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Background: Globally, sexually transmitted infections (STIs) collectively cause 2.3 million deaths and 1.2 million cases of cancer annually. However, the epidemiology of STIs in the Middle East and North Africa (MENA) is not well assessed because of various social and cultural factors., Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and covering 23 MENA countries, 19 STIs, and data from 20,435,971 participants. PubMed, Embase, regional and international databases, and country-level reports were searched up to May 2024., Results: The analysis revealed significant regional variations in the prevalence of STIs within the MENA region. In North Africa, the most common STIs were bacterial vaginosis (31%), human papillomavirus (HPV, 23%), and Candida spp. (15%). In the Gulf Cooperation Council region and Yemen, Ureaplasma (25%), nongonococcal urethritis (NGU, 16%), and Mycoplasma spp. (12%) were the predominant infections. In the Levant region, the top STIs were HPV (20%), hepatitis B virus (HBV, 9%), and Candida spp. (9%). In Iran, Ureaplasma spp. (18%), HPV (17%), and cytomegalovirus (8%) were the most prevalent infections, whereas Ureaplasma spp. (20%), Candida spp. (18%), and HPV (16%) were most frequently detected in Türkiye. Gender-based disparities were observed, with a higher prevalence of Ureaplasma spp., Neisseria gonorrhoeae, and herpes in men and higher rates of Mycoplasma spp., HPV, HBV, and Candida spp. in women. Overall, high rates of nongonococcal urethritis (16.3%), Ureaplasma spp. (13.7%), HPV (12.7%), and Candida spp. (9.4%) were recorded in the MENA region., Conclusions: Most MENA countries lack national STI screening programs, and the reported data are primarily from symptomatic individuals. Establishing robust surveillance systems, addressing stigma and barriers to healthcare access, and expanding STIs screening and vaccination programs are crucial for accurately capturing the true burden of STIs in MENA countries., (© 2024. The Author(s).)

Breast reconstruction in postbariatric patients presents unique challenges due to substantial weight loss-induced body deformities. We present the case of a 51-year-old woman with massive lower abdominal deformities who underwent a mastectomy treatment followed by a temporary expander-based reconstruction. A year later, a fleur-de-lis-shaped free deep inferior epigastric artery perforator flap and abdominoplasty were performed for autologous reconstruction and abdominal contouring. This design addressed both purposes while allowing a voluminous flap to be harvested on periumbilical perforators. No postoperative complications were found, and the outcomes were favorable. Although deep inferior epigastric artery perforator flaps are standard in autologous breast reconstruction, our case demonstrates the utility of the fleur-de-lis design in massive weight loss patients for vascular safety and volume enhancement. Finally, we discuss this rarely described approach and compare it with other variants, showcasing versatility in addressing complex reconstruction needs in this particular patient population., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Axillary hidradenitis suppurativa (HS) can result in significant functional impairment in both personal and professional lives. Stage 3 HS requires radical surgical treatment. Flap reconstruction allows for faster healing and better functional and aesthetic outcomes. We compared the results of thoracodorsal artery perforator (TDAP) and propeller inner arm artery perforator (IAAP) flap reconstructions after radical surgical treatment of axillary HS., Methods: We conducted a retrospective study that included 13 consecutive patients who underwent stage 3 axillary HS treatment between August 2015 and January 2023. Seven patients underwent reconstruction by islanded TDAP flaps, whereas six patients underwent reconstruction by propeller IAAP flaps, with one patient undergoing bilateral reconstruction. The data collected from the patient records included age, gender, smoking status, body mass index, comorbidities, operative time, defect size, flap size, hospital stay, and complications., Results: Although not statistically significant ( P = 0.1923), a higher rate of flap complications is reported here with propeller IAAP flaps (42.86 %), whereas islanded TDAP flaps had no flap complications (0%). We found a statistically significant difference in operative time ( P = 0.0006), defect size ( P = 0.0064), and flap size ( P = 0.0012) between the two groups. All patients exhibited satisfactory functional and aesthetic outcomes. Fourteen flaps were performed in total; only one case exhibited recurrence (7.14%)., Conclusion: After radical surgical management, both islanded TDAP and propeller IAAP flap reconstructions offer excellent outcomes for stage 3 axillary HS. We strongly encourage our peers to consider performing perforator flaps over secondary healing for these patients with a major functional impairment., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Objective: To test medical students' perceptions of the impact of artificial intelligence (AI) on radiology and the influence of these perceptions on their choice of radiology as a lifetime career., Methods: A cross-sectional multicenter survey of medical students in Saudi Arabia was conducted in April 2019., Results: Of the 476 respondents, 34 considered radiology their first specialty choice, 26 considered it their second choice, and 65 considered it their third choice. Only 31% believed that AI would replace radiologists in their lifetime, while 44.8% believed that AI would minimize the number of radiologists needed in the future. Approximately 50% believed they had a good understanding of AI; however, when knowledge of AI was tested using five questions, on average, only 22% of the questions were answered correctly. Among the respondents who ranked radiology as their first choice, 58.8% were anxious about the uncertain impact of AI on radiology. The number of respondents who ranked radiology as one of their top three choices increased by 14 when AI was not a consideration. Radiology conferences and the opinions of radiologists had the most influence on the respondents' preferences for radiology., Conclusion: The worry that AI might displace radiologists in the future had a negative influence on medical students' consideration of radiology as a career. Academic radiologists are encouraged to educate their students about AI and its potential impact when students are considering radiology as a lifetime career choice., Advances in Knowledge: Rapid advances of AI in radiology will certainly impact the specialty, the concern of AI impact on radiology had negative influence in our participants and investing in AI education and is highly recommended., Competing Interests: Declaration of interest: The authors declare no conflict of interest., (© 2020 The Authors. Published by the British Institute of Radiology.)

Recently, many platforms have outsourced tasks to numerous smartphone devices known as Mobile Crowd-sourcing System (MCS). The data is collected and transferred to the platform for further analysis and processing. These data needs to maintain confidentiality while moving from smartphones to the platform. Moreover, the limitations of computation resources in smartphones need to be addressed to balance the confidentiality of the data and the capabilities of the devices. For this reason, elliptic curve cryptography (ECC) is accepted, widespread, and suitable for use in limited resources environments such as smartphone devices. ECC reduces energy consumption and maximizes devices' efficiency by using small crypto keys with the same strength of the required cryptography of other cryptosystems. Thus, ECC is the preferred approach for many environments, including the MCS, Internet of Things (IoT) and wireless sensor networks (WSNs). Many implementations of ECC increase the process of encryption and/or increase the space overhead by, for instance, incorrectly mapping points to EC with extra padding bits. Moreover, the wrong mapping method used in ECC results in increasing the computation efforts. This study provides comprehensive details about the mapping techniques used in the ECC mapping phase, and presents performance results about widely used elliptic curves. In addition, it suggests an optimal enhanced mapping method and size of padding bit to secure communications that guarantee the successful mapping of points to EC and reduce the size of padding bits.