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Purpose: Perianal fistula is one of the most common anorectal diseases in adult patients, especially men. A relationship between pyogenic perianal abscess and fistula formation is established in multiple domains. This is the first exploration of such association among patients in the country as no related study has been published in Bahrain. We expect this study to be a foundation for future protocols and evidence-based practice.Methods: A retrospective study was conducted in Salmaniya Medical Complex of Bahrain. A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018. Data were collected from the electronic files database used in Salmaniya Medical Complex (iSeha) as well as phone calls to the patients. Collected data were analyzed using statistical software.Results: The most predominant presentation of perianal abscess was pain. Over 50% of abscesses were classified as perianal (56.9%) and among those, left-sided abscesses were more common, followed by right-, posterior-, and anterior-sited, respectively. No recurrence of abscess was recorded among 80% of patients. A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage. Posterior fistulas were the most common, followed by anterior and left-sided fistulas.Conclusion: The incidence of anal fistula in Bahrain after perianal abscess was 33.9%. Most of the patients who developed a fistula following pyogenic abscess drainage were males and above the age of 40 years. The most common site for fistula was posterior.

Objectives: This study aimed to identify the main barriers that prevent patients with diabetes mellitus from accepting insulin therapy. Methods: This cross-sectional study was conducted from May to December 2019. Convenience sampling was used to recruit participants from three diabetes clinics in Muscat, Oman. Eligible participants were interviewed in person based on a pre-prepared questionnaire. The questionnaire, which was administered in Arabic, includes demographic data and 19 specific items on barriers to insulin therapy. Results: A total of 201 participants (response rate: 93%) were enrolled in the study. The most common barriers were as follows: concern of frequent blood glucose checking (36.3%), long-term injections (33.8%), side-effects of insulin (29.9%) and weight gain (29.4%). Needle phobia was considered a barrier by only 9% of the participants. Overall, 125 (62.2%) participants were willing to initiate insulin therapy despite the presence of these barriers and only 20 (10%) of them were influenced by these barriers to such a degree that they rejected the insulin therapy. Conclusion: The majority of participants had no identifiable reasons to stop them from accepting insulin therapy. Effective strategies should be developed to address each of the main barriers to improve acceptance and adherence to insulin therapy.Keywords: Diabetes Mellitus; Insulin; Treatment Refusal; Needles; Phobic Disorders; Hypoglycemia; Weight Gain; Oman.

BACKGROUND: There is a gap between the necessity of effective mental health interventions in the workplace and the availability of evidence-based information on how to evaluate them. The available evidence outlines that mental health interventions should follow integrated approaches combining multiple components related to different levels of change. However, there is a lack of robust studies on how to evaluate multicomponent workplace interventions which target a variety of outcomes at different levels taking into account the influence of different implementation contexts. METHOD: We use the MENTUPP project as a research context to develop a theory-driven approach to facilitate the evaluation of complex mental health interventions in occupational settings and to provide a comprehensive rationale of how these types of interventions are expected to achieve change. We used a participatory approach to develop a ToC involving a large number of the project team representing multiple academic backgrounds exploiting in tandem the knowledge from six systematic reviews and results from a survey among practitioners and academic experts in the field of mental health in SMEs. RESULTS: The ToC revealed four long-term outcomes that we assume MENTUPP can achieve in the workplace: 1) improved mental wellbeing and reduced burnout, 2) reduced mental illness, 3) reduced mental illness-related stigma, and 4) reduced productivity losses. They are assumed to be reached through six proximate and four intermediate outcomes according to a specific chronological order. The intervention consists of 23 components that were chosen based on specific rationales to achieve change on four levels (employee, team, leader, and organization). CONCLUSIONS: The ToC map provides a theory of how MENTUPP is expected to achieve its anticipated long-term outcomes through intermediate and proximate outcomes assessing alongside contextual factors which will facilitate the testing of hypotheses. Moreover, it allows for a structured approach to informing the future selection of outcomes and related evaluation measures in either subsequent iterations of complex interventions or other similarly structured programs. Hence, the resulting ToC can be employed by future research as an example for the development of a theoretical framework to evaluate complex mental health interventions in the workplace. ispartof: BMC PUBLIC HEALTH vol:23 issue:1 ispartof: location:England status: published

Background: In Yemen; initial surveillance of COVID-19 focused primarily on patients with symptoms or severe disease, and, as such, the full spectrum of the disease, are not clear that make the epidemiology of COVID-19 is uncertain. To the best of our knowledge, this is the first seroprevalence study done in Yemen to measure the seroprevalence of anti-SARS-CoV-2 antibodies in the general population by sex and age group in Aden, Yemen. Methods: It is a one-time cross-sectional investigation among 2000 participants from all age groups from four districts in Aden at southern Yemen. A multi-stage sampling method used. Data collected by using a well-structured questionnaire and blood sample were collected. Healgen COVID-19 IgG/IgM Rapid Test Cassette was used in all participants. All positive RDT and 14% of the negative RDTs underwent ELISA test (WANTAI SARS-CoV-2 Ab Elisa Kit). Results: A 549 out of 2001 participants were RDT positive and proved by ELISA giving the prevalence of COVID-19 infection to 27·4% and specifically the prevalence of IgG was 25%. The prevalence of asymptomatic COVID-19 infection in all the study group was 7·9%. The highest prevalence was observed in Al-Mansurah district (33·4%). Regarding socio-demographic factors females, housewives and history of contact with COVID-19 patients have significant higher prevalence rates (32%, 31% and 39% respectively). Interpretation: high prevalence of SARS-CoV-2 antibodies was reported. Household contacts are the main factors for transmission. Enhancing population immunity is recommended by introducing COVID-19 vaccine. Funding: The study was funded from WHO/ EMRO. Aden Office Declaration of Interest: None to declare. Ethical Approval: This study was approved by the University of Yemen.

In this paper, we study the indirect relationship between the adoption of Computer-aided Detection or Diagnostic (CADe or CADx) systems for Hepatic Resection (HR) and the patient’s health post-surgery. We vary the number, actual size, and the estimated size of tumors along with model parameters of tumor growth over 1000 simulations of HR according to predefined statistical distributions of parameter values. The average time (t) taken by the tumors to relapse is assessed for the non-adoption of CAD (Case 1), the adoption of semi-automatic CAD (Case 2) and the adoption of automatic CAD (Case 3) in HR. In this study, we have simulated 126 automatic CAD algorithms (Case 3). For tumor volumes (TV) less than 50 cm, if administration of bevacizumab, a post-operative therapy, is (not) adopted in the simulation, t is found to be 646, 84, and 60 days (40, 24, and 17 days) for Case 1, Case 2, and Case 3, respectively. For TV greater than 50 cm, and with (without) bevacizumab, t is found to be 86, 1, and 6 days (28, 6, and 3 days) for Case 1, Case 2, and Case 3, respectively. For with (without) bevacizumab treatment and for all tumor volumes, t is found to be 260, 90, and 104 days (38, 13, and 11 days) for Case 1, Case 2, and Case 3, respectively. We have observed that the tumors relapsed quickly in those cases where CAD was adopted.

Extensive reviews and cross-comparison studies are essential to analyze the emerging developments in a specific field of research. In the past decade, hydrocarbon exploration and exploitation from the shale reservoirs have been the most discussed and researched area around the globe. A dramatic development in shale formations became the game-changer, especially in the US. On the other hand, Artificial Intelligence (AI) and Machine Learning (ML) are playing an important role in the rapid development in all the industries through automating most of the routine operations. The oil industry is also getting equal benefits of AI and ML for the reservoir development planning and its operational accuracy through a series of automated systems. For the field development, computerized static and dynamic simulation models are generated based on several Petrophysical and Geomechanical properties gathered through different resources that are quite a time taking and expensive. AI and ML have made this process much easier, faster, and economical by means of learning through uncounted experiences from already explored and developed reservoirs, their rock properties, and the cross-ponding fluid flow behavior under different circumstances and hence, predicts accordingly. This article provides a comprehensive literature review in the area of AI and ML application to model Petrophysical and Geomechanical properties using different approaches and algorithms. Also, a systematic publication counts in each field of subject study per year in different literature databases are presented that infect reflects the trending interest in this subject. Finally, multiple AI and ML techniques are discussed in detail that has been tested in the last decade for the sake of achieving more accuracy in Petrophysical and Geo-Mechanical simulation models.

Background: Febrile Seizures (FS) are the most common seizures in children younger than 5 years. In the last decade, various coding and noncoding sequence variations of voltage-gated sodium channels SCN2A have been identified in patients with seizures, implying their genetic base. We aimed to evaluate the association between SCN2A c. G/A genetic polymorphism among Egyptian children with febrile seizure plus. Methods: The present cross-sectional study was carried out on 100 epileptic infants and children, attendants of the Neurology Unit, pediatric department, Menoufia University Hospitals (Group Ι). The patients were sub-classified into two groups, according to response to anti-epileptic treatment; Group Ι a (drug responder) and Group Ι b (drug-resistant). Evenly divided number of apparently healthy, age and gender-matched children were selected as controls (Group II). A complete history, throughout the systemic examination and radiological & metabolic assessment, whenever needed was provided, all participants were genotyped for SCN2A rs17183814 polymorphism by Restriction Fragment Length Polymorphism (PCR-RFLP). Results: Both of A allele and AA, GA genotypes of SCN2A c. 56 G/A were detected more in patients with febrile seizure plus comparison to the control group with a statistically significant difference at frequencies of 17% and 11% and 12% respectively; OR (CI95%): 10.04 (3.49-28.87) and p Conclusion: SCN2A rs17183814 (A) allele was specifically associated with developing febrile seizure plus and could modulate the patient's response to anti-epileptic medications.

Background & Objectives: Antiphospholipid syndrome can lead to variable systemic and ophthalmic manifestations. The study aims to establish the relationship between retinal vein occlusion (RVO) or choroidal neovascular membrane (CNVM) with Antiphospholipid Syndrome (APS). Methods: A multicentric prospective cross-sectional study was carried out in three major eye centers in Bahrain that included The Eye Infirmary, Bahrain Royal Hospital, and King Hamad University Hospital. All young patients aging from 35 to 50 years, presenting with either RVO or CNVM and not known to have any underlying systemic disease were included in the study. Antiphospholipid confirmatory tests and coagulation profiles were done for all patients. Results: Total number of fourteen eyes of ten patients were enrolled in the study. Six patients had RVO, three out of them had central retinal vein occlusion (CRVO) and three had branch retinal vein occlusion (BRVO). Four patients had bilateral CNVM (total of 8 eyes). All patients recorded high activated partial thromboplastin time (aPTT) readings, six out of ten patients were labeled as primary APS, four of them had positive anti-cardiolipin antibodies and the other two patients were positive for plasma lupus anticoagulant. Conclusion: APS should be considered as an etiological factor in all cases of retinal vein occlusion and choroidal neovascular membrane affecting young otherwise healthy individuals. In this study, 60% of patients who fit the inclusion criteria were labeled as primary APS patients. Timely investigations and treatment in these cases can prevent major catastrophic thrombotic events which may involve any system or organ in the body. Keywords: Antiphospholipid syndrome, Blood coagulation tests, Eye, Lupus coagulation inhibitor, Retinal vein occlusion

Background The hospital environment is characterised by a dense network of interactions between healthcare workers (HCWs) and patients. As highlighted by the coronavirus pandemic, this represents a risk for disease transmission and a challenge for contact tracing. We aimed to develop and pilot an automated system to address this challenge and describe contacts between HCWs and patients. Methods We developed a bespoke Bluetooth Low Energy (BLE) system for the hospital environment with anonymous tags worn by HCWs and fixed receivers at patient room doors. Proximity between wearable tags inferred contact between HCWs. Tag-receiver interactions inferred patient room entry and exit by HCWs. We performed a pilot study in four negative pressure isolation rooms from 13 April to 18 April 2021. Nursing and medical staff who consented to participate were able to collect one of ten wearable BLE tags during their shift. Results Over the four days, when divided by shift times, 27 nursing tags and 3 medical tags were monitored. We recorded 332 nurse–nurse interactions, for a median duration of 58 s [interquartile range (IQR): 39–101]. We recorded 45 nursing patient room entries, for a median 7 min [IQR: 3–21] of patient close contact. Patient close contact was shorter in rooms on airborne precautions, compared to those not o transmission-based precautions. Conclusion This pilot study supported the functionality of this approach to quantify HCW proximity networks and patient close contact. With further refinements, the system could be scaled-up to support contact tracing in high-risk environments.

Fiber Reinforced Polymer (FRP) composite is an attractive material for strengthening various civil infrastructures. The strengthening system that based on FRP composites consists of many elements. These are: strengthening material (FRP), strengthened element (concrete, steel, wood, etc) and bonding agent. The latter is the most important elements which affect the performance of the whole strengthening system. Different types of bonding agent are used based on service conditions. Epoxy-based adhesive (EBA) is the most commonly used to strengthen concrete or steel structures. Due to the limitations of the application of EBA, cement-based adhesive (CBA) is utilized as an alternative bonding agent. The CBA have been developed by modifying its properties. The modification was conducted using different powder-state materials or by magnetic water treatment. The development of bonding agent that used in FRP strengthening system is addressed in this paper in order to highlight the most modern bonding agent which consider as a promising material to employ in the actual outdoor structures.

There is paucity of studies that discussed the role of peritoneal dialysis (PD) in managing end stage renal disease (ESRD) in sickle cell disease (SCD) patients. The present study compares the outcome of SCD-ESRD patients treated with hemodialysis (HD) or PD. Sixty incident ESRD patients were allotted to HD, (HD group, n=40) or PD, (PD group, n=20). Causes and severity of renal injury were assessed at the time of initiating dialysis. The primary outcome was hospital mortality at 5 years, and secondary outcomes were infection rates, incidents of vasoocclusive crisis (VOC) and acute chest syndrome (ACS), response to erythropoietic agents and improvement of cardiac function. No statistically significant differences were observed between groups in regard to patients’ characteristics. The survival at 5 years was significantly better in the patients treated with PD when compared to HD (75.0% vs. 57.5%, p=0.026). Infectious complications (15% vs 35%, p

The purpose of this study is to analyze the relationship between different audit committee attributes and company performance in Bahrain. This paper investigates the impact of audit committee independence, size, and meeting frequency on company performance (employing ROE, ROA, and Tobin’s Q). Data from all 14 non-financial publicly listed companies on Bahrain Bourse during 2005–2019 were used. The results revealed that companies with independent audit committees and big audit committees in terms of size are performing poorly. It is also shown that the number of audit committee meetings does not affect company performance. Further, this study failed to find any association between the number of audit committee meetings and company performance. The findings show that shareholders might lack knowledge of the importance of corporate governance mechanisms. The results of this study should be of potential interest to different stakeholders, including regulators, investors, and auditors, in their attempts to improve company performance and monitoring mechanisms in emerging economies.

This work aims to build an inverse electromagnetic imaging scheme exploiting the best of the following two methodologies: iterative nonlinear regularization and recently developed machine learning models. The proposed method is designed to achieve three targets: i) the elimination of user intervention to empirically select inverse parameters, ii) high-quality image recovery, and iii) stable scheme with accelerated reconstruction time. To achieve these targets, an iterative imaging algorithm is developed based on projected nonlinear Landweber (PNLW) supported by three neural networks that i) predict first-norm solutions, which is an inverse parameter required by the projection operator, ii) predict iteration step lengths that ensure PNLW convergence, and iii) filter recovered images via PNLW to enhance image quality. The first-norm projection operator satisfies the sparse constraint. The proposed scheme is efficient for applications where the number of measurements is limited by adopting sparse optimization. The results of the proposed scheme and conventional approach are compared in numerical tests to assess the efficiency and performance of the proposed scheme.

BACKGROUND: With increasing knowledge of beta-lactam pharmacodynamics and interpatient and intrapatient variability in pharmacokinetics, the usefulness of therapeutic drug monitoring (TDM) is becoming increasingly clear. However, little research has been conducted to identify potential barriers and facilitators in the clinical implementation of beta-lactam TDM. This study provides an overview of the current practices of beta-lactam TDM and barriers and facilitators in its implementation. METHODS: A systematic search was conducted using the Ovid MEDLINE database in April 2021, without restrictions on the publication date. All studies reporting the implementation of beta-lactam antibiotic TDM in critically ill patients through questionnaires or surveys were included in this review. RESULTS: Six eligible studies were identified from 215 records, all of which were cross-sectional. All studies identified barriers and facilitators in the implementation of beta-lactam TDM in critically ill patients. The main barriers were insufficient knowledge about various aspects regarding the implementation of beta-lactam TDM and the unavailability of assays. Furthermore, a delay in the acquisition of TDM results reduces the probability of physicians altering drug dosages. Finally, doubts about the cost-effectiveness and clinical effectiveness of beta-lactam TDM in critically ill patients hinder broad implementation. Moreover, to improve the willingness of physicians to use beta-lactam TDM, collaboration between physicians and clinical pharmacists and clinical microbiologists should be strengthened. CONCLUSIONS: Although the evidence for application of beta-lactam TDM continues to grow, its clinical implementation remains limited. To enable optimal implementation of these antibiotics in critically ill patients, several barriers need to be overcome regarding logistics, equipment availability, clinical evidence, and proof of cost-effectiveness.

Background For specific medical specialties it has been shown that clinical pharmacists can have a beneficial effect on the reduction of drug-related problems by performing medication reviews. However, little is known on the cost–benefit ratio of hospital-wide implementation of medication reviews. Aim To investigate the effect of conducting hospital-wide medication reviews on the detection and resolution of drug-related problems, and to calculate the cost–benefit ratio of the intervention. Method In this observational prospective period prevalence study, medication reviews were conducted during five consecutive working days in a Dutch university hospital. Patients admitted for more than 24 h were included. The cost–benefit ratio of conducting the medication reviews was calculated by dividing the total costs by the total savings. Results In 622 medication reviews, 709 potential drug-related problems (1.1 per patient) were detected. The most common advice was to stop medication (38.6%). Patients with a potentially drug-related problem were significantly older, had a higher median number of prescriptions, and the median number of days from admission to the time of medication reviews was longer. Conducting medication reviews showed a positive cost–benefit ratio of 9.7. Conclusions Hospital-wide medication reviews by clinical pharmacists have a positive cost–benefit ratio and contribute to the detection and the resolution of drug related problems (DRPs), mainly by reducing overtreatment.

Due to the ongoing and dramatic growth in the volume of consumer returns, retailers continue to struggle with the trade-off in returns service strategies between implementing stricter return policies to lower operational costs versus providing customers with lenient return policies to positively stimulate customers' value perceptions and patronage intentions. This paper argues that an effective management of this trade-off requires a deep understanding of the process through which customers perceive, evaluate, and respond to return policies that vary in terms of leniency across five key dimensions identified in the literature: monetary, time, effort, scope, and exchange. To this end, we propose a theory-based, cognitive process model and test it in completely randomized experiments with diverse consumer samples. By viewing each of the five leniency dimensions as returns service design levers, we examine: 1) how a retailer's return policy leniency across different levers impacts a customer's intention to purchase from a retailer, through the influence of leniency on the perceptions regarding returns service quality and transaction costs that jointly form perceived returns service value and 2) how different leniency levers compare in terms of their impacts. We find significant heterogeneity in the effectiveness of different leniency levers in influencing customers' purchase intentions through increased perceived service quality, reduced perceived transaction costs, and subsequently increased perceived service value.

ObjectivesTo obtain more powerful assessment of the prognostic value of fractional flow reserveCT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFRCT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD).MethodsWe searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserveCT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as ‘all-cause mortality (ACM) or myocardial infarction (MI)’ at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint.ResultsFive studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFRCT>0.80% and 1.4% (47/3334) with FFRCT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFRCT ≤0.80 versus patients with FFRCT >0.80. Each 0.10-unit FFRCT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), pConclusionsThe 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFRCT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFRCT numerical value was inversely associated with outcomes.

We examine how restrictive changes to long-established lenient return policies can impact consumers' trust toward retailers and their subsequent behavioral intentions using a vignette-based experiment that is based on a pre-test post-test control group design. The baseline return policy is operationalized as a no-questions-asked lenient return policy that has no time limit on returns and offers full refund. We examine two types of return policy changes as treatments: introducing a 15% restocking fee for non-defective returns and restricting the return time limit to 30 days. We examine the role of providing rationale for the restrictive policy change decision, and the type of rationale provided (i.e., internally vs externally focused). Our hypotheses are that 1) Restrictive changes to lenient return policies result in a decrease in trust toward retailer, leading to lowered favorable behavioral intentions, 2) Providing rationale for the policy change decisions decreases the negative reactions to the changes, 3) The decrease in negative reactions is stronger when the provided rationale is internally (focusing on operational cost increases) as opposed to externally (blaming abusive customer behaviors) focused. The experiment will be conducted on Prolific and will consist of 7 treatment conditions (1 control group with no policy change, 3 restocking fee conditions, with 1 no rationale, 1 internal, and 1 externally focused rationale, and 3 time limit conditions, with 1 no rationale, 1 internal, and 1 externally focused rationale). The initial sample size will be 7 x 120 = 840 subjects. Subjects will have to pass an instructional manipulation and an attention check questions. Only subjects who pass both checks will be included in the final analysis. Additional data may be collected if the number of subjects in the final sample is less than the target sample size of 700 (100 per group on average). Regression-based mediation and moderation analyses will be conducted to test the hypotheses. Non-parametric bootstrapping will be used for standard errors and confidence intervals.

Purpose Blockchain looks to be the next step of technology transformation and would redesign the business landscape. It is expected to have an impact on business methods in the next few years; which add new challenges and complexity to the accounting and assurance profession. This paper aims to analyze the perceptions of accountants and auditors toward the implementation of blockchain technology in the UAE after the government decided to transform 50% of government transactions into the blockchain platform by 2021. Design/methodology/approach A qualitative approach has been used in this study. A semi-structural interview has been conducted with 19 accountants, internal auditors, auditors and risk managers on the potential opportunities and challenges of blockchain technology on accounting and auditing practices in the UAE. Findings The findings show that the blockchain impacts on the accounting profession in terms of recording of transactions, storing evidence and providing a secured environment for conducting business transactions. For the auditors, the results indicate that the blockchain changes their audit process and strategy. The blockchain has great potential to supplement traditional auditing by providing a low-cost and decentralized audit process and automated audit evidence. The accounting of the companies will not be changed but it will be automated with the development of cryptocurrencies and blockchain activities. The blockchain will be developed in assurance services through the awareness and involvement of accounts and auditors. Originality/value The study contributes to the existing literature as follows. First, the research is one of the very few studies that discussed empirically the effect of blockchain on the accounting and assurance profession, which contributes to improved knowledge about the potential of blockchain technology to accounting and assurance services. Second, our research is the first to explore the accountants and financial auditors’ perceptions regarding the potential effect of blockchain technology on their profession in the UAE context after the government decided to transform 50% of government transactions into the blockchain platform by 2021. Third, the research identifies the pending challenges for blockchain and possible factors for its effectiveness.

Data security is a challenge for end-users of cloud services as the users have no control over their data once it is transmitted to the cloud. A potentially corrupt cloud service provider can obtain the end-users’ data. Conventional PKI-based solutions are insufficient for large-scale cloud systems, considering efficiency, scalability, and security. In large-scale cloud systems, the key management requirements include scalable encryption, authentication, and non-repudiation services, as well as the ability to share files with different users and data recovery when the user keys of encrypted data are not accessible. Further requirements in cloud systems include the ability to provide the means for digital forensic investigations on encrypted data. Once data on the cloud is encrypted with a user’s key it becomes impossible to access by forensic investigation teams. In this regard, distributing the trust of key management into multiple authorities is desirable. In the literature, there is no available secure cloud storage system with secure and efficient Type-3 pairings, supporting Encryption-as-a-Service (EaaS) and multiple Public Key Generators (PKGs). This paper proposes an efficient Identity-based cryptography (IBC) architecture for secure cloud storage, named Secure Cloud Storage System (SCSS), which supports distributed key management and encryption mechanisms and support for multiple PKGs. During forensic investigations, the legal authorities will be able to use the multiple PKG mechanism for data access, while an account locking mechanism prevents a single authority to access user data due to trust distribution. We also demonstrate that, the IBC scheme used in SCSS has better performance compared to similar schemes in the literature. For the security levels of 128-bits and above, SCSS has better scalability compared to existing schemes, with respect to encryption and decryption operations. Since the decryption operation is frequently needed for forensic analysis, the improved scalability results in a streamlined forensic investigation process on the encrypted data in the cloud.

Energy consumption has increased dramatically over the past century due to many factors, including both technological, social and economic factors. Therefore, predicting energy consumption is of great importance for many parameters, including planning, management, optimization and conservation. Data-driven models for predicting energy consumption have grown significantly over the past several decades due to their improved performance, reliability, and ease of deployment. Artificial neural networks are among the most popular data-driven approaches among the many different types of models today. This article discusses the possibility of using artificial neural networks for medium-term forecasting of the power consumption of an enterprise. The task of constructing an artificial neural network using a feedback algorithm for training a network based on the Matlab mathematical package has been implemented. The authors have analyzed such characteristics as parameter setting, implementation complexity, learning rate, convergence of the result, forecasting accuracy, and stability. The results obtained led to the conclusion that the feedback algorithm is well suited for medium-term forecasting of power consumption.

Purpose This meta-analysis aims to evaluate inappropriate antibiotic prescribing in the Gulf region and determine the effect of pharmacist-led antimicrobial stewardship (AMS) programmes on reducing inappropriateness. Method Articles were searched, analysed, and quality assessed through the risk of bias (ROB) quality assessment tool to select articles with a low level of bias. In step 1, 515 articles were searched, in step 2, 2360 articles were searched, and ultimately 32 articles were included by critical analysis. Statistical analysis used to determine risk ratio and standard mean differences were calculated using Review manager 5.4; 95% confidence intervals were calculated using the fixed-effect model. The I2 statistic assessed heterogeneity. In statistical heterogeneity, subgroup and sensitivity analyses, a random effect model was performed. The α threshold was 0.05. The primary outcome was inappropriateness in antibiotic prescribing in the Gulf region and reduction of inappropriateness through AMS. Result Detailed review and analysis of 18 studies of inappropriate antibiotic prescribing in the Gulf region showed the risk of inappropriateness was 43 669/100 846=43.3% (pooled RR 1.31, 95% CI 1.30 to 1.32). Test with overall effect was 58.87; in the second step 28 AMS programmes led by pharmacists showed reduced inappropriateness in AMS with pharmacist versus pre-AMS without pharmacist (RR 0.36, 95% CI 0.32 to 0.39). Conclusion Inappropriate antibiotic prescribing in the Gulf region is alarming and needs to be addressed through pharmacist-led AMS programmes.

Key Points A simplified frailty score predicts survival and toxicity in older patients with DLBCL and can inform treatment-intensity decisions.Full-dose R-CHOP is not superior to R-miniCHOP in older unfit DLBCL patients, whereas older fit patients likely benefit from full-dose R-CHOP., Visual Abstract, Patients with diffuse large B-cell lymphoma (DLBCL) have a median age of 70 years. Yet, empirical knowledge about the treatment of older patients is limited because they are frequently excluded from clinical trials. We aimed to construct a simplified frailty score and examine survival and treatment-related mortality (TRM) according to frailty status and treatment intensity in an older real-world population with DLBCL. All patients aged ≥70 years diagnosed with DLBCL between 2006 and 2016 in southeastern Norway (N = 784) were included retrospectively and divided into training (n = 522) and validation (n = 262) cohorts. We constructed and validated a frailty score based on geriatric assessment variables and examined survival and TRM according to frailty status and treatment. The frailty score identified 3 frailty groups with distinct survival and TRM, independent of established prognostic factors (2-year overall survival [OS]: fit, 82%; unfit, 47%; frail, 14%; P < .001). For fit patients, full-dose R-CHOP (initial dosage >80%) was associated with better survival than attenuated R-CHOP ([R-miniCHOP]; 2-year OS: 86% vs 70%; P = .012), also in adjusted analyses. For unfit and frail patients, full-dose R-CHOP was not superior to R-miniCHOP, whereas an anthracycline-free regimen was associated with poorer survival in adjusted analyses. A simplified frailty score identified unfit and frail patients with a higher risk for death and TRM, which can aid treatment-intensity decisions in older patients with DLBCL. In this study, fit patients benefited from full-dose R-CHOP, whereas unfit and frail patients had no benefit from full-dose R-CHOP over R-miniCHOP. An online calculator for assessment of the frailty score is available at https://wide.shinyapps.io/app-frailty/.

Scale formation is one of the major issues in the petroleum industry. The development of these scale layers could result in production losses and equipment instability because of pipeline blockage, energy leakage, corrosion acceleration and severe accidents which will impact the safety of the production process. The utilization of chemical scale inhibitors (SIs) is considered an economical and successful route for the scale prevention. Two main components of the chemical SIs are phosphonate and polymer. Many of the phosphorous compounds are toxic and very expensive. Besides, portions of the phosphonate compounds are thermally less stable than polymeric scale inhibitors in a harsh environment of high temperature and high pressure (HTHP). This is considered as an issue as a good scale inhibitor should be able to be applied under wide range of temperature and pressure. Therefore, the continuous development in petroleum production imposes the need to develop a novel phosphorus-free scale inhibitor. Meanwhile, polymers have been broadly applied as a scale inhibitor in oil and gas fields because of their enhanced thermal stability and improved environmental compatibility. Polymeric scale inhibitors also show better dispersing efficiency. Today, the biopolymers have pulled in a tremendous consideration from the industry to replace the utilization of synthetic polymer due to their interesting qualities such as their lightness, strong mechanical properties, and appealing functionality. Biopolymers are insensitive toward brine salinity yet are vulnerable to biological degradation. Specifically, these polymers present enormous potential for environmental application because of their biodegradability, chemical adaptability and reactivity, biocompatibility, and nontoxicity. Recently, several new eco-friendly scale inhibitors have been reported in the literature. Hence, this paper provides a review of the utilization of biopolymer as scale inhibitor in the application of oil and gas industry under laboratory approach or field trial application. The types of scales, chemical scale inhibitors (SIs) and biopolymers are likewise reviewed here. The presented work in this paper is expected to enhance the fundamental understanding of scale formation, as well as contribute to the development process of biopolymer scale inhibitors.

Subject. The adoption of International Financial Reporting Standards (IFRS) was a significant milestone to unify financial reporting standards. However, there are many conflicting views regarding the impact of IFRS implementation on the investment attractiveness of banks. This put us on analyzing the sensitivity of changes in the equity securities market in terms of information risk and adoption of IFRS. Objectives. The article aims to explore the relationship between the harmonization of accounting and international standards and the banks’ share prices in eleven OECD countries by analyzing panel data within 1997–2015. Methods. For the study, we used a set of tests, such as the Ordinary Least Squares regression, Hausman specification test, Variance Inflation Factor, Unit Root test, Panel-Corrected Standard Error regression, and the Breusch-Pagan test. Results. The obtained results indicate a positive impact of the IFRS adoption on the change in prices for bank shares. In particular, changes in stock prices averaged 64 units. This is explained by the benefits of applying IFRS, which include positive investor expectations, improved financial reporting quality and comparability across countries, and reduced information risk. Conclusions. The hypothesis of bank share price increase after the IFRS adoption is true for the OECD countries.

Choledochal cysts in adults are rare congenital abnormalities. Approximately 80% are found in childhood. Thus, their presentation in adults is always associated with complications, such as stone formation, inflammation and malignancies. The pathophysiology of this disease is yet uncertain. There are different types of choledochal cysts. Diagnosis can be challenging clinically; however, imaging techniques, such as ultrasound, magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT), can be helpful. We found several procedures performed in the extant literature, such as choledochoduodenostomy and choledochojejunostomy submucosal excision of the cyst; however, the best surgical option is excision with hepaticojejunostomy. We discuss the unusual presentation of a 33-year-old female patient with an obstructed choledochal cyst, despite having undergone a drainage procedure in childhood.

Lymph node yield is an important factor to ensure adequate staging in rectal cancer. In rectal cancer after neoadjuvant treatment, the nodal yield decreases. However, many studies showed better outcomes for those patients with lesser nodal yield. This is a retrospective study from a prospectively maintained database, assessing factors affecting nodal yield in rectal cancer after neoadjuvant therapy and its prognostic implications with regard to disease recurrence. Patients who underwent curative resection of rectal cancer after neoadjuvant therapy from 2016 to 2018 were included. Nodal yield was calculated, and relevant clinical factors were collected and analysed. Patients were then followed up for assessing oncological outcomes. A total of 501 consecutive patients were included in the study period of 3 years. 87.9% of patients had pre-op neoadjuvant chemoradiation (NACRT). Mean nodal yield was 12.3 nodes with a range of 5–42. On multivariate analysis, nodal yield significantly increased with increasing pathological stage (p = 0.002) and positive lymphovascular invasion (p = 0.021). After a median follow-up of 24 months, disease-free survival probability at 3 years was 84.1% for those with less than or equal to 12 nodes vs 83% for more than12 nodes (p = 0.253). This trend was more so among those who attained pathological complete response (pCR) (96.1% vs 92.9%; p = 0.677). Presence of lymphovascular invasion significantly increases nodal yield. Pathological complete response was significantly associated with lesser nodal yield. Thereby, lesser nodes harvested after surgery may be a surrogate marker of better responses to radiation and thereby may indicate a better prognosis.

Background and Aim: Backyard chicken flocks have traditionally been regarded as an essential food source in developed countries; however, they may act as reservoirs and spread various zoonotic bacterial pathogens. This study was designed to investigate the prevalence, phenotypic resistance, biofilm formation (BF), and pathotypes of Escherichia coli isolates from backyard poultry farms. Materials and Methods: Cloacal swabs (n=150) and internal organs (n=150) were collected from 30 backyard chicken flocks; 20 of them were experiencing systemic infection, and the other ten were apparently healthy. Samples were bacteriologically examined for E. coli isolation. Isolates were identified biochemically by the VITEK® 2 COMPACT system (BioMérieux, France). For molecular identification, 16S rRNA was amplified and sequenced. Ten antimicrobials were selected for E. coli antimicrobial susceptibility testing. The minimum inhibitory concentration for each antimicrobial was determined. The extended-spectrum β-lactamase activity in isolates was investigated using cephalosporin/clavulanate combination disks. The ability of isolates for BF was determined by the microtiter plate method. Thirteen virulence genes linked to different E. coli pathotypes and two serotype-related genes were investigated by real-time polymerase chain reaction. Results: Eighty-six E. coli strains were isolated from 30 backyard chicken flocks. The isolates were biochemically identified to the species level. Genetically, sequences of the 16S rRNA gene showed >98% identity with E. coli in the National Center for Biological Information database. The frequency of isolation from diseased flocks was significantly higher (p

Introduction Patient-centered care is concordant with patient values and preferences. There is a lack of research on patient values and preferences for pulmonary embolism (PE) testing in the emergency department (ED), and a poor physician understanding of patient-specific goals. Our aim was to map patient-specific values, preferences, and expectations regarding PE testing in the ED. Method This qualitative study used constructivist grounded theory to identify patient values and expectations around PE testing in the ED. We conducted semi-structured interviews with ED patients who were being tested for PE in two EDs. Patients who were waiting for PE imaging or D-dimer results were approached and consented to take part in a 30-minute audio-recorded interview. Each interview was transcribed verbatim and analyzed using constant comparative coding. The interview script was modified to maximize information on emerging themes. Major themes and subthemes were derived, each representing an opportunity, barrier, or value to address with patient-centered PE testing. Results From 30 patient interviews, we mapped four major themes: patient satisfaction comes from addressing the patient's primary concern (for example, their pain); patients expect individualized care; patients prefer imaging over clinical examination for PE testing; and patients expect 100% confidence from their emergency physician when given a diagnosis. Subthemes included symptomatic relief, finding a diagnosis, receiving tests, rapid progression through their care, perception of highly accurate CT scans, willingness to seek a second opinion, direct physician communication, and expectation of case-specific testing with cognitive reassurance. Conclusion Addressing each of these four themes by realigning ED processes could provide patient-centered PE testing.

Background: Diarrheal diseases are still a major cause of mortality and morbidity after respiratory infection in most developing countries. There are about 1.7 billion cases of diarrheal illness and 760,000 deaths in children under 5 every year around the world. Moreover, it has an undesirable effect on the development and growth of infants and young children. Aim: The main objective of this study was to evaluate the mothers’ knowledge, attitude, and practice (KAP) regarding diarrhea and its management in Aden-Yemen. Methods: A cross-sectional study was conducted among mothers who visited Aden health centers in Aden city from April 2020 to July 2020. The respondents were chosen conveniently due to the difficulty of having a sampling frame. Data was collected using a KAP questionnaire. Results: A total of 414 mothers aged 18 - 40 years had a child/children with diarrhea at the time of enrollment or in the preceding 3 to 6 months from enrollment. About 344 (83.1%) of mothers knew the definition of diarrhea, 244 (58.9 %) of mothers attributed the teething as a cause of diarrhea, and 284 (68.6%) of mothers recognized lethargy as a sign of dehydration. Nearly 201 (48.6 %) of the mothers mentioned that diarrhea could be managed and prevented at home, and 174 (42.0%) agreed that ORS is the first-line treatment for diarrhea, and 286 (69.1%) of mothers continue exclusive breastfeeding during diarrhea. However, only 170 (41.1%) of mothers prepared ORS at home, and most of them did not know the correct way of preparing it. About 327 (79.0%) of mothers consulted the medical centers during the episode, and 199 (48.1 %) of mothers took the child to the primary health center as an immediate response. Conclusion: The findings revealed that the KAP of the mothers was unsatisfactory for the management of diarrheal diseases. Therefore, there must be educational intervention provided by health sectors to increase awareness. Furthermore, the government should provide quality water, sanitation, essential medicines, public education, etc., to reduce the causes of the prevalence of diarrhea.

Land degradation is a complex process and significant environmental problem affected by both natural and anthropogenic driving factors. Globally, the prevention of land degradation has become one o...

Mesenteric ischemia is a condition in which the amount of oxygen available is insufficient to meet the needs of the intestines. The small intestine, colon, or both can be affected by ischemia. The most common cause of occlusive ischemia is an abrupt obstruction of a major artery, which causes a considerable drop in intestinal blood flow. Early diagnosis is one of the most essential components in achieving a favorable outcome. The most prevalent treatment is surgical management. However, there are minimally invasive therapy alternatives that have been shown in observational studies. For arterial thrombosis, endovascular stenting is an option, and anticoagulation is an option for venous thrombosis. Endovascular aspiration, mechanical embolectomy, and local thrombolysis are all possibilities for patients with arterial embolism.

Categorizing the market focus of larger samples of companies can be a tedious and time-consuming process for both researchers and business analysts interested in developing insights about emerging business sectors. The objective of this article is to suggest a text analytics approach to categorizing the application areas of companies operating in the digital health sector based on the information provided on their websites. More specifically, we apply topic modeling on a collection of text documents, including information collected from the websites of a sample of 100 innovative digital health companies. The topic model helps in grouping the companies offering similar types of market offers. It enables identifying the companies that are most highly associated with each of the topics. In addition, it allows identifying some of the emerging themes that are discussed online by the companies, as well as their specific market offers. The results will be of interest to inspiring technology entrepreneurs, organizations supporting new ventures, and business accelerators interested to enhance their services to new venture clients. The development, operationalization, and automation of the company categorization process based on publicly available information is a methodological contribution that opens the opportunity for future applications in research and business practice.

Background: Most medical research today focuses on three aspects: stress and burnout at work mental illness such as depression and suicide and drug addiction. On the other hand, little research has been done among physicians so far on behavioral and preventive interventions including healthy lifestyles habits among physicians. Therefore, the aim of this study to assess the lifestyle habits practicing among KSMC physicians, Saudi Arabia. Methodology: This is an analytical cross-sectional study conducted in Kingdom of Saudi Arabia, Riyadh (including all physicians in King Saud Medical City), from April, 2020 till December 2021 using pre-designed questionnaire which was distributed online. The questionnaire was prepared to assess the demographic factors, physical activity, eating pattern, health concern. Statistical Package for the Social Sciences (SPSS) version 23 for data analysis. Results: we were able to collect data from 104 physicians in response to our questionnaire where all of them where medicine physicians and 57.7 % of them were males. The prevalence of overweight and obesity were 18.4 % and 27.2 % respectively. Moreover, 55.8 % of physicians reported that they did not practice any type of exercises however, 32.7 % practiced endurance or aerobic exercise. Furthermore, 24 % of the participants reported being on diet where 8.7 % were on keto diet and 1.9 % were on Mediterranean diet. In our study, poor exercise and diet habits were associated with poor BMI, poor sleep pattern and higher prevalence of medical conditions. Conclusion: We found that there is high prevalence of obesity and overweight among physicians at KSMC, Saudi Arabia which in addition to poor sleep pattern and high incidence of other medical conditions were significantly associated with the poor life-style habits including low level of practicing exercise and having health diet regime.

Introduction: Factors such as comorbidity, age and gender distribution are mostly related to hospitalization, numbers requiring intensive care and case fatality rate. In this review, the fatality rate of coronavirus disease 2019 (COVID-19) in different population health background according to comorbidity, age, gender distribution, and laboratory prognosis for COVID-19. Methodology: The current review was based on the data from copious studies that had homogeneity in relation to the review’s objectives. It included the newest studies from December 2019 to September 2020. The epidemiological reasons for the high morbidity and mortality rates among COVID-19 patients were analyzed in different countries. Results: The highest comorbidity prevalence of COVID-19 was recorded in the United States of America (USA) (93.9%) and Italy (68%). Among population health background factors, comorbidity was the most common cause of COVID-19 fatality in the USA. The mean age of the most COVID-19 fatalities was more than 60 years old. Most of the studies show that 60% of COVID-19 patients were male. The fatality rates for the age group of 80-89 years-old in Korea, China, and Italy were 8.7 %, 14.7 %, and 18.8 % respectively. Lymphocytopenia has been observed in 91% of COVID-19 death cases. C - reactive protein had increased in 40-60% of COVID-19 patients. Conclusions: Many factors contribute to COVID-19 severity and fatality rates. Comorbidity, age, and gender were the main reasons for the Case Fatality Rate. This review recommends to follow preventive measures for overcoming the challenges faced during this emerging pandemic disease.

Transverse sacral fracture is a rare entity in the pediatric age group, primarily resulting from a fall from height. This case report stresses the importance of proper neurological assessment, adequate imaging and highlights different modalities of management of this fracture. We report a case of a 13-year-old child with type III Roy-Camille sacral fracture with associated bladder and bowel dysfunction. The patient underwent spinopelvic fixation and decompression of the sacral canal. The patient partially regained bowel and urinary function and had improved motor function after three months of follow-up. Operative management is generally advocated for such fractures. Keywords: Decompression; Bone fractures; Neural tube; Pediatrics; Sacrum

Oil and gas projects are at high risk and the reasons can be the adoption of complex technology, participation of different parties, etc. Oil and gas industries are often vulnerable to risks and hazards, but they overcome these problems by following tools and techniques of risk management, which results in employee and organizations safety. Based on the facts, this research report aims to evaluate and identify the risk management strategies and procedures and assess the efficiency of risk management tools in the Oil and Gas Company in the Kingdom of Bahrain. The survey was conducted among two groups using quantitative as well as qualitative methods. One hundred twenty-four participants comprising of Engineers, Superintendents, Fire and Safety Officers, HR Managers, Health and Safety Environment Officers were among the respondents of the Survey Questionnaire. For the semi-structured interview, managers from supply and marine, Operation Specialist, Acting Manager of Health, Safety and Environment (HSE), Managers of Operational Plant Department were selected. The data collected through the survey question was analyzed using statistical analysis. The data collected through the survey questions were later imported to IBM SPSS (Statistical Package for Social Science) version 23.0 and performed descriptive analysis to explain the participants’ characteristics, discrete variables expressed as frequencies and percentages and continuous variables expressed as mean and SD. The reliability of the instrument was assessed using Cronbach’s alpha. This research indicated that around 56 % of the engineers and majority of the participating managers agree and strongly agree that the company has the Oil and Gas Company in the Kingdom of Bahrain have has implemented several safety precautions, training, and appropriate risk management tools to ensure the safety of the employees and work to eliminate any risk which could be hazardous to life and property.

Based on CdTe and CdZnTe detectors a number of promising devices were created, which found their application in metallurgy, in solving the problems of customs control and control of nuclear materials, as well as matrix detectors created for the manufacture of medical devices and devices for space research. Detectors, created on the basis of polycrystalline semiconductor CdTe and CdZnTe films with a columnar structure on a molybdenum substrate with a thickness d = 30150 μm, had a specific resistance p > 10^5 10^8 W-cm. The energy resolution of the CdTe and CdZnTe detectors at room temperature reached ~ 5 keV on the 59.6 keV 241Am line.

Previous studies have found that patients with lung cancer report worse patient experience compared to other tumour groups. Reasons that may negatively impact patient experience include delays in diagnosis as well as inadequate symptom management. The purpose of this study was to compare the diagnostic timelines and symptom reports of patients with lung and gastrointestinal (GI) cancers. This study included patients diagnosed with lung or GI cancers who attended a radiation oncology (RO) consultation and/or received radiation treatment between May and August 2019 at the Tom Baker Cancer Centre, Calgary, Alberta, Canada. Data collected included demographics, dates of diagnostic time points, and self-reported symptom scores across 3 time points. A descriptive analysis was completed, and the median number of days between time points was compared between tumour groups. Patients with lung cancer had longer diagnostic timelines compared to GI patients. The median number of days between the first investigative test and biopsy was 21 days longer for patients with lung cancer (p

Objectives Vitamin D deficiency (VDD) is associated with coronary artery disease (CAD) directly by augmenting atherosclerosis and indirectly through cardiovascular risk factors. The present study was aimed to find an association of 25 hydroxyvitamin D (25(OH)D) with lipid profile among established CAD. Methods A cross-sectional study was conducted among 73 patients of angiographically confirmed CAD aged between 35 and 55 years of both gender. Serum 25(OH)D and lipid profile were estimated by ELISA kit and Roche autoanalyzer respectively. Atherogenic index of plasma (AIP) and sdLDL (small dense low-density lipoprotein) were calculated using the accepted formula. Results The mean 25(OH)D level was 17.95 ± 13.51. Only 15% had sufficient 25(OH)D level. There was a significant negative correlation of 25(OH)D with TC/HDL (T.cholesterol/High-density lipoprotein) ratio (p=0.022). Multivariate logistic regression analysis showed no statistically significant impact of 25(OH)D with lipid biomarkers. Conclusions We found low 25(OH)D mean value among CAD and a significant negative correlation of 25(OH)D with TC/HDL. This study suggests VDD may affect primary lipid target resulting in unfavorable outcomes in CAD.

Purpose The health-care industry has multiple stakeholders, with knowledge dispersed among clinicians, experts and patients and their families. As the adoption of health-care information technologies (HITs) depends on multiple factors, this study aims to uncover the motivators for adopting them. Design/methodology/approach The study considers 391 respondents, representing the health-care sector, to evaluate the motivators for adopting HITs for better-dispersed knowledge management. The authors analyze the responses using exploratory factor analysis (EFA) to identify the actual structure of the factors, followed by confirmatory factor analysis (CFA). Findings EFA categorized the factors into four classes: quality management; information sharing; strategic governance; and available technological infrastructure. CFA revealed that the strategic governance factor is most predictive of successfully adopting HITs that model the normative pressure of Institutional theory in health-care organizations. These results indicate that, along with considerations of finances, care quality and infrastructure, effective government involvement and policy-making are important for successful HIT adoption. Practical implications Results reveal that stakeholders’ motivating factors for HIT adoption in a developed economy like the United Arab Emirates are based on considering HITs as a knowledge management mechanism. These factors may help other nations in HIT implementation and drive valuable innovations in the health-care sector. This research presents the implications for health-care professionals and stakeholders in relation to adopting HITs and their role in knowledge flow for efficient care. Originality/value HITs offer an affordable and convenient platform for collaboration among diverse teams in the health-care sector. Apart from this, it helps in facilitating an interactive platform for knowledge creation and transfer for the benefit of users and providers.

Limited evidence exists on the effect of xanthine oxidase inhibitors in nephrolithiasis patients on iron status markers, beyond their effects on urate. The aim of this study was to investigate whether allopurinol therapy was associated with a significant impact on parameters related to iron status, in patients with renal stones. Allopurinol treatment was associated with a nonsignificant decline in serum uric acid. There were no significant differences in serum levels of transferrin and ferritin after treatment with allopurinol compared to pre-treatment levels. A non-significant fall in serum levels of haptoglobin was registered. The drug was associated with a significant rise in serum iron levels. Serum uric acid and iron did not show a significant correlation with any parameter in the study. Allopurinol exerted an overall non-significant effect on iron metabolism in nephrolithiasis patients, save for serum iron, this entails lack of untoward effects in populations with-iron related conditions.

The root of Pueraria labata, Puerariae radix(PR), a leguminous plant that grows wild, is one of the first and most significant basic herbs used in traditional medicine for a variety of therapeutic uses. PR is high in isoflavonoids including daidzein and genistein, which have been shown to protect against bone loss caused by oestrogen insufficiency. In an osteoporotic animal model, soybean isoflavones have been shown to reduce bone loss. CGF (canagliflozin) appears to raise the risk of fractur. In diabetic rats, the potential function of PR in reversing CGFinduced bone loss was investigated. A rat model was used to investigate the effects of Puerariae radix extract (PRE) on blood glucose, HBA1C levels, and bone mineral density. Control group (vehicle therapy), Diabetic group, `PRE group, Canagliflozin (CGF), and CGF +PRE group were all made up of six Wistar albino rats. Each medication was given by gastric gavage once a day for 35 days. PRE treatment increased bone mass substantially when compared to normal controls. This suggests that PRE might be developed as an alternative therapy for osteoporosis caused by anti-diabetic drugs. Keywords: Puerariae radix, Diabetic osteoporosis, streptozotocin, Canagliflozin.