articles+ search results

General Dentistry

General Medicine, Otorhinolaryngology, and Surgery

General Pharmacology, Toxicology and Pharmaceutics and Pharmacy

Clinical Neurology and Neurology

AcademicSubjects/MED00910, jscrep/070, and Case Report

The frontal sinus is the most common site for paranasal mucoceles, resulting in potentially threatening intraorbital or intracranial complications. Surgical drainage of mucoceles is the mainstay of treatment, which can be achieved usually through open or endoscopic transnasal approaches. Transorbital endoscopic surgery is a relatively novel approach to selective skull base lesions with limited data in the literature. It could be utilized as a safe and effective alternative approach in managing frontal sinus lesions when the endoscopic transnasal access alone is insufficient or inadequate. Here, we present a case of an isolated lateral left frontal mucocele that was managed successfully using an endoscopic transorbital approach alone with complete resolution of symptoms during a 10-month follow-up period.

Computer Science Applications and Education

Education

General Medicine, Surgery, Case Report, Acute gastric volvulus, Organoaxial volvulus, Borchardt's triad, and Gastric gangrene

Introduction and importance Gastric volvulus is the abnormal gastric rotation upon itself. It carries a considerable risk for gastric strangulation which may lead to gangrene and perforation, which can be fatal. It commonly presents with non-specific and vague abdominal symptoms making prompt diagnosis and management imperative. This is a case report describing a case of acute organo-axial gastric volvulus. Case presentation A 74-year-old female, with no comorbidities, presented to our department with non-specific abdominal symptoms. Gastric outlet obstruction was suspected. The patient was reviewed by the gastroenterologist and was offered an urgent upper endoscopy. The upper endoscopy findings described a gastric volvulus, and a Computed Tomography (CT) scan was done to confirm the diagnosis. The patient underwent exploratory/diagnostic laparoscopy and successful reduction and fixation followed. There was no evidence of tissue compromise or ischemia. The patient was discharged on post-operative day 4 following an unremarkable postoperative course. Clinical discussion Acute gastric volvulus is a surgical emergency which can be associated with a high morbidity and mortality, if complications occur. The most important factor in diagnosing acute volvulus of the stomach is a high index of suspicion of the clinical symptoms and should be confirmed by imaging. Contrast enhanced computed tomography (CT) scan is the preferred imaging modality. Urgent surgical intervention is needed to prevent potentially fatal complications. Conclusion Acute Gastric Volvulus is rare and carries the risk of significant morbidity and mortality. Prompt recognition and treatment is required to prevent complications.
Highlights • Acute gastric volvulus is a rare potentially life-threatening condition. • Prompt diagnosis and treatment is vital to improve patient outcome. • Contrast enhanced Computed Tomography is the preferred imaging modality used to confirm the diagnosis of gastric volvulus. • Surgical repair is the treatment of choice.

Computer Science Applications and Education

General Chemistry

General Medicine

Purpose of the studyThis study aims at identifying the predominant learning approaches by Saudi medical students across Saudi Arabia and assess its possible associations with sociodemographic and educational characteristics.Study designA cross-sectional study design using the Approaches and Study Skills Inventory for Students questionnaire. The questionnaire gives rise to three possible learning approaches; deep, strategic and surface approaches. Bivariate analyses were performed through independent samples t-test and χ2 tests where appropriate. A multinominal regression analysis was performed to obtain risk estimates and 95% CIs.ResultsA total of 3767 students participated and were included in the analysis. The predominant learning approach was the deep approach, followed by the strategic and surface approaches (40.59%, 37.81% and 21.60%, respectively). Males and students belonging to private medical schools were more likely to adopt a strategic rather than a deep one (relative risk ratio (RRR) 1.22, 95% CI 1.06 to 1.42 and RRR 1.32, 95% CI 1.05 to 1.65, respectively). Students with an A grade point average (GPA) were less likely to adopt a surface approach, whereas those with a C GPA were more likely to adopt it (RRR=0.67, 95% CI 0.54 to 0.83 and RRR=1.29, 95% CI 1.02 to 1.61, respectively).ConclusionThe findings from this study show that medical students predominantly favour the deep learning approach. Results from this study encourage the continuous adaptation of clinical teaching in medical schools to optimise students’ learning experiences.

Research Article, COVID-19, Telemedicine, Remote programing, Cochlear implant, Questionnaire, Speech and Hearing, Sensory Systems, Otorhinolaryngology, and Physiology

Introduction: The daily escalation in incidence and mortality caused by Coronavirus disease (COVID-19) has mandated forced curfew in our country (same as many other countries) to limit the spread of infection. This is predicted to have a more negative impact on cochlear implant (CI) patients since this group of patients needs a unique type of psychological, medical, and technical care in addition to a daily rehabilitation program. Methods: A cross-sectional study based on Arabic questionnaire that looked into the collateral consequences of COVID-19 on the pediatric CI patients. The questionnaire was designed to highlight different problems such as exposure to head trauma or ear infection, difficulties in device maintenance and getting spare parts, impacts of the delay of programing or switch on appointments, and the impacts of missing rehabilitation sessions. Different ways of management of these problems are presented and discussed. Results: A total of 174 parents responded to the questionnaire. The main problem met by the patients was missing their device programing and rehabilitation sessions. Many children had device maintenance and spare parts problems. Virtual clinics were helpful in solving different problems. Additionally, children who needed device programing were scheduled for remote programing sessions. Conclusion: Although the inevitable consequences of the COVID-19 pandemic are catastrophic, they are forcing the medical field to explore new opportunities by sitting up an infrastructure for future usage of telemedicine. Telemedicine is cost-effective and more convenient and enables health-care providers to be immune to future circumstances.

Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270, Public Health, Environmental and Occupational Health, Community and Home Care, Original Research, COVID-19, Parkinson’s disease, SARS-CoV-2, neurological, and ACE2

BackgroundCOVID-19 has affected global communities with multiple neurological complications in addition to other critical medical issues. COVID-19 binds to the host’s angiotensin-converting enzyme2 (ACE2) receptors, which are expressed in the neurons and glial cells, acting as an entry port to the central nervous system (CNS). ACE2 receptors are abundantly expressed on dopamine neurons, which may worsen the prognosis of motor symptoms in Parkinson’s disease (PD). SARS-CoV-2 may lead to an indirect response via immune-mediated cytokine storms and propagate through the CNS leading to damage. PD is also been associated with certain post-viral infections apart from COVID-19, such as HSV, Influenzavirus A, Measles virus, Cytomegalovirus, and Mumps.ObjectiveIn this systematic review, we aim to provide a thorough analysis of associations between COVID-19 and neurological outcomes for patients with PD.MethodsUsing PRISMA statement 2020, a systematic review was conducted to isolate confirmed COVID-19 patients and analyze the PD-associated neurological outcomes. A systematic literature search was conducted using the following databases: PubMed, Science Direct, Google Scholar, and Cochrane databases. The following keywords were used “COVID19, SARS-CoV-2, Parkinson’s disease, Pandemic, Mortality.” A modified Delphi process was employed to include the studies and ensure that the clinical outcome measures were addressed.ResultsOf the 355 records located during the initial round of screening, 16 were included in the final synthesis. Of PD patients who tested positive for SARS-CoV-2, worsening motor symptoms and other viral-associated symptoms were reported. These symptoms included bradykinesia, tremors, gait disturbances, delirium and dementia, and severe spasms of arms and legs. Encephalopathy was presented in two of the included studies. Increased mortality rates were identified for hospitalized patients due to COVID-19 and PD as compared to other patient groups, albeit with limited generalizability due to high bias of included studies.ConclusionPatients with PD may experience substantial worsening of motor and non-motor symptoms due to COVID 19. Given the novelty of neurological-viral associations, clinical studies in the future ought to explore the disease severity and neurological outcomes in COVID-19 positive patients with PD as compared to non-PD patients, in addition to understanding the role of ACE2 in increased vulnerability to contracting the infection and as a treatment modality.

Otolaryngology, tonsillectomy, post-tonsillectomy complication, surgical emphysema, gag-reflex, facial emphysema, respiratory tract diseases, and respiratory system

Subcutaneous facial emphysema is a rare complication of tonsillectomy that can lead to infection, upper airway obstruction or invasion into the thorax. The latter can cause pneumomediastinum or pneumothorax, with possible subsequent cardiorespiratory function impairment. Although multiple causes are suggested in the literature, the main causative factor is still unclear. Moreover, the rationale for its management is inconsistent and the outcomes are unpredictable. We report a case of a 14-year-old pediatric male patient, known to have a hypersensitive gag reflex, who developed post-tonsillectomy cervicofacial subcutaneous emphysema; management has achieved complete clinical resolution after two weeks of complication onset. Additionally, we present a literature review that showcases the potential causes and management of subcutaneous emphysema.

Dermatology, Allergy/Immunology, chronic idiopathic urticaria, antihistamines, leukotriene receptor antagonists, montelukast, singulair, immune system diseases, and respiratory tract diseases

Introduction Chronic urticaria (CU) is a common disorder that can significantly affect the quality of life. The goal of treatment is complete symptomatic relief. Conventional therapy, with antihistamines, is not always effective in all patients. Leukotrienes are believed to be involved in the pathogenesis of urticaria. Leukotriene receptor antagonists (LTRAs), such as montelukast, have been suggested as useful agents in patients with chronic idiopathic urticaria. Our objective is to document the efficacy of montelukast in our patients. Materials and methods Patients who received montelukast were identified from clinic letters. Data including clinical features were collected and analyzed. The main endpoint was adequate disease control. Results A total of nine patients who met the inclusion criteria were included in this study. Four patients reported having a good response to montelukast and three patients reported full control of the disease. Conclusion These findings suggest that leukotriene antagonists, such as montelukast, are effective as an add-on therapy to anti-histamines and their use in histamine resistant patients is justifiable.

Genetics, Molecular Biology, Biochemistry, and Biotechnology

Genetics, Molecular Biology, Biochemistry, and Biotechnology

Ophthalmology

Public Health, Environmental and Occupational Health, Nutrition and Dietetics, and Medicine (miscellaneous)

Objective: Preventing a food allergy reaction depends primarily on eliminating allergens from the diet. In October 2019, the Saudi Food and Drug Authority (SFDA) introduced new legislation requiring food establishments providing and selling non-prepacked foods to state the presence of the top fourteen food allergens on their menus. The current study aimed to assess the allergen-labelling knowledge, practices, preferences and perceptions towards the new SFDA allergen-labelling legislation among consumers with food allergy in Saudi Arabia. Design: Observational cross-sectional study using an online questionnaire. Setting: Saudi Arabia; February – March 2020. Participants: Residents of Saudi Arabia with food allergy (n 427), aged 18–70 years. Results: Among participants, only 28·1 % knew that there were governmental regulations in Saudi Arabia regarding food-allergen labelling and approximately two-thirds (67 %) check labels on prepacked food products for allergens. The majority of the participants preferred food products carrying safety statements (84·1 %) and symbols (80·1 %). A total of 47·1 % were aware that regulations in Saudi Arabia require allergens to be declared in ingredient lists, while 51·3 % were aware that advisory allergen labelling is not required by law. Only 26·2 % were aware of the new SFDA legislation regarding provision of allergen information by food establishments. However, the majority (94·4 %) were supportive of the new legislation, and most of them were more likely to eat at restaurants that reported allergen information for food items on the menu. Conclusions: The new SFDA food allergen-labelling legislation needs to be more widely and effectively disseminated to increase the level of awareness among adults with food allergy in Saudi Arabia.

strength, plyometric training, function performance, resisted sprint training, young football players, Medicine, Article, Health, Toxicology and Mutagenesis, Public Health, Environmental and Occupational Health, human activities, and education

The main objectives of this study were to evaluate the short-term effects of resisted sprint and plyometric training on sprint performance together with lower limb physiological and functional performance in collegiate football players. Ninety collegiate football players participated in this three-arm, parallel group randomized controlled trial study. Participants were randomly divided into a control group and two experimental groups: resisted sprint training (RST) (n = 30), plyometric training (PT) (n = 30), and a control group (n = 30). Participants received their respective training program for six weeks on alternate days. The primary outcome measures were a knee extensor strength test (measured by an ISOMOVE dynamometer), a sprint test and a single leg triple hop test. Measurements were taken at baseline and after 6 weeks post-training. Participants, caregivers, and those assigning the outcomes were blinded to the group assignment. A mixed design analysis of variance was used to compare between groups, within-group and the interaction between time and group. A within-group analysis revealed a significant difference (p <
0.05) when compared to the baseline with the 6 weeks post-intervention scores for all the outcomes including STN (RST: d = 1.63
PT: d = 2.38
Control: d = 2.26), ST (RST: d = 1.21
PT: d = 1.36
Control: d = 0.38), and SLTHT (RST: d = 0.76
PT: d = 0.61
Control: d = 0.18). A sub-group analysis demonstrated an increase in strength in the plyometric training group (95% CI 14.73 to 15.09, p = 0.00), an increase in the single leg triple hop test in the resisted sprint training group (95% CI 516.41 to 538.4, p = 0.05), and the sprint test was also improved in both experimental groups (95% CI 8.54 to 8.82, p = 0.00). Our findings suggest that, during a short-term training period, RST or PT training are equally capable of enhancing the neuromechanical capacities of collegiate football players. No adverse events were reported by the participants.

Column: Guest Editors’ Notes, Computer Science Applications, and Education

citizen science, urban ecology, biodiversity, amphibian, conservation planning, urbanization, Biology (General), QH301-705.5, Nature and Landscape Conservation, Agricultural and Biological Sciences (miscellaneous), Ecological Modelling, and Ecology

As cities adopt mandates to protect, maintain and restore urban biodiversity, the need for urban ecology studies grows. Species-specific information on the effects of urbanization is often a limiting factor in designing and implementing effective biodiversity strategies. In suburban and exurban areas, amphibians play an important social-ecological role between people and their environment and contribute to ecosystem health. Amphibians are vulnerable to threats and imbalances in the aquatic and terrestrial environment due to a biphasic lifestyle, making them excellent indicators of local environmental health. We developed a citizen science program to systematically monitor amphibians in a large city in Alberta, Canada, where 90% of pre-settlement wetlands have been removed and human activities continue to degrade, alter, and/or fragment remaining amphibian habitats. We demonstrate successes and challenges of using publicly collected data in biodiversity monitoring. Through amphibian monitoring, we show how a citizen science program improved ecological knowledge, engaged the public in urban biodiversity monitoring and improved urban design and planning for biodiversity. We outline lessons learned to inform citizen science program design, including the importance of early engagement of decision makers, quality control assessment, assessing tensions in program design for data and public engagement goals, and incorporating conservation messaging into programming.

Infectious Diseases, Microbiology (medical), and General Medicine

Gastroenterology and Hepatology

Gastroenterology and Hepatology

Psychiatry and Mental health, Clinical Neurology, Pediatrics, medicine.medical_specialty, medicine, Epilepsy, medicine.disease, Hydrocephalus, Febrile seizure, Convulsive status epilepticus, Generalized epilepsy, Stroke, Etiology, Status epilepticus, medicine.symptom, business.industry, business, and Original Articles

Objectives To assess the etiology of status epilepticus (SE) among the pediatric patients of a tertiary center in Jeddah, Kingdom of Saudi Arabia (KSA). Methods Data from 88 cases was obtained retrospectively from 2006 to 2017 from King Abdulaziz University Hospital (KAUH). Patients aged between 28 days and 14 years with the symptoms of SE were selected for this study. Results The data show that the proportions of SE etiologies were 30.5% for febrile seizure, 11.9% for electrolytes imbalance, 8.5% for hydrocephalus, 6.8% for CNS infections, and 6.8% for neoplasm. The other etiologies of SE were trauma, fever, intractable epilepsy, cerebrovascular accident, hemorrhagic stroke, etc. There were no clear etiologies in 8 cases. Most of the patients were not of Saudi origin (64.3%), boys (67.8%), and had generalized epilepsy types (91.8%), and 58.6% of the patients complied with epilepsy medications. Conclusion The most prevalent etiology of convulsive status epilepticus was a febrile seizure, followed by electrolyte imbalance and hydrocephalus. However, a nationwide study in KSA must be conducted to determine the major etiologies of SE for its effective management and prevention. Educating families and patients regarding antiepileptic drugs is necessary.

Clinical Neurology and Epidemiology

Objectives: The objective of this study was to evaluate the prevalence of medically resistant epilepsy (MRE) in our hospital and to compare the prevalence with that in other populations. Methods: We retrospectively analyzed the data of patients who visited the epilepsy clinics at King Fahd University Hospital, Al-Khobar, Saudi Arabia between January 2017 and December 2018. This study included patients aged ≥14 years who had at least 2 unprovoked seizures 24 h apart. Patients who had provoked seizure(s), paroxysmal events, or syncope or had incomplete medical records were excluded. The definition and classification of the International League Against Epilepsy were used. Moreover, we searched the En­glish literature using PubMed and Google Scholar to compare the prevalence of MRE between our population and other populations. Results: In total, 1,151 patients were screened, and 751 patients were included in the final analysis. Of the 751 patients, 229 (male: 56.3%, female: 43.7%; mean age: 32.07 years, and standard deviation, 12.2 years) had MRE, with a cumulative prevalence of 30%. The etiology was as follows: unknown, 63.3% (n = 145); structural, 31.9% (n = 73); genetic, 3.1% (n = 7); and infectious, 1.7% (n = 4). None of the patients had metabolic or immune-related etiologies. Conclusion: The prevalence of MRE in our population (30%) is close to that in other populations (30–36.5%). Early identification of such patients is crucial to improve their management.

Case Report, Guillain-Barré syndrome, Miller Fisher syndrome, ventilator-associated pneumonia, Pseudomonas aeruginosa, International Medical Case Reports Journal, Medicine (General), R5-920, and General Medicine

Danah Aljaafari,1 Salam Almustafa,2 Abdulrahman Saleh Ali,3 Hosam Aldalbahi,3 Norah Ibrahim Albahli,3 Feras AlSulaiman,1 Anas Al dehailan,1 Majed Alabdali1 1Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Neurology, King Fahad Medical City, Riyadh, Saudi ArabiaCorrespondence: Danah AljaafariDepartment of Neurology, College of Medicine Imam Abdulrahaman Bin Faisal University, 2835 King Faisal Road, Dammam, 34212, Kingdom of Saudi ArabiaTel +966 503864084Background: Miller Fisher syndrome (MFS), a triad of ophthalmoplegia, areflexia and ataxia, is one of the regional variants of Guillain-Barré syndrome (GBS) that might account for a quarter of all cases of GBS, especially in Asian countries. There is history of an antecedent upper respiratory tract infection in up to two thirds of MFS cases. However, association of MFS in adults and pneumonia is rarely reported and in those cases causative pathogen was Mycoplasma pneumoniae. To our knowledge, association of MFS and ventilator-associated pneumonia has never been reported. So, we hereby report the first case of MFS which followed ventilator-associated pneumonia (VAP).Case Report: We report case of a 22-year-old male who was known to have temporal lobe epilepsy and mental retardation. He presented with status epilepticus. He was sedated and put on mechanical ventilation. Two days later, he developed a fever associated with increased tracheobronchial secretions and new infiltrates on chest X-ray. Diagnosis of VAP was made. Upon improvement, he was extubated and shifted out of ICU. Ten days after the onset of fever, he developed gradual onset bulbar weakness and ataxia. On examination, he had generalized areflexia and ataxia. CSF analysis showed cytoalbuminic dissociation. Antibodies against ganglioside complex were elevated. Diagnosis of sero-negative MFS was made, and intravenous immunoglobulin (IVIG) was started. He improved remarkably within two days.Conclusion: MFS is immune-mediated entity which is usually triggered by upper respiratory tract infection but in rare cases it can be consequence of pneumonia including VAP. Further research is needed to establish link between MFS and VAP.Keywords: Guillain-Barré syndrome, Miller Fisher syndrome, ventilator-associated pneumonia, Pseudomonas aeruginosa

Human papillomavirus, Female schoolteachers, Unawareness, HPV vaccine, HPV vaccine uptake, HPV transmission routes, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270, Infectious Diseases, Public Health, Environmental and Occupational Health, General Medicine, Viral infection, Medicine, business.industry, business, Reproductive tract, Future studies, Logistic regression, HPV infection, medicine.disease, Demography, Family income, and Cervical cancer

Background: Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. This cross-sectional study among female schoolteachers assessed the prevalence of i) unawareness of HPV infection’s causal role in cervical cancer; ii) unawareness of HPV vaccine availability and iii) examined the sociodemographic variables associated both the outcome variables. Methods: This cross-sectional study was conducted among female schoolteachers employed in public and private sectors schools in Kuwait using a structured questionnaire for data collection. Prevalence of each of the outcome variables was computed. Multivariable logistic regression analyses were used to evaluate independent predictors of two dependent variables. Results: A total 1341 female schoolteachers were enrolled. Of the participants, 60% were unaware of HPV causal role in cervical cancer and 88% were unaware of HPV vaccine availability. Among those who were aware of HPV vaccine availability, 83.8% were unvaccinated. Multivariable logistic regression (MLR) model showed that 20–29 years old participants or those with low family income (< 500 KD/month) were significantly (p < 0.05) more likely to be unaware of HPV causal role in cervical cancer. Moreover, participants with family/ personal history of cervical cancer were significantly (p < 0.05) less likely to be unaware of HPV role in causation of cervical cancer. A separate MLR model revealed that the participants were significantly more likely to be unaware of HPV vaccine availability if they were Kuwaiti nationals or non-Kuwaiti Arabs (p < 0.05), employed in public schools (p = 0.003) or less likely to be unaware if they had personal or family history of cervical cancer (p < 0.001). Conclusion: High prevalences of unawareness of causal role of HPV in cervical cancer and unawareness of HPV vaccine availability were recorded. Targeted education among identified sociodemographic groups with high levels of unawareness is warranted. If undertaken, future studies may evaluate the impact of recommended efforts.

Pharmaceutical Science, Pharmacology, Original Article, Biomarkers, Breast cancer, Ceramide expression, Molecular subtypes, Saudi Arabia, Therapeutics. Pharmacology, RM1-950, and lipids (amino acids, peptides, and proteins)

Background/Introduction: Despite advances in the diagnosis and management of breast cancer (BC), it is still associated with high mortality rates. New biomarkers are being developed for the diagnosis, treatment, and prediction of responses of BC. Ceramide (CER), a bioactive sphingolipid, has emerged recently as a useful diagnostic tool in several types of tumors. In this study, we evaluated CER expression in invasive BC and assessed its relation to the molecular subtypes of BC. Materials and methods: The clinical data and histopathological slides of 50 patients with invasive ductal carcinoma were retrieved and reviewed. The cases were then stained with a mouse monoclonal anti-ceramide antibody. Pearson correlation was used to assess the correlation between CER percentage and intensity and other clinical and pathological variables. Results: CER expression showed a direct relationship with estrogen and progesterone receptors Allred scores. However, it showed an inverse relation with tumor grade, HER2/neu status and Ki-67 index. Conclusions: CER expression is likely to be associated with luminal BC molecular subtypes. However, more research is needed to confirm these results and to explore its relation to the different clinical outcomes, including response to treatment and prognosis.

Psychiatry and Mental health and Developmental and Educational Psychology

General Medicine, Otorhinolaryngology, and Surgery

Management, Monitoring, Policy and Law and Ecology, Evolution, Behavior and Systematics

Abstract ContextRoad mitigation to reduce animal–vehicle collisions (AVCs) is usually based on analysis of road survey animal carcass data. This is used to identify road sections with high AVC clusters. Large mammals that are struck and die away from a road are not recorded nor considered in these analyses, reducing our understanding of the number of AVCs and the cost–benefit of road mitigation measures. AimsOur aim was to develop a method to calculate a correction factor for large mammal carcass data reported through road survey. This will improve our understanding of the magnitude and cost of AVCs. MethodCitizen scientists reported animal carcasses on walking surveys along transects parallel to the highway and reported observations using a smartphone application at three sites over a 5-year period. These data were compared with traditional road survey data. Key resultWe found that many large mammals involved in AVCs die away from the road and are, therefore, not reported in traditional road surveys. A correction factor of 2.8 for our region can be applied to road survey data to account for injury bias error in road survey carcass data. ConclusionsFor large mammals, AVCs based on road survey carcass data are underestimates. To improve information about AVCs where little is known, we recommend conducting similar research to identify a correction factor to conventionally collected road survey carcass data. ImplicationsIdentifying road mitigation sites by transportation agencies tends to focus on road sections with above-threshold AVC numbers and where cost–benefit analyses deem mitigation necessary. A correction factor improves AVC estimate accuracy, improving the identification of sites appropriate for mitigation, and, ultimately, benefitting people and wildlife by reducing risks of AVCs.

Computer Science Applications and Education

Case Report, AcademicSubjects/MED00910, jscrep/0160, and Surgery

Gallstone ileus (GSI) is an uncommon entity that causes obstruction of the intestinal lumen due to gallstones. It affects mainly the elderly with multiple comorbidities, leading to a high mortality rate. In this case, an 81-year-old woman was admitted due to GSI. She had a recurrence after 5 days of the index surgery. Recurrent intestinal obstruction due to GSI during the same hospitalization despite complete clearance of the small bowel from stones is rare. Through our case, we will discuss management along with a review of the current evidence.

Psychiatry and Mental health and humanities

Background: The underutilization of mental health services is a recognized problem for the growing number of Muslims living in the West. Despite their unique mental health risk factors and the pivotal role they play in determining mental health discourse in their families and in society, Muslim women in particular have not received sufficient study. Aim: To help remedy this research gap, we examined factors that may impact the rejection attitudes of Muslim women toward professional mental health care using the first psychometrically validated scale of its kind; the M-PAMH (Muslims’ Perceptions and Attitudes to Mental Health). Methods: A total of 1,222 Muslim women responded to questions about their cultural and religious beliefs about mental health, stigma associated with mental health, and familiarity with formal mental health services in an anonymous online survey. Results: Hierarchical multiple regression analysis revealed that higher religious and cultural beliefs, higher societal stigma, and lower familiarity with professional mental health services were associated with greater rejection attitudes toward professional mental healthcare. The final model was statistically significant, F (5, 1,216) = 73.778; p Conclusions: Findings suggest that although the examined factors contributed significantly to the model, they may not be sufficient in the explanation of Muslim women's rejection attitudes toward mental health services. Future research may explore additional variables, as well as predictive profiles for Muslim women’s perceptions and attitudes of mental health based on a combination of these factors.

Physical and Theoretical Chemistry

Pharmacology, Immunology, and Immunology and Allergy

Journal of Multidisciplinary Healthcare, internal jugular vein, high jugular bulb, facial nerve palsy, high jugular bulb dehiscence, headache, surgery, lcsh:Medicine (General), lcsh:R5-920, Case Report, General Medicine, and General Nursing

Fahd Alkhamis,1 Khalid Alhajri,1 Danah Aljaafari,1 Ali Alhashim,1 Adnan Alsamarah,2 Abdulaziz Sharydah,2 Osama Basheir,1 Feras AlSulaiman,1 Majed Alabdali1 1Department of Neurology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Radiology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Majed AlabdaliNeurology Departments, King Fahad Hospital of the University – Imam Abdulrahman Bin Faisal University, PO Box 40236, Dammam, 31952, Kingdom of Saudi ArabiaTel +966-534347474Email mmalabdali@iau.edu.saBackground: A high mega jugular Bulb is an enlarged and swollen upper portion of the internal jugular vein with a variation of its anatomical position among the population, mostly situated below the hypotympanum. Although most cases of jugular bulb diverticulum are asymptomatic, excessive pressure on the surrounding structures might cause various symptoms, most prominently vertigo, sensorineural hearing loss, or tinnitus.Case Report: A middle-aged male who was referred to the Department of Neurology with a recurrent complaint of left-sided facial weakness associated with headache and vertigo for a period of 24 months. His symptoms were episodic, furthermore exacerbated by visiting high altitude sites. Non-resolving with conventional medical treatment. After thorough investigation, including preoperative and postoperative audiograms, neuroimaging, including computed tomography as well as magnetic resonance angiography, he was diagnosed to have right-sided superior mega jugular bulb as a causative factor. After surgical management, the patient improved significantly. At his regular follow-up in our clinic there were no exacerbations of his symptoms.Conclusion: Among patients who present with recurrent non-resolving facial palsy in which no apparent causative factor is identified, high jugular bulb should be suspected and investigated. Comprehensive and detailed medical history is essential for raising the suspicion for the diagnosis. Such as the case presented eliciting high altitudes as the main precipitating factor. The diagnosis is clinically elusive, commonly obscured by other common diagnoses. Surgery is recommended if antihypertensive drugs do not show improvement.Keywords: internal jugular vein, high jugular bulb, facial nerve palsy, high jugular bulb dehiscence, headache, surgery

Drug Discovery, Pharmaceutical Science, Molecular Medicine, Medicine, business.industry, business, Global health, Authorization, Coronavirus disease 2019 (COVID-19), Food and drug administration, Drug, media_common.quotation_subject, media_common, Adverse effect, Intensive care medicine, medicine.medical_specialty, Pandemic, belantamab mafodotin-blmf, 64Cu-DOTATATE, drugs, FDA, 68Ga-PSMA-11, lumasiran, lcsh:Medicine, lcsh:R, lcsh:Pharmacy and materia medica, lcsh:RS1-441, Setmelanotide, Oligonucleotides, Peptides, Viltolarsen, and Review

2020 has been an extremely difficult and challenging year as a result of the coronavirus disease 2019 (COVID-19) pandemic and one in which most efforts have been channeled into tackling the global health crisis. The US Food and Drug Administration (FDA) has approved 53 new drug entities, six of which fall in the peptides and oligonucleotides (TIDES) category. The number of authorizations for these kinds of drugs has been similar to that of previous years, thereby reflecting the consolidation of the TIDES market. Here, the TIDES approved in 2020 are analyzed in terms of chemical structure, medical target, mode of action, and adverse effects.
This work was funded in part by the following: the National Research Foundation (NRF) and the University of KwaZulu-Natal (South Africa); MINECO, (RTI2018-093831-B-100), and the Generalitat de Catalunya (2017 SGR 1439) (Spain).

Education, Situated, Educational technology, Sociology, Emerging technologies, Engineering ethics, Enthusiasm, media_common.quotation_subject, media_common, Curriculum, Conceptual model, Common ground, Creativity, and ComputingMilieux_COMPUTERSANDEDUCATION

Internationally, creativity is a widely discussed construct that is pivotal to educational practice and curriculum. It is often situated alongside technology as a key component of education futures. Despite the enthusiasm for integrating creativity with technologies in classrooms, there is a lack of common ground within and between disciplines and research about how creativity relates to technology in teaching and learning—especially in the uncertain space of classroom implementation. This article provides a critical thematic review of international literature on creativity and technology in the context of educational practice. We identify four essential domains that emerge from the literature and represent these in a conceptual model, based around: (1) Learning in regard to creativity, (2) Meanings of creativity, (3) Discourses that surround creativity, and (4) the Futures or impacts on creativity and education. Each of these clusters is contextualized in regard to emerging technologies and the developing scope of twenty-first century skills in classroom implementation. We offer conclusions and implications for research and practice.

age of acquisition, bilingualism, english as a second language, perception of speech in noise, signal-to-noise ratio, snr loss, Otorhinolaryngology, RF1-547, Industrial medicine. Industrial hygiene, RC963-969, and Original Article

Background: Previous studies have highlighted that bilingual listeners have a deficit in speech perception in their second language compared with monolingual listeners in noisy listening environments. This deficit may give rise to educational and occupational implications for bilingual speakers who are studying or working in non-native language environments in poor acoustic conditions. Objectives: To compare the speech perception performance of monolingual English speakers and English as a second language (ESL) bilinguals within environments with various levels of background noise and to examine whether bilinguals with an early age of second language acquisition would perform better than those with a late age of acquisition. Study sample: Two groups of adult listeners with normal hearing participated: monolingual British English listeners (N = 15) and bilingual Arabic listeners for whom English was their second language and who were proficient in English (N = 15). The quick speech-in-noise (QuickSIN) test was used to assess signal-to-noise ratio (SNR) loss and SNR-50 for both groups. Results: The QuickSIN test results indicated that bilingual Arabic listeners with normal hearing displayed a mild SNR loss comparable to that observed for a person with hearing loss, indicating a higher SNR needed for this population to achieve a comparable level of comprehension to their monolingual English peers. Conclusion: Results highlight the importance of measuring SNR loss to obtain accurate diagnosis and potential rehabilitative information that is not available from audiogram studies.

Communication, Public relations, business.industry, business, Publics, Public life, Social media, Architecture, Affordance, Information technology, and Sociology

Social media complicate the very nature of public life. In this article, we consider how technology reconfigures publicness, blurs 'audiences' and publics, and alters what it means to engage in public life. The nature of publicness online is shaped by the architecture and affordances of social media, but also by people's social contexts, identities, and practices. Navigating socially mediated publicness requires new mechanisms of control and new skills. Understanding socially-mediated publicness is an ever-shifting process throughout which people juggle blurred boundaries, multi-layered audiences, individual attributes, the specifics of the systems they use, and the contexts of their use.

Infectious Diseases, Public Health, Environmental and Occupational Health, General Medicine, Intensive care, Retrospective cohort study, Cohort study, Medicine, business.industry, business, Extracorporeal membrane oxygenation, medicine.medical_treatment, Procalcitonin, Intensive care unit, law.invention, law, Comorbidity, medicine.disease, Emergency medicine, medicine.medical_specialty, Univariate analysis, Children, SARS-CoV-2, Mortality, lcsh:Infectious and parasitic diseases, lcsh:RC109-216, lcsh:Public aspects of medicine, lcsh:RA1-1270, and Article

Background Characteristics of critical Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) infection in children is not well understood. This study described the clinical characteristics of children admitted to intensive care units (ICU) and explored factors associated with the need for invasive ventilation or mortality. Methods A multicenter, retrospective, cohort study was conducted over eight medical centers, including all patients younger than 18 years of age and admitted to the ICU due to a direct consequence of coronavirus disease 2019 (COVID-19). Patients who were admitted to the ICU for any alternate reason and tested positive for SARS-CoV-2 by screening test, and patients who were admitted due to multi-inflammatory syndrome in children, were excluded. Demographic, laboratory, imaging, and clinical data were collected. Descriptive statistics were used to compare survivors and non-survivors. Fine and Gray’s hazard model was used to estimate the association between clinical variables and ICU death. Results During the study period, 25 pediatric COVID-19 patients received care in the ICUs. The median age was 2.78 years (IQR 0.21–8.51), and 60% were male. Only three patients were reported to be previously healthy at admission. Nine (36%) patients required invasive mechanical ventilation, including two were on extracorporeal membrane oxygenation. Four (16%) patients died during ICU care. In univariate analysis, the presence of comorbidity (HR 0.0001; 95%CI 0.00001–0.00016), platelets count (HR 0.99; 95% CI 0.98–0.99), elevated procalcitonin (HR 1.05; 95%CI 1.016–1.09), and circulatory compromise (HR 16.34; 95%CI 1.99–134.35), all at the time of ICU admission, were associated with in-ICU mortality. Conclusion Our findings suggest that children admitted to the ICU with SARS-CoV-2 infection, generally, have a favorable outcome. Low platelets count, elevated procalcitonin, presence of comorbidity, and shock at the time of ICU admission were associated with death. This study may shed more light on the disease dynamics of critical pediatric COVID-19.

Multidisciplinary, Coronavirus disease 2019 (COVID-19), Competing interests, OpenURL, Computational sociology, Critical research, Research data, Sociology, Library science, Public life, and Public accountability

In their Policy Forum “Computational social science: Obstacles and opportunities” (28 August, p. [1060][1]), D. M. J. Lazer et al. propose ethical data infrastructures for computational social science research. Concentrating on access to platform trace data, they dismiss third-party market data from such companies as Nielsen and comScore because of “opaque” methods and high cost. We believe both have virtues, but their proper use requires a keener appreciation of each measurement regime. All data result from measurement processes designed and executed to serve a given institutional context ([ 1 ][2], [ 2 ][3]). Platforms profit from shaping usage and they measure toward that end. Using their trace data to understand human conduct remains problematic as long as platforms are themselves opaque about their methods for managing user behavior ([ 3 ][4]). Social Science One and Twitter's COVID-19 application programming interface may be productive precedents of platform data provision, but computational social science should reckon with the effects of platform measurement. Unlike platforms, third-party measurement firms are not invested in how users behave. As with public-sector data (such as the U.S. Census), third-party measurement is periodically audited ([ 4 ][5]). Its procedures and consequences are constantly appraised by actors with competing interests ([ 5 ][6]). Serving industries, policy-makers, and academics, third-party market research has invested for decades in refining what Lazer et al. aspire to: “an administrative infrastructure… enforcing compliance with privacy and ethics rules,” which aligns “with critical research norms” including “transparency, reproducibility, replication, and consent” ([ 3 ][4], [ 6 ][7], [ 7 ][8]). Third-party measurement firms such as Nielsen and comScore supply data to a broad subscriber base of advertising agencies and content publishers, which lowers data costs. Academic institutions worldwide may access numerous such third-party datasets via Wharton Research Data Services and Chicago Booth, brokers that partner with third-party firms for this purpose. Meanwhile, public data can be cost prohibitive (such as CDC's National Death Index). What ensures data's “public accountability” is not a public-sector origin but how the measurement regime is institutionally arranged ([ 3 ][4]). In addition to expanding data collaborations and data infrastructures, attention to the measurement regimes of “found data” and reflexive triangulation across data sources are indispensable to development of computational social science. 1. [↵][9]1. T. M. Porter , Trust in Numbers: The Pursuit of Objectivity in Science and Public Life (Princeton University Press, Princeton, NJ, 1995). 2. [↵][10]1. W. N. Espeland, 2. M. L. Stevens , Arch. Eur. Sociol. 49, 401 (2008). [OpenUrl][11] 3. [↵][12]1. A. X. Wu, 2. H. Taneja , New Media Society 10.1177/1461444820933547 (2020). 4. [↵][13]1. P. M. Napoli, 2. A. B. Napoli , First Monday 24, 10.5210/fm.v24i12.10124 (2019). 5. [↵][14]1. N. Anand, 2. R. A. Peterson , Org. Sci. 11, 270 (2000). [OpenUrl][15] 6. [↵][16]Advertising Research Foundation, Member Code of Conduct (2019); . 7. [↵][17]ESOMAR, The ICC/ESOMAR Code (2020); [www.esomar.org/what-we-do/code-guidelines][18]. [1]: http://www.sciencemag.org/content/369/6507/1060 [2]: #ref-1 [3]: #ref-2 [4]: #ref-3 [5]: #ref-4 [6]: #ref-5 [7]: #ref-6 [8]: #ref-7 [9]: #xref-ref-1-1 "View reference 1 in text" [10]: #xref-ref-2-1 "View reference 2 in text" [11]: {openurl}?query=rft.jtitle%253DArch.%2BEur.%2BSociol.%26rft.volume%253D49%26rft.spage%253D401%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [12]: #xref-ref-3-1 "View reference 3 in text" [13]: #xref-ref-4-1 "View reference 4 in text" [14]: #xref-ref-5-1 "View reference 5 in text" [15]: {openurl}?query=rft.jtitle%253DOrg.%2BSci.%26rft.volume%253D11%26rft.spage%253D270%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [16]: #xref-ref-6-1 "View reference 6 in text" [17]: #xref-ref-7-1 "View reference 7 in text" [18]: http://www.esomar.org/what-we-do/code-guidelines

Poster Abstracts, AcademicSubjects/MED00290, Infectious Diseases, Oncology, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 2019-20 coronavirus outbreak, Virology, Medicine, business.industry, business, and Coronavirus disease 2019 (COVID-19)

Background Clinical presentation of coronavirus disease-2019 (COVID-19) ranges from asymptomatic to severe and life threatening. National-level registries found that children, generally, have less severe disease when compared to adults. However, most asymptomatically infected children will not present to hospital and may be missed. We aimed to describe the clinical characteristics in pediatric COVID-19 patients in Kuwait, and to estimate the potential duration of viral shedding. Methods A retrospective cohort study was performed in Jaber Alahmad Hospital (JAH) from Feb. 29th to Apr. 30th, 2020. During the study period and as part of the public health measures to contain COVID-19, all SARS-CoV-2 infected patients 1 month-18 years old, regardless of symptoms, were hospitalized at JAH, and were included. Demographics, clinical data, and laboratory results were collected. Polymerase chain reaction (PCR) negativity was defined as having two consecutive negative PCR results from a respiratory specimen. Descriptive statistics and multivariable regression analyses were performed. Results A total of 134 pediatric SARS-CoV-2 infections were identified. Of those, 91 patients (67.9%) were asymptomatic, the remaining cases had mild COVID-19 illness and mild pneumonia. The median age was 8.8 years (IQR: 4.7–12.4), 55.2% were males, and 89.5% were healthy. Cough and fever were the most commonly reported symptoms. The median duration to PCR negativity was 15 days (IQR: 13–19) for symptomatic patients and 15.5 days (IQR: 14–21) for asymptomatic patients. Predictors for symptoms included abnormal procalcitonin (aOR 6.6; 95% CI 1.48 -29.3), C-reactive protein (aOR 9.10; 95% CI 1.29–32.13), and X-ray finding of pneumonia (aOR 6.44; 95% CI 1.29–32.13). Conclusion Asymptomatic SARS-CoV-2 infection is very common in children. Among symptomatic patients, the disease seems to be mild. Children exhibit substantial duration of viral shedding, as measured by PCR positivity, regardless of symptoms. Disclosures Jesse Papenburg, MD, AbbVie (Consultant, Scientific Research Study Investigator, Research Grant or Support, Speaker’s Bureau)BD Diagnostics (Research Grant or Support)Cepheid (Speaker’s Bureau)MedImmune (Scientific Research Study Investigator)Sanofi Pasteur (Scientific Research Study Investigator)Seegene (Research Grant or Support, Speaker’s Bureau)

Biomedical sciences, Family medicine, medicine.medical_specialty, medicine, Male gender, Authoritarianism, Academic preparation, Mental illness, medicine.disease, Health care, business.industry, business, Stigma (botany), Mentally ill, Original Article, Medical students, mental illness, mentally ill, stigma, lcsh:Medicine, lcsh:R, and education

Aim: The study aimed to measure the level of the stigma of medical students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh campus, towards mentally ill patients. Material and Methods: A cross-sectional survey was conducted in King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh. The data collection was started in July 2017 till March 2018. The students completed a self-administered questionnaire consisting of sociodemographic data and the Community Attitudes toward the Mentally Ill (CAMI) Scale. Results: The sample size was realized as 274 participants. There were no significant differences in all CAMI subscales for the different academic years except for Authoritarianism which showed a significant increase in the level of stigma (P-value = 0.04). Male gender, previous psychiatric treatment, and having a relative with psychiatric illness were associated with higher Authoritarianism and Social Restrictiveness scores and lower Benevolence and CMHI scores. Discussion: More stigma was observed among the 4th year students and it might be due to insufficient academic preparation as well as more exposure to psychiatric rotations. Conclusion: The results support the importance of implementing anti-stigma programs throughout the medical program to improve the healthcare provided to mentally ill patients.

Plastic crystal, Ionic bonding, Solid state electrolyte, Materials science, and Chemical engineering

Infectious Diseases, Virology, Medicine, business.industry, business, Retrospective cohort study, Public health, medicine.medical_specialty, Procalcitonin, Asymptomatic, medicine.symptom, Coronavirus, medicine.disease_cause, Epidemiology, Internal medicine, Disease, Viral shedding, Short Communication, Short Communications, , epidemiology, , and

Clinical presentation of coronavirus disease‐2019 (COVID‐19) ranges from asymptomatic to severe and life‐threatening. National‐level registries found that children, generally, have less severe disease when compared with adults. However, most asymptomatically infected children will not present to hospital and may be missed. We aimed to describe the clinical characteristics in pediatric COVID‐19 patients in Kuwait, and to estimate the potential duration of viral shedding. A retrospective cohort study was performed in Jaber Alahmad Hospital (JAH) from February 29 to April 30, 2020. During the study period and as part of the public health measures, all severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐infected patients from 1 month to 18 years old, regardless of symptoms, were hospitalized at JAH, and were included. Polymerase chain reaction (PCR) negativity was defined as having two consecutive negative PCR results from a respiratory specimen. Descriptive statistics and multivariable regression analyses were performed. We found that 67.9% (95% CI, 59.4%–75.3%) of 134 SARS‐CoV‐2‐infected children were asymptomatic. Median PCR positivity was 15 days and did not vary with symptoms. Among patients who had laboratory investigations and chest imaging, symptomatic infection was associated with elevated C‐reactive protein and procalcitonin, and radiographic pneumonia. Asymptomatic SARS‐CoV‐2 infection is very common in children. Among symptomatic patients, the disease seems to be mild. Children exhibit substantial duration of viral shedding, regardless of symptoms.