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Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations. Materials and Methods:Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 coun-tries were analyzed descriptively, with a Delphi process used for expert recommendations. Results:Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoosper-mia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differ-entiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate. Conclusions:Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.

Background: Developmental dysplasia of the hip (DDH) is a spectrum of disorders that develop in utero, involving the femoral head and acetabular cup development, ranging from dysplasia to dislocation. The prevalence of DDH in Saudi Arabia is 10.46 per 1000 live births. However, the late presentation of DDH in Saudi Arabia is around 30%, believed to be significantly due to a lack of awareness of the disease among mothers and pregnant women. AIMS: This study aimed to measure maternal perceptions and awareness regarding DDH in children among mothers and pregnant women in Makkah City, Saudi Arabia. Method: In total, 406 women participated in an electronic survey. The survey questions were adapted from previously published research, and the questionnaire was available in Arabic. Results: The age distribution of the participants ranged from below 20 to over 50 years, with the largest group being 31–40 years old. Most of the participants had a university-level education (61.1%). The overall assessment showed a predominance of poor knowledge (41.1%), followed by good knowledge (34.7%), and then medium knowledge (24.1%). Conclusion: The present study revealed significant knowledge gaps and barriers to the early detection and intervention of DDH among Makkah City mothers and pregnant women. The findings underscore the need for targeted educational campaigns, increased access to screening programs, and heightened healthcare provider knowledge to improve DDH’s perception and awareness. Future interventions should focus on addressing these gaps and promoting early detection and intervention strategies to minimize the long-term consequences of DDH.

Abstract Background Influenza is a common cause of hospital admissions globally with regional variations in epidemiology and clinical profile. We evaluated the characteristics and outcomes of patients with influenza admitted to a tertiary-care center in Riyadh, Saudi Arabia. Methods This was a retrospective cohort of adult patients admitted with polymerase chain reaction-confirmed influenza to King Abdulaziz Medical City-Riyadh between January 1, 2018, and May 31, 2022. We compared patients who required intensive care unit (ICU) admission to those who did not and performed multivariable logistic regression to assess the predictors of ICU admission and hospital mortality. Results During the study period, 675 adult patients were hospitalized with influenza (median age 68.0 years, females 53.8%, hypertension 59.9%, diabetes 55.1%, and chronic respiratory disease 31.1%). Most admissions (83.0%) were in the colder months (October to March) in Riyadh with inter-seasonal cases even in the summertime (June to August). Influenza A was responsible for 79.0% of cases, with H3N2 and H1N1 subtypes commonly circulating in the study period. Respiratory viral coinfection occurred in 12 patients (1.8%) and bacterial coinfection in 42 patients (17.4%). 151 patients (22.4%) required ICU admission, of which 62.3% received vasopressors and 48.0% mechanical ventilation. Risk factors for ICU admission were younger age, hypertension, bilateral lung infiltrates on chest X-ray, and Pneumonia Severity Index. The overall hospital mortality was 7.4% (22.5% for ICU patients, p 20%. Female sex, high Pneumonia Severity Index, ischemic heart disease, and immunosuppressed state were associated with increased mortality.

Cloud seeding involves boosting precipitation by releasing substances into the air that act as cloud condensation or ice nuclei. These substances encourage the development of clouds and precipitation. It’s like giving Mother Nature a gentle push to assist with rainfall in specific areas. The current work aimed to suggest Al2O3 as an alternate compound in cloud seeding rather than silver iodide. In this research, a unique approach is used to identify condensation nuclei, which play a crucial role in cloud formation and droplet growth. Various samples and four sources were included in the current study; refrigerated helfa powder, Himalayan salt, generator powder, and pollen, were analyzed using different physicochemical instruments. The proportions of chemical compounds in the samples show that there is 1.392% of Al2O3 in Refrigerated helfa which is the highest than in the other 3 sources, while the proportions of elements in the samples indicate that refrigerated helfa contains the lowest toxic compound, and although Al2O3 is insoluble in water, it is hygroscopic and can absorb 6.4% of humidity within 24 hours. As for the surface tension, refrigerated helfa shows lower density and surface tension than the other three sources with values of 0.9480 and 47.89 respectively. Al2O3 shows high humid absorptivity and refrigerated helfa can be used as a main source for Al2O3 which has a low effect on biota and is recommended for use in cloud seeding. However further work is recommended to be carried out in using Al2O3 as an alternative compound to silver iodide in cloud seeding.

RATIONALE: The prognosis of patients with lung cancer admitted to the intensive care unit (ICU) is often perceived as poor. We described the characteristics, management, and outcomes of critically ill patients with lung cancer and determined the predictors of mortality. METHODS: We retrospectively studied patients with lung cancer who were admitted to the ICU of a tertiary care hospital between 1999 and 2021 for the reasons other than routine postoperative care. We noted their characteristics, ICU management, and outcomes. We performed the multivariable logistic regression analysis to determine the predictors of hospital mortality. RESULTS: In the 23-year period, 306 patients with lung cancer were admitted to the ICU (median age = 63.0 years, 68.3% males, 45.6% with moderate/severe functional disability, most had advanced lung cancer, and median Acute Physiology and Chronic Health Evaluation II score = 24.0). Life support measures included invasive mechanical ventilation (47.1%), vasopressors (34.0%), and new renal replacement therapy (8.8%). Do-Not-Resuscitate orders were implemented during ICU stay in 30.1%. The hospital mortality was 43.8% with a significantly lower rate in patients admitted after 2015 (28.0%). The predictors of mortality were moderate/severe baseline disability (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.22, 5.78), advanced lung cancer (OR 8.36, 95% CI 1.81, 38.58), lactate level (OR 1.45, 95% CI 1.12, 1.88, invasive mechanical ventilation (OR 10.92, 95% CI 4.98, 23.95), and admission period after 2015 (OR 0.37, 95% CI 0.16, 0.85). CONCLUSIONS: The mortality rates in patients with lung cancer admitted to the ICU during a 23-year period decreased after 2015. Functional disability, advanced lung cancer stage, vasopressor use, and invasive mechanical ventilation predicted mortality.

Abstract Background Orthodontic pain affects the physical and mental health of patients. The spinal trigeminal subnucleus caudalis (SPVC) contributes to the transmission of pain information and serves as a relay station for integrating orofacial damage information. Recently, glial cells have been found to be crucial for both acute and maintenance phases of pain. It has also been demonstrated that rho kinase (ROCK) inhibitors can manage different pain models by inhibiting glial cell activation. Here, we hypothesized that orthodontic pain is related to glial cells in the SPVC, and Fasudil, a representative rho/rock kinase inhibitor, can relieve orthodontic pain by regulating the function of glial cells and the related inflammatory factors. In this study, we constructed a rat model of tooth movement pain and used immunofluorescence staining to evaluate the activation of microglia and astrocytes. Quantitative real-time PCR was used to detect the release of related cytokines and the expression of pain-related genes in the SPVC. Simultaneously, we investigated the effect of Fasudil on the aforementioned indicators. Results In the SPVC, the expression of c-Fos peaked on day 1 along with the expression of OX42 (related to microglial activation), CD16 (a pro-inflammatory factor), and CD206 (an anti-inflammatory factor) on day 3 after tooth movement, followed by a gradual decrease. GFAP-staining showed that the number of activated astrocytes was the highest on day 5 and that cell morphology became complex. After Fasudil treatment, the expression of these proteins showed a downward trend. The mRNA levels of pro-inflammatory factors (IL-1β and TNF-α) peaked on day 3, and the mRNA expression of the anti-inflammatory factor TGF-β was the lowest 3 days after tooth movement. Fasudil inhibited the mRNA expression of pain-related genes encoding CSF-1, t-PA, CTSS, and BDNF. Conclusion This study shows that tooth movement can cause the activation of glial cells in SPVC, and ROCK inhibitor Fasudil can inhibit the activation of glial cells and reduce the expression of the related inflammatory factors. This study presents for the first time the potential application of Fasudil in othodontic pain.

The ultrafunctional potential of zinc oxide (ZnO) and copper oxide (CuO) nanoparticles (NPs) has generated a great interest in using such metal oxides as remarkable and electroactive nanocomposites in the studies on potentiometry and sensors. These nano-oxides were prepared from the extract of Leucaena leucocephala seeds as an environmentally friendly process. The development of a ZnO/CuO “core-shell nanocomposite-modified” coated copper wire film sensor was proposed as a new method for potentiometric determination of pseudoephedrine hydrochloride (PSD) in pure and pharmaceutical dosage forms. With the existence of polyvinyl chloride (PVC) as a polymer with high molecular weight and “o-nitrophenyl octyl ether (o-NPOE) as a solvent mediator”, PSD was combined with phosphotungstic acid (PTA) to produce pseudoephedrine hydrochloride-phosphotungstate (PSD-PT) as a sensing substance. The improved sensor showed a very high sensitivity and selectivity for determining and quantifying the PSD with a linear relationship of 1.0×10-8-1.0×10-2 mol L-1. It was estimated that the regression equation was represented by the EmV = (-58.143) log [PSD] + 526.71. With the proposed sensors, pseudoephedrine hydrochloride could be effectively determined in pure and commercial product forms.

Artificial intelligence (AI) literacy is a crucial aspect of media and information literacy (MIL), regarded not only as a human right but also as a fundamental requirement for societal advancement and stability. This study aimed to provide a comprehensive, cross-border perspective on AI literacy levels by surveying 1,800 university students from four Asian and African nations. The findings revealed significant disparities in AI literacy levels based on nationality, scientific specialization, and academic degrees, while age and gender did not show notable impacts. Malaysian participants scored significantly higher on the AI literacy scale than individuals from other countries. The results indicated that various demographic and academic factors influenced respondents’ perceptions of AI and their inclination to utilize it. Nationality and academic degree were identified as the most influential factors, followed by scientific specialization, with age and gender exerting a lesser influence. The study highlights the necessity of focusing research efforts on the detailed dimensions of the AI literacy scale and examining the effects of previously untested intervening variables. Additionally, it advocates for assessing AI literacy levels across different societal segments and developing the appropriate measurements.

Abstract Background The optimal amount and timing of protein intake in critically ill patients are unknown. REPLENISH (Replacing Protein via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients) trial evaluates whether supplemental enteral protein added to standard enteral nutrition to achieve a high amount of enteral protein given from ICU day five until ICU discharge or ICU day 90 as compared to no supplemental enteral protein to achieve a moderate amount of enteral protein would reduce all-cause 90-day mortality in adult critically ill mechanically ventilated patients. Methods In this multicenter randomized trial, critically ill patients will be randomized to receive supplemental enteral protein (1.2 g/kg/day) added to standard enteral nutrition to achieve a high amount of enteral protein (range of 2–2.4 g/kg/day) or no supplemental enteral protein to achieve a moderate amount of enteral protein (0.8–1.2 g/kg/day). The primary outcome is 90-day all-cause mortality; other outcomes include functional and health-related quality-of-life assessments at 90 days. The study sample size of 2502 patients will have 80% power to detect a 5% absolute risk reduction in 90-day mortality from 30 to 25%. Consistent with international guidelines, this statistical analysis plan specifies the methods for evaluating primary and secondary outcomes and subgroups. Applying this statistical analysis plan to the REPLENISH trial will facilitate unbiased analyses of clinical data. Conclusion Ethics approval was obtained from the institutional review board, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia (RC19/414/R). Approvals were also obtained from the institutional review boards of each participating institution. Our findings will be disseminated in an international peer-reviewed journal and presented at relevant conferences and meetings. Trial registration ClinicalTrials.gov, NCT04475666 . Registered on July 17, 2020.

Abstract Background Inflammatory bowel disease (IBD) is a chronic gastrointestinal disease that causes anorexia, malabsorption, and increased energy requirements. Childhood IBD can significantly impact nutritional status and future health. Objective This study aimed to analyze the nutritional status of patients with pediatric IBD at presentation and during follow-up and to identify predictors of nutritional outcome. Methods This retrospective cohort study reviewed the medical records of children diagnosed with IBD in the Pediatric Department, Salmaniya Medical Complex, Bahrain, 1984 − 2023. Demographic data, clinical characteristics, and anthropometric data were collected. World Health Organization growth standards were used to interpret nutritional status. Results Of the 165 patients, 99 (60%) had anthropometric data at presentation, and 130 (78.8%) had follow-up data. Most patients were males (64.6%) and had Crohn’s disease (CD) (56.2%), while 43.8% had ulcerative colitis (UC). The median age at presentation was 10.9 years and the mean follow-up duration was 12.6 years. At presentation, 53.5% of the patients were malnourished, that decreased to 46.9% on follow-up. Thinness was reduced from 27.3% at presentation to 12.1% at follow-up (p = 0.003). There was an increased tendency to normal weight on follow-up (59.6%) compared to time of presentation (46.5%), p = 0.035. Overweightness showed a non-significant increase from 26.3% at presentation to 28.3% at follow-up (p = 0.791). Children with IBD were more likely to become obese when they grow up to adulthood (2.3% versus 20.5%, respectively, p

Third-Person Effect theory (TPE) postulates that audiences deny the media's direct impact on themselves but perceive the same media as having a larger impact on others. This study examines TPE and its relationship with Islamic religiosity in shaping perceptions of moral and non-moral issues on social networking sites (SNS) among students at the International Islamic University Malaysia (IIUM). Another objective of this study is to determine how students perceive the effect of moral and non-moral issues in SNS on themselves compared to others. This study employed a quantitative design, with 357 students from the IIUM serving as respondents. The findings indicate that participants perceive moral issues as affecting others more than themselves, which is consistent with TPE. However, non-moral issues are perceived as influencing both the self and others. The results also indicate that Islamic religiosity positively affects the perceived impact of moral issues on others and non-moral issues on oneself in SNS. The data were analyzed using SPSS, with paired t-tests comparing self versus others' perceptions of moral and non-moral issues on SNS. The findings confirm that students perceive moral issues as having a greater impact on others than on themselves, aligning with TPE. Conversely, non-moral issues are perceived as influencing both the self and others, demonstrating SPE. The study also reveals that Islamic religiosity positively influences the perceived effect of moral issues on others and non-moral issues on oneself in SNS.

Sol–gel method was used to prepare Sr1-xCdxZn2Fe4O11 (x = 0.00, 0.02, 0.06, 0.1) R-type hexaferrite. The synthesized materials were sintered at 850oC and desired phase was obtained. X-ray diffraction analysis confirms that R-type hexaferrite exists only as a single phase. Using the Scherer formula, crystallite size for all of the prepared samples was found to be in the range of 10.39–12.62 nm. Crystallite size (D), the lattice parameters (a, c), and the cell volume (Vcell), d-spacing, bulk density, X-ray density, porosity, dislocation density and micro strain were determined in structural analysis. Fourier transform infrared spectroscopy method was used to identify the metal-oxygen vibrations at different locations. FT-IR verifies the presence of the Fe–O stretching vibration band at 743 and 867 cm−1. The typical grain size in surface morphology investigation ranges from 0.56 to 0.82 μm. Dielectric response of ferrite ceramic samples replaced with Cd2+ was investigated in the frequency range of 1 MHz–3 GHz. The AC conductivity rises with an increase in frequency because they are proportional to one another. This increasing tendency is effectively described by the theory of Maxwell-Wagner and Koop. Q-values remain constant as frequency rises and behaves independently of frequency as long as frequency reaches 1.7 GHz. These types of materials are utilized in high-frequency applications including frequency filters and resonant circuits. All of the magnetic properties determined by analyzing the M − H loops, including saturation magnetization (Ms), retentivity (Mr), and coercivity (Hc), exhibit an increasing trend as the substitution of Cd2+ rises. Ms (49.76–56.38 emu/g), Mr (15.82–18.30 emu/g) and Hc range from 203.20 Oe to 215.80 Oe. Grain size decreases cause arise in coercivity, which is caused by an enhancement in magneto-crystalline anisotropy. Overall results suggest that Cd2+ replaced R-type hexagonal ferrites are a great resource for longitudinal recording media; they have the potential to be used in a wide variety of electronic applications, including resonant circuits and high-frequency filters, security, detecting and switching.

PURPOSEAML is a heterogeneous hematologic malignancy. Region-specific recommendations for AML management can enhance patient outcomes. This article aimed to develop recommendations for the Gulf Cooperation Council (GCC) countries.METHODSTen AML panel members from Kuwait, Oman, Qatar, and the United Arab Emirates (KOQU) participated in a modified two-round Delphi process. The panel first identified the unmet regional needs and finalized a list of core variables. Next, they voted on iterative statements drawn from international recommendations and provided feedback via a questionnaire. Consensus voting ≤70% was discussed, and additional clinical decision making statements were suggested. At round closure, a consensus vote took place on revised statements.RESULTSThe panel reached ≥97.8% consensus on AML management. The panel agreed to use international risk stratification categories for personalized treatment of AML. The presence of ≥10% blasts for recurrent genetic abnormalities was required for a diagnosis of AML. Key consensus was reached for different treatment stages. The panel noted that older patients pose a challenge because of poor cytogenetics and genetic anomalies and require different treatment approaches. The panel recommended venetoclax-hypomethylating agents; fludarabine, cytarabine, idarubicin, and granulocyte colony-stimulating factor; and targeted therapy for AML relapsed/refractory disease. Supportive care is considered on the basis of prevailing organisms and drug resistance.CONCLUSIONThe GCC KOQU's consensus-based recommendations for managing AML include an evidence-based and region-specific framework.

Purpose: The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles. Materials and Methods: The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intraperson before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies). Results: Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129–0.278; p

Background: The e-prescriptions service connects primary healthcare centers and hospitals to selected community pharmacies in various locations to allow easy access to the nearest pharmacy in the neighborhood, thus facilitating the process of drug dispensing. This study aims to assess patients' satisfaction towards Wasfaty services delivered by Ministry of Health healthcare centers. Materials and Methods: A cross-sectional study was conducted in Al Ahsa province in Saudi Arabia among adult patients who used Wasfaty services. An electronic Arabic questionnaire including demographic characteristics of patients and questions to assess their satisfaction level with the e-prescription “Wasfaty” service in terms of different aspects. Results: A total of 481 participants were included in the study. Females represented 53.4% of them, and 28.1% were aged 50 years or over. Overall, most of the patients (84.1%) were either satisfied or strongly satisfied with the service (4.28 ± 0.57). After controlling for confounding, patients with chronic diseases were more satisfied with the “wasfaty” service compared to those without chronic diseases. The history of chronic disease was responsible for approximately 2.4% variability of patient satisfaction (r-square = 0.024). Patients' geographic region, age, sex, and educational level were not significantly associated with their satisfaction with “wasfaty” service. Conclusion: The majority of patients, particularly those with chronic diseases, were satisfied with Wasfaty service. However, less satisfaction was observed regarding medication availability.

Ulcerative colitis (UC) is a persistent inflammatory intestinal disease that consistently affects the colon and rectum. Its exact cause remains unknown. UC causes a considerable challenge in healthcare, prompting research for novel therapeutic strategies. Although probiotics have gained popularity as possible candidates for managing UC, studies are still ongoing to identify the best probiotics or probiotic mixtures for clinical applications. This study aimed to determine the efficacy of a multi-strain probiotic mixture in mitigating intestinal inflammation in a colitis mouse model induced by dextran sulfate sodium. Specifically, a multi-strain probiotic mixture consisting of Tetragenococcus halophilus and Eubacterium rectale was used to study its impact on colitis symptoms. Anti-inflammatory effects were evaluated using ELISA and flow cytometry. The configuration of gut microbial communities was determined using 16S rRNA metagenomic analysis. According to this study, colitis mice treated with the probiotic mixture experienced reduced weight loss and significantly less colonic shortening compared to untreated mice. Additionally, the treated mice exhibited increased levels of forkhead box P3 (Foxp3) and interleukin 10, along with decreased expression of dendritic cell activation markers, such as CD40+, CD80+, and CD83+, in peripheral blood leukocytes and intraepithelial lymphocytes. Furthermore, there was a significant decrease in the frequencies of CD8+N.K1.1+ cells and CD11b+Ly6G+ cells. In terms of the gut microbiota, probiotic-mixture treatment of colitis mice significantly increased the abundance of the phyla Actinobacteria and Verrucomicrobia (p < 0.05). These results provide valuable insights into the therapeutic promise of multi-strain probiotics, shedding light on their potential to alleviate colitis symptoms. This research contributes to the ongoing exploration of effective probiotic interventions for managing inflammatory bowel disease.

Background: Marine ecosystems, covering 70% of Earth’s surface, hold immense biodiversity and potential for biomaterials. Cuttlefish bone (CB) and marine resources have gained attention as eco-friendly biomaterials. Objectives: We aim to comprehensively study biomedical applications of CB-derived materials. By evaluating both in vivo and in vitro investigations, the review seeks to uncover the diverse potential of CB in the biomedical field. Methods: A comprehensive search of electronic databases yielded 51 articles from 2408 studies. These studies encompassed in vivo animal studies and in vitro investigations. Results: In vivo studies employed for bone repair, dorsal subcutaneous defects, thermal wound healing, muscle injections, and avian blood testing. In vitro studies focused on HAp synthesis, scaffold development, dental material enhancement, and antimicrobial properties. Risk of bias assessments revealed varying degrees of methodological quality in both animal and in vitro studies, underscoring the need for standardised reporting and rigorous study design in future research. Conclusions: This review fills a gap in the literature by providing a comprehensive overview of the applications of CB-derived materials in the biomedical field. Additionally, it offers valuable insights for researchers, clinicians, and policymakers interested in sustainable and effective biomaterials for diverse medical purposes, advancing the fields of regenerative medicine and dentistry.

Abstract Background Protein intake is recommended in critically ill patients to mitigate the negative effects of critical illness-induced catabolism and muscle wasting. However, the optimal dose of enteral protein remains unknown. We hypothesize that supplemental enteral protein (1.2 g/kg/day) added to standard enteral nutrition formula to achieve high amount of enteral protein (range 2–2.4 g/kg/day) given from ICU day 5 until ICU discharge or ICU day 90 as compared to no supplemental enteral protein to achieve moderate amount enteral protein (0.8–1.2 g/kg/day) would reduce all-cause 90-day mortality in adult critically ill mechanically ventilated patients. Methods The REPLENISH (Replacing Protein Via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients) trial is an open-label, multicenter randomized clinical trial. Patients will be randomized to the supplemental protein group or the control group. Patients in both groups will receive the primary enteral formula as per the treating team, which includes a maximum protein 1.2 g/kg/day. The supplemental protein group will receive, in addition, supplemental protein at 1.2 g/kg/day starting the fifth ICU day. The control group will receive the primary formula without supplemental protein. The primary outcome is 90-day all-cause mortality. Other outcomes include functional and quality of life assessments at 90 days. The trial will enroll 2502 patients. Discussion The study has been initiated in September 2021. Interim analysis is planned at one third and two thirds of the target sample size. The study is expected to be completed by the end of 2025. Trial registration ClinicalTrials.gov Identifier: NCT04475666 . Registered on July 17, 2020.

Background Chronic constipation is common among children worldwide. Constipation includes functional constipation (FC) and organic constipation (OC). The early recognition of the causes of childhood constipation and its subsequent complications is important. Purpose This study aimed to evaluate the prevalence and causes of childhood constipation and compare the clinical characteristics, treatment, and outcomes of children with FC versus OC to identify the predictive factors. Methods This retrospective cross-sectional study analyzed children with FC or OC diagnosed in pediatric gastroenterology clinics, Salmaniya Medical Complex, Bahrain, 2017–2021. The Rome IV criteria were used to define FC. Results A total of 7,287 gastroenterology appointments were attended by 4,346 children during the study period. Of the 639 children (14.7%) with constipation, 616 (96.4%) were included in the study. Most patients had FC (n=511, 83%), whereas 17% (n=105) had OC. FC was more common in females than in males. Children with OC were younger (P

A key encapsulation mechanism (KEM{\mathsf{KEM}}) that takes as input an arbitrary string, i.e., a tag, is known as tag-KEM{\mathsf{KEM}}, while a scheme that combines signature and encryption is called signcryption. In this article, we present a code-based signcryption tag-KEM{\mathsf{KEM}} scheme. We utilize a code-based signature and an IND-CCA2{\mathsf{IND}}\hspace{0.1em}\text{-}\hspace{0.1em}{\mathsf{CCA2}} (adaptive chosen ciphertext attack) secure version of McEliece’s encryption scheme. The proposed scheme uses an equivalent subcode as a public code for the receiver, making the NP-completeness of the subcode equivalence problem be one of our main security assumptions. We then base the signcryption tag-KEM{\mathsf{KEM}} to design a code-based hybrid signcryption scheme. A hybrid scheme deploys asymmetric- as well as symmetric-key encryption. We give security analyses of both our schemes in the standard model and prove that they are secure against IND-CCA2{\mathsf{IND}}\hspace{0.1em}\text{-}\hspace{0.1em}{\mathsf{CCA2}} (indistinguishability under adaptive chosen ciphertext attack) and SUF-CMA{\mathsf{SUF}}\hspace{0.1em}\text{-}\hspace{0.1em}{\mathsf{CMA}} (strong existential unforgeability under chosen message attack).

Purpose: To assess the utility of using dynamic ultrasound for postoperative evaluation after superior capsular reconstruction (SCR) by evaluating graft integrity and its correlation with clinical outcomes at a minimum 2-year follow-up. Methods: A retrospective chart review was conducted to identify patients who underwent SCR between July 2015 and July 2020 with a minimum 2-year clinical and ultrasound follow-up. Clinical outcome measures included Simple Shoulder (SS) and American Shoulder and Elbow Surgeon (ASES) scores. Integrity of the SCR graft was evaluated by dynamic ultrasound. Results: We evaluated 22 shoulders in 21 patients with a mean follow-up of 44.8 months (range, 24-71 months). The graft was found to be intact by ultrasound evaluation in 82% (18/22). Patients with intact grafts had higher mean SS (11.6 vs 7.8, P = .00079) and ASES (91.2 vs 64.1, P = .0296) scores at latest follow-up compared to those with failed grafts. Those with intact grafts also had significant improvement in SS (3.7 vs 11.6, P < .00001) and ASES (23.2 vs 91.2, P < .00001) scores at latest follow-up compared to their preoperative scores. In contrast, patients with graft failure had no significant improvement in SS (6.3 vs 9.0, P = .123) and ASES (40.4 vs 58.3, P = .05469) scores at latest follow-up compared to their preoperative scores. There was no difference between clinical outcomes at 6 to 12 months vs latest follow-up for both SS (P = .11, P = .5) and ASES (P = .27, P = .21) scores. Conclusions: SCR grafts were found by ultrasound to be intact in 82% of cases. Patients with intact grafts on ultrasound had significant improvement in functional outcome scores while those with graft failure did not. Functional outcome scores suggest that maximal recovery from this procedure occurs by 6 to 12 months. Level of Evidence: Level IV, therapeutic case series.

Soybean (Glycine max L.) is an important crop in Asia, accounting for 17% of global soybean cultivation. However, this crop faces formidable challenges from the devastating foliar disease, Asian Soybean Rust (ASR), caused by Phakopsora pachyrhizi, a biotrophic fungus with a broad host range, causing substantial yield losses (10–100%) in Asia. This comprehensive review consolidates knowledge on ASR, encompassing its impact, historical perspectives, genetic diversity, epidemic drivers, early detection, risk assessment, and sustainable management strategies of ASR in the region. ASR has expanded globally from Asia, reaching Africa and Americas, driven by wind-dispersed urediniospores. Genetic diversity studies reveal the complexity of P. pachyrhizi, with distinct populations exhibiting varying virulence patterns. Factors affecting ASR epidemics in Asia include host susceptibility, landscape connectivity, climate, and environmental conditions. Understanding the interplay of these factors is essential for early intervention and control of ASR in soybean fields. Effectively managing ASR can exploit the utilization of diverse intervention strategies, encompassing disease forecasting, automated early detection, disease resistance, fungicide application, and biological control. A pivotal aspect of successful, sustainable disease management lies in reducing the ASR pathogen virulence and preventing it from developing fungicide resistance, while the highpoint of effectiveness in disease control is attained through a synergistic approach, integrating various strategies. In summary, this comprehensive review provides insights into multifaceted approaches that contribute to the development of sustainable and economically impactful soybean production in the face of the persistent threat of ASR in Asia.

Introduction. The objective of this study was to describe Do-Not-Resuscitate (DNR) practices in a tertiary-care intensive care unit (ICU) in Saudi Arabia, and determine the predictors and outcomes of patients who had DNR orders. Methods. This retrospective cohort study was based on a prospectively collected database for a medical-surgicalIntensive CareDepartment in a tertiary-care center in Riyadh, Saudi Arabia (1999–2017). We compared patients who had DNR orders during the ICU stay with those with “full code.” The primary outcome was hospital mortality. The secondary outcomes included ICU mortality, tracheostomy, duration of mechanical ventilation, and length of stay in the ICU and hospital. Results. Among 24790 patients admitted to the ICU over the 19-year study period, 3217 (13%) had DNR orders during the ICU stay. Compared to patients with “full code,” patients with DNR orders were older (median 67 years [Q1, Q3: 55, 76] versus 57 years [Q1, Q3: 33, 71], p

Infantile-onset multisystem neurologic, endocrine, and pancreatic disease (IMNEPD) is a rare autosomal recessive multisystemic disease with a prevalence of < 1/1 000 000. The wide spectrum of symptoms and associated diseases makes the diagnosis of this disease particularly challenging. Here, we report a 12-year-old Bahraini male who presented with the core clinical features of IMNEPD including intellectual disability, global developmental delay, sensorineural hearing loss, endocrine dysfunction, and exocrine pancreatic insufficiency. The diagnosis was confirmed by genetic testing using whole exome sequencing. This is the first reported case of IMNEPD from Bahrain and was found to have a novel homozygous peptidyl-tRNA hydrolase 2 (PTRH2) gene mutation (NM_001015509.2: c.370del p.(Glu124Lysfs*4)). Moreover, we conducted an extensive literature review with an emphasis on the variable clinical spectrum and genotypes of previously reported patients in comparison to our case.

Background: Spontaneous coronary artery dissection and takotsubo cardiomyopathy are increasingly recognized in the last two decades. Case reports have shown both entities can present concomitantly - however, little is known about their association. Methods: In this retrospective study we aimed to explore a potential association between SCAD and TCM using the Nationwide Inpatient Sample. The odds of having TCM among patients with SCAD compared with those who did not have SCAD were calculated as an odds ratio. Conversely, the odds of having SCAD among patients with TCM compared with those who did not have TCM were also calculated. The primary outcome was the odds of TCM among patients with a primary diagnosis of SCAD and vice versa. The secondary endpoint was the odds of in-hospital mortality among patients with SCAD, and/or TCM. Results: Hospitalized patients who had SCAD were 7.12 (95 % CI: 6.28–8.08) times more likely to also have TCM than those who did not have SCAD (p

Tocilizumab (TCZ) is recommended in patients with COVID-19 who require oxygen therapy or ventilatory support. Despite the wide use of TCZ, little is known about its safety and effectiveness in patients with COVID-19 and renal impairment. Therefore, this study evaluated the safety and effectiveness of TCZ in critically ill patients with COVID-19 and renal impairment. A multicenter retrospective cohort study included all adult COVID-19 patients with renal impairment (eGFR˂60 mL/min) admitted to the ICUs between March 2020 and July 2021. Patients were categorized into two groups based on TCZ use (Control vs. TCZ). The primary endpoint was the development of acute kidney injury (AKI) during ICU stay. We screened 1599 patients for eligibility; 394 patients were eligible, and 225 patients were included after PS matching (1:2 ratio); there were 75 TCZ-treated subjects and 150 controls. The rate of AKI was higher in the TCZ group compared with the control group (72.2% versus 57.4%; p = 0.03; OR: 1.83; 95% CI: 1.01, 3.34; p = 0.04). Additionally, the ICU length of stay was significantly longer in patients who received TCZ (17.5 days versus 12.5 days; p = 0.006, Beta coefficient: 0.30 days, 95% CI: 0.09, 0.50; p = 0.005). On the other hand, the 30-day and in-hospital mortality were lower in patients who received TCZ compared to the control group (HR: 0.45, 95% CI: 0.27, 0.73; p = 0.01 and HR: 0.63, 95% CI: 0.41, 0.96; p = 0.03, respectively). The use of TCZ in this population was associated with a statistically significantly higher rate of AKI while improving the overall survival on the other hand. Further research is needed to assess the risks and benefits of TCZ treatment in critically ill COVID-19 patients with renal impairment.

AbstractA novel, sensitive, economical, and environmentally friendly method is described for the quantitative determination of diphenhydramine hydrochloride (DPH). The method is based on the preparation of silver nanoparticles (AgNPs) from the extract of Capparis spinosa L. (CPL) fruits to determine DPH as one of the antihistamine drugs. The colour intensity of the solution increases with increasing DPH concentrations due to the interaction of AgNPs with DPH. FTIR, X-ray, EDX, SEM, and UV-Vis techniques characterised the prepared nanoparticles. The current method presented a linear relationship over the concentration range of 2–45 µg/mL at a wavelength of 415 nm. The detection limit (LOD) and quantitation limit(LOQ) are studied, and the values ​​are 0.36 and 1.19 µg/mL, respectively. The recovery percentage (accuracy function) is more than 99.5%, and the relative standard deviation (RSD%, as a precision function) was 0.73%. The molar absorptivity and Sandel’s sensitivity index are 5.14 × 103 L.mol−1.cm−1 and 0.057 µg.cm−2, respectively. The data were compared to those from other previous approaches using t-test and F-test with a 95% confidence level and found to be 2.107 and 3.18, respectively. According to the ICH guidelines (2005), the proposed method has been validated and provides promising results for determination of DPH in pure form and pharmaceutical preparations.

Abstract Background A thorough understanding of root and canal anatomy is crucial for successful root canal treatment outcomes. This systematic review aims to explore the published micro-CT studies investigated the anatomy of root and canal system in permanent mandibular first molars. Method An electronic search was performed on Web of science, PubMed, and Scopus. Micro-CT journal studies investigated the root and canal anatomy of permanent double-rooted mandibular first molars were included. Data on study characteristics, objectives of interest, specifications of the studies, and micro-CT specifications were extracted. Risk of bias assessment (ROB) of the included studies was performed using Anatomical Quality Assessment (AQUA) tool. The extracted data were presented in tables and figures to present and synthesise the results. A meta-analysis was performed for the studies related to the prevalence of Vertucci's canal configurations, middle mesial canal (MMC) configurations, and Fan's isthmus types. Results Amongst 1358 identified studies, thirty met the inclusion criteria. In terms of the objectives, the selected studies showed high anatomical variability in mandibular first molars. Twenty-two (73%), 25 (83%), and 12 (40%) of the studies reported the population/ethnicity, micro-CT specifications, and ethical approval, respectively. 28 (93%) studies did not disclose the method of sample size estimation. In only 6 (20%) of the studies, the authors had calibrated the assessment approaches. Mostly, a potential ROB was reported in domain 1 (objective(s) and subject characteristics) and domain 3 (methodology characterization). Whilst, low risk was reported in domains 2 (study design), 4 (descriptive anatomy), and 5 (reporting of results). The overall ROB was reported to be ''moderate'' in the vast majority of the studies (27/30). Meta-analysis results showed high levels of heterogeneity among the studies related to MMCs (I 2 = 86%) and Fan's isthmus (I 2 = 87%). As for the root canal configuration, pooled prevalence showed that Vertucci type IV and type I were the most prevalent in mesial and distal root canals, respectively. Conclusion Based on moderate risk of bias level of evidence, micro-CT studies have shown wide range of qualitative and quantitative data presentations of the roots and canals in mandibular first molars. Protocol and registration. The protocol of this systematic review was prospectively registered in the Open Science Framework database ( https://osf.io ) on 2022–06-20 with the registration number 10.17605/OSF.IO/EZP7K.

Abstract Prior research looking at Arab experiences in media education, despite its importance, did not provide a comprehensive evaluation of the curricula and study plans in Arab media colleges and departments but rather treated media education in a narrow and partial way. Therefore, this study fills this research gap by analysing the curricula of 21 media colleges, departments and institutes in 10 Arab countries from a perspective related to pressing issues of the Arab world, namely, the issues of diversity, pluralism, rights and freedoms. Three levels of content analysis were adopted to evaluate media education in the Middle East and North Africa—specifically, the learning objectives for managing diversity and differences based on UNESCO’s Media and Information Literacy Curriculum for Educators and Learners. The results showed that 33.2% (79 out of 238) of the total number of learning objectives in the UNESCO curriculum were specific to the skills of managing diversity. The study classified them into five main areas: promoting human rights, equality, pluralism, the culture of dialogue, and the commitment to ethics. Emphasis on adherence to media ethics was the most evident in all of the Arab academic plans, followed by, to a lesser extent, the emphasis on promoting the culture of dialogue, peace, and understanding, and finally promoting human rights. The weaknesses were represented in the lack of clarity on the items related to pluralism, democratic practice, equality, and the empowerment of women. The paper concludes with a discussion of the importance of adopting deeper methods of analysis to evaluate the items on enhancing diversity management in all Arab education curricula, in addition to the importance of establishing a practical discussion among decision-makers and experts to integrate new media education into the curricula of media students in line with advanced international experiences and take into account the notion of cultural privacy.

Abstract Background This study assessed the mobility levels among critically ill patients and the association of early mobility with incident proximal lower-limb deep-vein thrombosis and 90-day mortality. Methods This was a post hoc analysis of the multicenter PREVENT trial, which evaluated adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis with an expected ICU stay ≥ 72 h and found no effect on the primary outcome of incident proximal lower-limb deep-vein thrombosis. Mobility levels were documented daily up to day 28 in the ICU using a tool with an 8-point ordinal scale. We categorized patients according to mobility levels within the first 3 ICU days into three groups: early mobility level 4–7 (at least active standing), 1–3 (passive transfer from bed to chair or active sitting), and 0 (passive range of motion). We evaluated the association of early mobility and incident lower-limb deep-vein thrombosis and 90-day mortality by Cox proportional models adjusting for randomization and other co-variables. Results Of 1708 patients, only 85 (5.0%) had early mobility level 4–7 and 356 (20.8%) level 1–3, while 1267 (74.2%) had early mobility level 0. Patients with early mobility levels 4–7 and 1–3 had less illness severity, femoral central venous catheters, and organ support compared to patients with mobility level 0. Incident proximal lower-limb deep-vein thrombosis occurred in 1/85 (1.3%) patients in the early mobility 4–7 group, 7/348 (2.0%) patients in mobility 1–3 group, and 50/1230 (4.1%) patients in mobility 0 group. Compared with early mobility group 0, mobility groups 4–7 and 1–3 were not associated with differences in incident proximal lower-limb deep-vein thrombosis (adjusted hazard ratio [aHR] 1.19, 95% confidence interval [CI] 0.16, 8.90; p = 0.87 and 0.91, 95% CI 0.39, 2.12; p = 0.83, respectively). However, early mobility groups 4–7 and 1–3 had lower 90-day mortality (aHR 0.47, 95% CI 0.22, 1.01; p = 0.052, and 0.43, 95% CI 0.30, 0.62; p

This study discusses the overall performance of the behavior the shear stud in the composite steel beam. The work has been modeled by using ANSYS APDL program. Under of the influence of lateral horizontal pressure. The analyzed structure is a composite of beam-slab. The beam section is (254 X 254 X 73 kg/m) with slab of (1600 mm length, 1200 mm width and 150 mm height) and 6 headed studs 19mm diameter with 100 mm high featuring a single row of pointed studs spaced at 150 mm intervals. First, the study was placed on 200 mm from the end of the slabs on both sides. Headed studs and the value of the limited load are the most relevant dimensions for the aims of this study. One parameter was changed which was the load value. The resulted composite steel was analyzed for each change in the parameters. The results were compared to those from the experimental which revealed a possible alternate analysis that included the selected changes. Besides, the Von-mises stresses and stress intensity have been studied. It was found through structural analysis that there were stresses in the area of the studs which they are resistance to horizontal slips caused by lateral pressure loading. Four composite steel were evaluated at each parameter and were checked with the other factors. For this aim a utilizing parametric analysis software using ANSYS. Language of Design (APDL) was constructed to examine the behavior of the structure.

Abstract Background Globally, the increased use of cesarean sections has become prevalent in high-income and low and middle-income countries. In Palestine, the rate had risen from 20.3% in 2014 to 25.1% in 2018. We have rates as high as 35.8% in some governmental hospitals and some as low as 15%. This study aimed to understand better why there is a variation in cesarean rates in governmental hospitals that use the same guidelines. Methods A qualitative and quantitative research approach was used. In-depth interviews were conducted with 27 specialists, obstetrics and gynecologists, and midwives in five government hospitals. The hospitals were selected based on the 2017 Annual Health Report reported cesarean section rates. The interview guide was created with the support of specialists and researchers and was piloted. Questions focused mainly on adherence to the obstetric guidelines and barriers to the use, sources of information, training for healthcare providers, the hospital system, and the factors that affect decision-making. Each hospital's delivery records for one month were analyzed to determine the reason for each cesarean section. Results The results indicated that each governmental hospital at the system level had a different policy on cesarean sections. The National Guidelines were found to be interpreted differently among hospitals. One obstetrician-gynecologist decided on a cesarean section at high-rate hospitals, while low-rate hospitals used collective decision-making with empowered midwives. At the professional level, all hospitals urged the importance of a continuous training program to refresh the medical team knowledge, in-house training of new members joining the hospital, and discussion of cases subjective to obstetrician-gynecologists interpretations. Conclusion Several institutional factors were identified to strengthen the implementation of the national obstetric guidelines. For example, encouraging collective decision-making between obstetrician-gynecologists and midwives, promoting the use of a second opinion, and mandatory training.

Abstract Background Thrombotic events are common in critically ill patients with COVID-19 and have been linked with COVID-19- induced hyperinflammatory state. In addition to anticoagulant effects, heparin and its derivatives have various anti-inflammatory and immunomodulatory properties that may affect patient outcomes. This study compared the effectiveness and safety of prophylactic standard-doses of enoxaparin and unfractionated heparin (UFH) in critically ill patients with COVID-19. Methods A multicenter, retrospective cohort study included critically ill adult patients with COVID-19 admitted to the ICU between March 2020 and July 2021. Patients were categorized into two groups based on the type of pharmacological VTE thromboprophylaxis given in fixed doses (Enoxaparin 40 mg SQ every 24 hours versus UFH 5000 Units SQ every 8 hours) throughout their ICU stay. The primary endpoint was all cases of thrombosis. Other endpoints were considered secondary. Propensity score (PS) matching was used to match patients (1:1 ratio) between the two groups based on the predefined criteria. Multivariable logistic, Cox proportional hazards, and negative binomial regression analysis were used as appropriate. Results A total of 306 patients were eligible based on the eligibility criteria; 130 patients were included after PS matching (1:1 ratio). Patients who received UFH compared to enoxaparin had higher all thrombosis events at crude analysis (18.3% vs. 4.6%; p-value = 0.02 as well in logistic regression analysis (OR: 4.10 (1.05, 15.93); p-value = 0.04). Although there were no significant differences in all bleeding cases and major bleeding between the two groups (OR: 0.40 (0.07, 2.29); p-value = 0.31 and OR: 1.10 (0.14, 8.56); p-value = 0.93, respectively); however, blood transfusion requirement was higher in the UFH group but did not reach statistical significance (OR: 2.98 (0.85, 10.39); p-value = 0.09). The 30-day and in-hospital mortality were similar between the two groups at Cox hazards regression analysis. In contrast, hospital LOS was longer in the UFH group; however, it did not reach the statistically significant difference (beta coefficient: 0.22; 95% CI: -0.03, 0.48; p-value = 0.09). Conclusion Prophylactic enoxaparin use in critically ill patients with COVID-19 may significantly reduce all thrombosis cases with similar bleeding risk compared to UFH.

In this study, natural fibers were extracted from Imperata cylindrica (ICY) by mechanical fractionation followed by characterization. The morphological, microstructural, and thermal properties of ICY fibers were examined by scanning electron microscopy (SEM), energy-dispersive X-ray, and thermal gravimetric analysis (TGA). Kinetic analysis was examined through Flynn Wall Ozawa (FWO) and Kissinger Akahira Sunose (KAS) models. Results showed that mechanical fractionation successfully extracted natural fibers from ICY. SEM analyses revealed a compact surface structure interrupted by contours and protrusions due to disoriented fractionation of the fibers. Thermal analysis revealed significant mass loss (72.94–77.03%), whereas the TG/DTG plots shifted correspondingly due to multiple heating rates (10–30°C/min) and thermal lag during TGA from 30 to 800°C. Likewise, the onset, midpoint, offset, drying, and devolatilization peak temperatures increased at higher heating rates. Tons increased from 257.99–269.25°C, whereas Tmid was 313.57–319.17°C, Toff was 363.70–376.58°C. The OFW and KAS kinetic models revealed activation energy (Ea) and frequency factor (ko) ranged from 38.09 to 514.33 kJ mol−1 and 1.65 × 1002 to 1.24 × 1048 min−1, respectively, for conversions α = 0.05 to 0.95, which indicate ICY fibers are thermally stable and suitable for utilization as bio-composite reinforcement.

Abstract Background At present, there are still controversies about the influence of orthodontic treatment on the size of upper airway and the position of hyoid bone. We investigated the effect of orthodontic vertical control therapy on the size of the upper airway and position of the tongue and hyoid bone in adult patients with hyperdivergent skeletal Class II. Methods Overall, 15 adults with hyperdivergent skeletal Class II and normal occlusion, respectively, were selected as the experimental and control groups. The angle and line of the craniofacial structure, upper airway, hyoid bone position and three-dimensional (3D) upper airway indexes were measured using the Uceph 4.2.1 standard version and Mimics 21.0 software, respectively. The paired t-test, Wilcoxon symbol rank test, t-test of two independent samples, two independent sample nonparametric tests, Mann–Whitney U test, Pearson correlation analysis, the Univariate linear regression analysis and Multiple linear regression analysis were performed. Results After treatment, the S-Go/N-Me (%) and the MP-SN and XiPm-SN angles were significantly different (P

Abstract Background This study aimed to three-dimensionally evaluate the qualitative and quantitative maxillary basal, dentoalveolar, and dental dimensions in patients with unilateral or bilateral maxillary impacted canines relative to their normal peers. Materials and methods This is a retrospective comparative study. Cone-beam computed tomography images of one hundred and fifty adult patients were divided into three equal groups: unilateral, bilateral, and control groups. Each had 50 patients that were three-dimensionally analysed. The quantitative measurements involved three basal (molar basal width, premolar basal width, and arch depth), seven dentoalveolar (molar alveolar width, premolar alveolar width, inter-molar width, inter-premolar width, inter-canine width, arch length, and arch perimeter), and two dental (canine length and width) measurements. The qualitative measurements included four bone density areas (buccal, lingual, mesial, and distal) around the maxillary impacted canines. Result Differences between the three groups were statistically different for the quantitative measurements involving the two basal variables (molar basal width and premolar basal width) and all measured dentoalveolar variables; these were smaller in the unilateral and bilateral groups compared with the control group (p

Abstract Background and Aims Despite the significant milestone of vaccine discovery, the spread of misinformation and pseudoscientific claims has resulted in an increasing number of people refusing vaccination in Syria. In this study, we aimed to explore fears and misconceptions towards COVID‐19 vaccines among the Syrian population. Methods We conducted a nationwide cross‐sectional study between January and May 2022, using a convenience sample of 10,006 participants aged at least 18 years and living in Syria. We administered a validated online/paper questionnaire and conducted face‐to‐face interviews. We used SPSS software (version 26) for statistical analysis, assessing our data using frequency and χ2 tests, with p

Sustainability is providing the needs without compromising the ability of the strategical forming to meet their requirements. The production of warm asphalt mixtures using recycled pavements produces economic and environmentally friendly mixtures, which is the most important advantage of this work. This research aims to determine the effect of recycled asphalt concrete (RAP) on the indirect tensile strength of warm asphalt mixtures and Marshall Properties. Models of warm asphalt mixtures using Aggregate from the Al-Nibaay quarry, Asphalt with a degree of penetration (40-50) from the refinery of the cycle, and obtained Recycled asphalt concrete from Salah Al-Din Road, Al-Ameriya area in Baghdad are prepared. Use five ratios of (0, 10, 20, 30, and 40%) of recycled asphalt concrete. Marshall Design method is adopted to estimate the perfect existence of the asphalt cement for sample preparation. The mixtures properties, volumetric properties, and indirect tensile strength test are evaluated to assess bonding strength. Results show that the increase in the replacement percentage of RAP causes an increase in flow and air void and decreases the bulk density, voids in mineral aggregate (VMA), and voids filled with Asphalt (VFA). Stability increases with increased RAP content until it reaches its peak and falls. The highest stability value is at 30% RAP by 58%, about the indirect tensile strength test. The increase in the RAP ratio increases the tensile strength and the bonding between the components. So including RAP material in warm asphalt mixtures improves properties and meets performance requirements.

A new pavement technology has been developed in Highway engineering: asphalt pavement production is less susceptible to oxidation and the consequent damages. The warm mix asphalt (WMA) is produced at a temperature of about (10-40) oC lower than the hot asphalt paving. This is done using one of the methods of producing a WMA. Although WMA's performance is rather good, according to previous studies, as it is less susceptible to oxidation, it is possible to modify some of its properties using different materials, including polymers. Waste tires of vehicles are one of the types of polymers because of their flexible properties. The production of HMA, WMA, and WMA modified with proportions of (1, 1.5, and 2%) of rubber crumbs by the dry method are accomplished in this work. Marshall Test and volumetric properties determination are performed to evaluate its performance. The results showed that using 1% of rubber crumbs as a replacement for fine aggregate in the warm asphalt mixture produced the best properties of the WMA compared to the conventional WMA.

The simulate microphysical processes in the atmosphere, a cloud chamber, which behaves as the atmosphere, has been designed and fabricated in order to be used to execute several atmospheric experiments. These experiments allow a better understanding of clear visual cloud formation. The executed temperature and saturated pressure experiments clarify the basic mechanisms of the ice crystals nucleation, which in contrast, represent the core of the cloud microphysics. The cloud chamber can represent an isolated environment that deals with a certain volume of pure air and contains certain nucleation particles or ice nuclei. The temperature range in such a chamber is similar to that found at the mid-latitudes between the surface of the earth and the top of the troposphere. Thus, it is possible to simulate clouds of the type of Cirrostratus at the bottom of the chamber. It has been designed with dimensions of 22×22×59 cm3 and made of 3mm in thickness copper with a purity of 99.9%, and thermal conductivity of 401 W/m.°K.

Background: Antibiotic-resistant Acinetobacter baumannii is a continuously-emerging worldwide health crisis, with mortality rates approaching 50% in intensive care unit (ICU) patients. The objective of this study was to evaluate regional, patient-related, and organism-related predictors of survival among critically-ill patients with confirmed Acinetobacter infection. Methods: This prospective cohort study was conducted within ten ICUs across six geographically- and climatologically-distinct cities across Saudi Arabia over 13 months. Results: Of 169 patients with confirmed Acinetobacter infection enrolled in the study, 80 (47.6%) died. Survivors were statistically younger, predominantly male, more likely to be admitted for trauma, less likely to have hypertension, diabetes, or have undergone hemodialysis, and more likely to have been treated with antibiotics prior to having a positive culture for Acinetobacter, but less likely to have received an aminoglycoside. Survivors also had lower baseline APACHE II and SOFA scores and were infected with stains of Acinetobacter that had less meropenem- or colistin-resistance. Multivariate analysis identified the following independent predictors of survival: younger age, lower ICU-day#1 APACHE-II and ICU-day#3 SOFA scores, being admitted for trauma, and having no history of hemodialysis. Conclusions: Patient-related factors outweigh regional and hospital-related factors as predictors of survival among critically-ill patients with Acinetobacter infection.

Objectives: Though the prevalence of biliary atresia (BA) in the Middle East is low, its role in causing life-threatening liver diseases is disproportionately high. This study aimed to assess the prevalence, clinical presentations, diagnosis, surgical interventions, and long-term outcomes including survival rate, and to analyze prognostic factors affecting the survival of infants with BA in Bahrain. Methods: A retrospective cohort review of cases of infants diagnosed with BA between January 1993 and December 2021 at Salmaniya Medical Complex, Bahrain, was conducted. Demographic, clinical, laboratory, imaging, and histopathological data were analyzed. Outcomes measured included 5-year native liver survival (NLS) and overall liver survival (OLS) rates. Results: Out of 27 infants diagnosed with BA, 26 were included in the study. The overall prevalence was 0.007% and was significantly higher among Bahraini (0.006%) compared to the non-Bahraini population (0.001%), p< 0.001. Most patients had clay-colored stool (19 of 22; 86.4%) and hepatomegaly (18; 81.8%). Kasai procedure was performed in 23 (88.5%) patients and primary liver transplant (LT) in three. Ten (38.5%) infants required LT after the Kasai procedure. The median age at diagnosis was 56 days with interquartile range (IQR) of 30–90, and the median age at the Kasai procedure was 61 days (IQR = 56–90). NLS and OLS rates were 53.8% and 65.4%, respectively. The overall mortality rate was 34.6%. Six of the 13 (46.2%) patients who were subjected to Kasai procedure alone died awaiting LT donors. Infants with lower birth weight and older age at diagnosis had significantly better odds of survival (p< 0.029 and p< 0.044, respectively). Conclusions: BA is uncommon among infants in Bahrain. Despite effective treatment options, late diagnosis can lead to significant morbidity and mortality. Our study found a relatively low prevalence of NLS (53.8%) and OLS (65.4%). Since the majority of the diagnosed patients had presented with clay-colored stools, implementing an infant stool card for screening may be beneficial in raising parental awareness and detecting BA early. Early detection and treatment using novel therapies are likely to improve the survival rates.

Abstract There are contradictory data regarding the effect of intermittent pneumatic compression (IPC) on the incidence of deep-vein thrombosis (DVT) and heart failure (HF) decompensation in critically ill patients. This study evaluated the effect of adjunctive use of IPC on the rate of incident DVT and ventilation-free days among critically ill patients with HF. In this pre-specified secondary analysis of the PREVENT trial (N = 2003), we compared the effect of adjunctive IPC added to pharmacologic thromboprophylaxis (IPC group), with pharmacologic thromboprophylaxis alone (control group) in critically ill patients with HF. The presence of HF was determined by the treating teams according to local practices. Patients were stratified according to preserved (≥ 40%) versus reduced (

Abstract Background Understanding the anatomical relationship between the maxillary sinus floor (MSF) and the posterior maxillary teeth (PMT) is important when planning the orthodontic intrusion of the posterior teeth. This study aimed to determine the vertical relationship between posterior maxillary teeth and maxillary sinus floor in different skeletal classes in the Chinese adult population. Methods This is a retrospective cross-sectional study involved cone beam computed tomography images of 298 adult patients (145 males and 153 females) between 20 and 45 years old. The sample was categorized according to A point, Nasion, B point (ANB) angle into 102 Class I, 102 Class II, and 94 Class III malocclusion. Non-parametric Wilcoxon Mann–Whitney U and Kruskal–Wallis tests were used to compare the studied groups. The Intra-class Correlation Coefficient (ICC) was used to assess the intra- and inter-observer reliability analysis. Results Overall, there was a statistically significant difference in the mean distance between both genders (P

The current pandemic of the novel coronavirus disease 2019 (COVID-19) originated in Wuhan, China in December 2019. The most common clinical manifestations are fever, fatigue, and cough. Other common symptoms include anorexia, chest tightness and shortness of breath. Extrapulmonary manifestations including gastrointestinal symptoms were also reported in patients with COVID-19 infection. It has been found that the ACE2 receptor of SARS-CoV-2 is expressed more in the pancreas than in the lungs. However, only few cases reported with pancreatic injury were caused by COVID-19. In this paper, we report a young patient presenting with acute necrotizing pancreatitis that is complicated with portal vein thrombosis and found to have COVID-19 infection.

Abstract Background Noninvasive respiratory support is frequently needed for patients with acute hypoxemic respiratory failure due to coronavirus disease 19 (COVID-19). Helmet noninvasive ventilation has multiple advantages over other oxygen support modalities but data about effectiveness are limited. Methods In this multicenter randomized trial of helmet noninvasive ventilation for COVID-19 patients, 320 adult ICU patients (aged ≥14 years or as per local standards) with suspected or confirmed COVID-19 and acute hypoxemic respiratory failure (ratio of arterial oxygen partial pressure to fraction of inspired oxygen < 200 despite supplemental oxygen with a partial/non-rebreathing mask at a flow rate of 10 L/min or higher) will be randomized to helmet noninvasive ventilation with usual care or usual care alone, which may include mask noninvasive ventilation, high-flow nasal oxygen, or standard oxygen therapy. The primary outcome is death from any cause within 28 days after randomization. The trial has 80% power to detect a 15% absolute risk reduction in 28-day mortality from 40 to 25%. The primary outcome will be compared between the helmet and usual care group in the intention-to-treat using the chi-square test. Results will be reported as relative risk and 95% confidence interval. The first patient was enrolled on February 8, 2021. As of August 1, 2021, 252 patients have been enrolled from 7 centers in Saudi Arabia and Kuwait. Discussion We developed a detailed statistical analysis plan to guide the analysis of the Helmet-COVID trial, which is expected to conclude enrollment in November 2021. Trial registration ClinicalTrials.gov NCT04477668 . Registered on July 20, 2020