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Ali AlSahow,1 Bassam Bulbanat,2 Bassam Alhelal,3 Khaldoun Alhumoud,4 Ahmad Alkharaza,5 Torki Alotaibi,6 Heba Alrajab,7 Anas Alyousef,8 Fatimah Hadi9 1Nephrology division, Jahra Hospital, Al Jahra, Kuwait; 2Cardiac Center, Amiri Hospital, Kuwait City, Kuwait; 3Nephrology Division, Adan Hospital, Hadiya, Kuwait; 4Al salam International Hospital, Kuwait City, Kuwait; 5Cardiology Division, Adan Hospital, Hadiya, Kuwait; 6Hamad AlEssa Transplant Center, Ibn Sina Hospital, Kuwait City, Kuwait; 7Nephrology Division, Farwaniya Hospital, Sabah Al Nasser, Kuwait; 8Nephrology Division, Amiri Hospital, Kuwait City, Kuwait; 9Cardiology Division, Chest Diseases Hospital, Kuwait City, KuwaitCorrespondence: Ali AlSahow, Nephrology Division, Department of Medicine, Jahra Hospital, Bishr Bin Awana, Jahra, 00004, Kuwait, Email alsahow@hotmail.comIntroduction: Hyperkalemia is common in heart failure (HF) patients on renin angiotensin aldosterone inhibitors (RAASi), in chronic kidney disease (CKD), and in hemodialysis, and it negatively impacts their management. New potassium binders, such as sodium zirconium cyclosilicate (SZC), are effective in management of acute and chronic hyperkalemia. However, guidelines inconsistencies and lack of standardized treatment protocols are hindering proper and wider use of such agents. Therefore, an expert panel from Kuwait developed a consensus statement to address hyperkalemia management in acute settings, in HF, in CKD, and in hemodialysis.Methods: A three-step modified Delphi method was adopted to develop the present consensus, which consisted of two rounds of voting and in-between a virtual meeting. Twelve experts from Kuwait participated in this consensus. Statements were developed and shared with experts for voting. A meeting was held to discuss statements that did not reach consensus at the first round and then the remaining statements were shared for final voting.Results: The consensus consists of 44 statements involving an introduction to and the management of hyperkalemia in acute settings, HF, CKD, and hemodialysis. Thirty-six statements approved unanimously in the first vote. In the second vote, four statements were removed and four were approved after editing.Conclusion: Hyperkalemia management lacks standardized definitions, treatment thresholds and consistent guidelines and laboratory practices. This consensus is in response to lack of standardized treatment in the Arabian Gulf, and it aims to establish guidance on hyperkalemia management for healthcare practitioners in Kuwait and highlight future needs.Keywords: chronic kidney disease, heart failure, hemodialysis, hyperkalemia, potassium binders

Ahmed Fathi Elkeraie,1 Saeed Al-Ghamdi,2 Ali K Abu-Alfa,3 Torki Alotaibi,4 Ali Jasim AlSaedi,5 Abdulkareem AlSuwaida,6 Mustafa Arici,7 Tevfik Ecder,8 Mohammad Ghnaimat,9 Mohamed Hany Hafez,10 Mohamed H Hassan,11 Tarik Sqalli12 1Department of Internal Medicine and Nephrology, Alexandria University, Alexandria, Egypt; 2Department of Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut, Beirut, Lebanon; 4Transplant Nephrology, Hamed Al-Essa Organ Transplant Center, Sabah Health Region, Kuwait City, Kuwait; 5Department of Nephrology, College of Medicine, University of Baghdad, Nephrology and Transplantation Center, Medical City Complex, Baghdad, Iraq; 6Department of Medicine, King Saud University, Riyadh, Saudi Arabia; 7Department of Nephrology, Faculty of Medicine, Hacettepe University, Altındağ, Ankara, Turkey; 8Department of Medicine, Istinye University; Division of Nephrology, Topkapı, Istanbul, Turkey; 9Department of Nephrology, Specialty Hospital, Jaber Ibn Hayyan St. Shmeisani, Amman, Jordan; 10Department of Nephrology and Medicine, Cairo University, Cairo, Egypt; 11Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; 12Department of Nephrology, Moroccan Society of Nephrology, Casablanca, MoroccoCorrespondence: Ahmed Fathi Elkeraie, Department of Internal Medicine and Nephrology Alexandria University, Alexandria, Egypt, Email drahmed@hotmail.comAbstract: Chronic kidney disease (CKD) is a major public health concern in the Middle East and Africa (MEA) region and a leading cause of death in patients with type 2 diabetes mellitus (T2DM) and hypertension. Early initiation of sodium-glucose cotransporter - 2 inhibitors (SGLT-2i) and proper sequencing with renin-angiotensin-aldosterone system inhibitors (RAASi) in these patients may result in better clinical outcomes due to their cardioprotective properties and complementary mechanisms of action. In this review, we present guideline-based consensus recommendations by experts from the MEA region, as practical algorithms for screening, early detection, nephrology referral, and treatment pathways for CKD management in patients with hypertension and diabetes mellitus. This study will help physicians take timely and appropriate actions to provide better care to patients with CKD or those at high risk of CKD.Keywords: chronic kidney disease, nephrology referral, screening, sodium-glucose cotransporter-2 inhibitors

Abdulrhman Alghamdi,1,2 Abdullah Alshibani,1,2 Meshary Binhotan,1,2 Mohmad Alsabani,2,3 Tareq Alotaibi,2,4 Rayan Alharbi,5 Abdullah Alabdali1,2 1Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 3Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 4Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Department of Emergency Medical Service, College of Applied Medical Sciences, Jazan University, Jazan, Saudi ArabiaCorrespondence: Abdulrhman Alghamdi, Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, P.O. Box.3660, Riyadh, 11481, Saudi Arabia, ; +96611 429 51986, Email Ghamdia@ksau-hs.edu.saPurpose: Paramedics’ decision to notify receiving hospitals and transport patients to an appropriate healthcare facility is based on the Prediction of Intensive Care Unit (ICU) and Hospital Admissions guide. This study aimed to assess the paramedics’ gestalt on both ward and ICU admission.Patients and Methods: A prospective study was conducted at King Abdulaziz Medical City between September 2021 and March 2022. Paramedics were asked several questions related to the prediction of the patient’s hospital outcome, including emergency department (ED) discharge or hospital admission (ICU or ward). Additional data, such as the time of the ambulance’s arrival and the staff years of experience, were collected. The categorical characteristics are presented by frequency and percentage for each category.Results: This study included 251 paramedics and 251 patients. The average age of the patients was 62 years. Of the patients, 32 (12.7%) were trauma, and 219 (87.3%) were non-trauma patients. Two-thirds of the patients (n=171, 68.1%) were predicted to be admitted to the hospital, and 80 (31.8%) of the EMS staff indicated that the patient do not need a hospital or an ambulance. The sensitivity, specificity, PPV, and NPV of the emergency medical service (EMS) staffs’ gestalt for patient admission to the hospital were, respectively (77%), (33%), (16%), and (90%). Further analysis was reported to defend the EMS staffs’ gestalt based on the level of EMS staff and the nature of the emergency (medical vs trauma), are reported.Conclusion: Our study reports a low level of accurately predicting patient admission to the hospital, including the ICU. The results of this study have important implications for enhancing the accuracy of EMS staff predictive ability and ensuring that patients receive appropriate care promptly.Keywords: emergency medical service, predictably, hospital admission, ambulance, patient discharge, sensitivity, specificity, positive predictive value, negative predictive value

Shaya Yaanallah AlQahtani,1 Ahmed Anwer Alabdulqader,2 Waleed Abdulrahman Al Mashhour,3 Zahra Mohammed Aldawood,4 Osama Ali Al Masari,1 Thabit Alotaibi,1 Zeead M AlGhamdi,5 Ibrahim M Alzahrani,6 Noor Nabil Albaloushi7 1Department of Internal Medicine and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2King Fahad Hospital Hofuf, Hofuf, Saudi Arabia; 3Dammam Medical Complex, Dammam, Saudi Arabia; 4King Khalid Hospital- AlKharaj, Alkharaj, Saudi Arabia; 5Thoracic Surgery Division, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 6Department of Internal medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia; 7Ministry of Health, Dammam, Saudi ArabiaCorrespondence: Shaya Yaanallah AlQahtani, Department of Internal Medicine and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box. 2208, Dammam, 31952, Saudi Arabia, Email saalQahthani@iau.edu.saObjective: We aim to identify the clinical characteristics and outcome of vaccine breakthrough infection in critically ill COVID-19 patients and to compare the clinical course of disease between vaccinated and non-vaccinated patients.Methods: A retrospective review of all adult patients aged ≥ 18 years admitted to the ICU in King Fahd Hospital of the University in Saudi Arabia with positive COVID-19 RT-PCR test between the period of January 1st to August 31st, 2021, were included. The recruited patients were grouped in to “vaccinated and non-vaccinated group” based on their immunization status. The demographic data, co-morbidities, modality of oxygen support, ICU length of stay (ICU LOS) and mortality were collected and analyzed.Results: A total of 167 patients were included. Seventy-two patients (43%) were vaccinated. Cardiovascular diseases were higher among the vaccinated group (33.3% vs 12.6%, p value < 0.001). Requirements of Non-invasive ventilation was significantly lower in vaccinated group compared to non-vaccinated group (73.6% vs 91.6%, p value < 0.011). The rates of intubation were similar between both groups. The total intubation days was longer in non-vaccinated patients compared to vaccinated patients and the median duration of intubation was 8 days vs 2 days, respectively (p value 0.027). In subgroup analysis, the P/F ratio was significantly higher in patients who received two doses of vaccine compared to single dose (p value < 0.002).Conclusion: In critically ill COVID-19 patients, the vaccinated group has significantly less need for Non-invasive ventilation, fewer intubation days and less hypoxia compared to non-vaccinated patients. We recommend more policies and public education nationwide and worldwide to encourage vaccination and raise awareness of the general population.Keywords: COVID-19 vaccine, breakthrough infection, intensive care unit, vaccine effectiveness, inflammatory markers

Saeed Al-Ghamdi,1 Ali Abu-Alfa,2 Turki Alotaibi,3 Ali AlSaaidi,4 Abdulkareem AlSuwaida,5 Mustafa Arici,6 Tevfik Ecder,7 Ahmed F El Koraie,8 Mohamed Ghnaimat,9 Mohamed H Hafez,10 Mohamed Hassan,11 Tarik Sqalli12 1Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom Saudi of Arabia; 2Department of Nephrology and Hypertension, American University of Beirut, Beirut, Lebanon; 3Department of Transplant Nephrology, Hamed Al-Essa Organ Transplant Center, Kuwait City, Kuwait; 4Department of Nephrology, College of Medicine, University of Baghdad, Nephrology and Transplantation Center, Medical City Complex, Baghdad, Iraq; 5Department of Medicine, King Saud University, Riyadh, Saudi Arabia; 6Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey; 7Department of Nephrology, Demiroglu Bilim University Faculty of Medicine, Istanbul, Turkey; 8Department of Internal Medicine and Nephrology, Alexandria Faculty of Medicine, Alexandria, Egypt; 9Department of Nephrology Specialty Hospital, Amman, Jordan; 10Department of Nephrology and Medicine, Cairo University, Cairo, Egypt; 11Department of Medical Affairs, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; 12Department of Nephrology, Moroccan Society of Nephrology, Casablanca, MoroccoCorrespondence: Mohamed Hassan, Department of Medical Affairs, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, Tel +971 508187944, Email mohamedhas@msn.comAbstract: The burden of chronic kidney disease (CKD) and other comorbidities, such as hypertension and diabetes, which increase the risk of developing CKD, is on the rise in the Middle East and Africa. The Middle East and Africa CKD (MEA-CKD) steering committee, comprising eminent healthcare specialists from the Middle East and Africa, was formed to identify and propose steps to address the gaps in the management of CKD in these regions. The current article lists the MEA-CKD steering committee meeting outcomes and evaluates the available evidence supporting the role of novel therapeutic options for patients with CKD. The need of the hour is to address the gaps in awareness and screening, early diagnosis, along with referral and management of patients at risk. Measures to bring about appropriate changes in healthcare policies to ensure access to all benefit-proven protective therapies, including novel ones, at community levels are also vital for reducing the overall burden of CKD on the healthcare system as well as governing bodies, especially in developing countries of the Middle East and Africa.Keywords: chronic kidney disease, Middle East and Africa, CKD management, CKD management gaps, CKD concerns, novel therapies

Fahad Dakheel Alosaimi,1 Mohammed Asiri,2 Saleh Alsuwayt,2 Tariq Alotaibi,2 Mohammed Bin Mugren,2 Abdulmalik Almufarrih,2 Saad Almodameg,2 1Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia; 2College of Medicine, King Saud University, Riyadh, Saudi Arabia Background: A number of reports suggest a link between depression and nonadherence to recommended management for end-stage renal disease (ESRD) patients on maintenance dialysis. However, the relationship between nonadherence and other psychosocial factors have been inadequately examined. Objectives: To examine the prevalence of psychosocial factors including depression, anxiety, insecure attachment style, as well as cognitive impairment and their associations with adherence to recommended management of ESRD. Methods: A cross-sectional observational study was carried out from 2014 to 2015. Chronic dialysis patients were recruited conveniently from four major dialysis units in Riyadh, Saudi Arabia. Nonadherence was defined as decreased attendance in dialysis sessions, failure to take prescribed medications, and/or follow food/fluid restrictions and exercise recommendations. Results: A total of 234 patients (147 males and 87 females) were included in this analysis, with 45 patients (19.2%) considered as nonadherent (visual analog scale < 8). Approximately 17.9% of the patients had depression (Patient Health Questionnaire score ≥10), 13.2% had anxiety (Hospital Anxiety and Depression scale-anxiety >7), while 77.4% had cognitive impairment (Montreal Cognitive Assessment score

OBJECTIVE: Emotional intelligence is the ability to monitor one's emotions and feelings and those of others, to distinguish between them, and to use this information to guide one's thoughts and actions. A growing body of evidence suggests that highly emotionally intelligent student groups have better academic performance, better emotional awareness, and relationship management. We set forward to determine if any such positive relation exists among medical students. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted on undergraduate medical students of Majmaah University. Convenient sampling was done to enroll the consenting students. A self-administered questionnaire on emotional intelligence was adapted from a model by Paul Mohapel. The questions based on a 5-point Likert scale assessed the four domains of emotional intelligence i.e., emotional awareness, emotional intelligence; demographic details and grade-point averages (GPA) were also collected. The data was tabulated and analyzed using SPSS 22.0 (IBM Corp., Armonk, NY, USA). RESULTS: Hundred and forty medical undergraduates enrolled in the study with a male-tofemale ratio of 1:06. The median semester score was 4.47 (range 1.1-5.8) and the median cumulative score was 4.44 (range 2.8-5.0). The emotional management score was highest among those with a CGPA >4.50 (p=0.048). A significantly higher mean emotional awareness score (p<0.001), social-emotional awareness score (p<0.001), and relationship management score (p=0.030), and the mean EQ total was higher among males than for females (p<0.001). A small but significant correlation was observed and also with EQ total score (r= 0.18, p= 0.032). CONCLUSIONS: Emotional management affects the academic performance of medical students. There should be more sessions to improve the emotional intelligence of the students so that it can aid in their academic performance. [ABSTRACT FROM AUTHOR]

The purpose of the current study is to find exact travelling wave solutions of the Rosenau equation. By the use of the extended auxiliary equation method, various exact solutions are obtained in terms of Jacobi elliptic functions and exponential functions. Moreover, several solitary and periodic wave solutions are given as special cases. When the parameters take some values, some graphical illustrations are shown in order to understand the behaviour of these new solutions. Furthermore, we compare our solutions with some familiar solutions, which can be considered as special cases.

Background and Objective: Sickle cell disease (SCD) complications, such as sickle cell nephropathy (SCN), may begin in childhood and progress insidiously to chronic kidney disease in adulthood. In Saudi Arabia (SA), there is a lack of studies evaluating kidney function in children with SCD. This study aims to assess microalbuminuria (MA) as an early marker of renal dysfunction in SCD children living in the Eastern region of SA, to potentially institute appropriate early treatment., Materials and Methods: A prospective cross-sectional study was conducted on 114 Saudi children with SCD under the age of 14 years who attended the pediatric hematology clinic for routine follow-up. Demographic and clinical information were collected from the patients and their parents, who provided informed consent. Morning urine samples were collected and tested for the presence of MA using the urinary albumin/creatinine ratio (ACR). Blood samples were also collected for basic laboratory investigations. The prevalence of MA and its correlation with various clinical and laboratory data were analyzed. Additionally, a comparison of clinical characteristics and MA was conducted between children originating from the Southwestern (SW) and Eastern regions of the country, all of whom lived in the Eastern Province., Results: A total of 114 children with SCD were included in the study. The mean age was 8.8 ± 3.2 years, with a male-to-female ratio of 1.3:1. Based on their region of origin, they were divided into two groups: Eastern (n = 26/114) and SW (n = 88/114). MA was detected in 28 patients (24.6%), with no significant difference in prevalence between the two groups. There was no significant statistical difference in clinical and laboratory data between the groups, except for hemoglobin F (HBF) levels and the use of hydroxyurea (HU). HBF levels were significantly higher in children from the Eastern region, while more SW patients used HU. No correlation was found between MA and any of the studied variables., Conclusion: MA is common in children with SCD in the Eastern region of SA, with no difference in its prevalence between children of the two different ancestries carrying the Arab-Indian (AI) and African haplotypes. It is not associated with any of the studied clinical variables in this report. Further studies are needed to confirm these findings., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Armed Forces Hospitals Eastern Province Institutional Review Board (IRB) issued approval AFHER-IRB-2021-018. Approval is granted with the understanding that the King Abdulaziz City for Science and Technology (KACST) Implementing Regulations of the Law of Ethics of Research will be strictly adhered to. 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, Zayed et al.)

Objectives: To report the development and administration of the Saudi pediatric speech intelligibility (SPSI) test., Methods: This study was carried out at King Abdullah Ear Specialist Center, King Saud University, Riyadh, Saudi Arabia, between 2021 and 2023. A pilot study was carried out in 5 regions of Saudi Arabia including 100 normal hearing children aged 7-11 years old, with 20 children from each region. The final test materials were voice-recorded by a native Saudi radio announcer, and a software-based application for administering the SPSI was developed., Results: During the pilot study, minor adjustments were carried out to the test for more clarity. The developed SPSI software is an android-based application that includes features like automatic result calculation, data saving, and individual user accounts for examiners to review results. The SPSI test comprises 4-word cards and 2 sentence cards, each with 5 pictures, and operates in 3 modes: quiet, background noise, and competing sentences., Conclusion: The SPSI test has been developed in an android-based software using the Saudi local dialects. It can facilitate comprehensive and accurate assessment of speech intelligibility, particularly in children with hearing impairments., (Copyright: © Saudi Medical Journal.)

Background: Since its debut in 1949, lithium (Li) has been regarded as a gold standard therapy for mood stabilization. Neuroprotective effects of Li  have been replicated across many different paradigms ranging from tissue cultures to human studies. This has generated interest in potentially repurposing this drug. However, the optimal dosage required for neuroprotective effects remains unclear and may be different than the  doses needed for treatment of bipolar disorders. Recent studies on trace-Li levels in the water suggest that Li, could slow cognitive decline and prevent dementia with long-term use even at very low doses. The current review aims to synthesize the data on the topic and challenge the conventional high-dose paradigm., Results: We systematically reviewed five available studies, which reported associations between trace-Li in water and incidence or mortality from dementia. Association between trace-Li levels and a lower risk or mortality from dementia were observed at concentrations of Li in drinking water as low as 0.002 mg/L and 0.056 mg/L. Meanwhile, levels below 0.002 mg/L did not elicit this effect. Although three of the five studies found dementia protective properties of Li in both sexes, a single study including lower Li levels (0.002 mg/l) found such association only in women.  CONCLUSION: The reviewed evidence shows that trace-Li levels in the water are sufficient to lower the incidence or mortality from dementia. Considering the lack of options for the prevention or treatment of dementia, we should not ignore these findings. Future trials of Li should focus on long term use of low or even micro doses of Li in the prevention or treatment of dementia., (© 2024. The Author(s).)

(1) Background: Food allergy (FA) is an immune-mediated hypersensitivity to foods, significantly contributing to childhood morbidity and mortality. This study aimed to assess the prevalence, characteristics, and influencing factors of parent-reported FAs among children in Saudi Arabia. (2) Methods: This cross-sectional study utilized a validated parental questionnaire distributed across all regions of Saudi Arabia. Data from 2130 participants were collected and analyzed using SPSS v. 26 and Prism software v. 10.3.0. (3) Results: Parent-reported FA prevalence was 15.2%. Egg was the most common allergen (6.2%), followed by tree nuts (4.1%), peanuts (4.0%), milk (3.8%), and sesame (3.2%). Significant geographical variations were observed, with the western region having the highest burden ( p < 0.001). Older children had higher rates of shellfish and fish allergies. Parental allergies and co-existing asthma/drug allergies were positively associated with childhood FAs. (4) Conclusions: This study highlights a substantial burden of parent-reported FAs in Saudi Arabia, with regional variations in food allergen distribution. Parental allergies and co-existing allergic conditions may influence FA risk.

Background Hypertension (HTN) is a global health issue as it causes significant mortality and morbidity among the worldwide population. Various treatments are available, but many patients are unable to control the disease. There are various factors like medication non-adherence and lifestyle habits that contribute to this problem. There is a need for evidence-based interventions to address HTN effectively, especially in regions like Saudi Arabia, where there is limited data on uncontrolled HTN. This study aimed to assess the prevalence of uncontrolled HTN and contributing factors to poor blood pressure control among patients in Primary Health Centers (PHCs) in Riyadh, Saudi Arabia. Methodology An analytical cross-sectional study was conducted using an interviewer-administered questionnaire among all patients aged 18 years and above who have uncontrolled HTN and who visited the PHCs of Riyadh's first health cluster in Saudi Arabia. Data was cleaned in Microsoft Excel and analyzed using IBM SPSS 29. Results The study comprised 516 patients with HTN. The majority were males (53.1%, n=274) compared to females (46.9%, n=242), with an average age of 58 years (SD=10.5). Notably, most patients were obese (63.2%, n=326), and 62.4% (n=322) had uncontrolled HTN. Multivariate analysis identified sociodemographic factors like higher education (p-value = 0.013, adjusted odds ratio (AOR) = 0.795) as protective against uncontrolled HTN, while employment (p-value = 0.031, AOR = 1.786) increased the risk of uncontrolled HTN. Risk factors such as smoking (p-value = 0.001, AOR = 3.011) and salt restriction (p-value = 0.021, AOR = 0.643) significantly influenced HTN control. Management-related predictors like stopping medication after feeling better (p-value = 0.001, AOR = 3.196) were also found significant. Conclusion This study revealed a high prevalence of uncontrolled HTN, especially among males and obese individuals. Sociodemographic factors like higher education were protective, while employment increased the risk of the disease. Further, smoking, salt restriction, and medication adherence significantly impacted HTN control, highlighting the importance of tailored interventions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board of King Saud Medical City issued approval H0RI-08-Feb24-04. 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, Alshuhri et al.)

The orientational effect concept in a molecular-scale junction is established for asymmetric junctions, which requires the fulfillment of two conditions: (1) design of an asymmetric molecule with strong distinct terminal end groups and (2) construction of a doubly asymmetric junction by placing an asymmetric molecule in an asymmetric junction to form a multicomponent system such as Au/Zn-TPP+M/Au. Here, we demonstrate that molecular-scale junctions that satisfy the conditions of these effects can manifest Seebeck coefficients whose sign fluctuates depending on the orientation of the molecule within the asymmetric junction in a complete theoretical investigation. Three anthracene-based compounds are investigated in three different scenarios, one of which displays a bithermoelectric behavior due to the presence of strong anchor groups, including pyridyl and thioacetate . This bithermoelectricity demonstration implies that if molecules with alternating orientations can be placed between an asymmetric source and drain, they can be potentially utilized for increasing the thermovoltage in molecular-scale thermoelectric energy generators (TEGs)., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Introduction: The global pandemic was an emerging challenge that significantly impacted healthcare systems and the delivery of care. Prompt actions and adaptive techniques, such as the virtual clinic, were implemented to ensure the quality and continuity of the care provided. The aim of this quality improvement project was to ensure the smooth implementation and effectiveness of the virtual clinic during the COVID-19 crisis., Methods: A specialized team of multidisciplinary healthcare providers was established to systematically ensure the implementation of the virtual clinic within the Department of Oncology. The team used multiple Plan-Do-Study-Act (PDSA) cycles of the quality improvement model to achieve the final goal and facilitate the transition to the virtual clinic., Results: A total of 29 weekly virtual clinic sessions were conducted, covering various oncology services. From March to December 2020, 81% of the scheduled patients (3888) responded to virtual clinic calls. Physicians initiated 234 unplanned virtual clinic calls to follow up on a patient's condition. In addition, 916 medications were shipped to patients as needed. A patient satisfaction survey in May 2020 indicated an overall satisfaction rate of 92% with the virtual clinic process. Staff satisfaction was also high (91%), and 88% of the physicians believed that the virtual clinic would continue beyond the pandemic., Conclusion: Implementing the virtual clinic is achievable through following systematic steps and effectively addressing emerging challenges as required. The concept of the virtual clinic was well accepted by patients and staff., Competing Interests: Source of Support: None. Conflict of Interest: None.

Allopurinol is a commonly prescribed agent in the urologic population for the prevention of urinary stones. Although generally well-tolerated, several serious potential side effects can occur with its use. Allopurinol hypersensitivity syndrome (AHS), in particular, is a relatively rare but potentially life-threatening complication. With the observed increase in urinary stone disease, especially those of uric acid composition, it is likely that the use of allopurinol will increase. Urologists play an important role in the assessment and medical management of patients with urinary stones, thus a greater awareness of the potential adverse events associated with allopurinol use, especially AHS, is important, as well as strategies that can minimize such risks. Herein, we review the potential adverse effects of allopurinol. In addition, the results of a comprehensive review of the current literature on AHS will be presented, highlighting those patients at highest risk, reviewing the genetic susceptibility testing currently available, and providing guidance on best practices when allopurinol therapy is being considered.

This study aims to prepare new nanocomposites consisting of Cr 2 O 3 /CaCO 3 as a catalyst for improved hydrogen production from NaBH 4 methanolysis. The new nanocomposite possesses nanoparticles with the compositional formula Cr 2-x Ca x O 3 (x = 0, 0.3, and 0.6). These samples were prepared using the sol-gel method, which comprises gelatin fuel. The structure of the new composites was studied using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), Raman spectroscopy, environmental scanning electron microscopy (ESEM), and X-ray spectroscopy (XPS). The XRD data showed the rhombohedral crystallinity of the studied samples, and the average crystal size was 25 nm. The FTIR measurements represented the absorption bands of Cr 2 O 3 and CaO. The ESEM micrographs of the Cr 2 O 3 showed the spherical shape of the Cr 2 O 3 nanoparticles. The XPS measurements proved the desired oxidation states of the Cr 2-x Ca x O 3 nanoparticles. The optical band gap of Cr 2 O 3 is 3.0 eV, and calcium doping causes a reduction to 2.5 and 1.3 eV at 15.0 and 30.0% doping ratios. The methanolysis of NaBH 4 involved accelerated H 2 production when using Cr 2-x Ca x O 3 as a catalyst. Furthermore, the Cr 1.7 Ca 0.3 O 3 catalyst had the highest hydrogen generation rate, with a value of 12,750 mL/g/min.

Objectives: The benefits of reduction in low-density lipoprotein cholesterol by evolocumab by nearly 60% has not been evaluated among kidney transplant recipients to our knowledge. We assessed the efficacy and safety of evolocumab, a proprotein convertase subtilisin/kexin-9 inhibitor, in reducing lipids and cardiovascular events among kidney transplant recipients in a randomized controlled study., Materials and Methods: Between June 2017 and June 2019, we enrolled 197 kidney transplant recipients with high cardiovascular risk score (>20). Patients who received evolocumab (140 mg/2 weeks) comprised group 1 (n = 98), and patients maintained on statin therapy comprised group 2 (n = 99). We followed patients clinically and with necessary laboratory investigations over 24 months., Results: The 2 groups had comparable demographic characteristics (P > .05). Before enrollment in the study, smokers were significantly more prevalent in group 1, whereas posttransplant diabetes mellitus was more prevalent in group 2 (P = .033). Moreover, baseline serum creatinine was higher in group 1, whereas immunosuppression was equivalent in both groups (P > .05). We found no significant differences between the 2 groups concerning cardiovascular events, and both graft and patient outcomes were comparable (P > .05). The higher baseline cholesterol in group 1 (5.5 vs 4.7 mmol/L; P < .001) decreased significantly after 3 months and thereafter (P = .031) compared with levels in group 2 and baseline values (P < .001). We reported 2 cases of acute myocardial infarction and 1 atrial fibrillation in group 2., Conclusions: Proprotein convertase subtilisin/kexin-9 inhibitors, as an added therapy to statins, are safe and effective in treating hypercholesterolemia after kidney transplant. Evolocumab can minimize cardiovascular events after kidney transplant in patients with high events at baseline. Longer-term trials with larger number of patients are needed to confirm its beneficial effects on cardiovascular complications and patient and graft survival.

Background: Job satisfaction plays an important foundation in the health system to deliver high-quality care services to patients. Job satisfaction describes the inside feeling of workers about their jobs whether they like it or not. Job satisfaction of health practitioners is considered an essential factor that affects their efficiency, well-being, and mental health., Aim: This research study is part of an integrated research aiming to understand the determinants of a revised Workforce Planning Strategy in Saudi Arabia, in close relevance to the demand and supply side in Saudi Arabia., Results: This study showed that males were significantly more satisfied than females in relation to specialty, organization, and overall global score. There is also evidence for a significant association between age groups and job satisfaction. Older health practitioners had a higher level of satisfaction than younger ones. Regarding nationality, we found that Saudi health practitioners were less satisfied in all aspects, while non-Saudi (Arab) healthcare practitioners were the most satisfied in all aspects except city happiness., Conclusion: Our study found statistically significant differences that medicine and surgery practitioners are the most satisfied professionals and the least satisfied are dentist practitioners. Health practitioners with more than five years of experience were significantly the most satisfied., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alotaibi et al.)

Background: Few studies have looked at how SARS-CoV-2 affects pulmonary function, exercise capacity, and health-related quality of life over time. The purpose of this study was to evaluate these characteristics in post COVID-19 subjects 1 year after recovery., Methods: The study included two groups. The case group included post COVID-19 subjects who had recovered after a year, and the control group included healthy participants who had never tested positive for COVID-19., Results: The study screened 90 participants, 42 of whom met the eligibility criteria. The findings revealed that the majority of post COVID-19 subjects had relatively normal lung function 1-year post-recovery. A significant reduction in DLCO (B/P%) was observed in the case group vs . control. The exercise capacity test revealed a clinically significant difference in distance walked and a significant difference in the dyspnea post-walk test in the case group compared to the control group. The case group's health-related quality of life domain scores were significantly affected in terms of energy/fatigue, general health, and physical function., Conclusions: The post COVID-19 subjects were shown to have well-preserved lung function after 1 year. However, some degree of impairment in diffusion capacity, exercise capacity, and health-related quality of life remained., Competing Interests: The authors declare that they have no competing interests., (© 2023 Alahmari et al.)

Despite the fact that the number of patients seeking home healthcare in Saudi Arabia is rising, this speciality confronts significant obstacles. This qualitative, descriptive phenomenological study investigates views, feelings and attitudes of nursing students practicing in home healthcare and how they perceive it as a future career. Data were gathered during five face-to-face focus group interviews of five students each (a total of 25 students) and analysed using thematic analysis. It was found that the majority of students did not perceive home healthcare as a viable career option compared to working in a hospital. They vacillated due to the nature of the work, safety concerns, working demands, the invariability of health cases, and a lack of opportunities for professional development. Nevertheless, some nursing students were amenable to pursuing a career in home healthcare due to the less working hours, sense of autonomy, and ability to provide holistic care and educate patients and their families. Population awareness programs are needed to overcome cultural barriers, increase student motivation, and ultimately bolster the number of certified nurses working in home healthcare.

Background: The simultaneous measurement of serum amylase and lipase levels in the diagnosis of pancreatitis was deemed unnecessary in several studies. We aim at evaluating the prevalence of the simultaneous co-ordering of serum amylase and lipase., Methods: This retrospective chart review was conducted at King Saud University Medical City in Riyadh, Saudi Arabia, between January 2021 and January 2022. We examined requests for serum amylase or serum lipase levels that had been sought for suspected pancreatitis within the electronic health system (EHS)., Results: A total of 9,617 requests for serum amylase and serum lipase levels for 5,536 patients were made in a year; 6,873 (71.5%) were made for serum lipase alone; 1,672 (17.4%) were made for co-ordered serum lipase and amylase; 322 (3.3%) were made for amylase alone; and 750 (7.8%) were made for repeated amylase testing. Four hundred and thirteen tests (4.3%) yielded a diagnosis of pancreatitis. The estimated cost reduction when serum amylase was removed if serum lipase was co-ordered was 108,680 SAR (approximately US$28,960)., Conclusion: Serum amylase and lipase were co-ordered for about 17.4% of pancreatitis diagnostic tests, all of which were unnecessary. Eliminating serum amylase testing for any patient who receives a test of their lipase levels would exert a significant impact on institutional costs and savings., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2023 Bader Alyahya et al.)

Aim: To evaluate the quality of nursing clinical placement among nursing students., Design: This is a descriptive cross-sectional study., Methods: Two hundred eighty two nursing student completed self-administered, online questionnaires. The questionnaire assessed participants' socio-demographic data, and the quality of their clinical placement., Results: The students had a high mean score for the overall satisfaction of their clinical training placement with high mean score for the item of "patient safety was fundamental to the work of the units" and the item of "I anticipate being able to apply my learning from this placement," while the lowest mean score was related to "This placement was a good learning environment" and "Staff were willing to work with students." Patient or Public Contribution: Quality of clinical placement is critical for improving the everyday quality of care for patients who are in desperate need of caregivers with professional knowledge and skills., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Introduction: The outpatient oncology infusion unit is very busy, serving 60 to 70 patients per day. Due to a limited number of nurses, treatment chairs, only one pharmacy hood for bio-hazardous drug preparation, and other factors, patients wait a long time before starting their treatment, which affects the patient experience negatively. We conducted a quality improvement project to reduce the waiting time before starting the treatment, improve the patients' experience, and allow the unit to work more effectively through better resource utilization and accommodating more patients., Methods: A committee was formed with representatives from oncology nursing and the quality specialist, chemotherapy pharmacy supervisor, data manager, and a medical consultant (team leader). We studied baseline data of patient waiting times from January to March 2019 and the factors that contributed to delays before starting the treatment. The charge nurse identified patients who could safely have their medication released early in the morning at 7 am, enabling the pharmacy to dispense at 8 am without their actual presence being required in the infusion suite (i.e., medication early release program or MERP). Multiple plan-do-study-act (PDSA) cycles were implemented to achieve a wait time from check-in to medication administration of less than 60 minutes. Data collected included check-in time, chair time, vital signs time, administration time, and discharge time. Additionally, reasons for drug wastage were assessed for patients who did not receive the prepared medication. A patient satisfaction survey was conducted with the patients before and after being enrolled in the program., Results: At baseline, average waiting time for patients receiving similar medications in the MERP was 2 hours and 27 minutes. After the first intervention, average waiting time was reduced to 1 hour and 24 minutes, and small improvements were observed after each PDSA cycl. A major breakthrough occurred after an intensive patient education program and enforcement of strict compliance with the criteria in selecting the patients appropriate for theMERP. Average waiting time wasreduced to ≤ 60 minutes, and in November 2022, it was 30 minutes on average. Drug wastage was identified as a balancing measure. We were successful in reducing drug wastage by implementing several changes and patient education measures and achieved zero wastage. The patient satisfaction survey showed better satisfaction with the new changes., Conclusion: A positive impact was achieved in this quality improvement project, with a significant reduction in the average waiting time for patients to start receiving chemotherapy. The outcome of this project has been maintained for 4 years and is still ongoing., Competing Interests: Source of Funding: None. Conflict of Interest: None.

In this work, the S@g-C 3 N 4 and CuS@g-C 3 N 4 catalysts were prepared via the polycondensation process. The structural properties of these samples were completed on XRD, FTIR and ESEM techniques. The XRD pattern of S@g-C 3 N 4 presents a sharp peak at 27.2° and a weak peak at 13.01° and the reflections of CuS belong to the hexagonal phase. The interplanar distance decreased from 0.328 to 0.319 nm that facilitate charge carrier separation and promoting H 2 generation. FTIR data revealed the structural change according to absorption bands of g-C 3 N 4 . ESEM images of S@g-C 3 N 4 exhibited the described layered sheet structure for g-C 3 N 4 materials and CuS@g-C 3 N 4 demonstrated that the sheet materials were fragmented throughout the growth process. The data of BET revealed a higher surface area (55 m 2 /g) for the CuS-g-C 3 N 4 nanosheet. The UV-vis absorption spectrum of S@g-C 3 N 4 showed a strong peak at 322 nm, which weakened after the growth of CuS at g-C 3 N 4 . The PL emission data showed a peak at 441 nm, which correlated with electron-hole pair recombination. The data of hydrogen evolution showed improved performance for the CuS@g-C 3 N 4 catalyst (5227 mL/g·min). Moreover, the activation energy was determined for S@g-C 3 N 4 and CuS@g-C 3 N 4 , which showed a lowering from 47.33 ± 0.02 to 41.15 ± 0.02 KJ/mol.

In this work, a synthesis technique for highly homogeneous PVDF-CaFe 2 O 4 polymer films direct from solution was developed. The structural characterizations were conducted using XRD, FTIR, and ESEM experimental techniques. The XRD characteristic peaks of CaFe 2 O 4 nanoparticles revealed a polycrystalline structure. The average crystallite size for CaFe 2 O 4 was calculated to be 17.0 nm. ESEM micrographs of PVDF nanocomposites containing 0.0, 0.25, 0.75, and 1.0 wt% of CaFe 2 O 4 showed smooth surface topography. The direct E dir and indirect E ind band gap energies for the PVDF-CaFe 2 O 4 nanocomposites were decreased with the additions of 0.0-1.0 wt% CaFe 2 O 4 . In addition, the refractive index ( n 0 ) increased from 3.38 to 10.36, and energy gaps (E g ) decreased from 5.50 to 4.95 eV. The nonlinear refractive index (n 2 ) for the PVDF-CaFe 2 O 4 nanocomposites was improved with the addition of CaFe 2 O 4 nanoparticles, exceeding those reported in the literature for PVC, PVA, and PMMA nanocomposites. Therefore, the PVDF-CaFe 2 O 4 nanocomposites are expected to take the lead in optoelectronic applications because of their unusual optical properties.

Staghorn calculi (SC) are defined as large kidney stones that fill the renal pelvis and at least one renal calyx. They represent 10-20% of all renal stones in developing countries and require prompt diagnosis and management. Massive SC (over 5 cm) are treated exclusively via open surgery, despite percutaneous nephrolithotomy (PCNL) being the gold standard treatment for large stones. Descriptions of PCNL for massive SC are very limited in the literature., Case Presentation: We report a case of a 63-year-old male who presented with chronic abdominal pain, hepatosplenomegaly, and normal renal function. He was later diagnosed with polycythemia vera. Computed tomography of the abdomen revealed massive, bilateral staghorn stones measuring 7.3×5.5 cm and 1.8×4.5 cm on the right and left, respectively. Additionally, the right stone was found to be compressing the inferior vena cava (IVC). The patient was promptly scheduled for right-sided PCNL and the target of 80% stone fragmentation was successfully attained., Discussion: We present the first case of a stone of such size in the Middle East, as well as the first known case of a renal stone compressing the IVC. Unlike previous reports, the stone was successfully fragmented via PCNL - a procedure that has not been described for stones of such size., Conclusion: This report highlights that ultrasound-guided PNCL without any other intervention is sufficient for the successful treatment of giant SC. Greater research is needed on the potential utility of using ultrasound-guided PCNL for the fragmentation of stones sized over 5 cm., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

The nanocomposites of S@g-C 3 N 4 and NiS-g-C 3 N 4 were synthesized for catalytic hydrogen production from the methanolysis of sodium borohydride (NaBH 4 ). Several experimental methods were applied to characterize these nanocomposites such as X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and environmental scanning electron microscopy (ESEM). The calculation of NiS crystallites revealed an average size of 8.0 nm. The ESEM and TEM images of S@g-C 3 N 4 showed a 2D sheet structure and NiS-g-C 3 N 4 nanocomposites showed the sheet materials that were broken up during the growth process, revealing more edge sites. The surface areas were 40, 50, 62, and 90 m 2 /g for S@g-C 3 N 4 , 0.5 wt.% NiS, 1.0 wt.% NiS, and 1.5 wt.% NiS, respectively. The pore volume of S@g-C 3 N 4 was 0.18 cm 3 , which was reduced to 0.11 cm 3 in 1.5 wt.% NiS owing to the incorporation of NiS particles into the nanosheet. We found that the in situ polycondensation preparation of S@g-C 3 N 4 and NiS-g-C 3 N 4 nanocomposites increased the porosity of the composites. The average values of the optical energy gap for S@g-C 3 N 4 were 2.60 eV and decreased to 2.50, 2.40, and 2.30 eV as the NiS concentration increased from 0.5 to 1.5 wt.%. All NiS-g-C 3 N 4 nanocomposite catalysts had an emission band that was visible in the 410-540 nm range and the intensity of this peak decreased as the NiS concentration increased from 0.5 to 1.5 wt.%. The hydrogen generation rates increased with increasing content of NiS nanosheet. Moreover, the sample 1.5 wt.% NiS showed the highest production rate of 8654 mL/g·min due to the homogeneous surface organization.

Hydrogen production as a source of clean energy is high in demand nowadays to avoid environmental issues originating from the use of conventional energy sources i.e., fossil fuels. In this work and for the first time, MoO 3 /S@g-C 3 N 4 nanocomposite is functionalized for hydrogen production. Sulfur@graphitic carbon nitride (S@g-C 3 N 4 )-based catalysis is prepared via thermal condensation of thiourea. The MoO 3 , S@g-C 3 N 4 , and MoO 3 /S@g-C 3 N 4 nanocomposites were characterized using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), Field Emission Scanning Electron Microscope (FESEM), STEM, and spectrophotometer. The lattice constant (a = 3.96, b = 13.92 Å) and the volume (203.4 Å 3 ) of MoO 3 /10%S@g-C 3 N 4 were found to be the highest compared with MoO 3 , MoO 3 /20-%S@g-C 3 N 4 , and MoO 3 /30%S@g-C 3 N 4 , and that led to highest band gap energy of 4.14 eV. The nanocomposite sample MoO 3 /10%S@g-C 3 N 4 showed a higher surface area (22 m 2 /g) and large pore volume (0.11 cm 3 /g). The average nanocrystal size and microstrain for MoO 3 /10%S@g-C 3 N 4 were found to be 23 nm and -0.042, respectively. The highest hydrogen production from NaBH 4 hydrolysis ~22,340 mL/g·min was obtained from MoO 3 /10%S@g-C 3 N 4 nanocomposites, while 18,421 mL/g·min was obtained from pure MoO 3 . Hydrogen production was increased when increasing the masses of MoO 3 /10%S@g-C 3 N 4 .

Introduction: Data regarding contrast-induced nephropathy (CIN) in kidney transplant (KT) recipients are scarce despite the distinct risk factors such as the use of immunosuppressive agents, sympathetic denervation, glomerular hyperfiltration, and high prevalence of the cardiovascular disease. This study aimed to determine the prevalence of CIN in KT recipients who received low-osmolality iodine-based contrast material (CM) for radiological assessment., Methods: Between 2010 and 2020, 79 of the 3180 KT recipients followed at Hamed Al-Essa organ transplant center received low-osmolality iodine-based contrast for radiological assessment for various indications. Preventive measures including holding metformin, intravenous hydration, sodium bicarbonate and N-acetylcysteine were given before contrast administration. CIN was defined as an increase in serum creatinine of 25% from the baseline within 72 hours., Results: The enrolled patients were divided into two groups: those who developed CIN (n = 7) and those with no increase in serum creatinine level (n = 72). The mean age of the patients was 52.1 ± 12.3 years; 44 of them were males, and the cause of end-stage kidney disease was mostly diabetic nephropathy. The pre-transplant demographics were comparable between the two groups. Fortyseven cases received contrast for coronary angiography, and 32 received it for a CT scan. The graft function deteriorated in group 1, but no significant difference was found between the two groups at the end of the study., Conclusion: CIN is not uncommon in KT recipients receiving CM, especially with ischemic heart disease. Risk stratification, optimizing hemodynamics, and avoiding potential nephrotoxins are essential before performing CM-enhanced studies in KT recipients.  DOI: 10.52547/ijkd.7165.

Through a comprehensive theoretical study, we demonstrate that single-molecule junctions formed from asymmetric molecules with different terminal groups can exhibit Seebeck coefficients, whose sign depends on the orientation of the molecule within the junction. Three anthracene-based molecules are studied, one of which exhibits this bi-thermoelectric behaviour, due to the presence of a thioacetate terminal group at one end and a pyridyl terminal group at the other. A pre-requisite for obtaining this behaviour is the use of junction electrodes formed from different materials. In our case, we use gold as the bottom electrode and graphene-coated gold as the top electrode. This demonstration of bi-thermoelecricity means that if molecules with alternating orientations can be deposited on a substrate, then they form a basis for boosting the thermovoltage in molecular-scale thermoelectric energy generators (TEGs)., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

For the purpose of creating single-molecule junctions, which can convert a temperature difference Δ T into a voltage Δ V via the Seebeck effect, it is of interest to screen molecules for their potential to deliver high values of the Seebeck coefficient S = -Δ V /Δ T . Here we demonstrate that insight into molecular-scale thermoelectricity can be obtained by examining the widths and extreme values of Seebeck histograms. Using a combination of experimental scanning-tunnelling-microscopy-based transport measurements and density-functional-theory-based transport calculations, we study the electrical conductance and Seebeck coefficient of three endohedral metallofullerenes (EMFs) Sc 3 N@C 80 , Sc 3 C 2 @C 80 , and Er 3 N@C 80 , which based on their structures, are selected to exhibit different degrees of charge inhomogeneity and geometrical disorder within a junction. We demonstrate that standard deviations in the Seebeck coefficient σ S of EMF-based junctions are correlated with the geometric standard deviation σ and the charge inhomogeneity σ q . We benchmark these molecules against C 60 and demonstrate that both σ q , σ S are the largest for Sc 3 C 2 @C 80 , both are the smallest for C 60 and for the other EMFs, they follow the order Sc 3 C 2 @C 80 > Sc 3 N@C 80 > Er 3 N@C 80 > C 60 . A large value of σ S is a sign that a molecule can exhibit a wide range of Seebeck coefficients, which means that if orientations corresponding to high values can be selected and controlled, then the molecule has the potential to exhibit high-performance thermoelectricity. For the EMFs studied here, large values of σ S are associated with distributions of Seebeck coefficients containing both positive and negative signs, which reveals that all these EMFs are bi-thermoelectric materials.

Background: The management of Acinetobacter baumannii infection is considered a challenge especially in an intensive care setting. The resistance rate makes it difficult to manage and is believed to lead to higher mortality. We aim to investigate the prevalence of Acinetobacter baumannii and explore how different antibiotic regimens could impact patient outcomes as there are no available published data to reflect our population in our region., Methods: We conducted a retrospective review of all infected adult patients admitted to the intensive care unit at King Fahad University Hospital with a confirmed laboratory diagnosis of Acinetobacter baumannii from 1 January 2013 until 31 December 2017. Positive cultures were obtained from the microbiology department and those meeting the inclusive criteria were selected. Variables were analyzed using descriptive analysis and cross-tabulation. Results were further reviewed and audited by blinded co-authors., Results: A comprehensive review of data identified 198 patients with Acinetobacter baumannii . The prevalence of Acinetobacter baumannii is 3.37%, and the overall mortality rate is 40.81%. Our sample consisted mainly of male patients, that is, 68.7%, with a mean age of 49 years, and the mean age of female patients was 56 years. The mean age of survivors was less than that of non-survivors, that is, 44.95 years of age. We observed that prior antibiotic use was higher in non-survivors compared to survivors. From the review of treatment provided for patients infected with Acinetobacter baumannii , 65 were treated with colistin alone, 18 were treated with carbapenems, and 22 were treated with a combination of both carbapenems and colistin. The mean length of stay of Acinetobacter baumannii- infected patients was 20.25 days. We found that the survival rates among patients who received carbapenems were higher compared to those who received colistin. Conclusion:: We believe that multidrug-resistant Acinetobacter baumannii is prevalent and associated with a higher mortality rate and represents a challenging case for every intensive care unit physician. Further prospective studies are needed., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)