Arrhythmic Manifestations and Outcomes of Definite and Probable Cardiac Sarcoidosis.

BACKGROUND: The 2014 HRS consensus statement defines histological (definite) and clinical (probable) diagnostic categories of cardiac sarcoidosis (CS), but few studies have compared their arrhythmic phenotypes and outcomes. OBJECTIVE: Evaluate the electrophysiologic/arrhythmic phenotype and outcomes of patients with definite and probable CS. METHODS: We analyzed the arrhythmic/electrophysiologic phenotype in a single-center North American cohort of 388 patients (median age 56 years, 39% female) diagnosed with definite (n=58) or probable (n=330) CS (2000-2022). The primary composite outcome was survival to first ventricular tachycardia/fibrillation (VT/VF) or sudden cardiac death (SCD). Key secondary outcomes were also assessed. RESULTS: At index evaluation, in situ cardiac implantable electronic devices and antiarrhythmic drug use were more common in definite CS. At median follow-up 3.1 years, the primary outcome occurred in 22 (38%) definite and 127 (38%) probable CS patients (log-rank p=0.55). In multivariable analysis, only higher 18F-FDG SUVmax myocardium:SUVmax blood pool ratio (HR 1.09 [95% CI 1.03, 1.15], p=0.003, per 1 unit increase) was associated with the primary outcome. During follow-up, definite CS patients had higher burden of device-treated VT/VF events (mean 2.86 vs 1.56 per patient-year) and higher rate of progression to heart transplant/left ventricular assist device implantation, but no difference in all-cause mortality compared to probable CS patients. CONCLUSION: Definite and probable CS patients had similarly high risks of first sustained VT/VF/SCD and all-cause death though definite CS patients had a higher overall arrhythmic burden. Both CS diagnostic groups as defined by the 2014 HRS criteria require an aggressive approach to prevent arrhythmic complications.

Terahertz binary computing in a coupled toroidal metasurface.

The applications of terahertz metamaterials are being actively explored in recent times for applications in high-speed communication devices, miniature photonic circuits, and bio-chemical devices because of their wide advantages. The toroidal resonance, a new type of metasurface resonance, has been examined with great interest to utilize its properties in terahertz metasurface applications. This study reports a proof of concept design of a toroidal metasurface that experimentally demonstrates binary computing operations in the terahertz frequency regime. The analog computing of binary operations is achieved by the passive tuning of distance between the split ring resonators comprising the meta-molecule. The amplitude modulation is utilized as a method of determining the Boolean logic outputs of the system. The proposed metasurface could be further optimized for high amplitude modulations and active logic gate operations using tunable materials including graphene and ITO. The proposed metasurface consists of three split-ring resonators, and the near-field coupling between the adjacent resonators dictates the Boolean operations. A multipole analysis of the scattered powers of terahertz radiation determines the toroidal excitation in the metasurface. The proposed metasurfaces experimentally define AND Boolean logic operation at 0.89 terahertz, and OR Boolean logic operation at 0.97 terahertz. Numerical simulations support the experimentally obtained results. Additionally, we numerically report the excitation of NAND operation at 0.87 THz. Such toroidal analog computing metasurfaces could find applications in digitized terahertz circuits and integrated photonic devices.

A Cross-Sectional Study of Anesthesia Safety in Wad Medani, Sudan: A Pre-war Status Indicating a Post-war Crisis.

BACKGROUND: As the surgical burden grows, increasing patient safety during anesthesia and surgery becomes a major global public health priority. Anesthesia can be safely administered in higher-income countries, yet it is more challenging in third-world countries. This study focuses on Sudan, a third-world country, and its unmet anesthetic needs before the current war and how these needs might compromise the post-war status. AIM: The aim of this study is to compare Sudan's outstanding anesthesia requirements to the World Health Organization's safe anesthesia practice standards in terms of workforce, medications, equipment, and anesthesia conduct. METHODS: This study was carried out in four hospitals (Wad Medani Teaching Hospital, Wad Medani Maternity Hospital, Gezira Centre for Renal and Urological Surgeries, and the National Centre for Pediatric Surgeries) in Wad Medani, two of which were referral and two were state-run. Each hospital from every category was identified using a convenience sampling technique. The World Health Organization-World Federation of Societies of Anesthesiologists International Standard and earlier regional African publications were used to determine the minimum predicted safe anesthesia needs. RESULTS: The results of our study demonstrate that overall, the hospitals surveyed fulfilled the minimum standards set by the World Health Organization and the World Federation of Societies of Anesthesiologists (WHO-WFSA) for safe anesthesia practice by 73% with no significant difference in the safety of anesthesia practice between state and referral hospitals. CONCLUSIONS: The state of safe anesthesia care in Wad Medani hospitals surveyed fell well short of the expected minimal criteria due to important requirements such as patient monitoring indicators, the inaccessibility of life-saving facilities such as defibrillators, and difficult intubation instruments. More importantly, the conduct of anesthesia was far below the standard.

Cost effectiveness of malaria vector control activities in Sudan.

BACKGROUND: Malaria vector control activities in Sudan rely largely on Long-Lasting Insecticidal Nets (LLINs), Indoor Residual Spray (IRS) and Larval Source Management (LSM). The present study attempted to determine cost effectiveness of inputs and operations of vector control interventions applied in different environmental settings in central and eastern Sudan, as well as their impact. METHODS: The inputs utilized and cost of each vector control activity, operational achievements and impact of the applied malaria vector control activities; IRS, LLINs and LSM were determined for eight sites in Al Gazira state (central Sudan) and Al Gadarif state (eastern Sudan). Operational costs were obtained from data of the National Malaria Control Program in 2017. Impact was measured using entomological indicators for Anopheles mosquitoes. RESULTS: The total cost per person per year was $1.6, $0.85, and $0.32 for IRS, LLINs and LSM, respectively. Coverage of vector control operations was 97%, 95.2% and 25-50% in IRS, LLINs and LSM, respectively. Vectorial capacity of malaria vectors showed statistically significant variations (P < 0.034) and ranged 0.294-0.65 in areas implemented LSM in comparison to 0.097-0.248 in areas applied IRS and LLINs, respectively. Both indoor and outdoor biting Anopheles mosquitoes showed noticeable increase that reached 3-12 folds in areas implemented LSM in comparison to areas implemented IRS and LLINs. Annual malaria prevalence was 13.1-21.1% in areas implemented LSM in comparison to 3.20%, 4.77% in areas implemented IRS and LLINs, respectively. CONCLUSION: IRS and LLINs are cost effective control measures due to adequate inputs and organized process. However, the unit cost of LSM intervention per outcome and subsequently the impact is hugely affected by the low coverage. The very weak support for implementation of LSM which includes inputs resulted in weakness of its process and consequently its impact. Implementation of LSM by local government in urban settings is challenged by many factors the most important are maintenance of adequate stable level of funding, un-adequate number of well trained health workers, unstable political and administrative conditions and weak infrastructure. These challenges are critical for proper implementation of LSM and control of malaria in urban settings in Sudan.

Noncoding RNAs as therapeutic targets in autophagy-related diabetic cardiomyopathy.

Diabetic cardiomyopathy, a multifaceted complication of diabetes mellitus, remains a major challenge in clinical management due to its intricate pathophysiology. Emerging evidence underscores the pivotal role of autophagy dysregulation in the progression of diabetic cardiomyopathy, providing a novel avenue for therapeutic intervention. Noncoding RNAs (ncRNAs), a diverse class of regulatory molecules, have recently emerged as promising candidates for targeted therapeutic strategies. The exploration of various classes of ncRNAs, including microRNAs (miRNAs), long noncoding RNAs (lncRNAs), and circular RNAs (circRNAs) reveal their intricate regulatory networks in modulating autophagy and influencing the pathophysiological processes associated with diabetic cardiomyopathy. The nuanced understanding of the molecular mechanisms underlying ncRNA-mediated autophagic regulation offers a rationale for the development of precise and effective therapeutic interventions. Harnessing the regulatory potential of ncRNAs presents a promising frontier for the development of targeted and personalized therapeutic strategies, aiming to ameliorate the burden of diabetic cardiomyopathy in affected individuals. As research in this field advances, the identification and validation of specific ncRNA targets hold immense potential for the translation of these findings into clinically viable interventions, ultimately improving outcomes for patients with diabetic cardiomyopathy. This review encapsulates the current understanding of the intricate interplay between autophagy and diabetic cardiomyopathy, with a focus on the potential of ncRNAs as therapeutic targets.

Is High-Flow Nasal Oxygenation a Game Changer in Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration?: A pilot study.

Objectives: This study aimed to compare the high-flow nasal oxygen (HFNO) and supraglottic airway device (SAD) techniques in oncological patients undergoing endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) to evaluate the efficacy of HFNO in them. Methods: This pilot study was conducted at Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman, from May 2022 to March 2023. Patients undergoing EBUS TBNA under moderate sedation were quasi-randomised into the HFNO and SAD groups. The episodes and duration of hypoxia and the lowest level of oxygen saturation were the primary outcomes measured. Results: A total of 24 patients were included in the study (10 of them were in the HFNO group and 14 were in the SAD group), with an equal number of males and females. The duration of the procedure in both groups was similar (45 ± 20 and 44 ± 17 minutes in the HFNO and SAD groups, respectively). The mean lowest oxygen saturation in the HFNO group was 93.5 ± 4.5%, which was significantly higher than that of the SAD group (90 ± 3%; P <0.001). In both groups, maximum hypoxia occurred during the early phase of the procedure. However, the HFNO and SAD groups were similar in terms of the cumulative duration of hypotension (140 versus 95 seconds, respectively) and bradycardia (25 versus 40 seconds, respectively). Conclusion: HFNO is a good alternative to SAD and could be used safely and efficiently in patients undergoing EBUS TBNA.

Comprehensive performance evaluation of ligand-binding assay-LC-MS/MS method for co-dosed monoclonal anti-SARS-CoV-2 antibodies (AZD7442).

Aims: AZD7442 is a combination SARS-CoV-2 therapy comprising two co-dosed monoclonal antibodies. Materials & methods: The authors validated a hybrid ligand-binding assay-LC-MS/MS method for pharmacokinetic assessment of AZD7442 in human serum with nominal concentration range of each analyte of 0.300-30.0 µg/ml. Results: Validation results met current regulatory acceptance criteria. The validated method supported three clinical trials that spanned more than 17 months and ≥720 analytical runs (∼30,000 samples and ∼3000 incurred sample reanalyses per analyte). The data generated supported multiple health authority interactions, across the globe. AZD7442 (EVUSHELD) was approved in 12 countries for pre-exposure prophylaxis of COVID-19. Conclusion: The results reported here demonstrate the robust, high-throughput capability of the hybrid ligand-binding assay-LC-MS/MS approach being employed to support-next generation versions of EVUSHELD, AZD3152.

The measurement of antibodies in human body fluids (e.g., blood, serum) has historically been tied to laboratory tests that may face operational limitations, including susceptibility to interference from other blood components and a reliance on unique reagents that can take months to produce. As such, there is a pursuit of alternative analytical methods to more accurately detect and measure antibody drugs from complex matrices. In the method, the authors describe different techniques that once combined were used to capture, separate, filter, fragment and then detect and measure the co-dosed antibody drugs. This method has been validated in accordance with current health authority guidelines and has been used to support three clinical trials that spanned more than 17 months; that is, the validated method was used to analyze nearly 30,000 serum samples from more than 2000 patients. Collectively, the results reported here demonstrate the robustness and high-throughput capability of this analytical approach.

Magnetocaloric effect modeling of dysprosium-transition metal based intermetallic alloys for magnetic refrigeration application using hybrid genetic algorithm based support vector regression intelligent method.

Intermetallic alloy containing rare earth dysprosium ions with the associated unfilled 4f shell electrons and sub-lattice of 3d-transition metal, results into fascinating magnetic properties which are useful for green refrigeration technological application. Magnetocaloric effect remains the fundamental principle upon which magnetic refrigeration technology is based while this cooling technology has advantages of cost effectiveness, high efficiency and environmental friendliness as compared with the existing conventional gas compression systems. Maximum magnetic entropy change (which controls the hugeness of magnetocaloric effect) of intermetallic alloy Dy-T-X (where T = transition metal and X = any other metal or nonmetal) is modeled in this work using hybrid genetic algorithm based support vector regression (GSVR) computational intelligent method with applied magnetic field, ionic concentration and ionic radii descriptors. The developed GSVR-G model with kernel Gaussian function outperforms GSVR-P model with polynomial function with improvement of 85.23%, 78.82% and 78.67% on the basis of the computed correlation coefficient (CC), mean absolute error (MAE) and root mean square error (RMSE) on testing sample, respectively. The developed model further investigates the influence of applied external magnetic field on magnetocaloric effect of DyCuAl intermetallic alloy. The developed models in this work circumvent experimental challenges of magnetocaloric effect determination while the recorded precision of the developed model further opens doors for possible exploration of these intermetallic compounds for addressing environmental challenges associated with the present system of cooling.

Knowledge and Awareness of Systemic Lupus Erythematosus Among the Population of Jeddah, Saudi Arabia: A Cross-Sectional Study.

Background The immune system, composed of various molecules and cells, protects humans from cancer and pathogens. A breach of tolerance, known as autoimmune disease (AD), is the root of these diseases. Systemic lupus erythematosus (SLE) is an autoimmune condition characterized by chronic inflammation, causing tissue damage in various organ systems. The disease is influenced by hormonal, environmental, and genetic factors. The pathophysiology is unclear, and 20% to 30% of patients have a persistent illness. SLE affects young females more than males, and treatments focus on organ manifestations. Despite advancements and better diagnoses, SLE continues to contribute significantly to morbidity and early mortality. Objective This study aims to assess knowledge of SLE among the general population of Jeddah, Saudi Arabia. Methodology An online cross-sectional survey using Google Forms was conducted for Jeddah residents aged 18 and above. The survey was open for responses from August 2023 to October 2023. Results The study included 479 participants, with 19 (25%) males and 57 (75%) females diagnosed with SLE. The majority of these individuals were housewives and unemployed. The majority were married (46, 60.5%), with only 25 (32.9%) being single. Among healthy participants, there were 173 (42.9%) males and 230 (57.1%) females, with a majority being housewives and government employees (95, 23.6%). Singles accounted for 124 (30.8%), while married individuals constituted 253 (62.8%). Among the healthy population respondents, 254 (63%) lacked knowledge about SLE treatment, while 40 (52.6%) SLE patients believed that a combination of chemotherapy, malaria medication, and steroids was the best treatment. The study found that 393 (82%) of the sample had heard about SLE, and 250 (52%) believed it was not a contagious disease. More than 30 were unaware of SLE. The majority of the respondents felt they needed more awareness and health promotion about SLE, with 410 (85.77%) stating they needed more promotion. The majority of the people believed SLE was dangerous to some extent. Conclusions This study revealed the need and necessity of awareness of SLE among the general community of Jeddah. We advocate undertaking disease awareness programs and activities to increase general community knowledge and awareness of SLE in the city of Jeddah.

The Association Between Preoperative Insulin-Like Growth Factor 1 Levels and the Total Body Weight Loss in Women Post Laparoscopic Sleeve Gastrectomy.

BACKGROUND: Despite the well-described optimal initial clinical response of sleeve gastrectomy (SG) in the treatment of obesity, some patients do not achieve optimal initial clinical response. Insulin-like growth factor-1 (IGF-1) has currently shown an association with post-bariatric surgery weight loss. This study aimed to assess the IGF-1 levels in female patients with obesity, the change after surgery, and their association with the metabolic profile and weight loss after surgery. PATIENTS AND METHODS: This was a prospective study that was conducted on adult female patients who were recruited for SG. The patients underwent clinical and laboratory investigations that included the IGF-1 measurement. At the 1-year follow-up, the same clinical and laboratory measures were repeated. RESULTS: This study included 100 female patients. At the 1-year follow-up, there was a statistically significant reduction in body mass index (BMI) (p < 0.001), fasting HbA1C levels (p < 0.001), and triglycerides (p < 0.001), as well as a statistically significant increase in HDL (p < 0.001) and IGF-1 (p < 0.001). Multiple regression analysis revealed that, among the patients baseline characteristics, the significant predictors for the percentage of total weight loss (%TWL) were the patients' BMI (p < 0.001) and IGF-1 levels (p < 0.001). The ROC curve showed that an IGF1 cutoff value of ≤ 23 ng/ml detected suboptimal initial clinical response, with a sensitivity of 95.35% and a specificity of 100%. CONCLUSION: This study underscores the significant impact of SG on weight loss and metabolic improvements in female patients. Baseline IGF-1 levels emerged as a crucial predictor of optimal initial clinical response.

Digital image determination of copper in food and water after preconcentration and magnetic tip separation for in-cavity desorption/color development.

A new analytical method for measuring copper in food and water was developed and validated, employing a solid-phase extraction (SPE) technique combined with digital-image-based (DIB) detection. A novel magnetic adsorbent of zinc ferrite/Citrullus colocynthis biochar (ZF@C.BC) was used to preconcentrate copper. A magnetic tip was used to separate the copper-loaded adsorbent from the extraction medium and to dispense it to the DIB plate. In-situ desorption and development of the spot color with iodide-starch reagent were carried out, and a digital image of the developed spots was captured using a smartphone and processed using ImageJ software. The copper adsorption capacity was 91.3 mg g-1. Desorption was effected using a 0.3 mol L-1 hydrochloric acid. The preconcentration factor was 300, the limit of detection was 4.8 µg L-1, the linearity was 16-600 µg L-1 and the sample throughput was 12 h-1. The developed approach was validated by analyzing food and water samples, confirming recoveries ≥ 91 % and 88 %, respectively, with RSD ≤ 8.4 %, n = 3.

Activating Mn Sites by Ni Replacement in α-MnO2.

Transition metal oxides are characterized by an acute structure and composition dependent electrocatalytic activity toward the oxygen evolution (OER) and oxygen reduction (ORR) reactions. For instance, Mn containing oxides are among the most active ORR catalysts, while Ni based compounds tend to show high activity toward the OER in alkaline solutions. In this study, we show that incorporation of Ni into α-MnO2, by adding Ni precursor into the Mn-containing hydrothermal solution, can generate distinctive sites with different electronic configurations and contrasting electrocatalytic activity. The structure and composition of the Ni modified hollandite α-MnO2 phase were investigated by X-ray absorption spectroscopy (XAS), X-ray diffraction (XRD), transmission electron microscopy coupled to energy-dispersive X-ray spectroscopy (TEM-EDX), inductively coupled plasma-optical emission spectroscopy (ICP-OES), and X-ray photoelectron spectroscopy (XPS). Our analysis suggests that Mn replacement by Ni into the α-MnO2 lattice (site A) occurs up to approximately 5% of the total Mn content, while further increasing Ni content promotes the nucleation of separate Ni phases (site B). XAS and XRD show that the introduction of sites A and B have a negligible effect on the overall Mn oxidation state and bonding characteristics, while very subtle changes in the XPS spectra appear to suggest changes in the electronic configuration upon Ni incorporation into the α-MnO2 lattice. On the other hand, changes in the electronic structure promoted by site A have a significant impact in the pseudocapacitive responses obtained by cyclic voltammetry in KOH solution at pH 13, revealing the appearance of Mn 3d orbitals at the energy (potential) range relevant to the ORR. The evolution of Mn 3d upon Ni replacement significantly increases the catalytic activity of α-MnO2 toward the ORR. Interestingly, the formation of segregated Ni phases (site B) leads to a decrease in the ORR activity while increasing the OER rate.

Continent-wide parallel urban evolution of increased heat tolerance in a common moth.

Urbanization and its urban-heat-island effect (UHI) have expanding footprints worldwide. The UHI means that urban habitats experience a higher mean and more frequent extreme high temperatures than rural habitats, impacting the ontogeny and resilience of urban biodiversity. However, many organisms occupy different microhabitats during different life stages and thus may experience the UHI differently across their development. While evolutionary changes in heat tolerance in line with the UHI have been demonstrated, it is unknown whether such evolutionary responses can vary across development. Here, using common-garden-reared Chiasmia clathrata moths from urban and rural populations from three European countries, we tested for urban evolution of heat shock tolerance in two life stages: larvae and adults. Our results indicate widespread urban evolution of increased heat tolerance in the adult stage only, suggesting that the UHI may be a stronger selective agent in adults. We also found that the difference in heat tolerance between urban and rural populations was similar to the difference between Mid- and North-European regions, suggesting similarity between adaptation to the UHI and natural, latitudinal temperature variation. Our observations incentivize further research to quantify the impact of these UHI adaptations on fitness during urbanization and climate change, and to check whether life-stage-specific adaptations in heat tolerance are typical of other ectothermic species that manage to survive in urbanized settings.

Seasonal variations in the distribution of aliphatic hydrocarbons in surface sediments from the Selangor River, Peninsular Malaysia's West Coast.

The seasonal variation of petroleum pollution including n-alkanes in surface sediments of the Selangor River in Malaysia during all four climatic seasons was investigated using GC-MS. The concentrations of n-alkanes in the sediment samples did not significantly correlate with TOC (r = 0.34, p > 0.05). The concentrations of the 29 n-alkanes in the Selangor River ranged from 967 to 3711 µg g-1 dw, with higher concentrations detected during the dry season. The overall mean per cent of grain-sized particles in the Selangor River was 85.9 ± 2.85% sand, 13.5 ± 2.8% clay, and 0.59 ± 0.34% gravel, respectively. n-alkanes are derived from a variety of sources, including fresh oil, terrestrial plants, and heavy/degraded oil in estuaries. The results of this study highlight concerns and serve as a warning that hydrocarbon contamination is affecting human health. As a result, constant monitoring and assessment of aliphatic hydrocarbons in coastal and riverine environments are needed.

Exploring factors influencing patient activation in Saudi rheumatoid arthritis patients: A Nationwide Cross-Sectional Survey-Results from the COPARA study.

OBJECTIVES: To evaluate patient activation in rheumatoid arthritis (RA) patients using patient activation measure 13 (PAM-13) on a national level in Saudi Arabia. METHOD: A national survey was administered across multiple centers in Saudi Arabia. Patient activation was assessed using the PAM-13. The Compliance Questionnaire for Rheumatology (CQR) and the RA Impact of Disease (RAID) tool were also administered. The data from the survey were analyzed, and the results were stratified based on activation level. All factors affecting patient activation were explored and reported. RESULTS: A total of 1241 participants were included. Most of the patients were females (85%), the mean age was 47 (±14), and most patients lived in the central region (47%). The mean (±standard deviation) patient activation score was 578.7 (±13.0). Patient activation was affected by multiple factors: demographic characteristics, such as education, with a beta value of 1.11 (95% confidence interval [CI] 0.64 ̶1.58, p < .001). Higher CQR scores were associated with higher activation levels, with a beta value of 2.61 (95% CI 0.80 ̶4.44, p = .005), and higher RAID scores were associated with lower activation levels, with a beta value of 3.13 (95% CI 1.36 ̶4.91, p = .001). CONCLUSIONS: Patient activation was affected by several demographic characteristics and the impact of RA. A higher activation may improve compliance. Future longitudinal studies are required to confirm these findings and should explore the underlying mechanism of these effects.

Discontinuation of Levetiracetam and Valproic Acid Due to Adverse Effects in Early Post-traumatic Seizure Prophylaxis.

INTRODUCTION: Levetiracetam (LEV) and valproic acid (VPA) are two anti-epileptic drugs (AEDs) routinely used for post-traumatic seizure (PTS) prophylaxis at our institution. In our practice, VPA is used for its beneficial effects on behavioral agitation and headaches, but it is also associated with abnormal liver function tests (LFTs). Both medications may be associated with thrombocytopenia. There is less literature comparing the adverse effect profiles and discontinuation rates of LEV and VPA in the context of PTS prophylaxis. We conducted a quality improvement (QI) analysis to determine the safety of LEV and VPA for traumatic brain injury (TBI) patients at our institution. In particular, our QI analysis involved calculating the rates of discontinuation or change of drug regimen due to the adverse effects. METHODS: Our QI analysis focused on patients treated for TBI at our institution during a six-year period. We recorded the AED used and if the AED was discontinued or switched due to thrombocytopenia, behavioral agitation, headaches, or elevated LFTs (including elevated aspartate aminotransferase or alanine aminotransferase values). We also recorded the incidence of early PTS, defined as seizures within seven days of the TBI. RESULTS: Our QI analysis included patients with a mean age of approximately 49 years with nearly 75% males. The mean Glasgow Coma Scale (GCS) score was 12.88, with 73.11% of patients having a mild GCS. The three leading injury mechanisms were fall, assault, and motor vehicle collision. The three leading types of TBI were traumatic subarachnoid hemorrhage, subdural hematoma, and cerebral contusion. Among patients with no prior history of seizures, we found an early PTS incidence of 7.28%. For patients administered LEV and VPA, 0.11% (1/898) and 3.85% (4/104) had the medication discontinued or changed because of thrombocytopenia (p < 0.001), respectively. For patients on LEV, 4.01% (36/898) and 1.78% (16/898) had the medication discontinued or changed because of behavioral agitation and headaches, respectively. For patients on VPA, 2.88% (3/104) had the medication discontinued or changed because of hepatotoxicity. In total, 5.90% versus 6.73% (p > 0.5) of patients on LEV and VPA, respectively, had their medication regimens changed due to the adverse effects. CONCLUSIONS: The incidence of early PTS in our patients is within the range of what has been reported in the literature. The rate of discontinuation of LEV and VPA on account of adverse events is low in the context of PTS prophylaxis. Both medications had similar overall rates of discontinuation. VPA was discontinued more frequently than LEV due to thrombocytopenia, but discontinuation was not common in either case. LEV is associated with behavioral agitation and headaches, which makes VPA a desirable alternative for patients suffering from these symptoms.

Exploring Impact of Multidisciplinary Care on Patient Activation in Saudi Rheumatoid Arthritis Patients: A Cross-Sectional Survey-Extended Results from the COPARA National Project.

Introduction: Multidisciplinary setting in healthcare provide positive patient outcomes. Objective: To evaluate the impact of specialized rheumatology clinics (multidisciplinary settings) on the activation and engagement of rheumatoid arthritis (RA) patients. Material and Methods: This cross-sectional survey assessed patient activation using the patient activation measure-13. Participants attending Specialized Rheumatology Clinics (SRC multidisciplinary clinics) were compared with age- and sex-matched patients attending Standard of Care (SOC). The study was observational in nature, assessing several demographic and therapeutic options and their relation to the clinical setting and patient activation. Results: This study included 117 SRC matched RA patients with 117 SOC. The majority of the included patients were female (n=211, 90.2%), >40 years of age (n=177, 75.6%), and had intermediate-to-high education (n=147, 62.8%). Patients in the SRC were also more likely to have activation levels 3 and 4 with an odds ratio of 3.194 (95% confidence interval [CI] 1.835-5.562, p<0.001). In addition, SRC participants were more likely to be in levels 3 and 4 activation, even after adjustment for confounding variables, with an adjusted odds ratio of 2.401 (95% CI 1.121-4.758, p=0.012) and 2.175 (95% CI 1.127-4.196, p=0.020), respectively. Conclusion: Establishing SRC for RA patients seems to have a positive impact on patient activation and engagement and adds to the previously explored benefits of multidisciplinary care in chronic disease management.

In response to the Saudi healthcare reform: a cross-sectional study of awareness of and attitudes toward the public health model among health students.

Background: Saudi Arabia's health sector is experiencing a significant transformation toward an emphasis on the public health model. This model is a population-based approach to preventing and controlling disease, and its importance becomes evident during infectious outbreaks and pandemics, such as COVID-19. This study aimed to assess the awareness and attitudes of health students in Jazan toward the public health model. Methods: This study applied a cross-sectional online survey. Data were collected from 3-18 November 2020 using Google Forms. A convenience sampling method was used with a final sample of 425 participants. Results: Most participants (71%) were aware of the public health model, with an average score of 11.36 out of 16. Multiple regression analysis revealed a significant association between the awareness level of the public health model and participants' demographics, namely, gender, major of study, year of study, and prior training in public health. Participants who completed public health training (ß = 0.220) had higher awareness scores than others. On the other hand, participants from public health (ß = -0.342), medicine (ß = 0.164), and nursing in Jazan (ß = 0.128) had higher awareness of the public health model than the reference group (Nursing at Addayer College). Addayer is an area located in the rural northeast of the Jazan region. In addition, final-year students (ß = 0.113) had higher awareness of the public health model than the reference group (year 2 pre-final students). Female participants (ß = -0.142) had lower awareness of the public health model than male participants. Most participants (95.3%) believed that the clinical care and public health models are essential for promoting people's health. However, 4.7% of participants believed that clinical health care is more important than public health. Conclusion: Health students, who are future healthcare professionals, must understand and value the public health model to support the planned health system reforms. It is recommended to evaluate how the education and training of students in public health, medicine, and nursing in Jazan impact the understanding and views of this cohort on the public health model compared to those of students in other health-related majors.

Analyzing Cardiovascular Characteristics of Patients Initially Diagnosed with Breast Cancer in Saudi Arabia.

Introduction Cancer is a condition where abnormal cells proliferate uncontrollably, leading to metastasis, which can be related to death. Breast cancer is the most prevalent type among women worldwide. Early detection with screening mammography has contributed to the decline in breast cancer incidence and mortality. Breast cancer patients are more likely to develop cardiovascular disease, with elderly patients dying from complications. Understanding the patients' cardiovascular status prior to treatment is essential. The study's objective was to evaluate the cardiovascular characteristics of women with breast cancer at diagnosis within the designated time frame of one year. Methodology This was a retrospective study that focused on patients in Taif City, Saudi Arabia, who were initially diagnosed with primary breast cancer over a span of one year. The inclusion criteria encompassed eligible patients, while those not meeting the criteria were excluded. Data extraction from patients' records was conducted, and the analysis was executed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Results This study analyzed the cardiovascular attributes of breast cancer patients, focusing on 136 female cases. The study found significant patterns concerning cardiovascular risk factors in breast cancer patients, categorized by menopausal status. Premenopausal female cases had a mean age of 43.09 ± 8.31 years, while postmenopausal patients had an average age of 58.07 ± 11.70 years. Postmenopausal patients had a higher prevalence of overweight/obesity, irregular menstrual cycles, type II diabetes, hypertension, and hyperlipidemia compared to their premenopausal counterparts. No significant differences were found between the two groups regarding low-density lipoprotein (LDL) cholesterol levels, axillary lymph node metastasis, or distant metastasis. This study emphasized the importance of regular check-ups for menopausal women to detect potential health complications early. Conclusion In summary, breast cancer is a global health concern, and understanding its impact on the cardiovascular system is crucial for comprehensive patient care. A study in Saudi Arabia found associations between cardiovascular risk factors and menopausal status in breast cancer patients. Postmenopausal patients had more prevalent risk factors, emphasizing the need for proactive assessment and management. Age-appropriate screenings and interventions are essential. Integrated healthcare approaches should consider the interplay between breast cancer and cardiovascular health, with medical professionals vigilant in evaluating and addressing risk factors to mitigate complications and optimize long-term outcomes.