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Megameatus intact prepuce (MIP) presents with diverse phenotypes that complicate the management of this rare but complex hypospadias variant. Current data on optimal treatment methods and patient outcomes are sparse, unintegrated, and therefore challenging to implement clinically. A comprehensive systematic review of the existing literature on MIP was conducted according to PRISMA guidelines. Electronic databases including PubMed, Embase, and Scopus were searched for relevant articles published up to [2024]. Key aims were to assess the safety and efficacy of different surgical interventions, and synthesize corresponding outcomes reported in the literature. The search yielded 18 articles meeting the inclusion criteria, representing a total of 524 enrolled patients across multiple geographic regions. Diagnosis of MIP typically involves clinical examination, imaging studies, and urological evaluation. Surgical management options included preputial reconstruction, urethroplasty, and meatal advancement with glanuloplasty. Reported outcomes varied, with success rates ranging from [77.1-100%]. Long-term follow-up data on functional and cosmetic outcomes were limited. Megameatus intact prepuce presents diagnostic and management challenges due to low prevalence and variable presentation. This systematic review presents a current understanding of MIP diagnosis, surgical techniques, and patient outcomes. Future studies should assess the long-term functional outcomes of different surgical approaches, and investigate the underlying genetic and environmental factors contributing to the diverse clinical manifestations of MIP., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s).)

Increased intestinal leakiness and associated systemic inflammation are potential contributors to osteoarthritis (OA) and postural imbalance in the geriatric population. To date, no successful treatment to correct postural imbalance in OA is known. We aimed to explore the effects of a multistrain probiotic upon postural imbalance in OA-affected patients. In this randomised, double-blind trial with a placebo group, 147 patients suffering from knee OA (age span = 64-75 years) were divided into placebo ( n 75) and probiotics ( n 72) study groups. Vivomix 112 billion, multistrain probiotic was given once a day for 12 weeks. The outcomes of study variables were determined first at baseline and later after 12 weeks of intervention. These were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee flexion range of motion (ROM), pain intensity by visual analogue scale, handgrip strength (HGS), gait speed and balance control assessed in standing, semi-tandem and tandem stances. We determined plasma zonulin to determine intestinal leak along with c-reactive protein and 8-isoprostanes levels. A total of 136 OA patients taking placebo ( n 71) and probiotics ( n 65) were analysed. The probiotics group exhibited a reduction in pain intensity, disease severity and WOMAC scores along with improvement in balance scores, HGS and walking speed ( P < 0·05 for all), no change in ROM, resting pain and 8-isoprostanes levels. The correlation analysis revealed a robust association of balance scores with plasma markers of intestinal leakiness and inflammation in probiotics but not in the placebo group. Probiotics reduce postural imbalance in OA patients partly due to a reduction in intestinal leakiness.

Takayasu arteritis (TA), a rare large-vessel vasculitis, primarily affects women of childbearing age, causing granulomatous inflammation in the aorta and its major branches. This inflammation can lead to stenosis, aneurysms, or occlusion, with the abdominal aorta, subclavian, and brachial arteries commonly involved. We present the case of a 26-year-old female with TA with a rare involvement of the superior mesenteric artery (SMA). The patient presented with progressive shortness of breath and exertional pain in the left upper limb, suggesting claudication. Echocardiography showed an ejection fraction of 45% and right ventricular systolic pressure of 65 mmHg. CT angiography (CTA) revealed diffuse involvement of the abdominal aorta with non-opacification of SMA, and other findings were consistent with TA type 5. The patient was successfully treated with methylprednisolone to induce remission, along with guideline-directed medical therapy for heart failure., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Oruganti et al.)

Posterior nutcracker syndrome (PNCS) is a rare vascular disorder involving the compression of the retro-aortic left renal vein between the aorta and the vertebral column. It often presents with left flank pain, hematuria, and varicocele. We report the case of a 39-year-old male who presented with diffuse abdominal pain, acute urinary retention, and left flank pain. Radiologic evaluation revealed retro-aortic left renal vein compression with proximal dilatation, consistent with PNCS. The atypical presentation and non-specific clinical findings led to a conservative management approach. This case highlights the diagnostic challenges of asymptomatic PNCS and underscores the need for further research into its management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nadeem et al.)

Motion Estimation (ME) and the two-dimensional (2D) discrete cosine transform (2D-DCT) are both computationally expensive parts of HEVC standard, therefore real-time performance of the HEVC may not be free from glitches. To address this issue, this study deploys the graphics processing units (GPUs) to perform the ME and 2D-DCT tasks. In this concern, authors probed into four levels of parallelism (i.e., frame, macroblock, search area, and sum of the absolute difference (SAD) levels) existing in ME. For comparative analysis, authors involved full search (FS), test zone search (TZS) of HEVC, and hierarchical diamond search (EHDS) ME algorithms. Similarly, two levels of parallelism (i.e., macroblock and sub-macroblock) are also explored in 2D-DCT. Notably, the least computationally complex multithreaded Loeffler DCT algorithm is utilized for computing 2D-DCT. Experimental results show that ME processing task corresponding to 25 frames, with each frame of size (3840×2160) pixels, is accomplished in 0.15 seconds on the NVIDIA GeForce GTX 1080, whereas the 2D-DCT task along with the image reconstruction and differencing corresponding to 25 frames took 0.1 seconds. Collectively, both ME and 2D-DCT tasks are processed in 0.25 seconds, which still leaves enough room for the encoder's remaining parts to be executed within one second. Due to this enhancement, the resultant encoder can safely be used in real-time applications., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Agha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In this study, we propose LDMRes-Net, a lightweight dual-multiscale residual block-based convolutional neural network tailored for medical image segmentation on IoT and edge platforms. Conventional U-Net-based models face challenges in meeting the speed and efficiency demands of real-time clinical applications, such as disease monitoring, radiation therapy, and image-guided surgery. In this study, we present the Lightweight Dual Multiscale Residual Block-based Convolutional Neural Network (LDMRes-Net), which is specifically designed to overcome these difficulties. LDMRes-Net overcomes these limitations with its remarkably low number of learnable parameters (0.072 M), making it highly suitable for resource-constrained devices. The model's key innovation lies in its dual multiscale residual block architecture, which enables the extraction of refined features on multiple scales, enhancing overall segmentation performance. To further optimize efficiency, the number of filters is carefully selected to prevent overlap, reduce training time, and improve computational efficiency. The study includes comprehensive evaluations, focusing on the segmentation of the retinal image of vessels and hard exudates crucial for the diagnosis and treatment of ophthalmology. The results demonstrate the robustness, generalizability, and high segmentation accuracy of LDMRes-Net, positioning it as an efficient tool for accurate and rapid medical image segmentation in diverse clinical applications, particularly on IoT and edge platforms. Such advances hold significant promise for improving healthcare outcomes and enabling real-time medical image analysis in resource-limited settings.

Robotic assisted partial nephrectomy is the gold standard treatment for small renal masses. Ureteric stricture is a rare but serious complication that significantly increase the morbidity and worsens the quality of life for cancer patients. Definitive treatment such as surgical reconstruction or ureteroureterostomy is not always feasible as in patients with significant morbidity or high-risk patients. Other options include ureteric double J stent or nephrostomy tube placement with regular exchange. We present a case of iatrogenic upper ureteric stricture post robotic assisted partial nephrectomy for right renal mass that was discovered on postoperative follow up imaging treated with metallic ureteral stent (Memokath) as reconstructive surgery was difficult due to proximity to the tumor bed. We found that if reconstructive surgery is not feasible, metallic ureteral stents has good durability, better quality of life than ureteric double stents for the management of ureteric stricture., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction: Diabetic retinopathy (DR) is the leading cause of preventable blindness in Saudi Arabia. With a prevalence of up to 40% of patients with diabetes, DR constitutes a significant public health burden on the country. Saudi Arabia has not yet established a national screening program for DR. Mounting evidence shows that Artificial intelligence (AI)-based DR screening programs are slowly becoming superior to traditional screening, with the COVID-19 pandemic accelerating research into this topic as well as changing the outlook of the public toward it. The main objective of this study is to evaluate the perception and acceptance of AI in DR screening among eye care professionals in Saudi Arabia., Methods: A cross-sectional study using a self-administered online-based questionnaire was distributed by email through the registry of the Saudi Commission For Health Specialties (SCFHS). 309 ophthalmologists and physicians involved in diabetic eye care in Saudi Arabia participated in the study. Data analysis was done by SPSS, and a value of p < 0.05 was considered significant for statistical purposes., Results: 54% of participants rated their level of AI knowledge as above average and 63% believed that AI and telemedicine are interchangeable. 66% believed that AI would decrease the workforce of physicians. 79% expected clinical efficiency to increase with AI. Around 50% of participants expected AI to be implemented in the next 5 years., Discussion: Most participants reported good knowledge about AI. Physicians with more clinical experience and those who used e-health apps in clinical practice regarded their AI knowledge as higher than their peers. Perceived knowledge was strongly related to acceptance of the benefits of AI-based DR screening. In general, there was a positive attitude toward AI-based DR screening. However, concerns related to the labor market and data confidentiality were evident. There should be further education and awareness about the topic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Barakat, Mobarak, Javaid, Awad, Hamweyah, Ouban and Al-Hazzaa.)

Background: Since the initial emergence of the novel SARS-CoV-2 coronavirus responsible for the 2019 coronavirus disease (COVID-19) pandemic, many studies have been exploring the nature and characteristics of this virus and its associated clinical manifestations. The present study aimed to describe the clinical presentation and outcomes of COVID-19 infections in pediatric patients., Methods: A retrospective review of findings associated with 143 pediatric patients (age <14 years) with a confirmed COVID-19 diagnosis who had undergone inpatient or outpatient treatment at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia, between March 2020 and October 2020, was conducted. The analyzed data included patient demographic information, pre-existing medical conditions, symptoms, interventions, and outcomes., Results: The median age of this patient population was 7 years. Of these 143 patients, 67 (46.8%) had known pre-existing medical conditions including bronchial asthma (12.8%), chronic lung disease (CLD) (3%), congenital heart disease (CHD) (17%), primary immunodeficiencies (1.5%), malignancies (9.8%), and 7.5% were post-transplant patients. Thirty-seven patients (26%) were overweight or obese. Sixty-three of these patients (51%) were symptomatic, with the most common symptom being fever (55%). Ultimately, 45 patients (31%) required admission to the hospital, with a median duration of hospitalization of 9.6 days for admitted patients. There were no documented cases of infection-related mortality among this pediatric cohort, although 11 patients experienced post-infectious complications that primarily manifested as a loss of taste and smell., Conclusion: These findings suggest that pediatric COVID-19 patients tend to experience mild forms of the disease, without any significant differences in disease severity as a function of patient gender or immune status., (© 2022 Publishing services provided by Elsevier B.V. on behalf of King Faisal Specialist Hospital & Research Centre (General Organization), Saudi Arabia.)

Objective: Preventing pressure ulcers is an essential part of patient care and it is important to be aware of the best way to prevent it. Hence, the present study aims to look for the demographics, clinical characteristics, and risk factors in patients with and without pressure ulcer among elderly patients., Methods: A retrospective longitudinal study was conducted in elderly (above 65 years) patients from a period of October 2014 to October 2015 in the medical ward under acute Geriatric care at Hamad General Hospital in Qatar., Results: Overall, a total of 90 patients were included with an average age of 79 ± SD 11.3 years of which 45 patients developed pressure ulcer. There was male (64.4%) preponderance in the study population. Most common comorbidity was hypertension (77.8%). Anemia correction (91%), high protein diet supplementation (1.5 g/kg body wt.) (100%), and 2 h repositioning (100%) were implemented for majority of the pressure ulcer patients as preventive intervention., Conclusions: From the study finding, it is observed that, anemia correction, high protein diet supplementation and 2 h repositioning are the best practices for the management of pressure ulcer. Hence, these best practices are recommended for the early prevention of pressure ulcer among elderly.

To find the best option to treat White Spot Lesion in existing caries treatments, and to identify the selected articles discussing etiology of caries along with White spot lesion. Null hypothesis was that "Only anticariogenic agent can cure White Spot Lesion". PRISMA guidelines were used to conduct the systematic analysis. An electronic customized search was performed using mesh terminologies on PubMed database based on inclusion criteria that included studies with; any treatment option that can treat or prevent WSL; and minimally invasive treatment options that may be altered to treat WSL. While exclusion criteria comprised studies with treatment of rampant caries, severe early childhood caries and root caries. Inclusion criteria for etiological factors incorporated studies with factors that lead to white spot lesion or carious lesion. Finally, therapeutic agents of dental caries were analyzed. Only the use of anti-cariogenic agent cannot cure White Spot Lesion. Hence study fails to prove the null hypothesis. Although combination of anti-cariogenic agents with a re-mineralizing agent can provide additional options for the treatment or prevention of WSL.

Objective: The objective of this study was to assess the surface properties (microhardness and wear resistance) of various composites and compomer materials. In addition, the methodologies used for assessing wear resistance were compared., Materials and Methods: This study was conducted using restorative material (Filtek Z250, Filtek Z350, QuiXfil, SureFil SDR, and Dyract XP) to assess wear resistance. A custom-made toothbrush simulator was employed for wear testing. Before and after wear resistance, structural, surface, and physical properties were assessed using various techniques., Results: Structural changes and mass loss were observed after treatment, whereas no significant difference in terms of microhardness was observed. The correlation between atomic force microscopy (AFM) and profilometer and between wear resistance and filler volume was highly significant. The correlation between wear resistance and microhardness were insignificant., Conclusions: The AFM presented higher precision compared to optical profilometers at a nanoscale level, but both methods can be used in tandem for a more detailed and precise roughness analysis., Competing Interests: There are no conflicts of interest.