Awareness of Appendectomy and Its Complications Among Saudis.

BACKGROUND: Acute appendicitis is one of the most common surgical causes of acute abdominal pain in adults and children in the emergency department. It is treated by appendectomy by either an open or laparoscopic approach. Although laparoscopic appendectomy has been used for the last 35 years, there are still indications for an open approach in some cases. OBJECTIVES:  The aim of this study was to explore the awareness of the general population in Saudi Arabia of appendectomy according to the surgical approach. METHODS: A cross-sectional survey using a questionnaire constructed by an expert based on Google Forms (Google, Mountain View, CA) was used from February to March 2022. Variables were demographical data, general knowledge, history of appendectomy, its surgical approach, and postoperative complications, if any. RESULTS: The study included 162 participants. The awareness level of acute appendicitis was high (72.2%). History of appendectomy was almost 30% and was significantly more common in males than females (p = 0.045). The rate of postoperative complications showed a significant difference between open (4.3%) vs. laparoscopic approaches (8%) (p = 0.001). CONCLUSION:  Young, educated Saudis are aware of the importance of surgical intervention for acute appendicitis. However, further hospital-based studies are recommended concerning the role of the surgical approach and its various impacts on postoperative complications.

Distress symptoms during the COVID-19 lockdown: A study with the general population of the United Arab Emirates.

Background: Since the declaration of the COVID-19 pandemic, the United Arab Emirates (UAE) government has taken a series of preventive measures to control the spread of the Coronavirus. Dealing with the unforeseen challenges caused by the pandemic has had a profound impact on people all around the world. Pharmacists played an important public health role during the COVID-19 pandemic, and they were the first point of contact with the public and the first source of information, providing accurate and reliable management and preventive measures. The aim of this study was to analyse the distress symptoms and the associated factors among a sample of the UAE population. Materials and Methods: This was an observational cross-sectional study conducted over the period of September to October 2020. A bilingual online self-administered questionnaire was distributed among individuals aged 15 years and above. Data was analyzed using Statistical Package for Social Sciences (SPSS). Results: Most of the students in the sample found online learning less effective than in-class learning. Among these, 49.9% and 62.8 % reported that they had normal sleep and eating habits, respectively. In all the sample, most of the participants (96%) were adherent to preventive measures. Higher levels of distress during the COVID-19 lockdown were found among females, individuals younger than 35 years old, those who neglected personal hygiene and who had worse quality of family gatherings and relationships. Conclusion: This study identified factors associated with distress symptoms experienced by people during the lockdown and perceived attitudes regarding online learning, preventive measures and changes in people's behaviours and family environment. Knowledge about how lockdown has affected the lives of the populations can be used to design public health interventions aimed at promoting the health and well-being of the communities.

Optimum inhibition of MCF-7 breast cancer cells by efficient targeting of the macropinocytosis using optimized paclitaxel-loaded nanoparticles.

AIMS: Breast cancer (BC) is the third leading cause of death among other cancer types. Worldwide, it is the most common harmful disease in women, representing 1/4 of all cancers. Treatment of BC remains an ongoing challenge to most researchers. Understanding how cancer cells differ from normal cells can enhance drug targeting and overall disease progression. Endocytosis is a major physiological process modified in cancer cells and affects the cellular uptake of chemotherapeutic agents. MCF-7 breast cancer cells exhibit constitutive macropinocytic activity in comparison to normal non-macropinocytic MCF-10A breast cells. Therefore, we hypothesized that blocking the macropinocytosis mechanism in MCF-7 cells may inhibit the cancer progression while maintaining the safety of normal cells. MAIN METHODS: Using nano-precipitation technique, paclitaxel-PLGA-NPs were successfully prepared in the size range and charge required to opt for macropinocytosis in MCF-7 cells. KEY FINDINGS: Uptake and endocytosis inhibitor assays indicated that the developed NPs acquired size and surface charges that efficiently target macropinocytosis of MCF-7 cells. Paclitaxel-loaded PLGA-NPs showed higher efficacy against MCF-7 cells, while providing no toxicity on normal MCF-10A cells. Metabolomics analysis indicated the nutrients deprivation because of occupying the macropinocytosis. However, treatment of fresh MCF-7 cancer cells by metabolites secreted from PLGA-NPs-treated MCF-7 cells showed a potential metastatic activity. Thus, co- administration with an anti-metastatic drug is advised. SIGNIFICANCE: Collectively, adjusting the size and surface characteristics of a drug can critically control its cellular uptake, affecting the efficacy of drugs and the microenvironment of cancer cells.

Impacts of COVID-19 Pandemic on Geopolitics, Health, Economics, Education and Sociocultural Events.

The number of active cases of COVID-19 and deaths is markedly escalating. The pandemic had affected almost every aspect of our lives including geopolitics, health, economics, education, and sociocultural events. However, besides the negative impacts of the pandemic, there are some positive impacts as well, such as improving our awareness of the daily hygienic practices, emphasizing digital inequality, and increasing global collaboration in combating the crisis by intensifying scientific research to establish a promising vaccine. Other positive impacts are the activation and use of online education, also raising awareness about close family relationships and much more. This review addresses the impacts of the COVID-19 pandemic on various important aspects of life.

Endocrine Toxicity and Outcomes in Patients With Metastatic Malignancies Treated With Immune Checkpoint Inhibitors.

CONTEXT: Immune checkpoint inhibitors (ICIs) have gained a revolutionary role in management of many advanced malignancies. However, immune-related endocrine events (irEEs), have been associated with their use. irEEs have nonspecific clinical presentations and variable timelines, making their early diagnosis challenging. OBJECTIVE: To identify risk factors, timelines, and prognosis associated with irEEs development. DESIGN AND SETTING: Retrospective observational study within the Cleveland Clinic center. PATIENTS: Metastatic cancer adult patients who received ICIs were included. METHODS: 570 charts were reviewed to obtain information on demographics, ICIs used, endocrine toxicities, cancer response to treatment with ICI, and overall survival. MAIN OUTCOME MEASURES: Incidence of irEEs, time to irEEs development and overall survival of patients who develop irEEs. RESULTS: The final cohort included 551 patients. The median time for the diagnosis of irEEs was 9 weeks. Melanoma was associated with the highest risk for irEEs (31.3%). Ipilimumab appeared to have the highest percentage of irEEs (29.4%), including the highest risk of pituitary insufficiency (11.7%), the most severe (Grade 4 in 60%) and irreversible (100%) forms of irEEs. Forty-five percent of patients with irEEs had adequate cancer response to ICI compared to 28.3% of patients without irEEs (P = 0.002). Patients with irEEs had significantly better survival compared to patients without irEEs (P < 0.001). CONCLUSIONS: In the adult population with metastatic cancer receiving treatment with ICI, irEEs development may predict tumor response to immunotherapy and a favorable prognosis. Ipilimumab use, combination ICI therapy, and melanoma are associated with a higher incidence of irEEs.

Role of Exosomes in Breast Cancer Management: Evidence-Based Review.

The field of cancer research has massively grown in recent decades, leading to a better understanding of the underlying causes and greatly improving the therapeutic approaches. Breast cancer (BC) is the third leading cause of mortality among all cancers and the most common malignant disease in women worldwide, representing one in four of all cancers in women. The crosstalk between cancer cells and the surrounding microenvironment is crucial for tumor progression and metastatic process. Tumor cells communicate not only through classical paracrine signaling mechanisms, including cytokines, chemokines, growth factors, but also through "exosomes". Exosomes are nano-vesicles that are released by various types of cells. Over the last decade, researchers have been attracted by the role of exosomes in breast cancer. It has been proven that exosomes influence major tumor-related pathways, including invasion, migration, epithelial-to-mesenchymal transition (EMT), metastasis, and drug resistance. Additionally, exosomes play important roles in clinical applications. Several studies have demonstrated the potential applications of exosomes in cancer therapy and diagnosis. Furthermore, exosomes have been engineered to function as nano-delivery systems of chemotherapeutic drugs. They can also be designed as vaccines to trigger the patient's immune system. This review discusses the recent progress regarding the use of exosomes as drug delivery systems, therapeutic agents, biomarkers, and vaccines against breast cancer.

Designer benzodiazepines versus prescription benzodiazepines: can structural relation predict the next step?

Designer benzodiazepines are a part of the recently discovered abuse synthetic drugs called Novel Psychoactive Substances (NPS) which need to be controlled due to their constantly growing market. Most of them are derived from the medically approved benzodiazepines used nowadays yet, may possess stronger effects, more toxicity, and longer durations of action. Some differences have also been observed in their detection and characteristics, in addition to the variations discovered in postmortem redistribution and drug stability. All these major alterations in features can result from only minor structural modifications. For example, a classic benzodiazepine (BZD) like diazepam only lacks one fluorine atom which exists in its derivatized designer drug, diclazepam, making substantial differences in activity. For this reason, it is essential to study the designer drugs in order to identify their dangers and distinguish them thus rule out their abuse and control the spread of such drugs. This review would highlight the distinct characteristics of some of the most commonly abused designer benzodiazepine analogies in relation to their original prescription BZD compounds.

Serological evidence of HIV, Hepatitis B, C, and E viruses among liver disease patients attending tertiary hospitals in Osun State, Nigeria.

Hepatitis infection in HIV positive individuals with liver diseases causes high mortality worldwide. HIV worsens the pathological effect of hepatitis viruses and potentiates reactivation of latent hepatitis infections due to reduced immunity. This research therefore aimed to study the occurrence of HIV and hepatitis viruses among liver diseases patients (LVDP) attending tertiary hospitals in Osun State, southwestern Nigeria. A total of 121 LVDP blood samples collected were tested for HIV and Hepatitis B, C, and E using and enzyme linked Immunossorbent assay (ELISA). Data were analyzed using packages within SPSS and P ≤ 0.05 was considered significant. Prevalence of 32.2%, 0.8%, 10.7%, and 18.2% for HBsAg, Anti-HCV, HEV-IgM, and HIV were found respectively. Marital status showed a significant association with HEV-IgM infection (χ2 = 9.869, P = .020). The prevalence of HBsAg, HEV, and HIV among LVDP in Osun State is alarming and health education among the patients and general populace is hereby advocated. High HEV-IgM seroprevalence implies that HEV routine screening should be incorporated into blood screening. Since HEV is associated with unhygienic practice, people should be enlightened on how to improve their living conditions.

High seroprevalence of viral hepatitis among animal handlers in Abeokuta, Ogun State, Nigeria.

Viral hepatitis is a deadly disease which can manifest as acute, chronic, hepatocellular carcinoma, and liver failure. Information about hepatitis is scarce among animal handlers. Due to Federal Government of Nigeria diversification programmes, many people are now involved in animal farming which can make them susceptible to viral hepatitis. This study aimed at determining the prevalence of Hepatitis B, C, and E viruses among animal handlers in Abeokuta, southwestern Nigerian. A total of 156 subjects were recruited for the study. Sociodemographic and risks factors data were fetched from subjects using interviewer-administered questionnaire. Blood samples were collected via venepuncture and tested for HCV, HBV, and HEV using ELISA technique. Results were analyzed using SPSS software version 21.0 and P value ≤ 0.05 was considered significant. The prevalence of HCV, HBV, and HEV were 46 (29.5%), 20 (12.8%), and 4 (2.6%) respectively while 6 (3.8%), 1 (0.6%), and 1 (0.6%) had co-infection of HBV-HCV, HBV-HEV, and HCV- HEV respectively. This study concludes that there is high prevalence of hepatitis C and B viruses among animal handlers in Abeokuta, Ogun state which is of significant public health problem, warranting further attention and research.

Obesity and its associated risk factors among school-aged children in Sharjah, UAE.

BACKGROUND: The most prevalent nutritional disorders worldwide are childhood overweight or obesity. Various factors clearly contribute to the childhood obesity epidemic. The aim of this study is to investigate the prevalence of childhood obesity in children of primary schools, and determine the influence of eating behavior and lifestyle in such a condition. METHODS: The study based on a cross sectional survey including school children aged 6-11 years. Pupils were from different schools in Sharjah, UAE. Outcome measures used in this study covered health characteristics; child habits and lifestyle; disease status and medication. RESULTS: The number of pre-validated surveys distributed was 932 and those returned counted to 678, giving a response rate of 72.8%. More than half (379; 55.9%) of the participants were females and 191 (28.2%) of the children were obese or overweight. Almost one quarter (162; 23.9%) of the children was physically inactive. Additionally, candy and fast food consumption was significantly high (370; 54.6%) and (324; 47.8%) respectively. Participant's food, age and time spent on TV were significantly associated with body mass index (BMI). CONCLUSION: Prevalence of overweight and obesity in the Emirate of Sharjah is high in both genders and across all ages of the study population. Contributing factors may include; sedentary lifestyle, consumption of unhealthy food and family history. There is a need for an immediate attention and measures to reduce the prevalence of obesity and associated diseases.

Interventions to Decrease Overuse of Cardiac Monitoring (Telemetry) When Transitioning from the Intensive Care Unit to the Regular Nursing Floor.

Background Cardiac monitoring (telemetry) is a common over-utilized hospital resource in the United States. Previous studies have shown that telemetry does not improve outcomes for low-risk patients. Inappropriate utilization occurs because of lack of awareness of guideline-based indications or non-adherence to known indications. Objective A quality improvement study was conducted to reduce telemetry overutilization during the transition of care from the intensive care unit (ICU) by 15% through increasing awareness of indications for telemetry. Methods The study cohort included patients originally admitted to the ICU for sepsis who had improved and were stable for transfer to a non-ICU setting. Subjects were identified and included during pre-intervention (six weeks) and intervention (six weeks) periods. Resident physicians and nurse practitioners were targeted using multiple modalities of education: didactic lectures during week one, poster demonstrations during week three, and video presentations during week five. Results A total of 246 study subjects during the pre-intervention and 94 study subjects in the intervention period were studied; 187 of the 246 subjects in the pre-intervention arm (76%) and 58 of the 94 subjects in the intervention arm (61.7%) were transferred with telemetry. Telemetry utilization dropped by 23.1% at the end of the intervention period. Conclusion Educating the caregivers about the indications for telemetry led to a decrease in over-utilization of telemetry on the transition of care from the ICU to the regular nursing floor. Repetitive and multi-modality educational interventions were effective tools and associated with increased adherence to established guidelines for telemetry usage.

Falls in the elderly: assessment of prevalence and risk factors.

BACKGROUND: Falls in elderly people can lead to serious health problems. There is limited knowledge about the prevalence of falls, risk factors and causes of falls in the United Arab Emirates. OBJECTIVE: To assess the prevalence of falls among older adults aged 60 years and above and to determine the risk factors associated with falls. METHODS: This cross-sectional study was conducted using an anonymous, 20-item questionnaire which was developed in English and Arabic to be delivered as a semi-structured interview. The pre-piloted questionnaire was distributed to 510 families with at least one elderly person. The study was conducted in Sharjah and Dubai, United Arab Emirates, from September to November 2017. RESULTS: Participants were Arabs (368; 99.5%), living with family (339; 91.6%), females (256; 69.2%), married (240; 64.9%), holders of a university Bachelor's degree (110; 29.7%), and unemployed (154; 41.6%). Almost half of the participants (188; 50.8%) had a fall in the past two years, and three quarters (141; 75%) of those claimed that their illness was the reason for their fall. The results indicate that female and 70 years and above old participants are more likely to experience falls than males and younger counterparts respectively. A larger proportion of elderly participants not taking medications did not experience falls, while those on 1-4 medications fallers were less than non-fallers. However as the number of medications increased to 5-8 and more than 8 the number of those experiencing falls was significantly higher than non-fallers. CONCLUSIONS: Falls are prevalent among the elderly population studied and efforts should be made to decrease the incidence of falls, identify those at risk and increase awareness about falls and their health consequences among the elderly and the general public.

Erratum to: What drives using antibiotic without prescriptions? A qualitative interview study of university students in United Arab Emirates.

[This corrects the article on p. 1172 in vol. 16, PMID: 30023027.].

What drives using antibiotic without prescriptions? A qualitative interview study of university students in United Arab Emirates.

Background: Bacterial resistance to antibiotics is considered as natural phenomenon that occurs over the time due to genetic changes. Bacterial resistance to antibiotics is significantly increasing in the UAE. Self-medication with antibiotics has been identified as a major factor for the development of antibiotic resistance, which is significantly increasing in the UAE. Objectives: The purpose of this study was to explore the factors that contribute to the use of antibiotics without prescriptions among first year healthcare university students in UAE. Methods: Based on the findings of an earlier survey study, a qualitative interview study was designed to explore common themes related to student's knowledge, awareness, attitude, views, and perceptions. Data were analyzed thematically for the identification of themes and subthemes within the data through the use of coding. Results: The interview study identified four main themes with multiple subthemes related to the use of antibiotics without a physician's prescription by first-year healthcare students. The thematic analysis of the interviews revealed four main themes; medication habits and practices; reasons for self-medication; access to antibiotics without a prescription and gaps in students' knowledge regarding antibiotic resistance. Conclusions: Healthcare students in UAE are influenced by several factors including parents and friends influence, successful previous experience and investment of time and money to visit a physician. Our sample of healthcare students has a misconception about the use of antibiotics. The current interview study identified six new reasons for using antibiotics without prescriptions as compared to our earlier survey study. There is a need of multifaceted strategies to decrease unnecessary antibiotic use in our population sample.

Wear behavior of Al-7%Si-0.3%Mg/melon shell ash particulate composites.

The present study examined wear characteristics of A356/melon shell ash particulate composites. Dry-sliding the stainless steel ball against specimen disc revealed the abrasive wear behavior of the composites under loads of 2 and 5N. The composite showed lower wear rate of 2.182 × 10-4 mm3/Nm at 20 wt% reinforced material under load of 5N. Results showed that wear rate decreased significantly with increasing weight percentage of melon shell ash particles. Microstructural analyses of worn surfaces of the composites reveal evidence of plastic deformation of matrix phase. The wear resistance of A356 increased considerably with percentage reinforcement. In other words, the abrasive mass loss decreased with increasing percentage of reinforcement addition at the both applied loads. The control sample suffered a highest mass loss at 5 N applied load.

Effect of Low Dose Lead (Pb) Administration on Tail Immersion Test and Formalin-induced Pain in Wistar Rats: Possible Modulatory Role of Cobalt (II) Chloride.

Lead (Pb) is cheap and there is a long tradition of its use, but its toxic effects have also been recognized. There is increased public health concern regarding the hazards of low dose Pb exposure to adults and children. Studies have shown the risks for hypertension, decrements in renal function, subtle decline in cognitive function, and adverse reproductive outcome at low blood Pb level. In this study, the possible modulatory role of cobalt (II) chloride (CoCl2) on low level Pb exposure on tail immersion test and formalin induced pain was investigated. Twenty adult Wistar rats of both sexes (weight 150g to 200g) were used. The animals were divided into four groups (n = 5) and administered Pb (5mg/kg), Pb (5mg/kg) + CoCl2 (50mg/kg) and CoCl2 (50mg/kg) orally for twenty-eight days. The last group served as control and were given distilled water only. In the tail immersion test, there was no significant change in reaction time for all three groups when compared to the control. In the formalin-induced pain, pain score after five and forty-five minutes also do not show significant change for all the three groups when compared to control. This work suggested that exposure to 5mg/kg Pb for twenty-eight days do not significantly impair reaction time in tail immersion test and pain score in formalin induced pain in Wistar rats. Also, administration of 50mg/kg CoCl2 do not improve performance of the animals in the experiments.

Common atrium: a rare cause of acute decompensated heart failure.

We report a rare case of common atrium and acute decompensated heart failure most likely precipitated by acute bacterial pericarditis leading to premature death, in a 25-year-old male footballer. The silent course of the disease for decades as well as the diagnostic and management pitfalls of this case illustrates the importance of early detection by echocardiography and urgent appropriate treatment in intensive care settings to limit the poor prognosis of the condition.

Seroprevalence of infectious bursal disease virus in local chickens in Udu Local Government Area of Delta State, South East Nigeria.

Infectious Bursal Disease Virus (IBDV) poses a great global threat to the poultry industry. Knowledge of the occurrence of the disease is important in the design and implementation of a control program, therefore this study determines the seroprevalence of IBDV in local chickens in Udu Local Government Area of Delta State. 250 chickens were bled by exsanguination and sera obtained were screened using Agar Gel Immunodiffusion (AGID) test. The seropositivity was 51.6%, which is indicates endemicity of the disease. Biosecurity and good sanitary measures are recommended. Molecular characterization of the strains should be carried out for inclusion in generic vaccines.

The effect of educational intervention on family planning knowledge, attitudes, and practices among married women in a military barrack in northern Nigeria.

Army barracks in Nigeria have low contraceptive prevalence rates (CPRs) and many children per family. The aim of this interventional study, involving 963 married women, is to determine the impact of health education on family planning knowledge, attitudes, and practices among married barrack women. The intervention group attended a 50-minute health talk and demonstrations on family planning methods. In the intervention group, the mean knowledge score rose significantly, from 5.5 points to 7.8 points post-intervention (t = -16.7281, p = 0.0000, df = 460). In addition, the CPR increased significantly, from 11.8% at baseline to 22.4% post-intervention (McNemar's chi2 = 125.41, p = 0.0000). Such significant changes were not noted in the control group. We conclude that health education is an effective intervention for improving knowledge about and attitudes towards contraceptives and their use among married women in military barracks in Nigeria. Intense and sustained health education is therefore recommended in addressing the low CPR in Nigeria.