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Background Case analysis is a dynamic and interactive teaching and learning strategy that improves critical thinking and problem-solving skills. However, there is limited evidence about its efficacy as an assessment strategy in nursing education. Objectives This study aimed to explore nursing students’ perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education. Methods This study used a mixed methods design. Students filled out a 13-item study-advised questionnaire, and qualitative data from the four focus groups was collected. The setting of the study was the College of Nursing at Sultan Qaboos University, Oman. Descriptive and independent t-test analysis was used for the quantitative data, and the framework analysis method was used for the qualitative data. Results The descriptive analysis of 67 participants showed that the mean value of the perceived efficacy of case analysis as an assessment method was 3.20 (SD = 0.53), demonstrating an 80% agreement rate. Further analysis indicated that 78.5% of the students concurred with the acceptability of case analysis as an assessment method (mean = 3.14, SD = 0.58), and 80.3% assented its association with clinical competencies as reflected by knowledge and cognitive skills (m = 3.21, SD = 0.60). No significant difference in the perceived efficacy between students with lower and higher GPAs (t [61] = 0.05, p  > 0.05) was identified Three qualitative findings were discerned: case analysis is a preferred assessment method for students when compared to MCQs, case analysis assesses students’ knowledge, and case analysis assesses students’ cognitive skills. Conclusions This study adds a potential for the case analysis to be acceptable and relevant to the clinical competencies when used as an assessment method. Future research is needed to validate the effectiveness of case analysis exams in other nursing clinical courses and examine their effects on academic and clinical performance.

Background Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis. Case presentation This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock. Conclusions Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.

A total of 22 patients with cleft palate aged 8 to 12 years were selected and categorized into two groups: the first group was treated with alternate rapid maxillary expansion and constriction (Alt-RAMEC) using an expander with differential opening (EDO) and facemask, while the second group was treated using slow maxillary expansion (SME) using an EDO. Finally, the pharyngeal airway volume in the two groups was compared using cone beam computed tomography (CBCT). CBCT scans were performed before expansion and six months following the expansion. Alveolar crest level, maxillary breadth, nasal cavity width, arch width, inclination of the molar teeth, buccal and palatal alveolar bone thickness, and maxillary alveolar width were all assessed. Paired t-tests (p=0.05) were applied to compare interphase data. The two groups showed a non-significant difference in terms of nasopharyngeal volume (cm ), oropharyngeal volume (cm ), and overall pre- and post-treatment results (p>0.005). Results of comparison of pre- and post-treatment periods in the Alt-RAMEC group revealed a significantly higher cleft volume (cm ) (p=0.001). Results of comparison of pre- and post-treatment periods in the SME group revealed a substantial rise in cleft volume (cm ) (p=0.003). Results from a comparison of the cleft volume (cm ) between the two study groups pre- and post-intervention revealed a non-significant difference (p=0.200 and 0.054, respectively).

Hyperhidrosis is a disorder associated with detrimental effects on patients' quality of life, occupational activities, and social interactions. This study compares C-arm guided percutaneous radiofrequency (RF) ablation of the second and third thoracic sympathetic ganglions and local intradermal botulinum toxin type A (BTX-A) injection for the treatment of primary palmar hyperhidrosis. It focuses on clinical effectiveness, patient satisfaction, quality of life, safety, and the time at which repetition of the procedure is needed over one-year follow-up. This is a randomized single-blinded trial. This study took place in a single hospital. Eighty patients with primary palmar hyperhidrosis were randomly assigned to one of 2 interventions: local intradermal BTX-A injection (n = 40) or C-arm guided percutaneous RF ablation (n = 40). The Dermatology Life Quality Index (DLQI) questionnaire and the Hyperhidrosis Disease Severity Scale (HDSS) were used for assessment at one week, one month, and 2, 6, and 12 months after intervention. The number of patients who required repetition of the procedure later on and the time at which they needed it were recorded, and possible side effects were assessed. HDSS scores in the RF group were statistically significantly lower than in the BTX-A group at one week, one month, and 2, 6, and 12 months of follow-up. DLQI scores in the RF group were statistically significantly lower than in the BTX-A group at 6- and 12-month follow-up, whereas at one week, one month, and 2 months of follow-up, there was no statistically significant difference between both groups. The number of patients who required that the procedure be repeated was statistically significantly lower in the RF group than in the BTX-A group. The time at which patients needed repetition of the procedure in the BTX-A group was about 3 to 7 months after the first intervention. All patients in this group showed an increase in HDSS scores within this one-year follow-up. In the RF group, however, only one patient complained of increased HDSS scores after 8 months. There was no statistically significant difference in side effects between both groups. The first limitation of this study is that results were based on subjective scales. The second is the radiation exposure associated with the technique described. This study supports percutaneous C-arm guided RF ablation of the second and third thoracic sympathetic ganglions and local intradermal BTX-A injection as safe, effective options and rapid lines of treatment of primary palmar hyperhidrosis. However, percutaneous RF ablation proved to be more effective, with longer effectiveness time and better patient satisfaction, compared to local intradermal BTX-A injection. Botulinum toxin, hyperhidrosis, quality, radiofrequency ablation.

Introduction: In December 2019, a new severe acute respiratory syndrome coronavirus, SARS-CoV-2, emerged in China, causing coronavirus disease 2019. The present study investigated genetic profiles and variations of SARS-CoV-2 distributed in different regions of Saudi Arabia to begin to understand the pathogenesis and transmission of SARS-CoV-2 in this country and analyzed associations of these variations with host factors. Methodology: In total, 774 SARS-CoV-2 genomic sequences obtained and annotated by the Global Initiative on Sharing All Influenza Data (GISAID) were captured and analyzed. Results: The most common SARS-CoV-2 clades in Saudi Arabia were GH followed by O, GR, G, and S. Statistically significant associations were detected between clades and patient outcome. Age, as a host factor, was significantly associated with many variables, including virus geographical location, clade, and patient outcome. The most common variants detected were the NSP12_P323L mutation 94.9%, followed by the D614G mutation (76%) and the NS3_Q57H mutation (71.4%). The concerned variants B.1.1.7, B.1.351, and P.1 were not detected in our population. D614G was associated with higher morbidities than the wild-type virus, including higher rates of death and hospitalization. The NS3_Q57H mutation was the only variant associated with better patient outcome than the wild type. Risk of death was highest with the NSP12_P323L mutation (OR = 1.84; 95% CI = 0.37-9.30) and lowest with the NS3_Q57H mutation (OR = 0.43; 95% CI = 0.25-0.727). Conclusions: SARS-CoV-2 has evolved uniquely and independently in Saudi Arabia. Our findings provide evidence to begin linking the evolutionary implications to host factors and their effects on the virus severity and transmission.

Background Snoring is an inspiratory noise due to partial obstruction of the upper airways. It is commonly linked to a sleep problem known as obstructive sleep apnea (OSA). The clinical criteria of OSA in non-obese patients are distinct and warrant more investigation, despite being well-studied in the obese population. Objective The aim of this study is to provide a diagnostic profile of snoring and OSA in non-obese patients using various assessment tools in order to identify upper airway obstruction patterns and potential risk factors in these patients to improve their management and prevent related comorbidities. Methodology An observational cross-sectional study of 30 non-obese (BMI < 29.9) snorers (18 males and 12 females) with a mean age of 38.13 ± 8.4 years. All patients underwent polysomnography and thorough clinical examination, including searching for possible risk factors/co-morbidity, Epworth Sleepiness Score (ESS), Mallampati score, awake upper airway endoscopy combined with Muller maneuver, and drug-induced sleep endoscopy (DISE). Results OSA presented in 80% of our patients, the age range of 17–58 years, apnea–hypopnea index (AHI) mean 20.63 ± 17.8 event/h, and its severity was mild 7 (23.3%), moderate 6 (20%), and severe 11 (36.7%). Findings of oral and nasal examination showed no association with AHI. Also, sleep endoscopy findings regarding specific structures causing upper airway obstruction showed no significant association. A positive correlation was found between the extent of retropalatal airway collapse and AHI. A notable association was found between smoking and AHI as a risk factor for OSA in non-obese individuals. No significant relationship was found between ESS, concomitant diseases, and AHI. Conclusion OSA is common in non-obese patients and probably may be attributed to retropalatal/oropharyngeal airway collapse and associated with smoking as a risk factor. Further studies are warranted to reveal other pathophysiological aspects in this group of patients.

Background: Upper limb motor impairment is a common and disabling consequence of stroke, often showing limited recovery with conventional rehabilitation. Non-invasive brain stimulation (NIBS), particularly transcranial alternating current stimulation (tACS), has emerged as a promising neuro-modulatory technique; however, the effects of cerebellar tACS remain underexplored. Objective: To investigate the efficacy of cerebellar tACS combined with repetitive motor training (RMT) on upper limb motor recovery in patients with subacute ischemic stroke. Methods: In this randomized, double-blind, sham-controlled trial, 52 patients with subacute ischemic stroke and unilateral upper limb hemiparesis were randomly assigned to receive either active cerebellar tACS or sham stimulation. Active tACS (70 Hz, 1 mA, 20 minutes) was delivered prior to daily RMT sessions (60 min/day, 5 days/week for 3 weeks). The primary outcome was upper limb motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE). Secondary outcomes included manual dexterity (Box and Block Test; BBT), spasticity (Modified Ashworth Scale; MAS), and hand grip strength. Assessments were conducted at baseline, post-intervention, and 4-week follow-up by blinded evaluators. Results: Participants receiving active tACS demonstrated significantly greater gains in FMA-UE (+11.2 vs. +3.8; p = 0.01), BBT (+7.1 vs. +1.8 blocks/min; p = 0.03), MAS (p = 0.04), and grip strength (+4.8 kg vs. +1.9 kg; p = 0.02) compared to the sham group. A large effect size was observed for FMA-UE (Cohen’s d > 0.8). Conclusion: Cerebellar tACS combined with repetitive motor training significantly enhances upper limb motor recovery in subacute stroke. These findings support cerebellar neuromodulation as a promising adjunct in post-stroke rehabilitation. Antecedentes: El deterioro motor de las extremidades superiores es una consecuencia común e incapacitante del accidente cerebrovascular, que a menudo muestra una recuperación limitada con la rehabilitación convencional. La estimulación cerebral no invasiva (NIBS), en particular la estimulación transcraneal con corriente alterna (tACS), se ha convertido en una técnica neuro-moduladora prometedora; sin embargo, los efectos de los TACS cerebelosos siguen sin explorarse lo suficiente. Objetivo: Investigar la eficacia de los TAC cerebelosos combinados con entrenamiento motor repetitivo (TRM) en la recuperación motora de miembros superiores en pacientes con accidente cerebrovascular isquémico subagudo. Métodos: En este ensayo aleatorizado, doble ciego, controlado simulado, 52 pacientes con accidente cerebrovascular isquémico subagudo y hemiparesia unilateral de miembros superiores fueron asignados al azar para recibir tACS cerebelosos activos o estimulación simulada. Se administraron TAC activos (70 Hz, 1 mA, 20 minutos) antes de las sesiones diarias de RMT (60 min/ día, 5 días / semana durante 3 semanas). El resultado primario fue la función motora de las extremidades superiores (Evaluación Fugl-Meyer para Extremidades Superiores; FMA-UE). Los resultados secundarios incluyeron destreza manual (Prueba de Caja y Bloque; BBT), espasticidad (Escala Ashworth Modificada; MAS) y fuerza de agarre manual. Las evaluaciones se realizaron al inicio del estudio, después de la intervención y durante el seguimiento de 4 semanas por evaluadores cegados. Resultados: Los participantes que recibieron TAC activos demostraron ganancias significativamente mayores en FMA-UE (+11.2 vs. +3.8; p = 0.01), BBT (+7.1 vs. +1.8 bloques/ min; p = 0.03), MAS (p = 0.04) y fuerza de agarre (+4.8 kg vs. +1.9 kg; p = 0.02) en comparación con el grupo simulado. Se observó un gran tamaño del efecto para FMA-UE (d de Cohen > 0,8). Conclusión: Los TAC cerebelosos combinados con entrenamiento motor repetitivo mejoran significativamente la recuperación motora de las extremidades superiores en el accidente cerebrovascular subagudo. Estos hallazgos respaldan la neuromodulación cerebelosa como un complemento prometedor en la rehabilitación posterior al accidente cerebrovascular. Introdução: O comprometimento motor dos membros superiores é uma consequência comum e incapacitante do AVC, que apresenta frequentemente uma recuperação limitada com a reabilitação convencional. A estimulação cerebral não invasiva (EIN), particularmente a estimulação transcraniana por corrente alternada (ETCA), surgiu como uma técnica neuromoduladora promissora; no entanto, os efeitos da TC cerebelosa permanecem pouco explorados. Objectivo: Investigar a eficácia da TC cerebelosa combinada com o treino motor repetitivo (TMR) na recuperação motora dos membros superiores em doentes com AVC isquémico subagudo. Métodos: Neste ensaio clínico randomizado, duplo-cego e controlado por placebo, 52 doentes com AVC isquémico subagudo e hemiparesia unilateral dos membros superiores foram aleatoriamente designados para receber ETC cerebelosa ativa ou estimulação simulada. Foram administradas TC ativas (70 Hz, 1 mA, 20 minutos) antes das sessões diárias de TRM (60 min/dia, 5 dias/semana, durante 3 semanas). O desfecho primário foi a função motora dos membros superiores (Fugl-Meyer Higher Extremity Assessment; FMA-UE). Os desfechos secundários incluíram destreza manual (Teste de Caixa e Blocos; BBT), espasticidade (Escala de Ashworth Modificada; MAS) e força de preensão manual. As avaliações foram realizadas no início do estudo, após a intervenção e durante o seguimento de 4 semanas por avaliadores cegos. Resultados: Os participantes que receberam TC ativa demonstraram ganhos significativamente mais elevados na FMA-UE (+11,2 vs. +3,8; p = 0,01), BBT (+7,1 vs. +1,8 blocos/min; p = 0,03), MAS (p = 0,04) e força de preensão manual (+4,8 kg vs. +1,9 kg; p = 0,02) em comparação com o grupo placebo. Foi observado um grande tamanho de efeito para o FMA-UE (d de Cohen > 0,8). Conclusão: A TC cerebelosa combinada com treino motor repetitivo melhora significativamente a recuperação motora dos membros superiores em casos de AVC subagudo. Estas descobertas apoiam a neuromodulação cerebelosa como um complemento promissor na reabilitação pós-AVC.

Cloud computing needs a strong and efficient authentication system because the user will access his rented part through a faraway connection and it will make the authentication sensor device besides the user place for identification and verification so how to know the user who claimed himself to be the legal user. Keystroke identification system as a biometric authentication technique is strongly Candidate for the security issues in cloud computing technology. Keystroke dynamics as a security system did not need extra hardware because the authentication device will be the existing keyboard based on everyone has a unique style for writing. The other biometric methods are addressed with each advantage and disadvantage along with keystroke method. In this paper, all known studies about keystroke technique are explained and compared between them according to the classification technique, number of the participated users and each study results then introduces a survey on software and hardware of other biometric authentication techniques and after the literature review is addressed then keystroke as a biometric authentication system is suggested to access cloud computing environment because it has many advantages to being a part of the known security systems which spread in our world.

Objectives To evaluate the changes in macular vascular density (VD), ganglion cell complex GCC thickness, and Fovea Avascular Zone (FAZ) Area at one and six months after Sub-Scleral Trabeculectomy SST with mitomycin C (MMC) in patients with Primary Open Angle Glaucoma POAG and correlate those changes with reduction of IOP using optical coherence tomography angiography (OCTA). Methods Thirty eyes of 30 patients with POAG who underwent SST with MMC were prospectively evaluated. OCTA (AngioVue, Optovue) was used before surgery and at one and six months after surgery to quantify the vascular density of superficial capillary plexus (SCP-VD), deep capillary plexus (DCP-VD), whole image (WI-VD), fovea (F-VD), Parafovea (PAF-VD), Perifovea (PER-VD), in addition to the GCC thickness, FAZ area (FAZ-A), FAZ perimeter (FAZ-P), and foveal density (FD). Results All patients showed a significant reduction in mean IOP at each follow-up from (31.31 ± 4.52) preoperatively to 14.19 ± 2.10 and 13.75 ± 1.27 mmHg at one month and six months postoperative, respectively ( p  < 0.001). There was a significant improvement in macular deep capillary plexus DCP-VD in all parameter’s values ( p  < 0.001). The mean whole-image DCP-VD increased from 48.19 ± 2.20% preoperatively to 49.50 ± 2.30% at one month and 53.38 ± 1.78% at six months postoperatively. Similar significant increases were observed in the foveal, parafoveal and perifoveal regions. The FAZ area decreased significantly from 0.398 ± 0.062 mm² preoperatively to 0.357 ± 0.060 mm² at one month and 0.372 ± 0.058 mm² at six months ( p  = 0.010). The FAZ perimeter also showed a significant reduction from 2.238 ± 0.385 mm preoperatively to 1.889 ± 0.350 mm at one month and 2.075 ± 0.293 mm at six months ( p  = 0.001). Foveal density increased significantly from 46.88 ± 1.81% preoperatively to 48.52 ± 2.00% at one month and 49.71 ± 2.56% at six months ( p  < 0.001). Postoperative increases in macular SCP-VD and GCC thickness were minimal and not statistically significant ( p  > 0.05). A significant negative correlation was found between IOP reduction and DCP-VD at six months ( p  < 0.05), whereas IOP reduction correlated positively with decreases in FAZ area and perimeter at one month ( p  = 0.011, p  = 0.027) and six months ( p  = 0.010, p  = 0.029). Conclusion OCTA revealed significant postoperative improvement in deep macular vessel density and FAZ metrics following SST with MMC. These findings highlight the vascular benefits of surgical IOP reduction in restoring macular microcirculation among patients with POAG.

The proliferation of multiprocessor system-on-chip (MPSoC) architectures within the Internet of Things (IoT) has introduced notable security challenges. These architectures’ distributed nature, required for smooth communications between the IP cores, opens them up to potential attacks. Among the most significant issues is increased vulnerability to denial-of-service (DoS) attacks in IoT-based MPSoCs, which can influence their functional capabilities and performance. The situation with this vulnerability is further aggravated by the growing tendency to use third-party IPs in MPSoC designs, relying on global supply chains that can provide necessary performance levels as requirements change. This paper addresses the securing network-on-chip (NoC)-based MPSoCs in an IoT environment, targeting their inherent vulnerability due to third-party IP (3PIP) implementation. For timely prediction, in order to prevent potential security risks, particularly DoS attacks, the authors introduce a runtime monitoring mechanism based on ML. The proposed methodology includes the static training of ML models in a smart-placed strategic manner used for runtime attack detection with nominal performance loss. This analysis examines diverse ML models and features in detail, trying to define the use of machine learning for DoS attack identification. The results show considerable differences between the model performances, with XGBoost showing better accuracy, thus implying its potential as a strong solution. Even though the Nive Bayes model shows some degree of reduced accuracy, it implies that a wise selection of models is critical for strengthening the security position in IoT-based MPSoCs.