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Health policy debates rely on reliable and timely information on major causes of mortality and their associated attributors, especially to overcome the traditional public health focus restricted to the biomedical cause of death (COD). This study explores relevant social and health system circumstantial barriers to accessing healthcare services among deceased patients with Type 2 Diabetes Mellitus (T2DM) in Saudi Arabia. A total of 302 verbal autopsy (VA) interviews were conducted with relatives or caregivers of the deceased who died between 2018 and 2021, based on T2DM medical records from Alnoor Specialist Hospital in the Western Province, Saudi Arabia. The Bayesian-based InterVA-5 algorithm was employed as a validated source to determine the probable COD and Circumstances Of Mortality Categories (COMCATs) for each case. COMCATs stand for predetermined categories of multiple social and healthcare system circumstances that contribute to an individual's death. The likelihoods of COD and COMCATs derived from InterVA-5 software were computed independently to generate the 'cause-specific mortality fractions' (CSMFs) of the COD and COMCATs. The CSMFs for the seven COMCATs categories were then ranked based on their derived probabilities for the corresponding COMCATs across all major COD categories. The top CODs were circulatory diseases (35.8%), stroke (16.6%), and diabetes mellitus (14.3%). The probabilities of COMCATs indicated that most deaths were attributed to 'inevitable' causes (e.g., terminal illness), followed by 'recognition' (inability to recognize the severity of illness) and 'traditions' (local attitudes deterring patients from seeking medical services on time). Addressing 'recognition' and 'traditions' barriers could reduce mortality rates and improve access to healthcare, helping the Saudi health system accelerate the progress towards the systematic measurement of key universal health coverage indicators. The study emphasizes the need for a robust and standardized VA method within routine medical services to address factors influencing healthcare access towards improved health outcomes.

Conclusion: Precharging a defibrillator before a rhythm check during chest compression, in anticipation of a potentially shockable rhythm, reduces the time required for defibrillation and limits interruptions in chest compression during CPR. This practice effectively enhances the CCF. Enhancing the continuity of chest compressions can potentially improve survival rates in ARC.

Multiple primary cancers (MPCs) are defined as the presence of more than one cancer in an individual that is not due to recurrence, metastasis, or local spread. Different factors such as copathogenic genetic mutations, environmental factors, lifestyle, and first cancer treatment increase the possible occurrence of subsequent malignancies. In recent years, the risk of MPCs has increased due to improved treatment; however, quadruple primary malignancies are still rare and require further investigation and treatment of the underlying cause. Here, we present a 64-year-old man with a 40-year history of cigarette smoking who developed quadruple primary malignancies of the epiglottis, kidney, pancreas, and lung. To investigate the possible genetic cause, we performed WES, and a variant of c.580G > A (Ala194Thr) was discovered in exon 5 of the Krebs cycle enzyme gene, fumarate hydratase (FH). This substitution was classified as VUS in Clinvar and likely pathogenic by Varsome and Franklin software. The structural analysis showed that the variation found was localized in a highly conserved alpha helix in the D2 domain near the FH hinge region (

Objective: The reported hypocalcemia in postmenopausal women with osteoporosis who received Denosumab was low (0.05%-1.7% to 7.4%). The major prediction factors were vitamin D and calcium levels and renal function. The objective is to evaluate the incidence of hypocalcemia in patients with osteoporosis, normal renal function, and vitamin D who received Denosumab. Method: A retrospective analysis was conducted using the medical records (2022-2023). We looked for hypocalcemia (albumin-adjusted calcium lower than 2.2 mmol/L). Results: Two hundred one postmenopausal women diagnosed with osteoporosis and received denosumab treatment were included. All patients received vitamin D3 capsules and calcium supplementation. The mean age of the patient was 75.7 ± 7.0 years (56-91 years). Hypocalcemia was observed in 46 (23%) patients following a subcutaneous dose of Denosumab 60 mg. Median calcium was 2.25 mmol/L (minimum: 0.890 mmol/L, maximum: 2.6 mmol/L). Fourteen (30.4%) patients had severe hypocalcemia (

Background In 2019 and 2020, 2 randomized trials of basilar artery occlusion (BAO) thrombectomy reported no improvement in functional outcomes with thrombectomy, despite observational evidence. The objective of this study was to assess whether neutral clinical trials may have influenced BAO thrombectomy practice. Methods The National Inpatient Sample (2018–2020) was queried for US patients with BAO, and comparisons were made between patients admitted in 2020 versus 2018 to 2019 for the primary outcome of thrombectomy. Unadjusted and adjusted multivariable regression was used, accounting for demographic and clinical covariates, with propensity‐score matching to balance clinical and hospital‐level characteristics between years. Results Of the 14 945 patients with BAO, 3,605 (24.1%) underwent thrombectomy,with an increase in the unadjusted rate of thrombectomy between 2020 and 2018–2019 (26.9% vs 22.9%, P = 0.04). Following multivariable adjustment, BAO thrombectomy was not independently associated with a year of treatment (adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 0.95–1.54, P = 0.12). Thrombectomy was independently associated with having a NIHSS of 10–19 (OR: 3.67, 95% CI: 2.79–4.83, P < 0.01) or >19 (OR: 5.80, 95% CI: 4.41–7.64) versus a NIHSS of 10, while uinsured patiends hadal owe likelihood of receiving a thombectomy (OR: 0.49, 95% C: 0.26–0.92). These relationships were preserved in the PSM cohort, and admission year lacked association with thrombectomy for BAO (aOR: 1.10, 95% CI: 0.83–1.45, P = 0.52). Conclusion Following publication of neutral BAO randomized clinical trials in late 2019 and 2020, there was no significant change in thrombectomy rate among US patients with BAO. The latest trials support thrombectomy for select patients with moderate‐to‐severe BAO symptoms, and this appears consistent with the practice of US clinicians before these trials.

Examining the behavior of non-Newtonian fluids in natural environments like rivers and groundwater flow is essential for evaluating their environmental impact. The Soret and Dufour impacts significantly influence the transportation of contaminants and heat within these systems. With this application in mind, this study investigates the impacts of steady-state Soret/Dufour and radiation on a porous perpendicular plate in the context of the Maxwell fluid model. Additionally, the study considers the impact of magnetohydrodynamics (MHD) and heat generation to provide a comprehensive modeling framework. The similarity technique is employed to transform the partial differential equations (PDEs) into nonlinear ordinary differential equations (ODEs). These ODEs are subsequently solved numerically using the inbuilt software bvp4c in MATLAB. The study presents graphical representations of Sherwood, skin friction, Nusselt number profiles, momentum, temperature, and concentration contours. These visual representations and tables illustrate the results for various fluid flow parameters, highlighting the influence of different flow characteristics. Key findings of this research include a rise in Nusselt and Sherwood numbers and skin friction with higher radiation values. Furthermore, there is an observed increase in temperature and concentration profiles as the Soret parameter value rises, indicating the significant impact of these parameters on the studied phenomena.

Background: Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2-IS) have been shown to increase hemoglobin (Hb) levels, hematocrit, and erythrocyte count. It has also been found that these agents can potentially reduce the risk of anemia and minimize the need for erythropoiesis stimulating agents (ESA) and other treatments in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However the precise mechanism for such an effect is still conflicting. Aim: We aimed at providing an overview of the effects of SGLT2-IS on hematological parameters, specifically focusing on their potential to improve anemia and erythropoiesis in patients with diabetes mellitus (DM). Additionally the proposed mechanisms by which SGLT2-IS may improve Hb levels besides their clinical importance and future directions will also be highlighted. Results: Based on the obtained data from latest literatures, SGLT2-IS may improve the status of anemia and other linked abnormalities via their mild diuretic potential, effects on erythropoietin (EPO) production, and possible increase in renal oxygen delivery. Conclusion: SGLT2-IS may have a promising role in improving multiple aspects of blood, circulatory and renal systems health in patients with DM, beyond their primary glucose-lowering role.

Urinary tract infections are the most common illnesses that impact pregnant women. This study aimed to investigate bacterial urinary tract infections and antibiotic susceptibility profiles in pregnant women. This study was conducted on pregnant women between April and October 2021 in clinics and hospitals in the Damt district. Midstream urine samples were collected, cultured, identified and tested for antibiotic susceptibility. The prevalence of UTI in pregnant women was 210/350 (60%). Escherichia coli accounted for 90/210 (42.9%), Staphylococcus aureus 50/210 (23.8%), and Klebsiella pneumoniae 25/210 (11.9%). Staphylococcus epidermidis, Pseudomonas aeruginosa, and Proteus mirabilis exhibited 15/210 (7.1%) of each with the moderately identified bacterial species. Antimicrobial sensitivity testing showed that bacterial isolates were resistant to amoxicillin (80-100%), ceftriaxone (40-70%), gentamycin (0-60%), amikacin (0-50%), tetracycline, ciprofloxacin, azithromycin, and amoxiclav (0-40%), and azithromycin (0-30%). Significant bacteriuria was associated with age (p = 0.01), pregnancy trimesters (p = 0.00), gestation (p = 0.00), and residence (p = 0.03), whereas there was no association with education (p = 0.05). Most isolates have become resistant toward antibiotic used in the study treatments, especially ceftriaxone and amoxicillin. Therefore, it is recommended that pregnant women undergo health education on the prevalence and causes of urinary tract infections.

Background and Purpose New studies have shown that endovascular thrombectomy (EVT) is safe and effective for acute ischemic stroke (AIS) patients with large ischemic areas. The aim of our study is to conduct a living systematic review and meta-analysis of randomized trials comparing EVT versus medical management only. Methods We searched MEDLINE, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT versus medical management alone in AIS patients with large ischemic regions. We conducted our meta-analysis using fixed-effect models to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH) between EVT and standard medical management only. We assessed the risk of bias using the Cochrane risk-of-bias tool and the certainty of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Results Of 14,513 citations, we included 3 RCTs with a total of 1,010 participants. We found low-certainty evidence of possibly a large increase in the proportion of patients with functional independence (risk difference [RD] 30.3%, 95% CI 15.0% to 52.3%), low-certainty evidence of possibly a small non-significant decrease in mortality (RD -0.7%, 95% CI -3.8% to 3.5%), and low-certainty evidence of possibly a small non-significant increase in sICH (RD 3.1%, 95% CI -0.3% to 9.8%) for AIS patients with large infarcts who underwent EVT compared to medical management only. Conclusion Low-certainty evidence shows that there is possibly a large increase in functional independence, a small non-significant decrease in mortality, and a small non-significant increase in sICH amongst AIS patients with large infarcts undergoing EVT compared to medical management only.

تأتي هذه الدراسة للإجابة عن التساؤل الرئيس الذي يمثل تحديدًا لمشكلتها وهو: ما أفعال التستر التجاري التي تعتبر جريمةً في ضوء نظام مكافحة التستر السعودي الجديد؟ وكيف يمكن ضبطها عن طريق تحديد الاعتبارات والعناصر المكونة لها؟ وذلك لأن نظام مكافحة التستر التجاري الجديد بُني على تفصيل وتفريق لم يكن في النظام السابق، فلم يجعل أفعال التستر التجاري على درجة واحدة في الخطورة والأثر والمعالجة القانونية؛ فقد نصَّ النظام على أن هذه الأفعال تأتي على درجتين من المسؤولية القانونية، أفعال يترتب على ارتكابها المسؤولية الجنائية، وجاء تحديدها في المادة الثالثة، وأفعال يترتب على فعلها المسؤولية التأديبية الإدارية، وحددت في المادة الرابعة، في إشارة مهمة إلى أن أفعال التستر تختلف فيما بينها في درجاتها وخطورتها، فلا يمكن أن يسوى بين فعل التمكين والممارسة الفعلية مع فعل الحيازة واستخدام الأدوات غير النظامية التي هي في الأساس أفعال ممهدة للوصول إلى التمكين. وقد توصلت هذه الدراسة إلى أن هناك اعتبارات وعناصر مهمة جدًّا يجب توافرها وتحققها في سلوك التستر التجاري حتى يوصف الفعل بالجريمة، ومتى اختل أحد هذه العناصر وجودًا أو عدمًا بشكل كامل أو جزئي خرج السلوك عن دائرة التجريم، وهذه العناصر تتمثل في التمكين والممارسة وعدم الترخيص، وأوصت الدراسة بأهمية ضبط هذه العناصر ضبطًا أكثر تحديدًا وتدقيقًا لارتباطها بقيام التجريم من عدمه مع تفعيل سبل الوقاية وتشديد الرقابة منعًا من انتشار هذه الجريمة.

CXCL10 (IP-10) plays a key role in leukocyte homing to the inflamed tissues and its increased levels are associated with the pathophysiology of various inflammatory diseases including obesity and type 2 diabetes. IL-1β is a key proinflammatory cytokine that is found upregulated in meta-inflammatory conditions and acts as a potent activator, inducing the expression of cytokines/chemokines by immune cells. However, it is unclear whether IL-1β induces the expression of CXCL10 in monocytic cells. We, therefore, determined the CXCL10 induction using IL-1β in THP1 monocytic cells and investigated the mechanisms involved. Monocytes (human monocytic THP-1 cells) were stimulated with IL-1β. CXCL10 gene expression was determined with real-time RT-PCR. CXCL10 protein was determined using ELISA. Signaling pathways were identified by using Western blotting, inhibitors, siRNA transfections, and kinase assay. Our data show that IL-1β induced the CXCL10 expression at both mRNA and protein levels in monocytic cells (p = 0.0001). Notably, only the JNK inhibitor (SP600125) significantly suppressed the IL-1β-induced CXCL10 expression, while the inhibitors of MEK1/2 (U0126), ERK1/2 (PD98059), and p38 MAPK (SB203580) had no significant effect. Furthermore, IL-1β-induced CXCL10 expression was decreased in monocytic cells deficient in JNK/c-Jun. Accordingly, inhibiting the JNK kinase activity markedly reduced the IL-1β-induced JNK/c-Jun phosphorylation in monocytic cells. NF-κB inhibition by Bay-117085 and resveratrol also suppressed the CXCL10 expression. Our findings provide preliminary evidence that IL-1β stimulation induces the expression of CXCL10 in monocytic cells which requires signaling via the JNK/c-Jun/NF-κB axis.

The research presented in the following paper focuses on the effectiveness of a modern standard Arabic corpus, AraFast, in training transformer models for natural language processing tasks, particularly in Arabic. In the study described herein, four experiments were conducted to evaluate the use of AraFast across different configurations: segmented, unsegmented, and mini versions. The main outcomes of the present study are as follows: Transformer models trained with larger and cleaner versions of AraFast, especially in question-answering, indicate the impact of corpus quality and size on model efficacy. Secondly, a dramatic reduction in training loss was observed with the mini version of AraFast, underscoring the importance of optimizing corpus size for effective training. Moreover, the segmented text format led to a decrease in training loss, highlighting segmentation as a beneficial strategy in Arabic NLP. In addition, using the study findings, challenges in managing noisy data derived from web sources are identified, which were found to significantly hinder model performance. These findings collectively demonstrate the critical role of well-prepared, segmented, and clean corpora in advancing Arabic NLP capabilities. The insights from AraFast’s application can guide the development of more efficient NLP models and suggest directions for future research in enhancing Arabic language processing tools.

This study unveils verapamil’s compelling cytoprotective and proliferative effects on pancreatic β-cells amidst diabetic stressors, spotlighting its unforeseen role in augmenting cholecystokinin (CCK) expression. Through rigorous investigations employing MIN6 β-cells and zebrafish models under type 1 and type 2 diabetic conditions, we demonstrate verapamil’s capacity to significantly boost β-cell proliferation, enhance glucose-stimulated insulin secretion, and fortify cellular resilience. A pivotal revelation of our research is verapamil’s induction of CCK, a peptide hormone known for its role in nutrient digestion and insulin secretion, which signifies a novel pathway through which verapamil exerts its therapeutic effects. Furthermore, our mechanistic insights reveal that verapamil orchestrates a broad spectrum of gene and protein expressions pivotal for β-cell survival and adaptation to immune-metabolic challenges. In vivo validation in a zebrafish larvae model confirms verapamil’s efficacy in fostering β-cell recovery post-metronidazole infliction. Collectively, our findings advocate for verapamil’s reevaluation as a multifaceted agent in diabetes therapy, highlighting its novel function in CCK upregulation alongside enhancing β-cell proliferation, glucose sensing, and oxidative respiration. This research enriches the therapeutic landscape, proposing verapamil not only as a cytoprotector but also as a promoter of β-cell regeneration, thereby offering fresh avenues for diabetes management strategies aimed at preserving and augmenting β-cell functionality.

An active intelligent reflecting surface (IRS)-assisted, secure, multiple-input–single-output communication method is proposed in this paper. In this proposed scheme, a practical and unfavorable propagation environment is considered by assuming that multiple colluding eavesdroppers (Eves) coexist. In this case, we jointly optimize the beamformers of the base station (BS) and the active IRS for the formulated sum secrecy rate (SSR) maximization problem. Because the formulated problem is not convex, we apply the alternating optimization method to optimize the beamformers for maximizing the SSR. Specifically, we use the semi-definite relaxation method to solve the sub-problem of the beamforming vector of the BS, and we use the successive convex approximation method to solve the sub-problem of the power amplification matrix of the active IRS. Based on the solutions obtained using these stated methods, numerical results show that deploying an active IRS is superior compared to the cases of a passive IRS and a non-IRS for improving the physical layer security of wireless communication with multiple colluding Eves under different settings, such as the numbers of users, Eves, reflecting elements, and BS antennas as well as the maximum transmit power budget at the BS.

Contamination by fungi and the toxins they secrete is a worldwide health concern. One such toxin is zearalenone (Zea), which is structurally similar to the hormone estrogen, interferes with its action on the reproductive system, and is therefore classified as an endocrine disruptor. This study aims to determine the effectiveness of hispidin and magnesium nanoparticles (MgONPs) against zearalenone-induced myotoxicity, which causes polycystic ovary syndrome (PCOS) in rats. A three-month exposure study was performed using female Wistar rats (n = 42) with an average weight of 100–150 g. The animals were divided into six groups (I to VI) of seven rats each. Group I was administered distilled water as a negative control. Group II was exposed to Zea 0.1 mg/kg b.w. through gavage daily. Group III was treated with 0.1 mg/kg of hispidin through gavage daily. Group IV was given 150 µg/mL MgONPs orally each day. Group V was treated with Zea 0.1 mg/kg b.w. + 0.1 mg/kg hispidin orally each day. Group VI was treated with Zea 0.1 mg/kg b.w. and the combination treatment of 0.1 mg/kg hispidin + 150 µg/mL MgONPs through gavage every day. The effectiveness of hispidin and MgONPs against Zea toxicity was evaluated in terms of ovarian histological changes, gene expression, oxidative stress biomarkers, biochemical variables, and hormone levels. The findings showed that exposure to Zea promotes PCOS in rats, with Zea-treated rats displaying hyper-ovulation with large cysts; elevated testosterone, luteinizing hormone, insulin, and glucose; and reduced sex hormone-binding globulin. In addition, qRT-PCR for aromatase (Cyp19α1) showed it to be downregulated. Treatment with hispidin improved the histopathological and hormonal situation and rescued expression of Cyp19α. Our data indicate the potential therapeutic effects of hispidin against Zea-induced Fungal Toxicity.

Lead poses significant health risks to humans, including neurological and developmental impairments, particularly in children. Additionally, lead pollution in the environment can contaminate soil, water, and air, endangering wildlife and ecosystems. Therefore, this study reports the straightforward fabrication of Na2Ca2Si3O9/Ca8Si5O18 nanostructures (NaCaSilicate) utilizing a sol-gel technique. Additionally, the produced nanostructures underwent further modification with chitosan (CS@NaCaSilicate) and chitosan crosslinked with terephthalaldehyde (CCS@NaCaSilicate), resulting in new nanocomposite materials. These samples were developed to efficiently extract Pb(II) ions from aqueous media through complexation and ion exchange mechanisms. Furthermore, the maximum adsorption capacity for Pb(II) ions by the NaCaSilicate, CS@NaCaSilicate, and CCS@NaCaSilicate samples is 185.53, 245.70, and 359.71 mg/g, respectively. The uptake of Pb(II) ions was characterized as spontaneous, exothermic, and chemical, with the best description provided by the Langmuir equilibrium isotherm and the pseudo-second-order kinetic model. Furthermore, a 9 M hydrochloric acid solution effectively eliminated Pb(II) ions from the synthesized samples, attaining a desorption efficacy surpassing 99%. Additionally, the fabricated samples exhibited efficient reusability across five successive cycles of adsorption and desorption for capturing Pb(II) ions.

In the current work, cytotoxicity and genotoxicity of different organoselenium compounds were examined using Trypan blue exclusion and alkaline comet assays with silver staining respectively. Leukocytes were subjected to a 3-hour incubation with organoselenium compounds at concentrations of 1, 5, 10, 25, 50, and 75 μM, or with the control vehicle (DMSO), at a temperature of 37 °C. The viability of the cells was evaluated using the Trypan blue exclusion method, while DNA damage was analyzed through the alkaline comet assay with silver staining. The exposure of leukocytes to different organoselenium compounds including i.e. (Z)-N-(pyridin-2-ylmethylene)-1-(2-((2-(1-((E)-pyridin-2-ylmethyleneamino)ethyl)phenyl)diselanyl)phenyl)ethanamine (C1), 2,2′(1Z,1′E)-(1,1′-(2,2′-diselanediylbis(2,1-phenylene))bis(ethane-1,1-diyl)) bis(azan-1-yl-1-ylidene)bis -methan-1-yl-1-ylidene)diphenol (C2), and dinaphthyl diselenide (NapSe)2, At concentrations ranging from 1 to 5 μM, no significant DNA damage was observed, as indicated by the absence of a noteworthy increase in the Damage Index (DI).Our results suggest that the organoselenium selenium compounds tested were not genotoxic and cytotoxic to human leukocytes in vitro at lower concentration. This study offers further insights into the genotoxicity profile of these organochalcogens in human leukocytes. Their genotoxicity and cytotoxicity effects at higher concentration are probably mediated through reactive oxygen species generation and their ability to catalyze thiol oxidation.

Background: Novel α-amylase inhibitors play a crucial role in managing diabetes and obesity, contributing to improved public health by addressing these challenging and prevalent conditions. Moreover, the synthesis of anti-oxidant agents is essential due to their potential in combating oxidative stress-related diseases and promoting overall health. Objective: Synthesis of thoisemicarbazone derivatives of 2,4-dichlorophenyl acetic acid and to screened them for their biological activities. Method: Thiosemicarbazone derivatives (4–13) were synthesized by refluxing 2,4-dichlorophenyl acetic acid with sulfuric acid in ethanol to get the ester (2), which was further refluxed with thiosemicarbazide to get compound (3). Finally, different aromatic aldehydes were refluxed with compound (3) in ethanol in catalytic amount of acetic acid to obtained the final products (4–13). Using modern spectroscopic techniques including HR-ESI-MS, 13C-, and 1H NMR, the structures of the created derivatives were confirmed. Results: The synthesized derivatives showed excellent to good inhibitory activity in the range of IC50 values of 4.95 ± 0.44 to 69.71 ± 0.05 µM against α-amylase enzyme when compared to standard drug acarbose (IC50 = 21.55 ± 1.31 µM). In case of iron chelating activity, these products showed potent activity better than standard EDTA (IC50 = 66.43 ± 1.07 µM) in the range of IC50 values of 22.43 ± 2.09 to 61.21 ± 2.83 µM. However, the obtained products also show excellent to good activity in the range of IC50 values of 28.30 ± 1.17 to 64.66 ± 2.43 µM against hydroxyl radical scavenging activity when compared with standard vitamin C (IC50 = 60.51 ± 1.02 µM). DFT used to calculate different reactivity factors including ionization potential, electronegativity, electron affinity, chemical softness, and chemical hardness were calculated using frontier molecular orbital (FMO) computations. The molecular docking studies for the synthesized derivatives with α-amylase were carried out using the AutoDock Vina to understand the binding affinities with active sites of the protein.

Background and objective: Asthma is a common disease that has a significant influence on patients’ quality of life. Although Arabic tools for assessing symptom control and quality of life in individuals with asthma are available, no sufficient studies have evaluated the validity of these tools. Therefore, the aim of the current study was to validate the Arabic version of these tools. Methods: Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted on the Arabic versions of the Asthma Control Test (ACT) and Mini Asthma Quality of Life Questionnaire (Mini AQLQ). Results: A total of 314 participants (70.1 % females) were enrolled in the current study. The mean age of the participants was 51.47 (±16.37). EFA suggested a three-factor model for Mini AQLQ and a one-factor model for ACT, which was confirmed by CFA analyses. High correlations were found between spirometric values and ACT and Mini AQLQ scores, indicating good concurrent validity. The area under the curve produced by the Roc curve was 0.861 (p

Treatment of the non-purified mixture of dinitro isomers obtained from the nitration of 1,4-dimethoxybenzene with piperidine led to the isolation of novel but minor adduct, 1-(2,5-dimethoxy-4-nitrophenyl)piperidine (2b) in 15% yield. Yields of nucleophilic aromatic substitution adducts are high when using purified 1,4-dimethoxy-2,5-dinitrobenzene (1b) with piperidine and pyrrolidine to give (2b) and 1-(2,5-dimethoxy-4-nitrophenyl)pyrrolidine (3b) in 76% and 82% yield, respectively.

Introduction Endovascular thrombectomy (EVT) is the gold standard treatment for patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), and there are several factors that can influence the outcomes of EVT in AIS‐LVO patients. We conducted this meta‐analysis to investigate the effect of cerebral microbleeds (CMBs) on the functional and safety outcomes of EVT in patients with AIS caused by LVO. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. We included observational studies that recruited AIS‐LVO patients, used susceptibility‐sensitive magnetic resonance imaging (MRI) to detect CMBs, and examined the association between them and predefined outcome events. The outcomes of interest included functional independence, revascularization success, and hemorrhagic adverse events. We conducted a meta‐analysis using the Mantel‐Haenszel method and calculated the risk ratios. Results Four studies involving 1,514 patients were included. A significant reduction in the likelihood of achieving a favorable functional outcome, as measured by the modified Rankin Scale (mRS), was observed in patients with CMBs (Risk Ratio (RR) 0.70, 95% Confidence Interval (CI): 0.53 ‐ 0.91, P=0.01). No significant differences were observed between the two groups in terms of successful revascularization (RR 0.93, 95% CI [0.74 to 1.17], P=0.51), mortality (RR 0.93, 95% CI [0.74 to 1.17], P=0.51), hemorrhagic transformation (RR 0.93, 95% CI [0.59 to 1.45], P=0.74), and parenchymal hematoma (RR 1.23, 95% CI [0.79 to 1.91], P=0.35). Conclusion The presence of CMBs significantly reduced the likelihood of achieving a favorable functional outcome after EVT in AIS‐LVO patients. However, CMBs did not impact the rates of successful revascularization, mortality, or the occurrence of various hemorrhagic complications. Future research should explore the mechanisms of this association and strategies to mitigate its impact.

Introduction Cardiomyopathy (CM) is a diverse pathology defined by both structural and functional changes in the heart. Many studies have aimed to determine if heart failure (HF) is an independent risk factor in the development of AIS, but there is a paucity of literature describing the interventions and functional outcomes in this group of patients. We aimed to investigate the safety of intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MT) for acute ischemic stroke (AIS), and compare the functional outcome in cardiomyopathy patients with and without HF. We hypothesized that CM and HF patients would have higher rates of mortality and complications but would still benefit from reperfusion therapy with improved functional outcomes. Methods This is a multi‐center, retrospective study. The National Inpatient Sample (NIS) database from 2016‐2019 for patients with a principal diagnosis of AIS using the ICD‐10 code I63 was queried. AIS patients with CM and HF were compared to those without. Outcome measures studied included prolonged length of stay (LOS), discharge disposition, and inpatient mortality. Results We identified 2,939,160 patients with AIS between 2016 and 2019. Of those patients, 2.8% (80,915) had concomitant diagnoses of both CM and HF. Compared to matched cohorts, CM‐HF patients were more likely to be younger (age 2 (99.4% v. 90.9%, p < 0.001). Lastly, this cohort was more likely to use anticoagulant medication (18.1% v. 9.5%, p < 0.001). CM‐HF patients were more likely to have a severe stroke (25.9% v. 19.6%, p < 0.001). Additionally, CM‐HF patients were more likely to receive both EVT (8.8% v. 5.6%, p < 0.001) and EVT and tPA (0.9% v. 0.6%, p < 0.001). An analysis of the rates of post‐intervention intracerebral hemorrhage showed that there was no significant difference observed between groups. This finding was regardless of the type of intervention received, including tPA (15.9% v. 13.6%, p = 0.192), EVT (15.6% v. 17.4%, p = 0.171), or both tPA and EVT (25.9% v. 22.3%, p= 0.321). CM‐HF patients had higher rates of in‐patient complications such as PEG placement, tracheostomy, sepsis, DVT or PE, pneumonia, UTI, AKI, myocardial infarction, and intracerebral hemorrhage. CM‐HF patients were more likely to have a prolonged LOS (47.8% v. 31.4%, p < 0.001) and higher rates of inpatient death (6.6% v. 5.4%, p < 0.001). Despite these outcomes, CM‐HF patients were less likely to have a non‐favorable discharge to both a skilled nursing facility (43.8% v. 44.9%, p < 0.001) and short‐term hospitalization (2.8% v. 4.6%, p < 0.001). Rates of favorable discharge were higher for CM‐HF patients (45.7% v. 43.9%, p < 0.001). Conclusion Patients with AIS and concomitant HF and CM are more likely to have favorable functional outcomes despite having higher rates of inpatient death and in‐hospital complications. Reperfusion therapies can be used safely in CM and HF patients.

Introduction Due to the relative rarity of unruptured intracranial aneurysms (UIA) in the pediatric population, evidence regarding treatment modalities and clinical outcomes remains limited. This study aims to characterize the utilization and clinical outcomes of endovascular therapy (EVT) and microsurgical clipping (MSC) for pediatric UIAs over a two‐decade interval using a large national registry. Methods Pediatric (< 18 years of age) UIA hospitalizations were identified in the National Inpatient Sample from 2002 to 2019. Temporal utilization and clinical outcomes were compared for treatment with EVT and MSC. Results Among 734 UIAs identified during the study period, 64.9% (n = 476) were treated with EVT. Utilization of EVT significantly increased during the study period from 54.3% (2002‐2004) to 78.6% (2017‐2019) (p = 0.002 by Cochrane‐Armitage test). Treatment with EVT did not differ as a function of increasing age, but was mostly highly utilized in the youngest age grouping [70.4% (0‐2 years), 64.0% (3‐12 years), 64.3% (13‐17 years); p = 0.578]. In comparison with those treated with MSC, pediatric patients treated with EVT demonstrated higher rates of favorable outcomes (discharge to home without services) (96.0% vs. 91.1%, p = 0.006), shorter durations of hospital stay (4.6 vs. 10.0 days, p < 0.001), and lower rates of ischemic or hemorrhagic procedural‐related complications (1% vs. 4%, p = 0.010). Conclusion A retrospective evaluation of nearly twenty years of population‐level data from the United States demonstrates increasing utilization of EVT for the treatment of pediatric UIAs with high rates of favorable outcomes and shorter hospital stays in comparison to those treated with microsurgery. However, limitations of available registry data (such as absence of radiographic parameters and aneurysm morphological characteristics) temper any definitive claims regarding treatment efficacy.

Introduction Existing evidence remains conflicting regarding the association between oral hormonal contraceptive (OCP) use and the risk of acute ischemic stroke (AIS). Large‐scale analyses and observational data evaluating this clinical question in recent years are scarce, despite widespread use of hormonal contraception in adult females of child‐bearing age. Modern OCP formulations contain lower doses of estrogen, the putative causative agent for AIS in this population, and underscores the need to re‐evaluate the risk initially demonstrated in older formulations containing higher levels of estrogen. Methods Hospitalizations for female patients aged 15‐50 were identified in the National Inpatient Sample (NIS) registry from 2015‐2020, excluding admissions associated with pregnancy or the postpartum period. The study exposure was use of OCPs and the primary endpoint was AIS, identified by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) coding. Propensity score (PS) adjustment by inverse probability weighting (IPW) was used to mimic the effects of randomization by balancing baseline clinical characteristics associated with stroke between OCP and non‐OCP users to reduce measured confounding. In addition to age and race/ethnicity, a battery of more than forty confounding covariates representing established risk factors for AIS in the general and young population were identified (cardiovascular disease, lifestyle risk factors, congenital abnormalities, vasculopathies, hypercoagulable states, migraine with aura, among others) and balanced between OCP and non‐OCP users. Sensitivity testing was performed by evaluating stroke incidence in a sub‐group of patients without any risk factors present and by assessing a negative control (head trauma), with which an association of OCP use would not be expected. The effect size of the association between OCPs and AIS was presented as an adjusted odds ratio (aOR) with 95% confidence interval (CI), with statistical significance evaluated at p < 0.001. Results PS adjustment by IPW to balance all available AIS risk factors between OCP users and non‐users yielded 23,253,209 hospitalizations, 11,654,398 (50.1%) of which were associated with OCP use. The incidence of AIS was significantly greater in OCP users compared to non‐OCP users (2.8% vs. 0.4%; aOR 7.50, 95% CI 7.43 to 7.58; p < 0.001). Sub‐group analysis of hospitalizations without any stroke risk factors also demonstrated a significant association of OCP use with the development of AIS (1.3% vs. 0.1%; aOR 14.84, 95% CI 13.16 to 16.72; p < 0.001) following adjustment for age and race/ethnicity. In negative control analysis, OCP use was not associated with admissions associated with head trauma (1.4% vs. 1.4%; OR 1.03, 95% CI 0.95 to 1.10; p = 0.485). Conclusion Retrospective observational data from the United States in recent years suggests an association between OCP use and AIS, independent of well‐established risk factors for stroke and despite widespread adoption of lower estrogen formulations.

Introduction Virtual reality (VR) has shown great promise in stroke rehabilitation, providing interactive exercises that target motor and cognitive impairments with minimal adverse events and positive outcomes in improving motor function, balance, and patient motivation. However, most post‐stroke rehabilitation focuses on recovery after discharge, emphasizing the need for efficient interventions like VR to make the most of limited hospital rehab time for stroke survivors. This study aimed to evaluate the safety and feasibility of incorporating hyperacute virtual reality augmented rehabilitation (VRAR) as part of acute stroke care. Methods A prospective, proof‐of‐concept study was conducted with 13 eligible patients who experienced hemorrhagic or ischemic stroke between July 1st, 2021, and January 1st, 2022. Enrolled patients received VRAR in addition to the standard‐of‐care rehabilitation. Patients with dementia, expressive aphasia, delirium, or were unable to participate in physical therapy/ utilize the virtual reality hardware were excluded. Demographic data, functional scores, and complications were collected. Results Of the 13 patients who used the VRAR rehabilitation program, ten completed up to three visits. The cohort consisted of 50% male patients with a mean age of 73.6 years. Half of the patients had a primary diagnosis of ischemic stroke, while the rest were diagnosed with either hemorrhagic stroke (30%) or transient ischemic attack (20%). The mean length of hospital stay was 11.1 days, and the median time from admission to rehabilitation was 4 days. Most patients (80%) were discharged to outpatient rehabilitation, while 20% were discharged home. The median number of sessions was one, with four patients using the VRAR program multiple times. Despite the withdrawal of two patients (15.4%) who expressed mild discontent, there were no adverse events reported during the use of the VRAR rehabilitation program. Conclusion The findings of this study offer evidence backing the safety and feasibility of integrating VRAR as a supplementary tool in hyperacute stroke care. These results underscore the potential of VR therapy as a promising addition to conventional stroke rehabilitation methods.

Introduction Heparin‐induced thrombocytopenia (HIT) is a rare complication characterized by a decreased platelet count and hypercoagulability following heparin and light‐molecular weight heparin administration. Both anticoagulants can be used intraoperatively and postoperatively for DVT prophylaxis in patients undergoing subarachnoid hemorrhage (SAH) treatment. Patients with SAH are an understudied population in terms of assessing incidence and impact of HIT. This study aims to investigate the incidence, complications, and outcomes of SAH patients who develop HIT. Methods ICD‐9‐CM and ICD‐10‐CM codes were used to query the National Inpatient Sample for patients with SAH between 2010 and 2019. Subgroup analysis was stratified by HIT development. SAH severity was determined using the National Institute of Health Stroke Scale as a template. Patients from both groups were assessed for baseline clinical characteristics, comorbidities, interventions, complications, and outcomes. Cohorts containing ten or fewer patients must only be described qualitatively. Descriptive statistics, multivariate regressions, and propensity score‐matching were all performed using IBM SPSS 28. Results 76,387 patients were diagnosed with SAH between 2010 and 2019. 166 (.22%) had developed HIT in response to anticoagulant administration. The incidence of HIT was higher in patients who were younger (58.04 vs 61.39, p = 0.01), obese (0.4% vs 0.2%, p < 0.01), on long‐term anticoagulant use (10.84% vs 5.72%, p < 0.01), and had an implanted cerebrospinal fluid drainage device (p < 0.01). Patients with HIT were associated with higher SAH severity (1.42 vs 1.06, p < 0.01). Through both the complete cohort and propensity score‐matched cohort, patients with HIT were associated with higher rates of endovascular coiling, external ventricular drain placement (p < 0.01), and ventriculoperitoneal shunt placement (p < 0.01). HIT patients had significantly higher rates of deep vein thrombosis (p < 0.01), pulmonary embolism (p < 0.01), central venous sinus thrombosis (p = 0.01), pneumonia (p < 0.01), urinary tract infection (p < 0.01), acute kidney injury (p < 0.01), and cerebral vasospasm (p < 0.01). Patients who develop HIT had a longer length of stay (LOS) (24.04 vs 10.48, p < 0.01). HIT continued to be a significant predictor of having an above average LOS (OR: 6.799, CI: 3.985 ‐ 11.6, p < 0.01) when controlling for age, SAH severity, and significant comorbidities. Conclusion Our study revealed that younger SAH patients with various comorbidities are more prone to developing HIT, leading to higher rates of thrombotic events, acute kidney injury, and nosocomial infections, which can significantly prolong their hospital stay. Considering the extended postoperative recovery period for SAH, investigating the causes of HIT can facilitate earlier detection and prevention of thrombotic complications. This nationwide, multicenter, retrospective study provides valuable insights for clinicians on how to prevent and manage HIT in patients with subarachnoid hemorrhage.

Introduction Subarachnoid Hemorrhage (SAH) resulting from the spontaneous rupture of an aneurysm is a rare and highly debilitating condition. Despite its severity, patients with aneurysmal SAH remain understudied, particularly concerning the evaluation of the incidence and consequences of subsequent acute kidney injury (AKI). Thus, the objective of this study was to explore the predictors and ramifications of AKI in patients with aneurysmal SAH. Further research and attention to this area are crucial for improving patient outcomes and guiding clinical interventions in this challenging condition. Methods ICD‐10‐CM codes were used to query the National Inpatient Sample (NIS) for patients with AIS between 2010 and 2019. Subgroup analysis was stratified by the presence of a definitive AKI diagnosis. The AKI and non‐AKI groups were assessed for baseline clinical characteristics, interventions, complications, and outcomes. Descriptive statistics, multivariate regressions, and propensity score‐matching were all performed using IBM SPSS 28. Results 76,553 patients within the NIS were diagnosed with nontraumatic SAH between 2010 and 2019, of which 10,634 (13.89%) had a comorbid diagnosis of AKI. Patients with AKI were on average older (63.29 vs 61.07, p < 0.01), more often obese (12.15% vs 9.32%, p < 0.01), of the white race (55.82% vs 51%, p < 0.01), and considered long‐term users of anticoagulants (8.12% vs 5.34%, p < 0.01) when compared to the non‐AKI group. In terms of complications, patients within the AKI cohort had lower rates of decompressive hemicraniectomy (1.37% vs. 2.38%, p = 0.52) and, interestingly, cerebral vasospasms (4.47% vs. 8.22%, p < 0.01). However, AKI patients had higher rates of deep vein thrombosis (6.36% vs. 3.54%, p < 0.01), pulmonary embolism (4.22% vs. 1.42%, p < 0.01), pneumonia (21.39% vs. 8.84%, p < 0.01), urinary tract infection (19.07% vs. 13.32%, p < 0.01), sepsis (20.27% vs. 4.18%, p < 0.01), acute myocardial infarction (12.14% vs. 3.21%, p < 0.01), and cardiac arrest (10.25% vs. 3.23%, p < 0.01). In a multivariate regression assessing the impact of AKI on SAH outcome, this diagnosis was found to be independently correlated with poor functional outcome (OR: 3.306, CI: 3.11 – 3.513, p < 0.001) above average LOS (OR: 1.503, CI: 1.438 ‐ 1.571, p

Introduction Neurointervention has become one of the most competitive specialties in the United States due to the limited number of training spots, and a larger pool of applicants from different backgrounds: neurosurgery, neurology, and radiology. The training standards are continuously updated to ensure solid learning experiences, which ultimately factors in better outcomes and fewer complications. There is a move towards a structured competency assessment of training requirements via collaboration among several professional societies. However, the substantial drivers of candidate selection by program directors (PDs) have not been fully established yet. The goal of our study is to investigate the factors influencing the selection of fellowship candidates. Methods We distributed a 52‐question electronic survey via REDCap to 93 PDs. The questionnaire was divided into 5 categories: program characteristics; candidate demographics; educational credentials; personal traits; and research and extracurricular activities. The PDs were then asked to rank 5 pre‐selected factors from across all 5 categories. Each category included a subset of multiple‐choice questions to be graded as indicated for each category. Characteristics for these categories were scored from a range of 1 through 10 and means with standard deviations (SD) were calculated for each characteristic. Results Of the 93 PDs surveyed, 55 PDs filled the survey with a response rate of 59.1%. As per the programs’ characteristics, Neurosurgery was the most involved specialty in running the training programs (69.1%), followed by neurology (38.2%), and radiology (30.9%). Most programs were based in academic hospitals (87.3%, n=48/55). The most important criterion for candidate’s demographic characteristics was the need for visa sponsorship, followed by career gap and number of years from graduation from residency program, as summarized in Figure 1A. The most important criteria for educational credentials were being a graduate from a neurosurgical residency program (5.4 ± 2.9), and the institution where the candidate’s residency training is/was based (5.4 ± 2.5). Regarding the candidate’s personal traits, assessment by faculty members at the interview had the highest score (8.9 ± 1). In terms of research and extracurricular activities, fluency in English had the highest score (7.2 ± 1.9), followed by the number of peer‐reviewed/PubMed‐indexed publications (6.4 ± 2.2). Ranking of a final set of 5 characteristics from across all categories is summarized in Figure 1B, with knowledge of the candidate being the single most important contributing factor. Conclusion Neurointerventional training is open to candidates in neurosurgery, neurology, and radiology. To our knowledge, our survey is the first to investigate the factors that might be implicated in the final decision made by PDs when choosing the future neurointerventional trainee, including demographic, educational, research and extracurricular activities.

The synthesis and characterization of novel 2,4-dinitrophenylhydrazone (2,4-DNPH) derivatives were investigated using a comprehensive combination of experimental and theoretical approaches. Spectroscopic techniques such as 1H NMR, IR, Raman, and UV–Vis were employed to probe the structural and chemical properties of the synthesized compounds. These compounds were tested for their in vitro anti-oxidant activity. All the synthesized derivatives showed good to excellent activities. Density functional theory (DFT) calculations at the B3LYP functional with 6-31G and 6–311++G(d,p) basis sets were performed to reveal the molecular nature of the synthesized derivatives. Conformational analysis confirmed the stability of the optimized structures. The DFT simulations revealed the presence of hydrogen bonding between the N–H and nitro groups and further explored the charge transfer within the molecule as well as the sites that are favorable for electrophilic and nucleophilic attacks. The frontier molecular orbital (FMO) calculations provided insights into various reactivity parameters, such as ionization potential, electron affinity, electronegativity, chemical hardness, and chemical softness. Overall, this study provides a deeper understanding of the molecular structure, spectroscopic properties, and reactivity of these new 2,4-dinitrophenylhydrazone derivatives, which could have potential applications in the field of biochemistry.

Primary embryonal rhabdomyosarcomas of the kidney are extremely rare, especially in adults. The presented case, a 32-year-old female with a background of autosomal polycystic kidney disease, was initially referred with a left hemorrhagic renal cyst. Despite angioembolization, she eventually underwent radical nephrectomy which revealed the diagnosis of embryonal rhabdomyosarcoma. The diagnosis and presentation of this case is unique as she presented with hemorrhagic renal cyst. Adult renal rhabdomyosarcoma has a poor prognosis, as shown by other reported cases. Unfortunately, She passed away 88 days post operatively due to disease progression.

Arthroscopic posterior bone block procedure using cortical screws has been reported since 2012 for management of recurrent posterior instability associated with bone defects. To avoid screw complications, we describe a full arthroscopic technique based on cortical button fixation. With 4 portals (posterior, poster lateral, anterior, and anterolateral), we use a specific glenoid guiding system (to perform 2 tunnels) and 2 cortical buttons fixation. With a specific glenoid guide, the iliac crest bone graft (ICBG) is secured to the posterior glenoid rim by fixation with 2 cortical buttons. The ICBG is positioned protruding outside the joint through the space, and the posterior capsule is repaired while maintaining an extra-articular bone graft. The protruding bone graft increases the concavity of the glenoid with a progressive bony remodeling to improve the posterior stability of the shoulder in our clinical experience.

Artificial intelligence-based question-answering (QA) systems can expedite the performance of various tasks. These systems either read passages and answer questions given in natural languages or if a question is given, they extract the most accurate answer from documents retrieved from the internet. Arabic is spoken by Arabs and Muslims and is located in the middle of the Arab world, which encompasses the Middle East and North Africa. It is difficult to use natural language processing techniques to process modern Arabic owing to the language’s complex morphology, orthographic ambiguity, regional variations in spoken Arabic, and limited linguistic and technological resources. Only a few Arabic QA experiments and systems have been designed on small datasets, some of which are yet to be made available. Although several reviews of Arabic QA studies have been conducted, the number of studies covered has been limited and recent trends have not been included. To the best of our knowledge, only two systematic reviews focused on Arabic QA have been published to date. One covered only 26 primary studies without considering recent techniques, while the other covered only nine studies conducted for Holy Qur’an QA systems. Here, the included studies were analyzed in terms of the datasets used, domains covered, types of Arabic questions asked, information retrieved, the mechanism used to extract answers, and the techniques used. Based on the results of the analysis, several limitations, concerns, and recommendations for future research were identified. Additionally, a novel taxonomy was developed to categorize the techniques used based on the domains and approaches of the QA system.

BACKGROUND: Intracerebral hemorrhage (ICH) carries significant morbidity and mortality. Previous single-center retrospective analysis suggests that end-stage renal disease (ESRD) is a risk factor for severe ICH and worse outcomes. This investigation aims to examine the impact of ESRD on ICH severity, complications, and outcomes using a multicenter national database. METHODS: The International Classification of Disease, Ninth and Tenth Revision Clinical Modification codes were used to query the National Inpatient Sample for patients with ICH and ESRD between 2010 and 2019. Primary endpoints were the functional outcome, length of stay (LOS), and in-hospital mortality. Multivariate variable regression models and a propensity-score matched analysis were established to analyze patient outcomes associated with baseline patient characteristics. RESULTS: We identified 211,266 patients with ICH, and among them, 7,864 (3.77%) patients had a concurrent diagnosis of ESRD. Patients with ESRD were younger (60.85 vs. 67.64, P < 0.01) and demonstrated increased ICH severity (0.78 vs. 0.77, P < 0.01). ESRD patients experienced higher rates of sepsis (15.9% vs. 6.15%, P < 0.01), acute myocardial infarction (8.05% vs. 3.65%, P < 0.01), and cardiac arrest (5.94% vs. 2.4%, P < 0.01). In addition, ESRD predicted poor discharge disposition (odds ratio [OR]: 2.385, 95% confidence interval [CI]: 2.227–2.555, P < 0.01), longer hospital LOS (OR: 1.629, 95% CI: 1.553–1.709, P < 0.01), and in-hospital mortality (OR: 2.786, 95% CI: 2.647–2.932, P < 0.01). CONCLUSIONS: This study utilizes a multicenter database to analyze the effect of ESRD on ICH outcomes. ESRD is a significant predictor of poor functional outcomes, in-hospital mortality, and prolonged stay in the ICH population.

Introduction: Opioid may cause undue risk after surgical procedures like orthognathic surgeries. The present study was aimed to determine how the preoperative administration of oral montelukast affected the degree of postoperative discomfort following bimaxillary orthognathic surgery (BOS). Methodology: This study included all skeletal class III subjects scheduled for BOS. The participants were split into placebo and montelukast groups at random. Every patient received a 10-mL serving of apple juice an hour prior to the surgery; however, for the intervention group, a montelukast 10 mg pill was dissolved in the juice. The same surgical team and general anesthetic guidelines were used for all procedures. The visual analog scale (VAS) was used to calculate postoperative pain at designated intervals. The significance level for the statistical analysis was determined using the Statistical Package for the Social Sciences (SPSS) version 23. Results: The control subjects had a higher level of pain at all the intervals than the intended drug test group. Also, the control group needed more analgesics than the test group. There was one observation made that the length of the surgery had an impact on the postoperative pain. Conclusion: Preoperative montelukast medication may be useful in minimizing postoperative discomfort following bimaxillary orthognathic surgery. More research is required for greater relevance.

The goal of this study is to find a cure for the masticatory muscle disease known as hemimasticatory spasm (HMS). This retrospective investigation intends to find a more efficient therapeutic approach for HMS patients by examining the clinical effectiveness of masseteric nerve avulsion performed on HMS using a temporomandibular arthroscope. A clinical study was piloted where the subjects were treated for masseter nerve avulsion by TMJ arthroscopy. The follow-up was done till 2 years, and the subjects were evaluated for the various characteristics like difficulties, masticatory abilities, and various sounds at the joint for the various functions of the joint. The diagnosis was done using the electrophysiological electromyogram (EMG) at the designated time intervals. There was a complete remission in all the subjects. The masseter nerve avulsion was effective since the scores lowered. Within 3 years of the operation, electrophysiological EMG depicted no discharge potential with a high frequency, and the total efficiency when paired with the clinical effectiveness was deemed acceptable. The maximal masseter power between the treated and nontreated sides was comparable. The mastication, on comparing, was also as effective as the normal side; however, lower mastication was noted in the first year. The avulsed nerve tissues lacked any apparent demyelination. Masseteric nerve avulsion with temporomandibular arthroscope assistance provided acceptable and stable total effectiveness for the intervention of the hemimasticatory spasm. While the strength of the muscle of the afflicted side was only marginally reduced, its masticatory effectiveness was optimally preserved.

Gastrointestinal (GI) manifestations of the coronavirus disease 2019 (COVID-19) pandemic are frequently observed in SARS-CoV-2-infected individuals at distinct time intervals after the initial diagnosis. Psychological distress in the form of anxiety, burnout, and depression is regarded as a common complication of COVID-19, but also as a risk factor for the development and exacerbation of irritable bowel syndrome (IBS), which is highly prevalent among COVID-19 patients and the general population. The pathophysiological mechanisms culminating in the diagnosis of IBS are yet to be fully understood, however, factors including gut–brain interaction, COVID-19-related intestinal damage, and other external influences might play a role in this process. While long-term GI complications of COVID-19 such as IBS are speculated to develop as a result of a multifaceted interaction between the virus itself with the host, in addition to the effects of psychological distress, further research on this topic is warranted. The purpose of this study was to explore possible factors correlating with the development of IBS and depression during the follow-up period post-COVID-19 infection.

Background and Purpose Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials. Methods We searched the National Readmission Database for LVO patients treated with MT between 2016–2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders. Results Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P

Background and Purpose Venous thromboembolism (VTE) is a life-threatening complication of stroke. We evaluated nationwide rates and risk factors for hospital readmissions with VTE after an intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS) hospitalization. Methods Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included patients with a principal discharge diagnosis of ICH or AIS from 2016 to 2019. Patients who had VTE diagnosis or history of VTE during the index admission were excluded. We performed Cox regression models to determine factors associated with VTE readmission, compared rates between AIS and ICH and developed post-stroke VTE risk score. We estimated VTE readmission rates per day over a 90-day time window post-discharge using linear splines. Results Of the total 1,459,865 patients with stroke, readmission with VTE as the principal diagnosis within 90 days occurred in 0.26% (3,407/1,330,584) AIS and 0.65% (843/129,281) ICH patients. The rate of VTE readmission decreased within first 4–6 weeks (P

Self-driving cars are going to be the main future mode of transportation. However, such systems like, any other cyber-physical system, are vulnerable to attack vectors and uncertainties. As a response, resilience-based approaches are being developed. However, the approaches lack a sound attack model that recognizes the attack vectors and vulnerabilities such a system would have and that does a proper severity analysis of such attacks. Moreover, the existing attack models are too generic. Currently, the domain lacks such specific work pertaining to self-driving cars. Given the technology and architecture of self-driving cars, the field requires a domain-specific attack model. This paper gives a review of the attack models and proposes a domain-specific attack model for self-driving cars. The proposed attack model, severity-based analytical attack model for resilience (SAAMR), provides attack analysis based on existing models. Also, a domain-based severity score for attacks is calculated. Further, the attacks are classified using the decision-tree method and predictions of the type of attacks are given using long short-term memory network.

Ali Fawaz, Omar Abdel-Rahman Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, CanadaCorrespondence: Omar Abdel-Rahman, Department of Oncology, University of Alberta, Cross, Cancer Institute, Edmonton, Alberta, T6G 1Z2, Canada, Tel +1 780-432-8290, Email omar.abdelsalam@ahs.caBackground: Pancreatic ductal adenocarcinoma (PDAC) remains a significant worldwide health problem with a poor prognosis. A borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) is a tumor with limited vascular involvement that is technically resectable but with a high risk of positive margins (R1 resection).Objective: To identify the current challenges that exist in the management of BR-PDAC.Methods: A review of the literature was conducted to identify articles discussing the definitions and management of BR-PDAC.Key Findings: Several anatomic definitions of BR-PDAC exist, and there is significant heterogeneity in their utilization across published trials. To improve the odds of a margin negative (R0) resection, a neoadjuvant treatment approach involving chemotherapy with or without radiation is currently preferred. While supporting the efficacy of a neoadjuvant approach in BR-PDAC, the largest published randomized trials have utilized older gemcitabine-based regimens. Recently published Phase II evidence and meta-analyses have supported the use of modern multi-agent regimens such as FOLFIRINOX. The utility of adding radiation to a chemotherapy backbone remains in question. Due to remnant fibrosis and edema following neoadjuvant therapy, accurately selecting patients for resection based on a restaging CT scan is challenging. Furthermore, the role of adjuvant therapy in BR-PDAC patients receiving neoadjuvant therapy needs to be defined.Conclusion: Though progress has been made, the optimal management of BR-PDAC is uncertain. Phase III trials utilizing modern chemotherapeutic regimens are needed to establish a standard of care.Keywords: pancreatic cancer, borderline resectable disease, surgery, neoadjuvant chemotherapy

Abstract The ability to screen environmental water samples for gastroenteritis pathogens, particularly viruses remains challenging. Here, we investigated the presence of enteric viruses in treated sewage effluent water samples collected from a cooling tower in The Kingdom of Saudi Arabia (SA) from 2018 to 2019. Our ultimate aim was to determine the optimal handling and processing conditions for the water samples and the most sensitive detection method for the assessment of viral contamination. Sewage was collected before and after treatment at three defined zones. Samples were concentrated by ultracentrifugation and analyzed using a multiplexed bead-based assay system (Luminex technology) or multiplex PCR (QIAstat-Dx). The efficiency of these modalities to accurately detect virus contamination were subsequently compared. In total, 64 samples (16 controls and four treated samples per-control) were analyzed for 26 enteric pathogens. Of the samples, 98.7% were negative for viruses following treatment. Detection rates were higher for the multiplex PCR (QIAstat-Dx) system compared to the hybridization method, highlighting its higher sensitivity. The current water sewage treatment protocols in KSA could efficiently eradicate viral pathogens, minimizing their potential for waterborne transmission. We provide the first systematic analysis of two molecular detection methods for the assessment of gastroenteritis-associated pathogens from environmental samples in KSA. We conclude that the multiplex PCR (QIAstat-Dx) system outperforms the Luminex technology for the detection of virus pathogens in treated water samples.

Abstract Background There are no studies that have assessed advanced glycation end products (AGEs) and interleukin 17A (IL-17A) levels in whole saliva (WS) of patients with dental implants. The aim was to compare levels of AGEs and IL-17A in WS and peri-implant clinical and radiographic status of patients with and without osteoporosis at 6-years’ follow-up. Methods Osteoporotic (Group-1) and systemically healthy controls (Group-2) having undergone dental implant therapy at least 5 years ago were included. A questionnaire was used to collect information about age, gender, duration and treatment of osteoporosis, number and duration of implants in function, and frequencies of toothbrushing, flossing and hygiene visits. Modified bleeding and plaque indies (mBI and mPI), peri-implant probing depth (PD) and crestal bone loss (CBL) were recorded. WS was collected and levels of AGEs and IL-17A were determined using enzyme linked immunosorbent assay. Sample-size estimation was done and statistical analyses were doing using the independent t- and Wilcoxon rank-sum tests. Statistical significance was marked for P-values that were below 0.01. Results In patients with (n = 24) and without (n = 27) osteoporosis, implants were in function for 6.3 ± 0.27 and 6.6 ± 0.5 years, respectively. There was no significant difference in peri-implant mBI, PD, mPI and CBL in both groups. Levels of AGE in patients with (119.6 ± 26.5 μg/ml) and without (91.5 ± 14.6 μg/ml) osteoporosis were comparable. Levels of whole salivary IL-17A in patients without and with osteoporosis were 4.6 ± 0.3 and 5.1 ± 0.8 pg/ml, respectively. Flossing of full mouth interproximal spaces once and twice daily toothbrushing daily was reported by 100% patients with osteoporosis. Among patients with osteoporosis 75% and 25% individuals were receiving professional dental prophylaxis every 4 and 6 months, respectively. Conclusion Within the limitations of the present study osteoporotic patients are not at an increased risk of peri-implant diseases and can demonstrate salivary AGE and IL-17A levels comparable to non-osteoporotic individuals as long as oral hygiene is stringently maintained.

The healthcare sector has gradually embraced effective project management for improved healthcare outcomes. This paper explores the application of the agile methodology for managing the healthcare sector. This study significantly contributes to the healthcare sector by providing insights into the application of Agile methodology, potentially enhancing healthcare management and patient outcomes. In this article, the author reviews ten peer-reviewed articles, analyses the findings, and generates three themes: Agile methodology development and implementation in the healthcare sector, the healthcare sector's readiness factors/levels for applying the agile methodology, and how agile methods improve healthcare outcomes. The findings across the three identified themes reiterate the crucial role of organizational leadership, flexible structures, and advanced technology in enhancing agility within the healthcare sector. Moreover, the studies highlight the potential of agile principles to enhance customer-centricity, customer satisfaction, and overall adaptability in healthcare organizations. The study recommends healthcare institutions priorities Agile competency development through training programs and cultivate a culture of adaptability to support Agile methodology adoption. Furthermore, it suggests quantitative research to validate readiness factors' influence, focusing on patient-centered outcomes and comparative studies between Agile and traditional healthcare approaches to bridge literature gaps.

Background Physical activity can improve health-related quality of life (HRQoL) in adults. However, the effect of physical activity on quality of life is unclear among the Saudi adult population. The study aimed to determine the association between physical activity and HRQoL in apparently healthy adults in Jeddah, Saudi Arabia. Methods This cross-sectional study was conducted among visitors of shopping malls, walking tracks/fitness centres/gyms and governmental hospitals in Jeddah from March to September 2022. Physical activity was measured with the electronic template of the general practice physical activity questionnaire (GPPAQ), while the HRQoL was measured using the 36-Item Short Form Survey (SF-36) questionnaire. A multiple linear regression model investigated the relationship between physical activity and HRQoL. Results A total of 693 individuals participated in this study, with a mean age of 36 (±11). Individuals who fall in the active category of the physical activity level were mostly younger men (37% vs 21%), were non-smokers (30% vs 10%) and had no comorbid condition (29% vs 15%). After adjusting for covariates, men (adjusted β 4.43, 95% CI [1.44–7.41]) with higher physical activity levels (active-adjusted β 10.11, 95% CI [5.44–14.77]) had better scores on the physical component summary (PCS). Similarly, mental component summary (MCS) scores for men (adjusted β 6.51, 95% CI [3.40–9.63]) and physical activity levels (active-adjusted β 9.77, 95% CI [4.90–14.64]) were high. Conclusion The article reinforces how physical activity contributes towards each dimension of HRQoL. Physical inactivity is a growing public health challenge in Saudi Arabia, affecting all age groups. Investing in innovative strategies and establishing targeted health education programs for academic institutions and communities are required to enhance healthy habits. Additionally, constructing more local sports facilities and concession packages, especially for the females at the gyms, can motivate individuals and promote physical activity.

Background Flow diverters are now considered first‐line tools for treating intracranial aneurysms. However, few devices are available for patients with large‐diameter vessels (LDVs). Hence, we evaluated the performance of the largest diameter Surpass Streamline for aneurysms in LDVs. Methods We performed a subanalysis of the SESSIA (Safety and Efficacy of the Surpass Streamline for Intracranial Aneurysms) multicenter cohort study of patients treated with Surpass Streamline between 2018 and 2021. Patients in whom a 5‐mm diameter Surpass Streamline was implanted were divided into 2 groups according to vessel diameter at the landing zones (LDV, ≥5.3 mm versus non‐LDV [N‐LDV],

In our current research, an intriguing magnetic nano sorbent Fe3O4@Zr-MOF was synthesized in the lab. We used this adsorbent for successfully removing tetracycline (TC) from water. We performed a number of experiments and studies to further support this, including the following: vibrating sample magnetometer (VSM), Fourier transform infrared spectroscopy (FTIR), energy-dispersive X-ray photoelectron spectroscopy (XPS), scanning electron microscope (SEM), X-ray diffraction (XRD), and Brunauer-Emmett-Teller surface area (BET). Our studies have determined that the Fe3O4@Zr-MOF boasts a considerable surface area of 868 m2/g with the highest adsorption capacity (qmax) of 942.12 mg/g. Study the factors that effect on adsorption process such as pH, TC concentration, adsorbent dose, and temperature. The adsorption isotherm was fitted to the Langmuir equation, whereas the kinetic isotherm to the pseudo-second-order equation. The adsorption process was chemisorption as well as the adsorption energy was 20 kJ/mol. Adsorption thermodynamics indicated that the adsorption process was both endothermic and spontaneous. As temperatures increased, the amounts of materials absorbed also increased. The Fe3O4@Zr-MOF has magnetic properties as it easily to remove from the solution after adsorption process. The adsorbent was used for five cycles with high efficiency and without change in the chemical composition as well as the XRD was the same before and after reusability. The mechanism of the interaction between Fe3O4@Zr-MOF and TC was expected on: Electrostatic interaction, π-π interaction, hydrogen bonding, and pore filling. The adsorption results were optimized using Box Behnken-design (BBD).

Myoglobin (MB) is a cytoplasmic hemoprotein that is predominantly expressed in the heart and oxidative myofibers of skeletal muscle. It has been demonstrated that MB binds to oxygen and promotes its diffusion for energy production in the mitochondria. Recently, MB was found to be expressed in different forms of malignant tumors and cancer cell lines. Further studies using gene disruption technology will enhance the understanding of MB’s role in human cardiovascular biology and cancers. Here, we describe the generation of a homozygous MB knockout in human embryonic stem cells (hESC-MB−/−) via CRISPR/Cas9 to study MB function in human biology and diseases.

Urolithiasis is a rare complication of orthotopic neobladder after cystectomy. We report a case of a 25-year-old female with studer neobladder and Monti valve presenting with recurrent urinary tract infections, abdominal pain, and difficult catheterization. Imaging revealed multiple large stones in the neobladder. Neocystolitholapaxy and neocystolithotripsy failed, leading to an open neocystolithotomy with retrieval of 14 large stones. Stone composition analysis showed struvite (30%), carbonate apatite (46%), and whitlockite (24%). Neobladder repair with omental interposition was performed. Follow-up confirmed an intact neobladder without leaks. Neobladder stones may be asymptomatic, and open neocystolithotomy is an effective treatment for multiple neobladder stones.

Background: Urease belongs to the family of amid hydrolases with two nickel atoms in their core structure. On the basis of literature survey, this research work is mainly focused on the study of bis-Schiff base derivatives of benzyl phenyl ketone nucleus. Objective: Synthesis of benzyl phenyl ketone based bis-Schiff bases in search of potent urease inhibitors. Method: In the current work, bis-Schiff bases were synthesized through two steps reaction by reacting benzyl phenyl ketone with excess of hydrazine hydrate in ethanol solvent in the first step to get the desired hydrazone. In last, different substituted aromatic aldehydes were refluxed in catalytic amount of acetic acid with the desired hydrazone to obtain bis-Schiff base derivatives in tremendous yields. Using various spectroscopic techniques including FTIR, HR-ESI-MS, and 1H NMR spectroscopy were used to clarify the structures of the created bis-Schiff base derivatives. Results: The prepared compounds were finally screened for their in-vitro urease inhibition activity. All the synthesized derivatives (3–9) showed excellent to less inhibitory activity when compared with standard thiourea (IC50 = 21.15 ± 0.32 µM). Compounds 3 (IC50 = 22.21 ± 0.42 µM), 4 (IC50 = 26.11 ± 0.22 µM) and 6 (IC50 = 28.11 ± 0.22 µM) were found the most active urease inhibitors near to standard thiourea among the synthesized series. Similarly, compound 5 having IC50 value of 34.32 ± 0.65 µM showed significant inhibitory activity against urease enzyme. Furthermore, three compounds 7, 8, and 9 exhibited less activity with IC50 values of 45.91 ± 0.14, 47.91 ± 0.14, and 48.33 ± 0.72 µM respectively. DFT used to calculate frontier molecular orbitals including; HOMO and LUMO to indicate the charge transfer from molecule to biological transfer, and MEP map to indicate the chemically reactive zone suitable for drug action. The electron localization function (ELF), non-bonding orbitals, AIM charges are also calculated. The docking study contributed to the analysis of urease protein binding.