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Abstract Asphalt is widely used as a coating resin due to its excellent adhesion strength and cost-effectiveness; however, its limited corrosion protection necessitates enhancement. In this study, poly(amidoamine) (PAMAM), combined with zinc oxide (ZnO) nanoparticles, was incorporated into the asphalt matrix to improve its anticorrosive properties. Various ratios of PAMAM-ZnO nanocomposite (1, 2, 4, and 6% by weight) were added to the asphalt binder, with the materials characterized using XRD, ¹H-NMR, and SEM techniques. The 2% PAMAM-ZnO/asphalt ratio exhibited the most significant improvement, achieving a corrosion protection efficiency (η%) of 97.93%, as confirmed by Tafel analysis, and a charge transport resistance (RCT) of 75.91 Ω cm² according to electrochemical impedance spectroscopy (EIS) data. A combination of barrier formation and sacrificial protection drives the corrosion inhibition mechanism. The PAMAM-ZnO nanocomposite forms a highly uniform layer on the carbon steel surface, creating an effective physical barrier that prevents the penetration of corrosive agents, thereby minimizing defects like pinholes. This barrier effect is complemented by the sacrificial protection provided by the ZnO nanoparticles, which are more reactive than the underlying steel and preferentially interact with corrosive ions (e.g., chloride ions). This interaction leads to the formation of stable ZnO corrosion products, which enhance the barrier and reduce the likelihood of corrosion on the steel surface. Additionally, PAMAM facilitates the even distribution and strong adhesion of ZnO within the asphalt matrix, ensuring a durable protective layer. The synergic impact between the polymer barrier and sacrificial ZnO protection results in the exceptional corrosion resistance observed in the 2% PAMAM-ZnO/asphalt formulation, offering a promising approach for advanced anticorrosive coatings.

Introduction Continuous assessment of community health needs is essential to predict, recognize, and act on healthcare issues. Conducting community health needs assessments (CHNAs) in Saudi Arabia has become a priority to overcome the current healthcare challenges and keep pace with the Saudi Arabia 2030 vision. Studies reporting community health needs in Saudi Arabia regions are limited despite the high incidence of chronic diseases. This study aims to understand the community’s health problems and the range of healthy behaviors and determine the priority health problems. Methods We conducted a cross-sectional study based on the adults in Primary Health Care Centers in Hail, Northern Saudi Arabia, by using the CHNA standard questionnaire. In addition to the demographic information, the questionnaire collects data on personal health status, the health status of adults and children, health facilities access information, receiving of healthcare procedures, traveling for healthcare, source of medical information, safety measures and behaviors, health problems, childcare (special needs), and perceived community problems. Results In all, 336 individuals were approached to participate in this study; 303 agreed to participate (response rate: 90%). The analysis comprised 276 individuals after eliminating 27 who did not fulfill the age inclusion criteria or had missing gender data. Of these, 107 (38.8%) were men and 169 (61.2%) were women. Our data revealed that almost half of the participants, 135 (52.9%) constantly or 107 (42%) occasionally, were able to visit the doctors when needed. Conclusion Our findings reported positive health behaviors and good accessibility to healthcare services when needed. However, the study findings also revealed healthcare challenges that required urgent action from Hail healthcare leaders. Developing healthcare strategies, screening/prevention programs, and changing healthcare policies in the Hail region are needed to control and prevent health problems and improve the population’s health.

الملخص: أهداف البحث: البحث الطبي هو مؤشر مهم لسمعة الأمة وتطورها. وهناك مخاوف بشأن محدودية الأبحاث المتعلقة بتخصص جراحة العظام في المملكة العربية السعودية. لذلك، في هذه الدراسة، تم إجراء تحليل إحصائي (ببليومتري) للتحقق من مخرجات أبحاث العظام في المملكة العربية السعودية. طرق البحث: تم البحث في قاعدة بيانات (بوب ميد) للأبحاث المتعلقة بجراحة العظام، التي تضم على الأقل مؤلفًا واحدًا متخصصًا في جراحة العظام تابعًا للمملكة العربية السعودية، وتم نشره منذ عام ٢٠٠٠ فصاعدًا. وقد استبعدت هذه الدراسة المقالات المكررة، والتصحيحات، والرسائل، والافتتاحيات، والتعليقات، والاتصالات الموجزة. كما تمت الإشارة إلى عناوين المقالات المضمنة، وسنوات النشر، والانتماءات الأساسية للمؤلفين الأوائل والبلدان التي ينتمي اليها الباحثون، وإجمالي الاستشهادات. بعد ذلك، تم تحليل الإسهام البحثي على مدار العام، وأفضل الدول المسهمة والمتعاونة، وأفضل الانتماءات المسهمة، وأنواع الدراسات، ومستويات الأدلة، وتوزيع المجلات، والمعلومات المتعلقة بالربع، واتجاهات الاستشهاد وعامل تأثيرها. النتائج: أسفرت استراتيجية البحث عن وجود ١٠٤٧ بحثاً منشوراً. وقد لوحظ اتجاه متزايد في الإسهامات البحثية في السنوات الأخيرة، حيث كان الإسهام بأقل عدد من الأبحاث (٨) في عام ٢٠٠٥ وأكثرها (١٤٠) في عام ٢٠٢٣. وتم إجراء أغلب الأبحاث المنشورة في المملكة العربية السعودية (٨٣.٤٨٪). وكانت أعلى نسبة تعاون مع مؤلفين من خارج السعودية كانت من دولة كندا بنسبة ٣.٤٤٪ من الأبحاث. وكانت جامعة الملك سعود هي المؤسسة الأكثر إسهاما في عدد الأبحاث المنشورة (١٧.٣٨٪).بالنسبة لمواضيع الدراسات المنشورة فقد كان منها ٦٦ (٦.٣٪) متعلقا بالعلوم الأساسية، و٨٧٣ (٨٣.٣٪) بحثا متعلقا بالدراسات السريرية التي كان أغلبها (٨٤.٥١٪) تصنف من المستوى الرابع من ناحية قوة مستوى الأدلة. ٧٣٪ من جنسية الباحثين والمؤلفين الأساسين للأبحاث المنشورة من المملكة العربية السعودية. بشكل عام، تم نشر ٣١.٢٣٪ من المقالات التي تحتوي على معلومات ربعية متاحة في مجلات الربع الأول. الاستنتاجات: إن إنتاجية أبحاث جراحة العظام في المملكة العربية السعودية محدودة. ولكن هناك تزايد ملحوظ في إنتاجية أبحاث جراحة العظام في السنوات الأخيرة. ومع ذلك، فإن جودة البحوث السريرية، وخاصة مستوى الأدلة، تحتاج إلى تحسين. ولذلك، ينبغي بذل المزيد من الجهود لتعزيز فرص البحث وتشجيع المشاركة البحثية بين المراكز الطبية وجراحة العظام. Abstract: Purpose: Medical research is a crucial indicator of a nation's reputation and development. However, there are concerns about the limited orthopedic research in Kingdom of Saudi Arabia (KSA). Therefore, this study conducted bibliometric analysis to investigate orthopedic research output from KSA. Methods: PubMed database for orthopedic articles, with a minimum of one KSA-affiliated orthopedic author published from the year 2000 onwards, was searched. This excluded duplicate articles, corrections, letters, editorials, commentaries, and brief communications. The titles of the included articles, publication years, first and corresponding authors' primary affiliations and countries, countries and institutes of research, and total citations were noted. Thereafter, year-wise research contribution, top contributing and collaborating nations, top contributing affiliations, study types, levels of evidence, journal distribution, their impact factor, h-index and quartile-related information, and citation trends were analyzed. Results: The search strategy yielded 1047 eligible articles. An increasing trend in research contributions in recent years was observed, with the least number of articles (8) contributed in 2005 and the most (140) in 2023. The research was conducted in KSA for most articles (83.48%). Authors from Canada collaborated in 3.44% of the articles. King Saud University was the top contributing institution (17.38% of all articles). There were 66 (6.30%) basic science studies and 873 (83.3%) clinical studies. Among non-basic science studies, 84.51% had level IV evidence. Overall, 73.83% of articles had either first/corresponding or both authorships from KSA-affiliated orthopedic authors. The eligible articles were published in 303 journals, with a mean impact factor of 3.04 (range 0.4-51.1, 165 journals) and a mean h-index of 59.2 (range 1-367, 277 journals). Overall, 31.23% of articles with quartile information available were published in first-quartile journals. Conclusions: The orthopedic research productivity in KSA is limited. However, there has been an increasing trend in orthopedic research in recent years. Nevertheless, the quality of clinical research, particularly the level of evidence, needs improvement. Therefore, further efforts should be made to strengthen research opportunities and encourage research participation among orthopedic and medical institutes.

Background: An aging population ultimately has deprived physiological stores making them vulnerable for development of a syndrome called frailty, which presents with a cumulative decrease in tolerance, immunity, vision, balance, organ functions, health, and independent living. All these result in rising prevalence of frailty and its components, along with burden of disease, dependence, and health care cost. Thus, early estimation and assessment and interventions to correct it mark the mile stone in geriatric medicine. The present study was conducted with an aim to compare and correlate FIRE-MADE (Frailty Index in Rural Elderly – Mental status, Activities of daily living, Depression, and Events) FI (frailty index) with LASA (Longitudinal Aging Study Amsterdam) FI in central rural India’s geriatric population. Methodology: A cross-sectional study for assessment of frailty in the geriatric population of central rural India, reporting to the medicine department of a tertiary hospital, situated at Wardha district, by using FIRE-MADE and LASA FI was undertaken. Their scores were compared. The efficiency of FIRE-MADE FI in comparison with LASA FI was calculated. A frailty threshold of ≥ 0.25 is considered for diagnosing frailty. Standard descriptive and inferential statistics were used to evaluate all parametric and non-parametric data. Results: Out of 250 geriatric people, 224 (89.6%) were frail according to LASA FI and 204 (81.6%) were frail according to FIRE-MADE FI. As compared to LASA FI, FIRE-MADE FI was 91.07% sensitive and 73.08% specific, with a positive predictive value of 96.68% and a diagnostic accuracy of 89.20%. Conclusion: The Indian rural population of central India has high prevalence of frailty. FIRE-MADE FI can be used as a potential, effective, and validated tool for early diagnosing and management of frailty. Among the parameters of FIRE-MADE FI, IHD was the most important contributing factor for development of frailty, followed by cognitive impairment, polypharmacy, and remaining factors mentioned in FIRE-MADE FI.

Abstract Background Gaucher disease (GD), an autosomal recessive, lysosomal storage disorder, is caused due to mutations in the glucocerebrosidase (GBA) gene. GD can occur at any age and is classified as type 1 (non-neurologic), type 2 (infantile form, with acute early neurologic manifestation), and type 3 (subacute/chronic neuropathic form). The rarity of the disease and its overlapping symptoms with other diseases increase the delay in diagnosis. The Egyptian cohort of patients with GD is specifically different regarding the prevalence of type 3 as well as the severity and progression of the disease. The unavailability of precise diagnostic tests and lack of awareness among clinicians are the current challenges associated with diagnosing and managing GD in Egypt. Method An expert panel meeting was convened with 19 experts from Egypt to address the current unmet challenges in the diagnosis and management of GD from the region and to develop country-specific diagnostic algorithms based on the existing literature for pediatric and adult groups. In addition, management strategies and preventive measures were also discussed. Result The algorithms presented in this review can be implemented in clinical practice for the timely diagnosis of patients with GD in Egypt. Early diagnosis is crucial in selecting the best treatment for patients with GD, and evidence suggests that early initiation of therapy can result in better outcomes. Conclusion The evidence-based expert opinion presented in this review will help clinicians in the early initial diagnosis of GD in Egypt, leading to appropriate management of the disease.

In the present paper, we introduce and investigate a new subcategory H_Σ (q,β;ς) of analytic and bi-univalent functions in the open unit disk D based on the ideas of q-derivative operator and subordination. For the functions belong to the subcategory H_Σ (q,β;ς) , upper bounds for the second and third coefficients are found and some special outcomes of the main result are also presented.

An FT-IR spectrometer and a UV–Visible spectrometer were utilised in order to characterise the Cyanidin-3-O-glucoside chloride (C3OC) dye. The dye’s thermally induced optical nonlinearity was measured in a dimethylformamide solvent using an adjustable diode-pumped solid-state (DPSS) laser at 473 nm. The optical response was measured using the Z-scan technique. The dye showed negative and large nonlinear refractive index) NRX) values, with high nonlinear absorption coefficients (NBO). Because of its ability to change with concentration, the NRX is a viable candidate for applications in the field of nonlinear optics. Thermal lens (THS) technique was used to investigate thermo-optical properties and the NRX. The optical limiter capabilities of the C3OC dye are being investigated as a potential use.

Abstract The detection of N-hexanoyl-l-homoserine lactone (C6-HSL), a crucial signal in Gram-negative bacterial communication, is essential for addressing microbiologically influenced corrosion (MIC) induced by sulfate-reducing bacteria (SRB) in oil and gas industries. Metal oxides (MOx) intercalated into conducting polymers (CPs) offer a promising sensing approach due to their effective detection of biological molecules such as C6-HSL. In this study, we synthesized and characterized two MOx/polyaniline-dodecyl benzene sulfonic acid (PANI-DBSA) nanocomposites, namely ZnO/PANI-DBSA and Fe2O3/PANI-DBSA. These nanocomposites were applied with 1% by-weight carbon paste over a carbon working electrode (WE) for qualitative and quantitative detection of C6-HSL through electrochemical analysis. The electrochemical impedance spectroscopy (EIS) confirmed the composites’ capability to monitor C6-HSL produced by SRB-biofilm, with detection limits of 624 ppm for ZnO/PANI-DBSA and 441 ppm for Fe2O3/PANI-DBSA. Furthermore, calorimetric measurements validated the presence of SRB-biofilm, supporting the EIS analysis. The utilization of these MOx/CP nanocomposites offers a practical approach for detecting C6-HSL and monitoring SRB-biofilm formation, aiding in MIC management in oil and gas wells. The ZnO/PANI-DBSA-based sensor exhibited higher sensitivity towards C6-HSL compared to Fe2O3/PANI-DBSA, indicating its potential for enhanced detection capabilities in this context. Stability tests revealed ZnO/PANI-DBSA's superior stability over Fe2O3/PANI-DBSA, with both sensors retaining approximately 85–90% of their initial current after 1 month, demonstrating remarkable reproducibility and durability.

Mechanical downsizing of waste lignocellulosic fibers to small-size particles is a promising way to produce efficient reinforcing elements for bio-composites, both from commercial and environmental perspectives. This study specifically aims to make nano-sized lignocellulosic fillers from date palm agro-residues using a mechanical ball milling technique supplemented with liquid Nitrogen. The researchers aimed to obtain efficient reinforcing elements for bio-composites by fragmenting and downsizing waste lignocellulosic fibers. Several tests were conducted to evaluate and characterize the fillers' properties. The morphological analysis using TEM and FE-SEM showed that the microparticles had irregularly shaped particles with sizes ranging from 0.6 to 0.8 μm for micro-untreated particles and 0.22–0.32 μm for micro-treated particles. The nanoparticles had smaller particle sizes, with nano-untreated particles ranging from 80 to 122 nm and nano-treated particles ranging from 32 to 55 nm. XRD analysis revealed a boost in crystallinity due to the treatment process; (45 %) for micro-treated and (67 %) for nano-treated. TGA analysis indicated that the chemically treated fillers contributed to the improved thermal stability of the samples. Specifically, MT showed the best thermal stability due to increased crystallinity and stronger binding among the cellulose chains than that of NT.

Integrated health care has the ability to provide adequate care system in different modalities of medical care. Saudi Arabia is going through major transformation in its health care services in order to provide sufficient resources. A 12-dimension SCIROCCO online self-assessment tool, was extracted from the B3-MM, was used for the scaling up of health intervention and for assessing the maturity level of integrated care within different regions. SCIROCCO tool assess a step wise scaling up technique to evaluate how to scale up integrated care during heath transformation. By having knowledge of the factors which make this strategy difficult to implement this study evaluates to what extent SCIROCCO technique was applied. The SCIROCCO tool was used to assess the maturity of systems of Jazan, Saudi Arabia for integrated care system and for the evaluation of factors affecting scaling up. Data was collected from Stakeholders from multiple disciplines including decision-maker, healthcare professional, IT specialist by self-assessment method. The outcomes of the self-assessment process were visually captured in the form of spider diagrams. All three fundamental steps of the scaling up procedure were executed with satisfactory devotion. Integrated heath transformation in Jazan yielded 18 points out of 60 on spider diagram according to SCIROCCO tool. Majority of the dimensions have no more than 3 score. Digital Health care transformation in Jazan needs to be improved in most of the aspects. This study assesses maturity level of integrated care in Jazan and concludes that An ICT infrastructure to support integrated care has been agreed together with a recommended set of technical standards but there are Still local variations or some systems in place are not yet standardized. Learning about integrated care and change management was in place but not widely implemented.

Background: Gastroesophageal reflux disease (GERD) gives rise to distressing symptoms and is closely linked to several risk factors. Objectives: This study aimed to explore the characteristics of GERD patients and predictors of severity in Saudi Arabia among university students. Patients and methods: This is a cross-sectional observational prospective study that was conducted between April and June 2022 at the Imam Mohammad Ibn Saud University Medical Center, Saudi Arabia. The study included four positive predictors: heartburn, regurgitation, sleep disruption and the use of OTC medication in addition to prescribed medication. Additionally, there are two negative predictors: epigastric pain and nausea. GerdQ questionnaire was used for data collection. A binary logistic regression statistical analysis was employed to ascertain the factors that exhibited an influence on individuals affected by the disease and the severity. A total of 160 patients were involved in this study. Results: In final analysis of 160 participants, the mean GerdQ score was 8.1 (SD: 2.5). The majority of them are postgraduate students (Master and PhD). Bad eating habits were associated with being more influenced by GERD (having sleep disturbance together with using OTC medications) (p0.05). Conclusion: University students’ lifestyle and eating habits are largely affecting GERD patients causing sleep disturbances leading to larger usage of OTC medications. Future studies are warranted to design appropriate interventions to decrease the disease burden.

The histological, histomorphometrical, and macroscopical properties of the pancreas in local partridge (Francolinus francolinus) were the objectives of this study. Twelve adult partridges were purchased from the market of Baquba city. The gland was examined in situ macroscopically, and multiple sections of pancreatic tissue underwent microscopic analysis after preparation and staining with different stains. Macroscopic findings of the partridge pancreas determined the presence of the gland between the ascending part and descending part of the duodenum arms, and it consists of four lobes, which were ventral, splenic, third, and dorsal lobes. Three pancreatic ducts were detected. Histologically, it was noted that a thin capsule of connective tissue was surrounding the partridge's pancreas, and many septa were sent to the parenchyma, forming several lobules. The average thickness of the capsule was 12.54±0.65 µm. Two portions were identified within the gland's parenchyma: the endocrine and exocrine portions. The endocrine part occupies a smaller area in the gland when compared with an exocrine one. Islets of Langerhans in various sizes and forms were observed, which represented the endocrine part. Cells of beta, alpha, and delta were located in those islets. The mean diameter of islets was 70.51±4.75, 65.75±4.1, 53.65±3.85, and 45.22±3.20 µm in different lobes, respectively. The exocrine contained cells are arranged in acini, associated with the ductal system. In conclusion, the present research gives a window for histomorphometry and anatomical properties of the pancreas in local partridge. Nevertheless, more examinations as immunohistochemical and ultrastructure should be conducted on partridge's pancreas in future investigations.

This study examined spectroscopic, thermal, and other qualities, such as the lasing parameters, of Sm3+-doped glass with the composition 40P2O5–30ZnO–20LiCl–10BaF2. The ellipsometric data were used in a Sellmeier dispersion relation to estimate the refractive index values of the glasses investigated. The measured absorption spectra of the doped glass reveal the presence of various absorption bands assigned to transitions from the 6H5/2 ground state attributed to Sm3+-ion-excited states. We studied the decay of the 4G5/2 level of the Sm3+ ions in the doped glass by analyzing its absorption and emission fluorescence spectra. The Judd–Ofelt hypothesis allowed us to determine that the quantum efficiency of the 4G5/2–6H7/2 transition is high: 96% and 97% for glass doped with 4.05 × 1019 ions/cm−3 and 11 × 1019 ions/cm−3, respectively. Furthermore, this glass exhibits efficient red/orange enhanced spontaneous emission that matches the excitation band of the photosensitizer material used in medical applications.

The need of higher powers in electrical drives has forced the researchers to develop new power source possibilities. Multilevel inverters have been presented as a cost effective solution for various high voltage and high power applications including power quality and motor drive problems. The traditional pulse width modulated (PWM) Inverter does not completely eliminate the unwanted harmonics in the output waveform. Using the multilevel inverter as an alternative to traditional PWM inverters for electric motor drive applications is investigated. The concept of the Optimized Harmonic Elimination Stepped-Waveform (OHESW) technique for a multilevel inverter is presented. The effectiveness of this technique in minimizing the inverter switching losses and its output voltage harmonic content which cause reducing harmonic losses and torque pulsations of an induction motor fed form is investigated analytically. Comparison between the Selective Harmonic Eliminated PWM (SHEPWM) as a traditional PWM technique for three-level inverter and the OHESW technique for multilevel inverter with regard to the switching losses, harmonic distortion, additional harmonic losses in the motor and the pulsating torques is also presented.

Background: Lower gastrointestinal bleeding is known as hemorrhage which originates from the lower gastrointestinal system. Undergraduate students must have adequate knowledge of this topic to help them in their practice and to be effectively engaged with their patient’s assessment and diagnosis. Objectives: This study aims to assess the awareness and knowledge among medical students about lower gastrointestinal bleeding etiology in the governmental universities of Riyadh, Saudi Arabia. Materials and methods: This cross-sectional study was conducted using a prepared electronic self-reported questionnaire among medical students at four different universities in the Riyadh region. After collecting the data, MS Word was used for data entry while SPSS version 23 was used for data analysis. Results: In this study, a total number of 1,129 responses were collected from students at four different universities. Most of the participants (61.6%) were between 21-23 years old. In general, it was shown that 58.2% of students have enough knowledge regarding the symptoms related to lower gastrointestinal bleeding. Moreover, the participant medical students have chosen the hemorrhoids (33.2%) to be the leading cause followed by diverticulosis (20.0%), and anal fissures (11.1%). Conclusion: It was found that among the more than 1000 medical students in Riyadh region, Saudi Arabia, the awareness level toward symptoms and causes of lower GI bleeding is inadequate. There is a need to improve the awareness of medical students regarding lower GI bleeding presentation, particularly those in pre-clinical years.

Abstract Background The issue of surgical safety has increased significantly over the last few decades. Several studies have established that it is linked to non-technical performance, rather than clinical competencies. Non-technical skills can be blended with technical training in the surgical profession to improve surgeons’ abilities and enhance patient care and procedural skills. The main goal of this study was to determine orthopedic surgeons’ requirements of non-technical skills, and to identify the most pressing issues. Methods We conducted a self-administered online questionnaire survey in this cross-sectional study. The questionnaire was piloted, validated, pretested, and clearly stated the study’s purpose. After the pilot, minor wording and questions were clarified before starting the data collection. Orthopedic surgeons from the Middle East and Northern Africa were invited. The questionnaire was based on a five-point Likert scale, the data were analyzed categorically, and variables were summarized as descriptive statistics. Results Of the 1713 orthopedic surgeons invited, 60% completed the survey (1033 out of 1713). The majority demonstrated a high likelihood of participating in such activities in the future (80.5%). More than half (53%) of them preferred non-technical skills courses to be part of major orthopedic conferences, rather than independent courses. Most (65%) chose them to be face-to-face. Although 97.2% agreed on the importance of these courses, only 27% had attended similar courses in the last three years. Patient safety, infection prevention and control, and communication skills were ranked at the top as topics to be addressed. Moreover, participants indicated they would most likely attend courses on infection prevention and control, patient safety and teamwork, and team management. Conclusion The results highlight the need for non-technical skills training in the region and the general preferences regarding modality and setting. These findings support the high demand from orthopedic surgeons’ perspective to develop an educational program on non-technical skills.

A vast range of pesticides have been routinely employed for plant protection throughout the last few decades. Pesticides can enter non-target organisms in various ways, posing health hazards. Exposure to different environmental pollutants, including pesticides, can affect the human gut flora. Metabolites generated from the gut microbiota play an essential role in the host’s health by regulating metabolic homeostasis. A disruption in this equilibrium can lead to the emergence of numerous illnesses and their etiology. Pesticides have been shown in a few recent studies to harm the host’s gut microbiome. As a result, there is an urgent need to investigate the impact of pesticides on gut microbiota-mediated immunity. Metabolic alterations in the host may give a better understanding of pesticide-induced harm. This review highlights the potential consequences of pesticide exposure on gut microbiota composition and function, mainly focusing on how it might alter the production of secondary metabolites with potential downstream implications for host health.

Background: Limited studies from Saudi Arabia have assessed the quality of life (QoL) of end-stage kidney disease (ESKD) patients on hemodialysis and its associated factors. Objective: To determine the physical, psychological, familial, and social factors that impact the QoL of ESKD patients in Saudi Arabia. Materials and Methods: This cross-sectional study included adult patients with ESKD who underwent hemodialysis at King Salman Center for Kidney Disease and King Fahad Medical City, Riyadh, Saudi Arabia, between June and July 2021, and had been on dialysis for ≥1 year were included. The Arabic version of the Quality of Life Index–Dialysis (QLI-D) version III was used, which has four sub-scales. Results: A total of 173 respondents completed the questionnaire. The overall mean (±SD) QoL score was 22.2 (±4.30), while the scores for the sub-scales ranged from 20.8 (±5.25) (Health and Functioning subscale) to 26.0 (Family subscale). Respondents aged >70 years had significantly lower average score (P < 0.05) and lower Health and Functioning subscale score (P < 0.05). Education and higher income had significant positive correlation with the Social and Economic subscale (r = 0.234, P < 0.01; and r = 0.162, P < 0.05, respectively). Diabetes was significantly associated with lower scores in the Health and Functioning subscale (P < 0.05). There was a positive linear trend in the association between the number of years on dialysis and the overall QLI-D score and the subscales of QLI-D (P < 0.05). Conclusion: Higher education level and income and longer duration of dialysis were factors associated with better QoL, while older age and having diabetes were associated with poorer QoL. Awareness among healthcare providers regarding these factors can help improve the QoL of these patients.

This practice guideline was developed by the chronic kidney disease (CKD) Task Force, which was composed of clinical and methodological experts. The Saudi Arabian Ministry of Health and its health holding company commissioned this guideline project to support the realization of Vision 2030's health-care transformation pillar. The synthesis of these guidelines was guided by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)- ADOLOPMENT methodology. The final guidelines addressed 12 clinical questions on the management of blood pressure in patients with CKD through a set of recommen-dations and performance measures. The recom-mendations included antihypertensive agents in children; renin- angiotensin system inhibition (RASi) versus non-RASi in adults; intensive versus standard blood pressure targets; early versus late assessment for kidney replacement therapy (KRT); late versus early preparation strategies for KRT; CKD symptoms during assessment for KRT or conservative manage-ment; initiation of KRT in patients with deteriorating CKD; choice of KRT modality or conservative management in certain CKD patient groups; changing or discontinuing KRT modalities; the frequency of reviews for KRT or conservative management; and information, education, and support. These conditional recommendations were based on a low to very low certainty of evidence, which highlights the need for high-quality randomized trials com-paring different antihypertensive agents in patients with CKD.

Helicobacter pylori (H. pylori) is a Gram-negative bacterium that colonizes the gastric mucosa and is associated with various gastrointestinal disorders. H. pylori is a pervasive pathogen, infecting nearly 50% of the world’s population, and presents a substantial concern due to its link with gastric cancer, ranking as the third most common cause of global cancer-related mortality. This review article provides an updated and comprehensive overview of the current understanding of H. pylori infection, focusing on its pathogenesis, diagnosis, and treatment strategies. The intricate mechanisms underlying its pathogenesis, including the virulence factors and host interactions, are discussed in detail. The diagnostic methods, ranging from the traditional techniques to the advanced molecular approaches, are explored, highlighting their strengths and limitations. The evolving landscape of treatment strategies, including antibiotic regimens and emerging therapeutic approaches, is thoroughly examined. Through a critical synthesis of the recent research findings, this article offers valuable insights into the contemporary knowledge of Helicobacter pylori infection, guiding both clinicians and researchers toward effective management and future directions in combating this global health challenge.

Abstract Objectives Acute compartment syndrome (ACS) can be caused by multiple causes that affect people of different ages. It is considered an orthopedic emergency condition that requires immediate diagnosis and surgical intervention to avoid devastating complications and irreversible damages. This systematic review aimed to present the etiology of trauma-related forearm ACS. Methods A systematic review was performed on four different databases: Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of systematic review register databases via Ovid, with no restriction on dates (last date was June 30, 2021). It included all the studies containing data about the etiology of trauma-related forearm ACS. Results A total of 4893 articles were retrieved: 122 met the inclusion criteria, 39 were excluded, 25 were out of scope and 14 had insufficient details. Hence, this review constituted 83 articles and 684 patients. The etiology of ACS causing forearm ACS was classified into three groups: fracture-related, soft tissue injury-related and vascular injury-related. The fracture-related group was the most common group (65.4%), followed by soft tissue injury (30.7%), then vascular injuries (3.9%). Furthermore, supracondylar humerus fractures were the most common cause of fractures related to forearm ACS. Blunt traumas were the most common cause of soft tissue injuries-related forearm ACS, and brachial artery injuries were the most common cause of vascular-related forearm ACS. Conclusion Frequent assessment of patients with the most prevalent etiologies of forearm ACS is recommended for early detection of forearm ACS and to save limbs.

A new chemical treatment method to extract rich cellulosic fibers from date palm agro-residues is developed. The method yielded high-performance natural date palm fibers based on multistep process, which is efficient, sustainable, and unique. The proposed method consists of three steps: dewaxing, acetylation, and mercerization, which are unique in terms of time control and their sequence resulting in optimal properties of extracted fiber. Each step is strictly time-controlled and designed to achieve specific objectives in preparation for the next step. Optimization techniques including design of experiment are used to adjust input parameters so as to obtain optimized output from the treatment method. Two approaches are used for supplying heat during the fiber extraction procedure i.e. conventional heat source and microwave heat source. Experimental characterization of extracted fibers is carried out to determine its mechanical and physical properties. Results showed 32% increase in crystallinity degree of the treated fiber over the untreated one. The new method achieved around five-fold increase in ultimate tensile strength and three-fold increase in elastic modulus. The significant enhancement in properties of treated fibers over untreated counterparts confirms the effectiveness of the new process.

Abstract Cytotoxic (CD8) T-cells and natural killer (NK) cells have a significant immune function role. The ongoing stimulation of immunity and the excessive release of proinflammatory cytokines observed in pediatric patients with Gaucher disease (GD) can affect immune cells. Few studies have looked at the proportion of cytotoxic CD8 T-cells and their subsets in children with GD. A prospective case–control study was performed involving twenty pediatric patients with type 1 GD and twenty healthy age-matched controls. All patients received regular enzyme replacement therapy (ERT) for at least 6 months before the study. Complete blood count and flow cytometric analyses of CD8 T, Tc1, Tc2, NK, and NK T-cells were performed. GD patients showed significantly increased of CD8 T, Tc1 and significantly decreased NK cells frequencies when compared to healthy controls. However, no significant difference in Tc2 and NK T-cells was found between the studied groups. GD patients on regular ERT have increased CD8+ T-cell frequencies, predominantly Tc1, together with a reduction in NK cells than in healthy controls. These crucial immunological changes may contribute to some extent to the pathogenesis and the progression of GD.

In this manuscript, we implement analytical multiple soliton wave and singular soliton wave solutions for coupled mKdV with a time-dependent variable coefficient. Based on the similarity transformation and Hirota bilinear technique, we construct both multiple wave kink and wave singular kink solutions for coupled mKdV with a time-dependent variable coefficient. We implement the Hirota bilinear technique to compute analytical solutions for the coupled mKdV system. Such calculations are made by using a software with symbolic computation software, for instance, Maple. Recently some researchers used Maple in order to show that the bilinear method of Hirota is a straightforward technique which can be used in the approach of differential, nonlinear models. We analyzed whether the experiments proved that the procedure is effective and can be successfully used for many other mathematical models used in physics and engineering. The results of this study display that the profiles of multiple-kink and singular-kink soliton types can be efficiently controlled by selecting the particular form of a similar time variable. The changes in the solitons based on the changes in the arbitrary function of time allows for more applications of them in applied sciences.

Over the past three decades, minimally invasive robotic technology has evolved substantially in urological practice, replacing many open procedures and becoming part of routine clinical practice. The Health Sector Transformation Program for the Kingdom's Vision 2030 aims to restructure the health sector and optimize its status and prospects as an effective and integrated ecosystem centered on the patient's health. Therefore, this consensus seeks to endorse the clinical practice guidelines for robotic surgery (RS) in the KSA, highlighting its effectiveness, safety, and favorable outcomes compared to open and laparoscopic surgeries in certain procedures when used by trained surgeons in well-structured RS programs.

Abstract Background Anorexia Nervosa is highly comorbid with depressive, anxiety, and obsessive-compulsive spectrum disorders. However, it has not previously been reported as comorbid with antisocial personality traits, except when substance use disorder is also identified. We present an unusual case of a patient with resistant anorexia nervosa and comorbid conduct disorder. This case was also unique in that the juvenile justice system was involved during treatment. Case presentation A 13-year-old female was admitted to our pediatric hospital for the treatment of anorexia nervosa. She had a history of violent behaviors toward family members, often jeopardizing her care. During hospitalization, she physically attacked a physician on her care team shortly before she transitioned to an eating disorders treatment program. She was diagnosed with conduct disorder, and following discharge, she attacked her father in a premeditated act. This led to her entry into the juvenile justice system. While under the custody of the juvenile justice system, she was readmitted to our hospital for further treatment of anorexia nervosa. Our treatment strategy included psychotropics, positive reinforcement, close interdisciplinary coordination among the various hospital teams, and the juvenile justice system. Following discharge from her second hospitalization back to the juvenile detention system, our patient maintained a healthy weight and appeared to show improvements in the cognitive distortions related to her eating disorder. Conclusions To our knowledge, this is the first reported successful treatment of an individual with resistant anorexia nervosa and conduct disorder. It was likely a combination of weight gain, psychotropic medications, and the structured milieu provided by the juvenile justice system that led to the effective treatment of our patient. This case illustrates that a non-traditional healthcare setting can be an asset to treatment through persistence and close collaboration across institutions.

Abstract Our study aimed to evaluate the levels of MDSCs and Tregs in pediatric B-cell acute lymphoblastic leukemia (B-ALL), their relation to patients’ clinical and laboratory features, and the impact of these cells on the induction response. This study included 31 pediatric B-ALL patients and 27 healthy controls. All patients were treated according to the protocols of the modified St. Jude Children’s Research Hospital total therapy study XIIIB for ALL. Levels of MDSCs and Tregs were analyzed using flow cytometry. We observed a reduction in the levels of CD4 + T-cells and an increase in both the polymorphonuclear MDSCs (PMN-MDSCs) and Tregs. The frequencies of PMN-MDSCs and Tregs were directly related to the levels of peripheral and bone marrow blast cells and CD34 + cells. Complete postinduction remission was associated with reduced percentages of PMN-MDSCs and Tregs, with the level of PMN-MDCs in this subpopulation approaching that of healthy controls. PMN-MDSCs and Tregs jointly play a critical role in maintaining an immune-suppressive state suitable for B-ALL tumor progression. Thereby, they could be independent predictors of B-ALL progress, and finely targeting both PMN-MDSCs and Tregs may be a promising approach for the treatment of B-ALL.

Abstract Background Several trend analyses on liver transplantation (LT) indications have been published in the U.S. and in other countries, but there are limited data on LT indication trends in Saudi Arabia (SA), especially since the availability of direct-acting antivirals (DAAs) treatment for hepatitis C virus (HCV). This study aimed to analyze trends in the frequency of LT indications among LT recipients in SA over a 19-year period and examine associations between etiologic-specific trends and clinicodemographic characteristics. Methods This retrospective study analyzed clinical and surgical data of adult patients (n = 1009) who underwent LT at the King Faisal Specialist Hospital & Research Center (Riyadh, SA) between 2001 and 2019. Spearman’s rank correlation, Poisson regression, and Joinpoint regression analysis were employed to assess changes in LT etiologic trends. Results In the first period (2001–2010), the main LT indications were HCV (41.9%) and hepatitis B virus (HBV) (21.1%), but nonalcoholic steatohepatitis (NASH) (29.7%) surpassed HCV (23.7%) as the leading LT indication in the second period (2011–2019); and the trends were significant in correlation analyses [incidence rate ratio (IRR) = 1.09 (1.06–1.13) for NASH; IRR = 0.93 (0.91–0.95) for HCV]. In the Joinpoint regression analysis, increases in NASH from 2006 to 2012 (+ 32.1%) were statistically significant, as were the decreases in HCV from 2004 to 2007 (− 19.6%) and from 2010 to 2019 (− 12.1%). Similar patterns were observed in LT etiological comparisons before and after the availability of DAAs and within hepatocellular carcinoma stratifications. Conclusions Trends in the epidemiology of LT indications among LT recipients in SA have changed over a 19-year period. Most notably, NASH has eclipsed HCV in the country due to the effective treatment strategies for HCV. These trends in NASH now need an aggressive public health response to minimize and avert future onset of additional clinical and economic strains on health care systems and LT centers in SA.

Contrast medium-induced nephropathy (CIN) is a leading cause of acquired acute kidney injury and has been associated with prolonged hospitalization and adverse clinical outcomes. This study aimed to determine if omega 3 fatty acids reduce the risk of CIN in patients with chronic kidney disease undergoing coronary angiography. A total of 130 consecutive patients undergoing coronary angiography were randomly assigned to one of two groups as follows: 67 patients were assigned to the N-acetylcysteine (NAC; 1200 mg) and 63 patients were assigned to the omega 3 fatty acid (4 g). Both drugs were administered orally twice per day one day before and on the day of contrast administration. Of the 130 patients enrolled in this study, 10 (7.7%) experienced an increase of at least 0.5 mg/dL (44 μmol/L) in serum creatinine levels 48 h after administration of the contrast agent including 5 of the 67 patients in the NAC group (7.5%) and 5 of the 63 patients in the omega 3 fatty acids group (7.9%; P = 0.919). There were no significant differences in the need for renal replacement therapy (3.0% vs. 9.5%, P = 0.121) or in the mortality rate (3.0% vs. 6.3%, P = 0.361) between the two groups. Short-term prophylactic omega 3 fatty acid treatment with hydration does not reduce the risk of CIN in patients with chronic kidney disease undergoing coronary angiography.

الملخص: تاريخيا، علاج داء بلونت مثير للجدل دائما. حيث لجميع التقنيات الموصوفة لعلاجه إيجابياتها وسلبياتها. لا يوجد إجماع على نهج جراحي واحد لعلاج هذا المرض. الهدف من هذا التقرير هو مشاركة النتائج المبكرة لتقنية الجمع حيث قمنا بتجميع ثلاث خطوات جراحية معروفة في إجراء واحد. ينصح بهذا الإجراء المشترك للحالات الشديدة والمتكررة. تجمع تقنية ''ثلاثة في واحد'' بين قطع عظمي داخل المشاشية لرفع الهضبة، وقطع العظم الظنبوبي الكردوسي وإيثاق جانبي المؤقت لمشاشة الظنبوب الدانية. ونذكر في التقرير النتائج الأولية لثلاثة أطراف في مريضين عولجا بهذه التقنية. كانت الحالة الأولى لمراهق مصاب بداء بلونت الشديد في الجهة اليسرى (لانغنشيولد المرحلة الرابعة) مع الدفع الجانبي. بينما كانت الحالة الثانية مصابة بداء بلونت الطفولي الحاد على الجانبين (لانغنشيولد المرحلة الخامسة) والدفع الجانبي. تحسنت جميع القياسات بشكل ملحوظ في كليهما خلال تقييم ما بعد الجراحة. وكان التباين في طول الأطراف ٠.٦سم في الحالة الأولى و٠.٥ سم في الحالة الثانية. تم تصحيح الدوران الداخلي الظنبوبي والدفع الجانبي بشكل عفوي. كما لم يتم تسجيل أي مضاعفات في كلا المريضين. جراحة ''الثلاثة في واحد'' هي طريقة جراحية آمنة ومتعددة الاستخدامات يمكن استخدامها في الحالات الشديدة والمقاومة والمتكررة مع المشاشة المفتوحة. إلى جانب ذلك، يمكن أن تحل مشاكل الدفع الجانبي والدوران الظنبوبي الداخلي. يجب دراسة المزيد من الحالات قبل أن نتمكن من إقرار سلامة وفعالية هذه التقنية. Abstract: The treatment of Blount's disease has historically remained controversial. All the described techniques for its treatment have their own advantages and disadvantages, and no consensus has been reached on a single surgical approach. The aim of this report is to share the early results of a combination technique in which we have collated three well-known surgical steps in one procedure. This combined procedure is indicated for severe and recurrent cases. Our ‘three-in-one’ technique combines an intra-epiphyseal plateau elevating osteotomy with a tibial metaphyseal osteotomy and a lateral tibial temporary hemi-epiphysiodesis. We also report initial results of three limbs in two patients who were treated using this technique. The first case was that of an adolescent with severe left Blount's disease (Langenskiold stage IV) and a lateral thrust. The second case was that of bilateral severe infantile Blount's disease (Langenskiold stage V) and the infant had a lateral thrust. All measurements remarkably improved in both patients during the post-surgical assessment. The limb length discrepancy was 0.6 cm in the first case and 0.5 cm in the second. The preoperative internal tibial rotation and lateral thrust were corrected spontaneously. No complications were recorded in either patient. The three-in-one technique is a safe and versatile surgical approach that can be used in severe, refractory, and recurrent cases of open physis. Furthermore, it can potentially solve the problems of lateral thrust and internal tibial rotation. More cases should be studied before we can endorse the safety and effectiveness of this technique.

الملخص: أهداف البحث: يعتبر سوء استخدام المواد المحظورة من قبل سلطات (تعاطي المنشطات) مشكلة كبيرة في الرياضة، وقد هزت وسائل الإعلام بنشرها لعدد من حالات تعاطي المنشطات الحديثة السلطات والجمهور العام. وقد أدين عدد كبير من الرياضيين بتعاطي المنشطات. على الرغم من وجود قناعة لدى الرياضيين أن استخدام المنشطات يخالف روح الرياضة ويدركون عواقبها، إلا أنهم ما زالوا يستخدمونها. يُعتقد أن استهلاك المواد المحظورة بين الرياضيين في المملكة العربية السعودية أمرا شائعا. هدفت هذه الدراسة إلى دراسة استخدام المنشطات بين الرياضيين السعوديين. طرق البحث: تم عمل مسح منهجي لأخذ عينات عشوائية لكل الرياضيين السعوديين الذين تتراوح أعمارهم بين ١٥ و٤٥ عاما، المرتبطين بالاتحادات الرياضية السعودية والهيئة العامة للرياضة. خلال الفترة من ٢٠٠٩ إلى ٢٠١٨م، وقد شارك ٣٨٨ من ضباط مكافحة المنشطات في البرنامج الوطني لمكافحة المنشطات، بمجموع ٤٦٠ زيارة منشأة و١٧١ زيارة مدينة لجمع البيانات. النتائج: تم اختبار ما مجموعه ٦٣٠٦ عينة خلال فترة الدراسة. وكانت العينات السلبية ٦١٦٥ عينة، والعينات الإيجابية ١٤١ (٢.٢٤٪) لتعاطي المنشطات. كان عدد العينات الإيجابية أعلى بشكل ملحوظ بالنسبة للرياضيين المنافسين مقارنة بالرياضيين غير المنافسين. وأظهرت الدراسة أن تعاطي المنشطات يمثل مشكلة كبيرة في السعودية حيث بلغت نسبة انتشاره ٢.٢٤٪ خلال فترة الدراسة، أثبتت لدى الرياضيين السعوديين نتائج إيجابية لتعاطي المنشطات في جميع الألعاب الرياضية. الاستنتاجات: يعتبر تعاطي المنشطات مشكلة كبيرة في المملكة العربية السعودية. يحتاج البرنامج الوطني لمكافحة المنشطات إلى زيادة الأنشطة التعليمية للوصول إلى جميع الرياضيين في البلاد من أجل ضمان اللعب الآمن والعادل لجميع الرياضيين السعوديين. Abstract: Objectives: The abuse of substances banned by anti-doping authorities is a significant problem in sports. Recently, several doping cases have been reported by the media. Additionally, a large number of athletes have been found guilty of using banned substances. Although athletes believe that doping is against the spirit of sports and are aware of its consequences, they continue to use these substances. The consumption of banned substances among Saudi athletes is rising. This study aimed to investigate the abuse of drugs among Saudi athletes. Methods: A systematic random sampling cross-sectional survey was administered to all 15-45-year-old Saudi male athletes who were registered with Saudi Sports Federations and the General Sports Authority. From 2009 to 2018, 388 doping control officers participated in the National Anti-Doping Program across 460 facilities. The study necessitated 171 city visits for data collection. Results: A total of 6306 samples were tested during the study period. There were 6165 negative and 141 (2.24%) positive samples for doping. We report a doping prevalence of 2.24% among Saudi athletes. During the study period, Saudi athletes from all types of sports were tested positive for doping. The number of positive samples was significantly higher among competing athletes than non-competing athletes. Conclusion: Doping is a significant problem in KSA. For safe and fair play by all Saudi athletes, the National Anti-Doping Program should enhance the educational campaigns for all athletes in the country. الكلمات المفتاحية: المواد المحظورة, المنشطات, تعاطي المخدرات, البرنامج الوطني لمكافحة المنشطات, الرياضيون السعوديون, Keywords: Banned substances, Doping, Drug abuse, National anti-doping program, Saudi athletes

Developing more accurate, fast and cheap means of analysing chemical species is everlasting. Towards this objective, two new electrodes for the determination of malachite green dye (MG) are devised: one incorporating an ion-pair in polyvinyl chloride membrane (MG-PVCE), designated S1, and the other, S2. is a coated wire electrode (MG-CWE). S1 comprises malachite–phosphomolybdate (MG-PM) as an ion exchanger and DBP as a plasticizer. S2 has DOA as a plasticizer. Each electrode exhibits a good Nernstian slope over a linear range ∼2.00 ​× ​10−7 – 1.00 ​× ​10−2 ​M as well as the limit of detection (LOD) of 2.00 ​× ​10−7 ​M, the response time (∼5s), and thermal stability up to 55 ​°C. The sensors showed high selectivity of MG determination in commercial aquaculture and waste water samples with good recovery.

The research aims are to measure the Koya University teacher self-efficacy, gender differences effect and its relationship with their academic levels. To achieve these aims, 72 Koya University teachers voluntarily participated. For collecting the data, a 10-item instrument with 5 options have been adapted, the validity and validity for the instrument were at satisfied level. Using SPSS as a tool for analyzing the data, the research found the level of teachers’ self-efficacy very high, and gender has no effect of their teaching efficacy level even though the female scored higher but was not statistically significant. In addition, the research found negative relationship between the teachers’ academic level and teacher self-efficacy, but wasn’t statistically significant.

In this paper, the synchronization of fractional-order uncertain delayed neural networks with an event-triggered communication scheme is investigated. By establishing a suitable Lyapunov–Krasovskii functional (LKF) and inequality techniques, sufficient conditions are obtained under which the delayed neural networks are stable. The criteria are given in terms of linear matrix inequalities (LMIs). Based on the drive–response concept, the LMI approach, and the Lyapunov stability theorem, a controller is derived to achieve the synchronization. Finally, numerical examples are presented to confirm the effectiveness of the main results.

This paper introduces a novel synchronization scheme for fractional-order neural networks with time delays and reaction-diffusion terms via pinning control. We consider Caputo fractional derivatives, constant delays and distributed delays in our model. Based on the stability behavior, fractional inequalities and Lyapunov-type functions, several criteria are derived, which ensure the achievement of a synchronization for the drive-response systems. The obtained criteria are easy to test and are in the format of inequalities between the system parameters. Finally, numerical examples are presented to illustrate the results. The obtained criteria in this paper consider the effect of time delays as well as the reaction-diffusion terms, which generalize and improve some existing results.

High-dose dexamethasone (HD-DXM) is debated as a second-line therapy for chronic Immune thrombocytopenia (ITP) in children. The aim of this study is to evaluate the efficacy and safety of HD-DXM as an emergency therapy in uncontrolled bleeding in children with chronic ITP and to assess its immunological effect on dendritic cells (DCs) percentage and their co-stimulatory markers CD86 and CD83. Totally, 20 children previously diagnosed as chronic ITP were enrolled in this study and all admitted to hospital with uncontrolled bleeding. Patients received HD-DXM as a single daily dose for 4 days. Blood samples were withdrawn from patients just prior to HD-DXM therapy and on day 5 to evaluate the platelet count and for flowcytometric analysis of DCs. Daily assessment of bleeding severity was performed. The platelet counts significantly increased in patients after 5 days of initiation of therapy compared with platelet count before therapy (p-value = 0. 0002). Control of bleeding observed in (90%), complete response (CR) documented in (50%), response (R) documented in (40%), and no response (NR) documented in (10%) of patients. The time to respond was raging from 1 to 3 days and minor complication recorded in two patients. Both plasmacytoid DCs and myeloid DCs percentage and their expression of co-stimulatory markers, CD86 and CD83 decreased significantly after HD-DXM therapy. Conclusion: short course of HD-DXM as a rescue therapy seems to be an effective alternative emergency treatment for uncontrolled bleeding in chronic ITP children especially in nations with limited resources.

الملخص: أهداف البحث: السعي إلى أن تصبح جراح عظام هو تحد في جميع أنحاء العالم. يهدف الباحثون إلى معرفة في أي مستوى من التدريب يتم اختيار تخصص جراحة العظام كمهنة من قبل المقيمين والخريجين في دول مجلس التعاون الخليجي. وأسباب اختياره والعقبات التي تواجههم. طرق البحث: دراسة مقطعية عن طريق استبانة تم توزيعها إلكترونيا على جميع أطباء جراحة العظام المقيمين في دول مجلس التعاون الخليجي. وتضمنت معايير الاشتمال الأطباء المقيمين الحاليين وكذلك أطباء الزمالة المسجلين في برامج جراحة العظام في المملكة العربية السعودية وعمان والكويت والبحرين. وشملت معايير الاستبعاد الأطباء المقيمين في السنة الأولى من التدريب وأولئك الذين أنهوا برنامج الإقامة قبل عام ٢٠١٣م. النتائج: كان معدل الاستجابة ٤٨.٣٣٪ (٢٧٥ من أصل ٥٦٩ من الأطباء المقيمين). اختار أكثر من نصفهم (٥٤.٥٪) تخصص جراحة العظام أثناء دراستهم الجامعية. وتصدر الدافع الشخصي المرتبة الأولى بنسبة ٦١.٠٩٪، في حين كان ضغط الوالدين أقل مرتبة بنسبة ٠.٣٦٪. وأقرت أغلبية عظمى (٨٨٪) أن تخصص جراحة العظام يتطلب جهدا بدنيا، في حين أن ٣٣.١٪ أرادوا ترك تخصص جراحة العظام. فيما كانت أغلب رغبات الأطباء المقيمين مستقبلا بالتخصصات الفرعية تنصب نحو جراحة عظام الأطفال، وكذلك الطب الرياضي والمناظير، بنسبة ١٦.٤٪ و١٦.٠٪ على التوالي. الاستنتاجات: هناك نسبة مقلقة من الأطباء المقيمين في تخصص جراحة العظام الذين يرغبون في ترك التخصص. التحديات التي يواجهها الأطباء المقيمين هي الإنهاك، وضيق الوقت، ومحدودية المستشفيات التعليمية، والمقاعد المحدودة لبرامج التخصصات الفرعية. نوصي برامج التدريب بزيادة عدد برامج التخصصات الفرعية وعدد مقاعد التدريب في التخصصات الفرعية والبحث بشكل أكثر تعمقا في مصلحة الأطباء المقيمين. Abstract: Objectives: Becoming an Orthopaedic Surgeon is a challenge worldwide. This study attempted to determine the level of training at which orthopaedic surgery is chosen as a career by residents and graduates of Gulf Cooperation Council (GCC) countries. The reasons for choosing this surgical speciality and barriers faced by residents were also explored. Methods: In this cross-sectional study, a questionnaire was electronically distributed to all GCC orthopaedic surgery residents. All currently enrolled residents and fellows in orthopaedic surgery programmes in KSA, Oman, Kuwait, and Bahrain were invited. Exclusion criteria included first-year residents and those who had completed their residencies before 2013. Results: A total of 275 out of 569 residents responded, a response rate of 48.33%. More than half of the participants (54.5%) chose orthopaedic surgery during their undergraduate studies. Personal interest ranked number one at 61.09%, while parental pressure was found to be the least important reason (0.36%). The majority (88.0%) agreed that orthopaedic surgery was physically demanding, whereas 33.1% wanted to quit orthopaedic surgery. The interest of residents for future subspecialities was mostly in paediatric orthopaedics and sports medicine, as suggested by 16.4% and 16.0%, respectively. Conclusion: This study showed an alarming number of residents who wanted to quit orthopaedic surgery. The challenges residents faced were burnout, lack of time, limited exposure to teaching hospitals, and limited seats for subspeciality training. We recommend increasing the number of orthopaedic surgery subspeciality fellowships, as well as the number of fellowship seats in training programmes. The well-being of orthopaedic surgery residents should also be given consideration. الكلمات المفتاحية: البحرين, برامج جراحة العظام في مجلس التعاون الخليجي, الكويت, عمان, المملكة العربية السعودية, Keywords: Bahrain, GCC orthopaedic programmes, Kuwait, Oman, KSA

الملخص: أهداف البحث: لقد أظهرت الدراسات المنشورة أن بعض المقيِّمين يضعون درجات نجاح لطلاب طب ما كان ينبغي لهم في حقيقة الأمر أن ينجحوا. فشل أعضاء هيئة التدريس هذا في ترسيب الطلاب ضعاف الأداء من الممكن أن يسيء إلى سمعة البرامج المهنية، سواء كان في الحقل الطبي أو خارجه. في الوقت نفسه، يصبح الطلاب الضعفاء أطباء غير أكفاء وبالتالي يعرِّضون المجتمع الذي يخدمونه للخطر. كان الدافع وراء إجراء هذه المراجعة المنهجية هو تحديد العوائق التي تمنع أعضاء هيئة التدريس من ترسيب طلاب الطب المتعثرين. طرق البحث: تم البحث في قواعد بيانات مدلاين، وسكوبس، ومكتبة وايلي على الإنترنت، ومكتبة كوكرين، وأوفد، وتَيلر وفرانسس، وسِنال، ورابط سبرنجر، وبروكويست وشبكة أي اس أي للمعرفة، تم البحث فيها باستخدام عناوين الموضوعات الطبية (مصطلحات ''مش”) التالية: ''ترسيب عضو هيئة التدريس '' و'' ترسيب الطلاب'' و''العجز عن الترسيب'' أو ''التقييم''. تم تنسيق البيانات وتحليل النتائج. النتائج: أظهر هذا البحث وجود وفرة من الحواجز لدى أعضاء هيئة التدريس تساهم في منعهم من الترسيب، مثل مخاوف أعضاء هيئة التدريس من الإجراءات القانونية، وعمليات الطعن، والتوتر من ترسيب الطلاب، ونقص المعرفة بالتوثيق المناسب، وعدم توافر مكاتب الدعم والموارد لأعضاء هيئة التدريس، وغياب التوجيهات الإدارية، وإجراءات الفصل المعقدة، التي تثني عضو هيئة التدريس عن ترسيب الطلاب. الاستنتاجات: ينبغي على برامج تطوير أعضاء الهيئة التدريسية في المؤسسة والورش التدريبية أن تيسر تعليم المشرفين والمقيِّمين على التقييم المتكرر والتوثيق المنتظم لتقييم المتدرب. كما نؤكد على ضرورة توفير المشورة القانونية في حالة الطعن ودعم ذوي الاختصاص من قبل مكتب الموارد والدعم. Abstract: Objectives: Literature has shown that some assessors assign passing grades to medical students who, in fact, should not have passed. This inability of the faculty to fail underperforming students can jeopardise the reputation of professional programs, be it in the medical field or beyond. Simultaneously, weak students become incompetent physicians and, thus, endanger the community they serve. The impetus for conducting this systematic review was to identify barriers to faculty in failing struggling medical students. Methods: The databases of MEDLINE, Scopus, Wiley online library, Cochrane library, OVID, Taylor and Francis, CINAHL, Springer link, ProQuest, and ISI Web of knowledge were searched using Medical Subject Headings (MeSH) terms ‘Faculty failure’ AND ‘Failing students’ AND ‘Failure to fail’ OR ‘Assessment’. The data were synthesised, and the results were analysed. Results: This search showed a wealth of barriers to faculty contributing to a ‘failure to fail’ such as their concerns about legal action and an appeals process; the stress of failing students; a lack of knowledge about proper documentation; unavailability of support, resources, and offices for faculty; absence of administrative guidelines; and complex dismissal procedures discouraging the faculty from failing students. Conclusion: Institutional faculty development programs and training workshops should facilitate the education of supervisors and assessors for timely evaluation and regular documentation of trainee assessment. The provision of legal advice in cases of appeal and professional support by the resource and support office is emphasised. الكلمات المفتاحية: التقييم, ترسيب أعضاء هيئة التدريس, ترسيب الطلاب, العجز عن الترسيب, التعليم الطبي, Keywords: Assessment, Faculty failure, Failing students, Failure to fail, Medical education

Introduction: Gastroesophageal reflux disease (GERD) is one of the most common chronic gastrointestinal disorders in adults, it develops when the stomach contents reflux and rise up into the esophagus as a result from lower esophageal sphincter dysfunction. Stomach acid that touches the lining of the esophagus causes symptoms and complications. The classical symptoms of GERD include heartburn, usually after eating, chest pain, and regurgitation. Aim: To measure the prevalence of gastroesophageal reflux disease and determine its risk factors among the students of Shaqra University. Methods: A cross-sectional study was conducted using a structured questionnaire distributed among Shaqra University students after multistage stratification and random sampling technique to stratify students according to gender and the three main colleges in Shaqra city, Saudi Arabia. The sample size was determined to be 435 with the precision of ± 5% and a 95% confidence interval (CI). The questionnaire included demographic data like age, gender, height and weight, lifestyle, and dietary habits. Statistical data were analyzed using the Statistical Package for Social Sciences (SPSS) version 16. Results with a P value of 25 kg/m2), fast food, tea, carbonated beverages consumption, quick eating, and sleeping within 1 hour of dinner are associated with symptomatic GERD (P < 0.05). Conclusion: The results show a high prevalence of GERD in Shaqra university students and the presence of many modifiable risk factors which merits the conduction of public health campaigns to raise awareness about the disease and its risk factors.

The study aimed to find out the level of anxiety and motivation among kindergarten and grade one teachers toward teaching English as a medium of instruction, and also to figure out the correlation between anxiety and motivation, according to the selected variables. 42 grade one and kindergarten teachers randomly participated (10 males, 32 females). This study exercises Hopkins symptom checklist-25 for measuring anxiety and English Teacher Motivation Scale 30-items for measuring motivation that has been used. The result indicated that there is low level of anxiety and high level of motivation among participants. Moreover, there was a negative Pearson correlation between teachers’ motivation and anxiety. The Level of anxiety was higher in female teachers. On the other hand level of motivation was higher in male teachers. Each demographic variable such as gender and workplace had effect on both teachers’ motivation and anxiety.

Background: Sleep is crucial to human's health and essential for a person's wellbeing. It is involved in multiple physiological mechanisms, such as metabolism, appetite regulation, immune and hormone function, and cardiovascular systems. The National Sleep Foundation recommends 7–9 h of sleep each night for adults. Short (

The melt-quenching approach was used to prepare phosphate–titanite glasses with the composition P2O5-Na2O-CaO-8KF-CaCl2-xTiO2 (where x = 2, 4, and 6) in a mol %. The optical, physical, and shielding properties, such as the mass attenuation coefficient (MAC), half-value layer (HVL), effective electron density (Neff), and effective atomic number (Zeff), of the glasses were investigated at energies ranging between 15 and 200 keV. The shielding parameters were investigated using recently developed software (MIKE). The optical properties were examined using devices such as UV-Vis-NIR spectroscopy over wavelengths ranging between 190 and 2500 nm. The reported results showed that increasing the concentration of TiO2 led to an increase in the density from 2.657 to 2.682 g/cm3 and an increase in the OPD from 66.055 to 67.262 mol/L, while the molar volume (VM) and oxygen molar volume (VO) decreased from 39.21 to 39.101 cm3/mol and from 15.139 to 14.867 cm3/mol, respectively. The energy gap was found to decrease from 3.403 to 3.279 eV when the TiO2 concentration increased. Furthermore, as the surface plasmon resonance of TiO2 increases, so does its third-order susceptibility, non-linear refractive indices, linear attenuation, and mass attenuation. The shielding performance evaluation indicates that the most suitable energy range is between 15 and 50 keV. Based on the results, the PCKNT3 glass sample exhibits the highest attenuation performance of all of the samples tested.

A new glass with a composition of 40P2O5-30ZnO-20LiCl-10BaF2 (in mol%), doped with 3.5Nd2O3-3.5Yb2O3, was fabricated by the quenching melt technique. The luminescence (PL) and gamma spectroscopy of the glass were investigated systematically. The spectroscopic parameters of the prepared glass, such as the optical energy gap, Judd–Ofelt parameters Ωk (where k = 2, 4 and 6), lifetimes and branching ratio of the Nd3+/Yb3+ level, were evaluated. Moreover, the shielding parameters, such as the linear and mass attenuation coefficients, mean free path and half-value layer, were evaluated. The prepared glass had a spectroscopic quality factor (Ω4/Ω6) of 0.84, which is about three-times larger than that of the most standard laser host, Nd3+:YAG. The energy of the 2P1/2 (Nd3+) level (~23,250 cm−1) was twice the energy of the Yb3+ transition (~10,290 cm−1). The value of the emission cross section (σem(λ)) of Nd3+:4F3/2→4I9/2 and Yb3+:2F5/2→2F7/2 were 2.23 × 10−24 cm2 and 2.88 × 10−24 cm2, respectively. The fabricated glass had a high emission cross section and low mean free path parameters, which makes the fabricated glass a potential candidate for multifunctional applications, such as laser emissions for medical purposes.

Background: Clopidogrel is an antiplatelet therapy that is widely used in pre and post percutaneous (PCI) coronary intervention procedures to prevent platelet aggregation and stent restenosis. However, there is a wide inter-individual variation in clopidogrel response and some patients showed resistance against the activity of Clopidogrel. Kinase insert domain receptor (KDR) gene is responsible for the transcription of vascular endothelial growth factor receptor 2 (VEGFR2) that plays a major role in the cardiovascular diseases (CVDs) and platelet aggregation. The aim of this study was to find out the association of KDR rs1870377 genotype with clopidogrel resistance (CR) in CVD patients, of Iraqi Arabic origin, hospitalized for elective PCI. Materials and methods: This study was a case-control study with a total of 324 PCI patients. Those patients were classified into 213 patients with non-clopidogrel resistant and 111 patients with CR, depending on the analysis of platelet activity phenotype after clopidogrel administration. KDR rs1870377 was genotyped for all patients using polymerase chain reaction-restriction fragment length polymorphism technique and confirmed by DNA Sänger sequencing through applying Biosystems Model (ABI3730x1). Results: KDR rs1870377 SNP is strongly associated (Chi-sqaure, p vale

The Mediterranean hemopathic syndromes (MHS) are the most prevalent hemoglobinopathies in the Mediterranean basin. Transfusion therapy is the main therapy for these disorders, particularly for severe forms of the disease. Currently, pre-transfusion serological typing of erythrocyte antigens is the standard tool for reducing complications of transfusion in those patients. This study compared genotyping with phenotyping of non-ABO erythrocyte antigens in patients with MHS and assessed the effect of transfusion therapy on their results. One-hundred ninety-eight MHS patients were recruited, screened, and proven negative for allo-antibodies. They were grouped into two groups: (1) 20 newly diagnosed patients with no transfusion history and (2) 178 previously diagnosed patients undergoing transfusion therapy. Patients were interviewed and clinically examined. Full blood count (FBC) and high performance liquid chromatography (HPLC) were done for group 1 only. Genotyping and phenotyping of non-ABO erythrocyte antigens were performed for group 1, and 25 patients out of group 2 were propensity score-matched (PSM) with group 1. Both groups were gender and age matched; 55% and 74% of groups 1 and 2 had major disease, respectively. Insignificant differences were observed between genotyping and phenotyping of non-ABO erythrocyte antigens in group 1, while significant discrepancies and mixed field results were noted in group 2 patients. Discrepancies were obvious with JKa, JKb, and little c antigens. Conclusively, molecular typing is a powerful tool for pre-transfusion testing in chronically transfused MHS patients. This testing reduces incidence of transfusion reactions. JKa, JKb and little c antigens are the most clinically significant non-ABO erythrocyte antigens.

Background: Acinetobacter baumannii is an opportunistic pathogen associated with healthcare infections and high mortality rates in intensive care units all over the globe. Porins and efflux pumps over-expression have been reported as contributing factors in escalating drug resistance and rendering treatment ineffective. In this study, we investigated the mechanisms of multidrug resistance (MDR) in A. baumannii clinical isolates. Methods: A total of 30 A. baumannii isolates were included in the present study from Nehru Hospital (PGIMER-Chandigarh) located in North India. Kirby Bauer disk diffusion assay and MIC were performed to determine the antimicrobial susceptibility pattern. Screening of beta-lactamases was performed using PCR. Relative gene expression of four RND, one MATE efflux pump, and two outer membrane proteins were determined using RT-PCR. Molecular typing of 22 isolates was carried out using MLST Oxford scheme. Results: CarO porin genes showed over-expression in 63% isolates followed by adeGandabeM efflux pump downregulation/underexpression (A. baumannii isolates. Interestingly, NDM-1 and OXA-58 were traced in 10 and3 A. baumannii isolates respectively; 13 of 22 (59%) isolates showed novel Sequence Types (STs) in the Multi-Locus Sequence Typing (MLST) analysis. ST 1087 was most commonly found ST among all others (16 STs). Conclusions: This study indicated a possible role of carO porin genes and adeG (RND) andabeM (MATE) efflux pumps in carbapenem susceptibility of A. baumannii. New STs were also reported in the majority of the isolates.

Acute scrotum considered to be a common and one of the urological top emergency cases. However, acute testicular pain due to testicular vein thrombosis is rare especially if this thrombosis considered to be a complication of an infection, and not due to varicocele or malignancy-related conditions. A rare case of right epididymo-orchitis case complicated by right pampiniform plexus thrombosis, which resolved spontaneously with no anticoagulant management., Testicular vein thrombosis considered to be a rare differential diagnoses of acute scrotum presentation. With a limited number of reported cases, it requires more evaluation to develop a proper medical approach.

Various treatments on the PEDOT:PSS films were carried out to investigate it’s influence on the conductivity, morphology, transmittance and the corresponding impact of the performance of the organic photovoltaic devices based on the PCPDTBT:PCBM and P3HT:PCBM blends. These processing including doping PEDOT:PSS with DMF and ME solvents and exposing these films to the vapor of DMF and ME solvents, separately. A considerable enhancement of the conductivity and transmittance of PEDOT:PSS was observed after doping solvent into the PEDOT;PSS solution followed by solvent treatment through exposing these films to solvents environment. The best organic PV doped devices based on either PCPDTBT:PCBM or based on P3HT:PCBM with power conversion efficiency were 2.93% compared to 1.87% for the pristine PV devices or 2.79% compared to 1.77% for the pristine devices, respectively. The conductivity improvement was highly influenced by solvent treatment.

Background and Aim. We studied through flow cytometry the expression of CD146 on different T cells, and B-cell ALL blasts trying to correlate its expression with different prognostic factors of B-cell ALL and treatment outcomes. Patients and Methods. All pediatric patients with B-cell ALL were subjected to bone marrow examination and cytochemistry, flow cytometric immunophenotyping using monoclonal antibodies utilized for diagnosis of B-ALL including CD34, CD19, CD10, CD22, and intracellular IgM. The diagnosis was based on standard morphologic, cytochemical, and immunophenotypic followed by flow cytometric detection of CD146 expression on blast cells, CD4+, and CD8+ T cells. Results. Significant accumulations of CD146+CD4+ cells, CD146+CD8+ cells, CD4+, CD8+, and lymphocytes in patients were compared to controls, the mean percentages of CD146+CD4+ cells, CD146+CD8+ cells, and CD146+ blasts were significantly higher in patients than controls, and in addition, these cells were associated with poor overall survival and disease-free survival. The median OS for patients with complete response was 22±1.633 (95%CI=18.799‐25.201), while for those without complete response, it was 13±3.928 (95%CI=5.301‐25.699), with log‐rank=5.71, P=0.017. Conclusion. CD146 was expressed significantly in children’s B-ALL and associated with poor prognostic features including poor response and treatment outcomes and could be a possible poor prognostic factor in pediatric B-cell ALL.

Background. Seasonal influenza is an acute respiratory infection caused by influenza viruses that are highly contagious and circulate in all parts of the world. It gives rise to an estimated 3 to 5 million cases of severe illness and about 250,000 to 500,000 deaths globally each year. Influenza tends to cause epidemics with serious illness and death among high-risk groups such as children aged 5 years and younger, pregnant women, elderly ≥65 years of age, and with chronic medical conditions. According to the Centers for Disease Prevention and Control (CDC), all people who are 6 months old and above are recommended to receive the seasonal influenza vaccine annually. Despite the fact that influenza vaccine is readily available, and the severity of the disease is known to adversely affect the individual’s quality of life and well-being, vaccination uptake rates are still low, contributing to the increased burden of the disease worldwide. Objectives. To measure the influenza vaccine uptake among residents of Riyadh Province, Saudi Arabia, that determines their attitude, knowledge, and beliefs regarding the vaccine. Methods. A cross-sectional study was conducted using a self-administered structured questionnaire distributed online targeting residents of Riyadh Province, Saudi Arabia, from 1st of August 2019 till 30th of September 2019. Participants were selected through volunteer sampling. The questionnaire included demographic data including age, gender, occupation, education level, marital status, and comorbidities. It also included questions regarding knowledge, attitude, and beliefs regarding influenza vaccine. After collection of data, statistical analyses were conducted by using Statistical Package for Social Sciences (SPSS) version 19.0. A P value of