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Abstract Background Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse manifestations, which resembles a clinical challenge to be managed. Lupus nephritis is a life-threatening condition as about 10% of patients develop chronic kidney disease. Aim of the work To assess the role of resistive index (RI) as a noninvasive parameter in detecting renal affection in SLE patients. Results A case–control study included 3 matched groups: 30 patients, 15 SLE with no renal affection, and 15 SLE lupus nephritis patients, who were selected, diagnosed according to ACR criteria 2019 for SLE, beside 15 age- and gender-matched healthy controls without any risk factors of chronic diseases. Written informed consent was obtained from all the three groups, and the study was approved by ethical committee. There was a statistically significant increase in both SLEDAI and renal SLEDAI scores, serum BUN, creatinine, urinary pus cells, RBCs, casts and proteins, 24-h urinary proteins, and protein/creatinine ratio beside a statistically significant increase in both right and left resistive indices in the group of lupus nephritis than the other group. There was highly statistically significant difference between SLE without nephritis and SLE with nephritis regarding renal echogenicity. There was statistically significant positive correlation between average RI and SLEDAI, rSLEDAI, serum creatinine, BUN, 24-h urinary proteins, protein/creatinine ratio, and renal echogenicity. Relation between renal echogenicity and demographic, laboratory, and clinical data was highly statistically significant with rSLEDAI, serum creatinine, BUN, 24-h urinary proteins, and P/C ratio. Our study highlighted that the best cutoff point of Rt average RI to detect SLE with nephritis group was found > 0.68 with sensitivity of 86.7% and specificity of 100.0%, while the best cutoff point of left average RI to detect SLE with nephritis group was found > 0.7 with sensitivity of 80.0% and specificity of 100.0%. Conclusion Renal RI is a noninvasive technique that can be used for detection renal disease activity in SLE patients, together with renal parenchymal echogenicity by grayscale US.

Abstract Background Sudanese children with End-Stage Kidney Disease (ESKD) often show limited improvement in hemoglobin levels despite treatment with recombinant human erythropoietin (rHuEPO). This study aims to assess the response to rHuEPO therapy by analyzing β-globin mRNA expression and reticulocyte parameters. Additionally, it classifies anemia among Sudanese pediatric patients based on iron status, considering age and gender as biological markers for evaluating treatment response. Methods A prospective observational cohort study was conducted from January 2019 to February 2020 in Khartoum, Sudan, involving 45 anemic children aged 2 to 15 years diagnosed with ESKD. The treatment protocol included rHuEPO injections and maintenance hemodialysis. Laboratory assessments consisted of complete blood count (CBC), absolute reticulocyte count, ferritin, and transferrin measurements. β-globin mRNA expression was quantified using reverse transcription polymerase chain reaction (RT-PCR), and reticulocyte parameters, including Reticulocyte Hemoglobin Content (CHr), percentage of hypochromic reticulocytes (HYPO%), and Immature Reticulocyte Fraction (IRF), were measured via flow cytometry. Results Significant variations in hemoglobin levels were observed across different age groups (p = 0.011). Gender analysis revealed a significant association with IRF, showing a lower IRF in male patients (p = 0.017). However, there were no significant differences in hemoglobin levels between genders (p = 0.999). β-globin mRNA expression showed considerable variability, with a strong positive correlation with hemoglobin levels (r = 0.875, p

Abstract Background The current trial evaluated the midfacial gingival margin changes, volumetric, radiographic and clinical alterations 1-year following immediate implant placement with customized healing abutment (IIP + CHA) either solely, or in combination with xenograft (IIP + Bonegraft) or with connective tissue grafting (IIP + CTG) at sites with thin labial bone in the esthetic zone. Methods Thirty-nine non-restorable maxillary teeth indicated for extraction in the esthetic zone were included. Participants were randomly assigned into three equal group; IIP + Bonegraft (Control), IIP + CTG and IIP + CHA. Midfacial gingival margin changes(mm) as primary outcome, labial soft tissue contour change(mm), interdental tissue height changes and total volume(mm3) were assessed. Amount of bone labial to the implant and crestal bone level changes were also recorded. All outcomes were measured 1-year post-operative. Results The midfacial gingival margin changes demonstrated a significant difference (P ≤ 0.05) between the groups showing -0.98, -0.74 and -1.54 mm in sites treated with IIP + Bone graft, IIP + CTG and IIP + CHA respectively after1-year. While labial soft tissue contour change (mm), total volume (mm3) and distal interdental tissue height changes (mm) revealed a significant difference after one-year between the studied groups, yet mesial interdental tissue height changes showed no difference (P > 0.05). Both IIP + Bone graft and IIP + CHA groups revealed a significant positive correlation between the total volume loss (mm3) after 1 year and mid-facial gingival margin changes (P ≤ 0.05). However, no significant correlation was observed in the IIP + CTG group (P = 0.63). CBCT measurements showed a significant difference in crestal bone changes between the three groups (P ≤ 0.05), yet, there was no significant difference regarding mean amount of bone labial to the implant(P > 0.05). Conclusions This investigation suggests that the mere presence of CTG simultaneous with IIP in the anterior maxilla reduced the midfacial gingival margin alterations (mm), besides, CTG decreased the overall volume loss (mm3) by 5-folds compared to the other studied groups after one year. Meanwhile, using CHA alone with IIP failed to maintain the peri-implant soft tissues contour. Trial registration The current trial was retrospectively registered at Clinical trials.gov (ID: NCT05975515, Date: 27-July-2023).

Brain tumors are a significant health concern worldwide, necessitating accurate and timely diagnosis for effective treatment planning and management. However, conventional methods for brain tumor identification through medical imaging analysis often face challenges related to accuracy, efficiency, and privacy concerns. Current approaches may struggle with limited datasets, privacy regulations hindering data sharing, and the need for specialized expertise in interpreting medical images. Accurately identifying brain tumors is pivotal in diagnosis, treatment planning, and patient prognosis. This research proposes a novel approach for advancing brain tumor identification by integrating Synthetic Generative Adversarial Networks with federated convolutional neural Networks in medical imaging analysis. Federated-CNNs are a type of neural network architecture designed for federated learning scenarios. In federated learning, model training occurs locally on data distributed across multiple devices or institutions without exchanging raw data. Federated CNNs allow collaborative model training across these distributed datasets by aggregating local model updates rather than exchanging raw data. This approach ensures that sensitive data remain localized within each participating institution, thus addressing privacy concerns in medical imaging analysis. Our methodology harnesses the power of GANs to generate synthetic brain MRI images, addressing data scarcity issues commonly encountered in medical imaging datasets. These synthetic images are then utilized in conjunction with Federated-CNNs, enabling cooperative model training between many healthcare institutions while maintaining the anonymity and privacy of data. Moreover, integrating Federated CNNs ensures that sensitive medical imaging data remain localized within participating institutions, addressing data privacy concerns and fostering collaboration among medical professionals. The research advances medical imaging analysis by introducing a novel methodology that leverages existing technologies to improve brain tumor identification accuracy. Specifically, the feature extraction phase using DenseNet121, implemented in MATLAB, achieves an outstanding accuracy of 99.82 % and outperforms Various existing methods, including Inception-V3, ResNet-18, and GoogleNet, demonstrating the efficacy of our approach in capturing discriminative features from medical imaging data. This high accuracy underscores the potential of our methodology to enhance diagnostic accuracy and clinical decision-making in neurology and oncology. The research offers a promising avenue for further exploration and innovation in medical imaging analysis, with significant implications for improving patient outcomes and advancing healthcare practices.

Abstract Background Optical coherence tomography angiography (OCTA) is a relatively new extension of Optical coherence tomography (OCT) that generates non-invasive, depth-resolved images of the retinal microvasculature which allows for the detection of various features of diabetic retinopathy. Objectives This study aimed to detect biomarkers that may predict an early anatomical response to the treatment of diabetic macular edema (DME) with intravitreal ranibizumab (IVR) by means of OCTA. Patients and methods This prospective interventional study was undertaken on 111 eyes of 102 naïve participants who had diabetic macular edema; enrolled patients were evaluated by taking a complete ophthalmologic history, examination and investigations by use of a pre-designed checklist involving Optical Coherence Tomography Angiography. Results Regarding the best corrected visual acuity (BCVA) the Mean ± SD was 0.704 ± 0.158 preoperatively and 0.305 ± 0.131 postoperatively in good responder patients; and was 0.661 ± 0.164 preoperatively and 0.54 ± 0.178 postoperatively in poor responders. The central macular thickness (CMT) was 436.22 ± 54.66 μm preoperatively and 308.12 ± 33.09 μm postoperatively in good responder patients; and was 387.74 ± 44.05 μm preoperatively and 372.09 ± 52.86 μm postoperatively in poor responders. By comparing the pre injection size of the foveal avascular zone area (FAZ-A) in both groups, it found that the mean ± SD of FAZ-A was 0.297 ± 0.038 mm in good responder patients compared to 0.407 ± 0.05 mm in non-responder patients. The preoperative superficial capillary plexus (SCP) foveal vascular density (VD) was 24.02 ± 3.01% in good responder patients versus 17.89 ± 3.19% um in poor responders. The preoperative SCP parafoveal VD was 43.06 ± 2.67% in good responder patients versus 37.96 ± 1.82% um in poor responders. The preoperative deep capillary plexus (DCP) foveal VD was 30.58 ± 2.89% in good responder patients versus 25.45 ± 3.14% in poor responders. The preoperative DCP parafoveal VD was 45.66 ± 2.21% in good responder patients versus 43.26 ± 2.35% um in poor responders, this was statistically significant. Conclusion OCTA offers an accurate measurement for VD in the macula as well as the FAZ-A which could be used to predict an early anatomical response of anti-VEGF treatment in DME.

Wireless Body Area Networks (WBANs) play a crucial role in healthcare and various other domains by enabling continuous monitoring of vital signs and activities. However, challenges such as low-powered sensors, unstable links, and routing issues hinder their efficiency and reliability. In this paper, we propose the Thermal Aware High Throughput (TAHT) routing protocol to address these challenges. TAHT utilizes a multi-hop topology and prioritizes stable links for efficient routing, considering parameters like energy, link quality, and temperature. Through experimental evaluation, TAHT demonstrates a 10% to 20% improvement in throughput, a 15% reduction in temperature overheads, and enhanced overall performance compared to benchmark protocols. By effectively managing energy consumption, minimizing duplicate data transmissions, and optimizing routing paths, TAHT offers a novel solution to improve the reliability and sustainability of WBANs, thus advancing the field beyond previous efforts in the literature.

Abstract Background Acute pulmonary embolism is recorded as one of the most common and critical medical conditions, resulting in a notable mortality rate requiring a multidisciplinary management. In this series, we address the management of massive and sub-massive pulmonary embolism utilizing catheter-based intervention, in particular the conjunction of mechanical thrombus disruption and aspiration with pharmacological thrombolysis (pharmacomechanical thrombectomy). Results 37 patients were diagnosed with massive and sub-massive pulmonary embolism based on the clinical and radiological findings. Pre-procedural vital parameters were obtained, including oxygen saturation, pulse rate, and blood pressure. Under continuous monitoring and conscious sedation, a pulmonary angiography via right common femoral vein access was performed for pre-procedural assessment. Pharmacomechanical thrombectomy was performed using the AngioJet Ultra System (Boston Scientific). Using the power pulse option, a fibrinolytic agent was infused into the thrombus. After 5–10 min, mechanical thrombectomy is performed with a maximum 3 passes through the thrombus. This technique is performed in the main pulmonary artery and lower branch. The procedure is repeated on the other side. The maximum duration of thrombectomy is 2–3 min on each side. Procedure success was based on improvement of vital signs and not related to post-procedure angiographic findings. All patients showed immediate improvement of vital signs (blood pressure, 02 saturation, and pulse rate) with progressive improvement over the following days. There were no procedure-related complications. Conclusion Pharmacomechanical thrombectomy is a safe and effective technique in the treatment of massive and submassive pulmonary embolism. It can be a first-line treatment even in patients without absolute contraindication to systemic thrombolysis.

Abstract Background The rise of antimicrobial resistance, which is partially attributed to the overuse and/or misuse of antibiotics in health care, is one of the world’s largest public health challenges. The distribution of antibiotics in absence of a prescription in pharmacies is a significant contributor to the growing global public health crisis of antibiotic resistance. A pharmacist’s clinical and lawful knowledge of antibiotic provide has an impact on the proper way to dispense medication. There are few novel studies assessing pharmacists comprehension and experience in prescribing antibiotics in low- and middle-income countries, including those in the Arabian region. Objectives (I) assess pharmacy team members Knowledge about antibiotics as reported by individuals themselves and their behavior in dispensing antimicrobial without a prescription and (ii) find potential influences on this behavior. Setting Pharmacists were chosen from various regions in Algeria, Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen, based on their convenience and ease of access. Methods A descriptive cross-sectional assessment among a random sample (n = 2833) of community pharmacists was conducted Utilizing a structured, validated, and questionnaire that underwent pilot testing, a comprehensive survey with four distinct sections covering biography, knowledge, practice, and attitude domains was employed. The main outcome Measures were knowledge, attitude, and practice toward dispensing antibiotics without prescription. Results Of the 3100 pharmacists reached, 2833 completed and return the questionnaires (response rate 91.3%). Most of the respondents were male (57.4%). Aged between 19 and 31 years old (76.2%). Most of them held a B.Sc. Degree (78.5%). Worked as staff pharmacists (73.2%). During the survey, it was discovered that there were gaps in their knowledge regarding antibiotic usage. A total of 45.7% of the respondents were unaware that antibiotics can be used as prophylaxis, while 33.3% did not recognize the consequences of making incorrect antibiotic choices. Regarding their practice patterns, 53.8% of the pharmacists admitted that they did not consistently adhere to guidelines when dispensing antibiotics. In terms of attitudes toward antibiotic usage, 36.8% disagreed with the guidelines of not supply antibiotics without a prescription, suggesting some variation in opinions among pharmacists on this matter. Additionally, a significant percentage (75%) believed that community pharmacists had qualifications to prescribe antibiotics for infections. Conclusion The recent survey has shed light on the differences among pharmacists in regard to dispensing antibiotics without prescriptions and their understanding of resistance. The findings are concerning, indicating a deficient in of knowledge as regards the use of antibiotics. It is crucial to implement regulations and enhance education efforts to tackle the growing problem of resistance. Collaboration between healthcare professionals and awareness campaigns is essential in addressing this issue.

Background and Study Aim. Chronic mechanical neck pain significantly impacts the quality of life and functional capacity of individuals, often necessitating long-term management strategies. Traditional stretching exercises are commonly prescribed, but their effectiveness compared to other interventions remains underexplored. The objective of this study was to compare the effectiveness of traditional stretching exercise regimens against thoracic spine and rib mobilization in patients with chronic mechanical neck pain. Material and Methods. This randomized controlled trial included 30 patients aged between thirty and fifty years, all suffering from mechanical neck pain. Patients were randomly assigned to one of two groups, with 15 in each group (Group A: n=15; Group B: n=15). Group A received thoracic spine mobilization coupled with standard passive stretching exercises, whereas Group B underwent a traditional stretching exercise regimen. Both groups were evaluated using the visual analogy scale for pain, active cervical range of motion (ROM), and chest expansion, both before and after a two-week therapy course. Results. Findings from this study were analyzed using a two-way mixed-model multivariate analysis of variance (MANOVA). The results showed no significant differences between Group A (thoracic spine mobilization and standard passive stretching) and Group B (traditional stretching regimen) regarding pain intensity, active cervical range of motion, and chest expansion after the two-week intervention period (p > 0.05). However, significant improvements were observed within each group across all measured outcomes, including reductions in pain intensity and increases in cervical range of motion and chest expansion (p < 0.001). Conclusions. The study confirms that both passive stretching exercises and thoracic spine mobilization are beneficial interventions for enhancing physical outcomes in patients with mechanical nonspecific neck pain. These approaches are equally effective in improving overall physical functionality, underscoring their value in therapeutic settings for neck pain management.

Background: Anterior cruciate ligament (ACL) injuries are common, particularly among young, active individuals, and are associated with significant morbidity. Arthroscopic ACL reconstruction has become the gold standard for restoring knee stability and function, yet the optimal candidate and timing for surgery remain subjects of ongoing research. Patients and Methods: This descriptive follow-up study, conducted at Basra Teaching Hospital from October 2011 to January 2014, enrolled 35 male patients aged 18-65 years with confirmed ACL injuries. Participants underwent arthroscopic ACL reconstruction using hamstring and gracilis tendon grafts. Outcomes were assessed using the Tegner-Lysholm scoring system, focusing on knee function and stability, over one year post-surgery. Statistical analyses were performed using SPSS version 26, with significance set at p < 0.05. Results: The majority of participants (62.8%) were aged 21-30 years, with a mean age of 24.6 ± 2 years. Right knee injuries were more common (57.1%). Most injuries (82.8%) were sports-related, predominantly from contact sports (74.3%). Post-operatively, significant improvements were observed in knee stability tests: Lachman test positive rates dropped from 100% to 5.7%, Pivot Shift test rates from 71.4% to 5.7%, and Anterior Drawer test rates from 100% to 14.2% (p < 0.001). The Tegner-Lysholm scores showed substantial enhancement, with poor outcomes decreasing from 48.5% to 5.7% and excellent ratings increasing from 0% to 22.8% (p < 0.001). Professional athletes had better recovery outcomes (average score 91.7) compared to non-professionals (average score 79.9, p = 0.041). Complications were minimal, with infection and ACL failures each occurring in 5.7% of cases, and leg-foot paresthesia in 2.8%. Conclusion: Arthroscopic ACL reconstruction is effective in significantly improving knee function and stability among young, active males, particularly those engaged in professional sports. Early surgical intervention, coupled with tailored rehabilitation, is crucial in achieving optimal outcomes. These findings advocate for a proactive approach in managing ACL injuries

Groundwater is becoming more and more recognized as a crucial and indispensable water supply on a worldwide basis. The previous few decades witnessed a high increase in its demand due to the overpopulation and improving living standards. Natural radioactivity in water has garnered a lot of attention in recent years. Twenty-two groundwater samples from Kirkuk region in Iraq were tested for radon using RAD7, an electronic radon detector coupled to a RAD-H2O accessory (Durridge Co., USA) with an average value of 10.31 BqL-1, the observed radon concentration ranged from 0.18 BqL-1 to 23.005 BqL-1. The radon concentration readings that were measured fall well within the range of the maximum contamination limit (MCL) of 11.1 BqL-1 set by the EPA. The annual effective dose for individual consumer was 0.039 mSvy-1 within the public exposure limit of 1 mSvy-1 set by the WHO and UNSCEAR. Farmers can feel secure here, and the population is not particularly at risk from radon concentrations, based on the measured values for subterranean water in the study location. This study ended without considering how radon concentration is impacted by the physics of groundwater and chemical properties like PH and EC. After the sample is kept for a month, the radon concentration is recalculated.

Background: Since December 2019, when a new coronavirus disease 2019 (COVID-19) was detected in Wuhan, China, over 774 million confirmed COVID-19 cases and over seven million deaths have been reported globally, as of 7 January 2024 (WHO, 2024). Venous thromboembolism is a recognized complication of COVID-19. This study aimed to investigate the prevalence of pulmonary embolism (PE) diagnosed by CT pulmonary angiography (CTPA) in COVID-19 patients and the features of the associated factors. Methods and Results: The study included 162 patients from the Imam Abdulrahman Al-Faisal Hospital who had COVID-19-confirmed infections while hospitalized in the ICU. Patients were diagnosed as COVID-19 positive by RT-PCR and underwent CTPA examination on the Discovery 16-slice CT scanner (Siemens, Germany) following standard protocol. For contrast enhancement, non-ionic, iodinated, intravenous contrast material (Omnipaque 350 mg) was used. PE was detected by CTPA in 87(53.7%) COVID-19 patients. The D-dimer level was significantly higher in the PE group than in the non-PE group. The frequency of renal impairment in the PE group was 2.3 times higher than in the non-PE group. The ICU duration was longer in the PE group than in non-PE group (12.9±11.3 and 8.6±7.2 days, P=0.005). The death rate was 17.2% in the PE group and 1.3% in the non-PE group (P=0.001). The heart and respiratory rates, blood pressure, BMI, BUN, and creatinine levels did not differ in the study groups. The frequency of diabetes, hypertension, asthma, COPD, and smoking were comparable in the groups. Conclusion: CTPA is very important in diagnosing PE in COVID-19 patients. CTPA-diagnosed PE is significantly associated with D-dimer, ICU duration, and death.

This is a case of probable pernicious anemia in the setting of autoimmune hepatitis. A 55-year-old male patient presented to the Emergency Room at Dr. Ruth K.M. Pfau Civil Hospital, Karachi with complaints of diarrhea and fever and was subsequently transferred to the medicine ward. The patient also had signs of unexplained anemia. We performed laboratory tests and were able to rule out the common causes of liver pathology, including viral hepatitis. For blood, the values showed decreased hemoglobin levels and an elevated Mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) (114 fL), indicating macrocytosis. Finally, we were able to conclude autoimmune pathology after the results of antibody testing demonstrated positive lab values for anti-smooth muscle antibodies, antinuclear antibodies, and anti-gastric parietal cell antibodies. The patient had developed pernicious anemia in the setting of autoimmune hepatitis, which is an extremely rare case and documented instances are scarce in the available literature regarding such cases.

Social media has swiftly established itself as a primary source of products’ information for customers. Nowadays, Small and Medium-size Enterprises (SMEs) can use social media to develop Customer Relationship Management platforms (social CRM). Firms, particularly SMEs in developing countries need to understand the factors affecting their performance by implementing social CRM. However, there is a dearth of awareness on the impact of social CRM on the performance of SMEs. This study proposes an integrated model that aims to investigate the effects of social CRM on SMEs’ performance. The model is constructed by incorporating three dominant theoretical frameworks: the Fit-Viability Model (FVM), Network Externalities, and the Resource-Based View (RBV). A cross-sectional survey was used to gather data from 149 SMEs managerial staff. Findings revealed that almost 50% of the variability in the performance of SMEs is explained by the fitness and viability of social CRM. In addition, network externalities of social media significantly impact the social CRM fitness in the context of SMEs with path coefficient 0.617. Furthermore, the internal financial resources factor makes sCRM viable for SMEs as the results show significant relationship between the internal financial resources and the sCRM viability with 0.536 path coefficient. Manager innovativeness, IT knowledge, top management support, and government assistance, on the other hand, do not contribute significantly to the viability of social CRM for SMEs. The model aids SMEs in making well-informed decisions regarding the adoption of social CRM by evaluating both the suitability of social media for CRM tasks and the enterprise preparedness to implement social CRM, leading to enhanced performance.

Water scarcity is a critical issue worldwide. This study explores a novel method for addressing this issue by using ductile cast iron (DCI) solid waste as an adsorbent for phosphate ions, supporting the circular economy in water remediation. The solid waste was characterized using XRD, XRF, FTIR, and particle size distribution. Wastewater samples of different phosphate ion concentrations are prepared, and the solid waste is used as an adsorbent to adsorb phosphate ions using different adsorbent doses and process time. The removal percentage is attained through spectrophotometer analysis and experimental results are optimized to get the optimum conditions using Design Expert V13. The pseudo-second order (PSO) kinetics model and Langmuir isotherm were fitted with the experimental results with maximum adsorption capacity (qmax = 0.28 mg/g). The thermodynamic analysis indicated that this adsorption process was spontaneous based on the negative value of Gibbs free energy (∆G). Additionally, the positive values of enthalpy (∆H) indicated the endothermic nature of this adsorption system. It was able to reach the highest adsorption percentage of 98.9 (%) for phosphate ions from aqueous solutions using response surface methodology (RSM) with optimum conditions of 10 mg/L phosphate ion concentration, pH = 8, normal room temperature, 9 min adsorption, and 0.5 g/L adsorbent dosage.

Background: Hepatocarcinogenesis is a multifactorial process that arises from a integration of genetic and epigenetic anomalies leading to abnormal gene expression and function. It is difficult to characterize HCC with a single biomarker. Our study aimed at detecting the expression of a panel of 8 methylated genes (SOCS1, APC, Gadd45b, CDKN1B, P15, PAX6, STAT1 and MSH2) as regulatory factors among Egyptian patients with HCC. Methods: This study was conducted on HCC tissue samples of 30 Egyptian patients in comparison with their non-cancerous adjacent cirrhotic tissue as a control. Tissue samples were obtained from patients who have undergone living donor liver transplantation (LDLT) or liver resection at El Sahel Teaching Hospital (Cairo, Egypt). A special Custom designed PCR Arrays was used to analyze the expression profiles of chosen methylated genes associated with HCC. Results: Expression of SOCS1, APC, Gadd45b, CDKN1B, P15, PAX6, STAT1 and MSH2 were lower in the HCC tissue compared to the cirrhotic tissue (pvalue = 0.015, 0.081, 0.004, 0.027, 0.211, 0.015, 0.025 and 0.0001 respectively). 5 genes (SOCS1, APC, GAdd45b, CDKN1B, and MSH2) showed the ability to be used as diagnostic biomarkers for HCC with high sensitivity and specificity values at cut off values: 1.05, 1.17, 0.995, 0.546, and 0.125 respectively. As for the other 3 genes (P15, PAX6, STAT1), PAX6 gene has the highest sensitivity at a cut off value of 0.3364. A significant negative correlation was shown between alpha fetoprotein (AFP) and 5 of the studied genes (SOCS1, APC, Gadd45b, STAT1, and MSH2). Conclusions: Expression of the selected hypermethylated genes (SOCS1, APC, Gadd45b, CDKN1B, P15, PAX6, STAT1 and MSH2) in HCC tissue samples was lower than adjacent tissue. Their role should be further studied to solve the mystery that surrounds the pathogenesis of HCC.

Abstract Background Commercial tobramycin ophthalmic solution is frequently used empirically to treat ocular disorders in equines, despite being primarily formulated for use in humans. It has been noted that tobramycin MIC90 concentration (minimal inhibitory concentration to 90% of microbial growth) rapidly declined following topical administration. It is hypothesized that adjustment of the pH of the empirically used tobramycin ophthalmic solution -prepared for human use- with the pH of the tears of donkeys, could increase the bioavailability of the drug and subsequently improve its penetration to the aqueous humor. Therefore, this study aimed to evaluate the impact of pH adjustment of the empirically used tobramycin ophthalmic solution on MIC90 concentration in tears and aqueous humor of donkeys (Equus asinus). The study was conducted on six (n = 6) clinically healthy donkeys. In each donkey, one eye was randomly selected to receive 210 µg tobramycin of the commercial tobramycin (CT) and used as a positive control (C group, n = 6). The other eye (treated eye) received 210 µg of the modified tobramycin ophthalmic solution (MT) (T group, n = 6). Tears and aqueous humor samples were collected 5-, 10-, 15-, 30- min, and 1-, 2-, 4-, and 6 h post-instillation. Results Modifying the pH of the empirically used commercial tobramycin ophthalmic solution in donkeys at a pH of 8.26 enhanced the drug’s bioavailability. The MIC90 of the most hazardous bacteria isolated from equines’ eyes such as Pseudomonas aeruginosa (MIC90 = 128 µg/ml) and Staphylococcus aureus (MIC90 = 256 µg/ml) was covered early (5 min post-instillation) and over a longer period in donkey tears (239–342 min) and aqueous humor (238–330 min) with the modified tobramycin solution. Conclusions Adjustment of the pH of the commercial tobramycin ophthalmic solution, empirically used by veterinarians to treat donkeys’ ophthalmic infections at a pH of 8.26, isotonic with the donkeys’ tears pH, resulting in higher concentrations of tobramycin in tears and aqueous humor for a longer time.

Abstract Limited data exist on viral hepatitis among migrant populations. This study investigated the prevalence of current hepatitis B virus (HBV) infection and lifetime hepatitis C virus (HCV) infection among Qatar's migrant craft and manual workers (CMWs), constituting 60% of the country's population. Sera collected during a nationwide COVID-19 population-based cross-sectional survey on CMWs between July 26 and September 9, 2020, underwent testing for HBsAg and HCV antibodies. Reactive samples underwent confirmatory testing, and logistic regression analyses were employed to explore associations with HBV and HCV infections. Among 2528 specimens tested for HBV infection, 15 were reactive, with 8 subsequently confirmed positive. Three samples lacked sufficient sera for confirmatory testing but were included in the analysis through multiple imputations. Prevalence of current HBV infection was 0.4% (95% CI 0.2–0.7%). Educational attainment and occupation were significantly associated with current HBV infection. For HCV infection, out of 2607 specimens tested, 46 were reactive, and 23 were subsequently confirmed positive. Prevalence of lifetime HCV infection was 0.8% (95% CI 0.5–1.2%). Egyptians exhibited the highest prevalence at 6.5% (95% CI 3.1–13.1%), followed by Pakistanis at 3.1% (95% CI 1.1–8.0%). Nationality, geographic location, and occupation were significantly associated with lifetime HCV infection. HBV infection is relatively low among CMWs, while HCV infection falls within the intermediate range, both compared to global and regional levels.

Abstract The operational characteristics of freight shipment will significantly change after the implementation of Autonomous and Connected Trucks (ACT). This change will have a significant impact on freight mobility, transportation safety, and the sustainability of infrastructure. Truck platooning is an emerging truck configuration that is expected to become operational in the future due to the rapid advancements in connected vehicle technology and autonomous driving assistance. The platooning configuration enables trucks to be connected with themselves and the surrounding infrastructure. This arrangement has shown to be a promising solution to improve the vehicles’ fuel efficiency, reduce carbon dioxide emission, reduce traffic congestion, and improve transportation service. However, platooning may accelerate the damage accumulation of pavement and bridge structures due to the formation of multiple load axles within each platoon since those structures were not designed for such loads. According to AASHTO, bridges are designed based on a notional live load model comprised of one or two trucks per lane in conjunction with or separate from an applied uniform load (AASHTO, LRFD 2022). This damage, if accumulated, its repair would require billions of dollars from the government and would impede the movement of both people and goods. The potential damage to infrastructure may arise due to various factors such as the number of trucks in a platoon, gap spacing between trucks, and the type of trucks. This research work includes a thorough parametric study with 295,200 computer simulations using SAP 2000. The goal was to evaluate the effect of different truck platooning configurations on the load rating of existing bridges. The obtained results served as the dataset for training various machine learning models, including Random Tree, Random Forest, Multi-Layer Perceptron (MLP), Support Vector Regression (SVR), K-Nearest Neighbor (KNN), and Extreme Gradient Boosting (XGBoost). Results showed that Random Forest model performed the best, with the lowest prediction errors. The proposed machine learning model has shown its effectiveness in identifying optimal platooning configurations for bridge structures within the scope of the study. Graphical Abstract

Around 68% patients undergoing radical prostatectomy face postoperative erectile dysfunction. This systematic review aims to investigate the studies pertaining to efficacy of stem cell therapy in alleviating erectile dysfunction (ED) of radical prostatectomy (RP) patients. Furthermore, it provides evidence-based potential benefits of stem cell therapy in addressing erectile dysfunction of those patients. A systematic literature search from PubMed, Google Scholar, Science Direct and clinicaltrial.gov databases was conducted for the clinical trials evaluating efficacy and safety of stem cell therapy in post-prostatectomy erectile dysfunction. The inclusion criteria pertained to the studies reporting pre- and post-outcome erectile function and safety results. Cochrane Robins I was employed for the quality and bias risk. Four studies were finally included. The studies were of high quality as revealed from the quality assessment results. They were the non-randomized human-based clinical trials. Patients follow-up ranged from 3 to 12 months. Intercourse satisfaction scores were improved after 6 and 12 months of stem cell therapy. No serious adversities were reported during and after the study period. It was thus a safe therapeutic option as per these results. This study evaluated the role of stem cell therapy in post-RP ED. The included studies depicted its efficacy and safety. The information on stem cell therapy for ED was limited, however it could provide foundation for future research. Large-scale human studies with robust research designs would bring more objectivity and conclusive evidence.

The post-tanning procedure involves neutralizing the iso-electric point, which ensures that there is no imbalance between carboxylic groups and amino groups. This balance allows for the penetration of dyes, fatliquoring agents, and other chemical materials. Bicarbonate is used during the neutralization phase, and to eliminate it, 4 metric tons of water are needed for each metric ton of leather. Additionally, this leads to an elevation in both Biological Oxygen Demand (BOD) and Chemical Oxygen Demand (COD). The objective of the research was to substitute bicarbonate with sodium borate, sodium acetate, and sodium formate, and neutralise syntan to decrease the quantities of pollutants generated from this process, minimize the consumption of water, and improve the quality of the produced leather. Each experimental group's BOD, COD, microscopic micrographs, physical, chemical, and organoleptic parameters were determined. The use of sodium borate, neutralizing syntan, sodium acetate, and sodium formate resulted in a significant decrease in the discharge of BOD, COD, and water consumption. Furthermore, the use of 2.5% sodium borate has proven to be the most effective neutralizing agent in reducing water consumption by 80%, total oxygen demand by 39% and costs of neutralization chemicals by 0.62%. Also, the physical and chemical properties of the leather product were similar to those of the control. Therefore, the leather that has been neutralized with sodium borate is considered to have the best organoleptic characteristics compared to the control.

The 5 G networks are effectively deployed worldwide, and academia and industries have begun looking at 6 G network communication technology for consumer electronics applications. 6 G will be built on pervasive artificial intelligence (AI) to enable data-driven Machine Learning (ML) applications in massively scalable and heterogeneous networks. Conventional ML technique involves centralizing train data in data centers where centralized ML algorithms can be employed for data inference and analysis. The data inference and analysis are frequently inconvenient or impracticable for the devices to submit information to the preset sever because of privacy concerns and inadequate communication capabilities in wireless networks. However, privacy limitations and restrictions in wireless network communication capacity are frequently impractical or undesirable for the devices to acquiesce data to the parameter server. Federated learning (FL) enables the devices to train a practical and standard model while needing data exchange and transfer, which might solve these issues. This paper presents an overview of FL, 6 G, and FL enables 6 G communication technology. In particular, 6 G requirements and applications, and the proposed FL framework algorithm with evaluation are described. Finally, FL-enabling 6 G communication technologies open challenges, and research directions are discussed to help future researchers improve the FL-enabled 6 G network.

Background: Esophageal Squamous Cell Carcinoma (ESCC) contributes to the global burden of disease. Conventional treatments such as surgical resection and chemotherapy offer limited long-term survival rates. Recently, immunotherapies targeting PD-1 have shown promise in other cancers, but their efficacy in ESCC remains unclear. Methods: The 31 studies eligible for this study included a total of 10,681 patients who were subjected to immunotherapy, either alone or in combination with traditional chemotherapy. A comprehensive search was conducted on September 1, 2023, across databases including CENTRAL, PubMed, MEDLINE, Web of Science, Embase, and Scopus. Results: For OSR, results indicate a significantly improved survival at different time points (6, 12, and 24 months), with an odds ratio of 0.636 (95 % CI 0.595–0.680; Z = −13.292; p

Abstract Background Owing to crowded and unsanitary conditions, internally displaced persons (IDPs) have an increased risk of COVID-19 infection. Adoption of COVID-19 preventive measures among this population is premised on accurate information, adequate knowledge, and risk perception. We assessed COVID-19 knowledge and risk perception and investigated the association between risk perception and COVID-19 preventive measures, including vaccination among IDPs in Northeast Nigeria. Methods We conducted a cross-sectional study during July–December 2022 and sampled 2,175 IDPs using stratified sampling. We utilized a 12-point assessment tool to evaluate COVID-19 knowledge. Participants who scored ≥ 6 points were considered to have adequate knowledge. We used a 30-item Risk Behavior Diagnosis Scale to assess COVID-19 risk perception and evaluated each item on a 5-point Likert scale. Participants were divided into risk perception categories by the median of Likert scale scores. We performed weighted logistic regression analysis to identify factors associated with risk perception. Pearson’s chi-squared with Rao-Scott adjustment was used to determine the relationship between risk perception and COVID-19 preventive measures. Results Of 2,175 participants, 55.7% were 18–39 years old, 70.9% were females, and 81.7% had no formal education. Among the IDPs, 32.0% (95% CI: 28.8 – 35.0) were considered to have adequate COVID-19 knowledge, and 51.3% (95% CI: 47.8 – 54.8) perceived COVID-19 risk as high. Moreover, 46.3% (95% CI: 42.8 – 50.0) had received one dose of COVID-19 vaccine, and 33.1% (95% CI: 29.8 – 36.0) received two doses. Adequate knowledge (Adjusted Odds Ratio (AOR) = 2.10, [95% CI: 1.46 – 3.03]) and post-primary education (AOR = 3.20, [95% CI: 1.59 – 6.46]) were associated with risk perception. Furthermore, high risk perception was significantly associated with wearing face masks (χ2 = 106.32, p-value

Postpartum depression (PPD) is becoming increasingly prevalent worldwide, often manifesting in new mothers due to a complex interplay of physical, behavioral, and emotional transformations post-childbirth. The primary aim of our research is to analyze the contributory factors leading to PPD, including familial, social, and other maternal health-related aspects, and to devise a predictive model that can accurately assess the risk of PPD. In this research, we analyzed a benchmark dataset of 1,503 entries gathered from a medical institution, where the data was compiled through questionnaires disseminated using a digital Google Forms platform. We deployed eleven advanced machine-learning algorithms for comparison. We proposed a novel MDKR model, a meta-learner designed to excel in predicting PPD. Questionnaire data is initially processed in the proposed MDKR through the decision tree, k-nearest classifier, and random forest models. Subsequently, the outputs from these models are fed into a meta-learner multi-layer perceptron for the final prediction. Compared to state-of-the-art studies, the proposed MDKR model surfaced as the most proficient, with an exemplary accuracy of 99% in detecting PPD. In addition, we have confirmed the performance using k-fold validation and tuning hyperparameters. In the comparative assessment of all the models concerning their ability to predict PPD risk levels, MDKR emerged as the superior model. This meta-learning model has significantly contributed to identifying pivotal factors influencing PPD, enhancing the predictive framework within maternal healthcare domains.

This paper presents a systematic review of K-12 cybersecurity education literature from around the world. 24 academic papers dated from 2013–2023 were eligible for inclusion in the literature established within the research protocol. An additional 19 gray literature sources comprised the total. A range of recurring common topics deemed as aspects of cybersecurity behavior or practice were identified. A variety of cybersecurity competencies and skills are needed for K-12 students to apply their knowledge. As may be expected to be the case with interdisciplinary fields, studies are inherently unclear in the use of their terminology, and this is compounded in this field due to the pervasive nature of cybersecurity, relevant and important to every person using a digital device. Almost all the studies within the data focused on secondary school settings and it appears the primary school years are largely ignored. This review suggests that most aspects of cybersecurity are not being systematically taught at K-12 around the world.

The massive yearly population growth is causing hazards to spread swiftly around the world and have a detrimental impact on both human life and the world economy. By ensuring early prediction accuracy, remote sensing enters the scene to safeguard the globe against weather-related threats and natural disasters. Convolutional neural networks (CNNs), which are a reflection of deep learning, have been used more recently to reliably identify land use in remote sensing images. This work proposes a novel bottleneck residual and self-attention fusion-assisted architecture for land use recognition from remote sensing images. First, we proposed using the fast neural approach to generate cloud-effect satellite images. In neural style, we proposed a 5-layered residual block CNN to estimate the loss of neural-style images. After that, we proposed two novel architectures, named 3-layered bottleneck CNN architecture and 3-layered bottleneck self-attention CNN architecture, for the classification of land use images. Training has been conducted on both proposed and original neural-style generated datasets for both architectures. Subsequently, features are extracted from the deep layers and merged employing an innovative serial approach based on weighted entropy. By removing redundant and superfluous data, a novel chimp optimization technique is applied to the fused features in order to further refine them. In conclusion, selected features are classified using the help of neural network classifiers. The experimental procedure yielded respective accuracy rates of 99.0% and 99.4% when applied to both datasets. When evaluated in comparison to state-of-the-art methods, the outcomes generated by the proposed framework demonstrated enhanced precision and accuracy.

Spur dikes are one the most important factors affecting the degree of activity of the erosion and deposition processes, particularly the vertical at the Nile streambed. In order to study the mutual relations between them, the study relies on the environmental systems approach using artificial intelligence techniques to produce 1D, 2D, 3D maps. The study’s inputs are classified into main ones such as characteristics of spur dikes, DEM, topographic maps, and satellite images; and secondary ones such as hydrological and mechanical characteristics of the Nile streambed sediments, through which it is possible to understand many of the ambiguities in the occurrence of geomorphological changes and try to reach the best suitable spur dikes to protect the banks from the erosion process.This is conducted by application to the Nile stream in the Abnub area, due to the spread of many spur dikes in their various shapes. In addition, they play a major role in the occurrence of vertical and horizontal geomorphological changes, and result in the spread of many phenomena including scour holes, sandbars, and swamps. Above all, spur dikes have proven effective in protecting the banks from the erosion process, and thus have achieved their intended aim.تعد الرؤوس الحجرية من أهم العوامل المؤثرة في درجة نشاط عمليتي النحت والإرساب وخاصةً الرأسي بقاع مجرى النيل. ولدراسة العلاقات المتبادلة بينهما اعتمدت الدراسة على منهج النظم البيئية باستخدام تقنيات الذكاء الاصطناعي في إنتاج خرائط أحادية وثنائية وثلاثية الأبعاد، وقد تم تصنيف مدخلات الدراسة إلى رئيسية، مثل: خصائص الرؤوس الحجرية وDEM وخرائط طبوغرافية ومرئيات فضائية، ومدخلات ثانوية، مثل: الخصائص الهيدرولوجية والميكانيكية لرواسب قاع مجرى النيل، والتي يمكن عن طريقها تفهم الكثير من الغموض في حدوث التغيرات الجيومورفولوجية ومحاولة الوصول إلى أفضل الرؤوس الحجرية ملائمة لحماية الضفاف من عملية النحت. وذلك بالتطبيق على مجرى النيل بمنطقة أبنوب، وذلك لانتشار العديد من الرؤوس الحجرية بأشكالها المختلفة، كما أن لها دورًا كبيرًا في حدوث التغيرات الجيومورفولوجية الرأسية والأفقية وانتشار العديد من الظاهرات الناتجة عنها، مثل: حفر انجراف، وحواجز رملية، ومستنقعات، كما أثبتت الرؤوس الحجرية فاعليتها في حماية الضفاف من عملية النحت، وبذلك فقد حققت الهدف المنوط بها.

Abstract In this study, a ZnO/MnO nanocomposite was myco-fabricated using the isolated endophytic Clonostachys rosea strain EG99 as the nano-factory. The extract of strain EG99, a reducing/capping agent, was successfully titrated with equal quantities of Zn(NO3)2·6H2O and Mn(NO3)2·6H2O (precursors) in a single step to fabricate the rod-shaped ZnO/MnO nanocomposite of size 6.22 nm. The ZnO/MnO nanocomposite was myco-fabricated in 20 min, and the results were validated at 350 and 400 nm using UV–Vis spectroscopy. In a 7-L bioreactor, an industrial biotechnological approach was used to scale up the biomass of this strain, EG99, and the yield of the myco-fabricated ZnO/MnO nanocomposite. A controlled fed-batch fermentation system with a specific nitrogen/carbon ratio and an identical feeding schedule was used in this production process. Higher yields were obtained by adopting a controlled fed-batch fermentation approach in a 7-L bioreactor with a regular feeding schedule using a nitrogen/carbon ratio of 1:200. Overall, the fed-batch produced 89.2 g/l of biomass at its maximum, 2.44 times more than the batch's 36.51 g/l output. Furthermore, the fed-batch's maximum ZnO/MnO nanocomposite yield was 79.81 g/l, a noteworthy 14.5-fold increase over the batch's yield of 5.52 g/l. Finally, we designed an innovative approach to manage the growth of the endophytic strain EG99 using a controlled fed-batch fermentation mode, supporting the rapid, cheap and eco-friendly myco-fabrication of ZnO/MnO nanocomposite. At a dose of 210 µg/ml, the tested myco-fabricated ZnO/MnO nanocomposite exhibited the maximum antibacterial activity against Staphylococcus aureus (98.31 ± 0.8%), Escherichia coli (96.70 ± 3.29%), and Candida albicans (95.72 ± 0.95%). At the same dose, Staphylococcus aureus biofilm was eradicated in 48 h; however, Escherichia coli and Candida albicans biofilms needed 72 and 96 h, respectively. Our myco-fabricated ZnO/MnO nanocomposite showed strong and highly selective antagonistic effects against a variety of multidrug-resistant human pathogens. Therefore, in upcoming generations of antibiotics, it might be employed as a nano-antibiotic.

Abstract The introduction of fish skin as a biological dressing for treating burns and wounds holds great promise, offering an alternative to existing management strategies. However, the risk of disease transmission is a significant concern. Therefore, this study aimed to examine how established sterilization and preservation procedures affected fish skin grafts' microbiological and histological properties for long-term usage. Lyophilization of the fish skin graft followed by rehydration in normal saline for 15 min did not change the collagen content. Furthermore, gamma irradiation of the lyophilized fish skin graft at different lengths 5, 10, and 25 KGy showed a significant reduction in microbial growth (aerobic bacteria, aerobic yeasts, and fungi) at 15- and 30 days after the irradiation. However, exposure to 10 KGy was found to be the most effective intensity among the different gamma irradiation lengths since it preserved the collagen fiber content and intensity in the lyophilized fish skin grafts at 15- and 30 days after the irradiation. These findings provide efficient preservation and sterilization methods for long-term usage of the fresh Tilapia skin grafts used for biological dressings.

According to WHO, a burn is a type of tissue injury that may be caused by thermal, electric, radioactive, or chemical agents. Burns represent a critical public health concern worldwide, particularly in developing countries that experience a disproportionately high incidence of burn injuries and mortality rates. Accurate and comprehensive statistics regarding the causes of mortality and their associated factors are crucial for informed healthcare decision-making. Unfortunately, there is a notable scarcity of studies that specifically address these issues, and a significant disparity exists between clinically diagnosed causes of death and postmortem findings. This study aims to determine the causes of mortality among patients admitted to the Burns Center to improve healthcare provision and reduce the mortality rate of burn patients. This retrospective cohort study involved 262 patients, comprising 58 % (n = 152) males and 42 % (n = 110) females. The mean age of males was 34.5 years (std = 13.9) while for males was 31.9 years (std = 13.2). The data was retrieved from patients' files and autopsy reports collected from the burns centre. The chi-square test and T-test were used to identify any correlation between the variables. The causes of mortality included sepsis (48.9, n = 128), hypovolemic shock (27.5, n = 72), renal failure (22.9, n = 60), and cardiac failure (0.8, n = 2). Significant associations were observed between the causes of mortality and factors such as age, total body surface area affected (TBSA), inhalational injury, and etiology of burns (p-value 0.05). Our study illustrates sepsis/multiple organ failure (MOF) as the most common cause of death in burn patients, along with highlighting the risk factors having a strong correlation with the causes of mortality in individuals with burn injuries.

Background: Stigma and discrimination (SAD) can greatly impact the management of Coronavirus Disease-19 (COVID-19) patients. Studies examining SAD in managing COVID-19 patients in Saudi Arabia (SA) are limited. This study examined the discrimination and inequality in treating COVID-19 patients and the associated beliefs among healthcare workers (HCWs) during the pandemic. Methods: This was a cross sectional study using an online self-administrated questionnaire by 414 HCWs from September 2022 to January 2023. Results: Of the 414 participants, 53.4% aged 18–30 years, were males (53.4%), mostly Saudi (82.1%), and residents of western SA (90.8%). Almost one-third of the participants (32.1%) were physicians, and 23.7% were pharmacists. 53.1% of the HCWs had work experience

Abstract Background The infection caused by the SARS-CoV-2 virus has led to the emergence of a novel diagnostic entity known as “post-COVID syndrome” (PCS). It is characterized by a constellation of medical and psychiatric symptoms that occur and persist for variable duration following the COVID infection. Among these post-COVID psychiatric symptoms are depressive and anxiety disorders, which were found to be the highest prevalence in the post-COVID period. The frequency and severity of post-COVID symptoms are correlated with the severity of the infection. Many inflammatory and coagulation markers have been involved in the severity of post-COVID symptoms and hence the development of post-COVID psychiatric symptoms/disorders. Limited research has been conducted to examine the psychological challenges experienced by individuals in the early stages of post-COVID recovery in Egypt, specifically within a timeframe of 1 to 3 months. The current study aims to estimate the occurrence rate of early post-COVID psychiatric symptoms/disorders such as depression and anxiety and to detect its association with clinical and severity parameters of COVID-19 infection. Methods The current study was a comparative cross-sectional approach, from the chest department’s “post-COVID-19 follow-up” outpatient clinic at Kobri ElKoba Medical Complex in Cairo, Egypt. A convenient sample of adult Egyptian patients were recruited between October 2021 and June 2022. They were subjected to the following: a pre-designed questionnaire to collect the patients’ demographic characteristics, Arabic version of General Health Questionnaire (GHQ) to identify potential cases, Arabic version of Structured Clinical Interview for DSM-IV (SCID I) Clinician Version (SCID-CV) and retrieval of essential related clinical and laboratory data like C-reactive protein (CRP), systemic immune-inflammation index (SII): (neutrophils × platelets)/lymphocytes), neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), and D-dimer and COVID-19 treatment lines together with a liker scale questionnaire to assess the severity of COVID-19 infection. Results Depression was found to be the most prevalent psychiatric disorder (45.6%) among the study participants, followed by generalized anxiety disorder (42.1%). Subthreshold GAD and depression were found in 17.5% and 14% of patients respectively. COVID was a major predictor of GAD (p 0.000), while being on antibiotics (p = 0.033), having cardiac illnesses (p = 0.007), and an increased D dimer (p = 0.022) were the most predictive factors for depression. Conclusion COVID-19 infection has demonstrated an increased risk of mental health problems in multiple domains. It was evident that depression was the most presenting psychiatric illness among the studied sample (45.6%), while generalized anxiety disorder was the second most prevalent disorder (42.1%). And suicide was found in 9.6% of the study sample. It is worth noting that our results displayed a high prevalence of subthreshold psychiatric symptoms. These findings emphasize the utmost need for mental health assessments for all survivors.

ABSTRACTBackground Infection with SARS-CoV-2 is a leading source of illness and death in the world. Millions of people contract SARS-CoV-2 every day as the incidence of infection rises. The mortality rate is mostly attributed to respiratory failure. Many studies have been carried out to identify biomarkers that can be used in the early detection of at-risk patients. CRP is a sensitive inflammatory biomarker; however, it can be measured by simple, inexpensive methods that are widely available in hospitals. Therefore, it was selected for this clinical trial.Methods This retrospective cohort analysis included 100 patients who were accepted to El-Obour Ain Shams University Specialized Hospital for Isolation between May and October 2020. Admission CRP was investigated, and data were analyzed in relation to severity and mortality.Results Regarding history, older patients or those who had been diagnosed with hypertension, diabetes mellitus, chronic hepatic diseases, or active cancer have been statistically more prone to mortality. Concerning the laboratory investigations, those who did not survive had significantly lower haemoglobin levels and a higher TLC count. In addition, serum ferritin and D-dimer levels were significantly higher in the non-survivors. As regards CRP, the non-survivor group had significantly higher levels, with a cutoff value of >129 mg/l to predict mortality. It has also been correlated with severity in terms of need for ICU admission and need for respiratory support, with a cutoff value of >55.3 mg/L.Conclusion CRP can be used as a prognostic biomarker in patients with SARS-CoV-2 infection as it is a simple and effective predictor.

This study employs a microstructure-based finite element modeling approach to understand the mechanical behavior of asphalt mixtures across different length scales. Specifically, this work aims to develop a multi-scale modeling approach employing representative volume elements (RVEs) of optimal size; this is a key issue in asphalt modeling for high-fidelity fracture modeling of heterogeneous asphalt mixtures. To determine the optimal RVE size, a convergence analysis of homogenized elastic properties is conducted using two types of RVEs, one made with polydisperse spherical inclusions, and another made with polydisperse truncated cylindrical inclusions, each aligned with the American Association of State Highway and Transportation Official’s maximum density gradation curve for a 12.5 mm Nominal Maximum Aggregate Size (NMAS). The minimum RVE lengths for this NMAS were found to be in the range of 32–34 mm. After the optimal RVE size for each inclusion shape is obtained, computational models of heterogeneous Indirect Tensile Asphalt Cracking Test samples are then generated. These models include the components of viscoelastic mastic, linear elastic aggregates, and cohesive zone modeling to simulate the rate-dependent failure evolution from micro- to macro-cracking. Examination of load-displacement responses at multiple loading rates shows that both heterogeneous models replicate experimentally measured data satisfactorily. Through micro- and macro-level analyses, this study enhances our understanding of the composition-performance relationships in asphalt pavement materials. The procedure proposed in this study allows us to identify the optimal RVE sizes that preserve computational efficiency without significantly compromising their ability to capture the asphalt material behavior under specific operational conditions.

The widespread use of reinforced concrete continues to face challenges, particularly in mitigating alkali-silica reaction (ASR), due to its detrimental effects on concrete strength and durability. This paper investigates the effectiveness of using binary supplementary cementitious materials (SCMs) in mitigating ASR by incorporating metakaolin (MK) and waste glass powder (GP) as partial replacements for cement. Additionally, the potential of a new cement product, “NewCem Plus” (NCM), along with the use of basalt fibers and lithium, was evaluated through a 14-day accelerated mortar bar test following the ASTM C1260. This study also assessed concrete’s properties such as its compressive strength and workability using the flow test. The results indicated that MK was effective, reducing expansion by 79%, 84%, and 88% with 10%, 20%, and 30% cement replacement, respectively, compared to the control mixture. On the other hand, GP showed a more modest reduction in expansion, with 10%, 20%, and 30% replacement levels reducing expansion by 20%, 43%, and 75%, respectively. Furthermore, the addition of lithium to MK significantly mitigated ASR, reducing expansion below the ASTM threshold. However, mixtures containing NewCem Plus, lithium, and basalt fibers showed minimal impact on ASR reduction. These findings underscore the viability of using binary or ternary blends of SCMs to mitigate ASR in concrete, encouraging their adoption in future concrete applications.

Background: Microscopic colitis (MC) is a recognized cause of chronic diarrhea and is often underestimated when a colonoscopy appears normal. This study aims to accurately diagnose chronic diarrhea through histopathological examination of colonoscopic mucosal biopsies and assess the prevalence of microscopic colitis and the diagnostic value of biomarkers. Methods: A hospital-based cohort study was conducted on 116 patients with chronic diarrhea. Colonoscopies and colonic mucosal biopsies were performed and analyzed, along with various tests including fecal calprotectin (FC) level, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), stool analysis, routine laboratory tests, and clinical data related to nocturnal diarrhea, abdominal pain, and unexplained weight loss. Results: In the study group, 32.8% had MC, with 25.9% having lymphocytic colitis (LC) and 6.9% having collagenous colitis (CC). Patients with MC had significantly higher FC, ESR, and CRP levels than those without colitis (p < 0.001). Factors associated with MC included nocturnal diarrhea (OR = 4.26; 95% CI [1.64–11.08]; p-value = 0.003) and abdominal pain (OR = 4.62; 95% CI [1.85–11.54]; p-value = 0.001). ESR at a cutoff >14 mm/h and FC at a cutoff >64 mcg/g showed excellent validity in diagnosing MC with area under the curve (AUC) values of 0.94 and 0.97, respectively. Conclusions: Microscopic colitis, particularly LC-type, is not an uncommon cause of chronic diarrhea, especially when accompanied by symptoms such as abdominal pain and nocturnal diarrhea, warranting further investigation, including inflammatory markers and colonic biopsy. Inflammatory markers can be useful in diagnosing MC with proper values and approaches; however, further studies are needed.

Workplace drug testing (WDT) is essential to prevent drug abuse disorders among the workforce because it can impair work performance and safety. However, WDT is limited by many challenges, such as urine adulteration, specimen selection, and new psychoactive substances (NPS). This review examined the issues related to WDT. Various scientific databases were searched for articles on WDT for drug detection published between 1986 (when WDT started) and January 2024. The review discussed the history, importance, and challenges of WDT, such as time of specimen collection/testing, specimen adulteration, interference in drug testing, and detection of NPS. It evaluated the best methods to detect NPS in forensic laboratories. Moreover, it compared different techniques that can enhance WDT, such as immunoassays, targeted mass spectrometry, and nontargeted mass spectrometry. These techniques can be used to screen for known and unknown drugs and metabolites in biological samples. This review assessed the strengths and weaknesses of such techniques, such as their validation, identification, library search, and reference standards. Furthermore, this review contrasted the benefits and drawbacks of different specimens for WDT and discussed studies that have applied these techniques for WDT. WDT remains the best approach for preventing drug abuse in the workplace, despite the challenges posed by NPS and limitations of the screening methods. Nontargeted techniques using high-resolution liquid chromatography-mass spectrometry (MS)/gas chromatography–tandem MS can improve the detection and identification of drugs during WDT and provide useful information regarding the prevalence, trends, and toxicity of both traditional and NPS drugs. Finally, this review suggested that WDT can be improved by using a combination of techniques, multiple specimens, and online library searches in case of new NPS as well as by updating the methods and databases to include new NPS and metabolites as they emerge. To the best of the author's knowledge, this is the first review to address NPS as an issue in WDT and its application and propose the best methods to detect these substances in the workplace environment.

Background: The aims of the current study were to explore the true representation of female academic staff who have advanced to leadership positions in Saudi health academic institutions and to determine the possible barriers to women’s advancement to leadership positions in academia. Methodology: This was a cross-sectional study conducted between August 2022 and August 2023 using an adapted self-reported online questionnaire via Google form. Data was analyzed descriptively and comparatively by presenting frequencies with percentages besides means with standard deviations across various background categories and comparing them using student t test. Results: A total of 115 educators in health care professions participated in the study, three fifths of them were Saudi and female, with the majority being married and employed by government organizations. The most impactful structural challenges for female leadership included the centralization of decision-making within the institution, unclear organizational bylaws for leadership qualifications and appointment processes, and the existence of a wide range of administrative units. The prevailing belief that men possess superior capacity and management skills compared to women in leadership roles and the reluctance to accept women’s authority by their subordinates were identified as the most influential culture challenges for female leadership. Most influential personality-related challenges included difficulty of balancing professional responsibilities with family obligations, stress and tension arising from reconciling the needs of subordinates with organizational goals and the complexity of traveling for work. Conclusions: The study identified the most influential structural, culture, and personality-related barriers and other potential perceived challenges faced by female leadership. A collective effort involving academic institutions, leadership, and relevant stakeholders is critical to address these barriers. Academic institutions must eliminate these challenges to utilize female leaders’ talent fully, as they contribute unique perspectives and skills to their institutions.

Acute lymphoblastic leukemia (ALL) is a fatal blood disorder characterized by the excessive proliferation of immature white blood cells, originating in the bone marrow. An effective prognosis and treatment of ALL calls for its accurate and timely detection. Deep convolutional neural networks (CNNs) have shown promising results in digital pathology. However, they face challenges in classifying different subtypes of leukemia due to their subtle morphological differences. This study proposes an improved pipeline for binary detection and sub-type classification of ALL from blood smear images. At first, a customized, 88 layers deep CNN is proposed and trained using transfer learning along with GoogleNet CNN to create an ensemble of features. Furthermore, this study models the feature selection problem as a combinatorial optimization problem and proposes a memetic version of binary whale optimization algorithm, incorporating Differential Evolution-based local search method to enhance the exploration and exploitation of feature search space. The proposed approach is validated using publicly available standard datasets containing peripheral blood smear images of various classes of ALL. An overall best average accuracy of 99.15% is achieved for binary classification of ALL with an 85% decrease in the feature vector, together with 99% precision and 98.8% sensitivity. For B-ALL sub-type classification, the best accuracy of 98.69% is attained with 98.7% precision and 99.57% specificity. The proposed methodology shows better performance metrics as compared with several existing studies.

This article reports a case of an unruptured rudimentary horn viable pregnancy at 18 weeks of gestation. The diagnosis was missed at two previous cesarean sections and on a second-trimester ultrasound scan of the index pregnancy. The condition is extremely rare, life-threatening and difficult to diagnose. This case report highlights the importance of checking the anatomy of the uterus and appendages during cesarean section.

Abstract Background Currently, over two million persons are internally displaced because of the complex humanitarian emergency in Nigeria’s northeast region. Due to crowded and unsanitary living conditions, the risk of communicable disease transmission, morbidity, and mortality among this population is high. This study explored patterns and factors associated with health-seeking among internally displaced persons (IDPs) in northeast Nigeria to inform and strengthen disease surveillance and response activities. Methods In a cross-sectional study conducted during June–October 2022, we employed stratified sampling technique to select 2,373 IDPs from 12 IDPs camps. A semi-structured tool was used to collect data on health-seeking patterns, socio-demographics, households, and IDPs camps characteristics. We classified health-seeking patterns into three outcome categories: ‘facility care’ (reference category), ‘non-facility care’ (patent medicine vendors, chemists, traditional healers, religious centers), and ‘home care/no care’. We performed complex survey data analysis and obtained weighted statistical estimates. Univariate analysis was conducted to describe respondents’ characteristics and health-seeking patterns. We fitted weighted multivariable multinomial logistic regression models to identify factors associated with health-seeking patterns. Results Of 2,373 respondents, 71.8% were 18 to 39 years old, 78.1% were females, and 81.0% had no formal education. Among the respondents, 75.7% (95% CI: 72.9–78.6) sought ‘facility care’, 11.1% (95% CI: 9.1–13.1) sought ‘non-facility care’, while 13.2% (95% CI: 10.9–15.4) practiced ‘home care/no care’. Respondents who perceived illness was severe (Adjusted Odds Ratio (AOR) = 0.15, [95% CI: 0.08–0.30]) and resided in officially-recognized camps (AOR = 0.26, [95% CI: 0.17–0.39]) were less likely to seek ‘non-facility care’ compared to ‘facility care’. Similarly, respondents who resided in officially-recognized camps (AOR = 0.58, [95% CI: 0.36–0.92]), and received disease surveillance information (AOR = 0.42, [95% CI: 0.26–0.67) were less likely to practice ‘home care/no care’ rather than seek ‘facility care’. Conclusions This population exhibited heterogeneous patterns of health-seeking at facility and non-facility centers. Perception of illness severity and camps’ status were major factors associated with health-seeking. To enhance surveillance, non-facility care providers should be systematically integrated into the surveillance network while ramping up risk communication to shape perception of illness severity, prioritizing unofficial camps.

Mohamed Sheikh Hassan,1,2 Abdiwahid Ahmed Ibrahim,1 Engin Nakus,1 Bakar Ali Adam,1 Nor Osman Sidow,1 Mohamed Farah Osman Hidig,1 Said Abdi Mohamed,1 Abdulkadir Ahmed Mohamed,1 Abdulkamil Abdullahi Adani,3 Yahye Garad Mohamed,4 Ismail Gedi Ibrahim,4 Said Abdirahman Ahmed5 1Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 2Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia; 3Department of Internal Medicine, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 4Department of Radiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia; 5Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Abdiwahid Ahmed Ibrahim, Email drabdiwahid00@gmail.comAbstract: Cerebral venous thrombosis (CVT) is a less common type of stroke, mostly in young patients. The majority of these cases are due to thrombosis of superior sagittal sinus and transverse sinus. Isolated thrombosis of the inferior sagittal sinus is very rare. Here, we report a 22-year-old male patient with no significant past medical history who presented to the emergency department of our hospital with a convulsion, decreased level of consciousness, and right side weakness. His laboratory investigations, including the coagulation profile, were normal. A non-contrast brain CT showed a 5 × 3 cm hematoma in the left parasagittal parietal lobe with no associated midline shift or intraventricular extension. The cerebral magnetic resonance (MR) angiogram did not show any underlying aneurysm or vascular lesion. However, the cranial MR venogram showed inferior sagittal sinus thrombosis, while other cranial veins and dural sinuses were patent. The patient was admitted to the hospital and managed with low-molecular-weight heparin and warfarin sequentially. He had significant improvement (consciousness and weakness have improved, and seizures are under control). This present case illustrates a rare case of isolated cerebral venous thrombosis and also reviews the known literature on this condition.Keywords: cerebral venous thrombosis, inferior sagittal sinus, convulsion

The performance of a new film cooling scheme has been numerically investigated. The scheme consists of a blade-type swirl generator that adds a swirl pattern to the injected coolant stream. Reynolds-Averaged Navier-Stokes equations along with a realizable k-ε turbulence model have been solved. The film cooling effectiveness over a flat plate downstream the coolant injection hole was determined for different generator geometric parameters and operating conditions. These parameters are the generator length to the injection hole diameter ratio, twist angle, and location from the hole inlet. The operating conditions are four different blowing ratios, constant density ratio of 2.0, mainstream turbulence intensity of 5% and Reynolds number of 80,000 based on the hole diameter and mainstream velocity. The results showed an enhancement in the laterally averaged cooling effectiveness accompanied by enriched jet spreading downstream the in-hole swirl generator, while the area-averaged cooling effectiveness increased by 74%, 293%, and 805% at blowing ratios 1.0, 1.5 and 2.0, respectively, compared to that for a scheme without swirl generator. Such enhancement is attributed to the vortical structure generated and hence the interaction with the mainstream. Optimization was carried out on obtained results to determine the optimal swirl generator geometric parameters.

Ensuring environmental and human safety is a crucial requirement in modern industrial practices. Consequently, the utilization of natural substances in the tanning industry could serve as a reliable approach to prevent chemical contamination associated with the use of traditional chromium salts during the tanning process. This study aimed to assess the potential application of black liquor derived from rice straw as a tanning agent for leather. The black liquor was prepared using the Kraft method, and a modified version called modified black liquor (MBL) was created by gradually reducing the pH from 13 to 7. Subsequently, MBL was employed in the tanning of pickled sheep pelts using four different concentrations: 10%, 20%, 30%, and 40% of the pelts' weight. The physical, chemical, and organoleptic properties of the resulting MBL-tanned leathers were compared with those of leathers tanned with quebracho extracts to evaluate the suitability of MBL as a tanning agent. The findings demonstrated that MBL leathers exhibited slightly lower physical and organoleptic properties when compared to the quebracho-tanned leathers. Increasing the concentration of MBL up to 30% was sufficient to enhance the properties of the tanned leathers, while concentrations exceeding this threshold did not yield any significant improvements in the leather's properties. Consequently, the study recommends the use of MBL in leather tanning either in combination with other tanning agents or as a re-tanning agent to enhance the fullness, smoothness, and overall physical quality of the leather, thereby elevating its overall quality.

Abstract Background Autism spectrum disorder (ASD) is a neurobehavioural disorder, characterized by abnormal affiliative and socio-emotional responses which are generally regulated by certain neuropeptides in the hypothalamus (an anatomic component of the ventral diencephalon (VD)). The use of volumetric MRI for studying VD volume change could provide a novel approach for identification of structural brain changes in ASD; this could assist in understanding the pathophysiology of ASD and would reflect on treatment strategies. The aim of the current work was to investigate the role of MRI volumetric analysis of the ventral diencephalon in young children diagnosed with autism spectrum disorder. Methods Fifty children diagnosed with ASD underwent volumetric brain analysis, on a fully automated MRI brain volumetry system (volBrain), with voxel-based morphometry of various segmental structures of the brain including the VD, using vol2Brain 1.0 pipeline software analysis suite. Results There were 48 out of 50 children who demonstrated abnormal VD volume which was found below the normal limits compared with reference standard normalized volume. All cases were normocephalic demonstrating normal intra-cranial cavity volumes. Forty out of fifty cases showed increased total volume of grey matter, and eighteen out of fifty cases showed increased total volume of white matter. Regarding the amygdala and hippocampus, there were only two cases (4.0%) which showed slightly increased relative volume of the total amygdala, and two other cases (4.0%) demonstrated increased relative volume of the total hippocampus. Comparison between the autistic patients and normal references revealed a significant difference regarding the VD volume and total volume of grey matter, whereas no significant differences were found regarding the white matter amygdala and hippocampus. Conclusions Based on the consistent significant volume decrease in the ventral diencephalon in patients with childhood autism, this study concluded that volumetric MRI analysis could be useful for diagnosis of childhood spectrum disorder and could be utilized as a reliable screening method in the clinically vague cases. Further study with a larger sample size including more age groups is recommended for more validation of the results.

Introduction: Burn is defined as any injury due to heat or acute trauma, according to the International Society of Burns Injury (ISBI). A neglected aspect of our country is the gender-specific pattern of burn injuries. This study aims to highlight the gender-based disparities of burns injuries and overcome the drastic effects of burns on an individual's life. Method: The data from the burns centre of Dr Ruth.K.M.Pfau Civil Hospital Karachi from Jan 1, 2021, to Dec 31, 2021, were retrospectively analyzed to perform this study. Different variables such as aetiology, circumstances, residence, age, TBSA, degree and occupation were recorded from the patient's files. They were compared by gender to find out any existing correlation. Results: The estimated sample size was 375, 180(48%) females, and 195(52%) were burned males. A significant correlation was found for gender with a degree of burns, aetiology, age, occupation, and residence. Whereas circumstances of burns and TBSA were non-significantly correlated to gender. Conclusion: In conclusion, our study determined that men most commonly suffer from burn injuries. In contrast, thermal injury is the most dominant etiological factor in every age group in both genders. Several risk factors are associated with a specific gender, requiring adaptive prevention and management approaches to culminate this issue.

Abstract Background Staphylococcus aureus (S. aureus) is a bacterium of public health importance. The zoonotic spread of this pathogen through animal-derived foods has been reported. This systematic literature review investigates the prevalence, distribution, antimicrobial resistance (AMR) profiles, and molecular characteristics of S. aureus in the food chain in Nigeria. Methods A systematic search of online databases (Pub Med, Google Scholar, and Web of Science) for published articles from January 2002 to January 2022 was performed using the Prisma guideline. Results Fifty articles were included from an initial 511 extracted documents. These papers included research carried out in 22 states across Nigeria. S. aureus detection in most studies was above the satisfactory level for foods (≥ 104 CFU/g). The prevalence of S. aureus ranged from 1.3% in raw cow meat to 72.5% in fresh poultry meat. Most S. aureus isolates demonstrated multiple drug resistance patterns, especially being resistant to beta-lactams. There is a lack of information on the molecular typing of the S. aureus isolates. The different spa types of S. aureus isolated were t091, t314, t1476, and t4690, categorized into Multi-Locus-Sequence Types ST8, ST121, ST152, and ST789. Virulence genes detected include pvl, sea, see, spa, coa, edin, tsst, and hly. Certain AMR-encoding genes were detected, such as mecA, blaZ, fos, tet, and dfsr.. Factors contributing to the presence of S. aureus were reported as poor processing, poor sanitary conditions of the food processing units, inadequate storage units, and poor handling. Conclusion We showed that S. aureus is a major food contaminant in Nigeria despite the need for more information on the molecular typing of strains from animal-derived food sources. There is a need to control S. aureus by targeting specific entry points based on the findings on risk factors and drivers of food contamination.

Purpose – The tourism and hospitality sectors are experiencing radical innovation boosted by the advancements in Information and Communication Technologies. Increasingly sophisticated chatbots are introducing novel approaches, re-shaping the dynamics among tourists and service providers, and fostering a remarkable behavioral change in the overall sector. Therefore, the objective of this paper is two-folded: (1) to highlight the academic and industrial standing points with respect to the current chatbots designed/deployed in the tourism sector and (2) to develop a proof-of-concept embodying the most prominent opportunities in the tourism sector. Design/methodology/approach – This work elaborates on the outcomes of a Systematic Literature Review (SLR) and a Focus Group (FG) composed of experts from the tourism industry. Moreover, it presents a proof-of-concept relying on the outcomes obtained from both SLR and FG. Eventually, the proof-of-concept has been tested with experts and practitioners of the tourism sector. Findings – Among the findings elicited by this paper, we can mention the quick evolution of chatbot-based solutions, the need for continuous investments, upskilling, system innovation to tackle the eTourism challenges and the shift toward new dimensions (i.e. tourist-to-tourist-to-chatbot and personalized multi-stakeholder systems). In particular, we focus on the need for chatbot-based activity and thematic aggregation for next-generation tourists and service providers. Originality/value – Both academic- and industrial-centered findings have been structured and discussed to foster the practitioners' future research. Moreover, the proof-of-concept presented in the paper is the first of its kind, which raised considerable interest from both technical and business-planning perspectives.