Macroporous polymeric resin for the purification of flavonoids from medicinal plants: A review.

The purification of flavonoids using the macroporous polymer resin method has gained attention in recent years due to its simplicity, precision, cost-effectiveness, and the ability to separate flavonoids from other constituents. Several studies have been conducted to investigate the efficiency and effectiveness of macroporous polymer resin in purifying flavonoids from various plant sources. This review aims to evaluate the existing literature on macroporous polymer resin purification of flavonoids and provide a comprehensive analysis of the current research trends and advancements in this field. It also highlights the importance of optimizing the adsorption parameters and conditions such as resin type, resin concentration, pH, and temperature for efficient purification of flavonoids using macroporous polymer resin. The key findings of this review reveal that macroporous resins with weak polarity, large surface areas, and pore diameters have a stronger adsorption capacity for flavonoids compared to polar resins. Furthermore, ultrasonic-solvent assisted extraction often combines with macroporous resin for effective the extraction and purification of flavonoids.

Dumping Syndrome after Bariatric Surgery.

Dumping syndrome (DS) is a collection of gastrointestinal (GI) and vasomotor symptoms arising postprandially because of prompt gastric emptying. This can develop due to any changes in gastric anatomy or innervation during esophageal, gastric, or bariatric surgery. Due to the increase in the number of bariatric operations and innovative surgeries performed internationally, bariatric surgery has emerged as the most common cause of this disease entity. 25-50% of all gastric surgery patients experience dumping symptoms after their procedures. Patients who have had Roux-en-Y gastric bypass (RYGB) are at an extremely high risk (up to 40%) of developing dumping syndrome postoperatively. The goal of this review is to provide an insightful evaluation of the most recent literature on the overlooked scientific and clinical elements of dumping syndrome, such as diagnostic aspects, pathogenesis, terminology, and management. More research is needed to establish guidelines and terms used to properly document and manage dumping syndrome.

General surgery educational resources for Jordanian medical students.

Background: To outline the resources deemed most beneficial to medical students during their general surgery clerkship, as well as to examine their link to students' general surgery scores and the usage of artificial intelligence in general surgery study. Methods: A retrospective survey of Jordanian medical students from six universities was done between March and June 2023 using a 7-item questionnaire covering questions concerning general surgery study methods and scores. Descriptive statistics were used to evaluate demographic data. Chi-square is used to evaluate categorical data, with a P value <0.05 deemed significant. Results: The average age of respondents was 23.3 years, and 54.2 % of the respondents were females, 47.8 % were from Mutah University. Most students (48.2 %) relied on tutor lectures. Students who studied through instructor lectures had the highest grades (9 % excellent, 17 % very good), followed by students who studied using surgery textbooks (6.8 % and 14.6 %, respectively). The relationship between the study method and academic achievement was statistically significant (P < 0.05). Conclusions: Traditional face-to-face learning with instructor lectures and surgery textbooks is still the most efficient approach to attain the greatest scores. Medical students are still underutilizing artificial intelligence.

Evaluation of short and mid-term clinical outcomes in patients with aortic coarctation treated with self-expandable stents.

The present study aimed to evaluate the outcomes of percutaneous treatment of aortic coarctation using self-expandable uncovered Nitinol stents. We conducted a retrospective clinical data review of all patients with aortic coarctation and treated with self-expandable uncovered Nitinol stents at our institution between 2009 and 2019. The gradient pressure across the coarctation site was measured using aortography. Follow-up echocardiography and computed tomography angiography were performed to assess possible stent complications. A total of 127 stents were successfully implanted in 125 patients (64.8% males) with a mean age of 35.36 ± 11.9 years. The gradient across the coarctation site decreased significantly from 67.48 ± 14.79 to 5.04 ± 3.01 mmHg (P < 0.001) after self-expandable stent implantation. Systolic blood pressure (SBP) decreased significantly from 175.53 ± 15.99 to 147.22 ± 12.83 mmHg (P < 0.001) after self-expandable stenting. There were no major technical or clinical complications, including balloon rupture, aneurysmal formation, infection, secondary stent migration, thrombosis, death during the procedure, and in-hospital mortality. On a mean follow-up of 48 ± 23.6 months (12-120 months), the gradient [from 59.43 ± 15.42 to 3.72 ± 1.38 mmHg (P < 0.001)] and SBP [from 175.53 ± 15.99 to 127.99 ± 7.82 mmHg (P < 0.001)] decreased significantly. There was no mortality, aneurysmal formation in the stent site, dislocation, or aortic re-stenosis requiring intervention during mid-term follow-up. Treatment of aortic coarctation using a self-expandable uncovered nitinol stent is safe and effective with promising mid-term outcomes.

Serum interleukin 18 level in kidney diseases and age.

Background: Interleukin-18 (IL-18), also known as interferon-gamma inducing factor is a protein which in humans is encoded by the IL18 gene, it is a member of the IL 1 family and has a molecular weight of 18 kDa. Innate and adaptive immunity can be regulated by IL-18, and disorders involving its dysregulation might result in inflammatory or autoimmune conditions. Aim of the Work: To distinguish between acute kidney injury (AKI) and chronic renal failure (CRF), this research investigates the utility of IL-18 as a novel biomarker and examines how age affects its level. Materials and Methods: Three hundred participants were included and divided into three groups using the following methodology. Group I consisted of 100 control subjects who were split up by age and gender. Group II consisted of 100 AKI patients who were divided into two groups and subgroups based on age and gender. Group III, which consisted of 100 CRF (hemodialyzed patients), was divided into two groups and subgroups, as patients with acute renal injury and previously healthy people. Patients' blood was drawn to conduct a laboratory investigation blood urea, serum creatinine, sodium, potassium, pH, GFR and PCO2. Results: Patients with CRF had higher serum levels of IL-18 than patients with AKI, regardless of gender, and both groups of patients had levels of IL-18 that rise with age. Conclusion: IL-18 is a reliable indicator for the differentiation between AKI and CRF patients receiving hemodialysis and its level correlates with age independent with gender.

Prediction of Reproductive Outcomes of Intracytoplasmic Sperm Injection Cycles Using a Multivariate Scoring System.

Background: Prediction of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) success is crucial in counselling patients about their real chance of getting a live birth before commencing treatment. A multivariate scoring system proposed by Younis et al., 2010, was amongst the predictive models used to evaluate IVF/ICSI success. The score entitles basal endocrine, clinical and sonographic parameters. Aims: The objective of this study is to assess the predictability of the Younis multivariate score for pregnancy outcomes in ICSI cycles. Settings and Design: This prospective observational cohort study (NCT03846388) included patients who pursued IVF or ICSI in a tertiary infertility unit between February 2019 and December 2021. Materials and Methods: The score variables were age, body mass index, antral follicle count, basal follicle-stimulating hormone (FSH), basal FSH/luteinising hormone ratio, infertility duration, number of previous cancellations and mean ovarian volume. For each woman included in the study, Younis multivariate score was calculated. Then, we correlate the different reproductive outcomes with score levels to validate the score predictability. A score of ≤14 was defined as a low score based on the previous study's results. Statistical Analysis Used: The student's t-test and Mann-Whitney test were used to compare numerical variables, whereas categorical variables were analysed using the Chi-square test. A receiver operating curve (ROC) and a multivariate logistic regression model were used to investigate the predictability of the Younis scoring model for cycle outcomes. Results: Two hundred ninety-two ICSI-ET cycles were analysed. Of the total cohort, 143 (48.97%) women included showed a low score (≤14), whereas 149 (51.03%) women showed a high score (>14). Women with low scores had significantly higher pregnancy and live birth rates compared to women with high scores (60.1% vs. 7.4%, respectively, P < 0.001; 44.7% vs. 6.7%, respectively, P < 0.001). The area under the curve (AUC) in the ROC curve analysis showed a higher predictability for the scoring system for live birth rate with an AUC of 0.796, with a sensitivity of 86.5% and specificity of 63.8% when using a cut-off level of ≤14. For pregnancy prediction, the AUC was 0.829, with a sensitivity of 88.66% and a specificity of 70.77% when using the same cut-off. Women who have a low score have a high chance of having frozen embryos. Likewise, women who have a high score have a very high chance of cycle cancellation. Conclusions: The Younis multivariate score can be used for the prediction of ICSI cycle outcomes and to calculate the chance of cycle cancellation, pregnancy and take-home baby before ICSI.

Single-Dose enoxaparin for portomesenteric venous thrombosis prophylaxis after sleeve gastrectomy.

Introduction: Portomesenteric venous thrombosis (PMVT) may complicate sleeve gastrectomy. We believe that single dose of enoxaparin postoperatively can reduce the risk of PMVT. Objective: The objective was to study the outcomes of enoxaparin single dose compared to other perioperative prophylactic doses in preventing PMVT. Methods: Participants included 590 patients who underwent laparoscopic sleeve gastrectomy (LSG). These retrospective cohort data were collected from patient medical charts after bariatric surgery. Patients were followed up in the close postoperative period and at 1, 3, 6, 12, and 18 months. Descriptive statistical analysis was carried out. The objective was to estimate the incidence of PMVT with postoperative single 40 mg subcutaneous enoxaparin prophylactic regimen. Results: From January 2017 to December 2021, 590 patients with obesity underwent LSG. Five patients developed PMVT with an estimate incidence of 0.85%. Three patients had unexplained tachycardia and three patients had postoperative bleeding. Conclusions: Single-dose enoxaparin 40 mg is an effective thrombosis prophylaxis without increasing risk of bleeding.

Résumé Introduction: La thrombose veineuse portomésentérique (TVPM) peut compliquer la gastrectomie en manchon. Nous pensons qu'une dose unique d'énoxaparine en postopératoire peut réduire le risque de PMVT. Objectif: L'objectif était d'étudier les résultats de la dose unique d'énoxaparine par rapport à d'autres doses prophylactiques périopératoires dans la prévention de la PMVT. Méthodes: Les participants comprenaient 590 patients ayant subi une gastrectomie laparoscopique en manchon (LSG). Ces données de cohorte rétrospectives ont été collectées à partir des dossiers médicaux des patients après une chirurgie bariatrique. Les patients ont été suivis dans la période postopératoire étroite et à 1, 3, 6, 12 et 18 mois. Une analyse statistique descriptive a été réalisée. L'objectif était d'estimer l'incidence de la PMVT avec un régime prophylactique postopératoire unique d'énoxaparine sous-cutanée de 40 mg. Résultats: De janvier 2017 à décembre 2021, 590 patients obèses ont subi une LSG. Cinq patients ont développé une PMVT avec une incidence estimée à 0,85 %. Trois patients présentaient une tachycardie inexpliquée et trois patients présentaient des hémorragies postopératoires. Conclusions: Une dose unique d'énoxaparine de 40 mg est une prophylaxie efficace contre la thrombose sans augmenter le risque de saignement. Mots-clés: Énoxaparine, gastrectomie laparoscopique en manchon, thrombose veineuse portomésentérique prophylaxie, thromboembolie veineuse.

Novel fabrication of mixed wettability micromodels for pore-scale studies of fluid-rock interactions.

Wettability plays a crucial role in multiphase fluid flow in porous media, impacting various geological applications such as hydrocarbon extraction, aquifer remediation, and carbon dioxide sequestration. Microfluidic methods have attracted interest for their capacity to explore and visualize essential multiphase flow dynamics at the pore level, mimicking actual rock pore structures. However, creating micromodels with representative mixed wettability is currently a challenge. Existing technology is limited to producing micromodels with a singular wettability, either water-wet or oil-wet, leaving a gap in representing mixed-wet scenarios. In this study, we introduce a novel method to fabricate microfluidic devices with controlled spatial distribution of wettability at the micro-scale, mimicking actual configurations of mixed-wet rocks arising from varied mineralogy and pore structures. The proposed method combines the soft lithography process with thin film deposition techniques. The micromodels were designed to mimic the pore network of actual reservoir rocks, and a silicon substrate served as the foundation for the photolithography process optimization and wettability alteration methodology. Perfluorodecyltrichlorosilane coating was applied using molecular vapor deposition technology for surface wettability modification. The coated parts of the microdevice substrate altered the localized wetting state of the silicon towards hydrophobic, while the wettability remained unchanged in the non-coated areas. We utilized surface measurements, including contact angle, X-ray photoelectron spectroscopy, transmission electron microscopy, scanning electron microscopy, and atomic force microscopy, to assess the wettability, composition, thickness, shape, roughness, and overall quality of the coating. Our fabrication process successfully produced a microfluidics device with tailored mixed-wet attributes at the micro-scale, which is, to our best knowledge, the first achievement in the field. This method enables the replication of mixed-wet characteristics commonly seen in various applications, such as carbonates and shales within underground rocks, providing a more accurate examination of fundamental multiphase fluid dynamics and rock interactions at the pore level.

Awareness, Knowledge, and Attitude Towards Urinary Tract Infections: An Appraisal From Saudi Arabia.

Introduction Urinary tract infections (UTIs) are a common global health issue, yet awareness and knowledge about UTIs among the general population can vary widely. This study aimed to assess the awareness, knowledge, and attitudes regarding UTIs among Saudi Arabian citizens residing in Al-Ahsa, Saudi Arabia. Methods A descriptive cross-sectional study was conducted among Saudi Arabian citizens aged 18 and above residing in Alhassa. A structured questionnaire was used to collect data on participants' awareness, knowledge, attitudes, and experiences related to UTIs. Data were analyzed using IBM® SPSS® Statistics. Results The study included 445 participants, predominantly males, with 279 (62.7%) and a range of educational backgrounds. Approximately 302 (70.1%) of the participants were aware of UTIs. However, misconceptions about the definition of UTI and its risk factors were common. Most participants recognized bacteria as the primary cause of UTIs, with 261 (58.7%) identifying this factor. Symptoms such as painful urination were recognized by 390 participants, which is a significant proportion. When experiencing UTI symptoms, 285 (66.1%) indicated they would go to the hospital. Significant associations were found between awareness, knowledge, and socio-demographic factors. Conclusion This study highlights the need for increased awareness and knowledge about UTIs among Saudi Arabian citizens in Alhassa. Tailored educational interventions are essential to correct misconceptions, promote accurate risk factor awareness, and encourage appropriate management strategies. Public health campaigns can contribute to reducing the burden of UTIs in the community.

Systematic observations of enhanced oil recovery and associated changes at carbonate-brine and carbonate-petroleum interfaces.

Enhanced oil recovery (EOR) from carbonates is obtained by injection of controlled ionic strength brines containing "active ions" (e.g., SO42-, Mg2+, Ca2+). It is generally believed that this occurs through the interaction of the active ions at the carbonate-brine interface (e.g., within a thin brine layer separating the petroleum and the carbonate phases). Here, in-situ observations show how one active ion, SO42-, alters behavior at the carbonate-petroleum interface. Displacement of petroleum from initially oil-wet carbonate rocks using brines with variable SO4 concentrations systematically changes oil recovery, in situ contact angles, and connectivity of the oil phase, confirming that the active ion alters interactions at the oil/brine/carbonate interface, as expected. Measurements of model calcite-fluid interfaces show that there is no measurable sorption of SO4 to carbonate-brine interfaces but reveals that the carbonate-petroleum interface is altered by previous exposure to SO4-containing brines. These results suggest that EOR in carbonates is controlled indirectly by active ions. We propose that this may be due to a reduced oleophilicity of the carbonate caused by chemical complexation between the active ion and petroleum's acidic and basic functional groups. This mechanism explains how both anions and cations act as active ions for EOR in carbonates.

A mathematical model of COVID-19 and the multi fears of the community during the epidemiological stage.

Within two years, the world has experienced a pandemic phenomenon that changed almost everything in the macro and micro-environment; the economy, the community's social life, education, and many other fields. Governments started to collaborate with health institutions and the WHO to control the pandemic spread, followed by many regulations such as wearing masks, maintaining social distance, and home office work. While the virus has a high transmission rate and shows many mutated forms, another discussion appeared in the community: the fear of getting infected and the side effects of the produced vaccines. The community started to face uncertain information spread through some networks keeping the discussions of side effects on-trend. However, this pollution spread confused the community more and activated multi fears related to the virus and the vaccines. This paper establishes a mathematical model of COVID-19, including the community's fear of getting infected and the possible side effects of the vaccines. These fears appeared from uncertain information spread through some social sources. Our primary target is to show the psychological effect on the community during the pandemic stage. The theoretical study contains the existence and uniqueness of the IVP and, after that, the local stability analysis of both equilibrium points, the disease-free and the positive equilibrium point. Finally, we show the global asymptotic stability holds under specific conditions using a suitable Lyapunov function. In the end, we conclude our theoretical findings with some simulations.

Double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula in uncircumcised patients with distal hypospadias.

Urethrocutaneous fistula may complicate hypospadias repair. We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula. The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula. A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital (Amman, Jordan). Boys who were aged between 6 months and 5 years, diagnosed with distal hypospadias, and not circumcised were included. The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The results showed a total of 163 boys with distal hypospadias; among them, 116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap, and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month, 6 months, and 12 months (6.9% vs 0, 10.3% vs 0, and 5.2% vs 0, respectively), and the difference after 6 months was statistically significant (P = 0.02).

A fractional-order mathematical model based on vaccinated and infected compartments of SARS-CoV-2 with a real case study during the last stages of the epidemiological event.

In 2020 the world faced with a pandemic spread that affected almost everything of humans' social and health life. Regulations to decrease the epidemiological spread and studies to produce the vaccine of SARS-CoV-2 were on one side a hope to return back to the regular life, but on the other side there were also notable criticism about the vaccines itself. In this study, we established a fractional order differential equations system incorporating the vaccinated and re-infected compartments to a S I R frame to consider the expanded and detailed form as an S V I I v R model. We considered in the model some essential parameters, such as the protection rate of the vaccines, the vaccination rate, and the vaccine's lost efficacy after a certain period. We obtained the local stability of the disease-free and co-existing equilibrium points under specific conditions using the Routh-Hurwitz Criterion and the global stability in using a suitable Lyapunov function. For the numerical solutions we applied the Euler's method. The data for the simulations were taken from the World Health Organization (WHO) to illustrate numerically some scenarios that happened.

Absence of anomalous underscreening in highly concentrated aqueous electrolytes confined between smooth silica surfaces.

Recent surface forces apparatus experiments that measured the forces between two mica surfaces and a series of subsequent theoretical studies suggest the occurrence of universal underscreening in highly concentrated electrolyte solutions. We performed a set of systematic Atomic Force Spectroscopy measurements for aqueous salt solutions in a concentration range from 1 mM to 5 M using chloride salts of various alkali metals as well as mixed concentrated salt solutions (involving both mono- and divalent cations and anions), that mimic concentrated brines typically encountered in geological formations. Experiments were carried out using flat substrates and submicrometer-sized colloidal probes made of smooth oxidized silicon immersed in salt solutions at pH values of 6 and 9 and temperatures of 25 °C and 45 °C. While strong repulsive forces were observed for the smallest tip-sample separations, none of the conditions explored displayed any indication of anomalous long range electrostatic forces as reported for mica surfaces. Instead, forces are universally dominated by attractive van der Waals interactions at tip-sample separations of ≈2 nm and beyond for salt concentrations of 1 M and higher. Complementary calculations based on classical density functional theory for the primitive model support these experimental observations and display a consistent decrease in screening length with increasing ion concentration.

Impact of Different Preparations of Tooth Graft vs Xenogeneic Bone Graft on Bone Healing: An Experimental Study.

AIM: This study aims to compare the effect of demineralized xenogeneic tooth graft in its two forms, particulate and block, with bovine xenograft in the healing of a rabbit tibial bone defect model. MATERIALS AND METHODS: Two monocortical bony defects were made in the right tibias of 36 rabbits, and were divided into four groups. Group I defects were left empty, while group II, III, and IV were filled with bovine xenograft, demineralized particulate tooth graft, and demineralized perforated block tooth graft, respectively for evaluation of the bone healing process. Three rabbits from each group were euthanized at 2, 4, and 6 weeks after surgery. The bone specimens were processed and stained with hematoxylin and eosin (H&E) and osteopontin (OPN) immunohistochemical staining. The results were subjected to image analysis and quantitative evaluation. RESULTS: Demineralized particulate tooth graft showed the best bone healing capacity compared to all other groups at all time points tested, as it showed a large amount of the formed bone, rapid closure of the defect with a significant increase in OPN expression, and the least amount of the residual grafted particles. CONCLUSION: In comparison to bovine xenograft and demineralized dentin block graft, the demineralized particulate tooth grafting material is a promising bone grafting substitute as it proved to be osteoconductive, biocompatible, and bioresorbable. CLINICAL SIGNIFICANCE: Demineralized tooth grafting material can aid in the regeneration of large bone defects, leading to improvement in the filling of the bone defects which can help in oral and maxillofacial reconstruction.

Behind male Saudi nursing students' mental health facade: a husserlian phenomenological approach.

BACKGROUND: Every person has a persona (or mask) which is the façade that every person shows to the world. Thus, males use façade to reveal or conceal their true feelings and emotions. Also, the male uses mental health façade to protect themselves from prejudice and judgment. Thus, the study aimed to explore the experiences of male Saudi nursing students of mental health. METHOD: Husserl's descriptive phenomenology was used as a guiding lens to explore. Eleven participants were involved in the study by using the referral sampling technique. An unstructured interview was performed to gather information from the participants. The seven steps of the descriptive Colaizzi process were followed to investigate and examine the obtained data. The credibility, dependability, confirmability, transferability, and reflexivity criteria were observed to ensure the rigor of the study. RESULTS: The findings have two major themes. The first theme is the unadulterated smile that describes optimism in the family and mutual guarantee. The second theme is the orchestrated smile, which describes avoiding diverting burdens, social responsibility, protection of self, and reputation. CONCLUSIONS: The findings document that the mental health façade of male Saudi nursing students is associated with the expectation of family optimism, mutual guarantee, the expectation of society, and self-protection.

Post-acne hyperpigmentation: Evaluation of risk factors and the use of artificial neural network as a predictive classifier.

Acne is common among young individuals. People with dark skin have a higher risk for developing pigmentary complications. Inflammation is an important factor in post-acne hyperpigmentation however other factors are also involved in developing this complication however these factors are not well studied. The aim of this study is to identify risk factors involved in post-acne hyperpigmentation. Clinical data related to acne, acne- related hyperpigmentation were collected. Data was analyzed for risk factors associated with acne pigmentation. Artificial neural network was used as predictive disease classifier for the outcome of pigmentation. Majority of patients in this study (339 patients) had dark skin phototypes (3 and 4). Post- acne hyperpigmentation was seen in more than 80% of patients. Females, darker skin color, severe acne, facial sites, and excessive sunlight exposure, squeezing or scratching lesions are important risk factors for post-acne hyperpigmentation. Post-acne hyperpigmentation is multifactorial. Several factors implicated in PAH are modifiable by adequate patient education (lesion trauma, excessive sunlight exposure). The use of ANN was helpful in predicting appearance of post-acne hyperpigmentation based on identified risk factors.

A fractional-order model of COVID-19 considering the fear effect of the media and social networks on the community.

Since December 2019, the world has experienced from a virus, known as Covid-19, that is highly transmittable and is now spread worldwide. Many mathematical models and studies have been implemented to work on the infection and transmission risks. Besides the virus's transmission effect, another discussion appears in the community: the fear effect. People who have never heard about coronavirus, face every day uncertain and different information regarding the effect of the virus and the daily death rates from sources like the media, the medical institutions or organizations. Thus, the fear of the virus in the community can possibly reach the point that people become scared and confused about information polluted from different networks with long-term trend discussions. In this work, we use the Routh-Hurwitz Criteria to analyze the local stability of two essential critical points: the disease-free and the co-existing critical point. Using the discretization process, our analysis have shown that one should distinguish between the spread of "awareness" or "fear" in the community through the media and others to control the virus's transmission. Finally, we conclude our theoretical findings with numerical simulations.

Patients response to pre-operative counseling for the appropriate type of bariatric surgery.

INTRODUCTION: Obesity is a major cause of metabolic and health disorders like diabetes mellitus (DM) and gastro esophageal reflux disease (GERD). Patients usually offered a professional preoperative consultation and objective information regarding the bariatric surgery type and the advantages and disadvantages of each type for best outcome and satisfaction. PURPOSE: To study the patient response to preoperative advice and recommendation and the patient's decision to undergo the recommended bariatric surgery. OBJECTIVE: To determine the statistical significance of preoperative recommendation and the patient personal choice of the type of bariatric surgery. MATERIALS AND METHODS: This original article is a cross-sectional survey of 188 patients underwent bariatric surgery between February 2015 and December 2018 in the General Surgery Departments - Bariatric Surgery Clinics in Jordan University Hospital affiliated to the College of Medicine in the University of Jordan and Al Karak Governmental Hospital affiliated to the College of Medicine in Mutah University. 144 patients underwent longitudinal sleeve gastrectomy (LSG) and 44 patients underwent Roux en-Y gastric bypass (RYGB) as the recommended type of surgery for the selected comorbidities diabetes, gastroesophageal reflux disease, or both. RESULTS: Of 188 patients data collected, 54 patients who should had undergone RYGB as the recommended type of surgery, preoperative counseling did not have a significant effect on their decision to undergo the appropriate type of bariatric surgery. The number of patients who had pre-operative recommendation = 37 (68.5%). Out of these, only 15 patients choose the surgical team recommended surgery; p-value 0.183, odds ratio 2.22, (95% confidence interval (CI) = 0.6-8.12). CONCLUSION: Preoperative surgical procedure type advice did not have a significant effect on patients' choice of the recommended bariatric procedure.

Research Title: Factors Associated with Cessation of Exclusive Breastfeeding.

PURPOSE: The study aimed to determine the prevalence of exclusive breastfeeding (EBF), measure the association between EBF and sociodemographic and obstetric characteristics of lactating mothers, and determine challenges of EBF. METHODS: The study was cross-sectional and was conducted in four primary health care centres (PHCCs) at Alehsa region in Saudi Arabia (SA). Lactating mothers coming to vaccinate their babies (0-6 months) were recruited. Sample size totalled 372, where 93 were randomly selected from each centre. Sociodemographic and obstetric characteristics of participants, breastfeeding (BF) status, and challenges of EBF were collected. Basic univariate descriptive statistics were conducted to explore the sociodemographic and obstetric characteristics, BF status and challenges of BF. Bivariate analyses were done to explore the association between the dependent and independent variables. Binary logistic regression models were then executed. A 2-tailed p-value < 0.05 was considered significant. RESULTS: EBF rate was nearly 60%. Cessation of EBF was associated with younger age, inconvenience/fatigue due to BF, sore breasts or nipples/too painful, perceived low milk quantity, BF skills were not effective, maternal choice, and baby-centred factors. CONCLUSION AND RECOMMENDATIONS: EBF was associated with problems/difficulties in BF technique. It is recommended that health care professionals like doctors, nurses, and midwives should train mothers during and after pregnancy regarding BF technique or pumping breast milk in case of BF difficulties, improve mothers' confidence about the ability to breastfeed and enhance mothers' knowledge on the normal process of lactation. Secondly, it is the role of policymakers to ensure implementation of Baby-Friendly Hospital Initiative (BFHI) guidelines in hospitals to meet the WHO's global target of infants being exclusively breastfed until six months of age.