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Abstract Background This research investigates the fundamental factors which may stymie or simplify the adoption of m-learning by medical college educators in Sudan. We made use of the Extended Unified Theory of Acceptance and Use Technology (UTAUT) with COVID-19 fear (CF) and social isolation (SIS) as exogenous components. Objective This research aims to find out factors impacting medical students’ behavioural intention to use mobile learning. Methods Data was gathered from 499 undergraduate learners from different universities in Sudan. Partial Least Square (PLS) and structural equation modeling (SEM) were used to examine the data. The results Showed that expected performance, effort expectancy (EE), social influence (SI), facilitation condition (FC), COVID-19 fear, and social isolation (SIS) are predictors of behavioural intentions (BI). In addition, our findings show that COVID-19 fear and social isolation increase student adoption of mobile learning during the COVID-19 epidemics in developing countries. Conclusions The study unveiled that the suggested framework, derived from UTAUT, effectively discerns the factors impacting students’ intentions in mobile learning during pandemics. Sudanese medical students’ can strategize and execute effective classroom environments based on these findings.

Abstract Crithmum maritimum (sea fennel), is a halophytic plant species found globally in coastal environments. This study is the first investigation into the chemical composition and biological activities of C. maritimum growing wildly in Jebel Akhdar, Libya. Gas Chromatography-Mass Spectrometry (GC-MS) analysis was utilized to identify and profile the plant’s volatile components; it resulted in the identification of twenty-four components, representing 99.17% of the total peaks in the GC-MS chromatogram. The analysis revealed that thymyl methyl ether, γ-terpinene, and ledene oxide, were the major volatile constituents of the plant at relative percentage levels of 56.86, 16.17, and 4.32%, respectively. The analysis also indicated substantial variations in the volatile composition of C. maritimum Libyan species compared to those from various geographic regions. The plant’s volatile oil quality was evaluated by investigating its in vitro antioxidant activity and the oil’s ability to inhibit acetylcholinesterase (AChE) and tyrosinase enzymes. The oil markedly scavenged the free radicals and reduced the ferric ions in the DPPH and FRAP assays at levels of 34.30 ± 0.10 and 38.90 ± 0.51 Trolox equivalents, respectively. The plant’s volatile oil has substantially reduced the AChE at the IC50 value of 34.43 ± 0.25 compared to its effect against tyrosinase (IC50 12.449 ± 0.68). The in silico approach was used to highlight the mechanisms underlying the enzyme inhibitory effect of the plant volatile oil. The stigmastene and γ-santonin demonstrate stronger binding affinity towards AChE and tyrosinase compared to the co-crystalized controls, donepezil and tropolone. The study provides significant information for the environmental changes effect on the volatile constituents of C. maritimum and highlights the plant’s importance within the scope of its antioxidant and enzyme inhibition activities.

Abstract MRI imaging primarily focuses on the soft tissues of the human body, typically performed prior to a patient's transfer to the surgical suite for a medical procedure. However, utilizing MRI images for tumor diagnosis is a time-consuming process. To address these challenges, a new method for automatic brain tumor diagnosis was developed, employing a combination of image segmentation, feature extraction, and classification techniques to isolate the specific region of interest in an MRI image corresponding to a brain tumor. The proposed method in this study comprises five distinct steps. Firstly, image pre-processing is conducted, utilizing various filters to enhance image quality. Subsequently, image thresholding is applied to facilitate segmentation. Following segmentation, feature extraction is performed, analyzing morphological and structural properties of the images. Then, feature selection is carried out using principal component analysis (PCA). Finally, classification is performed using an artificial neural network (ANN). In total, 74 unique features were extracted from each image, resulting in a dataset of 144 observations. Principal component analysis was employed to select the top 8 most effective features. Artificial Neural Networks (ANNs) leverage comprehensive data and selective knowledge. Consequently, the proposed approach was evaluated and compared with alternative methods, resulting in significant improvements in precision, accuracy, and F1 score. The proposed method demonstrated notable increases in accuracy, with improvements of 99.3%, 97.3%, and 98.5% in accuracy, Sensitivity and F1 score. These findings highlight the efficiency of this approach in accurately segmenting and classifying MRI images.

Abstract Background: This study observes fetal, pregnancy, and maternal outcomes with different regimens of Magnesium sulphate (MgSO 4 ), used for prophylaxis and treatment of convulsions in eclampsia. Methods: In this observational study, the current prescribing practice and management outcomes of pre-eclampsia/eclampsia were observed in three tertiary care hospitals in Lahore, Pakistan.Data were collected by using data collection form, containing information related to patient demographics, history, laboratory findings, drug administration record, and therapeutic outcomes for pregnancy, fetus, and mother. Results: Of the 50 patients studied, most (74%) were of eclampsia. The mean age of the patients was 25.7 (+5.05) years with the majority (36%) in the age range 21–25 years. Forty-one patients received MgSO 4 , of which most received the Pritchard regimen (n = 35), whereas only 5 patients were managed with Zuspan regimen. Liner logistic analysis revealed better fetal outcomes (OR 0.217, CI –0.283 – 1.543) and pregnancy outcomes (OR 0.186, CI –0.164 – 0.635) with Zuspan regimen as compared to Pritchard. Whereas, both regimens showed no difference in maternal outcomes (OR 0.044, CI –0.129 – 0.170). Conclusion: Zuspan regimen proved to be better in morbidity and mortality associated with eclampsia. Additionally, national as well as institutional guidelines should be developed, implemented, properly monitored, and evaluated for management of pre-eclampsia/eclampsia. Mandatory in-service training and expertise should be provided for health professionals at all levels of the healthcare system, especially those working in gynecological setup.

BACKGROUND: Non-communicable diseases (NCDs) are a major public health challenge globally, including in Saudi Arabia. However, measuring the true extent of NCD prevalence has been hampered by a paucity of nationally representative epidemiological studies. OBJECTIVES: Assess the prevalence of selected NCDs, using population-based electronic health records and applying novel analytical methods to identify cases of NCDs. DESIGN: Retrospective SETTINGS: A large healthcare network in Saudi Arabia. PATIENTS AND METHODS: We included all beneficiaries aged 16 years or older (n=650 835[a]) and used the International Classification of Disease (ICD-10) codes, laboratory results, and associated medications to identify individuals with diabetes, obesity, hypertension, dyslipidemia, mental disorders, and injuries. For diabetes and hypertension, we used natural language processing (NLP) on clinical notes in the electronic health records. The prevalence of multimorbidity across age groups was also tabulated, and logistic regression was used to examine its association with glycemic control. MAIN OUTCOME MEASURES: The primary outcomes measured were the prevalence of diabetes, hypertension, and multimorbidity, and their association with glycemic control. SAMPLE SIZE: 650 835 individuals aged 16 years or older. RESULTS: The study population was relatively young, with 41.2% aged between 26 and 45 years, and around two-thirds were married. The prevalence of diabetes and hypertension was 18.5% (95% CI: 18.5-18.7) and 13.0% (95% CI: 12.9-13.1), respectively. Approximately 26.7% (95% CI: 26.7-26.8) of the population had multimorbidity, with levels increasing to 62.9% for those aged 65 or older. Multimorbidity was associated with a four-fold increase in the likelihood of poor glycemic control. NLP analysis suggested that the prevalence of diabetes or hypertension may be underestimated by no more than 1.5%. CONCLUSIONS: The study suggests a higher prevalence of NCDs than earlier national estimates. Electronic health records with regular analysis provide an opportunity to estimate changes in the prevalence of NCDs in Saudi Arabia. Health policies and interventions are needed to address the high levels of multimorbidity, which adversely impact glycemic control. LIMITATIONS: Retrospective design and reliance on electronic health records, which may not capture all cases of NCDs.

Abstract Ephedra alata Decne is a medicinal plant widely used in traditional medicine for the management of bronchial asthma and cancer. Phytochemical analysis and biological activities, including antioxidant and anticancer effects, were investigated in the current work as new findings for the plant E. alata, a species growing wildly in the marsh and saline environments of the central area of Saudi Arabia. The Ultra Pressure Liquid Chromatography coupled with Electron spray ionization-Quadropole-Time of flight (UPLC-ESI-Q-TOF) system was used for the phytochemical analysis of the plant constituents. In addition, Polyphenolic profiling including the total phenolic (TPC) and flavonoid (TFC) contents of the plant extracts were measured. Phenolic acids were found at the highest relative percentages among all the identified compounds and were measured at 66.07 mg GAE (Gallic acid equivalent). The UPLC analysis of the E. alata extract indicated the presence of chlorogenic acid, syringic acid, caffeic acid, vanillic acid, rosmarinic acid, umbelliferone, isorhoifolin, and apigenin at the highest relative percentages. Mineral analysis indicated that the microelement content of E. alata was relatively low, except for magnesium (Mg). In vitro antioxidant assays revealed the ability of the plant to scavenge DPPH free radicals, reduced molybdenum ions, and ferrous at levels of 14.63, 19.97, and 27.78 mg Trolox equivalents, respectively. The extract induced transition metal chelation at 31.36 mg EDTA equivalents. The extract induced cytotoxic effects against MDA-231 and A549 cell lines at IC50 levels of 25.31 and 39.81 µg/mL, respectively. The plant extract inhibited the colonization and migration of cancer cells as part of its potential anticancer effects. In addition, major E. alata constituents like isorhoifolin, chlorogenic acid, apigenin, and rosmarinic acid exhibited the lowest binding energy to the CAIX enzyme at − 8.41, − 6.64, − 6.32, and − 6.26 kcal/mol, respectively, compared to the binding energy (− 7.72 kcal/mol) of the co-crystallized ligand (Y0R). The docking results further supported the selection of the CAIX enzyme as a standard predictive therapeutic target, since it exhibited significant binding interactions with the major constituents of the plant.

Background: Thyroid cancer, the most common endocrine neoplasm, has a strong female predominance. There has been a steady increase in the incidence of thyroid cancer worldwide. This study aimed to investigate the prevalence of thyroid cancer and identify its predominant histological subtypes in the Aljuf region of Saudi Arabia. The study findings and new data obtained will contribute to advancing knowledge about thyroid cancer at the national level. Methods and Results: This retrospective, cross-sectional descriptive study was conducted in Sakaka, Aljouf region, Saudi Arabia. Data from thyroid specimens collected at King Abdul-Aziz Specialist Hospital and Prince Mutaib Hospital between January and December 2022 was analyzed. Among 3102 histopathological samples and 298 cytology samples received in both hospitals, 181 were thyroid specimens: histopathology samples [63(34.8%)] and fine-needle aspiration (FNA) samples for cytological diagnosis [118 (65.2%)]. The age of patients with thyroid disorders ranged from 17 to 69, with a mean age of 38.4 ± (SD)1.2 years. The highest percentage, 76(42%), were in the age group over 40. The majority of patients with thyroid disorders, 139 (76.8%), were women compared to 42(23.2%) men, giving a female-to-male ratio of 3.3: 1. 165(91.2%) of the study population were Saudi patients, while the non-Saudis represented only 16(8.8%) cases. Among 181 thyroid specimens, thyroid cancer was diagnosed in 33 patients (18.2%), benign tumors in 43 patients (23.8%) [follicular adenoma 39 (90.7%) and Hürthle cell adenoma 4 (9.3%)], goiter in 96 (53.0% cases), Hashimoto's thyroiditis in 6 cases (3.3%), and chronic lymphocytic thyroiditis in 3 cases (1.7%). The age of patients with thyroid cancer ranged from 20 to 57 years, with a mean age of 36.9 years. There were 25 (75.8%) females versus 8 (24.2%) males, with a ratio of 3.1:1. Papillary thyroid carcinoma was the most frequent histological subtype among patients with thyroid cancer, accounting for 75.8%, while follicular thyroid carcinoma represented 24.2%. Among 155 cancer cases, thyroid cancer ranked third (21.3%) after breast cancer (26.4%) and colon adenocarcinoma (23.9%). Conclusion: Thyroid pathology, including cancer, is notably prevalent among females and older age groups in the Al-Jouf region. Thyroid carcinoma is the third most diagnosed cancer type after breast carcinoma and colon adenocarcinoma in Al-Jouf in 2022. Papillary thyroid carcinoma is the most frequent histological subtype among Saudi patients with thyroid cancer.

Objective: Various side effects of the COVID-19 vaccine, such as fatigue, have been reported. However, there has been a recent increase in reports of menstrual cycle changes among women. This study assessed the effect of the COVID-19 vaccine on the menstrual cycle of Saudi women. Methods: In this cross-sectional study, data were collected between November and December 2021 from 500 healthy Saudi females between 20 and 40 years. We included all women who reported having a normal menstrual cycle before being vaccinated against COVID-19. Results: A total of 65.6% of participants reported having significant changes in their cycle in terms of period timing, blood flow, and pain following the first and 65.6.% following the second COVID-19 vaccination doses. Both the mRNA and adenovirus vectored COVID-19 vaccines affected the cycle similarly. The induced COVID-19 vaccine menstrual cycle abnormality is a short-term effect lasting

Abstract Aporosa cardiosperma is a plant species majorly found in the Indian Western Ghats that belongs to the phyllanthaceae family with ethnobotanical importance. Using a Fourier Transform-Infrared Spectrometer (FT-IR) and Gas Chromatography-Mass Spectrometry (GC–MS) for evaluating leaf extracts of A. cardiosperma, significant functional groups and metabolite constituents were determined, and its total flavonoid, phenol, and tannin content were quantified. Further, its antibacterial efficacy was investigated against microorganisms that cause fish and human disease and are resistant to common antibiotics, including Staphylococcus aureus, Bacillus subtilis, Mycobacterium tuberculosis, Klebsiella pneumoniae, Aeromonas hydrophila, and Pseudomonas aeruginosa. Regarding the outcomes of GC–MS analysis, the primary metabolites in the A. cardiosperma leaf extracts were heneicosane (57.06%), silane (13.60%), 1-heptadecene (10.09%), 3-hexadecene (9.99%), and pentadecane (9.54%). In comparison to other solvents, methanolic extract of A. cardiosperma leaves had increased phenolic, flavonoid, and tannin content; these findings are consistent with in vitro antioxidant potential and obtained that the methanolic extract (100 µg/mL) exhibited the higher percentage of inhibition in DPPH (82.35%), FRAP (86.20%), metal chelating (72.32%), and ABTS (86.06%) antioxidant assays respectively. Similar findings were found regarding the antibacterial efficacy against pathogenic bacteria. Comparatively, to other extracts, methanolic extracts showed more significant antibacterial activity at a lower minimum inhibitory concentration (MIC) value (250 µg/mL), whilst ethyl acetate and hexane solvent extracts of A. cardiosperma leaves had higher MIC values 500 µg/mL and 1000 µg/mL respectively. The antimicrobial potential was validated by investigating bacterial growth through the extracts acquired MICs and sub-MICs range. Bacterial growth was completely inhibited at the determined MIC range. In conclusion, A. cardiosperma leaf extract's phytochemical fingerprint has been determined, and its potent antibacterial and antioxidant activities were discovered. These findings of the current study will pave the way for developing herbal treatments from A. cardiosperma for various fish and human diseases.

Abstract Background Quality sleep is vital for well-being, especially for healthcare workers facing high risks of fatigue and burnout. Sleep deprivation impairs cognitive and motor functions, contributing to medical errors. Addressing sleep disorders among healthcare professionals is crucial for enhancing patient care. Tailored interventions are needed to support their well-being and improve healthcare outcomes. Objective To evaluate the effect of Sleep Quality and its Deprivation on Sudanese Healthcare Professionals amidst conflict in Sudan. Methods A cross-sectional online survey of Sudanese doctors was conducted using convenience sampling. The questionnaire covered sleep quality, daytime sleepiness, and psychological well-being. Pilot testing ensured questionnaire clarity. Data collection utilized Google Forms distributed through social media and professional networks. A minimum sample size of 384 was calculated. Statistical analysis included descriptive statistics and various tests for significance. Data were securely stored and analyzed using SPSS and R software. Results Among 649 participants, 404 (62.2%) were women, with a mean age of 30.34 years. Most were single (434, 66.9%). General practitioners constituted the largest professional group (267, 41.1%), followed by registrars/residents (142, 21.9%). Participants took an average of 43.70 minutes to fall asleep and slept an average of 5.90 hours per night. According to the PSQI, 300 (46.2%) reported mild sleep disturbance, 287 (44.2%) moderate, 42 (6.5%) severe, and only 20 (3.1%) normal sleep. The ESS revealed 285 (43.9%) with lower normal daytime sleepiness, 188 (29.0%) with higher normal, and various levels of excessive daytime sleepiness. Stress levels varied, with 398 (61.3%) reporting normal stress, while anxiety ranged from 248 (38.2%) normal to 148 (22.8%) extremely severe. Conclusion This study emphasizes the importance of addressing sleep quality, mental health, and performance challenges among Sudanese healthcare professionals. It highlights the need for hospitals to implement measures enabling more time off, adequate sleep, and reduced on-call service days. Healthcare workers must recognize the significance of these factors for their well-being and patient care quality. The research outcomes can raise awareness about the necessity of regulating healthcare practitioners' working hours and ensuring adequate sleep.

Introduction: Autism Spectrum Disorder (ASD) is a lifelong hereditary neurodevelopmental disorder characterised by a lack of social communication and restricted and repetitive behaviours. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classified symptoms of autism into two domains: the social communication and interaction domain. However, studies on autism in Saudi Arabia are still insufficient. Therefore, awareness and knowledge about autism can facilitate early detection and treatment, resulting in better outcomes. Aim: To evaluate parents’ knowledge, awareness, and attitude towards their autistic children in a tertiary care hospital in Saudi Arabia. Materials and Methods: This hospital-based cross-sectional study was conducted at Baljurashi Mental Health Hospital, AL-Baha region, Saudi Arabia, from January 2023 to November 2023. A total of 69 parents with autistic children who attended the outpatient clinic at Baljurashi Mental Health Hospital were included in the study. A questionnaire was administered among parents to assess their knowledge, awareness, and attitude regarding autism. Data was statistically analysed using descriptive statistics and the Chi-square test. Results: The age of the parents ranged from 16 to over 50 years, with 47 (68.1%) being males and 22 (31.9%) being females. Almost 29 (42.0%) of the parents were postgraduates, and 21 (30.4%) had a university-level education. About 24 (34.8%) of the participants believed that consanguineous marriage increases the risk of autism, 19 (27.5%) believed that some vaccines increase the risk of autism, and 39 (56.5%) knew that autism is associated with learning disabilities. Three-quarters of the participants, 54 (78.3%), stated that autism was known to them, 50 (72.5%) thought that an autistic child could be affected by a normal child, and 53 (76.8%) had good knowledge about autism. Conclusion: The study showed that the majority of parents had good knowledge about autism disorder. The findings reflect the positive impact of focused training initiatives and public awareness efforts aimed at improving parents’ knowledge, awareness, and attitude toward autism.

Abstract Co-creation of education within the context of student inclusion alongside diverse stakeholders merits exploration. We studied the perspectives of students and teachers from different institutions who participated in co-creating a transition to residency curriculum. We conducted post-hoc in-depth interviews with 16 participants: final-year medical students, undergraduate, and postgraduate medical education stakeholders who were involved in the co-creation sessions. Findings build on the Framework of Stakeholders’ Involvement in Co-creation and identify the four key components of co-creation with diverse faculty: immersion in positive feelings of inclusivity and appreciation, exchange of knowledge, engagement in a state of reflection and analysis, and translation of co-creation dialogues into intended outcomes. Despite power dynamics, participants valued open communication, constructive feedback, mutual respect, and effective moderation. The study broadened our understanding of the co-creation process in diverse stakeholder settings. Incorporating key elements in the presence of power relations can enrich co-creation by leveraging wider expertise.

Introduction: Vaccine hesitancy is undermining individual and community protection from vaccine-preventable diseases. This study aimed to investigate the level of awareness and perception of the COVID-19 vaccine and its determinants among people in Wad Madani City, Gezira State, as well as its known side effects. Methods and Results: This cross-sectional, descriptive, and correlative study included 400 participants (56.8% females and 43.2% males) who visited Wad Madani neighborhood COVID-19 centers during the data collection period (June 2022). The data was collected using a structured questionnaire based on prior published studies. Approximately 93.0% of the participants knew the importance of the COVID-19 vaccines, 84.8% knew about their effectiveness, and 83.8% knew that the vaccines help to reduce the risk of virus infection. However, only 58.0% were vaccinated against COVID-19. The results showed that 56.8% of the participants did not develop side effects. Among those who did, the most common side effects were headache and fever (10.2%), injection site pain (7.9%), myalgia (7.1%), and chills and swelling (5.6%). The results showed that 52.5% had negative perceptions of the COVID-19 vaccines. Urban residents were 2.17 times more likely to have a positive perception of the COVID-19 vaccine than rural residents (P=0.05). Furthermore, study participants with nuclear family type have shown a positive attitude toward the COVID-19 vaccines and were 2.32 times more likely to have had a positive attitude than participants with extended family (P=0.036). Moreover, participants not vaccinated were found to be less likely to have had a positive attitude toward the COVID-19 vaccine, when compared with vaccinated participants (P= 0.005). Conclusion: Although society is aware of the need for COVID-19 immunization, the community has a low positive perception toward COVID-19 vaccination. Similarly, people in rural areas are less aware of the significance of immunization. Local health officials must collaborate to address public fears about vaccinations through the media.

Background: Cardiac arrest remains a critical global health challenge, necessitating effective interventions to improve outcomes. Autopulse Mechanical Chest Compression has emerged as a potential adjunct to conventional manual cardiopulmonary resuscitation (CPR). This study aimed to comprehensively investigate the association between Autopulse use and various outcomes following cardiac arrest. Methods: A thorough literature review was conducted using PubMed, Embase, Scopus, Google Scholar, CINAHL, and the Cochrane Library. Articles were evaluated for eligibility according to predefined criteria. The collected data was synthesized, and the findings were subsequently presented. Results: Sixteen studies were included in the study. A synthesis of diverse studies revealed nuanced perspectives on Autopulse Mechanical Chest Compression. Enhanced CPR success and improved survival rates in out-of-hospital cardiac arrest were demonstrated, while potential drawbacks were suggested, warranting scrutiny of device design and implementation strategies. Meta-analyses on ROSC favored Autopulse, indicating a statistically significant advantage over Manual CPR (relative risk 1.43, 95% CI 1.07-1.92). Complication analyses showed no significant difference (relative risk 1.11, 95% CI 0.93-1.33), emphasizing comparable safety profiles. Patient survival rates exhibited variations, with Autopulse demonstrating higher rates in some studies, but nuances were observed in 30-day survival and hospital discharge rates. Conclusion: Autopulse Mechanical Chest Compression holds promise as a supplementary strategy in cardiac arrest resuscitation. However, complexities arose in longer-term outcomes, highlighting the need for contextual considerations. [SJEMed 2024; 5(1.000): 030-041]

Abstract Limited data exist on viral hepatitis among migrant populations. This study investigated the prevalence of current hepatitis B virus (HBV) infection and lifetime hepatitis C virus (HCV) infection among Qatar's migrant craft and manual workers (CMWs), constituting 60% of the country's population. Sera collected during a nationwide COVID-19 population-based cross-sectional survey on CMWs between July 26 and September 9, 2020, underwent testing for HBsAg and HCV antibodies. Reactive samples underwent confirmatory testing, and logistic regression analyses were employed to explore associations with HBV and HCV infections. Among 2528 specimens tested for HBV infection, 15 were reactive, with 8 subsequently confirmed positive. Three samples lacked sufficient sera for confirmatory testing but were included in the analysis through multiple imputations. Prevalence of current HBV infection was 0.4% (95% CI 0.2–0.7%). Educational attainment and occupation were significantly associated with current HBV infection. For HCV infection, out of 2607 specimens tested, 46 were reactive, and 23 were subsequently confirmed positive. Prevalence of lifetime HCV infection was 0.8% (95% CI 0.5–1.2%). Egyptians exhibited the highest prevalence at 6.5% (95% CI 3.1–13.1%), followed by Pakistanis at 3.1% (95% CI 1.1–8.0%). Nationality, geographic location, and occupation were significantly associated with lifetime HCV infection. HBV infection is relatively low among CMWs, while HCV infection falls within the intermediate range, both compared to global and regional levels.

Abstract High temperatures (HT) and drought are two major factors restricting wheat growth in the early growth stages. This study investigated the role of glutathione (GSH) amendment (0.0, 0.5, 1.0, and 2.0 mM) to soil in mitigating the adverse effect of HT (33 °C, with 25 °C as a control), water regimes (60% of field capacity and control), and their combinations. HT decreased the length, project area, surface area, volume, and forks of the root, while drought had the reverse effect. Shoot length, leaf area, leaf relative water content, and shoot and root dry matter were significantly decreased by HT and drought, and their combined impact was more noticeable. GSH significantly promoted the root system, shoot growth, and leaf relative water content. The combined treatment reduced chlorophyll a, chlorophyll b, and total chlorophyll. However, 0.5 mM GSH raised chlorophyll a, chlorophyll b, and total chlorophyll by 28.6%, 41.4%, and 32.5%, respectively, relative to 0.0 mM GSH. At combined treatment, 0.5 mM GSH decreased malondialdehyde (MDA) by 29.5% and increased soluble protein content by 24.1%. GSH meaningfully enhanced the activity of superoxide dismutase, catalase, and ascorbate peroxide in different treatments. This study suggested that GSH could protect wheat seedlings from the adverse effects of HT and/or drought stresses.

Liver transplant (LT) candidates undergo transthoracic echocardiography (TTE) before surgery to assess cardiac function and evaluate the echocardiographic probability of pulmonary hypertension (PHT). The improvement of pulmonary artery systolic pressure (PAPS) after transplant is associated with higher survival rates in patients with mild or moderate PHT. Although studies analyze the outcomes of LT in patients treated for PHT, the prognostic value of PAPS in patients without PHT in the follow-up is unknown. The aim of our study is to evaluate pre- and post-LT cardiac function, right ventricular function, pulmonary artery pressure, and their association with long-term mortality. 102 patients who underwent LT between 2011 and 2018 were compared for echocardiographic and hemodynamic parameters pre- and post-LT. After LT, systolic blood pressure, heart rate (HR), and PASP significantly increased, while tricuspid annular plane systolic excursion/PAPS decreased. Moreover, the higher difference in HR and PASP between pre- and post-LT was highlighted in those patients who died during the follow-up period after LT. Among all the parameters tested, in the multi-variable Cox regression for mortality, left ventricular ejection fraction and PASP difference were predictors of mortality. This study highlights the importance of TTE in LT screening as a tool to stratify patients at higher risk of death due to advanced cirrhotic cardiomyopathy and the importance of the change of echocardiographic parameters, in particular right and left ventricular hemodynamics, during the follow-up period. These parameters could be used to guide a more aggressive therapy.

Background: Children with medical complexity (CMC) account for a substantial proportion of healthcare spending, and one-third of their expenditures are due to readmissions. However, knowledge regarding the healthcare-resource utilization and characteristics of CMC in Saudi Arabia is limited. Objectives: To describe hospitalization patterns and characteristics of Saudi CMC with an unplanned 30-day readmission. Methodology: This retrospective study included Saudi CMC (aged 0–14 years) who had an unplanned 30-day readmission at six tertiary centers in Riyadh, Jeddah, Dammam, Alahsa, and Almadina between January 2016 and December 2020. Hospital-based inclusion criteria focused on CMC with multiple complex chronic conditions (CCCs) and technology assistance (TA) device use. CMC were compared across demographics, clinical characteristics, and hospital-resource utilization. Results: A total of 9139 pediatric patients had unplanned 30-day readmission during the study period, of which 680 (7.4%) met the inclusion criteria. Genetic conditions were the most predominant primary pathology (66.3%), with one-third of cases (33.7%) involving the neuromuscular system. During the index admission, pneumonia was the most common diagnosis (33.1%). Approximately 35.1% of the readmissions were after 2 weeks. Pneumonia accounted for 32.5% of the readmissions. After readmission, 16.9% of patients were diagnosed with another CCC or received a new TA device, and the in-hospital mortality rate was 6.6%. Conclusion: The rate of unplanned 30-day readmissions in children with medical complexity in Saudi Arabia is 7.4%, which is lower than those reported from developed countries. Saudi children with CCCs and TA devices were readmitted approximately within similar post-discharge time and showed distinct hospitalization patterns associated with specific diagnoses. To effectively reduce the risk of 30-day readmissions, targeted measures must be introduced both during the hospitalization period and after discharge.

Abstract Cancer is responsible for approximately 10 million deaths worldwide, with 70% of the deaths occurring in low- and middle-income countries; as such safer and more effective anti-cancer drugs are required. Therefore, the potential benefits of Ziziphus nummularia and Ziziphus spina-christi as sources of anti-cancer agents were investigated. Z. nummularia and Z. spina-christi extracts were prepared using chloroform, ethanol, ethyl acetate, and water. The extracts’ anti-cancer properties were determined using the MTT Cell Viability Assay in four cancer cell lines: breast (KAIMRC2 and MDA-MB-231), colorectal (HCT8), and liver (HepG2). The ApoTox-Glo Triplex Assay and high-content imaging (HCI)-Apoptosis Assay were used to assess KAIMRC2 and HCT8 cells further. In addition, KAIMRC2 cells were tested for microtubule staining, and AKT/mTOR protein expression was determined by western blot analysis. Liquid chromatography-mass spectrometry (LC–MS) was performed to identify the secondary metabolites in the ethanol and ethyl acetate extracts, followed by in silico techniques to predict molecular targets and interactions, safety, and pharmacokinetic profile for identified metabolites. Out of the eight extracts, the ethanolic extract of Z. nummularia, exhibited the most potent activity against KAIMRC2 cells with an IC50 value of 29.2 μg/ml. Cancer cell treatment with the ethanolic extract of Z. nummularia resulted in a dose-dependent decrease in cell viability with increased apoptosis and cytotoxic effects. Microtubule staining showed a disrupted microtubular network. The ethanolic extract treatment of KAIMRC2 cells led to upregulated expression of pAKT and pmTOR. In silico studies predicted luteolin-7-O-glucoside to be a ligand for tubulin with the highest docking score (− 7.686) and similar binding interactions relative to the native ligand. Further computational analysis of the metabolites showed acceptable pharmacokinetic and safety profiles, although ethanolic extract metabolites were predicted to have cardiotoxic effects. Ethanolic extraction is optimal for solubilizing active anticancer metabolites from Z. nummularia, which may act by causing M-phase arrest via inhibition of tubulin polymerization. Luteolin-7-O-glucoside is the lead candidate for further research and development as an anti-cancer agent. In addition, this study suggests that herbal treatment could switch on mechanisms of adaptation and survival in cancer cells.

Abstract Background Recurrent pregnancy Loss (RPL) is common problem affecting many couples. A certain genetic variants link to increase the danger of this condition particularly HPA-1, HPA-3 and Human Factor XIII Val34Leu Mutation. The present study aims to find an association between RPL and the Factor XIII Val34Leu polymorphism, as well as HPA-1 and HPA-3 in Sudanese women with RPL. Methods This case-control study conducted between June 2022 and December 2022 included 216 women, with 103 cases having minimum three abortions in the past, and 113 healthy controls with at least two full-term births and no abortion history. DNA was isolated from whole blood and the status of three genetic polymorphisms (HPA-1, HPA-3, and factor XIII) was done using a polymerase chain reaction (PCR). Data was analysed using the SPSS version 24 software. Results The A/A genotype was found to be more prevalent in cases (79.6%) and controls (96.5%) regarding HPA-1. A significant difference was observed in overall allele frequency for B allele (97.0%) and expected frequency of A allele was (81.1%) using the Hardy-Weinberg distribution (p 0.05). Conclusion Our results indicate a link between Human Platelet Antigen-1 (HPA-1), Human Platelet Antigen-3 (HPA-3) and Factor XIII gene polymorphism with RPL.

Background: Various factors, such as genetic causes, anatomic abnormalities of the uterus, infectious diseases, coagulative disorders, and endocrinological and immunological diseases, might influence recurrent pregnancy loss (RLP). This study aimed to evaluate the prevalence and frequency of the FII G20210A, FVL G1691A, and MTHFR C677T polymorphisms in Sudanese women with RPL. Methods and Results: This descriptive cross-sectional study involved 100 women with a history of 3 or more RPLs (the case group) and 94 healthy multiparous women without pregnancy complications (the control group). DNA was extracted from peripheral blood samples. The study of the FII G20210A, FVL G1691A, and MTHFR C677T polymorphisms was performed by PCR and RFLP analysis. For the FII G20210A, the genotype distribution in the case group and control group was as follows: GG=97.0%, GA=3.0%, AA=0% and GG=94.0%, GA=0%, AA=0%, respectively. In the case group, the allelic distribution was as follows: G=98.5%, A=1.5%. In the control group, the A allele was absent, and the frequency of the G allele was 100%. For the MTHFR C677T, the genotypic and allelic frequencies in the case group were 97%, 3%, and 0%, respectively, for the CC, CT, and TT genotypes, and 98.5% and 1.5%, respectively, for the C and T alleles. In the control group, the genotype distribution was as follows: CC-100% CT-0%, TT-0%; the T allele was absent, and the frequency of the C allele was 100%. For the FVL G1691A, the genotype distribution in the case group and control group was as follows: GG=92.0%, GA=8.0%, AA=0% and GG=93.6%, GA=6.4%, AA=0%, respectively. For G and A alleles, the frequencies were 96.0% and 4.0%, respectively, for the case group, and 96.8% and 3.2%, respectively, for the control group. Our analysis did not reveal a significant positive association between the MTHFR C677T, FII G20210A, and FVL G1691A polymorphisms and the risk of RPL across the dominant model, multiplicative model, and a comparison of the frequencies of the heterozygous and homozygous dominant genotypes. Conclusion: The research findings suggest that the MTHFR C677T, FVL G1691A, and FII G20210A variants do not significantly contribute to the increased susceptibility to RPL in this specific population of Sudanese women. Continued scientific inquiry is crucial for developing more nuanced and personalized strategies for the diagnosis and prevention of RPL, ultimately improving women's reproductive health.

Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) have shown promising effectiveness in migraine management compared to other preventative treatment options. Many questions remain regarding switching between antibody classes as a treatment option in patients with migraine headaches. This preliminary retrospective real-world study explored the treatment response of patients who switched between CGRP mAb classes due to lack of efficacy or poor tolerability. A total of 53 patients with migraine headache switched between three of the CGRP mAbs types due to lack of efficacy of the original prescribed CGRP mAbs, specifically eptinezumab, erenumab, and galcanezumab. Fremanezumab was not included due to unavailability in the UAE. Galcanezumab and eptinezumab target the CGRP ligand (CGRP/L), while erenumab targets CGRP receptors (CGRP/R). The analysis of efficacy demonstrated that some improvements were seen in both class switch cohorts (CGRP/R to CGRP/L and CGRP/L to CGRP/R). The safety of switching between CGRP classes was well observed, as any adverse events presented before the class switch did not lead to the discontinuation of treatment following the later switch. The findings of this study suggest that switching between different classes of CGRP mAbs is a potentially safe and clinically viable practice that may have some applications for those experiencing side effects on their current CGRP mAb or those witnessing suboptimal response.

Key Clinical Message Bronchopulmonary sequestration, a rare congenital anomaly, involves a nonfunctioning lung tissue mass supplied by anomalous vessels. It is rarely infected by Actinomyces, further complicating the clinical presentation, with limited reported cases. This case highlights the distinctive clinical aspects, diagnostic challenges, and successful management strategies of such a rare clinical entity.

Abstract Background: Attention deficit hyperactivity disorder, which is a prevalent neurodevelopmental condition, commonly manifests during early childhood and has the potential to adversely affect an individual's social, academic, and occupational performance in multiple settings. Students with ADHD may struggle with attention, focus, listening, and completing schoolwork. Additionally, they may exhibit restless or disruptive behavior in class and may have learning disabilities that affect their academic performance. The aim of this study was to explore the perspectives of primary school teachers on ADHD in Alkadrow, Khartoum, Sudan. Methods: A descriptive cross-sectional study was conducted in Alkadrow-Bahri locality, Sudan, over a period of three to six months in 2022. The study population included primary school teachers who had taught for at least one year and encountered at least one student with ADHD. A convenience sampling technique was used to select a minimum of 59 participants, and data were collected using a self-administered questionnaire with closed-ended questions. SPSS version 23 was used to analyze the data, including descriptive statistics and inferential statistics such as chi-square tests and logistic regression analysis. Results: The study had 59 participants, with the majority being female and in the age group of 41–45 years. The participants were mostly married and had obtained psychology courses, with a bachelor's degree being the most common level of education. Many participants had over 20 years of teaching experience. Regarding the attitude toward attention deficit hyperactivity, most participants strongly agreed that they did have a negative/positive attitude toward it, and a majority agreed or were neutral toward ADHD. However, in the case of attention deficit hyperactivity, a significant percentage of participants disagreed or strongly disagreed with the statement. Conclusion: The study found that most participants had a negative attitude toward student referrals for medical care and believed that most symptoms of ADHD can be lowered by aging. Additionally, more than half strongly disagreed that punishment has a positive effect on ADHD.

Background: Seroconversion of hepatitis B surface antigen (HBsAg) to hepatitis B surface antibody (anti-HBs) is a recognized goal of HBV therapy. This dynamic transition responsible for the coexistence of HBsAg and anti-HBs is rarely detected in clinical cases. However, with vaccination and the use of various antiviral drugs, as well as the development of new medical technologies, recognizing the coexistence of HBsAg and anti-HBs has become more common. In addition, mutations in viral genomes, immune status, and human genetic factors may also contribute to such coexistence. The current study was designed to determine the prevalence of the coexistence of HBsAg and anti-HBs and HBeAg and anti-HBe in CHB patients in Sudan. Methods and Results: This was a descriptive cross-sectional study conducted in Khartoum state from November 2018 to January 2019. The study included 70 HBV-infected patients who were positive for HBsAg for more than six months. Blood samples were tested for HBsAg/Anti-HBs and HBeAg/Anti-HBe using Commercial ELISA Kits (Foresight, United Kingdom) and (PRECHEK, USA). Demographic data were collected using a structured questionnaire, and any antiviral agent and laboratory results were also recorded for each participant. The current study showed that one case (1.4%) was reactive for the coexistence of HBsAg/HBsAb and two cases (2.8%) for the coexistence of HBeAg/HBeAb. There was no statistical difference between the coexistence of HBsAg/HBsAb and HBeAg/HBeAb with age, gender, residence, and treatment status. Conclusion: Our study indicates that the frequencies of the coexistence of HBsAg/HBsAb and HBeAg/HBeAb among Sudanese patients with chronic HBV infection were low compared to previous studies in a different population.

Background Globally, cardiovascular disease (CVD) remains the leading cause of death, warranting effective management and prevention measures. Risk prediction tools are indispensable for directing primary and secondary prevention strategies for CVD and are critical for estimating CVD risk. Machine learning (ML) methodologies have experienced significant advancements across numerous practical domains in recent years. Several ML and statistical models predicting CVD time-to-event outcomes have been developed. However, it is not known as to which of the two model types—ML and statistical models—have higher discrimination and calibration in this regard. Hence, this planned work aims to systematically review studies that compare ML with statistical methods in terms of their predictive abilities in the case of time-to-event data with censoring.Methods Original research articles published as prognostic prediction studies, which involved the development and/or validation of a prognostic model, within a peer-reviewed journal, using cohort or experimental design with at least a 12-month follow-up period will be systematically reviewed. The review process will adhere to the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist.Ethics and dissemination Ethical approval is not required for this review, as it will exclusively use data from published studies. The findings of this study will be published in an open-access journal and disseminated at scientific conferences.PROSPERO registration number CRD42023484178.

This study investigated the link between angiotensin I-converting enzyme insertion/deletion (ACE I/D) polymorphism and unexplained spontaneous abortion. This retrospective analytical case-control was conducted at the Omdurman Maternity Hospital in Sudan. The current study contained 230 individuals, including 119 cases (women who had at least three abortions) of unknown cause and 119 controls (healthy women who had at least two full-term deliveries without spontaneous abortion). Patients and controls were provided five ml of ethylenediaminetetraacetic acid blood and answered questionnaires about their demographics, personal lives, and family histories. ACE I/D polymorphisms were assessed using a conventional polymerase chain reaction approach after total genomic DNA was isolated from blood leukocytes using the GF-1 blood DNA extraction kit. Data was analyzed using the Statistical Package for the Social Sciences version 24. ACE I/D polymorphism is strongly linked to unexplained spontaneous abortion, and women with the I/D and D/D genotypes are more likely to have it than those with the I/I genotype. The current study reveals that ACEI/D polymorphism increases pregnancy problems. Sudanese women may have spontaneous abortions due to the ACE I/D polymorphism.

Bacillus cereus and Staphylococcus aureus are the most important bacteria that cause nosocomial infection and are resistant to antibiotics. Crude proteins from Cassia fistula and Ricinus communis were isolated to study their medicinal potential against Bacillus cereus, and Staphylococcus aureus. Extraction of the crude proteins from plants was done by phosphate buffer saline (PBS) and Tris NaCl buffer by using the roots and seeds of both plants. Antimicrobial activity was checked against bacterial strains by using agar disc diffusion and agar well diffusion methods. Zones of inhibitions were measured. On well diffusion method, PBS buffer protein extract of C. fistula roots showed a maximum zone of inhibition of 25 mm against B. cereus. Tris NaCl buffer extracts of C. fistula roots and seeds showed zones of inhibition of 12mm and 5mm respectively against S. aureus while Ricinus communis roots showed a zone of 12mm against B. cereus. Because the protein of the plants showed good antimicrobial activity, we can use these plants against various diseases caused by Bacillus cereus and Staphylococcus aureus.

Background Decisions on the management of interstitial lung diseases (ILD) and prognostication require an accurate diagnosis. It has been proposed that multidisciplinary team (MDT) meetings for ILD (ILD-MDT) improve these decisions in challenging cases of ILD. However, most studies in this field have been based on the decisions of individual clinicians and there are few reports on the outcomes of the ILD-MDT approach. We therefore describe the experience of the ILD-MDT meetings at our institution.

Abstract Human Papillomavirus (HPV) is the most common cause of sexually transmitted diseases and causes a wide range of pathologies including cervical carcinoma. Integration of the HR-HPV DNA into the host genome plays a crucial role in cervical carcinoma. An alteration of the pRb pathways by the E7 proteins is one of the mechanisms that’s account for the transforming capacity of high-risk papillomavirus. For the proper understanding of the underline mechanism of the progression of the disease, the present study investigate the correlation of concentration of host pRb protein, viral E7 oncoprotein and viral load in early and advanced stages of cervical carcinoma. It was found that the viral load in early stages (stage I and II) was less (log10 transformed mean value 2.6 and 3.0) compared to advanced stages (stage III and IV) (Log10 transformed value 5.0 and 5.8) having high expression of HPV E7 onco-protein and reduced level of pRb protein, signifying the role of viral load and expression level of E7 oncoprotein in the progression of cervical cancer.

This in vivo study was conducted to evaluate the antiviral activity of Arabian coffee (Coffea arabica) and green tea (Camellia sinensis) extracts against the influenza virus. High-performance liquid chromatography (HPLC) was used to determine the active components in each extract, and eighty experimental mice were treated. Electrophoresis was performed to detect protein expression, and reverse transcription-polymerase chain reaction (RT-PCR) was used to analyze gene expression and quantify viral RNA. Lung tissue histopathology was processed to observe pathological signs. Oral administration of all extracts reduced the viral quantification in mice lungs by 61.6% in the early phase of infection, measured by PCR. From the extracts tested, unroasted green Arabica coffee (AC) extract in protective groups showed remarkable body weight stability of 16.76 g, a survival rate of 100%, and healthier lung tissue, compared to other groups. The antiviral effects of the tested AC and GT (green tea) revealed that AC extracts induced veridical effects, increased body weight, and improved survival rate. Those natural extracts may interfere with viral replication and reduce virus infection. The observed anti-influenza activity demonstrated by reduced symptoms and increased survival rate in animal models suggests that AC extracts might be used as a promising prophylactic agent against influenza viral infections. The active compound in the unroasted green AC extract requires further in vitro analysis as to which viral proteins are targeted by the natural extract and which molecular mechanism this antiviral inhibition is interfering with.

Abstract Introduction Adult Intussusception is an uncommon diagnosis, with one to three cases occurring in a population of 1,000,000 per year, primarily due to underlying pathological lead points, of which 70% are malignant. Lipoma is the most common benign tumour, and primary adenocarcinoma is the most common malignant one. Early diagnosis and treatment are essential to reducing poor outcomes, including ischemia, perforation, and sepsis. Computed tomography imaging is a modality of choice for diagnosis. With a diagnostic accuracy of up to 100% and a specificity of up to 71%. Surgical intervention is the definitive treatment, and the decision is taken according to the situation. Case presentation A 61-year-old Black African female presented to our surgical casualty with intermittent colicky abdominal pain for 1 month. After that, she started to experience abdominal swelling in the right iliac fossa. A CT scan confirmed the presence of colo-colic Intussusception, cecum-ascending-transverse colon. Laparotomy was scheduled, and a right hemicolectomy was done accordingly. Diagnosis of adenocarcinoma (Dukes stage B2) was made histologically. Conclusion Intussusception in adults is a challenging diagnosis requiring high clinical suspicion and has a high incidence of fatal complications. Colonic cancer can be worsening by any infection and chronic medical problem. CT imaging is the lifesaving modality of choice for diagnosis. Good patient outcomes depend on timely diagnosis and recruitment of a multi-disciplinary team.

Aim: This meta-analysis and systematic review aims to investigate and compare the efficacy of mannitol and hypertonic saline in treating patients who have suffered from traumatic brain injury (TBI). Methods: We reviewed publications from the Medline database, Web of Science, and Google Scholar from inception to 13 October 2022 with only English-based literature. The risk of bias from included Randomized controlled trial (RCT) s was assessed using the Cochrane Collaboration's Tool. Newcastle-Ottawa Scale was employed to assess the included cohort's quality. The main outcomes of this review were treatment failure, mortality, intracranial pressure (ICP) reduction, and Cerebral Perfusion Pressure (CPP) increment. All the statistical analyses were performed using the Review Manager 5.4.1. A random-effects model was used to pool the studies when heterogeneity was seen, and the results were reported in the odds ratios (OR) and mean differences (MD) and the corresponding 95% confidence intervals. Results: The results of the statistical study found that there was a significantly lower treatment failure rate [OR = 1.80 (1.26, 2.57); p = 0.001; I 2 = 74%], the lower mortality rate [OR = 2.17 (1.26, 3.73); p = 0.005; I 2 = 0%], a greater increase in CPP [MD = -1.28 (-2.50, -0.05); p = 0.04; I 2 = 0%] associated with hypertonic saline treatment as compared to mannitol treatment. However, concerning ICP decrease, there was no significant difference between the two treatment options [MD = 1.86 (-0.64, 4.36); p = 0.14; I 2 = 70%]. Conclusions: Quantitative and qualitative analysis of trials and observational studies comparing the efficacy of hypertonic saline and mannitol demonstrates that hypertonic saline is a preferable treatment option with greater effectiveness and safety than mannitol in managing patients with TBI. [SJEMed 2023; 4(1.000): 051-059]

Background: In published animal studies, N-methyl-D-aspartate antagonists such as ketamine (KET) have been reported to reduce Status epilepticus (SE) even after benzodiazepines had failed. In addition, there are studies on the human population that have reported on the use of KET to manage SE seizures. However, despite its history of use as an anesthetic, there are few published review studies on using KET in the treatment of refractory SE (RSE). Objective: This research aims to determine whether KET is an effective treatment for RSE and super-refractory (SRSE) in both children and adult patients. Methods: A systematic search was done on PubMed, EMBASE, Google Scholar, and Cochrane databases from inception until September 12, 2022. In addition, a search was also done for gray literature (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform). Results: The initial search identified 164 articles and only 21 were included in this systematic review; 10 case reports, 9 case series, and 2 cohort studies. In total, the study population is 408. Regarding individual case reports, there were 56 cases, of which 52 were adults. In addition, there were 27 males, 26 females, and 3 unidentified (50). Conclusion: The admission of KET as management for RSE and SRSE has effectively controlled and terminated SE seizures. KET presented to generally be safe, as there are a few reported adverse events. The mortality rates appeared to be high, but none of the studies reported any direct link between these adverse outcomes and using KET to manage SE. [SJEMed 2023; 4(1.000): 060-072]

The requirement for infection control during the COVID-19 pandemic led to modifying the exposure parameters in conventional radiography for performing chest X-ray radiography (CXR) through-the-glass (TTG) for imaging COVID-19 pneumonia. Herein, we reviewed and reported the current experiences with the TTG protocol, and summarized the current implementation strategies and modified technique factors. For implementing TTG techniques, measurements are required in a simulated environment using a patient equivalent phantom, and a certain number of investigations must be performed before the patient examination. However, the TTG technique requires modification due to the decrease in photon intensity caused by the attenuation in the glass barrier. This study discussed factors affecting CXR and some related radiation dose terminology required for implementing the TTG technique. Moreover, it summarized the exposure factors of CXR using the TTG technique compared with the standard CXR. Radiation exposure to the patient and the staff using the TTG technique remains within the recommended limits for safe practice. Image quality issues arose following the implementation of the TTG technique, mainly related to suboptimal positioning; image artifacts resulted due to glass attenuation, the increased source-to-image distance (SID), and patient movement. Overall, the reviewed results in this study could help formulate international guidelines and recommendations for the TTG technique for COVID-19 patient imaging, thereby minimizing the cost and time required for setting up the protocol.

Background: Thyroid dysfunction has a strong association with anemia. Red blood cell distribution width (RDW) was traditionally regarded as a part of the routine evaluation of anemia. Several studies have indicated that elevated RDW level is significantly associated with subclinical hypothyroidism and hypothyroidism. The present study aimed to assess the impact of subclinical hypothyroidism (SHT) on RDW in Sudanese patients. Methods and Results: The study was designed as a case-control, laboratory-based study carried out at the National Cancer Institute – University of Gezira (NCI-UG) (Wad Medani, Gezira State, Sudan) from January to October 2020.The samples were collected randomly from 100 subjects: 50 patients (mean age 38.50±10.46 years; 36% males and 64% females) with hypothyroidism (case group) and 50 apparently healthy individuals (mean age 35.52±11.64 years; 46% males and 54% females) (control group). The case group was divided into 2 subgroups: Sub1 included 43(86%) patients with SHT grade 1 (TSH of 6-10μIU/mL), and Sub2 included 7(14%) patients with SHT grade 2 (TSH>10μIU/mL). A 3ml venous blood sample was collected in an EDTA container from each participant. The parameters of the RBCs (RBC count, MCV, RDW-CV, and RDW-SD) were measured using the Sysmex XP-300 Automated Hematology Analyzer. In the case group, the average levels of RDW-SD, RDW-CV, and MCV were higher than in the control group (P=0.000 in all cases). There was a significant difference in RDW-CV between Sub1 and Sub2 (P=0.040). We found no significant differences in RDW-SD and RDW-CV between different age groups. There was a significant difference in RBC count between different age groups (P=0.022), and significant differences in RBC count and MCV between males and females. RDW-SD and RDW-CV had a significant positive correlation within TSH and a significant negative correlation within T3 and T4. Conclusion: RDW-CV may be used as a marker of SHT grade 2.

Background: Nonalcoholic fatty liver disease (NAFLD) is a growing public health problem. With the growing severity of NAFLD, there are considerable alterations in the hemodynamics of the hepatic circulation that might affect the prognosis of the condition, according to numerous reports written to assess the vasculature of the liver in patients affected with fatty liver disease. The aim of the study was to examine hemodynamic alterations in the hepatic artery (HA) and portal vein (PV) in NAFLD patients and determine how they relate to the severity of the condition, and to classify patients into various categories of NAFLD and connect the results to liver size and body mass index (BMI). Methods and Results: One hundred and six diagnosed NAFLD patients who attended the Imaging department at King Fahad Hospital from December 2019 to January 2020 were retrospectively studied. The mean age of the patients was 45.75±15.6 years, with a range of 10-79 years. The patients were examined by a TOSHIBA Xario, SSA-660A ultrasound system utilizing a multifrequency convex transducer (2–5 MHz) for all sonographic exams. B-mode assessed the liver parenchyma, and spectral Doppler estimated the HA and PV. The US appearance of hepatosteatosis, according to the severity of echogenicity, was graded (0-3). Most participants were asymptomatic (76.4%), and diabetes and diabetes with hypertension were diagnosed in 12.3% and 11.3%, respectively. It was observed that grade 1 hepatosteatosis was more prevalent than the other grades: 54 cases versus 41 cases for grade 2 and 11 cases for grade 3. The mean values of liver size and BMI in grade 3 were higher than in grade 1 (P=0.0033 and P=0.0054, respectively). A Spearman test found that the liver size (R=0.19, P=0.05) and BMI (R=0.26, P=0.01) had weak positive, but statistically significant, correlations with the severity of the hepatosteatosis grade. Doppler indices of the HA and PV in NAFLD patients did not differ significantly in hepatosteatosis grades 1-3. Only the PSV and EDV of the main PV showed a significant decrease in the hepatosteatosis grade 2 compared to grade 1 (P=0.0065 and P=0.0234, respectively). Despite the insignificant differences, the Doppler flow parameters of the HA decreased with the severity of hepatic steatosis; for example, the hepatic artery resistive index (HARI) was 0.77±0.16 in grade 1, 0.72±0.16 in grade 2, and 0.75±0.10 in grade 3, respectively. The hepatic artery pulsatility index (HAPI) was 1.62±49 in grade 1, 1.63±.68 in grade 2, and 1.74±0.77 in grade 3. There was also a trend toward a decrease in PSV and end-diastolic velocity (EDV) of HA with the severity of hepatosteatosis. Conclusion: The severity of hepatic steatosis is significantly correlated with liver size and BMI. The blood flow parameters of PV and HA decrease with the severity of hepatic steatosis except for the pulsatility index.

Nurses are at the frontline, dealing with people’s most immense healthcare needs in stressful and demanding work environments. Consequently, it is essential to thoroughly examine how various coping mechanisms might affect the relationship between stress and quality of life (QOL). This study aimed to examine the mediation effect of both problem-focused coping (PFC) and emotion-focused coping (EFC) mechanisms on mitigating the effect of stress on the QOL among Jordanian nurses. A multisite cross-sectional descriptive correlational design was used in this study. An online survey was completed by 203 nurses using a convenience sampling technique between October 2023 and January 2024. The study included nurses working in different Jordanian healthcare sectors including governmental, private, and university-affiliated hospitals. Several measures were used to collect data, including questionnaires on sociodemographics, QOL, coping, and stress. Two models were hypothesized for this study. The two models were analyzed using Andrew Hayes Process Macro Model 4 for testing the mediation effects. Additionally, descriptive and correlational analyses were run prior to the main analysis. The results showed that coping significantly mediated the relationship between stress and QOL with variations between PFC and EFC. In conclusion, psychological distress symptoms were common among Jordanian nurses; psychological distress, coping, and QOL are correlating variables. Nurses’ stress levels and coping modalities can predict QOL with a superior effect of PFC compared with EFC. Strategies should be put in place to improve effective coping to improve nurses’ QOL. The results of this study have important implications for nursing education, practice, future research, and policy.

This paper proposes a novel cache replacement technique based on the notion of combining periodic popularity prediction with size caching. The popularity, size, and time updates characteristics are used to calculate the value of each cache item. When it comes to content replacement, the information with the least value is first eliminated. Simulation results show that the proposed method outperforms the current algorithms in terms of cache hit rate and delay. The hit rate of the proposed scheme is 15.3% higher than GDS, 17.3% higher than MPC, 20.1% higher than LRU, 22.3% higher than FIFO, and 24.8% higher than LFU when 350 different categories of information are present. In real-world industrial applications such as including supply chain management, smart manufacturing, automation energy optimization, intelligent logistics transportation, and e-healthcare applications, it offers a foundation for the selection of caching algorithms.

In Industry 4.0, the adoption of new technology has played a major role in the transportation sector, especially in the electric vehicles (EVs) domain. Nevertheless, consumer attitudes towards EVs have been difficult to gauge but researchers have tried to solve this puzzle. The prior literature indicates that individual attitudes and technology factors are vital to understanding users' adoption of EVs. Thus, the main aim is to meticulously investigate the unexplored realm of EV adoption within nations traditionally reliant on oil, exemplified by Saudia Arabia. By integrating the "task technology fit" (TTF) model and the "unified theory of acceptance and usage of technology" (UTAUT), this research develops and empirically validates the framework. A cross-section survey approach is adopted to collect 273 valid questionnaires from customers through convincing sampling. The empirical findings confirm that the integration of TTF and UTAUT positively promotes users' adoption of EVs. Surprisingly, the direct effect of TTF on behavioral intentions is insignificant, but UTAUT constructs play a significant role in establishing a significant relationship. Moreover, the UTAUT social influence factor has no impact on the EVs adoption. This groundbreaking research offers a comprehensive and holistic methodology for unravelling the complexities of EV adoption, achieved through the harmonious integration of two well-regarded theoretical frameworks. The nascent of this research lies in the skilful blending of technological and behavioral factors in the transportation sector.

Wireless communications have lately experienced substantial exploitation because they provide a lot of flexibility for data delivery. It provides connection and mobility by using air as a medium. Wireless sensor networks (WSN) are now the most popular wireless technologies. They need a communication infrastructure that is both energy and computationally efficient, which is made feasible by developing the best communication protocol algorithms. The internet of things (IoT) paradigm is anticipated to be heavily reliant on a networking architecture that is currently in development and dubbed software-defined WSN. Energy-efficient routing design is a key objective for WSNs. Cluster routing is one of the most commonly used routing techniques for extending network life. This research proposes a novel approach for increasing the energy effectiveness and longevity of software-defined WSNs. The major goal is to reduce the energy consumption of the cluster routing protocol using the firefly algorithm and high-efficiency entropy. According to the findings of the simulation, the suggested method outperforms existing algorithms in terms of system performance under various operating conditions. The number of alive nodes determined by the proposed algorithm is about 42.06% higher than Distributed Energy-Efficient Clustering with firefly algorithm (DEEC-FA) and 13.95% higher than Improved Firefly Clustering IFCEER and 12.05% higher than another referenced algorithm.

PurposeTo identify experiences of boredom and associations with psychosocial well-being during and following homelessness.MethodsUsing a convergent, mixed-methods explanatory design, we conducted quantitative interviews with 164 participants) (n = 102 unhoused; n = 62 housed following homelessness) using a 92-item protocol involving demographic components and seven standardized measures of psychosocial well-being. A sub-sample (n = 32) was approached to participate in qualitative interviews. Data were analyzed by group (unhoused; housed). Quantitative data were analyzed using descriptive statistics designed to generate insights into boredom, meaningful activity engagement, and their associations with psychosocial well-being during and following homelessness. Qualitative data were analyzed using thematic analysis. Quantitative and qualitative findings were integrated at the stage of discussion.ResultsQuantitative analyses revealed small to moderate correlations between boredom and increased hopelessness (rs = .376, p < .01), increased drug use (rs = .194, p < .05), and lowered mental well-being (rs = -.366, p < .01). There were no statistically significant differences between unhoused and housed participants on any standardized measures. Hierarchical regression analyses revealed that housing status was not a significant predictor of boredom or meaningful activity engagement (p>.05). Qualitative interviews revealed profound boredom during and following homelessness imposing negative influences on mental well-being and driving substance use.ConclusionsBoredom and meaningful activity are important outcomes that require focused attention in services designed to support individuals during and following homelessness. Attention to this construct in future research, practice, and policy has the potential to support the well-being of individuals who experience homelessness, and to contribute to efforts aimed at homelessness prevention.

Regular monitoring of bacterial susceptibility to antibiotics in clinical settings is key for ascertaining the current trends as well as re-establish empirical therapy. This study aimed to determine bacterial contaminants and their antimicrobial susceptibility patterns from medical equipment, inanimate surfaces and clinical samples obtained from Thika Level V Hospital (TLVH), Thika, in Central Kenya. Three hundred and five samples were collected between the period of March 2021 to November 2021 and comprised urine, pus swabs, catheter swabs, stool, and environmental samples. Bacterial identification and antimicrobial susceptibility were performed using VITEK 2 and disc diffusion respectively. We observed that Coagulase-negative Staphylococci (28 /160, 17.5%) were the most commonly isolated species from clinical samples followed by E. coli (22 /160 13.8%) and S. aureus (22/160, 13.8%). The bed rails were the mostly contaminated surface with S. aureus accounting for 14.2% (6/42). Among the clinical samples, pus swabs yielded the highest number of pathogens was pus (92/160). Trauma patients had the highest proportion of isolates (67/160, 41.8%). High level of antimicrobial resistance to key antimicrobials, particularly among Enterobacterales was observed. Extended Spectrum Beta Lactamase (ESBL) phenotype was noted in 65.9% (29/44) of enteric isolates. While further ESBL genetic confirmatory studies are needed, this study highlights the urgent need for actions that mitigate the spread of antibiotic-resistant bacteria.

Introduction: Nigella sativa (NS) has been shown to improve periodontal health by reducing alveolar bone resorption and lowering periodontal indices and subgingival bacterial counts. However, public health and safety concerns are emerging, and there have been a few reported adverse effects associated with the use of NS. Thus, the current study aims to review clinical studies on the effectiveness NS for oral health conditions. Methods: The databases Pubmed and Google Scholar were used to search the literature; the year of publication was not restricted in the search. Studies conducted in animal models in laboratories, as well as those involving an intervention of NS in combination with other herbs, were excluded. Results: A total of thirteen human clinical studies that used NS as an intervention for treating different types of oral health conditions were included in this review. Improvement in clinical parameters was reported in all the included studies, although the statistical significance varied. Conclusion: Although the studies show that NS is beneficial in the treatment and management of oral health conditions, there is still a need for more rigorous research in this area, particularly in the application of NS in real-world clinical settings.

SARS-CoV-2 causes COVID-19. COVID-19 has led to severe clinical illnesses and an unprecedented death toll. The virus induces immune inflammatory responses specifically cytokine storm in lungs. Several published reports indicated that pregnant females are less likely to develop severe symptoms compared with non-pregnant. Putative protective role of maternal blood circulating fetal mesenchymal stem cells (MSCs) has emerged and have been put forward as an explanation to alleviated symptoms. MSCs with immune-modulatory, anti-inflammatory and anti-viral roles, hold great potential for the treatment of COVID-19. MSCs could be an alternative to treat infections resulting from the SARS-CoV-2 and potential future outbreaks. This review focuses on the MSCs putative protective roles against COVID-19 in pregnant females.

Abstract Background Cases of large bowel closed-loop phenomenon with cecal perforation are extremely rare, especially when extracolonic epiploic appendage and peritoneal bands are the cause. However, sporadic cases exist in the literature with various presentations, but very few occur in patients in the abdomen without a previous scar. Case presentation An 89-year-old Sudanese farmer was admitted to the emergency department with 9-day history of generalized colicky abdominal pain, abdominal distension, anorexia, persistent vomiting, and constipation. Given his clinical presentation and assessment, he was diagnosed with peritonitis due to a perforated viscus in a virgin abdomen. Operative exploration revealed an extraluminal left-sided omento–epiploic band that resulted in closed-loop colonic obstruction with secondary multiple cecal perforations. Standard right hemicolectomy with adhesiolysis was done. Postoperative wound infection and hypoalbuminemia were treated, and the patient was discharged on postoperative day 9 on a regular oral diet. Conclusions Although this condition is rare, it can be extremely dangerous, requiring prompt investigation and surgical intervention. It usually occurs secondary to raised intraluminal pressure with subsequent ischemia of the cecal wall. Through this case report, we aim to reflect on this rare experience, shedding light on the benign, extracolonic pathologies that can be life threatening or even fatal.

Objective(s): Breast cancer is the most prevalent cancer among females with different molecular subtypes. Corosolic acid is a pentacyclic triterpenoid with anti-cancer properties. Materials and Methods: The MTT assay was used to assess the cytotoxic activity of corosolic acid on MDA-MB-231 and MCF7 cell lines. To determine the apoptotic cells, the flow cytometry technique was utilized. The expression levels of apoptosis-related genes and proteins were quantified using quantitative real time-PCR (qRT-PCR) and Western blotting methods. The activity of caspase enzymes was measured by spectrophotometry. Results: Corosolic acid significantly inhibited the proliferation of both cell lines compared with controls. This agent markedly induced apoptosis in MDA-MB-231 cells but did not affect MCF7 cells compared with controls. Treating the MADA-MB-231 and MCF7 cell lines with corosolic acid showed an inducing effect on apoptosis-associated caspases, including Caspase-8, 9, and -3, in MADA-MB-231 cells with no effect on apoptotic markers in MCF7 cells. Further experiments uncovered corosolic acid-induced apoptosis in MADA-MB-231 cells by decreasing the expression of the phosphorylated form of JAK2 and STAT3 proteins.Conclusion: The present data suggested that corosolic acid is an apoptosis-inducing phytochemical in triple-negative breast cancer MADA-MB-231 cells. Also, corosolic acid triggered apoptosis in these cells by stimulating both pathways of apoptosis and inhibiting the JAK/STAT signaling. Furthermore, corosolic acid was found to inhibit MCF7 cell proliferation by a non-apoptotic mechanism.