Entropy optimization and response surface methodology of blood hybrid nanofluid flow through composite stenosis artery with magnetized nanoparticles (Au-Ta) for drug delivery application

Entropy creation by a blood-hybrid nanofluid flow with gold-tantalum nanoparticles in a tilted cylindrical artery with composite stenosis under the influence of Joule heating, body acceleration, and thermal radiation is the focus of this research. Using the Sisko fluid model, the non-Newtonian behaviour of blood is investigated. The finite difference (FD) approach is used to solve the equations of motion and entropy for a system subject to certain constraints. The optimal heat transfer rate with respect to radiation, Hartmann number, and nanoparticle volume fraction is calculated using a response surface technique and sensitivity analysis. The impacts of significant parameters such as Hartmann number, angle parameter, nanoparticle volume fraction, body acceleration amplitude, radiation, and Reynolds number on the velocity, temperature, entropy generation, flow rate, shear stress of wall, and heat transfer rate are exhibited via the graphs and tables. Present results disclose that the flow rate profile increase by improving the Womersley number and the opposite nature is noticed in nanoparticle volume fraction. The total entropy generation reduces by improving radiation. The Hartmann number expose a positive sensitivity for all level of nanoparticle volume fraction. The sensitivity analysis revealed that the radiation and nanoparticle volume fraction showed a negative sensitivity for all magnetic field levels. It is seen that the presence of hybrid nanoparticles in the bloodstream leads to a more substantial reduction in the axial velocity of blood compared to Sisko blood. An increase in the volume fraction results in a noticeable decrease in the volumetric flow rate in the axial direction, while higher values of infinite shear rate viscosity lead to a significant reduction in the magnitude of the blood flow pattern. The blood temperature exhibits a linear increase with respect to the volume fraction of hybrid nanoparticles. Specifically, utilizing a hybrid nanofluid with a volume fraction of 3% leads to a 2.01316% higher temperature compared to the base fluid (blood). Similarly, a 5% volume fraction corresponds to a temperature increase of 3.45093%.

Knowledge and Attitude of Saudi Physicians Toward Cannabidiol for Pediatric Epilepsy: A Cross-Sectional Study

Background Epilepsy is one of the most common neurological diseases. Various institutions have shown an interest to investigate the role of cannabidiol (CBD) in treating pediatric epilepsy. CBD is a chemical extracted from the cannabis plant and lacks the euphoria-inducing characteristic. Despite the FDA approval, the physicians' attitude toward CBD is controversial. Therefore, we aim to measure physicians' knowledge and acceptance of the use of CBD in managing epilepsy patients in Saudi Arabia. Objectives The aim of this study is to measure the knowledge and attitude of physicians regarding CBD use in pediatric epilepsy. Methods In this cross-sectional study, a validated electronic survey was distributed in the period between September 2021 and October 2021 among pediatricians and neurologists at King Abdulaziz Medical City. The survey consisted of four sections: demographics, the perceived knowledge regarding CBD, the knowledge test, and the attitudes toward CBD. Three-scoring systems were established to assess these sections. Results A total of 94 participants were included in this study; 50% of them were males, 81.9% of the participants were in the pediatric field, 13.8% were in the field of neurology, and 4.3% were pediatric neurologists. As for the professional tenure, approximately half of the participants were residents/trainees. Overall, respondents tend to have low perceived knowledge (94.7%) and attitude (93.6%) regarding CBD use. The perceived knowledge and attitude levels were found to be significantly associated with specialty (p < 0.001 and p = 0.001, respectively). Pediatric neurologists had a significantly higher self-assessment score, while pediatricians had the lowest attitude level (p < 0.05). For the knowledge test, surprisingly only one respondent answered all questions correctly, and age was found to be significantly associated with knowledge score (p = 0.001). Conclusion This study demonstrates that physicians have poor knowledge and attitude levels regarding the usage of CBD in pediatric epilepsy. Therefore, more education is highly suggested before the introduction of this medication to Saudi patients.

Treatment Beliefs and Practices towards Low Back Pain among Teachers in Asir Region, Saudi Arabia-A Cross-Sectional Study

The prevalence of low back pain (LBP) is increasing exponentially, with this public health issue affecting over 70% of the population. However, sedentary careers exacerbate the problem further, with professions such as teaching disproportionately affected. In addition, the general population does not seek interventions from medical professionals for LBP; instead, they opt to manage their pain with over-the-counter medications, such as sedatives. The purpose of this study was to explore practices and beliefs related to back pain treatment among schoolteachers in the Asir region. This cross-sectional study included a sample of 312 teachers from the Asir region, with data collected regarding the prevalence of back pain, management approaches, and beliefs surrounding medical interventions. Chi-square or exact tests defined the association between variables, with significance determined at p < 0.05. Our results revealed that 67.3% of Saudi Arabian teachers experienced LBP within the last two months, with a continuous condition representing 36.7% of cases. This study identified several different treatment modalities the participants use to manage their pain, including sedatives, best rest, kaiy (traditional cautery), and local adhesives, with sedatives being the most employed method. It also highlighted that increased daily working hours and total days worked significantly increased the prevalence of LBP (p < 0.05). Although a considerable number of the included teachers were highly educated, with some teaching experience, they had a poor level of awareness and an incorrect attitude towards pain management. Enhanced efforts should be made to improve teachers' awareness regarding back pain causes and management methods.

Metabolic and hormonal changes after laparoscopic sleeve gastrectomy in pediatric population: An observational study

Introduction

Despite the growing popularity of laparoscopic sleeve gastrectomy (SG) for managing severe obesity in children, adolescents, and adults, there is a paucity of studies reporting the effects of SG on metabolic and hormonal outcomes in pediatric populations.

Methodology

In this single-centre, retrospective study, we assessed nutritional biomarkers (hemoglobin, ferritin, iron profile, Vitamin B12, Vitamin D, and calcium), glucose homeostasis indicators (C-peptide, HbA1C, and random blood glucose), blood lipids (triglycerides and cholesterol components), hormones involved in the hypothalamic-pituitary-adrenal axis (cortisol and adrenocorticotropic hormone), and thyroid hormones (T3, T4, thyroid-stimulating hormone, and parathyroid hormone) preoperatively and 12-month after SG in children aged 5-15 years.

Results

This study included 64 adolescents (mean age = 11.2 ± 2.3 years) who underwent laparoscopic SG. Significant reduction in circulatory C-peptide (-62.1%; p = 0.005), HbA1C (-10.9%; p = 0.001), random blood glucose (-15.4%; p = 0.036), and triglycerides (-39.4%; p = 0.003) were observed postoperatively at 12 months compared to baseline. Although we did not observe any changes in cortisol levels, adrenocorticotropic hormone levels declined significantly by -40.9% postoperatively (p = 0.033). However, cholesterol components, thyroid hormones, and nutritional biomarkers remained unchanged from baseline.

Conclusions

Consistent with prior literature, our study demonstrates improvement or resolution of diabetes and hypertriglyceridemia in the year following SG. However, given that blood cholesterol components, nutritional biomarkers, and thyroid profiles remained unchanged warrants long-term monitoring of nutritional, metabolic, and endocrine factors in adolescents undergoing laparoscopic SG. To the best of our knowledge, this is the first study reporting the effects of SG on thyroid and hypothalamic-pituitary-adrenal axis hormones in pediatric populations.

CBCT based study to analyze and classify root canal morphology of maxillary molars - A retrospective study

OBJECTIVE

The study aims to evaluate maxillary molars' root and root canal morphology among the Saudi population using Cone-Beam Computed Tomography scanning (CBCT).

SUBJECTS AND METHODS

Retrospectively, the CBCT scans of 483 Saudi nationals were evaluated to identify the number of roots and root canals in maxillary first and second molars. The records were tabulated and classified according to Vertucci and a new system for root and canal classification given by Ahmed and Dummer. Fisher's exact test was used to analyze the data statistically. To check for symmetry, comparisons were made between all the maxillary first molars (MFM's) and maxillary second molars (MSM's) on opposing quadrants. Inter Observer variability was seen using Cohen's Kappa test.

RESULTS

MFM's presented with three roots with Type II Vertucci canal configuration (VC) commonly seen among them. MSM's had more variations in the number of roots and canals, although three roots and Type I VC were predominantly seen. When comparing the two genders statistically significant difference was observed in both maxillary molars at a 5% level using Fisher's exact test. Three roots with four canals (3R4C) were predominantly observed in the MFM's (85.6%) and three roots with three canals (3R3C) identified in 51.95% were more common than 3R4C (43.55%) in MSM's. Both the maxillary molars bilaterally, exhibited a high percentage of symmetry in root and canal configurations.

CONCLUSIONS

Identification of root canal morphology of molars would reduce the chances of root canal failures by making sure all canals are obturated. This study provides supplemental information about the root canals of maxillary molars in a Saudi Arabian subpopulation.

Assessment of Knowledge of Monkeypox Viral Infection among the General Population in Saudi Arabia

Monkeypox is re-emerging and spreading over the world, posing a serious threat to human life, especially in non-endemic countries, including Saudi Arabia. Due to the paucity of research on knowledge about monkeypox in Saudi Arabia, this study aimed to evaluate the general population’s knowledge of monkeypox in a sample of the country. A web-based cross-sectional survey was conducted from 25 May 2022 to 15 July 2022. Participants’ knowledge about monkeypox on a 23-item scale and socio-demographic characteristics were gathered in the survey. Pearson’s Chi-square test was used to compare knowledge level (categorized into high and low) and explanatory variables. Out of 480, only 48% of the respondents had high knowledge (mean score > 14). Participants’ age, marital status, residential region, living in the urban area, education level, employment status, being a healthcare worker, income, and smoking status were significantly associated with the level of knowledge about monkeypox (p < 0.01). Overall, social media (75.0%) was the most frequently reported source from where participants obtained monkeypox-related information followed by TV and radio (45.6%), family or friend (15.6%), and healthcare provider (13.8%). We found that overall knowledge of monkeypox infection was slightly poor among the Saudi population. These findings highlight the urgent need for public education on monkeypox to promote awareness and engage the public ahead of the outbreak.

Uptake of COVID-19 Booster Dose among Saudi Arabian Population

Backgroundand objectives: Although several vaccines have been produced and administered around the world, new SARS-CoV-2 worsened the COVID-19 infection risk and impacted the initial vaccine dosage effectiveness. Based on studies indicating that the third and fourth COVID-19 vaccine doses significantly reduced COVID-19 transmission, Saudi Arabia has been administering COVID-19 booster vaccine doses to its citizens. The purpose of this study was to evaluate the uptake of the COVID-19 vaccine booster in relation to the socio-demographic characteristics and other associated factors among the Saudi population. Materials and Methods: This study was an online analytical cross-sectional study using a self-administered questionnaire. Pearson Chi-square test and multiple logistic regression analyses were used to determine factors associated with the uptake of COVID-19 booster dose vaccines. Results: A total of 2332 responded to our study. Overall, 527 (22.6%) participants had received a booster dose. An age of 55 and above (aOR: 5.415; 95% CI: 2.719–10.783), Eastern region (aOR: 2.513; 95% CI: 1.566–4.033), history of influenza vaccination at annual intervals (aOR: 2.387; 95% CI: 1.730–3.293), the first dose of Moderna vaccine (aOR: 1.324; 95% CI: 1.160–1.510), and cancer (aOR: 2.161; 95% CI: 1.218–3.879) were independent factors most associated with a higher uptake of the COVID-19 vaccine booster dose. In contrast, the second dose of Moderna vaccine (aOR: 0.794; 95% CI: 0.683–0.922), AstraZeneca vaccine (aOR: 0.691; 95% CI: 0.509–0.939), strong symptoms from side effects after the second dose of the COVID-19 vaccine (aOR: 0.615; 95% CI: 0.404–0.935) were independent factors most associated with a lower uptake of the COVID-19 vaccine booster dose. Conclusions: Our findings indicate low COVID-19 vaccine booster uptake. This necessitates the need for strategies to address discouraging factors of the COVID-19 vaccine booster dose uptake and engage the Saudi population to raise awareness about the importance of the booster dose.

Awareness, knowledge, attitudes, and practices before the second wave of the COVID-19 pandemic in Saudi Arabia

OBJECTIVE

The COVID-19 outbreak was first reported in Wuhan City, China in early December 2019. It was declared a pandemic by WHO in March 2020. This study aimed at assessing the knowledge, awareness, and attitudes of the general population in Saudi Arabia towards COVID-19, as well as its adherence to preventive measures and its willingness to take the vaccine.

PATIENTS AND METHODS

This descriptive cross-sectional study involved an online sample of 7,188 participants (from five regions of Saudi Arabia) who completed a self-administered online-based questionnaire. They were recruited from 23 November 2020 to 29 November 2020 based on the nonprobability convenience sampling method. The self-administered questionnaire comprised four main sections: gathering information about participants' demographics, knowledge and awareness of COVID-19, participants' practices (hygiene and other) against infection, and vaccine acceptability.

RESULTS

More than half of the study participants were knowledgeable about COVID-19. The mean scores were 10.4 (SD=3.44, range: 0-18 - with high scores indicating better knowledge or awareness) for knowledge and 6.1 (SD=2.26, range: 0-11) for awareness, indicating a need for more educational campaigns to improve the level of knowledge and awareness among the Saudi Arabian population about COVID-19. The mean score for attitude was 5 (SD=1.67, range: 0-8 - from 0=very pessimistic to 8=very optimistic), indicating moderate optimism. As for practices, the mean score was 7.8 (SD=1.57, range: 0-10), indicating good practices to prevent or control infection. Concerning acceptability of the COVID-19 vaccine, 63.8% of the participants agreed to take the vaccine if it was proven to be 95% effective.

CONCLUSIONS

The findings of this study can help us designing effective measures against COVID-19 infections. Our results highlight the best practices adopted by the Saudi Arabian population, as well as those areas requiring improvement, including knowledge, attitudes, and practices against this disease.

Melting aspects in flow of second grade nanomaterial with homogeneous–heterogeneous reactions and irreversibility phenomenon: A residual error analysis

Here, we scrutinize the entropy analysis in magnetohydrodynamic flow of second-grade nanomaterials with melting effect subject to stretchable bended surface. Heat attribution is modeled through first law of thermodynamics with radiation effect. Major physical effect of random and thermophoretic motion is also addressed. Feature of irreversibility (entropy rate) analysis is also discussed. Isothermal cubic autocatalyses chemical reaction at catalytic surface is discussed. Nonlinear dimensionless differential system is developed through adequate transformation. Optimal homeotypic analysis method (OHAM) is employed to construct convergent solution. Influence of physical variables on entropy rate, fluid flow, concentration, and thermal field is discussed. An augmentation in fluid flow is noticed through curvature variable, while reverse effect holds for magnetic variable. A reverse effect holds for fluid flow and thermal field through melting variable. Entropy analysis is augmented with variation in melting variable. Reduction occurs in concentration through thermophoretic variable, while an opposite effect holds for thermal field. An increment in melting variable leads to reduced concentration. Larger estimation of radiation variable improves entropy analysis.

Prevalence and factors associated with mental health problems in Saudi general population during the coronavirus disease 2019 pandemic: A systematic review and meta-analysis

This systematic review and meta-analysis generates evidence of the prevalence and associated factors of common mental disorders (i.e., depression, anxiety, and stress) related to the pandemic among the Saudi general population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was performed in the respective databases (e.g., PubMed, Scopus, Web of Science), from 22 July to 17 August 2021, and identified a total of 220 articles. Adhering to the inclusion criteria (i.e., original research concerning the prevalence and/or associated factors of depression and/or anxiety and/or stress disorders among the general Saudi population, published in English peer-reviewed journals), 15 studies were included in this review which consisted of a total of 262,656 participants. The overall prevalence of depression, anxiety, and stress was 30% (95% confidence interval [CI]: 22% to 38%, I²  = 99.58%), 20% (95% CI: 16% to 24%, I²  = 99.32%), and 29% (95% CI: 11% to 47%, I²  = 99.76%), respectively. Risk factors of mental health problems were found to be female sex, younger age group, single/divorced marital status, lower education, lower income, non-Saudis, unemployment status, students, being in a small family and living with elderly of the sociodemographic factors. Smokers, less physical activities, lower resilience, reduced immune status, chronic health problems, and psychiatric illness history were associated with a higher degree of mental health problems. In addition, coronavirus disease 2019 (COVID-19)-related risk factors of mental illness included lack of knowledge, fear, worry and concern, family member or friends' infection or death, lockdown restrictions, quarantine, confirmed or suspected of COVID-19 infection, and even pandemic effects. In conclusion, appropriate mental health preventive approaches for the Saudi general people are highly needed, where this review can be worthy of help by providing in detailed information to the respective authorities.

Electroosmosis modulated bio flow of nanofluid through a rectangular peristaltic pump induced by complex travelling wave with zeta potential and Heat source

Electrokinetic micro peristaltic pumps are important biomechanical devices that help in targeted drugging of sick body parts. The current article is written to focus on mathematical modelling and analysis of some important aspect of such flows in a rectangular duct with wall properties. Effects of zeta potential, heat source and deby length are focused. Carbon nanotubes (CNTs) in the Newtonian base fluid is assumed as drugging material. A comparison of single-walled CNTs (SWCNTs) and multiwalled CNTs (MWCNTs) is also presented. It is considered that the walls are flexible and encapsulating the region with limited permeability. The defined flow problem is modelled and analyzed analytically for the transport of CNT-water nanofluid. It is accepted that the flow is steady, nonturbulent and propagating waves do have a considerably longer wavelength when compared to amplitude. The conditions and assumptions lead to a model of coupled partial differential equations of order two. The exact results by Eigenfunction expansion method are procured and shown accordingly. The predictions about the behaviour of important appearing parameters are displayed for SWCNT and MWCNT -water nanofluid behaviour using figures. The impact of sundry parameters is analyzed. The application of the current study involved transporting/ targeted drug delivery system using Peristaltic micropumps and magnetic field in pharmacological engineering. This article is protected by copyright. All rights reserved.

Binary chemical reaction with activation energy in dissipative flow of non-Newtonian nanomaterial

This paper deals with the entropy optimization and heat transport of magneto-nanomaterial flow of non-Newtonian (Jeffrey fluid) towards a curved stretched surface. MHD fluid is accounted. The modeling of energy expression is developed subject to Brownian diffusion, Joule (Ohmic) heating, thermophoresis and viscous dissipation. Total entropy rate is discussed with the help of fluid friction irreversibility, mass transfer irreversibility, Joule heating irreversibility and heat transfer irreversibility. Binary chemical reaction with the smallest amount of activation energy is further considered. The governing equations of Jeffrey fluid with effects of hydrodynamic, thermal radiation, heat and mass transfer were solved through built-in-shooting method. The flow variables on the entropy rate, velocity field, concentration, Bejan number, skin friction coefficient and temperature are physically discussed through various graphs. The outcomes reveal that the entropy rate increases with an enhancement in curvature parameter. Such obtained outcomes help in mechanical and industrial engineering sciences. Moreover, the velocity and temperature decays versus ratio of relaxation to retardation times are also noticed.

Biomathematical model for gyrotactic free-forced bioconvection with oxygen diffusion in near-wall transport within a porous medium fuel cell

Bioconvection has shown significant promise for environmentally friendly, sustainable “green” fuel cell technologies. The improved design of such systems requires continuous refinements in biomathematical modeling in conjunction with laboratory and field testing. Motivated by exploring deeper the near-wall transport phenomena involved in bio-inspired fuel cells, in the present paper, we examine analytically and numerically the combined free-forced convective steady boundary layer flow from a solid vertical flat plate embedded in a Darcian porous medium containing gyrotactic microorganisms. Gyrotaxis is one of the many taxes exhibited in biological microscale transport, and other examples include magneto-taxis, photo-taxis, chemotaxis and geo-taxis (reflecting the response of microorganisms to magnetic field, light, chemical concentration or gravity, respectively). The bioconvection fuel cell also contains diffusing oxygen species which mimics the cathodic behavior in a proton exchange membrane (PEM) system. The vertical wall is maintained at iso-solutal (constant oxygen volume fraction and motile microorganism density) and iso-thermal conditions. Wall values of these quantities are sustained at higher values than the ambient temperature and concentration of oxygen and biological microorganism species. Similarity transformations are applied to render the governing partial differential equations for mass, momentum, energy, oxygen species and microorganism species density into a system of ordinary differential equations. The emerging eight order nonlinear coupled, ordinary differential boundary value problem features several important dimensionless control parameters, namely Lewis number (Le), buoyancy ratio parameter i.e. ratio of oxygen species buoyancy force to thermal buoyancy force (Nr), bioconvection Rayleigh number (Rb), bioconvection Lewis number (Lb), bioconvection Péclet number (Pe) and the mixed convection parameter ([Formula: see text] spanning the entire range of free and forced convection. The transformed nonlinear system of equations with boundary conditions is solved numerically by a finite difference method with central differencing, tridiagonal matrix manipulation and an iterative procedure. Computations are validated with the symbolic Maple 14.0 software. The influence of buoyancy and bioconvection parameters on the dimensionless temperature, velocity, oxygen concentration and motile microorganism density distribution, Nusselt, Sherwood and gradient of motile microorganism density are studied. The work clearly shows the benefit of utilizing biological organisms in fuel cell design and presents a logical biomathematical modeling framework for simulating such systems. In particular, the deployment of gyrotactic microorganisms is shown to stimulate improved transport characteristics in heat and momentum at the fuel cell wall.

Synchronization of complex dynamical networks with random coupling delay and actuator faults

This paper addresses the issue of passivity-based synchronization problem for a family of Markovian jump neutral complex dynamical networks (NCDNs) with coupling delay and actuator faults. Also, by considering the effect of random fluctuation in complex dynamical network systems, the occurrence of coupling delay are taken in terms of a stochastic distribution, which obeys the Bernoulli distribution. To handle the fault effects in actuators of proposed complex network systems, an actuator fault model is considered. The main objective of this paper is to develop a robust state feedback controller such that for all possible actuator failures and random coupling delays, all nodes of the proposed Markovian jump NCDNs is globally asymptotically synchronized to the reference node in mean square sense and guarantee the output strict passivity performance. By developing a suitable Lyapunov-Krasovskii functional and utilizing the Wirtinger-based integral inequality, the required a set of sufficient conditions for the synchronization of proposed system is established in form of linear matrix inequalities. Finally, three numerical examples including a 3-dimensional Lorenz chaotic model are provided to demonstrate the correctness and superiority of the proposed control scheme.

Design of observer-based non-fragile load frequency control for power systems with electric vehicles

This paper establishes an observer-based finite-time non-fragile load frequency control design using electric vehicles for power systems with modeling uncertainties and external disturbances. A state space representation of the addressed power systems together with dynamic interactions of electric vehicles is formulated. A full-order observer-based non-fragile controller is designed to ensure finite-time boundedness and satisfactory finite-time H_∞ performance of the considered system. By constructing an augmented Lyapunov-Krasovskii functional and employing Wirtinger-based integral inequality, the required conditions are obtained in terms of linear matrix inequalities. The desired non-fragile load frequency control law is presented via the observer-based feedback approach. Simulations are given to show the effectiveness of the proposed control scheme.

Dissipativity-based non-fragile sampled-data control design of interval type-2 fuzzy systems subject to random delays

This paper investigates the β-dissipativity-based reliable non-fragile sampled-data control problem for a class of interval type-2 (IT2) fuzzy systems. In particular, it is allowed to have randomly occurring time-varying delays in the controller design, which are modeled by Bernoulli distributed white noise sequences. Precisely, the IT2 fuzzy model and the non-fragile sampled-data controller are formulated by considering the mismatched membership functions. By constructing an appropriate Lyapunov-Krasovskii functional, a set of delay-dependent conditions is derived to guarantee that the closed-loop IT2 fuzzy system is strictly <Q,S,R>-β-dissipative. Moreover, the gain matrices of feedback reliable non-fragile sampled-data controller are derived in terms of linear matrix inequalities (LMIs), which can be solved by using existing LMI solvers. Two numerical examples are eventually given to illustrate the applicability and effectiveness of the proposed controller design technique.

Clinical genomics expands the morbid genome of intellectual disability and offers a high diagnostic yield

Intellectual disability (ID) is a measurable phenotypic consequence of genetic and environmental factors. In this study, we prospectively assessed the diagnostic yield of genomic tools (molecular karyotyping, multi-gene panel and exome sequencing) in a cohort of 337 ID subjects as a first-tier test and compared it with a standard clinical evaluation performed in parallel. Standard clinical evaluation suggested a diagnosis in 16% of cases (54/337) but only 70% of these (38/54) were subsequently confirmed. On the other hand, the genomic approach revealed a likely diagnosis in 58% (n=196). These included copy number variants in 14% (n=54, 15% are novel), and point mutations revealed by multi-gene panel and exome sequencing in the remaining 43% (1% were found to have Fragile-X). The identified point mutations were mostly recessive (n=117, 81%), consistent with the high consanguinity of the study cohort, but also X-linked (n=8, 6%) and de novo dominant (n=19, 13%). When applied directly on all cases with negative molecular karyotyping, the diagnostic yield of exome sequencing was 60% (77/129). Exome sequencing also identified likely pathogenic variants in three novel candidate genes (DENND5A, NEMF and DNHD1) each of which harbored independent homozygous mutations in patients with overlapping phenotypes. In addition, exome sequencing revealed de novo and recessive variants in 32 genes (MAMDC2, TUBAL3, CPNE6, KLHL24, USP2, PIP5K1A, UBE4A, TP53TG5, ATOH1, C16ORF90, SLC39A14, TRERF1, RGL1, CDH11, SYDE2, HIRA, FEZF2, PROCA1, PIANP, PLK2, QRFPR, AP3B2, NUDT2, UFC1, BTN3A2, TADA1, ARFGEF3, FAM160B1, ZMYM5, SLC45A1, ARHGAP33 and CAPS2), which we highlight as potential candidates on the basis of several lines of evidence, and one of these genes (SLC39A14) was biallelically inactivated in a potentially treatable form of hypermanganesemia and neurodegeneration. Finally, likely causal variants in previously published candidate genes were identified (ASTN1, HELZ, THOC6, WDR45B, ADRA2B and CLIP1), thus supporting their involvement in ID pathogenesis. Our results expand the morbid genome of ID and support the adoption of genomics as a first-tier test for individuals with ID.

Excessively redundant umbilical skin as a potential early clinical feature of Morquio syndrome and FKBP14-related Ehlers-Danlos syndrome

Several umbilical abnormalities have been linked to and utilized to aid in the clinical diagnosis of certain syndromes. For instance, umbilical skin redundancy has long been recognized as a core feature of Rieger syndrome although its association with other disorders is unknown. In this article, we report for the first time the occurrence of this distinct clinical sign in association with two other syndromes: Morquio syndrome and FKBP14-related Ehlers-Danlos syndrome (EDS). Our observation is clinically significant because patients with Morquio syndrome are often diagnosed only after they develop typical skeletal manifestations, which reduces the efficacy of available enzyme replacement therapy, so the umbilical sign we report here can facilitate a much earlier diagnosis. In addition, the extreme rarity of FKBP14-related Ehlers-Danlos syndrome (EDS) can greatly delay the diagnosis of this condition unless it is recognized in the differential diagnosis of redundant umbilical skin as we argue in this report.