Search

A cooperative shared haptic virtual environment (CSHVE), where the users can kinesthetically interact and simultaneously feel each other over the network, is beneficial for many distributed VR simulations. A little is known about the influences of the network delay on the quality of haptic sensation and the task performance in such environments. This paper has addressed these issues by conducting a subjective evaluation to the force feedback and the task performance in a tele-handshake cooperative shared haptic system for different delay setting. Also, four subjective measures to evaluate the quality of haptic in CSHVEs have been proposed. These measures are the feeling of force, the consistency between the haptic-visual feedback, the vibration, and the rebound in the haptic device. In addition, a detailed description of the haptic sensation for different time delays is also described. A network emulator was utilized to simulate the real network cloud. An objective evaluation of the force feedback and the performance showed that there was no effect of the delay on the force feedback. It had a negative impact on the task performance. In general, the quality of haptic deteriorated as the delay increased and vibration and rebound hampered the users for large time delay. The haptic-visual consistency was robust in the presented system even for large time delays. Nevertheless, the examined tele-handshake system was able to deliver a high quality of haptic sensation, good performance, and stability for large time delay over the network. [Copyright &y& Elsevier]

Context. Mutations in the androgen receptor (AR) gene result in androgen insensitivity syndrome (AIS). In milder forms of AIS, male infertility appears as primary or even sole symptom. Identification of such mutations is fundamental for accurate diagnosis and for appropriate genetic counseling. Objectives. To determine the prevalence of known point mutations in the AR gene causing male infertility in Syrian azoospermic men. Design. 15 known point mutations in the AR gene were screened in a cohort of 110 Syrian infertile men. Subjects and methods. The study involved 173 Syrian infertile men suffering from non-obstructive azoospermia. Chromosome aberrations and Y microdeletions were excluded in 110 patients, which were further tested for point mutations in the AR gene by real time PCR or DNA sequencing. Results. The prevalence of AR mutations in our cohort was 3.6% (4/110). We found two patients with the Ala474Val mutation and one patient bearing the Pro390Ser mutation. Furthermore, one patient had a new mutation, del 57Leu, described for the first time in an infertile man. None of the 50 fertile Syrian men had this mutation, indicating that it is not a sequence polymorphism in the Syrian population. Conclusion. The del 57Leu mutation in the AR gene is a possible cause of idiopathic male infertility. Furthermore, the Ala474Val and Pro390Ser mutations (previously found in several infertile men in Italy) might be significant markers for male infertility in Mediterranean populations. [ABSTRACT FROM AUTHOR]

Background and Objective: This paper proposes a fully automated and unsupervised stochastic segmentation approach using two-level joint Markov-Gibbs Random Field (MGRF) to detect the vascular system from retinal Optical Coherence Tomography Angiography (OCTA) images, which is a critical step in developing Computer-Aided Diagnosis (CAD) systems for detecting retinal diseases., Methods: Using a new probabilistic model based on a Linear Combination of Discrete Gaussian (LCDG), the first level models the appearance of OCTA images and their spatially smoothed images. The parameters of the LCDG model are estimated using a modified Expectation Maximization (EM) algorithm. The second level models the maps of OCTA images, including the vascular system and other retina tissues, using MGRF with analytically estimated parameters from the input images. The proposed segmentation approach employs modified self-organizing maps as a MAP-based optimizer maximizing the joint likelihood and handles the Joint MGRF model in a new, unsupervised way. This approach deviates from traditional stochastic optimization approaches and leverages non-linear optimization to achieve more accurate segmentation results., Results: The proposed segmentation framework is evaluated quantitatively on a dataset of 204 subjects. Achieving 0.92 ± 0.03 Dice similarity coefficient, 0.69 ± 0.25 95-percentile bidirectional Hausdorff distance, and 0.93 ± 0.03 accuracy, confirms the superior performance of the proposed approach., Conclusions: The conclusions drawn from the study highlight the superior performance of the proposed unsupervised and fully automated segmentation approach in detecting the vascular system from OCTA images. This approach not only deviates from traditional methods but also achieves more accurate segmentation results, demonstrating its potential in aiding the development of CAD systems for detecting retinal diseases., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Sickle cell disease (SCD) is an autosomal recessive genetic disorder characterized by the presence of a mutated form of hemoglobin (Hb) known as sickle hemoglobin (HbS). Individuals with SCD are susceptible to a variety of osteoarticular complications. Osteomyelitis is a commonly seen infection affecting the tibia, diaphysis of the femur and humerus, and vertebras., Aim: The aim of this study was to define the indicators suggesting the diagnosis of osteomyelitis in patients with SCD., Methods: This study is a descriptive, analytical, non-interventional, prospective study of pediatric patients with SCD admitted with vaso-occlusive crisis (VOC) and/or osteomyelitis, which were identified by laboratory and radiological features. Retrospective data was included for patients who met the inclusion criteria. The statistical analysis included a description of the primary and secondary outcomes in the cohort., Results: A total of 28 children were included in this study. Participants' ages ranged from 11 months to 13 years. Males represented the majority (64.3%) of the participants. The blood culture of most of the participants (89.3%) showed no growth; however, 7.1% had salmonella, and only 3.6% had Gram-positive cocci. Most cases (75%) had leukocytosis. Thrombocytosis was present mainly in patients with VOC (40%). CRP was 1-4.9 mg/dL, mainly in patients with osteomyelitis (50%). The ferritin level exceeded 5000 ng/mL in patients with osteomyelitis or both osteomyelitis and VOC (50%). Ultrasound examinations revealed no hip effusion in 24 of the 28 examined patients. A plain X-ray examination showed no abnormality in 24 out of the 28 examined cases; with MRI, three cases exhibited marrow edema with bone enhancement, two (66.7%) were complicated by osteomyelitis, and the last (33.3%) had osteomyelitis and VOC. Aspiration was performed only in seven of the 28 examined, of which six (85.7%) were complicated by osteomyelitis, while the last one (14.3%) had acute chest syndrome., Conclusion: Based on the outcomes of this study, we recommend an individualized multidisciplinary examination (hematology, infectious disease, orthopedic surgery, and interventional radiology) for SCD patients with suspected osteomyelitis admitted with VOC, considering the entire clinical history and laboratory and MRI results., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Academic Affairs Research Ethics Committee-King Salman Armed Forces Hospital issued approval KSAFH-REC-2021-425. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tashkandi et al.)

Background: The role of cytomegalovirus infection as an opportunistic pathogen in exacerbating ulcerative colitis and its response to treatment remain a topic of ongoing debate. Clinicians encounter numerous challenges, including the criteria for differentiating between an acute ulcerative colitis flare and true cytomegalovirus colitis, the diagnostic tests for identifying cytomegalovirus colitis, and determining the appropriate timing for initiating antiviral therapy., Case Presentation: A 28-year-old Syrian female with a seven-year history of pancolitis presented with worsening bloody diarrhea, abdominal pain, and tenesmus despite ongoing treatment with azathioprine, mesalazine, and prednisolone. She experienced a new flare of acute severe ulcerative colitis despite recently completing two induction doses of infliximab (5 mg/kg) initiated four weeks prior for moderate-to-severe ulcerative colitis. She had no prior surgical history. Her symptoms included watery, bloody diarrhea occurring nine to ten times per day, abdominal pain, and tenesmus. Initial laboratory tests indicated anemia, leukocytosis, elevated C-reactive protein (CRP) and fecal calprotectin levels, and positive CMV IgG. Stool cultures, Clostridium difficile toxin, testing for Escherichia coli and Cryptosporidium, and microscopy for ova and parasites were all negative. Sigmoidoscopy revealed numerous prominent erythematous area with spontaneous bleeding. Biopsies demonstrated CMV inclusions confirmed by immunohistochemistry, although prior biopsies were negative. We tapered prednisolone and azathioprine and initiated ganciclovir at 5 mg/kg for ten days, followed by valganciclovir at 450 mg twice daily for three weeks. After one month, she showed marked improvement, with CRP and fecal calprotectin levels returning to normal. She scored one point on the partial Mayo score. The third induction dose of infliximab was administered on schedule, and azathioprine was resumed., Conclusion: Concurrent cytomegalovirus infection in patients with inflammatory bowel disease presents a significant clinical challenge due to its associated morbidity and mortality. Diagnosing and managing this condition is particularly difficult, especially regarding the initiation or continuation of immunosuppressive therapies., (© 2024. The Author(s).)

Background: Polycystic ovary syndrome (PCOS) is a common chronic endocrine disorder in women with complex and poorly understood etiologies. The present study aimed to describe the clinical features of PCOS in a sample of Syrian women as well as the risk factors, associated comorbid diseases, and patterns and efficacy of treatment., Methods: The present study is cross-sectional observational study conducted on a sample of Syrian women diagnosed with PCOS, using self-administered questionnaire during the period between December 25, 2023 and January 18, 2024. Overall, 1666 women with PCOS were recruited through online platforms., Results: Higher frequency of PCOS was observed in young women aged 15-25 years (63.1%) and in single ladies (76.5%). The main chief complaints experienced by patients with PCOS were hirsutism (71.25%), irregular menstrual cycle (70.95%), depressed mood (53.9%), acne (49.52%), abdominal obesity (43.88%), alopecia (38.12%), and weight gain (34.57%). The most common risk factors observed in patients with PCOS were lack of physical exercise (76.4%), unhealthy food habits (51.6%), family history (38.5%), and history of taking anabolic steroids (17.2%). Comorbid diseases were found in 11.5% of PCOS patients. These diseases were hypothyroidism (5.7%), hypertension (3.06%), dyslipidemia (1.68%), heart diseases (1.56%), and diabetes mellitus (0.78%). Most patients were treated with oral contraceptive pills (82.11%) or metformin (64.83%). The efficacy of treatment was observed as complete cure in 430 patients (25.8%) and partial response alleviating symptoms in 819 patients (49.2%), while and no benefit was found in 417 patients (25%)., Conclusions: PCOS is associated with widespread dermatological and metabolic aberrations that pose psychological burden on women and increase their risk for having comorbid diseases. Most patients with PCOS do not receive adequate therapy. Understanding the risk factors and clinical features for each patient is essential to choose the proper treatment.

Aim and Background: The Hall technique preformed metal crowns (HT-PMCs) are allegedly oversized, temporarily altering inter-arch relationships. Intra-arch dimensions and leeway space (LWS) HT effects are unknown., Aim: To study single HT-PMC intra-arch effects and treated tooth dimensional changes., Materials and Methods: Split-mouth, quasi-experimental, non-randomized feasibility pilot study. Intraoral scans (iTero II®) were taken preorthodontic separator placement (scan 1 ), immediately post single HT-PMCs (scan 2 ) in 13 children, and 1 month later (scan 3 ) in eight children. Control and study quadrants' lengths ("arcs") and HT-PMCs/control tooth dimensions [mesiodistal (MD), buccopalatal/lingual (BP/L), diagonal (Diag1/Diag2)] were recorded in mm (OrthoCAD® software). Paired t -test, repeated analysis of variance (ANOVA) post hoc analysis statistics ( p < 0.05)., Results: Compared to scan 1 , the mean study arc increased by 0.7 mm (±0.5) ( n = 13, t -test, p < 0.001) at scan 2 , while at scan 3 , it increased by 0.8 mm (±0.34) ( n = 8, repeated ANOVA, p = 0.008). The HT-PMCs-treated tooth mean dimensions increased at scan 2 by 0.9 mm (MD), 0.8 mm (BP/L), 0.5 mm (Diag1), and 0.7 mm (Diag2) ( t -test, p < 0.001) with similar observations at scan 3 . There were no significant changes in the control arc or the control tooth measurements., Conclusion: One single HT-PMC increased the intra-arch quadrant length by approximately up to <1 mm. The HT-PMC-treated tooth was marginally oversized. This pilot study paves the way for a more robust study with a larger sample size., How to Cite This Article: AlRamzi B, AlHalabi M, Kowash M, et al. Do Hall Technique Crowns Affect Intra-arch Dimensions? A Split-mouth Quasi-experimental Non-randomized Feasibility Pilot Study. Int J Clin Pediatr Dent 2024;17(6):673-682., Competing Interests: Source of support: This study was funded by the postgraduate fund of Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates. Conflict of interest: NoneConflict of interest: None, (Copyright © 2024; The Author(s).)

Introduction: Thrombotic events are more than twice as common in inflammatory bowel disease patients as in the general population. We report an interesting and rare case of portal vein thrombosis as a venous thromboembolic event in the context of extraintestinal manifestations of Crohn's disease. We also conducted a literature review on portal vein thrombosis associated with inflammatory bowel disease, with the following concepts: inflammatory bowel diseases, ulcerative colitis, Crohn's disease, portal vein, and thrombosis., Case Presentation: A 24-year-old Syrian female with active chronic Crohn's disease was diagnosed 11 years ago and classified as A1L3B1P according to the Montreal classification. She had no prior surgical history. Her previous medications included azathioprine and prednisolone. Her Crohn's disease activity index was 390 points. Gastroduodenoscopy revealed grade I esophageal varices, a complication of portal hypertension. Meanwhile, a colonoscopy revealed several deep ulcers in the sigmoid, rectum, and descending colon. An investigation of portal vein hypertension revealed portal vein thrombosis. We used corticosteroids to induce remission, followed by tapering; additionally she received ustekinumab to induce and maintain remission. She began on low-molecular-weight heparin for 1 week, warfarin for 3 months, and then apixaban, a novel oral anticoagulant, after excluding antiphospholipid syndrome. Primary prophylaxis for esophageal varices was not required. After 1 year, she achieved clinical, biochemical, and endoscopic remission. Despite 1 year of treatment, a computed tomography scan revealed no improvement in portal vein recanalization., Conclusion: Portal vein thrombosis is a rare and poorly defined complication of inflammatory bowel disease. It is usually exacerbated by inflammatory bowel disease. The symptoms are nonspecific and may mimic a flare-up of inflammatory bowel disease, making the diagnosis difficult. Portal vein Doppler ultrasound for hospital-admitted inflammatory bowel disease patients may contribute to the diagnosis and management of this complication., (© 2024. The Author(s).)

Problem: Syrian medical research synthesis lags behind that of neighboring countries. The Syrian war has exacerbated the situation, creating obstacles such as destroyed infrastructure, inflated clinical workload, and deteriorated medical training. Poor scientific writing skills have ranked first among perceived obstacles that could be modified to improve Syrian research conduct at every academic level. However, limited access to personal and physical resources in conflict areas consistently hampers the implementation of standard professional-led interventions. Intervention: We designed a peer-run online academic writing and publishing workshop as a feasible, affordable, and sustainable training method to use in low-resource settings. This workshop covered the structure of scientific articles, academic writing basics, plagiarism, and the publication process. It was also supplemented by six practical assignments to exercise the learned skills. Context: The workshop targeted healthcare professionals and medicine, dentistry, and pharmacy trainees (undergraduate and postgraduate) at all Syrian universities. We employed a systematic design to evaluate the workshop's short- and long-term impact when using different instructional delivery methods and assignment formats. Participants were assigned in a stratified manner to four groups; two groups attended the workshop synchronously, and the other two groups attended asynchronously. One arm in each group underwent a supervised peer-review evaluation for the practical writing exercises (active), while the other arm in each group self-reviewed their work on the same exercises using exemplary solutions (passive). We assessed knowledge (30 questions), confidence in the learned skills (11 questions), and the need for further guidance in academic writing (1 question) before the workshop and one month and one year after it. Impact: One-hundred-twenty-one participants completed the workshop, showing improved knowledge, confidence, and need for guidance. At one-year follow-up, participants showed stability in these gains. Outcomes for the synchronous and asynchronous groups were similar. Completing practical assignments was associated with greater knowledge and confidence only in the active arms. Participants in the active arms engaging in the peer-review process showed greater knowledge increase and reported less need for guidance compared to those who did not engage in the peer-review. Lessons learned: Peer-run interventions can provide an effective, affordable alternative to improving scientific writing skills in settings with limited resources and expertise. Online academic writing training can show improvements regardless of method of attendance (i.e., synchronous versus asynchronous). Participation in supplementary practical exercises, especially when associated with peer-review, may improve knowledge and confidence.

Background: Treating Helicobacter pylori is becoming increasingly difficult with the development of bacterial resistance to many established treatment regimens. As a result, researchers are constantly looking for novel and effective treatments. This trial aims to establish the efficacy of levofloxacin-based sequential treatment regimen and concomitant levofloxacin-based regimen as empirical first-line therapy in the Syrian population., Method: This is an open-label, prospective, single-center, parallel, active-controlled, superiority, randomized clinical trial. The recruitment will target Helicobacter pylori-positive males and females between the ages of 18 and 65 to evaluate the efficacy of empirical first-line therapy in the Syrian population. We are planning to recruit up to 300 patients which is twice the required sample size. One hundred fifty individuals will be randomly assigned to undergo either a sequential levofloxacin-based treatment regimen or a concomitant levofloxacin-based regimen. High-dose dual therapy (proton-pump inhibitor and amoxicillin) will be the rescue therapy in the event of first-line failure. The first-line eradication rate in both groups is the primary outcome, and one of the secondary outcomes is the overall eradication rate of high-dose dual therapy in the event of first-line treatment protocol failure. Intention-to-treat analysis and per-protocol analysis will be used to evaluate the eradication rates of Helicobacter pylori for first-line treatment protocols., Discussion: For the first time in the Syrian population, this randomized controlled trial will provide objective and accurate evidence about the efficacy of a sequential levofloxacin-based treatment regimen., Trial Registration: ClinicalTrials.gov NCT06065267 . Registered on October 3, 2023. Prospective registered. Enrollment of the first participant has not started yet., (© 2024. The Author(s).)

Several studies have been shown that Annexin V (ANXV) autoantibodies concentrations are associated with both early recurrent pregnancy losses (RPLs) or in vitro fertilization failure (IVFf). We investigated the association between ANXV autoantibodies and ANVX levels in RPL, IVFf and normal group women. The study was conducted on 22 female patients with RPLs, 66 patients with IVFf, and 16 normal samples from women who had given birth. ANXV autoantibodies were measured using an ELISA test developed by fixing a homemade recombinant ANXV protein and examined with labeled human antibodies, while ANXV concentrations were measured by a competitive ELISA using a homemade anti ANXV polyclonal antibody. The results showed a clear relationship between the high levels of ANXV autoantibodies and the recurrent abortion. On the other hand, ANXV measurement in those patients showed decreased concentrations compared to normal samples. Negative correlation between ANXV and its autoantibodies levels was reported in almost all patients' samples. Our data supports the possibility that ANXV autoantibodies are a risk factor for reproductive failures associated with both RPLs and/or IVFf and the significant role for ANXV in the maintenance of pregnancy., (© 2023. The Author(s).)

AA amyloidosis is a rare and significant complication of long-term inflammation that can be caused by a variety of disorders, including inflammatory bowel disease, and is linked to an increased risk of morbidity and mortality. To date, there has been no effective direct treatment, and treatment aims at treating the underlying condition with potent immunosuppression to limit inflammatory activity and, as a result, switch off amyloidogenesis. Theoretically, biological treatment can control AA amyloidosis by inducing and maintaining inflammatory bowel disease remission and inhibiting the synthesis of Serum Amyloid A, which is an acute phase reactant and precursor protein of AA amyloidosis that accumulates in the organs. We report the first case of ustekinumab's therapeutic effect after infliximab's loss of response in AA amyloidosis associated with Crohn's disease. We also conducted a literature review of the therapeutic effect of biological treatment on AA amyloidosis., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leading cause of global cancer-related deaths. The American College of Radiology (ACR) introduced the Breast Imaging Reporting and Data System (BI-RADS) as a standard terminology facilitating communication between radiologists and clinicians; however, an update is now imperative to encompass the latest imaging modalities developed subsequent to the 5th edition of BI-RADS. Within this review article, we provide a concise history of BI-RADS, delve into advanced mammography techniques, ultrasonography (US), magnetic resonance imaging (MRI), PET/CT images, and microwave breast imaging, and subsequently furnish comprehensive, updated insights into Molecular Breast Imaging (MBI), diagnostic imaging biomarkers, and the assessment of treatment responses. This endeavor aims to enhance radiologists' proficiency in catering to the personalized needs of breast cancer patients. Lastly, we explore the augmented benefits of artificial intelligence (AI), machine learning (ML), and deep learning (DL) applications in segmenting, detecting, and diagnosing breast cancer, as well as the early prediction of the response of tumors to neoadjuvant chemotherapy (NAC). By assimilating state-of-the-art computer algorithms capable of deciphering intricate imaging data and aiding radiologists in rendering precise and effective diagnoses, AI has profoundly revolutionized the landscape of breast cancer radiology. Its vast potential holds the promise of bolstering radiologists' capabilities and ameliorating patient outcomes in the realm of breast cancer management.

Background: Chromosomal aberrations are as common as 13.8% in the infertile population. The incidence of pericentric inversion of chromosome 9 is approximately 1-3%. However, although these inversions do not alternate phenotype, there have been conflicting data about their effect as they were correlated with infertility, recurrent pregnancy loss, and deceased children, with no clear evidence of the inversions being the causative factor for these events., Case Presentation: We report a case report of an Arab family with many members with inv(9)(p22q13). Our proband male aged 35 years at time of presentation with primary infertility. Some members, such as a brother aged 34 years, who had this inversion suffered from recurrent pregnancy loss while other members of similar reproductive age did not., Conclusions: inv(9)(p22q13) might be a hereditary anomaly that might be a risk factor for recurrent pregnancy loss in its members., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Although most scald burn injuries involve children under six, because of the challenges of using head mounted displays with young children there is very little research exploring the use of VR in children under six. The current clinical pilot study measured the analgesic effectiveness of our new desktop VR system (with no VR helmet) in children under six during burn wound care (a within-subjects design with randomized treatment order). Between December 2021-April 2022, nine children with burn injuries (10 months to 5 years age, mean = 18 months) participated. The mean burn size was 10% Total Body Surface Area, range 2-22%. Using nurse's ratings, VR significantly reduced children's pain during burn wound care by 40% on the observational Faces, Legs, Activity, Crying, and Consolability (FLACC) pain scale. Specifically, non-parametric within-subject sign tests compared nurse's ratings of the young patients' pain during burn wound care using usual pain medications with no VR = 6.67, (SD = 2.45) vs. adjunctive Animal Rescue World VR (VR = 4.00, SD = 2.24, p < 0.01). The observational Procedure-Behavior Checklist (PBCL) nurse's scale measured a 34% reduction in anxiety with VR as compared to pharmacologic treatment alone ( p < 0.005). Similarly, when using single graphic rating scales the patients' parents reported a significant 36% decrease in their child's pain during VR ( p < 0.05), a 38% ( p < 0.005) decrease in their child's anxiety during VR, and a significant increase in patients' joy during VR. It can be concluded that during burn wound care with no distraction (traditional pain medications), children under 6 years old experienced severe pain during a 10 min burn wound cleaning session. During burn wound care combining desktop virtual reality and traditional pain medications, the same pediatric patients experienced only mild pain during burn wound cleaning/debridement. VR significantly reduced the children's pain and anxiety during burn wound care.

Standard precautions practices are crucial management skills among nurses against the highly infectious novel COVID-19. The study aimed to investigate the level of nurses' compliance infected with standard precautions, and identify the main challenges experienced by nurses during their work with COVID-19 patients. A cross-sectional survey design was used. The study was done at the beginning of the pandemic in public and private hospitals in Jordan. About 386 front-line nurses filled out the online questionnaire. Most of the participants revealed dealing with COVID-19 patients (73.6%). Generally, nurses demonstrated a good level of compliance with standard practices (71%). The staff reported that they mostly adhere to performing hand hygiene after all procedures (65.8%). On the other hand, they were the least adherence to maintaining a physical distance of patients and staff of at least 6 feet apart (28.5%). Strict observation of the compliance of nurses with the standard precautions practices is crucial to be maintained at the highest level to eliminate the spreading of COVID-19 among other community members. More efforts should be come to light including continuous training and education sessions to enhance nurses' level of knowledge and practice concerning controlling the outbreak of the novel pandemic.

Ustekinumab is not recommended for the treatment of children with inflammatory bowel disease, but its off-label use is increasing despite a lack of pediatric pharmacokinetic data. The purpose of this review is to evaluate the therapeutic effects of Ustekinumab on children with inflammatory bowel disease and to recommend the best treatment regimen. Ustekinumab was the first biological treatment for a 10-year-old Syrian boy with steroid-refractory pancolitis who weighed 34 kg. A 260 mg/kg (~6 mg/kg) intravenous dose was followed by 90 mg of subcutaneous Ustekinumab at week 8 (induction). The patient was supposed to receive the first maintenance dose after twelve weeks, but after ten weeks, he developed acute severe ulcerative colitis which was managed according to treatment guidelines, except receiving 90 mg of subcutaneous Ustekinumab when he was discharged. The maintenance dose of 90 mg subcutaneous Ustekinumab was intensified to every 8 weeks. Throughout the treatment period, he achieved and maintained clinical remission. In pediatric inflammatory bowel disease, a dose of intravenous ~6 mg/kg of Ustekinumab is a common induction regimen, while children weighing < 40 kg may require a dose of 9 mg/kg. For maintenance, children may require 90 mg of subcutaneous Ustekinumab every 8 weeks. The outcome of this case report is interesting with improved clinical remission and highlighting the expansion of clinical trials on Ustekinumab for children., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background and Aims: Excessive pain during medical procedures is a worldwide medical problem. Most scald burns occur in children under 6, who are often undermedicated. Adjunctive Virtual Reality (VR) distraction has been shown to reduce pain in children aged 6-17, but little is known about VR analgesia in young children. This study tests whether desktop VR (VR Animal Rescue World) can reduce the just noticeable pressure pain of children aged 2-10., Methods: A within-subject repeated measures design was used. With treatment order randomized, each healthy volunteer pediatric participant underwent brief cutaneous pressure stimuli under three conditions: (1) no distraction, (2) a verbal color naming task (no VR), and (3) a large TV-based desktop VR distraction. A hand-held Wagner pressure pain stimulation device was used to generate just noticeable pain sensations. Participants indicated when a steadily increasing non-painful pressure stimulus first turned into a painful pressure sensation (just noticeable pain)., Results: A total of 40 healthy children participated (43% aged 2-5 years; and 57% aged 6-10 years). Compared to the no distraction condition, the 40 children showed significant VR analgesia (i.e., a significant reduction in pain sensitivity during the VR Animal Rescue World condition), t (39) = 9.83, p < 0.001, SD = 6.24. VR was also significantly more effective at reducing pain sensitivity vs. an auditory color naming task, t (39) = 5.42, p < 0.001, SD = 5.94. The subset of children aged 2-5 showed significant reductions in pain during VR. Children under 6 showed greater sensitivity to pain during no distraction than children aged 6-10., Conclusion: During no distraction, children under 6 years old were significantly more sensitive to pain than children aged 6-10. Virtual reality (VR) significantly reduced the "just noticeable" pressure pain sensitivity of children in both age groups., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Alrimy, Alhalabi, Malibari, Alzahrani, Alrajhi, Alhalabi and Hoffman.)

Activated protein C resistance (APCR) is a common thrombophilia, caused mainly by a mutation. The impact of APCR on the efficacy of In Vitro Fertilization (IVF) are still unclear, and no solid recommendations for its management were published. To investigate the effect of APCR on IVF outcomes and assess the efficacy of our management protocol, we retrospectively scanned the medical records of women who were tested with APCR assay in 2019 at our fertility centre. The 66 women (12%) positive for APCR had lower odds of reaching clinical pregnancies after IVF 0.18 [95% CI: 0.07-0.47] and fewer live births. The administration of low-molecular-weight heparin and aspirin associated with more implantation in treated compared to untreated APCR-positive women with an odds ratio of 43.2 [7.51-248.6]. In conclusion, APCR negatively affects the number of clinical pregnancies after IVF, but anticoagulation therapy can mitigate this effect and significantly increase clinical pregnancies.Impact Statement What is already known on this subject? The evidence about the impact of APCR on IVF outcomes is still inconclusive. According to the Canadian guideline, routine screening for thrombophilia in patients with recurrent pregnancy loss is not recommended. No clear recommendations regarding the management of APCR in the planning for IVF are yet available. What do the results of this study add? APCR significantly increases implantation failure among infertile women who conduct IVF. Management of APCR using LMWH and aspirin was effective in mitigating this effect and increasing successful implantation. What are the implications of these findings for clinical practice and/or further research? Our findings can support the recommendation to include APCR assay in the routine tests for infertile women conducting IVF, and suggest the combination between LMWH and aspirin as an effective therapy to increase successful implantation in APCR positive candidates. However, more controlled clinical trials are still needed to confirm our results.

Rationale: Inflammatory bowel disease patients may suffer from extraintestinal manifestations. Although muscles, joints, and skin are the most commonly affected, respiratory involvement is more prevalent than previously believed, and the majority of these patients have no symptoms. Although the large airways are the most frequently affected, the small airways, lung parenchyma, and pulmonary vasculature may also be affected., Patient Concerns: A 24-year-old nonsmoking Syrian female was referred to the pulmonary medicine clinic in December 2020 due to a chronic cough. Her cough had been present for the last year, it was described as scratchy, and produced small amounts of mucoid sputum occasionally. She denied any related wheeze, hemoptysis, weight loss, or night sweats. Multiple courses of antibiotics were prescribed by many doctors, also previous chest radiographs were reported as normal. She was diagnosed with ulcerative colitis in 2012 after presentation with abdominal pain and per rectal bleeding. The diagnosis was confirmed via colonoscopy and colon biopsies, with no prior surgery. Her past medications included prednisone, mesalamine, azathioprine, and infliximab. Tests, including complete blood count, C-reactive protein (CRP), fecal calprotectin, and chest X-ray, were normal., Diagnosis: Ulcerative colitis-associated bronchiectasis was established through history and clinical examination beside pulmonary function test, which revealed a mild obstructive pattern, and a chest computed tomography follow-up that revealed bilateral bronchiectasis., Interventions: Bronchiectasis was treated with inhaled oral steroids and sputum expectoration while she continued mesalamine and azathioprine for ulcerative colitis., Outcome: Cough improvement and sustained ulcerative colitis remission., Conclusions: Identification of inflammatory bowel disease pulmonary exacerbation is probably poor, as pulmonary symptoms might emerge at any moment during the illness, and are most commonly diagnosed later in life and with the disassociation of inflammatory bowel disease activity. Pulmonologists should be involved in the care of inflammatory bowel disease patients who developed lung symptoms., Competing Interests: Competing interests: The authors have no funding and conflicts of interest to declare., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Vitamin D has recently raised a great deal of controversy, not because of its traditional role of absorbing calcium and maintaining bone health, but because of its unconventional role as an endocrine factor and the extent of its impact when linked to its specific receptors (VDR) found in different tissues. Research has raced trying to find its different roles in those tissues and its association with different clinical or medical conditions, and among these cases, its role in reproductive functions and fertility in women, these studies conflicted between supporting and denying the role of vitamin D in reproductive function and rejecting this hypothesis according to the results of their study., Materials and Methods: The in vitro fertilization process allowed us to study the possible hypotheses, as this technique provides an opportunity to study the relationship between vitamin D levels with the in vitro fertilization outcomes, thus providing us with an idea of the relationship of vitamin D with fertility in women. In order to study this relationship, we designed our research as a cross-sectional study to confirm or deny this claim. Vitamin D was measured in the blood and in the follicular fluid for all cases using the electrochemiluminescence immunoassay (ECLIA) for the assay of total vitamin D, then IVF outcomes were compared with the levels of vitamin D in the blood., Results: the levels of vitamin D are not related to the criteria of eggs such as the number of eggs and the maturity rate (MR) of eggs, but they are correlated in a statistically significant manner with the fertility rate (FR), and at the same time the levels of vitamin D in the blood were completely independent of the clinical pregnancy rate (CPR)., Conclusion: blood vitamin D levels will affect the FR when its levels in the blood drop below a specified value, vitamin D did not correlate with the CPR. In the long run, there is scope for more research projects on vitamin D. Future research could include case-control studies of patients on vitamin D supplementation, and the study of its correlation with IVF outcomes., Competing Interests: The authors declare no conflicts of interest., (© 2022 The Authors.)