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Saudi Experts Consensus on Diagnosis and Management of Pediatric Functional Constipation

  • Alshehri, Dhafer B.;Sindi, Haifa Hasan;AlMusalami, Ibrahim Mohamod;Rozi, Ibrahim Hosamuddin;Shagrani, Mohamed;Kamal, Naglaa M.;Alahmadi, Najat Saeid;Alfuraikh, Samia Saud;Vandenplas, Yvan
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.25 no.3
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    • pp.163-179
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    • 2022
  • Although functional gastrointestinal disorders (FGIDs) are very common in pediatric patients, there is a scarcity of published epidemiologic data, characteristics, and management patterns from Saudi Arabia, which is the 2nd largest Arabic country in terms of area and the 6th largest Arabic country in terms of population, with 10% of its population aged <5 years. Functional constipation (FC) is an FGID that has shown a rising prevalence among Saudi infants and children in the last few years, which urges us to update our clinical practices. Nine pediatric consultants attended two advisory board meetings to discuss and address current challenges, provide solutions, and reach a Saudi national consensus for the management of pediatric constipation. The pediatric consultants agreed that pediatricians should pay attention to any alarming signs (red flags) found during history taking or physical examinations. They also agreed that the Rome IV criteria are the gold standard for the diagnosis of pediatric FC. Different therapeutic options are available for pediatric patients with FC. Dietary treatment is recommended for infants with constipation for up to six months of age. When non-pharmacological interventions fail to improve FC symptoms, pharmacological treatment with laxatives is indicated. First, the treatment is aimed at disimpaction to remove fecal masses. This is achieved by administering a high dose of oral polyethylene glycol (PEG) or lactulose for a few days. Subsequently, maintenance therapy with PEG should be initiated to prevent the re-accumulation of feces. In addition to PEG, several other options may be used, such as Mg-rich formulas or stimulant laxatives. However, rectal enemas and suppositories are usually reserved for cases that require acute pain relief. In contrast, infant formulas that contain prebiotics or probiotics have not been shown to be effective in infant constipation, while the use of partially hydrolyzed formula is inconclusive. These clinical practice recommendations are intended to be adopted by pediatricians and primary care physicians across Saudi Arabia.

Pseudo Image Composition and Sensor Models Analysis of SPOT Satellite Imagery for Inaccessible Area (비접근 지역에 대한 SPOT 위성영상의 Pseudo영상 구성 및 센서모델 분석)

  • 방기인;조우석
    • Korean Journal of Remote Sensing
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    • v.17 no.1
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    • pp.33-44
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    • 2001
  • The paper presents several satellite models and satellite image decomposition methods for inaccessible area where ground control points can hardly acquired in conventional ways. First, 10 different satellite sensor models, which were extended from collinearity condition equations, were developed and then behavior of each sensor model was investigated. Secondly, satellite images were decomposed and also pseudo images were generated. The satellite sensor model extended from collinearity equations was represented by the six exterior orientation parameters in $1^{st}$, $2^{nd}$ and $3^{rd}$ order function of satellite image row. Among them, the rotational angle parameters such as $\omega$(omega) and $\Phi$(phi) correlated highly with positional parameters could be assigned to constant values. For inaccessible area, satellite images were decomposed, which means that two consecutive images were combined as one image, The combined image consists of one satellite image with ground control points and the other without ground control points. In addition, a pseudo image which is an imaginary image, was prepared from one satellite image with ground control points and the other without ground control points. In other words, the pseudo image is an arbitrary image bridging two consecutive images. For the experiments, SPOT satellite images exposed to the similar area in different pass were used. Conclusively, it was found that 10 different satellite sensor models and 5 different decomposed methods delivered different levels of accuracy. Among them, the satellite camera model with 1st order function of image row for positional orientation parameters and rotational angle parameter of kappa, and constant rotational angle parameter omega and phi provided the best 60m maximum error at check point with pseudo images arrangement.

Rate of Sediment Accumulation and Geochemical Characteristics of Muddy Sediment in the Central Yellow Sea (황해 중앙부 해역 니질 퇴적물의 지화학적 특성 및 퇴적률)

  • 윤정수;김여상
    • The Korean Journal of Quaternary Research
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    • v.16 no.1
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    • pp.1-16
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    • 2002
  • A total of 4 muddy sediment samples collected from the Central Yellow Sea were analyzed for chemical composition. The results are compared with the previously published Huanghe, Changjiang and Keum River geochemical data in order to understand provenance and sedimentation of fine-grained mud, and the sediment accumulation rates estimated. The sandy sediment facies is distributed in the eastern area, a patch of fine-grained mud exists in the western central prat, and the sandy mud and clay sedimentary facies shot. north to south zonal distribution in the central region. The content of calcium carbonate ranges from 2.8 to 10.5%, and its distributional trends to be more concentrated on the western muddy sediments near toward the China side rather than on the eastern sandy sediments. The accumulation rates obtained using Pb-210 geochronologies for the muddy sediments in the Central Yellow Sea showed ranges from 0.21 to 0.68 cm/yr or 0.176 to 0.714 g/$\textrm{cm}^2$. yr. The sedimentation rate from core CY96010 located in the eastern near side of Shandong Peninsula which is affected by the Huanghe River shows 0.68 cm/yr or 0.714 g/$\textrm{cm}^2$ . yr. The sediment cores CY96008 and CY96002 in the Central Yellow Sea, the estimated of sediment accumulation rates shows 0.21~0.23cm1yr or 0.176~0.220 9/$\textrm{cm}^2$.Vr respectively, which are much lower than above samples. These indicate that the muddy sediments in central area of the Yellow Sea may have received influence of the sediment discharge from the Huanghe River. The concentrations of Ca, Na, Sr, Ho, La, Tb, Ta and Ca/Ti ratio of the muddy sediments in the Central Yellow Sea are higher than those of the Changjiang sediments and lower than those of the Huanghe sediments. However, these element values showed similar concentration patterns than those of the Huanghe sediment. The element contents such as Fe, Ti, Nl, Co, Cr, Cu, Pb, Sc, Ce, Nd, Sm, Eu, Cd and Dy in the study area are higher than those of the Huanghe sediments and lower than the Changjiang River sediments, but these values showed close to resemblance content trends those of the Changjiang sediment. The concentration of Mn, K and Sr in sediments of the study area are similar to those of the Keum River and eastern Yellow Sea sediment. They are rich in Zn, Rb, Cd, U, Cs and Li than those of the other comparison legions. Therefore, the terrigenous materials sources of the muddy sediment in the Central Yellow Sea comes mainly from Huanghe River in the past and present, and also have party derived from the Changjiang and Keum River, while the biological deposit in this area are carried by the Yellow Sea Warm Current.

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A Study on the Distribution, Contents and Types of Stone Inscription of Wuyi-Gugok in China (중국 무이구곡 바위글씨(石刻)의 분포와 내용 및 유형에 관한 연구)

  • Rho, Jae-Hyun;Cheng, Zhao-Xia;Kim, Hong-Gyun
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.38 no.1
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    • pp.115-131
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    • 2020
  • Through literature research and field investigation, this paper attempts to study the distribution, morphology and the typification of the visual and perceptual stone inscription in Wuyi-Gugok of China. The results are as follows: First, there are 350 stone inscriptions in total from the 1st Gok to 9th Gok in Wuyi-Gugok. Second, according to the analysis of the stone inscription distribution, 74(21.2%) stone inscriptions in the 5th Gok, 67(19.2%) in the 6th Gok, 65(18.6%) in the 1st Gok, 60(17.2%) in the 2nd Gok and 53(15.2%) in the 4th Gok are confirmed. The above five Goks contain 319(91.1%) stone inscriptions, so they have rich cultural landscape. Third, according to the survey, the number of the stone inscriptions existed in the Sugwangseok of the 1st Gok are 41(22.6%), in the Homagan of Cheonyubong of the 6th Gok are 29(8.3%), in the Jesiam of the 4th Gok are 23(6.6%), in the Nyeongam of the 2nd Gok are 22(6.3%), in the Hyangseongam of the 6th Gok are 21(6%), in the Unwa of the 5th Gok are 19(5.4%), in the Bokhoam of the 5th Gok are 18(5.1%), in the Eunbyeongbong of the 5th Gok are 17(4.9%), in the Daejangbong of the 4th Gok are 14(4%), in the Daewangbong of the 1st Gok and the Geumgokam of the 4th Gok are 12(3.4%). Thus, a total of 228 (65.1%) stone inscriptions are concentrated in these 11 sites, which represent the popularity and cultural value of these rocks. Fourth, the stone inscription of Wuyi-Gugok, praising the landform and topographical geological landscape of Mount Wuyi, mainly describe the scenic name of each Gok related to Zhu Xi's Gugok culture, appreciate Zhu Xi's tracks and the stone inscription in the sacred land of Neo-Confucianism culture, and also record the Confucian edification of mencius thoughts, Muigun(武夷君) and the myths and legends related to the site names of Wuyi mountain, which can remind people of the worldview of the celestial paradise where the gods live and the fairyland of the land of peach blossoms. In addition, it indicates that the historical and cultural landscape, which is full of colorful history and myths and legends, including allusions related to Confucian, buddhist and Taoist celebrities and the ancestor ancient things related to traditional culture of China is very diverse. Fifth, the results of the classification, based on the content of the stone inscription in Wuyi-Gugok, are classified as the scenery name inscription, the praise scene inscription, the recording travel inscription, the recording event inscription, the philosophy inscription, the expressing emotion inscription, the religion inscription, the inscription for auspiciousness, the slogan and expressing ambition inscription and the official document notice inscription, among which there are 102(29.1%) praise scene inscriptions, 93(26.6%) scenery name inscriptions and 61(17.4%) recording travel inscriptions. The stone inscriptions of Wuyi-Gugok have the characteristics of the special emphasis on scenery names, landscape praise and commemorative tours. Sixth, the analysis of the intertext between the 「Figure of Wuyi-Gugok」 and Wuyi-Gugok rock letters, in the study found that the method of propagation between media was mostly the method of propagation of quotations and maintained intermedia through extension, repetition, extension, and compression.

The Origin of Radioactive Elements Found in Groundwater Within the Chiaksan Gneiss Complex: Focusing on the Relationship with Minerals of the Surrounding Geology (치악산 편마암 복합체에 분포하는 지하수 내 함유된 방사성 원소의 기원: 주변 지질을 구성하는 광물과의 연관성을 중심으로)

  • Kim, Hyeong-Gyu;Lee, Sang-Woo;Kim, Soon-Oh;Jeong, Do-Hwan;Kim, Moon-Su;Kim, Hyun-Koo;Jeong, Jong Ok
    • Korean Journal of Mineralogy and Petrology
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    • v.35 no.2
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    • pp.153-168
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    • 2022
  • Petrological and mineralogical analyses were conducted to identify minerals containing radioactive elements (uranium) in the Chiaksan gneiss complex and to confirm their association with the surrounding groundwater. Fourteen minerals were identified through the microscopic and electron microscopy (SEMEDS) investigation. The principal minerals included plagioclase, biotite, quartz, alkali feldspar, chlorite, and calcite. Minor minerals were sphene, allanite, apatite, zircon, thorite, titanite, pyrite, and galena. A small amount of thorite was observed in the size of ~1 mm within macrocrystalline allanite. Allanite, which includes a large amount of rare earth elements, appeared in three distinctive patterns. The results of the EPMA analyses indicated that macrocrystalline allanite had higher elemental contents of TiO2~1.70 wt.%, Ce2O3~11.86 wt.%, FeO ~13.31 wt.%, MgO ~0.90 wt.% and ThO2 ~1.06 wt.% with the lowest average content of Al2O3 17.35 ± 2.15 wt.% (n = 7), CaO 12.13 ± 1.81 wt.% (n = 7). An allanite existing at the edge of the sphenes encompassing titanites had a higher element content of Al2O3 ~24.00 wt.%, Nd2O3 ~5.10 wt.%, Sm2O3~0.66 wt.%, Dy2O3~0.86 wt.% and Y2O3~1.38 wt.% with the lowest average content of TiO2 0.35 ± 0.21 wt.% (n = 11), Ce2O3 5.25 ± 1.03 wt.% (n = 11), FeO 9.84 ± 0.26 wt.% (n = 11), MgO 0.12 ± 0.05 wt.% (n = 11), and La2O3 1.49 ± 0.29 wt.% (n = 11). Allanites in a matrix of parental rocks exhibited intermediate values between the two elemental compositions mentioned above. None of the uranium-rich minerals were observed in the migmatitic gneiss within the study area. Consequently, the origin of uranium in the groundwater was not associated with the geology of the surrounding environment, but our investigation proved the existence of abundant allanites containing significant amounts of radioactive thorium and rare earth elements.

A Study on the Visions of Zechariah in the Old Testament from a Perspective of Analytical Psychology (구약성서 '스가랴'서의 환상에 대한 분석심리학적 연구)

  • Sang Ick Han
    • Sim-seong Yeon-gu
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    • v.29 no.1
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    • pp.1-45
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    • 2014
  • Mystic experience such as seeing an vision could be explained as experiencing elusive and mysterious unique existence in religious way. In depth psychology, which is based on unconsciousness like analytical psychology, this could be explained as a something that gives a meaning of life and purpose through discovering health and healing. The importance of primodial experience in depth psychology is that it can possibly discover the base of present acts. In Christian theology, symbolic mystery and truth of religious experience that appear in Christian tradition have interest on human situation. These two fields' approach methods are different, but both show common interest on unique experience which can be said properly as raw experience. Various visions appear in many parts of the Bible. Among many visions, the book of Zechariah, one of the 12 Prophets, describes rich and diverse 8 visions through chapter 1 to chapter 8. However, due to the Genre of revelation, it lacks historicity, and because of vagueness and symbolic meanings, its visions are hard to understand and interpret. Theologically, visions of Zechariah show communality of Israelites by reconstructing kingdom of Judah and church in a way of historical circumstances. Though, these visions could deliver the meaning of an ethnical aspect as reporting continuous conversation between the God and humans. Furthermore, it could mean a personal aspect of the Prophet Zechariah as reaching for a opportunity of new change. Moreover, those who read these visions could try to interpret the meanings of various images which represent meeting mysterious existences. Therefore, the Author would concentrate on the fact that 8 visions in the book of Zechariah, which has not been received much attention to neither Christians nor non-believers, develop in chiastic structure (stylistic contrast), so that tries to interpret the first, second, seventh, and the eighth visions in analytic psychology way. In visions of Zechariah, excepting the 4th vision which probably was inserted later, rest of 7 visions each shows the stage of the hours of darkness. 1st to 3rd visions represent evening, 5th vision represents deep in the night, and 6th to 8th visions represent dawn to morning. Moreover, since structure of visions arranged in chiastic way, horse appears in 1st and 8th vision, measuring rope and measure tools are used as main motif in 2nd and 7th vision. However, same motifs could have different symbolic meanings and roles as visions are formed in different situations and conditions. In the first vision, angels who ride horses look around the world and report it is calm and peaceful. Concerning the political situation back in the day, the world being calm and peaceful in the beginning of evening means that it is not ready to change to a whole new world. Psychologically, if there is no readiness to adopt new world, it means being hopeless. It is sending you a message to get out of those kinds of situation. Moreover, appearance of four angels who rode red, brown, and white horses to a myrtus tree in the valley means that it is time for individuation and it is right and good timing for changing. In second vision, you will be able to see that Israelites had long years being caught in the shadows by foreign country, and long years succumbed by the strength of four horns, which shows the progress of renewing strength and being oneness with oneself from overwhelmed situation by paternity. In seventh vision, meaning of two women bringing the godness of the sky, who were locked up in a rice basket, back to the temple in Babylon is going towards in a level of Self-actualization by separating one's ego captured excessively by matherhood and putting back to a place where it was before. In eighth vision, chariots pulled by horses are scattered far and wide, and horses which went to north had rest in the land of North. After horses and chariots are seen between two mountains of bronze with the image of Self and anima/animus. These images can be explained as the changing progress are almost completed and the God and human, in other words Self and ego are being united and is now time for rest. All of 8 visions contains the conversation between angel and Zechariah who willing to know the meaning of visions. Zechariah asks the angel actively about the meaning of visions because of his wish for Israelites to return home and rebuild church. Conversation among the God, Zechariah, who asks questions until he knows everything, an Angel, who gives answer to given questions, is conversation between ego and anima/animus. Eventually, it is a conversation between Self and ego.