Pseudomyxoma peritonei of appendiceal mucinous neoplasm origin: A case report and review of literature.

Appendiceal mucinous neoplasms, a rarity comprising less than 1% of all cancers, present intricate challenges in clinical management, and their incidence is on the rise. Notably, these neoplasms tend to metastasize intraperitoneally, leading to peritoneal carcinomatosis and concurrent accumulation of mucinous material, resulting in pseudomyxoma peritonei. Due to its spectrum of presentation, the classification of the appendiceal mucinous neoplasms remains a controversial subject with a range of management from a simple appendicectomy to a complex hyperthermic intraperitoneal chemotherapy (HIPEC). A 42-year-old Chadian male presented to the hospital with a sudden onset of right lower abdominal pain radiating to the inguinal region for 24 hours, associated with nausea and vomiting. The abdomen was distended and ascitic. Laboratory investigations revealed anemia, leukocytosis, hypernatremia, hypokalemia, elevated ESR, high CEA marker, and normal CA19-9. An abdominopelvic CT with contrast demonstrated extensive ascites and cystic masses in the liver, and pancreas with soft tissue thickening of the cecum; however, the appendix is not well-delineated. Patient was managed with chemotherapy and HIPEC followed by removal of all the affected parts. Nodules of the peritoneum and liver were submitted for histopathological analysis and a final diagnosis of pseudomyxoma peritonei of primary appendicular origin was established. This case highlights a case of extensive pseudomyxoma peritonei of appendicular origin managed aggressively by HIPEC and multiple resections of the involved organs. Prognosis of such a case is determined by the grade of the appendiceal tumor and the extent of invasion.

Immune Checkpoints and Cellular Landscape of the Tumor Microenvironment in Non-Melanoma Skin Cancer (NMSC).

Non-melanoma skin cancer (NMSC) is primarily categorized into basal cell carcinoma (BCC), the most prevalent form of skin cancer, and cutaneous squamous cell carcinoma (cSCC), the second most common type. Both BCC and cSCC represent a significant health burden, particularly in immunocompromised individuals and the elderly. The immune system plays a pivotal role in the development and progression of NMSC, making it a critical focus for therapeutic interventions. This review highlights key immunological targets in BCC and cSCC, with a focus on immune checkpoint molecules such as PD-1/PD-L1 and CTLA-4, which regulate T cell activity and contribute to immune evasion. This review also highlights anti-tumor immune cell subsets within the tumor microenvironment (TME), such as tumor-infiltrating lymphocytes (TILs) and dendritic cells. Additionally, it examines the immunosuppressive elements of the TME, including regulatory T cells (Tregs), myeloid-derived suppressor cells (MDSCs), tumor-associated macrophages (TAMs), and cancer-associated fibroblasts (CAFs), as well as their roles in NMSC progression and resistance to therapy. Emerging strategies targeting these immune elements, such as monoclonal antibodies, are also discussed for their potential to enhance anti-tumor immune responses and improve clinical outcomes. By elucidating the immunological landscape of BCC and cSCC and drawing comparisons to melanoma, this review highlights the transformative potential of immunotherapy in treating these malignancies.

Energy-conversion efficiency for producing oxy-hydrogen gas using a simple generator based on water electrolysis.

Producing hydrogen efficiently through water electrolysis could greatly reduce fossil fuel consumption. As well as this renewable energy source will also help combat global warming and boost economic investment opportunities. This paper studied some factors affecting the performance of oxy-hydrogen/hydroxy (HHO) gas generator, such as applied voltage (from 10.5 to 13.0 V) and electrolyte solution concentration (from 0.05 to 0.20 M), using a dry fuel cell based on the electrolyzing technique of water. The results revealed that the HHO gas production rate, power consumption, and temperature change of electrolyte solution increased significantly with increasing the tested applied voltage and electrolyte concentration. This study concluded that the optimum conditions for producing HHO gas ranged from 11.5 to 12.0 V for applied voltage and from 0.05 to 0.10 M for KOH concentration according to the lowest specific energy and highest HHO gas generator efficiency. Under the previous optimum conditions, the highest productivity, specific energy, and efficiency of the HHO gas generator were 343.9 cm3 min-1, 3.43 kW h m-3, and 53.79%, respectively, using 12.0 V for applied voltage and 0.10 M for electrolyte solution concentration. These findings provide an unambiguous direction for adjusting the operational factors (applied voltage and electrolyte concentration) for efficient HHO gas production and use in different applications. Furthermore, the required energy to operate the HHO gas generator can be obtained from renewable sources.

Left Middle Phalanx Tuberculous Dactylitis Masquerading as a Tumor: First Case Report in Saudi Arabia.

Tuberculous dactylitis can cause osteomyelitis, which is a rare extrapulmonary manifestation of tuberculosis, often misdiagnosed due to its nonspecific presentation and resemblance to other conditions like neoplasms. A 15-year-old male patient reported to our clinic with a 1-year history of left index finger pain and swelling following a football-related injury. Despite conservative management, the symptoms had progressively worsened over the past few months. Clinical examination revealed deformity and swelling of the middle phalanx, along with induced pain on range of motion. Bacteriological analysis indicated polymorphic nuclear cells and the presence of coagulase-negative Staphylococcus (Staphylococcus hominis). Radiographic evaluation, including x-ray and magnetic resonance imaging, revealed medullary expansion, trabecular thinning, and focal soft tissue swelling. Magnetic resonance imaging displayed extensive soft tissue and bone marrow involvement, raising concerns of a tumor. An open biopsy was performed, yielding unexpected findings of necrotizing and suppurative granulomatous inflammation, strongly suggesting an ongoing infectious process. The subsequent Quantiferon TB Gold Test confirmed tuberculosis infection. Treatment encompassed debridement, synovectomy, and initiation of an antituberculosis regimen. The patient showed significant improvement after treatment. Timely diagnosis and treatment of tuberculous dactylitis are crucial, as highlighted by the patient's positive response to combined surgical and pharmacological intervention, despite initial diagnostic challenges.

Long-term Visual Acuity Outcomes of Deep Sclerectomy in Pediatric Glaucoma.

PRCIS: This study provides evidence of the long-term efficacy and safety of Deep Sclerectomy as a successful surgical intervention option in cases with childhood glaucoma. OBJECTIVES: The primary objective was to evaluate the long-term visual acuity outcomes of Deep Sclerectomy in pediatric glaucoma and identify factors predicting poor prognosis. The secondary objective was to evaluate the long-term success rate of Deep Sclerectomy in controlling intraocular pressure. METHODS: A retrospective review was conducted of all pediatric patients who underwent deep sclerectomy at King Abdulaziz University Hospital (KAUH) between 2001 and 2016. We included all patients who had valid visual acuity tests. The preoperative findings and long-term visual and intraocular pressure outcomes were analyzed. RESULTS: A total of 83 eyes of 68 patients were included. The mean (SD) age of participants was 11.1 (4.0) years (range: 5-25 years). The mean age at surgery was 5.9 months, and the mean follow-up period was 10.75 years. The majority of cases (83.1%) were primary congenital glaucoma. Visual acuity was ≥ 20/40 in 56.6% of cases, ranged between 20/40 and 20/200 in 18.1%, and was ≤ 20/200 in 25.3% of the operated eyes. Complete success rate (IOP ≤ 21 mmHg without medications) after one surgery was achieved in 53 eyes (63.86%). Qualified success rate (IOP ≤ 21 mmHg with medications) was achieved in 8 eyes (9.6%), while 22 eyes (26.5%) failed to achieve target IOP of ≤ 21 mmHg or needed additional surgery to achieve it. Nine eyes (10.74%) had post-operative complications. CONCLUSION: Deep sclerectomy is a reasonable option for pediatric glaucoma that can provide good long-term visual outcomes and IOP control with a lower risk of surgical complications.

Hybrid surgical approach excision of gastrointestinal stromal tumor (GIST): A case report of GIST at an unusual location and review of the literature.

Gastrointestinal stromal tumors are the most common malignant subepithelial lesions involving the gastrointestinal tract. Surgical techniques have been the mainstay of treatment, however, in recent times hybrid surgeries are being introduced yielding better clinical outcomes.

Surgical Outcomes of Retinal Detachment in Knobloch Syndrome.

PURPOSE: To describe the rate, characteristics, and outcomes of rhegmatogenous retinal detachment (RD) in patients with Knobloch syndrome. DESIGN: A single-center retrospective cohort study. PARTICIPANTS: Fifty patients with Knobloch syndrome diagnosed clinically, with or without molecular confirmation of recessive pathogenic COL18A1 variants. METHODS: A retrospective chart review of all patients diagnosed with Knobloch syndrome from November 1, 1983 to March 31, 2023. Demographic data, ophthalmic evaluation at baseline and follow-up, interventions, and final anatomic and visual outcomes were collected. MAIN OUTCOME MEASURES: Rate, time of onset, characteristics, and treatment outcomes of RD. RESULTS: Fifty patients with Knobloch syndrome were included. Males constituted 56% of cases. The diagnosis was confirmed with molecular genetic testing in 37 (74%) patients. Twenty-two patients (44%) had documented occipital bony defects or scalp lesions. Forty-eight of 100 eyes (48%) developed RD at a mean (standard deviation [SD]) age of 6.5 (6.1) years. The mean (SD) follow-up was 7.7 (5.6) years (range, 6 months to 24.3 years). Macular hole-related RD comprised 33% of RD cases. The overall single-surgery success rate was 36% and the final anatomic success rate was 70%. Macular hole-related RD carried a slightly worse prognosis with a 58% final anatomic success rate. Vitrectomy with adjunct scleral buckle and silicone oil tamponade provided the highest single-surgery success (62.2%). In eyes with measurable best-corrected visual acuity (BCVA), the mean preoperative BCVA was 1.2 logarithm of the minimum angle of resolution (Snellen equivalent, 20/320). After successful repair, mean visual acuity was 1.3 logarithm of the minimum angle of resolution (Snellen equivalent, 20/500). CONCLUSIONS: Retinal detachment in Knobloch syndrome is frequent and occurs in young children. Macular hole-related RD comprises one third of RD cases and requires careful macular evaluation. Vitrectomy, combined with scleral buckling and silicone oil tamponade, appears to provide the best anatomic outcomes. FINANCIAL DISCLOSURES: The authors have no proprietary or commercial interest in any materials discussed in this article.

Prevalence of spinal deformity development after surgical management of a congenital heart disease among children: a systematic review and meta-analysis.

INTRODUCTION: Open heart surgery is the most common treatment for congenital heart disease. Thoracotomy, sternotomy, or a combination of both are the main approaches used in open heart surgeries. In cardiac surgery, there have been concerns that these surgeries increase the likelihood of spinal deformities. Therefore, this systematic review and meta-analysis provided updated evidence on the prevalence of spinal deformities following congenital heart surgery. METHOD: EMBASE, Medline, ScienceDirect, and Google Scholar were used to search for studies published until 2022. We include randomized clinical trials and observational studies that reported the prevalence of spinal deformities (scoliosis and kyphosis) after congenital heart surgery among participants without these deformities before surgery. Two independent reviewers independently screened literature identified from the databases. Two reviewers independently conducted screening of studies identified during the search, data extraction, and quality assessment of the included studies. RESULTS: In total, 688 studies were screened; 13 retrospective and one prospective cohort studies were included, encompassing 2294 participants. The pooled prevalence of spinal deformities (scoliosis and kyphosis) after open heart surgery performed on skeletally immature patients was 23.1% (95% confidence interval [CI] = 23.1-35.3; I2 = 97.5%). CONCLUSION: This review suggests that the prevalence of spinal deformities was high among patients who underwent sternotomy or thoracotomy.

Capsicum annuum Oleoresin Nanoemulgel - Design Characterization and In vitro Investigation of Anticancer and Antimicrobial Activities.

BACKGROUND: The use of naturally occurring bioactive materials is getting great attention owing to their safety and environmental properties. Oily compounds, known as oleoresins, are expected to provide an important source for the natural products industry aiming to develop novel treatments for skin conditions. In this work, Capsicum annuum oleoresin nanoemulgel formulations have been prepared and investigated for their antibacterial and anticancer properties. METHODOLOGY: Several C. annuum oleoresin nanoemulgel formulations were prepared by incorporating a Carbopol 940 gel in a self-nanoemulsifying nanoemulsion consisting of C. annuum, tween 80, and span 80. The systems were characterized for particle size, polydispersity index (PDI), zeta potential, and rheology. The in vitro antimicrobial and cytotoxic activities of the optimum formulation were evaluated. RESULTS: The selected formulation is composed of 40% tween, 10% span 80, and 40% C. annuum oleoresin. This formulation produced a stable nanoemulsion with a narrow PDI value of 0.179 ± 0.08 and a droplet size of 104.0 ± 2.6 nm. Results of the in vitro antimicrobial studies indicated high potency of the systems against methicillin-resistant Staphylococcus aureus (MRSA) (zone of inhibition of 29 ± 1.9 mm), E. coli (33 ± 0.9 mm), K. pneumonia (30 ± 1.4 mm), and C. albicans (21 ± 1.5 mm), as compared to the reference antibiotic, ampicillin (18 ± 1.4 mm against K. pneumonia), and antifungal agent, fluconazole (12 ± 0.1 mm against C. albicans). Furthermore, cytotoxicity results, expressed as IC50 values, revealed that the oleoresin and its nanoemulgel had the best effects against the HepG2 cell line (IC50 value of 79.43 µg/mL for the nanoemulgel) and MCF7 (IC50 value of 57.54 µg/mL), and the most potent effect was found against 3T3 (IC50 value of 45.7 µg/m- L). On the other side, the system did not substantially exhibit activity against By-61 and Hela. CONCLUSION: C. annuum oleoresin and its nanoemulgel can be considered valuable sources for the discovery of new antibacterial, antifungal, and anticancer compounds in the pharmaceutical industry, especially due to their potent activity against various cancer cell lines as well as bacterial and fungal strains.

Exploring the relation between Interleukin-6 and high-sensitive cardiac troponin T in asymptomatic hemodialysis patient: A cross-sectional study.

BACKGROUND: High-sensitive cardiac troponin T (h-cTnT), which serves as a marker for myocardial damage, has also been linked to adverse outcomes in asymptomatic hemodialysis patients. This study aims to explore the correlation between interleukin-6 (IL-6) and h-cTnT in asymptomatic hemodialysis patients to unravel the relationship between inflammation and cardiovascular risk. METHODS: A cross-sectional study involving 81 patients was conducted from November 2022 to March 2023 at An-Najah National University Hospital in Palestine. We gathered clinical data, including comorbidities, and obtained blood samples for measuring IL-6 and h-cTnT levels. We performed statistical analyses, including correlation tests and linear regression, to assess the associations between these variables. RESULTS: The study revealed a notable increase in both h-cTnT and IL-6 levels, and a significant correlation between the two (rho = 0.463, P<0.001) in asymptomatic hemodialysis patients. Likewise, h-cTnT levels displayed positive correlations with age (rho = 0.519, P<0.001) and negative correlations with albumin (rho = -0.297, p = 0.007) and transferrin saturation (rho = -0.227, P = 0.042). IL-6 levels exhibited correlations with age (rho = 0.422, P<0.001), albumin (rho = -0.389, P<0.001), iron (rho = -0.382, P<0.001), and transferrin saturation (rho = -0.362, P = 0.001). Notably, higher h-cTnT levels were associated with diabetes, hypertension, a history of coronary artery disease, cerebrovascular accidents, older age, and male gender. CONCLUSION: This study underscores the significant association between the inflammatory marker IL-6 and h-cTnT in asymptomatic hemodialysis patients, suggesting that inflammation may play an essential role in the elevation of h-cTnT levels. This association may have implications for predicting cardiovascular events and guiding interventions to reduce cardiovascular disease morbidity and mortality in hemodialysis patients.

Chromatographic analysis of the chemical composition and anticancer activities of Curcuma longa extract cultivated in Palestine.

Curcuma longa (turmeric) is a plant that has been extensively utilized in traditional medicine for centuries. Turmeric has a long history of use in both food and traditional medicine for the treatment of ailments such as diarrhea, cancer, flatulence, and dyspepsia. In Palestine, this plant was cultivated for the first time. The objective of this study was to characterize the extract of C. longa and assess its antimutagenic activity against a variety of cancer cells. Gas chromatography-mass spectrometry (GC-MS) and high-performance liquid chromatography (HPLC) methods were employed to identify the constituents of turmeric. The cytotoxic effects of C. longa were evaluated on cancer and normal cell lines using the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium assay. The results revealed the presence of 10 components in turmeric extract as identified by GC-MS. The major constituents comprising 78% of the total constituents were α-zingiberene (27.51%), tumeron (19.44%), ß-sesquiphellandrene (19.40%), and aromatic-tumeron (11.63%). HPLC analysis successfully separated the main constituent, curcumin (1.78%), along with two other curcumin derivatives. The cytotoxicity results demonstrated potent anticancer activity of the C. longa extract against HeLa and LX2 cell lines, with IC50 values of 46.84 ± 2.12 and 29.77 ± 1 µg/mL, respectively. Furthermore, the plant extract at a concentration of 250 µg/mL exhibited over 95% inhibition against all tested cancer cell lines. These findings highlight the promising potential of turmeric as a natural source with powerful anticancer activities. Moreover, the extract may possess other biological activities such as antioxidant and antimicrobial properties, which could be explored in future studies.

Biological Evaluation of Xanthene and Thioxanthene Derivatives as Antioxidant, Anticancer, and COX Inhibitors.

Xanthene and thioxanthene analogues have been investigated for their potential as anticancer and anti-inflammatory agents. Additionally, cysteine analogues have been found to possess antioxidant, anti-inflammatory, and anticancer activities due to their role in cellular redox balance, scavenging of free radicals, and involvement in nucleophilic reactions and enzyme binding sites. In this study, we synthesized a library of tertiary alcohols derived from xanthene and thioxanthene, and further, some of these compounds were coupled with cysteine. The objective of this research was to explore the potential anticancer, antioxidant, and anti-inflammatory activities of the synthesized compounds. The synthesized compounds were subjected to test for anticancer, antioxidant, and anti-inflammatory activities. Results indicated that compound 3 exhibited excellent inhibition activity (IC50 = 9.6 ± 1.1 nM) against colon cancer cells (Caco-2), while compound 2 showed good inhibition activity (IC50 = 161.3 ± 41 nM) against hepatocellular carcinoma (Hep G2) cells. Compound 4 demonstrated potent antioxidant inhibition activity (IC50 = 15.44 ± 6 nM), and compound 7 exhibited potent anti-inflammatory activity with cyclooxygenase-2 (COX-2) inhibition IC50 (4.37 ± 0.78 nM) and high selectivity for COX-2 (3.83). In conclusion, certain synthesized compounds displayed promising anticancer activity and anti-inflammatory effects. Nevertheless, additional research is necessary to create more analogues, develop a more distinct comprehension of the structure-activity relationship (SAR), and perform in vivo experiments to evaluate the pharmacokinetic and pharmacodynamic characteristics of the compounds under examination. Such research may pave the way for the development of novel therapeutic agents with potential applications in cancer and inflammatory diseases.

Spindle cell lipoma of the tongue: First case report from the Gulf region and review of the literature.

Spindle cell lipoma is a histological variant of oral lipomas. In this report, we present the first case from the Gulf region with the most comprehensive literature review. Clinicians should consider rare tumors in the differential diagnoses of oral masses.

Assessing the Efficacy of Hyperbaric Oxygen Therapy on Facelift Outcomes: A Case-Control Study Comparing Outcomes in Patients With and Without Hyperbaric Oxygen Therapy.

Background: Wound healing remains among the most concerning complications in aesthetic surgery. The use of hyperbaric oxygen therapy (HBOT) is an accepted method of supporting wound healing. Objectives: The aim of this study is to assess the role of HBOT in postoperative healing and complication rates following facelift surgery. Methods: This case-control study comprised facelift patients who received HBOT and those who did not between 2019 and 2022. Data were extracted from the patients' medical records, with the primary outcomes being the presence of complications, wound-healing duration, and patient satisfaction. Results: The authors recruited 20 female patients who underwent facelift for this study, with 9 patients in the HBOT group and 11 patients in the control group. The average number of HBOT sessions received was 7.22, and each session lasted an average of 78 ± 5 min. The duration of wound healing in the HBOT group ranged from 7 to 30 days (mean of 13.3 days), whereas the control group ranged from 6 to 90 days (mean of 36.9 days). This indicates a statistically significant shorter time to wound healing in the HBOT group compared to the control group (P < .001). Conclusions: Future prospective randomized controlled trials with larger sample sizes and blinding are needed to further evaluate the potential benefits of HBOT in the postoperative period. Nonetheless, our findings suggest that HBOT may be a promising adjunctive therapy for patients undergoing facelift surgery.

Assessment of anticancer, antimicrobial, antidiabetic, anti-obesity and antioxidant activity of Ocimum Basilicum seeds essential oil from Palestine.

BACKGROUND: Many modern pharmaceutical researchers continue to focus on the discovery and evaluation of natural compounds for possible therapies for obesity, diabetes, infections, cancer, and oxidative stress. Extraction of Ocimum basilicum seed essential oil and evaluation of its antioxidant, anti-obesity, antidiabetic, antibacterial, and cytotoxic activities were the goals of the current study. METHOD: O. basilicum seed essential oil was extracted and evaluated for its anticancer, antimicrobial, antioxidant, anti-obesity, and anti-diabetic properties utilizing standard biomedical assays. RESULTS: O. basilicum seed essential oil showed good anticancer activity against Hep3B (IC50 56.23 ± 1.32 µg/ml) and MCF-7 (80.35 ± 1.17 µg/ml) when compared with the positive control, Doxorubicin. In addition, the essential oil showed potent antibacterial (against Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Proteus mirabilis, and Pseudomonas aeruginosa) and antifungal (against Candida albicans) activities. Moreover, as for the anti-amylase test, IC50 was 74.13 ± 1.1 µg/ml, a potent effect compared with the IC50 of acarbose, which was 28.10 ± 0.7 µg/ml. On the other hand, for the anti-lipase test, the IC50 was 112.20 ± 0.7 µg/ml a moderate effect compared with the IC50 of orlistat, which was 12.30 ± 0.8 µg/ml. Finally, the oil had a potent antioxidant effect with an IC50 of 23.44 ± 0.9 µg/ml compared with trolox (IC50 was 2.7 ± 0.5 µg/ml). CONCLUSION: This study has provided initial data that supports the importance of O. basilcum essential oil in traditional medicine. The extracted oil not only exhibited significant anticancer, antimicrobial, and antioxidant properties but also antidiabetic and anti-obesity effects, which provided a foundation for future research.

Li-Fraumeni syndrome in the setting of re-occurring malignancies after 27 years of remission: a case report.

Multiple primary tumors are defined as multiple simultaneous (within 6 months) or heterogeneous tumors. Case presentation: Here, the authors present the case of a 58-year-old Saudi female patient with Li-Fraumeni syndrome who has multiple primary tumors. Clinical discussion: The surgical cytoreduction or 'debulking' technique is the main treatment option started in individuals with High Grade Serous Ovarian CanceR. This surgical strategy aims to completely remove all disseminated tumor masses that are present in the patient's peritoneal cavity on a macroscopic level. Conclusion: In conclusion, in our case, she has developed her ovarian cancer 27 years after her breast cancer got treated. This was already stage IIIB to stage IV. If it was not for her incidental discovery of her urinary bladder cancer, which is most likely is a long-term sequel of using cyclophosphamide 27 years ago.Multiple primary tumors are defined as multiple simultaneous (within 6 months) or heterogeneous tumors. Here, the authors present the case of a 58-year-old Saudi female patient with Li-Fraumeni syndrome who has multiple primary tumors. In conclusion, in our case, she has developed her ovarian cancer 27 years after her breast cancer got treated. This was already stage IIIB to stage IV. If it was not for her incidental discovery of her urinary bladder cancer, which is most likely is a long-term sequel of using cyclophosphamide 27 years ago.

Polypharmacy among patients with hypertension attending primary healthcare centres.

Saudi Arabia has several hypertensive patients who require close attention and specialised care for their medications. Polypharmacy is one of the reasons for the failure of patient compliance with antihypertensive medications. Therefore, this study aims to gain a better perspective on polypharmacy in hypertensive patients attending primary healthcare (PHC) centres in Makkah, Saudi Arabia. Methods: This was an observational, cross-sectional, descriptive study of hypertensive patients followed up at 10 PHC centres in Makkah, Saudi Arabia, from 1 July 2019 to 30 June 2022. Frequencies and percentages were used to present categorical data, and Pearson's χ 2 test was used to measure differences. A P value less than 0.05 was considered statistically significant. Results: A total of 506 patients were included in this study. The mean age of the patients was 60 years, and more than half (69%) were females. Regarding antihypertensive medication use, 64% were on antihypertensive combination therapy, 76% on dual therapy, 21% on triple therapy, and 3% on quadruple therapy. Moreover, 21% of the hypertensive patients were exposed to polypharmacy. There was a significant relationship (P<0.001) between the overall number of chronic medications used per day and the duration of hypertension. Conclusion: More clinical research is needed to identify the impact of polypharmacy on the quality of healthcare in PHC centres in general and hypertensive patients specifically in different regions of Saudi Arabia.

Fractured Lateral Humeral Condyle Accompanied by Acute Radial Nerve Palsy in a Child: First Reported Case in the United Arab Emirates.

Despite being very common, lateral condyle fractures in children are rarely associated with acute nerve injuries. We present the case of a 10-year-old, left-handed male child who presented with a left lateral humeral condyle fracture associated with radial nerve injury. The patient was managed by open reduction and internal fixation plus radial nerve exploration, which was found entrapped in the fracture site. The patient achieved full recovery after 16 weeks. We report this case to present the approach and the operative findings and to emphasize the importance of a preoperative clinical examination in addition to preoperative planning to achieve a favorable outcome.

An atypical concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma: First case reported in Saudi Arabia.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most frequent endocrine cancer and most common thyroid cancer. The concurrent occurrence of both tumors however is a very rare occasional finding. Surgical treatment via excision is the only definitive. Our study aims to highlight a rare occurrence of concurrent parathyroid adenoma and micropapillary thyroid carcinoma. CASE PRESENTATION: We describe a 36-year-old female who presented to the outpatient clinic with a left thyroid nodule. Both a Tc-99m-MIBI parathyroid scan and Tc-99m thyroid scan were performed. A left total thyroidectomy was performed then subsequently the parathyroid adenoma was localized. Intra-operative parathyroid hormone decreased by >50 % from 531.5 pg/ml iPTH Stat to 39.8 pg/ml iPTH Stat which is diagnostic for proper localization. Two specimens were sent for histopathological evaluation. Histopathological evaluation of the first specimen confirmed the diagnosis of parathyroid adenoma. Histopathological evaluation of the second specimen revealed that the presence of papillary microcarcinoma of a size of 0.8 cm and pathologic staging to be pT1a, pNx, pMx. CONCLUSION: To our knowledge, this is the first case of concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma reported in the Kingdom of Saudi Arabia. Intraoperatively, management was done by via excision and confirmation of the parathyroid localization was done via intraoperative parathyroid hormone level measurement. We recommend more extensive studies to identify any possible patterns or predictors of finding these two concurrent tumors.

Zinc Oxide Nanoparticles Promise Anticancer and Antibacterial Activity in Ovarian Cancer.

BACKGROUND: Ovarian cancer is the most lethal cancer in gynaecology. Surgery, chemotherapy, and radiotherapy are the most often used cancer-fighting strategies. Post-surgery infection is fairly prevalent, especially among people with insufficient immunity. Zinc oxide nanoparticles (ZnOnps) have amazing biomedical features as anticancer and antibacterial agents. METHODS: We investigated the behaviour of ZnOnps synthesized by green methods on ovarian cancers using established human ovarian cancer cell lines, besides the antibacterial action toward models of gram + ve and gram -ve bacteria. The cytotoxic effect of ZnOnps was calculated using a Sulforhodamine B (SRB) trial. Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) were tested as models for gram + ve and gram -ve bacteria. The selected bacteria were subjected to concentrations of 20, 40, 80, and 100 µg/ml. RESULTS: The synthesized ZnOnps induced 50% inhibitory concentration (IC50) at a concentration of 27.45 µg/ml. The diameter of inhibition ranged between 20.16 ± 0.16 and 27 ± 0.57 mm for S. aureus and 25.66 ± 0.33 to 31 ± 0.33 mm for E. coli. ZnOnps antagonistic effect statistically differed with neomycin, cefaclor, and cefadroxil. CONCLUSIONS: Green synthesis of ZnOnps is easily prepared, low cost, non-toxic, and eco-friendly. Their cytotoxic action on SKOV3 cells and their antibacterial characteristics pave the way to be an alternative therapy for ovarian cancer and S. aureus and E. coli infection.