Acceptance of electronic referrals across the Kingdom of Saudi Arabia: results from a national e-health database.

Introduction: An effective referral system is necessary to ensure quality and an optimum continuum of care. In the Kingdom of Saudi Arabia, an e-referral system known as the Saudi Medical Appointments and Referrals Centre (SMARC), has been fully functioning since 2019. This study aims to explore the rate of medical e-referral request acceptance in the KSA, and to study the factors associated with acceptance. Methods: This period cross-sectional study utilised secondary collected data from the SMARC e-referral system. The data spans both 2020 and 2021 and covers the entirety of the KSA. Bivariate analyses and binary logistic regression analyses were performed to compute adjusted Odds Ratios (aORs) and 95% confidence intervals. Results: Of the total 632,763 referral requests across the 2 years, 469,073 requests (74.13%) were accepted. Absence of available machinery was a significant predictor for referral acceptance compared to other reasons. Acceptance was highest for children under 14 with 28,956 (75.48%) and 63,979 (75.48%) accepted referrals, respectively. Patients requiring critical care from all age groups also had the highest acceptance including 6,237 referrals for paediatric intensive care unit (83.54%) and 34,126 referrals for intensive care unit (79.65%). All lifesaving referrals, 42,087 referrals, were accepted (100.00%). Psychiatric patients were observed to have the highest proportion for accepted referrals with 8,170 requests (82.50%) followed by organ transplantations with 1,005 requests (80.92%). Sex was seen to be a significant predictor for referrals, where the odds of acceptances for females increased by 2% compared to their male counterparts (95% CI = 1.01-1.04). Also, proportion of acceptance was highest for the Eastern business unit compared to all other units. External referrals were 32% less likely to be accepted than internal referrals (95% CI = 0.67-0.69). Conclusion: The current findings indicate that the e-referral system is mostly able to cater to the health services of the most vulnerable of patients. However, there remains areas for health policy improvement, especially in terms of resource allocation.

A new approach for imparting durable multifunctional properties to linen-containing fabrics.

This study focused on upgrading the antibacterial activity, UV-protection property, self-cleaning ability and durability to wash of linen and linen/cotton (50/50) blend fabrics to develop multifunctional textile materials without adversely affecting their hydrophilicity. Herein, linen-containing fabrics were first pre-carboxymethylated to create new active sites (-CH2COOH groups) to facilitate subsequent loading of selected active ingredients namely chitosan (Cs), organosilane quaternary ammonium compound (Si-QAC), silver-nanoparticles (Ag-NPs) and titanium oxide nanoparticles (TiO2-NPs) individually and in admixtures. The developed products, especially in case of using mixed active ingredients, exhibit a noticeable improvement in the imparted functional properties regardless of the used substrate. The effectiveness of the imparted functions is determined by type of substrate, its extent of modification, type, concentration and degree of fixation of the used active ingredient onto the pre-modified substrate. Functionalized samples loaded with mixed active ingredients demonstrated a high durability to wash even after 15 washing cycles.

New finishing possibilities for producing durable multifunctional cotton/wool and viscose/wool blended fabrics.

This research work focuses on the development of a one-bath functional finishing procedure for imparting durable multifunctional properties such as easy care, soft-hand, antibacterial and/or ultra violet (UV) protection to cotton/wool and viscose/wool blends using diverse finishing combinations and formulations. In this study finishing agents such as reactant resin, silicon softeners, 4-hydroxybenzophenone, triclosan, and pigment colorant were selected using magnesium chloride/citric acid as a mixed catalyst and the pad-dry microwave fixation technique. The results reveal that enhancement in the imparted functional properties are governed by type of the finished substrate as well as nature and concentration of finishing formulation components. The finished fabrics still retained high level of functionalities even after 15 consecutive laundering. Surface morphology and composition of selected samples were investigated using scan electron microscope (SEM) and energy-dispersive X-ray spectroscopy (EDX) analysis. The mode of interactions was also investigated. Practical applications for multifunctionlization of cellulose/wool blended fabrics are possible using these sorts of proper finishing formulations and unique finishing application method.

Cellulosic/wool pigment prints with remarkable antibacterial functionalities.

Several bio-active agents namely choline chloride, triclosan derivative, PEG-600 and 4-hydroxybenzophenone were successfully included into solvent-free pigment formulations, in a single-stage process, followed by screen printing and microwave-fixation to obtain antibacterial functionalized cellulosic/wool pigment prints. Results obtained signify that both the improvement in functionalization and coloration properties are governed by type of antibacterial agent, kind of substrate as well as pigment colorant. The imparted antibacterial activity of the loaded bio-active agents follows the decreasing order: G+ve (Staphylococcus aureus)>G-ve (Escherichia coli), keeping other parameters constant. The imparted functional and coloration properties showed no significant decrease even after 15 washings. Mode of interactions among the nominated substrates, the pigment paste constituents and the bioactive agents were also proposed.

Functional finishes of stretch cotton fabrics.

Functionalized cotton cellulose/spandex woven fabrics with different structures namely plain (1/1), twill (2/2) and satin were produced. Factors affecting the imparted functional properties such as weave structure and constituents of the finishing formulations including ether or ester cross-linker and catalyst type, silicone-micro-emulsion, water/oil repellent, Ag-NP(,)s and TiO2-NP(,)s were studied. The treated fabrics were found to have easy care property together with one or more of the imparted functional properties such as soft-handle, water/oil repellence, antibacterial, UV-protection and self cleaning. The effectiveness of the imparted properties is not seriously affected even after 10 washing cycles. Surface modifications as well as the composition of certain samples were confirmed by SEM images and EDX spectra. Mode of interactions was also suggested.

Functionalization of linen/cotton pigment prints using inorganic nano structure materials.

The present work opens up a novel strategy for the development of new multifunctional cellulosic pigment prints. The developed process aims at modifying the solvent-free pigment printing formulations via inclusion of certain inorganic nano materials namely silver (Ag-NPs), zinc oxide (ZnO-NPs), zirconium oxide (ZrO2-NPs) or titanium dioxide (TiO2-NPs) at 20 g/kg paste followed by screen printing and microwave fixation. The imparted functional properties together with the depth of the obtained prints are governed by the type of nano additives, type of binder and the pigment colorant. The imparted antibacterial and/or UV protection properties to the pigment prints were retained with an acceptable level (>70%) of durability even after 20 washing cycles. The presence of nano materials on the surface of the obtained pigment prints was confirmed using SEM images and EDX spectra.

Multifunctional finishing of cellulosic/polyester blended fabrics.

Innovative/efficient finishing systems for imparting multi-functional properties to cotton/polyester and viscose/polyester blends were developed. Factors affecting the extent of functionalization including type and concentration of the nano-hybrid, i.e. silver nanoparticles/polyvinyl pyrolidone hybrid (Ag-NP's/PVP) or zinc oxide nanoparticles/hyperbranched polyamide-amine hybrid (ZnO-NP's/HBPAA), concentration of Basic Blue 9, or chitosan and sequence of treatment using citric acid as cross-linker were reported. Loading of ß-CD, with its hydrophobic cavities, onto the cross-linked substrates and subsequent treatment with Neem-oil, Lavender-oil or 4-hydroxybenzophenone was also studied. The obtained products exhibit a remarkable easy care, antibacterial and/or UV-blocking functional properties. The improvement in the imparted properties and durability to wash is governed by type and amount of loaded active ingredients. Mode of interactions was suggested, and surface modifications together with composition of selected samples were also confirmed by SEM images and EDX spectra.

A smart approach to add antibacterial functionality to cellulosic pigment prints.

This study was devoted to enhancing the antibacterial functionality of pigment printed cotton, linen and viscose fabrics. Ag-NP's/PVP colloid, triclosan derivatives, chitosan or choline chloride was successfully incorporated into the pigment paste followed by printing and microwave curing to impart antibacterial activity to the cellulosic prints. Results obtained demonstrate that the modified pigment prints exhibit a remarkable antibacterial activity against the G+ve (Staphylococcus aureus) and G-ve (Escherichia coli) bacteria with a noticeable durability after 20 washing cycles without adversely affecting the printing and softness properties. The extent of printability and functionality of the nominated substrates are significantly governed by the type of: bio-active ingredient, binder, pigment and substrate. TEM, SEM and EDX analysis confirmed the formation of Ag-NP's/PVP colloid, of particle size range 7-14 nm, deposition of cross-linked-binder film onto the modified pigment prints, and the existence of elementary Ag and Si loaded onto fabrics surface, respectively.

Combined antimicrobial finishing and pigment printing of cotton/polyester blends.

This study demonstrates the possibility of enhancing the antibacterial functionality and pigment printing properties of cotton/polyester blends (50/50 and 35/65) in one step. Inclusion of chitosan (10 g/kg), choline chloride (15 g/kg), triclosan derivative (20 g/kg), hyperbranched poly amide-amine/silver or zinc oxide nanoparticles (HBPAA/Ag-NP's hybrid or HBPAA/ZnO-NP's hybrid - 20 g/kg) into a pigment print formulation followed by printing and microwave curing at 386 W for 5 min results in an improvement in antibacterial activity and pigment printability. It was further noted that, in all cases, the G+ve (S. aureus) bacteria is more susceptible to the action of the immobilized antibacterial agents than the G-ve bacteria (E. coli). The functionalized pigment prints exhibited very sufficient antibacterial activity even after 20 washing cycles. Modes of interactions were proposed, and surface modification was also confirmed by SEM and EDX analysis.

Functionalization of cellulose-containing fabrics by plasma and subsequent metal salt treatments.

In order to upgrade the UV-protection and antibacterial functional properties of cotton/polyester (80/20), cotton/linen (50/50) and linen/viscose-polyester (50/50) fabric blends, they were treated with different plasma gases (oxygen, air, and argon) followed by subsequent treatment with certain metal salts namely Zn-acetate, Cu-acetate, Al-chloride, and Zr-oxychloride. The obtained results show that the type of plasma gas, the kind of metal salt as well as the nature of the treated substrate play an important role in the extent of enhancing the demanded functional properties. Oxygen plasma treatment followed by Cu-acetate or Zn-acetate treatment gives the best UV-protection or antibacterial activity respectively, keeping other parameters constant. The surface morphology of some untreated and plasma-treated samples was also analyzed by SEM.

Anaplastic large cell lymphoma associated with breast implants: a report of 13 cases.

We report 13 cases of anaplastic large cell lymphoma (ALCL) associated with breast implants. Patient age ranged from 39 to 68 years, and the interval from implant to ALCL was 4 to 29 years. All tumors were composed of large, pleomorphic cells that were CD30 and ALK1, and all 7 cases assessed had monoclonal T-cell receptor γ-chain rearrangements. Two patient subgroups were identified. Ten patients presented with effusion surrounded by fibrous capsule without a grossly identifiable tumor mass. Nine patients had stage I and 1 had stage II disease. Eight patients underwent implant removal and capsulectomy. Four patients received chemotherapy and 4 radiation therapy. All patients were alive without disease at last follow-up. A second subgroup of 3 patients had effusion and a distinct mass adjacent to the implant. One patient had stage I and 2 stage II disease. One patient had a 3-year history of lymphomatoid papulosis, and 1 patient had a 1-year history of CD30 T-cell lymphoma adjacent to the breast before the diagnosis of ALCL associated with breast implant. Two patients received chemotherapy and 1 radiation therapy. Two patients died 2 and 12 years after diagnosis, respectively. We conclude that the clinical behavior of ALCL associated with breast implants is heterogeneous. Patients who present with effusion without a distinct mass have an indolent disease course, similar to CD30 lymphoproliferative disorder of skin. In contrast, patients who present with a distinct mass may have advanced stage or possibly systemic disease and have a poorer prognosis.

A novel approach for adding smart functionalities to cellulosic fabrics.

A water soluble nanocomposite, based on Ag-nanoparticles (Ag-NPs) loaded on hyperbranched poly (amide-amine, HBPAA) was prepared, characterized and utilized in functional finishing as well as in combined reactive dyeing/and functional finishing of linen, cotton and viscose fabrics. Incorporation of the nanocomposite alone and in combination with reactive dyes in easy care finishing formulations brought about an outstanding antibacterial functionality of the finished and the dyed/finished fabrics even after 15 laundering cycles along with a slight negative impact on other performance properties. Improvement or decrement in the functional, comfort, and dyeing properties is governed by the type of cellulosic substrate.

Poly(acrylic acid)/poly(ethylene glycol) adduct for attaining multifunctional cellulosic fabrics.

Aqueous polymerization of partially neutralized acrylic acid (AA) along with polyethylene glycol (PEG-600) at AA/PEG-600 mass ratio 3/1 using ammonium persulfate as initiator under proper conditions results in formation of PAA/PEG-600 adduct. The structure of the adduct was confirmed by FT-IR spectra. The potential applications of the prepared adduct in: sizing, durable hand building of cotton cellulose, as well as in functional finishing of cellulose containing fabrics, i.e. cotton, viscose and cotton/polyester, with Ag- or TiO2-nanoparticles were investigated. The modified substrates using the prepared adduct showed a remarkable improvement in their sizing, hand building and/or functional properties, i.e. antibacterial, anti-UV, and self cleaning, in addition to durability to wash. TEM images of the prepared nano-particles, SEM images of the untreated and treated substrates, as well as EDX spectra to analyze the surface elemental compositions were examined. The tentative mechanisms were also suggested.

Mild Campomelic Dysplasia: Report on a Case and Review.

We report on a 10.5-year-old girl with a mild form of campomelic dysplasia. She presented with short stature of prenatal onset, dysmorphic facial features, limitation of supination and pronation of the forearms, dysplastic nails, and bone abnormalities consisting especially of cone-shaped epiphyses of the middle phalanx of the 2nd fingers, brachydactyly and clinodactyly of the middle phalanx of both 5th fingers, short 4th metacarpals, radial and femoral head subluxation, hypoplastic scapulae, humeral and ulnar epiphyseal abnormalities, unossified symphysis pubis, and a significant delay in bone age. Molecular analysis of the SOX9 gene revealed the presence of a de novo missense mutation: p.P170L (c.509C>T). Mild and surviving cases of campomelic dysplasia are reviewed.

Congenital segmental dilatation of the small bowel (CSD).

Congenital segmental dilatation (CSD) is a rare pathology of unknown etiology, usually with early-onset presentation in the neonatal age. We present a case of CSD of the jejunum of a 9-year-old boy with severe malnutrition. Its clinical, radiological and histological features are similar to those described in the literature but the remarkable aspect of this case lies in its late presentation.

[Liver transplantation in infants and children. Evaluation of the first 40 cases (March 1991-March 1997)]. / La transplantation hépatique chez le nourrisson et l'enfant. A propos de 40 observations (mars 1991-mars 1997).

BACKGROUND: Liver transplantation (LT) is the treatment of end-stage liver disease in children. We report our experience with LT using grafts from living related (LRD) and cadaver donors (CD). POPULATION: From March 1991 to March 1997, 40 children and infants received a total of 42 liver grafts. A reduced-size liver was used in 28 cases. We studied pre-transplantation status, survival rate, and medical and surgical complications in these patients. RESULTS: The survival rate in our series was respectively 85 and 80% at 1 and 7 years after LT. Low weight infants required a prolonged ventilatory assistance. Five of the six deaths noticed during the first three months after LT occurred in children weighing less than 12 kg. One year after LT, no significant difference in the incidence of rejection was found, neither between low-weight children and the others, nor between patients transplanted from CD or LRD. Biliary tract stricture was the major surgical complication. CONCLUSION: This series consisted of a majority of low-weight children. The survival rate in the patients weighting less than 12 kg is lower than in the others. This may be explained by the nutritional status of these patients and early postsurgical complications. The use of grafts from living donors offers more flexibility since the operation is performed electively, but it did not seem to modify the incidence of acute rejections and surgical complications.