Network Pharmacology, Molecular Docking, and Molecular Dynamics Simulation Analysis Reveal Insights into the Molecular Mechanism of Cordia myxa in the Treatment of Liver Cancer.

Traditional treatments of cancer have faced various challenges, including toxicity, medication resistance, and financial burdens. On the other hand, bioactive phytochemicals employed in complementary alternative medicine have recently gained interest due to their ability to control a wide range of molecular pathways while being less harmful. As a result, we used a network pharmacology approach to study the possible regulatory mechanisms of active constituents of Cordia myxa for the treatment of liver cancer (LC). Active constituents were retrieved from the IMPPAT database and the literature review, and their targets were retrieved from the STITCH and Swiss Target Prediction databases. LC-related targets were retrieved from expression datasets (GSE39791, GSE76427, GSE22058, GSE87630, and GSE112790) through gene expression omnibus (GEO). The DAVID Gene Ontology (GO) database was used to annotate target proteins, while the Kyoto Encyclopedia and Genome Database (KEGG) was used to analyze signaling pathway enrichment. STRING and Cytoscape were used to create protein-protein interaction networks (PPI), while the degree scoring algorithm of CytoHubba was used to identify hub genes. The GEPIA2 server was used for survival analysis, and PyRx was used for molecular docking analysis. Survival and network analysis revealed that five genes named heat shot protein 90 AA1 (HSP90AA1), estrogen receptor 1 (ESR1), cytochrome P450 3A4 (CYP3A4), cyclin-dependent kinase 1 (CDK1), and matrix metalloproteinase-9 (MMP9) are linked with the survival of LC patients. Finally, we conclude that four extremely active ingredients, namely cosmosiin, rosmarinic acid, quercetin, and rubinin influence the expression of HSP90AA1, which may serve as a potential therapeutic target for LC. These results were further validated by molecular dynamics simulation analysis, which predicted the complexes with highly stable dynamics. The residues of the targeted protein showed a highly stable nature except for the N-terminal domain without affecting the drug binding. An integrated network pharmacology and docking study demonstrated that C. myxa had a promising preventative effect on LC by working on cancer-related signaling pathways.

A systematic literature review for evaluation of knowledge, attitude, and self-care practice regarding common eye diseases in the healthy general population.

Background and purpose: Increasing people's knowledge and then changing their attitude and practice with the aim of taking care of their eye health are very important. Considering the importance of the mentioned topic, the main goal of this study was to evaluate the knowledge, attitude, and practice about eye diseases in the general population of the world in the form of a systematic literature review. Materials and Methods: This study was a systematic literature review study, and to do it, a systematic search was conducted in internationally available databases including Web of Science, ScienceDirect, Scopus, PubMed, and Google Scholar in the time range of 1998 to 2023. Finally, considering the inclusion and exclusion criteria of the study, the results of 18 articles were extracted. Results: The findings showed that in general, people's level of knowledge about glaucoma was lower compared to other eye diseases, and the level of knowledge of men and women about eye diseases was different. In addition, the results showed that there was significant relationship between age and knowledge of various eye diseases. The results of all evaluated studies showed that people with higher education have more knowledge about eye diseases. Conclusion: Based on this, it can be concluded that as glaucoma is one of the most important causes of blindness worldwide, it is necessary to plan to increase the level of public knowledge to recognize the symptoms and complications of this disease. In addition to that, it is necessary to increase people's advertisement by ophthalmology centers and eye specialists about the use of glasses and also to encourage people to visit the eye physician regularly.

Pulmonary Manifestations of Systemic Lupus Erythematosus Among Adults in Aseer Region, Saudi Arabia.

Background: Nearly half of the Systemic lupus erythematosus (SLE) patients develop lung involvement. The study assessed the extent of pulmonary involvement among SLE patients and to identify the associated factors in the population. Methodology: This retrospective cohort study was conducted at Aseer Hospital and Khamis Myshat Hospital in the Southern region of Saudi Arabia. The study spanned from January 1, 2016, to June 3, 2023. Patient inclusion criteria encompassed individuals who received a definitive diagnosis and classification as per American College of Rheumatology criteria, while patients under 18 years of age and those with mixed connective tissue diseases were exclude. Results: A total of 247 participants were included. 41.7% (n=103) aged 41 years and older, 95.1% (n = 235) were females. Around 10.10% had diabetes mellitus and 17.00% had hypertension and hypothyroidism. Lupus Nephritis was in 15.40%. Chest involvement was reported in 21.9%, in the form of pleuritis (6.10%), pleural effusion (4.00%), and lupus pneumonitis (4.00%), interstitial lung disease (4.00%), pulmonary embolism (3.60%) of individuals, and pulmonary hemorrhage (2.80%). The respiratory symptoms reported by SLE were; dyspnea, cough, and chest pain each having a prevalence of around 18.0%. Palpitations have a relatively high occurrence at 13.80%. Meanwhile, hemoptysis (blood coughing) has a lower prevalence of 1.20%, and fever is reported at 2.80%. Having chronic kidney disease and hypertension were significantly associated with having pulmonary involvement; (χ2=3.308, p=0.027) and (χ2=7.782, Fisher's p=0.002) respectively. The seropositivity for antiphospholipid Abs, anti-CCP, and antids-DNA were significantly associated with pulmonary involvement (χ2=3.239, =p=0.049), (χ2=4.621, Fisher's p=0.023), and (χ2=8.248, p=0.010) respectively. Conclusion: The study found that 21.9% of SLE patients experience chest involvement, with varying degrees of pulmonary symptoms. Factors such as chronic kidney disease, hypertension, antiphospholipid antibodies, Anti-CCP positivity, and seropositivity for Anti-dsDNA were found to be significant associations with lung involvement, contributing to our understanding of SLE.

The connectivity indices concept of neutrosophic graph and their application of computer network, highway system and transport network flow.

To address information ambiguities, this study suggests using neutrosophic sets as a tactical tool. Three membership functions (called T r , I n , and F i ) that indicate an object's degree of truth, indeterminacy, and false membership constitute the neutrosophic set. It becomes clear that the neutrosophic connectivity index (CIN) is an essential tool for solving practical problems, especially those involving traffic network flow. To capture uncertainties, neutrosophic graphs are used to represent knowledge at different membership levels. Two types of C I N s , mean CIN and CIN, are investigated within the framework of neutrosophic graphs. In the context of neutrosophic diagrams, certain node types-such as neutrosophic neutral nodes, neutrosophic connectivity reducing nodes (NCRN) , and neutrosophic graph connectivity enhancing nodes (NCEN) , play important roles. We concentrate on two types of networks, specifically traffic network flow, to illustrate the real-world uses of CIN. By comparing results, one can see how junction removal affects network connectivity using metrics like Connectivity Indexes (CIN) and Average Connectivity Indexes (ACIN) . A few nodes in particular, designated by ACIN as Non-Critical Removal Nodes ( N C R N s ) , show promise for increases in average connectivity following removal. To fully comprehend traffic network dynamics and make the best decisions, it is crucial to take into account both ACIN and CIN insights. This is because different junctions have different effects on average and overall connectivity metrics.

Knowledge, Attitude, and Practices Related to Foot Care Among Diabetic Patients in Tabuk City, Saudi Arabia.

Introduction Diabetic foot ulcer (DFU) is a prevalent complication of diabetes mellitus (DM), affecting approximately 15% of all diabetic patients. This condition poses significant challenges due to its association with major morbidity, mortality, high costs, and diminished quality of life. The incidence of diabetic foot complications among diagnosed diabetes cases is alarming, making it a primary concern in diabetes management. Diabetes mellitus, a chronic metabolic disorder, impacts nearly every system in the body. Methods In this study, a cross-sectional design was employed to assess the level of knowledge, attitude, and practices related to foot care among 432 diabetic patients in Tabuk City, Saudi Arabia. Results The participants' ages ranged from 18 to above 60 years, with (n = 206, 47.69%) being male and (n = 226, 52.31%) female. Type 2 diabetes was prevalent, constituting (n = 277, 64.12%) of cases, whereas (n = 187, 38.29%) had type 1 diabetes. Approximately (n= 224, 51.9%) of patients had been diagnosed with diabetes for less than 10 years. A significant portion (n= 302, 69.91%) of patients did not report any foot complaints. However, (n= 88, 20.37%) had a history of healed ulcers, and (n= 21, 4.9%) had undergone amputation due to diabetes. The majority of patients (n = 228, 52.78%) were under oral agent treatment. Conclusion The study population demonstrated adequate knowledge about diabetes management and exhibited positive attitudes toward diabetes and its related complications, particularly concerning foot care. While most patients displayed appropriate practices related to diabetic foot care, some participants showed inadequate adherence to essential procedures. Addressing these gaps in knowledge and practices is crucial for enhancing the overall management of diabetic foot complications among patients.

A Retrospective Study of Ocular Cancer in Saudi Arabia: 25-Year Analysis.

Background: Ocular malignancies are uncommon among eye diseases; however, they jeopardize both vision and life. The main objective of this study was to use to describe the epidemiology of eye and ocular adnexa malignancies across different ages and sex. Methods: The King Khaled University institutional review board approved this study. Data on ocular cancer were retrieved from the Saudi Cancer Registry between 1994 and 2018. The registry collected important patient information such as demographic information (age, gender, and nationality), clinical details, and tumor classification. Results: The total number of cases with ocular cancer diagnosed was 1051 cases. The highest number was recorded in Riyadh (35.39%, n=372), followed by Makkah (16.93%, n=178). The incidence was higher in the 0-4 years' age group (55.21%), and it got down as people got older. The data also revealed differences in the number of reported cases over time, as well as in the representation of eye cancer cases by gender and nationality. While many ocular cancer pathologies were seen, with "Retinoblastoma, not otherwise specified" being the most common (53.32%), the incidence rates for males and females remained largely stable over time. Conclusion: The study emphasizes the need for continued monitoring, research, and analysis of potential of epidemiology of ocular cancer occurrence in Saudi Arabia. Identifying the geographical distribution and age pattern of Ocular malignancies have the potential to assist healthcare authorities and policymakers in developing precise strategies to reduce, recognize at an early stage, and successfully manage this condition.

Bacterial Species Causing Secondary Pneumonia Infection in Pregnant Women with COVID-19.

Sputum samples were taken from pregnant women infected with the COVID-19, where the study was conducted on 112 cases, and the results showed that 87 cases developed secondary bacterial infections at a rate of 78% and 25 cases were negative by 22%. The samples were cultured on solid media and incubated at 37°C. Then the samples were diagnosed by biochemical tests and using the API system. Six species of bcteria have been isolated (S. aureus, K.pneumonia P. auroginosa, H. influenza, S. pneumonia S. pyogens) by 31, 29, 12, 10, 7, and 5 isolates, respectively, where the result showed that the most common types of pneumonia were S. aureus with a percentage of 34%, followed by K. pneumonia with a percentage of 29%. The sensitivity of the isolates to eight types of common antibiotics was tested (Erythromycin, Trimethoprim, Ampicillin, Tetracycline, Augmentin, Nitrofurantoin, Meropenem, and Amikacin), where the isolates showed a high resistance to antibiotics (Erythromycin, Trimethoprim, Ampicillin), a high sensitivity of 100% to the Nitrofurantoin, and an average sensitivity to other antibiotics.

Knowledge assessment on cleft lip and palate among recently graduated dentists: a cross-sectional study.

BACKGROUND: The complex presentation, associated co-morbidities and multi-disciplinary requirements dictate the requirement for in-depth knowledge in order to effectively manage patients with cleft lip and palate (CLP). We aimed to develop a validated questionnaire for cleft lip and palate knowledge assessment and to evaluate the knowledge of cleft lip and palate among a group of recently-graduated dentists. MATERIALS AND METHODS: A multiple-site, cross-sectional questionnaire-based study was conducted. The study population included recently graduated dentists involved in a dental internship program. A bespoke questionnaire was developed and validated, with internal consistency assessed using Cronbach's alpha and factor analysis performed. A 47-item prototype was distilled into a 15-item questionnaire. This was distributed to the participants with a response rate of 67% obtained. RESULTS: The overall proportion of correct responses among dental interns was moderate (73%). The best results were found in relation to CLP treatment including the effect of unfavorable surgical outcomes on speech (89.5%) and the impact of CLP on the occlusion (87.6%). The lowest rate of correct responses (26.7%) was identified in relation to the association between CLP and smoking. CONCLUSION: A validated CLP questionnaire was developed, permitting evaluation of the knowledge of cleft lip and palate and its management among recently graduated dentists. There is limited appreciation among dental interns of the risk factors for CLP as well as post-surgical complications. Given that general dentists are often the gatekeepers for the management of patients with cleft lip and palate, it is important that the findings of this survey are used to inform the curriculum and teaching of cleft lip and palate.

Correlation between Subclinical Hypothyroidism and Metabolic Syndrome: A Retrospective Study.

Background: Several studies worldwide have studied the correlation between subclinical hypothyroidism (SCH), and metabolic syndrome (MetS), but have reported inconsistent findings. Objectives: To assess the correlation between SCH and MetS in a population from Saudi Arabia. Methods: This retrospective study was conducted at King Abdulaziz University Hospital and analyzed all thyroid function tests conducted between January 1, 2019, to December 31, 2021. A predesigned checklist was used to collect data about patients' characteristics such as age, gender, nationality, TSH, FT4 level, and MetS components. Results: A total of 41,519 thyroid function tests were conducted during the study period. From this, 1303 (3.1%) patients were found to have SCH, with the majority being females (74.4%). The prevalence did not differ according to gender but increased to 3.5% among those aged >60 years. MetS components between mildly and markedly elevated TSH were significant for total cholesterol (P < 0.001) and high-density lipoprotein cholesterol (P < 0.05). Male patients with SCH were at a higher risk of developing diabetes (P < 0.001) and hypertension (P < 0.02), than female patients with SCH. After adjusting for age, in the multiple stepwise linear regression analysis, a significant association was found between TSH levels and ALT (odds ratio: 0.77) and SBP (odds ratio: 0.35). Conclusion: The study demonstrated that the prevalence of SCH is similar between both genders but increases with age. MetS components were abnormal in patients aged >50 years and in males with SCH. SCH and MetS components were found to be correlated, and thus monitoring these variables in patients with SCH is advisable.

Regulation of iron metabolism is critical for the survival of Salmonella Typhimurium in pasteurized milk.

Salmonella is known to survive in raw/pasteurized milk and cause foodborne outbreaks. Lactoferrin, present in milk from all animal sources, is an iron-binding glycoprotein that limits the availability of iron to pathogenic bacteria. Despite the presence of lactoferrins, Salmonella can grow in milk obtained from different animal sources. However, the mechanism by which Salmonella overcomes iron scarcity induced by lactoferrin in milk is not evaluated yet. Salmonella employs the DNA binding transcriptional regulator Fur (ferric update regulator) to mediate iron uptake during survival in iron deplete conditions. To understand the importance of Fur in Salmonella milk growth, we profiled the growth of Salmonella Typhimurium Δfur (ST4/74Δfur) in both bovine and camel milk. ST4/74Δfur was highly inhibited in milk compared to wild-type ST4/74, confirming the importance of Fur mediated regulation of iron metabolism in Salmonella milk growth. We further studied the biology of ST4/74Δfur to understand the importance of iron metabolism in Salmonella milk survival. Using increasing concentrations of FeCl3, and the antibiotic streptonigrin we show that iron accumulates in the cytoplasm of ST4/74Δfur. We hypothesized that the accumulated iron could activate oxidative stress via Fenton's reaction leading to growth inhibition. However, the inhibition of ST4/74Δfur in milk was not due to Fenton's reaction, but due to the 'iron scarce' conditions of milk and microaerophilic incubation conditions which made the presence of the fur gene indispensable for Salmonella milk growth. Subsequently, survival studies of 14 other transcriptional mutants of ST4/74 in milk confirmed that RpoE-mediated response to extracytoplasmic stress is also important for the survival of Salmonella in milk. Though we have data only for fur and rpoE, many other Salmonella transcriptional factors could play important roles in the growth of Salmonella in milk, a theme for future research on Salmonella milk biology. Nevertheless, our data provide early insights into the biology of milk-associated Salmonella.

Multifocal malignant peripheral nerve sheath tumor in patients with neurofibromatosis type I: Report of two cases and review of literature.

Background: Malignant peripheral nerve sheath tumors (MPNSTs) are one of the rarest soft-tissue sarcomas with a prevalence of 0.001% in the general population. It is closely associated with a unique neurocutaneous stigmata under the spectrum of the dermatological manifestations of neurofibromatosis type 1 (NF1). Almost 81% of MPNST arises from a precursor neuroma, and multifocality of these lesions is extremely rare, making up to 0.001% of cases. Moreover, spinal cases are extremely uncommon with only four cases reported internationally. Here, we present the fifth and sixth spinal MPNST cases with a brief review of literature. Case Description: We describe two unusual cases of multifocal MPNST in relation to NF1 occurring in the spinal cord. Both patients presented with local pain and myelopathic symptoms. The two patients underwent wide surgical resection, followed by neoadjuvant radiotherapy and reported immediate postoperative improvement of the presented complaint; however, one patient suffered from rapid recurrence and metastasis. Conclusion: Due to the scarcity of spinal cases related to MPNST, no clear guidelines regarding the management of these cases are set in the literature. Histopathological diagnosis remains as the most pivotal diagnostic tool as they can mimic other peripheral nerve sheath lesions, such as neuromas and schwannomas, in imaging. Cases that were managed by early surgical intervention in addition to neoadjuvant radiotherapy reported the best outcome. However, cases of MPNST in concomitance with NF1 were found to be resistant to both chemo and radiotherapy and have high recurrence rate.

Changes in the level of cytokines in the saliva of hypertensive patients with chronic periodontitis after scaling and root planning.

INTRODUCTION: Cytokines have a key role in the pathogenesis of both hypertension and periodontitis. Salivary diagnosis is a promising field with numerous clinical applications. Since limited studies have been carried out on how salivary inflammatory cytokines can be determined and how well periodontal disease and hypertension might react to scaling and root planning (SRP). The goal of this study was to identify the pattern of changes in salivary inflammatory cytokines in chronic periodontitis subjects with hypertension after nonsurgical periodontal therapy. METHODS: It included observational trial recruited 94 chronic periodontitis patients, 44 of whom had hypertension. All subjects have undergone non- surgical periodontal treatment. The clinical periodontal parameters included gingival index (GI), plaque index (PI), and probing of pocket depth (PPD). Unstimulated saliva was collected to determine the inflammatory biomarkers (using a commercial Elisa kit) both before and after SRP RESULTS: In comparison to non-hypertensive participants, the periodontal PPD was significantly higher in hypertensive subjects. All clinical parameters in the first examination, except for PI, were significantly higher in hypertensive than in non-hypertensive subjects. Plaque Index, GI, and PPD parameters at first visit and after finishing treatment positively correlated with salivary IL-1ß, excluding pretreatment GI. The current results demonstrate the presence of a positive correlation between diastolic blood pressure and TNF (r = 0.330 and P = 0.029). All patients enrolled in this study showed a significant increase in the salivary levels of IL-4 after SRP. CONCLUSIONS: The current study offer important and valuable information concerning the practical application of pro-inflammatory and anti-inflammatory cytokines as useful biomarkers and indicators for determining the outcome of SRP and progression of chronic periodontitis in patients with hypertension.

Association of Serum Leptin and Adiponectin Concentrations with Type 2 Diabetes Biomarkers and Complications Among Saudi Women.

Objective: Hyperglycemia and insulin resistance (IR) put obese women with Type 2 diabetes mellitus (T2DM) at risk for cardiovascular disease (CVD). Methods: 150 T2DM women aged 30-45 were studied cross-sectionally at Madinah Hospital lab to find T2DM risk factors and their association with adiponectin/leptin levels. Results: Women with T2DM showed greater fasting blood glucose (FBG), hemoglobin A1c (HbA1c), triglycerides (TG), body mass index (BMI), waist circumference (WC), insulin resistance (IR), high-sensitivity C-reactive protein (hs-CRP), and CVD risk (high atherogenic index of plasma (AIP) and leptin), but decreased high-density lipoprotein (HDL-cholesterol) and poor insulin sensitivity with low adiponectin. Obese women with T2DM had increased leptin and reduced adiponectin. Leptin levels were significantly related to IR, BMI, and AIP (B= 3.97, P= 0.02) but not WC. Leptin levels were negatively correlated with insulin sensitivity (IS) and HDL-c (P< 0.05). In linear regression analysis, adiponectin levels had a significant association with IS and HDL-c (P= 0.03, P= 0.04) but an inverse relationship with IR, BMI, WC (B=-2.91, P= 0.04), and AIP (P< 0.05). Conclusion: Increased leptin levels are related to high IR, AIP, and BMI among T2DM female patients. Similarly, adiponectin levels decrease IS and HDL-c. Therefore, obese T2DM women with high leptin and low adiponectin levels should be periodically checked to avoid or decrease consequences like CVD.

Operative management and outcomes in patients with myxomas: A single-center experience.

Background: Cardiac myxoma is a rare cardiac tumor that may be asymptomatic or can cause embolization or intracardiac obstruction, leading to heart failure, sudden cardiac death, and arrhythmia. This study aims to report an 11-year experience of a single center in the management of cardiac myxoma. Method: This study is a single-center retrospective case series. Eighty cases of cardiac myxoma were collected in Ibn Albitar's specialized center for cardiac surgery. Transthoracic echocardiography was used to make the preoperative diagnosis in all patients. The surgeries were undertaken through the standard approach of a median sternotomy. All four cardiac chambers were thoroughly explored for additional myxomas. The major objective of the operations was complete tumor resection. Result: The mean age of the patients was 46.3 years. Females (67.5%) were predominant over males (32.5%). Shortness of breath was the most common symptom (86.25%). The left atrium was the most affected site (83.75%), followed by the right atrium (13.75%). Coronary artery bypass grafting was required as the secondary or associated intervention in 19 (23.75%) cases. The recurrence rate was 11.25%, with a mortality rate of 3.75%. Conclusion: Recurrence and tumor embolism are risks of surgical intervention for myxoma. Good preparation using transthoracic echocardiography as a diagnostic tool and standard median sternotomy to complete resection of the tumors can decrease the rate of recurrence, embolism, and even mortality.

Endovascular Biopsy of an Inferior Vena Cava Mass: A Case Report.

We describe the case of an 82-year-old female referred to the vascular clinic for further evaluation and management of suspected inferior vena cava (IVC) thrombosis. She had previously presented to the general practitioner with a one-week history of vague abdominal pain in the right and left loins. Contrast-enhanced magnetic resonance imaging (MRI) of the abdomen and magnetic resonance angiography/magnetic resonance venography (MRA/MRV) revealed a 10 cm filling defect in the IVC, with the inferior margin of ≈5.8 cm proximal to the aortic bifurcation and its superior margin in the intrahepatic portion of the IVC. The filling defect had a transverse diameter of 2.6 cm and displayed heterogenous enhancement with contrast. We performed an endovascular biopsy with fluoroscopy (anteroposterior {AP} and lateral views) being utilized throughout the procedure to locate the mass and position the forceps in the tumor bed. The IVC was accessed via the right common femoral vein with a 10F catheter sheath. The sheath was advanced using the Seldinger technique to within ≈1 cm of the mass; then, a biopsy forceps (Micro-Tech single-use 8.5 mm biopsy forceps, Nanjing, China) was inserted, and six tissue samples were obtained. We report this case to add to the growing evidence that endovascular biopsy of IVC tumors can be performed safely and effectively.

Antimicrobial and Antioxidant Activities and Phytochemical Analysis of Rosmarinus officinalis L. Pod and Thymus vulgaris L. Leaf Ethanolic Extracts on Escherichia coli Urinary Isolates.

The indiscriminate use of antibacterial agents has resulted in one of the largest recent global health problems, which is the emergence of bacterial resistance. This study aimed to examine the antimicrobial and antioxidant activities of ethanolic extracts of the two medicinal plants; Rosmarinus officinalis pods and Thymus vulgaris leaves on Escherichia coli urinary isolates. Both plants were extracted by absolute ethanol, and various concentrations (100, 50, 25, and 12.5 mg/ml) of the ethanolic extracts were prepared and tested against 53 urinary isolates of E. coli. An antibiotic susceptibility test was performed using chloramphenicol, gentamycin, amoxicillin, ceftriaxone, and ciprofloxacin against isolated bacteria. The antioxidant activity was measured using the DPPH method. The chemical analysis of both extracts was determined using gas chromatography-mass spectrometry (GC/MS) technique. The results showed that 88.7% of the isolated bacteria were sensitive to chloramphenicol and 87% were sensitive to gentamycin, while all isolates were resistant to amoxicillin, 13% of E. coli isolates were found to be multidrug-resistant (MDR). The inhibitory zone of R. officinalis extract against E. coli ranged between 8 and 23 mm and for T. vulgaris extract ranged between 8 and 20 mm at concentrations between 25, 50, and 100 mg/ml. The MIC of both extracts against isolates is between 12.5 and 50 mg/ml, while the MBC is between 50 and 100 mg/ml. The DPPH radical scavenging potential of T. vulgaris was 83.09%, followed by R. officinalis (81.26%). The chemical analysis by GC-MS of R. officinalis showed that the most active compounds were: eucalyptol (18.57%), bicycloheptan (10.01%), and octahydrodibenz anthracene (7.44%) and for T. vulgaris the most active compounds were: thymol (5.7%), phytol (7.92%), and hexadecanoic acid (18.51%). R. officinalis and T. vulgaris ethanolic extracts possessed antimicrobial and antioxidant activities and were found to be rich natural sources of active constituents used as traditional medicine.

Pseudo­Wellens syndrome in an elderly female patient with pulmonary embolism: A case report.

Pseudo-Wellens syndrome refers to any electrocardiogram (ECG) pattern that mimics Wellens syndrome with no critical left anterior descending (LAD) artery-associated coronary artery disease. The present study describes a rare case of pseudo-Wellens syndrome associated with pulmonary embolism. A female patient presented with chest tightness for 72 h. The precordial examination and heart sounds were normal. A mild bilateral lower pitting leg edema with a superficial varicose vein was observed. The levels of C-reactive protein (98.80 mg/l) and D-dimer (7599.9 ng/ml) were abnormal. An electrocardiogram presented a biphasic inversion of the T-wave in precordial leads in the pain-free interval. Coronary angiography did not reveal any notable findings. A computed tomography pulmonary angiography demonstrated an acute pulmonary embolism. The patient received unfractionated heparin (20,000 IU) by intravenous infusion. She was discharged on rivaroxaban (15 mg) twice daily for 21 days. The inverted T-wave specificity, sensitivity and positive predictive values for LAD stenosis are 89, 69 and 86% respectively. This indicates that ECG alternations with the properties of Wellens syndrome do not always guarantee its occurrence, and in the presence of a normal coronary artery, the condition may be pseudo-Wellens syndrome. The case described herein suggests that clinicians need to carefully screen patients that have pulmonary embolisms with an abnormal electrocardiographic pattern in order to prevent unnecessary intervention.

Acute gastroenteritis-related acute kidney injury in a tertiary care center.

BACKGROUND: Acute gastroenteritis (AGE) can cause acute kidney injury (AKI) via hypoperfusion mechanisms. Early detection of AKI caused by AGE can significantly decrease mortality rates. In Saudi Arabia, studies investigating the association between AGE and AKI are limited; thus, we aimed to fill this knowledge gap. OBJECTIVES: Analyze all cases of AGE reported in tertiary-care hospitals to assess the prevalence of AKI among AGE patients. DESIGN: Retrospective cohort SETTINGS: Single tertiary-care center PATIENTS AND METHODS: The study included patients treated for AGE between October 2017 and October 2022. Stool culture was used to diagnose AGE. Inclusion criteria were infective diarrhea and/ or vomiting, and availability of data (demographics, comorbidities, malignancies, length of hospital stay, vital signs at the time of diagnosis, dehydration, causative agents of diarrhea, hemodialysis status, and laboratory data. MAIN OUTCOME MEASURES: Prevalence of AKI among AGE patients and factors associated with development of AKI. SAMPLE SIZE: 300 patients diagnosed with AGE. RESULTS: Of the 300 patients with AGE, 41 (13.6%) had AKI, those older than 60 years were more likely to develop AKI. The most frequent cause of AGE was Salmonella spp. (n=163, 53.3%), whereas AKI was most common in Clostridium difficile AGE patients (n=21, 51.2%). Furthermore, the most common comorbidity in the present study was malignancy, especially leukemia and lymphoma the risk of AKI was independently associated with mild dehydration, higher serum urea concentrations and low GFR values. CONCLUSIONS: Patients hospitalized for diarrheal disease are at an increased risk of developing AKI due to dehydration and comorbid conditions. It is crucial to keep kidney function in mind for AGE patients as this is associated with a high mortality rate and poor prognosis. LIMITATIONS: The main limitation of this study was its retrospective design. Another limitation is that it is limited to a single center. CONFLICTS OF INTEREST: None.

Bentall procedure as a lifesaving surgery: A single center experience.

The Bentall procedure is a surgical technique used in the management of aortic root abnormalities with ascending aorta and aortic valve issues. The present study aimed to evaluate the outcomes of 18 patients treated with the Bentall procedure in a single center. The present study was a single-center retrospective case series conducted over a period of 3 years. The patients had either acute ascending dissection and/or dilated ascending aorta with aortic valve dysfunction. The Bentall procedure was performed via standard median sternotomy. St. Jude Medical composite grafts with a valve were applied in all cases. A total number of 18 patients with either acute ascending dissection and/or dilated ascending aorta with aortic valve dysfunction were included in the study. The age of the participants ranged from 27-60 years. The ratio of males to females was 16:2 (males, 88.8%). The symptoms developed 3-4 days prior to hospital admission. Chest pain was the most common presenting symptom (n=10, 55.5%). Hypertension was the most common risk factor (n=12, 66.6%). In total, 14 cases underwent emergency surgery (77.7%). The emergency surgery was performed in 9 patients within 24 h of arrival owing to the association of aortic root dissection with tamponade. For the other cases, the surgery was performed within 2 and 7 days (n=5, 27.7% and n=4, 22.2%) respectively. Early post-operative complications occurred in 5 patients (27.7%). On the whole, as demonstrated herein, the modifications of the Bentall procedure have a notable impact on decreasing the overall mortality rates. Raising the awareness of clinicians and the general population as regards aortic dissection may aid in the early referral of patients to specialized centers and may thus decrease the overall mortality rate.