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Integrating Artificial Intelligence (AI) in higher education presents opportunities and ethical challenges, particularly regarding the increase in students submitting AI-generated assessments. This trend calls for ethical engagement from faculty and students to ensure that AI supports learning without diminishing cognitive skills. Despite existing academic integrity policies, the complexities of AI introduce new dilemmas, often blurring the lines of misconduct and unintentional deception. Focusing on a Chinese-British Sino-Foreign university where students used increasing amounts of AI- generated content from ChatGPT in their Entrepreneurship project, the study emphasises the necessity of critically evaluating AI-generated content due to potential biases and ethical concerns. Through qualitative interviews with 24 participants from the university's Entrepreneurship and Enterprise Hub, issues of transparency, fairness, and policy development emerged as central themes. The findings emphasize the need for a structured, culturally sensitive approach to AI integration. A proposed curriculum matrix aims to facilitate responsible AI usage, supporting faculty in promoting ethical standards while preparing students for a tech-driven workforce. The study concludes by advocating for ongoing dialogue and professional development to foster responsible AI practices in education, ultimately enhancing critical thinking and ethical decision-making in entrepreneurship.

Abstract Background Among gynaecological malignancies, endometrial cancer (EC) is the most prevalent type of uterine cancer affecting women. This study explored the proteomic profiles of plasma samples obtained from EC patients, those with hyperplasia (Hy), and a control group (CO). A combination of techniques, such as 2D-DIGE, mass spectrometry, and bioinformatics, including pathway analysis, was used to identify proteins with modified expression levels, biomarkers and their associated metabolic pathways in these groups. Methods Thirty-four patients, categorized into three groups—10 with EC, 12 with Hy, and 12 CO—between the ages of 46 and 75 years old were included in the study. Untargeted proteomic analysis was carried out using two-dimensional difference in gel electrophoresis (2D-DIGE) coupled with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Results In all three groups, 114 proteins that were significantly (p ≤ 0.05 and fold change ≥ 1.5) altered were successfully identified using peptide mass fingerprints (PMFs). Compared with those in the control group (CO), the EC samples had 85 differentially expressed proteins (39 upregulated and 46 downregulated), and in the Hy group, 81 proteins were dysregulated (40 upregulated and 41 downregulated) compared to those in the CO group, while 33 proteins exhibited differential regulation (12 upregulated and 21 downregulated) in the EC plasma samples compared to those in the Hy group. Vitamin D binding protein and complement C3 distinguished Hy and EC from CO with the greatest changes in expression. Among the differentially expressed proteins identified, enzymes with catalytic activity represented the largest group (42.9%). In terms of biological processes, most of the proteins were involved in cellular processes (28.8%), followed by metabolic processes (16.7%). STRING analysis for protein interactions revealed that the significantly differentially abundant proteins in the three groups are involved in three main biological processes: signalling of complement and coagulation cascades, regulation of insulin-like growth factor (IGF) transport and uptake by insulin-like growth factor binding proteins (IGFBPs), and plasma lipoprotein assembly, remodelling, and clearance. Conclusion The identified plasma protein markers have the potential to serve as biomarkers for differentiating between EC and Hy, as well as for early diagnosis and monitoring of cancer progression.

Objectives: Finding radical solutions to it, considering the workforce as the tool implementing all agricultural operations, as well as keeping pace with the development that is taking place in agricultural production because it is considered one of the important economic activities in Anbar Governorate in general and the countryside of Ramadi District in particular. Method: The research relied on the analytical-deductive approach to identify the problems and obstacles that directly affected the agricultural workforce in Ramadi district. Results: An increase in the population of rural families in 2021 in the provinces that own large and spacious agricultural lands, where they witnessed stability on both sides of the Euphrates River due to the environmental conditions and fertile soil in the study area, in addition to the available community services. An increase in the agricultural labor force for the youth group in the provinces with large areas. And the large ones for agriculture, as they are the breadwinners for the two groups of less than (15) young people, and those older than (65) of the elderly group. Conclusion: The agricultural labor force is of great importance and strong connection in agricultural operations and the production of crops such as vegetables, while the importance of the agricultural labor force in grain crops decreases due to the use of agricultural mechanization in managing its agricultural operations

The study aims to know the demographic characteristics of the labor force, clarify the effects and their distribution according to the statistical standards that are followed, shed light on their productive activity, reveal the phenomenon of unemployment for the labor force and indicate the extent of its impact and impact on the agricultural activity. The basis for production and its increase. Given the importance of agricultural activity as one of the important economic activities in Iraq in general and in the countryside of Ramadi district in particular, since this activity relies heavily on human forces in agriculture as an important factor of change. The impact of human labor forces on the productivity of agricultural lands in particular comes through The characteristics of these forces, represented by the number, type, experience, and skill that distinguished these human forces, and given this importance, this research topic has been chosen.مشکلة الدراسة:تمثل الخطوة الأولى من خطوات البحث العلمی اختیار مشکلة البحث وتحدیدها بدقة، وأن أصعب مهام الباحث فی البدایة تحدید المشکلة ولهذا السبب یجب أن یکون أی بحث متضمن مشکلة اساسیة، والتی لها الدافع الرئیسی للبحث ویمکن تحدید مشکلة البحث بالسؤال التالی:هل هناک علاقة بین الخصائص السکانیة للأیدی العاملة الزراعیة والإنتاج الزراعی؟فرضیة البحث:وان کانت هناک مشکلة للبحث لابد أن تکون هناک فرضیــة البحث کجواب لمشکلة البحث.یرتبط الإنتاج الزراعی من حیث النوع والکم بعلاقات ارتباط مکانیة مع الخصائص السکانیة للأیدی العاملة الزراعیة.حدود منطقة البحث:

Concrete-filled steel tube (CFST) columns, incorporating various types of concrete, are increasingly prevalent in engineering applications. This study develops a finite element (FE) model and a design methodology for rectangular dune sand-concrete-filled steel tube (DS-CFST) columns. Investigating the composite behavior of rectangular DS-CFST columns and the effects of different DS replacement ratios, the results indicate a reduction in the ultimate bearing capacity compared to traditional CFST columns, attributed to diminished confinement effects, particularly at higher DS replacement ratios. Analysis of different design factors, including concrete and steel strengths, steel ratio, and aspect ratio, assesses their impacts on axial load-bearing capacity and composite behavior. This analysis leads to the establishment of a design formula, validated through experiments and FE analysis. The formula's efficacy and conciseness are evaluated against current design codes, with a reliability study assessing sensitivity to fluctuations. The proposed formula demonstrates accurate predictions of the ultimate load-bearing capacity.

Abstract Background Numerous challenges have crippled the Afghan healthcare system on individual, organizational, and societal levels. The Afghans have acknowledged that an evidence-based perspective is paramount to enhancing medical training capacities across the country, which may, in turn, best ensure appointing highly competent authorities to address health system problems on such multiple levels. Objectives This study assessed current Afghan senior medical students’ perceptions, and experiences of their medical education and their future professional intentions. Methods We conducted this cross-sectional study at seven public and private Afghan medical institutes from March to April 2022. We invited 665 senior medical students through an anonymous survey using the Google survey online forms via social-media platforms, such as WhatsApp Messenger. Descriptive statistics were employed for the data analyses. Results The mean age (± SD) of the students was 23.7 (± 2.2) years and males constituted 79.9% (510) of the study sample. About 22.6% of them rated their medical training as excellent, and nearly a third of them (37%) said that it is good. Nearly half (48.7%) of the students would prefer to stay in Afghanistan. The leading motives for moving overseas were to obtain more advanced and quality education (69.9%), and a decent personal life (43.9%). Nearly two-thirds (67.4%) of them asserted that current political and armed conflicts in Afghanistan may have influenced their professional choices. Conclusion This study epitomizes that the quality of medical education in Afghanistan has room for growth and development to meet the standards set on regional and global grounds.

An innovative composite structural element, the dune sand concrete-filled circular steel tube (DS-CFCST) column combines the mechanical performance of concrete-filled steel tube (CFST) columns with the environmental and economic benefits of dune sand (DS) concrete. However, current experimental investigations into DS-CFCST columns’ axial compressive behavior are limited. This study conducts a numerical analysis to examine the effects of varying DS replacement ratios and the influence of confinement on DS-CFCST stub columns. Finite element (FE) analysis reveals that DS-CFCST stub columns exhibit reduced ultimate bearing capacity compared to CFST columns, primarily due to weakened confinement effects at higher DS replacement ratios. A parametric study investigated the impacts of various design parameters on the ultimate axial bearing capacity of DS-CFCST stub columns. A practical design formula, based on equilibrium principles and the FE model, was developed. This formula simplifies the prediction of the ultimate load-bearing capacity of DS-CFCST stub columns using the superposition method. Its accuracy was validated by comparing it with experimental data and FE results. Lastly, a reliability analysis was performed, showing the DS-CFCST columns’ reliability index sensitivity to variations in concrete strength, steel yield strength, steel content ratio, load effect ratio, load combination factor, and DS replacement ratio.

Abstract The Bénard problem consists in a system that couples the well-known Navier–Stokes equations and an advection-diffusion equation. In thin varying domains this leads to the g-Bénard problem, which turns out to be the classical Bénard problem when g is constant. The main goal of this paper is to, first of all, introduce the g-Bénard problem with time-fractional derivative of order α ∈ ( 0 , 1 ) $\alpha \in (0,1)$ . This formulation is new even in the classical Bénard problem, that is with constant g. The second goal of this paper is to prove the existence and uniqueness of a weak solution by means of the Faedo–Galerkin approximation method. Some recent works on time-fractional Navier–Stokes equations have opened new perspectives in studying variational aspects in problems involving time-fractional derivatives.

Background: Placental chorangiosis is a response to fetal hypoxia, linked to be associated with maternal/fetal disorders and higher mortality rates. Therefore, this study aimed to explore the association of placental chorangiosis with specific maternal clinical risk factors, as well as its impact on pregnancy outcomes compared to pregnancies with normal placental conditions. Methods: This retrospective case-control study was conducted at King Saud University Medical City (KSUMC) between September 2018 and December 2021. A total of 78 pregnant women were included, and 26 cases of placental chorangiosis were identified and included in the study, which were randomly matched to 52 controls. The demographic data of maternal factors (age, body mass index (BMI), type of gestation, gravidity, and parity) and pregnancy outcomes (abortion, gestation age at delivery, mode of delivery, born alive or not, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score at 1 and 5 minutes, birth weight, and mean placental weight) were retrieved from the patient’s medical records, all placental histopathological examination were reviewed. Simple and multiple logistic regression analysis were used, and crude and adjusted odds ratios (ORs) and relative risk (RR) were reported with a 95% confidence interval (95% CI). Results: None of the potential maternal risk factors (age, BMI, type of gestation, gravidity, and parity) were statistically associated with chorangiosis. Chorangiosis, however, exhibit statistically significant associations with an increased number of abortions (RR: 21.59, 95% CI: 1.24–376.20, p = 0.003), intrauterine fetal death (IUFD; RR: 4.50, 95% CI: 1.53–13.25, p = 0.004), and low neonatal APGAR scores at 5 minutes (RR: 3.31, 95% CI: 1.22–9.01, p = 0.029). Conclusion: Placental chorangiosis is a rare pathological change in the placenta resulting from the interaction of several maternal and fetal disorders. When present, it can serve as an important indicator of chronic fetal hypoxia and predict poor obstetrical outcomes.

Uterine cancer is the most prevalent gynecologic malignancy in women worldwide. Endometrial cancer (EC) has an 81% five-year survival rate, depending on disease stage and time of diagnosis. While endometrial cancer is largely treatable when detected early, no established screening techniques are available in clinical practice. As a result, one of the most significant issues in the medical field is the development of novel ways for early cancer identification, which could boost treatment success rates. Liquid chromatography–high-resolution mass spectrometry (LC-HRMS)-based metabolomics was employed to explore the metabolomic markers and pathways unique to this cancer type and link them to the benign endometrial hyperplasia that may progress to cancer in 5% to 25% of patients. The study involved 59 postmenopausal participants, 20 with EC type 1, 20 with benign hyperplasia, and 19 healthy participants. Metabolite distribution changes were analyzed, and 338 of these features were dysregulated and significant. The first two main components, PC1 and PC2, were responsible for 11.5% and 12.2% of the total metabolites, respectively. Compared with the control group (CO), EC samples had 203 differentially expressed metabolites (180 upregulated and 23 downregulated); in hyperplasia (HP), 157 metabolites were dysregulated (127 upregulated and 30 downregulated) compared to the CO group while 21 metabolites exhibited differential regulation (16 upregulated and 5 downregulated) in EC plasma samples compared to the HP group. Hyperplasia samples exhibited similar metabolic changes to those reported in cancer, except for alterations in triglyceride levels, 7a,12 b-dihydroxy-5b-Cholan-24-oic acid, and Hept-2-enedioyl carnitine levels. The metabolites N-heptanoyl glycine and -(Methylthio)-2,3-isopentyl phosphate and formimino glutamic acid can be specific markers for hyperplasia conditions and dimethyl phosphatidyl ethanolamine and 8-isoprostaglandin E2 can be specific markers for EC conditions. Metabolic activities rely on mitochondrial oxidative phosphorylation for energy generation. The changes in metabolites identified in our study indicate that endometrial cancer cells adopt alternative strategies to increase energy production to meet the energy demand, thereby supporting proliferation.

Objectives: The objectives of this study were to assess the prevalence of abusive and disrespectful behavior from healthcare workers toward women during childbirth, to determine the type of abuse with the highest prevalence, and to assess the factors that contributed to the prevalence of abuse and disrespectful behavior. Methods: This is a quantitative observational cross-sectional study that was conducted among mothers who gave birth in a tertiary hospital in Riyadh, Saudi Arabia, from September 2019 to mid-March 2020, with a target sample size of 261. Descriptive statistics were described by frequencies and percentages, bivariate statistical analysis was carried out by using Chi-square test. Results: The overall prevalence of disrespect and abuse (D&A) was 62.5%, the non-consented category was the commonest type in this study. D&A was 2.8 times more prevalent in women whose newborn suffered complications during delivery. Likewise, mothers who delivered in a room with 5 or more caregivers were 2 times more likely to be disrespected than others. Mothers who underwent a natural delivery without episiotomy were 53% less likely to face the risk of being disrespected than others. Conclusion: This study reveals that the prevalence of disrespect and abuse towards women during labor in the chosen setting was high. The type of delivery, number of caregivers present, and complications that occurred during delivery were significantly associated with disrespect and abuse. Therefore, the authors of this study present an IDEAL approach as a way to upgrade the maternity care standards.

Abstract Objective The present study aimed to explore the opinion and ethical consideration of vulvovaginal aesthetics procedures (VVAPs) among health professionals and medical students in Saudi Arabia. Methods This is a cross-sectional study performed between January 2020 and April 2020. Data was collected through electronic media, WhatsApp, and emails. The results were analyzed by applying the Students t-test, and correlations were considered significant if they presented a p-value

Abstract In this paper, we introduce a new class of hemivariational inequalities, called dynamic boundary hemivariational inequalities, reflecting the fact that the governing operator is also active on the boundary. In our context, it concerns the Laplace operator with Wentzell (dynamic) boundary conditions perturbed by a multivalued nonmonotone operator expressed in terms of Clarke subdifferentials. We show that one can reformulate the problem so that standard techniques can be applied. We use the well-established theory of boundary hemivariational inequalities to prove that under growth and general sign conditions, the dynamic boundary hemivariational inequality admits a weak solution. Moreover, in the situation where the functionals are expressed in terms of locally bounded integrands, a “filling in the gaps” procedure at the discontinuity points is used to characterize the subdifferential on the product space. Finally, we prove that, under a growth condition and eventually smallness conditions, the Faedo–Galerkin approximation sequence converges to a desired solution.

Abstract In view of the worldwide coronavirus disease 2019 (COVID-19) pandemic, hospitals need contingency planning. This planning should include preparation for an unexpected patient surge. This measure is evolving concomitantly with the implementation of the needed infection control rules. Here, we present our experience in contingency planning at four large tertiary hospitals in Saudi Arabia during this global pandemic, with a focus on dealing with COVID-19 patients who need to undergo surgery. The planning covers response measures required in the operating room and supporting units, including the administrative department, intensive care unit, and different sections of the surgical department. Furthermore, it covers the role of education and simulation in preparing health care providers and ensuring smooth workflow between all sections. We additionally discuss the guidelines and policies implemented in different surgical specialties. These measures are necessary to prevent the transmission of COVID-19 within healthcare facilities. Throughout the COVID-19 pandemic, the healthcare system should develop a comprehensive pandemic plan and set guidelines addressing the management of urgent and malignant cases. The guidelines should be in concordance with internal guidelines.

Spring Loaded Pantographs (SLPs) are frequently used in designing lightweight limbs for multi-legged robots. Quadruped robots that incorporate cable-pulled SLP legs have proven to be agile, robust and capable of conserving energy during their gait cycle. In such designs, the extension of the distal segments via the knee joint is dependent upon the length of the cable. In this article we propose the use of an Elastically Loaded Scissors Mechanism (ELS Mechanism or ELSM), which is a variant of the SLP. Driven by 'pulling' onto the proximal joint of the scissors as opposed to the distal joint, this proposed leg utilizes the increased mechanical advantage of the scissors mechanism to 'amplify' input angles to larger output displacement by the knee joint. Analysis and Simulations reveal that the proposed mechanism achieves increased motion speed as compared to the SLP mechanism. This, however, comes at the cost of higher load on the actuator which serves as an engineering trade-off. This is validated by experimentation using motion capture and load motor techniques of the SLP and ELS configurations in a physical quadruped robot.

With the growing demand for water resources, the need for monitoring has become a necessity for rational and sustainable use of this resource. Water meter data collection is an essential step toward this goal. In Morocco, this task is performed manually at most once a month due to constraints related to the cost and time. In general, the consumption is estimated and calculated based on the average consumption recorded in the previous months. This causes many claims from customers because of higher invoices, which does not reflect reality. In this paper, we propose a fully AI-based system to automate water meter data collection, which is composed of a Recognition System (RS) and a web services platform. This framework offers multiple services for both customers and water service providers, such as consumption monitoring, detecting water leaks, visualizing water consumption, and potable water coverage in a geographic map. It also provides a powerful tool to help ensure accurate decision making with multiple reporting services. The main component of the RS is the Convolutional Neural Network model trained on a proposed MR-AMR (Moroccan Automatic Meter Reading) dataset. In the model test phase, we achieved an accuracy of 98.70%. Our system was tested and validated by experiments.

Using an audience response system (ARS) is very effective to improve learning through active participation and enhanced interaction among medical students. Although the validity of ARS in engagement during the learning process is clear, we know little about its impact on self-motivation. Aim: This study aimed to investigate the effectiveness of ARS as compared to other used methods such as quizzes on paper/verbal questioning and analyzed how ARS nurture motivation among medical students. Methods: This is mixed-method research and assessed the medical student's perceptions about the use of ARS and its role in the augmentation of motivation for learning. We used a google doc questionnaire for data collection and the qualitative part of the study we conducted by semi-structured focused group discussions to explore the impact on self-motivation. For data analysis, we applied students paired t-test, and a p-value of less than 0.05 determined the significant correlation between ARS and other methods of formative assessment (quiz on paper/verbal questions). We coded the focused group discussions and identified themes based on the grounded theory. Results: There is a significant correlation (P value= 0.008) for the comfort level of the formative assessment methods with ARS as compared to quizzes on paper/verbal response. ARS helped significantly to enhance the self-evaluation and self-motivation through instant comparisons of the results with the rest of the audience with P-value=0.027 and 0.021 respectively. ARS is a validated and proficient tool to assess student's learning and generating self-motivation. Conclusion: In medical education, ARS enhances the opportunity to recognize the knowledge gaps and encouraged conceptual learning. It provided students with a powerful insight into the learning of key concepts and self-assessment. Using ARS triggers not only motivation but also generates novel ideas and lifelong learning skills.

Uterine cancers are among the most prevalent gynecological malignancies, and endometrial cancer (EC) is the most common in this group. This study used tissue-based proteomic profiling analysis in patients with endometrial cancer and hyperplasia, and control patients. Conventional 2D gel electrophoresis, followed by a mass spectrometry approach with bioinformatics, including a network pathway analysis pipeline, was used to identify differentially expressed proteins and associated metabolic pathways between the study groups. Thirty-six patients (twelve with endometrial cancer, twelve with hyperplasia, and twelve controls) were enrolled in this study. The mean age of the participants was 46–75 years. Eighty-seven proteins were significantly differentially expressed between the study groups, of which fifty-three were significantly differentially regulated (twenty-eight upregulated and twenty-five downregulated) in the tissue samples of EC patients compared to the control (Ctrl). Furthermore, 26 proteins were significantly dysregulated (8 upregulated and 18 downregulated) in tissue samples of hyperplasia (HY) patients compared to Ctrl. Thirty-two proteins (nineteen upregulated and thirteen downregulated) including desmin, peptidyl prolyl cis-trans isomerase A, and zinc finger protein 844 were downregulated in the EC group compared to the HY group. Additionally, fructose bisphosphate aldolase A, alpha enolase, and keratin type 1 cytoskeletal 10 were upregulated in the EC group compared to those in the HY group. The proteins identified in this study were known to regulate cellular processes (36%), followed by biological regulation (16%). Ingenuity pathway analysis found that proteins that are differentially expressed between EC and HY are linked to AKT, ACTA2, and other signaling pathways. The panels of protein markers identified in this study could be used as potential biomarkers for distinguishing between EC and HY and early diagnosis and progression of EC from hyperplasia and normal patients.

As of late quantum calculus is broadly utilized in different parts of mathematics. Uniquely, the hypothesis of univalent functions can be newly portrayed by utilizing q-calculus. In this paper, we utilize our recently presented symmetric p,q-number m˜ p,q to characterize new symmetric p,q-derivative D p,q of analytic function f in the open unit disk U. Utilizing D p,q, we introduce new class of analytic star-like functions and examine some fascinating results.

Background Over time, there has been a gradual decline in the selection of obstetrics and gynecology (OBGY) as a career choice worldwide, which is of great concern for the medical educators, stakeholders, and policymakers to optimize the demand of this specialty. Objective To explore the perceptions of medical students about the attractive and distracting factors to choose obstetrics and gynecology. Method The focused group discussion was conducted from September 2019 to December 2019 and thematic analysis was done based on grounded theory. Results In the study, a total of 49 students participated out of 75 expected participants, and the response rate was 65%. Few participants who agreed to continue their careers in this field supported their ideas because of female gender acceptance for this specialty in Saudi culture, opportunity to observe procedures, and family pressures. The main reason was the tough experience during OBGY clinical rotations, the clinician's attitude towards training at the hospital workplace, and work stress. Conclusion There is a profound influence on learning experience during the course and clinical training in hospital settings. The positive impact of teaching faculty, successful stories of patients, and teaching techniques supported by simulations can provoke the enthusiasm in the students. A mnemonic "BE SMART" is proposed to apply by medical educators to optimize the need of OBGY specialists in the future. It applies the abilities of true professionals indicated by doctors as beneficent, educators; enforces to augment the use of simulators as teaching modality; practices of meditation, and affectionate the mutual relationships.

Exposure to ultraviolet-B (UV-B) radiation can lead to oxidative damage in plants, increasing reactive oxygen species (ROS) production. To overcome ROS burst, plants have antioxidant mechanisms related to ROS scavenging which can be improved by elicitation with biological agents or derived molecules (elicitors), as they can trigger a physiological alert state called “priming”. This work describes the effects of lipo-chitooligosaccharides (LCOs) treatment applied to tomato plants under UV-B stress. The LCOs used in the study are produced by three species of the genus Ensifer (formerly Sinorhizobium) (SinCEU-1, SinCEU-2, and SinCEU-3) were assayed on tomato plants under UV-B stress. LCOs were able to significantly increase most of the enzymatic activities related to ROS scavenging while non-enzymatic antioxidants were not modified. This response was associated with a lower oxidative stress, according to malondialdehyde (MDA) levels and the higher antioxidant capacity of the plants. Furthermore, the photosynthetic efficiency of LCOs-treated plants indicated a better physiological state than the control plants. Therefore, although more studies and deepening of certain aspects are necessary, LCOs have shown great potential to protect plants from high UV-B radiation conditions.

Endometrial cancer (EC) is the most common form of gynecological cancer. Type 2 diabetes mellitus is associated with an increased risk of EC. Currently, no proteomic studies have investigated the role of diabetes in endometrial cancers from clinical samples. The present study aims to elucidate the molecular link between diabetes and EC using a proteomic approach. Endometrial tissue samples were obtained from age-matched patients (EC Diabetic and EC Non-Diabetic) during surgery. Untargeted proteomic analysis of the endometrial tissues was carried out using a two-dimensional difference in gel electrophoresis (2D-DIGE) coupled with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF). A total of 53 proteins were identified, with a significant difference in abundance (analysis of variance (ANOVA) test, p ≤ 0.05; fold-change ≥ 1.5) between the two groups, among which 30 were upregulated and 23 downregulated in the EC Diabetic group compared to EC Non-Diabetic. The significantly upregulated proteins included peroxiredoxin-1, vinculin, endoplasmin, annexin A5, calreticulin, and serotransferrin. The significantly downregulated proteins were myosin regulatory light polypeptide 9, Retinol dehydrogenase 12, protein WWC3, intraflagellar transport protein 88 homolog, superoxide dismutase [Cu-Zn], and retinal dehydrogenase 1. The network pathway was related to connective tissue disorder, developmental disorder, and hereditary disorder, with the identified proteins centered around dysregulation of ERK1/2 and F Actin signaling pathways. Cancer-associated protein alterations such as upregulation of peroxiredoxin-1, annexin 5, and iNOS, and downregulation of RDH12, retinaldehyde dehydrogenase 1, SOD1, and MYL 9, were found in the EC tissues of the diabetic group. Differential expression of proteins linked to cancer metastasis, such as the upregulation of vinculin and endoplasmin and downregulation of WWC3 and IFT88, was seen in the patients with diabetes. Calreticulin and alpha-enolase, which might have a role in the interplay between diabetes and EC, need further investigation.

The current healthcare systems are facing many issues in terms of data management, data sharing, information security and patient privacy, data immutability, trust, and transparency. In addition, the multiple existing healthcare systems are centralized which complicates the healthcare professionals, patients in managing their data and causes several problems. Blockchain technology as a decentralized peer-to-peer network has the power to digitalize and transform the manner that the data are managed in the healthcare industry, in this regard, is one such domain that might benefit from Blockchain technology in different manners. This paper aims to improve a review of recent works on Blockchain-based healthcare applications.

Background and Objectives: Cervical cancer (CC) is the eighth most common cancer among Saudi women of all ages. With limited national data, we aimed to evaluate the public awareness of cervical cancer, CC risk factors, HPV infection, and HPV vaccines in different regions of Saudi Arabia. Materials and Methods: This was a survey-based cross-sectional study that encompassed 564 Saudi women over a period of a month. A self-administrated questionnaire was distributed through different social media platforms. Results: The collected data included sociodemographic variables and questions assessing awareness of CC, and the attitudes toward CC screening and human papillomavirus (HPV) vaccination. Most respondents were aware of CC (84.0%), although their primary source of information was the internet. However, only 45 females (8.0%) had a history of cervical screening. Furthermore, most females did not know that HPV was transmitted sexually (78.9%), or that it caused genital warts (81.7%) and CC (81.9%). Regarding the HPV vaccine, 100 females (17.7%) had heard about it, but only 11 (2.0%) took the vaccine, although more than half of the respondents (54.1%) were willing to take the vaccine after being informed about it. Conclusions: We noticed a remarkable lack of awareness among the respondents regarding HPV’s clinical implications; and the HPV vaccine, and its importance and availability. The main source of information for most of the Saudi women in this study was the internet, which may be an unreliable source, or provide misleading information that may delay screening or discourage vaccination. Thus, organized campaigns by the Ministry of Health or other health-advocating agencies, in addition to screening and vaccination programs, are strongly encouraged.

Objective: The aim of this study was to demonstrate the superiority of benfluorex over placebo as an add-on therapy in type 2 diabetic patients in whom diabetes is insufficiently controlled by sulfonylurea monotherapy and who have a limitation for the use of metformin.Research Design and Methods: Type 2 diabetic patients with HbA(1c) (A1C) (7-10%) who were receiving the maximum tolerated sulfonylurea dose and had a contraindication to or poor tolerance of metformin were randomly assigned (double blind) to receive benfluorex 450 mg/day (n = 165) or placebo (n = 160) for 18 weeks. The main efficacy criterion was A1C, analyzed as the change from baseline to the end of treatment using ANCOVA with baseline and country as covariates. Secondary criteria were fasting plasma glucose (FPG), insulin resistance, and plasma lipid level.Results: Both groups were similar at baseline in the intention-to-treat population. A1C significantly decreased with benfluorex from 8.34 +/- 0.83 to 7.52 +/- 1.04% (P < 0.001) and tended to increase with placebo from 8.33 +/- 0.87 to 8.52 +/- 1.36% (NS), resulting in a mean adjusted difference between groups of -1.01% (95% CI -1.26 to -0.76; P < 0.001). The target A1C (< or =7%) was achieved in 34% of patients receiving benfluorex versus 12% of patients receiving placebo. Significant between-group differences in favor of benfluorex were observed for mean FPG (-1.65 mmol/l) (P < 0.001) and for homeostasis model assessment of insulin resistance. Overall tolerance was similar in both groups. Serious adverse events were more frequent in the benfluorex group, without evidence of causality relationship.Conclusions: Benfluorex as an add-on therapy was superior to placebo in lowering A1C with a between-group difference of 1% in type 2 diabetic patients whose disease was insufficiently controlled with sulfonylurea alone and in whom metformin was contraindicated or not tolerated. [ABSTRACT FROM AUTHOR]

In this paper, we consider the evolutionary Navier-Stokes equations subject to the nonslip boundary condition together with a Clarke subdifferential relation between the dynamic pressure and the normal component of the velocity. Under the Rauch condition, we use the Galerkin approximation method and a weak precompactness criterion to ensure the convergence to a desired solution. Moreover, a control problem associated with such system of equations is studied with the help of a stability result with respect to the external forces. At the end of this paper, a more general condition due to Z. Naniewicz, namely the directional growth condition, is considered and all the results are reexamined.

Introduction: Sputum conversion is an important indicator of successful Tuberculosis (TB) treatment and control program. There is no published research on sputum conversion rate and its determinants, from Afghanistan. Aim: To determine sputum smear conversion rate and identify the factors associated with delayed sputum conversion following TB treatment among smear positive pulmonary TB patients. Materials and Methods: The study was based on a secondary data analysis of a retrospective cohort of 345 newly diagnosed sputum smear positive pulmonary TB patients, from 13 public health facilities in Kandahar city, Afghanistan during the year 2017. Data was extracted in a predesigned format, which included socio-demographic, clinical, microbiological, radiological, and treatment initiation and follow-up data from TB registers. Sputum conversion rate was presented as percentage. Bivariate analysis and multiple logistic regressions were used to identify the predictors of delayed sputum conversion. Results: The mean age of the study participants was 38.3 years (SD±17.6). Of the total, 165 (48%) were male and 180 (52%) were female. About 83% study participants were successfully converted to sputum smear negative at the end of the intensive phase of treatment. On bivariate analysis, age group 50 years and above, female sex, haemoptysis at the first visit, and heavy bacterial load (sputum acid fast bacilli grading 3+) were found to be associated with delayed sputum conversion. Multiple logistic regression showed that heavy sputum bacterial load (adjusted odds ratio=15.7, 95% CI=7.82-31.6) was the single independent predictor of delayed conversion. Conclusion: Higher sputum AFB grading has a greater risk of poor outcome than the patients with lower smear grading. Hence, the policy makers in Afghanistan should take a note of the results of this study to accelerate the TB control in the country.

The globalization and saturated domestic markets force international firms to gradually expand their businesses across the borders to capture potential emerging markets. The decision to select a country for a new cement plant location demands analysis of a large number of factors. It is a multifaceted problem which requires investigation and prioritization of factors in a hierarchical way.This paper uses an FAHP (Fuzzy Analytic Hierarchy Process) based procedure proposing a practical framework for solution of the GCPLP (Global Cement Plant Location Problem). It deals with real world ambiguities and handles a broader spectrum of influencing factors. The criteria for selection of a country for a new cement plant installation are prioritized from the FAHP based evaluation made by experts. Different global databases including the World Bank are used for the fuzzy ratings of the alternatives. It has been learnt in this particular problem that cement specific and cost related factors are the most sensitive while legal regulations and economic conditions are relatively less sensitive for the decision makers. Therefore, the countries having strong lime stone reserves, cheaper fuel costs and good internal marketing positions are higher in ranking. The paper concludes with different rankings of the four countries analyzed which assist the strategic managers in making decisions on the basis of mathematically computed results.

In south-western Spain, Macrophomina phaseolina and Fusarium solani were found to be associated in strawberry plants with, respectively, charcoal rot, and crown and root rot symptoms. For management of both fungal diseases, the antagonistic effects of two commercial formulations, one based on Trichoderma asperellum T18 strain (Prodigy®) and the other on Bacillus megaterium and B. laterosporus (Fusbact®), were evaluated in vitro and under controlled environment and field conditions. Two inoculation methods (root-dipping and soil application) and two application times (pre- and post-pathogen inoculation, as preventive and curative treatments, respectively) were assessed. Dual plate confrontation experiments demonstrated the antagonistic effects of T. asperellum and Bacillus spp. by inhibiting radial growth of M. phaseolina and F. solani by more than 36%. Preventive application of T. asperellum by root-dipping reduced the incidence of charcoal rot (up to 44% in a growth chamber and up to 65% under field conditions) and also reduced disease progression, the percentage of crown necrosis, as well as the level of infection measured as ng of pathogen DNA g-1 plant by quantitative real-time PCR. This treatment was also the most effective for reduction of crown and root rot caused by F. solani (up to 100% in a greenhouse and up to 81% under field conditions). These results were nearly comparable with the control achieved using chemical fungicides. The Bacillus spp.-based formulation was also effective for control of charcoal rot and showed variable results for control of F. solani, depending on the growth conditions.

Frequency of clinical cases of dogs with massive skin losses is very high in urban areas of Pakistan following road accidents, sharp objects exposure and attack by other dog. These cases need intensive veterinary assistance for safe and speedy healing of wounds. Recently, skin of Nile tilapia fish (Oreochromis niloticus) is internationally gaining hype in medical field as biological dressing to boost dermatological reconstruction process. Nile tilapia skin is a recent research trend and a very limited research data is available on this topic for both human and animal subjects. This study was conducted at Department of Small Animal Clinical Sciences, University of Veterinary and Animal Sciences (UVAS), Lahore, Pakistan considering the wound healing promoter properties of Nile tilapia skin as a biological dressing for dogs with massive skin losses. Aim of this study was to evaluate Nile tilapia fish skin as wound healing promoter biological dressing following sutured and non-sutured application techniques. For this study 10 clinical cases of dogs were randomly selected as per set criteria and divided into groups A and B comprising 5 dogs each. Consent document was signed by each dog owner for volunteer participation in this study. Nile tilapia skin was collected from fresh subjects and treated with 10% povidone-iodine for 10-15 minutes to prepare biological dressing. In group A, biological dressing was sutured on wound (non-absorbable silk suture material) on the area with dermal loss. In group B, biological dressing was applied in a wrap manner on area of dermal loss without application of sutures. Wound healing was evaluated grossly and histologically on days 0, 7 and 14. Statistical analysis of comparison between groups A and B revealed that application of Nile tilapia skin derived biological dressing in wrap fashion results in fast and complication-free wound healing as compared to sutured tilapia biological dressing in dogs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Khan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Return to school (RTS) after adolescent idiopathic (AIS) scoliosis surgery is a critical outcome measure signifying a return to everyday life. Prior studies in Western populations report an average RTS of 42.3 days for AIS surgery. This study aims to estimate RTS and identify factors affecting it in Saudi Arabia., Method: This retrospective cross-sectional study included 48 AIS patients who underwent posterior spinal fusion (PSF). Data collected included demographics, surgical details, and recovery timelines. After identifying the average time to return to school, patients were categorized based on RTS duration, with a 42-day cutoff. Factors that could delay the time to return to school were analyzed., Result: Among the 48 patients, 41 (85.4%) were female, with a mean age of 14.47 years (SD 2.7). The average RTS was 60.1 days (SD 24). Significant associations were found between RTS and age at surgery (12.92 years for RTS ≤ 42 days vs 14.84 years for RTS > 42 days, p  = 0.04) and levels fused (15.40 for RTS ≤ 42 days vs 13.38 for RTS > 42 days, p  = 0.036). Other factors showed no significant associations., Conclusion: The average RTS after scoliosis correction in Saudi Arabia is two weeks longer than the average in other countries. Further studies are needed to develop solutions to reduce the delayed RTS in Saudi Arabia., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Hair loss is a serious health concern, with individuals having to bear the associated psychological impact of the condition. Alopecia has been linked to emotional and psychological anguish in relationships, career, and personal life., Objective: This study aimed to elucidate the intricate association, prevalence, and impact of hair loss with anxiety disorders, distinguished from other psychological impacts of alopecia., Methods: The current review and meta-analysis were performed in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) framework. A comprehensive search was performed using the Cochrane, PubMed, and Google Scholar electronic databases studies published in English and conducted between January 2014 and September 2024. Statistical analysis was performed using STATA version 16.0 (StataCorp LLC), and the Newcastle-Ottawa Scale and RoB 2 tools were used for critical quality appraisal., Results: A total of 24 eligible articles were included in the current study, with a cumulative of 5553 patients presenting with 1 or more forms of hair loss. Anxiety disorder was significantly prevalent among patients with alopecia event rate (ER) 0.47 (95% CI: 0.39-0.54). Anxiety severity analysis also showed a significant relationship between anxiety and hair loss, with ERs of 0.35 (95% CI: 0.10-0.60), 0.15 (95% CI: 0.01-0.29), and 0.05 (95% CI: 0.03-0.29), respectively. Statistical significance was also demonstrated by a mean HADS-A score of 7.87 (95% CI: 6.85-8.88). However, considerable heterogeneity was observed in various statistical analyses., Conclusion: In summary, our study showed that among people with hair loss-related diseases, alopecia was substantially linked to anxiety disorders, with the frequency of anxiety among those affected being noticeably higher., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Immune checkpoint inhibitors (ICIs) are currently the primary approach for managing NSCLC. However, numerous combination therapies are currently under investigation. Our goal is to investigate the overall efficacy and safety of ICIs and taxane-based chemotherapy., Methods: We conducted a systematic review and meta-analysis, searching web databases for relevant literature. We limited our eligibility to phase II/III randomized clinical trials involving advanced/metastatic NSCLC patients., Results: We performed a meta-analysis encompassing nineteen studies derived from sixteen RCTs. For patients with sq-NSCLC PD-L1 ≥ 50%, using ICIs plus taxane significantly improve PFS and OS with HR of 0.58 (95% CI, 0.45-0.74, p  < 0.0001) and 0.41 (95% CI, 0.33-0.50, p  < 0.00001), respectively. For patients with non-sq NSCLC PD-L1 1-49%, the analysis revealed significant improvement of OS and PFS with HR of 0.64 (95% CI, 0.47-0.88, p  = 0.005) and 0.62 (95% CI, 0.47-0.81, p  = 0.0004), respectively. For TRAEs of all grades, ICIs plus taxane resulted with no significant difference compared to control group with risk ratio (RR) 1.00 (95% CI 0.99-1.02)., Conclusion: The analysis revealed significant improvement in efficacy of ICIs with taxane in advanced/metastatic NSCLC patients compared with ICI/taxane monotherapy. Registration: PROSPERO (CRD42023447532).

Background: Coronary and carotid artery diseases are manifestations of a systemic atherosclerotic process, often coexisting in patients affected by both conditions. This association emphasizes the importance of evaluating both coronary and carotid atherosclerosis in high-risk individuals. Ultrasound 2D shear-wave elastography (2D-SWE) has shown promise as a noninvasive technique for assessing carotid plaque stiffness. This prospective pilot study aimed to assess carotid plaque stiffness in patients undergoing coronary artery bypass grafting (CABG) and those not scheduled for the procedure as a control group. Methods: 32 patients (17 CABG and 15 controls) were recruited, collectively presenting 43 carotid plaques. Bilateral carotid ultrasound was performed using a high-resolution linear transducer. Plaque stiffness was quantified via 2D-SWE, expressed in shear-wave velocity (SWV, m/s) and Young's modulus (YM, kPa). Plaque characteristics, including GSM, were quantified. Intra-observer reproducibility was evaluated with intraclass correlation coefficients (ICCs) and Bland-Altman plots. Statistical differences and correlations were assessed using Mann-Whitney U and Spearman's correlation tests. Results: Carotid plaques in the CABG group exhibited significantly lower stiffness compared to controls (median stiffness SWV: 3.64 m/s vs. 4.91 m/s, p < 0.0001; YM: 20.96 kPa vs. 72.54 kPa, p < 0.0001). ICCs demonstrated excellent reproducibility for stiffness measurements (SWV: ICC = 0.992; YM: ICC = 0.992), with minimal bias in measurements. A positive correlation was observed between 2D-SWE and GSM values (SWV: r = 0.343, p = 0.024; YM: r = 0.340, p = 0.026). Conclusions: Ultrasound 2D-SWE has shown promise as a reliable tool for quantifying carotid plaque stiffness, demonstrating high reproducibility and a significant correlation with GSM. The observed reduction in plaque stiffness among CABG patients highlights its potential as a valuable parameter for identifying high-risk plaques and assessing cerebrovascular risk in patients undergoing CABG.

Nowadays, polyethylene terephthalate (PET) bottles are widely used for packaging drinks and food. However, concerns have been raised about the possible migration of harmful chemicals, particularly phthalates, from these containers into their contents. Therefore, this study investigates the effects of sunlight exposure and PET bottle reuse on phthalate migration, focusing on three common phthalates: bis(2-ethylhexyl) phthalate (DEHP), dibutyl phthalate (DBP), and benzyl butyl phthalate (BBP). The study used two experimental designs. First, new PET bottles filled with distilled water were stored in the shade and under direct sunlight for 30 days. Second, PET bottles were reused to store various foods (vinegar, mint extract, salty leaves, pickled cucumber, and lemon juice) at 4 °C and 40 °C for 10, 30, 60, and 90 days. Phthalate concentrations were analyzed using solid phase extraction followed by gas chromatography-mass spectrometry (GC/MS). The results showed that exposure of PET bottles to sunlight significantly increased phthalate migration compared to shaded storage (P < 0.001). When reused, storing PET bottles at 40 °C resulted in significantly higher phthalate release from the bottle walls in all storage periods than at 4 °C (P < 0.001)-at 40 °C, longer storage times resulted in a significant increase in phthalate migration (P < 0.001), while at 4 °C storage time had no significant effect on phthalate levels (P < 0.001). This study shows that sunlight, higher storage temperatures, and longer storage times significantly increase the migration of phthalates from PET bottles into their contents. These results highlight the importance of maintaining appropriate storage conditions and limiting the reuse of PET bottles, particularly at higher temperatures and longer storage times, to minimize potential exposure to phthalates., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Angiopoietin-1 (Ang-1) and its receptor Tie-2 promote vascular integrity and angiogenesis. MicroRNAs (miRNAs) are involved in the regulation of many cellular functions, including endothelial cell (EC) survival, proliferation, and differentiation. Several reports indicate that these effects of miRNAs on EC functions are mediated through the modulation of angiogenesis factor signaling including that of vascular endothelial growth factor (VEGF). To date, very little is known about the roles played by miRNAs in the signaling and angiogenesis promoted by the Ang-1-Tie-2 receptor axis. Our high-throughput screening of miRNAs regulated by Ang-1 exposure in human umbilical vein endothelial cells (HUVECs) has identified miR-1233-3p as a mature miRNA whose cellular levels are significantly downregulated in response to Ang-1 exposure. The expression of miR-1233-3p in these cells is also downregulated by other angiogenesis factors including VEGF, fibroblast growth factor 2 (FGF-2), transforming growth factor β (TGFβ), and angiopoietin-2 (Ang-2). The overexpression of miR-1233-3p in HUVECs using specific mimics significantly attenuated cell survival, migration, and capillary-like tube formation, and promoted apoptosis. Moreover, miR-1233-3p overexpression resulted in reversal of the anti-apoptotic, pro-migration, and pro-differentiation effects of Ang-1. Biotinylated miRNA pull-down assays showed that p53 and DNA damage-regulated 1 (PDRG1) is a direct target of miR-1233-3p in HUVECs. The exposure of HUVECs to Ang-1, angiopoietin-2 (Ang-2), fibroblast growth factor 2 (FGF2), vascular endothelial growth factor (VEGF), or transforming growth factor β (TGFβ) triggers the regulation of PDRG1 expression. This study highlights that miR-1233-3p exerts inhibitory effects on Ang-1-induced survival, migration, and the differentiation of cultured ECs.

Aim: This systematic review and meta-analysis aimed to evaluate the safety and efficacy of combined laser and anti-VEGF therapy for (retinopathy of prematurity ROP), focusing on both structural and functional outcomes., Methods: A comprehensive search was conducted in multiple databases to identify randomized controlled trials (RCTs) that investigated combination therapy for ROP. The PRISMA guidelines were followed. Data were extracted and analyzed using risk ratios and 95% confidence intervals (CIs). The Cochrane Risk of Bias tool was used to assess the risk of bias., Results: Three RCTs involving a total of 162 premature infants were included in the meta-analysis. Combination therapy of anti-VEGF and laser photocoagulation was compared with other interventions. The pooled analysis of favorable structural outcomes did not show a statistically significant difference between combination therapy with anti-VEGFs and laser therapy compared to the interventions in the control groups (P=0.25). The incidence of adverse events was comparable between the combination therapy group and other intervention groups., Conclusion: This systematic review and meta-analysis suggest that risk ratio of combination therapy with anti-VEGF and laser for ROP is associated with favorable outcomes, albeit insignificant. The safety profile of combination therapy appears to be similar to other interventions. However, due to the limited number of included studies, further research is needed., Competing Interests: The authors report no conflicts of interest in this work., (© 2025 Alamoudi et al.)

Background & Objective: Many patients after cholecystectomy, develop gastrointestinal (GI) symptoms and are worried. The objective of this study was to find out the risk factors for severe GI symptoms following laparoscopic cholecystectomy (LC) during first year of follow-up., Methods: It is a multi-center prospective observational study. In this study, patients who underwent LC for gallstones as elective or emergency at different hospitals of Al-Ahsa region of the Kingdom of Saudi Arabia from January 2020 to December 2021were evaluated for the development of severe GI symptoms postoperatively. They were followed-up for one year after the surgery., Results: One thousand and two patients who underwent LC, 139(13.87%) developed severe GI symptoms after LC. The patients affected were mostly females 103(74.1%). After LC, the GI symptoms observed were increased frequency of defecation 113(81.3%), loose stools 102 (73.4%), urgency 63(45.3%) and bloating 60 (43.16%) patients. Forty-seven (33.8%) patients had two GI symptoms at a time, followed by 36 (25.9%) who had three. The median time of the start of GI symptoms was two weeks after surgery and the symptoms ended at 12 weeks after surgery. Forty-five (32.4%) patients had less than three-weeks' duration, followed by 35(25%) having less than 15 weeks. A BMI more than 40 showed a significant association. A higher frequency of cholecystitis attacks and a delayed onset of GI symptoms showed a significant severity of GI symptoms, resulting in delayed resolution. The bowel symptoms were more prominent in the emergency group. Age and gender had no significance., Conclusion: Early laparoscopic cholecystectomy of patients with cholelithiasis who have a smaller number of attacks of cholecystitis have less frequency of severe GI symptoms after the surgery., (Copyright: © Pakistan Journal of Medical Sciences.)

Purpose: Oral isotretinoin is a derivative of vitamin A, used to treat acne vulgaris. One of its effects is altering the corneal surface and ocular glands, resulting in eye dryness and various other symptoms. This study aimed to analyze the impact of systemic isotretinoin treatment on ocular health and investigate the potential risk factors contributing to ocular pathology., Patients and Methods: This cross-sectional study was conducted on 489 participants in the Jazan region using a convenience sampling method. An online questionnaire composed of five sections, including the Arabic version of the validated Ocular Surface Disease Index (OSDI), was used to assess the presence of ocular symptoms associated with isotretinoin usage as well as the potential contributing risk factors., Results: A significant association was established between oral isotretinoin use and specific eye symptoms, including a gritty feeling in the eye (66.4%), sore eyes (68.6%), blurry vision (75.9%), and the need for moisturizing drops (35%). OSDI severity varied according to isotretinoin usage status, with severe OSDI grades reported in 56.9% of current users, 51.2% of those who stopped < 2 months ago, and 38.8% of those who stopped ≥ 2 months ago. Furthermore, significant risk factors associated with worse OSDI grades included contact lens use and isotretinoin dose, with contact lens use being associated with a 17.5-point increase in OSDI scores, while each 10 mg increase in isotretinoin dose was linked to a 0.20-point rise in OSDI score., Conclusion: This study emphasizes the importance of assessing individual risk factors before starting isotretinoin therapy and monitoring ocular health in patients undergoing therapy. Clinicians should be aware of preventive methods and should consider high-risk patients to an ophthalmologist for interventions, such as punctal plugs, that can reduce complications. Further research targeting specific populations with shared risk factors is needed to validate these findings., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Abuallut et al.)

Background: Gallstone disease is one of the most resource-intensive surgical conditions. Despite the significant burden of emergency cholecystectomy on healthcare system, there is lack of research assessing the risk factors predisposing scheduled elective cholecystectomy patients to emergency surgery. Characterization of patients with gallstones helps to prioritize delivery of health care to avoid urgent surgery. The objective of the present study is to analyze risk factors associated with emergency cholecystectomy and assess the impact of delay on electively scheduled patients., Methods: This retrospective cohort study at a tertiary care center in Jeddah, Saudi Arabia, between January 2018 and June 2022. Net total of 823 patients.The study has collected data retrospectively from an electronic health record system. The data were entered and coded in excel sheet. All statistical tests were 2-sided and were conducted using SAS statistical software version 9.4 (SAS Institute Inc. Cary, NC)., Results: A total of 823 patients met the inclusion criteria and enrolled in the analysis. Among them, 129 patients (15.67%) underwent emergency cholecystectomy, while 694 patients (84.33%) underwent elective cholecystectomy. The waiting time in days was significantly longer for patients undergoing emergency cholecystectomy (mean of 362 days) compared to those undergoing elective cholecystectomy (mean of 305 days). Patients with more than two previous ED visits were over five times more likely to undergo emergency cholecystectomy compared to those who had never visited the ED previously (p-value < 0.0001) Moreover, patients diagnosed with acute cholecystitis and pancreatitis were more likely to undergo emergency cholecystectomy compared to those not diagnosed with these conditions (p-value < 0.0001; p-value 0.02)., Conclusion: Analysis of risk factors and delay in patients with gallstones scheduled for elective cholecystectomy demonstrates that long waiting times, severity of the initial visit setting, Hemolytic anemia, and male gender were significantly related to emergency cholecystectomy. Independent risk factors for emergency cholecystectomy were frequency of ED visits, acute cholecystitis, pancreatitis, and CBD stone. Patients with these risk factors should be given priority on the waiting list to avoid emergency surgery. Future research is required to design a scoring system or specific criteria for elective patients at risk of developing acute cholecystitis., Competing Interests: Declarations. Ethics approval and consent to participate: The need for consent to participate was waived by our Institutional Review Board (IRB) and was deemed unnecessary according to national regulations. Approval by: King Abdullah International Medical Research Center (KAIMRC) Saudi Arabia E-CTS Ref. No : JED-23-427780-11385. National Committee Of Bioethics Registration No : H-01-R-005. IRB Approval No: IRB/0235/23. Study Number: NRJ22J/312/11. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Coffee is one of the most commonly consumed beverages worldwide, so assessing its quality for potential health risks is essential. Therefore, this review aimed to determine the levels of ochratoxin A (OTA) in coffee worldwide and then estimate its human intake and health risks. The systematic search took place from June 1997 to April 2024 and 40 of 254 articles were selected based on the selection criteria. The results showed significant differences in average levels of OTA between countries, continents and coffee types ( p  < 0.001). Of 3256 samples, OTA was detected in 1778, accounting for 54.6% of the total, with the percentage of positive results varying between 7.5% and 100%. Only two studies reported OTA average levels in roasted coffee exceeding the maximum limit (ML) set by the European Commission (ML-EC = 5 μg/kg). The average OTA in soluble coffee was lower than ML-EC (10 μg/kg) in all studies, and in instant coffee, the level of OTA was higher than ML-EC (10 μg/kg) only in one study. The estimated daily intake (EDI) of OTA in all coffee types was lower than the provisional tolerable daily intake (PTDI) values set by joint FAO/WHO Expert Committee on Food Additives (JECFA) (14 ng/kg bw/day) and proposed by the European Food Safety Authority (EFSA) (17 ng/kg bw/day). Non-carcinogenic risk assessment through coffee consumption indicated that the hazard quotient (HQ) was below the acceptable level, HQ = 1. The Margin of Exposure (MoE) for neoplastic effects was acceptable and unacceptable for non-neoplastic effects (NNE) in 4.5% (one of 22 cases) of the roasted and soluble coffees, but acceptable for all instant coffees. In conclusion, the study shows that the OTA content of coffee is not toxic to consumers worldwide. However, preventative measures should be taken, including inhibiting fungal growth and reducing OTA-producing fungal growth.

Cerebral vasospasm (CV) following subarachnoid hemorrhage (SAH) remains one of the leading causes of high mortality and poor outcomes. Understanding the risk factors associated with CV is pivotal to improving patients' outcomes. We conducted an extensive search for analytical observational studies that analyzed the correlation between various variables and the likelihood of CV development among adult patients with SAH (age ≥ 18 years). Five scholar databases were used, namely, PubMed, EBSCO, Web of Science, Science Direct, and Google Scholar. Relevant studies published between January 1st, 2016, and August 9th, 2023, were included. The Newcastle-Ottawa Scale was adopted to assess the risk of bias among included observational studies. A total of 33 studies met the inclusion criteria. Of the 24,958 patients with SAH who were identified, 6,761 patients had a subsequent CV (27.1%). Several statistically significant risk factors were reported across the literature. Younger age, female sex, smoking, alcohol intake, modified Fisher grade 3-4, higher Hunt and Hess grading, and the presence of multiple comorbidities (diabetes, hypertension, congestive heart failure, and history of stroke) were among the well-established risk factors for CV. Additionally, leukocytosis was consistently reported to be a significant predictor in multiple studies, providing compelling evidence for its association with CV. Even though single studies reported an association between CV and certain variables, further research is necessary to investigate the implications of these findings. These include arterial tortuosity, hypokalemia, potassium to glucose gradient, hypoalbuminemia, anemia, von Willebrand factor and vascular endothelial growth factor, use of desflurane, and hemodynamic stability. Overall, this systemic review provides a comprehensive summary of the current data that evaluates the potential risk factors for the development of CV after SAH. However, because of data heterogeneity, certain factors require further validation in their correlation with CV development. Larger-scale observational and clinical trials are mandatory to extensively investigate the significant predictors of CV to lay the scientific foundation for improving outcomes in susceptible patients with SAH., Competing Interests: Conflict of interest: The authors declare that there is no conflict of interest. Ethical approval/informed consent: All authors declare adherence to ethical guidelines. This is a systematic review, and it does not involve study on human or animal subjects. Therefore, ethical approval, an institutional review board, or consent were not necessary for conducting this study. The use of a reporting checklist for systematic reviews has been used., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)

Background: Polycystic ovarian syndrome (PCOS) is the most prevalent endocrine concern among women of reproductive age. In Saudi Arabia, there is a lack of evidence to identify who is at higher risk of PCOS and what the potential risk factors are. Thus, this study aimed to investigate the associations of PCOS risk with demographic and socioeconomic characteristics, access to healthcare, health behaviors, and health status., Methods: This cross-sectional study was conducted among women in all different regions of Saudi Arabia to assess PCOS risk and related factors. Ethical approval was obtained, and data collectors distributed anonymous, self-administered questionnaires through social media platforms, with informed consent from participants. Sociodemographic characteristics, health behaviors, and perceived stress were measured, with stress assessed using the Arabic version of Cohen's Perceived Stress Scale. Data management and analyses included statistical description, bivariate analysis, and multinomial logistic regression analyses using SPSS, with significance set at p < 0.05., Results: The majority were younger than 30 years old, single, educated, urban residents, employed or students, and non-smokers. Most participants reported no chronic illnesses, with an average stress level of 19.71 (± 6.68). Concerning the risk of PCOS, 41.3% were at low risk, 33.3% were at suspected risk, 2.9% were at high risk, and 22.5% were diagnosed with PCOS. Factors associated with PCOS risk included age, region of residence, income, weight status, smoking status, presence of chronic conditions, medication and herbal remedy use, and perceived stress. Adjusted findings indicated that younger age, lower income, and higher stress levels were linked to an increased risk of PCOS, while chronic conditions were significantly associated with PCOS diagnosis rates., Conclusion: The study suggested the need for tailored interventions addressing lifestyle, stress, and comorbid disease management to reduce the risk of PCOS and improve women's health outcomes., Competing Interests: Declarations. Ethics approval and consent to participate: Per the Declaration of the Declaration of Helsinki, all procedures and documents were reviewed and approved by the Institutional Review Board (IRB) at Princess Nourah Bint Abdulrahman University (IRB log No. 23–0975). Participants provided informed consent before taking part in the survey. The online survey required participants to confirm their consent by checking a box on the first page before continuing. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: HPV represents one of the most common sexually transmitted infections worldwide, with significant adverse clinical consequences such as cervical cancer. However, the knowledge and awareness regarding HPV and its vaccination, particularly among Saudi women, are still under debate. Our study aims to investigate the knowledge, awareness, and attitude toward HPV and its vaccines among women in the Medina region., Methods: A descriptive cross-sectional study was conducted from July 2024 to September 2024 in women aged more than 18 years and residing in Medina. The collected data included information regarding women's demographics, knowledge, awareness, and attitudes toward HPV and its vaccination. All the statistical analyses were executed using SPSS., Results: A total of 721 participants enrolled in our study after adequate completion of the online questionnaire. The majority of the population (45.2%) is aged 18-25 years, with 51.3% of participants being single regarding marital status. A total of 59.4% of the participants have heard about HPV, 37% know that it is sexually transmitted, and 37.4% know about its ability to cause cervical cancer. Social media and the internet were the primary sources of information regarding the HPV vaccine, with 41.6% thinking that the HPV vaccine can be effective against HPV infection. Around 40% of the participants showed an attitude toward receiving the HPV vaccine as they feel they are at risk. The educational status and monthly income were notably associated with the overall knowledge and awareness regarding HPV and its vaccine., Conclusions: Our descriptive cross-sectional study highlights the significant gap in knowledge and awareness regarding HPV and its vaccine, with a lack of awareness identified as the commonest barrier preventing people from receiving the HPV vaccination. Hence, enhancing the knowledge and awareness level is essential to increase vaccination rates.