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Maha Ali Al Mohaya,1 Mansour M Almaziad,2 Khalid A Al-Hamad,3 Mohammad Mustafa4 1Oral Medicine & Special Care Dentistry, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 2Oral Medicine and Pathology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 3Oral and Maxillofacial Department, Majmaah University, Majmaah, Saudi Arabia; 4Scientific Research Center, Prince Sultan Military Medical City, Riyadh, Saudi ArabiaCorrespondence: Maha Ali Al MohayaOral Medicine and Special Care Dentistry, Prince Sultan Military Medical City, Riyadh, Saudi ArabiaEmail malmohaya2013@gmail.comBackground: The coronavirus disease 2019 (COVID-19) pandemic necessitated widespread changes in delivery of dental care. Telemedicine utilization increased overnight during this pandemic because of its ability to enhance access to oral healthcare, easily link to remote area, time management, low cost, etc. We aimed to identify the utilization of telemedicine among oral medicine practitioners in Saudi Arabia during COVID-19 pandemic and identify future impacts, potential challenges and barriers hindering the implementation of telemedicine.Methods: The present cross-sectional electronically self-administered supplement-based survey Supplement Based Survey study was conducted among different professional levels of oral medicine involving consultants, specialists, and residents. The supplement includes demographic data, the current use of telemedicine, participant’s perspective on future implications, and potential barriers and limitations of telemedicine. Internal consistency was measured using Cronbach’s alpha (α) to assess how closely related a set of items in our study.Results: Of the total (N = 75) oral healthcare professionals, 52% were male, 70.7% were Saudi, 45.3% were consultant, 42.7% had 1– 5 years of experience, 82.7% were practicing in urban areas, 93.3% stated COVID-19 affected their clinics, consultation was the major reason for the use of telemedicine before (50.7%) and during (72%) COVID-19 outbreak, 57.3% were communicating with their patients, 97.33% had not experienced any cyber risk, and 45% patients were satisfied with the telemedicine service; our data showed a high level of homogeneity (α = 0.82). The poor knowledge and training on telemedicine technologies may substantially (p < 0.05) impact the future implications of telemedicine in oral medicine practice.Conclusion: Telemedicine could be a useful adjunct for oral medicine practice, especially for remote diagnosis, consultation, referral, training and education. Our study emphasizes an urgent need to increase the awareness and education on how to utilize and practice telemedicine technologies among medical staff to maximize the efficiency.Keywords: awareness, barriers, COVID-19, oral medicine, telemedicine

The objective of the study is to know whether creditors terms and Micro, Small and Medium Enterprises (MSMEs) accounting process affect MSMEs debtor’s management and to know the need for novel Information Technology (IT) tools. This study proposes a definite set of survey questionnaires to measure variables such as the influence of suppliers’ credit policies and the accounting process of selected MSMEs. The sample size of this study focuses on various MSMEs owners or accountants in Oman. The questionnaire survey findings are based on 44 MSMEs that responded. The study used Partial Least Squares Structural Equation Modeling (PLS-SEM) to analyze creditors terms, accounting process of MSMEs with its impact on MSMEs debtors’ management. MSMEs' accounting process and suppliers' credit policies do influence MSMEs debtors’ management. Increased working capital risks due to inefficient debtors’ management may lead MSMEs to be resource-efficient in managing their accounting process by using IT tools. The practice of using IT tools by MSMEs can scientifically manage their outstanding debtors which leads to a higher level of hostile working capital management and MSMEs sustainable development. MSMEs play a key role in the development of the national economy, there is a dearth of similar published MSMEs broad studies in Oman that validates the importance of the current research.

Aim This study is a longitudinal multicenter study which aims to find the prevalence, the demographic data, survival and mortality rates of patients with systemic lupus erythematosus (SLE) in Oman. Method All Omani patients, pediatrics and adults diagnosed with SLE, who fulfill either the 1997 American College of Rheumatology or Systemic Lupus International Collaborating Clinics classifications criteria for SLE were included from January 2006 till February 2020. Results In total 1160 patients were included in this cohort. Data analysis showed that patient's ages ranged from 2-82 years with female predominance and female-to-male ratio of 7:1 (87.7% female,12.3% male). The mean prevalence of SLE among different age groups was 38.8 (range 5-63 per 100 000 inhabitants). The mortality rate was found to be 5%. Male patients had significantly higher mortality rate than females (7.6% vs 5.4%, P value = .04). Sepsis was the commonest cause of mortality (34%). The coexistence of systemic sclerosis correlates significantly with death (P = .002). Survival analysis in our data showed 5, 10, 20, 40-year survival rates of 100%, 100%, 99% and 90% respectively for antinuclear antibody (ANA) positive patients and lower survival rate for ANA negative patients with 5,10, 20, 40-year survival rates of 100, 99%, 99% and 75%, respectively. Conclusion This study showed that the mean prevalence of SLE in Oman to be 38.8 (range 5-63) per 100 000 inhabitants. The 40-year survival rate among patients with positive ANA was found to be 90%, while patients with negative ANA had worse survival outcomes.

Colorectal cancer is one of the most prevalent and deadly cancers worldwide. MicroRNAs are short single stranded non-coding RNAs that play important roles in carcinogenesis, tumor growth and tumor survival. Circulating microRNAs are increasingly becoming efficient and important biomarkers for several types of cancers. Herein, we aim to evaluate the diagnostic potentials of plasma microRNA-211 and microRNA-25 in colorectal cancer patients. Forty-four patients diagnosed with colorectal cancer and 40 healthy controls were recruited for the present study. Expressions of circulating microRNAs -211 and 25 were assessed by quantitative real-time polymerase chain reaction (RT-qPCR). Expression of transforming growth factor-beta, a key factor in tumorigenesis and a key inducer of epithelial to mesenchymal transition was assessed by enzyme-linked immunosorbent assay (ELISA) in patients' tissue and plasma. Our results demonstrated upregulated expressions of plasma microRNAs-211 and 25 correlated with the high transforming growth factor-beta (TGF-β1) expression in patients. In addition, plasma levels were positively correlated with lymph node metastasis. Moreover, receiver operating characteristic analysis demonstrated the reliability of microRNAs-211 and 25 for discriminating colorectal cancer patients from healthy individuals. MicroRNA-211 and microRNA-25 might have a tumorigenic role in colorectal cancer and their plasma levels could be potential biomarkers in its diagnosis.

Background Chronic Hypersensitivity Pneumonitis (CHP) is caused by an immune mediated response in the lung tissue after exposure to an inhaled environmental antigenic stimulant. We previously documented the ways in which CHP impacts patients’ lives and have now developed a disease-specific instrument, the CHP-HRQOL instrument, to measure health-related quality of life (HRQOL). The objective of this study was to assess content validity for the CHP-HRQOL. Methods Cognitive interviews were conducted among adults with CHP. The instrument was revised and refined between each round of interviews. Feedback was obtained on the instructions, items, response options, and recall period. Items where participants had difficulty with comprehension, wording, or misinterpretation were marked by the interviewer and participant feedback was reviewed to make revisions, add or delete items when appropriate. Readability statistics were calculated using Flesch-Kincaid grade level and reading ease scores. Results Ten participants were interviewed over three rounds, with revisions made to the questionnaire in an iterative process. In the initial 39 item instrument, we identified 7 items where two or more participants reported difficulty. Participants preferred a four-week recall period (compared to a two-week recall period) and response options with a 5-point response scale. The final version of the CHP-HRQOL includes 40 items with a median reading level between 6th and 7th grade. Conclusion The CHP-HRQOL instrument demonstrated high content validity and is ready for psychometric testing in further validation studies.

Lung cancer remains incurable; therefore, novel therapeutical approaches are of great demand. This study was designed to investigate the effectiveness of cisplatin nanoparticles combined with vitamin-D3 on urethane-induced early lung cancer in rats and to clarify the underlying signaling mechanisms. Early lung cancer was induced in male Wistar rats by urethane. Rats were divided into six groups: I-control, II-cancer untreated, III-cancer + free cisplatin, IV-cancer + cisplatin nanoparticles, V-cancer + free cisplatin + vitamin-D3 , VI-cancer + cisplatin nanoparticles + vitamin-D3 . Inflammation, proliferation, and apoptosis were evaluated together with the levels of tumor marker CK-19 along with histological assessment. Treatment of lung cancer with either free or nanoparticles of cisplatin alone demonstrated significant suppression in the expression of inflammatory, anti-apoptotic and tumor markers compared to rats with lung cancer. Moreover, vitamin-D3 supplementation with either cisplatin forms lead to a further decrease of all markers, markedly with cisplatin nanoparticles. The present study shows the synergistic effect of cisplatin-nanoparticles combined with vitamin-D3 as a new therapy regimen against lung cancer. Further studies with larger sample sizes and longer duration are needed to confirm these results.

Purpose Streptococcus pneumoniae (S. pneumoniae) is the etiology of severe and life-threatening infections in children less than 5 years old. Though pneumococcal conjugate vaccines (PCVs) are effective in the prevention of pneumococcal infections, yet they are not included in the National Immunization Program in Egypt pending the identification of pathogenic serotypes. As S. pneumoniae colonization of the pharynx predisposes to pneumonia and invasive pneumococcal disease (IPD) caused by the colonizing serotypes, identification of the nasopharyngeal (NP) serotypes can be a surrogate to the invasive serotypes. In this study, we aimed to 1. Identify the serotypes and antimicrobial susceptibility testing (AST) of Streptococcus pneumoniae colonizing the nasopharynx of Egyptian children younger than 5 years in two successive winter seasons. 2. Correlate the identified serotypes with vaccine coverage of the 13-valent conjugate pneumococcal vaccines (PCV13). 3. Compare the serotypes and AST of S. pneumoniae from NP to those of IPD that were routinely identified in our clinical laboratory during the study period. Materials and methods The study was conducted in two successive winter seasons (December 2015-March 2016; December 2016-March 2017). We enrolled 334 children, aged 6 months to 5 years, attending the outpatient general clinics of Cairo University Children Hospital, excluding those with fever, signs of infection, history of antibiotic intake or hospitalization in the preceding month. We tested NP swabs for S. pneumoniae by culture and real-time PCR. Serotyping was performed by sequential multiplex PCR for all positive samples. AST was done to S. pneumoniae isolates by Vitek-2™ (BioMerieux, Marcy-L'Etoile, France). We included routinely detected S. pneumoniae from sterile body sites during the study period, and identified their serotypes and AST. Results PCR was positive for pneumococci in 217 out of 334 pharyngeal swabs (65%), including 186 typable samples. The most common serotypes were serotypes 1, 6ABC, 19 F, 5 and 18ABC. By culture, we isolated only 110 out of 334 pharyngeal swabs (32.9%). The theoretical coverage of the PCV13 vaccine for the detected serotypes was 77.4%. The AST of NP isolates revealed low susceptibility rates to all antimicrobials except for vancomycin, linezolid, levofloxacin and clindamycin. During the study period, we identified 40 IPD; 21 identified by PCR and 19 by culture. The commonest pneumococcal serotypes were 1, 18ABC, 6ABC and 5. The PCV13 coverage was 75%. By Vitek-2, the isolates showed 100%, 100%, 94.7%, 89.5%, 84.2%, 84.2% and 78.9% susceptibility to vancomycin, linezolid, clindamycin, levofloxacin, penicillin, cefotaxim and erythromycin, respectively. Conclusion Based on the serotype vaccine coverage and the emerging antimicrobial resistance of S. pneumoniae, PCVs will be valuable to Egyptian children.

Background: Neonatal sepsis (NS) is a clinical syndrome characterized by signs and symptoms of infection in neonatal period of life. It covers various systemic infections of newborn such as septicemia, meningitis, pneumonia, arthritis, osteomyelitis and urinary tract infections (UTIs). Objective: This study aims to evaluate the risk factors of neonatal sepsis and early detection of neonatal sepsis with easily accessible, inexpensive, and widely used laboratory tests. Patients and methods: This cross section study was conducted during a period of 6 months, on cases admitted to Atfal Misr Neonatal Intensive Care Unit (NICU) on 80 newborns who were divided into 3 groups: group A (n = 22): proven NS, group B (n = 18): clinical NS and Group C (n = 40): apparently healthy control. Results: In current study, there was significant positive correlation between MPV with age (r= 0.22 and p= 0.04), WBC (r= 0.66 and p= 0.0001) and CRP (r= 0.77 and p= 0.0001). On the other hand, there was significant negative correlation between MPV with HB (r= -0.74 and p=0.0001), platelet (r= -0.62 and p=0.0001) and uric acid (r= -0.37 and p= 0.001). In current study, there was significant positive correlation between uric acid with HB (r= 0.31 and p= 0.005), and platelet (r= 0.46 and p= 0.0001). On the other hand, there was significant negative correlation between uric acid with age (r=-0.11 and p=0.3), WBC (r= -0.42 and p=0.0001) and CRP (r= -0.42 and p= 0.0001). Conclusion: The presence of the particular set of risk factors can help in deciding the empirical antibiotic and thereby prevent delay in starting appropriate treatment. The combined use of CRP and MPV should be considered in the early diagnosis of NS; however uric acid levels may only be utilized as an additional tool to support diagnosis.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy in the upper limb. The most consistent risk factors are female gender, age, and obesity. The results of previous studies are conflicting, and moreover, data from studies regarding obesity and nerve conduction velocity are not available for our Egyptian population. AIM: This study was designed to investigate the contribution of age and body anthropometry as predictor factors to the CTS and to identify patients at high risk for CTS among Egyptian obese women. METHODS: The study included 120 obese women grouped according to the clinical and electrodiagnostic (EDX) findings into two groups: 60 with CTS and 60 without CTS (non-CTS). EDX study was used in the diagnosis of median nerve entrapment at the level of the wrist, according to the American Association of Neuromuscular and EDX Medicine. Body weight and height were measured and then body mass index (BMI) was calculated. Waist-to-hip ratio (WHR) was determined from the measured waist circumference (WC) and hip circumference (HC). Mid upper arm circumference (MUAC) was measured as well. The receiver operating characteristic (ROC) curve was used to assess the power of age and body anthropometry as predictor factors for CTS. RESULTS: CTS obese cases showed significantly lower values of both median motor nerve conduction velocity (MMNCV) and median sensory nerve conduction velocity compared to those without CTS. Significantly higher median sensory latency and median motor latency have been found in CTS cases compared to non-CTS group. Significant differences in the mean age have been found between the two groups and a tendency for higher body anthropometry measures in the CTS cases relative to those without CTS. Moreover, there were negative correlations between MMNCV and obesity indices. Age showed the highest area under the ROC curve, followed by BMI, WHR WC, HC, and MUAC. CONCLUSION: Age and obesity indices are important risk factors that can be used as predictors to CTS in obese women. Age is a more powerful diagnostic tool relative to the anthropometric measurements. Women of age above 40 years and suffering from a high degree of obesity are at risk of developing CTS.

Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI, 3.025-15.585) and the hospital-acquired origin of bacteremia (OR, 2.643; 95%CI, 1.462-3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI, 1.189-5.626) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076-2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted.

Information regarding the spread and effect of coffee and caffeine intake by individuals with type II diabetes remains unclear. This study aims to identify the amount and sources of habitual caffeine intake by individuals with type II diabetes and to investigate its association with other health outcomes, especially HbA1c. This is a cross-sectional survey involving 100 people medically defined as having type II diabetes comprising both genders, recruited from a care centre. All participants completed a caffeine semi-quantitative food frequency questionnaire (C-FFQ) to estimate their caffeine consumption, a two day 24-h recall, and a detailed questionnaire. The average caffeine intake was calculated from all sources and the differences in mean by gender were tested using a regression model (adjusted to important confounders). Regression models were used to verify the association between average caffeine intake on HbA1c and other health outcomes with adjustment for important confounders. A p value &lt, 0.05 represented statistical significance. Arabic coffee (gahwa) and tea were the most common sources of caffeine among Saudi adults living with diabetes. Average caffeine intake for the whole sample was 194 ± 165 mg/day, which is 2.3 ± 2 mg/kg. There was an inverse association between caffeine intake and age: difference in mean −3.26 mg/year (95%CI: −5.34, −1.18, p = 0.003). Males had significantly higher consumption of caffeine compared to females: difference in mean 90.7 mg/day (95%CI: 13.8, 167.6, p = 0.021). No association was found between average caffeine intake and HbA1C or any other cardiovascular risk factors. This information can help public health practitioners and policy makers when assessing the risk of caffeine consumption among this vulnerable group.

Enhanced permeation retention (EPR) was a significant milestone discovery by Maeda et al. paving the road for the emerging nanomedicine as a powerful tool in the fight against cancer. Sildenafil is a potent inhibitor of phosphodiesterase 5 (PDE-5) used for treatment of erectile dysfunction (ED) through the relaxation of smooth muscles and the modulation of vascular endothelial permeability. Overexpression of PDE-5 was reported in lung, colon, metastatic breast cancers and bladder squamous carcinoma. Accordingly, there has been a growing interest in using sildenafil as monotherapy or chemoadjuvant in EPR augmentation and management of different types of cancer. Sildenafil had been reported to increase the sensitivity of tumor cells of different origins to the cytotoxic effect of chemotherapeutic agents with augmented apoptosis mediated through inducing the expression of Bad and Bax proapoptotic proteins. It was also reported that the use of sildenafil prior to the administration of Doxorubicin (DOX) increased its EPR-related concentration in breast cancer tissues by 2 folds. Further, a substantial reason of anticancer chemotherapeutic failure is due to multidrug resistance (MDR), exacerbated by the overexpression of ATP-binding cassette (ABC) transporters such as ABCB1 and ABCCs. Sildenafil has demonstrated inhibitory effects on the efflux activity of ABCC4, ABCC5, ABCB1, and ABCG2, ultimately reversing MDR caused by these transporters. In this review, we critically examine the overall potential of sildenafil in enhancing EPR-based anticancer drug delivery pointing up the outcome of the most important related preclinical and clinical studies.

Enhanced permeation retention (EPR) was a significant milestone discovery by Maeda et al. paving the path for the emerging field of nanomedicine to become a powerful tool in the fight against cancer. Sildenafil is a potent inhibitor of phosphodiesterase 5 (PDE-5) used for the treatment of erectile dysfunction (ED) through the relaxation of smooth muscles and the modulation of vascular endothelial permeability. Overexpression of PDE-5 has been reported in lung, colon, metastatic breast cancers, and bladder squamous carcinoma. Moreover, sildenafil has been reported to increase the sensitivity of tumor cells of different origins to the cytotoxic effect of chemotherapeutic agents with augmented apoptosis mediated through inducing the downregulation of Bcl-xL and FAP-1 expression, enhancing reactive oxygen species (ROS) generation, phosphorylating BAD and Bcl-2, upregulating caspase-3,8,9 activities, and blocking cells at G0/G1 cell cycle phase. Sildenafil has also demonstrated inhibitory effects on the efflux activity of ATP-binding cassette (ABC) transporters such as ABCC4, ABCC5, ABCB1, and ABCG2, ultimately reversing multidrug resistance. Accordingly, there has been a growing interest in using sildenafil as monotherapy or chemoadjuvant in EPR augmentation and management of different types of cancer. In this review, we critically examine the basic molecular mechanism of sildenafil related to cancer biology and discuss the overall potential of sildenafil in enhancing EPR-based anticancer drug delivery, pointing to the outcomes of the most important related preclinical and clinical studies.

Objectives: The objectives of this study are to determine the association between the incidence of attention-deficit and hyperactivity disorder (ADHD) in children of mothers with and without amalgam fillings. Design: The study design was a cross-sectional descriptive study. Setting: The study was conducted at a dental college's clinic in Riyadh, Saudi Arabia. Participants: In total, 869 children (512 males and 357 females) aged 6–12 years and 796 mothers were included. Children suffering from hearing impairment, language impairment, or learning disabilities or those diagnosed with mental health problems were excluded from the study. Primary and Secondary Outcome Measures: The primary outcome measures included the results of the Vanderbilt scale used for ADHD diagnosis in children and the mercury concentration in 1 ml saliva samples obtained from both the mother and the children. The secondary outcome measures included the number of dental amalgam restorations in the oral cavity determined through a dental examination of children and their mothers. Methodology: A consent form was signed by the mothers who agreed to participate in our study, they were all examined for amalgam presence and a saliva samples were collected and digested. Results: Children with ADHD showed significantly higher levels of mercury in saliva than did children without ADHD. The mothers who had dental amalgam fillings during pregnancy had significantly higher mercury levels than did the mothers who did not have dental amalgam fillings. Conclusion: Prenatal mercury exposure is associated with a higher risk of ADHD behavior. Further research can be carried out to identify the toxic effects of mercury on different body organs owing to dental amalgam fillings. The study scale can be further increased to obtain a more accurate percentage of ADHD cases in Saudi Arabia.

Food neophobia is a widely prevalent eating behavior among children, which has been linked to poor dietary variety and quality. Nevertheless, data pertaining nutrient intakes in relation to food neophobia among children in Middle East countries are lacking. The present study aimed to examine the associations between food neophobia and nutrient intakes in children aged 6–12 years. A cross-sectional study of 424 children was conducted. Food neophobia among children was evaluated using the Food Neophobia Scale. Dietary data of children were collected using 24-hour dietary recalls, and nutrient densities were calculated. Intakes of macro- and micronutrients were compared to dietary recommendations. Proportions of children who met the dietary recommendations for all nutrients were similar across food neophobia groups. No significant difference in macro- or micronutrient intake was observed across categories of food neophobia in univariate analyses; however, in multiple regression models, higher food neophobia score was associated with lower protein intake (β = -0.04% of total energy, 95% CI −0.07 to −0.01), cholesterol (β = -1.79 mg/1000 kcals, 95% CI −3.51 to −0.06), potassium (β = -11.02 mg/1000 kcals, 95% CI −20.5 to −1.54), phosphorus (β = -5.30 mg/1000 kcals, 95% CI −9.74 to −0.86), magnesium (β = -1.20 mg/1000 kcals, 95% CI −2.15 to −0.25), iron (β = -0.07 mg/1000 kcals, 95% CI −0.14 to −0.01), zinc (β = -0.04 mg/1000 kcals, 95% CI −0.07 to −0.001), and selenium intake (β = -0.48 ug/1000 kcals, 95% CI −0.93 to −0.04). Our findings suggest negative associations between food neophobia in children and intake of a number of important nutrients. Further investigations are needed to identify potential factors that could influence food and nutrient intake among food neophobic children.

Software-Defined Networking (SDN) is being widely implemented by critical infrastructure networks, however providing security features still a challenge. In this work, we present SafeFlow an Automatic Trust Negotiation Protocol for SDN, a first line of defense and fine-grained authentication protocol, in order to deny the access of OpenFlow switches without valid digital credentials. Traditional security approaches based on identity or capabilities do not solve the problem of establishing trust between strangers. One alternative approach to mutual trust establishment is Trust Negotiation, the bilateral exchange of digital credentials to establish trust gradually. The proposed protocol describes Trust Negotiation in OpenFlow protocol, probable extension to the OpenFlow handshake protocol. In this paper, we describe the implementation of SafeFlow. The proposed protocol ensures the security of the infrastructure itself, as there are also other proposals for developing security application on OpenFlow network infrastructure.

We sought to define the type and antibiotic sensitivity response of pathogens isolated from diabetic foot ulcers based on ulcer location and Wagner classification. This retrospective analysis was done among 126 patients between 40 and 70 years of age at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia, using the swab culture method for microbiological assessment. Data on demographic variables, ulcer sites (location), and depth of ulcer (Wagner classification) were also collected. A total of 134 pathogens were isolated from 126 patients. The most common gram-negative pathogen identified was Pseudomonas aeruginosa (15.6%), followed by Klebsiella spp (6.7%). The most common gram-positive pathogen was Staphylococcus aureus (35%), followed by Streptococcus (8.9%). The most widely accepted antibiotic to which the gram-negative bacteria were sensitive was gentamycin (20.1%), followed by ciprofloxacin (19%). The most routinely used antibiotic in the treatment of the gram-positive bacteria was erythromycin (16%), with trimethoprim-sulfamethoxazole (14.1%) being the next most effective. In conclusion, Pseudomonas aeruginosa, Klebsiella spp, Staphylococcus aureus, and Streptococcus were the most common causes of diabetic foot infections. However, the frequency of encountered pathogens and respective sensitivity to antibiotic therapy may be influenced by the location site and severity of the ulceration.

Background: Nurses play crucial role in avoiding hospital procured infections, by guaranteeing that all viewpoints of their nursing practice is prove based, and also through nursing inquire research and understanding instruction. Aim: The study aimed to evaluate the nurse's compliance with infection control measures and-barrier precautions in delivery room. Methods: Research design: An exploratory design had been chosen for carrying out our paper. Setting: The study was carried out in four hospitals in Damietta governorate. Subjects: 51 on duty nurses were taken at the time of the study. Tools of data collection: Data were collected using self-administers questioners. Results: Findings revealed the existence of poor standard precautions (100%). There is connection between age, education level, work involvement experience, and compliance with standard safety measures and precautions at p

Leguminous crops are significantly involved in the global symbiotic biological N2 Fixation (BNF), an eco-friendly process in the agriculture system. Biochar is considered as a vital amendment in improving growth and quality of crops and soils. Few investigations have been conducted to determine the combination effect of biochar with microelements on growth of legumes and soil properties. This study was designed to study the effect of soybean straw-derived biochar (SSDB) with or without microelements on soil microbial and chemical properties, growth, yield, and seed chemical composition of faba bean (Vicia faba L.). Results revealed that dehydrogenase (DHA) and phosphatase (P-ase) activities were markedly improved with the increase of SSDB rates under addition of microelements and their highest values were recorded after 90 d. Significant increases were noticed in nodulation activities, nodulation numbers (30.1–72.8), concentrations of N (1.62–1.93%), P (0.15-0.21%), and K (0.53-0.67%), and seed chemical constituents due to the addition of SSDB in the presence of microelements. Moreover, the combination of biochar with microelements caused significant changes in microbial counts. Overall, this investigation shows the potential and role of SSDB in enhancing the growth quality of faba bean seeds as well as an improvement of soil characteristics.

Introduction Media interventions can potentially play a major role in influencing health policies. This integrative systematic review aimed to assess the effects of planned media interventions—including social media—on the health policy-making process. Methods Eligible study designs included randomized and non-randomized designs, economic studies, process evaluation studies, stakeholder analyses, qualitative methods, and case studies. We electronically searched Medline, EMBASE, Communication and Mass Media Complete, Cochrane Central Register of Controlled Trials, and the WHO Global Health Library. We followed standard systematic review methodology for study selection, data abstraction, and risk of bias assessment. Results Twenty-one studies met our eligibility criteria: 10 evaluation studies using either quantitative (n = 7) or qualitative (n = 3) designs and 11 case studies. None of the evaluation studies were on social media. The findings of the evaluation studies suggest that media interventions may have a positive impact when used as accountability tools leading to prioritizing and initiating policy discussions, as tools to increase policymakers’ awareness, as tools to influence policy formulation, as awareness tools leading to policy adoption, and as awareness tools to improve compliance with laws and regulations. In one study, media-generated attention had a negative effect on policy advocacy as it mobilized opponents who defeated the passage of the bills that the media intervention advocated for. We judged the confidence in the available evidence as limited due to the risk of bias in the included studies and the indirectness of the evidence. Conclusion There is currently a lack of reliable evidence to guide decisions on the use of media interventions to influence health policy-making. Additional and better-designed, conducted, and reported primary research is needed to better understand the effects of media interventions, particularly social media, on health policy-making processes, and the circumstances under which media interventions are successful. Trial registration PROSPERO 2015:CRD42015020243 Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0581-0) contains supplementary material, which is available to authorized users.

Introduction More than its motor symptoms, cognitive impairment is being increasingly identified as a cause of worse functional outcome, morbidity and mortality, and caregiver dependence in Parkinson’s disease (PD). The aim of this study was to identify the frequency of cognitive decline and evaluate the factors associated with it. Methods In this cross-sectional study, 124 PD patients fulfilling the United Kingdom Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria were included. Motor and non-motor symptoms were recorded. Disease duration, age at the time of onset, and severity of disease on Hoehn and Yahr Scale (HY scale) were recorded. Data was entered and analyzed using SPSSs v. 22.0. Results The ratio of men to women was 7.2:1. The mean age of the participants was 64 ± 10 years (range: 38-82 years). Rigidity (n = 121; 97.5%), bradykinesia (n = 119; 95.9%), and tremor (n = 11; 90.3%) were the three most common symptoms. Cognitive impairment was present in 45 (36.3%) patients. Cognitive decline was more frequent in patients of age less than 50 years at the time of disease onset (p < 0.00001) and in those with disease duration more than 10 years (p = 0.00001). Patients with longer disease duration had more severe disease (stage III or above on HY scale; p = 0.008). Conclusion Motor symptoms such as rigidity, bradykinesia, and tremor remain the most frequent clinical presentation among Pakistani Parkinson’s patients. One-third of these patients have cognitive dysfunction. Early age at the time of disease onset and longer duration of disease were associated with cognitive impairment.

In this paper, we propose Soter a HIPAA compliance distributed personalized authentication mechanism for the Internet of Medical Things (IoMT), based on Multiparty Trust Negotiation. Multiparty Trust Negotiation (MTN)is a promising approach for establishing trust between multiparty (Things)demanding to share resources, by gradually exchanging digital credentials based on personalized Access Control Policies. Previous work has been proposed for authentication in IoMT environment, however the proposed approaches are not the best for IoMT as they are centralized and based on Identity Access Control Policies (IBAC)which have limitations make them unsuitable for open distributed environment such as the IoMT, we explain these limitation on the next section. Soter framework presents a number of innovation features, such as the use of Multiparty Trust Negotiation to establish trust between Medical Things, the support of Virtual Federations (VFs)and the Circle of Trust, and the use of personalized and dynamic access control policies (DACP).

Multiparty Trust Negotiation (MTN) is an emerging methodology for establishing trust between peers by gradually requesting and disclosing digitally signed credentials. However, a MTN strategy must be utilized to search for a successful negotiation based on the Access Control Policies (ACP). Previous work in this area focused on establishing trust between two parties (ATN), yet real life scenarios involved more than two parties in the negotiation process. Even if multiparty is involved, the Access Control Policies (ACP)proposed are either Identity based Access control policies (IBAC)as well as static policies, where the client has no say in decisions, like in the single sign-on systems, Shibboleth [11], and OpenID [14]; or the process is state full and has a high communication cost like in Zhang and Winslett work [9]. This paper provides a formal definition for the multiparty trust negotiation problem and proposes a novel MTN strategy, SafeFlow- $x$ . SafeFlow-x is a stateless, safe, efficient and complete strategy. In the worst case, its communication complexity is $O(n)$ , where $n$ is the total number of credentials requested, and its computational complexity is $O(k)$ , where $k$ is the total size of peer's ACP when no cyclic dependencies occur.

Introduction: World most prevalence disease, is diabetes mellitus, with countless causes, it on increasing, genetic, lifestyle, infections could all be contributors as causative agents especially type 2 diabetes mellitus, increase inflammatory biomarkers plays extremely critical and vital role in progression of type 2 diabetes mellitus. So this study aimed to assess glycated hemoglobin levels and inflammatory biomarkers among T2DM and find such correlation and compare data with healthy control. Method: Cross-sectional case control study among 100 case group T2DM and 100 healthy subjects as control group, HbA1c and inflammatory biomarkers, C-reactive protein, IL6 and TNF-alpha were measured for study groups. Enzyme linked immunoassay (ELISA) used for measurement of inflammatory biomarkers TNF-α, CRP, IL6 and Cystatin C. while HbA1c assessed by ichroma device. Result: HbA1c, C-reactive protein, IL6 and TNF-alpha were increased among T2DM patients than healthy subjects, giving increased significant difference for each, as p value

Introduction The average life expectancy is increasing with better medical facilities and evolving technology. The ratio of the geriatric population is increasing, which drives a need to invest more in the physical and psychological health of older people. The aim of this study was to assess the incidence of depression in community-dwelling healthy older adults. Methods Geriatric Depression Scale-15 (GDS-15) was utilized in this study. Community-dwelling older adults (age 65+ years) were approached in parks, mosques, grocery stores, and waiting areas of banks. Demographic information including age, gender, education, marital status, employment, and financial status, and family structure was recorded. Data were entered and analyzed using SPSS v. 22.0. Results Out of the 367 elderly participants, there were 165 (45%) men and 202 (55%) women. Depression was reported in 37% (n = 136) individuals; 29.7% (n = 109) were suggestive of depression, while 33.2% (n = 122) were not depressed. Risk factors for the development of depression included female gender, not living with a spouse (separated/spouse died/single), being financially dependent, being employed, and living alone (not in a joint or nuclear family). Conclusion The incidence of depression is high among healthy community-dwelling elderly individuals in Pakistan. Geriatric health should be taken into consideration. There should be strategies and guidelines to screen the geriatric population for psycho-social symptoms and provide them with psychological counseling.

Breast cancer (BC) is one of the most frequently diagnosed cancers among Saudi women. Vascular endothelial growth factor (VEGF) is a key mediator of breast cancer angiogenesis. Hence, the present study was aimed to investigate the genetic association of VEGF (-2578 C > A, rs699947) polymorphism with BC among Saudi women. The present study includes 104 BC cases and 100 controls. Polymorphic analysis was carried out adopting polymerase chain reaction with restriction fragment length polymorphism (PCR-RFLP) method. The homozygous variant (AA) (RR = 3.96, EF = 0.583, p = 0.005) and allele A (RR = 1.56, EF = 0.206, p = 0.03) of VEGF (-2578C > A) gene were significantly (p 40 years of age. AA genotype was significantly (p = 0.023) associated with advanced (T4) stage and high histologic tumor grades II (p = 0.015) and III (p = 0.006) of BC patients as well. Therefore, the homozygous variant and allele A of VEGF (−2578 C > A) gene polymorphism could be an associative genetic risk factor for BC in Saudi population. Regulatory region polymorphism in VEGF may help better to predict the risk of the BC at an early stage and will be assistive in the development of new diagnostic markers and treatment strategies.

Obesity has emerged as a leading cause of death in the last few decades, mainly due to associated cardiovascular diseases. Obesity, inflammation, and insulin resistance are strongly interlinked. Lisofylline (LSF), an anti-inflammatory agent, demonstrated protection against type 1 diabetes, as well as reduced obesity-induced insulin resistance and adipose tissue inflammation. However, its role in mitigating cardiac inflammation associated with obesity is not well studied. Mice were divided into 4 groups; the first group was fed regular chow diet, the second was fed regular chow diet and treated with LSF, the third was fed high fat diet (HFD), and the fourth was fed HFD and treated with LSF. Cardiac inflammation was interrogated via expression levels of TNF α, interleukins 6 and 10, phosphorylated STAT4 and lipoxygenases 12 and 12/15. Apoptosis and expression of the survival gene, AMPK, were also evaluated. We observed that LSF alleviated obesity-induced cardiac injury indirectly by improving both pancreatic β-cell function and insulin sensitivity, as well as, directly via upregulation of cardiac AMPK expression and downregulation of cardiac inflammation and apoptosis. LSF may represent an effective therapy targeting obesity-induced metabolic and cardiovascular complications.

Background: prevention of smoking is a key strategy to improve general health. However, survey data from Jeddah, Saudi Arabia have indicated that a large number of female medical students are addicted to smoking despite the knowledge of its harmful effects. This article comparatively explores the impact of smoking on health among female medical students in Jeddah, Saudi Arabia. Data were collected as part of a program of qualitative and quantitative research investigating the prevalence of smoking among female medical students. Objectives:to study the prevalence of smoking among females in the college of ibn Sina and it is impact on their health in relation to personal and family character, CAP knowledge attitude and practice, and association of medical condition as chronic bronchitis and bronchial asthma. Methods:the study was conducted among female’s students attending college of ibn Sina-Jeddah-Saudi Arabia. An open-ended questionnaire was developed to cover the objectives. Conclusion: this study indicated that across the targeted sites, the descriptions made by female smokers about the harmful impact of smoking on their health were often vague. After assessment of the risk factor and variables that may increase prevalence of smoking among medical students, the prevalence of smoking was only 7.95% and used to practice smoking habit despite the knowledge of its side effects.

The rate of surgical site infection (SSI) in patients who undergo emergency operations is higher than in other patients. Previous studies showed an increasing role of gram- negative pathogens (GNP) in SSI. We aimed to identify GNP causing SSIs after emergency surgery, to characterize the carbapenemase-resistance genes in carbapenem-resistant pathogens (CRPs), and to identify the risk factors for SSI caused by CRP.We conducted a one-year prospective study from September 2014 in the Emergency Hospital of Cairo University Hospitals. Surveillance for SSIs was conducted according to the case definitions of the U.S. Centers for Disease Control and Prevention. Clinical specimens from patients suspected of having SSI were collected; pathogens were identified by Bruker matrix-assisted laser desorption ionization time of flight (MALDI-TOF) mass spectometry. Antimicrobial susceptibility was tested by the VITEK-2 and E-test. Carbapenem-resistant GNPs were characterized by multiplex polymerase chain reaction for IMP, VIM, SPM, OXA-48, NDM, KPC, BIC, AIM, GIM, SIM, and DIM. Clinical data for patients with SSI infected with CRP were compared with the non-infected patients for detection of risk factors.Surgical site infection affected 6.7% of patients who had emergency operations, and GNP represented 85% of these pathogens. Carbapenem-resistant pathogens caused 61% of the SSI, including all those caused by Acinetobacter baumannii, 70% of those caused by Pseudomonas aeruginosa, and 67% of those caused by Klebsiella pneumoniae. The PCR revealed that VIM, KPC, and NDM were the most common resistance genes. Risk factors for SSI were previous hospitalization, longer hospital stay, type of surgical incision, and abundant drainage; whereas previous hospitalization and infection by non-enteric environmental GNP were the risk factors for SSI caused by CRP.The rate of SSIs caused by CRP was high after emergency surgery. VIM, KPC, and NDM were the most commonly found genes. Prior hospitalization and infection by non-enteric GNP were risk factors, which can be mitigated by eradication of bacterial populations in environmental reservoirs and control of transmission.

Software Defined Networking (SDN) is being widely implemented by critical infrastructure networks, however providing security features still a challenge. In this work, we present SafeFlow an Automatic Trust Negotiation Protocol for SDN, a first line of defense and fine-grained authentication protocol, in order to deny the access of OpenFlow switches without valid digital credentials. Traditional security approaches based on identity or capabilities do not solve the problem of establishing trust between strangers. One alternative approach to mutual trust establishment is Trust Negotiation, the bilateral exchange of digital credentials to establish trust gradually. The proposed protocol describes Trust Negotiation in OpenFlow protocol, an extension to the OpenFlow handshake protocol. In this paper, we describe the implementation of SafeFlow. The proposed protocol ensures the security of the infrastructure itself, as there are also other proposals for developing security application on OpenFlow network infrastructure.

Background: Orthodontic mini-implants are increasingly used in orthodontics and the bone density is a very important factor in stabilization and success of mini-implant. The aim of this study was to observe the relationship among maximum bite force (MBF); body mass index (BMI); face width, height and type; and bone density in an attempt to predict bone density from these variables to eliminate the need for CT scan which have a highly hazard on patient. Materials and Methods: Computed tomographic (CT) images were obtained for 70 patients (24 males and 46 females) with age range 18-30 years. The maxillary and mandibular buccal cortical and cancellous bone densities were measured between 2nd premolar and 1st molar at two levels from the alveolar crest (3 and 6 mm). Face height and width were measured from CT. Clinically; Maximum bite force was measured on first molar region unilaterally by a digital device. The sample was divided into two groups according to the body mass index into; normal and overweight. Results: The results obtained showed that there were no statistical significant differences in MBF or bone density in both genders. Only the cortical bone density in maxilla in overweight group tended to be higher than normal BMI group. The face width and height correlated significantly negatively with MBF which correlated significantly positively with cortical bone density. Conclusions: It was concluded that a prediction of cortical bone density of preselected areas can be made from maximum bite force, body mass index and inter-zygomatic width.

Background: The improvement in the survival rate from cancer is increased due to advancement in the early detection, combined modality therapy and right therapeutic strategies. This study was aimed to assess the survival outcomes of patients diagnosed with non-small cell lung cancer (NSCLC) at King Abdulaziz University Hospital (KAUH).Methods: This retrospective cohort study included all patients aged 14 years and older with a diagnosis of NSCLC from 2007 to 2017 using electronic medical records at KAUH. Data analysis was performed by using Stata SE, version 15.0. Survival was defined as the time the patient lived in months from the date of pathological diagnosis to the date of last follow-up or death. All variables in a univariate and multivariate analysis were included.Results: Adenocarcinoma was the most common type of NSCLC observed in both genders, accounting for 43.70% of all cases. Of the patients diagnosed with NSCLC the overall median survival was 12.2 months (interval=16.9). And among all variables, surgical treatment was associated with a 71% relative reduction in risk of death (hazard ratio 0.29, p

Objective: To study the effect of cerebral ischemic vascular insult on the localization of language areas as regard to automatic speech, initiation, and mutism. Materials and Methods: Seventy ischemic stroke patients were selected within the first 48 h of the onset of stroke with left hemispheric stroke with aphasia. Inclusion criteria: any age above seven years, both sexes, first ever clinical stroke, admitted within the first 2 days of stroke insult. Patients underwent careful history taking, neurological examination, routine laboratory investigations, echo cardiography, and carotid duplex and language assessments. Results: Automatic speech disorders were mainly seen along left insular, left supramarginal and left frontal inferior orbital lesions. Initiation difficulty is seen mainly along as left insular, left temporal superior and left periventricular lesions. Mutism is seen along left external capsule, left internal capsule, left pallidum, left frontal inferior orbital and left inferior trigone lesions. Conclusions: Deep periventricular white matter and insular area in the dominant hemisphere play an important role in many language tasks. Thus aphasia is not a mere cortical function.

AIM To identify reproductive disturbances among adolescent girls and young women with type 1 diabetes mellitus (T1DM) in Saudi Arabia. METHODS This cross sectional study was conducted among 102 female with T1DM, (aged 13-29 years) who attended the Diabetes Clinic at Diabetes Treatment Center, Prince Sultan Military Medical City, Saudi Arabia between April 2015 to March 2016. Clinical history, anthropometric characteristics and reproductive disturbance were collected through a questionnaire. RESULTS Of 102 patients included in this analysis, 26.5% (27/102) were reported that they experienced an irregular menses. Of these patients, when compared to whose diabetes was diagnosed before menarche (35.4%, 17/48), patients diagnosed with diabetes after menarche (18.5%, 10/54) showed significantly less irregular menses (difference 16.9%, P = 0.04). Similarly, compared to patients diagnosed with diabetes prior to menarche (mean age 12.9 years; n = 48), patients diagnosed with diabetes after menarche (mean age 12.26 years; n = 54) were found to have 0.64 years delay in the age of menarche (P = 0.04). Among the studied patients, 15.7% (16/102) had polycystic ovary syndrome (PCOS). Of these PCOS patients, 37.5% (6/16) had irregular menses, 6.3% (1/16) had Celiac disease, 37.5% (6/16) had Hashimoto thyroiditis and 18.7% (3/16) had acne. CONCLUSION More than one fourth of the study population with T1DM experiencing an irregular menses. Adolescent girls and young women diagnosed with diabetes prior to menarche showed higher menstrual irregularity and a delay in the age of menarche.

Background: Development of techniques that could adequately provide anchorage in moving individual tooth or groups of teeth in desired direction is one of the major concerns of orthodontic. Mini-implants provide reliable stable anchorage. The aim of this study was to compare of the bone density between two points within alveolar bone to decide which one was more reliable for insertion of mini-implant. Materials and method: Computed tomographic images were obtained for 70 patients (24 males and 46 females) with an age range 18- 30 years. Bone density of buccal cortical and cancellous bones was measured between 2nd premolar and 1st molar at two preselected level (points 3 and 6 mm) from the alveolar crest in both maxilla and mandible. Results: According to independent t-test, the bone density at point 6 mm was higher than that at point 3 mm with a statistically significant difference between them in both maxilla and mandible except in maxillary cancellous bone which shows a non-significant difference. Conclusions: It was concluded that the alveolar bone density increased from the alveolar bone crest toward the basal bone. Point 6 mm is more recommended in the upper jaw, while in the lower jaw, point 3 mm is more recommended.