Application of different counseling strategies for better adult asthma control.

OBJECTIVE: We aimed to compare the effectiveness of three distinct counseling methods to determine the most effective approach. METHODS: In this prospective cohort study with a two-month follow-up, A group of non-smoking adults, aged 19-60 years, were randomly collected at outpatients clinic with prior asthma diagnosis, based on the forced expiratory volume in one seconds to forced vital capacity ratio (FEV1/FVC) and the guidelines outlined by the Global Initiative for Asthma (GINA), At the baseline assessment, all patients, underwent FEV1/FVC measurements, asthma symptom evaluations using Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), and GINA symptoms control assessment questionnaire, and assessment of pressurized metered-dose inhaler (pMDI) usage. The patients were divided into three groups, each assigned a distinct counseling strategy: traditional verbal counseling, advanced counseling utilizing the Asthma smartphone-application, and a combination of advanced-verbal counseling. We conducted a two-month monitoring period for all three groups. RESULTS: Significant differences (p < .001) were observed among the three counseling groups in ACT, FEV1/FVC ratio, and GINA symptoms control assessment scores from the first month to the second month visit. Regarding ACQ, the study unveiled a noteworthy disparity in ACQ scores during the second week, with a significant difference (p = .025) observed between the verbal and advanced-verbal counseling groups. Similarly, a significant difference (p = .016) was noted between the advanced counseling group and the advanced-verbal counseling groups. CONCLUSION: The study findings indicate that the combining advanced-verbal counseling by incorporating the Asthma smartphone-application alongside traditional verbal counseling is a more effective approach for improving asthma control in adults.

Effects of a team Quality Improvement method in a national clinical audit programme of four clinical specialties in Ministry of Health hospitals in Saudi Arabia.

In 2018, the Ministry of Health (MoH) in Saudi Arabia developed a clinical excellence strategy. An objective was to reduce variation in clinical practices in MoH hospitals, particularly for conditions with high mortality in Saudi Arabia, by applying best practice clinical standards and using the clinical audit process to measure clinical practice. The strategy included working with multiprofessional teams in hospitals to implement improvements needed in clinical practice. To test the feasibility of carrying out national clinical audits in MoH hospitals, audits were carried out in 16 MoH hospitals on four clinical subjects-acute myocardial infarction, major trauma, sepsis, and stroke. Clinical expert groups, including Saudi clinicians and an international clinical expert, developed clinical care standards for the four conditions from analyses of international and Saudi clinical guidelines. The audits were designed with the expert groups. Multiprofessional teams were appointed to carry out the audits in designated MoH hospitals. Data collectors in each hospital were trained to collect data. Workshops were held with the teams on the clinical care standards and how data would be collected for the audits, and later, on the findings of data collection and how to use the improvement process to implement changes to improve compliance with the standards. After 4 months, data collection was repeated to determine if compliance with the clinical care standards had improved. Data collected from each hospital for both cycles of data collection were independently reliably tested. All designated hospitals participated in the audits, collecting and submitting data for two rounds of data collection and implementing improvement plans after the first round of data collection. All hospitals made substantial improvements in clinical practices. Of a total of 84 measures used to assess compliance with a total of 52 clinical care standards for the four clinical conditions, improvements were made by hospital teams in 58 (69.1%) measures. Improvements were statistically significant for 34 (40.5%) measures. The project demonstrated that well-designed and executed audits using evidence-based clinical care standards can result in substantial improvements in clinical practices in MoH hospitals in Saudi Arabia. Keys to success were the improvement methodology built into the audit process and the requirement for hospitals to appoint multiprofessional teams to carry out the audits. The approach adds to evidence on the effectiveness of clinical audits in achieving improvements in clinical quality and can be replicated in national audit programmes.

Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference?

PURPOSE: We aimed to compare the impact of urethral transection after different techniques of bulbar urethroplasty on erectile function outcome. MATERIALS AND METHODS: We retrospectively reviewed the records for 245 patients who underwent different urethroplasty techniques for bulbar urethral stricture between February 2013 and January 2021. The comparison between the transecting and non-transecting cohorts included patients' demographics, clinicopathological features of the urethral stricture, post-urethroplasty erectile function, and success of urethroplasty. Outcomes were erectile function status verified by IIEF5-15 score at preoperative, three months, and 12 months post-surgery. We defined Post-urethroplasty ED as a decrease of 5 points or more. RESULTS: The urethroplasty success rate of the entire cohort was 86.9% after a mean follow-up of 45.59 ± 21 months. Out of 245 patients, 18 (7.3%) experienced 90-day complications. Transecting bulbar urethroplasty techniques were performed in 74 patients (30.2%), while non-transecting techniques were performed in 171 patients (69.8%). there were no differences between the cohorts regarding urethroplasty success (87.8% Vs. 86.5%, Mantel-Cox test p = 0.93) or postoperative complications (8.1% Vs. 7%, p = 0.73). Transient ED was evident in the transecting cohort as reported in 8.1% compared to 2.9% for the non-transecting (p = 0.07).Still, but de novo permanent ED was comparable (4.1% Vs. 2.9%, p = 0.65), for transecting and non-transecting, respectively. CONCLUSIONS: Unfortunately, some patients who undergo transecting techniques of bulbar urethroplasty experience transient erectile dysfunction that can improve within the first post- urethroplasty year; however, de novo permanent erectile dysfunction is uncommon after different techniques of bulbar urethroplasty and is not predisposed by urethral transection.

Efficacy of pentasodium diethylenetriamine pentaacetate in ameliorating anosmia post COVID-19.

BACKGROUND: COVID-19 has been frequently demonstrated to be associated with anosmia. Calcium cations are a mainstay in the transmission of odor. One of their documented effects is feedback inhibition. Thus, it has been advocated that reducing the free intranasal calcium cations using topical chelators such as pentasodium diethylenetriamine pentaacetate (DTPA) could lead to restoration of the olfactory function in patients with post-COVID-19 anosmia. METHODOLOGY: This is a randomized controlled trial that investigated the effect of DTPA on post-COVID-19 anosmia. A total of 66 adult patients who had confirmed COVID-19 with associated anosmia that continued beyond three months of being negative for SARS-CoV-2 infection. The included patients were randomly allocated to the control group that received 0.9 % sodium chloride-containing nasal spray or the interventional group that received 2 % DTPA-containing nasal spray at a 1:1 ratio. Before treatment and 30 days post-treatment, the patients' olfactory function was evaluated using Sniffin' Sticks, and quantitative estimation of the calcium cations in the nasal mucus was done using a carbon paste ion-selective electrode test. RESULTS: Patients in the DTPA-treated group significantly improved compared to the control group in recovery from functional anosmia to hyposmia. Additionally, they showed a significant post-treatment reduction in the calcium concentration compared to the control group. CONCLUSION: This study confirmed the efficacy of DTPA in treating post-COVID-19 anosmia.

Prevalence of pharmacological and non-pharmacological coping mechanisms for anxiety management during the COVID-19 pandemic: investigating the transition to online learning among medical students.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic had a devastating effect on college students worldwide. Here, the authors aimed to determine the prevalence of anxiety and its related coping strategies, provide a theoretical basis for understanding self-prescription, and identify the factors contributing to stress and anxiety in medical students during the pandemic. METHODS: The authors conducted a cross-sectional study among medical students in Saudi Arabia from September to November 2020. They assessed anxiety using the GAD-7 scale based on seven core symptoms. The authors also examined perceived psychological stress using a single-item measure of stress, the factors contributing to stress during the transition to online learning and examinations, and related coping strategies. The Statistical Package for Social Sciences (SPSS) version 26.0 was used to examine the data for both descriptive and inferential analyses. Chi-square test, one-way ANOVA, and univariate linear regression were used to test the research hypotheses. RESULTS: The authors collected and analyzed data from 7116 medical students distributed across 38 medical colleges. Among them, 40% reported moderate to severe anxiety symptoms. Pre-clinical and female students experienced more stress than clinical and male students. 12.19% (n = 868) of respondents reported using medication during their college years. Among those, 58.9% (n = 512) had moderate to severe anxiety, and the most commonly used drug was propranolol (45.4%, n = 394). Among the studied sample, 40.4% (n = 351) decreased their medication use after switching to online teaching. Most students used these medications during the final exam (35.8%, n = 311) and before the oral exam (35.5%, n = 308). In terms of coping strategies, males were much more likely to use substances than females, who mainly resorted to other strategies. CONCLUSIONS: This study provides a national overview of the impact of COVID-19 on the mental health of medical students. The results indicated that the pandemic is associated with highly significant levels of anxiety. These findings can provide theoretical evidence for the need for supportive psychological assistance from academic leaders in this regard.

Association of B-cell lymphoma 2/microRNA-497 gene expression ratio score with metastasis in patients with colorectal cancer: A propensity-matched cohort analysis.

BACKGROUND: Deregulated microRNAs (miRs) significantly impact cancer development and progression. Our in silico analysis revealed that miR-497 and its target gene B-cell lymphoma-2 (BCL2) could be related to poor cancer outcomes. PURPOSE: To investigate the BCL2/miRNA-497 expression ratio in colorectal cancer (CRC) and explore its association with the clinicopathological characteristics and CRC prognosis. METHODS: Archived samples from 106 CRC patients were enrolled. MiR-497 and BCL2 gene expressions were detected by Taq-Man Real-Time quantitative polymerase chain reaction in propensity-matched metastatic and nonmetastatic cohorts after elimination of confounder bias. RESULTS: B-cell lymphoma-2 gene was upregulated in metastatic samples (median = 1.16, 95%CI = 1.09-1.60) compared to nonmetastatic (median = 1.02, 95%CI = 0.89-1.25, p < 0.001). In contrast, lower levels of miR-495 were detected in specimens with distant metastasis (median = 0.05, 95%CI = 0.04-0.20) than nonmetastatic samples (median = 0.54, 95%CI = 0.47-0.58, p < 0.001). Estimated BCL2/miR-497 ratio yielded a significant differential expression between the two cohort groups. Higher scores were observed in metastasis group (median = 1.39, 95%CI = 0.9-1.51) than nonmetastatic patients (median = 0.29, 95%CI = 0.19-0.39, p < 0.001). Receiver operating characteristic curve analysis showed BCL2/miR-497 ratio score to have the highest predictive accuracy for metastasis at presentation. The area under the curve was 0.90 (95%CI = 0.839-0.964, p < 0.001) at cut-off of >0.525, with high sensitivity 81.1% (95%CI = 68.6%-89.4%) and specificity 92.5% (95%CI = 82.1%-97.0%). Also, the ratio score was negatively correlated with disease-free survival (r = -0.676, p < 0.001) and overall survival times (r = -0.650, p < 0.001). Kaplan-Meier curves showed lower survival rates in cohorts with high-score compared to low-score patients. CONCLUSION: The BCL2/miR497 expression ratio is associated with poor CRC prognosis in terms of metastasis and short survival.

Chaotic Search-and-Rescue-Optimization-Based Multi-Hop Data Transmission Protocol for Underwater Wireless Sensor Networks.

Underwater wireless sensor networks (UWSNs) have applications in several fields, such as disaster management, underwater navigation, and environment monitoring. Since the nodes in UWSNs are restricted to inbuilt batteries, the effective utilization of available energy becomes essential. Clustering and routing approaches can be employed as energy-efficient solutions for UWSNs. However, the cluster-based routing techniques developed for conventional wireless networks cannot be employed for a UWSN because of the low bandwidth, spread stay, underwater current, and error probability. To resolve these issues, this article introduces a novel chaotic search-and-rescue-optimization-based multi-hop data transmission (CSRO-MHDT) protocol for UWSNs. When using the CSRO-MHDT technique, cluster headers (CHs) are selected and clusters are prearranged, rendering a range of features, including remaining energy, intracluster distance, and intercluster detachment. Additionally, the chaotic search and rescue optimization (CSRO) algorithm is discussed, which is created by incorporating chaotic notions into the classic search and rescue optimization (SRO) algorithm. In addition, the CSRO-MHDT approach calculates a fitness function that takes residual energy, distance, and node degree into account, among other factors. A distinctive aspect of the paper is demonstrated by the development of the CSRO algorithm for route optimization, which was developed in-house. To validate the success of the CSRO-MHDT method, a sequence of tests were carried out, and the results showed the CSRO-MHDT method to have a packet delivery ratio (PDR) of 88%, whereas the energy-efficient clustering routing protocol (EECRP), the fuzzy C-means and moth-flame optimization (FCMMFO), the fuzzy scheme and particle swarm optimization (FBCPSO), the energy-efficient grid routing based on 3D cubes (EGRC), and the low-energy adaptive clustering hierarchy based on expected residual energy (LEACH-ERE) methods have reached lesser PDRs of 83%, 81%, 78%, 77%, and 75%, respectively, for 1000 rounds. The CSRO-MHDT technique resulted in higher values of number of packets received (NPR) under all rounds. For instance, with 50 rounds, the CSRO-MHDT technique attained a higher NPR of 3792%.

Improved Metaheuristics-Based Clustering with Multihop Routing Protocol for Underwater Wireless Sensor Networks.

Underwater wireless sensor networks (UWSNs) comprise numerous underwater wireless sensor nodes dispersed in the marine environment, which find applicability in several areas like data collection, navigation, resource investigation, surveillance, and disaster prediction. Because of the usage of restricted battery capacity and the difficulty in replacing or charging the inbuilt batteries, energy efficiency becomes a challenging issue in the design of UWSN. Earlier studies reported that clustering and routing are considered effective ways of attaining energy efficacy in the UWSN. Clustering and routing processes can be treated as nondeterministic polynomial-time (NP) hard optimization problems, and they can be addressed by the use of metaheuristics. This study introduces an improved metaheuristics-based clustering with multihop routing protocol for underwater wireless sensor networks, named the IMCMR-UWSN technique. The major aim of the IMCMR-UWSN technique is to choose cluster heads (CHs) and optimal routes to a destination. The IMCMR-UWSN technique incorporates two major processes, namely the chaotic krill head algorithm (CKHA)-based clustering and self-adaptive glow worm swarm optimization algorithm (SA-GSO)-based multihop routing. The CKHA technique selects CHs and organizes clusters based on different parameters such as residual energy, intra-cluster distance, and inter-cluster distance. Similarly, the SA-GSO algorithm derives a fitness function involving four parameters, namely residual energy, delay, distance, and trust. Utilization of the IMCMR-UWSN technique helps to significantly boost the energy efficiency and lifetime of the UWSN. To ensure the improved performance of the IMCMR-UWSN technique, a series of simulations were carried out, and the comparative results reported the supremacy of the IMCMR-UWSN technique in terms of different measures.

An Efficient Metaheuristic-Based Clustering with Routing Protocol for Underwater Wireless Sensor Networks.

In recent years, the underwater wireless sensor network (UWSN) has received a significant interest among research communities for several applications, such as disaster management, water quality prediction, environmental observance, underwater navigation, etc. The UWSN comprises a massive number of sensors placed in rivers and oceans for observing the underwater environment. However, the underwater sensors are restricted to energy and it is tedious to recharge/replace batteries, resulting in energy efficiency being a major challenge. Clustering and multi-hop routing protocols are considered energy-efficient solutions for UWSN. However, the cluster-based routing protocols for traditional wireless networks could not be feasible for UWSN owing to the underwater current, low bandwidth, high water pressure, propagation delay, and error probability. To resolve these issues and achieve energy efficiency in UWSN, this study focuses on designing the metaheuristics-based clustering with a routing protocol for UWSN, named MCR-UWSN. The goal of the MCR-UWSN technique is to elect an efficient set of cluster heads (CHs) and route to destination. The MCR-UWSN technique involves the designing of cultural emperor penguin optimizer-based clustering (CEPOC) techniques to construct clusters. Besides, the multi-hop routing technique, alongside the grasshopper optimization (MHR-GOA) technique, is derived using multiple input parameters. The performance of the MCR-UWSN technique was validated, and the results are inspected in terms of different measures. The experimental results highlighted an enhanced performance of the MCR-UWSN technique over the recent state-of-art techniques.

Interlayer Defect Detection in Intra-Ply Hybrid Composite Material (GF/CF) Using a Capacitance-Based Sensor.

Combining two types of reinforcement fiber in a common matrix may lead to different failure modes such as micro-cracks between the layers when the structure is subjected to lower stress levels. Real-time damage detection should be integrated into the hybrid composite structure to provide structural integrity and mitigate this problem. This paper outlines the working mechanisms and the fabrication of an integrated capacitive sensor in an intra-ply hybrid composite (2 × 2 twill weave). Uniaxial tensile and flexural tests were conducted to characterize the proposed sensor and provide self-sensing functionality (smart structure). The sensitivity and repeatability of the capacitive sensor were measured to be around 1.3 and 185 µΔC/Co, respectively. The results illustrate that onset of damage between layers can be detected by in situ monitoring. It can be seen that the initial damage was detected at the turning point where the relative change in capacitance begins to reduce while the load increases. Finite element modeling was also constructed to analyze the test results and explain the reasons behind the turning point. It was shown that the carbon yarns experienced high transverse shear stress (τxz) in the crimp region, leading to inter-fiber cracks.

Synthesis of Starch-Grafted Polymethyl Methacrylate via Free Radical Polymerization Reaction and Its Application for the Uptake of Methylene Blue.

In this research, a new biodegradable and eco-friendly adsorbent, starch-grafted polymethyl methacrylate (St-g-PMMA) was synthesized. The St-g-PMMA was synthesized by a free radical polymerization reaction in which methyl methacrylate (MMA) was grafted onto a starch polymer chain. The reaction was performed in water in the presence of a potassium persulfate (KPS) initiator. The structure and different properties of the St-g-PMMA was explored by FT-IR, 1H NMR, TGA, SEM and XRD. After characterization, the St-g-PMMA was used for the removal of MB dye. Different adsorption parameters, such as effect of adsorbent dose, effect of pH, effect of initial concentration of dye solution, effect of contact time and comparative adsorption study were investigated. The St-g-PMMA showed a maximum removal percentage (R%) of 97% towards MB. The other parameters, such as the isothermal and kinetic models, were fitted to the experimental data. The results showed that the Langmuir adsorption and pseudo second order kinetic models were best fitted to experimental data with a regression coefficient of R2 = 0.93 and 0.99, respectively.

Knowledge, attitude, and perception of community pharmacists towards antimicrobial stewardship in Saudi Arabia: A descriptive cross-sectional study.

Background: Antimicrobial resistance is of paramount concern globally. Community pharmacists (CPs) play a vital role in supporting judicious antimicrobial use in the community as they are the key healthcare providers at a public level. This study aimed to assess the knowledge, attitude, and perception of CPs towards antimicrobial stewardship at the community level in Saudi Arabia. Methods: A self-administered questionnaire was distributed to all community pharmacies in four major cities of Saudi Arabia. A simple random sampling approach was used to select pharmacies in each chain. Results: A total of 520 CPs responded to the survey with a response rate of 98.6 %. Most of the pharmacists (n = 479, 92.1 %) accepted that antimicrobial stewardship programs are essential tools to limit injudicious usage of antimicrobials at the community level. Interestingly, very few (n = 105, 21 %) agreed to recommend antibiotics for common illnesses, including upper respiratory tract infections, cold, and flu without a valid prescription. Further, we found a significant role of Saudi health authorities, e.g., Saudi food & drug authorities and the Ministry of Health, in restricting antimicrobials sale in community pharmacies without a valid prescription. Conclusion: Our study findings revealed that CPs had good knowledge about antimicrobial stewardship in Saudi Arabia. The CPs play an active role in the optimization of antimicrobial therapy and infections caused by different microbes. Strict policies by the Saudi health care authority regarding the restricted dispensing of antimicrobials are welcomed by the CPs and thus may contribute toward lowering of antimicrobial resistance burden on the patients and Saudi health care authorities.

Telepsychiatry: knowledge, effectiveness, and willingness; assessments of psychiatrists in Saudi Arabia.

OBJECTIVES: To assess psychiatrists' knowledge and perception regarding telepsychiatry and evaluate their willingness to adopt telepsychiatry clinical practice in Saudi Arabia. METHODS: A cross-sectional study was conducted among psychiatrists working in Saudi Arabia from November 2020 through May 2021. A self-administered questionnaire comprising socio-demographic data, factors related to knowledge, perception, willingness, barriers, and the effectiveness of telepsychiatry, was distributed via. online platform. Data were tabulated and cleaned in MS Excel, and all statistical analyses were performed using SPSS v26. RESULTS: There were 328 psychiatrists enrolled in the group with an average age of 25-35 years (48.8%). The group comprised mainly Saudis (83.5%); male participants outnumbered females (70.4% to 29.6%). Overall, the psychiatrists' telepsychiatry knowledge level was poor (51.8%), while (48.2%) of the respondents showed good knowledge. However, nearly all respondents exhibited good perception (80.8%), with only 19.2% classified as poor. In addition, older individuals, consultants, clinicians with 11-15 years of experience, clinicians interacting with patients via email, and those who frequently received patient questions regarding online communication indicated increased knowledge. CONCLUSION: Although perception was positive regarding telepsychiatry, psychiatrists' knowledge on the subject was deemed insufficient. Psychiatrists' knowledge depended on their age, position, years of experience, frequent interaction with patients through an online platform, and clients that provided their online contact details.

Prevalence and associated factors of alexithymia among medical students: A cross-sectional study from Saudi Arabia.

OBJECTIVES: To assess the prevalence of alexithymia and its associated factors among medical students at King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia. METHODS: A cross-sectional study was conducted at KSU, including 420 medical students from all years of medical college (i.e., first to the fifth year), by using an electronic questionnaire distributed during August 2021. The questionnaire consisted of sociodemographic-related questions and the 20-item Toronto alexithymia scale (a validated scale in the literature). RESULTS: The prevalence of alexithymia among the participants was found to be 26.9%. A statistically significant association between alexithymia and gender (p=0.013) was found. A diagnosis with any psychiatric condition (p=0.026), history of abuse during childhood (p=0.006), and lack of physical activity were associated with alexithymia. CONCLUSION: The prevalence of alexithymia among medical students at KSU was significantly higher than general population in literatures. It was indicated in the results that being female, having a psychiatric condition or history of childhood abuse, and lack of physical activity were all associated with alexithymia. We recommend increasing awareness of and screening for alexithymia and its associated factors among medical students.

To disclose, or not to disclose? Perspectives of clinical genomics professionals toward returning incidental findings from genomic research.

BACKGROUND: Clinical genomic professionals are increasingly facing decisions about returning incidental findings (IFs) from genetic research. Although previous studies have shown that research participants are interested in receiving IFs, yet there has been an argument about the extent of researcher obligation to return IFs. We aimed in this study to explore the perspectives of clinical genomics professionals toward returning incidental findings from genomic research. METHODS: We conducted a national survey of a sample (n = 113) of clinical genomic professionals using a convenient sampling. A self-administered questionnaire was used to explore their attitudes toward disclosure of IFs, their perception of the duties to return IFs and identifying the barriers for disclosure of IFs. A descriptive analysis was employed to describe participants' responses. RESULTS: Sixty-five (57.5%) respondents had faced IFs in their practice and 31 (27.4%) were not comfortable in discussing IFs with their research subjects. Less than one-third of the respondents reported the availability of guidelines governing IFs. The majority 84 (80%) and 69 (62.7%) of the study participants indicated they would return the IFs if the risk of disease threat ≥ 50% and 6-49%, respectively and 36 (31.9%) reported they have no obligation to return IFs. CONCLUSION: Clinical genomics professionals have positive attitudes and perceptions toward the returning IFs from genomic research, yet some revealed no duty to do so. Detailed guidelines must be established to provide insights into how genomics professionals should be handled IFs.

The assessment of perioperative risk factors of anastomotic leakage after intestinal surgeries; a prospective study.

BACKGROUND: Anastomotic leaks (AL) are among the most serious complications due to the substantial impact on the quality of life and mortality. Inspite of the advance in diagnostic tools such as laboratory tests and radiological adjuncts, only moderate improvement has been recorded in the rate of detected leaks. The purpose of the research was to assess the perioperative risk factors for AL. METHODS: This study was achieved at MUH and MIH/Egypt within the period between January 2016 and January 2019 for the candidates who underwent bowel anastomosis for small intestinal (except duodenal one) and colorectal pathology. The collected data were analyzed using SPSS of V-26. RESULTS: This study included 315 cases, among them, 27 cases (8.57%) developed AL. The percentage of covering stoma was significantly higher in the non-leakage group vs leakage one (24.3% vs 11.1% respectively). lower albumin, operative timing, perforation, and covering stoma were shown as significant risk factors for leakage, but with multivariate analysis for these factors, the emergency operation, and serum albumin level was the only independent risk factors that revealed the significance consequently (p = 0.043, p = 0.015). The analysis of different predictors of AL on the third day showed that the cut-off point in RR was 29 with 83% sensitivity and 92% specificity in prediction of leakage, the cut-off point in RR was 118 with 74% sensitivity and 87% specificity in prediction of leakage and the cut-off point in CRP was 184.7 with 82% sensitivity and 88% specificity in prediction of AL and all had statistically significant value. CONCLUSIONS: The preoperative serum albumin level and the emergency operations are independent risk factors for anastomotic leakage. Moreover, leakage should be highly suspected in cases with rising respiratory rate, heart rate, and CRP levels.

Sliding Avalanches Between Nacreous Tablets.

Nacre, also known as mother of pearl, possesses extraordinary mechanical properties resulting from its intriguing hierarchical brick-and-mortar microstructures. Despite prior studies, interactions between nanoasperities during sliding still need to be elucidated. In this study, we measure slip events between nanograins of microlayers at high temporal resolution during torsion-induced sliding. We model the slips as avalanches caused by interactions of atoms on nanograin surfaces, from which power laws and scaling functions describing statistics and dynamics of slip events are studied. The largest avalanche occurs when nanograins leave each other after the maximum contact. The agreement between measurements and predictions shows that avalanches act essentially in the inhomogeneous sliding of nacreous tablets. Further insights into nanofriction provided in this work may lead to the development of nanoscale tribological systems.

Clinical characteristics and treatment outcomes of severe (ICU) COVID-19 patients in Saudi Arabia: A single centre study.

BACKGROUND: There is limited information describing the presenting features and treatment outcomes of intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19) in Saudi Arabia. OBJECTIVE: To investigates the clinical, epidemiological, laboratory, radiological, vital signs and treatment characteristics/outcomes of severe (ICU) COVID-19 patients in Albaha region, Saudi Arabia. METHODS: A retrospective cohort study was conducted from 01 April 2020 to 31 August 2020 involving files review of 171 patients admitted to the ICU of a COVID-19 treatment centre as a result of severe symptoms. RESULTS: Around a third of the ICU patients admitted were over 66 years of age, 59.6% males, 45% diabetics, 39% hypertensive, 25.7% smokers. Patients had symptoms such as 79% fever, 78% cough, 75% headache, 59% sore throat, 57% runny nose, and 75% cough. More than half of the patients had <90% oxygen saturation. Bilateral infiltration was present in about 43% of patients. 85.4% lymphopenia, and 70.8% D-dimer (>0.5 u/ml) were the most significant laboratory results. The median stay in the hospital ranged from 4 to 15.6 days, and the ICU time ranged from 4 to 12.7 days. Approximately 29% of patients received antiviral, antimalarial, and antibiotic treatment, while 27.5% of patients received antibiotics and antimalarial therapy alone. Incorporating hydroxychloroquine in treatment protocols did not improve patients' outcomes. CONCLUSIONS: Older age and cardio-metabolic comorbidities increase the risks of sever COVID-19. Different treatment protocols fail to improve mortality rates and urgent efforts are required to prevent the disease and reduce its severity.

Assessment of quality of work life (QWL) among healthcare staff of intensive care unit (ICU) and emergency unit during COVID-19 outbreak using WHOQoL-BREF.

OBJECTIVE: The study aimed to document the quality of work life (QWL) among healthcare staff of intensive care units (ICUs) and emergency units during COVID-19 outbreak using the WHOQoL-BREF. METHODS: A multicenter cross-sectional study was conducted for two months (May - June 2020) among healthcare staff working in intensive care units (ICUs) and emergency units of the hospitals under the National Guard Health Authority (NGHA) across five cities of Saudi Arabia. The study used the WHOQoL-BREF instrument to document the QWL through an electronic institutional survey. The data was analyzed through IBM SPSS version 23. The study was approved by an ethics committee. RESULTS: A total of 290 healthcare professionals responded to the survey. The mean overall quality of life score was 3.37 ± 0.97, general health = 3.66 ± 0.88, domains, i.e., physical = 11.67 ± 2.16, psychological = 13.08 ± 2.14, social = 13.22 ± 3.31 and environment = 12.38 ± 2.59. Respondents aged > 40 years, male gender, married status, being a physician and, having a work experience > 15 years and no extra working hours, had higher mean scores for several domains of Quality of life (QoL), overall QoL and general health (p < 0.05). CONCLUSION: The QWL among healthcare staff during COVID-19 pandemic was low. Demographic factors were mainly the determinants for a higher QWL while the variable of extra working hours was a determinant of lower QWL. Despite the pandemic, no COVID-19 related variables affected the work life of healthcare staff.

Stress Reactions and Coping Strategy among Healthcare Professionals during COVID-19 Outbreak.

BACKGROUND: Psychological impacts among healthcare professionals have increased significantly due to the increasing number of COVID-19 cases. This study aimed to identify stress and coping strategies among healthcare professionals in Saudi Arabia during the COVID-19 outbreak. SUBJECTS AND METHODS: A cross-sectional study online survey was conducted for health care professionals during a peak of COVID-19 from March to June 2020 at different healthcare institutions at KSA (n=342). RESULTS: Sixty-five percent of responders often and always feel fears about infection and subsequent effects on themselves, the patient, and the family. 57% of them stated that they felt sometimes depressed mode and 47% anxiety during the outbreak. Eighty-four percent of the respondent always focusing on prevention as the first biosecurity measures such as hand-washing habits and using hand sanitizer, and 38.3% of them make sometimes relax and rest. While half of the responses (50%) sometimes had physical exercise. Also, thirty-eight percent joined sometimes community and/or group online chat groups, and 56.1% always keep contact with family and friends through social messaging or phone calls. CONCLUSION: Understanding this topic is important for healthcare organizations, effective strategies, and programs is needed to provide holistic staff care and wellbeing during outbreaks that focus on the value of mental and emotional support.