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Background Diabetes distress (DD) has broad-ranging effects on type 2 diabetes (T2DM) management and outcomes. DD research is scarce among ethnic minority groups, particularly Arabic-speaking immigrant communities. To improve outcomes for these vulnerable groups, healthcare providers, including pharmacists, need to understand modifiable predictors of DD. Aim To assess and compare DD and its association with medication-taking behaviours, glycaemic control, self-management, and psychosocial factors among first-generation Arabic-speaking immigrants and English-speaking patients of Anglo-Celtic background with diabetes, and determine DD predictors. Setting Various healthcare settings in Australia. Method A multicentre cross-sectional study was conducted. Adults with T2DM completed a survey comprised of validated tools. Glycated haemoglobin, blood pressure, and lipid profile were gathered from medical records. Multiple linear regression models were computed to assess the DD predictors. Main outcome measure Diabetes distress level. Results Data was analysed for 696 participants: 56.3% Arabic-speaking immigrants and 43.7% English-speaking patients. Compared with English-speaking patients, Arabic-speaking immigrants had higher DD, lower medication adherence, worse self-management and glycaemic control, and poorer health and clinical profile. The regression analysis demonstrated that higher DD in Arabic-speaking immigrants was associated with cost-related medication underuse and lower adherence to exercise, younger age, lower education level, unemployment, lower self-efficacy, and inadequate glycaemic control. Whereas among English-speaking patients, higher DD was associated with both cost- and non-cost-related underuse of medication and lower dietary adherence. Conclusion Results provided new insights to guide healthcare providers on reducing the apparent excess burden of DD among Arabic-speaking immigrants and potentially improve medication adherence, glycaemic control, and self-management.

Hepatocellular carcinoma (HCC) is the fastest-growing cancer worldwide, causing significant morbidity and mortality. Surgical resection, ablation, or transplantation is the best treatment option for patients with HCC. However, only about one-fifth of patients are suitable for such primary curative treatments due to underlying liver disease or rapid extension of the tumor. Image-guided locoregional therapies may prove an important alternative in this scenario, particularly transarterial radioembolization (TARE) with yttrium-90 (Y-90). Based on many studies, TARE can be considered a curative treatment option for patients with early-stage HCC, a bridge to transplantation, and a method for downstaging tumors to give patients with unresectable HCC a chance to potentially receive a curative treatment. TARE can be also combined with other treatment modalities to provide a better quality of life in patients when compared with systemic therapy in patients with unresectable HCC. Here, we discuss the use of TARE in the approach to HCC patients who are in early, intermediate, or advanced stages.

Obesity is a global health concern associated with the dysbiosis of intestinal microbial composition. In this study, we investigated the potentials of urolithin A (Uro-A) and urolithin B (Uro-B), two gut microbiota-derived metabolites of ellagitannins, in reducing body weight gain through the modulation of the gut microbiota. We established a high-fat diet (HFD)-induced obesity model in rats that were later administered with either 2.5 mg/kg of Uro-A or Uro-B. Serum biochemical parameters were quantified, and changes in the composition of the gut microbial community were analysed using 16S rDNA gene sequencing. Our results showed that the urolithins significantly decreased the body weight in HFD-fed rats and restored serum lipid profile. The taxonomic analysis showed that both Uro-A and Uro-modulated gut microbes related to body weight, dysfunctional lipid metabolism and inflammation. Overall, our results suggest that Uro-A and Uro-B possess anti-obesity properties, which may be related to the modulation of the gut microbial composition.

Lung cancer is reported to be the second most common cancer disease. This paper proposes a comprehensive and comparative global and local feature extraction framework for lung cancer detection using CT scan images. This framework consists of three main phases: data collection, global training and testing, and local training and testing. A set of 1000 CT scan images is used in this study. During the global training and testing phase, the collected images are preprocessed through image warping and cropping. Global features are then extracted from images to represent each image with feature vectors, using ten different image feature types. The feature vectors are then used to build detection models with six different machine learning algorithms. In the local training and testing phase, each image is divided into a set of local blocks. Those feature types that performed well in the global phase are then extracted from each of these blocks, to represent each block with feature vectors. These feature vectors are then used to build detection models for all of the image blocks, using the learning algorithms that performed well in the global phase. The results show that the Gabor Filter, the Histogram of Oriented Gradients (HOG), and the Haar Wavelet feature types outperformed the other seven feature types. The results also show that Support Vector Machine (SVM) outperforms the other five learning algorithms. Of most importance, the proposed local feature extraction approach outperforms the traditional global one. In the local phase, using SVM with Haar Wavelet features achieved 90% accuracy, 88% sensitivity, and 91% specificity. Using SVM with HOG features achieved 88% accuracy, 85% sensitivity, and 89% specificity. Finally, using SVM with Gabor Filter features achieved the best accuracy, sensitivity, and specificity rates of 97%, 96%, and 97%, respectively.

Osteoporosis is a common public health challenge globally but the relative contribution of variousrisk factors for osteoporosis in Saudi Arabia is not well established. We conducted this study to determine the prevalence of risk factors for osteoporosis among females aged 35 years and above in Saudi Arabia. We performed a descriptive cross-sectional study with a sample size of 2070 and determined the prevalence of risk factors as percentages of the total sample size. We foundthat vitamin D deficiency is the major modifiable risk factor for osteoporosis in Saudi Arabia followed by cigarette smoking. Autoimmune and endocrine diseases were also not uncommon. Our results therefore suggest for the strengthening of measures to prevent vitamin D deficiency, reduce corticosteroid-related osteoporosis and curb cigarette smoking.

Objectives To report our immediate and delayed outcomes of non-stented tubularized incised plate (TIP) distal hypospadias repair. Methods We retrospectively reviewed all charts of children who underwent distal hypospadias repair in a single children's hospital from 2013 to 2018. Patients’ demographics, hypospadias characteristics, operative technique, and immediate and delayed outcomes were recorded. Results Of 280 consecutive distal hypospadias repairs that were identified, 74 were excluded due to the use of a repair other than TIP. Eleven stented TIP repairs were excluded as well. Of 195 non-stented repairs, immediate post-operative voiding complications were recorded in 11 (5.6%) and included multiple/ split stream in 6 (3%), dysuria and voiding difficulty in 2 (1%), urinary retention in 2 (1%), and gross hematuria that spontaneously resolved in 1 (0.5%). Late follow up was recorded in 142/195 (72.8%) repairs. Delayed urethroplasty/glansplasty complications were recorded in 12 (8.5%) and included urethrocutaneous fistula (UCF) in 10 (7.0%), meatal stenosis (MS) in 6 (4.2%) and glans/urethroplasty dehiscence (GD) in 2 (1.4%). Conclusion Avoiding post-operative urethral stents in distal hypospadias TIP repair reduces the morbidity associated with the stent and is a feasible option that carries acceptable immediate and delayed complication rates. Avoiding the stent eliminates stent-related bladder spasms, the need for other medications, and the short-term office visit for stent removal, therefore reducing parental anxiety, patient discomfort, and reducing cost.

Introduction: Rhabdomyosarcoma is the most common pediatric soft tissue sarcoma. It represents 5-8% of pediatric tumors. Head and neck is considered the most common site of RMS origin (40%). Parameningeal, orbital and non parameningeal RMS approximately represent 50%, 25% and 25% respectively. Histopathological evaluation demonstrates small round cells with high cytological variability which stain positive with desmin, myogenin and MyoD1. The mainstay treatment of RMS depends on chemotherapy and radiation therapy with a limited role of surgery. Method: A retrospective chart review for pediatric sinonasal rhabdomyosarcoma diagnosed and managed at King Fahad Specialist Hospital, Dammam, Saudi Arabia, and a literature review of pediatric sinonasal rhabdomyosarcoma was conducted. Results: A total of four cases were identified for the period (2011-2017), and a thorough review of their medical records and radiological imaging were done. Conclusion: Pediatric sinonasal rhabdomyosarcoma may initially present with symptoms mimicking rhinosinusitis. Biopsy and histological evaluation are the most essential steps to exclude malignancy. Intergroup Rhabdomyosarcoma Studies (IRS) established a staging system based on tumor extension and resectability. The role of surgery in RMS may be limited for obtaining biopsies for diagnosis and for palliative purposes. Popular antineoplastic agents used to treat RMS include vincristine, cyclophosphamide, actinomycin D, and adriamycin. Chemotherapy with alkylating agents has achieved a relapsed free survival 90% for nonparameningeal tumors and 65% for parameningeal tumors.

Introduction:diastolic dysfunction refers to impaired ventricular relaxation or filling regardless of ejection fraction and symptoms. It accounts for 8% and 25% in the hospitalized and general population, respectively. The present study was conducted to determine the prevalence and correlates of diastolic dysfunction in hypertensive patients living in Saudi Arabia. Methods:a multicentric, cross-sectional study was conducted from February 2019 to February 2020 at King Khalid Hospital and Prince Sultan Center for Health Services, Prince Sattam Bin Abdulaziz University hospital in Al Kharj, and Al Kharj Military Industries Corporation hospital, KSA. All patients with hypertension who underwent an echocardiography were included in the study. Logistic regression analysis was performed to determine factors associated with left ventricular diastolic dysfunction (LVDD). Results:the study included a total of 104 participants, where 51.9% were females andthe mean age of the patients was 48.01±12.81 years.Most patients had an abnormal echocardiography finding (64.4%, n = 67). The most common abnormalities were left ventricular (LV) hypertrophy (44.2%, n = 46), and diastolic dysfunction, (35.6%, n = 37). The study revealed that age (aOR: 6.1, 95% CI 1.17-31.3; p = 0.032) and dyslipidemia (aOR: 3.45, 95% CI 1.16-10.24; p = 0.026) have significant association with LVDD in the patients with hypertension. Conclusion:in conclusion, diastolic dysfunction is prevalent among older hypertensive patients and those with dyslipidaemia. Age and dyslipidaemia were non-modifiable and modifiable factors associated with LVDD in hypertensive patients, respectively.

Background Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies. Objective This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic. Methods We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data. Results Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%). Conclusions Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic.

Background: Ischemia–reperfusion injury (IRI) is one of the major risk factors implicated in morbidity and mortality associated with cardiovascular disease. During cardiac ischemia, the buildup of acidic metabolites results in decreased intracellular and extracellular pH, which can reach as low as 6.0 to 6.5. The resulting tissue acidosis exacerbates ischemic injury and significantly affects cardiac function. Methods: We used genetic and pharmacologic methods to investigate the role of acid-sensing ion channel 1a (ASIC1a) in cardiac IRI at the cellular and whole-organ level. Human induced pluripotent stem cell–derived cardiomyocytes as well as ex vivo and in vivo models of IRI were used to test the efficacy of ASIC1a inhibitors as pre- and postconditioning therapeutic agents. Results: Analysis of human complex trait genetics indicates that variants in the ASIC1 genetic locus are significantly associated with cardiac and cerebrovascular ischemic injuries. Using human induced pluripotent stem cell–derived cardiomyocytes in vitro and murine ex vivo heart models, we demonstrate that genetic ablation of ASIC1a improves cardiomyocyte viability after acute IRI. Therapeutic blockade of ASIC1a using specific and potent pharmacologic inhibitors recapitulates this cardioprotective effect. We used an in vivo model of myocardial infarction and 2 models of ex vivo donor heart procurement and storage as clinical models to show that ASIC1a inhibition improves post-IRI cardiac viability. Use of ASIC1a inhibitors as preconditioning or postconditioning agents provided equivalent cardioprotection to benchmark drugs, including the sodium-hydrogen exchange inhibitor zoniporide. At the cellular and whole organ level, we show that acute exposure to ASIC1a inhibitors has no effect on cardiac ion channels regulating baseline electromechanical coupling and physiologic performance. Conclusions: Our data provide compelling evidence for a novel pharmacologic strategy involving ASIC1a blockade as a cardioprotective therapy to improve the viability of hearts subjected to IRI.

INTRODUCTION AND OBJECTIVE:Prior studies using nationwide databases have implicated an increased incidence of renal cell carcinoma (RCC) over time. Granular data, however, may highlight potential g...

Experimental cell lines provide evidence on Kiss-1 gene as a regulator of metastasis in many kinds of cancers, including breast cancer. However, there is scarcity in data for kiss1 gene expression profile in many malignancies, and to date, no effort has been made to explore kiss-1 gene-associated microsatellite markers in many types of tumors, including breast cancer. The present study aims to investigate the microsatellite markers associated with Kiss-1 gene and the current loss of Heterozygosity LOH in Iraqi patients with breast cancer; this was further correlated with immunohistochemical Kiss-1 gene expression. One hundred and three breast carcinoma samples were collected after mastectomy. Kiss-1 gene expression was analyzed using immunostaining. Three microsatellite marker sites: SHGC-76112, SHGC-76186 intragenic, and SHGC-33412 in chromosome 1q32.1 were selected to define allelotyping of kiss-1 gene in paired DNA samples `from tumor cells and control blood cells of each patient. The loss of Kiss-1 gene expression was significantly correlated with the clinical tumor stage (p-value andGLT; 0.01). Loss of heterozygosity (LOH) occurs in 60 (60%) samples. Seven of the examined samples show LOH in two markers; none of the samples show LOH in the three markers. Seven samples show LOH for both intragenic markers (SHGC-76112 and SHGC-76186). The highest LOH percentage was 28%, which occurred within the intragenic microsatellite marker (SHGC-76186), and the lowest was 14% within the flanking region microsatellite marker (SHGC-33412). Interestingly, a statistically significant relationship was found between the LOH and Loss of Kiss-1 gene expression (p-value = 0.0005). This study convinced us to consider the vital role of this gene in the progression of the carcinoma in Iraqi patients with breast cancer.

Introduction:We reviewed patient demographics and body morphology in a contemporary cohort of patients presenting to a tertiary care center for treatment of penile cancer.Methods:The Univer...

Diabetic Foot Ulcer (DFU) is the main complication of Diabetes, which, if not properly treated, may lead to amputation. One of the approaches of DFU treatment depends on the attentiveness of clinicians and patients. This treatment approach has drawbacks such as the high cost of the diagnosis as well as the length of treatment. Although this approach gives powerful results, the need for a remote, cost-effective, and convenient DFU diagnosis approach is urgent. In this paper, we introduce a new dataset of 754-ft images which contain healthy skin and skin with a diabetic ulcer from different patients. A novel Deep Convolutional Neural Network, DFU_QUTNet, is also proposed for the automatic classification of normal skin (healthy skin) class versus abnormal skin (DFU) class. Stacking more layers to a traditional Convolutional Neural Network to make it very deep does not lead to better performance, instead leading to worse performance due to the gradient. Therefore, our proposed DFU_QUTNet network is designed based on the idea of increasing the width of the network while keeping the depth compared to the state-of-the-art networks. Our network has been proven to be very beneficial for gradient propagation, as the error can be back-propagated through multiple paths. It also helps to combine different levels of features at each step of the network. Features extracted by DFU_QUTNet network are used to train Support Vector Machine (SVM) and K-Nearest Neighbors (KNN) classifiers. For the sake of comparison, we have fine-tuned then re-trained and tested three pre-trained deep learning networks (GoogleNet, VGG16, and AlexNet) for the same task. The proposed DFU_QUTNet network outperformed the state-of-the-art CNN networks by achieving the F1-score of 94.5%.

Cardiovascular diseases (CVDs) are a leading cause of death globally. This article explores the evidence surrounding community pharmacist interventions to reduce cardiovascular events and related mortality and to improve the management of CVD risk factors. We summarize a range of systematic reviews and leading randomized controlled trials and provide critical appraisal. Major observations are that very few trials directly measure clinical outcomes, potentially owing to a range of challenges in this regard. By contrast, there is an extensive, high-quality evidence to suggest that improvements can be achieved for key CVD risk factors such as hypertension, dyslipidemia, tobacco use, and elevated hemoglobin A1c. The heterogeneity of interventions tested and considerable variation of the context under which implementation occurred suggest that caution is warranted in the interpretation of meta-analyses. It is highly important to generate evidence for pharmacist interventions in developing countries where a majority of the global CVD burden will be experienced in the near future. A growing capacity for clinical registry trials and data linkage might allow future research to collect clinical outcomes data more often.

Background: Parkinson’s Disease (PD) is a chronic neurodegenerative disorder that has been ranked second after Alzheimer’s disease worldwide. Early diagnosis of PD is crucial to combat against PD to allow patients to deal with it properly. However, there is no medical test(s) available to diagnose PD conclusively. Therefore, computer-aided diagnosis (CAD) systems offered a better solution to make the necessary data-driven decisions and assist the physician. Numerous studies were conducted to propose CAD to diagnose PD in the early stages. No comprehensive reviews have been conducted to summarize the role of AI tools to combat PD. Objective: The study aimed to explore and summarize the applications of neural networks to diagnose PD. Methods: PRISMA Extension for Scoping Reviews (PRISMA-ScR) was followed to conduct this scoping review. To identify the relevant studies, both medical databases (e.g., PubMed) and technical databases (IEEE) were searched. Three reviewers carried out the study selection and extracted the data from the included studies independently. Then, the narrative approach was adopted to synthesis the extracted data. Results: Out of 1061 studies, 91 studies satisfied the eligibility criteria in this review. About half of the included studies have implemented artificial neural networks to diagnose PD. Numerous studies included focused on the freezing of gait (FoG). Biomedical voice and signal datasets were the most commonly used data types to develop and validate these models. However, MRI- and CT-scan images were also utilized in the included studies. Conclusion: Neural networks play an integral and substantial role in combating PD. Many possible applications of neural networks were identified in this review, however, most of them are limited up to research purposes.

The modern studies on the treatment of obesity have dedicated on the potential activity of plants to control obesity on the metabolism of lipid and glucose. The aim of this study is to investigate about the effect of AB slim on body metabolism of its – takers and determine its safety. 16 female rats (150 - 250) divided equally into 4 groups, the first group considered as control group and administered distilled water, the three other groups daily administered the prepared aqueous solution of AB slim capsule for 45 days. The animals weighed after 24 hr. of the last administration, the animals were weighed. The results showed after weeks of treatment that the animals gain weight instead of losing it and there were no beneficial effects of this remedy on lipid profile, in contrast there was an increase in LDL levels and decrease in HDL. The hisopathological study showed degeneration and necrosis in most organs , liver, kidney, spleen and gastrointestinal tract.

Background Diabetes distress (DD) has broad-ranging effects on type 2 diabetes (T2DM) management and outcomes. DD research is scarce among ethnic minority groups, particularly Arabic-speaking immigrant communities. To improve outcomes for these vulnerable groups, healthcare providers, including pharmacists, need to understand modifiable predictors of DD. Objective To assess and compare DD and its association with medication-taking behaviours, glycaemic control, self-management, and psychosocial factors among first-generation Arabic-speaking immigrants and English-speaking patients of Anglo-Celtic background with diabetes, and determine DD predictors. Setting: Various healthcare settings in Australia. Method: A multicentre cross-sectional study was conducted. Adults with T2DM completed a survey comprised of validated tools. Glycated haemoglobin, blood pressure, and lipid profile were gathered from medical records. Multiple linear regression models were computed to assess the DD predictors. Main outcome measure: Diabetes distress level. Results Data was analysed for 696 participants: 56.3% Arabic-speaking immigrants and 43.7% English-speaking patients. Compared with English-speaking patients, Arabic-speaking immigrants had higher DD, lower medication adherence, worse self-management and glycaemic control, and poorer health and clinical profile. The regression analysis demonstrated that higher DD in Arabic-speaking immigrants was associated with cost-related medication underuse and lower adherence to exercise, younger age, lower education level, unemployment, lower self-efficacy, and inadequate glycaemic control. Whereas among English-speaking patients, higher DD was associated with both cost- and non-cost-related underuse of medication and lower dietary adherence. Conclusion Results provided new insights to guide healthcare providers on reducing the apparent excess burden of DD among Arabic-speaking immigrants and potentially improve medication adherence, glycaemic control, and self-management.

Aims Aim of this study is to evaluate the capacity of a pharmacist-delivered screening model for type 2 diabetes and cardiovascular disease (CVD) in identifying and referring individuals at risk. Method A screening programme was implemented in 12 community pharmacies in three cities in the United Arab Emirates. Trained pharmacists screened adults (≥40 years) without a previous diagnosis of diabetes or CVD. Most participants were recruited during their visits to the pharmacies; pharmacy-based advertising and social media were also used. The screening included medical history, anthropometric measurements, point-of-care glycated haemoglobin (HbA1c ) levels, and a lipid panel. High-risk individuals (HbA1c ≥ 5.7% [39 mmol/mol], a high diabetes risk score, or a 10-year CVD risk ≥7.5%) were given a referral letter and advised to visit their physician. Risk factors for elevated HbA1c were identified by logistic regression. Results Of the 568 screened participants, 332/568 (58%) were identified to be at risk: HbA1c levels were consistent with diabetes 67/560 (12%) or prediabetes 148/560 (26%), high diabetes risk score 243/566 (43%), CVD risk score > 7.5% 79/541 (15%). Obese people were more likely to have prediabetes or diabetes OR (95% CI): 3.2 (1.3, 7.5), as were those who spent more than 11 h/day sitting: 5.7 (1.8, 17.6). Of the 332 at-risk participants, 206 (62%) responded to a telephone follow-up at six weeks; one-third had discussed screening results with their physician. Conclusions Community pharmacists detected and referred individuals at risk for diabetes or CVD, although participant follow-up with their physician could be improved. Pharmacy screening is feasible and will potentially improve outcomes.

Background Postpartum depression (PPD) is a significant psychological disorder that can affect women during or after pregnancy. Its risk increases throughout the first 90 days and may last up to almost two years, which can create an overall burden on society. Although the etiology is unknown yet, there are risk factors that contribute to developing PPD. This study aims to assess the prevalence of PPD and the risk factors among women in Jeddah, western Saudi Arabia in 2019. Methods A cross-sectional study was conducted in infant vaccination clinics of the primary healthcare centers (PHC) of the Ministry of Health (MOH) and Ministry of National Guard (MNGHA) Jeddah, Saudi Arabia. Data were collected through a self-administered questionnaire with Edinburgh Postnatal Depression Scale (EPDS) from mothers up to four months postpartum. Results Of the 172 postpartum women, the study estimated the prevalence of postpartum depression to be 20.9%. The significant risk factors predicted by multivariate regression analysis were history of previous depression (odds ratio {OR}=4.7; 95% confidence interval {CI} 1.9 to 11.5), difficult life event interval (OR=3.5; 95% CI 1.1 to 10.7), and attitude toward pregnancy (OR=2.1; 95% CI 0.9 to 4.5). Conclusion A fairly high prevalence of postpartum depression was revealed among the females in Jeddah. Therefore, we recommend screening of mothers after delivery to help early intervention and management along with psychosocial support.

Purpose To investigate the effect of immunosuppressive therapy on blood flow and waveform parameters in the choroid and optic nerve head (ONH) in patients with initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. Methods In this prospective study, 18 patients (36 eyes) were studied. Laser speckle flowgraphy was performed at baseline and at 4 weeks, 8 weeks and 12 weeks after treatment. We analysed longitudinal changes in mean blur rate (MBR), blow-out time, blow-out score (BOS), acceleration time index (ATI), flow acceleration index (FAI), resistivity index (RI) and blood flow fluctuation. Results After immunosuppressive therapy, MBR, representing blood flow velocity, in the choroid and ONH significantly increased at each post-treatment time point compared to baseline values. Among the analysed pulse waveform parameters, BOS significantly increased, while RI and fluctuation significantly decreased. Increased BOS and decreased RI indicate decreased vascular resistance following treatment. There was a strong negative correlation between BOS and RI. Additionally, FAI increased in the choroid and ATI increased in ONH. Conclusions Immunosuppressive therapy in the acute uveitic phase of VKH disease improved inflammation-related impairment in choroidal and ONH blood flow.

A high proportion of lung cancer cases are detected at a late cancer stage when they present with symptoms to general practitioners (GP). Early diagnosis is a challenge because many symptoms are also common in other diseases. Therefore, this study aims to assess UK primary care data of patients one, two and three years prior to lung cancer diagnosis to capture trends in clinical features of patients with the goal of early diagnosis and thus potentially curative treatment. This longitudinal study utilises data from the Clinical Practice Research Datalink (CPRD) with linked data from the National Cancer Registration and Analysis Service (NCRAS). A comprehensive list of Read codes is created to select features of interest to establish if a patient has experienced a certain medical condition or not. The comparison of the relative frequencies of the identified predictors associated with cases and controls reveals the importance of the following groups of features: ‘Cough Wheeze’ and ‘Bronchitis unspecified’, ‘Dyspnoea’ and ‘Upper Respiratory Infection’, which are frequent events for lung cancer cases, where a high proportion of cases were also identified using ‘Haemoptysis’ and ‘Peripheral vascular disease’.

Rationale and Objectives Celiac plexus and retrocrural splanchnic nerve (CP/RSN) blocks are widely used for cancer-related abdominal pain, but there is limited literature on their efficacy for non-cancer related pain. Our aim was to determine the indications and effectiveness of CT-guided CP/RSN blocks performed on patients with abdominal pain from non-cancer related sources. Materials and Methods CT-guided CP/RSN blocks for non-cancer related abdominal pain from 2011-2020 were retrospectively reviewed for patient demographics, procedure details, duration of pain relief, and complications. Effective blocks were defined as patient-reported pain relief or decrease in opioid use lasting 2 or more days for temporary blocks and 14 or more days for permanent blocks. Results Of 72 CT-guided CP/RSN blocks for non-cancer related abdominal pain, 48 (67%) were effective for a mean of 51 days (median 14, range 2-700). Of the 18 permanent blocks, 9 (50%) were effective for a mean of 111 days (median 90, range 14-390). Of the 54 temporary blocks, 39 (72%) were effective for a mean of 37 days (median 9, range 2-700). Indications included postural orthostatic tachycardia syndrome/dysautonomia (77% effective, 20/26), pancreatitis (86% effective, 12/14), postsurgical pain (62% effective, 8/13), median arcuate ligament syndrome (70% effective, 7/10), chronic pain syndrome (20% effective, 1/5), gastroparesis (80% effective, 4/5), and renal cystic disease (33% effective, 1/3). For postural orthostatic tachycardia syndrome /dysautonomia, pancreatitis, post-surgical pain, and MALS, there were no statistically significant differences in effectiveness between celiac vs. splanchnic blocks in groups matched by indication and intended duration (temporary/permanent). Conclusions CT-guided CP/RSN blocks can effectively manage non-cancer related abdominal pain, though there is discrepancy in efficacy between temporary and permanent blocks.

Context: COVID 19 vertical transmission is a great concern in different aspects of mother, child, healthcare staff and community safety and protection. There is lack of definitive evidence confirming or declining mother to child COVID 19 transmission. This article is an update on this challenging issue. Evidence Acquisition: This article is a comprehensive search in scientific major database from 1 January 2020 up to 25 April 2020 with the key words of “COVID 19” and “vertical transmission” or “neonatal”. Two researchers reviewed all selected articles to extract data about neonatal COVID 19 and vertical transmission. Those reports that provided the results of PCR on fetus or neonate blood, amniotic fluid or pharyngeal secretion samples or elevated COVID 19 specific IgM were included. Those reports based on clinical COVID 19 characteristics or radiological findings were not included in data extraction. Thirty six articles have been reviewed and evidence supporting or against COVID 19 Vertical transmission have been extracted and discussed. Results: Most previous studies on vertical COVID 19 transmission have been tested placenta, amniotic fluid, cord blood and newborn blood or pharyngeal swab sample using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) that may show false negative results due to suboptimal sampling or inefficient viral load. Increased COVID 19 specific IgG/IgM antibodies have been reported in newborns from COVID 19 mothers; however, data is limited and longitudinal follow up is needed. Evidence supporting COVID 19 vertical transmission: Recent reports indicated that pharyngeal PCR test turned positive in first few hours of life in several neonates. Also increased level of COVID 19 specific IgM and IgG antibodies in newborns to COVID 19 positive mothers were observed. Rate of perinatal complications were higher among newborns of COVID 19 mothers. Evidence against COVID 19 vertical transmission: All tissue or blood specimens and pharyngeal swab qRT-PCR tests among neonates born from COVID 19 mothers were negative. Rate of cross reactivity and false positive results are high in serologic studies. Conclusions: COVID 19 vertical transmission is a growing health care concern that needs further investigation; however, it is suggested to be equipped with PPE on contacts with both COVID 19 pregnant woman and her newborn baby and apply early separation, isolation, testing and close follow up for both mother and child.

Background Respiratory distress syndrome is one of the most common problems of newborns. Respiratory distress syndrome occurs when there is no enough surfactant in the lungs. Heavy metals are naturally occurring elements that have a high atomic weight and a density at least 5 times greater than that of water. Lead is a heavy metal, it is important environmental toxicant; the toxic effects of lead include many systems in the body like central and peripheral nervous system. Cadmium is heavy metal that exerts toxic effects on the kidney, the skeletal and the respiratory systems, and is classified as a human carcinogen. Nicotine, the main alkaloid of tobacco. It is readily absorbed from tobacco smoke, and its concentration rises over 6-8 hours during the day in regular smokers. About 70 to 80% of nicotine is metabolized to cotinine. Methods The study was carried out for 50 newborns divided in two groups: Group 1: 25 newborns with respiratory distress syndrome. Group 2: 25 newborns without respiratory distress syndrome. Results According to Demographic characteristics there are no significant differences when compered the age, gender, duration of pregnancy and the age of the mothers of newborns with respiratory distress syndrome and normal newborns (p

Background Although choanal atresia (CA) was first described 250 years ago, its description and understanding remain incomplete, as is the distinction between unilateral and bilateral CA. Among the surgical techniques introduced to manage this condition are intranasal Hegar's dilator (IHD) and transnasal endoscopic excision (TNEE). Objectives This study retrospectively evaluated the outcomes and effectiveness of IHD and TNEE in the treatment of patients with CA, including differences in the incidence of re-stenosis with these techniques. Methods Patients diagnosed with CA who underwent surgical interventions in the Otolaryngology Department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, between 1997 and 2017 were analyzed. Postoperative outcomes including re-stenosis rates were compared in patients who underwent IHD and TNEE. Factors associated with patient outcomes were analyzed, including ages at diagnosis and surgery, nationality, gender, type of atresia (unilateral/bilateral and bony/membranous/mixed), surgical intervention (IHD or TNEE), and re-stenosis and need for revision surgery after IHD and TNEE. Results A total of 30 patients were diagnosed with CA, including 21 (70%) girls and 9 (30%) boys. Of them, 18 (60%) patients were diagnosed at younger than one month of age, 28 (93%) were Saudi nationals, and 20 (67.70%) were aged younger than three months at the time of surgery. Of these 30 patients, 17 (56.70%, all Saudi nationals) underwent IHD, and 13 (43.30%), including 15 Saudi nationals, underwent TNEE. The 17 patients who underwent IHD included 13 (76.50%) girls and 4 (23.50%) boys, whereas the 13 patients who underwent TNEE included 8 (61.50%) girls and 5 (38.50%) boys. Fifteen patients (50%) had mixed-type CA, nine (30%) had bony-type CA, and six (20%) had membranous-type CA. Twenty-six (86.67%) patients underwent primary surgery, whereas four (13.33%) underwent revision surgery; of the latter, three (75%) had undergone primary IHD, and one had undergone primary TNEE. Only one (3.33%) patient experienced re-stenosis after revision surgery, which consisted of IHD. Twelve patients (40%) underwent stenting, with one developing re-stenosis. The relationships between surgical approach and re-stenosis after primary and secondary surgery were not statistically significant. Conclusion The outcomes in patients with CA treated with IHD and TNEE are comparable. Rates of re-stenosis and need for revision surgery do not differ significantly in patients treated with these surgical approaches.

With prostate cancer not observed in eunuchs and total androgen suppression by castration an effective first-line treatment for advanced prostate cancer, the dramatic regression seen in tumour symptoms after castration, lead to the theory that high levels of circulating androgens were a risk factor for prostate cancer. This theory however, ignored the effects testosterone variations within a physiologic range could have on early tumour events and since the early 2000s, clinical evidence discounting testosterone as a linear mechanistic cause of prostate cancer growth mounted, with alternative mechanistic hypotheses such as the saturation model being proposed. Together with a growing understanding of the negative health effects and decreased quality of life in men with testosterone deficiency or hypogonadism, a paradigm shift away from testosterone as a prostate cancer inducer occurred allowing clinicians to use testosterone therapy as potential treatment for men with difficult and symptomatic hypogonadism that had been previously treated for prostate cancer. In this review we contextualise the idea of testosterone as a risk factor for prostate cancer inducement and compile the most current literature with regards to the influence of testosterone and testosterone therapy in prostate cancer.

Breast cancer is a significant factor in female mortality. An early cancer diagnosis leads to a reduction in the breast cancer death rate. With the help of a computer-aided diagnosis system, the efficiency increased, and the cost was reduced for the cancer diagnosis. Traditional breast cancer classification techniques are based on handcrafted features techniques, and their performance relies upon the chosen features. They also are very sensitive to different sizes and complex shapes. However, histopathological breast cancer images are very complex in shape. Currently, deep learning models have become an alternative solution for diagnosis, and have overcome the drawbacks of classical classification techniques. Although deep learning has performed well in various tasks of computer vision and pattern recognition, it still has some challenges. One of the main challenges is the lack of training data. To address this challenge and optimize the performance, we have utilized a transfer learning technique which is where the deep learning models train on a task, and then fine-tune the models for another task. We have employed transfer learning in two ways: Training our proposed model first on the same domain dataset, then on the target dataset, and training our model on a different domain dataset, then on the target dataset. We have empirically proven that the same domain transfer learning optimized the performance. Our hybrid model of parallel convolutional layers and residual links is utilized to classify hematoxylin&ndash, eosin-stained breast biopsy images into four classes: invasive carcinoma, in-situ carcinoma, benign tumor and normal tissue. To reduce the effect of overfitting, we have augmented the images with different image processing techniques. The proposed model achieved state-of-the-art performance, and it outperformed the latest methods by achieving a patch-wise classification accuracy of 90.5%, and an image-wise classification accuracy of 97.4% on the validation set. Moreover, we have achieved an image-wise classification accuracy of 96.1% on the test set of the microscopy ICIAR-2018 dataset.

Purpose: Several studies show conflicting results regarding the prognosis and predictors of the outcome of critically ill patients with a solid malignancy. This study aims to determine the outcome of critically ill patients, admitted to a hospital, with a solid malignancy and the factors associated with the outcomes. Methods and Materials: All patients with a solid malignancy admitted to an intensive care unit (ICU) at a tertiary academic medical center were enrolled. Clinical data upon admission and during ICU stay were collected. Hospital, ICU, and six months outcomes were documented. Results: There were 252 patients with a solid malignancy during the study period. Urogenital malignancies were the most common (26.3%) followed by lung cancer (23.5%). Acute respiratory failure was the most common ICU diagnosis (51.6%) followed by sepsis in 46%. ICU mortality and hospital mortality were 21.8% and 34.3%. Six months mortality was 38.4%. Using multivariate analysis, acute kidney injury, OR 2.82, 95% CI 1.50-5.32 and P=0.001, use of mechanical ventilation, OR 2.67 95% CI 1.37 – 5.19 and P=0.004 and performance status of ≥2 with OR of 3.05, 95% CI of 1.5-6.2 and P= 0.002 were associated with hospital mortality. There were no differences in outcome between African American patients (53% of all patients) and other races. Conclusion: This study reports encouraging survival rates in patients with a solid malignancy who are admitted to ICU. Patients with a poor baseline performance status require mechanical ventilation or develop acute renal failure have worse outcomes.

Gross hematuria is common in autosomal dominant polycystic kidney disease (ADPKD). It is an alarming symptom and may be the first manifestation of ADPKD. Cyst hemorrhage is a frequent cause of hematuria in ADPKD while other differential diagnoses include cyst infection, urinary tract infection, renal stones and an underlying malignancy. Knowledge of the precipitating factors and clinical presentation of these conditions will help practicing internists in performing an appropriate evaluation and management of these entities and their complications, as well as executing timely referrals to subspecialists when indicated.

The focal and non-focal epilepsy is seen to be a chronic neurological brain disorder, which has affected $\approx ~60$ million people in the world. Hence, an early detection of the focal epileptic seizures can be carried out using the EEG signals, which act as a helpful tool for early diagnosis of epilepsy. Several EEG-based approaches have been proposed and developed to understand the underlying characteristics of the epileptic seizures. Despite the fact that the early results were positive, the proposed techniques cannot generate reproducible results and lack a statistical validation, which has led to doubts regarding the presence of the pre-ictal state. Various methodical and algorithmic studies have indicated that the transition to an ictal state is not a random process, and the build-up can lead to epileptic seizures. This study reviews many recently-proposed algorithms for detecting the focal epileptic seizures. Generally, the techniques developed for detecting the epileptic seizures were based on tensors, entropy, empirical mode decomposition, wavelet transform and dynamic analysis. The existing algorithms were compared and the need for implementing a practical and reliable new algorithm is highlighted. The research regarding the epileptic seizure detection research is more focused on the development of precise and non-invasive techniques for rapid and reliable diagnosis. Finally, the researchers noted that all the methods that were developed for epileptic seizure detection lacks standardization, which hinders the homogeneous comparison of the detector performance.

Background: Non-alcoholic fatty liver sickness (NAFLD) is a variety of liver pathological conditions that intensely related to other chronic diseases including obesity and diabetes. Objectives: Systematically evaluating the role of lifestyle interventions on reducing the activity of NAFLD. Methods: Collecting all the studies regarding the effects of changing the diet, exercise or combination of both on the activity or markers of NAFLD during the period from 2006 to 2017. Results: Database searches returned 122 citations with 92 included in more than one search then the final studied which include in this study was 19 articles. Five articles studied the effects of a combination of dietary and exercise interventions, four of these articles showed positive results regarding the Dietetic Association (ADA) Quality Criteria Checklist, while only one article showed a neutral results, i.e. 80.0% of the articles showed a positive effect of the combination of diet and exercise on the effect of NAFLD patients. Conclusion: This review showed that the combination of healthy life interventions, including exercise and health diet, are effective in reducing the activity of NAFLD and could result in complete reversal of the condition. Thus NAFLD patients are advised to lose about 10% of their weight and engaging in regular exercises for 5 days per week.

Lower urinary tract symptoms (LUTS) due to benign prostatic hypertrophy (BPH) are a very common problem in men ranging from mild urinary symptoms to recurrent urinary tract infections or renal failure. Numerous treatment options are available ranging from conservative medical therapies to more invasive surgical options. Prostate artery embolization (PAE) has emerged as a novel treatment option for this common problem with clinical efficacy comparable to the current surgical gold standard, transurethral resection of the prostate (TURP). PAE offers fewer complications and side effects without a need for general anesthesia or hospitalization. This review discusses the indications for prostate artery embolization in addition to LUTS, patient evaluation in patients with LUTS, PAE technique and clinical results, with an emphasis on efficacy and safety.

Endoscopic retrograde cholangiopancreatography (ERCP) is minimally invasive procedure commonly performed for biliary and pancreatic diseases. According to literature, the most common related complication are pancreatitis, post-sphincterotomy bleeding, perforation and cholangitis. This is rare and exceptional ERCP complication and only few cases have been reported. We report a case of rare post-ERCP complication, subcapsular liver hematoma that was diagnosed 16 hour post-ERCP in 28-year-old lady with intra-abdominal collection, ultrasound guided drainage of suspected bile leak was done, but the drained fluid was bloody (blood mixed with bile), with total amount of 900 ml in the first 36 hours. Patient received 2 units packed RBCs and she maintain her vital sign and hemoglobin 8.5 g/dl. Computed tomography scan of abdomen revealed a large left hepatic lobe subcapsular hematoma 16x7x12 cm with no active bleeding causing compression of the left hepatic vessels. On the basis of laboratory, clinical, and hemodynamic parameters the patient was hemodynamically stable. She was managed conservatively with only ultrasound guided drained of abdominal collection and no any radiological or surgical intervention needed for the hematoma.

In spite of the fact that anemia is the most widely recognized systemic sign of inflammatory bowel disease (IBD), among the expansive range of extraintestinal malady complexities experienced in IBD, including joint inflammation and osteopathy, it has for the most part gotten little thought. In any case, as far as recurrence, as well as to its potential impact on hospitalization rates and on the personal satisfaction and work, sickliness is, in fact, a huge and expensive intricacy of IBD. Frailty is multifactorial in nature, the most predominant etiological structures being iron deficiency anemia (IDA) and anemia of a chronic disease. In a condition related to irritation, for example, IBD, the assurance of iron status utilizing normal biochemical parameters alone is insufficient. A more exact evaluation might be achieved utilizing new iron lists including reticulocyte hemoglobin content, the rate of hypochromic red cells or zinc protoporphyrin. While oral iron supplementation has generally been a backbone of IDA treatment, it has likewise been connected to a broad gastrointestinal reactions and conceivable infection compounding. Be that as it may, numerous doctors are as yet hesitant to administer iron intravenously, in spite of the wide accessibility of an assortment of new IV arrangements with enhanced safety profiles, and in spite of the proposals of worldwide master rules. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD.

Sickle cell anemia (SCA) is a blood disease, which causes distortion in the shape of Red Blood Cells (RBCs) and becomes like a crescent. Traditional methodologies of classifying and counting RBCs that have been used by medical analysts are time-consuming, as well as, cost-effective. In addition, it is possible to make errors throughout the classifying and counting stages. We overcome these limitations by proposing a novel convolutional neural network model that classifies the RBCs into three categories: Normal, Abnormal (sickle shape) and other blood content. We enhanced the model’s efficiency using a hardware accelerator called FPGA (Altera DE2 Cyclone II) to take advantage of its parallelism features. We have evaluated the model’s efficiency with different platforms to show the differentiation in terms of time execution and power computation. Based on our knowledge, the results show that our proposed model has achieved the best accuracy (87.15%) and has high efficiency for real-time diagnosis.

Ischemia-reperfusion injury (IRI) is one of the major risk factors implicated in morbidity and mortality associated with cardiovascular disease. Here we show that the proton-gated acid-sensing ion channel 1a (ASIC1a) plays a key role during cardiac ischemia and demonstrate that ASIC1a is a promising therapeutic target to improve the tolerance of cardiac tissue to IRI. Genetic ablation of ASIC1a leads to improved functional recovery following global myocardial IRI in ex vivo mouse hearts, and this effect can be recapitulated by therapeutic blockade of ASIC1a using specific and potent pharmacological inhibitors. We used two models of ex vivo donor heart procurement and storage, an in vivo model of myocardial infarction, and in vitro studies using human iPSC-derived cardiomyocytes to show that ASIC1a inhibition improves post-IRI cardiac viability. Use of ASIC1a inhibitors as pre- or post-conditioning agents provided equivalent cardioprotection to benchmark drugs, including the sodium-hydrogen exchange inhibitor zoniporide. At the cellular and whole organ level, we show that acute exposure to ASIC1a inhibitors has no impact on cardiac ion channels regulating baseline electromechanical coupling and physiological performance. Collectively, our data provide compelling evidence for a novel pharmacological strategy involving ASIC1a blockade as a cardioprotective therapy to improve the viability of donor hearts exposed to myocardial ischemia.

Rationale: Anomalous Origin of Left Coronary Arteries from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland (BWG), is a rare form of coronary artery anomaly that is usually discovered in the first few months of life. Only rarely can patients with this anomaly reach adulthood without symptoms. Patient concerns: A 28-year-old female was witnessed suddenly collapse with a seizure-like episode by her colleagues at work. Diagnosis and Intervention: Routine cardiopulmonary resuscitation was performed by emergency medical service technologists. The patient was unable to be revived. Postmortem examination revealed the patient had ALCAPA with a focal chronic ischemic injury of the left ventricle. Moreover, a high take-off of the right coronary artery was also discovered. Outcomes: The patient passed away due to ALCAPA. The mechanism of death was cardiac arrhythmia being triggered by myocardial ischemic changes. Lessons: In the rare cases where ALCAPA manifests in an asymptomatic adult, the mortality rate is very high. This case demonstrates the importance of awareness of such patients living under the tremendous risk of sudden cardiac death.

One of the main reasons for death among women is breast cancer. The traditional diagnosis process of breast cancer is time-consuming and expensive. Also, an early cancer diagnosis may reduce the breast cancer death rate. With the help of computer-aided diagnosis system, the efficiency increased and the cost is reduced of the cancer diagnosis. Traditional classification methodologies are based on feature extraction techniques. Currently, deep learning techniques have become the alternative solution for diagnosis and overcame the problems of the handcrafted features methods. Increasing the depth in a deep convolutional neural network makes the network suffer from gradient vanishing problems, which are not caused by overfitting but instead by an increase in depth. Therefore, our proposed network is designed based on the idea of increasing the width of the network. A novel two-branch deep convolutional neural network is proposed for the classification of histopathological breast images. The proposed network is trained on the dataset of ICIAR-2018 to classify images into four classes; invasive carcinoma, in situ carcinoma, benign lesion, and normal tissue image. The proposed network is beneficial for gradient propagation as the error can be back-propagated through multiple paths. It also helps to combine different levels of features at each step of the network since it is a two-branch network. The proposed network is superior to the existing methods by achieving a patch-wise classification accuracy of 83.6% and image-wise classification accuracy of 91.3% on the divided part from the training set. Moreover, we have achieved an image-wise classification accuracy of 89.4% on the unseen test images of ICIAR-2018.

Prednisolone and prednisone are synthetic corticosteroids used to treat different diseases. They are well known to be used for treating many conditions like asthma, autoimmune diseases, many skin conditions, and may help to prevent or at least to suppress inflammations and immune responses. It was proved previously the correlation between prednisolone and the function of liver in patients having liver problems. In patients with alcoholic hepatitis, for example, prednisolone was accompanied with a short-term reduction in the rates of mortality, but this effect was not clear after 2 years. This research was performed to study the possible effects of prednisolone on the histology and the enzyme histochemistry of the liver and kidney in healthy rabbits. Twelve females adult rabbits (Six animals considered as treated group and other six animals as control group) were used in this experiment. After two weeks of adaptation time, treatment by the drug began. Animals treated by prednisolone oral dose 20 mg daily by gavage. Animals sacrificed under anesthesia, then ordinary histological sections (stained with hematoxylin-eosin) and frozen sections (by freezing microtome for Alp activity) of liver and kidney were prepared. The histological results and the ALP activity in both liver and kidney were found to be normal in treated group in compare with the control group. Prednisolone has many various effects on the physiology, psychology, immunology, even the molecular and genetics, varied from beneficial effects to undesired side effects. In the field of hepatology, prednisolone treatment was found to ameliorate many symptoms and enhance many biochemical and histologic abnormal changes in many types of liver diseases like autoimmune hepatitis, liver cirrhosis, septic shock patients, and cases of liver transplantation. In conclusion; according to the results of this research there no any effects of prednisolone on histology of liver and kidney and the ALP activity in these organs.

The aim of this article is to focus on etiology, risk factors, clinical presentation and classification systems of acute and chronic PVT as well as focusing on current diagnostic and therapeutic options for the management of acute and chronic PVT. PVT represents a serious clinical concern in cirrhotic patients and in those with specific local or systemic risk factors. The rate and extent of thrombus formation can significantly impact patient presentation and the resulting clinical outcomes. The presentation of acute PVT can range from abdominal pain to intestinal ischemia/infarction and even death, while chronic PVT can remain clinically silent. A number of imaging modalities including US, CT and MRI can be used to confirm the diagnosis. In addition to addressing underlying risk factors, AC therapy forms a cornerstone of treatment and has demonstrated efficacy in both acute and chronic settings. Proper caution should be used when initiating AC therapy in cirrhotic patients given their underlying coagulopathic status with attention now being paid to NOACs and LMWH. For patients with bowel ischemia, extensive thrombosis, contraindications or poor response to AC, or for those with co-morbidities that preclude AC, minimally invasive endovascular techniques offer alternative treatment options. Familiarity with the etiology, clinical presentation and classification of PVT optimize early detection and incorporate effective therapeutic options, the management of these complex patients should be undertaken by a multidisciplinary team. Minimally invasive catheter-based therapies and endovascular portosystemic shunt creation demonstrated efficacy in the treatment of AC-resistant patients and for patients with extensive or complicated disease.

Sickle cell anemia is an abnormal red blood cell which leads to blood vessel obstruction joined by painful episodes and even death. It is also called abnormal hemoglobin. Hemoglobin is responsible for passing oxygen through the blood vessel for all over the body. Normal red blood cells are in a circular shape and they are compact and flexible, enabling them to move freely through small capillaries. On the other hand, abnormal red blood cells are in sickle shape and they are stiff and angular causing them to become stuck in small capillaries. Due to that, it will be a reason for pain to patients and lead to low oxygen and dehydration. The manual assessment, classification, and counting of biological cells require for an immense spending of time and it may lead to wrong classification and counting since red blood cells are millions in one smear. Also, cells classification is challenging due to heterogeneous and complex shapes, overlapped cells and a variety of colors. We overcome these drawbacks by introducing a new robust and effective deep Convolutional Neural Network to classify Red Blood Cells (RBCs) in three classes namely: normal (‘N’) abnormal (sickle cells anemia type (‘S’)) and miscellaneous (‘M’). In order to improve the results further, we have used our model as features extractor then we applied an error-correcting output codes (ECOC) classifier for the classification task. Our model with ECOC showed outstanding performance and high accuracy of 92.06%.

Red Blood Corpuscles (RBCs) form the main cellular component of human blood. RBCs in common physiological status has a circular form in the front view and bi-concave form in side view. In case of a person is infected with anemia RBCs form as sickle-shaped cells which drive to blood vessel obstruction joined by painful episodes and even death. Precise and robust cells classification and counting are essential in evaluating the level of anemia disease danger. The classification and counting of red blood cells (normal and abnormal RBC cells) are challenging due to the complex and heterogeneous shapes and overlapped cells. In this paper, we propose a new robust approach to classify red blood cells to two groups: Normal and Abnormal RBC cells based on area and Eccentricity of each cell, then count the total number of normal and abnormal RBC cells individually. For the sake of comparison, we also implement the latest Sickle cell research, which uses circular Hough transform. We compare our approach to circular Hough transform in the same execution environment. Our new approach sets the state-of-the-art performance in term of effectiveness (cell counting) and efficiency (execution time).

INTRODUCTION: We aimed to identify high-risk nonalcoholic fatty liver disease (NAFLD) patients seen at the primary care and endocrinology practices and link them to gastrohepatology care. METHODS: Using the electronic health record, patients who either had the diagnosis of type 2 diabetes or had 2 of 3 other metabolic risk factors met criteria for inclusion in the study. Using noninvasive fibrosis tests (NITs) to identify high risk of fibrosis, patients who met the NIT prespecified criteria were referred to gastrohepatology for clinical assessment and transient elastography. RESULTS: From 7,555 patients initially screened, 1707 (22.6%) met the inclusion criteria, 716 (42%) agreed to enroll, and 184 (25.7%) met the prespecified NIT criteria and eligibility for linkage to GE-HEP where 103 patients (68 ± 9 years of age, 50% men, 56% white) agreed to undergo linkage assessments. Their NIT scores were APRI of 0.38 ± 0.24, FIB-4 of 1.98 ± 0.87, and NAFLD Fibrosis Score of 0.36 ± 1.03; 68 (66%) linked patients had controlled attenuation parameter >248 dB/m, 62 (60%) had liver stiffness 12 kPa. Liver stiffness for the overall group was 6.7 ± 4.2 kPa, controlled attenuation parameter 282 ± 64 dB/m, and FAST score 0.22 ± 0.22. Linked patients with presumed advanced fibrosis had significantly higher body mass index (36.4 ± 6.6 vs 31.2 ± 6.4 kg/m2, P = 0.025) and higher NIT scores (APRI 0.89 ± 0.52 vs 0.33 ± 0.14, FIB-4 3.21 ± 2.06 vs 1.88 ± 0.60, and NAFLD Fibrosis Score 1.58 ± 1.33 vs 0.25 ± 0.94). DISCUSSION: By applying a simple prespecified multistep algorithm using electronic health record with clinical risk factors and NITs followed by transient elastography, patients with nonalcoholic fatty liver disease seen in PCP and ENDO practices can be easily identified.

Transarterial embolization has shown promise as a safe, effective, and less invasive treatment modality for benign liver lesions (hemangioma, focal nodular hyperplasia (FNH), and hepatic adenoma (HA)) with fewer complications compared to surgical intervention. There is no consensus regarding the most appropriate embolization material(s) for the treatment of benign liver tumors. The purpose of this study was to review the current literature regarding the transarterial embolization of benign liver tumors and to share our single center experience. This was a non-blinded, retrospective, single-institution review of the bland embolization of benign liver tumors. Clinical data and imaging before and after embolization were used to evaluate lesion response to transarterial embolization. Twelve patients were included in the study. Five patients with six hemangiomas were treated. Pain was a presenting complaint in all five of these patients. The median change in tumor volume was −12.4% and ranged from −30.1% to +42.3%. One patient with two FNH lesions was treated, and both lesion volumes decreased by more than 50%. Six patients with 10 adenomas were treated. Pain was a presenting complaint in three patients, and five patients had a lesion &gt, 5 cm. The median change in tumor volume was −67.0% and ranged from −92.9% to +65.8%. Bland transarterial embolization of liver hemangiomas, FNH, and HA can be an effective and minimally invasive treatment modality to control the size and/or symptoms of these lesions. There is a variable response depending on tumor type and the embolization materials used.

The production and distribution of videos and animations on gaming and self-authoring websites are booming. However, given this rise in self-authoring, there is increased concern for the health and safety of people who suffer from a neurological disorder called photosensitivity or photosensitive epilepsy. These people can suffer seizures from viewing video with hazardous content. This paper presents a spatiotemporal pattern detection algorithm that can detect hazardous content in streaming video in real time. A tool is developed for producing test videos with hazardous content, and then those test videos are used to evaluate the proposed algorithm, as well as an existing post-processing tool that is currently being used for detecting such patterns. To perform the detection in real time, the proposed algorithm was implemented on a dual core processor, using a pipelined/parallel software architecture. Results indicate that the proposed method provides better detection performance, allowing for the masking of seizure inducing patterns in real time. Healthy viewing.Real-time detection of hazardous video content for photosensitive seizures.Multicore parallel computation.Seizure pattern inducer testing benchmark.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease where the body's immune system attacks its own healthy tissue. It can affect many organs such as skin, joints, brain, kidneys and other organs. Objectives: to evaluate the knowledge toward Systemic Lupus Erythematosus (SLE) among citizens in Al-Dammam city. Methods: a questionnaire-based quantitative cross-sectional study which focuses on determining the knowledge of Systemic lupus erythematosus in Al-Dammam city. Results: 240 participants filled the surveys, 130 participants (54%) have no idea about SLE. The majority of respondents had no clear idea regarding treatment and complications of the disease. 32% respondents had idea that SLE is more prevalent among females. In fact, this disorder is reported more prevalent in women. Conclusion: this study indicated that the public have low awareness with some misconception regarding the SLE. The awareness campaigns are needed to increase the awareness about SLE which will be helpful to educate the public about its symptoms and methods of treatments.