Examining the reliability and validity of the arabic version of the Glasgow Sleep Effort Scale (GSES).

BACKGROUND: Sleep effort refers to the cognitive and behavioral exertion involved in initiating and maintaining sleep. High sleep effort is increasingly recognized as perpetuating insomnia and poor sleep quality. Validated sleep effort scales enable the quantification of this construct in clinical and research settings. However, no Arabic version has been available. This study translated and validated the Glasgow Sleep Effort Scale (GSES) into Arabic to assess sleep effort in Arabic-speaking populations. METHOD: The GSES was translated into Arabic using the forward-backward translation approach. This involved an initial Arabic translation from the source followed by a back translation into English to ensure accuracy. A total of 369 participants were recruited to assess the psychometric properties of the Arabic version of the GSES, specifically its reliability and validity. The reliability analysis included Cronbach's α, McDonald's ω, and test-retest reliability. Validity was examined using confirmatory factor analysis (CFA) to evaluate the unidimensionality of the scale and assess model fit. Convergent validity was also assessed through correlation analysis with the Athens Insomnia Scale (AIS) and the Generalized Anxiety Disorder-7 Scale (GAD-7). RESULTS: The Cronbach's α reliability coefficient and McDonald's ω for the scale were found to be 0.87 (95% CI: 0.85-0.89). The test-retest reliability was 0.95 (95% CI: 0.93 - 0.97) after two weeks. The one-factor model showed an acceptable fit, with a CFI of 0.96, a TLI of 0.94, and an SRMR of 0.04. Invariance analysis revealed that male and female participants conceptualized and responded to the GSES items similarly, without differences in factor loadings or scale characteristics between the sexes. The Arabic version of the GSES has good convergent validity, as shown by the significant correlation between the AIS and the GSES (r = 0.72, p < 0.001). Similarly, the GAD-7 score was significantly correlated with the GSES score (r = 0.77, p < 0.001). CONCLUSION: This is the first study in which the GSES was validated in Arabic. This allows the scale to reliably gauge sleep effort among Arabic speakers, providing new clinical and research opportunities to understand how maladaptive sleep effort may contribute to insomnia and suboptimal sleep in this demographic population.

The Psychometric Properties of the Arabic Version of the Anxiety and Preoccupation About Sleep Questionnaire (APSQ).

Background: Insomnia disorder is a common health condition; it has a role in increasing the possibility of developing other psychological disorders, including anxiety and depression. Anxiety and preoccupation with sleep are two examples of common cognitive factors that contribute to the development of chronic insomnia; thus, it is important to have a tool that assesses worry in insomnia. There is no comprehensive psychiatric measure to assess anxiety and preoccupation with sleep in Arabic. We conducted this study to translate, adapt, and validate the Arabic version of the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), providing a reliable psychometric tool to assess concerns regarding sleep within Arabic-speaking communities. Methods: The translation process of the scale involved several steps, including forward and backward translation. A cross-sectional study was conducted using an online survey completed by 523 participants from various Arabic-speaking countries. Psychometric analysis was performed utilizing the R software, including internal consistency, test-retest reliability, and confirmatory factor analysis. In addition, convergent and divergent against the Athens insomnia scale (AIS) and general anxiety disorder (GAD) were conducted. Results: The Arabic-translated form of the APSQ expresses excellent internal consistency with a value of 0.91 for both Cronbach's α and McDonald's ω. The test-retest reliability of a subsample showed an excellent coefficient of 0.93 (p<0.01). A good fit of the APSQ was observed by CFI = 0.93, TLI = 0.91, SRMR = 0.05, and RMSEA = 0.1. Convergent and divergent against AIS and GAD showed statistically significant correlations of 0.85 (p<0.01) and 0.69 (p<0.01), respectively. Our sample showed a mean APSQ score of 31.28 ± 8.31, and the mean age was 23.62 ± 7.5. Conclusion: The Arabic APSQ is reliable and valid for measuring anxiety and preoccupation with sleep in Arabic countries. Using translated APSQ for clinical diagnosis and research is currently trustworthy.

Adversarial-Aware Deep Learning System Based on a Secondary Classical Machine Learning Verification Approach.

Deep learning models have been used in creating various effective image classification applications. However, they are vulnerable to adversarial attacks that seek to misguide the models into predicting incorrect classes. Our study of major adversarial attack models shows that they all specifically target and exploit the neural networking structures in their designs. This understanding led us to develop a hypothesis that most classical machine learning models, such as random forest (RF), are immune to adversarial attack models because they do not rely on neural network design at all. Our experimental study of classical machine learning models against popular adversarial attacks supports this hypothesis. Based on this hypothesis, we propose a new adversarial-aware deep learning system by using a classical machine learning model as the secondary verification system to complement the primary deep learning model in image classification. Although the secondary classical machine learning model has less accurate output, it is only used for verification purposes, which does not impact the output accuracy of the primary deep learning model, and, at the same time, can effectively detect an adversarial attack when a clear mismatch occurs. Our experiments based on the CIFAR-100 dataset show that our proposed approach outperforms current state-of-the-art adversarial defense systems.

Plasma Homocysteine Levels and Cardiovascular Events in Patients With End-Stage Renal Disease: A Systematic Review.

BACKGROUND: Patients with chronic renal disease or failure are at a heightened risk of mortality due to cardiovascular disease (CVD), which is a predominant cause of death in this population. Hyperhomocysteinemia is prevalent in patients with end-stage renal disease (ESRD), which may increase their susceptibility to CVD. METHODS: We conducted a comprehensive search of PubMed, Science Direct, and Google Scholar for articles published between 2003 and February 2023, using a combination of keywords such as "plasma homocysteine levels," "hyperhomocysteinemia," "end-stage renal disease," "renal failure," "kidney failure," "cardiovascular events," "cardiovascular disease," "myocardial infarction," "coronary artery disease," and "stroke." Our inclusion criteria were studies that investigated the association between total homocysteine (Hcy) level and CVD or total mortality, as well as the impact of vitamin supplementation on cardiovascular or mortality risk. We restricted our search to English-language studies that included ESRD patients and provided data on plasma Hcy levels and associated CVD events. RESULTS: This systematic review includes 11 articles published between 2003 and 2023 that enrolled a total of 3,953 subjects, of whom 79.15% were male patients. All studies included in the review were either quantitative randomized trials or non-randomized studies, such as cross-sectional, cohort, or case-control studies. Of the total studies included, 10 reported either cardiovascular mortality or CVD events, including cardiovascular death, myocardial infarction (MI), angina, and stroke. One study reported the CVD risk score of the patients, and most of them had higher total homocysteine (tHcy) levels. Overall, a total of 817 CVD events were reported across the studies. CONCLUSION: In conclusion, the relationship between Hcy and cardiovascular events in ESRD patients is not straightforward and requires further research. However, our review suggests that Hcy could be a predictor of cardiovascular events in this population, and its nutritional characteristics as well as other associated comorbidities may contribute to its inverse association with outcomes.

Technical Outcome, Clinical Success, and Complications of Low-Milliampere Computed Tomography Fluoroscopy-Guided Drainage of Lymphoceles Following Radical Prostatectomy with Pelvic Lymph Node Dissection.

To evaluate the technical outcome, clinical success, and safety of low-milliampere CT fluoroscopy (CTF)-guided percutaneous drain (PD) placement in patients with lymphoceles following radical prostatectomy (RP) with pelvic lymph node dissection (LND). This retrospective analysis comprised 65 patients with PD placement in lymphoceles following RP under low-milliampere CTF guidance. Technical and clinical success were evaluated. Complications within a 30-day time interval associated with CTF-guided PD placement were classified according to SIR. Patient radiation exposure was quantified using dose-length products (DLP) of the pre-interventional planning CT scan (DLPpre), of the sum of intra-interventional CT fluoroscopic acquisitions (DLPintra) and of the post-interventional control CT scan (DLPpost). Eighty-nine lymphoceles were detected. Seventy-seven CT-guided interventions were performed, with a total of 92 inserted drains. CTF-guided lymphocele drainage was technically successful in 100% of cases. For all symptomatic patients, improvement in symptoms was reported within 48 h after intervention. Time course of C-reactive protein and Leucocytes within 30 days revealed a statistically significant (p < 0.0001) decrease. Median DLPpre, DLPintra and DLPpost were 431 mGy*cm, 45 mGy*cm and 303 mGy*cm, respectively. Only one minor complication (self-resolving haematoma over the bladder dome; SIR Grade 2) was observed. Low-milliampere CTF-guided drainage is a safe treatment option in patients with lymphoceles following RP with pelvic LND characterized by high technical and good clinical success rates, which provides rapid symptom relief and serves as definite treatment or as a bridging therapy prior to laparoscopic marsupialisation.

Clinical Evaluation of Single-Use, Fiber-Optic, and Digital Ureterorenoscopes in the Treatment of Kidney Stones.

INTRODUCTION: Indication of ureteroscopy for the treatment of urolithiasis has expanded immensely over the last decade. Fiber-optic and digital reusable instruments present the standard in clinical practice, but various newly available single-use devices might offer an exciting alternative. To date, the evidence is limited to clinical evaluation and efficacy of single-use ureteroscopes (URS) compared to standard instruments. Therefore, we evaluate a single-use instrument's clinical characteristics and efficacy in direct comparison with a fiber-optic and digital device. METHODS: A prospective study was conducted for patients undergoing endoscopic therapy for urolithiasis at a tertiary care center. We evaluated the different instruments' clinical performance in categories of visibility, the stability of visibility, irrigation flow, and surgeon's satisfaction. Statistical analyses were performed by SPSS using the Chi-Quadrat and Kruskal-Wallis test. A p value of p ≤ 0.05 was defined as statistically significant. RESULTS: A total number of 77 patients were included and distributed as follows: 35 (46.7%) single-use, 19 (25.3%) digital, and 23 (28%) fiber-optic URS. Patients' characteristics were homogenous over the three cohorts in sex, stone amount, and localization. The stone-free rate was equal in all three cohorts (p = 0.31). We identify stability of visibility, irrigation flow, and satisfaction were equal in all cohorts (p = 0.73; p = 0.20; p = 0.20). We report a significant difference in visibility, with 100% rated excellent in the digital URS group (p = 0.028). DISCUSSION/CONCLUSIONS: Single-use URS achieve comparable clinical outcomes with equal stone-free rates in direct comparison with fiber-optic and digital reusable instruments. Accordingly, single-use devices present an adequate alternative for endoscopic therapy of urolithiasis.

The Association Between Screen Time Exposure and Autism Spectrum Disorder-Like Symptoms in Children.

Research problem Advances in technology have ensured its inevitable integration in our life. Children, being at a vulnerable age period of development, are spending more time on electronic devices. Some studies reported negative effects on sleep, physical health such as obesity and vision problems, and behavioral changes such as aggressive behavior with exposure to violent media content. Research significance We will study the effect of using electronic devices on communication skills in children in Saudi Arabia. Our findings can be used to raise awareness on this matter. Research objectives The aim of our study is to examine the association between screen time and social communication skills among children of four years to six years of age in Saudi Arabia. Research methodology A cross-sectional study was conducted to investigate the relationship between social skills development and screen time by using a validated Arabic version of the Social Communication Questionnaire (SCQ). The sample in this study consists of 308 children from four to six years of age. Research results The results showed that the hours spent using the electronic device were significantly associated with having an SCQ score ≥ 15 (P < 0.05). A high SCQ score was prevalent in 19.7% (n = 31) of children who spent >3 hours using an electronic device compared to 10.2% (n = 5) and 7.84% (n = 8) of children who spent an hour or <2 hours using electronic devices, respectively. Conclusion Our study highlighted a significant association between the daily hours spent on devices and having an SCQ score above 15, which suggests a deficit in social skill development and having autism spectrum disorder-like symptoms.

Influence of the laser pulse shape in the treatment of stones in the upper urinary tract.

PURPOSE: Urinary stones can be successfully treated using a Holmium: Yttrium-Aluminum-Garnet (Ho: YAG) laser. Regarding success rates, laser pulse energy, frequency, and pulse width are well-known contributing factors. Whether the pulse shape might be a further factor influencing the laser efficiency is unclear. This study aimed to evaluate different modes of laser pulse shapes in a real-world setting. MATERIALS AND METHODS: The Dornier Medilas® H Solvo (Weßling, Germany) was used in the treatment of ureter and kidney stones. Patients were randomized into standard pulse shape (SPS) and new pulse shape groups (NPS1; ureter) and (NPS2; kidney pelvis), depending on the stone localization. The primary endpoint was laser efficiency defined as mm³ stone destruction per overall operating time. Secondary endpoints encompassed number of stone recoveries and stone-free rate. RESULTS: Altogether 145 patients (24 SPS vs. 32 NPS1; 51 SPS vs. 38 NPS2) were included. No differences in sex, age, body mass index, stone localization and stone composition were found, except for preoperative stone size (133±95 [SPS] vs. 197±139 [NPS1] mm³; p=0.023) and (348±298 [SPS] vs. 525±429 [NPS2] mm³; p=0.042). Regarding the primary endpoint, a significant increase in laser efficiency could be detected for the NPS1 and NPS2 groups compared to the SPS groups (39.9±44.9 vs. 28.8±30.2 and 51.7±61.3 vs. 22.4±24.2 mm³/min [mean±standard deviation]). No statistically significant differences were found for secondary endpoints and perioperative complication rates. CONCLUSIONS: Efficiency of the Ho: YAG laser can be positively influenced by different pulse shapes. This adds the variable of individualized intraoperative decision making.

Comparative evaluation of tissue damage induced by ultrasound and impact dual-mode endoscopic lithotripsy versus conventional single-mode ultrasound lithotripsy.

OBJECTIVE: The aim of our study was to perform comparative investigation of the tissue safety of three different endoscopic lithotripter devices including a new single-probe/dual-energy lithotripter in an in vivo animal model. The Swiss LithoClast Trilogy was compared to the Storz Calcuson and the Swiss LithoClast Vario. The safety test simulated the accidental direct contact between lithotripter probes and the urothelium, which can occur when sliding off a stone or drilling through a calculus during lithotripsy. The safety test included a smallest (1.5 mm) and largest (3.3/3.4 mm) probe diameter per device. METHODS: Testing was performed in nine pigs (three animals per device). The bladder tissue was exposed to direct lithotripter probe contact at maximum power for 10 s to produce visible tissue lesions. Acute tissue trauma was evaluated using a simplified scoring model describing the expected bladder wall injuries for histological examination. After 7 days, all animals were killed, necropsied and examined post mortem. For between-group comparisons regarding microscopic histopathologic features, a Chi-square test was used. A p value < 0.05 was considered to be statistically significant. RESULTS: Irrespective of the lithotripter used, no systemic signs of toxicity were observed. Histologically, signs of normal ongoing healing were observed on the bladder mucosa. There were no significant differences in histological findings taking changes of the epithelium (p = 0.360), the leucocyte infiltration (p = 0.123), the vascular congestion (p = 0.929) and the edema (p = 1.0) between the groups into account. CONCLUSIONS: The results of this study demonstrated a comparable safety between all lithotripsy devices.

Ileal volvulus secondary to cystic lymphangioma: A rare case report with a literature review.

Lymphangioma is a benign malformation of the lymphatic system. It usually affects the neck, head, and rarely, the abdomen. Volvulus is a serious condition, which occurs as a result of bowel twisting around itself or around the mesentery leading to severe consequences such as obstruction. The most common cause of volvulus in children is malrotation. We report a rare case of a 2-year-old boy who was brought by his parents to the emergency room with the complaint of constipation for 5 days and vomiting for the last 4 days. Examination and plain abdominal X-ray suggested intestinal obstruction. Furthermore, ultrasonography indicated the presence of a cyst and dilatation of the bowel. On exploratory laparotomy, an ileal volvulus caused by cystic lymphangioma developed on the mesenteric wall and associated with ileal and jejunal dilatation was observed. The diseased segments were resected in addition to 5cm before and after the cystic lymphangioma to prevent recurrence.

An innovative technique of robotic-assisted/laparoscopic re-pyeloplasty in horseshoe kidney in patients with failed previous pyeloplasty for ureteropelvic junction obstruction.

OBJECTIVES: To describe an innovative laparoscopic/robotic-assisted re-pyeloplasty technique in patients with recurrent ureteropelvic junction obstruction (UPJO) in horseshoe kidneys. PATIENTS AND METHODS: Data from five patients (37-65, median 54 years) with symptomatic recurrence of UPJO in horseshoe kidney who underwent laparoscopic/robotic-assisted re-pyeloplasty at our institution since 2004 were evaluated retrospectively. The upper ureter together with wedge resection of the pelvis at the lower calyx was performed. The ureter is spatulated till beyond the isthmus and anastomosed to lower calyx. Rotational renal pelvis flap is used for reconstruction and conisation of the pelvis. RESULTS: Median operative time was 137 min (92-180) with a negligible blood loss. There was no need for conversion or revisions. Perioperative periods were uneventful. The intraoperatively inserted JJ was left for 6-8 weeks. Median postoperative differential function of affected kidney at 3 months (MAG III) was 38 % (26-42 %), unchanged from 35 % (21-41 %), preoperatively. This was stable in three patients and higher in two (5 and 7 %). There were no obstructive elements indicating anatomical ureteric obstruction. After convalescence period, three patients recurred to their work at 5 weeks, while all at 8 weeks. All patients remained asymptomatic and have not required any further interventions during whole follow-up. CONCLUSIONS: Described technique of laparoscopic/robotic-assisted re-pyeloplasty in horseshoe kidneys is technically feasible, safe and effective with high patient satisfaction and early convalescence. Its success rate is comparable with the results after primary pyeloplasty in horseshoe and heterotopic kidneys. Larger series may be required to allow for more accurate comparison.