Community experience and awareness regarding foreign body aspiration in Asir region, Kingdom of Saudi Arabia.

Foreign body aspiration (FBA) is a serious preventable pediatric health problem and one of the main causes of accidental death in children. Although unusual in adults, it is often overlooked as a cause of airway obstruction with serious consequences. This study assessed awareness and previous FBA experiences in the Asir community, Kingdom of Saudi Arabia. Using validated questionnaire, an annonymous online survey was conducted among 870 people aged 18 years and above. The questionnaire was used to collect data about the personal and sociodemographic characteristics of the respondents, as well as their experiences with FBA, and participants' knowledge and perceived seriousness of FBA. The level of knowledge was deemed good if the score ranged between 60% and 100%, and bad if the score fell below 60%The level of knowledge was deemed good if the score ranged between 60% and 100%, and bad if the score fell below 60%. The majority of the participants (79.7%) were females, 48.1% were aged 18 to 30 years, 72.9% had university degree, 30.6% were students, 26.9% worked in the educational sector, 43.6% reported monthly income of <5000 Saudi Riyals and 19.8% of them identified themselves as healthcarepractitioners. Although the community experience with FBA was considerably high (70.6%) among the study participants, their awareness levels about FBA were deficient. Only 24.7% of the respondents had good knowledge of FBA. Older age, being a health practitioner, and perceiving FBA as a serious incident were significantly associated with good knowledge (P < .001). The findings of this study indicate an urgent need to raise community awareness of FBA. To reduce FBA morbidity and mortality, health education efforts in community and healthcare settings are required to educate people about the seriousness and importance of early diagnosis and management of the condition.

Total Hip Arthroplasty Complications in Sickle Cell Disease: Systematic Review and Meta-Analysis.

Background: Microvascular occlusions caused by sickle-shaped erythrocytes in patients with sickle cell disease (SCD) can lead to increased intraoperative and postoperative complications during total hip arthroplasty (THA). This systematic review and meta-analysis aimed to estimate the overall rate of complications following THA in patients with SCD and to identify the predictors of these complications including the surgical approach. Methods: The search was conducted across the grey literature, Google Scholar, and seven databases: Scopus, MEDLINE Central/PubMed, ProQuest, SciELO, SAGE, and Web of Science. All observational studies reporting the proportional THA complications in SCD were included. The Newcastle-Ottawa Scale quality assessment tool was used to assess the quality of the studies. The random effect model was applied to estimate the pooled outcomes. A sub-group analysis for the different approaches was performed. A sensitivity analysis and meta-regression were used to explain heterogeneity and to identify the THA complication predictors. Results: Of 3230 citations, only 23 studies were eligible for the meta-analysis. The pooled proportion of total primary THA complications in patients with SCD was 42% (95% CI: 30-56%, I2 = 95%). The sub-group analysis highlighted the anterolateral approach as the approach accompanied with the least complications. The meta-regression revealed that the anterolateral approach decreases the complications significantly, -28.67 (95%CI, -56.45--0.88, p = 0.044), while the number of hips increased the complications by 0.43 (95%CI, 0.30-0.57, p < 0.001). Male gender, age, lateral approach, and HbSS non-significantly affect the THA complications in SCD 52.05, 0.18, 6.06, and 55.78, respectively. The pooled proportions for an SCD crisis 9% (95%CI, 5-14%, I2 = 61%), dislocation 4% (95%CI: 2-7%, I2 = 66%), aseptic loosening 12% (95%CI, 7-20%, I2 = 91%), revision 6% (3-11, I2 = 92%), heterotopic ossification 12% (95%CI, 3-35%, I2 = 95%), and prosthetic joint infection (PJI) 6% (95%CI, 3-11%, I2 = 92%). The most fitted model of meta-regression illustrated that HbSS significantly increases PJI, 0.05 (95%CI: 0.02-0.08, p = 0.009), and male gender and age non-significantly increase PJI, 2.28 (95%CI: -4.99-13.56, p = 0.311) and 0.001 (95%CI: -0.27-0.27, p = 0.990), respectively. Meanwhile, the anterolateral, lateral, and posterior approaches non-significantly decrease PJI, -3.55, -0.92, and -1.27, respectively. The pooled proportion for a sickle cell disease crisis after revision was 16% (95%CI: 6-36%, I2 = 0) and for aseptic loosening after revision, it was 24% (95%CI: 12-43%, I2 = 0). Conclusions: This study revealed the high rate of complications in patients with SCD and highlighted that the anterolateral approach was associated with the lowest rate of complications. Furthermore, this study illustrated that homozygous (HbSS) individuals are more susceptible to prosthetic joint infection.

Clinical characteristics and outcomes of COVID-19 cases admitted to adult intensive care units during the pandemic: A single center experience.

BACKGROUND: COVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting. METHODS: A retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality. RESULTS: A total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs. CONCLUSIONS: COVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type.

Knowledge of Diabetes Mellitus and Practices Regarding Lifestyle Factors and Diabetes Management in a General Adult Population of Aseer Region, Saudi Arabia.

Introduction: Many studies report a lack of public awareness of the risk factors and complications of Diabetes Mellitus. Adequate glycemic control is crucial in preventing or delaying the onset of type 2 diabetes complications, and medication adherence is one of the key factors in achieving this goal. This study aimed to measure the knowledge about diabetes mellitus and practices regarding lifestyle factors and diabetes management in the study population in the Aseer region, of Saudi Arabia. Material and Methods: A descriptive cross-sectional survey was conducted in Abha, a city in the Aseer region of Saudi Arabia. The general population of 18 years of age and above, who were residing in the study area during the period of study, ie, January 2023 to June 2023, were included. The questionnaire was distributed through social media and e-mail for data collection. The descriptive variables were presented using frequency, percentage, and graphs. Pearson's chi-square test was used at a 5% level of significance. Multivariate tests were applied to further explore the findings of univariate analysis. The data were analyzed using SPSS version 20.0. Results: Out of the total 348 participants, a higher proportion was males (56.3%). About 78.7% of the participants were ever diagnosed with diabetes mellitus and 21.3% were never diagnosed with diabetes mellitus. Nearly 31.6% knew that the major cause of diabetes mellitus was obesity and 31.3% knew that it was a hereditary disease. About 42.2% of respondents exercised regularly and 27.6% were smokers. Adherence to prescribed anti-diabetic medications was seen in 63.2% of the respondents. Self-alterations in the timing and dose of prescribed anti-diabetic drugs were seen in 36.5% and 34.8%, respectively. About 60.1% had a moderate level of self-rated knowledge about Diabetes Mellitus, and 27.6% and 12.4% had good and poor self-rated knowledge levels of Diabetes mellitus, respectively. On multivariate analysis, the age group 60-69 years had significant variations as compared to the other age groups on DM, bachelor's degree holders had significant variations as compared to other education variables, being married had significant differences as compared to those unmarried, those employed had significant variations as compared to the other occupation categories, and smokers had a significant impact on DM as compared to non-smokers. Conclusion: Findings indicated less number of respondents exercised regularly, low adherence to prescribed anti-diabetic medications and low levels of self-rated knowledge of diabetes mellitus. Enhancing the patients' knowledge of diabetes mellitus and improving their self-management and adherence to its medications is necessary through public health education.

Tracking the epidemiological trends of female breast cancer in Saudi Arabia since 1990 and forecasting future statistics using global burden of disease data, time-series analysis.

BACKGROUND: Female breast cancer stands as the prime type of cancer in the Kingdom of Saudi Arabia (KSA), with a high incidence and mortality rates. This study assessed the burden of female breast cancer in KSA by analyzing and forecasting its incidence, mortality, and disability-adjusted life years (DALYs). METHODS: We retrieved data from the Global Burden of Disease (GBD) about female breast cancer from 1990 to 2021. Time-series analysis used the autoregressive integrated moving average (ARIMA) model to forecast female breast cancer statistics from 2022 to 2026. RESULTS: From 1990 to 2021, KSA reported 77,513 cases of female breast cancer. The age groups with the highest number of cases are 45-49 years, followed by 40-44 years, 50-54 years, and 35-39 years. The analysis also showed fewer cases in the younger age groups, with the lowest number in the less than 20-year-old age group. From 1990 to 2021, KSA reported 19,440 deaths due to breast cancer, increasing from 201 cases in 1990 to 1,190 cases in 2021. The age-standardized incidence rate/100,000 of breast cancer increased from 15.4 (95% confidence interval (CI) 11.2-21.0) in 1990 to 46.0 (95%CI 34.5-61.5) in 2021. The forecasted incidence rate of female breast cancer will be 46.5 (95%CI 45.8-46.5) in 2022 and 49.6 (95%CI 46.8-52.3) in 2026. The age-standardized death rate per 100,000 Saudi women with breast cancer increased from 6.73 (95%CI 6.73-9.03) in 1990 to 9.77 (95%CI 7.63-13.00) in 2021. The forecasted female breast cancer death rate will slightly decrease to 9.67 (95%CI 9.49-9.84) in 2022 and to 9.26 (95%CI 8.37-10.15) in 2026. DALYs increased from 229.2 (95%CI 165.7-313.6) in 1990 to 346.1 (95%CI 253.9-467.2) in 2021. The forecasted DALYs of female breast cancer will slightly decrease to 343.3 (95%CI 337.2-349.5) in 2022 reaching 332.1 (95%CI 301.2-363.1) in 2026. CONCLUSIONS: Female breast cancer is still a significant public health burden that challenges the health system in KSA, current policies and interventions should be fashioned to alleviate the disease morbidity and mortality and mitigate its future burden.

Comparison of the post-operative outcomes between different surgical techniques for inferior turbinate reduction surgery: A cross sectional study.

OBJECTIVES: To compare and measure post-operative outcomes among various surgical techniques for reducing inferior turbinate hypertrophy (ITH), and to identify the factors associated with the clinical outcomes of turbinoplasty in patients with this condition. METHODS: A cross-sectional study was carried out from January 2021 to December 2022 at the Otorhinolaryngology Department of King Abdulaziz Medical City in Riyadh, Saudi Arabia. A total of 301 adult patients with ITH were included and were divided into different groups. Postoperative follow-up assessments were completed after one week, one month, and 6 months to evaluate outcomes and complications associated with each surgical technique; descriptive analysis, cross-tabulation, and exact logistic regression were utilized as data analysis methods. RESULTS: Most patients in both groups experienced partial or complete improvement after surgery, with 92% showing positive outcomes. Common clinical signs included deviated nasal septum deviation and external nasal deformity, while nasal obstruction was most frequently reported as the primary symptom. Post-surgery bleeding occurred in 3.7% of cases; no adhesions were noted. Microdebrider, medial flap, out-fracture, and submucosal diathermy techniques all demonstrated significantly higher improvement rates than others. CONCLUSION: The identified techniques with higher improvement rates offer evidence-based guidance for selecting optimal surgical approaches, while the study's limitations warrant further prospective research to validate these findings. Ultimately, it contributes valuable knowledge to the field of otorhinolaryngology, aiming to enhance patient outcomes and improve the management of ITH worldwide.

Characterization and Antimicrobial Susceptibility Patterns of Enterococcus Species Isolated from Nosocomial Infections in a Saudi Tertiary Care Hospital over a Ten-Year Period (2012-2021).

INTRODUCTION: The Enterococcus genus is a common cause of nosocomial infections, with vancomycin-resistant enterococci (VRE) posing a significant treatment challenge. METHOD: This retrospective study, spanning ten years (2012 to 2021), analyzes antimicrobial susceptibility patterns of Enterococcus species from clinical samples in a Saudi Arabian tertiary care hospital. RESULT: A total of 1034 Enterococcus isolates were collected, 729 from general wards and 305 from intensive care unit (ICU) patients. VRE accounted for 15.9% of isolates. E. faecalis was the most common species (54.3% of isolates and 2.7% of VRE), followed by E. faecium (33.6% of isolates and 41.2% of VRE). E. faecium exhibited the highest resistance to ciprofloxacin (84.1%), ampicillin (81.6%), and rifampicin (80%), with daptomycin (0.6%) and linezolid (3.1%) showing the lowest resistance. In E. faecalis, ciprofloxacin resistance was highest (59.7%), followed by rifampicin (20.1%) and ampicillin (11.8%). Daptomycin (0%), linezolid (1.5%), and vancomycin (2.7%) had the lowest resistance. VRE cases had higher mortality rates compared to vancomycin-sensitive enterococci (VSE). CONCLUSION: Eight different strains of Enterocci were identified. E. faecalis was the most commonly identified strain, while E. faecium had the highest percentage of VRE. VRE cases had a significantly higher mortality rate than VSE cases.

Publications in Plastic Surgery and Reconstruction: A Review from a Developing Country, Sudan.

Background: Plastic and reconstructive surgery services need to be improved in developing African countries. Research and article publications from those countries are limited. This review was conducted to identify published articles from Sudan in the area of plastic and reconstructive surgery. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used for the preparation of this systematic review. A comprehensive systematic search was performed using PubMed, ScienceDirect, and Web of Science databases. Articles published in Sudan, specifically in the area of plastic and reconstructive surgery, and written in English were included in this review. Results: The total number of articles that fulfilled the inclusion criteria was 23. The articles were written from 1969 to 2023. Only two articles were published in the 20th century. The most common study type was a retrospective study of eight articles, and the most common study area was Khartoum Teaching Hospital. Regarding the publishing journals, the number of subscription journals was six (30%), whereas open access was 17 (70%). Conclusion: This review demonstrates the lack of articles published on plastic surgery in Sudan. Further investigation is needed to determine the challenges and problems associated with possible clarifications.

Exploring the burden of irritable bowel syndrome among university students in Saudi Arabia: A study on prevalence, psychological associations, and well-being.

Patients with irritable bowel syndrome (IBS) experience not only a detrimental impact on their physical health but also a significant influence on their psychological well-being. This study aimed to assess the prevalence of IBS among university students, investigating the sociodemographic and lifestyle factors influencing its onset. Furthermore, it explored the potential impact of psychological factors such as depression, anxiety, and overall well-being on the prevalence of IBS. A cross-sectional analytical study was conducted at Saudi Arabian universities in November and December 2023. To collect data, an anonymous, validated, predesigned questionnaire was used. The diagnosis of IBS was carried out using the validated Arabic version of the Rome IV questionnaire. We used the Arabic version of the World Health Organization Well-being Index to assess the participants' well-being. We used the Arabic version of the Hospital Anxiety and Depression Scale (HADS) to identify people who show clinically significant symptoms of anxiety and depression. Our study included a total of 379 university students, 46.7% were female 86.0% of participants resided in urban areas, and 7.2% had been previously diagnosed with IBS. The prevalence of IBS among participants was found to be 31.9%. We observed a significant association between marital status and IBS (χ2 = 3.95, P = .047). Furthermore, the highest prevalence of IBS was observed among students majoring in literary and scientific disciplines (χ2 = 0.952, P = .049). Individuals with IBS demonstrate a significantly higher prevalence of anxiety (71.90% vs 41.09%, P < .001) and depression (64.46% vs 42.64%, P < .001) compared to those without IBS. Furthermore, people with IBS had a slightly higher prevalence of poor well-being (38.84%) compared to those without IBS (33.72%), but this association was not statistically significant. In multivariate analysis, having a family history of IBS [OR = 1.75 (95% CI, 1.06-2.87), P = .029] having borderline anxiety [OR = 7.58, 95% CI (2.12-27.06), P = .012] and anxiety [OR = 16.07, 95% CI (4.57-56.52), P < .001], and depression [OR = 2.97, 95% CI (1.13-7.83), P = .010] were the main significant predictors of IBS among university students. The high prevalence of IBS among university students was associated with a family history of IBS as well as depression and anxiety. Increasing awareness, multidisciplinary support, and access to mental health services is required to ensure university students' well-being.

Degree of Hearing Improvement and Reduction of Air-Bone Gap After Tympanoplasty in a Tertiary Hospital in Saudi Arabia.

BACKGROUND:  A clinical condition known as chronic otitis media (COM) is characterized by tympanic membrane perforation, varying degrees of hearing loss, and otorrhea that lasts for two to six weeks. COM alone or with cholesteatoma may result in ossicular chain discontinuity and ossicular erosion. The hearing restoration procedure includes repairing the eardrum and building the ossicular chain in ears with damaged ossicles. Multiple studies suggest the predictive value of preoperative air-bone gap (ABG) to detect the ossicular chain status can help with proper preoperative planning for surgery. OBJECTIVE: To determine the degree of hearing improvement and reduction in ABG after tympanoplasty and to investigate the correlation between preoperative ABG and the status of the ossicular chain during surgery. Study design, setting, and date: This retrospective hospital file-based study was conducted at Aseer Central Hospital, Southern Region, Saudi Arabia, between November 2022 and April 2023. Hospital records of patients who underwent tympanoplasty during 2018-2023 were reviewed. Eighty-five patients were diagnosed with chronic suppurative otitis media (CSOM) between 2018 and 2023. A data collection sheet was employed to record extracted data, including the patient's age, sex, hearing assessment, type of surgical intervention, and outcome. We calculated the average of ABG decibels (dB) by summing the ABG values at 500 Hz, 1000 Hz, and 2000 Hz frequencies and dividing by three. RESULTS: In the present study, data from 85 patients who underwent tympanoplasty were analyzed. Approximately one-third of the patients were in the age group of 31 to 40 years (25, 29.4%), and 50 (58.8%) of them were females. Chronic medical conditions were observed in 30 (35.3%) patients, with diabetes being reported in 19 (63.3%) of those cases. CSOM was found to be present in the left ear of 47 (56.0%) patients. Among the patients, 25 (29.4%) had subtotal perforations, 12 (14.1%) had marginal perforations, and two (2.4%) had total tympanic membrane perforations. The majority of patients (67, 78.8%) exhibited conductive hearing loss, while the remaining 18 (21.2%) had mixed hearing loss. Of the patients, 13 (15.3%) and 20 (23.5%) had fixed and disrupted ossicular chains, respectively. In terms of ossicular disruption, incudostapedial joint (ISJ) fixing (21.2%), fixed stapes (18.2%), and ISJ dislocation (18.2%) were the most prevalent kinds. Prior to operations, the mean ± SD of ABG was 22.6 ± 7.5. ABG values were 19.0 ± 9.3 on average after surgery. The statistical difference between pre- and postoperative ABG was statistically significant (paired t-test, p = 0.007), with a mean difference of -3.7. There were no significant differences between the different statuses of ossicular chains and the type of tympanic membrane perforation. CONCLUSION: This study suggests that the degree of preoperative ABG (dB) is a valuable predictor of intraoperative ossicular chain status and can aid in preoperative planning for ossicular chain reconstruction. Furthermore, the study found that the type of tympanic membrane perforation preoperatively is not a reliable indicator of the ossicular chain status. Finally, tympanoplasty is considered a beneficial surgical procedure with a significant improvement in hearing status postoperatively.

The Predictors and Risk Factors of 2-Year Rejection in Renal Transplant Patients: A Multicenter Case-Control Study.

INTRODUCTION: Kidney transplantation is a definitive treatment for end-stage renal disease. It is associated with improved life expectancy and quality of life. One of the most common complications following kidney transplantation is graft rejection. To our knowledge, no previous study has identified rejection risk factors in kidney transplant recipients in Saudi Arabia. Therefore, this study aimed to determine the specific risk factors of graft rejection. METHODS: A multicenter case-control study was conducted at four transplant centers in Saudi Arabia. All adult patients who underwent a renal transplant between January 1, 2015 and December 31, 2021 were screened for eligibility. Included patients were categorized into two groups (cases and control) based on the occurrence of biopsy-proven rejection within 2 years. The primary outcome was to determine the risk factors for rejection within the 2 years of transplant. Exact matching was utilized using a 1:4 ratio based on patients' age, gender, and transplant year. RESULTS: Out of 1,320 screened renal transplant recipients, 816 patients were included. The overall prevalence of 2-year rejection was 13.9%. In bivariate analysis, deceased donor status, the presence of donor-specific antibody (DSA), intraoperative hypotension, Pseudomonas aeruginosa, Candida, and any infection within 2 years were linked with an increased risk of 2-year rejection. However, in the logistic regression analysis, the presence of DSA was identified as a significant risk for 2-year rejection (adjusted OR: 2.68; 95% CI: 1.10, 6.49, p = 0.03). Furthermore, blood infection, infected with Pseudomonas aeruginosa or BK virus within 2 years of transplant, were associated with higher odds of 2-year rejection (adjusted OR: 3.10; 95% CI: 1.48, 6.48, p = 0.003, adjusted OR: 3.23; 95% CI: 0.87, 11.97, p = 0.08 and adjusted OR: 2.76; 95% CI: 0.89, 8.48, p = 0.07, respectively). CONCLUSION: Our findings emphasize the need for appropriate prevention and management of infections following kidney transplantation to avoid more serious problems, such as rejection, which could significantly raise the likelihood of allograft failure and probably death. Further studies with larger sample sizes are needed to investigate the impact of serum chloride levels prior to transplant and intraoperative hypotension on the risk of graft rejection and failure.

Postoperative Patient Pain Severity and Its Association With Anxiety, Depression, and Sleep Quality.

Introduction The experience of pain is a complex phenomenon. A patient in the acute postsurgical pain setting may feel a constant bombardment of nociceptive input from the surgical site; this in turn influences psychological factors that determine the overall emotional experience of pain, which is significant. The aim of our study was to investigate the severity of pain in postsurgical patients three days after surgery using the 100 mm visual analog scale (VAS). Methods This was a cross-sectional assessment of postoperative pain. Participants were patients between 18 and 64 years of age who had undergone a surgical procedure (laparoscopic or open surgery), three days prior to the data collection and who were admitted or discharged postoperatively at the Al Salmaniya Complex, Manama, Bahrain. Participants were asked demographic questions about whether they had laparoscopic or open surgeries and completed self-reporting scales. Patient Health Questionnaire-9 (PHQ-9) was utilized to screen for both the presence and severity of depression; Generalized Anxiety Disorder 7-item (GAD-7) was administered to screen for anxiety; the Insomnia Severity Index (ISI) was used to evaluate insomnia; and the VAS was used to evaluate pain.  Results Sixty-seven patients were recruited, with a mean age of 61.53 years (SD = 7.37). Twenty-nine (43%) were females, 38 (57%) were males, 36 (54%) underwent elective surgery, 31 (46%) underwent emergency surgery, 31 (46%) underwent laparoscopic surgery, and 36 (54%) underwent open surgery. The average score on the Brief Pain Inventory Short Form (BPISF) was 8.12 (SD = 1.16), indicating a moderate level of pain. Twenty-six (43%) patients had moderate-severe insomnia, 21 participants (31%) had no insomnia, 17 participants (25%) had subthreshold insomnia, 28 (42%) had moderate depression, five (7%) had moderate-severe depression, and 34 (51%) had severe depression. Eighteen participants (27%) had mild anxiety, 46 (69%) had moderate anxiety, and 3 (4%) had severe anxiety. Six of the participants (9%) reported moderate pain, while 61 participants (91%) reported severe pain.

Retraction: Isolated Polycystic Liver Disease: A Rare Genetic Disorder.

[This retracts the article DOI: 10.7759/cureus.18560.].

The analysis of a new fractional model to the Zika virus infection with mutant.

We present a new mathematical model to analyze the dynamics of the Zika virus (ZV) disease with the mutant under the real confirmed cases in Colombia. We give the formulation of the model initially in integer order derivative and then extend it to a fractional order system in the sense of the Mittag-Leffler kernel. We study the properties of the model in the Mittag-Leffler kernel and establish the result. The basic reproduction of the fractional system is computed. The equilibrium points of the Zika virus model are obtained and found that the endemic equilibria exist when the threshold is greater than unity. Further, we show that the model does not possess the backward bifurcation phenomenon. The numerical procedure to solve the problem using the Atangana-Baleanu derivative is shown using the newly established numerical scheme. We consider the real cases of the Zika virus in Colombia outbreak are considered and simulate the model using the nonlinear least square curve fit and computed the basic reproduction number R0=0.4942, whereas in previous work (Alzahrani et al., 2021) [1], the authors computed the basic reproduction number R0=0.5447. This is due to the fact that our work in the present paper provides better fitting to the data when using the fractional order model, and indeed the result regarding the data fitting using the fractional model is better than integer order model. We give a sensitivity analysis of the parameters involved in the basic reproduction number and show them graphically. The results obtained through the present numerical method converge to its equilibrium for the fractional order, indicating the proposed scheme's reliability.

Impacts of sugarcane industrial effluent as an alternate source of irrigation on growth, chlorophyll contents and antioxidants of different canola varieties.

The sugarcane industry often utilizes effluent for irrigation purposes; however, its intricate composition and elevated metal contaminants pose a potential risk of soil and crop contamination. Consequently, it is imperative to employ effective strategies to ensure the safe utilization of this resource for crop cultivation. One such strategy involves the dilution of sugarcane industry effluent. Dilution is a practical approach to mitigate its toxicity, minimizing its adverse impact on soil and crop health. That's why the current study explored the best dilution of sugarcane industrial effluent (SW) for cultivating canola varieties. A total of 15 canola varieties were cultivated 0%, 20%, 40%, 60%, 80%, and 100% SW. Results showed that 60% SW Faisalabad Canola and Punjab Canola improved germination, shoot length, root length, shoot fresh and dry weight, root fresh and dry weight, and chlorophyll contents compared to other treatments and control. AARI Canola and CON-III showed poor growth and chlorophyll contents under 60%SW. Dunkled and Oscar cultivars showed moderate improvement in growth and chlorophyll contents under 60SW. The 60% SW can be recommended for maximum growth benefits in canola cultivars, specifically Faisalabad Canola and Punjab Canola. At 20SW, the root dry weight of Faisalabad Canola increased by 2.7%, while Punjab Canola increased by 3.4%. Canola showed the highest increase in POD activity compared to the control, with a 55.45% increase, followed by Sandal Canola, with a 43.26% increase. However, additional field-level experiments are needed to determine the best cultivars suitable for optimal growth under 80SW and 60SW irrigation conditions.

Polyphenol Fingerprint, Biological Activities, and In Silico Studies of the Medicinal Plant Cistus parviflorus L. Extract.

Cistus parviflorus L. (Cistaceae) is a medicinal plant with several folkloric applications, including being used for urinary tract infections and as a food additive. In this study, the polyphenolic diversity and the antioxidant, antidiabetic, and antimicrobial activities of the C. parviflorus methanolic extract were evaluated. Spectrophotometric and HPLC-based analyses using standard polyphenolic compounds were conducted to measure the phenolics and flavonoids in the plant extract. The in vitro DPPH, ORAC, FRAP, and α-glucosidase assays were used to evaluate the plant's antioxidant and antidiabetic activities. Furthermore, disc diffusion and MIC-based microdilution tests were applied to evaluate the antimicrobial activity of the plant against broad-spectrum microorganisms. The analysis revealed the existence of high phenolic and flavonoid quantities that were measured at 302.59 ± 0.6 µg GAE and 134.3 ± 0.5 µg RE, respectively. The HPLC-based analysis revealed the existence of 18 phenolic acids and 8 flavonoids. The major phenolic acid was ellagic acid (169.03 ppm), while catechin was the major flavonoid (91.80 ppm). Remarkable antioxidant activity was measured using three different assays: DPPH, ORAC, and FRAP. Furthermore, strong inhibition of α-glucosidase compared to acarbose was recorded for the plant extract (IC50 0.924 ± 0.6). The results showed that C. parviflorus's extract had a strong anti-Escherichia coli effect with MIC value of 0.98 µg\mL and IZD value of 32.2 ± 0.58 mm compared to 25.3 ± 0.18 mm for gentamycin, the positive control. Moreover, Aspergillus niger, Aspergillus fumigatus, Staphylococcus aureus, Streptococcus pyogenes, and Salmonella typhimurium all showed significant growth inhibition in response to the extract, a result that may be related to the use of the plant in traditional medicine to treat urinary tract infections. The docking study indicated the higher binding affinity of the major identified compounds, i.e., ellagic acid, rutin, naringin, catechin, and punicalagin, to the S. aureus gyrase-DNA complex, which might suggest the possible mechanisms of the plant as antimicrobial agents.

Foreign Body in the Nasal Cavity: A Case Report.

We present a case of a pediatric patient who presented to the emergency room with acute nasal discharge, foul smell, and nasal pain. The patient's mother witnessed her inserting a foreign body into the nasal passage. After thorough examination and diagnostic imaging, a metallic necklace bead was identified as the foreign body lodged in the nasal cavity. The patient was promptly prepared for emergency operating room intervention. The metallic foreign body was successfully extracted without complications using endoscopic equipment and careful manipulation. The patient recovered well, was admitted for one day for observation and supportive care, and was discharged home in excellent condition. Follow-up in the clinic revealed a satisfied patient with no complaints, no septal perforation, and a patent airway.

The Effectiveness of Prehospital Administration of Tranexamic Acid in Reducing Mortality in Trauma Patients: An Overview.

Tranexamic acid (TXA) is an antifibrinolytic drug that reduces bleeding by inhibiting plasminogen activation and fibrin clot degradation. Its role in prehospital trauma management remains unclear. This article aims to systematically review the current evidence on the effect of prehospital TXA administration on mortality in adult and pediatric trauma patients. A literature search was conducted of PubMed, Web of Science, Scopus, and Cochrane databases from March 2023 to August 2023 for studies evaluating the impact of prehospital TXA use on trauma mortality. Inclusion criteria were articles published in the English language in the past 20 years focusing on clinical outcomes of prehospital TXA administration. Data on all-cause mortality, thromboembolic events, and time to TXA administration were extracted. In adult trauma, prehospital TXA appears to reduce early all-cause mortality when given within three hours of injury without increasing thromboembolic risks. Some studies found decreased delayed mortality, while others found no difference. In pediatric trauma, preliminary evidence suggests TXA may lower in-hospital mortality in hemodynamically unstable patients, though higher doses may increase seizure risk. Early prehospital administration of TXA within three hours of adult trauma may reduce mortality through improved hemorrhage control. Potential benefits in pediatric trauma warrant further investigation, balancing efficacy against safety risks such as seizures from high doses. Well-designed randomized trials are needed to validate optimal TXA dosing strategies across age groups and injury severity levels.