Behçet's Syndrome in a Child: A Case Report and a Review of Literature.

Behçet's syndrome is a complex chronic inflammatory disorder characterized by widespread inflammation of the blood vessels, affecting various systems in the body. Although its exact cause remains unknown, genetic predisposition, particularly HLA-B51/B5 gene carriage, and environmental factors are believed to play roles. The disease typically manifests in individuals aged 20-40 years, with an uncommon occurrence in children and elderly individuals. Key clinical manifestations include recurrent oral and genital ulcers, skin lesions, ocular involvement, positive pathergy test results, and other systemic symptoms. Eye involvement is common and can lead to severe visual impairment if left untreated. This diversity of Behçet's disease (BD) presentations and complications emphasizes the importance of early recognition and management. An eight-year-old girl presented with a deep painful ulcer in the mouth and a history of chronic constipation, severe joint pain, and recurrent mouth ulcers. Initial examination revealed an ulcer scar on the tongue and a deep ulcer on the left side of the mucobuccal fold. The patient was diagnosed with a recurrent major aphthous ulcer and prescribed Predo pediatric syrup as a mouthwash and paracetamol to relieve the pain. A biopsy was recommended by her physician to be done under general anesthesia and to rule out malignancy; the biopsy result revealed the presence of a benign squamous epithelium with reactive changes. The genetic result revealed HLA B*51 positivity and normal immunoglobulin levels. Treatment with colchicine led to the complete healing of the ulcer with scar formation after three months. This case report highlights the unique presentation of Behçet's syndrome in children and the challenges associated with its diagnosis. It emphasizes the importance of the early recognition and prompt management of BD in the pediatric population, in which disease progression can be more severe than in adult-onset cases. This case provides valuable insights into the clinical features of and diagnostic approach to Behçet's syndrome in children.

The relationship between intraocular pressure and glaucoma: an evolving concept.

Intraocular pressure (IOP) is the most important modifiable risk factor for glaucoma and fluctuates considerably within patients over short and long time periods. Our field's understanding of IOP has evolved considerably in recent years, driven by tonometric technologies with increasing accuracy, reproducibility, and temporal resolution that have refined our knowledge regarding the relationship between IOP and glaucoma risk and pathogenesis. The goal of this article is to review the published literature pertinent to the following points: 1) the factors that determine IOP in physiologic and pathologic states; 2) technologies for measuring IOP; 3) scientific and clinical rationale for measuring diverse IOP metrics in patients with glaucoma; 4) the impact and shortcomings of current standard-of-care IOP monitoring approaches; 5) recommendations for approaches to IOP monitoring that could improve patient outcomes; and 6) research questions that must be answered to improve our understanding of how IOP contributes to disease progression. Retrospective and prospective data, including that from landmark clinical trials, document greater IOP fluctuations in glaucomatous than healthy eyes, tendencies for maximal daily IOP to occur outside of office hours, and, in addition to mean and maximal IOP, an association between IOP fluctuation and glaucoma progression that is independent of mean in-office IOP. Ambulatory IOP monitoring, measuring IOP outside of office hours and at different times of day and night, provides clinicians with discrete data that could improve patient outcomes. Eye care clinicians treating glaucoma based on isolated in-office IOP measurements may make treatment decisions without fully capturing the entire IOP profile of an individual. Data linking home blood pressure monitors and home glucose sensors to dramatically improved outcomes for patients with systemic hypertension and diabetes and will be reviewed as they pertain to the question of whether ambulatory tonometry is positioned to do the same for glaucoma management. Prospective randomized controlled studies are warranted to determine whether remote tonometry-based glaucoma management might reduce vision loss and improve patient outcomes.

Readiness of University Students in Riyadh to Participate in Basic Life Support Programs: A Cross-Sectional Study.

Introduction Out-of-hospital cardiac arrest is one of the greatest causes of death in the world. When basic life support (BLS) techniques are performed rapidly, the odds of survival increase. The aim of this research is to assess the university students' preparation and knowledge level regarding their interest in participating in BLS. Methods A cross-sectional study using an online self-administered questionnaire was conducted between January 20 and March 20, 2022. The questionnaire addressed awareness about BLS, willingness to participate in such courses, perceived barriers and incentives, and course uptake, in addition to the sociodemographic profile of participants. Logistic regression analysis was used to identify the factors significantly associated with the willingness to participate in BLS courses and the associations are reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results A total of 1,546 students completed the questionnaire; almost half of them (n=761, 49.2%) were aged 17 to 21 and the majority were females (n=1,132, 73.2%). Only one-third of the population had heard about BLS (n=519, 33.6%), 27.1% (n=419) recognized where to register for BLS training, and 20.3% (n=314) had taken a BLS course. Most participants (n=1,081, 69.9%) demonstrated a low level of awareness. Conversely, a substantial portion (n=1,204, 77.9%) expressed a personal interest in undertaking the course. It was observed that participants who are affiliated with healthcare specialties (AOR = 5.96, 95% CI = 4.66-7.63, p<0.05) exhibited greater knowledge about BLS, while females (OR = 2.49, 95% CI = 1.52-4.08, p<0.05) and those in healthcare specialties (OR = 2.23, 95% CI = 1.29-3.82, p<0.05) displayed a notably higher inclination to enroll in BLS courses compared to their counterparts. Conclusion Despite the limited awareness of BLS among university students, there is a strong willingness to engage in BLS courses. It is crucial to motivate students to partake in these courses and emphasize the availability of accredited centers for their education institutes.

Concurrent identification of follicular lymphoma and papillary thyroid carcinoma.

INTRODUCTION: PTC has high lymph node metastasis, affecting central and lateral lymph nodes. On the other hand, follicular lymphoma is the second most frequent non-Hodgkin lymphoma in the West and affects cervical lymph nodes. CASE PRESENTATION: A 66-year-old Saudi man with type 2 diabetes and hypertension presented with neck lumps on both sides of his neck. The swelling was progressive, with no apparent cause, no history of hypothyroidism or hyperthyroidism, and no constitutional symptoms. Physical examination revealed multiple lymph node enlargements and a hard, firm mass on his thyroid gland. CLINICAL DISCUSSION: Multiple malignant neoplasms are rare, but secondary primary cancers have been documented in patients with PTC. The occurrence of both cancers is commonly detected during follow-up and aided by modern imaging techniques. The main treatment for PTC is surgery, usually with a good prognosis. CONCLUSION: A 66-year-old male was diagnosed with follicular lymphoma during a papillary thyroid carcinoma workup, emphasizing the importance of careful lymph node dissection and microscopic examination for rare cases.

Development of oculomics artificial intelligence for cardiovascular risk factors: A case study in fundus oculomics for HbA1c assessment and clinically relevant considerations for clinicians.

Artificial Intelligence (AI) is transforming healthcare, notably in ophthalmology, where its ability to interpret images and data can significantly enhance disease diagnosis and patient care. Recent developments in oculomics, the integration of ophthalmic features to develop biomarkers for systemic diseases, have demonstrated the potential for providing rapid, non-invasive methods of screening leading to enhance in early detection and improve healthcare quality, particularly in underserved areas. However, the widespread adoption of such AI-based technologies faces challenges primarily related to the trustworthiness of the system. We demonstrate the potential and considerations needed to develop trustworthy AI in oculomics through a pilot study for HbA1c assessment using an AI-based approach. We then discuss various challenges, considerations, and solutions that have been developed for powerful AI technologies in the past in healthcare and subsequently apply these considerations to the oculomics pilot study. Building upon the observations in the study we highlight the challenges and opportunities for advancing trustworthy AI in oculomics. Ultimately, oculomics presents as a powerful and emerging technology in ophthalmology and understanding how to optimize transparency prior to clinical adoption is of utmost importance.

Attention-Based Deep Learning Approach for Breast Cancer Histopathological Image Multi-Classification.

Breast cancer diagnosis from histopathology images is often time consuming and prone to human error, impacting treatment and prognosis. Deep learning diagnostic methods offer the potential for improved accuracy and efficiency in breast cancer detection and classification. However, they struggle with limited data and subtle variations within and between cancer types. Attention mechanisms provide feature refinement capabilities that have shown promise in overcoming such challenges. To this end, this paper proposes the Efficient Channel Spatial Attention Network (ECSAnet), an architecture built on EfficientNetV2 and augmented with a convolutional block attention module (CBAM) and additional fully connected layers. ECSAnet was fine-tuned using the BreakHis dataset, employing Reinhard stain normalization and image augmentation techniques to minimize overfitting and enhance generalizability. In testing, ECSAnet outperformed AlexNet, DenseNet121, EfficientNetV2-S, InceptionNetV3, ResNet50, and VGG16 in most settings, achieving accuracies of 94.2% at 40×, 92.96% at 100×, 88.41% at 200×, and 89.42% at 400× magnifications. The results highlight the effectiveness of CBAM in improving classification accuracy and the importance of stain normalization for generalizability.

Effectiveness of Autologous Fat Grafting in the Treatment of Scars: A Systematic Review and Meta-Analysis.

BACKGROUND: Autologous fat transfer (AFT) has been proposed as a possible treatment for scar tissue and its associated symptoms. Its effectiveness's evidence is yet unidentified though. The aim of this meta-analysis is to evaluate the currently available evidence on the efficacy and safety of autologous fat transfer in treating post-burn and post-traumatic scars using a validated scar measurement tool. METHODS: This study performed a systematic literature review in November 2023 using the following electronic databases: MEDLINE, SCOPUS, Directory of Open Access Journals (DOAJ), PUBMED, and Google Scholar. The following key terms were included: (Fat grafting OR Autologous fat transfer) AND (body scars OR body burns OR body wounds) AND (Efficacy OR Safety OR satisfaction). We evaluated articles according to predefined quality criteria. The following data were included during the extraction period: patient demographics, indications for AFT, the number of AFT sessions, follow-up periods, and changes in the Patient and Observer Scar Assessment Scale (POSAS) scores, which contain both the patient and observer components. RESULTS: This study included 1326 patients and 23 published articles. A total of 14 prospective studies, 7 retrospective studies, and 2 Randomized clinical trials studies were evaluated. These 23 articles came from diverse global locations; the earliest was published in 1992, and the most recently published in 2022. CONCLUSION: Our findings demonstrated significant enhancements in scar characteristics from both patient and observer perspectives. Overall, AFT holds promise as a valuable treatment option for scar-related conditions as it enhances scar quality ,contributing to improved patient outcomes and satisfaction. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

Prevalence, perception, and attitude regarding electronic cigarettes usage among young adults in Riyadh, Saudi Arabia. A cross-sectional study.

OBJECTIVES: To determine the prevalence of electronic cigarette (e-cigarette) usage among young adults in Riyadh, Saudi Arabia; their perceptions of its harm and legal age, and the reasons and factors influencing their use. METHODS: This cross-sectional study was carried out within the general community of Riyadh, Saudi Arabia, between December 2023 and April 2024. Participants aged 18-25 years were included. A self-administered online questionnaire was used to gather demographic data, perceptions, and attitudes toward e-cigarettes and reasons for their use. RESULTS: The majority of the 476 participants were female (n=378, 79.4%) and Saudi nationals (n=451, 94.7%). Current e-cigarette usage was 10.5% (n=50), being more prevalent among males (n=46, 46.9%) and non-Saudis (n=12, 48%). Respondents living alone (n=11, 34.4%) or with friends (n=4, 80%), those who perceived e-cigarettes as safer than cigarettes (n=38, 42.2%), or were unsure of age restrictions demonstrated high usage. Key motivators included flavors available, stress relief, and curiosity. CONCLUSION: Eelectronic cigarette use among Riyadh's youth was remarkable, especially among males. Reducing the e-cigarette usage prevalence in Saudi Arabia should be prioritized.

Corrigendum: Progression of functional and structural glaucomatous damage in relation to diurnal and nocturnal dips in mean arterial pressure.

[This corrects the article DOI: 10.3389/fcvm.2022.1024044.].

Association Between Lower Levels of Vitamin D and Inflammation in the Geriatric Population: A Systematic Review and Meta-Analysis.

There have been suggestions that vitamin D has anti-inflammatory effects; however, the variabilities of vitamin D levels among specific groups of patients and its association with these inflammatory events have not been demonstrated. This study aims to study the association between vitamin D levels and vitamin D deficiency and inflammatory events among the elderly population. PubMed, Web of Science, Scopus, Science Direct, and ClinicalKey were systematically searched in December 2023 to include the relevant data. Comprehensive Meta-Analysis (version 3.0, Biostat, Inc., Englewood, NJ) was the software used for data analyses. A total of 12 studies were included in this analysis with 14,717 elderly patients. There was an overall significant decrease in vitamin D levels in elderly patients with high inflammatory markers compared to controls (Hedges' g = -0.221, 95% CI: -0.268, -0.173, P < 0.001), and event of vitamin D deficiency was found to be 0.321 (95% CI: 0.305, 0.337, P < 0.001). There is a significant decrease in vitamin D levels among the elderly with different inflammatory conditions. Future longitudinal studies and well-designed, large, randomized controlled trials are required to study the association between vitamin D deficiency and the incidence of inflammatory events in this specific group of patients.

Efficacy of Continuous Lumbar Plexus Blockade in Managing Post-Operative Pain after Hip or Femur Orthopedic Surgeries: A Systematic Review and Meta-Analysis.

Background: Post-operative pain management is essential for optimizing recovery, patient comfort, and satisfaction. Peripheral nerve blockade, or lumbar plexus block (LPB), has been widely used for analgesia and regional anesthesia. This study explored the existing literature to determine the efficacy of continuous lumbar plexus blockade in managing post-operative pain following hip or femur surgery. Methods: Reviewers comprehensively searched electronic databases to identify peer-reviewed scholarly articles reporting the efficacy of lumbar plexus block in managing post-operative pain after orthopedic surgery. The potential articles were carefully selected and assessed for the risk of bias using the Cochrane Collaboration Risk of Bias assessment tool. Data were systematically extracted and analyzed. Results: The literature search yielded 206 articles, 20 of which were randomized controlled trials. Lumbar plexus block demonstrated superior pain relief compared to conventional pain management approaches like general anesthetics. In addition, LPB reduced patients' overall opioid consumption compared to controls, reduced adverse effects, and enhanced functional recovery, which underlines the broader positive impact of meticulous pain management. More patients could walk more than 40 feet after the second day post-operatively among the lumbar plexus group (14.7%) compared to the continuous femoral group (1.3%). Other parameters, including cortisol levels and hemodynamic stability, were evaluated, showing comparable outcomes. Conclusions: Lumbar plexus block is effective in pain management after orthopedic surgery, as shown by the lower pain scores and less opioid consumption. Additionally, patient satisfaction was relatively higher in LPB-treated patients compared to other approaches like general anesthesia.

Facilitators and barriers to learning faced by female students with disability in higher education.

This study was aimed to investigate the learning experiences' facilitators and barriers that is encountered by the physically disabled female students during their higher education. Twenty semi-structured interviews were conducted with female students with physical disabilities aged between 19 and 33 years. Interviews were transcribed, confirmed, and analyzed after being recorded. The average age of the sample was 22.15 ± 3.48 years and one-fourth of the participants' disability was due to cerebral palsy and 35% participants used wheelchairs. All the factors promoted inclusive education and equal opportunities for both disabled and nondisabled students. This study reveals that in order to improve the learning experiences of students with disabilities (SwD) and to give them more opportunities for success, it is important to consider all the barriers discussed in this study. It can be concluded that high effort is required to transform the higher educational institutions to be more accommodating for students with disabilities.

Levels of Awareness Regarding Pediatric Eye Diseases Among Saudi Parents From the Hail and Al-Qassim Regions, Saudi Arabia.

BACKGROUND: The importance of children's eye health cannot be overstated as it has significant implications for personal life, education, career, health, financial status, and overall satisfaction. This study aims to assess the awareness of parents regarding pediatric eye diseases to identify potential gaps in knowledge. By understanding parental awareness, we can develop targeted educational initiatives to promote early detection, timely intervention, and overall improved eye health in children. This research seeks to contribute valuable insights for enhancing preventive measures and fostering healthier eyesight in younger generations. METHODOLOGY:  A descriptive cross-sectional study was conducted in the Hail and Al-Qassim regions, of Saudi Arabia. Parents with children aged less than 15 years were included. Targeted parents were selected consecutively using an online questionnaire for data collection. Data included parents' data, children's eye diseases, and parents' knowledge, practice, and attitude toward pediatric eye diseases.  Results: A total of 618 eligible parents were included, 429 (69.4%) from Al-Qassim and 189 (30.6%) from Hail. Parents' ages ranged from 20 to 59 years with a mean age of 35.4 ± 11.5 years. A total of 510 (82.5%) respondents were females. A total of 442 (71.5%) of the study parents had poor knowledge about their pediatric eye problems, 154 (24.9%) had a good knowledge level, and only 22 (3.6%) had excellent knowledge. As for their practice, 458 (74.1%) of the parents arranged for their children to undergo an eye or visual test; 254 (55.5%) did so when the child was six to ten years of age. CONCLUSION:  The current study showed poor awareness levels about pediatric eye diseases among parents, mainly regarding cataracts and glaucoma. On the other hand, parents demonstrated a high level of engagement in visually assessing their children. The primary hindrance to conducting assessments was the absence of symptoms and signs or active complaints, leading to a lack of proactive seeking of visual evaluations.

Targeting liver and adipose tissue in obese mice: Effects of a N-acylethanolamine mixture on insulin resistance and adipocyte reprogramming.

N-acylethanolamines (NAEs) are endogenous lipid-signalling molecules involved in inflammation and energy metabolism. The potential pharmacological effect of NAE association in managing inflammation-based metabolic disorders is unexplored. To date, targeting liver-adipose axis can be considered a therapeutic approach for the treatment of obesity and related dysfunctions. Here, we investigated the metabolic effect of OLALIAMID® (OLA), an olive oil-derived NAE mixture, in limiting liver and adipose tissue (AT) dysfunction of high-fat diet (HFD)-fed mice. OLA reduced body weight and fat mass in obese mice, decreasing insulin resistance (IR), as shown by homeostasis model assessment index, and leptin/adiponectin ratio, a marker of adipocyte dysfunction. OLA improved serum lipid and hepatic profile and the immune/inflammatory pattern of metainflammation. In liver of HFD mice, OLA treatment counteracted glucose and lipid dysmetabolism, restoring insulin signalling (phosphorylation of AKT and AMPK), and reducing mRNAs of key markers of fatty acid accumulation. Furthermore, OLA positively affected AT function deeply altered by HFD by reprogramming of genes involved in thermogenesis of interscapular brown AT (iBAT) and subcutaneous white AT (scWAT), and inducing the beigeing of scWAT. Notably, the NAE mixture reduced inflammation in iBAT and promoted M1-to-M2 macrophage shift in scWAT of obese mice. The tissue and systemic anti-inflammatory effects of OLA and the increased expression of glucose transporter 4 in scWAT contributed to the improvement of gluco-lipid toxicity and insulin sensitivity. In conclusion, we demonstrated that this olive oil-derived NAE mixture is a valid nutritional strategy to counteract IR and obesity acting on liver-AT crosstalk, restoring both hepatic and AT function and metabolism.

Transparency in Artificial Intelligence Reporting in Ophthalmology-A Scoping Review.

Topic: This scoping review summarizes artificial intelligence (AI) reporting in ophthalmology literature in respect to model development and validation. We characterize the state of transparency in reporting of studies prospectively validating models for disease classification. Clinical Relevance: Understanding what elements authors currently describe regarding their AI models may aid in the future standardization of reporting. This review highlights the need for transparency to facilitate the critical appraisal of models prior to clinical implementation, to minimize bias and inappropriate use. Transparent reporting can improve effective and equitable use in clinical settings. Methods: Eligible articles (as of January 2022) from PubMed, Embase, Web of Science, and CINAHL were independently screened by 2 reviewers. All observational and clinical trial studies evaluating the performance of an AI model for disease classification of ophthalmic conditions were included. Studies were evaluated for reporting of parameters derived from reporting guidelines (CONSORT-AI, MI-CLAIM) and our previously published editorial on model cards. The reporting of these factors, which included basic model and dataset details (source, demographics), and prospective validation outcomes, were summarized. Results: Thirty-seven prospective validation studies were included in the scoping review. Eleven additional associated training and/or retrospective validation studies were included if this information could not be determined from the primary articles. These 37 studies validated 27 unique AI models; multiple studies evaluated the same algorithms (EyeArt, IDx-DR, and Medios AI). Details of model development were variably reported; 18 of 27 models described training dataset annotation and 10 of 27 studies reported training data distribution. Demographic information of training data was rarely reported; 7 of the 27 unique models reported age and gender and only 2 reported race and/or ethnicity. At the level of prospective clinical validation, age and gender of populations was more consistently reported (29 and 28 of 37 studies, respectively), but only 9 studies reported race and/or ethnicity data. Scope of use was difficult to discern for the majority of models. Fifteen studies did not state or imply primary users. Conclusion: Our scoping review demonstrates variable reporting of information related to both model development and validation. The intention of our study was not to assess the quality of the factors we examined, but to characterize what information is, and is not, regularly reported. Our results suggest the need for greater transparency in the reporting of information necessary to determine the appropriateness and fairness of these tools prior to clinical use. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A Comparison of Knowledge, Attitude, and Practice (KAP) Between Private- and Government-Sector Pharmacists With Regard to Psychotropic Medications in Riyadh City.

Background Pharmacists play a significant role in patient care, and many patients consider them to be their primary source of information regarding medications. Therefore, pharmacists must have an adequate level of knowledge about psychotropic medications. This study aims to assess and compare the levels of knowledge, attitudes, and practices regarding psychotropic medications in governmental and private-sector pharmacists in Riyadh, Saudi Arabia. Methods An observational cross-sectional study was conducted, which included 355 pharmacists (governmental and private sector pharmacists). Each pharmacist was interviewed and asked to answer a structured questionnaire that consisted of four sections: demographic data, knowledge, attitude, and practice regarding psychotropic medications. Results Our findings indicate that the overall knowledge regarding psychotropic medications among private and government-sector pharmacists is insufficient. While 282 (79.4%) had insufficient knowledge, 20.6% of pharmacists had adequate knowledge regarding psychotropic medications, and good knowledge was detected among 29.1% of government-sector pharmacists compared to 18.1% of private-sector pharmacists (P = .033). Our results also revealed that 31.5% of the pharmacists felt comfortable with their knowledge of psychotropic agents. In addition, 18.9% of the pharmacists reported that they received adequate training on psychotropic medications (12.7% of the governmental group versus 20.7% of the private-sector group; P =.048). Conclusion The insufficient knowledge among pharmacists regarding psychotropic medications highlights the importance of providing more training programs and educational courses to improve pharmacists' knowledge about psychotropic medications in Saudi Arabia.

Liraglutide Attenuates Diabetic Cardiomyopathy via the ILK/PI3K/AKT/PTEN Signaling Pathway in Rats with Streptozotocin-Induced Type 2 Diabetes Mellitus.

One of the possible candidates for the treatment of diabetic cardiomyopathy is liraglutide, a glucagon-like peptide-1 receptor (GLP1R) agonist. In this study, the impacts of liraglutide on the integrin-linked kinase (ILK)-related PI3K/AKT axis in rats with type 2 diabetes induced via streptozotocin were examined. Twenty-four Wistar albino rats were distributed in four different groups, and a high-fat diet and streptozotocin were used to induce type 2 in two groups. Rats in the untreated control groups were administered 0.9% NaCl solution over a 6-week period, and those in the treatment groups were administered 0.9% NaCl for 3 weeks, followed by subcutaneous injection of liraglutide (150 µg/kg) for an additional 3 weeks. In the liraglutide-treated diabetic group, the heart-to-body weight ratio was significantly reduced, levels of cardiac biomarkers, troponin I and creatine-kinase-MB, were improved; activities of antioxidant enzymes, glutathione peroxidase and superoxide dismutase, were increased; and levels of malondialdehyde were decreased. Western blotting and immunohistochemical studies revealed increased levels of ILK, P-PI3K, P-AKT, and BCL2, as well as those of caspase 3, BAX, and P-PTEN, indicating mitigation of cardiomyocyte apoptosis. Our results show that liraglutide, by targeting GLP1Rs, enhances the expression of proteins in the ILK/PI3K/AKT/PTEN pathway and thereby exerts its cardioprotective effects in rats with DCM.