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BACKGROUND: Medical research productivity is globally increasing, with a lagging progress in third-world countries due to significant challenges, including inadequate training and brain drain. Syria had been showing a slow upward trend until the war broke out and severely hindered academic growth and productivity. A deeper understanding of the factors influencing research productivity in this context are fundamental to guide educational policies and resource allocation. Previous cross-sectional studies that evaluated the perspectives of Syrian academics on the issue were limited by the small sample size of published healthcare workers, making it difficult to identify the factors that enabled them to pursue research. METHODS: To address this challenge, we employed a case-control design. We isolated published early-career Syrian healthcare workers and compared their characteristics and perceptions to unpublished matched controls. Authors in the fields of medicine, dentistry, and pharmacy affiliated with any Syrian University were identified through an extensive search of PubMed and Google Scholar.These authors were invited to complete a questionnaire that covered participants' research contributions, alongside their self-assessed knowledge, attitudes, and barriers towards research. The questionnaire was publicly published to recruit an equal sample of matching controls, with half consisting of unpublished researchers and the other half of participants without prior research contributions. RESULTS: Six-hundred-sixteen participants were recruited. Their knowledge, attitudes, and perceived barriers explained 46% and 34% of the variability in research involvement and publication, respectively (P < 0.001). Getting involved in and publishing research studies associated with higher research-related knowledge and attitudes (P < 0.001). Respondents' assessment of research-related barriers and their academic scores did not differ between cases and controls. Superior research-related knowledge and attitudes were associated with male gender, higher English competency, and better internet connectivity. Meanwhile, extracurricular training and mentors' support were associated with more positive research-related attitudes and less perceived barriers. CONCLUSIONS: Research productivity of medical professionals in Syria exhibits a positive correlation with their knowledge and favorable attitudes towards medical research. Noteworthy, the demographic variations are linked to disparities in research-related knowledge and motivation. In conclusion, these results suggest a potential avenue for enhancement through concentrated efforts on improving extracurricular training interventions and mentors' support.
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Pesquisa Biomédica , Síria , Humanos , Estudos de Casos e Controles , Masculino , Feminino , Adulto , Pessoal de Saúde/educação , Inquéritos e Questionários , Conflitos Armados , EficiênciaRESUMO
Wireless sensor networks (WSNs) are essential for a wide range of applications, including environmental monitoring and smart city developments, thanks to their ability to collect and transmit diverse physical and environmental data. The nature of WSNs, coupled with the variability and noise sensitivity of cost-effective sensors, presents significant challenges in achieving accurate data analysis and anomaly detection. To address these issues, this paper presents a new framework, called Online Adaptive Kalman Filtering (OAKF), specifically designed for real-time anomaly detection within WSNs. This framework stands out by dynamically adjusting the filtering parameters and anomaly detection threshold in response to live data, ensuring accurate and reliable anomaly identification amidst sensor noise and environmental changes. By highlighting computational efficiency and scalability, the OAKF framework is optimized for use in resource-constrained sensor nodes. Validation on different WSN dataset sizes confirmed its effectiveness, showing 95.4% accuracy in reducing false positives and negatives as well as achieving a processing time of 0.008 s per sample.
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BACKGROUND: Enhanced recovery programmes are associated with improved short-term outcomes following liver surgery. The impact of enhanced recovery programmes on medium- and long-term outcomes is incompletely understood. This study aimed to assess the impact of an enhanced recovery programme on long-term survival in patients undergoing surgery for colorectal liver metastases. METHODS: At a tertiary hepatobiliary centre, we analysed short-, medium- and long-term outcomes in consecutive patients undergoing liver resection for colorectal liver metastases. A five-year retrospective review was carried out comparing the enhanced recovery programme to standard care. RESULTS: A total of 172 patients were included in the analysis: 87 on standard care and 85 on an enhanced recovery programme. Open surgery was performed in 122 patients: 74 (85.1%) and 48 (56.5%) patients in the standard care and enhanced recovery programme, respectively (p < 0.001). There was a significant reduction in the median (IQR) length of hospital stay in the enhanced recovery programme compared with standard care (7 (5) days vs. 8 (3) days, p = 0.0009). There was no significant difference in survival between standard care and the Enhanced Recovery Programme at one (p = 0.818), three (p = 0.203), and five years (p = 0.247). CONCLUSION: An enhanced recovery programme was associated with a reduced length of hospital stay. There was no effect on the one-, three- and five-year survival.
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Neoplasias Colorretais , Neoplasias Hepáticas , Humanos , Hepatectomia , Estudos Retrospectivos , Tempo de Internação , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/patologiaRESUMO
Energy and security are major challenges in a wireless sensor network, and they work oppositely. As security complexity increases, battery drain will increase. Due to the limited power in wireless sensor networks, options to rely on the security of ordinary protocols embodied in encryption and key management are futile due to the nature of communication between sensors and the ever-changing network topology. Therefore, machine learning algorithms are one of the proposed solutions for providing security services in this type of network by including monitoring and decision intelligence. Machine learning algorithms present additional hurdles in terms of training and the amount of data required for training. This paper provides a convenient reference for wireless sensor network infrastructure and the security challenges it faces. It also discusses the possibility of benefiting from machine learning algorithms by reducing the security costs of wireless sensor networks in several domains; in addition to the challenges and proposed solutions to improving the ability of sensors to identify threats, attacks, risks, and malicious nodes through their ability to learn and self-development using machine learning algorithms. Furthermore, this paper discusses open issues related to adapting machine learning algorithms to the capabilities of sensors in this type of network.
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Redes de Comunicação de Computadores , Tecnologia sem Fio , Algoritmos , Segurança Computacional , Fontes de Energia Elétrica , Aprendizado de MáquinaRESUMO
Background/objective: Burnout is a condition in which a person feels physically fatigued and mentally drained. It occurs after a long period of work-related stress and may lead to mental disorders, such as depression and anxiety. Therefore, healthcare providers especially require early intervention. Regular physical activity has been reported to benefit individuals with mental illness, suggesting that a relationship between physical activity and burnout might exist. Hence, this study's objective was to analyze the relationship between physical activity and burnout among respiratory therapists and student interns in Jeddah City, Saudi Arabia. Methods: A cross-sectional descriptive study with respiratory therapists and interns working in public and private hospitals was conducted from November 2, 2020, to November 27, 2020. Participants responded to an electronic survey consisting of the Maslach Burnout Inventory - Human Services Survey for Medical Personnel, which measures the burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. They also completed the International Physical Activity Questionnaire - Long Form and a demographic questionnaire. Results: Among the 250 eligible respiratory therapists and interns, data from the 152 respondents who completed the electronic survey were analyzed. Although no association between physical activity and burnout was found, a significant effect of the novel coronavirus disease 2019 (COVID-19) on physical activity and significant associations of high burnout (emotional exhaustion) with nationality and smoking were found. Conclusion: No association was found between burnout level and physical activity. Confounding factors, such as the COVID-19 pandemic during the study's data collection and analyses, likely contributed to the study's findings.
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Wireless Sensor Networks (WSNs) continue to face two major challenges: energy and security. As a consequence, one of the WSN-related security tasks is to protect them from Denial of Service (DoS) and Distributed DoS (DDoS) attacks. Machine learning-based systems are the only viable option for these types of attacks, as traditional packet deep scan systems depend on open field inspection in transport layer security packets and the open field encryption trend. Moreover, network data traffic will become more complex due to increases in the amount of data transmitted between WSN nodes as a result of increasing usage in the future. Therefore, there is a need to use feature selection techniques with machine learning in order to determine which data in the DoS detection process are most important. This paper examined techniques for improving DoS anomalies detection along with power reservation in WSNs to balance them. A new clustering technique was introduced, called the CH_Rotations algorithm, to improve anomaly detection efficiency over a WSN's lifetime. Furthermore, the use of feature selection techniques with machine learning algorithms in examining WSN node traffic and the effect of these techniques on the lifetime of WSNs was evaluated. The evaluation results showed that the Water Cycle (WC) feature selection displayed the best average performance accuracy of 2%, 5%, 3%, and 3% greater than Particle Swarm Optimization (PSO), Simulated Annealing (SA), Harmony Search (HS), and Genetic Algorithm (GA), respectively. Moreover, the WC with Decision Tree (DT) classifier showed 100% accuracy with only one feature. In addition, the CH_Rotations algorithm improved network lifetime by 30% compared to the standard LEACH protocol. Network lifetime using the WC + DT technique was reduced by 5% compared to other WC + DT-free scenarios.
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Redes de Comunicação de Computadores , Tecnologia sem Fio , Algoritmos , Análise por Conglomerados , Aprendizado de MáquinaRESUMO
Myelodysplastic syndromes (MDS) comprise a diverse group of clonal and malignant myeloid disorders characterized by ineffective hematopoiesis, resultant peripheral cytopenias, and a meaningful increased risk of progression to acute myeloid leukemia. A wide array of recurring genetic mutations involved in RNA splicing, histone manipulation, DNA methylation, transcription factors, kinase signaling, DNA repair, cohesin proteins, and other signal transduction elements has been identified as important substrates for the development of MDS. Cytogenetic abnormalities, namely those characterized by loss of genetic material (including 5q- and 7q-), have also been strongly implicated and may influence the clonal architecture which predicts such mutations and may provoke an inflammatory bone marrow microenvironment as the substrate for clonal expansion. Other aspects of the molecular pathogenesis of MDS continue to be further elucidated, predicated upon advances in gene expression profiling and the development of new, and improved high-throughput techniques. More accurate understanding of the genetic and molecular basis for the development of MDS directly provides additional opportunity for treatment, which to date remains limited. In this comprehensive review, we examine the current understanding of the molecular pathogenesis and pathophysiology of MDS, as well as review future prospects which may enhance this understanding, treatment strategies, and hopefully outcomes.
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Predisposição Genética para Doença , Síndromes Mielodisplásicas/etiologia , Síndromes Mielodisplásicas/metabolismo , Biomarcadores , Aberrações Cromossômicas , Evolução Clonal/genética , Descoberta de Drogas , Epigênese Genética , Regulação da Expressão Gênica/efeitos dos fármacos , Estudos de Associação Genética , Humanos , Terapia de Alvo Molecular , Mutação , Síndromes Mielodisplásicas/diagnóstico , Síndromes Mielodisplásicas/terapia , Fenótipo , Prognóstico , Transdução de Sinais/efeitos dos fármacosRESUMO
Aplastic anemia (AA) is rare disorder of bone marrow failure which if severe and not appropriately treated is highly fatal. AA is characterized by morphologic marrow features, namely hypocellularity, and resultant peripheral cytopenias. The molecular pathogenesis of AA is not fully understood, and a uniform process may not be the culprit across all cases. An antigen-driven and likely autoimmune dysregulated T-cell homeostasis is implicated in the hematopoietic stem cell injury which ultimately founds the pathologic features of the disease. Defective telomerase function and repair may also play a role in some cases as evidenced by recurring mutations in related telomerase complex genes such as TERT and TERC. In addition, recurring mutations in BCOR/BCORL, PIGA, DNMT3A, and ASXL1 as well as cytogenetic abnormalities, namely monosomy 7, trisomy 8, and uniparental disomy of the 6p arm seem to be intimately related to AA pathogenesis. The increased incidence of late clonal disease has also provided clues to accurately describe plausible predispositions to the development of AA. The emergence of newer genomic sequencing and other techniques is incrementally improving the understanding of the pathogenic mechanisms of AA, the detection of the disease, and ultimately offers the potential to improve patient outcomes. In this comprehensive review, we discuss the current understanding of the immunobiology, molecular pathogenesis, and future directions of such for AA.
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Anemia Aplástica/etiologia , Anemia Aplástica/metabolismo , Anemia Aplástica/diagnóstico , Animais , Apoptose , Medula Óssea/metabolismo , Medula Óssea/patologia , Aberrações Cromossômicas , Evolução Clonal/genética , Suscetibilidade a Doenças , Hematopoese/genética , Hematopoese/imunologia , Células-Tronco Hematopoéticas/metabolismo , Humanos , Mutação , Telômero/genética , Telômero/metabolismo , Homeostase do Telômero , Trombopoetina/metabolismoRESUMO
OBJECTIVE: Persons with colon cancer experience considerable psychological stress due to physical and social changes brought on by illness, increasing their risk of depressive disorder (DD). We examine the prevalence of DD and depressive symptoms and determine baseline demographic, social, psychological, and physical health correlates. METHODS: A convenience sample of 70 cancer patients in Jeddah, Saudi Arabia, was screened for DD using an abbreviated version of the Structured Clinical Interview for Depression (SCID) and for depressive symptoms using the Hamilton Depression Rating Scale (HDRS). Demographic, psychosocial, psychiatric, and physical health characteristics were also assessed, along with past treatments for colon cancer. Bivariate and multivariate analyses identified predictors of DD and symptoms. RESULTS: The 1-month prevalence of DD was 30.0% (12.9% major depression, 5.7% minor depression, and 11.4% for dysthymia) and significant depressive symptoms were present in 57.1% (HDRS 8 or higher), including having persistent suicidal thoughts for 2 weeks or longer wthin the past month (14.3%) . Low social support and having a co-morbid psychiatric illness (particularly anxiety) independently predicted DD based on the SCID. Saudi nationality, poor financial situation, low social support, and co-morbid psychiatric illness independently predicted depressive symptoms on the HDRS. Surprisingly, stage of cancer, duration of cancer, and treatments for cancer were unrelated to DD or depressive symptoms. CONCLUSIONS: DD and significant depressive symptoms are common in patients with colon cancer in Saudi Arabia, and are predicted by a distinct set of demographic and psychosocial risk factors that may help with identification. Demographic and psychological risk factors were more likely to be associated with depression than cancer characteristics in this sample.
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Ansiedade/epidemiologia , Neoplasias Colorretais/psicologia , Depressão/epidemiologia , Depressão/etiologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Ideação Suicida , Adulto , Idoso , Ansiedade/complicações , Ansiedade/etiologia , Transtornos de Ansiedade/epidemiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/terapia , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Arábia Saudita/epidemiologia , Apoio SocialRESUMO
Background and objective Cosmetic surgery is a field that primarily focuses on the preservation, rebuilding, or improvement of the physical appearance of an individual through surgical and therapeutic methods. This specialization encompasses various interventions, both surgical, such as blepharoplasty, rhinoplasty, and breast augmentation, and non-surgical, including procedures such as chemical peeling, Botox injections, and dermal fillers. This study aims to assess the acceptance of cosmetic surgeries and non-surgical cosmetic procedures and the reasons for non-acceptance in a population from Jazan, Saudi Arabia. Methods This cross-sectional survey study was conducted in the general population of Jazan, Saudi Arabia, between July and August 2023. An online self-administered questionnaire was created using Google Forms and distributed through social media. The acceptance was measured using the Arabic translation of the Acceptance of Cosmetic Surgery Scale (ACSS). Results The mean cosmetic surgery acceptance score was 62.1 ± 25.9, whereas the mean non-surgical procedure acceptance score was 63.7 ± 24.5. Engaged and widowed participants had a higher mean acceptance score for cosmetic surgery, whereas divorced participants had a higher mean acceptance score for non-surgical cosmetic procedures. Higher age was associated with higher acceptance of cosmetic surgery (95% CI: 1-15), while having higher income was associated with lower acceptance (95% CI: -14 to -0.32). A higher level of parental education was associated with lower acceptance of surgical and non-surgical cosmetic procedures (95% CI: -23 to -3.5). The perceived lack of a need for cosmetic procedures was the most commonly cited reason for not accepting these procedures, while religious beliefs were the second most common reason. Conclusion Non-surgical cosmetic procedures generally had higher acceptance than cosmetic surgeries. Age, sex, marital status, income level, familial influence, and prior experience all played significant roles in shaping these attitudes. The perceived lack of a need for the procedures and religious beliefs were common reasons for not accepting cosmetic procedures.
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INTRODUCTION: The effectiveness of extracorporeal membrane oxygenation (ECMO) in treating COVID-19 patients has been variable. To gain a better insight, we examined the outcomes of ECMO in COVID-19 patients using data from the 2020 National Inpatient Sample database. METHODS: We analyzed data from adult hospital admissions where COVID-19 was the primary diagnosis. The primary outcome was all-cause inpatient mortality. Secondary outcomes were length of stay (LOS), cost, and discharge disposition. RESULTS: We identified 1,048,025 COVID-19 admissions, of which 98,528 were on mechanical ventilation (MV), and only 1.8% received ECMO. In-hospital mortality of mechanically ventilated patients who received ECMO was 49%, compared to 59% with no ECMO (p < 0.001). ECMO treatment was associated with a reduced risk of mortality (HR = 0.67, p < 0.0001, CI 0.57-0.79) even after adjustment for confounders and other comorbidities. Patients on ECMO had significantly extended hospital stays and were more likely to be discharged to an acute care facility. Younger and male patients were more likely to receive ECMO treatment. Females had a lower mortality risk, while race and obesity were not associated with an increased risk of death. CONCLUSION: ECMO treatment may offer survival benefits in severe COVID-19. Based on our findings, we suggest early ECMO treatment for patients with a high mortality risk.
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BACKGROUND: Perinatal depression is a mental health disorder that is associated with feelings of hopelessness, despair, and lack of motivation. Its effects on pregnant women are not limited to hemorrhage and hypertension and may lead to maternal mortality. As a result, maternal antidepressant usage during pregnancy has rapidly increased in the United States. Selective serotonin reuptake inhibitors (SSRIs) are considered one of the most prescribed antidepressants. Thus, this study aims to measure the prevalence of SSRI use during pregnancy. METHODS: A retrospective cross-sectional study was carried out in King Abdulaziz Medical City, Jeddah (KAMC-J), Saudi Arabia. The population consisted of all pregnant women aged 18 or older from the period of January 2017 to December 2020 (N=13484). The sampling technique was non-probability consecutive sampling. RESULTS: The study included 13,484 pregnant women, and further analysis revealed that 62 (0.459%) were exposed to at least one type of antidepressant during pregnancy. Of these, 12 (19.35%) had used more than one class of antidepressants. The majority of the sample, comprising 39 (62.90%) women, were between 34 and 44 years old. Furthermore, SSRIs were found to be the most commonly used antidepressant (41, 66.13%). In addition, fluoxetine was the most frequently prescribed antidepressant, with 23 (37.10%) patients receiving this medication. The dosage did not exceed 20 mg for the majority of the patients on SSRIs. CONCLUSION: This study measured the prevalence and patterns of SSRIs and use of different antidepressant classes during pregnancy. After calculating the prevalence of each class of antidepressants among 62 pregnant women exposed to antidepressants, the analysis concluded that SSRIs are the most prescribed antidepressant during pregnancy. This study contributes to the growing body of literature on the use of antidepressants during pregnancy and highlights the need for ongoing research in this area.
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OBJECTIVE: To evaluate the effect of colchicine and high-intensity rosuvastatin in addition to standard of care on the progression of COVID-19 disease in hospitalised patients. DESIGN: A pragmatic, open-label, multicentre, randomised controlled trial conducted from October 2020 to September 2021. Follow-up was conducted at 30 and 60 days. The electronic medical record was used at all stages of the trial including screening, enrolment, randomisation, event ascertainment and follow-up. SETTING: Four centres in the Yale New Haven Health System. PARTICIPANTS: Non-critically ill hospitalised patients with COVID-19. INTERVENTIONS: Patients were randomised 1:1 to either colchicine plus high-intensity rosuvastatin in addition to standard of care versus standard of care alone. Assigned treatment was continued for the duration of index hospitalisation or 30 days, whichever was shorter. PRIMARY AND SECONDARY OUTCOME MEASURES: The prespecified primary endpoint was progression to severe COVID-19 disease (new high-flow or non-invasive ventilation, mechanical ventilation, need for vasopressors, renal replacement therapy or extracorporeal membrane oxygenation, or death) or arterial/venous thromboembolic events (ischaemic stroke, myocardial infarction, deep venous thrombosis or pulmonary embolism) evaluated at 30 days. RESULTS: Among the 250 patients randomised in this trial (125 to each arm), the median age was 61 years, 44% were women, 15% were Black and 26% were Hispanic/Latino. As part of the standard of care, patients received remdesivir (87%), dexamethasone (92%), tocilizumab (18%), baricitinib (2%), prophylactic/therapeutic anticoagulation (98%) and aspirin (91%). The trial was terminated early by the data and safety monitoring board for futility. No patients were lost to follow-up due to electronic medical record follow-up. There was no significant difference in the primary endpoint at 30 days between the active arm and standard of care arm (15.2% vs 8.8%, respectively, p=0.17). CONCLUSIONS: In this small, open-label, randomised trial of non-critically ill hospitalised patients with COVID-19, the combination of colchicine and rosuvastatin in addition to standard of care did not appear to reduce the risk of progression of COVID-19 disease or thromboembolic events, although the trial was underpowered due to a lower-than-expected event rate. The trial leveraged the power of electronic medical records for efficiency and improved follow-up and demonstrates the utility of incorporating electronic medical records into future trials. TRIAL REGISTRATION: NCT04472611.
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Isquemia Encefálica , COVID-19 , Acidente Vascular Cerebral , Feminino , Humanos , Pessoa de Meia-Idade , Masculino , Rosuvastatina Cálcica , SARS-CoV-2 , Colchicina , Resultado do TratamentoRESUMO
Background COVID-19 pandemic represents a significant risk factor for developing, relapsing, or exacerbating pre-existing mental health conditions. This negative impact on mental health results in increasing demand for psychiatric services. This study aimed to explore the effects of COVID-19 pandemic lockdown on the utilization of mental health services in three periods - prior, during, and after the lockdown - compared to the matched weeks in the previous years 2018 and 2019. Materials and Method In this retrospective cohort, quantitative, single-center study, data were collected from electronic medical records, including all patients with referrals\consultations to the psychiatric section prior, during, and after COVID-19 lockdown. Results In total, 2,454 patients were either referred to psychiatric outpatient clinics or needed consultation as inpatients during the study periods. Only 2,326 patients were included in our study. The total number of inpatient consultations was 1,410, with a statistically significant increase during the lockdown (p-value<0.001) and post-lockdown (p<0.016) in comparison to previous years. A significant reduction in outpatient referrals was observed during the lockdown (p=0.005) and post-lockdown period. Psychiatric disorders were identified in most patients (N=1,599), representing 65%, 54%, and 74% of patients in pre-lockdown, lockdown, and post-lockdown periods compared to 71%, 71%, and 76%, respectively, in the previous years. A total of 821 patients manifested symptoms of depression, constituting the largest proportion among all reasons for referral\consultations. The number of patients referred for substance/alcohol use disorders during the lockdown increased compared to patients in the same period in 2019. Suicidal behavior was identified in 70 patients across all study periods, with the lowest number observed in 2020. Conclusion Our findings indicate that during the COVID-19 lockdown, a significant increase in inpatient psychiatric services utilization was observed. Outpatient psychiatric service utilizations were significantly reduced. Implementation of evidence-based policy and protocol to guide mental health challenges in future health emergencies is needed.
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Substance use disorders (SUDs) patients have longer lengths of hospital stay, and more unplanned readmissions than other hospitalized patients. We aim to evaluate SUD-related rehospitalization and length of hospital stay in a major rehabilitation center that serves countries of the Gulf States. In a retrospective cohort study for 16-year data set in Al-Amal Hospital Electronic Health Record in the city of Dammam, Eastern region of Saudi Arabia, patients received services from the SUD treatment programs in the period of January 1, 2005, to December 31, 2021. We used cause-specific Cox proportional hazards regression model to estimate risk of readmission, and general linear model to examine the association between substance use disorders and length of hospital stay. Of the total cohort, 4398 (30.17%) were readmitted within 1 year of discharge date. More than half of the cohort were unemployed patients (52.93%). Patients diagnosed with amphetamine use disorder were 1.36 higher risk of readmission compared to no amphetamine disorder (HR = 1.36; CI (1.04, 1.78) P.02). Patients diagnosed with mental disorder had 7.25 times higher risk of longer hospital stay compared to no mental health disorder (coefficient = 7.25; P < .0001). Amphetamine use disorder increased the risk of readmission. A secondary diagnosis of mental disorders among SUD patients increased length of hospital stay. As a targeted region of amphetamine smuggling in the world, policy and clinical decision-makers in Saudi Arabia and the Gulf States should consider taking proactive steps to minimize the future anticipated high demand for addiction treatment in the region.
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Introduction: Despite the recent development in diagnostic techniques, many surgeons experience unexpected findings during the course of surgery. We aim to examine the incidence of all IFs in abdominal surgery -laparoscopy or laparotomy- and identify possible associations. Methods: This study is a cross-sectional study conducted in Aleppo University Hospital - Department of Surgery. We collected patients' data who underwent abdominal surgery during the period of the two-consecutive years 2018-2019. Results: The data revealed detection of incidental findings during abdominal surgery -which included proper inspection of peritoneal cavity-in 6 out 543 cases (1.1%), whereas only one case included a misdiagnosis event (0.2%). Conclusion: Epidemiological information about IFs in abdominal surgery can be extremely useful for the surgeons on various aspects, and can assist them with being more prepared for the surgery and the possible unexpected lesions that might be encountered. We strongly recommend that further studies with larger numbers of participants are conducted as they can provide more generalizable data.
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Background: Obesity and its complications are associated with several adverse effects that may cause a serious impact on health. Antipsychotics-induced weight gain (AIWG) is one of the major, yet often neglected side effects of first and second generations antipsychotics. Importantly, several researches have shown metformin to be effective in managing weight gain especially, with AIWG. This study investigated the effect of antipsychotics use on weight gain and the theory of metformin concomitant use on the prevention of AIWG. Methods: A retrospective cohort review of the medical records of patients from the psychiatry outpatient clinics in the King Abdulaziz Medical city, a tertiary hospital in Jeddah from May 2016 to August 2021. The population of patients in Psychiatry section was 4,141. The sampling technique was a non-random consecutive sampling technique. Moreover, the included patients' records were divided to group 1 (patients on antipsychotics) and group 2 (patients using antipsychotics with Metformin). Results: According to the study criteria, 395 patients' records were included. A total of 309 (78%) patients were using antipsychotics without metformin, which in this study were depicted as group 1. In addition, a total of 86 (22%) were using antipsychotics with metformin, which in this study were assigned as group 2. Out of Group 1 patients (n = 309), only 67 patients experienced weight loss (21.68%), 43 remained with no weight change (13.92%), and 199 experienced weight gain (64.4%). Out of Group 2 patients (n = 86), 35 patients experienced weight loss (40.7%), 18 patients remained with no weight change (20.93%), and 33 experienced weight gain (38.37%). In addition, group 1 had a mean weight change of 2.5 kg, whereas group 2 had a mean weight change of -0.04 kg. Conclusion: Statistical analysis revealed that patients on antipsychotics alone experienced weight gain, whereas the concomitant use of metformin showed reduction in the weight gain tendency. Thus, study outcomes indicate that concomitant use of metformin with antipsychotics might significantly reduce the AIWG.
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Behavioral addiction is identified as any compulsive, repeated, and persistent behavior that leads to significant and functionally impairing harm or distress. The aim of this study is to determine the prevalence of internet, video-gaming, and pornography addictions among medical students in Western region. In addition, we intend to investigate the relationship between these behavioral addictions with stress and anxiety. Our study was a cross-sectional study with a sample size of 225. The study participants were medical students in their 3rd, 4th, and 5th academic years from five different medical colleges in Western region. The questionnaire included demographics and adapted five different pre-validated scales: Young's Internet Addiction Test - Short Version (IAT-SV), Internet Gaming Disorder Scale 9 - Short Form (IGDS9-SF), (PPC scale), Perceived Stress Scale (PSS), and Generalized Anxiety Disorder 7-item scale (GAD-7). The IAT-SV scale showed: 71 (31.6%) of the participants had normal internet usage, 51 (22.7%) participants showed problematic usage, and 103 (45.8%) used the internet pathologically. The IGDS9-SF scale had observed the following values: 220 participants (97.8%) were non-disordered, and 5 participants (2.2%) were found to be disordered. Statistical analysis showed a highly significant association between stress and problematic pornography consumption (P < 0.01), and internet addiction (P <0.001). Moreover, there was a significant association between anxiety and internet gaming disorder (P < 0.01). This study showed high prevalence of internet addiction and low prevalence of internet gaming disorder. Also, it gave more understanding to a possible association between these behavioral addictions with stress and anxiety.
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Introduction C-reactive protein (CRP) has been reported as a predictor of the severity of acute pancreatitis (AP). However, there is conflicting evidence in the literature. The proposed cut-off values and intervals for best prediction include an absolute value of 150 at 48 hours; an absolute value of 190 at 48 hours; and the interval change in CRP of 90 at 48 hours. The current study assesses the value of CRP at different intervals and cut-offs in predicting complicated acute pancreatitis (CAP) and compares its performance against other available predictors like neutrophil to lymphocyte ratio (NLR); Glasgow scoring system and modified CT severity index (MCTSI). Methods Analysis of prospectively maintained data for index episodes of acute pancreatitis managed in 225 patients over a period of five years (2014-2018) was done. CAP was defined by using revised Atlanta classification and included all the AP patients with local and or systemic complications. It was used as a gold standard. Diagnostic and predictive performance of different biochemical markers and multifactorial scoring systems were determined by analyzing receiving operating curves (ROCs), the area under the curve (AUC), sensitivity, specificity, and predictive values (positive and negative). Results Out of 225 patients, 122 were female while 103 patients were male. CAP developed in 47 patients (20.9%) while 178 (79.1%) patients had mild AP. Overall, in-hospital mortality rate was 1.8% (n=4). ROC analysis demonstrated that CRP at admission had low discriminatory value (AUC= 0.54, p-value=0.74). CRP at 48 hours had AUC of 0.70 (p-value=0.007). At a cut-off of 150, the positive predictive value (PPV) of 150 was 30 %. The PPV of CRP at 48 hours at a cut-off of 190 was 28%. Interval change in CRP at 48 hours greater than 90 had a PPV of 26 %. Further comparison of CRP with other scoring systems like Glasgow scoring system (AUC= 0.65), NL ratio (AUC=0.54), and MCTSI was performed. Among the single predictors, although, NL ratio showed good sensitivity at a cut-off value of 4.7 (87.23%), however, its discriminatory power was negligible (AUC=0.542, p-value=0.513). The overall best performance was achieved by the MCTSI scoring system at a cut-off of 3 (AUC=0.90, sensitivity=83.33 %, specificity=100%, diagnostic accuracy=94.49%). Conclusion CRP measured at admission or at 48 hours has a very limited role in the prediction of CAP. Along with other scoring systems, its negative predictive value should be used to predict cases with mild AP which can help in clinical decision making for early discharge or management of such patients on ambulatory care basis. MCTSI scoring system can be used in cases with high suspicion of CAP.
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BACKGROUND: No clinical studies have evaluated shear bond strength and the clinical failure rates of the rebonded metallic brackets following different enamel-reconditioning methods. The objective of the study was to compare the in vivo clinical failure rate and the in vitro rebond strength of bonded brackets following two enamel surface preparation methods. METHODS: For the in vitro study, 45 extracted human premolars were etched; brackets were bonded using light-cured composite resin. Forty-five premolars were divided into three groups (15 in each group): the initial bonding group (IB group), the rebonding group in which enamel was reconditioned using sandblasting before acid etching (SBE group), and the rebonding group in which enamel was reconditioned using acid etching only (E group). For the in vivo study, 80 premolars in 20 patients (13-18 years old) were rebonded using the same procedures in the SBE group and E group. The two methods were used in all patients using a split-mouth design. The number of failing brackets was quantified over 6 months. Differences were statistically analyzed by one-way analysis of variance, followed by post hoc tests. RESULTS: The mean shear bond strength for the IB, SBE, and E groups was 19.38, 22.37, and 17.31 MPa, respectively. A significant difference was observed in the bond strength of the three evaluated groups (P < 0.001). The differences in the bond strength were significant between the IB group and the SBE group, as well as between the SBE group and the E group. The clinical failure rate for bonded brackets was 10% in the SBE group, and 25% in the E group and this difference was statistically significant (P < 0.001). CONCLUSIONS: Reconditioning of enamel surfaces using both intraoral air abrasion and etching in the rebonding process led to higher rebond strength than using acid etching alone and even higher than the initial brackets bonding. This trial was retrospectively registered at ClinicalTrials.gov (ID: NCT04606043).