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Male, Humans, Infant, Retrospective Studies, Urologic Surgical Procedures, Male methods, Urethra surgery, Treatment Outcome, Hypospadias surgery, and Fistula surgery

Urethrocutaneous fistula may complicate hypospadias repair. We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula. The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula. A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital (Amman, Jordan). Boys who were aged between 6 months and 5 years, diagnosed with distal hypospadias, and not circumcised were included. The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The results showed a total of 163 boys with distal hypospadias; among them, 116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap, and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month, 6 months, and 12 months (6.9% vs 0, 10.3% vs 0, and 5.2% vs 0, respectively), and the difference after 6 months was statistically significant (P = 0.02).
Competing Interests: None

In this paper, a numerical model is designed to evaluate the performances of a two-terminal tandem Perovskite-CIGS solar cell. Tandem perovskite solar cells (TPSCs) are a type of device that has attracted great attention for their scalability, low cost, and high efficiency. In order to validate the investigated model, the obtained data have been compared with the fabricated cell. Since a tandem cell is quite complex, to obtain realistic results, the study was conducted in several steps by optimizing first the perovskite solar cell, then performing ultrathin CIGS solar cell, and finally the tandem structure. Intrinsic organic material Methylammonium lead iodide (CH3NH3PbI3) was used as an absorber layer and its thickness has been optimized. The effect of adding an anti-reflective coating (ARC) on the top of ITO front contact on PSC device performance was studied too. The cell efficiency of the optimized perovskite cells was achieved by about 16.13%. For a good substrate, the ultrathin CIGS (u-CIGS) solar cell was calibrated to the fabricated cell characteristics. Finally, a two-terminal perovskite/CIGS tandem device was successfully simulated with an efficiency of up to 20.84%. [ABSTRACT FROM AUTHOR]

Cross-Sectional Studies, Health Knowledge, Attitudes, Practice, Humans, Parents, Patient Acceptance of Health Care, Vaccination, Social Media, and Vaccines

Vaccination has had tremendous impact on human health. The tendency to hesitate or delay vaccination has been increasing, which has contributed to outbreaks of vaccine-preventable diseases. This cross-sectional study aimed to investigate the prevalence of childhood vaccine hesitancy and social media misconceptions in vaccine refusal among randomly selected parents from October 2019 through March 2020 in the outpatient clinics of King Khalid University Hospital, Riyadh, Saudi Arabia. The data were collected using a three-part questionnaire: the socio-demographic and economic questions, the Parents' Attitudes about Childhood Vaccines (PACV) survey, and questions concerning social media use. Based on the PACV survey tool, 37 parents (11%) scored a value > 50 and were suggested as hesitant (8% hesitant and 3% very hesitant). Overall, 288 parents (89%) scored < 50, hence deemed to not be hesitant about childhood vaccination. There was no significant association between high educational level or social media exposure with vaccine hesitancy. The most commonly used social media platform was Twitter (40%). In conclusion, we report a low prevalence of vaccine hesitancy about childhood vaccination among parents, with no significant impact of education level or social media on vaccine hesitancy. Further studies are required to replicate these findings in other regions and cities to generalize these observations for Saudi Arabia.

Honor killing is a violent crime committed by one or more perpetrators, in which the crime's intention is to restore honor to their family. In this narrative review, the authors investigate the epidemiology of honor killing in the Eastern Mediterranean Region. Furthermore, the social, cultural, and legal aspects of honor killing are discussed. Numerous socio-cultural factors lead to the action of killing for honor in this region. They include deeply rooted patriarchal dominance, the desire to maintain social status, and being poorly educated. Honor killing perpetrators have similar characteristics, such as rating female chastity at a higher price and justifying violence against women. The impact of honor killing on family members is much greater than the perceived families' beliefs of the community's rejection of the female's dishonorable behavior. Silence culture dominates these societies, and many crimes are under-reported in this region. Often, a judicial trial is not conducted for such heinous crimes. Penal code reforms, campaigns to promote human rights, steps to improve the education level, and active participation of civil society in condemning such crimes are a few essential measures that need to be considered in order to curb the social evil of honor killing.

Humans, Saudi Arabia epidemiology, Exome Sequencing, Pedigree, Genetic Predisposition to Disease, Exome genetics, Epilepsy epidemiology, Epilepsy genetics, and Epilepsy diagnosis

Background: Epilepsy, a serious chronic neurological condition effecting up to 100 million people globally, has clear genetic underpinnings including common and rare variants. In Saudi Arabia, the prevalence of epilepsy is high and caused mainly by perinatal and genetic factors. No whole-exome sequencing (WES) studies have been performed to date in Saudi Arabian epilepsy cohorts. This offers a unique opportunity for the discovery of rare genetic variants impacting this disease as there is a high rate of consanguinity among large tribal pedigrees.
Results: We performed WES on 144 individuals diagnosed with epilepsy, to interrogate known epilepsy-related genes for known and functional novel variants. We also used an American College of Medical Genetics (ACMG) guideline-based variant prioritization approach in an attempt to discover putative causative variants. We identified 32 potentially causative pathogenic variants across 30 different genes in 44/144 (30%) of these Saudi epilepsy individuals. We also identified 232 variants of unknown significance (VUS) across 101 different genes in 133/144 (92%) subjects. Strong enrichment of variants of likely pathogenicity was observed in previously described epilepsy-associated loci, and a number of putative pathogenic variants in novel loci are also observed.
Conclusion: Several putative pathogenic variants in known epilepsy-related loci were identified for the first time in our population, in addition to several potential new loci which may be prioritized for further investigation.
(© 2022. The Author(s).)

Mice, Animals, Fibrosis, Myofibroblasts metabolism, Cardiomegaly metabolism, Fibroblasts metabolism, Myocardium pathology, Mice, Inbred C57BL, Ventricular Remodeling, and Heart Failure pathology

Aims: In response to pro-fibrotic signals, scleraxis regulates cardiac fibroblast activation in vitro via transcriptional control of key fibrosis genes such as collagen and fibronectin; however, its role in vivo is unknown. The present study assessed the impact of scleraxis loss on fibroblast activation, cardiac fibrosis, and dysfunction in pressure overload-induced heart failure.
Methods and Results: Scleraxis expression was upregulated in the hearts of non-ischemic dilated cardiomyopathy patients, and in mice subjected to pressure overload by transverse aortic constriction (TAC). Tamoxifen-inducible fibroblast-specific scleraxis knockout (Scx-fKO) completely attenuated cardiac fibrosis, and significantly improved cardiac systolic function and ventricular remodelling, following TAC compared to Scx+/+ TAC mice, concomitant with attenuation of fibroblast activation. Scleraxis deletion, after the establishment of cardiac fibrosis, attenuated the further functional decline observed in Scx+/+ mice, with a reduction in cardiac myofibroblasts. Notably, scleraxis knockout reduced pressure overload-induced mortality from 33% to zero, without affecting the degree of cardiac hypertrophy. Scleraxis directly regulated transcription of the myofibroblast marker periostin, and cardiac fibroblasts lacking scleraxis failed to upregulate periostin synthesis and secretion in response to pro-fibrotic transforming growth factor β.
Conclusion: Scleraxis governs fibroblast activation in pressure overload-induced heart failure, and scleraxis knockout attenuated fibrosis and improved cardiac function and survival. These findings identify scleraxis as a viable target for the development of novel anti-fibrotic treatments.
Competing Interests: Conflict of interest: None declared.
(© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Humans, Infliximab adverse effects, Tumor Necrosis Factor Inhibitors, Antibodies, Monoclonal adverse effects, Antibodies, Monoclonal, Humanized therapeutic use, Inflammation drug therapy, Crohn Disease drug therapy, Crohn Disease chemically induced, Crohn Disease complications, and Orbital Diseases drug therapy

Anti-TNF-α agents (e.g. infliximab, adalimumab, etanercept) are effective management options in various inflammatory and autoimmune diseases (e.g. inflammatory bowel disease). The occurrence during anti-TNF-α agent therapy of a new onset or exacerbation of an inflammatory condition that usually responds to this class of drug has been termed a paradoxical adverse event (PAE). A wide range of ophthalmic PAEs have been reported including uveitis, optic neuritis/neuropathy, scleritis, orbital myositis, retinal vasculitis, and others. The patient reported herein developed a dramatic orbital inflammatory PAE during his infliximab infusions, which manifested as an acute orbital apex syndrome with vision loss. Physicians using this medication should be aware of this serious vision-threatening PAE, and urgent therapy with high dose intravenous corticosteroids may be required.

Phonetics plays a major role in the fabrication of prostheses. This study aimed to assess the knowledge of students regarding the role of phonetics in denture fabrication and to improve the educational process and the clinical application. The study was conducted at the College of Dentistry, Imam Abdulrahman Bin Faisal University, and involved a survey of 344 dental students and interns. The questionnaire contained 20 questions and was divided into three sections: general knowledge, clinical correlations, and clinical evaluations. The data were collected and analyzed statistically using independent t -tests, one-way ANOVA, and Tukey's post hoc tests. The response rate was 100%. Male and female students only differed significantly in terms of their scores for answers to general knowledge questions, with females achieving better results ( p = 0.023). General knowledge varied significantly between fourth-year students and all other levels ( p < 0.001), and fifth-year students and interns ( p = 0.027). The clinical correlations varied significantly between fourth-year students and interns ( p = 0.01), whereas the clinical evaluations varied between all the academic years and interns (fourth-year, p < 0.001; fifth-year, p = 0.003; and sixth-year, p = 0.017). The interns obtained the highest scores in all sections. There was a lack of awareness among dental students of some aspects of the role of phonetics in denture fabrication. The study highlights the deficiencies that need to be addressed and the need for adjustments to the curriculum related to removable prosthodontics in order to improve the knowledge of students regarding the role of speech in denture fabrication.

Eastern Mediterranean region, honor killing, violence against women, femicide, homicide, and Medicine

Honor killing is a violent crime committed by one or more perpetrators, in which the crime’s intention is to restore honor to their family. In this narrative review, the authors investigate the epidemiology of honor killing in the Eastern Mediterranean Region. Furthermore, the social, cultural, and legal aspects of honor killing are discussed. Numerous socio-cultural factors lead to the action of killing for honor in this region. They include deeply rooted patriarchal dominance, the desire to maintain social status, and being poorly educated. Honor killing perpetrators have similar characteristics, such as rating female chastity at a higher price and justifying violence against women. The impact of honor killing on family members is much greater than the perceived families’ beliefs of the community’s rejection of the female’s dishonorable behavior. Silence culture dominates these societies, and many crimes are under-reported in this region. Often, a judicial trial is not conducted for such heinous crimes. Penal code reforms, campaigns to promote human rights, steps to improve the education level, and active participation of civil society in condemning such crimes are a few essential measures that need to be considered in order to curb the social evil of honor killing.

Epilepsy, Neurological conditions, WES, Saudi Arabia, Variants, Medicine, Genetics, and QH426-470

Abstract Background Epilepsy, a serious chronic neurological condition effecting up to 100 million people globally, has clear genetic underpinnings including common and rare variants. In Saudi Arabia, the prevalence of epilepsy is high and caused mainly by perinatal and genetic factors. No whole-exome sequencing (WES) studies have been performed to date in Saudi Arabian epilepsy cohorts. This offers a unique opportunity for the discovery of rare genetic variants impacting this disease as there is a high rate of consanguinity among large tribal pedigrees. Results We performed WES on 144 individuals diagnosed with epilepsy, to interrogate known epilepsy-related genes for known and functional novel variants. We also used an American College of Medical Genetics (ACMG) guideline-based variant prioritization approach in an attempt to discover putative causative variants. We identified 32 potentially causative pathogenic variants across 30 different genes in 44/144 (30%) of these Saudi epilepsy individuals. We also identified 232 variants of unknown significance (VUS) across 101 different genes in 133/144 (92%) subjects. Strong enrichment of variants of likely pathogenicity was observed in previously described epilepsy-associated loci, and a number of putative pathogenic variants in novel loci are also observed. Conclusion Several putative pathogenic variants in known epilepsy-related loci were identified for the first time in our population, in addition to several potential new loci which may be prioritized for further investigation.

Humans, Infant, Newborn, Prospective Studies, Reperfusion, Neuroimaging, Ischemic Stroke, Stroke diagnostic imaging, and Stroke drug therapy

Objective: Wake-up stroke (WUS) comprises a significant proportion of ischemic strokes. However, due to unclear onset, these patients are often not considered for reperfusion therapy. The objective of this study was to investigate the clinical and imaging differences between WUS patients and those with clear-onset stroke, documenting any sex, age, or risk factor predilection for WUS.
Methods: This prospective observational cohort study used an ongoing stroke registry to identify patients with acute ischemic stroke admitted to a hospital in Saudi Arabia within 5 days of symptom onset from April 2018 to March 2020. Patients were classified into 2 groups: WUS and clear-onset stroke.
Results: Among 645 patients, 448 met the criteria for acute ischemic stroke and were included in the study. WUS was identified in 112 (25%) patients. There were no differences in sex or median age between the 2 groups. Diabetes mellitus, hypertension, and dyslipidemia were higher in the WUS group, while atrial fibrillation, history of stroke and epilepsy were higher in the clear-onset stroke group. Bihemispheric stroke was higher in the clear-onset stroke group than in the WUS group (6.0% vs 2.7%).
Conclusions: Only minor dissimilarities between clinical and radiologic features of WUS and clear-onset stroke were found. Circadian patterns of stroke onset were observed in both groups. Stroke was more likely to occur during waking than during sleep, and a diurnal pattern of common occurrence during the morning was documented. Recognition of the acceptable timeframe for acute reperfusion therapy in unwitnessed strokes is crucial so that thrombolytic treatment can be started for these patients.
(© Copyright 2022 Physicians Postgraduate Press, Inc.)

Introduction: We evaluated the real-world effectiveness and safety of ustekinumab (UST) in patients with Crohn's disease (CD).
Methods: This study used a retrospective, multicenter, multinational consortium of UST-treated CD patients. Data included patient demographics, disease phenotype, disease activity, treatment history, and concomitant medications. Cumulative rates of clinical, steroid-free, endoscopic, and radiographic remissions were assessed using time-to-event analysis, and clinical predictors were assessed by using multivariate Cox proportional hazard analyses. Serious infections and adverse events were defined as those requiring hospitalization or treatment discontinuation.
Results: A total of 1,113 patients (51.8% female, 90% prior antitumor necrosis factor exposure) were included, with a median follow-up of 386 days. Cumulative rates of clinical, steroid-free, endoscopic, and radiographic remissions at 12 months were 40%, 32%, 39%, and 30%, respectively. Biologic-naive patients achieved significantly higher rates of clinical and endoscopic remissions at 63% and 55%, respectively. On multivariable analyses, prior antitumor necrosis factor (hazard ratio, 0.72; 95% confidence interval, 0.49-0.99) and vedolizumab exposure (hazard ratio, 0.65; 95% confidence interval, 0.48-0.88) were independently associated with lower likelihoods of achieving endoscopic remission. In patients who experienced loss of remission, 77 of 102 (75%) underwent dose optimization, and 44 of 77 (57%) achieved clinical response. An additional 152 of 681 patients (22.3%) were dose-optimized because of primary nonresponse incomplete response to UST, of whom 40.1% (61 of 152) responded. Serious infections occurred in 3.4% of patients while other noninfectious adverse events (lymphoma [n = 1], arthralgia [n = 6], rash [n = 6], headache [n = 3], hepatitis [n = 3], hair loss [n = 3], neuropathy [n = 1], and vasculitis [n = 1]) occurred in 2.4% of patients.
Discussion: UST represents a safe and effective treatment option for CD, with 40% of patients from a highly refractory cohort achieving clinical remission by 12 months. The greatest treatment effect of UST was seen in biologic-naive patients, and dose escalation may recapture clinical response.
(Copyright © 2022 by The American College of Gastroenterology.)

Introduction: Human papillomavirus (HPV) is a virus infection and can lead to different epithelial lesions and cancer. Nevertheless, HPV infection is a disease that can be prevented with vaccine. Genital warts, cancer, and HPV infections can all be prevented with this vaccine. In this study, we aimed to investigate awareness, knowledge of HPV infection, and acceptance of its vaccine among the general population in Saudi Arabia.
Methodology: An observational cross-sectional study was conducted in Eastern Province, Saudi Arabia between September and October 2022, using a self-administered validated questionnaire. beginning with informed consent, followed by questions about demographic data. Finally, there were questions about participants' knowledge, awareness, and attitudes around HPV and its vaccine. Rustles: The results showed 645 participants and only 4% of them had received their HPV vaccination. Knowledge, awareness, and attitude levels were all 35% with mean of 1.14, 28% with mean of 3.03, and 51% with mean of 2.02, respectively. Social media was found to be the most reliable source of information about the HPV vaccine (33%), followed by health practitioners (21%). The most common reasons for refusing vaccinations are "belief we are healthy" (48%), followed by "lack of information" (38%).
Conclusion: Regarding HPV infection and its vaccination, Saudi Arabia significantly lacks knowledge and awareness. It is essential to provide instructions and information in schools for students, families, and healthcare providers about infection and its vaccination.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright © 2022, Almaghlouth et al.)

Addressing complex future challenges requires transdisciplinary practices. However, existing approaches for transdisciplinary collaboration tend to be limited to science-expert directions. Successful collaboration across disciplines and diverse contexts requires community agency, blurring disciplinary boundaries, and combining sciences and arts. We argue that traditional and emergent design practices provide a powerful mindset to support productive transdisciplinary collaborations for addressing complex societal problems such as climate change and social justice. Designers, historically, have struggled to translate the practices of arts and sciences into professional practice; and design can be understood as a third way of knowing that is unique from arts and sciences. Designers may use evidence, but they also generate proposals that are about preferred possibilities. We propose components of a design mindset (synthesis, modelling, speculation, facilitation, and implementation) for transdisciplinary teams to enhance future-oriented collaboration outcomes. These guidelines expand research-oriented approaches and can be used for co-designing futures in collaborative work. [ABSTRACT FROM AUTHOR]

Background: Several studies have demonstrated gender influence on asthma prevalence, being higher among males during early childhood. Little is known about the impact of gender and age on asthma exacerbation characteristics in pediatrics. This study aimed to determine the differences in acute asthma between males and females in three different age groups regarding perinatal characteristics of asthmatic patients, comorbidities, medication adherence, level of blood eosinophils, and pattern of hospitalization.
Methods: The medical records of 130 pediatric patients with asthma, who presented to the emergency department at Jordan University hospital with asthma exacerbations, were retrospectively reviewed. Demographic information and clinical characteristics were collected.
Results: The mean age of patients was 10.7±4.7 years. The age at diagnosis and gestational age were significantly higher in older children. Furthermore, younger children were significantly more likely to experience winter exacerbations and more emergency presentations. Male patients were considerably younger than their female counterparts and were diagnosed younger. In addition, male patients were more likely to have eosinophil levels higher than 3% than female patients.
Conclusion: Gender plays a role in the development and outcome of asthma exacerbations at different ages of pediatrics. A better understanding of gender-based and age-based differences in asthma dictates a personalized approach to treatment.
(©Copyright: the Author(s).)

The pathogenesis of psoriasis involves the interaction of several environmental and genetic factors. Predicting the disease risk cannot depend on individual genetic alleles. Consequently, some studies have evaluated the use of genetic risk scores that combine several psoriasis susceptibility loci to increase the accuracy of predicting/diagnosing the disease. This meta-analysis summarizes the evidence regarding using genetic risk scores (GRS) in the diagnosis or prediction of psoriasis. A search of MEDLINE/PubMed, the Latin American Caribbean Health Sciences Literature (LILACS) database, Cochrane Library, Scopus, Web of Science, and ProQuest was conducted in July 2022. The primary objective was to record the area under the curve (AUC) for GRS of psoriasis. Secondary objectives included characteristics of studies and patients. The risk of bias (ROB) was assessed using the PROBAST tool. Five studies fulfilled the eligibility criteria of this review. None of the studies described the clinical criteria (reference standard) that were employed to diagnose psoriasis. The AUCs of the 11 GRS models ranged from 0.6029-0.8583 (median: 0.75). Marked heterogeneity was detected (Cochran Q: 1250.051, p < 0.001, and I 2 index: 99.2%). So, pooling of the results of the included studies was not performed. The ROB was high for all studies and clinical application was not described. Genetic risk scores are promising tools for the prediction of psoriasis with fair to good accuracy. However, further research is required to identify the most accurate combination of loci and to validate the scores in variable ethnicities.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright © 2022, Mirghani et al.)

Male, Humans, Saudi Arabia epidemiology, Cross-Sectional Studies, Schools, Medical, Students, Medical, and Education, Medical, Undergraduate

Purpose of the Study: This 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 Design: A 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 χ 2 tests where appropriate. A multinominal regression analysis was performed to obtain risk estimates and 95% CIs.
Results: A 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).
Conclusion: The 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.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Choosing a future career path is a very important decision for undergraduate medical students. Determining the factors that affect specialty choices is essential to attaining a balanced distribution. Dermatology is known to be one of the most appealing and highly competitive specialties. The aim of this study was to determine the factors influencing the choice of dermatology as a future career by medical students.
Materials and Methods: A cross-sectional study was carried out in 28 medical schools throughout Saudi Arabia. The questionnaire was prepared following a literature search of relevant studies and was distributed electronically to medical students and interns. The self-administered questionnaire included sociodemographic data, interest in dermatology as a future career, and factors that may affect specialty choices.
Results: The study included 1087 participants. Sixty percent were female, and 39% were male. Approximately half of the participants considered dermatology as their preferred specialty. We found that 53.6% of females were more interested in dermatology. Students who were exposed to dermatology in both pre-clinical and clinical years showed greater interest. Personal interest, lifestyle/flexible work schedule, and private sector opportunities were the most captivating factors. Personal interest and high competition in dermatology residency program matching were the main factors among students who did not consider dermatology as a future career choice.
Conclusions: Several factors are influencing medical students when choosing dermatology as their future specialty; the lifestyle/flexible work schedule and personal interest were the most attractive factors. Recognizing these factors could be a useful tool that may lead mentors and residency training program directors to reach a balanced distribution of doctors in the various specialties.
(Copyright: © International Journal of Health Sciences.)

Acute annular outer retinopathy, Acute zonal occult outer retinopathy, Invasive ductal carcinoma, Retinal disease, Case report, Ophthalmology, and RE1-994

Abstract Background Acute annular outer retinopathy (AAOR) is an uncommon disease. To date, there are few documented cases in the literature. Our case report is the first to describe a case of acute annular outer retinopathy in a patient with invasive ductal breast carcinoma. Case presentation The patient presented with photopsias and visual loss approximately 3 weeks prior to a diagnosis of invasive ductal breast carcinoma. We have documented the outer annular white ring seen in the acute phase of this disease and correlate it anatomically with Spectral-domain optical coherence tomography (SD-OCT) imaging. We identified RPE atrophy with nodular hyperreflectivity and loss of ellipsoid layer within the white annular ring with corresponding visual field loss. Fundus autofluorescence correlated with structural alterations seen on SD-OCT and showed both presumed active hyperautofluorescent zones with patchy hypoautofluorescent zones of atrophy and a classic annular hyperautofluorescent border. This case provides additional information about the natural history of this rare entity and its prognosis and varied presentation. Conclusions The authors report a single case of acute annular outer retinopathy in a patient with invasive ductal breast carcinoma with the corresponding SD-OCT, fundus autofluorescence and visual field findings, during the acute phase of the disease. These findings provide new insight into the characteristic features, etiology and progression of this rare disease.

Background Patellofemoral pain (PFP) is a common cause of knee pain. This condition can restrict daily activities by trying to avoid activities that aggravate their pain. This study aimed to determine the prevalence of PFP and knee pain and its associated factors among Saudi young adults. Methods A descriptive cross-sectional study was conducted in Saudi Arabia. A validated translated Arabic questionnaire was used. Data was collected through an online self-administered questionnaire. Saudi young adults of both genders aged between (18 to 40 years) were included. The mean ±SD was described for continuous variables, whereas categorical variables were reported using frequencies and percentages. The chi-square test was used for descriptive analysis. Results A total of 1558 subjects were enrolled in the current study. About 663 (42.6%) were males and 895 (57.4%) were females. Of the total participants, 718 (46%) were within the age group of 18 to 25. The overall prevalence of PFP among the current study participant was found to be 30.3%. The prevalence of PFP among males was found to be 31.4% and the prevalence of PFP among females was found to be 29.5%. The overall prevalence of knee pain among study participants was found to be 13.2% as 205 of the participants reported knee pain. The prevalence of knee pain among males was found to be 14% and the prevalence of knee pain among females was found to be 12.3%. The multivariate analysis included the following variables: age, gender, and marital status. The following factors predicted higher rate of PFP: being 18 to 25 years old (p-value < 0.001, odds ratio = 1), being 26 to 35 years old (p-value = 0.001, odds ratio = 1.689). Conclusion The prevalence of PFP and knee pains was found to be relatively high in Saudi Arabia. Age less than 40 years old was found to be associated with a higher prevalence of PFP and knee pain when compared to other age groups.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright © 2022, Aldharman et al.)

Globally, postpartum hemorrhage (PPH) is the top cause of maternal death. Multiple uterotonic medications are available to prevent PPH; however, it is still unclear whether one is the most effective. The current study compared the efficacy and safety of intravenous carbetocin with rectal misoprostol for the active management of the third stage of labor in order to prevent PPH. Eligible studies were found utilizing digital medical sources, including the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WOS), PubMed, Scopus, and Google Scholar, from inception until September 2022. Only randomized controlled trials (RCTs) that matched the inclusion requirements were chosen. We used the Cochrane Risk of Bias scale (version 2) to assess the quality of the included studies. The Review Manager (version 5.4 for Windows) was used to conduct the meta-analysis. The results were summarized as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) in fixed- or random-effects models according to the degree of between-study heterogeneity. Collectively, we screened 621 articles after omitting duplicates and eventually included three RCTs for analysis. Overall, 404 patients were included in these studies; 202 patients were allocated to the intravenous carbetocin group whereas 202 patients were allocated to the rectal misoprostol group. Two RCTs were judged as "low" risk of bias, whereas one RCT was judged as having "some concerns" regarding the quality assessment. Regarding efficacy endpoints, the intravenous carbetocin group had significantly lower blood loss (n=3 RCTs, MD=-117.74 mL, 95% CI [-185.41, -50.07], p<0.001), need for additional uterotonics (n=2 RCTs, RR=0.06, 95% CI [0.01, 0.46], p=0.007), need for uterine massage (n=2 RCTs, RR=0.40, 95% CI [0.20, 0.80], p=0.009), and need for blood transfusion (n=2 RCTs, RR=0.38, 95% CI [0.15, 0.95], p=0.04) compared with the rectal misoprostol group. Regarding safety endpoints, the rates of diarrhea (n=3 RCTs, RR=0.18, 95% CI [0.06, 0.55], p=0.003) and chills (n=2 RCTs, RR=0.31, 95% CI [0.12, 0.83], p=0.02) were significantly lower in the intravenous carbetocin group compared with the rectal misoprostol group. However, there was no significant difference between both groups regarding the rates of headache (n=3 RCTs, RR=1.23, 95% CI [0.06, 1.91], p=0.35) and facial flushing (n=2 RCTs, RR=0.88, 95% CI [0.46, 1.68], p=0.70). In conclusion, it was discovered that intravenous carbetocin was a superior substitute for rectal misoprostol for the active management of the third stage of labor. With far fewer side effects, intravenous carbetocin decreased postpartum blood loss and further uterotonic use. For women who have a high risk of PPH, intravenous carbetocin is advised.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright © 2022, Albazee et al.)

This study aims to provide comprehensive insights into the social media marketing characteristics affecting customer buying intention. The model was theoretically based on and explored using a quantitative approach. A survey strategy was adopted, and a five-point Likert questionnaire was distributed to Jordanian citizens. A total of 237 responses were received. The hypothesis testing followed structural equation modeling using SPSS software. The findings suggest that all social media marketing subcontracts exhibit a significant positive effect on buying intention, whereby accessibility is the highest. Customer involvement also moderates the relationship between social media marketing and customer buying intention. The proposed model provides new insights into social media marketing drivers affecting buying intentions and engagement with an entrepreneurial brand or product. This study reaffirms that social media marketing can significantly influence the success of Jordanian entrepreneurial firms and understanding how to use this tool effectively can significantly change how businesses operate. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) differ in their memory, attention, and visuoconstructional characteristics. The subscales of the well-known Mini-Mental State Examination (MMSE) provide an opportunity to assess these characteristics. Previous research has shown that analysis of the MMSE subscale performance of AD and DLB patients helps to differentiate them.Objective: Study the MMSE scores of AD and DLB patients to see if the ability of previously reported analyses to differentiate them could be improved. Include other dementia patients for perspective.Methods: We studied the MMSEs of all patients seen in our clinics during an 18-month period. Different equations were studied, derived from the subscales of Memory (M, 3 points maximum), Attention (A, 5 points maximum), and Pentagon-copying (P, 1 point maximum).Results: We obtained 400 MMSEs, 136 from AD patients and 24 from DLB patients, scoring range 1-30. The equation P minus M provided the best discrimination between AD and DLB. Using a P-M score = 1 to identify AD, the positive predictive value was 0.97, negative predictive value 0.22, specificity 0.92, and sensitivity 0.43. As a secondary finding, the P-M = 1 equation was also helpful to differentiate AD from Parkinson's disease dementia.Conclusion: Considering AD versus DLB in our clinic population, a demented patient who was unable to recall the three memory words on the MMSE but able to copy the intersecting pentagons had a 97% likelihood of having AD. Additional work is needed to improve the sensitivity of the P-M = 1 equation. [ABSTRACT FROM AUTHOR]

Background: Intracranial atherosclerotic disease (ICAD) is an important etiologic subtype of acute ischemic stroke (AIS). However, little direct evidence is available regarding ICAD-related stroke in Saudi Arabia (SA). This study aimed to identify the prevalence and describe the clinico-radiological spectrum of ICAD-related AIS in a SA cohort.
Methods: This was a hospital-based retrospective study enrolling patients with ICAD-related AIS between 2017 and 2020. The electronic charts were reviewed. The mechanisms of stroke were identified as artery-to-artery embolization (AAE), in situ thrombotic occlusion, hypoperfusion, or perforator branch occlusion. Pearson's χ2 test was performed to calculate the P values to establish the statistical significance of factors that could correlate with the mechanisms of stroke and functional outcome.
Results: ICAD was found in 133 of AIS comprising 26% of total. Data from all patients were reviewed. Left ICA (25%) was the most frequently affected vessel. Territorial pattern (63.9%) was the most common infarct pattern, and AAE (44.3%) was the most common underlying mechanism. Perforator branch occlusion was more prevalent in women than in men. Malignant and hemorrhagic transformation (P=0.00) were more prevalent in the AAE group. Left-sided vascular involvement was statistically associated with unfavorable outcomes than the right (P=0.019).
Conclusions: The prevalence of ICAD in our cohort from Western Asia did not differ from that in Southern Asia. ICA involvement was observed more frequently than previously reported. Further research from SA is required to better understand ICAD-related strokes in this region.
Competing Interests: The authors declare no conflict of interest.
(Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Case-Control Studies, England epidemiology, Humans, Middle Aged, Risk, Huntington Disease epidemiology, and Suicide

Objective: To examine the relative risk of suicide mortality in patients with Huntington's disease (HD).
Methods: A case-control study design was used. We used linked electronic records from primary care, secondary care and Office for National Statistics from England from 2001 through 2019. Controls were matched to cases by general practice and suicide date. Odds ratios (ORs) were adjusted for gender and age at suicide/index date.
Results: Data were available for 594,674 individuals. Patients with HD who died from suicide were significantly younger at time of death than patients with HD who died from causes other than suicide (p < 0.001). The adjusted OR for HD was 9.2 (95% confidence intervals, CI 4.9-17.4) compared to those without HD. The increase in risk was higher amongst the younger age group who were ≤ 45.8 years at suicide/index date (OR 54.5, 95% CI 10.8-276.1).
Conclusion: The markedly elevated suicide risk in patients with HD suggests that implementation of suicide risk assessment may improve survival in individuals with these diseases, especially in younger patients.
(© 2022. The Author(s).)

Diagnosis, Differential, Humans, Magnetic Resonance Imaging adverse effects, Papilledema diagnostic imaging, Papilledema etiology, Pseudotumor Cerebri complications, and Pseudotumor Cerebri diagnostic imaging

Increased intracranial pressure is the most common cause of papilledema. Multiple etiologies such as cerebral edema, hydrocephalus, space occupying lesions, infection, and idiopathic intracranial hypertension among others should be considered. Imaging plays a critical role in the detection of pathologies that can cause papilledema. MRI with contrast and CE-MRV, in particular, are key for the diagnosis of idiopathic intracranial hypertension. This review will focus in common and infrequent causes of papilledema, the role of imaging in patients with papilledema as well as its potential mimickers.

low-carbon concrete, sustainability, structural resilience, self-healing concrete application, Building construction, and TH1-9745

The sustainability of the construction industry is a priority in innovations made towards mitigating its notoriously high carbon emissions. Developments in low-carbon concrete technology are of peak interest today under the scrutiny of emerging policy pressures. Concrete is the external part of most structures vulnerable to permanent degradation and weathering, the possibility of an intrinsic restoration of its engineering properties promises unprecedented advancements towards structural resilience. Existing research in self-healing concrete (SHC) has often concerned the scope of material development and evaluation with inconclusive field testing, hindering its progress towards structural feasibility. This paper presents an overview of recent progress in SHC, and possible opportunities and challenges of popular healing systems are discussed. Moreover, trends are observed to investigate SHC’s influence on the engineering properties of concrete, and future projections of SHC are suggested with identification of potential research needs.

CONCRETE, CARBON emissions, CARBON nanofibers, and TECHNOLOGICAL innovations

The sustainability of the construction industry is a priority in innovations made towards mitigating its notoriously high carbon emissions. Developments in low-carbon concrete technology are of peak interest today under the scrutiny of emerging policy pressures. Concrete is the external part of most structures vulnerable to permanent degradation and weathering, the possibility of an intrinsic restoration of its engineering properties promises unprecedented advancements towards structural resilience. Existing research in self-healing concrete (SHC) has often concerned the scope of material development and evaluation with inconclusive field testing, hindering its progress towards structural feasibility. This paper presents an overview of recent progress in SHC, and possible opportunities and challenges of popular healing systems are discussed. Moreover, trends are observed to investigate SHC's influence on the engineering properties of concrete, and future projections of SHC are suggested with identification of potential research needs. [ABSTRACT FROM AUTHOR]

MYOFIBROBLASTS, FIBROBLASTS, BIOLOGY, HEART fibrosis, ORGANS (Anatomy), and STROMAL cells

Fibroblasts are stromal cells found in virtually every tissue and organ of the body. For many years, these cells were often considered to be secondary in functional importance to parenchymal cells. Over the past 2 decades, focused research into the roles of fibroblasts has revealed important roles for these cells in the homeostasis of healthy tissue, and has demonstrated that activation of fibroblasts to myofibroblasts is a key step in disease initiation and progression in many tissues, with fibrosis now recognized as not only an outcome of disease, but also a central contributor to tissue dysfunction, particularly in the heart and lungs. With a growing understanding of both fibroblast and myofibroblast heterogeneity, and the deciphering of the humoral and mechanical cues that impact the phenotype of these cells, fibroblast biology is rapidly becoming a major focus in biomedical research. In this review, we provide an overview of fibroblast and myofibroblast biology, particularly in the heart, and including a discussion of pathophysiological processes such as fibrosis and scarring. We then discuss the central role of Canadian researchers in moving this field forwards, particularly in cardiac fibrosis, and highlight some of the major contributions of these individuals to our understanding of fibroblast and myofibroblast biology in health and disease. [ABSTRACT FROM AUTHOR]

INFORMED consent (Medical law) and PLASTIC pipe

Self-application of topical therapy to the skin of the back skin can be challenging. The metal hanger is unwound and passed through the plastic tube, and then the metal wire is bent to hold the tube (Fig. (a) A metal clothes hanger covered with paint or plastic and part of a plastic water pipe are used; (b) the hanger is unwound and passed through the tube; (c) the metal wire is bent on each side of the tube. [Extracted from the article]

EMPLOYER attitudes, SOFT skills, EMPLOYMENT, GRADUATE attitudes, and DATA analysis

In recent years, there has been a shift towards seeing employability as a key outcome of higher education (HE). Despite this, there is still a concern that graduates are not well prepared for the labour market. One way to bridge the gap between education and the labour market is to involve employers in considerations of employability frameworks or sets of required graduate attributes. This paper reports on a study aimed at identifying how employers of medical graduates in Saudi Arabia conceptualise quality in HE. The main objective of this study is to develop a model of quality in HE that incorporates employers' views of medical education and its graduates. An exploratory two-stage design was adopted, utilising interviews and survey data. This paper discusses the interview findings relating to medical graduates' attributes in particular. Fourteen medical employers were interviewed to determine how they conceptualise quality in relation to medical educational experience and graduate attributes. Thematic Analysis of these interviews suggests that views of quality fall into three broad themes: Graduate Abilities, Graduate Readiness, and Research and Engagement Experience. Data drawn from these interviews indicate that employers favour the soft skills of medical graduates over their basic medical knowledge. Additionally, effective practical skills were cited as being of particular importance and highly desirable. This study has implications for the development and delivery of medical education in Saudi Arabia, aspiring to narrow the gap between HE and the labour market. [ABSTRACT FROM AUTHOR]