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Abstract Pancreatic cancer, a highly fatal malignancy, has shown a global rise in the incidence and mortality rates. However, these rates vary significantly across different regions worldwide. This study aims to assess the incidence and mortality of pancreatic cancer in Saudi Arabia. We collected the data from 16 annual cancer incidence reports in Saudi Arabia for the study period (2005–2020) and from the WHO's IARC Global Cancer Observatory website. Although the burden of pancreatic cancer in Saudi Arabia is relatively lower compared to global rates, the disease incidence has shown a steady increase over the study period, in addition to regional variations within the country. The disease predominantly affects the elderly population, aged 50 years and above in both genders, with males exhibiting higher rates than females. Further studies are required to identify the potential risk factors for pancreatic cancer in the Saudi population.

Background: COVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting. Methods: A retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality. Results: A total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs. Conclusions: COVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type.

Purpose: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. Materials and Methods: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. Results: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). Conclusions: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial.

Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method.Results: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions: This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.

Background and Objectives: The frequency of multidrug-resistant Klebsiella pneumoniae (MDRKP) has dramatically increased worldwide in recent decades, posing an urgent threat to public health. The aim of this study was to assess the extent of K. pneumoniae in the Aseer region and explore the corresponding antimicrobial resistance profile over the last ten years. Materials and Methods: A record-based retrospective study was conducted in a tertiary hospital during the period of 2013 to 2022. The study targeted laboratory samples taken from patients admitted to the hospital and sent for K. pneumoniae culturing. We included only samples taken from the patient and confirmed by the lab. Data were extracted using a pre-structured data extraction sheet to avoid data-collection bias and confirm the inter-rater precision. Statistical Package for Social Sciences (SPSS) version 26 was employed for statistical analysis. All relationships were tested using Pearson X2 test for categorical data or chi-square for linear trend for resistance rate over years. Results: We obtained 3921 samples of isolated K. pneumoniae out of 28,420 bacterial samples. The isolation rate began at 11.3% in 2013, decreased to 6.1% in 2016, and then increased to a peak of 16.3% in 2021, before slightly decreasing to 12.8% in 2022. In total, 23.7% of K. pneumoniae samples were identified in urine samples, 19% in sputum samples, 14% in wound samples, and 11.7% in blood samples. The overall antibiotic resistance rate of K. pneumoniae from 2013 to 2022 showed a significant increase, particularly during 2020 and 2021, before decreasing again in 2022. The resistance rate decreased from 22.2% in 2013 to 18.6% in 2016 and increased to 54.6% and 56.4% during 2020 and 2021, respectively (p = 0.039). Conclusions: We observed a significant shift in K. pneumoniae resistance for some antibiotics during the study period, highlighting the urgent need for enhanced antimicrobial stewardship and infection-control measures.

Cell-free massive multiple-input multiple-output (CF-MIMO) system has been considered a promising technology for 5G and 6G networks for its ability to handle the rise in demand effectively. With CF-MIMO, improved energy efficiency can be obtained from straightforward signal processing. One of the potential problems in CF-MIMO systems is high power consumption due to the large numbers of distributed Access Points (APs), which decrease energy efficiency. This research proposes a modified algorithm to improve overall energy efficiency by reducing total power consumption via using the APs selection technique while maintaining the system's sum of rate. The technique used for APs selection is the largest large-scale-based selection, where each user is served by a subset of APs that offer the best channel condition rather than by all of APs. Total energy efficiency has been calculated for three cases: without APs selection, fixed APs selection, and dynamic APs selection (proposed approach). The simulation result shows that the proposed approach significantly improves energy efficiency by 45% at the signal-to-noise ratio (SNR) equal to 6 dB than the case where the selection of APs is fixed due to the optimal APs selection for each user.

In the setting of healthcare, the use of hand sanitizers and antiseptics for hand hygiene is of paramount importance to avoid transfer of pathogenic microorganism through hand and skin contact. There is an increasing interest in the incorporation of essential oils in hand sanitizer’s formula to avoid the adverse effect of conventional hand sanitizers on health. This study aimed to detect the chemical constituents of citrus peel essential oils and study their antimicrobial activity compared with commercial hand sanitizers. The qualitative and quantitative analysis of the hydrodistillated essential oils of peels of grapefruit (Citrus paradisi), lime (Citrus aurantifolia), and orange (Citrus sinensis) were carried out using gas chromatography mass spectroscopy. The disc diffusion method was used to screen the antibacterial activity of the essential oils against Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis, Staphylococcus aureus, and Candida albicans compared with a 78% alcohol-based commercial hand sanitizer. The antimicrobial testing results were statistically analyzed. The highest yield percentage of the obtained essential oils was 1.09% obtained by orange oil. The GC-MS analysis indicated that monoterpene and sesquiterpene hydrocarbons occupied the largest portion of the chemical composition of the three essential oils with D-limonene as the most predominant component. All essential oils showed activity against all tested organisms. Lime essential oil showed comparable antimicrobial activity relative to the commercial 78% alcohol hand sanitizer. In conclusion, essential oils obtained from citrus fruit peel represent a rich source of compounds possessing antimicrobial properties and could be an alternative to synthetic antimicrobial agents.

The method of internal distillation (in situ retorting) and internal treatment for extracting shale oil is one of the modern methods developed with good economic quality but at a higher cost. Therefore, the net of fossil oil can be considered alternative energy. Hydrocarbon-rich hydrogen turns into oily shale, which distills by heat and turns into gases and petroleum liquids suitable for use as fuel. The fumes from burning oil shale are considered cancer-causing, so advanced treatment is required before extraction. As the temperature increases, the speed of oil extraction increases dramatically, but at 510°C, the production rate begins to decline. Oil extraction produces more than gas; the highest production peak is around 550 h. The permeability is closely proportional to the oil producers, and the permeability is inversely proportional to the highest temperature in the case of high heat through the combustion of coal with oxygen internally. The type of oil shale is affected by the surrounding environment and the temperature of the earth’s crust.

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.

BACKGROUND: Lymphoma is a cancer of the lymphatic system with two main types, namely Hodgkin lymphoma (HL) and non-HL (NHL). Within these, there are many subtypes. Based on data from the National Cancer Institute, NHL accounts for 4.2% whereas HL accounts for 0.5% of all cancers in the United States. The treatment strategy depends on the type and the stage of the lymphoma. In this study, we are studying the incidence rate of lymphoma in a military-nononcology center for better understanding and recording of the condition. METHODS: We conducted an observational, analytical, retrospective study in a tertiary care hospital on 56 patients admitted to the hospital between January 2016 and the end of December 2021, with lymphadenopathy or body mass, who were diagnosed with lymphoma. The modality of diagnosis was tissue histopathology. All data including demographics, details of lymphoma lesions, and laboratory and histopathology results were obtained from health informatics or manual records. RESULTS: In this study, we found that 67.9% of the cases were male, with a significantly higher rate among Saudi patients in comparison to non-Saudi (94.6% and 5.3%, respectively). Among Saudi cases, we found that a significantly higher percentage of lymphoma cases were originally from the Eastern and the Southern provinces (47.1% and 35.8%, respectively), and 46.5% of them were living in Dammam at the time of diagnosis. The percentage of NHL was significantly higher than Hodgkin type (80.3% and 19.6%, respectively). The majority of the cases belonged to B-cell NHL (73.2%). Moreover, the incidence rate increased from 2016 to 2021 with an accumulative rate of 25.14 / 100,000 person-years. CONCLUSION: Our data indicate that the incidence rate of lymphoma increased in the last 5 years at a tertiary care center. We found evidence for associations between the original province and the rate of the lymphoma. Moreover, the rate of B-cell NHL was significantly higher with superior mortality rate in comparison to other types of lymphoma in our cohort, which supported previous studies in the Kingdom of Saudi Arabia. There was no increase in incidence of lymphoma in our study cohort of military personnel, and it matches the incidence data of other local studies. Further national studies and initiation of lymphoma registry may add a value for future researches.

There have been no nationwide studies of patient opinions regarding telehealth in Saudi Arabia to identify the factors that might influence patients’ perceptions and satisfaction. This was a prospective cross-sectional study of adults in the general population who last engaged with a healthcare practitioner via a virtual appointment. The participants were recruited by convenience sampling across Saudi Arabia between November 2023 and January 2024, completing a questionnaire that gathered data on (i) basic demographic and virtual consultation information and (ii) telehealth service delivery and technology based on the Telehealth Usability Questionnaire. Of the 916 participants, 53.7% were female, with a mean age of 47.2 (14.1) years. Nearly half attended primary care appointments, with the remainder attending a range of hospital specialties. Over 90% preferred having a virtual appointment over an in-person visit. About half had telephone consultations, while about a third had video calls through hospital-provided platforms; >90% found virtual appointments useful and convenient, easy to use, effective, reliable, and produced a favorable clinical interaction; and 97.4% were satisfied with their remote consultation experience despite the technical interruptions. The individuals who were less happy with their virtual consultation were significantly younger, lived in urban areas, attended specialty clinics, were seen by a psychologist, preferred in-person appointments, and had consultations by telephone. These data provide momentum to continue with and expand telehealth, especially through video calls, supported by educational initiatives.

(1) Background: Bone bruises in acute anterior cruciate ligament (ACL) injuries are closely linked to the occurrence of simultaneous meniscal and cartilage damage. Despite the frequent occurrence of associated injuries including bone bruises, meniscus, and cartilage damage in patients with ACL injuries, a systematic review of the relationships between the presence of bone bruises and the extent of meniscus and cartilage injuries has yet to be conducted. (2) Methods: Multiple comprehensive databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched for studies that evaluated the relationship between bone bruises and meniscus or cartilage injuries following ACL injuries. Study selection, data extraction, and meta-analysis were performed. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessments, and Review Manager 5.3 was used for data analysis. (3) Results: Data were extracted from 22 studies encompassing a total of 2891 patients with ACL injuries. Among the included studies, six studies investigated the relationships between bone bruises and medial meniscus (MM) or lateral meniscus (LM) injuries, while three studies investigated the relationships between bone bruises and cartilage injuries. There were no significant correlations between the presence of bone bruises and MM injuries (relative risk (RR) = 1.32; p = 0.61). A quantitative analysis indicated that individuals with bone bruises had a 2.71-fold higher likelihood of sustaining LM injuries than those without bone bruises (RR = 2.71; p = 0.0003). The analysis confirmed a significant relationship between bone bruises and cartilage injuries (RR = 6.18; p = 0.003). (4) Conclusions: Bone bruises occur most frequently in the lateral compartment. Bone bruises resulting from ACL injuries are related to accompanying LM injuries and cartilage injuries. Knowing these associations and the frequency of injuries may allow orthopedic surgeons to promptly address ACL-related meniscus and cartilage injuries on MRI results and in future clinical practice.

(1) Background: The purpose of this systematic review was to determine the prevalence of bone bruises in patients with anterior cruciate ligament (ACL) injuries and the location of the bruises relative to the tibia and femur. Understanding the relative positions of these bone bruises could enhance our comprehension of the knee loading patterns that occur during an ACL injury. (2) Methods: The MEDLINE, EMBASE, and the Cochrane Library databases were searched for studies that evaluated the presence of bone bruises following ACL injuries. Study selection, data extraction, and a systematic review were performed. (3) Results: Bone bruises were observed in 3207 cases (82.8%) at the lateral tibia plateau (LTP), 1608 cases (41.5%) at the medial tibia plateau (MTP), 2765 cases (71.4%) at the lateral femoral condyle (LFC), and 1257 cases (32.4%) at the medial femoral condyle (MFC). Of the 30 studies, 11 were able to assess the anterior to posterior direction. The posterior LTP and center LFC were the most common areas of bone bruises. Among the 30 studies, 14 documented bone bruises across all four sites (LTP, MTP, LFC, and MFC). The most common pattern was bone bruises appearing at the LTP and LFC. (4) Conclusions: The most frequently observed pattern of bone bruises was restricted to the lateral aspects of both the tibia and femur. In cases where bone bruises were present on both the lateral and medial sides, those on the lateral side exhibited greater severity. The positioning of bone bruises along the front–back axis indicated a forward shift of the tibia in relation to the femur during ACL injuries.

Abstract Background In revision surgery with significant segmental acetabular defects, adequate implant selection and fixation methods are critical in determining successful bony ingrowth. Commercially available total hip prosthesis manufacturers generally offer additional multi-hole options of acetabular shells with identical designs for use in revision THAs where screw holes configurations vary from product to product. This study aims to compare the mechanical stability of the two types of acetabular screw constructs for the fixation of acetabular components: spread-out and pelvic brim-focused configurations. Methods We prepared 40 synthetic bone models of the male pelvis. In half of the samples with acetabular defects, identical curvilinear bone defects were manually created using an oscillating electrical saw. On the right side, multi-hole-cups in which the direction of the screw holes are centered on the pelvic brim (brim-focused) and, on the left side, multi-hole-cups with the direction of the screw hole spread throughout the acetabulum (spread-out) were implanted into the pelvic synthetic bones. Coronal lever-out and axial torsion tests were performed with a testing machine, measuring load versus displacement. Results The average torsional strengths were significantly higher in the spread-out group over the brim-focused group regardless of the presence of the segmental defect of the acetabulum (p

Osteoid osteoma is a common benign primary bone tumor, but it is very uncommon in the proximal humerus. This case report describes the clinical course and treatment of a patient with shoulder pain and osteoid osteoma of the proximal humerus and provides a review of the literature. A 22-year-old healthy male patient presented to our clinic with a 2-year history of constant throbbing right shoulder pain. The patient was referred for orthopedic consultation. A series of plain radiographs, bone scintigraphy, and a magnetic resonance imaging were done and revealed an osseous lesion at the medial aspect of the proximal meta diaphyseal region of the right proximal humerus, with a diagnosis of osteoid osteoma. The patient underwent radiofrequency ablation of the tumor nidus, which was successful and resulted in resolution of symptoms with minimal pain at follow up. This case demonstrates that osteoid osteoma can present with clinical features that mimic various causes for shoulder pain.

Utilizing blockchain technology for different applications has seen a growing interest in recent years. Academic institutions can consider implementing a student information system (SIS) based on blockchain technology as a promising area. This research paper explores in detail the design and execution aspects of an SIS powered by blockchain technology implemented through ASP.net, C#, Ethereum, Solidity, Ganache and IPFS. The main goal of the proposed system is to tackle important problems concerning data security and accessibility in conventional paper-based or centralized systems. In the proposed SIS system based on blockchain technology there are five distinct user categories: students, stage managers, department managers, college managers, and super administrators. Every user possesses specific functionalities like accessing grades, attendance, subjects, schedules, and profiles. Data integrity and privacy are ensured by the system's design using cryptographic techniques and smart contracts implemented in Solidity. The paper also addresses the technical implementation aspects, involving using ASP.net and C# to develop both the user interface and backend logic. To store decentralized data, the Ethereum blockchain is utilized. The proposed system is evaluated through a series of experiments and performance tests. The assessment of the blockchain-based SIS includes evaluating its efficiency, security, and usability through these tests. The paper highlights the effectiveness of the system in enhancing data security, accessibility, and transparency by providing detailed results and findings.

The primary objective of this study is to identify and optimize the critical variables that influence the operational effectiveness of warehouses. This study adds to previous research by providing a deeper understanding of how these factors affect operational effectiveness. Specifically, it is found that insufficient workforce numbers have a negative effect on operational performance and increase expenses. These findings contribute to the existing body of knowledge and emphasize the importance of considering these variables when optimizing warehouse operations, thereby increasing productivity and efficiency. SPSS is used as the analysis tool to examine the relationships between Warehouse Operations Efficiency (WOE) and various parameters. The findings demonstrate strong positive relationships between all of the variables. These findings demonstrate the importance of warehouse optimization in boosting productivity and efficiency. Aspects that affect operational efficiency include staffing levels, personnel skill sets, communication throughout the supply chain network, material handling technology, and inventory management systems. The report also discusses warehouse layout issues, such as inefficient picking metrics, unnecessary motions, safety and security concerns, dead-end aisles, and inadequate overflow space. The study also identifies supply chain visibility obstacles, limited resources, and resistance to technological advancements as obstacles to achieving warehouse operating efficiency.