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Accurate prediction of pressure drops in multi-phase flow systems is essential for optimizing processes in industries such as oil and gas, where operational efficiency and safety depend on reliable modeling. Traditional models often need help with the complexities of multi-phase flow dynamics, resulting in high relative errors, particularly under varying flow regimes. In this study, we simulate a comprehensive multiphase flow experimental data collected from the lab. This study presents innovative methods for accurately modeling pressure drops in multi-phase flow systems. It also studies the complicated dynamics of multi-phase flows, which are flows with more than one phase at the same time. It does this by using two different data-driven models, nonlinear ARX and Hammerstein-Wiener, instead of neural networks (NNs), so that the models don’t get too good at fitting environments with lots of changes and little data. Our research applies system identification approaches to the intricacies of this domain, providing new insights into choosing the best appropriate modeling strategy for multi phase flow systems, taking into account their distinct properties. The experimental results show that the nonlinear Hammerstein-Wiener and ARX models were much better than other methods, with fitting accuracy rates of 81.12% for the Hammerstein-Wiener model and 86.52% for the ARX model. This study helps the creation of more advanced control algorithms by providing a reliable way to guess when the pressure drops and showing how to choose a model that fits the properties of the multi-phase flow. These findings contribute to enhanced pressure management and optimization strategies, setting a foundation for future studies on real-time flow control and broader industrial applications.

Background: Multiple sclerosis (MS) is considered the most prevalent neurological disorder in young adults with many patients manifesting sleep-related disorders (SRD) due to its pathomechanisms. This is subsequently reflected in patients’ quality of life and physical activities. Material and Methods: This is a cross-sectional study at a tertiary care center. Patients diagnosed with MS were enrolled, and assessment of their sleep patterns and related disorders were measured using pre-validated scales. A questionnaire consisting of 38 items was used, and the obtained data were analyzed using RStudio software. Results: A total of 260 patients participated in the study. Most participants were aged 31–40 (n = 112) with a mean age of 36.49 ± 8.41 (age range: 18–56 years). The most used medications were rituximab (27%) and ocrelizumab (25%). Shapiro–Wilk Test was significant (P = 0.04) and just below the significance level of α = 0.05, suggesting potential significant deviation in the distribution of age. Logistic regression model was applied, and the female probability of sleeping more than six hours was 3.60 times the probability of sleeping six hours or less. Conclusion: Sleep quality is multifaceted and requires intensive investigation in patients with chronic disorders including MS. In this study, several novel data have been presented in a population that has very little literature data.

Background The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) aims to standardize the terminology and morphologic criteria associated with thyroid fine-needle aspiration cytology (FNAC) results while also providing corresponding risk assessments for malignancy. contributing to more consistent and standardized reporting of thyroid nodules and aiding clinicians in making informed decisions. Since then, it has been undergoing revisions and updates to further improve its utility and accuracy. Materials and Methods This is a retrospective study conducted at a tertiary care center. All patients with a history of thyroid gland swelling who had previously undergone FNA were included. The procedure included cytopathologists performing FNAC for all cases of midline neck swelling. Demographic and histopathology data were correlated with the cytological diagnosis. Results We included 288 cases. Of those, 234 (81.3%) were female and 54 (18.8%) were male. The presentation age range was 18–91 years. The most reported category was benign, which constituted 30.9% of the cases followed by malignancy (27.1%). As for thyroid lesions, papillary carcinoma was the most prevalent (43.6%). The correlation on cyto-histopathology was presented in every diagnostic category, showing high heterogeneity in diagnostic specificity and sensitivity. The overall diagnostic specificity and sensitivity were 56.05% (95% confidence interval [CI]: 47.92–63.95%) and 80.92% (95% CI: 73.13–87.25%), respectively. Positive and negative predictive values were 60.57% and 77.88%, respectively. Conclusion Our data suggests that the TBSRTC system promotes similar sensitivity and specificity to those reported elsewhere. It standardizes reporting and improves communication between cytopathologists and clinicians.

Background Biological therapies are effective for psoriasis, but patient responses vary, often requiring therapy switching or discontinuation.Objectives To identify physicians’ prescribing patterns of biological therapies at a referral tertiary center in Saudi Arabia and assess the probability of biologic persistence following treatment initiation.Methods We conducted a retrospective study of biologic-naïve adult psoriasis patients who initiated therapy from October 2013 to July 2022 in Dammam. Descriptive statistics and a Kaplan-Meier analysis evaluated treatment persistence at 6, 12, 24, and 36 months.Results A total of 151 patients received adalimumab (n = 89), etanercept (n = 17), risankizumab (n = 30), ustekinumab (n = 14), and ixekizumab (n = 1). At 6 months, all therapies demonstrated 100% persistence. At 12 months, persistence was highest for ustekinumab (100%) and lowest for etanercept (88.2%). At 24 months, ustekinumab maintained 100% persistence, followed by risankizumab (96.6%), adalimumab (94.3%), and etanercept (76.4%). At 36 months, risankizumab had the highest persistence (96.6%), followed by adalimumab (83.1%), ustekinumab (78%), and etanercept (70.6%). The most common reasons for discontinuation were lack of effectiveness and intolerability.Conclusion This study shows changing psoriasis treatment patterns with new therapies. Risankizumab demonstrated high long-term persistence, while etanercept and ustekinumab showed declining persistence, suggesting evolving treatment considerations.

This research seeks to promote the field via the design and implementation optimized robotic manipulator control systems, recognizing control techniques' vital role in current engineering applications. This study introduces an improved particle swarm optimization (IPSO) technique that maximizes the efficiency of a Fractional Order Proportional-Integral-Derivative (FOPID) controller by optimally adjusting FOPID gains in robotic manipulator systems. The controller has undergone refinement and enhancement using state-of-the-art particle swarm optimization (PSO) techniques incorporating a cost function and a representative bio-inspired algorithm. The IPSO algorithm enhances global search efficiency by preventing premature convergence and local minima trapping through chaos-based initialization and adaptive mutation strategies. The performance of IPSO-tuned FOPID controllers is benchmarked against conventional PSO-tuned FOPID controllers using various objective functions. The stabilizing fractional order PID controllers demonstrated a higher stability margin than traditional PID controllers. Numerical simulations support the developed strategy by analyzing the step and sinusoidal responses of the closed-loop system within the stability region. The results indicate that IPSO outperforms PSO with improvements of approximately 50% for 10 iterations, about 12% for 50 iterations, and around 20% for 100 iterations across ITSE, ITAE, and ITAE metrics, respectively. Furthermore the statistical analysis based on Wilcoxon sign rank test proof that the IPSO algorithm significantly improves convergence speed, controller accuracy, and overall performance, thereby enhancing the effectiveness of the IPSO technique such as in case of 10 iteration the confidence intervals do not include zeros, which indicates that IPSO outperformed the traditional POS in all scenarios.

This paper presents a comparative analysis of a fractional-order proportional–integral–derivative (FO-PID) controller against the standard proportional–integral–derivative (PID) controller, applied to a nonlinear robotic arm manipulator systems. The genetic algorithm (GA) optimization method was implemented to tune the gain parameters of the FO-PID and PID controllers. The performance of the FO-PID and PID controllers were evaluated though different cost functions, including integral of squared error (ISE), integral of absolute error (IAE), integral of time-weighted absolute error (ITAE), and integral of time-weighted squared error (ITSE). The performance of these controllers was examined via extensive simulations by using MATLAB/SIMULINK for different operating scenarios of the robotic arm manipulator system. Based on the obtained results, a comparative performance matrix is proposed, wherein cost functions ISE, IAE, ITAE, and ITSE are represented as columns while characteristic parameters (overshoot, rising time, and settling time) are represented as rows. The proposed performance matrix facilitates the selection between the PID and FO-PID controllers.

This study proposes a novel discrete-time integral sliding mode control (ISMC) framework for managing pressure in multi-phase flow systems (MPFS), a critical component of hydrocarbon production and transportation. The primary goal is to achieve precise pressure regulation and minimize fluctuations under diverse operational conditions. Unlike traditional approaches, this work employs a Hammerstein nonlinear modeling technique to accurately represent the system dynamics and design the control strategy. The contributions of this research include the development of a data-driven system identification methodology using a single-input, single-output (SISO) Hammerstein model, enabling precise pressure prediction based on experimental data collected from the lab. A robust ISMC algorithm is introduced to address the inherent nonlinearities, disturbances, and uncertainties in multi-phase flow dynamics. The proposed controller is comprehensively validated through numerical simulations and experimental data, demonstrating its capability to reduce pressure fluctuations, enhance stability, and maintain operational efficiency. This novel integration of Hammerstein modeling with discrete-time ISMC offers a scalable and reliable solution to the challenges of pressure control in MPFS. The results demonstrate significant advantages over conventional controllers, such as traditional sliding mode, in terms of robustness and precision, contributing to the safety, efficiency, and sustainability of oil and gas operations.

BackgroundDrug-resistant epilepsy (DRE) impacts a significant portion, one-third, of individuals diagnosed with epilepsy. In such cases, exploring non-pharmacological interventions are crucial, with the ketogenic diet (KD) standing out as a valuable option. KD, a high-fat and low-carb dietary approach with roots dating back to the 1920s for managing DRE, triggers the formation of ketone bodies and modifies biochemistry to aid in seizure control. Recent studies have increasingly supported the efficacy of KD in addressing DRE, showcasing positive outcomes. Furthermore, while more research is needed, limited data suggests that KD May also be beneficial for specific genetic epilepsy syndromes (GESs).ObjectiveThis study aimed to assess the short-term efficacy of KD among pediatric patients diagnosed with GESs.Materials and methodsThis is a multi-center retrospective analysis of pediatric patients with GESs diagnosed using next-generation sequencing. The enrolled patients followed the keto-clinic protocol, and the KD efficacy was evaluated at 3, 6, and 12-month intervals based on seizure control and compliance. The collection instrument included demographic, baseline, and prognostic data. The collected data was coded and analyzed promptly.ResultsWe enrolled a cohort of 77 patients with a mean current age of 7.94 ± 3.83 years. The mean age of seizure onset was 15.5 months. Notably, patients experienced seizures at a younger age tended to have less positive response to diet. Overall, 55 patients responded favorably to the diet (71.4%) while 22 patients (28.6%) showed no improvement. Patients with genetic etiology showed a significantly more favorable responses to the dietary intervention. Patients with Lennox–Gastaut syndrome showed the most significant improvement (14/15) followed by patients with Dravet syndrome (6/8), and West syndrome (3/4). The number of used anti-seizure medications also played a significant role in determining their response to the diet. While some patients experienced mild adverse events, the most common being constipation, these occurrences were not serious enough to necessitate discontinuation of the diet.ConclusionThe study revealed a high improvement rate in seizure control, especially among younger patients and those with later seizure onset. The success of dietary treatment hinges greatly on early intervention and the patient’s age. Certain genetic mutations responded favorably to the KD, while efficacy varied among various genetic profiles.

Background: The illnesses associated with changes in barometric pressure can be classified into three types: acute mountain sickness, high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema. HAPE is a rare form of pulmonary edema that occurs in susceptible individuals after arriving at altitudes over 2500 m above sea level (m). Only a few studies have reported classical HAPE among children with underlying cardiopulmonary comorbidities. In this study, we report two pediatric cases of classical HAPE that occurred immediately upon arriving at Abha city (with an average elevation of 2270 m above sea level). Notably, both patients possessed underlying chronic lung diseases, raising crucial questions about susceptibility factors and the early onset manifestations of HAPE. Case: Two pediatric cases of HAPE are presented. The first patient, with a medical history of repaired right congenital diaphragmatic hernia and subsequent right lung hypoplasia, developed HAPE following their ascent to a high altitude. The second patient, diagnosed with diffuse lung disease of unknown etiology, experienced HAPE after a rapid high-altitude ascent. Both patients resided in low-altitude areas prior to ascent. The initial emergency room assessment revealed that both patients had severe hypoxia with respiratory distress that mandated the initiation of respiratory support and 100% oxygen therapy. They required intensive care unit admission, improved after 5 days of hospitalization, and were sent home in good condition. Conclusion: HAPE is a complex, potentially life-threatening high-altitude illness with diverse clinical presentations and variable risk factors. This case report sheds light on a potential predisposition factor—pre-existing lung disease—in children experiencing severe HAPE. While further validation is crucial, this valuable insight opens doors for improved preventative strategies and informed medical decisions for children with pre-existing lung conditions traveling to high altitudes.

Ali Alsuheel Asseri,1 Ahmad A Alzoani,2 Mohammed Almahdi,3 Hussein Almahdi,4 Nouf Almushayt,3 Noha Saad Alyazidi,3 Basmah Mohammed Al Mufarrih5 1Department of Child Health, King Khalid University, Abha, 61421, Saudi Arabia; 2Department of Neonatology, Abha Maternity and Children Hospital, Ministry of Health, Abha, 62521, Saudi Arabia; 3Department of Pediatrics, Abha Maternity and Children Hospital, Ministry of Health, Abha, 62521, Saudi Arabia; 4College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia; 5Department of Obstetrics and Gynecology, Abha Maternity and Children Hospital, Ministry of Health, Abha, 62521, Saudi ArabiaCorrespondence: Ali Alsuheel Asseri, Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia, Tel +966500186013, Fax +9662418139, Email alsoheel11@kku.edu.saAbstract: Jeune syndrome, or asphyxiating thoracic dystrophy (JATD), is a rare autosomal recessive skeletal dysplasia with heterogeneous genetic and clinical phenotypes, which primarily affects cartilage and bone development. Herein, we report a patient with a lethal form of SRTD3 without polydactyly (JATD), which led to severe restrictive lung disease and fatal respiratory failure. A full-term boy was born to a 30-year-old mother who was known to have hypothyroidism and was on thyroxine. The parents were first-degree cousins and had one healthy older son. Fetal ultrasound showed a cephalic fetus, normal amniotic fluid and a fundal placenta. All long bones and ribs were below the 1% percentile. The femur was bowed with no fractures or signs of significant demineralization at time of imaging. Head and abdominal circumference were within normal range. An echocardiogram on the 2nd day of life showed severe pulmonary hypertension (PHTN). Nitric oxide was started due to the presence of persistent hypoxia and severe PHTN. The patient continued to require high cardiorespiratory support, but the medical condition worsened, and respiratory failure persisted. The patient died of severe respiratory failure at 16 days of life due to respiratory insufficiency secondary to a severely restricted thoracic cage. Whole-exome sequencing (WES) revealed a homozygous mutation in the DYNC2H1 (NM_001377.3) gene, namely, the c.9041G>T NP_001368.2: p.(Arg3014Ile) missense variant, which results in the substitution of the arginine codon at amino acid position 3014 with an isoleucine codon. The phenotyping of the patient’s JATD and the detection of a homozygous variant in the DYNC2H1 gene confirmed the diagnosis of short-rib thoracic dysplasia-3 without polydactyly. In summary, the patient had isolated skeletal anomalies without polydactyly or other organ involvement. Additionally, the infant had severe PHTN on top of the respiratory failure, which eventually caused death. Considerably more work will need to be done to determine the clinical spectrum of JATD and understand its genetic heterogeneity.Keywords: SRTD3, Jeune syndrome, asphyxiating thoracic dystrophy, DYNC2H1

This research presents an optimized DC motor controller designed to enhance performance and efficiency in speed regulation, acknowledging the pivotal role of control strategies in modern engineering applications. The controller maximizes the capabilities of the integral linear quadratic regulator (ILQR) framework, fine-tuned using state-of-the-art particle swarm optimization (PSO) techniques and a well-defined cost function alongside other bio-inspired algorithms. Additionally, a disturbance observer is incorporated into the LQR scheme to improve the system’s resistance to external disturbances, both constant and time-varying. PSO and genetic algorithms (GA) are employed to identify appropriate LQR weighting, significantly increasing control performance. This integration produces a robust control system to improve the performance and efficiency of DC motor speed regulation. It provides an elaborate structure that can be adapted to various technical applications. Numerous simulations demonstrate the enhanced performance of the developed technique in achieving optimal speed control while maintaining high robustness.

Background and Aims: Throughout their years of study, undergraduate medical students are expected to gain broad comprehension of all medical specialties. After acquiring an undergraduate degree, the decision to choose a specialty is critical for every student's life as it determines the rest of their career path. This study aims to determine factors influencing medical students' choices between various specialties in different countries in the Middle East and North Africa. Subjects and Methods: A cross-sectional study was conducted in March 2022 targeting medical students from the Middle East and North African countries. A questionnaire was used to collect data from the students, which consisted of four sections. Ethical approval was obtained from the Unit of Biomedical Ethics Research Committee at King Abdulaziz University. Participation was voluntary and anonymous. For statistical analysis, IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows (Version 21.0; IBM Corp., Armonk, NY, USA) was used. Categorical variables were presented using numbers, associated frequencies, and percentages (%). Categorical variables were correlated using the Chi-square test. One-way analysis of variance (ANOVA) test was used to compare the means of three or more independent groups. Logistic regression, odds ratio (OR), and 95% confidence interval (CI) were used to identify the factors associated with specialty selection. P < 0.05 was considered statistically significant. Results: A total of 1109 students responded to the questionnaire. Participants' gender characteristics showed that there were 672 (60.6%) females and 437 (39.4%) males. Among them, 127 were in their second year, 180 in their third year, 362 in their fourth year, 85 in their fifth year, 37 in their sixth year, and 108 were interns. The median age of the participants was 22.0 years (mean = 22.09 ± 2.891). There were 473 (42.6%) students who were undecided about their future medical specialty. Income (759, 68.4%) and career prospects (723, 65.2%) were the most preferred factors in their decision to pursue a future medical specialization. Conclusions: In conclusion, medical and surgical specialties have been identified as the preferred future career path. It was discovered that student's decision-making is influenced by income, career prospects, and the sense of competency needed to choose a future medical specialty. Future research would be more revealing.

Health policy debates rely on reliable and timely information on major causes of mortality and their associated attributors, especially to overcome the traditional public health focus restricted to the biomedical cause of death (COD). This study explores relevant social and health system circumstantial barriers to accessing healthcare services among deceased patients with Type 2 Diabetes Mellitus (T2DM) in Saudi Arabia. A total of 302 verbal autopsy (VA) interviews were conducted with relatives or caregivers of the deceased who died between 2018 and 2021, based on T2DM medical records from Alnoor Specialist Hospital in the Western Province, Saudi Arabia. The Bayesian-based InterVA-5 algorithm was employed as a validated source to determine the probable COD and Circumstances Of Mortality Categories (COMCATs) for each case. COMCATs stand for predetermined categories of multiple social and healthcare system circumstances that contribute to an individual's death. The likelihoods of COD and COMCATs derived from InterVA-5 software were computed independently to generate the 'cause-specific mortality fractions' (CSMFs) of the COD and COMCATs. The CSMFs for the seven COMCATs categories were then ranked based on their derived probabilities for the corresponding COMCATs across all major COD categories. The top CODs were circulatory diseases (35.8%), stroke (16.6%), and diabetes mellitus (14.3%). The probabilities of COMCATs indicated that most deaths were attributed to 'inevitable' causes (e.g., terminal illness), followed by 'recognition' (inability to recognize the severity of illness) and 'traditions' (local attitudes deterring patients from seeking medical services on time). Addressing 'recognition' and 'traditions' barriers could reduce mortality rates and improve access to healthcare, helping the Saudi health system accelerate the progress towards the systematic measurement of key universal health coverage indicators. The study emphasizes the need for a robust and standardized VA method within routine medical services to address factors influencing healthcare access towards improved health outcomes.

Apraxia of eyelid closure (AEC) is a rare disorder characterized by the inability to close the eyes on command with the preservation of the motor and sensory systems, coordination, comprehension, and cooperation. The prevalence of AEC is extremely small and the exact pathophysiological mechanisms underlying this condition remain unknown. It is, however, associated with extrapyramidal disorders. Very few cases of bilateral AEC have been reported. We report a case of an 81-year-old male patient having multiple comorbidities including neurological, respiratory, and abnormalities complicated by COVID-19 infection, who developed AEC that was noticed by the caregiver. We illustrate the clinical course leading to the diagnosis of bilateral AEC and highlight the important role of the caregiver in reporting subtle signs such as AEC.

Health policy debates rely on reliable and timely information on major causes of mortality and their associated attributors, especially to overcome the traditional public health focus restricted to the biomedical cause of death (COD). This study explores relevant social and health system circumstantial barriers to accessing healthcare services among deceased patients with Type 2 Diabetes Mellitus (T2DM) in Saudi Arabia. A total of 302 verbal autopsy (VA) interviews were conducted with relatives or caregivers of the deceased who died between 2018 and 2021, based on T2DM medical records from Alnoor Specialist Hospital in the Western Province, Saudi Arabia. The Bayesian-based InterVA-5 algorithm was employed as a validated source to determine the probable COD and Circumstances Of Mortality Categories (COMCATs) for each case. COMCATs stand for predetermined categories of multiple social and healthcare system circumstances that contribute to an individual's death. The likelihoods of COD and COMCATs derived from InterVA-5 software were computed independently to generate the 'cause-specific mortality fractions' (CSMFs) of the COD and COMCATs. The CSMFs for the seven COMCATs categories were then ranked based on their derived probabilities for the corresponding COMCATs across all major COD categories. The top CODs were circulatory diseases (35.8%), stroke (16.6%), and diabetes mellitus (14.3%). The probabilities of COMCATs indicated that most deaths were attributed to 'inevitable' causes (e.g., terminal illness), followed by 'recognition' (inability to recognize the severity of illness) and 'traditions' (local attitudes deterring patients from seeking medical services on time). Addressing 'recognition' and 'traditions' barriers could reduce mortality rates and improve access to healthcare, helping the Saudi health system accelerate the progress towards the systematic measurement of key universal health coverage indicators. The study emphasizes the need for a robust and standardized VA method within routine medical services to address factors influencing healthcare access towards improved health outcomes. [ABSTRACT FROM AUTHOR]

Background It is of utmost importance for the elements that influence public compliance with vaccination against COVID-19 to be assessed, including misconceptions, rumors, and conspiracy theories. Hence, in this study, we aimed to estimate the distribution of the most common misconceptions regarding COVID-19 vaccines and their predictors in Saudi Arabia. Methods We distributed an online questionnaire to participants aged 18 years or older. The survey included two sections. The first section comprised questions related to participants’ demographic characteristics, level of education, and their sources of information about COVID-19. The second section assessed participants’ perceptions regarding 11 of the most common misconceptions regarding COVID-19 vaccines, rated using a 5-point Likert scale. Using ordinal logistic regression, we conducted an evaluation of the relationships among different predictors including age, sex, educational level, and sources of information, as well as acceptance of misconceptions about vaccination. Results The most widely accepted misconception was that the COVID-19 vaccine had severe side effects, with 34.8% of participants believing this misinformation. Factors that were significantly associated with acceptance or non- acceptance of misconceptions were: 1) sex, with female respondents in this survey accepting rumors significantly more often than male respondents (p Conclusion It is of critical importance to increase assurance regarding the safety of COVID-19 vaccines, the issue most likely to involve misconceptions, and to address the elements that affect belief in rumors among the population.

The paper introduces a robust adaptive fault-tolerant control system for the six-degree-of-freedom (six-DOF) dynamics of quadrotor unmanned aerial vehicles (UAVs), incorporating disturbances and abrupt actuator faults to represent real-world conditions. The proposed control scheme employs robust control terms to manage unknown disturbances. However, robust control performance may degrade due to sudden fault impacts. To handle this issue, we introduce adaptive laws to ensure continuous adaptation. The control architecture ensures the tracking system’s stability by combining robust control using sliding-mode control (SMC) with adaptive control developed using the certainty equivalence principle. The sliding-surface error limits the adaptive laws, in which the convergence of estimated parameters to the actual unknown variables is not required as they fully rely on the convergence of the tracking error. We provide rigorous mathematics to validate the proposed control design. Furthermore, we conduct numerical simulations for a quadrotor UAV to showcase the effectiveness of the proposed scheme. The results demonstrate the efficacy of the proposed design in handling external disturbances and abrupt actuator faults.

BackgroundWith the advancement of next-generation sequencing, clinicians are now able to detect ultra-rare mutations that are barely encountered by the majority of physicians. Ultra-rare and rare diseases cumulatively acquire a prevalence equivalent to type 2 diabetes with 80% being genetic in origin and more prevalent among high consanguinity communities including Saudi Arabia. The challenge of these diseases is the ability to predict their prevalence and define clear phenotypic features.MethodsThis is a non-interventional retrospective multicenter study. We included pediatric patients with a pathogenic variant designated as ultra-rare according to the National Institute for Clinical Excellence's criteria. Demographic, clinical, laboratory, and radiological data of all patients were collected and analyzed using multinomial regression models.ResultsWe included 30 patients. Their mean age of diagnosis was 16.77 months (range 3-96 months) and their current age was 8.83 years (range = 2-15 years). Eleven patients were females and 19 were males. The majority were of Arab ethnicity (96.77%). Twelve patients were West-Saudis and 8 patients were South-Saudis. SCN1A mutation was reported among 19 patients. Other mutations included SZT2, ROGDI, PRF1, ATP1A3, and SHANK3. The heterozygous mutation was reported among 67.86%. Twenty-nine patients experienced seizures with GTC being the most frequently reported semiology. The mean response to ASMs was 45.50% (range 0-100%).ConclusionThe results suggest that ultra-rare diseases must be viewed as a distinct category from rare diseases with potential demographic and clinical hallmarks. Additional objective and descriptive criteria to detect such cases are needed.

Background It is of utmost importance for the elements that influence public compliance with vaccination against COVID-19 to be assessed, including misconceptions, rumors, and conspiracy theories. Hence, in this study, we aimed to estimate the distribution of the most common misconceptions regarding COVID-19 vaccines and their predictors in Saudi Arabia. Methods We distributed an online questionnaire to participants aged 18 years or older. The survey included two sections. The first section comprised questions related to participants’ demographic characteristics, level of education, and their sources of information about COVID-19. The second section assessed participants’ perceptions regarding 11 of the most common misconceptions regarding COVID-19 vaccines, rated using a 5-point Likert scale. Using ordinal logistic regression, we conducted an evaluation of the relationships among different predictors including age, sex, educational level, and sources of information, as well as acceptance of misconceptions about vaccination. Results The most widely accepted misconception was that the COVID-19 vaccine had severe side effects, with 34.8% of participants believing this misinformation. Factors that were significantly associated with acceptance or non- acceptance of misconceptions were: 1) sex, with female respondents in this survey accepting rumors significantly more often than male respondents (p

Background: Phelan-McDermid syndrome (PMS) is a rare genetic condition caused by a heterozygous deletion in chromosome 22 in the 22q13 region or by a heterozygous pathogenic variant in SHANK3 gene. PMS is one of the important etiologies in children presenting mainly with intellectual delay, epilepsy, or autism spectrum disorder. Case Presentation: We describe a case of a 9-year-old male with a nonspecific neurodevelopmental disorder characterized by early signs of autism noticed from the age of 2 years. During his infancy, the patient exhibited slow gains of his milestones. He was later diagnosed with PMS and speech and intellectual disability. Conclusion: This study presented a novel case of a patient diagnosed with PMS in Saudi Arabia. Therefore, highlighting the clinical findings is essential to establish a common understanding of the disease. Patient education and awareness is a major part of the management plan since many families might require further explanation as they might need to deliver special education to their children affected by the syndrome. PMS is gaining great interest in research and patient awareness. [JBCGenetics 2022; 5(2.000): 053-058]

Diabetes mellitus is a serious global health issue which significantly impacts public health and socioeconomic development. Exploring how the community perceives the causes of death and their associated risk factors is crucial for public health. This study combines verbal autopsy (VA) with the Type 2 Diabetes Mellitus (T2DM) register to explore community perceptions of causes of death and associated influential factors in Makkah province, Saudi Arabia. 302 VA interviews were conducted with relatives or caregivers of deceased who died between 2018 and 2021 based on T2DM medical register from Alnoor Specialist Hospital in Makkah City, Saudi Arabia. Cause-specific mortality fractions (CSMFs) obtained from the VA using the InterVA-5 model were utilized to assess community perception. We used a multivariable logistic regression model to determine factors influencing community perceptions of causes of death. Lin's CCC with 95% CI was used to analyze the concordance for the CSMFs from verbal autopsy causes of death (VACoD) as a presumed reference standard and family-reported causes of death (FRCoD). The outcomes of this study demonstrate a generally broad spectrum of community perceived mortalities, with some critical misconceptions based on the type of death and other vital events like marital status, with an overall CCC of 0.60 (95% CI: 0.20-1.00; p = 003). The study findings demonstrate that community perception is weak if the deceased was male compared to female (aOR: 0.52; 95% CI: 0.26-1.03) and if the deceased was > = 80 years compared to 34-59 years (aOR: 0.48; 95% CI: 0.16-1.38), but it significantly improves among married compared to single (aOR: 2.13; 95% CI: 1.02-4.42). Exploring community perception of causes of death is crucial as it provides valuable insights into the community's understanding, beliefs, and concerns regarding mortality. Higher or lower community perception is attributed to how people may perceive risk factors associated with the causes of death, which can guide public health planning and interventional programs. The study findings further emphasize the need to employ robust and standardized VA methods within the routine medical services for a systemized assessment of families' reported causes of death.

Background: Biological therapies are effective for psoriasis, but patient responses vary, often requiring therapy switching or discontinuation. Objectives: To identify physicians' prescribing patterns of biological therapies at a referral tertiary center in Saudi Arabia and assess the probability of biologic persistence following treatment initiation. Methods: We conducted a retrospective study of biologic-naïve adult psoriasis patients who initiated therapy from October 2013 to July 2022 in Dammam. Descriptive statistics and a Kaplan-Meier analysis evaluated treatment persistence at 6, 12, 24, and 36 months. Results: A total of 151 patients received adalimumab (n = 89), etanercept (n = 17), risankizumab (n = 30), ustekinumab (n = 14), and ixekizumab (n = 1). At 6 months, all therapies demonstrated 100% persistence. At 12 months, persistence was highest for ustekinumab (100%) and lowest for etanercept (88.2%). At 24 months, ustekinumab maintained 100% persistence, followed by risankizumab (96.6%), adalimumab (94.3%), and etanercept (76.4%). At 36 months, risankizumab had the highest persistence (96.6%), followed by adalimumab (83.1%), ustekinumab (78%), and etanercept (70.6%). The most common reasons for discontinuation were lack of effectiveness and intolerability. Conclusion: This study shows changing psoriasis treatment patterns with new therapies. Risankizumab demonstrated high long-term persistence, while etanercept and ustekinumab showed declining persistence, suggesting evolving treatment considerations. [ABSTRACT FROM AUTHOR]

Cyclic alcohols are commonly found in natural and synthetic products and are involved in many biological processes. An ability to model their thermodynamic properties is of interest in food, flavouring, and pharmaceutical manufacturing, particularly for mixtures for which available experimental data are limited. Good examples are mixtures including menthol, a naturally occurring cyclic alcohol widely used in the food and pharmaceutical industries, well-known for its cooling-sensation properties and its role in the discovery of the TRPM8 receptor. Here, we extend the SAFT-γ Mie group-contribution method to model cyclic alcohols, by introducing a new cCHOH group (c for cyclic) composed of two identical Mie segments. Three association sites (two electronic sites of type e and one hydrogen site of type H) are also included to mediate hydrogen bonding. New parameters that characterise the group interactions (one new like interaction and 26 new unlike interactions) are developed and are employed to determine the thermophysical properties (vapour pressure, saturation density, vaporisation enthalpy, and second-order thermodynamic derivative properties) of pure cyclic alcohols, and mixture properties (vapour–liquid equilibria, liquid–liquid equilibria, solid–liquid equilibria, density, and excess enthalpy) of cyclic alcohols in several solvents. The quality of the model is evaluated by comparing predictive calculations with experimental data of 76 systems: six pure fluids and 70 binary mixtures, selected from a large range of solvent families: cyclic, linear, and branched alkanes, 1-alcohols, 2-alcohols, 2-ketones, esters, aromatic compounds, water, and carbon dioxide. Very good overall agreement is found, including for the prediction of solid–liquid solubility, which confirms the transferability of the new group parameters. Together with previously developed parameters, these open the way for the prediction of the thermodynamic properties of further complex mixtures. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Multiple sclerosis (MS) is considered the most prevalent neurological disorder in young adults with many patients manifesting sleep-related disorders (SRD) due to its pathomechanisms. This is subsequently reflected in patients' quality of life and physical activities. Material and Methods: This is a cross-sectional study at a tertiary care center. Patients diagnosed with MS were enrolled, and assessment of their sleep patterns and related disorders were measured using pre-validated scales. A questionnaire consisting of 38 items was used, and the obtained data were analyzed using RStudio software. Results: A total of 260 patients participated in the study. Most participants were aged 31–40 (n = 112) with a mean age of 36.49 ± 8.41 (age range: 18–56 years). The most used medications were rituximab (27%) and ocrelizumab (25%). Shapiro–Wilk Test was significant (P = 0.04) and just below the significance level of α = 0.05, suggesting potential significant deviation in the distribution of age. Logistic regression model was applied, and the female probability of sleeping more than six hours was 3.60 times the probability of sleeping six hours or less. Conclusion: Sleep quality is multifaceted and requires intensive investigation in patients with chronic disorders including MS. In this study, several novel data have been presented in a population that has very little literature data. [ABSTRACT FROM AUTHOR]

Introduction: Neurological disorders present in different age groups. In children, the spectrum of neurological diseases is multifactorial and varies between motor delay, speech delay, cognitive delay, and global developmental delay. Dental caries constitutes a public health problem that impacts approximately 80% of children nationwide. Aims: This study aims to evaluate the magnitude of dental problems in children with neurological disorders. Materials and Methods: An epidemiological investigation using a cross-sectional design was conducted. A total number of 2451 electronic surveys were sent to parents of children attending the pediatric neurology clinic. Children who attended the clinic from January 2017 to January 1, 2021, were included. Six hundred and seventy-five parents (28%) answered the survey. Statistical Analysis Used: For statistical analysis, IBM SPSS Statistics for Windows (Version 21.0; IBM Corp., Armonk, NY, USA) software was used. Categorical variables were presented using numbers, associated frequencies, and percentages (%). Categorical variables were correlated using the Chi-square test. Results and Discussion: A total number of 2451 surveys were distributed. The response rate was 28%. A total of 675 patients were labeled eligible. Patients' gender characteristics were as follows: 389 (58%) were male while 286 (42%) were female. Patients were distributed into two age groups, a group aged

Background: The seizure threshold 2 (SZT2) gene encodes a protein of unknown function, which is widely expressed, confers a low seizure threshold, and enhances epileptogenesis. It also comprises the KICSTOR protein complex, which inhibits the mTORC1 pathway. A pathogenic variant in the SZT2 gene could result in hyperactive mTORC1 signaling, which can lead to several neurological disorders. Aim of the study: To review every reported case and present two novel cases to expand the current knowledge and understanding of the mutation. Methods: Whole exome sequencing (WES) was used to identify the novel cases and present their clinical and radiological findings. A detailed revision of the literature was conducted to illustrate and compare findings. The clinical, genetical, neuroimaging, and electrophysiological data were extracted. Results: The study included 16 female patients and 13 male patients in addition to the 2 novel male cases. Eighteen patients had heterozygous mutations; others were homozygous. The majority presented with facial dysmorphism (n = 22). Seizures were noted as the predominant hallmark (n = 26). Developmental delay and hypotonia were reported in 27 and 15 patients, respectively. The majority of patients had multifocal epileptiform discharges on the electroencephalogram (EEG) and short and thick corpus callosum on the magnetic resonance imaging (MRI). Conclusion: Several promising features are becoming strongly linked to patients with SZT2 mutations. High variability among the cases was observed. Developmental delay and facial dysmorphism can be investigated as potential hallmarks; aiding clinicians in diagnosing the condition and optimizing management plans.

Musim Alotaibi,1,2 Ahmed Ali,1,3 Duaa Bakhshwin,4 Yasser Alatawi,5 Sultan Alotaibi,6 Abdullah Alhifany,7 Badr Alharthi,2 Nasser Alharthi,2 Awatef Alyazidi,2 Yasmeen Alharthi,2 Aziza Alrafiah8 1Department of Pharmacology, King Abdulaziz University, Jeddah City, Kingdom of Saudi Arabia; 2Department of Pharmacy, King Faisal Medical Complex, Taif City, Kingdom of Saudi Arabia; 3Department of Pharmaceutics, Assiut University, Assiut City, Egypt; 4Department of Pharmacotherapy and Outcomes Science, King Abdulaziz University, Jeddah City, Kingdom of Saudi Arabia; 5Department of Pharmacy Practice, University of Tabuk, Tabuk City, Kingdom of Saudi Arabia; 6Department of Pharmacy, King Abdul-Aziz Medical, Jeddah City, Kingdom of Saudi Arabia; 7Department of Clinical Pharmacy College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia; 8Department of Medical Laboratory Technology, King Abdulaziz University, Jeddah City, Kingdom of Saudi ArabiaCorrespondence: Aziza Alrafiah P.O Box 80200, Jeddah, 21589, Kingdom of Saudi ArabiaTel +966 126401000 Ext. 23495Fax +966 126401000 Ext. 21686Email aalrafiah@kau.edu.saBackground: Coronavirus disease (COVID-19) is an infectious disease due to SARS-COV-2. Patients with risk factors are vulnerable to severe morbidity and mortality. Favipiravir (FPV) and hydroxychloroquine (HCQ) are considered possible COVID-19 treatments.Objective: To investigate the effectiveness and safety of FPV compared to HCQ in patients with COVID-19 as the standard of care approved by the national protocol there.Methods: This is a retrospective cohort study on patients with COVID-19 who were administered either FPV or HCQ at King Faisal Medical Complex, Taif, Saudi Arabia, from June 2020 to August 2020.Results: In total, 508 patients were included in the analysis. Patients were categorized into three groups by medication. Patients enrolled in this study were 244 (55.8%) on FPV, 193 (44.2%) on HCQ and 71 (13.81%) on neither medication. Patients who received FPV had higher age and greater comorbidity. Most of the patients were discharged on day 14 (n = 303, 59.6%), 26 (36.6%) in neither med, 154 (63.1%) in FPV and 123 (63.7%) in HCQ groups with significant difference between groups (P < 0.0001). Mortality rate was 8.2% (n = 20) in FPV and 7.3% (n = 14) in HCQ groups with significant difference between groups (P = 0.048). Regarding drug safety, 19.7% of patients treated with FPV vs 7.8% HCQ have adverse effects with significant difference between groups (P < 0.0001). Most of the side effects were increase ALT and AST. Meanwhile, prolonged Q-T interval was reported only in the HCQ group (2.6%). From Cox regression modeling, only mechanical ventilation due to Covid 19 was predictive for mortality (HR: 16.598, 95% CI: 7.095– 38.828, P < 0.0001). Meanwhile, there was no significant difference in the prediction of discharge of FPV (vs HCQ) (HR: 0.933, 95% CI: 0.729– 1.195, P = 0.5843), predictors of mortality were HCQ (vs FPV) (HR: 2.3, 95% CI: 0.994– 5.487, P = 0.0518). Kaplan–Meier survival curves showed improved survival time and discharged time among patients in the HCQ versus FPV group with an insignificant difference between them (P = 0.85, P = 0.06, respectively).Conclusion: The present study concluded that FPV and HCQ showed comparable efficacy in decrease mortality and oxygen requirements. FPV likely has a more favorable safety profile regarding cardiac toxicity. A randomized clinical trial with large patient numbers is recommended to confirm the effectiveness of these drugs in COVID-19 patients.Keywords: coronavirus disease, COVID-19, favipiravir, hydroxychloroquine, mortality, risk factors

Objectives: Extended-spectrum β-lactamases (ESBLs) mechanism of resistance in Enterobacterales leads to poor clinical outcomes. Ceftazidime/avibactam and ceftolozane/tazobactam are two broad-spectrum antimicrobial combinations that are effective against multidrug-resistant organisms with regional variations. This study aims to evaluate the antimicrobial susceptibility test (AST) for both combinations against ESBL-producing Enterobacterales isolated from intensive care units (ICUs) in tertiary hospitals from November 2012 to October 2013 in Qatar. Methods: A total of 629 Enterobacterales isolates from ICUs were screened for ESBL production using BD-PhoenixTM confirmed by double-disk potentiation, while ESBL-genes were detected by polymerase chain reaction. The ASTs for ceftazidime/avibactam and ceftolozane/tazobactam were assessed by minimum inhibitory concentration (MIC) test strips. A single isolate that was resistant to both combinations was subjected to whole-genome sequencing. Results: The prevalence of ESBL-producing Enterobacterales isolated from ICUs was 17.3% (109/629) with predominance of Klebsiella pneumoniae (56/109; 51.4%) and Escherichia coli (38/109; 34.9%). The susceptibility of ceftazidime/avibactam and ceftolozane/tazobactam against ESBL-producers was 99.1% (108/109) and most (81/109; 74.3%) had MICs < 0.5 for both combinations. The predominant ESBL-gene was blaCTX-M (72/109; 66.1%). A single isolate that was resistant to both combinations harbored multiple ESBL resistant-genes including blaVEB-5 and blaVIM-2.Conclusions: ESBL-producing Enterobacterales isolated from ICUs were predominantly K. pneumoniae and E. coli, mainly harboring blaCTX-M gene. They were highly susceptible to ceftazidime/avibactam and ceftolozane/tazobactam suggesting potential alternatives to currently available therapeutic options.

Choroid plexus papilloma (CPP) is a benign but rare central nervous system (CNS) neoplasm of the choroid plexus. The onset of symptoms is usually in the first decade and may occur at birth (i.e., congenital). It accounts for 0.4–0.6% of all brain tumors. Usually seen in patients who are young children. The object of this clinical case to highlight early surgical intervention, intensive and multidisciplinary care, and pharmaceutical prescriptions can enhance the patient’s condition and quality of life. We herein report a rare presentation of CPP in a 6-year-old Sudanese female child with seizures. Who suffered from obstructive hydrocephalus with lateral ventricular choroid plexus papilloma. The patient underwent resection at the age of 6 months in our center’s neurosurgery department. Intensive and multidisciplinary follow-up managed to maintain positive outcome and better quality of life in a relatively benign neoplasm. In spite of a wide range of therapeutic options for the management of CPP described in the literature, studies demonstrated that patients with CPP alone and underwent a surgical procedure can live independently as adults and work full-time with uncommon recurrences.

Background: It is of utmost importance for the elements that influence public compliance with vaccination against COVID-19 to be assessed, including misconceptions, rumors, and conspiracy theories. Hence, in this study, we aimed to estimate the distribution of the most common misconceptions regarding COVID-19 vaccines and their predictors in Saudi Arabia. Methods: We distributed an online questionnaire to participants aged 18 years or older. The survey included two sections. The first section comprised questions related to participants’ demographic characteristics, level of education, and their sources of information about COVID-19. The second section assessed participants' perceptions regarding 11 of the most common misconceptions regarding COVID-19 vaccines, rated using a 5-point Likert scale. Using ordinal logistic regression, we conducted an evaluation of the relationships among different predictors including age, sex, educational level, and sources of information, as well as acceptance of misconceptions about vaccination. Results: The most widely accepted misconception was that the COVID-19 vaccine had severe side effects, with 34.8% of participants believing this misinformation. Factors that were significantly associated with acceptance or non- acceptance of misconceptions were: 1) sex, with female respondents in this survey accepting rumors significantly more often than male respondents (p Conclusion: It is of critical importance to increase assurance regarding the safety of COVID-19 vaccines, the issue most likely to involve misconceptions, and to address the elements that affect belief in rumors among the population.

Background: Epilepsy is one of the most common neurological disorders. Existing antiseizure medications (ASMs) are still unable to control seizures in one-third of these patients, making the discovery of antiseizure therapies with novel mechanisms of action a necessity. Aim of the Study: This study aimed to determine the safety and efficacy of perampanel (PER) as an adjuvant treatment for children with drug-resistant focal-onset seizures with or without focal to bilateral tonic-clonic seizures. Patients and methods: This is a single-center retrospective study of 38 epileptic pediatric patients, aged 2 to 14, at King Faisal Specialist Hospital and Research Center whose seizures were pharmaco-resistant to more than two antiseizure medications and followed for at least three months after PER adjuvant therapy initiation. Efficacy was assessed by the PER response rate at 3-, 6-, and 12-month follow-up evaluations, and side effects were also reported. Results: Multiple seizure types were reported. Myoclonic seizures were the predominant type of epilepsy in 17 children (44.7%). At 3 months, 6 months, and 12 months of follow-up, approximately 23.4%, 23.4%, and 18.4% of the patients were seizure-free at these time points, respectively. Adverse events were documented in 14 patients (35.7%) and led to the discontinuation of PER in 26.3%, 31.6%, and 36.8% of the studied group at the 3-, 6-, and 12-month follow-ups, respectively. The most common adverse events included dizziness or drowsiness, irritability, gait disturbance, and confusion; however, all were transient, and no serious adverse effects occurred. Conclusion: Our findings confirm the therapeutic efficacy of adjunctive PER in the treatment of drug-resistant epilepsy in children. As an adjunctive treatment for epilepsy, perampanel demonstrated sufficient effectiveness and tolerability.

Background: Drug-resistant epilepsy (DRE) impacts a significant portion, onethird, of individuals diagnosed with epilepsy. In such cases, exploring nonpharmacological interventions are crucial, with the ketogenic diet (KD) standing out as a valuable option. KD, a high-fat and low-carb dietary approach with roots dating back to the 1920s for managing DRE, triggers the formation of ketone bodies and modifies biochemistry to aid in seizure control. Recent studies have increasingly supported the efficacy of KD in addressing DRE, showcasing positive outcomes. Furthermore, while more research is needed, limited data suggests that KD May also be beneficial for specific genetic epilepsy syndromes (GESs). Objective: This study aimed to assess the short-term efficacy of KD among pediatric patients diagnosed with GESs. Materials and methods: This is a multi-center retrospective analysis of pediatric patients with GESs diagnosed using next-generation sequencing. The enrolled patients followed the keto-clinic protocol, and the KD efficacy was evaluated at 3, 6, and 12-month intervals based on seizure control and compliance. The collection instrument included demographic, baseline, and prognostic data. The collected data was coded and analyzed promptly. Results: We enrolled a cohort of 77 patients with a mean current age of 7.94 ± 3.83 years. The mean age of seizure onset was 15.5 months. Notably, patients experienced seizures at a younger age tended to have less positive response to diet. Overall, 55 patients responded favorably to the diet (71.4%) while 22 patients (28.6%) showed no improvement. Patients with genetic etiology showed a significantly more favorable responses to the dietary intervention. Patients with Lennox-Gastaut syndrome showed the most significant improvement (14/15) followed by patients with Dravet syndrome (6/8), and West syndrome (3/4). The number of used anti-seizure medications also played a significant role in determining their response to the diet. While some patients experienced mild adverse events, the most common being constipation, these occurrences were not serious enough to necessitate discontinuation of the diet. Conclusion: The study revealed a high improvement rate in seizure control, especially among younger patients and those with later seizure onset. The success of dietary treatment hinges greatly on early intervention and the patient's age. Certain genetic mutations responded favorably to the KD, while efficacy varied among various genetic profiles. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) aims to standardize the terminology and morphologic criteria associated with thyroid fine-needle aspiration cytology (FNAC) results while also providing corresponding risk assessments for malignancy. contributing to more consistent and standardized reporting of thyroid nodules and aiding clinicians in making informed decisions. Since then, it has been undergoing revisions and updates to further improve its utility and accuracy. Materials and Methods: This is a retrospective study conducted at a tertiary care center. All patients with a history of thyroid gland swelling who had previously undergone FNA were included. The procedure included cytopathologists performing FNAC for all cases of midline neck swelling. Demographic and histopathology data were correlated with the cytological diagnosis. Results: We included 288 cases. Of those, 234 (81.3%) were female and 54 (18.8%) were male. The presentation age range was 18–91 years. The most reported category was benign, which constituted 30.9% of the cases followed by malignancy (27.1%). As for thyroid lesions, papillary carcinoma was the most prevalent (43.6%). The correlation on cyto-histopathology was presented in every diagnostic category, showing high heterogeneity in diagnostic specificity and sensitivity. The overall diagnostic specificity and sensitivity were 56.05% (95% confidence interval [CI]: 47.92–63.95%) and 80.92% (95% CI: 73.13–87.25%), respectively. Positive and negative predictive values were 60.57% and 77.88%, respectively. Conclusion: Our data suggests that the TBSRTC system promotes similar sensitivity and specificity to those reported elsewhere. It standardizes reporting and improves communication between cytopathologists and clinicians. [ABSTRACT FROM AUTHOR]

This paper presents a comparative analysis of a fractional-order proportional–integral–derivative (FO-PID) controller against the standard proportional–integral–derivative (PID) controller, applied to a nonlinear robotic arm manipulator systems. The genetic algorithm (GA) optimization method was implemented to tune the gain parameters of the FO-PID and PID controllers. The performance of the FO-PID and PID controllers were evaluated though different cost functions, including integral of squared error (ISE), integral of absolute error (IAE), integral of time-weighted absolute error (ITAE), and integral of time-weighted squared error (ITSE). The performance of these controllers was examined via extensive simulations by using MATLAB/SIMULINK for different operating scenarios of the robotic arm manipulator system. Based on the obtained results, a comparative performance matrix is proposed, wherein cost functions ISE, IAE, ITAE, and ITSE are represented as columns while characteristic parameters (overshoot, rising time, and settling time) are represented as rows. The proposed performance matrix facilitates the selection between the PID and FO-PID controllers. [ABSTRACT FROM AUTHOR]

Choroid plexus papilloma (CPP) is a benign but rare central nervous system (CNS) neoplasm of the choroid plexus. The onset of symptoms is usually in the first decade and may occur at birth (i.e., congenital). It accounts for 0.4–0.6% of all brain tumors. Usually seen in patients who are young children. The object of this clinical case to highlight early surgical intervention, intensive and multidisciplinary care, and pharmaceutical prescriptions can enhance the patient's condition and quality of life. We herein report a rare presentation of CPP in a 6-year-old Sudanese female child with seizures. Who suffered from obstructive hydrocephalus with lateral ventricular choroid plexus papilloma. The patient underwent resection at the age of 6 months in our center's neurosurgery department. Intensive and multidisciplinary follow-up managed to maintain positive outcome and better quality of life in a relatively benign neoplasm. In spite of a wide range of therapeutic options for the management of CPP described in the literature, studies demonstrated that patients with CPP alone and underwent a surgical procedure can live independently as adults and work full-time with uncommon recurrences.