Artificial Intelligence in Gastrointestinal Endoscopy.

Artificial intelligence (AI) is rapidly integrating into modern technology and clinical practice. Although in its nascency, AI has become a hot topic of investigation for applications in clinical practice. Multiple fields of medicine have embraced the possibility of a future with AI assisting in diagnosis and pathology applications. In the field of gastroenterology, AI has been studied as a tool to assist in risk stratification, diagnosis, and pathologic identification. Specifically, AI has become of great interest in endoscopy as a technology with substantial potential to revolutionize the practice of a modern gastroenterologist. From cancer screening to automated report generation, AI has touched upon all aspects of modern endoscopy. Here, we review landmark AI developments in endoscopy. Starting with broad definitions to develop understanding, we will summarize the current state of AI research and its potential applications. With innovation developing rapidly, this article touches upon the remarkable advances in AI-assisted endoscopy since its initial evaluation at the turn of the millennium, and the potential impact these AI models may have on the modern clinical practice. As with any discussion of new technology, its limitations must also be understood to apply clinical AI tools successfully

The Effectiveness of the Letters of Guarantee Platform within Banking Legislation and its Reflection in Reducing the Risks of Letters of Guarantee Through/Applied Research

Purpose: Of the research is to show the importance of the letter of guarantee platform as an electronic supervisory control for managing the process of issue isng letters of guarantee and limiting fraud and forgery operations, and to determine the impact between the independent variable of the letter of guarantee platform in light of banking legislation with its dimensions of (traditional issuance procedures before the platform and issuance procedures after the platform, and the position beneficiariesies), and the dependent variable reducing the risks of letters of guarantwith in idimensionons of (centralization of the decision), identifying the reasons for resorting to the use of the letter Andand the research problem has been identifi is the adequacy of the electronic platform in reducithe riskssks of letters of guarantee?    Theoretical framework: In solving its problems, the research was based on a hypothesis: correlation and influence, where the first main impact hypothesis was: "There is no statistically significant effect of the issuance of traditional letters of guarantee (X) in reducing the risks of letters of guarantee (Y)", and the second hypothesis was: "There is no effect of statistically significant significance of the issuance of letters of guarantee after the electronic platform (Z) in reducing the risks of letters of guarantee (Y)", and the research adopted the method of the inductive approach: in the theoretical side to review the research problems and prove its hypotheses to achieve the objectives of the research.   Design: The relationship supported by the quantitative aspect of analyzing the annual financial statements of private commercial banks, the research sample before and after the platform (2017-2021), which represented the first community of the research sample and numbered six commercial banks, field visits and personal interviews with the Central Bank of Iraq As the entity responsible only for managing the platform, as well as the statistical tests of the second community of the research sample to measure the attitude of the beneficiaries towards the letters of guarantee platform, the questionnaire was adopted as a research tool for the purpose of With the data from the sample of 50 individuals, i.e., 87% of the total study population, in the administrative levels (senior management, middle management, and executive) in a number of beneficiaries, the questionnaire was used as a means to obtain data from the sample of  50 people"by the beneficiaries represented by the ministries and their departments, and the paragraphs of the questionnaire were analyzed based on the statistical programs:SPSS,version 26; (Exce;) and(Amo)  Security in the Iraqi banking environment and a steptowardr applying electronic governance.    Results: The research reached a set of results, the most prominent of which were: The weakness of the centralization of the decision and the procedures followed for the issuance process for letters of guarantee before the platform contributed to the expansion of risks for letters of guarantee, and in addition, the "Letters of Guarantee platform" contributed more broadly  In ensuring the rights of the beneficiaries due to electronic supervisory oversigh, and recommendation, it is necessary: to develop the platform’s work and work to create an additional field in the platform and develop it in broader areas by making the customer’s account linked to the platform to support customer operation.    Originality/Value: The value of the study was finance, as well as "documents related to in-kind guarantees,especially real estate that is mortgaged,y" are provided with the validity of electronic issuance with the availability of advanced means to detect them if theyd areforged to encourage the use of technology more widely in state departments andf electroniccontrol and to achieved electronic governance, and accordingly the research structure consisted of four chapterss: the first axis is the research methodolog;, the second axis is the theoretical aspec;, the third axis is the practical aspect of the researc;, and the fourth axis is the conclusions and recommendations

Assessment of knowledge and foot self-care practices among diabetes mellitus patients in a tertiary care centre in Makkah, Saudi Arabia: a cross-sectional analytical study

Introduction: diabetic foot is a common long-term complication of uncontrolled diabetes mellitus. Knowledge about foot self-care practices among diabetic patients in Saudi Arabia is limited. Thus, the aim of this study was to assess the level of patients´ knowledge and practices regarding self-care of diabetic foot among diabetic patients. Methods: a cross-sectional analytical study was conducted using a sample of diabetic patients attending outpatient clinics at Heraa Diabetic Center, Ministry of Health, Makkah City, Saudi Arabia from June 2020 to July 2020. The participants were interviewed through a self-administered questionnaire inquiring sociodemographic factors, patients´ knowledge and practices regarding foot self-care. Results: a total of 409 patients were included in this study. Respondents' ages ranged between 6 and 75 years with a mean of 42.5 years and standard deviation of 13.9 years. Females represented 51.1% of the participants. Type 2 diabetes represented 85.6% of the responses. Overall, most of the participants (72.4%) had a poor level of knowledge whereas only 4.2% expressed a good level of knowledge. Being employed (P = 0.046), type II diabetes patients (P = 0.047) and those whose main source of information was health staff (P = 0.026) were more knowledgeable compared to their peers. Almost two-thirds (63.3%) of patients showed a poor level of practice related to diabetic foot self-care. Conclusion: low level of knowledge and practice of foot care are prevalent among diabetic patients attending outpatient clinics at Heraa Diabetic Center. Designed interventions should be implemented to enhance diabetic foot self-care

Contemporary Endodontic Sealers

Endodontic treatment over goes multiple phases to ensure long term successful outcome. Starting with an accurate diagnosis and treatment planning, through proper debridement and disinfection of the root canal system. Finally maintaining a sterile environment of the pulpal space, by filing its root’s with an inert biocompatible material and securing it with a final restoration, a process known as obturation. Accordingly, quality of the seal was shown to be an influencing factor in the long term success of an endodontic treatment, as root canal obturation act as a barrier isolating both periapical tissue and radicular space from ingress of microbial contaminant, and promotes healing as it entombs any remaining pulpal or microbial irritants. (1)(2) Traditionally, root canal obturation consist of a core material most typically gutta-percha (GP), and some sort of an endodontic sealant to produce a homogenous filling. (3) These Sealers play a major role in obturation by overcoming the physical limitation of the core material, they help to seal minor anomalies, accessory canals and foramina, and fill any voids between root canal walls and core material. (4)  Sealers also facilitate placement of core material. (5)(6) While the broader objective of these sealers is to ban microbial ingress, some sort of micro leakage does occur in almost all types of sealant used. (7) Apart from antimicrobial activities, ideal properties desired in an endodontic sealer were outlined by Grossman. These sealers must be biocompatible or at least non-toxic, insoluble in tissue fluids but dissolve in retreatment solvent, and must display excellent sealing ability. Other include; appropriate adhesion to dentinal walls, bacteriostatic, dimensionally stable, provide adequate working time, radiopaque, and must not stain the tooth. (8) Unfortunately, no available sealer displays all of these properties yet. (9) In light of this, selection of any type of an endodontic sealer could therefore affect treatment outcome. (10-13) Root canal sealers are available in various quantities and have been grouped in a number of arrangement according to either their chemical composition, usage, or tissue absorbance (14) This paper will touch upon conventional ones and will attempt to introduce contemporary and new ones

Evaluation on the SPT Based Design Approach for Shallow Foundations

This research evaluated four SPT-based design equations used to estimate the carrying capacity of shallow footing. Using different methods, two plate load tests performed on silty clay and clay soil in Nasiriyah have been used to obtain the ultimate load-carrying capacity. Further, this study aims to utilize the finite element method based on Plaxis 3D foundation software to simulate the behavior of load settlement of the foundation with actual dimensions. It was concluded that the numerical analysis methods showed a good convergence to the actual test results, where the numerical results were 67 and 65 ton/m2 for two projects, respectively. The field values were 70 ton/m2 for projects with a number of possibilities in determining the failure areas of the soil to give a sufficient picture of the load expectations. The boundary of the influence zone obtained by the finite element method has functioned as an influence zone proposed for a new proposed equation which gave a good convergence with the measured bearing capacity values

Does emergency medicine clerkship change students' misconceptions towards this specialty? Pre- and post-clerkship perceptions

Objective: This study aims to understand students' skills based on their self-assessment and their perceptions regarding emergency medicine (EM) physicians, EM patients, and choosing EM as a future career. Methods: This study employed prospective observational design. It was conducted from 2 October to 2 November 2022 in Saudi Arabia. The study participants were senior medical students at King Faisal University. Senior students who finished a four-week EM rotation were involved as post-cases, and senior students who had not finished their EM rotation were involved as pre-cases. An online survey was administrated to all students who met out criteria. Results: A total of 161 students were included in the study; 65.2% had not yet done their EM clerkship, while 34.8% had completed their EM clerkship. Among them, 48.4% were male, and 51.6% were female. On average, post-EM clerkship students showed greater confidence in their skills of conducting an initial assessment of a patient (p=0.027), developing a management plan (p=0.007), explaining the principles of EM to others (p<0.001), presenting patient cases formally (p=0.049), interpreting electrocardiogram (p=0.006), and applying medical resuscitation (p=0.041). No significant differences were found between the average confidence in the skills and abilities of male and female students. Post-EM clerkship and male students were more likely to choose EM as a career when compared with pre-EM clerkship (p<0.001) and female students (p=0.006). Conclusion: It seems that, after completing a four-week rotation, students exhibited significant advances in knowledge, illness management, and procedural skills. It is likely that the EM clerkship significantly improved students' perceptions of the EM specialty

3D effects of a bone-anchored intra-oral protraction in treating class III growing patient: a pilot study

Objectives: The aim of this prospective case series study is to assess the three-dimensional (3D) skeletal and soft tissue effects of the alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol in conjunction with a miniscrew-supported class III elastic wear in class III growing patients. Materials and methods: Fourteen consecutive participants (mean age 12.05 ± 1.09 years), who displayed class III malocclusions with retrognathic maxillae, were recruited. A cone beam computed tomography (CBCT) scan was acquired before commencing treatment (T1). All participants were treated with a tooth-bone-borne rapid maxillary expansion (hybrid MARME) appliance that was activated by the Alt-RAMEC protocol for 9 weeks. This was followed by full-time class III elastics, delivering 400 g/side, to protract the maxilla. When a positive overjet was achieved, protraction was ceased and a post-treatment CBCT scan (T2) was taken. The 3D analysis of pre- and post-treatment CBCT scans was blinded. The scans were registered on the anterior cranial base. The Euclidean distance between the two extracted surface models of the pre- and post-treatment scans was displayed as a color surface map. Results: All participants completed the intervention successfully. The majority of the participants showed protraction of the anterior maxillary region (71.4%) and in the zygomatic processes (64.2%). The maxilla significantly protracted (SNA 1.87° ± 1.06°; Vert.T-A 3.29 ± 1.54 mm), while the mandibular base significantly redirected posteriorly (SNB − 2.03° ± 0.85°, Vert.T-B − 3.43 ± 4.47 mm) and that was reflected on the ANB and Wits measurements. No adverse effects were observed. Conclusion: Class III elastics combined with the Alt-RAMEC activation protocol of the hybrid MARME appliance is an effective treatment method for mild/moderate class III malocclusions. A long-term follow-up and comparisons with other treatment modalities are required

Survival Rate of Patients with Cardiothoracic Injuries in Road Traffic Accidents, and their Relationship with ISS, GCS and blood transfusions.

Severe thoracic trauma is one of the major causes of injury-related mortality. In the United States, thoracic trauma results in one-fourth of all trauma deaths. Globally, cardiothoracic trauma is also a major contributor to mortality. The most common cardiothoracic injuries include rib fractures, thoracic vertebral fractures, haemothorax, pneumothorax, flail chest, and lung contusions. The purpose of the present study was to determine the survival rate of patients with cardiovascular injuries in road traffic accidents and its relationship with ISS, GCS and blood transfusions at King Khalid Hospital. This study is a useful addition to the literature, as research in this topic is lacking. A total of 189 patients were transported to the hospital with cardiothoracic injuries during the study period. Data was gathered regarding age, gender, nationality, vehicle user type, anatomical region injured, Intensive Care Unit (ICU) admission, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), blood transfusion, treatment and mortality rate. The neurological status was assessed using the GCS score. Injury Severity Scores were calculated to categorize the injury severity. The mean patient age was 31.81 years, with a peak age of between 21–30 years. Males predominated (93.7%) with a male to female ratio of 15:1. Most of the patients were Saudi nationals (61.3%). Overall mortality was 7.9%. Factors that were significantly associated with mortality were head and neck involvement, ICU admission, age (above 60), treatment delivered, and blood transfusions. Cardiothoracic trauma is associated with a high mortality rate, which may depend on the clinical presentation such as GCS, ISS, degree of shock, pattern of injuries, and associated injuries. Immediate management is vital for patients with life-threatening cardiothoracic trauma, as mortality is high if the diagnosis is missed, wrong or left untreated

Perception and satisfaction of stakeholders regarding the patient care area pharmacist initiative in a military hospital in Saudi Arabia

Purpose: To explore the perceptions and satisfaction of stakeholders (physicians, nurses, and pharmacists) regarding services provided by the patient care area pharmacist (PCAP) initiative. Methods: This was a cross-sectional study conducted at Prince Sultan Military Medical City (PSMMC). The questionnaire was hand-delivered to a random sample of stakeholder groups (including physicians, nurses, and pharmacists) in three different areas of the hospital: the neonatal intensive care unit (NICU), high dependency unit (HDU), and pediatric nephrology. The questionnaire consisted of three sections. The first section collected demographic information of the participants, and the other sections collected anonymous opinions regarding services provided by the PCAP. Results: Ninety-nine participants, comprising physicians (n = 27; 27.27 %), nurses (n = 55; 55.55%), inpatient pharmacists (n = 13; 13.13%), and PCAPs (n = 4; 4.04%), participated in the survey. A majority of the respondents (92.3 %) were satisfied with the PCAP services, and all respondents recommended expansion of the PCAP service to cover all wards. Conclusion: The findings show that all participants have a positive perception of the PCAP service; PCAPs were seen by the participants as drug experts, and their recommendations were perceived as clinically relevant. All stakeholders sought to continue working with the PCAP. Keywords: Patient care, PCAP, Attitude, Satisfaction, Pharmac

Prevalence and correlates of diastolic dysfunction in patients with hypertension: a cross-sectional study from in The Kingdom of Saudi Arabia

Introduction: diastolic dysfunction refers to impaired ventricular relaxation or filling regardless of ejection fraction and symptoms. It accounts for 8% and 25% in the hospitalized and general population, respectively. The present study was conducted to determine the prevalence and correlates of diastolic dysfunction in hypertensive patients living in Saudi Arabia. Methods: a multicentric, cross-sectional study was conducted from February 2019 to February 2020 at King Khalid Hospital and Prince Sultan Center for Health Services, Prince Sattam Bin Abdulaziz University hospital in Al Kharj, and Al Kharj Military Industries Corporation hospital, KSA. All patients with hypertension who underwent an echocardiography were included in the study. Logistic regression analysis was performed to determine factors associated with left ventricular diastolic dysfunction (LVDD). Results: the study included a total of 104 participants, where 51.9% were females andthe mean age of the patients was 48.01±12.81 years.Most patients had an abnormal echocardiography finding (64.4%, n = 67). The most common abnormalities were left ventricular (LV) hypertrophy (44.2%, n = 46), and diastolic dysfunction, (35.6%, n = 37). The study revealed that age (aOR: 6.1, 95% CI 1.17-31.3; p = 0.032) and dyslipidemia (aOR: 3.45, 95% CI 1.16-10.24; p = 0.026) have significant association with LVDD in the patients with hypertension. Conclusion: in conclusion, diastolic dysfunction is prevalent among older hypertensive patients and those with dyslipidaemia. Age and dyslipidaemia were non-modifiable and modifiable factors associated with LVDD in hypertensive patients, respectively