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Background: With the continuation of the COVID-19 pandemic, some COVID-19 patients have a risk of SARS-CoV-2 reinfection. Viral gene sequencing has found that some of these patients were reinfected by a different and others by the same strains. This has raised concerns about the effectiveness of immunity after infection and the reliability of vaccination. We conducted a survey study to assess the characteristics of patients with reinfection and possible causes. Methods and Results: An online survey study was conducted in October 2021 on Facebook social media. This study included 2413 respondents: 1315 subjects received the BNT162b2 mRNA-based Vaccine (Pfizer/BioNTech), 811 received the ChAdOx1 (AZD1222) adenoviral vector vaccine (Oxford–AstraZeneca), and 287 received the Sinopharm inactivated COVID-10 vaccine (BBIBP-CorV). The Pfizer/BioNTech vaccine appeared to be the most effective (84%) in preventing reinfection compared to the Oxford–AstraZeneca vaccine (79%) and the Sinopharm vaccine (70%) (P

The main work of philosopher Günter Figal (1949–2024) was to undertake the continuation of hermeneutical philosophy after the deaths of its three major proponents: Heidegger, Gadamer, and Ricoeur. Figal’s philosophical project combines both phenomenology and hermeneutics and presents the task of philosophy as being essentially hermeneutical. He also proposes that aesthetics is phenomenology, as nothing is more phenomenal than the work of art, which is out there to be interpreted. His contribution to aesthetics is generally based on his notions of the objectivity [Gegenständlichkeit] and spatiality of artworks. The objectivity of artworks makes obvious their spatiality, and space makes the objectness of the art object most apparent. Both objectivity and spatiality are also essential to the hermeneutics of art. Figal’s contribution to aesthetics, however, is underexplored. The present study thus aims to undertake a conceptual analysis of Figal’s contributions to aesthetics, especially his concepts of objectivity [Gegenständlichkeit] and spatiality of art. In so doing, the present study aims to present an account of Figal’s aesthetics, highlighting its place in the German aesthetic tradition.

This investigation presents a new approach for evaluating soil organic carbon (SOC) content in farming soils using a photocatalytic chemical oxygen demand (PeCOD) analyzer combined with geographic information system (GIS) technology for spatial analysis. Soil samples were collected at various sites throughout Canada and were analyzed using sieve analysis, followed by further SOC evaluation using three distinct techniques: loss on ignition (LOI), Walkley-Black, and PeCOD. The PeCOD system, which relies on the photochemical oxidation of organic carbon, showed an exciting correlation between its evaluations and SOC content, making it a prompt and reliable method to evaluate SOC. In this investigation, finer materials such as clayey soils (soil fractions of (75 µm)) and decreased SOC content with increased soil depth, generally below the 30 cm mark. It should be noted that this investigation revealed that other variables, such as land management practices, precipitation, and atmospheric temperature, have drastic effects on the formation and residence time of SOC. GIS georeferencing еnablеd mapping of the SOC distribution and identification of hotspot areas with high SOC content. The results of this study have implications for sustainable farming, climate change mitigation, and soil health operations by providing farmers with schemes that amplify carbon sequestration while simultaneously improving soil health.

Abstract In light of population growth and climate change, groundwater is one of the most important water resources globally. Groundwater is crucial for sustaining many vital sectors in Syria, including industrial and agricultural sectors. However, groundwater exploitation has significantly escalated to meet different water needs especially in the post-war period and the earthquake disaster. Therefore, the goal was this study delineation of the groundwater potential zones (GPZs) by integrating the analytic hierarchy process (AHP) method in a geographic information systems (GIS) within the AlAlqerdaha river basin in western Syria. In this study, ten criteria were used to map the spatial distribution of GPZs, including slope, geomorphology, drainage density, land use/land cover (LU/LC), lineament density, lithology, rainfall, soil, curvature and topographic wetness index (TWI). GPZs map was validated by using the location of 74 wells and the Receiver Operating Characteristic Curve (ROC). The findings suggest that the study area is divided into five GPZs: very low, 21.39 km2 (10.87%); low, 52.45 km2 (26.65%); moderate, 65.64 km2 (33.35%); high, 40.45 km2 (20.55%) and very high, 16.90 km2 (8.58%). High and very high zones mainly corresponded to the western regions of the study area. The conducted spatial modeling indicated that the AHP-based GPZs map showed a remarkably acceptable correlation with wells locations (AUC = 87.7%, n = 74), demonstrating the precision of the AHP–GIS as a rating method. The results of this study provide objective and constructive outputs that can help decision-makers to optimally manage groundwater resources in the post-war phase in Syria.

Background: Post cardiac arrest left ventricular ejection fraction (LVEF) is routinely assessed, but the implications of this are unknown. This study aimed to assess the association between post cardiac arrest LVEF and survival to hospital discharge. Methods: In this retrospective cohort study, all in-hospital and out of hospital cardiac arrests at our tertiary care center between January 2012 and September 2015 were included. Baseline demographics, clinical data, characteristics of the arrest, and interventions performed were collected. Earliest post cardiac arrest echocardiograms were reviewed with LVEF documented. The primary outcome was survival to discharge. Results: A total of 736 patients were included in the analysis (mean age 58 years, 44% female). 15% were out of hospital cardiac arrest (24% shockable rhythm). After adjusting for covariates, patients with LVEF

With the current struggles of the world nowadays with several epidemics, modeling the dynamics of disease outbreaks has become much more important than any time before. In this context, the present paper aims at studying a stochastic hepatitis B virus epidemic model with treatment cure rate. Our model consists of three epidemic compartments describing the interaction between the susceptible, the infected and the recovered individuals; an SIR model where the infected individuals transmit the infection to the susceptible ones with a transmission rate perturbed by white noise. Our paper begins by establishing that our hepatitis B stochastic model has unique global solution. It moves then to giving sufficient conditions for the stochastic extinction and persistence of the hepatitis B disease. Finally, our paper provides some numerical results to support the analytical study, showing numerically that the treatment cure rate facilitates the extinction of the hepatitis B disease among the population.

هدفت الدراسة بشكل رئيس إِلى بيان تأثير نظام معالجة المعاملات بأبعاده (الأفراد، الأجهزة، البرمجيات، البيانات) في تحسين الكفاءة التشغيلية إحدى أبعاد الأداء التشغيلي في سوق الهال في محافظة اللَّاذقيَّة. قام الباحث بالاعتماد على المنهج الوصفي التحليلي لتوصيف متغيِّرات الدِّراسة وتحليلها اعتماداً على البيانات الأَولية الَّتي تم جمعها من خلال القيام بدراسةٍ ميدانية في سوق الهال في اللاذقية، وذلك بالاعتماد على استبانة تم تصميمها من خلال اطِّلاع الباحث على الدِّراسات والأَدبيَّات السَّابقة، ومن أَجل اختبار الفرضيَّات قام الباحث بتفريغ البيانات الأَوليَّة في قاعدة بيانات تم تحليلَها باستخدام برنامج SPSSإِصدار /21/. توصلت الدراسة إلى وجود علاقة معنوية بين نظم معالجة المعاملات وتحسين الكفاءة التشغيلية إحدى أبعاد الأداء التشغيلي في سوق الهال في اللاذقية؛ حيث بلغت قيمة معامل الارتباط بيرسون 0.648 وهو يدلّ على ارتباط مقبول بين نظم معالجة المعاملات والكفاءة التشغيلية. أوصت الدراسة بضرورة الاهتمام بنظم معالجة المعاملات من خلال الاهتمام بمكوناته (الأفراد، الأجهزة، البرمجيات، البيانات) نظراً لدورها المهم في تحسين الكفاءة التشغيلية.

Nadia Muhaidat,1 Abdulrahman M Karam,2 Mohammed Saad Nabhan,1 Tala Dabbah,2 Bilal Odeh,2 Mira Eid,2 Nadia Jamal Almahallawi,3 Mohammad Ali Alshrouf2 1Department of Obstetrics & Gynaecology, School of Medicine, The University of Jordan, Amman, 11942, Jordan; 2The School of Medicine, The University of Jordan, Amman, 11942, Jordan; 3Department of Family Medicine, School of Medicine, The University of Jordan, Amman, 11942, JordanCorrespondence: Nadia Muhaidat, Department of Obstetrics & Gynaecology, School of Medicine, The University of Jordan, Amman, 11942, Jordan, Tel +962798385775, Email Nadiadat@hotmail.comBackground: The outcome of embryo transfer (ET) is multifactorial. A variety of patient-related, procedural-related, and operator-related factors are known to play a role. This study aims to evaluate the outcomes of ET and determine the factors that affect the outcome.Methods: The study involved a retrospective design involving 300 first in vitro fertilization and embryo transfer (IVF-ET) cycles between 2011 and 2021. The outcome included 155 unsuccessful cycles and 145 successful IVF-ET leading to pregnancy. The outcomes were examined for different variables, including age, weight, height, body mass index, cause of infertility, number of embryos fertilized during the cycle, day of ET, whether the embryo was frozen, presence of blood or mucus during the procedure, the use of a stylet, tenaculum, uterine sound/dilator, and catheter type. Logistic regression was used to analyze factors affecting the outcomes of ET.Results: The mean age was 27.84 ± 3.77 years. Patients who had blood during the procedure (32.9% vs 17.2%, p = 0.002), mucus (31% vs 20.7%, p = 0.049), or used the tenaculum (16.8% vs 6.9%, p = 0.012) were more likely to have unsuccessful IVF-ET. Logistic regression to adjust for related factors revealed that the presence of blood (AOR = 2.21, 95% CI 1.04 to 4.66, p = 0.038) during the ET had a higher likelihood of an unsuccessful outcome.Conclusion: This study showed that the presence of blood during the ET cycle influenced clinical pregnancy. This highlights the importance of performing the procedure under atraumatic conditions.Level of Evidence: Level III; retrospective comparative study.Plain Language Summary: Infertility is considered an important public health problem in terms of high expenses, treatment complications, and failure. Addressing the factors that impact embryo transfer outcomes may help in guiding counseling and management. Therefore, the aim of this study was to evaluate the results of IVF-ET and assess several patient-related and procedural-related factors that impact those results. It included retrospectively 300 cycles from 2011 to 2021. The presence of blood after embryo transfer was shown to be the major predictor of an unsuccessful cycle. Moreover, although the usage of additional instruments was not significantly associated with a higher risk of failed embryo transfer cycles, the operators should use these instruments with caution in order to avoid any trauma that might result in bleeding.Keywords: IVF, assisted reproductive technique, infertility, pregnancy, predictive factors

Despite the fact that zinc is recognized to be less hazardous than other heavy metals, e.g. cadmium, lead, mercury and arsenic, it may cause acute and chronic toxicities in case of exposure to high doses. Aims of the study : To investigate biochemical and histopathological toxic effects of zinc acetate on rats kidney. Material and Methods: Twenty five healthy male albino rats were divided into five equal groups : Normal saline solution was given to the control group, groups 2,3,4, and 5 received zinc acetate (4,8,12, and 24mg/kg) respectively, all the treatment were given intraperitoneally once every other day for 3 consecutive weeks, for serum biochemical evaluation and renal histopathological assessment. Results : There was a significant increment in serum urea concentration in group 5 in comparison with other groups, but there was no significant difference in creatinine concentration between all of the groups (P ≤ 0.01), histopathological examination of kidney sections of rats of different groups revealed different lesions which were more severe at 4th and 5th groups. In conclusion: Subacute zinc acetate toxicity produce a dose-dependent significant effects on serum urea concentration in all the treated groups without any significant effects on creatinine concentration, this effect was reflected on renal histo-architecture which was more severe at 4th and 5th groups.

This study examines integrating Enterprise Resource Planning (ERP) systems with performance management (PM) practices in the UAE healthcare sector, identifying key factors for successful adoption. It addresses a critical gap by analyzing the interplay between ERP systems and PM to enhance operational efficiency, patient care, and administrative processes. A literature review identified thirty-six critical factors, refined through expert interviews to highlight nine weak integration areas and two new factors. An online survey with 81 experts, who rated the 38 factors on a five-point Likert scale, provided data to calculate the Relative Importance Index (RII). The results reveal that employee involvement in performance metrics and effective organizational measures significantly impact system effectiveness and alignment. Mid-tier factors such as leadership and managerial support are essential for integration momentum, while foundational elements like infrastructure, scalability, security, and compliance are crucial for long-term success. The study recommends a holistic approach to these factors to maximize ERP benefits, offering insights for healthcare administrators and policymakers. Additionally, it highlights the need to address the challenges, opportunities, and ethical considerations associated with using digital health technology in healthcare. Future research should explore ERP integration challenges in public and private healthcare settings, tailoring systems to specific organizational needs.

The development and utilization of wind energy is of great significance to the sustainable development of China’s economy and the realization of the “dual carbon” goal. Under typhoon conditions, the randomness and volatility of wind speed significantly impact the energy efficiency and design of wind turbines. This paper analyzed the changes in wind speed and direction using the BFAST method and Hurst index based on data collected at 10 m, 30 m, 50 m, and 70 m heights from a wind power tower in Yancheng, Jiangsu Province. Furthermore, the paper examined the causes of wind speed and direction changes using wind speed near the typhoon center, distance from the typhoon center to the wind tower, topographic data, and mesoscale system wind direction data. The conclusions drawn are as follows: (i) Using the BEAST method, change points were identified at 10 m, 30 m, 50 m, and 70 m heights, with 5, 5, 6, and 6 change points respectively. The change points at 10 m, 30 m, and 50 m occurred around node 325, while the change time at 70 m was inconsistent with other heights. Hurst index results indicated stronger inconsistency at 70 m altitude compared to other altitudes. (ii) By analyzing the wind direction sequence at 10 m, 30 m, 50 m, and 70 m, it was found that the wind direction changes follow the sequence Southeast (SE)—East (E)—Southeast (SE)—Southwest (SW)—West (W)—Northwest (NW). Notably, the trend of wind direction at 70 m significantly differed from other altitudes during the wind speed strengthening and weakening stages. (iii) Wind speed at 10 m and 70 m altitudes responded differently to the distance from the typhoon center and the wind near the typhoon center. The correlation between wind speed and the distance to the typhoon center was stronger at 10 m than at 70 m. The surface type and the mesoscale system’s wind direction also influenced the wind speed and direction. This study provides methods and theoretical support for analyzing short-term wind speed changes during typhoons, offering reliable support for selecting wind power forecast indicators and designing wind turbines under extreme gale weather conditions.

Background Free tissue transfer is considered the gold standard option for the reconstruction of distal leg defects. Free tissue transfer using recipient vessels in the contralateral leg (cross-leg bridge) is a potential option to supply the flap if there are no suitable recipient vessels in the injured leg. Most studies have described this technique using end-to-end anastomosis which sacrifices the main vessel in the uninjured leg. This study evaluated the use of a cross-leg free latissimus dorsi muscle flap for the reconstruction of defects in single-vessel legs, using end-to-side anastomosis to recipient vessels in the contralateral leg without sacrificing any vessel in the uninjured leg.

Introduction: In the implementation of public policy, there are many factors and obstacles, the identification of which will lead to the efficient way of implementing the policies. Method: The present research was conducted with the aim of identifying and prioritizing the obstacles to the implementation of Iran's social welfare policies. The research is of a meta-composite type, in the qualitative part, semi-structured interviews were used so as to collect the data with open coding, and finally the obstacles to the implementation of social welfare policies were identified. In the quantitative part, using the review of related literature and research studies, six fundamental research studies in the field of policymaking were selected according to the citations and the items affecting the implementation of policies having been extracted from other studies in the form of commonalities. Then, the 10 experts cooperated, and the three-step Delphi method was used. Findings: Based on Friedman's test, ten priorities were identified, which are as follows: existence of opposing and supporting parties, technical difficulties, lack of use of new technologies, legitimacy of the country's political and governance system, lack of attention to the intellectual and political maturity of the target group, political factors, political conflicts, the welfare state of the target group, the lack of appropriate executive instructions, the lack of alignment of programs, and the lack of optimal allocation of the country's budget. Discussion: It was found that the influential factors are in the hands of the government and the role of the executives in the implementation of social welfare policies is weaker. Therefore, it is suggested that the government should pay more attention to the use of pro and opposition parties, the legitimacy of the ruling political system, and executive guidelines.

Reducing environmental pollution is a critical goal in global environmental economics and economic development. The European Union (EU) faces environmental challenges due to its development activities. Here we present a comprehensive approach to assess the impact of carbon dioxide (CO2) emissions, energy consumption (EC), population structure (POP), economy (GDP), and policies on the environment within the EU using the environmental Kuznets curve (EKC). Our research reveals that between 1990 and 2019, the EU-27 experienced an increase of +1.18 million tonnes of oil equivalent (Mtoe) per year in energy consumption (p

This article addresses the class imbalance problem in urban gain modelling (UGM) of Tabriz and Isfahan megacities in Iran by proposing novel cost-sensitive machine learning models, namely cost-sensitive support vector machine (CSVM), random forest (CRF) and artificial neural network (CANN). Random sampling, a frequently utilized method, fails to effectively tackle this issue by biasing models towards no change samples, which outnumber change samples. The results showed that CRF exhibited the highest accuracy (AUC = 0.560), followed by CANN (AUC = 0.557) and CSVM (AUC = 0.448) in Isfahan. In Tabriz, CRF (AUC = 0.809) and CANN (AUC = 0.818) excelled, outperforming balanced sampling models constructed with ANN, RF and SVM with the AUROC of ANN and RF boosted by 15% and 2% in validation. By emphasizing the significance of addressing class imbalance appropriately, this research highlights the improvement in modelling outcomes achievable through the cost-sensitive models especially in Tabriz case.

هدفت هذه الدراسة التعرف الى اتجاهات طلبة كلية التربية الرياضية نحو ممارسة بعض الالعاب الرياضية في جامعة اليرموك، واستخدم الباحثين المنهج الوصفي لملائمته لطبيعة وأهداف الدراسة، وبعد اطلاع الباحثين على الادب النظري والدراسات السابقة ذات الصلة بموضوع الدراسة الحالي قام الباحثين بالتعديل والتطوير على اداة دراسة كل من دراسة الزحراوي(2018) ودراسة الزعبي(2017) ودراسة ابو عنزة وشمروخ(2011)، وتكون مجتمع الدراسة الحالي من طلبة كلية التربية الرياضية في جامعة اليرموك المسجلين لمساق كرة القدم والعاب القوى والبالغ عددهم (1022) طالب وطالبة في حين بلغت عينة الدراسة (237) طالب وطالبة، ولمعالجة البينات احصائيا قام الباحثين باستخدام برنامج التحليل الاحصائي spss من خلال استخدام عدة عمليات حسابية (المتوسطات الحسابية، الانحرافات المعيارية، كرون باخ الفا، اختبار ت، اختبار تحليل التباين الاحادي)، واظهرت النتائج ان اتجاهات طلبة كلية التربية الرياضية نحو ممارسة بعض الالعاب الرياضية كانت بدرجة مرتفعة، كما وأظهرت النتائج انه توجد هناك فروق دالة احصائيا تبعا لمتغير الجنس في المحور النفسي ولصالح الاناث في حين أظهرت النتائج وجود فروق تبعا لمتغير اللعبة في محور (التفوق الرياضية، النفسي، الجمال والتعبير) ولصالح لعبة كرة القدم كما واظهرت النتائج فروق دالة احصائيا تبعا لمتغير السنة في محور ( الصحة واللياقة البدنية) لصالح السنة الرابعة، ومحور(التفوق الرياضي) ولصالح السنة الاولى، ومحور(الجمال والتعبير) ولصالح السنة الاولى والثانية، ويوصي الباحثين استثمار اتجاهات الطلبة الايجابية لنشر الوعي والاهتمام بالرياضات الاخرى وحثهم على ممارستها.

The use of fast food and soft drinks, coupled with a lack of physical activity and exercise, is causing a global increase in the number of overweight people. The study included 250 samples of 12-years-old children from 3 governmental primary schools and three private primary schools in Erbil City in Iraq. Data were compared between subjects with different variables using a statistical significance level of 0.05 and evaluated using Pearson Chi square or Fisher's exact tests. 24% of students were caries free, and the dental caries prevalence was 76%. Caries free were more common in boys 63% than girls 37%, with significant difference (P-value: 0.038), while caries more common in girls 53% than boys 47%, also 78% caries free were from private school students while 22% from governmental school with significance difference (P-value: 0.001). The caries presented in normal weighted students 77% while obese students only had about 4% with over weighted students having 19% with significance difference (P-value: 0.665). Fort canine eruption was more in boy students in governmental school 53%, while erupted canine was in girls 67% in private school. For normal weighted student’s canine were erupted 76%, while it was 20% in over weighted students and 4% in obese students, with significant difference (P-value: 0.016). Dental caries was more prevalent among students. The dental caries was higher among governmental school students than private school. Girl students had more caries than boys. The normal weighted students experienced higher caries prevalence than overweight/obese students.

In continuation of our reserach for synthesizing heterocyclic derivatives with a broad range of biological activities, the current research was performed to synthesize 3β-hydroxypregn-5-ene-20-one derivatives of coumarin, isoxazole, pyrazole, pyridine and pyrimidine and screen for antitumor activity. Synthesis of amino-thiopephen derivatives (1a-1b) was performed through reaction of 3β-hydroxypregn-5-ene-20-one with ethyl cyanoacetate or malononitrile and sulphur. 3β-Hydroxypregn-5-ene-20-one was reacted with ethyl cyanoacetate in the presence of hydrazine, urea or thiourea to obtain aminopyrazole (3), aminopyrimidine (4a-4b) derivatives, respectively. The amino-thiophene derivatives (1a-1b) further reacted with either phenylisothiocyanate or benzoylisothiocyanate to form fused thienopyrimidine derivatives (5a-5d). The products 1a and 1b were also treated with ethyl cyanoacetate to afford cyanoacetamidothiophene derivatives (6a-6b) which were converted to fused thienopyridone derivatives (7a-7b) through cyclization reaction. The compounds 6a and 6b were allowed to react with different carbonyl compounds including salicyaldehyde, cyclopentanone-sulphur mixture, acetylacetone and malonaldehyde to prepare coumarin (8a-8b), cyclopentylthiophene (9a-9b) and 2-pyridinone (10a-10d) derivatives respectively. Furthermore, the reactions of hydroxylamine hydrochloride and benzoylacetonitrile with the compounds 6a-6b separately afforded new aminoisoxazole (12a-12b) and phenylpyridone (14a-14b) derivatives, respectively. The structures of new products were established through IR, 1H NMR, 13C NMR spectroscopic and mass spectrometric analysis. The synthesized compounds (1a-1b to 14a-14b) displayed in-vitro antitumor activity against human cell-lines, including MCF-7 (breast adenocarcinoma), SF-268 (CNS cancer) and NCI-H460 (non-small lung cancer cell). The results suggested that all the screened products exhibited cell growth inhibitory activity in a dose-dependents manner. However, the compound 12a showed highest level of inhibition against all three cell-lines.

Abstract Due to rapid population growth and the limitation of land resources, the sustainability of agricultural ecosystems has attracted more attention all over the world. Human activities will alter the components of the atmosphere and lead to climate change, which consequently affects crop production badly. In this context, wheat is considered an important crop and ranks as one of the top strategic crops globally. The main objective of this research is to develop a new approach (a weighted climatic suitability index) for evaluating the climate suitability for wheat production. The specific objectives are to project the impact of future climate change on wheat suitability using three models based on WCSI and CMIP6-based projections and to identify the most vulnerable area to climate change and productivity reduction. The climatic criteria for wheat production were selected and classified into eight indicators based on the Sys' scheme and the FAO framework, and then the weighted overlay approach was used in conjunction with the analytic hierarchy process. To confirm the reliability of the integrated WCSI, we determined the nonlinear curve fitting of integrated WCSI-induced wheat yields by the exponential growth equation. Finally, the CMIP6-GCMs projected from three shared socioeconomic pathways were used for WCSI mapping and predicting wheat yields in the short and long term (Southern Syria was selected as a case study). The results show that the nonlinear correlation between wheat yields and the integrated WCSI was 0.78 (R2 = 0.61) confirming the integrated WCSI's reliability in reflecting yield variation caused by climate suitability. The results indicated that WCSI for wheat will be lower over the study area during 2080–2100 compared to the current climate. During 2080–2100, the wheat yield is projected to decrease by 0.2–0.8 t. ha−1 in the western parts of the study area. The findings of this study could be used to plan and develop adaptation strategies for sustainable wheat production in the face of projected climate change. The results of the study will also help in the strategic planning of wheat production in Syria under the projected climate. The results of this research are limited to small areas as a case study, although they are not relevant to similar regions worldwide. However, the study employs novel analytical methods that can be used broadly.

هشاشة العظام هو مرض جهازي يتأثر به ملايين الناس على مستوى العالم. يؤثر المرض في الغالب على الإناث بعد انقطاع الطمث ويرتبط ارتباطًا وثيقًا بالشيخوخة. ناقشت العديد من الدراسات احتمالية حدوث فشل مبكر للغرسات السنية عند هؤلاء المرضى. هدفت هذه الدراسة لتحري تأثير كثافة العظم العامة على ثبات الغرسات السنية. شملت عينة البحث مجموعتين: مجموعة الدراسة وتكونت من 9 مرضى هشاشة عظام مشخص وفق مقياس ال T-Score حيث قيمة T-Score عندهم أصغر أو تساوي -2,5 بأعمار 45-58 سنة, وتكونت المجموعة الشاهدة من 9 أفرد سليمين بأعمار 48-57 سنة, تم إنزال 18 غرسة سنية عند كلا المجموعتين وإجراء قياس ثبات الغرسات باستخدام تقنية تحليل تردد الرنين (RFA) بعد الغرس مباشرة وبعد تركيب الدعامات (بعد ثلاثة أشهر من الغرس). أظهرت النتائج وجود فروق ذات دلالة إحصائية في قيم ثبات الغرسات السنية بين مجموعة مرضى هشاشة العظام والمجموعة الشاهدة حيث أن القيم المنخفضة للثبات عند مجموعة مرضى هشاشة العظام تـؤشر بأن ثبات الغرسات السنية يتأثر بكثافة العظم الهيكلية عند المريض.

In this paper, we will study a fractional-order SIR epidemic model with treatment cure rate. The paper starts with the investigation of some needed preliminaries related to fractional calculus. Next, we investigate the well-posedness of the fractional-order model in terms of positivity and boundedness of solution. Then, we give the basic reproduction number via the next generation matrix method. The model has two steady states, namely, the disease-free equilibrium and the endemic equilibrium. It was proven that when the basic reproduction number is less than unity, then, the disease-free-equilibrium is globally asymptotically stable. While, when the basic reproduction number is greater than unity, then the endemic-equilibrium is globally asymptotically stable. Numerical simulations are carried out in order to confirm the theoretical results. To this end, we will apply a numerical approach based on the fundamental theorem of fractional calculus and a three-step Lagrange polynomial interpolation technique. It is shown that any increase of the fractional order derivative leads to a decrease in the convergence speed towards the studied equilibrium.

Pulmonary aspiration is a potentially lethal perioperative complication related to gastric size and contents. Several perioperative factors are believed to increase gastric size, while others are less studied. This prospective observational study aimed to investigate the effect of preoperative anxiety and hormone-induced ovarian stimulation on gastric size examined by gastric ultrasound. We recruited 49 female patients undergoing hormone-induced ovarian stimulation and oocyte retrieval for in vitro fertilization at Rabin Medical Centre, Petah Tikva, Israel. Preoperatively, women ranked their anxiety level using a verbal numeric anxiety score (VNS). In addition, we recorded the extent of ovarian stimulation and measured the antral cross-sectional area (CSA) using gastric ultrasound. There was no substantial correlation between preoperative VNS anxiety and antral CSA (p = .697). Moreover, the number of follicles, blood estradiol, and progesterone levels did not correlate with antral CSA (p = .590, p = .104, and p = .511, respectively). In conclusion, neither preoperative anxiety nor extensive ovarian stimulation affects gastric size in fasting healthy patients. However, further studies are warranted in this area to define these findings better. Trial registration: Clinicaltrials.gov, identifier: NCT04833530

هدفت هذه الدراسة التعرف الى درجة ممارسة مشرفي التربية الرياضية للسلوك الاشرافي التشاركي وعلاقته بتحسين اداء المعلمين من وجهة نظر معلمي التربية الرياضية ، حيث قام الباحث باستخدام المنهج الوصفي لملائمته لطبيعة وأهداف الدراسة، حيث تكونت عينة الدراسة من(241) معلمي التربية الرياضية في محافظة اربد، بغرض اعداد اداة الدراسة قام الباحث وبعد مراجعته للأدب النظري والدراسات السابقة بالتعديل والتطوير على دراسة الهاجري وحراحشة،(2016) ودراسة الدجاني،(2013) ودراسة البلوي،(2008) ودراسة الافندي،(2011) ودراسة حمد،(2014) بما يتلائم مع طبيعة واهداف الدراسة الحالية حيث تكونت اداة الدراسة بصورتها النهائية من (7) محاور وهي(النمو المهني، التخطيط لتحسين الاداء، التقويم، تحليل المنهاج، السلوكات، المهارات، الاداء التعليمي) و (35) فقرة واجراء معاملات الصدق والثبات لها، وتوصلت نتائج الدراسة الى ان درجة ممارسة المشرفين للسلوك الاشرافي التشاركي كانت بدرجة متوسطة بينما اظهرت النتائج ان مستوى تحسين اداء المعلمين كان مرتفعا، اما فيما يتعلق بالعلاقة بين درجة الممارسة للسلوك الاشرافي التشاركي وتحسين اداء المعلمين فكانت ايجابية، ويوصي الباحث بعقد الدورات التدريبية وورش عمل وبرامج تأهيل خاصة بمشرفي التربية الرياضية تدور موضوعاتها حول مفهوم الاشراف التشاركي وكيفية تفعيله وتوظيفه في ميدان التربية الرياضية بغية الارتقاء بممارسة المشرفين للسلوك الاشرافي التشاركي

Background: This study reviews the literature on gastric metastases (GM) in terms of diagnosis, treatment, and outcomes. The goal of this study was to provide clinicians with a reliable and beneficial source to understand gastric metastases arising from various primary tumors and to present the growing literature in an easily accessible form. Methods: Articles published in English language from implementation of MEDLINE and Cochrane databases until May 2022 were considered for the systematic review. Articles other than English language, letters to the editor, posters, and clinical images were excluded. Hematogenous and lymphogenic metastases were included whereas direct tumoral invasion and seeding were excluded. Articles and abstracts were analyzed and last selection was done after cross-referencing and by use of defined eligibility criteria. Results: In total 1,521 publications were identified and 170 articles were finally included totaling 186 patients with GM. The median age of patients was 62 years. Gynecologic cancer was the most common cancer type causing GM (67 patients), followed by lung cancer (33 patients), renal cancer (20 patients), and melanoma (19 patients). One of the main treatment methods performed for metastasis was resection surgery (n=62), sometimes combined with chemotherapy (ChT) or immunotherapy. ChT was the other most used treatment method (n=78). Also, immunotherapy was amongst the most preferred treatment options after surgery and ChT (n=10). Conclusions: As 172 case reports were screened in the systematic review from different journals, heterogeneity was inevitable. Some articles missed important information such as complete follow-up or clinical information. Moreover, since all of the included articles were case reports quality assessment could not be performed. Among 172 case reports reviewed, resection surgery was performed the most and was sometimes combined with ChT and immunotherapy. Further research about what type of treatment has the best outcomes for patients with gastric metastases is needed.

Lutembacher’s syndrome is a rare disease defined as the combination of atrial septal defect and mitral stenosis, which relieves the progression of symptoms resulting from mitral stenosis. We present a case of a previously asymptomatic 70-year-old man having Lutembacher’s syndrome with sinus venosus type of interatrial defect associated with partial anomalous pulmonary venous drainage. Our patient’s only complaint was of mild exertional dyspnea, which started six months prior to referral. Clinical suspicion of the combination of defects arose during transthoracic echocardiography. The patient underwent transesophageal echocardiography and multi-slice computed tomography for defect confirmation. The combination of Lutembacher’s syndrome with this complex deformity of pulmonary venous drainage has rarely been described. Such complex congenital defects with multifaceted physiological repercussions can go largely undiagnosed for the patients affected for most of their lifetimes.

Of the factors predisposing to gastric cancer is Helicobacter pylori infection affecting more than 50% of the general population. Genetic variation is an established player in certain diseases susceptibility. TAS2R38 gene polymorphisms have been found to influence bitter taste ability to chemicals with malicious characteristics and consequently affect metabolism and disease development. This study aimed to investigate the correlation between TAS2R38 gene polymorphisms and H. pylori seropositivity. The study involved 105 apparently healthy individuals. They were grouped into four groups according to their age and gender; young male, young female, middle-aged male and middle-aged female. All groups were tested for H. pylori serum antibody using screening rapid test. Participants were also tested for tasting PTC for TAS2R38 gene detection by using Bartovation PTC test paper and grouped accordingly into: homozygote (highly bitter taste), heterozygote (slight to moderate bitter taste), or negative gene carrier (no taste at all). ABO and Rhesus- blood grouping was determined by standard serological analysis. Of the 105 patients, 22.85% were tested homozygotes for TAS2R38 gene, 40.95% were heterozygotes and 36.19% were nontasters, no significant difference (p > 0.9). H. pylori seropositivity was encountered in 16.19% of the whole participants, 11.5% of the male participants and 20.75% of the female participants (p > 0.9). No significant difference in seropositivity was monitored among the four age groups (p > 0.3) and the ABO/Rh blood groups (p > 0.9). A lack of significant correlation (r = 0.046) between H. pylori antibody test positivity and tasting PTC (TAS2R38 gene) was reported. Similarly, no association was found between PTC tasting and participants’ ABO blood grouping, age or gender (r = 0.086, 0.083 and 0.029, respectively). Yet, weak negative (reverse) relationship (r = -0.29, p-value = 0.002) was gained between PTC and Rh grouping. No correlation was revealed between TAS2R38 polymorphism and the studied variable; age, gender and blood group indicating the absence of an apparent role of the gene in vulnerability to H. pylori infection. Further studies involving a larger sample size is required to confirm the obtained result.

Aims: This study aims to assess the apical microleakage of root canals after irrigation by NaOCl, EDTA, and MTAD. Materials and methods: 36 lower premolars were used in this study. Preparation of the samples was done by files of ProTaper to size F3. Samples were distributed into three experimenting groups; each one contained ten samples as follows: Group 1- samples were finally washed for five minutes with five ml of 5.25% NaOCl. Group 2- samples were finally washed for five minutes with five ml of 17% EDTA. Group 3- samples were finally washed for five minutes with five ml of MTAD. Six samples were utilized as positive and negative control groups, each one contained three samples. The samples were obturated by single cone technique except for the samples of the positive control group, which were not obturated. All the samples were incubated at 37 OC for 7 days in 100% humidity. The dye penetration method was used to assess apical leakage. Finally, data was collected and statistically analyzed. Results: MTAD group revealed the least leakage supervened by the EDTA group and the NaOCl group revealed the highest leakage. The MTAD group did not differ significantly from the EDTA group, while the NaOCl group differed significantly from MTAD and EDTA groups. A group of positive control revealed a dye leak through the whole length of the root, while a group of negative control did not reveal any dye leak. Conclusions: Under the conditions of this study, the final irrigation with MTAD or EDTA is better than the final irrigation with 5.25 % NaOCl in terms of less apical microleakage.

Background and objectives: To assess the prevalence of smoking among university in Erbil city in relation to gender, also the difference in brushing between the two groups (smoker and non-smoker students). Methods: a cross sectional survey were planned to consist of 600 students from 3 different universities (Hawler Medical University, Tishk International University and Salahaddin University) with an age range 17-25 years old. Results: The prevalence of smoking was 33.1% and those smoking students smoked Hookah in about 47.2%, while 39.2% smoked cigarettes and 13.6% of them smoked Vipe. Prevalence of brushing among smokers and non-smokers were approximately the same (98.5%- 98.3%) respectively. Conclusions: the prevalence of smokers was nearly one third of students. Male smokers were more than female. Hookah used mainly by the students than the other types. Prevalence of brushing teeth was approximately the same among both groups. Nearly three-fourth of the students among smokers and non-smokers did not have bad breath.

Aim of study: This study aims at comparing the anti-microbial efficacy of irrigation with Biopure MTAD against irrigation with 5.25 % NaOCl, CHX, NaOCl/MTAD, and CHX/MTAD in E. faecalis-root canals. Materials and Methods: Thirty (30) human single-rooted lower premolar teeth were extracted and de-coronated at the cemento-enamel junction (CEJ). Then, the roots were instrumented by k-file until the size is 40. Furthermore, these teeth were exposed to bacterial contamination in brain heart infusion (BHI) for 48 h. The contaminated samples were divided into 5 groups (MTAD, NaOCl, CHX, NaOCl / MTAD, and CHX / MTAD). The dentin chips in the canals of the samples were removed using a sterile low-speed handpiece round bur and transferred to BHI. The media was cultured, and the bacterial colonies were counted and recorded as CFU/mL. Results: NaOCl / MTAD showed a significantly higher antimicrobial activity compared to 5.25 % NaOCl, MTAD, CHX, and CHX / MTAD. Conclusion: The antimicrobial activity of a combined NaOCl and Biopure MTAD was strongest against E. faecalis compared to the other irrigant solutions.

Background: Rubella or German measles is a viral disease transmitted via aerosol droplets affecting mainly children, Mostly, rubella is a simple and self-limiting disease with no chronic consequences, except in infected pregnant women which may result in devastating outcomes depending on the trimester of pregnancy. Materials and methods: the study enrolled 1004 women suffering from spontaneous miscarriage tested for rubella IgM antibodies using ELISA. The sampling was conducted in two different seasons, summer and winter. Results: Test reading showed that 15.23% of all tested women were positive for rubella IgM antibodies i.e. 153 out of 1004 women. Seasonal change showed no significant variation in the percentage of the infection, where 15.8% of all participants were positive in summer versus 14.35% seropositive in the winter season (p˃ 0.05). Conclusion: Rubella infection is affecting a relatively high number of women suffering from a spontaneous miscarriage in Mosul city, and there was no seasonal variation in the rate of infection.

Abstract Landslide vulnerability prediction maps are among the most important tools for managing natural hazards associated with slope stability in river basins that affect ecosystems, properties, infrastructure and society. Landslide events are among the most hazardous patterns of slope instability in the coastal mountains of Syria. Thus, the main goals of this research are to evaluate the performance of three different statistical outputs: Frequency Ratio (FR), Statistical Index (SI) and Index of Entropy (IoE) and therefore map landslide susceptibility in the coastal region of Syria. To this end, we identified a total of 446 locations of landslide events, based on the preliminary inventory map derived from fieldwork and high-resolution imagery surveys. In this regard, 13 geo-environmental factors that have a high influence on landslides were selected for landslide susceptibility mapping. The results indicated that the FR method outperformed the SI and IoE models with a high AUC of 0.824 and better adaptability, followed by the SI with 0.791. According to the SCAI values, although the FR model achieved the best reliability, the other two models also showed good capability in determining landslide susceptibility. The result of FR-based modelling showed that 18.51 and 19.98% of the study area fall under the high and very high landslide susceptible categories, respectively. In the map generated by the SI method, about 36% of the study area is classified as having high or very high landslide sensitivity. In the IoE method, whereas 14.18 and 25.62% of the study area were classified as “very high susceptible” and “high susceptible,” respectively. The relative importance analysis demonstrated that the slope aspects, lithology and proximity to roads effectively motivated the acceleration of slope material instability and were the most influential in both the FR and SI models. On the other hand, the IoE model indicated that the proximity to faults and roads, along with the lithology factor, were important influences in the formation of landslide events. As a result, the statistical bivariate models-based landslide mapping provided a reliable and systematic approach to guide the long-term strategic planning procedures in the study area.

The study aimed to: - Detecting the significance of the statistical differences in lactate level in blood and performance in the 400-meter sprint between the pre and post tests after using the method of (speed escalation and distance stabilization) According to a Computerized Running Training programs for interval training . - Detecting the significance of the statistical differences in lactate level in blood and performance in the 400-meter sprint between the pre and post tests after using the method of (distance escalation and speed stabilization) According to a Computerized Running Training programs for interval training . - Recognize the significance of the statistical differences in lactate level in blood and performance in a 400-meter sprint between the two methods (speed escalation and distance stabilization) and (distance escalation and speed stabilization) According to a Computerized Running Training programs for interval training in the post-test . The researchers used the experimental approach for its convenience to the study nature, and the research experiment was carried out on a sample of short distance runners (junior category) at the Specialized School of Athletics in Nineveh Governorate for the sports season (2019-2020) and they were (12) runners, and this sample was divided into two experimental groups through using the randomization method with (6) runners for each group, The first depends on interval training in the method of (speed escalation and distance stabilization) and the second depends on interval training in the method of (distance escalation and speed stabilization) by relying on a programmed system for the sprint in interval training . The researchers reached the following conclusions: - Interval training in the method of (speed escalation and distance stabilization) and Interval training in the method of (distance escalation and speed stabilization) made positive progress in lactate level in blood and performance in the 400-meter sprint . - Despite the positive effect of interval training in the two methods (speed escalation and distance stabilization) and (distance escalation and speed stabilization) there was a relative superiority of interval training in the method of (speed escalation and distance stabilization) in the special endurance consisting of (speed endurance and strength endurance) and performance in Sprint 400 meters . The researchers recommended a set of recommendations, the most important of which are : - The use of interval training in the method of (speed escalation and distance stabilization) and not being satisfied with the use of interval training in the method (distance escalating and speed stabilization) when training a 400-meter sprint because of its importance in developing the performance in the 400-meter sprint, as well as its creation For functional adaptation in relation to blood lactate level after improvement in performance. - measuring the level of lactate in the blood in the training of runners from time to time, as a functional indicator that helps in detecting the level of training status and identifying the adaptation and recovery of runners, in order to evaluate the training process. - The possibility of relying on the Computerized Running Training programs for interval training in designing interval training methods and curricula for all short-distance runners, including 400-meter sprinting for all levels and age groups .

Global warming has resulted in increases in the intensity, frequency, and duration of drought in most land areas at the regional and global scales. Nevertheless, comprehensive understanding of how water use efficiency (WUE), gross primary production (GPP), and actual evapotranspiration (AET)-induced water losses respond to exceptional drought and whether the responses are influenced by drought severity (DS) is still limited. Herein, we assess the fluctuation in the standardized precipitation evapotranspiration index (SPEI) over the Middle East from 1982 to 2017 to detect the drought events and further examine standardized anomalies of GPP, WUE, and AET responses to multiyear exceptional droughts, which are separated into five groups designed to characterize the severity of extreme drought. The intensification of the five drought events (based on its DS) increased the WUE, decreased the GPP and AET from D5 to D1, where both the positive and negative variance among the DS group was statistically significant. The results showed that the positive values of standardized WUE with the corresponding values of the negative GPP and AET were dominant (44.3% of the study area), where the AET values decreased more than the GPP, and the WUE fluctuation in this region is mostly controlled by physical processes, i.e., evaporation. Drought’s consequences on ecosystem carbon-water interactions ranged significantly among eco-system types due to the unique hydrothermal conditions of each biome. Our study indicates that forthcoming droughts, along with heightened climate variability, pose increased risks to semi-arid and sub-humid ecosystems, potentially leading to biome restructuring, starting with low-productivity, water-sensitive grasslands. Our assessment of WUE enhances understanding of water-carbon cycle linkages and aids in projecting ecosystem responses to climate change.

The control of deformable linear objects (DLOs) such as cables presents a significant challenge for robotic systems due to their unpredictable behavior during manipulation. This paper introduces a novel approach for cable shape control using dual robotic arms on a two–dimensional plane. A discrete point model is utilized for the cable, and a path generation algorithm is developed to define intermediate cable shapes, facilitating the transformation of the cable into the desired profile through a formulated optimization problem. The problem aims to minimize the discrepancy between the cable configuration and the targeted shape to ensure an accurate and stable deformation process. Moreover, a cable dynamic model is developed in which the manipulation approach is validated using this model. Additionally, the approach is tested in a simulation environment in which a framework of two manipulators grasps a cable. The results demonstrate the feasibility and accuracy of the proposed method, offering a promising direction for robotic manipulation of cables.

The principal aim of this work it to study and analyze a spatio-temporal fractional Susceptible–Infected–Recovered SIRinfection model. We will assume vaccination of susceptible population as well as the temporary immunity of the recovered. The dynamics of the infection is described by three partial differential equations with a fractional derivative order and diffusion for each equation. First, we will prove the existence, uniqueness and boundedness of the solutions. The infection-free equilibrium point and the endemic equilibrium point have been presented as function of the basic reproduction number R0. Next, we will concluded that the local stability of the each equilibrium depends mainly on the basic reproduction number. Finally, the theoretical results are verified by numerical simulations.

المقدمة :الاختلاف في البنى الداعمة للزرعات عن الأسنان الطبيعية تجعلها أكثر تأثرا بالعوامل الالتهابية عند تجمع اللويحة حولها مقارنة بالأسنان الطبيعية ,لذلك يجب التأكيد على العناية الدائمة بالصحة الفموية لإطالة عمر الزرعة وتجنب المشاكل الوظيفية والتجميلية المرافقة للتعويض . المواد والطرق: تم تقييم الصحة الفموية للمرضى وفق مشعر الصحة الفموية المبسط ومشعر تقييم حالة المخاطية حول الزرعات ,تم اختيار عينة من 100 مريض مراجعين لكلية طب الأسنان جامعة تشرين في اللاذقية بشرط مرور عام على الأقل على إجراء عملية الزرع السني ,تم إجراء البحث على مدى 8 أشهر. النتائج: بلغ متوسط قيمة OHI-S لدى العينة 2.11 وهي تشير الى صحة فموية متوسطة, متوسط قيمة مشعر حالة النسج المخاطية الحفافية حول الغرسات السنية بلغ 1.21 . لدراسة علاقة الارتباط بين مشعر الصحة الفموية المبسط و مشعر تقييم حالة النسج المخاطية الحفافية حول الزرعات تم استخدام اختبار مربع كاي , وجدنا أن قيمة مستوى الدلالة للاختبار هي 0.000 وهي أصغر من القيمة 0.05 وبالتالي توجد علاقة ارتباط بين مستوى الصحة الفموية وحالة النسج المخاطية الحفافية حول الغرسات. الخلاصة: بعد التحقق من الإندماج العظمي للزرعات واستكمال عملية التعويض تصبح عناية المريض المنزلية بالإضافة للعناية الدورية عند الطبيب عاملين حاسمين ومؤثرين بشدة لإطالة عمر الزرعة ونجاح عملية التعويض .

Introduction Millions of patients receive general anaesthesia for surgery annually. Crucial gaps in evidence exist regarding which technique, propofol total intravenous anaesthesia (TIVA) or inhaled volatile anaesthesia (INVA), yields superior patient experience, safety and outcomes. The aim of this pilot study is to assess the feasibility of conducting a large comparative effectiveness trial assessing patient experiences and outcomes after receiving propofol TIVA or INVA.Methods and analysis This protocol was cocreated by a diverse team, including patient partners with personal experience of TIVA or INVA. The design is a 300-patient, two-centre, randomised, feasibility pilot trial. Patients 18 years of age or older, undergoing elective non-cardiac surgery requiring general anaesthesia with a tracheal tube or laryngeal mask airway will be eligible. Patients will be randomised 1:1 to propofol TIVA or INVA, stratified by centre and procedural complexity. The feasibility endpoints include: (1) proportion of patients approached who agree to participate; (2) proportion of patients who receive their assigned randomised treatment; (3) completeness of outcomes data collection and (4) feasibility of data management procedures. Proportions and 95% CIs will be calculated to assess whether prespecified thresholds are met for the feasibility parameters. If the lower bounds of the 95% CI are above the thresholds of 10% for the proportion of patients agreeing to participate among those approached and 80% for compliance with treatment allocation for each randomised treatment group, this will suggest that our planned pragmatic 12 500-patient comparative effectiveness trial can likely be conducted successfully. Other feasibility outcomes and adverse events will be described.Ethics and dissemination This study is approved by the ethics board at Washington University (IRB# 202205053), serving as the single Institutional Review Board for both participating sites. Recruitment began in September 2022. Dissemination plans include presentations at scientific conferences, scientific publications, internet-based educational materials and mass media.Trial registration number NCT05346588.

Background The prognostic factors for patients with full-thickness rotator cuff tears (RCTs) include tear size, muscle atrophy and fatty infiltration. However, the influence of early coexisting degenerative changes on RCT outcomes is unappreciated. The purpose of this study was to calculate the impact that pre-existing partial glenohumeral cartilaginous changes have on patients undergoing arthroscopic RCT repair. Methods A study of 54 patients undergoing arthroscopic RCT repair was undertaken. The presence of co-existing patches of glenohumeral degenerative cartilaginous changes and RCT size was recorded at surgery. Pre- and postoperative outcomes were assessed using traditional (Oxford Shoulder Score [OSS], 5-level EuroQol-5D [EQ-5D-5L] questionnaire and EuroQol visual analog scale [EQ-VAS]) and patient-centric re-formatted prisms. Outcomes were assessed as an entire dataset, and sub-group analysis was performed according to the grade of co-existing arthritis and tear size. Results Significant improvements (p

Abstract Recurrence and biochemical remission rates vary widely among different histological subtypes of pituitary adenoma. In this prospective study, we evaluated 107 consecutive primary pituitary adenomas operated on by a single neurosurgeon including 28 corticotroph, 27 gonadotroph, 24 somatotroph, 17 lactotroph, 5 null-cell and 6 plurihormonal. In each case, we performed direct endoscopic intraoperative inspection of the medial wall of the cavernous sinus, which was surgically removed when invasion was visualized. This was performed irrespective of tumor functional status. Medial wall resection was performed in 47% of pituitary adenomas, and 39/50 walls confirmed pathologic evidence of invasion, rendering a positive predictive value of intraoperative evaluation of medial wall invasion of 78%. We show for the first-time dramatic disparities in the frequency of medial wall invasion among pathological subtypes. Somatotroph tumors invaded the medial wall much more often than other adenoma subtypes, 81% intraoperatively and 69% histologically, followed by plurihormonal tumors (40%) and gonadotroph cell tumors (33%), both with intraoperative positive predictive value of 100%. The least likely to invade were corticotroph adenomas, at a rate of 32% intraoperatively and 21% histologically, and null-cell adenomas at 0%. Removal of the cavernous sinus medial wall was not associated with permanent cranial nerve morbidity nor carotid artery injury, although 4 patients (all Knosp 3-4) experienced transient diplopia. Medial wall resection in acromegaly resulted in the highest potential for biochemical remission ever reported, with an average postoperative day 1 GH levels of 0.96 ug/L and surgical remission rates of 92% based on normalization of IGF-1 levels after surgery (mean = 15.56 months; range 3–30 months). Our findings suggest that tumor invasion of the medial wall of the cavernous sinus may explain the relatively low biochemical remission rates currently seen for acromegaly and illustrate the relevance of advanced intradural surgical approaches for successful and durable outcomes in endonasal pituitary surgery for functional adenomas.

Abstract This study examined the physical properties of agricultural drought (i.e., intensity, duration, and severity) in Hungary from 1961 to 2010 based on the Standardized Precipitation Index (SPI) and the Standardized Precipitation Evapotranspiration Index (SPEI). The study analyzed the interaction between drought and crop yield for maize and wheat using standardized yield residual series (SYRS), and the crop-drought resilient factor (CDRF). The results of both SPI and SPEI (-3, -6) showed that the western part of Hungary has significantly more prone to agricultural drought than the eastern part of the country. Drought frequency analysis reveals that the eastern, northern, and central parts of Hungary were the most affected regions. Drought analysis also showed that drought was particularly severe in Hungary during 1970–1973, 1990–1995, 2000–2003, and 2007. The yield of maize was more adversely affected than wheat especially in the western and southern regions of Hungary (1961–2010). In general, maize and wheat yields were severely non-resilient (CDRF

Abstract Background Dexmedetomidine (DEX), is a highly selective alpha2 adrenoceptor (α2-AR) agonist, successfully used in various procedures including flexible bronchoscopy. Randomized controlled trials (RCTs) evaluating DEX sedation during bronchoscopy report equivocal results regarding respiratory and hemodynamic outcomes. Methods We conducted an RCT to evaluate the efficacy and safety of dexmedetomidine compared to propofol for sedation during bronchoscopy. The primary outcome was the number of desaturation events, secondary outcomes were transcutaneous Pco2 level, hemodynamic adverse events and physician and patient satisfaction. Results Overall, 63 patients were included, 30 and 33 in the DEX and propofol groups, respectively. The number of desaturation events was similar between groups, median (IQR) 1 (0–1) and 1 (0–2) in the DEX and control groups, respectively (P = 0.29). Median desaturation time was 1 (0–2) and 1 (0–3) minutes in the DEX and control groups, respectively (P = 0.48). Adverse events included hypotension, 33% vs 21.1% in intervention and control groups, respectively (P = 0.04), bradycardia, cough, and delayed recovery from sedation. Total adverse events were 22 and 7 in DEX and propofol groups, respectively (P = 0.009). Conclusion Dexmedetomidine sedation during bronchoscopy did not show differences in oxygen saturation and transcutaneous CO2 level in comparison to propofol. Moreover, DEX sedation required a significantly higher number of rescue boluses, due to inadequate sedation and was associated with a higher rate of adverse events. Trial registration NCT04211298, registration date: 26.12.2019.

Nadia Muhaidat,1 Mohammad A Alshrouf,2 Muayad I Azzam,2 Abdulrahman M Karam,2 Majed W Al-Nazer,2 Abdallah Al-Ani3 1Department of Obstetrics & Gynaecology, Jordan University Hospital, Amman, Jordan; 2The School of Medicine, The University of Jordan, Amman, Jordan; 3King Hussein Cancer Center, Amman, JordanCorrespondence: Nadia Muhaidat, Department of Obstetrics & Gynaecology, Jordan University Hospital, Queen Rania Street, Amman, 11942, Jordan, Tel +962 798385775, Email Nadiadat@hotmail.comBackground: Since the emergence of COVID-19 vaccinations, many women around the world are reporting abnormalities in their menstrual periods post-vaccination. The aim of this study is to investigate the prevalence and impact of menstrual abnormalities after the COVID-19 vaccine among females residing within the Middle East and North Africa (MENA).Methods: The study utilized a cross-sectional online self-administered survey from July 2021 to August 2021 targeting females living in the MENA region above the age of menarche who had received vaccine and were not pregnant or lactating, and do not have a history of primary ovarian insufficiency, hypothalamic menopause, or have undergone a hysterectomy. The survey was distributed regionally via social media.Results: A total of 2269 females were included in our study, with a mean age of 34.3 ± 8.5 years. About 66.3% of participants reported menstrual symptoms post-vaccination, of which 46.7% experienced them after their first dose. However, in 93.6% of participants, the symptoms resolved within 2 months. Vaccine type did not significantly influence the incidence of abnormalities (p > 0.05). Participants who had confirmed previous COVID-19 infection had a very similar percentage of menstrual abnormalities compared to people who did not have COVID-19 infection or symptoms suspected of COVID-19 infection and did not test (67.5%, 66.8%, respectively); nevertheless, those who had experienced the COVID-19 vaccine general side effects had significantly more abnormalities (p < 0.001). Compared to their pandemic status, females reported significantly more abnormalities post-vaccination.Conclusion: The study showed a possible link between the COVID-19 vaccine and menstrual abnormalities that have impacted their quality of life.Keywords: COVID-19, MENA, menstrual abnormalities, menstrual cycle, vaccine

لتشخيص الإصابة بهشاشة العظام عند المتقدمين بالعمر باستخدام التصوير المقطعي المحوسب ذو الحزمة المخروطية CBCT. شملت عينة البحث مجموعتين: مجموعة الدراسة وتكونت من (10) مرضى هشاشة عظام مشخص وفق مقياس ال T-Score حيث قيمة T-Score عندهم أصغر أو تساوي -2,5 بأعمار 45-61 سنة, وتكونت المجموعة الشاهدة من (12) فرد سليم بأعمار 48-60 سنة حيث قيمة T-Score عندهم أكبر أو يساوي -1. تم تقييم كل من المتغيرات التالية: المؤشر الذقني MI والذي يمثل عرض الصفيحة القشرية للفك السفلي أسفل الثقبة الذقنية, مشعر CI والذي يمثل شكل الصفيحة القاعدية القشرية للفك السفلي على صورة ال CBCT عند كلا المجموعتين. أظهرت النتائج وجود فروق ذات دلالة إحصائية في قيم MI و CI بين مجموعة مرضى هشاشة العظام والمجموعة الشاهدة أي أن هنالك علاقة ارتباط بين قيم MI و CI وكثافة معادن العمود الفقري القطني.

Broncho-biliary fistula (BBF) is an extremely rare but serious medical condition resulting from pathological communication between the biliary system and the bronchial tree. Treatment options include both surgical and non-surgical approaches. Several endobronchial techniques, such as the spigot and glue, can be used for this purpose. This report discusses a patient who developed a broncho-biliary fistula following a liver biopsy. The BBF was diagnosed during bronchoscopy and successfully treated with an endobronchial Amplatzer device. To the best of our knowledge, this is the first report of the use of the Amplatzer device to manage BBF.

This study was performed to evaluate phytochemical composition of Khaya senegalensis stem bark and Azadirachta indica leaf hydroethanolic (80%) extracts using GC-MS technique as a tentative identification method and screen for antioxidant and antidiabetic properties in Wistar rats. Diabetes was induced by intraperitoneal injection of alloxan (150 mg/kg·bw). Animals were divided into groups of six and treated by extracts (400 mg/kg·bw) for 28 days. The results compared with positive and negative control groups of animals. After treatment, blood samples were collected to determine the blood glucose level, lipid profile, liver and kidney function markers, and DPPH free radical scavenging activity was evaluated. Phytochemical investigations revealed that extracts were enriched with a wide range of secondary metabolites such as phenols, saponins, triterpenes, alkaloids, flavonoids, sterols, fatty acids, siloxane derivatives, and anthraquinones in diverse concentrations with reported antioxidant and antidiabetic properties. Biological screening results indicated that both extracts exhibited free-radical scavenging property in DPPH screening, and in that, K. senegalensis stem bark extract (91 ± 0.02%) showed greater reduction than A. indica leaf extract (55 ± 0.03%), with an IC50 of 0.023 ± 0.03 g/mL, which was lower than the reference drug propylgallate (0.077 ± 0.03 g/mL). Both the extracts remarkably reduced the blood glucose concentration in diabetic rats (p

Abstract Background and Aims On March 11, 2020, the WHO has declared COVID‐19 a global pandemic, affecting our day‐to‐day lives. Physical distancing and lockdown made significant obstacles to populations, particularly healthcare systems. Most healthcare workers were reallocated to COVID‐19 facilities. Noncommunicable disease patients were given low priority and are at a higher risk of severe COVID‐19 infection, which disrupted the treatment and disease management of these patients. This review aimed to assess the effect of COVID‐19 on different types of noncommunicable diseases and the severity it may cause to patients. Methods We have conducted a review of the literature on COVID‐19 and noncommunicable diseases from December 2019 until January 2022. The search was done in PubMed and Cochrane for relevant articles using variety of searching terms. Data for study variables were extracted. At the end of the selection process, 46 papers were selected for inclusion in the literature review. Result The result from this review found that the COVID‐19 pandemic has affected the efficiency of the patient's treatment indirectly by either delaying or canceling sessions, which solidified the need to rely more on telemedicine, virtual visits, and in‐home visits to improve patient education and minimize the risk of exposure to the patients. The major and most common types of noncommunicable diseases are known to be related to the severe outcomes of COVID‐19 infection. It is strongly recommended to prioritize these patients for vaccinations against COVID‐19 to provide them with the protection that will neutralize the risk imposed by their comorbidities. Conclusion We recommend conducting more studies with larger population samples to further understand the role of noncommunicable diseases (NCDs) in this pandemic. However, this pandemic has also affected the efficiency of NCDs treatment indirectly by delaying or canceling sessions and others.

Agricultural soil pollution has attracted the attention of scientists and agricultural managers because of its importance to food security worldwide. In Syria, limited studies have been conducted to determine heavy metals (HMs) concentrations in arable lands. The objective of this study was to investigate the concentration of HMs in the southern part of Syria, and to identify the potential sources HMs. To achieve the study goals, 38 soil samples (0–25 cm) were collected and analysed for physical and chemical soil properties, while the DTPA (Diethylenetriamine pentaacetate) method was to extract HMs from soil.The results of this study showed that the average concentration of HMs in the study area are 2.00; 12.70; 8.56; 4.37; 0.12; and 0.12 ppm for Cu; Fe; Mn; Zn; Cd; and Pb, respectively. A multivariate statistical analysis showed that Cu, Fe, and Mn originated from parent material (natural resources), while Zn and Cd were related to agricultural activities (anthropogenic one) and Pb was relatively related to industrial activities. Interestingly, the spatial distribution indicates that Cu, Fe, and Mn distributed in the southern and eastern part of the study area, while Pb and Zn were dominant in the western and northern part. In addition, Cd was observed in the central part of the study area. We conclude that human activities are the main contributor of HMs accumulation in soil. The distribution of these HMs could affect the safety of agricultural product in the future.

Nadia Muhaidat,1 Mohammad A Alshrouf,2 Abdulrahman M Karam,2 Mohammed Elfalah2 1Department of Obstetrics and Gynecology, School of Medicine, The University of Jordan, Amman, 11942, Jordan; 2School of Medicine, The University of Jordan, Amman, 11942, JordanCorrespondence: Nadia MuhaidatFaculty of Medicine, The University of Jordan, Queen Rania Street, Amman, 11942, JordanTel +962798385775Email nadiadat@hotmail.comPurpose: This study aims to assess the degree of infertility management service disruption during the pandemic from the patient’s point of view, as well as patients’ attitudes toward seeking investigations and management, and their thoughts on how appropriate it is for health establishments to continue offering these services during this period while assessing their concerns regarding the risk of COVID-19 infection during treatment or pregnancy.Methods: This study involved a cross-sectional survey of 213 women who were seeking infertility management in January 2021 in Jordan. An electronic questionnaire was designed and validated, which was then distributed on social media platforms.Results: Over half of the participants had experienced some form of voluntary or involuntary disruption of their infertility management journey. The decision to postpone treatment was significantly associated with fear of infection (p = 0.009) and was more likely if they had undergone two or more previous cycles of in vitro fertilization treatment (p = 0.004). The majority of participants agreed that infertility services should remain available during the pandemic for those who chose not to delay their treatment journey, as the delay may have negative financial and psychological implications and may affect the chance to achieve a successful pregnancy in the future.Conclusion: The patients have faced uncertainty regarding the achievability of their long-term fertility goals amidst an atmosphere of general unpredictability for the duration and extent of disruption of their treatment, combined with the fear of infection. Therefore, it is necessary to highlight the need to address how infertility services can be maintained for those who decide to seek treatment during an outbreak while minimizing the risk of contracting COVID-19 in the process.Keywords: subfertility, assisted reproduction services, pandemic, Jordan, cross-sectional study, contagion anxiety