Search

Shariah screening discards the firms that belong to impermissible business sectors (or sin industries) and follow capital structure with high debt and current assets. This study tests whether the firms passing Shariah screening have better (or worse) governance quality as compared to firms not subjected to Islamic screening. The screened firms may have lesser governance quality as they cannot use debt to discipline managers or achieve optimal capital structure. On the contrary, they may be better governed as these firms get higher presence of institutional investors and better analyst coverage. This paper provides comparison of governance quality of Shariah compliant (SC) firms in United States by using proprietary dataset of Dow Jones US Indices. The screened firms offer ground for a natural experiment as they pass negative ethical screening and meet financial criteria for the inclusion in the index. The findings suggest that the SC firms have lesser governance quality than Shariah Non-Compliant firms. The lower level of governance can be attributed to lower Size, lower Profitability, higher Dividend Payout, higher Total Risk and lower Free Cash Flow. Various robustness tests are performed to validate the findings and the results remained robust. These findings provide useful insights about the governance mechanism of SC firms that are emerging as an important alternative investment class in the last two decades.

Tuberculosis is a top 10 leading cause of death worldwide. Lungs are primarily involved organs in tuberculosis. The rest of cases are extrapulmonary tuberculosis (14% reported in 2017). Extrapulmonary tuberculosis always presents with non-specific symptoms, thus at risk of delay diagnosis and management. In genitourinary tuberculosis, kidney alone and kidney with urinary bladder or ureter is affected in more than 70% of cases. The ureter and urinary bladder infections are almost always secondary to tuberculous involvement of the kidney. Bacilli haematogenic spreading is a known transmission pathway to the kidney. In this case, we diagnosed isolated urinary bladder tuberculosis caused by direct gastrointestinal tuberculosis infiltration, a rare occurrence of extrapulmonary tuberculosis. We illustrate the multiorgan involvement in tuberculosis infection including pulmonary, gastrointestinal, peritoneal and urinary bladder.

Introduction: Phantom limb pain (PLP) as neuropathic pain affects the life of amputees. It is believed an efficient PLP treatment should consider the underlying neurological mechanisms. Hereby, we investigated brain activity in PLP and its relationships to the psychological and cognitive dimensions of chronic pain. We investigate differences in resting brain activities between amputees with and without pain. We hypothesize significant differences in the motor cortex and parietal cortex activity that are related to pain perception. Also, we hypothesize two groups have significant differences in cognitive and psychological components. Methods: Behavioral assessment (psychological status, life satisfaction, and pain level) and EEG signals of 19 amputees (12 without pain and 7 with pain) were recorded. Data were statistically compared between the two groups. Also, the association between behavioral and neurophysiological data was computed. Results: The results showed a significant decrease in the pain group for the beta and gamma waves, as well as, for the theta and delta waves in the posterior temporal on both sides, during the eye-open condition. The eyes-closed condition showed that the delta waves were decreased on the right side of the cortex. Also, data showed a significant difference in the correlation of pain features with brain waves between the two groups. Conclusion: Significant differences were mostly observed in regions related to pain perception rather than the motor cortex. This can be due to the learned strategies to deal with pain and the degree of pain. Results showed maladaptive cognitive processes had a relationship with brain wave activities. According to the result of brain wave activities, it seems that cognitive factors have a role in the experience of PLP rather than neuroplasticity through amputation.

Introduction: Research evidence indicates that maladaptive reorganization of the brain plays a critical role in amplifying pain experiences and pain chronification; however, no clear evidence of change exists in brain wave activity among patients with chronic low back pain (CLBP). The objective of this study was to assess brain wave activity in patients with CLBP, compared to healthy controls. Methods: Twenty-five patients with CLBP and twenty-four healthy controls participated in the study. A quantitative electroencephalography device was used to assess brain wave activity in eyes-open and eyes-closed (EO and EC) conditions. The regional absolute and relative power of brain waves were compared between the groups. Results: Our results showed a significant increase in the absolute power of theta (F=5.905, P=0.019), alpha (F=5.404, P=0.024) waves in patients with CLBP compared to healthy subjects in both EC and EO conditions. Patients with CLBP showed a reduced delta absolute power in the frontal region (F=5.852, P=0.019) and augmented delta absolute power in the central region (F=5.597, P=0.022) in the EO condition. An increased delta absolute power was observed in the frontal (F=7.563 P=0.008), central (F=10.430, P=0.002), and parietal (F=4.596, P=0.037) regions in patients with CLBP compared to the healthy subjects in the EC condition. In the EC condition, significant increases in theta relative power (F=4.680, P=0.036) in the parietal region were also found in patients with CLBP. Conclusion: The increased absolute power of brain waves in people with CLBP may indicate cortical overactivity and changes in the pain processing mechanisms in these patients.

Surgical site infections (SSIs) following lower extremity amputations (LEAs) are a major cause of patient morbidity and mortality. The objectives of this study are to investigate the annual incidence of SSI and risk factors associated with SSI after LEA in diabetic patients.LEAs performed on diabetic patients between 2005 and 2017 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Incidence rates were calculated and analyzed for temporal change. Multivariable logistic regression was conducted to identify the independent predictors of SSIs in LEA.In 21,449 diabetic patients, the incidence of SSIs was 6.8% after LEA, with an overall decreasing annual trend (P = 0.013). Amputation location (below-knee in reference to above-knee) [OR (95% CI): 1.35 (1.20 - 1.53), P0.001], smoking [OR (95% CI): 1.25 (1.11 - 1.41), P0.001)], female sex [OR (95% CI): 1.16 (1.03 - 1.30)], preoperative sepsis [OR (95% CI): 1.24 (1.10 - 1.40), P0.001], P = 0.013], emergency status [OR (95% CI): 1.38 (1.17 - 1.63), P0.001], and obesity [OR (95% CI): 1.59 (1.12 - 2.27), P = 0.009] emerged as independent predictors of SSIs, while moderate/severe anemia emerged as a risk-adjusted protective factor [OR (95% CI): 0.75 (0.62 - 0.91), P = 0.003]. Sensitivity analysis found that moderate/severe anemia, not body mass index (BMI) class, remained a significant risk factor in the development of SSIs in below-the-knee amputations; in contrast, higher BMI, not preoperative hematocrit, was significantly associated with an increased risk for SSI in above-the-knee amputations.The incidence of SSIs after LEA in diabetic patients is decreasing. Overall, below-knee amputation, smoking, emergency status, and preoperative sepsis appeared to be associated with SSIs. Obesity increased SSIs in above-the-knee amputations, while moderate/severe preoperative anemia appears to protect against below-the-knee SSIs. Surgeons should take predictors of SSI into consideration while optimizing care for their patients, and future studies should investigate the role of preoperative hematocrit correction and how it may influence outcomes positively or negatively.

Background The use of ACS-NSQIP has increased in pancreatic surgery (PS) research. The aim of this study is to critically appraise the methodological reporting of PS publications utilizing the ACS-NSQIP database. Study design PubMed was queried for all PS studies employing the ACS-NSQIP database published between 2004 and 2021. Critical appraisal was performed using the JAMA-Surgery Checklist, STROBE Statement, and RECORD Statement. Results A total of 86 studies were included. Median scores for number of fulfilled criteria for the JAMA-Surgery Checklist, STROBE Statement, and RECORD Statement were 6, 20, and 6 respectively. The most commonly unfulfilled criteria were those relating to discussion of missed data, compliance with IRB, unadjusted and adjusted outcomes, providing supplementary/raw information, and performing subgroup analyses. Conclusion An overall satisfactory reporting of methodology is present among PS studies utilizing the ACS-NSQIP database. Areas for improved adherence include discussing missed data, providing supplementary information, and performing subgroup analysis. Due to the increasing role of large-scale databases, enhanced adherence to reporting guidelines may advance PS research.

The medical dataset replicates the patient's crucial information, such as important details regarding the patient's health. It includes disease diagnoses, interventions, and descriptions of the examined results. Also, detecting the mindset of an acute disease-affected patient is a primary challenging task. Though sentiment analysis plays a role in seeing their perspective, the significant broad medical application does not yet meet the analysis of patient mindset. So here we identified major shortcoming exists while studies the diversified disease-affected people mindset. Hence, we introduce a practical framework to analyse patients' perspectives using a socio-medical dataset that contains various reviews and feedback of critical diseases-affected people—initially, we applied a pre-processing technique, including Lowercase Conversion, removing special characters, removing stop words, Number to word conversion, Stemming, and lemmatization over dataset. Next, N-gram tokenization methodology is used to extract the valuable features followed by assigning polarity score to each sentiment we extract and calculate the overall polarity of the context. Finally, a probabilistic LDA model was employed to combine the review. Furthermore, various machine learning classifiers are explored to evaluate the performance of the proposed framework.

To report a rare case of pattern dystrophy-like retinal changes in a young β-thalassemia major patient with a very high serum ferritin level.Observational case report of a β-thalassemia major patient with bilateral pattern dystrophy-like retinal changes.An 18-year-old man experienced blurring of vision in both eyes. Patient had a very high serum ferritin level and had a history of using various iron-chelating drugs. Funduscopy revealed bilateral widespread retinal pigment epithelium changes with macular involvement, which resembled pattern dystrophy-like changes. Fundus autofluorescence imaging showed extensive area of decreased autofluorescence signal interspersed with increased autofluorescence signals, whereas optical coherence tomography demonstrated macular retinal pigment epithelium thinning and interdigitation zone disruption corresponding to retinal pigment epithelium damage and atrophy.Pattern dystrophy-like changes should be considered as a possible manifestation of retinal changes in patients with β-thalassemia major. Iron overload, which is indicated by a very high serum ferritin level, might have a role in the formation of this rare retinal manifestation in β-thalassemia major.

In this article, a two-hop simultaneous wireless information and power transfer relay network using a decode-and-forward strategy is considered. In order to improve the spectral efficiency, the relay node performs in full-duplex (FD) mode, and each node is equipped with multiple antennas. First, the end-to-end achievable rate is formulated for FD and half-duplex (HD) modes under imperfect channel state information (ICSI). Then, the optimal closed-form expressions for power allocation at the source and relay, as well as the energy harvesting ratios, are derived for primal variables associated with the dual variables through analytical solutions. We propose an iterative primal-dual algorithm based on the ellipsoid method so as to obtain final answers. Numerical results demonstrate the FD achievable rate superiority over the HD mode under proper self-interference cancellation (SIC). According to the existing results, there is an immense discrepancy between the achievable rates in perfect CSI and ICSI cases. Also, the impact of the relay distance from the source node, the number of antennas, and different SIC modes are investigated on the end-to-end achievable rate.

Background Neurofibromas are benign peripheral nerve sheath tumours. Hypoglossal nerve neurofibromas in cervical region are relatively rare, bilateral occurrence is extremely rare. Methods A 32-year-old man with type 1 neurofibromatosis presented with bilateral neck masses. Magnetic resonance imaging showed parapharyngeal masses consistent with neurogenic tumours, most likely neurofibromas. Results Surgical exploration through lateral cervical approach revealed unexpected finding of the tumour that arose from the hypoglossal nerve. The tumour had totally engulfed the nerve with no normal nerve fascicles identifiable, thus resected in toto. In the postoperative course, the patient developed right hypoglossal palsy and vocal fold palsy treated with augmentation of the paralysed vocal fold with temporary injection material. Conclusions The authors described a patient with type 1 neurofibromatosis with neurofibroma originating from cervical part of hypoglossal nerve. This paper discussed this rare condition and the management on how to improve the treatment outcome.

The unprecedented growth of mobile technology has generated an increase in malware and raised concerns over malware threats. Different approaches have been adopted to overcome the malware attacks yet this spread is still increasing. To combat this issue, this study proposes an Android malware detection system based on permission features using Bayesian classification. The permission features were extracted via the static analysis technique. The 10,000 samples for the judgement were obtained from AndroZoo and Drebin databases. The experiment was then conducted using two algorithms for feature selection: information gain and chi-square. The best accuracy rate of detection of permission features achieved was 91.1%.

Background COVID-19 is a global pandemic that has raised worldwide public health concerns. The wide spread of the virus has led to unprecedented disturbance to regular life for people around the globe and impacted their mental health. Aims The aims of the current study were to investigate the prevalence of psychiatric symptoms related to insomnia, depression, and anxiety, and identify risk factors contributing to psychological stress in Lebanese young population during COVID-19 pandemic. Method A cross-sectional study was done on the Lebanese young population. Participants were 4397 males and females aged 18 to 35 years who filled a self-administered online questionnaire. Three validated scales were used to measure the mental health status of the participants during the COVID-19 pandemic: 7-item Insomnia Severity Index for insomnia, the Patient Health Questionnaire 9-item depression module for depression, and the 7-item Generalized Anxiety Disorder scale for anxiety. Results The median interquartile range scores for anxiety, insomnia, and depression, were 8 (4–13), 10 (5–14), and 9 (5–12) respectively. Higher anxiety scores were reported with female gender (P

The present study involves fabrication and photovoltaic characterization including impedance properties of dye-sensitized solar cells based on natural dye from beetroot. The electrode of the cell was prepared with commercial Fluorine-doped Tin Oxide glass with 100 μm layer of nanostructured TiO2 whereas, the counter electrode consisted of platinum-coated glass. Fresh juice was extracted from beetroot to use as dye. The dye exhibited high absorption in visible range. Photovoltaic measurements of the solar cell gave a short circuit current density (Jsc) of 130 μA/cm2 and an open-circuit voltage (VOC) of 0.38 V under AM 1.5 illumination intensity. The VOC and Jsc showed linear behavior at higher values of illumination intensities. The conductance-voltage, the capacitance-voltage and the series resistance voltage characteristics of the dye solar cell was measured at frequency range from 5 kHz to 5 MHz to study performance of the dye-sensitized solar cells with natural dyes.

With the growing demand for geospatial data, challenging aerial images with high spatial, spectral, and temporal resolution achieve excellent development. Currently, deep Convolutional Neural Network (CNN) structures are applied widely for object detection. Nevertheless, existing deep CNN-based models consist of complex network structures and require immense amounts of graphics processing unit (GPU) computation power with high energy consumption. Thus, achieving efficient real-time object detection for limited memory and processing capacity embedded device is a major challenge. This paper proposes a feasible and lightweight object detection model based on deep CNN where a mobile inverted bottleneck module is adopted in the backbone structure. Moreover, an enhanced spatial pyramid pooling is adopted to increase the receptive field in the network by concatenating the multi-scale local region features. The experimental results demonstrated that the proposed model achieved higher average precision and required the smallest memory storage compared to previous works. Moreover, the proposed model offers the best trade-offs in terms of detection accuracy, model size, and detection time which has excellent potential to be deployed on limited capacity embedded device.

Background: Dengue is known as the most severe arboviral infection in the world spread by Aedes aegypti. However, conventional and laboratory-based enzyme-linked immunosorbent assays (ELISA) are the current approaches in detecting dengue virus (DENV), requiring skilled and well-trained personnel to operate. Therefore, the ultrasensitive and label-free technique of the Silicon Nanowire (SiNW) biosensor was chosen for rapid detection of DENV. Methods: In this study, a SiNW field-effect transistor (FET) biosensor integrated with a back-gate of the low-doped p-type Silicon-on-insulator (SOI) wafer was fabricated through conventional photolithography and Inductively Coupled Plasma – Reactive Ion Etching (ICP-RIE) for Dengue Virus type-2 (DENV-2) DNA detection. The morphological characteristics of back-gated SiNW-FET were examined using a field-emission scanning electron microscope supported by the elemental analysis via energy-dispersive X-ray spectroscopy. Results and Discussion: A complementary (target) single-stranded deoxyribonucleic acid (ssDNA) was recognized when the target DNA was hybridized with the probe DNA attached to SiNW surfaces. Based on the slope of the linear regression curve, the back-gated SiNW-FET biosensor demonstrated the sensitivity of 3.3 nAM-1 with a detection limit of 10 fM. Furthermore, the drain and back-gate voltages were also found to influence the SiNW conductance changed. Conclusion: Thus, the results obtained suggest that the back-gated SiNW-FET shows good stability in both biosensing applications and medical diagnosis throughout the conventional photolithography method.

Although skin infections are usually uncomplicated, it may indicate systemic disease or lead to life-threatening systemic infections. Staphylococcus aureus is the most common cause of skin infectio...

In oil palm plantations, Basal Stem Rot (BSR) disease has been acknowledged by many researchers worldwide to be a core and consistent danger. Given this problem, the early evaluation of the disease...

OBJECTIVE Although it has been shown that surgery for glioblastoma (GBM) at high-volume facilities (HVFs) may be associated with better postoperative outcomes, the use of such hospitals may not be equally distributed. The authors aimed to evaluate racial and socioeconomic differences in access to surgery for GBM at high-volume Commission on Cancer (CoC)–accredited hospitals. METHODS The National Cancer Database was queried for patients with GBM that was newly diagnosed between 2004 and 2015. Patients who received no surgical intervention or those who received surgical intervention at a site other than the reporting facility were excluded. Annual surgical case volume was calculated for each hospital, with volume ≥ 90th percentile defined as an HVF. Multivariable logistic regression was performed to identify patient-level predictors for undergoing surgery at an HVF. Furthermore, multiple subgroup analyses were performed to determine the adjusted odds ratio of the likelihood of undergoing surgery at an HVF in 2016 as compared to 2004 for each patient subpopulation (by age, race, sex, educational group, etc.). RESULTS A total of 51,859 patients were included, with 10.7% (n = 5562) undergoing surgery at an HVF. On multivariable analysis, Hispanic White patients (OR 0.58, 95% CI 0.49–0.69, p < 0.001) were found to have significantly lower odds of undergoing surgery at an HVF (reference = non-Hispanic White). In addition, patients from a rural residential location (OR 0.55, 95% CI 0.41–0.72, p < 0.001; reference = metropolitan); patients with nonprivate insurance status (Medicare [OR 0.78, 95% CI 0.71–0.86, p < 0.001], Medicaid [OR 0.68, 95% CI 0.60–0.78, p < 0001], other government insurance [OR 0.68, 95% CI 0.52–0.86, p = 0.002], or who were uninsured [OR 0.61, 95% CI 0.51–0.72, p < 0.001]); and lower-income patients ($50,354–$63,332 [OR 0.68, 95% CI 0.63–0.74, p < 0.001], $40,227–$50,353 [OR 0.84, 95% CI 0.76–0.92, p < 0.001]; reference = ≥ $63,333) were also found to be significantly associated with a lower likelihood of surgery at an HVF. Subgroup analyses revealed that elderly patients (age ≥ 65 years), both male and female patients and non-Hispanic White patients, and those with private insurance, Medicare, metropolitan residential location, median zip code–level household income in the first and second quartiles, and educational attainment in the first and third quartiles had increased odds of undergoing surgery at an HVF in 2016 compared to 2004 (all p ≤ 0.05). On the other hand, patients with other governmental insurance, patients with a rural residence, and those from a non-White racial category did not show a significant difference in odds of surgery at an HVF over time (all p > 0.05). CONCLUSIONS The present analysis from the National Cancer Database revealed significant disparities in access to surgery at an HVF for GBM within the United States. Furthermore, there was evidence that these racial and socioeconomic disparities may have widened between 2004 and 2016. The findings should assist health policy makers in the development of strategies for improving access to HVFs for racially and socioeconomically disadvantaged populations.

Indonesia has been known to have abundant natural resources and culture-based creative industries. The country is therefore vulnerable to the practice of fraud of origin. One of many industrial sectors susceptible to that particular crime is the wooden furniture businesses. In many cases, it is apparent that natural products and raw materials of Indonesia are being exported without listing the country as the place of origin. The most common Indonesian material falls within this illegal practice are timber products. In the province of Central Java, Jepara has been a prominent center of timber industry producing high quality timber products and wooden raw materials. From a unique standpoint, the timber industry in Jepara is deeply rooted to the culture and identity of the natives, making the attempt to separate the discussion between timber industry and the people of Jepara not only imprudent but virtually impossible. By looking at the statistic in which Jepara’s public education level is assessed to be still below the national standard, and as well bearing to the general fact that the timber actors in Jepara are more focused on product sales rather than important technical aspects such as certification of origin, it should be projected that crimes such as fraud of origin could be easily committed in Jepara. This study is using a comparative advantage theory and theories or models of H-O to investigate how the practice of fraud of origin in Jepara occurs and how to resolve such problem.

Background Personalized treatment for clinical T1 renal cortical masses (RCMs) should take into account competing risks related to tumor and patient characteristics. Objective To develop treatment-specific prediction models for cancer-specific mortality (CSM), other-cause mortality (OCM), and 90-d Clavien grade ≥3 complications across radical nephrectomy (RN), partial nephrectomy (PN), thermal ablation (TA), and active surveillance (AS). Design, setting, and participants Pretreatment clinical and radiological features were collected for consecutive adult patients treated with initial RN, PN, TA, or AS for RCMs at four high-volume referral centers (2000–2019). Outcome measurements and statistical analysis Prediction models used competing-risks regression for CSM and OCM and logistic regression for 90-d Clavien grade ≥3 complications. Performance was assessed using bootstrap validation. Results and limitations The cohort comprised 5300 patients treated with RN (n = 1277), PN (n = 2967), TA (n = 476), or AS (n = 580). Over median follow-up of 5.2 yr (interquartile range 2.5–8.7), there were 117 CSM, 607 OCM, and 198 complication events. The C index for the predictive models was 0.80 for CSM, 0.77 for OCM, and 0.64 for complications. Predictions from the fitted models are provided in an online calculator ( https://small-renal-mass-risk-calculator.fredhutch.org ). To illustrate, a hypothetical 74-yr-old male with a 4.5-cm RCM, body mass index of 32 kg/m2, estimated glomerular filtration rate of 50 ml/min, Eastern Cooperative Oncology Group performance status of 3, and Charlson comorbidity index of 3 has predicted 5-yr CSM of 2.9–5.6% across treatments, but 5-yr OCM of 29% and risk of 90-d Clavien grade 3–5 complications of 1.9% for RN, 5.8% for PN, and 3.6% for TA. Limitations include selection bias, heterogeneity in practice across treatment sites and the study time period, and lack of control for surgeon/hospital volume. Conclusions We present a risk calculator incorporating pretreatment features to estimate treatment-specific competing risks of mortality and complications for use during shared decision-making and personalized treatment selection for RCMs. Patient summary We present a risk calculator that generates personalized estimates of the risks of death from cancer or other causes and of complications for surgical, ablation, and surveillance treatment options for patients with stage 1 kidney tumors.

The increasing use of patient-reported outcome (PRO) measures is forcing clinicians and health care systems to decide which to select and how to incorporate them into their records and clinical workflows. This overview addresses 3 topics related to these concerns. First, a literature review summarizes key psychometric and practical factors (such as reliability, responsiveness, computer adaptive testing, and interpretability) in choosing PROs for clinical practice. Second, 3 clinical decision support issues are highlighted: gathering PROs, electronic health record effect on providers, and incorporating PROs into clinical decision support design and implementation. Lastly, the salience of crosscutting domains as well as 9 key pragmatic decisions are reviewed. Crosscutting domains are those that are relevant across most medical and mental health conditions, such as the SPADE symptom pentad (sleep problems, pain, anxiety, depression, low energy/fatigue) and physical functioning. The 9 pragmatic decisions include (1) generic vs disease-specific scales; (2) single- vs multidomain scales; (3) universal scales vs user-choice selection; (4) number of domains to measure; (5) prioritization of domains when multiple domains are assessed; (6) action thresholds; (7) clinical purpose (screening vs monitoring); as well as the (8) frequency and (9) logistical aspects of PRO administration.

Introduction and objectives Most of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients’ satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws. Materials and methods This study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent). Results In group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p = 0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p = 0.001). Conclusions Adding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients’ satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory. Trial registration number: IRCT20120527009878N3.

Metal oxide semiconductor materials have shown a great potential in the fabrication of heterojunction thin film due to its improved properties for photovolatic mechanism in solar cell application. In this work, p-(111)-Cu2O based heterostructure was successfully developed with uniformity and highly oriented n-TiO2/(002)-ZnO bilayer thin film in order to overcome improper electron mobility between the heterointerface of n and p-type layer by optimizing several properties. n-TiO2/ZnO bilayer acts as window layer deposited on FTO substrate by using sol–gel spin coating method. The crystallize size and transmittance spectrum of n-TiO2 thin film was improved after n-ZnO was coated onto TiO2 thin film. Meanwhile, cyclic voltammetry (CV) measurement was carried out and potential deposition of −0.4 V vs Ag/Cl at 40 °C was acquired. p-Cu2O which acts as absorbing layer was deposited onto n-TiO2/ZnO bilayer by using electrodeposition technique. The successful fabrication of n- TiO2/ZnO/p- Cu2O heterostructure were confirmed by the existence of all peaks on the XRD spectrum. Two strong absorption edges observed and the merged shape of p-Cu2O grain with other layer leads to the surface flatness improvement. The optical energies of n-TiO2/ZnO bilayer and p-Cu2O thin film are estimated as 3.15 and 1.75 eV, respectively. The structural, morphological, optical, and topological properties of thin films were characterized using X-ray diffraction, Field emission-scanning electron microscope, Ultraviolet–visible spectroscopy, and Atomic force microscopy, respectively.

BACKGROUND: Myelomeningocele is one of the most complex congenital malformations of the central nervous system. It is one of the most common types of spina bifida which involves a failure of neural tube closure. Reconstruction surgery for myelomeningocele had always been challenging for plastic and neurosurgeons. CLINICAL CASE: We report a case of a new-born with lumbosacral myelomeningocele who received treatment in the Hospital Universiti Sains Malaysia. The myelomeningocele was repaired by the neurosurgery team and subsequently, the child was left with huge lumbosacral skin defect. The large defect was successfully covered by using a combined method of bilateral bipedicle flap with lateral releasing incision and remaining lumbosacral and secondary defect resurfaced using Integra dermal regeneration template (DRT). We used ACTICOAT interfaced negative pressure wound therapy (NPWT) as our main dressing in preparing the wound bed for autologous epidermal graft. The result of our closure technique provides tension free closure. DISCUSSION: We incorporated bilateral bipedicle fasciocutaneous flap technique together with DRT for closure of the lumbosacral defect. The bilateral bipedicle flap with lateral releasing incision served to reduce tension on the skin at bilateral lumbar region. The DRT downsized the lumbosacral defect and NPWT dressing provided an optimal sterile environment in giving time for neodermis generation. The remaining secondary defect were also resurfaced utilizing DRT and autologous skin grafting. CONCLUSIONS: The outcome of surgery demonstrated that the combined use of bilateral bipedicle fasciocutaneous flap with lateral releasing incision and DRT with delayed skin grafting is safe, effective and provide long term stable and supple scar for large, exposed dura defect.

Background: Cerebrovascular diseases (CVD), including stroke, are considered as a high burden heath issue around the world. Diabetes is a well-established risk factor for stroke that affects both severity and outcome. Objectives: The objective of this study is to evaluate cerebral stroke in diabetic patients and the impact of diabetes mellitus on the severity and outcome of all types of strokes. Patients and Methods: This study included 500 patients with the first attack stroke who were classified into two groups; Group A: 404 diabetic patients & Group B: 96 non-diabetic patients. All patients were diagnosed clinically and with base line CT (Computed Tomography) brain and stroke severity was evaluated by NIHSS within 24 hours of admission. Results: The mean NIHSS in the diabetic cases was 10.35 ± 2.51 which was statistically significant higher as compared with the non-diabetic cases (7.25 ± 1.02) (P

Waqf or religious endowment is of a benevolence instrument emerged to help reduce the burden of the disadvantaged people. As the cost for medical expenses are exorbitant, the availability of waqf should contribute to the improvement of the community health. The establishment of Universiti Sains Islam Malaysia (USIM) Specialist healthcare clinic was founded by the idea of waqf through healthcare for the less fortunate. With collaboration from many agencies the establishment of the clinic has served community in need to access better health care. The primary aim of waqf clinic establishment is to continually uphold the Islamic aspects in its establishment and management for betterment of health among disadvantaged people.

PurposeThis paper aims to investigate the relationship between a sustainable university brand and the intention of international students to study at Universiti Sains Malaysia (USM), one of Malaysia’s premier universities. Moreover, the study explored the moderating effect of opinion leaders on the intention of international students to study at USM. Design/methodology/approachA survey involving 391 international students was conducted using a self-assessment questionnaire, data from which were analysed using partial least squares structural equation modelling. FindingsEmpirical data show that USM’s sustainability brand had a positive impact on international students’ intention to study at the university, but opinion leaders had no significant sway in influencing this decision. This finding could be attributed to USM’s established reputation as a sustainable university, which helps cement its standing as the top choice for international students. Research limitations/implicationsThis research only focussed on international students at one Malaysian university. Hence, the findings are not generalisable, in particular, to illuminate the experiences of students at non-Malaysian institutions, whose contexts are inevitably different than Malaysia’s. Practical implicationsThis study offered a dimensional insight into the university management on the pivotal branding of sustainability as one of the important tools for attracting international students to study at the university. In light of the findings, it is suggested that universities magnify their efforts to support the sustainable agenda, to help create a sustainable university brand that adds value to the interests of stakeholders. Originality/valueUniversities are continuously faced with challenges in terms of branding. Besides, not many universities are branded as sustainable universities despite the high involvement in sustainability-focused activities. Research has scarcely focused on the influence of the “sustainable university brand” on the marketing effort of the university to international students. In studies where this topic was highlighted, they focused on the opinion leader as the moderating influence of the choice of university amongst international students.

Background and aim Postpartum depression (PPD) is a familiar problem which is associated with about 10–20% of women after child delivery. Fish oil (FO) has a therapeutic potentials to many diseases including mood disorders. However, there is paucity of data on the effects of FO supplementation on PPD rat model. Hence, this study aimed at investigating the potentials of FO in ameliorating depressive-like behaviors in PPD rat by evaluating the involvement of NLRP3-inflammasome. Experimental procedure Thirty six virgin adult female rats (n = 6) were randomly divided into six groups; Group 1–3 were normal control (NC), Sham (SHAM) and ovariectomized group (OVX) respectively whereas group 4–6 were PPD rats forced-fed once daily with distilled water (PPD), fish oil (PPD + FO; 9 g/kg) and Fluoxetine (PPD + FLX; 15 mg/kg) respectively from postpartum day 1 and continued for 10 consecutive days. Rats behaviors were evaluated on postpartum day 10 through open field test (OFT) and forced swimming test (FST), followed by biochemical analysis of NLRP3 inflammasome proteins pathway in their brain and determination of neutrophil to lymphocyte ratio (NLR). Results PPD-induced rats exhibited high immobility and low swimming time in FST with increased inflammatory status; NLR, IL-1β and NFкB/NLRP3/caspase-1 activity in their hippocampus. However, administration of FO or fluoxetine reversed the aforementioned abnormalities. Conclusion In conclusion, 10 days supplementation with FO ameliorated the depressive-like behaviors in PPD rats by targeting the NFкB/NLRP3/caspase-1/IL-1β activity. This has shed light on the potential of NLRP3 as a therapeutic target in treatment of PPD in rats., Graphical abstract Image 1, Highlights • Pioneer study on 10 days effect of Menhaden fish oil in post partum depression rat model. • Menhaden fish oil attenuates post partum depression in rat model. • Menhanden fish oil acted through NLRP3 inflammasome pathways.

Extranodal sinonasal natural killer/T-cell lymphoma is known for its locally destructive nature at the midface region. The initial presentations are related to the localized granulomatous-like lesion usually in the nasal cavity that may lead to symptoms of nasal obstruction, discharge, hyposmia and epistaxis. Advanced disease may present with a rapid dissemination of disease to the liver, spleen, skin, lymph nodes, and bone marrow hence poorer prognosis. We report a case of a young lady with rapid progression of extranodal sinonasal NK/T cell lymphoma with torrential tumour bleeding from the oral and nasal cavities compromising the upper airway patency, which warranted an emergency tracheostomy and arterial embolization.

ntroduction Fall is a health problem for older persons. This study investigates the potential factors of concern: the nutritional status of the elderly and non-communicable disease association with incidents of falls. Methods and Materials This study used data from NHMS 2018, a cross-sectional design, applied two-stage stratified cluster sampling. Descriptive statistics such as the percentage of each variable were done. Factors associated with falls were determined at both univariate and multivariable levels using simple logistic regression and multiple logistic regression. The data were presented as standard values for each analysis and adjusted odds ratios with 95% CI with p values (

Photoelectrochemical (PEC) water splitting is a green and sustainable approach capable of driving mass hydrogen production in the future. To realize this vision, development of a well-performing photoelectrode is highly demanded. In this comprehensive study, electrodeposition technique was applied for fabricating BiVO4 films by regulating the deposition time from 1 min until 9 min. Interestingly, the morphology, crystallinity, chemical structure, and optical properties of BiVO4 films depend strongly on the deposition time. It is found that BiVO4 layer deposited for 7 min with a cross-section thickness of around 321.1–326.5 nm showed the optimum performance, whereby the photocurrent reached up to ~0.32 mA/cm−2 at 1.23 V vs. RHE. The deposited BiVO4 represents tiny and long petals, similar to “needle” nanostructures, which is embedded closely into compact agglomerates. Such morphology enables the BiVO4 films to perform efficiently as photoanode in PEC cells. Besides, high crystallinity is detected from the sharp peaks of XRD and Raman analysis, as well as good light absorption capability that are the main contributors to the enhancement of PEC performance. In addition to the facile fabrication offered by electrodeposition method, the non-toxic attributes and the impressive PEC performance of the optimum BiVO4 layer could serve as an interesting option for other applications such as gas sensors, solar cells, degradation of pollutants and photocatalytic water splitting.

This study presents findings on the implementation of a teaching learning tool to enhance culturally responsive learning to enhance awareness of and knowledge about Malaysian traditional crafts in Visual Art classes. Most research in the Malaysian context exploring culturally responsive pedagogical methods has investigated theoretical and general properties, but few have attempted to investigate innovating tools to improve teaching and learning in schools and higher education. New methods with interesting features to teach certain cultural elements will not only trigger learning but can also instil the targeted values in students especially those living in multi racial countries. Using the Design and Development Method for one such tool, this study presents an evaluation of the Craft Fun Kit utilised by an experienced Visual Arts Education teacher in his class to study the students’ responses to and acceptance of the tool both to enhance learning and multicultural awareness. The overall results found that the Craft Fun Kit is relevant and appropriate as a learning tool which can enable students to attain Visual Art education learning outcomes at the secondary school level in Malaysia.

The rapid development of online distance learning (ODL) in the higher education settings worldwide is largely contributed to its massive benefits in addressing inclusive education through meeting d...

Objective: Caring for children with neurological conditions is challenging. This study aimed to determine the prevalence of burnout and its associated factors among caretakers of children with chronic neurological illness. Method: This cross-sectional study involved 18 years or older caretakers of children with neurological illness for more than 3 months duration. They were recruited from Paediatric Neurology outpatient clinics over a period of 3 months from July to October 2019 at a general hospital in the state of Kelantan, Malaysia. Each caretaker was given a set of questionnaires that included General Stressor Questionnaire (GSQ) which was translated into Malay version ‘Soal Selidik Umum (SSU)’, Copenhagen Burnout Inventory-Malay version (CBI-M) and Demographic Information Form. Results: Overall, only 20 caretakers had mean score of 50 or higher in all component in CBI-M, making the prevalence of total burnout among the caretakers of 8.3% (95% CI = 5.2%, 12.6%). Personal burnout involved 78 caretakers (32.5%, 95% CI = 26.6%, 38.8%), 42 caretakers with client-related burnout (17.5%, 95% CI = 12.9%, 22.9%) and 11 caretakers had work-related burnout (4.6%, 95% CI = 2.3%, 8.1%). Most common stressors were performance pressure, work-family conflict and poor job prospects. Multiple logistic regression analyses showed that family stressors, types of children’s neurological illness and number of household occupants were associated with personal burnout, client-related burnout and total burnout in their caretakers. Conclusions: Prevalence of total burnout among the caretakers was low, but personal burnout was prominent. Caretakers of children with genetic illness, cerebral palsy and autism had higher prevalence of burnout compared to other chronic neurological illness.

Currently, the primary energy supply in Malaysia is dominant by non-renewable energy sources such oil, natural gas and coal which contributed to the scarcity of these sources and occurrence of global warming. This phenomenon raises the public concerns to diversify the energy sources to sustain energy availability. To address these predicaments, biomass sources is among the prominent alternative energy sources since it is renewable and possesses minimal harms to the environment. Thus, the woody plant with high growth rate and high energy content that can be used to serve as potential biomass energy sources. In this study, small diameter (5-8cm) of wild Acacia mangium species have been determined and compared accordingly three (3) different portions (bottom, middle and top) and two (2) different particle sizes (0.5 and 1.5mm). The analysis conducted to determine the properties of raw material of Acacia mangium as biomass energy sources were proximate, physical and energy content properties. The result obtained for the energy content analysis of small diameter wild Acacia mangium has a mean calorific value range from 16.35 to 18.35MJ/kg between portions and particle sizes. In order to determine the effect of portions and particle sizes on each of the proximate, physical and energy content properties, two-way ANOVA was performed. It shows that both the portions and particle sizes have significant effect on calorific value (energy content) of small diameter wild Acacia mangium at 99% of confidence level. In a nutshell, the biomass energy properties of small diameter wild Acacia mangium with different portions and particle sizes were being determined.

Migranya; Estimulació magnètica transcranial; Escorça prefrontal Migraña; Estimulación magnética transcraneal; Corteza prefrontal Migraine; Transcranial magnetic stimulation; Prefrontal cortex Background Migraine may lead to a negative impact on the patients’ quality of life with a subsequent substantial burden to society. Therapy options for treatment and prevention of migraine have progressed over the years and repetitive transcranial magnetic stimulation (rTMS) is one of the promising non-pharmacological options. It induces and alters electric current in the brain via repetitive non-invasive brain stimulation in high frequency. In migraine patients, two common stimulation sites are the M1 cortex and dorsolateral prefrontal cortex (DLPFC). The mechanism on how rTMS exerts therapeutic effects on migraine is not fully established, but the main postulation is that the neuromodulation via high-frequency rTMS (hf-rTMS) might inhibit pain perception. However, evidence from studies has been conflicting, thus the usefulness of hf-rTMS as migraine preventive treatment is still uncertain at this moment. Methods This is a systematic review protocol describing essential reporting items based on the PRISMA for systematic review protocols (PRISMA-P) (Registration number: CRD42020220636). We aim to review the effectiveness, tolerability, and safety of hf-rTMS at DLPFC in randomised controlled trials (RCTs) as migraine prophylactic treatment. We will search Scopus, Cumulative Index to Nursing and Allied Health Literature Plus, PubMed, Cochrane Central Register of Controlled Trials and Biomed Central for relevant articles from randomised controlled clinical trials that used hf-rTMS applied at DLPFC for the treatment of migraine. The risk of bias will be assessed using the version 2 “Risk of bias” tool from Cochrane Handbook for Systematic Reviews of Interventions Version 6.1. We will investigate the evidence on efficacy, tolerability and safety and we will compare the outcomes between the hf-rTMS intervention and sham groups. Discussion This systematic review will further determine the efficacy, safety, and tolerability of hf-rTMS applied at DLPFC for migraine prophylaxis. It will provide additional data for health practitioners and policymakers about the usefulness of hf-rTMS for migraine preventive treatment. This work is funded by Research Management Centre of Universiti Putra Malaysia under research grant number GPB/2017/9585500.

Introduction: This research paper is a cross-sectional study that aims to estimate the prevalence of oral health problems among adult patients in palliative care, as well as to investigate the oral hygiene practices of palliative care patients in Brunei Darussalam. Patients and methods: In this study, the Oral Palliative Care and Assessment and Referral tool (OPCAR) along with a 15–item questionnaire were utilized as reliable tools for measurements. All palliative care patients who had been assessed in this study were invited to participate. A total of 90 palliative care patients were invited to participate and 73 patient data were used for the subsequent data analysis. Results: The three most common problems among in palliative care patients were saliva, lips, and teeth category. Fisher’s exact test identified there was a significantly higher teeth-related problems (teeth caries, fracture, broken root stumps) in non-denture wearing patients as compared with denture wearing patients. However, other associations between denture wearing to oral hygiene was of little significance. Conclusions: Using the normal approximation sample method, it was revealed that almost all the participants were eligible to be referred to the dental clinic for at least one oral problem.

This article presents a high-performance hardware-in-the-loop (HIL) system aimed to assist experts in developing and testing power electronics control board and their logic with real-time (RT) models of both electrical and mechanical components. For demonstrating the effectiveness of this system for HIL testing, a new industrial doubly-fed induction generator (DFIG) control board is tested based on a comprehensive wind energy conversion model developed in MATLAB/Simulink hardware description language (HDL) coder and LabVIEW environment. The interaction between MATLAB/Simulink and LabVIEW is accomplished by National Instrument (NI) intellectual property (IP) integration node, which loads very high-speed integrated circuit hardware description language (VHSIC-HDL or VHDL) codes (that enable those two software exchange RT data). LabVIEW implements a VHDL code of electrical model with fixed-point variables on an R-Series reconfigurable input/output (I/O) field-programmable gate array (FPGA) module on NI-PXIe 7858R installed on NI PXIe 1062Q chassis, and the mechanical models deployed in its PXIe 8133 central processing unit (CPU). Finally, through a uniquely developed interface board, the HIL emulator connects to an external DFIG control board. In FPGA, the model and other communicational and logging components' step-time in each iteration is $5.0~\mu \text{s}$. For verifying the results, a comparison is made between the proposed emulator system and Typhoon HIL602+ as a commercially available HIL system. It is proven that there is little or no significant deviation between the outputs of two systems. The proposed HIL emulator does not have the limitation of commercial HIL systems in adding custom-made new components.

OBJECTIVE Degenerative cervical myelopathy (DCM) results in significant morbidity. The duration of symptoms prior to surgical intervention may be associated with postoperative surgical outcomes and functional recovery. The authors’ objective was to investigate whether delayed surgical treatment for DCM is associated with worsened postoperative outcomes. METHODS Data from 1036 patients across 14 surgical centers in the Quality Outcomes Database were analyzed. Baseline demographic characteristics and findings of preoperative and postoperative symptom evaluations, including duration of symptoms, were assessed. Postoperative functional outcomes were measured using the Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scale. Symptom duration was classified as either less than 12 months or 12 months or greater. Univariable and multivariable regression were used to evaluate for the associations between symptom duration and postoperative outcomes. RESULTS In this study, 513 patients (49.5%) presented with symptom duration < 12 months, and 523 (50.5%) had symptoms for 12 months or longer. Patients with longer symptom duration had higher BMI and higher prevalence of anxiety and diabetes (all p < 0.05). Symptom duration ≥ 12 months was associated with higher average baseline NDI score (41 vs 36, p < 0.01). However, improvements in NDI scores from baseline were not significantly different between groups at 3 months (p = 0.77) or 12 months (p = 0.51). Likewise, the authors found no significant differences between groups in changes in mJOA scores from baseline to 3 months or 12 months (both p > 0.05). CONCLUSIONS Surgical intervention resulted in improved mJOA and NDI scores at 3 months, and this improvement was sustained in both patients with short and longer initial symptom duration. Patients with DCM can still undergo successful surgical management despite delayed presentation.

This study develops an empirical approach that underlines the effect of land use mix and development grain on pedestrian movement in the streets and public spaces of urban neighborhoods. The study begins with the end in mind; it compares two urban sectors in Abu Dhabi city with broadly recognized contrasting levels of pedestrian movement. The research works backward to identify the combination of built environment attributes that result in differing levels of pedestrian activity between the eastern and western sectors of Abu Dhabi city center. Using Geographic Information Systems maps/data files, direct observations, and field metrics, the study computes various indices related to land use mix, density, and street connectivity for Abu Dhabi central business district. The findings of this study highlight the land use, spatial and street network configurations that enhance pedestrian activity in urban centers. From a local perspective, the research outcome would inform future visions aimed at transforming the city of Abu Dhabi into a global metropolis that provides its citizens and visitors with unique and vibrant urban settings conducive to intra- and inter-neighborhood walkability.

This study investigates the role of governance quality in maintaining financial stability and enhancing financial inclusion in Asian countries using the stakeholder theory. Composite variables were constructed for the governance quality, financial stability, and financial inclusion dimensions using principal component analysis (PCA). The impact of governance quality on financial stability and financial inclusion was analyzed using dynamic system generalized method of moments (GMM) estimations. Additionally, using Baron and Kenny's approach, the mediating role of financial inclusion in the relationship between governance quality and financial stability was examined. The results obtained were robust to various standardization techniques. This study's findings suggest that governance quality negatively affects financial inclusion but has a positive influence on financial stability. Furthermore, financial inclusion positively affects financial stability in Asia. Finally, based on the results, we conclude that financial inclusion mediates the relationship between governance quality and financial stability.

Background & Aims Hereditary factors play a role in the development of colorectal cancer (CRC). Identification of germline predisposition can have implications on treatment and cancer prevention. This study aimed to determine the prevalence of pathogenic germline variants (PGVs) in CRC patients using a universal testing approach, association with clinical outcomes, and the uptake of family variant testing. Methods We performed a prospective multisite study of germline sequencing using a more than 80-gene next-generation sequencing platform among CRC patients (not selected for age or family history) receiving care at Mayo Clinic Cancer Centers between April 1, 2018, and March 31, 2020. Results Of 361 patients, the median age was 57 years (SD, 12.4 y), 43.5% were female, 82% were white, and 38.2% had stage IV disease. PGVs were found in 15.5% (n = 56) of patients, including 44 in moderate- and high-penetrance cancer susceptibility genes. Thirty-four (9.4%) patients had incremental clinically actionable findings that would not have been detected by practice guideline criteria or a CRC-specific gene panel. Only younger age at diagnosis was associated with the presence of PGVs (odds ratio, 1.99; 95% CI, 1.12–3.56). After a median follow-up period of 20.7 months, no differences in overall survival were seen between those with or without a PGV (P = .2). Eleven percent of patients had modifications in their treatment based on genetic findings. Family cascade testing was low (16%). Conclusions Universal multigene panel testing in CRC was associated with a modest, but significant, detection of heritable mutations over guideline-based testing. One in 10 patients had changes in their management based on test results. Uptake of cascade family testing was low, which is a concerning observation that warrants further study.

Introduction This study analyzes the changing levels of circulating inflammatory cytokines Interferon gamma (IFN-γ) and interleukin (IL)-10 (as the main cytokines of T-helper-1 and T-helper-2 immune responses) in patients with chronic hepatitis C virus (HCV) infection undergoing therapy with direct-acting antivirals (DAAs) and to correlate them with laboratory markers. Methods This Pilot study included 50 HCV monoinfected patients who received DAAs for 12 or 24 weeks. They were followed up monthly during therapy and 3 months after the end of the treatment. Liver disease was determined by transient elastography, in addition to FIB-4 indices. Analysis of IFN-gamma and IL-10 was carried out using an enzyme-linked immunosorbent assay. Results All patients carried HCV genotype 4. The Sustained virological response was 100% and 92% in cirrhotics and noncirrhotics, respectively. There was no significant difference between groups in baseline IL-10 or IFN-gamma. In noncirrhotics, IL-10 showed a significant reduction at Week 4 after treatment start. In cirrhotics, IL-10 showed a significant reduction at Week 4 after treatment starts and a significant reduction at Week 12 after the end of the treatment. At Week 12 after the end of the treatment, serum IL-10 levels were significantly lower in cirrhotics. IFN-γ showed nonsignificant changes in noncirrhotics. A significant increase of IFN-γ occurred in cirrhotics from Week 4 after treatment starts to 12 weeks after the end of the treatment. IFN-γ was significantly higher in cirrhotics at Week 12 after the end of the treatment. IFN-γ and IL-10 showed different correlations with laboratory markers. Conclusion Viral eradication induced by DAAs caused a significant change in IL-10 and IFN-gamma.

Exposure of newborns to persistent organic pollutants (POPs) is a public health concern. The objective of this study was to assess the prevalence of POPs in human milk collected from lactating mothers in Lebanon and to investigate the sociodemographic, nutritional, and other lifestyle determinants. Fifty-four breast milk samples were collected as per World Health Organization guidelines. A survey was used to assess the anthropometric and demographic characteristics of participants. Dietary habits were evaluated based on a semiquantitative food frequency questionnaire. Organochlorine pesticides and polychlorinated biphenyls were measured in milk samples with liquid-liquid extraction and gas chromatography. Among the screened POPs, dichlorodiphenyldichloroethylene (DDE) was the only POP detected in breast milk samples and was found in only 17.9% of the samples, with a mean (SD) of 11.6 (5.0) μg/L and a range of 5.7 to 21.4 μg/L. Prepregnancy body mass index and age were positively associated with DDE contamination in breast milk. Women who consumed cereals at least two times per week had detectable DDE contamination in their breast milk. Consumption of potatoes and beans at least once per week was also associated with DDE contamination. Our study is the first to assess the presence of POPs in breast milk in Lebanon. The benefits of breastfeeding compensate for the low prevalence of DDE in the breast milk. Our findings highlight the high need to implement monitoring policies, good agricultural practices, and education programs for breastfeeding mothers.

Patients with systemic mastocytosis (SM) are at increased risk of hypersensitivity reactions (HRs). Although Hymenoptera venoms are the predominant triggers, cases of contrast media-induced HR (CMIHR) have also been reported and prophylactic premedication is often performed. However, data from larger series are limited and differences between indolent and advanced SM have not yet been investigated.To determine the incidence and severity of CMIHR in all subtypes of SM.We analyzed 162 adult patients with SM (indolent systemic mastocytosis [ISM], n = 65; advanced systemic mastocytosis [advSM], n = 97). First, the cumulative incidence of CMIHR was retrospectively assessed in the patient's history. Second, at our institution, patients underwent 332 contrast media (CM)-enhanced imaging including 80 computed tomography (CT) scans with iodine-based contrast agent and 252 magnetic resonance imaging (MRI) with a gadolinium-based contrast agent, and tolerance was assessed.Previous CMIHRs to CT (vomiting, n = 1, erythema, n = 1, cardiovascular shock, n = 1), and MRI (dyspnea, n = 1, cardiovascular shock, n = 1) had been reported by 4 out of 162 (2.5%) patients (ISM, n = 3; advSM, n = 1). In contrast, during or after 332 CM-enhanced CT or MRI examinations at our institution, no CMIHRs were reported. Premedication was solely given to 3 patients before CT scans, including 1 with previous CMIHR, who tolerated the imaging well.We conclude that: (1) there is a substantial discrepancy between the perception and prevalence of HRs to CM in SM; (2) reactions are scarce in ISM and even rarer in advSM; and (3) in SM patients without previous history of CM hypersensitivity, prophylactic premedication before CM-enhanced CT or MRI is dispensable.

Rationale and Objective This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. Methods PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. Results After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64–0.69), 0.78 (CI: 0.76–0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80–18.43), 0.31 (CI: 0.22–0.44), and 3.87 (CI: 2.83–5.29), respectively. Conclusion Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.