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Fasting during Ramadan is mandatory for all adult healthy Muslims. International studies found that most Muslims with diabetes mellitus fast during Ramadan. The main risk factors are hypoglycemia, Hyperglycemia, diabetic ketoacidosis, and dehydration during fasting. Therefore, stratification of the risks for severe acute diabetes complications needs to be considered for each individual and strategies personalized to advert these complications. The advent of new diabetes medications which are effective yet with a better safety profile and monitoring of blood glucose levels during the day are important to reduce the risk of untoward effects of hypoglycemia and hyperglycemia during Ramadan fasting. Here we review the safety and effectiveness of the newer diabetes medications for Ramadan fasting and whether it is safe to perform fasting after bariatric surgery.An extensive literature search using PubMed and Google Scholar was done using different search terms. The eligible studies were 48 randomized controlled trials, prospective observational studies, and reviews from January 2008 to June 2022 which were conducted in individuals living with diabetes.The newer diabetes medications such as GLP-1 agonists, DPP-4 inhibitors, SGLT-2 inhibitors, and new Insulin therapy are thought to be safe and effective during fasting of Ramadan. These medications are associated with a reduction in HbA1c, body weight, systolic blood pressure and risk of hypoglycemia during Ramadan fasting. However, further studies with larger sample size are needed to confirm the efficacy and safety of these newer medications during Ramadan fasting. Individuals with Bariatric surgery should seek advice and approval to fast from the bariatric dietician, physician, and surgeon before the beginning of the month of Ramadan.

Introduction COVID-19 is characterized by a procoagulant state that increases the risk of venous and arterial thrombosis. The dose of anticoagulants in patients with severe COVID-19 pneumonia without suspected or confirmed thrombosis has been debated. Aim of the study We evaluated the prevalence, predictors, and outcomes of venous thromboembolism (VTE) in critically ill COVID-19 patients and assessed the association between the dose of anticoagulants and outcomes. Materials and methods This retrospective cohort included patients with COVID-19 who were admitted to the ICU between March and July 2020. Patients with clinically suspected and confirmed VTE were compared to those not diagnosed to have VTE. Results The study enrolled 310 consecutive patients with severe COVID-19 pneumonia: age 60.0±15.1 years, 67.1% required mechanical ventilation and 44.7% vasopressors. Most (97.1%) patients received anticoagulants during ICU stay: prophylactic unfractionated heparin (N=106), standard-dose enoxaparin (N=104) and intermediate-dose enoxaparin (N=57). Limb Doppler ultrasound was performed for 49 (15.8%) patients and chest computed tomographic angiography for 62 (20%). VTE was diagnosed in 41 (13.2%) patients; 20 patients had deep vein thrombosis and 23 had acute pulmonary embolism. Patients with VTE had significantly higher D-dimer on ICU admission. On multivariable Cox regression analysis, intermediate-dose enoxaparin versus standard-dose unfractionated heparin or enoxaparin was associated with lower VTE risk (hazard ratio, 0.06; 95% confidence interval, 0.01-0.74) and lower risk of the composite outcome of VTE or hospital mortality (hazard ratio, 0.42; 95% confidence interval, 0.23-0.78; p=0.006). Major bleeding was not different between the intermediate- and prophylactic-dose heparin groups. Conclusions In our study, clinically suspected and confirmed VTE was diagnosed in 13.2% of critically ill patients with COVID-19. Intermediate-dose enoxaparin versus standard-dose unfractionated heparin or enoxaparin was associated with decreased risk of VTE or hospital mortality.

Cholestatic liver diseases (CLDs) are a group of diseases characterized by jaundice and cholestasis as the main presentation with different complications, which have considerable impact on the liver and can lead to end-stage liver disease, cirrhosis, and liver-related complications. In the last few years, tremendous progress has been made in understanding the pathophysiology, diagnosis, and treatment of patients with these conditions. However, several aspects related to the management of CLDs remain deficient and unclear. Due to the lack of recommendations that can help in the management, treatment of those conditions, the Saudi Association for the Study of Liver diseases and Transplantation (SASLT) has created a task force group to develop guidelines related to CLDs management in order to provide a standard of care for patients in need. These guidelines provide general guidance for health care professionals to optimize medical care for patients with CLDs for both adult and pediatric populations, in association with clinical judgments to be considered on a case-by-case basis. These guidelines describe common CLDs in Saudi Arabia, with recommendations on the best approach for diagnosis and management of different diseases based on the Grading of Recommendation Assessment (GRADE), combined with a level of evidence available in the literature.

Loranthaceae family includes hemiparasitic members which are seen invading a wide range of commercial crops. Helicanthes elasticus (Desv.) Danser is very common on mango trees. Though parasitic in nature, this mistletoe is also medicinally important as fetoprotective, against vesicular calculi and kidney infections. This study is an attempt to document macro-microscopical features of parasitic root, fruit and host-mistletoe tissue interaction in the haustorium of H. elasticus growing on mango stems. Collection, preservation, sectioning, staining and photomicrography of the root, fruit and host-mistletoe union were done as per standard methodologies of anatomical studies. Though there is resemblance to the normal roots in morphology as well as anatomy, the microscopic finding of large number of branched stone cells in the roots is interesting. The morpho-anatomical features recorded would help in understanding the infection biology of this mistletoe. The eradication during the earlier stages of its establishment from seed or from the root creeping over the surface of the host can help in controlling this parasite infection on commercially important host plants.

Introduction Cardiovascular implantable electronic devices (CIEDs) are long-term cardiac treatments that address a variety of cardiac diseases. In the recent years, a steady growth has been noticed in CIEDs, mainly due to expanding indications for their usage. Possible device-related infection, whether pocket or systemic, which leads to high morbidity and mortality, is one of the most worrying complications. In addition, there are limited studies conducted on the topic of CIED infection rate and their clinical presentation both regionally and locally. Methods In this retrospective cohort study, we reviewed the medical records of all patients with CIEDs who presented to our medical center (implanted, followed up, or referred to our hospital) between January 2016 and January 2019.The medical records were extracted from the BestCare electronic medical records system (ezCaretech Co, Seoul, Korea). All consecutive patients were included as we had no exclusion criteria. Results During the three years of the study period, a total of 612 patients with CIEDs were identified at our medical center. Among this cohort, 436 subjects (71.2%) were male and 176 (28.8%) were female. Thirty-four patients experienced device-related infections from among the total patient population (n = 612) who presented with CIEDs between January 2016 and January 2019, for a total rate of 5.6%. Of the infected patients, 29 (85%) presented with local infections and five (15%) presented with systemic infections. Conclusion The infection rate of 5.6% observed in this study was higher than expected. Therefore, we conclude that action should be taken to reduce infection rates at our medical center to at least that seen in prior studies or below that, if possible. Moreover, we found that CIED infections were often caused by

Highlights • Osteochondral patella fractures commonly associated with soft tissue injuries. • We report a rare case of a child with isolated osteochondral patella fracture. • Open reduction and internal fixation of the dicplaced fragment was successful with good outcome., Introduction Osteochondral fracture of the patella is a fairly common pathology, but almost always associated with a spectrum of soft tissue injuries including anterior cruciate ligament (ACL) rupture. We present a rare case of an osteochondral fracture of the patella in the absence of ligament or soft tissue injuries and with no dislocation of the patella in a pediatric patient. Presentation of case An 11-year-old male presented to the orthopedic clinic on crutches following a football injury. The patient had pain in his left knee with flexion deformity. Plain film radiography of the left knee was taken, and an osteochondral fracture of the patella was suspected. Further imaging studies were conducted including computed tomography (CT) and magnetic resonance imaging (MRI) which revealed an isolated osteochondral fracture of the patella with no other associated injuries. Open reduction and internal fixation of the displaced fragment was successfully preformed with favorable outcomes. During follow-up, almost full range of motion was regained, and plain film radiography revealed healed fracture with a normal appearance of the patella. Discussion Traumatic osteochondral fracture of the patella is a common injury and most of these injuries are commonly accompanied by an acute dislocation of the patella or soft tissue injuries such as rupture of the anterior cruciate ligament (ACL) and almost half of all patellar dislocations incidence are associated with osteochondral fractures of the patella. This case had an isolated osteochondral fracture of patella. Conclusion As demonstrated in this case, osteochondral fractures are common among younger population and patients need to be thoroughly evaluated. Advanced Imaging such as MRI and CT are essential to exclude soft tissue injuries. Although management is highly variable, the importance of open reduction and early fixation should be emphasized for optimal outcomes.

Purpose: Atherosclerotic stenosis of the extracranial carotid artery accounts for approximately 20% of all strokes. Both carotid artery endarterectomy and carotid artery angioplasty with stenting (CAAS) are recommended for symptomatic patients with 50% or more stenosis or asymptomatic patients with 70% or more stenosis. CAAS is under-reported in Saudi Arabia, as evidenced by a thorough literature search. In this article, we aim to share our experience of CAAS to call for the necessity of conducting more research on stroke and emphasize the local need of utilizing more endovascular treatments like CAAS.Materials and Methods: A retrospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria consisted of all adult patients (18 years and above) with carotid stenosis who were treated with CAAS.Results: A total of 16 patients were included in the study. The mean age of the participants was 66.9±13.5 years (range 30–87 years). All patients were symptomatic (had a previous stroke or transient ischemic attack). The procedure was successful in 14 patients (87.5%), while it failed in 2 patients (12.5%) due to technical reasons. All patients had no stroke or myocardial infarction within 30 days of the procedure.Conclusion: Despite the advancement in medicine with free healthcare services in Saudi Arabia, the interventional procedures for secondary prevention of strokes are underutilized. Collaboration between different hospitals will be extremely helpful since few centers in each city are providing such treatments by an expert neurointerventionist and/or strokologist. The good selection of candidates, optimal management of comorbid conditions, and multidisciplinary care may improve outcomes and reduce mortality.

Introduction The impact of Ramadan fasting, a type of intermittent fasting, on the management of diabetes has not been well investigated. Physical activity, sleep duration, and time of sleep are susceptible to alterations during Ramadan due to the changes in the times and numbers of meals. This study compared physical activity and sleep patterns of individuals with type 2 diabetes mellitus (T2DM) during and after Ramadan using the international physical activity questionnaire (IPAQ) and a Fitbit Flex 2 accelerometer. Methods Saudi individuals (n = 36) with T2DM completed a self-reported questionnaire and wore a Fitbit device for seven consecutive days during and after Ramadan. Fitbit generated weekly step counts, activity intensities, sedentary time, and sleep durations and times. IPAQ was used to estimate the physical activity and sitting time of participants in each period. Sleep patterns were assessed in each period by a self-reported questionnaire. Results Both Fitbit and IPAQ indicated a high prevalence of low physical activity among the participants with non-significant variances between the during and after Ramadan periods. Also, a significant short daily total sleeping hours and daily night-time sleeping hours was seen during the Ramadan period. The duration of night-time sleep was observed to be low in each period. Conclusions This is the first study to use a Fitbit device to monitor individuals with T2DM who chose to fast during Ramadan. The study shows a high prevalence of low physical activity among Saudi individuals with T2DM in each period, and short sleep durations in the during Ramadan period compared to after Ramadan period. A high prevalence of short night-time sleep duration and excessive daytime sleeping was observed in both periods and significantly in the during Ramadan period. A larger study is needed in the future covering before, during, and after Ramadan to evaluate the impact of lifestyle changes related to Ramadan fasting on type 2 diabetes. Electronic Supplementary Material The online version of this article (10.1007/s13300-020-00825-x) contains supplementary material, which is available to authorized users.

Background: Rhinoplasty is one of the most challenging esthetic operations as it demands an optimal esthetic and practical outcome. Complications of rhinoplasty may occur intraoperatively or postoperatively during wound healing and contracture. Objectives: The aim of this study was to assess the complications of septorhinoplasty at King Abdullah Medical City Hospital (KAMCH) and to evaluate the satisfaction scores of the patients and the doctors after primary and revision septorhinoplasty. Materials and methods: In the last five years, 32 out of 425 patients (7.5%) underwent revision septorhinoplasty to correct complications of the previous operations performed at KAMCH. This is a retrospective single descriptive study that included Saudi patients aged 18 years and above who underwent primary and revision septorhinoplasty at KAMCH from January 2015 to March 2020. We reviewed the medical records of the patients to identify postoperative complications. Data were analyzed using SPSS statistical program (versions 7 and 8; SPSS Inc, Chicago). Results: The mean age of the 32 patients who underwent revision septorhinoplasty was 26 ± 8.5 years. Most of the complications involved the nasofrontal angle and the columellolabial angle. Statistically significant improvements in the satisfaction scores of the patients and the doctors were observed before the first surgery, after the first surgery, and after the second surgery (P = 0.000 for each time point). Conclusion: The satisfaction levels of the patients and the doctors improve after the second surgery.

Highlights • Chylous ascites due to intestinal malrotation is a rare occurrence, especially in adolescent and adult patients. • Chylous ascites due to intestinal malrotation typically occurs early in life with painless distension of the abdomen. • Our case is a male adolescent who presented with abdominal pain and a history of congenital hernia repair. • Ladd’s procedure was successfully performed in our case with no complications., Introduction Intestinal malrotation is a rare etiology of chylous ascites in adolescents. Chylous ascites is caused by lymphatic system disarrangement, which can result in an anomalous build-up of a lymphatic fluid rich in lipid, namely chyle in the peritoneal cavity. Presentation of case We present a case of a 16-year-old Saudi Arabian male who came to the emergency department with right upper quadrant pain associated with difficulty in passing stool for one day and a history of congenital diaphragmatic hernia (CDH) repair at the age of 4 months. Free fluid in the abdomen was noticed in the bedside ultrasound. Abdominopelvic computed tomography revealed dilated small bowel loops and a whirl sign of the mesentery, which indicated intestinal torsion. The patient was treated using Ladd’s procedure, and a large volume of chylous fluid was removed from the abdomen. Postoperatively, the abdominal drain revealed no chyle, and the patient was followed-up as an outpatient at which point, he reported no abdominal pain. Discussion Intestinal malrotation is more commonly reported in children and associated with congenital chylous ascites. Chylous ascites by itself is a rare occurrence, and very few cases attribute it to intestinal malrotation in adults. Surgical management with Ladd’s procedure is a well-documented surgery in pediatric patients, and yet it was successfully performed in our adolescent patient. Conclusion Surgical management of chylous ascites secondary to intestinal malrotation in an adolescent, which is considered novel in this age group, including peritoneal lavage of chyle, resulted in favorable outcomes.

During the ongoing coronavirus disease 2019 pandemic, over 1.5 billion students worldwide have been deprived of access to traditional learning. This situation has necessitated the use of social distancing-based educational methods; consequently, a tremendous shift towards e-learning has been observed. This study assesses medical students' social anxiety levels in e-learning environments. The study was conducted in two phases. In the first phase, the original Turkish Social Anxiety Scale for E-Learning Environments (SASE) was adapted in English and tested for validity and reliability. This instrument has two subscales: social anxiety in learner-learner interaction and in learner-instructor interaction. In the second stage, we explored the associations of gender, age, and perceived academic performance with medical students' social anxiety levels in e-learning environments. A total of 325 responses were analysed. Consistent with the original version, the adapted scale is a reliable and valid measure of social anxiety in e-learning. Social anxiety in e-learning was related to gender (p = 0.008) and age (p = 0.013). Social anxiety levels were higher in students with lower perceived performance during e-learning compared to students with enhanced performance, but the difference was not significant. The SASE is a useful instrument for evaluating social anxiety in e-learning environments across English educational frameworks. Considering the shift in social interaction environments, efforts are required to reduce medical students' social anxiety levels and enhance learning.

Background The Kingdom of Saudi Arabia (KSA) was the first country in the Middle East to adopt the hepatitis B virus (HBV) vaccine. Despite an expanded HBV immunization program and significant progress in HBV prevention in the country, HBV infection is a significant public health burden. This review lists coordinated solutions for healthcare stakeholders, patients, and health authorities to curb HBV and its impact in KSA. It further aims to draw policymakers' attention to key priorities to bridge HBV care gaps in the country. Methods As part of the pre-engagement activity, medical experts across KSA were interviewed to gain a preliminary understanding of the current unmet needs in HBV management in the country. Top-recommended action points derived from the pre-engagement activity were discussed. Key priority action points to curb the impact of HBV in KSA were identified. Results The priority action points together with the challenges and unmet needs in the management and care of HBV in KSA were: (a) establish a national-level registry, (b) implement screening campaigns, (c) improve linkage of care between primary care physicians (PCPs) and specialists, and (d) increase PCP education and awareness. Conclusion This work is an endeavor to set the stage for a strategic policy framework aimed at eliminating HBV in KSA. The action points/steps for the identified priorities must run parallelly across various regions in KSA, to successfully manage and further eliminate the threat of HBV.

Background: Ambient temperature is predicted to rise in Saudi Arabia, and how this will impact the health of its population has not been investigated. Saudi Arabia is one of the top ten countries with the highest prevalence of diabetes. The current study investigates the correlation between ambient temperature and HbA1c levels in a group of Saudis in Riyadh. Methods: Age, gender, and HbA1c data for six years were obtained from patients’ records. The maximum daily temperature of Riyadh city for the same period was obtained. Results: A total of 168,614 patient records were obtained. There was a statistically significant positive correlation between ambient temperature and HbA1c levels, where for each 1°C increase in average weekly temperature HbA1c increased by 0.007%. Patients were at higher risk of having HbA1c ≥ 7% in high and moderate temperature than in low temperature (P < 0.001, odds ratio (OR): 1.134, and P < 0.001, odds ratio (OR): 1.034; respectively). The mean of HbA1c in females (7.27±1.96) was significantly lower than in males (7.40±1.86), and the probability of males having HbA1c ≥ 7% was about 17.4% higher than females. However, the HbA1c levels in females were significantly more affected by rising temperature compared to males (B = 0.003, P = 0.008). Conclusion: Overall, rise in ambient temperature is associated with worsening HbA1c, which could be harmful to the health of Saudis suffering from diabetes. Possible reasons for the increase in HbA1c could include reduced physical activity, reduced sunlight exposure, and dehydration during hot weather. More research on the relationship between climate change and public health in Saudi Arabia is needed.

Hydrogen sulfide (H2S) and nitric oxide (NO) have been known to affect vast number of processes in plants under abiotic stresses. Also, calcium (Ca) works as a second messenger in plants, which underpins the abiotic stress-induced damage. However, the sequence of action of these signaling molecules against cadmium (Cd)-induced cellular oxidative damage remains unidentified. Therefore, we studied the synergistic actions and/or relationship of signaling molecules and Ca-dependent activation of tolerance mechanisms in Vigna radiata seedlings under Cd stress. The present study shows that exogenous Ca supplemented to Cd-stressed V. radiata seedlings reduced Cd accumulation and improved the activity of nitrate reductase, and L/D-cysteine desulfhydrase (LCD/DCD) that resulted in improved synthesis of NO and H2S content. Application of Ca also elevated the level of cysteine (Cys) by upregulating the activity of Cys-synthesizing enzymes serine acetyltransferase and O-acetylserine(thiol)lyase in Cd-stressed seedlings. Maintenance of Cys pool under Cd stress contributed to improved H2S content which together with Ca and NO improved antioxidant enzymes and components of ascorbate-glutathione (AsA-GSH) cycle. All these collectively regulated the activity of NADPH oxidase and glycolate oxidase, resulting in the inhibition of Cd-induced generation of reactive oxygen species. The elevated level of Cys also assisted the Cd-stressed seedlings in maintaining GSH pool which retained normal functioning of AsA-GSH cycle and led to enhanced content of phytochelatins coupled with reduced Cd content. The positive effect of these events manifested in an enhanced rate of photosynthesis, carbohydrate accumulation, and growth attributes of the plants. On the contrary, addition of NO scavenger cPTIO [2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide], H2S scavenger HT (Hypotaurine) and Ca-chelator EGTA (Ethylene glycol-bis(b-aminoethylether)-N,N,N',N'-tetraacetic acid) again developed a condition similar to stress and positive effect of the signaling molecules was abolished. The findings of the study postulate that Ca in association with NO and H2S mitigates Cd-induced impairment and enhances the tolerance of the V. radiata plants against Cd stress. The results of the study also substantiate that Ca acts both upstream as well as downstream of NO signals whereas, H2S acts downstream of Ca and NO during Cd-stress responses of the plants.

Background: Glycated haemoglobin (HbA1c) is the gold standard measurement in the screening, diagnosis and monitoring of diabetes mellitus. Saudi Arabia has a high prevalence of diabetes mellitus that is expected to rise, and the HbA1c test is commonly used in the screening, diagnosis and monitoring of diabetes. Objective: This study aims to assess the impact of age and gender on HbA1c levels, and the influence of menopausal status on HbA1c variation in a large group of Saudis. Method: Age, gender, and HbA1c results of 168,614 Saudi adult individuals were obtained from their medical records. Patients’ records were extracted irrespective of their status regarding the presence of diabetes and the status of glycaemic control. Linear regression models were used for predicting HbA1c from age and gender, and their interaction term. HbA1c levels were compared between genders in different age groups and different HbA1c categories. Results: There was a statistically significant positive correlation between age and HbA1c levels, where for each ten years increase in age, HbA1c increased by 0.35%. Although the overall mean HbA1c in women was significantly lower than in men (P < 0.001), women showed a significant increase in HbA1c with older age compared to men (B = 0.014, P < 0.001). Furthermore, the mean HbA1c levels in the age group > 50 years was significantly higher than before that age (P < 0.001). Thus, HbA1c increased by 1.118% in age > 50 years group compared to age ≤ 50 years, and this increase in HbA1c was significantly higher in women compared to men (B = 0.495, P < 0.001). Conclusion: HbA1c levels are lower in women before the estimated menopausal age, which should be taken into consideration when using HbA1c for screening, diagnosis, and monitoring of diabetes in Saudi adult women. The short lifespan of red blood cells, due to loss of blood through menstruation, in women before menopause age, is a possible reason for these variations.

Background/Aims: Ledipasvir/sofosbuvir (LDV/SOF) combination is administered for 12 to 24 weeks to treat hepatitis C virus (HCV); guidelines recommend 8 weeks treatment duration for HCV genotype (GT) 1 infection based on the patient's baseline characteristics. Data on treating HCV GT4 with LDV/SOF are limited. In this prospective cohort study, the efficacy and safety of 8 weeks treatment duration with LDV/SOF was evaluated in HCV GT4 patients in Saudi Arabia. Patients and Methods: Treatment-naïve, non-cirrhotic HCV GT4 patients received LDV/SOF for 8 weeks. HCV RNA levels and laboratory evaluations were recorded at baseline and at Weeks 4, 8, and 20. The primary endpoint was sustained virologic response 12 weeks after the end of the treatment (SVR12). Safety data were also recorded. Results: Forty-five patients with a mean age of 43.9 ± 17.2 years participated, of whom 57.8% were male. Mean log10 HCV RNA was 6.26 ± 6.32 IU/mL and most (91.1%) had baseline HCV RNA levels

In this study, we aimed to review scientific studies and research to present a view of artificial intelligence in education to achieve sustainable development in accordance with the foundations of the Kingdom’s Vision 2030. We conducted a systematic review of previous literature by extrapolating and analyzing 17 previous studies published from 2018 to 2020. We found that the application of artificial intelligence has proven effective in improving and developing education, simplifying basic teaching tasks, assisting managers of educational institutions, and contributing to solving problems and challenges faced by the education sector.

Summary Limited clinical trial data has shown high efficacy of co-formulated ledipasvir/sofosbuvir (LDV/SOF) in the treatment of hepatitis C virus (HCV) genotype (GT)-4 infected cirrhotic patients. We assessed real-world safety and efficacy of LDV/SOF with or without ribavirin (RBV) in GT4-infected patients with compensated and decompensated cirrhosis. Patients & Methods This observational cohort (n = 213) included GT4 treatment-naive (59.6%) and -experienced (40.4%) patients with advanced fibrosis (F3, Metavir; n = 30), compensated (F4, n = 135) and decompensated cirrhosis (n = 48) treated for 12 (n = 202) or 24 weeks (n = 11) with LDV/SOF. RBV was dosed by physician discretion between 600–1200 mg daily. Patients with prior DAA failure were excluded from the analysis. The primary efficacy endpoint was sustained virologic response 12 weeks after treatment (SVR12) on an intention-to-treat analysis, and occurrence of serious adverse events (SAEs). Results The mean age of the overall cohort was 59.6 ± 12.1 years and 125 (58.7) were female. Overall, 197 (92.5%) of the patients achieved SVR12, including 93.3% of F3 fibrosis, 93.3% of compensated cirrhotics and 89.6% of the decompensated cirrhotics ( P = 0.686). Addition of RBV (68.5%) did not enhance efficacy (91.8% vs. 94.0% without RBV, P = 0.563), including in F3 fibrosis, compensated and decompensated cirrhosis ( P > 0.05, for all). There was no difference in SVR12 rates with 24 and 12 weeks therapy (90.9% and 92.6%, respectively; P = 0.586). Treatment failure (n = 16) was mostly related to relapse (n = 11), while on-treatment death (n = 3) and breakthrough (n = 2) comprised a minority. SAEs occurred in 9 (4.2%) patients requiring early treatment discontinuation in 4 (3 on-treatment deaths and 1 pregnancy). Conclusion LDV/SOF therapy yielded high SVR12 rates in both compensated and decompensated cirrhotic GT4 patients. The addition of RBV to this regimen did not improve efficacy. The safety profile of this regimen was comparable with that reported for other HCV genotypes.

BACKGROUND & AIMS Limited data have shown high efficacy of co-formulated ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) in the treatment of hepatitis C virus (HCV) genotype (GT)-4, and combined with dasabuvir (DSV) in GT1 patients, with chronic kidney disease (CKD) stages 4-5 (

Autophagy is a key metabolic process where cells can recycle its proteins and organelles to regenerate its own cellular building blocks. Chemotherapy is indispensable for cancer treatment but associated with various side-effects, including organ damage. Stem cell-based therapy is a promising approach for reducing chemotherapeutic side effects, however, one of its main culprits is the poor survival of transplanted stem cells in damaged tissues. Here, we aimed to test the effects of activating autophagy in adipose-derived mesenchymal stem/stromal cells (ADSCs) on the survival of ADSCs, and their therapeutic value in cisplatin-induced liver injury model. Autophagy was activated in ADSCs by rapamycin (50 nM/L) for two hours before transplantation and were compared to non-preconditioned ADSCs. Rapamycin preconditioning resulted in activated autophagy and improved survival of ADSCs achieved by increased autophagosomes, upregulated autophagy-specific LC3-II gene, decreased protein degradation/ubiquitination by downregulated p62 gene, downregulated mTOR gene, and finally, upregulated antiapoptotic BCL-2 gene. In addition, autophagic ADSCs transplantation in the cisplatin liver injury model, liver biochemical parameters (AST, ALT and albumin), lipid peroxidation (MDA), antioxidant profile (SOD and GPX) and histopathological picture were improved, approaching near-normal conditions. These promising autophagic ADSCs effects were achieved by modulation of components in TGF-β1/Smad and PI3K-AKT signaling pathways, besides reducing NF-κB gene expression (marker for inflammation), reducing TGF-β1 levels (marker for fibrosis) and increasing SDF-1 levels (liver regeneration marker) in liver. Therefore, current results highlight the importance of autophagy in augmenting the therapeutic potential of stem cell therapy in alleviating cisplatin-associated liver damage and opens the path for improved cell-based therapies, in general, and with chemotherapeutics, in particular.

Ambient temperature is predicted to rise in Saudi Arabia, and how this will impact the health of its population has not been investigated. Saudi Arabia is one of the top ten countries with the highest prevalence of diabetes. The current study investigates the correlation between ambient temperature and HbA1c levels in a group of Saudis in Riyadh. Age, gender, and HbA1c data for six years were obtained from patients’ records. The maximum daily temperature of Riyadh city for the same period were obtained. A total of 168,614 patient records were obtained. There was a statistically significant positive correlation between ambient temperature and HbA1c levels, where for each 1°C increase in average weekly temperature HbA1c increased by 0.007%. Patients were at high risk of having HbA1c ≥ 7% in high and moderate temperature than in low temperature (P < 0.001, odds ratio (OR): 1.134, and P < 0.001, odds ratio (OR): 1.034; respectively). The mean of HbA1c in females (7.27 ± 1.96) was significantly lower than in males (7.40 ± 1.86), and the probability of males having HbA1c ≥ 7% was about 17.4% higher than females. However, the HbA1c levels in females were significantly more affected by rising temperature compared to males (B = 0.003, P = 0.008). Overall, rise in ambient temperature is associated with worsening HbA1c, which could be harmful to the health of Saudis suffering from diabetes. Possible reasons for the increase in HbA1c could include reduced physical activity, reduced sunlight exposure, and dehydration during hot weather. More research on the relationship between climate change and public health in Saudi Arabia is needed. Funding Statement: This study is a part of the PhD research project of Abdullah S. Alghamdi who is supported and funded by the General Directorate of Medical Services of the Interior Ministry in Saudi Arabia. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Ethical approvals were obtained from De Montfort University (Faculty of Health and Life Sciences Research Ethics Committee) and Security Forces Hospital (Riyadh, Saudi Arabia). All obtained data were performed in accordance with relevant guidelines and regulations.

Background The aim of this study was to evaluate the surface treatment of dentin with phototherapy (ER-CR-YSGG laser) in the presence of different bonding systems on their shear bond strength and microleakage. Materials and methods Eighty intact human third molars were divided into two groups. Forty teeth were treated with conventional flat wheel diamond bur and the remaining forty were treated with Er Cr YSGG laser (phototherapy). The two groups i.e. treated with laser (l) and group treated with abrasive bur (NL) were further divided into two subgroups of twenty samples each. Subgroup 1 was surface treated with etch and rinse (ER) and other 20 remaining samples were treated with self- etch (SE) bonding regime. Specimens from all the groups were assessed for shear bond strength and microleakage scores. Ten samples from all groups were immersed in 2% methylene blue for 24 h and assessed under a digital microscope for microleakage. Data was assessed using analysis of variance and tukey multiple comparisons test. Results The lowest bond strength was achieved in laser prepared phototherapy group bonded with self-etch (LSE-11.87 ± 1.21). The maximum bond strength score was observed in non-laser-etch and rinse group (NLER-23.66 ± 2.56). The highest mean microleakage was observed among laser bonded with self-etch (LSE) specimens (1.0 ± 0.13). The lowest microleakage scores were seen in group treated with non-phototherapy etch and rinse (NLER-0.4 ± 0.11) regime. Conclusion Use of etch and rinse dentin bonding regime in combination with ER-CR-YSGG phototherapy dentin treatment has the potential for clinical application in comparison to conventional conditioning technique.

The Web has become a tremendously huge data source hidden under linked documents. A significant number of Web documents include HTML tables generated dynamically from relational databases. Often, there is no direct public access to the databases themselves. On the other hand, RDF (Resource Description Framework) gives an efficient mechanism to represent directly data on the Web based on a Web-scalable architecture for identification and interpretation of terms. This leads to the concept of Linked Data on the Web. To allow direct access to data on the Web as Linked Data, we propose in this paper an approach to transform HTML tables into RDF triples. It consists of three main phases: refining, pre-treatment and mapping. The whole process is assisted by a domain ontology and the WordNet lexical database. A tool called Htab2RDF has been implemented. Experiments have been carried out to evaluate and show efficiency of the proposed approach.

Background/Aims: Around 101,000 individuals are estimated to be viremic for chronic hepatitis C virus (HCV) in the Kingdom of Saudi Arabia (KSA) in 2014; however, only about 20% have been diagnosed. We aim to assess baseline epidemiology, disease burden, and evaluate strategies to eliminate HCV in KSA. Materials and Methods: The infected population and disease progression were modeled using age- and gender-defined cohorts to track HCV incidence, prevalence, hepatic complications, and mortality. Baseline assumptions and transition probabilities were extracted from the literature. The impacts of two scenarios on HCV-related disease burden were considered through increases in treatment efficacy alone or treatment and diagnosis. Results: In 2030, it is estimated by the base scenario that viremic prevalence will increase to 103,000 cases, hepatocellular carcinoma (HCC) to 470, decompensated and compensated cirrhosis cases to 1,300 and 15,400, respectively, and liver-related mortality to 670 deaths. Using high efficacy treatment alone resulted in 2030 projection of 80,700 viremic cases, 350 HCC cases, 480 liver-related deaths, and 850 and 11,500 decompensated and compensated cirrhosis cases, respectively. With an aggressive treatment strategy, in 2030 there will be about 1,700 viremic cases, 1 HCC case, about 20 liver-related deaths, and 5 and 130 cases of decompensated and compensated cirrhosis, respectively. Delaying this strategy by one year would result in 360 additional deaths by 2030. Conclusions: HCV in KSA remains constant, and cases of advanced liver disease and mortality continue to rise. Considered increases in treatment efficacy and number treated would have a significantly greater impact than increased treatment efficacy alone. The projected impact will facilitate disease forecasting, resource planning, and strategies for HCV management. Increased screening and diagnosis would likely be required as part of a national strategy.

Quality of service (QoS)-adaptive service configuration is crucial for seamless access to video services in cloud-assisted video surveillance systems. To maintain seamless access to video on a user's preferred device, suitable video transcoding services are needed. It is a challenging task to choose and configure these services for various devices to ensure QoS-adaptive user experiences. To configure these services for the desired user devices, a suitable configuration algorithm is needed. Therefore, this paper describes a QoS-adaptive service configuration approach to choose the optimal configuration for the preferred user devices in varied contexts so that the user can access the services ubiquitously. We implemented a cloud-assisted video surveillance prototype to show how the proposed method can handle ubiquitous access to target video for possible QoS-adaptive and video processing requirements in terms of bandwidth, delay, and frame rates. The results show that the proposed configuration method outperforms the other comparable approaches.