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Diabetic neuropathy is a long-term consequence of diabetes that can cause significant morbidity and a decline in quality of life in many individuals. Low vitamin D levels, in addition to causing rickets in infants and chondrosteoma in adults, may have a role in the development of DM and its underlying disorders, according to a growing body of evidence. Vitamin D deficiency has been linked to type 1 or type 2 diabetes, as well as the microvascular and macrovascular problems that come with it. Vitamin D insufficiency has been linked to diabetic peripheral neuropathy (DPN) as an independent risk factor. Vitamin D, both topical and oral, has been shown to considerably improve DPN symptoms and pain.

Purpose: This study aimed to compare the pediatric nickel-titanium (Ni-Ti) rotary system and manual instrumentation for root canal preparation for primary molar teeth to assess their efficiency in preparation time and cleaning capacity. Material and methods: Sixty-four primary molar canals were categorized into two groups randomly—Group I, 27 canals manually instrumented with K-files; and group II, 31 canals instrumented with Ni-Ti rotary files (Kedo-SG). India ink was injected into the root canals in both groups with insulin syringes. The instrumentation times were recorded; thereafter, the teeth were cleared using various solutions, following which, two observers evaluated and observed the root canals under a stereomicroscope. Results: The preparation time in group I using K-files was significantly longer than that in group II, which used exclusive pediatric primary tooth rotary files (group I vs. group II, 01:30 vs. 00:58, respectively; P=.0202; t-test, P

Background: There is a lack of data regarding breakfast consumption and quality among college students in the Kingdom of Saudi Arabia. Objective: The objective of this study was to assess the prevalence of breakfast consumption and examine the effect of breakfast location on breakfast nutritional quality and obesity risk among female college students at Taibah University. Methods: A total of 658 students participated in this cross-sectional study. Based on the Child and Adult Care Food Program (CACFP) recommendations, breakfast quality scores were computed by summing the individual food components and categorizing participants according to tertiles of the breakfast score distribution. Mixed-effects repeatedmeasures models were used to examine BMI categories with increasing tertiles of breakfast quality scores, stratified by breakfast location. Results and Discussion: Approximately 68% of the participants reported having breakfast regularly. The mean breakfast quality score was determined for students who had breakfast at home (12.5 ± 0.11), at college (10.41± 0.06), and in other places (8.19± 0.48). Obesity was associated with lower average breakfast quality scores based on breakfast location [mean quintile 3 compared with 1 difference: home 13.6 (P < 0.001), college 9.1 (P < 0.001), other 8.6 (P < 0.001)]. Conclusion: The findings presented here indicated that a high percentage of students consume breakfast regularly. Students who had breakfast at home had high scores, which indicated good breakfast quality and a decreased risk of obesity. Further research on breakfast quality is needed in this area, as it affects the nutritional status and quality of life of the younger population.

Purpose In patients with primary hyperparathyroidism (PHPT) and severe hypercalcemia, parathyroidectomy remains the only curative therapy. During the coronavirus disease 2019 (COVID-19) pandemic, when many hospital visits are suspended and surgeries cannot be performed, the management of these patients represents a challenging clinical situation. This article presents a literature review and discussion of the pharmacologic management of PHPT and severe hypercalcemia, which can be used as a temporary measure during the COVID-19 pandemic until parathyroidectomy can be performed safely. Methods This narrative review was conducted by searching literature on the PubMed, Medline, and Google Scholar databases using the terms primary hyperparathyroidism, hypercalcemia, cinacalcet, bisphosphonates, denosumab, vitamin D, raloxifene, hormone replacement therapy, coronavirus, and COVID-19. Findings Appropriate monitoring and remote medical follow-up of these patients are essential until the resolution of the pandemic. Cinacalcet is the drug of choice for controlling hypercalcemia, whereas bisphosphonate or denosumab is the drug for improving bone mineral density. Combined therapy with cinacalcet and bisphosphonates or cinacalcet and denosumab should be considered when the effects on serum calcium and bone mineral density are simultaneously desired. Implications Medical management of PHPT and severe hypercalcemia presents a reasonable alternative for parathyroid surgery during the COVID-19 outbreak and should be instituted until the pandemic ends and surgery can be performed safely.

Supplemental Digital Content is available in the text., Background: Cardiac involvement among hospitalized patients with severe coronavirus disease 2019 (COVID-19) is common and associated with adverse outcomes. This study aimed to determine the prevalence and clinical implications of COVID-19 cardiac involvement in young competitive athletes. Methods: In this prospective, multicenter, observational cohort study with data from 42 colleges and universities, we assessed the prevalence, clinical characteristics, and outcomes of COVID-19 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020, to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible COVID-19 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Imaging Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations. Results: Among 19 378 athletes tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 3018 (mean age, 20 years [SD, 1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least 1 element of cardiac triad testing (12-lead ECG, troponin, transthoracic echocardiography) followed by cardiac magnetic resonance imaging (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21 of 2999 [0.7%]), cardiac troponin (24 of 2719 [0.9%]), and transthoracic echocardiography (24 of 2556 [0.9%]). Definite, probable, or possible SARS-CoV-2 cardiac involvement was identified in 21 of 3018 (0.7%) athletes, including 15 of 2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6 of 198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-CoV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15 of 119 [12.6%]) versus a primary screening CMR (6 of 198 [3.0%]). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (odds ratio, 3.1 [95% CI, 1.2, 7.7]) or at least 1 abnormal triad test result (odds ratio, 37.4 [95% CI, 13.3, 105.3]). Five (0.2%) athletes required hospitalization for noncardiac complications of COVID-19. During clinical surveillance (median follow-up, 113 days [interquartile range=90 146]), there was 1 (0.03%) adverse cardiac event, likely unrelated to SARS-CoV-2 infection. Conclusions: SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short-term follow-up.

Studies of bioactive glasses give an advanced roadbook to realize radiation applications in nuclear medicine and other medical applications. This paper aims to investigate the gamma ray interaction parameters of the PbCl2–SnCl2–P2O5 glass system. The mass attenuation coefficients (μm) of the selected bioactive glasses have been obtained using XCOM and dosimetry Phy-X/PSD programs in the photon energy range 10–150 keV and also correlated with those simulated through MCNP5 code. The other parameters, such as the effective atomic number (Zeff), electron density (Ne), and mean free path (MFP), tenth-value layer (TVL), and half-value layer (HVL) values have also been computed. Among all the selected bioactive glasses, the S4 bioactive glass has the lowest MFP, HVL, and TVL, showing that it is highly effective in absorbing gamma rays. The values of MFP of all samples (S1–S8) are also compared to the RS 253G18 and RS 360 commercial glasses at energy 150 keV. The fast neutron removal cross-sections have been obtained to study the fast neutron absorption behavior with the selected bioactive glasses.

Indium phthalocyanine chloride, InPcCl, in the form of thin films were prepared with different thicknesses by thermal evaporation technique. X-ray diffraction showed a hump at 2θ = 28°, which identified that the prepared InPcCl films have an amorphous structure. The particle size increased from 56 to 357 nm with increased film thickness as indexed by Atomic Force Microscope technique. The transmittance and reflectance spectral distribution of InPcCl films was measured through a range of 250–2500 nm of wavelength. The optical transition is indirectly allowed with two optical energy gaps (Eg1 = 1.37 eV and Eg2 = 2.84 eV) for InPcCl thin films, which are smaller than other phthalocyanine films. The dispersion parameters were calculated for the different film thickness of InPcCl films from refractive index analysis in the region of normal dispersion. The linear, third-order, non-linear refractive index and non-linear susceptibility have also been measured. The optical limiting response was evaluated for the InPcCl films under the He–Ne laser and a green diode laser. The InPcCl film of thickness 95 nm exhibits the highest output power values and the normalized power. This advanced result will hopefully apply to the field of photodiode devices in an industrial approach.

الملخص: ورم القواتم هو ورم نادر يفرز هرمونات الكاتيكولامين ويحدث في حوالي ٠.١-٠.٥٪ من مرضى ارتفاع ضغط الدم. تشمل علامات ورم القواتم وأعراضه عادة ارتفاع ضغط الدم ونوبات من الصداع والتعرق والخفقان. في حالات نادرة قد يشكو المريض من أعراض وعلامات أقل شيوعا من الأعراض التقليدية لورم القواتم.في هذا التقرير نناقش حالة سيدة كانت أعراض شكواها الأساسية فشل القلب الاحتقاني وجلطة في الأوردة العميقة لليد اليمنى، ثم تم تشخيصها بورم القواتم. مع العلاج الطبي والجراحي تم شفاء اعتلال عضلة القلب بالكامل وتم علاج الجلطة بأدوية منع تخثر الدم.يعتبر ورم القواتم أحد العلل المسببة لفشل القلب المفاجئ وغير المبرر و/أو سبب لجلطة الأوردة العميقة.يمكن شفاء اعتلال عضلة القلب الناجم عن ورم القواتم بالعلاج الطبي والجراحي. Abstract: Pheochromocytomas are rare catecholamine-secreting neoplasms, occurring in approximately 0.1–0.5% of the patients with hypertension. Typically, a pheochromocytoma presents with hypertension, a paroxysm of headaches, sweating, and palpitation. However, patients may also present with atypical clinical manifestations on rare occasions. This report presents a case involving a young woman who presented with two rare manifestations of pheochromocytomas: congestive heart failure and right upper extremity deep vein thrombosis (DVT). Her cardiomyopathy was completely resolved by surgical and medical therapy, while DVT was resolved with anticoagulation. Pheochromocytoma should be considered in case of sudden and unexplained cardiac failure and/or DVT. Pheochromocytoma-induced cardiomyopathy can be reversed with medical and/or surgical therapy for pheochromocytomas.

Vehicles authentication, the integrity of messages exchanged, and privacy-preserving are essential features in vehicular ad hoc network (VANETs) security. Most of the previously proposed VANETs security solutions do not sufficiently satisfy the security and efficiency requirements. Besides, most of those solutions are heavily dependent on the system key and long-term sensitive data stored in an ideal tamper-proof device, which may not be practical or ideal for resource-constrained onboard units (OBUs), especially in the case of an unexpected cloning or physical attack. Therefore, a robust authentication solution should consider those security issues and the nature of resource-constrained nodes. To satisfy all these requirements, we propose a lightweight multi-factor authentication and privacy-preserving security solution for VANETs. It employs a combination of physically unclonable functions (PUF) and one-time dynamic pseudo-identities as authentication factors. Furthermore, it eliminates the heavy dependency on the system key by decentralising the wide precinct of the certificate authority (CA) into regional domains and achieves robust control of domains keys. A detailed analysis demonstrates that our scheme efficiently meets the VANETs security requirements, and offers more suitable communication and computation costs and features than existing schemes.

IntroductionAnti-drug antibodies to infliximab (ATI) and adalimumab (ATA) are associated with loss of response to tumor necrosis factor antagonist (anti-TNF) therapy in inflammatory bowel disease (IBD). We evaluated the relationship between patient sex and serum TNF antagonist drug and antibody concentrations in inflammatory bowel disease. MethodsA nationwide multicenter retrospective cohort study was conducted by evaluating patient charts from July 2018 until February 2021. The effect of patient sex on anti-drug antibodies and serum drug concentration in patients with IBD across 7 hospitals was investigated. A subgroup analysis also investigated the effect of anti-TNF combination therapy. ResultsIn the total study sample (n = 1093), males receiving infliximab had higher anti-drug antibody concentrations (38.3 vs. 22.3 AU/ml; aRoGM = 1.72, 95% CI: 1.30-2.27, p-value

IntroductionImmunogenicity of SARS-CoV-2 vaccines in patients with inflammatory bowel disease (IBD) on biologics are not well studied. The goal of this study is to measure serological response to BNT162b2 and ChAdOx1 nCoV-19 vaccines in patients with IBD receiving different biologic therapies.MethodWe performed a multi-center prospective study between August 1st, 2021, and September 15th, 2021. We measured seropositivity of SARS-CoV2 antibodies, SARS-CoV-2 IgG and neutralizing antibody concentrations, in patients with IBD receiving biologic therapies between 4–10 weeks after second dose or 3-6 weeks after first dose of vaccination with BNT162b2 or ChAdOx1 nCoV-19 vaccines.ResultsThere were 126 patients enrolled (mean age, 31 years; 60% male; 71% Crohn’s disease, 29% ulcerative colitis). 92 patients were vaccinated with BNT162b2 vaccine (73%) and 34 patients with ChAdOx1 nCoV-19 vaccine (27%). The proportion of patients who achieved positive anti-SARS-CoV-2 IgG antibody levels after receiving 2 doses of the vaccine in patients treated with infliximab and adalimumab were 44 out of 59 patients (74.5%) and 13 out of 16 patients (81.2%), respectively. Whereas the proportion of patients who achieved positive anti-SARS-CoV-2 IgG antibody levels after receiving two doses of the vaccine in patients treated with ustekinumab and vedolizumab were 100% and 92.8%, respectively. In patients receiving infliximab and adalimumab, the proportion of patients who had positive anti-SARS-CoV-2 neutralizing antibody levels after two-dose vaccination was 40 out of 59 patients (67.7%) and 14 out 16 patients (87.5%), respectively. Whereas the proportions of patients who had positive anti-SARS-CoV-2 neutralizing antibody levels were 12 out of 13 patients (92.3%) and 13 out of 14 patients (92.8%) in patients receiving ustekinumab and vedolizumab.ConclusionThe majority of patients with IBD on infliximab, adalimumab, and vedolizumab seroconverted after two doses of SARS-CoV-2 vaccination. All patients on ustekinumab seroconverted after two doses of SARS-CoV-2 vaccine. BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 are both likely to be effective after two doses in patients with IBD on biologics. A follow up larger studies are needed to evaluate if decay of antibodies occurs over time.

OBJECTIVE: Comprehensive control of diabetes and its related comorbidities is essential to avoid diabetes complications and reduce diabetes care expenses. Nevertheless, several reports have uncovered the gap in diabetes management and confirmed the suboptimal glycemic control globally. This study aims to assess the metabolic control among patients with diabetes attending primary care clinics (PCCs) in Madinah, Saudi Arabia. METHODS: A cross-sectional study was conducted at 15 PCCS in Madinah, Saudi Arabia. Consecutive 692 adult diabetic patients who attended the clinics between January 2016 to December 2017 were included. The primary outcome measures were achieving blood glucose, blood pressure, and lipids goals. The achievement of adequate metabolic control followed the American diabetes association (ADA) guidelines. RESULT: Majority (98%) of the patients had type 2 diabetes (T2DM) with a mean age of 55.1±11.6 years and a mean diabetes duration of 11.02±7.8 years. The mean HbA1c was 8.39±1.7, and glycemic goals (HbA1C < 7%) were achieved in 15.7%. Achievement of LDL, triglyceride, and HDL goals were as follow; 46.4%. 53.3%, 70.8%, respectively. 66.3% of subjects achieved systolic blood pressure, and 88.7% achieved diastolic blood pressure goals. Younger age, longer diabetes duration, and higher LDL levels were associated with poor glycemic control. CONCLUSION: Glycemic control is inadequate among patients with diabetes following at the PCCs in Madinah, Saudi Arabia. A patient-centered approach and individualized management plan considering all risk factors are required.

Background: Iron deficiency (ID) and ID anemia (IDA) are common in the member states of the Gulf Cooperation Council (GCC). The unique genetic and lifestyle factors of the patient population in the region have necessitated the development of recommendations to help educate health-care professionals on appropriate diagnosis and management of ID/IDA. Methods: A panel of regional experts, including gastroenterologists and hematologists with expertise in the treatment of IDA, was convened to develop regional practice recommendations for ID/IDA. After reviewing the regional and international literature, the expert panel developed consensus recommendations for screening, diagnosis, and treatment of patients with IDA in the GCC region. Results: The recommendations proposed were customized to the patient population keeping in view the increasingly recognized burden of coeliac disease, high fertility and obesity rates, high prevalence of alpha- and beta-thalassemia traits, and poor tolerance and low treatment compliance with oral iron therapy. Conclusions: This consensus statement proposes recommendations for screening, diagnosis, and treatment of IDA in the GCC region.

Background Healthcare workers (HCW) were amongst the front-liners in the mission to tackle the COVID-19 pandemic and thus bore a huge risk of infection. Therefore, personal protective equipment (PPE) is of vital importance. There are several methods described in the literature to increase compliance with PPE use and reduce occupational infections. One of those methods is the institution of PPE inspectors that ensure proper adherence to PPE protocols and ultimately improve the outcomes of many HCWs. Methods A team of PPE inspectors was introduced in a tertiary care university hospital, where they randomly evaluated and reinforced PPE use in accordance with the guidelines set by the local health authority. The study period was from the 10th of May 2020 until the 31st of August 2020. The evaluations were divided into three categories; appropriate, missing, or unnecessary use of PPE and were compared to trends in healthcare workers' COVID-19 infection rates. Results A total of 720 HCWs were evaluated from the 10th of May 2020 until the 31st of August 2020. The appropriate use of PPE increased from 56% to 89% during the study period. Meanwhile, the incidence of COVID-19 infection among HCWs, which has peaked to 31 cases per day on the 18th of May 2020, has been declining to below 5 cases per day towards the end of the study period. Conclusion PPE inspectors' team served a positive role in increasing compliance with PPE use and was associated with a reduction in the transmission of SARS-Cov-2 among HCWs.

Background Asthma is a common public health issue in the pediatric population. The prevalence of asthma in children in Saudi Arabia is increasing. All asthmatic children with continuous symptoms should use controller medications. These medications if used correctly by the patients will diminish the symptoms and avoid exacerbations that lead to hospitalization. Perception of parents toward a particular device can affect the adherence rate. Aim Assessing the parental perception about metered-dose inhalers (MDIs) and nebulizers differences among the Saudi population. Methods A cross-sectional study was conducted to assess Parental perception about MDIs and nebulizers among Saudi parents with an asthmatic child. The data were collected from the parents and caregivers by using an online questionnaire and informed consent was obtained. The questionnaire was focused on demographic characteristics, knowledge, perception and practice of treating the asthmatic child. Data were analyzed through the Statistical Package for the Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY) and the results were considered statistically significant if P < 0.05. Results A total of 1,021 participants included in this study. This study found asthma is predominant in males (64.4%) and the most affected age is between 8 and 14 years (56.3%). More than half of the parents (58.7%) had a bachelor's degree and above. MDI is the most method used for controlling asthma (32.7%) and the majority of them (70.2%) thought there is a therapeutic difference between MDI and nebulizer. Providing instructions and information on usage MDI was received from 65.2%. Significant relationships were found between the level of satisfaction and receiving enough information about MDI and level of education. Conclusion This study found that asthma is more prevalent in males, where MDI is more common. Majority of the parents had thought that there is a difference in the therapeutic effects between MDI and nebulizer. They believed that nebulizer is more effective, less side effect and cheaper while MDI is easier to use.

Blind FOE for PS-QAM is experimentally analyzed in fiber-mmWave integrated system. QS-FOE can relax the requirements on FFT size, shaping factor and laser linewidth of the FFT-FOE by improving PMNR by more than 10 dB.

OBJECTIVES: The DaR Global survey was conducted to determine the impact of the COVID-19 pandemic on the intentions to fast and the outcomes of fasting in

Background Maternal obesity and gestational diabetes (GDM) are commonly encountered during pregnancy. Both conditions are independently associated with unfavorable pregnancy consequences. The objective of this study was to compare the effects of obesity and GDM on birth weight, macrosomia, and other adverse pregnancy outcomes. Methods This cohort study involved 531 women with a singleton pregnancy attending the Maternity and Children’s Hospital, Medina, Saudi Arabia, between June 2014 and June 2015. Participants underwent a 75-g oral glucose tolerance test between 24 and 28 weeks. The International Association of Diabetes and Pregnancy Study Groups criteria were used for GDM diagnosis. BMI was assessed at the first antenatal visit, and obesity was defined as a BMI ≥30.0 kg/m2. All women were followed up until delivery. Women were divided into 4 groups: non-GDM nonobese (reference group), GDM nonobese, obese non-GDM, and obese GDM. Clinical characteristics and adverse pregnancy outcomes were compared. Results The mean age and BMI of the participants were 30.5 years and 29.3 kg/m2, respectively. GDM was diagnosed in 50.2% of the participants, and obesity was diagnosed in 47.8% of the participants. Obese women with GDM were the oldest and heaviest among all women. The mean birth weight increased in order among the four groups; it was highest in the infants in the obese GDM group, followed by those in the obese non-GDM, GDM nonobese and reference groups. Obesity and GDM alone or in combination were associated with higher rates of macrosomia and cesarean deliveries than the reference group. Neonatal intensive care unit (NICU) admission was higher in infants in the GDM nonobese and obese GDM groups. The frequency of low Apgar score was significantly higher in infants in the obese GDM group than in infants in the reference group. Conclusions Maternal obesity seems to influence birth weight more than GDM, while GDM is associated with a greater risk of admission to the NICU. The combination of both conditions is associated with the greatest risk of adverse pregnancy outcomes.

Objective: Published data show a clear link between psoriasis (Ps) and the increasing prevalence of comorbid conditions, such as diabetes mellitus type 2 (DM2). The role of the mitochondrial genomic haplogroup in the potential coexistence of Ps and DM2 comorbidity is the subject of this study. Material and Methods: Ninety-eight Kuwaiti individuals were recruited in 4 cohorts (20 healthy controls, 15 with DM2, 34 with Ps, and 29 with Ps and diabetes mellitus). An Ion Torrent S5XL was used to sequence mitochondrial DNA (mtDNA). χ2 test was used to assess differences in the distribution of each haplogroup between cases and controls (p < 0.05). The Bonferroni correction was applied (p < 0.004). The mtDNA haplogroups were analyzed by HaploGrep. Results: Haplogroups R0, U, J, T, N, L3, M, H, X, HV, R, and K were detected in the studied population. Haplogroup M had a high risk for Ps (odds ratio (OR) 4.0, p = 0.003). Haplogroup R0 and J had decreased the risk of DM2 (OR 0.28, p = 0.007). Conclusion: Our results indicated that mtDNA haplogroups have a potential contribution to the pathogenesis of Ps and DM2 comorbidity. We show for the first time that the comorbidity of diabetes in Ps may be related to mitochondrial dysfunction.

We propose and experimentally verify a fine-grained, Per-UE, flexible fronthaul where different applications are transported over different function splits (i.e., URLLC over A-RoF-based fronthaul, Option-9, and other traffic over Option-7), exploiting two RU-level puncturing methods.

Background Coronavirus disease 2019 (COVID-19) has evolved into a devastating pandemic since December 2019. Saudi Arabia's first case was reported in March 2020. Subsequently, some 220,000 cases and 2000 deaths were recorded through July 2020. COVID-19 infection aggravates glycemic control and provokes acute hyperglycemic crises, according to some reports. We made the same observations in some of our patients diagnosed with COVID-19. However, we are unaware of any reported cases of diabetic ketoacidosis (DKA) among COVID-19 patients in Saudi Arabia. Objective Highlighting the significance of hyperglycemia on COVID-19 patient outcomes. Methods Five patients with DKA were admitted and diagnosed with COVID-19 based on real-time reverse transcription-polymerase chain reaction assays. Electronic medical records were reviewed and informed consent was obtained before reporting the index cases. Results Five patients presenting with DKA complicating a concurrent COVID-19 infection were reported. Three were known to have preexisting diabetes and 2 had newly diagnosed diabetes based on significantly elevated glycated hemoglobin levels at admission. Four recovered and were discharged to their homes and 1 had a complicated course and died. Conclusions Our cases demonstrate that COVID-19 infection can trigger DKA. DKA can occur among patients who are known to have diabetes mellitus or appears as a first presentation. Clinicians should be extremely careful in checking for admission hyperglycemia and closely monitor respiratory status during fluid resuscitation of COVID–19-related DKA. (Curr Ther Res Clin Exp. 2020; 81:XXX–XXX)

We first analyze the nonlinearities in the analog radio-over-fiber (A-RoF)-based mobile fronthaul systems with a multi-user uplink load. The inter-band cross modulations (XMs) present in the common fiber channel cause severe inter-user interference. Then, we propose a novel complex-valued multi-level artificial neural network nonlinear equalizer (ANN-NLE) for single-carrier frequency division multiple access signal uplink transmissions. The inter-user interference can be mitigated by employing a multi-user ANN-NLE. Finally, we design an experimental test bed comprising a 60-GHz wireless link and an A-RoF link in order to verify the model predictions and thereby demonstrate the ability of the ANN-NLE to overcome the nonlinear intra-band and inter-band XMs in the case of simultaneous joint equalizations of all users (multi-point-to-single-point) as well as in the case of individual user equalizations (point-to-point). From the experimental and simulation results, we demonstrate that the ANN-NLE can substantially reduce the inter-user interference and communication bit error.

Transcatheter aortic valve replacement (TAVR) initially emerged as a therapeutic option for high-risk patients with severe aortic stenosis. Advancement in technologies since the first era of TAVRs, experience from previous obstacles, and lessons learned from complications have allowed the evolution of this procedure to the current state. This review focuses on the updates on the most current devices, complications, and outcomes of TAVR. Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Transcatheter aortic valve replacement

Background Epidermolysis bullosa (EB) is a clinically and genetically heterogeneous blistering skin disease, but in countries such as Kuwait, there are very limited data on the clinical and molecular pathology of EB. To improve understanding of EB in Kuwait, we report the experience of a local tertiary referral center over a 17.5 year period (January 2000-June 2017) in establishing clinical and molecular diagnoses. Methods Review of hospital records and diagnostic reports. Individual cases were diagnosed by combinations of clinical assessment, skin biopsy (immunohistochemistry and transmission electron microscopy), Sanger sequencing of EB genes, and whole exome sequencing. Results Fifty-four families with EB were registered with the clinic over this period, 41 of whom (84 patients) participated in diagnostic studies. Thirty-seven of these 41 families had consanguineous marriages; 34 had recessive forms of EB, while only seven had dominant subtypes. Recurrent mutations were observed in epidermal dystonin, transglutaminase 5, and type VII collagen. Conclusions The prevalence of EB in Kuwait is approximately three times that of internationally cited rates with an over-representation of autosomal recessive variants. Establishing the molecular basis of EB in Kuwait with accurate diagnostic subtyping provides a basis for determining healthcare requirements and improving patient management of EB.

Background: Vaccination is a promising strategy to protect vulnerable groups like inflammatory bowel disease (IBD) patients against COVID-19 and associated severe outcomes. COVID-19 vaccine clinical trials excluded IBD patients taking infliximab with azathioprine or 6-mercaptopurine (infliximab combination). Therefore, we sought to evaluate serologic responses to COVID-19 vaccination with the mRNA vaccine, BNT162b2, in patients with IBD receiving infliximab combination therapy compared with healthy participants. Method: This was a multicenter prospective study. Patients with IBD were recruited at the time of attendance at infusion center between 1 August 2021, and 15 September 2021. Our primary outcome were the concentrations of SARS-CoV-2 antibodies 4–10 weeks after vaccination with two doses of BNT162b2 vaccine in patients with IBD taking infliximab combination therapy (study group) compared with a healthy participants group (control group). Both study and control groups were matched for age, sex, and time-since-last-vaccine-dose using optimal pair-matching method. Results: In total, 116 participants were recruited in the study, 58 patients in the study group and 58 in the control group. Median (IQR) IgG concentrations were lower in the study group (99 BAU/mL (40, 177)) than the control group (139 BAU/mL (120, 188)) following vaccination (p = 0.0032). Neutralizing antibodies were also lower in the study group compared with the control group (64% (23, 94) vs. 91% (85, 94), p &lt, 0.001). The median IgA levels in the study group were also significantly lower when compared with the control group (6 U/mL (3, 34) vs. 13 U/mL (7, 30), p = 0.0097). In the study group, the percentages of patients who achieved positive IgG, neutralizing antibody and IgA levels were 81%, 75%, and 40%, respectively. In the control group, all participants (100%) had positive IgG and neutralizing antibody levels while 62% had positive IgA levels. Conclusion: In patients with IBD receiving infliximab combination therapy, SARS-CoV2 IgG, IgA, and neutralizing antibody levels after BNT162b2 vaccination were lower compared with healthy participants. However, most patients treated with infliximab combination therapy seroconverted after two doses of the vaccine.

Thin films of Au/Ch-diisoQ/p-Si/Au were prepared by vacuum thermal evaporating technique. The structure and morphology of Ch-diisoQ on the p-Si substrate were studied by the analysis of X-ray diffract pattern and atomic force microscopy. The dark current density-voltage characteristics were investigated at various temperatures ranging from 298 to 393 K. A thermionic emission mechanism dominates the current at low voltage. At high forward bias voltage, the space charge limited current controlled by exponential trap distribution was the dominant mechanism. The dependence of the reverse current density on various temperatures was expounded via Poole-Frenkel and Schottky effects. Depend on the capacitance-voltage characteristic, the carrier concentration values and the built-in voltage were evaluated at different temperatures. The photocurrent characteristics of Ch-diisoQ/p-Si heterojunctions under the illumination of 100 W/cm2 were discussed. The values of the short circuit current (Jsc), the open-circuit voltage (Voc), the fill factor (FF), and power conversion efficiency (η%) of Ch-diisoQ/p-Si heterojunctions were comparing with other related organic/inorganic heterojunctions.

Researchers have long identified the ability of secondary stressors to have impacts on people's wellbeing and mental health that are similar to the direct effects of major incidents (e.g., emergencies, disasters, infectious disease outbreaks, and conflicts) experientially, and in respect of their prevalence and the strain on services. But there is a lack of clarity about the nature of secondary stressors that can hinder efforts to mitigate their effects. We develop a new theoretical approach in this article. We argue that most secondary stressors are a function of: 1. Social factors and people's life circumstances (that include the policies, practices, and social, organisational, and financial arrangements) that exist prior to and impact them during the major incident; and/or 2. Societal and organisational responses to an incident or emergency. We show that this conceptual framework makes sense of the evidence from different domains and represents a more coherent approach than do previous definitions. We present a worked example from our research on the psychosocial effects on healthcare staff of the COVID-19 pandemic that was declared by the World Health Organization in 2020. We argue that our social model enables a holistic approach to conceptualising and intervening to remedy many of the longer-term and widespread negative psychosocial effects of disasters, conflicts and infectious diseases.

Objectives: To determine the optimal cutoff value for neck circumference (NC) that define overweight/obesity and assess its predictive potential for cardiometabolic risks (CMR) among Saudi subjects. Methods: A cross sectional study of 785 adults recruited from a public health awareness campaign in Medina, Saudi Arabia during June 2015. Waist circumference (WC), NC, body mass index (BMI), blood pressure (BP), and random blood glucose (RBG) were assessed, and the presence of CMR were collected by a questionnaire. Pearson’s correlation coefficients were used to evaluate the associations of NC with other anthropometric indices and CMR. The optimal cutoff value for NC to identify overweight/obesity was determined by receiver operating characteristic (ROC) curves. Results: There were significant correlations between NC and BMI, weight, WC, age, RBG, and BP. The area under the curve for NC and WC in the ROC analysis was 0.86 for men and 0.77 for women, and NC ≥39.25 cm for men and ≥34.75 cm for women were the best cutoff levels for identifying subjects with central obesity with an 89% sensitivity and a 71% specificity for men and an 80% sensitivity and a 65% specificity for women. These cutoff levels for NC were associated with a significantly increased risk for diabetes, dyslipidemia, and hypertension. Conclusion: Neck circumference is positively correlated with BMI and WC, and can be used to identify overweight/obesity and predict CMR in Saudi individuals. Saudi Med J 2017; Vol. 38 (12): 1219-1223 doi: 10.15537/smj.2017.12.20926 How to cite this article: Alfadhli EM, Sandokji AA, Zahid BN, Makkawi MA, Alshenaifi RF, Thani TS, Habeeb HA.Neck circumference as a marker of obesity and a predictor of cardiometabolic risk among Saudi subjects. Saudi Med J . 2017 Dec;38(12):1219-1223. doi: 10.15537/smj.2017.12.20926.

In this study, investigation of the energy performance, environmental impact, and cost assessments of one MWp plant using the main 2017 market available photovoltaic technologies under hot climatic conditions for the state of Kuwait is carried out. Influence of climatic parameters on modules efficiencies, net energy production per unit area and plant performance ratio with PV modules made from crystalline silicon-based and thin film technologies-based is assessed on hourly, daily, monthly, and yearly basis respectively. The PV modules technologies used are the monocrystalline, polycrystalline, and thin-film with cell types of cadmium telluride (CdTe) and CdS/CdTe semiconductor. These technologies are assessed based on their manufacturer provided characteristics and an average of 20 years hourly climatic data of the ambient air-dry temperatures, horizontal solar radiation, and average wind speed for the state of Kuwait. The result show that compared with monocrystalline as a base of minimum required modules area, it is found that: the polycrystalline technology plant requires an additional area of 19.33%, thin-film cadmium telluride (CdTe) plant needs extra area of 8.39% and thin-film cadmium sulphide (CdS)/cadmium telluride (CdTe) (CdS/CdTe) plant needs extra area of 39.76%, respectively. The net produced annual energy per unit area compared with the monocrystalline PV technology are as follows. The Polycrystalline technology produces less annual net energy per unit area by −10.54%, thin-film cadmium telluride (CdTe) technology produces less annual energy per unit area by −6.07%, and thin-film CdS/CdTe technology produces less annual energy per unit area by −22.73%, respectively. The main study conclusion is that the thin-film cadmium telluride (CdTe) technology has the yearly average right energy cost performance parameters with less Levelised energy produced and capital cost with minimum environmental harmful emission and it can be recommended for use under Kuwait climate condition.

In this study, the potential effect of three HFE gene polymorphisms (C282Y, H63D and S65C) and the SLC40A1 A77D polymorphism on iron balance was investigated in 234 subjects (91 Arab beta-thalassemia major (BTM) patients, 34 beta-thalassemia trait (BTT) individuals and 109 health controls). Genotyping was done using restriction-fragment-length polymorphism and direct-sequencing. Serum-iron, total iron binding capacity, transferrin and ferritin were estimated in all BTT and BTM, and in 65 healthy controls. H63D was the only polymorphism detected in our cohort. Allele frequency was 13% in both BTM and BTT and 10% in controls with no significant difference. Serum iron, ferritin and transferrin saturation were significantly higher in normal males heterozygous for H63D as compared to homozygous wild-type males. Ferritin was significantly higher in BTT males with or without H63D polymorphism when compared to the healthy males with H/H genotype. No such difference was observed between H/H versus H/D BTT subgroups. We conclude that H63D is the only significant hemochromatosis-associated polymorphism in the Arabian Gulf region. The heterozygous state of H63D may significantly alter iron parameters in normal males. In BTT, it appears that the beta-thalassemia allele has an overriding influence on ferritin values, and this generally manifest in males.

The migration of wireless mobile networks from the relatively limited microwave radio spectrum to the “all-spectrum” principle of communication, which aims to make use of microwave and millimeter wave mobile networks as well as fixed point sub-terahertz and visible light communications, has predetermined the need for new network paradigm. Therefore, designing an efficient network along with specialized protection system that encompasses the densely distributed remote radio units (RRUs) as well as fronthaul fiber links and their RF interfaces becomes increasingly important and complex. In this paper, we first analyze the function split concept in the design of fronthaul schemes, mindful of the required fronthaul bandwidth and RRU complexity. We then experimentally demonstrate a mobile-fronthaul protection algorithm that supports proactive, low complexity self-healing by making use of low complexity RRUs while imposing minimum changes on fronthaul performance. The proposed scheme exploits RF domain switching to support seamless 5G-grade service restoration in less than 2 microseconds without causing any service disruption to connected users.

© 2019 by the AGA Institute, Background & aims: Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly owing to the large burden of advanced alcohol-related liver disease (ALD). We investigated whether patients with ALD are initially seen at later stages of disease development than patients with hepatitis C virus (HCV) infection or other etiologies. Methods: We performed a cross-sectional study of 3453 consecutive patients with either early or advanced liver disease (1699 patients with early and 1754 with advanced liver disease) seen at 17 tertiary care liver or gastrointestinal units worldwide, from August 2015 through March 2017. We collected anthropometric, etiology, and clinical information, as well as and model for end-stage liver disease scores. We used unconditional logistic regression to estimate the odds ratios for evaluation at late stages of the disease progression. Results: Of the patients analyzed, 81% had 1 etiology of liver disease and 17% had 2 etiologies of liver disease. Of patients seen at early stages for a single etiology, 31% had HCV infection, 21% had hepatitis B virus infection, and 17% had nonalcoholic fatty liver disease, whereas only 3.8% had ALD. In contrast, 29% of patients seen for advanced disease had ALD. Patients with ALD were more likely to be seen at specialized centers, with advanced-stage disease, compared with patients with HCV-associated liver disease (odds ratio, 14.1; 95% CI, 10.5-18.9; P < .001). Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. These patients had significantly more visits to health care providers, with more advanced disease, compared with patients without excess alcohol use. The mean model for end-stage liver disease score for patients with advanced ALD (score, 16) was higher than for patients with advanced liver disease not associated with excess alcohol use (score, 13) (P < .01). Conclusions: In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-stage disease than patients with HCV-associated liver disease. Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. Early detection and referral programs are needed for patients with ALD worldwide., This study was funded by the National Institute of Alcohol Abuse and Alcoholism grants U01AA021908 and U01AA020821, a scholarship grant from the Spanish Association for the Study of the Liver (M.V.-C.), and a grants NSFC 81570530 and 81370550 from the National Natural Science Foundation of China (L.Y.).

Robotics industry is rapidly growing, and it has grown spectacularly in the past century. Due to their complex components and complicated underlying physics, people have chosen to circumvent understanding the phenomena within the actions that a robot makes, and actually study robotics from a technical point of view rather than using an engineering approach. In this project, a group of students designed and built a robot that is capable of executing two to three different gestures. The team ultimately designed and built a robot miniature car that has the ability to detect obstacles on its way, and is capable of following a black line path, along with other sound and light sensitive gestures. The robot was collected and gathered using a robotic components kit, and the designed robot car was constructed using low budget mechanical tools and equipment. Mainly, two servomotors were used along with other mechanical components and an Arduino control board. The robot was programmed using Arduino open-source software and it was intended to make the robot do the different gestures. The testing procedure for the robot car was successful as the team hypothesized; the robot was able to successfully operate as programmed and performed all the intended gestures. This paper will describe how the robot was built using only $250 resource and how it was programmed and demonstrated in some detail, so that other students can follow the design and controls of the robot.

Vehicular ad-hoc networks (VANETs) have got a wide range of attention to improve traffic systems and smart cities. Security and privacy are critical issues and need to be addressed for effective VANET systems. In this paper, we propose an efficient conditional privacy-Preserving authentication scheme based on a group secret key. Many VANETs schemes have utilized a group signature to realize the identity-less authentication, but the existing schemes suffering from long and high computational procedures, especially in the Certificate Revocation List (CRL) verification process, and group management complexity issues. As a result, they cannot satisfy the VANETs efficiency requirements. On another hand, many pseudonym-ID based VANETs schemes utilized a system key signature, but those schemes suffering from communication overhead increasing which could be caused by the increasing of the revocation list, in addition to that, and any damage in the key will cause damage for the entire system. In our scheme, we use a permanent vehicle pseudonym-ID and temporary group secret key that offers a lightweight verification and authentication process for a secure and efficient VANET system.

Thin films of manganese phthalocyanine chloride (MnPcCl) were prepared using a thermal deposition onto a polyacetate sheet substrate. The structure analyses of the obtained MnPcCl thin films of different thicknesses ranging from 55 to 125 nm were investigated using the X-ray diffraction technique. The transmittance and reflectance of MnPcCl thin films were measured at the normal incident light in the 200–2500 nm wavelength range. The absorption coefficient analysis revealed that the films were characterized by indirect allowed transition with two energy gaps. The Wemple-DiDomenico single oscillator model explained the refractive index's dispersion behavior, and dispersion parameters were calculated. The third-order nonlinear optical susceptibility (χ(3)) and nonlinear refractive index (n2) were determined using Miller's principles. Optical limiting behavior was estimated using the He–Ne (633 nm) and green (533 nm) lasers power. The obtained results indicate that MnPcCl films are excellent nonlinear optical materials for optical limiters.

We present an adaptive threshold method for salt and pepper noisy fingerprint images. At first, we applied a threshold algorithm to detect noisy and corrupt pixels. Fingerprint image optimized with window filter produced pixels values. We measured the quality of the fingerprint images with peak signal to noise ratio and other efficient noise removing techniques were compared with it. The result shows improving performance of our method with remove salt and pepper noise from a fingerprint image. Our present work is useful to reduce or minimize medium level noise in fingerprint image. In future, we will work to reduce more than 80 percent noise level in fingerprint image.

The expression of interferon inducible genes are reported to be heightened in systemic lupus erythematosus (SLE); nevertheless, not much is known regarding the genetic variants underlying these genes and their role in the pathogenesis of disease. Herein, we aim to explore the potential association and contribution of polymorphisms in MX1 gene (i) promoter with part of exon 1 (ii) intron 6, and (iii) their resulting haplotypes, with susceptibility to SLE. A total of 306 subjects, 152 SLE and 154 healthy controls (HC), were screened by direct sequencing method. Statistical analysis was carried out using appropriate software. The screening region of interest in MX1 revealed the existence of promoter (-123C/A, -88G/T, -20 A/C) and intron 6 (+9862G/A, +10190G/A, +9901C/G, +9920C/A, +9959C/T, +10047A/G) variants in SLE and HC. A significant association was observed between MX1 -88G/T SNP and susceptibility to SLE (χ (2) = 4.18, p = 0.04, OR = 1.89, 95 % CI 1.03-3.5). Haplotype analysis also revealed increased risk of SLE among individuals carrying CTA haplotype (-123 C, -88 T, -20 A) (χ (2) = 5.74, p = 0.017, OR = 4.28, 95 % CI 1.30-14.06). None of the other tested variants showed any significant association with SLE. The present study is the first to reveal the influence of genetic variation in MX1 gene in susceptibility to SLE.

The complement system anchors the innate inflammatory response by triggering both cell-mediated and antibody-mediated immune responses against pathogens. The complement system also plays a critical role in sterile tissue injury by responding to damage-associated molecular patterns. The degree and duration of complement activation may be a critical variable controlling the balance between regenerative and destructive inflammation following sterile injury. Recent studies in kidney transplantation suggest that aberrant complement activation may play a significant role in delayed graft function following transplantation, confirming results obtained from rodent models of renal ischemia/reperfusion (I/R) injury. Deactivating the complement cascade through targeting anaphylatoxins (C3a/C5a) might be an effective clinical strategy to dampen reperfusion injury and reduce delayed graft function in liver transplantation. Targeting the complement cascade may be critical in donor livers with mild to moderate steatosis, where elevated lipid burden amplifies stress responses and increases hepatocyte turnover. Steatosis-driven complement activation in the donor liver may also have implications in rejection and thrombolytic complications following transplantation. This review focuses on the roles of complement activation in liver I/R injury, strategies to target complement activation in liver I/R, and potential opportunities to translate these strategies to transplanting donor livers with mild to moderate steatosis.

The objective of this research was to know the role of accounting education in light of the information revolution and its effect on university graduates (applied study on graduates of (University of Tripoli/University of Benghazi 2012-2017). The researchers relied on the statistical analysis program (SPSS) and descriptive analysis. The researchers used arithmetic mean and standard deviation describe the variables and the Cronbach’s alpha factor in determining the association of the variables, and use the Pearson correlation coefficient to determine the relationship between the variables of the research. The study found that there is a strong relationship between the independent variables (intellectual skills, practical and technical skills, personal skills, communication skills and communication skills and business skills) and the dependent variable of accounting education. The research concluded that accounting education in the Libyan universities is capable of providing students with skills and the use of statistical methods and the preparation of reports and financial statements and some lack of graduates of accounting ability and experience in project management and decision-making alone in sensitive matters, and recommended the need to develop the ability of students to predict and extract and the development of their ability to make the necessary decisions, and the addition of new curricula in the Libyan universities for scientific research and urged students to do scientific papers to gain the ability to write and access to the required results and defend.

People with IRD are at increased risk of infection, and in 2011 EULAR made general recommendations for vaccination in these patients. Global and European perspectives are important, but they cannot accurately reflect the individual situations of patients in different countries and regions. Based on our clinical experience and opinions, we have sought to tailor the original EULAR recommendations to include advice for vaccination with new agents approved in the intervening years—including the new class of targeted synthetic disease-modifying antirheumatic drugs. We have also considered the specific demographic needs of patients in local populations in the Gulf region. The resulting 16 recommendations are grouped into four main categories covering general vaccination guidelines and best-practice for all patients with IRD, followed by a set of recommended vaccines against specific pathogens. The last two categories include recommendations for certain patient subgroups with defined risks and for patients who wish to travel.

We experimentally demonstrate a flexible and reconfigurable Fronthaul-I with analog RoF integration that aims to optimally serve different 5G applications. RoF integration can reduce the latency by more than %15 to support URLLC applications.

Introduction Gingivitis is a common clinical condition characterized by swelling, redness, and bleeding at the gums and it is described as an inflammatory reaction. Esthetics is an important aspect that can affect the quality of patient's life. However, it is not known if the perception of esthetic can affect patient‘s gingival health. Objective The present study was designed to assess the relationship between the perception of esthetic and gingivitis in a population of intermediate school students in Dammam, Saudi Arabia. Material & methods A cross-sectional study was conducted at the public intermediate schools in Dammam in the form of a questionnaire. An oral examination to record gingival index was also used in this study. The study population consisted of students (11–19 years old). The sample size was 1638 students. The subjects with disabilities or special needs were excluded from the study. Schools were stratified by gender and randomly selected. The students in each school were included in cluster samples. The perception of esthetics was the exposure of our study and it was measured by the Arabic version of the Orofacial Esthetic Scale (OES-Ar). Gingivitis was the outcome of our study and it was measured by the gingival index of the Loe & Silness. The inter-examiner agreement was determined using kappa statistics (0.6) with a 95% confidence interval (CI) based on WHO examination form. SPSS version 21 was used for the statistical analysis. Results There was a significant correlation (p = 0.002) between perception of esthetic and gingival index. The correlation was negative and weak. There was a significant difference in esthetic perception and gingival index for both genders. The correlation between age and gingival index was −0.086 (p = 0.000) which was significant, however, correlation was negative and weak. Conclusions Gingivitis can be affected by the individual's perception of esthetic.

BACKGROUND AND OBJECTIVES: Use of the criteria of the International Association of Diabetes and Pregnancy Study Group (IADPSG) identifies additional cases of gestational diabetes mellitus (GDM) that have a lesser degree of hyperglycemia. The objective of this study was to compare the clinical characteristics and the pregnancy outcomes of GDM cases identified by IADPSG versus those identified by the former American Diabetes Association (ADA) criteria. DESIGN AND SETTING: Prospective cohort study of Saudi women conducted at the Maternity and Children Hospital, Madinah, Saudi Arabia from October 2011 to August 2012. PATIENTS AND METHODS: Consecutive pregnant women treated in the antenatal service performed oral glucose tolerance tests between 24 to 28 weeks of gestation. GDM was diagnosed according to IADPSG and the former ADA criteria. The women were divided into three groups by GDM diagnosed by both criteria, additional GDM identified by the IADPSG criteria, and cases with normal glucose tolerance (NGT). Clinical characteristics and pregnancy outcomes were compared. RESULTS: Of 277 women who underwent OGTT, 47 (16.9%) were diagnosed by the former ADA criteria and 115 (41.5%) by the IADPSG criteria. The IADPSG criteria identified all women with GDM by the former ADA criteria and an additional 68 cases. The additional GDM cases had the same clinical characteristics as cases diagnosed by both criteria except for lower blood pressure and less frequent glycosuria. On the other hand, they were older, heavier and had a higher frequency of past GDM and history of recurrent abortions than the NGT group. In addition, they had significantly more cesarean deliveries, neonatal hypoglycemia, and a lower Apgar score than the NGT group. LIMITATIONS: Relatively small numbers of subjects, which could limit the power of statistical findings. CONCLUSIONS: The IADPSG criteria increased GDM frequency. The additional GDM cases identified by IADPSG have the same clinical characteristics and adverse pregnancy outcomes as cases with GDM identified by the older criteria.

Background and study aims Chronic infection caused by Helicobacter pylori ( H. pylori ) is associated with chronic gastritis, peptic ulcer disease, and gastric cancer. Eradication of H. pylori reduces morbidity of chronic gastritis and incidence of gastric cancer in high-risk population. We aimed at testing the efficacy of clarithromycin-based triple therapy and bismuth-based quadruple therapy for eradicating H. pylori in patients with chronic gastritis in Kuwait. Patients and methods A total of 218 dyspeptic patients from different countries who were proved to have chronic gastritis by endoscopy and gastric biopsy were enroled. All of them were naive to H. pylori eradication therapy. They were randomised into two groups: group A, received triple therapy (omeprazole, amoxicillin, and clarithromycin) for 10 days; and group B, received quadruple therapy (omeprazole, bismuth subcitrate potassium, tetracycline, and metronidazole) for 10 days. All patients were tested for eradication of H. pylori by carbon-13 urea breath test 4 weeks after treatment. Results Total response rate of eradication therapy in both groups was 77.5% ( n = 169). However, group B ( n = 100) had a higher eradication rate (88%) than group A ( n = 118) (68.6%). H. pylori eradication rate was significantly higher in males (84.2%) than females (70.2%) in both groups ( p Conclusion Bismuth-based quadruple therapy is more effective as a first-line therapy than clarithromycin-based triple therapy for eradicating H. pylori in patients with H. pylori -related chronic gastritis in Kuwait.

BACKGROUND AND OBJECTIVES: The prevalence of gestational diabetes (GDM) has increased recently worldwide, mainly due to adoption of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. The objectives of this study were to determine the prevalence of GDM in Saudi women and to assess risk factors and pregnancy outcomes using the IADPSG criteria. DESIGN AND SETTING: A prospective descriptive study of pregnant Saudi women presenting at the Maternity and Children Hospital, Medina, Saudi Arabia, between October 2011 and June 2014. METHODS: Fasting plasma glucose, glycated hemoglobin, and random plasma glucose concentrations were obtained for all participants at the first antenatal visit. In women with normal results, screening for GDM was performed at 24 to 28 weeks of gestation, with a 75-g oral glucose tolerance test (OGTT). Women who had GDM were treated with diet, exercise, and insulin as needed. Pregnancy outcomes were recorded after delivery. Multiple logistic regression was used to assess possible risk factors for GDM. RESULTS: Early screenings showed abnormal glucose in 211 of 954 women (22.1%). In 445 women, the OGTT showed GDM in 183 women (39.4%). GDM cases identified by OGTT and by early screening increased the rate of GDM to 51% (292 women). Older maternal age, higher body mass index, higher blood pressure, past GDM, history of delivering a malformed child, and family history of diabetes were the main risk factors for GDM. GDM increased the risk of neonatal hypoglycemia (OR 9.353), low Apgar score (OR 5.546), and induction of labor (OR 2.33). The newborns of GDM mothers had a higher birth weight: 3043 g vs. 2890 g in the non-GDM group (P=.004). Other maternal and neonatal outcomes were not significantly different between the two groups. CONCLUSION: The prevalence of GDM is high among Saudi women. Timely and effective treatment reduces perinatal morbidity and improves outcomes.