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Coronary artery disease (CAD) is the most prevalent form of cardiovascular disease that may result in myocardial infarction. Annually, it leads to millions of fatalities and causes billions of dollars in global economic losses. Limited resources and complexities in interpreting results pose challenges to healthcare centers in implementing deep learning (DL)-based CAD detection models. Ensemble learning (EL) allows developers to build an effective CAD detection model by integrating the outcomes of multiple medical imaging models. In this study, the authors build an EL-based CAD detection model to identify CAD from coronary computer tomography angiography (CCTA) images. They employ a feature engineering technique, including MobileNet V3, CatBoost, and LightGBM models. A random forest (RF) classifier is used to ensemble the outcomes of the CatBoost and LightGBM models. The authors generalize the model using two benchmark datasets. The proposed model achieved an accuracy of 99.7% and 99.6% with limited computational resources. The generalization results highlight the importance of the proposed model’s efficiency in identifying CAD from the CCTA images. Healthcare centers and cardiologists can benefit from the proposed model to identify CAD in the initial stages. The proposed feature engineering can be extended using a liquid neural network model to reduce computational resources.

Objective To assess the efficacy of newly designed butterfly splint with special technique for middle turbinate stabilization in preventing adhesion following bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). Study design Prospective, double-blind, randomized controlled. Setting University hospitals. Methods Following ESS, in cases of traumatized and/or unstable middle turbinates, newly designed butterfly plastic splint was randomly inserted in the middle meatus of one nasal side, while no splint was inserted in the other (control). Patients were followed up on after 1 week, 1 month, and 6 months. Endoscopic examination and a visual analog scale were used to evaluate each side of the nasal cavity for adhesion, crusting, pus, pain, nasal obstruction, and nasal discharge. Results Thirty patients (60 nasal sides) were included. For all investigated parameters, there was no significant difference between the splinted and non-splinted sides at the first week visit. Adhesion was found significantly less in the splinted sides (3%) than the non-splinted sides (27%) after 1 month ( P  = 0.038). The adhesion rate in the splinted sides remained 3% at the 3 month follow-up visit, however, in the non-splinted sides, the rate increased up to 30% ( P  = 0.007). Throughout the follow-up visits, all other investigated parameters remained statistically insignificant between both sides. Conclusions The newly designed butterfly plastic splints to avoid middle turbinate adhesion is safe and effective in both reducing middle meatal adhesion with low complication rate in CRSwNP patients undergoing ESS and middle turbinate stabilization in its intermediate position.

Marine environments are facing several threats from climate change. The threats include changing salinity, temperature and acidity. Changes in these environmental aspects can have an influence on individual foraging and patterns of growth in marine fish and ultimately entire food webs. Understanding the foraging biology of marine fish is important because their feeding habits and their diet selection are vital characteristics of trophic relationships in marine ecosystems. In this thesis, I explored the food web structure of the Arabian Gulf Marine Fishery, the growth rate of estuarine threespine stickleback (Gasterosteus aculeatus) fish, and their diet choice. The focus for all three studies was the potential threat caused by the elevation of salinity, temperature and associated changes in productivity and diet. In Chapter 2, I present a study on diet selectivity in larval and juvenile G. aculeatus along a salinity gradient of how this environmental parameter along with temperature, prey species richness, prey diversity and productivity affected the diet choice of these fish. I found that prey selectivity, which I defined as the difference between size in gut and size in pond, declines with salinity but that selectivity was unaffected by temperature, productivity, prey species richness, and prey diversity. In Chpater 3 I present a study of how salinity, temperature, productivity and zooplankton food size affects the growth rate of larval and juvenile threespine sticklebacks. I found that salinity, zooplankton prey size and zooplankton species richness all affected the growth rate of these fish, while no effect was observed for temperature, productivity and other features of the environment. In Chapter 4 I present the largest marine food web ever constructed, for the Arabian (=Persian) Gulf. The Arabian Gulf is experiencing increased salinity in spawning ground areas due to alterations of freshwater influx. I examined the structure of this community in comparison to other previously reported marine food webs and found it to be similar. I also explored how the structure of the food web changes when only species were considered (taxonomic food webs) versus of the consideration of life stages as species (disaggregated food webs). I also explored the impact on the food web structure due to the removal of all commercial species from both webs. One of the major findings was that copepods, mainly calanoids, were the most common prey. Thus, their productivity is vital to the fishery. My work in this thesis on larval and juvenile fish growth and on diet choice shows that larval and juvenile fish are sensitive to the changes in environmental parameters, particularly salinity. My work also shows that calanoid copepods are a major prey in a large fishery. In general, this suggests that it is very important to understand the sensitivity of larval and juvenile fish to environmental characteristics and the management of their prey (e.g. copepods).

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a severe pandemic of the current century. The vicious tentacles of the disease have been disseminated worldwide with unknown complications and repercussions. Advanced COVID-19 syndrome is characterized by the uncontrolled and elevated release of pro-inflammatory cytokines and suppressed immunity, leading to the cytokine storm. The uncontrolled and dysregulated secretion of inflammatory and pro-inflammatory cytokines is positively associated with the severity of the viral infection and mortality rate. The secretion of various pro-inflammatory cytokines such as TNF-α, IL-1, and IL-6 leads to a hyperinflammatory response by recruiting macrophages, T and B cells in the lung alveolar cells. Moreover, it has been hypothesized that immune cells such as macrophages recruit inflammatory monocytes in the alveolar cells and allow the production of large amounts of cytokines in the alveoli, leading to a hyperinflammatory response in severely ill patients with COVID-19. This cascade of events may lead to multiple organ failure, acute respiratory distress, or pneumonia. Although the disease has a higher survival rate than other chronic diseases, the incidence of complications in the geriatric population are considerably high, with more systemic complications. This review sheds light on the pivotal roles played by various inflammatory markers in COVID-19-related complications. Different molecular pathways, such as the activation of JAK and JAK/STAT signaling are crucial in the progression of cytokine storm; hence, various mechanisms, immunological pathways, and functions of cytokines and other inflammatory markers have been discussed. A thorough understanding of cytokines’ molecular pathways and their activation procedures will add more insight into understanding immunopathology and designing appropriate drugs, therapies, and control measures to counter COVID-19. Recently, anti-inflammatory drugs and several antiviral drugs have been reported as effective therapeutic drug candidates to control hypercytokinemia or cytokine storm. Hence, the present review also discussed prospective anti-inflammatory and relevant immunomodulatory drugs currently in various trial phases and their possible implications.

BackgroundCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Treatments for CTS alternate from conservative strategies to surgical decompression of median nerve. Few studies have applied platelet-rich plasma (PRP) for treating idiopathic CTS, with acceptable success rates. Further studies are needed to reach concrete conclusion.ObjectiveTo study the effect of PRP injection in treatment of mild to moderate idiopathic CTS.MethodsThis is a randomized controlled trial in a cohort of Egyptian patients suffered from mild to moderate CTS. They were randomly divided into two groups. Group 1: patients received ultrasound guided PRP injection and group 2 patients received ultrasound guided corticosteroid injection. The outcome measures were assessed via Visual Analog Scale, the Boston Carpal Tunnel Syndrome Questionnaire, electrophysiological findings in sensory and motor functions of median nerve and morphological changes of median nerve detected by ultrasound.ResultsThis study included 150 patients suffered from mild to moderate idiopathic CTS 15 did not provide the written consent and 37 participants were excluded from the study based on the exclusion criteria leaving only 98 patients to participate in the study they were divided into two groups PRP Injection Group (PRP-inj-G) — this group included 49 patients (40 females and 9 males) steroid injection Group (St-inj-G) — included 49 patients (41 females and 8 males). At the beginning of study there was no significant difference between both groups in all parameters. (a) PRP injection had significantly improved the clinical manifestations, the electrodiagnostic examination (EDX) parameters of the median nerve (MN), and the median nerve cross sectional area (m-CSA) at 1 month and 3 months post-injection evaluation in comparison to baseline recordings; (b) local steroid injection had significantly improved the clinical manifestations, the EDX parameters of the MN, and the m-CSA at 1 month and 3 months post-injection evaluation in comparison to baseline recordings and (c) PRP injection was superior to the local steroid injection in the improvement of clinical manifestations as well as the MN motor conduction velocity along the wrist-elbow segment, the sensory latency (SL) and the MN sensory conduction, this superiority was observed in third month follow-up suggesting better outcomes in long-term follow-up.ConclusionPlatelet-rich plasma could be effective treatment of mild to moderate idiopathic CTS and superior to corticosteroid in improving pain, function, and distal sensory latency of median nerve.Trial registrationClinical Trials.gov Identifier: NCT03863873Key Points:• PRP is effective treatment of mild to moderate CTS.• PRP is superior to corticosteroids in improving pain and function in CTS.

Background Evidence-based medicine (EBM) is “the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients. It has become an essential part of practicing in all aspects of healthcare. Objective We aimed to investigate evidence-based medicine education of medical students in Sudan. Methods The study employed a descriptive cross-sectional online survey on Sudanese medical students via convenience sampling. Data collection spanned from March 10, 2023, to September 18, 2023. The questionnaire, adapted with input from faculty members, covered sociodemographic data, search engine usage, evidence-based medicine (EBM) skills, attitudes toward EBM, and knowledge of EBM terms. Randomization of questions and response validation were utilized to minimize bias. Data were collected via Google Forms and analyzed using R and SPSS software, and appropriate statistical tests were performed. Results The cross-sectional study consisted of 1201 Sudanese medical students from various private and public schools. Most participants were female (61.0%), with a mean age of 22.36 ± 2.36 years. The majority were fourth-year students (25.4%). Over half (51.3%) had attended previous EBM training, with 71.4% having taken research methodology courses. However, only 50.4% read scientific literature monthly or less, and 30.8% never read scientific literature monthly. Google, Wikipedia, and Google Scholar were the predominant search engines. Self-reported EBM skills varied, with no significant difference between trained and untrained students. Attitudes towards EBM were generally positive, though variations existed. Understanding of EBM terms varied, with case report being the most recognized study design term. In patient care, most students rated their EBM skills as average. Conclusion Medical students lack knowledge and skills related to evidence-based medicine (EBM) and have a positive attitude towards its use in healthcare practice. Many rely on non-scientific search engines for medical information due to limited access to institutional resources. They primarily obtain medical information from books and lecture notes, highlighting the need for education on accessing scientific literature.

Neurodegenerative disorders such as Alzheimer’s disease (AD), Parkinson’s disease (PD), Huntington’s disease (HD), and amyotrophic lateral sclerosis (ALS) are characterized by the progressive degeneration of neuronal structure and function, leading to severe cognitive and motor impairments. These conditions present significant challenges to healthcare systems, and traditional treatments often fail to account for genetic variability among patients, resulting in inconsistent therapeutic outcomes. Pharmacogenomics aims to tailor medical treatments based on an individual’s genetic profile, thereby improving therapeutic efficacy and reducing adverse effects. This focused review explores the genetic factors influencing drug responses in neurodegenerative diseases and the potential of pharmacogenomics to revolutionize their treatment. Key genetic markers, such as the APOE ε4 allele in AD and the CYP2D6 polymorphisms in PD, are highlighted for their roles in modulating drug efficacy. Additionally, advancements in pharmacogenomic tools, including genome-wide association studies (GWAS), next-generation sequencing (NGS), and CRISPR-Cas9, are discussed for their contributions to personalized medicine. The application of pharmacogenomics in clinical practice and its prospects, including ethical and data integration challenges, are also examined.

This record study aimed to investigate the prevalence of metabolic syndrome (MetS) profiles regarding sex, age, and obesity for the riskier factor of cardiovascular diseases in a general population in Saudi Arabia. Laboratory and anthropometric measurements were performed on non-specific participants with variant ages and BMI in either sex. Serobiochemical changes were measured for metabolic profiles, i.e., A1C/FSG, TC, TGC, HDLC/LDLC, Vit.D, TSH/T4, Hb, and Cr. The study was applied in a Polyclinic, Abha, Saudi Arabia in 2020 G. The general population showed variable incidences of MetS profiles, such as 69.4% diabetes, 85.5% hypothyroidism, and 92.2% obesity. Hypothyroidism showed a higher incidence in women rather than in men, but men were more dyslipidemic, with higher TGC and LDLC but low HDLC, compared to women. Men <40 Y. showed diabetes and hypothyroidism, but elders were dyslipidemic. Women <40 Y. showed anemia and hypovitaminosis-D but were suffering from hypothyroidism at all ages. Diabetes, hypothyroidism, hypovitaminosis-D, and dyslipidemia were the main MetS components in both overweight and obese participants, and an incidence of more than 50% in each profile was recorded. Diabetes with hypertension was characteristic of obese participants rather than those overweight. About 66.1% of the mixed-hypercholesterolemic cases were diabetic, but 18.9% of the mixed-diabetic participants were hypercholesterolemic. Castelli’s risk factors, CRI-I and CRI-II, and atherogenic indices, AIP and AC, were measured for evaluating the cardiac risk in different populations based on the AUC–ROC and cut-off values. Insulin-resistance marker (TyG) was also measured, showing considerable cut-off values for diabetic susceptibility in the lipidemic participants with higher TGC and TC rather than HDLC or LDLC. In conclusion, MetS showed higher susceptibility to sex and age with increased incidence in women rather than men. However, the cardiac risk was more susceptible to men of higher TGC and low HDLC than women. Type 2 Diabetes mellitus (T2DM) was more prominent in both elders (≥40 Y.) than younger ages of either sex. Anemia and deficiency of Vit. D was characteristic of young women (<40 Y.). Hypothyroidism affects young men <40 Y. but was recorded in women of all ages. Both dyslipidemia and diabetes could trigger CVD, showing higher cardiac risk in mixed-hypercholesterolemic men rather than women. Our study strongly suggests that the consumption of unhealthy junk food, tobacco smoking, lack of exercise, and physical inactivity could be conclusive evidence of MetS in the Saudi population.

We report the clinical efficacy against COVID-19 infection of BBV152, a whole virion inactivated SARS-CoV-2 vaccine formulated with a toll-like receptor 7/8 agonist molecule adsorbed to alum (Algel-IMDG) in Indian adults. We did a randomised, double-blind, placebo-controlled, multicentre, phase 3 clinical trial in 25 Indian hospitals or medical clinics to evaluate the efficacy, safety, and immunological lot consistency of BBV152. Adults (age ≥18 years) who were healthy or had stable chronic medical conditions (not an immunocompromising condition or requiring treatment with immunosuppressive therapy) were randomised 1:1 with a computer-generated randomisation scheme (stratified for the presence or absence of chronic conditions) to receive two intramuscular doses of vaccine or placebo administered 4 weeks apart. Participants, investigators, study coordinators, study-related personnel, the sponsor, and nurses who administered the vaccines were masked to treatment group allocation; an unmasked contract research organisation and a masked expert adjudication panel assessed outcomes. The primary outcome was the efficacy of the BBV152 vaccine in preventing a first occurrence of laboratory-confirmed (RT-PCR-positive) symptomatic COVID-19 (any severity), occurring at least 14 days after the second dose in the per-protocol population. We also assessed safety and reactogenicity throughout the duration of the study in all participants who had received at least one dose of vaccine or placebo. This report contains interim results (data cutoff May 17, 2021) regarding immunogenicity and safety outcomes (captured on days 0 to 56) and efficacy results with a median of 99 days for the study population. The trial was registered on the Indian Clinical Trials Registry India, CTRI/2020/11/028976, and ClinicalTrials.gov, NCT04641481 (active, not recruiting). Between Nov 16, 2020, and Jan 7, 2021, we recruited 25 798 participants who were randomly assigned to receive BBV152 or placebo; 24 419 received two doses of BBV152 (n=12 221) or placebo (n=12 198). Efficacy analysis was dependent on having 130 cases of symptomatic COVID-19, which occurred when 16 973 initially seronegative participants had at least 14 days follow-up after the second dose. 24 (0·3%) cases occurred among 8471 vaccine recipients and 106 (1·2%) among 8502 placebo recipients, giving an overall estimated vaccine efficacy of 77·8% (95% CI 65·2–86·4). In the safety population (n=25 753), 5959 adverse events occurred in 3194 participants. BBV152 was well tolerated; the same proportion of participants reported adverse events in the vaccine group (1597 [12·4%] of 12 879) and placebo group (1597 [12·4%] of 12 874), with no clinically significant differences in the distributions of solicited, unsolicited, or serious adverse events between the groups, and no cases of anaphylaxis or vaccine-related deaths. BBV152 was highly efficacious against laboratory-confirmed symptomatic COVID-19 disease in adults. Vaccination was well tolerated with no safety concerns raised in this interim analysis. Bharat Biotech International and Indian Council of Medical Research.

Salinity stress adversely affects plant growth by disrupting water uptake, inducing ion toxicity, initiating osmotic stress, impairing growth, leaf scorching, and reducing crop yield. To mitigate this issue, the application of kaempferol (KP), caffeic acid (CA), and plant growth-promoting rhizobacteria (PGPR) emerges as a promising technology. Kaempferol, a flavonoid, protects plants from oxidative stress, while caffeic acid, a plant-derived compound, promotes growth by regulating physiological processes. PGPR enhances plant health and productivity through growth promotion, nutrient uptake, and stress mitigation, providing a sustainable solution. However, combining these compounds against drought requires further scientific justification. That’s why the current study was conducted using 4 treatments, i.e., 0, 20 µM KP, 30 μM CA, and 20 µM KP + 30 μM CA without and with PGPR ( Bacillus altitudinis ). There were 4 replications following a completely randomized design. Results showed that 20 µM KP + 30 μM CA with PGPR caused significant enhancement in potato stem length (14.32%), shoot root, and leaf dry weight (16.52%, 11.04%, 67.23%), than the control. The enrichment in potato chlorophyll a, b, and total (31.86%, 46.05%, and 35.52%) was observed over the control, validating the potential of 20 µM KP + 30 μM CA + PGPR. Enhancement in shoot N, P, K, and Ca concentration validated the effective functioning of 20 µM KP + 30 μM CA with PGPR evaluated to control. In conclusion, 20 µM KP + 30 μM CA with PGPR is the recommended amendment to alleviate salinity stress in potatoes.