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Abstract Introduction Kuwait has a large expatriate community who experience both restricted access to public health services and lower income than Kuwaiti citizens. Given these conditions, we examined differences in characteristics and management of chronic kidney disease (CKD) between Kuwaitis and expatriates. Methods Clinical and laboratory data for adult CKD Stages 3–5 not on dialysis (CKD 3–5 ND) patients with native kidneys attending nephrology clinics in all Ministry of Health hospitals collected from January 1, 2022, to December 31, 2022. Cohort was then divided into Kuwaiti patients and expatriates patients for comparison. Results We collected data from 2,610 patients (eGFR: 30.8 ml/min/1.73m2; age: 62.6 years; males: 56.7%; Kuwaitis: 62.1%). Kuwaitis were older (63.94 vs. 60.3 years, p

Spinal muscular atrophy is a neuromuscular genetic condition associated with progressive muscle weakness and atrophy. Nusinersen is an antisense oligonucleotide therapy approved for the treatment of 5q spinal muscular atrophy in pediatric and adult patients. The objective of this clinical case series is to describe the efficacy and safety of nusinersen in treating spinal muscular atrophy in 20 pediatric and 18 adult patients across six treatment centers in Kuwait. Functional motor assessments (Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders, Hammersmith Functional Motor Scale Expanded, and Revised Upper Limb Module) were used to assess changes in motor function following nusinersen treatment. The safety assessment involved clinical monitoring of adverse events. The results demonstrate clinically meaningful or considerable improvement in motor performance for nearly all patients, lasting over 4 years in some cases. A total of 70% of patients in the pediatric cohort and 72% of patients in the adult cohort achieved a clinically meaningful improvement in motor function following nusinersen treatment. Additionally, nusinersen was well-tolerated in both cohorts. These findings add to the growing body of evidence relating to the clinical efficacy and safety of nusinersen.

As the demand for renewable energy sources continues to increase, solar energy is becoming an increasingly popular option. Therefore, effective training in solar energy systems design and operation is crucial to ensure the successful implementation of solar energy technology. To make this training accessible to a wide range of people from different backgrounds, it is important to develop effective and engaging training methods. Immersive virtual reality (VR) has emerged as a promising tool for enhancing solar energy training and education. In this paper, a unique method is presented to evaluate the effectiveness of an immersive VR experience for solar energy systems design using a multi-modal approach that includes a detailed analysis of user engagement. To gain a detailed analysis of user engagement, the VR experience was segmented into multiple scenes. Moreover, an eye-tracker and wireless wearable sensors were used to accurately measure user engagement and performance in each scene. The results demonstrate that the immersive VR experience was effective in improving users’ understanding of solar energy systems design and their ability to perform complex tasks. Moreover, by using sensors to measure user engagement, specific areas that required improvement were identified and insights for enhancing the design of future VR training experiences for solar energy systems design were provided. This research not only advances VR applications in solar energy education but also offers valuable insights for designing effective and engaging training modules using multi-modal sensory input and real-time user engagement analytics.

Rationale & Objectives: Acute kidney injury (AKI) incidence and outcome in Kuwait are unknown. Moreover, non-Kuwaitis, who represent 66% of the population, have lower income, and their access to public health services is restricted compared with Kuwaitis who have free full access. Study Design: Observational prospective multicenter cohort study. Setting & Participants: Adult inpatients with AKI in 7 public hospitals from January 1 to December 31, 2021. Exposure: AKI identified using Kidney Disease: Improving Global Outcomes serum creatinine-based criteria. Outcomes: For hospitalized patients with AKI, the outcomes included 30-day outcomes of mortality, need for dialysis, kidney recovery rates, and differences in outcomes between Kuwaitis and non-Kuwaitis. Analytical Approach: A backward stepwise multiple logistic regression analysis was performed to assess possible independent risk factors for the outcomes. Results: We recruited 3,744 patients (mean age: 63 years; mean baseline estimated glomerular filtration rate [eGFR]: 66.7 mL/min; non-Kuwaitis: 42.3%), representing 3.2% of hospitalizations and 19.5% of intensive care unit (ICU) admissions. Non-Kuwaitis were significantly younger (57.6 vs 66.9 years), with higher baseline eGFR (73.1 vs. 62 mL/min), more frequent community acquired AKI (53.8% vs 46.7%), and AKI in summer (34.7% vs 26.9%). Dialysis was provided to 33.5% of patients, with a higher need for non-Kuwaitis (35.5% vs 32.1%). At 30 days, 34.4% of patients died, representing 24.8% of hospital mortality and 59.8% of ICU mortality. No differences in mortality or kidney recovery were noted between Kuwaitis and non-Kuwaitis. Low eGFR did not affect the mortality rate. Limitations: Observational nature and short follow-up period of 30 days only. Conclusions: AKI was associated with high dialysis need and mortality. Non-Kuwaitis accounted for less cases despite representing 66% of the population because they were younger with higher baseline eGFR and fewer comorbid conditions. Non-Kuwaitis had higher rates of community acquired AKI and AKI in summer and a higher need for dialysis but had similar mortality and complete kidney recovery rates. Plain-Language Summary: Incidences of acute kidney injury (AKI), its management, and its outcomes are unknown in Kuwait. In addition, Kuwait has a large population of ethnically diverse expatriates who have lower income and do not enjoy the same level of access to public hospital services. We recruited hospitalized adults who have a diagnosis of AKI in several public hospitals in Kuwait. We analyzed characteristics, management, and outcomes data for more than 3,700 patients and found that AKI affects 3.2% of hospitalized patients. AKI leads to high dialysis utilization rates and causes high mortality rates. Although more Kuwaitis were affected by AKI, the mortality rates for Kuwaitis and non-Kuwaitis were similar. Non-Kuwaitis were younger with better baseline kidney function and fewer chronic diseases than Kuwaitis.

This paper presents a comprehensive and systematic review of virtual reality (VR) as an innovative educational tool specifically for solar photovoltaic energy systems. VR technology, with its immersive and interactive capabilities, offers a unique platform for in-depth learning and practical training in the field of solar energy. The use of VR in this context not only enhances the understanding of solar photovoltaic (PV) systems but also provides a hands-on experience that is crucial for developing the necessary skills in this rapidly evolving field. Among the 6814 articles initially identified, this systematic review specifically examined 15 articles that focused on the application of VR in PV education. These selected articles demonstrate VR’s ability to accurately simulate real-world environments and scenarios related to solar energy, providing an in-depth exploration of its practical applications in this field. By offering a realistic and detailed exploration of PV systems, VR enables learners to gain a deeper understanding of harnessing, managing and using such a vast energy resource. The paper further discusses the implications of employing VR in educational settings, highlighting its potential to change the way solar energy professionals are trained, thereby contributing significantly to the acceleration of photovoltaic technology adoption and its integration into sustainable energy solutions.

This study investigated the variability and trends in 115 years (1909–2023) of daily precipitation observed at three hydrometeorological stations in southern (Kaisaniemi), central (Kajaani), and northern (Sodankylä) Finland. We also identified the most significant climate teleconnections influencing daily precipitation variability at these three stations during the period 1951–2023. The daily precipitation records were primarily classified into six grades, including very light (≤1 mm), light (1–≤5 mm), moderate (5–≤10 mm), heavy (10–≤15 mm), very heavy (15–≤20 mm), and extreme (>20 mm). On average, the most intense daily precipitation was determined at the Kaisaniemi station in southern Finland. At this station, however, very light and light precipitation showed the lowest frequency, but other graded daily precipitation events were the most frequent. At all three stations, the intensity of very light precipitation significantly declined during the past 115 years, while its frequency increased. The highest rates of such decreases and increases in the intensity and frequency of very light daily precipitation were found at the Sodankylä stations in northern Finland, respectively, but the lowest rates were at the Kaisaniemi station in the south. At the Kajaani station in central Finland, the intensity of light precipitation decreased, but very heavy precipitation intensified. At this station, however, the number of both moderate and heavy precipitation events increased over time. Finally, historical variations in both the intensity and frequency of graded daily precipitation events in Finland showed significant relationships with different climate teleconnections, particularly the Scandinavia (SCAND) and the North Atlantic Oscillation (NAO) patterns.

Inclusive education has become a global trend in the provision of services for students with disabilities. While attitudes towards inclusion have been studied widely in some countries, little research in this area has been conducted in Kuwait. This study responds to this need by researching pre-service teachers' attitudes towards inclusive education. This study examined Kuwaiti pre-service teachers' attitudes towards including students with Moderate Learning Difficulties (MLD) in general education classrooms. Questionnaires were distributed to 452 Kuwaiti pre-service male and female teachers at the College of Basic Education. Several factors, such as teachers' knowledge, were found to be related to pre-service teachers' attitudes towards inclusion. The results of the study indicated that, overall, Kuwaiti pre-service teachers hold positive attitudes towards inclusion.

Point of care ultrasound (POCUS) can make an expedited diagnosis, which might lead to early correct management. POCUS should be used in a systemic and integrated approach to evaluate multiple organs in patients with sepsis and septic shock. We present a rare case of sepsis due to Salmonella endocarditis with abscess in which a POCUS examination led to expedited treatment.

Abstract Background There is currently very little research evidence on the benefits and safety of liraglutide in the management of weight regain or inadequate weight loss following metabolic and bariatric surgery. This study aimed to determine the clinical effectiveness and tolerability of liraglutide as an adjunct therapy for managing weight regain and inadequate weight loss following sleeve gastrectomy (SG). Methods This was a retrospective analysis of medical records conducted at a private clinic in Kuwait. Results Data of 57 post‐SG patients were included in the analysis. The mean (±SD) pre‐treatment weight was 96.12 (29.26) kg. Following a median liraglutide treatment duration of approximately 3 months, the mean post‐treatment weight was 90.19 (26.82) kg. This represents a statistically significant mean weight loss of 5.94 (6.31) kg (p

Clinical practice guidelines advise patients with atrial fibrillation who are at risk for stroke to undergo thromboprophylaxis with oral anticoagulants. However, it is noted that guidelines are not always followed. We sought to learn how Saudi Arabian general practitioners (GPs) self-reported using risk assessment tools and atrial fibrillation clinical practice guidelines created by cardiology associations, as well as how GPs felt about the resources that were available. Through the use of a self-administered questionnaire, we carried out a cross-sectional survey. A total of two-hundred GPs participated in the study. The guidelines were frequently used when a clinical decision regarding anticoagulation therapy appeared difficult (n = 57, 28.4%). The most predominant strengths of participants’ chosen clinical guidelines were clear recommendations (n = 56, 27.9%), easy-to-follow algorithms (n = 39, 16.9%), detailed recommendations supported by evidence (n = 34, 16.9%), and online availability (n = 27, 13.4%). Many respondents said they used a formal stroke risk assessment tool in addition to their clinical judgment as a GP for most decisions (60%). Most respondents preferred using the CHA2DS2-VASc (n = 106, 52.7%), CHA2DS2-VA (n = 45, 22.4%), CHADS2 (n = 35, 17.4%), and GARFIELD (n = 14, 7.0%). HAS-BLED (n = 100, 49.8%) and HEMORR2HAGES (n = 50, 24.9%) were the most frequently utilized formal tools for assessing the risk of bleeding among GPs. Over half of the participants referred to guidelines when deciding thromboprophylaxis in patients with atrial fibrillation. Additionally, many respondents used formal procedures for assessing the risks of bleeding and stroke in addition to their clinical judgement in their roles as GPs. The guideline was assessed as being extremely helpful overall by GPs who used it to make thromboprophylaxis decisions.

Background: Ever since the emergence of coronavirus disease-2019 (COVID-19) infection in the UAE, the government had taken several preventive measures against the disease, including vaccination. Acceptance of the vaccine among the population played a crucial role in determining whether the pandemic could be successfully controlled. This study aimed to assess the acceptance, knowledge, and perception of the COVID-19 vaccine among the adult population of the UAE. Methods: A cross-sectional study was conducted using a snowball sampling method among UAE residents above 18 years of age. Data were collected using an online questionnaire consisting of 33 close-ended questions divided into three sections. Results: A total of 825 adults (males = 18.4% and females = 81.6%) participated in the study. Males were 3.3 times more likely to get vaccinated than females (95% confidence interval [CI]: 1.9–5.7). Those participants who took the flu vaccine before were 1.4 times more likely to get vaccinated (95% CI: 1.003–1.897). Employed participants were three times more likely to take the vaccine as compared with students and those who were unemployed (95% CI: 2.078–4.577). Likewise, those who were over 40 years old and those who believed in the efficacy and safety of vaccines were more willing to get vaccinated. Conclusion: The acceptance of the COVID-19 vaccine was overall high, especially among males and employees. Our findings may help identify vulnerable groups in order to expand vaccination coverage and help raise awareness among UAE residents.

Abstract Background An increasing proportion of women are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. Intrauterine viral infections induce an increase in the levels of proinflammatory cytokines, which inhibit the proliferation of neuronal precursor cells and stimulate oligodendrocyte cell death, leading to abnormal neurodevelopment. Whether a maternal cytokine storm can affect neonatal brain development is unclear. The objective of the present study was to assess neurodevelopmental outcomes in neonates born to mothers with SARS-CoV-2 infections during pregnancy. Methods In this prospective cohort study, the neurodevelopmental status of infants (N = 298) born to women with SARS-CoV-2 infections during pregnancy was assessed at 10–12 months post-discharge using the Ages and Stages Questionnaire, 3rd edition (ASQ-3). The ASQ-3 scores were classified into developmental delays (cutoff scores ≤ 2 standard deviations (SDs) below the population mean) and no delays (scores > 2 SDs above the population mean). Results The majority (90%) of the infants born to mothers with SARS-CoV-2 infections during pregnancy had favorable outcomes and only 10% showed developmental delays. Two of the 298 infants tested positive for SARS-CoV-2, and both had normal ASQ-3 scores. The majority of the pregnant women had SARS-CoV-2 infections during their third trimester. The risk of developmental delays among infants was higher in those whose mothers had SARS-CoV-2 infections during the first (P = 0.039) and second trimesters (P = 0.001) than in those whose mothers had SARS-CoV-2 infections during the third trimester. Conclusion The neurodevelopmental outcomes of infants born to mothers with SARS-CoV-2 infections seem favorable. However, more studies with larger sample sizes and longer follow-up periods are required.

This study investigated the variability and trends in 115 years (1909–2023) of daily precipitation observed at three hydrometeorological stations in southern (Kaisaniemi), central (Kajaani), and northern (Sodankylä) Finland. We also identified the most significant climate teleconnections influencing daily precipitation variability at these three stations during the period 1951–2023. The daily precipitation records were primarily classified into six grades, including very light (≤1 mm), light (1–≤5 mm), moderate (5–≤10 mm), heavy (10–≤15 mm), very heavy (15–≤20 mm), and extreme (>20 mm). On average, the most intense daily precipitation was determined at the Kaisaniemi station in southern Finland. At this station, however, very light and light precipitation showed the lowest frequency, but other graded daily precipitation events were the most frequent. At all three stations, the intensity of very light precipitation significantly declined during the past 115 years, while its frequency increased. The highest rates of such decreases and increases in the intensity and frequency of very light daily precipitation were found at the Sodankylä stations in northern Finland, respectively, but the lowest rates were at the Kaisaniemi station in the south. At the Kajaani station in central Finland, the intensity of light precipitation decreased, but very heavy precipitation intensified. At this station, however, the number of both moderate and heavy precipitation events increased over time. Finally, historical variations in both the intensity and frequency of graded daily precipitation events in Finland showed significant relationships with different climate teleconnections, particularly the Scandinavia (SCAND) and the North Atlantic Oscillation (NAO) patterns. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency is common in chronic kidney disease (CKD) patients not on dialysis (ND). Restoring depleted iron stores through intravenous (IV) route is faster and associated with less side effects. There is conflicting data regarding intravenous iron use and its impact on clinical outcomes in this population. Objective: This study aims at evaluating any negative clinical impact associated with IV iron use in CKD patients at stages (3-5) before dialysis. Design: Retrospective chart review. Setting and Population: Chart analysis of ND CKD 3-5 (estimated glomerular filtration rate [eGFR]

Solid particle erosion (SPE) is a major source of damage to, and cause of failure of, turbomachinery, including centrifugal and axial compressors and gas turbines. There is considerable interest within the turbomachinery industry to develop the means to enhance durability and improve prediction of likely breakdowns of machinery operating in locations and conditions where ingestion of, for example, dust and sand grains is unavoidable during operation. The present study examines the implications of degradation of the compressor on gas turbine cycle performance, caused by operating in eroding environments, linking compressor aerodynamics with the thermodynamic cycle. The research engine employed in the study comprised a fan, bypass, and two stages of the low-pressure compressor (booster). A numerical simulation using Computational Fluid Dynamics (CFD) software was performed to predict the likely erosion patterns due to solid particles (SPs) impacting on the blades of the first two stages of an axial compressor. This study introduces a method that provides the freedom to apply roughness to a particular region of the blade following the SPE patterns identified as part of the CFD simulations so as to represent the effects of the erosion spots on the overall flow field. The localised roughness method employs a perturbation of the geometry of the blade in the regions corresponding to the location predicted by the SPE model. The intensity of the perturbation, which is governed by a “fraction factor” coded in a Matlab script, was calibrated by reference to a roughness case, applied over the entire blade surface, with equivalent sand-grain roughness (ks) of 60 μm. Turbomatch, the Cranfield in-house gas turbine performance simulation software, was employed to model the degradation of engine performance. The research confirmed that SPE is linked with significant decreases in engine performance parameters such as isentropic efficiency (ηis) and pressure ratio (PR). These quantities showed, for the SPE cases considered, a drop of 8.8% and 5.2%, respectively. These findings are useful to link local SPE events to global GTE cycle performance.

Envenomation by the Indian ornamental tarantula (Poecilotheria regalis) is medically relevant to humans, both in its native India and worldwide, where they are kept as pets. Muscle-related symptoms such as cramps and pain are commonly reported in humans following envenomation by this species. There is no specific treatment, including antivenom, for its envenomation. Moreover, the scientific knowledge of the impact of this venom on skeletal muscle function is highly limited. Therefore, we carried out this study to better understand the myotoxic properties of Poecilotheria regalis venom by determining its effects in cultured myoblasts and in the tibialis anterior muscle in mice. While there was no effect found on undifferentiated myoblasts, the venom affected differentiated multinucleated myotubes resulting in the reduction of fusion and atrophy of myotubes. Similarly, intramuscular administration of this venom in the tibialis anterior muscle in mice resulted in extensive muscle damage on day 5. However, by day 10, the regeneration was evident, and the regeneration process continued until day 20. Nevertheless, some tissue abnormalities including reduced dystrophin expression and microthrombi presence were observed on day 20. Overall, this study demonstrates the ability of this venom to induce significant muscle damage and affect its regeneration in the early stages. These data provide novel mechanistic insights into this venom-induced muscle damage and guide future studies to isolate and characterise individual toxic component(s) that induce muscle damage and their significance in developing better therapeutics.