Assessment of stress level and depression among orthopaedic surgeons in Saudi Arabia.

PURPOSE: The aim of this study was to assess the stress level and depression among orthopaedic surgeons in Saudi Arabia. In addition, to evaluate orthopedic training programs related factors that might have a critical role in the development of depression among orthopaedic surgeons. METHODS: The study adopted a cross-sectional study design. Two validated questionnaires were utilized, the Patient Health Questionnaire 9 (PHQ-9) and the Perceived Stress Scale (PSS-10) for assessing depressive symptoms and stress levels. Data was collected by sending the survey to the Saudi Commission for Health Specialties so they could be distributed throughout all registered orthopaedic surgeons. RESULTS: The study sample consisted of 325 participants. The results revealed that the severity of depression varied across the different groups. As per the PHQ-9 criteria, 74 (22.8%) were initially diagnosed with major depression. Among assistant consultants, 39.5% reported severe depression, while 34.9% reported mild depression. Consultants predominantly reported moderate perceived stress (82.9%) with a notable proportion experiencing high perceived stress (12.4%). Assistant consultants showed a balanced distribution, with 93.0% reporting moderate perceived stress and 4.7% reporting high perceived stress. Demographic variables gender, relationship status and having children revealed statistically significant relationship with PHQ-9 scores (p-value < 0.05) but not with PSS-10 scores. CONCLUSION: The study highlights pressing need to address mental health concerns within orthopaedic surgeons. To address these challenges, healthcare institutions should implement comprehensive mental health support programs offering resources for stress management, counseling services, and peer support groups.

The Impact of COVID-19 Vaccine Controversy on Parents' Perceptions of Routine Vaccinations.

Background The COVID-19 pandemic has significantly influenced public perceptions and behaviors related to vaccination. Understanding parental attitudes, knowledge gaps, and vaccination practices post-pandemic is crucial for informing effective public health strategies. This study aimed to investigate parental attitudes, knowledge, and practices toward routine childhood vaccination in the post-COVID-19 era, emphasizing shifts in perspectives and implications for vaccination strategies. Methodology A cross-sectional survey was conducted among 498 parents to assess their attitudes, knowledge, and practices regarding vaccination. Data were analyzed using descriptive statistics, chi-square tests, and t-tests where applicable, with p-values <0.05 considered statistically significant. Results The study revealed diverse parental attitudes toward vaccination post-COVID-19. While a majority (72.9%) maintained positive attitudes toward vaccination schedules and benefits, concerns regarding vaccine safety and efficacy were noted. Knowledge gaps persisted, with 16.5% strongly agreeing that children's vaccinations are weak and have no impact on disease prevention. Despite high adherence to vaccination schedules (68.9%), motivations behind vaccine administration were questioned, as 48.2% strongly disagreed that vaccination was solely for regulatory purposes. Conclusions Post-COVID-19, parental attitudes toward vaccination have evolved, reflecting increased concerns about safety and efficacy. Addressing knowledge gaps, combating misinformation, and enhancing trust in vaccination programs are imperative. Tailored communication strategies, education campaigns, and policy interventions are essential to promote vaccination acceptance and safeguard public health resilience in the post-pandemic era.

CO2 gap changes compared with cardiac output changes in response to intravenous volume expansion and/or vasopressor therapy in septic shock.

Background: The difference in partial pressure of carbon dioxide (PCO2) between mixed or central venous blood and arterial blood, known as the ∆PCO2 or CO2 gap, has demonstrated a strong relationship with cardiac index during septic shock resuscitation. Early monitoring of the ∆PCO2 can help assess the cardiac output (CO) adequacy for tissue perfusion. Objectives: To investigate the value of ∆PCO2 changes in early septic shock management compared with CO. Methods: This observational prospective study included 76 patients diagnosed with septic shock admitted to Cairo University Hospital's Critical Care Department between December 2020 and March 2022. Patients were categorised by initial resuscitation response, initial ∆PCO2 and 28-day mortality. The primary outcome was the relationship between the ∆PCO2 and CO changes before and after initial resuscitation, with secondary outcomes including ICU length of stay (LOS) and 28-day mortality. Results: Peri-resuscitation ∆PCO2 changes predicted a ≥15% change in the cardiac index (CI) (area under the curve (AUC) 0.727; 95% CI 0.614 - 0.840) with 66.7% sensitivity and 62.8% specificity. The optimal ∆PCO2 change cut-off value was <-1.85, corresponding to a <-22% threshold for a 15% cardiac index increase. The PCO2 gap ratio (gap/gap ratio of T1- PCO2 gap to T0 -PCO2 gap) also predicted a ≥15% change in cardiac index (AUC 745; 95% CI 0.634 - 0.855) with 63.6% sensitivity and 79.1% specificity. The optimal CO2 gap/gap ratio cut-off value was <0.71. A significant difference in 28-day mortality was noted based on the gap/gap ratio. Conclusion: Peri-resuscitation ∆PCO2 and the gap/gap ratio are useful non-invasive bedside markers for predicting changes in CO and preload responsiveness. Contribution of the study: The current study provides an insight to the PCO2 gap changes during and after early resuscitation of septic shock patients, which correlate to cardiac output changes and might also serve as a fluid responsiveness indicator.

Obesity in Saudi Medical Students and Alignment with Eating Disorders: A Stratified Random Cross-Sectional Investigation.

As a result of the increasing global incidence of obesity and related diseases, this study aims to investigate the prevalence of obesity and its correlation with eating disorder (ED) screening among medical students to develop effective prevention strategies and provide better outcomes for these students. We conducted a quantitative analytical cross-sectional study at the College of Medicine at King Saud University between November 2023 and February 2024. A stratified random sampling technique was utilized, enrolling a net number of 415 participants. Participants were asked several questions, including demographic information, weight, height, and past medical history, and were given a validated screening tool for EDs. Participants' mean age was 21.4 ± 1.67 years, and 17.6% were considered obese. The prevalence of positive screening for EDs was 27.7%; it was more common in females (p = 0.013) and those who earned more than 1000 SAR per month (p = 0.011). Female students also exhibited almost twice the odds of having EDs than males (AOR = 1.957; 95% CI = 1.218-3.146; p = 0.006). Furthermore, non-obese students showed decreased odds of having EDs compared with obese students by at least 48% (AOR = 0.517; 95% CI = 0.287-0.929; p = 0.027). Our study revealed a concerning prevalence of ED symptoms and obesity among medical students, suggesting profound implications. Therefore, multicenter studies are needed to assess the generalizability of the results and apply the findings to targeted national campaigns and interventions tailored specifically to medical students.

Reference Hallucination Score for Medical Artificial Intelligence Chatbots: Development and Usability Study.

BACKGROUND: Artificial intelligence (AI) chatbots have recently gained use in medical practice by health care practitioners. Interestingly, the output of these AI chatbots was found to have varying degrees of hallucination in content and references. Such hallucinations generate doubts about their output and their implementation. OBJECTIVE: The aim of our study was to propose a reference hallucination score (RHS) to evaluate the authenticity of AI chatbots' citations. METHODS: Six AI chatbots were challenged with the same 10 medical prompts, requesting 10 references per prompt. The RHS is composed of 6 bibliographic items and the reference's relevance to prompts' keywords. RHS was calculated for each reference, prompt, and type of prompt (basic vs complex). The average RHS was calculated for each AI chatbot and compared across the different types of prompts and AI chatbots. RESULTS: Bard failed to generate any references. ChatGPT 3.5 and Bing generated the highest RHS (score=11), while Elicit and SciSpace generated the lowest RHS (score=1), and Perplexity generated a middle RHS (score=7). The highest degree of hallucination was observed for reference relevancy to the prompt keywords (308/500, 61.6%), while the lowest was for reference titles (169/500, 33.8%). ChatGPT and Bing had comparable RHS (ß coefficient=-0.069; P=.32), while Perplexity had significantly lower RHS than ChatGPT (ß coefficient=-0.345; P<.001). AI chatbots generally had significantly higher RHS when prompted with scenarios or complex format prompts (ß coefficient=0.486; P<.001). CONCLUSIONS: The variation in RHS underscores the necessity for a robust reference evaluation tool to improve the authenticity of AI chatbots. Further, the variations highlight the importance of verifying their output and citations. Elicit and SciSpace had negligible hallucination, while ChatGPT and Bing had critical hallucination levels. The proposed AI chatbots' RHS could contribute to ongoing efforts to enhance AI's general reliability in medical research.

Public Knowledge and Attitude Regarding Symptoms of Acute Coronary Syndrome and Its Related Risk Factors in Western Region, Saudi Arabia.

BACKGROUND: Acute coronary syndrome (ACS) is the leading cause of mortality and morbidity worldwide. Recognition of its symptoms affects the time-sensitive benefits of reperfusion therapy. Furthermore, lowering the risk factors can prevent long-term complications. OBJECTIVES: To evaluate the public knowledge and perception of the symptoms and risk factors of ACS in the Saudi-Western region. METHOD: A cross-sectional study was conducted on a convenience sample of 733 among the general population in the western region of Saudi Arabia by using the Acute Coronary Syndrome Response Index, with additional questions about risk factors for heart attack and physical activities. The research information was acquired through a self-administered questionnaire without any identifying personal information. RESULT: Participants demonstrated awareness of certain ACS symptoms and risk factors. Chest pain was widely recognized (49.2%, n = 361), followed by shortness of breath (44.8%, n = 329), arm pain or shoulder pain (38.6%, n = 283), palpitation (37.3%, n = 274), and fatigue (22.2%, n = 163). A total of 544 (74.2%) and 474 (64.6%) respondents were aware that smoking and obesity are the most common risk factors for ACS, respectively. However, gaps persisted, particularly regarding the association between diabetes mellitus and ACS, with 31.6% (n = 232) reporting diabetes mellitus. A total of 331 (45.2%) and 322 (43.9%) study sample were unsure whether they could identify ACS in themselves or other people. However, 391 (53.3%) decided that they should go to the hospital as soon as possible when they have chest pain that does not stop after 15 minutes. Notably, female participants demonstrated substantially higher knowledge (OR = 2.40, p = 0.001). The study highlights the influence of gender, age, and education on ACS-related awareness. CONCLUSION: This study provides valuable insights into ACS awareness in the western region of Saudi Arabia. Relatively older respondents, female participants, and those with postgraduate education were more knowledgeable about ACS than the others. These findings emphasize the importance of tailored interventions for specific demographic groups in enhancing public health outcomes.

Seed priming with potassium nitrate alleviates the high temperature stress by modulating growth and antioxidant potential in carrot seeds and seedlings.

Early season carrot (Daucus carota) production is being practiced in Punjab, Pakistan to meet the market demand but high temperature hampers the seed germination and seedling establishment which cause marked yield reduction. Seed priming with potassium nitrate breaks the seed dormancy and improves the seed germination and seedling growth potential but effects vary among the species and ecological conditions. The mechanism of KNO3 priming in high temperature stress tolerance is poorly understood yet. Thus, present study aimed to evaluate high temperature stress tolerance potential of carrot seeds primed with potassium nitrate and impacts on growth, physiological, and antioxidant defense systems. Carrot seeds of a local cultivar (T-29) were primed with various concentration of KNO3 (T0: unprimed (negative control), T1: hydroprimed (positive control), T2: 50 mM, T3:100mM, T4: 150 mM, T5: 200 mM, T6: 250 mM and T7: 300 mM) for 12 h each in darkness at 20 ± 2℃. Seed priming with 50 mM of KNO3 significantly enhanced the seed germination (36%), seedling growth (28%) with maximum seedling vigor (55%) and also exhibited 16.75% more carrot root biomass under high temperature stress as compared to respective control. Moreover, enzymatic activities including peroxidase, catalase, superoxidase dismutase, total phenolic contents, total antioxidants contents and physiological responses of plants were also improved in response to seed priming under high temperature stress. By increasing the level of KNO3, seed germination, growth and root biomass were reduced. These findings suggest that seed priming with 50 mM of KNO3 can be an effective strategy to improve germination, growth and yield of carrot cultivar (T-29) under high temperature stress in early cropping. This study also proposes that KNO3 may induces the stress memory by heritable modulations in chromosomal structure and methylation and acetylation of histones that may upregulate the hormonal and antioxidant activities to enhance the stress tolerance in plants.

Knowledge and Attitude Toward Otitis Externa: A Saudi Arabian Perspective.

Objectives: This study intended to assess the level of awareness and attitude toward otitis externa (OE) and specific limitations that counter the attempts to uplift the understanding and notion related to OE among the general population of Saudi Arabia. Methods: A cross-sectional quantitative study using a questionnaire was done via Google Forms between May 2023 and July 2023. The scoring method was used to determine the participant's awareness or attitude; participants who scored >50% were considered aware or to have a good attitude. Results: Approximately 52.2% had a good attitude toward the OE, and majority were willing to visit healthcare professionals (81%) to provide care and receive proper education during office visits (80.1%). Of all the participants, 69%, 33.4%, and 30.8% suggested that a lack of awareness, cost, and health insurance, respectively, might prevent patients from seeking a healthcare professional. Only 10.9% of participants demonstrated good awareness (score >13) of outer ear inflammation. Conclusion: The findings indicate a poor level of awareness regarding OE, and a positive attitude toward seeking healthcare, with the majority recommending professional visits and relying on healthcare professionals for information.

Assessment of the Saudi Population's Knowledge and Awareness Toward a Sedentary Lifestyle Risk Factors in the Post-COVID-19 Era.

Introduction: Sedentary behaviors have been on the rise, potentially exacerbated by lockdowns, remote work, and lifestyle shifts during the pandemic, emphasizing the need to assess public awareness regarding associated health risks. This study investigated the knowledge and awareness levels of the Saudi population regarding sedentary lifestyle risk factors in the post-COVID-19 era. Methodology: This cross-sectional study included 400 participants and was conducted from May 2023 to July 2023 using a questionnaire distributed randomly through social media in multiple regions of Saudi Arabia. Results: The majority of the participants were females (57.1%), aged 15-25 years (54.3%), had a higher educational degree (65.4%) and were single (62%). Most (62%) of the participants reported declined/physical activity levels in the post-COVID-19 era. Our study found that 65% of the participants had increased usage of online shopping and delivery applications after the pandemic, and a significant portion (66%) had less than 150-300 min of moderate aerobic activity weekly. Barriers, such as bad weather and insufficient time for exercise, had significant impacts. Conclusion: This study provides valuable insights into the Saudi population's demographic characteristics, knowledge, and behaviors related to physical activity and health.

Awareness of Side Effects of Corticosteroids among Users and Nonusers in Saudi Arabia.

Background: Corticosteroids are anti-inflammatory medications that are used to reduce inflammation and inhibit the immune system in a variety of disorders, including allergies, asthma, systemic lupus erythematous, eczema, inflammatory bowel disease, and swollen joints or muscles. The goal of this study was to assess the level of awareness and sources of information about the side effects of corticosteroids among the general population in Saudi Arabia. Methods: This observational cross-sectional study was conducted in Saudi Arabia using an electronic questionnaire. A non-probability convenience sampling technique was used. Statistical Package for the Social Sciences (SPSS) was used for data analysis. Results: The study included 755 participants from Saudi Arabia (67.3% females and 32.7% males). Around 26.8% reported using corticosteroids, and 73.9% were aware of the side effects of glucocorticoids. Among steroid users (202 participants), the most common conditions were allergies (36.1%), asthma or chronic obstructive pulmonary disease (COPD) (21.8%), and skin diseases (27.7%). The majority of respondents (57.9%) used steroids for less than 2 weeks, and topical application (52.5%) was the most common form. Only 30.7% received information about side effects at the time of prescription. The most reported side effects were truncal obesity, moon face, skin thinning, bruising, and slower wound healing. Conclusion: This study highlights the importance of promoting awareness and knowledge regarding the side effects of corticosteroids in Saudi Arabia. While overall awareness levels were relatively satisfactory, specific side effects require further attention in educational efforts.

Awareness and Attitude About Ototoxic Drugs Among Medical Doctors in Arar City, Saudi Arabia.

OBJECTIVES: The purpose of this study was to assess the awareness of ototoxicity among medical doctors in Arar City, Saudi Arabia. METHODS: This is a cross-sectional study based on a pre-formed validated questionnaire (Appendix) that included three sections covering participants' demographic data (three questions), their attitudes (five questions), and knowledge (13 questions) regarding drug-induced ototoxicity. RESULTS: After obtaining their informed consent, 213 physicians from government and private sector health facilities in Arar were enrolled in the study. Interns and general practitioners represented 57.8% of the participants; consultants represented 17.8%. Only 71.8% of participants were interested in drug-induced ototoxicity, while 26.3% considered ototoxicity a rare complication. Approximately 90% of the participants were knowledgeable about the adverse effects of drugs on the vestibulocochlear system, and 26.7% reported having experienced cases of drug-induced ototoxicity in their practice. Participants showed an overall knowledge score about ototoxicity of 9.3±3.27 (out of 14). The knowledge score was significantly higher (p-value=0.0007) for participants with more years of clinical experience. The most widely known ototoxic drug for participants was frusemide (72.3%), followed by aminoglycoside (68.5%), while acetaminophen (44.1%) ototoxicity was the least known among participants. CONCLUSION: Awareness of drug-induced ototoxicity is satisfactory among physicians in the Northern Borders region. However, workshops about all types of drugs with ototoxic effects and the main lines for the management of drug-induced ototoxicity are recommended to increase awareness.

Autosomal Recessive Spastic Paraplegia and Psychomotor Retardation With or Without Seizures: A Case Report From Saudi Arabia.

Spastic paraplegia and psychomotor retardation with or without seizures (SPPRS) is a rare neurodevelopmental disorder associated with autosomal recessive mutations in the HACE1 gene. This case report presents the clinical features and genetic analysis of an 11-month-old girl and her sister with SPPRS, making it the third reported case in the Middle East and the second in Saudi Arabia. The patient exhibited hypotonia, global developmental delay, speech delay, swallowing difficulties, and recurrent respiratory infections. A homozygous pathogenic variant in the HACE1 gene (p.R664*) was identified through genetic analysis, confirming the diagnosis of SPPRS. This case report emphasizes the importance of considering variations in clinical presentation, especially in rare disorders where only a few cases are reported. Further research and case studies are needed to better understand the complete phenotypic spectrum of SPPRS and its complications.

Phytochemical screening, antibacterial, antioxidant, and cytotoxic activities of Geranium pusillum leaves.

Traditional medicinal plants play an important role in primary health care worldwide. The phytochemical screening and activities of Geranium pusillum were investigated in this research. The dried plant leaves were extracted with ethanol, n-hexane, chloroform, dichloromethane, methanol, acetone, and aqueous solvents. These extracts were qualitatively analyzed, GC-MS, antimicrobial activities by using the disc diffusion method, antioxidant activity was determined by 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) radical scavenging, and cytotoxic activity was analyzed by the hemolytic activity of human red blood cells. The results showed phytochemicals such as flavonoids, terpenoids, steroids, phenols, saponins, tannins, and cardiac glycosides were detected in plant leaves. The ethanol extract at a concentration of 10 mg/mL showed a maximum inhibition zone 17.5 ± 0.09, 15.6 ± 0.11, 14.2 ± 0.17, 18.4 ± 0.11, 16.6 ± 0.15, 12.5 ± 0.13, 15.9 ± 0.10, and 13.1 ± 0.11 mm, and at 15 mg/mL showed 24.5 ± 0.09, 27.2 ± 0.12, 26.3 ± 0.17, 28.4 ± 0.10, 27.9 ± 0.16, 22.5 ± 0.13, 27.1 ± 0.10, and 24.1 ± 0.16 mm against Escherichia coli, Pasturella multocida (gram-negative), Staphylococcus aureus, Bacillus subtilus (gram-positive), Rhizopus solani, Aspergillus flavus, Aspergillus niger, and Alternaria alternate (fungal strain), respectively, and dichloromethane showed a minimum inhibition zone as compared to other extracts against bacterial as well as fungal strains. Chloroform extract had maximum antioxidant activity (45.00 ± 0.08%) and minimum in dichloromethane (12.20 ± 0.04%). Cytotoxic activity was found maximum in acetone extract (19.83 ± 0.07%) and minimum in ethanol extract (4.72 ± 0.04%). It is concluded that phytochemicals like phenols, flavonoids, and others may be responsible for these activities, which is why this plant is used for traditional medicine. RESEARCH HIGHLIGHTS: Geranium pusillum has therapeutic properties that exhibit various biological activities beneficial for human health. G. pusillum has significant inhibitory effects against bacterial and fungal strains. Chloroform solvent extract indicates potential free radical scavenging abilities. Acetone extract exhibits notable effects on human red blood cells and demonstrates significant cytotoxic activity.

A Systematic Review of Perinuclear Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis Following Coronavirus Disease 2019 Vaccination: A 2024 Update.

Antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN) is an immune-mediated kidney disease characterized by the inflammation of small blood vessels in the kidney, leading to renal impairment and potentially irreversible damage. Concerns have been raised over the reports of myeloperoxidase/perinuclear (MPO/p) ANCA GN following the coronavirus disease 2019 (COVID-19) vaccination. Our study provides a comprehensive insight into perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) GN after COVID-19 vaccination. We conducted a comprehensive literature search on PubMed, Cochrane Library, and EMBASE using the Medical Subject Headings (MeSH) terms related to "covid-19 vaccine," "glomerulonephritis," "p-ANCA," and "MPO-ANCA" up to March 5, 2024, to include cases of p-ANCA-associated GN following COVID-19 vaccination. Of the 4,102 articles, we included 29, reporting 35 patients demonstrating COVID-19 vaccine-induced p-ANCA GN, with 23 (65.7%) females and a median age of 69 years (mean ± SD = 63.22 ± 16). Twenty-six (74.28%) patients received the mRNA vaccine (Pfizer = 19, Moderna = 7). Seventeen (48.57%) patients presented with p-ANCA GN after the second dose of the COVID-19 vaccine, with a median gap of 19 days (1-84 days). Constitutional symptoms (54.28%) and acute kidney injury (42.85%) were the most reported initial presentations, and elevated serum creatinine (mean peak serum creatinine = 4.98 ± 5.02 mg/dL), hematuria, and proteinuria were the laboratory findings. MPO/p-ANCA was positive in 31 (88.6%) patients. All patients underwent renal biopsy, and crescentic GN was the most common finding among 27 (77.14%) patients. Management of p-ANCA GN included steroids in 30 (85.71%) patients, followed by rituximab (28.57%), and plasmapheresis (22.86%). Most patients responded well to treatment, with complete remission in 29 (82.86%) and relapse in four (11.42%) patients. Two patients did not achieve remission and became dialysis dependent. ANCA-associated GN is a rare and life-threatening complication of the COVID-19 vaccine, necessitating urgent evaluation and management. COVID-19 vaccine-induced p-ANCA GN should be included in the differential diagnoses of patients presenting with kidney injury after vaccination.

Transforming Virtual Healthcare: The Potentials of ChatGPT-4omni in Telemedicine.

The introduction of OpenAI's ChatGPT-4omni (GPT-4o) represents a potential advancement in virtual healthcare and telemedicine. GPT-4o excels in processing audio, visual, and textual data in real time, offering possible enhancements in understanding natural language in both English and non-English contexts. Furthermore, the new "Temporary Chat" feature may improve privacy and data confidentiality during interactions, potentially increasing integration with healthcare systems. These innovations promise to enhance communication clarity, facilitate the integration of medical images, and increase data privacy in online consultations. This editorial explores some future implications of these advancements for telemedicine, highlighting the necessity for further research on reliability and the integration of advanced language models with human expertise.

Supplementation of Jasmonic acid Mitigates the Damaging Effects of Arsenic Stress on Growth, Photosynthesis and Nitrogen Metabolism in Rice.

Experiments were conducted to evaluate the role of exogenously applied jasmonic acid (JA; 0.1 and 0.5 µM) in alleviating the toxic effects of arsenic (As; 5 and 10 µM) stress in rice. Plants treated with As showed considerable decline in growth attributes like height, fresh and dry weight of plant. Arsenic stress reduced the content of δ-amino livulenic acid (δ-ALA), glutamate 1-semialdehyde (GSA), total chlorophylls and carotenoids, with more reduction evident at higher (10 µM) As concentrations, however exogenously supplied JA alleviated the decline to considerable extent. Arsenic stress mediated decline in photosynthetic gas exchange parameters, Fv/Fm (PSII activity) and Rubisco activity was alleviated by the exogenous treatment of JA. Arsenic stress caused oxidative damage which was evident as increased lipid peroxidation, lipoxygenase activity and hydrogen peroxide concentrations however, JA treatment declined these parameters. Treatment of JA improved the activity of nitrate reductase and glutamate synthase under unstressed conditions and also alleviated the decline triggered by As stress. Activity of antioxidant enzymes assayed increased due to As stress, and the supplementation of JA caused further increase in their activities. Moreover, the content of proline, free amino acids and total phenols increased significantly due to JA application under stressed and unstressed conditions. Treatment of JA increased the content of nitrogen and potassium while as reduced As accumulation significantly.

ChatGPT-3.5 System Usability Scale early assessment among Healthcare Workers: Horizons of adoption in medical practice.

Artificial intelligence (AI) chatbots, such as ChatGPT, have widely invaded all domains of human life. They have the potential to transform healthcare future. However, their effective implementation hinges on healthcare workers' (HCWs) adoption and perceptions. This study aimed to evaluate HCWs usability of ChatGPT three months post-launch in Saudi Arabia using the System Usability Scale (SUS). A total of 194 HCWs participated in the survey. Forty-seven percent were satisfied with their usage, 57 % expressed moderate to high trust in its ability to generate medical decisions. 58 % expected ChatGPT would improve patients' outcomes, even though 84 % were optimistic of its potential to improve the future of healthcare practice. They expressed possible concerns like recommending harmful medical decisions and medicolegal implications. The overall mean SUS score was 64.52, equivalent to 50 % percentile rank, indicating high marginal acceptability of the system. The strongest positive predictors of high SUS scores were participants' belief in AI chatbot's benefits in medical research, self-rated familiarity with ChatGPT and self-rated computer skills proficiency. Participants' learnability and ease of use score correlated positively but weakly. On the other hand, medical students and interns had significantly high learnability scores compared to others, while ease of use scores correlated very strongly with participants' perception of positive impact of ChatGPT on the future of healthcare practice. Our findings highlight the HCWs' perceived marginal acceptance of ChatGPT at the current stage and their optimism of its potential in supporting them in future practice, especially in the research domain, in addition to humble ambition of its potential to improve patients' outcomes particularly in regard of medical decisions. On the other end, it underscores the need for ongoing efforts to build trust and address ethical and legal concerns of AI implications in healthcare. The study contributes to the growing body of literature on AI chatbots in healthcare, especially addressing its future improvement strategies and provides insights for policymakers and healthcare providers about the potential benefits and challenges of implementing them in their practice.

Contemporary Insights into Intractable Epilepsy in Children.

While most children with epilepsy find their seizures manageable through medication, some continue to experience seizures despite trying multiple drugs. Failure of medical treatment often becomes apparent early on, and for these cases, it is advisable to seek further treatment options at a specialized epilepsy center. Such centers offer additional treatments like epilepsy surgery, vagus nerve stimulation, and ketogenic diets. There is no universal definition for what constitutes "medically intractable" epilepsy. A proposal by a task force from the International League Against Epilepsy suggests that drug-resistant epilepsy could be defined as the inability to control seizures even after two adequate treatment attempts with well-chosen and tolerated medications, either alone or in combination. In this review, the authors discussed the management of intractable epilepsy in children.

Human papillomavirus prevalence and dynamics: Insights from a 5-year population-based study in Jeddah, Kingdom of Saudi Arabia.

OBJECTIVES: To estimate the prevalence and dynamics of human papillomavirus (HPV) infection, over a 5-year period, among Saudi women. METHODS: A 2-phase, population-based study combining cross-sectional and cohort designs was carried out with 5360 ever-married women aged 30-65 from Jeddah, Saudi Arabia, between 2013 and 2018. Participants were enrolled in a designated screening program and screened using the hybrid capture 2 HPV test. Women testing positive for HPV were followed up after one year to estimate the HPV clearance rate, while those testing negative had a follow-up after 5 years to assess new HPV infections. Factors associated with HPV positivity and clearance, including sociodemographic and clinical aspects, were analyzed. RESULTS: Participant's mean age was 44.3 and the average marriage duration was 22.6 years. The initial HPV prevalence was 4.7%. After one year, the HPV clearance rate among initially positive women was 84.3%. The rate of new HPV infections among initially negative women after 5 years was 0.2%, resulting in a cumulative HPV prevalence of 5% over the study period. The incidence rate was estimated at 47 per 100,000 person-years. Parity was the only independent factor inversely associated with HPV positivity, with an odds ratio of 0.93 (95% confidence interval: 0.8 - 0.99). CONCLUSION: The prevalence of HPV in Saudi women was relatively low, suggesting a low transmission rate of HPV. This finding indicates the need for continuous monitoring and tailored prevention strategies.