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Revealing customer satisfaction through big social data has been an interesting research topic in tourism and hospitality. Big data analysis is an effective way to detect customers’ behaviors in their decision-making. This study aims to perform big social data analysis to reveal whether food quality impacts the relationship between hotel performance criteria and travelers’ satisfaction. A two-stage methodology is developed to address the objectives of this study. The findings demonstrated that there is a positive relationship between eco-friendly hotels’ performance criteria and satisfaction. The results and implications for managers and future research directions are discussed.

I ntroduction: The severity of chronic renal failure (CRF) classified by professional guidelines in five stages, stage 5 is a severe illness often called end stage kidney failure or end stage renal disease (ESRD), dialysis may be used for this stage. Dialysis treatments replace some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal). Hemodialysis, is a process of purifying the blood, when the kidneys are not working normally. It is one of three renal replacement therapies (the other two being peritoneal dialysis and renal transplant). Materials and Methods: The samples of this study consists of 80 patients (42 males, 38 females) and 85 healthy individuals (43 males, 42 females) from (20 - 70) years old of age. Serum paraoxonase-1 (PON1), `5-nucleatidase, blood urea ( BU), serum creatinine Cr, serum iron (Fe), serum total iron binding capacity (TIBC), Serum feritin, serum amylase activity and serum lipase activity were determined. Some hematological parameters includes packed cell volume (PCV), hemoglobin (Hb), white blood cells count (WBCs), red blood cell count (RBCs) were measured, the erythrocyte sedimentation rate (ESR), Body mass index (BMI) and creatinine clearance Ccl were also measured. Results: Decreased levels of some enzymes activity and some biochemical and hematological parameters and increased others in continuous and regular hemodialysis patients in Kirkuk city. Blood urea and serum creatinine showed significant increased (P˂0.05) in their levels, while the creatinine clearance was significantly decreased (P˂0.05) in patients with continuous hemodialysis patients when compared to those of controls . In the present study; there was significant decreased (P˂0.05) in PON-1 in patients when compared to those of controls. However, the serum`5-NT, amylase and lipase activities were significantly increased (P ˂ 0.05) in these patients when compared with serum of normal individuals. In the present study; there was significant decreased in Fe and TIBC concentrations in the serum of patients when compared to those of healthy control individuals (P˂0.05). While the serum ferritin was significantly increased (P˂0.05) in these patients as compared to the controls. In the present study; there was significant decreased (P ˂ 0.05) in Hb and PCV and RBCs concentrations inthese patients when compared to those of controls. While WBCs and ESR was significantly increased (P˂0.05) in these patients as compared to the controls. Conclusion: Serum paraoxonase PON -1 activity is the most commonly affected than other biochemical parameters in continuous hemodialysis patients. Anemia, pancreatitis are the common and often an early complication of chronic renal diseases. http://dx.doi.org/10.25130/tjps.23.2018.031

The food industry has been widely regarded as an effective sector due to its contribution to the national economy, job creation, and people's welfare. Malaysia as one effective country in the food industry and leading country in Halal food brand emphasized the importance of food quality in both operation and supply chain. Despite the importance of the Halal food industry to countries' economy including Malaysia, this industry is facing multiple challenges. In addition, halal food literature still in the infant stage despite the rapid growth of this important industry. Therefore, this review study aims to identify the challenges that surrounded the Halal industry worldwide generally and Malaysian firms particularly. This study also aims to identify the potential solution to overcome Halal food challenges. The finding of this study uncovers multiple challenges surrounded the Halal food industry in operation, marketing, and certification processes. This study also suggests that the application of the manufacturing execution system can bring a new insight to overcome Halal food challenges. This study contributes to the body of knowledge by providing a clear understanding of Halal food industry operation and certification and their challenges and explains how MES can improve the efficiency of this industry.

Objective This study is designed to assess the polypharmacy use by elderly patients having multimorbidity in Kirkuk, Iraq Methodology. This descriptive cross sectional study conducted over one year period (1 January - 31 December, 2017) with 105 adults (75 females and 30 males) aged ≥65 years, who attended outpatient clinic of the Geriatric Medicine Department in Azadi Teaching Hospital in Kirkuk Province in Iraq. Patients with ≥2 considered as multimorbidity subjects and patients taking >5 medications considered as polypharmacy subjects. Data were collected directly from the patients by face-to-face interview technique Results The mean age was 70.49±3.88 years. The most common diseases were Hypertension and diabetes mellitus (n: 105, 100%). It was determined that (n: 95, 90.5%) of patients aged 65 to 74 years and (n: 10, 9.5%) of patients aged 75 to 82 years had multimorbidity, the difference between the two age groups was statistically significant. The mean number of drugs used by participants was 7.3±1.1 drug/ day, the highest polypharmacy was 6,7 and 8 drugs per day (n: 31, 29.52%), (n: 30, 28.57%) and (n: 30, 28.57%) respectively. There was a statistical significant increase in polypharmacy with the increase in the multimorbidity. Conclusion The prevalence of polypharmacyin multimorbid elderly patients was very high.

Infectious diseases are the common cause of morbidity and mortality among humans. Electrolyte imbalance occurs frequently in patients with infectious diseases. This study aims to identify electrolyte imbalances in hospitalised patients with infectious diseases.Two hundred and eighty-three patients with age mean 36.48 ± 18.86 years, consisting of 127 (53.4%) males, 111 (46.6%) females, enrolled in a retrospective cohort study carried out at the King Abdulaziz University Hospital, Jeddah, KSA from September to December 2020. All hospitalised patients with infectious diseases were included. Demographic data, comorbidity, and diagnosis were collected from patients' sheets. Serum levels of electrolytes (chloride, potassium, sodium), urea, and creatinine were collected at admission (period 1), during hospital stay (period 2), and at discharge (period 3). Levels were compared during different periods.Most infectious diseases were viral infections (63.4%), while comorbidity was diabetes mellitus (7.1%). Serum chloride elevated from period 1 to period 3 (P = 0.046). Sodium elevated between period 1 and both period 2 and period 3 (P 0.001). Urea decreased between period 1 and both period 2 (P = 0.018) and period 3 (P 0.001). Creatinine decreased between period 1 and both period 2 and period 3 (P 0.001) and between period 2 and period 3 (P 0.001). Patients with decreased chloride and sodium levels were mostly in the 1st period, while those with decreased potassium levels were mostly in the period 2.Prevalence of electrolyte imbalance in hospitalised patients with an infectious disease at the King Abdulaziz University Hospital, Jeddah was high, especially at admission and during the hospital stay.الأمراض المعدية سبب شائع للأمراض والوفيات بين الناس. الخلل بتوازن الكهارل يحدث بكثرة لدى مرضى الأمراض المعدية. هدفت هذه الدراسة إلى معرفة الخلل بتوازن الكهارل لدى المرضى المصابين بأمراض معدية بالمستشفيات.فى هذه الدراسةالاستعاديةتم إدراج 283مريضا متوسط أعمارهم 36.48 ± 18.86 سنة؛يتألفوا من 127 (53.4٪) من الذكور و111 (46.6٪) من الإناث. أجريت هذه الدراسه بمستشفى الملك عبد العزيز الجامعي في جدة، المملكة العربية السعودية في الفترة من سبتمبر إلى ديسمبر2020. شملت الدراسة جميع المرضى المقيمين المصابين بأمراض معدية في المستشفيات. تم جمع وتسجيل البيانات الديمغرافية، والأمراض المصاحبة وتشخيص الأمراض المعدية من ملفات المرضى. وتم جمع مستويات المصل من الكهارل (الكلوريد والبوتاسيوم والصوديوم)، واليوريا والكرياتينين التي يتم قياسها في وقت الإدخال للمستشفى (الفترة 1)، وأثناء الاستشفاء في المستشفى بعد التشخيص (الفترة 2) وعند الخروج من المستشفى (الفترة 3). وتم مقارنة المستويات خلال الفترات المختلفة.كانت أغلب الأمراض المعدية عبارة عن التهابات فيروسية (63.4%)، في حين كانت الأمراض المصاحبة مرض البول السكري (7.1%). ووجد ارتفاع الكلوريد فى المصل بشكل ملحوظ من الفترة 1 إلى الفترة 3، وارتفع الصوديوم بشكل ملحوظ بين الفترة 1 والفترة 2 والفترة 3، بينما انخفضت اليوريا بشكل ملحوظ بين الفترة 1 وكل من الفترة 2 والفترة 3. وانخفض الكرياتينين بشكل ملحوظ بين الفترة 1 وكل من الفترة 2 والفترة 3، وكذلك بين الفترة 2 والفترة 3. كان عدد المرضى الذين يعانون من انخفاض مستويات الكلوريد والصوديوم في الغالب خلال الفترة الأولى بينما أولئك الذين كانت لديهم مستويات منخفضة من البوتاسيوم كانوا في الغالب في الفترة الثانية.كان انتشار اختلال توازن الكهارل في مرضى الأمراض المعدية بالمستشفيات في مستشفى الملك عبد العزيز الجامعي بجدة مرتفعا خاصة عند الدخول للمستشفى وأثناء الاستشفاء بالمستشفى. ولذلك يلزم إجراء مزيد من الدراسات لمعرفة العوامل المساهمة المرتبطة باختلال توازن الكهارل أثناء الاستشفاء بالمستشفى.

Background and aim: Hepatocellular carcinoma (HCC) is one of the most common and most lethal cancers worldwide. The objective of this study was to investigate the relationship between basal parameters and survival characteristics in patients with HCC. Materials and methods: the records of 1447 HCC patients of a tertiary center during the period 2000-2017 were screened retrospectively. The demographic details; basal clinical, laboratory, and radiological characteristics; treatments; and survival time were recorded and prognostic scores were calculated. Results: a total of 788 patients with HCC (male/female: 623/165; mean age: 60.5±10.9 years) were included in the study. The median length of survival was 26.3 months (95% confidence interval [CI], 22.3-30.4 months). The 5-year survival rate was 28.1%. The number and diameter of the tumors; platelet count; platelet-to-lymphocyte ratio; level of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase; portal and hepatic vein involvement; and an alpha-fetoprotein level of, NA

Resumen El tumor glioneuronal leptomeningeo difuso es una entidad infrecuente, con un curso indolente; fue descrito en la clasificacion de los tumores del sistema del sistema nervioso central de la OMS 2016. Presentamos el caso de un varon de 11 anos que comienza con un cuadro clinico inespecifico de cefalea, dolor lumbosacro e hidrocefalia comunicante. En el curso clinico aparecen crisis epilepticas con lesiones nodulares en RM craneal; fue diagnosticado de meningitis tuberculosa y tratado con tuberclostaticos. Ante un deterioro clinico progresivo, a pesar del tratamiento, y empeoramiento de los hallazgos en RM craneoespinal, se le realiza biopsia cerebral y de leptomeninges que confirma el diagnostico de tumor glioneuronal leptomeningeo difuso. El tumor glioneuronal leptomeningeo difuso debe incluirse en el diagnostico diferencial de los cuadros que se presentan con hidrocefalia comunicante y lesiones leptomeningeas. Se precisa un diagnostico histologico precoz mediante biopsia para establecer un tratamiento adecuado.

Microglia are the resident immune cells of the brain and play a crucial role in housekeeping and maintaining homeostasis of the brain microenvironment. Upon injury or disease, microglial cells become activated, at least partly, via signals initiated by injured neurons. Activated microglia, thereby, contribute to both neuroprotection and neuroinflammation. However, sustained microglial activation initiates a chronic neuroinflammatory response which can disturb neuronal health and disrupt communications between neurons and microglia. Thus, microglia-neuron crosstalk is critical in a healthy brain as well as during states of injury or disease. As most studies focus on how neurons and microglia act in isolation during neurotrauma, there is a need to understand the interplay between these cells in brain pathophysiology. This review highlights how neurons and microglia reciprocally communicate under physiological conditions and during brain injury and disease. Furthermore, the modes of microglia-neuron communication are exposed, focusing on cell-contact dependent signaling and communication by the secretion of soluble factors like cytokines and growth factors. In addition, how microglia-neuron interactions could exert either beneficial neurotrophic effects or pathologic proinflammatory responses are discussed. We further explore how aberrations in microglia-neuron crosstalk may be involved in central nervous system (CNS) anomalies, namely: traumatic brain injury (TBI), neurodegeneration, and ischemic stroke. A clear understanding of how the microglia-neuron crosstalk contributes to the pathogenesis of brain pathologies may offer novel therapeutic avenues of brain trauma treatment.

Statement of problem The anatomic complexity of the ear challenges conventional maxillofacial prosthetic rehabilitation. The introduction of specialized scanning hardware integrated into computer-aided design and computer-aided manufacturing (CAD-CAM) workflows has mitigated these challenges. Currently, the scanning hardware required for digital data acquisition is expensive and not readily available for prosthodontists in developing regions. Purpose The purpose of this virtual analysis study was to compare the accuracy and precision of 3-dimensional (3D) ear models generated by scanning gypsum casts with a smartphone camera and a desktop laser scanner. Material and methods Six ear casts were fabricated from green dental gypsum and scanned with a laser scanner. The resultant 3D models were exported as standard tessellation language (STL) files. A stereophotogrammetry system was fabricated by using a motorized turntable and an automated microcontroller photograph capturing interface. A total of 48 images were captured from 2 angles on the arc (20 degrees and 40 degrees from the base of the turntable) with an image overlap of 15 degrees, controlled by a stepper motor. Ear 1 was placed on the turntable and captured 5 times with smartphone 1 and tested for precision. Then, ears 1 to 6 were scanned once with a laser scanner and with smartphones 1 and 2. The images were converted into 3D casts and compared for accuracy against their laser scanned counterparts for surface area, volume, interpoint mismatches, and spatial overlap. Acceptability thresholds were set at 0.70 for spatial overlap. Results The test for smartphone precision in comparison with that of the laser scanner showed a difference in surface area of 774.22 ±295.27 mm2 (6.9% less area) and in volume of 4228.60 ±2276.89 mm3 (13.4% more volume). Both acceptability thresholds were also met. The test for accuracy among smartphones 1, 2, and the laser scanner showed no statistically significant differences (P>.05) in all 4 parameters among the groups while also meeting both acceptability thresholds. Conclusions Smartphone cameras used to capture 48 overlapping gypsum cast ear images in a controlled environment generated 3D models parametrically similar to those produced by standard laser scanners.

This study aimed to biochemically and histopathologically investigate the effect of sunitinib on oxidative testicular damage induced by ischemia/reperfusion in rats.Experimental animals were divided into three groups of six rats each: testicular torsion-detorsion (TTD), sunitinib+testicular torsion-detorsion (STD), and sham control (SC). Sunitinib (25mg/kg) was administered orally to the STD group by gavage. Normal saline (0.9% NaCl) was administered orally to the TTD and control groups as the solvent. One hour after administration of sunitinib and 0.9% NaCl, all animal groups were done torsion-detorsion. Then, all the rats were killed by high-dose anesthesia, and their testicles were removed. Biochemical and histopathological examinations were performed on the removed testicular tissues.Malondialdehyde; it was observed that the results in the STD group were close to those of the SC group and statistically significant lower compared to the TTD group (p=0.001). The glutathione values were statistically significantly higher in the STD group compared to the TTD group (p0.001). Nuclear factor kappa B values, revealing a statistically significant difference between the TTD and STD groups (p0.001). The TNF-α levels were measured and indicating that the results of the STD group were statistically significantly lower than those of the TTD group (p0.001). Histopathologically, animal tissues given sunitinib were observed to resemble normal tissues.Sunitinib was shown to prevent histopathological changes in testicular tissue against ischemia/reperfusion damage.

Objectives Investigate the prevalence of Rh and the K antigens and their phenotypes in the red blood cells of blood donors in Riyadh, Saudi Arabia. Methods This is a retrospective study. The five principal Rh antigens (D, C, c, E, e) and the Kell antigen from the Kell blood group were tested in 4,675 random samples collected from four blood bank centers in Riyadh. Data were collected for seven weeks (from January 4, 2019 to February 28, 2019). Antigens were tested using the TANGO Optimo system. Results We found that approximately 86% of the donors had the D antigen, 66% had C, 78% had c, 26% had E, 97% had e and 14% had K. The most common Rh phenotypes were R1r (31%) and R1R1 (22%). Conclusion The differences in the results between the study population and other populations, such as Caucasian, Indian and African populations indicate the importance of establishing a population-specific database.

Highlight Research This is the first report of the occurrence of gregarine species in Peninsular Malaysia. The information of these findings will lead to the identification of species using genetic analysis. This information can help to solve the cultured problem of the Macrobrachium rosenbergii industry worldwide. Abstarct Studies on the parasite of prawn are likely to be important due to the commercial value of the prawn. Investigation study about gregarine parasites of M. rosenbergii in Malaysia is still lacking. Objective of this study is to determine the occurrence of gregarine parasites in shrimp, M. rosenbergii from Setiu Lagoon, Terengganu. The study was done specifically to observe the prevalence and the mean intensity of the parasites which include the morphological prevalence and parasitological study. Prevalence of the parasites in this study is 42.4% with 95% Cumulative Index (CI) 25.6% to 59.3% and value of Odd Ratio (OR) is 0.74 (CI = 0.29 to 1.88). Two structures of the gregarine which is gamont and syzygy found in this study are closely related to morphology characteristic of gregarine in the previous report.

Background/Aim. Dentists and particularly general dental practitioners (GDPs) should be able to identify problems such as malocclusions and refer patients with such problems to orthodontics. The aim of the study was to evaluate the awareness of orthodontic problems and referral practices among GDPs and non-orthodontic specialists practicing in the Kingdom of Saudi Arabia. Methods. A cross-sectional prospective study included GDP and specialists/consultants of both genders, aged between 22?60 years, practicing general dentistry and specialists other than orthodontics who had worked in their field for two or more years. Non-practicing dentists and nonregistered dentists were excluded. Data was analyzed on SPSS version 21.00. Results. Among the respondents, 55.5% were men, and 44% were GDPs. Out of the total number of respondents, 107 (53.5%) GDPs and 66 (33%) non-orthodontic specialists practiced orthodontic referral in their practices. By using the ?2 test, statistical analysis of different variables depending on the participants? gender and specialty was performed. It revealed that variables with significant p-value were: orthodontist referral, the recommendation of orthodontic treatment only after the eruption of all permanent teeth, awareness of tooth extraction for alignment of irregular teeth, and awareness regarding worsening of temporomandibular joint problems by orthodontic treatment. Conclusion. The referral practices of dentists practicing in the Kingdom of Saudi Arabia concerning orthodontic patients were satisfactory, although awareness regarding orthodontic problems requires continuous learning and considerate positive progression toward basic orthodontics.

BackgroundThe rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU).MethodsThe SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations.ResultsThe SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. ConclusionThe SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.

Objective: Rectal prolapse is a rare condition characterized by protrusion of the rectum with all its layers from the anus. It is a disease that causes social and functional problems. In this study, it was aimed to investigate the abdominal and perineal approaches together with postoperative early and late results in our patients who underwent surgical treatment for rectal prolapse. Method: The records of 39 patients who were operated on with the diagnosis of rectal prolapse between 2010 and 2020 in the Department of General Surgery, Dicle University Faculty of Medicine were evaluated retrospectively. Demographic and physical examination findings of the patients, surgical methods applied, early and late postoperative complications, recurrence and mortality rates were recorded. Results: The most common complaints on admission to the hospital were gas control disorder, difficulty in defecating and getting wet with mucus. On physical examination, stage 1 rectal prolapse was found in 12.8% of the patients, and full-thickness prolapse was found in the other patients. The mean age of 39 patients included in the study was 36 (14- 88) years. Of the patients included in the study, 14 (35.9%) were female and 25 (64.1%) were male. Surgery was performed with an abdominal and perineal approach in 53.8% of the patients, while laparoscopy was performed in 46.2%. The most frequently used abdominal surgical technique was Notaras (35.8%). The most common perineal approach technique was Altemeier (5.1%). Patients who underwent the perineal approach were older and had a shorter hospital stay, and it was often performed under regional anesthesia. Complications developed in the early postoperative period in 10.4% of the patients. The median hospital stay was 5 days (2-19) and the follow-up period was 13 months (9-19). Postoperative mortality did not occur in any of the patients. Hospital stay was significantly shorter in patients who underwent laparoscopic surgery. There was no statistical difference in terms of early postoperative complications and recurrence. Conclusion: Although more than a hundred surgical procedures have been described to date for the treatment of rectal prolapse, the ideal treatment method is still unclear. In terms of surgical treatment, the results of abdominal or perineal approaches to be applied are similar, considering the risk factors, patient findings and surgeon’s experience. Amaç: Rektal prolapsus, rektumun tüm katmanlarıyla birlikte anüsten çıkması ile karakterize nadir bir durumdur. Sosyal ve fonksiyonel sorunlara neden olan bir hastalıktır. Bu çalışmada, rektal prolapsus için laparoskopik ve açık cerrahi yöntemin postoperatif erken ve geç sonuçlarının araştırılması amaçlanmıştır. Yöntem: Dicle Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’nda 2010-2020 yılları arasında rektal prolapsus tanısıyla ameliyat edilen 39 hastanın kayıtları geriye dönük olarak değerlendirildi. Demografik ve fizik muayene bulguları, cerrahi yöntem, postoperatif erken ve geç komplikasyonlar, morbidite ve mortalite oranları kaydedildi. Bulgular: Hastaneye başvuruda en sık başvuru şikayetleri gaz kontrol bozukluğu, dışkılamada güçlük ve mukusla ıslanma idi. Fizik muayenede hastaların %12,8’inde evre 1 rektal prolapsus, diğer hastalarda tam kat prolapsus saptandı. Çalışmaya alınan 39 hastanın yaş ortalaması 36 (14- 88) idi. Çalışmaya alınan hastaların 14’ü (%35,9) kadın, 25’i (%64,1) erkekti. Hastaların %53,8’ine açık karın cerrahisi yapılırken, %46,8’ine laparoskopi yapıldı. En sık kullanılan abdominal cerrahi teknik Notaras (%35,8) idi. En yaygın perineal yaklaşım tekniği Altemeier (%5,1) idi. Perineal yaklaşım uygulanan hastalar daha yaşlıydı ve hastanede kalış süreleri daha kısaydı ve sıklıkla bölgesel anestezi altında uygulanıyordu. Hastaların %10,4’ünde erken postoperatif dönemde komplikasyon gelişti. Ortanca hastanede kalış süresi 5 gün (2-19), takip süresi 13 ay (9-19) idi. Hiçbir hastada postoperatif mortalite olmadı. Laparoskopik cerrahi uygulanan hastalarda hastanede kalış süresi anlamlı olarak daha kısaydı. Erken postoperatif komplikasyonlar ve nüks açısından istatistiksel olarak fark yoktu. Sonuç: Rektal prolapsusu olan hastanın risk faktörleri göz önüne alındığında hem laparoskopik hem de açık cerrahi yaklaşımların sonuçları benzerdir. Cerrahın deneyimine ve hastane olanaklarına göre cerrahi yöntemi seçmek gerekir.

The aim of this study was to compare optic canal parameters of syndromic craniosynostosis patients with those of normal patients to visit the possibility of optic nerve impingement as a cause of visual impairment. Computed tomography scan images were processed using the Materialise Interactive Medical Image Control System (MIMICS) Research 21.0 software (Materialise NV, Leuven, Belgium). Eleven optic canal parameters were measured: 1) height of optic canal on the cranial side, 2) height of optic canal on the orbital side 3) length of the medial wall of the optic canal, 4) length of the lateral canal wall of the optic canal, 5) diameter of the optic canal at five points (Q1-Q4 and mid canal), and 6) area and perimeter of optic canal. These measurements were obtained for both the right and left optic canals. The study sample comprised four Crouzon syndrome, five Apert syndrome, and three Pfeiffer syndrome patients. The age of these syndromic craniosynostosis patients ranged from 2 to 63 months. The height of the optic canal on the orbital side (p = 0.041), diameter of the mid canal (p = 0.040), and diameter between the mid-canal and the cranial opening (Q3) (p = 0.079) for syndromic craniosynostosis patients were statistically narrower compared with those of normal patients when a significance level of 0.1 was considered. Scatter plots for the ages of patients versus the above parameters gave three separated clusters that suggested the arresting of optic canal development with age. The findings from this study demonstrated a narrowing of the optic canal in syndromic craniosynostosis patients, and indicate that optic canal anatomical characteristics may have an association with visual impairment among pediatric syndromic craniosynostosis patients.

The von willebrand disease (vWD) accounts to be one of the most common hereditary bleeding ailment that amounts its incidence to almost 1.5% of normal population. It is mostly associated with a defect in primary hemostasis as well as secondary defect in coagulation factor VIII as diagnosis of vwd happened to be challenging with earlier diagnostic criteria’s. Testing Vwd in menorrhagia patients was not at ease. A cross-sectional study was conducted in female patients who have visited obstetrics and gynecology clinic at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. The inclusion criteria consist of adult female patients between 16 and 45 years old with menorrhagia. A sample of 45 patients were screened and selected for the above-mentioned study. The SPSS Statistical analysis package was performed to analyze the data’s. The fisher’s exact test was conducted to compare the demographic variables. The independent samples t-test was conducted to compare the means of subjects. The P value of ≤0.05 considered as statistically significant. The cases manifested with a history of bleeding during periods stretching from 7 to 90 days. The vWD was reported in 6.6 % (n = 3) women out of the total 45 patients. The vWF: Ac mean ± SD (51.4 ± 6.3) and vWF: Ag Mean ± SD (93 ± 67) were significantly lesser in vWD patients with that of non-vWD (98.7 ± 22.6) vs (116 ± 42.4) (p = 0.027) (p = 0.032) respectively. WBC, ESR, MCV, MCH, Hemoglobin, PLT count, INR, PT, APTT and FVIII showed no significant difference among the groups (p > 0.05).

Fibromyalgia is a debilitating condition that is frequently misdiagnosed. It affects 2% of the population, with middle-aged women having the highest frequency. Fibromyalgia affects more women than men, and It becomes worse as you get older. Because medical treatment for fibromyalgia is typically only partial, health professionals must provide patients with ongoing assistance in order for them to become effective, active self-managers. There is no one-size-fits-all drug for fibromyalgia, but you do have a lot of options for treating your symptoms. However, Antidepressants in general such as “duloxetine” and Gabapentinoids drugs such as “pregabline” are the most used drugs. There is some evidence that NSAIDs may have a synergistic effect when combined with centrally active agents such as tricyclic antidepressants and anticonvulsants. Among non-pharmacological therapy, exercise and psychoeducational techniques have the most evidence of efficacy, but they must be personalized to the individual. In this review we will be looking at diagnosis and treatment of fibromyalgia.

Background Recently, radial artery access has gained popularity for interventional neurovascular procedures due to patient comfort and fewer complications. However, there are instances where the radial artery approach is not feasible. In such cases, trans-ulnar artery access (TUA) can offer an alternate route. There is limited data regarding neuro-interventional procedures performed via this approach. This study aims to evaluate the feasibility and safety of trans-ulnar approach for a wide range of interventional neurovascular procedures. Materials and methods The data for all patients who underwent ulnar artery access for diagnostic or interventional neuroradiology procedures was retrospectively collected between September 2020 and March 2021. Patient demographics, procedural details, procedure success, and complications were recorded. Results During the study period, 23 patients underwent 24 trans-ulnar approach procedures. The mean age of patients was 50.1 ± 14.2 years. Fourteen diagnostic cerebral angiograms and ten interventional procedures were performed. All procedures were successfully completed via trans-ulnar approach without a switch to alternate access. No major access site complication was observed. Conclusion Ulnar artery access is a safe and feasible option for neurovascular procedures. It can be effectively utilized for diagnostic cerebral angiography and a wide range of interventional procedures.

Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10–14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15–19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1–4 years (2·4%), and around a third less than in females aged 1–4 years (2·5%). The proportion of global deaths in people aged 0–24 years that occurred in people aged 10–24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10–24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Funding Bill & Melinda Gates Foundation.

This article aims to analyze the principles of sustainable income according to Islam based on the writings of Imam al-Syaibani in Al-Kasb. He highlighted the principles of responsibility and trust in seeking income, the appreciation of the concept of tawakkal and the priority of earning a living. This study is qualitative, using content analysis methods to extract some of the themes mentioned above. The study found book Al-Kasb is an injection of Islamic economic thought that encourages the practice of sustainable wealth management by al-Shaybani to respond to economic problems involving Muslims. Keywords: Al-Kasb, Al-Shaybani, Sustainable wealth management. eISSN: 2398-4287 © 2021. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v6iSI6.3034

Guillain-Barré-Syndrome (GBS) is one of the reported neurological manifestations linked to a severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2)(COVID-19). We are presenting a case of a 72-years-old male patient who attended Sultan Qaboos University Hospital with a history of progressive bilateral limbs weakness and numbness. After exclusion of other possible causes, a diagnosis of GBS induced by COVID-19 was made. He received Intravenous Immunoglobulin (IVIG) 0.4g/kg/day for 5 days. This diagnosis is in line with a rare complication of COVID-19. This case highlights the characteristics and the course of GBS following COVID-19 infection. Further studies are needed to characterize the manifestations and the course of various neuromuscular disorders in relation to COVID-19 infection. Keywords: COVID-19, Guillain-Barré-Syndrome (GBS), IVIG, Oman

With the promising advances in the telecommunication and automotive industries, there are increasing concerns on the reliability of Intelligent Transportation Systems (ITS) applications and standardization efforts. Nowadays, vehicles are empowered with innovative communications and sensing capabilities to accelerate next-generation Connected and Autonomous Vehicles (CAV) or Vehicle-to-Everything (V2X) communications. Furthermore, V2X is based on many radio access technologies including Dedicated Short-Range Communications (DSRC), Cellular-V2X, and millimeter-wave. It is expected that a single technology is incapable to support the diverse QoS and reliability requirements of vehicular safety and non-safety applications. Therefore, recent research works have investigated and developed different approaches to enable multi-radio access technologies (Multi-RAT) in V2X networks to support these multitudes of requirements. In addition, the heterogeneity of diverse radio access technologies and rigidity in their deployment increases the complexity of the network management. Complications may also arise from inefficient resource utilization due to the complexity of an optimum RAT selection or multi-link establishment through Multi-RATs. Therefore, a global monitoring paradigm such as Software-Defined Vehicular Network (SDVN) has been identified as a solution to reduce this bottleneck, by adding flexibility and agility to the vehicular network. This paper extensively reviews recent related works on Multi-RAT V2X networks focusing on the opportunistic selection mechanism of RAT, allocation of radio resources, and simultaneous establishment of multi-link over a heterogeneous network. Consequently, we have outlined the SDVN architecture, layers, features, and significance towards enhancing the performance of such Multi-RAT networks. Finally, several potential challenges with probable solutions and opportunities are discussed.

Surrogate-assisted evolutionary algorithms have been intensively used to solve computationally expensive problems with some success. However, traditional evolutionary algorithms are not suitable to deal with high-dimensional expensive problems (HEPs) with high-dimensional search space even if their fitness evaluations are assisted by surrogate models. The recently proposed autoencoder-embedded evolutionary optimization (AEO) framework is highly appropriate to deal with high-dimensional problems. This work aims to incorporate surrogate models into it to further boost its performance, thus resulting in surrogate-assisted autoencoder-embedded evolutionary optimization (SAEO). It proposes a novel model management strategy that can guarantee reasonable amounts of re-evaluations, hence the accuracy of surrogate models can be enhanced via being updated with new evaluated samples. Moreover, to ensure enough data samples before constructing surrogates, a problem-dimensionality-dependent activation condition is developed for incorporating surrogates into the SAEO framework. SAEO is tested on seven commonly used benchmark functions and compared with state-of-the-art algorithms for HEPs. The experimental results show that SAEO can further enhance the performance of AEO on most cases and SAEO performs significantly better than other algorithms. Therefore, SAEO has great potential to deal with HEPs.

In Bangladesh, riverbank erosion has turned into one of the most frequently occurring natural disasters, and it affects the socio-economic and livelihood status as well as the environment of the adjoining areas. Kirtankhola River in Barishal, is this kind of river. This study assesses the amount of erosion-accretion, examines river profile, detecting key anthropogenic factors behind it, and signifying channel shifting of the river within 10 years (from 2009 to 2019). The study used Landsat Satellite imageries, geospatial techniques, and a semi-structured questionnaire survey throughout the study area. The study showed that erosion dominants at the left bank of river (17.1 ha/year), whereas the accretion rate is higher at the right (19.72 ha/year). Besides, cross-section at selected points of the river providing an evident indication of the river widening thus river course shifting. According to 61% of the participants in the questionnaire, high waves generated through water vehicles are the main culprit for this extensive erosion. The number of launches has increased significantly within the studied time-period, and most of the launches run over 30 km/h velocity, where it should be less than 20km/h. The study explored a mechanism of how centrifugal force produced by water vehicles increases the intensity of riverbank erosion in the meandering area.

In the clinical assessment of chronic rhinosinusitis with nasal polyps (CRSwNP), evaluation of symptoms, nasoendoscopy findings and sinus computed tomography (CT) scan staging is employed in the management plan. Although prior studies have been done to assess the correlation of the three modalities in CRSwNP, such evaluation in patients with eosinophilic and non-eosinophilic types of CRSwNP requires further investigation. The aim of this study was to correlate the sinus CT scan staging to symptom and endoscopic scores in both types of CRSwNP.Patients with CRSwNP were classified into 2 types, eosinophilic and non-eosinophilic. Both types were assessed by Sino-Nasal Outcome Test 22 (SNOT-22) symptom score, nasal endoscopy Lund Kennedy grading (LK) score and sinus CT Lund Mackay (LM) staging score. All three modalities were correlated.Forty-four patients were recruited for this study. There was significant correlation between sinus CT and symptom scores in the eosinophilic (r=.51, p=.031) and the non-eosinophilic (r=.76, p.001) types. There was no significant correlation between symptom and nasoendoscopic scores in the eosinophilic (r=.12, p=.641) and the non-eosinophilic (r=.22, p=.276) types. There was also no significant correlation between sinus CT and nasoendoscopic scores in the eosinophilic (r=.20, p=.418) and the non-eosinophilic (r=.14, p=.508) types.Sinus CT staging correlates well with the symptom score for both the eosinophilic and the non-eosinophilic types of CRSwNP. The good correlation suggests both modalities are a reliable guide for their evaluation and management planning.

Despite impressive advancements in Autonomous Driving Systems (ADS), navigation in complex road conditions remains a challenging problem. There is considerable evidence that evaluating the subjective risk level of various decisions can improve ADS' safety in both normal and complex driving scenarios. However, existing deep learning-based methods often fail to model the relationships between traffic participants and can suffer when faced with complex real-world scenarios. Besides, these methods lack transferability and explainability. To address these limitations, we propose a novel data-driven approach that uses scene-graphs as intermediate representations. Our approach includes a Multi-Relation Graph Convolution Network, a Long-Short Term Memory Network, and attention layers for modeling the subjective risk of driving maneuvers. To train our model, we formulate this task as a supervised scene classification problem. We consider a typical use case to demonstrate our model's capabilities: lane changes. We show that our approach achieves a higher classification accuracy than the state-of-the-art approach on both large (96.4% vs. 91.2%) and small (91.8% vs. 71.2%) synthesized datasets, also illustrating that our approach can learn effectively even from smaller datasets. We also show that our model trained on a synthesized dataset achieves an average accuracy of 87.8% when tested on a real-world dataset compared to the 70.3% accuracy achieved by the state-of-the-art model trained on the same synthesized dataset, showing that our approach can more effectively transfer knowledge. Finally, we demonstrate that the use of spatial and temporal attention layers improves our model's performance by 2.7% and 0.7% respectively, and increases its explainability., 10 pages, 5 figures, 1 table

Cloud Computing is a robust model that allows users and organizations to purchase required services per their needs. The model offers many services such as storage, platforms for deployment, convenient access to web services, and so on. Load Balancing is a common issue in the cloud that makes it hard to maintain the performance of the applications adjacent to the Quality of Service (QoS) measurement and following the Service Level Agreement (SLA) document as required from the cloud providers to enterprises. Cloud providers struggle to distribute equal workload among the servers. An efficient LB technique should optimize and ensure high user satisfaction by utilizing the resources of VMs efficiently. This paper presents a comprehensive review of various Load Balancing techniques in a static, dynamic, and nature-inspired cloud environment to address the Data Center Response Time and overall performance. An analytical review of the algorithms is provided, and a research gap is concluded for the future research perspective in this domain. This research also provides a graphical representation of reviewed algorithms to highlight the operational flow. Additionally, this review presents a fault-tolerant framework and explores the other existing frameworks in the recent literature.

Background Left atrial appendage closure (LAAC) during cardiac surgery in atrial fibrillation (AF) patients has been investigated in multiple studies with variable safety and efficacy results. Methods A comprehensive review was performed of all studies comparing LAAC and placebo arm during cardiac surgery in AF patients. A random-effect model was used to calculate risk ratios, mean differences, and 95% confidence intervals. Results Five randomized controlled trials and 22 observational studies were included with a total of 540,111 patients. The LAAC group had significantly decreased postoperative stroke/embolic events as compared to the no LAAC group with all cardiac surgeries (3.74% vs 4.88%, p = 0.0002), isolated valvular surgery (1.95% vs 4.48%, p = 0.002). However, CABG insignificantly favored the LAAC group for stroke/embolic events (6.72% vs 8.30%, p = 0.07). There was no difference between both groups in all-cause mortality in the perioperative period (p = 0.42), but was significantly lower in the LAAC arm after two years (14.1% vs 18.3%, p = 0.02). There was no difference in major bleeding, all-cause rehospitalizations, or cross-clamp time between both groups (p = 0.53 and p = 0.45). The bypass and the cross-clamp time were longer in the LAAC group (4 and 9 min, respectively). Conclusion In AF patients, LAAC during cardiac surgery had a decreased risk of stroke and long-term all-cause mortality. Additionally, there was no difference in major bleeding, all-cause rehospitalizations, or cross-clamp time.

Introduction Bacterial infections in CF patients are common and start early in life. The prognosis of the disease is substantially dependent on chronic respiratory infection and inflammation. Pseudomonas aeruginosa (PA) infection or chronic colonization have been established to cause a chronic decline in pulmonary function (PFT), and/or increase CF mortality. Objectives To obtain the prevalence of all bacterial pathogens in our CF patients and assess their evolution over time. Method A retrospective review of 327 patients with confirmed CF of all age groups, who had respiratory culture samples at the first visit and on a regular follow-up between January 1, 1990 and December 2018, was conducted. Results A total of 327 patients had a respiratory culture obtained at presentation. Two hundred and sixteen (66%) of 327 patients are alive, while 111 (34%) have died. Respiratory cultures were taken from nasopharyngeal aspiration (NPA) in 199 patients (61%), tracheal aspirate in 9 (3%), bronchoalveolar lavage (BAL)in one (0.29%), and in 124 patients (38%), sputum was induced. The eastern province contributed to the highest number of patients (122, 37.7%). There is a persistent increase in the prevalence of the common bacteria over the follow-up period of 7 years, namely Hemophilus influenzae (H. influenzae), Staphylococcus aureus (S. aureus), and all Pseudomonas (P. aeruginosa) culture types. Comparing cultures from the first and last follow-up visits, there was an increase in the prevalence of all (P. aeruginosa) cultures from 120 (34%) to 137 (53%), and a decrease in the prevalence of (S. aureus) and (H. influenzae) during the same follow-up period. Conclusion There is a progressive increase in the number of patients with the most pathogenic types of bacteria because of the advanced age at presentation. As more adult patients are enrolled, there is a need for improved awareness regarding the early eradication of pathogenic bacteria to prevent progressive pulmonary damage.

Background Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder. Dentists should play an essential role in OSA screening, referral, and management. However, few studies have investigated dentists’ knowledge and attitude towards OSA. Objective This cross-sectional survey aimed to assess the level of knowledge and attitude regarding OSA amongst dentists and evaluate whether the level of knowledge affects their attitude towards OSA. Methods Using the Google Forms platform, an online questionnaire was distributed via e-mail to all Ministry of Health dentists (N = 352). The questionnaire included 3 sections: demographics, knowledge, and attitude. Participant responses were stratified by professional title (general dentists, specialists, or consultants) and practice sector (primary health care centres or hospitals). Descriptive statistics, independent t tests, one-way analyses of variance, and Pearson's correlation were used to analyse the data. Results Of the 352 dentists, 191 responded to the questionnaire (54.55%). Although 80.6% of the respondents reported having previous OSA knowledge in the self-assessment question, 65.58% scored below 12 in the total knowledge scores, and 63.35% scored below 3 in the total attitude scores based on Bloom's cutoff. The mean total knowledge score was 9.86, while the mean total attitude score was 2.08. No significant differences between the mean total knowledge and attitude scores were found based on sex, professional title, or practice sector. A positive and statistically significant correlation was found between total knowledge and attitude scores (P value = .001). Conclusions This study showed that dentists had a low OSA-related knowledge and a negative attitude towards OSA, and a positive association was seen between knowledge level and attitude. Dental practitioners with high knowledge scores tended to have a positive attitude towards OSA. These findings suggest that dentists in Jeddah require more education and clinical training in sleep medicine to maximise patient benefits and minimise adverse outcomes.

This paper proposes the salp swarm algorithm (SSA) combined with a backpropagation neural network (BPNN) to solve the software fault prediction (SFP) problem. The SFP problem is one of the well-known software engineering problems that are concerned with anticipating the software defects that are likely to appear during a software project or thereafter. In order to find the optimal BPNN parameters, a combination of SSA optimizer and BPNN named (SSA-BPNN) is proposed, so as to enhance prediction accuracy. The proposed method is evaluated against several datasets for the SFP problem. These datasets vary in both size and complexity. The results obtained are evaluated using a variety of performance measures (i.e., the AUC, Confusion Matrix, Sensitivity, Specificity, Accuracy, and Error Rate). The results obtained by SSA-BPNN are better than those obtained by the conventional BPNN over all of the datasets. The proposed method also has the ability to outperform several state-of-the-art methods over the same datasets in respect of most of the aforementioned performance measures. Therefore, the hybridization of SSA with BPNN is a valuable addition to the software engineering issues and can be utilized to achieve higher prediction accuracy for a variety of prediction problems.

To evaluate the electro-clinical manifestations and outcomes of children with absence epilepsy at a tertiary center in Saudi Arabia.This retrospective study reviewed the medical and EEG records of patients who were diagnosed to have CAE as per the International League Against Epilepsy (ILAE) definition for CAE. The study was conducted in the pediatric neurology clinic of King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia, between January 2000 and December 2019. Patients who did not meet (ILAE) criteria, lost follow-up, and those who did not receive treatment at KKUH were excluded. Data regarding the patient's disease, electro-clinical manifestations, anti-seizure medication response, and outcomes were collected.A total of 35 patients, with an average age at diagnosis of 7 ± 2.1 y, were included in the study; among them, 51.4% were female and approximately 48.6% presented with a family history of epilepsy. Regarding clinical features, all patients experienced staring and altered awareness, 94.2% had less than 20 spells per day at the time of diagnosis, and 65.7% were provoked by the hyperventilation test. Regarding EEG findings, all patients had bilateral, symmetrical, and synchronous discharges in the form of regular 3 Hz spike-and-wave complexes, and 94.3% had a generalized initial ictal discharge. Also, 22.8% had eye fluttering with electrographic seizures. Ethosuximide (ESM) was used as the drug of choice in 45.7% of the patients. Regarding clinical outcomes, 94.3% had their disease clinically controlled, and 80% had a normalized EEG after few months of starting anti-seizure medication. Finally, 37.2% experienced complete remission of epilepsy after 3-5 y; however, one patient developed juvenile myoclonic epilepsy.This study described the electro-clinical manifestations of patients with childhood absence epilepsy and outcomes. Furthermore, early diagnosis and prompt treatment of childhood absence epilepsy improve treatment outcomes.

INTRODUCTION The development of anti-platelet factor 4 (PF4) antibodies is linked to a rare thrombotic complication described now as vaccine-induced immune thrombotic thrombocytopenia (VITT). This clinical syndrome with thrombosis and thrombocytopenia was reported after exposure to the Oxford-AstraZeneca COVID-19 vaccine, ChAdOx1 nCoV-19 vaccine (AZD1222), and Ad26.COV2.S vaccine (Janssen/Johnson & Johnson). In the absence of the clinical features, the incidence of positive anti-PF4 antibodies in asymptomatic individuals post-vaccination is unclear. METHODS The aim of this study was to evaluate the development of anti-PF4 antibodies in asymptomatic individuals 14-21 days after receiving the first dose of ChAdOx1 nCoV-19 vaccine (AZD1222) and BNT162b2 vaccine. Prospectively, we collected serum from individuals before and after ChAdOx1 nCoV-19 vaccine and BNT162b2 vaccine and measured anti-PF4 antibodies using the Asserachrom HPIA IgG ELISA (Stago, Asnieres, France). RESULTS We detected positive anti-PF4 antibodies in 5 of 94 asymptomatic individuals post-vaccine with a rate of 5.3% with low titers (OD 0.3-0.7). Four of 5 individuals who tested positive after the vaccine had also positive anti-PF4 antibodies before the vaccine, which indicates that a majority of the positive results are due to preexisting anti-PF4 antibodies. We did not find a relation between the development of anti-PF4 antibodies and the immune response to the vaccine, status of prior COVID-19 infection, and baseline characteristics of participants. None of the participants developed thrombosis nor thrombocytopenia. CONCLUSION Our results provide new evidence to guide the diagnostic algorithm of suspected cases of VITT. In the absence of thrombosis and thrombocytopenia, there is a low utility of testing for anti-PF4 antibodies.

BACKGROUND Stroke is a spectrum of medical emergencies resulting from a direct insult to the cerebral blood flow. Cerebral computed tomography angiogram (CTA) plays an important role in the diagnostic algorithm of acute stroke. However, the role of CTA in the subacute phase is not well-established. This study aimed to assess the diagnostic role of CTA in subacute ischemic stroke and transient ischemic attack (TIA) in identifying underlying etiology. It also aimed to describe the commonly encountered CTA findings in the subacute phase of ischemic events. METHODS This is a retrospective study in which we evaluated the radiologic records of all patients who had a cerebral CTA for subacute stroke and TIA during the period from January 1, 2010 to May 30, 2018. RESULTS The study included 104 cases diagnosed with subacute ischemic stroke or TIA. Patients' ages ranged from 8 to 96 years with a mean age of 52.9 (18.1) years. Most of the patients were males (68.3%; 71). CTA findings were abnormal in 86 cases (82.7%). Stenosis was diagnosed in 34 (32.7%) cases, followed by acute arterial thrombosis (25; 24%) and chronic occlusion (17; 16.3%). The internal carotid artery was the most affected (57.6%), followed by the vertebrobasilar arteries. CONCLUSION The current study revealed that CTA has a high diagnostic yield in the subacute phase of ischemic cerebrovascular events, with an important role in detecting clinically relevant findings in this group of patients.

Psoriasis is a chronic multifactorial inflammatory disease that affects 3% of people worldwide. Ustekinumab is a selective anti-IL-12/23 biologic that alleviates psoriasis, and curcumin is a natural, effective dietary turmeric extract applied to treat numerous diseases through its antioxidant and anti-inflammatory effects.The current study evaluated the therapeutic effects of curcumin and ustekinumab cotherapy (CUC) on imiquimod (IQ)-induced psoriasis in a rat model.Twenty rats were divided into four groups, G1 (control group), G2 (IQ-treated group), G3 (IQ + ustekinumab), and G4 (IQ + CUC). Clinical, histopathological (HP), immunohistochemical (IHC), antioxidant, and biochemical investigations evaluated the efficacy of these drugs for treating IQ induced-psoriasis.Rats of G2 exhibited clinical signs of psoriatic skin lesions (erythema, scaling, and skin thickening) with epidermal changes (acanthosis and parakeratosis). Additionally, the biochemical analysis revealed significant (Ustekinumab inhibits the inflammatory cytokines IL-12P40 and IL-23, while curcumin has antioxidant effects (increasing SOD, GPx, and CAT levels) with anti-inflammatory effects (decreasing the proinflammatory cytokine TNF-α and IL-17). Therefore, CUC could be an excellent cost-effective regimen that can improve the treatment of psoriasis by the synergistic effects of CUC.HighlightsIQ-induces psoriasis by elevating TNF-α, IL-17A, IL-12, and IL-23 and decreasing GPx, SOD, and CATUstekinumab exhibits anti-inflammatory effects by inhibiting IL-12 and IL-23Curcumin inhibits TNF-α and IL-17A, and increases GPx, SOD, and CAT levelsCUC mitigates psoriasis by synergistic antioxidant and anti-inflammatory effectsCUC inhibits TNF-α, IL-17A, IL-12, and IL-23 and increases GPx, SOD, and CAT levels.

Aims: To determine the relationship between distant learning and neck pain during COVID-19 pandemic especially among medical students, thus we aim to assess prevalence of neck pain for specific Group and time. Study Design: An observational cross-sectional study. Place and Duration of Study: Conducted in Saudi Arabia, between July 2020and October 2021. Methodology: This is a cross-sectional observational descriptive study that started in July 2020. Our target population include all medical students either male or female suffering from neck pain in Kingdom of Saudi Arabia during the period of distant learning due to the Covid-19 pandemic. Sample size: Total Number of medical students in KSA (26126), Confidence level 95% and margin of error 5%. The sample size 379 was estimated using the Qualtrics calculator. Results: A total of 2071 participants were a part of study. Most of them are female n=1509(72.9%) and least of them are male n=562(27.1%). The minimum age of participant was 18 years old n=61(2.9%), And the maximum age was 30 years old n=10(0.5%). Most of medical students noticed increase of neck pain during the period of pandemic. Most of them had noticed exacerbation of neck pain during COVID-19 pandemic n=1002(72.3%), where n=384(27.7%) had same pain before and during pandemic. Majority of them were completely relying on electronic devices for their education. Conclusion:A high Pervasiveness of neck pain in the medical students during COVID-19 pandemic has been observed. Most of medical students noticed increase of neck pain during the period of pandemic. Majority of them were completely relying on electronic devices for their education.

Osteoarthritis is estimated to be the most prevalent musculoskeletal disorder in the world. Estimates show that the disease is prevalent in 18% and 10% in women and men that are aged >60 years old. The quality of life of the affected patients can also be significantly impacted due to the associated morbidities and functional loss. Many interventions have been proposed to preserve the joint and enhance the functional outcomes in patients with osteoarthritis. In the present literature review, we have discussed the different orthobiologic therapies for patients with osteoarthritis for joint preservation and subsequent improvement in the functional and pain outcomes. Variable modalities that have been proposed in the literature include Bone Marrow Aspirate Concentrate (BMAC), gene therapy and platelet rich plasma (PRP). All of these modalities were reported with favorable outcomes and minimal complications. PRP has been reported to have a clinical efficacy that is boosed when co-administered with hyaluronic acid. However, it should be noted that the clinical efficacy is limited in the long term, and administration is continuously required. On the other hand, gene therapy is a promising technique that offers maintained favorable outcomes with no adverse events. However, further studies are still needed to indicate the effectiveness and cost-efficacy of this approach.

Bacterial arthritis is an inflammation of the joints caused by an infectious etiology, usually bacterial, but there are also fungi, mycobacteria, viruses, or other rare pathogens. Both healthy and predisposed people can be infected. Nongonococcal infectious arthritis, usually a monoarticular disease, affects multiple joints in about 10% of patients and is a new form of septic arthritis. Without treatment, it can progress rapidly and cause irreversible damage to the joints. The overall incidence of bacterial arthritis is 2 to 6 per 100,000, depending on the presence of risk factors. Bacterial arthritis is more common in children than in adults. The incidence of septic arthritis peaks between the ages of 2 and 3 and is predominantly male (2: 1). Most septic joints develop as a result of hematogenous dissemination of the vascular synovium due to bacterial episodes. Osteoarthritis, rheumatoid arthritis, and corticosteroid therapy are the most common predisposing conditions. Typical symptoms of acute septic arthritis without gonorrhea include recent fever, malaise, and local findings of pain, warmth, swelling, and restricted mobility of the affected joint. Accurate history and assessment of risk factors can provide important clues for diagnosis. Careful assessment of risk factors can significantly change the likelihood of a provider developing septic arthritis prior to testing. Laboratory findings, diagnostic imaging, and synovial fluid assessment are all useful for diagnosis. Management components include early detection and treatment with joint aspiration, antibiotics, and orthopedic advice for possible surgical management. Widespread antibiotics are often needed due to the potential for rapid joint destruction. A combination of cefepime or anti-Pseudomonas aeruginosa beta-lactams and vancomycin is recommended to cover both Gram-negative and MRSA bacteria.

Background: Chronic pain is a common clinical feature that accompanies osteopathy. Knowledge and attitudes of both patients and their treating clinicians would influence the patients' outcomes and pain control. Objective: This systematic review will provide an understanding of the knowledge and attitudes of patients and clinicians towards musculoskeletal pain accompanying osteopathy. Methods: Different keywords were used to search the medical literature, including: “knowledge” OR “Attitude” AND “Osteopathy” AND “Pain” AND “patient” OR “clinician." The search databases included Medline, Embase PubMed, and SCOPUS. The following step was reviewing the appearing results to ensure that they were original research articles that examined the knowledge and attitudes about chronic musculoskeletal pain with osteopathy. All the eligible studies should mention the type of participants examined (either patients or clinicians). Results: A total of 89 studies were obtained. After removing review articles and choosing original research studies solely, 11 studies appeared from the filtration process. Eight research articles were eligible. All the included studies had a quantitative cross-sectional design. Only health care professionals were asked about osteopathy, where all the studies included osteopaths from different countries, except one study that included physiotherapists. Osteopaths knew about the benefits of osteopathy, particularly for lower back pain; however, their knowledge about biopsychosocial factors requires improvement. Conclusion: Knowledge about osteopathy benefits for controlling chronic musculoskeletal pain should be improved even among osteopaths. Awareness campaigns are also needed for patients in orthopedic and physiotherapy clinics about osteopathy.

Gallstones cause biliary obstruction in about 5 out of 1000 people, whereas 10 to 15% of the adult population in the United States will have gallstones at some point in their lives. Gall stones, also known as cholelithiasis, are the precursor of choledocholithiasis, which occurs when gall stones pass through the cystic duct and lodge in the common hepatic ducts, causing an obstruction. Routine labs and some specialized labs are used in the diagnosis of biliary blockage. Severe complications can happen if left unchecked such as damaging the hepatic dysfunction, renal failure, nutritional deficiencies, bleeding problems, and infections. Treatment depends on the causing effect of bile duct obstruction. Sphincterotomy with lithotripsy, choledochotomy, choledochoduodenostomy, choledochojejunostomy, or cholecystectomy are the most used for large gall stones treatment. This review looks at the prevalence, etiology and management of the disease.

Favism is most common in those who have G6PD deficiency from the Mediterranean region. As hemolytic anaemia is the most common complication of G6PD deficiency, and it can be life-threatening in certain people. Infection, hyperglycemia, certain meals, and certain drugs can all cause hemolysis therefore, the most prevalent enzymopathy is glucose-6-phosphate dehydrogenase (G6PD) deficiency, which affects an estimated 400 million individuals, globally. Exposure to some medicines might cause hemolytic anaemia. The most important management technique is to avoid oxidative stresses by avoiding a hemolytic crisis. Also, avoidance of exposure to food and medicines that causes hemolytic anaemia episodes This review looks at etiology, epidemiology, pathopysiology, evaluation and management of the disease.

Background In Oman, many extended families tend to live in one household. Some families can include 20–30 individuals with the majority of them being children. This study investigates the role of children in spreading SARS-CoV-2 causing COVID-19 within family clusters in Oman. Methods This retrospective study includes data of 1026 SARS-CoV-2 positive children (≤18 years) collected from the national surveillance database for COVID-19 between 1 February 2020 and 30 May 2020. Results We included 1026 patients. Most, 842 were Omani (82%), 52% male, and 28.5% asymptomatic. Close to the half of symptomatic 419 (40%), patients presented with fever associated with other respiratory symptoms. Fifty pediatric patients were index cases who transmitted the virus to 107 patients in total (86 adults and 21 children) with a mode of 1. There is no statistical significance of all studied risk factors in the transmission of the SARS-CoV-2 virus including age, gender, and cycle threshold (CT) value. Conclusions According to this study, children are not to be considered a significant driver of transmission of SARS-CoV-2 in Oman.

Purpose This study compared microleakage of different resin based composite (RBC) materials bonded to dentin, after chlorhexidine (CHX) application, by different adhesion protocols of a universal adhesive system. Methods Class V cavities were prepared on the buccal and lingual surfaces of 40 premolar teeth. The “etch-and-rinse” technique of a universal bond adhesive system (Single Bond Universal Adhesive) was used on buccal preparations, while the “self-etch” protocol was used on the lingual surfaces. Two RBCs, one bulk fill (Filtek Bulk Fill [FBF]) and one conventional (Filtek Z350 XT [Z350XT]), were used. Teeth were divided into two groups of 20 teeth each, 10 per each RBC (n = 10): (1) control; and (2) pretreatment with 2% CHX. For FBF groups, teeth were restored with a single increment; however, for Z350XT, a layering technique was used. Teeth were aged by thermo-cycling and prepared for microleakage testing. Dye penetration was evaluated and scored from 0 to 4. Data were analyzed at a significance level of P Results The highest microleakage mean scores were found in the control group of the etched margins for both RBCs (2.80 ± 1.033 FBF and 2.10 ± 1.370 Z350XT). The CHX-pretreated group showed significantly lower microleakage than the control for FBF only (P = 0.008). No significant difference was found between groups for the “self-etch” protocol (χ2 = 0.884, P = 0.08). No significant differences were found between FBF and Z350XT in all study groups (P > 0.2). Conclusions When the “self-etch” protocol of the universal adhesive system was used, dentin microleakage was not affected by CHX-pretreatment when teeth were restored with bulk fill or conventional RBCs. In the “etch-and-rinse” protocol, CHX application improved the marginal seal before restoration with bulk fill material. However, in the absence of CHX, the “etch-and-rinse” protocol negatively affected marginal integrity.

Background ST-segment elevation myocardial infarction (STEMI) patients are treated with dual antiplatelet therapy comprising aspirin and a P2Y12 inhibitor. Clopidogrel is widely used in these patients in several areas worldwide, such as Middle East, but is associated to sub-optimal platelet inhibition in up to 1/3 of treated patients. We investigated a CYP2C19 genotype-guided strategy to select the optimal P2Y12 inhibitor. Methods This prospective randomized clinical trial included STEMI patients. The standard-treatment group received clopidogrel, while the genotype-guided group were genotyped for CYP2C19 loss-of-function alleles and carriers were prescribed ticagrelor and noncarriers were prescribed clopidogrel. Primary outcome was a combined ischemic and bleeding outcome, comprising myocardial infarction, non-fatal stroke, cardiovascular death, or Platelet Inhibition and Patient Outcomes major bleeding one year after STEMI. Results STEMI patients (755) were randomized into a genotype-guided- (383) and standard-treatment group (372). In the genotype-guided group, 31 patients carrying a loss-of-function allele were treated with ticagrelor, while all other patients in both groups were treated with clopidogrel. Patients in the genotype-guided group had a significantly lower risk of primary outcome (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.20–0.59,), recurrent myocardial infarction (OR 0.25, 95%CI 0.11–0.53), cardiovascular death (OR 0.16, 95%CI0.06–0.42) and major bleeding (OR 0.49, 95%CI 0.32–0.74). There was no significant difference in the rate of stent thrombosis (OR 0.85, 95%CI 0.43–1.71). Conclusion A genotype-guided escalation of P2Y12 inhibitor strategy is feasible in STEMI patients treated with clopidogrel and undergoing PCI and is associated with a reduction of primary outcomes compared to conventional antiplatelet therapy.