Causes and Clinical Outcomes of Patients Who Failed Screening for Transcatheter Tricuspid Valve Interventions.

Transcatheter tricuspid valve intervention (TTVI) has recently emerged as a promising alternative to surgery for tricuspid regurgitation (TR). However, a significant proportion of patients fail screening for TTVI, and little is known about their characteristics and natural history. This study sought to investigate causes of screen failure and outcomes of patients declined for TTVI. This was a retrospective single-center study of 32 patients who were ineligible for participation in transcatheter tricuspid valve replacement and tricuspid transcatheter edge-to-edge repair trials. Patients were classified into 2 groups according to the therapy they received: optimized medical therapy (OMT) group or intervention group. The mean age was 82 ± 7.8 years and 68.8% were women. The most common reasons for TTVI exclusion were anatomic/procedural impediment (53.1%), inclusion criteria not met (40.6%), and multivalvular disease (6.3%). Overall, 19 patients (59.4%) did not undergo subsequent tricuspid intervention. The clinical outcomes of these patients who received OMT alone were poor, with a 1-year composite of cardiac death or heart failure readmission of 47.4%. These rates were worse than in patients who subsequently underwent an intervention, albeit not statistically significant (OMT: 47.7% vs 23.1% interventions, p = 0.3), and were significantly more pronounced in the subgroup of patients who were excluded for anatomic/procedural limitations (OMT: 70% vs 14.3% interventions, p = 0.05). In conclusion, patients ineligible for TTVI, particularly, those with anatomic/procedural limitations, and treated medically have poor outcomes. These data underscore the importance of earlier referral and support the need for further transcatheter therapy iterations.

Compact terahertz harmonic generation in the Reststrahlenband using a graphene-embedded metallic split ring resonator array.

Harmonic generation is a result of a strong non-linear interaction between light and matter. It is a key technology for optics, as it allows the conversion of optical signals to higher frequencies. Owing to its intrinsically large and electrically tunable non-linear optical response, graphene has been used for high harmonic generation but, until now, only at frequencies < 2 THz, and with high-power ultrafast table-top lasers or accelerator-based structures. Here, we demonstrate third harmonic generation at 9.63 THz by optically pumping single-layer graphene, coupled to a circular split ring resonator (CSRR) array, with a 3.21 THz frequency quantum cascade laser (QCL). Combined with the high graphene nonlinearity, the mode confinement provided by the optically-pumped CSRR enhances the pump power density as well as that at the third harmonic, permitting harmonic generation. This approach enables potential access to a frequency range (6-12 THz) where compact sources remain difficult to obtain, owing to the Reststrahlenband of typical III-V semiconductors.

Terahertz microscopy using laser feedback interferometry based on a generalised phase-stepping algorithm.

In this paper we report an improved method of coherent sensing through the use of a generalized phase-stepping algorithm to extract magnitude and phase information from interferometric fringes acquired by laser feedback interferometry (LFI). Our approach allows for significantly reduced optical sampling and acquisition times whilst also avoiding the need for fitting to complex models of lasers under optical feedback in post-processing. We investigate theoretically the applicability of this method under different levels of optical feedback, different laser parameters, and for different sampling conditions. We furthermore validate its use experimentally for LFI-based sensing using a terahertz (THz)-frequency laser in both far-field and near-field sensing configurations. Finally we demonstrate our approach for two-dimensional nanoscale imaging of the out-of-plane field supported by individual micro-resonators at THz frequencies. Our results show that fully coherent sensing can be achieved reliably with as little as 4 sampling points per imaging pixel, opening up opportunities for fast coherent sensing not only at THz frequencies but across the visible and infra-red spectrum.

County-level variation in healthcare coverage and ischemic heart disease mortality.

BACKGROUND: Healthcare coverage has been shown to have implications in the prevalence of coronary artery disease. We explore the impact of lack of healthcare coverage on ischemic heart disease (IHD) mortality in the US. METHODS: We obtained county-level IHD mortality and healthcare coverage data from the CDC databases for a total of 3,119 US counties. The age-adjusted prevalence of current lack of health insurance among individuals aged 18 to 64 years were obtained for the years 2018 and 2019 and were placed into four quartiles. First (Q1) and fourth quartile (Q4) had the least and highest age-adjusted prevalence of adults without health insurance, respectively. IHD mortality rates, adjusted for age through the direct method, were obtained for the same years and compared among quartiles. Ordinary least squares (OLS) regression for each demographic variable was conducted with the quartiles as an ordinal predictor variable and the age-adjusted mortality rate as the outcome variable. RESULTS: We identified a total of 172,942 deaths related to ischemic heart disease between 2018 and 2019. Overall AAMR was higher in Q4 (92.79 [95% CI, 92.35-93.23]) compared to Q1 (83.14 [95% CI, 82.74-83.54]), accounting for 9.65 excess deaths per 100,000 person-years (slope = 3.47, p = 0.09). Mortality rates in Q4 for males (126.20 [95% CI, 125.42-126.98] and females (65.57 [95% CI, 65.08-66.05]) were higher compared to Q1 (115.72 [95% CI, 114.99-116.44] and 57.48 [95% CI, 57.04-57.91], respectively), accounting for 10.48 and 8.09 excess deaths per 100,000 person-years for males and females, respectively. Similar trends were seen among Hispanic and non-Hispanic populations. Northeastern, Southern, and Western regions had higher AAMR within Q4 compared to Q1, with higher prevalence of current lack of health insurance accounting for 49.2, 8.15, and 29.04 excess deaths per 100,000 person-years, respectively. CONCLUSION: A higher prevalence of adults without healthcare coverage may be associated with increased IHD mortality rates. Our results serve as a hypothesis-generating platform for future research in this area.

Drug-Coated Balloon Venoplasty to Treat Iatrogenic Pulmonary Vein Stenosis.

Pulmonary vein stenosis (PVS) is a condition that has seen a decrease in incidence in recent years. Whereas balloon angioplasty and stenting are both acceptable treatment options for PVS, they are limited by the high rate of restenosis. This research paper presents 4 cases of severe symptomatic PVS that were successfully treated with the use of drug-coated balloons, resulting in positive outcomes. (Level of Difficulty: Advanced.).

Study the Anticancer Properties of Thymol-Loaded PEGylated Bovine Serum Albumin Nanoparticles Conjugated with Folic Acid.

Phenolic compounds such as Thymol have an effective role in suppressing cancer, however, their low solubility in aqueous solution has limited their use. This study aimed to prepare Thymol (TY)-loaded bovine serum albumin (BSA) nanoparticles surface-modified with polyethylene glycol (PEG) conjugated with folic acid (FA) and evaluate their inhibitory activity on cancer cells. The TY-BSA-PEG-FA was characterized using DLS, FESEM, and FTIR. The encapsulation efficiency (EE) was evaluated indirectly by using UV absorption. The antioxidant property of nanoparticles was evaluated by 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), 2,2-diphenyl-1-picrylhydrazyl (DPPH), and ferric reducing ability of plasm (FRAP) methods. The effects of nanoparticles against cancer cells were investigated by MTT, AO/PI, flow cytometry, and real-time qPCR methods. The results showed the spherical morphology of TY-BSA-PEG-FA with an average size of 70.0 nm, a PDI of 0.32, a zeta potential of -11.3 mV, and an EE of 89.0±2.3 %. The cytotoxicity effects of nanoparticles against all cell lines were in a concentration-dependent manner. AGS gastric cancer cells were reported to be the most vulnerable to treatment, while pancreatic cancer cells (PANC-1) and normal skin cells (HFF) would be the most resistant. The SubG1 phase arrest of about 66 % occurred at 85 µg/mL. An increase in apoptotic cells in fluorescent staining, along with decreased expression of Bcl-2 and increased expression of the BAX gene demonstrated the induction of apoptosis in treated cells. The powerful inhibitory effect of nanoparticles in inhibiting ABTS free radicals (IC50 =82 µg/mL) and DPPH free radicals (IC50 =844 µg/mL) and the ability to reduce iron ions indicated the antioxidant effects of TY-BSA-PEG-FA. Based on these results, the synthesized nanoparticles may be suitable for further investigation in the treatment of cancer, notably gastric cancer.

Recurrence of tuberculous tenosynovitis in wrist tendon of a butcher: rare case report.

Diagnosing of tuberculous arthritis can be challenging due to its insidious onset and non-specific clinical presentation. A high index of suspicion is required for early diagnosis. A 54-year-old butcher was admitted to an orthopedic clinic with complaints of pain, paresthesia and an enlarging mass in the left wrist, which limited finger flexion. Initially the patient was diagnosed with carpal tunnel syndrome (CTS); the patient had no history of tuberculosis (TB), but had direct contact with animals. On clinical examination, a small mass was found in the distal volar region of the forearm and no lymphadenopathy was observed. Despite the diagnosis the patient refused to receive TB treatment. After a period of 4 months, the patient once again exhibited symptoms of CTS. This case highlights the importance of considering TB as a potential etiology for persistent symptoms of carpal tunnel surgery. Early diagnosis and prompt initiation of TB treatment can result in favorable outcomes and can prevent future recurrence.

Assessment of Lower Limb Deep Vein Thrombosis: Characterization and Associated Risk Factors Using Triplex Doppler Imaging.

Background: Deep vein thrombosis (DVT) is a common health problem. Accurate diagnosis of DVT is essential to avoid potentially fatal acute consequences of pulmonary embolism. Aim: The study aims to assess deep venous thrombosis (DVT) of the lower limbs and to analyze the related risk factors. Methods: This is a retrospective study including 60 patients who were examined using Triplex Doppler imaging. The patients were referred to the imaging departments with symptoms of lower limb DVT. The risk of DVT was expressed as an odds ratio (OR) with 95% confidence interval. Multiple logistic regression analysis was used to detect the independent risk factors. P value <0.05 was considered a significant statistic. Results: Among the Saudi patients in Najran, acute DVT was more prevalent than chronic one (56.7% vs 38.3%), while subacute is less frequent (5%). DVTs are more prevalent in females than males (60% vs 40%) and most commonly affect patients older than 40. DVTs affect the left lower limb veins more than the right limb (75% vs 15%) and are less frequent on both sides (10%). The left popliteal vein (PV) and left common femoral vein (CFV) were the most common sites for acute DVTs. Binary logistic analysis revealed the independent risk factors for developing lower extremity DVT; malignancy (OR = 2.84, 95% CI = 0.518-15.513), surgery (OR = 2.66, 95% CI = 0.411-17.281), trauma (OR = 2.30, 95% CI = 0.452-11.658), and diabetes and hypertension (OR = 1.53, 95% CI = 0.335-6.969). Conclusion: Acute lower limb DVT was more prevalent than chronic one. Malignancy, surgery, trauma, diabetes mellitus, and hypertension were the most common risk factors for lower limb DVTs. Left popliteal and left common femoral veins were the most common sites of acute DVTs.

Successful Revascularization of Critical Limb Ischemia: A Challenging Case of a Unilateral Tibial-to-Tibial Intervention.

Critical limb ischemia requires urgent diagnosis and intervention. Limitations to percutaneous revascularization therapy stem from multilevel diseased vasculature. Retrograde revascularization utilizing anterior tibial artery access in complex and proximal lesions is an alternative route for intervention that can lead to limb salvage and symptom resolution.

Dual acting acid-cleavable self-assembling prodrug from hyaluronic acid and ciprofloxacin: A potential system for simultaneously targeting bacterial infections and cancer.

The incidence and of bacterial infections, and resulting mortality, among cancer patients is growing dramatically, worldwide. Several therapeutics have been reported to have dual anticancer and antibacterial activity. However, there is still an urgent need to develop new drug delivery strategies to improve their clinical efficacy. Therefore, this study aimed to develop a novel acid cleavable prodrug (HA-Cip) from ciprofloxacin and hyaluronic acid to simultaneously enhance the anticancer and antibacterial properties of Cip as a superior drug delivery system. HA-Cip was synthesised and characterised (FT-IR, HR-MS, and H1 NMR). HA-Cip generated stable micelles with an average particle size, poly dispersion index (PDI) and zeta potential (ZP) of 237.89 ± 25.74 nm, 0.265 ± 0.013, and -17.82 ± 1.53 mV, respectively. HA-Cip showed ≥80 % cell viability against human embryonic kidney 293 cells (non-cancerous cells), ˂0.3 % haemolysis; and a faster pH-responsive ciprofloxacin release at pH 6.0. HA-Cip showed a 5.4-fold improvement in ciprofloxacin in vitro anticancer activity against hepatocellular cancer (HepG2) cells; and enhanced in vitro antibacterial activity against Escherichia coli and Klebsiella pneumoniae at pH 6.0. Our findings show HA-Cip as a promising prodrug for targeted delivery of ciprofloxacin to efficiently treat bacterial infections associated, and/or co-existing, with cancer.

Anticipated stigma and associated factors among chronic illness patients in Amhara Region Referral Hospitals, Ethiopia: A multicenter cross-sectional study.

BACKGROUND: Anticipated stigma related to chronic illness patients undermines diagnosis, treatment, and successful health outcomes. The study aimed to assess the magnitude and factors associated with anticipated stigma among patients with chronic illness attending follow-up clinics in Amhara Region Referral Hospitals, Ethiopia. METHODS: A cross-sectional institution-based study was conducted in Amhara Region Referral Hospitals from 01 March to 15 April 2021. A simple random sampling technique was used to select the three Referral Hospitals in the region and study subjects. Data were collected using a pre-tested interview-based questionnaire. Data were entered and cleaned with Epi-Info version 6 and exported for analysis STATA version 14. Multiple linear regression was used to show the association between anticipated stigma and potential factors. Associations were measured using ß coefficients and were considered statistically significant if the p-value > 0.05. RESULTS: A total of 779 patients were included for analysis with a response rate of 97%. Their mean (Standard deviation) of anticipated stigma was estimated at 1.86 and 0.5, respectively. After running an assumption test for multiple linear regression; educational status, cigarette smoking, psychological distress, medication adherence, alcohol consumption, and social part of the quality of life were statically significantly associated with anticipated stigma. CONCLUSION AND RECOMMENDATION: The result showed a high level of anticipated stigma reported among the participants. Emphasizing improving their social part of the quality of life, avoiding risky behaviors like alcohol consumption and cigarette smoking, access to health education for chronically ill patients, integrating mental health in all types of chronic disease, and developing strategies and protocols which will help to improve patient medication adherence to their prescribed medication will be crucial. This can provide a foundation for government andnon-governmental organizations, and researchers implementing evidence-based interventions and strategies on chronic care to address factors related to anticipated stigma.

Gross Hematuria Caused by Intravesical Migration of a Forgotten Intrauterine Device: A Case Report and Literature Review.

Intrauterine device (IUD) is the second most widely used method of contraception worldwide. Up to 14% women prefer IUD for its attractive advantages such as cost effectiveness, high efficiency, and low complication rate. Despite these advantages, however, some complications may occur. One of these complications is uterine perforation and migration of the device to involve adjacent viscera such as peritoneum, bowel, vessels, and rarely bladder. IUD migration into the urinary bladder is uncommon, and only 70 cases are reported in the literature. Recurrent urinary tract infection and bladder calculi are the commonest presentations, and, rarely, women can present with gross hematuria. A high index of suspicion is needed in the evaluation of women who report pregnancy after IUD insertion as it might be the first clue to suspect migration. A forgotten and long-standing IUD increases the risk of uterine perforation and migration. A routine abdominal radiography, cystoscopy, and transvaginal ultrasonography are diagnostic. A computed tomography can also be employed in selected cases to delineate anatomic relations. Urologists should consider a vesical foreign body such as migrated IUD in women with recurrent lower urinary infections. Gross hematuria in a young woman should alert the urologist, and the evaluation should address a detailed contraceptive history. Every migrated IUD should be removed via endoscopy, laparoscopy, or open surgery. Proper follow-up and education of women before and after IUD insertion is also recommended to pick up on complications in time. Here, we report the successful open surgical treatment of a woman who had a forgotten IUD for 15 years and ultimately presented with gross hematuria due to trans-vesical migration. As to our literature search, there was no similar case reported from a urology center from Ethiopia.

Newly Substituted Anilino-Fluoroquinolones with Proliferation Inhibition Potential against a Panel of Cancer Cell Lines.

BACKGROUND: From a chemistry point of view, we hypothesized that superlative dual cytotoxicity-radical scavenging bioefficacies of series 4 FQs correlate to their acidic groups and C8-C7 ethylene diamine Chelation Bridge. METHODOLOGY: Newly synthesized 16 lipophilic-acid chelating FQs have been screened for in vitro duality of proliferation inhibition and radical scavenging capacities. RESULTS: Substantially in LPS prompted RAW264.7 macrophages inflammation, IC50 values (µM) in the ascending order of  new FQs' NO scavenging/antiinflammation capacity were 4e<4b<3d<4f<5c0.05). In comparison to classical and robust antineoplastic agent cisplatin and unlike triazoloFQs; nitroFQs (3a, 3b and 3f) and the reduced FQs (4a, 4c, 4d and 4e) exerted antiproliferation IC50 values <50 µM in leukaemia K562. Besides nitroFQ 3, the reduced FQs (4c and 4f) exhibited antineoplastic IC50 values <50 µM in lung A549 carcinoma. NitroFQ 3c and reduced FQs 4b, 4c, and 4f in breast MCF7 and reduced 4c in pancreatic PANC1 had reduction of viability IC50 values <50 µM. NitroFQ 3e, reduced FQs 4b and, 4c and triazoloFQ 5a exerted antiproliferation IC50 values <50 µM in breast T47D cells. Also nitroFQ 3e, reduced FQ 4c and triazoloFQ 5f exhibited antineoplastic IC50 values <50 µM in PC3 prostate cancer cells. Exceptionally triazoloFQ 5a, but neither nitro- nor reduced FQs, had cytotoxicity IC50 value <50 µM in resistant melanoma A375 cells. Unequivocally 4b antineoplastic effectiveness linked with its radical scavenging and antiinflammation effects while 3d and 5c lacked matching antiproliferation potentialities to their exquisite antiinflammation capacities. Explicitly reduced 4e and 4f exerted antiinflammation-selective cytotoxicity duality in vitro. CONCLUSION: Collectively, this work reveals lipophilic-acidic chelator FQs as authentic agents for the repurposing approach in anticancer chemotherapy/prevention.

Momento de la cirugía en pacientes iraquíes con Contagio de COVID-19 / Timing of surgery in Iraqi patients with COVID-19 infection

Los pacientes con infección perioperatoria por COVID-19 tienen un alto riesgo de muerte y complicaciones posoperatorias. En la actualidad, la infección por COVID-19 en Irak representó 1.696.390 casos con 19.087 muertes. Un estudio nacional, único y observacional que incluyó pacientes con infección por COVID-19 que se sometieron a cualquier tipo de cirugía en el Hospital General de Abu-Graib, Bagdad, Irak, durante el período del 19 de marzo de 2020 al 30 de abril de 2021. Tiempo desde el diagnóstico de la infección por COVID-19 El día de la cirugía se recogió como factor categórico dividido en: (a) 0-3 semanas; (b) 4­6 semanas; (c) >6 semanas. Edad; sexo; estado físico de la Sociedad Americana de Anestesiólogos (ASA); comorbilidades cardíacas; comorbilidades respiratorias; indicación de cirugía; grado de cirugía; y se documentaron los tipos quirúrgicos. Se incluyeron un total de 378 pacientes con una edad media de 47,89±16,03 años. Las mujeres eran más que los hombres (65,87% > 34,13%). Aproximadamente, el 76,72% de los pacientes pertenecían a ASA I-II, mientras que el 23,28% eran ASA III-IV. Alrededor del 19,05% de los pacientes sufría de comorbilidades cardíacas. 266/378 de los pacientes se quejaron de comorbilidades respiratorias. Cirugía indicada en 35,45% condiciones benignas, 27,5% obstetricia, 7,65% cirugía oncológica y 29,4% operaciones traumáticas. Operaciones mayores documentadas en 205/378 pacientes. Las intervenciones quirúrgicas de urgencia realizadas en (176, 46,56%), mientras que los casos electivos fueron 202/378 (53,44%). En total, en el momento de la operación, 80 (21,16 %) pacientes tenían un diagnóstico preoperatorio de COVID-19. El tiempo desde el diagnóstico de COVID-19 hasta la cirugía fue de 0 a 3 semanas en 98 pacientes (25,93 %), de 4 a 6 semanas en 115 pacientes (30,42 %) y >6 semanas en 165 pacientes (43,65 %). La tasa de mortalidad postoperatoria global fue del 9,52% (36/378). Con respecto a la complicación cardiaca de la O.P., no hubo asociación significativa en relación al momento previo a la cirugía (p=0,08). Sin embargo, la complicación cardíaca global fue del 16,4%. En general, el 44,97 % (170/378) de los pacientes desarrollaron una complicación pulmonar por O.P. durante el período de seguimiento. Hasta donde sabemos, este es el primer estudio que proporciona datos sólidos sobre el momento óptimo para la cirugía después de la infección por COVID-19 en Irak. El momento óptimo de la cirugía después de la infección por COVID-19 fue de más de 6 semanas. Descubrimos que los riesgos de morbilidad y mortalidad por O.P. son mayores si los pacientes son operados dentro de las 6 semanas posteriores al diagnóstico de infección por COVID-19.

Patients with perioperative COVID-19 infection are at high risk of death and complications postoperatively. Nowadays, COVID-19 infection in Iraq accounted 1,696,390 cases with 19,087 deaths. A national, single, and observational study that included patients with COVID-19 infection undergoing any type of surgery in Abu-Graib General Hospital, Baghdad Iraq during period from 19 March 2020 to 30 April 2021. Time from the diagnosis of COVID-19 infection to day of surgery was collected as a categorical factor divided into: (a) 0­3 wks; (b) 4­6 wks; (c) >6 wks. Age; sex; American Society of Anesthesiologists (ASA) physical status; cardiac comorbidities; respiratory comorbidities; indication for surgery; surgery grade; and surgical types were documented. A total of 378 patient were included with mean age was 47.89±16.03 years. Females were more than males (65.87% > 34.13%). Approximately, 76.72% of patients belonged within ASA I-II, whereas 23.28% were ASA III-IV. About 19.05% of patients suffered from cardiac comorbidities. 266/378 of patients complained from respiratory comorbidities. Surgery indicated in 35.45% benign conditions, 27.5% obstetrics, 7.65% oncological surgery, and 29.4% traumatic operations. Major operations documented in 205/378 patients. Emergencies surgical intervention done in (176, 46.56%), whereas elective cases were 202/378 (53.44%). In total at operation timing, 80(21.16%) patients had a preoperative COVID-19 diagnosis. The time from COVID-19 diagnosis to surgery was 0­3 weeks in 98 patients (25.93%), 4­6 weeks in 115 patients (30.42%), and >6 weeks in 165 patients (43.65%). The overall postoperative mortality rate was 9.52% (36/378). In regard to P. O. cardiac complication, there was no significant association in relation to timing before surgery (p=0.08). However, the overall cardiac complication was 16.4%. Overall, 44.97% (170/378) of patients developed a P. O. pulmonary complication within period of follow-up. To our knowledge this is the first study to provide strong data regarding the optimal timing for surgery following COVID-19 infection in Iraq. The optimal timing of surgery after COVID-19 infection was more than 6 wks. We found that risks of P. O. morbidity and mortality are greatest if patients are operated within 6 wks of diagnosis of COVID-19 infection

Translation and psychometric evaluation of chronic illness anticipated stigma scale (CIASS) among patients in Ethiopia.

BACKGROUND: Stigma is common among patients with chronic illnesses. It affects the delivery of healthcare for not addressing the psychological components and may interfere with the patient's attendance to necessary health care services. Therefore, a valid and reliable instrument to measure anticipated stigma related to chronic illness is vital to inform possible interventions. This study aimed to translate the Chronic Illness Anticipated Stigma Scale (CIASS) into the Amharic language and evaluate its psychometric properties in Ethiopia. METHODS: The CIASS was translated into Amharic language using standard procedures. The Amharic version was completed by 173 patients (response rate 96%) with chronic illness from three referral hospitals in the Amhara region. Internal consistency was examined through Cronbach's alpha. Construct validity was evaluated by confirmatory factor analysis and convergent validity by using a Pearson correlation of P-value less than or equal to 0.05. RESULTS: The internal consistency was estimated at Cronbach alpha of 0.92. By using a structural equation model, and modification indices a model fitness testing was run and shows a root mean squared error of approximation 0.049 (90% CI, 0.012-0.075). The structural validity results in 78.8% of confirmatory factor analysis showed from the extraction of the three-dimension (components). Validity tests for convergent by using Pearson correlation positively correlated with common mental distress and negatively correlated with quality of life-BREF, and the construct validity shows a good valid tool to CIASS. CONCLUSION: The Amharic language version of the chronic illness anticipated stigma scale shows a satisfactory level of reliability and validity on different psychometric measures of assessment. The tool may be useful for future researchers and patients with chronic illness in the Amharic-speaking population. Moreover, it will be used to see the psychological burden related to chronic illness and for comparison among international population groups.

Presentation of Novel Architecture for Diagnosis and Identifying Breast Cancer Location Based on Ultrasound Images Using Machine Learning.

Breast cancer is one of the main causes of death among women worldwide. Early detection of this disease helps reduce the number of premature deaths. This research aims to design a method for identifying and diagnosing breast tumors based on ultrasound images. For this purpose, six techniques have been performed to detect and segment ultrasound images. Features of images are extracted using the fractal method. Moreover, k-nearest neighbor, support vector machine, decision tree, and Naïve Bayes classification techniques are used to classify images. Then, the convolutional neural network (CNN) architecture is designed to classify breast cancer based on ultrasound images directly. The presented model obtains the accuracy of the training set to 99.8%. Regarding the test results, this diagnosis validation is associated with 88.5% sensitivity. Based on the findings of this study, it can be concluded that the proposed high-potential CNN algorithm can be used to diagnose breast cancer from ultrasound images. The second presented CNN model can identify the original location of the tumor. The results show 92% of the images in the high-performance region with an AUC above 0.6. The proposed model can identify the tumor's location and volume by morphological operations as a post-processing algorithm. These findings can also be used to monitor patients and prevent the growth of the infected area.