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من أبرز الهياكل الإنشائية التي من الممكن أن تستخدم في المنشآت العامة هي القشريات حيث تسمح للمصمم بالوصول لمجازات كبيرة والقشرية الكروية هي أحد هذه المنشآت من خلال هذا البحث تم دراسة تأثر تغيير زاوية القشرية على معامل الانبعاج في القشرية الكروية حيث تم دراسة أربعة أنواع من الزوايا (30,45,60,90)من أجل سماكات مختلفة (8,10,12)سم وبتأثير حمولات ميتة وحية على سطح القشرية وبنوعي استناد موثوق ومتمفصل وتم التوصل إلى أن معامل الانبعاج يتناسب عكساً مع زاوية القشرية من أجل حالتي الاستناد تتناسب سماكة القشرية عكساً مع معامل الانبعاج من أجل الزاوية نفسها أكبر هبوط لقيم معامل الانبعاج في حالة الاستناد الموثوق بين الزاويتين(60,90) , لا يمكن تعميم التشابه في أشكال الانبعاج من أجل الزاوية نفسها, وكذلك شكل الانبعاج يختلف باختلاف الزاوية.

تنتشر القشريات بشكل واسع وخاصة في الأماكن العامة والصالات في بحثنا هذا سوف نقوم بدراسة القبب نصف الكروية المصنوعة من البيتون المسلح والتي تتمتع باستناد متمفصل عند الأطراف تحت تأثير الانبعاج وذلك لمعرفة علاقة نسبة نصف القطر إلى السماكة بمعامل الانبعاج الذي هو بمثابة عامل أمان ضد الانبعاج، وكذلك علاقة نسبة نصف القطر الى السماكة بشكل الانبعاج الحاصل، ونوع الحمولة المطبقة، خلصت الدراسة إلى أن شكل الانبعاج المسيطر لا يتعلق بنسبة نصف قطر القشرية إلى سماكتها، و يختلف هذا الشكل باختلاف نوع تراكب الحمولة المستخدم، وقيمة معامل الانبعاج تنخفض مع زيادة نسبة نصف قطر القشرية إلى سماكتها من أجل السماكة نفسها، وتم تحديد النسبة الفعالة لنصف قطر القشرية إلى سماكتها للتنفيذ بين وأنه من أجل زيادة المجاز فإن قيمة معامل الانبعاج تتناقص.

Abstract Objective The aim of this study was to translate the Sinus and Nasal Quality of Life Surgery Survey into the Serbian language to evaluate the test‐retest reliability and validity. Study Design The study included 49 consecutive patients between 12 and 18 years old with rhinologic symptoms. Patients were given a paper survey to complete along with a link to complete the online survey within the same day. Setting The study was conducted at the University Children's Hospital Clinic for Pulmonology and Allergology between January 2023 and March 2023. Methods Responses between the paper and online survey were compared and regression analysis was performed to evaluate the relationship. Internal reliability and test‐retest reliability were assessed using Cronbach's α coefficient and intraclass correlation coefficient. All data were collected and analyzed using SPSS 29.0. Results Pearson correlation coefficient between the paper and online survey was very high and statistically significant (r = 0.999; P

Reversible thermochromic polymers have emerged as compelling candidates in recent years, captivating attention for their application in heat detection systems. This comprehensive review navigates through the multifaceted landscape, intricately exploring both the virtues and hurdles inherent in their integration within these systems. Their innate capacity to change colour in response to temperature fluctuations renders reversible thermochromic nanocomposites promising assets for heat detection technologies. However, despite their inherent potential, certain barriers hinder their widespread adoption. Factors such as a restricted colour spectrum, reliance on external triggers, and cost considerations have restrained their pervasive use. For instance, these polymer-based materials exhibit utility in the domain of building insulation, where their colour-changing ability serves as a beacon, flagging areas of heat loss or inadequate insulation, thus alerting building managers and homeowners to potential energy inefficiencies. Nevertheless, the limited range of discernible colours may impede precise temperature differentiation. Additionally, dependency on external stimuli, such as electricity or UV light, can complicate implementation and inflate costs. Realising the full potential of these polymer-based materials in heat detection systems necessitates addressing these challenges head-on. Continuous research endeavours aimed at augmenting colour diversity and diminishing reliance on external stimuli offer promising avenues to enhance their efficacy. Hence, this review aims to delve into the intricate nuances surrounding reversible thermochromic nanocomposites, highlighting their transformative potential in heat detection and sensing. By exploring their mechanisms, properties, and current applications, this manuscript endeavours to shed light on their significance, providing insights crucial for further research and potential applications.

ABSTRACT Helicobacter pylori vacuolating cytotoxin A (VacA) is an intracellular-acting protein exotoxin that induces mitochondrial dysfunction and energy depletion within host cells. Although exposure to VacA results in mitochondrial dysfunction, one recent study revealed that, following limited exposure to VacA, mitochondrial function and cellular ATP levels were restored in a time-dependent manner. Studies performed to address the mechanism by which host cells detect and respond to intracellular VacA identified the adenosine monophosphate (AMP)-activated protein kinase (AMPK) as a sensor of toxin-dependent alterations in cellular energy status. Activation of AMPK in response to VacA was demonstrated to orchestrate alterations in mitochondrial dynamics which resulted in restoration of mitochondrial function. Specifically, upregulation of dynamin-related protein 1 (Drp-1)-dependent mitochondrial fission resulted in reversible fragmentation of filamentous mitochondria and time-dependent reduction in mitochondrial-associated VacA, suggesting that fragmentation is important for removal of VacA from mitochondria. Cells with reduced levels of Drp-1 were more susceptible to VacA-dependent cell death, suggesting that mitochondrial dynamics is important for maintaining cell viability through the reduction in mitochondrial-associated toxin. Collectively, these studies support a model that cellular recovery and survival in response to VacA-dependent mitochondrial dysfunction is linked to host cell modulation of mitochondrial dynamics. This study provides new insights into cellular recognition and responses to intracellular-acting toxin modulation of host cell function, which could be relevant for the growing list of pathogenic microbes and viruses identified that target mitochondria as part of their virulence strategies. IMPORTANCE Persistent human gastric infection with Helicobacter pylori is the single most important risk factor for development of gastric malignancy, which is one of the leading causes of cancer-related deaths worldwide. An important virulence factor for Hp colonization and severity of gastric disease is the protein exotoxin VacA, which is secreted by the bacterium and modulates functional properties of gastric cells. VacA acts by damaging mitochondria, which impairs host cell metabolism through impairment of energy production. Here, we demonstrate that intoxicated cells have the capacity to detect VacA-mediated damage, and orchestrate the repair of mitochondrial function, thereby restoring cellular health and vitality. This study provides new insights into cellular recognition and responses to intracellular-acting toxin modulation of host cell function, which could be relevant for the growing list of pathogenic microbes and viruses identified that target mitochondria as part of their virulence strategies.

Abstract Tracheobronchial stenosis (TBS) in adults derives from congenital and acquired conditions, including prolonged mechanical intubation, expiratory central airway collapse, infectious or inflammatory disease, and malignancy. The most common clinical presentation is shortness of breath, recurrent infections, and chronic cough. TBS is usually diagnosed via computed tomography or bronchoscopy, with the latter doubling as a therapeutic tool. We present a case of an atypical fibrotic bridge connecting the walls of the distal trachea and fibrotic bronchial stenosis treated with electrocautery knife and balloon dilation, in an adult patient with bronchopulmonary dysplasia.

The recently described protein HAPSTR1 governs cellular stress resilience. Here, the authors discover a mammalian HAPSTR1 paralog, called HAPSTR2, which formed via retro-transposition and operates to augment and buffer cellular stress signaling.

Intravesical Bacillus Calmette–Guérin (BCG) therapy for nonmuscle-invasive bladder cancer rarely leads to the development of granulomatous renal masses (renal BCGosis). The management includes nephroureterectomy, antitubercular therapy (ATT), or both. Here, we present a case of a 62-year-old male who was treated with ATT alone for renal masses. Six months after intravesical BCG therapy for transitional cell carcinoma, he developed high-grade fever and night sweat and had multiple renal parenchymal hypodensities on computed tomography (CT) scan. Repeat CT scan 6 months after ATT revealed full resolution of renal hypodensities. This case report highlights the importance of follow-up for early detection of adverse effects of BCG treatment.

Introduction Transient Ischemic Attack (TIA) evaluation requires urgent etiology identification and targeted stroke prevention, traditionally performed via hospital admission. The literature suggests that outpatient evaluation may be safe and cost‐effective. Hence, we implemented an expedited outpatient pathway (OP) for patients presenting to our institution’s Emergency Department (ED) with TIA. To further guide future practice, we compared clinical features and outcomes between expedited OP and our well‐established inpatient pathway (IP). Methods We implemented an algorithm of direct communication between ED providers and Vascular Neurologists for all TIA patients. Certain screening studies (head CT, CT angiogram, basic laboratories) and acute therapies were implemented in the ED, whereas others (brain MRI, echocardiogram, etc) and Vascular Neurology consultations were expedited outpatient within 48–72 hours.We included all patients that underwent OP evaluation from May 2021‐May 2022. Further, we extracted patients with a final diagnosis of TIA and compared them with IP TIA patients hospitalized (2017‐2021), matched by age, gender, and clinical severity (ABCD2). Descriptive statistics were used to summarize patient demographics, clinical data, treatments, and 3‐month outcomes. Continuous variables were summarized with mean and standard deviations while categorical variables were shown as counts and percentages. Chi‐square test was used for categorical variables and Mann‐Whitney U test was used to compare continuous variables. P‐values < 0.05 were considered statistically significant and all tests were two‐sided. Statistical Analysis was completed in R 4.0.3. Results Of 43 patients who underwent expedited OP TIA workup, TIA or minor stroke was diagnosed in 21/43 (48.9%). 18 TIAs underwent comparative analyses. Mean symptom duration was longer in the IP (2.06 hours) than OP (0.99 hours), p = 0.370%. TIA was more likely to be diagnosed in the OP 14/18 (78%) versus IP 12/18 (67%), (p = 0.423). OP had more transesophageal echocardiograms (17% vs 5%, p = 0.630) and longer duration of ambulatory cardiac monitoring (mean 574.3 vs 381.7 hours, p = 0.100). IP patients were more likely to get started on anticoagulation compared to OP (38% vs 11%, p = 0.258) and high‐intensity statin (38% vs 17%, p = 0.260). All laboratories, echocardiograms and brain MR imaging were performed significantly sooner for the IP (p< 0.05 for all). IP had higher rate of return ED visits (22%) and readmissions at 3 months (11%), whereas OP had none. OP had no deaths or recurrent strokes, whereas 11% and 5.6% respectively were noted in the IP at 3 months (p = 0.310, p = 0.310). Conclusions Our study shows that routine IP evaluation for patients presenting with TIA in the ED may not offer diagnostic superiority nor lead to improvement of short‐term clinical outcomes, as compared to the expedited OP evaluation. Careful evaluation of TIA patients in the ED followed by expedited OP evaluation might be a plausible approach to help lower costs and avoid hospitalization without compromising the safety of these patients.

Abstract The development of drug resistance by Mycobacterium tuberculosis and other pathogenic bacteria emphasizes the need for new antibiotics. Unlike animals, most bacteria synthesize isoprenoid precursors through the MEP pathway. 1-Deoxy-d-xylulose 5-phosphate synthase (DXPS) catalyzes the first reaction of the MEP pathway and is an attractive target for the development of new antibiotics. We report here the successful use of a loop truncation to crystallize and solve the first DXPS structures of a pathogen, namely M. tuberculosis (MtDXPS). The main difference found to other DXPS structures is in the active site where a highly coordinated water was found, showing a new mechanism for the enamine-intermediate stabilization. Unlike other DXPS structures, a “fork-like” motif could be identified in the enamine structure, using a different residue for the interaction with the cofactor, potentially leading to a decrease in the stability of the intermediate. In addition, electron density suggesting a phosphate group could be found close to the active site, provides new evidence for the D-GAP binding site. These results provide the opportunity to improve or develop new inhibitors specific for MtDXPS through structure-based drug design.

Squamous cell carcinoma is a common malignant condition affecting the oral cavity and may involve the surrounding maxillofacial regions. Treatment commonly involves resection of the tumor, followed by prosthetic rehabilitation of the resection defect. This clinical report presents a 62‐year‐old Asian male patient who had previously undergone surgical resection, resulting in a post‐surgical Aramany Class II maxillary defect. The patient's medical history included severe trismus, characterized by restricted mouth opening, as well as a diagnosis of maxillary sinus verrucous squamous cell carcinoma. This report provides a comprehensive account of the rapid fabrication of an interim obturator using digitally assisted dentistry techniques. [ABSTRACT FROM AUTHOR]

Khaled Al-Surimi,1– 3 Zahra Alhayek,1,2 David Edvardsson,4 Badr Al-Khateeb,1,2 Naila Shaheen1,5 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 2King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; 3Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen; 4Department of Nursing, Umea University, Umea, Sweden; 5Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Naila Shaheen Email drnaila@hotmail.comIntroduction: Most health care systems strive to improve the quality, safety and value of healthcare, with an emphasis on moving towards patient-centered care/person-centered care (PCC) approach. The aim of the current study was to assess health care providers’ perspectives on PCC climate in hospital setting and to identify the role of providers in determining the perception of the PCC climate.Methods: A survey, using person-centered climate questionnaire-staff version, was employed in health care providers of a tertiary care hospital. Data included variables age, gender, education level, occupation, and years of experience and three PCC dimensions. PCC overall and subscale scores were reported as mean and standard deviation. Factors associated with PCC climate perception were analyzed using a Poisson model.Results: Out of 1216 respondents; the majority 47% aged between 18 and 34 years; 79% women, 68% were nurses. The overall mean score was 45.96± 15.36 (range 0– 70). Subscale scores were Safety 20.15± 5.0 (range 0– 30), Everydayness 12.02± 3.52 (range 0– 20) and Community 13.79± 3.34 (range 0– 20). Increasing age was a significant factor associated with PCC scores for the overall, safety, everydayness, and community scales, with a positive association. Lower scores were reported more by women compared with men, for overall (p=0.0005), and everydayness (p=0.006) scales. Higher safety scores were reported by health care providers with a diploma compared to master’s degree (p=0.009), Ph.D. (p=0.007), for technicians compared with nurses (p=0.007), and for day shift compared with day/night shift workers (p=0.025). PCC scores were not significantly different across health care providers’ years of experience.Conclusion: There is a room for PCC climate improvement based on the low scores compared to the literature. The study findings indicated that the main factors associated with HCPs’ perception of PCC were higher age and female gender, and these factors would benefit from further research.Keywords: health care providers’ perception, person-centered care, psychosocial climate, tertiary care facility, work climate

This paper presents an experimental and numerical investigation of pultruded composite glass fibre-reinforced polymer (pGFRP) cross-arms subjected to flexural creep behaviour to assess their performance and sustainability in composite cross-arm structure applications. The primary objective of this study was to investigate the failure creep behaviour of pGFRP cross-arms with different stacking sequences. Specifically, the study aimed to understand the variations in strain rate exhibited during different stages of the creep process. Therefore, this study emphasizes a simplified approach within the experiment, numerical analysis, and mathematical modelling of three different pGFRP composites to estimate the stiffness reduction factors that determine the prediction of failure. The findings show that Findley’s power law and the Burger model projected very different strains and diverged noticeably outside the testing period. Findley’s model estimated a minimal increase in total strain over 50 years, while the Burger model anticipated PS-1 and PS-2 composites would fail within about 11 and 33 years, respectively. The Burger model’s forecasts might be more reasonable due to the harsh environment the cross-arms are expected to withstand. The endurance and long-term performance of composite materials used in overhead power transmission lines may be predicted mathematically, and this insight into material property factors can help with design and maintenance.

The green plant-mediated synthesis of silver (GPS-Ag) nanoparticles (NPs) has been increasingly popular due to its eco-friendliness, availability, cost-effectiveness, and the fact that it can be safely handled and possesses a broad variability of metabolites, such as antioxidant and antimicrobial activities. In this current study, the synthesis of AgNPs has been demonstrated using aqueous extracts of fresh leaves of Ficus carica and Salvia rosmarinus (rosemary) that reduced aqueous silver nitrate. This procedure made the synthesis of NPs possible, which was characterized by numerous analytical techniques such as ultraviolet-visible (UV-Vis) spectrophotometry, Fourier transform infrared spectroscopy, transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy, and dynamic light scattering studies. The visual observation indicated that the colour of aqueous silver nitrate turned brownish yellow after treatment with the fresh leaf extracts and was confirmed by UV-Vis spectra. In addition, the TEM analysis showed that the synthesized NPs well dispersed with average sizes less than 22 nm. Furthermore, AgNPs and aqueous leaf extracts of F. carica and rosemary were examined for their antimicrobial activities against different Gram-positive and Gram-negative bacteria strains. The results indicated that the AgNPs, derived from F. carica, have more antibacterial activities than others and inhibited bacterial growth.

Abstract Objective Physicians on the frontline of the COVID‐19 pandemic are at increased risk of contracting the disease. Otolaryngologists are amongst the high‐risk practitioners, as they are in close proximity to patient's upper airway, which may induce their psychological stress. Methods A cross‐sectional survey study, conducted among otolaryngologists in Saudi Arabia from June 11 to June 22. Survey consisted of sociodemographic questionnaire, Coronavirus Anxiety Scale (CAS), Obsession with COVID‐19 Scale (OCS) and Patient Health Questionnaire‐9 (PHQ‐9). Available otolaryngologists with no history of mental health problems were included. A P‐value lower than .05 was considered statistically significant. Results The study included 129 participants; 63.6% men and 36.4% women. 81.4% of participants were living with family, 57.4% living with either a child or an elderly family member. Nearly 7.8% of participants had dysfunctional COVID‐19 anxiety and 75.2% had COVID‐19‐related depression symptoms ranging from minimal to severe. Obsession and dysfunctional thinking regarding COVID‐19 were found in 26.4% of participants. Single otolaryngologists had significantly higher CAS (P = .025), OCS (P = .048), and PHQ‐9 (P

BackgroundA major antioxidant, glutathione (GSH), is a key factor in the antioxidant defense mechanism against oxidative stress and aging-related functional declines. Our previous observational study showed positive correlations between brain GSH concentrations and dairy food consumption, particularly milk (p < 0.001), in older adults.ObjectiveTo investigate whether a recommended amount of milk intake (3 cups/day) in low dairy consumers enhances brain GSH concentrations through an intervention trial.MethodsSeventy-three older adults (60–89 years) with a low dairy intake (≤1.5 servings/day) were randomized (5:2 ratio) in this 3-month randomized clinical trial. The intervention group was provided 1% milk weekly and instructed to consume 3 cups of milk/day for 3 months while the control group continued their habitual intake of total dairy ≤ 1.5 servings/day (

A hydrocele is an abnormal collection of fluid within the tunica vaginalis which may either be congenital or acquired. Hydroceles are usually painless and don't require immediate intervention unless they impact activities of daily living. This case demonstrates a rare complication of hydroceles termed tension hydrocele which presented with scrotal swelling and acute pain. Unlike the classic presentation of hydroceles with minimal pain or discomfort, it is important to recognize tension hydroceles as an extremely rare but possible cause of acute scrotum, which needs to be emergently diagnosed and treated.

Highlights This paper presents the experimental, analytical, and numerical extensive investigation into the flexural creep performance of pultruded glass fiber reinforced polymer (pGFRP) composites at elevated service temperatures. The experimental phase involved a physical testing program on pGFRP coupons in a four‐point bending setup covering a wide range of loads (12%, 24%, and 37% stress levels) and temperature conditions (20, 40, and 60°C) over a long test duration of 720 h. The analytical Burgers model was employed to provide theoretical insights into the time‐dependent deformation behaviors, while the finite element analysis (FEA) simulations using derived reduction factor validated the accuracy of the proposed procedure. Burgers model was able to capture the experimental data very well and reached the ultimate strain failure limit within about 1.4–50 years depending on the case. The proposed simple FEA procedure yielded a pattern closely resembling the one observed from Burgers model in which they resulted in estimated endurance times with a roughly 15% difference between them. The higher stress and/or temperature, the longer the primary creep stage is. Burgers model is able to capture the experimental data very well in all conditions. Burgers general equation is able to predict failure within about 1.4–50 years. A proposed reduction factor based on Burgers model is utilized in FEA The FEA procedure shows a roughly 15% difference compared to Burgers model. [ABSTRACT FROM AUTHOR]

Fly-ash geopolymer composites are an exciting advancement in eco-friendly construction materials. Fly-ash has become a sustainable alternative to regular cement because the approach addresses critical concerns in construction, such as high energy use, excessive carbon emissions and the challenge of managing industrial waste. In this review, a brief discussion on how fly-ash geopolymer composites could transform construction practices and reduce their impact on the environment. The construction industry is a major contributor to climate change, whereas industrial byproducts like fly-ash can also be an environmental challenge. Thus, the fly-ash geopolymer composites offer an innovative solution by reusing this waste to create environmentally friendly binding materials. Fly-ash can effectively replace traditional cement in construction, improving the durability and sustainability of buildings. By reducing our reliance on regular cement, these composites could revolutionise construction practices across various industries. Developing and widely adopting fly-ash geopolymer composites could bring substantial benefits. It could significantly reduce the construction industry's carbon footprint and contribute to global efforts to combat climate change. Additionally, ongoing research aims to enhance these composites' strength, heat resistance, and chemical durability, further promoting sustainable construction and supporting a circular economy by turning industrial waste into valuable construction materials. [ABSTRACT FROM AUTHOR]

This study uses numerical simulation to explore the performance of a portable bamboo girder designed for emergency scenarios and compares it to its steel counterpart. It underscores bamboo's appeal, offering a lightweight, quickly deployable, and eco-friendly alternative to steel. The research aims to assess bamboo's viability in emergency bridge construction, utilising SOLIDWORKS and ANSYS to create and simulate bamboo and steel girders. A bamboo girder aimed at humanitarian assistance and disaster relief (HADR) operations was analysed through ANSYS software under a Toyota Hilux truck's weight. Material properties, loads, and boundary conditions were defined for an accurate simulation. Three individual bamboo culms were tested in four-point flexural experiments, and the results revealed a modulus of elasticity of 14583 MPa and a local failure due to crushing and splitting with an ultimate strength of 263 MPa. Finite element analysis results indicated that the bamboo girder had a stress of 85.56 MPa and a deflection of 84.68 mm. Although the steel girder showed lower deflection, it had significantly higher stresses and weighed 180% more than the bamboo version. The bamboo girder's deflection surpassed the recommended limit under a fully loaded truck, indicating room for improvement. However, stress analysis revealed that the bamboo's structural integrity remained below its design strength. Conversely, the steel girder exhibited higher stresses and considerably greater weight. Despite deflection concerns, the bamboo girder demonstrated structural soundness and lower weight compared to steel. This positions it as a viable solution for swift emergency deployment, warranting further refinement for enhanced performance. [ABSTRACT FROM AUTHOR]

Reversible thermochromic polymers have emerged as compelling candidates in recent years, captivating attention for their application in heat detection systems. This comprehensive review navigates through the multifaceted landscape, intricately exploring both the virtues and hurdles inherent in their integration within these systems. Their innate capacity to change colour in response to temperature fluctuations renders reversible thermochromic nanocomposites promising assets for heat detection technologies. However, despite their inherent potential, certain barriers hinder their widespread adoption. Factors such as a restricted colour spectrum, reliance on external triggers, and cost considerations have restrained their pervasive use. For instance, these polymer-based materials exhibit utility in the domain of building insulation, where their colour-changing ability serves as a beacon, flagging areas of heat loss or inadequate insulation, thus alerting building managers and homeowners to potential energy inefficiencies. Nevertheless, the limited range of discernible colours may impede precise temperature differentiation. Additionally, dependency on external stimuli, such as electricity or UV light, can complicate implementation and inflate costs. Realising the full potential of these polymer-based materials in heat detection systems necessitates addressing these challenges head-on. Continuous research endeavours aimed at augmenting colour diversity and diminishing reliance on external stimuli offer promising avenues to enhance their efficacy. Hence, this review aims to delve into the intricate nuances surrounding reversible thermochromic nanocomposites, highlighting their transformative potential in heat detection and sensing. By exploring their mechanisms, properties, and current applications, this manuscript endeavours to shed light on their significance, providing insights crucial for further research and potential applications. [ABSTRACT FROM AUTHOR]

Bilateral macular hole is a rare secondary effect of tamoxifen, a condition which is probably underdiagnosed. We describe the case of a 63-year-old woman who had received low-dose treatment with tamoxifen for 10 years. She presented with a best-corrected visual acuity of 20/40 in both eyes and bilateral macular hole with posterior hyaloid attachment. No reflective deposits were observed. A 23-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade was performed in the right eye with no anatomical or functional improvement. The most accepted mechanism of macular hole related to tamoxifen is Müller cell toxicity with retinal tissue loss. Therefore, it seems that the standard procedure used in idiopathic macular hole is not the optimal choice, due to a different pathogenic mechanism.

Majdi Al Qawasmeh, Belal Aldabbour, Kefah Alhayek, Khalid El-Salem Department of Neurology, King Abdullah University Hospital (KAUH), Jordan University of Science and Technology (JUST), Irbid, JordanCorrespondence: Majdi Al QawasmehNeurology Department of KAUH, King Abdullah University Hospital, P.O. Box 630001, Irbid 22110, JordanTel +962 797477731Email m0alqawasmeh@just.edu.joAbstract: Encephalocraniocutaneous lipomatosis “ECCL” is a rare, sporadic neurocutaneous disorder that results from a lethal autosomal mutation surviving by somatic mosaicism. It is characterized by unilateral involvement of skin, eyes and central nervous system in addition to a propensity for mesenchymal tumors. A 30-year-old male with previously controlled epilepsy presented with recurrent seizures. Brain imaging revealed a left parietal parasagittal enhancing tumor, in addition to left sided gyriform calcifications, and bilateral cerebral atrophy and ventricular dilatation more prominent on the left side. He also presented multiple left sided sebaceous nevi and abundant subcutaneous lipomas in addition to left mandibular condylar cysts. The brain tumor was excised, and cytopathology revealed a WHO grade I fibrous meningioma. After a thorough evaluation and exclusion of alternative diagnoses, the patient was diagnosed with definite encephalocraniocutaneous lipomatosis as per Moog’s criteria. Several cases of ECCL recently presented with different intracranial neoplasms. Here we report the first case of ECCL in association with meningioma.Keywords: neurocutaneous syndromes, neurocutaneous disorders, encephalocraniocutaneous lipomatosis, Haberland syndrome

Background In the absence of definitive treatment, vaccination against COVID-19 emerged as an effective solution to the spread of the pandemic. This study aimed to investigate the factors impacting the rates of COVID-19 vaccine acceptance in Jordan, in addition to examining the relationship between COVID-19 risk perception and vaccine acceptance among the Jordanian population. Methods This cross-sectional study was conducted among a sample of adults (aged ≥18) residing in Jordan. Data were collected using an online questionnaire disseminated using social media platforms between December 2nd and December 29th, 2020. Results A total of 2,268 (72.3%) participants demonstrated willingness to receive the COVID-19 vaccine. The mean COVID-19 risk perception score among the participants was 4.65 out of 10 (median 5; IQR 3–6). Higher risk perception scores were significantly associated with being female (p = .001), young (p

Background. Osteoporosis is a progressive decline in the bone mass, which occurs with no alterations to the bone’s composition. It is associated with increased bone fragility that may eventually lead to fractures. In this study, we aim to assess the level of awareness that Syrian women possess regarding osteoporosis and spread the knowledge about its prevention measures. Methods. This study was approved by the Institutional Review Board of the Syrian Private University. A validated questionnaire was asked to be filled in by women aged 18 and above, who were presented to clinics at Damascus, Al Helal, and Al Zahrawi hospitals between 28 November 2021 and 5 March 2022. Results. 6082 women were included, of which 63.9% (n=3884) were under 30 years old and 89.3% (n=5429) were in their reproductive age. The average knowledge score of osteoporosis was 69.2±7.7 (28-100); 88.1% correctly defined osteoporosis while the majority (93.4%) has heard of it. The majority of our participants were living in rural areas (77.2%; n=4698) while only 22.8% (n=1384) were living in urban areas. The respondents from urban areas reported the highest knowledge scores (OR=1.472; 95% CI: 1.258-1.723; P

Background: Renal stones (nephrolithiasis and urolithiasis) and nephrocalcinosis are uncommon in children; however, their incidences in pediatric populations have been increasing.Patients and Methods: This multicenter retrospective study compared the clinical presentation, etiology, and outcomes of childhood nephrolithiasis or urolithiasis with those of nephrocalcinosis.Results: The study included 144 children: 93 with renal stones and 51 with nephrocalcinosis. The mean age at presentation was 72 months and 54 months for children with renal stones and nephrocalcinosis, respectively. A history of consanguinity was found in 65% and 76% of the cases of renal stones and nephrocalcinosis, respectively. Congenital anomalies of the kidneys and urinary tract (CAKUT) were present in 28 and 9.8% of the patients with renal stones and nephrocalcinosis, respectively. The most common symptoms of renal stones were flank pain (29%), hematuria (15%), and dysuria (11%). Urinary tract infection was the primary presentation in the nephrocalcinosis group (18%), followed by failure to thrive (16%), polyuria (12%), and dehydration (12%). The majority of renal stone cases were caused by metabolic disorders, including hyperoxaluria (18%), cystinuria (18%), hypercalciuria (12%), and hyperuricosuria (2%). In contrast, the most common underlying disorders in cases of nephrocalcinosis were familial hypomagnesemia, hypercalciuria, nephrocalcinosis (35%), distal renal tubular acidosis (23%), and Bartter syndrome (6%). Clinical outcomes were significantly better in children with nephrolithiasis/urolithiasis than in those with nephrocalcinosis, who showed radiological evidence of worsening/persistent calcinosis and progressed more frequently to chronic kidney disease (stage II-IV) and end-stage kidney disease.Conclusion: The average age at presentation for children with renal stones was greater than that for those presenting with nephrocalcinosis. More than 25% of the children with renal stones were found to have CAKUT. Nephrocalcinosis was associated with worse clinical outcomes related to kidney function and disease resolution than nephrolithiasis.

Central retinal artery occlusion (CRAO) is a subtype of acute ischaemic stroke leading to severe visual loss. A recent American Heart Association scientific statement proposed time-windows for thrombolysis in CRAO similar to acute ischaemic cerebral strokes. We aimed to review our academic multi-site stroke centre experience with intravenous (IVT) and intra-arterial thrombolysis (IAT) in CRAO between 1997 and 2022. Demographic, clinical characteristics, thrombolysis timeline, concurrent therapies, complications, and 3-month follow-up visual acuity (VA) were collected. The thrombolysed cohort follow-up VA was compared with an age, gender and baseline VA matched cohort of CRAO patients that received conservative therapies. Thrombolytic therapy was administered to 3.55% (n = 20) of CRAO admissions; 13 IVT (mean age 68, 61.5% male, 12 alteplase and 1 tenecteplase, all embolic aetiology, 1 CRAO mimic) and 7 IAT (mean age 55, 85.7% male, 3 post-operative and 3 embolic). Additional conservative CRAO-targeting therapies was received by 60%. The median time from onset of visual loss to IVT was 158 minutes (range 67–260). Improvement by at least two Snellen lines was achieved by 25% with 12.5% improving to 20/100 or better. Intracranial haemorrhage post IVT occurred in 1/13 (7.6%). The median time from onset of visual loss to IAT was 335 minutes. Improvement by at least two Snellen lines was achieved by 42%. No difference in 3-month VA was noted between patients that received thrombolysis, either alone (n = 8) or combined with other therapies, and those that received conservative therapies. Our results suggest that the management of acute CRAO remains heterogeneous. The lack of obvious benefit of thrombolysis in our small series supports the need for randomizsd clinical trials comparing thrombolysis to placebo to guide hyperacute CRAO management. [ABSTRACT FROM AUTHOR]

In recent decades, non-wood lignocellulosic materials have gained significant attention, particularly in concrete applications for construction purposes. This study delves into utilising non-wood lignocellulosic materials for reinforcing concrete in construction applications. Lignocellulosic material emerges as a promising option for formulating new fibre cement compositions, thereby enhancing the sustainability, affordability, and performance of construction materials. Moreover, this research broadens the horizons of recycling agricultural waste by facilitating rational disposal and optimal utilisation. Through a comprehensive review, the study reveals that flax fibres, coir pith, prickly pear fibres, and rice husk ash waste exhibit superior workability compared to their counterparts. Furthermore, the strength of non-wood lignocellulosic reinforced concrete, incorporating bagasse ash, rice husk ash, and nutshell ash, peaked when fine aggregate replacement reached 15%, surpassing other types of non-wood lignocellulosic reinforced concrete. Adding a small quantity of prickly pear fibre to cement enhances the thermal conductivity of concrete, consequently improving compressive strength, flexural strength, tensile strength, and elastic modulus. This research is relevant to international research as it advances sustainable construction materials with desirable properties, benefiting society and various industries. [ABSTRACT FROM AUTHOR]

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Abstract Background The present study aimed to determine whether laypeople and professionals rate the facial appearance of individuals with repaired complete unilateral or bilateral cleft lip and palate (UCLP, BCLP) similarly based on viewing full facial images. Methods The study followed a cross-sectional analytical design where five young patients aged 10 to 14 years, who had completed all stages of their unilateral or bilateral cleft lip and palate treatment (bilateral: three, unilateral: two), were evaluated by two groups. The assessment was done by laypeople and 97 qualified professionals (33 orthodontists, 32 plastic surgeons, and 32 oral and maxillofacial surgeons). Professionals were not involved in any stage of the patients’ treatment. Results The facial appearance assessment of the professional groups on different facial aesthetics was significantly lower than that of laypeople, and they had higher perceived need for further treatment. On the other hand, laypeople had higher aesthetic ratings and lower perceived need for further treatment. Differences were also observed between the assessments of the professional groups. Participants who had lower aesthetic assessments of the repair tended to report a higher influence of cleft lip and palate on social activities and professional life. Conclusion Differences in perception exist between healthcare professionals and laypeople. The discrepancies between the professional groups could be attributed to different treatment modalities and protocols.

Introduction: The choice of prosthetic replacement is largely determined by the patient's choice and economic status, available technology and expertise, as well as the number of missing teeth. The aim of this study was to identify the trend in prosthetic replacement, in partially edentulous patients treated at Riyadh Elm University (REU) hospitals, as well as to investigate the factors that might influence the prosthetic choice. Methods: The records from Dentoplus digital system of all partially edentulous patients who had a prosthetic replacement at REU 2013, until June 2018, were screened and analyzed using Statistical software SPSS version 25. Chi-square and Fisher exact tests were performed. Alpha level was set at ≤0.05. Results: 6,340 patients received implants, removable or fixed prosthesis. Majority of the patients were females (60%). RPDs were the highest placed restorations (69%). Students (73%) placed most RPDs. Implants significantly increased through the years by almost (30%) (P-value = 0.00). Among FPDs, metal-ceramics were the highest restorations (74%), with a significant increase of all-ceramic restorations through years (P-value = 0.00). Moreover, FPDs were significantly the highest restorations among young-adult and middle-aged patients (P-value = 0.00). Conclusion: There was a clear change in prosthetic rehabilitation trends over the past few years. Although removable partial dentures continued to play a major role in prosthetic teeth replacement, the use of dental implants showed a steady increase every year. Students' requirements and level of experience, along with the patient age, had an influence in the prosthetic choice.

Background: This study aimed to calculate the frequency of elevated liver enzymes in hospitalized patients with coronavirus disease 2019 (COVID-19) infection and to test if liver enzyme biochemistry levels on admission could predict the computed tomography (CT) scan severity score of bilateral interstitial pneumonia. Methods: This single-center study comprised of 323 patients including their demographic data, laboratory analyses, and radiological findings. All the information was taken from electronic health records, followed by statistical analysis. Results: Out of 323 patients, 115 of them (35.60%) had aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) over 40 U/L on admission. AST was the best predictor of CT scan severity score of bilateral interstitial pneumonia (R2 = 0.313, Adjusted R2 = 0.299). CT scan severity score in the peak of the infection could be predicted with the value of AST, neutrophils, platelets, and monocytes count (R2 = 0.535, Adjusted R2 = 0.495). Conclusion: AST, neutrophils, platelets, and monocytes count on admission can account for almost half (49.5%) of the variability in CT scan severity score at peak of the disease, predicting the extensiveness of interstitial pneumonia related to COVID-19 infection. Liver enzymes should be closely monitored in order to stratify COVID-19 patients with a higher risk of developing severe forms of the disease and to plan the beforehand step-up treatment.

Pultruded glass fibre reinforced polymer (pGFRP) composites provide outstanding properties for composite polymer cross arms in power transmission line applications. This study has investigated the effects of various stacking sequences of fibres directions of pGFRP on flexural strength and creep behaviour. The use of static four-point bending flexural tests revealed that Stacking Sequence 2 (±45/0/90/0/90/0) had a significant flexural strength of 399.9 MPa while Stacking Sequence 1 (±45/90/0/±45) had a flexural strength of 242.5 MPa. Furthermore, the four-point bending creep experiments were performed at three distinct stress levels, notably 12%, 24%, and 37% of the ultimate flexural strength, to characterise the creep behaviour of distinct stacking sequences. Moreover, Findley’s power law equation for bending creep behaviour has revealed that the time-dependent reduction factor of Stacking Sequence 1 and Stacking Sequence 2 estimates a drop in flexural modulus of 23% and 10% respectively.