Descriptive Analysis of Adverse Events Reported for New Multiple Myeloma Medications Using FDA Adverse Event Reporting System (FAERS) Databases from 2015 to 2022.

BACKGROUND: New multiple myeloma (MM) medications have revolutionized the treatment landscape, but they are also associated with a range of adverse events (AEs). This study aims to provide a comprehensive overview of AEs reported for four new MM medications: daratumumab, ixazomib, elotuzumab, and panobinostat. METHODS: This study uses a descriptive retrospective approach to analyze the FDA Adverse Event Reporting System (FAERS) from 2015 to 2022. It includes variables like medication names, report details, patient demographics, adverse events, and reporter types. The initial dataset consists of over 3700 adverse events, which are categorized into 21 groups for clarity and comparison. RESULTS: The FAERS database revealed 367,756 adverse events (AEs) associated with novel multiple myeloma drugs from 2015-2022. Ixazomib had the highest number of reported AEs with 206,243 reports, followed by daratumumab with 98,872 reports, then elotuzumab with 26,193 AEs. Ixazomib's AE reports increased dramatically over the study period, rising approximately 51-fold from 1183 in 2015 to 60,835 in 2022. Of the medications studied, ixazomib also recorded the highest number of deaths (24,206), followed by daratumumab (11,624), panobinostat (7227), and elotuzumab (3349). The majority of AEs occurred in patients aged 55-64 and 65-74 years. CONCLUSIONS: Ixazomib, a new MM medication, had the highest number of AEs reported. Also, it has the highest rate of reported deaths compared to other new MM medications. Clinicians should be aware of the potential AEs associated with this medication and further research is needed to understand the reasons for the high number of AEs and to develop mitigation strategies. More attention should also be paid to the safety of new multiple myeloma medications in younger patients.

Garcinol-Attenuated Gastric Ulcer (GU) Experimentally Induced in Rats Via Affecting Inflammation, Cell Proliferation, and DNA Polymerization.

BACKGROUND:  Gastric ulcer (GU) is one of the most critical gastrointestinal tract disorders. Garcinol is a polyisoprenylated benzophenone in Garcinia fruit with antioxidant and anti-inflammatory priorities. OBJECTIVES:  We aimed to assess the protective effects of garcinol against GU induced in rats. We investigated garcinol's effects on DNA polymerization via mammalian targets of rapamycin (mTOR) and cyclin D1, cell proliferation via proliferating cell nuclear antigen (PCNA), inflammatory pathway via cyclooxygenase-2 (COX2), TNF-α, and IL-1ß, and anti-inflammatory pathway via IL-4 and IL10. METHODS:  In our study, we administered a single oral dose of 80 mg/kg of indomethacin to rats to induce GU. Some of the rats were given a treatment of 50 mg/kg of garcinol. We examined the expressions of mTOR, cyclin D1, PCNA, COX2, TNF-α, and IL-1ß/4/10 in the gastric tissues. Furthermore, we stained sections of the gastric tissues with Masson trichrome. RESULTS:  The areas of gastric tissues in the GU group showed severe hemorrhage and extensive fibrosis. Treating GU rats with garcinol prevented bleeding and ameliorated the fibrosis caused in gastric cells by GU. Moreover, treatment with garcinol significantly decreased the expression of mTOR, cyclin D1, PCNA, COX2, TNF-α, and IL-1ß associated with elevation of IL-4 and IL-10. CONCLUSION:  Garcinol has been found to provide therapeutic benefits in rats with induced GU. These benefits may be due to its ability to decrease the expression of DNA polymerization markers, cell proliferation markers, and inflammatory markers at the gene and protein levels.

Sarcopenia and associated risk factors in oncology outpatients in specialized cancer centers in Saudi Arabia: a cross-sectional study.

Sarcopenia is a comorbidity associated with cancer, which takes advantage of a patient's deteriorating state and decreases the survival rate. Thus, early detection of sarcopenia could improve oncology outpatient prognosis, treatment, and general quality of life. Objective: To measure the prevalence of probable sarcopenia and the associated risk factors in patients with cancer. Methods: This is a cross-sectional study. A total of 324 cancer patients were screened for sarcopenia using a simple questionnaire to rapidly diagnose sarcopenia [SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls)] and a hand grip dynamometer tool. The study was conducted from 1 January 2021 till 28 February 2021, in the outpatient department of Princess Noorah Oncology Center. Results: Among 324 cancer patients receiving active chemotherapy treatment, 28.4% screened positive for sarcopenia (SARC-F score ≥4). Moreover, 23.45% were identified as probable cases [SARC-F score ≥4 and a low hand grip strength (HGS)] of sarcopenia, according to the European Working Group on Sarcopenia in Older People consensus 2 (EWGSOP2) case-finding algorithm, which is sufficient to initiate a management plan. Conclusions: One-quarter of the cancer patients had probable sarcopenia at our institution. Sarcopenia risk was independently associated with patient age, and the risk of sarcopenia was low among patients with higher albumin concentrations. Screening cancer patients for sarcopenia using the SARC-F questionnaire and HGS may offer a useful strategy to mitigate the risk of unfavorable consequences that may occur during cancer treatment.

Optic Nerve Head Infiltration in Presumed Tuberculous Uveitis.

To report the clinical and multimodal imaging findings of presumed tuberculous optic nerve head (ONH) infiltration in 3 patients at a tertiary eye care center. In addition to unilateral presumed tuberculous ONH infiltration, all patients had clinical findings suggestive of tuberculous choroidal involvement which was confirmed by Indocyanine green angiography (ICGA). All patients were treated successfully with a combination of antituberculous regimen and systemic corticosteroids.

Iron dyshomeostasis and time-course changes in iron-uptake systems and ferritin level in relation to pro-inflammatory microglia polarization in sepsis-induced encephalopathy.

Encephalopathy is a frequent and lethal consequence of sepsis. Recently, a growing body of evidence has provided important insights into the role of iron dyshomeostasis in the context of inflammation. The molecular mechanisms underlying iron dyshomeostasis and its relationship with macrophage phenotypes are largely unknown. Here, we aimed to characterize the changes in iron-transporter and storage proteins and the microglia phenotype that occur during the course of sepsis, as well as their relationship with sepsis-induced encephalopathy. We used a cecal ligation and puncture (CLP) murine model that closely resembles sepsis-induced encephalopathy. Rats were subjected to CLP or sham laparotomy, then were neurologically assessed at 6 h, 24 h, and 3 days after sepsis induction. The serum and brain were collected for subsequent biochemical, histological, and immunohistochemical assessment. Here, an iron excess was observed at time points that followed the pro-inflammatory macrophage polarization in CLP-induced encephalopathy. Our results revealed that the upregulation of non-transferrin-bound iron uptake (NTBI) and ferritin reduction appeared to be partially responsible for the excess free iron detected within the brain tissues. We further demonstrated that the microglia were shifted toward the pro-inflammatory phenotype, leading to persistent neuro-inflammation and neuronal damage after CLP. Taken together, these findings led us to conclude that sepsis increased the susceptibility of the brain to the iron burden via the upregulation of NTBI and the reduction of ferritin, which was concomitantly and correlatively associated with dominance of pro-inflammatory microglia and could explain the neurological dysfunction observed during sepsis.

Burden and Disease Characteristics of Psoriatic Arthritis at a Tertiary Center.

BACKGROUND: Psoriatic arthritis (PsA) has a detrimental influence on the quality of life (QoL). The goal of this study was to evaluate the QoL of patients with PsA and its determinants at the King Abdulaziz University Hospital in Jeddah, Saudi Arabia. METHODS:  A cross-sectional study was conducted on 60 PsA patients. A questionnaire was used to collect data about their demographics. Assessment of health-related quality of life (HRQOL) was done by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue and the FACIT-General (FACIT-G) scales were used to assess fatigue. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess disease activity. RESULTS: The mean age of the patients was 50.33 ± 11.15 years and 78.3% were females. The mean HRQOL, FACIT-G, FACIT, and BASDAI scores were 59.99 ± 34.67, 28.18 ± 5.95, 20.01 ± 9.68, and 4.05 ± 2.54, respectively. The HRQOL scores were found to have a highly significant negative correlation with both the FACIT and BASDAI scores, as well as the patients' age and BMI. The FACIT-G scores and the BASDAI scores, as well as the BASDAI scores and the FACIT scores, were found to have a strong positive correlation with age and BMI. CONCLUSION: PsA has a significant detrimental influence on QoL, with a link between QoL and disease activity and fatigue. A greater understanding of QoL issues will help improve the quality of care.

Successful Pars Plana Vitrectomy with Zonulo-hyaloidectomy Performed 4 Years after the Onset of Chronic Low-Grade Aqueous Misdirection.

In aqueous misdirection, the interval between diagnosis and surgical intervention is inversely proportional to the success of the surgery. Here, we report a successful outcome of pars plana vitrectomy (PPV) with irido-zonulo-hyaloidectomy 4 years after the onset of the disease. A 34-year-old female, known to have primary angle closure glaucoma, underwent trabeculectomy with mitomycin C in the right eye for uncontrolled intraocular pressure (IOP). Six weeks after the surgery, the patient presented with a shallow anterior chamber centrally and peripheral iridocorneal touch along with a patent peripheral iridectomy. Ultrasound biomicroscopy showed a shallow AC centrally with peripheral iridocorneal touch, and the ciliary body was rotated forward confirming the diagnosis of aqueous misdirection. The patient refused surgical management and was managed medically, which was unsuccessful. Four years after the diagnosis, the patient underwent PPV with irido-zonulo-hyaloidectomy because of progressive shallowing of the AC and corneal edema. One month postoperatively, visual acuity improved from 20/200 to 20/60, and the AC maintained appropriate depth. In conclusion, PPV with irido-zonulo-hyaloidectomy may result in a complete resolution of a chronic low-grade form of aqueous misdirection.

Pitfalls of Advanced Retinopathy of Prematurity Presentation: A Content Analysis of Medical Records.

PURPOSE: To identify the pitfalls in retinopathy of prematurity (ROP) screening leading to advanced disease at Ministry of Health (MOH) hospitals in Saudi Arabia. METHODS: A qualitative deductive content analysis was used to study the phenomena of defects in ROP screening. A retrospective review of medical records of newborns presenting to two tertiary eye care centers with advanced ROP (stage 4 and 5) from January 2012 to June 2019 was completed. An extensive review of the original files at the referring hospitals was conducted, including the general condition and findings of ophthalmic examination and the sequence of follow-up until the infant was discharged/referred. Data analysis was completed using pre-structured categorization matrix. RESULTS: Records of 29 infants with advanced stage ROP were identified. Only 13 medical records were available and obtained. The pitfalls in screening found in the study were failure to refer by the neonatologist, delayed follow-up by the ophthalmologist, failure to follow-up by the ophthalmologist, failure to diagnose by the ophthalmologist, poor documentation in patient files, unavailability of ophthalmologist, family negligence, lack of treatment and delayed referral to a higher center, and progression despite timely screening and management. CONCLUSION: Although clear ROP screening guidelines are available, implementations of these guidelines are suboptimal. This study showed that the most common defect in screening is physician's inadequacy and unavailability. A proper network of competent ROP screening physicians in all neonatal intensive care units should be established. Centers for advanced ROP surgery should be allocated to deliver a timely surgical care if needed.

The Antimicrobial, Antioxidant, and Anticancer Activity of Greenly Synthesized Selenium and Zinc Composite Nanoparticles Using Ephedra aphylla Extract.

The current work aimed to synthesize selenium and zinc nanoparticles using the aqueous extract of Ephedra aphylla as a valuable medicinal plant. The prepared nanoparticles were characterized by TEM, zeta potential, and changes in the phytochemical constituents. Hence, the phenolic, flavonoid, and tannin contents were reduced in the case of the prepared samples of nanoparticles than the original values in the aqueous extract. The prepared extract of Ephedra aphylla and its selenium and zinc nanoparticles showed high potency as antioxidant agents as a result of the DPPH• assay. The samples were assessed as anticancer agents against six tumor cells and a normal lung fibroblast (WI-38) cell line. The selenium nanoparticles of Ephedra aphylla extract revealed very strong cytotoxicity against HePG-2 cells (inhibitory concentration (IC50) = 7.56 ± 0.6 µg/mL), HCT-116 cells (IC50 = 10.02 ± 0.9 µg/mL), and HeLa cells (IC50 = 9.23 ± 0.8 µg/mL). The samples were evaluated as antimicrobial agents against bacterial and fungal strains. Thus, selenium nanoparticles showed potent activities against Gram-negative strains (Salmonella typhimurium, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli), Gram-positive strains (Bacillus cereus, Listeria monocytogenes, Staphylococcus aureus, and Staphylococcus epidermidis), and the fungal strain Candida albicans. In conclusion, the preparation of nanoparticles of either selenium or zinc is crucial for improved biological characteristics.

SomatoSim: precision simulation of somatic single nucleotide variants.

BACKGROUND: Somatic single nucleotide variants have gained increased attention because of their role in cancer development and the widespread use of high-throughput sequencing techniques. The necessity to accurately identify these variants in sequencing data has led to a proliferation of somatic variant calling tools. Additionally, the use of simulated data to assess the performance of these tools has become common practice, as there is no gold standard dataset for benchmarking performance. However, many existing somatic variant simulation tools are limited because they rely on generating entirely synthetic reads derived from a reference genome or because they do not allow for the precise customizability that would enable a more focused understanding of single nucleotide variant calling performance. RESULTS: SomatoSim is a tool that lets users simulate somatic single nucleotide variants in sequence alignment map (SAM/BAM) files with full control of the specific variant positions, number of variants, variant allele fractions, depth of coverage, read quality, and base quality, among other parameters. SomatoSim accomplishes this through a three-stage process: variant selection, where candidate positions are selected for simulation, variant simulation, where reads are selected and mutated, and variant evaluation, where SomatoSim summarizes the simulation results. CONCLUSIONS: SomatoSim is a user-friendly tool that offers a high level of customizability for simulating somatic single nucleotide variants. SomatoSim is available at https://github.com/BieseckerLab/SomatoSim .

Saudi Arabia Guidelines for diabetic macular edema: A consensus of the Saudi Retina Group.

Diabetes mellitus (DM) and its complications are major public health burdens in Saudi Arabia. The prevalence of diabetic retinopathy (DR) is 19.7% and the prevalence of diabetic macular edema (DME) is 5.7% in Saudi Arabia. Diabetic macular edema is a vision-threatening complication of DR and a major cause of vision loss worldwide. Ocular treatments include retinal laser photocoagulation, anti-vascular endothelial growth factor (anti-VEGF) agents, intravitreal corticosteroids, and vitreoretinal surgery when necessary. The present consensus was developed as a part of the Saudi Retina Group's efforts to generate Saudi guidelines and consensus for the management of DME, including recommendations for its diagnosis, treatment, and best practice. The experts' panel stipulates that the treatment algorithm should be categorized according to the presence of central macula involvement. In patients with no central macular involvement, laser photocoagulation is recommended as the first-line option. Patients with central macular involvement and no recent history of cardiovascular (CVS) or cerebrovascular disorders can be offered anti-VEGF agents as the first-line option. In the case of non-responders (defined as an improvement of <20% in optical coherence tomography or a gain of fewer than 5 letters in vision), switching to another anti-VEGF agent or steroids should be considered after 3 injections. Within the class of steroids, dexamethasone implants are recommended as the first choice. In patients with a recent history of CVS events, the use of anti-VEGF agents is not recommended, regardless of their lens status. The experts' panel recommends that a future study be conducted to provide a cut-off point for early switching to steroid implants in pseudo-phakic eyes.

Mucoadhesive Low Molecular Chitosan Complexes to Protect rHuKGF from Proteolysis: In-vitro Characterization and FHs 74 Int Cell Proliferation Studies.

BACKGROUND: Recombinant Keratinocyte Growth Factor (rHuKGF) is a therapeutic protein used widely in oral mucositis after chemotherapy in various cancers, stimulating lung morphogenesis and gastrointestinal tract cell proliferation. In this research study, chitosan-rHuKGF polymeric complex was implemented to improve the stability of rHuKGF and used as rejuvenation therapy for the treatment of oral mucositis in cancer patients. OBJECTIVE: Complexation of rHuKGF with mucoadhesive low molecular weight chitosan to protect rHuKGF from proteolysis and investigate the effect of chitosan-rHuKGF complex on the proliferation rate of FHs 74 Int cells. METHODS: The interaction between chitosan and rHuKGF was studied by molecular docking. Malvern ZetaSizer Nano Zs and Fourier-Transform Infrared spectroscopy (FTIR) tests were carried out to characterize the chitosan-rHuKGF complex. In addition, SDS-PAGE was performed to investigate the interaction between chitosan-rHuKGF complex and pepsin. The effect of chitosan-rHuKGF complex on the proliferation rate of FHs 74 Int cells was studied by MTT assay. RESULTS: Chitosan-rHuKGF complex was formed through the hydrogen bonding proven by the docking studies. A stable chitosan-rHuKGF complex was formed at pH 4.5 and was protected from proteolysis and assessed by SDS PAGE. According to the MTT assay results, chitosan-rHuKGF complex increased the cell proliferation rate of FHs 74 Int cells. CONCLUSION: The developed complex improved the stability and the biological function of rHuKGF.

Posterior Segment Characterization in Children With Pierson Syndrome.

BACKGROUND AND OBJECTIVE: Pierson syndrome is a rare genetic disease defined by congenital nephrotic syndrome in association with microcoria. The authors aim to describe the posterior segment and retinal features in Pierson syndrome. PATIENTS AND METHODS: A retrospective chart review of nine patients diagnosed with Pierson syndrome was ascertained. Details of ophthalmic history, ocular examination, retinal imaging, and surgical interventions were obtained during a median duration of 17 months of follow-up (range: 6 to 60 months). Retinal interventions included scatter laser photocoagulation and surgical retinal repair. RESULTS: Sixteen eyes of nine patients were included. The axial length of five eyes with flat retina was 26.59 mm ± 0.99 mm. Highly myopic features including tessellated fundus with accompanying optic disc pallor, unidentifiable cup, and abnormal retinal vascular emanation from the disc were observed in all eyes (100%), whereas 12 eyes (75%) had parapapillary chorioretinal atrophy. Features of abnormal retinal vascularization included avascular peripheral retina on fluorescein angiography, aberrant course of the temporal arcades in 13 eyes (81.3%), and straightened nasal retinal blood vessels in 12 eyes (75%). Tortuous retinal blood vessels were observed in three eyes (18.75%). Surgical repair was performed in five out of seven eyes with rhegmatogenous retinal detachment (RRD). Recurrence was observed in all eyes, which required two to three procedures to achieve final reattachment. CONCLUSIONS: Combined features of high axial myopia with incomplete peripheral vascular maturation characterize the posterior segment in Pierson syndrome. Careful posterior segment examination is essential to detect RRD or retinal neovascularization. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:618-627.].

Pyrolysis of oil extracted safflower seeds: Product evaluation, kinetic and thermodynamic studies.

In this study, pyrolysis kinetics and thermodynamic parameters of Safflower residues (SR) obtained from oil extraction were investigated by using TG/DSC-FTIR and py-GC/MS. Thermal analysis was performed from ambient temperature to 750 °C under a nitrogen atmosphere. The first-order reaction kinetics model was applied to thermal analysis data to determine apparent kinetic parameters. Activation energy and pre-exponential factor were calculated as 76.60 kJ.mol-1 and 1.89x106 min-1, respectively. The thermodynamic parameters such as the change in Gibb's free energy, the difference in enthalpy and the entropy change were calculated to be 201.36 kJ mol-1, 71.79 kJ mol-1, and -0.196 kJ mol-1, respectively. TG/FTIR analysis revealed that CO2, C6H5OH, and CC functional group as the main pyrolysis gas products. According to Py-GC/MS results of SR, the presence of high energy-containing compounds among the pyrolysis products was proved. All these results show that SR is suitable for pyrolysis to produce biofuel and/or chemicals.

Clear Cell Sarcoma of the Foot in an 18-Year-Old Female.

We report a case of an 18-year-old female without a relevant medical history who presented with an 8-month history of a left foot mass. It started as a small nodule that progressively increased in size over time. The mass then became ulcerative with foul-smelling discharge. There was no palpable left inguinal or other lymph nodes upon physical examination. Histological examination of the biopsy confirmed a diagnosis of clear cell sarcoma. Clear cell sarcoma is a rare soft tissue neoplasm. However, early diagnosis is crucial to prevent metastasis and worsened prognosis. Clear cell sarcoma has an extremely poor prognosis once metastasis occurs, and to the best of our knowledge, only fewer than 100 cases have been reported in the literature.

Colorectal cancer patients in western Saudi Arabia. Outcomes and predictors for survival over a 10-years period (2002-2014).

OBJECTIVES: To determine the survival outcomes and to describe the epidemiological characteristics of patients with colorectal cancer (CRC) in western Saudi Arabia. METHODS: Our study is a retrospective analysis of patients with CRC diagnosed between 2002 and 2014. We recruited 279 patients who were selected randomly and followed until the end of July 2017. A Kaplan-Meier curve was used to estimate the survival rate for CRC patients according to gender, histopathological pattern, tumor site, and mutation type, taking into consideration time factor, dropouts, and loss to follow-up. RESULTS: The mean age of CRC patients was 57±13 years, and most of them were Saudi (87.5%). Regarding tumor epidemiology, 32.4% of the patients at Best American Joint Committee on Cancer (Best AJCC) stage 4; 28.9% were at stage 3; and 1.2% were at stage zero. The most frequent pathological variant was adenocarcinoma (77.4%); the most affected site was the rectum (40.5%). By Cox regression analysis, age at diagnosis, tumor stage, Kirsten Ras (KRAS) mutation, and lymphovascular invasion were signifcant prognostic factors for survival in CRC patients. CONCLUSION: Colorectal cancer patients presented to the hospital late in the disease course. This may call for lowering the screening age, increasing awareness programs, and establishing a national screening program.

Arabic translation and psychometric testing of the self-screening malnutrition universal screening tool in inflammatory bowel disease patients.

OBJECTIVES: To translate and validate the malnutrition universal screening tool (MUST) for use in Arabic-speaking outpatients with inflammatory bowel disease (IBD). METHODS: We translated the MUST into Arabic by using the Brislin back-translation method. This methodological study was performed between August 2016 and November 2017 on 143 outpatients with IBD at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The patients must completed the self-administered (PSA) Arabic version of the MUST. Then, the health-care practitioners (HCPs) administered the Arabic MUST and performed standard patient clinical assessment. The nutrition risk was defined as low (MUST score=0), medium (MUST score=1), or high (MUST score greater than 1). The chance-corrected proportional agreement between the scores from the PSA and HCP-administered Arabic MUST was evaluated using Cohen's kappa coefficient. Internal consistency was evaluated using Cronbach's alpha statistic. RESULTS: The overall agreement between the PSA and HCP-administered Arabic MUST was almost perfect (agreement=95.9%, expected agreement=72.4%, kappa=0.85, p less than 0.0001). The calculated Cronbach's alpha statistic for MUST scores in 15/143 (10%) patients was 0.79. The calculated Pearson's correlation coefficient between PSA and HCP-administered MUST scores was 0.93 (p less than 0.0001). CONCLUSIONS: The PSA and HCP-administered Arabic MUST showed perfect agreement in outpatients with IBD.

Prevalence and correlates of depression among male medical students and interns in Albaha University, Saudi Arabia.

BACKGROUND: Depression in medical students and interns appear higher than the general population, with evidence of mental health deterioration over a period of medical training. OBJECTIVES: To estimate the prevalence and evaluate the predictors of depression among male medical students and interns, Albaha University, Saudi Arabia. SUBJECTS AND METHODS: A cross-sectional analytic study was conducted which includes a representative stratified random sample with the proportional allocation of male medical students and interns, College of Medicine, Albaha University (2017-2018). A questionnaire included sociodemographic characteristics of the participants as well as a medical and family history of depression, medical or psychiatric illness, abuse or violence, and the major traumatic event was utilized. In addition, the validated reliable Arabic version of Becks Depression Inventory (BDI) questionnaire was used to screen for depression. RESULTS: The study included 161 medical students and 21 interns. Their age ranged between 19 and 26 years with a mean of 22.03 ± 1.94 years. Majority of the participants (98.9%) were Saudis and singles (84.6%). The prevalence of depression, based on the BDI scale, was 53.8%; it was mild in 25.8% and severe or extreme in 4.4% of the participants. No factor was significantly associated with depression. However, severe or extreme depression was more reported among students/interns with a history of domestic abuse or violence and those who had a history of major trauma or psychiatric event, P < 0.001. CONCLUSION: Depression is a common problem among male medical students and interns in AlBaha University, with no difference according to demographics, smoking history, family history of depression, history of chronic medical or psychiatric illness, history of domestic/violence abuse, and history of major trauma or psychiatric event.

Unleashing Type-2 Dendritic Cells to Drive Protective Antitumor CD4+ T Cell Immunity.

Differentiation of proinflammatory CD4+ conventional T cells (Tconv) is critical for productive antitumor responses yet their elicitation remains poorly understood. We comprehensively characterized myeloid cells in tumor draining lymph nodes (tdLN) of mice and identified two subsets of conventional type-2 dendritic cells (cDC2) that traffic from tumor to tdLN and present tumor-derived antigens to CD4+ Tconv, but then fail to support antitumor CD4+ Tconv differentiation. Regulatory T cell (Treg) depletion enhanced their capacity to elicit strong CD4+ Tconv responses and ensuing antitumor protection. Analogous cDC2 populations were identified in patients, and as in mice, their abundance relative to Treg predicts protective ICOS+ PD-1lo CD4+ Tconv phenotypes and survival. Further, in melanoma patients with low Treg abundance, intratumoral cDC2 density alone correlates with abundant CD4+ Tconv and with responsiveness to anti-PD-1 therapy. Together, this highlights a pathway that restrains cDC2 and whose reversal enhances CD4+ Tconv abundance and controls tumor growth.