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Abstract Digital transformation is a growth strategy that has attracted a significant amount investment and is projected to boost the global economy by 2030. However, organizations face challenges in their efforts to develop effective approaches to digital transformation because of the constant need for new strategic choices. Dynamic capabilities and change management are vital with respect to organizations’ ability to maintain competitiveness in the changing environment established by digital technologies. The effective management of these changes is crucial, and failure is often the result of the absence of a suitable change management model. This study examines the significance of dynamic capabilities in digital transformation and explores the mediating role of a well-defined approach to change management in the context of digital projects. A quantitative research approach is used to investigate a population of 902 managers and team leaders working in the telecommunications sector in Yemen. A questionnaire is developed and administered to a sample of 350 participants, and the data collected were analyzed via SmartPLS. The findings reveal a positive relationship between dynamic capabilities and the successful implementation of digital transformation initiatives. Effective change management techniques facilitate digital transformation by playing a mediating role in the abovementioned relationship. The results of this research provide valuable insights into the theoretical framework underlying this topic by integrating dynamic capabilities, change management, and digital transformation. This information can help decision-makers in the telecommunications sector develop a roadmap for successful digital transformation projects in their organizations.

Abstract Introduction The prevalence of low back pain among nurses is notably high, which negatively affects their job performance and overall work quality. Aim of study This research aimed to evaluate the prevalence of low back pain among nurses in Nablus city and investigate how personal and work-related factor and the occurrence of low back pain in this population. Method Employing a cross-sectional study design, we employed validated instruments, including the Nordic Musculoskeletal Disorder Questionnaire. The study encompassed 258 nursing employees from both the largest and smallest Ministry of Health (MOH) and private sector hospitals in Nablus city, West Bank, Palestine. Data were collected through a self-administered questionnaire. Result A total of 258 nurses participated in the study, yielding a response rate of 98%. The lifetime prevalence of Low Back Pain (LBP) was 82% (n = 212) throughout their life. Additionally, the prevalence of LBP in the 12 months preceding data collection was 78% (N = 201), 71% (N = 182) in the month leading up to the study, and 61% (N = 156) on the day of data collection. Conclusion The study disclosed a high prevalence of low back pain among nurses, underscoring the urgency for effective solutions. These findings highlight the need for more comprehensive research to better understand and address this issue.

Abstract Purpose The aim of this study is to investigate and highlight the most important factors influencing the candidate’s selection for residency matching by program directors of surgical and non-surgical specialties in Saudi Arabia. Method This cross-sectional study was conducted in the Central, Eastern, Western, Northern, and Southern regions of Saudi Arabia from February 1, 2023, to August 31, 2023. A total of sixty-one program directors completed a questionnaire, which was adapted and validated from a previous study with permission and tailored to meet the objectives of this research. Results The mean age of the study population was 40.2 years, with surgical specialty program directors being older at 41.7 years and nonsurgical specialty program directors being younger at 39.6 years. In both cases, the highest importance was given to ‘Applicant’s attitude and professionalism’, followed in surgical specialties by ‘Doing clinical rotations in the PD institution’ and ‘Performance in clinical rotation during internship’ in non-surgical specialties. with a mean score of 4.13 and 4.95, respectively. The importance of ‘The impression/opinion of current residents’ has had a certain importance in both specialties. While the number of research projects was prioritized more by surgical PDs (38.6%) compared to non-surgical PDs (29.4%). Conclusion This study highlights the critical role of professionalism and a positive attitude in clinical rotations and interviews for program acceptance in Saudi Arabia. The significance of letters of recommendation and research focus varies between surgical and non-surgical program directors. Program directors should adopt effective recruitment strategies that incorporate practical implications during internships.

A 46-year-old farmer living in a rural area, who sustained an injury to his left foot 10 years ago, consulted due to progressive swelling of the same foot. An MRI revealed the “dot-in-circle” sign, suggestive of mycetoma of the foot, also known as Madura foot. This condition primarily affects soft tissues and bones and can occasionally lead to potentially severe visceral complications. Foot involvement is predominant, observed in 80% of cases.

A rare disorder called congenital infiltrating lipomatosis of the face is characterized by a diffuse fatty infiltration of the soft tissues of the face. Muscle involvement and related bony hyperplasia may coexist. This particular form of lipomatous tumor is rare and typically appears in childhood. It is congenital in nature. Collections of mature, nonencapsulated lipocytes that infiltrate local tissues and frequently recur following surgery define congenital infiltrating lipomatosis, a unique clinicopathologic condition. The best modalities are, CT scan and MRI since they can determine the extent of the lesions and reveal their fat content. The treatment of this disease is surgical as soon as possible to restrict their infiltrative growth and improve the appearance of the face. We describe a case of massive facial invading lipoma that was investigated using MRI.

The case presented illustrates a very rare chronic granulomatous disease called the Madura foot or also called mycetoma. It is a chronic granulomatous disease, caused by a contained infection that penetrates the subcutaneous tissues and spreads to the nearby bone by damaging the affected area's vascularization. Early diagnosis is greatly aided by clinical history and imaging, especially if the “dot-in-circle” sign—a pathognomonic marker of mycetoma—is seen on the MRI. Compared to ordinary radiographs, computed tomography offers a more accurate study of changes in the bone. In order to apply the appropriate course of treatment, it is critical to identify the causal species, which can be caused by either a true fungus (eumycetoma) or a bacterium Actinomyces (Actinomycetoma). Treatment can be extremely challenging and can even result in amputation, particularly if the diagnosis is delayed.

Central nervous system (CNS) tuberculosis is a postprimary form of tuberculosis with high mortality and morbidity rates, even with early diagnosis and treatment. Focal tuberculous cerebritis is extremely rare, typically occurring in patients without AIDS, and often associated with tuberculous meningitis. In endemic regions, it should be a primary consideration when encountering cerebral anomalies suggestive of granulomatous conditions. Its meningeal pseudo-tumor form poses a significant diagnostic challenge.We present the case of a 26-year-old man who arrived at the emergency room with cerebellar and pyramidal syndrome. Cerebral magnetic resonance imaging (MRI) revealed an expansive lesion in the right hemicerebellum with glove-finger edema and leptomeningeal thickening. Given the MRI findings and associated lung involvement, the diagnosis of tuberculosis was strongly suggested in our epidemiological context. Due to contraindications for lumbar puncture, high surgical risk, and strong clinical and radiological suspicion, antituberculous treatment was initiated in collaboration with neurologists and infectious disease specialists.The clinical and radiologic manifestations of CNS tuberculosis can mimic other infectious and noninfectious neurological conditions, as seen in our patient. Thus, familiarity with the imaging presentations of CNS tuberculosis among infectious disease specialists and radiologists is crucial for prompt and accurate diagnosis.

Background: T-LAK cell-originated protein kinase (TOPK), a member of the MEK3/6-related mitogen-activated protein kinase kinase (MAPKK) family, is highly overexpressed in various cancers. This overexpression is linked to the mitotic phase of the cell cycle, highlighting its potential as a prognostic marker and therapeutic target. Unlike many other cancer targets, TOPK exhibits limited expression or is even absent in non-proliferative tissues. Therefore, TOPK inhibitors hold promise for developing anticancer agents with high selectivity and specificity for cancer cells, potentially leading to fewer side effects compared to conventional therapies. This study builds on our previous success in identifying TOPK inhibitors and aims to optimize them for improved potency. Methods: An integrated approach combining computational modeling and organic synthesis was employed. Ninety-two analogs of the lead compound (N2 ,N7 -dibenzyl-9-oxo-9H-fluorene-2,7-disulfonamide) were designed virtually and assessed for binding affinity to TOPK using docking simulations. Eight top-scoring analogs were synthesized and their inhibitory activity against TOPK was evaluated in vitro. Results: The in-silico analysis identified eight promising analogs. However, the most active synthesized analog (compound 10) exhibited moderate inhibitory activity (IC50 = 86 µM) compared to the lead compound (IC50 = 54 µM). Conclusion: While the computational approach identified potential candidates, further optimization of the synthetic analogs is necessary to achieve superior TOPK inhibitory activity. This study highlights the value of a combined computational and synthetic strategy for TOPK inhibitor development. TOPK inhibitory activity. This study highlights the value of a combined computational and synthetic strategy for TOPK inhibitor development.

Abstract Structural health monitoring ensures the safety and longevity of structures like buildings and bridges. As the volume and scale of structures and the impact of their failure continue to grow, there is a dire need for SHM techniques that are scalable, inexpensive, can operate passively without human intervention, and are customized for each mechanical structure without the need for complex baseline models. We present a novel “deploy-and-forget” approach for automated detection and localization of damage in structures. It is a synergistic integration of entirely passive measurements from inexpensive sensors, data compression, and a mechanics-informed autoencoder. Once deployed, the model continuously learns and adapts a bespoke baseline model for each structure, learning from its undamaged state’s response characteristics. After learning from just 3 hours of data, it can autonomously detect and localize different types of unforeseen damage. Results from numerical simulations and experiments indicate that incorporating the mechanical characteristics into the autoencoder allows for up to a 35% improvement in the detection and localization of minor damage over a standard autoencoder. Our approach holds significant promise for reducing human intervention and inspection costs while enabling proactive and preventive maintenance strategies. This will extend the lifespan, reliability, and sustainability of civil infrastructures.

Abstract The molecular mechanisms that link stress and biological rhythms still remain unclear. The habenula (Hb) is a key brain region involved in regulating diverse types of emotion-related behaviours while the suprachiasmatic nucleus (SCN) is the body’s central clock. To investigate the effects of chronic social stress on transcription patterns, we performed gene expression analysis in the Hb and SCN of stress-naïve and stress-exposed mice. Our analysis revealed a large number of differentially expressed genes and enrichment of synaptic and cell signalling pathways between resilient and stress-naïve mice at zeitgeber 16 (ZT16) in both the Hb and SCN. This transcriptomic signature was nighttime-specific and observed only in stress-resilient mice. In contrast, there were relatively few differences between the stress-susceptible and stress-naïve groups across time points. Our results reinforce the functional link between circadian gene expression patterns and differential responses to stress, thereby highlighting the importance of temporal expression patterns in homoeostatic stress responses.

Pilonidal sinus disease is a frequent and recurrent pathology in young adults, with a male predominance, while malignant transformation of the pilonidal sinus is a rare complication, it occurs in 0.1% of patients, with a poor prognosis. Early surgical removal of the primary lesion remains the best treatment. We report a case of malignant transformation of pilonidal disease into squamous cell carcinoma.

Background: Serum vitamin B12 plays a crucial role in cellular growth, DNA synthesis, and maintaining a healthy nervous system. Its deficiency can lead to various health issues, including cardiovascular problems. The reference range for vitamin B12 varies between populations due to cultural, genetic, and dietary differences. Methods: A cross-sectional study was conducted on 127 healthy An-Najah National University students aged between 18 and 25. Blood samples were collected, and a questionnaire assessed factors affecting vitamin B12 levels. Serum vitamin B12 levels were measured using ACCUBIND ELIZA microwells. Results: The study found a reference range for serum vitamin B12 of 136–640 pg/mL (5th to 95th percentile) among the studied population, which differed from the manufacturer’s claimed range of 200–835 pg/mL. Gender did not significantly affect the reference intervals. Conclusion: The study highlights the importance of establishing local reference values for laboratory tests like vitamin B12 due to variations in demographics. Further research in different Palestinian regions and age groups with larger sample sizes is recommended to refine these reference values.

Abstract Motivated by certain results known from the literature, in this paper we give several new dynamic inequalities for B-monotone functions with respect to time scales nabla calculus. If the time scale represents the set of real numbers, our results reduce to integral inequalities known from the literature. On the other hand, in the setting of positive integers, we obtain new discrete inequalities for B-monotone sequences.

The production of food-grade salt from crude solar salt has been examined through a techno-economic evaluation. This study aimed to investigate a salt factory to analyze its technical and economic aspects to determine the precise parameters for improving the quality of food-grade salt. The primary process of this factory involves grinding, washing, draining, drying, and fortification, supported by equipment like brine management, conveyors, sieves, and packaging. The proposed salt plant, designed for a 3-ton daily output over 15 years, requires 30 months for construction and a 4-month startup. The total capital outlay is USD 1,921,000, with USD 310,000 for technology and equipment. Economic indicators, including a Net Present Value (NPV) of USD 7,862,000, an Internal Rate of Return (IRR) of 46.48%, payback in 1.56 years, and a Return on Investment (ROI) of 64.28%, demonstrate feasibility. Establishing a salt plant in Indonesia supports food-grade salt production, stabilizes solar salt prices and enhances the welfare of traditional salt farmers. Ultimately, the results of this study can provide valuable insights for evaluating the feasibility of establishing a food-grade salt production plant in Indonesia.

Background & objectives: The battle against malaria has witnessed remarkable progress in recent years, characterized by increased funding, development of life-saving tools, and a significant reduction in disease prevalence. Yet, the formidable challenge of drug resistance persists, threatening to undo these gains. Methods: To tackle this issue, it is imperative to identify new effective drug candidates against the malaria parasite that exhibit minimal toxicity. This study focuses on discovering such candidates by targeting PfRecQ1, also known as PfBLM, a vital protein within the malaria parasite Plasmodium falciparum. PfRecQ1 plays a crucial role in the parasite’s life cycle and DNA repair processes, making it an attractive drug development target. The study employs advanced computational techniques, including molecular modeling, structure-based virtual screening (SBVS), ADMET profiling, molecular docking, and dynamic simulations. Results: The study sources ligand molecules from the extensive MCULE database and utilizes strict filters to ensure that the compounds meet essential criteria. Through these techniques, the research identifies MCULE-3763806507-0-9 as a promising antimalarial drug candidate, surpassing the binding affinity of potential antimalarial drugs. However, it is essential to underscore that drug-like properties are primarily based on in silico experiments, and wet lab experiments are necessary to validate these candidates’ therapeutic potential. Interpretation & conclusion: This study represents a critical step in addressing the challenge of drug resistance in the fight against malaria.

Background: Pre-clinical and retrospective data suggest that doxycycline added to treatment regimens has benefit in AL amyloidosis. However, a recent multicenter, open-label, randomized controlled trial in AL amyloidosis patients treated with CyBorD did not demonstrate a progression-free survival (PFS) or cardiac PFS benefit with added doxycycline. Objective: The main objective of this study was to explore the role of doxycycline combined with bortezomib-containing regimens (BCRs) for newly diagnosed AL amyloidosis patients with cardiac involvement and to compare them with a cohort of concurrent patients treated with BCR only. Material and Methods: AL amyloidosis patients, newly diagnosed between January 2012 and March 2022, who were treated with BCR at the Amyloidosis Program of Calgary (APC) were evaluated. Results: Sixty-four concurrent patients were identified. Thirty-nine patients received doxycycline in addition to BCR (BCR-D) for a median of 8 months. The overall response rate was similar among the groups. No significant differences in VGPR/CR, dFLC at 1 month, time to first response, time to best response, or organ responses were noted between the BCR alone and BCR-D groups. Summary and Conclusions: Our retrospective study demonstrated that doxycycline combined with BCR failed to prolong OS, PFS, or cardiac responses compared with BCR alone in patients with cardiac AL amyloidosis.

Abstract Background Encephalocele refers to protrusion of the meninges and brain tissue through a skull bone defect. It results from congenital, traumatic, neoplastic, or spontaneous reasons. Traumatic encephalocele occurs because of the posttraumatic fracture of the skull bone or iatrogenic causes. The manifestations vary a lot, such as rhinorrhea, seizures, headaches, and focal neurological deficits. Case presentation A 20-year-old Syrian male presented to our department with the complaint of clear cerebrospinal fluid drainage from his right nostril, which started 6 years ago after a head trauma, moderate headache, and episodes of tonic–clonic seizures without any response to medical treatment. Then, 2 months ago, the patient had meningoencephalitis, so he was admitted to the intensive care unit and treated for a month until he was cured. The patient underwent radiological investigations, which showed that he had a base fracture with an encephalocele in the nasal cavity. The brain tissues with the meninges herniated through the skull base fracture with a significant expansion of the subarachnoid spaces in the right hemisphere. He was advised to undergo surgical repair at that time, but he refused the surgery. During this visit, surgery was indicated. The surgery was done by a specialist who returned the herniated brain tissues to their normal location, repaired the meninges, and reconstructed the skull base with bone cement and bio-glue. The patient’s recovery after the surgery was uneventful. Conclusion Traumatic encephalocele is a rare and unexpected complication of trauma, but we should keep it in mind when the patient comes with head trauma because of its life-threatening consequences. This complication can happen after years of trauma if the patient refuses treatment, therefore, we must educate patients about the dangerous results of neglecting cerebrospinal fluid leakage and skull fractures.

Abstract Introduction Stroke is a potentially debilitating complication of heart valve replacement surgery, with rates ranging from 1 to 10%. Despite advancements in surgical techniques, the incidence of postoperative stroke remains a significant concern, impacting patient outcomes and healthcare resources. This study aims to investigate the incidence, risk factors, and outcomes of in-hospital adverse neurologic events, particularly stroke, following valve replacement. The analysis focuses on identifying patient characteristics and procedural factors associated with increased stroke risk. Methods This retrospective study involves a review of 417 consecutive patients who underwent SVR between January 2004 and December 2022. The study cohort was extracted from a prospectively recorded cardiac intensive care unit database. Preoperative and perioperative data were collected, and subjects with specific exclusion criteria were omitted from the analysis. The analysis includes demographic information, preoperative risk factors, and perioperative variables. Results The study identified a 4.3% incidence of postoperative stroke among SVR patients. Risk factors associated with increased stroke susceptibility included prolonged cardiopulmonary bypass time, aortic cross-clamp duration exceeding 90 min, prior stroke history, diabetes mellitus, and mitral valve annulus calcification. Patients undergoing combined procedures, such as aortic valve replacement with mitral valve replacement or coronary artery bypass grafting with AVR and MVR, (OR = 10.74, CI:2.65–43.44, p-value =

Abstract Background To explore intraocular lens (IOL) preferences of United Kingdom-based (UK) refractive surgeons in cataract and refractive lens exchange (RLE) surgery. Methods An online survey on IOL preferences (and reasons for their choice) in cataract and RLE surgery was distributed. It also enquired about implementing mini-monovision with extended depth of field (EDoF) IOLs, about utilising IOL mix-and-match (different IOL types in each eye), and at what level of corneal astigmatism they prefer toric lenses. Results Following an 81.6% response rate, thirty responses were analysed; median years of refractive surgery experience was 12.5. The most popular IOL choices for cataract surgery were EDoF lenses (30%), monofocals (20%), and trifocals (20%). The most cited reason for each was better overall visual outcomes (88.9%), fewer unwanted symptoms (66.7%) and best spectacle independence (66.7%), respectively. For RLE, EDoF remained most popular (36.7%), followed by trifocals (30%), and multifocals (16.7%) with the same reasons for choice cited above. Mini-monovision with EDoF lenses was well-regarded (83% recommend for most/select patients), unlike utilising IOL mix-and-match (60% did not recommend). 40% prefer toric IOLs for astigmatism of 1 dioptre (D) or higher, whilst 30% opt for them at

Purpose Deep learning–based image enhancement has significant potential in the field of ultrasound image processing, as it can accurately model complicated nonlinear artifacts and noise, such as ultrasonic speckle patterns. However, training deep learning networks to acquire reference images that are clean and free of noise presents significant challenges. This study introduces an unsupervised deep learning framework, termed speckle-to-speckle (S2S), designed for speckle and noise suppression. This framework can complete its training without the need for clean (speckle-free) reference images. Methods The proposed network leverages statistical reasoning for the mutual training of two in vivo images, each with distinct speckle patterns and noise. It then infers speckle- and noise-free images without needing clean reference images. This approach significantly reduces the time, cost, and effort experts need to invest in annotating reference images manually. Results The experimental results demonstrated that the proposed approach outperformed existing techniques in terms of the signal-to-noise ratio, contrast-to-noise ratio, structural similarity index, edge preservation index, and processing time (up to 86 times faster). It also performed excellently on images obtained from ultrasound scanners other than the ones used in this work. Conclusion S2S demonstrates the potential of employing an unsupervised learning-based technique in medical imaging applications, where acquiring a ground truth reference is challenging.

This review aims to demonstrate how biochar, derived from agricultural wastes can improve soil physical and chemical properties, reduce greenhouse gas emissions, and contribute to increased agricultural productivity and long-term sustainability. In this review, we analyze the effects of biochar on various soil parameters, including soil bulk density, soil porosity, microbial activity, nutrient content, cation exchange capacities, pH, water holding capacity, and infiltration rates. The results highlight the practical importance of utilizing biochar to improve soil physical and chemical properties. Additionally, the results show that biochar is a practical strategy for improving the growth and yield of crops and reducing greenhouse gas emissions. It can be concluded that biochar can significantly contribute to sustainable agriculture and food security in Jordan by improving soil health, enhancing water retention, and mitigating salinity

Exostosis, or osteochondroma, represents the most prevalent primary benign bone tumor, often viewed as a developmental anomaly rather than a true neoplasm. This article presents 2 cases illustrating complications associated with tibial osteochondroma. The first case involves a 25-year-old patient with recurrent medial knee pain attributed to pes anserine bursitis secondary to tibial osteochondroma, managed successfully with surgical excision. The second case features a 15-year-old with similar symptoms and unsuccessful conservative management, highlighting the diagnostic challenges and therapeutic options for this condition. Discussion encompasses the clinical presentation, diagnostic modalities including MRI and ultrasound, and management strategies such as conservative measures, corticosteroid injections, and surgical excision. Recognizing and promptly managing complications like pes anserine bursitis in tibial osteochondroma is crucial to prevent chronic pain and functional impairment, emphasizing the importance of a multidisciplinary approach involving orthopedic surgeons, radiologists, and physical therapists.

Complete cerebellar agenesis is an extremely rare condition characterized by the complete absence of cerebellar tissue. Only a small number of cases have been reported, with varying motor and cognitive deficits. We describe a case of an 11-month-old baby with developmental delay, whose CT scan evaluation showed the complete absence of the cerebellum with no other associated cerebral malformation.

Wet-cupping therapy (WCT) is one of the oldest known medical techniques, used as a traditional and complementary therapy with a wide application all around the world for general health. Research on the effects of WCT on sports performance are sparse and inconsistent. Thus, we aimed to explore the effects of WCT on repeated sprint ability, wellness, and exertion in young active males. Forty-nine active adult males (age: [28 ​± ​5] years; body height [177 ​± ​8] cm; body mass: [79 ​± ​7] kg; body mass index: [25.4 ​± ​1.8] kg/m2) were selected for the study. The participants performed a running-based sprint test on two separate occasions (Control and Post-WCT). WCT was performed 24 ​h before the testing session. They completed the Hooper questionnaire to assess their well-being (i.e., sleep, stress, fatigue, and soreness) before each session. The rating of perceived exertion (RPE) was collected after each testing session. A higher maximum power (p ​

Purpose – This paper aims to examine the low-cost carriers (LCC) impact on the high-quality carriers (HQC) in the aviation industry. The impact of LCCs on high-quality producers in the aviation industry has been a significant and multifaceted phenomenon. Design/methodology/approach – The study employs a captivating case study approach, investigating into the intricate fabric of the subject matter. Interviews serve as the cornerstone of primary evidence, offering first-hand insights, while secondary data sourced from documents adds depth to the exploration of the challenges encountered by the HQC. Findings – The study concludes that LCCs have disrupted the traditional aviation landscape by offering low fares, simplified service models and aggressive cost-cutting strategies. This disruption has affected both the high-quality producers, such as full-service airlines. Full-service airlines have adopted a strategy of segmenting their market by offering multiple fare classes, with varying levels of service and flexibility. This allows them to target both price-sensitive travelers and those seeking premium services, catering to a broader customer base. The competition from LCCs has spurred innovation within the aviation industry, leading to advancements in technology, digital services and operational efficiency. Airlines, both LCCs and traditional carriers, have had to adapt to evolving consumer preferences and embrace digital solutions for booking, check-in and in-flight services. Research limitations/implications – While this study provides a valuable cost-benefit analysis of the impact of LCC on high-quality producers in the aviation industry, it is essential to acknowledge its limitations and recognize the avenues for future research to further enhance our understanding of this complex and evolving industry landscape. While this study contributes valuable insights into the impact of LCCs on high-quality producers in the aviation industry, it is essential to recognize its limitations and identify opportunities for future research to expand our understanding of this complex and dynamic landscape. By addressing these limitations and exploring new avenues of inquiry, we can continue to advance our knowledge and inform evidence-based decision-making within the industry. Originality/value – This study pioneers an exploration into the intricate tapestry of factors molding the future of the aviation sector. Through its groundbreaking analysis, it furnishes indispensable insights for industry stakeholders, policymakers and the discerning traveling public, setting a new benchmark for understanding and navigating the aviation landscape.

Abstract Background The Arab Teens Lifestyle (ATLS) questionnaire was an initiative to assess the lifestyle habits influencing obesity rates in the Middle East and North Africa (MENA) region, including physical activity (PA) patterns, sedentary and eating behaviours. Since its implementation, the ATLS questionnaire has been used in several studies among different age groups and populations. This instrument has not previously been administered among the university students of the Eastern Province of Saudi Arabia, where the obesity rates are the highest in the country. This research was the first that aimed to identify lifestyle habits influencing the rates of obesity among 18-25-year-old university students in the Eastern Province of the Kingdom of Saudi Arabia (KSA) using the ATLS questionnaire. Methods Quantitative cross-sectional research among n = 426 students of the Eastern Province of Saudi Arabia using the ATLS questionnaire. Results Out of n = 426 participants, n = 200 (47%) were categorised (using body mass index) as normal weight; n = 113 (26.5%) were overweight, and n = 73 (17.1%) were obese. The findings showed that most of the nutritional, PA, and sedentary behavioural factors (e.g., screen time) in the questionnaire were not associated with obesity status amongst the participants. In the obese group, more of the males that consumed fruits, French fries, cakes, sweets and doughnuts more than three times per week were likely to be obese, which was not the case for females. Conclusion The reported lifestyles of the students could potentially lead to long-term negative health effects, which is of concern given the rising rates of overweight, obesity, and obesity-related non-communicable diseases (NCDs) among the Kingdom’s adult and ageing population. Further studies are recommended to explore the knowledge, attitudes, and perceptions of Saudi students in the Eastern Province in relation to PA, sedentary behaviours, and dietary habits, along with their views on how these can be improved.

Abstract Introduction Distal locking is a challenging and time-consuming step in interlocked intramedullary nailing of long bone fractures. Current methods have limitations in terms of simplicity, universality, accuracy, speed, and safety. We propose a novel device and software for distal locking using computer vision. Methods and materials The device consists of an universal ancillary clamp, a telescopic arm, a viewfinder clamp, and a radio-opaque cross. The software uses a camera photo from the C-arm intensifier and adjusts for geometric projection deformities. The software employs edge detection, Hough transform, perspective interpolation, and vector calculation algorithms to locate the distal hole center. The device and software were designed, manufactured, and tested using 3D CAD, FEM, DRR, and performance testing on phantom bones. Results The device and software showed high accuracy and precision of 98.7% and 99.2% respectively in locating the distal hole center and calculating the correctional vector. The device and software also showed high success ratio in drilling the hole and inserting the screw. The device and software reduced the radiation exposure for the surgeon and the patient. The success ratio of the device and software was validated by the physical testing, which simulated the real clinical scenario of distal locking. The radiation exposure was as low as 5 s with a radiation dose of 0.2mSv, drastically reducing radiation exposure during distal locking. Discussion Our device and software have several advantages over other distal locking methods, such as simplicity, universality, accuracy, speed, and safety. Our device and software also have some disadvantages, such as reliability and legislation. Our device and software can be compared with other distal locking methods based on these criteria. Our device and software have some limitations and challenges that need to be addressed in the future, such as clinical validation, and regulatory approval. Conclusion The device showed promising results in terms of low-cost, reusability, low radiation exposure, high accuracy, fast distal locking, high stiffness, and adaptability. The device has several advantages over other distal locking techniques, such as free-hand technique, mechanical aiming devices, electromagnetic navigation systems, and computer-assisted systems. We believe that our device and software have the potential to revolutionize the distal locking technique and to improve the outcomes and quality of life of the patients with long bone fractures.

Most of the pulmonary endobronchial lesions are malignant in origin. In rare instances, benign lesions such as endobronchial hamartoma may be the cause of the endobronchial tree obstruction. We present the case of a 57-year-old male patient from North Africa who presents with a history of a 5-month cough. Imaging, particulary CT scan, showed a mass on the right intermediate bronchus whose radiological characteristics are consistent with hamartoma. A biopsy of the mass obtained via bronchoscopy revealed chronic inflammation with no evidence for malignancy. The patient was treated surgically, and anatomopathology confirmed the diagnosis of hamartoma.

Ovarian dysgerminoma is a rare germ cell tumor accounting for 1%-2% of all malignant ovarian tumors and is generally associated with a good prognosis. The condition is more frequent in young women and can arise in dysgenetic gonads that contain gonadoblastomas. Imaging findings, particularly MRI, have a prominent role in the early and correct identification of ovarian dysgerminoma, the most common ovarian malignant germ cell tumor. On CT and MR images, ovarian dysgerminoma often appears as a large, solid mass. The edematous condition of characteristic fibrovascular septa can be well displayed by imaging, which can guide the radiologists to make an accurate diagnosis. This article describes 2 cases of patients with ovarian dysgerminoma who presented with pelvic pain. Imaging showed a right ovarian mass that was surgically and histologically confirmed.

Cerebellar liponeurocytoma is a rare WHO grade II glioneuronal tumor, characterized by a benign course and a more favorable prognosis. In this paper, we report a 52-year-old man, hospitalized in emergency because of clinical signs of increased intracranial pressure, and gait disturbances. The MRI revealed a lateral well shaped solid lesion within the left cerebellar hemisphere, having a low signal intensity compared to the cerebrospinal fluid, and causing a triventicular hydrocephalus and tonsillar herniation. The patient underwent a direct approach of the tumor through a left suboccipital craniectomy. Total removal of the lesion was achieved, and the histological diagnosis was cerebellar liponeurocytoma. The tumor cell proliferation index was < 6 %, therefore, radiotherapy and chemotherapy were not implemented after surgery. After 5 years of close follow-up there were no clinical or radiological signs of recurrence.Our objective in reporting another case of this unusual tumor is to discuss clinical profile, radiologic and histologic features as well as treatment and prognosis of this rare posterior fossa tumor.

The prevalence of intracranial aneurysms (IA) is higher in patients with stenosis of the internal carotid artery (ICA), the intracavernous internal carotid aneurysm is an intracranial aneurysm causing major functional and vital complications. We report the case of a 26-year-old man who consulted for a reduction in visual acuity, converging strabismus and ptosis of the right eye evolving for 7 months before his consultation, the various neuro-radiological examinations made it possible to identify diagnose a giant aneurysm of the right intracavernous internal carotid artery associated with severe stenosis of the contralateral internal carotid artery, hence the performance of a therapeutic arteriography consisting of an occlusion of this aneurysm. In summary, we describe successful management of a giant aneurysm of the intracavernous portion of a single functional internal carotid artery, while preserving optimal cerebral vascularization.

Abstract Background The belief that cannabis has analgesic and anti-inflammatory properties continues to attract patients with chronic musculoskeletal (MSK) pain towards its use. However, the role that cannabis will play in the management of chronic MSK pain remains to be determined. This study examined 1) the rate, patterns of use, and self-reported efficacy of cannabis use among patients with chronic MSK pain and 2) the interest and potential barriers to cannabis use among patients with chronic MSK pain not currently using cannabis. Methods Self-reported cannabis use and perceived efficacy were prospectively collected from chronic MSK pain patients presenting to the Orthopaedic Clinic at the University Health Network, Toronto, Canada. The primary dependent variable was current or past use of cannabis to manage chronic MSK pain; bivariate and multivariable logistic regression were used to identify patient characteristics independently associated with this outcome. Secondary outcomes were summarized descriptively, including self-perceived efficacy among cannabis users, and interest as well as barriers to cannabis use among cannabis non-users. Results The sample included 629 patients presenting with chronic MSK pain (mean age: 56±15.7 years; 56% female). Overall, 144 (23%) reported past or present cannabis use to manage their MSK pain, with 63.7% perceiving cannabis as very or somewhat effective and 26.6% considering it as slightly effective. The strongest predictor of cannabis use in this study population was a history of recreational cannabis use (OR 12.7, p

Introduction: We aimed to describe a case of bilateral keratoconjunctivitis after exposure to the toxic sap of Euphorbia lathyris. Case Report: A 76-year-old gentleman presented after exposure to E. lathyris whilst he was gardening. He had 6/12 visual acuity in his right eye, and 6/4 in his left. Examination revealed marked periocular dermatitis, conjunctival injection and corneal oedema in the right eye with diffuse punctate epithelial staining. He was treated with ocular irrigation, topical steroids, antibiotics, cycloplegics and lubricants. Over 48 h, his left eye started to become symptomatic. He developed bilateral corneal epithelial defects and anterior chamber inflammation. His visual acuity worsened to 6/36 right and 6/24 left. At his 3-week follow-up, there was marked improvement in the resolution of the toxic keratoconjunctivitis in both eyes. Conclusion: Toxic sap from E. lathyris can cause severe keratoconjunctivitis. Irrigation of both eyes despite unilateral symptoms and early follow-up should be considered signs of toxicity may only become evident after 24–48 h.

Cardiac echinococcosis, although rare, presents a range of clinical manifestations depending on the cyst's location within the heart. These manifestations can range from asymptomatic conditions to serious complications such as arrhythmias, valvular dysfunction, cardiac tamponade, heart failure, shock, or even death.This case report describes the unusual presentation of a young man with an intramyocardial hydatid cyst, which was incidentally discovered following an ischemic stroke. Diagnostic evaluation included echocardiography, as well as chest and abdominal angiography via computed tomography (angio-CT). Surgical intervention was undertaken, involving cystectomy and the removal of the cyst contents. The patient's postoperative recovery was uneventful and favorable.This report emphasizes important diagnostic and management considerations specific to cardiac hydatid cysts and includes a review of the relevant literature to provide context and depth to our findings.

Wilm's tumor (WT) accounted for the vast majority of renal tumors in children (92%). However, there are many atypical or rare forms of kidney cancer, and it is certainly useful to have a diagnostic orientation in imaging to differentiate between the different diagnoses, guiding that way the therapeutic management.We report the cases of 3 patients who were initially diagnosed with nephroblastoma on the basis of radiological data (via PACS search), underwent pre-operative chemotherapy and then nephrectomy, and whose anatomopathological evidence came back in favor of benign renal tumors.Nephroblastoma is the most common renal tumor in children, but other benign tumors should not be neglected, radiological signs that may point to this entity should be taken into account, so that neoadjuvant chemotherapy with its enfeebling side effects can be avoided.

The effect of different irrigation methods (sprinkler, surface, surface-drip, and subsurface-drip) using treated wastewater, on alfalfa yield quantity and quality, was studied under semi-arid conditions. Randomized complete block design considering irrigation methods on 5 × 5 m plots replicated four times. Applied irrigation water was based on the Penman–Monteith equation using the FAO Cropwat software and accounting for the efficiencies of used irrigation systems. Surface irrigation gave the highest alfalfa fresh yield without significant difference compared to subsurface-drip. Average fresh production was 123, 120, 109, and 91 tons/h for surface, subsurface-drip, surface-drip, and sprinkler irrigation, respectively. Alfalfa fresh weight from subsurface-drip irrigation was 32 and 10% higher compared to sprinkler and surface-drip irrigation. Alfalfa dry weight from subsurface-drip irrigation was 10, 21, and 47% higher compared to surface-drip, surface, and sprinkler irrigation, respectively. N percentage in alfalfa leaves was significantly lower by 12% under subsurface-drip irrigation as compared to the other irrigation methods. Escherichia coli (E. coli) and fecal coliform (FC) were not detected on alfalfa leaves using subsurface-drip irrigation. E. coli and FC counts were high on leaves using sprinkler and surface irrigation. Subsurface-drip irrigation may be adapted as an efficient irrigation method when using non-conventional water under semi-arid conditions. HIGHLIGHTS Irrigation study: Examined methods using treated wastewater in semi-arid areas.; Subsurface-drip: Tops in dry yield, matches in fresh yield.; Health benefits: Subsurface-drip reduces E. coli and fecal coliform on alfalfa.; Smart water use: Advocates calculated use with FAO Cropwat insights.; Alternative water: Recommends subsurface-drip for treated wastewater in semi-arid regions.;

Abstract Antibiotic resistance among bacteria is recognized as the primary factor contributing to the failure of treatment. In this research, our objective was to examine the prevalence of antibiotic resistance in H. pylori bacteria in Palestine. We enlisted 91 individuals suffering from dyspepsia, comprising 49 females and 42 males. These participants underwent esophagogastroduodenoscopy procedures with gastric biopsies. These biopsies were subsequently subjected to microbiological assessments and tested for their susceptibility to various antimicrobial drugs. Among the 91 patients, 38 (41.7%) exhibited the presence of H. pylori. Notably, Ciprofloxacin displayed the highest efficacy against H. pylori, followed by Levofloxacin, Moxifloxacin, and Amoxicillin, with resistance rates of 0%, 0%, 2.6%, and 18.4%, respectively. On the contrary, Metronidazole and Clarithromycin demonstrated the lowest effectiveness, with resistance percentages of 100% and 47.4%, respectively. The outcomes of this investigation emphasize that H. pylori strains within the Palestinian patient group exhibit substantial resistance to conventional first-line antibiotics like clarithromycin and metronidazole. However, alternative agents such as fluoroquinolones and amoxicillin remain efficacious choices. Consequently, we recommend favoring quinolone-based treatment regimens for H. pylori infections and adopting a more judicious approach to antibiotic usage among the Palestinian population.

Abstract Ferroptosis is a unique iron-dependent form of non-apoptotic cell death characterized by devastating lipid peroxidation. Whilst growing evidence suggests that ferroptosis is a type of autophagy-dependent cell death, the underlying molecular mechanisms regulating ferroptosis are largely unknown. In this study, through an unbiased RNA-sequencing screening, we demonstrate the activation of a multi-faceted tumor-suppressor protein Par-4/PAWR during ferroptosis. Functional studies reveal that genetic depletion of Par-4 effectively blocks ferroptosis, whereas Par-4 overexpression sensitizes cells to undergo ferroptosis. More importantly, we have determined that Par-4-triggered ferroptosis is mechanistically driven by the autophagic machinery. Upregulation of Par-4 promotes activation of ferritinophagy (autophagic degradation of ferritin) via the nuclear receptor co-activator 4 (NCOA4), resulting in excessive release of free labile iron and, hence, enhanced lipid peroxidation and ferroptosis. Inhibition of Par-4 dramatically suppresses the NCOA4-mediated ferritinophagy signaling axis. Our results also establish that Par-4 activation positively correlates with reactive oxygen species (ROS) production, which is critical for ferritinophagy-mediated ferroptosis. Furthermore, Par-4 knockdown effectively blocked ferroptosis-mediated tumor suppression in the mouse xenograft models. Collectively, these findings reveal that Par-4 has a crucial role in ferroptosis, which could be further exploited for cancer therapy.

Introduction. Systemic antibacterial treatment in patients with infected pancreatic necrosis often fails to resolve the infection due to impaired penetration in necrotic areas. The endoscopic step-up approach based on endoscopic transmural drainage followed, if necessary, by endoscopic necrosectomy has become the standard of care in patients who do not respond to systemic antibiotics. The additional local administration of antibiotics may increase their concentration in necrotic tissue. Aim. To evaluate the efficacy of local infusion of antibacterial agents to the site of infection in addition to systemic treatment after endoscopic drainage to resolve the infection and decrease the need for necrosectomy in patients with walled-off infected pancreatic necrosis. Materials and methods. Major databases were searched for clinical studies assessing the efficacy of local perfusion of antibiotics for the treatment of infected pancreatic necrosis. Results. Four studies were included, two cohort studies and two single-case reports. The majority of patients with infected pancreatic necrosis developed polymicrobial infection. More than one-third of patients additionally had fungal infection. Local irrigation of antibiotics in patients with infected pancreatic necrosis resulted in the eradication of bacteria and fungi, avoiding necrosectomy in almost half of cases. No local or systemic side effects were reported with this strategy. Conclusions. Evidence evaluating the efficacy of local antibiotics for the treatment of infected pancreatic necrosis is scarce. Simultaneous local and systemic administration of antibiotics after endoscopic drainage could reduce the need for necrosectomy. Randomized clinical trials are needed to evaluate the impact of adding local to systemic antibiotics in the prognosis of patients with infected pancreatic necrosis.

According to Federal Court of Cassation Decision No. 2153 of the Appellate Body from 7/8/2022, the entity employing the individual is not liable for errors stemming from personal actions, not related to their duties. However, it is unclear if the employee involved in the plaintiff's arrest is associated with the arresting party or another entity.

Rickettsiosis is a widespread infection throughout the world and in Africa, it covers a wide range of infectious diseases caused by Rickettsia species. Rickettsial infections, with the exception of Q fever, typically present with fever, rash, and vasculitis. The central nervous system (CNS) can be affected by all rickettsial diseases and is an important target for several of them.Clinical manifestations are suggestive of rickettsial infection, but serology and skin biopsy provide confirmation.Although the presence of abnormal neuroimaging is rare, its presence is associated with a worse clinical prognosis. Computed tomography (CT) and magnetic resonance imaging (MRI) scans mainly show signs of vasculitis, which may be reversible if appropriate treatment is initiated early in the course of the disease.We present here a case of infectious cerebral vasculitis due to rickettsiosis with some MRI features.

Lipoma arborescens is a rare and benign intra-articular lesion characterized by a lipomatous proliferation of the synovial membrane, usually affects the knee joint. It presents as an unusual cause of intermittent knee pain and joint effusion.We report a case of lipoma arborescens of the knee in a 23-year-old man that initially resembled inflammatory arthropathy. The diagnosis of Lipoma arborescens was made by magnetic resonance imaging of the knee and confirmed histologically by synovectomy.The purpose of our case is to show the imaging features enabling early diagnosis and appropriate treatment.

The pseudoaneurysms of the cystic artery (CAP) are very uncommon. They usually develop as a result of an acute cholecystitis or after a cholecystectomy. Among the complications, we can find hemorrhaging, biliary blockage, and haemobilia. Limited understanding of the illness makes managing specific cases difficult. We describe a case of a cystic artery pseudoaneurysm complicating an acute cholecystitis that was successfully treated by transcatheter arterial embolization.

Prolapsed uterine tumors within the cervix or vagina, are attached to the uterine cavity by a soft tissue stalk. Malignant tumors and leiomyoma are the first diagnostic considerations for a prolapsed uterine mass with a visible stalk at MRI. This article describes 4 cases of patients who presented with large, necrotic prolapsed uterine tumors that were surgically confirmed and were diagnosed prospectively on the basis of MRI findings. Imaging, particularly MRI, plays a crucial role in the management of patients with prolapsed pedunculated uterine tumors, especially for pre-operative localization and surgical treatment. The 4 patients underwent a total hysterectomy with a complete resection of the mass. The histopathological report confirmed in the first case the diagnosis of a uterine leiomyoma with aseptic necrobiosis, in the second and third cases a sarcoma, and in the fourth case a serous adenocarcinoma.

هدف البحث الى التعرف على اعداد تمرينات بالأسلوب البالستي البليومتري لتطوير القوة الخاصة وسرعة الاستجابة الحركية للتحركات الدفاعية للاعبي كرة اليد الشباب وقد استعمل الباحثان المنهج التجريبي للمجموعة الواحدة ذات الاختبار القبلي والبعدي، على عينة من لاعبي كرة اليد الشباب وهم لاعبي نادي الكرخ الرياضي بكرة اليد للموسم الرياضي 2019- 2020 والبالغ عددهم (12) لاعباً وقد اشتمل المنهج المطبق للتمرينات بهذا الاسلوب على (24) وحدة تدريبية بمعدل (3) وحدات تدريبية في الاسبوع، واستنتج الباحثان ان هذه التمرينات بهذا الاسلوب التدريبي قد كان لها أثر في تطوير القوة الخاصة وبالتالي انعكاسه على تطوير سرعة الاستجابة للتحركات الدفاعية للاعبين افراد عينة البحث وكذلك اوصى الباحثان الى بناء تمرينات هذا الاسلوب بشكل علمي سليم يتناسب مع الفئة العمرية التي يراد تطويرها وذلك من خلال تقنين الاحمال التدريبية واستخدام طرق تدريبية مناسبة وتتطابق مع الهدف من استخدامها

Objectives: To evaluate the utility of regression analysis in the assessment of conduction slowing in diabetic distal symmetrical polyneuropathy (DSP) and in identifying superimposed demyelination beyond fiber loss. Background: Causes of conduction slowing beyond pure axonal loss has been attributed to an additional demyelinating component. We therefore evaluated the utility of regression analysis in the assessment of conduction slowing in diabetic DSP and in identifying superimposed demyelination beyond fiber loss. Methods: We previously established regression analysis to develop confidence intervals that assess the range of conduction slowing from primary demyelination in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). In this study, by using the regression equations, we analyzed conduction slowing in patients with diabetic DSP. Results: Mean conduction velocity (CV) was significantly slower in diabetic DSP than in the non-diabetic DSP for all tested nerves. More patients were found to fulfill the regression equation criteria in the diabetic group compared to the non-diabetic group (47.0 % vs. 23.3 %). The estimated likelihood of having more than two motor nerves with CV slowing in the demyelination range by American Academy of Neurology or regression equations criteria was significantly higher in the diabetic DSP (0.73) compared to non-diabetic DSP (0.52). Conclusions: Conduction slowing in diabetic DSP beyond what is expected exclusively from axonal loss could be identified by regression analysis.

Salah satu provinsi dengan Indeks Pembangunan Manusia yang cukup tinggi ialah Provinsi Jawa Timur, hal ini tidak terlepas oleh kondisi perekonomian daerah tersebut. Penelitian ini bertujuan untuk melihat determinan Indeks Pembangunan Manusia Provinsi Jawa Timur dengan Inflasi sebagai Variabel. Penelitian ini menggunakan data sekunder berupa data dari Badan Pusat Statistik (BPS) selama periode 2020-2023. Sampel penelitian ini mencakup 38 kota dan kabupaten selama kurun waktu 3 tahun, sedangkan populasi penelitian mencangkup provinsi Jawa Timur. Penelitian ini menggunakan metode kuantitatif dengan alat uji software JASP 2023 dan menggunakan analisis regresi berganda data panel. Hasil penelitian ini menunjukan bahwa TPT mempunyai pengaruh positif dan signifikann terhadap IPM. Sedangkan PE mempunyai pengaruh negatif dan signifikan terhadap IPM. Temuan lainnya menunjukan bahwa Inflasi tidak mampu memoderasi hubungan antara TPT terhadap IPM, sedangkan hasil lainya menunjukan bahwa inflasi mampu memoderasi hubungan antara PE terhadap IPM. Implikasi penelitian ini menggambarkan kondisi perekonomian daerah dalam pembangunan sumber daya manusia provinsi Jawa Timur.