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Water-in-diesel (W/D) emulsion fuel is a potentially viable diesel fuel that can simultaneously enhance engine performance and reduce exhaust emissions in a current diesel engine without requiring engine modifications or incurring additional costs. In a consistent manner, the current study examines the impact of adding water, in the range of 5–30% wt. (5% increment) and 2% surfactant of polysorbate 20, on the performance in terms of brake torque (BT) and exhaust emissions of a four-cylinder four-stroke diesel engine. The relationship between independent factors, including water addition and engine speed, and dependent factors, including different exhaust released emissions and BT, was initially generated using machine learning support vector regression (SVR). Subsequently, a robust and modern optimization of the sea-horse optimizer (SHO) was run through the SVR model to find the optimal water addition and engine speed for improving the BT and lowering exhaust emissions. Furthermore, the SVR model was compared to the artificial neural network (ANN) model in terms of R-squared and mean square error (MSE). According to the experimental results, the BT was boosted by 3.34% compared to pure diesel at 5% water addition. The highest reduction in carbon monoxide (CO) and unburned hydrocarbon (UHC) was 9.57% and 15.63%, respectively, at 15% of water addition compared to diesel fuel. The nitrogen oxides (NOx) emissions from emulsified fuel were significantly lower than those from pure diesel, with a maximum decrease of 67.14% at 30% water addition. The suggested SVR-SHO model demonstrated superior prediction reliability, with a significant R-Squared of more than 0.98 and a low MSE of less than 0.003. The SHO revealed that adding 15% water to the W/D emulsion fuel at an engine speed of 1848 rpm yielded the optimum BT, CO, UHC, and NOx values of 49.5 N.m, 0.5%, 57 ppm, and 369 ppm, respectively. Finally, these outcomes have important implications for the potential of the SVR-SHO approach to minimize engine exhaust emissions while maximizing engine performance.

During the last four centuries, there have been extensive research activities looking for green and clean sources of energy instead of traditional (fossil) energy in order to reduce the accumulation of gases and environmental pollution. Natural dye-sensitized solar cells (DSSCs) are one of the most promising types of photovoltaic cells for generating clean energy at a low cost. In this study, DSSCs were collected and experimentally tested using four different dyes extracted from Mentha leaves, Helianthus annuus leaves, Fragaria, and a mixture of the above extracts in equal proportions as natural stimuli for TiO2 films. The result show that solar energy was successfully turned into electricity. Additionally, DSSCs based on mixtures of dyes showed better results than those based on single dyes. Efficiency (η) was 0.714%, and the fill factor (FF) was 83.3% for the cell area.

Background. The presence of extensive workload and pressure associated with COVID19 has resulted in a lot of mental and physical trauma in primary health care physicians (PHCC) across the world. Aim of the study. The present study is aimed at understanding the level of dissatisfaction in PHCC physicians in the Asser region of Saudi Arabia. The various risk factors associated with dissatisfaction also have been analyzed in this study. Method. An analytical cross-sectional study was performed on various PHCCs who were working in the Ministry of Health in the Asser region. Results. The overall analysis showed that around 73% of the physicians who responded showed dissatisfaction. The major factors that were found to affect satisfaction based on the variables analyzed include physicians who are males, Saudi Nationals, training residents, and those who received recognition. These four variables had a p value of less than 0.0001 making it statistically significant. Conclusion. The study observed that there is dissatisfaction amongst PHCC physicians towards the management of pandemics. The factors identified should help officials in order to address these issues

Renewable energy is a sustainable source of energy that never ends. Ejectors are reliable devices as they rely on solar energy to run. Ejectors can be used as an alternative to compressors in refrigeration systems or provide vacuum zones in various applications. Ejectors have no moving parts, compact, and stable operation. However, they have lower efficiency at the current time. There may be opportunities to improve ejector efficiency under some conditions and develop a thorough understanding of the impact of their design parameters. This paper presents the numerical simulations CFD study to investigate the effect of various design parameters on the flow structure inside an ejector. This was achieved by modelling a variable ejector geometry with the ideal gas flow. This is a CFD study with new approaches. The numerical model has been validated by conducting different meshing levels. Three mesh size has been suggested, and the medium size was considered. The results showed that the secondary inlet with a diameter of 90 mm resulted in a reduction with the generated vortices compared to the Model I result. Also, the effect of changing the diffuser throat to 45 mm in Model II, has shown improvement in reducing vortices.

This study evaluates cellular phones for potential risk of nosocomial infection amongst dental operators and auxiliary staff in a dental school. Each participant's mobile phone was first cleaned with 70% isopropyl alcohol swab. Following the cleansing protocol, the partakers were asked to make a short phone call. The mobile phones were then washed aseptically by rotating damp cotton swabs with sterile normal saline. Bacterial growth was identified on sheep blood agar and McConkey's agar plates. Sabouraud dextrose agar media was used for fungi species. Descriptive statistics was established with the data statistically explored with SPSS version 17.0. About 50% of dental professionals had shown active bacterial and fungal growth in which 35% (n=35) were dental operators and 15% (n=15) were dental nurses. 53% Gram-positive organisms, 2% Gram-negative organisms, and 3% fungi were identified growths on cellular phones. Thus, it can be concluded that the cellular phones of dental operators as compared to auxiliaries can act as a potential source of nosocomial infection.

Breast cancer is the most common malignancy affecting women, manifesting as a heterogeneous disease with diverse molecular characteristics and clinical presentations. Recent studies have elucidated the role of epigenetic modifications in the pathogenesis of breast cancer, including drug resistance and efflux characteristics, offering potential new diagnostic and prognostic markers, treatment efficacy predictors, and therapeutic agents. Key modifications include DNA cytosine methylation and the covalent modification of histone proteins. Unlike genetic mutations, reprogramming the epigenetic landscape of the cancer epigenome is a promising targeted therapy for the treatment and reversal of drug resistance. Epidrugs, which target DNA methylation and histone modifications, can provide novel options for the treatment of breast cancer by reversing the acquired resistance to treatment. Currently, the most promising approach involves combination therapies consisting of epidrugs with immune checkpoint inhibitors. This review examines the aberrant epigenetic regulation of breast cancer initiation and progression, focusing on modifications related to estrogen signaling, drug resistance, cancer progression, and the epithelial–mesenchymal transition (EMT). It examines existing epigenetic drugs for treating breast cancer, including agents that modify DNA, inhibitors of histone acetyltransferases, histone deacetylases, histone methyltransferases, and histone demethyltransferases. It also delves into ongoing studies on combining epidrugs with other therapies and addresses the upcoming obstacles in this field.

Clinical pharmacists play a critical role in cardiology by optimizing pharmacotherapy and improving patient outcomes. However, despite their growing importance, standardized quality indicators to evaluate their impact in clinical practice remain lacking. This study aimed to develop and validate a set of cardiology-specific Quality Indicator Drug Therapy Problems (QI-DTPs) defined as medication-related quality indicators focused on identifying, preventing, and resolving drug therapy problems-using a modified Delphi technique in Saudi Arabia. Twenty-three candidate QI-DTPs were developed based on a comprehensive review of current cardiology guidelines and evidence-based literature, refined by an expert advisory group. A panel of sixteen experienced clinical pharmacists with cardiology expertise from Saudi Arabia evaluated these indicators using a modified Delphi approach conducted over three iterative rounds. Each indicator was rated on a nine-point Likert scale (1 = strong disagreement to 9 = strong agreement). Indicators achieving ≥75% consensus were considered validated. Sixteen expert clinical pharmacists participated (69% male, 31% female), most of whom had completed a pharmacy residency and had cardiology-related clinical experience. High levels of agreement were achieved across the Delphi rounds, and all 23 proposed QI-DTPs met the predefined ≥75% consensus threshold, demonstrating strong agreement regarding their relevance, clarity, and applicability in cardiology practice. The study successfully identified and validated 23 QI-DTPs, reflecting strong consensus among clinical pharmacists in Saudi Arabia. Implementation of these indicators in clinical practice could enhance the quality of cardiovascular care, reinforce pharmacist-led interventions, and promote medication safety. Future research should assess the direct impact of these quality metrics on patient outcomes.

Background Critically ill patients are at a higher risk of developing infections and related complications, which can lead to death. Each additional day of antipseudomonal β-lactam use increases the risk of resistance; therefore, de-escalation is highly recommended to improve antibiotic use. To our knowledge, there are limited studies that have evaluated the clinical impact of de-escalation in critically ill patients with proven Methicillin-Susceptible Staphylococcus aureus (MSSA) pneumonia alone. Therefore, our study aimed to assess the clinical impact of the de-escalation strategy compared with the non-de-escalation strategy in critically ill patients with proven MSSA pneumonia. Methods This multicenter retrospective cohort study was conducted in three tertiary hospitals from January 2016 to July 2021. Adult critically ill patients admitted to the intensive care unit with proven MSSA respiratory culture who received antibiotics with anti-MSSA activity were screened for eligibility. Eligible patients were categorized into two groups according to their de-escalation status: De-escalated and Non-de-escalated. The De-escalation was defined as the reduction of the antimicrobial activity spectrum of antibiotics by switching to a narrower-spectrum agent that targets MSSA. The primary outcome was treatment failure rate, while other outcomes were considered secondary. Propensity score (PS) matching was applied at a 1:1 ratio, and multivariate regression analyses were utilized as appropriate. Results After PS matching (1:1), 58 patients were included in the study (29 patients in non-deescalated vs 29 patients in de-escalated). The treatment failure rate was significantly higher in the de-escalated group compared to the non-de-escalated (OR 16.98; 95% CI (3.304–87.225), p  = 0.0007). In contrast, no significant differences were found in 30-day mortality, hospital and ICU length of stays, ventilator-free days, ICU readmission rate, or MSSA infection recurrence rate. Conclusion Our results showed that de-escalation of antibiotics in critically ill patients with confirmed MSSA pneumonia was associated with significantly higher rate of treatment failure while no significant differences were observed in the other clinical outcomes. These findings highlight the need for prospective studies to better inform safe and effective de-escalation strategies in this population.

We aimed to prospectively evaluate and compare the effectiveness of Alvogyl and Cutanplast as intra-alveolar dressings for managing pain associated with extraction and incidence of dry socket. All patients who underwent maxillary and mandibular teeth extraction and fulfilled our inclusion and exclusion criteria from Feb 2021 to Oct 2021 were included in our study. Patients who were diagnosed with postoperative pain after tooth extraction were randomly allocated to three groups: Group A (Alvogyl), Group B (Cutanplast), and Group C (placebo). Pain relief and healing of the socket were compared between these groups. The collected data were analyzed using the Chi-square test and Z test of proportionality. Alvogyl was superior to the other medication for providing initial pain relief, and the incidence of dry socket was significantly lower than in the Cutanplast and placebo groups (p<0.05). However, wound healing was statistically non-significant among groups A, B, and C (p>0.05). Alvogyl is still the material of choice in terms of pain relief, wound healing, and low incidence of dry socket. Furthermore, no statistically significant difference was detected between the groups in the biographic information, location, and condition of the extracted tooth, presence of a radiologic pathology, or type of extraction procedure. Moreover, whether it is the first extraction or not, Alvogyl and Cutanpast are comparable in postoperative pain management as intra-alveolar dressing materials.

Background Effective cancer management include comprehensive evaluation of treatment patterns to ensure optimal resource utilization. This is a single center study review anticancer drug utilization, with an emphasis on adherence to the World Health Organization Essential Medicines List (WHO EML) and regional prescribing trends amid increasing cancer incidence. Methods We conducted a retrospective cohort study of 512 adult patients with histologically confirmed malignant neoplasms that were managed with anti-cancer therapy at King Khaled Hospital, Najran, from 2014 to 2022. Data extraction included demographic characteristics, treatment regimens, and supportive medications, analyzed using IBM SPSS Statistics (version 21). Prescription quality was assessed against WHO EML criteria and Saudi Food and Drug Authority (SFDA) standards. Results The study revealed slight male predominance (56.4%), with a mean age 55.2 ± 17.0 years. Gastrointestinal (29.7%) and breast cancers (25.8%) accounted for the majority of cases, and 46.7% of patients presented with metastatic disease. First-line regimens predominantly included doxorubicin-cyclophosphamide (20.1%) and FOLFOX (13.5%). Notably, 86.7% of prescribed agents were listed on the WHO EML, surpassing the 85.3% benchmark, and 90.1% were generics. Supportive care commonly involved metoclopramide-based antiemetics (76.1%). Medication shortages occurred in 8.4% of cases, predominantly involving BCG. Conclusion Our findings demonstrate an optimal utilization of WHO Essential Medicines List, reflecting evidence-based, cost-effective prescribing practices that exceed international benchmarks. Despite the observed supply chain vulnerabilities, the study reinforces the relevance and applicability of the WHO model at the regional level.