Ameliorative impacts of sinapic acid against mercuric chloride-induced renal toxicity: role of antioxidants and inflammatory cytokines.

Because of their beneficial properties, natural products, especially medicinal plants, are becoming increasingly popular worldwide and play a significant role in research. This study was aimed to evaluate the nephroprotective effect of sinapic acid against mercuric chloride-induced renal toxicity in mice. The mice were allocated to four groups named a normal group (G1), model group (G2; received HgCl2, 1 mg/kg bw), treatments groups (G3 and G4: received 50 and 100 mg/kg bw of sinapic acid together with HgCl2). Mice received HgCl2 remarkably showed alteration in all examined biochemical biomarkers (urea, creatinine, and bilirubin), and induced alteration in blood cell picture and anemia. HgCl2 intoxication decreased both systemic and renal antioxidant activity and induced over all oxidative stress as indicated by alteration in inflammation and oxidative stress associated markers. HgCl2 affected renal histology with leukocytic and inflammatory cell infiltration, fibrosis and tubular necrosis. Administration of sinapic acid (50 and 100 mg/kg bw) markedly restored the HgCl2-induced oxidative stress (serum and renal: MDA, GSH, CAT, SOD, and T-AOC), proinflammatory cytokines (serum and renal: TNF-α, IL-6, IL-1ß, and PGE2) and restored the changes on biochemical markers, and hematological parameters (hemoglobin, erythrocytes, platelets, and leukocytes). Taken together, the results of the present study disclose that sinapic acid has the potential to attenuate HgCl2-induced renal toxicity and may be an ideal choice against mercury poisoning.

Advanced hybrid silica nanoparticles with pH-responsive diblock copolymer brushes: optimized design for controlled doxorubicin loading and release in cancer therapy.

This study delves into the development, characterization, and application of modified mesoporous silica nanoparticles (MSNs) for targeted drug delivery in cancer therapy. MSNs were functionalized with poly(2-(diisopropylamino)ethyl methacrylate) (PDPA) and poly(glycidyl methacrylate) (PGMA), and further modified with cross-linkers DAE and Ornithine. Characterization using FT-IR, SEM, TEM, DLS, and XPS confirmed the successful surface modifications, revealing particle sizes primarily within the 63-94 nm range. The MSNs demonstrated a pH-responsive behavior, crucial for smart drug delivery. Loading and release studies using Doxorubicin (DOX) showed a controlled release, with an 8 µg mg-1 loading capacity. Cytotoxicity assays on Caco2 colon cancer cells revealed that unloaded nano-systems, at concentrations above 45 µM, resulted in approximately 60% cell death, indicating inherent anti-cancer properties. However, variations in cytotoxic effects were observed in drug-loaded MSNs, with some modifications showing reduced anti-cancer activity. These findings highlight the potential of MSNs in drug delivery and cancer treatment, emphasizing the importance of nanoparticle design in therapeutic efficacy.

Knowledge and Attitude of Parents Regarding the Human Papillomavirus Vaccine as a New Component in the Saudi Vaccination Schedule.

Background The most frequent gynecologic cancer in women is cervical cancer. The majority of incidents take place in less developed nations without access to reliable screening tools. Human papillomavirus (HPV) exposure, smoking, and immune system dysfunction are risk factors. As a result of effective screening, its incidence and death have significantly decreased in many nations. Hence, this study aims to assess the level of knowledge and awareness among parents regarding HPV, including its associated health risks and the benefits of vaccination. Methodology A descriptive cross-sectional study was carried out in the Riyadh region of Saudi Arabia from September to November 2023. The main tool used for gathering data was an online, self-administered survey via Google Forms. Collected data was analysed using SPSS v. 24 (IBM Corp., Armonk, NY), where all applicable statistical tests were used. Results Females exhibited higher levels of confidence and agreement with COVID-19 and HPV vaccination recommendations compared to males. A substantial percentage of males expressed strong disagreement and reduced confidence in HPV vaccination, contributing to the gender-based divergence. Individuals with higher education levels, such as university degree graduates, showed greater support for compulsory vaccines and a preference for natural immunity development in their children. Marital status played a role in vaccine-related decisions, with variations in vaccine refusal rates and difficulty discussing the HPV vaccine noted among individuals based on their marital status. Conclusion The study highlights the value of medical experts and specifically created training programs to close knowledge gaps and boost HPV vaccination rates. Demographic factors have an impact on attitudes, which highlights the need for targeted interventions.

Effectiveness of adjunctive screening tools for potentially malignant oral disorders and oral cancer: A systematic review.

Background and objectives: To enhance the abilities of healthcare professionals to make informed treatment decisions and establish accurate diagnoses, it is essential to assess the diagnostic reliability of different adjunctive aids. This systematic review aimed to compare the accuracy of various adjunctive methods for diagnosing suspected oral cancer (OC) or potentially malignant oral disorders (OPMD) in adults against histopathological investigative results. Materials and methods: The review protocol registered in the PROSPERO database (CRD42023463525) was developed in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Diagnostic Test Accuracy checklist. A comprehensive electronic search was conducted to identify relevant research articles published between January 2014 and April 2023 using the PubMed and EBSCO databases. The research question was meticulously structured following the participants' index test, reference standard, target condition, and study setting framework. To evaluate methodological quality and assess the risk of bias (RoB), the Quality Assessment for Diagnostic Accuracy Studies-2 tool was used. Results: An initial search yielded 483 publications, which were reduced to 278 after removal of duplicates. Finally, 85 publications underwent full-text review by two investigators, which lead to 29 studies that met the inclusion criteria. Among these, 7% had a low RoB, 72% had an unclear RoB, and 21% had a high RoB. Applicability concerns were expressed in 59% of the studies with low concern, 31% with unclear quality evidence of concern, and 10% with high concern. Conclusion: The review findings support the use of these diagnostic methods as valuable adjuncts to biopsy for the early detection of various OPMD and OC. They also highlight the importance of regular screening and awareness in reducing the global burden of OC, while acknowledging that they cannot replace the gold standards of surgical biopsy and histopathological evaluation.

A meta-analysis evaluating wound infections and other complications following distal versus complete gastrectomy for gastric cancer.

A meta-analysis investigation was carried out to measure the wound infections (WIs) and other postoperative problems (PPs) of distal gastrectomy (DG) compared with total gastrectomy (TG) for gastric cancer (GC). A comprehensive literature investigation till February 2023 was used and 1247 interrelated investigations were reviewed. The 12 chosen investigations enclosed 2896 individuals with GC in the chosen investigations' starting point, 1375 of them were TG, and 1521 were DG. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilized to compute the value of the WIs and other PPs of DG compared with TG for GC by the dichotomous approaches and a fixed or random model. TG had significantly higher overall PP (OR, 1.58; 95% CI, 1.15-2.18, p = 0.005), WIs (OR, 1.69; 95% CI, 1.07-2.67, p = 0.02), peritoneal abscess (PA) (OR, 2.99; 95% CI, 1.67-5.36, p < 0.001), anastomotic leakage (AL) (OR, 1.90; 95% CI, 1.21-2.97, p = 0.005) and death (OR, 2.26; 95% CI, 1.17-4.37, p = 0.02) compared to those with DG in individuals with GC. TG had significantly higher overall PP, WIs, PA, AL and death compared to those with DG in individuals with GC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.

Phytochemical profiling and anti-inflammatory, analgesic activity of Ficus religiosa L. and molecular docking study against iNOS, TNF-α enzyme.

Ficus religiosa L., a member of the Moraceae family, is a medicinal plant having a number of pharmacological properties. The anti-inflammatory and analgesic actions of an ethanolic extract of F. religiosa bark FRE (at 100 and 200mg/kg dosages) and the biomarker component quercetin QC (at 5 and 10mg/kg doses) were investigated. The estimate of quercetin was carried by using an HPTLC analysis of FRE. Additionally, qualitative and quantitative screening for key important phytocomponents was done using dried, ground plant stem barks. By using molecular docking, the molecular interaction profile with several anti-inflammatory drug targets was examined. Both the FRE as well as QC showed a substantial decline in paw volume when compared with the relevant control groups (p<0.01 & p<0.001). Following the administration of acetic acid to mice, the FRE and QC both demonstrate a substantial lengthening of the paw licking or leaping towards Eddy's hot plate as well as a decrease in the number of writhes (p<0.01 & p<0.001). This study supports the use of these herbs in conventional medicine to treat pain and inflammation by through similar mechanism as compound quercetin (QC).

Artificial Intelligence in Diagnosis of Oral Diseases: A Systematic Review.

AIM: To understand the role of Artificial intelligence (AI) in oral radiology and its applications. BACKGROUND: Over the last two decades, the field of AI has undergone phenomenal progression and expansion. Artificial intelligence applications have taken up new roles in dentistry like digitized data acquisition and machine learning and diagnostic applications. MATERIALS AND METHODS: All research papers outlining the population, intervention, control, and outcomes (PICO) questions were searched for in PubMed, ERIC, Embase, CINAHL, database from the last 10 years on first January 2023. Two authors independently reviewed the titles and abstracts of the selected studies, and any discrepancy between the two review authors was handled by a third reviewer. Two independent investigators evaluated all the included studies for the quality assessment using the modified tool for the quality assessment of diagnostic accuracy studies (QUADAS- 2). REVIEW RESULTS: After the removal of duplicates and screening of titles and abstracts, 18 full texts were agreed upon for further evaluation, of which 14 that met the inclusion criteria were included in this review. The application of artificial intelligence models has primarily been reported on osteoporosis diagnosis, classification/segmentation of maxillofacial cysts and/or tumors, and alveolar bone resorption. Overall study quality was deemed to be high for two (14%) studies, moderate for six (43%) studies, and low for another six (43%) studies. CONCLUSION: The use of AI for patient diagnosis and clinical decision-making can be accomplished with relative ease, and the technology should be regarded as a reliable modality for potential future applications in oral diagnosis.

Anti-inflammatory potential of Penicillium brefeldianum endophytic fungus supported with phytochemical profiling.

Various factors contribute to the development of the acute inflammation process, like the pro-inflammatory cytokines, certain enzymes as well as oxidative stress mediators. The anti-inflammatory potential of the endophytic fungus Penicillium brefeldianum was explored in carrageenan-induced inflammation in rats. After isolation of the fungus from Acalypha hispida leaves, it was identified by 18S rRNA gene sequencing. Then, its phytochemical profile was elucidated using LC-ESI-MS/MS technique. There was a remarkable decrease in the edema weight in the endophytic fungi-treated group (200 mg/kg). Also, this group had few inflammatory cells and thickened epidermis with underlying moderate collagenosis when stained with haematoxylin and eosin. Besides, immunostaining with monoclonal antibodies of cyclooxygenase-2 and tumor necrosis factor alpha showed a decrease in the positive immune cells in the endophytic fungi treated group (200 mg/kg) in relation to the positive control. Interestingly, the levels of the inflammatory as well as oxidative stress markers, including prostaglandin E2, nitric oxide, and malondialdehyde, which are hallmarks of the inflammatory process, considerably diminished (p < 0.05) in this group. qRT-PCR was utilised to elucidate the impact of the endophytic fungi treatment on the expression of interleukins (IL-1ß and IL-6) genes, which decreased in comparison with the positive control group. Consequently, we can deduce that P. brefeldianum endophytic fungus has a promising anti-inflammatory potential and should be extensively studied on a broader range in the near future.

Montmorillonite-based polymethacrylate composite monoliths as stationary phase materials for food and pharmaceutical analysis in capillary liquid and gas chromatography.

This work relates to the preparation of novel and promising stationary phases containing inorganic-organic composites for capillary liquid and gas chromatography. A naturally occurring montmorillonite was introduced to polymethacrylate monoliths, then used under different conditions of GC and HPLC at the same time. The performance of the columns was evaluated for the separation of alkane and alkylbenzene series in GC and capillary HPLC, respectively. While the bare monoliths failed to separate the model analytes, montmorillonite-based polymethacrylate allowed a full separation of the mixtures with Rs≥1.42. The columns were applied for the determination of myrcene and limonene isomers in the peel extracts of some fruits using GC, and for the analysis of active ingredients including aspirin, vitamin-C, caffeine, and ibuprofen extracted from common drugs using capillary HPLC. In GC, fast separation was achieved in 1.0 min with Rs of 6.53. The columns exhibited the best efficiency for myrcene with 20,900 plates/m. Using the capillary HPLC columns, the active ingredients were resolved in 10 min with Rs≥5.72. The efficiency values located between 12,800-21,700 plates/m in all cases. The developed methods were found to be linear in the range of 0.10-10.0 and 0.20-180 µg/mL for GC and HPLC, respectively. In comparison with commercial columns, the results in GC methods reveal that, despite their much shorter length, the prepared columns proved a faster separation with higher efficiency and comparable detection limits and chromatographic resolution. The prepared HPLC capillaries exposed lower run times and detection limits with comparable efficiency and resolution, and consume fewer samples and mobile phase solvents. The results demonstrate that the montmorillonite-based polymethacrylate composites are applicable as stationary phases for routine analysis and quality control of important fields such as food and pharmaceutical samples.

Hepatoprotective Effect of Moringa Oil on Rats under Fungicide Toxicity.

The present study is designed to evaluate whether pretreatment with moringa would have a protective effect on thioacetamide (TAA)-induced liver fibrosis, assessing biochemical and histopathological changes in Wistar male rats. Exposure to TAA induced notable biochemical and histopathological alterations. Liver fibrosis induced by TAA, along with associated biochemical and histological damage, has not been previously investigated in male rats supplemented with moringa oil. The experiment involved forty male rats distributed across four groups, each comprising ten rats. Group 1 served as controls and received intraperitoneal injections of saline solution twice weekly for six weeks. Group 2 rats were injected with 300 mg/kg body weight of TAA (Sigma-Aldrich Corp.) twice weekly for the same duration. Group 3 rats were orally supplemented with moringa oil at 800 mg/kg body weight/day and received intraperitoneal injections of TAA at the same dosage as Group 2 for six weeks. Finally, Group 4 rats were injected with saline solution twice weekly and orally supplemented with moringa oil at 800 mg/kg body weight/day for the same period. At the end of the experiment, we determined body weight and performed liver function analysis. Additionally, we examined the liver histology of the different groups. Results showed that moringa oil treatment protected rat livers from TAA toxicity by improving liver function analysis and preventing liver fibrosis. Moringa oil can be considered a promising agent for protection against TAA toxicity.

Radiation metrics for vascular and interventional radiology procedures in a tertiary care institution: A retrospective cohort study over 5-years.

OBJECTIVES: To evaluate the radiation metrics from frequently carried out vascular and interventional radiology (VIR) procedures at a tertiary care institution and compare them to international diagnostic reference levels (DRLs). METHODS: A retrospective study of the radiation metrics of VIR-procedures carried out from January 2015 to December 2019. The collected data included age, gender, height and weight, reference point air kerma (mGy), dose area product (DAP; Gy.cm2), and fluoroscopy time (min.) The body mass index (BMI) and peak skin dose were calculated. The study cohort included 8942 adult patients (54.4% male, 45.6% female) with a mean age of 56.96 years and mean BMI of 26.86. RESULTS: Transjugular intrahepatic portosystemic shunt (TIPS) creation recorded the highest mean fluoroscopy time of 69.41 min., followed by central venous recanalization 39.67min. TIPS creation had the highest mean DAP (1161.16 Gy.cm2), followed by trans arterial chemoembolisation (TACE) (500.63Gy.cm2). TIPS creation was associated with the highest peak skin dose (2766.81mGy), followed by TACE (1588.29mGy). Compared to other studies, TIPS creation and TACE are associated with significantly higher DAP. CONCLUSION: Majority of VIR-procedures demonstrate no significant institutional variations in dosimetry compared to other studies. Using these studied values as reference levels may help identifying procedures that need quality control to minimize unnecessary exposures.

The first report on the association of celiac disease and cystic fibrosis in a tertiary care center in Saudi Arabia.

Introduction: Celiac disease (CD) has been described before in Saudi Arabia (SA) to be at the range of 1%-2% in the general population, but the association of celiac disease and cystic fibrosis (CF) has never been described before in the Middle East. Objectives: To describe the prevalence of the association of CD and CF in patients with gastrointestinal symptomatology in a tertiary care center. Method: ology: A retrospective charts review of all confirmed CD and CF patients for the years 1989-2018. Results: In a total of 391 confirmed CF patients, 74 of them (19%) had celiac screening due to their symptomatology in the form of (abdominal pain and distension, vomiting, diarrhea despite adequate pancreatic enzyme replacements, and had high antigliadin antibodies and anti-transglutaminase IgA (tTGA). Thirty-five of the 74 patients were male (47.3%, and 39 (52.7%) were female patients. The mean age at diagnosis of CD was 6.1 (3.9), and the mean age at follow up was 7 (5 years). Only 2 of the 74 patients (3%) had bowel biopsies with the typical pathological findings of CD with villous atrophy. Both patients were placed on a gluten-free diet and showed marked improvement in symptomatology and weight gain. Conclusion: CD screening should be considered in all CF patients despite the absence of symptoms. The prevalence of CD in CF patients in SA is similar to or slightly higher than that of the general population. A further study to screen the whole CF population is needed to delineate the actual prevalence, particularly in nonsymptomatic CF.

Antibacterial, Immunomodulatory, and Lung Protective Effects of Boswelliadalzielii Oleoresin Ethanol Extract in Pulmonary Diseases: In Vitro and In Vivo Studies.

Lung diseases such as asthma, chronic obstructive pulmonary diseases, and pneumonia are causing many global health problems. The COVID-19 pandemic has directed the scientific community's attention toward performing more research to explore novel therapeutic drugs for pulmonary diseases. Herein, gas chromatography coupled with mass spectrometry tentatively identified 44 compounds in frankincense ethanol extract (FEE). We investigated the antibacterial and antibiofilm effects of FEE against Pseudomonas aeruginosa bacteria, isolated from patients with respiratory infections. In addition, its in vitro immunomodulatory activity was explored by the detection of the gene expression of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide synthase (iNOS), cycloxygenase-2 (COX-2), and nuclear factor kappa-B (NF-κB) in lipopolysaccharide (LPS)-induced peripheral blood mononuclear cells (PBMC). In addition, its anticancer activity against the A549 lung cancer cell line and human skin fibroblast (HSF) normal cell line was studied. Moreover, the in vivo lung protective potential of FEE was explored histologically and immunohistochemically in mice using a benzo(a)pyrene induced lung damage model. FEE exhibited antibacterial and antibiofilm activities besides the significant inhibition of gene expression of TNFα, IL-6, and NF-κB. FEE also exerted a cytotoxic effect against A549 cell line. Histological and immunohistochemical investigations with morphometric analysis of the mean area percentage and color intensity of positive TNF-α, COX-2, and NF-κB and Bcl-2 reactions revealed the lung protective activity of FEE. This study outlined the promising therapeutic activity of oleoresin obtained from B. dalzielii in the treatment of different pulmonary diseases.

Clopidogrel-herb Interactions: A Pharmacokinetic and Pharmacodynamic Assessment in a Rat Model.

BACKGROUND: Herbs usually contain a mixture of biologically active constituents, which can interact with numerous prescribed drugs and alter their safety profiles. OBJECTIVES: The current investigation was aimed to evaluate the effect of commonly used herbal products including black seed (Nigella sativa), garden cress (Lepidium sativum), and fenugreek (Trigonella foenum-graecum) on the pharmacokinetics and pharmacodynamics of clopidogrel using a Wistar rat model. METHODS: A GC-MS analysis revealed the presence of several phytoconstitutents (polyphenols) in the extracts of black seed, garden cress, and fenugreek. These polyphenols have the potential to interfere with clopidogrel effect. Plasma concentrations of clopidogrel were measured at different time points in the absence and presence of the concurrent use of tested herbal products and the pharmacokinetic parameters were calculated. Bleeding time was measured in various groups as a measure of the antiplatelet effect of clopidogrel. RESULTS: Area under the plasma concentration-time curves (AUC0-∞) of clopidogrel were 35.53 ±0.89 µg/ml*h (p<0.05), 26.01 ±0.90 µg/ml*h (p>0.05) and 32.80 ±2.51 µg/ml*h (p<0.05) in the black seed, garden cress and fenugreek group, respectively, compared with that of the control group (27.02 ±0.42 µg/ml*h). Treatment with black seed also caused an increase in clopidogrel Cmax by 31.52% (p<0.05) and with fenugreek by 21.42% (p<0.05); Cmax, did not changed with garden cress treatment (6.48 ±0.15 µg/ml versus 6.12 ±0.21 µg/ml, p>0.05). The pharmacodynamic evaluation of the antiplatelet effect of clopidogrel in the presence of herbal products treatment showed a significant prolongation in the bleeding time from a control baseline by ~22-26%, and by added ~8-12% in reference to clopidogrel therapeutic effect (p<0.05). CONCLUSION: The concurrent use of black seed, fenugreek, or garden cress can alter the pharmacokinetics and pharmacodynamics of clopidogrel to varying degrees due to the presence of various bioactive polyphenols. This is probably due to changes in drug disposition and its antiplatelet action. Further confirmation can determine the clinical relevance of these observations and identify the exact constituents responsible for such activities.

Bilateral Renal Lymphangiectasia with No Significant Morbidity for Over 25 Years: A Case Report.

BACKGROUND Renal lymphangiectasia is a rare benign disorder with unknown pathophysiology. Renal lymphangiectasia can affect both males and females with no known age predilection. Its diagnosis can be accomplished with radiological images and confirmed by aspiration of lymphatic fluid in certain cases. However, there is no clear presentation to be relied on, apart from incidental findings or presentation of complications, such as hypertension due to mass effect on the kidney or renal failure from chronic compression and obstruction or renal vein thrombosis. Management is directed toward symptomatic relief and protection of the kidneys from failure or obstruction. The timing of possible complications and the duration of conservative therapy are undetermined. CASE REPORT Here, we present a case of a healthy 39-year-old woman with bilateral renal lymphangiectasia. It was initially discovered and confirmed to be lymphangiectasia when she was 13 years old and underwent bilateral renal aspiration. She recently presented to the Emergency Department with abdominal symptoms that were found to be caused by diverticulitis. The radiological images showed the persistence of her previous diagnosis of bilateral renal lymphangiectasia. She has had the same condition for more than 25 years, with no related complications or further intervention beyond conservative management. CONCLUSIONS Renal lymphangiectasia has a benign long-term course with insignificant and minor effects in certain patients regardless of the considerable size of cysts and bilateral involvement of the kidneys. The findings of our case could reassure patients with a diagnosis of a similar condition.

Poly(oligo(ethylene glycol) methyl ether methacrylate) Capped pH-Responsive Poly(2-(diethylamino)ethyl methacrylate) Brushes Grafted on Mesoporous Silica Nanoparticles as Nanocarrier.

In this paper, a new pH-responsive nanosystem based on mesoporous silica nanoparticles (MSNs) was developed for cancer therapy. Poly(2-(diethylamino) ethyl methacrylate) (PDEAEMA) was grafted on their outer surface and acts as a gatekeeper, followed by subsequent modification of the polymer by cysteine (MSN-PDEAEMA-Cys) and poly(oligo(ethylene glycol) methyl ether methacrylate) (MSN-PDEAEMA-Cys-POEGMEMA). The physicochemical properties of these nanocarriers were characterized using scanning and transmission electron microscopies (SEM and TEM), Fourier-transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), and dynamic light scattering (DLS). The synthesized nanoparticles were well-dispersed with a diameter of ca. 200 nm. The obtained XPS results confirm the successful modification of MSN-PDEAEMA with Cys and POEGMEMA by increasing the peak intensity of C-O and C=O groups at 286.5 and 288.5 eV, respectively. An anti-cancer drug, doxorubicin (DOX), was encapsulated into the fabricated nanoplatform. The DOX release amount at physiological pH of 7.4 was limited (10%), while an accumulation drug release of ca. 35% was accomplished after 30 h in acidic media. The MTT cell line was used to assess the cytotoxicity of the unloaded and DOX-loaded fabricated nanoplatforms. Upon loading of DOX on these nanomaterials, they showed significant toxicity to human liver cancer cells. These results suggest that the prepared nano-structured materials showed good biocompatibility as well, and they can serve as nanocarriers for the delivery of anti-cancer drugs.

Angiotensin converting enzyme inhibitors and risk of lung cancer: A systematic review and meta-analysis.

BACKGROUND: We performed a meta-analysis to determine whether a consistent relationship exists between the use of angiotensin converting enzyme inhibitors (ACEIs) and the risk of lung cancer. Accordingly, we summarized and reviewed previously published quantitative studies. METHODS: Eligible studies with reference lists published before June 1st, 2019 were obtained from searching several databases. Random effects' models were used to summarize the overall estimate of the multivariate adjusted odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Thirteen observational studies involving 458,686 ACEI users were included in the analysis, Overall, pooled risk ratios indicate that ACEIs use was not a risk factor for lung cancer (RR 0.982, 95% C.I. 0.873 - 1.104; P = .76). There was significant heterogeneity between the studies (Q = 52.54; P < .001; I2 = 86.07). There was no significant association between ACEIs use and lung cancer in studies with over five years of ACEIs exposure (RR 0.95, 95% C.I. 0.75 - 1.20; P = .70); and ≤ 5years of exposure to ACEIs (RR 0.98, 95% C.I. 0.83 - 1.15; P = .77). There were no statistically significant differences in the pooled risk ratio obtained according to the study design (Q = 0.65; P = .723) and the comparator regimen (Q = 3.37; P = .19). CONCLUSIONS: The use of ACEIs was not associated with an increased risk of lung cancer. Nevertheless, well-designed observational studies with different ethnic populations are still needed to evaluate the long-term (over 10 years) association between ACEIs use and lung cancer.

Risk Factors Linked to Depression After Treatment in Cancer Survivors in Jeddah, Saudi Arabia.

Background While many cancer patients survive long after diagnosis, one is bound to experience long-term and latent side effects as a result of the treatment. This experience results in a poor quality of life, morbidity, and mortality for cancer survivors. Understanding how to manage these side-effects is quite important and a key to cancer survivorship. Objective Given the importance of this area, the main objective of this study seeks to understand the risk factor associated with cancer survivorship. Methods A cross-sectional study was conducted among 154 cancer survivors from King Fahad General and Kind Abdul-Aziz hospitals. Descriptive and inferential statistics were used in analyzing the responses. Descriptive statistics were used in understanding the extent of the risk factors while inferential statistics were used to understand the cross-relationships. Results This study included 154 cancer survivors aged 18 and above at King Fahad Hospital and King Abdul-Aziz Hospital in Jeddah, Makkah Region, KSA. Thirty-one (20.1%) of the sample were males and 123 (79.9%) were females. Of all the survivors who screened, 111 (72.9%) symptoms occur before treatment, 116 (75.3%) within the treatment, and 57 (37.09%) after treatment. The relationship between Socioeconomic Status Cross Symptoms categories demonstrated below includes accommodation type, education level, age, gender, and job. Conclusion The study concludes that post-cancer treatment symptoms are highly affected by other factors such as social-economic status as well as family support. As a result, the study recommends the establishment of educational materials on post-treatment symptoms, care-plans, and support groups for cancer survivors.

Gut Hormones in Health and Obesity: The Upcoming Role of Short Chain Fatty Acids.

We are currently facing an obesity pandemic, with worldwide obesity rates having tripled since 1975. Obesity is one of the main risk factors for the development of non-communicable diseases, which are now the leading cause of death worldwide. This calls for urgent action towards understanding the underlying mechanisms behind the development of obesity as well as developing more effective treatments and interventions. Appetite is carefully regulated in humans via the interaction between the central nervous system and peripheral hormones. This involves a delicate balance in external stimuli, circulating satiating and appetite stimulating hormones, and correct functioning of neuronal signals. Any changes in this equilibrium can lead to an imbalance in energy intake versus expenditure, which often leads to overeating, and potentially weight gain resulting in overweight or obesity. Several lines of research have shown imbalances in gut hormones are found in those who are overweight or obese, which may be contributing to their condition. Therefore, this review examines the evidence for targeting gut hormones in the treatment of obesity by discussing how their dysregulation influences food intake, the potential possibility of altering the circulating levels of these hormones for treating obesity, as well as the role of short chain fatty acids and protein as novel treatments.

The Efficacy of Dose Increments of Botulinum Toxin A in the Treatment of Childhood Esotropia.

BACKGROUND: Botulinum toxin is known to have a powerful chemodenervation effect, and it is a well-established alternative to incisional surgery for strabismus. This study aims to investigate the efficacy of dose increments of botulinum toxin A (BTA) for the treatment of specific ranges of angle deviation. METHODS: This was a prospective study that included patients presenting with esotropia to Dhahran Eye Specialist Hospital between 2016 and 2020, who were managed by a single surgeon. Botulinum toxin was given in different dosages (2.5, 5, 7.5, 10 international units (IU)) according to the size of deviation (11-19, 20-29, 30-39, and ≥40 prism diopters (PD)), respectively. A successful outcome was defined as deviation ≤10 PD in the last visit (a minimum of 6 months) following a single injection. RESULTS: A total of 56 patients with esotropia were included. The mean pre-treatment angle of deviation was 38.6 ± 2.5 PD. BTA injection in a dose of 2.5 IU for the 11-19 PD angle of deviation showed the highest rate of successful outcomes (75%). According to the type of esotropia, partially accommodative esotropia showed the best response to the use of dose increments (59%). The incidence of ptosis post-BTA injection was the least (37.5%) with the smallest dose (2.5 IU). CONCLUSION: BTA usage in dose increments is safe, efficient, and might be more cost-effective with less incidence of BTA associated complications. Different esotropia diagnoses have different clinical responses. However, larger studies are necessary to better predict the outcome of using dose increments.