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BACKGROUND: New multiple myeloma (MM) medications have revolutionized the treatment landscape, but they are also associated with a range of adverse events (AEs). This study aims to provide a comprehensive overview of AEs reported for four new MM medications: daratumumab, ixazomib, elotuzumab, and panobinostat. METHODS: This study uses a descriptive retrospective approach to analyze the FDA Adverse Event Reporting System (FAERS) from 2015 to 2022. It includes variables like medication names, report details, patient demographics, adverse events, and reporter types. The initial dataset consists of over 3700 adverse events, which are categorized into 21 groups for clarity and comparison. RESULTS: The FAERS database revealed 367,756 adverse events (AEs) associated with novel multiple myeloma drugs from 2015-2022. Ixazomib had the highest number of reported AEs with 206,243 reports, followed by daratumumab with 98,872 reports, then elotuzumab with 26,193 AEs. Ixazomib's AE reports increased dramatically over the study period, rising approximately 51-fold from 1183 in 2015 to 60,835 in 2022. Of the medications studied, ixazomib also recorded the highest number of deaths (24,206), followed by daratumumab (11,624), panobinostat (7227), and elotuzumab (3349). The majority of AEs occurred in patients aged 55-64 and 65-74 years. CONCLUSIONS: Ixazomib, a new MM medication, had the highest number of AEs reported. Also, it has the highest rate of reported deaths compared to other new MM medications. Clinicians should be aware of the potential AEs associated with this medication and further research is needed to understand the reasons for the high number of AEs and to develop mitigation strategies. More attention should also be paid to the safety of new multiple myeloma medications in younger patients.

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The current study investigated the primary and secondary compressibility characteristics of organic clay with two biopolymers, Chitosan (Dch) and Casein (Dca) at dosages of 0.5%, 1%, 2%, and 4%. The primary compression index (Cc) values were reduced by 18% and 59% at dosage (Dch and Dca) of 4% at a consolidation pressure of 800 kPa. The secondary compression indices of chitosan and casein-treated soils fell below the normal range specified for organic soils and lay in the range of 0.01-0.017. The biopolymers also accelerated the consolidation process at all dosages (Dch) and 2% Dca. The hydraulic conductivity increased for all dosages of chitosan whereas it declined for all dosages of casein compared to untreated soil. The reliability analysis was conducted for biopolymer-treated soils and presented a rational approach toward the selection of a suitable liner. Chitosan failed to achieve a target reliability index of 3 whereas casein-amended samples attained values equal to and greater than 3 at all dosages and consolidation pressures at COV of Kmax = 20%. At all dosages, the casein-treated soils exhibited reliability index values greater than 3 up to COV of Kmax = 40% indicating the higher stability of casein mixes as a liner material.

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Background Celiac disease is an autoimmune disorder triggered by gluten and related prolamines, which can cause a variety of symptoms and complications if left untreated. Despite being a common lifelong disorder, it often goes undiagnosed for a long time, leading to negative impacts on patients' health and quality of life. The diagnosis of celiac disease requires the presence of celiac-specific autoantibodies and distinctive histological changes in the small intestinal mucosa. Lack of disease knowledge among healthcare professionals and patients' adherence to gluten-free diets may contribute to diagnostic delays. Objectives This study aims to assess the reasons for celiac disease underdiagnosis and identify the functional deficiencies of healthcare professionals in the diagnosis and treatment of celiac disease, particularly in the Saudi population. Materials and methods A cross-sectional, questionnaire-based study was conducted among physicians in the Eastern Province of Saudi Arabia during the year 2023, between May and July. Participants were asked to complete an online self-administered questionnaire that included questions about their demographic characteristics, professional experience, and knowledge and attitudes toward celiac disease. The study recruited gastroenterologists, gastroenterology fellows, internal and family medicine specialists, residents, and general practitioners working in private or public health centers in various cities of the Eastern Province. Results The data were collected from 180 physicians who fulfilled the inclusion criteria of the study, with most participants aged under 30 years and predominantly male. Family medicine and general practitioners were the most represented specialties. While 49.4% of physicians knew that adult celiac disease was rare, only 19.4% frequently recommended celiac disease serology to their patients. In terms of risk, most physicians knew that adult celiac disease was a moderately severe and disabling disease, but only 24.4% thought that the cancer risk in patients with celiac disease was moderate. About 75.6% of physicians had an overall poor knowledge level regarding celiac disease, with gastroenterologists and internal medicine specialists demonstrating better knowledge compared to other specialties (P = 0.001). Conclusion The study found that a majority of physicians in the Eastern Province of Saudi Arabia had poor knowledge about celiac disease. This lack of knowledge could have implications for patient care, as it could lead to delays in diagnosis, inadequate treatment, and increased risk of complications.

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Recently, the improvement of the engineering properties of soil has been centered on using sustainable and eco-friendly materials. This study investigates the efficacy of three biopolymers: Acacia, sodium alginate, and pectin, on the unconfined compressive strength (UCS) of dune sand. The UCS test measured the effects of the biopolymer type and concentration, curing intervals and temperature, and moisture loss. The changes in the morphology caused by the biopolymer addition were examined via scanning electron microscopy (SEM). Results indicate that the UCS of the biopolymer-modified sand increased with biopolymer concentration and curing intervals. Varying the curing temperature from 25-110 °C, slightly affected the strength of the acacia-modified sand specimen, increased that of the sodium alginate-modified sand specimen up to a temperature of 85 °C, and continued to decrease that of the pectin-modified sand specimen as the temperature was increased from 25 to 110 °C. The SEM images indicated that the biopolymer's presence within the sand pores significantly contributed to the strength. Bond decomposition occurs at temperatures greater than 110 °C for sodium alginate and pectin-modified sands, whereas bonds remain stable at higher temperatures for the acacia-modified sand. In conclusion, all three biopolymers show potential as robust and economic dune stabilisers.

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The utilization of industrial by-products as stabilizers is gaining attention from the sustainability perspective. Along these lines, granite sand (GS) and calcium lignosulfonate (CLS) are used as alternatives to traditional stabilizers for cohesive soil (clay). The unsoaked California Bearing Ratio (CBR) was taken as a performance indicator (as a subgrade material for low-volume roads). A series of tests were performed by varying the dosages of GS (30%, 40%, and 50%) and CLS (0.5%, 1%, 1.5%, and 2%) for different curing periods (0, 7, and 28 days). This study revealed that the optimal dosages of granite sand (GS) are 35%, 34%, 33%, and 32% for dosages of calcium lignosulfonate (CLS) of 0.5%, 1.0%, 1.5%, and 2.0%, respectively. These values are needed to maintain a reliability index greater than or equal to 3.0 when the coefficient of variation (COV) of the minimum specified value of the CBR is 20% for a 28-day curing period. The proposed RBDO (reliability-based design optimization) presents an optimal design methodology for designing low-volume roads when GS and CLS are blended for clay soils. The optimal mix, i.e., 70% clay blended with 30% GS and 0.5% CLS (exhibiting the highest CBR value) is considered an appropriate dosage for the pavement subgrade material. Carbon footprint analysis (CFA) was performed on a typical pavement section according to Indian Road Congress recommendations. It is observed that the use of GS and CLS as stabilizers of clay reduces the carbon energy by 97.52% and 98.53% over the traditional stabilizers lime and cement at 6% and 4% dosages, respectively.

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Polymers have attracted widespread interest as soil stabilizers and are proposed as an ecologically acceptable means for enhancing the geotechnical properties of soils. They have found profound applications in diverse fields such as the food industry, textile, medicine, agriculture, construction, and many more. Various polymers are proven to increase soil shear strength, improve volume stability, promote water retention, and prevent erosion, at extremely low concentrations within soils through the formation of a polymer membrane around the soil particles upon hydration. The purpose of this work is to provide an overview of existing research on synthetic polymers for soil improvement. A fundamental evaluation of many synthetic polymers used in soil stabilization is provided, Furthermore, the impact of different polymer types on the geotechnical parameters of treated soil was assessed and compared. Limiting factors like polymer durability and the effect of changing climatic conditions on the engineering behavior of the polymer-treated soils have been critically reviewed. The dominant mechanisms responsible for the alteration in the behavior of polymer-soil admixture are reviewed and discussed. This review article will allow practicing engineers to better understand the intrinsic and extrinsic parameters of targeted polymers before employing them in real-field scenarios for better long-term performance.

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Kikuchi-Fujimoto Disease (KFD) is a rare self-limiting condition of unknown etiology. It is characterized by fever, and lymphadenopathy most commonly involving posterior cervical lymph nodes. Although it is of uncertain etiology, it is associated with viral infections and autoimmune diseases. Distinction from lymphadenopathy-associated alternate disorders is crucial to avoid unneeded diagnostic procedures and treatment. KFD is diagnosed based on histopathologic examination of the excised lymph node. The management is supportive with favorable outcomes within a few weeks or months. In this case, we describe a 13-year-old boy who complained of painful cervical lymphadenopathy and fever for more than three weeks following COVID-19. Diagnostic workup has been established and KFD diagnosis made based on the histopathologic features of the involved lymph node. The patient showed complete recovery with no recurrence during follow-up. So, this case highlights the possible association between COVID-19 and KFD during this pandemic and keeping it in the differential diagnosis.

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Introduction Adenoid hypertrophy, a common condition in children, represents one of the common indications for surgery in pediatrics. Medical treatment alone is not effective, and most of the time patients are managed by surgical removal of the adenoid. The aim of this study is to assess the safety and efficacy of intranasal Maxitrol® drops (Novartis Pharmaceuticals, Basel, Switzerland) in pediatric patients with adenoid hypertrophy aged less than two years and to document any side effects during its use. Methods This retrospective cohort study was conducted at King Abdullah Specialist Children's Hospital (KASCH). We reviewed the charts of 86 pediatric patients aged less than two years who were diagnosed with adenoid hypertrophy between 2015 and 2018. Patients were grouped according to the type of intervention (use of Maxitrol®, and no use). The follow-up time was up to one year. Results Out of 86 patients, 55 (63.9%) patients had adenoid hypertrophy alone and 31 (36.1%) had adenoid hypertrophy plus another disease. Patients with obstructive sleep apnea symptoms (p=0.026) and grade of adenoid (p=0.040) showed a significant relationship with surgery booking after one year. The probability of booking for surgery for those who used Maxitrol® was 1.394 times higher than for those who were not using it (odds ratio [OR]=1.394; 95% confidence interval [CI]=0.549-3.537). Suppression of growth and eye complications were not reported in any of our patients. Conclusion In this small sample, the use of Maxitrol® in the pediatric age group below two years with adenoid hypertrophy was safe and effective in relieving nasal symptoms; however, eventually, surgery was needed in most of our patients. Suppression of growth and eye complications were not reported in any of our patients during the follow-up time.

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One of the significant issues persisting in the study of soil stabilization is the establishment of the optimum proportions of the quantity of stabilizer to be added to the soil. Determining optimum solutions or the most feasible remedies for the utilization of stabilizing products in terms of their dose rates has become a significant concern in major civil engineering design projects. Using the response surface methodology, this study primarily focused on investigating the optimal levels of reinforcement fiber length (FL), fiber dosage (FD), and curing time (CT) for geotechnical parameters of stabilized soil. To realize this objective, an experimental study was undertaken on the California bearing ratio (CBR) and unconfined compressive strength (UCS). Hydraulic conductivity (HC) tests were also performed, with stabilizer proportions of 6-12 mm for the FL and 0.2-0.6% for the FD calculated for the total dry weight of soil and 6% lime (total weight of dry soil). The curing times used for testing were 0, 7, and 14 days for the CBR tests; 60, 210, and 360 days for the UCS tests; and 7, 17, and 28 days for the HC tests. All practical experiments were conducted with experimental techniques using stabilizer proportions and curing times. The FL, FD, CT, CBR, UCS, and HC response factors were determined using the central composite design. The results point toward a statistically significant model constructed (p ≤ 0.05) using the analysis of variance. The results from this optimization procedure show that the optimal values for the FL, FD, and CT were 11.1 mm, 0.5%, and 13.2 days, respectively, as these provided the maximum values for the CBR; 11.7 mm for the FL, 0.3% for the FD, and 160 days for the CT corresponded to the maximum values for the UCS; and 10.5 mm for the FL, 0.5% for the FD, and 15 days for the CT led to the minimum value for the HC. In practice, the suggested values may be useful for experiments, especially for preliminary assessments prior to stabilization.

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Fabrication of efficient and low-cost adsorbents through enzyme induced carbonate precipitation (EICP) of sand embedded with binding agents for sulfathiazole (STZ) removal is reported for the first time. Sand enriched with biochar (300 °C, 500 °C, and 700 °C), xanthan gum, guar gum, bentonite, or sodium alginate (1% w/w ratios) was cemented via EICP technique. Enrichment with binding agents decreased the unconfined compressive strength, improved the porosity, and induced functional groups. Biochar enrichment reduced the pH, and increased the calcite contents and electrical conductivity. Fixed-bed column adsorption trials revealed that biochars enrichment resulted in the highest STZ removal (64.7-87.9%) from water at initial STZ concentration of 50 mg L-1, than the adsorbents enriched with other binding agents. Yoon-Nelson and Thomas kinetic models were fitted well to the adsorption data (R2 = 0.91-0.98). The adsorbents embedded with 700 °C biochar (BC7) exhibited the highest Yoon-Nelson rate constants (0.087 L min-1), 50% breakthrough time (58.056 min), and Thomas model-predicted maximum adsorption capacity (4.925 mg g-1). Overall, BC7 removed 168% higher STZ from water than pristine cemented sand. Post-adsorption XRD and FTIR analyses suggested the binding of STZ onto the adsorbents. π-π electron-donor-acceptor interactions, aided-by electrostatic interactions and H-bonding were the main STZ adsorption mechanisms.

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This study investigated shear strength behaviour of compacted sand-clay mixtures used as liners, with 10%, 20%, and 30% clay contents. A natural high-plasticity and highly expansive clay found in the eastern province of Saudi Arabia was used. A series of consolidated undrained triaxial tests and pore water pressure measurements of saturated samples with various clay contents and confining pressures was conducted using a computer-controlled Bishop and Wesley triaxial cell. The unit was equipped with pressure volume controllers and a pressure transducer for measuring sample volume changes and excess pore water pressure. The experimental test results indicate that clay content and confining pressure significantly affect stress strain response curves, pore water pressure generation curves, and steady-state shear strength. Sand-clay mixtures with clay content less than 10% showed a tendency toward contractive behaviour. The failure line slope increased in accordance with clay content increase. The deviator stress versus axial strain of saturated sand-clay mixtures indicated a hyperbolic trend. The stress ratio versus axial strain representation was more informative for the shear strength behaviour assessment. Clay content did not significantly affect critical-state friction angle. Scanning electron microscope images of the sand-clay mixtures with different clay contents are presented.

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A 28-month-old boy mistakenly received intranasal atropine sulfate instead of Otrivin (xylometazoline hydrochloride) for the treatment of adenoid hypertrophy. Later on, he came to the emergency department with anticholinergic manifestations after the administration of multiple drops. The child presented with a tonic-clonic seizure lasting for a few minutes, followed by a brief loss of consciousness, vomiting, agitation, and irritability, all of which were stabilized by a dose of intravenous lorazepam. Subsequently, he was admitted to the pediatric intensive care unit for observation. Afterwards, he developed agitation and unsteady gait, both of which resolved after receiving neostigmine. Eventually, the child became asymptomatic and was discharged home. To the best of our knowledge, only one similar case has been reported in the literature. SIMILAR CASES PUBLISHED: 1.

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Specimens of silica sand treated via enzyme induced carbonate precipitation (EICP) showed surprisingly high strength at a relatively low carbonate content when non-fat powdered milk was included in the treatment solution. EICP is a biologically-based soil improvement technique that uses free urease enzyme to catalyze the hydrolysis of urea in an aqueous solution, producing carbonate ions and alkalinity that in the presence of calcium cations leads to precipitation of calcium carbonate. The strength achieved at less than 1.4% carbonate content via a single cycle of treatment was unprecedented compared to results reported in the literature from both EICP and microbially induced carbonate precipitation (MICP). Scanning electron microscope images show that in the specimens treated with the solution containing powdered milk the carbonate precipitate was concentrated at interparticle contacts. The impact of these results include reductions in the concentration of substrate and enzyme required to achieve a target compressive strength, reduction in the undesirable ammonium chloride by-product, and, depending on the desired strength, reduction in the number of cycles of EICP treatment. These advantages enhance the potential for development of a sustainable method of soil improvement via hydrolysis of urea.

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We have developed a novel method to synthesize a hyper-branched biomimetic hydrogel network across a soil matrix to improve the mechanical strength of the loose soil and simultaneously mitigate potential contamination due to excessive ammonium. This method successfully yielded a hierarchical structure that possesses the water retention, ion absorption, and soil aggregation capabilities of plant root systems in a chemically controllable manner. Inspired by the robust organic-inorganic composites found in many living organisms, we have combined this hydrogel network with a calcite biomineralization process to stabilize soil. Our experiments demonstrate that poly(acrylic acid) (PAA) can work synergistically with enzyme-induced carbonate precipitation (EICP) to render a versatile, high-performance soil stabilization method. PAA-enhanced EICP provides multiple benefits including lengthening of water supply time, localization of cementation reactions, reduction of harmful byproduct ammonium, and achievement of ultrahigh soil strength. Soil crusts we have obtained can sustain up to 4.8 × 103 kPa pressure, a level comparable to cementitious materials. An ammonium removal rate of 96% has also been achieved. These results demonstrate the potential for hydrogel-assisted EICP to provide effective soil improvement and ammonium mitigation for wind erosion control and other applications.

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