Real-Time Arabic Sign Language Recognition Using a Hybrid Deep Learning Model.

Sign language is an essential means of communication for individuals with hearing disabilities. However, there is a significant shortage of sign language interpreters in some languages, especially in Saudi Arabia. This shortage results in a large proportion of the hearing-impaired population being deprived of services, especially in public places. This paper aims to address this gap in accessibility by leveraging technology to develop systems capable of recognizing Arabic Sign Language (ArSL) using deep learning techniques. In this paper, we propose a hybrid model to capture the spatio-temporal aspects of sign language (i.e., letters and words). The hybrid model consists of a Convolutional Neural Network (CNN) classifier to extract spatial features from sign language data and a Long Short-Term Memory (LSTM) classifier to extract spatial and temporal characteristics to handle sequential data (i.e., hand movements). To demonstrate the feasibility of our proposed hybrid model, we created a dataset of 20 different words, resulting in 4000 images for ArSL: 10 static gesture words and 500 videos for 10 dynamic gesture words. Our proposed hybrid model demonstrates promising performance, with the CNN and LSTM classifiers achieving accuracy rates of 94.40% and 82.70%, respectively. These results indicate that our approach can significantly enhance communication accessibility for the hearing-impaired community in Saudi Arabia. Thus, this paper represents a major step toward promoting inclusivity and improving the quality of life for the hearing impaired.

The risk of tuberculosis infection in Saudi patients receiving adalimumab, etanercept, and tocilizumab therapy.

BACKGROUND: The risk of infection including tuberculosis (TB) infection or reactivation during biological therapy with the current various clinical application is a major concern. This risk may be higher in countries endemic to TB. Our aim of this study is to determine the risk of TB infection in patients receiving 3 biological treatments, Adalimumab, Etanercept and Tocilizumab. METHODS: A retrospective cohort study extending over 2 years follow-up for all patients receiving Adalimumab, Etanercept and Tocilizumab for various clinical indications in a tertiary care center in Saudi Arabia. RESULT: Over the period of 2015-2019, A total of 410 patients received Adalimumab, 271 received Etanercept and 58 patients received Tocilizumab. Rheumatoid arthritis was the most common indication for therapy in all groups and for Adalimumab the most common indication was inflammatory bowel disease, for Etanercept was psoriatic arthritis and for Tocilizumab was juvenile idiopathic arthritis. After a mean follow up period of 36 ± 8.9 months for patients receiving Adalimumab, 21.5 ± 8.4 months for patients receiving Etanercept and 21 ± 2.5 months for patients receiving Tocilizumab there were no reported cases of TB infection in all groups. Only one patient was diagnosed with latent TB 7 months later after starting Adalimumab and tow patients after starting Etanercept. The overall Interferon Gamma Release Assays (IGRA) positivity rate was 9.7%. There was significant association between IGRA positivity rate and patient age. The cutoff age in which IGRA positivity has significantly increased was 53.20 years. CONCLUSION: In our study, patients receiving Etanercept, Adalimumab and Tocilizumab had no increased risk of TB infection. Only 0.3% of patients treated with Adalimumab and 0.9% of patients treated with Etanercept converted to a positive IGRA during therapy.

A Multicenter Cross-Sectional Study of the Awareness and Screening for Retinopathy of Prematurity Among NICU Pediatricians in Makkah and Jeddah, Saudi Arabia.

Purpose This study aims to evaluate neonatal intensive care unit (NICU) pediatricians' knowledge about retinopathy of prematurity (ROP) in the major tertiary centers in Makkah and Jeddah, Saudi Arabia. Methods This cross-sectional study uses a self-administered electronic questionnaire completed by NICU pediatricians at the main hospitals of Makkah and Jeddah cities. Based on the participants' correctly selected responses to the validated questionnaire, a scoring system was used in the data analysis to show their level of ROP knowledge. Results Seventy-seven responses were analyzed. The male gender was 49.4%. The majority were recruited from the ministry of health hospitals (63.6%). A small proportion (28.6%) correctly identified who performs the examination. Around three-quarters of the participants have correctly stated that ROP therapy is a very good option to prevent blindness (72.7%). The treatment should generally begin within 72 hours after diagnosis of sight-threatening ROP (79.2%). The requirements for ROP screening were unknown to more than half of our participants (53.2%). With the lowest score of 4.0 and a maximum score of 17.0, the median knowledge score was 13.0 (IQR = 11.0 to 14.0). Based on pediatricians' clinical qualifications, knowledge scores varied significantly. Residents had a significantly lower knowledge score than specialists and consultants (median = 7.0, IQR = 6.0 to 9.0, p = 0.001). Additionally, pediatricians with less experience (<5 years) performed significantly lower on the knowledge score (median = 10.0, IQR = 6.2 to 12.8) than those with more experience (median = 13.0, IQR = 11.0 to 15.0) for participants with 5-10 years of experience, and (median = 13.0, IQR = 11.0 to 14.0) for participants with >10 years of experience). Conclusion Our study showed that NICU pediatricians understood ROP risk factors and treatment options. Nevertheless, they needed to understand the ROP screening inclusion criteria and when the screening could be stopped. Residents scored substantially lower in knowledge overall. Accordingly, we emphasized the need for NICU pediatricians to increase their level of awareness by having regular educational sessions and standardizing one guideline to be strictly followed.

Assessing the Perceptions and Practices Toward Eye Injuries First Aid Among General Population in the Western Region of Saudi Arabia: A Cross-Sectional Study.

Aim  The eye is a vital and extraordinarily perceptive part of the human body. A wide spectrum of possible outcomes from eye injuries, from temporary vision loss to permanent blindness. There is a lack of information about how to handle an eye injury. Education and raising awareness are the best way to prevent severe complications and eventual loss of vision. Therefore, the purpose of this study is to evaluate and assess general population knowledge and first aid practices regarding eye injuries in the Western Region of Saudi Arabia, focusing on the importance of early management. Methodology A cross-sectional questionnaire was administered among residents of western Saudi Arabia using a validated questionnaire. One thousand two hundred seventy-nine adults of both genders were randomly chosen to represent the sample. In December 2022, we used a web-based survey to gather our data. Result This study analyzed data from 1279 responses on the online platform. Results showed that good knowledge was significantly higher among females than males, those without a history of eye injury than their peers with injuries, and those with higher educational levels than those with lower educational levels. Additionally, good knowledge was predicted by the female gender (OR = 1.6, 95% CI, 1.3 to 2.1, p < 0.001). Conclusion The study found that public awareness of eye injury first aid was good in the western region. The role of physicians should be expanded and health education campaigns and social media are recommended to achieve the goal of reduction and limiting the most crucial damage to the most sensitive organ in the body.

The Association between Admission Procalcitonin Level and The Severity of COVID-19 Pneumonia: A Retrospective Cohort Study.

Background and Objectives: An elevated procalcitonin level has classically been linked to bacterial infections. Data on the association between elevated procalcitonin and the outcome of coronavirus disease 2019 (COVID-19) are conflicting. Some linked it to associated bacterial co-infections, while others correlated the elevation with disease severity without coexisting bacterial infections. We aimed to investigate the association between high procalcitonin and the severity of COVID-19. Materials and Methods: Hospitalized patients with confirmed COVID-19 pneumonia were divided into two groups: the normal-procalcitonin group and the high-procalcitonin group (>0.05 ng/mL). Patients with concomitant bacterial infections on admission were excluded. The primary outcomes were the need for intensive care unit (ICU) admission, progression to invasive mechanical ventilation (IMV), and in-hospital 28-day mortality. Results: We included 260 patients in the normal procalcitonin group and 397 patients in the high procalcitonin group. The mean age was 55 years and 49% were females. A higher number of patients in the elevated procalcitonin group required ICU admission (32.7% vs. 16.2%, p < 0.001) and IMV (27.2% vs. 13.5%, p < 0.001). In-hospital mortality was significantly higher in the elevated procalcitonin group (18.9% vs. 8.5%, p < 0.001). After adjusting for other covariates, procalcitonin > 0.05 ng/mL was an independent predictor of progression to IMV (OR, 1.71; 95% CI, 1.08−2.71; p = 0.022), ICU admission (OR, 1.73; 95% CI, 1.13−2.66; p = 0.011), and in-hospital mortality (OR, 1.99; 95% CI, 1.14−3.47; p = 0.015). An elevated procalcitonin level was the strongest predictor of in-hospital mortality. Conclusions: Measurement of procalcitonin can have a prognostic role among COVID-19 patients. The admission procalcitonin level can identify patients at risk of ICU admission, progression to IMV, and in-hospital mortality.

Neuropsychiatric Lupus and Lupus Nephritis Successfully Treated with Combined IVIG and Rituximab: An Alternative to Standard of Care.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with unpredictable course and flares. The clinical manifestation can vary from mild to severe and life-threatening disease. Infection is the primary cause of mortality in hospitalized SLE patients. There is a paucity of evidence to support the co-management of SLE with major organ involvement and sepsis. We describe the clinical response of a 35-year-old male diagnosed with SLE; then, he developed severe sepsis and a flare of SLE with major organ involvement including lupus nephritis (LN), myocarditis, and neuropsychiatric systemic lupus erythematosus (NPSLE). Based on the patient's condition, a treatment dilemma was encountered, and after a multidisciplinary meeting, the decision was made to use a combination of rituximab (RTX), intravenous immunoglobulin (IVIG), and pulse steroid. Shortly, the patient's condition started to improve, and his symptoms were resolved. In conclusion, our clinical case suggests that combined RTX, IVIG, and pulse steroid seem to be effective and safe in achieving clinical response, thus representing a good choice for managing severe SLE flares in sepsis.

Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19.

Evidence is conflicting about the diabetes characteristics associated with worse outcome among hospitalized COVID-19 patients. We aimed to assess the role of stress hyperglycemia ratio (SHR) as a prognostic marker among them. In our retrospective cohort study, patients were stratified according to SHR, admission glucose, and glycated hemoglobin tertiles. The primary outcome was a composite endpoint of invasive mechanical ventilation, intensive care unit admission, and in-hospital mortality. The study included 395 patients with a mean age of 59 years, and 50.1% were males. Patients in the third tertile of SHR developed more primary events, and the difference was significant compared to the first tertile (p = 0.038) and close to significance compared to the second tertile (p = 0.054). There was no significant difference in the outcomes across admission glucose and glycated hemoglobin tertiles. A higher SHR tertile was an independent risk factor for the primary outcome (OR, 1.364; 95% CI: 1.014-1.836; p = 0.040) after adjustment for other covariables. In hospitalized COVID-19 diabetic patients, SHR third tertile was significantly associated with worse outcome and death. SHR can be a better prognostic marker compared to admission glucose and glycated hemoglobin. A higher SHR was an independent risk factor for worse outcome and in-hospital mortality.

Multi-constraints based deep learning model for automated segmentation and diagnosis of coronary artery disease in X-ray angiographic images.

Background: The detection of coronary artery disease (CAD) from the X-ray coronary angiography is a crucial process which is hindered by various issues such as presence of noise, insufficient contrast of the input images along with the uncertainties caused by the motion due to respiration and variation of angles of vessels. Methods: In this article, an Automated Segmentation and Diagnosis of Coronary Artery Disease (ASCARIS) model is proposed in order to overcome the prevailing challenges in detection of CAD from the X-ray images. Initially, the preprocessing of the input images was carried out by using the modified wiener filter for the removal of both internal and external noise pixels from the images. Then, the enhancement of contrast was carried out by utilizing the optimized maximum principal curvature to preserve the edge information thereby contributing to increasing the segmentation accuracy. Further, the binarization of enhanced images was executed by the means of OTSU thresholding. The segmentation of coronary arteries was performed by implementing the Attention-based Nested U-Net, in which the attention estimator was incorporated to overcome the difficulties caused by intersections and overlapped arteries. The increased segmentation accuracy was achieved by performing angle estimation. Finally, the VGG-16 based architecture was implemented to extract threefold features from the segmented image to perform classification of X-ray images into normal and abnormal classes. Results: The experimentation of the proposed ASCARIS model was carried out in the MATLAB R2020a simulation tool and the evaluation of the proposed model was compared with several existing approaches in terms of accuracy, sensitivity, specificity, revised contrast to noise ratio, mean square error, dice coefficient, Jaccard similarity, Hausdorff distance, Peak signal-to-noise ratio (PSNR), segmentation accuracy and ROC curve. Discussion: The results obtained conclude that the proposed model outperforms the existing approaches in all the evaluation metrics thereby achieving optimized classification of CAD. The proposed method removes the large number of background artifacts and obtains a better vascular structure.

COVID-19 convalescent plasma treatment of moderate and severe cases of SARS-CoV-2 infection: A multicenter interventional study.

OBJECTIVE: To study the effectiveness of COVID-19 convalescent plasma (CCP) therapy for patients with moderate and severe COVID-19 disease. METHODS: This non-randomized prospective cohort study was conducted from May 21 to June 30, 2020, at four major tertiary hospitals in Kuwait. CCP was administered to 135 patients. The control group comprised 233 patients who received standard treatment. All patients (N = 368, median age 54 [range 15-82]) had laboratory-confirmed SARS-CoV-2 infection and either moderate or severe COVID-19 disease. RESULTS: CCP treatment was associated with a higher rate of clinical improvement in patients with moderate or severe disease. Among those with moderate COVID-19 disease, time to clinical improvement was 7 days in the CCP group, versus 8 days in the control group (p = 0·006). For severe COVID-19 disease, time to clinical improvement was 7 days in the CCP group, versus 15.5 days in the control group (p = 0·003). In the adjusted analysis, patients with moderate disease treated with CCP had a significantly lower 30-day mortality rate. Compared to the control group, oxygen saturation improved within 3 days of CCP transfusion, and lymphocyte counts improved from day 7 in patients with moderate COVID-19 disease and day 11 in patients with severe disease. C-reactive protein levels declined throughout the first 14 days after CCP transfusion. None of the CCP patients developed a serious transfusion reaction. CONCLUSIONS: The data show that administration of CCP is a safe treatment option for patients with COVID-19 disease with a favorable outcome in the rate of, and time to, clinical improvement.

Silica nanoparticles boost growth and productivity of cucumber under water deficit and salinity stresses by balancing nutrients uptake.

The role of amorphous silica nanoparticles (SiNPs) in enhancing growth and yield of cucumber under water deficit and salinity stresses was assessed. A field experiment under greenhouse conditions was established using 4 different levels of SiNPs (100, 200, 300 and 400 mg kg-1) and 3 different watering regimes calculated based on crop evapotranspiration (ETc) (100, 85 and 70% of ETc). Electrical conductivity and sodium adsorption ratio of irrigation water were 1.7 dS m-1 and 4.63 respectively. The results revealed that SiNPs improved growth and productivity of cucumber regardless of quantity of supplied water; however, the greatest increase corresponded to irrigating cucumber at the rate of 85% of ETc. Applying SiNPs at rate of 200 mg kg-1 showed the greatest increase specially when cucumber plants received 85% of their ETc causing an increase of 20, 51 and 156% in plant height, chlorophyll and fruit yield, respectively, compared to untreated plants. These increases could be due to alerting nutrient uptake as SiNPs clearly increased contents of nitrogen (by 30%), potassium (by 52, 75 and 41% in root, stem and leaf, respectively) and silicon (by 51, 57, 8 and 78% in root, stem, leaf and fruit, respectively). Otherwise, same treatment reduced sodium uptake by 38, 77 and 38% in root, stem and leaf, respectively; consequently, potassium-sodium ratio increased by 149, 735 and 127% in root, stem and leaf, respectively. The significant role of SiNPs in mitigating water deficit and salinity stresses could be referred to high silicon content found in leaf which regulates water losses via transpiration. Also, high K+ content found in roots of cucumber helps plants to tolerate abiotic stresses as a result of maintaining ion homeostasis and regulating the osmotic balance as well as controlling stomatal opening which helps plants to adapt to salinity and water deficit stresses.

Exogenous nanosilica improves germination and growth of cucumber by maintaining K+/Na+ ratio under elevated Na+ stress.

The current work was aimed to elucidate the role of engineered nanosilica (SiNPs) particles to mitigate the damaging impacts of Na+-derived salinity on cucumber (Cucumis sativus) Beit Alpha variety by conducting in vitro experiments applying various Na+ concentrations i.e. 0, 1000, 2000, 3000, 4000 and 5000 mg L-1. By treating seeds and seedlings, respectively, of cucumber with SiNPs (0, 100, 200 and 300 ppm) and subsequent determination some germination and vegetative parameters as well as chemical analysis of seedlings, we verified that SiNPs succeeded to alleviate the detrimental effects of high Na+ salinity by increasing germination parameters and vegetative growth of cucumber seedlings. Even as little as 100 ppm of N-Si results in considerable improvement of seed germination and seedlings growth of cucumber compared to the control, while 200 ppm was optimal among the doses tested. At 5000 mg Na+ L-1, applying SiNPs with 200 ppm increased final germination percentage by 101% over control, vigor index by 101%, germination rate index by 116%, germination index by 110%, fresh mass by 13%, K+/Na+ ratio by 77%, shoot dry mass by 384%, root dry mass by 304% and plant height by 70%. The results mentioned in this paper obviously outline the large practical relevance of SiNPs and imply that applying of SiNPs for cucumber seeds and seedlings under high Na+-derived salinity enhances germination and growth as a result for decreasing Na+ uptake and sequentially improves high K+/Na+ ratio.

Engineered silica nanoparticles alleviate the detrimental effects of Na+ stress on germination and growth of common bean (Phaseolus vulgaris).

During the past 10 years, exploiting engineered nanoparticles in agricultural sector has been rapidly increased. Nanoparticles are used to increase the productivity of different crops particularly under biotic and abiotic stresses. This study aims to test the ability of nanosilica (NS) to ameliorate the detrimental impact of Na+ with different concentrations on the seed germination and the growth of common bean seedlings. Five doses of Na+ have been prepared from NaCl, i.e., 1000, 2000, 3000, 4000, and 5000 mg L-1, and distilled water was applied as a control. Seeds and seedlings were treated with three different NS concentrations (100, 200, and 300 mg L-1). The results proved that Na+ concentrations had detrimental effects on all measured parameters. However, treating seeds and seedlings with NS improved their growth and resulted in higher values for all measurements. For instance, the addition of 300 mg L-1 NS leads to an increase of the final germination percentage, vigor index, and germination speed for seeds irrigated with 5000 mg Na+ L-1 by 19.7, 80.7, and 22.6%, respectively. Although common bean seedlings could not grow at the highest level of Na+, fortification seedlings with NS helped them to grow well under 5000 mg L-1 of Na+. An increase of 11.1 and 23.1% has been measured for shoot and root lengths after treating seedlings with 300 mg L-1 NS under irrigation with 5000 mg Na+ L-1 solutions, and also at the same treatment, shoot and root dry masses are enhanced by 110.9 and 328.0%, respectively. These results proved the importance of using NS to relieve the detrimental effects of Na+-derived salinity. This finding could be reinforced by low Na content which was measured in plant tissues after treating seedlings with 300 mg L-1 of NS.

Attitudes of medical students toward communication skills learning in Western Saudi Arabia.

OBJECTIVES: To explore medical students' attitudes towards communication skills learning in Western Saudi Arabia and to examine impact of socio-demographic variables on the attitudes towards learning these skills.   METHODS: In this cross-sectional study, sample of medical students were recruited from Taif University, Taif, Kingdom of Saudi Arabia during the second semester (January-May 2014). Participants were all year 2 (197 students) and year 5 (151 students). The study utilize the Communication Skills Attitude Scale (CSAS) to measure students' attitudes toward communication skills learning. The response rate was 93.9%.  RESULTS: The study showed that Taif medical students hold highly positive attitudes towards learning communication skills. Positive attitude score (PAS) was significantly higher in level 5 students, older age group.   CONCLUSION: Significant positive attitude toward learning communication skills clearly observed in target group. Students with more positive attitudes towards communication skills learning tended to be higher level and older age.

The effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review of randomized placebo-controlled trials.

Although inhaled corticosteroids are commonly used to treat patients with chronic obstructive pulmonary disease (COPD), their effect on clinical outcomes such as exacerbation and mortality is unknown. This systematic review was conducted to determine whether inhaled corticosteroids improve clinical outcomes for patients with stable COPD. All placebo-controlled randomized trials of inhaled corticosteroids given for at least 6 months for stable COPD were identified by searching MEDLINE (1966-2000), EMBASE (1980-2001), CINAHL (1982-2000), SIGLE (1980-2000), the Cochrane Controlled Trial Registry, and the bibliographies of published studies. We independently extracted data from each of the studies using a specified protocol, and determined the summary risk ratios (RRs) and 95% confidence intervals (CIs) for exacerbations and deaths. Nine randomized trials (3976 patients with COPD), including four with a systemic steroid run-in phase, were identified. Use of inhaled corticosteroid therapy reduced the rate of exacerbations (RR = 0.70; 95% CI: 0.58 to 0.84), with similar benefits in those who were and were not pretreated with systemic steroids. Inhaled corticosteroid therapy was also associated with increased rates of oropharyngeal candidiasis (RR = 2.1; 95% CI: 1.5 to 3.1), skin bruising (RR = 2.1; 95% CI: 1.6 to 2.8), and lower mean cortisol levels. No effects were seen on all-cause mortality (RR = 0.84; 95% CI: 0.60 to 1.18) in the five trials that measured this outcome. This systematic review demonstrates a beneficial effect of inhaled corticosteroids in reducing rates of COPD exacerbation. Further research is required to define the long-term effects of these medications and the benefit/risk ratio for patients with COPD.