Valorization of hydro-distillate of fruit peels of Citrus paradisi macfad. Cultivar. Foster: Chemical profiling, antioxidant evaluation and in vitro and in silico enzyme inhibition studies.

The major commercial crops in Pakistan are citrus fruit trees, which are farmed extensively and serve as the country's principal source of foreign exchange. A local citrus plant, Citrus paradisi, variety Foster is famous for its valuable fruit and fruit juice, however, tons of peels of this fruit are thrown as waste, which otherwise can be utilized in formulating nutraceutical and cosmetics. In the present study, essential oil of fruit peels was obtained through hydro-distillation, which was then analyzed through GC-MS analysis and studied for its antioxidant and enzyme inhibition potential. GCMS analysis revealed the presence of several components; major were found to be limonene, α-terpineol, caryophyllene, δ-amorphene, elemol, γ-eudesoml, nootkatone and di-isooctyl phthalate. Although, the oil showed weak free radical inhibition, it was potentially active in CUPRAC, FRAP, phosphomolybdenum and metal chelating antioxidant assays. The oil also exhibited anti-glucosidase, anti-amylase activities and also exhibited potent inhibition of the enzyme tyrosinase, which makes it strong candidate for nutraceuticals and skin care products. The docking studies also substantiate our results and caryophyllene, γ-eudesoml and nootkatone showed good binding affinity α-glucosidase and α-amylase and all tested compounds showed the higher binding affinity towards the enzyme tyrosinase.

Optimizing leaf nutrient status, growth, and yield parameters in high-density apple orchards (cv. Super chief) via integrated drip irrigation and fertigation techniques.

Nutrients and water are important ecophysiological components for apples' development and productivity. The combination of high-density plantation, drip irrigation, and weekly fertigation not only conserves irrigation water, but also reduces cultivation costs compared to conventional methods. Leaf nutrient analysis provides insight into nutrient levels and assists in determining irrigation and fertigation schedules. We conducted the current research over two years (2021-22 and 2022-23) to evaluate different drip-fertigation effects on leaf nutrient status, vegetative growth, and yield of high-density apples. The experimental study employed a factorial randomised block design, replicating 16 different treatment combinations three times each. Each replication consisted of three plants, and the treatments included four irrigation levels (100 %, 80 %, 60 %, and control) and four fertigation levels (absolute control, 100 %, 75 %, and 50 % of the recommended NPK dosage). Analysis of the leaves indicated that IR1 (Drip irrigation at 100 % ETc) showed notably higher levels of nitrogen at (3.06 %), phosphorus at (0.48 %) and potassium at (2.07 %) compared to other treatments. Regarding fertigation levels, FN1 [100 % (AD) NPK] showed the highest nitrogen (3.12 %), phosphorus (0.50 %), and potassium (2.09 %) content. Parameters related to vegetative growth, including tree height, plant spread in both east-west (EW) and north-south (NS) directions, trunk girth, annual extension growth, and leaf area showed significant increases with higher irrigation and fertigation levels, surpassing conventional irrigation (IR4) by 6.17 percent, 7.78 percent (EW), 8.62 percent (NS), 10.49 percent, 4.53 percent and 1.96 percent, respectively. Among fertigation, FN1- 100 % AD (NPK) registered a maximum increase in growth parameters. Our analysis demonstrated that combining irrigation and fertigation improved leaf nutrient status and vegetative growth characteristics, which are critical determinants of fruit yield.

Comparative Analysis of Lifestyle Practices Between Diabetic Patients and Healthy Non-diabetic Individuals in the Saudi Population.

BACKGROUND: The burden of diabetes mellitus in Saudi Arabia is considerable, with high prevalence rates affecting the population's health and healthcare resources. This situation necessitates attention from healthcare policymakers. The study aims to compare lifestyle practices between diabetic and non-diabetic individuals in Saudi Arabia to inform targeted health interventions. OBJECTIVES: The primary aim is to compare lifestyle practices, including dietary habits, physical activity levels, and smoking habits, between diabetic and non-diabetic individuals in Saudi Arabia. METHODS: A 12-month cross-sectional study was conducted in Riyadh, Saudi Arabia. A total of 424 participants, evenly distributed across age, gender, and socioeconomic status, were enrolled. A total of 424 participants, balanced for age, gender, and socioeconomic status, were recruited. Data were collected via structured interviews employing a validated questionnaire. The King Fahad Medical City IRB approved the study. Informed consent was obtained from all participants. RESULTS: The study found that diabetic individuals were more likely to be older, male, and sedentary (p < 0.001). They were also at a higher likelihood of being current smokers (p = 0.002) and consuming whole grains regularly. Non-diabetic individuals consumed more fruits and fast food and had more flexible meal schedules (p < 0.001). Both groups had similar levels of regular vegetable consumption. A significantly lower proportion of diabetics (40 individuals; 20%) engaged in moderate physical activity three to four days a week compared to non-diabetics (80 individuals; 36%), which was highly significant (p < 0.001). CONCLUSION: The study identified critical differences in lifestyle practices between diabetic and non-diabetic individuals in Saudi Arabia. These findings underscore the need for tailored health interventions to address the rising diabetes rates and promote healthier lifestyle practices among the Saudi population.

Challenges University Students Face while Studying away from Hometown: A Cross-Sectional Study.

This study aims to highlight the challenges that undergraduates face when traveling a significant distance from home to study. These challenges are psychological, financial, and nutritional. The study was descriptive and based on a survey conducted to investigate the challenges faced by university students while studying away from their hometown. A questionnaire was used to collect data from 214 undergraduates between February and April 2021. The collected data were analyzed using the computer program SPSS version 24. Pearson's Chi-square and Fisher's exact tests were applied to observe associations between qualitative variables. A total of 214 undergraduates participated in the study, with a median age of 22 years. The study found significant relationships between weight change and housing (P < 0.001), weight change and distance (P < 0.001), level of homesickness and housing (P < 0.001), level of homesickness and college distance (P < 0.001), and financial status with housing (P = 0.025). The study revealed that a significant number of undergraduate participants face psychological, financial, and nutritional challenges. These challenges include psychosocial issues, such as homesickness financial difficulties, such as money issues, and nutritional concerns, such as weight changes.

Secondary metabolic profiling, antioxidant potential, enzyme inhibitory activities and in silico and ADME studies: a multifunctional approach to reveal medicinal and industrial potential of Tanacetum falconeri.

Tanacetum falconeri is a significant flowering plant that possesses cytotoxic, insecticidal, antibacterial, and phytotoxic properties. Its chemodiversity and bioactivities, however, have not been thoroughly investigated. In this work, several extracts from various parts of T. falconeri were assessed for their chemical profile, antioxidant activity, and potential for enzyme inhibition. The total phenolic contents of T. falconeri varied from 40.28 ± 0.47 mg GAE/g to 11.92 ± 0.22 mg GAE/g in various extracts, while flavonoid contents were found highest in TFFM (36.79 ± 0.36 mg QE/g extract) and lowest (11.08 ± 0.22 mg QE/g extract) in TFSC (chloroform extract of stem) in similar pattern as found in total phenolic contents. Highest DPPH inhibition was observed for TFFC (49.58 ± 0.11 mg TE/g extract) and TFSM (46.33 ± 0.10 mg TE/g extract), whereas, TFSM was also potentially active against (98.95 ± 0.57 mg TE/g) ABTS radical. In addition, TFSM was also most active in metal reducing assays: CUPRAC (151.76 ± 1.59 mg TE/g extract) and FRAP (101.30 ± 0.32 mg TE/g extract). In phosphomolybdenum assay, the highest activity was found for TFFE (1.71 ± 0.03 mg TE/g extract), TFSM (1.64 ± 0.035 mg TE/g extract), TFSH (1.60 ± 0.033 mg TE/g extract) and TFFH (1.58 ± 0.08 mg TE/g extract), while highest metal chelating activity was recorded for TFSH (25.93 ± 0.79 mg EDTAE/g extract), TFSE (22.90 ± 1.12 mg EDTAE/g extract) and TFSC (19.31 ± 0.50 mg EDTAE/g extract). In biological screening, all extracts had stronger inhibitory capacity against AChE while in case of BChE the chloroform extract of flower (TFFC) and stem (TFSC) showed the highest activities with inhibitory values of 2.57 ± 0.24 and 2.10 ± 0.18 respectively. Similarly, TFFC and TFSC had stronger inhibitory capacity (1.09 ± 0.015 and 1.08 ± 0.002 mmol ACAE/g extract) against α-Amylase and (0.50 ± 0.02 and 0.55 ± 0.02 mmol ACAE/g extract) α-Glucosidase. UHPLC-MS study of methanolic extract revealed the presence of 133 components including sterols, triterpenes, flavonoids, alkaloids, and coumarins. The total phenolic contents were substantially linked with all antioxidant assays in multivariate analysis. These findings were validated by docking investigations, which revealed that the selected compounds exhibited high binding free energy with the enzymes tested. Finally, it was found that T. falconeri is a viable industrial crop with potential use in the production of functional goods and nutraceuticals.

The temporal association between adverse drug reactions and antirheumatic drugs utilisation in Western Australia: a retrospective study from real-world data (1995-2015).

BACKGROUND/OBJECTIVES: Adverse drug reactions (ADRs) can result in morbidity, mortality, and higher healthcare costs. Given the limited information available on ADRs associated with antirheumatic medications, this study aims to analyse and compare ADR reporting for these drugs in the pharmacovigilance datasets of Western Australia (WA) and the United States (US). METHODS: Therapeutic Goods Administration provided WA pharmacovigilance data of selected antirheumatic drugs to from 1995 to 2015. The proportional reporting ratio (PRR) for WA case reports was compared to corresponding USA pharmacovigilance data by assessing the disproportionality of each ADR. clinically significant or true ADRs were determined using the Evans 2001 criteria (n > 2, chi-square > 4, PRR > 2). RESULTS: A total of 232 reports were found in WA, mostly on sixty-nine women aged 45 to 69. Methotrexate, leflunomide, azathioprine, sulfasalazine, and infliximab had the highest reported ADRs, related to gastrointestinal disorders. Patients who used biological agents in WA had 2.7 times the likelihood of reporting true ADRs compared to conventional antirheumatic drugs. The ADR rates in the two datasets were comparable over the study period. CONCLUSIONS: The PRR values of ADRs were consistent between WA and US databases. Methotrexate and infliximab use were commonly associated with ADR reports in WA females, with incidence rates comparable to the US; while patients using biological agents were more likely to report true ADRs than those on conventional antirheumatic drugs in WA.

Zinc oxide nanoparticles and Klebsiella sp. SBP-8 alleviates chromium toxicity in Brassica juncea by regulation of antioxidant capacity, osmolyte production, nutritional content and reduction in chromium adsorption.

Heavy metals are one of the most damaging environmental toxins that hamper growth of plants. These noxious chemicals include lead (Pb), arsenic (As), nickel (Ni), cadmium (Cd) and chromium (Cr). Chromium is one of the toxic metal which induces various oxidative processes in plants. The emerging role of nanoparticles as pesticides, fertilizers and growth regulators have attracted the attention of various scientists. Current study was conducted to explore the potential of zinc oxide nanoparticles (ZnONPs) alone and in combination with plant growth promoting rhizobacteria (PGPR) Klebsiella sp. SBP-8 in Cr stress alleviation in Brassica juncea (L.). Chromium stress reduced shoot fresh weight (40%), root fresh weight (28%), shoot dry weight (28%) and root dry weight (34%) in B. juncea seedlings. Chromium stressed B. juncea plants showed enhanced levels of malondialdehyde (MDA), electrolyte leakage (EL), hydrogen peroxide (H2O2) and superoxide ion (O2• -). However, co-supplementation of ZnONPs and Klebsiella sp. SBP-8 escalated the activity of antioxidant enzymes i.e., superoxide dismutase (SOD), catalase (CAT), ascorbate peroxidase (APX) in B. juncea grown in normal and Cr-toxic soil. It is further proposed that combined treatment of ZnONPs and Klebsiella sp. SBP-8 may be useful for alleviation of other abiotic stresses in plants.

Phytoremediation ability and selected genetic transcription in Hydrocotyle umbellata-under cadmium stress.

Cadmium (Cd) is the most toxic element which may cause serious consequences to microbial communities, animals, and plants. The use of green technologies like phytoremediation employs plants with high biomass and metal tolerance to extract toxic metals from their rooting zones. In the present work, Hydrocotyle umbellata was exposed to five Cd concentrations (2, 4, 6, 8, and 10 µmol) in triplicates to judge its phytoextraction ability. Effects of metal exposure on chlorophyll (Chl), bio-concentration factor (BCF), translocation factor (TF), and electrolyte leakage (EL) were analyzed after 10 days of treatment. Metal-responding genes were also observed through transcriptomic analysis. Roots were the primary organs for cadmium accumulation followed by stolon and leaves. There was an increase in EL. Plants showed various symptoms under increasing metal stress namely, chlorosis, browning of the leaf margins, burn-like areas on the leaves, and stunted growth, suggesting a positive relationship between EL, and programmed cell death (PCD). Metal-responsive genes, including glutathione, expansin, and cystatin were equally expressed. The phytoextraction capacity and adaptability of H. umbellata L. against Cd metal stress was also demonstrated by BCF more than 1 and TF less than 1.

The results of the current study demonstrated that Hydrocotyle umbellata is a good choice for environmental cleanup in areas with mild Cd contamination. According to TF and BCF, the plant demonstrated a considerable uptake of Cd. Additionally, H. umbellata's eligibility as a phytoremediation agent for Cd was supported by the transcription of numerous metal-responsive genes, including glutathione, expansin, cystatin, and other genes associated with growth.

Exogenous Application of 24-Epibrassinolide Confers Saline Stress and Improves Photosynthetic Capacity, Antioxidant Defense, Mineral Uptake, and Yield in Maize.

Salinity is one of the major environmental stresses threatening crop production, the natural ecosystem, global food security, and the socioeconomic health of humans. Thus, the development of eco-friendly strategies to mitigate saline stress and/or enhance crop tolerance is an important issue worldwide. Therefore, this study was conducted during the summer of 2022 to investigate the potential of 24-Epibrassinolide (EBL) for mitigating saline stress and improving photosynthetic capacity, antioxidant defense systems, mineral uptake, and yield in maize (Zea mays L.) grown under a controlled hydroponic system. Three saline stress levels-S1 (control/no added NaCl), S2 (60 mM NaCl), and S3 (120 mM NaCl)-were continuously applied with nutrient solution, whereas exogenous EBL (i.e., control, 0.1 µM and 0.2 µM) was applied as exogenous application three times (i.e., 40, 55, 70 days after sowing). The experiment was designed as a split-plot in a randomized complete block design (RCBD) in which saline stress was the main factor and EBL treatment was the sub-factor. Results showed that saline stress significantly affected plant growth, physiological performance, biochemistry, antioxidant activity, and yield attributes. However, the exogenous application of EBL at 0.2 µM significantly mitigated the salt stress and thus improved plant performance even under 120 mM NaCl saline stress. For instance, as compared to untreated plants (control), 0.2 µM EBL application improved plant height (+18%), biomass (+19%), SPAD (+32%), Fv/Fm (+28%), rate of photosynthesis (+11%), carboxylation efficiency (+6%), superoxide dismutase (SOD +14%), catalase (CAT +18%), ascorbate peroxidase (APX +20%), K+ (+24%), 100-grain weight (+11%), and grain yield (+47%) of maize grown under salt stress. Additionally, it resulted in a 23% reduction in Na+ accumulation in leaves and a 25% reduction in for Na+/K+ ratio under saline stress as compared to control. Furthermore, the Pearson's correlation and principal component analysis (PCA) highlighted the significance of exogenous EBL as saline stress mitigator in maize. Overall, our results indicated the protective effects of EBL application to the alleviation of saline stress in crop plants. However, further exploration of its mechanism of action and crop-specific response is suggested prior to commercial use in agriculture.

Breast Cancer Awareness and Screening Among Menopaused Females in Al-Qassim Region.

BACKGROUND: Breast cancer (BC) is one of the most prevalent types of cancer among women worldwide including those in Saudi Arabia. The risk of developing BC can be lowered by reducing risk factors through early screening and by women having full knowledge of this condition. The aim of this study is thus to evaluate knowledge of the importance of early screening and detection of BC among post-menopausal women in Saudi Arabia's Qassim region and to compare it with pre-menopausal women. METHODOLOGY: A cross-sectional study was conducted among post-menopausal women in the Qassim region. Data were collected by using a pre-tested, pre-coded, validated self-administered online questionnaire. Data were analyzed using SPSS (Social Package of Statistical Science) Statistics version 23.0. RESULTS: Data were collected from 1386 women who agreed to participate in this study, of which 484 women reported that their menstruation had stopped (34.9%). In general, it was found that 73.7% of the participants had adequate knowledge with a significant difference between pre-menopausal and post-menopausal women. Concerning knowledge of BC (p = 0.042), pre-menopausal women had a higher level of knowledge (75.5% had adequate knowledge compared with 70.5% of post-menopausal women). Considering the source of knowledge of the participants regarding BC, websites or social media is considered the main source for 71.8% of the participants, followed by family and friends (52.2%). Concerning the knowledge about the risk factors of BC, 26.4% of the participants reported that they did not know them, and 11.8% of the participants did not know any of the symptoms of BC. CONCLUSION: In this study, the knowledge of post-menopausal women was found to be adequate; however, it is significantly lower than that of the pre-menopausal women. Educational level is a significant factor that affects the level of knowledge regarding BC risk factors and different modalities for diagnosis and approaches for management, and this indicates the importance of increasing interest in education in our society.

The Effects of Health Education on the Awareness of Antimicrobial Resistance Among High School Students in Riyadh, Saudi Arabia During 2023: A Quasi-experimental Study.

Introduction Antimicrobial resistance (AMR) is a major health threat, recently declared a crisis by the WHO, and recognized as one of the top 10 threats to global health. One of the strategies to curb AMR is interventional education to raise awareness. Therefore, this study evaluated the impact of interventional education on awareness of antimicrobial resistance among high school students in Riyadh, Saudi Arabia. Methods This was a quasi-experimental study that included 120 high school students as a control group and 120 students as the experimental group. It used a questionnaire pre- and post-educational intervention, which was a lecture by trained healthcare workers. Pearson's Chi-square test and ANOVA were used to assess the effects of the intervention, and the p-value was set at <0.05 for significance. Results Over half (53.4%) of the controls reported no prior exposure to an antibiotic awareness campaign, compared to 46.6% in the intervention (experimental) group. Half of the participants in both groups were without a family relative who works in the healthcare sector. Almost half (51.2%) in the intervention group used antibiotics compared to 48.2% of controls; 53.3% in the control group reported self-medication compared to 46.7% in the intervention group. We found a statistically significant increase in the overall mean scores regarding knowledge of antibiotics resistance before and after the education intervention in the control group (p<0.001) and intervention group (p<0.001). Post-intervention, there was a significant reduction in the mean scores of misbeliefs about antibiotic use (p<0.001). We found an improvement in the perception scores toward AMR and antibiotic resistance post-educational intervention (P=0.008), and the perception difference remained significant between the two study groups (p=0.002). Conclusion These findings showed that interventional education effectively raises awareness, knowledge, and perceptions toward AMR. Therefore, public health, medical, and scientific professionals in Saudi Arabia are urged to emphasize education to fight AMR, in addition to other strategies.

Effect of Nighttime Exercise on Sleep Quality Among the General Population in Riyadh, Saudi Arabia: A Cross-Sectional Study.

Introduction Engaging in physical activity has been proven to have health benefits, with a positive impact on sleep quality. While the timing of exercise plays a significant role in determining its effect on sleep, nighttime exercise still needs to be explored, especially in Saudi Arabia. This study assessed the effect of nighttime exercise on sleep quality among the general population in Riyadh, Saudi Arabia. Methods A cross-sectional study was conducted on people performing physical exercises in the gym, training, and walking places using a self-administered questionnaire evaluating exercising behaviors and sleep quality. Comparisons were performed using the Chi-square test and ANOVA, and p<0.05 was considered for significance. Results We enrolled 385 participants, among whom 53.8% were male, and 47.2% were female. The mean age was 28.2±7.85 years, and mostly aged 25-29 years (24.7%), followed by 20-24 years old (21.3%). Most had university degrees (61.3%) and were also employed (60%). Of all participants, the majority were overweight and obese (61.3%). Most (n=225) participants practiced vigorous physical exercise, and the mean Pittsburgh Sleep Quality Index (PSQI) global score was 7.37±3.49 points. Evening vigorous (r= 0.25, p=0.038) and moderate (r=0.30, p=0.025) physical exercise sessions lasting > 90 min had a significant positive correlation with poor sleep quality (high PSQL score). There was no statistically significant correlation between sleep quality and other variables (p>0.05). Conclusion This study found that participants had poor sleep quality, and lengthy, intense evening exercises had a negative effect on sleep. Incorporating regular exercise tailored to individual preferences and encouraging people to widen the time interval between exercise and bedtime could improve sleep quality.

Determinants of Flu Vaccine Uptake Among the General Population in Saudi Arabia: A Study Based on the Health Belief Model.

Background and objective Recently, influenza has emerged as a significant public health concern worldwide, including in Saudi Arabia. Vaccination against the flu is widely recognized as a crucial preventive measure to reduce morbidity and mortality associated with the virus. However, the uptake of flu vaccines among the general population in Saudi Arabia still remains low. In light of this, this study aimed to examine the determinants of influenza vaccine uptake in Saudi Arabia by using the Health Belief Model (HBM). Methods This cross-sectional study was conducted among adults living in all regions of Saudi Arabia by using an online self-administered questionnaire based on the HBM. The questionnaire inquired about demographics, knowledge about influenza, knowledge about vaccines, and beliefs/barriers. It was distributed via social media platforms, including WhatsApp, Twitter, and Instagram. IBM SPSS Statistics software version 29 (IBM Corp., Armonk, NY) was used for statistical analyses, and both the Chi-square test and logic regression analyses were applied to determine associations between explanatory and response variables, with the level of significance set at p<0.05. Results This study enrolled a total of 1040 participants, and the majority were Saudi nationals (96.9%). Of note, 66.2% of the participants were males, and the rest were females. Most of the participants were employed by governmental institutions (42.0%), had bachelor's degrees (58.4%), had never worked in the health sector (70.2%), and earned above 10,000 Saudi riyals per month (62.1%). Over half (55.7%) of participants had taken the flu vaccine at the time of this study. Working in the healthcare sector was associated with increased flu vaccine uptake [adjusted odds ratio (aOR): 3.84, p<0.001]. The likelihood of getting the flu vaccines was greater among men (aOR: 1.38, p=0.027), and obesity was associated with lower flu vaccine uptake (aOR: 0.29, p=0.034). Having contact with people with flu, having had flu in the past, and experiencing severe flu complications (aOR: 4.71, p=0.029; aOR: 0.13, p=0.006; and aOR: 0.29, p=0.033, respectively) were significantly associated with the flu vaccine uptake among our study participants. Perceived potential risks of the flu vaccine were also associated with taking the flu vaccine (aOR: 0.213, p=0.042). There was a significant association between seeing an advertisement for the flu vaccine and the likelihood of taking the vaccine (aOR: 5.488, p=0.042). Conclusion This study found that certain sociodemographic factors are associated with flu vaccine uptake. These factors included contact with flu-infected individuals, past experiences with flu, perceived risks, and exposure to flu vaccine advertisements. Improving healthcare accessibility, conducting awareness campaigns, and implementing workplace initiatives are recommended to address the issues related to flu vaccine uptake.

Compliance of Healthcare Providers With the Notifiable Diseases Surveillance System in Riyadh, Saudi Arabia.

Introduction Though reporting notifiable diseases is obligatory in Saudi Arabia, and the Saudi Ministry of Health establishes guidelines, there are concerns about healthcare providers' compliance, and studies evaluating the notifiable diseases surveillance system (NDSS) are lacking, underlying the urgent need to assess the compliance of healthcare providers with the NDSS in Saudi Arabia. Methods This cross-sectional study involved doctors, nurses, and epidemiologists working in healthcare facilities in Riyadh, Saudi Arabia. The data collection was done using a self-administered questionnaire. SPSS version 27 software (IBM Corp., Armonk, NY) was used for statistical analyses. Results We included 420 participants enrolled in our study, and 63.1% were female. Of 51.4% of participants who worked in private healthcare facilities, 75.7% of them were nurses, while the majority of those working in governmental facilities were doctors (69.1%). The age range was 20-62 years, and the dominant age group was 31-40 years (63.8%). Most participants had no training in epidemiology (79.7%) and of those trained, 64% had a certificate training level. Most notifiable diseases worked were detected in governmental health facilities (35.6% vs. 18.8%). Of those who identified notifiable diseases, 84.3% notified them. COVID-19, measles, and hepatitis A, B, and C were the most notified diseases. The lack of knowledge of the notification system was the most common barrier to the notification among 81 nurses, 39 doctors, and one epidemiologist. There was a significant relationship between being a doctor in the governmental institution and notification timeline (p = 0.024). Conclusion This study showed that identifying notifiable diseases was poor despite good compliance among those who identified them. This study showed the lack of proper training of participants, explaining poor knowledge. The findings highlight the differences in notification practices between private and governmental facilities and the need for educational interventions to tackle the knowledge barrier reported.

Plant Growth Regulators with a Balanced Supply of Nutrients Enhance the Phytoextraction Efficiency of Parthenium hysterophorus for Cadmium in Contaminated Soil.

Heavy metal contamination in soil, such as cadmium (Cd), poses a serious threat to global food security and human health. It must be managed using environmentally friendly and cost-effective technologies. Plants with high resistance to Cd stress and high biomass production could be potential candidates for the phytoremediation of Cd-contaminated soils to improve Cd phytoextraction. In this regard, the present study was carried out to determine the effect of gibberellic acid (GA3), indole acetic acid (IAA), and fertilizers (N, P, and K) on Parthenium hysterophorus growth and biomass production as well as Cd phytoextraction capabilities. A pot experiment was conducted with various combinations of PGRs and fertilizers, with treatments arranged in five replicates using a completely randomized design. After harvesting, each plant was divided into various parts such as stems, roots, and leaves, and different growth, physiological, and biochemical parameters were recorded. Results showed that under Cd stress, growth, physiological, and biochemical parameters were all significantly decreased. With the combined application of plant growth regulators (GA3 and IAA) and nutrients, Cd stress was alleviated and all parameters significantly improved. In comparison to the control treatment, the combined application of N + P + K + GA3 + IAA resulted in the highest fresh and dry biomass production of the root (12.31 and 5.11 g pot-1), shoot (19. 69 and 6.99 g pot-1), leaves (16.56 and 7.09 g pot-1), and entire plant (48.56 and 19.19 g pot-1). Similarly, the same treatment resulted in higher chlorophyll a and b and total chlorophyll contents under Cd stress, which were 2.19, 2.03, and 3.21 times higher than the control, which was Cd stress without any treatment. The combination of N + P + K + GA3 + IAA also resulted in the highest proline and phenolic contents. In the case of different enzyme activities, the combined application of N + P + K + GA3 + IAA under Cd stress led to a high increase in catalase (2.5 times), superoxide (3.5 times), and peroxidase (3.7 times) compared to the control. With the combined application of N+ P+ K + GA3 + IAA, the maximum values of BCF (8.25), BAC (2.6), and RF (5.14%) were measured for phytoextraction potential. On the basis of these findings, it is concluded that P. hysterophorus has a high potential to grow, produce the most biomass, and act as a Cd hyperaccumulator in Cd-contaminated soil.

Mortality Trends Among Patients with Rheumatoid Arthritis in Western Australia.

INTRODUCTION: With scarce comparative data on mortality in Australian patients with rheumatoid arthritis (RA), we investigated temporal changes in standardized mortality rates for patients with RA using longitudinal linked population-wide health data in Western Australia (WA) over the period 1980 to 2015. METHODS: The study included 17,125 patients with a first-time hospital contact for RA (ICD-10-AM M05.00-M06.99 and ICD-9-AM 714.00-714.99) in the study period. Standardized mortality rate ratios (SMRRs) for the RA cohort versus the WA general population was estimated using direct age standardization. We analyzed temporal trends over with dates and causes provided by the WA Death Registry. RESULTS: During 356,069 patient-years of follow-up, a total of 8955 (52%) deaths occurred in the RA cohort. The SMRR was 2.24 (95% CI 2.15-2.34) in males and 3.09 (95% CI 3.00-3.19) in females over the study period. SMRR decreased since 2000 to 1.59 (95% CI 1.39-1.81) for the period 2011-2015. Median survival was 26.80 years (95% CI 26.30-27.30), where age and comorbidity independently increased the risk of death. The leading causes of deaths were cardiovascular diseases (26.60%), cancer (16.80%), rheumatic diseases (5.80%), chronic pulmonary disease 491 (5.50%), dementia (3.00%), and diabetes 235 (2.6%). CONCLUSIONS: The mortality rate in patients with RA in WA has decreased but remains 1.59-times higher than in community counterparts, suggesting that there is room for further improvement. Comorbidity is the main modifiable risk factor to further reduce mortality in patients with RA.

The Outcome of Multicystic Dysplastic Kidney Disease Patients at King Abdulaziz Medical City in Riyadh.

Background Multicystic dysplastic kidney (MCDK) is a type of kidney dysplasia consisting of many irregular, various-sized cysts divided by dysplastic renal tissue, which negatively impacts kidney function. MCDK is one of the most common renal congenital disorders seen in antenatal ultrasounds. The typical prognosis of MCDK is complete or partial involution that starts antenatally and continues postnatally. The aim of the study was to shed light on the overall outcome of patients with MCDK. Methods We retrospectively collected data on MCDK patients from 2016 until 2022 at King Abdulaziz Medical City, Ministry of National Guard Health Affairs in Saudi Arabia, Riyadh. The data included the recording of epidemiological data, radiological and laboratory reports, and the presence of urological or non-urologically associated anomalies. Results A total of 57 patients with MCDK were reviewed. Seven of them were excluded due to the diagnosis of bilateral MCDK, which was incompatible with life. Of the remaining 50 patients, the right kidney was affected in 52% of them. Most patients were diagnosed antenatally (98%). The mean duration of follow-up for the study was 48 months. Vesicoureteral reflux (VUR) was detected in 22% of the total sample. Overall, 90% of the patients underwent kidney involution. A small percentage had genitourinary anomalies (20%), while a larger percentage (48%) had extrarenal abnormalities. Conclusion Multicystic dysplastic kidney disease is relatively common in children. The prognosis is affected by the presence of genitourinary and non-genitourinary anomalies. Patients have an overall good prognosis with conservative management. Antenatal screening, diagnosis, and long-term nephrological follow-up are essential for the optimal management of patients.

Factors Associated With Emergency Department Visits or Readmission of Late Preterm Infants at the Neonatal Intensive Care Department, National Guard Health Affairs, Riyadh.

Background Infants who are born between 34 0/7 and 36 6/7 weeks of pregnancy as a result of maternal or fetal factors are defined as "late preterm infants". Compared to term infants, late preterm infants are more predisposed to pregnancy complications because they are less mature physiologically and metabolically. In addition, health practitioners still face difficulties in differentiating between term and late preterm infants due to similar general appearance. The aim of this study is to explore the epidemiology of readmission among late preterm infants at the National Guard Health Affairs. The objectives of the study were to calculate the rate of readmission among late preterm infants in the first month after discharge and to identify the associated risk factors for readmission. Methods A retrospective cross-sectional study was carried out at the neonatal intensive care unit (NICU at King Abdulaziz Medical City in Riyadh). We identified preterm infants born in 2018 and the risk factors for readmission within the first month of life. Data on risk factors were collected using the electronic medical file. Results A total of 249 late preterm infants with a mean gestational age of 36 weeks were included in the study. Of them, 64 infants (25.7%) suffered from at least a subsequent admission and stayed overnight in either the inpatient department or pediatric emergency room. Maternal diabetes was a significant risk factor for readmission; on the other hand, a positive maternal Rh factor was a protective factor against readmission. Among readmitted infants (n=64), 51 infants were admitted to the emergency room (79.69%), eight infants were readmitted to the pediatric ward (12.5%), and five infants were readmitted to both (7.8%). The most common cause for pediatric ER visits was gastrointestinal (GIT) problems (27%), followed by upper respiratory tract infection (URTI) (18%) and jaundice (14%). The most common cause for direct ward readmission was jaundice (n= 5; 62%). Conclusion Gastrointestinal (GIT) issues and upper respiratory tract infections (URTIs) were the leading causes of pediatric emergency room admissions. In contrast, jaundice, congenital diaphragmatic hernia (CDH), airway problems, and regurgitation were the most frequent causes of admission to the ward, with jaundice being the primary cause. Although studies suggest that the late preterm population is at a higher risk for long-term health issues, further research is necessary to investigate this topic thoroughly.

Safety and Effectiveness of Evolocumab During Acute and Sub-acute Phases of Acute Coronary Syndrome (ACS): A Systematic Review and Meta-analysis.

BACKGROUND: Coronary artery disease (CAD), manifested mainly as acute coronary syndrome (ACS), continues to be a major cause of mortality globally and a significant contributing factor to the global disease burden. Elevation of low-density lipoprotein cholesterol levels attributed to proprotein convertase subtilisin/Kexin type-9 (PCSK9) during and following ACS puts patients at high risk of subsequent adverse events. Evolocumab is a PCSK9 inhibitor that is associated with a significant reduction in low-density lipoprotein cholesterol (LDL-C) levels through PCSK9 inhibition in comparison to traditional statin therapy. METHODS: We conducted a systematic review and meta-analysis of literature addressing the efficacy and safety of evolocumab compared to other lipid-lowering therapies or placebo. An extensive internet-based literature search using pre-determined key phrases supported by medical sub-headings and Boolean operators was performed in October 2022 to identify literature pertinent to the research topic. The search was primarily based on the National Library of Medicine (PubMed and Clinical Trials), MEDLINE, Cochrane, and the Science direct literature databases. Subsequently, the researchers devised PICOs-based screening criteria which had to be met by each identified study for inclusion in the review and meta-analysis. Two independent reviewers conducted data stratification and quality assessment of identified studies. Statistical analysis of the primary and secondary outcomes was conducted on the Cochrane REVMAN 5.4 statistical software for randomized trials. RESULTS: Two thousand five hundred and seventy-six potential studies were identified for inclusion in the systematic review. Data stratification, screening, and quality assessment of these studies based on the eligibility criteria led to the exclusion of two thousand five hundred and sixty-seven studies as they did not meet the standards set. Nine randomized controlled trials progressed to numerical analysis for validity and reliability. Eight studies were included in the meta-analysis. Meta-analytical results showed a significant decrease in LDL-C changes from initiation of evolocumab therapy to 8 weeks following ACS compared to placebo. Similar results were derived in the sub-acute phase of ACS [SMD -1.95 (95% CI -2.29, -1.62)]. The meta-analysis revealed no statistically significant relationship between the risk of adverse effects, serious adverse effects, and major adverse cardiovascular events (MACE) from treatment using evolocumab in comparison to placebo [(relative risk, RR 1.04 (95% CI 0.99, 1.08) (Z = 1.53; p=0.12)]. CONCLUSION: Early evolocumab therapy initiation was associated with a significant decrease in LDL-C levels and was not associated with an increased risk of adverse effects in comparison to placebo.

Metabolomics reveals arbuscular mycorrhizal fungi-mediated tolerance of walnut to soil drought.

BACKGROUND: Arbuscular mycorrhizal fungi (AMF) have a positive effect on drought tolerance of plants after establishing reciprocal resymbiosis with roots, while the underlying mechanism is not deciphered. Metabolomics can explain the mechanism of plant response to environmental stress by analyzing the changes of all small molecular weight metabolites. The purpose of this study was to use Ultra High Performance Liquid Chromatography Q Exactive Mass Spectrometer to analyze changes in root metabolites of walnut (Juglans regia) after inoculation with an arbuscular mycorrhizal fungus Diversispora spurca under well-watered (WW) and drought stress (DS). RESULTS: Sixty days of soil drought significantly inhibited root mycorrhizal colonization rate, shoot and root biomass production, and leaf water potential in walnut, while AMF inoculation significantly increased biomass production and leaf water potential, accompanied by a higher increase magnitude under DS versus under WW. A total of 3278 metabolites were identified. Under WW, AMF inoculation up-regulated 172 metabolites and down-regulated 61 metabolites, along with no changes in 1104 metabolites. However, under DS, AMF inoculation up-regulated 49 metabolites and down-regulated 116 metabolites, coupled with no changes in 1172 metabolites. Among them, juglone (a quinone found in walnuts) as the first ranked differential metabolite was up-regulated by AMF under WW but not under DS; 2,3,5-trihydroxy-5-7-dimethoxyflavanone as the first ranked differential metabolite was increased by AMF under DS but not under WW. The KEGG annotation showed a large number of metabolic pathways triggered by AMF, accompanied by different metabolic pathways under WW and DS. Among them, oxidative phosphorylation and phenylalanine metabolism and biosynthesis were triggered by AMF in response to WW and DS, where N-acetyl-L-phenylalanine was induced by AMF to increase under DS, while decreasing under WW. CONCLUSION: This study provides new insights into the metabolic mechanisms of mycorrhiza-enhanced drought tolerance in walnuts.