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Abstract Breast cancer is a type of cancer that is common in women worldwide, which emphasises its significance in identification with preventative treatment methods. The invented Photonic Crystal Fibre (PCF) exhibits outstanding performance in detecting Breast Cancer. The suggested model of the authors includes Hybrid layout within clad surface alongside Square Core. Introduced PCF detector exhibits max Relative Sensitivity (RS) of 96.82% as well 96.74% for breast cancer cell MCF‐7 as well MDA‐MB‐231 correspondingly. The authors also investigated the Confinement Loss of 1.642 × 10−10 dB/m, 2.461 × 10−10 dB/m with Effective Material Loss of 0.0473, 0.0565 cm−1 for the mentioned cells. Increased outcomes, customised therapy, plus quick action are made possible by swift identification in breast carcinoma. Timely malignancy detection reduces requirements to severe therapy by enabling simpler medicines. Additionally, making continuous illness detection easier, improving patient treatment. Furthermore, reliable evaluation contributes for investigating advancements that improve worldwide recognition as well as therapy alternatives. The introduced PCF Perhaps crucial in quick identification of these deadly cells as it has an extraordinary sensing ability. In conclusion, it has numerous possibilities in the healthcare sector.

Abstract Jurkat cells are immortalised lines of human T lymphocyte cells widely used in research to study leukaemia, signalling of T cells, and immune responses. These cells can be used as models to define the mechanisms of leukaemia and to develop mechanism‐based therapies. Jurkat cells can be detected with remarkable accuracy using the recently created Photonic Crystal Fibre (PCF). The suggested design has a hybrid arrangement on its clad surface and a rectangular core. The recently released PCF analyser displays a maximum Relative Sensitivity are 95.81% for Jurkat (type I) and 94.93% for Jurkat (type II), respectively. The Effective Material Loss of 0.0070 cm−1, 0.0080 cm−1, and the Confinement Loss of 9.11 × 10−9 dB/m, 9.15 × 10−8 dB/m were also examined for the previously described units. Jurkat cells represent a model of leukaemia that is very malignant and proliferative, representative of aggressive T‐cell acute lymphoblastic leukaemia with the ability to progress rapidly and hence poor prognosis for patients. The benefit of applying a suggested PCF sensor to Jurkat cell detection lies in the high sensitivity to refractive index changes, allowing label‐free and real‐time monitoring of cell interaction. This PCF sensor can offer high light‐matter interaction, custom geometry, and biocompatibility for specific and reliable detection of deadly Jurkat cells in biomedical research and clinical diagnostics.

Abstract The authors present an innovative photonic crystal fibre (PCF) detector that has the ability to detect sulphur dioxide (SO2) gas. This deadly gas having no tone at all with a strong aroma. Our suggested sensor is designed with heptagonal cladding along with octagonal core. It displays exclusive performance in detecting SO2 with an elevated relative sensitivity (RS). The max RS for this sensor is 87.39% with a tiny Confinement Loss of 6.8194 × 10−4 dB/m and having a total loss of 1.80609 × 10−2 dB/m at optimum frequency of 1.8 THz. Suggested PCF sensor also has effective material loss of 0.017379 cm−1 and effective area of 5.39710 × 10−8 m2. Among the principal air pollutants that can irritate and make respiration tough is SO2 and prolonged exposure could be a factor in permanent breathing problems. It also contributes to the development of acid rain, which damages aquatic environments. Therefore, it becomes necessary to detect this harmful gas and that can be effectively done with the proposed PCF sensor. The suggested PCF sensor can be crucial to minimise the air pollution rate. It will play a vital role for the improvement of human health safety from this deadly element.

Abstract The detection of human diseases is a major application for biosensors. During this work, a 2D photonic crystal fibre (PCF) biosensor design for dengue virus detection has been suggested. This work presents the decagonal hollow core PCF‐based dengue virus bio‐sensor and quantitatively investigates it over the terahertz regime. The suggested biosensor's performance is assessed using COMSOL Multiphysics, a professional tool that uses the Finite Element Method. The simulation's outcomes show that the suggested sensor performed better than earlier research, with a high sensitivity of 98.79%, 97.96%, 97.71%, 98.58%, 96.99% and 97.47% with more less confinement loss 1.2766 × 10−12 dB/m, 1.6385 × 10−12 dB/m, 2.8015 × 10−13 dB/m, 1.1798 × 10−13 dB/m, 7.0336 × 10−12 dB/m and 0.00 dB/m respectively for infected Haemoglobin (Hgb), Normal Haemoglobin (Hgb), Infected Platelets (Plt), Normal Platelets (Plt), Infected Plasma (Psm) and Normal Plasma (Psm) at 3.0 THz using the ideal geometric configuration. Very soon, its remarkable sensitivity and guiding capabilities will be crucial to dengue virus detection technology.

The article presents an illegal drug detector that utilizes photonic crystal fiber (PCF). The fiber structure of the H-PCF comprises a dodecagonal core and circular air gaps in cladding areas. We have analyzed the designed terahertz (THz) frequency range utilizing the Finite Element Method (FEM) and the COMSOL Multiphysics application. The revised design has a high sensitivity in detecting amphetamine (n = 1.518) and cocaine (n = 1.5022) at a frequency of 3 THz, via detection rates of 99.43% and 99.20%, correspondingly. Furthermore, the suggested fiber, which operates at a frequency of 3 THz, has a relatively tiny confinement loss of 4.93×10-08 dB/m and 6.16×10-09 dB/m and a minimal effective material loss of construction of 0.0032 cm-1. In conclusion, it may be stated that drug misuse not only leads to immediate repercussions but also has severe and enduring impacts on human health, potentially resulting in fatality. Hence, it is imperative to accurately and effectively detect illicit substances. H-PCF architecture we offered is well-suited to detect illegal drugs. Doi: 10.28991/ESJ-2024-08-06-020 Full Text: PDF

Methanol (CH₃OH) is a volatile, transparent, and toxic substance widely used in chemical substrates, antifreeze, and industrial applications. Ethanol (C₂H₅OH), in contrast, is commonly used in alcoholic beverages, as a fuel additive, and as an antiseptic. Differentiating between methanol and ethanol is critical due to the severe health risks associated with methanol ingestion, while ethanol is safe for consumption in moderation. To tackle this challenge, we present a highly sensitive and accurate Photonic Crystal Fiber (PCF) sensor designed for the detection of both methanol and ethanol. The proposed sensor demonstrates impressive performance, with maximum relative sensitivities (RS) of 95.72 % for methanol and 97.55 % for ethanol, while operating within the 2.2 to 3.2 THz range. Additionally, it achieves low Effective Material Loss (EML) values of 0.0066 cm⁻1 for ethanol and 0.0044 cm⁻1 for methanol, with Numerical Aperture (NA) values of 0.257 and 0.270, respectively. The key advantages of this sensor include its exceptional precision, high sensitivity, and low material loss, making it a reliable solution for accurately distinguishing between methanol and ethanol in various industrial and commercial applications. By providing enhanced detection capability in the THz range, this sensor improves safety monitoring and quality control processes in sectors where these substances are frequently used.

In this article, an advanced-level type of Photonic Crystal Fiber (PCF) sensor, having a flower shape core with a unique hexagonal cladding, is proposed. Performance for detecting is evaluated in various animal's milk, such as camel, cow, and buffalo milk, with the suggested PCF sensor. The maximum Relative Sensitivities (RS) of the PCF sensor are 88.2 %, 88.5 %, and 88.8 % for detecting camel milk, cow milk, and buffalo milk, respectively. Moreover, it has a negligible Confinement Loss (CL) of 2.04018402 × 10−14 dB/m and Total Loss (TL) of 2.1520000 × 10−01 dB/m and Effective Material Loss (EML) of 0.21520 cm−1. Since Milk is as great source of nutrients such as Calcium, Vitamin D, Vitamin B12, Phosphorus and Protein. The nutrient composition of different animals' milks and their respective quantities are determined by set values at the beginning and differ among the types of milk. As all of them hold the same tone, it becomes challenging to identify them. Our suggested PCF sensor comes with its remarkable detection capacity to identify them. Therefore, the use of suggested PCF sensor will be helpful for both the industry and consumers. For the industry, it aids in ensuring the quality and composition of animal milk. For consumers, it means they can trust that the milk they purchase has been accurately tested and verified for its nutrient content and safety. With the implementation of the PCF sensor, the industry can better ensure the quality and authenticity of animal milk, reducing the risk of fraud and helping consumers make more informed choices about the milk they consume. This contributes to better assurance of proper nutrient intake.

Cyanide is very poisonous and raises environmental problems because of its industrial application and potential as a terrorist weapon. Given CN's toxicity and possible hazard to people, an effective and adaptive detection approach is needed. This specification suggests using a PCF to build a terahertz Hexagonal Core and Curved rectangular air holes sensor to detect NaCN and KCN. The recently created PCF analysis, which was promptly delivered, reveals an RS concentration of 99.62 % for NaCN and a maximum concentration of KCN is 99.08 %. In addition, we analyzed the Confinement Loss (CL) at a value of 5.88 × 10−09 dB/m and 2.07 × 10−05 dB/m, as well as EML at values of 0.0020 cm−1 and 0.0026 cm−1, accordingly, about these hazardous substances. The designed detector can identify NaCN and KCN at low concentrations even with small RI shifts due to its high sensitivity. Real-time NaCN and KCN detection and monitoring through nerve reflexes is essential for life-threatening conditions. It can selectively work in NaCN and KCN, ensuring accurate detection even in complex chemical compositions. Additionally, its tiny size allows for emergency use.

Abstract Background: Peripheral neuropathy is a serious complication of diabetes, which has socioeconomic consequences as well as a reduced quality of life. Early neuropathic process recognition and management could alter its course and considerably reduce the associated morbidity and mortality. This study determines the effect of long-term glycemic control on diabetic peripheral neuropathy in people with type 2 diabetes (T2DM). Methods: A hospital-based study was carried out at the National Centre of Neurosciences and Ibrahim Malik Hospital in Khartoum. All individuals who were older than 18 years and have had T2DM for less than 10 years were recruited. Using accepted techniques, the BMI, HbA1c level, and nerve conduction studies (NCS) were measured. Data were analyzed using the Statistical Package for Social Sciences (SPSS), version 25.0 software. P-value ≤ 0.05 was considered significant. Results: Of the 95 patients with T2DM, 52 were male patients. Our findings showed that as the duration of diabetes increased, the sensory velocity reduced from 64.07 ± 3.22 to 54.00 ± 5.34 and the motor nerve from 63.39 ± 2.38 to 53.87 ± 2.08 (P = 0.05, P = 0.003, respectively). Additionally, with increased duration of diabetes, a significant decrease was seen in both motor nerve amplitude from 8.79 ± 3.11 to 6.94 ± 1.84 (P = 0.05) and sensory nerve amplitude from 25.71 ± 5.70 to 19.51 ± 6.51 (P = 0.003). Also, all parameters of NCS (velocity and amplitude) decreased when Hb A1c was > 6 – sensory velocity from 63.96 ± 2.36 to 55.49 ± 2.43 (P = 0.03) and motor velocity from 63.00 ± 2.59 to 51.44 ± 1.66 (P = 0.02). And sensory amplitude decreased from 26.91 ± 1.26 to 20.85 ± 2.1 (P = 0.05), while motor amplitude decreased from 6.88 ± 3.55 to 6.61 ± 3.29 (P = 0.05). Additionally, there is a substantial (P = 0.05) correlation between sensory and motor amplitudes and the BMI. Conclusion: High BMI and poorly controlled (high HbA1c) long-term diabetes had a negative impact on all nerve conduction study parameters.

Background: Femoral neck fractures are prevalent and make up the highest per cent of proximal femur fractures. The femoral neck is the most common location for a hip fracture. This study aims to assess elderly awareness and perception of neck femur fracture in Saudi Arabia. Methods: A descriptive cross-sectional web-based study was conducted targeting all persons aged 60 years or above. An online questionnaire was developed by the study researchers based on literature review and after consultation of the field experts. The anonymous questionnaire was published using the social media platforms from October 2022 to January 2023 by the researchers and their families. Results: A total of 410 elderly completed the study questionnaire. Elderly age ranged from 60 to 89 years with mean age of 68.2 ± 10.9 years old. A total of 44 (10.7%) of the study elderly had an overall good awareness regarding NFF. The most reported sources were physician (61.7%), social media (41.2%), mass media (33.4%) and books and magazines reading (20.5%). Conclusion: In conclusion, elderly awareness regarding femur neck fracture was very low especially among male elderly and those with no history of trauma. Poor awareness for clinical presentation and complications of NFF was reported.

Abstract Background Malaria remains a public health problem in Kenya despite several concerted control efforts. Empirical evidence regarding malaria effects in Kenya suggests that the disease imposes substantial economic costs, jeopardizing the achievement of sustainable development goals. The Kenya Malaria Strategy (2019–2023), which is currently being implemented, is one of several sequential malaria control and elimination strategies. The strategy targets reducing malaria incidences and deaths by 75% of the 2016 levels by 2023 through spending around Kenyan Shillings 61.9 billion over 5 years. This paper assesses the economy-wide implications of implementing this strategy. Methods An economy-wide simulation model is calibrated to a comprehensive 2019 database for Kenya, considering different epidemiological zones. Two scenarios are simulated with the model. The first scenario (GOVT) simulates the annual costs of implementing the Kenya Malaria Strategy by increasing government expenditure on malaria control and elimination programmes. The second scenario (LABOR) reduces malaria incidences by 75% in all epidemiological malaria zones without accounting for the changes in government expenditure, which translates into rising the household labour endowment (benefits of the strategy). Results Implementing the Kenya Malaria Strategy (2019–2023) enhances gross domestic product at the end of the strategy implementation period due to more available labour. In the short term, government health expenditure (direct malaria costs) increases significantly, which is critical in controlling and eliminating malaria. Expanding the health sector raises the demand for production factors, such as labour and capital. The prices for these factors rise, boosting producer and consumer prices of non-health-related products. Consequently, household welfare decreases during the strategy implementation period. In the long run, household labour endowment increases due to reduced malaria incidences and deaths (indirect malaria costs). However, the size of the effects varies across malaria epidemiological and agroecological zones depending on malaria prevalence and factor ownership. Conclusions This paper provides policymakers with an ex-ante assessment of the implications of malaria control and elimination on household welfare across various malaria epidemiological zones. These insights assist in developing and implementing related policy measures that reduce the undesirable effects in the short run. Besides, the paper supports an economically beneficial long-term malaria control and elimination effect.

The World Health Organization (WHO) has collected information on policies on sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) over many years. Creating a global survey that works for every country context is a well-recognized challenge. A comprehensive SRMNCAH policy survey was conducted by WHO from August 2018 through May 2019. WHO regional and country offices coordinated with Ministries of Health and/or national institutions who completed the questionnaire. The survey was completed by 150 of 194 WHO Member States using an online platform that allowed for submission of national source documents. A validation of the responses for selected survey questions against content of the national source documents was conducted for 101 countries (67%) for the first time in the administration of the survey. Data validation draws attention to survey questions that may have been misunderstood or where there was a lot of missing data, but varying methods for validating survey responses against source documents and separate analysis of laws from policies and guidelines may have hindered the overall conclusions of this process. The SRMNCAH policy survey both provided a platform for countries to track their progress in adopting WHO recommendations in national SRMNCAH-related legislation, policies, guidelines and strategies and was used to create a global database and searchable document repository. The outputs of the SRMNCAH policy survey are resources whose importance will be enriched through policy dialogues and wide utilization. Lessons learned from the methodology used for this survey can help to improve future updates and inform similar efforts.

Background: Traditionally, graduates from colleges of pharmacy in Saudi Arabia work mainly in hospital settings, and only a few graduates work in other practice settings. However, several initiatives and national plans have recently been introduced to facilitate employment in community pharmacies and the pharmaceutical industry/companies. Consequently, the objectives of this study were to explore the current state of career placement, type of employment sectors, and practice settings that Doctor of Pharmacy (PharmD) graduates join based on recent developments in the profession. Methods: This study is a cross-sectional, descriptive study. The target population was PharmD graduates from Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Consequently, all 162 graduates from three recent cohorts (2018–2020) were contacted to participate in this survey. Results: A total of 157 graduates participated in this study, yielding a response rate of 96.91 %. Of the participants, 92 (58.6 %) were female graduates. The overall rate of employment was 84.7 %. Moreover, a higher proportion of male graduates than female graduates (97.1 % versus 73.7 %, P = 0.006) were employed. In this study, the three main sectors that the graduates joined were the pharmaceutical industry and companies (41.2 %), community pharmacies (29.4 %), and medical cities, hospitals and clinics (23.5 %). In addition, almost the same proportions of male and female graduates joined the pharmaceutical industry and companies (40.3 % versus 42.1 %). However, a higher proportion of male graduates than female graduates joined community pharmacies (32.3 % versus 26.3 %). Conversely, a higher proportion of female graduates joined medical cities, hospitals and clinics compared to male graduates (28.1 % versus 19.4 %). Conclusion: The current employment of PharmD graduates in the job market is generally high, but further improvement could be made, especially for female graduates. Moreover, the study findings showed that jobs are shifting toward community pharmacies and the pharmaceutical industry. Therefore, we believe that decision-makers in pharmacy education and curriculum developers must consider these trends and ensure that there is adequate preparation for careers in community pharmacy practice and other sectors of the profession in the curriculum.

Objective: This case series was carried out to determine the efficacy of ultrasound guided foam sclerotherapy as first line and minimally invasive treatment of varicose veins. Study Design: Prospective case series. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital, Malir from 1st January 2020 to 31 March 2021. Materials and Methods: Total one hundred patients with varicosities mainly of great saphenous vein (GSV) were included after detailed history and examination. Ultrasound Doppler was done to rule out deep venous thrombosis (DVT) and any secondary reason for varicose vein. Patients were followed up after 3 days, 10 days, 1month and 3 months with a Doppler ultrasound. Results: One hundred patients and 130 legs were studied. Age ranges from 30-60 years with mean of 39.75 years, 70 (70%) of the patients were males and 30 (30%) were females. 98 legs (75.38%) had varicosities of GSV, 10 legs (7.692%) with mixed great and small saphenous vein and 22 legs (16.92%) with isolated small saphenous vein. 25 patients (25%) developed pain at cannula site, 3 patients (3%) had bradycardia following procedure and 4 (4%) developed ulceration on skin at the site of cannulation. All patients were followed up for 3 months with a Doppler ultrasound and no recurrence was found post procedure. Average return period to normal function and work was 15 days. In terms of leg pain and physical functioning, patients who underwent intervention achieved health better in short term. Conclusion: Ultrasound guided foam sclerotherapy is safe, least complicated, and efficacious management for varicose veins with minimal chance of technical failure. This being an outpatient procedure saves time and space for arterial casualties of a vascular surgeon.

The Grand Ethiopian Renaissance Dam (GERD) on the Nile is expected to influence many ecosystem services, such as flood regulation, hydro-electricity production, food supply, and habitat provision, among others. Understanding these impacts (positive and negative) requires a comprehensive evaluation framework. This study develops and applies an integrated simulation framework for assessing the impacts of the GERD on Sudan, focusing on the simultaneous economywide effects of riverine flood hazards, irrigation water supply, hydropower generation, and floodplain-dependent industries, namely traditional fired clay brick production. The simulation framework incorporates three models: a river infrastructure system model, a flood model, and a Computable General Equilibrium Model. Results indicate positive impacts for hydropower generation and flood control, marginal benefits for water supply to existing irrigation, and negative consequences for brick production and the construction sector. Assuming that the GERD starts its long-term operation in 2025, we find an overall positive economic impact on Sudan’s Gross Domestic Product in 2025, with an increase of up to just over 0.1%, subject to river flow conditions. Recognizing the differences in impacts across sectors and income groups, the study emphasizes the need for interventions that ameliorate negative effects. While the study captures several impacts, other effects on the environment, recession agriculture, and soil fertility require further investigation. Still, our findings underscore the importance of adopting an integrated simulation approach to dam evaluation, acknowledging the interconnected nature of water and related sectors in national economies.

ObjectiveChronic hyperglycemia induces pathogenic changes in the vascular endothelium and leads to the development of microvascular complications in patients with type 2 diabetes mellitus. Early identification of markers of diabetes complications may help to minimize the risk of the development and progression of microvascular complications.MethodsThis follow-up study was conducted in type 2 diabetic cohort aged between 30-70 years. Out of 160 eligible participants, 70 of them completed follow-up. Levels of cell adhesion molecules and selectins (VCAM-1, ICAM-1, E-selectin, L-selectin and P-selectin) at baseline and follow-up were measured using Randox Evidence biochip analyzer (UK). Development of microvascular complications (diabetic neuropathy, retinopathy and nephropathy) was evaluated.ResultsDuring the follow-up (2 years, median), 31 (44.3%) developed diabetic neuropathy, 10 (14.3%) developed diabetic retinopathy and, 27 (38.6%) developed diabetic nephropathy. A significant difference in levels of cell adhesion molecules and selectins were found in type 2 diabetic patients with and without microvascular complications. Multiple logistic regression analysis reveals that baseline level of VCAM-1 is significantly associated with microvascular complications; diabetic neuropathy(p=0.028), retinopathy (p=0.007) and nephropathy(p=

Background: COVID-19 is diagnosed using RT-PCR assays of samples from nasal and oropharyngeal swabs. People with negative RT-PCR often presented with clinical manifestations of COVID-19. The data on such patients are lacking. The present study aims to characterize the patients who were suspected COVID-19 cases and tested negative in RT-PCR compared to patients who had been tested RT-PCR positive. Methods: This is a retrospective, observational study of adult suspected and confirmed patients of COVID-19 admitted to King Saud University Medical City, Riyadh, Saudi Arabia, from 1st March 2020 until 30th November 2020. Laboratory confirmation is done through nasal/pharyngeal swab specimens, tested positive in RT-PCR assay. Patients with initial negative RT-PCR test results were assessed again within 48−72 h to avoid false-negative results. Patient data were extracted from the electronic medical files of each included patient using a predesigned case report form. Results: The study included 488 (80.93%) patients with RT-PCR swab results positive, and 115 (19.07%) patients who were negative. Respiratory rate and diastolic blood pressure were higher among the swab-positive cases. More number of swab-negative patients had comorbidities such as coronary heart disease, chronic kidney disease, and carcinoma. Fever, cough, and shortness of breath were reported higher among the swab-positive cases. ALT and AST, and LDH levels were found higher among RT-PCR-positive patients. Serum creatinine, blood urea nitrogen and troponin were more elevated in RT-PCR-negative patients. Antibiotics, anticoagulants, and corticosteroids were used more by swab-positive patients. Significantly higher number of RT-PCR-positive patients required proning, high-flow nasal cannula, non-invasive mechanical ventilation, and invasive mechanical ventilation. Acute cardiac ischemia and death were found to be similar among the patients. However, deaths occurred significantly earlier among the swab-positive cases when compared to the swab-negative group. Conclusion: Distinctive symptoms and markers of COVID-19 are more frequent among patients who had RT-PCR-positive results.

BackgroundPost-acute coronavirus disease 2019 (COVID-19) syndrome, also known as long COVID, is a prolonged illness after the acute phase of COVID-19. Hospitalized patients were known to have persisting symptoms of fatigue, headache, dyspnea, and anosmia. There is a need to describe the characteristics of individuals with post-COVID-19 symptoms in comparison to the baseline characteristics.PurposeTo investigate the clinical and biochemical characteristics of people who recovered from COVID-19 after 6 months of discharge from the hospital.MethodsThis was a prospective follow-up investigation of hospitalized and discharged COVID-19 patients. Adult patients admitted to King Saud University Medical City, Riyadh, Saudi Arabia, with laboratory-confirmed COVID-19 and discharged were recruited. The baseline demographic information, comorbidities, vital signs and symptoms, laboratory parameters, COVID-19 therapy, and outcomes were collected from the medical records. Blood samples were collected for cytokines estimation. A detailed interview about signs and symptoms was undertaken during the follow-up.ResultsHalf of the followed-up people reported experiencing at least one of the COVID-19-related symptoms. The mean blood pressure was found higher in follow-up. People with the symptoms were characterized by low lymphocyte count, lower serum calcium levels, and hyperglycemia compared to people without any post-COVID-19 symptoms. Cytokines IL-8, VEGF, and MCP-1 were higher in people with the most frequent symptoms.ConclusionPeople with post-COVID-19 symptoms were characterized by lower lymphocyte count, lower serum calcium levels, and hyperglycemia compared to people without symptoms. Individuals with the most frequent post-COVID-19 symptoms had higher baseline pro-inflammatory, chemotactic, and angiogenic cytokines.

BackgroundChronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) is the major cause of end stage renal disease, characterized by proteinuria with a subsequent decline in glomerular filtration rate. Although hyperglycemia is the major risk factor for the development and progression of kidney disease among diabetic patients, many other risk factors also contribute to structural and functional changes in the kidneys. As recommended by Kidney Disease Improving Global Outcomes (KDIGO), CKD classification based on cause and severity, links to risk of adverse outcomes including mortality and kidney outcomes.ObjectiveThe aim of this study is to investigate the involvement of risk factors associated with the severity of CKD among participants with longer duration of diabetes. This study also aims to find whether number of risk factors vary among risk of CKD progression categories based on KDIGO classification.Material and methodsThis cross-sectional study retrospectively selected 424 participants from type 2 diabetic cohort and categorized them based on the classifications for the diagnosis of kidney diseases in patients with diabetes, according to the KDIGO guidelines. Odds ratios and 95% CI of each risk factors according to severity of renal disease were determined.ResultsBased on KDIGO classification, participants with type 2 diabetes (T2D) were categorized in to low risk (n=174); moderately increased risk (n=98); and high/very high risk (n=152). Type 2 diabetic participants with risk factors such as, hyperlipidemia, hypertension, DM duration ≥15 years and diabetic retinopathy showed a high/very high risk of CKD progression when compared with low-risk category. While T2D participants with risk factors such as, lack of exercise, hypertension, and diabetic retinopathy showed a moderately increased risk of CKD progression. In addition, participants with highest number of risk factors were significantly distributed among high/very high risk of CKD progression category.ConclusionThis study findings conclude that patients with T2DM and duration of ≥15 years, hyperlipidemia, hypertension and diabetic retinopathy have an increased prevalence of advanced CKD. In addition to this, increased number of risk factors could be an indicator of the severity of CKD in T2D.

This study was conducted at the Department of Vascular Surgery at Combined Military Hospital Lahore from December 2019to June 2020. The mortality of patients on the waiting list for vascular access in our institution three months afterimplementing strict policies for elective surgeries (30th March 2020 to 29th June 2020) was compared with the preceding threemonths. The mortality of patients in the pre-COVID-19 periods on the waiting list for HD was 11 (7.9%) in the pre-COVID-19 period, while this increased to 5 (12.5%) in the post-COVID-19 period. COVID-19 related suspension of vascular access services negatively influences CKD patients waiting for permanent vascular access.

Integrating river system and economy-wide models in a dynamic, iterative, bidirectional fashion allows assessing some economic impacts of interventions in river systems. Here the authors use this framework to compare water resources management strategies for the Nile in a quest for efficient use of the river’s limited and stressed water resources.

(1) Background: Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease caused by the destruction of pancreatic insulin-producing beta cells. T1D is one of the most common endocrine and metabolic disorders occurring in children. Autoantibodies against pancreatic insulin-producing beta cells are important immunological and serological markers of T1D. Zinc transporter 8 autoantibody (ZnT8) is a recently identified autoantibody in T1D; however, no data on ZnT8 autoantibody in the Saudi Arabian population have been reported. Thus, we aimed to investigate the prevalence of islet autoantibodies (IA-2 and ZnT8) in adolescents and adults with T1D according to age and disease duration. (2) Methods: In total, 270 patients were enrolled in this cross-sectional study. After meeting the study’s inclusion and exclusion criteria, 108 patients with T1D (50 men and 58 women) were assessed for T1D autoantibody levels. Serum ZnT8 and IA-2 autoantibodies were measured using commercial enzyme-linked immunosorbent assay kits. (3) Results: IA-2 and ZnT8 autoantibodies were present in 67.6% and 54.6% of patients with T1D, respectively. Autoantibody positivity was found in 79.6% of the patients with T1D. Both the IA-2 and ZnT8 autoantibodies were frequently observed in adolescents. The prevalence of IA-2 and ZnT8 autoantibodies in patients with a disease duration < 1 year was 100% and 62.5%, respectively, which declined with an increase in disease duration (p < 0.020). Logistic regression analysis revealed a significant relationship between age and autoantibodies (p < 0.004). (4) Conclusions: The prevalence of IA-2 and ZnT8 autoantibodies in the Saudi Arabian T1D population appears to be higher in adolescents. The current study also showed that the prevalence of autoantibodies decreased with disease duration and age. IA-2 and ZnT8 autoantibodies are important immunological and serological markers for T1D diagnosis in the Saudi Arabian population.

Abstract Background Water fetching and firewood collection are among home activities that are part of the daily routine of many households in rural Ethiopia. Households travel long distances and spend large amounts of time every day for collecting water and firewood. Fetching water and firewood reduce labor available for market related activities such as agriculture that affects production and productivity of these sectors negatively. Better access to water facility and energy efficient technology (such as improved stoves) is expected to release labor for market related activities that can have economy-wide impacts. The objective of this study is to investigate the economy-wide effects of access to water facility and improved stoves. Methods The study uses the updated 2004/05 Social Accounting Matrix (SAM) of Ethiopia. The SAM is modified to account for a detailed representation of water fetching, firewood collection and leisure activities and commodities. This study applies a single country Computable General Equilibrium (CGE) model to the updated SAM of Ethiopia. The simulation scenario is a 50% increase in the Total Factor Productivity (TFP) of both water fetching and firewood collection activities due to better access to water infrastructure and cooking improved stoves. Results The findings of the study show that better access to drinking water supply and improved stoves reduces labor time spent for water fetching and firewood collection. The released labor from water fetching and firewood collection partly reallocated to leisure consumption and partly to market related activities. Those freed labors that are reallocated to marketed sectors including agricultural and non-agricultural activities leads to increase employment and enhance domestic production. Better access to drinking water and improved stoves also enhances household welfare. Households that allocate a relatively large proportion of labor to water fetching and firewood collection gain relatively more welfare. Macroeconomic indicators such as GDP, total domestic production, absorption, and imports are also positively affected due to improved access to water and energy efficient technology. Conclusions It is helpful to recognize the economic significance of labor released from water fetching and firewood collection in any developing economy with a limited supply of water facility and access to energy technology.

Abstract Background/aim In recent years, the diagnostic utility of urinary protein levels has been demonstrated for the early detection and progression of kidney disease. This study aimed to evaluate the associations of the non-albumin protein (NAP) with different urinary marker for tubular and glomerular damage in patients with type 2 diabetes (T2D). Methods In this observational cross-sectional study, 424 patients with T2D duration > 10 years were classified into two groups according to estimated glomerular filtration rate (eGFR). The ratios of different urinary markers (albumin, NAP, total protein, transferrin, retinol-binding protein (RBP), and neutrophil gelatinase-associated lipocalin (NGAL) to creatinine were analyzed. Results The levels of urinary biomarkers increased significantly with decrease in eGFR levels. In the group with moderately decreased eGFR, the albumin to-creatinine ratio (ACR), non-albumin protein-to-creatinine ratio (NAPCR), and total protein-to-creatinine ratio (PCR) were independently associated with all urinary markers after being adjusted for risk factors. The area under the receiver operating characteristics (ROC) curve for ACR and PCR had a better diagnostic value than other urinary biomarkers. Comparing ROC curve of NAPCR with other urinary biomarkers, it was significantly better than NGAL/Cr (p = 0.033). Conclusions The findings of the present study confirm that ACR and PCR are diagnostic biomarkers in T2D patients with decreased eGFR. NAPCR in these patients diagnostically only outperformed NGAL/Cr.

Abstract COVID‐19 is of uncommon diagnosis in pediatric with their presentation in much of time of a non‐specific entity; here, we experienced the case of a 2‐year‐old female with malaria presented with fever, cough, rhinorrhea, hemoptysis, and convulsion diagnosed as COVID‐19, complicated with encephalitis, received treatment, and improved over weeks.

With the COVID-19 pandemic spreading across the world, its disruptive effect on the provision and utilization of non- COVID related health services have become well-documented. As countries developed mitigation strategies to help continue the delivery of essential health services through the pandemic, they needed to carefully weigh the benefits and risks of pursuing these strategies. In an attempt to assist countries in their mitigation efforts, a Benefit-Risk model was designed to provide guidance on how to compare the health benefits of sustained essential reproductive, maternal, newborn and child (RMNCH) services against the risk of SARS-CoV-2 infections incurred by the countries’ populations when accessing these services. This article describes how two existing models were combined to create this model, the field-testing process carried out from November 2020 through March 2021 in six countries and the findings. The overall Benefit-Risk Ratio in the 6 countries analyzed was found to be between 13.7 and 79.2, which means that for every 13.7 to 79.2 lives gained due to increased RMNCH service coverage, there was one loss of a life related to COVID-19. In all cases and for all services, the benefit of maintaining essential health services far exceeded the risks associated with additional COVID-19 infections and deaths. This modelling process illustrated how essential health services can continue to operate during a pandemic and how mitigation measures can reduce COVID-19 infections and restore or increase coverage of essential health services. Overall, this Benefit-Risk analysis underscored the importance and value of maintaining coverage of essential health services even during public health emergencies, including the recent COVID-19 pandemic

Background: Resistin is an adipose tissue secreted protein link with the mechanism involved in the pathophysiology of insulin resistance. Aim of the work: This study aims to investigate the potential role of resistin in insulin resistance in relation with inflammatory markers and endothelial dysfunction markers in impaired fasting glucose (IFG) and type 2 diabetes (T2D). Patients and Methods: This pilot study assess the relation of resistin with insulin resistance (HOMA-IR), adipokines (adiponectin, leptin), inflammatory markers [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6)] and endothelial dysfunction markers [vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1)] cross-sectionally using serum samples obtained from 64 participants; controls (n=29), IFG (n=20) and T2D (n=15). The levels of biomarker were measured by using Randox Evidence biochip analyzer. Statistical analyses were performed by SPSS 21.0 software. Results: Resistin levels in IFG and T2D groups were higher compared to control group. A positive correlation was detected between serum resistin levels with HOMA-IR (p= 0.02), inflammatory markers; TNF-α (p=

Type 2 Diabetes (T2D) is a polygenic and multi-factorial complex disease. The significant challenge of finding genetic markers that could be used to predict T2D risk remains unresolved. Saudi Arabia is one of several ethnicities with a high prevalence rate of T2D. A large number of studies have been performed that explored genetic factors associated with T2D risk. In this work, we conducted a systematic review of published studies on T2D genetic markers in the Saudi population. Multiple databases were employed in the literature review, which focused on studies that either reported the association or non-association of a genetic marker with T2D risk. Using appropriate search terms, we collected, analyzed, and selected 428 articles published between the years of 2000-2018, Of these, 18 articles reported a total of 67 polymorphisms in 46 genes that are strongly linked to T2D in the Saudi population. Most of the relevant studies used genotyping as the primary methodology to identify genetic markers of T2D. Most of these studies were published between the years of 2012-2017. A total of 23 polymorphisms in 17 genes were found to be associated with T2D risk in the Saudi population: KCNJ11, PPARG2, IRS1, VDE, WFS1, JAZF1, CDKN2A/B, TCF7L2, KCNQ1, HNF4A, DUSP9, APOE, HNF1A, SLC30A8, APOC3, SNAP25, and ACE. [JBCGenetics 2018; 1(2.000): 57-65]

BACKGROUND: Saudi Arabia is facing an epidemic of type 2 diabetes that is complicated by a high rate of chronic complications such as kidney disease, which have a major impact on the healthcare system and economy. The Saudi diabetic kidney disease (SAUDI-DKD) study was launched to understand the implications of chronic diabetic kidney disease. OBJECTIVES: Examine the hematological, biochemical and metabolic parameters of the selected cohorts to look for biomarkers of diabetic nephropathy. DESIGN: Cross-sectional, hospital-based. SETTING: Four general hospitals and two dialysis centers in Riyadh. PATIENTS AND METHODS: We recruited adult type 2 diabetic patients aged between 35 and 70 years, with a duration of diabetes >10 years, including subjects with microalbuminuria, macroalbuminuria and end stage renal disease (ESRD). They were compared with subjects with normal albumin excretion classified according to American Diabetes Association (ADA) criteria. MAIN OUTCOME MEASURES: The effect of different stages of diabetic nephropathy on hematological and biochemical parameters. RESULTS: Of 427 subjects with nephropathy, 184 (43%) had microalbuminuria, 83 (19%) had macroalbuminuria and 160 (37%) had end stage renal disease (ESRD). The remaining 213 (50%) subjects did not have nephropathy. Patients with nephropathy were older with a mean age (SD) of 55.62 (6.00) years and had a longer duration of diabetes (mean [SD], 19.04 [6.33]) years), and had a lower monthly income and body mass index (BMI) than patients without nephropathy. Insulin resistance, elevated uric acid level, low red blood cells (RBCs) count and low hemoglobin level were associated with significantly increased risk of macroalbuminuria and ESRD. Elevated uric acid and LDH were associated with significantly increased risk of microalbuminuria and ESRD, while elevated red blood cell distribution width was significantly associated with an increased risk of ESRD. CONCLUSION: Diabetic nephropathy is associated with insulin resistance, changes in liver enzymes and uric acid in addition to abnormalities in the red blood cell count and red blood cell shape that warrant frequent monitoring among patients with diabetic kidney disease. LIMITATIONS: Cross-sectional study design and exclusion of patients with some risk factors.

Abstract Albuminuria is widely used to indicate early phases of diabetic nephropathy although it is limited by the fact that structural damage might precede albumin excretion. This necessitates identifying better biomarkers that diagnose or predict diabetic nephropathy. This is a cross-sectional hospital based study recruiting type 2 diabetic patients cohort aged 35–75 years with diabetes duration of ≥10 years. Out of total eligible 467 patients, 200 patients were with normal albumin excretion, 184 patients with microalbuminuria and 83 patients with macroalbuminuria. All the patients were tested for the 22 selected biomarkers including serum, plasma and urinary markers. Sensitivity, specificity, and area under the curve (AUC) were calculated as measures of diagnostic accuracy. Out of the tested biomarkers, urinary transferrin, urinary Retinol binding protein (RBP) and serum osteopontin had the best diagnostic value for diabetic nephropathy presence based on the AUC value. The rest of the biomarkers had comparatively less or even no discriminative power. The urinary transferrin and RBP and serum osteopontin, had the best diagnostic value in type 2 diabetic patients at different stages of diabetic nephropathy. Further longitudinal prospective studies are needed to evaluate the predictive power of those markers for detecting diabetic nephropathy before any structural damage occurs.

In this paper, we simulate the macroeconomic and distributional impacts of exchange rate devaluation in Ethiopia using a dynamic single country Computable General Equilibrium model. We find that although devaluation helps exports to be more competitive in the short term, thereby increasing export earnings, over the long term the policy is found to have a contractionary and inflationary impact in a developing country like Ethiopia. It also comes at the cost of a reduction in household welfare and investment. In terms of distributional impact, the policy simulation result suggests that devaluation disproportionately affects urban households than rural households in Ethiopia given the nature of their consumption basket.

BACKGROUND AND OBJECTIVES: Saudi Arabia underwent opulence-driven socio-cultural and lifestyle changes leading to soaring rates of diabetes mellitus. This study exposes the epidemiology of abnormal glucose metabolism namely: diabetes and impaired fasting glucose (IFG) in 13 administrative regions of Saudi Arabia. DESIGN AND SETTINGS: This is a nationwide, household, population-based cross-sectional study that was conducted through primary health care centers during the period 2007–2009. PATIENTS AND METHODS: A nationwide, household, population-based cohort of 53 370 participants aged 0–100 years adjusted to be compatible with population census was interviewed and anthropometric measures were collected. Fasting blood sample was used to screen for IFG and diabetes. RESULTS: The overall prevalence of abnormal glucose metabolism was 34.5%, which included 22.6% patients with IFG, 11.9% patients with diabetes, and 6.2% patients who unaware of their disease. Diabetes prevalence was 40.2% for subjects aged ≥45 years and 25.4% for those aged ≥30 years that decreased to 11.9% when the full age spectrum was considered. Type 1 diabetes prevalence was 0. 8%, contributing only to 6.6% of the total population of patients with diabetes. The top 5 regions with the highest abnormal glucose metabolism prevalence were Makkah (43.4%), Aljouf (41.7%), Eastern region (37.16%), Madinah (35.4%), and Qassim (33.7%). Urbanization, age, and obesity were behind the wide variations in diabetes and IFG prevalence in the 13 regions. CONCLUSION: Abnormal glucose metabolism has reached an epidemic state in Saudi Arabia, where one-third of the population is affected and half of diabetic cases were unaware of their disease. This observation warrants an urgent strategy for launching diabetes primary prevention and screening programs.

We report a case of renal hydatid cyst in a 25-year-old male who presented with hydatiduria. Intravenous pyelography revealed presence of a space-occupying lesion in the lower pole of right kidney with curvilinear calcifications. Ultrasound, computed tomography and MRI were suggestive of hydatid cyst in the right kidney. Patient underwent right-sided nephrectomy. Passage of hydatid cysts in urine is an exceedingly rare occurrence. Urinary tract involvement develops in 2-4% of all cases of hydatid cyst. Hydatiduria is an extremely rare manifestation of renal hydatid cyst. We report such a case with emphasis on IVU, sonographic, CT and MRI findings.

Este artículo ofrece un análisis sobre un personaje importante en el ámbito šī‘í, Mīṯam b. Yaḥyà al-Tammār, un seguidor cercano y de confianza de ‘Alī b. Abī Ṭālib, que desempeñó un papel considerable durante los primeros tiempos del šī‘ismo, pero que, sin embargo, ha sido completamente olvidado por los estudios modernos. El propósito de este trabajo es “recuperar” el personaje y proporcionar un nuevo punto de vista de su biografía y su relación con ‘Alī analizando cómo esa relación enriquece el pensamieto šī‘í y la jurisprudencia religiosa de los inicios en ese ámbito. Para ello, se analizarán los orígenes de Mīṯam, su personalidad, sus discípulos y el papel que éstos desempeñaron en la jurisprudencia šī‘í. Estudiaremos también sus comentarios sobre el Corán y otros escritos, el papel que desempeñó como transmisor de tradiciones, su conocimiento sobre la mística y los principales acontecimientos en torno a su muerte.

This research project focuses on an alternative pathway of devulcanizing waste tire rubber by using amine based chemicals. Waste tire rubbers are known to be as toxic, non-degradable material due to their vulcanized crosslink carbon structure, and disposing of such waste could impose hazardous impacts on the environment. The current rubber recycling methods that are practiced today are rather uneconomical, non-environmentally friendly, and also producing recycled rubber with low quality due to the alteration in the main polymeric chains of waste rubber. This project aims to answer the question of whether the usage of amine can produce high quality rubber, where the properties of recycled rubber is almost the same as new/virgin rubber. With known potential of amine, it is a challenge for the chemical to selectively cleave the sulfur bonds without affecting the main carbon backbone chain in the rubber structure and diminishing much of the rubber properties. To study this research, amine-treated rubber must undergo devulcanisation process by applying heat and sonication energy. Then, the properties of the amine-treated rubber were determined through a set of characterization tests and analysis which are: gel content test to determine the weight of rubber before and after devulcanization, the thermogravimetric analysis (TGA) to determine the thermal degradation and stability of rubber, and Fourier Transform Infrared Spectroscopy (FTIR) to determine any structural change of the rubber. In this research so far, the first two preliminary analysis tests have been performed. The gel content test has shown that tertiary amine samples possessed a lower gel content (%) of (77 – 63 %), compared to primary amine samples (falls within the range of 80%), as well as the TGA test in which tertiary amine samples degrade faster than primary amine samples (suggesting a higher degree of rubber structure breakdown). For each type of amine, the concertation of amine did not play a major role in affecting the degree of devulcanization (as the concentration increased, the degree of devulcanization decreased for some samples). FTIR analysis showed that only sulphur-sulphur bonds were cleaved during the devulcanization process, leaving the carbon-sulphur bonds unaffected.

Macro elements are the minerals of which the body needs more amounts and are more important than any other elements. Trace elements constitute a minute part of the living tissues and have various metabolic characteristics and functions. Trace elements participate in tissue and cellular and subcellular functions; these include immune regulation by humoral and cellular mechanisms, nerve conduction, muscle contractions, membrane potential regulations, and mitochondrial activity and enzyme reactions. The status of micronutrients such as iron and vanadium is higher in type 2 diabetes. The calcium, magnesium, sodium, chromium, cobalt, iodine, iron, selenium, manganese, and zinc seem to be low in type 2 diabetes while elements such as potassium and copper have no effect. In this review, we emphasized the status of macro and trace elements in type 2 diabetes and its advantages or disadvantages; this helps to understand the mechanism, progression, and prevention of type 2 diabetes due to the lack and deficiency of different macro and trace elements.

Background: Risk Analysis Index (RAI) has been increasingly used to assess surgical frailty in various procedures, but its effectiveness in predicting mortality or in-patient hospital outcomes for spine surgery in metastatic disease remains unclear. The aim of this study was to compare the predictive values of the revised RAI (RAI-rev), the modified frailty index-5 (mFI-5), and advanced age for extended length of stay, 30-day readmission, complications, and mortality among patients undergoing spine surgery for metastatic spinal tumors., Methods: A retrospective cohort study was performed using the 2012-2022 ACS NSQIP database to identify adult patients who underwent spinal surgery for metastatic spinal pathologies. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of RAI-rev, mFI-5, and greater patient age with extended length of stay (LOS), 30-day complications, hospital readmission, and mortality., Results: A total of 1,796 patients were identified, of which 1,116 (62.1%) were male and 1,008 (70.7%) were non-Hispanic White. RAI-rev identified 1,291 (71.9%) frail and 208 (11.6%) very frail patients, while mFI-5 identified 272 (15.1%) frail and 49 (2.7%) very frail patients. In the ROC analysis for extended LOS, both RAI-rev and mFI-5 showed modest predictive capabilities with area under the curve (AUC) values of 0.5477 and 0.5329, respectively, and no significant difference in their predictive abilities (p = 0.446). When compared to age, RAI-rev demonstrated superior prediction (p = 0.015). With respect to predicting 30-day readmission, no significant difference was observed between RAI-rev and mFI-5 (AUC 0.5394 l respectively, p = 0.354). However, RAI-rev outperformed age (p = 0.001). When assessing the risk of 30-day complications, RAI-rev significantly outperformed mFI-5 (AUC: 0.6016 and 0.5542 respectively, p = 0.022) but not age. Notably, RAI-rev demonstrated superior ability for predicting 30-day mortality compared to mFI-5 and age (AUC: 0.6541, 0.5652, and 0.5515 respectively, p < 0.001). Multivariate analysis revealed RAI-rev as a significant predictor of extended LOS [aOR: 1.96, 95% CI: 1.13-3.38, p = 0.016] and 30-day mortality [aOR: 5.27, 95% CI: 1.73-16.06, p = 0.003] for very frail patients. Similarly, the RAI-rev significantly predicted 30-day complications for frail [aOR: 2.63, 95% CI: 1.21-5.72, p = 0.015] and very frail [aOR: 3.69, 95% CI: 1.60-8.51, p = 0.002] patients. However, the RAI did not significantly predict 30-day readmission [Very Frail aOR: 1.52, 95% CI: 0.75-3.07, p = 0.245; Frail aOR: 1.46, 95% CI: 0.79-2.68, p = 0.225]., Conclusion: Our study demonstrates the utility of RAI-rev in predicting morbidity and mortality in patients undergoing spine surgery for metastatic spinal pathologies. Particularly, the superiority that RAI-rev has in predicting 30-day mortality may have significant implications in multidisciplinary decision making., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Many patients with cervical spondylotic myelopathy (CSM) undergo anterior cervical discectomy and fusion (ACDF). Many of these patients are readmitted, but there is no clear understanding of drivers of readmission. The aim of this study was to assess the patient- and hospital-level factors that contribute to 7-, 30-, and 90-day readmissions after treatment of CSM., Methods: A retrospective cohort study was performed using the 2016-2019 Nationwide Readmissions Database (NRD). All adult patients undergoing ACDF for CSM were identified using ICD-10 coding. Patients were stratified by no readmission, readmission within 7 days, readmission within 8-30 days, or readmission within 31-90 days. Patient demographic information, comorbidities, and adverse events were collected., Results: Of the 19,621 patients included, 576 were readmitted within 7 days, 568 within 30, 794 within 90, and 17,683 who were not readmitted. The patients readmitted within 7 and 30 days were significantly older than the 90-day patients, who were older than the non-readmitted patients (p < 0.001) and had a higher frailty score by the modified frailty index (p < 0.001). The 30-day readmission cohort had the longest mean LOS (p < 0.001) and the greatest mean total admission costs (p < 0.001). Drivers of readmission included sepsis, infection, and acute kidney failure., Conclusion: Our study found that the most common diagnoses during readmission included sepsis and other infection for 7-, 30-, and 90-day readmission for CSM patients who underwent ACDF. Further studies are needed to understand how to decrease likelihood for readmission., 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 © 2024 Elsevier Ltd. All rights reserved.)

Objective: The prognostic significance of body composition phenotypes for survival in patients undergoing surgical intervention for spinal metastases has not yet been elucidated. This study aimed to elucidate the impact of body composition phenotypes on surgical outcomes and 5-year survival., Methods: The records of patients treated surgically for spinal metastases between 2010 and 2020 were retrospectively evaluated. A deep learning pipeline assessed preoperative CT scans obtained within 3 months of surgery and identified muscle and fat content and composition. These data were used to categorize patients into 4 body composition phenotypic groups: 1) not sarcopenic, not obese; 2) sarcopenia alone; 3) obesity alone; and 4) sarcopenic obesity (SO). The groups were matched using a comprehensive propensity-matching procedure. Rates of postoperative outcomes and survival were evaluated. Cox proportional hazard models were used to evaluate the influence of body composition phenotypes on 5-year survival. Kaplan-Meier plots were used to evaluate survival probability further., Results: Following a propensity-matching procedure, 102 matched patient records were identified (not sarcopenic, not obese, n = 24; sarcopenia alone, n = 27; obesity alone, n = 37; and SO, n = 14). SO was found to be associated with a significantly increased mortality risk within 60 months (HR 3.27, 95% CI 1.43-7.48). Kaplan-Meier plots demonstrate evident divergence in survival probability within 5 years among patients in the SO group compared to the others (log-rank test, p = 0.022). Additionally, time to death was also lower in patients with SO (p = 0.018). Significant differences in postoperative ambulation rates were noted among patients with SO (p = 0.048), whereas no preoperative difference existed (p = 0.12). No significant differences in postoperative disposition, length of hospital stay, wound-related complications, or inpatient medical complications were otherwise noted (p > 0.05)., Conclusions: This study identifies SO as a distinct prognostic factor for increased mortality risk in patients undergoing surgery for spinal metastases, highlighting the complex interplay between body composition and patient outcomes. These findings advocate for integrating body composition analysis into preoperative assessment and tailored postoperative care strategies, promoting personalized treatment plans to improve survival and quality of life for this vulnerable patient population.

Background and Objectives: The Accreditation Council for Graduate Medical Education Milestones assessment system provides a structured framework for evaluating the developmental progression of neurosurgery residents. Understanding the variability in learning trajectories and identifying critical intervention points are essential for refining educational strategies and enhancing training outcomes. In this article, we aim to identify learning trajectories of neurosurgery residents and pinpoint pivotal junctures for potential interventions to aid residents struggling to meet expected competency levels., Methods: We analyzed Accreditation Council for Graduate Medical Education Milestones data from 3541 neurosurgery residents across 124 programs from 2013-2014 to 2022-2023. We examined the reliability of Milestone assessments across programs and addressed potential biases because of program-level differences. Through cluster analysis, we identified distinct learning trajectories, focusing on competency-specific developments and crucial intervention points based on divergences in trajectory., Results: Our analysis revealed 5 distinct learning trajectories among neurosurgery residents, highlighting diverse developmental pathways. Cluster 1 (n = 1,719, 48.5%) and Cluster 2 (n = 341, 9.6%) demonstrated initial foundational competencies but varied in progression, with Cluster 2 failing to meet the threshold for independent practice by postgraduate year 7 consistently. Cluster 3 (n = 459, 13%), starting with the lowest initial competency levels, surpassed independence thresholds, illustrating the potential for significant growth regardless of initial competency levels. Cluster 4 (n = 520, 14.7%) and Cluster 5 (n = 502, 14.2%) exhibited accelerated competency development, achieving early readiness for independent practice. We found no significant association between cluster membership and program characteristics, suggesting that the trajectories reflect individual variations rather than programmatic differences., Conclusion: Our findings highlight the need for educational strategies tailored to residents' unique development paths to support the achievement of competency thresholds. While the data suggest potential benefits of adaptive learning, further exploration is required to confirm its impact on educational outcomes., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.)

Background: This study investigates the predictive values of the Risk Analysis Index (RAI), the modified 5-item Frailty Index (mFI-5), and advanced age for predicting 30-day extended length of stay (LOS), 30-day complications, and readmissions in patients undergoing posterior spinal fusion (PSF) for adult spinal deformity (ASD)., Methods: A retrospective cohort study was performed using the 2012-2021 American College of Surgeons National Surgical Quality Improvement Program database. Adults undergoing PSF for ASD were identified using Current Procedural Terminology and International Classification of Diseases codes. Using receiver operating characteristic and multivariable analyses, we compared the discriminative thresholds and independent associations of RAI, mFI-5, and greater patient age for extended LOS, 30-day complications, and readmissions., Results: In this cohort of 3814 patients, RAI identified 90.7% as Robust, 6.0% as Normal, and 3.3% as Frail/Very frail, while mFI-5 classified 47.1% as Robust, 37.5% as Normal, and 15.3% as Frail/Very frail. Multivariable analysis revealed both RAI and mFI-5 as significant predictors of extended LOS for Normal (RAI: P < 0.001; mFI-5: P = 0.013) and Frail/Very frail patients (RAI: P < 0.001; mFI-5: P = 0.003). Additionally, RAI was a significant predictor of 30-day complication risk for Normal patients (P = 0.005). Furthermore, mFI-5 was a significant predictor of 30-day readmission among Frail/Very frail patients (P = 0.002)., Conclusions: This study suggests that the utility of RAI and mFI-5 in predicting extended LOS patients undergoing PSF for ASD. RAI was found to be superior to mFI-5 for predicting 30-day readmissions, while mF-5 was greater for 30-day complications. These findings highlight the need for future studies to identify optimal methods in incorporating frailty assessments into preoperative surgical planning and patient discussions., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The concurrent presentation of meningioma and intracranial aneurysm (IA) poses diagnostic and therapeutic challenges, with no standardized management protocol available. This study aims to address this through an updated systematic review, delineating optimal strategies for managing this dual pathology., Methods: A systematic review was conducted across PubMed, Web of Science, and Embase databases. Articles were screened independently by two reviewers. Treatment strategies and patient outcomes were comprehensively analyzed to formulate a treatment framework based on several characteristics. In addition, one concurrent meningioma and IA case from our institution was presented., Results: A total of 69 articles comprising 115 patients were included in the study. The cohort exhibited a female predominance (80%) with a mean age of 56 (±13) years. Meningiomas were primarily localized to the frontotemporal and sellar regions, while aneurysms favored the anterior circulation - notably, 16.5% of cases presented with ruptured aneurysms. Management strategies varied based on the spatial relationship between lesions and aneurysm rupture status. In unruptured cases, 34% underwent a single craniotomy for simultaneous resection of both pathologies, while endovascular intervention was favored when the IA originated from an artery feeding the meningioma (73%). Remarkably, postoperative aneurysm rupture occurred in 33% of cases managed solely through tumor resection (range 0-30 days postop)., Conclusion: This study proposes a comprehensive treatment algorithm to guide neurosurgeons in managing concurrent meningioma and IA cases. By considering individual patient intricacies, the feasibility of simultaneous management, aneurysm rupture risk, and symptomatology, this framework is a valuable tool for clinical decision-making in these complex scenarios., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)

Objective: Semaglutide, a novel glucagon-like peptide-1 receptor agonist, has transformed the therapeutic landscape for type 2 diabetes mellitus. However, its effect on osteoclast activity and its potential to induce weight-related muscle loss raises concerns about its impact on spine surgery outcomes. As such, evaluating semaglutide's influence on transforaminal lumbar interbody fusion (TLIF) is imperative, given the procedure's reliance on successful bony fusion to prevent postoperative instability and further interventions., Methods: Using an all-payer database (MARINER), the authors analyzed data from patients with type 2 diabetes mellitus who were 18-74 years of age and who underwent short-segment fusion (≤ 3-level) TLIFs between January 2018 and October 2022. Patients were either exposed to semaglutide or not. A comprehensive 1:3 (exposure vs no exposure) matching was performed based on age, sex, obesity, hypertension, coronary artery disease, chronic kidney disease, smoking status, osteoporosis, levels of surgery, and basal-bolus insulin dependence. Kaplan-Meier survival curves and log-rank testing were performed to study the probability of additional lumbar fusion surgery within 1 year., Results: After the 1:3 matching, 1781 patients were identified, with 447 in the semaglutide-exposed cohort and 1334 in the nonexposed cohort. Most patients in both groups were 55-69 years old, and 59.3% were female. Analysis showed that the likelihood of undergoing additional lumbar fusion surgery within 1 year post-TLIF was significantly higher in the semaglutide-exposed group than in the nonexposed group (OR 11.79, 95% CI 8.17-17.33). Kaplan-Meier plots and log-rank testing further confirmed a statistically significant divergent probability in the need for additional surgery within 1 year between the cohorts (log-rank, p < 0.001)., Conclusions: Semaglutide exposure appears to be associated with a higher likelihood of additional lumbar fusion surgeries within 1 year post-TLIF, especially in patients receiving the medication for longer durations. Although the mechanisms remain speculative, potential impacts on bone turnover and the onset of muscle loss may be contributory factors. Further research is needed to elucidate the exact mechanisms and to develop strategies for optimizing surgical outcomes in these patients.

Study Design: A retrospective cohort study., Purpose: To examine the effect of cannabis use history on postoperative opioid utilization in patients undergoing one- to three-level lumbar fusion for degenerative spine disease., Overview of Literature: Strategies to minimize dosing and chronic opioid use are needed for spine surgery given their widespread prescription for postsurgical pain management., Methods: In this database study, medical coding was used to identify patients who had undergone one- to three-level lumbar fusions between 2012 and 2021. Propensity score matching was used to create two equal cohorts with respect to cannabis use history. Opioid utilization rates (morphine milligram equivalents [MME]/day) and overuse rates at 6 months post-index procedure were assessed. All pvalues <0.05 were considered statistically significant., Results: Following examination of 153,500 patient records, 1,216 patients were matched into cannabis user and non-cannabis user cohorts. Cannabis users had lower rates of opioid utilization compared to non-cannabis users as early as 2 months after fusion (47.7% vs. 41.1%, p <0.05), a relationship which persisted at 6 months (46.2% vs. 37.7%, p <0.01). Additionally, cannabis users had lower rates of high-dose opioid utilization (≥100 MME per day) during the initial 14-30 days following surgery (6.91% vs. 3.79%, p <0.05)., Conclusions: Patients with a history of cannabis use were less likely to be using opioids as early as 2 months postoperatively and had lower rates of high-dose opioid utilization in the immediate postoperative period. Physicians operating on these patients should consider their cannabis use patterns to provide appropriate titration of pain medication over time.

Introduction: To explore the effect of cigarette smoking on the risk for developing diabetic macular edema (DME) among patients with diabetes. Methods: This retrospective exactly-matched cohort study used claims data for patients from all 50 states in the United States from 2010 through 2020. Patients with an initial diagnosis of diabetes were stratified into 3 cohorts as follows: active smokers, never smokers, and former smokers. After exact matching based on demographics and comorbidities, Kaplan-Meier survival functions for the 3 cohorts were compared using pairwise log-rank tests. Results: After matching, there were 42 298 patients in each cohort. Over 6 years of follow-up, the cumulative risk for DME was significantly higher among never smokers (1.18%) than among active smokers (0.88%) and former smokers (0.90%) (both P  < .001). Conclusions: Among patients with diabetes, smoking may decrease the risk for developing DME. Although the harms of smoking far outweigh any potential protective benefits, further investigation into the mechanisms behind these findings has potential to uncover new therapeutic targets., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of the article., (© The Author(s) 2024.)

Background and Objectives: Significant evidence has indicated that the reporting quality of novel predictive models is poor because of confounding by small data sets, inappropriate statistical analyses, and a lack of validation and reproducibility. The Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement was developed to increase the generalizability of predictive models. This study evaluated the quality of predictive models reported in neurosurgical literature through their compliance with the TRIPOD guidelines., Methods: Articles reporting prediction models published in the top 5 neurosurgery journals by SCImago Journal Rank-2 (Neurosurgery, Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of NeuroInterventional Surgery, and Journal of Neurology, Neurosurgery, and Psychiatry) between January 1st, 2018, and January 1st, 2023, were identified through a PubMed search strategy that combined terms related to machine learning and prediction modeling. These original research articles were analyzed against the TRIPOD criteria., Results: A total of 110 articles were assessed with the TRIPOD checklist. The median compliance was 57.4% (IQR: 50.0%-66.7%). Models using machine learning-based models exhibited lower compliance on average compared with conventional learning-based models (57.1%, 50.0%-66.7% vs 68.1%, 50.2%-68.1%, P = .472). Among the TRIPOD criteria, the lowest compliance was observed in blinding the assessment of predictors and outcomes (n = 7, 12.7% and n = 10, 16.9%, respectively), including an informative title (n = 17, 15.6%) and reporting model performance measures such as confidence intervals (n = 27, 24.8%). Few studies provided sufficient information to allow for the external validation of results (n = 26, 25.7%)., Conclusion: Published predictive models in neurosurgery commonly fall short of meeting the established guidelines laid out by TRIPOD for optimal development, validation, and reporting. This lack of compliance may represent the minor extent to which these models have been subjected to external validation or adopted into routine clinical practice in neurosurgery., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Malnutrition is a common condition that may exacerbate many medical and surgical pathologies. However, few have studied the impact of malnutrition on surgical outcomes for patients undergoing surgery for metastatic disease of the spine. This study aims to evaluate the impact of malnutrition on perioperative complications and healthcare resource utilization following surgical treatment of spinal metastases. Methods: We conducted a retrospective cohort study using the 2011-2019 American College of Surgeons National Surgical Quality Improvement Program database. Adult patients with spinal metastases who underwent laminectomy, corpectomy, or posterior fusion for extradural spinal metastases were identified using the CPT, ICD-9-CM, and ICD-10-CM codes. The study population was divided into two cohorts: Nourished (preoperative serum albumin values ≥ 3.5 g/dL) and Malnourished (preoperative serum albumin values < 3.5 g/dL). We assessed patient demographics, comorbidities, intraoperative variables, postoperative adverse events (AEs), hospital LOS, discharge disposition, readmission, and reoperation. Multivariate logistic regression analyses were performed to identify the factors associated with a prolonged length of stay (LOS), AEs, non-routine discharge (NRD), and unplanned readmission. Results: Of the 1613 patients identified, 26.0% were Malnourished. Compared to Nourished patients, Malnourished patients were significantly more likely to be African American and have a lower BMI, but the age and sex were similar between the cohorts. The baseline comorbidity burden was significantly higher in the Malnourished cohort compared to the Nourished cohort. Compared to Nourished patients, Malnourished patients experienced significantly higher rates of one or more AEs (Nourished: 19.8% vs. Malnourished: 27.6%, p = 0.004) and serious AEs (Nourished: 15.2% vs. Malnourished: 22.6%, p < 0.001). Upon multivariate regression analysis, malnutrition was found to be an independent and associated with an extended LOS [aRR: 3.49, CI (1.97, 5.02), p < 0.001], NRD [saturated aOR: 1.76, CI (1.34, 2.32), p < 0.001], and unplanned readmission [saturated aOR: 1.42, CI (1.04, 1.95), p = 0.028]. Conclusions: Our study suggests that malnutrition increases the risk of postoperative complication, prolonged hospitalizations, non-routine discharges, and unplanned hospital readmissions. Further studies are necessary to identify the protocols that pre- and postoperatively optimize malnourished patients undergoing spinal surgery for metastatic spinal disease.

Background: The WATCHMAN device (Boston Scientific; Marlborough, MA, USA) is noninferior to warfarin in preventing ischemic strokes while reducing bleeding risks associated with long term anticoagulation in nonvalvular atrial fibrillation (AFib). The device's performance compared to direct oral anticoagulants (DOAC) is less well known., Objective: To compare 5-year major bleeding and ischemic stroke rates in patients with nonvalvular AFib who received a WATCHMAN device or DOAC therapy after a major bleeding event., Methods: This retrospective, multicenter, 1:1 matched cohort study was derived from the PearlDiver Mariner database from 2010 to 2020. Patients with nonvalvular AFib on oral anticoagulation who had a major bleeding event were identified. Those who received either WATCHMAN or DOAC after resolution of the bleeding event were selected. The two groups were exactly matched 1:1 based on various comorbidities. Rates of ischemic stroke, transient ischemic attack (TIA), major bleeding, and hemorrhagic stroke were compared over 5 years., Results: Each cohort consisted of 2248 patients after 1:1 matching. The mean CHADS2-VASC score was 4.81 ± 1.25. At 5 years, the WATCHMAN cohort had significantly lower rates of major bleeding events [OR 0.24 (0.21, 0.27)], TIAs [OR 0.75 (0.58, 0.95)], and ischemic strokes [OR 0.72 (0.61, 0.86)]. There was no significant difference in hemorrhagic strokes [OR 1.14 (0.83, 1.58)]., Conclusion: Even in a high-risk population, the WATCHMAN is comparable to DOAC therapy in the primary prevention of hemorrhagic strokes and may provide benefit in the rates of bleeding events, TIAs, and ischemic strokes., Competing Interests: Declaration of competing interest No authors have conflicts of interest to disclose related to this research., (Copyright © 2023 Elsevier Ltd. All rights reserved.)