bluuebunny/crossref_metadata_2025 huggingface dataset:
Blockchain Technology in Agriculture: A Case Study of Blockchain Start-Up Companies
Authors: Sekhar Bhusal Chandra
Published: November 2021

Agriculture is one of the areas where blockchain technology could bring a revolution by solving the existing problem of Agri-product fraud, its traceability, price manipulation, and lack of customer trust in the product. This paper aims to demonstrate the potential application of blockchain technology in the agriculture industry and how it could address the existing issues by surveying the existing paper and following case studies of the blockchain start-up companies. Blockchain technology shows a promising approach to fostering a safer, better, more sustainable, and dependable agri-foods system in the future. While the application of blockchain in agriculture is in the initial phase and faces various issues like cost of implementation, privacy, security scalability, performance, and infancy, it can bring a revolution in the agriculture industry.
Circuit Break Connect Monitoring to 5G Mobile Application
Authors: Tsang Ton , Yip Kan Cheung
Published: November 2021

Along by a continuous improvement to composite electronic devices, a safety to technicians takes additionally become the matter to good concern, as a result to technicians' lives is in jeopardy while their work through shutting down circuit breakers, even that even once the breaker takes been switched off, someone will inadvertently flip to while a technician remains working. That should be a system to guarantee safety that technicians. Also, individuals do not love switching all the time toward turn on / off appliances like fans/lighting/air conditioners. It ends in wasted energy thanks to unnecessarily placing the instrument. To address these issues, we tend to come up through the system through mobile app-controlled circuit breakers that degrade wireless management to home appliances to hunt down a golem app. That replaces a traditional breaker through the mobile app-controlled system in the on / off system, where no one will activate the breaker, while not the word. The remote of home appliances helps a user to save electricity. That enhances a quality of life and luxury. Additionally, a system includes the home security mechanism against drone intrusion using the mobile app-controlled door lock system besides the mechanism that sleuthing dangerous gas leaks. A formation of the system subtracts the degree of victim associate ESP 32 microcontroller, the Bluetooth module, matrix 4x4 keyboards, and the paraffin gas detector associate with a golem mobile application. The entire system is usually compact systems.
The BitcoinHeist: Classifications of Ransomware Crime Families
Authors: Al Harrack Micheline
Published: November 2021

Ransomware attacks are on the rise and attackers are hijacking valuable information from different critical infrastructures and businesses requiring ransom payments to release the encrypted files. Payments in cryptocurrencies are designed to evade tracing the transactions and the recipients. With anonymity being paramount, tracing cryptocurrencies payments due to malicious activity and criminal transactions is a complicated process. Therefore, the need to identify these transactions and label them is crucial to categorize them as legitimate digital currency trade and exchange or malicious activity operations. Machine learning techniques are utilized to train the machine to recognize specific transactions and trace them back to malicious transactions or benign ones. I propose to work on the Bitcoin Heist data set to classify the different malicious transactions. The different transactions features are analyzed to predict a classifier label among the classifiers that have been identified as ransomware or associated with malicious activity. I use decision tree classifiers and ensemble learning to implement a random forest classifier. Results are assessed to evaluate accuracy, precision, and recall. I limit the study design to known ransomware identified previously and made available under the Bitcoin transaction graph from January 2009 to December 2018.
DDoS Attack Detection on Internet o Things using Unsupervised Algorithms
Authors: Tekleselase Hailye
Published: November 2021

The increase in the deployment of IoT networks has improved productivity of humans and organisations. However, IoT networks are increasingly becoming platforms for launching DDoS attacks due to inherent weaker security and resource-constrained nature of IoT devices. This paper focusses on detecting DDoS attack in IoT networks by classifying incoming network packets on the transport layer as either “Suspicious” or “Benign” using unsupervised machine learning algorithms. In this work, two deep learning algorithms and two clustering algorithms were independently trained for mitigating DDoS attacks. We lay emphasis on exploitation based DDOS attacks which include TCP SYN-Flood attacks and UDP-Lag attacks. We use Mirai, BASHLITE and CICDDoS2019 dataset in training the algorithms during the experimentation phase. The accuracy score and normalized-mutual-information score are used to quantify the classification performance of the four algorithms. Our results show that the autoencoder performed overall best with the highest accuracy across all the datasets.
Fuzzy Control of a Servomechanism: Practical Approach using Mamdani and Takagi- Sugeno Controllers
Authors: Aguiar Renato , Sirqueira Izabella
Published: November 2021

The main objective of this work is to propose two fuzzy controllers: one based on the Mamdani inference method and another controller based on the Takagi- Sugeno inference method, both will be designed for application in a position control system of a servomechanism. Some comparations between the methods mentioned above will be made with regard to the performance of the system in order to identify the advantages of the Takagi- Sugeno method in relation to the Mamdani method in the presence of disturbances and nonlinearities of the system. Some results of simulation and practical application are presented and results obtained showed that controllers based on Takagi- Sugeno method is more efficient than controllers based on Mamdani method for this specific application.
Fuzzy-Based Temperature Controller for Culturing Mesophilic and Thermophilic Bacterial using Firing Angle
Authors: Tizhe Thuku Iliya , Iliya Alhassan Allo , Shuaibu Kadalla Adamu
Published: November 2021

Temperature control is an important parameter in the fields of engineering and medical Laboratory. Culturing of micro bacteria and enzymes for the purpose of medical diagnoses or process development in manufacturing industries require their optimum temperature to be monitored and control. In this research work Fuzzy logic controller was designed to control the incubator Temperature, by computing appropriate firing angle. MATLAB Simulink toolbox was used for simulation. The results show that the fuzzy logic controller tracks the optimum Temperature for culturing Mesophilic and Thermophilic bacteria at 37.5oC and 55.2oC respectively. The transient response shows an overshot of 0.5% for the two responses. The rise time were 787ms and 792ms for 310.5 Kelvin and 328.2 Kelvin respectively. The settling time for the 310.5 Kelvin response was 1s; whereas it took 2s for the 328.2 Kelvin response to attain steady state.
Development of Web Application for Packaging Design
Authors: Charunphankasem Rawiphon
Published: November 2021

The majority of One Tambon One Product (OTOP) entrepreneurs desired a new packaging design that attracts the attention of consumers. The aims of this research were to 1) determine the packaging demands of entrepreneurs, 2) develop a conceptual framework for web applications, and 3) create web applications. Finally, 4) to ascertain entrepreneurs' satisfaction with the use of web applications in packaging design. The demographic and sample were recruited from the central region's population, entrepreneurs, and customers. Purposive sampling was used to choose 400 entrepreneurs and customers in Saraburi province. The main result was that requirement of entrepreneursabout package must be easy to portable. And Web Application must be also easy to use. By opinion of experts the result of web application development was overall high level and satisfaction of web application that help entrepreneurs to design package was high level. So the benefit of research is that entrepreneurs had web application to design the package and lower cost.
Natural Language Processing through the Subtractive Mountain Clustering Algorithm - A Medication Intake Chatbot
Authors: A. Salgado Paulo , Perdicoulis T-P Azevedo
Published: November 2021

In this work, the subtractive mountain clustering algorithm has been adapted to the problem of natural languages processing in view to construct a chatbot that answers questions posed by the user. The implemented algorithm version allosws for the association of a set of words into clusters. After finding the centre of every cluster — the most relevant word, all the others are aggregated according to a defined metric adapted to the language processing realm. All the relevant stored information (necessary to answer the questions) is processed, as well as the questions, by the algorithm. The correct processing of the text enables the chatbot to produce answers that relate to the posed queries. Since we have in view a chatbot to help elder people with medication, to validate the method, we use the package insert of a drug as the available information and formulate associated questions. Errors in medication intake among elderly people are very common. One of the main causes for this is their loss of ability to retain information. The high amount of medicine intake required by the advanced age is another limiting factor. Thence, the design of an interactive aid system, preferably using natural language, to help the older population with medication is in demand. A chatbot based on a subtractive cluster algorithm is the chosen solution.
Built to Scale: A Corpus-Based Analysis of Adjective Scales in the Mcgill Pain Questionnaire
Authors: Stern Miriam
Published: November 2021

Modern medical diagnosis relies on precise pain assessment tools in translating clinical information from patient to physician. The McGill Pain Questionnaire (MPQ) is a clinical pain assessment technique that utilizes 78 adjectives of different intensities in 20 categories to quantify a patient’s pain. The questionnaire’s efficacy depends on a predictable pattern of adjective use by patients experiencing pain. In this study, I recreate the MPQ’s adjective intensity orderings using data gathered from patient forums and modern NLP techniques. I extract adjective intensity relationships by searching for key linguistic contexts, and then combine the relationship information to form robust adjective scales. Of 17 adjective relationships predicted by this research, only 4 diverge from the MPQ’s orderings, which is statistically significant at the 0.1 alpha level. The results suggest predictable patterns of adjective use by people experiencing pain, but call into question the MPQ’s categories for grouping adjectives.
Political Opinion Analysis in Social Networks: Case of Twitter and Facebook
Authors: TIENDREBEOGO Telesphore , ZAGRE Yassia
Published: November 2021

The 21st century has been characterized by an increased attention to social networks. Nowadays, going 24 hours without getting in touch with them in some way has become difficult. Facebook and Twitter, these social platforms are now part of everyday life. Thus, these social networks have become important sources to be aware of frequently discussed topics or public opinions on a current issue. A lot of people write messages about current events, give their opinion on any topic and discuss social issues more and more. The emergence and enormous popularity of these social networks have led to the emergence of several types of analysis to take advantage of them. One of them is the analysis of opinions in texts. It aims at automatically classifying opinions in order to position them on a sentiment scale, thus allowing to characterize a set of opinions without having to rely on a human to read them. Currently, opinion analysis offers us a lot of information related to public opinion, either in the commercial world or in the political world. Many studies have shown that machine learning techniques, such as the support vector machine (SVM) and the naive Bayes classifier (NB), perform well in this type of classification. In our study, we first propose an approach for tracking and analyzing political opinions in social networks. Then, we propose a trained and evaluated machine learning model for political opinion classification. And finally, the study aims at setting up a web interface to collect and analyze in real time political opinions from social networks
A Self-Supervised Tibetan-Chinese Vocabulary Alignment Method
Authors: Hou Enshuai , zhu Jie , Yin Liangcheng , Ni Ma
Published: November 2021

Tibetan is a low-resource language. In order to alleviate the shortage of parallel corpus between Tibetan and Chinese, this paper uses two monolingual corpora and a small number of seed dictionaries to learn the semi-supervised method with seed dictionaries and self-supervised adversarial training method through the similarity calculation of word clusters in different embedded spaces and puts forward an improved selfsupervised adversarial learning method of Tibetan and Chinese monolingual data alignment only. The experimental results are as follows. The seed dictionary of semi-supervised method made before 10 predicted word accuracy of 66.5 (Tibetan - Chinese) and 74.8 (Chinese - Tibetan) results, to improve the self-supervision methods in both language directions have reached 53.5 accuracy.
Dual-carrier modulation (DCM) is used to implement a species of tone reservation to reduce the PAPR of COFDM, wherein the reserved tones convey coded digital data (CDD) a second time. The same CDD is conveyed by carriers in a lower-frequency sub-band of the COFDM and by carriers in a higher- frequency sub-band. Each pair of carriers conveying the same CDD are separated by a subband width, enabling receivers better to ameliorate the effects of multipath reception. There is labeling diversity between the QAM symbol constellations that respectively govern modulation of carriers in the lower- frequency sub-band and modulation of carriers in the higher-frequency subband, which labeling diversity is designed to reduce PAPR of the COFDM. The labeling diversity also improves bit-error ratio (BER) for increased-size QAM symbol constellations used to increase CDD throughput despite the halving of CDD throughput owing to the use of DCM.
Authors: Le Roy Limberg Allen
Published: November 2021

Dual-carrier modulation (DCM) is used to implement a species of tone reservation to reduce the PAPR of COFDM, wherein the reserved tones convey coded digital data (CDD) a second time. The same CDD is conveyed by carriers in a lower-frequency sub-band of the COFDM and by carriers in a higher- frequency sub-band. Each pair of carriers conveying the same CDD are separated by a subband width, enabling receivers better to ameliorate the effects of multipath reception. There is labeling diversity between the QAM symbol constellations that respectively govern modulation of carriers in the lower- frequency sub-band and modulation of carriers in the higher-frequency subband, which labeling diversity is designed to reduce PAPR of the COFDM. The labeling diversity also improves bit-error ratio (BER) for increased-size QAM symbol constellations used to increase CDD throughput despite the halving of CDD throughput owing to the use of DCM.
Dual Band GNSS Antenna Phase Center Characterization for Automotive Applications
Authors: Liu and Ran , N. Aloi Daniel
Published: November 2021

High-accuracy Global Navigation Satellite System (GNSS) positioning is a prospective technology that will be used in future automotive navigation systems. This system will be a composite of the United States' Global Positioning System (GPS), the Russian Federation's Global Orbiting Navigation Satellite System (GLONASS), China Beidou Navigation Satellite System (BDS) and the European Union’s Galileo. The major improvement in accuracy and precision is based on (1) multiband signal transmitting, (2) carrier phase correction, (3) Real Time Kinematic (RTK). Due to the size and high-cost of today’s survey-grade antenna solutions, this kind of technology is difficult to use widely in the automotive sector. In this paper, a low-cost small size dual-band ceramic GNSS patch antenna is presented from design to real sample. A further study of this patch antenna illustrates the absolute phase center variation measured in an indoor range to achieve a received signal phase error correction. In addition, this low-cost antenna solution is investigated when integrated into a standard multi-band automotive antenna product. This product is evaluated both on its own in an indoor range and on a typical vehicle roof at an outdoor range. By using this evaluation file to estimate the receiver position could achieve phase motion error-free result.
Combining of Narrative News and VR Games: Comparison of Various Forms of News Games
Authors: Feng Xiaohan , Murakami Makoto
Published: November 2021

The information explosion makes it easier to ignore information that requires social attention, and news games can make that information stand out. There is also considerable research that shows that people are more likely to remember narrative content. Virtual environments can also increase the amount of information a person can recall. If these elements are blended together, it may help people remember important information. This research aims to provide directional results for researchers interested in combining VR and narrative, enumerating the advantages and limitations of using text or non-text plot prompts in news games. It also provides hints for the use of virtual environments as learning platforms in news games. The research method is to first derive a theoretical derivation, then create a sample of news games, and then compare the experimental data of the sample to prove the theory. The research compares the survey data of a VR game that presents a story in non-text format (Group VR), a game that presents the story in non-text format (Group NVR), a VR game that presents the story in text (Group VRIT), and a game that presents the story in text (Group NVRIT) will be compared and analyzed. This paper describes the experiment. The results of the experiment show that among the four groups, the means that can make subjects remember the most information is a VR news game with a storyline. And there is a positive correlation between subjects' experience and confidence in recognizing memories, and empathy is positively correlated with the correctness of memories. In addition, the effects of "VR," "experience," and "presenting a story from text or video" on the percentage of correct answers differed depending on the type of question.
Mixed Spectra for Stable Signals from Discrete Observations
Authors: Sabre Rachid
Published: November 2021

This paper concerns the continuous-time stable alpha symmetric processes which are inivitable in the modeling of certain signals with indefinitely increasing variance. Particularly the case where the spectral measurement is mixed: sum of a continuous measurement and a discrete measurement. Our goal is to estimate the spectral density of the continuous part by observing the signal in a discrete way. For that, we propose a method which consists in sampling the signal at periodic instants. We use Jackson's polynomial kernel to build a periodogram which we then smooth by two spectral windows taking into account the width of the interval where the spectral density is non-zero. Thus, we bypass the phenomenon of aliasing often encountered in the case of estimation from discrete observations of a continuous time process.
Fractional Order Butterworth Filter for Fetal Electrocardiographic Signal Feature Extraction
Authors: Mohsen Alkanfery Hadi , Mustafa Mehedi Ibrahim
Published: November 2021

The non-invasive Fetal Electrocardiogram (FECG) signal has become a significant method for monitoring the fetus's physiological conditions, extracted from the Abdominal Electrocardiogram (AECG) during pregnancy. The current techniques are limited during delivery for detecting and analyzing fECG. The non - intrusive fECG recorded from the mother's abdomen is contaminated by a variety of noise sources, can be a more challenging task for removing the maternal ECG. These contaminated noises have become a major challenge during the extraction of fetal ECG is managed by uni-modal technique. In this research, a new method based on the combination of Wavelet Transform (WT) and Fast Independent Component Analysis (FICA) algorithm approach to extract fECG from AECG recordings of the pregnant woman is proposed. Initially, preprocessing of a signal is done by applying a Fractional Order Butterworth Filter (FBWF). To select the Direct ECG signal which is characterized as a reference signal and the abdominal signal which is characterized as an input signal to the WT, the cross-correlation technique is used to find the signal with greater similarity among the available four abdominal signals. The model performance of the proposed method shows the most frequent similarity of fetal heartbeat rate present in the database can be evaluated through MAE and MAPE is 0.6 and 0.041209 respectively. Thus the proposed methodology of de-noising and separation of fECG signals will act as the predominant one and assist in understanding the nature of the delivery on further analysis.
Effect of smoking on clinical outcomes in patients receiving rotational atherectomy in calcified coronary lesions: from the ROCK Registry, South Korea
Authors: Jang Won Young , Lee Su Nam , Her Sung-Ho , Moon Donggyu , Moon Keon-Woong , Yoo Ki-Dong , Lee Kyusup , Choi Ik Jun , Lee Jae Hwan , Lee Jang Hoon , Lee Sang Rok , Lee Seung-Wan , Yun Kyeong Ho , Lee Hyun-Jong
Published: November 2021

BACKGROUND:

Tobacco smoking and its harmful health effects also increase economic burdens globally. Surprisingly, despite the detrimental health consequences of smoking, some studies have shown better survival among smokers compared with non-smokers, a phenomenon called “smoker's paradox”. However, the impact of smoking status on clinical outcomes in severe calcified coronary artery disease (CAD) patients has yet to be reported.

OBJECTIVES:

Investigate the impact of smoking on clinical outcomes in calcified CAD receiving rotational atherectomy (RA).

DESIGN:

Retrospective review of medical records.

SETTING:

Multicenter registry in South Korea.

PATIENTS AND METHODS:

This multicenter registry included consecutive patients with calcified CAD who underwent RA at nine tertiary centers in Korea between January 2010 and October 2019.

MAIN OUTCOME MEASURES:

Target-vessel failure (TVF) which included the composite of cardiac death, target-vessel myocardial infarction (TVMI), and target-vessel revascularization (TVR).

SAMPLE SIZE:

583 lesions in 540 patients followed for a median of 16.1 months.

RESULTS:

Lesions were divided into two groups: non-smokers (n=472, 81.0%) and smokers (n=111, 19.0%). TVF in the smoker group was significantly more frequent than in non-smoker group (log rank
P
=.016). The inverse probability of treatment weighting analysis also showed that smoking was significantly associated with a higher incidence of the primary outcome (HR: 1.617; 95% CI: 1.127–2.320;
P
=.009), cardiac death (HR 1.912; 95% CI: 1.105-3.311;
P
=.021), myocardial infarction (HR: 3.914; 95% CI: 1.884-8.132;
P
<.001), TVMI (HR: 3.234; 95% CI: 1.130-9.258;
P
=.029), and TVR (HR: 1.661; 95% CI: 1.043-2.643;
P
=.032). However, any bleeding was significantly observed less in the smokers.

CONCLUSION:

Smoking is significantly associated with adverse clinical outcomes in CAD patients requiring RA.

LIMITATIONS:

Retrospective design.

CONFLICTS OF INTEREST:

None.
Outcomes of autologous stem cell transplantation for multiple myeloma in Saudi Arabia
Authors: Abdrabou Ahmed Kotb , Sharif Fahad Al , Fakih Riad El , Hashmi Shahrukh , Khafaga Yasser Mohamed , Alhayli Saud , Zahrani Hazaa Al , Ahmed Syed , Fraih Feras Al , Shaheen Marwan , Rasheed Walid , Chaudhri Naeem Arshad , Mohareb Fahad Al , Khalil Hala , Aljurf Mahmoud , Hanbali Amr
Published: November 2021

BACKGROUND:

In 2015, multiple myeloma (MM) represented 1% of all cancers and about 5% of hematologic malignancies in Saudi cancer registry. We conducted this large study because only small pilot studies have examined MM outcomes after autologous stem-cell transplantation (ASCT). The standard therapy for eligible patients is induction chemotherapy followed by ASCT.

OBJECTIVES:

Determine the demographic characteristics of MM patients and the outcomes of ASCT.

DESIGN:

Retrospective.

SETTING:

Tumor registry database of major tertiary cancer care center in Riyadh.

PATIENTS AND METHODS:

We identified patients with newly diagnosed MM who underwent ASCT from October 1997 to March 2015.

MAIN OUTCOME MEASURES:

The demographic characteristics of MM patients and the outcomes of ASCT in the form of response evaluation, progression-free survival (PFS) and overall survival (OS).

SAMPLE SIZE:

169 patients with newly diagnosed MM.

RESULTS:

The median age at diagnosis was 51 years (range 23–69) and 100 (59.2%) were male. The most common immunoglobulin (Ig) subtype was IgG-kappa (80 patients; 47.6%). Most patients presented with advanced ISS stage III (75 patients; 47.5%). The cytogenetic analysis was documented in only 87 patients (51.4%); about half (48.3%) had normal cytogenetics by fluorescence in situ hybridization. Deletion 13 was present in 18.4% of patients. In post-induction therapy, 84 patients (50%) achieved a complete response, which increased to 78.1% (132 patients) after ASCT. The median PFS and OS post-transplantation were 30 and 202 months, respectively. Only one patient (<1%) died in the first 100 days after transplantation.

CONCLUSIONS:

Our transplant eligible MM patients tend to be younger with a higher OS and a low ASCT-related mortality (<1%) than is reported internationally.

LIMITATIONS:

Usual limitations of a retrospective analysis using registry-level data; no data on quality of life.

CONFLICTS OF INTEREST:

None.
Outcomes of flexible fiberoptic laryngoscopy in patients with stridor: a cross-sectional study in a tertiary care pediatric center in Saudi Arabia
Authors: Alsowailmi Ghada , Alshammari Jaber , Arafat Abdullah Saud , Alotaibi Amal , Alsahli Afnan , Alshahwan Sara Ibrahim , Omair Aamir , Alsafi Maryam
Published: November 2021

BACKGROUND:

Successful evaluation of a patient with stridor requires a thorough history and physical examination followed by a flexible fiberoptic laryngoscopy (FFL), which provides visualization of the upper airway.

OBJECTIVES:

Estimate the prevalence of causes of stridor in children who underwent FFL and compare different age groups. Find any significant associations between symptoms and laryngoscopic findings. Identify patients who needed further evaluation using direct laryngobronchoscopy (DLB).

DESIGN:

Retrospective, cross-sectional.

SETTING:

Tertiary care center in Riyadh.

PATIENTS AND METHODS:

We included all pediatric patients aged 1 month to 14 years who underwent fiberoptic laryngoscopy for stridor evaluation from January 2015 to January 2018 (37 months). Patients older than the age of 14 years, and patients with a workable diagnosis with adenotonsillar hypertrophy, choanal atresia, or laryngotracheo-bronchitis (croup) were excluded.

MAIN OUTCOME MEASURES:

Findings of FFL.

SAMPLE SIZE:

217 pediatric patients.

RESULTS:

The median (interquartile range) age of the patients was 5 (8) months. Laryngomalacia was the most common diagnosis (n=149, 69%) followed by laryngopharyngeal reflux (n=42, 19%). Subglottic stenosis was the most common finding in patients who underwent DLB for further evaluation (n=19, 49%). Laryngomalacia was more frequent in children ≤12 months of age (83% vs 43% in children >12 months,P<.001). Vocal cord paralysis was more common in children >12 months of age (27% vs 9%,P<.001). FFL was effective in finding the diagnosis in 178 (82%) patients; only 39 (18%) patients needed further assessment using DLB.

CONCLUSION:

FFL is an effective and important tool for evaluating patients with stridor.

LIMITATIONS:

Retrospective design and single-centered.

CONFLICTS OF INTEREST:

None.
Characteristics and outcomes of mechanically ventilated elderly patients in the absence of an end-of-life care policy: a retrospective study from Bahrain
Authors: Saeed Mahmood Al , Almoosawi Barrak Mahmood , Awainati Mahmmod Al , Barni Mohammed Al , Abbas Fadhel
Published: November 2021

BACKGROUND:

Globally, the percentage of elderly patients has been increasing, leading to a higher demand for healthcare resources and intensive care. Bahrain has a majority Muslim population and Islam governs most policies, including end-of-life care. All patients at our institute receive full resuscitative measures regardless of the prognosis, leading to a high number of mechanically ventilated patients.

OBJECTIVES:

Assess characteristics, outcomes, theoretical costs, and use of antibiotics in critically ill elderly patients requiring mechanical ventilation.

DESIGN:

Retrospective.

SETTING:

Intensive care unit and general ward of a tertiary medical care center.

PATIENTS AND METHODS:

We studied all elderly patients (≥60 years old) admitted under general medicine in the period of January to June 2018 who needed intensive care and were intubated.

MAIN OUTCOME MEASURES:

The duration of mechanical ventilation, theoretical costs, antibiotic usage.

SAMPLE SIZE:

140 patients.

RESULTS:

Of 140 patients, 136 died (97%) and half of the deaths (n=69, 50.7%) occurred within the first 24 hours of intubation. Sixty-nine (79.3%) of the patients on short-term ventilation (≤96 hours) died within 24 hours of intubation, while the four survivors were on long-term ventilation (>96 hours) (P<.001). All the nonsurviving patients (n=136) were on antimicrobial therapy, mostly for hospital-acquired infections. The median (interquartile range) APACHE II score was relatively high at 28.0 (8.0) with significantly higher scores in the early mortality group compared to the late mortality group (30 [10] vs 26 [7],P=.013) and higher scores in the short-term vs long-term ventilation group (29 [10] vs 26 [7],P=.029). The median theoretical cost per patient in the early and late mortality groups was USD 10 731 and USD 30 660, respectively (P<.001).

CONCLUSIONS:

Given that less than 3% of patients had a favorable outcome, 50% of the cases died within 24 hours after intubation, hospital costs and antimicrobial use were high, the current policy of “full resuscitative measures for all” should be revised. We suggest implementing an end-of-life care policy, since the goal of resuscitation is to reverse premature death, not prolong the dying process.

LIMITATIONS:

Small sample size and absence of long-term follow-up. Theoretical costs were used as no direct calculated costs were available in our hospital.

CONFLICT OF INTEREST:

None
Frequency of molar incisor hypomineralization and associated factors among children with special health care needs
Authors: Mohamed Roshan Noor , Basha Sakeenabi , Al-Thomali Yousef , Al Zahrani Fatma Salem , Ashour Amal Adnan , Al Shamrani Ammar Saleh , Almutair Nada Eid
Published: November 2021

BACKGROUND:

Molar incisor hypomineralization (MIH) is a frequently encountered oral condition that varies from mild opacities to posteruptive enamel breakdown. No previous published studies have investigated the frequency of MIH and associated risk factors among children with special health care needs (CSHCN) to our awareness.

OBJECTIVES:

Assess the frequency of MIH and associated risk factors among CSHCN.

DESIGN:

Cross-sectional.

SETTING:

Schools in provincial city of Saudi Arabia.

PATIENTS AND METHODS:

The study was conducted among 400 (180 boys and 220 girls) special needs children. Diagnosis of MIH was according to the European Academy of Paediatric Dentistry criteria.

MAIN OUTCOME MEASURE:

Result of logistic regression analysis that assessed the association between MIH prevalence and associated prenatal, perinatal, and postnatal factors.

SAMPLE SIZE:

400 (180 boys and 220 girls) special needs children.

RESULTS:

Among 400 CSHCN, 98 (24.5%) presented with MIH. Children with multiple disabilities had a 3.89 times greater risk of MIH (95% CI: 1.91–6.19,
P
=.002). Children with positive prenatal factors had an adjusted odds ratio (aOR) of 2.31 times for MIH (95% CI: 1.22–4.73,
P
=.012). Children with a childhood infection history had an aOR of 2.43 times for MIH (95% CI: 1.31–5.85,
P
=.014). Children with a breastfeeding history >18 months had an aOR of 3.73 for MIH (95% CI: 1.62–8.60,
P
=.002). Permanent maxillary first molars were the most frequently affected teeth, and demarcated opacity was the most frequent MIH type.

CONCLUSION:

MIH should be recognized as one of the prevalent oral health problems among CSHCN to prevent tooth mortality.

LIMITATIONS:

A cross-sectional study cannot establish a causal relationship.

CONFLICTS OF INTEREST:

None.
Giant splenic artery aneurysm treated surgically with spleen and pancreas preservation
Authors: Atanasijevic Igor , Babic Srdjan , Tanaskovic Slobodan , Gajin Predrag , Ilijevski Nenad
Published: November 2021

Aneurysms of the splenic artery represent a rare clinical entity, even though they account for 60-70% of all visceral artery aneurysms. Splenic artery aneurysms larger than 5 cm are extremely rare, and they are considered to be giant. Possible causes of splenic artery aneurysm development include: trauma, hormonal and local hemodynamic changes in pregnancy, portal hypertension, arterial degeneration, infection and postsplenectomy occurrence. Surgical treatment of giant splenic artery aneurysms includes procedures that frequently require pancreatectomy and splenectomy. We present a case of a 10.2 cm giant splenic artery aneurysm, firmly adhered to the pancreas, which was treated surgically, with spleen and pancreas preservation.

SIMILAR CASES PUBLISHED:

Although many cases on treatment of giant splenic artery aneurysm have been published, the majority have described additional visceral resections associated with aneurysmectomy, which is in contrast with our report. Furthermore, aneurysms reaching 10 cm in size were extremely rare.
Kuwait National Mammography Screening Program: outcomes of 5 years of screening in Kuwaiti women
Authors: Alkhawari Hanaa Abdulla , Asbeutah Akram Mahmoud , Almajran Abdullah Abdulaziz , AlKandari Latifa Abdullah
Published: November 2021

BACKGROUND:

Breast cancer is the most common malignancy among women in Kuwait, representing 39.8% of all female cancer cases.

OBJECTIVES:

Report the data of the Kuwait National Mammography Screening Program (KNMSP) for a 5-year period.

DESIGN:

Prospective data collection.

SETTING:

Population-based screening.

SUBJECTS AND METHODS:

We included mammography screens done for Kuwaiti women (age 40 years and older) who attended the KNMSP from 2014 to 2019 to screen for breast cancer. A full-field digital mammography system was used to acquire the mammographic images in craniocaudal and mediolateral oblique projections. Independent double-blind reading of the mammograms was performed by two radiologists.

MAIN OUTCOME MEASURE:

Early detection of breast cancer.

SAMPLE SIZE:

14 773 asymptomatic women met inclusion criteria (mean [SD] age, 51.8 (8.2).

RESULTS:

Lesions were detected in 551 women (3.7%). These included 233 malignant lesions (233/551, 42.3%), 57 high-risk lesions (10.3%) and 261 benign lesions (47.4%). The participation rate was 7.8% of the target population of women 40–69 years of age. The majority of breast cancer cases were reported in the age group 45–49 years (23.2%). The KNMSP study recall rate for 5 consecutive years was in a range of 11.9–16.5% (mean, 14.3%). The detection rate of ductal/lobular carcinoma in situ and invasive breast cancer were 2.5 and 13.6 per 1000 screened women, respectively. Invasive ductal carcinoma was the most common type. Only 4314 women followed up within 12–15 months of the first mammography for a retention rate of 29.2%.

CONCLUSIONS:

Screening mammography improves early detection of breast cancer in women older than 40 years but poor participation is a limitation. We are aiming to increase the participation rate to 70% of the population.

LIMITATIONS:

Lack of participation by women.

CONFLICT OF INTEREST:

None.
Patients with hypertension hospitalized with COVID-19 pneumonia using angiotensinconverting enzyme inhibitors and angiotensin II receptor blockers or other antihypertensives: retrospective analysis of 435 patients
Authors: Baslilar Seyma , Saylan Bengu
Published: November 2021

BACKGROUND:

The angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARBs) are widely used for the treatment of hypertension (HT). Whether the use of these drugs increases the infectivity of novel coronavirus and results in an additional risk for morbidity and mortality of COVID-19 is a matter of interest.

OBJECTIVES:

Assess the effect of ACEI/ARBs compared with other hypertensives on the clinical course and outcome in COVID-19 pneumonia.

DESIGN:

Retrospective.

SETTINGS:

Tertiary care hospital.

PATIENTS AND METHODS:

We collected data on adult inpatients with COVID-19 pneumonia using ACEI/ARBs versus other antihypertensives between 15 March 2020, and 15 February 2021.

MAIN OUTCOME MEASURES:

Severity, clinical course, mortality, and time to PCR negativity between patients using ACEI/ARBs and other antihypertensives.

SAMPLE SIZE:

435

RESULTS:

ACEI/ARBs were used by 203 patients (46.6%) (median age: 71 [41–94] years), while 232 patients (53.4%) were using other antihypertensives (median age: 69 [22-93] years,
P
=.645 vs age of ACEI/ARB users). There were no statistically significant differences between the ACEI/ARBs users and non-users in the number of patients admitted to intensive care (65 cases [32%] vs. 74 cases [31.9%],
P
=.978), the median duration of stay in hospital (8 [1–54] days vs.7 [1–55] days,
P
=.806) the median duration of ICU stay (8 [1–40] days vs. 6 [1–25] days), and the mortality rate (48 cases [23.6%] vs. 61 [26.3%],
P
=.525). While the median days before transfer to the ICU was shorter in ACE/ARBI non-users (2 [1–15] days vs. 3 [1–21] days,
P
=.02), the difference was not important clinically. The median time to PCR negativity was similar in ACEI/ARBs users and non-users (13 [7–34] days for users and 13 [5–45] days for non-users), (
P
=.083).

CONCLUSIONS:

ACEI/ARB use is probably unrelated to poor prognosis in COVID-19 pneumonia inpatients. ACEI/ARBs did not prolong the time to PCR negativity. We conclude that using ACEI/ARBs probably does not increase the infectivity of SARS-CoV-2.

LIMITATIONS:

Pharmacological therapies were not discussed in detail. The use of corticosteroids may affect the time to PCR negativity. We could not analyze the effect of obesity because of a lack of data.

CONFLICT OF INTEREST:

None.
Comparison of pregnancy outcomes between women of advanced maternal age (≥35 years) versus younger women in a tertiary care center in Saudi Arabia
Authors: Shams Taghreed , Gazzaz Tala , Althobiti Khalda , Alghamdi Nouf , Bamarouf Waleed , Almarhoumi Lujain , Alhashemi Hashem
Published: November 2021

BACKGROUND:

Pregnancy in women aged 35 years or above is generally considered an advanced maternal age (AMA). AMA is associated with an increased rate of maternal and neonatal complications.

OBJECTIVES:

Assess the effect of AMA on maternal and neonatal outcomes.

DESIGN:

Analytical cross-sectional study of medical records.

SETTINGS:

In-patient hospital tertiary care setting in Jeddah.

PATIENTS AND METHODS:

All women who attended antenatal care and delivered at King Abdulaziz Medical City in Jeddah in the first half of 2018 were included in the study. Outcomes for women 35 years of age or older were compared with younger women. Significant factors in a univariate analysis were entered in a multiple logistic regression model to assess the association between AMA and outcomes.

MAIN OUTCOME MEASURES:

Rates of maternal neonatal complications, analysis of factors associated with advanced maternal, gestational diabetes mellitus (GDM), cesarean delivery.

SAMPLE SIZE:

1586 women.

RESULTS:

Of the 1586 women, 406 were 35 years of age or older (25.6%), and 1180 were younger than 35 years. The AMA group had a significantly higher proportion of GDM (32.0% versus 13.2%,
P
<.001). The adjusted odds ratio (OR) for GDM was 2.6 (95% CI 2–3.5,
P
<.001.) compared with younger women in the multivariate logistic regression analysis. Older women had a higher rate of cesarean delivery (43.6% versus 30.8%,
P
<.001). The adjusted OR for cesarean vs. vaginal delivery was 1.5 (CI 1.2–1.9,
P
=.002).

CONCLUSION:

Pregnancy in women 35 years or older was associated with an increased risk of GDM and cesarean delivery.

LIMITATIONS:

Cross-sectional design, small sample size, single hospital.

CONFLICT OF INTEREST:

None.
Conjunctivitis and other ocular findings in patients with COVID-19 infection
Authors: Layikh Haider Aswad , Hashim Zainab Adel , Kadum Alyaa A.
Published: November 2021

BACKGROUND:

COVID-19 is an acute respiratory illness caused by a novel coronavirus (SARS-CoV-2). COVID-19 that might affect the eye in the form of conjunctivitis and other ocular features.

OBJECTIVES:

Assess the frequency and clinical profile of conjunctivitis and other ocular findings in Iraqi patients with confirmed COVID-19 infection.

DESIGN:

Analytical cross-sectional study.

SETTING:

Secondary care center.

PATIENTS AND METHODS:

This study involved patients diagnosed with SARS-CoV-2 viral infection of variable disease severity from June 2020 to December 2020. Ocular history and the severity of SARS-CoV-2 viral infection was assessed for all of the patients.

MAIN OUTCOME MEASURES:

Frequency of conjunctival inflammation and other ocular findings in patients with coronavirus infection.

SAMPLE SIZE:

186 patients.

RESULTS:

The patients had a mean (standard deviation, range) age of 44.4 (18.8, 18–78) years. Conjunctivitis was present in 25 patients (13.4%). There was no significant association between prevalence of conjunctivitis and patient gender (
P
=.868). However, conjunctivitis was significantly associated with the severity of the disease (
P
=.018): the rate of conjunctivitis was significantly higher in cases with severe disease (28%) in comparison with those with mild to moderate clinical presentation (9.3%). The natural course of conjunctivitis seemed to be mild with no effect on visual acuity and no short-term complications.

CONCLUSION:

Conjunctivitis can occur in patients with SARS-CoV-2 viral infection, and could be a presenting sign. Conjunctivitis is more common in cases of severe COVID-19 infection and since it could be a presenting sign it might be of benefit in the early diagnosis and treatment of COVID-19.

LIMITATION:

Single-center study, safety limitations in the examination of the patients.

CONFLICT OF INTEREST:

None.
The risk of tuberculosis infection in 410 Saudipatients receiving adalimumab therapy
Authors: Al-Sohaim Abdullah , Bawazir Abdullah Saleh , Al-Turki Turki , Alsafi Eiman Omar , Al-Roqy Abdullah , Layqah Layla , Baharoone Salim Alawi
Published: November 2021

BACKGROUND:

Adalimumab is a fully humanized monoclonal antibody inhibitor of tumor necrosis factor-a used to treat various autoimmune disorders. Adalimumab poses a risk for tuberculosis (TB) infection, especially in countries where TB is endemic.

OBJECTIVE:

Determine the rate of TB infection after adalimumab therapy in Saudi Arabia.

DESIGN:

Medical record review.

SETTINGS:

Tertiary care center in Riyadh.

PATIENTS AND METHODS:

Demographic and clinical data were retrieved from the electronic healthcare records of all patients who received adalimumab treatment from 2015 to 2019.

MAIN OUTCOME MEASURES:

Occurrence of TB after adalimumab therapy.

SAMPLE SIZE:

410 patients (median ([QR] age, 37 [28], range 4–81 years), 40% males

RESULTS:

Rheumatoid arthritis was the most frequent indication (n=153, 37%). The patients were followed for a mean of 36 (8.9) months. No case of TB infection or reactivation was observed. An inter-feron-gamma release assay (IGRA) was requested in 353/391 (90.3%) patients, prior to initiating therapy. The IGRA was positive in 26 cases (6.6%). The IGRA-positive patients received isoniazid prophylactically. Bacterial infectious complications of adalimumab therapy occurred in 12 (2.9%) patients. Urinary tract infection was the most frequent complication (culture requested in 48 patients, positive in 8).

CONCLUSION:

Adalimumab treatment was not associated with a risk of TB disease or TB reactivation in our cohort over the follow-up observation period. No TB reactivation occurred with adalimumab therapy when TB prophylaxis was used. The positive IGRA rate in patients on adalimumab treatment was low (7%).

LIMITATIONS:

Single center and one geographical area in Saudi Arabia.

CONFLICT OF INTEREST:

None.
Cryptosporidium spp.
during chemotherapy: a cross-sectional study of 94 patients with malignant solid tumor
Authors: Karabey Mehmet , Can Hüseyin , Öner Tülay Öncü , Döşkaya Mert , Alak Sedef Erkunt , Döşkaya Aysu Değirmenci , Karakavuk Muhammet , Köseoğlu Ahmet Efe , Ün Cemal , Gürüz Adnan Yüksel , Alacacıoğlu Ahmet , Pektaş Bayram , Gül Aytül , Kaya Selçuk , Gökmen Ayşegül Aksoy
Published: November 2021

BACKGROUND:

Cryptosporidium spp
. is a protozoan parasite that infects many vertebrate animals, including humans. Since
Cryptosporidium spp
. can cause chronic life-threatening diarrhea and severe malabsorption in immunocompromised patients, we investigated the prevalence of this parasite among patients undergoing chemotherapy for malignant solid tumors.

OBJECTIVE:

Investigate the prevalence of
Cryptosporidium spp
. in stool samples.

DESIGN:

Cross-sectional.

SETTING:

Tertiary care.

PATIENTS AND METHODS:

Stool samples were collected from adult patients with malignant solid tumors receiving chemotherapy and diarrhea.
Cryptosporidium spp
. prevalence was determined using Ziehl–Neelsen staining, ELISA, and real-time PCR targeting of the
COWP
gene.

MAIN OUTCOME MEASURE:

The prevalence of
Cryptosporidium spp
. in patients undergoing chemotherapy for malignant solid tumors.

SAMPLE SIZE:

94

RESULTS:

The prevalence was 2.1% (2/94), 5.3% (5/94), and 5.3% (5/94) as detected by Ziehl–Neelsen staining, real-time PCR and ELISA, respectively. The prevalence reached 8.5% (8/94) using all results obtained from the three methods. Among eight positive stool samples, four were positive by at least two different methods (Ziehl–Neelsen staining-ELISA or ELISA-real-time PCR) whereas the remaining four were positive by either ELISA or real-time PCR.

CONCLUSION:

These findings show the risk of cryptosporidiosis in cancer patients and the necessity to use at least two diagnostic methods during the diagnosis of cryptosporidiosis to reach more accurate and trustworthy results.

LIMITATIONS:

Further studies with a larger sample size are recommended.

CONFLICT OF INTEREST:

None.