Search

Congenital enteropeptidase deficiency (CEP), also known as enterokinase deficiency. CEP is an uncommon autosomal recessive genetic disorder mostly characterized by severe chronic diarrhoea after delivery, hypoproteinemia, and failure to grow. Enteropeptidase activity is anticipated to play a significant role in protein digestion. For growth and appropriate development in newborns with a congenital lack of the enzyme, pancreatic enzyme replacement treatment or an amino acid combination must be given. Only 13 cases of enterokinase insufficiency have been recorded since it was originally characterized in 1969. Couples should be informed that prenatal screening is an option and that EKD has a favourable prognosis. However, if an EKD patient is born, parents should be aware of the feeding issue and offer the proper pancreatic exocrine secretion medication. One research found that all patients had been diagnosed as newborns 25 years ago. Even when the pancreatic-enzyme replacement was stopped, they appeared to lead regular lives as adults, free of gastrointestinal issues and with normal body weight. This can be explained by the fact that trypsin, once liberated from its precursor, encourages additional trypsinogen activation in a positive-feedback manner. Better pharmaceutical preparations such as enteric-coated minimicrospheres and delayed-release capsules are used for better results as it maintains the enzyme and prevents its breakdown by stomach acidity. This review aims to summarise current knowledge of pathophysiology, causes, and treatment of Intestinal Enterokinase Deficiency in Pediatrics

This article proposes a hybrid scheme of maximum power point tracking (MPPT) based on artificial neural network (ANN) and ripple current correlation (RCC). ANN model is established using the data generated through RCC MPPT. Scaled conjugate gradient ANN is applied to gauge the performance improvement. The proposed scheme is validated through simulations. For this, the proposed system is applied to three different environmental scenarios which are standard testing condition of a PV module, under variable irradiance condition, and variable temperature condition. It is established that the proposed system is well capable of tracking the maximum power point under various test conditions.

Supplementary Material 1

Mental health is one of the 3 essential health columns which is defined according to WHO as "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".

The emergence of the novel coronavirus (SARS-CoV-2) had affected us significantly from the individual level, to nationwide and global with a big loss of finances, and the freezing of various factories, schools, and transportation in communities The pandemic started with anxiety and a loss of health guidance and policies due to the unknown causes of viral transmission to human features as well as a high infection rate with low mortality It remains the original source of Covid-19 where it comes from and what is the reality of real viral entities and its origin such as natural born and recombinant viral variants in the case of COVID-19 pandemic. This sentence is unclear. In this short perspective article, we address some issues of risk assessment and management issues using molecular-based decision tools which may benefit or provide future drills to counteract health and clinic safety against a viral pandemic. Every pandemic gives us life threatening lessons on previous and disconnected human networks due to uncertainty of viral infection, which we learned from this COVID-19 pandemic case as well. It gives us some insight on how to rebuild our community regarding the strength of public health and the integration of science tools into the early phase of medical application, such as the role of molecular diagnostics through educational engagement. To promote the value of awareness with solid knowledge-based communication and to develop resilient preventive solutions for supply chains or prevention, the systematic practice of connectivity through visual format using multidimensional data outcomes could help reconsider the leverage of molecules as a bridge for the improvement and application of updated scientific tools of prediction precisely to identify unknown pathogens encompass rigor community-based activity likelihood sensitivity and resistance to pathogen infiltrated society in the future.

Background: Burnout is observed when there is chronic exposure to work-related stress. This is commonly seen in physicians and undergraduate medical students. Thus, the study assessed and compared the severity of burnout among medical and dental senior undergraduate students in Abha, Saudi Arabia. Materials and method: 517 medical and dental senior undergraduate students were evaluated using a well-designed and formulated questionnaire. Different levels of burnout were evaluated with the related scores of burnout categories. Data collected was evaluated using SPSS version 25.0. Results: A total of 772 medical and dental senior undergraduate students were included in the study, out of which 517 responded to the questionnaire, with a response rate of t 67%. Demographic parameters like age, gender, marital status, and the course were assessed. The mean scores of Personal Accomplishment (PA), Emotional Exhaustion (EE), and Depersonalization (DP) for all study subjects were recorded, showing an insignificant difference (p-value > 0.05) between both the groups in all the three categories. Considering Personal Accomplishment, the lowest mean values were observed with subjects aged 23 years old, female participants, and unmarried students, with insignificant correlation, observed statistically. Conclusion: Moderate to high levels of burnout with no significant difference was observed between medical and dental students in all three burnout categories.

Funding Information: The authors extend their appreciation to the Deanship of Scientific Research at King Khalid University (KKU) for funding this research through the Research Group Program under the Grant Number: R.G.P.2/248/43. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This research reports the first-ever study on abundantly available, environmentally friendly, low-cost and ready-for-use Nutraceutical Industrial Cumin Seed Spent (NICUS) as an innovative adsorbent for bioremediation of a bisazo Acid Red 119 (AR119) dye, a probable mutagen from textile industrial effluents (TIEs). The experiment at the laboratory scale is designed to suit the concepts of sustainability and valorisation under the domain of circular economy. The experimental qe value obtained was 96.00 mg g−1 . The optimised conditions of parameters are as follows: pH of 2; adsorption time, 210 min; adsorbent dosage, 0.300 g L−1; particle size, 175 µM; initial dye concentration, 950 mg L−1; orbital shaking, 165 rpm and temperature, 50◦C, producing an impressive value of 748 mg of dye adsorbing on 1 g of dry NICUS. The adsorption capacity of NICUS obtained from the quadratic model developed for process optimisation gave values of 748 mg g−1 . As a prelude to commercialisation, five variables that affect the adsorption process were experimentally studied. For the feasibility and efficiency of the process, a two-level fractional factorial experimental design (FFED) was applied to identify variables that influence the adsorption capacity of NICUS. The identified variables were applied to scale experiments by three orders. Nine isotherm models were used to analyse the adsorption equilibrium data. The Vieth–Sladek adsorption isotherm model was found to be the best fit. The pseudo-second-order reaction was the appropriate mechanism for the overall rate of the adsorption process. Mechanistic studies related to mass transfer phenomena were more likely to be dominant over the diffusion process. Techniques such as SEM, FTIR and CHN analysis were used to characterise NICUS. The dye-adsorbed NICUS obtained as “sludge” was used as a reinforcing material for the fabrication of composites using plastic waste. The physicomechanical and chemical properties of thermoplastic and thermoset composite using dye-adsorbed NICUS were evaluated and compared with NICUS composites. Prospects of integrating Small and Medium Enterprises (SMEs) into the circular economy of Nutraceutical Industrial Spent (NIS) are discussed. publishersversion published

University of Technology Sydney. Faculty of Engineering and Information Technology. Information and communication technology (ICT) has become integral to all communities. Governments utilise ICT to interact and connect over the internet with different stakeholders including citizens, employees, people from other countries, private businesses and other governments and people who use the services; this is named e-government. Security threats to digital infrastructure such as e-government are growing exponentially with the proliferation of digital devices and users of ICT are experiencing more data breaches, service unavailability and other digital disruptions than ever before. That is where information security plays a vital role. Information security protects information from unauthorised access, disclosure, disruption, modification, and destruction to ensure integrity, confidentiality, and availability. To combat information security threats, organisations create security measures to stop threats against their information and technology resources. To exemplify this, information security policies specify the proper uses of organisational information and technology resources, and include formalised sets of guidelines, procedures and technical controls to which employees must adhere. However, while these guidelines provide the best directions for security, they do not automatically translate into desirable security behaviours. Cyber criminals are widely recognised in mainstream media as being responsible for data breaches and attacks. However, employees’ intentional and unintentional non-compliance causes most security breaches despite ISPs and measures. Hence, identifying what drives employees’ compliance with ISPs and requirements is a significant advance that can guide organisations to define strategies to improve their employees’ compliance with ISPs and requirements. To this end, first a systematic literature review was conducted to lay the groundwork for understanding the factors influencing and enhancing information security compliance behaviour. Drawing on findings from the systematic literature review and informed by concepts from social support theory and the theory of planned behaviour, along with aspects of the unified theory of acceptance and use of technology model, a theoretical framework was developed that shows the factors that can enhance employees’ compliance with information security. The framework has been based on the identified factors such as accountability of employees; adaptability of individuals; information security awareness; facilitating conditions and resources provided by the employer; monitoring of employees; social influence and technical controls that predicts information security compliance attitude and behaviour. The framework was then validated through findings from a quantitative and qualitative study in the context of e-government in Saudi Arabia. This study augments previous compliance studies by confirming previously identified factors for predicting compliance behaviour and identifying new factors.

Nanotechnology is a rapidly evolving discipline as it has a wide variety of applications in several fields. They have been synthesized in a variety of ways. Traditional processes such as chemical and physical synthesis have limits, whether in the form of chemical contamination during synthesis operations or in subsequent applications and usage of more energy. Over the last decade, research has focused on establishing easy, nontoxic, clean, cost-effective, and environmentally friendly techniques for nanoparticle production. To achieve this goal, biological synthesis was created to close this gap. Biosynthesis of nanoparticles is a one-step process, and it is ecofriendly in nature. The metabolic activities of biological agents convert dissolved metal ions into nanometals. For biosynthesis of metal nanoparticles, various biological agents like plants, fungus, and bacteria are utilized. In this review paper, the aim is to provide a summary of contemporary research on the biosynthesis of gold nanoparticles and their applications in various domains have been discussed.

Introduction: Sudden infant death syndrome (SIDS) is characterized as the sudden unexpected death of a healthy infant below the age of 12 months with an unknown cause even after careful death scene assessment. The aim of this study is to estimate the percentage of proper sleep practices among infants and assess the knowledge and awareness of SIDS and its associated risk factors among Saudi and non-Saudi mothers. Methods: This cross-sectional study was done in Riyadh, Saudi Arabia. The data were collected using an anonymous, self-administered questionnaire that consisted of 36 items that were divided into demographic data of the parents and child, observations of the child’s sleep practice, and knowledge and awareness of SIDS and its associated risk factors. Results: A total of 667 participants completed the questionnaire. The mean age of the mothers was 31.44 + 7.55. As for the nationality, 527 (79%) were Saudi and 140 (21%) were non-Saudi. The majority had bachelors’ degrees 407 (61%). Sleep practices assessment demonstrated that 391 (58.6%) of infants were sleeping in the supine position. A total of 329 (49.3%) participants reported hearing about SIDS from social media and websites as being the major source of information. SIDS acknowledgment was higher in non-Saudi mothers compared to Saudis. Conclusion: The results provide informative descriptive data on childcare practices in Saudi Arabia. Considerable variation was noted and the results from this study are intended to have a better understanding of the prevalence of childcare practices and knowledge of SIDS risk factors in Saudi and non-Saudi mothers.

Pharmacoeconomics research identifies, compares, and measures the costs and outcomes of several pharmaceutical products. Pharmacoeconomics refers to a sub-discipline of health economics for over 25 years. Pharmacoeconomic is applied to guide the use of limited resources to yield maximum value to patients, society, and healthcare payers. The implementation of the pharmacoeconomic course in pharmacy colleges has been done in several countries as learning pharmacoeconomics improves the skill, knowledge, and competence to value pharmaceutical interventions. Thus, this study was conducted to assess the awareness and attitude of health professions about health economics and pharmacoeconomics education. Methods: This was a cross-sectional study design conducted from January to June 2021. The demographics, awareness level, knowledge, and attitude towards health economics and pharmacoeconomics education were investigated. Results: Almost 300 participants were included in the current study; 35%, 52%, and 13% were nurses, pharmacists, and physicians, respectively. Only 41% and 34% had heard about health economics and pharmacoeconomics before, respectively. The overall awareness level was high among 51.3% participants. The factors that significantly influenced the awareness level included age (P=0.0001), sex (p=0.0001), health profession (P=0.0001), hearing about health economics (P=0.0001), and pharmacoeconomics (P=0.0001), courses taken in this field (P=0.0001), and training through extracurricular activities (P=0.0001). Conclusion: The health professionals in this study showed low awareness regarding health economics and pharmacoeconomics; almost one-half only had high awareness, whereas the remaining percentage reported a low level of awareness. Keywords: Awareness, Knowledge, Health economics, Pharmacoeconomics

BackgroundMisconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base.MethodsWe reviewed studies with more than 2,000 participants or meta-analyses from five or more studies or 2,000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder.ResultsWe generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 79 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 362 people who have read this document and agree with its contents.ConclusionsMany findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.

This research was designed to investigate the effects of using online undergraduate courses, based on Self-Regulated Learning (SRL) strategies, in order to enhance students’ self-regulation and academic outcomes at the University of Bisha in Saudi Arabia. A quasi-experimental design was applied in this study. Sampling consisted of 70 female students from the Educational Faculty at the University of Bisha. Two types of online courses were used to teach the same concept. A group of students was taught online course supported on SRL strategies and the other group by using an online course not supported on SRL strategies. The result of independent samples t-test and one-way analysis of covariance (ANCOVA) showed that the online course supported on SRL strategies has a significant effect on students’ self-regulation and academic outcomes.

Since it was declared a worldwide pandemic, COVID-19 has ravaged almost all over the world and has overloaded several health-care systems. The pandemic also resulted in job losses as a result of lengthy shutdowns, which burdened the global economy. Even though significant clinical research progress has led to a better perceiving of the virus ( SARS-CoV-2) nature and the disease (COVID-19) management, preventing the virus's spread has become a major concern as SARSCoV-2 continues to wreak havoc around the world. Several countries suffered from the second or third wave of viral disease outbreaks, primarily caused by the mutation of SARS-CoV-2. Imaging is critical in the diagnosis and follow-up of patients with new coronavirus-infected pneumonia (NCIP). The primary imaging modality in clinically suspected cases is CT scan and it is useful for monitoring imaging changes following therapy. Therefore, CT is regarded as a useful diagnostic technique for clinically suspected cases of COVID-19. CT has the ability to detect patients who have a negative reverse transcription-polymerase chain reaction (RT-PCR) but are highly suspicious of NCIP in terms of clinical problems. In addition, the results of a CT scan may also reveal information concerning the severity of the condition. In this review article, the diagnosis of COVID-19 is discussed and CT characteristics are defined based on the newest research for the diagnosis and management of COVID-19.

The emission of gamma radiation in nuclear reactors manifests itself as heat which may substantially impact irradiation applications and reactor safety. Evaluating this phenomenon can increase the efficiency and safety of the reactor and its irradiation materials. Calculating or predicting the gamma heating (GH) in a nuclear reactor is not a simple task, especially when not all parameters of the reactor are known. This dissertation incorporates various methods for verifying results, including operational data, calculations and measurements. The thesis is divided into five research chapters to illuminate uncharted areas for simulation codes and to better understand factors influencing the GH. Study 1 applies the overall system for calculation of reactors (OSCAR-4) code system to the McMaster Nuclear Reactor (MNR) for understanding and verifying core-follow calculations against the MNR operational data. Based on this understanding, the calculational scheme presented advances to the operational fuel management data by (i) embodying an axial U-235 distribution profile and (ii) including all fissile materials present in the core. Study 2 gives insight into the impact of control rods (CR) movement on axial fuel inventory using the OSCAR-4 and Serpent-2 simulation codes. This was done to study whether OSCAR-4 performs as well as the time-consuming Serpent-2 for core-follow calculations. It was found that averaging the CRs movement can precisely predict fuel inventory without requiring detailed CRs tracking. Study 3 focused on improving MNR fuel operational data which were subsequently used in both the OSCAR-4 and Serpent-2 simulation codes. This research emphasizes the importance of applying the fuel inventory correction factor to any MNR cycle to accurately predict the fuel inventory at any given stage of a cycle. Study 4 involved the experimental measurement of GH using the SCK-CEN gamma thermometer (GT) in three irradiation sites at 27 GH values. In addition, a Serpent-2 simulation was conducted to calculate the GH at the same 27 points with an understanding of uncertainties accompanied by the measurement. Similarly, MCNP-6 code was implemented with the same methodology used for both OSCAR-4 and Serpent-2 and showed a very good agreement with the reactor operation data and GH measurement. The computational tools program provided a good prediction and evaluation of the GH. Finally, study 5 expanded the evaluation and uncertainty quantification of the GH under several reactor core conditions and time-dependent sets. The measurements presented in this work indicate that, even over four years, the combined effects of fuel burnup and fuel management operations do not significantly change the GH level inside the beryllium site. This is likely due to the overall distribution of the MNR core configuration and fuel burnup. Thesis Doctor of Science (PhD)

Due to the spatio-temporal complexity in energy consumption profiles of multiple consumers at different regions, it is expected that more cost savings and higher resiliency to power disruptions can be achieved using a network of mobile prosumers, defined as entities that can both provide and consume energy. In this dissertation, the prosumer is assumed to be an autonomous vehicle equipped with different distributed energy resources (e.g., solar panel, battery). In addition, the demand on energy is uncertain and subject to change with time due to several factors including the emergence of new technology, entertainment, divergence of people’s consumption habits, changing weather conditions, etc. Moreover, increases in energy demand are growing every day due to increases in world population and growth of the global economy, which substantially increase the chances of disruptions in power supply. This makes the security of power supply a more challenging task especially during peak usage seasons (e.g., summer and winter). Furthermore, the majority of the applications of smart grids in the existing literature include a large number of agents (e.g., electric vehicles), and each agent interacts with other agents and affects their decisions (i.e., mobility and scheduling). This causes the operational complexity of smart grids to increase exponentially. To date, most of the existing research in energy management in smart grids aims to find efficient controlling schemes that seek renewable energy resources and dispatch energy to shift energy peaks between different daily periods. However, there are limitations and gaps in the current state-of-art in the field of energy management in smart grid including: (i) most of the literature focuses on energy transactions between EV's and power grids while the benefits of mobility in EV to mitigate the impact of spatio-temporal complexity in energy load and production are not maximally exploited; (ii) the existing solution approaches (e.g., mixed integer programming, dynamic programming, etc.) are not computationally efficient to handle system dynamics with the uncertainty inherent in energy problems; (iii) traditional/exact optimization tools are computationally expensive and are not efficient in solving high dimensional energy problems. Thus, the aim of this dissertation is to thus advance the state-of-the-art in energy management of smart grids to contribute to reducing energy costs, dependency of the main power grid, computational time, and carbon emissions. This is done in several stages. First, an integrated vehicle routing and energy scheduling decision model is proposed to adaptively dispatch vehicles to balance the temporally and spatially distributed energy requests subject to vehicle mobility constraints, and thus to maximally exploit the potential of a mobile prosumer network for cost savings and carbon emission reductions. Second, a reinforcement learning model is developed to address the uncertainties in power supply and demand by dispatching a set of electric vehicles to supply energy to different consumers at different locations. Finally, a multiagent reinforcement learning (MARL) algorithm is introduced to address the scalability issues of large-scale smart grid systems. This algorithm uses centralized training and distributed execution, where all agents are trained using an actor network for each agent and sharing the same critic network, and then executed to make actions independent of other agents to reduce computation time.

Background: The novel corona virus disease, also known as COVID-19, has emerged as a major health concern globally. Its association with comorbid condition has increased its mortality. Diabetes mellitus (DM) is associated with increased risk of infection in comparison to general population. This risk is higher in type 1 DM that type 2 DM. Methods: A cross sectional study was done in T1DM patients in whom a structured questionnaire was administered after lockdown. Data regarding social demographical variables, Information regarding sugar levels, psychological effects, changes in weight, exercise habits and other variables were included in the validated, electronic questionnaire. Ethic approval was obtained from the Diabetic center Abha, study duration was from January-2020 to October-2020. Results: Out of 143 total patients (46.9%) were males while 53.1% were females. Mean ± S.D of age was obtained 29.6 ± 1.8. [Figure 1] depicted that 23% of the respondents were effected psychologically. [Figure 2] depicted that 80.4% used insulin as a treatment. [Figure 3] depicted that 8% of the respondents make an emergency visit to the health care centers for high rise in diabetes during lockdown. Conclusion: COVID-19 and the lockdown affected the management of T1DM. It resulted in changes in lifestyle, compliance to medication, and psychological impact on the participant.

External fixation is a common technique for the treatment and stabilization of bone fractures using pins or wires. Different designs were considered, but all of them present limitations such as high weight (they are based on heavy frame), not comfortable to use and not customized to individual patients. Therefore, this paper proposes a novel lightweight customized external fixator, overcoming some of the identified limitations. It also investigates the mechanical characteristics of the newly developed fixator considering different stages of healing using finite element method., Transactions on Additive Manufacturing Meets Medicine, Vol 2 No 1 (2020): Trans. AMMM

Background:smile is considered as one of the most important facial expressions, in order to obtain a highly esthetic result when restoring a patient’s smile, the clinician must consider the effect different tooth forms generate when arranged next to each other. The Golden Proportion (GP) has been considered the most harmonious recurrent tooth-to-tooth ratio and has long been proposed as an aesthetic guideline for restoringmaxillary anterior teeth. The aim of the study was to evaluateof esthetic dental and facial measurements of Saudi young adult male patients. Methods:a total of60 Saudi young adult male patients (20 to 25 years old) with natural smiles. Frontal photographs were captured for all participants whilerest position, smiling andclose-upanterior with cheek retractorsusing a digital camera with standardized settings. Photo-editing software was used to measure the perceivedmesiodistalwidth of each anterior maxillary tooth in all digital images. Calculated ratios of the perceivedmesiodistalwidths of the teeth were compared with their respective GP values using a one sample t-test. Results:for dental measurements, there were no significant differences among the tested groups at (P< 0.05) between the calculated ratios and the golden ratios. No significant differences among the tested groups at (P< 0.05) were detected for facial measurements. Conclusion:the results of the present study have shown that this GP did not exist between the widths of the maxillary anterior teeth in individuals who have an esthetic smile. While thedento-facial measurements were in accordance to GP.

Ilizarov systems are required to treat critical bone defects. However, they are not customized to the patient present significant risk of infection and induces pain and discomfort. This paper presents a novel customizable functional brace overcoming the main limitations of the Ilizarov system. This brace is being designed, together with clinicians, to be produced using additive manufacturing (AM). This paper presents preliminary design concept assessed using Finite Element Analysis (FEA), considering different impact loading conditions and different materials., Transactions on Additive Manufacturing Meets Medicine, Vol 1 (2019): Trans. AMMM

Background: There is a high prevalence of dyslipidemia in the Arabian Gulf. There is a gradual increase in Total Cholesterol Concentration (TCC) with age, reaching a maximum at the 50s and 60s for male subjects. Our study aims to assess hypercholesterolemia level awareness among Saudi People. Methods: cross-sectional. Study sample size was 150. Our sample technique was simple random. We included Saudi citizens of age 18 or above and we excluded medical personnel. Data collection tool was a self-administered questionnaire. We used Statistical Package for the Social Sciences (SPSS) to analyze our collected data. We considered P value less than 0.05 significant. Results: Level of awareness Regarding management of Hypercholesterolemia, our results showed that 25.33% of the participants had poor, 46.00% had moderate and 28.67% had good awareness. Regarding risk factors awareness of Hypercholesterolemia, our results showed that 44.00% of the participants had poor and moderate and 12.00% had good awareness. Regarding complications awareness of Hypercholesterolemia, our results showed that 24.00% of the participants had poor, 28.67% had moderate and 47.33% had good awareness. conclusion: the proportion of hypercholesterolemia among participant was one-fifth of the collected sample. Majority of them had poor to moderate knowledge regarding awareness of Hypercholesterolemia. Key words: Hypercholesterolemia; dyslipidemia; awareness; cardiovascular disease; Saudi Arabia

Ebestien-barr virus (EBV) is a wide spread herpesvirus, with up to 95% exposure rate in the adult population. Less than 10% of exposed population develop clinical manifestation. EBV infection is usually a benign infection, but in rare cases it can cause complications with lasting effects. EBV is also a very rare cause of encephalitis, accounting for less than 5% of clinical viral meningoencephalitis cases. It is also very rare for such a commonly presenting virus to cause secondary Hemophagocytic lymphohistiocytosis (HLH),or Gillian barre syndrome (GBS), not to mention fatality. We describe a case of a 5 years old girl who presented initially with acute otitis media (AOM) at top of chronic and Infectious mononucleosis with expected discharge after IV antibiotic course, from that point she rapidly deteriorated with development of EBV complications in the form of encephalitis and then developed GBS and secondary HLH, she died after one month of admission due to these complications. Although each of described rare complication is documented in literature, the combination of all of these findings was not reported previously. Key words: EBV, encephalitis, HLH, GBS.

One of the major leading cause of mortality is Diabetes Mellitus (DM) foot complication is many developed and developing countries. Diabetes Mellitus is a complex disease, and foot ulceration is one of the most common complications. Due to poor foot care knowledge and practices, it poses important risk factors for foot problems among people with diabetes. The aim of Work: The study aimed to assess the knowledge and practices regarding foot careand management on a daily basis in patients with diabetes mellitus 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: knowledge and practice, diabetic foot care, foot care measures, diabetic foot ulcer Conclusion: Good knowledge and practice regarding foot care will reduce the risk of diabetic foot complications and ultimately amputation. There is no significant association between patient’s demography with direct knowledge and practice of foot care. Educational programs focusing on awareness of diabetic foot care must directly involve the community, and thereupon to lessen the incidence of diabetic foot complications. It should be done in primary care up to tertiary care centers as a multidisciplinary effort. Keywords: Knowledge and practice, diabetic foot care, foot care measures.

Objectives. To explore the association between obesity and dental caries in children and adolescents. Furthermore, to consider the possible reasons behind this relationship. Methods. A database search for papers published between January 2015 and May 2018, inclusive, addressing the association between obesity and dental caries was conducted. A review and critical appraisal of all included studies was performed. Results. Twenty-six studies were included in this review from different populations worldwide. Eight studies assessed the primary dentition, nine studies were conducted on permanent dentition, and remaining nine studies on both dentitions. The results regarding the association between obesity and dental caries were conflicting and inconsistent. Nine studies concluded that there was no relationship between obesity and dental caries. A positive association was reported in five studies, while the inverse association was reported in eleven studies. Studies included in this review had significant variations in methodology and the investigated cofactors. Possible explanations of the controversial association between obesity and dental caries are discussed in this review. Conclusion. Both obesity and dental caries are multifactorial diseases, and their association is far more complex that can be explained by a single common risk factor, presenting evidence for the complexity of this association.

Additional file 1. The file contained Proton NMR spectra.

Introduction: Sickle cell disease is considered to be one of the commonest hereditary diseases around the world with being highly prevalent in the regions of sub-Saharan Africa, Mediterranean, Middle East, and Southeast Asia. Sickle cell disease is known to be a chronic hematological disease that leads to severe hemolysis, and is characterized by hemoglobin particles that tend to polymerize within the RBCs and cause the RBC to become in a crescent, sickle shape, which will cause hemolysis along with vasoocclusive events in different organs. Aim of the work: we tried to understand the pathogenesis, impact, diagnosis, and management of sickle cell disease in this study. Methodology: we conducted this review using a comprehensive search of MEDLINE, PubMed and EMBASE from January 1950 to March 2018. The following search terms were used: sickle cell anemia, hemoglobinopathy, genetics of sickle cell, complications of sickle cell, management of sickle cell disease Conclusion: It is important to develop therapeutic options that reduce the risk of complications of sickle cell disease. Despite all advances in treatment, sickle cell disease remains to be an important serious disease that is associated with severe morbidity and mortality, and poor quality of life. More research and clinical trials should be conducted on this disease to develop advanced treatment options that will further improve quality of life and decrease mortality and complications. Keywords: sickle cell disease, hemoglobinopathies, Middle-east hematological disorders

Introduction: Ectopia lentis is defined as a crystalline lens displacement, either partially or completely, due to zonular abnormalities. It can be a result of trauma, hereditary ocular disease, or part of systemic diseases, like Marfan syndrome and homocystinuria. Case description: We report a case of a medically free 16-year-old girl, who was referred to our hospital complaining of poor vision and a squint in both eyes since childhood. Her history included a traffic accident when she was one-year-old. She was previously diagnosed with alternating esotropia, which was treated with glasses, alternating patching, and bilateral Botox injections. On examination, she had a visual acuity of 6/7.5 with correction in the right eye and 6/6 with correction in the left eye. She had an esotropia of 60 prism diopters, which was partially corrected to 40 prism diopters for near and distance vision. Fundus examination showed myopic changes in each eye and dislocated lenses in the posterior pole at 6 o’clock. Our case was stable, so we used conservative management with contact lenses. Conclusion: Bilateral posterior lens dislocation is very rare. A proper examination is important and early diagnosis can prevent serious complications, such as retinal detachment or pupillary block glaucoma., GMS Ophthalmology Cases; 7:Doc26

Additional file 3: Table S1. Differentially expressed genes between group 1 (Tumors Jed49_MN, Jed36_MN) versus group 2 (Tumors Jed04_MN, Jed18_MN, Jed34_MN, Jed40_MN).

Additional file 6: Figure S4. AGR2 co-expression with CSCs markers in situ. A) Images for immunofluorescence co-staining of stem cell markers Nestin+AGR2+(Green, Red), CD133+AGR2+(Green, Red), and Sox2+AGR2+ (Green, Red) in low grade (Jed62_MN and Jed40_MN) and high grade (Jed49_MN and Jed45_MN) tumors. B) Mean percentages of co-positive cells. Error bars represent count errors between three independent regions within each tissue. All images were taken at 20Ă .

Additional file 8: Figure S6. The expression of AGR2 in G type cell lines. A) Immunofluorescence images for two G Type cell lines (Jed39_MN and Jed40_MN). Images show cells co-stained positively for Vimentin+AGR2+ (Green, Red). B) Average percentages of cells positive for AGR2. Error bars represent errors between three independent counts.

Additional file 4: Table S2. Predicted differential pathways generated by Ingenuity Pathway Analysis Software. The transcriptome comparison was carried out for group 1 (Tumors Jed49_MN, Jed36_MN) versus group 2 (Tumors Jed04_MN, Jed18_MN, Jed34_MN, Jed40_MN).

Additional file 7: Figure S5. Average percentages of morphologies counts for Jed62_MN and Jed79_MN. Each tumor was divided into four portions that were grown in either DMEM-F12 +10% FBS (Blue line), or DMEM high glucose concentrations of 4500 mg/L (Gibco) +10% FBS (Grey line), or DMEM high glucose concentrations of 4500 mg/L (Gibco) + 5% FBS (Yellow line), or DMEM low glucose concentrations of 1000 mg/L (Gibco) + 10% FBS (Orange line). Horizontal accesses represent morphologies described in Figure 2a (M: M Type, N: N Type, O:G: O Type, G: G Type, A: A Type, and D: D Type). A minimum of 500 cells were counted per week per cell line, per condition.

Additional file 1: Figure S1. Growth inhibition assays for A) Cisplatin and B) Etoposide for NG cell lines Jed38_MN, Jed45_MN and Jed49_MN.

Additional file 5: Figure S3. CSCs markers expression in situ. A) Images for immunofluorescence co-staining of stem cell markers CD133+Sox2+ (Green, Red) or Nestin+Ki67+ (Green, Red) and AGR2+ BMI1+ (Red, Green) in low grade (Jed62_MN) and high grade (Jed45_MN) tumors. B) Mean percentages of co-positive cells. Error bars represent count errors between three independent regions within each tissue. All images were taken at 20Ă .

Mobile phones and tablets shipments are surpassing those of the PC category, as well as in relation to Internet usage as of 2016; all details which have made mobile adoption a priority for many enterprises and a challenge for them as well. Many enterprises have fallen into a paradox of spending on creating and updating mobile services, and gaining less than expected in return.\ud Reasons for this include the lack of vision, and the lack of a clearly defined, well communicated mobile strategy. Enterprise Architecture ‘EA’ facilitates a successful transformation by controlling and managing the transitions in order to arrive at a clearly defined future state. It is regarded as the science of change to many. However, EA frameworks are very comprehensive and require weeks of training and resources, and are often too generic for mobile transformation.\ud Therefore, an EA-based mobile holistic enterprise framework has been developed to support enterprises in making mobile initiatives a priority. The proposed framework ensures a clearly defined, well-communicated, holistic future state that is continually evaluated, as opposed to many of the existing frameworks.\ud The proposed Mobile Holistic Enterprise Architecture Framework - ‘MHETF’ - is based on the realisation of the capabilities of smartphones that are aimed at individual average consumers (the backbone of the current mobile trend). The capabilities are categorised and translated into four sets of services categories for business use. They are linked to another two components of the framework which are: (i) the categorisation of goals and objectives that are incorporated into the Balanced Scorecard for evaluation at a later stage in planning, and continually referred to during transitions and (ii) the categorisation of the implementation forms (categorisation of end solutions’ functionalities).\ud The framework is supported by EA inter-operability and maturity models to ensure continuity and alignment with the existing initiatives, the enterprise’s strategic objectives, and the change required in the scope of transformation. An evaluation for the available enterprise architecture frameworks was carried out and resulted in the selection of The Open Group Architecture Framework (TOGAF). The decision was also commended by the participants in the case study evaluation due to their familiarity with this framework, which is being adopted as the Saudi E Government Standard in contrast to the other major frameworks of Zachman and Federal Enterprise Architecture (FEA). MHETF has been applied to three case studies in the Kingdom of Saudi Arabia; two applications for a leading national outsourcing company, and the third for\ud the outpatient clinics in a large hospital in the capital city of Riyadh. The results have shown major improvements in the four goal areas of mobile transformation; productivity, processes, satisfaction improvement and facilitating new opportunities. Eventually, the final evolution has\ud shown that the participants are satisfied with the framework overall, and indicates that the framework changed their perspective of the power of mobile applications significantly, is relatively easy to understand, and that they are planning to adopt it for future mobile initiatives.

Background: Waterpipe (hookah) smoking is gaining in popularity as a form of smoking tobacco. There is a noticeable increase in hookah smoking worldwide, among young adults. There is a growing body of literature that indicates that college students may not be as knowledgeable as should be in making decisions about smoking waterpipes. Purpose: This study was performed to evaluate the prevalence, knowledge, attitudes and beliefs regarding hookah (waterpipe) use among college-based health care students. Methods: Participants in this study were chosen based on their readiness and willingness to participate. The questionnaire was distributed by the researcher to graduate students through a link for a web-based survey. A paper copy was distributed in class to undergraduate students only. There were 319 college-based health care students who participated in this study from the following specialties: nursing, physical therapy, respiratory therapy, occupational therapy and nutrition. Data were analyzed using descriptive statistics. Results: Respondents have used or tried hookah (waterpipe) smoking before (n=156, 49%), while the majority of students who have not tried or used the hookah smoking (n=163, 51%). Students were able to identify health hazards that might result from hookah smoking, for example cancer (n=258, 80.9%), respiratory problems (n=308, 97%), cardiovascular impairments (n=202, 63%), hematological impairments (n= 98, 31%), harm during pregnancy (n=214, 67%), and diarrhea (n=37, 11.6%) as potential health hazard. This study showed that 187 students (58.6%) believed that cigarette smoking is more harmful than water pipe smoking due to the false beliefs that they have. There was also general disagreement regarding students? attitudes and opinions about waterpipe smoking. Finally, this study showed the reasons why students engage in hookah smoking; for example, (241, 75.5%)of the students reported that the reason for water pipe smoking is an increased opportunity to smoke a water pipe in cafes, etc. Also, students said other reasons like flavor/aroma of Hookah itself (219, 68.7%), and utility of water pipe in leisure & pleasure activities (217, 68%). Conclusion: This study showed that the prevalence of hookah (waterpipe) smoking is common among students in health care especially in young adults. Further studies are needed to ask more students and at different institutions. Finally, we recommended conducting educational campaigns to increase students? knowledge and awareness and to correct the wrongs beliefs and attitudes.

Additional file 2: Figure S2. H&E slides for studied variants including meningothelial (Jed18_MN, Jed34_MN, and Jed39_MN) showing lobules of uniform eosinopholic cells with central nuclei and intranuclear inclusions forming abundant whorls with no evidence of atypia, necrosis or mitosis; fibroblastic (Jed33_MN, Jed40_MN, and Jed49_MN) showing spindle cells with indistinct cell boundaries running in fascicle; transitional (Jed04_MN, Jed36_MN, and Jed38_MN) with ratios of meningothelial to fibroblastic patterns ranging from 20:80 for Jed04_MN, 50:50 for Jed09_MN, 30:70 for Jed36_MN, and 40:60 for Jed38_MN; rhabdoid (Jed45_MN) showing hypercellular sheets with rhabdoid morphology (eccentric pleomorphic nuclei, abundant esinophilic cytoplasm) and necrosis; psammomatous (Jed43_MN) composed of whorled clusters of spindle cells with numerous psammoma bodies; and angiomatous (Jed12_MN) showing neoplastic growth in the form of nests and whorled of bland- looking polygonal cells with vascular component exceeding 50% of total tumor area and with no evidence of atypia, necrosis or mitosis. All images were taken at 20Ă .

Purpose Methods and materials Results Conclusion Personal information References, Purpose: The need to improve patient management in the surgical theatre has led to the development of many new medical imaging systems [1,2]. The Hybrid Compact Gamma Camera (HCGC) has been developed to provide additional localisation information during...

Background. Primary hyperparathyroidism is rare in pregnancy. An association between primary hyperparathyroidism and preeclampsia has been reported in few cases worldwide. Case. A 28-year-old woman (gravida 2, para 0, and abortus 1) in her 27th week of gestation was hospitalized due to a high reading of blood pressure (194/115 mmHg) that was not accompanied by any symptoms or signs of preeclampsia. Incidentally, she was found to have a high adjusted calcium and serum parathyroid hormone (PTH) level during admission. Ultrasonographic examination of the neck revealed the presence of parathyroid adenoma. She was scheduled for surgical excision after receiving an intravenous hydration. Fetal ultrasonography revealed a growth restricted fetus with normal biophysical profile. On the sixth day of hospitalization, the patient complained of headache and epigastric pain, with elevated BP and proteinuria. The fetal nonstress test was “nonreassuring.” Subsequently, she had an emergency cesarean delivery and surgical removal of the adenoma. The mother and her newborn were then transferred to intensive care, where their clinical course was unremarkable. The mother was discharged after 3 days, while the neonate stayed for close observation for 60 days. Conclusion. Early recognition of primary hyperparathyroidism among women with preeclampsia is important to prevent maternal and fetal morbidity and mortality.

Additional file 1: Figure S1. Cell viability assay on HUVEC treated with sunitinib. Figure S2. Effect of metformin on euglycemia-hypoxia treated CD34+ cells. Figure S3. Validation of selected pro-angiogenic factors and angiogenic inhibitors in CD34+ cells by qRT-PCR. Figure S4. Heatmap of the pro-angiogenic and angiogenic inhibitors in CD34+ stem cells. Table S1. Effect of 3 h hypoxia on biological functions involved in CD34+ cells. Table S2. Top 30 differentially expressed genes in CD34+ cells induced by hyperglycemia compared to control. Table S3. Top biological functions involved in CD34+ cells cultured in hyperglycemia. Table S4. Top canonical pathways involved in CD34+ cells cultured in hyperglycemia. Table S5. Top 30 differentially expressed genes in CD34+ cells induced by hyperglycemia and treated with metformin compared to hyperglycemia. Table S6. Effect of metformin on canonical pathways involved in CD34+ cells cultured in combined hyperglycemia-hypoxia for 3 h. Table S7. Comparison of microarray and real-time PCR data on CD34+ cells treated with hypoxia, hyperglycemia and hyperglycemia-hypoxia in the presence and absence of metformin.

The remarkable advances of mobile technologies and the prevalence of mobile devices have profoundly transformed telephony systems. They provide functionalities which surpass telephony needs, and which motivate the development of value-added mobile services and functions. The number of mobile phones in use far exceeds any other technical devices that could be used to market, sell, produce, or deliver products and services to consumers. These developments open lucrative opportunities to retailers and service providers. The literature highlights the fact that mobile transactions (m-transactions) are one of the most critical incentives for successful mobile commerce (m-commerce). However, the successfulness of m-transaction systems in Saudi Arabia requires a strong acceptance of the Saudi consumers. The importance of this study is accentuated by the fact that mobile commerce and its services are still in their infancy and there is still an apparent lack of acceptance of mobile transactions amongst Saudi users. Research needs to address the issue of acceptance of m-transactions from the user’s perspective, particularly within developing countries as they suffer from a noticeable lack of studies in this field. This research initially starts with a comprehensive literature review about the critical factors affecting the acceptance and use of electronic commerce (e-commerce), m-commerce and focuses on m-transactions, including different technology acceptance models and theories, helping to investigate whether there exists an effective comprehensive framework for adopting m-transactions within the context of Saudi Arabia and, more specifically, from a consumer’s perspective. Furthermore, to emphasize the true value measure of m-transaction, we must comprehend and evaluate the potency and limitations of mobile purchasing and the key factors affecting the m-transaction use decision. M-transactions hold a huge potential for online business and sales, but merely having an m-transaction service “hosted” on the World Wide Web (WWW) should not lead us to believe that customers will rush into mobile commercial websites for their desired products. Recognising that fact and realizing that there are different important factors and concerns over m-transactions playing a significant role, highlight the need for investigating and developing a framework that encompasses the critical factors affecting the intention to use m-transaction within the context of a Saudi consumer’s perspective. In order to achieve this goal, this study evolved in several stages aiming to reach a satisfactory level of maturity. These stages can be divided into three main phases: (1) exploratory phase which contains three exploratory studies which helped to add the cultural qualities as a further dimension that would play a significant role in such a unique cultural region. Consequently, a holistic framework is integrated that includes the key factors affecting the intention to use m-transactions. This framework is empirically validated in (2) a further study using a statistically representative sample size of 1008 Saudi users from different demographic backgrounds. The empirical analysis revealed that security, ease of use, usefulness, social influence, navigational structure, telecommunication infrastructure, individualism, masculinity, power distance, uncertainty avoidance, and visual appeal have a significant impact on the intention to use m-transactions. Amongst those factors, ease of use was the most significant influential factor. Therefore, this led to (3) another study aiming to empirically investigate the level of ease of use (usability) of conducting m-transactions within the Saudi context. In total, this research comprised five different empirical studies to extend our understanding of the phenomenon of m-transactions. The ultimate product of this research is to develop a consolidated framework for the intention to use m-transactions, combined with a set of recommendations for mobile websites and application developers, designers, government, and other organizations that intend to extend their business in the mobile commerce area, and this should eventually benefit the users.