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OBJECTIVE: To review new drugs and devices relevant to otolaryngology approved by the Food and Drug Administration (FDA) in 2022. DATA SOURCES: Publicly available FDA data on drugs and devices approved in 2022. REVIEW METHODS: A preliminary screen was conducted to identify drugs and devices relevant to otolaryngology. A secondary screen by members of the American Academy of Otolaryngology-Head and Neck Surgerys (AAO-HNS) Medical Devices and Drugs Committee differentiated between minor updates and new approvals. The final list of drugs and devices was sent to members of each subspecialty for review and analysis. CONCLUSION: A total of 1251 devices and 37 drugs were identified on preliminary screening. Of these, 329 devices and 5 drugs were sent to subspecialists for further review, from which 37 devices and 2 novel drugs were selected for further analysis. The newly approved devices spanned all subspecialties within otolaryngology. Many of the newly approved devices aimed to enhance patient experience, including over-the-counter hearing aids, sleep monitoring devices, and refined CPAP devices. Other advances aimed to improve surgical access, convenience, or comfort in the operating room and clinic. IMPLICATIONS FOR PRACTICE: Many new devices and drugs are approved each year to improve patient care and care delivery. By staying up to date with these advances, otolaryngologists can leverage new innovations to improve the safety and quality of care. Given the recent approval of these devices, further studies are needed to assess long-term impact within the field of otolaryngology.

Introduction: This cross-sectional study investigates the prevalence of knowledge and awareness of Helicobacter pylori (H. pylori) infection among the urban population of the Kingdom of Saudi Arabia (KSA). The study is motivated by the need to understand the specific demographic segments within the urban setting and their awareness levels of this prevalent bacterial infection affecting the digestive system. Methodology: The cross-sectional study, employing a purposive sampling method and involving 840 participants from major cities in the KSA, utilized a structured survey questionnaire to gather data on demographic factors, awareness levels, attitudes, and experiences related to H. pylori infection, with subsequent statistical analysis and adherence to ethical guidelines for participant confidentiality and privacy protection. Result: The study involved 840 participants from major cities, revealing that 59.16 ​% were aware of H. pylori. Demographic variations included higher participation from Jeddah and Riyadh, with the majority being females aged 18–25, Saudi nationals, and individuals with undergraduate education. About 57.02 ​% reported experiencing suspected H. pylori symptoms, and 49.16 ​% had prior infections, with varying severity. Hesitancy toward screening (42.61 ​%), but 72.97 ​% believed in preventability. Limited awareness of treatments (15.35 ​%) and identification of factors like water and food were noted. Participants perceived the seriousness of H. pylori in the mid-range (5–7). Conclusion: The findings shed light on variations in awareness, knowledge gaps, and attitudes, emphasizing the need for targeted public health interventions, educational campaigns, and policy measures to address the challenges associated with H. pylori infections in urban areas.

Background: The global healthcare system faces challenges in diagnosing and managing lung and colon cancers, which are significant health burdens. Traditional diagnostic methods are inefficient and prone to errors, while data privacy and security concerns persist. Objective: This study aims to develop a secure and transparent framework for remote consultation and classification of lung and colon cancer, leveraging blockchain technology and Microsoft Azure cloud services. Dataset and Features: The framework utilizes the LC25000 dataset, containing 25,000 histopathological images, for training and evaluating advanced machine learning models. Key features include secure data upload, anonymization, encryption, and controlled access via blockchain and Azure services. Methods: The proposed framework integrates Microsoft Azure’s cloud services with a permissioned blockchain network. Patients upload CT scans through a mobile app, which are then preprocessed, anonymized, and stored securely in Azure Blob Storage. Blockchain smart contracts manage data access, ensuring only authorized specialists can retrieve and analyze the scans. Azure Machine Learning is used to train and deploy state-of-the-art machine learning models for cancer classification. Evaluation Metrics: The framework’s performance is evaluated using metrics such as accuracy, precision, recall, and F1-score, demonstrating the effectiveness of the integrated approach in enhancing diagnostic accuracy and data security. Results: The proposed framework achieves an impressive accuracy of 100% for lung and colon cancer classification using DenseNet, ResNet50, and MobileNet models with different split ratios (70–30, 80–20, 90–10). The F1-score and k-fold cross-validation accuracy (5-fold and 10-fold) also demonstrate exceptional performance, with values exceeding 99.9%. Real-time notifications and secure remote consultations enhance the efficiency and transparency of the diagnostic process, contributing to better patient outcomes and streamlined cancer care management.

Abstract Background Surgical safety remains a critical global health concern, with complications from surgical procedures resulting in significant morbidity and mortality, particularly in low- and middle-income countries. The World Health Organization (WHO) Surgical Safety Checklist (SSC) has been shown to reduce surgical complications and mortality rates. However, its implementation and impact in resource-limited settings like Somalia remain understudied. This study aimed to evaluate the implementation of the WHO SSC in selected hospitals in Mogadishu, Somalia, and assess its impact on surgical safety practices. Methods A pre- and post-intervention study was conducted in 15 randomly selected hospitals in Mogadishu, Somalia. The intervention involved a comprehensive training program on the WHO SSC for surgical teams. Data on hospital characteristics, surgical details, and adherence to the SSC were collected over two periods: pre-intervention (April 12th to May 4th, 2024) and post-intervention (May 12th to June 3rd, 2024). The primary outcome was the adherence to the SSC, categorized as good (> 60%) or poor (≤ 60%). Descriptive statistics, McNemar’s test, and binary logistic regression were used for data analysis. Results Adherence to the WHO SSC significantly improved post-intervention, with 98.8% of surgical cases demonstrating good adherence compared to 37% pre-intervention (p

Abstract Background Echinococcosis, or hydatid disease, is caused by the larval forms of taeniid cestodes belonging to the genus Echinococcus. Echinococcus granulosus and E. multilocularis are the primary species responsible for human echinococcosis, and mostly they affect the liver. The disease course is typically slow, and the patients tend to remain asymptomatic for many years. Case presentation A case of 19-year-old male Somali from Medina, Saudi Arabia, was presented to the Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital with the complaint of right upper quadrant abdominal pain and dysuria for 1 month. A thorough physical examination, laboratory examination, and imaging investigations, including abdominal sonography and computed tomography (CT), were conducted. Both ultrasound and CT scans revealed a cystic lesion in the right lobe of the liver, confirming the diagnosis of a hydatid cyst. Consequently, the patient underwent exploratory laparotomy. It was successfully managed surgically, and the definitive diagnosis was provided by the pathologist, confirming degenerated echinococcal cysts that contain abundant debris. Additionally, the patient received oral albendazole both before and after the surgery and after 7 months and is currently symptom-free. Conclusions Hydatid disease in the liver may persist without symptoms and often goes undiagnosed due to the slow growth of the cysts. The diagnosis needs careful history reporting, physical examination, and appropriate imaging investigations.

Abstract In recent years, the proliferation of Massive Open Online Courses (MOOC) platforms on a global scale has been remarkable. Learners can now meet their learning demands with the help of MOOC. However, learners might not understand the course material well if they have access to a lot of information due to their inadequate expertise and cognitive ability. Personalized Recommender Systems (RSs), a cutting-edge technology, can assist in addressing this issue. It greatly increases resource acquisition through personalized availability for various people of all ages. Intelligent learning methods, such as machine learning and Reinforcement Learning (RL) can be used in RS challenges. However, machine learning needs supervised data and classical RL is not suitable for multi-task recommendations in online learning platforms. To address these challenges, the proposed framework integrates a Deep Reinforcement Learning (DRL) and multi-agent approach. This adaptive system personalizes the learning experience by considering key factors such as learner sentiments, learning style, preferences, competency, and adaptive difficulty levels. We formulate the interactive RS problem using a DRL-based Actor-Critic model named DRR, treating recommendations as a sequential decision-making process. The DRR enables the system to provide top-N course recommendations and personalized learning paths, enriching the student's experience. Extensive experiments on a MOOC dataset such as the 100 K Coursera course review validate the proposed DRR model, demonstrating its superiority over baseline models in major evaluation metrics for long-term recommendations. The outcomes of this research contribute to the field of e-learning technology, guiding the design and implementation of course RSs, to facilitate personalized and relevant recommendations for online learning students.

Abstract This study assessed the radioactivity levels and associated risks in the black sand-separated products obtained from the black sand separation plant in Delta, Egypt. A total of sixteen samples were taken from hot spots during and after the separation process. These include water samples and other samples that represent monazite, rutile, zircon, granite, ilmenite, and silica products. The hot spots included the area where the ore was stored. The activity concentrations of $$^{232}Th$$ 232 T h , $$^{226}Ra$$ 226 R a , and $$^{40}K$$ 40 K were determined in these samples using a p-type HPGe detector. Based on gamma spectrometric analysis, samples of rutile, zircon, and monazite had the highest amounts of radioactivity because they contained the highest NORM’s activity concentrations. In addition, it indicated that the radiological hazard indices of the collected samples were higher than the average world limits for sand texture. These findings suggest that the black sand separation process reveals potential risks to human health and the environment, and therefore, appropriate measures need to be taken to mitigate these risks, especially for the safety of the workers on-site. Reducing the risk associated with those sites should be controlled by implementing the recommendations declared for the series of International Basic Safety Standards of the International Atomic Energy Agency (GSR) Part 3, as affirmed in Document No. 103 of 2007 by the International Commission on Radiological Protection (ICRP) as will be presented in the paper body.

Background: A low COVID-19 vaccination rate has been observed in some countries. Misinformation regarding COVID-19 vaccines is commonly available on social media. This study aims to conduct an empirical, in-depth analysis of the digital space, particularly misinformation regarding COVID-19 vaccines across social media, including socio-demographic factors on COVID-19 vaccine hesitancy. This provides opportunities to set policies to properly utilize social media in public health and vaccination. Methods: A web-based questionnaire was administered to elicit responses from social media users ages 15 years and older. Data regarding the level of social media usage, attitudes toward information on social media, and COVID-19 vaccines were collected. Results: A total of 2231 people completed the questionnaire. The majority of the participants were concerned about the negative consequences of taking COVID-19 vaccines, but they had more confidence in the aspects of vaccine safety, importance, and effectiveness. Social media is not considered a credible channel to disseminate information about COVID-19, its vaccination, and its consequences, with females expressing a higher level of distrust. People who are spending more time using social media tend not to believe in vaccination in terms of safety and importance. Conclusions: Social media has played a negative role and led to vaccine hesitancy among the public, especially young people. Public health institutions should establish health education initiatives using both traditional and social media platforms to immunize the public against misinformation.

Background: Anal fistula, which causes periodic swelling and pain in the perianal area followed by spontaneous leakage, is an abnormal connection between the anal canal and the perianal skin. The majority are connected to the development of abscesses, with a perianal fistula existing at the time of presentation in one-third of patients with an anorectal abscess. Objectives: to determine the safety and efficacy of the Ligation of Intersphicteric Fistulous Tract operation (LIFT) in comparison with fistulotomy. Patients and methods: On 60 patients with low trans-sphincteric perianal fistulas, this prospective, randomized comparative research was done at the General Surgery Department of Qena Faculty of Medicine. Patients were split into two groups: Group (A): 30 patients underwent LIFT techniques. Group (B): 30 patients underwent fistulotomy. The duration of the study ranged between 6-12 months, Results: Body Mass Index (BMI) was statistically substantial greater in patients treated by LIFT than those treated by fistulotomy. While pain score and healing time were statistically substantial lower in patients treated by LIFT than those treated by fistulotomy. There is no statistically substantial variation between patients treated by fistulotomy and LIFT as regard the development of complications as recurrence or incontinence. Conclusion: In comparison to open fistulotomy, the LIFT operation is a successful and preferred sphincter-saving method for fistula-in-ano, with a quicker healing period and a decreased frequency of postoperative anal leakage.

To advance defense interoperability, foster productive collaboration, and enhance the capabilities of defense systems to respond to evolving threats, it is imperative to tackle the challenges of defensive strategic issues in Network security. That is why an experimental study was done to assess the application of the interoperability defense theory to an operational target network system. The study used five strategies, including “Risk,” “Complexity,”Dependency,” “Personnel,” and “Environment,” and employed DEMATEL and performance analysis evaluation. These five defense techniques to interoperability are conceptualized. The experimental results revealed that network defense, instead of being consistently passive, is the recipient of influence in an interoperable defensive system. Interoperability protective strategies have varying degrees of influence on network security evaluations. A significant relationship was observed between the level of technological complexity and the ability to tolerate its significant effects. Within the complexity group, further analysis showed a noteworthy reduction in “Risk”. However, there were no significant variations in “ Environment” before and after the interoperable implementation. Finally, the DEMATEL analysis indicates that the entire variables are effect criteria no cause criteria. Given that all criteria are categorized as “effect” and none as “cause,” it suggests a scenario in which each criterion is interconnected and influenced by other criteria within the system, but none of them serve as direct influencers or causes. Therefore, this study contributes to the evaluation of interoperability in strategic network security defense.

This study explores the feasibility of employing (U, Th)-based accident tolerant fuels (ATFs), specifically (0.8UO2, 0.2ThO2), (0.8UN, 0.2ThN), and (0.8UC, 0.2ThC). The investigation assesses the overall performance of these proposed fuel materials in comparison to the conventional UO2, focusing on deep neutronic and thermal-hydraulic (Th) analyses. Neutronic analysis utilized the MCNPX code, while COMSOL Multiphysics was employed for thermal-hydraulic analysis. The primary objective of this research is to overcome the limitations associated with traditional UO2 fuel by exploring alternative fuel materials that offer advantages in terms of abundance and potential improvements in performance and safety. Given the limited abundance of UO2, long-term sustainable nuclear energy production faces challenges. From a neutronic standpoint, the U–Th based fuels demonstrated remarkable fuel cycle lengths, except (0.8UN, 0.2ThN), which exhibited the minimum fuel cycle length and, consequently, the lowest fuel burn-up. Regarding thermal-hydraulic performance, (0.8UN, 0.2ThN) exhibited outstanding performance with significant margins against fuel melting compared to the other materials. Overall, when considering the integrated performance, the most favourable results were obtained with the use of the (0.8UC, 0.2ThC) fuel configurations. This study contributes valuable insights into the potential benefits of (U, Th)-based ATFs as a promising avenue for enhanced nuclear fuel performance.

Abstract Background Iatrogenic portal vein (PV) injuries following pleural drainage catheter (PDC) insertion are rare but life-threatening. This case report emphasizes the importance of prompt recognition and effective interventional radiology (IR) management. Case presentation A 38-year-old Asian male, admitted for a non-ST-segment elevation myocardial infarction, suffered a critical PV injury during PDC insertion, leading to rapid clinical deterioration. The IR team conducted a portogram, retrieved the catheter, and successfully executed an embolization procedure. The patient's recovery, confirmed through imaging and improving liver function tests, enabled discharge with follow-up instructions. Conclusions This case highlights the clinical significance of promptly recognizing and effectively managing iatrogenic PV injuries during PDC insertion, with the pivotal role of IR. Collaboration between IR and surgical teams is crucial for optimizing patient outcomes.

هدفت الدراسة إلى تحديد أثر الثقافة التنظيمية في الإبداع الإداري لدى القيادات الأكاديمية والإدارية في الجامعات الأهلية بأمانة العاصمة صنعاء، واستخدمت المنهج الوصفي التحليلي لتحقيق أهداف الدراسة واختبار فرضياتها، وتكون مجتمع الدراسة من (40 جامعة أهلية) تم الاختيار منها (4) جامعات، ونظراً لصغر حجم مجتمع الدراسة فقد تم اعتماد أسلوب الحصر الشامل لتحديد عينة الدراسة التي شملت (249) قيادياً أكاديمياً وإدارياً. وبعد إجراء التحليل الإحصائي لعدد (233) استبانة باستخدام برنامج الحزمة الإحصائية للعلوم الاجتماعية (SPSS v.23)، توصلت الدراسة إلى نتائج أهمها؛ أن الثقافة التنظيمية تؤثر ايجاباً في الإبداع الإداري. كما اتضح أنه لا يوجد اختلاف دال احصائياً في مستوى الإبداع الإداري لدى القيادات الأكاديمية والإدارية في الجامعات محل الدراسة تُعزى لأي من المتغيرات الديموغرافية (الجنس، العُمر، المؤهل العلمي، سنوات الخدمة، نوع الوظيفة). وقدمت الدراسة عدد من التوصيات أهمها؛ تعزيز ونشر مفاهيم الثقافة التنظيمية والإبداع الإداري، وتوجيه الطقوس التنظيمية في الجامعات إلى ما من شأنه العمل على زيادة الإبداع الإداري في الجامعات. كما أوصت بالعمل بأبعاد الدراسة في الجامعات عموماً أو على مستوى كل جامعة. وكذلك أوصت الدراسة بالاستفادة من الإبداع الإداري المتوفر في الجامعات من أجل زيادة حل المشكلات التي تعيق عملية تحسين الأداء.

ABSTRACTBackground We hypothesized that adding nalbuphine to bupivacaine would prolong the duration of caudal epidural anaesthesia (CEA) in pediatric patients undergoing hypospadias repair surgery.Methods 60 children scheduled for elective hypospadias surgery under general anesthesia combined with CEA were divided into two equal groups: the control group received caudal bupivacaine 0.25% 1 ml/kg plus 2 ml normal saline. The Nalbuphine group received caudal bupivacaine 0.25% 1 ml/kg plus nalbuphine 0.1 mg/kg in 2 ml normal saline. Intraoperative and postoperative rescue analgesia was managed by giving intravenous paracetamol 15 mg/kg and/or 100mcg nalbuphine. The Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, and the Richmond AgitationSedation Scale (RASS) score were measured. Pre-operative and postoperative blood samples were collected for a subgroup of patients for cortisol analysis.Results The duration of postoperative analgesia was significantly longer in the nalbuphine group (p

ObjectiveTo evaluate new medical devices and drugs pertinent to otolaryngology-head and neck surgery that were approved by the Food and Drug Administration (FDA) in 2021.Data sourcesPublicly available FDA device and drug approvals from ENT (ear, nose, and throat), anesthesia, neurosurgery, plastic surgery, and general surgery FDA committees.Review methodsFDA device and therapeutic approvals were identified and reviewed by members of the American Academy of Otolaryngology-Head and Neck Surgery's Medical Devices and Drugs Committee. Two independent reviewers assessed the relevance of devices and drugs to otolaryngologists. Medical devices and drugs were then allocated to their respective subspecialty fields for critical review based on available scientific literature.ConclusionsThe Medical Devices and Drugs Committee reviewed 1153 devices and 52 novel drugs that received FDA approval in 2021 (67 ENT, 106 anesthesia, 618 general surgery and plastic surgery, 362 neurosurgery). Twenty-three devices and 1 therapeutic agent relevant to otolaryngology were included in the state of the art review. Advances spanned all subspecialties, including over-the-counter hearing aid options in otology, expanding treatment options for rhinitis in rhinology, innovative laser-safe endotracheal tubes in laryngology, novel facial rejuvenation and implant technology in facial plastic surgery, and advances in noninvasive and surgical treatment options for obstructive sleep apnea.Implications for practiceFDA approvals for new technology and pharmaceuticals present new opportunities across subspecialties in otolaryngology. Clinicians' nuanced understanding of the safety, advantages, and limitations of these innovations ensures ongoing progress in patient care.

Online teaching has globally become a part of the learning process and has been more well-established in developed countries. In developing countries, online teaching or e-Learning is not practiced or recognized officially by educational organizations and policymakers. On the other hand, it is well-known that computers and technology are the future; in such a case, the advancement of distance-learning or online learning is immensely remarkable. It has reduced teachers' and students' introversion concerning e-learning and technology and has provided a platform for learning new technologies and developing new skills. The recent COVID-19 lockdown impelled governments to start implementing E-learning in schools, which resulted in several challenges. This study attempts to analyze and interpret the challenges and potentials of implementing online learning by surveying through an online questionnaire using 'Google Forms' (N = 968) with responses from high school and primary school English teachers during the first week of March through the last week of April. The findings revealed that most teachers had negative perceptions of implementing e-learning for several reasons, including lack of essential facilities such as electricity, electronic devices, and the absence of required skills. The actual contributions of students and educators are also among the major obstacles. This research suggests introducing Information Communication Technology modules across media platforms and applications in the education departments, opening intensive courses for teachers, and developing educational facilities in the education departments and schools to overcome these limitations and challenges.