Room-Temperature Magnetic Phase Transition in an Electrically Tuned van der Waals Ferromagnet.

Finding tunable van der Waals (vdW) ferromagnets that operate at above room temperature is an important research focus in physics and materials science. Most vdW magnets are only intrinsically magnetic far below room temperature and magnetism with square-shaped hysteresis at room temperature has yet to be observed. Here, we report magnetism in a quasi-2D magnet Cr_{1.2}Te_{2} observed at room temperature (290 K). This magnetism was tuned via a protonic gate with an electron doping concentration up to 3.8×10^{21} cm^{-3}. We observed nonmonotonic evolutions in both coercivity and anomalous Hall resistivity. Under increased electron doping, the coercivities and anomalous Hall effects (AHEs) vanished, indicating a doping-induced magnetic phase transition. This occurred up to room temperature. DFT calculations showed the formation of an antiferromagnetic (AFM) phase caused by the intercalation of protons which induced significant electron doping in the Cr_{1.2}Te_{2}. The tunability of the magnetic properties and phase in room temperature magnetic vdW Cr_{1.2}Te_{2} is a significant step towards practical spintronic devices.

Effect of ultrasound-guided versus landmark-guided local corticosteroid injection for carpal tunnel syndrome: a systematic review and meta-analysis.

BACKGROUND: Carpal tunnel syndrome (CTS), the commonest neuropathy of the upper limb, can be managed with different therapeutic approaches. Local corticosteroid injection has been adopted widely in clinical practice, as it showed great efficacy in treating CTS. However, the best injection technique continues to be a subject of controversy. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) corticosteroid injection on the clinical and electrophysiological outcomes in patients with CTS. METHODS: We performed a systematic literature search in Medline, Embase, and CENTRAL, from which we included randomized controlled trials (RCTs) that compared US-guided and LM-based corticosteroid injection in treating individuals with CTS. We evaluated the following outcomes: Boston carpal tunnel questionnaire functional status scale (BCTQ-FSS) and symptom severity scale (BCTQ-SSS), and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcome. RESULTS: A total of 8 RCTs that enrolled 500 wrists were deemed eligible. US-guided injection showed a significantly better BCTQ-FSS (SMD = -0.22, 95% CI -0.39 to -0.04), BCTQ-SSS (SMD = -0.77, 95% CI -1.22 to -0.31), and adverse event rate (RR = 0.32, 95% CI 0.21 to 0.49) compared to LM-based injection. CONCLUSION: This meta-analysis showed the superiority of US-guided corticosteroid injection over LM-guided corticosteroid injection in enhancing functional status, improving symptom severity, and reducing the adverse event rate in individuals with CTS.

Spin-Momentum Locking Induced Anisotropic Magnetoresistance in Monolayer WTe2.

Monolayer WTe2 is predicted to be a quantum spin Hall insulator (QSHI), and its quantized edge transport has recently been demonstrated. However, one of the essential properties of a QSHI, spin-momentum locking of the helical edge states, has yet to be experimentally validated. Here, we measure and observe gate-controlled anisotropic magnetoresistance (AMR) in monolayer WTe2 devices. Electrically tuning the Fermi energy into the band gap, a large in-plane AMR is observed and the minimum of the in-plane AMR occurs when the applied magnetic field is perpendicular to the current direction. In line with the experimental observations, the theoretical predictions based on the band structure of monolayer WTe2 demonstrate that the AMR effect originates from spin-momentum locking in the helical edge states of monolayer WTe2. Our findings reveal that the spin quantization axis of the helical edge states in monolayer WTe2 can be precisely determined from AMR measurements.

A Review of Nonfatal Drowning in the Pediatric-Age Group: A 10-Year Experience at a University Hospital in Saudi Arabia.

OBJECTIVE: The aim of this study was to evaluate the nonfatal drowning experience, risk factors, intrahospital assessment and postincidental outcomes for children admitted to King Fahd Hospital of the University, AlKhobar, Saudi Arabia, over a 10-year period. METHODS: Children up to the age of 14 years who were admitted with the diagnosis of nonfatal drowning from July 2005 to June 2015 were included. Data regarding demographics, timing, season and location of drowning, presence of an assigned lifeguard, duration of submersion and transport to hospital, cardiopulmonary resuscitation, initial Glasgow Coma Scale, temperature, pH, blood sugar level, total hospital stay, and discharge status were extrapolated, and their effects on the patient's outcome analyzed. Patients' outcomes were classified into either full recovery, moderate to severe neurological damage, or brain death. RESULTS: Fifty-one subjects were included in the study; 66.7% were males, 57% were younger than 6 years, and 80% were Saudi citizens. Of the total cases, 94% recovered fully, and 6% were diagnosed as having brain death or discharged from the intensive care unit with severe neurological injury. Submersion time of more than 5 minutes, Glasgow Coma Scale of 4 or less, pH of less than 7.1, temperature of 35°C or less, and blood sugar of 180 mg/dL or greater were found to correlate with bad outcomes with great statistical significance. CONCLUSIONS: The findings of this study were in line with results of most of the international and local studies on the subject. Significant defects have been concluded in prehospital medical care and cardiopulmonary resuscitation. Adequate swimming safety regulations, assignments of lifeguards, and parental education should be taken into consideration by media and involved authorities.

The theory of multiple stupidities: education, technology and organisation in Arabia.

Traditional perspectives have envisaged intelligence as one entity dominated by a single set of abilities (i.e. cognitive abilities), whereas modern perspectives have defined intelligence in various shapes (e.g. linguistic, musical and interpersonal intelligences). By the same token, traditional perspectives have examined stupidity as one set of inabilities (i.e. cognitive inabilities). However, it is not clear whether modern perspectives have discussed whether stupidity exists in various forms-in the same way as they have envisaged intelligence. To address this limitation, 257 university members were asked to share what they perceived as being stupid educational and technological practices in their institutions. Analysis of the data suggested three concepts were important to the members: moral, spatial and administrative stupidities. That is, stupidity is perceived to come in the form of failing to meet certain moral, spatial and administrative values. This implies that modern perspectives may conceptualise stupidity differently from traditional perspectives, seeing it as going beyond cognitive inabilities and viewing it as existing in various forms (e.g. moral, spatial and administrative stupidities). Thus, there are multiple stupidities as there are multiple forms of intelligence. A strength of this research is that it views stupidity through an organisational and qualitative lens, although some may traditionally expect such a topic to be examined quantitatively through psychometric and biological approaches.

Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis in the elderly.

BACKGROUND: Peritoneal carcinomatosis is life-threatening without cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC). Only a few studies in the literature addressed the relationship between age and outcomes of peritonectomy. This study was designed to review the clinical outcomes in elderly patients who underwent CRS and PIC. METHODS: This is a retrospective study of prospectively collected data of 611 consecutive patients with peritoneal carcinomatosis who underwent CRS and PIC by the same surgical team at St George Hospital in Sydney, Australia, between January 1996 and December 2013. Patients were divided into two groups; group 1 (<65 years old, n = 487) and group 2 (≥ 65 years old, n = 124). Subgroup analysis was performed in patients who were ≥75 years old (n = 20). A significant difference was defined as p < 0.05. RESULTS: There was no significant statistical difference in terms of mean total hospital stay, intensive care unit stay, high dependency unit stay and complication rates. Postoperative mortality was 2 and 3 % in groups 1 and 2, respectively. Overall survival did not reach a statistical significance between the two groups. In subgroup analysis, patients showed similar morbidity results to patients who were <65 years old. CONCLUSIONS: CRS and PIC can be safely done in the elderly. Age alone should not be the single exclusion criterion but rather taken into consideration along with other factors to determine the suitability of elderly patients.

Health-Related Quality of Life of Asthmatic Patients in Al-Baha City, Saudi Arabia.

Introduction According to disability-adjusted life years (DALY), bronchial asthma (BA) is rated 28th among the top causes of disease burden globally and among the most significant reasons for years lived with disability. Internationally, 300 million people have asthma, and another 100 million individuals may develop it by 2025. In Al-Baha City, where environmental factors such as dust and pollen levels can exacerbate asthma symptoms, understanding and addressing the health-related quality of life of asthmatic patients is crucial. Understanding the health-related quality of life of asthmatic patients can inform public health policies and initiatives aimed at reducing environmental triggers and promoting better asthma management in the city. Objectives The study aims to assess the impact of asthma regarding physical, emotional, and social activities that affect health-related quality of life.  Subjects and methods A cross-sectional study was conducted from January 2023 to May 2023 at King Fahad Hospital in Al-Baha City, Saudi Arabia. The study used a Mini Asthma Quality of Life Questionnaire that measures physical, emotional, and social activities that affect health-related quality of life.  Results One hundred and fifty-one out of 185 participants responded, yielding a response rate of 81.6%. The average age of the participants was 52, with a standard deviation of 15.4 years. Participants' responses regarding symptoms related to the environment during the last two weeks indicated "all the time" experiencing feeling bothered by or having to avoid cigarette smoke (n=104, 69%) and dust (n=92, 61%) in the environment. Moreover, considering emotion-related symptoms, 54% reported they did not feel afraid of not having their asthma medication available. Similarly, 46% reported never feeling frustrated because of asthma, whereas 3.3% of the participants documented hardly ever feeling frustrated. Regarding social activity limitations, 44 individuals (29%) reported no limits in these activities, while 43 (28%) reported being completely limited. While there were limitations in work-related activities, 42 participants (28%) reported no restrictions, whereas 34 (23%) reported being completely limited.  Conclusion The study findings highlight a concern about suboptimal asthma control and the need to attain more satisfactory levels of asthma management.

Real-world evidence of the effects of sodium-glucose co-transporter 2 inhibitors on the dosing of diuretics in patients with heart failure: a retrospective cohort study.

Background: Heart failure (HF) was estimated to impact approximately 64 million individuals worldwide in 2017 and is predicted to rise in the coming years. Therefore, the aim of our study was to evaluate the effects of sodium-glucose transport protein 2 (SGLT2) inhibitors on the dosing of diuretics among individuals diagnosed with HF. Methods: A retrospective cohort study was conducted at Security Forces Hospital in Riyadh, Saudi Arabia, between January 2018 and August 2022. The study included adult patients who were diagnosed with heart failure and received dapagliflozin and/or diuretic. A descriptive analysis was conducted to identify significant differences between both groups by using the chi-square test for categorical variables and the Student's t-test for continuous variables. A logistic regression model was also run to identify the odds of each event. Statistical significance was indicated by p values less than .05. Results: Overall reduction in diuretics was reported in 68 patients in the SGLT2 inhibitors plus diuretic therapy group, while in the diuretic therapy group 25 patients reported overall reduction in diuretics (OR = 4.81, 95% [2.74-8.45]). The reduction of the loop dose level was reported by 58 patients in the SGLT2 inhibitors plus diuretic group and by 25 patients in the diuretic group (OR = 3.48, 95% [1.98-6.11]). The discontinuation of thiazide was reported by 16 patients in the SGLT2 inhibitors plus diuretic therapy group, but by only two patients in the diuretic group (OR = 9.04, 95% [2.03-40.19]). After 6 months, ejection fraction was increased by 2.74 in the SGLT2 inhibitors plus diuretic group (p = .0019) and decreased by 2.56 in the diuretic group (p = .0485), both of which were statistically significant. The mean dose changes were decreased by 14.52 in the SGLT2 inhibitors plus diuretic group (p < .0001), which was statistically significant. Conclusion: Treatment with SGLT2 inhibitors plus diuretic significantly reduced the patients' diuretic requirements. Therefore, our finding supports the theoretical concept of minimizing the level of diuretic upon the initiation of SGLT2 inhibitors.

Knowledge of Sickle Cell Disease Among Medical Students at Al-Baha University, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Sickle cell disease (SCD) presents a major health challenge in Saudi Arabia due to its high prevalence. The important role of medical students as future healthcare leaders necessitates high awareness and knowledge about the disease. AIM: To assess SCD awareness among Al-Baha University medical students, and to evaluate its relation to gender and academic level. METHODS: A cross-sectional study was conducted, including 105 medical students from the first to sixth year at Al-Baha University. Data collection utilized an online self-administered questionnaire, covering demographic characteristics and assessing SCD knowledge. Fisher's exact and Pearson Chi-squared tests were employed to analyze associations between gender, academic level, and SCD awareness. RESULTS: The majority of male participants 52 (89.6%) and all females 47 (100%) demonstrated awareness of SCD. Clinical year enrollment (68.6%) correlated with heightened awareness across various aspects of SCD compared to the preclinical year. Most participants were in clinical years (68.6%), and 94.3% of them had knowledge about SCD. Approximately, 75 (71%) of participants correctly identified features of sickle cell crisis, 83 (79%) reported the accurate cause of SCD, and 75 (71%) cited the appropriate preventive measures. Only 15 (14%) demonstrated knowledge of correct management of SCD. Contrarily, 84 (80%) were aware of SCD complications, 66 (63%) recognized different SCD types, 67 (64%) felt adequately informed about SCD, and 34 (32%) were involved in SCD counseling. Male participants exhibited greater awareness of SCD features than females. Notably, involvement in SCD counseling was more prevalent among students of clinical years. CONCLUSION: This study underscores the need for targeted educational initiatives, particularly among preclinical year students to enhance SCD awareness among students. We also emphasize the role of clinical education in fostering a comprehensive understanding of SCD, with increased participation in counseling programs.

Unlocking the Power of Influenza Vaccines for Pediatric Population: A Narrative Review.

The flu, often known as influenza, is a dangerous public health hazard for the pediatric population. Immunization is essential for decreasing the burden of the disease and avoiding complications related to influenza. However, the immunogenicity, efficacy, and safety of different influenza vaccines in children warrant careful evaluation. The purpose of this narrative review is to give a summary of the existing literature on the immunogenicity, efficacy, and safety of several vaccinations against influenza viruses in children. The review incorporates evidence from a range of studies focusing on the outcomes of interest. Immunogenicity studies have shown that influenza vaccines induce a robust immune response in children, primarily through neutralizing antibodies' formation. However, variations in vaccine composition influence the duration and magnitude of immune responses. Safety is a crucial consideration in pediatric vaccination. In children, influenza vaccinations have generally shown a high safety profile, with mild and temporary side effects being the most common. Vaccinations against influenza have shown a modest level of efficacy in avoiding hospitalizations linked to influenza, laboratory-confirmed influenza infections, and serious consequences in children. Live attenuated vaccines have shown higher effectiveness against matched strains compared to inactivated vaccines. In conclusion, this narrative review highlights that receiving influenza vaccination in children aged six to 47 months is very important. While different vaccines exhibit varying immunogenicity, safety profiles, and effectiveness, they all contribute to reducing the burden of influenza among children. Future research should focus on optimizing vaccine strategies, improving vaccine coverage, and evaluating long-term protection.

Gouty Arthritis Across Ages: Understanding Disease Patterns and Predictors.

Introduction Gout, a chronic inflammatory joint disease, is increasingly prevalent worldwide, mainly affecting men, young females, and post-menopausal women. This study aims to investigate gout epidemiology in Al-Baha, Saudi Arabia, addressing the dearth of localized data on prevalence, risk factors, and management practices. Methods A cross-sectional analysis was conducted at King Fahad Hospital, Al-Baha, Saudi Arabia, covering 116 patients from March 2016 to November 2017. Data encompassed demographics, clinical presentations, and biochemical markers relevant to gout. Results Among 116 patients, 41 (35.3%) were diagnosed with gout, with males exhibiting a significantly higher prevalence than females (43.9% vs. 24%). Significant associations were found between gout prevalence and residency, occupational status, education level, clinical presentations (podagra, arthralgia/arthritis), and biochemical markers. Conclusion This study enriches global knowledge by providing localized insights into gout's epidemiology and highlighting demographic influences and clinical presentations specific to the Saudi context. The findings underscore the importance of tailored approaches in gout management, considering regional variations in prevalence, risk factors, and clinical manifestations.

Irreversibility analysis through neural networking of the hybrid nanofluid for the solar collector optimization.

Advanced techniques are used to enhance the efficiency of the energy assets and maximize the appliance efficiency of the main resources. In this view, in this study, the focus is paid to the solar collector to cover thermal radiation through optimization and enhance the performance of the solar panel. Hybrid nanofluids (HNFs) consist of a base liquid glycol (C3H8O2) in which nanoparticles of copper (Cu) and aluminum oxide (Al2O3) are doped as fillers. The flow of the stagnation point is considered in the presence of the Riga plate. The state of the solar thermal system is termed viva stagnation to control the additional heating through the flow variation in the collector loop. The inclusion of entropy generation and Bejan number formation are primarily conceived under the influence of physical parameters for energy optimization. The computational analysis is carried out utilizing the control volume finite element method (CVFEM), and Runge-Kutta 4 (RK-4) methods. (FEATool Multiphysics) software has been used to find the solution through (CVFEM). The results are further validated through a machine learning neural networking procedure, wherein the heat transfer rate is greatly upgraded with a variation of the nanoparticle's volume fraction. We expect this improvement to progress the stability of heat transfer in the solar power system.

Bronchiolitis in Infants; Five Years' Experience of a Teaching Hospital.

Background: Bronchiolitis is a clinical syndrome affecting the lower respiratory tract of infants and toddlers <2 years old. Variability in clinical profile and response to therapy in children with Bronchiolitis calls for studying the different clinical aspects of local patient population. Aim: The goal of our study is to determine the clinical presentation, past medical history, hospitalization course and prognosis in children below two years of age who have been hospitalized in King Fahad University Hospital over the last five years. Materials and Methods: A retrospective chart review based on electronic health records of all Bronchiolitis-related hospitalization of infants and toddlers below two years of age, covering the period between January 1, 2015, to April 26, 2020. Results: Out of a total of 446 children <2 years of age, 202 were female (45.4%), and 243 were male (54.6%). Although the length of hospital stay was almost equal between the sexes, there was a significant (p-value=0.01) increase in length of intensive care unit stay among females compared to males. Furthermore, there was a significant prolongation in the duration of ventilator usage among females (p value = 0.062). Out of fifty-five patients admitted to the ICU, 83.63% of them were 12 months of age and below. Conclusion: Our results show a significant increase in length of ICU and ventilator use among females compared to males. It also shows that infants younger than 12 months account for most ICU admissions. These findings, among many others, may help pediatricians formulate a better diagnostic and therapeutic pathways.

Prevalence and Risk Factors of Diabetic Nephropathy Among Saudi Type-1 Diabetic Patients in Taif City, Saudi Arabia.

Purpose: We investigated the prevalence and associated risk factors of DNP in T1DM patients in Taif city, Saudi Arabia, where the renal diseases are prevalent. The incidence of diabetic nephropathy (DNP) is increasing in Saudi Arabia, and the country is also ranked 4th in terms of the number of diagnosed type-1 diabetes (T1DM) patients. Patients and Methods: The retrospective cohort study was conducted with type-1 diabetes patients registered at King Abdulaziz Specialist Hospital in Taif, Saudi Arabia. A total of 198 patients (aged > 18 years), had T1DM for more than 5 years with documented albuminuria; albumin-creatinine ratio (ACR) ≥30 mg/g creatinine in two of three urine samples or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, were included in the study. Patients' demographic and laboratory data were collected from medical records. A regression analysis model was used to identify risk factors for DNP. Statistical significance was set at P < 0.05. Results: The overall prevalence of DNP was 23.7% in our study group, with 8% having low eGFR alone, 20.71% having positive ACR and 6.22% having both positive ACR and low eGFR. A statistically significant correlation between DNP and risk factors was found for uncontrolled and longer duration of T1DM, elevated ACR, and hypertension (P < 0.05). No statistical significance was found for age, sex, or body mass index (BMI). Conclusion: The prevalence of DNP in T1DM patients in Taif city was higher (23.7%) than the pooled average prevalence in Saudi Arabia (20.59%). Patients' education regarding glycemic and blood pressure control could reduce the burden.

Surveying Hematologists' Perceptions and Readiness to Embrace Artificial Intelligence in Diagnosis and Treatment Decision-Making.

AIM: This study aims to explore the critical dimension of assessing the perceptions and readiness of hematologists to embrace artificial intelligence (AI) technologies in their diagnostic and treatment decision-making processes. METHODS: This study used a cross-sectional design for collecting data related to the perceptions and readiness of hematologists using a validated online questionnaire-based survey. Both hematologists (MD) and postgraduate MD students in hematology were included in the study. A total of 188 participants, including 35 hematologists (MD) and 153 MD hematology students, completed the survey. RESULTS: Major challenges include "AI's level of autonomy" and "the complexity in the field of medicine." Major barriers and risks identified include "lack of trust," "management's level of understanding," "dehumanization of healthcare," and "reduction in physicians' skills." Statistically significant differences in perceptions of benefits including resources (p=0.0326, p<0.05) and knowledge (p=0.0262, p<0.05) were observed between genders. Older physicians were observed to be more concerned about the use of AI compared to younger physicians (p<0.05). CONCLUSION: While AI use in hematology diagnosis and treatment decision-making is positively perceived, issues such as lack of trust, transparency, regulations, and poor AI awareness can affect the adoption of AI.

Tirzepatide-Induced Gastrointestinal Manifestations: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis determine how frequently and how seriously gastrointestinal manifestations affect people with type 2 diabetes mellitus on tirzepatide. Tirzepatide is a recently developed drug that attempts to enhance type 2 diabetics' ability to regulate their blood sugar levels and promote weight reduction. Despite its potential benefits, clinical trials have revealed that the medication may lead to gastrointestinal side effects, including nausea, vomiting, decreased appetite, dyspepsia, constipation, and diarrhea. These side effects may negatively affect the drug's efficacy and patient tolerance. A comprehensive search of electronic databases such as PubMed, Web of Science, and Cochrane Library, was conducted to find pertinent studies reporting on the frequency and severity of gastrointestinal symptoms in type 2 diabetes patients receiving tirzepatide. This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Study selection, data extraction, and quality assessment were performed. Six randomized controlled trials with a total of 4,586 patients were included. Most patients received tirzepatide to regulate their blood sugar levels and promote weight reduction, and the comparators were placebo, glucagon-like peptide one receptor agonists drugs, and insulin degludec. The dose of tirzepatide was 5mg, 10mg, and 15mg weekly. The incidence rate of nausea in patients who receive tirzepatide was 20.43%, while the incidence rate in the comparators was 10.47%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.90; 95% CI, 1.89 to 4.44; P ≤ 0.00001). The incidence rate of vomiting in patients who receive tirzepatide was 9.05%, while the rate in the comparators was 4.86%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.69; 95% CI, 1.67 to 4.36; P ≤ 0.0001). The incidence rate of constipation in patients who receive tirzepatide was 2.54%, while the rate in the comparators was 0.856%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 3.08; 95% CI, 1.83 to 5.20; P ≤ 0.0001). The incidence rate of decreased appetite in patients who receive tirzepatide was 9.64%, while the rate in the comparators was 2.88%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 5.04; 95% CI, 3.01 to 8.45; P ≤ 0.00001). The incidence rate of diarrhea in patients who receive tirzepatide was 16.24%, while the rate in the comparators was 8.63%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.07; 95% CI, 1.60 to 2.68; P ≤ 0.00001). The incidence rate of dyspepsia in patients who receive tirzepatide was 7.13%, while the rate in the comparators was 3.31%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.52; 95% CI, 1.58 to 4.01; P ≤ 0.0001). Tirzepatide usage is linked to a significant prevalence of gastrointestinal symptoms, including nausea, constipation, decreased appetite, dyspepsia, diarrhea, and vomiting, in people with type 2 diabetes. These findings may influence clinical decision-making and patient counseling on the use of tirzepatide and have significant implications for the medication's tolerance and efficacy. To find ways to reduce these negative effects and improve therapy for type 2 diabetes patients, more research is required.

The efficiency of high-flow nasal cannula for adult patients with coronavirus disease 19 in Jeddah, Saudi Arabia.

CONTEXT: Early use of a high-flow nasal cannula (HFNC) provides positive outcomes for preventing the risk of intubation. However, the efficiency and usage of HFNC in the case of coronavirus disease 2019 (COVID-19) among adult patients with multiple risk factors remain debatable and require more investigation. AIMS: The aim of this study was to determine the efficiency of HFNC in preventing the possible risk of intubation. SETTINGS AND DESIGN: This study was an observational cross-sectional study that was conducted at a selected hospital in Jeddah, Saudi Arabia, from July 2020 to August 2021. METHODS: The data were collected from patients' medical records through the hospital health information system. Adult COVID-19 patients who used HFNC were included, while those who used bilevel positive airway pressure or continuous positive airway pressure without any trials of HFNC and neonatal or pediatric patients were excluded. The exposure of HFNC setting which included variables such as percentages of the fraction of inspired oxygen and the duration of using HFNC were measured to find the relation with respiratory rate oxygenation (ROX) index as a measurement of patient outcome. STATISTICAL ANALYSIS USED: The data were analyzed by using the online calculator socscistatistics. com for prevalence statistics, and correlation tests of significance. Prevalence statistics were presented in mean, median, frequencies, and percentages. Statistical tests were used to measure correlations of key variables. P < 0.05 of ANOVA and t-tests was considered statistically significant. RESULTS: A total of 159 adult COVID-19 patients using HFNC were included, and most of these patients were male. The median age was 64 years. Most of patients were reported to have hypertension and diabetes mellitus. The majority (94.34%) of patients were successfully weaned from HFNC and shows effective intervention with a mean of 7.53 of ROX score. Appropriate implementation of HFNC might be a successful intervention for preventing the risk of intubation. CONCLUSIONS: According to the success rate of HFNC, which was considered a positive outcome, there might be a promising intervention for HFNC to prevent the risk of intubation and decrease the mortality rate.

E-cigarettes and Vaping: A Smoking Cessation Method or Another Smoking Innovation?

The prevalence of using e-cigarettes (vaping) has risen rapidly since its introduction in 2007, mostly among male youth. Although research on the health risks of e-cigarettes is still limited, there is growing evidence of debilitating pulmonary conditions and general immune weakness from e-cigarettes, leading to various infections. Moreover, there are concerns that vaping could be used as a new model of cannabis consumption, increasing cannabis addiction among adolescents. With well-known health risks from traditional smoking, e-cigarettes are viewed as a safe way of smoking, appealing more to youth. Additionally, extensive e-cigarette marketing boosted by the internet and fame has resulted in worries that e-cigarettes can lead to a renormalization of cigarette smoking and can be used as a new method to consume vaporized drugs. Although the concern that e-cigarettes are as harmful as traditional smoking has been raised, youth and most healthcare providers remain relatively unaware. Therefore, this review explored the association between e-cigarettes and traditional smoking. With the introduction of e-cigarettes in the last two decades, the topic is still new and less studied. Therefore, this review will help us understand the topic to better care for e-cigarette smokers and reduce the increasing public health burden from vaping.

A Comparison of Conventional and Tri-Polar EEG Electrodes for Decoding Real and Imaginary Finger Movements from One Hand.

The representations of different fingers in the sensorimotor cortex are largely overlapped, which necessitate a good signal-to-noise ratio (SNR) and high spatial resolution to classify individual finger movements from one hand. Electroencephalography (EEG) recorded with disc electrodes has low SNR and poor spatial resolution. The surface Laplacian has been applied to EEG to improve the spatial resolution and selectivity of the surface electrical activity recording. Tri-polar concentric ring electrodes (TCREs) were shown to estimate the Laplacian automatically with better spatial resolution than disc electrodes. For this work, movement-related potentials (MRPs) were recorded from four TCREs and disc electrodes while 13 subjects performed real and imaginary finger movements. The MRP signals recorded with the TCREs have significantly less mutual information and coherence between neighboring locations compared to disc electrodes. The results also show that signals from TCREs generated higher accuracy compared to disc electrodes. It further shows that TCREs using temporal EEG data as features yield an average accuracy of [Formula: see text]% and [Formula: see text]% for real and imaginary finger movements, respectively, which is significantly higher than utilizing EEG spectral power changes in [Formula: see text] and [Formula: see text] bands as features. Similarly, with the disc electrodes, it achieved highest accuracy of [Formula: see text]% and [Formula: see text]% for real and imaginary finger movements, respectively, with temporal EEG data feature.

Reversible Cerebral Vasoconstriction Syndrome in a Background of Eclampsia Responding to Milrinone Infusion.

BACKGROUND Reversible cerebral vasoconstriction syndrome (RCVS) is a rare neurological disorder with a complex physiopathology that is not fully understood. Suggested underlying mechanisms include failure of autoregulation, endothelial dysfunction, and oxidative stress. It is characterized by reversible multifocal constriction of the cerebral arteries, and can be triggered by many conditions, including, vasoactive medications (eg, triptans), cerebrovascular events, primary headache disorders, and metabolic causes (eg, hypercalcemia). RCVS can also be associated with pregnancy-related conditions, such as thrombotic thrombocytopenic purpura, eclampsia, and pre-eclampsia. Thunderclap headache is the most common clinical manifestation; however, other symptoms can result from complications of the disease, such as stroke, brain edema, and seizures. Several case reports have been published of an association between RCVS and eclampsia, but to the best of our knowledge, only 3 cases were successfully treated with intravenous milrinone and this is the only patient reported in Saudi Arabia. CASE REPORT We report a case of 25-year-old primigravida woman who presented with acute-onset headache, nausea, elevated blood pressure, and generalized tonic clonic seizure. She was diagnosed as having RCVS secondary to eclampsia based on clinical and radiological features. She was initially started on nimodipine, which is usually the first-line management of RCVS, as well as magnesium sulfate and levetiracetam; however, she only achieved full recovery after starting intravenous milrinone. CONCLUSIONS Milrinone is one of the emerging drugs for treatment of RCVS, and this case report delineates the potential of using the drug, especially in cases refractory to standard therapy.