Prevalence of Hemorrhoids and Their Risk Factors Among the Adult Population in Jazan, Saudi Arabia.

BACKGROUND: Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They can be either internal, external, or internoexternal, according to their position in relation to the dentate line. They can cause significant financial burdens and personal discomfort. However, the typical symptoms of hemorrhoids include bleeding, pain, skin irritation, fecal leakage, prolapse, mucus secretion, and developing a thrombosed hernia. Nonetheless, research has shown that individuals with and without hemorrhoids equally report these symptoms. This study aims to investigate the prevalence of hemorrhoids and their risk factors among adult subjects in Jazan, Saudi Arabia. METHODS: This investigation was a cross-sectional study targeting adults diagnosed with hemorrhoids in the Jazan region. Data collection was performed via a self-administered questionnaire to measure sociodemographic data of the participants, lifestyle factors associated with hemorrhoids, clinical presentations of the disease, and Rome IV criteria for diagnosis of functional constipation. The chi-squared test was used to assess the frequency of hemorrhoid symptoms according to the participants' sociodemographic and lifestyle characteristics. RESULTS: In the current study, which recruited 361 participants, 59% (216 individuals) reported experiencing at least one symptom of hemorrhoids. The majority of the sample were females (60%), Saudis (96%), and living in urban areas (59%) and had a university education (77.3%). The most common risk factors identified were lack of regular physical activity (83%), prolonged sitting during office work (51%), and consuming food with saturated fat (50%). A total of 44% (159 participants) had a family history of hemorrhoids, and 40% reported suffering from constipation three times or more per week. Only 34% (123 participants) had been diagnosed with hemorrhoids by a physician. Interestingly, the majority of participants (57%) preferred using home remedies instead of seeking medical care from a healthcare professional. When assessing factors associated with experiencing a minimum of six hemorrhoid symptoms per month, age, lifestyle factors, family history of hemorrhoids, and defecation practices were found to be significantly correlated with a higher occurrence of symptoms (with a p-value of less than 0.05). CONCLUSION: The current study identified a high prevalence of hemorrhoid symptoms and their risk factors among the adult population in the Jazan region of Saudi Arabia. The findings suggest a need to increase the awareness of the public about hemorrhoids risk factors and the importance of seeking healthcare at an early stage of the disease.

Novel Decision-Making Techniques in Tripolar Fuzzy Environment with Application: A Case Study of ERP Systems.

The intuitionistic fuzzy set (IFS) and bipolar fuzzy set (BFS) are all effective models to describe ambiguous and incomplete cognitive knowledge with membership, non-membership, negative membership, and hesitancy sections. But in daily life problems, there are some situations where we cannot apply the ordinary models of IFS and BFS, separately. Hence, there is a need to combine both the models of IFS and BFS into a single one. A tripolar fuzzy set (TFS) is a generalization of IFS and BFS. In circumstances where BFS and IFS models cannot be used individually, a tripolar fuzzy model is more dependable and efficient. Further, the IFS and BFS models are reduced to corollaries due to the proposed model of TFS. For this purpose in this article, we first consider some novel operations on tripolar fuzzy information. These operations are formulated on the basis of well-known Dombi T-norm and T-conorm, and the desirable properties are discussed. By applying the Dombi operations, arithmetic and geometric aggregation operators of TFS are proposed, and we introduce the concepts of a TF-Dombi weighted average (TFDWA) operator, a TF-Dombi ordered weighted average (TFDOWA) operator, and a TF-Dombi hybrid weighted (TFDHW) operator and explore their fundamental features including idempotency, boundedness, monotonicity, and others. In the second part, we propose TF-Dombi weighted geometric (TFDWG) operator, TF-Dombi ordered weighted geometric (TFDOWG) operator, and TF-Dombi hybrid geometric (TFDHG) operator. The features and specific cases of the mentioned operators are examined. Enterprise resource planning (ERP) is a management and integration approach that organizations employ to manage and develop many aspects of their operations. The study's primary contribution is to employ TFS to create certain decision-making strategies for the selection of optimal ERP systems. The proposed operators are then used to build several techniques for solving multiattribute decision-making (MADM) issues with TF information. Finally, an example of ERP system selection is investigated to demonstrate that the techniques suggested are trustworthy and realistic.

Gender Identification and Classification of Drosophila melanogaster Flies Using Machine Learning Techniques.

Drosophila melanogaster is an important genetic model organism used extensively in medical and biological studies. About 61% of known human genes have a recognizable match with the genetic code of Drosophila flies, and 50% of fly protein sequences have mammalian analogues. Recently, several investigations have been conducted in Drosophila to study the functions of specific genes exist in the central nervous system, heart, liver, and kidney. The outcomes of the research in Drosophila are also used as a unique tool to study human-related diseases. This article presents a novel automated system to classify the gender of Drosophila flies obtained through microscopic images (ventral view). The proposed system takes an image as input and converts it into grayscale illustration to extract the texture features from the image. Then, machine learning (ML) classifiers such as support vector machines (SVM), Naive Bayes (NB), and K-nearest neighbour (KNN) are used to classify the Drosophila as male or female. The proposed model is evaluated using the real microscopic image dataset, and the results show that the accuracy of the KNN is 90%, which is higher than the accuracy of the SVM classifier.

Establishing Sickle Cell Disease Stroke Prevention Teams in Africa is Feasible: Program Evaluation Using the RE-AIM Framework.

We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate a Stroke Prevention Team's readiness to prevent strokes in children with sickle cell anemia living in northern Nigeria. The NIH sponsored Stroke Prevention Trial in Nigeria included a goal of a sustainable stroke prevention program. The program's 1-year reach for transcranial Doppler screening was 14.7% (4710/32,000) of which 6.0% (281/4710) had abnormal velocities (≥200 cm/s). All participants with abnormal transcranial Doppler velocities were started on hydroxyurea (effectiveness). The leaders of all 5 hospitals agreed to adopt the program. After 1 year, program-implementation and maintenance rates were 100%, demonstrating the program's feasibility and short-term sustainability.

q-Rung Orthopair Fuzzy Rough Einstein Aggregation Information-Based EDAS Method: Applications in Robotic Agrifarming.

The main purpose of this manuscript is to present a novel idea on the q-rung orthopair fuzzy rough set (q-ROFRS) by the hybridized notion of q-ROFRSs and rough sets (RSs) and discuss its basic operations. Furthermore, by utilizing the developed concept, a list of q-ROFR Einstein weighted averaging and geometric aggregation operators are presented which are based on algebraic and Einstein norms. Similarly, some interesting characteristics of these operators are initiated. Moreover, the concept of the entropy and distance measures is presented to utilize the decision makers' unknown weights as well as attributes' weight information. The EDAS (evaluation based on distance from average solution) methodology plays a crucial role in decision-making challenges, especially when the problems of multicriteria group decision-making (MCGDM) include more competing criteria. The core of this study is to develop a decision-making algorithm based on the entropy measure, aggregation information, and EDAS methodology to handle the uncertainty in real-word decision-making problems (DMPs) under q-rung orthopair fuzzy rough information. To show the superiority and applicability of the developed technique, a numerical case study of a real-life DMP in agriculture farming is considered. Findings indicate that the suggested decision-making model is much more efficient and reliable to tackle uncertain information based on q-ROFR information.

Primary prevention of stroke in children with sickle cell anemia in sub-Saharan Africa: rationale and design of phase III randomized clinical trial.

Strokes in children with sickle cell anemia (SCA) are associated with significant morbidity and premature death. Primary stroke prevention in children with SCA involves screening for abnormal transcranial Doppler (TCD) velocity coupled with regular blood transfusion therapy for children with abnormal velocities, for at least one year. However, in Africa, where the majority of children with SCA live, regular blood transfusions are not feasible due to inadequate supply of safe blood, cost, and the reluctance of caregivers to accept transfusion therapy for their children. We describe the Primary Prevention of Stroke in Children with Sickle Cell Disease in Nigeria Trial [StrokePreventioninNigeria (SPRING) trial, NCT02560935], a three-center double-blinded randomized controlled Phase III clinical trial to 1) determine the efficacy of moderate fixed-dose (20 mg/kg/day) versus low fixed-dose (10 mg/kg/day) hydroxyurea therapy for primary stroke prevention; 2) determine the efficacy of moderate fixed-dose hydroxyurea for decreasing the incidence of all cause-hospitalization (pain, acute chest syndrome, infection, other) compared to low fixed-dose hydroxyurea. We will test the primary hypothesis that there will be a 66% relative risk reduction of strokes in children with SCA and abnormal TCD measurements, randomly allocated, for a minimum of three years to receive moderate fixed-dose versus low fixed-dose hydroxyurea (total n = 220). The results of this trial will advance the care of children with SCA in sub-Saharan Africa, while improving research capacity for future studies to prevent strokes in children with SCA.

Dengue meningoencephalitis in a child presenting with focal seizures.

We report a 9-year-old female child who presented with fever and focal seizures. The Cerebrospinal Fluid (CSF) analysis was compatible with viral meningoencephalitis and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) on same sample was positive for dengue virus RNA, serotype 2. The dengue IgM in blood sample was positive on the 8th day of the illness. This case demonstrates the emerging neurological manifestations of dengue infection and the first confirmed pediatric meningoencephalitis reported from Saudi Arabia. In areas where it does exist, dengue should be included in the differential diagnosis of cases of viral meningitis or meningoencephalitis.

A comparison of mid upper arm circumference with other Indices for discharge from community-based management of malnutrition clinics in Jigawa State, Nigeria

Background: Community-based management of acute malnutrition (CMAM) program has saved millions of children with severe acute malnutrition (SAM) globally. World Health Organization recommended discharge indices include Midupper arm circumference (MUAC) =12.5cm, =15-20% weight gain and weight-for-height Z score (WHZ) =-2. We compared MUAC with WHZ and percentage weight gain as discharge criteria from CMAM. Methods: It was a community based cohort study of children aged 6-59 months with SAM discharged from CMAM clinics in Jigawa State, Nigeria. Socio-demographic data, nutrition history and anthropometry were recorded at enrolment and discharge. Results: Of a total of 405 children studied, 209(51.6%) were females and had a peak age group of 12-23months (43.7%, range 6-42 months). At discharge, 353(87.2%) had MUAC = 12.5cm while 231(57.0%) and 204(50.4%) had percentage weight-gain =15% and WHZ=-2 respectively. There was weak agreement between MUAC and WHZ (agreement 50.8%, ê=0.012) and MUAC and percent weight-gain (agreement 54.8%, ê=-0.004). Children aged between 11-23 months (OR 2.12, p=0.006) and 24-35 months (OR 2.60, p=0.002) had increased risk of discharge with inadequate percentage weight gain. WHZ <-3 at enrolment was associated with increased risk of discharge with WHZ <-3 (OR 3.21, p<0.001) and reduced risk of discharge with inadequate percentage weight gain (OR 0.45, p<0.001). Age sex, WHZ at enrollment were not associated with MUAC at discharge. Conclusion: The use of MUAC alone as discharge criterion allows a significant proportion of children still needing urgent care exiting CMAM clinic prematurely. Stratifying these criteria may lead to better recovery before discharge

Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans.

BACKGROUND: Africa has a growing burden of stroke with associated high morbidity and a 3-year fatality rate of 84%. Cardiac disease contributes to stroke occurrence and outcomes, but the precise relationship of abnormalities as noted on a cheap and widely available test, the electrocardiogram (ECG), and acute stroke outcomes have not been previously characterized in Africans. OBJECTIVES: The study assessed the prevalence and prognoses of various ECG abnormalities among African acute stroke patients encountered in a multisite, cross-national epidemiologic study. METHODS: We included 890 patients from Nigeria and Ghana with acute stroke who had 12-lead ECG recording within first 24 h of admission and stroke classified based on brain computed tomography scan or magnetic resonance imaging. Stroke severity at baseline was assessed using the Stroke Levity Scale (SLS), whereas 1-month outcome was assessed using the modified Rankin Scale (mRS). RESULTS: Patients' mean age was 58.4 ± 13.4 years, 490 were men (55%) and 400 were women (45%), 65.5% had ischemic stroke, and 85.4% had at least 1 ECG abnormality. Women were significantly more likely to have atrial fibrillation, or left ventricular hypertrophy with or without strain pattern. Compared to ischemic stroke patients, hemorrhagic stroke patients were less likely to have atrial fibrillation (1.0% vs. 6.7%; p = 0.002), but more likely to have left ventricular hypertrophy (64.4% vs. 51.4%; p = 0.004). Odds of severe disability or death at 1 month were higher with severe stroke (AOR: 2.25; 95% confidence interval: 1.44 to 3.50), or atrial enlargement (AOR: 1.45; 95% confidence interval: 1.04 to 2.02). CONCLUSIONS: About 4 in 5 acute stroke patients in this African cohort had evidence of a baseline ECG abnormality, but presence of any atrial enlargement was the only independent ECG predictor of death or disability.

Bowel perforation due to break and distal passage of the safety ring of an adjustable intra-gastric balloon: A potentially life threatening situation.

A 45-year-old man of Middle Eastern origin, morbid obese, with a body mass index of 39 had an intra-gastric balloon, filled with 500 mL of saline/methylene blue and intended as definite therapy, inserted some 8 wk previously. He was admitted to the emergency department with abdominal cramps. An ultrasound of the abdomen was performed in ER which confirmed the balloon to be in place without any abnormality. He was discharged home on symptomatic medication. Patient remains symptomatic therefore he reported back to ER 2 d later. Computed tomography scan was performed this time for further evaluation which revealed a metallic ring present in the small bowel while the intra-gastric balloon was in its proper position. There was no clinical or radiological sign of intestinal obstruction. Patient was hospitalized for observation and conservative management. The following night, patient experienced sudden and severe abdominal pain, therefore an X-ray of the abdomen in erect position was done, which showed free air under the right dome of diaphragm. Patient was transferred to O.R for emergency laparotomy. There were two small perforations identified at the site of the metallic ring entrapment. The ring was removed and the perforations were repaired. Due to increasing prevalence of obesity and advances in modalities for its management, physicians should be aware of treatment options, their benefits, complications and clinical presentation of the known complications. Physicians need to be updated to approach these complications within time, to avoid life-threatening situations caused by these appliances.

Rhinolith: delayed presentation after head trauma-a case report.

Rhinoliths are uncommon clinical entities reported in clinical practice as unusual cause of unilateral nasal obstruction and foul smell nasal discharge. Rhinolith is calcified material found in the nasal cavity incidentally or due to patient complaint. It should be suspected when patient presents with nasal symptoms and found to have stony mass showed radiologically. We reported a 28-year-old Saudi male with left sided (LT) nasal obstruction and foul smell discharge for 5 years suspected as being due to foreign body presence since childhood due to head trauma following car accident in sandy area.

Response to the meningococcal meningitis epidemic (MME) at Aminu Kano Teaching Hospital, Kano (2008-2009).

In December 2008 an outbreak of Meningococcal Meningitis swept across sub Saharan Africa with Nigeria, especially its northern states worst affected. The management of Aminu Kano Teaching Hospital constituted an Emergency Preparedness & Response (EPR) committee. Over the course of 18 weeks from 5 January 2009 to 15 May 2009, AKTH managed 222 cases of suspected meningitis with 14 deaths (case fatality rate [CFR] of 6.3%). Twenty three per cent (23%) were microbiologically proven as meningococcal meningitis while 9% were confirmed to be pneumococcal meningitis. Male to female ratio was 1:1 with most patients (81%) aged below 14 years. The epidemic peaked in weeks 10 and 13 with 38 admissions in the respective weeks. Meningococcemia with purpura fulminans, post meningitic immune complex cutaneous vasculitis and polyarthritis were observed. Control measures instituted included provision of free ceftriaxone, chemoprophylaxis to contacts, vaccines to staff/families, and creation of dedicated isolation wards. Clinical management guidelines were developed and hospital staffs were also enlightened. Lessons learnt included the difficulty of discriminating between nosocomial transmission and community clusters; relative increase in pneumococcal meningitis during the epidemic; unreliability of penicillin/chloramphenicol; the utility of internet for communication; and the inadequacy of vaccines to meet staff & public demand.

Clinicopathological pattern of malignant parotid gland tumors in Saudi Arabia.

OBJECTIVE: To report our experience of varied presentations and diverse histopathological spectrum of parotid gland malignancies. METHODS: This retrospective analysis incorporated patients with histological evidence of malignant parotid tumors at King Khalid University Hospital, Riyadh, Saudi Arabia over a 20-year period from 1984 through 2004. The medical records of these patients were analyzed for their demographic characteristics, clinical features, operations performed, and pathological diversity. RESULTS: Thirty-two patients comprised this study group. There is a male preponderance over females with a ratio of 2.2:1 (22 men and 10 women) and mean age of 51.8 (range 28-81 years). A painless lump was the most frequent clinical manifestation observed in 23 (71.8%) patients followed by facial nerve dysfunction in 14 (43.7%) patients. Parotidectomy was performed in 22 (68.7%) patients: 16 superficial and 6 total. A partial facial nerve sacrifice was undertaken in 14 (43.7%), and total nerve sacrifice in 9 (28.1%) patients. Four (12.5%) patients presented with cervical lymph node metastases necessitating radical neck dissection. Nine (28.1%) patients had mucoepidermoid carcinoma, 8 (25%) adenoid cystic carcinoma, 6 (18.7%) adenocarcinoma, not otherwise specified, and 2 (6.2%) were reported to have carcinoma in pleomorphic adenoma. Twenty (62.5%) specimens revealed high-grade aggressive lesions, and out of these, 19 (59.3%) patients presented with stage III/IV disease. CONCLUSION: Malignant parotid tumors are exceedingly rare, occurring at a relatively earlier age group with male preponderance, and invariably declare at a late clinical stage in our community. Histopathological features hallmark a locally advanced disease with an aggressive behavior.

Solid-state fermentation of agricultural wastes into food through Pleurotus cultivation.

The technical feasibility of using agricultural wastes (mango and date industry wastes) as a substrate for the cultivation of Pleurotus ostreatus NRRL-0366 is evaluated. When comparing the biological efficiency of mushroom production, the highest yield of fruiting bodies was obtained using a mixture of date waste and rice straw at a ratio (1:1) (11.96%), followed by a mixture 3:1 (11.16%). The lowest one was the mixture 2:1 (9.19%). Fungus Pleurotus ostreatus NRRL-0366 can also be cultivated on mango waste supplemented with rice straw at a different ratio. The best one was the 1:1 mixture (10.18%), whereas the lowest was a mixture 3:1 (6.4%). Comparing the results obtained favored the use of date waste as a substrate for growing Pleurotus ostreatus NRRL-0366. Spawn was cultured on three different substrates as follows: Date waste alone (I); 1:1 (by wt) date waste and rice straw (II); 1:1:1 date waste, rice straw, and corncobs (III). Final dry weight and composition of the fruiting bodies are tabulated for the three sets of conditions. Date waste and rice straw mixture (II) is a good source of nonstarchy carbohydrate (67%) and protein (27.44%) containing amounts of essential amino acids, especially lysine and low RNA (3.81%). Elemental analysis were studied in the fruit bodies of the three media.