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ObjectivesInvestigate the weaponization of water during the Syrian conflict and the correlation of attacks on water, sanitation, and hygiene (WASH) infrastructure in Idlib and Aleppo governorates with trends in waterborne diseases reported by Early Warning and Response surveillance systems.MethodsWe reviewed literature and databases to obtain information on attacks on WASH in Aleppo and Idlib governorates between 2011 and 2019. We plotted weekly trends in waterborne diseases from two surveillance systems operational in Aleppo and Idlib governorates between 2015 and early 2020.ResultsThe literature review noted several attacks on water and related infrastructure in both governorates, suggesting that WASH infrastructure was weaponized by state and non-state actors. Most interference with WASH in the Aleppo governorate occurred before 2019 and in the Idlib governorate in the summer of 2020. Other acute diarrhea represented >90% of cases of diarrhea; children under 5 years contributed 50% of cases. There was substantial evidence (p < 0.001) of an overall upward trend in cases of diarrheal disease.ConclusionsThough no direct correlation can be drawn between the weaponization of WASH and the burden of waterborne infections due to multiple confounders, this research introduces important concepts on attacks on WASH and their potential impacts on waterborne diseases.

Background The Syrian conflict has had a profound impact on Syrian children and adolescents. We sought to determine the extent and range of literature on the conflict's health effects on this vulnerable population. Methods A scoping review describing the impact of the Syrian conflict on children was undertaken while utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews methodology. Qualitative thematic analyses were undertaken to both identify patterns of morbidity and mortality and gaps in evidence. Results A total of 982 articles meeting search criteria were identified between 1 January 2011 and 30 April 2021. After iterative screening, 12 were identified from academic databases and 4 were identified from grey literature and hand searching, yielding a total of 16 studies for final, full-text analysis. Four distinct themes recurred in the literature; these include children suffering from violent injury, a resurgence of communicable diseases, malnutrition and micronutrient deficiency and impacts on their mental health. Conclusions The health of children and adolescents in Syria has been significantly impacted by the indiscriminate attacks against civilians, flagrant human rights violations and the disintegration of the national health care system. Neonates were largely absent from the literature. The themes from this scoping review can inform health programming priorities by aid organizations. [ABSTRACT FROM AUTHOR]

Background: Steroids are an important pharmacologic treatment in patients with eosinophilic esophagitis (EoE). Fluticasone and budesonide are the 2 main steroid medications used in EOE treatment, but current United States (US) guidelines do not recommend one agent over the other. In this study, we conducted a meta-analysis to compare important patient outcomes when both agents are used. Methods: A comprehensive search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was performed from each database's inception to March 29th, 2023. Two independent reviewers systematically identified trials that compared the effect of budesonide vs. fluticasone in the management of EoE. A meta-analysis was performed using a fixed-effects model. The primary outcome was the histologic response (defined as an eosinophil count <15 per high-power field) which reflects the response to treatment. Results: Three studies met our inclusion criteria and were included in the analysis, with a total of 272 patients. All studies were carried out in the US and 1 was a randomized controlled trial. Our meta-analysis showed no statistically significant difference with the use of budesonide compared to fluticasone in achieving a histologic response (odds ratio 1.29, 95% confidence interval 0.77-2.14; P=0.34; I2=0%). Conclusion: Our systematic review and meta-analysis indicated no difference between budesonide and fluticasone in achieving a histologic response in patients with EoE. [ABSTRACT FROM AUTHOR]

Copyright of Neurosciences is the property of Neurosciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We describe the properties of novel III-N-based insulating gate heterostructure field-effect transistors (HFETs). For the gate isolation, these devices use either Si[O.sub.2] layer (in metal-oxide-semiconductor HFET (MOSHFET) structures) or [Si.sub.3][N.sub.4] layer (in metal-insulator-semiconductor HFET structures). These insulating gate HFETs have the gate-leakage currents 4-6 orders of magnitude lower than HFETs, even at elevated temperatures up to 300[degrees]C. A double-heterostructure MOSHFET with Si[O.sub.2] gate isolation exhibits current collapse-free performance with extremely low gate-leakage current. Insulating gate devices, including large periphery multigate structures, demonstrate high-power stable operation and might find applications in high-performance power amplifiers and microwave and high-power switches with operating temperatures up to 300[degrees]C or even higher. Index Terms--AlGaN, FET, GaN, heterostructure FET (HFET), microwave, metal-oxide-semiconductor HFET (MOSHFET).

Background and Aim: Autoimmune pancreatitis (AIP) and inflammatory bowel disease (IBD) are categorized into immune‐mediated inflammatory disorders (IMIDs). While AIP is a pancreato‐biliary IMID with an increased incidence and prevalence among patients with IBD, its features are still unclear. This systematic review and meta‐analysis aims to assess the prevalence and clinical characteristics of AIP‐IBD patients. Methods: Electronic databases were searched to identify observational studies assessing AIP and IBD. The primary outcome was the prevalence of IBD among AIP patients, and vice versa. Secondary outcomes included clinical findings and outcomes of each IMID in AIP‐IBD patients. The pooled rate of each outcome was determined using a random effects model. Results: For primary outcomes, 40 observational studies with 4031 AIP patients were included and the pooled prevalence of IBD was 10.5% (95% CI 7.2–15.0%). Meanwhile, five studies with 10,551 IBD patients were included and the pooled prevalence of AIP was 0.6% (95% CI 0.2–1.9%). For secondary outcomes, 53 observational studies with 469 AIP‐IBD patients were assessed. The rates of type 2 AIP and ulcerative colitis were 79.2% (95% CI 69.1–86.6%) and 74.8% (95% CI 68.2–80.4%), respectively. We also demonstrated AIP‐IBD patients were at a significant increased risk of AIP recurrence and colectomy compared with patients with either AIP or IBD (RR = 1.9, 95% CI 1.1–3.1 and P = 0.014 and RR = 3.7, 95% CI 1.9–6.9, P < 0.001, respectively). Conclusions: Our meta‐analysis reported the prevalence of AIP‐IBD patients and demonstrated patients with both IMIDs had a high risk of poor outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Constipation among peritoneal dialysis (PD) patients can lead to serious complications and impair the quality of life. The aim of this study was to determine the prevalence of constipation and its associated factors among PD patients in our center. Methods: A quantitative, cross-sectional study was conducted on PD patients at King Khaled University Hospital in Riyadh, Saudi Arabia, from November 2016 to January 2017. Results: A total of 36 PD patients were included; the male to female ratio was 1. Based on a self-reporting questionnaire, 15 PD patients (41.7%) reported suffering from constipation. However, the prevalence was the same using at least one of Rome III criteria (41.7%) and much lower using Bristol stool form Scale (11%). No significant difference was detected between PD patients with and without constipation in terms of dietary fiber intake, use of calcium and iron supplements, water intake, presence of diabetes and hypertension, or demographic profiles. Conclusion: The high prevalence of constipation among PD patients seen in our population is comparable to those seen in other studies. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. The clock drawing test (CDT) is frequently used to detect changes in cognition. Multiple scales of varying length have been published to assess performance. The aim of this study is to compare the CDT performance measured by three scales among a sample of nondemented patients on renal dialysis and identify the variables that affect performance. Methodology. This is a cross-sectional study performed at the dialysis unit at King Saud University Medical City. Eighty-nine dialysis patients performed the CDT. The CDT was scored by the methods of Rouleau et al. (RCS 10-point), Babins et al. (BCS 18-point), and the MoCA (MCS 3-point). Regression models were used to determine influencing demographic and dialysis variables. Scores were then correlated, and a combined factor analysis of scale components was done. Results. Females represented 44.6%, the mean (SD) age was 49.99 (15.49) years, and education duration was 10.29 (5.5) years. Dialysis vintage was 55.81 (62.91) months. The scores for the MCS, RCS, and BCS were 2.18 (1.08), 6.67 (3.07), and 11.8 (5.5), respectively, with significant correlation (P < 0.0001). In all scales, increasing age was associated with a lower score (each P < 0.0001). The scores increased with increasing education (each P < 0.0001). Diabetics had a lower score on both the BCS and MCS by 2.56 (SE 1.2) (P = 0.035) and 0.71 (P = 0.003) points, respectively. However, only age and years of education were significant in the multivariable analysis. In factor analysis, two shared factors appeared between the three scales: hand and number placement and the clock face. Conclusion. Age and education influence the performance on the CDT, and factors diverged into executive and visuospatial components. The MCS is likely to yield useful information but should be interpreted as part of the MoCA. [ABSTRACT FROM AUTHOR]

No models exist for fully depleted silicon-on-insulator (FD-SOI) metal-oxidesilicon field-effect-transistors (MOSFETs) that operate at high currents and voltages. Operation at high currents and voltages dictates the radio-frequency (rf) output power that such devices can deliver and transmit from the particular rf-integrated circuits used in today's cellular phones. In this work, a first order dc model for FD-SOI MOSFETs that are specifically designated to operate at high biases and large rf swings is presented. These devices typically incorporate HALO and body-tied-source (BTS), which enable much higher biases to be applied to the gate and drain and allow larger rf swings. They also employ dual-gated designs that further reduce the threshold voltage and increase the current. Although the newly established model accurately replicates the general dc behavior of any FD-SOI MOSFET that incorporates HALO and BTS, it is specifically tailored to an innovative and recently patented device structure for FD-SOI MOSFET. The new structure adopts an improved and unique design for BTS and HALO that most effectively filters the impact-ionization current to BTS and improves the device performance. New design rules that enable the designs of areaefficient layouts for FD-SOI MOSFETs that incorporate the HALO and BTS are also presented. [ABSTRACT FROM AUTHOR]

Background: Constipation is commonly encountered in clinical practice. The global population is witnessing a rapid increase in its occurrence. Objectives: Since there is paucity of data in Saudi Arabia, there is a need to assess its prevalence in Saudi population. This study was performed as a pilot to determine the symptoms and prevalence of constipation among adult population of Riyadh city. Materials and Methods: A questionnaire based cross sectional survey was done through twitter among Riyadh based accounts. The study was conducted among 388 adults older than 20 years, between November 2016 and January 2017. For the diagnosis of constipation three criteria were used; self-perception, Rome III and Bristol's criteria. Results: Our study showed that the prevalence of constipation in general population is 43%, 60% and 25% according to the three criteria, respectively. Females tend to have greater prevalence than males though not statistically significant. Multivariate analysis showed low dietary intake of fruits and vegetables, middle age (40- 49years), and strained defecation significantly associated with constipation. As per Bristol's criteria the most common stool form was Type 3 (sausage shaped with cracked surface). Conclusion: These findings suggest high prevalence of constipation among Saudi population. A wider margin of variation in rates by the three criteria is obtained. Limitation: This twitter based survey may only be considered as a pilot study and is non-representative of general population. [ABSTRACT FROM AUTHOR]

Abstract: Background: The axillary artery has been used as an alternate inflow source for revascularization of the lower extremities for four decades. Since 1997, there have been several reports of axillary artery to coronary artery bypass. Methods: All cases of axillary artery to coronary artery bypass at our institution from 1997 through 2003 were reviewed. PubMed was queried for publications on this subject and all pertinent reports were reviewed. Results: Thirty-eight patients underwent axillary artery to coronary artery bypass at our hospital. Most (34) of the operations were performed without cardiopulmonary bypass. Saphenous vein (37) or radial artery (1) grafts were placed to one or more coronary arteries from either the left (36) or right (2) axillary artery. Twenty patients underwent sternotomy, and 18 had either a left (16) or right (2) minimally invasive direct coronary artery bypass (MIDCAB) procedure performed. Most of the sternotomies were for primary myocardial revascularization and most of the MIDCABs were reoperations. There were three deaths—all from non-cardiac causes, one myocardial infarction, and one transient brachial plexus injury. Doppler ultrasound, angiographic, and clinical follow-up were limited, but graft patency has been demonstrated up to 9 years. Conclusion: Axillary artery to coronary artery bypass should be part of the armamentarium of surgeons who perform myocardial revascularization operations. [Copyright &y& Elsevier]

The article presents an answer to the country cardiograms case 40 in this issue. The patient's sinus rhythm, coincidental chest muscle twitches with the pacemaker spikes seen on a heart monitor, and recent insertion of a pacemaker are discussed. A loosened pacemaker wire was identified and repositioned.

Background: Climate change impacts health and threatens the stability of care delivery systems, while healthcare is mobilizing to reduce its significant environmental impact., Objective: This study aimed to assess knowledge, attitudes, and practices (KAP) about climate change among Canadian kidney care providers., Design Setting Participants Measurements and Methods: An electronic KAP survey, created by the Canadian Society of Nephrology-Sustainable Nephrology Action Planning committee, was distributed to kidney care providers across Canada, from March to April 2023., Results: A total of 516 people responded to the survey. Most respondents (79%) identified as women; 83% were aged 30 to 59 years. Nurses and nephrologists made up 44% and 23% of respondents, respectively. About half of the participants felt informed about climate change to an average degree. Most respondents (71%; 349/495 and 62%; 300/489) were either extremely or very concerned about climate change and waste generated in their kidney care program, respectively. The vast majority of respondents (89%; 441/495) reported taking steps to lower their personal carbon footprint. People who felt more informed about climate change presented higher degrees of concern. Similarly, both those who felt more informed and those who reported higher degrees of concern about climate change were more likely to take steps to reduce their carbon footprint. Over 80% of respondents (314/386) were at least moderately interested in learning sessions about environmentally sustainable initiatives in care., Limitations: This survey is at risk of social acceptability, representative, and subjective bias. Overrepresentation from Quebec and British Columbia, as well as the majority of respondents identifying as women and working in academic centers, may affect generalizability of the findings., Conclusions: Most kidney care providers who responded to this survey are informed and concerned about climate change, and their knowledge is directly associated with attitude and practices. This indicates that educational initiatives to increase awareness and knowledge on climate change will likely lead to practice changes., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Sandal has received an education grant from Amgen Canada to increase living donor kidney transplantation and improve outcomes of patients with graft failure. Dr. Samanta has received honoraria from GSK, Novartis, Otsuka, and Amgen. The rest of the authors have no relevant conflict of interest to disclose. The funding organizations had no role in the study design and conduct, data collection and management, interpretation of the results, and manuscript preparation., (© The Author(s) 2024.)

Introduction: Syria's protracted conflict has devastated the health system reversing progress made on maternal health preconflict. Our aim is to understand the state of maternal health in Syria focused on underage pregnancy and caesarean sections using a scoping review and quantitative analysis; the latter draws on data from the Syrian American Medical Society's (SAMS) maternal health facilities in northwest Syria., Methods: We performed a scoping review of academic and grey literature on the state of maternal health across Syria since the onset of conflict (taken as March 2011). Identified articles were screened using pre-established criteria and themes identified. We also performed a retrospective quantitative analysis of maternal health data from SAMS' facilities in a microcontext in north-west Syria between March 2017 and July 2020, analysing the trends in the proportion of births by caesarean section and age at pregnancy., Results: Scoping review: of 2824 articles, 21 remained after screening. Main themes related to maternal mortality rates, caesarean sections, maternal age and perinatal care. 12 studies reported caesarean section rates; these varied from 16% to 64% of all births: northern Syria (19%-45%,) Damascus (16%-54%,) Lattakia (64%) and Tartous (59%.) Quantitative analysis: Of 77 746 births across 17 facilities, trend data for caesarean sections showed a decrease from 35% in March 2017 to 23% in July 2020 across SAMS facilities. Girls under 18 years accounted for 10% of births and had a lower proportion of caesarean section births. There was notable geographical and interfacility variation in the findings., Conclusion: The quality of available literature was poor with country-level generalisations. Research which explores microcontexts in Syria is important given the different effects of conflict across the country and the fragmented health system. Our quantitative analysis provides some evidence around the changes to caesarean section rates in northwest Syria. Despite limitations, this study adds to sparse literature on this important topic., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Up to 80% of patients with Crohn's disease (CD) undergo intestinal resection at one point. However, the risk of post-operative recurrence (POR) increases with time, with half of these patients developing recurrence at five years after surgery. Treatment with anti-tumor necrosis factor (anti-TNF) agents has been shown to decrease the risk of clinical and endoscopic recurrence post-operatively. This meta-analysis aims to compare the rate of the two mostly commonly used anti-TNF agents (infliximab (IFX) and adalimumab (ADA)) and their efficacy in maintaining clinical and endoscopic remission in CD patients who were treated with adalimumab versus infliximab after surgery., Methods: A comprehensive search of Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus was conducted from each database's inception to May 29th 2021. Comparative studies assessing the efficacy and safety of infliximab and adalimumab for postoperative CD patients were included. Primary outcomes included postoperative clinical and endoscopic remission. Secondary outcome was the risk of adverse events due to anti-TNF agents. Pooled event rates were calculated per person-year of follow-up., Results: Four studies with total of 361 CD patients were included in the final analysis. Our meta-analysis showed no statistically significant difference in maintaining clinical and endoscopic remission rates between patients treated with infliximab and those with adalimumab (Pooled incidence rate ratio of 0.75 (95% CI 0.43-1.3), and 0.94 (95% CI 0.71-1.2), respectively) (Figure 1A, 2A). There were low to moderate heterogeneities (I2 = 57.1% for clinical remission and I2 = 0% for endoscopic remission). The funnel plot in each analysis indicated no publication bias, which was supported by Begg's and Egger's tests (Figure 1B, 2B). There was also no significant difference in the risk of adverse events between the two groups (RR= 0.56, 95% CI 0.068-4.5) (Figure 3)., Conclusion: Our meta-analysis demonstrated comparable efficacy of infliximab and adalimumab in maintaining post-operative clinical and endoscopic remission in Crohn's disease, with similar rates of adverse events. Our meta-analysis was limited by the small number of total studies and patients included and the lack of randomized controlled trials., (Copyright © 2021 by The American College of Gastroenterology.)

Competing Interests: Competing interests: None declared.

Objectives: Although necrotic lesions are common in proliferative lupus nephritis (LN), little is known about the impact of these lesions on outcomes. This study was undertaken to investigate the impact of glomerular necrotic lesions on renal outcomes of doubling serum creatinine in patients with class III and IV LN and necrotic lesions., Methods: 52 patients with ISN/RPS class III or IV LN were enrolled in this retrospective study, with mean follow-up of 7.4 years. All patients underwent a repeat biopsy at 12-18 months after a baseline biopsy., Results: The prevalence of necrotizing lesions was observed in 24% of those with class III versus 70.4% with class IV (P=0.001). The rate of no remission was 44% and 22.2% in those with and without necrosis (P=0.007), respectively. The doubling of serum creatinine was observed in 32% of those with necrosis and in 14.8% with no necrosis (P=0.01). The chronicity index in the repeat biopsy was significantly worse among those with necrosis., Conclusions: Glomerular necrosis identifies lupus nephritis patients at the greatest risk for progression to renal failure. Proactive intervention and possibly more aggressive induction therapies in patients with necrotizing lesions may protect the kidneys from developing chronic renal impairment.

We conducted a group interview with five hemodialysis patients of Acadian descent. Our purpose was to learn about their intakes of Acadian foods so we could tailor our advice for other Acadian patients receiving hemodialysis. This approach builds on evidence that addressing cultural aspects of food choice and aligning dietary recommendations with usual intakes create optimal conditions for diet adherence while preserving personal habits and heritage. In this study, "the Acadian diet" held multiple meanings for different participants, participants varied in their intakes of traditional Acadian foods, intakes of traditional Acadian foods were decreasing in younger generations, and the desire to preserve kidney function had priority over eating much-loved traditional foods. These findings support the practices of individualized nutritional and dialysis care and discourage generalized nutrition messages based on assumptions of homogeneity of all people within a cultural group.