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Enteric duplications (EDs) are rare congenital anomalies that result from defect during embryonic development of the gut. Although EDs can literally occur at any part of the gastrointestinal tract, ileocecal duplication is the commonest type followed by colorectal type. Morphologically, EDs are mostly cystic in nature; tubular duplications are uncommon. We report radiological diagnostic challenges encountered in dealing with a 10 month-old infant who presented with chronic constipation, progressive abdominal distension, and voiding difficulty for several weeks followed by colicky abdominal pain for three days. After a series of radiological procedures, a diagnosis of tubular colorectal duplication was made. The duplicated segment was loaded with impacted feces which exerted pressure effect on the rectum and urinary bladder. The case was treated surgically through laparoscopic procedure that included fenestration and stapling of the duplicated bowel followed by irrigation. Postoperatively, the child was followed up half-yearly for three years and was found to remain symptom-free. This case exemplifies the challenges a radiologist may experience while dealing with a case presenting with features of as acute-on-chronic intestinal obstruction and voiding difficulty.

Background: The benefit of revascularizing chronically occluded coronary arteries remains debatable, and available long-term outcome reports are sparse. Current guidelines recommend revascularization of chronically occluded arteries only in patients with myocardial ischemia and/or symptoms associated with angina. We investigated outcome of patients with total chronic occlusion of the right coronary artery (RCA) receiving coronary artery bypass grafting (CABG) surgery with and without revascularization of the RCA. Methods: We retrospectively analyzed all patients with chronically occluded RCAs receiving CABG with (group 1 = RCA-CABG; n = 487) and without (group 2 = No-RCA-CABG; n = 100) revascularization of the RCA. In total, 587 patients with complete follow-up of a minimum of 6 years were included (92%). Results: In total, 82% in group 1 versus 86% in group 2 were male (P = .38). European System for Cardiac Operative Risk Evaluation II was comparable between both groups (4.35 ± 7.09% vs 4.80 ± 5.77%, P = .56) with no major differences regarding preoperative characteristics between groups. Patients in group 1 received 3.24 ± 0.79 distal anastomoses, whereas group 2 received 2.45 ± 0.83 distal anastomoses (P

Purpose: Breast cancer in men accounts for approximately 1% of all breast cancers. Breast cancer trials have routinely excluded men. The aim of this analysis was to determine the effect of different treatment factors, in particular, postoperative radiation therapy (RT) on long-term outcomes. Methods and Materials: Seventy-one patients with male breast cancer treated in 5 closely cooperating institutions between 2003 and 2019 were analyzed. Results: Almost all patients (95%) underwent surgical resection. Forty-two patients (59%) received chemotherapy, and 59 (83%) received adjuvant hormonal therapy. Of the 71 patients, 52 (73%) were treated with RT. The rate of recurrence was 20% in the whole cohort, with a locoregional recurrence rate of 3%. In the entire group, the 5-year local control (LC) was 95%, whereas 5-year progression-free survival (PFS) and 5-year overall survival (OS) were 62% and 96%, respectively. There was a lower rate of relapses after adjuvant RT (19% vs 32%, P = .05) without in-field relapse after postoperative RT (0%) versus 10% in patients without RT (P = .02). In the multivariate analysis performed, hormonal therapy administration was found to have a possible significant effect on LC and PFS. Administration of adjuvant RT and stage affect PFS. In patients who received RT, there were no grade 3 or 4 acute toxicities. Conclusions: Adjuvant RT is an effective and safe treatment for male breast cancer patients with no infield relapses and better PFS. Hormonal therapy administration was found to have a possible effect on LC and PFS.

Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic disorder characterized by thrombotic microangiopathy. Neurologic symptoms are frequently seen in its presentation and the most common finding on neuroimaging of TTP is posterior reversible encephalopathy syndrome (PRES). Acute strokes, hemorrhages and atypical PRES are uncommonly seen. Our case reports the clinical and imaging details of a young male patient with TTP and Sjogren's syndrome, who made a complete recovery after aggressive plasmapheresis and immunosuppressive therapy with resolution of the imaging findings of PRES on follow up brain MR imaging. We briefly review the literature for the spectrum of imaging findings that can be seen on brain MRI with TTP.

Abstract. Rationale:. Since mass-scale severe acute respiratory syndrome coronavirus 2 vaccination, there have been case reports of several immune-mediated reactions, including new-onset and flares of glomerular disorders following immunization with mRNA coronavirus disease 2019 vaccines. Here, we report two cases, the first to our knowledge, of relapsing cryoglobulinemic vasculitis with new-onset severe renal involvement following mRNA coronavirus disease 2019 vaccination. Patient concerns:. The relapse of the cutaneous and the new onset of severe renal involvement of cryoglobulinemic vasculitis occurred three weeks after the second dose of the mRNA Moderna coronavirus disease 2019 vaccination and two days after the first dose of mRNA Pfizer coronavirus disease 2019 vaccination in the first and second patient, respectively. Diagnosis:. Kidney biopsies were performed. The first pacient's kidney biopsy showed a membranoproliferative pattern of glomerular injury with extensive mesangial and endocapillary hypercellularity, while severe endothelial swelling, loss of fenestrations and widening of subendothelial space were identified by electron-microscopy. The second patient's kidney biopsy was consistent with cryoglobulin associated membrano-proliferative pattern of glomerular injury. Interventions:. Our patients were managed with a combination of immunosuppressants consisting of corticosteroids, Cyclophosphamide and Rituximab with a favourable outcome at the end of the induction period. Outcomes:. Clinical and immunological response was achieved in both patients after four months of follow-up. Lessons:. The temporal association of the relapse of the cryoglobulinemic vasculitis to mRNA coronavirus disease 2019 vaccination suggest that the vaccine might have been a trigger for the reactivation of the disease in our cases. This possible association should be acknowledged by physicians in order to provide optimal monitoring and treatment in case of reactivation of the disease post-immunization.

الملخص: أهداف البحث: يعد فحص الخرف بين كبار السن ضروريا لتحديد الحالات المحتملة، وتأكيد التشخيص ووضع العلاج والتخطيط لاستراتيجيات رعاية الأسرة المستقبلية. هدفت هذه الدراسة إلى الكشف عن الخرف بين مرضى الشيخوخة في منطقة القصيم باستخدام أداة الخرف ذات الثماني بنود للكشف عن مرض الزهايمر القائم على المخبر. طرق البحث: أجريت دراسة مقطعية على مرضى الشيخوخة في القصيم في مستشفيات مختارة خلال الفترة من ديسمبر إلى مارس ٢٠١٩-٢٠٢٠. وتمت مقابلة مقدمي الرعاية لمئة من مرضى الشيخوخة باستخدام أداة الخرف ذات الثماني بنود للكشف عن مرض الزهايمر. النتائج: بين المئة مريض، كانت أعمار ٤٣٪ من المشاركين بين ٦٥-٧٥ عاما، وكان الذكور ٥٢٪ والإناث ٤٨٪، وكان متوسط العمر٧٨ عاما لكلا الجنسين. وكان مرض السكري أكثر الأمراض المزمنة (٦٨٪) يليه تاريخ لمرض الأوعية الدموية الدماغية (٥٢٪). وفقد ٤١٪ أكثر من أربعة ولكن أقل من نصف الأسنان بينما ذكر١٠٪ تعدد الأدوية. وكان الخرف إيجابيا في ٧٤٪ وترتبط إحصائيا بشكل كبير بتاريخ السكتة الدماغية، وعدد الأسنان المفقودة وعدد الأدوية التي يتم تناولها. وأظهر نموذج الانحدار اللوجستي الثنائي المجهز للتنبؤ بالخرف استنادا إلى تأثير تاريخ السكتة الدماغية، وعدد الأسنان المفقودة والأدوية المعطاة أن المرضى المصابين بالسكتة الدماغية لديهم ١.٤٣ عدد مرات احتمالية الإصابة بالخرف من أولئك الذين ليس لديهم تاريخ مرضي سابق بالسكتة الدماغية. الاستنتاجات: ينتشر الخرف بين مرضى الشيخوخة في منطقة القصيم، وكانت عوامل خطر الخرف شائعة بين المشاركين. كما ارتبط الفحص الإيجابي للخرف بتاريخ السكتة الدماغية، وعدد الأسنان المفقودة، وتعدد الأدوية والعمر. تقلل الوقاية من السكتة الدماغية والعلاج المبكر من احتمالية حدوث الخرف. Abstract: Objectives: The screening of dementia among geriatrics is necessary to identify probable cases, confirm diagnosis, institute treatment, and plan for future family caregiving strategies. This study aimed to screen the incidence of dementia among geriatric patients using the informant-based Alzheimer's disease eight-item tool for dementia (AD8) in a KSA region. Methods: A cross-sectional study was conducted among geriatric patients in the KSA region at selected hospitals from December 2019 to March 2020. The caregivers of 100 geriatric patients were interviewed using the AD8. Results: Among the 100 patients, 43% were 65–75 years old, 52% were men, and 48% were women, mean age was (78) for both genders. Diabetes mellitus was the most reported chronic illness, found in 68% of the patients, followed by a history of cerebrovascular disease (52%). Loss of more than four but less than half of the teeth was reported in 41% of the patients, while 10% were reported to be undergoing polypharmacy. Dementia was diagnosed in 74% of patients and had a statistically significant association with a history of stroke (p

Objective: The main objective was to describe and review a unique case that presented with diabetic ketoacidosis, positive insulin autoantibodies (IAAbs, which are found in Hirata disease and are usually present with hypoglycemia), and laboratory findings characteristic of type B insulin resistance syndrome (TBIRS) and systemic lupus erythematosus. Confirmation of TBIRS was obtained in Germany as immunoassay for insulin receptor antibodies (IRAbs) is not available in the United States. Methods: A literature review on TBIRS and cases that present with IAAbs and IRAbs simultaneously was conducted. Results: We found 6 cases presenting with hypoglycemia, both antibodies, and treatment attempts with various management approaches that were different from the proposed National Institutes of Health (NIH) protocol for TBIRS. Our case is distinct because of the demographic background, presentation with diabetic ketoacidosis, comparatively lower insulin requirement, and no significant hypoglycemic episodes in the third phase. Conclusion: We propose that access to IRAb immunoassays may be important for diagnosing milder cases of TBIRS, while IAAbs may provide prognostic and therapeutic insights. Despite completely different presentation from other TBIRS patients reviewed, we observed that the proposed NIH protocol consisting of dexamethasone, rituximab, and cyclophosphamide was successfully employed in our patient. Thus, we propose that our case and the findings regarding antibody testing and the NIH treatment regimen may assist clinicians with earlier recognition and effective management of milder cases of TBIRS.

Learning loss pertains to the decline or regression in knowledge and abilities, as well as setbacks in academic advancement. This phenomenon typically arises from prolonged interruptions or gaps in the pupil's educational journey. Learning loss can be observed in diverse manifestations due to many factors. One example that can be illustrated is the disruption of formal education due to the COVID-19 pandemic that struck the world in 2019. As a result, this phenomenon has impacted students' academics, whether at the school level or higher education institutions, especially primary school students, thus causing learning poverty. This scoping review aims to identify the degree of reading literacy among primary school students and to investigate the factors that contribute to the learning losses of primary school students from the reading aspect. Four databases, including Scopus, Education Resources Information Center (ERIC), Bielefeld Academic Search Engine (BASE), and Directory of Open Access Journals (DOAJ), were used in this research, which found 40 articles for eligibility. Only 20 articles are eligible for analysis and reference after the exclusion and inclusion process for data collection. The findings show that learning losses have impacted the education sector, leading to poverty, especially among primary school children. [ABSTRACT FROM AUTHOR]

The tailoring of the surface properties of cellulose nanocrystals (CNCs) to meet various requirements in environmental, food, and material areas has always been of great interest. In this study, the surface chemistry of CNCs was noncovalently modified by cetyltrimethylammonium bromide (CTAB), followed by characterizations and an investigation into its application as a coating material for interfacial interaction over various substrates. Due to the CTAB modification, the surface charge of the CNCs was neutralized, resulting in an increased size of each nanocrystal at the aqueous status and the aggregated microfibers when dried up. The CTAB modification not only decreased the crystallinity of the samples from 48.57% to 9.12%, but also reasonably hydrophobized the CNCs and decreased their total surface energy. Finally, the adsorption behavior of the CNCs and CTAB-CNCs over nonionic, anionic, and cationic polymers was investigated by ellipsometry. Based on the thickness of the CNC and CTAB-CNC layers over 2-Hydroxyethyl cellulose (HEC), carboxymethyl cellulose (CMC), and polyethyleneimine (PEI), we proposed that the adsorption behavior was overall influenced by electrostatic interaction, hydrogen bonding, and van der Waals forces, and the thickness of the adsorbed layers could be impacted by both the surface charge and the size of the crystals. [ABSTRACT FROM AUTHOR]

Outdoor learning encompasses a wide range of educational activities, from local natural play areas to formal school curriculum classes. Despite growing evidence of its benefits, outdoor learning is still underutilized in Malaysia's early childhood education system. Hence, this study aims to investigate preservice teachers' perceptions of the impact of outdoor learning on children's well-being since future teachers' perception is the most important indicator in predicting their intention to use it in the future. A quantitative approach was used, and the questionnaire was distributed to 63 pre-service teachers studying at Universiti Selangor, Malaysia. Based on the findings, the majority of respondents agree that outdoor learning benefits children's well-being, especially their social and psychosocial well-being. Thus, this study provides insight into the significance of outdoor learning on children's learning experiences and that it should be utilized more frequently in the classroom. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to assess the value of FLT-PET as a non-invasive tool to differentiate between patients with ET and Pre-PMF. This study is a pilot study to have a proof of concept only. Methods: This is a prospective, interventional study where a total of 12 patients were included. Each patient underwent FLT PET imaging as well as bone marrow examination (gold standard). In addition, semi-quantitative (SUVmax and SUVmean) measurements of FLT uptake in the liver, spleen, and Lspine, SUVmean, as well as the Total Lesion Glycolysis (TLG) of the Lspine were performed. Results from the two patient cohorts were compared using = Kruskal-Wallis statistical test. A P -value of .05). In contrast, TLG measurements in the LSpine were statistically different ( P = .013), and therefore, compared to gold standard bone marrow results, TLG can separate ET and Pre-PMF patients. Conclusion: This study is a proof of concept about the potential to discriminate between ET and pre-PMF patients in a non-invasive way. TLG of the LSpine in FLT PET images is a potential quantitative parameter to distinguish between ET and pre-PMF patients.

Background. We sought to evaluate the association between de novo donor-specific antibodies (dnDSAs) class and their mean fluorescence intensity (MFI) with donor-derived cell-free DNA (dd-cfDNA), aiming to further clarify the biomarker utility of these noninvasive tests in relation to renal allograft function and histology. Methods. The study included kidney transplant recipients (n = 171) who underwent surveillance testing with DSA and dd-cfDNA as part of their clinical care between September 2017 and December 2019 at our center. Results. We identified dnDSA in 43 patients (25%) at a median of 4.63 y (IQR, 1.5–7) posttransplant. The presence of DSA with MFI >2500 was associated with a median dd-cfDNA of 0.96% (IQR, 0.26–2.95) significantly higher than in patients with DSA MFI 2500 (82.9%). Patients with DQ-dnDSAs (47.4%) had higher MFI and dd-cfDNA levels than other class II dnDSAs. By comparison, all patients that developed only class I DSAs had MFI 2500 (P = 0.05). After multivariate adjustment, an elevated dd-cfDNA was independently associated with the presence of dnDSA with MFI ≥2500. We identified that both dd-cfDNA and dnDSAs were strongly associated with antibody-mediated rejection, whereas for individual Banff histological lesions, DSA MFIs ≥2500 had the strongest association with C4d staining score and dd-cfDNA >1% with microvascular inflammation. Conclusions. Our study identifies class II dnDSA as being strongly associated with late alloimmune injury post kidney transplant independent of allograft dysfunction and shows that dd-cfDNA may complement the clinical significance of dnDSAs.

The collaborative instructional design system is the transformation of the instructional design system, developed as an option for educationalists to design their instruction online in addressing the current educational needs. It is a new dimension with the wider concept at engaging teachers and other professional learning communities collaboratively involved virtually in the 21st century learning environment. It enhances the quality of educational practices, giving opportunities for learners to determine and create their own inspiring learning activities. It enriches teachers' professionalism in instructional planning as well as learners' experiences in collaborating and sharing information with different communities for their future career development.

This study aims to explore the application of online cooperative learning among music students in a faculty of a Malaysian public university. It adopts a qualitative approach utilizing a case study design. Participants were selected through purposive sampling, comprising 11 postgraduate students from a public university in Selangor. Each participant engaged in six sessions of online cooperative learning, with each session lasting four hours. Semi structured in-depth interview and participant observation were conducted for data collection purposes. Data triangulation was achieved by conducting a group interview with six undergraduate music students, ensuring a comprehensive approach to data collection. The results indicate ten significant aspects of online cooperative learning. The study demonstrates that online cooperative learning fosters cooperation among students, encourages active engagement, enhances learning quality, improves communication skills, facilitates knowledge acquisition, boosts motivation, cultivates leadership qualities, instils respectful values, sparks interest, and enhances student achievement. the study underscores the potential of online cooperative learning to enhance the online learning experience for music students. It also suggests a positive impact on student achievement, thereby contributing to the advancement of the Malaysian tertiary education system. Consequently, this research is crucial for strengthening and enhancing online learning methodologies, aligning them with the requirements of 21st-century education. [ABSTRACT FROM AUTHOR]

Introduction: Since the declaration of coronavirus disease 2019 (COVID-19) as a pandemic, patients with dementia, were specifically vulnerable to the negative impact of the outbreak. Objective: To examine the association between lockdown amid COVID-19 pandemic and the rate of cognitive decline among patients with dementia and mild cognitive impairment (MCI). Methods: We conducted a cross-sectional observational study on patients with dementia and MCI who attended the outpatient clinic at Ibn Sina Hospital, the main tertiary neurology center in Kuwait, during the month of September 2020. The rate of cognitive decline, estimated by MMSE scores, was compared between the period prior to, and during lockdown. Results: We evaluated 36 consecutive patients with cognitive impairment (23 females [63.9%], mean age 71 ± 10.8 years, mean disease duration 34.6 ± 29 months). Eleven patients (30.6%) progressed to a more severe stage during the study period; 1 MCI (2.8%) converted to mild dementia, 6 (16.6%) mild to moderate, and 4 (11.1%) moderate to severe dementia. Monthly decline of MMSE scores before lockdown was 0.2 ± 0.1 points, while it was 0.53 ± 0.3 points during lockdown, which was statistically significant ( p = .001). The most affected cognitive domain was the memory with a mean decline of 1.5 ± 0.8 points. Conclusions: This study provides “real-world” data suggesting rapid cognitive decline in patients with dementia during the lockdown period. Healthcare systems should pay more attention to this vulnerable group, to help them maintain their mental, physical and social well-being during this crisis.

Background: The variety and complexity of dermatologic diseases in Afghanistan and the associated diagnostic resource constraints have not been previously studied. Moreover, the utility of store-and-forward teledermatopathology in this resource-limited setting has not been investigated. Methods: A retrospective analysis was conducted of 150 store-and-forward teledermatopathology cases that were composed of a clinical history, clinical images, and histologic images that were sent from an academic teaching hospital in Kabul to a dermatology-trained dermatopathologist at Emory University in the United States between November 2013 and June 2017. For each case, the histologic impression of the Emory dermatopathologist was compared with that of the Kabul-based general pathologist and the clinical differential diagnosis and histologic impression of the Kabul-based dermatologist. Results: Eighty-one of the cases that were analyzed were from female patients. The diagnosis after telepathology consultation differed from the first entity in the clinical differential diagnosis in 34.7% of cases. The telepathology consultation refined the Afghan general pathologist’s histologic impression 45.5% of the time and the Kabul-based dermatologist’s histologic impression 24.3% of the time. A clinically significant difference in care was made in 19.3% of cases for which an analysis could take place between the histologic impressions of the Emory dermatopathologist and U.S.-trained dermatologist. The most common resource constraints that limited a definitive diagnosis were the inability to perform infectious stains and cultures to identify specific pathogens (19.3% of cases) and immunofluorescence studies to confirm autoimmune bullous disease (6.7% of cases). Conclusions: These results highlight the important diagnostic role that teledermatopathology can serve in resource-limited settings such as in Afghanistan.

In recent years, research on the epoxidation of fatty acids has attracted considerable attention due to the growing demand for eco-friendly epoxides generated from vegetable oils. Commercially available epoxides are primarily derived from petroleum and animal fats, which are non-environmentally friendly sources. Epoxide is a crucial chemical precursor for the manufacture of alcohols, glycols, and polymers such as polyesters and epoxy resin. The optimal process parameters were determined using the one factor at a time (OFAT) technique. This study's purpose is to identify the optimal process parameter for agitation speed in relation to the oxirane ring opening of epoxidized oleic acid. The result at 100 rpm and sulfuric acid as catalyst are the optimal process setting for achieving maximal relative oxirane conversion (93 %). Then, the ring opening formation's identity was validated using Fourier Transform Infrared (FTIR). [ABSTRACT FROM AUTHOR]

Purchasing in online platforms has become a significant trend among consumers in today's globalized market, thus receiving considerable attention from scholars and practitioners alike. Notwithstanding the growth of research, less comparative empirical studies have been devoted to this field. Centralizing the issue of online reviews in online platforms, this study focuses on consumers in two countries, Malaysia and China. This study examines how consumers in these countries assess online reviews from three aspects namely; balance reviews, expert reviews, and strong tie reviews before arriving at a purchase decision. A total of 346 questionnaires were distributed via online survey. Finally, 176 responses from Malaysia and 170 responses from China were returned. Data were statistically analyzed through exploratory factor analysis, to be exact Pearson correlation and regression analysis. This was followed by the confirmatory factor analysis using SEMPLS. The findings show that there were differences between Malaysia's and China's consumers in employing online reviews before making purchase decisions. Based on the findings, discussion and implications of the study as well as limitations and suggestions for future directions are also discussed at the end of this paper. [ABSTRACT FROM AUTHOR]

An effective and systematic design of instruction will determine the quality of learning and teaching practices. Hence, instructional design models are required, to move from just adopting a standard approach to developing models that have an impact on learners' profiles, creating a much better learning experience, skills, and knowledge both in the classroom and online. The 21st Century Learning Framework requires learners to develop their thinking skills, communication skills, collaborating skills and enhancing their creativity, (4Cs) towards establishing "globally competitive learners." An Integral ASIE Instructional Design Model is an innovative 21st Century teachers' designing tool that provides a solution to the above challenges. The Model assist teachers in Planning, Utilizing and Sharing (PLUS) instructions with others across nations. It promotes the Professional Learning Community practices where educationist, stakeholders, parents, and corporates work collaboratively ensuring its quality and sustainability in addressing the future employability issues of the learners. Results from 5 Likert Scales Questionnaires given to teachers in workshops and pilot project conducted, shows positive views on the model.

Research Aims: This study investigates the mediating role of functional conflict in explaining the effect of market orientation on the absorptive capacity of small and medium enterprises (SME) exporters in emerging markets. Design/Methodology/Approach: The data were successfully collected from 124 respondents and tested using structural equation modelling via Smart-PLS. Research Findings: The results support the notion that responsive market orientation and proactive market orientation positively influence absorptive capacity. In addition, functional conflicts serve as a quasi-mediator in the relationship between responsive market orientation and absorptive capacity. Theoretical Contribution/Originality: The export competitiveness of SMEs is the output of intangible assets of external knowledge. The ability to identify the relevant knowledge, disseminate that knowledge within the organisation and transform it into valuable products or services is pertinent. Nevertheless, firms vary in terms of the ability to develop absorptive capacity. Accordingly, previous research investigates the antecedent of absorptive capacity, but very few have looked at the role of market orientation and the conditions that influence the relationship. Managerial Implications in the South East Asian Context: Interaction with foreign importers affects SME knowledge development. Functional conflict requires open dialogues to develop meaningful outputs; as such, SMEs in South East Asia should aim to build good connections with their overseas importers. Research Limitations & Implications: The limitations of this study include the small sample size, the external condition of Covid-19 that was not included in this study and the cross-sectional approach of data collection which did not capture the dynamic nature of the firm’s capability. [ABSTRACT FROM AUTHOR]