A rare presentation of inguinal mass in postmenopausal women: leiomyoma of round ligament mimicking an irreducible inguinal hernia.

Tumors of the round ligament rarely happen; leiomyomas are considered the most common. Round ligament leiomyomas are benign tumors mimicking inguinal hernia, lymph nodes, or other inguinal masses. They are usually asymptomatic and take place in premenopausal female patients. This paper will present a case of a postmenopausal female patient who presented to our outpatient surgical clinic complaining of a right groin mass for 3 months. She was clinically diagnosed as a case of an irreducible inguinal hernia. After investigations, it turned out to be a round ligament leiomyoma, confirmed by the histopathological examination. There are broad differential diagnoses of inguinal masses. Although imaging exams could help diagnose leiomyomas, surgical excision followed by histopathological assessment is the best to confirm the diagnoses.

The severity of dry eye symptoms and risk factors among university students in Saudi Arabia: a cross-sectional study.

Dry eye syndrome (DES) is a tear film disorder caused by increased tear evaporation or decreased production. The heavy workload on the eye and the increased usage of digital screens may decrease blink frequency, leading to an increased evaporation rate and an upsurge in the incidence and severity of DES. This study aims to assess the severity of DES symptoms and the risk factors among university students. A cross-sectional study was conducted at Umm AlQura University to evaluate the severity of DES among students and explore its potential association with digital screen use. Validated questionnaires were used to assess the severity of DES and digital screen usage. The study included 457 participants, of which 13% had symptoms suggestive of severe DES. Furthermore, multiple risk factors had a significant association with the severity of DES, including gender, use of monitor filters, monitor and room brightness, and smoking habits. DES symptoms were prevalent among university students, particularly female students. Although there was no significant association with the duration of screen usage and collage distribution. Other factors however, such as the usage of screen monitors and the brightness of both the monitor and the room, were significantly associated with the severity of DES symptoms.

Hepatic Angiomyolipoma in Patients With Inflammatory Breast Cancer: A Case Report.

Hepatic angiomyolipoma (HAML) is a rare tumor comprising adipose tissue, smooth muscle cells, and blood vessels. On the other hand, inflammatory breast cancer (IBC) is a rare and severe form of breast cancer that progresses quickly and presents as breast inflammation. It is incredibly unusual for HAML and IBC to coexist in the same patient. In the present study, we describe a case of a 63-year-old Yemeni female patient diagnosed with locally advanced left breast cancer presented with pain at the left breast and axilla. A computed tomography (CT) scan for staging showed an incidental large hepatic mass, which was eventually discovered to be HAML. The patient underwent a modified radical mastectomy after completing her neoadjuvant treatment and later underwent parenchyma-sparing liver resection of that lesion; follow-up has continued till now. The diagnosis of HAML in the presence of IBC can pose challenges due to overlapping clinical and radiological features. Treatment decisions for patients with coexisting HAML and IBC require a multidisciplinary approach; surgical resection, embolization, targeted therapies, and systemic chemotherapy may be considered based on the extent of the disease and individual patient factors. Lastly, a brief review of the related literature was also carried out.

The Awareness and Knowledge of Retinopathy of Prematurity Among Pediatricians in Saudi Arabia.

BACKGROUND: Retinopathy of prematurity (ROP) affects premature low birth-weight infants with potentially blinding complications. Early diagnosis and treatment for indicated cases are essential to prevent unfavorable effects of the disease. OBJECTIVES: To determine the awareness and the level of knowledge of ROP among pediatricians in all regions of Saudi Arabia who worked at neonatal intensive care units. DESIGN AND SETTING:  This was a cross-sectional study. This study was undertaken in the Kingdom of Saudi Arabia. MATERIALS AND METHODS:  A semi-self-structured online questionnaire was designed to study the awareness and knowledge of ROP. The questionnaire contained items related to demographic data, participants' level of understanding and knowledge of ROP, and items related to hospital facilities, the availability of a trained ophthalmologist, and the source of knowledge. MAIN OUTCOME MEASURES: The awareness and knowledge of ROP among pediatricians of the Kingdom of Saudi Arabia. SAMPLE SIZE: The study included 145 pediatricians. RESULTS:  Awareness of ROP was found in 138 participants (95.2%). Seven participants (4.8%) were not aware of ROP and were excluded from further analysis. Of the participants, 116 (84.0%), 127 (92.0%), and 130 (94.3%) had knowledge about the stages, treatment, and precautions of treatment of ROP, respectively. Of the participants, 77 (55.8%), 63 (45.7%), 113 (81.9%), and 56 (40.6%) gave the correct answer about the indications of fundus examination, exact time of the first fundus examination, place of fundus examination, and minimum number of screening fundus examination for ROP, respectively. CONCLUSIONS:  The awareness and knowledge of ROP among pediatricians of Saudi Arabia is good, but knowledge about the indications and proper time of first referral to an ophthalmologist should be improved.

The Prevalence of Nephrolithiasis and Associated Risk Factors Among the Population of the Riyadh Province, Saudi Arabia.

Background and objective Kidney stones, also referred to as nephrolithiasis or renal calculi, is a condition where crystal depositions are formed within the kidney and ideally excreted from the body via the urethra with no pain; however, larger calculi may cause significant pain and require further medical assistance. The vast majority of patients who develop renal calculi form calcium stones, which are either a composition of calcium oxalate or calcium phosphate. Other types include uric acid, struvite, and cysteine. While kidney stones are one of the most significant diseases among the Saudi population, which require an acute emergency intervention to prevent serious long-term complications, there are limited studies published regarding this condition in Saudi communities. In light of this, we performed this study to assess the prevalence, incidence, and risk factors of kidney stones among the population of Riyadh, Saudi Arabia. Methods This was a cross-sectional study conducted in Riyadh, Saudi Arabia between August and October 2023, aiming to estimate the prevalence and risk factors of nephrolithiasis among residents of the Riyadh province. Data were collected through an electronic questionnaire in both Arabic and English and distributed via social media in addition to barcode handouts in various selected venues in Riyadh. The questionnaire involved 12 questions categorized into three sections. The first section obtained demographical information while the second section collected data about the past medical history of the participants. Lastly, the third section aimed to assess the prevalence of nephrolithiasis among participants or any history of the condition among their families. Results A total of 1,043 participants were surveyed, of whom 533 were males (51.1%). The prevalence of kidney stones was reported in 98 individuals (9.4%) overall. Individuals in the age groups of 36-50, 51-60, and >60 years showed significantly more renal stone prevalence than those in younger age groups (p<0.001). The prevalence was found to be higher in participants who were smokers, diabetic, hypertensive, and those who suffered from inflammatory bowel disease (IBD), gout, chronic kidney disease (CKD), hyperthyroidism, and hyperparathyroidism. Participants who took calcium supplements or had a positive family history of renal stones were found to have a higher prevalence of renal stones as well. However, only hypertension, gout, and family history showed any statistical significance (p<0.05). Conclusions A direct correlation was observed between hypertension, gout, positive family history, and aging and an increased prevalence of kidney stones among the inhabitants of the Riyadh province. Therefore, we encourage the local authorities to raise awareness of kidney stones and their related risk factors among the general public. Moreover, further local studies need to be conducted to gain deeper insights into kidney stone prevalence, especially pertaining to associated comorbidities and the pattern of the disease itself.

Assessment of knowledge towards first aid skills of epilepsy among undergraduate health students in Riyadh province of Saudi Arabia: A cross-sectional study.

BACKGROUND: Applying proper first-aid measures to patients with seizure episodes plays a vital role in preventing the adverse consequences of seizures. Most previous data focused on teachers, healthcare providers and the general public. This study aimed to assess the knowledge of seizure first-aid measures among undergraduate health students. METHODS: This descriptive, cross-sectional study was conducted between May 16 and 31, 2023, with 493 undergraduate health students of Riyadh Province who answered online surveys. The data were collected using the descriptive information form. The chi-square (χ2) test was employed to compare knowledge of seizure first aid between demographic variables. The relationship between knowledge score and independent variables was evaluated using multiple linear regression technique. RESULTS: Only 1.6 % of participants demonstrated good knowledge scores toward seizure first-aid measures. The skill most frequently reported was to remove all harmful objects from their vicinity and loosen the tight clothes around the neck during a seizure; 68.7 % of the participants correctly answered with agreed. Conversely, the skill that received the lowest knowledge score among participants was putting a piece object such as a cloth, wallet, or spoon between the teeth to prevent tongue biting during a seizure; only 37.3 % of the participants correctly answered with disagree. Moreover, participants in the advanced age group, medicine and fifth-year, were found to be significant predictors of knowledge and exhibited better knowledge scores toward seizure first aid measures than their peers (p < 0.001). Furthermore, lectures and books were identified (69.6 %) as the most common source of information about seizure first aid. CONCLUSION: The study concluded that most undergraduate health students demonstrated poor knowledge scores in delivering seizure first aid. This finding suggests that introducing epilepsy education from the first year in all health-related courses is crucial to improving overall awareness and skills in providing seizure first aid.

Enterococcus faecalis Infective Endocarditis Associated With Colorectal Cancer.

Enterococcus faecalis (E. faecalis) is considered the third most common source of infective endocarditis. Some of the published reports linked its origin to colorectal cancer. We report a 70-year-old male patient diagnosed with E. faecalis infective endocarditis complicated by myocardial infarction. The patient also experienced symptoms of melena and anemia, prompting a colonoscopy. A colon mass was found and a biopsy revealed adenocarcinoma. The patient underwent a left hemicolectomy. In addition to that, he was treated for his cardiac issues. Many studies suggest screening for colonoscopy in patients with E. faecalis infective endocarditis to investigate its origin and potential association with colorectal cancer.

Barriers and facilitators for oral health screening among tobacco users: a mixed-methods study.

OBJECTIVES: Tobacco consumption adversely affects general and oral health and is considered one of the significant public health burdens globally. The present study aims to assess the barriers and facilitators for attending oral and dental health screening among tobacco users who seek cessation advice. METHODOLOGY: The present mixed-methods study used group concept mapping (GCM) to identify the facilitators/barriers to attending oral health screening among young adults attending face-to-face and virtual Tobacco Cessation Clinic at King Saud University (Riyadh, Saudi Arabia) between September 2022 and April 2023. Study investigators included healthcare social workers, dental interns, and oral and maxillofacial medicinists. Information about demographics, general health, oral/dental health and tobacco use were collected using self-completed questionnaires. The barriers and facilitators were assessed following GCM by brainstorming, sorting, rating, and interpretation activities. Descriptive, multidimensional scaling and hierarchical cluster analysis were used to describe the study participants and produce concept maps of the generated statements. RESULTS: The study included 148 participants who generated 67 statements summarised into 28 statements as facilitators or barriers. Based on a 5-point importance scale, the participants indicated the importance of facilitators under health-related cluster [e.g. when I feel pain] as the highest, followed by personal [e.g. to maintain my mouth hygiene], social [e.g. the quality of treatment] and financial clusters [e.g. the reasonable cost]. Concerning barriers, financial factors [e.g. high cost] acted as the highest-rated barrier, followed by personal [e.g. lack of dental appointments] and health-related [e.g. worry that dental problems will worsen]. The social factors were the least considerable barrier [e.g. lack of time]. Clustering these facilitators/barriers on the concept map indicated their conceptual similarity by an average stress value of 0.23. CONCLUSION: Pain was the most important facilitator to attending oral health screening by young adults seeking tobacco cessation advice. Notable barriers included the high cost of dental treatment and the lack of scheduled appointments. Thus, oral health care providers need to consider scheduling periodic and timely dental check-ups to prevent and reduce the burden of tobacco-associated and pain-causing oral diseases.

Burnout syndrome and its correlation with musculoskeletal disorders among physiotherapists in Saudi: A cross-sectional study.

BACKGROUND AND PURPOSE: There is a significant impact of musculoskeletal disorders (MSDs) on individuals of all ages, professions, and fields from various countries worldwide, leading to a negative impact on quality of life and overall health outcomes. The study was conducted to investigate the association between Burnout syndrome (BS) and MSDs among physiotherapists in Saudi Arabia. METHODS: A cross-sectional study was carried out. Physiotherapists of either gender and with no known co-morbidities and who were not suffering from recent injuries and accidents were included in the study. The Copenhagen Burnout Inventory was used to determine the level of burnout. Musculoskeletal disorders were analyzed using the Standardized Nordic Questionnaire (NMQ). The chi-square test was used to observe the association between two categorical variables and a p-value <0.05 was considered to be statistically significant. RESULTS: A total of 133 participants were recruited and it was observed that 70 (53%) participants had low burnout levels (BoL). It was revealed that 65 (49%) had trouble in the neck and visited a physician clinic, 47 (35%) had trouble in the lower back during the last 12 months, 60 (45%) had trouble in the upper back during the last 12 months that prevented the normal activity and 13 (9.8%) participants had trouble in the shoulders during the last 7 days. History of chronic disease, education, practice setting, and smoking status with Burnout level was statistically significant. Trouble in the upper back, elbow, wrist/hands, hips/thighs, ankle/feet, and neck were also found to be significant. CONCLUSION: The outcomes revealed that a few demographic factors such as education, practice setting, smoking status, and chronic disease history were significantly associated with BS. Furthermore, it was observed that MSD had a significant impact on BoL.

Ethical Awareness and Practices Among Emergency Department Personnel in Riyadh's Tertiary Hospitals: A Cross-Sectional Analysis.

Introduction: Ethical dilemmas in healthcare, particularly in emergency medical services (EMS), present significant challenges for healthcare workers (HCWs), necessitating a profound understanding of ethics and decision-making. This study assesses the ethical awareness and practices among HCWs in emergency departments of tertiary hospitals in Saudi Arabia, aiming to identify areas of strength and opportunities for improvement. Methods: A cross-sectional survey was conducted among 256 HCWs, including physicians, nurses, and administrative staff, in emergency departments across tertiary hospitals in Riyadh, Saudi Arabia. The questionnaire evaluated participants' knowledge of healthcare ethics, their experiences with ethical dilemmas, and the sources from which they derived their ethical understanding. Results: The majority of participants exhibited a commendable level of ethical knowledge and practice, with frequent encounters of ethical or legal issues highlighting the pervasive nature of ethical challenges in emergency healthcare settings. Key sources of ethical knowledge included experiential learning and academic lectures, with a notable emphasis on practical experience. Despite the satisfactory level of ethical awareness, areas requiring further educational focus were identified, emphasizing the need for enhanced ethics training tailored to the emergency medical context. Discussion: The findings underline the critical importance of incorporating ethics into the core of healthcare education and ongoing professional development for HCWs. Establishing a culture of continuous ethical dialogue and learning is essential for fostering patient-centered care and making informed ethical decisions in the fast-paced environment of emergency services. The study advocates for revising current ethics training programs to ensure they are comprehensive, relevant, and accessible, preparing HCWs to effectively address both current and future ethical challenges.

Inhibition of Proprotein Convertase Subtilisin/Kexin-9 After Kidney Transplant: Single-Center Experience Among Patients With High Cardiovascular Risk.

OBJECTIVES: The benefits of reduction in low-density lipoprotein cholesterol by evolocumab by nearly 60% has not been evaluated among kidney transplant recipients to our knowledge. We assessed the efficacy and safety of evolocumab, a proprotein convertase subtilisin/kexin-9 inhibitor, in reducing lipids and cardiovascular events among kidney transplant recipients in a randomized controlled study. MATERIALS AND METHODS: Between June 2017 and June 2019, we enrolled 197 kidney transplant recipients with high cardiovascular risk score (>20). Patients who received evolocumab (140 mg/2 weeks) comprised group 1 (n = 98), and patients maintained on statin therapy comprised group 2 (n = 99). We followed patients clinically and with necessary laboratory investigations over 24 months. RESULTS: The 2 groups had comparable demographic characteristics (P > .05). Before enrollment in the study, smokers were significantly more prevalent in group 1, whereas posttransplant diabetes mellitus was more prevalent in group 2 (P = .033). Moreover, baseline serum creatinine was higher in group 1, whereas immunosuppression was equivalent in both groups (P > .05). We found no significant differences between the 2 groups concerning cardiovascular events, and both graft and patient outcomes were comparable (P > .05). The higher baseline cholesterol in group 1 (5.5 vs 4.7 mmol/L; P < .001) decreased significantly after 3 months and thereafter (P = .031) compared with levels in group 2 and baseline values (P < .001). We reported 2 cases of acute myocardial infarction and 1 atrial fibrillation in group 2. CONCLUSIONS: Proprotein convertase subtilisin/kexin-9 inhibitors, as an added therapy to statins, are safe and effective in treating hypercholesterolemia after kidney transplant. Evolocumab can minimize cardiovascular events after kidney transplant in patients with high events at baseline. Longer-term trials with larger number of patients are needed to confirm its beneficial effects on cardiovascular complications and patient and graft survival.

Developing a novel energy-based approach for measuring mental workload.

Minimal research has been conducted to develop non-invasive processes for quantifying and evaluating worker mental workload - a critical concern - at the task level in the construction industry. One reason for this gap in research is the complex and dynamic nature of the construction process, which makes construction work more complicated to measure and predict compared to work in other industries. This paper presents a novel approach and corresponding conceptual model to quantify and evaluate construction worker perception of mental workload at the task level using the energy concept. A conceptual process for assessing mental workload (MWL), i.e., the feeling of stress, pressure, and being overwhelmed due to the task nature, factors, conditions, and resources that accompany the performance of the task, was developed from extant research and interviews. The Delphi method was utilized to characterize the energy-based model and provide initial verification. The results from the literature review, expert insight, and four rounds of the Delphi survey revealed 14 constituents, 51 components, and one metric for each component to measure the level of MWL felt by a worker. These constituents, components, and metrics were used to develop a model for measuring construction worker MWL. This study contributes to knowledge by developing a novel non-invasive method for assessing potential task-level MWL using an energy-based model. The energy-based assessment model contributes to practice by providing a tool that could be used to measure the potential impact of construction tasks on workers perceived mental workload.

HbA1c and risk factors' prevalence in patients with stroke: a retrospective study in a tertiary care hospital in Saudi Arabia.

OBJECTIVES: To determine the relationship between hemoglobin A1c (HbA1c) and different types of stroke, and how different comorbidities and risk factors are related to the occurrence of stroke in a Saudi Arabian tertiary care hospital. METHODS: This retrospective study was conducted at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. The study included patients who experienced either hemorrhagic stroke (HS), ischemic stroke (IS), or transient ischemic attack (TIA) between 2015 and 2020. RESULTS: In total, 976 patients were included, of whom 670 were males (68.6%). The incidence of HS was significantly higher in males compared to females (14.2% vs. 6.9%), whereas the incidence of IS was higher in females (76.8% vs. 74.6%) (p=0.001). Ischemic stroke was significantly higher in the 65 years or older age group, whereas HS was comparatively higher among those aged <65 years. The means HbA1c levels in all three types of stroke were abnormally high. However, HbA1c levels were significantly higher in IS than in the other 2 stroke types (p=0.017). The HbA1c levels showed statistically significant differences between the different types of stroke, where the estimated marginal means were higher in patients with IS with a small effect size. Heart disease was also more prevalent in the IS group. Stroke-related mortality was reported in 16 patients and was significantly higher in the IS group than in the HS group. CONCLUSION: The HbA1c levels were elevated in all types of stroke, significantly in IS. Controlling patients' HbA1c and other modifiable risk factors could significantly reduce the risk of stroke.

The first retinoblastoma local experience in Kuwait: A retrospective case series.

Background: To report the first series of retinoblastoma (RB) cases that were managed locally in Kuwait by the retinoblastoma team that was established during the COVID-19 pandemic. Results: Six cases with RB were included in this study. The ages ranged from 3 months to 2 years with a male to female ratio of 2:1. All cases presented with an abnormal pupillary reflex with or without strabismus. Examination findings mostly showed leukocoria and an intra-retinal mass with calcification with or without vitreous seeding. Most cases were unilateral except for one case, which had bilateral RB. International classification of RB staging ranged from group B to E. Multidisciplinary approach was followed to manage these cases by applying a well-set protocol created by the RB team. Each case was treated according to grade at presentation. Conclusion: COVID-19 pandemic revolutionized the standard of care for RB in Kuwait and mandated the establishment of a multidisciplinary team to follow a standardized protocol to manage RB cases successfully.

The impact of non-pharmacologic interventions on respiratory syncytial virus hospitalization during the COVID-19 pandemic: A retrospective study from Saudi Arabia.

BACKGROUND: Acute respiratory tract infections (ARTIs) are frequently observed in infants and young children. The dynamics and transmission of ARTIs have been significantly impacted by the global COVID-19 pandemic. This study investigates the change in admission rates of Respiratory Syncytial virus (RSV) in a hospital in Saudi Arabia. METHODS: The study included hospitalized pediatric patients who underwent RSV testing in three periods: pre-pandemic (2019), during the pandemic (2020-2021), and the immediate post-pandemic (2022). RSV testing was conducted using either PCR or antigen tests. RESULTS: Between January 2019 to December 2022, out of 927 tested patients, 173 (18.7%) were positive for RSV. The yearly positivity rates were as follows: 42 (35.6%) of 118, 24 (33.3%) of 72, 15 (18.5%) of 81, and 92 (14%) of 656, yearly from 2019 to 2022, respectively (P < 0.00001). Among all cases, 150 (16.2%) required hospitalization, including 94 (62.7%) males and 56 (37.3%) females. The admission rate to the intensive care unit (ICU) was 25 (16.7%), and mechanical ventilation was required for 10 (6.6%) patients. The overall case fatality rate was 0.7%. A Binary logistic regression analysis showed upper respiratory tract symptoms were more common in patients admitted in 2019 compared to 2022 (odd ratio:20.9, 95% CI: 4.2-104.1, P value < 0.0001). CONCLUSION: The study showed that there were differences in RSV infection before and after COVID-19. Understanding how COVID-19 mitigation measures affect RSV transmission can aid in the development of effective prevention and control strategies.

Patients' Satisfaction With Virtual Phone Clinics During the COVID-19 Pandemic at Outpatient Clinics in a Teaching Hospital, Riyadh, Saudi Arabia.

Introduction The concept of virtual clinics, which have been in existence since the 1960s, was initially limited to military and space applications due to infrastructure limitations. However, with the evolution of communication technology and infrastructure improvements, virtual clinics became accessible to the general public, although they were not widely adopted until the coronavirus disease 2019 (COVID-19) pandemic. Virtual clinics offer several benefits, including overcoming distance-related challenges, providing healthcare services to underserved areas, reducing medical costs, and saving patients time. this research aims to assess patient satisfaction with virtual clinics in Saudi Arabia after the COVID-19 pandemic preventive measures are lifted, allowing for a comparison between virtual and traditional face-to-face clinics. This research aims to provide a more comprehensive assessment of patient satisfaction with virtual clinics. Methods We conducted a cross-sectional study and interviewed patients who had attended KKHU (King Khalid University Hospital) outpatient clinics during the COVID-19 pandemic to assess their level of satisfaction with virtual clinics through a questionnaire. Results The questionnaire was completed by 221 participants, 201 of whom met our inclusion criteria. The average score was 3.89, the standard deviation was 0.76, and the overall satisfaction ranged from 3.78 to 4. The mean and SD of the overall technical aspect satisfaction were 4.1 and 0.897, respectively. The mean and SD for the total perceived quality of care satisfaction were 3.89 and 0.95, respectively. The mean score for overall administration satisfaction was 3.74, and the SD was 0.92. The mean and SD for the virtual clinics as a whole were 3.82 and 0.73, respectively. Conclusion The overall level of satisfaction was 3.78 out of 5; however, 53% of participants did not want their next visit to be virtual and 73% of males and 63% of females were satisfied with KKHU outpatient clinics.

Parents and guardians perceptions of primary school students accessibility to dental health services in Riyadh City, Saudi Arabia: A cross-sectional study.

The success of healthcare delivery systems depends on accessibility. This study aimed to assess parental and guardian perceptions of dental health service accessibility among primary school students in Riyadh, Saudi Arabia. A descriptive cross-sectional survey was conducted among the parents and guardians of primary school students. A 23-item questionnaire was developed on the basis of previous studies. Demographic information, accessibility details, and barriers to dental services were recorded. A total of 385 participants responded to the questionnaire. Approximately 46.2 % of students encountered barriers to accessing dental services. Eighty (20.8 %) male students visited dental facilities more often than female students (72 [18.7 %]) within a 6-month period. Approximately 21 % of students had never visited a dental facility. The lowest number of preventive treatments were administered (15.4 %). Parents and guardians reported that private dental facilities were more accessible (185 [48 %]) than government dental facilities. There was an association between dental facilities and difficulties in accessing dental care services (χ2(4) = 42.753; p < 0.001). In conclusion, parents and guardians reported experiencing difficulties accessing dental services. However, parents and guardians must change their perspectives on accessibility, particularly for preventative care, because primary school children received the lowest.

Discovery of New Pyrrolo[2,3-d]pyrimidine Derivatives as Potential Multi-Targeted Kinase Inhibitors and Apoptosis Inducers.

In the pursuit of developing more potent and effective targeted kinase inhibitors (TKIs), a series of new compounds, specifically halogenated '(E)-4-((7H-pyrrolo[2,3-d]pyrimidin-4-yl)amino)-N'-benzylidenebenzohydrazides', were successfully synthesized in three steps with high yields. Among these novel compounds, namely 5e, 5h, 5k, and 5l, promising cytotoxic effects were observed against four different cancer cell lines, with IC50 values ranging from 29 to 59 µM. Notably, compound 5k emerged as the most potent inhibitor, exhibiting significant activity against EGFR, Her2, VEGFR2, and CDK2 enzymes, with IC50 values ranging from 40 to 204 nM, comparable to the well-known TKI sunitinib (IC50 = 261 nM). Mechanistic investigations of compound 5k revealed its ability to induce cell cycle arrest and apoptosis in HepG2 cells, accompanied by a notable increase in proapoptotic proteins caspase-3 and Bax, as well as the downregulation of Bcl-2 activity. Furthermore, molecular docking studies indicated similar binding interactions between compound 5k and the four enzymes, as observed with sunitinib. These findings highlight the potential of compound 5k as a promising candidate for further development as a multi-targeted kinase inhibitor with enhanced potency.

The Psychological Impact of Vitiligo in Saudi Arabia.

Background Vitiligo, the most common pigment disorder, impacts 0.5-2% of the global population, often causing psychological distress due to appearance changes and potential discrimination. Existing data on depressive symptoms and quality of life (QoL) effects in Saudi Arabian vitiligo patients are limited and inconsistent. Hence, this multi-center investigation was conducted in Saudi Arabia to determine the prevalence of depressive symptoms and quality of life (QoL) impairment in patients with vitiligo and to identify factors linked to increased psychological distress in this population. Methods We conducted a multi-center cross-sectional study in Saudi Arabia, employing two validated Arabic questionnaires, the Dermatology Life Quality Index (DLQI) and the Patient Health Questionnaire-9 items (PHQ-9), along with demographic information. Appropriate statistical analyses were performed. Results In total, 204 patients completed the survey. The median DLQI was 4 (range: 25), while the median PHQ-9 was 5 (range: 27). Factors associated with worse QoL included an early age of onset (under 18 years) and a disease duration exceeding five years. Conversely, only disease duration correlated with worse PHQ-9 scores. Vitiligo lesions on the lower extremities, feet, and genitalia were linked to poorer DLQI scores, while only genitalia were associated with worse PHQ-9 scores. We recommend further social awareness campaigns emphasizing the role of supportive families to improve the well-being of vitiligo patients.

Tetany in a Young Female Not Resulting From Hypocalcemia.

Here, we report on a case of a 24-year-old female who is previously medically healthy. She was admitted with a case of gastroenteritis. During her hospitalization, we noticed that the patient's wrists and metacarpophalangeal (MCP) joints were flexed, with her bilateral proximal (PIP) and distal (DIP) interphalangeal joints extended. Furthermore, she exhibited positive Chvostek and Trousseau signs. Her clinical features were consistent with acute tetany; however, she was demonstrating normal levels of calcium. Other laboratory results were positive for severe metabolic alkalosis and hypophosphatemia. Her signs and symptoms resolved completely after one dose of intravenous calcium gluconate. This case is notable because tetany alongside normocalcemia is a rare condition. Therefore, the immediate management of such cases is crucial.