Sorafenib and Piperine co-loaded PLGA nanoparticles: Development, characterization, and anti-cancer activity against hepatocellular carcinoma cell line.

Hepatocellular carcinoma (HCC) exhibits high mortality rates in the advanced stage (>90 %). Sorafenib (SORA) is a targeted therapy approved for the treatment of advanced HCC; however, the reported response rate to such a therapeutic is suboptimal (<3%). Piperine (PIP) is an alkaloid demonstrated to exert a direct tumoricidal activity in HCC and improve the pharmacokinetic profiles of anticancer drugs including SORA. In this study, we developed a strategy to improve efficacy outcomes in HCC using PIP as an add-on treatment to support the first-line therapy SORA using biodegradable Poly (D, L-Lactide-co-glycolide, PLGA) nanoparticles (NPs). SORA and PIP (both exhibit low aqueous solubility) were co-loaded into PLGA NPs (PNPs) and stabilized with various concentrations of polyvinyl alcohol (PVA). The SORA and PIP-loaded PNPs (SP-PNPs) were characterized using Fourier Transform Infrared (FTIR) Spectroscopy, X-ray Powder Diffraction (XRD), Dynamic Light Scattering (DLS), and Scanning Electron Microscopy (SEM), Release of these drugs from SP-PNPs was investigated in vitro at both physiological and acidic pH, and kinetic models were employed to assess the mechanism of drug release. The in vitro efficacy of SP-PNPs against HCC cells (HepG2) was also evaluated. FTIR and XRD analyses revealed that the drugs encapsulated in PNPs were in an amorphous state, with no observed chemical interactions among the drugs or excipients. Assessment of drug release in vitro at pH 5 and 7.4 showed that SORA and PIP loaded in PNPs with 0.5 % PVA were released in a sustained manner, unlike pure drugs, which exhibited relatively fast release. SP-PNPs with 0.5 % PVA were spherical, had an average size of 224 nm, and had a high encapsulation efficiency (SORA âˆ¼ 82 %, PIP âˆ¼ 79 %), as well as superior cytotoxicity compared to SORA monotherapy in vitro. These results suggest that combining PIP with SORA using PNPs may be an effective strategy for the treatment of HCC and may set the stage for a comprehensive in vivo study to evaluate the efficacy and safety of this novel formulation using a murine HCC model.

A Study on the Self-Reported Physician-Diagnosed Cardiac Complications Post mRNA Vaccination in Saudi Arabia.

Introduction The advent of mRNA-based vaccines has been a pivotal milestone in the global response to the pandemic, prompting widespread vaccination campaigns, including in Saudi Arabia. This study investigates self-reported physician-diagnosed cardiac complications post mRNA vaccination in Saudi Arabia, recognizing the need to monitor these rare events. The research aimed to study the self-reported physician-diagnosed incidence, nature, and associated factors of cardiac complications in this distinctive demographic group of post-mRNA vaccinations. Due to the scarcity of specific vaccine safety data, the study sought to provide data supporting public awareness and recommendations for global public health practices. Emphasizing ethical considerations, the study focuses on local factors, contributing valuable insights into the safety profile of mRNA vaccines, and aiding informed decision-making for public health strategies in Saudi Arabia and globally. Material and methods In a cross-sectional design, the study employs a culturally adapted questionnaire covering demographic details, vaccination history, health conditions, and perceptions. A rigorous development and validation process ensured the reliability of the questionnaire. A sample size of 804 participants was collected through an online survey link distributed via social media through the groups. Statistical analyses explored associations between demographic variables, vaccination behaviors, health diagnoses, and perceptions using IBM SPSS version 23 and Microsoft Excel. Results Significant associations were found among demographic variables, vaccination behaviors, health diagnoses, and perceptions of self-reported physician-diagnosed cardiac complications post mRNA vaccination in Saudi Arabia. Key findings included a high mRNA vaccine uptake with a frequency of 747 (92.79%) and a mere frequency of 218 (27.11%) reporting cardiac complications post vaccination. The study highlighted diverse influences on vaccine decisions, with a frequency of 384 (47.76%) expressing neutral confidence in vaccine safety. The study contributes to the global understanding of mRNA vaccine safety, emphasizing the unique Saudi demographic context. Methodological rigor, ethical considerations, and acknowledgment of limitations enhance credibility. Collaborative efforts and tailored recommendations for public health policies and communication strategies are underscored. Conclusion This study on self-reported physician-diagnosed cardiac complications post mRNA vaccination in Saudi Arabia is a crucial addition to global vaccine safety research. Providing insights shaped by local factors, the study aids in informed decision-making for public health strategies in Saudi Arabia and globally. It addresses the scarcity of specific vaccine safety data, fostering a nuanced understanding of mRNA vaccine-related cardiac complications worldwide.

A Case Report of an Unusual Presentation of a Pedunculated Gastrointestinal Stromal Tumor: Acute Upper Gastrointestinal Bleeding in a 57-Year-Old Female.

Gastrointestinal stromal tumors (GISTs) are rare tumors accounting for 0.1-3% of gastrointestinal (GI) neoplasms.  In the past, GIST was classified as leiomyomas, leiomyosarcomas, and leiomyoblastomas. However, now it is evident that GIST is a separate tumor entity, and it is the most frequent sarcoma of the GI tract. We report a case of a 57-year-old female with a five-day history of black tarry stools, two episodes of vomiting of dark-colored blood, dizziness, abdominal pain, night sweats, and palpitation, provoked by a change of position. After a computerized tomography (CT) of the abdomen and pelvis, a GIST was suspected, which was confirmed with histopathology. Acute upper GI bleeding is a rare presentation of GIST. Clear guidelines should be developed for GIST. An early diagnosis is crucial for a better prognosis.

Shark Fin Electrocardiogram: A Deadly Electrocardiogram Pattern in Takotsubo Cardiomyopathy During 15 Years of Follow-Up.

Takotsubo cardiomyopathy (TTC) or stress-induced cardiomyopathy is characterized by transient left ventricular apical ballooning in the absence of coronary occlusion. Although the underlying mechanism is still unknown, exaggerated sympathetic nervous system and catecholamine cardiotoxicity, followed by metabolic disturbance, and multi-vessel epicardial coronary artery vasospasm, are thought to be responsible for the development of this condition. TTC accounts for 1-2% of patients presenting with the acute coronary syndrome (ACS) with the majority of patients being postmenopausal women. Shark fin electrocardiogram (SFE) or triangular ST-segment elevation is an uncommon electrocardiogram (ECG) finding that is typically associated with an increased risk of ventricular fibrillation and cardiogenic shock, thus, it is considered a poor prognostic factor. We present a case of a 57-year-old postmenopausal female with TTC post-colonic perforation. Upon further investigation, an ECG revealed an SFE or triangular ST-segment elevation on the anterolateral leads, and an elevated serum troponin level was found. On trans-thoracic echocardiogram (TTE), hypokinesis and akinesis of the apex and left ventricular segments were observed with sparing of the basal segments. Eventually, the patient was successfully managed and monitored until regain of normal function.

Knowledge about the Risk of Cardiovascular Disease among Adults with Type 2 Diabetes Visiting the Outpatient Clinics at Tertiary Hospital in Riyadh, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: One of the primary goals of diabetes management is to prevent cardiovascular events. The rate of cardiovascular diseases (CVDs) is significantly high in the diabetic population. Inadequate knowledge of CVDs risk in diabetes may result in the failure of its early prevention, causing increased morbidity and mortality. The objectives of this study were to assess the CVD risk knowledge and determine the predictors of the knowledge among adults with type 2 diabetes. METHODS: A cross-sectional study was conducted to examine the study objectives. Convenience sampling was used to recruit adults with type 2 diabetes mellitus (DM) who visited the King Saud University Medical City (KSUMC) outpatient clinics. Data were collected using the Heart Disease Fact Questionnaire. SPSS software (version 24.0) was used for data analysis. RESULTS: A total of 383 patients were recruited. The level of CVD risk knowledge was high among all participants (19.04 ± 3.47). There were significant differences in knowledge scores between different groups, including age (p = 0.01), marital status (p = 0.01), and type of residence (p = 0.04). Participants who were older than 40 years, married, and lived in traditional houses had higher knowledge scores. CONCLUSION: The study findings indicated a high level of CVD risk knowledge in our study population. The presence of multidisciplinary intensive education programmes targeting type 2 DM patients, such as that conducted at KSUMC, might be responsible for the higher levels of knowledge among our study population. Thus, increasing the efforts towards the education of patients will improve the level of knowledge, including CVD risk knowledge.

Occupational and environmental exposures, the association with chronic sinusitis.

OBJECTIVES: To find the association between environmental and occupational exposures and chronic rhinosinusitis (CRS) development. METHODS: The Preferred Reporting Items Of Systematic Reviews Guidelines were used when a systematic literature review was conducted to find all published cases of CRS by searching PubMed database and Google Scholar. Published articles between 1989 and 2021 that reported chronic and occupational rhinosinusitis were included. However, articles that reported allergic rhinitis or upper airway diseases and non-English articles were excluded from this study. RESULTS: A total of 97 articles were extracted initially, and 15 articles were reviewed after excluding 82 articles that did not match our inclusion criteria. Most studies linked CRS development to smoke exposure (n=9734), followed by living in rural areas as farms (n=5504). Exposure to pesticides (n=4248) contributed to a higher prevalence of CRS. Blue-collar occupations, such as fire fighters, farmers, and fishermen were significantly related to CRS development in a total of 5260 patients. Chronic rhinosinusitis mainly affected more men (n=8912) than women (n=8076). CONCLUSION: We found that smoking was the most aggravating environmental factor. Chronic rhinosinusitis symptoms' severity increased with direct contact with allergens. Thus, the greatest proportion of patients with CRS was those with blue-collar occupations, such as firefighters, farmers, and fishermen.

Quartz Tuning Fork Sensor-Based Dosimetry for Sensitive Detection of Gamma Radiation.

This study generally relates to nuclear sensors and specifically to detecting nuclear and electromagnetic radiation using an ultrasensitive quartz tuning fork (QTF) sensor. We aim to detect low doses of gamma radiation with fast response time using QTF. Three different types of QTFs (uncoated and gold coated) were used in this study in order to investigate their sensitivity to gamma radiations. Our results show that a thick gold coating on QTF can enhance the quality factor and increase the resonance frequency from 32.7 to 32.9 kHz as compared to uncoated QTF. The results also show that increasing the surface area of the gold coating on the QTF can significantly enhance the sensitivity of the QTF to radiation. We investigated the properties of gold-coated and uncoated QTFs before and after irradiation by scanning electron microscopy. We further investigated the optical properties of SiO2 wafers (quartz) by spectroscopic ellipsometry (SE). The SE studies revealed that even a small change in the microstructure of the material caused by gamma radiation would have an impact on mechanical properties of QTF, resulting in a shift in resonance frequency. Overall, the results of the experiments demonstrated the feasibility of using QTF sensors as an easy to use, low-cost, and sensitive radiation detector.

Awareness About Glaucoma Management Among Physicians in Riyadh: A Multicenter Cross-Sectional Study.

Purpose Glaucoma is an irreversible chronic disease that damages the optic nerve. Knowledge and skills related to glaucoma are extremely important for frontline physicians. This study aimed to determine the knowledge and management as well as examination and referral practices related to glaucoma among physicians at primary care centers and secondary hospitals in Riyadh, Saudi Arabia. Method This was a cross-sectional study of 126 physicians, including general practitioners as well as emergency, internal, and family physicians from three hospitals and five medical centers in Riyadh. A validated self-administered questionnaire was used for data collection. It was divided into six categories: sociodemographic data and practice setting; and glaucoma assessment-questions regarding risk factors, knowledge, examination, management, and referral practices. Results Of the 126 participants, 32.8% were family physicians. Surprisingly, the overall knowledge score for glaucoma was suboptimal (34.2%). While half of the doctors were aware of the medications used in glaucoma, 88.7% considered themselves unqualified to manage glaucoma. Although 93.7% agreed that increased ocular pressure requires urgent referral to an ophthalmologist, only 33.3% stated they were comfortable using tonometry. Conclusion The majority of physicians (65.8%) showed a poor level of knowledge regarding glaucoma, which was reflected in their referral practices (66.9%). Therefore, promoting increased glaucoma awareness along with improved examination skills and referral practice among frontline physicians is essential to prevent this avoidable cause of blindness.

Patient Satisfaction Toward a Tele-Retinal Screening Program in Endocrinology Clinics at a Tertiary Hospital in Riyadh, Saudi Arabia.

PURPOSE: Tele-retinal screening programs use a nonmydriatic camera for retinal imaging. These images are reviewed by ophthalmologists, for interpretation and planning of appropriate treatment and follow up. Patient satisfaction is a critical tool to assess the quality of healthcare delivery and to reframe the current screening programs. The aim of this study is to measure satisfaction toward a tele-retinal screening program among diabetics attending endocrinology clinics at a tertiary hospital in Riyadh.  Methods: This is a cross-sectional study that included a total of 163 patients recruited while attending tele-retinal screening at King Abdul-Aziz University Hospital in Riyadh, during the period between May and August 2019. A self-administrated Patient Satisfaction Questionnaire PSQ18 was used which included demographic data, diabetes history, and seven domains of satisfaction that were measured.  Results: Some 54% of the respondents were male. The average age was 44.8 years. Some 49.7% had type 2 diabetes. The mean duration of diabetes was 15.3 years. The overall satisfaction level was 80.4%. The highest satisfaction rate was in the interpersonal manner (mean 4.45) while the lowest was in accessibility to an ophthalmologist when a referral was needed (mean 3.01). Some 60% of the participants were concerned it might take a long time to be referred to an ophthalmologist when it is needed. Some 90.1% found it easier to have diabetic retinopathy (DR) screening during routine diabetes follow up. Some 23.9% did not like the idea of only seeing the ophthalmologist when it is necessary and only 9.8% had some doubts of the doctor's ability to diagnose DR by evaluating retina photos only. No significant association was found between patient's satisfaction and demographic background or diabetes history. CONCLUSION:  Patients were found to be highly satisfied with tele-retinal screening program. Mostly the reason of dissatisfaction was found in accessibility to an ophthalmologist when a referral was needed. Therefore, it is important to reassure patients that timely referral for effective intervention is performed and part of the screening policies.

Obstetrics and Gynaecology as career maze: Perceptions of medical students in Saudi Arabia.

This article was migrated. The article was marked as recommended. Background Over time, there has been a gradual decline in the selection of obstetrics and gynecology (OBGY) as a career choice worldwide, which is of great concern for the medical educators, stakeholders, and policymakers to optimize the demand of this specialty. Objective To explore the perceptions of medical students about the attractive and distracting factors to choose obstetrics and gynecology. Method The focused group discussion was conducted from September 2019 to December 2019 and thematic analysis was done based on grounded theory. Results In the study, a total of 49 students participated out of 75 expected participants, and the response rate was 65%. Few participants who agreed to continue their careers in this field supported their ideas because of female gender acceptance for this specialty in Saudi culture, opportunity to observe procedures, and family pressures. The main reason was the tough experience during OBGY clinical rotations, the clinician's attitude towards training at the hospital workplace, and work stress. Conclusion There is a profound influence on learning experience during the course and clinical training in hospital settings. The positive impact of teaching faculty, successful stories of patients, and teaching techniques supported by simulations can provoke the enthusiasm in the students. A mnemonic "BE SMART" is proposed to apply by medical educators to optimize the need of OBGY specialists in the future. It applies the abilities of true professionals indicated by doctors as beneficent, educators; enforces to augment the use of simulators as teaching modality; practices of meditation, and affectionate the mutual relationships.

Barriers for Adherence to Diabetic Retinopathy Screening among Saudi Adults.

Background Diabetic retinopathy (DR) is one of the major complications of diabetes mellitus (DM) and the leading cause of blindness among adults. However, adherence to diabetic retinopathy screening (DRS) significantly reduces blindness. A substantial proportion of diabetics have suboptimal compliance to DRS, which inversely affects their outcomes. Therefore, the aim of this study is to determine the level of adherence to DRS and to explore the factors possibly associated with poor adherence to regular screening among diabetics in Riyadh, Saudi Arabia. Method A cross-sectional study was conducted that encompassed 404 adult diabetic patients attending outpatient clinics in four hospitals in Riyadh. A validated, self-administered questionnaire was used for data collection that included five main sections: sociodemographic data, diabetic profile, assessment of knowledge about DR, attitude toward DRS, and barriers to DRS. Data were analyzed by SPSS, version 23 (IBM Corp., Armonk, NY); qualitative variables were described as percentages, and quantitative variables were described as means ± standard deviation (SD). We used the chi-square test to measure the associations between qualitative variables and binary logistic regression analysis to predict the independent barriers to DRS. Result The average age of the participants was 54 years, and 69.1% were females. The average duration of diabetes was 12.3 years. Type 2 DM was the most prevalent form of DM (63.6%). DR was reported by 20% of participants. Poor knowledge about DRS was prevalent in 51%. More than one-fifth were never screened for DR. About one-third of participants agreed that cost was an important contributing barrier. Adequate knowledge, increased duration of diabetes, and presence of neurological complications increased independent adherence to screening. Conclusion One-fifth of participants reported having DR. Half the participants had poor knowledge about DR, which formed a major barrier against regular screening. However, most participants had positive attitudes about DR screening. Therefore, intervention strategies to increase patients' awareness of DR might be the cornerstone of ensuring proper adherence to DRS.