Estimating the cost due to resistance against antiretroviral therapies in individuals with HIV: Perspective of the Kingdom of Saudi Arabia.

Objectives: The emergence of resistance to antiretroviral therapy (ART) has an impact on the cost of HIV care. This study aimed to estimate the direct and indirect costs associated with the first episode of drug resistance in individuals with HIV receiving first-line ART. Methods: We developed a cost calculator to estimate the cost of drug resistance over a period of 12 months in the Kingdom of Saudi Arabia. The model inputs (estimated using expert opinion and publicly available sources) included costs associated with testing for resistance, adverse events of a new regimen, and indirect costs. Results: The direct and indirect medical expenses for the year resistance developed were 6980 Saudi Arabian riyal (SAR) and SAR 2862, respectively. The addition of the cost of new ARTs would increase the total annual costs (between SAR 5174 and SAR 34,265 per patient). One-way sensitivity analysis also reported significant impact of initial and switching therapies used after resistance develops on the total costs of resistance per year. Conclusions: There is a significant cost burden associated with drug resistance, which emphasizes the need to select an appropriate initial ART regimen that has a strong genetic barrier and conduct pre-treatment resistance tests (if possible).

Heart failure in children and adolescents: an update on diagnostic approaches and management.

Cardiac failure is a clinical syndrome that may develop in children owing to cardiac dysfunction or underlying structural heart diseases. Considering the differences in diagnostic and therapeutic approaches for pediatric heart failure (PHF) and adult heart failure, we have reviewed the current literature on PHF. Relevant studies were extracted from MEDLINE/PubMed, Google Scholar, and Clinical Trial Registries using the terms "pediatric heart failure" or "heart failure in children" and "management" or "decongestive therapy." Recent advances in diagnostic approaches, such as cardiac magnetic resonance, speckle-tracking echocardiography, tissue Doppler imaging, and molecular diagnostic techniques, have increased our under -standing of PHF. It is imperative that clinicians evaluate the interrelated factors responsible for the develop ment of PHF, including myocardial function, pulmonary and systemic blood flow, heart rhythm, valve function, and nutritional status. Although recent advances have demon strated the efficacy of many new drugs in adult heart failure trials, it cannot be concluded that these drugs will show similar efficacy in children, considering the heterogeneous nature of the underlying mechanisms and variable pharmacody-namics and pharmacokinetics. Therefore, the underlying pathophysiology of PHF and the mechanisms of action of different drugs should be considered when selecting appropriate therapies. Further trials are needed to establi sh the efficacy and safety of these drugs, and a combined mul-ti disciplinary strategy will help enhance PHF outcomes.

High-efficiency electromagnetic energy harvesting using double-elliptical metasurface resonators.

This study introduces a metasurface (MS) based electrically small resonator for ambient electromagnetic (EM) energy harvesting. It is an array of novel resonators comprising double-elliptical cylinders. The harvester's input impedance is designed to match free space, allowing incident EM power to be efficiently absorbed and then maximally channelled to a single load through optimally positioned vias. Unlike the previous research works where each array resonator was connected to a single load, in this work, the received power by all array resonators is channelled to a single load maximizing the power efficiency. The performance of the MS unit cell, when treated as an infinite structure, is examined concerning its absorption and harvesting efficiency. The numerical results demonstrate that the MS unit cell can absorb EM power, with near-perfect absorption of 90% in the frequency range of 5.14 GHz to 5.5 GHz under normal incidence and with a fractional bandwidth of 21%. The MS unit cell also achieves higher harvesting efficiency at various incident angles up to 60o. The design and analysis of an array of 4x4 double elliptical cylinder MS resonators integrated with a corporate feed network are also presented. The corporate feed network connects all the array elements to a single load, maximizing harvesting efficiency. The simulation and measurement results reveal an overall radiation to AC efficiency of about 90%, making it a prime candidate for energy harvesting applications.

Atrial fibrillation in a child with multisystem inflammatory syndrome in children.

Atrial fibrillation (AF) is a rare complication of multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 10-year-old boy with a history of SARS-CoV-2 infection 10 weeks before presentation developed AF following the onset of MIS-C. The patient presented with high fever, conjunctival congestion, erythematous throat, and a diffuse erythematous macular rash involving the face and both legs, in addition to respiratory distress and shock requiring oxygen and vasopressor support. Echocardiography revealed poor left ventricular contractility and normal-appearing coronary vessels. The patient received intravenous immunoglobulin, pulse methylprednisolone, and aspirin. AF resolved with synchronized cardioversion and the patient's clinical condition subsequently improved. This case reports a rare phenomenon of AF in a case of MIS-C. Further research is required to verify the association.

Assessment of healthcare workers' knowledge and attitude on Ebola virus disease in Somalia: a multicenter nationwide survey.

BACKGROUND: In September 2022, a new Ebola outbreak was reported in Uganda, East Africa, and 142 confirmed cases, including 19 Healthcare workers (HCWs) reported. Ebola is not endemic in Somalia, but the country is at a reasonable risk of the virus being introduced due to the direct connection with daily flights from Uganda without border health control and prevention activities. Therefore, evaluating HCWs' Knowledge and attitude is crucial since this is the first time being evaluated in Somalia. The study's objective is to evaluate the HCWs' Knowledge and attitude toward the Ebola virus disease in Somalia. METHOD: An online self-administrated cross-sectional survey was conducted among HCWs (n = 1103) in all six federal member states of Somalia using a validated, reliable, well-structured questionnaire. Data we analyzed using descriptive statistics and Logistic regression were used to determine sociodemographic characteristics associated with poor Knowledge and negative attitude. RESULT: Over one-third (37.3%) of HCWs had poor Knowledge; the mean knowledge score was 7.97 SD ± 2.15. Almost 40.1% of the HCWs had a negative attitude; the mean attitude was 27.81 SD ± 8.06. Low-income HCWs (AOR = 2.06, 95%CI:1.01-4.19), Married HCWs (AOR = 1.39, 95%CI: 1.110-1.963), Midwives (AOR = 2.76, 95%CI: 1.74-4.39), Lab technicians (AOR = 2.43, 95%CI: 1.43-4.14), HCWs work in Jubaland state of Somalia (AOR = 3.69, 95%CI: 2.39-5.70), Galmudug state (AOR = 8.50, 95%CI: 4.59-15.77), Hirshabelle state (AOR = 3.18, 95%CI: 2.15-4.71) were more likely to have poor Knowledge compared to their counterparts. HCWs who work in Hirshabelle state (AOR = 5.44,95%CI: 3.58-8.27), Jubaland state (AOR = 8.47, 95%CI: 4.69-15.29), and Galmudug state (AOR = 4.43, 95%CI: 3.03-6.48) was more likely to have a negative attitude than those working in the Banadir region administration. CONCLUSION: Most Somali healthcare workers showed good Knowledge and a positive attitude toward the Ebola virus. The implementation to enhance Knowledge and attitude must specifically focus on low-income HCWs, Midwives, Lab technicalities, and those who work in Hirshabelle, Jubaland, and Galmudug states of Somalia.

Gold and Silver Chains from Tetrahydrothiophenocucurbit[6]uril as Au or Ag-Nanoparticles.

Tetrahydrothiophenocucurbit[5 and 6]uril has been synthesized from tetrathiophenoglycoluril diether, providing thioether functionality at the exterior equatorial position of the cucurbituril cage. This functionality has been investigated for chemical modification through sulfoxide formation and subsequent Pummerer rearrangement to the acetoxy derivative of the tetrahydrothiophenocucurbit[5]uril. Nanoparticles of Au and Ag were prepared in the presence of tetrahydrothiophenocucurbit[6]uril, which curiously led to the formation of nanoparticle chains, growing in length over days to weeks.

Magnitude of opportunistic infections and associated factors among adult people living with human immune deficient virus on art at selected public hospital, mogadishu somalia: cross-sectional study.

Opportunistic infections (OIs) remain the leading cause of death among people living with Human immune deficient virus and OIs-related mortality in Africa is estimated at 310 000 cases. Besides, Somalia has scant data about OIs since a high burden of tuberculosis and HIV co-infection has been reported. Hence, up-to-date information is vital for better treatment and interventions and may support national and international HIV strategies and eradication programs. Therefore, this study aims to estimate the magnitude of OIs and determine factors associated with among people living with HIV/AIDs on anti-retroviral therapy (ART) in a selected public hospital in Mogadishu, Somalia. Materials and methods: A hospital-based cross-sectional study was conducted between 1 June and 30 August 2022 by interviewing HIV patients and reviewing case record files using a validated questionnaire containing sociodemographic, clinical, OIs history, behavioural and environmental characteristics. Logistic regression was used to determine factors associated with OIs at the significance level of a=0.05. Result: The magnitude of OIs among people living with HIV was 37.1% (95% CI=31.6-42.2); major identified OIs were pulmonary tuberculosis 8.2%, Diarrhoea 7.9%, and Pneumonia 4.3%. Based on Multivariable logistic regression drinking non-sterilized water [adjusted odds ratio (AOR)=2.395, 95% CI: 2.010-4.168], living with domestic animals (AOR=4.012, 95% CI: 1.651-4.123), Co-morbidity of chronic disease (AOR=2.910, 95% CI: 1.761-3.450), and poor ART adherence (AOR=3.121, 95% CI: 1.532-6.309) were factors associated with OIs. Conclusion: Human immune deficient virus patients in Mogadishu, Somalia, suffer from OIs. The OIs reduction strategies should improve drinking water sanitation, provide special consideration for those living with domestic animals and those with a co-morbid chronic disease, and improve ART adherence.

Dual-Band, Wide-Angle, and High-Capture Efficiency Metasurface for Electromagnetic Energy Harvesting.

A dual-band metasurface (MS) with a wide reception angle operating at Wi-Fi bands (2.4 GHz and 5.4 GHz) is presented for electromagnetic (EM) energy harvesting applications. The MS unit cell comprises a subwavelength circular split ring resonator printed on the low-loss substrate. An air layer is sandwiched between two low-loss substrates to enhance the harvesting efficiency at operating frequencies. One of the main advantages of the proposed MS is that it uses only one harvesting port (via) to channel the captured power to the optimized load (50 Ω), which simplifies the design of a combined power network. According to the results of full-wave EM simulations, the proposed MS has a near-unity efficiency of 97% and 94% at 2.4 GHz and 5.4 GHz, respectively, for capturing the power of incident EM waves with normal incidence. Furthermore, the proposed MS harvester achieves good performance at up to 60° oblique incidence. To validate simulations, the MS harvester with 5 × 5-unit cells is fabricated and tested, and its EM properties are measured, showing good agreement with the simulation results. Because of its high efficiency, the proposed MS harvester is suitable for use in various microwave applications, such as energy harvesting and wireless power transfer.

Arabic Translation of the Knee Outcome Survey-Sports Activities Scale With Cross-cultural Adaptation and Validation.

Background: There are few sports-specific knee functional scales in the Arabic language. The Knee Outcome Survey-Sports Activities Scale (KOS-SAS) is a validated sports-specific patient-reported outcome measure that assesses knee function in an athletic population. Purpose: To provide a validated Arabic version of the KOS-SAS (KOS-SAS-Ar) while achieving cross-cultural adaptation for use in an Arabic-speaking population with sports-related knee disorders. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: There were 2 independent translators who conducted a forward translation of the KOS-SAS, followed by a backward translation by different translators. Subsequently, researchers and expert invitees judged the conceptual content and cultural adaptations of the final translation. A total of 276 patients completed the KOS-SAS-Ar as well as the International Knee Documentation Committee (IKDC) subjective assessment of knee function and a visual analog scale (VAS) for pain. Statistical analysis was performed for test-retest reliability, convergent validity, construct validity, and factor analysis. Results: The test-retest reliability of the KOS-SAS-Ar was high (r = 0.9). The items of the KOS-SAS-Ar had statistically significant internal consistency, with a Cronbach alpha of .924 (P < .0001). The KOS-SAS-Ar Symptoms subscore correlated with the VAS pain score (P < .0001), and the KOS-SAS-Ar Functional Limitations subscore correlated with the IKDC subjective score (P < .0001). The construct validity of the KOS-SAS-Ar was satisfactory (Kaiser-Meyer-Olkin value = 0.868; Bartlett test: P < .0001). Factor analysis showed a statistical correlation among the 11 items of the KOS-SAS-Ar. Conclusion: The KOS-SAS-Ar demonstrated favorable reliability and validity, and it appears to be a suitable tool for Arabic-speaking patients with sports-related knee conditions.

Effects of a Home-Based Physical Activity Program on Blood Biomarkers and Health-Related Quality of Life Indices in Saudi Arabian Type 2 Diabetes Mellitus Patients: A Randomized Controlled Trial.

The purpose of this study was to undertake a randomized control trial examining the effects of a 12-week home-based physical activity program on Saudi Arabian adults with type 2 diabetes. Sixty-four patients with type 2 diabetes mellitus were recruited from the Jazan Diabetes and Endocrinology Center, located in the Jazan region of southwestern Saudi Arabia. Patients were randomly assigned to either control, i.e., usual care (males = 46.9% and females = 53.1%, age = 45.88 ± 8.51 years, mass = 76.30 ± 15.16 kg, stature = 160.59 ± 8.94 cm, body mass index (BMI) = 29.73 ± 6.24 kg/m2, years since diagnosis = 8.12 ± 6.22 years) or a home-based physical activity (males = 50% and females = 50%, age = 42.07 ± 9.72 years, mass = 74.58 ± 13.67 kg, stature = 158.94 ± 9.38 cm, BMI = 29.44 ± 4.38 kg/m2, years since diagnosis = 12.17 ± 8.38 years) trial arms. The home-based physical activity group was required to undertake aerobic training by increasing their habitual step count by 2000 steps per day and performing resistance training 3 times per week for 12 weeks. The primary outcome was hemoglobin A1c (HbA1c), and secondary measures of anthropometrics, blood biomarkers, physical fitness, and patient-reported quality of life outcomes pertinent to type 2 diabetes were measured at timepoints, i.e., baseline, 12 weeks, and 24 weeks (follow-up). Intention-to-treat analyses revealed no significant alterations in the primary outcome (control: baseline = 8.71%, 12-weeks = 8.35%, and follow-up = 8.72%; home-based physical activity: baseline = 8.32%, 12-weeks = 8.06%, and follow-up = 8.39%) between trial arms. However, improvements in psychological wellbeing at follow-up measured using the Patient Health Questionnaire-9 were significantly greater in the home-based physical activity group (baseline = 6.84, 12-weeks = 5.96, and follow-up = 5.00) compared to the control (baseline = 6.81, 12-weeks = 5.73, and follow-up = 8.53). No other statistically significant observations were observed. Home-based physical activity is not effective in mediating improvements in HbA1c levels or secondary hematological, blood pressure, anthropometric, or fitness indices. However, given the link between psychological wellbeing and the etiology/progression of disease activity in type 2 diabetes, home-based physical activity may be effective for tertiary disease management. Future trials should examine the efficacy of relative exercise intensities greater than those in the current study.

Impact of Growth Temperature of Lead-Oxide Nanostructures on the Attenuation of Gamma Radiation.

Chemical bath deposition (CBD) technique is utilized to grow lead-oxide (PbO) nanostructures (NSs) over PbO seed fabricated by physical vapor deposition (PVD) method on glass substrates. The effect of growth temperatures 50 and 70 °C on the surface topography, optical properties, and crystal structure of lead-oxide NSs has been studied. The investigated results suggested that the growth temperature has a huge and very considerable influence on the PbO NS, and the fabricated PbO NS has been indexed as the Pb3O4 polycrystalline tetragonal phase. The crystal size for PbO thin films grown at 50 °C was 85.688 nm and increased to 96.61 nm once the growth temperature reached 70 °C. The fabricated PbO nanofilms show a high rate of transmittance, which are ∼70 and 75% in the visible spectrum for the films deposited at 50 and 70 °C, respectively. The obtained Eg was in the range of 2.099-2.288 eV. Also, the linear attenuation coefficient values of gamma-rays for shielding the Cs-137 radioactive source increased at 50 °C. The transmission factor, mean free path, and half-value layer are reduced at a higher attenuation coefficient of PbO grown at 50 °C. This study evaluates the relationship between synthesized lead-oxide NSs and the radiation energy attenuation of gamma-rays. This study provided a suitable, novel, and flexible protective shield of clothes or an apron made of lead or lead oxide to protect against ionizing radiation that meets safety rules and protects medical workers from ionizing radiation.

Persistent Norovirus infection in a young patient with renal transplant: The challenging cost of immunosuppression and the negative impact on patient's quality of life.

Norovirus (NoV) is one of the most common causes of acute infectious gastroenteritis in the United States (US). The infection is typically short-lasting and self-limiting in immunocompetent hosts. Renal transplant recipients on immunosuppressive therapy are more prone to infectious gastroenteritis that can be caused by various common and opportunistic organisms. NoV infection in renal transplant patients presents as an acute diarrheal illness that may progress to a chronic infection with frequent relapses leading to adverse short-term complications (acute renal injury (AKI) and acute graft rejection from the reduction of the dose of immunosuppressive medications) and possibly long-term morbidities (malabsorption syndrome, and a decline in graft survival). The management of chronic NoV infections in renal transplant patients may be quite challenging, as no specific antiviral treatment is presently approved, and frequent adjustments of immunosuppressive therapy may be required in the setting of reduced renal clearance and the attempts to decrease immunosuppressive effects to enhance the viral clearance.Herein, the authors present a case of persistent NoV in a young female patient with a renal transplant that was associated with recurrent admissions with AKI, gross electrolyte disturbances, and significant weight loss. The relapsing NoV infection has negatively impacted the patient's quality of life and socioeconomic performance.

Metastatic Squamous Cell Carcinoma From Primary Hypopharynx Source to Gastric Mucosa Presenting as Massive Gastrointestinal Bleeding.

Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure that represents an important supportive adjunctive component for patients with primary head and neck squamous cell carcinoma (HNSCC). The HNSCC population is considered a high-risk group for developing critical nutritional deficiency due to a multitude of factors. Nevertheless, as the use of PEG in modern practice is gaining more popularity due to various indications, unusual complications have been increasingly reported. PEG site metastasis from primary HNSCC has emerged as a rare, yet serious oncological phenomenon that warrants careful consideration. The authors report an unusual case of squamous cell carcinoma (SCC) of the hypopharynx that metastasized to the gastric body mucosa through a PEG site. The metastatic SCC presented as massive gastrointestinal bleeding, and esophagogastroscopy revealed an ulcerated mass in the gastric body masquerading as a primary gastric adenocarcinoma. Histopathology and immunohistochemistry examination confirmed metastatic SCC which concurred with the patient's primary hypopharyngeal SCC. The review of the updated literature revealed that a total of 121 cases of this rare oncological entity have been reported to date. Physicians need to be vigilant of the symptoms of PEG site metastasis to accurately diagnose and manage the care of this rare occurrence as it is associated with poor prognosis.

Subarachnoid Hemorrhage From Cavernous Malformation Masquerading as Myocardial Infarction.

Intracranial hemorrhage, including subarachnoid hemorrhage (SAH), is associated with many cardiac effects, including cardiac rhythm abnormalities, ischemic electrocardiographic (ECG) changes, elevated cardiac troponin levels, and regional wall motion abnormalities on echocardiogram. About 40% of patients with SAH demonstrate increased serum markers for myocardial necrosis. Approximately 10% of patients with SAH demonstrate left ventricular (LV) wall motion abnormalities; a subset of these patients will have irreversible myocardial damage, but most regain LV function in several weeks. Cardiac effects of SAH are thought to be a result of an imbalance of the autonomic nervous system with resultant increased catecholamine effect on the myocardial cells rather than due to preexisting coronary artery disease. These cardiovascular complications carry a prognostic significance in patients with SAH and can also be misdiagnosed as primary cardiac problems and delay the diagnosis of SAH. Herein, we present a case of a 68-year-old female who presented to the emergency department with acute onset of upper back and neck pain. She was initially misdiagnosed with myocardial infarction in view of the ischemic changes in the ECG and elevated cardiac troponins. She was started on antiplatelets and anticoagulation but was later found to have a negative coronary angiography and was diagnosed with SAH via a computed tomography (CT) scan. Intracranial hemorrhage can be associated with elevated cardiac enzymes and ECG changes and can sometimes masquerade as an acute coronary syndrome (ACS). A careful history and examination and a high index of clinical suspicion are pivotal in such cases since early diagnosis significantly impacts prognosis and prevents the inadvertent use of antiplatelets and anticoagulation, which can be detrimental if used in such cases.

Prevalence of and factors associated with depression among adult patients living with HIV/AIDs undergoing ART unit in Banadir hospital, Mogadishu Somalia.

BACKGROUND: Depression is the most common psychiatric disorder in HIV/AIDs patients, and its prevalence is three times higher in HIV/AIDs patients. Globally, over 35 million people were living with HIV/AIDs, 24.7 million were in Sub-Saharan Africa. The study aims to estimate the prevalence and determine factors associated with depression among HIV/AIDs adult patients in the ART unit at Banadir Hospital Mogadishu, Somalia. METHOD: A hospital-based cross-sectional study was conducted between 1 May and 1 July 2022. Samples were recruited from the HIV/AIDs adult patients attending in ART unit at Banadir Hospital, Mogadishu, Somalia. A validated research tool, including sociodemographic, behavioral, clinical, and psycho-social characteristics, three items social support scale, an 11-item HIV stigma scale, and patient health questions-9 (PHQ-9) were used. The interview was conducted privet room in the ART unit. Logistic regression was used to determine factors associated with depression at the significance level a = 0.050. RESULT: The overall prevalence of depression among HIV/AIDs patients was 33.5% (95%CI = 28.1-39.0). In the multivariable logistic regression, three factors were associated with depression; the odds of depression were 3.415 times (95%CI=1.465-7.960) greater for those with poor social support than those with moderate-strong social support. Those with moderate and poor treatment adherence had 14.307 times (95%CI=5.361-38.182) greater odds of depression than those with good treatment adherence. Those who use substances had 3.422 times (95%CI=1.727-6.781) greater odds of having depression than those who did not. CONCLUSION: People living with HIV in Mogadishu, Somalia, suffer from depression. The implementation to reduce depression should be focused on empowering social support, developing an appropriate approach to increase treatment adherence, and reducing or eliminating substance use.

Sunlight harvesting for heat generation inside water using biosynthesized magnetite nanoparticles.

A low-cost, simple, inexpensive, and environmentally friendly method has been employed for synthesizing magnetite nanoparticles (Fe3O4 NPs). In this study, weeping willow (Salix babylonica L.) aqueous leaf extract has been utilized as a reducing, capping, and stabilizing agent. The synthesized Fe3O4 NPs were characterized by ultraviolet-visible (UV-Vis) spectroscopy, FT-IR spectroscopy, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), dynamic light scattering (DLS), zeta potential analysis, differential scanning calorimetry (DSC), and thermogravimetric analysis (TGA). The localized surface plasmon resonance (LSPR) performance of the Fe3O4 NPs was examined. It has been shown that the biosynthesized Fe3O4 NPs once dispersed in water can raise the temperature of water significantly when they absorb solar radiation through surface plasmon resonance (SPR). The impact of the pH value on the Fe3O4 NPs was also investigated. It has been shown that the optimum pH value among the examined pH values was pH 6. At this pH, the biosynthesized Fe3O4 NPs were able to increase the temperature of water from 25 °C to ∼36 °C. This dramatic increase in temperature was owing to the Fe3O4 NPs synthesized at pH 6 which acquired high crystallinity, monodispersity, high purity, minimum agglomeration, a small particle size, and high stability. In addition, the mechanism of converting solar energy to thermal energy has been discussed intensively. To the best of our knowledge, this study is unique and the novelty of this investigation is that Fe3O4 NPs acquire plasmonic-like properties under solar radiation. Also, they are anticipated to be an innovative photothermal adaptation material for solar-based water heating and heat absorption.

A Rare Case of Granulomatous Mastitis Associated With Positive Systemic Lupus Erythematosus Serology in a Young Female Patient: A Case Report and Literature Review.

Granulomatous mastitis (GM) is a rare benign breast disease that affects women of childbearing age, usually within five years of pregnancy. The hallmark diagnostic feature of GM is the presence of lobular granulomatous inflammation. The occurrence of this clinicopathological entity is usually idiopathic. Nevertheless, GM has often been associated with systemic inflammatory conditions of either infectious (such as tuberculosis) or autoimmune etiology (particularly sarcoidosis, vasculitis, and less likely systemic lupus erythematosus [SLE]). In this report, the authors described an unusual case of GM that was associated with features of SLE in a young female patient who presented with a painful breast lump. Histopathological examination of the lump's biopsy showed GM. Further laboratory workup revealed evidence of some immunological criteria of SLE. Steroid therapy led to the resolution of the patient's breast swelling. The breast mass remained in remission with hydroxychloroquine treatment. Only a handful of similar cases in the current literature demonstrated a plausible association between SLE and GM. Our case provides a reference to consider SLE as a possible differential diagnosis when GM is encountered in young-aged female patients.

Microwave Synthesis of Au Nanoparticles in the Presence of Tetrahydrothiophenocucurbituril.

The preparation of gold nanoparticles (AuNPs) from tetrachloroauric acid in the presence of tetrahydrothiophenocucurbit[n]uril (THTmQ[n]) has been effectively achieved in a microwave reactor. The reaction was performed in the presence of an excess of the tetrahydrothiopheno function in a partial reductant role, while the remainder formed AuNP-THTmQ[n] conjugates after the reduction was completed with formic acid. An affinity for the AuNPs by the THTmQ[n] was observed in the purification of the NPs via centrifugation, removal of the supernatant and resuspension of the conjugate.

Assessment of Awareness and Practice toward Diabetic Ketoacidosis among Diabetic Patients and Their Caregivers in Hail Region.

Introduction: Diabetic ketoacidosis (DKA) is one of the most serious consequences of diabetes. This serious issue occurs when the body cannot use the glucose as a source of energy because of a lack in the level of insulin which as consequence will lead to an increased level of glucose resulting in DKA. Aim: The goal of this study was to increase diabetic patients' and caregivers' awareness and practice of DKA at the community level in Hail City, Saudi Arabia, in 2022. The assessment of people's awareness and knowledge on DKA is importance to support any subsequent actions. Subjects and Methods. This is a cross-sectional study conducted in Hail City, Saudi Arabia, among diabetic patients and carers. A self-administered questionnaire in Arabic was given to the target demographic via an internet survey. The questionnaire includes basic demographic data (i.e., age, gender, and marital status), clinical characteristics of the diabetic patients, and a set of questionnaires to assess the awareness and practice of the subjects regarding DKA. Results: 348 surveys were received (51.1% males vs. 48.9% females). A total of 29.9% of patients have been diagnosed with DKA. Out of a possible 14 points, the average awareness score was 5.22 (SD 3.39). Poor awareness levels had been found in nearly 70% of the subjects, 23.6% were moderate, and only 8.6% were considered good. Factors associated with increased awareness were being younger, female gender, unmarried, students, type 1 DM, DKA diagnosis, and having good information about DKA. Conclusion: The awareness of diabetic patients and their caregivers toward DKA was unsatisfactory. Younger female patients who were single and who had been diagnosed with DKA tend to be more aware of DKA as compared to other subjects. There is a compelling reason to bridge the gaps in the awareness of DKA among the diabetic population and their caregivers in our region.

Steven-Johnson Syndrome: A Rare but Serious Adverse Event of Nivolumab Use in a Patient With Metastatic Gastric Adenocarcinoma.

Nivolumab is a humanized monoclonal anti-programmed cell death receptor-1 (PD-1) antibody that has been authorized for use in the treatment of advanced malignancies. Cutaneous reactions are the most common immune-related adverse events reported with anti-PD-1 agents, and they range broadly from mild localized reactions to rarely severe or life-threatening systemic dermatoses. The occurrence of Steven-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) with nivolumab use is an exceedingly rare phenomenon that was only documented in a handful of cases in the current literature, but it deserves careful attention as SJS/TEN may be associated with fatal outcomes. We present a case of nivolumab-induced SJS/TEN in a middle-aged female patient with metastatic gastric adenocarcinoma that was successfully treated with immunosuppressive therapy and supportive care. Prompt recognition of SJS/TEN with discontinuation of nivolumab is warranted when SJS/TEN is suspected clinically. Multidisciplinary management in a specialized burn unit is the key to improving outcomes of SJS/TEN.