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Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a monogenic disorder characterized by multi-systemic autoimmunity secondary to loss-of-function mutations in the gene coding the forkhead box P3 (FOXP3) transcription factor which is important for the development, maturation, and maintenance of CD4 + regulatory T (T-reg) cells. Fewer than 300 affected individuals have been identified worldwide. The occurrence of IPEX is below 1:1,000,000. Herein we present a case of a 15-day-old male who was admitted to NICU 15 days after delivery due to respiratory distress. He was found to have metabolic acidosis due to DKA. During his stay in the NICU, he experienced seizures and was intubated for a month. He was diagnosed with neonatal diabetes. He also experienced recurrent respiratory infections and multiple episodes of diarrhea rash, and meningitis. At the age of 7 months, genetic testing confirmed IPEX with FOXP3 mutation, specifically the p.(Pro75Leu) variant of the FOXP3 gene. Subsequently, multiple family members were diagnosed. The unique variability observed in organ involvement and presentation timing among individuals within the same family, despite carrying an identical mutation, is a distinctive aspect, particularly considering the monoallelic expression of the FOXP3 gene in males. This phenomenon strongly suggests the presence of modifying genes that play a significant role in the pathogenesis of IPEX syndrome. The case presentation underscores the importance of clinical suspicion of IPEX in cases of neonatal DM. It also highlights the challenges associated with managing rare genetic disorders in pediatric patients. It also emphasizes that the IPEX genotype has a wide phenotype. This case is considered the first documented case of IPEX in Palestine.

With the growing demand for sustainable and optimal packaging solutions, this study proposes a novel two-stage algorithm for the multi-container three-dimensional bin packing problem. The research addresses this problem within the context of a real-world industrial scenario and implements several practical constraints including: full shipment, customer positioning requirements, and product geometric interlocking, for increased stability and with the purpose of minimizing the use of plastic wrapping and/or additional supporting surfaces. The main optimization target is to minimize the total number of containers used in the palletization process of custom orders with varying degrees of complexity. The proposed algorithm includes two stages/phases of processing. In the first phase, the algorithm uses constructive heuristics to generate homogeneous product layers. The layers are then stacked to produce blocks, which are then placed on individual containers or pallets. The second phase packs the leftover items using a genetic algorithm. The performance of the proposed solution is benchmarked using real-world industrial data, as well as a more classic academic benchmark. It is demonstrated, across a very large set of orders, that the algorithm always achieves solutions for full palletization of the orders. The analysis shows that the approach is generic and the quality of the solutions generated is relatively even for both small and large, homogeneous and heterogeneous problem instances.

{AR}: اعتمدت هذه الدراسة اعتمادًا كليًّا في المقام الأول على الوثائق البردية اليونانية لاستقاء المعلومات والبيانات الخاصة نيستوس في محاولة منها لتغطية جوانب القرية المختلفة؛ وذلك من خلال البرديات المتوفرة والمتنوعة التي ترجع إلى العصر اليوناني والروماني والبيزنطي في مصر, فللوثائق سعة وقدرة شاملة ليس فقط على تقديم صورة موضوعية عن حياة القرية وأنشطة سكانها اليومية وإلقاء الضوء على النواحي الإدارية والمالية والاجتماعية وكذلك الممارسات الدينية للسكان، ولكن أيضًا لتحديد موقع القرية الجغرافي ومعرفة وتوضيح المسميات المتعددة التي اقترنت بها قرية نيستوس في الحقبة اليونانية والرومانية والبيزنطية. {EN}: This article attempts to acquire information about various aspects of the Nestos settlement using papyrological references dating back to the Graeco-Roman and Byzantine eras in Egypt.It attempts not only to present a comprehensive study on the social, economic, and religious activities of the inhabitants but also to discuss the name, location, and status of Nestos village in the Graeco-roman and Byzantine periods.

The Spheroid Reservoir Bioartificial Liver (SRBAL) is an innovative treatment option for acute liver failure (ALF). This extracorporeal support device, which provides detoxification and other liver functions using high-density culture of porcine hepatocyte spheroids, has been reported in three randomized large animal studies. A meta-analysis of these three preclinical studies was performed to establish efficacy of SRBAL treatment in terms of survival benefit and neuroprotective effect. The studies included two hepatotoxic drug models of ALF (D-galactosamine, α-amanitin/lipopolysaccharide) or a liver resection model (85% hepatectomy) in pigs or monkeys. The SRBAL treatment was started in three different settings starting at 12 h, 24 h or 48 h after induction of ALF; comparisons were made with two similar control groups in each model. SRBAL therapy was associated with significant survival and neuroprotective benefits in all three animal models of ALF. The benefits of therapy were dose dependent with the most effective configuration of SRBAL being continuous treatment of 24 h duration and dose of 200 g of porcine hepatic spheroids. Future clinical testing of SRBAL in patients with ALF appears warranted.

In the quest to enhance the efficiency of gas turbines, there is a growing demand for innovative solutions to optimize high-pressure turbine blade cooling. However, the traditional methods for achieving this optimization are known for their complexity and time-consuming nature. We present an automation framework to streamline the design, meshing, and structural analysis of cooling channels, achieving design automation at both the morphological and topological levels. This framework offers a comprehensive approach for evaluating turbine blade lifetime and enabling multidisciplinary design analyses, emphasizing flexibility in turbine cooling design through high-level CAD templates and knowledge-based engineering. The streamlined automation process, supported by a knowledge base, ensures continuity in both the mesh and structural simulation automations, contributing significantly to advancements in gas turbine technology.

The ability of oil supplementation to inhibit various metabolic syndromes has been recognized. However, there are currently no studies determining the effects of oil supplements on healthy conditions. Plukenetia volubilis L., also known as Sacha inchi, is a seed rich in essential unsaturated fatty acids that improves metabolic syndrome diseases, such as obesity and nonalcoholic fatty liver. However, the health benefits and effects of Sacha inchi oil (SIO) supplementation remain unclear. This study aims to evaluate the chemical effects and properties of Sacha inchi oil. The results of the chemical compound analysis showed that Sacha inchi is an abundant source of ω-3 fatty acids, with a content of 44.73%, and exhibits scavenging activity of 240.53 ± 11.74 and 272.41 ± 6.95 µg Trolox/g, determined via DPPH and ABTS assays, respectively, while both olive and lard oils exhibited lower scavenging activities compared with Sacha inchi. Regarding liver histology, rats given Sacha inchi supplements showed lower TG accumulation and fat droplet distribution in the liver than those given lard supplements, with fat areas of approximately 14.19 ± 6.49% and 8.15 ± 2.40%, respectively. In conclusion, our findings suggest that Sacha inchi oil is a plant source of ω-3 fatty acids and antioxidants and does not induce fatty liver and pathology in the kidney, pancreas, and spleen. Therefore, it has the potential to be used as a dietary supplement to improve metabolic syndrome diseases.

Objectives: Acyclovir is approved to treat herpes simplex virus (HSV) type 1, type 2 and varicella-zoster virus. It is mainly eliminated via the kidneys, for which drug crystals accumulation might lead to nephrotoxicity. This study aimed to determine the incidence, risk factors, preventive measures, and clinical outcomes of acyclovir induced-nephrotoxicity. Methods: This is a retrospective cohort study of patients >12 years of age at Sultan Qaboos University Hospital (SQUH) receiving IV acyclovir therapy between January 2016 and December 2020. Results: Out of 191 included patients, 40 (20.1%) developed acyclovir induced-nephrotoxicity. Age (per year older: OR 1.04, 95 %CI 1.01–1.07), total duration of treatment (per day OR1.19, 95 %CI 1.06–1.33), and concomitant use of vancomycin (OR 5.96, 95 %CI 1.87–19.01) were significant independent risk factors for acyclovir induced-nephrotoxicity development. Nine patients (4.5%) died during the same hospitalization, including those three patients who required renal replacement therapy (1.5%). Conclusion: Frequent monitoring of kidney function for older patients with concurrent use of vancomycin and IV hydration is essential to prevent IV acyclovir induced-nephrotoxicity. Antimicrobial stewardship is a crucial method to reduce the duration of treatment with IV acyclovir as appropriate.

While the significance of Abstract Expressionism in Frank O’Hara’s poetry has been widely discussed in academic researches, this paper aims at exploring the role of popular culture in his poetry and the significance of Pop Art in shaping his poetic production. The paper argues that O’Hara’s employment of topics, consumer and mundane objects, and images taken from popular culture and mass media was the very means to create an unorthodox art. Such an art challenged and opposed the American elitism of high culture and good taste, the very standards by which the artistic value of a piece of art was measured.

Stigmatizing attitudes of psychiatry professionals toward patients with various mental disorders may negatively impact treatment-seeking behaviors. However, in Saudi Arabia, little is known about psychiatry residents’ attitudes toward individuals with a specific disease/disorder. Therefore, the purpose of this study was to assess psychiatry residents’ attitudes toward patients with substance use disorder (SUD), bipolar disorder and schizophrenia in Saudi Arabia. Data for this cross-sectional study were collected from psychiatry residents (N = 79) in Saudi Arabia with a structured questionnaire containing sociodemographic and attitude-related variables. The 11-item Medical Condition Regard Scale (MCRS) for individuals with three conditions was used to assess participants’ attitudes. A linear regression model was fitted to investigate the association. Based on the MCRS (on a scale of 11 to 66), participants′ mean attitude scores were 41.59 (SD: 8.09), 54.53 (SD: 5.90) and 54.20 (SD: 6.60) for SUD, bipolar disorder and schizophrenia, respectively. Adjusted regression analysis demonstrated that senior residents, an age ≥ 27 years and a high confidence level were significantly associated with psychiatry residents’ positive attitudes toward patients with the three conditions. Psychiatry residents’ attitude scores were relatively lower (i.e., negative attitudes) for patients with SUD than for those with bipolar disorder and schizophrenia. Future longitudinal studies are recommended to explore the factors behind psychiatry residents’ negative attitudes toward patients with addictive behaviors and mental illnesses.

When it comes to equity and access through culturally proficient practices, what schools intend to do versus what they actually do can be incongruous by defaulting to traditional accountability metrics over change and innovation. Utilizing the Conceptual Framework for Culturally Proficient Practices, the purpose of this study was to investigate formal and nonformal educational leaders' perceptions regarding the barriers and next steps of Cultural Proficiency implementation following a 10-day Cultural Proficiency training. Findings indicated variations based on individual identity, position in the school system, and external socio-political factors that influence how individuals perceive the implementation, advancement, and/or limitations of Cultural Proficiency work.

This study explores advertising students' recognition and comprehension of in-feed native advertising on Instagram, a leading platform for social media native advertising. Data were collected from 303 U.S. college advertising students. It examines the impact of two key aspects of Instagram in-feed native advertising--an additional label ("Shop Now") and ad-context congruency--through both quantitative and qualitative data. Findings reveal a significant deficit in native ad recognition among advertising students. Qualitative analysis identified four themes constituting Instagram in-feed advertising for advertising students: professional photo quality, branded products, persuasive elements, and excessive hashtags. Quantitative results indicate that high ad-context congruency led to higher perceptions of nativeness and more positive emotions, but did not significantly influence ad attitudes or negative emotions. The study underscores practical and theoretical implications for advertising educators and scholars, emphasizing the need for enhanced digital advertising literacy and discussing broader implications for advertising pedagogy and practices.

Bioengineered livers (BELs) are an attractive therapeutic alternative to address the donor organ shortage for liver transplantation. The goal of BELs technology aims at replacement or regeneration of the native human liver. A variety of approaches have been proposed for tissue engineering of transplantable livers; the current review will highlight the decellularization-recellularization approach to BELs. For example, vascular patency and appropriate cell distribution and expansion are critical components in the production of successful BELs. Proper solutions to these components of BELs have challenged its development. Several strategies, such as heparin immobilization, heparin-gelatin, REDV peptide, and anti-CD31 aptamer have been developed to extend the vascular patency of revascularized bioengineered livers (rBELs). Other novel methods have been developed to enhance cell seeding of parenchymal cells and to increase graft functionality during both bench and in vivo perfusion. These enhanced methods have been associated with up to 15 days of survival in large animal (porcine) models of heterotopic transplantation but have not yet permitted extended survival after implantation of BELs in the orthotopic position. This review will highlight both the remaining challenges and the potential for clinical application of functional bioengineered grafts.

Iraq is one of the agricultural countries in the world. Agriculture is the second source of income after oil in Iraq. Agricultural development is a link between scientific research and agricultural extension because the use of scientific knowledge in agriculture has become very important, which has prompted many countries to increase their investment in scientific research. There is a main agricultural extension department in Baghdad, in addition to agricultural extension departments in the provinces. The aim of this study was to determine the actual relationship between the agricultural research and extension organizations in Iraq throw knowing the importance of activities that achieve the relationship and implementation level according to respondents' opinions. The study aimed also to identify the barriers facing the relationship between the agricultural research and extension organizations and respondents' suggestions that strength the link between the researches and agricultural extension agents. This study was conducted on group of researchers and extension agents who work in Agricultural Extension and Cooperation Department and Agricultural Researches Department. A random sample of 40% was selected. The total was (38) agricultural extension agents and (35) agricultural researchers. A questionnaire was used as a tool for data collection. Data were analyzed using the SPSS Version 24.0 statistical software. Descriptive statistics including percentages, frequencies, means, and standard deviations, were used to summarize the data. The most important results showed that the relationship between agricultural research and extension organizations was weak, while a high percentage of respondents believed that the relationship between them was very important. The study illustrated that the most important barrier facing the relationship between the agricultural research and extension organizations was the absence of regulations and laws that organize the relationship between them. The most important suggestions that respondents believed to strengthen the relationship are the establishment of legislations that organize the relationship and work through the research and extension teams and establishment of permanent committees to coordinate the work between them. In addition, the study found that the communication between agricultural researchers and extension agents was informal. Furthermore, the study recommended that the relationship should be continued, and that multiple organizational and administrative methods should be used to strengthen the linkages between agricultural research and extension organizations. Also, the study recommended that agricultural researchers and extension agents should participate in planning and implementing agricultural extension programs.

An understanding of the molecular basis of liver regeneration will open new horizons for the development of novel therapies for chronic liver failure. Such therapies would solve the drawbacks associated with liver transplant, including the shortage of donor organs, long waitlist time, high medical costs, and lifelong use of immunosuppressive agents. Regeneration after partial hepatectomy has been studied in animal models, particularly fumarylacetoacetate hydrolase–deficient (FAH−/−) mice and pigs. The process of regeneration is distinctive, complex, and well coordinated, and it depends on the interplay among several signaling pathways (eg, nuclear factor κβ, Notch, Hippo), cytokines (eg, tumor necrosis factor α, interleukin 6), and growth factors (eg, hepatocyte growth factor, epidermal growth factor, vascular endothelial growth factor), and other components. Furthermore, endocrinal hormones (eg, norepinephrine, growth hormone, insulin, thyroid hormones) also can influence the aforementioned pathways and factors. We believe that these endocrinal hormones are important hepatic mitogens that strongly induce and accelerate hepatocyte proliferation (regeneration) by directly and indirectly triggering the activity of the involved signaling pathways, cytokines, growth factors, and transcription factors. The subsequent induction of cyclins and associated cyclin-dependent kinase complexes allow hepatocytes to enter the cell cycle. In this review article, we comprehensively summarize the current knowledge regarding the roles and mechanisms of these hormones in liver regeneration. Articles used for this review were identified by searching MEDLINE and EMBASE databases from inception through June 1, 2019.

Energy insufficiency is obstructing the socio-economic and industrial improvement of Bangladesh. Renewable energy contributes about 560 Megawatt (MW) of the total electricity production of 20,430 MW, which can be a sustainable solution to the demand-supply crisis. This paper, summarises the current energy situation of Bangladesh and examines the available renewable energy resources and their future prospect. It has been revealed that Bangladesh is heavily (62%) relying on natural gas although government has already taken steps to generate electricity from renewable energy sources. Current policies and legislations related to generation of renewable energy in Bangladesh have been discussed explicitly. Finally, some suggestions have been made to tackle the ongoing energy crisis in the country, in addition to the renewable energy.Abbreviations: GDP: Gross domestic product; RNPP: Rooppur Nuclear Power Plant; Tcf: Trillion cubic feet; IDCOL: Infrastructure development company limited; BPDB: Bangladesh Power Development Board: GS: Grameen Shakti; BWDB: Bangladesh Water Development Board: USD: United States Dollar; IPP: Independent power producer: BCAS: Bangladesh center for advanced studies; NWPGCL: North West Power Generation Company Limited: BCSIR: Bangladesh Council of Scientific and Industrial Research; EGCB: Electricity Generation Company of Bangladesh: WRA: Wind Resource Assessment; REB: Rural Electrification Board: BRAC: Bangladesh Rural Advancement Committee; kW: Kilowatt: PJ: Petajoules; MW: Megawatt: IFRAD: Institute for fuel research and Development; GWh: Gigawatt hours: ICS: Improved Cooking Stoves; MWh: Megawatt hours: DoE: Department of Environment; TWh: Trillion-watt hour: DLS: Department of Livestock Services; RPCL: Rural Power Company Limited: mmcfd: million cubic feet per day; APSCL: Ashugang Power Station Company Limited: BSCIC: Bangladesh Small & Cottage Industries Corporation (BSCIC); GOB: Government of Bangladesh: BADC: Bangladesh Agricultural Development Corporation; SREDA: Sustainable and Renewable Energy Development Authority: DIDA: Danish International Development Agency; LGED: Local Government Engineering Directorate: BAU: Bangladesh Agricultural University; NGO: Non-Governmental Organization: HBRI: Housing & Building Research Institute; IRENA: International Renewable energy Agency: : BARD: Bangladesh Academy for Rural Development; ETP: Electronic Traffic Pricing: BCCD: Bangladesh Commission for Christian Development; PV: Photovoltaic: BRRI: Bangladesh Rice Research Institute; SHS: Solar Home Systems: NDBMP: National Domestic Biogas and Manure Program; TOE: Tonne of oil equivalent: K/km: Kelvin/kilometer; LEAP: Long range Energy Alternative Planning

Background. Acute kidney injury (AKI) is a well-known complication following a transcatheter aortic valve replacement (TAVR) and is associated with higher morbidity and mortality. Objective. We aim to compare the risk of developing AKI after transfemoral (TF), transapical (TA), and transaortic (TAo) approaches following TAVR. Methods. We searched Medline and EMBASE databases from January 2009 to January 2021. We included studies that evaluated the risk of AKI based on different TAVR approaches. After extracting each study’s data, we calculated the risk ratio and 95% confidence intervals using RevMan software 5.4. Publication bias was assessed by the forest plot. Results. Thirty-six (36) studies, consisting of 70,406 patients undergoing TAVR were included. Thirty-five studies compared TF to TA, and only seven investigations compared TF to TAo. AKI was documented in 4,857 out of 50,395 (9.6%) patients that underwent TF TAVR compared to 3,155 out of 19,721 (16%) patients who underwent TA-TAVR, with a risk ratio of 0.49 (95% CI, 0.36–0.66; p

Understanding the drying kinetics within a food dryer is an important step towards its improvement. This study investigates the drying kinetics of potato slices in a recently proposed waste-heat based convective dryer. Statistical analyses are conducted for ten dissimilar mathematical models to choose the best fit model for the experimental data at various drying temperatures (70 °C, 60 °C, and 50 °C). Results show that the Midilli et al. model is the best fit model to describe the drying kinetics of potato in the proposed dryer as it offers root mean square error (RMSE) of 0.0022, a coefficient of determination (R2) of 0.99, reduced chi-square (χ2) of 9.2 ×10−7. Results also demonstrate that the activation energy is 47.19 kJ⁄mol and the effective moisture diffusivity of dried potato sample is 4.22 ×10−10 to 11.67 × 10−10 m2/s at a drying air temperature of 50–70 °C. Moreover, if the proposed waste-heat based convective dryer is used instead of an electric convective dryer at 60 °C, it can reduce the external energy requirement by 29.98 MJ/kg. Exergo-environmental analysis of the proposed dryer shows that the CO2 emission and CO2 mitigation values for 20-year life cycle periods are 184.46 kg/year and 17.24 tons, respectively. Therefore, successful industrial application of the proposed drying system might be a striding stone towards the advancement of energy-efficient sustainable food drying systems.

This study aims to evaluate Jordanian sign language syntax for deaf students' teachers in Jordan. The Sample Consisted of (33) Teachers who work in Schools for the Deaf; (31) Females and (2) Males. A tool was used to measure the Jordanian Sign Language Syntax based on direct observation. Using the SPSS program, mean and standard deviations, and using the Mann-Whitney test to examine the significance of differences between two groups. In total, the evaluation ranged between a good and acceptable level. There were also statistically significant differences at the level of (Α = 0.05) and less due to the variable of the sign language license. For the benefit of those who have a license to practice. Results did not show any statistical significance in differences due to other variables. The study recommended including the syntax of sign language in current training programs of Jordanian sign language.

An infection of pathogenic microorganisms can create a big problem for human health. This has triggered the need for discovery and development of antibiotic drugs with altered modes of action. Approximately 45% of antibiotic drugs are derived from Streptomyces, which are the most commonly isolated actinomycete genera. The present investigation aimed to search for and study antimicrobial-producing actinomycetes isolated from soil samples from Sammuk Mountain, Chonburi province, Thailand. A total of 50 isolates from six soil samples were obtained and their actinomycetes were better isolated using humic acid-vitamin agar medium (64.0%) than starch casein nitrate agar medium (36.0%). In addition, the secondary metabolites produced from 13 isolates (26.0%) exhibited a broad spectrum of antimicrobial activity against Gram-positive bacteria and yeast. Thus, Sammuk Mountain soil is an important source of antibiotic-producing actinomycetes.

Aims: Percutaneous mitral balloon valvotomy PMBV is an acceptable alternative to Mitral valve surgery for patients with mitral stenosis. The purpose of this study was to explore the immediate results of PMBV with respect to echocardiographic changes, outcomes, and complications, using a meta-analysis approach. Methods: MEDLINE, and EMBASE databases were searched (01/2012 to 10/2018) for original research articles regarding the efficacy and safety of PMBV. Two reviewers independently screened references for inclusion and abstracted data including article details and echocardiographic parameters before and 24–72 h after PMBV, follow-up duration, and acute complications. Disagreements were resolved by third adjudicator. Quality of all included studies was evaluated using the Newcastle-Ottawa Scale NOS. Results: 44/990 references met the inclusion criteria representing 6537 patients. Our findings suggest that PMBV leads to a significant increase in MVA (MD = 0.81 cm2; 0.76–0.87, p

A simple, cheap and rapid colorimetric method to determine the total amount of ortho-hydroxyphenolic compounds (TOHPC) as the effective antioxidant agents in food and natural products samples using ferric chloride (FeCl3) reagent was developed. The developed assay shows good linearity, reproducibility, LOD and LOQ. In addition, the performance of the method was validated against the conventional assay by analyzing the total amount of phenolic content (TPC) of twenty tea samples. Similarly, a high correlation was observed between TOHPC and TPC (R2 = 0.9651). In addition, the correlations between TOHPC and TPC and antioxidant activities including DPPH· and ABTS·+ assays were studied. It was found that when the total phenolic content in both assays increased the antioxidant activities also increased. The results demonstrated that the developed assay could be used as an alternative method to determine the total amount of effective antioxidant agents in several food, beverages and natural products samples.

Background: Some previous studies have investigated the attitudes of healthcare professionals towards certain aspects of the COVID-19 outbreak. In addition, some general frameworks have been proposed to manage the pandemic. Objective: The purpose of this article was to analyze the attitudes of healthcare practitioners in Saudi Arabia towards the treatment of patients with COVID-19, work planning of practitioners, leadership approaches to manage the pandemic, sharing information strategies, medical errors, compliance with procedures, and challenges faced by the practitioners. Furthermore, another objective was to propose a general framework for managing the COVID-19 outbreak in Saudi Arabia. Methods: To achieve these purposes, a survey was designed based on an online questionnaire that was initially sent via WhatsApp, Twitter, Facebook, and email to 336 healthcare practitioners working in 7 hospitals in Saudi Arabia. The response rate was 30.4%. Results: The outcomes indicated that healthcare practitioners in Saudi Arabia had positive attitudes towards effective communication and interaction between health professionals and patients, leadership and maintenance of team coordination, work planning, communication and cooperation between team members, training and skills development of healthcare professionals, implementing strict procedures to avoid errors and control the spread of the COVID-19 pandemic, maintaining an adequate supply of medicines and medical equipment, and obtaining the support of the government, the community, and the people. Conclusion: Based on the findings, it was possible to suggest that the management of health care operations related to the COVID-19 outbreak in Saudi Arabia requires effective collaboration and information sharing among various stakeholders. In this sense, communication, effective leadership, coordination and work planning, adequate treatment for patients, strict compliance with hospital rules and procedures, preventive and regulatory measures, and training and support for health professionals, were parameters considered in the general qualitative framework suggested in this study for managing the COVID-19 pandemic in Saudi Arabia. The propositions presented in this study can help the Saudi Arabian government implement an effective plan to control the spread of the COVID-19 pandemic in this country.

Intestinal parasitic infections (IPIs) are among the major public health problems globally, particularly in developing countries like Egypt. This study aimed to evaluate prevalence and risk factors associated with IPIs among preschool and school children in Egypt. A cross-sectional study was conducted on 996 randomly selected preschool and school-aged children in Gharbia governorate during January to April 2018. Stool specimens were examined for the presence of the parasite by direct smear and the formol-ether concentration methods. The overall prevalence of IPIs was 46.2%. Entamoeba histolytica and Ascaris lumbricoides were the most predominant parasites (12.7% per each). This is followed by Enterobius vermicularis (8.6%), Giardia lamblia (7.1%), Cryptosporidium parvum (1.5%), Heterophyes heterophyes (1.4%), Hymenolepis nana (0.7%), Hookworms (0.6%), Fasciola hepatica (0.5%) and Dipylidium caninum (0.4%). Infected children with no symptoms (26.8%) were significantly (P < 0.001) more frequent than those with medical complaint (19.4%). Socio-demographic predictors of IPIs were preschool age (OR = 4.9; P < 0.001; 95%CI 3.3-7.3), living in rural dwellings (OR = 1.96; P < 0.001; 95%CI 1.5-2.5), and belonging to a low-income family (OR = 4.7; P < 0.001; 95%CI 2.3-9.3). The absence of safe drinking water, lack of hand washing (after soil contact, or before meals, or after toilet usage), and eating unwashed vegetables were risk factors for IPIs in the study region (OR = 1.3-6.9, P < 0.001 -P = 0.05). Higher odds for exposure to potential zoonotic parasites were evident in children with pets in their homes for G. lambia and D. caninum (OR = 2.1-8.3; P = 0.02 -P = 0.04), children having household reared ruminants for C. parvum (OR = 10.4; P < 0.001), and children that play with stray animals for E. histolytica and Hookworm (OR = 1.8-6.3; P = 0.04 -P = 0.05)compared to other children with no animal contact. The present study highlights the importance of periodic screening and treatment of IPIs in children, deworming companion animals, and public education for effective prevention of IPIs in children in Egypt.

Background: The Saskatchewan Medication Assessment Program (SMAP) compensates community pharmacists for medication reviews on eligible residents with the goal of optimizing patient care. Although medication reviews are meant to reduce risks associated with complex medication regimens, some patients may already be receiving specialized care from interdisciplinary health care teams from the renal programs in Saskatchewan. Objective: A qualitative analysis was undertaken to examine the perceptions of health care providers about the SMAP process for patients receiving renal care in Saskatchewan. The goal was to explore potential benefits, facilitators, challenges, and/or barriers of the program in this population. Design: Qualitative descriptive study. Setting: The semi-structured interviews took place in the province of Saskatchewan. Participants: Community pharmacists, renal pharmacist, and nephrologists. Methods: All nephrologists, renal pharmacists, and community pharmacies in Saskatoon and Regina were sent an invitation to participate in the study. Semi-structured interviews were completed with participants and were audio-recorded and transcribed verbatim. Coding was performed using NVIVO qualitative software, and meaning units and codes were consolidated into categories and subcategories using qualitative content analysis. Results: A total of 9 community pharmacists, 10 renal pharmacists, and 8 nephrologists were interviewed. Community pharmacists had mixed levels of comfort providing SMAP assessments for renal patients, but expressed the desire to provide the best care possible and described patient benefits. Some categories (eg, barriers and improvements) and subcategories (eg, “collaboration/communication”, “other challenges,” and “suggestions for improvement”) were consistent among all participant groups, while others (eg, “renal patients have complex care needs” and “duplication of service”) were common among both renal pharmacists and nephrologists. The nephrologists had little knowledge of the program and of the role of the community pharmacist, indicating the need for improved education and communication. Limitations: The lack of renal patient perceptions on the SMAP process should be acknowledged and studied in future. A further limitation is the small sample size per subsample group. Conclusion: Despite some negative experiences, all of the participants believed the program can be beneficial. However, several recommendations were suggested to improve the SMAP process in renal patients and other complex patient populations.

Background: Participation of the public is an important and most effective approach for controlling the spread of novel coronavirus. However, considering its novel nature, it is important to create awareness among the public to be able to take timely preventive measures. On the contrary, misinformation and myths from online communities result in severe damages in mitigation of this novel disease.Objective: Focusing on these aspects, this manuscript reviews public awareness about COVID-19, myths surrounding it, its symptoms, treatment, transmission, importance of information sources, types of information to be considered in awareness campaigns, promotional channels, and their implications in Saudi Arabia.Methods: An online questionnaire-based survey was used for collecting data related to five major aspects related to COVID-19 and awareness creation process. The survey was accessed by 1,881 people, out of whom 741 people participated in the survey. However, 150 dropouts left the survey in between, as a result of which a final sample of 591 was achieved, indicating the response rate of 39.3% and a completion rate of 79.76%.Results: Awareness levels of the participants related to COVID-19, its means of transmission, preventive measures, symptoms, and treatment were identified to be moderate to high (60–80%). However, reliance on a few myths and violation of certain preventive measures were identified with majority of the participants (more than 60%). The Ministry of Health was identified to be the most reliable source of information followed by family and friends. Moreover, 15 types of information were identified to be highly relevant and important, which need to be effectively disseminated among the public through effective communication channels.Conclusions: Lack of awareness can result in serious outcomes in relation to COVID-19. Effective awareness campaigns including relevant information from reliable sources can improve the knowledge of people, and they must be effective in developing positive attitudes among the public toward adopting preventive measures.

Objectives: There is substantial increase in referrals for investigations at Sultan Qaboos University Hospital (SQUH). Evaluating the quality of hospital referral notes (RNs) is necessary from diagnostic, patient, and economic perspectives. RNs for pulmonary function tests (PFTs) can be considered as representative of the array of tests performed at SQUH. Methods: This cross-sectional study evaluated the quality of RNs based on ‘completeness’ for all consecutive patients referred for PFTs at SQUH over six months. Evaluation included documentation of demographic features, RNs date, priority for investigation, referral reason, pulmonary and relevant medical and smoking history for spirometry RNs, and addition of hemoglobin level for full lung functions (Full-LuFs) tests. The proportion of complete RNs was determined and analyzed separately to study association of spirometry and full-LuFs tests with source and reasons for referral. Results: Only 644 of 683 RNs were available for analysis. Smoking history was stated in only 3.3% of all RNs; hence, it was excluded from the analysis. RNs were complete only in 12.4% of cases for spirometry and 14.4% for full-LuFs tests. RNs for patients who primarily had pulmonary disease were proportionately incomplete than those for patients with other reasons (p < 0.050). There was no significant association between incompleteness of RNs and referral hospital (SQUH vs. non-SQUH) and SQUH inpatient or outpatient status implying that the overall proportion of completeness of RNs from all concerned referral locations was similar and low in both types of RNs. Conclusions: There is a need to improve the quality of RNs at SQUH. Referring doctors must be made aware of the importance of completeness of RNs to improve test reporting, patient management and satisfaction, and reduce financial burden on hospital exchequer.

Background: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and use of INICC Surveillance Online System (ISOS) on ventilator-associated pneumonia (VAP) rates in Saudi Arabia from September 2013 to February 2017. Methods: A multicenter, prospective, before–after surveillance study on 14,961 patients in 37 intensive care units (ICUs) of 22 hospitals. During baseline, we performed outcome surveillance of VAP applying the definitions of the CDC/NHSN. During intervention, we implemented the IMA and the ISOS, which included: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on VAP rates and consequences and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using generalized linear mixed models to estimate the effect of intervention. Results: The baseline rate of 7.84 VAPs per 1000 mechanical-ventilator (MV)-days―with 20,927 MV-days and 164 VAPs―, was reduced to 4.74 VAPs per 1000 MV-days―with 118,929 MV-days and 771 VAPs―, accounting for a 39% rate reduction (IDR 0.61; 95% CI 0.5–0.7; P 0.001). Conclusions: Implementing the IMA was associated with significant reductions in VAP rates in ICUs of Saudi Arabia. Keywords: Hospital infection, Healthcare-acquired infection, Hospital-acquired pneumonia, Nosocomial pneumonia, Limited-resource countries, Surveillance

STUDY OBJECTIVE: Treatment of sleep-disordered breathing (SDB) with positive airway pressure (PAP) therapy has unique clinical challenges in individuals living with spinal cord injuries and diseases (spinal cord injury [SCI]/D). Interventions focused on increasing PAP use have not been studied in this population. We aimed to evaluate the benefits of a program to increase PAP use among Veterans with SCI/D and SDB. METHODS: Randomized controlled trial comparing a behavioral Intervention (n = 32) and educational control (n = 31), both including one face-to-face and five telephone sessions over 3 months. The intervention included education about SDB and PAP, goal setting, troubleshooting, and motivational enhancement. The control arm included non-directive sleep education only. RESULTS: Primary outcomes were objective PAP use (nights ≥4 hours used within 90 days) and sleep quality (Pittsburgh Sleep Quality Index [PSQI] at 3 months). These did not differ between intervention and control (main outcome timepoint; mean difference 3.5 [-9.0, 15.9] nights/week for PAP use; p = .578; -1.1 [-2.8, 0.6] points for PSQI; p = .219). Secondary outcomes included fatigue, depression, function, and quality of life. Only fatigue improved significantly more in the intervention versus the control group (p = .025). Across groups, more PAP use was associated with larger improvements in sleep quality, insomnia, sleepiness, fatigue, and depression at some time points. CONCLUSIONS: PAP use in Veterans with SCI/D and SDB is low, and a 3-month supportive/behavioral program did not show significant benefit compared to education alone. Overall, more PAP use was associated with improved symptoms suggesting more intensive support, such as in-home assistance, may be required to increase PAP use in these patients. CLINICAL TRIALS INFORMATION: Title: Treatment of Sleep Disordered Breathing in Patients with SCI. Registration number: NCT02830074. Website: https://clinicaltrials.gov/study/NCT02830074?cond=Sleep%20Apnea&term=badr&rank=5.

We evaluated carriage rates of extended spectrum β-lactam-producing Enterobacterales (ESBL-E), Carbapeneme-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) among pregnant women and determined the maternal-to-neonate transmission rates of these antibiotic-resistant bacteria (ARB). Pregnant women provided rectal and vaginal samples, proximal to delivery. Stool samples were collected from newborns within 48 h of birth. All samples were cultured on selective media for ARB identification. Clinical and demographic data were collected from the participants’ medical files. We performed molecular and phenotypic characterization of the different resistance mechanisms, and determined the isolates’ antibiotic susceptibility and biofilm-forming ability. The prevalence of ESBL-E, MRSA and VRE among pregnant women were 16%, 6% and 1%, respectively. The prevalence of ESBL-E and MRSA among neonates were 7.6% and 1.6%, respectively. Maternal-to-neonate transmission rates of ESBL-E and MRSA were 48% and 27.8%, respectively. Maternal and neonatal isolates shared similar characteristics. Maternal-to-neonate transmission of ARB plays an important role in bacterial colonization in newborns. Future studies should investigate the outcomes of the high ESBL-E transmission rate. The biofilm-forming ability of ARB was found to affect transmission. Additional factors should be investigated in order to understand the differences between transmitted and non-transmitted bacteria.

Owing to the increasing worldwide burden of liver diseases, the crucial need for safe and effective interventions for treating end-stage liver failure has been a very productive line of inquiry in the discipline of hepatology for many years. Liver transplantation is recognized as the most effective treatment for end-stage liver disease; however, the shortage of donor organs, high medical costs, and lifelong use of immunosuppressive agents represent major drawbacks and demand exploration for alternative treatments. Stem cell-based therapies have been widely studied in the field of liver diseases and are considered to be among the most promising therapies. Herein, we review recent advances in the application of stem cell-related therapies in liver disease with the aim of providing readers with relevant knowledge in this field and inspiration to spur further inquiry.

Background/Aim. Stroke or cerebrovascular accident is defined as sudden or sub acute onset of focal neurologic deficit, caused by the interruption of blood flow to parts of the brain. In this study, we aimed to investigate the prevalence of dyslipidemia and hyperglycemia among stroke patients in Palestine. Materials and Methods. A total of 70 patients with stroke were included in a cross-sectional study between November 2017 and February 2018. Stroke patients were diagnosed based on a CT scan reviewed by a neurologist. Fasting venous blood samples were collected to measure the lipid profile (cholesterol, low-density lipoproteins (LDL), triacylglycerol (TAG), high-density lipoproteins (HDL)), fasting blood glucose (FBG), and glycosylated hemoglobin (HbA1c) levels. An interview-based questionnaire, included background data, past medical history, family history, and other risk factors for stroke, was filled for each patient. Results. Based on our results, 28.57% of patients had high LDL, 17.1% had high cholesterol, 15.7% had high TAG and 61.3% had low HDL. About half of the patients (51.4%) had abnormal HbA1c and abnormal FBG (52.8%). The majority (67.1%) of patients were males, whereas, 11% of patients were obese (BMI of more than 30 kg/m2) and 51.4% were smokers. Regarding the family history of diseases, 81% of patients had a family history of hypertension, 50% had a family history of stroke, and 58% had a family history of diabetes mellitus. Conclusion. Male gender and smoking were most likely to increase the risk of stroke. Risk factors like low HDL, high LDL, high FBG, high HbA1c, and hypertension contribute substantially to the incidence of stroke. A family history of stroke, hypertension and diabetes were significant risk factors for stroke.