Moderating role of political stability and economic policy uncertainty between country governance practice and stock market performance. A comparative analysis of Pakistan and Kurdistan Region of Iraq.

The objective of the study is to explore the relationship between country governance practices along with political stability and Economic policy uncertainty, and stock market performance of two different economies, Pakistan and Kurdistan region of Iraq. To meet our objectives, we used the 25 years past data from 1996 to 2021. Data is collected from the DataStream database. The regression analysis is used as the method of estimation for linear and moderation effect. Our results show that regulatory quality, rules of law and political stability has significant positive relationship with stock market performance of Pakistan, but all the governance indicators have significant positive relationship with stock market performance of the Kurdistan Region of Iraq. Moreover, political stability has significant moderating impact between the governance practices and the performance of the stock markets of both economies indicating that the governance practices perform well with the political stability that leads to rise in the stock market indices of selected countries. Economic policy uncertainty has significant negative moderation impact due to creating the risk in both economies that decrease the performance of the stock markets of the selected economies. Finally, our study advocated some implications for the investors to increase their confidence on the stock of high political stability and low economic policy uncertainty economies. Government can take significant measures to control the uncertainty of the policy and portfolio managers can adjust their risk on the ground of the political stability and efficient governance practices countries.

Correction: High seroprevalence of antibodies against SARS-CoV-2 among healthcare workers 8 months after the first wave in Aden, Yemen.

[This corrects the article DOI: 10.1371/journal.pgph.0000767.].

Assessing suboptimal health status in the Saudi population: Translation and validation of the SHSQ-25 questionnaire.

Background: Suboptimal Health Status (SHS) is realised as a vital feature for improving global health. However, the Arabian world does not have a validated instrument for screening SHS in their population. Therefore, the study aimed to evaluate the psychometric properties of Arabic-translated SHS (ASHSQ-25) in the Saudi Arabian population. Methods: We conducted a cross-sectional study among the conveniently sampled 1590 participants from the Saudi population (with a 97.4% response rate). The data was gathered through an online survey and then exported into SPSS and AMOS version 26.0 for analysis. Mann-Whitney and Kruskal-Wallis tests were used to identify the median difference between demographic groups. The one-tailed 90% upper limit of SHS scores was chosen as the cut-off criteria for SHS. Reliability and confirmatory analysis were performed for the psychometric evaluation of ASHSQ-25 in the Saudi Arabian context. Results: This study demonstrates that the ASHSQ-25 has good internal consistency, interclass correlation coefficient (ICC) = 0.92; 95% confidence interval (CI) = 0.91-0.93) and reliability (Cronbach's α = 0.92). The confirmatory factor analysis (CFA) results indicated a good fit of the databased on the CMIN/degrees of freedom (df) = 4.461, comparative fit index (CFI) = 0.94, Tucker Lewis index (TLI) = 0.93, and Root Mean Square Error of Approximation (RMSEA) = 0.05. The result factor loadings for each item were high (≥ 0.55), except for one item from the immune system subscale. The SHS cut-off point for ASHSQ-25 was 33, leading to a 23.7% prevalence of SHS. Conclusions: This study reveals that ASHSQ-25 has appropriate internal consistency and structural validity to assess SHS in an Arabic-speaking population; therefore, it is recommended.

Avoidable emergency department visits among palliative care cancer patients: novel insights from Saudi Arabia and the Middle East.

BACKGROUND: Several studies emerging from developed countries have highlighted a significant number of potentially avoidable emergency department (ED) visits by cancer patients during the end-of-life period. However, there is a paucity of information from developing nations regarding palliative care practices and the utilization of the ED by palliative care patients. Herein, we aim to characterize ED admissions among patients receiving palliative care at our tertiary center in Saudi Arabia. METHODS: This is a retrospective, cross-sectional study evaluating ED visits amongst adult patients with advanced cancer who were receiving treatment under the palliative care department. This study took place over a period of 12 months from July 2021 through to July 2022. Three palliative care specialist physicians independently and blindly reviewed each patient's ED visits and determined whether the visit was avoidable or unavoidable. RESULTS: A total of 243 patients were included in the final analysis, of which 189 (78.1%) patients had unavoidable visits and 53 (21.9%) patient visits were classified as avoidable. A significantly higher proportion of breast cancer patients presented with unavoidable admissions (14.3% vs. 3.8%, P = 0.037) compared to other cancer types. The incidence of dyspnea (23.8% vs. 5.7%, P < 0.001) and fevers/chills (23.3% vs. 5.7%, P = 0.005) was significantly higher in patients with unavoidable visits. Patients with avoidable visits had a significantly greater proportion of visits for dehydration (13.2% vs. 2.1%, P = 0.002). Notably, although hospital stay was significantly longer in the unavoidable group (P = 0.045), mortality for palliative care patients-regardless of whether their ED visit was avoidable or unavoidable-was not statistically different (P=-0.069). CONCLUSION: To our knowledge, this is the largest and most comprehensive study from Saudi Arabia and the Middle East providing insights into the utilization of palliative care services in the region and the propensity of advanced cancer patients towards visiting the ED. Future studies ought to explore interventions to reduce the frequency of avoidable ED visits.

Effect of uncontrolled type-II diabetes mellitus and Its duration on nerve conduction parameters in adult Sudanese patients in Khartoum State

Background: Peripheral neuropathy is a serious complication of diabetes, which has socioeconomic consequences as well as a reduced quality of life. Early neuropathic process recognition and management could alter its course and considerably reduce the associated morbidity and mortality. This study determines the effect of long-term glycemic control on diabetic peripheral neuropathy in people with type 2 diabetes (T2DM). Methods: A hospital-based study was carried out at the National Centre of Neurosciences and Ibrahim Malik Hospital in Khartoum. All individuals who were older than 18 years and have had T2DM for less than 10 years were recruited. Using accepted techniques, the BMI, HbA1c level, and nerve conduction studies (NCS) were measured. Data were analyzed using the Statistical Package for Social Sciences (SPSS), version 25.0 software. P-value ≤ 0.05 was considered significant. Results: Of the 95 patients with T2DM, 52 were male patients. Our findings showed that as the duration of diabetes increased, the sensory velocity reduced from 64.07 ± 3.22 to 54.00 ± 5.34 and the motor nerve from 63.39 ± 2.38 to 53.87 ± 2.08 (P = 0.05, P = 0.003, respectively). Additionally, with increased duration of diabetes, a significant decrease was seen in both motor nerve amplitude from 8.79 ± 3.11 to 6.94 ± 1.84 (P = 0.05) and sensory nerve amplitude from 25.71 ± 5.70 to 19.51 ± 6.51 (P = 0.003). Also, all parameters of NCS (velocity and amplitude) decreased when Hb A1c was >6 ­ sensory velocity from 63.96 ± 2.36 to 55.49 ± 2.43 (P = 0.03) and motor velocity from 63.00 ± 2.59 to 51.44 ± 1.66 (P = 0.02). And sensory amplitude decreased from 26.91 ± 1.26 to 20.85 ± 2.1 (P = 0.05), while motor amplitude decreased from 6.88 ± 3.55 to 6.61 ± 3.29 (P = 0.05). Additionally, there is a substantial (P = 0.05) correlation between sensory and motor amplitudes and the BMI. Conclusion: High BMI and poorly controlled (high HbA1c) long-term diabetes had a negative impact on all nerve conduction study parameters

Chemical analysis of mineral trioxide agregate mixed with hyaluronic acids as an accelerant.

MATERIALS AND METHOD: Mineral trioxide aggregate (MTA) has many clinical applications in dentistry; the main drawback is the long setting. The main objective is to investigate and compare the chemical effect of using two commercially available hyaluronic acid hydrogels (HA) instead of distilled water for mixing MTA as an accelerant of setting time. Test materials were divided into three groups; Group 1: (control) mixing MTA with distilled water supplied by the manufacturer; Group 2: mixing MTA with a hybrid cooperative complex of high and low molecular weight HA (Profhilo®); Group 3: mixing MTA with High molecular weight / non-cross-linked HA (Jalupro®). Mixing time, and setting time (initial and final) were determined, Fourier-transform infrared spectroscopy, Energy-dispersive X-ray spectroscopy, Field emission Scanning Electron Microscopy, and X-ray diffraction were performed. RESULTS: mixing time, initial, and final setting time for (MTA + HA) groups were significantly different and lower in comparison to the control group (p < 0.05). This study revealed higher expression of calcium silicate hydrate and calcium hydroxide expression with higher Ca release in the MTA + HA group than the control group. CONCLUSION: commercially available HA demonstrated better chemical properties when used as a mixing medium for MTA. The Mixing and setting time for MTA + HA group were significantly shorter than those of the control group were. Thus, commercially available HA can be used as a mixing medium for MTA.

Practical prototype for energy management system in smart microgrid considering uncertainties and energy theft.

The conventional electrical grid faces significant issues, which this paper aims to address one of most of them using a proposed prototype of a smart microgrid energy management system. In addition to relying too heavily on fossil fuels, electricity theft is another great issue. The proposed energy management system can simultaneously detect electricity theft and implement demand response tactics by employing time-of-use pricing principles and comparing real electricity consumption with grid data. The system uses the Al-Biruni earth radius (BER) optimization algorithm to make smart choices about how to distribute the load, intending to reduce energy consumption and costs without sacrificing comfort. As a bonus, it considers limitations imposed by battery charging/discharging and decentralized power generation. Incorporating sensors and SCADA-based monitoring, the system provides accurate measurement and management of energy usage through load monitoring and control. An intuitive mobile app also helps consumers connect, allowing for more active participation and better control over energy use. Extensive field testing of the prototype shows that by moving loads from peak period to another off-peak period, electricity expenditures can be reduced by up to 48.45%. The energy theft value was calculated to be 1199 W, proving that the system's theft detection model was effective.

Safety and efficacy of paromomycin/miltefosine/liposomal amphotericin B combinations for the treatment of post-kala-azar dermal leishmaniasis in Sudan: A phase II, open label, randomized, parallel arm study.

BACKGROUND: Treatment for post-kala-azar dermal leishmaniasis (PKDL) in Sudan is currently recommended only for patients with persistent or severe disease, mainly because of the limitations of current therapies, namely toxicity and long hospitalization. We assessed the safety and efficacy of miltefosine combined with paromomycin and liposomal amphotericin B (LAmB) for the treatment of PKDL in Sudan. METHODOLOGY/PRINCIPAL FINDINGS: An open-label, phase II, randomized, parallel-arm, non-comparative trial was conducted in patients with persistent (stable or progressive disease for ≥ 6 months) or grade 3 PKDL, aged 6 to ≤ 60 years in Sudan. The median age was 9.0 years (IQR 7.0-10.0y) and 87% of patients were ≤12 years old. Patients were randomly assigned to either daily intra-muscular paromomycin (20mg/kg, 14 days) plus oral miltefosine (allometric dose, 42 days)-PM/MF-or LAmB (total dose of 20mg/kg, administered in four injections in week one) and oral miltefosine (allometric dose, 28 days)-LAmB/MF. The primary endpoint was a definitive cure at 12 months after treatment onset, defined as clinical cure (100% lesion resolution) and no additional PKDL treatment between end of therapy and 12-month follow-up assessment. 104/110 patients completed the trial. Definitive cure at 12 months was achieved in 54/55 (98.2%, 95% CI 90.3-100) and 44/55 (80.0%, 95% CI 70.2-91.9) of patients in the PM/MF and AmB/MF arms, respectively, in the mITT set (all randomized patients receiving at least one dose of treatment; in case of error of treatment allocation, the actual treatment received was used in the analysis). No SAEs or deaths were reported, and most AEs were mild or moderate. At least one adverse drug reaction (ADR) was reported in 13/55 (23.6%) patients in PM/MF arm and 28/55 (50.9%) in LAmB/MF arm, the most frequent being miltefosine-related vomiting and nausea, and LAmB-related hypokalaemia; no ocular or auditory ADRs were reported. CONCLUSIONS/SIGNIFICANCE: The PM/MF regimen requires shorter hospitalization than the currently recommended 60-90-day treatment, and is safe and highly efficacious, even for patients with moderate and severe PKDL. It can be administered at primary health care facilities, with LAmB/MF as a good alternative. For future VL elimination, we need new, safe oral therapies for all patients with PKDL. TRIAL REGISTRATION: ClinicalTrials.gov NCT03399955, https://clinicaltrials.gov/study/NCT03399955 ClinicalTrials.gov ClinicalTrials.gov.

Design of three-bit binary to gray converter based on metal-insulator-metal plasmonic waveguides.

Using the finite element method and COMSOL version 5.5, a three-bit binary to gray converter with three plasmonic substructures and five input and three output ports was designed. Using a 520n m×200n m metal-insulator-metal plasmonic structure, the plasmonic converter was developed. In this configuration, the transmission threshold (T t h r e s h o l d ) is set to 45% at an operating wavelength of 1310 nm. Utilizing the modulation depth, contrast ratio (CR), and insertion loss criteria, the effectiveness of the plasmonic converter is evaluated. For the first, second, and third output terminals, the CR has respective values of 40.1 dB, 9.3 dB, and 9.2 dB.

Assessing the Effectiveness of Eco-Friendly Management Approaches for Controlling Wheat Yellow Rust and Their Impact on Antioxidant Enzymes.

Wheat stripe rust, caused by Puccinia striiformis f. sp. tritici (Pst), is a destructive disease that causes significant yield losses in wheat production worldwide, including in Egypt. The use of biocontrol agents is among the best eco-friendly management strategies to control this disease, as they are more sustainable and environmentally friendly than traditional chemical control methods. In a comparative analysis, antioxidant enzyme activity and various management approaches were compared with two bacterial biocontrol agents, Bacillus subtilis and Pseudomonas putida. This study showed the remarkable efficacy of endophytic bacteria, B. subtilis and P. putida, in mitigating wheat stripe rust infection across three wheat varieties, namely Misr1, Gimmeiza11, and Sids12. B. subtilis exhibited superior performance compared to P. putida, resulting in infection types of 1 and 2.66, respectively, following inoculation. The highest reduction rate was observed with Tilit fungicide (500 ppm), followed by B. subtilis and Salicylic acid (1000 ppm), respectively. Variations in wheat varieties' response to Pst infection were observed, with Misr1 exhibiting the lowest infection and Sids12 showing high susceptibility. Among the tested inducers, Salicylic acid demonstrated the greatest reduction in disease infection, followed by Indole acetic acid, while Oxalic acid exhibited the lowest decrease. Additionally, the study evaluated the activities of five antioxidant enzymes, including Catalase, Ascorbate peroxidase (APX), glutathione reductase (GR), Superoxide dismutase (SOD), and peroxidase (POX), in the wheat-stripe rust interaction under different integrated management approaches. The wheat variety Misr1 treated with Tilit (500 ppm), B. subtilis, Salicylic acid, Montoro (500 ppm), and P. putida exhibited the highest increase in all enzymatic activities. These findings provide valuable insights into the effectiveness of B. subtilis and P. putida as biocontrol agents for wheat stripe rust control in Egypt, emphasizing their potential role in sustainable, integrated, and environmentally friendly management practices.

Prediction Factors of Radiation Esophagitis in Breast Cancer Patients Undergoing Supraclavicular Radiotherapy.

Purpose: The aim of this study was to investigate demographic and dosimetric parameters which may link with esophagitis in patients with breast cancer receiving three-dimensional conformal radiotherapy to the supraclavicular fossa. Materials and Methods: We examined 27 breast cancer patients with supraclavicular metastases. All patients were treated with radiotherapy (RT) with a prescribed dose of 40.5 Gy in 15 fractions for 3 weeks. Esophagitis was recorded weekly and esophagus toxicity was evaluated and graded according to the tadiation therapy oncology group. The following factors were examined regarding their correlation with grade 1 or worse esophagitis by univariate and multivariate analyses: age, chemotherapy, smoking history, maximum dose (Dmax), mean dose (Dmean), esophagus volume receiving 10 Gy (V10), esophagus volume receiving 20 Gy (V20), and length of esophagus in the treatment field. Results: Of 27, 11 (40.7%) patients developed no esophageal irritation throughout therapy. Approximately half of the patients 13/27 (48.1%) had maximum grade 1 esophagitis. 2/27 (7.4%) patients had grade 2 esophagitis. The incidence of grade 3 esophagitis was (3.7%). Dmean, Dmax, V10, and V20 were 10.48 ± 5.10 Gy, 38.18 ± 5.12Gy, 29.83 ± 15.16, and 19.32 ± 10.01, respectively. Our results showed that Dmean, V10, and V20 were the significant factors for the development of esophagitis, whereas esophagitis was not significantly associated with the chemotherapy regimen, age, and smoking status. Conclusions: We found that Dmean, V10, and V20 correlated significantly with acute esophagitis. However, the chemotherapy regimen, age, and smoking status did not affect esophagitis development.

Chest CT utilization in COVID-19: a dosimetric and diagnostic-quality study.

The purpose of this study is to look at the variations in chest computed tomography (CT) use, radiation dose and image quality in the 2019 novel coronavirus (COVID-19) pneumonia patients in Saudi Arabia. This is a retrospective study of 402 patients with COVID-19, who were treated between February and October 2021. Radiation dose was estimated using metrics of volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE). The imaging performance of the CT scanners was evaluated by measuring different parameters, such as resolution and CT number uniformity, with an ACR-CT accreditation phantom. Expert radiologists assessed the diagnostic quality and occurrence of artefacts. For all of the image quality parameters tested, the majority of the scanner sites (80%) were found to be within the suggested acceptance limits. Ground-glass opacities were the most common finding in our patient sample (54%). On chest CT exams with typical appearance of COVID-19 pneumonia, the most respiratory motion artefacts (56.3%) were present, followed by those with indeterminate appearance (32.2%). There were significant differences in CT utilization, CTDIvol and SSDE across the collaborated sites. The use of CT scans and radiation doses varied in the COVID-19 patients, highlighting the optimizations of CT protocols at participating sites.

An intelligent framework to measure the effects of COVID-19 on the mental health of medical staff.

The mental and physical well-being of healthcare workers is being affected by global COVID-19. The pandemic has impacted the mental health of medical staff in numerous ways. However, most studies have examined sleep disorders, depression, anxiety, and post-traumatic problems in healthcare workers during and after the outbreak. The study's objective is to evaluate COVID-19's psychological effects on healthcare professionals of Saudi Arabia. Healthcare professionals from tertiary teaching hospitals were invited to participate in the survey. Almost 610 people participated in the survey, of whom 74.3% were female, and 25.7% were male. The survey included the ratio of Saudi and non-Saudi participants. The study has utilized multiple machine learning algorithms and techniques such as Decision Tree (DT), Random Forest (RF), K Nearest Neighbor (KNN), Gradient Boosting (GB), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM). The machine learning models offer 99% accuracy for the credentials added to the dataset. The dataset covers several aspects of medical workers, such as profession, working area, years of experience, nationalities, and sleeping patterns. The study concluded that most of the participants who belonged to the medical department faced varying degrees of anxiety and depression. The results reveal considerable rates of anxiety and depression in Saudi frontline workers.

Developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep in Saudi Arabia: Electroclinical, etiologic, genetic, and outcome multicenter study.

OBJECTIVES: To investigate the clinical features of developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep (D/EE-SWAS), its electrographic characteristics, and etiology and to compare the effects of different treatment strategies on the outcomes using a Saudi Arabian database. METHODS: This multicenter study included children with D/EE-SWAS who were evaluated between 2010 and 2020 at 11 tertiary centers. Data were collected on their baseline clinical features, etiologies, and treatment modalities. Seizure reduction, spike-wave index, and cognitive state were examined as potential therapeutic outcomes. RESULTS: Ninety-one children were diagnosed with D/EE-SWAS, with a median age of 7 years (IQR: 3-5) and an almost equal sex distribution. The average age at which epilepsy was diagnosed was 3 years (IQR: 5-2). A genetic/metabolic etiology was found in 35.1% of the patients, and a structural etiology was found in 27.4%. Children with underlying genetic/metabolic diseases exhibited an earlier seizure onset (P = 0.001) than children with other etiologies. Benzodiazepines (76.6%) were the most common treatment, followed by steroids (51.9%). Sodium valproate (75%) was the most frequently used antiseizure medication, followed by levetiracetam (64.9%). Children with a later seizure onset were more likely to have better clinical responses (P = 0.046), EEG responses (P = 0.012), and cognitive outcomes (P = 0.006) than children with an earlier onset. Moreover, better seizure response and electrographic response were seen in patients with bilateral interictal discharges on the EEG than otherwise. Children had a higher likelihood of both clinical and electrographic improvement with combination therapy of benzodiazepines (P = 0.001) and steroids (P = 0.001) than with other therapies. SIGNIFICANCE: This study shows a higher prevalence of genetic/metabolic causes and suggests the superior efficacy of combination therapy with steroids and benzodiazepines in D/EE-SWAS. Prospective studies that strictly assess the treatment protocols and outcomes are needed.

Incidental left atrial appendage isolation after catheter ablation of persistent atrial fibrillation: Mechanisms and long-term risk of thromboembolism.

INTRODUCTION: Incidental left atrial appendage (LAA) isolation may occur during radiofrequency ablation of persistent atrial fibrillation (AF). The study aims to describe the mechanisms and long-term thromboembolic risk related to incidental LAA isolation. METHODS: Patients who experienced incidental LAA isolation after AF ablation were included. Culprit sites where ablation resulted in LAA isolation were identified. Thromboembolic risk despite oral anticoagulation (OAC) was compared to that in a propensity-matched control group without LAA isolation. RESULTS: Forty-one patients with LAA isolation, and 82 matched patients without LAA isolation were included. The patient age, ejection fraction, LA diameter, and CHA2 DS2 -VASc score were 64 ± 11 years, 55 ± 12%, 45.0 ± 7 mm and 2.62 ± 1.5, respectively. Culprit sites included the LAA base, mitral isthmus, inferior LA, Bachmann's bundle, coronary sinus, and Marshall vein. After 4.2 ± 3.6 years follow-up, thromboembolism occurred in 7 of 41 patients (17%) with LAA isolation versus 3 of 82 patients (4%) without isolation (log rank p < .009, HR 5.14, 95% CI [1.32-19.94], p = .02). Patients with and without thromboembolism had similar CHA2 DS2 -VASc scores (2.65 ± 1.3 vs. 2.71 ± 0.76, p = .89). Thromboembolism occurred during noncompliance with or temporary discontinuation of OAC in four of the seven patients. CONCLUSIONS: Incidental LAA isolation may occur during ablation of atrial arrhythmias in the vicinity of, or even at sites remote from the appendage. Patients with incidental LAA isolation had higher rates of thromboembolism compared to patients without isolation. Since thromboembolism may occur despite prescription for OAC, the risks of LAA isolation must be weighed against clinical benefit and appendage occlusion devices should be considered in vulnerable patients.

Energy management system in smart buildings based coalition game theory with fog platform and smart meter infrastructure.

This paper proposes a central energy management system (EMS) in smart buildings. It is based on the coalition method for optimal energy sharing between smart buildings. Game theory is applied to obtain an optimal allocation of the building's surplus energy on the deficient energy buildings using the Shapley value, which enables the unequal energy distribution based on the energy demand. The main objective is reducing energy waste while preserving the generation/demand balance. The fog platform with memory storage is applied, which handles all the measured data from the smart buildings through Wi-Fi-based communication protocol and performs the EMS program. The smart meter links the smart buildings with the fog-based EMS central unit. Two scenarios are implemented based on the difference between total deficient and surplus energy. Coalition game theory is applied for optimal surplus energy allocation on deficient buildings when the total energy surplus is lower than the total energy deficient. Also, there is a one-to-one relationship between the surplus and deficient building; if the surplus energy is larger than the deficit, the extra surplus energy is stored for further usage. The proposed EMS is applied and tested using a smart city with 10 buildings in the MATLAB program. A comparison between the result obtained with and without applying the proposed method is performed. The performance of the fog platform is introduced based on the run and delay time and the memory size usage. The results show the effectiveness of the proposed EMS in a smart building.

Psychometric Properties of Suboptimal Health Status Instruments: A Systematic Review.

BACKGROUND: Suboptimal health status (SHS) measurement has now been recognized as an essential construct in predictive, preventive, and personalized medicine. Currently, there are limited tools, and an ongoing debate about appropriate tools. Therefore, it is crucial to evaluate and generate conclusive evidence about the psychometric properties of available SHS tools. OBJECTIVE: This research aimed to identify and critically assess the psychometric properties of available SHS instruments and provide recommendations for their future use. METHODS: Articles were retrieved by following the guidelines of the PRISMA checklist, and the robustness of methods and evidence about the measurement properties was assessed using the adapted COSMIN checklist. The review was registered in PROSPERO. RESULTS: The systematic review identified 14 publications describing four subjective SHS measures with established psychometric properties; these included the Suboptimal Health Status Questionnaire-25 (SHSQ-25), Sub-health Measurement Scale Version 1.0 (SHMS V1.0), Multidimensional Sub-health Questionnaire of Adolescents (MSQA), and the Sub-Health Self-Rating Scale (SSS). Most studies were conducted in China and reported three reliability indices: (1) the internal consistency measured by Cronbach's α value ranged between 0.70 and 0.96; (2) the test-retest reliability; and (3) the split-half reliability coefficient values ranged between 0.64 and 0.98, and between 0.83 and 0.96, respectively. For the values of validity coefficients in the case of SHSQ-25 > 0.71, the SHMS-1.0 ranged from 0.64 to 0.87, and the SSS ranged from 0.74 to 0.96. Using these existing and well-characterized tools rather than constructing original tools is beneficial, given that the existing choice demonstrated sound psychometric properties and established norms. CONCLUSIONS: The SHSQ-25 stood out as being more suitable for the general population and routine health surveys, because it is short and easy to complete. Therefore, there is a need to adapt this tool by translating it into other languages, including Arabic, and establishing norms based on populations from other regions of the world.

Assessment of male patients' average glandular dose during mammography procedure.

Breast cancer is a common malignancy for females (25% of female cancers) and also has low incidence in males. It was estimated that 1% of all breast malignancies occur in males with mortality rate about 20%, with annual increase in incidence. Risk factors include age, family history, exposure to ionizing radiation and high estrogen and low of androgens hormones level. Diagnosis and screening are challenging due to limiting effectiveness of breast cancer screening. Therefore, patients may expose to ionizing radiation that may contribute in breast cancer incidence in males. In literature, limited studies were published regarding radiation exposure for males during mammography. The objective of this research is to quantify patient doses during male mammogram and to estimate the projected radiogenic risk during the procedure. In total, 42 male patients were undergone mammogram for breast cancer diagnosis during two consecutive years. The mean and range of patient age (years) is 45 (23-80). The mean and standard deviation (SD) of the peak tube potential and tube current time product are 28.64 ± 2. and 149 ± 35.1, respectively. The mean, and range of patients' entrance surface air kerma (ESAK, mGy) per single breast procedure was 5.3 (0.47-27.5). Male patient's received comparable radiation dose per mammogram compared to female procedures. With increasing incidence of male breast cancer, proper guidelines are necessary for the mammographic procedure are necessary to reduce unnecessary radiation doses and radiogenic risk.

Three-dimensional-guided and ICE-guided transseptal puncture for cardiac ablations: A propensity score match study.

INTRODUCTION: Transseptal puncture (TSP) is routinely performed for left atrial ablation procedures. The use of a three-dimensional (3D) mapping system or intracardiac echocardiography (ICE) is useful in localizing the fossa ovalis and reducing fluoroscopy use. We aimed to compare the safety and efficacy between 3D mapping system-guided TSP and ICE-guided TSP techniques. METHODS: We conducted a prospective observational study of patients undergoing TSP for left atrial catheter ablation procedures (mostly atrial fibrillation ablation). Propensity scoring was used to match patients undergoing 3D-guided TSP with patients undergoing ICE-guided TSP. Logistic regression was used to compare the clinical data, procedural data, fluoroscopy time, success rate, and complications between the groups. RESULTS: Sixty-five patients underwent 3D-guided TSP, and 151 propensity score-matched patients underwent ICE-guided TSP. The TSP success rate was 100% in both the 3D-guided and ICE-guided groups. Median needle time was 4.00 min (interquartile range [IQR]: 2.57-5.08) in patients with 3D-guided TSP compared to 4.02 min (IQR: 2.83-6.95) in those with ICE-guided TSP (p = .22). Mean fluoroscopy time was 0.2 min (IQR: 0.1-0.4) in patients with 3D-guided TSP compared to 1.2 min (IQR: 0.7-2.2) in those with ICE-guided TSP (p < .001). There were no complications related to TSP in both group. CONCLUSIONS: Three-dimensional mapping-guided TSP is as safe and effective as ICE-guided TSP without additional cost.

Chemical analysis of mineral trioxide agregate mixed with hyaluronic acids as an accelerant

Abstract Mineral trioxide aggregate (MTA) has many clinical applications in dentistry; the main drawback is the long setting. The main objective is to investigate and compare the chemical effect of using two commercially available hyaluronic acid hydrogels (HA) instead of distilled water for mixing MTA as an accelerant of setting time. Materials and method: Test materials were divided into three groups; Group 1: (control) mixing MTA with distilled water supplied by the manufacturer; Group 2: mixing MTA with a hybrid cooperative complex of high and low molecular weight HA (Profhilo®); Group 3: mixing MTA with High molecular weight / non-cross-linked HA (Jalupro®). Mixing time, and setting time (initial and final) were determined, Fourier-transform infrared spectroscopy, Energy-dispersive X-ray spectroscopy, Field emission Scanning Electron Microscopy, and X-ray diffraction were performed. Results: mixing time, initial, and final setting time for (MTA + HA) groups were significantly different and lower in comparison to the control group (p < 0.05). This study revealed higher expression of calcium silicate hydrate and calcium hydroxide expression with higher Ca release in the MTA + HA group than the control group. Conclusion: commercially available HA demonstrated better chemical properties when used as a mixing medium for MTA. The Mixing and setting time for MTA + HA group were significantly shorter than those of the control group were. Thus, commercially available HA can be used as a mixing medium for MTA.

Resumo O agregado de trióxido mineral (MTA) tem muitas aplicações clínicas em odontologia, mas a principal desvantagem é a longa presa. O objetivo principal é investigar e comparar o efeito químico do uso de dois hidrogéis de ácido hialurônico (HA) disponíveis comercialmente em vez de água destilada para misturar o MTA como um acelerador do tempo de presa. Materiais e método: Os materiais de teste foram divididos em três grupos: Grupo 1: (controle) misturando o MTA com água destilada fornecida pelo fabricante; Grupo 2: misturando o MTA com um complexo cooperativo híbrido de HA de alto e baixo peso molecular (Profhilo®); Grupo 3: misturando o MTA com HA de alto peso molecular/não reticulado (Jalupro®). Foram determinados o tempo de mistura e o tempo de presa (inicial e final), a espectroscopia de infravermelho com transformada de Fourier, a espectroscopia de raios X com dispersão de energia, a microscopia eletrônica de varredura com emissão de campo e a difração de raios X. Resultados: o tempo de mistura, o tempo de presa inicial e final dos grupos (MTA + HA) foram significativamente diferentes e menores em comparação com o grupo de controle (p < 0,05). Esse estudo revelou maior expressão de silicato de cálcio hidratado e expressão de hidróxido de cálcio com maior liberação de Ca no grupo MTA + HA do que no grupo de controle. Conclusão: a HA disponível comercialmente demonstrou melhores propriedades químicas quando usada como meio de mistura para o MTA. O tempo de mistura e de presa do grupo MTA + HA foi significativamente menor do que o do grupo de controle. Portanto, a HA disponível comercialmente pode ser usada como meio de mistura para o MTA.