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# Background In the realm of healthcare quality, outpatient parenteral antimicrobial therapy (OPAT) has emerged as the gold standard for managing patients who have transitioned from inpatient care but still require extended intravenous antimicrobial treatment. The adoption of OPAT at Al Hada Armed Forces Hospital in Taif, Saudi Arabia, not only bolsters patient satisfaction but also serves as a catalyst for reduced hospitalization durations, lower rates of emergency department readmissions, and an overall reduction in healthcare expenditures. The main objective of this study was to evaluate the effectiveness of OPAT in a tertiary center facility in Saudi Arabia. # Methods In this retrospective investigation, we conducted a thorough review of patient records spanning from November 2020 to October 2021. Our study encompassed all patients who had intravenous antibiotics and were participants in the hospital's OPAT program during this specific timeframe. Our primary goal was to achieve a 20% reduction in the total number of hospital bed days related to long-term antibiotic therapy. # Results The incorporation of OPAT has yielded a multifaceted transformation within the hospital. Over the span of one year, from November 2020 to October 2021, there was a notable decrease in the proportion of patients requiring intravenous antibiotics. This percentage initially dropped from 23% to 12% with the implementation of the OPAT quality improvement project, and later, it reached an even lower 8%. This positive transformation not only had a positive impact on patient care but also led to significant cost savings, exceeding 2 million riyals. These savings were primarily driven by the reduction in hospitalization duration and the more efficient allocation of resources. Moreover, this improvement contributed to the avoidance of 673 patient days of hospitalization, thereby creating additional resources for more critical cases. # Conclusion OPAT has emerged as a pivotal component of Al Hada Armed Forces Hospital's commitment to elevating healthcare quality. This abstract offers a concise insight into the quality-driven impact of OPAT within a specific healthcare context, underlining its capacity to optimize patient care, enhance healthcare efficiency, and elevate resource allocation. Ongoing research and continuous evaluation will play a critical role in refining and expanding the OPAT program while preserving its quality-oriented perspective.

Background: Colonoscopy is a critical and frequently used medical procedure that is essential in identifying colonic and rectal cancers on time. It remains the preferred method for visualizing the colonic and rectal mucosae, enabling the detection of conditions like carcinoma, adenoma, and inflammation. Colorectal cancer is the third most common cancer worldwide, and due to its tendency to present late, screening programs that rely on a sensitive tool like colonoscopy are of utmost importance. Objectives: To evaluate the clinical characteristics and colonoscopic findings, including colorectal cancer, among patients referred to the gastro-enterology unit in Al-Imamain Al-Kadhemain Medical City and determine the most common presenting symptoms of colorectal diseases. Patients and Methods: A study was conducted at the GIT unit of Al-Imamain Al-Kadhemain Medical City from November 2022 to March 2023 involving 120 patients who underwent colonoscopy. The study recorded the presenting complaint and colonoscopy results. The mean and standard deviation were used to express continuous variables, while frequency and percentage were used for categorical variables The difference between means was tested using Welch's t-test, and a P-value less than 0.05 was considered statistically significant. Result: The study included a total of 120 participants, with an average age of 46.57 years. The leading indication for colonoscopy was bleeding per rectum (45%), followed by chronic constipation (26.6%) and chronic abdominal pain (21.6%). The most common pathologies observed during colonoscopy were internal hemorrhoid (18.3%), polyposis (15%), and colorectal cancer (13.3%). Conclusion: Rectal bleeding is the primary reason for conducting colonoscopy and is also the most common symptom of colorectal cancer. During colonoscopy, Internal hemorrhoids are frequently observed, which is the most common cause of rectal bleeding. Polyps and colorectal cancer are the next most frequent causes of rectal bleeding.

Waste management is fundamental to resource and environmental sustainability. Expanded polystyrene (EPS) and polyurethane (PU) waste plastics were recycled and applied as binder in emulsion paint formulation. The recycled polystyrene (rPS) and polyurethane (rPU) were blended into composite resins, where toluene was used as the solvent. The blends of rPS and rPU were optimized, while some physicochemical properties of the composite blends (rPS/PU) were evaluated. The results showed that the incorporation of rPU into rPS increased the viscosity (1818 mPa–3924 mPa), rate of gelation (dry-to-touch time: 15 min–0.25 min), moisture content (2.7%–8.1%), moisture uptake (3.2%–5.0%), solid content (48%–53.4%) and density (0.82 g/cm3 to 1.050.82 g/cm3) of the rPS/PU composite resins. Characterization was carried out using Fourier transform infrared (FT-IR) spectroscopy, X-ray diffraction (XRD), thermogravimetric analysis (TGA), scanning electron microscope (SEM), and atomic force microscopy (AFM). The results summarily showed that there are interactions among the rPS and rPU molecules in the composite, where complimentary structural and morphological characteristics were also achieved. The composite resin also exhibited superior bond strength (0.5–4.24 Mpa) on wood, cast mortar, ceramic, and steel surfaces due to its stronger intra- and inter-surface interactions compared to the neat rPS resin. The composite resin was used as a binder in the formulation of emulsion paint. The paint exhibited stronger resistance to water, among other superior properties, when compared to the paints formulated using neat rPS and conventional polyvinyl acetate (PVA) resins. The reduction of plastic waste in this study holds potential for the production of highly water-resistant emulsion paint for outdoor and indoor applications.

Objetivo: Investigar los posibles efectos del período COVID-19 en la frecuencia y el curso clínico de los casos de isquemia mesentérica aguda (IAM). Material y métodos: Se incluyeron un total de 35 pacientes tratados y seguidos con diagnóstico de IAM durante 44 meses. Resultados: La edad media de los pacientes fue de 69 ± 12 años. De estos pacientes, 22 eran hombres (63%). La causa más frecuente de IAM en los pacientes fue la embolia/trombosis arterial (68.6%). Treinta y tres (94%) de los pacientes fueron intervenidos quirúrgicamente. La duración de los períodos pre-COVID-19 y COVID-19 fue igual a 22 meses, y 18 (51%) de los pacientes ingresaron durante el período pandémico. La tasa de mortalidad de los pacientes ingresados durante el periodo COVID-19 también fue significativamente mayor que la de los pacientes ingresados durante el periodo pre-COVID-19 (61% y 29%) (p = 0.05). Conclusiones: Si bien el período COVID-19 no provocó un aumento significativo en el número de casos de IAM en comparación con el período pre-COVID-19, la tasa de mortalidad fue mayor en este período. Se cree que se requieren más estudios para investigar la causa de este aumento en la tasa de mortalidad durante el período pandémico.

Background and Study Aim. Agility performance, which is a skill related to fast change of direction, explosiveness, and quickness, is a vital performance component for team sports. Illuminating factors that affect agility is substantial to understand the ability requirements and improve. This study aims to investigate correlations of the body analyze parameters and agility performance. Material and Methods. One hundred twenty three young participants (93 male, 30 female) were included in this research. Height, weight, fat (%), fat (kg), fat-free mass (FFM), muscle mass, total body water (TBW, kg, and %), bone mass, basal metabolic rate (BMR), metabolic age, visceral rating, and body mass index (BMI) measured for all participants. Illinois Agility Test (IAT) was used to analyze agility performance. A questionnaire including questions about the physical activity level of participants was applied to all participants after IAT. Results. Results showed that height was a dominant determinant of IAT performance. There were significant positive correlations between height (negative correlation in women), body weight, fat percentage, fat mass, and visceral rating level (p < 0.05). TBW (%) had a negative relation with IAT duration (p < 0.001). There was a statistically significant difference in terms of IAT between the participants who stated their physical activity levels as low, medium and high (p = 0.025*). Increased daily physical activity level and daily step count increased the agility performance (p < 0.05). Conclusions. Coaches and athletes should be considered especially body weight, fat (%), hydration status, and daily physical activity level to improve agility performance.

Category: Diabetes Introduction/Purpose: Complex foot and ankle deformities secondary to charcot neuroarthropathy continue to represent a significant challenge and management quandary. This is due to the combination of medical co-morbidities, peripheral neuropathy, immune compromise, and micro/macro vascular issues in addition to the surgical challenge of wide area of injury, progressive deformity and bone resorption. The technique of 'superconstructs' have been proposed as a method of combating these challenges with deformity correction achieved through fusion out with the zone of injury and fixation in unaffected 'normal' bone. We present here the outcomes of this technique at one year using internal fixation alone, external fixation alone and the novel technique of combined internal and external fixation using combined internal and external fixation internal/ external fixation only at one year. Methods: Retrospective two-surgeon case series with all cases jointly operated upon. Cases identified from a locally held charcot patient registry. Patients undergoing charcot foot and ankle reconstruction from 2017 to 2020 included. No exclusion criteria outlined. Patient demographics and comorbidities were collected, pre-op radiological markers (meary's angle) measured and repeated at 6-12 /52 and 1 year. Patient outcomes were recorded of ulcer recurrence, limb salvage, pain score, stable heel, able to ambulate, need for revision surgery, fusion and surgical complications. Proms are awaited for all patients. Results: 19 cases from 18 patients undergoing reconstruction identified. 18 cases were included for analysis. Fourteen patients were broadsky 1, one broadsky 2, one broadsky 3 and two broadsky 4. 3 patients had internal fixation, 5 external fixation and 10 combined internal and external fixation. Limb salvage was 94% with one amputation. Mortality rate was nil. All patients reported improved pain scores, a stable heel and were ambulating. No recurrence of ulceration reported and no prolonged antibiotic use. Mearys angle improved in all groups: Internal fixation pre-op -9.6o, post op 2.6o and 1 year -1o, external fixation pre-op -20o, post op -6o and 1 year -12o, IF + EF pre-op -24.6o, post op 1.2o and 1 year -2.3o. Fusion rate was 100% with average time to fusion 154 days and a range of 360 - 52. Complications of 2 tibial fractures and metalwork removal with delayed wound healing were noted. Conclusion: The outcome of all three methods is positive with 94% limb salvage, 100% fusion / ambulation/ improved pain and ulcer free at 1 year. Mearys angle is improved at one year however there is a loss of correction noted with external fixation alone. These results are encouraging and support the use of combined internal and external fixation in these complex cases. The added benefit of this technique of maintaining ambulation, avoiding the complications of nonweightbearing all whilst maintaining the structure of the reconstructed foot are promising. The complications reported were in the first 3 patient and represent a learning curve.

Aberrant splicing is a major contributor to rare disease, but detection accuracy using current methods is limited. Here, the authors develop an algorithm that detects aberrant splicing and intron retention events from RNA-seq data and apply it to diagnosis in mitochondrial disease.

Colorectal cancer (CRC) remains one of the most lethal human malignancies, and pursuit of new therapeutic targets for treatment has been a major research focus. Cyclin‐dependent kinase 9 (CDK9), which plays a crucial role in transcription, has emerged as a target for cancer treatment. CDKI‐73, one of the most potent and pharmacologically superior CDK9 inhibitors, has demonstrated excellent anti‐tumour efficacy against several types of cancers. In this study, we evaluated its therapeutic potential against CRC. CDKI‐73 elicited high cytotoxicity against all colon cancer cell lines tested. Cell cycle and apoptosis analysis in HCT 116 and HT29 cells revealed that CDKI‐73 induced cell death without accumulation of DNA at any phase of the cell cycle. Moreover, it caused depolarisation of mitochondrial membrane, leading to caspase‐independent apoptosis. Knockdown by shRNA demonstrated the CDK9‐targeted mechanism of CDKI‐73, which also affected the Mnk/eIF4E signalling axis. In addition, RT‐qPCR analysis showed that CDKI‐73 down‐regulated multiple pro‐survival factors at the mRNA level. Its in vivo anti‐tumour efficacy was further evaluated in Balb/c nude mice bearing HCT 116 xenograft tumours. CDKI‐73 significantly inhibited tumour growth (***P

Category: Diabetes; Trauma Introduction/Purpose: Management of complex foot and ankle deformities secondary to charcot neuroathropathy represents a significant challenge. This is a consequence of medical co-morbidities, vascular disease, peripheral neuropathy, and immune compromise with the surgical challenges of progressive bony defomity and bone resorption. To combat these challenges ‘superconstructs’ have been developed to improve fixation. These aim for fusion beyond the zone of injury with adequate deformity correction all whilst maintaining viability of the soft tissue envelope and mechanical function. This can be achieved with internal fixation using indication specific plates and beaming techniques, external fixation with a circular frame or a combination of the two. The aim of this study was to evaluate of a tertiary referral hospital in the operative management of charcot neuroarthopathy. Methods: This is a retrospective two surgeon case series with all cases jointly operated upon. Cases were identified from a locally held diabetic patient registry as those undergoing charcot foot and ankle reconstruction from 2017 to 2019. No exclusion criteria were outlined. Patient demographics and co-morbidities were collected, pre-op radiological markers (meary’s angle) measured and repeated at 6 weeks and one year. Pre-op radiographs were classifed accroding to brodsky classification. Patient outcomes were recorded of amputation, mortality, ulcer recurrence, reported pain, stable heel, ability to ambulate, need for revision surgery, need for prolonged antibiotics, fusion and surgical complications. PROMS were requested and still awaited at time of submission. Results: Eleven Cases were identified from ten patients, all were included for analysis. Three patients had internal fixation, two had external fixation and six had combined internal with external fixation. Eight patients were Brodsky 1, two patients were Brodsky 3 and one patient was Brodsky 2. Limb salvage was 100% with nil amputations, mortality 0%, ulcer recurrence 0%, 100% improved pain score, and 100% with a stable heel. Meary’s angle improved by a mean of 14o from -16o to -2o at 1 year. Fusion rate determined clinically and radiologically with X-ray was 100% with mean of 129 days and range of (360 - 52). Mean follow-up 454 days and range (547-417). Complications of 2 tibial fractures and 1 deep infection with delayed wound healing. Conclusion: The outcomes of using all three methods is positive with 100% limb salvage, 100% fusion rate, 100% ulcer free and maintenace of Meary’s angle at 1 year post op. We believe that combined internal and external fixation, not widely reported in the literature, is a good option in these cases. The complications reported here were in the first three patients undergoing said technique and represent a learning curve.

The aim of the paper is to determine the factors affecting the economic development levels of selected countries using bayesian ordered probit model. For this aim, Human Development Indices of 130 countries are involved in the analysis with respect to seven independent variables for the period of 2009-2014. According to the results obtained from the Bayesian ordered probit model, it was observed that while the variables of rural population, health expenditure, GDP, internet users, life expectancy at birth, share of expected years of schooling seats in parliament had a positive effect on human development level in short term; the variables of health expenditure, GDP, internet users, share of expected years of schooling and seats in parliament had a positive effect, but rural population and life expectancy at birth had a negative impact on human development in long term.Keywords: Human Development Indices, Ordered probit, Bayesyen, Economic developmentJEL Classifications: O150, C250, C110, O100

BackgroundThe Critical Assessment of Genome Interpretation (CAGI) aims to advance the state-of-the-art for computational prediction of genetic variant impact, particularly where relevant to disease. The five complete editions of the CAGI community experiment comprised 50 challenges, in which participants made blind predictions of phenotypes from genetic data, and these were evaluated by independent assessors.ResultsPerformance was particularly strong for clinical pathogenic variants, including some difficult-to-diagnose cases, and extends to interpretation of cancer-related variants. Missense variant interpretation methods were able to estimate biochemical effects with increasing accuracy. Assessment of methods for regulatory variants and complex trait disease risk was less definitive and indicates performance potentially suitable for auxiliary use in the clinic.ConclusionsResults show that while current methods are imperfect, they have major utility for research and clinical applications. Emerging methods and increasingly large, robust datasets for training and assessment promise further progress ahead.

7-(3-Chlorophenylamino)-1-cyclopropyl-6-fluoro-8-nitro-4-oxo-1,4-dihydro-quinoline-3-carboxylic acid (2) was prepared and fully characterized by NMR, IR, and MS. Compound 2 exhibited good antibacterial activity against gram-positive standard and resistant strains.

Background:

Background: Cyclin-dependent kinase 9 (CDK9) stimulates oncogenic transcriptional pathways in cancer and CDK9 inhibitors have emerged as promising therapeutic candidates. Methods: The activity of an orally bioavailable CDK9 inhibitor, CDKI-73, was evaluated in prostate cancer cell lines, a xenograft mouse model, and patient-derived tumor explants and organoids. Expression of CDK9 was evaluated in clinical specimens by mining public datasets and immunohistochemistry. Effects of CDKI-73 on prostate cancer cells were determined by cell-based assays, molecular profiling and transcriptomic/epigenomic approaches. Results: CDKI-73 inhibited proliferation and enhanced cell death in diverse in vitro and in vivo models of androgen receptor (AR)-driven and AR-independent models. Mechanistically, CDKI-73-mediated inhibition of RNA polymerase II serine 2 phosphorylation resulted in reduced expression of BCL-2 anti-apoptotic factors and transcriptional defects. Transcriptomic and epigenomic approaches revealed that CDKI-73 suppressed signaling pathways regulated by AR, MYC, and BRD4, key drivers of dysregulated transcription in prostate cancer, and reprogrammed cancer-associated super-enhancers. These latter findings prompted the evaluation of CDKI-73 with the BRD4 inhibitor AZD5153, a combination that was synergistic in patient-derived organoids and in vivo. Conclusion: Our work demonstrates that CDK9 inhibition disrupts multiple oncogenic pathways and positions CDKI-73 as a promising therapeutic agent for prostate cancer, particularly aggressive, therapy-resistant subtypes. [ABSTRACT FROM AUTHOR]

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