Impact of the Antioxidant Hydroxytyrosol on the Quality of Post-Thawed Stallion Semen.

The objective of this study was to investigate the impact of including hydroxytyrosol (HT) antioxidant on the viability of sperm after the processes of cooling and freezing. HT antioxidants were used in the HF-20 extender at concentrations of 1.25, 2.5, 5, and 10 µg/ml. The HF-20 extender was a basic extender and was used for the control group. The post-thawed semen exhibited significantly higher total motility in the 2.5 HT and 10 HT treatment groups than the control group. The straight line velocity (VSL) of the 2.5 HT group exhibited a significantly high value compared with the control group. However, the average path velocity (VAP), linearity (LIN), straightness index (STR), and wobble (WOB) revealed identical findings across all groups. The findings of the analysis of HOST, normal morphology, major abnormalities, and minor abnormalities revealed that there were no significant differences between the HT groups and the control groups. Nevertheless, the use of HT antioxidant for freezing semen led to a notable enhancement (p < 0.05) in both acrosome integrity and vitality tests when compared to the control group. In this case, the lower quantities of HT (1.25 and 2.5 µg/ml; p < 0.05) preserve the DNA fragmentation compared with the 5 HT, 10 HT, and control groups. In conclusion, the HT antioxidant has shown the capacity to enhance the quality of frozen-thawed spermatozoa and positively influence the viability and integrity of DNA inside the frozen-thawed spermatozoa. Additional research should be conducted to assess the fertility potential of cryopreserved stallion semen.

Perceptions and Factors That Influence the Choice of Pathology as a Career Among Medical Students in Saudi Arabia.

Introduction Pathologists play a pivotal role in diagnosing diseases and improving patient care. Nonetheless, research indicates that a mere fraction of medical school graduates opt for a career in pathology, ranging from 1% to 3%. Diverse factors influence students' perceptions of pathology, encompassing lifestyle, patient interaction, and income. Aim The aim of this study was to assess the perceptions and factors that influence students' selection of pathology as a career in Saudi Arabia. Methodology A cross-sectional, self-administered electronic questionnaire was distributed among students from various regions of Saudi Arabia. The questionnaire encompassed both quantitative and qualitative data. To ensure statistical rigor, a confidence level of 95%, response distribution of 10%, and margin of error of 5% were applied. Accordingly, the recommended sample size of 150 participants was determined. Data analysis was performed using IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY), with the chi-square test applied at a significance level of P < 0.05. Results Among the 664 participating students, 130 (19.6%) indicated an interest in pathology, of whom only 19 (2.9%) regarded it as their primary choice. No statistically significant difference was found between the male and female students or between the students in foundational and clinical years. Conclusions The female students generally held a more favorable perception of pathology, acknowledging its clinical significance and role in diagnosis, prognosis, and patient management. The absence of nocturnal calls emerged as the most encouraging factor, while limited patient interaction emerged as the primary deterrent in choosing pathology.

Bioequivalence trials for the approval of generic drugs in Saudi Arabia: a descriptive analysis of design aspects.

BACKGROUND: This retrospective analysis aimed to comprehensively review the design and regulatory aspects of bioequivalence trials submitted to the Saudi Food and Drug Authority (SFDA) since 2017. METHODS: This was a retrospective, comprehensive analysis study. The Data extracted from the SFDA bioequivalence assessment reports were analyzed for reviewing the overall design and regulatory aspects of the successful bioequivalence trials, exploring the impact of the coefficient of variation of within-subject variability (CVw) on some design aspects, and providing an in-depth assessment of bioequivalence trial submissions that were deemed insufficient in demonstrating bioequivalence. RESULTS: A total of 590 bioequivalence trials were included of which 521 demonstrated bioequivalence (440 single active pharmaceutical ingredients [APIs] and 81 fixed combinations). Most of the successful trials were for cardiovascular drugs (84 out of 521 [16.1%]), and the 2 × 2 crossover design was used in 455 (87.3%) trials. The sample size tended to increase with the increase in the CVw in trials of single APIs. Biopharmaceutics Classification System Class II and IV drugs accounted for the majority of highly variable drugs (58 out of 82 [70.7%]) in the study. Most of the 51 rejected trials were rejected due to concerns related to the study center (n = 21 [41.2%]). CONCLUSION: This comprehensive analysis provides valuable insights into the regulatory and design aspects of bioequivalence trials and can inform future research and assist in identifying opportunities for improvement in conducting bioequivalence trials in Saudi Arabia.

Recent Advances in Drug Delivery Systems Targeting Insulin Signalling for the Treatment of Alzheimer's Disease.

Alzheimer's disease (AD) is a complex neurodegenerative disorder characterized by the accumulation of neurofibrillary tangles and amyloid-ß plaques. Recent research has unveiled the pivotal role of insulin signaling dysfunction in the pathogenesis of AD. Insulin, once thought to be unrelated to brain function, has emerged as a crucial factor in neuronal survival, synaptic plasticity, and cognitive processes. Insulin and the downstream insulin signaling molecules are found mainly in the hippocampus and cortex. Some molecules responsible for dysfunction in insulin signaling are GSK-3ß, Akt, PI3K, and IRS. Irregularities in insulin signaling or insulin resistance may arise from changes in the phosphorylation levels of key molecules, which can be influenced by both stimulation and inactivity. This, in turn, is believed to be a crucial factor contributing to the development of AD, which is characterized by oxidative stress, neuroinflammation, and other pathological hallmarks. Furthermore, this route is known to be indirectly influenced by Nrf2, NF-κB, and the caspases. This mini-review delves into the intricate relationship between insulin signaling and AD, exploring how disruptions in this pathway contribute to disease progression. Moreover, we examine recent advances in drug delivery systems designed to target insulin signaling for AD treatment. From oral insulin delivery to innovative nanoparticle approaches and intranasal administration, these strategies hold promise in mitigating the impact of insulin resistance on AD. This review consolidates current knowledge to shed light on the potential of these interventions as targeted therapeutic options for AD.

Narrative review on nanoparticles based on current evidence: therapeutic agents for diabetic foot infection.

Diabetes's effects on wound healing present a major treatment challenge and increase the risk of amputation. When traditional therapies fail, new approaches must be investigated. With their submicron size and improved cellular internalisation, nanoparticles present a viable way to improve diabetic wound healing. They are attractive options because of their innate antibacterial qualities, biocompatibility, and biodegradability. Nanoparticles loaded with organic or inorganic compounds, or embedded in biomimetic matrices such as hydrogels, chitosan, and hyaluronic acid, exhibit excellent anti-inflammatory, antibacterial, and antioxidant properties. Drug delivery systems (DDSs)-more precisely, nanodrug delivery systems (NDDSs)-use the advantages of nanotechnology to get around some of the drawbacks of traditional DDSs. Recent developments show how expertly designed nanocarriers can carry a variety of chemicals, transforming the treatment of diabetic wounds. Biomaterials that deliver customised medications to the wound microenvironment demonstrate potential. Delivery techniques for nanomedicines become more potent than ever, overcoming conventional constraints. Therapeutics for diabetes-induced non-healing wounds are entering a revolutionary era thanks to precisely calibrated nanocarriers that effectively distribute chemicals. This review highlights the therapeutic potential of nanoparticles and outlines the multifunctional nanoparticles of the future that will be used for complete wound healing in diabetics. The investigation of novel nanodrug delivery systems has the potential to revolutionise diabetic wound therapy and provide hope for more efficient and focused therapeutic approaches.

Knowledge and attitude toward transcranial magnetic stimulation among rehabilitation specialists in Saudi Arabia.

Research has demonstrated the benefits of transcranial magnetic stimulation (TMS) in rehabilitation. TMS has been widely used in clinical and research settings for individuals with and without neurological dysfunctions. Therefore, understanding the knowledge and attitudes of rehabilitation specialists regarding TMS is crucial for its application. To our knowledge, no such studies have previously been conducted in the rehabilitation field. Therefore, this study is the first to assess rehabilitation specialists' knowledge of and attitudes toward TMS. An observational cross-sectional study using a self-administered online survey was conducted among 102 rehabilitation specialists to assess their knowledge and attitudes regarding TMS application in rehabilitation sciences. Descriptive and inferential statistics were used to describe the knowledge and attitudes of rehabilitation specialists toward TMS and examine the impact of different factors such as gender, education level, acceptability, and practice on these outcomes. Rehabilitation specialists who participated in this study showed a limited level of general knowledge of TMS in rehabilitation (7.81 ± 6.20, 37.19%). However, a significant association between educational levels and knowledge was found. Higher knowledge scores were observed for specialists with post-graduate degrees compared to those with only a bachelor's degree. Moreover, knowledge level, experience, and availability of TMS equipment in the workplace led to a positive attitude toward TMS among rehabilitation specialists. A low knowledge level among rehabilitation specialists was attributed to their level of education. Nevertheless, specialists showed an overall positive attitude toward TMS. Therefore, customized medical education is necessary to incorporate TMS theory and applications into neuroscience and rehabilitation courses for rehabilitation specialists as it holds significant promise as a therapeutic tool.

Sex Differences and Clinical Outcomes of Patients with Coronavirus Disease 2019 Infection and Cerebral Venous Sinus Thrombosis: A Systematic Review.

Cerebral venous sinus thrombosis (CVST) is a rare neurovascular condition that has been observed in individuals with coronavirus disease 2019 (COVID-19). This systematic review aimed to explore the sex differences and characteristics of concurrent COVID-19 and CVST cases. A total of 212 CVST patients were included in the study. Women with CVST had a slightly higher mean age compared to men (47.359 years vs 46.08 years). Women were more likely to report symptoms such as fever (56.1%) and decreased sense of smell or taste (71.4%), while men more frequently experienced nausea or vomiting (55.6%), headache (62.9%), and seizures (72%). Notably, current smokers, who were predominantly men, had a higher occurrence of CVST. On the other hand, women had a higher likelihood of CVST risk factors such as oral contraceptive pill (OCP) use and autoimmune diseases. Treatment approaches also showed sex-based differences. Unfractionated heparin was administered more often to women with CVST (63.2%). The in-hospital mortality rate for CVST patients was 21.3%, with men having a significantly higher mortality rate than women (65.2% vs 34.8%, P = .027). Survival analysis revealed that factors such as smoking history, diabetes mellitus, hypertension, OCP use, COVID-19 symptoms, CVST symptoms, and the need for intubation significantly influenced survival outcomes. Understanding these sex differences in COVID-19-related CVST is crucial for accurate diagnosis and effective management, ultimately leading to improved patient outcomes. Our findings highlight the importance of considering sex as a factor in the evaluation and treatment of individuals with COVID-19 and concurrent CVST.

Lumbar Spine Ganglion Cyst: A Case Report.

Ganglion cysts are typically periarticular soft tissue lesions commonly found in the wrist and forearm, with spinal involvement being rare. We present a clinical case of a 54-year-old female with a ganglion cyst at the L3-L4 level, causing radiculopathy symptoms. Despite initial difficulty in diagnosis due to MRI findings, surgical resection confirmed the extradural mass as a ganglion cyst. Postoperative recovery was uneventful, with immediate relief of radiculopathy symptoms. Challenges included distinguishing between synovial and ganglion cysts and accurately locating the cyst intraoperatively. This case highlights the importance of considering ganglion cysts in the differential diagnosis of spinal lesions and underscores the efficacy of surgical management for symptomatic relief.

Marine Predator Algorithm-Based Optimal PI Controllers for LVRT Capability Enhancement of Grid-Connected PV Systems.

Photovoltaic (PV) systems are becoming essential to our energy landscape as renewable energy sources become more widely integrated into power networks. Preserving grid stability, especially during voltage sags, is one of the significant difficulties confronting the implementation of these technologies. This attribute is referred to as low-voltage ride-through (LVRT). To overcome this issue, adopting a Proportional-Integral (PI) controller, a control system standard, is proving to be an efficient solution. This paper provides a unique algorithm-based approach of the Marine Predator Algorithm (MPA) for optimized tuning of the used PI controller, mainly focusing on inverter control, to improve the LVRT of the grid, leading to improvements in the overshoot, undershoot, settling time, and steady-state response of the system. The fitness function is optimized using the MPA to determine the settings of the PI controller. This process helps to optimally design the controllers optimally, thus improving the inverter control and performance and enhancing the system's LVRT capability. The methodology is tested in case of a 3L-G fault. To test its validity, the proposed approach is compared with rival standard optimization-based PI controllers, namely Grey Wolf Optimization and Particle Swarm Optimization. The comparison shows that the used algorithm provides better results with a higher convergence rate with overshoot ranging from 14% to 40% less in the case of DC-Link Voltage and active power and also settling times in the case of MPA being less than PSO and GWO by 0.76 to 0.95 s.

Level of Knowledge and Attitude Toward Acute Abdomen Among the Public: A Nationwide Study.

Introduction Treatment of patients suffering from acute abdominal pain (AAP) is often challenging due to its wide range of associated illnesses, which could delay or prevent the identification of the correct diagnosis. Multiple diagnoses should be considered, particularly those in life-threatening situations needing urgent intervention. Aim This study aimed to assess the level of knowledge among the general population related to acute abdomen and which specialty should be sought for consultation in AAP situations. Subject and methods This cross-sectional study was conducted among the general population living in Saudi Arabia. A self-administered questionnaire was sent to the Saudi population through the Google survey. The questionnaire included basic demographic characteristics (i.e., age, gender, etc.), perceived causes, barriers, the most common symptoms of AAP, and a five-item questionnaire to assess the general population's knowledge about AAP. Results Of the 2,703 respondents, 68.1% were females, and 42.4% were aged between 18 and 25 years old. The digestive system disorders (esophagus, stomach, intestine, and colon) were the most perceived causes that led to AAP (76.6%). The overall mean knowledge score was 1.35 (SD 1.07) out of five points. Accordingly, nearly all (87.2%) were considered to have poor knowledge, 9.5% were considered to have moderate knowledge, and only 3.3% were considered to have good knowledge. Being younger, being a male, and living in the Central Region were the factors associated with increased knowledge. Conclusion There was a lack of knowledge about AAP among the general population in Saudi Arabia. Younger age, gender males, and living in the Central Region were identified as the significant factors of increased knowledge. It is necessary to increase the knowledge of the population regarding acute abdomen. Media awareness campaigns may play a significant role in providing the necessary information to the general public.

Burden of Illness of Type 2 Diabetes Mellitus in the Kingdom of Saudi Arabia: A Five-Year Longitudinal Study.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is associated with huge clinical and economic burden in the Kingdom of Saudi Arabia (KSA) which can be curtailed by efficacious treatment. In order to achieve this, current treatment pathways for T2DM and associated costs need to be assessed. METHODS: A longitudinal cohort review was conducted to collect country-specific and patient-specific clinical data, over a minimum observation period of 5 years in the KSA. Patient demographics, clinical characteristics and treatment patterns were recorded. The IQVIA Core Diabetes Model (CDM) version 9.5 Plus was used to assess the burden of illness, which included long-term projections of clinical (life expectancy [LE], quality-adjusted life-years [QALYs], event rates of diabetes-related complications) and direct medical cost (per-patient annual or lifelong [50 years]) outcomes of the most commonly used first-line (1st-line) regimens for T2DM from a payer perspective in the KSA. RESULTS: Data were collected from a subpopulation of 638 patients from 15 participating centres. There was an equal gender representation with a majority of the patients belonging to Arabian/Saudi ethnicity (71.0%). Biguanides (81.5%), sulfonylureas (51.6%), dipeptidyl peptidase 4 (DPP4) inhibitors (26.2%) and fast-acting insulins (17.2%) were the most prescribed 1st-line agents. The most frequently used 1st-line regimens resulted in an estimated LE of 25-28 years, QALYs of 18-21 years and lifelong total cost of illness of 201,377-437,371 Saudi Arabian riyal (53,700-116,632 US dollars). CONCLUSION: Our study addresses gaps in the current research by providing a complete landscape of baseline demographic, clinical characteristics and treatment patterns from a heterogeneous group of patients with T2DM in the KSA. Additionally, the burden of illness analysis using CDM showed substantially higher cost of T2DM care from a payer perspective in the KSA.

Retraction: Schwannoma: A Rare Etiology of Pancoast Syndrome.

[This retracts the article DOI: 10.7759/cureus.19418.].

A Rare Presentation of Cutaneous Scalp Metastasis From a Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review.

This report presents a unique case of a 56-year-old female diagnosed with a malignant phyllodes tumor (PT). Following a modified radical mastectomy, the patient exhibited metastasis to the lungs, bones, and, uncommonly, the scalp. Despite treatment interventions, including chemotherapy and radiotherapy, the patient's condition progressed, underscoring the aggressive nature of malignant PTs. This case emphasizes the importance of recognizing unusual metastatic sites and the challenges in managing such aggressive tumors.

An unusual non-hematopoietic bone marrow finding.

We present an interesting case that showed a non-hematopoietic structure embedded in the bone marrow biopsy. Given the clinical and morphological difficulties, it was challenging to identify this artifact's nature. Publishing this case would familiarize pathologists with this artifact and save additional testing and delays in reporting.

Impact of telepharmacy on patients’ outcome during COVID-19: a systematic literature review

Background: Coronavirus disease (COVID-19) continues to be a major global public health issue. COVID-19 is highly contagious, and numerous mitigation strategies have recently been implemented to prevent the spread of this disease. Pharmacists utilize telecommunication technology to provide patient care services, thus increasing patient access to pharmaceutical services. There was a scarcity of evidence regarding the impact of telepharmacy on patient outcomes during COVID-19. Therefore, the aim of this study was to summarize the available research evidence on the impact of telepharmacy on patient outcomes during COVID-19. Methods: A systematic literature search was conducted between January 2020 to September 2022 in Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials, using appropriate terms on telepharmacy, COVID-19, and patient outcomes. Only studies that investigated the impact of telepharmacy on patient outcomes during COVID-19 were included. A systematic literature search was conducted between January 2020 to September 2022 in Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials, using appropriate terms on telepharmacy, COVID-19, and patient outcomes. Only studies that investigated the impact of telepharmacy on patient outcomes during COVID-19 were included. Results: A total of three studies were included in the review. The telepharmacy services were offered via virtual anticoagulation clinic, retail community telepharmacy through information technology tools, and RxLive® telepharmacy program. All studies included in the review demonstrated that the provision of telepharmacy services during COVID-19 had an overall positive impact on the patient outcomes such as a reduction in the rates of hospitalisation and medication-related problems and maintaining the international normalized ratio values within the therapeutic range (AU)

The Association of Psoriasis, Diabetes Mellitus, and Hypertension: A Meta-Analysis.

Psoriasis is a systemic disease affecting various organs; however, it is usually thought of as a skin disease. A multidisciplinary approach is needed for better outcomes. The current meta-analysis assessed the association between diabetes mellitus, high blood pressure, and psoriasis. We searched four databases, including Cochrane Library, PubMed, MEDLINE, and Google Scholar, for relevant articles using the following keywords: psoriasis, hypertension, high blood pressure, cardiovascular risk factors, and diabetes mellitus. The author's name, year, and country of publication, diabetes, and hypertension among patients with psoriasis and control subjects were collected and entered into a Microsoft Excel sheet. Out of 1209 articles retrieved, 903 articles remained after duplication removal. From the 82 full texts screened, only seven studies fulfilled the inclusion and exclusion criteria. Psoriasis was associated with diabetes and hypertension: odds ratio 1.38, 95% CI 1.17-1.64; P-value 0.0002, chi-square 224.93, and odds ratio 1.60, 95% CI 1.41-1.81, P-value 0.00001, chi-square 226.59, respectively. Substantial heterogeneity was observed (I2 for heterogeneity, 97%, P < 0.001). A broad approach is needed to address the associated comorbidities and select the appropriate therapeutic approach. Randomized controlled trials investigating the best drugs for the treatment of psoriasis and its associated cardiovascular risk factors are needed.

Comparison of Knowledge of Lactose Intolerance and Cow's Milk Allergy Among the Medical Students at Two Universities in Saudi Arabia.

Lactose intolerance is a condition causing an inability to absorb and digest lactose leading to gastrointestinal symptoms such as abdominal pain, diarrhea, and flatulence. Because of the similarities between lactose intolerance and cow's milk allergy, it is becoming necessary to increase physicians' understanding of these two diseases. Consequently, we aimed to determine the level of knowledge of lactose intolerance and cow's milk allergy among medical students. An electronic survey was distributed to 399 medical students at two universities in Saudi Arabia from October to November 2022. The majority of the respondents had an inadequate knowledge of both lactose intolerance and cow's milk allergy (99.75% and 97.99%, respectively). According to the study's results that showed a lack of awareness among health-related students, further studies and awareness programs are highly recommended.

The Incidence of Devitalization of Vital Teeth Associated with Pathologies of the Jaws Following Surgical Intervention: A Mixed-case Study.

AIM: The purpose of this mixed-case study is to explore the incidence of pulp necrosis of vital teeth after surgical treatment of adjacent lesions of the jaws. MATERIALS AND METHODS: The records of 341 biopsies submitted to the institute's histopathology laboratory were reviewed to include cases that met the inclusion criteria. About 84 biopsies collected from patients during surgical enucleation of lesions in proximity to healthy vital teeth were included of which 22 patients were recalled. Adjacent teeth were examined clinically and radiographically to assess their pulpal and periapical status after at least 8 months of follow-up. RESULTS: There were 7 different pathological lesions diagnosed histologically. The follow-up period ranged between 8 and 72 months; 12 cases (54.6%) have developed pulpal necrosis for at least one tooth after surgical enucleation of the lesion. The other 10 cases (45.4%) showed normal responses to sensibility testing for all the teeth adjacent to the lesion. Ten out of the 12 cases (83%) that underwent pulpal necrosis were associated with odontogenic cysts, whereas the remaining 2 were associated with periapical granuloma and fibrous dysplasia. CONCLUSION: Pulp necrosis is high in vital teeth associated with lesions without pulpal involvement. These teeth may benefit from root canal treatment prior to surgical enucleation of the lesion, which may prevent impaired healing or recurrence of infection. CLINICAL SIGNIFICANCE: Careful treatment planning and thorough discussion should take place between the surgeons, endodontists, and patients prior to executing the treatment. The patient should be aware that there is a possibility that they may need root canal treatment as a preventative measure to enhance the chances of healing following the surgical procedures and in case the patients opted not to perform root canal treatment beforehand, close follow-up in the future should take place to monitor the vitality of the teeth in the follow-up visits.

Acceptance and Attitude Toward Cosmetic Surgeries in the Western Region of Saudi Arabia: A Cross-Sectional Survey.

Cosmetic surgery refers to any surgical intervention that alters normal bodily characteristics in order to attain a more appealing appearance as perceived by the patient. Data from the American Society of Plastic Surgeons (ASPS) indicates a consistent rise in plastic surgery procedures over time. The objective of our research is to carry out a cross-sectional investigation to assess the perceptions and attitudes toward cosmetic surgery among individuals residing in the western region of Saudi Arabia. This study employed a descriptive, cross-sectional methodology. The intended sample includes residents of Makkah and Medina Regions who are 18 years of age or older, representing the general population. Data collection was carried out through an online questionnaire created using Google Forms, which was disseminated electronically via social media platforms. The questionnaire gathered demographic information and assessed participants' attitudes and acceptance towards cosmetic surgery. The study included a total of 1249 participants, with 1064 (85%) being female and 185 (15%) being male. In our sample, the overall acceptance rate for cosmetic surgery was 54.2%. There was a significant correlation between the acceptance level and factors such as gender, age, marital status, and occupational status (P value <0.001) for all the aforementioned factors. However, the level of education and financial status were not significantly associated. The majority of the participants in our study were accepting of cosmetic surgery. However, to gain a more comprehensive understanding of the acceptance of aesthetic surgery in Saudi Arabia, further research should be conducted across the country to assess the attitudes of the wider population.

A Ventriculoperitoneal Shunt With Anal Protrusion Causing Meningitis in A Child.

The ventriculoperitoneal (VP) shunt has been one of the primary methods for treating hydrocephalus for many years and is one of the most frequent surgical interventions performed in neurosurgery using a variety of techniques and different VP shunt types. Consequently, shunt insertion is associated with many complications, including insertion failure, functional failure, and mechanical failure such as shunt migration. Shunt migration to the gastrointestinal or urogenital tract is a rare and one of the most distressing complications, which can lead to ascending infection and even meningitis. We report a rare case of a 24-month-old male with a VP shunt tube that migrated and protruded from the anus, subsequently causing meningitis.