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Abstract Background Socioeconomic status (SES) is a social classification factor that takes into account income, parental education and occupation. SES has been shown to play an important role in shaping students’ academic performance, including in medical schools, but there still remains significant variation in findings around SES and academic achievement worldwide. We aim to assess and explore socioeconomic disparities and their effects on medical school performance at Sudanese public and private universities. Objectives The objective of our study was to assess the effects of age, sex, living conditions, parental education and income level on the academic achievement of medical students from universities in Sudan. Methods This cross-sectional study was conducted among undergraduate medical students at ten public universities in Sudan between September and December 2023. Participants were included if they were older than 18 years and were studying in their 2nd year or older. The data were collected using an online questionnaire with open- and closed-ended questions measuring age, living conditions, parental income level and education. A convenience sampling method was used to recruit participants from universities. The data were analyzed using SPSS v28.0.0, and a p value less than 0.05 was used to indicate statistical significance. Results We received 832 responses, 516 (62%) from females and 307 (36.9%) from males. The median age was 23 years. Most students lived with their families (61.1%), followed by student housing (28.2%). This study revealed age (p = .024) (95% Cl: 0.025- 0.023) andhigh family income (p = .019) (95% Cl: 0.018- 0.02) are associated with academic achievement in the long term, as demonstrated through cumulative grade point average (cGPA). Conclusion The findings underscore the importance of targeted support systems to bridge the socioeconomic gaps that exist among medical students, allowing all students to thrive academically regardless of their background. Clinical trial number None.

This study employs diverse machine learning models, including classic artificial neural network (ANN), hybrid ANN models, and the imperialist competitive algorithm and emotional artificial neural network (EANN), to predict crucial parameters such as fresh water production and vapor temperatures. Evaluation metrics reveal the integrated ANN-ICA model outperforms the classic ANN, achieving a remarkable 20% reduction in mean squared error (MSE). The emotional artificial neural network (EANN) demonstrates superior accuracy, attaining an impressive 99% coefficient of determination (R2) in predicting freshwater production and vapor temperatures. The comprehensive comparative analysis extends to environmental assessments, displaying the solar desalination system's compatibility with renewable energy sources. Results highlight the potential for the proposed system to conserve water resources and reduce environmental impact, with a substantial decrease in total dissolved solids (TDS) from over 6,000 ppm to below 50 ppm. The findings underscore the efficacy of machine learning models in optimizing solar-driven desalination systems, providing valuable insights into their capabilities for addressing water scarcity challenges and contributing to the global shift toward sustainable and environmentally friendly water production methods. HIGHLIGHTS The study employs diverse machine learning models to predict crucial parameters such as fresh water production and vapor temperatures.; Machine learning models including classic artificial neural network (ANN), hybrid ANN models, and the imperialist competitive algorithm (ANN-ICA) and emotional artificial neural network (EANN); The EANN model emerges as the most accurate in predicting freshwater production and vapor temperatures.;

Significance of this work is to examine enhanced thermal efficiency of magnetic nanofluid in the presence of Joule heating and radiation in missile technological devices, nuclear energy plants, rockets, solar energy systems and enhancing cyclic processes. Prominent aim of current investigation is to demonstrate the amplitude and oscillating analysis of mixed convective heat rate of Darcian magnetic nanoparticle movements with entropy generation, thermal radiation and Joule heat impact through porous stretching sheet. The magnetic layer along stretching surface plays important role to control thermal performance. Governing mathematical equations are reduced in convenient form by using non-dimensional analysis. The primitive mathematical form of steady and oscillating model is calculated through oscillatory stokes and primitive variables. Using Gaussian elimination and finite differences techniques, the geometrical and numerical outcomes of steady and oscillatory models are obtained by applying FORTRAN lahey-95 programming tool. The novelty of this problem is to study the oscillatory thermal and concentration profiles of Darcian magnetic nanoparticles with Joule heating and radiations. It is examined that momentum and temperature distribution grows as radiant-energy increases but decreases for maximum Joule heating. It is found that temperature and concentration distributions enhances as magnetic force decreases. Prominent enhancing amplitudes in heat and mass transfer are obtained for maximum Schmidt and thermophoresis parameter. Heat and mass transfer decreases as magnetic factor increases due to insulating magnetic nanoparticles.

Turbulent and non-turbulent analysis of thermomagnetic convection, heating rate and mass transport of Darcian radiating nanofluid flow through porous slanted sheet is the aim of present study. Influence of microgravity is more useful for the movement of thermophoresis nanoparticles with maximum temperature and density. Joule heating, porous medium, magnetic field and thermal radiations are incorporated for the performance of thermal convection. Governing equations are reduced in dimensionless form. Oscillatory stokes conditions are applied to separate the steady, real and imaginary equations. Finite difference, Primitive transformation, and Gaussian elimination techniques are applied for numerical outputs. For asymptotic results, the appropriate range of parameters such as 0.1≤JH≤15.0, 0.1≤Pr≤12.0, 0.1≤Rd≤25.0, 0.0≤λT≤5.0, 0.1≤NT≤1.0, 0.1≤Fr≥6.0, and 0.1≤δ≤1.0 is utilized. Main novelty of work is to examine the steady state and oscillatory behavior of friction-rate, heat/mass transport over slanted two-angles π/6 and π/4. Maximum amplitude in fluid velocity is observed by increasing radiations and buoyant forces. Temperature distribution and nanomaterial concentrations enhance as Joule-heating and Prandtl number increases under microgravity region. Amplitude and oscillation of heat and mass rate is increased as reaction rate, Joule heating and Forchheimer parameter increases. Enhancing behavior of energy transport is observed for maximum choice of Prandtl index with small magnetic effects. It is depicted that high rate of oscillating frequency in heat transmission is detected with maximum radiation effects.

A supramolecular structure is formed during the synthesis of a dihydrogen phosphate hybrid salt with the organic aromatic amine molecule 6-amino-1H-indazole. This work looks into the interactions between 6-amino-1H-indazole molecules and dihydrogen phosphate ions, which sheds light on the formation mechanisms and stability of the resulting crystal lattice. A slow evaporation process resulted in single crystal formation of [C7H9N3][H2PO4]2. The compound crystallizes in the centrosymmetric space group of the monoclinic system, with dimensions a = 7.074(13)Å, b = 14.134(3)Å, c = 12.716(3)Å, β = 91.231(15)°, and Z=4. Hydrogen bonds are essential for connecting the dihydrogen phosphate anions [H2PO4]- and the organic cations [C7H9N3]2+ in the mineral structure. According to Hirshfeld’s analysis oxygen-hydrogen interactions are the most important in the crystal of all potential chemical linkages. The IR and Raman spectra of the chemical collected at room temperature were analyzed in relation to literature data and theoretical groupings. Photoluminescence and UV measurements are linked to a number of electrical activities in the title chemical.

Abstract Background: Leishmania donovani is a protozoan parasite that causes visceral leishmaniasis, a potentially fatal disease in humans and dogs. The epidemiology and transmission dynamics of L. donovani in Sudan are poorly understood. We aim to determine the prevalence and characterization of L. donovani in human hospital cases and domestic dogs using different diagnostic methods in two localities in Gadarif State, Sudan. Methods: A cross-sectional study was conducted from October 2019 to April 2020. Whole blood samples and lymph node aspirates were collected from 69 human and 32 dog participants for parasitological, immunological, and molecular tests. Results: No parasites were detected in blood samples from either humans or dogs. Lymph node microscopy revealed 71.01% positivity in humans and 9.4% in dogs. The IT Leish test showed 82.6% positivity in humans and 43.75% in dogs. PCR confirmed L. donovani infection in all six selected samples (three from humans and three from dogs). Conclusion: The study confirmed the presence of L. donovani in both human and dog populations in the study area, suggesting that dogs may act as reservoirs or hosts for the parasite. The IT Leish kit test was the most sensitive and specific method, while microscopy of blood and lymph node smears was the least sensitive method. Further studies are needed to elucidate the role of dogs in the transmission cycle of L. donovani and the risk factors associated with human infection.

Mosques, revered as sacred spaces, are distinguished by their sustainable architectural designs. A critical aspect of these designs is the implementation of daylighting strategies, essential for ensuring adequate light levels, particularly for reading the Holy Quran. Traditional daylighting typologies in mosques, such as multi-lateral lighting, clerestories, skylights, and shading devices, are widely recognized. However, the potential application of electrochromic (EC) switchable glazing within mosque architecture remains underexplored. This study delves into the effectiveness of various daylighting typologies, assessing their performance before and after the integration of EC switchable glazing in the Al-Shagroud Mosque located in Saudi Arabia. Employing comprehensive radiance simulations in accordance with the LEEDv4.1 standards, the study evaluates additional metrics including useful daylight illuminance (UDI300–3000lux), workplane illuminance (WPI), uniformity index (Ui), and daylight glare probability (DGP) under multiple scenarios. The results demonstrate that clerestory lighting effectively meets LEEDv4.1 benchmarks but exhibits limitations in achieving uniform light distribution, particularly in the men’s prayer hall. In contrast, the women’s prayer hall benefits from a combination of clerestory lighting and shading devices, which improves light quality and mitigates glare issues. However, the use of skylights without adequate shading leads to excessive WPI and high DGP levels, compromising visual comfort. Moreover, managing daylight quantity and quality through the integration of different typologies, including hybrid models, presents substantial challenges. The integration of EC switchable glazing, while maintaining optimal WPI and reducing DGP, offers enhanced visual comfort in prayer areas. Nevertheless, this technology faces difficulties in ensuring even light distribution, as evidenced by lower uniformity index values. This research highlights the critical need for optimizing daylighting in mosques to balance sustainability and comfort, without detracting from their sacred ambiance.

Objectives: This study aims to assess cancer patients' accessibility to healthcare services and perceived barriers during the COVID-19 pandemic in Khartoum state, aiming to explore the consequent impact on cancer patients. It also aims to determine the coping strategies used by patients to overcome these barriers. Study design: This is a retrospective analytical cross-sectional study. Methods: Data were collected from August 2020 to March 2021, with a sample size of 316 cancer patients. Systemic random sampling and SPSS version 25 were utilized for data collection and analysis. Results: The study found that 55.7 % of the surveyed cancer patients had experienced disruptions in accessing essential cancer healthcare services during the lockdown. The study identified the most common cancers as breast (19.7 %), gastrointestinal (19 %), and ovarian (11 %). Notable barriers included governmental travel restrictions (51.6 %), outpatient service closures (41.8 %), and high costs (27.8 %). Additionally, delayed treatment was directly associated with a 33.3 % fatality rate among the participants. Conclusions: This study highlights the considerable negative impact of the COVID-19 lockdown on cancer care in Sudan. Recommendations include a focus on telemedicine as an alternative form of patient consultation, the expansion of health insurance schemes to encompass cancer treatments, and strengthening healthcare infrastructure to facilitate cancer care during crises.

AbstractCamel brucellosis is a major public health concern in Sudan; however, there is no overall estimation of the prevalence of camel brucellosis in Sudan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study aimed to perform a meta-analysis of 30 eligible studies published before December 31, 2022, with a total of 70059 dromedary camels, to estimate the pooled prevalence of camel brucellosis and its risk factors in Sudan. The random effect model was used for the final analysis due to the significantly high heterogeneity among the included studies, and the results showed that the overall pooled prevalence of camel brucellosis was 17%, with a confidence interval (CI) of 12%–21%. The prevalence was higher in males than females (54% vs. 46%) and in adults than youngling (77% vs. 23%). The prevalence also varied by region, with central and northern Sudan having the highest prevalence (24%), compared to other regions of Sudan. Moreover, the prevalence of camel brucellosis appeared to be decreasing over time. The current study concluded that camel brucellosis infection is still endemic in many areas of Sudan, with the disease being especially prevalent in central and northern Sudan. Thus, this study provides valuable information for the prevention and control of camel brucellosis in Sudan. However, the significant heterogeneity among the included studies should be taken into account when interpreting these results. Finally, to provide adequate information, research must be updated, and more research must be conducted in many regions of Sudan.

Abstract Background Im/migrants (immigrants and migrants, including refugees, asylum seekers, and individuals without legal documentation) experience unique assets and needs in relation to coronavirus disease 2019 (COVID-19). Community-based participatory research (CBPR) is one way to engage im/migrant communities. Rochester Healthy Community Partnership (RHCP) is a CBPR partnership in Rochester, Minnesota. RHCP partners noted that credible COVID-19 information was not available to their communities. In response, RHCP formed a COVID-19 Task Force and adapted the Centers for Disease Control and Prevention’s Crisis and Emergency Risk Communication (CERC) framework to create an intervention that prioritized im/migrant groups experiencing health disparities. In the CERC intervention, communication leaders delivered COVID-19 health messages to their social networks and documented related concerns. RHCP relayed these concerns to regional leaders to ensure that im/migrant experiences were included in decision making. Once vaccines were available, RHCP continued to deploy the CERC intervention to promote vaccination equity. The aims of this paper are to (1) describe the implementation of a bidirectional CERC intervention for vaccination equity, and (2) describe a community-engaged and community-based vaccine clinic intervention. Methods First, we surveyed participants (n = 37) to assess COVID-19 experiences, acceptability of the CERC intervention, and motivation to receive a COVID-19 vaccination. Second, we collaborated with community partners to hold vaccine clinics. We report descriptive statistics from each intervention. Results When asked about the acceptability of the CERC intervention for vaccine equity, most participants either reported that they ‘really liked it’ or ‘thought it was just ok’. Most participants stated that they would recommend the program to family or friends who have not yet received the COVID-19 vaccine. Almost all participants reported that they felt ‘much more’ or ‘somewhat more’ motivated to receive a COVID-19 vaccine after the intervention. We administered 1158 vaccines at the vaccination clinics. Conclusions We found that participants viewed the CERC intervention for vaccination equity as an acceptable way to disseminate COVID-19-related information. Nearly all participants reported that the intervention convinced them to receive a COVID-19 vaccine. In our experience, community-engaged and community-based clinics are a successful way to administer vaccines to im/migrant communities during a pandemic.

The surging demand for electricity, fueled by environmental concerns, economic considerations, and the integration of distributed energy resources, underscores the need for innovative approaches to smart home energy management. This research introduces a novel optimization algorithm that leverages electric vehicles (EVs) as integral components, addressing the intricate dynamics of household load management. The study’s significance lies in optimizing energy consumption, reducing costs, and enhancing power grid reliability. Three distinct modes of smart home load management are investigated, ranging from no household load management to load outages, with a focus on the time-of-use (ToU) tariff impact, inclining block rate (IBR) pricing, and the combined effect of ToU and IBR on load management outcomes. The algorithm, a multi-objective approach, minimizes the peak demand and optimizes cost factors, resulting in a 7.9% reduction in integrated payment costs. Notably, EVs play a pivotal role in load planning, showcasing a 16.4% reduction in peak loads and a 7.9% decrease in payment expenses. Numerical results affirm the algorithm’s adaptability, even under load interruptions, preventing excessive increases in paid costs. Incorporating dynamic pricing structures like inclining block rates alongside the time of use reveals a 7.9% reduction in payment costs and a 16.4% decrease in peak loads. In conclusion, this research provides a robust optimization framework for smart home energy management, demonstrating economic benefits, peak load reduction potential, and enhanced reliability through strategic EV integration and dynamic pricing.

While SARS-CoV-2 infection appears to have spread widely throughout Africa, documentation of associated mortality is limited. We implemented a representative serosurvey in one city of Sierra Leone in Western Africa, paired with nationally representative mortality and selected death registration data. Cumulative seroincidence using high quality SARS-CoV-2 serological assays was 69% by July 2021, rising to 84% by April 2022, mostly preceding SARS-CoV-2 vaccination. About half of infections showed evidence of neutralizing antibodies. However, excess death rates were low, and were concentrated at older ages. During the peak weeks of viral activity, excess mortality rates were 22% for individuals aged 30-69 years and 70% for those over 70. Based on electronic verbal autopsy with dual independent physician assignment of causes, excess deaths during viral peaks from respiratory infections were notable. Excess deaths differed little across specific causes that, a priori, are associated with COVID, and the pattern was consistent among adults with or without chronic disease risk factors. The overall 6% excess of deaths at ages ≥30 from 2020-2022 in Sierra Leone is markedly lower than reported from South Africa, India, and Latin America. Thus, while SARS-CoV-2 infection was widespread, our study highlights as yet unidentified mechanisms of heterogeneity in susceptibility to severe disease in parts of Africa.

Objectives The Bronchiolitis Endotracheal Surfactant Study (BESS) is a randomised controlled trial to determine the efficacy of endo-tracheal surfactant therapy for critically ill infants with bronchiolitis. To explore acceptability of BESS, including approach to consent within a limited time frame, we explored parent and staff experiences of trial involvement in the first two bronchiolitis seasons to inform subsequent trial conduct.Design A mixed-method embedded study involving a site staff survey, questionnaires and interviews with parents approached about BESS.Setting Fourteen UK paediatric intensive care units.Participants Of the 179 parents of children approached to take part in BESS, 75 parents (of 69 children) took part in the embedded study. Of these, 55/69 (78%) completed a questionnaire, and 15/69 (21%) were interviewed. Thirty-eight staff completed a questionnaire.Results Parents and staff found the trial acceptable. All constructs of the Adapted Theoretical Framework of Acceptability were met. Parents viewed surfactant as being low risk and hoped their child’s participation would help others in the future. Although parents supported research without prior consent in studies of time critical interventions, they believed there was sufficient time to consider this trial. Parents recommended that prospective informed consent should continue to be sought for BESS. Many felt that the time between the consent process and intervention being administered took too long and should be ‘streamlined’ to avoid delays in administration of trial interventions. Staff described how the training and trial processes worked well, yet patients were missed due to lack of staff to deliver the intervention, particularly at weekends.Conclusion Parents and staff supported BESS trial and highlighted aspects of the protocol, which should be refined, including a streamlined informed consent process. Findings will be useful to inform proportionate approaches to consent in future paediatric trials where there is a short timeframe for consent discussions.Trial registration number ISRCTN11746266.

The rise in household energy consumption globally has increased the necessity for effective electricity consumption management and load monitoring. Smart meters can facilitate fine-grained analysis by providing consumption insights even at the level of individual appliances, for detecting deterioration of appliances, anomalous behavior, and demand response. In this work, we propose a smart home appliance classification that utilizes the deep learning architecture of Long Short-Term Memory (LSTM) trained on the latest version of the Plug-Load Appliance Identification Database (PLAID). The model achieves competitive precision, recall and F1-scores across 16 different home appliances manufactured by 330 vendors. The model is then deployed on a Raspberry Pi micro-controller and interfaced with smart meters in a home to generate almost real-time classification of appliances and transmit this to a cloud database. The results and insights are made accessible to the end user or utility provider through a mobile application connected to the same database.

In the building sector, the low thermal conductivity of plastics makes them a viable option to increase the thermal resistance of construction materials. Incorporating recycled plastic in concrete panels can not only enhance the sustainability and circular economy of the buildings but also provide an affordable alternative to phase change materials (PCM) for thermal insulation. To evaluate the potential of waste plastic as a thermal insulation material, nine samples with varying thicknesses (1 mm, 2 mm, and 3 mm) and portions of shredded waste plastic were tested to determine their thermal and physical properties. The properties under investigation, such as density, water absorption, porosity, compressiveness, and thermal conductivity, have been tested. Upon completion of the physical and thermal assessments, it was determined that the PL.SH.layer.10% and PL.SH.layer.20% insulation samples exhibited higher thermal effective alternatives compared to the PCM samples. Additionally, the latter two options are deemed to be more cost-effective. Only the samples with with a melted plastic layer of 1 or 2 mm failed to boost their thermal efficiency in terms of heat insulation until the melted plastic was increased by more than 3 mm. The research emphasizes the capacity of recycled plastic to act as a cost-efficient substitute for thermal insulation. This substitution to boost the insulation of building envelopes, preserve energy, and enhance thermal comfort, boost increase the insulation of building envelopes, preserve maintain energy, and enhance thermal comfort, especially in hot developing countries. The results may provide valuable is for future investigations and advancements in sustainable construction materials, facilitating the shift towards a circular economic model.

AbstractBackground: Earlier studies on the use of inhaled nitric oxide (iNO) for premature infants born at

The basic objective of microgrid primary control is to preserve microgrid stability. On the other hand, microgrid secondary control has been proposed for ensuring reactive power-sharing and restoring the frequency and voltages of the microgrid. Therefore, this paper presents a complete model for evaluating the combined impact of primary and secondary control actions on microgrid domain of stability since the impact of the secondary control design on the domain of stability of the microgrid has not been addressed. Further, the developed model is used to assess the impact of reactive power-sharing, secondary controller design parameters, and communication delay on the domain of stability of the microgrid. The domain of stability is a supportive tool for determining the stable operating range for different microgrid droops. Simulation results have been obtained to validate the developed model and the domain of stability analysis. These results demonstrated that secondary control actions have a significant influence on the domain of stability of the microgrid, and thus it is important to consider the secondary control design in the determination of the microgrid’s stable range. Moreover, it has been demonstrated that primary control gains can be severely constrained by reactive power sharing gains.

Abstract Novel pectin-based films reinforced with crystalline nanocellulose (CNC) and activated with zinc oxide nanoparticles (ZnO NPs) were prepared by solvent-casting method. Film ingredients enhanced UV-blocking, thermal, and antibacterial properties of active films against well-known foodborne pathogens. Optimal active films exhibited higher mechanical, water vapor barrier properties compared to pristine pectin films. SEM confirmed the even distribution of CNC and ZnO NPs in pectin matrix and their interactions were proven using FTIR. Wrapping hard cheese samples artificially contaminated with Staphylococcus aureus and Salmonella enterica with the ternary nanocomposite film at 7 °C for 5 days significantly reduced the total population counts by at least 1.02 log CFU/g. Zn2+ migrating to wrapped cheese samples was below the specific limit (5 mg/kg), confirming their safety for food contact. Overall, ZnO/CNC/pectin nanocomposite films represent promising candidates for active food packaging as safe, eco-friendly alternatives for synthetic packaging materials.

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a complex and serious form of heart failure caused by the accumulation of transthyretin amyloid protein in the heart muscle. Variable symptoms of ATTR-CM can lead to a delayed diagnosis. Recognizing the diagnostic indicators is crucial to promptly detect this condition. A targeted literature review was conducted to examine the latest international consensus recommendations on a comprehensive diagnosis of ATTR-CM. Additionally, a panel consisting of nuclear medicine expert consultants (n = 10) and nuclear imaging technicians (n = 2) convened virtually from the Kingdom of Saudi Arabia (KSA) to formulate best practices for ATTR-CM diagnosis. The panel reached a consensus on a standard diagnostic pathway for ATTR-CM, which commences by evaluating the presence of clinical red flags and initiating a cardiac workup to assess the patient’s echocardiogram. Cardiac magnetic resonance imaging may be needed, in uncertain cases. When there is a high suspicion of ATTR-CM, patients undergo nuclear scintigraphy and hematologic tests to rule out primary or light-chain amyloidosis. The expert panel emphasized that implementing best practices will support healthcare professionals in KSA to improve their ability to detect and diagnose ATTR-CM more accurately and promptly. Diagnosing ATTR-CM accurately and early can reduce morbidity and mortality rates through appropriate treatment.

A Ten-year-old child presented to our emergency department with acute urinary retention. Three months ago, he was diagnosed with right renal hydronephrosis with renal calculus. Firstly, right nephrostomy was inserted. Next, he had been treated with ESWL for right renal stone in another center. After unsuccessful attempts for urethral catheterization, he was brought to the operating room for meatotomy and calculus extraction. An impacted urethral stone was detected at this point. He had a successful extraction of the stone. A six-month follow-up period has passed with no recurrence. This shows that although they are uncommon, urethral stones do happen.

Community-engaged research partnerships promote health equity through incorporation of regional contexts to inform partnership dynamics that shape research and interventions that reflect community voice and priorities. Long-term partnerships build trusted relationships and promote capacity building among community and academic partners, but there are many structural barriers to sustaining long-term partnerships. Here we describe lessons learned from sustaining Rochester Healthy Community Partnership (RHCP), an 18-year community-based participatory research (CBPR) partnership in Southeast Minnesota. RHCP collaborates with immigrant and refugee populations to co-create interventions that promote health equity for community health priorities. Challenges to sustainability include a tension between project-based funding and the needs of long-term community-based research infrastructure. These challenges can be met with a focus on shared CBPR principles, operating norms, partnership dynamics, and governance. RHCP began in 2004 through identification of a community health priority, defining the community, and establishment of CBPR principles. It grew through identification of broader community health priorities, capacity building for community and academic partners, and integration of diverse learners. We describe the capacity for RHCP to respond to new societal contexts, the importance of partnership dynamics as a barometer for partnership health, and lessons learned about sustainability of the CBPR partnership.

Background Cancer is a well-known risk factor of preventable thromboembolic disease. This study aims to provide guidance on the prevention and management of cancer-associated thrombosis (CT) that tailors prophylactic and therapeutic options for medical and surgical oncology patients presenting to health care settings in Saudi Arabia. Methods The present consensus was developed in concordance with the modified Delphi-based approach, which incorporates a face-to-face meeting between two voting rounds to gain experts' feedback on the proposed statements. All experts were either oncologists, hematologists, or hemato-oncologist with an active clinical and research profile in hemato-oncology. Results The experts highlighted that the comparatively high incidence of inherited thrombophilia among the Saudi population may account for a higher CT burden in the Kingdom than in other parts of the world. However, due to the lack of literature that assesses CT in Saudi Arabia, primary venous thromboembolism prophylaxis should be tailored according to a valid risk assessment of cancer patients and should be implemented in routine practice. For hospitalized medical oncology patients, the experts agreed that prophylaxis with low-molecular-weight heparin (LMWH) should be offered, regardless of the presence of acute illness. For ambulatory medical oncology patients, LMWH or direct oral anticoagulants (DOACs) prophylaxis should be offered for high-risk patients. Concerning surgical patients, they agreed that all oncology patients undergoing surgery should be offered thromboprophylaxis. In terms of secondary prophylaxis, the experts recommended continuing a prophylactic dose of anticoagulant (LMWH or DOAC), for an appropriate period depending on the cancer type and stage. Finally, they also provided a set of statements on management of CT in Saudi Arabia. Conclusion The present modified Delphi-based study combined the best available evidence and clinical experience with the current health care policies and settings in Saudi Arabia to build a consensus statement on the epidemiology, prevention, and management of CT.

The coronavirus has become the most interesting virus for scientists because of the recently emerging deadly SARS-CoV-2. This study aimed to understand the behavior of SARS-CoV-2 through the comparative genomic analysis with the closest one among the seven species of coronavirus that infect humans. The genomes of coronavirus species that infect humans were retrieved from NCBI, and then subjected to comparative genomic analysis using different bioinformatics tools. The study revealed that SARS-CoV-2 is the most similar to SARS-CoV among the coronavirus species. The core genes were shared by the two genomes, but there were some genes, found in one of them but not in both, such as ORF8, which is found in SARS-CoV-2. The ORF8 protein of SARS-CoV-2 could be considered as a good therapeutic target for stopping viral transmission, as it was predicted to be a transmembrane protein, which is responsible for interspecies transmission. This is supported by the molecular interaction of ORF8 with both the ORF7 protein, which contains a transmembrane domain that is essential to retaining the protein in the Golgi compartment, and the S protein, which facilitates the entry of the coronavirus into host cells. ORF1ab, ORF1a, ORF8, and S proteins of SARS-CoV-2 could be immunogenic and capable of evoking an immune response, which means that these four proteins could be considered a potential vaccine source. Overall, SARS-CoV-2 is most related to SARS-CoV. ORF8 could be considered a potential therapeutic target for stopping viral transmission, and ORF1ab, ORF1a, ORF8, and the S proteins of SARS-CoV-2 could be utilized as a potential vaccine source.

Objectives: Current diagnostic tests for tuberculosis (TB) in children living in low-endemic countries are limited by low specificity and the inability of the current tests to differentiate between active TB and latent TB infection (LTBI). This study aimed to evaluate the blood IP-10 mRNA expression level to detect LTBI in Egyptian pediatric household contacts (PHC). Methods: TB-specific IP-10 and IFN-γ mRNA levels were assessed by real-time quantitative PCR (RT-qPCR) in 72 Egyptian PHC of active pulmonary TB cases. All study participants were also assessed by Tuberculin Skin Test (TST) and Quantiferon gold in tube (QFN-GIT) assay. Results: IP-10 and IFN-γ mRNA expression levels were significantly higher in PHC with active TB or LTBI than TB negative (p < 0.0001). The level of IP-10 mRNA expression was significantly higher in PHC with active TB than LTBI (p = 0.0008). In contrast, there was no significant differences in the IFN-γ mRNA expression between PHC with active TB compared to LTBI (p = 0.49). The sensitivity and specificity of the IP-10 RT-qPCR were 94.2% and 95.2%, respectively, in PHC with active TB compared to 85.7% and 81.8% in PHC with LTBI. The negative and positive predictive values and accuracy of IP-10 RT-qPCR for distinguishing active TB from LTBI were 85.2%, 58.3%, and 72.6% respectively. Conclusion: Blood IP-10 mRNA expression level may be a potential diagnostic marker to help distinguish active TB from LTBI in PHC.

Background: Human metapneumovirus (hMPV) is a major novel cause of acute respiratory infections ranging from wheezing to bronchiolitis and pneumonia in children worldwide. The aim of this study was to detect hMPV in hospitalized children with acute respiratory tract infections (ARTIs) by using reverse transcription-loop mediated isothermal amplification (RT-LAMP) assay. Methods and Results: A total of 68 children with ARTIs who were clinically suspected of acquiring hMPV were included in the study in the period between January 2019 and February 2020. Posterior-pharyngeal (throat) swabs were obtained from each patient. hMPV RNA was revealed in 18(26.5%) cases. The age range was from

Pseudomonas aeruginosa (P. aeruginosa) is known to be associated with resistance to practically all known antibiotics. This is a cross-sectional, descriptive, laboratory-based analytical study in which 200 P. aeruginosa clinical isolates were involved. The DNA of the most resistant isolate was extracted and its whole genome was sequenced, assembled, annotated, and announced, strain typing was ascribed, and it was subjected to comparative genomic analysis with two susceptible strains. The rate of resistance was 77.89%, 25.13%, 21.61%, 18.09%, 5.53%, and 4.52% for piperacillin, gentamicin, ciprofloxacin, ceftazidime, meropenem, and polymyxin B, respectively. Eighteen percent (36) of the tested isolates exhibited a MDR phenotype. The most MDR strain belonged to epidemic sequence type 235. Comparative genomic analysis of the MDR strain (GenBank: MVDK00000000) with two susceptible strains revealed that the core genes were shared by the three genomes but there were accessory genes that were strain-specific, and this MDR genome had a low CG% (64.6%) content. A prophage sequence and one plasmid were detected in the MDR genome, but amazingly, it contained no resistant genes for drugs with antipseudomonal activity and there was no resistant island. In addition, 67 resistant genes were detected, 19 of them were found only in the MDR genome and 48 genes were efflux pumps, and a novel deleterious point mutation (D87G) was detected in the gyrA gene. The novel deleterious mutation in the gyrA gene (D87G) is a known position behind quinolone resistance. Our findings emphasize the importance of adoption of infection control strategies to prevent dissemination of MDR isolates.

Abstract Purpose To assess the corneal endothelial cells morphology and count in keratoconus patients and their correlation with different stages of keratoconus. Methods Prospective non randomized multi-centric clinical study included 150 eyes of 150 keratoconus patients. Four centers in Egypt participated in this study included: Departments of Ophthalmology in Alexandria University, Tanta University and Port Said University and Alex I-Care hospital. Pentacam (Wavelight Oculyzer II) and specular microscopy (Tomey EM-3000) were done to all eyes. Keratoconic eyes were classified according to Amsler classification into stage 1, 2 and 3. Stage 1 included 99 eyes, stage 2 included 32 eyes & stage 3 included 19 eyes. Results The mean age of keratoconus patients was 24.07 ± 6.154 years. Forty five cases were males (30%) and 105 cases were females (70%). There was statistically significant difference in endothelial cell density (p

Acoustic emission (AE) are stress waves created by the material deformation, which could be utilized to detect impacts of objects within different mechanical systems. In a mechanical system, impacts from dropped masses are pertinent to realistic wave sources where is to improve precision of source location in real situation. As such, work is required in order to experimentally evaluate the distortions of AE signals using a set of impacts tests. A series of source intensities were simulated on a steel pipe also the effects of signal type and intensity on the frequency and time domain features were determined. In order to locate and reconstitute the time- and frequency-domain signatures of the AE source, sensors were mounted externally on segments of the tested pipes. It is concluded that the AE energy was easily affected by the location of the indenter shape/geometry. This study demonstrated the significant features and the capability of AE associated with real sources for evaluating and determining the intensity, nature and the position of the damaging events.

Thyroid cancer is the most frequent endocrine neoplasm in the general population. Common risk factors include gender, radiation exposure, and genetic backgrounds. The association of papillary thyroid cancer and celiac disease has frequently been reported in the literature; however, the association of papillary thyroid cancer and thalassemia trait is rare. Likewise, the association of thalassemia major and celiac disease is also rare. We hereby report a unique case of papillary thyroid cancer in a patient with celiac disease and thalassemia trait.

Abstract Background Floating right heart thrombi (RHT) represent an underdiagnosed, potentially hazardous, and to some extent rare phenomenon in patients presenting with acute pulmonary embolism (APE). Emergent treatment is usually required for such a condition. Case presentation A 19-year-old young lady presented with progressive shortness of breath, marked renal impairment, thrombocytopenia, and a highly oscillating huge right atrial mass. After she was admitted to the intensive care unit, she arrested in asystole and was resuscitated, and her electrocardiogram (ECG) showed evidence of acute anterior myocardial infarction. Urgent cardiac surgery to remove the right atrial mass was proposed by the heart team as the best option of management. Surgery was emergently performed with extra-corporeal membrane oxygenator (ECMO) as a support. Following surgery, mechanical support and vasopressors were successfully weaned and the patient achieved a good recovery. Conclusions A pulmonary embolism response team (PERT) approach should always be considered where a multidisciplinary team involving a cardiologist, radiologist, cardio-thoracic surgeon, radiologist, and intensivist shall determine the management strategy for a challenging presentation of a massive pulmonary embolism or floating right heart thrombi causing the hemodynamically unstable clinical condition.

Selective immunoglobulin A (IgA) deficiency is one of many congenital immunodeficiencies. It is associated with several medical condition. It has been shown to be associated with some types of malignancies, some autoimmune disorders, and even with some infections. Here we report a young male with selective IgA deficiency who also tested positive for Helicobacter pylori and strongyloidiasis at the time when he was diagnosed with stomach adenocarcinoma. The presence of IgA deficiency with multiple etiological possibilities such as infections and cancer makes this case unusual.

Abstract Background Somali immigrants and refugees to the United States are at high risk for obesity and related cardiovascular risk. Social network factors influence health behaviors and are important contributors to the obesity epidemic. The objective of this study was to describe social networks and obesity-related characteristics among adult Somali immigrants in a Minnesota city in order to inform a community-based, participatory, research-derived, social network intervention to decrease obesity rates. Methods Survey data (demographics, general health measures, and sociobehavioral and network measures) and height and weight measures (for calculating body mass index) were collected from adult Somali immigrants by bilingual study team members at community locations. Descriptive statistics were used to report the survey and biometric data. Logistic regression models were used to describe the basic associations of participants and network factors. Network data were analyzed to identify nodes and ties, to visualize the network, and to identify potential interventionists for a future social network intervention. Results Of the 646 participants, 50% were overweight or affected by obesity. The network had 1703 nodes with 3583 ties between nodes, and modularity was high (0.75). Compared with respondents of normal weight, participants who were overweight or affected by obesity had more network members who were also overweight or obese (odds ratio [OR], 2.90; 95% CI, 1.11–7.56; P = .03); this was most notable for men (OR, 4.58; 95% CI, 1.22–17.22; P = .02) and suggestive for those 50 years or older (OR, 24.23; 95% CI, 1.55–377.83; P = .03). Weight loss intention among participants who were overweight or affected by obesity was associated with number of family members and friends trying to lose weight, enabling functional network factors (social norms for weight loss, social support for healthy eating, and social cohesion), and less favorable obesogenic social norms. Conclusions In this community sample of Somali immigrants, distinct social networks are clustered by weight status, and social contacts and functional network characteristics are related to individuals’ weight loss intentions. These factors should be considered in weight loss interventions and programs. A social network intervention targeting weight loss, within a community-based participatory research framework, is feasible in this vulnerable population.

Background: The process of mass immunization against COVID-19 may be impacted by vaccine reluctance despite intense and ongoing efforts to boost vaccine coverage. The COVID-19 vaccine is a crucial component for controlling the pandemic. To the best of our knowledge, we did not come across any study presenting the post-vaccination side-effect profile among the Sudanese population. Developing strategies to improve the vaccine acceptability and uptake necessitate evidence-based reports about vaccine’s side effects and acceptance. In this regard, this study aimed at estimating the prevalence of COVID-19 vaccine side-effects among the general population in Sudan. Methodology: A cross-sectional web-based quantitative study was conducted among the general population aged ≥18 years and residing in the Khartoum state of Sudan. A 30-item survey tool recorded the demographics, chronic diseases, allergy to other vaccines and COVID-19 vaccine side-effects after the first, second and booster doses. The data on the onset and duration of side-effects after each dose were also recorded. The distribution of side-effect scores after each dose of COVID-19 vaccine was compared using appropriate statistical methods. Results: A total of 626 participants were approached for this study. There was a preponderance of females (57.7%), and 19% of respondents had chronic diseases. The vaccination rate against COVID-19 was 55.8% (n = 349/626). The prevalence of side-effects after the first, second and booster doses were 79.7, 48 and 69.4%, respectively. Pain at the injection site, headache, fatigue, exhaustion and fever were the common side-effects after the first and second doses, while pain at the injection site, fatigue, headache and muscle pain were frequently reported after the booster dose. Most of these side-effects appeared within 6 h and resolved within one or two days following the administration of the vaccine dose. The average side-effects scores were 4.1 ± 4.4 (n = 349), 2.2 ± 3.6 (n = 202) and 3.5 ± 4.1 (n = 36) after the first, second and booster doses, respectively. The female gender had significantly higher side-effects after primary and booster doses. The age group 18-24 years indicated higher side-effects after the first dose compared to participants with ages ranging from 31 to 40 years (p = 0.014). Patients with chronic disease indicated significantly higher (p = 0.043) side-effects compared to those without any comorbid illness. Conclusions: This study showed a high prevalence of transient COVID-19 vaccine-related side-effects after primary and booster doses. However, these side-effects waned within 48 h. Pain at the injection site was the most common local side-effect, while fatigue, fever, headache and muscle pain were frequently reported systemic side-effects. The frequency of side-effects was more profound among females, young adults and those with comorbid conditions. These findings indicate that COVID-19 vaccines are safe and have side-effects as reported in the clinical trials of the vaccines. These results aid in addressing the ongoing challenges of vaccine hesitancy in the Sudanese population that is nurtured by widespread concerns over the safety profile.

Distribution transformers are an integral part of the power distribution system network and emerging smart grids. With the increasing dynamic service requirements of consumers, there is a higher likelihood of transformer failures due to overloading, feeder line faults, and ineffective cooling. As a consequence, their general longevity has been diminished, and the maintenance efforts of utility providers prove inadequate in efficiently monitoring and detecting transformer conditions. Existing Supervisory Control and Data Acquisition (SCADA) metering points are sparsely allocated in the network, making fault detection in feeder lines limited. To address these issues, this work proposes an IoT system for real-time distribution transformer load monitoring and anomaly detection. The monitoring system consists of a low-cost IoT gateway and sensor module which collects a three-phase load current profile, and oil levels/temperature from a distributed transformer network, specifically at the feeder side. The data are communicated through the publish/subscribe paradigm to a cloud IoT pipeline and stored in a cloud database after processing. An anomaly detection algorithm in the form of Isolation Forest is implemented to intelligently detect likely faults within a time window of 24 h prior. A mobile application was implemented to interact with the cloud database, visualize the real-time conditions of the transformers, and track them geographically. The proposed work can therefore reduce transformer maintenance costs with real-time monitoring and facilitate predictive fault analysis.

Sorghum is the fifth most produced cereal in the world and is a source of nutrients and bioactive compounds for the human diet. This study examined the nutrient composition and in vitro fermentation characteristics of sorghum varieties grown in 2020 and 2021 (n = 15 × 3 × 2) across three locations in the north of Italy (Bologna, Padova, and Rovigo). In 2020, the crude protein content of sorghum was significantly higher in the region of Padova than in the region of Bologna (124 vs. 95.5 g/kg dry matter). However, crude fat, sugar, and gross energy levels showed no significant differences among the different regions in 2020. In 2021, the levels of crude protein, crude fat, sugar, and gross energy had no significant differences among different sorghum varieties harvested from the three regions. Significant differences in some mineral contents were found among the samples particularly in manganese and zinc in both years. After 24 h of fermentation of two different sorghum hybrids (hybrids 1 and 2 of both years harvested in Bologna, n = 4 × 2 × 2), the pH value was significantly higher in hybrid 1 of year 2021 (3.98) than in the other fermented samples (range: 3.71–3.88). The sorghum harvested from the region of Bologna had a significantly higher viscosity value (1.22 mPa·s) compared to other regions (1.8–1.10 mPa·s) in 2021 only. The results show that the nutritional value and viscosity of different sorghum varieties could differ depending on the location and year of cultivation.

Nivolumab is a monoclonal antibody directed against programmed cell death-1 receptor. It has an increasing application in the treatment of various advanced metastatic cancers. The incidence of autoimmune side effects associated with such agents is expected to increase. New-onset autoimmune diabetes mellitus associated with immune checkpoint inhibitor treatment is rare, occurring in less than 1% of patients. Nivolumab-induced diabetes often presents as diabetic ketoacidosis, which could be life-threatening if not recognized and treated promptly. We present the case of a patient who developed severe diabetic ketoacidosis concomitant with hyperosmolar hyperglycaemic state (HHS) after receiving nivolumab for metastatic testicular lymphoma. Pre-nivolumab blood glucose levels were normal, apart from transient hyperglycaemia related to steroids as part of the chemotherapy protocol. The diagnosis was confirmed with extremely low C-peptide in the clinic.

Foot and mouth disease and lumpy skin disease of cattle is a common disease on commercial cattle farms which associated with changes in behavior, blood parameters, pain related behaviors and pain scale measurements, but little is known about this effect. The objectives of the present study were to test 2 hypotheses. First, investigate these changes; second, explained the effect of different treatment strategies (analgesic with Flunixin meglumine) or non-analgesic on lameness and pain scale. 125 bull cows were enrolled in the study based on visual observation of abnormal behavior the present study was done in Assiut governorate in Egypt was divided in three groups, which 25 clinically healthy bull (control group), FMD clinically infected group (25 analgesic + 25 non-analgesic and LSD (25 analgesic + 25 non analgesic). Obtained data illustrated that; there are significant increase physiological parameters (rectal temperature, heart rate and respiratory rate), lying behavior and total pain scale, while, there are significant decrease in feeding, drinking, rumination and standing behaviors, activity of exploration and activity of body care which may be corrected by Flunixin using. Conclusion: Flunixin injection may help in decreasing the negative pain behaviors and physiological changes caused by LSD or FMD

Abstract This article discusses the opinions of the multiple sclerosis (MS) experts in the Gulf region on the use of high-efficacy disease-modifying drugs (DMDs; natalizumab, fingolimod, alemtuzumab, cladribine tablets, and ocrelizumab) in clinical practice. The experts reviewed the current literature including pivotal clinical trials and meta-analyses for high-efficacy DMDs, supplemented by the expert opinions on the usage of these DMDs in clinical practice. Several criteria were discussed by the panel based on different efficacy, safety, and convenience attributes. The panel concluded that all the DMDs available for the treatment of MS have benefits and risks, which should be considered while discussing the treatment plan with the patient. It is important to have a personalized approach based on the risk-benefit assessment for each case. Common considerations while choosing treatments include effectiveness, side effects/safety, and convenience/route of administration. Funding: Merck Serono Middle East FZ LTD.

Accurate and timely monitoring is imperative to the resilience of forests for economic growth and climate regulation. In the UK, forest management depends on citizen science to perform tedious and time-consuming data collection tasks. In this study, an unmanned aerial vehicle (UAV) equipped with a light sensor and positioning capabilities is deployed to perform aerial surveying and to observe a series of forest health indicators (FHIs) which are inaccessible from the ground. However, many FHIs such as burrows and deadwood can only be observed from under the tree canopy. Hence, we take the initiative of employing a quadruped robot with an integrated camera as well as an external sensing platform (ESP) equipped with light and infrared cameras, computing, communication and power modules to observe these FHIs from the ground. The forest-monitoring time can be extended by reducing computation and conserving energy. Therefore, we analysed different versions of the YOLO object-detection algorithm in terms of accuracy, deployment and usability by the EXP to accomplish an extensive low-latency detection. In addition, we constructed a series of new datasets to train the YOLOv5x and YOLOv5s for recognising FHIs. Our results reveal that YOLOv5s is lightweight and easy to train for FHI detection while performing close to real-time, cost-effective and autonomous forest monitoring.

Numerous risk factors for breast cancer (BC) have been identified. High-risk human papilloma virus (HR-HPV) is the etiological agent of cervical cancer and in some cases of head and neck cancer, specifically oropharyngeal cancer, but the role of HR-HPV in evoking neoplasia in BC is still unclear. In this study, all women above the age of 18 visiting the oncology clinic at Al-Azhar university hospital and Ain Shams specialized hospital between the period of February 2017 and March 2018 were invited to participate. We determined the prevalence of HR-HPV genotypes 16, 18, and 31 in breast tissue samples from 72 women with treatment-naïve BC and 15 women with benign breast lesions (BBL) by quantitative real-time PCR (qRT-PCR) and primer sets targeting the E6 and E7 regions. High-risk human papilloma virus DNA was detected in 16 of 72 (22.2%) BC cases (viral load range = 0.3-237.8 copies/uL) and 0 of 15 women with BBL. High-risk human papilloma virus was detected in 14 of 16 (87.5%), 2 of 16 (12.5%), and 0 of 16 (0%) for genotypes 16, 18, and 31, respectively. Forty-three age-matched healthy Egyptian women were enrolled as controls for assessment of local risk factors that can be used to initiate a strategy of BC prevention in Egypt. Assessment of the risk factors demonstrated that low education level, passive smoking, lack of physical activity, family history of cancer, and use of oral contraception were significant risk factors for BC. In conclusion, our results lead us to postulate that HR-HPV infection may be implicated in the development of some types of BC in Egyptian women. In addition, identification of local risk factors can support practical prevention strategies for BC in Egypt.

Community engagement is important for reaching vulnerable populations in the coronavirus disease 2019 (COVID-19) pandemic. A risk communication framework was implemented by a community-engaged research (CEnR) partnership in Southeast Minnesota to address COVID-19 prevention, testing, and socioeconomic impacts. Bidirectional communication between Communication Leaders and community members within their social networks was used by the partnership to refine messages, leverage resources, and advise policy makers. Over 14 days, messages were delivered by 24 Communication Leaders in 6 languages across 9 electronic platforms to 9882 individuals within their networks. CEnR partnerships may effectively implement crisis and emergency risk communication to vulnerable populations in a pandemic.

Background: Candida species are one of the most important opportunistic fungal pathogens that cause both superficial and systemic infections, especially in immunocompromised individuals. Considering the sharp increase in the rate of Candida infections, and resistance to commonly used antifungal agents in the last decades; this study was conducted to determine the rate of resistance among clinical isolates of Candida species, and to characterize some of the resistant genes among resistant isolates collected in Khartoum. Methods: This is a cross-sectional laboratory-based study included 100 pre-screened Candida species isolates from Khartoum state hospitals. Chromogenic media was used for Candida isolation and/or identification. The standard disc diffusion method was performed to investigate the susceptibility to fluconazole, itraconazole, and amphotericin. Following genomic DNA extraction, the entire ERG11 gene was amplified from some C. albicans resistant isolates, sequenced, and further analyzed. Results: Out of 100 clinical isolates collected, 51% were C. albicans, followed by C. glabrata (31%), C. krusie (8%), C. tropicals (5%), and C. dupliniens (5%). Resistance rate was 23% for fluconazole, 4% for itraconazole, while there were no amphotericin resistant isolates detected. C. albicans ERG11 gene sequence reveals 15 different mutations. Among these, three (D116E, E266D, and V488I) were missense mutations; however, these substitutions do not contribute to fluconazole resistance. Conclusion: C. albicans was found to be the most common species. Resistance against fluconazole was observed most frequently; however, mutations in ERG11 are unlikely to be the reason behind fluconazole resistance among these isolates.

Abstract Investigating the etiological causes of acute myeloid leukemia (AML) at the molecular level should help in identifying targets and strategies that would increase the efficacy of the current management regimens. Some genes may act as molecular diagnostics, of these ASXL1 and PHF6 are involved in regulation of gene expression, and BAX , and ARC, are pro- and anti-apoptotic molecules, respectively. In this study, peripheral blood samples were collected from 54 recently diagnosed AML patients in addition to 20 healthy individuals (the control group). Cellular RNA was extracted from all the samples and were subjected to quantitative analysis of the transcript levels of the four selected markers. Our data showed a significant elevation in the expression levels of PHF6 and ARC in AML patients, when compared to the controls (77.8% and 83.3%, respectively). On the other hand, ASXL1 and BAX exhibited increase, to a lesser extent, in the expression levels of the AML patients (52% and 55.6%, respectively). Our study also showed that the expression levels of ARC and PHF6 exhibited a concomitant increase and this could be correlated with poor prognosis of the cases. Thus, we can suggest these markers as reliable prognostic markers for prediction of AML outcomes.

This study was conducted to determine the fermentation characteristics of rye or sorghum mixed with different ratios of water (25%, 37.5%, 50%, 62.5%, and 75% in dry matter (DM)), incubated up to 48 h. The pH of the fermented rye at a DM content of 25% after 24 h had the lowest values (3.57) compared to that at a DM content of 75% (6.42). In fermented sorghum, pH values were lower than 4 already after incubation at 25% DM for 12 h (3.93) in comparison to that at DM content 75% (6.51). The L-lactic acid concentration in the fermented rye with 25% DM content after 24 h was significantly the highest (18.7 g/kg DM), as was that of sorghum with 25% DM content after 24 h (22.2 g/kg DM). Moreover, the acetic acid level in the fermented rye with 25% DM content after 24 h was significantly the highest (3.02 g/kg DM) compared to the other DM contents of fermented rye. Also, in fermented sorghum (25% DM), the acetic acid content was significantly the greatest (1.49 g/kg DM) in comparison to the other DM contents of fermented sorghum. Overall, fermented rye and sorghum containing 25 or 37.5% DM for 24 h and 12 h for rye and sorghum, respectively are sufficient for fermentation to be optimized based on the values of pH and lactic acid content, except for acetic acid content, which may negatively affect the palatability in animals.

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Adult acquired flatfoot deformity is a complex deformity associated with the collapse of the medial longitudinal arch. Several factors have been proposed in the etiology of adult acquired flatfoot deformity including arthritic, neuromuscular, and traumatic conditions; however, posterior tibial tendon dysfunction remains the most common etiology. A spectrum of conditions affecting the posterior tibial tendon has been identified, with tendinitis occurring early in the disease process and tendon rupture occurring at the more advanced stages. Adult-acquired flatfoot deformity requires a complex operative plan that often utilizes several procedures to correct deformity, at both the hindfoot and midfoot. The objective of this study was to compare the efficacy of two different osteotomies commonly used to correct flexible flat feet. Methods: 42 Patients (21 males and 21 females) with stage II PTTD acquired flexible flatfeet were included with a mean age of 49.62 +- 6.2. Twinty-two patients had medial displacement calcaneal osteotomy (MDCO) while 20 cases had latercal column lenghtening (LCL). Strayer procedure, spring ligament plication and FDL transfer were done in all patients. Pre- and Post-operative clinical assessment was done using AOFAS and FFI questionaire. Six radiographic parameters were analyzed, two in the anteroposterior view ( talo-navicular coverage and talo-calcaneal angle), three in lateral view ( talo- first metatarsus angle, talo- calcaneal angle and calcaneal inclination angle) and tibio-calcanal angle in axial view. Results: At a mean follow up of 12 months, significant improvement in AOFAS and FFI scores in MDCO and LCL groups with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups. LCL group showed significant better correction in TNC and calcaneal inclination angles when compared to MDCO group. However, MDCO procedure showed significantly better correction in axial tibial calcaneal angle. Both techniques correct the deformity, however cases received LCL has better correction than MDCO cases and less reoperation rate. Conclusion: Reconstructions performed with LCL produced a greater change in the realignment of adult acquired flatfoot, maintained more of their initial correction over time, and were associated with a lower incidence of additional surgery than reconstructions with a MDCO of the calcaneus. However, a higher incidence of degenerative change in the hindfoot was observed in the LCL group. The ability of LCL to correct the deformity in anteroposterior and lateral plan and MDCO in lateral and axial plan suggests that proper osteotomy should be planned according to the existing deformity. Combination of both techniques may be required in certain cases.

Background: Acute skin toxicity is a common and usually transient side-effect of breast radiotherapy although, if sufficiently severe, it can affect breast cosmesis, aftercare costs and the patient's quality-of-life. The aim of this study was to develop predictive models for acute skin toxicity using published risk factors and externally validate the models in patients recruited into the prospective multi-center REQUITE (validating pREdictive models and biomarkers of radiotherapy toxicity to reduce side-effects and improve QUalITy of lifE in cancer survivors) study.Methods: Patient and treatment-related risk factors significantly associated with acute breast radiation toxicity on multivariate analysis were identified in the literature. These predictors were used to develop risk models for acute erythema and acute desquamation (skin loss) in three Radiogenomics Consortium cohorts of patients treated by breast-conserving surgery and whole breast external beam radiotherapy (n = 2,031). The models were externally validated in the REQUITE breast cancer cohort (n = 2,057).Results: The final risk model for acute erythema included BMI, breast size, hypo-fractionation, boost, tamoxifen use and smoking status. This model was validated in REQUITE with moderate discrimination (AUC 0.65), calibration and agreement between predicted and observed toxicity (Brier score 0.17). The risk model for acute desquamation, excluding the predictor tamoxifen use, failed to validate in the REQUITE cohort.Conclusions: While most published prediction research in the field has focused on model development, this study reports successful external validation of a predictive model using clinical risk factors for acute erythema following radiotherapy after breast-conserving surgery. This model retained discriminatory power but will benefit from further re-calibration. A similar model to predict acute desquamation failed to validate in the REQUITE cohort. Future improvements and more accurate predictions are expected through the addition of genetic markers and application of other modeling and machine learning techniques.

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019. The disease is caused by severe acute respiratory syndrome virus coronavirus 2 (SARS-CoV-2). A few published cases have linked COVID-19 and hyponatremia. The mechanism of hyponatremia in these cases is related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Here we present a unique case of urinary retention and SIADH as unusual presenting features of SARS-CoV-2 infection.

Over the past decade, the development of high-efficacy disease-modifying therapies (DMTs) has been responsible for more effective management of relapsing-remitting multiple sclerosis (RRMS). However, the gaps in optimal care for this complex disease remain. Alemtuzumab (Lemtrada®) is a highly efficacious DMT that shows better patient outcomes and therapeutic benefits, but its use is under-recognized in the Gulf region. Experts in the care of multiple sclerosis shared their opinions based on study data and daily clinical experience in identifying the appropriate patient profile suitable for alemtuzumab’s therapeutic benefits. Age, disease activity and severity, disability status, physician experience, and economic condition are some of the key indicators for alemtuzumab use.

Although tuberculosis is a treatable disease, the high frequency of treatment default remains a challenge. The use of mobile phones structurally in a TB program has the potential to lower the frequency of default. However, it’s impact on treatment outcome in Sudan has not yet been evaluated. The aim is to evaluate the potential use of cell phones for lowering treatment default. We conducted a controlled intervention pilot study during the period from 1st of May 2017 to 31st of March 2018, in eight TB treatment units in Khartoum state, Sudan. Newly diagnosed patient with positive sputum smear on DOTS therapy were enrolled in intervention and control groups. SMS reminder were sent to the intervention group.Assessments were done at the beginning and at the end of the treatment. One hundred and forty-eight patients were enrolled, seventy-four patients in each group.The participants in the two groups were similar in demographic characteristics and behavioral and knowledge related factors about TB disease at baseline. The patients in the intervention group had a lower default rate (6.8%), higher documented cure rate (78.4%), better knowledge compared to control group. SMS reminder was useful and facilitated good interaction between patients and health personnel. Mobile texting seemed useful and was highly accepted by participants. Further evaluation of it’s potential benefit was warranted.