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Liquid two-phase flow has been studied widely by many authors. Two phase flow exist in petroleum industries, nuclear power generation and chemical plants. In the present study a review on two phase flow such as oil/water was discussed, also the patterns of the flow and types of measurement are presented. Also a review on the new trends using the computational fluid dynamic (CFD) to predict the liquid-liquid two phase are viewed.

Background Obesity is a risk factor for gallstone formation, which can be exacerbated by bariatric surgery-induced rapid weight loss. Current guidelines do not recommend concomitant cholecystectomy (CC) for asymptomatic gallstones during the bariatric surgery procedure. However, long-term follow-up studies have shown that the incidence of post-bariatric surgery symptomatic gallstones necessitating therapeutic cholecystectomy increases to 40%. Therefore, some surgeons advocate simultaneous cholecystectomy during the bariatric surgery for asymptomatic individuals. This study aims to evaluate the safety of performing cholecystectomy for asymptomatic gallstones during the bariatric procedure. Methods Data from a consecutive series of patients that underwent primary laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB) or conversion of LSG to a LRYGB with or without concomitant cholecystectomy for asymptomatic gallstones between Jan 2010 and Dec 2017 were retrieved from the database. The primary endpoint was the complication rate. Secondary endpoints were the surgical operating room time (ORT) and the length of hospital stay (LOS). Results Out of the 2828 patients who were included, 120 patients underwent a concomitant cholecystectomy during their bariatric procedure (LSG or LRYGB) for asymptomatic gallbladder stones and were compared to the 2708 remaining patients who only had bariatric surgery. None of the concomitant cholecystectomy patients developed a gallbladder-related complication. There was no significant increase in the rate of minor or major complications between the CC groups and the non-CC groups (LSG: 6.7% vs. 3.2%, p=0.132; LRYGB: 0% vs. 2.3%, p =0.55; and conversion of LSG to LRYGB: 20% vs. 7.1%, p = 0.125, respectively). In addition, there was no significant increase in the length of hospital stay (1.85 ±4.19 days vs. 2.24 ±1.82, p=0.404) for LSG group and (1.75 ±2.0 vs. 2.3 ±2.1, p=0.179) for LRYGB group. Adding the cholecystectomy to the bariatric procedure only added an average of 23 min (min) (27 min when added to LSG and 18 min when added to LRYGB). Conclusion As one of the largest series reviewing concomitant cholecystectomy in bariatric surgery, this study showed that in skilled laparoscopic bariatric surgical hands, concomitant cholecystectomy during bariatric surgery is safe and prevents potential future gallstone-related complications. Long-term large prospective randomized trials are needed to further clarify the recommendation of prophylactic concomitant cholecystectomy during bariatric surgery.

Inhibition of luteinizing hormone (LH) by gonadotropin releasing hormone (GnRH) antagonist may lead to suboptimal response during ovarian stimulation. In addition, several studies suggest that low level of LH is associated with lowered fertilization and implantation rate and increased early pregnancy loss rate. The aim of this study is to study the effect of adding low dose human chorionic gonadotropin (hCG - 200 IU), as an LH supplement, to recombinant follicle stimulating hormone (rFSH) in a GnRH antagonist cycles in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Sixty-three infertile women undergoing IVF were randomly divided into two groups. One group was stimulated with the conventional stimulation protocol (rFSH alone), while the second group received 200 IU hCG in addition to rFSH in the late follicular phase (hCG + rFSH). Both groups' results including pregnancy rate, total dose of rFSH required, duration of stimulation, endometrial thickness, oocytes and embryos characteristic, serum hormone levels (Testosterone, Estradiol, Progesterone, and LH) and level of epidermal growth factor (EGF) were compared. The results show that pregnancy rate among the group of women who received the low dose hCG was higher than those who did not receive hCG. However, this difference did not reach statistical significance. Furthermore, other cycle outcomes and hormonal values were comparable between the two stimulation protocols.

BACKGROUND: Due to the rise in the number of deaths, the hepatitis C virus remains a public health issue worldwide. During the recovery period, cytokines are known as indicators of chronic liver infection. AIM: In this study, immunological parameters were measured and calculated in chronic hemodialysis patients after more than 6 months of drug administration. METHODS: We have picked 60 patients with hemodialysis who are anti-HCV positive. ELISA and the calculation of alkaline phosphatase (ALP) were used to evaluate IP-10 and IFN-γ. RESULTS: A substantial association between variables and infected cases was found. No worth was considered for genders or age categories. CONCLUSIONS: The serum IP-10 level can be a warning primarily for patients who have taken a variety of prescriptions intermittently. In both the RPT and RST cohorts, IFN-γ serum levels are usually elevated. Serum level ALP is not a particular chronic HCV predictor.

The crosstalk between a receptive endometrium and a functional blastocyst during human embryo implantation is crucial for conception. Because platelets rich plasma (PRP) with concentrated platelets 4-5 times higher than normal, when release of granules containing growth factors including VEGF, TGF, PDGF, IGF, and EGF, these factors involved for sub endometrial angiogenesis and endometrial receptivity. 44 women under the age of 40 were given antagonist ovarian stimulation treatments, the oocytes were harvested utilizing 2-D power doppler ultrasound guidance, then ICSI done for them. On the hCG day all had an intrauterine autologous PRP infusion. Power Doppler is utilized to measure endometrial thickness (EnT), pulsatility index (PI), and resistance index (RI) of sub endometrial arteries, as well as serum levels of VEGF and EGF were measured on the hCG day and ovum pickup (OPU). The ultrasound findings, on the hCG day compared to those of OPU in all women with intrauterine infused autologous PRP were highly significant (HS). The mean EnT, RI, PI, VEGF and EGF at OPU day was lower than that on hCG day in a HS manner, with (p < 0.001), (p < 0.001), (p = 0.047), (p < 0.001), and (p < 0.001) respectively. These characteristics were shown to be significantly and independently associated to intrauterine PRP infusion. After PRP injection, both growth factors serum levels (VEGF and EGF) increased, and ultrasonography sub-endometrial metrics such as EnT, RI, and PI changed as the thickness grew while vascular resistance decreased, and all considered as predictors of endometrial receptivity.

In recent years increasing evidence proposed that local immune cells at implantation site have largely contributed to embryo implantation. The intrauterine infusion of activated peripheral blood mononuclear cells culture 2 days before embryo transfer can enhance the implantation. One of the methods used to evaluate the endometrial receptivity is by assessing the sub endometrial blood flow. A total of 67 infertile women (30) women receives intrauterine non-invasive insemination of peripheral blood mononuclear cells (PBMC) culture 2 days before embryo transfer representing the PBMC test group, and (37) women without receiving any cell as Non-PBMC group. The cultured PBMC are administered into the uterine cavity of the patients. 2 days later, embryos are transferred into the uterine cavity. Endometrial thickness and sub-endometrial blood flow measurements are taken for all cases on trigger and embryo transfer days. On embryo transfer day there was no significant difference (p = 0.770) in mean endometrial thickness between the PBMC group and Non-PBMC group. There was a significant difference (p< 0.001) in the mean resistive index; the level being lower in the PBMC group. Moreover, there was a significant difference (p< 0.001) in the mean pulsatility index. Regarding all enrolled women, the pregnancy rate of 25.4 %, the rate was higher in the PBMC group in comparison with the Non-PBMC group, 43.3 % versus 10.8 %, respectively and the difference was significant (p = 0.002). The use of PBMC culture can improve sub-endometrial.

A cross-sectional observational study was conducted on 213 patients with COVID-19 who did not have a clinical history of diabetes at hospital admission. One week after hospitalization, they were stratified by random blood glucose levels. It was found that 25.4, 22.5 and 52.1% of COVID-19 patients were classified as normoglycemia, prediabetes and diabetes, respectively. The study indicated that diabetes may be a risk factor for COVID-19 or the disease may be associated with an increased risk of developing diabetes.

Durvalumab (IMFINZI®), a fully human monoclonal antibody against programmed cell death-ligand 1 (PD-L1), is approved for use in combination with etoposide and either carboplatin or cisplatin for the first-line treatment of patients with extensive-stage small cell lung cancer (ES-SCLC). In the pivotal phase III CASPIAN trial in previously untreated adults with ES-SCLC, the addition of durvalumab to chemotherapy for up to 4 cycles followed by maintenance durvalumab was associated with a significantly longer overall survival and a favourable hazard ratio for progression-free survival compared with chemotherapy alone for up to 6 cycles. A higher proportion of patients in the durvalumab plus chemotherapy group had an objective response compared with the chemotherapy alone group. The efficacy of durvalumab was also sustained with longer follow-up. Durvalumab in combination with etoposide and either carboplatin or cisplatin had a manageable tolerability profile in patients with ES-SCLC. Given the available evidence, durvalumab in combination with etoposide and either carboplatin or cisplatin represents a valuable treatment option for the first-line treatment of patients with ES-SCLC, and is an accepted standard of care option in this setting. Supplementary Information The online version contains supplementary material available at 10.1007/s11523-021-00843-0., Plain Language Summary Small cell lung cancer (SCLC) is the most aggressive form of lung cancer; extensive-stage (ES) disease, which accounts for about two-thirds of all SCLC, is associated with high relapse rates and a poor prognosis. Expression of programmed cell death-ligand 1 (PD-L1) on both tumour cells and tumour-associated immune cells is an adaptive immune response that helps tumour cells avoid detection and subsequent elimination by the immune system. Durvalumab (IMFINZI®) is a fully human monoclonal antibody against PD-L1, which blocks the interaction of PD-L1 with its receptors, thus enhancing anti-tumour immune responses. When used in combination with chemotherapy (etoposide and either carboplatin or cisplatin) in adults with untreated ES-SCLC, durvalumab prolonged overall survival compared with chemotherapy alone; the improvements in overall survival were also maintained with additional follow-up. The tolerability profile of durvalumab in combination with chemotherapy was manageable in patients with ES-SCLC. Durvalumab in combination with chemotherapy is an effective and valuable treatment option for previously untreated patients with ES-SCLC. Supplementary Information The online version contains supplementary material available at 10.1007/s11523-021-00843-0.

Green technique or chemical co-precipitation technique has been employed to synthesize the MgZnFe2O3, CoZnFe2O3 and NiZnFe2O3 quaternary alloys nanoparticles. The structural properties are investigated by X-ray diffraction (XRD) to determine structural parameters and crystallite size. XRD peaks index numbers and intensities are varied with the atomic number. The study of morphology for the mentioned quaternary alloys nanoparticles is analyzed by scanning electron microscopy (SEM) to measure the grain size. The optical properties are investigated via ultraviolet–visible (UV–vis) and Fourier-transform infrared spectroscopy (FTIR) to reveal the changing of absorption, transmission, reflection and bandgap as the atomic number changes for verifying optical dielectric constant and refractive index models. The obtained results suggest that MgZnFe2O3, CoZnFe2O3 and NiZnFe2O3 quaternary alloys nanoparticles are very suitable for potential application in optoelectronics and antibacterial treatment.

Wireless Sensor Networks (WSNs) have a wide range of applications in human life. Accordingly, WSNs have beenthoroughly considered in research community to improve their performance and address their challenges. Eventreporting in WSNs has always been a major challenge in terms of energy consumption. Event reporting requiressensing the event and sending a reporting packet from the sensor to the centralized base station (BS). However,sensor’s energy is limited and stored in a non-rechargeable battery. Therefore, several event-reporting (or datacollection) protocols have been proposed to improve energy consumption in WSNs, and consequently, to extendtheir lifetime. In this paper, we propose an efficient event reporting protocol for WSNs called Event ReportingProtocol Based on Distributed Data Aggregation (ERP-DDA). This protocol mainly aims at reporting any event byno more than one sensor node such that energy saving is satisfied in the whole network. To achieve this goal, ERPDDAis mainly based on the following features: it is a cluster-based protocol, it is a multi-hop routing protocol, itapplies distributed data aggregation, and it employs variable clustering and cluster head selection. Simulationsshow that ERP-DDA significantly extends the lifetime of WSNs compared with other related protocols.

Metyrapone (Metopirone®), a pyridine derivative, is a useful treatment option for the management of patients with endogenous Cushing’s syndrome, based on evidence from more than six decades of its use in clinical practice, prospective and retrospective studies, as well as case reports. Metyrapone is associated with a rapid onset of action and is effective in reducing cortisol levels and improving clinical and/or biochemical features and cortisol-related comorbidities of Cushing’s syndrome. The efficacy of metyrapone was demonstrated in all aetiologies of the condition, when used in a range of clinical settings (including presurgery treatment and when used in combination with other drugs) and in the short and long term. Metyrapone is generally well tolerated when used in the treatment of patients with endogenous Cushing’s syndrome, with gastrointestinal adverse events being the most commonly reported. Endogenous Cushing’s syndrome is a rare disease, resulting from cortisol hypersecretion, and is associated with substantial morbidity and mortality. Surgery is the mainstay treatment for the majority of patients with Cushing’s syndrome; however, medical therapy is increasingly being used, particularly when surgery is not indicated or is unsuccessful, or while waiting for radiotherapy to be effective. Oral metyrapone (Metopirone®), a pyridine derivative, is approved for the management of endogenous Cushing’s syndrome in the EU. Evidence for the efficacy of metyrapone in the treatment of Cushing’s syndrome has been demonstrated in prospective and retrospective studies. Metyrapone has a rapid onset of action (≈ 2 h), reduces cortisol levels, improves the clinical and/or biochemical features and cortisol-related comorbidities of the disease, and demonstrates sustained efficacy in the long term; the efficacy of metyrapone is evident in a range of clinical settings. Metyrapone is generally well tolerated in patients with endogenous Cushing’s syndrome. Given its efficacy and tolerability profile, metyrapone is a useful treatment option for the management of patients with endogenous Cushing’s syndrome.

Objectives To describe the epidemiological characteristics of the first 69,382 patients with COVID-19 infection in Oman. Methods A retrospective case series study of patients diagnosed with SARS-CoV-2 infection in Oman from 24 February to 23 July 2020. The data were obtained from the National surveillance COVID-19 network. Results The overall mean age of patients was 34 (± 14) years, 74% (n = 51,391) were males, 40,859 (59%) were Omani citizens, and 28,523 (41%) were foreign-born individuals. The most common symptoms at presentation were fever 50% (n = 34,600), cough 46% (n = 32,062), sore throat 46% (n = 31,953) and shortness of breath (SOB) 35% (n = 24,567). Overall, 8,960 (12.9%) patients required hospitalization with 1189 (13.3%) individuals requiring admission to the intensive care unit (ICU) and mechanical ventilation (MV). Patients hospitalized with COVID-19 infection were mostly Omani nationals and males between 30 and 39 years old (p n = 359) with rates of 9.4 (n = 278) and 4.8 (n = 81) deaths per 100,000 population in Omani nationals and foreign-born individuals, respectively. Females hospitalized with COVID-19 had a mean age of 64 (± 18) years versus a mean age of 55 (± 17) years in males. Mean age of patients with COVID-19-related mortality was 58 (± 18) years with significant differences in mean age between females and males 64 (± 18) versus 55 (± 17) years, respectively. Conclusions Young Omani males accounted for the highest incidence of COVID-19 infection and hospitalization, while mortality rates were higher among males and the older age (> 50 years). Identifying the epidemiological characteristics and outcomes of COVID-19-infected patients is essential for developing targeted intervention strategies and preparing for the resurgence of anticipated second and third waves of this pandemic.

Accurate estimation of air transport demand is vital for airlines, related aviation companies, and government agencies. For example, both short-term and long-term business plans of airlines require accurate forecasting of future air traffic flows. This study aims to forecast the volume of air passengers in Kuwait International Airport (KIA), which is in the state of Kuwait. Using monthly air traffic volume data between January 2012 and December 2018, this study focuses on the modelling and forecasting the number of air passengers in KIA. A wide range of time series forecasting models are considered in this research, including autoregressive-integrated-moving average model (ARIMA), exponential smoothing with errors term (ETS), Holt-Winters exponential smoothing, neural network autoregression (NNAR), hybrid and Bayesian structural time series (BSTS), and a hybrid model. The forecasting performance of these models are compared using multiple train-test splits where the models are fitted on the training sets and evaluated on the test sets. The mean absolute percentage error (MAPE) is used to compare the performance of various models. Empirical analysis suggests that the BSTS model compares favorably against the other time series models in its ability to forecast complex time series. The BSTS model may be applied to study other complex time series forecasting problems with irregularity.

The complement system represents an innate immune response consisting of a protein network. Over-activation of the complement system plays an important role in inflammation, tissue damage, and infectious disease severity. The prevalence of MERS-CoV in Saudi Arabia remains significant and cases are still being reported. The role of complement in Middle East Respiratory Syndrome coronavirus (MERS-CoV) pathogenesis and complement‐modulating treatment strategies has received limited attention, and studies involving MERS-CoV-infected patients have not been reported. This study offers the first insight into the pulmonary expression profile including Seven complement proteins including complement regulatory factors during MERS-CoV infection. We also measured the expression of lung neutrophil chemoattractant chemokine IL-8 (CXCL8) and RANTES (CCL5). Our results significantly indicate high expression levels of complement anaphylatoxins (C3a and C5a), IL-8, and RANTES in the lungs of MERS-CoV-infected patients. The upregulation of lung complement anaphylatoxins, C5a and C3a, was positively correlated with IL-8, RANTES and the fatality rate. Our results also showed upregulation of the positive regulatory complement factor P (properdin), suggesting positive regulation of the complement during MERS-CoV infection. In addition, we also demonstrated that a high viral load in all patients with MERS-CoV correlated with C5a and C3a levels. Pulmonary complement mediators, disease severity, and an increased fatality rate may be linked to the degree of complement activation against MERS-CoV. High levels of lung C5a, C3a, factor P, IL-8 and RANTES may contribute to the immunopathology, disease severity, ARDS development, and a higher fatality rate in MERS-CoV-infected patients. These findings highlight the potential prognostic utility of C5a, C3a, IL-8 and RANTES as biomarkers for MERS-CoV disease severity and mortality. To further explore the functional partners (protiens) prediction of highly expressed proteins (C5a, C3a, factor P, IL-8 and RANTES), the computational protein–protein interaction (PPI) network was constructed, and six proteins (hub nodes) were identified.

Efforts were made in this search to design a physical and computer model using the CFD techniques to simulate the problem of transporting pollutants through a porous media in unsteady state case. A physical model was built to measure the transmission of a copper nitrate pollutant at an initial concentration of 25 mg/l in a medium consists of (sand + gravel) and study the movement of the pollutant through. Then the results of the pollutant transport through used in the physical model were entered as entry data to the CFD simulated model using COMSOL 5.4. Software. The results of the CFD simulated model showed that the change in the inlet velocity to more than 20% of the initial velocity increases the pollutant concentration and reduces the time wanted to reach the highest value of the pollutant, while reducing the inlet velocity to less than 20% of the initial velocity, cause to decrease the concentration and increase the time to reach the highest pollutant value. When changing the porosity by (30%, -15%) of the initial porosity, it was noticed that increasing the porosity value reduces the pollutant concentration and increases the time required to reach the highest value of the pollutant. while when the porosity decreases to 15% of the initial porosity, the concentration increases the time decreases to reach the highest value of the pollutant at all control points. The adsorption factor has a noticeable effect on the emergence of the pollutant, while the temperature change was almost imperceptible for all degrees. However, the results of laboratory work were compared with the results of the CFD simulated model, which showed a good match between them.

The benefit of using a weir is that it allows flowrates to be measured and controlled in open channels and streams. The objectives of this research are: (1) to specify a suitable crest depth position as a control section for estimating the flowrate above a curved crump weir at ten different longitudinal slopes and (2) to compare the proposed flowrate versus measured and computational fluid dynamics (CFD)-simulated flowrates. In this research, the crest point of the curved crump weir was considered to be a control section, relating to the critical depth as a function of the crest depth. Experiments with eight different laboratory flowrates of flume were proposed at ten different channel slopes ranging from 0.0 to 2.5%. Statistical analysis of linear regression indicated that the relationship between critical depth and crest depth is 0.913 on average. Based on this finding, a new equation was derived to predict the discharge over the crump weir, which indicated an excellent match compared to the practical and CFD-simulated results (a maximum differences of 4% based on several standard error indexes and a one-way ANOVA). The CFD technique was performed to simulate the velocity and flow pattern of the curve crump weir based on the volume of fraction method. Six selective sections were tested along the flume with a total length of 1.36 m for a case study of 0.912 m3/h flowrate and zero bed slope to investigate and describe the water surface profile. The statistical analysis indicated insignificant differences between the measured and simulated water surface profiles, with a maximum difference of less than 15% observed at the section located at 0.69 m, while the average difference was 4.86% for all sections.

Integrase strand transfer inhibitors (INSTIs) bictegravir, dolutegravir, cabotegravir, elvitegravir and raltegravir, mostly available as fixed dose combinations are recommended treatments in both newly diagnosed and treatment-experienced patients with HIV. Their efficacy, good tolerability and simplified dosing regimens facilitate treatment adherence and a recently approved cabotegravir 4-weekly injection is a major advance.

Drilling operation is considered an extremely high-cost business within the petroleum industry. The cost of drilling fluid represents 15–30% of drilling operations. Measurements of all drilling mud properties were conducted in aged and fresh conditions. Furthermore, high pressure and temperature (HTHP) API filtration experiments were executed, as well. The findings were used as a reference comparative point for three concentrations of peanut shell powder (PSP) to comprehend the influence of various concentrations of PSP on the characteristics of spud mud. The findings of this experimental research revealed that the cheap and biodegradable PSP can be exploited as a new multi-role additive to develop filtration and viscosity under surface and sub-surface conditions. Moreover, the study findings demonstrated the suitability of PSP to replace or at minimum substitute traditional and non-degradable chemicals used in the petroleum industry (e.g., lignosulfonate, chrome-lignosulfonate, resinex, etc.). In addition to the benefit of using PSP as a multifunctional additive, it is cheap, easy to prepare, locally available and attainable in large quantities, and friendly to the environment. In summary, PSP has a possibility to be applied in the oilfield as it withstood 79 °C (175 °F) temperature and 30 h of aged time. The application of PSP in the drilling process can mitigate the detrimental impacts of the non-biodegradable conventional chemical materials on personal health safety and the environment in addition to decreasing the overall cost.

Software engineering, a fairly recent engineering discipline, is still evolving without a wide consensus on a body of fundamental principles as in traditional engineering fields with their own long-established principles originating from physics, chemistry and mathematics. This paper reports on a systematic mapping study (SMS) that identified 30 papers and books from 1969 to January 2020, each proposing their own sets of software engineering principles (SEP). Within these studies a total of 592 SEP were proposed, these studies were reviewed and classified on the basis of four mapping questions examining publication trends, use of explicit criteria for the proposed SEP, whether authors clearly described a methodology to come up with the proposed SEP, and the applicability of SEP throughout the development process. The key finding in this study are: a) the majority of the studies were published over two decades from 1989 to 2009, and then the publication rate slowed in the following decade; b) the largest number of SEP, by far, was proposed by Davis; c) only six studies used explicit criteria to identify their proposed SEP, and the other 24 studies identified their principles based on their own analysis without traceability to a methodology or selection criteria; d) most authors did not identify which principles to use in specific contexts of the software engineering domain; e) only two studies used some of the proposed SEP throughout the software development process.

Background: Depression during pregnancy occurs more often than most people realize. Early detection of depression during pregnancy is critical because depression can adversely affect birth outcome and neonatal health. Mental health care during pregnancy is a serious public health issue. Objectives: to estimate the prevalence of antepartum depression and its effects on pregnancy outcome; among pregnant women in the last trimester,living in rural Egypt. Methods: the first part of the study was cross sectional; to assess the prevalence of antepartum depression. This was followed by a prospective part to detect the effects of antepartum depression on the outcome of pregnancy. The sample size was 300 consented women. A structured interview questionnaire was designed including socio-demographic and economic data, obstetric history, and neonatal information. Hamilton Rating Scale was used to detect the prevalence and level of Depression Results: 68.7% of sampled women suffered from antepartum depression. The incidence of low birth weight was (4%), and about one fifth of babies were admitted in NICU in the first month. Death in first month of life was (3%). The only significant predictor of unfavorable birth outcome using logistic regression was depression level. Females with severe depression were 9.43 at higher risk to have unfavorable birth outcome than normal ones. Also females with moderate depression had 1.4 higher risk to have unfavorable birth outcome than females without depression. Conclusion: (68.7%) of women suffered from depression during pregnancy. Increasing level of depression was significantly associated with adverse birth outcome. Key Words: depression, pregnancy, mental health, ANC, neonatal health.

The paper aims to find out the best plane location of a construction company headquarter for n construction sites, and reducing the maintenance cost of the vehicles working between the headquarters and the sites to the lowest cost possible. The total traveled distance of all possible locations is calculated, by assuming each location in two ordinations (x, y). MATLAB software is used to generate an accurate model and calculations of each point presenting a construction site. The results found different models of different cases of locations with a variety of coordination. The results showed that a programmed model can solve many problems related to cost management in construction sites for any given organization. The model was successfully used to lower (theoretically) the cost of the used vehicles from and into the location sites and the headquarter of the company. Accordingly, the company can conclude some cost-effective factors, which aid in deciding on the necessity of road quality pavement.

Encorafenib (Braftovi®) is an oral small molecule BRAF inhibitor used in combination with cetuximab for the treatment of adult patients with metastatic colorectal cancer (mCRC) with a BRAF V600E mutation, who have received prior systemic therapy. In a clinical trial in adults with BRAF V600E-mutated mCRC who had disease progression after one or two previous regimens (BEACON CRC), encorafenib plus cetuximab was associated with a significantly longer median overall survival (OS), a higher objective response rate (ORR) and longer median progression-free survival (PFS), compared with standard therapy. Encorafenib plus cetuximab had a manageable tolerability profile in BEACON CRC. Current evidence suggests that encorafenib plus cetuximab combination therapy is an important targeted regimen for patients with mCRC and a BRAF V600E mutation who have received prior therapy.

Objectives: To translate the pregnancy physical activity questionnaire (PPAQ) into Arabic language, cross-culturally adapt and test its reliability and validity among Saudi pregnant women. Methods: Pregnancy physical activity questionnaire, which consisted of 36 items, was translated to Arabic following the World Health Organization’s guidelines for tool translation (forward translation, expert panel and back translation, pretesting and cognitive interviewing, and final version), followed by validation by experts. This is a cross-sectional study and data were collected from 118 healthy pregnant Saudi women from May to June 2019. Validity included content validity indices (CVI) and construct validity by Rasch analysis. Reliability was assessed by test-retest reliability and Cronbach’s alpha coefficient. Results: The mean age of the participants was 30.15 ± 5.59 years; 38.2% of them had normal pre-gestational body mass index (n=45). The median of total energy expenditure in physical activity was 356.1 METs.h/week (IQR=162.3-648.3). Item content validity index was good ranging between 0.8-1. Rasch analysis showed good construct validity and excellent reliability for all types of physical activity (>0.89). Conclusion: This Arabic PPAQ is a reliable and valid tool that can be used in Arab countries.

Komal Naeem,1,2,* Lina Tariq Al Kury,3 Faiza Nasar,1,* Abdullah Alattar,4 Reem Alshaman,4 Fawad Ali Shah,1 Arif-ullah Khan,1 Shupeng Li2 1Department of Pharmacology, Faculty of Pharmaceutical Sciences, Riphah International University, Islamabad, 747424, Pakistan; 2State Key Laboratory of Oncogenomics, School of Chemical Biology and Biotechnology, Shenzhen Graduate School, Peking University, Shenzhen, 518000, People’s Republic of China; 3College of Natural and Health Sciences, Zayed University, Abu Dhabi, 49153, United Arab Emirates; 4Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Tabuk, Tabuk, 71421, Saudi Arabia*These authors contributed equally to this workCorrespondence: Fawad Ali ShahDepartment of Pharmacology, Faculty of Pharmaceutical Sciences, Riphah International University, 7th Avenue, Sector G-7/4, Islamabad, 747424, PakistanTel +92-51-2891835-38Fax +92-51-2891471Email fawad.shah@riphah.edu.pkShupeng LiState Key Laboratory of Oncogenomics, School of Chemical Biology and Biotechnology, Shenzhen Graduate School, Peking University, Shenzhen, 518000, People’s Republic of ChinaEmail lisp@pku.edu.cnPurpose: Major depressive disorder (MDD) is a debilitating human health condition characterized by mood swings and is associated with a high probability of suicide attempts. Several studies have reported a role of neuroinflammation in MMD, yet the efficacy of natural drug substances on neuroinflammation-associated depression has not been well-investigated. The present study examined the neuroprotective effects of carvacrol on lipopolysaccharide (LPS)-induced neuroinflammation, depression, and anxiety-like behavior.Methods: Male Sprague Dawley rats were divided into two experimental cohorts to determine the effects and the effective dose of carvacrol (whether 20 mg/kg or 50 mg/kg), and further demonstrate the mechanism of action of nuclear factor E2-related factor (Nrf2) in depression.Results: We found marked neuronal alterations in the cortex and hippocampus of LPS-intoxicated animals that were associated with higher inflammatory cytokine expression such as cyclooxygenase (COX2), tumor necrosis factor-alpha (TNF-α), and c-Jun N-terminal kinase (p-JNK). These detrimental effects exacerbated oxidative stress, as documented by a compromised antioxidant system due to high lipid peroxidase (LPO). Carvacrol (20 mg/kg) significantly reverted these changes by positively modulating the antioxidant gene Nrf2, a master regulator of the downstream antioxidant pathway. To further investigate the role of Nrf2, an inhibitor of Nrf2 called all-trans retinoic acid (ATRA) was used, which further exacerbated LPS toxicity with a higher oxidative and inflammatory cytokine level. To further support our notion, we performed virtual docking of carvacrol with the Nrf2-Keap1 target and the resultant drug-protein interactions validated the in vivo findings.Conclusion: Collectively, our findings suggest that carvacrol (20 mg/kg) could activate the endogenous master antioxidant Nrf2, which further regulates the expression of downstream antioxidants, eventually ameliorating LPS-induced neuroinflammation and neurodegeneration.Keywords: depression, neuroinflammation, Nrf2 pathway, lipopolysaccharide, carvacrol, neurodegeneration

Objectives: The present research aimed to find an association between infection by Helicobacter pylori and vitamin D deficiency in type 2 diabetes mellitus among Iraqi individuals attending Al-Yarmouk Teaching Hospital. Methods: According to fasting blood glucose, the samples were divided into a non-diabetic group with ten diabetic individuals and a diabetic group with thirty individuals. Results: The anti-H. Pylori (IgG) levels were 86.77± 58.62 NTU/µL in diabetic patients compared with 10.12 ± 7.40 NTU/µL in non- diabetic group. Vitamin D levels were decreased significantly in infected patients compared to non-infected subjects. Conclusion: The H pylori-infected patients have recorded the lowest level of vitamin D than non-infected individuals.

The effect of fabrics on common atopic dermatitis (AD) is significant, but studies are sparse. Current evidence suggests ubiquitous cotton and silk do not exacerbate AD; like superfine wool, they may improve it. Coarse and/or occlusive fabrics like wool, nylon, acetate and most polyesters are not recommended. Newer manufactured options like lyocell and antimicrobial silver-impregnated textiles are promising. All these fabrics need further study in AD.

Kainic acid (KA) induced epileptic seizures in mice is a commonly used experimental model of epilepsy. Previous studies have suggested the roles of various neurotransmitters and oxidative stress in KA-induced seizures. An important role of hypothyroidism has also been suggested in epilepsy. Thiamazole (TZ) is an anti-hyperthyroid drug with antioxidant property. This study reports the effect of TZ on KA-induced epileptic seizures in mice, produced by intraperitoneal (IP) injection of KA (18 mg/kg). Prior to KA injection, the animals were treated with TZ (12.5, 25 and 50 mg/kg IP). Our results showed that in KA alone group, about half of the animals developed seizures. Pre-treatment of mice with TZ significantly increased the frequency of seizures in dose-dependent manner. Administration of TZ significantly reduced the latency time and aggravated the severity of seizures. TZ also increased the mortality in KA-treated mice. Striatal dopamine and serotonin levels were markedly increased in KA alone treated mice, which were not significantly affected by TZ treatment. Among the indices of oxidative stress, we observed a significant reduction in cerebral vitamin E whereas the levels of cerebral malondialdehyde and conjugated dienes were significantly increased in animals with high severity of seizures. In conclusion, TZ potentiated the frequency and severity of experimental seizure in mice. There is a possibility of altered metabolism of KA in presence of TZ that might have potentiated the toxicity of KA. These findings suggest a caution while administering anti-hyperthyroid drugs in epileptic seizures.

This study aimed to estimate rice farms efficiency using qualitative response models. The survied field included three districts in Najaf (Al Mishkhab, Al Hirah, Al Manadhira) during agricultural season 2017, including a random sample of 80 farms, representing 7.5% of the total farms. To achieve the goals, analysis was divided into two stages, the first stage was measuring the economic efficiency according to entry guidance of rice farms, while the second stage involved the analysis of factors affecting the economic efficiency of rice farms using the binomial logistic regression model to obtain a mathematical relationship between the dependent variable (response variable), which represents the economic efficiency of rice farms and the independent variables represented by age, experience and education of the owners , geographical area and type of possession for the farms. DEAP software was used to estimate economic efficiency and SPSS software to analyze the logistic regression of the factors affecting economic efficiency. The results showed that the average economic efficiency according to the Economic efficiency was 66.7%, which means that rice farmers can obtain the same production using 66.7% of the total costs i.e. there is a 33% waste in economic resources in the research sample.The logistic regression results indicated that each of experience (more than 35 years), education (university degree) and farm area (greater than 15 dunums) had a significant effect on the efficiency of the rice crop farms.

Biotherapeutics are highly efficacious, but the pain and inconvenience of chronic injections lead to poor patient compliance and compromise effective disease management. Despite innumerable attempts, oral delivery of biotherapeutics remains unsuccessful due to their degradation in the gastrointestinal (GI) environment and poor intestinal absorption. We have developed an orally ingestible robotic pill (RP) for drug delivery, which protects the biotherapeutic drug payload from digestion in the GI tract and auto-injects it into the wall of the small intestine as a safe, pain-free injection since the intestines are insensate to sharp stimuli. The payload is delivered upon inflation of a balloon folded within the RP, which deflates immediately after drug delivery. Here we present results from two clinical studies demonstrating the safety, tolerability and performance of the RP in healthy humans. In the first study, three versions of the RP (A, B and C) were evaluated, which were identical in all respects except for the diameter of the balloon. The RP successfully delivered a biotherapeutic (octreotide) in 3 out of 12 subjects in group A, 10 out of 20 subjects in group B and 16 out of 20 subjects in group C, with a mean bioavailability of 65 ± 9% (based on successful drug deliveries in groups A and B). Thus, reliability of drug delivery with the RP ranged from 25 to 80%, with success rate directly related to balloon size. In a separate study, the deployment of the RP was unaffected by fed or fasting conditions suggesting that the RP may be taken with or without food. These promising clinical data suggest that biotherapeutics currently administered parenterally may be safely and reliably delivered via this versatile, orally ingestible drug delivery platform. Graphical abstract

Background The prevalence of diagnosed chronic hepatitis C virus (HCV) infection among pregnant women in the Netherlands is 0.26%, yet many cases remain undiagnosed. HCV screening and treatment of pregnant HCV carriers could reduce the burden of disease and limit vertical transmission from mother to child. We assessed the impact of HCV screening and subsequent treatment with new direct-acting antivirals (DAAs) among pregnant women in the Netherlands. Methods An HCV natural history Markov transition state model was developed, to evaluate the public-health and economic impact of HCV screening and treatment. Besides all 179,000 pregnant women in the Netherlands (cohort 1), we modelled 3 further cohorts: all 79,000 first-time pregnant women (cohort 2), 33,000 pregnant migrant women (cohort 3) and 16,000 first-time pregnant migrant women (cohort 4). Each cohort was analyzed in various scenarios: i no intervention, i.e., the current practice, ii screen-and-treat, i.e., the most extensive approach involving treatment of all individuals found HCV-positive, and iii screen-and-treat/monitor, i.e., a strategy involving treatment of symptomatic (F1–F4) patients and follow-up of asymptomatic (F0) HCV carriers with subsequent treatment only at progression. Results For all cohorts, comparison between scenarios (ii) and (i) resulted in ICERs between €9,306 and €10,173 per QALY gained and 5 year budget impacts varying between €6,283,830 and €19,220,405. For all cohorts, comparison between scenarios (iii) and (i) resulted in ICERs between €1,739 and €2,749 per QALY gained and budget impacts varying between €1,468,670 and €5,607,556. For all cohorts, the ICERs (scenario iii versus ii) involved in delayed treatment of asymptomatic (F0) HCV carriers varied between €56,607 and €56,892, well above the willingness-to-pay (WTP) threshold of €20,000 per QALY gained and even above a threshold of €50,000 per QALY gained. Conclusion Universal screening for HCV among all pregnant women in the Netherlands is cost-effective. However, it would be reasonable to consider smaller risk groups in view of the budget impact of the intervention.

Heat-related illnesses (HRIs), mainly heat exhaustion (HE) and heat stroke (HS), are characterized by an elevation of core body temperature. In this study, we aimed to explore the HRIs' types and patient characteristics among a sample taken from various representative in-field points in the Hajj season. A cross-sectional study was conducted in 2018 at 80 data collection points distributed in the field. Data related to demographics, features and risk factors were collected and analyzed from all encountered cases with suspected HRIs. Moreover, we developed a diagnostic tree for HRIs by using the XGBoost model. Out of the 1200 persons encountered during the study period, 231 fulfilled the criteria of HRIs spectrum and were included in this study. Around 6% had HS and 20% had HE. All HS cases (100%) were from outside of Saudi Arabia as compared with 72.5% diagnosed with HE (27.5% were from Saudi Arabia). In addition, 16% were considered as heat-induced muscle spasms, and 7% had limb heat edema. Additionally, most of HRIs cases were reported between 11 am and 1 pm. The HRIs diagnostic tree model gave a diagnostic accuracy of 93.6%. This study highlights the magnitude of HRIs among pilgrims in Hajj and provides a diagnostic tree that can aid in the risk stratification and diagnosis of these patients. We advise the implementation of more educational campaigns to pilgrims regarding preventable measures especially for the vulnerable groups (e.g. from outside Saudi Arabia, those with comorbidities and light-skinned people).

Despite the growing interest in the interplay of machine learning and optimization, existing contributions remain scattered across the research board, and a comprehensive overview on such reciprocity still lacks at this stage. In this context, this paper visits one particular direction of interplay between learning-driven solutions and optimization, and further explicates the subject matter with a clear background and summarized theory. For instance, machine learning and its offsprings are trending because of their enhanced capabilities in automating analytical modeling. In this realm, learning-based techniques (supervised, unsupervised, and reinforcement) have grown to complement many of the optimization problems in testing and training. This paper overviews how machine learning-based techniques, namely deep neural networks, echo-state networks, reinforcement learning, and federated learning, can be used to solve complex and analytically intractable optimization problems, for which specific cases are examined in this paper. The paper particularly overviews when learning-based algorithms are useful at solving particular optimizing problems, especially those of random, dynamic, and mathematically complex nature. The paper then illustrates such applications by presenting particular use-cases in communications and signal processing including wireless scheduling, wireless offloading and resource management, power control, aerial base station placement, virtual reality, and vehicular networks. Lastly, the paper sheds light on some future research directions, where the dynamicity and randomness of the underlying optimization problems make deep learning-driven techniques a necessity, namely in sensing at the terahertz (THz) bands, cellular vehicle-to-everything, 6G communication networks, underwater optical networks, distributed optimization, and applications of emerging learning-based techniques.

Clean energy resources, like wind, have a stochastic nature, which involves uncertainties in the power system. Introducing energy storage systems (ESS) to the network can compensate for the uncertainty in wind plant output and allow the plant to participate in ancillary service markets. Advance in compressed air energy storage system (CAES) technologies and their fast response make them suitable for ancillary services. This paper investigates the participation of a combined energy system composed of wind plants and compressed air energy storage system (CAES) in the energy market from a private owner’s viewpoint, including trading in energy markets and bidding for frequency regulation and reserve capacity in ancillary service markets. Since this problem contains various uncertainties associated with market prices, wind generation levels, and regulation signals, distributionally robust optimization (DRO) is used to model the uncertainties and enhance the simultaneous participation of a combined wind-CAES system in day-ahead energy and ancillary service markets. This method combines the advantages of stochastic and robust optimization. In contrast to robust optimization (RO), the method consolidates specific statistical data to reduce conservative results. Simulation results demonstrate the proposed model’s effectiveness in handling uncertainties and provide a framework for investors in this area. In addition, case study analyses are applied to assess the model’s performance and validate the coordination of a wind plant and compressed air energy storage system in participating in a deregulated electricity market. Finally, DRO and RO are compared in modeling the uncertainties of the optimization problem. The optimal outputs demonstrate the effectiveness of DRO in terms of achieving higher realized profits with less conservative results.

The Golden Jackal (Canis aureus Linnaeus, 1758), which belongs to the Canidae family, is an opportunist carnivore in the Gaza Strip (365 square kilometers). The current study aims at giving notes on the occurrence and some ecological aspects of the species in the Gaza Strip, Palestine. The study, which lasted 14 years (2007-2020), is descriptive and cumulative in its style. It was based on frequent field visits, direct observations and meetings and discussions with wildlife hunters, farmers and other stakeholders. The findings of the study show that Gazans are familiar with the Golden Jackal to the extent that a Gazan family holds the Arabic name of the animal, which is “Wawi”. The Golden Jackal was sometimes encountered and hunted in the eastern parts of the Gaza Strip, which are characterized by the presence of wilderness areas, intensive agriculture, poultry pens and solid waste landfills. Like other a few mammalian faunas, the adult Golden Jackals enter the Gaza Strip through gaps in or burrows beneath the metal borders separating the Gaza Strip from the rest of the Palestinian Territories and Egypt. Gaza zoos were found to harbor tens of Golden Jackals trapped or hunted by clever wildlife hunters using different means such as wire cages known locally as “maltash” and foothold traps with metal jaws that may cause lesions to the trapped animals. Poisoning and shooting were also common methods used to control the jackals and other carnivores causing harm to agriculture and livestock. The animal was known among the Gazans as an omnivore, feeding on wild and domestic animals in addition to plant materials, garbage and carrions. In conclusion, the study recommends the need to raise ecological awareness to preserve the Golden jackal and to adopt safe control measures for jackals and other carnivores, including the construction of protective fences for agricultural fields and animal pens.

Introduction: There is paucity of data regarding change in arachnoid cyst (AC) volume following surgery. This study aimed at investigating the clinical outcome of ACs and applying 2 volumetric methods for determination of their volume change post microsurgical fenestration. Methods: Twenty-one ACs in 20 patients that underwent microsurgical fenestration were analyzed using 2 volumetric methods; the modified McDonald equation and the picture archiving and communication (PAC) system-based method. Patients were followed up for 23 ± 40.3 months. Results: The majority of the patients (13 or 65%) were children. Preoperative symptoms in children were mainly seizures and less commonly headache. Of the 20 patients, 12 (60%) had complete resolution of their preoperative symptoms with 8 (40.0%) showing partial improvement. Volumetric studies showed a mean reduction in AC size of 73.7% in children and 64.4% in adults using the PAC system versus 67.9% in children and 70.5% in adults using the modified McDonald equation method. There was no correlation between the percentage decrease in AC volume post surgery and degree of symptom improvement (49.2 ± 34.3% in patients with complete vs. 60.9 ± 40.3% in patients with only partial resolution of symptoms, p = 0.57). Discussion/Conclusion: Microsurgical fenestration is an effective approach for ACs with an excellent clinical outcome apparent in the complete or partial improvement of symptoms in all patients. Volumetric estimates of ACs and their change following surgery are feasible using the modified McDonald or PAC system methods. However, there is no correlation between the percentage decrease in AC volume after surgery and degree of clinical improvement.

Sprengel deformity is a congenital anomaly arising mainly in the shoulder girdle, associated with elevation of dysplastic scapula. skeletal anomalies, mainly Klippel-Feil syndrome, hemivertebrae, and omovertebral bone may be present along Sprengel anomaly. The omovertebral bone is an abnormal bone that originates from the superomedial edge of the scapula with different insertion points along the posterior cervical spine, seen in about third of the patients with Sprengel anomaly. While cosmetic to functional impairment is a common presentation to the omovertebral bone, cervical myelopathy is a rare presentation. Here, we described our experience, management and follow up of 13-year-old boy presented with cervical myelopathy secondary to the omovertebral bone.

Celastrol (CLT) is an active ingredient that was initially discovered and extracted from the root of Tripterygium wilfordii. The potential pharmacological activities of CLT in cancer, obesity, and inflammatory, auto-immune, and neurodegenerative diseases have been demonstrated in recent years. However, CLT's clinical application is extremely restricted by its low solubility/permeability, poor bioavailability, and potential off-target toxicity. The advent of nanotechnology provides a solution to improve the oral bioavailability, therapeutic effects or tissue-targeting ability of CLT. This review focuses on the most recent advances, improvements, inventions, and updated literature of various nanocarrier systems for CLT.

Objectives: Colorectal cancer (CRC) is the third most prevalent malignant neoplasm. Genetic variations in the xenobiotic metabolising cytochrome enzymes. Family 1 Subfamily A Member 1 (CYP1A1) and Family 1 Subfamily B Member 1 (CYP1B1) might play a role in cancer pathogenesis and prognosis. The aim of this work is to determine the frequency of Single Nucleotide Polymorphisms (SNPs) in CYP1A1 (rs1048943, Ile462VaI and rs4646903/MSP1) and CYP1B1 (rs1056836, Leu432Val) genes in patients with CRC cancer. It was also an attempt to identify the association between SNPs and CRC and its stage and grade at diagnosis. Methods: This case-control study was conducted in Kirkuk/Iraq, 200 patients with CRC and 200 cancer free control subjects were enrolled. Genomic DNA was extracted from venous blood samples and screened for SNPs using Restriction Fragment Length Polymorphism (RFLP) and confirmed by the direct DNA sequencing. Results: The reference genotype of CYP1A1 gene rs1048943 is AA. Both the AG and GG variants were significantly more frequent in the cancer group and associated with increased risks of CRC and its later stages (stages III and IV) and poor differentiation (p0.05) or with tumour stage or its grade (p>0.05). The GG genotype of CYP1B1 rs1056836 was the reference genotype. The CG and CC variants were not associated with increased risks of CRC (P>0.05) or its stage or grade except the CG genotype which was associated with poor differentiation (OR= 3.4, 95 % CI= 1.8 -6.5, P

Nanostructure such as quaternary alloy offers an unprecedented opportunity for alloy composition control in a wide range, unavailable with traditional epitaxial film materials. The technique of chemical co-precipitation has been employed to synthesize the NiZnFe2O3 quaternary alloy nanostructure, which is cost-effective and friendly environmentally. The study of morphology for the mentioned NiZnFe2O3 quaternary alloy nanostructure is elaborated by scanning electron microscopy (SEM) to measure the grain size. The optical properties are investigated via UV-visible spectrophotometry (UV-vis) and Fourier-transform infrared spectroscopy (FTIR) to research the absorption, transmission, reflection and bandgap for the mentioned NiZnFe2O3 quaternary alloy nanostructure, also, for verifying optical dielectric constant and refractive index models using specific empirical models. The grains size and energy gap are investigated to recommend the suitability results for NiZnFe2O3 quaternary alloy nanostructure. Finally, Ravindra et al. models are an appropriate for potential application in optoelectronics.

This work aims to provide a state-of-the-art review of the performance of combined cycle power plant (CCPP) based on several proposed inlet air cooling systems. Investigators strive to meet the significant need to promote and develop inlet air cooling technologies to recover heat from the wasted energy in the exhaust gasses of the CCPP and diminish the environmental impacts. Various types of cooling systems mainly offer a boost for electric power generation during the peak load hours. The output power of the CCPP directly depends on the mass flow rate of air that flows through the air compressor. Therefore, during extremely hot weather conditions, subsequently, the air density drops, and this leads to a drastic decrease in the power output. This paper reviews available studies investigated the impacts of inlet air cooling systems on the performance of the CCPP. The fogging cooling system contributed by up to 17% in improving the total performance of the CCPP; however, with the use of the evaporative cooling, the performance was enhanced by only 4%. The energy consumption of mechanical chiller compared to that of evaporative cooling is high due to the effectiveness of the evaporative cooler which depends on the humidity of inlet airflow. Further, the mechanical cooling system can provide the CCPP with a cooling effect for around 7-hour on-peak periods. This method increases the gain of the CCPP performance by 13.6%. Ultimately, the CCPP equipped with an absorption chiller demonstrates the best solution to increase the performance by up to 23%.

Milk fever (Hypocalcemia) is a metabolic disorder that has serious economic impacts on health of dairy cattle and production. Current research endeavored to evaluate the clinical, hematological and some biochemical alterations in cows affected with milk fever in the Gogjalee region, Mosul in Iraq. This research was conducted on 30 local breed cows aged (three to seven years) from private farms diagnosed with postparturient paresis according to clinical signs and laboratory confirmations. Ten healthy cows served as control groups.Blood samples were taken from each animal for biochemical and hemogram analysis. Results showed typical clinical signsof milk fever with different stages of the disease. Significant (P

Aims/Introduction Abnormalities in Ca2+ signaling have a key role in hemodynamic dysfunction in diabetic heart. The purpose of this study was to explore the effects of streptozotocin (STZ)‐induced diabetes on Ca2+ signaling in epicardial (EPI) and endocardial (ENDO) cells of the left ventricle after 5–6 months of STZ injection. Materials and Methods Whole‐cell patch clamp was used to measure the L‐type Ca2+ channel (LTCC) and Na+/Ca2+ exchanger currents. Fluorescence photometry techniques were used to measure intracellular free Ca2+ concentration. Results Although the LTCC current was not significantly altered, the amplitude of Ca2+ transients increased significantly in EPI‐STZ and ENDO‐STZ compared with controls. Time to peak LTCC current, time to peak Ca2+ transient, time to half decay of LTCC current and time to half decay of Ca2+ transients were not significantly changed in EPI‐STZ and ENDO‐STZ myocytes compared with controls. The Na+/Ca2+ exchanger current was significantly smaller in EPI‐STZ and in ENDO‐STZ compared with controls. Conclusions STZ‐induced diabetes resulted in an increase in amplitude of Ca2+ transients in EPI and ENDO myocytes that was independent of the LTCC current. Such an effect can be attributed, at least in part, to the dysfunction of the Na+/Ca2+ exchanger. Additional studies are warranted to improve our understanding of the regional impact of diabetes on Ca2+ signaling, which will facilitate the discovery of new targeted treatments for diabetic cardiomyopathy., This is the first report to investigate the effects of streptozotocin‐induced diabetes on L‐type Ca2+ current simultaneously measured with Ca2+ transients in epicardial and endocardial left ventricular myocytes isolated from rats 5–6 months after the induction of diabetes. Streptozotocin‐induced diabetes causes a progressive increase in the amplitude of endocardial and epicardial myocyte Ca2+ transients that is independent of the L‐type Ca2+ current. The effect of streptozotocin‐induced diabetes on Ca2+ handling might be attributed, at least in part, to the dysfunction of the Na+/Ca2+ exchanger.

Objectives : To explore the changing patterns of long-stay patients (LSP) to improve the utilization of pediatric intensive care units (PICUs) resources. Methods : This is a 2-points cross-sectional study (5 years apart; 2014-2019) conducted among PICUs and SCICUs in Riyadh, Saudi Arabia. Children who have stayed in PICU for more than 21 days were included. Results : Out of the 11 units approached, 10 (90%) agreed to participate. The prevalence of LSP in all these hospitals decreased from 32% (48/150) in 2014 to 23.4% (35/149) in 2019. The length of stay ranged from 22 days to 13.5 years. The majority of LSP had a neuromuscular or cardiac disease and were admitted with respiratory compromise. Ventilator-associated pneumonia was the most prevalent complication (37.5%). The most commonly used resources were mechanical ventilation (93.8%), antibiotics (60.4%), and blood-products transfusions (35.4%). The most common reason for the extended stay was medical reasons (51.1%), followed by a lack of family resources (26.5%) or lack of referral to long-term care facilities (22.4%). Conclusion : A long-stay is associated with significant critical care bed occupancy, complications, and utilization of resources that could be otherwise utilized as surge capacity for critical care services. Decreasing occupancy in this multicenter study deserves further engagement of the healthcare leaders and families to maximize the utilization of resources. Saudi Med J 2020; Vol. 41 (11): 1187-1196 doi: 10.15537/smj.2020.11.25450 How to cite this article: Temsah MA, Al-Eyadhy AA, Al-Sohime FM, Hassounah MM, Almazyad MA, Hasan GM, Jamal AA, Alhaboob AA, Alabdulhafid MA, Abouammoh NA, Alhasan KA, Alwohaibi AA, Al Mana YT, Alturki AT. Long-stay patients in pediatric intensive care units. Five-years, 2-points, cross-sectional study. Saudi Med J. 2020 Nov;41(11):1187-1196. doi: 10.15537/smj.2020.11.25450.

Global HIV program stakeholders, including the US President's Emergency Plan for AIDS Relief (PEPFAR), are undertaking efforts to ensure that eligible people living with HIV (PLHIV) receiving antiretroviral treatment (ART) receive a course of TB preventive treatment (TPT). In PEPFAR programming, this effort may require providing TPT not only to newly diagnosed PLHIV as part of HIV care initiation, but also to treatment-experienced PLHIV stable on ART who may not have been previously offered TPT. TPT scale-up is occurring at the same time as a trend to provide more person-centered HIV care through differentiated service delivery (DSD). In DSD, PLHIV stable on ART may receive less frequent clinical follow-up or receive care outside the traditional clinic-based model. The misalignment between traditional delivery of TPT and care delivery in innovative DSD may require adaptations to TPT delivery practices for PLHIV. Adaptations include components of planning and operationalization of TPT in DSD, such as determination of TPT eligibility and TPT initiation, and clinical management of PLHIV while on TPT. A key adaptation is alignment of timing and location for TPT and ART prescribing, monitoring, and dispensing. Conceptual examples of TPT delivery in DSD may help program managers operationalize TPT in HIV care.Les parties prenantes du programme mondial VIH, notamment le plan américain PEPFAR (US President’s Emergency Plan for AIDS Relief), entreprennent des efforts afin de s’assurer que les personnes vivant avec le VIH (PLVIH), éligibles, recevant un traitement antirétroviral (TAR), reçoivent également un traitement préventif TB (TPT). Dans la programmation PEPFAR, cet effort pourrait nécessiter de fournir le TPT non seulement aux PLVIH nouvellement diagnostiquées dans le cadre de l’initiation de la prise en charge du VIH, mais également aux PLVIH stables déjà traités par TAR à qui on n’aurait pas encore offert le TPT. L’expansion du TPT survient au même moment comme une tendance à offrir une prise en charge du VIH davantage centrée sur la personne à travers une prestation de services différenciée (DSD). Dans la DSD, les PLVIH stables sous TAR bénéficient d’un suivi clinique moins fréquent ou sont soignés hors du modèle traditionnel en structures de santé. Le décalage entre la prestation traditionnelle du TPT et la prestation de soins dans des DSD innovantes peut nécessiter des adaptations aux pratiques de prestation du TPT pour les PLVIH. Ces adaptations incluent des éléments de planification et d’opérationnalisation du TPT dans la DSD, comme la détermination de l’éligibilité au TPT et sa mise en route et la prise en charge clinique des PLVIH sous TPT. Une adaptation majeure est l’alignement en termes de temps et de lieu pour la prescription, le suivi et la délivrance du TPT et du TAR. Des exemples conceptuels de délivrance du TPT dans la DSD aideraient les gestionnaires de programme à rendre opérationnel le TPT au sein de la prise en charge du VIH.Los interesados directos del Programa Mundial del VIH, incluido el Plan de Emergencia del Presidente (de los Estados Unidos) para el Alivio del Sida (PEPFAR), emprenden ahora esfuerzos encaminados a garantizar que las personas con infección por el VIH (PLVIH), que siguen un tratamiento antirretrovírico (TAR) y que reúnen las condiciones, reciban un ciclo de tratamiento preventivo de la TB (TPT). En la programación del PEPFAR esta iniciativa puede necesitar la provisión de TPT no solo a las personas con un diagnóstico reciente de infección por el VIH, como parte del inicio de la atención del VIH, sino también a las PLVIH, con experiencia de tratamiento y que se encuentran estables recibiendo el TAR, a quienes tal vez no se haya propuesto antes el TPT. La ampliación del TPT ocurre de manera simultánea con la tendencia a ofrecer una atención del VIH más centrada en la persona mediante la prestación diferenciada de servicios (DSD). En la DSD, las PLVIH, estables con el TAR, pueden tener encuentros de seguimiento clínico menos frecuentes o recibir atención por fuera del modelo tradicional en los consultorios. La discordancia entre la provisión tradicional del TPT y la prestación de atención en el marco innovador de la DSD exige adaptaciones de las prácticas de prestación del TPT a las PLVIH. Las adaptaciones incluyen componentes de planeación y puesta en práctica del TPT en la DSD, como la determinación de los criterios para recibir el TPT, el inicio del mismo y el manejo clínico de las PLVIH mientras reciben el TPT. Una adaptación primordial es la coordinación del ritmo y el lugar de prescripción, supervisión y suministro del TPT y el TAR. La presentación de ejemplos teóricos de provisión del TPT en el marco de la DSD puede ayudar a los gerentes de programas a poner en práctica el TPT en la atención del VIH.

Objective: We aimed to assess the cost-effectiveness of hepatitis C virus (HCV) screening strategies among recently arrived migrants in the Netherlands. Methods: A Markov model was used to estimate the health effects and costs of HCV screening from the healthcare perspective. A cohort of 50,000 recently arrived migrants was used. In this cohort, three HCV screening strategies were evaluated: (i) no screening, (ii) screening of migrants from HCV-endemic countries and (iii) screening of all migrants. Results: Strategy (ii) screening of migrants from HCV-endemic countries compared to strategy (i) no screening, yielded an incremental cost-effectiveness ratio (ICER) of &euro, 971 per quality-adjusted life-years (QALYs) gained. Strategy (iii) screening of all migrants compared with strategy (ii) screening of migrants from HCV-endemic countries yielded an ICER of &euro, 1005 per QALY gained. The budget impact of strategy (ii) screening of migrants from HCV-endemic countries and strategy (iii) screening of all migrants was &euro, 13,752,039 and &euro, 20,786,683, respectively. Conclusion: HCV screening is cost-effective. However, the budget impact may have a strong influence on decision making.

Virtual consultations and telemedicine have been an emerging trend in modern medicine, which has seen acceleration in uptake across a wide range of specialties as a result of the COVID-19 pandemic. Following on from previous work by the authors in 2019 examining clinician and patient appetite for virtual consultations in maxillofacial surgery, we sought to evaluate whether there had been a change in attitudes as a result of the pandemic. A clinician survey of the consultants at a large teaching hospital and prospective data collection of virtual consultation outcomes was carried out from the inception of UK government lockdown measures to tackle the pandemic. From 151 consultations, 149 (98.7%) successfully established a working diagnosis and treatment plan and/or concluded an episode of patient care, without the need to convert to a face-to-face encounter between clinician and patient. The total number of consultations (virtual or otherwise) was significantly lower than the same time period the preceding year however (1,223 compared with 465 consultations). All consultants surveyed felt the pandemic had altered their opinion of virtual clinics and their place in maxillofacial surgery but cited a number of issues. Further work is required to understand the driving forces behind staff attitudes and the long-term adoption of telemedicine within the specialty as services return to some sense of normalcy.