Impacts of poultry by-product meal substituting fishmeal on growth efficiency, body composition, liver, and intestine morphology of European sea bass, Dicentrarchus labrax.

A twelve week feeding experiment was conducted to evaluate the replacement of fishmeal (FM) with poultry by-product meal (PBM) in practical diets for European sea bass, Dicentrarchus labrax with an average initial weight of 0.89 g. Five isocaloric (5.1 kcal lipid g-1) and isonitrogenous (451 g protein kg-1) diets were formulated with PBM replacing FM at levels of 0% (control), 25%, 50%, 75%, and 100%. The experiment was carried out in 30-in. nylon mesh net cages (hapas). At the termination of the trial, growth performance including final body weight, weight gain, specific growth rate, and protein growth rate of diets containing up to 75% PBM were comparable to those of the control group, whereas the diet with 100% PBM resulted in a significantly lower values (p < 0.05). Feed utilization exhibited variation among the treatments (p < 0.05). Whole body composition also showed significant differences across the dietary treatments. Essential amino acid (EAA) contents specifically arginine (Arg), histidine (His), methionine (Met), and threonine (Thr) in the whole body of fish fed diets with up to 50% PBM replacement were not significantly different from those in the control group. Furthermore, the intestinal microvilli length, width and absorption area increased significantly (p < 0.05) with PBM replacement levels up to 50%. Histological analysis of the liver revealed mild vacuolation of hepatocytes in fish fed up to 50% PBM,while pre-pancreatic fatty degeneration of hepatocytes was observed in fish fed diets with 75% and 100% PBM. Therefore, this study demonstrates that PBM can replace up to 50% of FM in the diets of European sea bass without adverse effects on growth performance, body composition, or liver and intestine morphology.

Post-operative pain after root canal preparation with different apical finishing sizes a triple blinded split mouth clinical trial.

BACKGROUND: This is a triple-blinded, prospective split-mouth clinical trial. It is important to shed light on the effect of different apical preparation sizes regarding postoperative pain within the same patient with the same pulpal histological status. The aim is to compare and evaluate the severity of postoperative pain following apical enlargement with two different sizes after the IBF using the visual analogue scale. METHODS: Fifty "teeth" in 25 patients were assigned into two equal groups (25 per group) using E3 Azure rotary files; Group A was prepared two sizes greater than the Initial binding file (IBF) (the largest K file to bind at the actual working length) mesial canals, which were enlarged to 35#/0.04 and 40#/0.04 for the distal canals. Group B was prepared in three sizes larger than the IBF: 40#/0.04 for mesial canals and 45#/0.04 for the distal canals. On a modified VAS form, patients were questioned to indicate the degree of their pain and assisted in narrating their pain intensity during the following periods: 12, 24, and 72 h, and after a week. VAS data were non-parametric and analyzed using the signed-rank test for intergroup comparisons, Freidman's test, and the Nemenyi post hoc test for intragroup comparisons. The significance level was set at p < 0.05. RESULTS: showed that regardless of measurement time, enlargement of apical preparation was significantly associated with higher pain scores (p < 0.001). Within both groups, there was a significant reduction of measured pain score with time, with values measured after 12 and 24 h being significantly higher than values measured at other intervals (p < 0.001) and with values measured after three days being significantly higher than 1-week value (p < 0.001). CONCLUSION: The size of apical preparation had a significant effect on postoperative pain. TRIAL REGISTRATION NUMBER & DATE: NCT05847738, 08/05/2023.

Efficacy and safety of empiric treatment with omeprazole continuous infusion in critically ill children with gastrointestinal bleeding.

Introduction: Gastrointestinal bleeding (GI) is a prevalent condition among pediatric patients, with a reported incidence of 6.4%, often severe enough to require admission to the pediatric intensive care unit (PICU). There are multiple therapies utilized in the management of GI bleeding in pediatrics, among which continuous intravenous (IV) infusion of omeprazole is used off-label without standard pediatric dosing recommendations. Reviewing the current literature reveals a lack of studies assessing the efficacy, safety, and appropriate dosing regimen of continuous omeprazole infusion in children with GI bleeding. This study aimed to evaluate the efficacy and safety of continuous IV omeprazole infusion in comparison to other therapeutic modalities in children. Methods: This study is a single-center, retrospective chart review of children admitted to the PICU at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. The treatment group included pediatric patients with GI bleeding and receiving omeprazole IV continuous infusion over ≥24 h while the control group included pediatric patients with GI bleeding managed using other therapies. Primary outcomes were the efficacy of omeprazole continuous infusion in stopping GI bleeding, and PICU length of stay (LOS). Secondary outcomes included instances of rebleeding post- therapy discontinuation, transfusion requirements, and the safety of omeprazole continuous infusion. Results: The study included 81 critically ill pediatric patients, 22 of whom received continuous infusion omeprazole while 59 received other therapies. The results indicated that patients in the control group had a significantly shorter PICU LOS (8 vs. 18.5 days, p < 0.001) and bleeding episode (4 vs. 10.5 days, p < 0.001) than those in the treatment group. However, no significant differences were observed between the two groups regarding secondary outcomes. The treatment group had a significantly lower all-cause mortality rate during hospitalization compared to the control group (16 patients [72.7%] vs. 56 patients [94.9%], respectively, p = 0.005). Conclusion: Empirical use of omeprazole continuous intravenous infusion in children with GI bleeding was not favorable in terms of shortening PICU LOS and duration of GI bleeding. Our study results provide evidence supporting the safety and tolerability of omeprazole continuous infusion. Additional larger studies are necessary to determine the implication of such results.

Effects of L-ascorbic acid on growth, non-specific immunity, antioxidant capacity, and intestinal and hepatopancreatic histology of red swamp crayfish, Procambarus clarkii.

This study investigated the dietary effects of coated L-ascorbic acid (LA) on growth, feed utilization, survival, serum biochemical indices, immunity, antioxidant capacity, and intestinal and hepatopancreatic histology of the pre-adult red swamp crayfish. Four isoproteinous and isolipidic diets were formulated to contain several LA levels as 0, 1300, 1600, and 1900 mg/kg and designated as control (LA0), LA13, LA16, and LA19, respectively. However, the analyzed LA concentrations in diets were 0.00, 199.57, 360.45, and 487.50 mg/kg in LA0, LA13, LA16, and LA19, respectively. Triplicate treatments of crayfish (21.60 ± 0.14 g) were fed the test diets and reared in fiberglass tanks with a density of 20 individuals per each for eight weeks. Results revealed that all LA treatments had significantly enhanced growth performance compared to the control. Of interest, the LA16 treatment recorded the highest final tank biomass, biomass gain, total feed intake, condition factor, and muscle yield among the other treatments. The tank feed conversion ratio was significantly decreased in LA treatments compared to the control. Moreover, dietary LA16 and LA19 had significantly higher survival rates (93.3%) compared to (85.0%) in the LA0 group. All dietary doses of LA significantly increased serum parameters (total protein, albumin, globulin, lysozyme activity) and respiratory burst activity compared to the LA0 treatment. Dietary LA16 significantly boosted the hepatopancreatic antioxidant capacity, manifested by decreased malondialdehyde concentrations, increased catalase, superoxide dismutase, and glutathione peroxidase enzyme activities, and reduced glutathione content compared to the LA-free diet. A normal histoarchitecture of the hepatopancreatic tubules was found in all LA treatments except with some minor degenerative changes in the tubular lumen, and hepatopancreatic cells associated with enlarged nuclei were found in the LA19. However, normal intestinal histoarchitecture was found in all treatments with no recorded intestinal lesions. Of interest, the polynomial regression performed on the analyzed LA concentrations suggested that 380 mg/kg would be suitable to provide maximal biomass gain for pre-adult crayfish. In conclusion, results revealed that coated LA could enhance the growth, immunity, and antioxidant capacity of pre-adult red swamp crayfish, suggesting its potential as a functional and necessary micronutrient for crayfish diets.

Effects of exogenous bile acids (BAs) on growth, lipid profile, digestive enzymes, and immune responses of thinlip mullet, Liza ramada.

An eight-week trial was designed to explore the dietary effects of commercially purchased exogenous bile acids (BAs) on growth, whole-body composition, lipid profile, intestinal digestive enzymes, liver function enzymes, oxidative stress biomarkers, and serum immunity of thinlip mullet, Liza ramada. Four triplicate groups (10.50 ± 0.05 g) were fed four soybean meal (SBM)-based diets supplied with several BAs levels at 0 (control), 50, 130, or 350 mg/kg feed. Results indicated that the growth was significantly increased in groups fed BAs-based diets, especially at 130 mg/kg feed. The body composition analysis showed that feeding fish on diets supplied with BAs up to 130 mg/kg decreased moisture (%) alongside increased crude protein (%). However, the body composition of fish fed a diet with 350 mg BAs/kg had the lowest moisture (%) and the highest crude protein (%). Moreover, there were significant increases in the intestinal (protease, α-amylase, and lipase) enzyme activities in the groups supplied with BAs up to 130 mg BAs/kg. Liver function enzymes (aspartate aminotransferase and alanine aminotransferase enzyme activities) were significantly decreased in BAs-supplemented groups compared to those fed the BAs-free group. On the other hand, the control group had higher total cholesterol, triglycerides, and low-density lipoprotein alongside the lower high-density lipoprotein than BAs-supplemented groups, especially at 350 mg BAs/kg feed. BAs significantly decreased hepatic malondialdehyde concentrations and increased the activity of hepatic catalase, superoxide dismutase, and total antioxidant capacity compared with those reared on the control diet. Serum lysozyme, respiratory burst, and alternative complement activities were significantly increased in BAs-supplied groups, particularly in the group supplied with 130 mg BAs/kg compared to those fed on the control diet. Accordingly, our findings recommend that including 130 mg BAs/kg in an SBM-based diet enhanced the growth, digestive enzyme activities, and liver functions, alleviated oxidative stress, boosted serum immunity, and lowered lipid metabolites in thinlip mullet. These findings will be beneficial for improving the quality of feed prepared for feeding mullets and an effective alternative strategy to support mullet farming.

Effects of Different Aquafeed Sources on Growth Performance, Oxidative Capacity, and Fatty Acid Profile of Three Carps Reared in the Semi-Intensive Composite Culture System.

The current experiment is designed to evaluate the effect of different aquafeeds (farm-made versus commercial) on growth, body composition, oxidative capacity, and fatty acid profile in the semi-intensive composite culture system. For this, 1,100 fingerlings/acre having initial body weight and length, Labeo rohita (61.34 g, 171 mm), Catla catla (71.45 g, 181 mm), and Cyprinus carpio (30.80 g, 91 mm) were randomly distributed to 16 ponds and randomly fed on eight different diets (n = 2 pond/diet) in a completely randomized research design. Aquafeed were farm-based diets (D1-D2) and commercial aquafeed (D3-D8). The farm-made diets contained various crude protein levels of maize gluten (24.9%) and rice polish (7.3%), whereas commercial diets were procured from commercial feed plants (AMG, Supreme, Aqua, Star Floating, Hi-Pro, and Punjab feed). The growth performance of carps (L. rohita and C. catla) was significantly improved (p < 0.05) by feeding D3 as compared to other diets. Similarly, white blood cell concentration was greater (p < 0.05) in all species fed by D3 than in those fed on D7, D8, D5, D6, D1, and D2 fed groups, respectively. Alanine transaminase, aspartate transaminase, and alanine phosphatase activities were significantly lower (p < 0.05) in the D3-fed L. rohita, C. catla, and C. carpio compared with those fed on the rest of the treatments. The activities of glutathione peroxidase and superoxide dismutase were also higher (p < 0.05) for the D3 fed L. rohita, C. catla, and C. carpio than those fed on the rest diets. The groups fed on D3 and D4 had greater (p < 0.05) concentrations of myristic (14), palmitic acid (16), and stearic (18) acids than those fed on the rest of the commercial diets. However, meat chemical composition was similar (p > 0.05) across the treatments. These results also prove that the increase in the dietary protein level and lipid content can improve the fish's body's crude protein and fat levels. Feeding D3 improved the production performance, oxidative status, and fatty acid profile in composite major carps culture systems. Thus, based on growth, survival, and body composition, it is concluded that D3 and D4 may be recommended for a commercial culture of major carps. Dietary treatments had no significant impact (p > 0.05) on water's physical-chemical properties. Calcium content and alkalinity varied (p < 0.05), with D5 showing the lowest calcium and the highest alkalinity.

Towards unlocking the biocontrol potential of Pichia kudriavzevii for plant fungal diseases: in vitro and in vivo assessments with candidate secreted protein prediction.

BACKGROUND: Plant fungal pathogens cause substantial economic losses through crop yield reduction and post-harvest storage losses. The utilization of biocontrol agents presents a sustainable strategy to manage plant diseases, reducing the reliance on hazardous chemical. Recently, Pichia kudriavzevii has emerged as a promising biocontrol agent because of its capacity to inhibit fungal growth, offering a potential solution for plant disease management. RESULTS: Two novel Pichia kudriavzevii strains, Pk_EgyACGEB_O1 and Pk_EgyACGEB_O2, were isolated from olive brine samples. The microscopic characterization of the strains revealed similar structures. However, there were noticeable differences in their visual morphology. Based on their internal transcribed spacer (ITS) DNA sequences, Pk_EgyACGEB_O1 and Pk_EgyACGEB_O2 strains assigned by GenBank IDs MZ507552.1 and MZ507554.1 shared high sequence similarity (~ 99.8% and 99.5%) with P. kudriavzevii, respectively. Both strains were evaluated in vitro against plant pathogenic fungi. The strains revealed the ability to consistently inhibit fungal growth, with Pk_EgyACGEB_O2 showing higher effectiveness. In addition, both P. kudriavzevii strains effectively controlled grey mold disease caused by B. cinerea in golden delicious apples, suggesting their potential as sustainable and eco-friendly biocontrol agents for post-harvest diseases. Based on a comprehensive bioinformatics pipeline, candidate-secreted proteins responsible for the potent antifungal activity of P. kudriavzevii were identified. A total of 59 proteins were identified as common among the P. kudriavzevii CBS573, SD108, and SD129 strains. Approximately 23% of the secreted proteins in the P. kudriavzevii predicted secretome are hydrolases with various activities, including proteases, lipases, glycosidases, phosphatases, esterases, carboxypeptidases, or peptidases. In addition, a set of cell-wall-related proteins was identified, which might enhance the biocontrol activity of P. kudriavzevii by preserving the structure and integrity of the cell wall. A papain inhibitor was also identified and could potentially offer a supplementary defense against plant pathogens. CONCLUSION: Our results revealed the biocontrol capabilities of P. kudriavzevii against plant pathogenic fungi. The research focused on screening novel strains for their ability to inhibit the growth of common pathogens, both in vitro and in vivo. This study shed light on how P. kudriavzevii interacts with fungal pathogens. The findings can help develop effective strategies for managing plant diseases.

The Expression of Triticum aestivum Cysteine-Rich Receptor-like Protein Kinase Genes during Leaf Rust Fungal Infection.

Understanding the role of cysteine-rich receptor-like kinases (CRKs) in plant defense mechanisms is crucial for enhancing wheat resistance to leaf rust fungus infection. Here, we identified and verified 164 members of the CRK gene family using the Triticum aestivum reference version 2 collected from the international wheat genome sequencing consortium (IWGSC). The proteins exhibited characteristic features of CRKs, including the presence of signal peptides, cysteine-rich/stress antifungal/DUF26 domains, transmembrane domains, and Pkinase domains. Phylogenetic analysis revealed extensive diversification within the wheat CRK gene family, indicating the development of distinct specific functional roles to wheat plants. When studying the expression of the CRK gene family in near-isogenic lines (NILs) carrying Lr57- and Lr14a-resistant genes, Puccinia triticina, the causal agent of leaf rust fungus, triggered temporal gene expression dynamics. The upregulation of specific CRK genes in the resistant interaction indicated their potential role in enhancing wheat resistance to leaf rust, while contrasting gene expression patterns in the susceptible interaction highlighted potential susceptibility associated CRK genes. The study uncovered certain CRK genes that exhibited expression upregulation upon leaf rust infection and the Lr14a-resistant gene. The findings suggest that targeting CRKs may present a promising strategy for improving wheat resistance to rust diseases.

Contamination of selected heavy metals in Limnothrissa miodon (Boulenger, 1906) in the four strata of Lake Kariba Zambia: are the consumers at risk?

Pollution of aquatic ecosystems is one of the major challenges affecting many countries of the world. Heavy metal pollutants, in particular, threaten the life of aquatic organisms (fauna and flora) and, more importantly, humans who consume aquatic products as a critical source of proteins. In the present study, the concentrations of selected heavy metals (cobalt- Co, Chromium-Cr, nickel- Ni and manganese- Mn) in Limnothrissa miodon, locally known as 'Kapenta' were assessed using the Microwave Plasma Atomic Emission Spectrometer (MP AES) 4200 at the Zambia Agricultural Research Institute (ZARI). The fish was collected from Lake Kariba, Zambia, which is divided into four fisheries management strata (I, II, III, and IV). The health risks to consumers were evaluated using the Estimated Daily Intake (EDI), Target Hazard Quotient (THQ) and Hazard Index (HI). Analysis of variance (ANOVA) was used to assess the difference in the means of heavy metal concentration across the four strata for each element. The concentrations of all the heavy metal elements were within the permissible limits considered to be safe for human consumption based on the Food and Agriculture Organization (FAO) standards. However, the concentration of individual heavy metal elements varied significantly across the strata with stratum I and II showing higher levels in general except for Mn which was highest in stratum II and III compared with the other strata. Furthermore, Mn concentration was the highest in all the strata and the highest concentration was observed in the fish from stratum II. The EDIs, THQs and HIs of each heavy metal element did not show any threat to consumers of the fish from the lake. Further studies are required to better understand the potential sources of heavy metals and to regularly monitor existing activities that may elevate the concentration levels.

A molecular study of pediatric pilomyxoid and pilocytic astrocytomas: Genome-wide copy number screening, retrospective analysis of clinicopathological features and long-term clinical outcome.

Background: Pilocytic Astrocytoma (PA) is the most common pediatric brain tumors. PAs are slow-growing tumors with high survival rates. However, a distinct subgroup of tumors defined as pilomyxoid astrocytoma (PMA) presents unique histological characteristics and have more aggressive clinical course. The studies on genetics of PMA are scarce. Methods: In this study, we report one of the largest cohort of pediatric patients with pilomyxoid (PMA) and pilocytic astrocytomas (PA) in Saudi population providing a comprehensive clinical picture, retrospective analysis with long-term follow-up, genome-wide copy number changes, and clinical outcome of these pediatric tumors. We examined and compared genome-wide copy number aberrations (CNAs) and the clinical outcome of the patients with PA and PMA. Results: The median progression free survival for the whole cohort was 156 months and it was 111 months for the PMA, however, not statistically significantly different between the groups (log-rank test, P = 0.726). We have identified 41 CNAs (34 gains and 7 losses) in all tested patients. Our study yielded the previously reported KIAA1549-BRAF Fusion gene in over 88% of the tested patients (89% and 80% in PMA and PA, respectively). Besides the fusion gene, twelve patients had additional genomic CNAs. Furthermore, pathway and gene network analyses of genes in the fusion region revealed alterations in retinoic acid mediated apoptosis and MAPK signaling pathways and key hub genes that may potentially be involved in tumor growth and progression, including BRAF, LUC7L2, MKRN1, RICTOR, TP53, HIPK2, HNF4A, POU5F, and SOX4. Conclusion: Our study is the first report of a large cohort of patients with PMA and PA in the Saudi population that provides detailed clinical features, genomic copy number changes, and outcome of these pediatric tumors and may help better diagnosis and characterization of PMA.

Growth performance, antioxidant activities, and immunological responses of hapa-reared thinlip mullet (Liza ramada) juveniles fed on diets supplemented with spirulina (Arthrospiraplatensis).

Spirulina (Arthrospira platensis) (SP) has been utilized for a long time as a valued feed supplement because of its proteinous content and other beneficial phytochemical compounds. Herein, we investigated the influences of SP-supplemented diets on growth, body somatic indices, digestive enzymes, hepatic antioxidant activities, and immunological responses of hapa-reared thinlip mullet (Liza ramada) juveniles. Fish were assigned in six triplicate groups and were fed for consecutive 60 days on the prepared experimental diets containing varying SP levels as 0.0, 2.0, 4.0, 6.0, 8.0, and 10.0 g/kg diet and defined as control (CNT or SP0), SP2, SP4, SP6, SP8, and SP10 groups, respectively. The results indicated that dietary SP supplementation linearly and quadratically improved the fish growth performance, and the highest growth indices were found in the SP8 group. However, dietary SP supplementation did not significantly alter feed conversion ratio (FCR), survival rate (%), hepato-somatic index, and viscera-somatic index among all experimental groups. Meanwhile, digestive enzymes (lipase, α-amylase, and proteases) in the mid-intestine were also linearly and quadratically increased in all SP-fed groups, and their uppermost values were noted in the SP8 group. Hepatic antioxidants such as superoxide dismutase, catalase, and total antioxidant capacity in SP-supplemented groups were significantly elevated than the CNT group. Conversely, hepatic malondialdehyde contents were decreased significantly along with increasing dietary SP-supplementation levels. The immunological parameters such as lysozyme, respiratory burst, and alternative complement activities were significantly elevated in SP-fed groups than in the CNT group. These findings evoked that feeding SP-supplemented diets (especially at 8.0 g/kg diet) significantly promoted the growth, digestive enzymes, hepatic antioxidant status, and immunity of L. ramada juveniles.

Voluntary and non-voluntary blood donations among doctors.

BACKGROUND: Physicians may be an important source of blood donations as they are more likely to be familiar with the importance of donating and the donation process. The aim of this study is to report physicians' knowledge, attitudes, and practices towards voluntary and non-voluntary blood donations. STUDY DESIGN AND METHODS: This was a cross-sectional study conducted at King Faisal Specialist Hospital and Research Centre (KFSH&RC), Saudi Arabia. One-hundred-and-sixteen physicians and dentists responded to an online structured questionnaire sent to their institutional emails. RESULTS: Sixty-eight percent of participants (79% of males and 43% of females) reported previously having donated blood. Eighty-six percent of donors had previously donated on a voluntary basis, whereas 31% of donors had previously donated for a specific person. A recent donation within 5 years was associated with the younger age group and knowledge of the minimum interval between donations. Fifty-six percent of participants agreed with using replacement donations. Compared to participants in the youngest age group (25-35 years), older participants in the age groups (46-55 years) and (>55 years) were less likely to express intention to donate in the next 6 months (OR 0.289, P = .022 and OR 0.083, P = .004, respectively). Participants reporting poor nutritional status or other medical reasons as a barrier to donating blood were less likely to intend to donate (OR 0.146, P < .001). Among previous donors, intention to donate was associated with a recent donation within 1 year (OR 27.13, P = .002) and having had a pleasant donation experience (OR 14.98, P < .001). CONCLUSION: Blood donation practices are strongly tied to physicians' gender and age and their knowledge of the donation process. The most significant barrier to blood donation was found to be nutritional and medical status.

The stress induced caleosin, RD20/CLO3, acts as a negative regulator of GPA1 in Arabidopsis.

KEY MESSAGE: A stress induced calcium-binding protein, RD20/CLO3 interacts with the alpha subunit of the heterotrimeric G-protein complex in Arabidopsis and affects etiolation and leaf morphology. Heterotrimeric G proteins and calcium signaling have both been shown to play a role in the response to environmental abiotic stress in plants; however, the interaction between calcium-binding proteins and G-protein signaling molecules remains elusive. We investigated the interaction between the alpha subunit of the heterotrimeric G-protein complex, GPA1, of Arabidopsis thaliana with the calcium-binding protein, the caleosin RD20/CLO3, a gene strongly induced by drought, salt and abscisic acid. The proteins were found to interact in vivo by bimolecular fluorescent complementation (BiFC); the interaction was localized to the endoplasmic reticulum and to oil bodies within the cell. The constitutively GTP-bound GPA1 (GPA1QL) also interacts with RD20/CLO3 as well as its EF-hand mutant variations and these interactions are localized to the plasma membrane. The N-terminal portion of RD20/CLO3 was found to be responsible for the interaction with GPA1 and GPA1QL using both BiFC and yeast two-hybrid assays. RD20/CLO3 contains a single calcium-binding EF-hand in the N-terminal portion of the protein; disruption of the calcium-binding capacity of the protein obliterates interaction with GPA1 in in vivo assays and decreases the interaction between the caleosin and the constitutively active GPA1QL. Analysis of rd20/clo3 mutants shows that RD20/CLO3 plays a key role in the signaling pathway controlling hypocotyl length in dark grown seedlings and in leaf morphology. Our findings indicate a novel role for RD20/CLO3 as a negative regulator of GPA1.

Employment and occupational safety among patients with seizure disorders - findings from a tertiary hospital in Saudi Arabia.

OBJECTIVE: Observational studies suggest that persons with seizure disorders are socially disadvantaged compared to the general population. There are scarce reports in the literature on the prevalence of employment and occupational safety among patients with seizure disorders in Saudi Arabia. We aimed to describe the occupational statuses of patients with seizure disorders and determine factors associated with unemployment. METHODS: This was a cross-sectional study conducted at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia. Five-hundred-and-forty patients with known seizure disorders or epilepsy who attended neurology and neurosurgery outpatient clinics between January and November 2018 completed a semi-structured questionnaire delivered by interview. RESULTS: Forty-four percent of participants were unemployed (27% of males and 64% of females). Fifteen percent of currently or previously employed participants reported that they had formerly resigned from their job due to their seizure disorder, most commonly as a result of their own fears or concerns. Almost half of the participants reported that their employer made arrangements in the workplace for their seizure disorder, while 18% reported that they did not disclose their diagnosis. Gender, age, and highest educational level were associated with employment status and reason for unemployment. Patients with seizures secondary to trauma were less than half as likely to be employed compared to other participants (aOR = 0.45 95%CI 0.21-0.97, p = 0.042). Holding a driving license increased the odds of being employed (aOR = 2.68 95%CI 1.32-5.46, p = 0.007). Participants on 4 or more antiepileptic medications were more likely to report not being well enough to work. SIGNIFICANCE: Patients with seizure disorders are at increased risk of unemployment, even though many desire work. Unemployment is linked to social factors rather than disease-specific characteristics. Employers in Saudi Arabia generally accommodate patients in the workplace; however, individuals should further be empowered with information on safety in the workplace and their rights to employment.

Outcomes of autologous stem cell transplantation for multiple myeloma in Saudi Arabia.

BACKGROUND: In 2015, multiple myeloma (MM) represented 1% of all cancers and about 5% of hematologic malignancies in Saudi cancer registry. We conducted this large study because only small pilot studies have examined MM outcomes after autologous stem-cell transplantation (ASCT). The standard therapy for eligible patients is induction chemotherapy followed by ASCT. OBJECTIVES: Determine the demographic characteristics of MM patients and the outcomes of ASCT. DESIGN: Retrospective. SETTING: Tumor registry database of major tertiary cancer care center in Riyadh. PATIENTS AND METHODS: We identified patients with newly diagnosed MM who underwent ASCT from October 1997 to March 2015. MAIN OUTCOME MEASURES: The demographic characteristics of MM patients and the outcomes of ASCT in the form of response evaluation, progression-free survival (PFS) and overall survival (OS). SAMPLE SIZE: 169 patients with newly diagnosed MM. RESULTS: The median age at diagnosis was 51 years (range 23-69) and 100 (59.2%) were male. The most common immunoglobulin (Ig) subtype was IgG-kappa (80 patients; 47.6%). Most patients presented with advanced ISS stage III (75 patients; 47.5%). The cytogenetic analysis was documented in only 87 patients (51.4%); about half (48.3%) had normal cytogenetics by fluorescence in situ hybridization. Deletion 13 was present in 18.4% of patients. In post-induction therapy, 84 patients (50%) achieved a complete response, which increased to 78.1% (132 patients) after ASCT. The median PFS and OS post-transplantation were 30 and 202 months, respectively. Only one patient (<1%) died in the first 100 days after transplantation. CONCLUSIONS: Our transplant eligible MM patients tend to be younger with a higher OS and a low ASCT-related mortality (<1%) than is reported internationally. LIMITATIONS: Usual limitations of a retrospective analysis using registry-level data; no data on quality of life. CONFLICTS OF INTEREST: None.

Tocilizumab Effect on Lipid Profile in Correlation to Cardiovascular Events: A Retrospective Cohort Study.

OBJECTIVE: To study the effect of tocilizumab initiation on the lipid profile, in correlation to a composite of any cardiovascular events. METHODS: A retrospective cohort study, using data from the King Faisal Specialist Hospital & Research Centre database, from January 2014 to December 2019. Patients with rheumatoid arthritis or juvenile idiopathic arthritis who were ≥18 years old, initiated either on tocilizumab or other biologic treatment (anti-TNFs or Rituximab), were included, with a follow-up interval duration at a minimum of 6-12 months up to 3-5 years. Any patient with established cardiovascular disease or aged <18 were excluded. RESULTS: Only one cardiovascular mortality was reported in the tocilizumab group. Fifty percent of patients reached high cholesterol levels ≥ 5.2 mmol/L and LDL ≥ 3.37 mmol/L in the tocilizumab group at 36 months in a shorter time period compared to controls (60 months), P 0.001. There were no significant differences between groups for statin use (27% vs. 28%) However, there was a significantly higher mean dose of atorvastatin in the tocilizumab group compared to controls (20.6 mg vs. 16.6 mg, P 0.03). CONCLUSION: There was a lack of evidence of increased cardiovascular risk in correlation to hyperlipidemia secondary to tocilizumab treatment.

Clinical manifestations and treatment outcomes of human brucellosis at a tertiary care center in Saudi Arabia.

BACKGROUND: Brucellosis, which has profound public health and economic consequences, is endemic to Saudi Arabia. Brucella is transmitted to humans by direct contact with infected animals or by consumption of unpasteurized dairy products. Manifestations of brucellosis are protean and require a combination of drugs to prevent the emergence of resistance. The WHO recommends the use of doxycycline with rifampicin or an aminoglycoside for brucellosis, but experts in Saudi Arabia prefer to avoid the use of rifampicin and aminoglycosides to lessen the possibility of emergence of drug-resistant tuberculosis. OBJECTIVES: Compare rifampicin and doxycycline in the treatment of human brucellosis versus various combinations of doxycycline, with either trimethoprim-sulfamethoxazole (co-trimoxazole), quinolones or aminoglycosides, and describe the clinical manifestations of brucellosis. DESIGN: Retrospective medical record review. SETTING: Single tertiary care center. PATIENTS AND METHODS: Diagnosis of brucellosis was based on positive serology by standard agglutination test (SAT), or isolation by culture of Brucella species from blood, body fluid or tissue. MAIN OUTCOME MEASURES: Cure rate with the use of doxycycline in combination with either co-trimoxazole, quinolone or aminoglyco-sides in comparison to doxycycline/rifampicin and the clinical features of brucellosis. SAMPLE SIZE: 123. RESULTS: In 118 (96%) patients, the median IgG/IgM antibody titers at diagnosis and at 6 and 12 months were 1:1280/1:1280, 1:640/1:640, and 1:320/1:160, respectively. There were no differences in outcome between treatment regimens, as evidenced by a significant decrease in SAT titers and symptom resolution within six months. Five (4%) patients relapsed from non-adherence to treatment, but responded well to a second course of treatment. Blood cultures were positive in 50 patients (41%) patients. Fever, arthralgia and back pain were the most common symptoms. Good serological and clinical responses were achieved in 96% of patients. Relapse in 4% (n=5) was due to self-reported non-adherence. LIMITATIONS: Retrospective, relatively small sample size. CONCLUSIONS: Doxycycline with co-trimoxazole is as efficacious as doxycycline/rifampicin in non-focal brucellosis and is preferred in countries with a high prevalence of tuberculosis. CONFLICT OF INTEREST: None.

The Immunostimulatory Effects of Commercial Feed Additives on Growth Performance, Non-specific Immune Response, Antioxidants Assay, and Intestinal Morphometry of Nile tilapia, Oreochromis niloticus.

The main objective of the present research was to investigate the impacts of commercial immunostimulants on growth, non-specific immune response, antioxidant enzymes, and intestinal morphometry of Nile tilapia, Oreochromis niloticus. Fish (100 ± 6.5 g) were randomly divided into five groups in triplicates (150 fish in each replicate), stocked in 20 m2 of aerated concrete ponds. The fish were fed on a control diet (30.0% crude protein) (control), and four experimental diets supplemented with Yeast Plus®, Digestarom®, and Biotronic® Top3 at 1 kg ton-1, and Sanolife PRO-F® at 0.5 kg ton-1. After the experimental period, the highest significant yield (kg m-3), mean final weight (g fish-1), average weight gain (g fish-1), and specific growth rate (% body weight day-1), were recorded in fish fed on the diet supplemented by Sanolife PRO-F, followed by Yeast Plus ponds. The lowest yield was recorded in the control group. However, the feed conversion ratio was significantly decreased with Sanolife PRO-F diet. Furthermore, the hematological analysis increased in the following ascending order: Sanolife PRO-F®; Yeast Plus®; Biotronic® Top3 and finally Digestarom® groups. The lowest concentrations of white blood cells, red blood cells, hematocrite, and hemoglobin (P ≤ 0.05) were observed in the control group. The levels of phagocytic activity and phagocytic index were significantly higher in fish fed with Sanolife PRO-F® group (P ≤ 0.05). Likewise, serum lysozyme activity was significantly highest in Sanolife PRO-F (0.63 and 0.68 U/mL, after 0.5 min and 3 min, respectively). Levels of total serum proteins, globulin, Immunoglobulin M, catalase, and super oxide dismutase were significantly higher in fish fed with Sanolife PRO-F® supplement. On the contrary, length measurement of the intestinal villus height/width, absorption area, crypt depth, and goblet cells, were significantly lower in the control group, whereas their highest values was observed in fish fed Sanolife PRO-F (P ≤ 0.05). Consequently, Sanolife PRO-F® is recommended at a level of 0.5 kg ton-1, to improve the growth performance, antioxidative capacity, and immune response of Nile tilapia.