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Minatallah A Elshafie, Magdy K Khalil, Maha L ElSheikh, Nagwa I Mowafy Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Sheeben Elkom City, EgyptCorrespondence: Minatallah A ElshafieDepartment of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt, Tel +20 111 224 8935, Email menna80mas@gmail.comBackground: Hepatic resection is a major abdominal surgery with challenging pain management. We aimed to investigate the effect of erector spinae plane block (ESPB) with opioid free anesthesia (OFA) in cirrhotic patients scheduled for liver resection on perioperative pain management in terms of hemodynamic stability. Secondarily, we assessed time to first request for analgesia and perioperative fentanyl consumption, nausea and vomiting within 24 hours after surgery.Methods: Forty patients were randomized to block group (n = 20): OFA with ESPB and conventional group (n = 20): conventional balanced anesthesia with opioids (OFA associated non-opioid drugs [dexmedetomidine, magnesium sulfate, xylocaine, and acetaminophen] and ESPB). Bilateral ESP block was done with ultrasound guidance at the level of thoracic vertebrae T 6– 7, the local anesthetic dose was 20 mL Bupivacaine 0.25% with adjuvant dexmedetomidine (0.5 μg/kg) on each side. We monitored hemodynamic stability as the primary endpoint (heart rate, mean arterial blood pressure, and cardiac output).Results: Bilateral ESPB offered somatic and visceral analgesia for hepatic resection patients with no intraoperative fentanyl required. Postoperatively, the block group with dexmedetomidine adjuvant to the local anesthesia drugs showed delay in the first request for analgesia (p = 0.092) and decreased fentanyl requirement (p < 0.001), so no patient in the ESP group suffered from postoperative nausea and vomiting compared to 50% in the conventional group (p < 0.001).Conclusion: Bilateral ESP block with OFA is an effective approach for intra- and postoperative analgesia in cirrhotic patients undergoing liver resection.Keywords: hepatic surgery, cirrhosis, coagulopathy, pain management

OBJECTIVES: To assess the status of complementary and alternative medicine (CAM) education in health colleges in Saudi Arabia. METHODS: A cross sectional descriptive study was conducted including all medical, dentistry, pharmacy, nursing, allied medical science, and health colleges in Saudi Arabia. A semi- structured questionnaire was designed to collect information covering CAM tracks, courses and contents in the college's curricula, available postgraduates programs, continuing medical education activities, number of colleges staff members specialized or interested in CAM. RESULTS: Out of 110 health colleges in Saudi Arabia, 90 (81.1%) participated in the survey. There is no CAM specialized track or postgraduate education in any health college. Eleven (12.2%) colleges are teaching CAM courses in their curricula. Fifteen (16.7%) colleges are teaching topics related to CAM in different study subjects. Five (5.6%) colleges conducted continuing medical education (CME) activities related to CAM. Among faculty members, there are only 16 CAM specialists working in 7 colleges and 84 interested staff members, working in 20 colleges. Colleges of pharmacy are more interested in CAM education compared to other colleges with 42.9% (6/14) of them have CAM courses in their curricula, (p=0.006). Also, they have more faculty CAM specialists (p=0.026) compared to other colleges. CONCLUSION: There is a low and diverse attention given to CAM in medical education in Saudi Arabia. There is a need for a national plan to review health colleges curricula to prepare health care providers for the integration of evidenced based CAM practices. [ABSTRACT FROM AUTHOR]

Mohammed Abdullah Al Mansour,1 Abdullah MN Al-Bedah,2 Mohammed Othman AlRukban,3 Ibrahim S Elsubai,2 Elsadiq Yousif Mohamed,4 Ahmed Tawfik El Olemy,2 Asim AH Khalil,2 Mohamed KM Khalil,2 Meshari Saleh Alqaed,2 Abdullah Almudaiheem,2 Waqas Sami Mahmoud,4 Khalid Altohami Medani,4 Naseem Akhtar Qureshi2 1College of Medicine, Majmaah University, Al Majma’ah, 2National Center of Complementary and Alternative Medicine, Ministry of Health, 3Department of Family Medicine and Community Medicine, College of Medicine, King Saud University, Riyadh, 4Department of Community Medicine and Public Health, College of Medicine, Majmaah University, Al Majma’ah, Saudi Arabia Background: Evidently, complementary and alternative medicine (CAM) is a recognized medical practice that efficiently uses multiple treatment therapies and techniques in the prevention and management of a variety of human disorders. Many medical schools have integrated CAM curriculum in medical education system worldwide. Research in knowledge, attitude, and practice (KAP) of diverse health professionals exposed to CAM courses is important from many perspectives including improvement in KAP and teaching skills of faculty, together with capacity building and curriculum development.Objective and setting: This pre- and post-design cross-sectional study aimed to assess CAM-KAP of two intakes of medical students in Majmaah University, Saudi Arabia.Methods: The second-year medical students of the first (year 2012–2013) and second (year 2013–2014) intake (n=26 and 39, respectively) were selected for this study. A reliable, 16-item self-administered questionnaire was distributed among all the students for answering before and after the 48-hour CAM course. The data were analyzed using appropriate statistical test of significance.Results: Medical students’ knowledge and attitude toward CAM significantly improved across some subitems of CAM questionnaire with a positive trend in the rest of its items including their views on CAM practices.Conclusion: CAM course tends to have a positive impact on KAP of medical students. The preliminary results of this study call for further research with a larger sample in academic settings across the nation.Keywords: traditional medical system, medical schools, undergraduate medical students, curriculum, Saudi Arabia

Reduced bacteria concentrations in wastewater is a key indicator of the efficacy of water resource recovery facilities (WRRFs). However, monitoring the presence of bacterial concentrations in real time at each stage of the WRRF is challenging as it requires taking and processing water samples offline. Although few studies have been proposed to predict bacterial concentrations using data-driven models, generalizing these models to unseen data from different WRRFs remains challenging. This paper proposes a calibration approach based on neural networks to adapt the optimal models across various WRRFs in Saudi Arabia for bacterial estimation at the influent and effluent stages. The calibration relies on the out-of-distribution (OOD) framework of the physiochemical water parameters (e.g., pH, COD, TDS, turbidity, conductivity) with a design threshold chosen based on the data distribution of the received unseen samples. We propose a calibration framework that continues updating the trained neural network model for accurate bacterial concentration estimation upon receiving new samples. We tested the effectiveness of the proposed calibration scheme on four WRRF datasets in Saudi Arabia, comparing the results with before and after calibration without the OOD. Before calibration model was based on a traditional and optimal neural network approach, typically considered the conventional method for building neural networks. After calibration without OOD, the model continued retraining without explicitly checking for OOD condition. The results showed that the proposed calibration framework of the selected baseline WRRF with the OOD scheme improved [Formula: see text] and [Formula: see text] of the worst-case influent bacteria concentration before calibration and after calibration without OOD, respectively. Similarly, the worst-case effluent bacteria concentration estimation was enhanced by [Formula: see text] before calibration and [Formula: see text] after calibration without the OOD. Our findings highlight the importance of integrating the calibration framework with neural network approaches to achieve model generalization., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

A total of 384 animals (sheep, goat, cattle, and buffalo) were examined for the presence of hydatid cysts only in the lungs. The lung tissue samples associated with the hydatid cyst were collected immediately after slaughter, followed by fixation in 10% formalin. The fixed tissue was subjected to paraffin embedding technique. Tissue sections of 5 microns were cut by microtome and stained using Harri's Haematoxilin and Eosin method. Overall, 13.80% of ruminants were found positive for lung infections with hydatid cyst. Only the sex of ruminants showed significant (P < 0.05) association with the infection of hydatid cyst in lungs. All other variables, such as species of ruminants, age, and months showed non-significant (P > 0.05) association. Pulmonary sections taken from infected animals revealed laminated membranes encased in a region with significant (P < 0.05) cellular infiltration (53.4 ± 7.9 µm2), primarily composed of lymphocytes, plasma cells, macrophages, and occasionally neutrophils, and eosinophils. In addition, significant (P < 0.05) epithelial disruption in the bronchioles (0.94 ± 0.05 µm2) and alveolar septa were also noticed in sections. These histopathological findings lead to the conclusion that pathological changes occur in the tissues surrounding the cyst as well as in areas more distant from the cyst.

Introduction: Metastasis to the conus medullaris (CM) is a rare but devastating condition. This systematic review aimed to evaluate the clinical presentation, diagnostic workup, treatment options, and outcomes of patients with CM metastasis. By synthesizing the available evidence, this study seeks to improve our understanding of this condition and inform clinical practice., Materials and Methods: A systematic review adhering to PRISMA guidelines analyzed literature on CM metastasis from 1997 to January 2024. Human studies in English were included, focusing on primary research articles. Screening criteria ensured a homogeneous study population, with data analyzed using SPSS 26 and assessed for quality using the JBI checklist., Results: The study analyzed 88 patients with conus medullaris metastasis. Common symptoms included back pain (49.3%), sensory impairment (75%), and bladder dysfunction (60.3%). MRI was the primary diagnostic tool, revealing lesions above L1 (37%) or between L1 and L2 (29%). Treatment involved surgery with laminectomy, and combined therapy (surgery plus radiotherapy) in 81.3%. Postoperative outcomes showed improved motor function in 59.6% of patients, while combined therapy yielded better sensory and bowel/bladder function recovery. Median survival was 100 days., Conclusion: Metastasis to the conus medullaris is rare but significant. Surgical resection can improve motor function, while combined therapy (surgery plus radiotherapy) is effective in improving sensory manifestations and bowel/bladder functions. Despite these treatments, the median survival remains around 100 days, which is shorter compared to other types of intramedullary spinal cord metastases., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The National Institute of Health R25 Research Education Program was evaluated in the second year of implementation. Twelve mentors and 20 underrepresented minority students (URMs) scholars from partnerships and collaborations among five colleges and universities were added to the program to provide a more diverse research experience. Findings reveal that 100% of research mentors agree that the approachableness and accessibility of the program coordinator were beneficial in achieving mentorship goals and objectives. In addition, 85% of the students strongly agreed that the presentation of their research findings and the weekly reflection on goals, identification of accomplishments, and obstacles through the individual development plan were very effective. Of the 23 successfully tracked students for 2 years, six URMs (26.09%) obtained a bachelor's degree and were admitted into a graduate program; two were directly admitted to a PhD program in biomedical sciences., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Bisphenol F (BPF) is an emerging contaminant extensively used in the pharmaceutical, chemical, and food industries, exerting deleterious effects on human and wildlife health. Therefore, the current study was conducted to assess the toxicity induced by BPF in rohu Labeo rohita using multiple biomarkers such as oxidative stress, activity of antioxidant enzymes, biochemical parameters, histology, and genotoxicity. Fish were separated into four groups (T1-T4). Group T1 served as a control (0 μg/L), while Groups T2, T3, and T4 were exposed to BPF concentrations of 600 μg/L, 1200 μg/L, and 1800 μg/L, respectively, for 21 days. Results showed a significant ( p < 0.05) increase in oxidative biomarkers (thiobarbituric acid reactive substance [TBARS] and reactive oxygen species [ROS]), while the concentration of antioxidant biomarkers (peroxidase [POD], superoxide dismutase [SOD], reduced glutathione [GSH], and catalase) was significantly ( p < 0.05) decreased with the rising concentration of BPF in the liver, gills, and kidney of fish. Significant reduction ( p < 0.05) in biochemical parameters was measured from collected whole blood, including red blood cells (RBCs), hemoglobin (HGB), mean corpuscular HGB (MCH), MC volume (MCV), hematocrit (HCT), MC HGB concentration (MCHC), platelets, low-density lipoprotein (LDL), cholesterol, high-density lipoprotein (HDL), total proteins, very LDL (VLDL), albumin and globulin, while white blood cells (WBCs), neutrophils, triglycerides, aspartate aminotransferase (AST), blood glucose, and alanine transaminase (ALT) levels were increased significantly ( p < 0.05). Comet assay showed the DNA damage potential of BPF in erythrocytes. Histological examination showed that exposure to BPF causes several degenerative effects in the soft tissues (gills, liver, and kidney) of treated fish. It is concluded that BPF induces deleterious effects via disruptions in histological, genotoxic, and biochemical alterations in several organs of exposed fish., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Shabbir Ahmad et al.)

Diseases are major constraints to developing large-scale aquaculture practices in many countries. For decades, synthetic chemotherapeutic agents have been widely applied both as prophylactics and therapeutics to inhibit and control aquatic disease outbreaks. However, their use has become more restricted due to the negative impacts they have on the environment, the host and humans, as well as their limitations in preventing the emergence of antimicrobial-resistant bacteria. Therefore, there is a growing interest in the use of medicinal plants and seaweeds as potential alternatives to antibiotics and other synthetic chemotherapeutics. Medicinal plants and seaweeds can enhance the immune systems of animals, thereby providing protection against numerous diseases while minimizing the adverse effects associated with synthetic chemotherapeutics. Furthermore, the advantages of medicinal plants and seaweeds, such as their effectiveness, easy availability and ability to be applied on a large scale, make them appealing for use in the aquaculture industry. The main goal of this study was to review the existing knowledge of the effects of medicinal plants and seaweeds, as well as their extracts, on shrimp growth, immune response and disease resistance against bacterial and viral agents. Moreover, this paper discusses the application of seaweeds in shrimp culture. We also conducted a literature review to identify gaps in the research and provide recommendations for further advancement in this field of study. Further studies should focus on evaluating other physiological aspects, such as feed and mineral utilization, enzyme activities and histological examination., (© 2024 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.)

Alzheimer's disease (AD), the most prevalent form of dementia, requires early prediction for timely intervention. Current deep learning approaches, particularly those using traditional neural networks, face challenges such as handling high-dimensional data, interpreting complex relationships, and managing data bias. To address these limitations, we propose a framework utilizing graph neural networks (GNNs), which excel in modeling relationships within graph-structured data. Our study employs GNNs on data from the Alzheimer's Disease Neuroimaging Initiative for binary and multi-class classification across the three stages of AD: cognitively normal (CN), mild cognitive impairment (MCI), and Alzheimer's disease (AD). By incorporating comorbidity data derived from electronic health records, we achieved the most effective multi-classification results. Notably, the GNN model (Chebyshev Convolutional Neural Networks) demonstrated superior performance with a 0.98 accuracy in multi-class classification and 0.99, 0.93, and 0.94 in the AD/CN, AD/MCI, and CN/MCI binary tasks, respectively. The model's robustness was further validated using the Australian Imaging, Biomarker & Lifestyle dataset as an external validation set. This work contributes to the field by offering a robust, accurate, and cost-effective method for early AD prediction (CN vs. MCI), addressing key challenges in existing deep learning approaches., (© 2024. The Author(s).)

Presence of bilateral cranio-orbital foramina, AKA Hyrtl foramina is rare yet existing. They carry the risks of retinal artery emboli due to reflux embolization for the neurovascular interventionalists, navigating complexities in olfactory groove meningioma management. A 59-year-old woman with progressive frontal lobe syndrome presented a large olfactory groove meningioma primarily supplied by bilateral sphenopalatine arteries together with bilateral anterior cerebral arteries, necessitating risky preoperative embolization and meticulous resection. This case underscores the intricate nature of vascular supply in frontal skull base tumors, emphasizing the need for multidisciplinary approaches, thorough preoperative planning, and detective research to optimize treatment outcomes., Competing Interests: None declared., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Plant-derived compounds are renowned for their remarkable pharmacological properties, holding immense promise for therapeutic interventions in human health. In this study, we aimed to assess the antimicrobial, anti-hemolytic, antioxidant, and wound healing attributes of watercress oil incorporated into Vaseline gel (OLG) compared to watercress oil alone. OLG was formulated through a meticulous process involving the addition of Vaseline gel to the oil under agitation conditions. High-performance liquid chromatography analysis of watercress oil unveiled a rich array of phenolic compounds, including gallic acid (10.18 μg/mL), daidzein (3.46 μg/mL), and hesperetin (3.28 μg/mL). The inhibitory zones caused by watercress oil alone against a spectrum of pathogens, including Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, and Candida albicans , were measured at 25 ± 0.3, 26 ± 0.1, 22 ± 0.2, 25 ± 0.2, and 24 ± 0.1 mm, respectively. Notably, OLG exhibited slightly larger zones of inhibition (27 ± 0.2, 30 ± 0.2, 24 ± 0.1, 28 ± 0.1, and 25 ± 0.3 mm) against the same microbial strains. Furthermore, the minimum inhibitory concentration (MIC) of OLG against E. coli and E. faecalis was lower compared to watercress oil alone, indicating enhanced efficacy. Similarly, the minimum bactericidal concentration (MBC) of OLG was notably lower across all tested bacteria compared to watercress oil alone. Inhibition of bacterial hemolysis, particularly K. pneumoniae , was significantly enhanced with OLG treatment, showcasing reductions of 19.4%, 11.6%, and 6.8% at 25%, 50%, and 75% MIC concentrations, respectively, compared to watercress oil alone. The antioxidant activity of both oil and OLG was quantified with IC50 values of 2.56 and 3.02 μg/mL, respectively. Moreover, OLG demonstrated remarkable efficacy in wound healing assays, with notable enhancements in migration rate, wound closure, and area difference compared to control cells. In light of the observed antibacterial, antifungal, anti-hemolytic, and wound healing properties of OLG, this formulation holds therapeutic potential in treating microbial infections and promoting wound healing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Alharbi, Qanash, Almashjary, Barnawi, Aldarhami, Alsaif, Alsamaan, Monjed, Al Shmrany and Bazaid.)

Empyema necessitans is a very rare and morbid complication of pleural empyema. It is defined as the extension of pleural infection to the chest wall and surrounding soft tissues. Our case highlights an unusual presentation of empyema necessitans in a 29-year-old man. The patient had no prior comorbidities and presented to the emergency department with a 15-day history of growing left unilateral chest pain and swelling. This was initially clinically misdiagnosed as a post-traumatic hematoma. Contrast-enhanced chest CT scan allowed a diagnosis and the ruling out of the main differentials, such as skeletal lesions extending to adjacent structures but also benign and malignant soft tissue masses. The treatment involved surgical drainage of the abscess. Microbiological analysis of the abscess content identified Mycobacterium tuberculosis as the causative pathogen. The patient was subsequently treated with antituberculous drugs, leading to a favorable clinical outcome. This case outlines the importance of an enhanced chest CT scan in making an early diagnosis, defining the extent of the disease, and discussing differentials, all of which are paramount to better results with fewer complications. Moreover, it highlights the fact that blunt trauma may facilitate the formation of a fistula when an underlying infection is present., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khabet et al.)

Ribonucleic acid (RNA) molecules can adopt a variety of secondary and tertiary structures in solution, with stem-loops being one of the more common motifs. Here, we present a systematic analysis of 15 RNA stem-loop sequences simulated with molecular dynamics simulations in an implicit solvent environment. Analysis of RNA cluster ensembles showed that the stem-loop structures can generally adopt the A-form RNA in the stem region. Loop structures are more sensitive, and experimental structures could only be reproduced with modification of CH···O interactions in the force field, combined with an implicit solvent nonpolar correction to better model base stacking interactions. Accurately modeling RNA with current atomistic physics-based models remains challenging, but the RNA systems studied herein may provide a useful benchmark set for testing other RNA modeling methods in the future.

Histological observation under light microscopy has long been used in human cadaveric studies. However, it can distort the interpretations of findings if not used appropriately; there is no guide for its proper use. The aim of this article is to revisit and discuss the correct use of histology in human cadaveric studies, following discussions with experts in multiple fields of medicine, and to create the first guide for such usage. We reached a consensus with the experts, agreeing that when this principle (structure, quantification, interaction, position: SQIP) is applied to histological observations, the findings will be interpreted correctly. Appropriate use of this recommendation can make human cadaveric studies more accurate and informative. This is the first histology guide for human cadaveric studies., (© 2024 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Background: Providing accurate and sufficient information is a crucial requirement for delivering effective diabetes care, making it essential for community pharmacists to possess adequate knowledge of diabetes mellitus (DM) and its management., Objective: To investigate community pharmacists' level of expertise and engagement in providing counseling and health promotion services for individuals with DM in the United Arab Emirates (UAE)., Methods: A cross-sectional study design was used. The community Pharmacies were chosen via random sampling and researchers then conducted face-to-face interviews with them using the structured questionnaire. The questionnaire included demographic data, 14 questions on the knowledge and 9 questions about the practice concerning pharmaceutical care for Diabetes Mellitus., Results: The average age ± SD was 31 ± 6.3. Of the total 516 community pharmacists recruited in the study, 37.2% (n=192) were male and 62.8% (n=324) were female. The average knowledge score about DM prevention and management was 9.7 with a 95% confidence interval (CI) [9.5, 9.9] and the average practice score about DM prevention and management was 7.1 with a 95% confidence interval (CI) [6.9, 7.2]. Better knowledge scores were observed in chief pharmacists (OR 1.29; 95% CI 1.08-1.56), pharmacists with 6-10 Years of experience (OR 6.92; 95% CI 3.43-8.86), pharmacist with > 10 years of experience (OR 1.99; 95% CI 1.67-2.36), when the number of patients the pharmacist serve is 5-10 (OR 1.27; 95% CI 1.06-1.53) and being trained on DM prevention and management (OR 2.18; 95% CI 1.92-2.47). Similarly, better practice scores were observed in older participants (OR1.02; 95% CI 1.001-1.03), chain pharmacies (OR 1.42; 95% CI 1.20-1.68), chief pharmacists (OR 1.56; 95% CI 1.18-2.06), when the number of patients the pharmacists serve was 5-10 (OR 12.26; 95% CI 7.26-16.19), when the number of patients the pharmacists serve was 11-20 (OR 4.23; 95% CI 3.54-5.06) and being trained on DM prevention and management (OR 1.33; 95% CI 1.11-1.59). The most commonly reported barriers to providing counseling and health promotion services for diabetes mellitus (DM) in community pharmacies include a lack of coordination with other healthcare professionals (77%) and insufficient knowledge or clinical skills (68.7%)., Conclusion: Our study revealed that community pharmacy staff members displayed a noteworthy level of involvement in providing pharmaceutical care services for patients with diabetes mellitus. Based on these findings, it is recommended to enhance pharmacy education by incorporating more advanced, evidence-based training and curricula focusing on disease management and appropriate therapies, particularly for diabetes., Competing Interests: All authors declare that they have no conflicts of interest in this work., (© 2024 Jairoun et al.)

Background: Evaluation of students' learning strategies can enhance academic support. Few studies have investigated differences in learning strategies between male and female students as well as their impact on United States Medical Licensing Examination® (USMLE) Step 1 and preclinical performance., Methods: The Learning and Study Strategies Inventory (LASSI) was administered to the classes of 2019-2024 (female (n = 350) and male (n = 262)). Students' performance on preclinical first-year (M1) courses, preclinical second-year (M2) courses, and USMLE Step 1 was recorded. An independent t-test evaluated differences between females and males on each LASSI scale. A Pearson product moment correlation determined which LASSI scales correlated with preclinical performance and USMLE Step 1 examinations., Results: Of the 10 LASSI scales, Anxiety, Attention, Information Processing, Selecting Main Idea, Test Strategies and Using Academic Resources showed significant differences between genders. Females reported higher levels of Anxiety (p < 0.001), which significantly influenced their performance. While males and females scored similarly in Concentration, Motivation, and Time Management, these scales were significant predictors of performance variation in females. Test Strategies was the largest contributor to performance variation for all students, regardless of gender., Conclusion: Gender differences in learning influence performance on STEP1. Consideration of this study's results will allow for targeted interventions for academic success., (© 2024. The Author(s).)

A 16-year-old female presented to an outpatient clinic with a 13-year history of recurrent episodes of abdominal pain, vomiting and mild cutaneous swelling, either spontaneously or following minor trauma. The episodes occurred every 1-2 months. There was no family history of a similar complaint or hereditary angio-oedema (HAE). At the age of 16, evaluation confirmed the diagnosis of HAE type II, characterised by low C4 levels and reduced C1 esterase inhibitor function. The patient was prescribed tranexamic acid 1 g twice daily as well as C1 esterase inhibitor used as rescue medication during symptomatic episodes. This case report emphasises the importance of considering a diagnosis of HAE in patients with recurrent, unexplained abdominal pain, even in the absence of a positive family history of HAE. Abbreviations: ANA Antinuclear antibodies; C1-INH C1-inhibitor; CBC Complete blood count; FMF Familial Mediterranean fever; HAE Hereditary angioedema; IBD Inflammatory bowel diseases; SDP Solvent detergent-treated plasma; SLE Lupus erythematosus.

Background: In this study, we investigated the association between motivation, cognitive load, difficulty, and performance in a stroke education outreach program implemented for middle school students., Methods: Various interactive instructional activities were developed to engage students throughout the program to assess cognitive and intrinsic load arising from learner implementation of various tasks in a stroke education program for middle school kids. Performance was measured using a post-test to assess knowledge gained by the 6th, 7th, and 8th-grade middle school students. A short questionnaire was also administered to collect data on students' motivation using the ARCS model to asses attention, relevance, confidence, and satisfaction. In addition, we evaluated difficulty level and cognitive load. The relationship between performance and motivation was assessed using Pearson's correlation., Results: In our results, there was no significant difference ( p  > 0.05) in performance between the 6th, 7th, and 8th-grade students. The difference in performance, cognitive load (mental effort and difficulty), or motivation between the 6th, 7th, and 8 t-grade students was not significant ( p  > 0.05). The correlation between motivation and performance was significant ( r  = 0.87, p  = 0.001), while the correlation between mental effort and performance was not significant ( r  = 0.34, p  = 0.270). Also, the correlation between difficulty and performance was not significant ( r  = 0.38, p  = 0.361). In the ARCS motivation model, attention, and confidence received the lowest mean scores (3.9), while relevance received the highest score (4.3)., Conclusion: Our findings reveal the importance of implementing novel activities to enhance students' motivation to improve performance in the implementation of stroke education outreach programs for middle school students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Imeh-Nathaniel, Iftikhar, Snell, Brown, Cooley, Black, Khalil and Nathaniel.)

Aeromonas septicemia still represents a serious challenge facing the global aquaculture sector. In the present study, Aeromonas caviae and A. veronii were isolated from four diseased European seabass (Dicentrarchus labrax) farms experiencing a high mortality rate. Diseased fish showed haemorrhages on the external body surface with exophthalmia, cataracts, scale desquamation, skin ulcers and fin erosions. The most common post-mortem findings were congested internal organs, particularly the liver and posterior kidney. Twenty-eight A. Veronii and 11 A. caviae isolates were identified biochemically by the Vitek 2 system and then confirmed by PCR and phylogenetic analysis. Hemolysin (hlyA) and aerolysin (aer) were the most abundant virulence genes in the recovered isolates, followed by cytotoxic enterotoxin (act) and heat-stable enterotoxin (ast). A. caviae was more virulent than A. veronii for D. labrax fingerlings as LD 50 ranging between (>1 × 10 8 -6.2 × 10 7 ) for A. veronii and (2.9 × 10 7 -8.3 × 10 7 ) for A. caviae. The sensitivity test indicated the effectiveness of norfloxacin, doxycycline and oxytetracycline against the tested isolates. Serum cortisol significantly increased in the infected groups, while catalase and glutathione peroxidase activities significantly decreased at 2 days post-infection (DPI) and then increased at 6 DPI. The presence of virulence genes was associated with bacterial pathogenicity expressed in fish mortality rate. Virulence genes also drastically affect cortisol levels more than catalase and glutathione peroxidase levels., (© 2023 John Wiley & Sons Ltd.)

Indoor localization of a mobile target represents a prominent application within wireless sensor network (WSN), showcasing significant values and scientific interest. Interference, obstacles, and energy consumption are critical challenges for indoor applications and battery replacements. A proposed tracking system deals with several factors such as latency, energy consumption, and accuracy presenting an innovative solution for the mobile localization application. In this paper, a novel algorithm introduces a self-localization algorithm for mobile targets using the wake-up media access control (MAC) protocol. The developed tracking application is based on the trilateration technique with received signal strength indication (RSSI) measurements. Simulations are implemented in the objective modular network testbed in C++ (OMNeT++) discrete event simulator using the C++ programming language, and the RSSI values introduced are based on real indoor measurements. In addition, a determination approach for finding the optimal parameters of RSSI is assigned to implement for the simulation parameters. Simulation results show a significant reduction in power consumption and exceptional accuracy, with an average error of 1.91 m in 90% of cases. This method allows the optimization of overall energy consumption, which consumes only 2.69% during the localization of 100 different positions.

This study examines the associations between working night shifts and various outcomes, including sleep patterns, healthcare workers' sleep quality, and physical, mental, and social well-being. A descriptive cross-sectional study was conducted, where the findings revealed that night shift healthcare workers experienced poor sleep quality and pattern. In addition, night shift healthcare workers were more likely to express their intent to leave, the impact of work on their social lives, and a low level of job satisfaction. Healthcare workers showed moderate anxiety and mild depression levels. Lower job satisfaction correlated with higher anxiety and depression levels among healthcare workers, while the negative impact of working hours on social life was associated with increased anxiety and depression. Organizations should consider establishing comprehensive wellness initiatives covering work-life balance, stress management strategies, and mental health resources.

Background: Platinum complexes are commonly used for cancer chemotherapy; however, they are not only highly-priced but also have various side effects. It is, therefore, important to design affordable anticancer drugs with minimal side effects., Methods: We synthesized a new gold(I) complex, PF6{(BDPEA)(TPPMS) digold(I)} (abbreviated as PBTDG) and tested its cytotoxicity in MCF-7 breast cancer cells. We also evaluated the effects of PBTDG on mitochondrial membrane potential, generation of reactive oxygen species (ROS) and apoptosis in breast cancer cells., Results: The IC 50 values for PBTDG and sorafenib were found to be 1.48 μM and 4.45 μM, respectively. Exposure to PBTDG caused significant and concentration-dependent depletion of ATP and disruption of mitochondrial membrane potential. PBTDG induced 2.6, 3.6, and 5.7-fold apoptosis for 1 μM, 3 μM, and 10 μM concentrations, respectively. The induction of apoptosis by the same concentrations of sorafenib was 1.2, 1.3, and 1.6-fold, respectively. The low concentration of PBTDG (1 μM) induced the generation of ROS by 99.83%, which was significantly higher than the ROS generation caused by the same concentration of sorafenib (73.76%). The ROS induction caused by higher concentrations (5 μM) of PBTDG and sorafenib were 104.95% and 122.11%, respectively., Conclusion: The lower concentration of PBTDG produced similar cytotoxicity and apoptotic effects that were caused by a comparatively higher concentration of known anticancer drug (sorafenib). The anticancer effects of PBTDG are attributed to its tendency to disrupt mitochondrial membrane potential, induction of apoptosis and generation of ROS. Further studies are warranted to test the anticancer effects of PBTDG in animal models of cancer., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Medicinal plants contain a wide variety of bioactive phytoconstituents which can serve as new therapeutic agents for several diseases. This study examines the antidiabetic potential of Aitchisonia rosea in alloxan-induced diabetic rats and identifies its bioactive phytoconstituents using GC-MS. In vitro, antidiabetic potential was established using the α-amylase inhibition assay. In vivo, antidiabetic potential was investigated by employing the oral glucose tolerance test (OGTT). GC-MS analysis was used to identify the bioactive phytoconstituents. The in vitro and in vivo tests showed that the aqueous extract of A. rosea possesses better antidiabetic potential. The α-amylase inhibition assay highlighted an IC 50 value of 134.87µg/ml. In an oral glucose tolerance test, rats given an aqueous A. rosea extract significantly lowered their blood sugar levels significant reduction in the blood glucose concentration was observed in the oral glucose tolerance test in rats treated with the aqueous A. rosea extract. GC-MS investigation revealed many phytoconstituents, with serverogenin acetate and cycloheptasiloxane tetradecamethyl being important antidiabetic agents. This study found anti-diabetic properties in A. rosea extract. The phytochemical and GC-MS investigation also found serverogenin acetate and cycloheptasiloxane tetradecamethyl, which could be used to develop new antidiabetic drugs.

Background: Nursing students constitute the future nursing workforce; their knowledge can readily influence potential donors' decisions on organ donation. This study aimed to assess nursing students' knowledge of organ donation, determine its impact on their attitude, and identify relevant factors., Methods: A cross-sectional comparative study assessed the level of knowledge and attitude toward organ donation among nursing students using the following two questionnaires: (1) knowledge about organ donation and (2) attitudes toward posthumous organ donation. Non-probability convenience sampling was employed to collect data., Results: A total of 278 nursing students demonstrated a low level of knowledge on organ donation, with a score of 6.43 out of 15. This influenced their attitude toward organ donation (χ 2 (3) = 33.91, p < 0.001). Nursing students who were willing to donate their organs showed higher knowledge (7.33 ± 3.23) compared to those who were not willing to donate their organs (5.21 ± 3.09), p < 0.001. Registered donors had higher knowledge (8.52 ± 2.99) than non-donors (5.80 ± 3.17), p < 0.001., Conclusions: Even though nursing students typically favor organ donation, findings have revealed a low knowledge score. Therefore, it is necessary to improve knowledge of organ donation through nursing curricula and research, which could potentially increase the number of donors among future nursing students and, by extension, the broader population.

Objective: The aim of this study was to explore the prevalence of low and high-risk HPV genotypes in PAP smear samples of women in northern region of the UAE using HPV direct flow CHIP method., Methods: A cross-sectional retrospective study was conducted between September 2021 to April 2022. A total of 104 liquid-based cervical cytology samples were obtained from women aged 20-59 years attending the Gynaecology out-patient department of Thumbay University Hospital and other hospitals of Northern Emirates of UAE, processed for the routine cytological examination to identify and differentiate morphological changes of the PAP smear samples. HPV genotyping was performed using HPV direct flow CHIP method., Results: In total, 112 HPV genotypes were detected in 63 women (60.57%) included 18 abnormal cytological and 45 normal epithelial samples. 63 LR and 49 HR HPV genotypes were identified in all the 63 positive samples. Highest rate of infection with multiple LR and HR HPV genotypes were detected in women aged 40-49 years (25.9%) and 20-29 years (23.5%). Infection by HPV6 (13.46%), HPV11 (9.61%), HPV16 (9.61%), HPV62/81 (7.69%) and HPV45 (7.69%) were the most common genotypes. A moderate increase than expected incidence of HPV45 and 62/81 (7.69%) were detected. Co-infection with multiple low and high-risk genotypes is present in 20.2% cases; in that, HPV6 (15.9%) was the most common followed by HPV62/81 (12.7%) and HPV16 (11.11%). The prevalence of HPV18 was found to be 1.6%., Conclusion: The genotypes 6, 45, 16, 11, 67, 62/81 were the most common HPV infections in the women between the age group of 21 and 59-years-old. A moderate increase of HPV45, 62/81 and much less prevalence of HPV18 were detected in the study population. 43.27% of the normal epithelia were positive to different low and high-risk HPV genotypes. This finding highlights the importance of molecular genotyping of HPV to emphasize the cervical screening triage., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Odeh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study was conducted to compare the scrotal skin dynamics of camel and buffalo bulls regarding thermoregulation, season and testosterone. Scrotal skin and blood samples (n = 8 each) were collected during breeding (October to March) and non-breeding seasons (April to August). Tissue slides were prepared by the paraffin embedding technique followed by hematoxylin and eosin (H&E) staining and were analysed by ImageJ®. Relative humidity and temperature were recorded in different seasons to calculate the thermal humidity index (THI). Serum testosterone level was estimated through radioimmunoassay (RIA). The data were analysed by applying ANOVA, the THS test was used as a post-ANOVA interface and the correlation coefficient was also calculated among season, testosterone and skin parameters. The results showed that skin thickness, season and THI were negatively correlated with testosterone levels. In the neck, body and apex, the papillary layer was thicker in buffalo bull compared to camel bull during the breeding season; however, the reticular layer followed a reverse trend in the apex when THI was low. In the scrotal neck during the non-breeding season, hair follicle (HF) length and density were recorded high in camel bull compared to buffalo bull when THI was elevated. The density of HF followed the otherwise trend in the apex during the breeding season. The density of SG was found highest in all regions of camel bull as compared to buffalo bull and showed direct relation with THI. To conclude, this study delineates how the histo-dynamics of scrotal skin varies and accommodate itself with testosterone and THI over the different season in camel and buffalo., (© 2023 Wiley-VCH GmbH. Published by John Wiley & Sons Ltd.)

The main goal of the present study was to evaluate the influence of thermal exposure on Vibrio population and HSP genes expression (HSP 90, HSP70, and HSP20) in rayed pearl oyster (P. radiata). To this end, the oysters were reared for 30 days at temperatures of 22 °C (control), 25 °C, 27 °C, and 29 °C. The results showed that five dominate Vibrio strains including Vibrio hepatarius, V. harveyi, V. alginolyticus, V. parahaemolyticus, and V. rotiferianus were identified. The highest population of V. parahaemolyticus, V. alginolyticus, and V. harveyi, was found in 29 ο C group. According to real-time PCR, mantle exhibited the highest expression levels of HSP20, HSP70, and HSP90 genes. A higher level of HSP20 expression was observed at high temperatures (25 °C, 27 °C, and 29 °C) in the gonad and mantle compared to the control group (22 °C) while decrease in HSP90 expression level was recorded in 25 °C, 27 °C, and 29 °C groups. HSP20 expression level in adductor muscle was remarkably down-regulated in 27 °C and 29 °C groups. In this tissue, HSP70 was detected at highest levels in the 29 ο C group. In mantle, HSP90 gene expression was lowest at 22 °C water temperature. Several Vibrio strains have been identified from pearl Gulf oyster that haven't been previously reported. The identification of dominant Vibrio species is essential for epidemiological management strategies to control and prevent Vibrio outbreaks in pearl oyster farms. The expression pattern of HSP genes differs in rayed pearl oyster tissues due to differences in their thermal tolerance capability and physiological and biological characteristics. The present study provides useful molecular information for the ecological adaptation of rayed pearl oysters after exposure to different temperature levels., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Social media systems are instrumental in the dissemination of timely COVID-19 pandemic information to the general population and contribute to the fight against the pandemic and waves of disinformation during the COVID-19 pandemic. This study uses the information adoption model (IAM) as the theoretical framework to examine the moderating influence of perceived government information transparency on the adoption of COVID-19 pandemic information on social media systems from the Ghanaian perspective. Government information transparency regarding the pandemic is crucial since any lack of transparency can negatively affect the global response to the pandemic by destroying trust (in government and public health authorities/institutions), intensifying fears, and causing destructive behaviors., Methods: It applies a convenient sampling technique to collect the responses from 516 participants by using self-administrated questionnaires. The data analysis was computed and analyzed with SPSS-22. The following statistical tests were conducted to test the hypotheses: descriptive statistics, scale reliability test, Pearson bivariate correlation, multiple linear regressions, hierarchical regression, and slope analysis., Results: The results indicate that information quality, information credibility, and information usefulness are significant drivers of COVID-19 pandemic information adoption on social media systems. Furthermore, the perceived government information transparency positively moderates the influence of information quality, information credibility, and information usefulness on the adoption of COVID-19 pandemic information on social media systems., Conclusion: The theoretical and managerial implications of these findings suggest the utilization of social media systems as an effective tool to support the continued fight against the current COVID-19 pandemic and its future role in national and global public health emergencies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mensah, Khan, Liang, Zhu, Lin and Mwakapesa.)

In this study, biodegradable film was prepared from polyvinyl alcohol (PVA), Silver chloride (AgCl) and spirulina (Sp). Surface morphology, mechanical properties, antioxidant, antimicrobial, optical properties, etc. were investigated. The FTIR results confirmed the effect of AgCl and Sp on PVA structure. Sp increased the moisture content and solubility in water. The XRD results showed the semi-crystalline structure of PVA. AgCl nanoparticles activated the antibacterial property of the film against Escherichia coli and Staphylococcus aureus bacteria and Sp caused a strong increase in the antioxidant property of the film. Examining the light transmittance of films containing AgCl nanoparticles showed that the transmittance of films containing nanoparticles decreased with exposure to sunlight and ultraviolet light with increasing treatment time, which indicates the activation of the photochromic property of films containing AgCl in the presence of light. The results showed the suitable photochromic property of the PVA/AgCl films., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Leafy vegetables are considered to have health-promoting potentials, mainly attributed to bioactive phenolic compounds. The antidiabetic effects of spinach, mustard, and cabbage were studied by feeding their phenolic-rich aqueous extracts to alloxan-induced diabetic mice. The antioxidant, biochemical, histopathological, and hematological indices of the control, diabetic, and treated mice were studied. Phenolic compounds present in the extracts were identified and quantified using HPLC-DAD. Results showed ten, nineteen, and eleven phenolic compounds in spinach, mustard, and cabbage leave aqueous extracts, respectively. The body weight, tissue total glutathione (GSH) contents, fasting blood sugar, liver function tests, renal function tests, and lipid profile of the mice were affected by diabetes and were significantly improved by the extract treatments. Likewise, hematological indices and tissues histological studies also showed recovery from diabetic stress in treated mice. The study's findings highlight that the selected leafy vegetables potentially mitigate diabetic complications. Among the studied vegetables, cabbage extract was comparatively more active in ameliorating diabetic stress., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Aneurysmal bone cysts (ABCs) are uncommon lesions in head and neck area that could be primary or secondary in origin. The main problem with the traditional curettage and debridement is the high rates of recurrence, and cosmetic disfigurement with the open approach. In this article, we describe the use of a combined endoscopic sinus surgery and endoscopic assisted Caldwell approach to achieve a complete surgical excision of left maxillary sinus ABC extending to the left infratemporal fossa, and to avoid facial disfigurement in a 13-year-old female patient presented to our hospital with diplopia, facial pain, and headache. The patient had uneventful post-operative recovery period with resolution of the presenting symptoms with no complications. Hence, we recommend this combined endoscopic surgical approach in such cases., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

In Pakistan, substantial changes to hepatitis C virus (HCV) programming and treatment have occurred since the 2008 nationwide serosurvey estimated a 4.8% anti-HCV prevalence. In the absence of an updated national study, this analysis uses provincial data to estimate a national prevalence and the interventions needed to achieve elimination. Using a Delphi process, epidemiologic HCV data for the four provinces of Pakistan (accounting for 97% of the population) were reviewed with 21 subject-matter experts in Pakistan. Province-level estimates were inputted into a mathematical model to estimate the national HCV disease burden in the absence of intervention (Base), and if the World Health Organization (WHO) elimination targets are achieved by 2030 (80% reduction in new infections, 90% diagnosis coverage, 80% treatment coverage, and 65% reduction in mortality: WHO Elimination). An estimated 9,746,000 (7,573,000-10,006,000) Pakistanis were living with viraemic HCV as of January 1, 2021; a viraemic prevalence of 4.3% (3.3-4.4). WHO Elimination would require an annual average of 18.8 million screens, 1.1 million treatments, and 46,700 new infections prevented anually between 2022 and 2030. Elimination would reduce total infections by 7,045,000, save 152,000 lives and prevent 104,000 incident cases of hepatocellular carcinoma from 2015 to 2030. Blood surveys, programmatic data, and expert panel input uncovered more HCV infections and lower treatment numbers in the provinces than estimated using national extrapolations, demonstrating the benefits of a bottom-up approach. Screening and treatment must increase 20 times and 5 times, respectively, to curb the HCV epidemic in Pakistan and achieve elimination by 2030., (© 2023 John Wiley & Sons Ltd.)

Background: Seasonal influenza vaccine can reduce the risk of influenza-associated hospitalizations and deaths among children. Given that parents are the primary decision makers, this study examined the parental attitude toward childhood influenza vaccine and identified determinants of vaccine hesitancy (VH) in the Eastern Mediterranean region (EMR)., Methods: A cross-sectional study was conducted using an anonymous online survey in 14 EMR countries. Parents of children aged 6 months to 18 years were included. The Parent Attitude about Childhood Vaccines (PACV) was used to assess VH. Chi square test and independent t-test were used to test for association of qualitative and quantitative variables, respectively. A structural equations model (SEM) was used to identify direct and indirect determinants of parental VH., Results: Almost half of the parents were hesitant about vaccinating their children against influenza (50.8%). Parental VH was significantly higher among older mothers (37.06 ± 8.8 years, p  = 0.006), rural residents (53.6%, p  < 0.001), high-income countries residents (50.6%, p  < 0.001), and mothers with higher educational levels (52.1%, p  < 0.001). Parents of school-aged children (5-9 years) (55.6%, p  < 0.001), children free from any comorbidities (52.5%, p  < 0.001), children who did not receive routine vaccination at all (51.5%, p  = 0.03), children who were not vaccinated against COVID-19 (54.3%, p  < 0.001), in addition to parents who were not vaccinated against influenza (57.1%, p  < 0.001) were significantly associated with increased likelihood of VH. Parents who were depending on healthcare provider as a source of information regarding vaccines were less likely to report VH (47.9%, p < 0.001), meanwhile those who used social media as their source of health information showed a significantly higher VH (57.2%, p < 0.001). The SEM suggested that mother's age, residence, country income level, child gender, total number of children and source of information regarding vaccines had a direct effect on VH. Meanwhile, parents vaccinated against influenza, children completely or partially vaccinated with routine vaccines and children vaccinated against Coronavirus disease 2019 (COVID-19) had an indirect effect on VH., Conclusion: A high proportion of included parents were hesitant to vaccinate their children against seasonal influenza. This attitude is due to many modifiable and non-modifiable factors that can be targeted to improve vaccination coverage., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Fadl, Al Awaidy, Elshabrawy, Makhlouf, Ibrahim, Abdel-Rahman, Tookhy, Alsalmani, Al-Saeedi, Al-Sawalha, El-Din, Saad, Ayoob, Rourou, Ali, Tawati, Gadain, Al-saidi, Hassan, Alsanafi, Sandouk, Youssef, Alothman, Yazbek, Al-Ansi, Mehdad, Adam, Gebreal and Ghazy.)

Background: The study was conducted on patients who received diagnostic X-rays in King Khalid Hospital (KKH), Majmaah., Introduction: The study included the seven most frequently performed investigations, which were carried out on over 1504 patients using digital radiography equipment., Methods: The X-ray tube's output and exposure parameters were used to calculate the effective dose (ED) and patient entry surface air kerma (ESAK). Additionally, based on these results, conversion coefficients were determined. This study also examined the 75th percentile distributions of ESAK and KAP. The findings of this research were compared with the findings of other researchers throughout the country and the world. The study presents the uncertainty U values, as well as the mean ESAK, KAP, and ED values., Results: The results of the ESAK, KAP, and ED values were 0.12-5.74 mGy, 0.9-1.84 Gy cm2, and 0.01-0.23 mSv, respectively. As a result, the dosages were much lower than those previously published for the European DRL, national standards, and other studies., Conclusion: The study concludes that during dose surveys, the importance of detecting and comprehending radiation doses, as well as the proper technique for taking the finest photos possible, can be emphasized to patients in order to assist them in avoiding radioactive particles and radiation exposure., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Cancer is a deadly disease characterized by abnormal cell proliferation. Chemotherapy is one technique of cancer treatment. Cyclophosphamide (CYP) is the most powerful chemotherapy medication, yet it has serious adverse effects. It is an antimitotic medicine that regulates cell proliferation and primarily targets quickly dividing cells, and it has been related to varying levels of infertility in humans. In the current study, we assessed the biochemical, histological, and microscopic evaluations of testicular damage following cyclophosphamide administration. Further, we have explored the potential protective impact of mesenchymal stem cell (MSCs) transplantation. The biochemical results revealed that administration of cyclophosphamide increased serum concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), while it decreased serum concentrations of free testosterone hormone (TH), testicular follicle-stimulating hormone, luteinizing hormone, and free testosterone hormone concentrations, testicular total antioxidant capacity (TAC), and testicular activity of superoxide dismutase (SOD) enzyme. The histology and sperm examinations revealed that cyclophosphamide induced destruction to the architectures of several tissues in the testes, which drastically reduced the Johnsen score as well as the spermatogenesis process. Surprisingly, transplantation of mesenchymal stem cell after cyclophosphamide administration altered the deterioration effect of cyclophosphamide injury on the testicular tissues, as demonstrated by biochemical and histological analysis. Our results indicated alleviation of serum and testicular sex hormones, as well as testicular oxidative stress markers (total antioxidant capacity and superoxide dismutase activity), and nearly restored the normal appearance of the testicular tissues, Johnsen score, and spermatogenesis process. In conclusion, our work emphasizes the protective pharmacological use of mesenchymal stem cell to mitigate the effects of cyclophosphamide on testicular tissues that impair the spermatogenesis process following chemotherapy. These findings indicate that transferring mesenchymal stem cell to chemotherapy patients could significantly improve spermatogenesis., Competing Interests: Author MA was employed by Dallah Pharma Company. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ibrahim, Abozied, Abdel Maboud, Alzamami, Alturki, Jaremko, Alanazi, Alhuthali and Seddek.)

Wireless sensor network (WSN) with energy-saving capabilities have drawn considerable attention in recent years, as they are the key for long-term monitoring and embedded applications. To improve the power efficiency of wireless sensor nodes, a wake-up technology was introduced in the research community. Such a device reduces the system's energy consumption without affecting the latency. Thereby, the introduction of wake-up receiver (WuRx)-based technology has grown in several sectors. The use of WuRx in a real environment without consideration of physical environmental conditions, such as the reflection, refraction, and diffraction caused by different materials, that affect the reliability of the whole network. Indeed, the simulation of different protocols and scenarios under such circumstances is a success key for a reliable WSN. Simulating different scenarios is required to evaluate the proposed architecture before its deployment in a real-world environment. The contribution of this study emerges in the modeling of different link quality metrics, both hardware and software metrics that will be integrated into an objective modular network testbed in C++ (OMNeT++) discrete event simulator afterward are discussed, with the received signal strength indicator (RSSI) for the hardware metric case and the packet error rate (PER) for the software metric study case using WuRx based on a wake-up matcher and SPIRIT1 transceiver. The different behaviors of the two chips are modeled using machine learning (ML) regression to define parameters such as sensitivity and transition interval for the PER for both radio modules. The generated module was able to detect the variation in the PER distribution as a response in the real experiment output by implementing different analytical functions in the simulator.

Aim: To investigate the perception of undergraduate nursing students in different countries in the Middle East about caring., Design: A cross-sectional, descriptive, comparative design., Methods: A total of 1,582 nursing students from six different countries in the Middle East completed the Caring Dimensions Inventory., Results: The total mean score of caring was 138.8 (± 15.8), indicating a high level of caring. The highest mean score was for nursing students from Egypt (M = 145.37 ± 15.97), whereas the lowest was for nursing students from Palestine (M = 135.36 ± 13.48). The caring perception was more significant for female students than male students, and no significant correlation was found between students' ages and caring scores., Conclusions: The high level of caring among nursing students reflects the involvement of caring behaviour in the nursing curricula, which motivates nursing schools to continue stressing the importance of caring and to enhance this behaviour among their graduates., Patient or Public Contribution: Improving the students' caring competencies as recommended by the study will influence the caregiving quality in the future that will be reflected in nurse-patient caring relationships and raise the patients' and public satisfaction with nursing care., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

The term Metaverse ("meta" defined as beyond, transcendence or virtuality, and "verse" meaning universe or world) denotes a "virtual reality space" for anatomy teaching. To ascertain how many anatomists are familiar or are using this adjunct in teaching, we conducted a short survey at the 2022 annual meeting of the American Association of Clinical Anatomists (AACA). Interestingly, only six respondents (9.4%) had used a Metaverse for teaching anatomy. Moreover, the vast majority of attendees were anatomy educators or basic science faculty, but not practicing physicians/surgeons or other actively practicing health care professionals; a group where this technology has been used much more commonly. The present manuscript was authored by anatomy educators, practicing physicians and other actively practicing health care professionals with backgrounds in diverse medical fields, that is, anatomists, medical doctors, physician assistants, dentists, occupational therapists, physical therapists, chiropractors, veterinarians, and medical students. Many of these authors have used or have been exposed to a Metaverse in the clinical realm. Therefore, the aim of the paper is to better understand those who are knowledgeable of a Metaverse and its use in anatomy education, and to provide ways forward for using such technology in this discipline., (© 2022 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Antimicrobial stewardship programs seek to improve patient outcomes, reduce cost, and hinder development of antimicrobial resistance. Collection of inpatient antimicrobial use data is foundational to these programs, and decisions to initiate and discontinue antibiotics are potentially amenable to improvement. In order to better understand our current practices and with a view toward improved antimicrobial stewardship, we reviewed charts of previously healthy children to age 16 years hospitalized with fever (without an evident localized source) and/or other findings suggestive of serious bacterial infection. Of 105 patients (18% 0-2 months of age, 42% 3-12 months, 25% 2-5 years), 100 (95%) received antibiotics, 72% for more than 2 days. Of 98 patients with negative body fluid cultures, 23 received antibiotics for 2 days or less, and 70 received antimicrobial therapy for more than 2 days. Focusing on selective initiation and earlier discontinuation of antimicrobial therapy in hospitalized children might reduce unnecessary antibiotic use., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Purpose: This study aimed to explore the perspectives of policymakers and patients on breast cancer (BC) management in the Gaza Strip., Methods: A descriptive qualitative study design was employed using semi-structured in-depth interviews with 13 policymakers and focus group discussions with 19 BC patients. The four criteria presented by Lincoln and Guba were used to evaluate the validity and reliability. Data were analysed using conventional content analysis approach., Results: Three categories were generated from the qualitative data analysis: (1) limited human resources in the BC management, (2) inadequate institutional level service provision in the BC management, and (3) a lack of policy level support for the BC management. The current health services provided to Gazan BC patients are either fragmented or partially unavailable. The roles and responsibilities at the policy, system and individual levels were ambiguous. Policymakers attributed the fragmented BC services to the shortage of qualified healthcare professionals, inadequate training programmes for the staff, and lack of coordination among health institutions. Some patients expressed an insufficient knowledge about cancer screening tests, while others ignored screening for cultural reasons., Conclusion: Gaza's BC services are fragmented and not well-organised and they have received inadequate attention at the leadership and governance levels. The government in the Gaza Strip should strengthen its leadership to upgrade and develop the policies and strategies necessary for proper BC management, including an improved information system and cooperation with national and international institutions to secure funding for developing BC services and ensure medication availability., Competing Interests: Declaration of competing interest The authors declare that there are no potential conflicts of interest with respect to research, authorship, financial interests or publication of this article., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The positive behavioral style of authentic leadership has attracted academicians' and practitioners' attention to focus more on a healthy workplace environment and its influence on followers' valued workplace relationship outcomes, such as employees' work engagement. From the lens of social exchange perspective, we tested a unified model of authentic leadership and its influence on the followers' wellbeing (hedonic and eudaimonic wellbeing) and work engagement. We also examined the mediating role of hedonic and eudaimonic wellbeing on followers' work engagement. Using a time-lagged design, we collected data from 250 telecom sector workers employed in the capital city of Islamabad, Pakistan. The results indicate the positive influence of authentic leadership on followers' work engagement and employees' hedonic and eudaimonic wellbeing. Hedonic and eudaimonic wellbeing also positively mediated the relationship between authentic leadership and followers' work engagement. The theoretical and practical implications of the study are also discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Farid, Iqbal, Basahal, Khattak, Khan and Salam.)

Introduction: Many medical schools have implemented near-peer tutoring (NPT) programs based on the substantial benefits of these programs to both tutors and tutees. This study correlated the frequency of attending weekly NPT sessions to students' academic performance, and also compared performance of high and low attending students., Methods: Twenty-one weekly NPT sessions were delivered by fourth-year (M4) students to first-year (M1) students. Attendance was recorded, and accordingly students were divided into three groups, high (15-21 sessions), moderate (7-14 sessions), and low (0-6 sessions) attendance groups. Pearson product-moment correlation coefficient was computed to assess the relationship between students' frequency of attendance and their overall performance on overall basic medical sciences at the end of M1 year and M2 mid-year NBME® CBSE. Students' performance was also analyzed using ANCOVA and Bonferroni post hoc test to compare differences between the three attendance groups., Results: An increase in number of attended NPT weekly sessions corresponds with an increase in students' performance on overall M1 basic sciences weighted average ( r (196) = .240, p  ≤ 0.001) and the M2 mid-year NBME® CBSE ( r (196) = .325, p  ≤ 0.001). High attending students performed significantly higher than low attending students on overall M1 weighted average of basic science courses ( F (2, 192) = 8.518, p  < .001) and M2 mid-year NBME® CBSE ( F (2, 192) = 15.494, p  < .001)., Conclusion: Attending NPT weekly sessions is a valuable experience that is associated with an improvement in M1 medical students' academic performance. However, low performing students tend to miss attending NPT weekly sessions., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) under exclusive licence to International Association of Medical Science Educators 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Honey exhibited potential antimicrobial activity against multidrug resistant (MDR) bacteria that continues to be a serious health problem. We reported the in-vitro activity of Saudi Sumra honey against clinical pathogenic bacteria and fungi, antibiofilm, anti-quorum-sensing (QS) and antioxidant activities in relation to its phytochemical composition assessed by gas chromatography-mass spectrometry (GC-MS). Broth dilution method and scavenging activities against 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) and 2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) and β-carotene bleaching assays were performed. The GC-MS analysis of Sumra honey showed that 2,4-dihydroxy-2,5-dimethyl-3(2H)-furan-3-one 1-methylcyclopropanemethanol were the major identified phytoconstituents. Sumra honey showed a minimum inhibitory concentration (MIC) to clinical isolates of Staphylococcus aureus including methicillin-resistant Staphylococcus aureus (MRSA) at 300 mg/mL, Pseudomonas aeruginosa (250 mg/mL), Escherichia coli (350 mg/mL) and Acinetobacter baumannii (250 mg/mL); clinical fungal isolates—Candida auris (600 mg/mL) and Cryptococcus neoformans (>1000 mg/mL); wild type fungal isolates—Candida krusei (>1000 mg/mL) and Candida albicans (700 mg/mL). In addition, Sumra honey demonstrated promising inhibition targeting biofilm formation by 59% for Bacillus subtilis, 48% for S. aureus, 38% for E. coli, and 33.63% for P. aeruginosa. The violacein production in Chromobacterium violaceum was reduced to 68%, whereas pyocyanin production in P. aeruginosa was reduced to 54.86% at ½ MIC. Furthermore, Sumra honey exhibited strong antioxidant activities (DPPH − IC50 = 7.7 mg/mL; ABTS − IC50 = 5.4 mg/mL; β-carotene − IC50 = >20 mg/mL). Overall, obtained data highlighted the promising potential therapeutic use of Sumra honey treating infections caused by MDR bacteria and fungi. Moreover, Sumra honey can be a good candidate as an inhibitor agent for bacterial cellular communication in strains of P. aeruginosa and C. violaceum.

Summary: The most frequent causes of pancreatitis classically have been known to be gallstones or alcohol. However, genetics can also play a key role in predisposing patients to both chronic and acute pancreatitis. The serine protease inhibitor Kazal type 1 (SPINK 1) gene is known to be strongly associated with pancreatitis. Patients with these underlying genetic mutations can have severe diseases with a high morbidity rate and frequent hospitalization. We report an Arab girl who presented with acute pancreatitis at the age of 7 years progressing to recurrent chronic pancreatitis over a few years. She had severe obesity from the age of 4 years and developed type 2 diabetes at the age of 12. She had a normal biliary system anatomy. Genetic analysis showed that she had combined heterozygous mutations in the SPINK1 gene (SPINK1, c.101A>G p.(Asn34Ser) and SPINK1, c.56-37T>C). Her parents were first-degree cousins, but neither had obesity. Mother was detected to have the same mutations. She had type 2 diabetes but never presented with pancreatitis. This case is the first to be reported from the Arab region with these combined mutations leading to recurrent chronic pancreatitis. It illustrates the importance of diagnosing the underlying genetic mutation in the absence of other known causes of pancreatitis. Considering the absence of pancreatitis history in the mother who did not have obesity but harboured the same mutations, we point out that severe obesity might be a triggering factor of pancreatitis in the presence of the mutations in SPINK1 gene in this child. While this is not an assumption from a single patient, we show that not all carriers of this mutation develop the disease even within the same family. Triggering factors like severe obesity might have a role in developing the disease., Learning Points: Acute recurrent pancreatitis and chronic pancreatitis are uncommon in children but might be underdiagnosed. Biliary tract anomalies and dyslipidaemias are known causative factors for pancreatitis, but pancreatitis can be seen in children with intact biliary system. Genetic diagnosis should be sought in children with pancreatitis in the absence of known underlying predisposing factors. SPINK1 mutations can predispose to an early-onset severe recurrent pancreatitis and acute pancreatitis.

Background: Bariatric surgery offers long-term weight loss and maintenance for patients with obesity. Several factors may be associated with patients' inability to achieve successful excess weight loss (EWL) after the surgery. The purpose of this study was to identify factors associated with improved or in-progress EWL among patients who had undergone laparoscopic sleeve gastrectomy (LSG)., Methods: This original clinical investigation was conducted at the Outpatient Surgical Department-Medical Research Institute Hospital at Alexandria University in Egypt. A sample size of 100 adult surgical patients who had undergone LSG was selected from patients who attended follow-up in the study setting. Group A had an EWL% ≥50 and group B had an EWL <50. Body Mass Index (BMI) classes were defined as 25-30 kg/m 2 , >30-35 kg/m 2 , >35-40 kg/m 2 , >40 ≥ 45 kg/m 2 ., Results: Post-operatively, after six months, 100% of the patients in group A had a BMI between 25 and 30 mg/m2, compared to 0% in group B. Nevertheless, patients in group EWL<50 (group B) who had pre-operatively BMI class ≥45 mg/m2, had a reduction in weight of 89.5% post-operatively, (n = 2 still had a BMI >45 kg/m 2 post operatively), In total, 63.9% of the patients in group B managed to get towards a BMI of 30-35 kg/m 2 post-operatively. The main factors associated with group B (less %EWL after 6 months) were found to be related to higher preoperative BMI, the onset of obesity started in childhood, less preoperative weight loss, longer postoperative duration towards weight reduction, and lower postoperative compliance to dietary instructions (P = 0.0001, 0.048, 0.0001, 0.017, and 0.016, respectively)., Conclusion: Routine cross-sectional surveying can help clinicians in understanding patients' post-operative follow-up routines. Special attention to pre-operative BMI, weight-loss regimens, and childhood-onset as well as post-operative duration, low responders, and compliance with clinical assessment can improve weight loss outcomes., (© 2022 The Author(s).)