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This study sought to determine the perception of healthcare workers (HCWs) about pre-hospital airway management and their experiences. Methods: This cross-sectional study was conducted among health workers at the emergency department of King Fahad Medical City in the capital of Saudi Arabia, Riyadh City. This study targeted physicians, nurses, paramedics, and respiratory therapists. Data were collected using an online questionnaire. The questionnaire included demographic characteristics, training, and experiences in airway management and a 5-item questionnaire to measure the perception of HCWs about airway management. Results: Of the 100 HCWs, 39% were doctors, and 37% were nurses. Approximately 23% had a poor experience with intubation. Traumatic injuries were the major difficulties involving airway management (44%). The overall perception of HCWs about prehospital airway management was good (68%), 31% were moderate, and only 1% were considered poor perception levels. No significant differences were observed between perception scores in relation to the demographic characteristics and experiences of HCWs in airway management (all p>0.05). Conclusion: Despite HCWs' good perception of prehospital airway management, some gaps have been identified mainly through intubation skills and experiences. This study provided evidence that perception towards prehospital airway management was not affected by profession, years of experience, regular practice of intubation, and airway management. Regular training should be implemented, with equipment and resources should be available to improve airway management and patient quality of care. [SJEMed 2024; 5(2.000): 128-133]

Let $ G $ be a group and $ S $ be a subset of $ G. $ We say that $ S $ normally generates $ G $ if $ G $ is the normal closure of $ S $ in $ G. $ In this situation, every element $ g\in G $ can be written as a product of conjugates of elements of $ S $ and their inverses. If $ S\subseteq G $ normally generates $ G, $ then the length $ \| g\|_{S}\in \mathbb{N} $ of $ g\in G $ with respect to $ S $ is the shortest possible length of a word in $ \text{Conj}_{G}(S^{\pm 1}): = \{h^{-1}sh | h\in G, s\in S \, \text{or} \, s{^{-1}}\in S \} $ expressing $ g. $ We write $ \|G\|_{S} = \text{sup}\{\|g\|_{S} \, |\, \, g\in G\} $ for any normally generating subset $ S $ of $ G. $ The conjugacy diameter of any group $ G $ is $ \Delta(G): = \sup\{ {\|G\|_{S}}\, \, | S\ \text{is a finite normally generating subset of } G \}. $ We say that $ G $ is uniformly bounded if $ \Delta(G) < \infty. $ This concept is a strengthening of boundedness. Motivated by previously known results approximating $ \Delta(G) $ for any algebraic group $ G, $ we find the exact values of the conjugacy diameters of the direct product of finitely many copies of $ SL_2(\mathbb{C}) $ and the direct product of finitely many copies of $ PSL_2(\mathbb{C}). $ We also prove that if $ G_1, \dots, G_n $ be quasisimple groups such that $ G_i $ is uniformly bounded for each $ i\in \{1, \dots, n\}, $ then $ G_1\times\dots \times G_n $ is uniformly bounded. This is also a generalization of some previously known results in the literature.

Abstract This study details the synthesis and application of magnetic copper ferrite (CuFe2O4) nanoparticles for the efficient removal of acid red 88 and crystal violet dyes from aqueous solutions. Utilizing a combustion method, nanoparticles were synthesized with succinic and malic acids as fuels, yielding samples with crystallite sizes of 28.54 ± 0.90 nm for the sample synthesized with malic acid and 19.79 ± 0.75 nm for the sample synthesized with succinic acid. Optimum removal conditions were found at a pH of 2 for acid red 88 and pH 10 for crystal violet, with a contact time of 80 min and an adsorbent dosage of 0.05 g in a 100 mL solution. Under these conditions, the sample synthesized using succinic acid achieved sorptive capacities of 452.49 mg/g for acid red 88 and 446.43 mg/g for crystal violet, while the sample synthesized using malic acid reached 408.16 mg/g and 374.53 mg/g, respectively. Both adsorption processes followed the pseudo-second-order kinetic model and aligned with the Langmuir isotherm. Thermodynamic analysis confirmed the process as exothermic and spontaneous. Practical trials demonstrated removal efficiencies above 95% for both dyes in real wastewater samples, underscoring the method’s practical potential in water purification applications.

Abstract Fibroblast activating protein (FAP) is a cell surface marker of cancer-associated fibroblasts with a distinct pro-tumorigenic role. The present study analyzed the pan-cancer expression; and clinical and mutational profiles of the FAP coding gene. Molecular dynamics simulation (MDS) deciphered the backbone dynamics and energetics of FAP. Virtual screening and subsequent pharmacokinetic-profiling (PK) filtered lead molecules, which were subjected to molecular docking. MDS projected a stable trajectory for the protein, as dynamics evidenced by low residue-level fluctuations, stable backbone dynamics, and energetics. Around five stabilization and deleterious mutations in the catalytic domain were identified. The low binding energy (BE) profiles from molecular docking studies screened the top five lead molecules for site-specific intermolecular interaction studies. Lead-16 (ZINC000245289699) exhibited a significant BE and inhibition constant of −6.87 kcal/mol and 12.27 μM, respectively, across FAP and its mutants. Interestingly, the docked complexes of Lead-16 interacted with the catalytic triad residues (S624, D702, and H734). The docked complexes of Lead-16 with FAP showed lower average root-mean-square fluctuations compared to the unbound protein, suggesting a stable ligand–protein complex. The tumor-specific expression and its critical overall survival suggest the inhibitors of FAP for potential cancer therapeutic intervention and hindering tumor microenvironment-driven cancer progression.

Abstract In this study, nickel ferrite (NiFe2O4) nanoparticles were synthesized using the Pechini sol-gel method and modified with sodium docusate surfactant. The modified nanoparticles showed an enhanced adsorption capacity of 384.62 mg/g for crystal violet dye, compared to 237.53 mg/g for unmodified NiFe2O4. Characterization was performed using Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDX), and scanning electron microscopy (SEM) techniques. The adsorption process was spontaneous, exothermic, and followed the Langmuir isotherm and pseudo-second-order kinetic model. Optimal conditions for maximum dye removal were achieved at pH 10, 50 min, and 298 K. Additionally, the synthesized adsorbents demonstrated excellent regeneration and reusability over five adsorption-desorption cycles with minimal efficiency loss.

Abstract Glaucoma, a leading cause of blindness due to elevated intraocular pressure (IOP), is managed with medications like latanoprost (LAT), a prostaglandin analogue, to enhance aqueous outflow. Despite the challenge posed by eye anatomy and tear dynamics, effective ocular bioavailability via topical administration remains elusive. This study aims to optimize self-assembled nanomicelles incorporating LAT, an anti-glaucoma drug, belonging to BCS Class II (low solubility and high permeability) via a two-level, two-factor full factorial design, the nanomicelles were formulated via direct dissolution method and validated using design of expert. The optimized nanomicelles exhibited a spherical morphology, with a size of 69 nm and encapsulation efficiency of 77.5%, demonstrating a sustained LAT release over 12 h. In normotensive rabbits, the nanomicelles elicited a substantial reduction in intraocular pressure (IOP) by up to 40% for a duration of three days, that was significantly longer than the IOP-lowering efficacy of XALATAN eye drops (24 h). These findings indicated that self-assembled nanomicelles hold promise for enhancing the ocular bioavailability and extending the therapeutic duration of LAT, while providing the physical stability.

Objectives The aim of this study was to investigate the level of burnout among postgraduate healthcare trainees at a tertiary care center in Riyadh, Saudi Arabia, and assess the need to establish a well-being program. Methods This cross-sectional study was conducted between December 2021 and January 2022 and used two validated questionnaires: the Copenhagen Burnout Inventory (CBI) for assessing burnout among postgraduate healthcare trainees, and a questionnaire for assessing program directors’ opinion on the need for a well-being program. Results A total of 386 trainees and 85 program directors completed the questionnaire. In both groups, the majority of the respondents were male (trainees: 53.9%; program directors: 61.2%). A total of 226 trainees (58.5%) scored above the CBI burnout cut-off score, with the median score being highest in the personal domain (62.5,IQR: 45.8–75). In the univariate analysis, the mean burnout score was higher among trainees who were married (P = 0.036), had children (P =

Abstract Basic yellow 28 dye, used extensively in the textile and leather industries, poses significant environmental and health risks, including allergic reactions, skin irritation, and respiratory problems. This study reports the Pechini sol-gel synthesis of novel ZnO/Mg3B2O6 nanostructures for the decontamination of basic yellow 28 dye from aqueous solutions. The nanostructures were synthesized by calcining at 650 and 850 °C for 5 h, producing ZM650 and ZM850, respectively. The average crystallite sizes were 39.28 nm for ZM650 and 51.03 nm for ZM850. BET surface areas were 70.71 m2/g for ZM650 and 48.13 m2/g for ZM850. FE-SEM and HR-TEM analyses revealed distinct morphological structures, with ZM650 exhibiting a dense aggregation of rod-like particles and ZM850 showing larger clusters. The maximum adsorption capacities were 381.68 mg/g for ZM650 and 303.03 mg/g for ZM850. The optimum adsorption was observed at a pH of 10, a contact time of 70 min, and a temperature of 298 K. Regeneration using a 6 M HCl solution demonstrated efficient reusability over five cycles. The adsorption process followed pseudo-second-order kinetics and the Langmuir isotherm, indicating monolayer adsorption. Also, the adsorption process was found to be physical and exothermic.

Abstract Background Fasting-induced headaches (FIHs) have been shown to occur on the first day of Ramadan and clearly decline thereafter. Despite the wealth of knowledge about different types of headaches (e.g., migraine-, cluster-, and tension-type headaches), research on the mechanism underlying FIHs, as well as their treatment, remains scarce. Our study aimed to investigate any association between FIHs during the first day of Ramadan and potential headache-related biomarkers, including fasting blood glucose (FBG), C-reactive protein (CRP), magnesium, vitamin B9, vitamin B12, homocysteine, and calcitonin gene related peptide (CGRP), and to assess whether a prophylactic use of paracetamol may influence these biomarkers. Methods As part of a randomized, open-label clinical trial that evaluated the effect of paracetamol as a prophylactic therapy for FIH, blood samples from stratified subjects in the prophylaxis and control groups were withdrawn while fasting after the 1st dose of paracetamol (in the prophylaxis group) and prior to reporting headache occurrence. Results Plasma and serum were separated for 61 subjects; 31 and 30 subjects from the prophylaxis and control groups, respectively. Overall, no significant differences were found in the levels of FBG, CRP, magnesium, vitamin B9, and vitamin B12 in headache-suffering subjects compared to those without headache despite the use of paracetamol for prophylaxis. Homocysteine, however, was significantly reduced in all subjects who experienced FIH compared to those without headache (median 6.9 [1.6] vs. 7.7 [2.7] umol/L; p = 0.041). On the contrary, when the CGRP was measured using immunoassay, it was found to be significantly elevated in all headache-suffering subjects compared to those without headache (median 126.1 [17.7] vs. 105.8 [19.6] pg/mL; p ≤ 0.0001). This difference was maintained upon comparing the headache to non-headache subjects in both the prophylaxis (median 121.5 [15.4] vs. 105.8 [9.4] pg/mL; p

Concerns regarding man‐made organic chemicals pervading our ecosystem and having adverse and detrimental effects upon organisms, including man, have now been studied for several decades. Since the 1970s, some environmental pollutants were identified as having endocrine disrupting affects. These endocrine disrupting chemicals (EDC) were initially shown to have estrogenic or anti‐estrogenic properties and some were also shown to bind to a variety of hormone receptors. However, since the 1990s it has also been identified that many of these EDC additionally, have the ability of causing abnormal alterations in Ca2+ signalling pathways (also commonly involved in hormone signalling), leading to exaggerated elevations in cytosolic [Ca2+] levels, that is known to cause activation of a number of cell death pathways. The major emphasis of this review is to present a personal perspective of the evidence for some types of EDC, specifically alkylphenols and brominated flame retardants (BFRs), causing direct effects on Ca2+ transporters (mainly the SERCA Ca2+ ATPases), culminating in acute cytotoxicity and cell death. Evidence is also presented to indicate that this Ca2+ATPase inhibition, which leads to abnormally elevated cytosolic [Ca2+], as well as a decreased luminal ER [Ca2+], which triggers the ER stress response, are both involved in acute cytotoxicity.

Background and Purpose Cerebral venous thrombosis (CVT) is associated with a high degree of morbidity and mortality. Our objective is to elucidate characteristics, treatments, and outcomes of patients with cancer and CVT (CA-CVT). Methods The 2016–2019 National Inpatient Sample (NIS) database was queried for patients with a primary diagnosis of CVT. Patients with a currently active diagnosis of malignancy (CA-CVT) were then identified. Demographics and comorbidities were compared between CA-CVT and CVT patients. Subgroup analyses explored patients with hematopoietic cancer and non-hematopoietic cancers. Stroke severity and treatment were explored. Inpatient outcomes studied were discharge disposition, length of stay, and mortality. Results Between 2016 and 2019, 6,140 patients had a primary diagnosis code of CVT, and 370 (6.0%) patients had a coexisting malignancy. The most common malignancy was hematopoietic (n=195, 52.7%), followed by central nervous system (n=40, 10.8%), respiratory (n=40, 10.8%), and breast (n=40, 10.8%). These patients tended to be older than non-CA-CVT and were more likely to have coexisting comorbidities. CA-CVT patients had higher severity scores on the International Study of Cerebral Vein and Dural Sinus Thrombosis Risk Score (ISCVT-RS) and increased complications. In a propensity-score matched cohort, there were no differences in inpatient outcomes. Conclusion Malignancy occurs in 6% of patients presenting with CVT and should be considered a potential comorbidity in instances where clear causes of hypercoagulabilty have not been identified. Malignancy was linked to higher mortality rates. Nonetheless, after adjusting for the severity of CVT, the outcomes for inpatients with cancer-associated CVT were comparable to those without cancer, indicating that the increased mortality associated with malignancy is probably due to more severe CVT conditions.

Background and Purpose Cold beverage intake (carbonated drinks, fruit juice/drinks, and water) may be important population-level exposures relevant to stroke risk and prevention. We sought to explore the association between intake of these beverages and stroke. Methods INTERSTROKE is an international matched case-control study of first stroke. Participants reported beverage intake using food frequency questionnaires or were asked “How many cups do you drink each day of water?” Multivariable conditional logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations with stroke. Results We include 13,462 cases and 13,488 controls; mean age was 61.7±13.4 years and 59.6% (n=16,010) were male. After multivariable adjustment, carbonated beverages were linearly associated with ischemic stroke (OR 2.39 [95% CI 1.64–3.49]); only consumption once/day was associated with intracerebral hemorrhage (ICH) (OR 1.58 [95% CI 1.23–2.03]). There was no association between fruit juice/drinks and ischemic stroke, but increased odds of ICH for once/day (OR 1.37 [95% CI 1.08–1.75)] or twice/day (OR 3.18 [95% CI 1.69–5.97]). High water intake (>7 cups/day) was associated ischemic stroke (OR 0.82 [95% CI 0.68–0.99]) but not ICH. Associations differed by Eugeographical region—increased odds for carbonated beverages in some regions only; opposing directions of association of fruit juices/drinks with stroke in selected regions. Conclusion Carbonated beverages were associated with increased odds of ischemic stroke and ICH, fruit juice/drinks were associated with increased odds of ICH, and high water consumption was associated with reduced odds of ischemic stroke, with important regional differences. Our findings suggest optimizing water intake, minimizing fruit juice/drinks, and avoiding carbonated beverages.

Abstract Crystal violet dye poses significant health risks to humans, including carcinogenic and mutagenic effects, as well as environmental hazards due to its persistence and toxicity in aquatic ecosystems. This study focuses on the efficient removal of crystal violet dye from aqueous media using novel Co3O4/Co3(BO3)2 nanostructures synthesized via the Pechini sol–gel approach. The nanostructures, which were abbreviated to EN600 and EN800, were fabricated at calcination temperatures of 600 and 800 °C, respectively. X-ray diffraction (XRD) analysis revealed that the synthesized samples have a cubic Co3O4 phase and an orthorhombic Co3(BO3)2 phase, with mean crystal sizes of 43.82 nm and 52.93 nm for EN600 and EN800 samples, respectively. The Brunauer–Emmett–Teller (BET) surface areas of EN600 and EN800 samples were 65.80 and 43.76 m2/g, respectively, indicating a significant surface area available for adsorption. Optimal removal of crystal violet dye was achieved at a temperature of 298 K, a contact time of 70 min, and a pH of 10. The maximum adsorption capacities were found to be 284.09 mg/g for EN600 and 256.41 mg/g for EN800, which are notably higher compared to many conventional adsorbents. The adsorption process followed the pseudo-second-order kinetic model and fitted well with the Langmuir isotherm. The adsorption was exothermic, spontaneous, and physical in nature. Moreover, the adsorbents exhibited excellent reusability, retaining high efficiency after multiple regeneration cycles using 6 mol/L hydrochloric acid. These findings highlight the potential of these Co3O4/Co3(BO3)2 nanostructures as effective and sustainable materials for water purification applications.

Abstract Mentha arvensis is an herbaceous plant commonly known as peppermint or Japanese mint. This study investigated the toxic potential and repellent efficacy of M. arvensis essential oil (MaEO) at varying concentrations (15.625–250 mg/mL) in Nauphoeta cinerea, along with its impact on biochemical parameters in N. cinerea. The potential of the major compounds as a new analgesic target was investigated using molecular docking. The essential oil was analyzed by gas Chromatography–mass spectrometry (GC–MS) and the toxic potential, repellent property, and changes in lipid peroxidation (LPO) levels were evaluated as markers of oxidative stress. GC–MS results revealed that the main components were oxygenated monoterpenes such as menthol (71.31%), mentone (13.34%) and isomentone (5.35%). MaEO significantly reduced lipid peroxidation (LPO), the levels of non-protein thiols and iron(II) at the concentration of 125 mg/mL in N. cinerea. Furthermore, the major components, l-(−)-Menthol and menthone demonstrated high gastrointestinal absorption and high affinity with the target protein, suggesting possible links that contribute to the analgesic effect of MaEO.

Human action recognition (HAR) based on skeleton data is a challenging yet crucial task due to its wide-ranging applications, including patient monitoring, security surveillance, and human- machine interaction. Although numerous algorithms have been proposed to distinguish between various activities, most practical applications require highly accurate detection of specific actions. In this study, we propose a novel, highly accurate spatiotemporal graph autoencoder network for HAR, designated as GA-GCN. Furthermore, an extensive investigation was conducted employing diverse modalities. To this end, a spatiotemporal graph autoencoder was constructed to automatically learn both spatial and temporal patterns from skeleton data. The proposed method achieved accuracies of 92.3% and 96.8% on the NTU RGB+D dataset for cross-subject and cross-view evaluations, respectively. On the more challenging NTU RGB+D 120 dataset, GA-GCN attained accuracies of 88.8% and 90.4% for cross-subject and cross-set evaluations. Overall, our model outperforms the majority of the existing state-of-the-art methods on these common benchmark datasets.

Purpose: This in vitro study aimed to evaluate and compare the physical and antimicrobial properties of provisional resin modified with two different nanoparticles, namely, silicon dioxide (nano-SiO2) and titanium dioxide (nano-TiO2). Methods: A commonly used commercially available polymethyl methacrylate (PMMA) provisional resin (Unifast III; GC Corp) was modified with nano-SiO2 and nano-TiO2 at different concentrations (1% wt. and 2.5% wt. respectively), while one unmodified group was used as a control. Rectangular specimens (60 × 10 × 3.3 mm) for strength (MPa) and elastic modulus, and square specimens (10 × 10 × 3.4 mm) for surface roughness (Ra, µm), hardness (VHN), and Candida albicans adhesion (colony forming unit, CFU/mL) were prepared and grouped into five groups (n = 10) according to (nanoparticles) NPs type and concentration. After polymerization, the specimens were finished and polished and then subjected to thermal cycling (5000 cycles). Analysis of variance and post-hoc Tukey test were used for data analysis (α = 0.05). The scanning electron microscope (SEM) was used for fracture surface analysis and C. albicans count. Results: The addition of 1% nano-SiO2 significantly increased the flexural strength, and 1% nano-SiO2 contributed to the highest flexural strength value, while 2.5% nano-SiO2 and nano-TiO2 showed non-significant increases (p > 0.05). The elastic modulus increased significantly for both NPs. Among the NP-modified groups, the nano-SiO2 groups showed an increased elastic modulus compared to the nano-TiO2 groups. The hardness significantly increased with NPs addition with no significant differences between NPs-modified groups. Surface roughness increased with 2.5% nano-TiO2 addition, while 1% nano-TiO2 and nano-SiO2 showed non-significant differences. Nano-SiO2 and nano-TiO2 significantly decreased C. albicans adhesion, and nano-TiO2 groups were significantly superior in their antimicrobial effect compared with nano-SiO2. Conclusions: Low nano-SiO2 addition increased the flexural strength of provisional resin. The addition of NPs increased elastic modulus and hardness and decreased the C. albicans adhesion to provisional resin. Nano-SiO2 did not alter the surface roughness, while 2.5% of nano-TiO2 increased the surface roughness.

Abstract Background Interstitial lung disease (ILD) is an increasingly recognized complication of rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. Many risk factors for RA-related ILD were reported. The current study aims to explore the features and risk factors of Saudi patients with RA-ILD. Methods This is a multicenter, retrospective, observational study of patients with RA-ILD. Clinical and radiological data from patients with RA-ILD were obtained from electronic medical records, including demographics, clinical characteristics, laboratory tests, pulmonary function tests, ECHO, and HRCT images. Result Out of 732 patients, 57 had RA-ILD. The mean age at the time of ILD diagnosis was 61.9 (± 12.2) years. RA-ILD diagnosis was significantly less among females (p = 0.008). Patients who ever smoked had significantly more RA-ILD (p 0.05). The most common symptoms of RA-ILD were cough (55.6%) and dyspnea (30.2%), and the most common ILD pattern was Non-specific Interstitial Pneumonia (NSIP) (55.6%) followed by Usual Interstitial Pneumonia (UIP) (38.9%). Traction bronchiectasis (75.5%) and glass ground opacities (73.6%) were also observed. The mean FVC and DLCO at baseline were 64.6% and 53.3%, respectively. Conclusion In this cohort of patients, Saudi RA-ILD patients had a predominant NSIP pattern conversely to what is seen globally. These findings could be explained by the lower rates of smoking in our patient population. Future prospective national studies are needed to confirm the current findings and better evaluate RA-ILD epidemiology and risk factors.

Investigating the therapeutic potentials of medicinal plants remains pivotal in the discovery of novel bioactive compounds for food and pharmaceutical applications. This research delves into the phytochemical composition and biological activities of Ceropegia foetida's methanol extract, employing comprehensive UHPLC-MS for secondary metabolites profiling. The study quantifies the extract's substantial phenolic (76.12 mg GAE/g) and flavonoid (21.58 mg QE/g) contents, revealing a promising correlation with robust antioxidant activities, as evidenced by notable ABTS, FRAP, and CUPRAC assay outcomes. Furthermore, the extract demonstrates significant inhibitory effects on key enzymes implicated in neurodegenerative disorders and diabetes, including acetylcholinesterase (3.56 mg GALAE/g), butyrylcholinesterase (2.91 mg GALAE/g), and tyrosinase (128.31 mg KAE/g). UHPLC-MS analysis confirms the presence of 39 distinct phytochemicals across six primary categories, affirming the extract's complex bioactive profile. In complement to experimental assays, computational analyses via molecular docking simulations provided insights into the interaction mechanisms of identified phytochemicals with the target enzymes. These simulations revealed a substantial binding affinity of the plant's constituents towards enzymes compared to standard inhibitors, highlighting the compounds responsible for C. foetida's bioactivity. Such computational insights, alongside empirical data, suggest that C. foetida merits further exploration as a natural source of therapeutic agents. Overall, the efficacious enzyme inhibition, coupled with the identified phytochemical diversity, underscores the potential of C. foetida as a valuable natural resource for developing nutraceuticals and therapeutic agents. These findings support the further investigation of C. foetida for its applicability in enhancing health and treating chronic conditions.

Isotretinoin, widely used for treating severe acne, has also been prescribed off-label for hidradenitis suppurativa (HS). While effective in some cases, isotretinoin is known to cause psychiatric side effects. This case report discusses a 24-year-old male with HS who developed severe nightmares after isotretinoin dosage was increased. Initially prescribed to manage his HS symptoms, the drug led to vivid, distressing nightmares that significantly disrupted his sleep, resulting in the discontinuation of treatment. The symptoms resolved upon cessation of isotretinoin, and a probable association was confirmed using the Naranjo algorithm. The patient was later transitioned to adalimumab, a biologic therapy for HS. This case highlights the need for careful psychiatric monitoring during isotretinoin therapy and emphasizes the importance of considering alternative treatments in cases of intolerable side effects. Further research is necessary to understand better the psychiatric implications of isotretinoin, including sleep disturbances like nightmares.

Fixation of carbon dioxide is a key issue for the sustainable synthesis of chemical compounds. A catalyst system for the preparation of cyclic carbonates by the fixation of carbon dioxide (CO2) onto epoxides is presented. This system is designed for easy application due to the availability of the compounds on an industrial scale as well as moderate reaction conditions. Notably, it avoids the use of metal-halogen catalysts and instead employs a tertiary amine as the catalytic center, in conjunction with an alcohol acting as a hydrogen bond donor (HBD). The kinetics of the cycloaddition reaction between epoxides and CO2 were thoroughly investigated using IR spectroscopy. Remarkably, optimization of the amino-to-alcohol group ratio and the amine structure was carried out to enhance the overall performance of the catalyst system showing a synergistic effect between the tertiary amine and the hydroxyl. Most notably, this entire process is conducted without the use of solvents and operates at ambient pressure, underscoring its significant ecological advantages.

Cities worldwide are experiencing substantial urban expansion, leading to environmental degradation. Riyadh is a good example of this, growing at a rapid pace resulting in the urban sprawl becoming environmentally, socially, and economically unsustainable. Urban densification and sustainable revitalization are approaches to limit land usage, accommodate a growing population, and maintain high-quality urban areas, particularly, in the inner city. This process is complex and dynamic and necessitates the involvement of private developers whose engagement plays a critical role in facilitating property redevelopment. This research examines the barriers and drivers that impact developer participation in rejuvenating inner city neighborhoods in Riyadh. The mixed methods of a survey and focus group discussions are used to examine the perspectives of private developers. Three key themes evolved focusing on investment potential, the regulatory environment, and key enablers of urban regeneration. The findings reveal a cautiously optimistic view of these themes, with several challenges and opportunities identified. This research highlights the need for a holistic approach to urban planning for regeneration and land use management, especially in inner-city residential areas. This study adds to the scarce research on urban regeneration in the Middle East context and establishes a foundation for future research.

Vaccine literacy is a significant part of health literacy. Although several tools have been developed to assess vaccine literacy, such tools are lacking in Arabic. Validating an Arabic version of a tool that evaluates vaccine literacy is critically important, as it would aid in understanding the decision-making process regarding vaccinations among individuals in Arabic-speaking countries. Therefore, the current study aimed to validate an Arabic tool for assessing vaccine literacy in adult vaccination. An online questionnaire was distributed to people throughout Jordan by sharing the questionnaire link via various social media platforms. The reliability and validity of the Arabic version of the vaccination literacy assessment tool (HLVa-Ar) were evaluated using factor analysis and Rasch analyses. The two-factor model generated fit indices were in the acceptable range (χ2/df = 2.48, RMSEA = 0.06, SRMR = 0.05, GFI = 0.94, CFI = 0.97, and TLI = 0.96). Cronbach’s alpha for functional Vaccination literacy (VL) and interactive/critical VL were 0.91 and 0.88 respectively. The Rasch analysis indicated acceptable infit/outfit values and high item and person separation reliabilities for the two factors (0.852, 0.868, and 0.771, 0.818 respectively). Overall, the 420 participants displayed a good understanding of the general benefits and importance of vaccination. The HLVa-Ar was shown to be a valid and reliable tool that portrayed a wide range of vaccination literacy levels in the studied sample and provided valuable insights into participants’ vaccination knowledge. The findings emphasize the need for developing targeted strategies to improve vaccination literacy and increase vaccination rates.

IntroductionOver-the-counter (OTC) medications are those obtained without a medical prescription from a healthcare professional. With the increasing availability of information from various sources, including social media, pharmacy students may be exposed to unreliable or inaccurate data. Incorrect medication use is particularly concerning due to its potential risk of causing adverse health effects.” Hence, this study aims to determine students’ knowledge and attitudes at Taif University’s pharmacy college.MethodsThis research utilized a cross-sectional online questionnaire-based study, employing data from a sample of 450 pharmacy students from Taif University in Saudi Arabia. Descriptive analysis included descriptive and differential analysis. The data were analyzed using statistical package for social sciences (SPSS) Version 27.ResultsThe majority of participants, 297 (88.2%), were aware that inappropriate use of over-the-counter medications might have negative implications. A total of 233 participants (51.8%) reported having previously used an OTC medication. Also, 293 (65.1%), were aware that using OTC medications beyond their expiration date was harmful. A total of 280 participants (62.2%) had a high knowledge of OTC medication, whereas 170 respondents (37.8%) had a low level of knowledge. A significant correlation was found between age, year of study, and the use of OTC medication p-values 0.05).ConclusionThe study found positive attitudes toward OTC medications. Due to increased pharmaceutical exposure and self-medication, upper-year students and OTC course graduates comprehend OTC medications better. The examination found safety protocol violations in expiration dates, prescription label interpretation, and storage. Therefore, the study provides useful information for future attempts. Also, this study may contribute to the literature and guide future research to fill knowledge gaps.

Background Mechanical thrombectomy is the standard of care in acute ischemic stroke with anterior large vessel occlusion presenting within 6 hours of symptom onset, but complications do exist. We assessed the feasibility of a hybrid simulation‐based workshop at a national meeting for interventional neurology trainees focused on the management of acute ischemic stroke and tissue‐plasminogen activator‐related hemorrhage. Methods In this prospective, observational, hybrid simulation‐based study at a fellows’ workshop at a national conference, participants were asked to manage a patient with acute ischemic stroke in the neurointerventional suite followed by thrombolytic‐related hemorrhage leading to cerebral herniation during mechanical thrombectomy. We evaluated the participants’ ability to complete critical actions that were developed based on best practices and relevant American Heart Association guidelines and the Neurocritical Care Society's Emergency Neurological Life Support protocols. The primary outcome was the improvement in knowledge from a precourse to postcourse test. Secondary outcomes included participant reactions. Results Sixty trainees completed the simulation session in 8 groups. The mean sum of critical actions completed by trainees was 9.75/14 (70%). There was a moderate effect of the intervention on trainees’ knowledge from pretest (mean 3.8, SD = 0.3) to posttest (mean 4.3, SD = 0.3). The simulation scenario was described as moderately realistic, very engaging, and extremely satisfactory. Following the workshop, all fellows endorsed an increase in proficiency and confidence in neurological emergency management. Conclusion Simulation‐based workshops at national conferences are feasible and a potentially useful tool for safely educating a large audience of trainees who may not have access to high‐fidelity simulation platforms at their institutions.

التحكيم بوجه عام وسيلة لفض المنازعات بين الأشخاص خارج ساحات المحكمة، ويتم اللجوء للتحكيم لما يحققه من مزايا عديدة وإمكانية تحديد الأطراف لأسلوب فض النزاع من بدايته حتى نهايته من تحديد القانون الواجب التطبيق واختيار المحكمين .......، وينقسم التحكيم من حيث الإجراءات المتبعة إلى تحكيم خاص وتحكيم مؤسساتي. تحدثنا في هذا البحث عن التحكيم الخاص والتحكيم المؤسساتي في المرحلة السابقة لصدور الحكم وتسليط الضوء على الفروق بينهما والمرحلة التالية لصدور الحكم وتسليط الضوء على تنفيذ الحكم. تتمحور الإشكالية في معرفة ما إذا كان الأشخاص الذين يلجؤون للتحكيم كوسيلة لفض نزاعهم يفضلون أي نوع من التحكيم الخاص أم التحكيم المؤسساتي توصلنا من لعدة نتائج: إن التحكيم الخاص أو المؤسساتي نوعي تحكيم وهذه التفرقة ناتجة عن الخلاف في الإجراءات المتبعة في كلا النوعين. لا تختلف طريقة إكساء الحكم سواء أكان خاص أم مؤسساتي. في كلا النوعين يهيمن مبدأ سلطان الإرادة بوجه عام على تحديد الإجراءات المتبعة. وفي كلا النوعين لا يجوز الاتفاق على أية إجراء يخالف النظام العام الدولي والنظام العام في بلد التنفيذ. يجب على سلطة اختيار المحكمين مراعاة الشروط القانونية والاتفاقية عند التعيين. سلطة التعين عند عدم الاتفاق يتولاها القضاء إذا كنا أمام تحكيم خاص وجهاز خاص في مركز التحكيم في التحكيم المؤسساتي. في حال عدم الاتفاق على القانون الذي يحكم الإجراءات يكون في التحكيم الخاص غالبا قانون مكان التحكيم لغايات تنفيذه أما في التحكيم المؤسساتي تكون قواعد المؤسسة التحكيمية هي واجبة التطبيق.

Summary: Diabetes mellitus significantly increases the risk of severe respiratory virus disease like influenza and COVID-19. Early evidence suggests that this susceptibility to respiratory viral disease is driven by glycemic variability, rather than average blood glucose levels. Here, we use blood samples and constant glucose monitoring (CGM) data obtained from people living with type 1 diabetes (T1D) to determine the effects of glycemic variability on the ex vivo T cell response to influenza virus. We show that high glycemic variability in participants living with T1D is associated with a reduced proportion of CD8+CD107a−IFNγ−MIP1β−TNF+ T cells in response to stimulation with influenza virus and an influenza virus peptide pool. Thus, this study provides evidence that glycemic variability affects the ex vivo T cell response to respiratory viruses. These data suggest that monitoring glycemic variability may have important implications in understanding the antiviral immune response in people with diabetes.

Background Antimicrobial resistance is increasing at an alarming rate. The use of antibiotics without a prescription by a patient or other family members and their inappropriate storage have caused serious health issues as it would lead to antibiotic resistance and exposure to the risk of harmful adverse effects unnecessarily. Therefore, the study aimed to evaluate the current behaviour of antibiotic usage, storage, re-usage and misuse among the residents of Saudi Arabia. Methods This is a cross-sectional study. Our target study population was the residents of Saudi Arabia. Data were collected by an online questionnaire and analysed by SPSS. Results A total of 738 participants answered the online questionnaire from all ages, genders, nationalities, and socioeconomic backgrounds residing in different regions across the Kingdom of Saudi Arabia. 76.42% knew that an antibiotic is a chemical substance used to treat infections. The participants were questioned about when they started using antibiotics, to which 95.66% (n=706) responded after consulting a physician, 3.25% (n=24) said when they felt ill for any reason, and 1.08% (n=8) replied after first attempting herbal medicine. A total of 147 participants admitted that they store excess pills of antibiotics after being prescribed for an infection and reuse them later on for symptoms like sore throat and fever. Conclusions The results indicated that nearly half of the participants used leftover antibiotics. Participants having children in their homes significantly reuse antibiotics. However, one-third of the participants didn’t complete the antibiotics course. A large portion of the population, regardless of age, level of education, or professional background, have continued to store leftover antibiotics after an infection treatment and reuse them once they think they need them for new symptoms. This advice further revises the current measures to fill those gaps and reduce this habit.

Objective: The present retrospective study aimed to determine the relationship between the secondary implant stability quotient and different parameters related to an oxidized implant. Methods: A total of 135 patients (305 oxidized implants) were included. Implant-related factors (length, diameter, surgical and loading protocols, grafting, insertion torque, and primary stability) were used for comparisons and linear regression analyses, using secondary ISQ as the dependent variable. Results: At the patient level, the mean time from implantation to secondary ISQ registration was 20.3 ± 29 weeks, and the mean secondary ISQ was 77.30 ± 7.22. The ISQ did not reveal significant differences regarding implant lengths, loading protocol, and simultaneous grafting. In contrast, platform diameters (3.5, 4.3, and 5.0), surgical protocols (one stage versus two stages), insertion torque (35 Ncm), and primary stability (achieved versus not achieved) all revealed significant secondary ISQ differences. Nevertheless, the regression analysis demonstrated that the platform diameter was the only variable significantly and positively predicted the secondary ISQ. Similar findings were found with the implant level analysis. Conclusions: Among different implant- and protocol-related parameters, the platform diameter of the oxidized implant appears to be the only significant predictor of high secondary ISQ values at the time of superstructure connection.

IntroductionMesenchymal stem cells/stromal cells from the Decidua Basalis of the human placenta (DBMSCs) express wide range of effector molecules that modulate the functions of their target cells. These properties make them potential candidate for use in cellular therapy. In this study, we have investigated the consequences of interaction between DBMSCs and natural killer (NK) cells for both cell types.MethodsDBMSCs were cultured with IL-2-activated and resting non-activated NK cells isolated from healthy human peripheral blood and various functional assays were performed including, NK cell proliferation and cytolytic activities. Flow cytometry and microscopic studies were performed to examine the expression of NK cell receptors that mediate these cytolytic activities against DBMSCs. Moreover, the mechanism underlying these effects was also investigated.ResultsOur findings revealed that, co-culture of DBMSCs and NK cells resulted in inhibition of proliferation of resting NK cells, while proliferation of IL-2 activated NK cells was increased. Contrarily, treatment of DBMSC’s with comparatively high numbers of IL-2 activated NK cells, resulted in their lysis, whereas treatment with low numbers resulted in reduction in their proliferation. Cytolytic activity of NK cells against DBMSCs was mediated by several activating NK cell receptors. In spite of the expression of HLA class I molecules by DBMSCs, they were still lysed by NK cells, excluding their involvement in cytolytic activity. In addition, preconditioning NK cells by DBMSCs, enhanced their ability to suppress tumor cell proliferation and in severe cases resulted in their partial lysis. Lysis and decrease of tumor cell proliferation is associated with increased expression of important molecules involved in anticancer activities.DiscussionWe conclude that DBMSCs exhibit dualfunctions on NK cells that enhance their anticancer therapeutic potential.

IntroductionFamilial hypercholesterolemia, the highly prevalent form of dyslipidemia, is a well-known risk factor for premature heart disease and stroke worldwide. Statins, which inhibit 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA) reductase, are the first-choice treatment for dyslipidemias, and have been effective in reducing the risk of stroke and myocardial infarction. However, emerging evidence indicates that statins may increase the incidence of new-onset type 2 diabetes by reducing β-cell mass and function. Notably, past in vitro reports studying the effects of statins on β-cells were performed without including free fatty acids in the model. This factor should have been addressed since these agents are used to treat individuals with hyperlipidemia.MethodsHere, we used a mouse insulinoma MIN6 β-cell culture model to assess the efficacy, cytotoxicity, and insulin-suppressive effects of simvastatin and pravastatin in the presence of palmitic, linoleic, and oleic acids cocktail to mimic mixed lipids challenge in a biologically relevant setting.Results and discussionOur findings indicate that simvastatin was more effective in lowering intracellular cholesterol but was more cytotoxic as compared to pravastatin. Similarly, simvastatin exhibited a higher suppression of total insulin content and insulin secretion. Both drugs suppressed insulin secretion in phases 1 and 2, dose-dependently. No significant effect was observed on mitochondrial respiration. More importantly, elution experiments showed that insulin content diminution by simvastatin treatment was reversible, while exogenous mevalonate did not improve total insulin content. This suggests that simvastatin's influence on insulin content is independent of its specific inhibitory action on HMG-CoA reductase. In conclusion, our study identified that simvastatin was more effective in lowering intracellular cholesterol, albeit it was more toxic and suppressive of β-cells function. Notably, this suppression was found to be reversible.

Cotton is one of the major cash crop in the agriculture led economies across the world. Cotton leaf diseases affects its yield globally. Determining cotton lesions on leaves is difficult when the area is big and the size of lesions is varied. Automated cotton lesion detection is quite useful; however, it is challenging due to fewer disease class, limited size datasets, class imbalance problems, and need of comprehensive evaluation metrics. We propose a novel deep learning based method that augments the data using generative adversarial networks (GANs) to reduce the class imbalance issue and an ensemble-based method that combines the feature vector obtained from the three deep learning architectures including VGG16, Inception V3, and ResNet50. The proposed method offers a more precise, efficient and scalable method for automated detection of diseases of cotton crops. We have implemented the proposed method on publicly available dataset with seven disease and one health classes and have achieved highest accuracy of 95% and F-1 score of 98%. The proposed method performs better than existing state of the art methods.

Applied linguists address translanguaging from a variety of angles to comprehend its effectiveness, applicability, and how it supports or undermines social and educational goals in various bilingual and multilingual environments around the world. A small number of studies have been carried out to demonstrate the reality of pedagogical translanguaging in the context of higher education and, more specifically, in countries where the official language is distinct from the language of instruction in language education. Therefore, this study broadens the understanding of translanguaging practices in English for Specific Purposes (ESP) programs in Saudi universities through the perceptions and perspectives of ESP undergraduate students. The participants of this study were ESP 150 students at the University of Bisha. The data was obtained quantitatively and qualitatively using three research tools: the learners’ questionnaire, observation of teaching sessions, and semi-structured interviews with the learners. The findings indicated that students have a positive attitude towards translanguaging. They found it a useful pedagogical strategy to improve their understanding of ESP terminologies and their field-related complex terms. On the pedagogical level, the study contributed to the field of translanguaging by providing a clear picture of how students perceive translanguaging and how the use of the mother tongue along with English in the classrooms was significant in engaging the students in the learning process.

Background: Atlantoaxial subluxation (AAS) is a diagnosis describing misalignment of the C1 vertebra relative to C2. Excessive translation of this joint, located adjacent to the medullary brain stem, can lead to devastating neurological consequences. A higher prevalence of AAS within the Down syndrome (DS) population has been well-established. This study aims to establish a prevalence rate of DS in patients hospitalized for AAS and compare outcomes between AAS patients with and without DS. Methods: This study utilized the National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project (HCUP). In accordance with HCUP 2023 Clinical Classifications Software Refined files, data were queried using the International Classification of Diseases 10th Edition codes for DS and AAS. Demographics, comorbidities, hospital course, and outcomes were examined and compared using binary and linear multivariate regression. IBM SPSS software was used for data analysis. Results: Of the 213,095 patients in the NIS database admitted between 2016 and 2020 with AAS as their primary diagnosis, 7.2% were DS patients. DS patients were significantly younger (26.56 ± 20.81 vs. 49.39 ± 27.63, P < 0.01), less likely to be female (33.30% vs. 52.10%), and had fewer comorbidities (diabetes mellitus, hypertension, and hyperlipidemia) than non-DS patients. There was no significant difference in likelihood to undergo surgical fusion between DS patients and non-DS patients with AAS. Conclusion: This large-scale study using NIS data determined that 7.2% of all patients admitted to hospitals for AAS are DS patients. The analysis of demographics, hospital course, and outcomes can influence the development of treatment protocols for AAS in the DS population.

This study evaluated and compared the effects of simulated tooth brushing and Arabic coffee thermocycling on the colour stability of lithium disilicate and translucent zirconia dental restorative materials. Sixty disc-shaped specimens (10×1.2 mm²) were fabricated from zirconia and lithium disilicate (N=30). The specimens from each material were allocated to three groups (n=10) based on the surface interventions - simulated tooth brushing (TB), Arabic coffee thermocycling (TC), and TC followed by TB (TC+TB) - to be received. The colour of the specimens was recorded at baseline and after the interventions using a spectrophotometer in 3D CIEL*a*b* colour space. The colour difference (ΔE) between the groups was statistically analysed using an analysis of variance (ANOVA) and the least significant difference post-hoc test (p˂0.05). The mean ΔE for both lithium disilicate and translucent zirconia was high after all the interventions (p˂0.05). The mean ΔE was high after TC+TB, followed by TB, and TC for both the tested materials. The overall mean ΔE was highest (1.98±0.92) in lithium disilicate after TC+TB and the least in translucent zirconia after TC (0.96±0.87). In comparison with translucent zirconia, the ΔE was highest in lithium disilicate after TC+TB followed by TB and the least in TC. For the lithium disilicate group, the mean ΔE was highest after TC+TB and the least after TC (p˂0.05). Similarly, the mean ΔE for the zirconia group was highest after TC+TB and the least after TC (p˃0.05). In comparison with the translucent zirconia, the ΔE was higher in lithium disilicate demonstrating lower colour stability. In conclusion, the combined effect of simulated tooth brushing and Arabic coffee thermocycling demonstrated the highest ΔE among the interventions, irrespective of the materials tested. Although the colour differences presented in the study were clinically perceptible following the interventions, the overall differences were clinically insignificant.

Abstract A series of novel Schiff base derivatives (1–28) of 3,4-dihydroxyphenylacetic acid were synthesized in a multi-step reaction. All the synthesized Schiff bases were obtained in high yields and their structures were determined by 1HNMR, 13CNMR, and HR-ESI–MS spectroscopy. Except for compounds 22, 26, 27, and 28, all derivatives show excellent to moderate α-glucosidase inhibition. Compounds 5 (IC50 = 12.84 ± 0.52 µM), 4 (IC50 = 13.64 ± 0.58 µM), 12 (IC50 = 15.73 ± 0.71 µM), 13 (IC50 = 16.62 ± 0.47 µM), 15 (IC50 = 17.40 ± 0.74 µM), 3 (IC50 = 18.45 ± 1.21 µM), 7 (IC50 = 19.68 ± 0.82 µM), and 2 (IC50 = 20.35 ± 1.27 µM) shows outstanding inhibition as compared to standard acarbose (IC50 = 873.34 ± 1.67 µM). Furthermore, a docking study was performed to find out the interaction between the enzyme and the most active compounds. With this research work, 3,4-dihydroxyphenylacetic acid Schiff base derivatives have been introduced as a potential class of α-glucosidase inhibitors that have remained elusive till now.

Introduction The global pandemic was an emerging challenge that significantly impacted healthcare systems and the delivery of care. Prompt actions and adaptive techniques, such as the virtual clinic, were implemented to ensure the quality and continuity of the care provided. The aim of this quality improvement project was to ensure the smooth implementation and effectiveness of the virtual clinic during the COVID-19 crisis. Methods A specialized team of multidisciplinary healthcare providers was established to systematically ensure the implementation of the virtual clinic within the Department of Oncology. The team used multiple Plan-Do-Study-Act (PDSA) cycles of the quality improvement model to achieve the final goal and facilitate the transition to the virtual clinic. Results A total of 29 weekly virtual clinic sessions were conducted, covering various oncology services. From March to December 2020, 81% of the scheduled patients (3888) responded to virtual clinic calls. Physicians initiated 234 unplanned virtual clinic calls to follow up on a patient’s condition. In addition, 916 medications were shipped to patients as needed. A patient satisfaction survey in May 2020 indicated an overall satisfaction rate of 92% with the virtual clinic process. Staff satisfaction was also high (91%), and 88% of the physicians believed that the virtual clinic would continue beyond the pandemic. Conclusion Implementing the virtual clinic is achievable through following systematic steps and effectively addressing emerging challenges as required. The concept of the virtual clinic was well accepted by patients and staff.

BACKGROUND: Since its first outbreak, coronavirus disease 2019 (COVID-19) has led to a great deal of published literature highlighting the short-term determinants of morbidity and mortality. Recently, several studies have reported radiological and functional sequelae from 3 months to 1 year among hospitalized COVID-19 survivors; however, long-term (more than 1 year) respiratory consequences in this population remain to be evaluated. OBJECTIVE: To assess the long-term radiological and pulmonary function outcomes of patients with COVID-19 2 years after resolution of the initial infection. METHODS: Hospitalized COVID-19 patients with moderate to severe disease who survived acute illness were included in this prospective and partially retrospective study. Clinical assessment, laboratory tests, high-resolution computed tomography scans, and pulmonary function tests (PFTs) were performed at baseline, followed by radiological and lung function assessments at 6 and 24 months. RESULTS: Among 106 enrolled participants (mean age 62 ± 13.5 years; males: 61), 44 (41.5%) and 27 (25.4%) underwent radiological assessment at 6 and 24 months, respectively. Overall, 22.6% (24) of patients had residual radiological abnormalities. Overt fibrosis was observed in 12.2% of patients. Computed tomography disease severity and extent diminished significantly at 6 (13 ± 6, P < 0.001) and 24 months (11 ± 6, P < 0.001) from baseline. PFTs were performed in 65 (61.3%), 22 (20.7%), and 34 (32%) patients at baseline, 6 and 24 months, respectively. Impaired diffusion capacity (median diffusion capacity for carbon monoxide: 60%, interquartile range [IQR]: 51–80), restrictive lung defect (mean total lung capacity: 73.4% ± 18% predicted), and reduced exercise tolerance (median 6-min walk distance: 360 m, IQR: 210–400) were the predominant features at baseline. With the exception of exercise tolerance, a statistically significant improvement was observed in lung function parameters at the extended follow-up (2 years). CONCLUSIONS: Hospitalized COVID-19 survivors are at increased risk of developing long-term pulmonary complications, including lung fibrosis. A protocol-based approach to the management of post-COVID-19 patients is mandatory to improve future outcomes.

BACKGROUND: In 2006, the World Health Organization (WHO) introduced new growth standards based on data derived globally from optimally nourished breastfed infants. The aim of this study was to assess the effects of implementing WHO growth standards on the growth patterns of Jordanian infants. In addition, it was to ascertain the necessity of establishing country-specific growth standards and charts tailored to Jordanian infants. MATERIALS AND METHODS: The data of 102,846 infants (50.1% boys, 49.9% girls) aged 0–24 months, from 115 primary healthcare centers across the country were retrieved from a National E-health Program. Weight and length measurements were analyzed, and age- and sex-specific z-scores were calculated relative to the WHO growth standards. Data was analyzed using SPSS version 26. Mann–Whitney U test was performed to determine significant differences between the measurements for boys and girls in terms of age, length, and weight. RESULTS: Jordanian infants exhibited significantly shorter length-for-age measurements than WHO standards with mean z-scores of −0.56 and −0.38, for boys and girls, respectively. Weight-for-age measurements showed a good fit and were comparable to the WHO growth standards for boys (mean z score = −0.05) and girls (mean z score = 0.04). Notably, Jordanian infants displayed higher weight-for-length measurements, with mean z-scores of 0.51 for boys and 0.47 for girls. CONCLUSION: The availability of Jordanian-specific growth standards will improve the accuracy of assessing infant growth and enhance the monitoring and evaluation of their health and development.

Head and neck cancers are being diagnosed more frequently in elderly patients and at advanced stages. In these cases, standard treatment methods are often not feasible due to patient frailty and malnutrition. A few trials have demonstrated the safety and effectiveness of immune checkpoint inhibitors (ICIs) as neoadjuvant therapy for locally advanced oral cancer. We present the case of a 51-year-old male patient who had locally advanced oral cavity cancer that was treated with the combination of pembrolizumab and weekly carboplatin and paclitaxel. This treatment resulted in a major pathological response, leading to a significant reduction in tumor size and allowing for surgical treatment. In addition, the patient remains free of locoregional disease nine months after the surgery. Clinical trials are essential to investigate the viability of this potentially less toxic and more convenient combined therapy in patients with advanced squamous cell carcinoma of the oral cavity.

Excessive production of Transforming Growth Factor β (TGFβ) is commonly associated with dominant and recessive forms of OI. Previous reports have indicated that administration of TGFβ-targeted antibodies maybe of potential therapeutic benefit to OI patients. However, direct targeting of TGFβ is likely to cause multiple adverse effects including simulation of autoimmunity. In the current study we use patient-derived normal and OI fibroblasts, osteoblasts and OIM mouse models to determine the effects of Losartan, an angiotensin II receptor type 1 (AT1) antagonist, on TGFβ signalling and bone morphology in OI. In OIM mice bred on a mixed background administration of 0.6 g/L losartan for 4 weeks was associated with a significant reduction in TGFβ from 79.2 g/L in the control to 60.0 ng/ml following losartan (p

Background This study proposes a modification to the traditional Hunt and Hess (tHH) grading scale for prognostication in aneurysmal subarachnoid hemorrhage (aSAH), which differentiates the most severe‐grade patients based on the presence or absence of brainstem dysfunction [determined by Glasgow Coma Scale (GCS) scores 3‐5]. Methods Weighted aSAH hospitalizations were retrospectively identified in the National Inpatient Sample from 2015 to 2019 and were stratified by tHH and modified HH (mHH) grades. mHH grade 5 was defined as tHH grade 5 with GCS score 3–5, while mHH grade 4 comprised tHH grade 5 with GCS score 6–8 and tHH grade 4. HH grades 1–3 do not differ between the traditional and modified scales. Measures of diagnostic performance were compared for the primary study end point [poor outcome as determined by the previously validated NIS‐SAH Outcome Measure (NIS‐SOM), shown to have high concordance with modified Rankin Scale scores > 2]. External validation of the mHH was performed using data from a prospectively maintained aSAH registry. Results Among 6130 aSAH hospitalizations, 2245 (36%) were tHH grade 5. Seven hundred and eighty‐five (35%) of these had a GCS 3–5 and were designated as mHH grade 5. Poor outcomes were identified in 78% and 77% of grade 4 tHH and mHH, respectively, and in 83% and 95% of grade 5 tHH and mHH, respectively. In comparison with the tHH, the mHH achieved superior discrimination [c‐statistic 0.793 (95% CI 0.768, 0.818) versus 0.780 (95% CI 0.750, 0.807); DeLong p < 0.001] for poor outcome, as well as improved specificity (0.929 versus 0.304) and positive predictive value (PPV) (0.949 versus 0.827). External registry validation of the mHH demonstrated excellent discrimination [c‐statistic 0.835 (95% CI 0.801, 0.870)], with a specificity of 0.950 and PPV of 0.905. Conclusion The mHH achieved a favorable diagnostic performance profile using retrospective data and may aid in the prognostication of high‐severity patients with aSAH.

Drug addiction is considered a worldwide concern and one of the most prevailing causes of death globally. Opioids are highly addictive drugs, and one of the most common opioids that is frequently used clinically is fentanyl. The potential harmful effects of chronic exposure to opioids on the heart are still to be elucidated. Although β-lactam antibiotics are well recognized for their ability to fight bacteria, its protective effect in the brain and liver has been reported. In this study, we hypothesize that β-lactam antibiotic, ceftriaxone, and the novel synthetic non-antibiotic β-lactam, MC-100093, are cardioprotective against fentanyl induced-cardiac injury by upregulating xCT expression. Mice were exposed to repeated low dose (0.05 mg/kg, i.p.) of fentanyl for one week and then challenged on day 9 with higher dose of fentanyl (1 mg/kg, i.p.). This study investigated cardiac histopathology and target genes and proteins in serum and cardiac tissues in mice exposed to fentanyl overdose and β-lactams. We revealed that fentanyl treatment induced cardiac damage as evidenced by elevated cardiac enzymes (troponin I). Furthermore, fentanyl treatment caused large aggregations of inflammatory cells and elevation in the areas and volumes of myocardial fibers, indicating hypertrophy and severe cardiac damage. Ceftriaxone and MC-100093 treatment, However, induced cardioprotective effects as evidenced by marked reduction in cardiac enzymes (troponin I) and changes in histopathology. Furthermore, ceftriaxone and MC-100093 treatment decreased the levels of hypertrophic genes (α-MHC & β-MHC), apoptotic (caspase-3), and inflammatory markers (IL-6 & NF-κB). This study reports for the first time the cardioprotective effect of β-lactams against fentanyl-induced cardiac injury. Further studies are greatly encouraged to completely identify the cardioprotective properties of ceftriaxone and MC-100093.

Background: Dental implants are now the typical tooth replacement method. Because it speeds up therapy, quick functional loading—attaching prosthetic restorations to implants following surgery—has become popular. Flapless implant implantation reduces surgical stress and expedites recovery. Methods: A prospective comparative study of 100 flap and flapless dental implant patients was done. Patient-reported outcomes, implant survival, peri-implant parameters, and surgical complications were assessed. Statistical analysis compared the two groups’ results. Results: Both flap and flapless methods exhibited good implant survival and similar peri-implant characteristics. Patients reported equal postoperative comfort and satisfaction in both groups. Surgical complications were similar for flap and flapless surgeries. Conclusion: In immediate functional loading, flap and flapless implant insertion are equally effective and safe. Both methods yield dependable implant survival, peri-implant health, patient comfort, and surgical safety. Dental professionals should evaluate patient variables and anatomical aspects while choosing an implant implantation surgery. Implant dentistry needs further study on long-term results and treatment regimens.

Objective: The objective of this research was to compare the longstanding stability of single-piece implant systems to typical two-piece systems by analyzing patient records retrospectively. Methods: A retrospective examination of patient records from January 2010 to December 2020 was undertaken at the Department of Oral Implantology, University Hospital. The research included dental rehabilitation patients who got single- or two-piece implant systems. Patient demographics, implant features, surgical procedures, and follow-up results were extracted. Implant success rates, stability defined by resonance frequency analysis (RFA) utilizing Osstell ISQ®, and peri-implant bone loss evaluated by standardized periapical radiographs at baseline and follow-up visits were the main outcomes. Results: The research involved 320 patients (160 per cohort). The average patient age was 52.7 years, with 55% men. The mandibular region received 65% of implants, and the maxillary region the rest. Single-piece cohort A had 94.6% implant success, and two-piece cohort B 96.2%. Implant success rates were similar between cohorts (P = 0.412). The mean ISQ scores were 72.4 ± 4.8 in cohort A and 74.8 ± 5.1 in cohort B (P = 0.086). Peri-implant bone loss was 1.8 ± 0.7 mm in cohort A and 1.4 ± 0.6 mm in cohort B (P = 0.031). Conclusion: Single-piece implant systems provide a stable and successful alternative to classic two-piece systems. However, patient selection, surgical technique, and monitoring are essential to reduce peri-implant problems and improve clinical results. To improve implant dentistry patient care and evidence-based clinical practice, single-piece and two-piece implant systems’ design, biomechanical features, and longstanding performance should be studied.

Purpose: The purpose of this study was to compare the efficacy of various suturing methods used in deep third molar extraction procedures. Methods: A total of four suturing method groups—simple interrupted, horizontal mattress, vertical mattress, and figure-of-eight—were randomly allocated to 100 patients having deep third molar surgery. Assessments were conducted on wound healing, operation time, intraoperative problems, postoperative pain scores, swelling measures, and patient satisfaction questionnaires. Appropriate tests were used for statistical analysis, with P < 0.05 being regarded as significant. Results: Compared to other procedures, the figure-of-eight technique showed better results in terms of postoperative pain scores, swelling measures, wound healing percentages, and patient satisfaction (P < 0.05). There was no discernible difference in the operating time or intraoperative problems between the groups. Conclusion: In conclusion, there seems to be a benefit to using the figure-of-eight suturing approach for deep third molar surgery in terms of improved postoperative results and patient satisfaction. It is recommended that clinicians give this strategy some thought to improve patient care and surgical results.

Objective: Comparing fixation procedures for managing naso-orbito-ethmoidal (NOE) fractures. Methods: Group A (plate and screw fixation), Group B (Kirschner wire (K-wire) fixation), Group C (absorbable plate and screw fixation), and Group D (No fixation) were formed from 120 NOE fracture patients. The facial injury severity scale, visual analogue scale, CT scans, and clinical examination examined functional and cosmetic outcomes, complications, and postoperative stability. Results: The study found that plate and screw fixation (Group A) had the highest stability and aesthetic results, followed by absorbable plate and screw fixation (Group C). Conservative management (Group D) had the worst outcomes, while K-wire fixation (Group B) had good results but more complications. Results showed substantial differences in functional, aesthetic, complications, and postoperative stability between groups (P < 0.05). Conclusion: Plate and screw fixation is the most successful and dependable approach for treating NOE fractures, with superior functional and aesthetic outcomes, reduced complications, and higher postoperative stability than K-wire fixation, absorbable plate and screw fixation, and conservative care. Absorbable plate and screw fixation may function instead of metal. Conservative care should be rare. Larger multicenter randomized controlled trials should corroborate these findings.

High-fat diets (HFDs) shape the gut microbiome and promote obesity, inflammation, and liver steatosis. Fish and soybean are part of a healthy diet; however, the impact of these fats, in the absence of sucrose, on gut microbial dysbiosis and its association with liver steatosis remains unclear. Here, we investigated the effect of sucrose-free soybean oil-and fish oil-based high fat diets (HFDs) (SF-Soy-HFD and SF-Fish-HFD, respectively) on gut dysbiosis, obesity, steatosis, hepatic inflammation, and insulin resistance. C57BL/6 mice were fed these HFDs for 24 weeks. Both diets had comparable effects on liver and total body weights. But 16S-rRNA sequencing of the gut content revealed induction of gut dysbiosis at different taxonomic levels. The microbial communities were clearly separated, showing differential dysbiosis between the two HFDs. Compared with the SF-Fish-HFD control group, the SF-Soy-HFD group had an increased abundance of Bacteroidetes, Firmicutes, and Deferribacteres, but a lower abundance of Verrucomicrobia. The Clostridia/Bacteroidia (C/B) ratio was higher in the SF-Soy-HFD group (3.11) than in the SF-Fish-HFD group (2.5). Conversely, the Verrucomicrobiacae/S24_7 (also known as Muribaculaceae family) ratio was lower in the SF-Soy-HFD group (0.02) than that in the SF-Fish-HFD group (0.75). The SF-Soy-HFD group had a positive association with S24_7, Clostridiales, Allobaculum, Coriobacteriaceae, Adlercreutzia, Christensenellaceae, Lactococcus, and Oscillospira, but was related to a lower abundance of Akkermansia, which maintains gut barrier integrity. The gut microbiota in the SF-Soy-HFD group had predicted associations with host genes related to fatty liver and inflammatory pathways. Mice fed the SF-Soy-HFD developed liver steatosis and showed increased transcript levels of genes associated with de novo lipogenesis (Acaca, Fasn, Scd1, Elovl6) and cholesterol synthesis (Hmgcr) pathways compared to those in the SF-Fish-HFD-group. No differences were observed in the expression of fat uptake genes (Cd36 and Fabp1). The expression of the fat efflux gene (Mttp) was reduced in the SF-Soy-HFD group. Moreover, hepatic inflammation markers (Tnfa and Il1b) were notably expressed in SF-Soy-HFD-fed mice. In conclusion, SF-Soy-HFD feeding induced gut dysbiosis in mice, leading to steatosis, hepatic inflammation, and impaired glucose homeostasis.

This study aimed at investigating the parents’ level of participation in the Individualized Educational Plan (IEP) of their children with intellectual disabilities in the Kingdom of Saudi Arabia. This study employed the qualitative descriptive approach, which helps the researcher to reach the study problem and its merits, as the semi-structured interview method was adopted. In this regard, an initial survey questionnaire, in which more than (33) parents whose children receive special education services and programs in the Kingdom of Saudi Arabia participated, was designed. The purpose of the survey questionnaire was to identify the target sample for the interviews, based on the participants' answers and their personal desire to conduct the interview or not. The study included (4) interviews with parents of students with intellectual disabilities. After analyzing the qualitative data, the results revealed several themes and topics that relate to parents and the IEP. For example, the results indicate that all the participants have good knowledge about the basic concepts of the IEP and in a way that makes them able to understand its objectives and basic contents. Regarding communication, the results showed that the participants expressed a noticeable concern about the limited communication with the school.