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With the advancement of next-generation sequencing, clinicians are now able to detect ultra-rare mutations that are barely encountered by the majority of physicians. Ultra-rare and rare diseases cumulatively acquire a prevalence equivalent to type 2 diabetes with 80% being genetic in origin and more prevalent among high consanguinity communities including Saudi Arabia. The challenge of these diseases is the ability to predict their prevalence and define clear phenotypic features. This is a non-interventional retrospective multicenter study. We included pediatric patients with a pathogenic variant designated as ultra-rare according to the National Institute for Clinical Excellence's criteria. Demographic, clinical, laboratory, and radiological data of all patients were collected and analyzed using multinomial regression models. We included 30 patients. Their mean age of diagnosis was 16.77 months (range 3-96 months) and their current age was 8.83 years (range = 2-15 years). Eleven patients were females and 19 were males. The majority were of Arab ethnicity (96.77%). Twelve patients were West-Saudis and 8 patients were South-Saudis. SCN1A mutation was reported among 19 patients. Other mutations included SZT2, ROGDI, PRF1, ATP1A3, and SHANK3. The heterozygous mutation was reported among 67.86%. Twenty-nine patients experienced seizures with GTC being the most frequently reported semiology. The mean response to ASMs was 45.50% (range 0-100%). The results suggest that ultra-rare diseases must be viewed as a distinct category from rare diseases with potential demographic and clinical hallmarks. Additional objective and descriptive criteria to detect such cases are needed.

Introduction: Urinary tract infections (UTIs) are common in children. UTIs can lead to serious and permanent damage to the urinary tract if treatment is delayed or insufficient, particularly in repeated infections. Knowledge of antibiotic resistance trends aids in the selection of appropriate empiric antibiotics. There is limited data regarding this in Saudi Arabia. This study aimed to investigate uropathogens and their antibiotic resistance patterns in the pediatric community in a tertiary care center. Methodology: The study population included children aged 0 to 14 years old who had culture-proven UTIs evaluated in the Department of Pediatrics, King Abdulaziz University Hospital in Jeddah, Saudi Arabia from February 2019 to September 2021. Results: Out of 510 UTI episodes, Escherichia coli (54.5%) was the predominant causative pathogen. Of the total episodes, 137 (26.8%) were caused by extended spectrum beta-lactamase (ESBL) producers. In general, the highest resistance was observed against ampicillin (73.2%), cefazolin (54.6%), co-trimoxazole (46%), and cefuroxime (40.6%), whereas amikacin (0.4%), imipenem (0.8%), and meropenem (0.8%) showed the lowest rates of resistance. Conclusions: Antibiotic resistance is a major concern worldwide due to misuse of antibiotics and subsequent rise of multidrug resistant organisms. Our findings highlight the rise in antibiotic resistance, particularly in E. coli strains. Furthermore, ESBL-producing bacteria were responsible for approximately one-third of UTIs. Our study emphasizes the importance of local antibiograms for pediatric community-acquired infections, as it guides clinicians in every center in the choice of appropriate empiric antibiotic treatment.

The recent advances of Augmented Reality (AR) in healthcare have shown that technology is a significant part of the current healthcare system. In recent days, augmented reality has proposed numerous intelligent applications in the healthcare domain including, wearable access, telemedicine, remote surgery, diagnosis of medical reports, emergency medicine, etc. These developed augmented healthcare applications aim to improve patient care, increase efficiency, and decrease costs. Therefore, to identify the advances of AR-based healthcare applications, this article puts on an effort to perform an analysis of 45 peer-reviewed journal and conference articles from scholarly databases between 2011 and 2020. It also addresses concurrent concerns and their relevant future challenges including, user satisfaction, convenient prototypes, service availability, maintenance cost, etc. Despite the development of several AR healthcare applications, there are some untapped potentials regarding secure data trans-mission, which is an important factor for advancing this cutting-edge technology. Therefore, this paper also analyzes distinct AR security and privacy including, security requirements (i.e., scalability, confidentiality, integrity, resiliency, etc.) and attack terminologies (i.e. sniffing, fabrication, modification, interception, etc.). Based on the security issues, in this paper, we propose an artificial intelligence-based dynamic solution to build an intelligent security model to minimize data security risks. This intelligent model can identify seen and unseen threats in the threat detection layer and thus can protect data during data transmission. In addition, it prevents external attacks in the threat elimination layer using threat reduction mechanisms.

[phrase omitted] Objectives: To establish reference values for peripheral oxygen saturation levels in children using pulse oximetry. Pulse oximetry to assess peripheral oxygen saturation is widely used in pediatric care as part of vital signs monitoring. Although readings between 95% and 100% are often considered normal in clinical practice, recent studies suggest that the normal peripheral oxygen saturation range should be between 97% and 100%. Methods: This cross-sectional study included children aged [less than or equal to]18 years attending pediatric clinics and not having respiratory distress or acute illness during their visit. Vital signs and anthropometric measurements were recorded. Oxygen saturation and pulse rate were measured using the Masimo Radical-7 pulse oximeter with age-appropriate saturation probes. Results: A total of 973 participants were enrolled in the study. The median oxygen saturation was 99%. Most participants (75.9%) exhibited oxygen saturation levels between 99% and 100%, while 24.1% had values between 97% and 98%. Importantly, no participant had an oxygen saturation below 97%. Additionally, statistical analysis showed no significant differences in oxygen saturation across age groups or genders. Conclusion: The findings highlight the importance of vigilant monitoring in pediatric care, particularly when peripheral oxygen saturation values measured by pulse oximetry fall below 97%. Such readings, especially when consistently observed, should not be dismissed, as they may indicate potential underlying health issues or impending emergencies that warrant further evaluation and intervention. Keywords: Oxygen saturation, O2SAT, SpO2, children, pulse oximetry

BackgroundAdverse childhood experiences (ACEs) are traumatic events that occur before 18 years of age. ACEs have been associated with many negative health problems, including the development of chronic diseases, such as irritable bowel syndrome (IBS), a functional gastrointestinal disorder characterized by abdominal pain. We investigated the prevalence of ACEs among patients with IBS, identified the types of ACEs commonly related to patients with IBS, and further assessed the impact of ACEs on IBS severity.MethodologyA cross-sectional study was performed. The study targeted patients with IBS aged ≥ 18 years who were recruited from gastroenterology outpatient clinics at King Abdulaziz University Hospital. Adults were contacted and invited to take part in the study by completing a survey. Data were collected using two validated questionnaires, the ACE questionnaire for adults and the IBS symptom severity scoring system.ResultsThe study included 109 patients with IBS (59.6% females). The prevalence of ACEs (patients with IBS exposed to at least one ACE) was 63.3%. The most prevalent type was emotional abuse (34.9%), followed by both physical abuse and emotional neglect (28.4%). Females reported significantly more ACEs (p = 0.035) than males. The overall IBS symptoms (r = 0.195, p = 0.043) and abdominal pain (r = 0.240, p = 0.012) severity were significantly correlated with total ACEs score.ConclusionsOur findings point to a probable association between ACEs exposure and IBS, demonstrating their long-term impacts on symptoms severity. Further studies are needed to acquire a better understanding of the potential impact of ACEs on IBS.

Background and objective Ramadan is the Muslim's holiest month; it is a time when believers engage in special practices that include fasting from dawn till dusk and making cultural and dietary modifications in their everyday lives. The impact of Ramadan on human activity, sleeping patterns, and circadian rhythms of hormones have been addressed in the literature. Fasting, which constitutes the main pillar of practices during Ramadan and lasts from sunrise to sunset, can significantly affect common health conditions, leading many to seek medical care in the Emergency Department (ED). Hence, it is important to understand the pattern of ED visits and understand the impact caused by fasting during this holy month in a Muslim-majority country. In light of this, this study aimed to gather new insights into the pattern of ED visits during Ramadan at a busy tertiary care center in the period from 2019 to 2021. Methods This study was conducted by reviewing the hospital health information system to gather relevant information in May 2022. Data of patients who visited the ED during Ramadan were collected, as well as during a month prior to and after Ramadan for the purpose of comparison. Sociodemographic characteristics and clinical profiles were collected for analysis.  Results The total number of ED visits in the three months of Ramadan during the study period (three years) was 33,142, all of which were included in our analysis. Sociodemographic data were analyzed for patients who visited the ED during the month of Ramadan and the two lunar months that precede and succeed Ramadan (Shaban and Shawal). Fever was the most common complaint (16.5%), followed by abdominal pain (14%). When analyzing the findings based on patient age groups, fever was found to be the most prevalent complaint in both adults (15.6%) and pediatric patients (34.4%). Of the total ED patient visits, 7,527 patients were admitted for further care, and 197 patients deceased. Conclusion Our study findings illustrate the change in ED visit patterns during the month of Ramadan in a Muslim-majority country. Also, the type of complaints was affected significantly due to the ongoing coronavirus disease 2019 (COVID-19) pandemic during the study period. The outcomes in patients reflected substantial progress and outcomes in the ED. These findings highlight that analyzing ED data can help provide accurate information that can be used to help modify/adjust the quality of services provided in the ED. However, these modifications may affect all hospital facilities, not just the ED.

This is an interpretive study, framed by sociocultural theory, and employing qualitative data collection methods to explore the nature of reading comprehension challenges faced by English as Foreign Language learners. These challenges were identified through analysis of the students' reading aloud processes, and the factors to which students attributed these challenges were investigated from the perspectives of both the readers themselves and those of their lecturers.Information about student reading aloud processes was obtained through participation in the Think Aloud Protocol by sixteen student volunteers from three universities in Saudi Arabia. Nine students then volunteered to reflect on their reading aloud processes in the follow-up Retrospective Verbal Report. All sixteen students then took part in a semi-structured interview in which they were questioned about the factors influencing their reading challenges. Six of their lecturers also volunteered to undertake a similar interview process with regard to their student's reading of English.The findings showed that Saudi EFL students exhibited a number of reading processes which interfered with comprehension. They paid little attention to punctuation, and used ineffective reading strategies such as repetition and guessing, which were usually incorrect. Words were often incorrectly decoded and therefore, mispronounced, particularly vowels which were pronounced by their alphabetic names rather than phonically, and words were substituted for those which were graphically or phonologically similar, indicating a failure to monitor comprehension. Students also read slowly which interfered with the development of coherency, fluency and comprehension. A number of themes were identified with regard to the source of these challenges. These themes relate to the social and cultural framework surrounding the student, including a cohesive, authoritarian society with a strong social tradition and a culture which does not value or prioritize reading for pleasure. Participants believed that these social and cultural forces lead to a lack of resources, poor access to English, poor teaching methods and a lack of background knowledge as they read. They claimed that this generated states of mind which contributed to their reluctance, and largely negative attitudes towards, reading in English. In particular, participants reported that the social demands of their culture, the failure to teach good phonic skills, and of negative mental and emotional states, influenced their reading fluency and contributed to their reading comprehension challenges.The unique approach and design of this study, particularly in the context of the Arab world, has produced findings which demonstrate the relevance and influence of social and cultural factors on reading processes and comprehension challenges. These findings have led to a number of recommendations for the learning and teaching of English reading in international contexts. The study concludes by suggesting that these processes and factors be further investigated by future studies

Alzheimer’s disease (AD) is a pressing global issue, demanding effective diagnostic approaches. This systematic review surveys the recent literature (2018 onwards) to illuminate the current landscape of AD detection via deep learning. Focusing on neuroimaging, this study explores single- and multi-modality investigations, delving into biomarkers, features, and preprocessing techniques. Various deep models, including convolutional neural networks (CNNs), recurrent neural networks (RNNs), and generative models, are evaluated for their AD detection performance. Challenges such as limited datasets and training procedures persist. Emphasis is placed on the need to differentiate AD from similar brain patterns, necessitating discriminative feature representations. This review highlights deep learning’s potential and limitations in AD detection, underscoring dataset importance. Future directions involve benchmark platform development for streamlined comparisons. In conclusion, while deep learning holds promise for accurate AD detection, refining models and methods is crucial to tackle challenges and enhance diagnostic precision.

This study-involved novelty of high power new aluminum (Al) fuel cell in 0.1 M HCl (less corrosive and strong conductive electrolyte instead of the aggressive alkali). The performance of aluminum (Al) anode enhanced by using antimony sulphate Sb 2 (SO 4 ) 3 salt effective poison (in acidic solution) the parasitic hydrogen evolution reaction (HER). Antimony ad-atom specifically adsorbed at cathodic sites of Al surface and stopped HER via retardation of recombination of step of H ads , consequently the formation of molecular hydrogen and its release from aluminum surface. The production of sustainable electricity from AFC and maximum power density achieved by Sb adsorption and using the low cost prepared porous air cathode (sulphur-Fe 2 O 3 -doped NiO nanocomposie). Corrosion control of Al and using NiO air cathode improved cell discharge capacity. The best cell parameters obtained at 1 × 10 − 5 M Sb 2 (SO 4 ) 3 were (cell potential 2.4 V, current density 20.4 Am − 2 and electrical power 30.30 kwhkg − 1 .

This study sought to understand students’ intentions regarding the use of ChatGPT in learning from the perspective of perceived value, exploring the influence of artificial intelligent (AI) literacy. Drawing on a sample of 676 university students from diverse academic backgrounds, we employed a structured survey questionnaire to measure their perceptions of ChatGPT as a learning tool. The collected data were then analyzed using structural equation modeling (SEM) via SmartPLS 4 software. The findings showed a strong effect of the students’ perceived value of ChatGPT on their intention to use it. Our findings suggest that perceived usefulness, perceived enjoyment and perceived fees had a significant influence on students’ perceived value of ChatGPT, while perceived risk showed no effect. Moreover, the role of AI literacy emerged as pivotal in shaping these perceptions. Students with higher AI literacy demonstrated an enhanced ability to discern the value of ChatGPT. AI literacy proved to be a strong predictor of students’ perception of usefulness, enjoyment, and fees for using ChatGPT in learning. However, AI literacy did not have an impact on students’ perceptions of using ChatGPT in learning. This study underscores the growing importance of integrating AI literacy into educational curricula to optimize the reception and utilization of innovative AI tools in academic scenarios. Future interventions aiming to boost the adoption of such tools should consider incorporating AI literacy components to maximize perceived value and, subsequently, use intention.