downregulated these genes in the BPA-treated group. Histological analysis showed that GR alleviated tissue damage caused by BPA. In conclusion, GR supplementation improved fish biochemical and histological parameters and mitigated the toxic effects of BPA. [ABSTRACT FROM AUTHOR]

Screening mammography is considered to be the most effective means for the early detection of breast cancer. However, epidemiological studies suggest that longitudinal exposure to screening mammography may raise breast cancer radiation-induced risk, which begs the need for optimization and internal auditing. The present work aims to establish a comprehensive well-structured Diagnostic Reference Level (DRL) system that can be confidently used to highlight healthcare centers in need of urgent action, as well as cases exceeding the dose notification level. Screening mammographies from a total of 2048 women who underwent screening mammography at seven different healthcare centers were collected and retrospectively analyzed. The typical DRL for each healthcare center was established and defined as per (A) bilateral image view (left craniocaudal (LCC), right craniocaudal (RCC), left mediolateral oblique (LMLO), and right mediolateral oblique (RMLO)) and (B) structured compressed breast thickness (CBT) criteria. Following this, the local DRL value was established per the bilateral image views for each CBT group. Screening mammography data from a total of 8877 images were used to build this comprehensive DRL system (LCC: 2163, RCC: 2206, LMLO: 2288, and RMLO: 2220). CBTs were classified into eight groups of <20 mm, 20–29 mm, 30–39 mm, 40–49 mm, 50–59 mm, 60–69 mm, 70–79 mm, 80–89 mm, and 90–110 mm. Using the Kruskal–Wallis test, significant dose differences were observed between all seven healthcare centers offering screening mammography. The local DRL values defined per bilateral image views for the CBT group 60–69 mm were (1.24 LCC, 1.23 RCC, 1.34 LMLO, and 1.32 RMLO) mGy. The local DRL defined per bilateral image view for a specific CBT highlighted at least one healthcare center in need of optimization. Such comprehensive DRL system is efficient, easy to use, and very clinically effective. [ABSTRACT FROM AUTHOR]

Introduction: Although there are well-defined guidelines for the management of mild-to-moderate ulcerative colitis (UC), there are still unmet needs. For this reason, we conducted an international expert consensus to standardize the management of patients with mild-to-moderate UC and provide practical guidance to clinicians. Areas covered: Based on Delphi methodology, 15 statements were approved after two rounds of voting, addressing several aspects of disease management from sequencing to treatment duration, from monitoring to optimization techniques and safety profile. Expert opinion: Growing knowledge of mild-to-moderate UC has led to the development of new ambitious outcomes such as histological remission and disease clearance. Furthermore, noninvasive tools for patient monitoring such as fecal calprotectin and intestinal ultrasound are now available. Their implementation in clinical practice will allow clinicians to tightly monitor disease activity and promptly adapt treatment, avoiding complications and disease progression and targeting better disease control. [ABSTRACT FROM AUTHOR]

Ration contamination with cadmium chloride (CdCl2) leads to serious economic loss. The current study aimed to explain the ameliorative effect of grape seed extract (GSE) either alone or in combination with CdCl2. One hundred and fifty chicks were used in the current study. They were equally alienated into 6 groups; group I was kept as control. Group II: given grape seed extract by the first dose (GSE1) of 250 mg/kg; group III: given grape seed extract by the second dose (GSE2) of 500 mg/kg; group IV: given cadmium chloride (CdCl2) to evaluate the undesirable effects of the dose (100 mg/kg diet). Group V: given combination of GSE1+ CdCl2, group VI: given combination of GSE2+ CdCl2. At the end of the 3rd and 5th weeks, the following parameters were measured: Serum oxidants and antioxidants (GSH, SOD, CAT and MDA), brain oxidants and antioxidants (SOD, CAT, MDA, and NO), semi-quantitative RT-PCR detection of brain and liver GST and GPx, as well as serum cytokines (IL-1ß, IL-10, and TNF-a), were determined. The results put on display show that GSE extract considerably ameliorated the levels of serum and tissue oxidants and antioxidants, as well as cytokines that ramshackle CdCl2. Histopathological assessment of brain tissue and BAX brain sections was in concurrence with the immunological, oxidant, antioxidant, and RT-PCR results. It is important to take into consideration that the immunostimulant, antioxidative properties of GSE are mechanistically achieved. So, GSE could be used as a protective agent against ration contamination. [ABSTRACT FROM AUTHOR]

This study investigates whether social norms impede informed trading. We use intraday data from Boursa Kuwait for January 2015 to December 2018, which clearly identifies institutions' religious identity. Consistent with our hypothesis, we find that the Islamic values of equality and trust lead to lower information asymmetry. Specifically, stocks of Islamic institutions experience lower informed trading in comparison to the stocks of non-Islamic institutions. [ABSTRACT FROM AUTHOR]