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Abstract Uremic Encephalopathy results from the elevation of toxins and blood-brain barrier (BBB) disruption. Renal Ischemia/Reperfusion (I/R) injury is the principal cause of acute kidney injury and brain tissue injury. The present study was crafted to estimate the restorative impact of platelet-rich plasma (PRP) and exosome injection before the reperfusion phase on the kidney following renal I/R injury and its influence on brain tissue by tracking the histopathological, biochemical, and Doppler ultrasonography alternations in both kidney and brain tissue. Forty mature male rats were divided into five groups as follows: control, I/R, PRP, exosome, and Exosome + PRP. Renal Doppler ultrasonography was traced for all rats. Serum kidney functions and acetylcholine esterase enzyme (AchE) were evaluated. Both Gamma-aminobutyric acid (GABA) and glutamate were assessed in brain tissues. The oxidative stress (malondialdehyde), anti-oxidative (glutathione and catalase), and pro-inflammatory (Tumor necrosis factor- α and interleukin-6) markers were estimated in renal tissues. Additionally, morphometric histological examination was performed in both renal and brain tissues. Both PRP and exosome-received rats exhibited a significant improvement in both serum kidney functions and AchE compared to I/R rats. There was a 3.39-fold increase in GABA and a 2.27-fold decrease in glutamate levels in the brain tissue of PRP rats compared to the I/R rats. A significant elevation (P ≤ 0.0001) of glutathione and catalase besides a significant reduction in the expression of TNF-α and IL-6 was observed in renal tissue compared to I/R rats. A significant severe reduction (P

Abstract Background Klebsiella pneumoniae is a significant global public health burden, especially in low-income countries and regions with fragile healthcare infrastructures, due to its ability to cause severe infections, increase mortality rates, and its rising antimicrobial resistance. This study aimed to estimate the proportion of multidrug-resistant (MDR) K. pneumoniae infections and identify associated risk factors. Methods Data were retrospectively collected from three academic hospitals in Beirut, Lebanon, between January 2021 and September 2023 using a standardized form. Binary logistic regression was used to determine risk factors associated with MDR, extended-spectrum beta-lactamase (ESBL)-producing, and carbapenem-resistant K. pneumoniae (CRKP) infections. Results Out of 2,655 K. pneumoniae cases, 410 met the inclusion criteria. The primary infection sources were the urinary tract (58.3%) and the respiratory tract (12.4%). Among the isolates, 61% were MDR K. pneumoniae, with 7.3% being extensively drug-resistant, and 0.5% pandrug-resistant. Additionally, 36.8% were ESBL-producing, while 6.3% were CRKP. Predictors significantly associated with MDR K. pneumoniae infections included male sex (adjusted odds ratio [AOR] = 3.46, 95% CI = 1.01–11.86, P = 0.04), recent antibiotics use (AOR = 4.52, 95% CI = 1.65–12.36, P = 0.003), and recent cancer chemotherapy (AOR = 3.43, 95% CI = 1.25–9.42, P = 0.01). ESBL-producing infections were associated with age ≥ 65 years, higher Charlson Comorbidity Index (CCI), and recent antibiotic use. CRKP infections were linked to male sex, prior antibiotic use, and longer hospital stays prior to infection (all P

The study was conducted on 60 Holstein dairy cows during 50 and 60 days postpartum in different rural areas in Al-Anbar Province, Iraq. This study evaluated the effects of two ovulation synchronization protocols on postpartum fertility performance compared to the conventional Ovsynch protocol. All cows were treated with GnRH (10.5 µg) and PGF2α (0.150 mg) through three different synchronization protocols: (1) Ovsynch protocol (n=20) as the control treatment [GnRH-7d-PGF2α-48h-GnRH]; (2) GPPG protocol (n=20) as (1), but with an extra dose of PGF2α-24h after the first one. (3) PG+G protocol (n=20) as (2), but with presynchronization treatment using PGF2α and GnRH simultaneously, seven days before the GPPG protocol. All cows were subjected to timed artificial insemination (TAI) 16-24 hours after the final GnRH injection. Ultrasound confirmed the pregnancy at 30-35 d post-TAI. There was no significant difference between the groups (P>0.05) regarding calving interval and open days. Overall, first-service conception rate (FSCR) tends to be significant (45%, P=0.07). Separately, FSCR for groups 1, 2, and 3 were 30, 40, and 65%, respectively. The difference between groups 1 and 3 was significant (P=0.02); however, group 2 did not differ from groups 1 (P=0.50) and group 3 (P=0.11). In conclusion, implementing TAI protocols during the 50-60-day postpartum period lowers the calving interval to standard limits. Furthermore, the PG+G presynchronization protocol significantly enhances FSCR compared to the traditional Ovsynch during the postpartum period.

Abstract Water quality in land-based fish production can be controlled through either instantaneous water exchange or costly wastewater treatment followed by recirculation. Agricultural-aquaculture integration is an excellent alternative technique for reducing nutrient discharge levels, boosting profitability, and converting fish culture wastewater into valuable products. The current study employed a solar energy system to power two separate IMTA-aquaponics systems (Nutrient Film Technique, NFT, and Floating Raft Systems, FRS) for the cultivation of Nile tilapia, African catfish, thin-lipped grey mullet, freshwater crayfish, freshwater mussels, and a variety of vegetables. Tilapia and catfish were fed exclusively on diets under the IMTA system. All wastewater from tilapia and catfish ponds, both dissolved and solid, flows sequentially to ponds containing other cultivated species. The water then flows through the IMTA system's terminal point to the NFT and FRS systems before returning to the tilapia and catfish ponds, allowing complete control of the nutrient flow throughout this entire circular system. Two 147-day production cycles were concluded. The results from the second production cycle are reported. Total biomass gain for aquatic species in the IMTA system was 736.46 kg, compared to 145.49 kg in the tilapia and 271.01 kg in the catfish monoculture systems. The current IMTA system had a cumulative feed conversion ratio (FCR) of 0.90, while the FCRs for tilapia and catfish were 1.28 and 1.42, respectively. Nile tilapia and catfish consumed 571.90 kg of feed containing 25.70 kg of nitrogen (N) and 9.70 kg of phosphorus (P), reflecting, and gaining 11.41 and 3.93 kg of dietary N and P, representing 44.40 and 40.46% dietary N and P retention, respectively. In the IMTA system, the addition of mullet and prawn as detrivores aquatic animals improves dietary N and P utilization efficiency to 59.06 and 51.19%, respectively, while the addition of mussels as herbivore animals improves dietary N and P utilization efficiency to 65.61 and 54.67%, respectively. Finally, using FRS and NFT as hydroponic systems increased dietary N and P efficiency to 83.51% N and 96.82% P, respectively. This study shows that the IMTA-Aquaponic system, as a bio-integrated food production system, can convert the majority of fish-fed residues into valuable products suitable for desert, rural, and urban areas in impoverished and developing countries.

IntroductionThe new ICD-11 code for chronic pain indicates a direction to divide chronic pain into two categories: chronic secondary pain, which has a clear underlying disease, and chronic primary pain, which is associated with significant emotional distress or functional disability and cannot be explained by another chronic condition. Until now, epidemiological studies have been hampered by the lack of a clear classification, but we believe that this new code system will provide a new perspective on the diagnosis and treatment of chronic pain, and we have begun work on this code system.MethodsWe studied 2,360 patients at Aichi Medical University, the largest pain center in Japan, and asked them to answer questionnaires on pain severity (NRS), pain-related functional impairment (PDAS, Locomo25), quality of life (EQ-5D), and psychological state and pain cognition (HADS, PCS, PSEQ, AIS) while their attending physicians were giving diagnoses according to ICD-11 and the results of the study were used to determine the coding of pain severity.Results and discussionThe ratio of primary to chronic secondary pain was almost 50%, and the group of patients with MG30.01 classification, which included fibromyalgia, had the highest severity among chronic primary pain. The MG30.01 classification of patients was also found to experience more severe pain compared to other classifications of chronic primary pain patients. The classification of patients with a major psychiatric component was not always clear, and some patients in the secondary category also had a clear psychiatric component, suggesting the need to develop complementary tools to support pain diagnosis.

Abstract Introduction Neodymium-iron-boron magnets have been suggested as a contemporary method for accelerating the process of orthodontic tooth movement (OTM). A limited number of clinical trials evaluated their effectiveness in accelerating OTM which is desirable for both orthodontists and patients. The present study aimed to investigate the effectiveness of a low-intensity static magnetic field (SMF) in accelerating upper canine retraction movement. Materials and methods Seventeen patients (mean age 20.76 ± 2.9 years) with their orthodontic treatment decision to extract the upper and lower first premolars due to bimaxillary protrusion malocclusion were included in this split-mouth study. Canine retraction was performed using Nickel-titanium (Ni-Ti) closed-coil springs (150 g of force on each side). The experimental side received SMF via an auxiliary wire that carried 4-neodymium iron-born magnets with an air gap of 2 mm between the magnets to produce a magnetic field density of 414 mT in the region corresponding to the lateral ligament of the upper canine. To determine the rate of upper canine retraction and upper molar drift, alginate impressions were taken once a month to create plaster casts, which were analyzed digitally via a three-dimensional method. Results The rate of upper canine retraction was significantly greater (P 0.05). Conclusion A low-intensity static magnetic field was effective at accelerating upper canine retraction. The difference between the two sides was statistically significant but may not be clinically significant. The SMF did not affect upper molar drift during the upper canine retraction phase. Trial registration The trial was retrospectively registered at the ISRCTN registry ( ISRCTN59092624 ) (31/05/2022).

Artificial intelligence (AI) is increasingly prevalent in biomedical and industrial development, capturing the interest of dental professionals and patients. Its potential to improve the accuracy and speed of dental procedures is set to revolutionize dental care. The use of AI in computer-aided design/computer-aided manufacturing (CAD/CAM) within the restorative dental and material science fields offers numerous benefits, providing a new dimension to these practices. This study aims to provide a concise overview of the implementation of AI-powered technologies in CAD/CAM restorative dental procedures and materials. A comprehensive literature search was conducted using keywords from 2000 to 2023 to obtain pertinent information. This method was implemented to guarantee a thorough investigation of the subject matter. Keywords included; “Artificial Intelligence”, “Machine Learning”, “Neural Networks”, “Virtual Reality”, “Digital Dentistry”, “CAD/CAM”, and “Restorative Dentistry”. Artificial intelligence in digital restorative dentistry has proven to be highly beneficial in various dental CAD/CAM applications. It helps in automating and incorporating esthetic factors, occlusal schemes, and previous practitioners’ CAD choices in fabricating dental restorations. AI can also predict the debonding risk of CAD/CAM restorations and the compositional effects on the mechanical properties of its materials. Continuous enhancements are being made to overcome its limitations and open new possibilities for future developments in this field.

Abstract Background Although epilepsy has been acknowledged as an illness since ancient time, the public attitude toward epilepsy has not changed drastically due to the lack of appropriate information. This study aims to determine the public perceptions of epilepsy in five main regions of Saudi Arabia. Methods In this cross-sectional questionnaire-based study, Saudi citizens living in the major cities of the five main regions of the Kingdom of Saudi Arabia (the central, eastern, western, northern, and southern regions) completed the survey that included 27 questions about epilepsy awareness. Results A total of 7118 individuals from five regions participated in the survey: 6749 (94.8%) of respondents were Saudi, and 369 (5.2%) were non-Saudi. Of the 7118 respondents, 6897 respondents (96.9%) did not have epilepsy, and 3378 respondents (47.5%) stated that they had never witnessed an epileptic episode. In addition, 3749 (52.7%) respondents incorrectly attributed epilepsy to non-neurologic conditions, and 4865 (68.3%) respondents had an overall negative attitude toward people with epilepsy (PWE). They expressed objections to their child associating with PWE (2002; 28.1%) or their close relatives marrying PWE (3192; 44.8%), some believed that PWE are inferior (402; 5.6%), refused to hire a PWE (1126; 15.8%), and would feel discomfort around PWE (724; 10.3%). In addition, 2025 individuals (28.4%) believed that the health of PWE deteriorates over time; 1485 individuals (20.9%) believed that PWE get sick more often than others; 181 individuals (2.5%) believed that epilepsy could be transmitted; and 568 individuals (8.0%) believed that epilepsy could progress to malignant disease. Conclusions In Saudi Arabia, there is a substantial need for increasing the awareness and improving education on epilepsy in order to reduce stigma and increase the understanding of epilepsy. Such efforts could help improve the lives of people afflicted with the disease and ultimately contribute to better health outcomes for the entire community.

Background: The COVID-19 pandemic has been linked to dyslipidemia in patients. Objective: To investigate the alterations in serum low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, very low-density lipoprotein (VLDL), total cholesterol (TC), and triglycerides (TG) levels in individuals with COVID-19 infection. Cases and Methods: This study was conducted at Jabra Hospital, Khartoum state, Sudan, from February to September 2021. It was an analytical, controlled hospital-based study that involved a total of 136 subjects. Of these, 68 were Sudanese patients who had contracted COVID-19, while the other 68 were healthy individuals who served as the control group. Data was collected through a questionnaire, and the serum lipid profile was estimated using spectrophotometric methods through an enzymatic process. The data was analyzed using SPSS (V25). Results: The study found that patients with COVID-19 had significantly lower levels of serum LDL, VLDL, TC, and TG compared to the control group. The p-values for these differences were 0.001, 0.002, 0.000, and 0.001, respectively. There was no significant difference in serum HDL and BMI between the two groups. In the case group, serum lipid profiles (excluding HDL) were significantly higher in overweight individuals compared to those with normal weight. The p-values for these differences were 0.001, 0.002, 0.001, 0.001, and 0.001, respectively. However, there was no significant difference in serum HDL levels between the two weight groups. Interestingly, the serum lipid profile was significantly higher in overweight controls compared to the cases. The p-values for these differences were 0.001, 0.041, 0.024, 0.001, and 0.001, respectively. Lastly, the study found that the serum lipid profile was significantly lower among severe COVID-19 patients compared to the control group with a p-value of ≤0.001. In particular, serum LDL and TC were significantly lower in patients than controls, with p-values of ≤0.001 and 0.003, respectively. On the other hand, serum TG was significantly higher in cases than controls with a p-value of ≤ 0.001. Serum VLDL and HDL levels were not significantly different between the two groups. Conclusion: Research has suggested that individuals who have contracted COVID-19 have shown a decrese in lipid profile values compared to those who have not been affected by the virus.

Abstract Background Acinetobacter baumannii is a major nosocomial pathogen capable of causing life-threatening infections. This bacterium is highly resistant to antibiotics and associated with high mortality rates. Therefore, this study aimed to evaluate A. baumannii's susceptibility patterns to antimicrobials, assess the appropriateness of the initiated antimicrobial therapy, determine the mortality rate, and identify predictors associated with mortality. Methods A retrospective observational study was conducted among patients infected with A. baumannii at a university hospital in Lebanon through the revision of medical records. Kaplan–Meier survival analysis and log-rank tests were used to analyze time-to-mortality. Binary logistic regression was performed to identify predictors of mortality. Results The records of 188 patients were screened, and 111 patients with A. baumannii infection were enrolled. Almost all isolates were resistant to carbapenem, and 43% of the isolates were extensively-drug resistant. Almost half of the patients received initial inappropriate antimicrobial therapy (n = 50, 45.1%). The 30-day mortality rate associated with A. baumannii infection was 71.2% (79/111). The time to mortality in patients who received inappropriate antimicrobial therapy (5.70 ± 1.07 days) was significantly shorter than in those who received appropriate antimicrobial therapy (12.43 ± 1.01 days, P

Abstract Background Excessive use of mobile phones leading to development of symptoms suggestive of dependence syndrome with teenagers are far more likely to become dependent on mobile phones as compared to adults. COVID-19 pandemic has had an impact on the mental health of several groups in society, especially university students. This study aimed to explore the prevalence of mobile phone dependence among university students and its associated factors. Methods Between September 2021 and January 2022, a cross-sectional study was conducted at universities in Jordan, Lebanon, Egypt, Bahrain, and Saudi Arabia utilizing an online and paper-based self-administered questionnaire. We employed a previously developed questionnaire by Aggarwal et al. Results A total of 5,720 university students were involved in this study (Egypt = 2813, Saudi Arabia = 1509, Jordan = 766, Lebanon = 432, and Bahrain = 200). The mean estimated daily time spent on using mobile phone was 186.4 (94.4) minutes. The highest mobile dependence score was observed for the university students from Egypt and the lowest mobile dependence score was observed for the university students from Lebanon. The most common dependence criteria across the study sample was impaired control (55.6%) and the least common one was harmful use (25.1%). Females and those reported having anxiety problem or using a treatment for anxiety were at higher risk of developing mobile phone dependence by 15% and 75%, respectively. Conclusion Mobile phone dependence is common among university students in Arab countries in the Middle East region. Future studies exploring useful interventions to decrease mobile phone dependence are warranted.

Abstract Intermediate filaments (IFs) are essential constituents of the metazoan cytoskeleton. A vast family of cytoplasmic IF proteins are capable of self-assembly from soluble tetrameric species into typical 10–12 nm wide filaments. The primary structure of these proteins includes the signature central ‘rod’ domain of ~ 300 residues which forms a dimeric α-helical coiled coil composed of three segments (coil1A, coil1B and coil2) interconnected by non-helical, flexible linkers (L1 and L12). The rod is flanked by flexible terminal head and tail domains. At present, the molecular architecture of mature IFs is only poorly known, limiting our capacity to rationalize the effect of numerous disease-related mutations found in IF proteins. Here we addressed the molecular structure of soluble vimentin tetramers which are formed by two antiparallel, staggered dimers with coil1B domains aligned (A11 tetramers). By examining a series of progressive truncations, we show that the presence of the coil1A domain is essential for the tetramer formation. In addition, we employed a novel chemical cross-linking pipeline including isotope labelling to identify intra- and interdimeric cross-links within the tetramer. We conclude that the tetramer is synergistically stabilized by the interactions of the aligned coil1B domains, the interactions between coil1A and the N-terminal portion of coil2, and the electrostatic attraction between the oppositely charged head and rod domains. Our cross-linking data indicate that, starting with a straight A11 tetramer, flexibility of linkers L1 and L12 enables ‘backfolding’ of both the coil1A and coil2 domains onto the tetrameric core formed by the coil1B domains. Through additional small-angle X-ray scattering experiments we show that the elongated A11 tetramers dominate in low ionic strength solutions, while there is also a significant structural flexibility especially in the terminal domains.

Objective: To test the hypothesis that the Monoclonal Antibody Screening Score performs consistently better in identifying the need for monoclonal antibody infusion throughout each “wave” of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant predominance during the coronavirus disease 2019 (COVID-19) pandemic and that the infusion of contemporary monoclonal antibody treatments is associated with a lower risk of hospitalization. Patients and Methods: In this retrospective cohort study, we evaluated the efficacy of monoclonal antibody treatment compared with that of no monoclonal antibody treatment in symptomatic adults who tested positive for SARS-CoV-2 regardless of their risk factors for disease progression or vaccination status during different periods of SARS-CoV-2 variant predominance. The primary outcome was hospitalization within 28 days after COVID-19 diagnosis. The study was conducted on patients with a diagnosis of COVID-19 from November 19, 2020, through May 12, 2022. Results: Of the included 118,936 eligible patients, hospitalization within 28 days of COVID-19 diagnosis occurred in 2.52% (456/18,090) of patients who received monoclonal antibody treatment and 6.98% (7,037/100,846) of patients who did not. Treatment with monoclonal antibody therapies was associated with a lower risk of hospitalization when using stratified data analytics, propensity scoring, and regression and machine learning models with and without adjustments for putative confounding variables, such as advanced age and coexisting medical conditions (eg, relative risk, 0.15; 95% CI, 0.14-0.17). Conclusion: Among patients with mild to moderate COVID-19, including those who have been vaccinated, monoclonal antibody treatment was associated with a lower risk of hospital admission during each wave of the COVID-19 pandemic.

The exploration of natural alternatives to antibiotics for enhancing productivity and performance in dairy cows is a crucial objective in farm animal management. This is the first study aimed at developing and evaluating the physicochemical properties and effects of Arabic gum–nano montmorillonite (AGNM) compost compared to ionophore monensin as feed additives on rumen fermentation, blood metabolites, and milk production of Holstein dairy cows. In a replicated 4 × 4 Latin square design, four multiparous mid-lactation Holstein dairy cows with an average body weight of 520 ± 15 kg were enrolled. The dietary treatments included a control diet (basal diet without feed additives), monensin diet [a basal diet supplemented with 35 mg/kg dry matter (DM) monensin], and AGNM diets comprising basal diet supplemented with two levels: low (L-AGNM) at 1.5 g/kg DM, and high (H-AGNM) at 3 g/kg DM. AGNM as a feed additive demonstrated promising physiochemical parameters, including containing highly bioactive components (α-amyrin and lupeol), functional groups (OH and Si-O), and essential mineral contents (Mg2+). Supplementations with H-AGNM significantly improved ruminal (p = 0.031) concentrations of total volatile fatty acids (VFAs), acetic (p = 0.05) and butyric (p = 0.05), enhanced (p < 0.05) digestibility of fiber and organic matter, while decreased (p = 0.013) estimated methane production. However, an increase (p = 0.04) in blood high-density lipoprotein levels and decrease (p < 0.05) in concentrations of creatinine (CREA), bilirubin (BILT), cholesterol (CHOL), and sodium (Na) were observed with H-AGNM supplementation. Both monensin and H-AGNM improved (p = 0.008) feed efficiency compared to L-AGNM; however, neither AGNM nor monensin affected the milk composition or energy status indicators of the dairy cows. The findings of this study highlight the potential of AGNM as a natural candidate to replace monensin in enhancing ruminal VFA production, nutrient digestibility, feed efficiency, blood metabolites, and milk yield in dairy cows.

Silver nanoparticles (Ag NPs) interact with both the surface and structural proteins of viral or bacterial cells, leading to destruction of the pathogenic cells or disruption of their metabolic processes. One of the benefits of using Ag NPs as sterilants is their inability to be adapted to by pathogenic cells, unlike traditional sterilization methods. While silver is generally non-toxic to human health, prolonged exposure can result in a condition known as argyria, characterized by blue discolouration of the skin. The proposed device utilizes Ag NPs for external sterilization of individuals entering a room measuring approximately (1 × 1 × 2) meters, through the release of a batch of steam. Ultrasonic vaporizers utilize a piezoelectric transducer to convert electrical energy into mechanical vibrations, which agitate the water stored within the device. This results in the production of water vapour infused with silver nanoparticles (Ag NPs) that are dissolved in the water. The silver nanoparticles possess antimicrobial properties, allowing the vapour to effectively sterilize the user by eliminating infectious agents present on the skin, hair, or clothing. The use of ultrasonic vaporizers in crowded areas can help to reduce the spread of infectious diseases, such as SARS-CoV-2 and influenza. Additionally, ultrasonic vaporizers are easy to operate and do not require specialized expertise, making them a suitable option for use outside of healthcare facilities.

Purpose: When treating esophageal cancer with radiation therapy, it is critical to limit the dose to surrounding structures, such as the lung and/or heart, as much as possible. Proton radiation therapy allows a reduced radiation dose to both the heart and lungs, potentially reducing the risk of cardiopulmonary toxicity. Here, we report disease control, survival, and toxicity outcomes among patients with esophageal cancer treated with proton radiation therapy and concurrent chemotherapy (chemoradiation therapy; CRT) with or without surgery. Materials and Methods: We enrolled 17 patients with thoracic esophageal carcinoma on a prospective registry between 2010 and 2021. Patients received proton therapy to a median dose of 50.4-GyRBE (range, 50.4–64.8) in 1.8-Gy fractions.Acute and late toxicities were graded per the Common Terminology Criteria for Adverse Events, version 4.0 (US National Cancer Institute, Bethesda, Maryland). In addition, disease control, patterns of failure, and survival outcomes were collected. Results: Nine patients received preoperative CRT, and 8 received definitive CRT. Overall, 88% of patients had adenocarcinoma, and 12% had squamous cell carcinoma. With a median follow-up of 2.1 years (range, 0.5–9.4), the 3-year local progression-free, disease-free, and overall survival rates were 85%, 66%, and 55%, respectively. Two patients (1 with adenocarcinoma and 1 with squamous cell carcinoma) recurred at the primary site after refusing surgery after a complete clinical response to CRT. The most common acute nonhematologic and hematologic toxicities, respectively, were grades 1 to 3 esophagitis and grades 1 to 4 leukopenia, both affecting 82% of patients. No acute cardiopulmonary toxicities were observed in the absence of surgical resection. Reagarding surgical complications, 3 postoperative cardiopulmonary complications occurred as follows: 1 grade 1 pleural effusion, 1 grade 3 pleural effusion, and 1 grade 2 anastomotic leak. Two severe late CRT toxicities occurred: 1 grade 5 tracheoesophageal fistula and 1 grade 3 esophageal stenosis requiring a feeding tube. Conclusion: Proton radiation therapy is a safe, effective treatment for esophageal cancer with increasing evidence supporting its role in reducing cardiopulmonary toxicity.

Background: The rapid global development of the pharmacy profession has led pharmacists to enter the cosmetic industry by administering injectable dermal fillers (DFs) to those in need. However, there is no clear indication that the Lebanese pharmacists are familiar with these procedures or are willing to do so. Objectives: We aimed to investigate the Lebanese community pharmacists' knowledge about DFs and their willingness to administer them. Methods: A self-administered questionnaire was sent to 461 randomly selected pharmacists who agreed to participate in the study after a phone call. A scoring system for the knowledge about DFs was employed. Results: Only 31.4 % of participants reported formal education as the source of knowledge about DFs, and 3.7 % of them reported practicing them on patients. The mean score of knowledge was 5.9 ± 2.5 (out of 14). High level of knowledge was observed in only 25 % of the participants, where females, older and experienced pharmacists, and those working in Beirut region were more significantly knowledgeable. Around 67 % of participants were willing to be trained in this field to expand their field of practice and improve their income. Conclusions: Lebanese community pharmacists are not yet ready for this new dimension in the career. Legislative procedures, training, licensing, and developed pharmacy curriculum must precede the practice of DFs by pharmacists in Lebanon.

The ndhA gene of NAD(P)H dehydrogenase in chloroplast DNA is vital for the electron transport chain and needs to be studied, especially in the context of RNA editing and its effects. Wild barley (Hordeum vulgare subsp. spontaneum) plants were studied in 4 groups, with exposure to 500 mM NaCl for 0 h – control (accession no. OM262848), and three treatment groups: 2 h (accession no. OM262849), 12 h (accession no. OM262850) and 24 h (accession no. OM262851) and their RNA was sent for RNA-seq sequencing. The sequences were submitted to NCBI SRA archives and analyzed together after filtering for high quality. This was done to show the RNA editing position and percentages at 10 sites across the ndhA gene. The RNA edits were validated using quantitative-PCR and homology models for the ndhA protein after exposure to salt stress were also generated. The four treatments showed five C to U changes (C50, C303, C563, C1042, C1047), three U to C changes (U550, U592, U1066), and two G to A changes (G111, G1046). We investigated the extent and effect of RNA editing in ndhA transcripts from chloroplasts of barley. We observed high RNA editing percentages after the second hour of salt stress.We have also observed for the first time about ‘U to C’ RNA edits in ndhA gene of wild barley.

Background: One of the main risk factors for cardiovascular illnesses and a widespread health issue, is hypertension which can result in improper calcium metabolism. Vitamin D may lessen the prevalence of hypertension as it has been suggested that rickets and osteomalacia are frequently brought on by vitamin D insufficiency. Objective: the present study aims to assess bone minerals density in hypertensive patients with vitamin D deficiency. Materials and Methods: this is a cross-sectional study conducted in April through June of 2019. Eighty-eight hypertension patients were included in the study, 46 men and 42 women, and they were divided into two groups depending on their vitamin D results: normal, >20 ng/ml, and case, 20 ng/ml. The data were analyzed by using SPSS version20. Serum vitamin D level was determined by using an ELISA competitive assay, serum ALP and Mg level was determined by using spectrophotometric methods, and serum Ca and Ph level was determined by using dye colorimetric methods. Results: Females, overweight subjects and more than 5 years patients showed a decrease in vitamin D level, with P-values (0.000, 0.003 and 0.041) respectively. The mean serum level of ALP and Mg were significantly increased in overweight group (P-values 0.048 and 0.041). The mean serum levels of ALP, Ca, Ph and Mg showed insignificant differences in the study group classified based on gender P-values (0.844, 0.546, 0.173 and 0.716) respectively. Patients with long history of disease (> 5 years) have significant increase in Ca levels p-value (0.019). Conclusion Patients with obesity have lower vitamin D levels, while having higher levels of ALP and Mg. Patients with long histories of disease (> 5 years) have higher levels of Ca. Females are more susceptible to vitamin D deficiency. There is no discernible difference in serum ALP, calcium, phosphate, or magnesium between hypertensive patients with normal or lower of levels vitamin D.

Objectives: The emergence of SARS-CoV-2 variants of concern has led to significant phenotypical changes in transmissibility, virulence, and public health measures. Our study used clinical data to compare characteristics between a Delta variant wave and a pre-Delta variant wave of hospitalized patients. Methods: This single-center retrospective study defined a wave as an increasing number of COVID-19 hospitalizations, which peaked and later decreased. Data from the United States Department of Health and Human Services were used to identify the waves’ primary variant. Wave 1 (August 8, 2020–April 1, 2021) was characterized by heterogeneous variants, whereas Wave 2 (June 26, 2021–October 18, 2021) was predominantly the Delta variant. Descriptive statistics, regression techniques, and machine learning approaches supported the comparisons between waves. Results: From the cohort (N = 1318), Wave 2 patients (n = 665) were more likely to be younger, have fewer comorbidities, require more care in the intensive care unit, and show an inflammatory profile with higher C-reactive protein, lactate dehydrogenase, ferritin, fibrinogen, prothrombin time, activated thromboplastin time, and international normalized ratio compared with Wave 1 patients (n = 653). The gradient boosting model showed an area under the receiver operating characteristic curve of 0.854 (sensitivity 86.4%; specificity 61.5%; positive predictive value 73.8%; negative predictive value 78.3%). Conclusion: Clinical and laboratory characteristics can be used to estimate the COVID-19 variant regardless of genomic testing availability. This finding has implications for variant-driven treatment protocols and further research.

Abstract Background Public acceptance of governmental measures are key to controlling the spread of infectious diseases. The COVID-19 pandemic has placed a significant burden on healthcare systems for high-income countries as well as low- and middle-income countries (LMICs). The ability of LMICs to respond to the challenge of the COVID-19 pandemic has been limited and may have affected the impact of governmental strategies to control the spread of COVID-19. This study aimed to evaluate and compare public opinion on the governmental COVID-19 response of high and LMICs in the Middle East and benchmark it to international countries. Methods An online, self-administered questionnaire was distributed among different Middle Eastern Arab countries. Participants’ demographics and level of satisfaction with governmental responses to COVID-19 were analyzed and reported. Scores were benchmarked against 19 international values. Results A total of 7395 responses were included. Bahrain scored highest for satisfaction with the governmental response with 38.29 ± 2.93 on a scale of 40, followed by the Kingdom of Saudi Arabia (37.13 ± 3.27), United Arab Emirates (36.56 ± 3.44), Kuwait (35.74 ± 4.85), Jordan (23.08 ± 6.41), and Lebanon (15.39 ± 5.28). Participants’ country of residence was a significant predictor of the satisfaction score (P

Abstract Background In the wake of COVID-19, community pharmacists (CP) were called upon to free up healthcare providers to treat more serious conditions and alleviate overcrowded healthcare centers. CPs were placed under tremendous pressure, where many patients primarily sought their health advice. This situation raised concerns about the preparedness of CPs in facing these challenges. Therefore, this study aimed to assess the appropriateness of pharmaceutical care provided by CPs to patients with suspected COVID-19 and to investigate their communication skills. Methods A simulated patient (SP) study was conducted among randomly selected community pharmacies in Beirut, Lebanon. Each pharmacy was visited by the SP who complained of fever and loss of smell sensation. Interactions between the attending pharmacist and the suspected COVID-19 patient were documented directly after each visit in a standardized data collection form. Results More than half of the CPs (56%) did not retrieve any relevant information to assess the patient’s condition. While pharmacists’ responses were limited to one to two recommendations, with the majority recommending the patient to perform the PCR test (90%). Inappropriate recommendations made by the CPs included mainly the confirmation that the patient had COVID-19 without prior testing (9%), and prescribing either an antimicrobial drug (5%) or dietary supplements (20%), claiming that the latter are essential to boost the patient’s immunity. As for the pharmacist-patient communication skills, the mean total score was 2.25 ± 0.79 (out of 4), displaying nonoptimal and ineffective communication. Conclusion An unsatisfactory and suboptimal provision of pharmaceutical care to a suspected COVID-19 case was evident. This may be a public health threat, particularly for developing countries that lack an efficient and unified healthcare system. The findings should alert health authorities to support and guide community pharmacists in assisting suspected COVID-19 patients.

The aim of this study was to test the antimicrobial properties of dental cements modified with magnesium oxide (MgO) nanoparticles. Zein-modified MgO nanoparticles (zMgO) in concentrations (0.0, 0.3, 0.5, and 1.0%) were mixed with dental cements (Fuji II, Rely X Temp E, Ionoglass Cem, Es Temp NE, and System P link). Eight discs were fabricated from each zMgO-cement pair for a total of 32 specimens for each cement. Characterization of the dental cements incorporating zMgO was done by X-ray Diffraction (XRD) and Field Emission Scanning Electron Microscopy (FESEM). The antimicrobial properties of the mixtures were tested using direct contact and agar diffusion assays against Streptococcus mutans, Staphylococcus aureus, Enterococcus faecalis, and Candida albicans. Data was analyzed using two-way analysis of variance and LSD post hoc test at 0.05 significance level. XRD spectra showed sharp peaks of zMgO indicating its high crystalline nature, while the amorphous dental cements with zMgO had broad peaks. FESEM analysis showed a uniform distribution of the zMgO nanoparticles in the cement. There were significant inhibition zone values associated with all concentrations of zMgO-cement mixtures tested compared to controls (p < 0.001) with a dose-response recorded only with Fuji II. Optical density values were significantly lower in zMgO groups compared to controls for all microorganisms. The effect was most prominent with Rely X against C. albicans and S. aureus. Dental cements containing zMgO showed significant antimicrobial properties that were dependent on the specific initial cement substrate.

Abstract Background Recent studies have reflected increased global concern regarding the possible acceleration of bacterial resistance secondary to the reported overuse and misuse of antibiotics during the COVID-19 pandemic. Therefore, this study aimed to investigate the nonprescribed sale of antibiotics by community pharmacies in Saudi Arabia during the COVID-19 outbreak and the pharmacists’ skills in triaging COVID-19 suspects. Methods Herein, 120 pharmacies were randomly selected and surveyed by simulated clients who presented gradual demands to convince the encountered pharmacists to agree to the over-the-counter sale of antibiotics. The pharmacists’ responses and counseling skills were documented in addition to their effectiveness in triaging suspected COVID-19 cases. Results Nineteen pharmacists (15.8%) were convinced to sell nonprescribed antibiotics after various levels of demand by clients. Moreover, twenty pharmacists (16.7%), who refused to sell nonprescribed antibiotics, referred the clients to clinics where they could easily obtain prescriptions, or to other pharmacies that violate the system. In addition, 29 pharmacists (24.2%) were not concerned about possible COVID-19 suspects, and 47–66 (39.2–55%) of them demonstrated different responses and recommendations. Moreover, 12 pharmacists of the 19 who violated the law did not offer any counseling regarding the use of the antibiotics. Conclusions The nonprescribed sale of antibiotics is still prevalent and may have increased during the COVID-19 outbreak in Saudi Arabia, thereby increasing the risk of accelerated bacterial resistance. The pharmacists’ skills in triaging COVID-19 suspects and patient education and counseling were below expectations. Further follow-up studies are highly recommended.

Abstract Background Primary dysmenorrhea (PD) is one of the most common gynecological conditions among young females, which has a significant negative impact on health-related quality of life and productivity. Despite its high prevalence, the evidence is limited regarding the management-seeking practices and its perceived effectiveness among females with PD. Methods This is a cross-sectional study conducted among 550 female students in six universities across Lebanon. The prevalence of PD, associated risk factors, and management-seeking practices were assessed using a self-administered questionnaire. Results The prevalence of PD was 80.9%. Most of the females with PD described their menstrual pain as moderate (56%) to severe (34.6%), which significantly affected their daily activities and studying ability (P

Abstract Background The COVID-19 pandemic has overburdened the healthcare facilities, which demanded the use of alternative and effective methods for delivering healthcare services. The use of telehealth has become a necessity to provide initial health services. Objective To identify the pharmaceutical care provided by community pharmacists to suspected high-risk COVID-19 patients using telehealth. Methods A simulated patient (SP) phoned 100 randomly-selected community pharmacies throughout Lebanon using a standard scenario of uncontrolled diabetes mellitus with typical symptoms of COVID-19. Pharmacists’ responses were compared with pre-defined ideal recommendations using a special form. Results The mean of the retrieved medical information score obtained by the pharmacists was 2.48 ± 2.79 (out of 21), with 34 % of the participants not retrieving any relevant medical data from the SP. The relative patient information, the exposure to COVID-19, and the possible COVID-19 symptoms were not retrieved by 61 %, 70 %, and 41 % of the pharmacists, respectively. Two percent of the pharmacists assured that the SP’s symptoms were related to common cold, while 5 % confirmed that the SP is infected with COVID-19. Notably, 35 % of the pharmacists did not offer any recommendation. Among them, 14 % claimed that they were too busy to respond. Only 39 % of the pharmacists provided an appropriate recommendation by referring the SP to her physician to seek medical attention within 24 h since the SP is a high-risk patient, and 41 % recommended doing a PCR test. Antipyretics, antibiotics, and dietary supplements were recommended by 27 %, 7 %, and 16 % of the pharmacists, respectively. Less than 16 % of the pharmacists recommended using protective measures against COVID-19. In addition, the overall communication skills of the pharmacists were generally below expectations. Conclusions This study is the first to assess the quality of pharmaceutical care provided by community pharmacists in the Middle East via Telehealth. An unsatisfactory level of preparedness through means of telehealth technology was evident. This resulted in the quality of pharmaceutical-care services provided to high-risk patients via telehealth to be below expectations. Therefore, health authorities should encourage community pharmacists to effectively adopt telehealth, by providing appropriate training, as well as recognizing their extra efforts with financial compensations, aiming to optimize patients’ health outcomes.

BRCA1-mutated prostate cancer has been shown to be less responsive to poly (ADP-ribose) polymerase (PARP) inhibitors as compared to BRCA2-mutated prostate cancer. The reason for this differential response is not clear. We hypothesized this differential sensitivity to PARP inhibitors may be explained by distinct genomic landscapes of BRCA1 versus BRCA2 co-segregating genes. In a large dataset of 7,707 men with advanced prostate cancer undergoing comprehensive genomic profiling (CGP) of cell-free DNA (cfDNA), 614 men harbored BRCA1 and/or BRCA2 alterations. Differences in the genomic landscape of co-segregating genes was investigated by Fisher’s exact test and probabilistic graphical models (PGMs). Results demonstrated that BRCA1 was significantly associated with six other genes, while BRCA2 was not significantly associated with any gene. These findings suggest BRCA2 may be the main driver mutation, while BRCA1 mutations tend to co-segregate with mutations in other molecular pathways contributing to prostate cancer progression. These hypothesis-generating data may explain the differential response to PARP inhibition and guide towards the development of combinatorial drug regimens in those with BRCA1 mutation.

Acute kidney injury (AKI) is common in cirrhotic patients affecting almost 20% of these patients. While multiple etiologies can lead to AKI, pre-renal azotemia seems to be the most common cause of AKI. Irrespective of the cause, AKI is associated with worse survival with the poorest outcomes observed in those with hepatorenal syndrome (HRS) and acute tubular necrosis (ATN). In recent years, new definitions, and classifications of AKI in cirrhosis have emerged. More knowledge has also become available regarding the benefits and drawbacks of albumin and terlipressin use in these patients. Diagnostic tools such as urinary biomarkers and point-of-care ultrasound (POCUS) became available and they will be used in the near future to differentiate between different causes of AKI and direct management of AKI in these patients. In this update, we will review these new classifications, treatment recommendations, and diagnostic tools for AKI in cirrhotic patients.

The purpose of this review is to give an up-to-date, thorough, and timely overview of monkeypox (Mpox), a severe infectious viral disease. Furthermore, this review provides an up-to-date treatment option for Mpox. The monkeypox virus (MPXV) has remained the most virulent poxvirus for humans since the elimination of smallpox approximately 41 years ago, with distribution mainly in central and west Africa. Mpox in humans is a zoonotically transferred disease that results in symptoms like those of smallpox. It had spread throughout west and central Africa when it was first diagnosed in the Republic of Congo in 1970. Mpox has become a major threat to global health security, necessitating a quick response by virologists, veterinarians, public health professionals, doctors, and researchers to create high-efficiency diagnostic tests, vaccinations, antivirals, and other infection control techniques. The emergence of epidemics outside of Africa emphasizes the disease’s global significance. A better understanding of Mpox’s dynamic epidemiology may be attained by increased surveillance and identification of cases.

Monkeypox virus has remained the most virulent poxvirus since the elimination of smallpox approximately 41 years ago, with distribution mostly in Central and West Africa. Monkeypox (Mpox) in humans is a zoonotically transferred disease that results in a smallpox-like disease. It was first diagnosed in 1970 in the Democratic Republic of the Congo (DRC), and the disease has spread over West and Central Africa. The purpose of this review was to give an up-to-date, thorough, and timely overview on the genomic diversity and evolution of a re-emerging infectious disease. The genetic profile of Mpox may also be helpful in targeting new therapeutic options based on genes, mutations, and phylogeny. Mpox has become a major threat to global health security, necessitating a quick response by virologists, veterinarians, public health professionals, doctors, and researchers to create high-efficiency diagnostic tests, vaccinations, antivirals, and other infection control techniques. The emergence of epidemics outside of Africa emphasizes the disease’s global significance. Increased monitoring and identification of Mpox cases are critical tools for obtaining a better knowledge of the ever-changing epidemiology of this disease.

Background: Epidemiologic studies suggest that Black, Asian, and minority ethnic (BAME) patients may be at risk of worse outcomes from coronavirus disease-2019 (COVID-19), but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality, and race in COVID-19 pneumonia. Methods: This was a multicentre, retrospective, observational study including 164 adults (aged 61 ± 13 years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (interquartile range 2-5) from admission. The primary outcome was all-cause mortality. Results: After a median follow-up of 31 days (interquartile range 14-42 days), 66 (40%) patients had died. The right ventricle was dilated in 62 (38%) patients, and 58 (35%) patients had right ventricular (RV) systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation, and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = −0.18, P = 0.025) and high-sensitivity cardiac Troponin (ρ = −0.30, P < 0.0001). Reduced RV systolic function (hazard ratio 1.80; 95% confidence interval, 1.05-3.09; P = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers, or mortality. Conclusions: In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is, however, no racial variation in the early findings on echocardiography, biomarkers, or mortality. Résumé: Contexte: Des études épidémiologiques suggèrent que les patients noirs, asiatiques et appartenant à des minorités ethniques (BAME) auraient un risque accru d'aggravation de la maladie à coronavirus 2019 (COVID-19), mais les facteurs physiopathologiques de cette association sont inconnus. Cette étude a cherché à étudier la relation entre les données d'échocardiographie, de mortalité, de l’origine ethnique avec la pneumonie associée à la COVID-19. Méthodes: Il s'agit d'une étude observationnelle rétrospective multicentrique portant sur 164 adultes (âgés de 61 ± 13 ans; 78 % d'hommes; 36 % de BAME) hospitalisés pour la COVID-19 et soumis à une échocardiographie entre le 16 mars et le 9 mai 2020, trois jours (écart interquartile 2-5) après leur admission. Le critère principal d’évaluation était la mortalité, toutes causes confondues. Résultats: Après un suivi médian de 31 jours (intervalle interquartile 14-42 jours), 66 (40 %) patients sont décédés. Le ventricule droit était dilaté chez 62 (38 %) des patients, et 58 (35 %) patients présentaient une dysfonction systolique du ventricule droit (VD). Seuls deux (1 %) patients présentaient une dilatation du ventricule gauche (VG), et 133 (81 %) avaient une fonction systolique VG normale ou en état hyperdynamique. Une réduction du déplacement systolique de l’anneau tricuspide a été associée à un taux de D-dimère élevé (ρ = -0,18, P = 0,025) et à une Troponine cardiaque de haute sensibilité (ρ = -0,30, P < 0,0001). Une fonction systolique VD réduite (rapport de risque de 1,80; intervalle de confiance à 95 %, 1,05-3,09 ; P = 0,032) était un facteur prédicteur indépendant pour la mortalité, toutes causes confondues, après ajustement pour les facteurs de risque démographiques et cliniques. En comparant les individus blancs et BAME, aucune différence n'a été constatée concernant les résultats d'échocardiographie, les biomarqueurs ou la mortalité. Conclusions: Chez les patients hospitalisés pour une pneumonie liée à la COVID-19, une réduction de la fonction systolique VD est apparue comme prévalente et associée à la mortalité, toutes causes confondues. Il n'y a cependant aucune influence de l’ethnicité en rapport avec les premiers résultats d'échocardiographie, des biomarqueurs ou de la mortalité.

The Anti-Nuclear Antibodies (ANAs) testing is the primary serological diagnosis screening test for autoimmune diseases. ANAs testing is conducted mainly by the Indirect Immunofluorescence (IIF) on Human Epithelial cell-substrate (HEp-2) protocol. However, due to its high variability, human-subjectivity, and low throughput, there is an insistent need to develop an efficient Computer-Aided Diagnosis system (CADs) to automate this protocol. Many recently proposed Convolutional Neural Networks (CNNs) demonstrated promising results in HEp-2 cell image classification, which is the main task of the HE-p2 IIF protocol. However, the lack of large labeled datasets is still the main challenge in this field. This work provides a detailed study of the applicability of using generative adversarial networks (GANs) algorithms as an augmentation method. Different types of GANs were employed to synthesize HEp-2 cell images to address the data scarcity problem. For systematic comparison, empirical quantitative metrics were implemented to evaluate different GAN models’ performance of learning the real data representations. The results of this work showed that though the high visual similarity with the real images, GANs’ capacity to generate diverse data is still limited. This deficiency in the generated data diversity is found to be of a crucial impact when used as a standalone method for augmentation. However, combining limited-size GANs-generated data with classic augmentation improves the classification accuracy across different variants of CNNs. Our results demonstrated a competitive performance for the overall classification accuracy and the mean class accuracy of the HEp-2 cell image classification task.

Pythiaceous fungi have variety of occurrences in different environments. If these fungi are present in water intended to irrigate crops, they pose high risk as pathogens. Pythium adhaerens, P. aquatile, P. diclinum, P. dissotocum, P. pachycaule and P. torulosum, in addition to asexual isolates of P. dissotocum (Pythium “group F”) and Phytopythium helicoides (the former, Pythium “group P”) were isolated from 5 rivers and a pond in Gifu, Japan, and their diversity were studied. All of the isolated species have been previously recorded from aquatic habitats except for P. pachycaule. Sequencing of the internal transcribed spacer regions of ribosomal DNA (rDNA-ITS) including the 5.8SrDNA of these fungi confirmed primary identification based on morphological characteristics. This study proves the dense presence of different species of these Pythiaceous fungi, based on the latest modern identification methods, through which a new genus of Pythium was recorded and divided into two species. The aim of this study was to study the biological diversity of Pythium, which is pathologically important for many crop plants that are irrigated with water from these five rivers and the pond in Gifu, Japan.

Purpose: Leadership characteristics and career development of women in a health sciences university in Saudi Arabia was investigated. This was also extended to leadership authenticity of women graduated from a master's in medical education (MME) program. Method: In this cross-sectional study, a self-administrated authentic leadership questionnaire (ALQ) was utilized where the data were collected at three campuses of a health sciences university. Results: The study sample consisted of 71 MME graduates and 75 academic leaders. Women represented 42.25% of the MME graduates, with an average age of 41.04 (±5.49) years. Among MME graduates, there were 17 (56.67%) women holding the positions of deans, associate deans, or assistant deans compared with 14 men (34.16%) with a p value of 0.59. There were fourteen (46.67%) women holding Doctor of Philosophy compared with 19 men (46.34%) either holding a clinical fellowship of a master's degree. There were no significant differences between the scores of women and men in the four ALQ domains. Among academic leaders. twenty (26.67%) women were academic leaders with an average age of 47.31 (±9.63) years; compared with 55 men (p = 0.53). Twelve (60.00%) women leaders were from professions other than medicine with a p value of 0.07. Seventeen (85.00%) women were appointed at a middle management position; compared with 43 (78.18%) men with a p value of 0.16. Women showed tendency for higher scores in all ALQ domains; however, it did not reach statistical significance. Discussion: Women received opportunities to be enrolled in the MME program and the authenticity of their academic leadership skills did not significantly differ from men. Women accounted for a quarter of academic leaders, with more appointments in middle management positions and a tendency toward a better authenticity of leadership skills.

Abstract Background and purpose The National Institutes of Health Stroke Scale (NIHSS) has been found to be biased toward the left hemispheric and motoric functions providing minimal assessment to the right hemispheric language and cognitive functions. The need to complement the role of the NIHSS is necessary in accurate and rapid assessment of AIS patients and better management. We hypothesized that combining the NIHSS with a quantitative analysis of Spoken Picture Description scale of Comprehensive Aphasia Test (SPD-CAT) could provide valuable data regarding side, site, and size of stroke. Subjects and methods Eighty-six AIS patients presented within 48 h of onset of stroke were enrolled from Stroke Units of Ain-Shams University Hospitals (ASUHS). Clinical Assessment with NIHSS and SPD-CAT were correlated with the radiological MRI Brain lesions of stroke regarding (site, side, size/volume and lesion volume percent to the whole brain volume “LV% WBV”). Results Total and subscale scores of NIHSS and SPD-CAT have a highly statistically significant correlation with the ischemic “LV% WBV.” Quantitative analysis (content units) of SPD-CAT may help in prediction of the lobar site of the stroke with higher significance in the tempro-parietal and brainstem regions. Right hemispheric strokes have clinically and statistically significant scores on SPD-CAT in comparison to NIHSS scores. Also, the left to right ratio of content units of information carrying words (ICWs) in SPD-CAT gives a significant difference between right and left hemispheric strokes. Recording and analysis time of SPD-CAT makes it easy and rapidly applicable in emergency room (ER) and stroke units. Conclusion Combining the quantitative analysis of NIHSS and SPD-CAT can better predict the side, size, and site of AIS within reasonable time table and without urgent MRI for AIS assessment and management.

Background. Improving both patient and graft survival after kidney transplantation are major unmet needs. The goal of this study was to assess risk factors for specific causes of graft loss to determine to what extent patients who develop either death with a functioning graft (DWFG) or graft failure (GF) have similar baseline risk factors for graft loss. Methods. We retrospectively studied all solitary renal transplants performed between January 1, 2006, and December 31, 2018, at 3 centers and determined the specific causes of DWFG and GF. We examined outcomes in different subgroups using competing risk estimates and cause-specific Cox models. Results. Of the 5752 kidney transplants, graft loss occurred in 21.6% (1244) patients, including 12.0% (691) DWFG and 9.6% (553) GF. DWFG was most commonly due to malignancy (20.0%), infection (19.7%), cardiac disease (12.6%) with risk factors of older age and pretransplant dialysis, and diabetes as the cause of renal failure. For GF, alloimmunity (38.7%), glomerular diseases (18.6%), and tubular injury (13.9%) were the major causes. Competing risk incidence models identified diabetes and older recipients with higher rates of both DWFG and nonalloimmune GF. Conclusions. These data suggest that at baseline, 2 distinct populations can be identified who are at high risk for renal allograft loss: a younger, nondiabetic patient group who develops GF due to alloimmunity and an older, more commonly diabetic population who develops DWFG and GF due to a mixture of causes—many nonalloimmune. Individualized management is needed to improve long-term renal allograft survival in the latter group.

Background Lung cancer in men and women is considered the leading cause for cancer-related mortality worldwide. Anti-cancer peptides represent a potential untapped reservoir of effective cancer therapy. Methodology Box-Behnken response surface design was applied for formulating Alendronate sodium (ALS)-mastoparan peptide (MP) nanoconjugates using Design-Expert software. The optimization process aimed at minimizing the size of the prepared ALS-MP nanoconjugates. ALS-MP nanoconjugates’ particle size, encapsulation efficiency and the release profile were determined. Cytotoxicity, cell cycle, annexin V staining and caspase 3 analyses on A549 cells were carried out for the optimized formula. Results The results revealed that the optimized formula was of 134.91±5.1 nm particle size. The novel ALS-MP demonstrated the lowest IC50 (1.3 ± 0.34 μM) in comparison to ALS-Raw (37.6 ± 1.79 μM). Thus, the results indicated that when optimized ALS-MP nanoconjugate was used, the IC50 of ALS was also reduced by half. Cell cycle analysis demonstrated a significantly higher percentage of cells in the G2-M phase following the treatment with optimized ALS-MP nanoconjugates. Conclusion The optimized ALS-MP formula had significantly improved the parameters related to the cytotoxic activity towards A549 cells, compared to control, MP and ALS-Raw.

This article investigates the size dependent on piezoelectrically layered perforated nanobeams embedded in an elastic foundation considering the material Poisson’s ratio and the flexoelectricity effects. The composite beam is composed of a regularly squared cut-out elastic core with two piezoelectric face sheet layers. An analytical geometrical model is adopted to obtain the equivalent geometrical variables of the perforated core. To capture the Poisson’s ratio effect, the three-dimensional continuum mechanics adopted to express the kinematics are kinetics relations in the framework of the Euler–Bernoulli beam theory (EBBT). The nonlocal strain gradient theory is utilized to incorporate the size-dependent electromechanical effects. The Hamilton principle is applied to derive the nonclassical electromechanical dynamic equation of motion with flexoelectricity impact. A closed form solution for resonant frequencies is obtained. Numerical results explored the impacts of geometrical and material characteristics on the nonclassical electromechanical behavior of nanobeams. Obtained results revealed the significant effects of the mechanical, electrical, and elastic foundation parameters on the dynamic behavior of piezoelectric composite nanobeams. The developed procedure and the obtained results are helpful for many industrial purposes and engineering applications, such as micro/nano-electromechanical systems (MEMS) and NEMS.

Conventional anticancer treatments, such as radiotherapy and chemotherapy, have significantly improved cancer therapy. Nevertheless, the existing traditional anticancer treatments have been reported to cause serious side effects and resistance to cancer and even to severely affect the quality of life of cancer survivors, which indicates the utmost urgency to develop effective and safe anticancer treatments. As the primary focus of cancer nanotheranostics, nanomaterials with unique surface chemistry and shape have been investigated for integrating cancer diagnostics with treatment techniques, including guiding a prompt diagnosis, precise imaging, treatment with an effective dose, and real-time supervision of therapeutic efficacy. Several theranostic nanosystems have been explored for cancer diagnosis and treatment in the past decade. However, metal-based nanotheranostics continue to be the most common types of nonentities. Consequently, the present review covers the physical characteristics of effective metallic, functionalized, and hybrid nanotheranostic systems. The scope of coverage also includes the clinical advantages and limitations of cancer nanotheranostics. In light of these viewpoints, future research directions exploring the robustness and clinical viability of cancer nanotheranostics through various strategies to enhance the biocompatibility of theranostic nanoparticles are summarised.

Automatic key gesture detection and recognition are difficult tasks in Human–Computer Interaction due to the need to spot the start and the end points of the gesture of interest. By integrating Hidden Markov Models (HMMs) and Deep Neural Networks (DNNs), the present research provides an autonomous technique that carries out hand gesture spotting and prediction simultaneously with no time delay. An HMM can be used to extract features, spot the meaning of gestures using a forward spotting mechanism with varying sliding window sizes, and then employ Deep Neural Networks to perform the recognition process. Therefore, a stochastic strategy for creating a non-gesture model using HMMs with no training data is suggested to accurately spot meaningful number gestures (0–9). The non-gesture model provides a confidence measure, which is utilized as an adaptive threshold to determine where meaningful gestures begin and stop in the input video stream. Furthermore, DNNs are extremely efficient and perform exceptionally well when it comes to real-time object detection. According to experimental results, the proposed method can successfully spot and predict significant motions with a reliability of 94.70%.

Introduction and Objectives: Renal dysfunction before liver transplantation (LT) is associated with higher post-LT mortality. We aimed to study if this association still persisted in the contemporary transplant era. Materials and Methods: We retrospectively reviewed data on 2871 primary LT performed at our center from 1998 to 2018. All patients were listed for LT alone and were not considered to be simultaneous liver–kidney (SLK) transplant candidates. SLK recipients and those with previous LT were excluded. Patients were grouped into 4 eras: era-1 (1998–2002, n = 488), era-2 (2003–2007, n = 889), era-3 (2008–2012, n = 703) and era-4 (2013–2018, n = 791). Pre-LT renal dysfunction was defined as creatinine (Cr) >1.5 mg/dl or on dialysis at LT. The effect of pre-LT renal dysfunction on post-LT patient survival in each era was examined using Kaplan Meier estimates and univariate and multivariate Cox proportional hazard analyses. Results: Pre-LT renal dysfunction was present in 594 (20%) recipients. Compared to patients in era-1, patients in era-4 had higher Cr, lower eGFR and were more likely to be on dialysis at LT (P

The objective of the present study was to evaluate the potential of the dietary addition of neem (Azadirachta indica) leaf powder (NLP) when compared to monensin (MON) on ruminal fermentation, feed intake, digestibility, and performance of growing lambs. Eighteen Omani lambs (22.8 ± 2.18 kg of body weight (BW)) were equally divided into three groups (n = 6 lambs/group) for 90 days. Animals were fed an ad lib basal diet consisting of Rhodes grass (Chloris gayana) hay (600 g/kg) and a concentrated mixture (400 g/kg) offered twice daily. Experimental treatments were control (basal diet without supplements); MON (control plus 35 mg/kg DM as a positive control); and NLP (control plus 40 g/kg DM). Lambs fed NLP had reduced ruminal ammonia nitrogen concentrations, protozoal counts, total volatile fatty acid, and blood urea nitrogen concentrations compared to the control. Compared to MON, lambs fed NLP had increased ruminal acetate and decreased propionate proportions. Inclusion of NLP in the diet increased blood total protein, globulin, and liver enzyme concentrations in comparison with the control, which was similar to MON. The lamb’s final BW and average BW gain were also increased with the NLP relative to the control. Further, adding NLP to the diet increased the digestibility of crude protein compared to the control diet. In conclusion, adding NLP to the diet with 40 g/kg DM could be used as a promising phytogenic supplement for growing lambs with no detrimental effects on the ruminal fermentation profile, nutrient intake, or digestibility.

The Coronavirus Disease 2019 (COVID-19) pandemic has critically struck healthcare systems and burdened emergency services. To date, there is no accurate and rapid point-of-care diagnostic test. This study aimed to investigate Lung Ultrasound (LUS) against Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test in suspected COVID-19 patients presenting to the emergency department. In 20 eligible patients (mean age ± standard deviation, 49 ± 15 years), 12 had a positive RT-PCR test and undergone an LUS examination over 12 lung zones using a handheld ultrasound device. Each zone was semiquantitatively scored according to the Lung Ultrasound Scoring System (LUSS) from 0 to 3 based on the severity of findings (pleural line irregularity, B-lines, consolidations) and documented the presence of light beam artifacts. A second blinded reader scored the images to investigate interreader reproducibility. The LUSS score had a modest diagnostic performance at 66.6% [95% Confidence Interval (CI), 34.9–90.0%] sensitivity and 75.0% (95% CI, 34.9–96.8%) specificity. The light beam artifact was more prevalent and sensitive to COVID-19 patients with 81.8% (95% CI, 48.2–97.7%) sensitivity and 75.0% (95% CI, 34.9–96.8%) specificity. LUS had an almost perfect interreader reproducibility for LUSS (Kendall’s W = 0.961; 95% CI, 0.894–0.985) and light beam artifact (Cohen’s κ = 0.890; 95% CI, 0.683–1.00). Overall, LUS using handheld devices can offer a safe, reproducible, rapid, and feasible first-line tool for detecting COVID-19 patients in emergency departments. The light beam artifact was more sensitive and specific to COVID-19 patients and can be useful for effectively triaging suspected cases.

Objective: To study the prevalence, etiology, and outcome of acute pancreatitis (AP) in kidney transplant and stage 5 chronic kidney disease (CKD) populations in comparison to a non-CKD cohort. Patients and Methods: Using the Nationwide Inpatient Sample database, we identified patients with acute pancreatitis as the primary discharge diagnosis, after which propensity scores were used to create 2 cohorts of patients: 1 with CKD (n=13,425) and 1 without CKD (n=13,425). The CKD group was subsequently subdivided into dialysis-independent stage 5 CKD (n=690), dialysis-dependent stage 5 CKD (n=11,415), and kidney transplant recipients (n=1320). Patients younger than 18 years old, those who received a kidney transplant during the incident admission, and pancreas transplant recipients were excluded. Results: The adjusted odds ratios (ORs) of AP were comparable between the no CKD, stage 5 CKD, and kidney transplant populations. Adjusted inpatient mortality was highest in patients with dialysis-dependent stage 5 CKD (OR, 2.72; 95% CI, 2.2-3.3; P

الملخص: تُظهر ضواحك الفك العلوي اختلافات تشريحية في أعداد الجذور والقنوات، ويشكل ذلك تحديا خلال علاج قناة الجذر. في تقرير الحالة هذا، نصف معالجة ضاحك الفك العلوي ذي ثلاثة جذور. أُحيل مريض يمني عمره ٤٧ عاما إلى كلية طب الأسنان بجامعة طيبة للمعالجة اللبية للضاحك العلوي الأول الأيمن (١٤#). لم يقدم التصوير الشعاعي التشخيصي الذروي نتائج كافية فيما يتعلق بتشكل نظام قناة الجذر وعدد الجذور. بعد ذلك، تم التقاط صورة مقطعية مخروطية ثلاثية الأبعاد أظهرت أن ضاحك الفك العلوي يحتوي على ثلاث جذور. أُجريت معالجة قناة الجذر تحت التكبير باستخدام مجهر جراحي للأسنان، وباستعمال نظام ''ريسبروك بلو'' ونظام تسليك نيكل – تيتانيوم، وتم الحشو الثلاثي الأبعاد للقنوات الجذرية بجهاز ''كلاموس''.ينبغي على الأطباء أن يكونوا قادرين على توقع الاختلافات التشريحية في الضواحك الفكية، كما ينبغي أن يكون لديهم المعرفة والمهارات الكافية للتعامل مع مثل هذه الحالات. Abstract: Maxillary premolars exhibit anatomical variations in the numbers of roots and canals, which pose a challenge during root canal therapy. In the present case report, we describe the endodontic management of a three-rooted maxillary premolar. A 47-year-old Yamani man was referred to the College of Dentistry, Taibah University for endodontic treatment of his right maxillary first premolar (#14). Periapical diagnostic radiography did not provide adequate information about the morphology of the root canal system and number of roots. Subsequently, a 3D cone-beam computed tomographic (CBCT) image was obtained, which revealed three roots in the aforementioned premolar. Root canal treatment was performed under magnification using a dental operating microscope, R25 RECIPROC blue NiTi single file system, and the Calamus dual 3-D obturation system. Clinicians should be able to predict the anatomical variations in maxillary premolars and have adequate knowledge and skills for managing such situations. Keywords: Anatomical variations, Endodontics, Maxillary premolars, Root canal, Three-rooted, الكلمات المفتاحية: الاختلافات التشريحية, المعالجة اللبية, الضواحك العلوية, القناة الجذرية, ثلاثي الجذور

This study was conducted to investigate the effects of 10 weeks supplementation of Quebracho tannins (QT; 0 [control], 100 [QT100] or 200 g/[cow·d] [QT200]) to 30 multiparous postpartum buffalo cows (10 cows per group) on milk yield and composition, blood metabolites and reproductive performance. Supplementation of QT100 had no significant effect on milk yield, whereas QT200 decreased (P