Iptacopan Efficacy and Safety to Treat Paroxysmal Nocturnal Hemoglobinuria (PNH): A Systematic Review and Meta-Analysis.

Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon blood condition caused by complement-mediated hemolysis. In early clinical studies, iptacopan, an oral factor B inhibitor, showed promise in treating PNH. This systematic review aimed to compile information on the effectiveness and safety of iptacopan for PNH. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The Medline, Embase, PubMed, and Cochrane Central databases were searched for randomized controlled trials (RCTs) and observational studies that evaluated iptacopan for PNH. The primary efficacy outcomes were hemoglobin and lactate dehydrogenase (LDH) changes. A fixed-effects model was used for the meta-analysis. Six studies (three prospective cohorts, two RCTs, and one non-randomized trial) were included, comprising 197 patients. Iptacopan therapy significantly increased hemoglobin levels (mean differences (MD) = 12.98 g/L; 95% CI: 11.82-14.13; p < 0.0001) and decreased LDH (MD = -83.55 IU/L; 95% CI: -83.77 to -83.34; p < 0.0001). Subgroup analyses revealed more significant hemoglobin increases in European vs. Asian populations, studies with baseline Hb > 10 g/dL vs. < 10 g/dL, and studies lasting > 24 weeks vs. ≤ 24 weeks. LDH decreases were more pronounced in studies with baseline LDH > 500 IU/L vs. < 500 IU/L. The incidence of adverse events ranged from 66% to 90%, with the most common being headache, nasopharyngitis, and diarrhea. Serious adverse events occurred in 0-20% of patients across studies. Only one patient withdrew because adverse effects were reported across all studies. Preliminary data support iptacopan's effectiveness in improving hemoglobin levels and lowering hemolysis in PNH, both as a monotherapy and in combination with usual treatment. The safety profile appears to be excellent, with a minimal incidence of major adverse events and treatment discontinuation. Further studies are needed to validate the effectiveness and safety of larger, longer-term trials. Iptacopan is a viable oral therapy option for PNH.

The Prevalence of Temporomandibular Disorders Among Dental and Medical Students in Taif, Saudi Arabia: A Cross-Sectional Study.

Objectives  This study was undertaken to investigate the prevalence of temporomandibular disorders (TMDs) and the impact of various contributing factors among undergraduate healthcare students in the region of Taif, Saudi Arabia. Methods A total of 100 undergraduate students were recruited from both the College of Medicine and the College of Dentistry at Taif University, Taif, Saudi Arabia. Data were collected on demographic parameters and the Helkimo's index (anamnestic {Ai} and clinical dysfunction {Di} component) using an anonymous self-administered questionnaire, as well as clinical examinations.  Results A significantly high prevalence (97%) of TMDs was observed among the sampled students, with most of them (44.0%) experiencing severe symptoms that might negatively impact their quality of life. On clinical examinations, most of the students (75.0%) showed signs of mild clinical dysfunction, which might indicate an early stage of TMD. Moreover, factors that include older age, majoring in "dentistry" studies, being allergic, having oral habits, poor mental health, and previous COVID-19 infections were found to be significantly associated with TMDs. Conclusion The findings indicate a relatively high TMD prevalence among the sampled undergraduate healthcare students, especially those studying "dentistry". Curriculum modifications, coupled with more awareness and education, are recommended to achieve early diagnosis and help in reducing the incidence of TMD among this population.

Artificial Intelligence and its Awareness and Utilization among Dental Students and Private Dental Practitioners at Alkharj, Saudi Arabia.

Introduction: Artificial intelligence (AI) is commonly used in the modern day medical system for medical and dental imaging diagnostics, decision support, precision, hospital monitoring, robotic assistants, and so on. All branches of dentistry have a role of AI, like endodontics, cancer diagnosis, and cephalometric analysis. With the advancing technology, dental professionals need to upgrade themselves. Aim of the Study: To assess awareness and attitude of dental students and dental practitioners in Alkharj toward AI. Methodology: A total of 100 dental students from a teaching institute and 100 private dental practitioners participated in the study. A closed-ended questionnaire was used containing 14 questions related to awareness and attitude toward AI. Participation was voluntary. Results: 33% of study participants were aware of the working principle of AI; 68% of study subjects are aware of uses of AI in the dental field. 87% thinks AI helps in radiological diagnosis; 56.5% thinks AI helps in cancer detection. Conclusion: Awareness about AI among study participants was less than 50%. The overall attitude of dental professionals was positive.

Potential and Risks Behind the National Transformation Program in Saudi Arabia.

Saudi Arabia guarantees citizens the right to receive medical care and treatment during emergencies or sickness and aging. However, with the consistent increase in expenditure and inability to provide access, the transformation was an unavoidable action. Therefore, this paper aims to address the potential and risks behind the National Transformation Program (NTP) in Saudi Arabia through the lens of the Value Transformation Framework. Multiple research databases (PubMed, Web of Science, UpToDate, Google Scholar, and Summon) were searched between 2016 and 2024. Relevant articles were selected by scanning the title and abstract, yielding 34 references after the screening, exclusion, and inclusion criteria were met. Citation software was used to identify additional sources as analysis proceeded, in accordance with the hermeneutic approach in mapping and classification. The most cited concerns were the sustainability and workforce of the healthcare system. In terms of care delivery, the literature was extensive. In contrast, insufficient studies have been conducted on infrastructure and people. Furthermore, limited information is available on how to assess the transformation, which remains an unaddressed research question. NTP could meet several hurdles. However, through the measurement, assessment phases, and development tracking, success could be achieved.

Assessment of Oral Health Conditions Among Physically Disabled Patients in Saudi Arabia.

OBJECTIVES: This study was undertaken to assess the oral health status among physically disabled Saudi patients. METHODS: Recruitment took place in the Armed Forces Centre for Health Rehabilitation in Taif, Saudi Arabia. 124 patients living with a physical disability were enrolled and divided into three groups: hemiplegia, paraplegia and quadriplegia. Data was collected on demographics and different oral indices, including the Decayed Missing Filled Teeth (DMFT) index, the Mean Decayed Teeth score, the Community Periodontal Index (CPI), the Community Periodontal Index of Treatment Needs (CPITN), and the Simplified Oral Hygiene Index (OHI-S). RESULTS: High DMFT was observed among the hemiplegia group (mean = 22.61; P-value = .008) with no difference in the Mean Decayed Teeth. All groups showed signs of gingivitis in the form of gingival bleeding. The most compromised periodontal health in the form of pockets 6 mm or deeper was found in the hemiplegia group (53.7%; P-value = .001). This was also reflected in the CPITN (39.0%; P-value = .001), indicating the need for complex treatments in the same group. Regarding oral hygiene, all groups showed a "fair" oral hygiene condition (OHI-S < 3.0), with significantly poorer hygiene (mean = 2.49; P-value = .042) and greater debris accumulation (mean = 1.52; P-value = .024) among the quadriplegia group. In the regression analysis, both age and gender had significant effects on some indices, while disability type showed borderline effects. CONCLUSION: The findings indicate poor oral health in these individuals, mainly due to physical limitations, hindering effective self-care practices. CLINICAL SIGNIFICANCE: Oral health is a critical aspect in people with physical disabilities, as it is intrinsically linked to overall health and well-being. Recognizing the clinical importance of oral health among physically disabled patients is essential to improve access and affordability of dental care for this vulnerable group of the population.

Structural Health Monitoring of Fiber Reinforced Composites Using Integrated a Linear Capacitance Based Sensor.

The demand for fiber-reinforced polymers (FRPs) has significantly increased in various industries due to their attributes, including low weight, high strength, corrosion resistance, and cost-efficiency. Nevertheless, FRPs, such as glass and Kevlar fiber composites, exhibit anisotropic properties and relatively low interlaminar strength, rendering them susceptible to undetected damage. The integration of real-time damage detection processes can effectively mitigate this issue. This paper introduces a novel method for fabricating embedded capacitive sensors within FRPs using a coating technique. The study encompasses two types of fibers, namely glass and Kevlar fiber/epoxy composites. The physical vapor deposition (PVD) technique is employed to coat bundle fibers with conductive material, thus creating embedded electrodes. The results demonstrate the uniform distribution of nanoparticles of gold (Au) along the fibers using PVD, resulting in a favorable resistance of approximately ≈100 Ω. Two sensor configurations are explored: axial and lateral embedding of the coated yarn (electrodes) to investigate the influence of load direction on the coating yarn. Axial-sensor configuration specimens undergo tensile testing, showcasing a linear response to axial loads with average sensitivities of 1 for glass and 1.5 for Kevlar fiber/epoxy composites. Additionally, onset damage is detected in both types of fiber composites, occurring before final fracture, with average stress at the turning point measuring 208 MPa for glass and 144 MPa for Kevlar. The lateral-sensor configuration for glass fiber-reinforced polymer (GFRP) exhibits good linearity towards strain until failure, with average gauge factors of 0.25 and -2.44 in the x and y axes, respectively.

Enhancement in Tomato Yield and Quality Using Biochar Amendments in Greenhouse under Salinity and Drought Stress.

Enhancing saline water productivity in arid regions is essential for sustainable agriculture. Adding biochar can improve the quantity and quality of tomato yield under higher levels of salinity and lower levels of irrigation. The experiment aimed to evaluate the effects of biochar on enhancing tomato fruit quality and yield under salinity and drought stress. The experiment combines two treatments for irrigation water quality (0.9 and 2.3 dS m-1), four irrigation levels (40, 60, 80, and 100%) of crop evapotranspiration (ETc), and the addition of 5% of biochar to treated soil (BC5%) and untreated soil (BC0%). The results showed that the decrease in the water quality and irrigation levels negatively impacted the yield and properties of tomato fruit, while 5% of biochar application positively improved the yield. Adding biochar decreased the tomato yield by 29.33% and 42.51% under lower-saline-irrigation water than the control, negatively affecting the fruit's physical parameters and mineral content. In contrast, adding biochar and irrigating with saline water at 60% of ETc improved the firmness and quality characteristics of the fruit by 56.60%, 67.19, 99.75, and 73.57% for vitamin C (VC), total titratable acidity (TA), total soluble solids (TSS), and total sugars (TS), respectively, compared to the control, and also reduced the sodium content of the fruits under all irrigation levels compared to untreated plants by biochar. Generally, biochar with saline water under deficit irrigation with 80 and 60% of ETc could be an excellent strategy to enhance the qualitative characteristics of tomato fruits and save approximately 20-40% of the applied water.

Saudi Female Sexual Dysfunction After Bariatric Surgery: A Cross-Sectional Survey.

Background Obesity disrupts the equilibrium of sexual hormones, resulting in decreased sexual desire, arousal, and orgasm. The aim of this study was to investigate the effects of substantial weight loss after bariatric surgery on sexual function, psychological health, and the overall quality of sexual life in a group of Saudi females. Method The study used a cross-sectional design and was conducted at King Fahad Hospital in Medina, Saudi Arabia. The study included adult female patients who had previously undergone bariatric surgery. We used the Sexual Quality of Life for Female (SQoL-F) and the Female Sexual Function Index (FSFI) questionnaires to collect data. The study was extended from January 1, 2021, to December 30, 2022. Results A total of 100 participants were included in this study, all the samples underwent vertical sleeve gastrectomy, their mean age was 36.7±9.3, 94% (n=94) of the respondents had high school education or above, 50.0% (n=50) were unemployed, and around 13% (n=13) of the samples had a psychiatric history. Surgery complications were reported in 10% (n=10), which were reported as esophagitis (n=4), gastric ulcer (n=2), gastric stricture (n=1), infection (n=2), and leakage (n=1). The median of the FSFI and SQoL-F was 47.0 and 24.5, respectively. Approximately 66% of the respondents agreed that their sexual lives improved after surgery, 22% did not feel any difference before and after surgery, and 9% witnessed deterioration. In total, 61.0% had female sexual dysfunction (FSD) (25% had no dysfunction afterward, 45% had mild dysfunction, 27% suffered mild to moderate dysfunction, and only 2% had severe dysfunction). Regarding SQoL-F, the mean score was 5.59 for sexual repression, 6.1 for self-worthlessness, 18.56 for sexual and relationship satisfaction, and 16.4 for psychological feelings. Conclusions Bariatric surgery was associated with the improvement of female sexual function.

Awareness of Bariatric Sleeve Gastrectomy Complications Among the General Population of Saudi Arabian Regions.

Sleeve gastrectomy (SG) is a type of procedure called bariatric surgery that provides large weight loss and has a positive impact on diseases associated with obesity. However, it has brought several complications that have an impact on those undergoing surgery, which are classified into intraoperative and postoperative issues. The study's goal is to assess the Saudi Arabian population's awareness of SG consequences. This study assessed the general population's knowledge in Saudi Arabia in 2023 using a cross-sectional approach. The total number of participants was 1,013, the majority of whom were individuals between the ages of 18 and 25 (471, 46%), and females (692, 68%). A total of 692 (68%) participants showed awareness of BMI; in addition, 987 (97%) were aware of gastric sleeve surgery, and 538 (53%) understood its indications correctly. Regarding SG complications, approximately 821 (81%) of participants showed awareness. There were significant associations between knowledge of gastric sleeve surgery and residence in the northern region of Saudi Arabia. In conclusion, our study indicated that the general population is aware of the complications of gastric sleeve surgery, but it found a deficiency in their knowledge about BMI.

Association Between Serum Vitamin D Levels and Body Mass Index Status: A Cross-Sectional Study at King Khalid Hospital, Jeddah, Saudi Arabia, From 2019 to 2020.

Introduction Low vitamin D levels have been associated more with overweight and obese people in previous studies. One of the possible explanations behind this association is the lipophilic property of vitamin D that causes the vitamin to deposit in adipose tissue and reduces the serum concentration of the vitamin, which still warrants further evaluation. Objective This study estimated the association between serum vitamin D levels and body mass index (BMI) among male patients in Jeddah, Saudi Arabia. Methods This is a cross-sectional study of male patients that was carried out in King Khalid Hospital, Jeddah, Saudi Arabia. Patients were included between October 2019 and November 2020. Results We concluded that almost half of the patients, 1,132 (48.3%), had adequate vitamin D, followed by 773 (33%) with vitamin D inadequacy, and only 288 (12.3%) had vitamin D deficiency. There was a significant relationship between age and vitamin D levels; younger people had lower vitamin D levels compared to older people (p<0.001). It was found that there was no significant relationship between BMI categories and vitamin D levels (p>0.05). Conclusion According to the findings of the current study, there was no discernible relationship between serum vitamin D levels and BMI. However, there was a substantial correlation between age and vitamin D levels, with younger age groups having lower amounts than older individuals. Future studies should adopt a prospective design encompassing multiple centers and preferably include the risk factors for developing vitamin D deficiency, such as sun exposure, dietary habits, comorbidities, etc. Such studies can provide a more accurate assessment of the association between BMI and vitamin D levels.

Assessment of Pulp Stones Among Western Saudi Populations: A Cross-Sectional Study.

BACKGROUND: The term "pulp stones" refers to conditions of calcification that can appear in any area of the dental pulp. This study aims to assess the prevalence of pulp stones and examine whether there is any connection between their occurrence and factors such as patient age, gender, tooth location, presence of decay, or dental restorations in a western Saudi subpopulation based on cone-beam computed tomography (CBCT). METHODOLOGY: 500 patients were randomly selected from the College of Dentistry, Taibah University, Madinah, Saudi Arabia, database. The study involved evaluating 2998 teeth in coronal, axial, and sagittal planes by four dental peer examiners observing and recording data (sequentially and simultaneously) that included whether pulp stones were present or absent, the teeth group (anterior, premolars, and molars), tooth location (maxillary or mandibular), presence or absence of restoration, presence or absence of caries, and the patient's gender. Chi-square tests were utilized for statistical analysis, and a significance level of p-value ≤0.05 was established. RESULTS: Out of 500 individuals (250 females and 250 males), only 130 individuals (26%) and 278 teeth out of 2998 (9.2%) had pulp stones, with no significant statistical correlation identified between the presence of pulp stones and gender. (P = 0.459). Molars exhibited the greatest incidence of pulp stones (238; 85.6%), followed by anterior teeth (30; 10.8%), and premolars had the lowest prevalence (10; 3.6%). Teeth that showed a higher occurrence of pulp stones were associated with caries (74; 26.6%) and restorations (58; 20.9%). The association between pulpal stone and periodontal involvement was seldom significant (0.7%). A significant association was found between the presence of pulp stones and nonintact teeth (P<0.001). There was a statistically significant difference in the distribution of pulp stones between females and males in the maxillary and mandibular (74.7% and 57.3%, respectively) (P = 0.002). Additionally, the frequency of pulp stones was statistically significant when comparing the left and right sides (P<0.001) (48.9% and 51.1%, respectively). CONCLUSION: Understanding the prevalence and distribution of pulp stones is crucial for dentists and endodontists, as it assists practitioners in devising an appropriate treatment plan for affected teeth that require root canal therapy. One-fourth of the Madinah population was confirmed to have pulp stones, with a higher incidence in molars, caries, and restored teeth. No difference was found between its occurrence and gender. The high prevalence is exhibited in individuals between 45 and 54 years old. However, further studies with equal patient distribution are needed to confirm this observation.

Effect of Biochar Application on Morpho-Physiological Traits, Yield, and Water Use Efficiency of Tomato Crop under Water Quality and Drought Stress.

The use of saline water under drought conditions is critical for sustainable agricultural development in arid regions. Biochar is used as a soil amendment to enhance soil properties such as water-holding capacity and the source of nutrition elements of plants. Therefore, the experiment was conducted to evaluate the effects of biochar application on the morpho-physiological traits and yield of tomatoes under combined salinity and drought stress in greenhouses. There were 16 treatments consist two water quality fresh and saline (0.9 and 2.3 dS m-1), three deficit irrigation levels (DI) 80, 60, and 40% addition 100% of Evapotranspiration (ETc), and biochar application by rate 5% (BC5%) (w/w) and untreated soil (BC0%). The results indicated that the salinity and water deficit negatively affected morphological, physiological, and yield traits. In contrast, the application of biochar improved all traits. The interaction between biochar and saline water leads to decreased vegetative growth indices, leaf gas exchange, the relative water content of leaves (LRWC), photosynthetic pigments, and yield, especially with the water supply deficit (60 and 40% ETc), where the yield decreased by 42.48% under the highest water deficit at 40% ETc compared to the control. The addition of biochar with freshwater led to a significantly increased vegetative growth, physiological traits, yield, water use efficiency (WUE), and less proline content under all various water treatments compared to untreated soil. In general, biochar combined with DI and freshwater could improve morpho-physiological attributes, sustain the growth of tomato plants, and increase productivity in arid and semi-arid regions.

Regulatory effects of ketogenic diet on the inflammatory response in obese Saudi women.

Objective: In recent years, the use of a ketogenic diet (KD) against obesity has gained popularity in KSA. This study was designed to determine the impact of KD on anthropometric indices and on the abnormal regulation of inflammatory activities in obese Saudi women. Moreover, we investigated the potential of beta-hydroxybutyrate (BHB) supplementation on the inhibition of pro-inflammatory activities. Methods: We enrolled 31 Saudi women (aged, 35.3 ± 8.4 years) with an average BMI of 33.96 ± 4.44 kg/m2 underwent an 8-week KD (8KD) from January to March 2021. Changes in anthropometric measurements were collected at baseline and after 4-8 weeks of intervention. Compliance with the dietary regimen was monitored weekly by plasma BHB level. Results: Twenty-nine females commenced the diets and 23 completed the study (a 79% completion rate). In comparison to pre-intervention, the 8KD resulted in a significant increase in the levels of plasma BHB (P < 0.001) throughout the duration of the trial. This was accompanied by a significant reduction in weight loss (7.7 kg ± 11.3; P < 0.001), BMI, waist circumference (P < 0.001), and levels of the inflammatory cytokine IL-1ß (P < 0.001). Conclusions: An 8-week KD was found to be useful in producing a positive impact on anthropometric indices, biochemical and inflammatory processes. This study indicated that the intake of a KD by obese Saudi women induced the release of BHB in the blood without stimulation of an overall starvation response. This may be useful to alleviate the severity of chronic inflammatory disorders associated with obesity.

Dental Treatment Characteristics of Autistic Children and Differences in Dental Procedures under General Anesthesia Relative to Healthy Counterparts.

Here, we assess the dental treatment characteristics among children with autism spectrum disorder (ASD) and compare the dental procedures delivered under general anesthesia (GA) with those of healthy-matched counterparts. In this retrospective cohort study, we collected data from medical records of ASD children (n = 82) which included demographic profile, medical status (including the severity of the ASD and associated comorbidities), and dental history (including dental visits, behavior, care approach, and dental procedures provided). For those children who received dental GA (DGA) (n = 64), we compared all procedures delivered and the number of repeat sessions with healthy children (n = 64). Our results reveal that most ASD children (78%) received DGA, mainly with one repeat session (63.4%). The dental procedures provided to the children differed significantly according to the severity of the ASD and the behavior of the children. Furthermore, increasing severity led to significantly worse behavior of the children, increased need for DGA and repeat sessions. Comparison of the dental procedures under GA with healthy children revealed a significantly lower mean of almost all dental procedures in ASD children, except fissure-sealed teeth (p < 0.05). Considering these findings, DGA is unavoidable for ASD children with moderate-to-severe conditions or negative behavior in the dental office, even when their dental needs are lower than healthy children. The severity of ASD was the most important factor affecting the behavior of the children and the care approach they received. Along with children's behavior, they most influenced the dental procedures delivered and the need for repeat DGA.

Insight into Oncogenic Viral Pathways as Drivers of Viral Cancers: Implication for Effective Therapy.

As per a recent study conducted by the WHO, 15.4% of all cancers are caused by infectious agents of various categories, and more than 10% of them are attributed to viruses. The emergence of COVID-19 has once again diverted the scientific community's attention toward viral diseases. Some researchers have postulated that SARS-CoV-2 will add its name to the growing list of oncogenic viruses in the long run. However, owing to the complexities in carcinogenesis of viral origin, researchers across the world are struggling to identify the common thread that runs across different oncogenic viruses. Classical pathways of viral oncogenesis have identified oncogenic mediators in oncogenic viruses, but these mediators have been reported to act on diverse cellular and multiple omics pathways. In addition to viral mediators of carcinogenesis, researchers have identified various host factors responsible for viral carcinogenesis. Henceforth owing to viral and host complexities in viral carcinogenesis, a singular mechanistic pathway remains yet to be established; hence there is an urgent need to integrate concepts from system biology, cancer microenvironment, evolutionary perspective, and thermodynamics to understand the role of viruses as drivers of cancer. In the present manuscript, we provide a holistic view of the pathogenic pathways involved in viral oncogenesis with special emphasis on alteration in the tumor microenvironment, genomic alteration, biological entropy, evolutionary selection, and host determinants involved in the pathogenesis of viral tumor genesis. These concepts can provide important insight into viral cancers, which can have an important implication for developing novel, effective, and personalized therapeutic options for treating viral cancers.

Using Date Palm Waste as an Alternative for Rockwool: Sweet Pepper Performance under Both Soilless Culture Substrates.

The degradation of soil quality due to environmental conditions and improper management practices has caused a shrinkage in land areas suitable for crop cultivation. This necessitates a transition towards soilless culture systems, which offer desirable conditions for crop growth and development and increase resource use efficiency. One of the growth-limiting factors in soilless culture systems is the type of growing substrate. The use of more sustainable resources and environmentally friendly growing substrates is a challenge that affects the soilless culture industry. This work evaluates the efficacy of date palm waste (DPW) and rockwool as growing substrates for sweet pepper (Capsicum annuum L.) under greenhouse conditions. The plant height, stem diameter, average total leaf area, φPSII, and Fm' of leaf fluorescence show significant increases when plants are grown in rockwool. No differences are found in terms of the total yield or the number of marketable fruits and fruit quality between the two substrates. However, the DPW substrate shows a significant decrease in the number of unmarketable fruits and number of Blossom End Rot (BER) fruits. Plants grown in both growing substrates consume equal water amounts for the optimal fruit production, while the water use efficiency of rockwool is better than that of DPW. Our results highlight DPW's role in soilless production and as a key solution for resource-saving production systems.

Impacts of COVID-19 on Patients With Common Surgical Emergencies at the King Fahad Specialist Hospital in Buraidah, Saudi Arabia.

INTRODUCTION: The COVID-19 pandemic is a global disaster with millions of infections and deaths. Healthcare systems and services were significantly affected, necessitating adjustments. These included postponement of scheduled appointments and elective surgeries. During the pandemic, there was an increase in the number of acute appendicitis, gallstones, and hernia with a significant impact on the signs and symptoms of presenting problems due to prehospital delay. AIM: This study aims to measure the impacts of COVID-19 on patients with common surgical emergencies in King Fahad Specialist Hospital, Buraidah, Saudi Arabia. METHODS: This is a single-center retrospective study conducted at King Fahad Specialist Hospital in Buraidah, Saudi Arabia. We reviewed all medical records of patients diagnosed with common surgical emergencies (acute appendicitis, gallstones, and hernia) during a selected time of COVID-19 lockdown and compared it with a similar set period before the crisis as a control sample. All medical records were reviewed to find out the overall number of admissions, frequency of emergency department (ED) visits, duration of illness, picture of clinical presentation, intraoperative findings, course and duration of admission, and final pathology if any. RESULTS: A total of 322 patients were included in the study. Of these, 119 (37%) patients underwent surgery before COVID-19 while 203 (63%) patients underwent surgery during the pandemic. The diagnosis of acute appendicitis was 63.9% and 47.7%, hernia 27.7% and 34.6%, and gallstone was 8.4% and 17.7% for control and pandemic periods, respectively. The duration varied from 10 hours to two days and four hours to one month, seven hours to one day to eight hours to six months, and two hours to one day to seven hours to one and half a month for acute appendicitis, hernia, and gallstone in control and pandemic period, respectively. The mean length of stay for acute appendicitis was reduced from two days during the control period to one day during the pandemic period, from four to three days for gallstone, and for hernia, it remained three days for both the control and pandemic periods, respectively. Regarding the course of admission for acute appendicitis, the uneventful cases were reduced while an increase in uneventful cases for both hernia and gallstone was observed. CONCLUSION: During the COVID-19 pandemic, there was a noticeable reduction in hospital visits. We observed an increase in the number of one-time visits and a reduction of three, four, and seven-time visits, which was attributed to the fact that patients have been reported to visit the hospital after a long time from the onset of symptoms with a higher chance of complication and subsequent surgeries. The number of acute appendicitis cases was reduced while the cases of hernia and gallstones increased significantly. The minimum period for the duration of acute illness for appendicitis was reduced in the pandemic period, while the minimum period for both gallstone and hernia was increased as both conditions could require conservative management. The mean length of hospital stay was reduced during the pandemic period, mainly due to the early discharge implemented in COVID-19 protocols to decrease the risk of infection. The severity of symptoms was increased due to the cancellation and delaying of surgeries.

Free convective trickling over a porous medium of fractional nanofluid with MHD and heat source/sink.

Nanofluids are considered as smart fluids that can improve heat and mass transfer and have numerous applications in industry and engineering fields such as electronics, manufacturing, and biomedicine. For this reason, blood-based nanofluids with carbon nanotubes (CNTs) as nanoparticles in the presence of a magnetic field are discussed. The nanofluid traverses the porous medium. The nanofluids move on a vertical plate that can be moved. The free convection heat transfer mode is considered when the heat source and heat fluxes are constant. Convective flows are often used in engineering processes, especially in heat removal, such as geothermal and petroleum extraction, building construction, and so on. Heat transfer is used in chemical processing, power generation, automobile manufacturing, air conditioning, refrigeration, and computer technology, among others. Heat transfer fluids such as water, methanol, air and glycerine are used as heat exchange media because these fluids have low thermal conductivity compared to other metals. We have studied the effects of MHD on the heat and velocity of nanofluids keeping efficiency in mind. Laplace transform is used to solve the mathematical model. The velocity and temperature profiles of MHD flow with free convection of nanofluids were described using Nusselt number and skin friction coefficient. An accurate solution is obtained for both the velocity and temperature profiles. The graph shows the effects of the different parameters on the velocity and temperature profiles. The temperature profile improved with increasing estimates of the fraction parameter and the volume friction parameter. The velocity of the nanofluid is also a de-escalating function with the increasing values of the magnetic parameter and the porosity parameter. The thickness of the thermal boundary layer decreases with increasing values of the fractional parameter.

Time Window for Acute Stroke Treatment: Current Practice in King Abdullah Medical City Specialist Hospital in Makkah, Saudi Arabia.

Introduction Stroke has become one of the most severe causes of long-term neurological impairment and disability and is considered one of the leading causes of mortality worldwide. This study aimed to determine time delays in stroke patients from symptoms onset to treatment with tissue plasminogen activator (tPA) initiation in King Abdullah Medical City Specialist Hospital, Makkah, Saudi Arabia. Patients and methods We reviewed 81 patients who suffered from acute stroke. The data were collected from patients' electronic and paper files. Patients were divided into two main categories based on interval time from recognition of symptoms to tPA treatment. Patients were divided into early treatment, if the duration was less than or equal to 120 minutes, and delayed treatment, if the interval time was more than 120 minutes. Results Nearly two-thirds (64.2%) were males, and more than half (5.6%) were in the older age group (>65 years). Patients who underwent thrombectomy were 7.4%. The mean value of the National Institutes of Health Stroke Scale (NIHSS) score was 10.7 (SD: 7.14). The mean time from symptoms onset to arrival at the hospital was 82.4 (SD: 44.1) minutes, while the total time from recognition of symptoms to tPA treatment was 154 (SD: 50.8) minutes. The prevalence of patients with delayed treatment was 72.8%, and the rest were assumed to have early treatment (27.2%). None of the socio-demographic variables were predicted to influence delayed treatment. Conclusion A significant number of patients were delayed in treatment. Patients' socio-demographic data and NIHSS scores seem to have no significant effect on delayed treatment. Further research is needed to establish the delay in time for pre-hospital and in-hospital treatment of stroke patients.

The Incidence of Respiratory Infections and Risk Factors Among Cancer Patients Undergoing Chemotherapy at a Tertiary Care Hospital in Western Saudi Arabia.

Introduction Cancer patients receiving chemotherapy are prone to infections because of the treatment regimens' immunosuppression.  Objectives This study estimated the overall incidence of respiratory infections among patients undergoing chemotherapy and associated risk factors. Methods This study is a retrospective chart review of cancer patients at Princess Noorah Oncology Center in Western Saudi Arabia from January 2017 to December 2020.  Results This study included 196 patients, 53.1% males and 50.5% older than 50 years. The estimated incidence of respiratory infections among participants was 8.7%, and the most commonly detected organism was Klebsiella pneumoniae (35.3%). The risk factors significantly associated with infection were ICU admission (p=0.001), the use of mechanical ventilation (p=0.003), and the presence of hematologic malignancy (p=0.02). Conclusion Future multi-center studies should employ a prospective design, including laboratory confirmation of causative organisms. Such studies may better estimate the infection-associated burden on cancer patients undergoing chemotherapy.