A two-stage transformer based network for motor imagery classification.

Brain-computer interfaces (BCIs) are used to understand brain functioning and develop therapies for neurological and neurodegenerative disorders. Therefore, BCIs are crucial in rehabilitating motor dysfunction and advancing motor imagery applications. For motor imagery, electroencephalogram (EEG) signals are used to classify the subject's intention of moving a body part without actually moving it. This paper presents a two-stage transformer-based architecture that employs handcrafted features and deep learning techniques to enhance the classification performance on benchmarked EEG signals. Stage-1 is built on parallel convolution based EEGNet, multi-head attention, and separable temporal convolution networks for spatiotemporal feature extraction. Further, for enhanced classification, in stage-2, additional features and embeddings extracted from stage-1 are used to train TabNet. In addition, a novel channel cluster swapping data augmentation technique is also developed to handle the issue of limited samples for training deep learning architectures. The developed two-stage architecture offered an average classification accuracy of 88.5 % and 88.3 % on the BCI Competition IV-2a and IV-2b datasets, respectively, which is approximately 3.0 % superior over similar recent reported works.

Community Awareness About Developmental Dysplasia of the Hip (DDH) in the Western and Southern Regions of Saudi Arabia.

BACKGROUND: Developmental dysplasia of the hip (DDH) is a disorder in which the hip joint does not develop normally in the pediatric age group. It is caused by a confluence of hereditary and environmental factors. We aimed to examine knowledge and awareness of DDH among the general population of the southern and western regions of Saudi Arabia. METHODOLOGY: A cross-sectional survey-based study was conducted in the western and southern regions of Saudi Arabia. This study included adult male and female participants above 18 years of age. Data were collected using a validated electronic questionnaire that was disseminated via social media platforms. All data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY). RESULTS: In this study, 1,232 participants were surveyed in Saudi Arabia. The majority were between 21 and 30 years old (663, 53.8%), unmarried (690, 56%), and had a baccalaureate or diploma certificate (886, 71.9%). Regarding knowledge of DDH, 86.4% of participants had poor knowledge of the causes of DDH, and 740 (60%) had poor overall knowledge of DDH. However, 492 (40%) participants had good knowledge. Respondents with a higher monthly income, those who were mothers, and those who obtained information from social media had a better awareness level. Concerning treatment, 531 (43.1%) participants were unsure about the best treatment for DDH, and 850 (69%) believed that early treatment was better. CONCLUSIONS: According to our literature, DDH is highly prevalent among Saudi populations. However, our findings indicate that the majority of the Saudi population residing in the western and southern regions of Saudi Arabia lacks basic knowledge of DDH. All capable facilities, such as medical schools, hospitals, and primary healthcare centers, must impart cultural education about DDH to address this awareness gap.

The Effectiveness of Denosumab in Middle Eastern Patients With Giant Cell Tumor of the Bone: A Single-Center, Retrospective Study.

BACKGROUND: Giant cell tumor of the bone (GCTB) is an aggressive benign tumor, which constitutes 5% of all primary bone tumors. Denosumab, a receptor activator of nuclear factor κB ligand monoclonal antibody, inhibits osteoclast-induced bone destruction and has demonstrated promising results in patients with GCTB. However, the long-term efficacy of the drug has not been extensively studied, especially in the Middle East. METHODOLOGY: In this study, we retrospectively analyzed the five-year progression-free survival (PFS) in patients with GCTB at a single Saudi center. PFS was defined as the time from diagnosis until disease progression, relapse, or death. Events were censored after five years from diagnosis. RESULTS: Sixty-two patients with GCTB were included in the study. The median age at diagnosis was 31.16 years, and 38 (61.3%) patients were female. Twenty-nine patients (46.8%) received denosumab during the study period. The median duration of denosumab treatment was 5.06 months, and the median number of cycles was 6. The median PFS was not reached, and the five-year PFS rate was 60.3%. Age, gender, body mass index, performance status at presentation, and tumor location had no impact on five-year PFS. Denosumab treatment prolonged PFS; however, this was not statistically significant compared to non-denosumab patients (P = 0.603). CONCLUSIONS: Denosumab does not seem to provide superior long-term outcomes compared to surgery alone. Although our findings are generally consistent with other studies in the literature, larger long-term studies are needed to confirm our findings.

Navigating parental attitudes on childhood vaccination in Jordan: a cross-sectional study.

This study investigated parental attitudes toward childhood vaccination in Jordan, focusing on acceptance, concerns, and perceptions. A cross-sectional survey conducted from January to February 2024 included 939 parents. Findings indicated that 85.4% (n = 802) of respondents received the COVID-19 vaccine, while only 25% (n = 229) vaccinated their children. Concerns regarding vaccine safety and efficacy were prevalent, with 63.9% (n = 600) expressing worries about side effects and 46.9% (n = 440) trusting immunization programs. Post-pandemic, 34% (n = 319) reported a more negative attitude. Logistic regression showed parents not vaccinating their children against COVID-19 were significantly less likely to exhibit positive attitudes toward childhood vaccination (OR = 0.412, p < 0.001). Older participants were more inclined toward negativity post-pandemic (OR = 1.031, p = 0.007). In conclusion, parental attitudes shifted post-COVID-19, reflecting hesitancy and decreased trust. Addressing concerns and restoring confidence are crucial, especially for children's health. Education through healthcare providers and dispelling social media misinformation are essential. Implementing strategies to enhance post-pandemic vaccine acceptance is imperative for preventing outbreaks of vaccine-preventable diseases.

The Expanding Problem of Regional Adiposity: Revisiting a 1985 Diabetes Classic by Ohlson et al.

Body fat distribution is a predictor of metabolic health in obesity. In this Classics in Diabetes article, we revisit a 1985 Diabetes article by Swedish investigators Ohlson et al. This work was one of the first prospective population-based studies that established a relationship between abdominal adiposity and the risk for developing diabetes. Here, we discuss evolving concepts regarding the link between regional adiposity and diabetes and other chronic disorders. Moreover, we highlight fundamental questions that remain unresolved.

Protocol for quantitative proteomic analysis of heterogeneous adipose tissue-residing progenitor subpopulations in mice.

Recent studies have revealed cellular heterogeneity of mesenchymal stromal cells and immune cells in adipose tissue and emphasized the need for quantitative analysis of small numbers of functionally distinct cells using state-of-the-art "omics" technologies. Here, we present an optimized protocol for precise protein quantification from minute amounts of samples. We describe steps for isolation of mouse adipose progenitor cells, proteomics sample preparation, mass spectrometry measurement, and computational analysis. This protocol can be adapted to other samples with limited amounts. For complete details on the use and execution of this protocol, please refer to Shan et al. (2022).1.

Perceptions and Knowledge of Public Towards Emerging Human Monkeypox in Yemen: A Cross-Sectional Study.

Background: The spread of monkeypox (mpox) worldwide poses a severe threat to human life. This virus leads to a disease with symptoms similar to smallpox in humans. To combat this threat, improving public knowledge and perception toward mpox is vital for public health preventive measures. Methods: A cross-sectional survey was carried out in Yemen from December 2022 to March 2023 to investigate public perception and knowledge of mpox. Individuals were approached through social media platforms using a convenient sampling approach. Linear regression was used to determine the association between participants' knowledge (dependent variable) and explanatory variables. Results: A total of 853 individuals consented to take part in the study. A significant proportion of respondents had a low knowledge level (N=572, 67.06%). Most participants knew about the nature of the diseases (75%, n=641), transmission mode (78.1%, n=668), hand sanitizer preventive measures, and skin- related symptoms. However, only 20.8% (n= 178) knew that diarrhea is not a symptom, and 25.4% (n= 217) knew antibiotics are unnecessary for mpox management. A proportion of 57.7% (n=492) of the participants feared human mpox, and 47.7% (n= 407) thought it was a conspiracy. Most participants had a good perception of local and international health authorities controlling the disease. Age, education level, having a health-related certificate, and receiving a 2-dose vaccination for COVID-19 had statistically significant associations with mpox knowledge level (P < 0.05). Social media platforms were the most often used information source about mpox (78.3%, n= 668), followed by articles (41.1%, n=351). Conclusion: The study reveals a low public knowledge about mpox in Yemen, emphasizing the need for targeted educational campaigns, especially via social media, to strengthen public health measures and disease control. Addressing Knowledge gaps and correcting misconceptions is crucial for improving preparedness and response to the disease.

Morpho-molecular characterisation of two new and two previously reported species of Acanthogyrus (Acanthogyrus: Quadrigyridae) from freshwater fishes in India.

Of the total 47 species in the subgenus Acanthosentis, 43 have been reported from the freshwater fishes of Asia. Amin et al. (2017) provided a key to the 23 species of the genus Acanthogyrus reported from the Indian subcontinent. The present study reports two new species: Acanthogyrus bispinosa n. sp. and A. garciai n. sp. from Cirrhinus mrigala Hamilton and Labeo calbasu Hamilton, respectively, and two previously described species: A. golvani Gupta and Jain, 1980 and A. hereterospinus Khan and Bilqees, 1990 from L. rohita Hamilton and L. catla Hamilton, respectively. A. bispinosa n. sp. comprises 3 circles of 6 proboscis hooks each. Trunk spines in A. bispinosa n. sp are divided into two groups: anterior and posterior separated by unarmed region, which has not been previously reported in the subgenus. Anterior spines are present in 7-8 and 7-10 circles in females and males, respectively, whereas posterior spines are in 23-28 and 31-38 circles in males and females, respectively. A. garciai n. sp. comprises 3 circles of 6-8 hooks each and a single set of trunk spines is present in A. garciai n. sp., comprising 35-42 and 25-45 circles in males and females, respectively. All four species were also characterised based on the 18S, 28S, and ITS1-5.8S-ITS2 rRNA molecular markers. The Bayesian inference tree generated based on these markers showed distinct identities of all the species, with a significant molecular divergence, ranging from 3.2 to 53.6%.

Mesenchymal stromal cells as conductors of adipose tissue remodeling.

Adipose tissue exhibits a remarkable capacity to expand, contract, and remodel in response to changes in physiological and environmental conditions. Here, we describe recent advances in our understanding of how functionally distinct tissue-resident mesenchymal stromal cell subpopulations orchestrate several aspects of physiological and pathophysiological adipose tissue remodeling, with a particular focus on the adaptations that occur in response to changes in energy surplus and environmental temperature. The study of adipose tissue remodeling provides a vehicle to understand the functional diversity of stromal cells and offers a lens through which several generalizable aspects of tissue reorganization can be readily observed.

Frequency of Low Cardiac Output Syndrome Following on Pump Coronary Artery Bypass Grafting Surgery and it's Association with Degree of Pre-operative Left Ventricular Dysfunction.

Background Low cardiac output syndrome (LCOS) is a serious complication after coronary artery bypass grafting (CABG) surgery. It is associated with 10 times to 17 times increase in mortality and markedly increase morbidity. Objective To find out the frequency of Low cardiac output syndrome following on pump coronary artery bypass grafting surgery, to determine the association of Low cardiac output syndrome with degree of pre-operative left ventricular dysfunction and to compare in hospital outcomes of coronary bypass surgery with and without low cardiac output syndrome. Method This prospective, descriptive study enrolled 200 patients who underwent on pump coronary artery bypass grafting surgery using antegrade St Thomas blood cardioplegia. Pre-operatively grouped into two groups consisting Group A of 100 patients with pre-operative left ventricular ejection fraction (LVEF) ≥ 40% and group B of 100 patients with pre-operative left ventricular ejection fraction (LVEF) < 40%. Post-operatively frequency of low cardiac output syndrome was compared between the groups and in-hospital outcomes were studied. Result The mean age of the patients in the study was 53.50±7.57 years. Male to female ratio was 1.8:1. Results showed overall frequency of low cardiac output syndrome was 21.5%. The frequency of LCOS was 15 vs 28% (p - 0.038) in patients with preoperative LV EF ≥ 40% and < 40% respectively. The outcomes of coronary artery bypass grafting surgery were stroke (3.82 vs. 30.23%, p - 0.001), acute kidney injury (5.09 vs. 23.25%, p - 0.001), respiratory failure (6.36 vs. 34.88%, p - 0.001), ICU stay days (4.75 ± 1.28 vs. 7.44 ± 4.66, p - 0.018), hospital stay days (9.56 ± 2.40 vs. 15.22 ± 3.89, p - 0.001) and mortality (4.45 vs. 32.55%, p - 0.001) in patients without and with low cardiac output syndrome respectively. Conclusion The frequency of low cardiac output syndrome following coronary artery bypass surgery is 21.5%. Left ventricular dysfunction pre-operatively is associated with high frequency of low cardiac output syndrome following surgery. There is significantly poor outcome of coronary artery bypass surgery with low cardiac output syndrome in terms of stroke, respiratory failure, acute kidney injury, mortality and significant ICU stay, hospital stay in compare to patients without low cardiac output syndrome.

Traumatic Isolated Avulsion Rupture of the Distal Semitendinosus Tendon in a Non-athlete.

Isolated distal semitendinosus (ST) injuries remain an uncommon hamstring injury, with avulsion ruptures reported even less frequently. These injuries occur due to eccentric overloading seen in sprinting or jumping injuries. Treatment ranges from conservative management to surgical tenotomy or reattachment to the tibial bone. We present a unique case of a 30-year-old male with an isolated avulsion rupture of the distal ST tendon after a fall. To our knowledge, this is the first case reported in the literature of an isolated distal ST injury in a non-athlete due to trauma.

GPR84-mediated signal transduction affects metabolic function by promoting brown adipocyte activity.

The G protein-coupled receptor 84 (GPR84), a medium-chain fatty acid receptor, has garnered attention because of its potential involvement in a range of metabolic conditions. However, the precise mechanisms underlying this effect remain elusive. Our study has shed light on the pivotal role of GPR84, revealing its robust expression and functional significance within brown adipose tissue (BAT). Mice lacking GPR84 exhibited increased lipid accumulation in BAT, rendering them more susceptible to cold exposure and displaying reduced BAT activity compared with their WT counterparts. Our in vitro experiments with primary brown adipocytes from GPR84-KO mice revealed diminished expression of thermogenic genes and reduced O2 consumption. Furthermore, the application of the GPR84 agonist 6-n-octylaminouracil (6-OAU) counteracted these effects, effectively reinstating the brown adipocyte activity. These compelling in vivo and in vitro findings converge to highlight mitochondrial dysfunction as the primary cause of BAT anomalies in GPR84-KO mice. The activation of GPR84 induced an increase in intracellular Ca2+ levels, which intricately influenced mitochondrial respiration. By modulating mitochondrial Ca2+ levels and respiration, GPR84 acts as a potent molecule involved in BAT activity. These findings suggest that GPR84 is a potential therapeutic target for invigorating BAT and ameliorating metabolic disorders.

Perplexing Initial Presentations of MOGAD in Two Children: Intracranial Hypertension and New-Onset Seizure.

We report two distinct challenging initial presentations of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Case 1 describes a 12-year-old boy who developed headaches refractory to pain medication followed by cranial neuropathies and intracranial hypertension, confirmed by lumbar puncture with an opening pressure >36 cm H2O. Case 2 describes a 3-year-old boy who developed new-onset seizures refractory to antiseizure medications, a presentation of FLAIR-hyperintense lesions in MOG-antibody associated encephalitis with seizures (FLAMES). On repeat magnetic resonance imaging, both patients were found to have cortical T2 hyperintensities, leptomeningeal contrast enhancement, and bilateral optic nerve enhancement. In the cerebrospinal fluid, both patients had CSF pleocytosis with neutrophilic predominance. The patients were treated with intravenous immunoglobulins, plasma exchange, and high-dose corticosteroids. The first patient achieved disease remission, whereas the second patient required the addition of rituximab for management of seizures. The two cases highlight the pleomorphic clinical phenotypes of MOGAD.

Patients' Attitudes Toward the Involvement of Medical Students in Their Health Care in the Family Medicine Clinics in the Makkah Region, Saudi Arabia.

Background The medical undergraduates in the College of Medicine at Umm Al-Qura University, Saudi Arabia, are dedicated to undergrad training in family health facilities. Throughout this clinical attachment, students receive instructions in family practice, patient management, communication skills, clinical examination, and history-taking. Objectives This study was conducted to assess patients' attitudes and key contributing variables toward having medical students participate in their health care consultations in family medicine clinics in the Makkah region of Saudi Arabia. Methods A descriptive cross-sectional study was conducted on a sample of 529 patients who attended family medicine clinics in primary health care settings and were living in the Makkah region. The researchers collected the relevant data during a three-month period (from February 1 to the end of April 2023) by administering a validated, well-structured, self-administered online survey of 24 items on several electronic platforms and analyzing it with SPSS Version 23. Results The mean of their answers on attitude was found to be 41.6 ± 8.51, suggesting a positive attitude of the patients toward the involvement of medical students in their health care. Around 150 (28.4%) of the participants strongly agreed that medical students obtained their histories, and 119 (22.5%) strongly agreed that medical students performed clinical examinations for them. Around 104 (19.7) of the participants strongly agreed and 140 (26.5) perceived that the involvement of medical students in their health care improves doctors' competence. Being 56 years old or older, widowed, retired, or having chronic diseases were found to be associated with a more positive attitude of the patients toward the involvement of medical students in their health care, with p-values of 0.024, 0.034, 0.009, and 0.005, respectively. Conclusions Patients showed favorable attitudes toward the existence and participation of medical students in their health care in family medicine clinics. The provision of health-related information and the taking of a detailed history were the most notable benefits of medical students' involvement in patient care, according to most of the patients. Older, widowed, retired, and those with chronic diseases seemed to possess a positive attitude toward the engagement of medical students in their health care in the family medicine clinics.

Lipoleiomyoma With Bizarre Nuclei and Abundant Mast Cells.

Lipoleiomyoma is an uncommon neoplasm of the uterus with a variable incidence in the literature. Histologically, it consists of smooth muscle cells intermixed with mature adipocytes. The histogenesis of this tumor remains obscure and the presence of atypical cells may raise the suspicion of leiomyosarcoma so it is crucial to distinguish between the two. On the other hand, tumor-associated mast cells are being recognized as tumor modulators and potential therapeutic targets. Here, we discuss the case of a 57-year-old female, who presented with a nonspecific symptom of postmenopausal bleeding. She was found to have a large uterine mass and had been treated surgically with a hysterectomy. Histological examination revealed the diagnosis of this uncommon entity. Considering the rarity of the disease, we report this case to add to the existing literature. Furthermore, the significance of these findings is still poorly understood and needs more investigation to fill in the lacking knowledge.

How do university students perceive the educational transition in the COVID-19 era: A cross-sectional study from 15 Arab countries.

Background and Aims: The viral agent of the novel coronavirus disease 2019 (COVID-19) continues to spread worldwide, leading to a global pandemic. this may negatively affect students' mental health who have to maintain their learning efforts. Therefore, we aimed to assess students' perceptions of the online learning programs designed for university students in Arab countries during the COVID-19 pandemic. Methods: This cross-sectional study was conducted on university students using a self-administered online questionnaire in 15 Arab countries, including 6779 participants. The actual sample size was calculated using the EpiInfo program calculator. The validated, piloted questionnaire assessed the effectiveness of internet-based distance learning applications used in these countries during the pandemic. The SPSS version 22 was used. Results: Among the 6779 participants, 26.2% believed that their teachers diversify learning methods, 22.0% thought that their teachers were able to treat the weakness the students have, and 30.7% agreed that their teachers efficiently communicate with them through COVID-19 internet-based learning process. Around 33% of students participated in lectures effectively, 47.4% submitted their homework within accepted deadlines, and 28.6% thought that their colleagues did not cheat during exams and homework. Around 31.3% of students believed that online-based learning had a role in directing them towards research, and 29.9% and 28.9%, respectively, believed that online learning had a role in developing analytical thinking and synthesis skills. Participants reported many suggestions to enhance the process of internet-based distance learning in the future. Conclusion: Our study suggests that online-based distance learning in Arab countries still needs more improvement as students still are more inclined toward face-to-face teaching. However, exploring the factors that influence students' perceptions of e-learning is vital for improving the quality of online-based distance learning. We recommend exploring the perceptions of educators regarding their experience towards online-based distance learning during COVID-19 lockdown.

Traumatic hemorrhage and chain of survival.

Trauma is the number one cause of death among Americans between the ages of 1 and 46 years, costing more than $670 billion a year. Following death related to central nervous system injury, hemorrhage accounts for the majority of remaining traumatic fatalities. Among those with severe trauma that reach the hospital alive, many may survive if the hemorrhage and traumatic injuries are diagnosed and adequately treated in a timely fashion. This article aims to review the recent advances in pathophysiology management following a traumatic hemorrhage as well as the role of diagnostic imaging in identifying the source of hemorrhage. The principles of damage control resuscitation and damage control surgery are also discussed. The chain of survival for severe hemorrhage begins with primary prevention; however, once trauma has occurred, prehospital interventions and hospital care with early injury recognition, resuscitation, definitive hemostasis, and achieving endpoints of resuscitation become paramount. An algorithm is proposed for achieving these goals in a timely fashion as the median time from onset of hemorrhagic shock and death is 2 h.