Teachers' perspectives on effective English language teaching practices at the elementary level: A phenomenological study.

This study examined instructional practices and challenges English language teachers face in elementary schools. This study used a phenomenological approach and a mixed-method design. The data were collected through four tools: questionnaires, case studies, interviews, and observations in eight elementary schools in which eight educators and two hundred students participated from schools of three districts in central Punjab, Pakistan. This study aimed to explore the perspectives of teachers and students regarding the current pedagogical and instructional practices employed in English language classes. This study identified issues related to the lack of professional training and qualifications, overcrowded classrooms, cultural and social barriers, limited availability of the latest resources and technology, and a lack of parental cooperation. The findings suggested revisiting teachers' professional development programs, focusing on innovative teaching methods, incorporating technology into language teaching classes and classroom materials development, and adaptation preparation. It further suggested that teachers with low levels of professional qualifications and training should consider focusing on specific approaches to meet the challenges they face in language classes instead of general teaching approaches.

Synthesis of Polyesters Containing Long Aliphatic Methylene Units by ADMET Polymerization and Synthesis of ABA-Triblock Copolymers by One-Pot End Modification and Subsequent Living Ring-Opening Polymerization.

The synthesis of high-molecular-weight (Mn up to 62,000 g/mol) polyesters has been achieved by acyclic diene metathesis (ADMET) polymerization of α,ω-dienes prepared from biobased bis(undec-10-enoate) and diols [ethylene glycol (M1), propylene glycol (M2), 1,9-nonanediol (M3), 1,4-benzenedimethanol (M4), and hydroquinone (M5)] using ruthenium-carbene catalysts. Replacement of the solvent during the ADMET polymerization was effective for obtainment of the high-molecular-weight polymers (expressed as P1-P5). The melting temperatures (Tm) in the resultant polyesters were dependent upon the diol (middle) segment employed, and the polymer prepared from M5 exceeded 100 °C (a Tm value of 122.5 °C). The polymerization of M3 and M4 in the presence of 1,4-cis-diacetoxy-2-butene (DAB, as the chain transfer agent) afforded the telechelic polyesters [P3(OAc)2 and P4(OAc)2, respectively] containing acetoxy end groups exclusively. The resultant polymers containing hydroxy group termini [P3(OH)2 and P4(OH)2], prepared by the selective deprotection of the acetoxy end groups, were treated with AlEt3 followed by addition of ε-caprolactone to afford the ABA-type triblock copolymers exclusively, through a living ring-opening polymerization. The depolymerization (hydrolysis) under basic conditions (NaOH aqueous solution) of P3 was explored.

Synthesis of Network Biobased Aliphatic Polyesters Exhibiting Better Tensile Properties than the Linear Polymers by ADMET Polymerization in the Presence of Glycerol Tris(undec-10-enoate).

Development of biobased aliphatic polyesters with better mechanical (tensile) properties in film has attracted considerable attention. This report presents the synthesis of soluble network biobased aliphatic polyesters by acyclic diene metathesis (ADMET) polymerization of bis(undec-10-enyl)isosorbide diester [M1, dianhydro-D-glucityl bis(undec-10-enoate)] in the presence of a tri-arm crosslinker [CL, glycerol tris(undec-10-enoate)] using a ruthenium-carbene catalyst, and subsequent olefin hydrogenation using RhCl(PPh3)3. The resultant polymers, after hydrogenation (expressed as HCP1) and prepared in the presence of 1.0 mol% CL, showed better tensile properties than the linear polymer (HP1) with similar molecular weight [tensile strength (elongation at break): 20.8 MPa (282%) in HP1 vs. 35.4 MPa (572%) in HCP1]. It turned out that the polymer films prepared by the addition of CL during the polymerization (expressed as a 2-step approach) showed better tensile properties. The resultant polymer film also shows better tensile properties than the conventional polyolefins such as linear high density polyethylene, polypropylene, and low density polyethylene.

Evaluation of the Effect of Oral Isotretinoin on the Level of Serum YKL40 in Acne Vulgaris Patients: A Cross-Sectional Case-Control.

Background: In the entire world, acne vulgaris (AV) is the most prevalent skin condition. Approximately 9.4% of people worldwide have acne vulgaris. This study compared the blood levels of chitinase 3-like protein 1 (YKL-40) in acne vulgaris patients before and after oral isotretinoin therapy. Patients and Methods: The design of the study was cross-sectional case-control. Forty patients with moderate to severe acne vulgaris and twenty healthy participants participated in this study. Using the Global Acne Grading System (GAGS) score, patients with acne vulgaris were evaluated both before and after concluding their treatment. Using the enzyme-linked immunosorbent assay (ELISA), the serum levels of YKL-40 were measured before and after oral isotretinoin therapy in healthy controls and acne patients. Results: Patients with acne vulgaris had considerably greater serum levels of YKL-40 than healthy control subjects (p 0.001) did. After three months of oral isotretinoin medication, the GAGS score and blood levels of YKL-40 in acne vulgaris patients both significantly decreased. Conclusion: The conclusion of this study was that reducing the blood levels of YKL-40 and the GAGS score in patients with acne vulgaris who took oral isotretinoin for three months was a crucial strategy.

Evaluation of Mitigation Role of L-Phenylalanine-Based Low-Molecular-Weight Gelator against Oil Pollution-Induced Nile Tilapia Toxicity.

A lot of oil is leaked into aquatic environments, significantly impacting fish health and, consequently, human populations. This study aimed to introduce an L-phenylalanine-based low-molecular-weight gelator (expressed as Z-Phe-C18) as a smart remediation tool for oil spills. Several groups of Nile tilapia were allocated in aquaria exposed to different doses of crude engine oil with/without the organogelator for 4 weeks. The results revealed a significant increase in biochemical oxygen demand, chemical oxygen demand, electrical conductivity, and total dissolved solids in water samples of fish aquaria exposed to oil pollution. The antioxidant activity levels, micronucleus formation, and expression patterns of stress-related genes were significantly higher in the livers of fish exposed to crude oil than in those of control fish. On the contrary, fish groups exposed to oil pollution and treated with the organogelator indicated that antioxidant enzymes, micronucleus incidence, and gene expression alteration of stress-related genes declined compared with those exposed to oil pollution only. The results suggest that oil pollution can induce oxidative stress via the enhancement of oxygen free radical formation. On the contrary, oil removal by the organogelator decreases oxidative stress and consequently strengthens fish immunity. So, we can conclude that organogelator treatment is promoting oxidative resistance development by increasing the activities of antioxidant enzymes, which are important in protection against oil pollution and preventing peroxidation of fish tissues. Promisingly, the organogelator could be used as a tool for the remediation of oil pollution in aquatic environments.

Mitochondrial dysfunction and neurological disorders: A narrative review and treatment overview.

Mitochondria play a vital role in the nervous system, as they are responsible for generating energy in the form of ATP and regulating cellular processes such as calcium (Ca2+) signaling and apoptosis. However, mitochondrial dysfunction can lead to oxidative stress (OS), inflammation, and cell death, which have been implicated in the pathogenesis of various neurological disorders. In this article, we review the main functions of mitochondria in the nervous system and explore the mechanisms related to mitochondrial dysfunction. We discuss the role of mitochondrial dysfunction in the development and progression of some neurological disorders including Parkinson's disease (PD), multiple sclerosis (MS), Alzheimer's disease (AD), depression, and epilepsy. Finally, we provide an overview of various current treatment strategies that target mitochondrial dysfunction, including pharmacological treatments, phototherapy, gene therapy, and mitotherapy. This review emphasizes the importance of understanding the role of mitochondria in the nervous system and highlights the potential for mitochondrial-targeted therapies in the treatment of neurological disorders. Furthermore, it highlights some limitations and challenges encountered by the current therapeutic strategies and puts them in future perspective.

Synthesis of High Molecular Weight Biobased Aliphatic Polyesters Exhibiting Tensile Properties Beyond Polyethylene.

Synthesis of high molecular weight polyesters prepared by acyclic diene metathesis (ADMET) polymerization of bis(undec-10-enoate) with isosorbide (M1), isomannide (M2), and 1,3-propanediol (M3) and the subsequent hydrogenation have been achieved by using a molybdenum-alkylidene catalyst. The resultant polymers (P1) prepared by the ADMET polymerization of M1 (in toluene at 25 °C) possessed high Mn values (Mn = 44400-49400 g/mol), and no significant differences in the Mn values and the PDI (Mw/Mn) values were observed in the samples after the hydrogenation. Both the tensile strength and the elongation at break in the hydrogenated polymers from M1 (HP1) increased upon increasing the molar mass, and the sample with an Mn value of 48200 exhibited better tensile properties (tensile strength of 39.7 MPa, elongation at break of 436%) than conventional polyethylene, polypropylene, as well as polyester containing C18 alkyl chains. The tensile properties were affected by the diol segment employed, whereas HP2 showed a similar property to HP1.

COVID-19 disease treatment: pivotal challenges in the arena of umbilical cord-mesenchymal stem cells (UC-MSCs).

This century's first major epidemic of a new coronavirus illness (2019-nCoV) was a tremendous shock to the healthcare system. The onset of the pandemic has caused severe economic and health shortages. At this time, there are no viable treatments for COVID-19. Several clinical studies using cell-based therapies, such as umbilical cord mesenchymal stem cells, have showed promising results (UC-MSCs). UC-MSCs have been the focus of much study because to their potential as a treatment option for COVID-19 patients. Cytokine release syndrome, often called cytokine storm, increases the risk of morbidity and mortality from COVID-19. It has been established that UC-MSCs may suppress and control both the adaptive and innate immune responses by modulating the release of immunostimulatory cytokines. The purpose of this study is to assess and clarify the use of UC-MSCs for the treatment of ARDS caused by COVID-19.

Biological Investigation of 2-Thioxo-benzo[g]quinazolines against Adenovirus Type 7 and Bacteriophage Phi X174: An In Vitro Study.

Mortality and morbidity caused by viruses are a global health problems. Therefore, there is always a need to create novel therapeutic agents and refine existing ones to maximize their efficacy. Our lab has produced benzoquinazolines derivatives that have proven effective activity as antiviral compounds against herpes simplex (HSV 1 and 2), coxsackievirus B4 (CVB4), and hepatitis viruses (HAV and HCV). This in vitro study was aimed at investigating the effectiveness of benzoquinazoline derivatives 1-16 against adenovirus type 7 and bacteriophage phiX174 using a plaque assay. The cytotoxicity against adenovirus type 7 was also performed in vitro, using a MTT assay. Most of the compounds exhibited antiviral activity against bacteriophage phiX174. However, compounds 1, 3, 9, and 11 showed statistically significant reductions of 60-70% against bacteriophage phiX174. By contrast, compounds 3, 5, 7, 12, 13, and 15 were ineffective against adenovirus type 7, and compounds 6 and 16 had remarkable efficacy (50%). Using the MOE-Site Finder Module, a docking study was carried out in order to create a prediction regarding the orientation of the lead compounds (1, 9, and 11). This was performed in order to investigate the activity of the lead compounds 1, 9, and 11 against the bacteriophage phiX174 by locating the ligand-target protein binding interaction active sites.

Antiviral activity of some benzo[g]quinazolines against coxsackievirus B4: biological screening and docking study.

BACKGROUND: Serotype coxsackievirus B (CVB) infection has been linked to viral myocarditis, dilated cardiomyopathy, meningitis, and pancreatitis in children and young adults. As of yet, no antiviral drug has been authorized for the treatment of coxsackievirus infection. Therefore, there is perpetual demand for new therapeutic agents and the improvement of existing ones. Benzo[g]quinazolines, the subject of several well-known heterocyclic systems, have risen to prominence and played a significant role in the development of antiviral agents, particularly those for anti-coxsackievirus B4 infection. METHODS: This study investigated the cytotoxicity of the target benzo[g]quinazolines (1-16) in the BGM cells line as well as their anti-coxsackievirus B4 activity. Determination of CVB4 titers using a plaque assay. RESULTS: Most of the target benzoquinazolines exhibited antiviral activity, however, compounds 1-3 appeared to be the most effective (reduction percentages of 66.7, 70, and 83.3%, respectively). The binding mechanisms and interactions of the three most active 1-3 with the constitutive amino acids in the active site of the multi-target of coxsackievirus B4 (3Clpro and RdRp) targets were also investigated using molecular docking. CONCLUSION: The anti coxsackievirus B4 activity has resulted, and the top three active benzoquinazolines (1-3) have bonded to and interacted with the constitutive amino acids in the active region of the multi-target coxsackievirus B4 (RdRp and 3Clpro). Further research is required in the lab. to determine the exact benzoquinazolines mechanism of action.

Evaluation of Some Benzo[g]Quinazoline Derivatives as Antiviral Agents against Human Rotavirus Wa Strain: Biological Screening and Docking Study.

Globally, rotavirus (RV) is the most common cause of acute gastroenteritis in infants and toddlers; however, there are currently no agents available that are tailored to treat rotavirus infection in particular. Improved and widespread immunization programs are being implemented worldwide to reduce rotavirus morbidity and mortality. Despite certain immunizations, there are no licensed antivirals that can attack rotavirus in hosts. Benzoquinazolines, chemical components synthesized in our laboratory, were developed as antiviral agents, and showed good activity against herpes simplex, coxsackievirus B4 and hepatitis A and C. In this research project, an in vitro investigation of the effectiveness of benzoquinazoline derivatives 1-16 against human rotavirus Wa strains was carried out. All compounds exhibited antiviral activity, however compounds 1-3, 9 and 16 showed the greatest activity (reduction percentages ranged from 50 to 66%). In-silico molecular docking of highly active compounds, which were selected after studying the biological activity of all investigated of benzo[g]quinazolines compounds, was implemented into the protein's putative binding site to establish an optimal orientation for binding. As a result, compounds 1, 3, 9, and 16 are promising anti-rotavirus Wa strains that lead with Outer Capsid protein VP4 inhibition.

Risk Factors for Unplanned Initiation of Dialysis in Patients with Advanced Chronic Kidney Disease: A Retrospective Cohort Study.

Many patients with advanced chronic kidney disease (CKD) managed in a specialized multidisciplinary clinic start dialysis urgently during hospitalization rather than electively as outpatients. This study aimed to identify risk factors for starting unplanned dialysis among patients with advanced CKD who attended multidisciplinary low-clearance clinics between January 1, 2020, and December 31, 2021. Of these, 175 patients started dialysis: 101 (26.7%) started it urgently, whereas 74 (19.5%) started it electively. Patients with urgent initiation of dialysis received less education, had fewer clinic visits and follow-up and were seen less often in the vascular clinic. In the univariate regression analysis, congestive heart failure significantly increased the risk of acute dialysis. Moreover, the risk increased in patients who did not receive dialysis education. The risk increased in patients who were not seen in a vascular clinic and did not have a vascular access plan. Moreover, high albumin levels at initial presentation to the clinic had a lower risk for elective initiation of dialysis. In the multivariate regression analysis, use of renin-angiotensin-aldosterone system inhibitors and attending a vascular clinic reduced the risk of unplanned dialysis by 73% and 96%, respectively. Acute unplanned initiation of dialysis is common even in CKD patients followed in low-clearance clinics. Early referral to multidisciplinary low clearance clinics, timely education, compliance with timely follow-up periods, and creation of access in patients at risk may reduce hospital admissions, hospital stays, admission to intensive care units, costs, and morbidity in these patients.

Maternal predictors of neonatal anthropometric measurements in the Sultanate of Oman.

This study aims to detect an association between potential maternal predictors and neonatal anthropometry in Oman. A retrospective cross-sectional study was conducted in Sultan Qaboos University Hospital, Oman, between November 2014 and November 2015. The study included all term healthy Omani neonate-mother pairs. Summary descriptive statistics of neonatal (N) weight (Wt), length (L), head circumference (HC), and potential maternal (M) characteristics were collected. Multiple linear regression analysis was used to assess associations between maternal predictors and neonatal anthropometry. The study cohort identified 2,783 eligible pairs. The data showed that parity, maternal weight (MWt), and height (MHt) explained a significant amount of the variance in birth weight (F-ratio = 115.4, p-value < 0.001, and R 2 adjusted = 0.12). MWt and MHt were significant predictors of length (F-ratio = 65.3, p-value < 0.001, and R 2 adjusted = 0.048). The predictors of HC were MWt, MHt, and parity (F-ratio = 53.1, p-value < 0.001, and R 2 adjusted = 0.57). Primiparous mothers were 2.2 times at greater risk of delivering low birth weight (LBW) newborns. There were no significant differences in anthropometric outcomes between consanguineous and nonconsanguineous groups. Maternal weight and height had significant positive associations with the three newborn anthropometric outcomes. Additionally, primiparity was associated with the increased risk of LBW. Consanguinity was not associated with LBW in term Omani neonates.

Reactivity of 4,5-Dichlorophthalic Anhydride towards Thiosemicarbazide and Amines: Synthesis, Spectroscopic Analysis, and DFT Study.

The cyclic anhydrides are broadly employed in several fields, such as the chemical, plastic, agrochemical, and pharmaceutical industries. This study describes the chemical reactivity of 4,5-dichlorophthalic anhydride towards several nucleophiles, including thiosemicarbazide and different amines, to produce the carboxylic acid derivatives resulting from anhydride's opening, namely, phthalimide and dicarboxylic acid (1-12) products. Their chemical structures are confirmed by NMR, IR and MS spectra analyses. Density-functional theory (DFT) studies are performed using (DFT/B3LYP) with the 6-311G(d, p) basis sets to recognize different chemical and physical features of the target compounds.

Spontaneous Intravesical Knotting of a Feeding Tube in a Late Preterm Neonate: A Case Report.

Feeding tubes (FTs) are commonly used as urinary catheters in neonates and children. Though generally safe, serious complications can result if the catheter spontaneously knots inside the bladder. We report a case of a spontaneous knotting of an intravesical Fr 6 FT in a late preterm female baby following urethral catheterization to collect a urine sample. The knotted catheter was removed via suprapubic cystotomy. The infant had good postoperative recovery.

Burden of Early Life Obesity and Its Relationship with Protein Intake in Infancy: The Middle East Expert Consensus.

Adequate nutrition in early life is proposed to shape a child's future health by launching the growth trajectory in the proper direction, which helps to avoid negative metabolic programming effects. Protein intake during infancy and early childhood is of great importance, as it plays a key role in infant metabolic programming and the future risk of obesity. Breastfeeding provides the best nutrition in early life, with many benefits tailored for the baby, including the appropriate quantity and quality of proteins. Considering the high prevalence of childhood, and subsequent adult, obesity in the region, a virtual Middle East expert consensus meeting was held to discuss an effective approach for managing childhood obesity. Leading pediatric experts from Bahrain, Egypt, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates participated in the meeting. The experts discussed, debated, and agreed on certain directions, including the importance of educating parents, endorsing breastfeeding, and ensuring optimum quantity and quality intake of proteins in early life. This expert consensus may serve as the starting point for healthcare professionals in the region who are interested in shaping a healthy future for the generations to come.

Fentanyl versus dexamethasone or both as adjuvants to bupivacaine in an ultrasound-guided paravertebral block in patients undergoing modified radical mastectomy: a randomized double-blind clinical study.

BACKGROUND: This study aimed to compare the effect of dexamethasone added to fentanyl and bupivacaine with the effect of either dexamethasone or fentanyl alone when combined with bupivacaine in the thoracic paravertebral block (TPVB). METHODS: Sixty female patients (aged 18-60 years), scheduled for modified radical mastectomy were enrolled. Patients received preoperative unilateral paravertebral block using 0.3 mL/kg of 0.5% bupivacaine combined with 8 mg dexamethasone (group 1), 1 µg/kg fentanyl (group 2), or 8 mg dexamethasone + 1 µg/kg fentanyl (group 3). The study drugs were diluted with normal saline 0.9% up to 25 mL volume. The primary outcome was the time to first postoperative analgesics request, Secondary outcomes were total analgesic consumption, verbal rating pain scale (VRS) over the first 24 hours postoperatively, hemodynamic parameters, and adverse effects. RESULTS: The time to first analgesic request for intravenous (IV) nalbuphine was longer in group 2 (15.75±0.9 h, P<0.001) than group 1 (10.45±1.1 h, P<0.001), while no patients requested it in group 3 (P<0.001). The total analgesic consumption of IV nalbuphine was lower in group 2 (8.6±3.5mg, P=0.04) than group 1 (11.3±2.1 mg), with a significant difference between group 2 and 3 (P<0.001). From the 8th till the 24th hours postoperatively, patients in group 3 showed the significantly lowest median VAS scores, followed by patients in group 2 (P<0.001) and lastly patients in group 1. There were no significant adverse effects. CONCLUSIONS: Dexamethasone and fentanyl combination enhances the analgesic effect of bupivacaine in TPVB.

Differential diagnostic features between congenital haemangioma, KHE, and congenital fibrosarcoma: a single-centre experience.

Congenital haemangioma (CH) is a rare benign vascular tumour presenting at birth with excellent prognosis. Usually, CH regresses without treatment within the first few months of life. Kaposiform Haemangioendothelioma (KHE) is another type of vascular tumours that has been described as benign with locally aggressive potential. Although the diagnosis of vascular tumours is usually straightforward based on typical clinical presentation, yet some confusing similarities may exist with congenital sarcomas.Conclusion: Data of cases managed at the vascular anomaly clinic during the period 2015 through 2019 were retrospectively analysed. The study included three groups of patients: cases diagnosed as congenital haemangioma (9 cases), cases of Kaposiform Haemangioendothelioma who presented in the neonatal period (7 cases), as well as cases of congenital fibrosarcoma (4 cases) that were referred to the vascular anomaly clinic because of apparent similarity with vascular tumours. The hallmark of the study was to compare clinical and imaging features in the three groups to facilitate differentiation and remove diagnostic confusion when managing these rare cases in the future. What is Known: • Congenital haemangioma is a rare benign vascular tumour presenting at birth. • Kaposiform Haemangioendothelioma is another type of vascular tumours that has been described as benign with locally aggressive potential. What is New: • Confusing similarities may exist between vascular tumours and congenital sarcomas.

Studying the Effect of High Substrate Temperature on the Microstructure of Vacuum Evaporated TAPC: C60 Organic Solar Thin Films.

Organic solar cells (OSCs), also known as organic photovoltaics (OPVs), are an emerging solar cell technology composed of carbon-based, organic molecules, which convert energy from the sun into electricity. Key for their performance is the microstructure of the light-absorbing organic bulk heterojunction. To study this, organic solar films composed of both fullerene C60 as electron acceptor and different mole percentages of di-[4-(N,N-di-p-tolyl-amino)-phenyl]-cyclohexane (TAPC) as electron donor were evaporated in vacuum in different mixing ratios (5, 50 and 95 mol%) on an ITO-coated glass substrate held at room temperature and at 110 °C. The microstructure of the C60: TAPC heterojunction was studied by grazing incidence wide angle X-ray scattering to understand the effect of substrate heating. By increasing the substrate temperature from ambient to 110 °C, it was found that no significant change was observed in the crystal size for the C60: TAPC concentrations investigated in this study. In addition to the variation done in the substrate temperature, the variation of the mole percent of the donor (TAPC) was studied to conclude the effect of both the substrate temperature and the donor concentration on the microstructure of the OSC films. Bragg peaks were attributed to C60 in the pure C60 sample and in the blend with low donor mole percentage (5%), but the C60 peaks became nondiscernible when the donor mole percentage was increased to 50% and above, showing that TAPC interrupted the formation of C60 crystals.

Wallop of Symptoms and Co-morbidities on COVID-19 Outcome.

BACKGROUND: Fever, cough, fatigue, and myalgia are usually the original clinical picture of the COVID-19 pandemic, which appears non-specific and not exclusive. OBJECTIVES: To illustrate the clinical picture pattern and assess the prevalence of underlying co-morbidities and their correlation with the severity of COVID-19 infected patients. METHODS: A cross-sectional online survey included 580 participants who were either suspected or confirmed with COVID-19 infection. RESULTS: The severity of the disease significantly correlates with both age (p=.01) and the time lag of the diagnosis of COVID-19 (p=.03). Hypertension (p=.015) and diabetes mellitus (p<.01) were significantly associated with the duration of symptoms. A wide range of ages (21-60 years) seemed to be the only risk factor for the severity. When symptoms were tested, dyspnea appeared to be the most prevalent symptom, predicting a more severe disease (OR= .066, 95% CI: .022- .200), followed by diarrhea (OR= .285, 95% CI: .122-.663), then fever (OR= .339, 95% CI: .139-.824). During the examination of co-morbidities influences on the severity, the only major co-morbidity that predicted a more severe disease was IHD (OR= .218, 95% CI: .073- .648), p= .006. CONCLUSION: Special consideration is required for patients with COVID-19 with an associated longer gap between symptoms and diagnosis and associated co-morbidities including hypertension, diabetes, and established chronic kidney disease (CKD), for which this study proved its profound influence on the severity of the illness and duration of symptoms.