This retrospective study aimed to collect data related to the clinical manifestations and laboratory investigations of systemic lupus erythematosus (SLE) patients in the eastern part of Saudi Arabia, in one of the tertiary-care centers, King Fahd Hospital Al-Hasa, and to compare it with other regions of Saudi Arabia. Forty-six patients fulfilling the American College of Rheumatology 1997 criteria (ACR) were collected over a period from January 2004 to December 2008. The results showed an average age of onset of 26.17 (±9.17). The most common clinical features were nonspecific constitutional symptoms (fever, fatigue and malaise) seen in 44 patients (95.7%). Musculoskeletal features seen were mostly arthralgias (91.3%) and arthritis (76.1%). Nephritis was seen in 58.7% and hypertension in 52.2%. Mucocutaneous involvement included oral ulcers (71.7%), hair loss (65.2%), butterfly rashes (67.4%), photosensitivity (47.8%) and discoid lupus (13%). Neurologic manifestations showed psychosis in 17.4%, depression in 15.2% and headache in 28.3%. The most common hematologic presentation was leukopenia (58.7%) followed by hemolytic anemia and anemia of chronic disease (47.8%). Antinuclear antibodies were positive in 44 (95.7%), anti-dsDNA in 38 (42.6%), anti-Ro SSA and La SSB in 38 (82.6%). Anticardiolipin antibodies and lupus anticoagulant were positive in eight (17.4%). Low complement levels (C3 and C4) were seen in 41 (89.1%) of the patients with active disease. The drugs used in treatment were NSAIDs (100%), antimalarials (97.8%), steroids (100%), intermittent cyclophosphamide and other immunosuppressive drugs (71.7%). We found that the age of onset and sex distributions were different from other areas of Saudi Arabia, while clinical manifestations were the same as in other areas. The prognosis of lupus was good overall despite the multi-organ involvement. However, further studies based on larger number of patients are needed.
Tremendous changes have taken place in medical curricula in the last two decades; these changes have arguably created some imbalances in the quality of medical graduates around the globe, which may be partly due to the number of resources often demanded by the design of the newer curricula. Therefore, resource-poor countries are often unable to adopt these newer models of training in their entirety and are thus compelled to follow the so- called “Subject-Based Curriculum”. The authors have discussed and prepared some guidelines to provide direction for the adaptation and implementation of Problem-Based Learning Curriculum (PBLC) in countries with different cultures and limited resources. This article addresses the issues and concerns raised by medical educationists on the implementation of PBLC especially in developing countries. These pointers include practical solutions for such common problems as staff, cost, infrastructure and training.
BACKGROUND: Patients' adherence to insulin therapy is crucial to achieve good glycemic control. The present study was conducted to determine psychological insulin resistance (PIR) and the effect of doctor–patient relationship on PIR among type 2 diabetes patients attending primary health-care centers of Al-Ahsa region in Saudi Arabia. MATERIALS AND METHODS: This was a cross-sectional survey of all type 2 diabetic patients attending the primary healthcare centers of Al-Ahsa. A multistage sampling technique was used. The calculated sample size was 396. Two validated structured questionnaires were used to collect information. The degree of agreement to insulin therapy was done on the Likert 5° scale. SPSS was used for data entry and analysis. Chi-square test was used to test for stistical significane at P=0.05. RESULTS: Out of 396 patients who were given the questionnaires, 366 filled the questionnaires yielding 92% response rate. Fifty-one percent were male and about 85% were older than 35 years. Willingness to use insulin was significantly associated with age ( P = 0.013) and duration of diabetes (P=0.0001). The strongest negative attitudes toward insulin therapy arose from participants having heard about a bad experience with insulin (59.34%, P < 0.05) and the fear of possible dependence (54.20%, P < 0.05). Participants who responded of “mostly appropriate” and “very appropriate” to questions on patient–doctor relationship were significantly more willing to take insulin (64.9% vs 24.5%, and 70.3% vs 22.9%, P = 0.0001). CONCLUSION: The study showed that one-third of the patients with type 2 diabetes had PIR. Since the behavior of doctor plays an important role in reducing PIR, there is a need for greater emphasis on the importance of good doctor–patient relationship and the establishment of a therapeutic education program.
The primary healthcare system is at a turning point in Saudi Arabia. However, the sustainability of family medicine as the core element of that system is increasingly being called into question because of lack of family physicians. In keeping view this problem; a postgraduate diploma program in family medicine has started in 2008. A validated measure of educational environment i.e., Dundee Ready Education Environment (DREEM) questionnaire consisting of 50 questions having five domains of perception was administered to all 13 trainees of the diploma course at the completion of the program to check their perception about learning evironment. The trainees comprised of 4 males (40%) and 6 females (60%). The overall score showed more positive than negative side (147/200). There is no significant difference (P > 0.05) in the mean scores of five different domains of perception. The subclasses of five domains showed that teaching perceived as positive by 50%, moving towards right direction by 80%, feeling more positive by 50%, positive attitude by 80% and the 70% scored the course as not too bad. The overall high score and positive attitude towards the course assures the better teaching environment. However, there are areas to improve and it requires continuous evaluation.
Living organisms including fishes, microbes, and animals can live in extremely cold weather. To stay alive in cold environments, these species generate antifreeze proteins (AFPs), also referred to as ice-binding proteins. Moreover, AFPs are extensively utilized in many important fields including medical, agricultural, industrial, and biotechnological. Several predictors were constructed to identify AFPs. However, due to the sequence and structural heterogeneity of AFPs, correct identification is still a challenging task. It is highly desirable to develop a more promising predictor. In this research, a novel computational method, named AFP-LXGB has been proposed for prediction of AFPs more precisely. The information is explored by Dipeptide Composition (DPC), Grouped Amino Acid Composition (GAAC), Position Specific Scoring Matrix-Segmentation-Autocorrelation Transformation (Sg-PSSM-ACT), and Pseudo Position Specific Scoring Matrix Tri-Slicing (PseTS-PSSM). Keeping the benefits of ensemble learning, these feature sets are concatenated into different combinations. The best feature set is selected by Extremely Randomized Tree-Recursive Feature Elimination (ERT-RFE). The models are trained by Light eXtreme Gradient Boosting (LXGB), Random Forest (RF), and Extremely Randomized Tree (ERT). Among classifiers, LXGB has obtained the best prediction results. The novel method (AFP-LXGB) improved the accuracies by 3.70% and 4.09% than the best methods. These results verified that AFP-LXGB can predict AFPs more accurately and can participate in a significant role in medical, agricultural, industrial, and biotechnological fields.
In this paper, an approach to incorporate a digital twin for legacy production systems is presented. Hardware-inthe-loop setups are routinely used by manufacturing companies to carry out virtual commissioning. However, manufacturing companies having online legacy production systems are still struggling to incorporate a digital twin due to the absence of verified and validated simulation models. Companies that use virtual commissioning as a part of their engineering tool chain, usually perform offline verification of the simulation model. This approach is typically based on visual inspection and is a tedious task as each aspect of the model has to be visually validated. For legacy systems, only assessing the behavior visually in the absence of updated documents can result in an incorrect simulation model, i.e. simulating incorrect behavior with respect to the specification. Due to this, such simulation models cannot be incorporated in the engineering tool chain, as the simulated results can lead to improper decisions and can even cause equipment damage. This paper presents a platform and an approach, based on model-based testing, that is a first step for manufacturing companies to incorporate a validated simulation model for existing online production systems that will serve as a digital twin.
Objective: To determine normal ranges for , tumour necrosis factor-alpha (TNF-α) and C-reactive protein (CRP) respectively, with 95% confidence intervals (11.6, 21.5 pg/mL; 24.0, 33.1 and 8.4, 15.1, respectively). Conclusion: The normal ranges for IL-6, TNF-α and CRP in umbilical cord blood for healthy term Trinidadian neonates were 0-16.4 pg/mL, 0-29.4 pg/mL and 0-12.4 mg/L, respectively. Keywords
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