Cubeb (Piper cubeba L.): nutritional value, phytochemical profiling and dermacosmeceutical properties.

Introduction: Cubeb, Piper cubeba L., has been used for centuries in traditional medicine and culinary practices, with a wide range of biological and pharmacological activities. Objective: Herein, we determined the phytochemical profile, mineral, fatty acids, and amino acid contents of P. cubeba berries and assessed the dermacosmeceutical properties of their water extract and essential oil (EO). These included assessing their antioxidant and antibacterial activities as well as their in vitro inhibitory activities against tyrosinase and elastase enzymes. In addition, molecular docking and molecular dynamics studies were performed on the major identified compounds of the EO. Results and discussion: A total of forty-three compounds belonging to organic acids, phenolic acids and flavonoids were found in the water extract, while 36 volatile compounds were identified in the EO with Z-isoeugenol, dihydroeugenol, ß-pinene, E-caryophyllene, and 1,8-cineole as major constituents. The berries were found to be rich in sodium and iron, have moderate zinc content along with low contents of total nitrogen, phosphorus, and potassium. Amino acid analysis revealed a considerable concentration of isoleucine and phenylalanine, whereas 11,14,17-eicosatrienoic acid and linoleic acid were identified as the major fatty acids. In the DPPH and FRAP assays, the water extract elicited considerable antioxidant activity compared to the reference compounds. Enzyme inhibitory assays revealed that the EO had a potential to inhibit tyrosinase and elastase enzymes with IC50 values of 340.56 and 86.04 µg/mL, respectively. The water extract and EO completely inhibited the bacterial growth at MIC of 50 mg/mL and 20%, respectively. At sub-MIC concentrations, the extract and the EO substantially reduced the biofilm formation by up to 26.63 and 77.77%, respectively, as well as the swimming and swarming motilities in a dose-dependent manner. Molecular docking and molecular dynamics showed that the five main components of P. cubeba EO could be the major contributors to the elastase and tyrosinase inhibitory effect. Conclusion: This study emphasizes the promising potential of P. cubeba as a valuable source of natural compounds that can be utilized for the development of innovative pharmaceuticals, dietary supplements, and dermacosmeceutical agents.

Exploring Genetic Determinants: A Comprehensive Analysis of Serpin B Family SNPs and Prognosis in Glioblastoma Multiforme Patients.

Serpins are serine proteinase inhibitors, with several serpins being overexpressed in cancer cells. Thus, we aim to analyze the single-nucleotide polymorphism (SNP) of Serpinb11 and its association with GBM survival. A cohort of 63 GBM patients recruited from King Abdullah University Hospital in Jordan underwent polymorphism analysis and overall survival (OS) assessments. The Cancer Genome Atlas (GBM) cohort was useful for validation. We constructed a risk score using the principal component analysis for the following Serpin genes: Serpinb3, Serpinb5, Serpinb6, Serpinb11, and Serpinb12, and patients were grouped into high- vs. low-risk groups based on the median cutoff. Univariable Cox models were used to study the survival outcomes. We identified a significant association between rs4940595 and survival. In the TCGA cohort, Serpinb3 alterations showed worse OS. Univariable Cox showed worse PFS outcomes with higher SERPINB5 and SERPINB6 expression. A Serpin B 5-gene risk score showed a trend towards worse PFS in the high-risk group. Upregulated DEGs showed GO enrichment in cytokine regulation and production, positive regulation of leukocyte activation, and the MAPK cascade. The high-risk group showed a significantly higher infiltration of M2 macrophages and activated mast cells. Our findings showed a significant role of the Serpin B family in GBM survival in the Jordanian population.

Tetraclinis articulata (Vahl) Mast.: Volatile constituents, antioxidant, antidiabetic and wound healing activities of its essential oil.

Type 2 diabetes mellitus (T2DM) is a metabolic syndrome known to contribute to impaired wound healing. This condition can be further worsened by excessive melanin production, elastin degradation, and chronic infections at the wound site, potentially leading to melasma and diabetic dermopathy. The purpose of this study was to investigate the phytochemical profile and inhibitory effects of Tetraclinis articulata essential oil (TAEO) on target enzymes involved in diabetes pathogenesis and chronic wound remodeling, namely α-amylase, α-glucosidase, tyrosinase, and elastase, as well as its in vitro antibacterial activity. Gas chromatography and mass spectrometry (GC-MS) analysis of TAEO led to the identification of 46 volatile compounds, representing 96.61 % of TAEO. The major metabolites were bornyl acetate (29.48 %), α-pinene (8.96 %), germacrene D (7.70 %), and d-limonene (5.90 %). TAEO exhibited limited scavenging activity against DPPH free radicals, whereas the FRAP and ABTS assays indicated a relatively higher antioxidant activity. Remarkably, TAEO disclosed a promising in vitro antidiabetic activity against α-glucosidase with an IC50 value of 178 ± 1.6 µg/mL, which is comparable to the standard inhibitor acarbose (IC50 = 143 ± 1.1 µg/mL). In silico, molecular docking analysis against α-glucosidase identified 15 compounds that interacted with the enzyme's active site, whereas skin permeability and sensitization assessments indicated that 26 out of the 44 identified volatile compounds were predicted to be free from any skin sensitivity risk. On the other hand, moderate inhibitory activity was recorded against α-amylase, tyrosinase, and elastase. Notably, TAEO at 5 % significantly suppressed biofilm formation by P. aeruginosa, S. aureus, and E. faecalis, common skin pathogens associated with wound infections, and reduced their swarming motility. Our findings suggest that TAEO may hold the potential as a natural remedy for type 2 diabetes and its associated co-morbidities, especially chronic wounds.

Cytomegalovirus and Epstein-Barr Virus Co-infection in a Patient With Chronic Granulomatous Disease Co-existing With Familial Mediterranean Fever and Early-Onset Inflammatory Bowel Disease: A Case Report.

The association between primary immunodeficiencies and autoinflammatory disorders has been popularized over the past decade. In this report, we illustrated the co-infection of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in a three-year-old Jordanian male patient with an extremely rare variant of the CYBB gene (c.125C>G, p.Thr42Arg) associated with chronic granulomatous disease (CGD) coexisting with familial Mediterranean fever (FMF). CGD and FMF co-existence induced early-onset inflammatory bowel disease mainly resembling Crohn's disease.

Cervical Ganglioneuroblastoma Diagnosed by 68Ga-DOTATOC PET/CT in a Child with Opsoclonus Myoclonus Syndrome.

We performed a 68Ga-DOTATOC PET/CT scan on a 25-mo-old female patient who presented with opsoclonus myoclonus ataxia syndrome and had negative initial anatomic imaging. The scan showed a somatostatin receptor-overexpressing cervical tumor in favor of a cervical neuroendocrine tumor, with subsequent histopathologic findings of ganglioneuroblastoma.

The impact of IDH and NAT2 gene polymorphisms in acute myeloid leukemia risk and overall survival in an Arab population: A case-control study.

Acute myeloid leukemia (AML) is a malignancy of the myeloid cells due to the clonal and malignant proliferation of blast cells. The etiology of AML is complex and involves environmental and genetic factors. Such genetic aberrations include FLT3, DNMT3, IDH1, IDH2, NAT2, and WT. In this study, we analyzed the relationship between five, not previously studied in any Arab population, single nucleotide polymorphisms (SNPs) and the risk and overall survival of AML in Jordanian patients. The SNPs are NAT2 (rs1799930 and rs1799931), IDH1 (rs121913500), and IDH2 (rs121913502 and rs1057519736). A total number of 30 AML patients and 225 healthy controls were included in this study. Females comprised 50% (n = 15) and 65.3% (n = 147) of patients and controls, respectively. For AML patients (case group) Genomic DNA was extracted from formalin-fixed paraffin-embedded tissues and from peripheral blood samples for the control subjects group. Genotyping of the genetic polymorphisms was conducted using a sequencing protocol. Our study indicates that NAT2 rs1799930 SNP had a statistically significant difference in genotype frequency between cases and controls (p = 0.023) while IDH mutations did not correlate with the risk and survival of AML in the Jordanian population. These results were also similar in the TCGA-LAML cohorts with the notable exception of the rare NAT2 mutation. A larger cohort study is needed to further investigate our results.

Tanacetum species: Bridging empirical knowledge, phytochemistry, nutritional value, health benefits and clinical evidence.

Introduction: The Tanacetum genus consists of 160 accepted flowering species thriving throughout temperate regions, mainly in the Mediterranean Basin, Northern America, and southwestern and eastern Asia. Tanacetum species bear a long-standing record of use in the folk medicine of indigenous tribes and communities worldwide, along with multitudinous applications in traditional cuisines, cosmeceuticals, and agricultural fields. Methods: Up-to-date data related to traditional uses, phytochemistry, biological activities, toxicity and clinical trials of the genus Tanacetum were systematically reviewed from several online scientific engines, including PubMed, Web of Science, Scopus, SciFinder, Wiley Online, Science Direct, and Cochrane library. Results and discussion: Over the past three decades, 241 metabolites have been isolated from nearly twenty species, including phenolic acids, flavonoids, coumarins, fatty acids and alkanes, aldehydes, volatile compounds, and naphthoquinones. Some unique metabolites have also been identified, such as the ceramides tanacetamide (A-D) from T. artemisioides, pyrethrins from T. cinerariifolium, and sesquiterpene lactones from several species. However, these secondary metabolites are still poorly studied despite in vitro clues highlighting their colossal pharmacological properties, especially as hypotensive, neuroprotective, anticancer, and antimicrobial agents. Scientific studies have validated some traditional claims of the plant, such as antidiabetic, anticancer, anthelmintic, insecticide, antioxidant, and hepatoprotective activities, as well as against festering wounds, skin ulcers, urinary tract infections, and sexually transmitted diseases. Other ethnomedicinal uses for arthritis, gout, rheumatism, anemia, and as a litholytic, antivenom and diaphoretic have not yet been supported and would constitute the subject of further research.

Cutaneous metastasis as the first presentation of poorly differentiated renal cell carcinoma: A case report.

Renal cell carcinoma (RCC) exhibits a propensity for unusual wide metastasis. Cutaneous metastasis from RCC is a rare and poorly recognized clinical entity. We present a case of cutaneous metastasis of poorly differentiated RCC in 49-year-old male patient. In the presented case, the skin lesion was the first sign of widely spread RCC. After the establishment of the diagnosis using radiological and histopathological assessments, the patient was labeled as a terminal case and was referred for pain management. He deceased after 6 months of the initial presentation.

Post-COVID-19 fatigue as a major health problem: a cross-sectional study from Missouri, USA.

BACKGROUND: Fatigue following acute viral illnesses is a major issue that complicates the clinical course of several epidemic and non-epidemic viral infections. There is a noticeably higher trend of patients with symptoms that persist after initial recovery from acute COVID-19. This study seeks to obtain more data about the prevalence of post-COVID-19 fatigue and the factors associated with higher fatigue frequency among patients who had COVID-19. METHODS: A single center cross-sectional study was performed between May 2021 and January 2022 at University Health, Kansas City, Missouri, USA. The Fatigue Assessment Scale (FAS) was utilized to measure post-COVID-19 fatigue. Descriptive and comparative statistics were used to describe clinical and sociodemographic features of patients. Analysis of variance (ANOVA), the chi-square test, and Fisher's exact test were used to examine the statistical association between the FAS score and other clinical and sociodemographic factors. RESULTS: One hundred and fifty-seven patients who had been diagnosed with COVID-19 and diagnosed at University Health were enrolled in our study. Overall, 72% of patients (n = 113) were female. The mean ± standard deviation of the FAS score was 21.2 ± 9.0. The prevalence of post-COVID-19 fatigue among our studied sample was 43.3%. The findings of this study suggest that female patients have a significantly higher fatigue score compared with male patients (P < 0.05). CONCLUSIONS: Post-COVID-19 fatigue is a major issue following the initial acute illness with COVID-19, with a prevalence of 43.3%. We recommend implementing standardized measures to screen for post-COVID-19 fatigue, especially among female patients.

Subcutaneous panniculitis-like T-cell lymphoma: an unusual cause of right thigh hypertrophy.

A man in his mid-20s presented with a painless swelling over his right thigh, which had been progressively increasing over 3 years. He underwent an excisional biopsy for the same, which showed reactive lymphadenopathy. Since the last year and a half, he developed a lower abdominal wall swelling with mild redness over it. In addition, over the last few months before presentation to haematology outpatient clinic, he experienced bouts of fever, night sweats, anorexia, weight loss and right inguinal lymphadenopathy. On examination, splenomegaly was identified. In view of the patients' symptoms, he underwent a positron emission tomography scan, which showed hypermetabolic activity in the subcutaneous tissue sparing the lymph nodes and spleen. A deep skin punch biopsy taken from his right thigh was consistent with the diagnosis of subcutaneous panniculitis-like T-cell lymphoma αß T-cell phenotype. The patient was treated successfully with oral steroids and on routine follow-up, he is in remission for 5 years.

Hemodynamic Effects of Ketamine Infusion in the Intensive Care Unit for Maintenance Sedation Compared With Propofol and Midazolam: A Retrospective Cohort Study.

Background: Sedation and analgesia in the intensive care unit (ICU) are major clinical challenges, and several continuous infusion medications have been used for these purposes. The use of these sedative medications has been associated with hemodynamic effects that complicate the patient's critical illness. Continuous ketamine infusion is an emerging sedative option that has been used more frequently in the ICU since 2017. The purpose of this study was to characterize the hemodynamic differences between 3 continuous sedative infusions: ketamine, propofol, and midazolam. Methods: For this single-center retrospective cohort study, we collected data for patients hospitalized between January 2015 and April 2020 at Saint Luke's Health System in Kansas City, Missouri. Adult patients in the ICU requiring a norepinephrine infusion and sedation were included. The change in norepinephrine requirement from baseline at 1 hour was the primary outcome. The change in vasopressor requirement at 3 and 30 hours after initiation of the infusion was also tabulated. Results: Sixty-eight critically ill patients with several types of shock requiring vasopressor support with norepinephrine were enrolled in our study. Patients who received ketamine had an increase in norepinephrine requirement compared to midazolam and propofol, although this difference was not statistically significant. Conclusion: In our study, continuous ketamine infusion did not reveal a statistically significant favorable hemodynamic effect compared with propofol and midazolam because of the small sample size. A trend toward an unfavorable hemodynamic effect is not expected, but large randomized trials are needed to further evaluate the hemodynamic effects of continuous ketamine infusion in the ICU.

Tetraclinis articulata (vahl) masters: An insight into its ethnobotany, phytochemistry, toxicity, biocide and therapeutic merits.

Tetraclinis articulata (Vahl) Masters, commonly known as Sandarac tree and Araâr, is the only species representing the genus Tetraclinis Masters. The plant has been extensively used for medicinal, artistic, and ritual purposes since its first recorded use in 1800 B.C. Recently, a full range of ethnobotanical investigations has been undertaken to document the plant's empirical knowledge. They reported the use of different parts, such as leaves, stems, cones, bark, and roots, as part of folk healing practices to manage diabetes mellitus, hypertension, fever, stomach disorders, and diarrhea, among others. The phytochemical studies have identified at least 130 compounds from leaves, cones, resin, bark, and woods. These chemical constituents are categorized into phenolic acids, flavonoids and their derivatives, volatile compounds, phytosterols, and fatty acids, among others. Furthermore, they have strongly been correlated with the promising antimicrobial, antioxidant, neuroprotective, antiurolithiatic, anti-inflammatory, antidiabetic, and cytotoxic properties of the plant. Toxicological studies argued that the plant is quite safe and devoid of eventual toxicity; however, in-depth investigations are required to validate the safety of the plant. The remarkable antimicrobial and antioxidant potencies of various extracts from the plant against a wide range of foodborne pathogens support their possible use to increase the shelf life of foodstuffs in the food industry. Likewise, various plant-based extracts have been proven to exert substantial biocidal properties, making them potential alternatives to synthetic pesticides in agriculture. The present review provides an up-to-date comprehensive insight about the ethnobotanical uses of T. articulata, along with its phytochemistry and biological activities to furnish directions for further studies. We also discussed the biocidal potency of the plant and highlighted its usage to extend the shelf life of perishable foods.

Association of TLR9-1237T>C; rs5743836 polymorphism with increased risk of Hodgkin's lymphoma: A case-control study.

Mature B-cell neoplasms are typically divided into Hodgkin and Non-Hodgkin Lymphomas. Hodgkin Lymphoma is characterized by the neoplastic Reed-Sternberg cells, usually harbored in an inflammatory background, with a frequent clinical presentation of mediastinal lymphadenopathy. Many studies link between autoimmunity and lymphomagenesis, a large proportion of these studies evidently trace the pathogenesis back to the misdirected detection of self-derived nucleic acids by Toll-Like Receptors (TLRs), especially those of the intracellular type. In this study, we analyzed the relationship between a selected SNP in TLR9 (TLR9-1237T>C; rs5743836) and the risk and overall survival of HL patients in a Jordanian Arab population. A total of 374 subjects; 136 cases of Hodgkin lymphoma and 238 matched healthy controls were incorporated in this study. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissues. Genotyping of the genetic polymorphisms was conducted using a sequencing protocol. The results show a statistically significant higher distribution of the rs5743836 (TLR9-1237T>C) allele among the case population, with a p-value of 0.031 (<0.05). This distribution proved significant when studied in the codominant (only significant in the T/C genotype, p-value = 0.030), dominant (p-value = 0.025), and overdominant (p-value = 0.035) models. None of the models showed any statistically significant difference in survival associated with the rs5743836 (TLR9-1237T>C) SNP.

Incarcerated Umbilical Hernia Following Therapeutic Paracentesis in a Cirrhotic Patient.

Umbilical hernia is a relatively common complication developing in patients with liver cirrhosis with recurrent ascites. Abdominal paracentesis is considered the mainstay procedure to manage refractory ascites and to diagnose spontaneous bacterial peritonitis. Incarceration of umbilical hernia is a rare but serious adverse event following therapeutic paracentesis that requires prompt management. We describe a case of an incarcerated umbilical hernia following paracentesis requiring surgical repair in a cirrhotic patient.

Primary Diffuse Large B Cell Lymphoma of Bone: A Single-Center Experience.

Background: Primary diffuse large B-cell lymphoma of the bone (PB-DLBCL) is a rare type of extra-nodal lymphoma. This study aimed to examine the clinical characteristics, outcomes, treatment modalities and risk of central nervous system relapse (CNSR) among adult Jordanian patients with PB-DLBCL. Methods: This retrospective study included patients aged >16 years who were diagnosed with PB-DLBCL and treated at our hospital between 2002 and 2021. Clinical characteristics, treatment modalities, outcomes and CNSR events were extracted from the hospital's data system and analysed. Patients were categorised into unifocal (UF) and multifocal (MF) PB-DLBCL groups according to the number of bone sites involved. The involvement of only one site was defined as UF, whereas the involvement of two or more sites was defined as MF. Results: In total, 12 patients were diagnosed with PB-DLBCL. Their median age was 47.5 years (range, 17-80 years). The male:female ratio was 1:1. There were eight patients in the UF PB-DLBCL group and four in the MF PB-DLBCL group. All patients received treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone. In the UF PB-DLBCL group, the male:female ratio was 5:3, the median age was 41 years, and the follow-up duration was 9-135 (mean, 83.3) months. In the MF PB-DLBCL group, the male:female ratio was 1:3, the median age was 51.5 years, and the survival time was 3-11 (mean, 7) months. Three patients with vertebral UF PB-DLBCL underwent early vertebroplasty without complications. The most common site involved was the vertebral column. Most patients with UF PB-DLBCL achieved complete remission (CR), whereas no patients with MF PB-DLBCL achieved CR. Conclusion: PB-DLBCL is rare in adult Jordanian patients. UF PB-DLBCL is more common than MF PB-DLBCL. Patients with UF PB-DLBCL had a good prognosis. Patients with MF PB-DLBCL had a high international prognostic index score, risk of CNSR and short survival time.

Exploring the Use of Iris Species: Antioxidant Properties, Phytochemistry, Medicinal and Industrial Applications.

The genus Iris from the Iridaceae family consists of more than 262 recognized species. It is an ornamental and medicinal plant widely distributed in the Northern Hemisphere. Iris species convey a long history as valuable traditional drugs with a wide variety of applications in various cultures, having been recorded since medieval times. Currently, Iris spp. still find application in numerous fields, including cosmetics, pharmaceutics and the food industry. Moreover, many of their empirical uses have been validated by in vitro and in vivo studies, showing that Iris spp. exhibit potent antioxidant, anticancer, anti-inflammatory, hepatoprotective, neuroprotective and anti-microbial properties. Phytochemicals investigations have revealed that the plant extracts are rich in phenolic compounds, especially flavonoids and phenolic acids. As such, they constitute a promising lead for seeking new drugs with high susceptibilities towards various health issues, particularly oxidative-stress-related diseases such as cancers, neurodegenerative diseases, cardiovascular diseases, diabetes, etc. Herein, we present a literature review of the genus Iris intending to determine the plant's chemical profile and establish a coherent overview of the biological applications of the plant extracts with reference to their traditional uses.

Hashimoto's Thyroiditis Presents as an Acute Encephalopathy: A Case Report of Unusual Presentation.

Hashimoto's thyroiditis is the most common thyroid disorder in the United States. Hashimoto encephalopathy is a rare presentation of Hashimoto's thyroiditis that is frequently misdiagnosed. We present the case of a 71-year-old female who had normal mental status at baseline. She presented with acute alteration in mental status. Further evaluation with brain MRI showed a hyperintense signal in the bilateral centrum. Spinal fluid analysis revealed elevated protein. Thyroid peroxidase (TPO) antibody was elevated at 59.7 and TSH was elevated at 4.9. Her mental status improved dramatically after treatment with steroids and levothyroxine. This diagnosis should be suspected when the patient develops acute encephalopathy with positive serum thyroid antibody settings with a complete return to normal mental status after treatment with steroids.

Organizing Pneumonia Secondary to Pulmonary Actinomycosis: A Case Report and Literature Review.

Pulmonary actinomycosis is a common clinical infection caused by Actinomyces species. Although its treatment is very effective with Intravenous (IV) antibiotics, its diagnosis is challenging and easily missed. Organizing Pneumonia (OP) can be cryptogenic or secondary to different clinical diseases. Herein, we discuss a case of acute hypoxemic respiratory failure that was found to be due to OP, secondary to pulmonary actinomycosis, with a brief review of the literature. A 64-year-old male presented with acute hypoxemic respiratory failure two days after undergoing elective right total hip arthroplasty. Chest imaging with CT scan showed symmetric bilateral ground-glass opacities most pronounced within the upper lung lobes. The patient was treated initially with IV diuresis, steroids, and broad-spectrum antibiotics. However, his clinical status continued to worsen and his chest imaging showed worsening lung opacities. Video-assisted thoracoscopic lung biopsy (VATS) was done, and pathology results showed features of organizing pneumonia. Tissue culture confirmed Actinomyces species. The patient had clinical improvement after treatment with IV methylprednisolone and IV penicillin G. Pulmonary actinomycosis is very rarely associated with OP but this bacterial infection should always be in the differential diagnosis when OP is confirmed as the treatment is effective with IV antibiotics.

Kikuchi-Fujimoto disease in the Eastern Mediterranean zone.

Kikuchi-Fujimoto disease (KFD) is a rare benign and self-limiting syndrome. We aim to review cases of KFD at our institution as a rare illness in the Arab ethnic descent and to analyse reports from most countries in the East Mediterranean zone. This is a retrospective study in which the histopathology database was searched for the diagnosis of KFD. A full review of KFD patients' medical records was done. Data regarding demographic features, clinical presentation, laboratory findings, comorbidities, and management protocols were obtained. Published KFD cases from east Mediterranean countries were discussed and compared to other parts of the world. Out of 1968 lymph node biopsies studied, 11 (0.6%) cases of KFD were identified. The mean age of patients with KFD was 32 years (4-59). 73% (8/11) were females. The disease was self-limiting in 5 patients (45%); corticosteroid therapy was needed in 4 patients (34%). One patient was treated with methotrexate and one with antibiotics. One patient died as a consequence of lymphoma. Jordanians and Mediterranean populations, especially those of Arab ethnic background, seem to have low rates of KFD. The genetic susceptibility theory may help to explain the significantly higher disease prevalence among East Asians. Early diagnosis of KFD-although challenging-is essential to reduce the morbidity related to this illness.