LRRK2 kinase inhibition protects against Parkinson's disease-associated environmental toxicants.

Idiopathic Parkinson's disease (PD) is epidemiologically linked with exposure to toxicants such as pesticides and solvents, which comprise a wide array of chemicals that pollute our environment. While most are structurally distinct, a common cellular target for their toxicity is mitochondrial dysfunction, a key pathological trigger involved in the selective vulnerability of dopaminergic neurons. We and others have shown that environmental mitochondrial toxicants such as the pesticides rotenone and paraquat, and the organic solvent trichloroethylene (TCE) appear to be influenced by the protein LRRK2, a genetic risk factor for PD. As LRRK2 mediates vesicular trafficking and influences endolysosomal function, we postulated that LRRK2 kinase activity may inhibit the autophagic removal of toxicant damaged mitochondria, resulting in elevated oxidative stress. Conversely, we suspected that inhibition of LRRK2, which has been shown to be protective against dopaminergic neurodegeneration caused by mitochondrial toxicants, would reduce the intracellular production of reactive oxygen species (ROS) and prevent mitochondrial toxicity from inducing cell death. To do this, we tested in vitro if genetic or pharmacologic inhibition of LRRK2 (MLi2) protected against ROS caused by four toxicants associated with PD risk - rotenone, paraquat, TCE, and tetrachloroethylene (PERC). In parallel, we assessed if LRRK2 inhibition with MLi2 could protect against TCE-induced toxicity in vivo, in a follow up study from our observation that TCE elevated LRRK2 kinase activity in the nigrostriatal tract of rats prior to dopaminergic neurodegeneration. We found that LRRK2 inhibition blocked toxicant-induced ROS and promoted mitophagy in vitro, and protected against dopaminergic neurodegeneration, neuroinflammation, and mitochondrial damage caused by TCE in vivo. We also found that cells with the LRRK2 G2019S mutation displayed exacerbated levels of toxicant induced ROS, but this was ameliorated by LRRK2 inhibition with MLi2. Collectively, these data support a role for LRRK2 in toxicant-induced mitochondrial dysfunction linked to PD risk through oxidative stress and the autophagic removal of damaged mitochondria.

The Use of CRISPR-Cas9 Genetic Technology in Cardiovascular Disease: A Comprehensive Review of Current Progress and Future Prospective.

Over the last century, there have been major landmark developments in the field of medicine, enabling us to control and cure various diseases on a larger scale. A few of these include the discovery of antibiotics, the development of vaccines, and the origin of organ and tissue transplants. The continued quest for innovation in microbiology and medicine has helped humankind save millions of lives and decrease morbidity at the global level. Genetic medicine has grown significantly in the last two decades and appears to be the next frontier of curative therapies for chronic diseases. One important landmark in genetic medicine is the development of CRISPR (clustered, regularly interspaced short palindromic repeats) technology. In this article, we describe the basic structure and function of the CRISPR-Cas9 system, which, simply put, consists of an RNA part and a protein. It works as a molecular scissor that can perform targeted cuts followed by repairs in and around the genes of interest to attain favorable translational outcomes. We focused on summarizing recent studies using CRISPR-Cas9 technology in diagnosing and treating cardiovascular disease. These studies are primarily experimental and limited to animal models. However, their results are promising enough to anticipate that this technology will undoubtedly be available in clinical medicine in the coming years. CRISPR-Cas9-mediated gene editing has been used to study and potentially treat congenital heart disease, hyperlipidemias, arrhythmogenic cardiomyopathies, and the prevention of ischemia-reperfusion injury. Despite the current progress, we recognize the several challenges this technology faces, including funding for research, improving precision and reproducible results for human subjects, and establishing protocols for ethical compliance so that it is acceptable to the scientific community and the general public.

Investigating the Role of FABP4 in Diabetes and Obesity and the Influence of Age and Ethnicity: A Comprehensive Analysis of a Cohort from the KEDP-Study.

Adipocyte P2 (aP2), also known as FABP4, is an adipokine that adipose tissue produces and expresses in macrophages. Its primary role is to facilitate the transportation of fatty acids across cell membranes. Numerous studies have reported associations between FABP4 and the development of metabolic disorders. However, there is limited knowledge regarding FABP4 expression in diabetes and obesity, especially about different age groups, genders, and ethnicities. This study aims to investigate the association between FABP4 levels, diabetes mellitus, and obesity within various ethnic groups. We measured plasma FABP4 concentrations in a cohort of 2083 patients from the KDEP study and gathered anthropometric data. Additionally, we collected and analyzed clinical, biochemical, and glycemic markers using multivariate regression analysis. The average FABP4 concentration was significantly higher in female participants than in males (18.8 ng/mL vs. 14.4 ng/mL, p < 0.001, respectively), and in those over 50 years old compared to those under 50 years of age (19.3 ng/mL vs. 16.2 ng/mL, p < 0.001, respectively). In this study, significant positive associations were found between the plasma level of FABP4 and obesity markers: BMI (r = 0.496, p < 0.001), hip circumference (r = 0.463, p < 0.001), and waist circumference (WC) (r = 0.436, p < 0.001). Similar observations were also seen with glycemic markers, which included HbA1c (r = 0.126, p < 0.001), fasting blood glucose (FBG) (r = 0.184, p < 0.001), fasting insulin (r = 0.326, p < 0.001), and HOMA-IR (r = 0.333, p < 0.001). Importantly, these associations remained significant even after adjusting for age, gender, and ethnicity. Furthermore, FABP4 levels were negatively associated with male gender (ß: -3.85, 95% CI: -4.92, -2.77, p < 0.001), and positively associated with age (ß: 0.14, 95% CI: 0.096, 0.183, p < 0.001), BMI (ß: 0.74, 95% CI: 0.644, 0.836, p < 0.001), and fasting insulin (ß: 0.115, 95% CI: 0.091, 0.138, p < 0.001). In this study, plasma FABP4 levels were significantly higher in diabetic and obese participants, and they were strongly influenced by age, gender, and ethnicity. These findings suggest that FABP4 may serve as a valuable prognostic and diagnostic marker for obesity and diabetes, particularly among female patients, individuals over 50 years old, and specific ethnic groups.

Prevalence, factors associated and management of needle phobia among the general population in Saudi Arabia and Egypt.

OBJECTIVE: This study aims to assess the prevalence of needle phobia among Saudi and Egyptian adult populations. In addition, underlying causes and strategies that can be utilized to address needle fear were investigated. METHODS: A cross-sectional online survey study was conducted in Saudi Arabia and Egypt between 1 May and 30 June 2023. Participants aged 18 years and above and living in Saudi Arabia and Egypt were eligible to complete the survey. Participants were invited to participate in this study through social media platforms (Facebook, X, Snapchat, and Instagram). A convenience sampling technique was used to recruit the study participants. A 21-item questionnaire consisting of four sections including a Likert scale score was used to answer the research objectives. Numeric data were presented as mean ± SD. For categorical variables, percentages were used. Comparison between groups were made by Student's t-test or Mann Whitney test according to data distribution. Chi squared tests for categorical values were conducted. A binary logistic regression analysis was conducted to investigate factors associated with needle phobia. RESULTS: A total of 4065 participants were involved in this study (Saudi Arabia: 2628 and Egypt: 1437). Around one-third of the study participants (36.5%) confirmed that they have needle phobia. Most of the study participants (81.1%) reported that they have had needle phobia since they were under 18 years of age. Pain, general anxiety, and fear of making a mistake during the procedure were the most commonly reported contributors for fear of needles during or before a medical procedure. Around 15.8% of the study participants reported that they have tried to get rid of phobia from needles. Non-surgical alternatives (such as oral medications and patches) and using smaller/thinner needles were the most commonly reported interventions that reduced fear of needles. Binary logistic regression analysis identified that females, those who are aged (41-50 years), widowed, those with bachelor's degrees and higher education, and those unemployed were more likely to have needle phobia compared to others. CONCLUSION: Our study highlighted the high prevalence of needle fear within an adult population in Egypt and Saudi Arabia. Females, those who are aged (41-50 years), those widowed, those with higher education degrees, those unemployed, those working in the health sector and people with low income were more likely to have needle phobia compared to others.

The Impact of Recurrent Epistaxis on the Quality of Life of Children and the Functioning of Their Families.

Introduction Epistaxis, or nosebleeds, is a common pediatric emergency, impacting their quality of life (QoL). Existing research on epistaxis has predominantly focused on clinical aspects, overlooking its broader impact on the quality of life of affected children and the functioning of their families. This study seeks to fill that gap by assessing the impact of recurrent epistaxis on children's QoL, family dynamics, and parental stress in Saudi Arabia's Eastern region. Methods A survey was conducted involving 168 parents of children with recurrent epistaxis, using the Pediatric Quality of Life InventoryTM (PedsQL 4.0TM) Short Form (SF) for QoL assessment across different age groups, the PedsQL 2.0 Family Impact Module to evaluate the effect of the child's health on family dynamics, and a custom questionnaire for gathering sociodemographic and health-related information. Better QoL and family functioning were indicated by higher scores. Results Recurrent epistaxis was more frequent (>4 times per year) in 58.9% of cases, with unknown causes in 72%. A total of 116 (69%) of the children never needed medical intervention for epistaxis and 52 (31%) visited ER 1-2 times. The lowest scores for both children and parents were in the emotional functioning domains (77.9 and 78.2, respectively). In the study, both parents and children who had no history of ER visits exhibited significantly higher quality of life (QoL) scores compared to those who did, with parents reporting 83.7% versus 77.2% (P=.022), and children showing 84.6% versus 79.9% (P=.049), respectively. Parents of older children, ages 13-18 years, reported a higher Quality of Life (QoL) at 83.9%, compared to those with younger children, ages 2-4 years, who reported a QoL of 57.3% (P=.003). Conclusion The overall QoL scores of families of children with recurrent epistaxis were relatively high, indicating a variable and limited general impact. Significantly higher QoL was observed in families of older children and those without ER visits.

The Prevalence and Predictors of Atherosclerotic Coronary Artery Disease in Rheumatic and Non-rheumatic Valvular Heart Disease Patients.

OBJECTIVES: The paradox of concurrent coronary artery disease (CAD) among patients with rheumatic and non-rheumatic valvular heart disease (RVHD; non-RVHD) is unclear. We aimed to evaluate the impact of the RVHD and non-RVHD on the prevalence of CAD and various risk factors, assess the number of diseased coronaries, clinical profile and the possible predictors of CAD in these patients, which may clarify the paradox and provide an insight for the prevention of CAD. METHODS: The records of 106 valvular heart disease patients who had undergone valve replacement surgery at the King Faisal Cardiac Centre from January 2014 to October 2019 were evaluated. The clinical data and established risk factors were compared and logistic regression analyses were performed to identify plausible predictors of CAD. RESULTS: Transthoracic echocardiographic diagnosis of 106 patients confirmed, 43 had RVHD (56.4 ± 8 years), of whom six (13.9%) had CAD with the highest mitral valve regurgitation (p < 0.01), and 63 had non-RVHD (60.0 ± 12 years). Of these, 31 patients showed the highest CAD (49.2%). Single- and triple-vessel disease was most common in RVHD and non-RVHD patients with concurrent CAD (33.3%; 41.9%, respectively), while non-RVHD patients also had quadruple vessel disease. The mean age of the RVHD and non-RVHD patients with coexisting CAD was significantly higher (66.7 ± 5; 66.7 ± 8 years) than those without CAD (46.1 ± 12.0; 54.7 ± 20, respectively). RVHD patients showed a significantly lower prevalence of diabetes, dyslipidaemia, hypertension, inflammatory cells, hepatorenal function markers, ejection fraction, and regional wall motion abnormality compared to RVHD patients with coexisting CAD (p < 0.01). Bivariate analysis indicated white blood cells, monocytes, neutrophils, gamma-glutamyl-transferase (GGT), bilirubin and blood urea nitrogen (BUN) to be significantly lower in RVHD patients. Predictors of high risk of CAD were BUN and hyperlipidaemia for RVHD and BUN, creatinine and GGT for non-RVHD patients. CONCLUSIONS: The prevalence of CAD in Saudi RVHD patients was significantly lower than in the Western countries, whereas non-RVHD was higher. The low prevalence may partly be attributed to age, reduced mitral regurgitation, and low frequency of risk and inflammatory factors.

Subtemporal Approach for the Treatment of Ruptured and Unruptured Distal Basilar Artery Aneurysms: Is There a Contemporary Use?

BACKGROUND AND OBJECTIVES: Distal basilar artery aneurysms (DBAs) are high-risk lesions for which endovascular treatment is preferred because of their deep location, yet indications for open clipping nonetheless remain. The subtemporal approach allows for early proximal control and direct visualization of critical posterior perforating arteries, especially for posterior-projecting aneurysms. Our objective was to describe our clinical experience with the subtemporal approach for clipping DBAs in the evolving endovascular era. METHODS: This was a retrospective, single-institution case series of patients with DBAs treated with microsurgery over a 21-year period (2002-2023). Demographic, clinical, and surgical data were collected for analysis. RESULTS: Twenty-seven patients underwent clipping of 11 ruptured and 16 unruptured DBAs with a subtemporal approach (24 female; mean age 53 years). Ten patients had expanded craniotomies for treatment of additional aneurysms. The aneurysm occlusion rate was 100%. Good neurological outcomes as defined by the modified Rankin Scale score ≤2 and Glasgow Outcome Scale score ≥4 were achieved in 21/27 patients (78%). Two patients died before hospital discharge, one from vasospasm-induced strokes and another from an intraoperative myocardial infarction. CONCLUSION: These results demonstrate that microsurgical clip ligation of DBAs using the subtemporal approach remains a viable option for complex lesions not amenable to endovascular management.

The Prevalence of Shoulder Pain and Awareness of Frozen Shoulder Among the General Population in Taif City, Saudi Arabia.

Background The global prevalence of shoulder pain varies widely across countries. Additionally, shoulder pain and frozen shoulder can significantly affect patients' quality of life due to high levels of pain and disability. Objective This study aimed to investigate the prevalence of shoulder pain and its risk factors. It also aims to assess the level of knowledge regarding frozen shoulders and its related factors in Taif City, Saudi Arabia. Methods A cross-sectional observational study was conducted in Taif City in December 2023 using a validated questionnaire comprised of socio-demographic characteristics, the prevalence of shoulder pain, and the awareness of frozen shoulders. Results A total of 378 participants enrolled in the study, with 54.8% being male and 62.7% being graduates and having jobs equally distributed among office (24.9%) and in the field (24.9%). Most participants were smokers (75.9%) and did not engage in body-building activities (79.6%). Around 26.5% of them had diabetes. The prevalence of shoulder pain was 32.8%. Aging from 35 to 44 years (p<0.001), having a higher salary from 6000 to 10000 SAR (p<0.001), retirement (p<0.001), engaging in body-building activities (p=0.035), having diabetes (p<0.001), and having other comorbidities (p<0.001) are significantly impacted having shoulder pain. Increased knowledge about the frozen shoulder is correlated with aging from 25-34 (p=0.026), smoking (p=0.002), engaging in bodybuilding (p<0.001), having diabetes (p=0.010), and having other medical conditions (p=0.010). Conclusion The study has shown that shoulder pain is prevalent among Taif City's population. Nevertheless, a low level of knowledge was observed. Therefore, enhancing the national educational programs is needed to increase public awareness of frozen shoulders.

Awareness and Attitude Regarding Contact Lens Use Among Female Students at the University of Bisha: A Cross-Sectional Study.

INTRODUCTION: Given the growing popularity of contact lenses among female students in Saudi Arabia for various reasons including vision correction as well as aesthetic and therapeutic purposes, it is essential to understand the knowledge about them, their uses, and how to handle them, given their significance in healthcare. METHODS: A cross-sectional study design was utilized in this research, employing data from a sample of 413 female students at the University of Bisha. The participants completed a self-administered questionnaire and were ensured anonymity. RESULTS: The study results showed that 52.9% (n=218) had a good knowledge level while 47.1% (n=195) had poor knowledge about contact lenses use. The results established a statistically significant association between region, faculty, and study year (p<0.005) with p-values of 0.002, 0.001, and 0.005, respectively, and level of knowledge about contact lens use. There was no statistically significant association between the age of the participants and the level of knowledge about contact lens use. CONCLUSION: Although there was a generally good level of awareness about contact lens use among female students, there is still insufficiency in knowledge with regard to particular aspects such as cleaning the contact lenses and contact lens cover. The study finds the need for more ocular educational sessions with ophthalmologists to increase awareness about contact lenses.

MXene@c-MWCNT Adhesive Silica Nanofiber Membranes Enhancing Electromagnetic Interference Shielding and Thermal Insulation Performance in Extreme Environments.

A lightweight flexible thermally stable composite is fabricated by combining silica nanofiber membranes (SNM) with MXene@c-MWCNT hybrid film. The flexible SNM with outstanding thermal insulation are prepared from tetraethyl orthosilicate hydrolysis and condensation by electrospinning and high-temperature calcination; the MXene@c-MWCNTx:y films are prepared by vacuum filtration technology. In particular, the SNM and MXene@c-MWCNT6:4 as one unit layer (SMC1) are bonded together with 5 wt% polyvinyl alcohol (PVA) solution, which exhibits low thermal conductivity (0.066 W m-1 K-1) and good electromagnetic interference (EMI) shielding performance (average EMI SET, 37.8 dB). With the increase in functional unit layer, the overall thermal insulation performance of the whole composite film (SMCx) remains stable, and EMI shielding performance is greatly improved, especially for SMC3 with three unit layers, the average EMI SET is as high as 55.4 dB. In addition, the organic combination of rigid SNM and tough MXene@c-MWCNT6:4 makes SMCx exhibit good mechanical tensile strength. Importantly, SMCx exhibit stable EMI shielding and excellent thermal insulation even in extreme heat and cold environment. Therefore, this work provides a novel design idea and important reference value for EMI shielding and thermal insulation components used in extreme environmental protection equipment in the future.

Pigtail with self-retaining bicanalicular intubation combined with Mitomycin C for the treatment of acquired lower punctal stenosis.

BACKGROUND: The pigtail was used to create an opening at the lower punctal site in grade 0 stenosis with insertion of self-retaining tube and Mitomycin C (MMC). METHODS: The patients with acquired lower punctal stenosis (grade 0) were divided randomly into equal groups, Group A: were treated with pigtail and MMC 0.02% and Group B: were treated with pigtail alone. The pigtail was inserted through the upper punctum until its tip reached the occluded punctum, this site was incised with a scalpel (No. 11). A self-retaining bicanalicular tube was then placed. RESULTS: Results of 36 eyes from 26 patients were included. No differences were observed between both groups regarding epiphora score, FDD test and punctal size preoperatively. The postoperative epiphora score, there were significant differences at 1 month (P = 0.035), 3 months (P = 0.005), and 6 months after removal (P < 0.001). The FDD test, there were significant differences at 6 months (P = 0.045), 1 month (P = 0.021), 3 months (P = 0.012), and 6 months post tube removal (P = 0.005). The punctal size, both groups differed at 1 month (P = 0.045), 3 months (P = 0.03), and 6 months post tube removal (P = 0.005). Only one case (5.5%) at each group showed extrusion of the tube. CONCLUSION: The pigtail probe, bicanalicular stent and MMC can be an effective method in treatment of severe punctal stenosis.

Bivariate ordered probit modelling of motorcycle riders and pillion passengers' injury severities relationship and associated risk factors.

This study simultaneously modelled the injury severity of motorcycle riders and their pillion passengers and determine the associated risk factors. The analysis is based on motorcycle crashes data in Ashanti region of Ghana spanning from 2017 to 2019. The study implemented bivariate ordered probit model to identify the possible risk factors under the premise that the injury severity of pillion passenger is endogenously related to that of the rider in the event of crash. The model provides more efficient estimates by considered the common unobserved factors shared between rider and pillion passenger. The result shows a significant positive relationship between the two injury severities with a correlation coefficient of 0.63. Thus, the unobservable factors that increase the probability of the rider to sustain more severe injury in the event of crash also increase that of their corresponding pillion passenger. The rider and their pillion passenger injury severities have different propensity to some of the risk factors including passengers' gender, day of week, road width and light condition. In addition, the study found that time of day, weather condition, collision type, and number of vehicles involved in the crash jointly influence the injury severity of both rider and pillion passenger significantly.

Metal organic framework-based polymeric hydrogel: A promising drug delivery vehicle for the treatment of breast cancer.

The constraints associated with current cancer therapies have inspired scientists to develop advanced, precise, and safe drug delivery methods. These delivery systems boost treatment effectiveness, minimize harm to healthy cells, and combat cancer recurrence. To design advanced drug delivery vehicle with these character, in the present manuscript, we have designed a self-healing and injectable hybrid hydrogel through synergistically interacting metal organic framework, CuBTC with the poly(vinyl alcohol) (PVA). This hybrid hydrogel acts as a localized drug delivery system and was used to encapsulate and release the anticancer drug 5-Fluorouracil selectively at the targeted site in response to the physiological pH. The hydrogel was formed through transforming the gaussian coil like matrix of PVA-CuBTC into a three-dimensional network of hydrogel upon the addition of crosslinker; borax. The biocompatible character of the hydrogel was confirmed through cell viability test. The biocompatible hybrid hydrogel then was used to encapsulate and studied for the pH responsive release behavior of the anti-cancer drug, 5-FU. The in vitro cytotoxicity of the drug-loaded hydrogel was evaluated against MCF-7 and HeLa cells. The study confirms that the hybrid hydrogel is effective for targeted and sustained release of anticancer drugs at cancer sites.

The knowledge regarding the impacts and management of black triangles among dental professionals and laypeople.

This study aimed to assess the knowledge regarding impacts, causes and management of black triangles (BT) among participants from different educational backgrounds including dental students, dentists and laypeople. This descriptive cross-sectional observational research included 435 participants who comprised 4 groups: pre-clinical (3rd year) dental students, clinical (4th and 5th year) dental students, dentists, and laypeople. A constructed self-reported questionnaire was utilized to assess participants' demographic data and their knowledge of the impacts, causes and management of BT. The VAS scale was used to assess participants' ratings for the impacts of BT on esthetics, with 0 meaning no impact and 10 meaning very severe negative impacts. The most reported treatments for BT were "cannot be treated" 99.3% and "non-surgical periodontal treatment" 67.1%. Meanwhile, the least reported was "modify the porcelain" 41.8%. The most reported cause of BT was "periodontal disease" 85.1%. However, the least reported were "parafunction" and "deep implants" 33.1% each. Dental professionals had better knowledge of the causes (t = 8.189, P < 0.001) and management (t = 8.289, P < 0.001) of BT than the non-dental participants. The dentists had the best knowledge, while the laypeople had the least knowledge of the causes (F = 62.056, P < 0.001) and treatment (F = 46.120, P < 0.001) of BT. The knowledge of the causes (t = 0.616, P = 0.538) and treatment (t = 1.113, P = 0.266) for BT was not significantly different between males and females. Age was not significantly related to the total knowledge about the causes (r = -0.034, P = 0.475) or treatment (r = -0.034, P = 0.482) for BT. Dental professionals had better knowledge of the impacts, causes and management of BT than the non-dental participants. The dentists were the best, while the laypeople were the worst in this regard. Age and gender had no relationships with the knowledge of causes or management of BT.

Good Practices and Initiatives for the Control and Elimination of Hepatitis B in the World: A Scoping Review.

Hepatitis B virus (HBV) infection remains a significant global public health challenge, leading to considerable morbidity and mortality. Implementation of effective strategies and novel initiatives is necessary to control and eliminate HBV. To identify the key approaches and actions used worldwide for HBV control and elimination, we conducted a comprehensive scoping review. We searched various sources, including PubMed, Scopus, Web of Science, Google Scholar, the official websites of the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), and relevant articles and reports published in the past decade. Our inclusion criteria focused on studies that reported on strategies for HBV control and elimination, provided evidence of their effectiveness, and assessed their impact on public health outcomes. We included 16 articles in our review, which highlighted a range of strategies, such as universal HBV vaccination, prevention of mother-to-child transmission, mass screening programs, and treatment of chronically infected individuals. These strategies have shown promising results in reducing HBV transmission rate, improving health outcomes, and making progress toward HBV elimination. Moreover, several challenges, including limited access to care, low awareness, stigma, and funding constraints, hinder the effectiveness of elimination programs. The findings underscore the importance of sustained efforts and investment in comprehensive strategies for HBV control and elimination. It is crucial to address barriers to care and enhance public awareness to achieve the goal of eliminating HBV as a public health threat by 2030.

The impact of scheduling ketamine as an internationally controlled substance on anaesthesia care in Sub-Saharan Africa: a case study and key informant interviews.

BACKGROUND: Access to anaesthesia and surgical care is a major problem for people living in Sub-Saharan Africa. In this region, ketamine is critical for the provision of anaesthesia care. However, efforts to control ketamine internationally as a controlled substance may significantly impact its accessibility. This research therefore aims to estimate the importance of ketamine for anaesthesia and surgical care in Sub-Saharan Africa and assess the potential impact on access to ketamine if it were to be scheduled. METHODS: This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in Sub-Saharan Africa. Data on availability of four anaesthetic agents were collected from hospitals (n = 54) in Rwanda. Semi-structured interviews with 10 key informants were conducted, collecting information on the importance of ketamine, the potential impact of scheduling ketamine internationally, and opinions on misuse of ketamine. Interviews were transcribed verbatim and analysed using a thematic analysis approach. RESULTS: The survey conducted in Rwanda found that availability of ketamine and propofol was comparable at around 80%, while thiopental and inhalational agents were available at only about half of the hospitals. Significant barriers impeding access to anaesthesia care were identified, including a general lack of attention given to the specialty by governments, a shortage of anaesthesiologists and migration of trained anaesthesiologists, and a scarcity of medicines and equipment. Ketamine was described as critical for the provision of anaesthesia care as a consequence of these barriers. Misuse of ketamine was not believed to be an issue by the informants. CONCLUSION: Ketamine is critical for the provision of anaesthesia care in Sub-Saharan Africa, and its scheduling would have a significantly negative impact on its availability for anaesthesia care.

Secure UAV adhoc network with blockchain technology.

Recent advances in aerial robotics and wireless transceivers have generated an enormous interest in networks constituted by multiple compact unmanned aerial vehicles (UAVs). UAV adhoc networks, i.e., aerial networks with dynamic topology and no centralized control, are found suitable for a unique set of applications, yet their operation is vulnerable to cyberattacks. In many applications, such as IoT networks or emergency failover networks, UAVs augment and provide support to the sensor nodes or mobile nodes in the ground network in data acquisition and also improve the overall network performance. In this situation, ensuring the security of the adhoc UAV network and the integrity of data is paramount to accomplishing network mission objectives. In this paper, we propose a novel approach to secure UAV adhoc networks, referred to as the blockchain-assisted security framework (BCSF). We demonstrate that the proposed system provides security without sacrificing the performance of the network through blockchain technology adopted to the priority of the message to be communicated over the adhoc UAV network. Theoretical analysis for computing average latency is performed based on queuing theory models followed by an evaluation of the proposed BCSF approach through simulations that establish the superior performance of the proposed methodology in terms of transaction delay, data secrecy, data recovery, and energy efficiency.

Clinical Presentations and Risk Factors of Gastrointestinal Bleeding in the Emergency Department: A Multicenter Retrospective Study.

BACKGROUND AND AIMS: Gastrointestinal bleeding is a major healthcare burden and is associated with significant morbidity and mortality. This study aimed to assess the prevalence, clinical presentation, and risk factors of patients presenting with gastrointestinal bleeding in the emergency department. MATERIALS AND METHODS: This retrospective study was conducted in two tertiary care hospitals in Riyadh, Saudi Arabia. The medical records of patients who presented to the emergency department with gastrointestinal bleeding between January 2010 and January 2020 were reviewed. Patients aged 18 years or older, with gastrointestinal bleeding (upper or lower) regardless of underlying cause, lifestyle, location of bleeding, health status, or medication use, were included. Demographic characteristics, initial vital signs, medical history, physical examination findings, comorbidities, medications, laboratory and radiological investigations, cause and stage of liver disease, management, and complications were recorded. Endoscopic findings and management of the bleeding site were collected according to the presenting symptoms. RESULTS: A total of 760 patients were included. The mean age was 62.7 ± 17.8 years, and 61.4% were males. The most common comorbidities at presentation were hypertension (54.1%), diabetes mellitus (51.2%), and ischemic heart disease (18.2%). The origins of the bleeding were lower gastrointestinal in 52% and upper gastrointestinal in 48% of patients. CONCLUSIONS: Lower gastrointestinal bleeding was found to be more common than upper gastrointestinal bleeding. Hemorrhoids, polyps, diverticular disease, and colonic ulcers were the major risk factors for lower gastrointestinal bleeding. In contrast, upper gastrointestinal bleeding was predominantly caused by esophageal varices, gastritis, and peptic ulcers.