Prevalence of Obstructive Sleep Apnea Among Atrial Fibrillation Patients: A Cross-Sectional Study from Jordan.

Background: Obstructive Sleep Apnea (OSA) is a common respiratory disorder that causes intermittent upper airway collapse during sleep and can lead to various acute cardiovascular complications. Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of cardiovascular hospitalization and all-cause mortality. Our study aimed to investigate the prevalence of individuals with AF and those considered at high risk for OSA. Methods: A cross-sectional study was conducted with a population comprising patients who had visited KAUH cardiology clinics between 2017-2019; subjects were categorized into AF patients and general cardiology patients. Patients were surveyed for OSA using the Berlin Questionnaire to assess the degree of OSA symptoms and to classify patients into high- or low-risk groups based on their responses. Results: Of the 656 patients, 545 met our inclusion criteria, of whom 192 were diagnosed with AF. Comparable demographic characteristics were observed between the AF and non-AF groups, barring higher rates of obesity (p=0.001) and smoking (p=0.042) in the AF group. The prevalence of high-risk OSA was significantly higher in AF patients (68.2%) compared to non-AF patients (29.4%), with an adjusted odds ratio of 2.473 times (95% CI: 1.434 -4.266, p=0.001) greater for AF. The age, gender, and BMI categories did not differ significantly between the two groups. Binary logistic regression revealed significant associations between OSA and risk factors such as asthma (OR=4.408, 95% CI: 2.634-7.376, p=0.001). Conclusion: These results serve to display a statistically significant increase in high-risk OSA in existing AF patients, irrespective of the presence of conventional OSA risk factors; this could imply a more immediate and direct relationship between both diseases and calls to include routine screening for OSA in patients diagnosed, newly or otherwise, with AF.

Histopathological Tracing of HPV Genotypes 6 and 11 in Pediatric Patients in Medical City with Chronic Palatine and Pharyngeal Tonsillitis.

BACKGROUND: HPVs are considered to have high-oncogenic risk. These genotypes have been proven to have a causal link to cancers, in pediatric and youth patients, with high rates of HPV presence in the tonsillar tissues. OBJECTIVE: A prospective case-control research for determining HPV 6/11 genotypes in tonsillar specimens of children who underwent operations in the otolaryngology departments of the Medical City Complex, Baghdad, Iraq, for their non-oncologic palatine and pharyngeal tonsillar hypertrophies. METHODS: This study enrolled 102 tonsillar tissues, 82 from pediatric patients aged from 4 to 12 years and who underwent tonsillectomies for non-oncologic palatine and pharyngeal tonsillar hypertrophies; 38 specimens were from single operations while 22 were multiple specimens from the same pediatric patients, represented as a total of 44 tissues). In addition, trimmed nasal tissues from 20 patients, with unremarkable pathological changes, were included as the control group. For HPV 6/11 DNA detection, specific DNA probes were used for the chromogenic in situ hybridization (CISH) technique. RESULTS: In the palatine tonsillar hypertrophied tissue group, 26.2% of the tissues revealed positive CISH signals for HPV 6/11 DNA. Regarding the pharyngeal tonsillar hypertrophied tissues, 22.5% of the specimens expressed positive CISH reactions. Among the 22 pediatric patients who had combined pharyngeal and palatine tonsillectomies, in 22.7% both sites expressed positive signals. No positive-CISH reactions were documented in the control nasal tissues. Statistically a significant difference was seen when compared to the control group. CONCLUSIONS: Significant rates of HPV were observed which pointed to the spread of HPV, among other STIs, and in mothers of at least this studied pediatric group. Also, this represented a critical mark as reservoir tissue sites, allowing transmission to other mucosal tissue localizations, playing part in their pathogenesis.

Tretinoin (2,4-difluoro-phenyl) triazole activates proapoptotic protein expression and targets NRP2 protein to inhibit esophageal carcinoma cell growth.

The present study investigated the effect of tretinoin (2,4-difluoro-phenyl) triazole (TDFPT) on the growth and proliferation of Kyse-270 and EC9706 esophageal carcinoma cells and explored the underlying mechanism. The results demonstrated that TDFPT treatment of Kyse-270 and EC9706 cells led to a dose-dependent reduction in cell proliferation. Colony formation was significantly (p < .05) reduced in Kyse-270 and EC9706 cells on treatment with various concentrations of TDFPT. In TDFPT-treated Kyse-270 and EC9706 cells, the expression of Bcl-2 protein showed a remarkable decrease, whereas the level of Bax protein was found to be higher compared with the control cells. Cell invasion showed a prominent decrease in Kyse-270 and EC9706 cells on treatment with TDFPT. Treatment with TDFPT led to a prominent suppression in the expression of MMP-9 and NRP2 in Kyse-270 and EC9706 cells. In silico studies using the AutoDock Vina and discovery studio software revealed that various confirmations of TDFPT bind to NRP2 protein with the affinity ranging from -8.6 to -6.1 kcal/mol. It was found that the TDFPT interacts with NRP2 protein by binding to alanine (ALA A:295), proline (PRO A:306), glutamine (GLN A:307), and isoleucine (ILE A:293) amino acid residues. In summary, TDFPT exposure suppresses esophageal carcinoma cell proliferation, inhibits colony formation ability, and activates apoptotic pathway. Thus, TDFPT acts as an effective antiproliferative agent for esophageal carcinoma cells and needs to be investigated further as chemotherapeutic molecule.

Cross-Sectional Assessment of Dermatologists' Knowledge and Attitude Towards Isotretinoin-Related Ocular Side Effects in Aseer, Saudi Arabia.

BACKGROUND: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, which includes the hair follicle, hair shaft and sebaceous gland. The only treatment that has an effect on all the main aetiological causes of acne is isotretinoin. However, it may have a variety of negative side effects. The aim of this study was to evaluate the knowledge and attitudes of dermatologists regarding ocular effects following isotretinoin prescribing in the Aseer region, Saudi Arabia. METHODOLOGY: An anonymous online cross-sectional survey was conducted in August 2022 to investigate dermatologists' knowledge and attitude regarding isotretinoin-related ocular side effects in Aseer, Saudi Arabia. Participants were recruited using convenience and snowball sampling methods. RESULTS: A total of 48 dermatologists were included in this survey. The age distribution ranged from 25 to over 60 years. Sixteen (37.5%) were aged 31-40 years, 29 (60.4%) were male and 20 (41.7%) were specialists. All dermatologists reported that it can cause dry eye, 32 (66.7%) reported that it can cause contact lens intolerance, 10 (20.8%) reported that it can cause a decrease in dark adaptation and two (4.2%) thought that it can cause ectopia lentis and retinoblastoma. Regarding attitude, 43 (87.5%) thought that a course of isotretinoin is not recommended if the patient has recently undergone refractive surgery, 30 (62.5%) always inform patients about ocular side effects, 31 (72.9%) do not consider referring patients for ophthalmic examinations before initiating isotretinoin, 12 (25.0%) always prescribe lubricant eye drops, 15 (31.3%) always ask patients about recent refractive surgery, 17 (35.4%) always warn patients about avoiding refractive surgery during isotretinoin use and 19 (39.6%) always inform patients concerning discomfort with contact lenses. CONCLUSIONS: The survey reveals that dermatologists in Aseer, Saudi Arabia, generally have good knowledge of isotretinoin related to some ocular side effects, especially dry eye and contact lens intolerance. However, there is some variation in their practices with regard to patient education, referrals for ophthalmic examinations, the use of lubricant eye drops and refractive surgery during isotretinoin treatment. Thus, dermatologists should receive educational training on the safety profile of isotretinoin while managing acne vulgaris.

Alpinetin: anti-human gastric cancer potential and urease inhibition activity in vitro.

Introduction: Alpinetin is the bioactive component of a traditional Chinese medicine. This compound, one of the main constituents of the seeds of Alpinia katsumadai Hayata, is a member of the flavonoids, with anti-inflammatory, antibacterial, and other significant therapeutic activities of important potency and low systemic toxicity. Material and methods: In our study, the inhibitory effect of isoliquiritigenin on HMG-CoA reductase showed a lower value of IC50 = 21.86 ±1.44 µg/ml. A molecular docking study was performed as a complementary study to provide additional data about the biological activities of alpinetin in the presence of urease. The docking calculations revealed that alpinetin with a docking score of -5.097 (kcal/mol) has an acceptable binding affinity to the enzyme, and because of various hydrophobic contacts and hydrogen bonds created by this chemical compound, alpinetin could be considered as an adequate inhibitor of urease. Results: In the cellular and molecular part of the study, the cells treated with alpinetin were assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay for 48 h as regards the cytotoxicity and anti-human gastric carcinoma properties towards normal (human umbilical vein endothelial cells (HUVECs)) and gastric carcinoma cell lines, i.e. SNU-1, Hs 746T, and KATO III. The IC50 values of alpinetin were 426, 586, and 424 µg/ml against SNU-1, Hs 746T, and KATO III cell lines, respectively. The viability of the malignant gastric cell line decreased dose-dependently in the presence of alpinetin. Conclusions: It seems that the anti-human gastric carcinoma effect of the investigated molecule is due to its antioxidant effects.

Analysis of anti-apoptotic PVT1 oncogene and apoptosis-related proteins (p53, Bcl2, PD-1, and PD-L1) expression in thyroid carcinoma.

BACKGROUND: An aberrant expression of long non-coding RNA PVT1 has been associated with apoptosis in various cancer types. We aimed to explore the PVT1 and four apoptosis-related proteins (p53, Bcl2, and PD-1/PD-L1) signature in thyroid cancer (TC). METHODS: The PVT1 expression level was measured in 64 FFPE TC paired samples by real-time quantitative PCR. Overall and stratified analyses by different clinicopathological features were done. The apoptotic proteins were evaluated by immunohistochemistry staining. RESULTS: Overall analysis showed significant PVT1upregulation in TC tissues (p < 0.001). Similarly, subgroup analysis by BRAFV600E mutation showed consistent results. Lower expression of p53 was associated with mortality (p = 0.001). Bcl2 overexpression was associated with greater tumor size (p = 0.005). At the same time, HCV-positive cases were associated with repressed Bcl2 expression levels (54.3% in HCV-negative vs. 6.9% in HCV-positive cases, p = 0.011). PD-1 expression was associated with lymph node metastasis (p = 0.004). Enhanced PD-L1 expression in the tumor was associated with a higher tumor stage, lymphovascular invasion, and mortality risk. Kaplan-Meier curves for overall survival showed that low p53 and high PD-L1 expressions were associated with lower survival time. The p53-positive staining is associated with a 90% decreased mortality risk (HR = 0.10, 95%CI = 0.02-0.47, p = 0.001), while patients with high PD-L1 were five times more likely to die (HR = 4.74, 95%CI = 1.2-18.7, p = 0.027). CONCLUSION: Our results confirm the upregulation of PVT1 in TC. The apoptosis-related proteins (p53, Bcl2, and PD-1/PD-L1) showed different prognostic utility in TC patients; in particular, low p53 and high PD-L1 expressions associated with low survival times. Further large-scale and mechanistic studies are warranted.

Grafting of Thiazole Derivative on Chitosan Magnetite Nanoparticles for Cadmium Removal-Application for Groundwater Treatment.

The synthesis and developments of magnetic chitosan nanoparticles for high efficiency removal of the cadmium ions from aquatic medium are one of the most challenging techniques. Highly adsorptive composite (MCH-ATA) was produced by the reaction of chitosan with formaldehyde and amino thiazole derivative. The sorbent was characterized by FTIR, elemental analyses (EA), SEM-EDX, TEM analysis, TGA and titration (volumetric). The modified material includes high nitrogen and sulfur contents (i.e., 4.64 and 1.35 mmol g-1, respectively), compared to the pristine material (3.5 and 0 mmol g-1, respectively). The sorption was investigated for the removal of Cd(II) ions from synthetic (prepared) solution before being tested towards naturally contaminated groundwater in an industrial area. The functionalized sorbent shows a high loading capacity (1.78 mmol Cd g-1; 200 mg Cd g-1) compared to the pristine material (0.61 mmol Cd g-1; 68.57 mg Cd g-1), while removal of about 98% of Cd with capacity (6.4 mg Cd g-1) from polymetallic contaminated groundwater. The sorbent displays fast sorption kinetics compared to the non-modified composite (MCH); 30 min is sufficient for complete sorption for MCH-ATA, while 60-90 min for the MCH. PFORE fits sorption kinetics for both sorbents, whereas the Langmuir equation fits for MCH and Langmuir and Sips for MCH-ATA for sorption isotherms. The TEM analysis confirms the nano scale size, which limits the diffusion to intraparticle sorption properties. The 0.2 M HCl solution is a successful desorbing agent for the metal ions. The sorbent was applied for the removal of cadmium ions from the contaminated underground water and appears to be a promising process for metal decontamination and water treatment.

Anti-human Glioma Cancer Potentials of Neobavaisoflavone as Natural Antioxidant Compound and Its Inhibition Profiles for Acetylcholinesterase and Butyrylcholinesterase Enzymes with Molecular Modeling and Spin Density Distributions Studies.

In this study, the carcinogenic potential of Neobavaisoflavone as a natural antioxidant compound and the inhibitory profiles of acetylcholinesterase and butyrylcholinesterase were investigated by molecular modeling and spin density distribution studies. To evaluate the antioxidant properties of neobavaisoflavone, DPPH test was performed in the presence of butyl hydroxytoluene as a control. Neobavaisoflavone cell viability was low compared to normal human glioma cancer cell lines, namely LN-229, U-87 and A-172 cell lines, without any effect of cytotoxicity on normal cell line. Neobavaisoflavone inhibited half of DPPH at 125 µg/mL. The best effects of Neobavaisoflavone antihypertensive glioma against the above cell lines were in the LN-229 cell line. In addition, the significant anti-cancer potential of human glioma Neobavaisoflavone against the popular human glioma cancer cell lines is related in this study. IC50 values were calculated by Neobavaisoflavone diagrams, 63.87 nM for AChE and 112.98 nM for BuChE, % Activity- [Inhibitor]. According to the above results, Neobavaisoflavone can be used to treat a variety of human glioma cancers in humans. In addition, molecular modeling calculations were performed to compare the biochemical activities of the Neobavaisoflavone molecule with enzymes. After molecular insertion calculations, ADME/T analysis was performed to investigate the properties of the neobavaisoflavone molecule, which will be used as a drug in the future. Then, different parameters for the antioxidant activity of the neobavaisoflavone molecule were calculated.

A Pre-clinical Trial Study: Anti-human Colon Cancer Effect of Thalassiolin B in vitro with Enzymes Inhibition Effects and Molecular Docking Studies.

In this study, it is recorded the inhibition effect of Thalassiolin B on aldose reductase, alpha-glucosidase and alpha-amylase enzymes. In the next step, the molecular docking method was used to compare the biological activities of the Thalassiolin B molecule against enzymes formed from the assembly of proteins. In these calculations, the enzymes used are Aldose reductase, Alpha-Amylase, and Alpha-Glucosidase, respectively. After the docking method, ADME/T analysis of Thalassiolin B molecule was performed to be used as a drug in the pharmaceutical industry. In the MTT assay, the anti-human colon cancer properties of Thalassiolin B against EB, LS1034, and SW480 cell lines were investigated. The cell viability of Thalassiolin B was very low against human colon cancer cell lines without any cytotoxicity on the human normal (HUVEC) cell line. The IC50 of the Thalassiolin B against EB, LS1034, and SW480 were 483, 252, and 236 µg/mL, respectively. Thereby, the best cytotoxicity results and anti-human colon cancer potentials of our Thalassiolin B were observed in the case of the SW480 cell line. Maybe the anti-human colon cancer properties of Thalassiolin B are related to their antioxidant effects.

Transdermal fentanyl to parenteral morphine route switch and drug rotation in refractory cancer cachexia.

It is recommended not to use transdermal fentanyl (Fe) patches (TFP) in cancer cachexia but TFP may be the only available option for pain. Limited evidence suggests lower Fe absorption from TFP in cachexia. We describe a case of metastatic breast cancer with refractory cachexia. Her pain was uncontrolled on TFP and was route switched and drug rotated to intravenous morphine (M). We were conservative and did not use the 1:100 TFP to oral M conversion ratio. Assuming opioid needs were similar before and after switch/rotation, the suitable conversion ratio in this case was about 1:25. Absent clear guidelines on converting from TFP in cachexia, it is better to avoid TFP. When essential to use TFP in cachexia, caution should be taken when switching from TFP to avoid overdose.

Awareness, knowledge, and practice regarding to diabetic retinopathy among KKU students besides medical students in Abha, Saudi Arabia.

BACKGROUND: Diabetes mellitus (DM) is a global public health problem. Global prevalence of diabetes is 8.5% in adult population. The prevalence of diabetic retinopathy (DR) is increasing day by day, the number of persons with diabetes will double by 2030. It is a serious cause of irreversible blindness and is the most common complication of diabetes. Annual fundus examination for diabetics aids in the prevention of blindness and allows intervening at a timely manner. This study's intent to estimate and improve level of awareness (A), knowledge (K), and practice (P) among all King Khalid University (KKU) students besides medical students in Abha, Saudi Arabia. METHODS AND MATERIALS: This is a cross-sectional survey that targets all KKU students besides medical students in Abha, Saudi Arabia. The researchers will use closed-end questions for awareness (A), knowledge (K), and practice (P). The data and the questionnaires will be sent to the sample by social media. The data will be analyzed by statistical package for the social sciences program (SPSS). RESULTS: A total of 635 KKU students completed the questionnaire. Female students were more than male students, 334 (52.6%) for females and 301 (47.4%) for males, respectively. Ages ranged from 18 to 24 years with a mean 23 ± 2 years. There was a good awareness for some of the factors related to the DR which is noted in the results. Awareness of smoking and pregnancy rate is extremely low compared to the rest of the factors related to the DR. CONCLUSION: There was high awareness regarding DR and its risk factors among KKU students but low awareness regarding smoking and pregnancy relationship with DR. Improvement is required for smoking and pregnancy with the progression DR.

Caregiver burden among family caregivers of incurable cancer patients in two eastern Mediterranean countries.

BACKGROUND: Although family caregivers (FCs) play an important role in the care provided to incurable cancer patients in our region, little is known about the burden they experience. This study was conducted to determine the prevalence of caregiver burden (CB) among FCs of incurable cancer patients in two Eastern Mediterranean countries and to identify factors that may be associated with significant CB. METHODS: The study included 218 FCs, 165 from Egypt and 53 from Saudi Arabia. The 22-item Zarit Burden Interview (ZBI-22) was used to assess caregiver burden CB. Significant CB was defined as a ZBI-22 score ≥ 21. The assistance with basic ADLs was classified into 3 levels according to FCs' assistance with early/middle/late-loss basic ADLs. The relationship between CB and the assistance with ADLs and other factors was studied. RESULTS: The mean (SD) ZBI-22 score among FCs was 23.4 (9.3) and the majority (128/218, 59%) had significant CB. Eighty-nine percent of FCs assisted with at least one basic ADL. Assistance with late-loss basic ADLs, best supportive care treatment plan and poorer performance status were associated with higher CB (p < 0.0001, =0.018 and = 0.005). However, in logistic regression analysis, only assistance with late-loss ADLs was independently associated with significant CB (OR = 3.4 [95%CI:1.2-9.7], p = 0.024). CONCLUSION: A substantial proportion of FCs of incurable cancer patients in our region experience significant CB. Family caregivers assisting with late-loss basic ADLs are at risk of significant CB and should be routinely screened for CB.

Anti-Viral and Immunomodulatory Properties of Propolis: Chemical Diversity, Pharmacological Properties, Preclinical and Clinical Applications, and In Silico Potential against SARS-CoV-2.

Propolis, a resin produced by honeybees, has long been used as a dietary supplement and folk remedy, and more recent preclinical investigations have demonstrated a large spectrum of potential therapeutic bioactivities, including antioxidant, antibacterial, anti-inflammatory, neuroprotective, immunomodulatory, anticancer, and antiviral properties. As an antiviral agent, propolis and various constituents have shown promising preclinical efficacy against adenoviruses, influenza viruses, respiratory tract viruses, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), human immunodeficiency virus (HIV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Over 300 chemical components have been identified in propolis, including terpenes, flavonoids, and phenolic acids, with the specific constituent profile varying widely according to geographic origin and regional flora. Propolis and its constituents have demonstrated potential efficacy against SARS-CoV-2 by modulating multiple pathogenic and antiviral pathways. Molecular docking studies have demonstrated high binding affinities of propolis derivatives to multiple SARS-CoV-2 proteins, including 3C-like protease (3CLpro), papain-like protease (PLpro), RNA-dependent RNA polymerase (RdRp), the receptor-binding domain (RBD) of the spike protein (S-protein), and helicase (NSP13), as well as to the viral target angiotensin-converting enzyme 2 (ACE2). Among these compounds, retusapurpurin A has shown high affinity to 3CLpro (ΔG = -9.4 kcal/mol), RdRp (-7.5), RBD (-7.2), NSP13 (-9.4), and ACE2 (-10.4) and potent inhibition of viral entry by forming hydrogen bonds with amino acid residues within viral and human target proteins. In addition, propolis-derived baccharin demonstrated even higher binding affinity towards PLpro (-8.2 kcal/mol). Measures of drug-likeness parameters, including metabolism, distribution, absorption, excretion, and toxicity (ADMET) characteristics, also support the potential of propolis as an effective agent to combat COVID-19.

Wasp Venom Biochemical Components and Their Potential in Biological Applications and Nanotechnological Interventions.

Wasps, members of the order Hymenoptera, are distributed in different parts of the world, including Brazil, Thailand, Japan, Korea, and Argentina. The lifestyles of the wasps are solitary and social. Social wasps use venom as a defensive measure to protect their colonies, whereas solitary wasps use their venom to capture prey. Chemically, wasp venom possesses a wide variety of enzymes, proteins, peptides, volatile compounds, and bioactive constituents, which include phospholipase A2, antigen 5, mastoparan, and decoralin. The bioactive constituents have anticancer, antimicrobial, and anti-inflammatory effects. However, the limited quantities of wasp venom and the scarcity of advanced strategies for the synthesis of wasp venom's bioactive compounds remain a challenge facing the effective usage of wasp venom. Solid-phase peptide synthesis is currently used to prepare wasp venom peptides and their analogs such as mastoparan, anoplin, decoralin, polybia-CP, and polydim-I. The goal of the current review is to highlight the medicinal value of the wasp venom compounds, as well as limitations and possibilities. Wasp venom could be a potential and novel natural source to develop innovative pharmaceuticals and new agents for drug discovery.

Variability of ophthalmology residents' perception toward different major training programs in Saudi Arabia.

PURPOSE: The constant demand for ophthalmologists has nationally resulted in creating more programs in different regions of the kingdom. We have previously reported the overall residents' satisfaction with the current local ophthalmology curriculum and the competency of the ophthalmic training (clinical and surgical) in our local programs in Saudi Arabia compared to international standards. In this study, we aim at comparing the major local training programs and analyze the differences among them aiming at improving our training. METHODS: This is a cross-sectional study using a questionnaire that was completed by residents and graduates of the local ophthalmology programs in Riyadh, Eastern and Western regions. A closed-ended questionnaire was validated and circulated online and a hard copy was distributed to residents and recently graduated ophthalmologists (2009-2015). Data were categorized by demographic variables, and basic statistics were done. The study has been approved by the Institutional Review Board (IRB) and Human Ethics Committee (HEC) of King Saud University. RESULTS: Of the 200 individuals surveyed, 175 (87.5%) completed their responses. The average age was 29.6 years (range: 24-39) with 67.5% males and 32.5% females. The overall satisfaction among senior residents and graduates showed a statistically significant higher result among graduates in Riyadh area (P=<0.001). Satisfaction of senior residents with the program director's support was higher in the Eastern region (P=<0.001). Clinic-based training was generally satisfactory. Refractive surgery was reported to be significantly insufficient in 70.6% (P=0.003). Most of the graduates in Riyadh area achieved the surgical requirements for training compared to other regions. CONCLUSION: Saudi postgraduate ophthalmology training programs show a variable level of satisfaction among senior residents and graduates. Better surgical exposure has been observed in Riyadh region, however reassessment of the current curriculum and the parameters for training are needed to fulfill the requirements with special attention to the surgical training in all programs.

Synthesis of N,N'-bis(1,5-dimethyl-2-phenyl-1,2-dihydro-3-oxopyrazol-4-yl) sebacamide that ameliorate osteoarthritis symptoms and improve bone marrow matrix structure and cartilage alterations induced by monoiodoacetate in the rat model: "Suggested potent anti-inflammatory agent against COVID-19".

To assess the chondroprotective effect and influence of N,N'-bis(1,5-dimethyl-2-phenyl-1,2-dihydro-3-oxopyrazol-4-yl) sebacamide (dpdo) that was synthesized through the reaction of phenazone with sebacoyl chloride and screened for its biological activity especially as anti-arthritic and anti-inflammatory agent in a monoiodoacetate (MA)-induced experimental osteoarthritis (OA) model. Thirty male albino rats weighing "190-200 g" were divided randomly into three groups (10 each): control, MA-induced OA, and MA-induced OA + dpdo. In MA-induced OA rat, the tumor necrosis factor alpha, interleukin 6, C-reactive protein, rheumatoid factors, reactive oxygen species, as well as all the mitochondrial markers such as mitochondria membrane potential, swelling mitochondria, cytochrome c oxidase (complex IV), and serum oxidative/antioxidant status (malondialdehyde level and activities of myeloperoxidase and xanthine oxidase) are elevated. Also, the activity of succinate dehydrogenase (complex II), levels of ATP, the level of glutathione (GSH), and thiol were markedly diminished in the MA-induced OA group compared to the normal control rats. These findings showed that mitochondrial function is associated with OA pathophysiological alterations and high gene expressions of (IL-6, TNF-a, and IL-1b) and suggests a promising use of dpdo as potential ameliorative agents in the animal model of OA and could act as anti-inflammatory agent in case of severe infection with COVID-19. It is clearly appeared in improving the bone cortex and bone marrow in the treated group with the novel compound in histological and transmission electron microscopic sections which is a very important issue today in fighting severe infections that have significant effects on the blood indices and declining of blood corpuscles like COVID-19, in addition to declining the genotoxicity and inflammation induced by MA in male rats. The novel synthesized compound was highly effective in improving all the above mentioned parameters.

Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-centre retrospective study.

BACKGROUND: Information on the clinical characteristics and outcomes of hospitalized Covid-19 patients with or without diabetes mellitus (DM) is limited in the Arab region. This study aims to fill this gap. METHODS: In this single-center retrospective study, medical records of hospitalized adults with confirmed Covid-19 [RT-PCR positive for SARS-CoV2] at King Saud University Medical City (KSUMC)-King Khaled University Hospital (KKUH), Riyadh, Saudi Arabia from May to July 2020 were analyzed. Clinical, radiological and serological information, as well as outcomes were recorded and analyzed. RESULTS: A total of 439 patients were included (median age 55 years; 68.3% men). The most prevalent comorbidities were vitamin D deficiency (74.7%), DM (68.3%), hypertension (42.6%) and obesity (42.2%). During hospitalization, 77 out of the 439 patients (17.5%) died. DM patients have a significantly higher death rate (20.5% versus 12.3%; p = 0.04) and lower survival time (p = 0.016) than non-DM. Multivariate cox proportional hazards regression model revealed that age [Hazards ratio, HR 3.0 (95% confidence interval, CI 1.7-5.3); p < 0.001], congestive heart failure [adjusted HR 3.5 (CI 1.4-8.3); p = 0.006], smoking [adjusted HR 5.8 (CI 2.0-17.2); p < 0.001], ß-blocker use [adjusted HR 1.7 (CI 1.0-2.9); p = 0.04], bilateral lung infiltrates [adjusted HR 1.9 (CI 1.1-3.3); p = 0.02], creatinine > 90 µmol/l [adjusted HR 2.1 (CI 1.3-3.5); p = 0.004] and 25(OH)D < 12.5 nmol/l [adjusted HR 7.0 (CI 1.7-28.2); p = 0.007] were significant predictors of mortality among hospitalized Covid-19 patients. Random blood glucose ≥ 11.1 mmol/l was significantly associated with intensive care admission [adjusted HR 1.5 (CI 1.0-2.2); p = 0.04], as well as smoking, ß-blocker use, neutrophil > 7.5, creatinine > 90 µmol/l and alanine aminotransferase > 65U/l. CONCLUSION: The prevalence of DM is high among hospitalized Covid-19 patients in Riyadh, Saudi Arabia. While DM patients have a higher mortality rate than their non-DM counterparts, other factors such as old age, congestive heart failure, smoking, ß-blocker use, presence of bilateral lung infiltrates, elevated creatinine and severe vitamin D deficiency, appear to be more significant predictors of fatal outcome. Patients with acute metabolic dysfunctions, including hyperglycemia on admission are more likely to receive intensive care.

[Applicability of the Arabic version of the French quality of life' (QOL) questionnaire (VQ11) in Tunisian patients with chronic obstructive pulmonary disease]. / Évaluation de la version arabe du questionnaire français de qualité de vie « VQ11 ¼ chez des patients tunisiens atteints de bronchopneumopathie chronique obstructive.

BACKGROUND: There is no validated Arabic version of the French questionnaire of quality of life, the VQ11. This study aimed to test the applicability of the Arabic version of the VQ11 in Tunisian patients with chronic obstructive pulmonary disease (COPD). METHODS: It was a prospective and cross-sectional study, spread over seven months, that included 40 stable COPD male patients. The Arabic version of VQ11, translated by a bilingual expert, was used. The functional, psychological, relational and total scores were calculated. Patients were divided into two groups according to the GOLD classification: "A-B" (n=25) and "C-D" (n=15). A significant correlation-coefficient (r) of≥0.51, between the VQ11 total score and the ADO index (age, dyspnoea, obstruction), and higher quality of life scores in GOLD "C-D" when compared to GOLD "A-B" would be in favour of application of the Arabic version of the VQ11. RESULTS: The mean±standard deviation of age, post-bronchodilator FEV1/FVC, ADO index and VQ11 total score were 64±8 years, 0.55±0.08, 4.8±1.7 and 2±10, respectively. A significant "r" (0.56) was identified between the ADO index and the total score. Psychological, relational and total scores of GOLD "A-B" patients were significantly lower than those in GOLD "C-D" patients: 10±4 vs. 12±3, 11±4 vs. 13±3 and 30±11 vs. 36±7, respectively. CONCLUSION: The Arabic version of VQ11 is applicable in Tunisian COPD patients with reliable results.

Ocular bleeding in an undiagnosed hemophiliac neonate causing irreversible loss of vision: A case report with review of the literature.

INTRODUCTION: Suprachoroidal hemorrhage is an unexpected complication after penetrating keratoplasty during childhood. We report the case of delayed suprachoroidal hemorrhage after penetrating keratoplasty in a neonate as the first manifestation of hemophilia. CASE REPORT: A 4-day-old neonate was referred to our hospital because of bilateral corneal opacities present since birth. A diagnosis of bilateral Peter's anomaly type 2 with right eye corneal perforation was made after examination. Appropriate treatment was commenced, and later, right eye therapeutic penetrating keratoplasty combined with lensectomy, and anterior vitrectomy was performed. This was complicated postoperatively with suprachoroidal hemorrhage and retinal detachment. Conservative management was advised due to poor visual prognosis. Three months later, the patient was found to have high intraocular pressure in the left eye and glaucoma surgery was recommended. Proper hematological investigations before glaucoma surgery in the left eye revealed a low level of factor VIII with normal levels of factor IX and von Willebrand's factor antigen. Therefore, a diagnosis of hemophilia type A was established. CONCLUSION: This case serves as a reminder that the occurrence of suprachoroidal hemorrhage, especially in the absence of other predisposing risk factors, should warrant detailed systemic assessment to exclude underlying bleeding disorders.

Assessment of Ophthalmology Residency Programs in Saudi Arabia: A Trainee-Based Survey.

PURPOSE: To assess the satisfaction and competency of Saudi ophthalmology residents and compare their performance against International Council of Ophthalmology (ICO) standards. METHODS: A cross-sectional web-based survey of senior ophthalmology residents (postgraduate years [PGY] 3-4) and recent graduates (from 2010 to 2015) assessed various aspects of training. The questionnaire was sent to the participants and was divided into 3 main domains: demographics, training program evaluation, and preparedness for board exams and clinical practice. RESULTS: Out of the 145 invitees, 120 (82.8%) responded. Fifty percent of respondents reported an overall satisfaction with the program. Adequate clinical exposure was reported in most subspecialties except refraction and low vision rehabilitation with inadequate exposure reported by 55.8% and 95.8%, respectively. Surgical exposure was reported as adequate for phacoemulsification (58.3%) and strabismus surgery (68.3%) only. Eighty-nine percent of respondents reported performing less than 80 cases of phacoemulsification. Of the respondents who had graduated, most (89.7%) passed the final board exam at the first attempt. There were 73.5% of respondents who reported that residency training prepared them well for the board exam. Ongoing clinical and call duties were reported as having a negative impact on exam performance. CONCLUSIONS: Saudi ophthalmology residents demonstrate a high level of clinical competency. However, additional efforts should aim at improving surgical training to increase the level of satisfaction among residents and improve the quality of training to meet international standards.