EFFECT OF ENLARGED ADENOIDS AND TONSILS ON BLOOD OXYGEN SATURATION IN AL BAHA, SAUDI ARABIA.

INTRODUCTION: The adenoids and palatine tonsils, part of the lymphoid tissue, act as a first line of defense protecting the lower airways and gastrointestinal tract. Adenotonsillar hypertrophy in children may lead to airway obstruction. This study aims to demonstrate the association between adenotonsillar hypertrophy and decreased blood oxygen saturation. METHODS: A retrospective cohort study was conducted among children aged 7-12 years with adenotonsillar hypertrophy and obstructive symptoms, admitted to King Fahad Hospital and Prince Mishari Hospital, Saudi Arabia, for tonsillectomy between July 2023 and January 2024. Exclusion criteria included respiratory diseases, cardiac disease, nasal polyps, nasal septum deviation, chest wall abnormality, and lower airway diseases. The control group included 56 healthy children. An otolaryngologist determined the severity of airway obstruction using the tonsil size. Oxygen saturation was measured using pulse oximetry. The determinants of oxygen saturation were assessed using multiple linear regression, with significance set at p<0.05. RESULTS: The study included 357 participants, with an even age distribution between 7-9 years (49.6%) and 10-12 years (50.4%), and 52% males. Diagnoses included adenoid hypertrophy (30%), tonsil hypertrophy (35%), both conditions (19%), and the control group (16%). Tonsil sizes ranged from Grade 1 (48%) to Grade 4 (8.4%), with 17% normal. The median oxygen saturation was 96.0% for the adenotonsillar hypertrophy group and 99.0% for the control. Oxygen saturation levels differed significantly across groups (p<0.0001), with lower median saturation in hypertrophy groups than controls. Males had a lower oxygen than females (estimate: -0.338, 95% CI [--0.640, -0.036], p=0.028). Adenoid hypertrophy (estimate: -3.863, 95% CI [-5.241, -2.484], p<0.001), tonsil hypertrophy (estimate: -3.631, 95% CI [-5.053, -2.208], p<0.001) and having both conditions (estimate: -3.777, 95% CI [-5.3.7, -2.247], p<0.001) was associated with lower oxygen saturation. Grade 1 tonsil size was associated with an increase in oxygen saturation (estimate = 2.905, 95% CI [1.616, 4.194], p<0.001). In contrast, Grade 4 tonsil size was linked to lower oxygen saturation (estimate=-4.848, 95% CI [-6.367, -3.329], p<0.001). Grades 2 and 3 were not significantly associated with changes in oxygen saturation. CONCLUSION: Adenotonsillar hypertrophy is significantly associated with decreased blood oxygen saturation and related cardiopulmonary complications in children. Early adenotonsillectomy may be of benefit in preventing these complications and improving oxygen saturation levels.

Ocular manifestations of craniosynostosis in Saudi Arabia.

PURPOSE: Visual and motility disorders have been reported in cases of syndromic and non-syndromic craniosynostosis. However, to the best of our knowledge, no regional or local studies have addressed the prevalence of ocular manifestations in craniosynostosis among Middle Eastern populations. The purpose of this study was to describe the frequency and nature of ophthalmic abnormalities in Arab children with craniosynostosis and to evaluate these findings pre- and post-craniofacial surgery. MATERIALS AND METHODS: A prospective cohort study of 31 children with craniosynostosis. Demographic information was gathered along with genetic results and ophthalmic evaluations, including cycloplegic refraction. RESULTS: Age at presentation to the ophthalmology service ranged from 14 months to 8 years, with a median of 3 years. Sixteen patients were female (52%), and 24 patients had undergone a cycloplegic refraction. Of these, 20.8% had significant refractive errors; of those with refractive errors, 40% were myopic and 60% were hyperopic. Eight patients (25.8%) had papilledema, with significant improvement after craniofacial surgery. Five patients (16%) had visual acuity≤20/30 in at least one eye at baseline with improvements in follow-up visits. CONCLUSION: Craniosynostosis has a significant impact on visual function in the Arab population. Potentially correctable cases of visual impairment, such as those caused by amblyogenic refractive error and papilledema, are commonly encountered; therefore, timely referral and regular ophthalmic evaluation are recommended for these patients.

ACV with/without IVM: a new talk on intestinal CDX2 and muscular CD34 and Cyclin D1 during Trichinella spiralis infection.

The current study assessed the efficacy of Acyclovir (ACV) and Ivermectin (IVM) as monotherapies and combined treatments for intestinal and muscular stages of Trichinella spiralis infection. One-hundred Swiss albino mice received orally 250 ± 50 infectious larvae and were divided into infected-untreated (Group-1), IVM-treated (Group-2), ACV-treated (Group-3), combined IVM+ACV (Group-4), and healthy controls (Group-5). Each group was subdivided into subgroup-A-enteric phase (10 mice, sacrificed day-7 p.i.) and subgroup-B-muscular phase (10 mice, sacrificed day-35 p.i.). Survival rate and body weight were recorded. Parasite burden and intestinal histopathology were assessed. In addition, immunohistochemical expression of epithelial CDX2 in the intestinal phase and CyclinD1 as well as CD34 in the muscular phase were evaluated. Compared, IVM and ACV monotherapies showed insignificant differences in the amelioration of enteric histopathology, except for lymphocytic counts. In the muscle phase, monotherapies showed variable disruptions in the encapsulated larvae. Compared with monotherapies, the combined treatment performed relatively better improvement of intestinal inflammation and reduction in the enteric and muscular parasite burden. CDX2 and CyclinD1 positively correlated with intestinal inflammation and parasite burden, while CD34 showed a negative correlation. CDX2 positively correlated with CyclinD1. CD34 negatively correlated with CDX2 and CyclinD1. IVM +ACV significantly ameliorated CDX2, CyclinD1, and CD34 expressions compared with monotherapies. Conclusion. T. spiralis infection-associated inflammation induced CDX2 and CyclinD1 expressions, whereas CD34 was reduced. The molecular tumorigenic effect of the nematode remains questionable. Nevertheless, IVM +ACV appeared to be a promising anthelminthic anti-inflammatory combination that, in parallel, rectified CDX2, CyclinD1, and CD34 expressions.

AWARENESS AND KNOWLEDGE OF OBSTRUCTIVE SLEEP APNEA AMONG THE POPULATION OF THE AL-BAHA REGION OF SAUDI ARABIA: A CROSS-SECTIONAL STUDY.

Obstructive sleep apnea (OSA) is a known sleep-disordered breathing, with known morbidity and mortality, that affects a lot of people worldwide. In Saudi Arabia, the prevalence of OSA is estimated to be around 8.8% among adult males and 5.1% among adult females. The research is a cross-sectional study design conducted in the Al-Baha region; Saudi Arabia in 385 participants. To evaluate the knowledge and awareness of OSA, the study utilized a validated and reliable adapted Arabic version of the OSA questionnaire. The degree of consciousness and understanding regarding OSA demonstrated a noteworthy connection with varying levels of education and a favorable family history of OSAS (p<0.05). The regression analyses unveiled that people with a familial OSA background had a 2.565-fold increased likelihood of identifying daytime fatigue as a symptom of OSA (p<0.05). The study reported an insufficient level of awareness and knowledge of OSA among the Saudi Arabian population. Various factors, including gender, education, and family history of OSA, may affect the awareness and knowledge of this condition.

Incidence of Guillain-Barré Syndrome post COVID-19: a systematic review of case reports and case series.

OBJECTIVE: The purpose of this systematic review was to study the incidence, risk factors and patients subjected to Guillain-Barré syndrome (GBS) after COVID-19. MATERIALS AND METHODS: For qualitative assessment and assessing the methodological quality, the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) checklist were utilized. Data from PubMed, Cochrane, Embase, CINAHIL, Medline, ResearchGate, and Scopus were searched. The relevant studies involved patients with confirmed COVID-19 diagnosis by RT-PCR, and GBS diagnosis based on typical clinical symptoms and/or confirmatory diagnostic results. A total of 12 English relevant articles (6 papers were case reports and 8 were case series with a total of 32 patients) published in a peer-reviewed journal from 2019 to 2021 were included. Following the review methodology, two independent raters were responsible for retrieving, extracting and checking for data eligibility. Demographic characteristics are presented as frequencies and percentages. Based on distribution of values, continuous data were expressed as median and interquartile range (IQR). RESULTS: Out of 32 patients, 26 patients reported neurological symptoms, 6 cases went unnoticed, 7 cases showed involvement of the cranial nerves, 12 cases did not, and 13 cases went unreported. CONCLUSIONS: It is too early to draw any conclusions concerning a potential relationship between SARS-CoV-2 infection and GBS. More large-scale observational studies are required to understand the pathogenesis of SARS-CoV-2-associated GBS and to demonstrate a definite causal relationship between GBS and SARS-CoV-2 infection.

Culinary Nutrition Education Programs in Community-Dwelling Older Adults: A Scoping Review.

BACKGROUND: Culinary nutrition education programs are increasingly used as a public health intervention for older adults. These programs often integrate nutrition education in addition to interactive cooking workshops or displays to create programs suitable for older adults' needs, ability and behaviour change. Synthesising the existing literature on nutrition education and interactive cooking programs for older adults is important to guide future program development to support healthy ageing. OBJECTIVES: To determine the extent of published literature and report the characteristics and outcomes of interactive culinary nutrition education programs for older adults (> 51 years). DESIGN: This scoping review followed the PRISMA-ScR guidelines recommended for reporting and conducting a scoping review. METHODS: Five databases were searched of relevant papers published to May 2022 using a structured search strategy. Inclusion criteria included: older adults (≥ 51 years), intervention had both an interactive culinary element and nutrition education and reported dietary outcome. Titles and abstracts were screened by two reviewers, followed by full-text retrieval. Data were charted regarding the characteristics of the program and outcomes assessed. RESULTS: A total of 39 articles met the full inclusion criteria. The majority of these studies (n= 23) were inclusive of a range of age groups where older adults were the majority but did not target older adults exclusively. There were large variations in the design of the programs such as the number of classes (1 to 20), duration of programs (2 weeks to 2 years), session topics, and whether a theoretical model was used or not and which model. All programs were face-to-face (n= 39) with only two programs including alternatives or additional delivery approaches beside face-to-face settings. The most common outcomes assessed were dietary behaviour, dietary intake and anthropometrics. CONCLUSION: Culinary nutrition education programs provide an environment to improve dietary habits and health literacy of older adults. However, our review found that only a small number of programs were intentionally designed for older adults. This review provides a summary to inform researchers and policy makers on current culinary nutrition education programs for older adults. It also recommends providing face-to-face alternatives that will be accessible to a wider group of older adults with fewer restrictions.

Melatonin attenuates thioacetamide-induced liver fibrosis in male rats through modulation of interleukin-6, interleukin-4, apoptosis and urokinase plasminogen activator receptor-associated protein/Endo180.

Liver fibrosis is a chronic progressive disease, its resolution still unclear, and the current study explored the role of melatonin in modulation of interleukin-6 (IL-6), interleukin-4 (IL-4), transforming growth factor beta1 (TGF-ß1) and urokinase plasminogen activator receptor-associated protein/Endo180 (uPARAP/Endo180) pathway in thioacetamide (TAA)-induced hepatotoxicity. Thirty two adult Sprague-Dawley rats were divided into four groups: vehicle control group, TAA-induced liver fibrosis group that was left untreated, melatonin administration before and along with TAA and melatonin along with TAA group. TTA-induced massive liver necrosis, fibrosis around portal tract and increases serum levels of liver enzymes and total bilirubin when compared with control vehicle group. While both melatonin pretreatment and treatment retained liver parenchyma and liver enzymes quite similar to control group and reduced TAA-induced liver injury. Notably, melatonin pretreatment and treatment increased collagen degradation in TAA liver injury by19, 31.7-fold respectively evidence by collagen percentage area. Melatonin also decreased the amount of thiobarbituric acid reactive compounds and retained the reduced glutathione and superoxide dismutase to basal level quite similar to control group. Additionally, melatonin significantly (P value ≤0.05) decreased the levels of TGF-ß1, epidermal growth factor (EGF), hydroxyproline, tissues IL-6, caspase-3, and receptor interacting serine/threonine kinase1 (RIPK1), fibrillin-1, and - smooth muscle actin in the liver tissues while significantly (P value ≤0.05) increasing the levels of IL-4 and uPARAP/Endo180. Due to its anti-inflammatory, anti-apoptotic, and antioxidant capabilities as well as its ability to decrease hepatic stellate cell activation and fibrogenesis, these data imply that melatonin has a powerful anti-fibrotic effect.

Nerve conduction study findings and their predictors in clinically diagnosed patients with carpal tunnel syndrome in a Saudi population.

BACKGROUND: Despite the reports of carpal tunnel syndrome (CTS) being commonplace in Saudi Arabia, there is scarcity of cross-sectional or prospective studies detailing the profile of nerve conduction study (NCS) findings in patients with CTS. OBJECTIVE: The study aimed to evaluate the neurophysiologic profile of CTS with the view to finding the determinant of abnormal findings in clinically diagnosed cases of CTS in a population of Saudis. METHODS: Nerve conduction study was performed on consecutive patients with clinically diagnosed CTS. Median sensory, ulnar sensory, radial sensory median motor and ulnar motor nerves were assessed. The nerve conduction parameters measured were median and ulnar sensory peak latency, amplitude and velocity. Median conduction velocity, distal latency, and amplitude were also measured. Comparative median-ulnar and median-ulnar-digit 4 studies were done and the severity of CTS was determined. Data was analyzed using STATA software version 12. RESULTS: A total of 152 patients, comprising 59 males and 93 females (mean age of 42.7 years) with clinically diagnosed CTS were seen during the study period. About 72.4% patients had numbness and paresthesia in the affected fingers, 66.5% had pain in the hands, and 10.5% had weakness in the affected hands. Majority of the patients (62%) had bilateral clinical features. Carpal tunnel syndrome was confirmed with NCS in 84 (55.26%) patients. Presence of weakness in the affected hand, positive Phalen' sign, and positive Tinel's sign in patients appear to predict [6.1 (1.2-30.7), 3.9 (1.2-30.2), and 4.9 (1.4-17.0) respectively] abnormal NCS findings after adjustment for age, gender and the presence of DM. CONCLUSION: The study revealed that over half of the patients with CTS had NCS/ Electromyography (EMG) abnormalities. Presence of hand muscles weakness, positive Phalen and Tinel's signs predict abnormal findings on NCS/EMG in patients with CTS.

Synchronous incidental double parathyroid adenomas and papillary thyroid carcinoma: A case report with literature review.

The association between parathyroid and thyroid diseases is not uncommon; however, the concurrent presence of parathyroid adenoma and thyroid cancer is rare. Awareness of this situation will enable clinicians to consider possible parathyroid pathology in patients with papillary thyroid cancer. The presence of parathyroid adenoma leading to primary hyperparathyroidism and the coexistence of thyroid papillary cancer is rare. We report a case of a 55-year-old female with papillary cancer admitted for surgery. Preoperative laboratory findings revealed normal calcium level and normal intact parathyroid hormone (PTH) level. Thyroidectomy and excision of abnormal enlarged double parathyroid glands were performed. Histological examination revealed parathyroid adenoma. Serum calcium was within the normal range after surgery. We recommend a preoperative check of calcium in patients with thyroid cancer.

When Friends Bring You Down: Peer Stress Proliferation and Suicidality.

Peers play a significant role in adolescent mental well-being and suicidality. While social integration among peers is often assumed to benefit mental health, a growing literature recognizes that peer relationships can increase suicidality. Conceptualizing friends' disclosure of mental distress as a stressor on teens' own mental health clarifies how distressed peers relate to suicidal ideation given integration in key social contexts, such as school. This study applies the stress process to examine peer depression and self-harm disclosure as stressors predicting teens' suicidal ideation. Using cross-sectional data from an understudied context, youth in Saudi Arabia (n = 545, 50% female, mean age = 16.8), models find friends' disclosure of depression and self-harm are associated with adolescents' higher suicidal ideation net of their own depression. Teens who are more attached to school see higher risk of suicidality from friends' depression, while friends' self-harm predicts higher suicidality overall. Results challenge assumptions of uniformly beneficial social integration by indicating that friends' mental distress, particularly self-harm, can act as a stressor increasing youth suicidality.

Aberrant right subclavian artery in a cadaver: a case report of an aortic arch anomaly.

In early embryogenesis, aortic anomalies occur as a consequence of disorders in the development of the primitive aortic arches system. Aberrant right subclavian artery, also known as arteria lusoria, is one of the important congenital anomalies of the aortic arch, in which the right subclavian artery arises from the arch of aorta instead of the brachiocephalic trunk. During routine dissection of a female cadaver, we observed retro-oesophageal aberrant right subclavian artery arising as the fourth branch from the aortic arch. In this case, the brachiocephalic trunk was absent. Early detection of aortic arch anomalies through diagnostic interventions is helpful to avoid complications during surgical procedures.

Cross-cultural validation and psychometric properties of the Arabic Brief COPE in Saudi population.

INTRODUCTION: Coping strategies for stress tend to vary in different cultural. The Brief COPE (BC) is the most commonly used self-report instrument to identify the types of coping strategies used which has a total of 14 strategies with 28 items. The aim of this study was to translate into Arabic and validate the Brief COPE scale in the Saudi Arabian population. METHODS: A cross-sectional method was used to assess the reliability, validity, and cultural appropriateness of the Arabic version of the Brief COPE (A-BC) among 302 males and females (33.8% females). RESULTS: The test-retest reliability was strong at 0.8, and the principal component factor analysis yielded a 3-factor structure, namely 'active coping', 'passive coping', and 'support-seeking', with Composite Reliability scores of 0.84, 0.75, and 0.81 respectively. Confirmatory factor analysis indicated an acceptable factors structure. CONCLUSION: The 3-factor structure of the A-BC was found to be a valid and reliable instrument among the Saudi population. This makes the scale useful in both clinical practice and clinical research.

Synthesis, spectroscopic, thermal, antimicrobial and electrochemical characterization of some novel Ru(iii), Pt(iv) and Ir(iii) complexes of pipemidic acid.

Three new solid complexes of pipemidic acid (Pip-H) with Ru3+, Pt4+ and Ir3+ were synthesized and characterized. Pipemidic acid acts as a uni-dentate chelator through the nitrogen atom of the -NH piperazyl ring. The spectroscopic data revealed that the general formulas of Pip-H complexes are [M(L) n (Cl) x ]·yH2O ((1) M = Ru3+, L: Pip-H, n = 3, x = 3, y = 6; (2) M = Pt4+, L: Pip-NH4, n = 2, x = 4, y = 0 and (3) M = Ir3+, L: Pip-H, n = 3, x = 3, y = 6). The number of water molecules with their locations inside or outside the coordination sphere were assigned via thermal analyses (TG, DTG). The DTG curves refer to 2-3 thermal decomposition steps where the first decomposition step at a lower temperature corresponds to the loss of uncoordinated water molecules followed by the decomposition of Pip-H molecules at higher temperatures. Thermodynamic parameters (E*, ΔS*, ΔH* and ΔG*) were calculated from the TG curves using Coats-Redfern and Horowitz-Metzeger non-isothermal models. X-ray powder diffraction (XRD), scanning electron microscopy (SEM) and transmission electron microscopy (TEM) techniques were carefully used to assign properly the particle sizes of the prepared Pip-H complexes. The biological enhancement of Pip-H complexes rather than free chelate were assessed in vitro against four kinds of bacteria G(+) (Staphylococcus epidermidis and Staphylococcus aureus) and G(-) (Klebsiella and Escherichia coli) as well as against the human breast cancer (MCF-7) tumor cell line.

Ultra-Sensitive Nano Optical Sensor Samarium-Doxycycline Doped in Sol Gel Matrix for Assessment of Glucose Oxidase Activity in Diabetics Disease.

A low cost and very sensitive method for the determination of the activity of glucose oxidase enzyme in different diabetics serum samples was developed. The method based on the assessment of the H2O2 concentration produced from the reaction of the glucose oxidase (GOx) enzyme with glucose as substrate in the serum of diabetics patients by nano optical sensor Sm-doxycycline doped in sol gel matrix. H2O2 enhances the luminescence intensity of all bands of the nano Sm-doxycycline complex [Sm-(DC)2]+ doped in sol-gel matrix, especially the 645 nm band at λex = 400 nm and pH 7.0 in water. The influence of the different analytical parameters that affect the luminescence intensity of the nano optical sensor, e.g. pH, H2O2 concentration and foreign ions concentrations were studied. The remarkable enhancement of the luminescence intensity of nano optical sensor [Sm-(DC)2]+ complex in water at 645 nm by the addition of various concentrations of H2O2 was successfully used as an optical sensor for the assessment of the activity of the glucose oxidase enzyme in different diabetics serum samples. The calibration plot was achieved over the activity range 0.1-240 U/L with a correlation coefficient of 0.999 and a detection limit of 0.05 U/L.

Health risk associated with airborne particulate matter and its components in Jeddah, Saudi Arabia.

Samples of PM2.5 and PM10 have been collected in all of four seasons at seven sites within the city of Jeddah, Saudi Arabia. The samples have been analysed for a range of trace elements. There is a large loading of wind-blown dust and the majority of elements are predominantly associated with coarse particles. Enrichment factors, however, show that some elements are markedly enriched above crustal abundance. Using mean data for the PM2.5 and PM10 fractions from each of the seven sampling sites, health risks have been estimated for particulate matter mass, the elements Cr, Mn, Ni, Pb, As, Cd and V measured in this study, and polycyclic aromatic hydrocarbons using data from an earlier study within Jeddah. Cancer risks are calculated from mean airborne concentrations and cancer slope factors for the carcinogenic metals and PAH, but the cancer risks are relatively modest compared to the lifetime risk of mortality due to PM2.5 exposure. The risks associated with exposure to V and Mn are considered to be small, while concentrations of cadmium far exceed the European Union Limit Value and World Health Organisation guideline. Cadmium shows a very high crustal enrichment factor but is present predominantly in the coarse particle fraction suggesting that local soils and surface dusts are unusually enriched in Cd relative to the global average. Using national data for mortality rates, the excess mortality due to PM2.5 exposure has been calculated and amounts to over 1100 deaths annually for the city of Jeddah.

MERS CoV infection in two renal transplant recipients: case report.

Middle East Respiratory Syndrome Coronavirus (MERS CoV) infection has recently emerged as a cause of severe potentially fatal pneumonia. The clinical presentation ranges from asymptomatic infection to severe pneumonia and acute renal failure. Data on the clinical presentation in solid organ transplant recipients are lacking. We report two cases of MERS CoV infections in two renal transplant recipients with variable clinical presentations and outcomes. The first patient presented with progressive respiratory symptoms, acute renal failure and died. While the second patient presented with respiratory tract symptoms, remained stable and had an excellent clinical recovery despite recent reception of thymoglobulin induction. This is a rare report of MERS CoV infection in renal transplant recipients. Further data are needed to gain better understanding of the impact of anti-rejection immunosuppressive therapy on the clinical presentation, severity and outcome of MERS CoV infections in solid organ transplant recipients.

A Legendre tau-spectral method for solving time-fractional heat equation with nonlocal conditions.

We develop the tau-spectral method to solve the time-fractional heat equation (T-FHE) with nonlocal condition. In order to achieve highly accurate solution of this problem, the operational matrix of fractional integration (described in the Riemann-Liouville sense) for shifted Legendre polynomials is investigated in conjunction with tau-spectral scheme and the Legendre operational polynomials are used as the base function. The main advantage in using the presented scheme is that it converts the T-FHE with nonlocal condition to a system of algebraic equations that simplifies the problem. For demonstrating the validity and applicability of the developed spectral scheme, two numerical examples are presented. The logarithmic graphs of the maximum absolute errors is presented to achieve the exponential convergence of the proposed method. Comparing between our spectral method and other methods ensures that our method is more accurate than those solved similar problem.

Health and well-being among physicians.

BACKGROUND AND AIM: Physicians' attitudes towards disease prevention are crucial. The purposes of this study are to examine the prevalence of cardiovascular risk factors and adherence to international preventive screening programmes by a group of physicians. METHODS: Online and paper format questionnaires were completed by a sample of 650 physicians from November 2010 to March 2011. The collected data included the main components of screening programmes, which are recommended in international guidelines. RESULTS: The data show that 30.5% of male physicians currently smoke, 19.4 % are obese, 15.2% have hypertension, 38% are physically inactive and 10.9% have diabetes. Nearly all (95%) of the female participants and most (83%) of the male participants older than 45 years had never had a colonoscopy. Of the male physicians older than 55 years, 36.4% had never had prostate-specific antigen testing, and only 10.9% had undergone a digital rectal examination. Among the female physicians, 27.4% were obese, and 42% had never had a mammogram. CONCLUSION: The prevalence of behavioural risk factors for cardiovascular disease is high among physicians. A substantial percentage of the practising physicians did not adhere to the age-specified preventive screening measures recommended in international guidelines.

Remediation of Cu(II), Ni(II), and Cr(III) ions from simulated wastewater by dendrimer/titania composites.

Generation 4 polyamidoamine (PAMAM) dendrimers with ethylenediamine cores (G4-OH) were immobilized on titania (TiO(2)) and examined as novel metal chelation materials. Characterization results indicate both the effective immobilization of dendrimers onto titania and retention of the dendrimer on titania following remediation. The effective remediation of Cu(II), Ni(II), and Cr(III), which are model pollutants commonly found in industrial electroplating wastewater, is demonstrated in this work. Important parameters that influence the efficiency of metal ion removal were investigated; e.g. solution pH, retention time, metal ion concentration, and composite material dosage. Metal ion removal was achieved over a wide metal concentration range within a 1 h equilibration time. Maximum metal ion removal was achieved at pH ≥7 for both Cu(II) and Cr(III), and pH ≥9 for Ni(II). Further, the dendrimer/titania composite materials were even more effective when metal ion mixtures were tested. Specifically, a dramatic increase was observed for Ni(II) chelation when in a mixture was compared to a pure nickel solution. These findings suggest new strategies for improving metal ion removal from industrial wastewater.