Evaluation of the therapeutic effect of Olibanum extract against enteric and intramuscular phases of trichinosis in experimentally infected mice.

Trichinosis is a global food-borne zoonotic disease. Most drugs used in its treatment have low bioavailability and reduced activity against larvae. Therefore, there is an urgent need for safe and effective medications. This study aimed to investigate the in vivo anti-parasitic and anti-inflammatory efficacy of olibanum (OL) extract, alone or combined with albendazole (ABZ) during both intestinal and muscular phases of trichinosis. Male Swiss albino mice (n = 130) were allocated to seven groups, with 20 mice in each group except for the negative control group (10 mice): negative control (GI), positive control (GII), OL25- treated (GIII), OL50- treated (GIV), ABZ50- treated (GV), OL25 + ABZ25 (GVI), and OL50 + ABZ25 (GVII). For intestinal and muscular phase analysis, each group was divided into two subgroups based on euthanizing day (6 and 35 days post-infection). The drug's efficacy was evaluated through parasitological, biochemical, histopathological, and immunohistochemical studies. OL extract at both concentrations (25 mg/kg/d, 50 mg/kg/d) significantly reduced adult (53.7% and 68.1%, respectively) and larval counts (57.3% and 78.8%, respectively). It improved the histopathological changes in intestine and muscle. The expression of CD8+ T cells and the serum level of IL-10 increased significantly during both intestinal and muscular phases (P < 0.05) in OL50 treated mice. Additionally, OL decreased abnormal levels of liver enzymes (ALT & AST). Its effects were dose-dependent in both adult and larval stages. In conclusion, OL exhibits promising in vivo activity against both stages of Trichinella spiralis infection, particularly at the intramuscular phase. It can be safe as an alternative treatment for trichinosis.

[Lymphangioma of the scrotum].

INTRODUCTION: Lymphangioma (lymphatic malformation) is a congenital malformation of lymphatic vessels. According to the classification of the International Society for the Study of the Vascular Anomalies, there are macrocystic, microcystic and mixed types of lymphatic malformations. The typical location of the lymphangiomas is the area of large lymphatic collectors (head, neck, axillary areas), while the scrotum is not frequently affected. AIM: To present a rare clinical case of lymphatic malformation of the scrotum with successful minimally invasive treatment (sclerotherapy). MATERIALS AND METHODS: A clinical observation of a 12-year-old child with a diagnosis of "Lymphatic malformation of the scrotum" is presented. From the age of 4, there was a large lesion in the left half of the scrotum. In other clinic, a surgical removal with a diagnosis of "left-sided inguinal hernia", "spermatic cord hydrocele", "isolated left-sided hydrocele" was performed. However, there was a recurrence after the procedure. When contacting the Clinic of pediatrics and pediatric surgery, scrotal lymphangioma was suspected. The diagnosis was confirmed by magnetic resonance imaging. The patient underwent minimally invasive sclerotherapy using the drug "Haemoblock". After 6 months of follow-up, no relapse was seen. CONCLUSION: Lymphangioma (lymphatic malformation) of the scrotum is a rare urological pathology that requires specific diagnosis, in-depth differential diagnosis and treatment by a multidisciplinary team of doctors, including a specialist in the treatment of vascular pathology.

Neurodevelopmental and epilepsy outcomes of patients with infantile spasms treated in a tertiary care center.

OBJECTIVES: To assess the neurodevelopmental and epilepsy outcomes in children with infantile spasms (IS). METHODS: A retrospective chart review of all patients with infantile spasms admitted to King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia between January 2000 and December 2017. Infants who were diagnosed to have IS as per the International League Against Epilepsy (ILAE) definition were included in this study. Patients who lost follow-up and those who did not receive treatment at KKUH were excluded. RESULTS: Total of 53 patients were included and categorized into unknown, cryptogenic and symptomatic type of IS. The majority had symptomatic etiology (71.7%). Type of etiology and delay in initiation of treatment were significant predictors of motor and cognitive outcomes, but not seizure control. Patients with unknown IS, who were diagnosed earlier (0.72-month), had better neurodevelopmental outcomes. Vigabatrin in combination with either Adrenocorticotropic hormone (ACTH) or Prednisolone showed better seizure control in comparison to monotherapy and other combination modalities. CONCLUSION: Neurodevelopmental outcomes of IS are strongly associated with the underlying etiology. Early initiation of treatments had a favorable cognitive and motor outcome. Early response to combination therapy with resolution of spasms and hypsarrhythmia had better seizure outcomes. However, motor and cognitive outcomes were not affected by the response to the combination therapy.

Tolerance of Vascularized Islet-Kidney Transplants in Rhesus Monkeys.

We previously reported that transplantation (Tx) of prevascularized donor islets as composite islet-kidneys (IK) reversed diabetic hyperglycemia in both miniature swine and baboons. In order to enhance this strategy's potential clinical applicability, we have now combined this approach with hematopoietic stem cell (HSC) Tx in an attempt to induce tolerance in nonhuman primates. IKs were prepared by isolating islets from 70% partial pancreatectomies and injecting them beneath the autologous renal capsule of five rhesus monkey donors at least 3 months before allogeneic IK Tx. HSC Tx was performed after mobilization and leukapheresis of the donors and conditioning of the recipients with total body irradiation, T cell depletion, and cyclosporine. One IK was harvested for histologic analysis and four were transplanted into diabetic recipients. IK Tx was performed either 20-22 (n = 3) or 208 (n = 1) days after HSC Tx. All animals accepted IKs without rejection. All recipients required >20 U/day insulin before IK Tx to maintain <200 mg/dL, whereas after IK Tx, three animals required minimal doses of insulin (1-3 U/day) and one animal was insulin free. These results constitute a proof-of-principle that this IK tolerance strategy may provide a cure for both end-stage renal disease and diabetes without the need for immunosuppression.

Public awareness of autism spectrum disorder.

OBJECTIVE: Examine the awareness of autism spectrum disorders (ASD) in our community which would help in early recognition and improved support of affected families. METHODS: A focused 20-item questionnaire was designed to survey the public awareness and knowledge of ASD. Personal interviews were conducted during an ASD awareness day, which was organized in a major shopping mall on February 20, 2015 in Jeddah, Kingdom of Saudi Arabia. RESULTS: A total of 259 individuals participated in the study with 47% being <30 years of age and 57% being females. Most participants (60%) were married, educated (68% university level), and employed (54%). When asked if they knew what autism is, 88% responded positively. However, when asked to rate their degree of knowledge, 41% felt that it is weak. Females and those older than 30 years of age were more likely to feel knowledgeable (p=0.04 for females and p=0.013 for those >30 years of age). Females were more likely to think that autistic children can be employed in the future (p=0.008), whereas males were more likely to think that autism is similar to mental retardation (p=0.005). CONCLUSION: The public awareness of ASD needs improvement. Areas for targeted education were identified to help improve the quality of life of autistic children and their families.

Vascularized composite allograft tolerance across MHC barriers in a large animal model.

Vascularized composite allograft (VCA) transplantation can restore form and function following severe craniofacial injuries, extremity amputations or massive tissue loss. The induction of transplant tolerance would eliminate the need for long-term immunosuppression, realigning the risk-benefit ratio for these life-enhancing procedures. Skin, a critical component of VCA, has consistently presented the most stringent challenge to transplant tolerance. Here, we demonstrate, in a clinically relevant miniature swine model, induction of immunologic tolerance of VCAs across MHC barriers by induction of stable hematopoietic mixed chimerism. Recipient conditioning consisted of T cell depletion with CD3-immunotoxin, and 100 cGy total body irradiation prior to hematopoietic cell transplantation (HCT) and a 45-day course of cyclosporine A. VCA transplantation was performed either simultaneously to induction of mixed chimerism or into established mixed chimeras 85-150 days later. Following withdrawal of immunosuppression both VCAs transplanted into stable chimeras (n=4), and those transplanted at the time of HCT (n=2) accepted all components, including skin, without evidence of rejection to the experimental end point 115-504 days posttransplant. These data demonstrate that tolerance across MHC mismatches can be induced in a clinically relevant VCA model, providing proof of concept for long-term immunosuppression-free survival.

Corridor and real-time 6-minute walk tests in healthy young adults: A randomized cross-over study.

Objective: Cardiopulmonary endurance is important for comfortably participating in activities of daily living. Exercise tests, such as the 6-minute walk test (6MWT), are commonly used to evaluate cardiopulmonary endurance. We investigated the effects of the Gait Real-Time Analysis Interactive Lab (GRAIL)- and corridor-based 6MWTs on functional performance. Methods: Thirty healthy men were randomly divided into two groups. Group A participants performed a corridor-based 6MWT, followed by a washout period (1 h). Subsequently, they performed the GRAIL-based 6MWT. Group B participants performed the tests in the reverse order of that performed by Group A participants. Results: The corridor-based 6MWT resulted in significantly higher 6MW distance and 6MW speed than the GRAIL-based 6MWT. No significant differences were observed between the two groups in any of the following secondary outcomes: systolic blood pressure, diastolic blood pressure, oxygen saturation, heart rate, dyspnea, and overall fatigue. A strong positive correlation was observed between the 6MW distance and 6MW speed. Conclusion: The corridor- and GRAIL-based 6MWT should not be used interchangeably.

Pediatric Neurology Workforce in Saudi Arabia: A 5-Year Update.

BACKGROUND: The medical workforce plays a pivotal role in advancing human health, particularly within the healthcare system of Saudi Arabia. While government-employed healthcare providers form the central structure of the system and offer free healthcare services, the private healthcare sector is also witnessing significant growth. In parallel, the field of child neurology has experienced notable transformations in recent years, with continued expansion. This expansion brings forth a range of challenges for both current and future pediatric neurologists, necessitating careful consideration and proactive measures to address them. AIM OF THE STUDY: To investigate and analyze the current characteristics of the workforce, with a specific focus on their employment status and related data. METHODS: This is a cross-sectional analysis, using a survey to assess the distribution of pediatric neurologists in Saudi Arabia (SA). The final analytical sample included 82 subjects, working in 13 regions in SA. A descriptive analysis was used to address the study question. RESULTS: The survey received responses from a total of 82 pediatric neurologists in Saudi Arabia (response rate 55%), with 38 (46%) being men and 44 (54%) being women. The mean age was 33 ± 1.225 years. The majority of participants practiced in major cities such as Riyadh and Jeddah. Nearly 50% of pediatric neurologists experienced some form of delay in obtaining their first job, ranging from 1 to 36 months. CONCLUSION: The landscape of the pediatric neurology workforce is currently witnessing noteworthy demographic shifts. With the majority of practitioners concentrated in major cities, there is an ongoing demand for qualified professionals in peripheral areas. This study describes the real-life challenges faced by pediatric neurologists, particularly the delay in securing employment after graduation, and underscores the critical importance of addressing these persistent issues along the journey of pediatric neurology.

Determinants of life satisfaction among stroke survivors 1 year post stroke.

ABSTRACT: Stroke is the major leading cause of death and severe long-term disability worldwide. The consequences of stroke, aside from diminished survival, have a significant impact on an individual's capability in maintaining self-autonomy and life satisfaction (LS). Thus, this study aimed to assess LS and other specific domains of LS in stroke survivors following their first-ever stroke, and to describe the relationship using socio-demographic and stroke-related variables.This study recruited 376 stroke survivors (244 men and 132 women, mean age: 57 years) 1 year following stroke. Data on participants' LS (measured using the Life Satisfaction Questionnaire [LiSat-11]), socio-demographics, and stroke-related variables were collected.Univariate analysis showed that LS and the 10 specific domains were not associated with the patients' gender or stroke type; however, age at onset, marital status, and vocational situation were significantly associated with some domains in LiSat-11 (Spearman's rho = 0.42-0.87; all P < 0.05). Logistic regression revealed that verbal and cognitive dysfunction were the most negative predictors of LS (odds ratio 4.1 and 3.7, respectively).LS is negatively affected in stroke survivors 1 year post onset. The results indicate that recovering social engagement is a positive predictor of higher LS in stroke survivors. More importantly, the findings revealed that cognitive and verbal dysfunctions were the most prominent negative predictors of the overall gross level of LS. Multidisciplinary rehabilitation for stroke survivors is therefore critical.

Olfactory learning prevents MK-801-induced psychosis-like behaviour in an animal model of schizophrenia.

There is mounting evidence to support the concept that education is associated with the formation of a functional reserve in the brain, a process that appears to provide some protection against certain aspects of severe central nervous system disorders. The goal of this study was to examine whether learning prevents psychosis-like behaviour in an animal model of schizophrenia. A series of behavioural tasks were used to assess olfactory learning-induced protection against the effects of NMDA channel blocker, MK801. This blocker caused sensory-motor disturbances, spatial learning acquisition deficit, and swimming strategy alterations in pseudo-trained and naive rats, but had a considerably lesser effect on trained rats. In sharp contrast, olfactory learning provided no protection against d-amphetamine application. Our data support the notion that learning-induced protection against schizophrenic behaviour is maintained by non-NMDA-mediated enhanced activation of local connections in the relevant cortical networks.

[Comparative assessment of extraperitoneoscopic and laparoscopic methods of varicocele treatment].

The article presents a comparative analysis of the results of extraperitoneoscopic and laparoscopic methods of internal seminal vein ligation in 90 varicocele patients (40 and 50 patients, respectively); describes insufficiently known method--extraperitoneoscopic operations. The working space in the prevesical space is created by direct introduction of trocars with optics into the prevesical space without any additional tools. The operations took the same time. Laparoscopic operations required more postoperative analgetic drugs than extraperitoneoscopic ones. By pain intensity and physical activity scales, varicocele patients' quality of life was higher after extraperitoneoscopic operations than after laparoscopic and open operations. Thus, extraperitoneal ligation of the seminal veins by direct introduction of endoscope into the preperitoneal space with CO2 insufflation without prior creation of working space is simple for use, low invasive, has low risk of visceral injury and can be applied as an alternative to laparoscopy.

Falls among elderly and its relation with their health problems and surrounding environmental factors in Riyadh.

BACKGROUND: Falls among the elderly are one of the major causes of morbidity and mortality worldwide. They constitute the second leading cause of unintentional deaths after road-traffic accidents. The aim of the study was to estimate the prevalence of falls among the elderly and to investigate the factors that contribute to this phenomenon. MATERIALS AND METHODS: A cross-sectional analytical study was conducted in the elderly, over the age of 60, in Riyadh. The sample under scrutiny was estimated to be 357 in total. A pilot study was conducted among 15 subjects. Two questionnaires were used for the interviews which were translated into Arabic using the "Morse Fall Scale." The questionnaires assessed: the participants' previous history of falls, whether a secondary diagnosis had been obtained, whether any ambulatory aids had been used or whether an IV connection had been fitted during convalescence. They also inquired if any gait/transferring device had been used to assist the patient at any time. RESULTS: Out of 357 participants, 206 (57.7%) had a history of falls. Study found an association between the number of falls recorded, the age of the participants, and whether the participant was female. Furthermore, there were statistically significant associations between the history of falls and a condition of impaired health. The results also showed that environmental hazards play a significant role in the occurrence of falls with P ≤ 0.001, in which 103 (81.7%) of the individuals who were exposed to environmental hazards revealed a history of falls. CONCLUSION: Falls among the elderly are common. Significantly, if the health of the individuals is impaired, and there are contiguous environmental risk factors, these elements combine to play a part in the occurrence of such falls. There is, therefore, a need to design and develop a health awareness program to prevent such problems in the elderly.

Swedish healthcare providers' perceptions of preconception expanded carrier screening (ECS)-a qualitative study.

Reproductive autonomy, medicalization, and discrimination against disabled and parental responsibility are the main ongoing ethical debates concerning reproductive genetic screening. To examine Swedish healthcare professionals' views on preconception expanded carrier screening (ECS), a qualitative study involving academic and clinical institutions in Sweden was conducted in September 2014 to February 2015. Eleven healthcare professionals including clinicians, geneticists, a midwife, and a genetic counselor were interviewed in depth using a semi-structured interview guide. The questionnaire was constructed after reviewing the main literature and meetings with relevant healthcare providers. The interviews were recorded, transcribed verbatim, and content analyzed for categories and subcategories. Participants nurtured many ethical and non-ethical concerns regarding preconception ECS. Among the ethical concerns were the potential for discrimination, medicalization, concerns with prioritization of healthcare resources, and effects on reproductive freedom. The effects of implementation of preconception ECS, its stakeholders, regulations, and motivation are some of non-ethical concerns. These concerns, if not addressed, may affect the uptake and usage of carrier screening within Swedish healthcare system. As this is a qualitative study with a small non-random sample size, the findings cannot be generalized. The participants had little to no working experience with expanded screening panels. Moreover, the interviews were conducted in English, a second language for the participants, which might have limited the expression of their views. However, the authors claim that the findings may be pertinent to similar settings in other Scandinavian countries.

Psychiatric diagnosis and prediction of drug and alcohol dependence.

Some sociodemographic variables that have distinguished the future addict from the general population have not been found to predict outcome in those already dependent. This study demonstrates that a past history of specific psychiatric disorders is predictive of outcome in narcotic addicts. Future research should focus on interactions among past histories, past and present personality and motivation, and situational variables in the search for reliable clinical prognostic factors.

Combined annular and supraannular prosthetic implantation for the small aortic annulus.

A simple new technique allows the implantation of a large-sized prosthesis in an aorta with a small annulus with or without a hypoplastic aortic route. Results in 2 patients are described.

Concomitant coronary and cerebral revascularization under cardiopulmonary bypass.

The question as to whether a staged or a combined surgical approach is safer in the management of patients with coexistent coronary and extracranial cerebrovascular disease has been widely investigated and debated. Advances in myocardial protection techniques have reduced cardiac morbidity and mortality and have rendered a combined approach as safe as a staged approach, if not safer. There have been no similar advances in cerebral protection, particularly for high-risk patients with bilateral disease. In this series, 32 consecutive patients with coexistent advanced coronary and extracranial vascular disease underwent cerebral and coronary revascularization that used the combined approach. Cerebral revascularization was performed under hypothermic cardiopulmonary bypass on 30 of these patients. There was no operative mortality, no hematoma formation, and no reoperation. Blood loss, length of hospital stay, and total cost were similar to those for isolated coronary bypass procedures.

The variation in hospital charges: a problem in determining cost/benefit for cardiac surgery.

Based on 417 itemized bills from 45 American hospitals that responded to a randomized, geographically stratified survey covering January to June, 1976, the middle 50% of hospital charges for cardiac operations ranged between $5,914 and $10,315. Nonitemizing hospitals submitted lower, but less accurate, estimates. As 60% of the itemized bill consisted of high charge/cost items such as laboratory and pharmacy fees, total charges were not lowered merely by increasing case load or decreasing operating room times. Careful individualization of services in 1 hospital, however, reduced charges up to 16%. Charge per day was a poor index of efficiency because patients staying longer had lower average daily charges. The variation in hospital charges and lack of accounting uniformity preclude meaningful quantitation of either the "typical" charge or the numerator of the cost/benefit ratio for cardiac operations.

Risk factors associated with overdose among Bahraini youth.

The aim of this study was to identify the risk factors of overdose among Bahraini youth (15-24 years). These factors included psychiatric disorders, family pathology, and psychosocial stress. All suicide attempters in the country during an 18-month period (N= 100) were identified prospectively. One hospital-matched control was selected for each case. Both cases and controls underwent a semistructured personal interview in the two state general hospitals. A matched pair analysis was done, as well as computation of McNemar's continuity corrected chi-square test, odds ratio, and the 95% confidence interval of the odds ratio. The overdose attempter was more likely than the control to be unemployed, a member of a non-intact family, having a mother whose education was high school or above, not having a friend, involved in a boy/girlfriend relationship, and a cigarette smoker. More students among attempters had failed an examination in the past year than matched controls. Father's education, social class, death of father, recent row with a friend, use of drugs and alcohol, relationship with teachers, recent mobility, financial difficulties, and legal problems were similar in both groups. Stresses generated from living in a non-intact family, interpersonal relationships mainly with the opposite sex, unemployment, and school performance came out as the main risk factors. The association of previously identified risk factors such as depression, aggressive behavior, and use of drug and alcohol was low among attempters. While the results of this study are consistent with the present view that suicidal behaviors are multifactorial in origin, the magnitude and effect of each factor are culturally determined.

Delayed rupture of the left ventricle after mitral valve replacement: report of two survivors.

Two patients, a man and a woman, with rupture of the left ventricular wall after mitral valve replacement are described. The postoperative course of the woman was complicated by respiratory and renal insufficiency from which she recovered; however, she developed fungal endocarditis and died. Both patients are reported as survivors of "delayed" rupture to show that such patients are occasionally salvageable, and to suggest that bypass grafting to the circumflex system distal to the site of injury will benefit immediate and long-term survival.