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Abstract The role of efficient fuel mixing and a stable flame holder is crucial in enhancing the performance and capabilities of scramjet engines for high-speed flight. The present research paper has tried to disclose the fuel mixing efficiency of 3-lobe annular nozzle on the mixing mechanism of the fuel jet behind the strut. In addition, using internal air jet flow for increasing the circulation strength and fuel mixing behind the strut is also examined in this study. Numerical simulation of the flow and fuel jet behind the strut is done to reveal the main physics related to the mechanism of fuel mixing inside the combustor with the proposed injection system. The results of our simulation show that using annular 3-lobe fuel jet improve the fuel mixing via production of the multiple vortex pairs within the combustor behind the strut. The use of internal air jet also enhances the fuel mixing efficiency up to 90% in combustor of scramjet engine.

Abstract Breast cancer, a prevalent and life-threatening disease, necessitates early detection for the effective intervention and the improved patient health outcomes. This paper focuses on the critical problem of identifying breast cancer using a model called Attention U-Net. The model is utilized on the Breast Ultrasound Image Dataset (BUSI), comprising 780 breast images. The images are categorized into three distinct groups: 437 cases classified as benign, 210 cases classified as malignant, and 133 cases classified as normal. The proposed model leverages the attention-driven U-Net’s encoder blocks to capture hierarchical features effectively. The model comprises four decoder blocks which is a pivotal component in the U-Net architecture, responsible for expanding the encoded feature representation obtained from the encoder block and for reconstructing spatial information. Four attention gates are incorporated strategically to enhance feature localization during decoding, showcasing a sophisticated design that facilitates accurate segmentation of breast tumors in ultrasound images. It displays its efficacy in accurately delineating and segregating tumor borders. The experimental findings demonstrate outstanding performance, achieving an overall accuracy of 0.98, precision of 0.97, recall of 0.90, and a dice score of 0.92. It demonstrates its effectiveness in precisely defining and separating tumor boundaries. This research aims to make automated breast cancer segmentation algorithms by emphasizing the importance of early detection in boosting diagnostic capabilities and enabling prompt and targeted medical interventions.

Abstract Suspensions containing microencapsulated phase change materials (MPCMs) play a crucial role in thermal energy storage (TES) systems and have applications in building materials, textiles, and cooling systems. This study focuses on accurately predicting the dynamic viscosity, a critical thermophysical property, of suspensions containing MPCMs and MXene particles using Gaussian process regression (GPR). Twelve hyperparameters (HPs) of GPR are analyzed separately and classified into three groups based on their importance. Three metaheuristic algorithms, namely genetic algorithm (GA), particle swarm optimization (PSO), and marine predators algorithm (MPA), are employed to optimize HPs. Optimizing the four most significant hyperparameters (covariance function, basis function, standardization, and sigma) within the first group using any of the three metaheuristic algorithms resulted in excellent outcomes. All algorithms achieved a reasonable R-value (0.9983), demonstrating their effectiveness in this context. The second group explored the impact of including additional, moderate-significant HPs, such as the fit method, predict method and optimizer. While the resulting models showed some improvement over the first group, the PSO-based model within this group exhibited the most noteworthy enhancement, achieving a higher R-value (0.99834). Finally, the third group was analyzed to examine the potential interactions between all twelve HPs. This comprehensive approach, employing the GA, yielded an optimized GPR model with the highest level of target compliance, reflected by an impressive R-value of 0.999224. The developed models are a cost-effective and efficient solution to reduce laboratory costs for various systems, from TES to thermal management.

Abstract Partial heart transplantation (PHT) is a novel surgical approach that involves transplantation of only the part of the heart containing a valve. The rationale for this approach is to deliver growing heart valve implants that reduce the need for future re-operations in children. However, prior to clinical application of this approach, it was important to assess it in a preclinical model. To investigate PHT short-term outcomes and safety, we performed PHT in a piglet model. Yorkshire piglets (n = 14) were used for PHT of the pulmonary valve. Donor and recipient pairs were matched based on blood types. The piglets underwent PHT at an average age of 44 days (range 34–53). Post-operatively, the piglets were monitored for a period of two months. Of the 7 recipient piglets, one mortality occurred secondary to anesthesia complications while undergoing a routine echocardiogram on post-operative day 19. All piglets had appropriate weight gain and laboratory findings throughout the post-operative period indicating a general state of good health and rehabilitation after undergoing PHT. We conclude that PHT has good short-term survival in the swine model. PHT appears to be safe for clinical application.

Abstract The abnormal heart conduction, known as arrhythmia, can contribute to cardiac diseases that carry the risk of fatal consequences. Healthcare professionals typically use electrocardiogram (ECG) signals and certain preliminary tests to identify abnormal patterns in a patient’s cardiac activity. To assess the overall cardiac health condition, cardiac specialists monitor these activities separately. This procedure may be arduous and time-intensive, potentially impacting the patient’s well-being. This study automates and introduces a novel solution for predicting the cardiac health conditions, specifically identifying cardiac morbidity and arrhythmia in patients by using invasive and non-invasive measurements. The experimental analyses conducted in medical studies entail extremely sensitive data and any partial or biased diagnoses in this field are deemed unacceptable. Therefore, this research aims to introduce a new concept of determining the uncertainty level of machine learning algorithms using information entropy. To assess the effectiveness of machine learning algorithms information entropy can be considered as a unique performance evaluator of the machine learning algorithm which is not selected previously any studies within the realm of bio-computational research. This experiment was conducted on arrhythmia and heart disease datasets collected from Massachusetts Institute of Technology-Berth Israel Hospital-arrhythmia (DB-1) and Cleveland Heart Disease (DB-2), respectively. Our framework consists of four significant steps: 1) Data acquisition, 2) Feature preprocessing approach, 3) Implementation of learning algorithms, and 4) Information Entropy. The results demonstrate the average performance in terms of accuracy achieved by the classification algorithms: Neural Network (NN) achieved 99.74%, K-Nearest Neighbor (KNN) 98.98%, Support Vector Machine (SVM) 99.37%, Random Forest (RF) 99.76 % and Naïve Bayes (NB) 98.66% respectively. We believe that this study paves the way for further research, offering a framework for identifying cardiac health conditions through machine learning techniques.

Abstract Software vulnerabilities pose a significant threat to system security, necessitating effective automatic detection methods. Current techniques face challenges such as dependency issues, language bias, and coarse detection granularity. This study presents a novel deep learning-based vulnerability detection system for Java code. Leveraging hybrid feature extraction through graph and sequence-based techniques enhances semantic and syntactic understanding. The system utilizes control flow graphs (CFG), abstract syntax trees (AST), program dependencies (PD), and greedy longest-match first vectorization for graph representation. A hybrid neural network (GCN-RFEMLP) and the pre-trained CodeBERT model extract features, feeding them into a quantum convolutional neural network with self-attentive pooling. The system addresses issues like long-term information dependency and coarse detection granularity, employing intermediate code representation and inter-procedural slice code. To mitigate language bias, a benchmark software assurance reference dataset is employed. Evaluations demonstrate the system's superiority, achieving 99.2% accuracy in detecting vulnerabilities, outperforming benchmark methods. The proposed approach comprehensively addresses vulnerabilities, including improper input validation, missing authorizations, buffer overflow, cross-site scripting, and SQL injection attacks listed by common weakness enumeration (CWE).

تُعتبر الأكاليزيا " "Achalasia اضطراباً حركياً نادراً مجهول السبب، يُصيب المري والمعصرة المريئية السفلية، ويُقدر حدوثها بنسبة 1/100000 بالعام، وبمعدل انتشار وسطي 10/100000. يمكن أن تكون الأعراض مبهمة مما يسبب تأخير في التشخيص، ولذلك قد لا يصل المريض إلاّ في المراحل المتقدمة من المرض. توجد طرقٌ مختلفة تُستخدم لتأكيد التشخيص متل: المامومتري " "Mamometry، صورة ظليلة بالباريوم، تنظير هضمي علوي، والطبقي المحوري مع شرب مادة ظليلة، وحديثاً يمكن استخدام المامومتري عالي الدقة الذي يستطيع تصنيف الأكاليزيا إلى ثلاث مراحل مختلفة. الخيارات العلاجية مختلفة من المعالجة الدوائية إلى التوسيع بالتنظير، وجراحة التنظير وأخيراً الجراحة الجذرية. شملت هذه الدراسة الاسترجاعية 39 مريضاً ومريضة، وصل إلينا منهم 32 بالمراحل الأولى للمرض، بينما ال 7 الآخرون فقد وصلوا بمرحلةٍ متقدمة جداً، ولكنهم كانوا جميعاً من الناحية السريرية والشعاعية استطباباً للتداخل الجراحي، لقد خضعوا جميعاً لنفس التقييم قبل الجراحة مع البحث بشكل أساسي عن أهم العوامل المساهمة في تطور هذه الإصابات، كما أن الاستطباب الجراحي كان متعلقاً بشكل أساسي بالمرحلة التي وصل بها المريض.

Objective: To note short-term outcome of patients undergoing tetralogy of fallot repair. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease, Karachi Pakistan, from Sep 2020 to Feb 2021. Methodology: A total of 113 patients under 25 years of age who underwent tetralogy of fallot correction were included. Pre-operative information, echocardiography, investigations and history of the patient were noted. Intra-operative and post-operative information and surgical procedure were also noted. Short-term outcome included data up to discharge or death of the patients enrolled. Results: Mean age was noted to be 9.40+5.01 years, with 59(52.2%) of the patients undergoing tetralogy of fallot repair were male. Mean saturation of peripheral Oxygen (SpO2) at the time of surgery was noted to be 79.27±.34. There were 76(67.3%) patients without history of previous surgery. Mean cardiopulmonary bypass time was noted to be 106.04±40.59 minutes. Mean aortic cross-clamp time was recorded to be 58.79±27.90 minutes. Additional procedures were required in 68(60.2%) patients. Mean duration of hospital stay was 13.96±8.68 days while mean duration of ICU stay was 87.04±69.37 hours. Mortality was reported in 3(2.7%) patients. Conclusion: Low mortality and low post-operative morbidity were noted among patients undergoing tetralogy of fallot repair.

Introduction: Coronavirus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged as a global pandemic in late 2019, quickly affecting millions worldwide. It presents with a range of symptoms, from mild respiratory issues to severe cases requiring hospitalisation. The disease’s long-term effects, especially cognitive impairments post-recovery, remain an area of active research and concern. Aim: To assess the prevalence and severity of cognitive impairments, including memory loss, attention deficits, and executive function disorders, in individuals who have recovered from COVID-19 in Riyadh, Saudi Arabia. Materials and Methods: This cross-sectional study was conducted from May to August 2023 in Riyadh, Saudi Arabia, involving 539 participants confirmed to have recovered from COVID-19 via Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) tests. Cognitive impairments, including memory loss, attention deficits, and executive function disorders were assessed. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 22.0 Chi-square tests and T-tests were utilised to examine the statistical significance of differences between recovered individuals and controls. Results: The study identified significant memory changes in 211 (39.15%) of post-COVID-19 patients, with specific challenges including difficulty recalling names/faces in 146 (27.09%), reduced attention span in 45 (8.35%), and verbal communication issues in 145 (26.9%) study subjects. Demographically, females (n=134, 24.86%) and individuals aged 21-30 reported higher rates of memory impairments compared to males (n=77, 14.29%) or other age groups, challenging prior assumptions about cognitive recovery and age. Further, patients with brain injuries and mental health conditions experienced exacerbated memory issues, underscoring the need for thorough patient assessments. Despite the considerable impact on daily activities reported by 111 (20.59%) of participants, only 17 (3.15%) sought medical help for these memory concerns. The findings highlight the prevalence of memory impairments among Saudi post-COVID-19 patients and call for increased healthcare interventions to manage these long-term cognitive effects. Conclusion: The study conclusively demonstrated that post-COVID-19 memory impairment was prevalent among recovered patients in Saudi Arabia, with significant variations by age, gender, and medical history. This underscored the critical need for healthcare providers to have enhanced awareness and to have developed targeted support services to effectively address and manage the long-term cognitive consequences of COVID-19.

This review examines a broad range of microbiota functions in terms of animal physiology, including its effect on digestion, immunological capabilities, metabolism, reproductive regulation, and nervous system. Its purpose is to provide a systematic overview of on-going research, determine the gap of knowledge and evaluate how environmental factors and the alteration of the microbiome can help to improve the health of animals and contribute to the conservation effort. This study describes the roles of microflora in digestion and absorption of nutrients, modulation of the immune system, and reproduction components and newborn development. Alongside this, it reports the interplay between the bacteria and the central nervous system, which underpins the behavior and mental health. This mission of the review is to offer an integrated overall comprehension of microbiota, which will be used to detect applicable insights and make actionable decisions for future research, veterinary care, and conservation efforts.

Abstract In Uganda, the challenge of generating and timely reporting essential antimicrobial resistance (AMR) data has led to overreliance on empirical antibiotic therapy, exacerbating the AMR crisis. To address this issue, this study aimed to adapt a one-step AMR testing protocol alongside an SMS (Short Message Service) result relay system (SRRS), with the potential to reduce the turnaround time for AMR testing and result communication from 4 days or more to 1 day in Ugandan clinical microbiology laboratories. Out of the 377 samples examined, 54 isolates were obtained. Notably, E. coli (61%) and K. pneumoniae (33%) were the most frequently identified, majority testing positive for ESBL. Evaluation of three AMR testing protocols revealed varying sensitivity and specificity, with Protocol A (ChromID ESBL-based) demonstrating high sensitivity (100%) but no calculable specificity, Protocol B (ceftazidime-based) showing high sensitivity (100%) and relatively low specificity (7.1%), and Protocol C (cefotaxime-based) exhibiting high sensitivity (97.8%) but no calculable specificity. ESBL positivity strongly correlated with resistance to specific antibiotics, including cefotaxime, ampicillin, and aztreonam (100%), cefuroxime (96%), ceftriaxone (93%), and trimethoprim sulfamethoxazole (87%). The potential of integrating an SRRS underscored the crucial role this could have in enabling efficient healthcare communication in AMR management. This study underscores the substantial potential of the tested protocols for accurately detecting ESBL production in clinical samples, potentially, providing a critical foundation for predicting and reporting AMR patterns. Although considerations related to specificity warrant careful assessment before widespread clinical adoption.

Background: Carditis describes heart inflammation with a variety of symptoms ranging from mild chest pain to cardiac shock or even sudden death. Myocarditis will result in heart failure (HF) in around 12%–17% of adults, with a death rate of approximately 8.4/100,000. The causatives of myocarditis include viral, bacterial, fungal, and protozoan infections. Aims: This retrospective cohort study aimed to statistically analyze the prevalence and diagnosis of myocarditis and other cardiovascular diseases (CVDs) among admitted patients to Al-Baha Hospitals in Saudi Arabia. Setting and Design: The study involved 384 patients diagnosed with CVDs at Al-Baha Hospital between January 2017 and December 2022. Statistical Analysis and Results: Overall, patients' ages ranged from 25 to 94 years, averaging 59 ± 14. The majority of patients with different CVDs were aged between 41 and 70 years (69% myocardial infarction (MI), 48% HF, and 56% heart block). Most of the patients were male (80%), and 90% of the participants were Saudis. The incidence of CVDs showed a gradual increase between 2017 and 2019 and a dramatic increase in 2020 and 2022 compared to other years. The analysis included the most common laboratory markers aimed for the diagnosis. The result of the study showed an increase in lactate dehydrogenase (91%), creatine kinase (CK) (95%), CK-myocardial band (93%), aspartate aminotransferase (94%), and white blood cells (89%) of the patients who were diagnosed with MI compared to the other CVDs. Conclusions: It is important to note that while electrocardiogram, complete blood count, and cardiac profile form the core of the diagnostic protocol, additional diagnostic measures may be considered depending on the specific circumstances.

Abstract Necrotizing enterocolitis (NEC) is the leading cause of gastrointestinal-related death in premature infants. Its etiology is multifactorial, with intestinal dysbiosis playing a major role. Probiotics are a logical preventative therapy for NEC, however their benefits have been inconsistent. We previously developed a novel probiotic delivery system in which planktonic (free-living) Limosilactobacillus reuteri (Lr) is incubated with biocompatible dextranomer microspheres (DM) loaded with maltose (Lr-DM-maltose) to induce biofilm formation. Here we have investigated the effects of Lr-DM-maltose in an enteral feed-only piglet model of NEC. We found a significant decrease in the incidence of Definitive NEC (D-NEC), death associated with D-NEC, and activated microglia in the brains of piglets treated with Lr-DM-maltose compared to non-treated piglets. Microbiome analyses using 16S rRNA sequencing of colonic contents revealed a significantly different microbial community composition between piglets treated with Lr-DM-maltose compared to non-treated piglets, with an increase in Lactobacillaceae and a decrease in Clostridiaceae in Lr-DM-maltose-treated piglets. Furthermore, there was a significant decrease in the incidence of D-NEC between piglets treated with Lr-DM-maltose compared to planktonic Lr. These findings validate our previous results in rodents, and support future clinical trials of Lr in its biofilm state for the prevention of NEC in premature neonates.

Objectives: Type 1 diabetes mellitus (T1DM) can profoundly influence different dimension of health such as sexual and reproductive health (SRH). The aim of this study is to develop and evaluate the psychometric properties of the Sexual and Reproductive Health Questionnaire for Women with Type 1 Diabetes Mellitus (SRHQ-WT1DM). Materials and Methods: This protocol for a sequential exploratory mixed-methods study has two phases. Conducting a literature review, the first phase of the study will develop the items of SRHQ-WT1DM. Data analysis in this phase will be performed using directed content analysis and according to the framework proposed by the United Nations Population Fund (UNFPA) and the World Health Organization (WHO) for SRH in women. The second phase will evaluate the psychometric properties of SRHQWT1DM through a methodological study. Face and content validity will be evaluated both qualitatively and quantitatively, and construct validity will be done by exploratory factor analysis and convergent validity. The questionnaire’s reliability and stability will be examined using internal consistency (by Cronbach’s alpha calculation) and test-retest method (by Intra class correlation coefficient calculation), respectively. Descriptive statistics, Pearson correlation coefficient, and independent t-test will also be used. Women with T1DM who are of childbearing age and have unknown mental disorders will be selected as participants in the study from the Iranian Diabetes Society. Discussion: Development and psychometric evaluation of a specific tool for SRH assessment in women will help identify and fulfill their SRH-related needs and improve dimensions of their SRH.

الهدف: دراسة انتشار الغمش وأسبابه لدى طلاب الحلقة الأولى من التعليم الأساسي في محافظة اللاذقية. الطرائق والمواد: تم فحص 946 طالب في هذه الدراسة المقطعية، استبعد منهم 7 طلاب، وتم اختيار المدارس بشكل عشوائي من مدراس الحلقة الأولى في محافظة اللاذقية في الجمهورية العربية السورية، وتم اختيار الطلاب عشوائيا وتراوحت أعمارهم من 6 إلى 12 سنة خلال العام 2023. تم جمع المعلومات المتعلقة بالطلاب من خلال استبيان صمم خصيصاً لغرض البحث تم إرساله إلى ذوي الطلاب، تم قياس القدرة البصرية لجميع الطلاب من دون تصحيح أو مع نظارات (بحال وجودها) باستخدام مخطط القدرة البصرية E-chart على بعد 5 م. تم قياس الانكسار للطلاب ممن كان لديهم حدة ابصار دون 10/10 باستخدام جهاز قياس أسواء الانكسار الآلي قبل وبعد شل المطابقة. بالنسبة لشل المطابقة تم تقطير ثلاث قطرات من السيكلوبينتولات (Cyclomed 1%, Medico Pharma Syria) بكل عين بفاصل عشر دقائق وقياس الانكسار بعد القطرة الثالثة بثلاثين دقيقة. كما تم الحصول على موافقة لجنة الأخلاقيات والبحث العلمي في جامعة تشرين، سورية. النتائج: نسبة انتشار الغمش 1.9% (18مريض)، كانت أسباب الغمش وفق التسلسل من الأشيع غمش تفاوت الانكسار (8) مرضى، غمش انكساري ثنائي الجانب (5) مرضى، غمش حولي (4) مرضى، غمش حرمان بصري (1) مريض. لم نثبت ارتباطاً بين الجنس أو الدرجة العلمية للاهل أو العمر مع الغمش، اكتشفنا وجود علاقة بين الغمش ومكان السكن ريف/مدينة حيث كانت نسبة الانتشار اقل في الريف. الخلاصة: إن نسبة انتشار الغمش في محافظة اللاذقية تقع ضمن النسب العالمية المنخفضة، وهذا ما يشير إلى واقع صحي جيد جداً من الناحية العينية للأطفال. تفاوت الانكسار كان العامل الأهم بتطور الغمش يليه الانكسار العالي المتساوي في العينين.

Key Clinical Message Pseudoangiomatous stromal hyperplasia (PASH) is a rare lesion of the breast stromal tissue with unknown mechanism. Hormonal stimulation of mammary myofibroblasts is the most important theory due to stromal positivity of progesterone receptor (PR) or/and estrogen receptor (ER). We report a case of PASH with stromal PR/ER negativity.

Background: Tonsillitis is considered one of the most otolaryngological diseases affecting children and adults. Tonsillectomy is one of the common surgical procedures mostly with children and in cases of chronic tonsillitis or recurrent tonsillitis. Aims: The objective of this study was to examine the incidence of tonsillitis, along with its methods of diagnosis and treatment, among patients residing in the Al-Baha region of Saudi Arabia. Settings and Design: A retrospective observational cross-sectional analysis of tonsillitis patients who attended the pediatric, emergency room, adult surgery, and ear, nose, and throat clinics at a hospital in Al-Baha, Saudi Arabia, from January 2019 to January 2023. Subjects and Methods: This research used purposive sampling. Covered examining data acquired and analyzed 348 tonsillitis-related throat swabs and blood samples. Statistical Analysis Used: Data were statistically analyzed using the Statistical Package for the Social Sciences software version 20.0 IBM (Armonk, New York, USA). Results: A total of 348 patients diagnosed with tonsillitis were examined. Males had tonsillitis more than females (n = 208, 60% and n = 140, 40%, respectively). The most frequent bacteria isolated were Streptococcus pyogenes group A beta-hemolytic, Staphylococcus aureus, methicillin-resistant S. aureus, and Klebsiella pneumoniae (n = 68, 19.5%; n = 24, 6.9%; n = 12, 3.4%; and n = 12, 3.4%, respectively). Conclusions: Tonsillitis is an oral and public disease affecting both children and adults in Al-Baha region. The emphasis should be on enhancing the public health system to reduce tonsillitis and its consequences via effective awareness efforts. Hospitals may also be urged to develop unique criteria for tonsillitis swabs in order to reduce contamination and improve diagnosing the etiology of bacterial tonsillitis.

Abstract The world's population is projected to grow 32% in the coming years, and the number of Muslims is expected to grow by 70%—from 1.8 billion in 2015 to about 3 billion in 2060. Hijri is the Islamic calendar, also known as the lunar Hijri calendar, which consists of 12 lunar months, and it is tied to the Moon phases where a new crescent Moon marks the beginning of each month. Muslims use the Hijri calendar to determine important dates and religious events such as Ramadan, Haj, Muharram, etc. Till today, there is no consensus on deciding on the beginning of Ramadan month within the Muslim community. This is mainly due to the imprecise observations of the new crescent Moon in different locations. Artificial intelligence and its sub-field machine learning have shown great success in their application in several fields. In this paper, we propose the use of machine learning algorithms to help in determining the start of Ramadan month by predicting the visibility of the new crescent Moon. The results obtained from our experiments have shown very good accurate prediction and evaluation performance. The Random Forest and Support Vector Machine classifiers have provided promising results compared to other classifiers considered in this study in predicting the visibility of the new Moon.

Objective: Stroke is a major cause of disability worldwide. Therefore, it is necessary to investigate the aspects of knowledge, attitudes, and management among emergency nurses to provide quality care for patients with acute stroke. Materials and Methods: This correlational research was conducted on 285 hospital emergency department nurses and emergency medical services (EMS) personnel in Ardabil city in 2021. The data collection tools included demographic information questionnaires, warning signs, nurses' knowledge of evidence-based care, attitudes toward stroke care, and acute stroke management. The data were analyzed using the SPSS-26 software using descriptive statistics and the t-test, F-test, linear regression analysis, and the one-way analysis of variance test. The significance level was set at P < 0.05. Results: The knowledge of evidence-based care and acute stroke management was more favorable in hospital emergency nurses than in EMS personnel (P < 0.05). The results of the multivariate regression model showed that knowledge of stroke warning signs and the attitude toward stroke care were stronger predictors in acute stroke management. Knowledge of evidence-based care, attitudes toward stroke care, age, work experience, and participation in stroke retraining courses were significantly correlated with the nurses' care management of patients with acute stroke. Conclusion: Since acute stroke management can be predicted by the knowledge of evidence-based care, attitudes toward stroke care, age, and experience of working with patients with stroke, the evaluation of these characteristics in emergency nurses and EMS personnel who provide care to these patients can affect their management methods. Therefore, the aforementioned variables can be used to evaluate and empower nurses in acute stroke management and improve patient care programs.

Objectives: Moroccan Arbutus unedo is an essential medicinal plant; however, little is known about the biological properties of its leaves mentioned in Moroccan traditional medicine.Methods : : Various standard experiments were performed to evaluate the phytochemical, antidiabetic, antioxidant, antibacterial, and acute and sub-chronic toxicity characteristics of A. unedo leaves.Results : : Phytochemical screening led to the identification of several phytochemical classes, including tannins, flavonoids, terpenoids, and anthraquinones, with high concentrations of polyphenols (31.83 ± 0.29 mg GAEs/g extract) and flavonoids (16.66 ± 1.47 mg REs/g extract). Further, the mineral analysis revealed high levels of calcium and potassium. A. unedo extract demonstrated significant antioxidant and anti-diabetic activities by inhibiting α-amylase (1.350 ± 0.32 g/mL) and α-glucosidase (0.099 ± 1.21 g/mL) compared to the reference drug Acarbose. Also, the methanolic extract of the plant exhibited significantly higher antibacterial activity than the aqueous extract. Precisely, three of the four examined bacterial strains exhibited substantial susceptibility to the methanolic extract . Minimum bactericidal concentration (MBC)/minimum inhibitory concentration (MIC) values indicated that A. unedo harbor abundant bactericidal compounds. For toxicological studies, mice were administered with A. unedo aqueous extract at single doses of 2,000 and 5,000 mg/kg. They did not exhibit significant abnormal behavior, toxic symptoms, or death during the 14-day acute toxicity test and the 90-day sub-chronic toxicity test periods. The general behavior, body weight, and hematological and biochemical status of the rats were assessed, revealing no toxicological symptoms or clinically significant changes in biological markers observed in the mice models, except hypoglycemia, after 90 days of daily dose administration.Conclusion : : The study highlighted several biological advantages of A. unedo leaves without toxic effects in short-term application. Our findings suggest that conducting more comprehensive and extensive in vivo investigations is of utmost importance to identify molecules that can be formulated into pharmaceuticals in the future.

Introduction Eurycoma longifolia Jack (EL), profoundly recognised as ‘Tongkat Ali’, is a medicinal herb originating from Southeast Asia. It is commonly used in traditional ‘antiageing’ treatments to address decreased energy, mood, libido and hormonal imbalances. While the benefits of EL have been extensively studied among the male population, less attention has been given to its effects on women. Menopause can impact the overall well-being of middle-aged women and incorporation of herbal supplements can aid them in managing the menopausal symptoms.Methods and analysis This 12-week randomised double-blind, placebo-controlled, parallel-group study aims to evaluate the efficacy of the standardised water extract of EL known as Physta in increasing the quality of life of perimenopausal and postmenopausal women. The study involves 150 women aged 40–55 years who score more than 61 on the Menopause-Specific Quality of Life (MENQOL) assessment. These participants will be randomised into three groups, receiving Physta at either 50 mg or 100 mg or a placebo. The outcomes measures include mood state, quality of life, fatigue, sleep quality, sexual function and pain score assessed using Profile of Mood State, MENQOL, Chalder Fatigue Scale, Pittsburgh Sleep Quality Index, Female Sexual Function Index and the Brief Pain Inventory questionnaires, respectively. The secondary outcome of the study includes full blood analysis, urine analysis, female reproductive hormone profiling, inflammatory and oxidative stress biomarkers analysis.Ethics and dissemination The research protocol of the study was reviewed and approved by the Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM/PPI/111/8/JEP-2021-898). The findings will be disseminated to participants, healthcare professionals and researchers via conference presentations and peer-reviewed publications.Trial registration number ACTRN12622001341718.

Background: An outbreak of food poisoning was investigated in a prison in AL-Muradia area in Diyala in June 23, after poisoning cases was reported to the primary health care center of the area on June 22, 2022. Objective: To determine the cause of food poisoning outbreak among the inmates. Patients and Methods: A retrospective cohort study was conducted in a prison in AL-Muradia area in Diyala in June 23 and the data has been collected using a questionnaire developed by the researcher and filled out by direct interview with all individuals who attended meals, all person in that prison were interviewed and traced back every meal served in the last two days before the investigation. Results: All people who had interviewed, (12) reported to have a common meal in afternoon of 21-June 2022, with age mean of 33.5+_ 6 SD. (5) of them met the probable case definition of food poisoning, and the first two cases had the onset of symptoms within 12hr. of the exposure, the last case experienced a symptom was after 24 hr., all cases had fever and headache followed by diarrhea (80%), nausea and abdominal pain (60%) and vomiting (40%). The meal items were canned meat, canned tuna, grilled chicken, apricot, plum and yogurt, the highest relative risk was for tuna (RR=4) with risk difference of (50%) Conclusion: The food item responsible for the outbreak was canned tuna. Based on the incubation period, symptoms and the unhealthy storage of food suggested that canned tuna could be contaminated with salmonella spp.

Abstract During mammalian spermatogenesis, the ubiquitin proteasome system maintains protein homoeostasis (proteastasis) and spermatogenic cellular functions. DCAF17 is a substrate receptor in the ubiquitin CRL4 E3 Ligase complex, absence of which causes oligoasthenoteratozoospermia in mice resulting in male infertility. To determine the molecular phenomenon underlying the infertility phenotype caused by disrupting Dcaf17, we performed RNA-sequencing-based gene expression profiling of 3-weeks and 8-weeks old Dcaf17 wild type and Dcaf17 disrupted mutant mice testes. At three weeks, 44% and 56% differentially expressed genes (DEGs) were up- and down-regulated, respectively, with 32% and 68% DEGs were up- and down-regulated, respectively at 8 weeks. DEGs include protein coding genes and lncRNAs distributed across all autosomes and the X chromosome. Gene ontology analysis revealed major biological processes including proteolysis, regulation of transcription and chromatin remodelling are affected due to Dcaf17 disruption. We found that Dcaf17 disruption up-regulated several somatic genes, while germline-associated genes were down-regulated. Up to 10% of upregulated, and 12% of downregulated, genes were implicated in male reproductive phenotypes. Moreover, a large proportion of the up-regulated genes were highly expressed in spermatogonia and spermatocytes, while the majority of downregulated genes were predominantly expressed in round spermatids. Collectively, these data show that the Dcaf17 disruption affects directly or indirectly testicular proteastasis and transcriptional signature in mouse.

Abstract Curcumin has demonstrated potential cytotoxicity across various cell lines despite its poor bioavailability and rapid metabolism. Therefore, our group have synthesized curcuminoid analogues with piperidone derivatives, FLDP-5 and FLDP-8 to overcome these limitations. In this study, the analogues were assessed on LN-18 human glioblastoma cells in comparison to curcumin. Results from cytotoxicity assessment showed that FLDP-5 and FLDP-8 curcuminoid analogues caused death in LN-18 cells in a concentration-dependent manner after 24-h treatment with much lower IC50 values of 2.5 µM and 4 µM respectively, which were more potent compared to curcumin with IC50 of 31 µM. Moreover, a significant increase (p

الهدف: لفحص تأثير جرعة واحدة من إعطاء قطرة الدمع الصناعي على فحص الساحة البصرية المحوسبة في المرضى الذين يعانون من الزرق ومتلازمة العين الجافة. نوع الدراسة: دراسة مقطعية. المواد والطرق: تم ادخال 50 مريض (50 عين عينة/ 50 عين شاهد) في هذه الدراسة يعانون من زرق بدئي مفتوح الزاوية ثنائي الجانب من ذوي الخبرة في فحص الساحة البصرية مع وجود متلازمة عين جافة. تم اجراء فحص الساحة البصرية المحوسبة بجهاز Octupus 900 برنامج G للعينين ثم إعادة بعد 15د وذلك بعد تقطير الدمع الصناعي في العين اليمنى فقط، حيث تبقى العين اليسرى كشاهد. تمت مقارنة معايير الموثوقية ومؤشرات الساحة البصرية بين الفحصين قبل وبعد التقطير. النتائج: تظهر دراستنا أن تطبيق جرعة وحيدة من قطرات الدمع الصناعي تحسّن بشكل هام إحصائياً من قيم MD و مدة الفحص و الإيجابية الكاذبة و السلبية الكاذبة ومعامل الموثوقية (p0.08). الخلاصة: يبدو أن اعطاء جرعة واحدة من قطرات الدمع الصناعي مباشرة قبل فحص الساحة البصرية عند مرضى الزرق المصابين بمتلازمة العين الجافة يحسن نتائج الفحص ويقلل من المدة الزمنية له.

مقدمة زاد انتشار البدانة لدى المراهقين بشكل ملحوظ في جميع أنحاء العالم. ترتبط بدانة المراهقات بزيادة اضطرابات الدورة الطمثية مما يحمل مضاعفات لاحقة مثل العقم، سرطان باطن الرحم واختلاطات الحمل. هدف الدراسة: تحديد نسبة انتشار اضطرابات الدورة الطمثية بين المراهقات، دراسة تأثير زيادة الوزن والبدانة على الدورة الطمثية عند المراهقات، البحث عن عوامل خطورة أخرى لحدوث اضطرابات الدورة الطمثية الطرق: دراسة مقطعية أجريت على 164 مراهقة في استبيان عن أسئلة حول الدورة الطمثية، العمر، الحالة العائلية، الوزن، الطول، سن البلوغ، التدخين، النشاط البدني. درسنا تأثير كل من زيادة الوزن والبدانة على كل معطى من معطيات الدورة الطمثية منفردا ثم بمشاركة عوامل أخرى مثل العمر، التدخين، سن البلوغ، الحالة العائلية للمشتركة، قلة النشاط البدني النتائج: تراوحت أعمار المشاركات بين 13 و21 سنة (1.8±19). 25% كن مدخنات. 17.7% كن زائدات الوزن. و5.5% بدينات. 41.5% عانين من عدم انتظام في الدورة الطمثية .4.3% من تباعد طموث. 3.6% من تعدد طموث. 26.8 % عانين من غزارة طمث.21.9% من نزوف بين الطموث. 45.7% من عسرة طمث. زيادة الوزن تزيد من خطر حدوث غزارة الطمث (pvalue 0.048) ونزوف بين الدورات (value

Objective: to find out the impact of cardiopulmonary bypass time (CPBT) and aortic cross-clamp time (ACCT) on immediate post-operative outcomes in patients with congenital heart disease (CHD) undergoing open heart surgery at a tertiary care centre. Study Design: Prospective longitudinal study. Place and Duration of the Study: Department of Paediatric, Cardiac Intensive Care Unit, National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan, from Jul to Dec 2021. Methodology: We enrolled 104 patients of both genders up to any age with CHD undergoing open heart surgeries. At the time of admission, age, gender, body weight, presence of cyanosis and types of CHDs were noted. Duration of mechanical ventilation, pediatric cardiac intensive care unit (PCICU) stay, and mortality was recorded. Baseline characteristics and postsurgery parameters were compared about CPBT and ACCT. Results: Of 104 patients, 58(55.8%) were males. Overall, the mean age was 7.9±5.1 years. Cyanosis was noted in 34(32.7%) cases. Mean CPBT was 74.6±42.9 minutes, while the mean ACCT was 43.5±29.5 minutes. Most types of CHDs were noted to be tetralogy of Fallot (ToF) 28(26.9%). An increase in the duration of CPBT and ACCT was found to have a significant association with post-surgical morbidity (p

المعلّقات هي أشكال صيدلانية سائلة مكونة من أنظمة غير متجانسة، تكون فيها المادة الفعالة متبعثرة بشكل متجانس في وسط سائل تظهر فيه انحلالية ضعيفة، حيث تعتبر صياغة المعلّقات هامة للمواد الدوائية ضعيفة الانحلال في الماء والتي نريد تقديمها للمرضى الذين يعانون من صعوبة البلع للأشكال الصيدلانية الصلبة، ويعتبر الألبندازول من مضادات الديدان الأكثر فعالية والذي أثبت أيضاً فعالية مضادة للسرطان، كما أنه يعاني من انحلالية ضعيفة في الماء. لذلك تم تحضير الالبندازول في شكل معلق صيدلاني، والتحري عن تأثير صمغ الكزانتان وCMC Na كعوامل معلّقة على تندف المعلّق وخصائصه. أظهرت الصيغ الحاوية على صمغ الكزانتان بتراكيز 0.2 و0.25 و0.3% كعامل معلّق حجم ترسب كبير وقابلية إعادة بعثرة سهلة وثباتية واضحة بعد تخزينها لمدة 4 أشهر في درجة حرارة الغرفة خاصة بتركيز 0.3%، في حين أن الصيغ الحاوية على CMC Na بتركيز 1% كان حجم الترسب فيها منخفضاً ومن الصعب إعادة بعثرتها، أما الصيغ المحضّرة بتراكيز 0.3 و0.5% من CMC Na فقد أظهرت حجم ترسب مقبول لكنها كانت ذات ثبات سيء بعد تخزينها.

مقدمة: يساعد النشاط البدني المنتظم في الوقاية من أمراض القلب والسكتة الدماغية والسكري. كما أنه يساعد على الوقاية من ارتفاع ضغط الدم والحفاظ على وزن الجسم الصحي ويمكن أن يحسن الصحة العقلية ونوعية الحياة. عالمياً 81٪ من المراهقين بين 11 و17 عامًا غير نشيطين بدنيًا بشكل كافٍ في عام 2016. أثبتت الدراسات أن الأنشطة البدنية والتمارين الرياضية لها تأثير كبير في الحد من اضطرابات الدورة الشهرية الطرق: دراسة مقطعية أجريت على 164 مراهقة في استبيان عن أسئلة حول مواصفات الدورة الطمثية، العمر، الحالة العائلية، الوزن، الطول، سن البلوغ، التدخين، النشاط البدني. درسنا تأثير النشاط البدني على كل معطى من معطيات الدورة الطمثية منفردا ثم بمشاركة عوامل أخرى مثل العمر، التدخين، الوزن, سن البلوغ، الحالة العائلية للمشتركة، النتائج: تراوحت أعمار المشاركات بين 13 و21 سنة (1.8±19). 25% كن مدخنات. 17.7% كن زائدات الوزن. و5.5% بدينات. 41.5% عانين من عدم انتظام في الدورة الطمثية .4.3% من تباعد طموث. 3.6% من تعدد طموث. 26.8 % عانين من غزارة طمث.21.9% من نزوف بين الطموث. 45.7% من عسرة طمث. 79.3% من المشاركات لا تمارس أي نشاط بدني خارج النشاطات اليومية، 20.7% تمارس نشاطا بدنيا أقله المشي. وجدنا في دراستنا أن قلة النشاط البدني يؤثر على معطيات الدورة الطمثية حيث يزيد خطورة حدوث غزارة الطمث والنزوف بين الطموث وعسرة الطمث ( p value 0.005,

Abstract Background Primary psoas tuberculosis is the presence of “Koch’s bacillus’’ within the iliopsoas muscle caused by hematogenous or lymphatic seeding from a distant site. Muscular tuberculosis has relatively low prevalence in comparison with other cases of extrapulmonary tuberculosis, which explains the difficulties in establishing the diagnosis. Case presentation In this report, we present a challenging diagnostic case of primary psoas tuberculosis in a 38-year-old middle eastern female from southern Syria. The diagnosis was based on the clinical orientation, the observation of pulmonary lesions on the computed tomography scan, and the necrotic signs in the vicinity of the infected area. Despite the misleading primary false-negative results, the final diagnosis was reached after sufficient repetition of tuberculosis-specific testing. The patient was treated with isoniazid–rifampin–pyrazinamide–ethambutol for 2 months, then isoniazid and rifampin for 7 months, with full recovery in follow-up. Conclusions This case highlights the importance of a clinical-based approach in the treatment of patients with psoas abscesses, especially in areas with high tuberculosis prevalence.

Background/Objective: Rotavirus is the main reason of diarrhea with gastroenteritis during childhood. This study aims to identify the demographical and clinical features of rotavirus (RV) suspected cases at Al-Baha Region. Materials and Methods: This is a cross-sectional study, it was conducted on selected 298 suspected cases with RV gathered from three noteworthy hospitals in Al-Baha area (King Fahd Hospital, Prince Meshari Hospital, and Aqiq General Hospital). The selected cases had been included based on case definition of the World Health Organization for rotavirus gastroenteritis. The data were collected from existing data in the selected hospitals' records, it was then analyzed using SPSS software. Results: The findings of this study expressed that male children are somewhat more than females (55% to 45%), the majority of them are under 2 years and most commonly are at infancy period (53.4%) and the greater part of them were admitted to Aqiq General Hospital (56.4%). The study showed that the clinical features of the hospitalized children with suspected rotavirus as 65.5% had stool motions at least twice a day, about 66.5% had no vomiting, while 59.1% with mild dehydration and 30.5% with moderate dehydration, 42.3% with lethargy, 35.2% with irritability, 53.4% with sunken eyes, and 48.3% unable to drink water. The children of the age group (≤2 years old) had significantly severe dehydration and diarrhea and were more febrile compared to other children. Conclusion: The rotavirus is a major reason of diarrhea with gastroenteritis among under 5 years children in Al-Baha region. Rotavirus suspected cases have been featured by severe diarrhea, vomiting, fever, and mild dehydration among suspected case in the governmental hospitals at Al-Baha region.

Abstract Mitochondrial dysfunction is a feature of type I and type II diabetes, but there is a lack of consistency between reports and links to disease development. We aimed to investigate if mitochondrial structure–function remodelling occurs in the early stages of diabetes by employing a mouse model (GENA348) of Maturity Onset Diabetes in the Young, exhibiting hyperglycemia, but not hyperinsulinemia, with mild left ventricular dysfunction. Employing 3-D electron microscopy (SBF-SEM) we determined that compared to wild-type, WT, the GENA348 subsarcolemma mitochondria (SSM) are ~ 2-fold larger, consistent with up-regulation of fusion proteins Mfn1, Mfn2 and Opa1. Further, in comparison, GENA348 mitochondria are more irregular in shape, have more tubular projections with SSM projections being longer and wider. Mitochondrial density is also increased in the GENA348 myocardium consistent with up-regulation of PGC1-α and stalled mitophagy (down-regulation of PINK1, Parkin and Miro1). GENA348 mitochondria have more irregular cristae arrangements but cristae dimensions and density are similar to WT. GENA348 Complex activity (I, II, IV, V) activity is decreased but the OCR is increased, potentially linked to a shift towards fatty acid oxidation due to impaired glycolysis. These novel data reveal that dysregulated mitochondrial morphology, dynamics and function develop in the early stages of diabetes.

Background: Consumption of tobacco is a prevalent public health problem in Saudi Arabia and worldwide. It remains one of the world's leading causes of preventable premature death and a public health concern. We aim to Estimation the prevalence of tobacco smoking among dental practitioners working at the Security Forces Hospital in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted in one of the largest government hospitals in Riyadh using a self-administered questionnaire. The study targeted dental practitioners including; oral and maxillofacial surgeons, orthodontists, periodontists, prosthodontists, endodontists, pediatric dentists, restorative dentists, general dentists, dental hygienists, dental assistants, and dental lab technicians. The study data were analyzed using the SPSS statistical software package. Results: Overall, 74 dental practitioners completed the study questionnaire; 54.1% were females. The age of study participants ranged between 24 to 56 years, while their mean age was 33.84 years. The prevalence of current smokers among the respondents in was 25.67%. Of the participants, 9.45% were ex-smokers. Stress relief was the main reason for smoking (52.6%), followed by relaxation (31.6%). Most respondents agreed that dental practitioners should serve as role models (73%), and that health care practitioners should give advice or information about smoking cessation to patients (79.7%). Most participants had insufficient training about tobacco hazards (56.8%). Conclusion: The prevalence of tobacco smoking among dental practitioners included in this study was closer to that in previous studies. Furthermore, study participants lacked sufficient training about tobacco hazards and control.

Colon cancer is a significant global health problem, and early detection is critical for improving survival rates. Traditional detection methods, such as colonoscopies, can be invasive and uncomfortable for patients. Machine Learning (ML) algorithms have emerged as a promising approach for non-invasive colon cancer classification using genetic data or patient demographics and medical history. One approach is to use ML to analyse genetic data, or patient demographics and medical history, to predict the likelihood of colon cancer. However, due to the challenges imposed by variable gene expression and the high dimensionality of cancer-related datasets, traditional transductive ML applications have limited accuracy and risk overfitting. In this paper, we propose a new hybrid feature selection model called HMLFSM-Hybrid Machine Learning Feature Selection Model to improve colon cancer gene classification. We developed a multifilter hybrid model including a two-phase feature selection approach, combining Information Gain (IG) and Genetic Algorithms (GA), and minimum Redundancy Maximum Relevance (mRMR) coupling with Particle Swarm Optimization (PSO). We critically tested our model on three colon cancer genetic datasets and found that the new framework outperformed other models with significant accuracy improvements (95%, ~97%, and ~94% accuracies for datasets 1, 2, and 3 respectively). The results show that our approach improves the classification accuracy of colon cancer detection by highlighting important and relevant genes, eliminating irrelevant ones, and revealing the genes that have a direct influence on the classification process. For colon cancer gene analysis, and along with our experiments and literature review, we found that selective input feature extraction prior to feature selection is essential for improving predictive performance.

[This corrects the article DOI: 10.1371/journal.pone.0161345.].

Early detection of breast cancer can be achieved through mutation detection in DNA sequences, which can be acquired through patient blood samples. Mutation detection can be performed using alignment and machine learning techniques. However, alignment techniques require reference sequences, and machine learning techniques still cannot predict index mutation and require supporting tools. Therefore, in this research, a Temporal Convolutional Network (TCN) model was proposed to detect the type and index mutation faster and without reference sequences and supporting tools. The architecture of the proposed TCN model is specifically designed for sequential labeling tasks on DNA sequence data. This allows for the detection of the mutation type of each nucleotide in the sequence, and if the nucleotide has a mutation, the index mutation can be obtained. The proposed model also uses 2-mers and 3-mers mapping techniques to improve detection performance. Based on the tests that have been carried out, the proposed TCN model can achieve the highest F1-score of 0.9443 for COSMIC dataset and 0.9629 for RSCM dataset, Additionally, the proposed TCN model can detect index mutation six times faster than BiLSTM model. Furthermore, the proposed model can detect type and index mutations based on the patient's DNA sequence, without the need for reference sequences or other additional tools.

Congenital heart defects are the most common type of birth defects in humans and frequently involve heart valve dysfunction. The current treatment for unrepairable heart valves involves valve replacement with an implant, Ross pulmonary autotransplantation, or conventional orthotopic heart transplantation. Although these treatments are appropriate for older children and adults, they do not result in the same efficacy and durability in infants and young children for several reasons. Heart valve implants do not grow with the. Ross pulmonary autotransplants have a high mortality rate in neonates and are not feasible if the pulmonary valve is dysfunctional or absent. Furthermore, orthotopic heart transplants invariably fail from ventricular dysfunction over time. Therefore, the treatment of irreparable heart valves in infants and young children remains an unsolved problem. The objective of this single-arm, prospective study is to offer an alternative solution based on a new type of transplant, which we call "partial heart transplantation." Partial heart transplantation differs from conventional orthotopic heart transplantation because only the part of the heart containing the heart valve is transplanted. Similar to Ross pulmonary autotransplants and conventional orthotopic heart transplants, partial heart transplants contain live cells that should allow it to grow with the recipient child. Therefore, partial heart transplants will require immunosuppression. The risks from immunosuppression can be managed, as seen in conventional orthotopic heart transplant recipients. Stopping immunosuppression will simply turn the growing partial heart transplant into a non-growing homovital homograft. Once this homograft deteriorates, it can be replaced with a durable adult-sized mechanical implant. The protocol for our single-arm trial is described. The ClinicalTrials.gov trial registration number is NCT05372757.

BackgroundCoronavirus disease 2019 (COVID-19) has emerged as an important cause of morbidity and mortality worldwide. The aim of this study is to identify the clinical predictors of mortality among patients with COVID-19 pneumonia during first and second waves in a treatment center in northwestern Nigeria.MethodsThis was a retrospective cohort study of 195 patients hospitalized with COVID-19 between April 2020 to March 2021 at a designated COVID-19 isolation center in Kano State, Northwest Nigeria. Data were summarized using frequencies and percentages. Unadjusted odds ratios and 95% confidence intervals and p-values were obtained. To determine independent determinants of mortality, we performed a stepwise multivariate logistic regression model.ResultsOf 195 patients studied, 21(10.77%) patients died. Males comprised 158 (81.03%) of the study population. In the adjusted stepwise logistic regression analysis, age>64 years (OR = 9.476, 95% CI: 2.181-41.165), second wave of the pandemic (OR = 49.340, 95% CI:6.222-391.247), cardiac complications (OR = 24.984, 95% CI: 3.618-172.508), hypertension (OR = 5.831, 95% CI:1.413-24.065) and lowest systolic blood pressure while on admission greater than or equal to 90mmHg were independent predictors of mortality (OR = 0.111, 95%CI: 0.021-0.581).ConclusionStrategies targeted to prioritize needed care to patients with identified factors that predict mortality might improve patient outcome.

IntroductionCardiac arrest is the leading cause of natural death in the United States, and most surviving patients suffer from neurological dysfunction. Although this is recognized as a problem, there have been very few changes to the cardiopulmonary resuscitation (CPR) procedure. Tourniquets have been recognized for their ability to increase truncal blood pressure and have been shown to improve CPR outcomes in animal models. However, the relationship between tourniquet application and blood pressure elevation has not been adequately explored in healthy human adults.ObjectivesThe objective of this study is to demonstrate that bilateral, non-invasive, peripheral vascular occlusion in the thighs results in an increased proximal systolic blood pressure ≥ 10 mmHg.MethodsThis is a single-center, non-blinded clinical trial. Volunteers will be screened for eligibility at least 24 hours before the day of the trial. On the day of the trial, volunteers will undergo an informed consent process. If they choose to participate in the trial after informed consent, their baseline blood pressure will be measured. Volunteers will then have a Combat Application Tourniquet (CAT) applied to each thigh, and the windlasses will be tightened by IRB-approved personnel. Once no pulse can be felt in the lower extremity, blood pressure will be measured in the arm. This will be replicated three times, and the tourniquets will be loosened between trials to allow the volunteers to rest. Any complications that arise during the trial will be handled by the physician that is present.AnalysisChanges in systolic blood pressure and diastolic blood pressure will be analyzed using a Shapiro-Wilk test. Then, a one-way repeated measures analysis of variance (ANOVA) will be performed with a Holm-Sidak post-hoc test to determine the mean differences. The significance level will be set to 5% for statistical significance.Registry and registration numberClinicaltrials.gov, NCT05324306.

Abstract Mice have served as an excellent model to understand the etiology of lung cancer for years. However, data regarding dual-stage carcinogenesis of lung squamous cell carcinoma (SCC) remain elusive. Therefore, we aim to develop pre-malignant (PM) and malignant (M) lung SCC in vivo using N-nitroso-tris-chloroethylurea (NTCU). BALB/C mice were allotted into two main groups; PM and M groups which received treatment for 15 and 30 weeks, respectively. Then, the mice in each main group were allotted into three groups; control, vehicle, and cancer (n = 6), which received normal saline, 70% acetone, and 0.04 M NTCU by skin painting, respectively. Histopathologically, we discovered a mix of hyperplasia, metaplasia, and dysplasia lesions in the PM group and intracellular bridge; an SCC feature in the M group. The M group was positive for cytokeratin 5/6 protein which confirmed the lung SCC subtype. We also found significantly higher (P

Abstract Mate preference in short-term relationships and long-term ones may depend on many physical, psychological, and socio-cultural factors. In this study, 178 students (81 females) in sports and 153 engineering students (64 females) answered the systemizing quotient (SQ) and empathizing quotient (EQ) questionnaires and had their digit ratio measured. They rated their preferred mate on 12 black-line drawing body figures varying in body mass index (BMI) and waist to hip ratio (WHR) for short-term and long-term relationships. Men relative to women preferred lower WHR and BMI for mate selection for both short-term and long-term relationships. BMI and WHR preference in men is independent of each other, but has a negative correlation in women. For men, digit ratio was inversely associated with BMI (p = 0.039, B = − 0.154) preference in a short-term relationship, and EQ was inversely associated with WHR preference in a long-term relationship (p = 0.045, B = − 0.164). Furthermore, men and women in sports, compared to engineering students, preferred higher (p = 0.009, B = 0.201) and lower BMI (p = 0.034, B = − 0.182) for short-term relationships, respectively. Women were more consistent in their preferences for short-term and long-term relationships relative to men. Both biological factors and social/experiential factors contribute to mate preferences in men while in women, mostly social/experiential factors contribute to them.

مقدمة: يؤثر مشعر كتلة الجسم BMI عند الحامل بشكل كبير على محصول الحمل الوالدي والوليدي وبالتالي زيادة معدل حدوث الولادة القيصرية. الهدف: دراسة تأثير مشعر كتلة الجسم BMI على معدل حدوث الولادة القيصرية. الطرق:دراسة حشدية مستقبلية شملت 101 سيدة حامل مع حمل وحيد مفرد . تم حساب BMI للسيدات والتقسيم إلى 4 مجموعات أجريت تحليلات الانحدار اللوغاريتمي لتقييم RR معدل الولادة القيصرية بين فئات BMI للأم بعد استبعاد المتغيرات ذات التأثير الوسيط مدة البحث عام كامل من كانون الأول 2020 إلى كانون الأول 2021. النتائج : كانت نسب توزع المرضى حسب قيمة BMI على الشكل التالي :ناقص الوزن(3%) طبيعي الوزن(60،4%) زائد الوزن(19،8%) بدينات (14%) مقارنة بالنساء طبيعيات الوزن فقد وجدنا زيادة في معدل حدوث الولادة القيصرية لدى البدينات و زائدات الوزن RR adj 3.4 CI95%(1.7-5.9)). بقيت فئة البدينات أعلى احتمالا للولادة القيصرية حتى بعد التعديل للعوامل ماقبل الولادية وما حول الولادة والمتعلقة بالوليد (RR adj 2.3 CI 95%(1.2-3.1) الخُلاصة : تعتبر البدانة لدى السيدات الحوامل عامل خطورة لزيادة معدل حدوث الولادة القيصرية ولذلك يجب أن تراقب بشكل لصيق خلال الحمل .

هدف الدراسة : تقييم تأثير توسيع الحدقة باستخدام تروبيكاميد1% على قيمة الضغط داخل المقلة. الطرائق : هذه الدراسة المقطعية ضمت 104عيون ل 70مريض في المجموعة العمرية بين 18-60 سنة. تم استبعاد حالات معروفة من مرضى زرقيين، زاوية مغلقة، وجود عمليات جراحية وأمراض عينية. بعد أخذ قصة مفصلة وإجراء الفحص، تم قياسIOP ثم تم تطبيق التروبيكاميد1%. بعد توسع الحدقة تم إعادة قياس IOP. تم جمع البيانات وتحليلها على مقياسSPSS 21 . متوسطات قيم IOP تمت مقارنتها قبل وبعد توسيع الحدقة. النتائج : اخذنا 104 عين ل 70مريض الذين كان منهم ذكور 18(25.7%) و إناث 52 ( 74.3%). متوسط أعمارهم كان 40.2±13.4، العيون السديدة22 (12.2%) ،العيون المديدة 50(48.1%) والعيون الحسيرة 32 (30.8%) . متوسط الضغط داخل المقلة قبل توسيع الحدقة 0.9±13.43 وبعد التوسيع 0.5±13.6 ملم ز . تمت مقارنة متوسطات قيم الضغط داخل المقلة قبل وبعد توسيع الحدقة عند كل من السديدين والمديدين والحسيرين. الخلاصة : لم تكن هناك أهمية إحصائية في تغير قيمة الضغط داخل المقلة بعد توسيع الحدقة بالتروببكاميد 1%. الكلمات المفتاحية : توسيع الحدقة ،الضغط داخل المقلة ،التروبيكاميد.

الهدف: دراسة دور خـزع الــفرج الواقي الـروتيني في التقليل من التمزقات العجانية والنزف أثناء الولادة وتقصير زمن طور الإنقذاف وتأثيره على حالة الوليد. الطرق: تضمنت عينة البحث 50 سّيدة من السّيدات الخروسات الحوامل بين العمر (14_36) سنة اللاتي راجعنّ قسم التوليد وأمراض النساء في مشفى تشرين الجامعي في اللاذقية خلال الفترة الزمنية 2021-2022 ،بعد أن تم قبول السّيدة في قسم المخاض تم التقييم السريري للمريضة وشمل : أخذ قصة سريرية مُفصلة وتوثيق المعلومات التالية : (العمر الوالدي _تاريخ آخر دورة طمثية (العمر الحملي) _السوابق الحملية _ السوابق الولادية _ السوابق المرضية _السوابق الجراحية) ، إجراء فحص سريري دقيق وتوثيق المعلومات التالية : ( العلامات الحيوية للمريضة _ التأكد من المخاض ( التقلصات الرحمية ) _الفحص النسائي )، شمل التقييم إجراء تصوير بالأمواج فوق الصوتية ( تقييم للجنين وتحديد نوع المجئ _ تقدير وزن الجنين ) وبعد التأكد من أن المريضة مُستوفية لمعايير الادخال والاستبعاد ، تم اخذ موافقة السيدة الطوعية للدخول في الدراسة ومن ثم تمت متابعة السيدات كافة أثناء المخاض والولادة وحتى ساعتين من حدوث الولادة حيث قمنا بما يلي: بحساب زمن طور الانقذاف ، تقييم وجود التمزقات العفوية للعجان ودرجتها، تقدير كمية النزف الإجمالي خلال الساعتين الأولى للولادة ، وبعد ذلك قمنا بتسجيل مُشّعر أبغار الوليد ( الدقيقة الأولى ). ومن ثم تم ملء الاستبيان المخصص للدراسة لكل مريضة وبعد ذلك قمنا بتحليل البيانات وجدولتُها واستخلاص النتائج. النتائج: تُشير نتائج هذه الدراسة إلى أن الخروسات لديهن فرصة أكبر للإحتفاظ بمنطقة العجان سليمة إذا تم إجراء الخزع فقط عندما يُنظر إليه بأنّ لا مفّر منهُ. حيث شوهد العجان السليم بنسبة 63.6% في خروسات مجموعة الخزع المقيّد مقابل 56% في مجموعة الخزع الروتيني خضعن للخزع فقط بدون أية تمزقات عفوية أُخرى، وبالمقارنة بين مجموعتي دراستنا الحالية تبعاً لحدوث التمزقات العجانية العفوية (الأمامية والخلفية) حيث بلغت نسبة التمزقات في مجموعة الخزع الروتيني( 44% مقابل 36.4% ) في مجموعة الخزع المقيد، كما أظهرت نتائج الدراسة الحالية أن التمزقات العجانية الأمامية العفوية (المهبل ،الشفرين وماحول الاحليل ) كانت أكثر شيوعاً في مجموعة الخزع المقيّد (27.3% مقابل 16%) في مجموعة الخزع الروتيني مع عدم وجود فرق هام احصائياً بين مجموعتي الدراسة، وبالمقارنة أيضاً بين المجموعتين من حيث التمزقات العجانية الشديدة من الدرجة الثالثة، فقد بلغت نسبة أعلى في مجموعة الخزع الروتيني( 8% مقابل 4.5%) في مجموعة الخزع المقيّد مع عدم وجود فرق هام احصائياً. ومن الجدير بالذكر لم تُسجل أي حالة تمزق عجاني من الدرجة الرابعة في مجموعتي دراستنا كما تم اثبات دور خزع الفرج الروتيني في تقصير مدة طور الانقذاف حيث بلغ متوسط مدة المرحلة الثانية للمخاض في مجموعة الخزع الروتيني (55.36 ±4.5 د مقابل 62.32 ±3.4 د) في مجموعة الخزع المقيّد بفارق حوالي 7 دقائق تقريباً مع وجود فرق احصائي هام، بلغت القيمة المتوسّطة لكميّة النزف الإجمالي المُقدّرة خلال الساعتين الأولى للولادة نسبة أعلى في مجموعة الخزع الروتيني 265.56 ±20.6)مل مقابل 238.11 ±16.4 مل) في مجموعة الخزع المقيّد. ففي مجموعة الخزع الروتيني تمت خسارة الدم من شق الخزع بالإضافة إلى التمزقات العفوية في حال وجودها، أما في مجموعة الخزع المقيد فقد كانت خسارة الدم فقط من التمزقات العفوية مع وجود فرق هام احصائياً، أما من ناحية النتائج الوليدية ، لم يكن هنالك فرق هام إحصائياً في دراستنا بين مجموعتي البحث من ناحية حالة الوليد المتمثلة بمشعر أبغار في الدقيقة الأولى. الخلاصة: تعزيز استخدام خزع الفرج المقيد وذلك في الحالات السريرية الضرورية التي تتطلب ذلك.

(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities––which are often not taken into account while estimating nurse-to-patient care time allocation––that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses’ overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time–motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.

Abstract Background Non-Hodgkin lymphoma is the fourth most common malignancy in children, and it is not considered to be a hereditary disorder. However, it could affect members from the same family. Case presentation We are presenting two cases of Caucasian female siblings who were diagnosed with mediastinal lymphoblastic lymphoma in the same year. The two young females were presented to the emergency department with respiratory symptoms. After doing radiological investigations and biopsies, they were diagnosed with lymphoblastic lymphoma. The elder sister died before confirming the diagnosis, and the other is on chemotherapy now, with good treatment outcomes. Conclusions This case emphasizes the crucial role of precursor genetics in lymphoblastic lymphomas and suggests a strong relation between these genetics and age at symptom presentation. This is the first report of non-Hodgkin lymphoma in a pair of siblings in the pediatric population.

Background: Hashimoto thyroiditis (HT) and Graves’ disease (GD) are autoimmune inflammatory thyroid disorders. The evolution from GD into HT is the most common scenario while the conversion from HT into GD seems to be less common. Case Presentation: A 20-year-old female patient referred to the endocrinology clinic with a three-month history of fatigue, lethargy, lack of appetite, constipation, menorrhagia, cold intolerance, and 5 kg weight gain in the last two months. Clinical examination showed dry skin, scalp hair loss, and painless hard goiter whereas thyroid ultrasound revealed generalized homogeneous hypoechoic thyroid hypertrophy. Laboratory tests demonstrated increased serum thyroid-stimulating hormone (TSH) 210 µIU/L (normal: 0.25-4.50), decreased free thyroxine (FT4) 0.37 ng/L (normal: 0.8-1.8) and free triiodothyronine (FT3) 1.94 pg/mL (normal: 1.8-4.6), and finally, increased thyroid peroxidase antibodies (anti-TPO) 462 IU/mL (normal: up to 34). Based on observations, HT was diagnosed and thus daily treatment with levothyroxine 75 mcg was started for the patient. Two months later, she referred with symptoms suggestive of hyperthyroidism with reduced TSH levels, which did not improve after levothyroxine cessation, thus more laboratory tests were conducted and revealed decreased TSH levels, increased T3 and T4, and TSH receptor stimulating antibody (TSAb)levels, and increased radioactive iodine uptake at 24 hours. Therefore, the diagnosis of GD was made. Five weeks after treatment, she was in full remission. Conclusion: Although the switch from HT into GD is rare, it can occur at any time during the disease. Nonetheless, early diagnosis and treatment would improve the quality of care.

Abstract Background Umbilical hernias are a frequent and well-known pathology in children or adults. Congenital umbilical hernias are commonly diagnosed in childhood, and in adulthood such a hernia is usually acquired. Umbilical hernia in pregnancy may result in serious obstetric complications including antepartum hemorrhage, intrauterine fetal demise, and preterm labor, particularly if incarcerated. Case presentation We present a rare case of a congenital umbilical hernia in a term pregnancy. The patient was a 34-year-old African (Malawian) woman, living with human immunodeficiency virus (HIV) and on antiretroviral treatment, gravida 4, with three previous vaginal deliveries, and with two babies weighing 4 kg at birth. We performed herniorrhaphy at caesarean section, and at 3 months of follow-up she had no evidence of a recurrent hernia. Conclusion Congenital umbilical hernias are commonly diagnosed in childhood but might first be seen by medical practitioners in adulthood. A patient-centered approach addressing patient complaints, associated risk factors, and possible complications is recommended. Primary repair at caesarean section is a feasible option.

With the increasing prevalence of end-stage kidney disease in Bahrain, kidney donation is of vital importance. In this study, we want to assess how financial incentives will influence peoples’ views and decisions regarding kidney donation. The aim is to establish strategies to increase the number of kidneys for transplantation in Bahrain. We adapted a previously established questionnaire on financial incentives for living kidney donations. The questionnaire assessed the public opinion in Bahrain on how kidney donation can be influenced by two different financial incentives, namely 10,000 Bahraini Dinars and life-long health insurance. We collected a convenient sample of 446 participants by distributing an electronic version of the questionnaire. IBM SPSS Statistics version 23 software was used for data entry and analysis. Of the total participants, 39% were male and 61% were female. Eighty percent of the participants believed that their chances for kidney donation will not increase in turn of receiving a financial compensation, while 20% of them believed that it will increase. Our study found that generally married participants (70%) find it a preferable development for health insurance companies to offer financial compensation for kidney donation, while nonmarried participants (30%) found it not a preferable but also not an adverse development (P = 0.038). Furthermore, there is a positive correlation between age and preferable views toward financial incentives to increase kidney donation (P