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In this paper, we introduce the class NK,φa,p of analytic functions in the unit disc D of the complex plane ℂ. By using functions with lacunary Taylor series, it is shown that different values for p give raise to different spaces. Finally, we study composition operators acting between NK,φa,p-type classes. [ABSTRACT FROM AUTHOR]

Using stratified random sampling technique, 1552 adolescent school age boys and girls in Abha city, southwestern Saudi Arabia, were screened for mental health using Arabic validated version of SCL-90-R. The overall prevalence of mental disorders amounted to 15.5%. The most frequent mental symptoms were phobic anxiety (17.3%), interpersonal sensitivity (14.7%), and obsessive compulsive (14.5%). In logistic regression analysis, some socio-demographic conditions (father education, mother working status, ranking among brothers and sisters, and type of school) were significantly affecting mental health. General practitioners and other primary care workers need to be educated to better engage young people, to recognize mental disorders, and to deliver simple treatments, including supportive counseling, and cognitive behavior therapy. There is a need for a national program in the country to integrate youth mental-health interventions with all existing youth programs, including those in health and education. [ABSTRACT FROM AUTHOR]

Background: Cancer, regardless of type, presents a formidable life challenge affecting patients' psychological well-being. Many perceive cancer diagnosis and treatment as traumatic., Objectives: This study aimed to estimate posttraumatic stress disorder (PTSD) prevalence in Omani adult cancer patients, identify predictors, and probe its correlation with social support., Methods: This cross-sectional study enrolled 343 adult cancer patients undergoing treatment from 3 hospitals in the Middle East country of Oman. Posttraumatic stress disorder was assessed via the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and perceived social support was measured using the Multidimensional Scale of Perceived Social Support., Results: The prevalence of PTSD among Omani adult cancer patients was 27.4%. Enhanced social support correlated with lower PTSD risk (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.93-0.97; P < .001). Predictors included shorter time since diagnosis (OR, 0.98; 95% CI, 0.97-0.99; P = .017), no psychiatric referral (OR, 0.46; 95% CI, 0.23-0.96; P = .04), and insufficient social support (OR, 0.96; 95% CI, 0.94-0.98; P < .001)., Conclusions: Social support significantly mitigates PTSD risk. Routine assessment and psychiatric referrals, especially for recent diagnoses, can enhance patients' lives. Reevaluating the PTSD diagnostic cutoff score (33) merits consideration for improved clinical use., Implications for Practice: Early PTSD assessment, particularly for low-social support new-diagnosed patients, is crucial for timely intervention. Psychiatric referrals can guide specialized treatments. Stressing social support's role can guide healthcare providers, including oncology nurses, in supporting patients effectively., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Patients with certain inherited metabolic disorders (IMD) are at high risk for metabolic decompensation with exposure to infections. The COVID-19 pandemic has been particularly challenging for health care providers dealing with IMD patients, in view of its unpredictable consequences in these patients. There is limited data in literature on evaluating the impact and the outcome of COVID-19 infection in these patients. This cross-sectional retrospective study on a large cohort of unvaccinated IMD patients, reviewed the incidence of COVID-19 infection, disease manifestation and outcome during the pandemic between November 2019 and July 2021. In this cohort of 1058 patients, 11.7% (n = 124) were infected with COVID-19. Their median age was 16 years (age range 2-42); 57% (n = 71) were males. Post-exposure positive test was noted in 78% (n = 97) patients, while 19% (n = 24) had symptomatic diagnosis and three patients tested positive during pre-hospital visits screening. Most patients, 68.5% (n = 85) had mild COVID-19 related symptoms such as fever, cough, headache and diarrhea while 13.7% (n = 17) patients had no symptoms. Of twenty-two patients (17.7%) who required hospitalization, 16 were adults with various intoxication and energy metabolism disorders, who developed IMD related complications such as metabolic acidosis, hyperammonemia, acute pancreatitis, hypoglycemia, rhabdomyolysis and thrombosis. Ten patients needed intensive care management. The cohort death rate was 2.4% (3 patients). Overall, the clinical course of COVID-19 infection in these IMD patients was relatively mild except for patients with intoxication and energy metabolism disorders who had high risk of developing acute metabolic decompensation with severe complications., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Introduction and Importance: COVID-19 represents a new challenge for patients with prosthetic valve, through increasing the risk of thrombosis and reducing the frequency of anticoagulation follow up visits., Case Presentation: A 37-year-old male patient on aspirin and warfarin for a mechanical aortic valve (AV, St Jude size 21 mm), presented with generalized fatigue and loss one of the mechanical heart sounds for 10 days. Urgent fluoroscopy showed stuck one of the AV leaflets in a closed and opening positions. Echocardiography showed high peak and mean AV gradients. The patient was confirmed with COVID-19 with fever on the day of admission. Cardiac CT with contrast showed stuck right (posterior) disc with a 6 × 4 mm thrombus surrounded by pannus formation. The patient was started on ultraslow thrombolytic therapy (alteplase 1 mg, every hour for 25 h, followed by 6 h of unfractionated heparin). Repeated fluoroscopy showed normal opening and closure of both discs. Repeated echocardiography showed a significant reduction in the peak and mean AV gradients back to baselines. The patient was discharged after 7 days with INR 3.0 for two consecutive days. The patient was asymptomatic with stable INR in three- and six-month follow-up visits. Transthoracic ultrasound demonstrated normally functioning mechanical AV., Clinical Discussion: Accurate and timely diagnosis of stuck mechanical AV requires high suspicion and timely diagnostic aids., Conclusion: Full recovery can be achieved after one cycle of ultraslow thrombolytic therapy. Further supportive data are still needed before recommending thrombolytic therapy as a successful alternative to surgery in COVID-19 patients., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Transcatheter implantation of the Edwards Sapien 3 valve (Edwards Lifesciences, Irvine CA) within the bioprosthetic mitral valve (MV) is an established method of treatment in adults. However, it has not been well studied in the pediatric age group., Methods: Transcatheter mitral valve-in-valve implantation was attempted in 4 symptomatic pediatric patients with a dysfunctional MV bioprosthesis implanted at an earlier stage due to severe MV stenosis or regurgitation. We reviewed our experience with MV implantation in this cohort., Results: The mean age and weight of the patients at the time of the procedure were 11.4 years (range: 10-14 years) and 36 kg (range: 31-44 kg), respectively. The transmitral mean gradient dropped from a mean of 19.75 mm Hg (range: 15-22 mm Hg) to a mean of 1 mm Hg (range: 0-3 mm Hg) after the procedure. The mean fluoroscopy time was 55.25 minutes (range: 40-72 minutes), and the mean hospital length of stay was 4 days (range: 3-7 days). The patients' functional class improved from New York Heart Association class IV to class I during the follow-up period., Conclusions: Transcatheter mitral valve-in-valve implantation can be performed safely for dysfunctional bioprosthetic MVs in the pediatric age group with favorable early and midterm outcomes. This procedure offers a viable alternative in patients who have high surgical risk or are deemed unfit for conventional surgery. However, we still recommend a long-term study of this approach in a large cohort, multicentre study., (© 2021 The Authors.)

Background: Exercise-associated immune response plays a crucial role in the aging process. The aim of this study is to investigate the effect of sport intensity on cytokine levels, oxidative stress markers and telomere length in aging elite athletes., Methods: In this study, 80 blood samples from consenting elite athletes were collected for anti-doping analysis at an anti-doping laboratory in Italy (FMSI). Participants were divided into three groups according to their sport intensity: low-intensity skills and power sports (LI, n = 18); moderate-intensity mixed soccer players (MI, n = 31); and high-intensity endurance sports (HI, n = 31). Participants were also divided into two age groups: less than 25 ( n = 45) and above 25 years old ( n = 35). Serum levels of 10 pro and anti-inflammatory cytokines and two antioxidant enzymes were compared in age and sport intensity groups and telomere lengths were measured in their respective blood samples., Results: Tumor necrosis factor-alpha (TNF-α) was the only cytokine showing significantly higher concentration in older athletes, regardless of sport intensity. Interleukin (IL)-10 increased significantly in HI regardless of age group, whereas IL-6 concentration was higher in the older HI athletes. IL-8 showed a significant interaction with sport intensity in different age groups. Overall, significant positive correlations among levels of IL-6, IL-10, IL-8 and TNF-α were identified. The antioxidant catalase activity was positively correlated with levels of TNF-α. Telomere length increased significantly with sport intensity, especially in the younger group., Conclusion: HI had longer telomeres and higher levels of pro- and anti-inflammatory cytokines, suggesting less aging in HI compared to low and moderate counterparts in association with heightened immune response. Investigation of the functional significance of these associations on the health and performance of elite athletes is warranted.

The Nubian ibex ( Capra nubiana ) is patchily distributed across parts of Africa and Arabia. In Oman, it is one of the few free-ranging wild mammals found in the central and southern regions. Its population is declining due to habitat degradation, human expansion, poaching and fragmentation. Here, we investigated the population's genetic diversity using mitochondrial DNA (D-loop 186 bp and cytochrome b 487 bp). We found that the Nubian ibex in the southern region of Oman was more diverse (D-loop HD; 0.838) compared with the central region (0.511) and gene flow between them was restricted. We compared the genetic profiles of wild Nubian ibex from Oman with captive ibex. A Bayesian phylogenetic tree showed that wild Nubian ibex form a distinct clade independent from captive animals. This divergence was supported by high mean distances (D-loop 0.126, cytochrome b 0.0528) and high F ST statistics (D-loop 0.725, cytochrome b 0.968). These results indicate that captive ibex are highly unlikely to have originated from the wild population in Oman and the considerable divergence suggests that the wild population in Oman should be treated as a distinct taxonomic unit. Further nuclear genetic work will be required to fully elucidate the degree of global taxonomic divergence of Nubian ibex populations., (© 2021 The Authors.)

Background and Objective: Dengue is the most important arthropod-borne viral disease which caused by the four-dengue virus serotypes (1-4) and its incidence has grown dramatically around the world in the recent decades. This study was conducted to determine the molecular characterization of dengue virus genotypes spreading in Jeddah province., Methodology: To distinguish dengue virus genotypes, serum samples from 13 infected patients were subjected to envelop and non-structural 1 (E/NS1) gene amplification and sequence analysis at the nucleotide and amino acid levels., Results: The present partial dengue virus phylogenetic analysis announced the domination of dengue virus 2 genotype among the current dengue virus samples circulating in Jeddah province. Dengue virus 2 current isolates were grouped in one branch and seemed to be more closely related to various strains isolated from Sri-Lanka, Australia and Singapore and confirmed by internucleotide distance average ranged +/-0.01. Interestingly, sequences analysis of amino acids confirmed substitution of 8 amino acid residue (Ser729Gua, Ser729Arg, Val762Gau, Val780phe, Val781Leu, Val781Ala, Glu858Asp and Gln873His) among the present isolates comparing with previous references strains isolated from different countries. Remarkably, one unique amino acid residue Ala741Val was verified in the 10 present isolates compared to the reference sequence previously isolated from Jeddah., Conclusion: Notably, the present study demonstrated the sequencing analysis of the dengue virus 2-E/NS1 on both nucleotide and amino acid levels and confirmed its endogenously prevalence in Jeddah.

Background: Sleep problems and poor sleep quality are important issues for medical students. This study aimed to investigate the sleep patterns, measure the prevalence of poor sleep quality, and identify the predictors of poor sleep among medical students in King Khalid University (KKU), Saudi Arabia., Methods: This cross-sectional study enrolled 318 medical students during October-November, 2015. Participants were selected by convenience sampling and data were collected using self-administered questionnaires to obtain information regarding socio-demographic variables and indicators of sleep quality., Results: The overall mean sleep quality score was 6.79 with a standard deviation of 3.06. Poor sleep quality was reported by 74.2% students. Significantly high mean sleep quality scores (Pittsburgh Sleep Quality Index) were observed for students with very poor subjective sleep quality (mean = 10.50, SD = 2.58), least sleep efficiency (mean = 11.21, SD = 2.23), shorter sleep duration (mean = 7.83, SD = 2.88), sleep onset latency more than 30 minutes (mean = 7.82, SD = 2.53), sleeping after midnight (mean = 7.53, SD = 2.95), and use of sleep aiding medication (mean = 8.78, SD = 3.5). Significant differences were observed between good sleepers and poor sleepers regarding these sleep characteristics. Poor sleep was predicted by sleep behaviours such as going to sleep after midnight (AOR = 2.18, 95% CI: 1.20, 3.94) and sleep duration of less than seven hours (AOR = 7.49, 95% CI: 4.24, 13.22)., Conclusion: Medical students of KKU have poor sleep quality. Longer sleep latency, going to sleep after midnight, and shorter sleep duration are important problems in this group., Competing Interests: None

Background: Mitral regurgitation (MR) is a frequent finding in patients with aortic stenosis (AS). The objective of this study is to assess the change in MR severity following transcatheter aortic valve implantation (TAVI)., Methods: MR changes were assessed by comparing transthoracic echocardiography before and after the procedure., Results: The prosthetic aortic valve was successfully implanted in 65 patients. The number of patients with pre-procedure MR was reduced from 58 (85.3%) to 43 (63.2%) (p < 0.001). Vena contracta width was decreased from 0.47 ± 0.28 to 0.25 ± 0.21, (p = 0.043). About 59.4% (19/32) of those who had moderate to severe MR and 85.7% (12/14) of those with severe MR experienced a significant improvement in MR after the procedure (p < 0.001). Improvement in MR was independent of prosthetic valve type with 54.2% in CoreValve and 43.9% in Edwards SAPIEN, p = 0.424; valve sizes were 25.8 ± 1.9 in those who improved vs. 25.0 ± 1.9 mm in those who did not improve, p = 0.105; femoral approach was 51.2% and apical approach was 41.7%, p = 0.457; MR etiology was 48.1% in organic and 48.6% in functional, p = 0.968; and operative risk was 50.0% in EuroScore >20 and 48.6% in EuroScore <20, p = 0.356., Conclusions: TAVI is associated with a significant improvement in MR, especially in severe types. The lack of influence of MR improvement by the etiology of MR, the type of valve implanted, and the operative risk need to be confirmed in a larger multi-center study.

Objective: The study objective was to evaluate the midterm results of a technique for correction of posterior leaflet prolapse without resection or use of artificial chordae., Methods: From May 2009 to October 2013, 96 patients with isolated posterior leaflet prolapse (n=36) or bileaflet prolapse (n=60) with or without chordal rupture underwent posterior leaflet repair at the Prince Sultan Cardiac Center. The novel Uniscallop ("U") technique was used in 46 patients (group U), based only on scallop suture without resection or artificial chordae application. A conventional approach (quadrangular or triangular resection, focal sliding, artificial chordae) was adopted in the remaining 50 patients (group C). In both groups, the annulus was reshaped using a 40- or 50-mm-long band. Postoperative echocardiography was performed in all patients after a mean follow-up of 18±13 months in group U and 20±9 months in group C., Results: There were no early or late deaths. No patients in either group showed systolic anterior motion. Both surgical strategies were successful in obtaining a significant reduction in mitral regurgitation grade. Left ventricular function was maintained, and tricuspid regurgitation grade was reduced overall. Moderate mitral regurgitation during follow-up developed in only 1 patient in group C, as the result of dehiscence of a plication stitch., Conclusions: Although the rationale for the use of the U technique is different from what is generally accepted, the midterm results of this approach are comparable to those obtained with more conventional techniques, remaining stable after a mean follow-up of 18 months., (Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: The optimal surgical treatment of ischemic mitral regurgitation (MR) has not been well defined. Second-order chordal cutting (CC), in selected patients, can improve surgical outcomes., Methods: From 2007 to 2011, 31 patients underwent CC for ischemic MR. The indication was the presence of increased tethering of the anterior leaflet, with a bending angle (BA) <145°. Patients with same echocardiographic characteristics were identified and propensity matched for age, ejection fraction (EF), MR grade, diameters, and BA. Only patients with preoperative and follow-up echocardiograms were included and divided into 2 groups of 26 patients each, CC and no-CC., Results: Preoperatively, in the CC and no-CC groups, the age was 61 ± 9 and 62 ± 10 years, EF was 31% ± 5% and 29% ± 8%, MR grade (0-4) was 3.6 ± 0.6 and 3.3 ± 0.8, and diastolic and systolic dimension was 56 ± 7 and 43 ± 8 mm and 57 ± 11 and 44 ± 11 mm, respectively. The New York Heart Association class and BA was 2.7 ± 0.6 and 2.6 ± 0.7 and 137° ± 4° and 137° ± 6°, respectively. All patients underwent overreductive annuloplasty. In the CC group, second-order chords were cut using aortotomy. After a mean of 33 ± 15 months, the MR grade was 0.6 ± 0.6 and 1.1 ± 0.8 (P = .014) and the EF was 40% ± 5% and 35% ± 7% (P = .005) in the CC and no-CC groups, respectively. The corresponding diastolic and systolic diameters were 52 ± 5 and 38 ± 8 mm and 53 ± 11 and 41 ± 12 mm (P = NS). The modifications were significant only in the CC group (P = .022 and P = .029 for the diastolic and systolic dimensions, respectively). The corresponding New York Heart Association class decreased to 1.1 ± 0.3 and 1.5 ± 0.6 (P = .004). The BA increased to 182° ± 4° in the CC (P < .001) and remained unchanged (137° ± 6°) in the no-CC group., Conclusions: In selected patients with a BA <145° and coaptation depth ≤10 mm, CC is related to less MR return or persistence, improved EF, and lower New York Heart Association class., (Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)

Mitral valve regurgitation which occurs immediately after repair can be due to anatomic (failure of repair) or functional (systolic anterior motion) reasons. We report a case where a patient with bileaflet prolapse showed, after surgical correction of the disease, moderate to severe regurgitation after cardiopulmonary bypass was stopped. The regurgitation was due to second-order tethering and was successfully treated with second-order chordal cutting., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Incidence of functional mitral regurgitation (FMR) is increasing due to aging and better survival after acute myocardial infarction, the most frequent cause of FMR. At the basis of FMR there is a displacement of one of both papillary muscle(s) and/or annular enlargement, which can be primitive or, more often, secondary. There is general agreement that its natural history is unfavorable, as witnessed by a considerable body of evidences. However, even if there is no clear evidence that surgical treatment of FMR changes consistently the outcome of patients with this disease, at least in terms of survival, there are some studies which show that function improves, as well as the global quality of life. The guidelines reflect this uncertainty, providing no clear indications, even in the gradation of severity of the FMR. Surgical techniques are variable and are mainly addressed to the annulus (restrictive annuloplasty), which is only a part of the anatomic problem related to FMR. Insertion of a prosthesis inside the native valve is appearing more and more a valuable option rather than a bail out procedure. On the other side, techniques addressed to modify the position of the papillary muscles appear to be still under investigation and not yet in the armamentarium of surgical treatment of FMR. Even after many years, rules are not established and results are fluctuating, but how and when to treat FMR is becoming more and more a topic of interest in cardiac surgery., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To identify a safety threshold of deep hypothermic circulatory arrest (DHCA) duration; to determine which protection offers the best outcome and whether a 10-min period of cold perfusion (20°C) preceding rewarming can reduce neurological events (NE)., Methods: From January 1988 to April 2009, 456 patients underwent aortic surgery using DHCA: for chronic disease in 239 and acute in 217. Cerebral protection was obtained by straight DHCA (sDHCA) in 69 cases, retrograde perfusion (RCP) in 198 and antegrade perfusion (ACP) in 189. In 247 subjects, a 10-min period of cold perfusion (20°C) preceded rewarming; in 209 rewarming was restarted without this preliminary., Results: Fifty-eight patients (13%) experienced NE. Twenty-two (5%) suffered temporary neurological dysfunction (TND) and 36 (8%) suffered stroke. DHCA duration >30 min was predictive for higher rate of NE (25.2% vs. 2.0%, P 0.001); after this value, only ACP was able to reduce incidence of NE (16.5% vs. 30.5%, P = 0.035). Cold reperfusion before rewarming significantly reduced incidence of NE (7.7% vs. 18.7%, P < 0.001) and extended the safe period to 40 min. Thirty-day mortality was 16.0%. Predictors of higher early mortality were acute aortic disease, longer DHCA, lack of ACP or prompt rewarming when DHCA >30 min and postoperative stroke., Conclusions: sDHCA remains a safe and easy tool for cerebral protection when DHCA duration is expected to be less than 30 min. When aortic surgery requires a longer period, ACP should be instituted. Before rewarming, a 10-min period of cold perfusion significantly reduces incidence of NE.

The tricuspid valve (TV) lies in between the right atrium and the right ventricle (RV), consisting of annulus, leaflets, chords and papillary muscles. The RV appears triangular-shaped in a lateral view and crescent-shaped in a cross-section one. In normal conditions, the septum is concave toward the left ventricle (LV) in both systole and diastole and the RV volume is larger than the LV volume, although its mass is a third of the LV. The strict relationship between the TV apparatus and the RV underlies the physiological mechanism of TV functioning, and so, the RV plays an important role in case of functional tricuspid regurgitation. Nevertheless, the systematic assessment of RV is still not performed mainly due to lack of standardization. Hence, new echocardiographic guidelines have recently been proposed to standardize the RV assessment using transthoracic 2D‑echocardiography. 3D-echocardiography and MRI are more useful to measure volumes and ejection fraction; in particular, MRI is able to provide a tissue evaluation. Today, surgical strategies are directed mainly to the annulus with fluctuating results because functional tricuspid regurgitation is not due only to the annulus but also to the RV, which is difficult to assess, due to its evolution being unpredictable and complicated by the interaction with LV.

A technique is described for correction of mitral regurgitation when the posterior leaflet has a reasonable length (approximately 10 mm), but its movements are limited by thickened and short chords. To avoid further retraction when a band or a ring is positioned to force leaflets coaptation, native chords are replaced by artificial chords (leaving 10 mm of extra length), which are then cut. In 6 patients, after 6 months of follow-up, the results are good., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

The title Schiff base, C(17)H(14)N(2)O(3), exists as an NH tautomer with the H atom of the phenol group transferred to the imine N atom. The iminium H atom is involved in a strong intra-molecular N(+)-H⋯O(-) hydrogen bond to the phenolate O atom, forming an S(6) motif. In the crystal structure, N-H⋯O hydrogen bonds form a C(9) chain parallel to [100] and a C(11) chain parallel to [010], while C-H⋯O hydrogen bonds form a C(11) chain parallel to [010]. The combination of N-H⋯O and C-H⋯O hydrogen bonds generates R(4) (3)(30) rings parallel to the ab plane.

In a study of injection safety in Abha health district, Saudi Arabia, data were collected from 47 physicians and 85 nurses at 24 primary health care centres, using an observation checklist and an interview questionnaire. All centres used individually packed disposable syringes and puncture-proof containers to collect used needles. Needlestick injury in the previous year was reported by 14.9% of physicians and 16.5% of nurses (0.21 and 0.38 injuries/person/year respectively). Logistic regression analysis identified recapping the needle after use (physicians and nurses) and bending the needle before disposal (physicians) as significant risk factors for injury.

Objective: This study aims to display the quality of the clinical notes at Abha Psychiatric Hospital out-patient clinics., Methods: In this chart review study, a total of 380 charts were randomly collected, and reviewed for the clinical items that should be included in the psychiatric clinical notes. Each chart note quality was indicated as good, fair or poor based on means and standard deviations., Results: The quality of clinical notes was good in 16.3%, fair in 71.1% and poor in 12.6% of the total records. The most frequent clearly present items were medications (92.1%), and personal data (91.1%); while the most frequent clearly absent items were psychotherapy (90.8%), and functioning (80.8%)., Conclusion: The quality of psychiatric clinical notes needs to be improved. Practical recommendations regarding this were stressed.