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Purpose This article assesses the feasibility, safety, and efficacy of peripherally inserted central catheters (PICCs) in conjoined twins.

ABSTRACT Background The use of exome sequencing (ES) has helped in detecting many variants and genes that cause primary adrenal insufficiency (PAI). The diagnosis of PAI is difficult and can be life‐threatening if not treated urgently. Consanguinity can impact the detection of recessively inherited genes. Here, we report families with PAI in a consanguineous population of Saudi Arabia. Materials and Methods A cohort of 47 PAI patients (41 males and six females) representing 30 families was recruited. The cohort excluded congenital adrenal hyperplasia (CAH) cases and had a known consanguinity of 70%. Using ES, molecular genetic causes of PAI were investigated. Results In 30 unrelated families with PAI, pathogenic/likely pathogenic variants were detected in 27 families with a diagnostic yield of (90%). Clinically associated variants of uncertain significance (VUS) were identified in a further two PAI families (7%). Hemizygous variants in ABCD1 were the most common cause of PAI in this cohort (16 families) leading to adrenoleukodystrophy. A total of six novel variants were detected, of which four were predicted to be pathogenic (P) / likely pathogenic (LP) and two were VUS. Four pathogenic variants in ABCD1, NR0B1, and MC2R were detected in 10 families suggesting founder mutations. Conclusion In this cohort, ES detected a diagnostic molecular abnormality in 90% of patients with PAI phenotypes. X‐linked inheritance is the most common cause of PAI and founder mutations likely contributed to a high diagnostic yield.

Introduction The use of mobile phone technology for chronic illness self-management is growing, and it may help people with type 2 diabetes mellitus (T2DM). Innovative methods are needed to improve patient involvement and disease management in the Kingdom of Saudi Arabia due to the high incidence of T2DM. Objective The purpose of this study was to explore how the T2DM patients in KSA utilizes their mobile phones for self-management. Methods A cross-sectional study was conducted between April and June 2025 among T2DM patients who were attending endocrinologists for their diabetes management in the Northern Border region (Rafha and Arar) and the Central region (Riyadh) in KSA using a validated questionnaire. Results This study included a total of 267 participants with T2DM. Nearly all participants (99.3%) possess a cellphone, with 94.8% having daily internet access. The majority of the patients reported to have an intention to use mobile phones and the internet for managing diabetes, with 78.3% for dietary planning, 79.4% for physical activity planning, and 78.7% for text messages as reminders. Factors such as female (p = 0.008), younger age (p = 0.001), and duration of diabetes (p =

Background Antimicrobial resistance is increasing at an alarming rate. The use of antibiotics without a prescription by a patient or other family members and their inappropriate storage have caused serious health issues as it would lead to antibiotic resistance and exposure to the risk of harmful adverse effects unnecessarily. Therefore, the study aimed to evaluate the current behaviour of antibiotic usage, storage, re-usage and misuse among the residents of Saudi Arabia. Methods This is a cross-sectional study. Our target study population was the residents of Saudi Arabia. Data were collected by an online questionnaire and analysed by SPSS. Results A total of 738 participants answered the online questionnaire from all ages, genders, nationalities, and socioeconomic backgrounds residing in different regions across the Kingdom of Saudi Arabia. 76.42% knew that an antibiotic is a chemical substance used to treat infections. The participants were questioned about when they started using antibiotics, to which 95.66% (n=706) responded after consulting a physician, 3.25% (n=24) said when they felt ill for any reason, and 1.08% (n=8) replied after first attempting herbal medicine. A total of 147 participants admitted that they store excess pills of antibiotics after being prescribed for an infection and reuse them later on for symptoms like sore throat and fever. Conclusions The results indicated that nearly half of the participants used leftover antibiotics. Participants having children in their homes significantly reuse antibiotics. However, one-third of the participants didn’t complete the antibiotics course. A large portion of the population, regardless of age, level of education, or professional background, have continued to store leftover antibiotics after an infection treatment and reuse them once they think they need them for new symptoms. This advice further revises the current measures to fill those gaps and reduce this habit.

Background: As of November 2023, twenty-four states, two territories, and DC have legalized marijuana for non-medical use, leading to concerns about its potential oral health effects. This study investigated the association between marijuana use and clinical dental outcomes among adults in the US. Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2018 using a cross-sectional survey of non-institutionalized US civilians. Marijuana use was assessed among 18–59-year-old adults and categorized as never, former, or current frequent use. The dental outcomes included the prevalence of untreated coronal caries, root caries, and missing teeth. We employed logistic and negative binomial regressions to assess the crude and adjusted associations between marijuana use, dental caries, and tooth loss. Results: Of the 6,424 participants, 13.85% of US adults aged 18–59 years were current frequent marijuana users (21.67 million), with the highest prevalence among 18–29-year-olds (21.31%), males (17.54%), and non-Hispanic Black individuals (21.31%). Frequent marijuana users showed the highest prevalence of untreated coronal caries (33.4%). Before adjusting for socioeconomic confounders, current frequent marijuana users had 1.76 times higher odds of having teeth with coronal caries, whereas former frequent users had 1.47 times higher odds. However, the associations between marijuana use and all dental outcomes were attenuated after adjusting for socioeconomic confounders, tobacco use, and access to dental care. Conclusion: Although marijuana use was associated with worse dental health, socioeconomic factors, tobacco use, and access to dental care were more significant contributors to the prevalence of untreated dental caries and missing teeth than marijuana use alone.

Robot engagement in healthcare has the potential to alleviate medical personnel workload while improving efficiency in managing various health conditions. This study evaluates the impact of robot-assisted education on knowledge acquisition and metabolic control in children with Type 1 Diabetes Mellitus (T1DM) compared to traditional education methods. A randomized controlled trial was conducted at the pediatric diabetes clinic of the University of Tabuk Medical Center, Saudi Arabia. Thirty children aged 5–15 years with T1DM were randomly divided into two groups: the robot education (intervention) group and the control education group. Both groups participated in six weekly one-hour educational sessions, with the intervention group interacting with a Pepper robot assistant and the control group receiving education from a qualified diabetes educator nurse. Knowledge was assessed using a 12-item questionnaire before and after the intervention, while metabolic control was evaluated through weekly mean home blood glucose measurements and HbA1c levels before and three months post intervention. The intervention group demonstrated a significantly greater improvement in knowledge scores compared to the control group (p < 0.05). Weekly mean blood glucose levels were consistently lower in the intervention group throughout the study period (p < 0.05 for all samples). Both groups showed a reduction in HbA1c levels after three months, with the intervention group exhibiting a greater mean decrease. The engagement of the Pepper robot in T1DM education for children resulted in improved knowledge acquisition and better metabolic control compared to traditional education methods. This approach may establish a foundation for “learning by interacting with robots” in long-term diabetes management. Further research with larger sample sizes and longer follow-up periods is warranted to confirm these findings and explore the long-term benefits of robot-assisted education in pediatric diabetes care.

Abstract Enhanced oil recovery (EOR) from carbonates is obtained by injection of controlled ionic strength brines containing “active ions” (e.g., SO4 2−, Mg2+, Ca2+). It is generally believed that this occurs through the interaction of the active ions at the carbonate-brine interface (e.g., within a thin brine layer separating the petroleum and the carbonate phases). Here, in-situ observations show how one active ion, SO4 2−, alters behavior at the carbonate-petroleum interface. Displacement of petroleum from initially oil-wet carbonate rocks using brines with variable SO4 concentrations systematically changes oil recovery, in situ contact angles, and connectivity of the oil phase, confirming that the active ion alters interactions at the oil/brine/carbonate interface, as expected. Measurements of model calcite-fluid interfaces show that there is no measurable sorption of SO4 to carbonate-brine interfaces but reveals that the carbonate-petroleum interface is altered by previous exposure to SO4-containing brines. These results suggest that EOR in carbonates is controlled indirectly by active ions. We propose that this may be due to a reduced oleophilicity of the carbonate caused by chemical complexation between the active ion and petroleum’s acidic and basic functional groups. This mechanism explains how both anions and cations act as active ions for EOR in carbonates.

Abstract Objective Whitefly-transmitted tomato yellow leaf curl virus (TYLCV) continues to be a major constraint to tomato production in Kuwait. However, very limited information is available about the population structure and genetic diversity of TYLCV infecting tomato in Kuwait. Results Whole genome sequences of 31 isolates of TYLCV, collected from commercial tomato crops grown in northern (Abdally) and southern (Al Wafra) parts of Kuwait, were deciphered. Eighteen isolates of TYLCV are identified as potential genetic recombinants. The isolates Abdally 6A and Abdally 3B reported in this study were identified to be potential recombinants. Compared to the 15 isolates from the Abdally area, and the three previously reported KISR isolates of Kuwait, six out of sixteen Al Wafra isolates showed an insertion of 19 extra nucleotides near the 5′-end. There are also four nucleotide variations before the 19-extra-nucleotides. The additional 19 nucleotides observed in nine isolates indicate that these isolates might have resulted from a single gene recombination/insertion event. Molecular phylogeny based on complete genome sequences of TYLCV isolates suggests transboundary movement of virus isolates due to geographic proximity. The information presented herein is quite useful for the comprehension of TYLCV biology, epidemiology and would aid in the management of disease in the long run.

Gene editing, especially with clustered regularly interspaced short palindromic repeats associated protein 9 (CRISPR-Cas9), has advanced gene function science. Gene editing’s rapid advancement has increased its medical/clinical value. Due to its great specificity and efficiency, CRISPR/Cas9 can accurately and swiftly screen the whole genome. This simplifies disease-specific gene therapy. To study tumor origins, development, and metastasis, CRISPR/Cas9 can change genomes. In recent years, tumor treatment research has increasingly employed this method. CRISPR/Cas9 can treat cancer by removing genes or correcting mutations. Numerous preliminary tumor treatment studies have been conducted in relevant fields. CRISPR/Cas9 may treat gene-level tumors. CRISPR/Cas9-based personalized and targeted medicines may shape tumor treatment. This review examines CRISPR/Cas9 for tumor therapy research, which will be helpful in providing references for future studies on the pathogenesis of malignancy and its treatment.

The utility of partial nephrectomy (PN) in locally advanced, stage T3 renal cell carcinoma (RCC) is controversial. This retrospective study aimed to review the oncological and functional outcomes of patients with T3a RCC who underwent PN. We included all patients with pT3a stage RCC undergoing either open, laparoscopic, or robotic PN at our center between January 2015 and 2023. A Wilcoxon rank sum test was utilized to compare nephrectomy types (radical nephrectomy [RN] vs PN). Survival analysis was conducted using Kaplan–Meier plots and a log-rank test. P-value < 0.05 indicated statistical significance. There were no significant differences in demographic characteristics between the RN and PN groups, except age (53.0 vs 6.5, respectively; P = 0.012) and body mass index (28.7 vs 34.3, respectively; P = 0.020). Furthermore, there were also no significant differences in the rates of local recurrence (P = 0.597), metastatic progression (P = 0.129), and chemotherapy use (P = 0.367) between nephrectomy types. Patient survival did not differ significantly based on the type of nephrectomy (log-rank P-value = 0.852). Together, our findings indicated that PN and RN yield near-equivalent oncological outcomes in terms of local recurrence, metastasis, and overall survival rates among pT3a RCC patients during a nearly 3-year follow-up period.

This retrospective study aims to describe the characteristics of renal cell carcinoma (RCC) in Saudi Arabia, in terms of epidemiology, clinical presentation, tumor subtype, Fuhrman grade, tumor size and stage, and overall survival. A total of 431 adult patients with a histopathological diagnosis of RCC between 2015 and 2023 were included in the analysis. Most patients (72.4%) had clear cell tumors, followed by chromophobe (15.1%) and papillary (12.5%) subtypes. In males, papillary RCC (85.2%) was more common compared to clear cell (59.8%) and chromophobe (67.7%) subtypes. Significant differences were observed in median body mass index (BMI) across tumor subtypes, and papillary tumor patients exhibited the highest incidence of hematuria (33.3%) compared to other subtypes. The Fuhrman grade also varied significantly among RCC types. Survival times were found to be lower for patients with papillary tumors. No significant difference was observed based on patients’ nationality. This study can inform clinical decision-making on patient prognosis and management as well as public health efforts aimed at reducing the alarming rise of RCC incidence.

Deep learning and image processing are used to classify and segment breast tumor images, specifically in ultrasound (US) modalities, to support clinical decisions and improve healthcare quality. However, directly using US images can be challenging due to noise and diverse imaging modalities. In this study, we developed a three-step image processing scheme involving speckle noise filtering using a block-matching three-dimensional filtering technique, region of interest highlighting, and RGB fusion. This method enhances the generalization of deep-learning models and achieves better performance. We used a deep learning model (VGG19) to perform transfer learning on three datasets: BUSI (780 images), Dataset B (162 images), and KAIMRC (5693 images). When tested on the BUSI and KAIMRC datasets using a fivefold cross-validation mechanism, the model with the proposed preprocessing step performed better than without preprocessing for each dataset. The proposed image processing approach improves the performance of the breast cancer deep learning classification model. Multiple diverse datasets (private and public) were used to generalize the model for clinical application.

Medication-related osteonecrosis of the jaw (MRONJ) is a major problem that can occur in people taking certain medications such bisphosphonates and denosumab. It can be used to treat osteoporosis or cancer. Bisphosphonate exposure, dental diseases and procedures, age, sex, anatomical factors, medical issues, and hereditary factors are all variables that enhance the risk of MRONJ. Even though MRONJ and antiresorptive medications have a close association, the pathophysiology of MRONJ is unknown. Careful dental preparation and oral hygiene instructions significantly minimize the risk of osteonecrosis of the jaw (ONJ). It is ideal to start antiresorptive treatment after the completion of required dental treatment; it is not contraindicated and carries low risk in patients who are on oral antiresorptive medications for less than three years. Drug holidays are one proposed solution to address MRONJ. However, there is still inadequate evidence to support their effectiveness. The objectives of this literature review are to recognize the main diagnostic principles and risk factors and to review the pathophysiology, protective procedures and treatment modalities related to MRONJ.The following topics are covered in the review: epidemiology, diagnostic criteria, risk factors, pathogenesis and mechanism, MRONJ staging and symptoms, clinical and radiographic findings, treatment strategies, prevention and drug holiday.

Human papillomavirus (HPV) genotype distribution varies according to the assessment method and the population targeted. This study aimed to assess HPV infection prevalence in women aged 23 to 82 with abnormal cytology attending King Fahad Medical City (KFMC), Riyadh, Saudi Arabia, using retrospective data collected from January 2021 to December 2022. Cytological distribution included 155 samples of atypical squamous cells of undetermined significance (ASCUS) (n = 83), low-grade squamous intraepithelial lesion (LSIL) (n = 46), high-grade squamous intraepithelial lesion (HSIL) (n = 14), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) (n = 10), and squamous cell carcinoma (SCC) (n = 2). All samples were submitted to HPV detection and genotyping using Xpert HPV assay specimens. The most prevalent epithelial abnormalities were ASCUS (53.50%). Positive HPV infection results were observed in 52.9% of the samples. The highest prevalence of HPV genotypes, accounting for 31%, was attributed to the other high-risk genotypes, including 31, 33, 35, 39, 51, 52, 56, 58, 59, 66, and 68, followed by high-risk genotype 16, which counted in 11.60% of cases. Individuals who tested positive for HPV 16 were at a high risk of ASC-H, HSIL, and LSIL. Those testing positive for HPV 18–45 exhibited an elevated risk of LSIL, and those with positive results for other high-risk HPV genotypes were at an increased risk of ASCUS and LSIL, suggesting a low oncogenic potential. The results suggest that the percentage of association between samples with abnormal cervical presentation and negative high-risk HPV diagnosis is noticeably increasing. This underscores the need for effective screening programs and an understanding of the impact of specific HPV genotypes on cervical abnormalities.

This article proposes a flexible hardware accelerator optimized from a throughput and area point of view for the computationally intensive part of elliptic curve cryptography. The target binary fields, defined by the National Institute of Standards and Technology, are GF(2163), GF(2233), GF(2283), GF(2409), and GF(2571). For the optimization of throughput, the proposed accelerator employs a digit-parallel multiplier. The size of the digit is 41 bits. The proposed accelerator has reused the multiplication and squaring circuit for area optimization to compute modular inversions. Flexibility is included using three additional buffers on top of the proposed accelerator architecture to load different input parameters. Finally, a dedicated controller is used to optimize control signal handling. The architecture is modeled using Verilog and implemented up to the post-place-and-route level on a Xilinx Virtex-7 field-programmable gate array. The area utilization of our accelerator in slices is 1479, 1998, 2573, 3271, and 4469 for m=163 to 571. The time needed to perform one-point multiplication is 7.15, 10.60, 13.26, 20.96, and 30.42 μs. Similarly, the throughput over area figures for the same key lengths are 94.56, 47.21, 29.30, 14.58, and 7.35. Consequently, achieved results and a comprehensive performance comparison show the suitability of the proposed design for constrained environments that demand throughput/area-efficient implementations.

The adoption of emerging technologies in healthcare systems plays a crucial part in anti-obesity initiatives. COVID-19 has intensified the Body Mass Index (BMI) discourses in AI (Artificial Intelligence)-powered social media. However, few studies have reported on the influence of digital content on obesity prevention policies. Understanding the nature and forums of obese metaphors in social media is the first step in policy intervention. The purpose of this paper is to understand the mutual influence between obesity and COVID-19 and determine its policy implications. This paper analyzes the public responses to obesity using Twitter data collected during the COVID-19 pandemic. The emotional nature of tweets is analyzed using the NRC lexicon. The results show that COVID-19 significantly influences perceptions of obesity; this indicates that existing public health policies must be revisited. The study findings delineate prerequisites for obese disease control programs. This paper provides policy recommendations for improving social media interventions in health service delivery in order to prevent obesity.

This paper proposes a novel hardware design for a compact crypto processor devoted to elliptic-curve point multiplication over GF(2233). We focus on minimizing hardware usage, which we obtain using an iterative bit–serial finite field modular multiplier for polynomial coefficient multiplication. The same multiplier is also used for modular squares and inversion computations, further optimizing the hardware footprint. Our design offers flexibility by permitting users to load different curve parameters and secret keys while keeping a low-area hardware design. To efficiently generate the control signals, we utilize a finite-state-machine-based controller. We have implemented the proposed crypto processor on Virtex-6 and Virtex-7 FPGA devices, and we have evaluated its performance at clock frequencies of 100, 50, and 10 MHz. Specifically, for one point multiplication computation on Virtex-7 FPGA, our crypto processor uses 391 slices, attains a maximum frequency of 161 MHz, has a latency of 4.45 ms, and consumes 77 mW of power. These results, along with a comparison to state-of-the-art designs, clearly demonstrate the practicality of our crypto processor for applications requiring efficient and compact cryptographic computations.

Background: Sphingosine Phosphate Lyase Insufficiency Syndrome SPLIS is a recently described condition, which is associated with loss of function mutations in SGPL1, encoding sphingosine-1-phosphate lyase. In 2017, several groups reported this novel childhood syndrome that featured a wide range of presentations including fetal hydrops, steroid-resistant nephrotic syndrome (SRNS), primary adrenal insufficiency (PAI), rapid or insidious neurological deterioration, immunodeficiency, acanthosis and endocrine abnormalities. Case Presentation: A 7-year-old boy was presented to us with primary adrenal insufficiency on hydrocortisone following pediatrics endocrinology at our hospital. Genetic testing identified a homozygous variant of sphingosine-1-phosphate lyase 1 (NM 003901: exon8: c.665G>A: p.R222Q). At the same time, he was found to have nephrotic syndrome, and renal function rapidly deteriorated. Biopsy of the right kidney showed focal segmental glomerulosclerosis with collapsing features and acute interstitial nephritis. Later, he received a living- related renal transplant. He is doing well after the transplant. Conclusion: Patients with primary adrenal insufficiency should be carefully followed to develop nephrotic syndrome features, and molecular testing is the key to the diagnosis of the underlying etiology. This is the first reported case with sphingosine-1-phosphate lyase 1 that underwent renal transplantation in our region. [JBCGenetics 2021; 4(1.000): 48-50]

Modern wheelchairs, with advanced and robotic technologies, could not reach the life of millions of disabled people due to their high costs, technical limitations, and safety issues. This paper proposes a gesture-controlled smart wheelchair system with an IoT-enabled fall detection mechanism to overcome these problems. It can recognize gestures using Convolutional Neural Network (CNN) model along with computer vision algorithms and can control the wheelchair automatically by utilizing these gestures. It maintains the safety of the users by performing fall detection with IoT-based emergency messaging systems. The development cost of the overall system is cheap and is lesser than USD 300. Hence, it is expected that the proposed smart wheelchair should be affordable, safe, and helpful to physically disordered people in their independent mobility.

Enamel demineralization and white-spot lesions (WSLs) around the orthodontic brackets are common clinical complications after orthodontic fixed appliance therapy. WSLs form mainly due to plaque deposition around the brackets during the orthodontic treatment period. This study was designed to compare and evaluate the efficacy of two different remineralization agents on WSLs, which are “Clinpro 5000 and Colgate Sensitive Pro-Relief”. 27 caries-free human premolar teeth were collected after extraction for orthodontic purposes. The crowns were set in acrylic resin, and the entire surfaces were coated with nail varnish apart from an area of 4 × 4 mm on the buccal surface. The surface microhardness (SMH) was measured using the Vickers microhardness testing machine at baseline, after demineralization, and after treatment. Then, the different SMH values were statistically analyzed using mixed-effects linear regression. All samples were immersed in demineralizing solution for ten days to create WSLs, and then the teeth were allocated randomly into one of the three groups: Group 1 (control group-immersed in artificial saliva), Group 2 (treated with Colgate sensitive Pro-Relief toothpaste), and Group 3 (Clinpro 5000 toothpaste). Cycles of treatment were done for 5 minutes every 12 hours for 14 days. The samples were stored in freshly prepared artificial saliva between cycles. The mixed-effects model was used to quantify the effect of different remineralization agents. All statistics were computed using STATA software (version14.1; Stata, College Station, TX). All statistical tests were two-tailed and interpreted at the 0.05 significance level. Both agents improved the surface hardness. Clinpro 5000 improved the surface hardness by 12.7 (P value 0.012), and Colgate Sensitive Pro-Relief improved surface hardness by 18.2 (P value

Inhibition of mTOR (mechanistic Target Of Rapamycin) signaling by rapamycin promotes healthspan and longevity more strongly in females than males, perhaps because inhibition of hepatic mTORC2 (mTOR Complex 2) specifically reduces the lifespan of males. Here, we demonstrate using gonadectomy that the sex-specific impact of reduced hepatic mTORC2 is not reversed by depletion of sex hormones. Intriguingly, we find that ovariectomy uncouples lifespan from metabolic health, with ovariectomized females having improved survival despite paradoxically having increased adiposity and decreased control of blood glucose levels. Further, ovariectomy unexpectedly promotes midlife survival of female mice lacking hepatic mTORC2, significantly increasing the survival of those mice that do not develop cancer. In addition to identifying a sex hormone-dependent role for hepatic mTORC2 in female longevity, our results demonstrate that metabolic health is not inextricably linked to lifespan in mammals, and highlight the importance of evaluating healthspan in mammalian longevity studies.

This is an update to the previously published Saudi guidelines for the evaluation and medical and surgical management of patients diagnosed with prostate cancer. Prostate cancer is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence levels based on a comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Local factors, such as availability, logistic feasibility, and familiarity of various treatment modalities, have been taken into consideration. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health-care policymakers in the management of patients diagnosed with adenocarcinoma of the prostate.

This is an update to the previously published Saudi guidelines for the evaluation and medical/surgical management of patients diagnosed with urothelial cell carcinoma of the urinary bladder. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The guidelines are presented with their accompanying supporting evidence level, which is based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health-care policymakers in the management of patients diagnosed with urothelial cell carcinoma of the urinary bladder.

In this report, we update the previously published Saudi guidelines for the evaluation and medical and surgical management of renal cell carcinoma. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The recommendations are presented with supporting evidence level.

This study aims to demonstrate the efficacy of gamification in developing HTML programming skills and academic achievement motivation for 10th-grade students. Despite the significance of computer programming in developing students' thinking, many students still need more motivation to learn it. One of the entertaining strategies of computer programming is gamification. The study used a quasi-experimental design for two groups. The experimental group (N=18) was taught by gamification and the control group (N=17) was taught by the traditional teaching method. The researcher conducted a pre-test to determine the equivalence between groups using a valid and reliable practical test and scale. After three-weeks of teaching, the same test and scale were applied to compare the groups. The result showed statistical differences between the two groups in favor of the experimental group in programming skills and all academic achievement motivation dimensions. This study recommended that using gamification in teaching programming languages to students at different stages would help computer teachers. More research should be conducted to investigate the impact of gamification on teaching different programming languages.

Heat shock response is an essential cellular stress response. Dysregulation of various heat shock proteins (HSPs), within the heat shock response (HSR) pathway, play a vital role in this host-defense mechanism contributing to obesity-induced insulin resistance and type 2 diabetes (T2D). Previously, we have reported changes in the expression levels of several HSPs such as HSP40, HSP60, HSP70, and HSP90 in obese compared with lean individuals. DNAJC27 is a member of the HSP40 protein family that was previously identified as a body mass index (BMI) associated locus in genome-wide association (GWAS) studies. However, not much is known about the changes in DNAJC27 expression levels in obesity and T2D. In the present study, we aimed at understanding changes in DNAJC27 expression levels in plasma, peripheral blood mononuclear cells (PBMCs) and adipose tissue in association with obesity and T2D. A total of 277 individuals enrolled including 160 non-diabetic (96 non-obese and 64 obese) and 117 T2D (45 non-obese and 72 obese) individuals. Plasma level of DNAJC27 was significantly higher in obese individuals (6.28 ± 0.64 ng/mL) compared with non-obese individuals (4.8 ± 0.45 ng/mL) with P = 0.043. Dividing the population based on diabetes status showed that there was a significant increase in the plasma level of DNAJC27 in obese (6.90 ± 1.3 ng/mL) compared with non-obese individuals (3.81 ± 0.43 ng/mL) (P = 0.033) in the non-diabetic group. Similarly, DNAJC27 expression level was also higher in PBMCs and adipose tissue of obese individuals. DNAJC27 was found to be associated with leptin and resistin, adipokines known to be dysregulated in obesity, that stimulate inflammatory processes leading to metabolic disorders. In conclusion, our data show that DNAJC27 is elevated in obese and T2D individuals and was positively associated with obesity biomarkers such as leptin and resistin suggesting that this protein may play a role in the pathophysiology of these disorders.

This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with renal cell carcinoma (RCC). It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and healthcare policy makers in the management of patients diagnosed with RCC.

This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with prostate cancer. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi oncology society and Saudi urological association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with adenocarcinoma of the prostate to.

This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with urothelial cell carcinoma of the urinary bladder. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with urothelial cell carcinoma of the urinary bladder.

This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with testicular germ cell tumors. It is categorized according to the stage of the disease using the tumor-node-metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with testicular germ cell tumors.

In this report, updated guidelines for the evaluation, medical and surgical management of renal cell carcinoma are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7 th edition. The recommendations are presented with supporting evidence level.

In this report, updated guidelines for the evaluation, medical, and surgical management of germ cell tumor of testes are resented. They are categorized according the stage of the disease using the tumor-node-metastasis staging system 7 th edition. The recommendations are presented with supporting level of evidence.

In this report, updated guidelines for the evaluation, medical, and surgical management of transitional cell carcinoma of the urinary bladder are resented. They are categorized according the stage of the disease using the TNM staging system 7 th edition. The recommendations are presented with supporting level of evidence.

In this report, updated guidelines for the evaluation, medical, and surgical management of prostate cancer are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7 th edition. The recommendations are presented with supporting evidence level.

Background Antimicrobial resistance is increasing at an alarming rate. The use of antibiotics without a prescription by a patient or other family members and their inappropriate storage have caused serious health issues as it would lead to antibiotic resistance and exposure to the risk of harmful adverse effects unnecessarily. Therefore, the study aimed to evaluate the current behaviour of antibiotic usage, storage, re-usage and misuse among the residents of Saudi Arabia. Methods This is a cross-sectional study. Our target study population was the residents of Saudi Arabia. Data were collected by an online questionnaire and analysed by SPSS. Results A total of 738 participants answered the online questionnaire from all ages, genders, nationalities, and socioeconomic backgrounds residing in different regions across the Kingdom of Saudi Arabia. 76.42% knew that an antibiotic is a chemical substance used to treat infections. The participants were questioned about when they started using antibiotics, to which 95.66% (n=706) responded after consulting a physician, 3.25% (n=24) said when they felt ill for any reason, and 1.08% (n=8) replied after first attempting herbal medicine. A total of 147 participants admitted that they store excess pills of antibiotics after being prescribed for an infection and reuse them later on for symptoms like sore throat and fever. Conclusions The results indicated that nearly half of the participants used leftover antibiotics. Participants having children in their homes significantly reuse antibiotics. However, one-third of the participants didn’t complete the antibiotics course. A large portion of the population, regardless of age, level of education, or professional background, have continued to store leftover antibiotics after an infection treatment and reuse them once they think they need them for new symptoms. This advice further revises the current measures to fill those gaps and reduce this habit.