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Continuous Renal Replacement Therapy (CRRT) serves as an intervention strategy for the management of acute kidney injury (AKI) in critically ill patients. However, owing to its complex nature and the potential for complications, the implementation of CRRT demands continuous monitoring to prevent patient safety risks. This study aims to identify and validate prevalent risks linked to CRRT within a real-world clinical setting, intending to propose preventive measures grounded in expert insights. To systematically categorize and visually depict the risks, their consequences, preventive measures, and recovery controls, our study employed the Bowtie method in conjunction with the Systems Engineering Initiative for Patient Safety (SEIPS) model. In addition to considering patient-related factors that exhibit variability among critically ill individuals, our key findings showed that the most influential risks impacting the effective delivery of CRRT are incidents of clotted filters, bleeding risks arising from the necessity of anticoagulation for filter efficacy, vascular catheter-related bloodstream infections, variations in proficiency levels among healthcare professionals regarding CRRT modalities, especially in operating the CRRT machines, high nursing workload, frequent nursing turnover, occurrences of hypophosphatemia, variability in CRRT prescribing patterns, and issues related to communication among stakeholders. This research sheds light on the primary risks associated with CRRT and provides practical and viable strategies for effective management. Furthermore, the Bowtie diagram developed as part of this study serves as a valuable tool for visually representing the healthcare system and facilitating the identification of system-related risks within healthcare settings.

ABSTRACT Background Immune stressors, such as lipopolysaccharides (LPS), profoundly affect microbiota balance, leading to gut dysbiosis. This imbalance disrupts the metabolic phenotype and structural integrity of the gut, increasing intestinal permeability. During puberty, a critical surge in estrogen levels is crucial for mammary gland development. However, inflammation originating from the gut in this period may interfere with this development, potentially heightening breast cancer risk later. The long‐term effects of pubertal inflammation on mammary development and breast cancer risk are underexplored. Such episodes can dysregulate cytokine levels and microRNA expression, altering mammary cell gene expression, and predisposing them to tumorigenesis. Methods This study hypothesizes that prebiotics, specifically Lentinula edodes Cultured Extract (AHCC), can counteract LPS's adverse effects. Using BALB/c mice, an acute LPS dose was administered at puberty, and breast cancer predisposition was assessed at 13 weeks. Cytokine and tumor‐related microRNA levels, tumor development, and cancer stem cells were explored through immunoassays and qRT‐PCR. Results Results show that LPS induces lasting effects on cytokine and microRNA expression in mammary glands and tumors. AHCC modulates cytokine expression, including IL‐1β, IL‐17A/F, and IL‐23, and mitigates LPS‐induced IL‐6 in mammary glands. It also regulates microRNA expression linked to tumor progression and suppression, particularly counteracting the upregulation of oncogenic miR‐21, miR‐92, and miR‐155. Although AHCC slightly alters some tumor‐suppressive microRNAs, these changes are modest, highlighting a complex regulatory role that warrants further study. Conclusion These findings underscore the potential of dietary interventions like AHCC to mitigate pubertal LPS‐induced inflammation on mammary gland development and tumor formation, suggesting a preventive strategy against breast cancer.

Abstract Background Diabetes is a chronic condition that can result in many long-term physiological, metabolic, and neurological complications. Therefore, early detection of diabetes would help to determine a proper diagnosis and treatment plan. Methods In this study, we employed machine learning (ML) based case-control study on a diabetic cohort size of 1000 participants form Qatar Biobank to predict diabetes using clinical and bone health indicators from Dual Energy X-ray Absorptiometry (DXA) machines. ML models were utilized to distinguish diabetes groups from non-diabetes controls. Recursive feature elimination (RFE) was leveraged to identify a subset of features to improve the performance of model. SHAP based analysis was used for the importance of features and support the explainability of the proposed model. Results Ensemble based models XGboost and RF achieved over 84% accuracy for detecting diabetes. After applying RFE, we selected only 20 features which improved the model accuracy to 87.2%. From a clinical standpoint, higher HDL-Cholesterol and Neutrophil levels were observed in the diabetic group, along with lower vitamin B12 and testosterone levels. Lower sodium levels were found in diabetics, potentially stemming from clinical factors including specific medications, hormonal imbalances, unmanaged diabetes. We believe Dapagliflozin prescriptions in Qatar were associated with decreased Gamma Glutamyltransferase and Aspartate Aminotransferase enzyme levels, confirming prior research. We observed that bone area, bone mineral content, and bone mineral density were slightly lower in the Diabetes group across almost all body parts, but the difference against the control group was not statistically significant except in T12, troch and trunk area. No significant negative impact of diabetes progression on bone health was observed over a period of 5-15 yrs in the cohort. Conclusion This study recommends the inclusion of ML model which combines both DXA and clinical data for the early diagnosis of diabetes.

الملخص: أهداف البحث: تشهد المملكة العربية السعودية تغييرات تحويلية في مجال الرعاية الصحية، مع إعطاء الأولوية لمراكز الرعاية الصحية الأولية لتحسين تجربة المرضى ونظام الرعاية الصحية الشامل. وتهدف هذه الدراسة إلى تقييم مدى الاستعداد للتغيير لدى مديري مراكز الرعاية الصحية الأولية في مكة المكرمة، المملكة العربية السعودية. طرق البحث: استخدمت دراسة مقطعية نموذج استبانة ''أدكار''، التي تتكون من 22 سؤالاً على مقياس ليكرت، لتقييم وعي المديرين ورغبتهم ومعرفتهم وقدراتهم وتعزيزهم واستعدادهم للتغيير بشكل عام. النتائج: وجدت الدراسة وجود ارتباط كبير بين مستويات التعليم العالي وزيادة الوعي، إلى جانب زيادة الرغبة، بين مديري الرعاية الصحية الأولية. بالإضافة إلى ذلك، تم العثور على ارتباط إيجابي بين العمر (أكبر من 41 سنة) والمعرفة بين مديري الرعاية الصحية الأولية. ومع ذلك، أظهر المديرون الذين لديهم 11 عامًا أو أكثر من الخبرة ارتباطا سلبيا بالاستعداد للتغيير. الاستنتاجات: يحدد نموذج ''أدكار'' خمسة أبعاد مفيدة لتحديد مدى استعداد المديرين واستعدادهم للخضوع للتغيير. تعتمد إدارة التغيير الناجحة على انفتاح الأفراد على التغيير، متأثرين بعوامل مثل العمر والتعليم والخبرة. Abstract: Background: KSA is currently undergoing significant changes in its healthcare system, with a particular emphasis on enhancing the role of primary healthcare centers (PHCs) to elevate patient experience and overall healthcare quality. At the forefront of this transformation are head managers in PHCs, who play a crucial role in implementing these changes effectively. The readiness of these managers is paramount to the successful execution of the envisioned transformation and the subsequent improvement of patient experience. Objective: This study aims to assess the readiness to change among head managers of primary healthcare centers in Makkah, KSA. Methodology: Cross-sectional study utilized the ADKAR model questionnaire, consisting of 22 Likert scale questions, to assess PHCs head managers' awareness, desire, knowledge, ability, reinforcement, and overall change readiness. Results: The study found a significant association between higher educational levels and increased awareness (β = 0.214, p = 0.030), along with greater desire (β = 0.207, p = 0.029) among primary healthcare (PHC) managers. Additionally, a positive association was found between age (≥41 years) and knowledge among PHC managers (β = 0.138, p = 0.030). However, managers with 11 or more years of experience showed a negative association with change readiness (β = −0.112, p = 0.001). Conclusion: The ADKAR model outlines five dimensions that are useful for identifying the readiness and willingness of head managers in PHCs in Makkah cluster to undergo change. Assessing change readiness is crucial for organizational transformation, with head managers playing a significant role. Factors such as age, education, and experience influence managers' readiness for change in primary healthcare centers (PHCs) in Makkah.

In this work, the higher order electrostatic and solitonic EA energy plasma in auroral plasma has been investigated. The perturbed KdV form has been solved. The modulated soliton speed, energy of the cold beam electrons, and the associated higher fifth order electrostatic field have been mathematically derived. The effect of perturbed beam density as well as beam temperature parameters on the dressed electrostatic and energy properties has been discussed. The auroral plasma results in this work may be important in space applications.

Introduction Worldwide, healthcare systems aim to achieve the best possible quality of care at an affordable cost while ensuring broad access for all populations. The use of artificial intelligence (AI) in healthcare holds promise to address these challenges through the integration of real-world data-driven insights into patient care processes. This study aims to assess nurses’ awareness and attitudes toward AI-integrated tools used in clinical practice. Methods A descriptive cross-sectional design captured nurses’ responses at three governmental hospitals in Saudi Arabia by using an online questionnaire administered over 4 months. The study involved 220 registered nurses with a minimum of one year of clinical experience, selected through a convenience sampling method. The online survey consisted of three sections: demographic information, an assessment of nurses’ AI knowledge, and the general attitudes toward the AI scale. Results Nurses displayed “moderate” levels of awareness toward AI technology, with 70.9% having basic information about AI and only 58.2% (128 nurses) were considered “aware” of AI as they dealt with one of its healthcare applications. Nurses expressed openness to AI integration ( M = 3.51) on one side, but also had some concerns about AI. Nurses expressed conservative attitudes toward AI, with significant differences observed based on gender (χ² = 4.67, p

A model of nonlinear electron acoustic electrostatic plasma waves having electron beams has been investigated. The structure of Korteweg–de Vries soliton energy and the corresponding electrostatic field have been discussed. The parametric regimes for wave existence of compressive and rarefactive structures have been examined via auroral zone data. The effects of densities and thermal temperature of electrons and beams on the nature of the electrostatic field and fluid energies have been taken into account.

This case report describes the surgical management of a giant left adrenal mass (27 x 26 × 27 cm, 9.370 kg) in a 69-year-old female. We review the multidisciplinary decision-making process for pre-operative preparation, embolization, resection feasibility, and strategies to mitigate intra-operative complications. This is the largest adrenal adenoma removal reported to date. The case highlights the importance of meticulous surgical planning and execution in managing rare and challenging cases, with significant implications for patient outcomes.

Mohammed Almuqbil,1– 3 Fatimah Yaseen Alshaikh,4 Waleed Altwaijri,1– 3 Duaa Baarmah,5 Raid Harb Hommady,2,3 Maryam Yaseen Alshaikh,1 Fares Alammari,6 Meshal Alhussain,7 Reem Almotawa,8 Faris Alqarni,9 Amna Kashgari,1,10 Rayan Alkhodair,1,2,11 Jumanah N Alkhater,1 Lujeen Nasser Alkhater,6 Sawsan A Alharthi,11 Mada Abdulkarim Alsadi,12 Ahmed AlRumayyan1– 3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard, Riyadh, Saudi Arabia; 3Division of Pediatric Neurology, Department of Pediatrics, King Abdullah Specialist Children’s Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia; 4Collage of Medicine, Princess Nora University, Riyadh, Saudi Arabia; 5Department of Pediatrics, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 6College of Medicine, Almaarefa University, Riyadh, Saudi Arabia; 7College of Medicine, King Khalid University, Abha, Saudi Arabia; 8Royal College of Surgeons, Dublin, Ireland; 9College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 10Department of Radiology, King Abdullah Specialist Children’s Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia; 11Division of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 12Division of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Riyadh, Saudi ArabiaCorrespondence: Mohammed Almuqbil, College of medicine, King Saud bin Abdulaziz University for health Sciences (KSAU-HS), Prince Mutib Ibn Abdullah Ibn Abdulaziz, Ar Rimayah, P.O. Box 22490, MC 1940, Riyadh, 11426, Saudi Arabia, Tel +966-11-8011111 ext 53594, Email muqbilm@ksau-hs.edu.sa; almuqbilmo@ngha.med.saPurpose: The aim of this manuscript was to assess the epidemiology and clinical features of Neurofibromatosis type 1 (NF-1) based on the newly published revised NF-1 diagnostic criteria and to evaluate complications of NF-1 including neurodevelopmental disorders.Patients and methods: A retrospective cross-sectional observational study was conducted in the Ministry of National Guard Health Affairs (MNGHA) healthcare organization branches including four tertiary hospitals and 51 primary health care centers in different regions in Saudi Arabia. This study included all patients diagnosed with NF1 using the revised NIH diagnostic criteria published in 2021 that were registered at the electronic medical records (EMR) from 2015 to 2021.Results: A total of 184 patients fulfilled the diagnostic criteria and were included in this study. The median age at diagnosis was 11 years (IQR: 4.00– 20.25). The most encountered diagnostic criteria in this study were Café-au-lait macules (85.3%), and (42.9%) were found to have two or more neurofibromas with plexiform neurofibroma being the most common subtype (23.36%), approximately (36.4%) of the patient with optic pathway glioma. Nearby (26.6%) of the patients displayed different type of tumors. Iris Lisch nodules were presented in 36.4% of patients at a median age of 12 years (IQR: 9.0– 21.8). Cardiovascular abnormality was encountered in 9.8% of the patients. Around 27.7% of the patients reported headache and 11.4% of the patient suffered from different type of epilepsy. Besides, 10.5% of the patients had intellectual disability, 33.8% suffered from communication disorders, and 4.9% patients had ADHD.Conclusion: The results of this study will enable practitioners to adopt a more holistic approach and prioritize numerous attributes, which they can subsequently incorporate into their therapeutic methodologies. Furthermore, the identification of these attributes will facilitate an expeditious and accurate diagnosis. Hence, the implementation of intervention during its nascent phase may result in a more advantageous consequence.Keywords: neurofibromatosis type 1, café-au-lait macule, glioma, neurofibromas

Abstract Background Sleep disturbances, a public health concern that may lead to critical physiological conditions, are associated with personal characteristics such as gender. Limited evidence is available from the Middle East population on the gender disparities in sleep quality. Therefore, the current study examined gender-specific differences in sleep quality and disturbances among Jordanian citizens. Method A cross-sectional design was used to recruit a convenient sample of 1,092 adults from different Jordanian cities. Data was collected using a self-reported questionnaire comprising the Pittsburgh Sleep Quality Index (PSQI), which was distributed online via social media networks. The participants were categorized according to their global PSQI scores into poor (PSQI ≥ 5) and good sleepers (PSQI

Background: Self-medication is a global concern among professionals and non-professionals, with a rapid increase in prevalence. The study aims to assess the prevalence of self-medication and its associated factors among university students. Materials and Methods: A cross-sectional, descriptive study was conducted in three universities, and a total of 817 college students participated in this study. Results: About 75.40% of the participants reported using medications without a professional prescription. The category of analgesics was the most commonly used in self-medication (82.80%), while the most common symptom was a headache (81.50%). Almost 74.10% percent of participants who have practiced self-medication stated that the reason was the “lack of time to consult a physician.” Most participants who have used self-medication (90.30%) stated that the source of knowledge was “previous prescription.” Conclusions: Health education programs concerning self-mediation should be held in university settings to improve attitudes and practices toward self-mediation.

This study explores the intricate relationships between entrepreneurial orientation (EO), digital orientation (DO), strategic agility (SA), and competitive advantage (CA) in Saudi firms. We investigate whether strategic agility serves as the missing link in these relationships. We examine direct and indirect effects among these constructs using structural equation modeling on data collected from 307 Saudi firms. The results confirm the direct positive links between EO and SA with CA. However, the findings also reveal a surprising result—there is no direct link between DO and CA. At the same time, both DO and EO exerted significant positive influences on SA. This study emphasizes the mediating role of SA. We find that SA partially mediates the relationship between EO and CA, underlining the importance of EO while pointing out the additional value given to this relationship by SA. Additionally, SA fully mediates the relationship between DO and CA, suggesting that firms must develop SA to translate their digital capabilities into CA. These results contribute to the strategic management literature by explaining the interplay between strategic orientations, agility, and competitive advantage in the Saudi context. They also provide practical implications for managers seeking to enhance the competitiveness of their firms during this digital age by showing that investing in SA in conjunction with entrepreneurial and digital resources is of paramount importance.

Key Clinical Message While Cerebral vascular malformations exhibit distinct clinical and radiographical features, rare instances of coexisting lesions occur. This case report sheds light on the rare coexistence of brain capillary telangiectasia and venous angioma in a patient presenting with a seizure attributed to frontal lobe bleeding. Though often silent, brain capillary telangiectasia can manifest with serious life‐threatening intracranial bleeding. Therefore, in cases of spontaneous intracranial bleeding, an MRI of the head is crucial to rule out such cerebral vascular malformations.

Key Clinical Message Adalimumab has become essential for managing various chronic inflammatory diseases, including inflammatory bowel disease (IBD). While hematologic complications of adalimumab therapy are rare, they can have significant clinical implications. This report highlights the importance of recognizing and monitoring for neutropenia in patients receiving adalimumab treatment. We also describe the potential mechanisms and management strategies for this adverse event.