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The pathobiology and classification of pulmonary edoema are more complex than the previous dichotomy of hydrostatic vs. permeability. The mechanisms of alveolar fluid clearance and the factors that influence the clearance rate are being studied thoroughly in order to develop therapeutic strategies. Patients require early oxygenation and ventilation stabilization, preferably with high-flow nasal cannula oxygen or noninvasive ventilation, while the diagnostic cause is quickly sought with echocardiography and other testing. Treatments must begin as soon as possible while evaluation continues and requires multimodal intervention. Diuretics, possibly morphine, and frequently nitrates, are used to treat cardiogenic pulmonary edema. This review summarizes current knowledge of the pathophysiology, causes, and treatment of cardiogenic pulmonary edema.

Ovarian torsion is among the gynecological life-threatening conditions that may require urgent surgical intervention among the appearance of clinical manifestations. The most common clinical manifestations include severe abdominal pain, nausea extending to vomiting. The ovarian torsion is not limited to children only. However, it can also occur in adult females, either pregnant or non-pregnant. The etiology of the disease tends to be related to the weakness of the uterine ligaments or malpositioning of it due to known and unknown causes. Despite that, the surgical intervention is needed to release the torsion. Sometimes, it can lead to adverse events or side effects such as decreased blood flow to the surrounding structures. Which by role may lead to unpleasant complications and clinical manifestations of hemorrhage and shock. In this article, we reviewed the topic of ovarian torsion from different aspects, including the definition, causes, clinical evaluation, and clinical management and its common complications.

Over 80% of strokes are caused by ischemic brain injury caused by a sudden decrease in blood supply. Large artery blockage occurs in 25-35% of strokes, and patients in this category frequently have severe neurological impairments.We conducted a narrative review due to 2021 for all relevant studies that were shown in one of the electrical databases such as; Medline. Recent advancements in stroke imaging enable near-real-time knowledge on several aspects of stroke pathology. The primary function of imaging is to rule out cerebral hemorrhage, characterize the ischemic zone, differentiate between infarct core and penumbra, and portray vascular health. CT and MRI are both reliable imaging modalities, each with their own set of advantages and disadvantages. Although CT is more readily available, MRI provides more information and is more sensitive to tiny infarctions.

Introduction: The exhaustion of healthcare resources due to the rising prevalence in Saudi Arabia mandates the search for each method that can help in better control of diabetes. Methods: The gathered task force gath-ered to develop an explicit, evidence-based consensus for the use of time-in-range targets as guidance for better glycemic control while using continuous glucose monitoring (CGM). This article has the recommenda-tions of this expert panel. Results: HbA1c and self-monitoring blood glu-cose (SMBG) are not enough to detect blood glucose (BG) fluctuations on a daily basis. The incorporation of technology like FreeStyle Libre with its applications like Libre View is now used in many institutes in Saudi Ara-bia. This system is comprehensive and has all the standardized metrics needed. However, training and support are always needed. Barriers and challenges include the awareness & experience of the technology, the time barrier, the patients’ barriers, the technical barriers, and of course, the availability barrier. All the barriers and challenges should be dealt with by designing new training programs. Conclusion: The expert panel recom-mended using CGMs technology in people with type 1 diabetes (T1DM) children and adults, type 2 diabetes (T2DM) on multiple insulin injections, gestational diabetes (GDM) who need further glycemic control, and those at high risk for hypoglycemia. In addition, we recommend using them for a short period for those who require intensive BG control or during acute illness or stress. In addition, Ambulatory Glucose Profile (AGP) could be used as an educational tool for any individuals with DM to study the im-pact of certain elements of lifestyle modifications on their immediate BG level.

A technical challenge of interfacing electric vehicles (EVs) to the grid is in the design of the LC or LCL filter. The filter must have the capability to meet both the EV automotive requirements and the distribution grid requirements such as current ripple and steady state error. Furthermore, the filter design must accommodate bidirectional energy flow and should be re-configurable for various grid types such as single-phase, three-phase, and three-phase four-wire grid systems. All these stringent requirements along with the fact that the input filter of the EV occupies 30% of the (onboard charger) OBC size, lead to a very difficult bottleneck to minimize the power density and cost. This paper proposes an adaptive gain tuning to allow using a powdered-core inductor that has a smaller size than its ferrite core counterpart. The main difference of the powdered core is that its inductance reduces linearly with the current passing through it, while ferrite cores inductance remains constant until it reaches the knee point where the inductance decreases sharply. The proposed adaptive gain tuning shows that the controller requirements can be met with the inductance value uncertainty and linearly changing core inductance.

The increasing trend in integrating intermittent distributed energy resources (DERs) into AC microgrids presents operational challenges in stability and protection. In islanded microgrids with power electronic interfaces, protection poses a major challenge due to the level of short circuit currents resulting from inverter output capabilities. However, traditional protection schemes that are utilized in distribution systems are no longer appropriate to protect the microgrid in the presence of different levels of fault currents This paper develops an integrated control and protection framework based on state observer and fault current limiter (FCL) devices. A single state observer has been developed to detect and identify the faults that occur within multiple protection zones. In addition, controlled switches, consisting of FCLs have been utilized to limit the fault currents and provide rapid switching during the faults. An adaptive integration proposed in this paper has been applied to islanded microgrid configuration and is demonstrated to be an effective means to protect the system and maintain the voltage and frequency within acceptable range with the capability of power continuity during both transient and persistent faults.

Background Dural closure is a routine surgical step in neurosurgery. The benefit of suturing the dura to achieve watertight closure—with or without the use of dural substitutes—has been questioned in supratentorial craniotomy. We performed a retrospective study to examine the possible benefits and harms of suturing the dura compared with no dural closure and the occurrence of postoperative infection, cerebrospinal fluid (CSF) leak, and postcraniotomy headaches. Methods We performed a retrospective study to compare the incidence of CSF leak, infection, surgical site swelling, and postcraniotomy headaches between patients with watertight dural closure (closed group) and patients without watertight dural closure (open group). Any method used to close the dura and to achieve watertight closure was included, whether primary or secondary closure (with or without using suturable dural substitute). Results Overall, 216 patients were included in the present study, with 112 patients in the open group and 114 in the closed group. The open group experienced a greater incidence of infection and CSF leak (6 in the open group vs. 2 in the closed group), but without statistical significance (P = 0.15). We found no difference in surgical site swelling (P = 0.29). However, the closed group showed a greater association with the development of postcraniotomy headaches (P = 0.001). Conclusion We found no difference in the occurrence of CSF leak, infection, or surgical site swelling between the closed and open groups. The incidence of postcraniotomy headaches was greater in the closed group, and the difference was statistically significant.

BDNF (brain-derived neurotrophic factor) has a tremendous effect on GABAergic synaptic transmission in the developing and adult central nervous system. Paired pulse stimuli are the common way to observe the paired-pulse ratio (PPR) that is the indicator of presynaptic transmission. During paired-pulse stimuli, the second response might be larger or smaller than the first one. To investigate BDFN induced presynaptic signal in the inhibitory neuron of the visual cortex, we used whole-cell patch-clamp recordings from the pyramidal neurons of mice visual cortex and studied signals evoked by paired-pulse stimuli. A total of seven mice brain slices were prepared for this study. AP5 and NBQX were added in artificial cerebrospinal fluid (aCSF) to block NMDA and non-NMDA receptors, respectively. Three levels of BDNF concentrations were used to see the effect of BDNF on GABAergic synaptic release; 0 ng/ml, 20 ng/ml, and 100 ng/ml of BDNF concentrations. Inhibitory postsynaptic currents as IPSC1 and IPSC2 were recorded after paired-pulse stimuli in the pyramidal neurons during all three conditions. PPR was measured as IPSC2/IPSC1. PPRs were compared among groups to see the significant differences. There were no significant differences between 0 ng/ml vs 20 ng/ml, 0 ng/ml vs 100 ng/ml and 20 ng/ml vs 100 ng/ml of BDNF concentrations. However, there was a tendency of reducing PPR during 20 & 100 ng/ml of BDNF concentration compare to 0 ng/ml might indicate diminished presynaptic transmitter releases. These results may suggest that BDNF has no activity-independent effect on the PPR of transmitter release at visual cortical inhibitory synapses.

Abdulrahman K Alkhaldi,1 Hamad Alshiddi,2 Mansour Aljubair,3 Saad Alzahrani,4 Adel Alkhaldi,5 Khalifa S Al-khalifa,6 Balgis Gaffar6 1Ministry of Health, Tabuk, Kingdom of Saudi Arabia; 2Majal Dental Center, Alkhobar, Kingdom of Saudi Arabia; 3Ministry of Health, Dammam, Kingdom of Saudi Arabia; 4RAM Dental Clinics, Dammam, Kingdom of Saudi Arabia; 5College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia; 6Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi ArabiaCorrespondence: Balgis GaffarDepartment of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam Costal Street, – B.O Box 1982, Dammam, 31441, Saudi ArabiaTel +966542269941Email bgosman@iau.edu.saBackground and Purpose: Adolescence is a crucial period for developing healthy lifestyle and dietary habits. The growing consumption of high-sugar foods and beverages constitutes a serious public health concern. The aim of this study was to evaluate sex differences in the consumption of a sugary diet and oral health among Saudi adolescents.Subjects and Methods: This cross-sectional study was conducted in the Eastern Province of the Kingdom of Saudi Arabia between January and February 2019. A multistage sampling technique was used to recruit 2265 middle-school children aged 12– 16 years. Data were collected via the Food Frequency Questionnaire and via an oral health examination, using the WHO criteria. The chi-squared test, Student’s t-test, and Mann–Whitney U-test were used to investigate the associations between the study variables.Results: The most consumed foods and beverages reported were water, juices, and biscuits (90%), while the least consumed were energy drinks and jams. A significant difference was found between males and females in the frequency of consumed sugary foods (P=0.01) and the quantity of consumed sugary beverages (P=0.000); males over all consumption were greater than their counterpart. However, no differences were found between sexes in the frequency of sugary drink consumption (P=0.2). The decayed–missing–filled index score was significantly higher in females (4.29 ± 3.44) than in males (3.61 ± 3.14; P=0.001). The mean plaque index among males and females was 1.72 (± 0.79) and 1.20 (± 0.78), respectively, while the mean gingival index was 1.31 (± 0.77) in males and 0.69 (± 0.73) in females—a statistically significant difference (P=0.001).Conclusion: Sex differences were found in sugary diet consumption and oral health status. Thus, policy makers are encouraged to consider sex-based differences when planning preventative programs and initiatives. Nevertheless, further research is needed on the dietary intake patterns of young adults.Keywords: adolescents, caries, sex, oral hygiene, sugar intake

Background: Glucose variability (GV) is a common and challenging clinical entity in the management of people with type 1 diabetes (T1DM). The magnitude of GV in Saudi people with T1DM was not addressed before. Therefore, we aimed to study GV in a consecutive cohort of Saudis with T1DM. Methods: We prospectively assessed interstitial glucose using FreeStyle® Libre flash glucose monitoring in people with TIDM who attended follow-up in the diabetes clinics at King Fahad Medical City between March and June 2017. Glycemia profile, standard deviation (SD), coefficient of variation (CV), mean of daily differences (MODD), and mean amplitude of glucose excursion (MAGE) were measured using the standard equations over a period of 2 weeks. Results: Fifty T1DM subjects (20 males) with mean age 20.2 ± 6.1 years and mean fortnight glucose 192 ± 42.3 mg/dl were included. The mean SD of 2-week glucose readings was 100.4 ± 36.3 mg/dl and CV was 52.1% ± 13%. Higher levels of glucose excursions were also observed. MODD and MAGE were recorded as 104.5 ± 51.7 and 189 ± 54.9 mg/dl, respectively which is 2 to 4 times higher than the international standards. Higher MODD and MAGE were observed on weekends compared to weekdays (111.3 ± 62.1 vs 98.6 ± 56.2 mg/dl and 196.4 ± 64.6 vs 181.7 ± 52.4 mg/dl, respectively; P ⩽ .001). Conclusion: Higher degree of glycemic variability was observed in this cohort of TIDM Saudis. Weekends were associated with higher glucose swings than weekdays. More studies are needed to explore these findings further.

Although the deployment of renewable energy sources (RES) alleviates several concerns related to energy, natural resources, and climate change, their lack of rotational kinetic energy is a key challenge to the stability and resilience of future power grids. Energy storage systems (ESS) hold the potential to compensate for this lack of rotational kinetic energy with virtual inertia—such a system is called a virtual synchronous generator (VSG). Determining optimal sizes of VSGs is a key factor to develop strategies that efficiently assure the capability of VSGs in maintaining the stability of future power systems. This paper proposes an approach for sizing ESS for grid inertial response in the presence of RES. Time domain simulations are used to determine the minimum inertia required by a power system to maintain its stability. A stochastic method involving Monte Carlo simulation is developed and utilized to determine the low frequency events for a given time period. A stability index is also developed to quantify the probability of occurrence of low inertia events in the system. The ESS is then sized accordingly to compensate for the lost inertia. The proposed method is demonstrated on the reduced Western System Coordinating Council 9-bus test system. The results show that VSG can compensate for the lack of rotational kinetic energy for a wide range of fault clearing times and penetration of RES.

Integration of wind energy into the grid poses serious challenges to the system reliability due to its intermittent nature. Variability of wind can be mitigated using various methods including deployment of energy storage systems (ESS), aggregation of geographically diverse wind, and the use of flexible loads. This paper proposes a novel method for reducing the variability of wind power by both deploying ESS and aggregating geographically diverse wind production. Although the aggregation of geographically diverse wind can reduce its intermittency to some extent, the benefits of this approach are limited due to a number of factors which are discussed in this paper. ESS, on the other hand, have been widely used for variability mitigation of wind and achieving reliability targets. However, ESS projects are expensive. In this context, this paper studies the impact of reliability enhancement of a system and the reduction in storage size by aggregating wind power from geographically diverse wind farms. The proposed approach is validated by performing sequential Monte Carlo simulation (MCS) using the IEEE Reliability Test System data. Results show that aggregation of geographically diverse wind can significantly reduce the size of ESS required for improving the reliability of the system.

Background: Diabetes mellitus (DM) is increasing dramatically throughout the world as the number of affected adults has quadrupled since 1980 to be more than 422 million adults in 2017. Diabetic nephropathy (DNP) is one of the severe complications of DM and the leading cause of end-stage renal disease (ESRD) in the USA, microalbuminuria is considered to be an early stage of diabetic nephropathy. Methodology: A cross-sectional study was conducted in outpatient clinics of the diabetic center in Prince Mansour Military Hospital. Diabetes type 2 patients above the ages of 25 years who attended the clinic between November 2017 to April 2018 were included in this study. Data were collected by questionnaire and reviewing medical records for demographic and disease-related variables. DNP was detected by measuring the albumin to creatinine ratio and diagnosed if this ratio was between 30-299 mcg/mg of creatinine as microalbuminuria and > 300 mcg/mg of creatinine as macroalbuminuria. ESRD was defined as GFR less than 15 mL/min/1.73 m2. Results: The prevalence of DNP was 56 (18.9%) out of 296 patients. A statistically significant correlation was found between DNP and duration of diabetes and hypertension, neuropathy, HbA1c %, serum creatinine and high-density lipoproteins (HDL). No statistical significance was found for gender, age, body mass index (BMI), retinopathy, and smoking. Conclusion: The prevalence of DNP in patients with type 2 diabetes in Taif city was lower compared to most studies in the same population. The study reported the need for screening DNP in Saudi society and importance of patient education about disease management and modifiable risk factors like maintaining good glycemic control, adherence to hypertension treatment which could reduce the burden of future ESRD.

Background: the dyslipidemia and its associated risk factors and co-morbid diseases are the focus of many studies in KSA, however the data regarding the prevalence are very little. Objectives: this study aimed to assess the risk factors of dyslipidemia and its association with the subject’s demographics and life style pattern in Kingdom of Saudi Arabia (KSA). Methods: this was a cross-sectional study based on a check list and questionnaire sheet conducted for 6 months among 840 Saudi adults. Results: about 33%of the subjects were suffered from dyslipidemia after checking their lipid profile and anthropometric measures. The subjects were divided into two groups: group I included dyslipidemic subjects and group II included control subjects. The older age and jobless subjects showed a significant association with the prevalence of dyslipidemia. Group I showed a significant association between dyslipidemia and comorbid conditions than group II. The irregular physical activity, consuming less healthy food and consuming more fast food are significantly related to Group I than group II. Conclusion: dyslipidemia is common among Saudi subjects and associated with health problem as hypertension, diabetes and obesity as well as bad lifestyle habits.

Background: Liver cirrhosis is chronic disease associated with high mortality and morbidity rates all over the world. Objectives: evaluating the knowledge of adult Saudi population toward liver cirrhosis. Methods: A qualitative study was conducted in Kingdom of Saudi Arabia among 820 Saudi subjects during the period from October to December 2017. Results: A total of 820 subjects were enrolled in the study. All the subjects had good knowledge regarding the definition of liver cirrhosis. The majority of subjects had moderate knowledge regarding the causes, prognosis and treatment of liver cirrhosis. More than half of the subjects (54%) had good knowledge regarding liver cirrhosis while 46% had poor knowledge. There was a positive significant association between younger age and high-level education with good awareness about cirrhosis of liver Conclusion: The level of awareness among Saudi population toward LC was moderate which necessitates encouraging the educational campaigns on T.V, internet and all over the whole parts of KSA.

Psychopathological morbidities represent a significant burden over the different sectors of populations exposed to the different crises. Many factors can contribute to the development of these events, including economic, health-related, and psychological factors. In addition, different factors can affect resilience, including demographic, environmental, and psychological factors. Many original studies have highlighted the impact of these factors on resilience in these settings. In the present literature review, we discussed the different psychological factors associated with resilience following a crisis. Some factors include the sense of avoidance and fear of being harmed or impacted by these crises. Our findings indicate the impact of different factors on psychological resilience during these events. For instance, reports show that fear of catching and transmitting the infection during infectious diseases pandemics was associated with reduced resilience and increased anxiety and stress. On the other hand, lockdown measures were associated with better resilience. In addition, social support, coping strategies, and adequate training and experience are essential factors that significantly contribute to resilience in a crisis.

Hernias are abnormal protrusions of a viscus (or part of it) through a normal or abnormal opening in a cavity (usually the abdomen). They are most commonly seen in the groin; a minority are para-umbilical or incisional. In the groin, inguinal hernias are more common than femoral hernias. Inguinal hernias occur in about 15% of the adult population, and inguinal hernia repair is one of the most commonly performed surgical procedures in the world. Although open, mesh-based, tension-free repair remains the criterion standard, laparoscopic herniorrhaphy, in the hands of adequately trained surgeons, produces excellent results comparable to those of open repair. We conducted this review using a comprehensive search of MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from January 1, 1985, through June 15, 2017.

Background: Low back pain (LBP) is one of the most common complaints, especially among healthcare workers, with great impact on daily lifestyle and job performance regarding disability and absence. Therefore, in this study, we aimed to assess the prevalence and associated risk factors of LBP among surgeons of different specialties in Taif city, Saudi Arabia. Methods: A cross-sectional study among surgeons in Taif city randomly selected from the three major hospitals in the city, using a self-administered questionnaire of 41 items divided into three parts including demographic data, individual and occupational characteristics, and prevalence data. Results: The prevalence data of LBP were point prevalence of 28 (20.3%), last month prevalence of 67 (48.6%), last year prevalence of 91 (65.9%), and lifetime prevalence of 101 (73.2%). Some of the investigated individual and occupational characteristics associated with the prevalence of LBP with a statistically significant (P < 0.05) such as smoking, specialty, overall standing time, perceived level of stress, and using preventive strategies. Others might be associated but with no statistically significant (P > 0.05) such as age, gender, body mass index, and job satisfaction. Rest and painkillers are the best option for most of the affected surgeons to relieve the pain. Conclusion: LBP has a high prevalence in the healthcare field, and the results of this study show high prevalence among surgeons, with many avoidable risk factors. Recommendations: More studies must be conducted and planning educational programs and campaigns to reduce the magnitude of this problem.

Estimates show that suicide is relatively common among Middle Eastern countries as a total of 26,000 fatalities in 2016 were attributable to suicide in them. However, the quality of care of mental illness in these countries is not adequate as compared to the international levels. The aim of the study was to discuss the different epidemiological and etiological factors that were linked with suicide in the Middle East, according to evidence obtained from studies in the literature. The impact of cultures and religions on dealing with mental illnesses and suicide as well as the roots of these conditions will be explored to find the appropriate solutions. Suicide in the Middle East is common but unique from other countries in the world. Religion, socio-economic status, war and conflict in many regions play a big role in the rate of suicide. Religion reduces the prevalence rates of suicide but other factors might be more dominant as many regions are in conflict and have low socio-economic status. Furthermore, gender, family conflicts and mental illnesses were identifiable risk factors in the literature. More efforts on a national level is warranted as well as among communities to reduce the rates of suicide. The initiation of support groups among those with mental illnesses and low socio-economic state will prove extremely beneficial in reducing the rate of suicide as they are almost non-existent in Middle East.

Background: hepatitis Virus B is a major health problem in Kingdom of Saudi Arabia (KSA) as it is one of the most endemicity countries for being hepatitis B seropositive. Objectives: evaluation of the knowledge, attitude and practice (KAP) of Saudi population toward hepatitis B infection in KSA. Methods: a descriptive cross sectional study was conducted among 890 Saudi subjects aged between 20-50 years old. All participants were interviewed during the period from February 2017 till June 2017 and filled-up a predesigned validated questionnaire that consisted of 4 parts including the demographics and KAP. Results: out of the 890 Saudi subjects, 69.3% were females, 48.3% were working, 77% had college degree and 50.9% of them aged from 20-30 years old. The prevalence of hepatitis B among the studied population sample showed that only 8% of subjects declared that they had hepatitis B infection. Most of the participants had good knowledge regarding the means of HB transmission, the definition, symptoms and effects of the disease. The attitude of subjects was good in 60% but the level of practice was poor among 66% of subjects as most of subjects hadn’t been screened or vaccinated for hepatitis B infection. Conclusion: the level of KAP toward hepatitis B was good in 56% of subjects with high scores of good knowledge and attitude but with poor practice levels among most of the subjects.

This study examines the acquisition of Arabic vocabulary by students studying Arabic as a foreign language in a multimedia computer-assisted language learning environment. For this, the researchers designed three separate interactive interfaces: (1) the verbal-based menu-driven interface (L2-L1: MDI), (2) the visual-based graphical user interface (L2-Picture: GUI), and (3) the spatial-based zoomable user interface (L2-Context: ZUI). L2 novel words were delivered in each of these three teaching methods by means of computer-assisted vocabulary acquisition software. The participants of this current study consisted of British monolingual undergraduate students, whose performance was assessed and analyzed during immediate and delayed posttests. The findings proved consistent with levels of processing theory, suggesting that, in comparison to GUI and MDI, the deeper semantic processing resulting from ZUI tended to result in improved long-term retrieval.

Hydrogen phosphide (PH3), also known as phosphine, is an ideal fumigant to control insect pest infestation of stored grain, as it is inexpensive, easy to use and leaves little or no chemical residue. As no other general use fumigant is available, phosphine is used to protect 80% of the Australian grain harvest, with the remainder consisting primarily of animal feed and seed grain for planting. Heavy reliance on phosphine has resulted in the development of resistance among insect pests of stored products. In this project, the model organism, Caenorhabditis elegans, was utilized for exploring the mechanisms of phosphine toxicity and interaction with other treatments including gamma radiation as well as testing for synergistic actions between these treatments and phosphine.By looking into the effect of oxygen, I found that hyperoxia synergistically enhances the toxicity of phosphine against wild type C. elegans at 15, 20 or 25 °C, but it only marginally increases the effectiveness of phosphine against phosphine-resistant animals at 20 °C. The sub-lethal concentration of phosphine (70 ppm) with 80% oxygen under 15, 20 and 25 °C gave 60%, 96%, and 99% mortality respectively, in the wild type nematodes. Interestingly, the nematodes of both strains consume significantly more oxygen at 20 °C comparing to the other temperatures. However, the wild type worms consume significantly more oxygen than dld-(wr4) at all three temperatures. The toxicity of arsenite, on the other hand, was negatively correlated with phosphine toxicity. The phosphine-resistant mutant exhibited sensitivity to arsenite, which was close to an arsenite-sensitive mutant. Combining 4 mM of arsenite (~LC50) with 70 ppm phosphine resulted in elevated mortality of 89% in the phosphine-resistant mutant, whereas the combination was not lethal to wild type animals.One method of grain disinfestation is gamma irradiation; a treatment that can co-exist with phosphine in the grain storage system. I tested the toxicity of two distinct forms of irradiation on C. elegans, UV and gamma irradiation. By utilizing mutant lines that are sensitive or resistant to either phosphine or radiation, I found hypersensitivity to phosphine of mutations originally selected for hypersensitivity to either UV or gamma radiation. The phosphine-resistant and the radiation-resistant mutants were each significantly more resistant to UV and ionizing radiation than wild type C. elegans. UV and gamma radiation-sensitive mutant exhibited hypersensitivity to phosphine, considerably higher than the wild type in most cases. Unexpectedly, a gamma and UV radiation-resistant mutant was also hypersensitive to phosphine.The effect of pre-exposure to UV, ionizing radiation, and heat-shock was investigated, and I observed that these pre-treatments induced tolerance against phosphine in C. elegans. Heat-shock increased phosphine tolerance in the wild type strain by 3-fold, but no significant induction was observed in the phosphine-resistant mutant (dld-1(wr4)). On the other hand, mild exposure to UV and gamma radiation doubled phosphine resistance in the dld-1(wr4) mutant, but this effect was only observed with gamma radiation in the wild type strain.The interaction between phosphine and the other treatments in my work demonstrates the involvement of phosphine toxicity with oxidative respiration, where temperature, oxygen, and arsenite have synergized phosphine. Also, the cross-resistance between phosphine and gamma radiation supports that oxidative damage is involved in the mode of action of phosphine. Finally, the observation that heat shock induces phosphine resistance in wild type, but not resistant animals provides a focus for future molecular studies.

Introduction: Chronic gastritis is one of the common serious pandemic infections in developing countries with severe sequelae such as peptic ulcer or gastric ulcer, though the prevalence of chronic gastritis has markedly declined in developed population. More than half of the people are suffering from chronic gastritis globally at present. Helicobacter pylori infection in childhood is a major contributing factor of chronic gastritis, which microbial origin is a critical factor for understanding epidemiology and course of the disease. An aggressive inflammation due to gastritis can cause severe destruction of stomach mucosa in years (Atrophic gastritis) and increases the risk of gastric cancer. Thus, prompt early diagnosis and proper measures and treatment is the key to manage chronic gastritis.The aim of Work: The review aims to understand the course, etiology, and management of chronic gastritis.Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1985, through February 2017. The following search terms were used: Chronic gastritis, gastric atrophy, Helicobacter pylori, peptic ulcer.Conclusion: Gastritis has a microbial origin and infectious background; chronic gastritis may occur in long course. With knowledge and epidemiology of H.pylori, it can be managed with well along with improvement in hygiene and socioeconomics. With such improvements risk of acquiring infection lessens and it may eradicate in future decades from medical practice, in most of the developed countries. Keywords: Chronic gastritis, gastric atrophy, Helicobacter pylori, peptic ulcer.

This study investigates coding features from cutting-edge multimedia technologies related to second language (L2) learning. The participants were fifty undergraduate students who were exposed to novel L2 words via three interfaces in the Computer-Assisted Vocabulary Acquisition software (CAVA): a verbal-based menu driven interface (L2-L1: MDI), a visual-based graphical user interface (L2-Picture: GUI), and a visuospatial-based zoomable user interface (L2-Context: ZUI). Immediate and delayed post-tests were conducted. The results for the immediate post-test revealed ZUI to be the most effective multimedia learning method. However, in the delayed post-test, ZUI’s effect declined dramatically, while GUI proved the most effective interface.

Background and objectives: Soave a single stage trans-anal procedure most commonly done early in life with good outcome. We used this technique in our patients with Hirschsprung disease (HD) presented in our hospital. Our research's main objective is to outline Soave technical aspects, outcome and rate of success in our center. Methods:This is a retrospective review study series of HD patients in our center who managed by Soave trans-anal approach, to look for postoperative adverse event including: stricture, anastomotic leakage, enterocolitis, and bowel functions. Results:In this study we operated 17 patients with HD, 14 of them primarily went for Soave trans-anal resection, except these three patients: 2 underwent a levelling colostomy, 1 with ileostomy, at neonatal period, follow by Soave. The length of resection was 20±10.5 cm. The follow-up period was 12.2 months (range 5–22 months). The patients ages between 3-14 years old. All patients on follow up bowel movements were voluntary, no fecal incontinence and no constipation which required the use of laxative. Conclusions:Our research strongly approve the fact that a single stage Soave approach without transabdominal dissection is a good technique for late HD patients with a good outcome. A multicenter prospective study and large number of patients is required to validate our results. Keywords:Hirschsprung disease; Soave; Trans-anal

Background: According to the World Health Organization (WHO), colorectal cancer (CRC) is the third most common cancer diagnosed among men, and the second most common in women. Yet more awareness is still required about this illness. Colorectal cancer treatment depends on the stage of the disease including radiation, ablation, chemotherapy or endoscopic treatment. Objective: The aim of this study is to investigate the level of knowledge towards laparoscopic surgery for colorectal cancer among medical students and interns in Kingdom of Saudi Arabia. Methods: This is a multicenter, cross-sectional observational study. Data was collected using an online designed questionnaire distributed, via a link to Google forms, to medical students and interns in Kingdom of Saudi Arabia. The questionnaire included some questions about; age, sex, level of education and the name of university in addition to assessment questions about laparoscopic surgery medical knowledge. Data were analyzed using Statistical Package for Social Sciences version (SPSS). Results: Number of participants was 106 (50% of each gender) with a mean± SD age of 24.5± 1.7 years. Around 63.2% of the participants were interns and 36.8% were students from different universities in Kingdom of Saudi Arabia. The largest proportion of the participants (38.7%) was from Taif University. Upon analysis of the questionnaire answers, the data revealed a median (IRQ) total score of 6(2) points out of 10 points. Conclusion: Although the participants tended to answer questions correctly more often, the level of knowledge about laparoscopic colorectal cancer surgery among students and interns in Saudi Arabia is considered to me moderate. There is a need to improve the level of knowledge about this management technique which will eventually ensure a better quality of care for the patients. Key words: Colorectal cancer, Laparoscopic surgery, Knowledge, Saudi Arabia.

We are reporting a case with rare side effect of propylthiouracil. Thirty-two years old Saudi female diagnosed to have graves disease and treated by propylthiouracil for more than 4 years. She started to complain of fever, joint pain and weight loss for 8 months. Clinically, she was found to be pale, generalized lymphoadenopathy and having moderate splenomegaly. Investigation revealed pancytopenia, high ESR, and multiple small cystic nodules in the liver, spleen, and both kidneys. We thought of propylthiouracil as a cause of her problem and advised to discontinue it before doing invasive investigation. Tqo weeks later she had better appetite, less joint pain, and no more fever. Complete blood count and ESR became improved and normalized in subsequent visits. We are reporting a case of generalized lymphoadenopathy, splenomegaly and fever caused by propylthiouracil. Keywords: propylthiouracil, vasculitis, Antithyroid drugs, lymphoadenopathy.

OBJECTIVE: The use of the emergency department by patients presenting with non-urgent conditions has become an important problem that is faced by all local and global health systems. The main objective of this article is to determine the causes of non-urgent emergency department visits by patients. METHOD This is a retrospective, descriptive study, conducted in the emergency department from January to April 2020. All patients triaged according to the Canadian Triage and Acuity Scale (CTAS) as CTAS -5 (non-urgent conditions) were included during the study period and their data such as demographics and presenting complaints were extracted from the hospital electronic files. Ethical approval was taken from the hospital's ethical review board. RESULTS Out of 1308 patients that visited the emergency department (ED), 327 (25%) patients were categorized as non-urgent visits (CTAS-5) according to the triage system. There was a slight female predominance of 165(50.5%) as compared to males 162(49.5%). 71% of patients were between 20-40 years of age. It was identified that 92% of the selected patients had non-urgent conditions, did not need any treatment in ED, and could be treated and followed up in primary health clinics or hospital polyclinics. 32.7% of patients had no chronic illness and 32.1 % of the patients had visited the ED before at least one time for the same complaint. The most common complaints at presentation for non-urgent visits were musculoskeletal system pain (30.5%), mild non-surgical abdominal pain (17.7%), Upper respiratory tract infection (9.5%), and fever (3.7%). It was found that 5.8% needs to be upgraded to CTAS 3-4 zone for further assessment and management. CONCLUSION The majority of non-urgent visits at the emergency department could be treated in other facilities like primary health care and hospital polyclinics. Proper, safe application of triage system and necessary education to the patients can reduce the emergency department overcrowdedness which will ensure patients safety and improve patients' clinical outcome.

The management of giant prolactinomas remains a major challenge, despite dopamine agonists being the first line of treatment, owing to its efficacy to normalize prolactin levels and reduce tumor volume. The aim of this study is to characterize the therapeutic aspects, manifestations and outcomes of 16 cases of giant prolactinomas admitted at a single tertiary center in Riyadh, Saudi Arabia.Retrospective data collection involving 16 Saudi patients diagnosed with giant prolactinoma at the Pituitary Clinic in King Fahad Medical City, Riyadh, Saudi Arabia between January 2006 and July 2012.A total of 16 patients (ten males; six females) with age of diagnosis between 21 and 55 years (mean 34.9 years) were included in the analysis. The most common presenting features include headache, visual defects and sexual dysfunction. Baseline mean serum prolactin level were extremely high for both sexes which eventually decreased by as much as 97% after cabergoline treatment. Serum prolactin concentrations completely normalized in six patients and significantly decreased in five patients 3-5 times that of normal range. Tumor volume also decreased by an average of 86% for males and 87% for females. Two patients had no tumor size change with cabergoline and required surgery.Findings indicate that cabergoline provides dramatic clinical improvements with excellent safety profile. Cabergoline should therefore be considered as the primary therapy for giant prolactinomas.

Prolactinomas are the most prevalent functional benign pituitary tumors due to a pituitary micro- or macroadenoma. The majority of patients presents with infertility and gonadal dysfunction. A dopamine agonist (DA) (bromocriptine or cabergoline) is the treatment of choice that can normalize prolactin levels, reduce tumor size, and restore ovulation and fertility. Cabergoline generally preferred over bromocriptine because of its higher efficacy and tolerability. Managing prolactinomas during pregnancy may be challenging. During pregnancy, the pituitary gland undergoes global hyperplasia due to a progressive increase in serum estrogens level that may lead to increase of the tumor volume with potential mass effect and visual loss. The risk of tumor enlargement may occur in 3% of those with microadenomas, 32% in those with macroadenomas that were not previously operated on, and 4.8% of those with macroadenomas with prior ablative treatment. Though both drugs appear to be safe during pregnancy, the data on fetal exposure to DAs during pregnancy have been reported with bromocriptine far exceeds that of cabergoline with no association of increased risk of pregnancy loss and premature delivery. It is advisable to stop the use of DAs immediately once pregnancy is confirmed, except in the case of women with invasive macroprolactinomas or pressure symptoms. This review outlines the therapeutic approach to prolactinoma during pregnancy, with emphasis on the safety of available DA therapy.