Aged garlic extract preserves beta-cell functioning via modulation of nuclear factor kappa-B (NF-κB)/Toll-like receptor (TLR)-4 and sarco endoplasmic reticulum calcium ATPase (SERCA)/Ca2+ in diabetes mellitus.

BACKGROUND: Peripheral insulin resistance and compromised insulin secretion from pancreatic ß-cells are significant factors and pathogenic hallmarks of diabetes mellitus (DM). NF-κß/TLR-4 and SERCA/Ca2+ pathways have been identified as potential pathways regulating insulin synthesis by preserving pancreatic ß-cell functioning. The current study aimed to evaluate the therapeutic effect of aged garlic extract (AGE) against DM in a streptozotocin (STZ)-induced rat model with particular emphasis on pancreatic ß-cell functioning. METHODS: AGE was characterized by gas chromatography-mass spectrometry (GC-MS), Fourier-transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM) to evaluate its physio-chemical characteristics followed by in-vitro anti-diabetic and antioxidant potential. This was followed by the induction of DM in laboratory animals for investigating the therapeutic action of AGE by evaluating the role of NF-κß/TLR-4 and the SERCA/Ca2+ pathway. The parameters assessed in the present experimental setup encompassed antioxidant parameters, metabolic indicators, insulin concentration, intracellular calcium levels, apoptotic markers (CCK-8 and Caspase Glo-8), and protein expression (P-62 and APACHE-II). RESULTS: AGE characterization by SEM, GC-MS, and X-ray diffraction (XRD) revealed the presence of phenylalanine, alliin, S-allylmercaptocysteine (SAMC), tryptophan, 1-methyl-1,2,3,4-tetrahydro-ß-carboline-3-carboxylic acid as major bioactive constituents of AGE. Metabolic studies, including intraperitoneal glucose tolerance test (IPGTT), revealed significantly lower blood glucose levels in the AGE group compared to the disease control group. In contrast, the intraperitoneal insulin tolerance test (ITT) exhibited no significant difference in insulin sensitivity between the AGE supplementation group and the DM control group. Interestingly, AGE was found to have no significant effect on fasting glucose and serum insulin levels. In contrast, AGE supplementation was found to cause significant hypoglycaemia in postprandial blood glucose and insulin levels. Importantly, AGE causes restoration of intracellular Ca2+ levels by modulation of SERCA/Ca2 functioning and inhibition NF-κB/TLR-4 pathway. AGE was found to interact with and inhibit the DR-5/ caspase-8/3 apoptotic complex. Furthermore, microscopic studies revealed degeneration and apoptotic changes in pancreatic ß-cells of the DM control group, while supplementation of AGE resulted in inhibition of apoptotic pathway and regeneration of pancreatic ß-cells. CONCLUSION: The current study suggests that AGE enhance glucose homeostasis by exerting their effects on pancreatic ß-cells, without ameliorating peripheral sensitivity. Moreover, AGEs promote an increase in ß-cell mass by mitigating the apoptosis of pancreatic ß-cells. These findings suggest that AGE could aid in developing a viable alternative therapy for diabetes mellitus (DM).

Cardiac Morbidity and Mortality in Patients with Sarcoma: A Population-Based Study.

Background: Soft tissue sarcoma (STS) is a rare malignancy that affects soft tissues. It encompasses various subtypes and requires different treatment strategies. Doxorubicin is a commonly used anthracycline in the management of localized and metastatic STS. However, high doses of doxorubicin are associated with cardiotoxicity, which can significantly impact patients' long-term outcomes. This study aimed to evaluate doxorubicin's effect on cardiac function in patients with sarcoma and to correlate the frequency of cardiotoxicity with potential risk factors. Methods: A retrospective analysis was conducted on patients with sarcoma who were treated with doxorubicin between 2016 and 2022 at King Abdulaziz Medical City in Saudi Arabia. Patient demographic information, comorbidities, cardiac measurements, laboratory values, systemic therapy, and treatment outcomes were collected from electronic medical records. A statistical analysis was performed to assess the association between cardiotoxicity and various factors. Results: A total of 133 patients were included in the study, with a median age of 30 years. Cardiotoxicity was observed in 9% of the patients. Female patients had a significantly higher risk of developing cardiotoxicity. Patients with a higher Eastern Cooperative Oncology Group (ECOG) performance status and lower troponin I levels also had an increased risk of cardiotoxicity. However, there was no significant association between cardiotoxicity and the number of chemotherapy cycles, total cumulative dose of doxorubicin, or history of radiation. Furthermore, patients with cardiotoxicity had a higher risk of mortality. The overall survival of the patients was 18 months. Conclusion: Doxorubicin-associated cardiotoxicity is a concern for patients with sarcoma. Female patients and patients with a higher ECOG performance status are at an increased risk of developing cardiotoxicity. Careful monitoring and risk assessment are crucial for mitigating the adverse effects of doxorubicin treatment in patients with sarcoma. Future studies are warranted to validate these findings and explore preventive strategies for doxorubicin-induced cardiotoxicity in patients with sarcoma.

Awareness and Perception Toward Obesity and Knee Osteoarthritis and Their Preventive Measures Among the Adult Population in the Northern Borders Region, Saudi Arabia.

BACKGROUND: Osteoarthritis (OA) of the knee poses a significant public health challenge, with its prevalence escalating globally. This study addresses a critical knowledge gap by investigating the awareness and perceptions of knee OA in the Northern Borders Region, Saudi Arabia, focusing on demographic factors that may influence community perspectives. STUDY AIM: The primary aim of this cross-sectional study is to comprehensively examine the awareness and perceptions of knee OA, exploring the influence of demographic variables, including region, gender, age, nationality, and educational levels. METHODOLOGY: A total of 501 participants from various cities in the Northern Borders Region, Saudi Arabia, were enrolled in this study. Demographic characteristics, including region, gender, age, nationality, and educational levels, were documented. A structured survey instrument was utilized to collect data on awareness and perceptions of knee OA. Statistical analyses included descriptive statistics, chi-square tests, and logistic regression to explore associations. RESULTS: Demographic insights revealed a predominance of participants from Arar (37.50%) and Rafha (36.50%), with a nearly equal gender distribution (52.90% male, 47.10% female). The majority fell within the 31-45 age group (37.50%), and 97.60% were Saudi nationals. Educational levels varied, with 55.30% holding a bachelor's degree. Awareness levels indicated that 75.40% recognized obesity as a significant factor in knee OA. Significant associations were found between gender and acknowledgment of obesity (p = 0.021), as well as between age and awareness of obesity (p = 0.040). Non-Saudi participants exhibited a higher awareness of knee injury as a reason for arthritis (p = 0.028). Educational levels demonstrated significant associations with awareness of rheumatoid arthritis (p = 0.012), growing old as a reason for knee arthritis (p = 0.002), and various preventive measures and treatment options. CONCLUSION: This study provides a nuanced understanding of knee OA awareness and perceptions in the Northern Borders Region, Saudi Arabia. The high recognition of obesity as a risk factor, coupled with demographic variations, highlights the need for tailored health education interventions. Addressing gender-specific, age-related, and educational disparities is crucial for promoting effective community-wide initiatives to prevent and manage knee OA.

Pregnancy and Inflammatory Rheumatological Diseases: A Single-Center Retrospective Cohort Study.

Background Rheumatic diseases pose risks to pregnant women, leading to complications like preterm birth, congenital heart block, and pregnancy loss. These diseases are expected to deteriorate during pregnancy and further in the postpartum period. The impact of these diseases on the pregnancy will add further burden on the patient, fetus, physician, and healthcare system. Advances in diagnosis and treatment have improved outcomes making them similar to that of healthy women, but close follow-up in a multidisciplinary clinic is essential. The objective of this study is to study the outcome of pregnancy in women with rheumatological disease and the behavior of the disease during pregnancy. Methods A retrospective cohort study was conducted in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia, to compare the outcomes of pregnancy across three rheumatological diseases: Sjogren syndrome (SS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) from 2016 to 2021. A total of 128 pregnancies in 107 women with rheumatological diseases were included in this study. Pregnancy measures and outcomes were investigated by assessing maternal health, fetal health, and pregnancy complications, specifically maternal disease activity, medications to control the disease, infection, preterm birth, birth weight, abortions/stillbirths, mode of delivery, bleeding, preeclampsia, congenital heart block, and neonatal lupus. Results There were 55 patients with RA (63 RA pregnancies), 44 with SLE (54 SLE pregnancies), and eight with primary SS (11 SS pregnancies). In most of the pregnancies (n= 108; 95.58%), the patients were in clinical remission before pregnancy. Lupus nephritis, which was in remission before pregnancy, has been reported in nine (16.67%) out of 54 SLE pregnancies. Vaginal delivery was the most common mode of delivery (n=87; 67.97%). On the other hand, there were 38 cesarean sections (29.69%). Rheumatological disease flares occurred in 10 pregnancies (7.87%). One hundred and twenty-two live births were delivered. Preterm infants were born in 25 pregnancies (20.16%), and 16 (13.22%) of the newborns needed neonatal intensive care unit (NICU) care. Interestingly, congenital heart block (CHB) was found in five (12.2%) neonates out of 41 anti-SS-related antigen A (anti-SSA) positive mothers; one of those five died from heart block. Eleven neonates were delivered with positive serology, and five were diagnosed with neonatal lupus. Conclusion The outcome of pregnancy in patients with rheumatological disease is favorable. A multidisciplinary team approach and close clinical follow-up are the cornerstone for such success. A small dose of prednisolone (5 mg or less) is safe and will not have a negative impact on maternal or fetal health. CHB is a concern for pregnant women with positive anti-SSA.

Effect of Rice Husk and Wood Flour on the Structural, Mechanical, and Fire-Retardant Characteristics of Recycled High-Density Polyethylene.

Given the rising consumption of plastic products, it is becoming imperative to prioritize the recycling of plastic items as a solution to reducing plastic waste and environmental pollution. In this context, this research focuses on assessing the impact of incorporating rice husk and wood flour into recycled high-density polyethylene (rec-HDPE) to analyze its mechanical properties, flammability, and thermal stability. The combined rec-HDPE content of wood flour and rice husk varied between 0% and 20%. The rec-HDPE content of maleic anhydride grafted polyethylene (MAPE) was fixed at 3%. Mechanical characteristics such as flexural, tensile, and impact strengths were assessed. Cone calorimetry (CC) tests, limited oxygen index (LOI) tests, and horizontal and vertical burning tests were performed to determine the flammability or fire retardancy of these composites. On the other hand, to characterize the thermal characteristics of these composites, thermogravimetric analysis (TGA) was used. To further characterize the fluctuation in these characteristics, scanning electron microscopy (SEM) and infrared spectroscopy (FTIR) studies were carried out. The mechanical characteristics were found to be increased in response to adding rice husk or wood flour. An 8% increase in tensile strength and a 20% increase in elastic modulus enhancement were recorded for a 20% rice husk-added composite. SEM revealed the reason for the variation in tensile properties, based on the extent of agglomeration and the extent of uniform distribution of fillers in rec-HDPE. Following these lines, the 20% rice husk-added composite also showed a maximum increase of around 6% in its flexural strength and a maximum increase of 50% in its flexural modulus. A decrease in impact strength was recorded for rice husk and wood flour-reinforced composites, compared with unreinforced rec-HDPE. Hybrid composites displayed a lack of mechanical strength due to changes in their nature. FTIR tests were performed for a much more elaborate analysis to confirm these results. Twenty percent of rice husk-added rec-HDPE displayed the best thermal properties that were tested, based on TGA and derivative thermogravimetric (DTG) analysis. This 20% composite also displayed the best fire-retardancy characteristics according to UL 94 tests, cone calorimetry tests, and limited oxygen index tests, due to the barrier created by the silica protective layer. These tests demonstrated that the incorporation of both fillers-rice husk and wood flour-effectively enhanced the thermal, mechanical, and fire-retardant attributes of recycled HDPE.

Nanocellulose-Based Passivated-Carbon Quantum Dots (P-CQDs) for Antimicrobial Applications: A Practical Review.

Passivated-carbon quantum dots (P-CQDs) have been attracting great interest as an antimicrobial therapy tool due to their bright fluorescence, lack of toxicity, eco-friendly nature, simple synthetic schemes, and possession of photocatalytic functions comparable to those present in traditional nanometric semiconductors. Besides synthetic precursors, CQDs can be synthesized from a plethora of natural resources including microcrystalline cellulose (MCC) and nanocrystalline cellulose (NCC). Converting MCC into NCC is performed chemically via the top-down route, while synthesizing CODs from NCC can be performed via the bottom-up route. Due to the good surface charge status with the NCC precursor, we focused in this review on synthesizing CQDs from nanocelluloses (MCC and NCC) since they could become a potential source for fabricating carbon quantum dots that are affected by pyrolysis temperature. There are several P-CQDs synthesized with a wide spectrum of featured properties, namely functionalized carbon quantum dots (F-CQDs) and passivated carbon quantum dots (P-CQDs). There are two different important P-CQDs, namely 2,2'-ethylenedioxy-bis-ethylamine (EDA-CQDs) and 3-ethoxypropylamine (EPA-CQDs), that have achieved desirable results in the antiviral therapy field. Since NoV is the most common dangerous cause of nonbacterial, acute gastroenteritis outbreaks worldwide, this review deals with NoV in detail. The surficial charge status (SCS) of the P-CQDs plays an important role in their interactions with NoVs. The EDA-CQDs were found to be more effective than EPA-CQDs in inhibiting the NoV binding. This difference may be attributed to their SCS as well as the virus surface. EDA-CQDs with surficial terminal amino (-NH2) groups are positively charged at physiological pH (-NH3+), whereas EPA-CQDs with surficial terminal methyl groups (-CH3) are not charged. Since the NoV particles are negatively charged, they are attracted to the positively charged EDA-CQDs, resulting in enhancing the P-CQDs concentration around the virus particles. The carbon nanotubes (CNTs) were found to be comparable to the P-CQDs in the non-specific binding with NoV capsid proteins, through complementary charges, π-π stacking, and/or hydrophobic interactions.

A Novel Microwave Hot Pressing Machine for Production of Fixed Oils from Different Biopolymeric Structured Tissues.

A microwave hot pressing machine (MHPM) was used to heat the colander to produce fixed oils from each of castor, sunflower, rapeseed, and moringa seed and compared them to those obtained using an ordinary electric hot pressing machine (EHPM). The physical properties, namely the moisture content of seed (MCs), the seed content of fixed oil (Scfo), the yield of the main fixed oil (Ymfo), the yield of recovered fixed oil (Yrfo), extraction loss (EL), six Efficiency of fixed oil extraction (Efoe), specific gravity (SGfo), refractive index (RI) as well as chemical properties, namely iodine number (IN), saponification value (SV), acid value (AV), and the yield of fatty acid (Yfa) of the four oils extracted by the MHPM and EHPM were determined. Chemical constituents of the resultant oil were identified using GC/MS after saponification and methylation processes. The Ymfo and SV obtained using the MHPM were higher than those for the EHPM for all four fixed oils studied. On the other hand, each of the SGfo, RI, IN, AV, and pH of the fixed oils did not alter statistically due to changing the heating tool from electric band heaters into a microwave beam. The qualities of the four fixed oils extracted by the MHPM were very encouraging as a pivot of the industrial fixed oil projects compared to the EHPM. The prominent fatty acid of the castor fixed oil was found to be ricinoleic acid, making up 76.41% and 71.99% contents of oils extracted using the MHPM and EHPM, respectively. In addition, the oleic acid was the prominent fatty acid in each of the fixed oils of sunflower, rapeseed, and moringa species, and its yield by using the MHPM was higher than that for the EHPM. The role of microwave irradiation in facilitating fixed oil extrusion from the biopolymeric structured organelles (lipid bodies) was protruded. Since it was confirmed by the present study that using microwave irradiation is simple, facile, more eco-friendly, cost-effective, retains parent quality of oils, and allows for the warming of bigger machines and spaces, we think it will make an industrial revolution in oil extraction field.

Tailoring the interfacial surfaces of tungsten and molybdenum tungsten disulfide electrodes for hybrid supercapacitors.

The layered structures of tungsten disulfide (WS2) and molybdenum tungsten disulfide (MoWS2) are considered as the most promising electrode materials for energy storage devices. Herein, MS (magnetron sputtering) is required for the deposition of WS2 and MoWS2 on the surface of the current collector to attain an optimized layer thickness. The structural morphology and topological behavior of the sputtered material were examined via X-ray diffraction and atomic force microscopy. Three-electrode assembly was used to start the electrochemical investigations to identify the most optimal and effective sample among WS2 and MoWS2. CV (cyclic voltammetry), GCD (galvanostatic charging discharging), and EIS (electro-impedance spectroscopy) techniques were employed to analyze the samples. After preparing WS2 with optimized thickness as the superior performing sample, a hybrid device was designed as WS2//AC (activated carbon). With a remarkable cyclic stability of 97% after 3000 continuous cycles, the hybrid supercapacitor generated a maximum energy density (Es) value of 42.5 W h kg-1 and 4250 W kg-1 of power density (Ps). Besides, the capacitive and diffusive contribution during the charge-discharge process and b-values were calculated by Dunn's model, which lay in the 0.5-1.0 range and the fabricated WS2 hybrid device was found to have a hybrid nature. The outstanding outcomes of WS2//AC make it suitable for future energy storage applications.

Current practice and beliefs of parents toward sunscreen use for their children: A cross-sectional study.

Parents are generally influencing the sun protection behaviors of their children, including sunscreen use. In Saudi Arabia, sunscreen use was estimated in adults but not children. The objective was to estimate the prevalence and predictors of sunscreen use among parents and their children. An observational cross-sectional study was conducted in April 2022. Parents who were visiting outpatient clinics at a university hospital in Al-Kharj city, Saudi Arabia, were invited to complete an online questionnaire. A total of 266 participants were included in the final analysis. The mean age of parents was 39.0 ± 8.9 years, and the mean age of children was 8.2 ± 3.2 years. The prevalence of sunscreen use was 38.7% in parents and 24.1% in their children. Females had higher sunscreen use than males in both parents (49.7% versus 7.2%, p < 0.001) and in children (31.9% versus 18.3%, p = 0.011). The most frequent sunburn protection measures practiced by children were wearing long-sleeved clothes (77.0%), sitting in the shade (70.6%), and wearing hats (39.2%). In multivariable analysis, predictors of sunscreen use in parents included female sex, history of sunburn, and sunscreen use by children. Independent predictors of sunscreen use in children included a history of sunburn, wearing hats, and practicing other sunburn protection measures on risky occasions, and sunscreen use in parents. Sunscreen use in parents and children in Saudi Arabia is still inadequate or limited. This calls for community/school intervention programs using educational activities and multimedia promotion. Further studies are needed.

Effect of Asymmetric Fins on Thermal Performance of Phase Change Material-Based Thermal Energy Storage Unit.

Phase change material (PCM)-based thermal energy storage units (TESU) have very low thermal conductivity that compromise their charging and discharging rate. The present study focuses on an enhancement in charging rate as well as an increase in the uniformity of the melting rate. A rectangular cavity consisting of two horizontal partial fins is studied. The horizontal partial fins are placed symmetrically in a PCM-based TESU. In the current work, the melting rate of PCM was enhanced using asymmetric arrangement while keeping all other parameters the same, thus showing the positive effect of asymmetric configuration in such storage systems. The position and the pitch of each fin is optimized to improve heat transfer characteristics of the TESU. The numerical investigation of the problem is performed. TESU with asymmetrically placed fins show better performance in terms of higher charging rate as well as uniformity of the charging rate. The asymmetric placement of the fins suggested by present study increased the charging rate by 74.3% on average as compared to the symmetrically placed fins in the storage system. The charging rate uniformity is improved by 43.7%. The asymmetric fin's placement conserved the convection strength for a longer melting duration and so increased the Nusselt number by 80.2% as compared to the symmetrically placed fins. Thus, it can be concluded that the performance of asymmetric fins is better in the charging of PCMs than the symmetrically placed fins in a PCM-based TESU.

Thrombocytosis as a paraneoplastic syndrome in metastatic malignant peritoneal mesothelioma of biphasic morphology mimicking ovarian adenocarcinoma: A case report.

Malignant peritoneal mesothelioma (MPM) is a rare malignancy, presenting with non-specific and potentially-misleading manifestations. It represents a diagnostic pitfall as it mimics ovarian carcinoma. Maintaining a low diagnostic threshold, obtaining a detailed history, and utilizing immunohistochemical markers to diagnose MPM is crucial as early diagnosis and treatment might improve survival.

A Case of Synchronous Multiple Primary Malignancies Involving Multiple Myeloma and Pharyngeal Plasmacytoma in an Elderly Male: A Case Report and Review of the Literature.

Monoclonal plasma cells form the solitary neoplasm known as solitary plasmacytoma. Isolated extramedullary plasmacytoma is less common than solitary bone plasmacytoma. An elderly male presented with coughing blood and was diagnosed with pharyngeal plasmacytoma with synchronous multiple myeloma. Herein, we present this challengingly rare case to increase awareness of this unusual entity.

The burden and predictors of venous thromboembolic diseases in patients with multiple primary malignancies.

BACKGROUND: Venous thromboembolism (VTE) represents a considerable burden on cancer patients' survival and quality of life, but this burden varies based on the patient's baseline characteristics and cancer-related factors. Although solid evidence on the predictors and effect of VTE in cancer patients exists. AIM: To evaluate VTE rate, morbidity, and mortality to develop parameters that could predict VTEs and their associated mortality in patients with multiple primary malignancies (MPMs). METHOD AND RESULTS: This was a retrospective cohort study that took place at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Two hundred and forty-two patients with at least two biopsy-proven malignancies and had at least 3 months of follow-up after MPMs diagnosis were included. VTE was diagnosed in 14.5% of the cases, two-thirds of which were deep vein thrombosis. VTE was significantly associated with a higher mortality and worse survival. Predictors of VTE after MPMs diagnosis were a high ECOG performance status at MPMs diagnosis, a metastatic first primary malignancy, and ICU admission after MPMs diagnosis. Having a GI or hematological malignancy as the second primary malignancy, a high D-dimer at ICU admission, and palliative care referral were significantly associated with a higher mortality in patients who had VTE. CONCLUSION: VTE was diagnosed in 14.5% of patients with MPMs and it significantly compromises their survival. We believe that these results might be of particular benefit since the phenomenon of MPMs is becoming more frequently encountered.

The Awareness of Child Abuse and Neglect Among the Saudi Population: A Narrative Review.

Child abuse and neglect (CAN) is a pressing global issue with profound implications for the well-being of children. The aim of this review is to examine the existing literature and synthesize evidence on the awareness, knowledge, and attitudes toward child abuse and neglect within the Saudi population. This review synthesizes the existing literature to illuminate the awareness, knowledge, and attitudes surrounding CAN within the Saudi population. Ten studies spanning the years 2019-2023 were meticulously analyzed, offering a comprehensive snapshot of CAN perceptions across various segments of society. The studies, encompassing diverse methodologies and populations, collectively underscore the commendable levels of awareness and knowledge demonstrated by healthcare professionals, including primary healthcare (PHC) physicians, nurses, and medical practitioners. Notably, several studies reveal that these professionals exhibit robust recognition of different forms of child abuse, a vital aspect in the identification and prevention of abuse cases. While positive attitudes toward CAN were prevalent among healthcare providers, barriers to reporting were highlighted. The fear of consequences and uncertainty emerged as key deterrents to reporting among medical and dental students and nurses, respectively. These findings emphasize the necessity for creating supportive environments that empower professionals to report suspected cases of abuse while addressing apprehensions. The parental perception of CAN also came into focus, revealing a disparity between the recognition of CAN as a common problem and the adequate knowledge of emotional abuse and neglect. These findings point toward a need for targeted public awareness campaigns that differentiate between disciplinary practices and abusive behaviors. In conclusion, this review offers a nuanced understanding of the Saudi population's awareness, knowledge, and attitudes toward child abuse and neglect. The synthesis of findings across diverse studies informs future interventions, advocating for enhanced awareness, reporting, and prevention strategies. By empowering individuals and professionals alike, a safer environment for Saudi children can be nurtured, fostering a future free from the shadows of abuse and neglect.

Single-Anastomosis Sleeve Jejunal Bypass as a Treatment for Morbid Obesity: A Systematic Review and Meta-Analysis.

Single-anastomosis sleeve jejunal (SASJ) bypass is a bariatric surgery technique with promising results. However, evidence of its efficacy and safety is still lacking. This study aimed to summarize the evidence regarding the efficacy and safety of SASJ bypass surgery in the treatment of morbid obesity. The literature was searched for English-language studies published from inception till November 26, 2023, on MEDLINE/PubMed, Cochrane Library, Web of Science, ProQuest, Scopus, SCINAPSE, and Google Scholar. The search terms included "morbid obesity," "bariatric surgery," and "single anastomosis sleeve jejunal bypass." Extracted data included the body mass index (BMI) before and after surgery, percent total weight loss (%TWL), percent excess weight loss (%EWL), and improvement in preoperative comorbidities. Pooling of the data was done using random effects or fixed-effect models based on the presence of significant heterogeneity. Nine studies were included in this systematic review and meta-analysis. The change in BMI from baseline at 12 months after SASJ bypass was significant (standardized mean difference (SMD) = -3.576, 95% confidence interval (CI) = -5.423, -1.730; I² = 99.23%). At 12 months after surgery, the pooled %TWL was 42.526 (95% CI = 37.948, 47.105; I² = 97.15%), and the pooled %EWL was 75.258 (95% CI = 67.061, 83.456; I² = 99.26%). The pooled incidence of postoperative improvement in diabetes mellitus was 91% (95% CI = 79.6%, 98%, I² = 82%). The overall rate of complications was 9.9% (95% CI = 2.5%, 21.6%; I² = 92.64%). Regarding the short- and mid-term outcomes, SASJ bypass is a safe and effective procedure for weight loss in patients with morbid obesity, with an acceptable rate of complications. The procedure is also associated with a marked improvement in obesity-related comorbidities.

Isolated Cardiac Sarcoidosis Presenting as Torsades de Pointes in a Patient With Non-ischemic Cardiomyopathy: A Case Report.

Sarcoidosis is an immune-mediated, inflammatory, non-caseating-granulomatous disease that can virtually infiltrate any organ. Cardiac sarcoidosis is a leading cause of death in patients with sarcoidosis. Its clinical presentation is highly heterogenous and unpredictable, ranging from asymptomatic to life-threatening conduction disturbances, such as ventricular arrhythmias, and heart failure. Herein, we report a case of isolated cardiac sarcoidosis presenting as sinus bradycardia with first-degree atrioventricular block and an episode of non-sustained polymorphic ventricular tachycardia in a 42-year-old male with non-ischemic cardiomyopathy. He was diagnosed by cardiac magnetic resonance imaging and positron emission tomography with fluorodeoxyglucose and treated with oral prednisone.

Refractory Salmonella Prosthetic Valve Endocarditis Complicated by Splenic Infarction and Aortic Pseudoaneurysm in a Patient with Double Prosthetic Valves: A Case Report.

Endocarditis is an extremely rare complication of Salmonellosis with an incidence of 0.2-0.4%. It is a destructive and invasive infection that follows a highly complicated course and carries a high mortality rate that exceeds 45%. Multiple predisposing factors for Salmonella endocarditis have been described in the literature, including human immunodeficiency virus infection, congenital heart diseases, and the presence of a prosthetic valve. Herein, we report a case of Salmonella prosthetic valve endocarditis complicated by splenic infarction and aortic pseudoaneurysm presenting as a month-long history of fluctuating fever, chills, and rigors, accompanied by occasional cough and shortness of breath in a 55-year-old female with aortic and mitral valves replacement and multiple comorbidities. She was diagnosed by multiple radiographic studies and successfully treated with the Commando procedure and a long course of IV antibiotics.

A Descriptive Study of the Types and Survival Patterns of Saudi Patients with Multiple Primary Solid Malignancies: A 30-Year Tertiary Care Center Experience.

BACKGROUND AND OBJECTIVE: Cancer survival has improved significantly, which reflects the achievements in screening, diagnosis, and treatment. As a consequence, multiple primary malignancies are diagnosed more frequently, with an incidence ranging from 0.52-11.7%. The types of malignancy that coexist and survival patterns vary notably in different countries and geographical areas. Due to the limited literature in Saudi Arabia, a baseline of prevalent malignancy combinations and their survival patterns would support early detection and disease management. METHOD: This was a retrospective descriptive study conducted from 1993-2022 at King Abdulaziz Medical City, Department of Medical Oncology, Riyadh, Saudi Arabia. Patients with at least two biopsy-proven solid malignancies were included. Patients with hematological malignancies, missing data, or an uncertain or indecisive pathology report were excluded. RESULT: In total, 321 patients were analyzed. More than half (57.3%) of the patients were female. A third (33%) of the cases were synchronous, and 67% were metachronous. The most frequent site of the first primary malignancy was breast cancer, followed by colorectal, skin, and thyroid cancers. The most frequent site of the second primary malignancy was colorectal cancer, followed by thyroid, breast, and liver cancers. Only 4% of the cases had a third primary malignancy, with colorectal and appendiceal cancers being the most frequent. The most frequently observed histopathology in the synchronous and metachronous malignancies was adenocarcinoma. Breast-colorectal, breast-thyroid, and kidney-colorectal were the most frequently observed malignancy combinations. CONCLUSION: The current study offers a baseline of multiple primary malignancies in Saudi Arabia and provides supporting evidence that the pattern of multiple primary malignancies varies among different countries and ethnicities. The possibility of developing another primary malignancy should be considered when treating and monitoring cancer patients.

Recurrent Adipsic Hypernatremia in a Fully Independent Non-psychiatric Patient With Multiple Congenital Anomalies: A Case Report.

Osmoregulation is a fundamental process of homeostasis that maintains metabolic and biochemical reactions, thermoregulation, and fluid-electrolytes balance. Fluid-electrolytes imbalance leads to various clinical manifestations ranging from mild weakness to severe neurological dysfunction. Adipsic hypernatremia is an exceedingly rare life-threatening condition characterized by defective osmoregulatory mechanisms. It is more often reported in patients with severe untreated psychiatric disorders for unknown etiologies, but it may result from congenital or acquired hypothalamic lesions in the form of stroke, neoplastic infiltration, trauma, or infection. Herein we report an unusual case of isolated hypernatremia in a fully independent non-psychiatric 27-year-old diabetic male with spina bifida, repaired cleft palate, and mild caudal regression syndrome.