Over-Expression of LEDGF/p75 in HEp-2 Cells Enhances Autoimmune IgG Response in Patients with Benign Prostatic Hyperplasia-A Novel Diagnostic Approach with Therapeutic Consequence?

Lens epithelium-derived growth factor splice variant of 75 kDa (LEDGF/p75) is an autoantigen over-expressed in solid tumors and acts as a stress-related transcriptional co-activator. Participation of autoimmune responses in the pathophysiology of benign prostatic hyperplasia (PBH) and a corresponding immunosuppressive therapy by TNFalpha antagonists has been recently suggested. Thus, autoAb testing could aid in the diagnosis of BPH patients profiting from such therapy. We generated CRISPR/Cas9 modified HEp-2 LEDGF knock-out (KO) and HEp-2 LEDGF/p75 over-expressing (OE) cells and examined IgG autoantibody reactivity to LEDGF/p75 in patients with prostate cancer (PCa, n = 89), bladder cancer (BCa, n = 116), benign prostatic hyperplasia (BPH, n = 103), and blood donors (BD, n = 60) by indirect immunofluorescence assay (IFA). Surprisingly, we could not detect elevated binding of autoAbs against LEDGF/p75 in cancer patients, but autoAb reactivity to LEDGF/p75 OE cells in about 50% of patients with BPH was unexpectedly significantly increased. Furthermore, a line immunoassay enabling the detection of 18 different autoAbs revealed a significantly increased occurrence of anti-dsDNA autoAbs in 34% of BPH patients in contrast to tumor patients and BD. This finding was confirmed by anti-mitochondrial (mDNA) autoAb detection with the Crithidia luciliae immunofluorescence test, which also showed a significantly higher prevalence (34%) of anti-mDNA autoAbs in BPH. In summary, our study provided further evidence for the occurrence of autoimmune responses in BPH. Furthermore, LEDGF/p75 over-expression renders HEp-2 cells more autoantigenic and an ideal target for autoAb analysis in BPH with a potential therapy consequence.

Effects of crystallization temperature on the characteristics of sugar crystals in date fruit syrup as measured by differential scanning calorimetry (DSC), polarized microscopy (PLM), and X-ray diffraction (XRD).

Characteristics of sugar crystals are important for developing set-syrup due to their contribution to the desired mouth feel when consumed. Two types of set-syrup (i.e. seeds with and without) were developed by storing the syrup at -20, 4 and 15 °C. The melting temperatures (onset and peak), and enthalpy of set-syrup without seeds (SN) were 30.2 °C, 74.6 °C and 42.2 kJ/kg respectively. In the case of SN, enthalpy decreased with the decrease of crystallization temperature (P < 0.05), while there was insignificant change in the case of set-syrup with seeds (SW) (P > 0.05). Polarized Light Microscopy (PLM) images showed that finer crystals were formed in the cases of set-syrups (i.e. SN and SW) as the storage temperature was decreased. X-ray diffraction (XRD) analysis showed the formation of different polymorphic sugar crystals. Crystallization temperatures at 4 and -20 °C can be used to produce finer crystals with varied polymorphic characteristics.

Possibility of using low-field nuclear magnetic resonance (LF-NMR) and differential scanning calorimetry (DSC) to monitor frying oil degradation.

In this work, chemical degradation of oil was determined as a function of frying time during intermittent deep-fat frying (i.e. 185 °C for 5 h per day for 12 days) and was correlated with the thermal characteristics as measured by Differential Scanning Calorimetry (DSC) and proton mobility by Low-Field Nuclear Magnetic Resonance (LF-NMR). Linear increases of FFAs and PV were observed as a function of frying time. FFAs and PV were strongly correlated with the melting enthalpy. The melting enthalpy of oil decreased exponentially, and the melting temperature remained nearly same until 30 h of frying time followed by a sharp increase. The relaxation times of rigid, semi-rigid and mobile protons (i.e. T 2b , T 21 , and T 22 ) decreased with the increase of frying time. The decrease of T 21 , and T 22 were steeper as compared to the T2b. A strong correlation was observed between conventional chemical parameters (i.e. PV and FFAs), and T 21 and T 22. The populations of the three pools of protons as identified by Inverse Laplace Transformation and Gaussian distribution function showed the interchange of the protons with the chemical changes during frying. It is concluded that chemical free DSC and LF-NMR could be potential methods to monitor frying oil degradation.

Burnout and depression among psychiatry residents during COVID-19 pandemic.

Very few studies have been concerned with assessing the prevalence of burnout and depressive symptoms, especially during an infectious outbreak on non-frontline health care workers, such as a psychiatrist. In such instances, the role of psychiatrists and other mental health providers as a source of psychological support to the public and frontline workers is indispensable and valuable. This study aims to assess the prevalence of burnout and depressive symptoms, and their correlation, during the COVID-19 pandemic among psychiatry residents in Saudi Arabia. A total of 121 out of 150 psychiatry residents in Saudi Arabia completed the Maslach Burnout Inventory and Patient's Health Questionnaire for the assessment of burnout and depressive symptoms. Burnout symptoms were found in 27.3%, and another 27.3% reported having depression symptoms. In addition, 16.5% reported having both burnout and depressive symptoms, with a significant relationship between them. Participants in the first 2 years of training and having a history of receiving mental health treatment in the past 2 years were at higher risk. The need is urgent to increase investment in mental health services and to construct a plan to reduce this risk of burnout and depression among psychiatrists by developing preventative strategies to prevent burnout and promote wellness is more important than ever.

Prevalence of Pre Diabetes and Type 2 Diabetes Mellitus among cement industry workers.

OBJECTIVES: Occupational and environmental pollution have become an imperative jeopardy for developing devastating metabolic diseases. Limited animal model studies have examined the impact of exposure to cement dust on metabolic conditions. This study aimed to assess the prevalence of pre-diabetes and Type-2 diabetic mellitus (T2DM) among non-smoking cement mill workers. METHODS: This epidemiological cross sectional study was conducted in the "Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia" during the period Oct 2016 to June 2017. Initially 310 cement mill workers were interviewed; after the interview and clinical history taking, 186 non-smoking cement mill employees were finally recruited. The cement mill employees were exposed to cement dust-related pollution in a cement industry for eight hours a day for six days a week. The mean age was 36.56 ± 0.78 years, mean BMI was 25.70 ± 0.29 m/kg2, and mean period of employment in the cement industry was 82.77 ± 6.95 months. HbA1c was measured using the Dimension Xpand Plus Integrated Chemistry System (USA). RESULTS: The cement mill employees were divided into three groups: non-diabetics group, with glycated hemoglobin (HbA1c) <5.7%; pre-diabetics group, with HbA1c 5.7-6.4%; and diabetics group, with HbA1c >6.4%. Among the cement mill personnel, 79 (42.47%) were non-diabetics, 28 (15.05%) were pre-diabetics, and 79 (42.47%) were diabetics. The prevalence of pre-diabetes and T2DM among cement mill employees was considerably associated with the period of employment in the cement industry (p=0.032). CONCLUSIONS: Exposure to cement dust was associated with an increased prevalence of pre- diabetes and T2DM among cement industry employees.

Ral mediates activity-dependent growth of postsynaptic membranes via recruitment of the exocyst.

Remodelling neuronal connections by synaptic activity requires membrane trafficking. We present evidence for a signalling pathway by which synaptic activity and its consequent Ca(2+) influx activate the small GTPase Ral and thereby recruit exocyst proteins to postsynaptic zones. In accord with the ability of the exocyst to direct delivery of post-Golgi vesicles, constitutively active Ral expressed in Drosophila muscle causes the exocyst to be concentrated in the region surrounding synaptic boutons and consequently enlarges the membrane folds of the postsynaptic plasma membrane (the subsynaptic reticulum, SSR). SSR growth requires Ral and the exocyst component Sec5 and Ral-induced enlargement of these membrane folds does not occur in sec5(-/-) muscles. Chronic changes in synaptic activity influence the plastic growth of this membrane in a manner consistent with activity-dependent activation of Ral. Thus, Ral regulation of the exocyst represents a control point for postsynaptic plasticity. This pathway may also function in mammals as expression of activated RalA in hippocampal neurons increases dendritic spine density in an exocyst-dependent manner and increases Sec5 in spines.

Prevalence of Irritable Bowel Syndrome and its Association with Anxiety among Medical Students at King Saud bin Abdulaziz University for Health Sciences in Riyadh.

OBJECTIVE: To quantify the prevalence of Irritable Bowel Syndrome (IBS) among medical students of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) and to observe the association between anxiety and IBS. METHODS: This cross-sectional observational study conducted during academic year 2015-2016 has used two self-administered, pre-validated questionnaires: Depression Anxiety Stress Scales-21 (DASS-21) and Rome III criteria. The sample size was 270, and proportional allocation was used to determine distribution of this sample across study population based on percentages of students in each academic year. Convenience sampling was used to select participants. RESULTS: The overall prevalence of IBS was 21% (n=57), with a higher prevalence among females (26%, n=23) than males (19%, n=34). IBS was most and least prevalent among first-year students (14%, n=5) and fifth-year students (29%, n=21) respectively. Anxiety levels were normal, mild, moderate, and severe or extremely severe in 39% (n=105), 7% (n=19), 26% (n=70), and 27%. A significant association was found between gender & IBS and anxiety levels & IBS. CONCLUSION: The prevalence of IBS in this study was 21% and higher among females than males but were highest among fifth-year students for both genders. More than 50% of students had moderate or high levels of anxiety for both genders. The prevalence of IBS was highest among students of 5th fifth year. The study provides evidence that, as medical students of higher year of their under graduation were having higher level of anxiety which leads to IBS.

Clinical characteristics and treatment outcome of childhood acute lymphoblastic leukemia in Saudi Arabia: a multi-institutional retrospective national collaborative study.

BACKGROUND: Treatment of childhood acute lymphoblastic leukemia (ALL) has been available in Saudi Arabia (SA) for over 30 years; however, only limited data have been published from there. This study was conducted to establish processes for collaborative data collection and provide clinical characteristics and outcome of children with ALL in SA. PROCEDURE: Clinical data for patients diagnosed from 2004 to 2008 were retrospectively collected at eight institutions and entered remotely into a custom-built database. Statistics regarding clinical and genetic characteristics and treatment outcome were calculated. RESULTS: The 594 evaluable patients had a median age of 4.37 years and 56.4% were boys. Majority of patients had B-precursor ALL while 10.7% had T-ALL. CNS leukemia was present in 5.2% of patients. The distribution of common genetic abnormalities was similar to that reported from western populations, with 24.6% hyperdiploidy, 21% RUNX1-ETV6 positivity, 4.2% BCR-ABL1 positivity, and 2.5% with MLL gene rearrangement. Patients received risk-adapted therapy according to various protocols, although treatment strategies for the majority were similar. Five-year OS, RFS and EFS were 86.9%, 79.1%, and 73.3%, respectively. The OS for patients with pre-B ALL was significantly higher than for T-ALL (88.0% vs. 71.8%; P = 0.019, Log-Rank test). Patients with pre-B ALL categorized as low-risk by NCI/Rome criteria and those with hyperdiploidy had OS of 93.4% and 95.8%, respectively. CONCLUSIONS: The characteristics of childhood ALL in SA are similar to those observed in developed countries. Future prospective studies utilizing unified national protocols are needed to further improve the outcome of our patients.

Involvement of Palliative Care in Malignant Pleural Mesothelioma Patients and Associations with Survival and End-of-Life Outcomes.

Malignant pleural mesothelioma is a rare, aggressive, and incurable cancer with a poor prognosis and high symptom burden. For these patients, little is known about the impact of palliative care consultation on outcomes such as mortality, hospital admissions, or emergency department visits. The aim of this study is to determine if referral to supportive and palliative care in patients with malignant pleural mesothelioma is associated with survival and decreased hospital admissions and emergency department visits. This is a retrospective chart review. Study participants include all malignant pleural mesothelioma patients seen at The Ottawa Hospital-an acute care tertiary center-between January 2002 and March 2019. In total, 223 patients were included in the study. The mean age at diagnosis was 72.4 years and 82.5% were male. Of the patients diagnosed between 2002 and 2010, only 11 (9.6%) were referred to palliative care. By comparison, of those diagnosed between 2011 and 2019, 49 (45.4%) were referred to palliative care. Median time from diagnosis to referral was 4.1 months. There was no significant difference in the median survival of patients referred for palliative care compared to those who did not receive palliative care (p = 0.46). We found no association between receiving palliative care and the mean number of hospital admissions (1.04 vs. 0.91) from diagnosis to death, and an increase in mean number of emergency department visits in the palliative care group (2.30 vs. 1.18). Although there was increased utilization of palliative care services, more than half of the MPM patients did not receive palliative care despite their limited survival. There was an increase in emergency department visits in the palliative care group; this may represent an increase in the symptom burden (i.e., indication bias) in those referred to palliative care.

Loss of mucosal tolerance to glycoprotein 2 isoform 1 is a potential novel diagnostic biomarker for cholangiocarcinoma.

BACKGROUND: Anti-glycoprotein 2 (anti-GP2) IgA and antineutrophil-cytoplasmic antibodies to proteinase 3 (PR3-ANCA) have been reported as predictive markers of cholangiocarcinoma (CCA) in patients with primary sclerosing cholangitis (PSC), but their prevalence in CCA patients without PSC remains unclear. METHODS: This study involved Asian discovery (n = 118) and European validation (n = 38) cohorts of CCA patients without PSC, alongside 49 Asian and 82 European pancreatic ductal adenocarcinoma (PDAC) patients, 21 with benign pancreatic neoplasms (BPN) and 45 with hepatocellular carcinoma (HCC), and 157 healthy controls (HC) from Asia and Europe. We analyzed the prevalence of PR3-ANCA, IgA and IgG against GP21 and GP24, and the CA19-9 levels. RESULTS: Anti-GP21 IgA was the most prevalent in both CCA cohorts (discovery: 55.1 %; validation: 42.1 %) and significantly higher than in other groups except PDAC (all p < 0.05). It demonstrated the best diagnostic performance in distinguishing CCA from disease controls and HC, outperforming tumor markers. No significant correlation was found between anti-GP21 IgA levels and CA19-9 levels. CONCLUSION: Our findings show that anti-GP21 IgA revealing the loss of mucosal tolerance is a potential novel diagnostic biomarker for CCA.

The Relation between Atrial Fibrillation Cardioversion Success Rate with Vitamin D Level in Patients Underwent Elective Cardioversion in King Abdulaziz Cardiac Center, King Abdulaziz Medical City for National Guards, Riyadh Saudi Arabia.

Objectives: To investigate the relation between serum Vitamin D (Vit-D) levels and the success rate of cardioversion for atrial fibrillation (AF). To examine the association between Vit-D level and successful cardioversion. This study also describes the general characteristics of patients with successful cardioversion. Materials and Methods: In this retrospective study, patients with AF who were treated using electrical cardioversion at King Abdulaziz Cardiovascular Center (KACC) between 2010 and 2021 were included. The information on demographic and clinical characteristics as well as outcome variables was collected. Results: Of 100 patients who were admitted to KACC during the study period, 63% were females and 9% were diagnosed with Vit-D deficiency. Furthermore, 66% of patients had successful cardioversion. Moreover, no significant difference in Vit-D deficiency was observed between patients who had successful cardioversion and those with unsuccessful outcomes (P = 0.485). Conclusions: There is no association between serum Vit-D levels and the success rate of cardioversion in patients with AF. However, further studies are needed for more conclusive evidence.

Obesity and metabolic syndrome in adolescent survivors of standard risk childhood acute lymphoblastic leukemia in Saudi Arabia.

BACKGROUND: This study estimated prevalence of unhealthy weight status and metabolic syndrome (MS) amongst Saudi survivors of standard risk ALL. PROCEDURE: We recruited 56 survivors, mean age 13.4 years (SD 4.1), a mean of 9.1 years (SD 4.1) post-diagnosis. The BMI for age was used to define weight status relative to national (Saudi) and international (Cole et al., Cole-IOTF, WHO, and CDC) reference data. We measured body composition by dual-energy X-ray absorptiometry (DXA), waist circumference, blood pressure, lipid profile (HDL-C, Triglycerides), fasting glucose and insulin. RESULTS: According to international definitions based on BMI for age, around half of the sample had unhealthy weight status. All of the approaches based on BMI for age underestimated overfatness, present in 27/51 (53%) of the sample according to DXA. Prevalence of MS was 7.1% (3/42 of those over 9-years old) and 5.4% (3/56) by applying the International Diabetes Federation (IDF) definition and National Cholesterol Education Program Third Adult Treatment panel Guidelines (NCEP III), respectively. However, MS by the NCEP III definition was present in 19% of the overweight and obese survivors and 7.1% of the sample had at least two of the components of MS. CONCLUSION: Unhealthy body weight and overfatness may be common amongst adolescent Saudi survivors of standard risk ALL, though overweight and obesity may be no more common than in the general Saudi adolescent population. Defining weight status using BMI underestimates overfatness. Ideally, body composition and cardiometabolic risk factors should be monitored at late effects clinics.

Clinicopathological features of pulmonary mucinous adenocarcinoma: A descriptive analysis.

BACKGROUND: Mucinous adenocarcinoma is a rare subtype of lung cancer characterized by abnormal mucin production. We sought to investigate the clinical and pathological features of pulmonary mucinous adenocarcinomas and to identify prognostic factors. METHODS: This was a single-institution retrospective review of patients with pulmonary mucinous adenocarcinoma diagnosed between January 1, 2015 and December 31, 2020. Descriptive analysis included demographics, diagnostic data, and treatment modalities. The primary outcome was overall survival (OS). RESULTS: Fifty-six patients were included in the study. Median age was 65 years (range: 26-84), 30 (54%) were female, 48 (86%) had a smoking history, and 41 (73%) patients had ECOG performance status 0-1. Nearly half (26, 46%) were stage IV at presentation, while 11 (20%) presented as stage I, 10 (18%) stage II, and 9 (16%) stage III. Biomarker testing increased through the study period. Where performed, 4/48 (8%) cases were ALK positive, but there were no EGFR cases identified (0/36). Only 3/20 cases had PD-L1 expression >50%. Curative intent therapy was performed in 23 patients (17 had surgery +/- chemotherapy/radiation, 4 had radiotherapy alone, 2 had chemoradiation). Median OS in the entire population was 16.1 months (m). OS by stage was 50.0m for stage I, not reached for stage II, 20.7m for stage III, and 8.1m for stage IV. CONCLUSIONS: The overall prognosis of pulmonary mucinous adenocarcinoma appears similar to that of non-mucinous adenocarcinomas, with distinct differences noted in the incidence of oncogenic driver mutations, particularly an absence of EGFR mutations.

Impact of taxation policy on tobacco consumption in Saudi Arabia.

BACKGROUND: Taxes on tobacco products that increase the price and target demand-reduction have been shown to be an efficient means of reducing tobacco consumption. A new policy introduced in 2017 has increased the price of a 20-cigarette pack of the most popular brand to 27.50 SAR (7.33 USD) with the tax portion being 68.09%, which is within the yardstick recommended by the World Bank. OBJECTIVE: Assess impact of taxes on cigarette consumption. DESIGN: Retrospective econometric analysis. MAIN OUTCOMES MEASURES: The annual importation of cigarettes containing tobacco (commodity code 24022000) in metric tons (as a proxy measure of consumption). METHODS: An econometric analysis of cigarette prices and consumption was performed using the methods of the World Bank Economics of Tobacco Toolkit. The impact was assessed statistically through price elasticity of cigarette demand. The study used yearly data for the period 2013-2019 to compare the price elasticity of demand according to the change in price. Cigarette consumption was equated to cigarette imports (dependent variable), and correlation with the cigarette price, income, education, and unemployment was assessed as independent variables of interest. RESULTS: Annual importation of cigarettes declined by 27.41% for the period 2013-2019 after the imposition of ad valorem and value-added taxes in 2017 and 2018, respectively. The price of a pack of cigarettes increased by 115.1% from 2016 to 2018. The per capita consumption was inversely correlated with price *P=.0003285, r=-0.969). The inverse correlation between income and per capita consumption was also statistically significant (P=.025, r=-0.816). Education did not correlate with per capita consumption (P=.740, r=-0.155), but unemployment was inversely correlated (P=.008, r=-0.884). From 2016 to 2018, the price elasticity of demand became negative with respect to income as recommended by the World Health Organization. The price elasticity of demand reached -0.07, -0.8, -0.93 in 2016, 2017, 2018, respectively. CONCLUSION: The modification of tax policy in 2017 has resulted in a decrease in both cigarette affordability and consumption. An additional 42.67% increase in the price, or pack price of 35.81 SAR (9.54 USD) might offset the increase in individual income noted in 2019 and maintain the decreased affordability. LIMITATIONS: The lack of more granular data on cigarette sales and more reliable data on prevalence. CONFLICT OF INTEREST: None.

PR3-ANCAs Detected by Third-Generation ELISA Predicts Severe Disease and Poor Survival in Primary Sclerosing Cholangitis.

A highly sensitive detection of anti-neutrophil cytoplasmic antibodies to serine proteinase-3 (PR3-ANCAs) aids in the serological diagnosis of autoimmune liver disorders and the prediction of severity in primary sclerosing cholangitis (PSC). Here, we evaluate a novel third-generation ELISA for the detection of PR3-ANCAs. In total, 309 patients with PSC, 51 with primary biliary cholangitis (PBC), and 120 healthy blood donors (BD) were analyzed. For the survival analysis in PSC, the outcome was defined as liver-transplantation-free survival during the follow-up. Positive PR3-ANCA levels were found in 74/309 (24.0%) of patients with PSC. No BDs and one patient with PBC demonstrated PR3-ANCA positivity. PR3-ANCAs were revealed as independent predictors for a poor PSC outcome (study endpoint: liver transplantation/death, log-rank test, p = 0.02). PR3-ANCA positivity, lower albumin levels, and higher bilirubin concentrations were independent risks of a poor survival (Cox proportional-hazards regression analysis, p < 0.05). The Mayo risk score for PSC was associated with PR3-ANCA positivity (p = 0.01) and the disease severity assessed with a model of end-stage liver disease (MELD) and extended MELD-Na (p < 0.05). PR3-ANCAs detected by a third-generation ELISA are diagnostic and prognostic markers for PSC. Their wider use could help to identify patients who are at-risk of a more severe disease.

Chemotherapy for Non-Small Cell Lung Cancer in the Intensive Care Unit.

BACKGROUND: patients with non-small-cell lung cancer (NSCLC) admitted to the intensive care unit have poor prognosis. There is limited data on cytotoxic chemotherapy in this setting. The standard of care for these patients is usually best supportive care. CASE: 60-year-old previously healthy female was admitted to the ICU with newly diagnosed mucinous adenocarcinoma of the lung. She received cisplatin and pemetrexed while intubated and mechanically ventilated. She was extubated a week later and discharged home after achieving an excellent radiographic and clinical response. DISCUSSION: in select patients with NSCLC admitted to the ICU due to complications from their malignancy, a trial of cytotoxic chemotherapy may be reasonable. To our knowledge, this is the first case of mucinous NSCLC treated in the ICU.

Three Decades of Malignant Pleural Mesothelioma: An Academic Center Experience.

BACKGROUND: Malignant pleural mesothelioma (MPM) remains a challenging disease to manage. In the past few decades, extrapleural pneumonectomy (EPP), pemetrexed-based chemotherapy, and indwelling pleural catheters were introduced to MPM care with variable levels of efficacy and evidence. PATIENTS AND METHODS: This was a retrospective review of patients diagnosed with MPM between January 1991 and March 2019. The primary outcome was overall survival (OS). Data were examined by decade to assess trends in MPM demographics, management, and OS. A subgroup analysis was then conducted to examine the impact of EPP, pemetrexed, and indwelling pleural catheters on OS. RESULTS: The study included 337 patients; 309 patients had died at last follow-up (91.7%). Median age at diagnosis and the proportion of female patients increased from 65.8 years (interquartile range [IQR], 57.1-73.7) and 11.6% female from 1991 to 1999 to 75 years (IQR, 68.1-80.6) and 20.5% female from 2010 to 2019. Median OS was largely unchanged in the three study periods: 9.0 months (95% confidence interval [CI], 6.9-12.7) in the 1991-1999 cohort, 9.3 months (95% CI, 7.6-13.2) in the 2000-2009 cohort, and 10.1 months (95% CI, 7.9-13.6) in the 2010-2019 cohort. Controlling for a number of demographic and prognostic factors, EPP (hazard ratio [HR] = 0.50; 95% CI, 0.3-0.9; P = .02), pemetrexed-based chemotherapy (HR = 0.59; 95% CI, 0.40-0.87; P = .007), and indwelling pleural catheters (HR = 0.3; 95% CI, 0.13-0.71; P = .006) were each associated with improvements in OS. CONCLUSION: Despite the small incremental improvements in survival shown by the three interventions we examined, prognosis remains guarded for MPM patients. Better modalities of management are needed.

Recent Advancements in the Nanomaterial Application in Concrete and Its Ecological Impact.

At present, nanotechnology is a significant research area in different countries, owing to its immense ability along with its economic impact. Nanotechnology is the scientific study, development, manufacturing, and processing of structures and materials on a nanoscale level. It has tremendous application in different industries such as construction. This study discusses the various progressive uses of nanomaterials in concrete, as well as their related health risks and environmental impacts. Nanomaterials such as nanosilica, nano-TiO2, carbon nanotubes (CNTs), ferric oxides, polycarboxylates, and nanocellulose have the capability to increase the durability of buildings by improving their mechanical and thermal properties. This could cause an indirect reduction in energy usage and total expenses in the concrete industry. However, due to the uncertainties and irregularities in size, shape, and chemical compositions, some nanosized materials might have harmful effects on the environment and human health. Acknowledgement of the possible beneficial impacts and inadvertent dangers of these nanosized materials to the environment will be extremely important when pursuing progress in the upcoming years. This research paper is expected to bring proper attention to the probable effects of construction waste, together with the importance of proper regulations, on the final disposal of the construction waste.

Assess and evaluate knowledge, attitude and practice of first aid management of epistaxis among general population in Aseer region.

INTRODUCTION: Epistaxis or nose bleeds is one the most common reported emergencies in the ear, nose and department. Causes of epistaxis varies from being trivial such as nose picking or dry air or trauma to concerning such as infections or elevated blood pressure to life threatening condition such as malignancies. METHODS: The purposely constructed questionnaire was used for this research. The questionnaire was constructed by the panel of experts, language, psychological, doctors and subject specialist was there in the team. Internal consistencies of the questionnaire was measure through cronbach alpha. RESULTS: Cronbach alpha = 0.84. Mean ± S.D of age of the respondents were 27.8 ± 9.8. 71.6% were females, 91.5% were belongs to Aseer region, 86.6% were living in village, 77.0% have intermediate level of education, 59.2% were single, 41.6% having health care profession. 51.1% having income less than 5000SAR. CONCLUSION: Most of them rely on internet and social media to gain knowledge regarding home management of epistaxis. This has limitations as they do not get a hands-on experience. Therefore, we recommend that first aid camps and workshops in management of epistaxis should be organized in order to properly educate the general population regarding its home management.