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ObjectiveTo investigate the associations of alkaline phosphatase (ALP) variability measures with new onset heart failure, cardiovascular mortality, and all-cause mortality in type 2 diabetes mellitus patients with a populational-cohort study.MethodThis study included patients with type 2 diabetes mellitus who presented to ambulatory, outpatient and inpatient facilities managed by the public sector in Hong Kong between January 1st, 2000 to December 31st, 2019. Comprehensive clinical and medical data including demographics, past comorbidities, medications, and laboratory examinations of complete blood, lipid/glycemic profile and their variability were collected. ALP and its variability measures were extracted. Univariable and multiple multivariable Cox regression were used to identify the associations of alkaline phosphatase variability with new onset heart failure and mortality risks. Patients were stratified into three subgroups based on the tertiles of baseline ALP level.ResultsThe study cohort consisted of 14289 patients (52.52% males, mean age at initial drug exposure: 74.55 years old [standard deviation (SD): 12.7]). Over a mean follow up of 2513 days [interquartile range (IQR): 1151-4173]), 10182 patients suffered from all-cause mortality (incidence rate [IR]: 71.25%), 1966 patients (IR: 13.75%) died from cardiovascular causes, and 1171 patients (IR: 8.19%) developed with new onset heart failure. Higher cumulative incidences of all three outcomes were observed for the highest tertile of ALP compared to medium/low tertiles. ALP baseline and variability level predicted new onset heart failure, cardiovascular and all-cause mortality before adjusting for subclinical biomarkers (p < 0.01). Amongst the measures of ALP variability, the hazard ratio (HR) of coefficient of variation (CV) was markedly raised in particular (new onset heart failure: HR=2.73, 95% confidence interval [CI]= [1.71-4.37], p ConclusionsRaised ALP level and variability are associated with increased risks of all-cause mortality, cardiovascular mortality and new onset heart failure amongst patients with type 2 diabetes mellitus.

Resume Nous rapportons un cas rare de granulome eosinophile isole de localisation vertebrale L3 chez un adolescent de 15 ans. Une progression de l’osteolyse avec instabilite vertebrale sans signe neurologique a ete observee sous corset. Le traitement chirurgical a permis de corriger la deformation et de stabiliser le rachis. Une chimiotherapie postoperatoire par vinblastine et corticoide a ete prescrite selon le protocole de prise en charge des histiocytoses langheransiennes (HL2010). Aucune recidive n’a ete observee a 5 ans de recul.

Primary cardiac lymphoma is a rare tumour especially in immunocompetent person. It is invariably fatal unless diagnosed and treated early. Our patient was a 76 year old Chinese gentlemen, known case diabetes mellitus and hypertension, who presented with 3 months history of failure symptoms. He also had loss of appetite. His vital signs were stable. There was bibasal crepitation, raised JVP with normal heart sounds and bilateral pedal edema. Chest X-ray showed bilateral pleural effusion.He was admitted for stabilization of heart failure and started on diuretics. Echocardiography showed the LV ejection fraction was 50% with grade 1 diastolic dysfunction. There was a global pericardial effusion with effusion size 2.52cm maximum at posterior to LV. There was partial RA collapse .Patient was otherwise hemodynamically stable. Patient was observed closely and diuretics continued. Echocardiography on the third day of admission showed a suspicious looking mass in the right atrial (RA) and right ventricular (RV) wall near the AV groove. It become apparent after pericardial effusion became less. Patient was counselled and agreed for pericardial tapping but procedure had to be abandoned as effusion has reduced compared to before ( MRI cardiac showed an infiltrating mass around the right atrio-ventricular groove extending to the right ventricular free wall and around the pericardial lining around the ascending aorta and pulmonary trunks. There is inhomogenous signal in STIR with iso-intensity on T1 weighted images. First pass metabolism revealed some vascularity. There was a patchy myocardial enhancement on late gadolinium enhancement. pericardium was thickened with global pericardial effusion- 16mm. Large right pleural effusion seen and minimal left pleural effusion. Mediastinal lymphadenopathy was seen. The finding were suggestive of cardiac lymphoma with differential sarcoma. Subsequent day, patient develop acute ischemic stroke which was complicated by aspiration pneumonia and septic shock. Fortunately he recovered after 1 week of antibiotics and non-invasive ventilatory support. FDG PET- CT scan showed FDG-avid primary cardiac lymphoma with pericardial involvement and conglomerate of multiple group of mediastinal and supra clavicular lymph nodes . Bilateral hypermetabolic adrenal nodule were seen but unable to determine its relevance to the primary pathology(lymphoma). No marrow or other organ involvement. Stage is likely IIE. We were unable to harvest the lymph node because they were too deep. Patient"s family was counselled for cardiac biopsy but family did not want to take the risk as patient was bedridden and fragile. They were also not keen for any chemotherapy or invasive procedure. Once patient was out of infection, they requested to bring back patient to home. He was sent to nursing home for full time care but succumbed to another bout of aspiration pneumonia one week after discharge. Abstract P884 Figure. Echo, MRI, Pet CT scan

Background There is increasing evidence that inflammatory biomarkers growth differentiation factor 15 (GDF-15) and neutrophil-lymphocyte ratio (NLR) appear to be associated with stroke and adverse cardiovascular events in patients with atrial fibrillation (AF). However, long-term impact of catheter ablation (CA) on GDF-15 and NLR is still unknown. Objective To evaluate the long-term change in GDF-15 and NLR after CA in paroxysmal AF patients. Methods A total of 58 paroxysmal AF patients were consecutively enrolled to perform CA. The inflammatory biomarkers GDF-15 and NLR were measured at baseline and 6-months postablation. Results All patients except one could complete 6-Months follow up. Fifty (87.7%) patients maintained sinus rhythm (SR group) and seven (12.3%) patients sustained AF recurrence (AFR group). No significant difference was noted in clinical and procedural characteristics between two groups (p>0.05), except mean fluoroscopy time (minutes 22±11.7 vs. 13±5.3, p=0.001) significantly longer in AFR than SR group. The GDF-15 (pg/ml 195±57 vs. 216±88, p=0.398), and NLR (% 1.8 (1.3–3) vs. 2.6 (1.4–3.4), p=0.395) were comparable at baseline in both SR and AFR groups respectively. At 6-months postablation, GDF-15 (pg/ml 133±41 vs. 195±57, p0.05) Conclusion Inflammatory biomarkers; GDF-15 and NLR significantly decreased at long-term on successful maintenance of sinus rhythm by CA in paroxysmal AF patients. Acknowledgement/Funding None

Background Several studies have reported an association between improvements in hand hygiene and the reductions in rates of intestinal parasitic diseases. However, only a some have addressed its link to the frequency of influenza-like illness. The current study aimed to find the correlation between personal hygiene habits and the frequency of influenza-like illness. Methods A cross-sectional study targeting 3000 participants conducted in Riyadh city, Saudi Arabia. A systematic random sampling methodology was applied for participant from different part of Riyadh city using a computer generating system. The researcher first started by calling each participant. A full explanation was given to each participant in details (from the purpose of the research, consent to answer the questionnaire, to the explanation of the outcome definition). Each point of the questionnaire was explained to them to make sure they had excellent comprehension, and therefore, respond accurately. Descriptive statistics and Odds Ratio and its 95% confidence intervals were used to determine the association between frequency of influenza-like illness and the studied variables. Results Two thousand eighty-two (69.4%) completed the questionnaire. The participants who spent 5–10 s in handwashing with soap and rubbing were at increased risk of more frequent influenza-like illness (odds ratio = 1.37, 1.08–1.75). Handwashing with soap and rubbing after handshaking is an independent protective habit against frequent influenza-like illness (adjusted OR = 0.59, 0.37–0.94). Conclusion The decrease of the frequency of influenza-like illness could be done through the following: getting the influenza vaccine annually, washing hands with soap and hand rubbing not less than 15 s after getting out of the bathroom, before and after handshaking and before eating. Soap companies should invent soaps that take less rubbing time to kill bacteria, and subsequently may maximize compliance in the community.

Objectives The current study aims to find the differences between glioblastoma multiforme (GBM) and giant cell glioblastoma (GCG) regarding mortality and prognosis among adults and elderly patients in the U.S. Methods and Materials This study is a historical cohort type of study and is conducted on adults and elderly individuals with GBM or GCG from the years 1985–2014 in the U.S. Data were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database. The study exposure was GBM or GCG and the outcome was mortality. The potential confounders were age, sex, race, ethnicity, year of diagnosis, primary site, brain overlap, and surgery. A chi‐square test was used for categorical data. A univariate analysis was used for variables having a p‐value, When comparing glioblastoma multiforme (GBM) and giant cell glioblastoma (GCG) using SEER database, the researches have found the following: GCG was not statistically significant in association with reduced mortality. Non‐Spanish–Hispanics with GBM or GCG had a higher mortality rate than did Spanish–Hispanics. Factors such as being female, being age 59–65, and having a year of diagnosis before 2010 were independently associated with increased mortality.

Brain cancer is the tenth leading cause of death in the U.S. Glioblastoma multiforme (GBM) is the most lethal primary malignant central nervous system tumor in adults. The present study employed samples from 1985-2014 to discover the difference in prognosis among glioblastoma subtypes after the evolution of treatment modalities over the past few years. The current study aims to find the differences between Glioblastoma multiforme (GBM) and giant cell glioblastoma (GCG) in terms of prognosis among adults and elderly patients in the U.S. This study is a historical cohort type of study and is conducted on adults and elderly individuals with GBM or GCG from the years 1985-2014 in the U.S. Data were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database. The study exposure was GBM or GCG and the outcome was mortality. The potential confounders were age, sex, race, ethnicity, year of diagnosis, primary site, and surgery. A chi-square test was used for categorical data. A univariate analysis was used for variables having a p-value < 0.05. Potential confounders were selected and evaluated using multivariate logistic regression models to calculate the odds ratio with stepwise selection. The study sample was 25,117. The incidences of GBM and GCG were not similar in relation to age group. Also, Spanish-Hispanic ethnicity was independently protective of GBM and GCG as compared to Non-Spanish-Hispanic ethnicity patients with GBM have a higher mortality rate than do GCG patients. The mortality rate was higher among patients diagnosed before 2010. In conclusion, GCG was not statistically significant in association to reduced mortality. Non-Spanish-Hispanics with GBM or GCG had a higher mortality rate than did Spanish-Hispanics. Factors such as being female, being age >59, and having a year of diagnosis before 2010 were independently associated with increased mortality.

The treatment objectives in congenital pseudarthrosis of the tibia are bone consolidation and a restored lower-limb axis. They are difficult to achieve, and various surgical techniques have been described, with varying results in terms of bone consolidation and complications. The present study reports clinical and radiographic results in 3 patients managed by the same original technique of transplantar intramedullary nailing using a custom-made proximal locking nail, without surgical approach or resection of the pseudarthrosis site. Good assembly stability allowed immediate weight-bearing. The technique is relatively noninvasive, offering a first-line alternative in under-3 year-olds.

IntroductionTo date there is no consensus on therapeutic indications in adolescent idiopathic scoliosis (AIS) with curvature between 30° and 60° at the end of growth.ObjectiveThe objective of this study was to assess outcome in patients with moderate AIS.Material and methodsA multicenter retrospective study was conducted. Inclusion criteria were: Cobb angle, 30–60° at end of growth; and follow-up > 20 years. The data collected were angular values in adolescence and at last follow-up, and quality of life scores at follow-up.ResultsA total of 258 patients were enrolled: 100 operated on in adolescence, 116 never operated on, and 42 operated on in adulthood. Mean follow-up was 27.8 years. Cobb angle progression significantly differed between the 3 groups: 3.2° versus 8.8° versus 23.6°, respectively; P 35° (OR=4.278, P=0.002). There were no significant differences in quality of life scores.DiscussionPatients operated on in adolescence showed little radiological progression, demonstrating the efficacy of surgical treatment for curvature greater than 50°. Curvature greater than 40° was progressive and may require surgery in adulthood. Lumbar scoliosis showed greater potential progression than thoracic scoliosis in adulthood, requiring fusion as of 35° angulation.Level of evidenceIV, retrospective study.

Aim. The current study aimed to evaluate the knowledge of eye disease and awareness of eye care among the Saudi adults and to explore existing eye-related misconceptions in the community. Methods. A cross-sectional study was conducted in Riyadh city during May and June 2016. A self-administered anonymous online questionnaire was used to explore the most common misconceptions related to eye diseases and eye care. Results. Out of 1000 individuals, only 711 (71.1%) participant responses were received. The participants’ acceptable knowledge (score ≥50%) was high about the eye problem in diabetes (88.6%), ocular trauma (81.2%), and other general eye diseases (91.3%), whereas low about refractive errors (63%), pediatric eye problems (51.5%), and glaucoma (14.8%). The variation in knowledge about specific ocular morbidities was significant (p<0.001). The majority of participants reported sources of information about the common eye diseases and eye care encountered from the community, internet-based resources, and social media. Conclusions. The majority of the participants had awareness about the common eye diseases, whereas low percentage of participant’s awareness about specific condition of eye diseases. Public eye health awareness should be more focused on social media and the internet to be able to cover the younger individuals of the community.

PURPOSE: The current study aimed to assess Saudi parents' awareness regarding pediatric eye diseases that can be screened and treated. METHODS: A cross-sectional study was conducted in Riyadh, Saudi Arabia. Targeted participants were selected randomly. An online questionnaire was used for data collection. A Chi-ANOVA test was used with considering a confidence interval of 95%. RESULTS: Of 1500 participants, 1070 (71%) Saudi adults responded. Most of the participants' knowledge test score about eye health and care was poor (91.9%). The majority of those who had acceptable knowledge were married with 94.3%. Knowledge about the eye problem in diabetes was the highest with 82.8%, then 54.3% had acceptable knowledge about eye emergencies, general eye health with 36.5%, and 26.2% for refractive error problem, whereas knowledge about strabismus, visual deprivation, glaucoma, and eye tumors was lowest (18.9, 16.1, 10.6, and 9.6%, respectively). The most commonly reported sources of knowledge were community members. Those who were at the university level of education had a higher level of acceptable knowledge (64.4%) with a mean of 5.63. Retired participants had the highest mean level of knowledge (7.25). After that, it showed that those in the medical field had the second highest mean level of knowledge (6.55). However, students recorded the lowest mean knowledge score with 2.47. CONCLUSION: The current study found evidence of a lack of awareness among parents about common pediatric eye diseases and proper eye care behaviors. Therefore, awareness programs should be targeting both parents with a focus on mothers. The higher the educational level, the higher the chances of health awareness.

The intercity passenger market has been expanding rapidly. Nowadays, it is easily observed that many people stand on the bus stations in order to get their desired bus, but sometimes it takes too much time for them to, due to many remarkable reasons. In this research, a new intelligent model for multi ID buses movement monitoring and station reporting system based on GPS and succession of RF Transceivers is presented. With this trend, wireless sensor networks for position tracking of a particular vehicle have been considered new parts for the proposed intelligent transportation systems deployed into buses station networks in order to enhance further the monitoring plan. In addition to some fundamental functions such as real-time monitoring, some featured functions are tightly combined to make the system compatible with the daily operations of any public transport scheme. The proposed method will surely improve the linear transmission to the bus stations which led people to take decision either to wait for the bus or not. Key words: Global positioning system (GPS), buses monitoring system, Xstreme transceiver, embedded system design.

Background: Depression among health professional students is a topic of concern. Often, it is associated with other unhealthy habits such as smoking. This study aimed to find the prevalence rate of depressive symptoms and smoking among applied medical science (AMS) students and their associations with each other. Methodology: In this descriptive-analytic, cross-sectional study, a stratified proportionate sampling strategy was used to select the study sample from the AMS school students, Saudi Arabia, during the academic year 2012–2013. The students were screened for depressive symptoms and smoking status using Beck Depression Inventory (BDI II) and a sociodemographic form, which included the smoking status. Results: The instruments were administered to 461 AMS students, representing 27.6% of the total school students (1672). Overall, 46% of the total sample (43% of males and 48% of females) had depressive symptoms. The rate of smoking currently was 11.5%, and it was much lower among female students (2.2%) as compared to their male counterparts (20.3%). There was a higher mean BDI score among current smokers compared to nonsmokers (P = 0.049). This association was statistically significant among the female students (P = 0.029) but not among the male students (P = 0.072). Conclusion: The rate of depressive symptoms in this study is alarmingly high. The association between the presence of depressive symptoms and smoking is in line with the literature on this topic. A qualitative study in this population is recommended to explore students' perception of the factors associated with smoking, depression, and stress and their coping strategies.

Malaysia was recorded outnumber of accidents in the world. The traffic Police is the responsible body for ensuring to maintain the law on the road which assists the public for smooth travelling The media reports stated that the traffic police uses their power in wrong ways and is showing not profession with their duties. This happens due to lack of organizational culture among civil servants which are not practiced in the right ways according to the justice and their professions. Therefore, this article focuses on the organizational culture that should be practiced and the decisions that need to be practiced. Further, the ethical factors based decisions should be performed by traffic police. The topic selected will expect to improve the organizational culture and an ethical decision making among law’s practitioner and traffic police. In addition, the positive view can also give to the public on the ethical decision making that could be practiced by traffic police. In conclusion, the improvement of organizational culture should be refined to produce law practitioners and implementers in ethical especially for civil servants in decision-making.

This letter presents an improved, compact, and tunable high-Q differential active inductor implemented in Silterra's industry standard 0.18 mum CMOS process. The improved differential active inductor demonstrates a Q ap 1000 at high frequency region. Low-current dissipation is achieved by reusing the current from the differential gyrator for stabilizer and negative impedance circuit. A replica bias circuit has been introduced to allow current-controlled inductance of the improved differential active inductor. Sensitivity of the improved differential active inductor to process variation is also included in this letter.

In many professions, nontechnical aspects such as motivation or coping with stress are known to influence performance, success, and outcome. These qualities are assessed and trained in novices for quality and safety reasons. This study explored the impact of self-belief of surgeons on laparoscopic performance using a virtual reality simulator (LapSim®). Eighteen inexperienced surgical residents (with less than ten laparoscopic procedures performed) and 22 advanced residents (with more than 50 laparoscopic procedures performed) filled out a ten-item questionnaire used for the assessment of the individual sense of general self-efficacy (GSE). Afterward the participants were asked to perform three defined tasks on the LapSim, each at two different levels of difficulty. The tasks consisted of coordination, dissection, and application of clips. To assess laparoscopic performance, the total time to complete the tasks, economy of motion, and damage parameters were analyzed and correlated with the GSE score by means of Bravis-Pearson correlation analysis. In novices, high GSE scores correlated with more errors and poor economy of motion, while in advanced residents, laparoscopic performance was independent of the level of assessed self-efficacy. In a small sample, high self-belief does not predict success. In novices it negatively correlates with laparoscopic skills, while in advanced residents it is independent of laparoscopic performance. Thus, training aspects seem to be of greater importance for laparoscopic skills. Nevertheless, nontechnical aspects like self-belief, motivation, stress-coping strategies, judgment, decision-making, and leadership should be included in the surgical curriculum.

Most current intrusion detection methods cannot process large amounts of audit data for real-time operation. In this paper, anomaly network intrusion detection method based on principal component analysis (PCA) for data reduction and fuzzy adaptive resonance theory (fuzzy ART) for classifier is presented. Moreover, PCA is applied to reduce the high dimensional data vectors and distance between a vector and its projection onto the subspace reduced is used for anomaly detection. Using a set of benchmark data from KDD (knowledge discovery and data mining) competition designed by DARPA for demonstrate to detection intrusions. Experimental results show the proposed model can classify the network connections with satisfying performance.

A new design of an integrated two-stage class-F power amplifier (PA) for wireless application operating in the 1.65 GHz frequency range is described. The circuit utilizes a simple method to drive the output stage with a half sinusoidal waveform that is optimal for class-F operation. The circuit was fabricated in a Silterra's standard 0.18 mum RF CMOS technology. Measurement result shows a maximum power-added efficiency (PAE) of 42% and a maximum gain of 19.7 dB. When operating from a 3 V voltage supply, the PA delivers an output power of 18.9 dBm. This work demonstrates the feasibility of using class-F PAs for short-range and low-power applications.

This paper is presented to explain the steps in removing the secondary part of Jawi characters (such as dots, hamzah, and madda). The method used is based on the connected component labelling algorithm or CCLA and is added with the secondary type detection algorithm (STDA) by Bushofa and Spann (see Image and Vision Computing, vol.15, p.167-79, 1997). Several steps in the algorithm however, have been modified in order for it to be matched with the handwritten Jawi characters. Several samples of the result from the suggested algorithm are also presented. The result promises a good outcome.