# Al Muhalab Bin Aby Sufra Hall, Ibri, Oman, 16 September 2024

## TL;DR

The paper discusses the role of fungi in health and disease, introduces a new method for diagnosing Staphylococcus aureus using a 'bacterial aura' sign, and explores genetic associations in Omani SLE patients.

## Contribution

A novel morphological sign, 'bacterial aura,' is introduced for rapid diagnosis of Staphylococcus aureus in blood cultures.

## Key findings

- The 'bacterial aura' sign in Gram staining showed 85.7% efficacy in diagnosing Staphylococcus aureus.
- TLR9 SNPs rs352139 and rs5743836 were not associated with SLE risk but influenced aCL antibody production and thrombocytopenia.
- Dexmedetomidine is expected to reduce postoperative emergence agitation in children undergoing ENT surgeries.

## Abstract

It is now commonly acknowledged that fungi exist in various environments and play important roles. While most fungi are beneficial to humans, others can be harmful and may infect people, animals, and plants. Fungi are known to be used in preserving food, particularly in pickling and fermentation, and are present in a number of our favourite foods, including cheese and bread. However, fungi can also produce mycotoxins and contribute to food spoilage. Pathogenic fungi may spread through specific foods and cause food poisoning. Fungi have significantly contributed to human health and well-being around the world. Their value to humans is demonstrated by their applications in industries such as medicine. Fungi also serve as essential decomposers in most environments. For many plants to thrive, the presence of mycorrhizal fungi is necessary. Fungi are consumed directly as food in the form of mushrooms and are also used as fermentation agents in the production of cheese, bread, soft drinks, and various other food products. Anticoagulants and antibiotics are examples of drugs derived from secondary metabolites of fungi. In addition, numerous fungi are employed in research laboratories as model organisms to study eukaryotic metabolism and genetics. In this talk, we discussed the main health issues related to fungi. These include increased patient risk, growing resistance to many antifungal treatments, limited testing for fungal infection diagnosis, and a shortage of effective antifungal medications. Furthermore, we highlighted some of the new fungal species that our research team has discovered, both in Oman and worldwide.

Staphylococcus aureus bacteraemia is a serious and frequent disease with high mortality rates. As a result, early detection is critical for initiating proper therapy. The goal of this study is to assess the accuracy of blood culture gram staining in conjunction with the discovery of a morphological sign we refer to it as ‘Bacterial aura’ and other several morphological characteristics in order to diagnose either Staphylococcus aureus or coagulase-negative staphylococci. The method will provide timely and effective delivered service, especially for critically ill cases.

A two-year period and single-centre prospective research is conducted in IRH. Standard blood culture bottles were utilised (BD BACTEC FX; Becton, Dickinson, and company 9 Loventon Circle, MD 21152 USA). Bacterial species were identified and the minimum inhibitory concentration was determined in Ibri Regional Hospital using the available testing methods VITEK2 and conventional method; if necessary, samples are forwarded to CPHL for identification using MALDITOF MS. Gram staining is done on bottles that showed signs of growth of only gram-positive coccus in groups for all nationalities, any other criteria that do not fulfil the previous criterion is to be excluded. Data will be analysed by SPSS and ethical clearance is obtained from the Centre of Studies and Research (CSR/MOH/26795).

The study showed an efficacy of true diagnosis of 85.7%, considering 14.3% not being able to detect due to the fact the samples were later identified as MRSA.

The available initial results suggest that the “bacterial aura” sign found in Gram staining of positive cocci has the potential to forecast positive S. aureus in BD BACTEC blood culture bottles. The method will be significantly a valuable addition to low-laboratory settings which is the case in most of the regional hospitals inside and outside Oman.

The specific aims of this study were to determine (1) the genotype and allelic frequency of TLR9 SNPs rs352139 and rs5743836 in Omani SLE patients and healthy control; (2) the association of TLR9 SNP genotypes with the risk of SLE; (3) the association of TLR9 SNP genotypes with APL antibodies; and (4) the association of TLR9 SNP genotypes with thrombocytopenia.

The study population included two groups: 99 adult Omani patients who have been diagnosed with SLE and attending the Rheumatology Clinic at Sultan Qaboos University Hospital (SQUH) for follow-up and 96 apparently healthy volunteers. The whole blood was collected from each study participant, and genomic DNA was isolated. The amplified DNA samples were sequenced using Sanger sequencing and their sequences were analyzed to identify TLR9 SNP genotypes.

There was no significant association between the TLR9 SNP rs352139 and rs5743836 genotypes and susceptibility to SLE in this study population. However, we found that rs352139 GG and rs5743836 CC genotypes were significantly associated with the occurrence of anti-cardiolipin (aCL) IgM (P = 0.034 and P = 0.028, respectively). In addition, rs352139 GG genotype was significantly associated with the thrombocytopenia (P = 0.0078). In contrast, rs352139 AG genotype was significantly associated with protection from developing thrombocytopenia in SLE patients (P = 0.0109).

TLR9 SNPs rs352139 and rs5743836 are not associated with the risk SLE among Omani population. However, the results suggest that both TLR9 SNPs may have an influence on aCL antibody production and rs352139 may affect the development of thrombocytopenia in Omani SLE patients.

Post Operative emergence agitation (POEA) or Emergence agitation (EA) is a common complication encountered in paediatric patients undergoing ENT surgeries, in particular adenotonsillectomy. Emergence agitation not only increases the incidence of postoperative bleeding, respiratory distress, and recovery time but also causes dissatisfaction in patients, parents and treating physicians. When it comes to protecting children having these procedures from EA, no established protocols exist. Different anaesthesiologists employ different medications for the same purpose.

We have planned a retrospective, observational study to see the presence and severity of POEA in children less than 8 years old undergoing adenotonsillectomy under general anaesthesia (GA) with sevoflurane with or without intravenous dexmedetomidine, in Ibri Regional Hospital. This study will cover the period from 01 July 2022 to 30 Jun 2023 and the study population will be all children who underwent adenotonsillectomy under GA during this period in IRH. Emergence agitation (EA) is evaluated in the postoperative period using a four-point AONO Score. The severity of EA is evaluated by the Paediatric Emergence Delirium Score (PEDS).

We expect the results will show that children who were given dexmedetomidine had lesser EA as compared to those who were not given dexmedetomidine. We also expect to find different severity of EA depending on different dose of dexmedetomidine used.

We expect to conclude that adding a particular dose of injection dexmedetomidine as part of the GA with sevoflurane will lead to a decrease in post operative emergence agitation in children undergoing adenotonsillectomy and therefore improve outcomes of the surgery and lead to better patient comfort and safety

Iron overload in patients with transfusion-dependent beta-thalassemia (TDT) is a major risk factor for hepatic fibrosis. Transient elastography (TE) is a promising noninvasive tool for the evaluation of hepatic fibrosis. Herein, we assessed the effectiveness of TE in predicting liver fibrosis among chronically patients with TDT.

This was a longitudinal study in which TE (FibroScan) with other hematological and iron overload parameters including serum ferritin (SF), liver iron content (LIC) by magnetic resonance imaging (MRI) T2* and the fibrosis-4 (FIB-4) score, were measured during a daycare visit in a cohort of adult patients with TDT followed at a single health center. Linear regression model was used to assess associations among study parameters.

A total of 91 eligible patients with a median age of 33 years underwent TE. Hepatitis C positivity and splenectomy were detected in 38% and 34% of the patients, respectively. Almost 50% of the patients were taking chelating agents. The median values and interquartile of TE, MRIT2*, LIC and SF levels were 6.38 (2.6) kPa, 32.4 (18) milliseconds, 7(9) g/dry wt., and 1881 (2969) ng/mL, respectively. Significant positive correlations were evidenced among TE measurements, SF (r = 0.43, P < 0.001), but not with MRIT2* or FIB-4 (P = 0.90). Longitudinal studies showed a significant improvement in hepatic fitness with the median TE values decreased from 8.4 to 6.4 kPa (P < 0.001).

Collectively, these findings demonstrated that TE is an effective method for assessing liver fibrosis in patients with TDT and correlated well with other measurements of tissue iron overload, namely the serial SF and MRI T2* measurements.

Healthcare innovation extends beyond quantifiable metrics such as traditional metrics of Research & Development expenses, patents, and multi-sectorial partnerships. Hence, the need to incorporate various service improvements and practice-based innovations that are often overlooked. This study examines the concept of ‘hidden innovation’ within the healthcare sector, focusing on the Royal Hospital and how it recognizes and fosters these un-captured innovations.

Employing a mixed method study, this research utilizes a qualitative and quantitative approach to gather insights into the Royal Hospital's innovative practices. Data collection methods include semi-structured interviews with hospital staff across various departments, analysis of internal documents related to the innovation activities.

The study reveals a preliminary results of a diverse array of ‘hidden innovation’ adoption activities during the time of January 2023 to February 2024 at the Royal Hospital. Product Innovations: More than 70 innovations adopted, including pharmaceutical, surgical items and medical equipment that introduced enhanced disease and practice management. Technological Innovations: Two major AI-assisted diagnostics projects funded by external partnership. Sustainability Innovations: Implementation of sustainable water piping and LED lighting. Regulatory Innovations: Adoption of 17 new quality standards policies.

The Royal Hospital's initiative to create an effective approach for identifying and managing hidden innovations demonstrates the vast potential of recognizing and nurturing innovation beyond traditional metrics. The findings highlight the importance of developing inclusive and flexible frameworks for innovation in healthcare settings, offering valuable lessons for other institutions seeking to maximize the full spectrum of innovation activities within their operations.

The outbreak of severe acute respiratory syndrome coronavirus 2 has emerged as public health worldwide. This study aimed to assess the mental health burden of postpartum population during COVID-19 pandemic, and to explore the potential influence factors. In a cross-sectional study 500 postnatal women at 18 to 45 years of age 2-48 weeks after birth were recruited via convenience sampling method in Mazandaran primary health centers (2020). World Health Organization Domestic Violence Questionnaire and Edinburgh Postnatal Depression Scale (EPDS) were used in assessing individual's intimate partner violence (IPV) and postpartum depression (PPD). The univariate and multivariate logistic regression were used to see which socio-economic-demographic and obstetrics variables have significant relationship with IPV and PPD during period of pandemic. We hope our study findings will provide data support for the target intervention.

To evaluate patient satisfaction with diverse sedation agents, to explore the frequent adverse effects in the Omani population, and to assess the adequacy of medication dosages used in practice locally.

It was multi-center descriptive cross-sectional study involving 116 patients presenting to the Emergency Departments of four different hospitals (Khoula Hospital, Ibri Hospital, Nizwa Hospital, and Sohar Hospital). A validated questionnaire was used to test overall patient satisfaction in three groups of procedural sedation agents (ketamine alone, midazolam with fentanyl, and ketamine with propofol-ketofol). Data analysis was conducted using the SPSS system.

The outcomes of the study indicate a notable level of satisfaction across all sedation methods, average scores nearing 9 out of 10, with no statistically significant differences between the three groups (P = 0.939). Overall satisfaction was not affected by all the sedation agent's dosage, except in propofol with minimal statistical significance (P = 0.049). Adverse effects were noted in 15.5% of the cases, with hypoxia emerging as the most frequent complication, accounting for 9.5% of these instances.

Overall procedure sedation satisfaction was high in all the agent groups without statistical difference. Adverse effects were minimal and mainly hypoxia, managed with simple maneuvers. The study limitations, such as missing data, and subjectivity in decision-making and reporting, might restrict its global applicability. Future larger, blinded, randomized studies should examine the effects of different dosage of various procedure sedation agents on patients' satisfaction.

This case study documents a rare manifestation of Takotsubo Cardiomyopathy (TCM) secondary to status epilepticus in a patient diagnosed with herpes simplex encephalitis (HSE). A 50-year-old male with a history of type II diabetes mellitus presented to the emergency department with active tonic-clonic convulsions. Management included intravenous diazepam, phenytoin, and sedation with endotracheal intubation to secure the airway. Hemodynamically, the patient exhibited hypotension, requiring inotropic support. Therefore, the RUSH protocol was conducted and revealed left ventricular apical dilatation and a significant reduction in the ejection fraction, leading to the diagnosis of Takotsubo cardiomyopathy. Further investigations confirmed herpes simplex encephalitis.~ After receiving intensive care management for approximately two weeks, the patient was discharged in good condition with mild neurological disability (Rankin scale 2). Subsequent echocardiograms indicated normalization of cardiac ejection fraction and satisfactory cardiac wall motion. While the precise pathophysiological mechanisms linking TCM and status epilepticus remain incompletely understood, theories involving sympathetic surge, catecholamine toxicity, and neurogenic stunning have been proposed. This report presents a rare instance of TCM secondary to status epilepticus in the context of herpes simplex encephalitis.~ Timely diagnosis, supportive care, and appropriately managing both conditions are essential to achieve favourable outcomes. Enhanced awareness among healthcare practitioners can facilitate identification and intervention in similar clinical scenarios.

Chronic Pseudomonas aeruginosa (PsA) infections in cystic fibrosis (CF) patients pose significant challenges, impacting morbidity and mortality. Early detection and treatment are crucial for successful eradication. Objectives: This single-center retrospective cohort study aimed to assess early PsA eradication success rates and explore eradication strategies for initial PsA infections.

Sultan Qaboos University Hospital's electronic medical records were reviewed to identify CF patients treated between January 2006 and January 2022 with PsA isolated from airway cultures. Patients meeting the criteria had either a first positive PA culture or the initial positive culture within 2 years.

45 patients with 54 initial positive PsA airway cultures were identified. Patient ages ranged from 7 months to 32 years, with a median age of PsA onset at 4 years. Sputum samples comprised 59.3% of culture specimens, followed by swab samples at 35.2%. Interestingly, 25.9% of initially cultured PsA were mucoid type, and 3.7% were MDR-PsA. Eradication treatment was attempted in 59.3% of episodes, with 59.4% success and a 47.3% recurrence rate within 2 years. The primary PsA eradication approach involved a 2-week course of oral ciprofloxacin combined with a three-month regimen of inhaled tobramycin or colistin (40.6%), followed by oral ciprofloxacin monotherapy (21.9%). Notably, only one out of seven patients receiving oral ciprofloxacin achieved successful eradication (14.3%), with recurrence. In contrast, thirteen patients receiving a combination of inhaled tobramycin or colistin with oral ciprofloxacin had successful eradication (76.9%).

Establishing a standardized hospital protocol for managing initial positive PsA cultures in CF patients is essential, following global guidelines. Enhanced airway culture surveillance is warranted to detect PsA early, especially with the high prevalence of mucoid PsA in initial cultures.

Due to the world's desperate need to develop new approaches for water treatment, the current study aims to synthesize new adsorbents with potential adsorption capacity, thermal stability, and resistance to the microenvironment pH changes.

The hydrogel beads are formulated by combining chitosan and nanoemulsion containing Tween 80, Span 20, water, and oil (palm, pine, or mixed palm/pine oils). The prepared chitosan-nanoemulsion hydrogel beads are characterized by different instruments such as SEM for morphology characterization, FTIR for structural identification, DSC, and TGA for thermal stability.

The research findings demonstrated the presence of heterogeneous pores (10–100 μm) within the produced beads with good thermal stability up to 100°C. The adsorption capacity of the beads illustrated their good ability to adsorb various stains and salts within one hour.

The produced chitosan-nanoemulsion beads have promising potential to remove the impurities in the water.

My research studies aimed to combine many essential oils, such as flaxseed, algal, sesame, avocado, orange, lemon, sage, rosemary, frankincense, carrot…etc, with the tween80/span20 blend in aqueous solutions.

The anticancer activities of these nanoemulsions uploaded with chemotherapeutic agents as well as their side effects were evaluated in vitro and in vivo using mainly cytotoxicity screening assay kits, light microscopy and apoptotic assay kits.

The research findings revealed the improved antitumor activities of the drugs including considerable reduced minimal inhibitory concentrations (IC50) and enhanced apoptotic effect. In addition, the assessment of the antimicrobial activity and wound healing capacity for the essential oil-nanoemulsions exhibited significant effect relative to the conventional therapies.

Essential oils loaded in emulsification systems have promising and potential effect as chemotherapeutic agent.

Serology is the method of choice for the detection of D antigen; however, it has limitations. This is a case report analysis based on studying the molecular background of serological D negative in Omani population. Rh (D,C,c,E & e) phenotyping was performed using Bio-Rad ID-card. D negative was further assessed for weak D by mixing 0.8% RBCs with Bio-Rad ID-DiaClon Anti-D in BioRad ID-Card Coombs rabbit Anti-IgG. For molecular RHD gene testing, singleplex real-time PCR was performed using RHD exon specific primers. The sample was further assessed by BaGene partial D-TYPE & BAGene RH-TYPE. Serological Rh phenotyping were observed to be D$-$ C+ c+ E$-$ e+ (Figure 1). However, BAGene RH-TYPE showed the existence of C, c, E, e alleles (Figure 2) that is inconsistent with serological Rh phenotyping. We present a possible novel DBS-0 like allele case with serological E negative phenotype unlike DBS-0 with partial E phenotype. RHCE transcript analysis would further confirm our finding.

To study families with intellectual disability (ID) in order to uncover the coding variants in genes associated with the risk of this prevalent developmental disorder. Identifying the underlying causatives is a crucial stride in comprehending its pathophysiology.

Homozygosity mapping, whole-exome sequencing, and co-segregation analyses were applied to pinpoint gene variants accountable for syndromic ID featuring autistic characteristics in two distinct consanguineous families hailing from the Arabian Peninsula. To conduct in-vivo functional studies on the implicated gene's role in cognition, Drosophila melanogaster and mice with targeted interference of the orthologous gene were utilized. Phenotypic testing involved behavioral assessments, electrophysiological evaluations, and structural magnetic resonance imaging analyses.

The presence of homozygous premature termination codons in PDZD8, responsible for encoding an endoplasmic reticulum–anchored lipid transfer protein, exhibited co-segregation with syndromic ID in both families. Drosophila melanogaster with knockdown of the PDZD8 ortholog displayed impaired long-term courtship-based memory. In mice homozygous for a premature termination codon in Pdzd8, deficits were observed in brain structure, hippocampal spatial memory, and synaptic plasticity.

These findings underscore the implication of homozygous loss-of-function mutations in PDZD8 in a neurodevelopmental cognitive disorder. Model organisms featuring manipulation of the orthologous gene replicated aspects of the human phenotype, suggesting plausible pathophysiological mechanisms focused on disrupted brain development and synaptic function.

The purpose of this study is to assess the effects of dextrin and maltodextrin on insulin resistance and type 2 diabetes.

A comprehensive review was undertaken to investigate the effects of dextrin and maltodextrin on insulin resistance and T2DM. Relevant studies were collected from sources such as PubMed, Scopus, and Web of Science, with the literature search extending through December 2023. Only human individuals were considered, allowing for a more concentrated analysis of the effects.

The review includes thirty studies. The findings revealed that resistant dextrin significantly improves insulin sensitivity and positively affects serum lipid profiles in people with T2DM. Maltodextrin data, on the other hand, was more diverse; although some research suggested it could decrease glycemic management, others found no evidence to support this claim. This demonstrates the complexity of its effects and the variety among participants.

The review reveals that resistant dextrin improves insulin sensitivity and lipid metabolism, most likely by modulating the gut flora. However, the research on maltodextrin suggests that it should be used with caution in populations at risk for or managing T2DM. Future studies, including Part 2 of this series, will use direct HPLC analysis to further study the biochemical interactions and mechanisms by which these dietary fibers influence T2DM, aiming to provide a clearer understanding of their role in dietary management of this condition.

HIV/AIDS is a global health issue, notably in the Middle East and North Africa (MENA). Inadequate HIV/AIDS knowledge among nurses may compromise PLWHA care. Stigmatizing attitudes and poor adherence to universal precautions.

This cross-sectional study examines nurses' PLWHA knowledge, attitudes, and practices. 563 nurses from five major governmental hospitals in Oman, across four governorates, completed a paper-based, self-administered questionnaire. The sampling method was convenient sampling.

Nurses' knowledge of HIV/AIDS was considered unsatisfactory, with a mean score of 14.30 ± 3.75 out of 28. Positive relationships were observed with older age, experience, education, and HIV/AIDS training (P < 0.001). Nurses demonstrated moderate attitudes (M = 34.60 ± 4.73 out of 50) toward caring for PLWHA, but 71.4% were worried about contracting HIV/AIDS and 41.7% thought PLWHA should be separated. In addition, 64.8% of nurses rarely or never cared for PLWHA. The study revealed significant positive correlations between knowledge-practice (r = 0.284, P < 0.001), knowledge-attitude (r = 0.254, P < 0.001), and attitude-practice (r = 0.97, P = 0.02). Despite 80.3% not receiving HIV/AIDS training, 68.4% showed interest in attending HIV/AIDS training programs.

This study highlights HIV/AIDS knowledge gaps and the need for training. It also reveals that improving nurses; knowledge can improve nurses; attitudes and practices toward PLWHA. The study suggests improving the HIV/AIDS education policy to improve the quality of care provided for PLWHA and eliminate the disease in the MENA region.

Oral route is considered as one of the most reliable routes for the administration of medicine. However, there are a few challenges in terms of degradation of the active drug due to digestion or degradation in GIT. This study aimed to modify the mucosa's physiological environment by administering active medicines through sublingual drug delivery devices. The natural mucoadhesive polymers have demonstrated features that can be adjusted to optimize their effectiveness. Due to their extended residence period and ability to provide patient comfort.

Films are always preferred over alternative therapy. The films were characterized using a variety of techniques, such as SEM, XRD, and FTIR, to evaluate the physiological and chemical characteristics of the lisinopril-loaded films.

Accordingly, SEM examinations revealed that our preparation lacked crystallization, and that the nature mixture was homogeneous. XRD data also showed that the amorphousness of the mixture increased directly with drug concentration. Our compounds hydrophilicity and lipophilicity characteristics are due to the presence of certain functional groups, as indicated by FTIR. Overall, the results are outstanding across all criteria.

Due to the minimal bioavailability due to the hepatic first pass effect, this drug always failed in achieving maximum therapeutic dose at the site of action; to increase the bioavailability and therapeutic effects, drug can be delivered via sublingual route.

This study aimed to establish a local reference range (RR) for serum free light chains (sFLC) and heavy light chains (sHLC) among healthy Omani adults.

This prospective observational cross-section study was conducted on healthy Omani adults aged 18 to 65 years. A total of 302 participants were selected and divided into two groups (155 females,147 males). The exclusion criteria were monoclonal gammopathies, fever, infection, inflammatory and renal disorders. Each participant was requested to answer a questionnaire containing personal data along with current and past medical history. Measurements of sFLC and sHLC were done using freelite and hevylite immunoturbidimetric assays on Cobas and SPA Plus analysers, respectively.

Reference range for sFLC using 95% confidence interval in mg/L was (κ: 11.1-31.8, λ: 8.1–18.1) in males, (κ: 11.0-46.1, λ: 9.0–22.9) in females and for sFLC κ/λ ratio was 1.03–2.37 for both genders. New established RR for κ and λ sFLC in females was higher than in males. Additionally, the RR for κ sFLC and hence sFLC κ/λ ratio were higher compared with that of the manufacturer ranges. Similarly, the RR for sHLC slightly differs (some higher and some lower) from the published manufacturer RR in both genders. However, small gender differences only exist in IgA κ/λ ratio, IgM κ, IgM λ and IgM κ/λ ratio.

It is very important for each laboratory to verify or establish its own local RR for sFLC and sHLC as they may differ from manufacturer ranges.

The present study aims to prepare, characterize and evaluate the biological activity of nanoemulsions consisting of three essential almond, lavender and rosemary oils.

Two samples of each essential oil were prepared. The first formula contained 5% essential oil, 9% tween 80, 6% span 20, and 80% water. The second formula contained 2% essential oil, 10.8% tween 80, 7.2% mL span 20, and 80% water. The six formulas were physically and chemically characterized by means of FTIR and UV-Visible spectroscopy. The biological activities were assessed by the enzyme inhibition assays for α-glucosidase, urease, prolyl endopeptidase and tyrosinase enzymes.

The FTIR and UV-Visible spectra demonstrate the formation of the o/w micelles dispersed in the nanoemulsion formula evident through subtle shifts and alterations in the emulsion peaks, closely aligning with those of water. All tested samples showed a degree of inhibitory activity against tyrosinase and α-glucosidase enzymes while suggested being biologically inactive against urease and prolyl endopeptidase. The lavender formula (5%) demonstrated the highest percent inhibition of tyrosinase enzyme (80.15%) while having the lowest IC50 value (39.70 ± 1.20) μg/ml among other samples. The α-glucosidase inhibition of the 5% oil formula for almond, lavender and rosemary oils exhibited much lower IC50 values of (64.17 ± 0.25) μg/ml, (57.11 ± 0.86) μg/ml and (30.29 ± 0.75) μg/ml, respectively compared to standard acarbose (377.26 ± 1.20) μg/ml.

Nanoemulsion formulas of almond, lavender and rosemary oils were successfully prepared with potential biological activity.

Identify the fashion of sustainable materials and experiments of researchers in the field of biomaterials.

The descriptive approach: characteristics of materials that allow the production of sustainable fashion. The classification of biomaterials and methods of preparing some of them. The experimental approach: in preparing some biomaterials. Laboratory practices, preparation, and sample characterization. The applied experiment for orange, cactus and kombucha biofabrics.

Biomaterials provided surface appearances and aesthetic features that distinguish them from conventional textile materials. Experimental conditions and preparation processes can be controlled so that various aesthetic results can be obtained for biomaterials, such as color, thickness, and transparency. The study presented an application for a women's abaya made of sustainable cotton material decorated with a bio-based material produced from orange peel.

(Fast fashion) is one of the negative results of the industrial revolution, it encourages hyper consumption. Sustainable thought began to appear in production a few decades ago. One of the most prominent and under-experimented trends in clothing production is biomaterials, such as spider silk, and mushroom skin. The current study provided a description of some types of biomaterials and the method of preparing. It also presented an applied experiment for preparing biomaterial from oranges and decorating a sustainable women's abaya. The results aim to display the product in exhibitions to promote sustainable thinking and practice of clothing within the Sultanate of Oman.

Ensuring equitable access to quality medical services for individuals with disabilities is a critical aspect of healthcare provision. This has also been a subject of substantial interest among researchers worldwide. This research aims to further enhance the ongoing discourse surrounding disability-inclusive healthcare practices by advocating for more inclusive and accessible medical services for all.

Specifically, this idea seeks to investigate how healthcare providers can effectively address challenges related to difficult venous access and patient anxiety related to intravenous injections. The proposed solution is the development of a smart sticker that can efficiently identify a suitable vein and automatically administer the prescribed medicine.

This intelligent sticker eliminates the necessity for human intervention during prescription dispensing. Its versatile application across all healthcare facilities and age demographics makes it a highly efficient and effective method for prescription delivery to patients.

The development of such a solution has the potential to significantly improve the quality of healthcare for individuals with disabilities, and further enhance the inclusive and accessible medical services for all.

This study aims to predict cancer incidence and mortality rates for the year 2025 in Oman, providing valuable insights into the country's cancer burden.

Using data spanning from 2000 to 2023 sourced from the National Center of Statistics in Oman, we employ a comprehensive approach of prediction. A linear regression model is utilized to analyze observed age-specific cancer rates over the specified timeframe, with subsequent projections made by multiplying these rates by the expected age-specific population for 2025. Additionally, artificial intelligence techniques, including machine learning algorithms, are employed to refine our predictive models. Moreover, an anchor regression model is implemented to identify significant linear trends in recent data, enhancing the accuracy of our projections.

Upward trend from 2000 to 2019 with a drop in 2008. Whether this drop is a start of a downward trend or not remains to be seen. Significantly higher number of patients among older (65+) compared to other types of cancer. No significant gender effect. Higher numbers in Muscat but could simply be a result of the larger population size in Muscat compared to other regions.

This study contributes to the understanding of cancer epidemiology in Oman, aiding in the formulation of effective public health policies and interventions.

The goal of the present study is to find a natural product that is acceptable to patients, has fewer side effects, and has an antidepressant activity of orange peel oil extracts.

Orange peel oil (OPO) was selected to find the most effective dose that provides a significant antidepressant effect. The fruit was obtained from Nizwa University Botanical Garden. The essential oil was separated by hydro distillation method and then analyzed by GC-MS. The antibacterial effect of OPO was tested against four bacterial strains by the disc diffusion method. The cytotoxic effect was determined using the BSL method. The enzyme inhibition potential against α-glucosidase, carbonic anhydrase II, prolyl endopeptidase, and tyrosinase was screened too. The antidepressant action was checked in vivo by the tail suspension method using CD1 mice.

The GC-Ms analysis showed that, major component of OPO was limonene 96.57%. The peel oil demonstrated very good antioxidant activity at various concentrations ranging from 82–85%. The highest antibacterial activity was against Gram + Staphylococcus aureus (9–7 mm) followed by Streptococcus pneumonia (9–6.5 mm). For gram-negative bacteria, the activity was around (9–6.5 mm) for Klebsiella pneumonia and (8–7 mm) for Escherichia coli. The cytotoxic activity was good with an IC50 of about 324.47 μg/mL against shrimp larvae. The enzyme inhibition potential was best against prolyl endopeptidase and α-glucosidase followed by tyrosinase and carbonic anhydrase II, 93%, 92%, 76%, and 27% respectively. For antidepressant screening, OPO showed a potent anxiolytic response at 200 mg/kg dose, the immobilization time was 104.8 sec while the citalopram (positive control) showed 58.5 sec.

These findings suggest that OPO may be used as a natural food preservative or as an effective treatment for a number of diseases.

HRQoL indicators are reliable for both people and groups, and they go beyond the scope of conventional biological outcome measures in gauging well-being. The main goal of the study was to measure the self-perceived health status of their own health and the physical and emotional functioning of students to highlight the benefit of being in a healthy state.

This study, which involved students who needed to achieve academic success, was carried out at the Ibri learning communities in Oman between January 2024 and March 2024. Regardless of their location, the subjects receiving treatment at various healthcare facilities with abundant access to high-quality healthcare services were included in this retrospective analysis.

In all, 75 subjects were involved in the research, HRQoL was supported by the samples that were obtained through random sampling. The majority of them prefer territory healthcare facilities due to their socioeconomic status (SES). A version of SPSS 20.0 was utilized for the statistical computations and a P-value of less than 0.05 was deemed statistically noteworthy. The lower sample size resulting from the shorter study period means that the results could not be generalized. Results indicated that there were no statistical differences between subjects.

Based on the findings, the researcher suggests designing longitudinal studies to assess how treatment outcomes are impacted by quality of life. The study underscores the need to educate women about diseases at an earlier age and shows that health knowledge has increased in the Al-Dhahirah region. Furthermore, delving into the correlation between academic excellence and seasonal health challenges offers a chance to evaluate how stress and lifestyle elements influence mental health. Attaining high academic standards might coincide with increased stress levels, potentially worsening seasonal health conditions and affecting overall psychological strength.

Antibiotics are chemical compounds used as medicine to treat infectious diseases as well as inhibit bacterial growth. Currently, antibiotics are widely used in the poultry sector to increase meat production and prevent infections. The antibiotic residue in poultry in our diet create significant human health problems. This aimed to study the quantitative and qualitative antibiotic residue characteristics in the poultry of Al-Batinah Governorate, Sultanate of Oman,

antibiotic residues were extracted applying the Oxy-tetracycline group (group 1) and Ciprofloxacin group (group 2) of antibiotics in the breast meat and kidney of local broiler chickens and the breast meat in the imported chickens by using MS/Q-TOF.

The experimental results showed that all the analyzed antibiotics were present in the kidney and breast meat for local chicken and in breast meat for imported chicken samples. Among the five commonly used antibiotics, gentamicin is present in the local breast meat samples in a high concentration for both Al Safwa and Waeel farms compared to the maximum residue level (MRL). In the imported meat samples and kidney samples in the local broiler chicken, the amount of all analyzed antibiotics was within the MRL values. Although chloramphenicol is a hazard to human health and prohibited from being used in food animals, it is present in all local and imported chicken samples.

all the imported and local broiler meat and kidney contains the five analyzed antibiotics within the MRL values, except gentamicin was the high amount in the local breast meat.

Triple-negative breast cancer (TNBC) is a highly aggressive breast cancer subtype that lacks progesterone receptor, estrogen receptor, and human epidermal growth factor receptor-2 expression. It is derived from about 27 cell lines, including MDA-MB-231. Chemotherapy individually or in combination with surgery and/or radiotherapy remains the current standard treatment, despite its low efficiency. Therefore, designing a new therapeutic agent is significant. Recent studies have shown that the main component of honeybee venom (BV) called melittin, possesses anti-cancer activity. Thus, this review is aimed to study the anti-cancerous effect of melittin on TNBC from the MDA-MB-231 cell line. The objectives of this study are to assess the cell viability and apoptosis of MDA-MB-231 cells post-treatment.

To meet the purpose of this review, PubMed and Google Scholar databases were used to select six articles out of 699 studies. Cell viability was measured by luminometric assay and colorimetric assays. Additionally, apoptosis was assessed by flow cytometry and DAPI staining;

The results demonstrated that melittin caused a significant decrease in cell viability, and induced apoptosis.

BV and melittin have the potential to be an effective treatment for patients with TNBC originating from the MDA-MB-231 cell line. However, melittin has severe side effects involving hemolysis when injected intravenously. Further researches ongoing to overcome them.

At every shift handover the complex information exchange and transfer of responsibilities can result in communication errors which could have a negative impact on patients' safety. Therefore, effective nursing handover procedures are imperative to patient safety and the quality of patient care. The aim of this research paper is to answer the PICO question: in med-surgical unit nursing does using the SBAR handover communication tool result in reducing clinical incidents compared to a non-standardised tool (verbal handover).

A literature review was undertaken to examine the impact of structured handover tools on nurses' satisfaction and patient's safety. The main three themes were nurses' perception on shift handover, the barriers and strategies for effective structured handover and the impact of structured handover communications on patients' safety and outcome.

The ‘Situation-Background-Assessment-Recommendation' (SBAR) handover tool has been shown to improve quality of the handover process.

A transformational leadership style was used to implement Tuckman's model to form a team and a PDSA cycle to pilot the SBAR tool in a surgical ward. Result in implementation of SBAR tool in a medical-surgical unit.

Simulation-based learning has become popular approach that mimics real-world environment and provides learners practical insights. It is used in various fields such as health care, aviation, agriculture, economic, mathematics, physics, chemistry, mathematics, statistics and others. Simulation can make abstract science phenomena more accessible and visible to learners. It helps learners visualize the phenomenon that might otherwise be difficult to depict. It can animate dynamic changes in scientific processes that are difficult to infer from static illustrations found in the textbooks.

In this study, we cast light on using simulation-based learning to learn statistics and mathematics. A sample from University of Nizwa were subjected to an experiment to investigate the effect of taking some mathematical and statistical topics by Monte Carlo simulation. The students performed a comprehension exam and responded to a questionnaire after the course had been finished.

The results showed high marks and good positive attitudes towards learning through Monte Carlo simulation. It helped them cope with many problems easily and with fun. It also increases their interest and motivation in their studies. It gives them chance to test their knowledge and detect gaps in their understanding of concepts. Learner is given chance to design and explore different scenarios, rather than just do calculations.

This approach promotes better comprehension, allowing learners to figure out the fundamentals without becoming overwhelmed by complexity.

The number of cases of cardiovascular diseases (CVD) is huge, and it has impacted and influenced morbidity and mortality. The modifiable and non-modifiable factors both trigger the occurrence of CVD. The study's general objectives are to examine the knowledge on cardiovascular disease, associated risk factor and awareness with regards to its prevention, to assess the behavioral lifestyle attitude regarding compliance on prevention of CVD among the young adults' population and to examine the relationship between the knowledge and the attitude.

Quantitative descriptive cross-section research design was utilized for the research activity. The study was conducted among adults (20–44 years old) in AL Dakhiliya Governorate in the Sultanate of Oman. The actual participants of the study were 300. The data was collected through a survey.

Among 300 participants, 46% have moderate knowledge level followed by 31.7% having poor knowledge whereas the fewest percentage have good knowledge with 22.3%. On the attitude part, the majority 64.3% have moderate level followed by good attitude level by 31% and the least who have poor attitude level by 4.7%.

The finding of the study showed that there is moderate level of knowledge about CVD risk factors, signs, and symptoms among the subjects. Additionally, the participants have moderate behavioral lifestyle attitude toward prevention of cardiovascular disease. Also, it showed that there is a positive relationship between knowledge and attitude. As knowledge increases, the attitude toward healthy lifestyle patterns increases too.

The objective of this study was to determine risk factors, outcome of infection, antimicrobial resistance patterns of carbapenem-resistant nonfermenting gram-negative bacilli (NFGNB) isolated in a secondary-care hospital, and to ascertain the optimal treatment modalities.

This retrospective study was carried out at Sohar Hospital. The study encompassed carbapenem-resistant NFGNB isolated from clinical samples of patients hospitalised in Sohar hospital between January 2017 and December 2021. The pertinent data of the study subjects, including demographic characteristics, antimicrobial resistance pattern of isolates, risk factors, and infection outcomes, was retrieved from the electronic health records of the hospital. The data was analysed utilizing the Statistical Software STATA version 14.

During the study period, 233 out of 1201 NFGNB strains (19.4%) were identified as being resistant to carbapenem. Most of the strains were acquired in the hospital setting (76%) and were more commonly found in males (61.2%). Many pathogens were primarily isolated from endotracheal secretions (28.8%), urine (23.6%), and blood (19.3%). Carbapenem resistance was more frequent in A. baumannii (59.3%, 144/243). Furthermore, A. baumannii exhibited high-level resistance to most antibiotics except for colistin and tigecycline. The independent risk factors for mortality (P < 0.05) were superimposed bacterial sepsis in COVID-19 patients, exposure to mechanical ventilation, central-venous catheterization, and haemodialysis.

Adherence to antibiotic stewardship guidelines and infection control procedures is of utmost importance for healthcare personnel to effectively combat antimicrobial resistance and uphold the efficacy of existing antimicrobial agents against carbapenem-resistant NFGNB.

car accidents one of the leading causes of the morbidity and mortality among infants and children. It is a global problem that affects both developed and developing countries. In addition, automobile accidents risks and deaths can be reduced by using a safety restraint. However, knowledge about children car restraints is limited among Oman. The main aim of this study is to shed light on the knowledge of mothers about children's safety in cars. It also aims to investigate if there is a relationship between the mother's awareness about children's safety in cars and the increased number of children's car injuries in Oman.

This is cross-sectional study in the form of a survey which included 132 Omani mothers with a full-term vaginal delivery at Sultan Qaboos University Hospital. SPSS was used to analyse the data.

The majority of the participants were middle ages female with high and intermediate educational certificates. Of 132 respondents, 34.85% seated a child in the car seat while 65.15% do not have a child car seat. Few mothers are aware about using the seat belt and reported that using seat belt always 31.06%, while 37.88%never use a seat belt in the car.

This study provided a new information about mother's awareness and practice regarding child car seat usage in Oman, that could help in reducing the rate of morbidity and mortality between infants and children.

To isolate nitrogen fixing bacteria from the soil of the Prosopis sp. plant and estimate their nitrogen fixing capacity.

In total, 32 colonies were isolated from deep 30 cm and the surfaces of the soil near the Prosopis sp plant at dilution factor 10–6. The isolates were identified as coccus or rod in shape based on the Gram staining.

The results shows that strain D.1.4 was the highest producer compared to other strains with capacity reach to 5.429 mg/l and the lowest one is strain D.1.7 present capacity 3.994 mg/l of ammonia. Moreover, further analysis is to characterize the isolated bacteria and identify it and measure the capability and ability of this bacteria to produce ammonia and use it to rise the effectiveness of ammonia production in industry file.

the isolated bacteria have a high ability to fix nitrogen which helps in making a bio-fertilizer for agricultural uses to reduce industrial wastes and gases while making ammonia in the industry to contribute to decreasing the climatic changes and increasing energy security.

This study aimed to investigate the ameliorative potential of astragaloside IV (AS IV) against Atrazine (ATZ)-induced male reproductive toxicity in mice.

Eight-week-old CD-1 mice underwent a one-week acclimatization period before random allocation into four equal groups (n = 10): Vehicle control, ATZ, AS-IV and ATZ. ATZ and AS-IV were given via oral gavage at a dose of 100 mg/kg/day and 40 mg/kg/day, respectively. Treatments persisted for 21 days, followed by sacrifice for plasma biochemical analysis and testes collection for histopathological examination. One-way ANOVA followed by Bonferroni's multiple comparison test was used for the data analysis. Ethical approval was obtained from the Sultan Qaboos University Animal Ethics Committee prior to experimentation (SQU/EC-AUR/2022-2023/2).

Biochemical analysis revealed significant reductions in the glutathione levels (P < 0.05), superoxide dismutase (P < 0.05) and glutathione peroxidase activity (P < 0.05), alongside elevated malonaldehyde levels (P < 0.05) following ATZ exposure. AS IV treatment in ATZ-exposed mice significantly improved these markers (P < 0.05). ATZ exposure led to significant decreases in testosterone (P < 0.05) and androgen binding protein (ABP) levels (P < 0.05) within the ATZ group, whereas AS IV treatment in ATZ-exposed mice markedly increased the testosterone P < 0.05) and ABP levels (P < 0.05). Histopathological examination revealed sloughed and collapsed seminiferous epithelium with vacuoles and poorly formed spermatids in ATZ-exposed mice, which was mitigated by AS-IV treatment.

AS-IV emerges as a promising natural compound for averting atrazine-induced male toxicity. Further investigations elucidating the molecular mechanisms behind such positive effects are warranted.

Fractionation, extraction, fractionation, and isolation of bioactive compounds from A. dhofarica. Screening of the extract, fractions, and compounds against different biological activities. In Silico modeling approach of the active compounds to see the drug-like properties. Validation of computational results through in vitro testing of the active compounds against the most suitable predicted target.

In the current study, methanol (ADAM) extracts and their fractions, including chloroform (ADAC), ethyl acetate (ADAE), n-hexane (ADAH), and aqueous (ADAA) fractions, were prepared from aerial parts of Anogeissus dhofarica and evaluated for phytochemical assessment, high-resolution electrospray ionization mass spectrometry (HR-ESI-MS) analysis, isolation, and in vitro bioassays.

The study analyzed samples from A. dhofarica, revealing all representative groups except alkaloids. The ADAE fraction had the highest total phenolic content, while the ADAM extract had the highest total flavonoid content. HR-ESI-MS identified twenty-two bioactive ingredients, mainly from sub-class flavanones. The ADAE extract showed antimicrobial activity against Staphylococcus aureus and Candida kruzei, and showed maximum scavenging potential. The ADAE extract was most effective against breast cancer cell lines and had a 70% mortality rate. The brine shrimp lethality assay demonstrated a correlation with the in vitro cytotoxicity assay, showing the ADAE extract as the most active, with a 70% mortality rate and an LC50 of 300.1 μg/mL. Furthermore, gioassay guided isolation of n-hexane and EtOAc fractions of the understudy plant species afforded one new natural product (lupeyl butyl ether, 1) along with sixteen known metabolites (2–17) reported from this source for the first time.

all the tested samples, especially the ADAE and ADAM extracts, have significant capabilities for the investigated activities that could be due to the presence of the bioactive compounds.

Progression and treatment outcome of colorectal cancer (CRC) vary significantly based on the primary tumour location, with right-sided and left-sided CRCs showing distinct clinicopathological profiles and treatment responses. These differences are crucial for developing tailored treatment strategies and effective screening in the face of rising global CRC incidence.

This single-centre retrospective cross-sectional study included 321 patients diagnosed with CRC between 2008 and 2018 at Sultan Qaboos University Hospital. Data was collected from the hospital electronic health information system, including patient demographics, tumour side, stage, grade, treatment modality, and survival outcomes.

There was no significant association between the side of CRC and gender or age of patients. However, tumour stages and grades significantly differ, with a higher prevalence among left sided CRC (LCC) compared to right sided CRC (RCC). The majority of patients presented at advanced stage, with significant differences observed in stage II, which is more common in RCC than LCC. The 5-year survival rates were similar for both RCC and LCC groups.

This study found left-sided colon cancers (LCC) more prevalent than right-sided (RCC). RCC showed a female predominance, while LCC was more common in males, and both types were mostly grade II, with RCC having more grade III cases. Despite worse prognostic features in RCC, survival rates between RCC and LCC were similar, often due to late-stage diagnosis.

Omeprazole, as a proton pump inhibitor (PPI), inhibits the hydrogen-potassium ATPase pump on the parietal cell membrane, effectively blocking stomach acid output. Omeprazole is the most widely used acid-suppressing medicine, with common side effects of headache, nausea, vomiting, diarrhea, stomach discomfort, and constipation. Erectile dysfunction is a rare reported adverse effect of omeprazole. A 38-year-old smoker-nonalcoholic man with gastrodoudenitis and no other significant medical history developed profound erectile dysfunction and loss of libido within 6 months of initiating omeprazole therapy. At the time of the episode, the patient was taking no other medications or supplements. Importantly, his erectile difficulties resolved within 10 days of discontinuing omeprazole. Further research is necessary to elucidate the underlying mechanisms and determine the prevalence of this adverse effect. Clinicians should consider PPIs as a possible cause of ED, particularly in patients without clear risk factors. When managing patients with ED, a thorough medication history, including PPI use, is crucial for accurate diagnosis and treatment planning.

This study aims to establish a relation between COVID-19 infection and drug abusers and know the impact of the COVID-19 infection on drug abusers.

This was a retrospective study in which drug abusers admitted to the Emergency Department (ED) at Sultan Qaboos University Hospital (SQUH) were studied. Demographic characteristics, clinical presentations, and outcomes of drug abusers with COVID-19 infection were collected between 1st March 2020 to 1st March 2021. Data were analyzed using SPSS software.

Over one year, 150 drug abusers were admitted to the ED. 104 (69.3%), drug abusers had a COVID-19 PCR test. A total of 9 cases (8.65%) were identified with COVID-19 infection, and most of them were males (88.9%). At the time of presentation, 22.2% of drug abusers with COVID-19 infection showed hepatic complications with hepatitis B or E, leading to a 5.5 and 26.9 increased risk of getting infected with COVID-19, respectively. Drug abuser patients with COVID-19 infection have an 11.4 increased risk of death along with worse outcomes as 88.9% were admitted, and with a mortality rate of 33.33%.

The prevalence of COVID-19 infection among drug abuser population was relatively high, as well as the mortality rate. Hepatic complications were the most associated with COVID-19 positive drug abusers. Patients with hepatitis B or hepatitis E virus are more prone to COVID-19 infection. Further studies are required to extend these findings along with the predictive factors associated with COVID-19 infection in drug abusers.

Patients with known or suspected HIV infection who come with symptoms such as fever, cough, headache, or malaise provide a diagnostic challenge to the emergency physician. A CD4 count of fewer than 200 cells/mm3 strongly predicts vulnerability to opportunistic infections.

We executed a retrospective data analysis of consecutive CD4 count assays done at Ibri Regional Hospital between January 1, 2015, and December 31, 2023. Consecutive CD4 counts and ALC were assessed concurrently in samples taken in inpatient, clinic, and emergency department settings. Statistical analysis tests were conducted to assess ALC's ability to predict a CD4 count of fewer than 200 cells/mm3. Data will be analysed by SPSS and ethical clearance is obtained from the Centre of Studies and Research (CSR/MOH/26792).

Over 300 samples were investigated, belonging to 197 patients. Based on the Pearson correlation analysis, ALC shows a statistically significant moderate positive correlation with CD4 count. This suggests that ALC can be used as a predictor of CD4 count to some extent. However, the correlation is not very strong (r = 0.369) which is 36.9%, so while ALC can provide some predictive information about CD4 count, it is not a perfect predictor. Further analysis, such as logistic regression and ROC curve analysis, can provide additional insights into the predictive power and practical utility of ALC for predicting CD4 counts, especially for clinical decision-making purposes.

The available preliminary results indicate that there is a correlation between the CD4 count and ALC from CBC, however, further statistical analysis using powerful tests is required along with a larger sample size extending to cover other regional hospitals. ALC and CD4 count have a consistent association.

Leaf curl viruses pose a significant threat to solanaceous crops, impacting agricultural productivity and food security. This research focuses on the molecular characterization of leaf curl viruses affecting solanaceous crops in Oman.

The research employs advanced molecular techniques for the genomic mapping of different leaf curl virus strains prevalent in Omani solanaceous crops. By analysing key genetic markers, we seek to uncover the genetic diversity of these viruses across different regions of Oman. Our study also delves into the host specificity of various strains, shedding light on how different crops respond to viral infections. The implications of this research extend to practical applications in Omani agriculture.

The molecular characterization of leaf curl viruses infecting solanaceous crops in Oman holds profound significance for the nation's agricultural landscape and broader socio-economic context. Several key aspects underscore the importance of this research to Oman: Food Security, Agricultural Economy, Sustainable Agriculture Practices, Local Farmer Empowerment, Collaborative Research Culture, International Agricultural Reputation. In essence, the molecular characterization of leaf curl viruses in Omani solanaceous crops is not only a scientific endeavour but a practical and impactful initiative with far-reaching implications for the well-being of the nation. It aligns with Oman's goals of ensuring food security, promoting sustainable agriculture, and fostering a resilient and thriving agricultural sector.

our research on the molecular characterization of leaf curl viruses infecting solanaceous crops in Oman will provide valuable insights into the intricate relationship between these pathogens and the agricultural ecosystem.