Medication management and electrocardiogram screening in children with attention deficit hyperactivity disorder.

BACKGROUND: To quantify the proportion of referrals sent to Crumlin Cardiology Department for cardiac screening prior to commencement or modifying attention deficit hyperactivity disorder medication and assess the number detected with a clinically significant abnormality. METHODS: A prospective audit was performed over a 6-month period, from November 2021 to April 2022 inclusive. Referrals sent via outpatient department triage letters, electrocardiogram dept. email, and walk-in electrocardiogram service were screened for those pertaining to commencing or modifying medication for children with attention deficit hyperactivity disorder. Each referral was coded against National Institute for Health and Care Excellence guidelines to determine the degree of clinical details given. Reported abnormalities, recommended management, and correspondence were recorded. RESULTS: Ninety-one referrals were received during the 6-month audit period. More than half lacked a clinical indication for referral (53/91, 58.2%), with fewer than one third (26/91, 28.5%) meeting National Institute for Health and Care Excellence criteria for referral for cardiology. Eighty (80/91) referrals had clinical outcomes available for review (missing outpatient department information and age outside of service range accounted for eleven referrals with unavailable clinical outcomes). Of the eighty clinically reviewed referrals, seventy-two (72/80, 90%) were reported as normal with no cardiology follow up required. Eight referrals (8/80, 10%) were reviewed in the Cardiology Outpatient Department prior to commencement or modifying attention deficit hyperactivity disorder medication. Of these, only one (1/80 1%) had a clinically significant abnormality which was a potential contraindication to attention deficit hyperactivity disorder medication use, and this referral was appropriate as per National Institute for Health and Care Excellence guidelines. CONCLUSION: Routine screening prior to attention deficit hyperactivity disorder medication prescription in the absence of clinical indications (as per National Institute for Health and Care Excellence) contributed to delays in medication initiation among young people with attention deficit hyperactivity disorder. Unnecessary referrals have resource implications for cardiology clinical team. Improved adherence to National Institute for Health and Care Excellence guidelines would provide benefits for patients and clinicians.

Effect of CYP2C19 genetic variants on bleeding and major adverse cardiovascular events in a cohort of Arab patients undergoing percutaneous coronary intervention and stent implantation.

INTRODUCTION: One-third of patients have clopidogrel resistance that may lead to major adverse cardiac events (MACEs). By contrast, it was found that some clopidogrel-treated patients have hyperresponsive platelets that are associated with higher bleeding risk. Several studies have shown that polymorphisms in the gene encoding the CYP2C19 contribute to the variability in response to clopidogrel. Data on genetic and nongenetic factors affecting clopidogrel response in the Arab population are scarce. In this prospective cohort study, we sought to assess the association between the increased function allele (CYP2C19*17) and bleeding events, and validate the effect of the CYP2C19 genetic variants and nongenetic factors on the incidence of MACEs. METHODS: Blood samples were collected from patients that were undergoing percutaneous coronary intervention and receiving clopidogrel at the Heart Hospital, a specialist tertiary hospital in Doha, Qatar. Patients were followed for 12 months. Genotyping was performed for CYP2C19*2, *3, and *17 using TaqMan assays. RESULTS: In 254 patients, the minor allele frequencies were 0.13, 0.004, and 0.21 for *2, *3, and *17, respectively. Over a 12-month follow-up period, there were 21 bleeding events (8.5 events/100 patient-year). CYP2C19*17 carriers were found to be associated with increased risk of bleeding (OR, 21.6; 95% CI, 4.8-96.8; P < 0.0001). CYP2C19*2 or *3 carriers were found to be associated with increased risk of baseline and incident MACE combined (OR, 8.4; 95% CI, 3.2-23.9; P < 0.0001). CONCLUSION: This study showed a significant association between CYP2C19*17 allele and the increased risk of bleeding, and CYP2C19*2 or *3 with MACE outcomes.

Transcriptomic and functional genetic evidence for distinct ecophysiological responses across complex life cycle stages.

Organisms with complex life cycles demonstrate a remarkable ability to change their phenotypes across development, presumably as an evolutionary adaptation to developmentally variable environments. Developmental variation in environmentally sensitive performance, and thermal sensitivity in particular, has been well documented in holometabolous insects. For example, thermal performance in adults and juvenile stages exhibit little genetic correlation (genetic decoupling) and can evolve independently, resulting in divergent thermal responses. Yet, we understand very little about how this genetic decoupling occurs. We tested the hypothesis that genetic decoupling of thermal physiology is driven by fundamental differences in physiology between life stages, despite a potentially conserved cellular stress response. We used RNAseq to compare transcript expression in response to a cold stressor in Drosophila melanogaster larvae and adults and used RNA interference (RNAi) to test whether knocking down nine target genes differentially affected larval and adult cold tolerance. Transcriptomic responses of whole larvae and adults during and following exposure to -5°C were largely unique both in identity of responding transcripts and in temporal dynamics. Further, we analyzed the tissue-specificity of differentially expressed transcripts from FlyAtlas 2 data, and concluded that stage-specific differences in transcription were not simply driven by differences in tissue composition. In addition, RNAi of target genes resulted in largely stage-specific and sometimes sex-specific effects on cold tolerance. The combined evidence suggests that thermal physiology is largely stage-specific at the level of gene expression, and thus natural selection may be acting on different loci during the independent thermal adaptation of different life stages.

SNP-PCR genotyping links alterations in the GABAA receptor (GABRG3: rs208129) and RELN (rs73670) genes to autism spectrum disorder among peadiatric Iraqi Arabs.

INTRODUCTION: Autism spectrum disorder (ASD) is an increasing concern among the Iraqi Arab population. The genetic alterations that cause ASD are likely to converge at the synapse. This study investigated polymorphisms in the GABAA receptor subunit (GABRG3) and the RELN gene as putative biomarkers of ASD in a pediatric population in Iraq. METHODS: The case control study included 60 patients with a clinical diagnosis of ASD (mild, moderate, or severe) according to DSM-IV criteria and matched healthy controls (n = 60). Blood samples were collected for DNA genotyping of SNPs rs736707 and rs208129 for RELN and GABRG3 using allele specific PCR. Assessment of genotype and allele distributions in patient groups used odd ratios (OR) with 95% confidence intervals and the Chi-square test. All statistical analysis was performed used SPSS software. RESULT: The patient cohort was highly consanguineous, with increased ratio (p > 0.05) of males to females (3:1) in both ASD (mean age, 6.66 ± 3.05) and controls (mean age, 5.76 ± 2.3). Both GABRG3 rs208129 genotypes TT (OR 4.33, p = 0.0015) and TA (OR 0.259, P = 0.008), and the T and A alleles were significantly associated with ASD. The RELN rs736707 TC genotype (OR 2.626, P = 0.034) was the only significant association with ASD. CONCLUSION: GABRG3 SNP rs208129 is a leading biomarker to predict genetic vulnerability to ASD in Iraqi Arabs. Expanded SNP panels and increased sample sizes are required for future GABRG3 studies, and to reach a consensus on RELN utility. Future ASD screening programs in Iraq should include genetic metrics in addition to clinical phenotype assessments.

THE POTENTIAL ROLE OF EPSTEIN BARR VIRUS IN MULTIPLE SCLEROSIS MOLECULAR AND SEROLOGICAL STUDY.

OBJECTIVE: The aim: To identify the relation between EBV infection/reactivation and multiple sclerosis, compared to the normal controls. PATIENTS AND METHODS: Materials and methods: A case-control study conducted in 120 MS patients, aged between 12-42 years, and 120 apparently healthy age- and sex-matched volunteers as controls. Viral DNA was extracted from 100µl of plasma samples, and then viral DNA was detected and quantified by quantitative real time-polymerase chain reaction (q-PCR). Serum samples were used for the detection of anti-EBNA-1 IgG. RESULTS: Results: Quantitative polymerase chain reaction of EBV showed absence of EBV viremia in all MS patients and control. However, anti EBNA-1 IgG antibody was positive in 51.7% (62/120) of MS patients and 39.2% (47/120) of controls, (P=0.035). The median of anti EBNA-1 IgG level in MS patients and controls were 81.08 U/ml and 67.73 U/ml, respectively (P=0.043). Additionally, EBNA-1 antibody was significantly higher in younger age groups. Patients with the first-line and second-line treatment showed no significant differences in anti EBNA-1 IgG levels, while the median level in patients without treatment (newly diagnosed) was higher. CONCLUSION: Conclusions: EBNA-1antibody could play a significant role in development of MS, as it is significantly higher in MS patients than in controls, especially at younger age groups, at early stages of the disease and in female patients.

Horizontal Transfer of Bacterial Cytolethal Distending Toxin B Genes to Insects.

Horizontal gene transfer events have played a major role in the evolution of microbial species, but their importance in animals is less clear. Here, we report horizontal gene transfer of cytolethal distending toxin B (cdtB), prokaryotic genes encoding eukaryote-targeting DNase I toxins, into the genomes of vinegar flies (Diptera: Drosophilidae) and aphids (Hemiptera: Aphididae). We found insect-encoded cdtB genes are most closely related to orthologs from bacteriophage that infect Candidatus Hamiltonella defensa, a bacterial mutualistic symbiont of aphids that confers resistance to parasitoid wasps. In drosophilids, cdtB orthologs are highly expressed during the parasitoid-prone larval stage and encode a protein with ancestral DNase activity. We show that cdtB has been domesticated by diverse insects and hypothesize that it functions in defense against their natural enemies.

Stage-specific genotype-by-environment interactions for cold and heat hardiness in Drosophila melanogaster.

Environments often vary across a life cycle, imposing fluctuating natural selection across development. Such fluctuating selection can favor different phenotypes in different life stages, but stage-specific evolutionary responses will depend on genetic variance, covariance, and their interaction across development and across environments. Thus, quantifying how genetic architecture varies with plastic responses to the environment and across development is vital to predict whether stage-specific adaptation will occur in nature. Additionally, the interaction of genetic variation and environmental plasticity (GxE) may be stage-specific, leading to a three-way interaction between genotype, environment, and development or GxDxE. To test for these patterns, we exposed larvae and adults of Drosophila melanogaster isogenic lines derived from a natural population to extreme heat and cold stress after developmental acclimation to cool (18 °C) and warm (25 °C) conditions and measured genetic variance for thermal hardiness. We detected significant GxE that was specific to larvae and adults for cold and heat hardiness (GxDxE), but no significant genetic correlation across development for either trait at either acclimation temperature. However, cross-development phenotypic correlations for acclimation responses suggest that plasticity itself may be developmentally constrained, though rigorously testing this hypothesis requires more experimentation. These results illustrate the potential for stage-specific adaptation within a complex life cycle and demonstrate the importance of measuring traits at appropriate developmental stages and environmental conditions when predicting evolutionary responses to changing climates.

Impact of letrozole versus clomiphene citrate on endometrial receptivity in Iraqi women with polycystic ovarian syndrome.

WHAT IS KNOWN AND OBJECTIVES: Letrozole is widely known for its use as an ovulation inductor. This study aims to investigate the effects of letrozole and clomiphene citrate in females with polycystic ovarian syndrome. METHODS: This is a randomized non-blinded controlled trial study that included 80 infertile females with polycystic ovarian syndrome receiving a standard dose of either clomiphene citrate or letrozole on day 2 of the cycle. An ultrasound was done to examine growth of the follicle, endometrial thickness on days 12-13, and a Doppler study to measure resistance index (RI), pulsatility index and ratio of systolic/diastolic velocity. RESULTS AND DISCUSSION: The mean levels of dominant follicle and oestradiol were significantly higher in the clomiphene citrate group than in the letrozole group. The letrozole group had a significantly greater endometrial thickness than the clomiphene citrate group. The resistance index and pulsatility index were lower in the letrozole group and in pregnant women than in the clomiphene citrate group and the non-pregnant group. WHAT IS NEW AND CONCLUSION: The use of letrozole for ovulation induction in polycystic ovarian syndrome patients has a better effect on endometrial receptivity markers when compared to clomiphene citrate.

Characterization of human Influenza Viruses in Lebanon during 2010-2011 and 2011-2012 post-pandemic seasons.

OBJECTIVE: To genetically characterize human influenza viruses and their susceptibilities to antivirals during two post-pandemic seasons in Lebanon. METHODS: Influenza virus was isolated from nasopharyngeal swabs that were obtained from patients with influenza-like illness during 2010-2012 and further analyzed both phenotypically and genotypically. RESULTS: During the 2010-2011 season, both 2009 pandemic H1N1 (H1N1p) and B viruses co-circulated with equal prevalence, while the H3N2 virus predominated during the 2011-2012 season. All H3N2 and H1N1 viruses were resistant to amantadine. Importantly, all viruses of the influenza A and B types were susceptible to the neuraminidase (NA) inhibitors oseltamivir, zanamivir, peramivir, and laninamivir. Nonetheless, all 2011-2012 H1N1p isolates had three mutations (V241I, N369K, and N386S) in the NA gene that were suggested to be permissive of the H275Y mutation, which confers resistance to oseltamivir. We also detected one H1N1p virus during the 2010-2011 season with a 4-fold decrease in susceptibility to oseltamivir due to an NA-S247N mutation. This isolate was phylogenetically distinct from other H1N1p viruses that were isolated in other regions. CONCLUSIONS: Influenza A viruses with reduced susceptibility to oseltamivir and mutations permissive for acquiring NA resistance-conferring mutation with minimal burden on their fitness were isolated in Lebanon.

Screening factors affecting proper levothyroxine therapy among patients with primary hypothyroidism: a cross-sectional study.

Primary hypothyroidism, the most common form of hypothyroidism, requires effective patient understanding and management for successful long-term treatment. This study aimed to investigate the influence of patient knowledge, attitude, practice (KAP), depression, and medication adherence on treatment response in primary hypothyroidism. A cross-sectional observational study was conducted at Al Hassan Metabolism, Endocrine, and Diabetes Center (HMEDC) in Iraq between September 2022 and March 2023. We enrolled 111 patients with signs and symptoms of primary hypothyroidism over 6 months. A validated questionnaire assessed patient knowledge, attitude, practice (KAP), depression, and medication adherence. Thyroid-stimulating hormone (TSH) levels were measured to assess treatment response. Data were analyzed using SPSS v26, with categorical variables presented as percentages. The student's t-test was used to assess statistical significance, with P - valuess below 0.05 considered significant and P - values below 0.01 considered highly significant. The mean age of patients was 45 ± 11.9 years. Approximately 34% of patients had insufficient knowledge, and 30% indicated a positive attitude towards their treatment. A total of 35% of patients had excellent practice. There was no statistically significant association between KAP and age or gender. There was a significant positive correlation between higher levels of education and improved KAP scores. A total of 44.1% of participants reported moderate depression, and 58% demonstrated adherence to levothyroxine (LT4) treatment. Despite good adherence, the combination of fair knowledge and moderate-to-severe depression resulted in suboptimal outcomes for replacement treatment.

Enhancing breast cancer treatment selection through 2TLIVq-ROFS-based multi-attribute group decision making.

Introduction: Breast cancer is an extremely common and potentially fatal illness that impacts millions of women worldwide. Multiple criteria and inclinations must be taken into account when selecting the optimal treatment option for each patient. Methods: The selection of breast cancer treatments can be modeled as a multi-attribute group decision-making (MAGDM) problem, in which a group of experts evaluate and rank alternative treatments based on multiple attributes. MAGDM methods can aid in enhancing the quality and efficacy of breast cancer treatment selection decisions. For this purpose, we introduce the concept of a 2-tuple linguistic interval-valued q-rung orthopair fuzzy set (2TLIVq-ROFS), a new development in fuzzy set theory that incorporates the characteristics of interval-valued q-rung orthopair fuzzy set (IVq-ROFS) and 2-tuple linguistic terms. It can express the quantitative and qualitative aspects of uncertain information, as well as the decision-makers' level of satisfaction and dissatisfaction. Results: Then, the 2TLIVq-ROF weighted average (2TLIVq-ROFWA) operator and the 2TLIVq-ROF weighted geometric (2TLIVq-ROFWJ) operator are introduced as two new aggregation operators. In addition, the multi-attribute border approximation area comparison (MABAC) method is extended to solve the MAGDM problem with 2TLIVq-ROF information. Discussion: To demonstrate the efficacy and applicability of the suggested model, a case study of selecting the optimal breast cancer treatment is presented. The results of the computations show that the suggested MAGDM model is able to handle imprecision and subjectivity in complicated decision-making scenarios and opens new research scenarios for scholars.

Gradenigo Syndrome: A Case Report of a Rare Complication of Otitis Media.

Otitis media, a common inflammation of the middle ear, frequently complicates upper respiratory infections. Gradenigo's syndrome, a rare complication, manifests as suppurative otitis media, abducens nerve palsy, and severe trigeminal nerve pain. Prompt recognition is vital because of the proximity of the infection to critical neurovascular structures. We present the case of a 38-year-old female who presented with facial pain, otalgia, and diplopia following an upper respiratory infection. Examination revealed facial weakness and abducens nerve palsy. Laboratory results showed elevated inflammatory markers. Imaging confirmed middle ear involvement. Antibiotics were initiated, and myringotomy was performed, resulting in a successful outcome. This case report contributes to understanding Gradenigo's syndrome's clinical nuances, emphasizing the necessity of a structured diagnostic and therapeutic approach. Ongoing research is crucial for refining diagnostic criteria, optimizing treatment, and enhancing pathophysiological understanding. Increased medical education is imperative to ensure early detection and improved patient outcomes.

Evaluation of cytotoxic potential of silver nanoparticles biosynthesized using essential oils of Jasminum sambac against breast cancer and bacterial cells.

Essential oils (EOs) which cover about 91% whole biomolecules formulated from Jasminum sambac leaves based on Gas chromatography-mass spectrometry were employed to identify structures. EOs were observed as good agents in the preparation of Silver nanoparticles (AgNPs) through the proposed mechanism that was attempted to interpret the pathway of the bio-preparation process. The characterization of EOs-AgNPs carried via ultraviolet-visible to reveal surface plasmon resonance at 420 nm, Fourier transform infrared to observe functional groups EOs compared to EOs-AgNPs. X-ray diffraction (XRD) revealed a broad chart owing to the small size of AgNPs in average size less than 10 nm calculated relying on image J software, spherical AgNPs with a small dispersive size observed by transmission electron microscopy. Quasi near spherical surface morphology of EOs-AgNPs had detected by field emission scanning electron microscope. EOs-AgNPs were assessed for their antibacterial potential against both Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria as suppressing bacterial agents. EOs-AgNPs had their anti-breast cancer MCF-7 cell line ability investigated by DNA fragmentation; cycle flow cytometry (apoptosis) at half maximal inhibitory concentration (IC50) was determined at 260 µg/mL which has been stated by cytotoxicity (MTT) assay. EOs-AgNPs have antibacterial and anticancer therapeutic potential, and it is safe, inexpensive, and scalable in the nanoscale range.

Assessment of Knowledge, Attitude, and Practice Towards Migraine Among the General Population in the Kingdom of Bahrain.

OBJECTIVE:  The primary objective of this research is to assess the general population's knowledge, attitude, and practice towards migraine. METHOD:  A cross-sectional study was conducted on a total sample of 255 participants. The data were obtained from a self-administered electronic questionnaire (Appendix) distributed through social media. Data analysis was done using the IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. For statistics, frequency, percentage, median, and standard deviation were calculated.  Results: Among the Bahraini population, knowledge about migraine definition, triggers, risk factors, symptoms, and treatment is satisfactory. However, knowledge about migraine prophylaxis is limited. Attitude and practice towards the disease showed adequate responses among the population, as they prefer consulting a doctor and believe that lifestyle modification is the best migraine treatment. CONCLUSION:  The general population of the Kingdom of Bahrain needs more awareness regarding migraine. Although the majority of the population showed good responses, which displayed some knowledge of the disease, community-based campaigns are still needed.

Detection of Coumarin Derivatives of Viola odorata Cultivated in Iraq.

Like other members of the viola family, Viola odorata may be found naturally occurring in Europe and Asia. This little plant is tough and perennially herbaceous. It's also known as sweet violet and English violet. There are several medicinal uses for this flowering plant, including its ability to fight cancer, bacteria, and inflammation., antioxidant activity, and antipyretic activity. The phytochemical studies of different parts of Viola odorata resulted in the isolation of different chemical constituents such as Coumarins, caffeic acid, methyl salicylate, flavonoids (Quercetin, kaempferol), glycosides (Rutin), and terpenoids (stigma sterol). Coumarins are important natural phenolic compounds of the family of benzopyrone. Coumarin's basic structure consists of a pyrone ring fused with a benzene ring. Umbelliferone and esculetin are the most common simple coumarins in nature. Coumarins become an attractive backbone drug with innovative impacts on illnesses and reduced side effects on healthy cells. Anti-inflammatory, anti-carcinogenic, and other biological properties are among those attributed to coumarins derivatives. In this study, Umbelliferone and esculetin of Viola odorata were identified by TLC, and HPTLC.

An efficient edge/cloud medical system for rapid detection of level of consciousness in emergency medicine based on explainable machine learning models.

Emergency medicine (EM) is one of the attractive research fields in which researchers investigate their efforts to diagnose and treat unforeseen illnesses or injuries. There are many tests and observations are involved in EM. Detection of the level of consciousness is one of these observations, which can be detected using several methods. Among these methods, the automatic estimation of the Glasgow coma scale (GCS) is studied in this paper. The GCS is a medical score used to describe a patient's level of consciousness. This type of scoring system requires medical examination that may not be available with the shortage of the medical expert. Therefore, the automatic medical calculation for a patient's level of consciousness is highly needed. Artificial intelligence has been deployed in several applications and appears to have a high performance regarding providing automatic solutions. The main objective of this work is to introduce the edge/cloud system to improve the efficiency of the consciousness measurement through efficient local data processing. Moreover, an efficient machine learning (ML) model to predict the level of consciousness of a certain patient based on the patient's demographic, vital signs, and laboratory tests is proposed, as well as maintaining the explainability issue using Shapley additive explanations (SHAP) that provides natural language explanation in a form that helps the medical expert to understand the final prediction. The developed ML model is validated using vital signs and laboratory tests extracted from the MIMIC III dataset, and it achieves superior performance (mean absolute error (MAE) = 0.269, mean square error (MSE) = 0.625, R 2 score = 0.964). The resulting model is accurate, medically intuitive, and trustworthy.

Effects of genetic and environmental variables on biofilm development dynamics in Achromobacter mucicolens.

Background and Objectives: The study aimed to investigate whether Achromobacter mucicolens IA strain biofilm formation, which contributes to antibiotic resistance, could be enhanced by readily available nutrient sources like carbohydrates and environmental factors such as pH and NaCl. Additionally, the study aimed to identify any inherent genes that support biofilm formation in this strain, which is an opportunistic pathogen that affects immunocompromised patients and is resistant to many antibiotics. Materials and Methods: Biofilm growth in different carbohydrate, pH, and NaCl concentrated media was measured using crystal violet microtiter assay. All the treatments were subjected to biostatistics analysis for normality, Test of Homogeneity, one way ANOVA analysis. Whole-genome sequencing of our IA strain was conducted to identify various gene sequences. Results: Biofilm formation was measured at different carbohydrate concentrations, and the optimum biofilm formation was observed at 3M glucose and 0.5M NaCl, while the lowest results were seen at 2M maltose concentration. Whole-genome sequencing identified potential genes involved in biofilm formation, pathogenicity, protein metabolism, flagellar motility, cell wall component synthesis, and a multidrug efflux pump. Conclusion: These findings suggest that biofilm formation is influenced by extrinsic and intrinsic factors, which could aid in the development of effective treatments for resistant infections.

Acceptance, Knowledge, and Attitude of Parents Toward the Human Papillomavirus Vaccine in the Eastern Region of Saudi Arabia: A Cross-Sectional Study.

Background Human papillomavirus (HPV) is a common sexually transmitted virus associated with conditions such as skin warts and cervical cancer. Although many individuals clear the infection, some face persistent risks. Cervical cancer, which is linked to certain types of HPV, is a major health concern both globally and in Saudi Arabia, with preventive measures including HPV vaccination. However, parental knowledge and attitudes toward vaccinating their children vary. Therefore, this research aims to assess parental acceptance and understanding of the HPV vaccine in the Eastern Region of Saudi Arabia. Methodology This cross-sectional study was conducted in the Eastern Region of Saudi Arabia using an online questionnaire during 2022-2023. The data were cleaned in Excel and analyzed using SPSS version 29 (IBM Corp., Armonk, NY, USA). The study assessed parents' knowledge and acceptance of HPV vaccination. Results A total of 380 participants were included in this study, the majority of whom were female, married, well-educated, and residents of Al-Ahsa, Saudi Arabia. Awareness about the HPV vaccine was modest, with only 46.6% of participants having heard of it. Most parents reported that their doctors did not mention the vaccine (62.9%), and 67.1% stated that their children had not received it. Factors influencing acceptance included support from the Ministry of Health and belief in the vaccine's effectiveness. Concerns about side effects and vaccine effectiveness were the main barriers to vaccination. Sociodemographic factors, including gender, age, education, employment, and number of children, significantly influenced both knowledge and acceptance. Notably, awareness of HPV was strongly associated with acceptance. Conclusions Our study revealed limited knowledge and vaccine acceptance among parents in the Eastern Region of Saudi Arabia. Sociodemographic factors, including gender, age, education, employment, and number of children, significantly influenced both knowledge and acceptance. Thus, sociodemographic factors played a significant role in shaping these attitudes, emphasizing the need for targeted awareness campaigns and improved communication between healthcare providers and parents to enhance vaccine uptake.

Design and characterization of a multi-epitope vaccine targeting Chlamydia abortus using immunoinformatics approach.

Chlamydiosis is a widespread ailment affecting humans, livestock, and wildlife, caused by C. abortus, a member of the Chlamydia genus. This disease leads to reproductive disorders in bovines and poses a zoonotic risk, resulting in adverse outcomes such as abortion, stillbirths, weak offspring, endometritis, repeat breeding, and perinatal mortality. However, current chlamydiosis vaccines have limitations in terms of safety, efficacy, and stability, necessitating the development of effective and safe alternatives. In this study, our objective was to design a multi-epitope vaccine (MEV) targeting all strains of C. abortus using bioinformatics and immunoinformatics approaches. We identified highly antigenic and non-allergic proteins (yidC, yajC, secY, CAB503, and CAB746) using VaxiJen and AlgPred tools. Physicochemical analyses and secondary structure predictions confirmed protein stability through ProtParam and SOPMA methods. Furthermore, we employed IEDB-AR, NETMHCpan, and ToxinPred2 tools to predict cytotoxic T lymphocyte (CTL), helper T lymphocyte (HTL), and B-cell epitopes, resulting in the identification of conserved epitopes for further analysis. The MEV construct, consisting of 545 amino acids, incorporated the adjuvant Beta defensin-3, along with 9 CTL epitopes and 21 HTL epitopes linked by EAAAK, KK, and AAY linkers. We assessed the safety and immunogenicity of the vaccine through comprehensive evaluations of antigenicity, toxicity, allergenicity, and physicochemical properties. Structural stability and quality were examined using 3D modeling via the ab initio approach with the Robetta platform. Molecular docking analysis explored the compatibility of the MEV with Toll-like receptor 9 (TLR9) using ClusPro, while molecular dynamics simulation with the DESMOND Maestro software predicted the stability and flexibility of the docked complex. Despite promising in silico findings, further wet lab investigations are crucial to validate the safety and efficacy of the MEV. Successful development and validation of this MEV hold significant potential in combatting chlamydiosis in both animal and human populations.Communicated by Ramaswamy H. Sarma.

Erratum: Rotavirus Genotypes and Vaccine Effectiveness from a Sentinel, Hospital-Based, Surveillance Study for Three Consecutive Rotavirus Seasons in Lebanon.

[This corrects the article DOI: 10.1371/journal.pone.0161345.].