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Background. Management of open proximal metaphyseal fractures poses a significant challenge and is fraught with complications. These injuries are severe, often accompanied by extensive soft tissue and vascular damage, leading to high risks of infection and long-term disability. Case presentation. A 72-year-old male was severely injured in a road traffic accident. Plain X-rays and CT angiogram identified a comminuted proximal tibial fracture with transection of the popliteal artery and vein. Initial emergency treatment included fasciotomies, external fixation, and vascular primary repair. On the 12th day of admission, the patient underwent open reduction and internal fixation (ORIF) with dual plate fixation using a two incision technique. A plastic surgeon performed skin grafting, harvested from the patient’s thigh, to allow closure of his fasciotomy wounds immediately following ORIF. Four weeks post-operatively, the patient developed a wound breakdown over the lateral fasciotomy site, exposing the metal plates with a small defect developing on the medial fasciotomy wound in tandem. The patient’s course was further complicated by persistent polymicrobial infections. Over 6 months of antibiotic regimes, operative intervention was ultimately required. All of the infected metal implants were removed, the non-union sites were aggressively debrided. The tibial canal was reamed to prepare for a tibial nailing. An antibiotic loaded bio-composite was then inserted through the non-union sites into the canal followed by an intramedullary nail. A blocking screw was used to address the procurvatum deformity in the sagittal plane. The patient currently shows signs of recovery, mobilizing over short distances, weight-bearing with assistive aids and with healing wounds and early signs of callus formation on recent CT scans and plain X-rays. Conclusions. The management of complex tibial fractures with vascular involvement demands an aggressive multidisciplinary approach and continuous adaptability in treatment plans to address the evolving challenges of such severe injuries. This case exemplifies the utility of injectable antibiotic-loaded bio-composites in a limb-salvage setting and their ability to provide high doses of local antibiotics to an infection site which, in conjunction with appropriate stable fixation and systemic antibiotics, can aid in eradicating and treating fracture-related infections.

Improving photovoltaic systems to better withstand variations in temperature and irradiance, lessen steady-state ripples, maintain high efficiency, require less tracking time, and have minimal complexity is becoming increasingly important. The PV array's overall power output is negatively impacted by partial shading because the shaded cells produce less power and consume less power overall, which lowers efficiency and creates localized hotspots. Although bypass diodes may be used to counteract these impacts by rerouting current around cells that are shaded, they can result in several peaks, which complicates maximum power point tracking (MPPT). To manage several peaks and optimize power output, metaheuristic algorithms are compulsory. A recently developed game-based optimization methodology known as Golf Optimization Approach (GOA) is used in this study to find a way to MPPT in a grid-connected photovoltaic (PV) system under partial shading conditions (PSCs). Additionally, the same suggested approach is applied to get optimal parameters for the inverter with the goal of optimizing its voltage and current regulators. It aims to evaluate a plan to lower the output voltage and current's total harmonic distortion and DC voltage error. The proposed technique is contrasted to other tracking approaches such as the traditional Perturb & Observe (P&O), Gray Wolf Optimization (GWO), and Sea-gull Optimization Approach (SOA). Simulation is performed in MATLAB R2022b/SIMULINK environment. The obtained outcomes demonstrate the ability of the suggested technique to enhance the utility grid's power quality and improve the tracking system under various partial shading effects and temperature alterations. The proposed technique achieves a tracking efficiency of 99.8 %, surpassing the effectiveness of both of the previous methods which are at 97.2 % and 96.7 %.

Abstract Background The spectrum of Juvenile Idiopathic Arthritis (JIA) in Africa is still largely unknown. We thus set out to illustrate how we set up the PAFLAR JIA registry and describe the clinical profile of Juvenile Idiopathic Arthritis across various regions in Africa. Methods We carried out a retrospective observational cohort study where collaborators were trained on use of the existing PAFLAR REDCAP database to enter data for the JIA patients currently under their care capturing their epidemiological data, clinical features, laboratory investigations, diagnosis and therapy at initial diagnosis. Descriptive statistics including means, standard deviations, medians, interquartile ranges (IQR) for continuous variables and proportions for categorical variables were calculated as appropriate. Tests for difference between groups were performed between categorical variables using Pearson’s chi-square or Fisher’s exact tests. All analyses were performed using SPSS version 22 software. Results We enrolled 302 patients, 58.6% (177 of 302) of whom were female. The median age of disease onset was 7 years (range 3–11 years) and the median age at diagnosis was 8.5 years (range 5–12 years). The median duration delay in diagnosis was 6 months (range 1-20.8 months). The JIA categories included Systemic JIA 18.9% (57), Oligoarticular JIA 19.2% (83), Polyarticular RF + ve 5% (15), Polyarticular RF-ve 17.9% (54), Enthesitis Related Arthritis (ERA) 18.2% (55), Psoriatic Arthritis 7% (21) and undifferentiated JIA 5.6% (17). As regards treatment the commonest therapies were NSAID therapy at 31.1%, synthetic DMARDs at 18.1%, synthetic DMARDs combined with NSAIDs at 17.5% and steroid therapy at 9.6%. Biological DMARDs accounted for 2.3% of therapies offered to our patients at diagnosis. The average JADAS score was 10.3 (range 4.8–18.2) and the average CHAQ score was 1.3 (range 0.7-2.0). Conclusion Our study highlights strategies involved in setting up a Pan-African paediatric rheumatology registry that embraces our broad diversity and the vast spectrum of JIA in Africa while comparing the various therapies available to our patients. The PAFLAR JIA registry strives to ensure a comprehensive representation of the diverse healthcare landscapes within the continent. Further longitudinal observation studies are required to ascertain the long-term outcomes of our patients and ultimately help inform policy to create a more favorable health ecosystem to support the healthcare needs of JIA patients in Africa.

Abstract Background Gender differences in the diagnosis and treatment of osteoporosis is a relatively common phenomenon, particularly amongst those patients under 80 years of age presenting with fragility fractures. The clinical implications of these findings are that strategies, which tend to focus on osteoporosis management in women, should also pay enough attention to osteoporosis in men. However, there have been questions whether there is a gender difference when setting intervention thresholds for osteoporosis management. This work was carried out aiming to determine the fracture probabilities calculated by FRAX at which therapeutic intervention in older men and women can be considered. Results Assessment of fracture risk probability thresholds in men revealed that for hip fractures, ROC was 0.754 (95% CI: 0.69–0.817). The sensitivity was 80.5% for threshold probabilities of 2.5%. For the major osteoporosis fracture, ROC was 0.828 (95% CI: 0.694–0.963). The sensitivity was 87.5% for threshold probabilities of 10%. Assessment of fracture risk probability threshold in women ROC was 0.760 (95% CI: 0.691–0.83). The sensitivity was 76.1% for threshold probabilities of 3%. For major osteoporosis fracture, ROC was 0.848 (95% CI: 0.784–0.912). The sensitivity was 87.3% for threshold probabilities of 15%. Conclusion Operational aspects of osteoporosis management should consider gender specific fracture thresholds. Interventional thresholds were found to be different in men compared to women. This helps to optimise fracture prevention in older men.

This research work aimed at isolation and characterisation of essential oils of Mangifera. indica (M. indica) leaves. Phytochemical screening was carried out to determine the bioactive components present in the leaf sample as well as the antimicrobial activity of the crude ethanolic extract. The percentage yield of essential oils (colourless) of the leaf was 0.19%. The phytochemical screening revealed the presence of alkaloid, glycoside, flavonoid, saponin and tannin. Steroids was absent in the extract. The antimicrobial evaluation of the essential oil of M. indica leaf revealed a significant activity (zone of inhibition). The percentage (%) of Diphenyl picryl hydrazine (DPPH) scavenged of antioxidant activities for the essential oils of M. indica at different concentration of 5µl, 10µl, 25µl and 100 µl showed a significant antioxidant activity. In concluded results, it’s clearly observed that, when the concentration of both ethanolic extract and essential oils leaf sample increases, the antimicrobial and antioxidant properties increases when compared to the standard (Amoxicillin) and that of essential oils has a significant property than other extracts. Considering the results of phytochemical screening, it’s also a potential source of cost-effective food supplements, nutritive ingredients and antibacterial agent for improving human health and curing acute and chronic diseases. The GC-MS analysis of the essential oils for the leaf sample revealed fifty two (52) different chemical compounds which include Alloaromadendrene, Humulene, Bicyclo[4,4,0]dec-1-ene, 2-isopropyl-5-methyl-9-methylene, Bicyclo[7.2.0]undec-4-ene,4,11,11,-trimethyl 8-methylene-,[1R-(1R*,4Z,9S*)].

Abstract Trabecular bone score (TBS) is a grayscale textural assessment resulting from a computed evaluation of pixel gray-level variations in previously obtained lumbar spine DXA images. It is an index of bone microarchitecture correlated with parameters of bone strength. Higher values of TBS indicate a better microarchitecture, whereas lower values indicate a degraded microarchitecture. TBS can be used alongside Fracture Risk Assessment tool “FRAX” and bone mineral density (BMD) to enhance the assessment of fracture risk and to inform treatment initiation and monitoring. A systematic review was carried out aiming to update the evidence on the clinical use of the TBS in the management of both primary and secondary osteoporosis. Results revealed that in both primary and secondary osteoporosis, TBS enhances the prediction of fracture risk, and when adjust with BMD and clinical risk factors, it is able to inform the decision-making process regarding initiating osteoporosis therapy and the choice of anti-osteoporosis medication. Evidence also implies that TBS provides valuable adjunctive information in monitoring osteoporosis therapy. In conclusion, this work provides an up-to-date evidence-based review and recommendations which informs the utility of trabecular bone score in standard clinical practice.

Aim of study: This study assessed the effectiveness of community-based interventions, health awareness, and treatment in controlling schistosomiasis among schoolchildren to improve policies and strategies. Methods: This pre- and post-intervention study was conducted in an Al-Alaqa male primary school, and systematic simple random sampling was used to investigate 237 participants, which resulted in 132 (55.7%) infected students. The infected and noninfected students (580 students) were treated by delivering the praziquantel doses immediately after the results; after 4 weeks, the infected students received the second dose. After 6 months, the rates were investigated again, and all procedures were performed after the height and weight of the students were recorded according to the protocol. Health education was provided for all participants using posters and leaflets. The data were collected via a questionnaire and urine test. The data were analyzed using SPSS (Statistical Package for the Social Sciences), and ANOVA and t-tests were used to determine the significant differences between the variables. Results: A urine investigation was conducted on 237 students; 132 (55.7%) had positive results which showed marked improvement and the prevalence in the school decreased to 3.8% after the intervention. The researcher found strong evidence of a relationship between the prevalence of schistosomiasis before the intervention and availability of water in the home (chi-square = 18.331, df = 1, p value = 000). ANOVA showed strong statistical significance (0.002 and F = 6.564) between the mean score of student age and reasons behind going to the pond. Conclusion: This study concluded that mass chemotherapy and treatment were highly effective when associated with a health program intervention. Mass chemotherapy alone may reduce the prevalence of disease for a short time. Recommendation: Community-based interventions should be applied in schools with an emphasis on health education programs through the training of schoolteachers on investigations for schistosomiasis, treatment with praziquantel, and the provision of materials (microscopes, reagents, and drugs).

The performance of the building envelope of a building is crucial for minimizing operational carbon emissions and maintaining indoor comfort. Contemporary building envelopes, such as highly engineered glazed façades, achieve high performance levels but also add a significant amount of embodied carbon. For example a 1mm reduction in glass thickness could save 3 kgCO2eq/m2. There is therefore an incentive to reduce the thickness of the glass panels, but the minimum thickness possible is often not governed by strength or manufacturing limits but rather by the deflection (serviceability) limits. Despite objective criteria guiding serviceability limits, occupant acceptance of deformation remains unexplored, leading to conservative designs. This paper introduces a novel method for measuring occupant satisfaction with glass deformations, aiming to establish acceptance thresholds comparable to objective criteria. An experimental campaign was conducted to assess volunteers' levels of perception and acceptance of various glass deformations. The glass was deformed using an electro-pneumatic system at levels corresponding to below, above, and at the current serviceability limit. The results demonstrate the feasibility of measuring human responses to deformations in the glazing and provide essential data for setting serviceability limits. The experiments indicate that, based on occupant feedback, the current serviceability limit of L/50, may be relaxed, thereby presenting opportunities for material efficiency, such as the adoption of thinner glass in facades. The methodology effectively captures human responses, revealing heightened perception of glazing movement at night and a higher acceptance during the day. Changes in reflection were the primary reason for the perception of movement, with lower acceptability at night. Overall, participants felt safe regardless of their prior knowledge on glass properties, and providing this information to participants did not improve acceptance, which was already sufficiently high. The findings from this research fill an important knowledge gap in understanding occupant acceptance of glass deformations, crucial for comprehensive user satisfaction assessments and evidence-based reductions in glazing thickness.

Precision cancer medicine primarily aims to identify individual patient genomic variations and exploit vulnerabilities in cancer cells to select suitable patients for specific drugs. These genomic features are commonly determined by gene sequencing prior to therapy, to identify individuals who would be most responsive. This precision approach in cancer therapeutics remains a powerful tool that benefits a smaller pool of patients, sparing others from unnecessary treatments. A limitation of this approach is that proteins, not genes, are the ultimate effectors of biological functions, and therefore the targets of therapeutics. An additional dimension in precision medicine that considers an individual’s cytokine response to cancer therapeutics is proposed. Cytokine responses to therapy are multifactorial and vary among individuals. Thus, precision is dictated by the nature and magnitude of cytokine responses in the tumor microenvironment exposed to therapy. This review highlights cytokine responses as modules for precision medicine in cancer therapy, including potential challenges. For solid tumors, both detectability of cytokines in tissue fluids and their being amenable to routine sensitive analyses could address the difficulty of specimen collection for diagnosis and monitoring. Therefore, in precision cancer medicine, cytokines offer rational targets that can be utilized to enhance the efficacy of cancer therapy.

Abstract Introduction Globally, the incidence of HIV and syphilis can be reduced by the use of validated point of care tests (POCTs). As part of the WHO PRoSPeRo Network, we aimed to evaluate the performance, acceptability, and operational characteristics of two dual HIV/syphilis POCTs (Bioline HIV/Syphilis Duo (Abbott) and DPP® HIV-Syphilis assay (Chembio) for the screening of HIV and syphilis amongst men who have sex with men (MSM). Method and analyses A cross sectional study of 2,577 MSM in Italy, Malta, Peru, and the United Kingdom (UK) presenting to seven clinic sites, were enrolled. Finger prick blood was collected to perform POCTs and results compared with standard laboratory investigations on venepuncture blood. Acceptability and operational characteristics were assessed using questionnaires. Diagnostic meta-analysis was used to combine data from the evaluation sites. Results Based on laboratory tests, 23.46% (n = 598/2549) of participants were confirmed HIV positive, and 35.88% of participants (n = 901/2511) were positive on treponemal reference testing. Of all participants showing evidence of antibodies to Treponema pallidum, 50.56% (n = 455/900) were Rapid Plasma Reagin (RPR) test reactive. Of HIV positive individuals, 60.62% (n = 354/584) had evidence of antibodies to T. pallidum, and of these 60.45% (n = 214/354) exhibited reactive RPR tests indicating probable (co)infection. For Bioline POCT, pooled sensitivities and specificities for HIV were 98.95% and 99.89% respectively, and for syphilis were 73.79% and 99.57%. For Chembio pooled sensitivities and specificities for HIV were 98.66% and 99.55%, and for syphilis were 78.60% and 99.48%. Both tests can detect greater than 90% of probable active syphilis cases, as defined by reactive RPR and treponemal test results. These dual POCTs were preferred by 74.77% (n = 1,926) of participants, due to their convenience, and the operational characteristics made them acceptable to health care providers (HCPs). Conclusions Both the Bioline and the Chembio dual POCT for syphilis and HIV had acceptable performance, acceptability and operational characteristics amongst MSM in the PRoSPeRo network. These dual POCTs could serve as a strategic, more cost effective, patient and healthcare provider (HCP) friendly alternative to conventional testing; in clinical and other field settings, especially those in resource-limited settings.

Abstract Purpose To assess the relationship between the triad of obesity, fracture risk factors, and osteoporosis and its impact on fragility fractures. Results Osteoporosis was least prevalent (p

Abstract Background The aim of this work is to set up the standards for performing musculoskeletal ultrasound scans and reporting as an additional procedure in the rheumatology setting. We used two rounds of the Delphi approach to get the consensus on a musculoskeletal ultrasound reporting. Results Fifteen expert panels had completed the two rounds of surveys. After the end of round two, eighteen recommendations distributed upon eight domains were released. The percentage of the agreement on the recommendations was 93.3 to 100 %. All eighteen key questions were answered at the end of the second round with agreement. Conclusion A musculoskeletal ultrasound report template has been developed by this study, based on outcomes of a Delphi process, by an international participants’ panel. All domains met the 80% voting threshold set in this work. The reporting template can be used for both clinical research as well as standard practice to provide guidance and standardize the musculoskeletal ultrasound reporting.

This study included 10 genotypes of bread wheat, namely M45, Yakora, Giza168, Sids 12, SK95, Misr2, Giemiza 9, Sahel 1, Sids14, and Silano. The genotypes (parents and their single crosses) were cultivated at the research station of the Department of Field Crops of the College of Agriculture University of Kirkuk. During the winter agricultural season (2021-2022) using a Randomized Complete Block Design (R.C.B.D) and with three replications. The performance and hybrid vigour of the genetic compositions were studied based on the average and best parents . The most important results can be summarized as follows: The best performance of the parent (Sids12) was for the traits of the No. of grains. spike-1 (111.409) grains, the weight 1000 grains (42.991)(g), and the single grains yield (60.250) (g) . The hybrid (Sids 12x Sahel 1) showed the highest hybrid vigour for the traits of spike length (22.041) cm, No. of grains. spike-1 (147.835) grains, and single grains yield (96.991) (g). The hybrids (Yakora * Sids 12), (Yakora * Sids14), (Giza168* Sahel 1), (Sids 12* Sahel 1), and (Sids 12* Sids14) also showed significant hybrid vigour, calculated on the basis of deviation from the mean of parents for all the studied traits Days 75 % flowering , No. of tillers plant-1, spike length (cm) , No. of grains spike-1 , weight1000 grains (g) , single grains yield (g) and Biological yield plant-1 (g) , The hybrid (Giemiza 9* Sids14) showed significant hybrid vigour, calculated on the basis of deviation of the first generation from the best parents for all the studied traits Days 75 % flowering, No. of tillers plant-1, spike length (cm), No. of grains spike-1, weight1000grains(g),singlegrainsyield (g) and Biological yield plant-1 (g).

Abstract Purpose (1) This was a multi-center, cross-sectional, observational study. Both old men and postmenopausal women over 50 years old who were admitted with an osteoporotic fracture (whether hip fracture or major osteoporosis) were consecutively recruited for this work and managed under the Fracture Liaison Service. All the patients were assessed for their sarcopenia risk (SARC-F), fracture risk (FRAX), and fall risk (FRAS) as well as functional disability (HAQ). The aim was to assess the prevalence of sarcopenia risk among older adult Egyptians presenting with fragility fractures. (2) To identify the relation between sarcopenia risk with the risk of falling as well as sustaining a fragility fracture. Results Two hundred and thirty-six patients (69 males, 167 females) were included in this work. The mean age was 70.1 (SD = 9.2) years. The prevalence of sarcopenia was 69.7%. The sarcopenia risk score was positively correlated with the FRAX score (p = 0.01). The prevalence of high sarcopenia risk was 78% of the patients presenting with a high 10-year probability of major osteoporosis fracture as well as a 10-year probability of hip fracture. The sarcopenia risk score was positively correlated with the increased fall risk (p = 0.01) as scored by the FRAS scale. There was a significant relation (p

Abstract Background Despite the recent advances in the management of inflammatory arthritis, a considerable proportion of arthritis patients remain symptomatic. This cohort has recently been identified as ‘difficult to treat’ (D2T). In view of the limited evidence base, management of these patients has been a challenge particularly in view of its associated significant economic health burden. A better understanding of the D2T may help recognise or develop new therapeutic targets and facilitate earlier intervention in the disease course to prevent the progression of such condition. The aim of this work is to address the unmet needs in the management of D2T arthritis and develop a comprehensive approach towards the identification and proper assessment of those patients. Results At the completion of round 3 Delphi process, a total of 20 items were obtained and divided into 5 domains. From 88.9 to 100% of respondents agreed with the recommendations (ranks 7–9). All 20 of the clinical standards that the scientific committee identified were agreed upon in terms of wording, recommendation grade, and level of evidence (i.e. 75% of respondents strongly agreed or agreed). Conclusion D2T inflammatory arthritis remains a relevant clinical challenge, despite the endorsement of the treat-to-target approach and the availability of a broad range of targeted arthritis medications. This study provided a comprehensive definition of the condition to facilitate the identification of this patients’ group. It also highlighted the goals and principles aiming at providing an effective framework for D2T assessment, closely monitor and set up a strategy to intervene in standard clinical practice.

Abstract Mini abstract This work studies the direct cost of hip fractures in Egypt. The direct cost was calculated based on the incidence of hip fracture in Egypt retrieved from the national database. The result of this work raises red flags to the policy makers in Egypt that such fragility fractures are preventable, should appropriate approaches be implemented. Background This study provides an analysis for the healthcare system in Egypt. It was carried out to assess the direct annual cost incurred to the Egyptian healthcare system in 2023 as a result of fragility hip fractures in older adult Egyptians. Results The direct costs of hip fractures incurred during the first year after the injury were estimated at 1,969,385,000 Egyptian pounds (US $63,734,142.4). Time from fracture to surgery was 2.2 + 0.5 days. The average hospital stay after hip fracture surgery was 5.2 + 2.6 days. 4.5% of patients died after surgery, on average 2.3 + 0.4 months. After being discharged from the hospital, all patients needed home care. Conclusion Hip fractures have a significant clinical and financial impact on patients and the healthcare system. This study raises red flags for the healthcare policy makers in Egypt, as the financial burden due to the direct costs of hip fractures justifies extensive prevention programs for osteoporosis and fragility fractures. There is an urgent need to implement diagnostic approaches and validated management protocols for bone health disorders and its associated fractures in Egypt.

Abstract Background Dual-energy X-ray absorptiometry (DXA) is an important diagnostic test for bone mass status. The aim of this work was to set the standards for structured reporting of DXA measurements in adults within the context of fracture and fall risk assessment. Results Two rounds of Delphi were completed. The first Delphi round had a 68% response rate, while round two had a 100% response rate. After round 2, a total of 28 items were obtained, which were classified into three domains. The percentage of people who agreed with the recommendations (ranks 9–7) ranged from 76.5 to 100%. The wording of all 19 clinical standards determined by the scientific committee was agreed upon (i.e., 75% of respondents strongly agreed or agreed). Conclusion The DXA scan report is an independent document that contains sufficient information to enable optimal osteoporosis management advised by an experienced healthcare professional. Setting up quality standards for DXA scans not only supports healthcare professionals reporting/interpreting bone densitometry but also meets the parameters outlined in national as well as international guidelines or recommendations for the optimal management of osteoporosis and subsequent prevention of low trauma fractures.

Aim: In order to understand the global variations in the growth trajectories of cerebral palsy patients, this study aimed to compare the growth patterns of cerebral palsy patients in Saudi Arabi with United States and United Kingdom counterparts. Method: Anthropometric data from 107 participants with cerebral palsy in Saudi Arabia were collected, including age, gender, cerebral palsy type, Gross Motor Function Classification System level, birth weight, weight at assessment, height at assessment, body mass index, and head circumference at assessment. Results: This study found discrepancies between the growth patterns of Saudi Arabian children with cerebral palsy and United Kingdom and the United States growth charts, particularly among those with severe cerebral palsy. Significant differences were observed in weight, height, and body mass index z-scores when comparing Saudi Arabian data with the United kingdom and United States reference data. Interpretation: These findings emphasize the importance of validating growth charts across different populations to ensure accurate monitoring and clinical management of children with cerebral palsy. Additionally, this study highlights the need for region-specific growth references to better address the diverse needs of individuals with cerebral palsy worldwide.

Abstract Background Transition of care means the process of educating and empowering adolescents and young adults to take an active role in their own healthcare, develop decision-making skills, and eventually transition from paediatric to adult healthcare providers. Most people do not switch doctors until they are young adults, but it can be beneficial to start preparing children earlier. We aimed to develop a specific toolkit tailored to paediatric and adult rheumatologists to assist them in transitioning of care of young people with juvenile onset rheumatic musculoskeletal diseases from the paediatric to adult rheumatology care. Results The expert panel was confined to an online survey (n = 18), all the experts completed the two rounds. At the conclusion of round 2, a total of 10 points were gathered. The range of respondents (ranks 7–9) who agreed with the recommendations was 88.9 to 100%. All 10 clinical standards identified by the scientific committee were written in the same way. Based on the answers to the structured key questions and the literature review, a structured template was developed presenting transition of care integrated pathway. Conclusion The developed rheumatology-specific guideline offers adolescents and young adults a focussed, multidisciplinary transition of care approach with equity of access, quality of care and flexibility and set up standards for transitional care for young adults with juvenile rheumatological diseases.

Abstract Background Renal stones are a prevalent urological disorder with various treatment options, including minimally invasive techniques such as Standard-PCNL (S-PCNL) and Mini-percutaneous nephrolithotomy (M-PCNL). This study aims to compare the efficacy and safety outcomes of M-PCNL and S-PCNL for managing renal calculi. Methods This randomized study enrolled 60 patients with renal stones, comparing the efficacy and safety of M-PCNL (Group A) and S-PCNL (Group B) procedures. Preoperative assessments, surgical procedures, and postoperative care were conducted, and outcomes such as operating time, stone clearance, analgesic requirement, and hospital stay were evaluated. Data analysis was performed using SPSS software, with comparisons between groups conducted using the Chi-square test and Student t test. Results M-PCNL had a longer operation time (133.73 ± 29.18 min) than S-PCNL (48.6 ± 17.88 min, p = 0.009) but a lower mean drop in hemoglobin levels (0.14 ± 0.01 g/dL vs. 0.82 ± 0.05 g/dL, p = 0.032). The success rates (stone-free rate) were significantly different, with 100% in the M-PCNL group and 86.7% in the S-PCNL group (p = 0.040). Complications were generally fewer in the M-PCNL group, including postoperative fever in 2 cases (M-PCNL) vs. 8 cases (S-PCNL) and mild collection in 4 cases (M-PCNL) vs. 26 cases (S-PCNL). Conclusions M-PCNL is an effective and safer method for managing renal calculi smaller than 3 cm, offering a higher stone-free rate, lower postoperative pain, and shorter hospital stays compared to S-PCNL. Despite longer operation times due to stone fragmentation, M-PCNL has fewer complications, including lower bleeding rates, hemoglobin drop, and leakage, and can be performed using an ureteroscope when a miniperc scope is unavailable.

Rare diseases (RDs) are rare complex genetic diseases affecting a conservative estimate of 300 million people worldwide. Recent Next-Generation Sequencing (NGS) studies are unraveling the underlying genetic heterogeneity of this group of diseases. NGS-based methods used in RDs studies have improved the diagnosis and management of RDs. Concomitantly, a suite of bioinformatics tools has been developed to sort through big data generated by NGS to understand RDs better. However, there are concerns regarding the lack of consistency among different methods, primarily linked to factors such as the lack of uniformity in input and output formats, the absence of a standardized measure for predictive accuracy, and the regularity of updates to the annotation database. Today, artificial intelligence (AI), particularly deep learning, is widely used in a variety of biological contexts, changing the healthcare system. AI has demonstrated promising capabilities in boosting variant calling precision, refining variant prediction, and enhancing the user-friendliness of electronic health record (EHR) systems in NGS-based diagnostics. This paper reviews the state of the art of AI in NGS-based genetics, and its future directions and challenges. It also compare several rare disease databases.

Abstract Background Kawasaki disease (KD) is an acute, self-limited febrile disease of unidentified cause that mostly affects children less than 5 years of age. This work aimed to provide an appropriate Egyptian evidence-based consensus on clinical practice recommendations for the management of Kawasaki disease. The main objective of this study, which employed the Delphi method, was to reach a consensus among experts on a treat-to-target management approach for KD. Results The expert panel was confined to an online survey (n=26), and all the expert completed the three rounds. At the conclusion of round 3, a total of 17 recommendation items were gathered, which were divided into two sections. The range of respondents (ranks 7–9) who agreed with the recommendations was 92.3 to 100%. All 17 clinical standards identified by the scientific committee were written in the same way. There have been algorithms proposed for managing various KD conditions. Conclusion The developed evidence-based consensus recommendations for the diagnosis and management of KD represent an up-to-date document that focuses on clinical management questions which are generally posed to health care professionals involved in the management of KD. This guideline was developed considering experience with and availability of treatment and diagnostic options in Egypt.

Abstract Background Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by having varying clinical presentation, severity, unpredictable course as well as outcomes. Recent disease-modifying conventional and biologic agents have enhanced rates of attaining both short- and long-term management goals, including minimization of glucocorticoid dose and use. This study was carried out to develop an up-to-date evidence-based, consensus on clinical practice guidelines for treat-to-target management of systemic lupus erythematosus in adults. Results The response rate to the online questionnaires, sent to the expert panel who participated in the three rounds, was 95.5%. At the end of round 3, a total of 14 recommendation sections were proposed for the T2T management of patients with SLE. Agreement with the recommendations (rank 7–9) ranged from 90.9–100%. Consensus was reached (i.e., ≥ 80% of respondents strongly agreed or agreed) on the proposed statements. Conclusion These recommendations provide a consensus on the treat-to-target management of patients with SLE. They provide strategies to reach optimal outcomes in common clinical scenarios, based on a combination of evidence and expert opinion.

Abstract Background Psoriatic arthritis (PsA) is a chronic multi-domains autoimmune inflammatory disorder. Patients with PsA have a significant prevalence of cardiovascular affection. Upregulated Interleukin-34 (IL-34) has been seen in many autoimmune disorders, and also in atherosclerotic plaques. The aim of this observational case–control study was to evaluate the serum levels of il-34 in PsA patients and correlate between its level and disease activity, and subclinical cardiovascular affection. Results In this study, there were 70 PsA patients and 70 healthy volunteers, 43 patients were on Methotrexate, 6 on sulfasalazine, while 40 patients were on biological therapy either monotherapy or in combination with DMARDs. There were significant differences between PsA patients and controls in ESR, high sensitivity-CRP, total lipid profile, and IL-34 levels (p

Drowsiness driving poses a significant risk to road safety, necessitating effective drowsiness detection models. Most of the prior research has primarily relied on composite facial-based features, mainly focusing on the mouth and/or eye states, to identify drowsiness status. However, these models tend to overlook crucial information from input signals, resulting in suboptimal detection accuracy. Moreover, the absence of suitable algorithms and techniques for extracting other essential facial features, such as the eyebrow and nostril, further impacts the accuracy of drowsiness detection. To address these limitations, this study introduces an innovative algorithm and a technique for extracting drowsiness-related information from the eyebrow and nostril regions. Additionally, we propose a method, leveraging four composite facial-based drowsiness features; eyebrow, nostril, eye, and mouth states as inputs to a Convolutional Neural Network (CNN). A novel multilevel feature fusion method is employed to effectively combine the deep representations of these drowsiness-related features. The final step involves employing a Long-short-term memory (LSTM) recurrent neural network to classify the drowsiness status of drivers. Our proposed model is rigorously evaluated using the National Tsing Hua University drowsy driver detection (NTHU-DDD) video dataset. The experimental results demonstrate an impressive accuracy in different scenarios, and the accuracy result reached 0.973, showcasing the effectiveness of our approach in enhancing drowsiness detection accuracy and promoting road safety.

Background: Diabetes mellitus (DM) is a common metabolic disorder affecting more than 400 million people worldwide. Pancreatic islet cell failure due to partial loss or dysfunction of islet cells is a common feature in type 2 DM. The aim of this study to assess the possible protective role of aqueous extract of stevia on pancreatic β cells of type 2 diabetic rats. Methods: Thirty-two male Sprague Dawley rats were divided into four groups; control, control received stevia, type 2 DM and type 2 DM treated with stevia. For all groups; fasting blood glucose, fasting insulin, pancreatic Malondialdehyde (MDA) and Catalase (CAT) were measured. Western blot analysis for measuring LC3 (microtubule associated protein-1 light chain-3) and LAMP2 (lysosomal associated membrane protein 2) was done. Also, histopathological, histomorphometric studies and tyrosine hydroxylase (TH) and norepinephrine (NE) expression by immunostaing in pancreatic tissues were detected. Results: Type 2 DM resulted in a significant increase in fasting blood glucose, pancreatic MDA, LC3 and LAMP2 expression, TH and NE density with a significant decrease in fasting insulin, pancreatic CAT, pancreatic islet area, the number of islets per unit area and the number of β cell per islet. Also, treatment with stevia extract significantly improved the laboratory and histopathological features of pancreas Conclusion: Stevia extract has protective effects on type 2 DM pancreas by its hypoglycemic and antioxidant actions in addition to its ability to attenuate hyperactive autophagy and sympathetic nerve density.

Autonomous vehicles (AV) are expected to improve, transform, and revolutionize ground transportation. Previous techniques are dependent on localization employing pricey inaccuracy Global Positioning sensor. Furthermore, the performance loss is caused by drifting errors of Simultaneous Localization and Mapping. Regarding categorizing and analyzing texture, cameras are much more accessible and practical. This work contributes to obtaining high accuracy for AV localization and reducing errors in predicted positions. Based on the light, accurate, and robust proposed Convolutional Neural Network (CNN), it will scale down the computational complexity and shorten the training time. Considering various weather and time of day conditions such as bright sunny, hard rain noon, and wet cloudy noon with a vision-only system Red, Green, and Blue (RGB) low-cost camera sensors. To check the positional accuracy of the CNN, RGB images are combined with depth images using the IHS method. The k-Mean technique evaluates the similarity between a specific image and all street images to obtain precise coordinates. The Simulation findings demonstrate the superiority of the suggested technique for different weather conditions, which has an accuracy of up to 94.74% and a Mean Squared Error MSE in a distance of 0 meters, as opposed to [19], where the MSE in the projected position is 4.8 meters. Another indication of the proposed method's effectiveness is that it yielded reliable results when its validity was tested on images from a dataset that had not been trained.

Context: The COVID-19 pandemic has changed the structure of the healthcare system. As a response to the pandemic, the ministry of health applied many changes to the primary healthcare system. These changes created new challenges for healthcare workers (HCWs). Aims: To identify the roles and challenges of practitioners in primary healthcare (PHC) centers during COVID-19 in Al-Baha city, Saudi Arabia, in 2022. Methods and Materials: An analytical cross-sectional study was carried out in 2022 in Al-Baha city, Saudi Arabia. An electronic online questionnaire was distributed formally to HCWs in PHC centers. All primary HCWs during the COVID-19 pandemic in Al-Baha city, Saudi Arabia, were included. Results: A total of 424 responses were analyzed. Half (50.7%) of the participants had fieldwork roles during the pandemic. The two most commonly agreed-upon challenges were stress (78.7%) and worry about getting infected (79.8%). The majority (74.4%) of the participants’ roles involved direct contact with suspected COVID-19 cases, whereas 50.9% involved direct contact with confirmed COVID-19 cases. Direct contact with confirmed cases showed a significant association with worrying about getting infected (P = 0.019). Conclusions: Workload, overtime, conflict ambiguity, fear of getting and transmitting the infection, stress, and lack of personal protective equipment were challenges faced by the primary HCWs, which negatively impacted the quality of delivered services and mental health. We recommend facilitating access of primary HCWs to psychiatric clinics to improve stress and help cope with new roles during the pandemics and changes in the healthcare system.

Abstract Background Despite the associated high prevalence of morbidity and mortality, osteoporotic fragility fractures remain underdiagnosed and undertreated. Furthermore, those who sustain a fragility fracture are at imminent risk of sustaining subsequent fractures. Post-fracture care (PFC) programs are systematic, coordinated care programs that recognize, evaluate, and manage older adults who sustained a fragility fracture with the goal of managing all the risk factors and preventing succeeding fractures. Main text This work was carried out to outline the PFC program adopted in Egypt and its applicability in standard clinical practice. A review of literature was conducted to identify an evidence-informed PFC strategies and protocols, which outlines the optimal manner to manage older adults living with fragility fractures. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to guide the reporting of this review. Based on this, a PFC integrated model of care based on a patient-centered approach has been developed aiming to optimize the outcomes. Conclusion This manuscript described the integrated model of care adopted in Egypt to provide care for older adults presenting with fragility fractures. This will pave the way to standardize patient identification and management. Additionally, to prevent occurrence of subsequent fractures and to enhance equity of care for patients with fragility fracture and osteoporosis, expansion of such service to rural and remote areas is highly recommended.

Abstract Background Coronavirus disease 2019 (COVID-19) infection is linked to high levels of inflammatory cytokines and prolonged immobilization; furthermore, corticosteroid treatment leads to increased bone loss and resorption. We aimed to study the change in bone mineral density (BMD) after COVID-19 infection in osteoporotic and osteopenic patients. One hundred osteoporotic or osteopenic patients were selected in this single-center retrospective study; the patients were divided into two groups. Group 1 included 56 patients who got COVID-19 infection. Group 2 included 44 patients who did not get COVID-19 infection. BMD was assessed at baseline, after 9 months of COVID infection, and then after 1 year follow-up using dual energy x-ray absorptiometry (DXA) scan. Results There was no significant difference between two groups regarding demographic data (p > 0.05); there was a significant decrease in BMD of the lumbar region and femur at 9 months as compared to baseline in group1 (p

Objective: The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. Methods: Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts’ suggestions, and the percent agreement was calculated. Statements receiving rates of 7–9 by more than 75% of experts’ votes were considered as achieving consensus. Results: The surveys were sent to an expert panel (n = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7–9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. Conclusion: A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management.

Abstract Background Busy rheumatologists, and busy patients as well as policy makers, require accurate, succinct, transparent, easily digested summaries of evidence and recommendations for management. Our objective was to develop an up-to-date evidence-based, consensus, clinical practice guidelines for treat-to-target management of rheumatoid arthritis in adults. Results Ninety-four (94.7%) of the expert committee completed the 2-round e-Delphi surveys. A total of 33 recommendation items, addressing the main rheumatoid arthritis (RA) domains, were identified. The level of agreement (rate 7–9), for the statements which reached consensus, ranged from 85 to 100%. Consensus was achieved on the wording of all the clinical practice guidelines identified by the scientific committee. A management algorithm for the management of rheumatoid arthritis have been developed. Conclusion These updated recommendations reflect the most recent evidence for the management of RA. It also outlines the multidisciplinary team role in enhancing the RA patients’ care. The recommendations offer strategies to achieve optimum treat-to-target outcomes. However, standards of care are defined based on the clinical data obtained for individual patients and are prone to modification. High-quality, broad scope evidence-based clinical practice guidelines offer a path for bridging the gap between best practice, policy, local settings and patients’ choice.

Abstract Background Lupus nephritis (LN) affects a substantial number of the patients living with Systemic lupus erythematosus (SLE), representing a major cause of morbidity and mortality. Patients with lupus nephritis should be referred to a lupus nephritis expert who can confirm the diagnosis, assess the level of disease activity, and offer guidance on treatment and monitoring of the disease, as well as its consequences and side effects. The aim of this guideline was to develop recommendations for the management of adult lupus patients, including lupus nephritis diagnosis, assessment, and monitoring. Nineteen key clinical questions were identified by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for LN. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 2-round Delphi process was conducted with 24 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the two rounds (response rate 100%). At the end of round 2, a total of 19 recommendation items, categorized into 11 sections to address the main LN categories, were obtained. The percentage of those who agreed with the recommendations (ranks 7–9) ranged from 90.5 to 100%. The phrasing of all 19 clinical standards identified by the scientific committee was agreed upon (i.e., 75% of respondents strongly agreed or agreed). Conclusion These recommendations provide an updated consensus on the pharmacological treatment of lupus nephritis and strategies to reach optimal treat to target outcomes in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.

Abstract Background Nephritis is known to be one of the most serious complications of lupus and a strong predictor of poor outcome. This study was carried out aiming at setting up an up-to-date recommendation for the management of women living with lupus nephritis and planning for a family throughout conception, pregnancy, and the postpartum period. Ten key clinical questions were identified by the scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. The literature review team performed a systematic review to summarise evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for women living with lupus nephritis (LN) and planning for a family. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-Based Medicine (CEBM) system. A 2-round Delphi process was conducted with 24 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the two rounds (response rate 100%). At the end of round 2, a total of 20 recommendation items, categorised into 10 domains to address the main LN with pregnancy categories, were obtained. The percentage of those who agreed with the recommendations (rank 7–9) ranged from 88.5 to 100%. On the phrasing of all the clinical standards defined by the scientific committee, a consensus was reached (i.e., 75% of respondents strongly agreed or agreed). An algorithm for the management of LN with pregnancy has been suggested. Conclusion These recommendations provide an updated consensus on the pharmacological treatment of LN with pregnancy and strategies to reach optimal outcomes for both the mother and newborn in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient’s situation.

Abstract Background Oral health-related quality of life, a prominent topic in dentistry, has been studied extensively. However, the comparison between various self-perceived and clinical oral health measures still needs to be explored. The purpose of the current study is; first, to report the self-perceived and clinically examined oral health measures that are associated with the oral impacts on daily performances. Second, to identify the oral health measure that best predicts greater oral impact scores. Third, to investigate the difference in findings related to the disease experience measures and the treatment measures. Methods A cross-sectional study was carried out on children aged 12–14 years. The prevalence, frequency, and oral impact scores of each daily performance were calculated. Thirteen self-perceived OH conditions were assessed. Clinically examined oral health measures included gingival health, oral hygiene status, DMFT, DT, MT, and FT scores and, one or more decay (1 + D), missing (1 + M) and filled (1 + F) teeth. Simple linear and multiple linear regressions were carried out to report the associations. Results At least one oral health impacted daily performance was reported by 40% of the total sample of schoolchildren (N = 700). Based on the magnitude and precision of adjusted regression coefficients (RC), decay severity (DT) was identified as a better predictor of a greater oral impact score with regression coefficient values ranging between 0.3 (social contact) and 2.4 (1 + performance). Contrariwise, MT and FT components of DMFT were associated with lower oral impact scores. The self-perceived measures were also associated with oral impact scores and presented similar findings to that of the clinical oral health measures. Conclusions Untreated decay significantly impacted daily performances, especially eating, sleeping, studying, and social contact. The findings are of importance to public health practitioners for reporting, treating, and preventing oral health problems in children, and eventually contributing to better oral health-related quality of life.

Abstract Background We aimed to provide up-to-date, evidence-based and consensus-based recommendations for Treat-to-Target management of psoriatic arthritis (PsA) and associated clinical manifestations. In this recommendations, 14 key clinical questions were identified by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature Review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and non-pharmacologic therapies for psoriatic arthritis. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 19 experts whom were drawn from different governorates and health centers across Egypt with diverse in their experiences, including private, governmental workplace, tertiary university hospitals, and insurance hospitals. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of 51 recommendation items, categorized into 6 sections to address the main 6 psoriatic arthritis categories, were obtained. Agreement with the recommendations (rank 7–9) ranged from 89.5 to 100%. Consensus was reached (i.e., ≥ 75%of respondents strongly agreed or agreed) on the wording of all the 51 clinical standards identified by the scientific committee. Algorithms for the management of psoriatic arthritis have been suggested. Conclusion These recommendations provide an updated consensus on the pharmacological treatment of psoriatic arthritis and strategies to reach optimal treat-to-target outcomes in in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.

Recent studies have indicated that microRNA and VEGF are considered to be genetic modifiers and are associated with elevated levels of fetal haemoglobin HbF, and thus they reduce the clinical impact of sickle haemoglobin (HbS) patients. This cross-sectional study was performed on clinical confirmed subjects of SCD cases. miR-423-rs6505162 C>T and VEGF-2578 C>A genotyping was conducted by ARMS-PCR in SCD and healthy controls. A strong clinical significance was reported while comparing the association of miR-423 C>T genotypes between SCD patients and controls (p = 0.031). The microRNA-423 AA genotype was associated with an increased severity of SCD in codominant model with odd ratio (OR = 2.36, 95% CI, (1.15–4.84), p = 0.018) and similarly a significant association was observed in recessive inheritance model for microRNA-423 AA vs (CC+CA) genotypes (OR = 2.19, 95% CI, (1.32–3.62), p < 0.002). The A allele was associated with SCD severity (OR = 1.57, 95% CI, (1.13–2.19), p < 0.007). The distribution of VEGF-2578 C>A genotypes between SCD patients and healthy controls was significant (p < 0.013). Our results indicated that in the codominant model, the VEGF-2578-CA genotype was strongly associated with increased SCD severity with OR = 2.56, 95% CI, (1.36–4.82), p < 0.003. The higher expression of HbA1 (65.9%), HbA2 (4.40%), was reported in SCD patients carrying miR-423-AA genotype than miR-423 CA genotype in SCD patients carrying miR-423 CA genotype HbA1 (59.98%), HbA2 (3.74%) whereas SCD patients carrying miR-423 CA genotype has higher expression of HbF (0.98%) and HbS (38.1%) than in the patients carrying AA genotype HbF (0.60%), HbS (36.1%). ARMS-PCR has been proven to be rapid, inexpensive and is highly applicable to gene mutation screening in laboratories and clinical practices. This research highlights the significance of elucidating genetic determinants that play roles in the amelioration of the HbF levels that is used as an indicator of severity of clinical complications of the monogenic disease. Further well-designed studies with larger sample sizes are necessary to confirm our findings.

"Watermarking" is one method in which digital information is buried in a carrier signal; the hidden information should be related to the carrier signal. There are many different types of digital watermarking, including traditional watermarking that uses visible media (such as snaps, images, or video), and a signal may be carrying many watermarks. Any signal that can tolerate noise, such as audio, video, or picture data, can have a digital watermark implanted in it. A digital watermark must be able to withstand changes that can be made to the carrier signal in order to protect copyright information in media files. The goal of digital watermarking is to ensure the integrity of data, whereas steganography focuses on making information undetectable to humans. Watermarking doesn't alter the original digital image, unlike public-key encryption, but rather creates a new one with embedded secured aspects for integrity. There are no residual effects of encryption on decrypted documents. This work focuses on strong digital image watermarking algorithms for copyright protection purposes. Watermarks of various sorts and uses were discussed, as well as a review of current watermarking techniques and assaults. The project shows how to watermark an image in the frequency domain using DCT and DWT, as well as in the spatial domain using the LSB approach. When it comes to noise and compression, frequency-domain approaches are far more resilient than LSB. All of these scenarios necessitate the use of the original picture to remove the watermark. Out of the three, the DWT approach has provided the best results. We can improve the resilience of our watermark while having little to no extra influence on image quality by embedding watermarks in these places.

Abstract Introduction New therapies, management approaches, and evidence regarding the management of gout have become available over the past years. This triggered the need for an updated recommendation for gout management. Through an up-to-date consensus evidence-based clinical practice guideline for the management of gout including recommendations for management of gout flares, optimum usage of urate lowering therapy for chronic gout, as well as patient education and lifestyle guidance. A wide systematic literature review was performed, and evidence-based recommendations were extrapolated, based on 16-key questions identified according to population, intervention, comparator, and outcomes (PICO) approach. These were evaluated by a panel consisted of 17 rheumatology experts via online surveys over a 2-round Delphi process. The purpose of this study is to offer an updated, consensus-evidence-based, and in the meantime patient-focused, expert recommendations for the treat-to-target approach of gout management. Results Results revealed that after round 2 ended, a total of 30-recommendation items, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7–9) ranged from 90 to 100%. Consensus was reached (i.e., ≥ 75% of respondents strongly agreed or agreed) on the wording, the grade of recommendation, and level of evidence of all the 30 clinical standards identified by the scientific committee. Conclusions This guideline provides updated evidence-based recommendations for the prevention and treatment of acute as well as chronic gout. This guideline provides an approach for physicians and patients making decisions on the management of gout. It will also facilitate improvement and uniformity of care.

Abstract Background Because of the subjective character of symptoms, absence of a diagnostic test, modest response to treatments, and, at times, patient reports of important functional disability, fibromyalgia remains a challenge for the treating health care professionals in the standard clinical practice. The aim of this study was to develop an up-to-date consensus and evidence-based clinical practice guidelines for a treat-to-target management of fibromyalgia. Fifteen key clinical questions were identified by a scientific committee according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. A literature review team performed a systematic review to summarize the evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for fibromyalgia. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 16 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifteen recommendation items, categorized into 10 sections to address the main fibromyalgia categories, were obtained. Agreement with the recommendations (ranks 7–9) ranged from 85 to 100%. Consensus was reached (i.e., ≥ 80% of respondents strongly agreed or agreed) on the wording of all the 15 clinical standards identified by the scientific committee. An algorithm for the management of fibromyalgia has been suggested. Conclusions These recommendations provide an updated consensus on both the non-pharmacological and the pharmacological treatments of fibromyalgia. The provided strategies to reach optimal treat-to-target outcomes in common clinical scenarios are based on a combination of evidence and expert opinions. Best treatment decisions should be tailored to each individual patient situation.

Abstract Background During COVID-19 disease era, there is an accelerated demand for hydroxychloroquine since it was suggested by some centers as potential therapy for COVID-19 which has led to diminished supplies for patients with rheumatic disease and which carried unexpected risk for disease flare particularly in patients with systemic lupus erythematosus and rheumatoid arthritis. The purpose of the work is to detect the effect of HCQ shortage in patients with RA and SLE on anxiety and disease activity. Results A total of 320 patients were divided into two groups: group 1—216RA patients with mean age 45.5 ± 9.59 years, disease duration 43.4 ± 25.6 months with female predominance (62.5%). Group 2—104 SLE patients with mean33.4 ± 7.9 age years, disease duration 52.1 ± 34.6 months with female predominance (85.6%). HCQ shortage occurred in 174 RA patients (80.5%) and 76 lupus patients (73.1%). Despite HCQ shortage, there were no significant change in disease activity of RA (using CDAI) and SLE (using SELENA) p = 0.063 and 0.064 respectively before and after HCQ shortage. Anxiety level was higher in patients who were exposed to HCQ shortage in both groups (SLE p 0.0058 and RA p 0.0044) when we compared them to those without HCQ shortage. Conclusion In most patients with RA and SLE, the COVID-19 pandemic resulted in a HCQ scarcity, with no effect on disease activity. Anxiety was found to be associated with HCQ shortage in both diseases.

The study aims to measure the influence of financial information systems (FIS) on competitive advantage in organizations listed on the Amman Stock Exchange (ASE). To achieve the objectives of the study, a quantitative approach is used. The study sample adopted in this study is a self-administered questionnaire handled by a study sample of 66 financial managers, internal auditors, information systems managers, and heads of departments in organizations listed on the ASE, categorized by the following competitive advantage variables, including service efficiency, cost flexibility, learning organization, and service variety. The results of the study accept the main hypothesis stating that financial information systems can increase competitive advantage within organizations. In addition, the results show that the service efficiency and learning organization variables have a positive and strong relationship with FIS and are highly influenced by it on the one hand. On the other hand, service variety has a medium relationship, while cost flexibility has a weak and positive relationship. The study recommends focusing on training programs that support employees’ skills in using the financial information systems in all their forms, in line with continuing technological developments and activating creativity in the organization in all its forms to achieve competitive advantage.

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Background Systemic sclerosis is characterized by extracellular matrix overproduction by activated fibroblasts. It was reported that microRNAs (miRNAs) participate in the regulation of processes that drive fibrosis, which include transforming growth factor-beta (TGF-β) signaling, fibroblast proliferation, differentiation, and deposition of extracellular matrix proteins. Objective To detect whether miRNA-21, miRNA-29b, miRNA-92, and miRNA-129, and TGF-β are considered as biomarkers for systemic sclerosis. Patients and methods The current study was a case–control study carried out on 80 Egyptian adults. Of the participants, 30 were apparently healthy controls, while the other 50 patients were classified into 58% with limited skin type, 26% with diffused skin type while 16% of the patients were with unclassified systemic sclerosis. miRNAs were quantitated by real-time PCR while TGF-β was measured by the ELISA technique. Results The results showed that the fold change level of miRNA-21 and miRNA-92 were upregulated compared with the control group with a P value of 0.001 each. Meanwhile, the fold change levels of miRNA-29b and miRNA-129 were downregulated compared with the control group (P=0.001, 0.048), respectively. The present study showed that the mean value of the serum level of TGF-β was 145.0±42.84 pg/ml compared with the control group 23.42±5.79 pg/ml with a P value of 0.001. There was a statistically significant negative correlation between miRNA-29 and TGF-β (r=−0.31, P=0.05) among cases. The cutoff points of miRNA-21, miRNA-29b, miRNA −92, and miRNA −129 were 2.45, 0.49, 5.38, and 0.55 fold changes. While for TGF-β, the cutoff point was 120 pg/ml. For miRNA-21, miRNA-29b, miRNA-92, and miRNA-129 sensitivities were 70.5, 41.1, 54.5, and 73.5%, respectively, and 70.5% for TGF-β. Specificity was 100% for all except 98% for miRNA-29b and 99% for miRNA-129. There was no significant relation of all these markers regarding the extent of skin involvement or duration of disease. Conclusion It was concluded that miRNA-21, miRNA-29b, miRNA-92, and miRNA-129 as well as TGF-β can be considered as biomarkers for the diagnosis of systemic sclerosis.

Abstract Background Thrombotic consequences have been reported in COVID-19-infected patients, especially those who are critically ill. Multiple studies have tested antiphospholipid antibodies (aPLs) among COVID-19 patients, but to date, the actual frequency of aPLs is still uncharted. In this cohort study, we analyzed the outcomes of 173 consecutive patients with confirmed COVID-19 infection. Anti-phospholipid antibodies, which include anti-cardiolipin antibodies [aCL (IgM), aCL (IgG)], and B2-glycoprotein I antibodies [aβ2GPI (IgM), aβ2GPI (IgG)] were detected by using immunoassays. In contrast, lupus anti-coagulant (LAC) antibodies are identified through a coagulation-based assay. Results The study demonstrated a high incidence of thrombotic consequences in severe COVID pneumonia cases and supported an increased risk of developing aPLs following COVID-19 infection. Pulmonary embolism had the most common prevalence of all thrombotic events. Among the various aPLs tested in thrombotic patients, lupus anti-coagulant (LAC) had the highest positivity (46.2%). Most patients with arterial thromboembolism (stroke, myocardial infarction, limb ischemia, bowel ischemia, and renal artery thrombosis) had triple positivity of anti-phospholipid antibodies. Testing aPLs antibodies after 12 weeks of recovery for survived patients only 2 out of 23 patients had aPLs positivity compared to 35 out of 65 tested during hospital admission. Furthermore, we found no significant changes in aPLs positivity between survived and non-survived patients with thrombotic event. Conclusions aPLs increased transiently as an inflammatory-mediated condition. Individuals with aPLs triple positivity (positive LAC, aCL, and aB2GPI) had a considerable risk of arterial thromboembolism (ATE).

This study is aimed to shed light on the electronic absorption and emission spectra of DBDMA (2-(1-(difluoroboraneyl)-1,2-dihydroquinolin-2-yl)-2-(1-methylquinoxalin-2-ylidene) acetonitrile) in different solvents. Both types of spectra were obtained theoretically and produced experimentally in different solvents. The photostability of dye was tested, and its energy transfer behavior in the presence of oxygen and hydrated copper sulfate quenchers was investigated. We also gave a qualitative estimation of the effect of acidic media on the absorption and emission spectra. There is good compatibility between the calculated and measured values of many photophysical parameters. DBDMA has a low chemical quantum yield in solvents of different polarities, and the fluorescence quantum yield is high enough, which confirms, together with the low values of the excited state lifetime, its efficiency as laser emitting dye in the range of wavelength emission maxima. The rigidity of the DBDMA molecule is the main reason for the photochemical stability and the absence of a considerable shift as a result of the change in the polarity of the solvents. Geometries of ground and excited states were optimized using the density functional theory (DFT) and the time-dependent density functional theory (TD-DFT), respectively. Upon using the TD-DFT method, the UV-Vis absorption and emission spectra of the DBDMA molecule in different solvents were illustrated. A slight change is observed in the position of the maximum emission and absorption wavelength with the change of the solvent due to the rigidity of the compound. There was no apparent effect of quenching by oxygen. Besides, no intersystem crossing (ISC) was observed for the excited state of the DBDMA as a result of aeration of a solution with O2 for 20 min, which was an explanation of the stability of peak emission intensity of dye after exposure to oxygen gas. The energy transfer rate constant has been calculated as well.

Heritage is one of the main pillars of tourism development, it a mean of spreading cultures among countries. tourism in Jordan is the most important activity that promotes prosperity.. The research aims to study aesthetic values in the heritage elements expressing Jordan's heritage identity and employ it in the interior design of tourist facilities, also, it aimed to create a special character for interior design emanating from the surrounding environment; Hence, the importance of research is in analyzing the design elements of Jordanian heritage and reviving its design lines in a new and contemporary style to employ them in interior design. The research went to study and analyze the heritage elements and reduce new design lines that can be employed in interior design supporting the aesthetic values of the place. The results of this research founded a design vision to employ Jordanian heritage in interior design in the hotel reception area, The researcher submitted a proposal to design a hotel reception area, which employed design lines inspired by Jordanian heritage in “a reduced style” to suit contemporary life and achieve the functional and aesthetic aspects in tourist facilities, thus, the research draw a vision of the design style of heritage elements in the design of tourist facilities with heritage identity through two main directions: first: studying heritage elements and analyzing its design lines and forming them in a new way, second: studying the engineering design of the interior vacuum and furniture to achieve functional and aesthetic standards.

The integer simulation and development finite impulse response (FIR) filters taking into account the possibilities of their realization on digital integer platforms are considered. The problem statement and solution of multifunctional synthesis of digital FIR filters such a problem on the basis of the numerical methods of integer nonlinear mathematical programming are given. As an several examples, the problem solution of synthesis FIR-filters with short coefficient word length has been given. The analysis of their characteristics is resulted. The paper discusses issues of modeling and synthesis of digital FIR filters with provision for the possibilities of their implementation on digital platforms with integer computation arithmetic. The formulation of the problem of multifunctional synthesis of cascade FIR filters using the methods of integer nonlinear mathematical programming is given. The efficiency of this approach is illustrated by examples of solving the problems of synthesizing integer FIR filters with a minimum coefficient word length. The analysis of the synthesized filter characteristics is made.

This paper aimed to look into the relationship between working capital management and industrial firms’ profitability listed on the Amman Stock Exchange (ASE) from 2014 to 2020. The data incorporated into the yearly statements of 23 listed industrial firms have been collated to investigate the developed model. In order to examine the data, pannel data procedure employed 161 observation. The empirical findings indicate that the working capital negatively influences the profitability of industrial companies in Jordan. Existing and potential financiers and stakeholders are incentivized to purchase more shares of quick conversion cash firms. More importantly, the study’s findings provide practitioners with crucial financial insights and policy consequences. The combination is an important component that has directly and indirectly affected the financial status of the firm, which will eventually be reflected in its value. Current and potential investors shall evaluate the companies’ total financial position rather than focusing on minor issues, such as payment days. This study contributes to the existing literature on the relationship between WCM and profitability of emerging market, and it’s one of the few studies that investigate the elements of CCC individually and aggregated.

Background: Lidocaine is a widely known drug used as a topical and local anesthetic and can be used as an antiarrhythmic drug. Lidocaine is relatively more neurotoxic compared to other local anesthetics especially if applied in high concentrations directly to vascular or neural compartments. Many cases were reported with fatal lidocaine toxicity after injection, but lidocaine toxicity due to the topical application or oral ingestion is uncommon. Cases: Two cases of fatal lidocaine intoxication were presented to our center. The first case was a male with a history of multiple drug abuse who suffered from generalized seizures followed by cardiopulmonary arrest after oral ingestion of lidocaine spray. The second case was a female who suffered from generalized seizures followed by cardiopulmonary arrest during committing criminal abortion with the unknown route of administration of lidocaine which was discovered by toxicological analysis. A full autopsy was done in both cases and specimens were taken from both cadavers for both toxicological analysis and histopathological examination. Both autopsy findings and histopathological examination revealed non-specific results, but toxicological examination revealed toxic levels in all specimens. Conclusion: Although the rarity of non-iatrogenic lidocaine intoxication, it should be suspected as the cause of death if victims suffered from seizures during suspicious circumstantial evidence.