Building the health workforce: Saudi Arabia's challenges in achieving Vision 2030.

BACKGROUND: Saudi Arabia's Vision 2030 represents a major structural shift in all economic sectors. Health care is one of the largest sectors significantly contributing to achievement of the vision OBJECTIVES: To provide an overview of health workforce in Saudi Arabia and identify various critical issues and challenges that need to be addressed in achieving health system goals envisaged in the Vision. METHODS: This paper is based on extensive review of literature conducted to stimulate pertinent descriptive information on health workforce in Saudi Arabia. FINDINGS: Saudi nationals constitute 44% of all health workforce and 29.5% of all physicians employed by the health system. Among Saudi nationals, there is a significant underrepresentation of females except in the nursing profession. The health workforce is beleaguered with numerical inadequacy, skill imbalance, gender disparity, and access issues. CONCLUSION: Health system needs to adopt a rigorous approach by investing heavily on medical, nursing, and other specialized fields of education. Planning for the health workforce needs to adopt appropriate strategies that reflect all aspects including the number, skills, and gender distribution for meeting the future health needs of population to facilitate achievement of Vision.

Investigational beta-2 adrenergic agonists for the treatment of chronic obstructive pulmonary disease.

INTRODUCTION: Long-acting bronchodilators are pivotal in the therapeutic management of COPD patients with moderate-to-severe airflow obstruction. New ultra-long-acting ß2-agnoists (ultra-LABAs) have been developed, some of which have been licensed for use as monotherapy and/or in combination with other bronchodilators or inhaled corticosteroids, for use in COPD patients with persistent symptoms and worsening airflow limitation. These new agents are faster in onset and have a prolonged duration of action, with a similar safety profile to the traditional twice-daily bronchodilators which may have an impact on patient concordance. Areas covered: A number of these ultra-LABAs are still under development and bi-functional hybrid molecules containing regions functioning as ß2-agonists, and as muscarinic agonists (MABAs) has been developed. This review summarizes these (excluding the licensed ultra-LABAs) with attention on phase II studies data available to-date on their pharmacological profiles, clinical efficacy and safety, and future perspectives. Expert opinion: Despite all the new agents' available, the challenges that persist include any differences in efficacy and safety between the various possible LAMA/LABA combinations, relative advantages of MABAs over fixed-dose LAMA/LABAs, and the impact of these new molecules in terms of long term safety, especially in certain populations in co-morbidities frequently associated with COPD.

Intrahippocampal Administration of Ibotenic Acid Induced Cholinergic Dysfunction via NR2A/NR2B Expression: Implications of Resveratrol against Alzheimer Disease Pathophysiology.

Although several drugs revealed moderate amelioration of symptoms, none of them have sufficient potency to prevent or reverse the progression toward Alzheimer's disease (AD) pathology. Resveratrol (RSV), a polyphenolic compound has shown an outstanding therapeutic effect on a broad spectrum of diseases like age-associated neurodegeneration, inflammation etc. The present study was thus conducted to assess the therapeutic efficacy of RSV in ameliorating the deleterious effects of Ibotenic acid (IBO) in male Wistar rats. Stereotactic intrahippocampal administration of IBO (5 µg/µl) lesioned rats impairs cholinergic transmission, learning and memory performance that is rather related to AD and thus chosen as a suitable model to understand the drug efficacy in preventing AD pathophysiology. Since IBO is an agonist of glutamate, it is expected to exhibit an excitotoxic effect by altering glutamatergic receptors like NMDA receptor. The current study displayed significant alterations in the mRNA expression of NR2A and NR2B subunits of NMDA receptors, and further it is surprising to note that cholinergic receptors decreased in expression particularly α7-nAChR with increased m1AChR. RSV administration (20 mg/kg body weight, i.p.) significantly reduced these changes in IBO induced rats. Glutamatergic and cholinergic receptor alterations were associated with significant changes in the behavioral parameters of rats induced by IBO. While RSV improved spatial learning performance, attenuated immobility, and improvised open field activity in IBO induced rats. NR2B activation in the present study might mediate cell death through oxidative stress that form the basis of abnormal behavioral pattern in IBO induced rats. Interestingly, RSV that could efficiently encounter oxidative stress have significantly decreased stress markers viz., nitrite, PCO, and MDA levels by enhancing antioxidant status. Histopathological analysis displayed significant reduction in the hippocampal pyramidal layer thickness and live neurons in IBO induced rats, with slight pathological changes in the entorhinal cortex (EC) of rat brain, which was prevented on RSV administration. Our study thus concludes that RSV administration significantly ameliorated the deleterious effects in the IBO lesioned rat model for AD by alleviating cholinergic pathways, reducing oxidative stress and thereby improving spatial memory.

Emerging therapeutic strategies in COPD.

Chronic obstructive pulmonary disease (COPD) management is changing with the advent of newer inhaled medications and devices that belong to the current group of therapies [i.e. inhaled corticosteroid (ICS), long-acting ß2 agonists (LABAs) and long-acting muscarinic antagonists (LAMAs)], providing patients as well as physicians with a wider range of options. In this review, we examine Phase II studies currently underway in COPD patients. With improved understanding of the condition, the role for biological and immunomodulatory therapies in COPD patients is also an interesting and important aspect looked upon with great enthusiasm. It is indeed interesting to note that the future COPD treatment options could include novel interventional strategies in addition to innovative inhaled therapies, which have been the backbone of COPD management for the past couple of decades.

High-throughput monitoring of major cell functions by means of lensfree video microscopy.

Quantification of basic cell functions is a preliminary step to understand complex cellular mechanisms, for e.g., to test compatibility of biomaterials, to assess the effectiveness of drugs and siRNAs, and to control cell behavior. However, commonly used quantification methods are label-dependent, and end-point assays. As an alternative, using our lensfree video microscopy platform to perform high-throughput real-time monitoring of cell culture, we introduce specifically devised metrics that are capable of non-invasive quantification of cell functions such as cell-substrate adhesion, cell spreading, cell division, cell division orientation and cell death. Unlike existing methods, our platform and associated metrics embrace entire population of thousands of cells whilst monitoring the fate of every single cell within the population. This results in a high content description of cell functions that typically contains 25,000 - 900,000 measurements per experiment depending on cell density and period of observation. As proof of concept, we monitored cell-substrate adhesion and spreading kinetics of human Mesenchymal Stem Cells (hMSCs) and primary human fibroblasts, we determined the cell division orientation of hMSCs, and we observed the effect of transfection of siCellDeath (siRNA known to induce cell death) on hMSCs and human Osteo Sarcoma (U2OS) Cells.

Familial hypercholesterolaemia IIA with bicuspid aortic valve.

A young male presented with multiple xanthomas and xanthelesmas, progressive breathlessness and angina on exertion. Investigations confirmed diagnosis of familial hypercholesterolaemia, bicuspid aortic valve with severe aortic stenosis and significant obstructive coronary artery disease.

Crataegus oxycantha extract attenuates apoptotic incidence in myocardial ischemia-reperfusion injury by regulating Akt and HIF-1 signaling pathways.

The objective of the present study was to evaluate the efficacy and mechanism of Crataegus oxycantha (COC) extract in preventing ischemia-reperfusion (IR) injury in an in vivo rat model of acute myocardial infarction induced by a 30-minute regional ischemia followed by 72 hours of reperfusion. The COC extract [100 mg/(kg body weight)] was administered 12 hours after the surgical procedure and then at 24-hour intervals for 3 days. Animals treated with COC extract showed a significant decrease in creatine kinase activity and infarct size. At the molecular level, COC administration resulted in a significant attenuation of PTEN (phosphatase and tensin homolog deleted on chromosome 10) and upregulation of phospho-Akt and c-Raf levels in the heart. As a consequence, cleaved caspase-9 and cleaved caspase-7 levels were significantly downregulated, indicating negative regulation of apoptosis by COC extract. In part with the hypoxia-inducible factor (HIF) signaling pathway, COC extract administration significantly upregulated the prolyl hydroxylase-2 level. In contrast, other proapoptotic proteins such as nuclear factor-κB, cytochrome c, apoptosis-inducing factor, and cleaved poly(adenosine diphosphate-ribose) polymerase levels were significantly downregulated in the COC-treated group when compared with the untreated control group. The results suggested that COC extract attenuated apoptotic incidence in the experimental myocardial ischemia-reperfusion model by regulating Akt and HIF-1 signaling pathways.

Effect of surfactant on the release of ciprofloxacin from gelatin microspheres

Gelatin microspheres with high entrapment efficiency were prepared by emulsification (using differentsurfactants) and crosslinking by glutaraldehyde with a view to improve stability of the microspheres.The microspheres were characterized for entrapment efficiency of ciprofloxacin, swelling, FT-IR,scanning electron microscopy (SEM) and leakage properties.From the results obtained we inferred thatthe gelatin microspheres entrapped with ciprofloxacin prepared by using three different surfactantsincreased the shelf life of gelatin microspheres(AU)

The coming of age of a joint elderly medicine-psychiatric ward: 18 years' experience.

INTRODUCTION: There is a large population of elderly medical inpatients with co-existent medical and mental health disorders who pose a significant management challenge for medical, nursing and allied staff. Our hospital has a joint elderly medicine-psychiatry unit to cater for this patient group; this article reviews how this unit was set up and presents a representative sample of inpatients. RESULTS: The mean age was 81 years with a female preponderance. The mean length of stay was 44 days. The commonest medical conditions were cerebrovascular disease, urinary tract infections, chest infections and falls. The commonest mental health diagnoses were cognitive impairment, delirium and depression. The mortality rate was 21%; of the remainder, 55% were discharged to long-term care, 40% returned home and 5% were transferred to the local psychiatric hospital. DISCUSSION: This cohort of elderly patients has complex medical, nursing and therapy needs in addition to complex discharge planning needs. Our unit has a shared care approach, with joint responsibility shared by a consultant in Medicine for the Elderly and a Consultant in Old Age Psychiatry. This, in combination with a multidisciplinary team approach, provides an effective means of delivering care to this patient group. CONCLUSION: A joint elderly medicine-old age psychiatry ward provides a high standard of care for elderly patients with co-existent physical and mental health needs. We hope that the information presented in this article will be of use to those hoping to set up a similar unit in their own hospitals.

Identification of a vibrational frequency corresponding to H-atom translocation in hypericin.

Using time-resolved infrared spectroscopy, ab initio quantum mechanical calculations and synthetic organic chemistry a region in the infrared spectrum of triplet hypericin has been found between 1400 and 1500 cm-1 corresponding to the translocation of the hydrogen atom between the enol and the keto oxygens, O...H...O. This result is discussed in the context of the photophysics of hypericin and of eventual measurements to observe directly the excited-state H-atom transfer.

Tumor cell toxicity of hypericin and related analogs.

A series of hypericin analogs were found to differ in their cytotoxic activity induced by ambient light levels. These analogs vary in their ability to partition into cells, to generate singlet oxygen as well as in other photophysical properties. The data suggest that the biological activity of hypericin is due to a combination of factors whose roles may vary under different circumstances.

A survey of physiotherapy and occupational therapy provision in UK nursing homes.

BACKGROUND: Nursing homes in the UK are increasingly regarded as potential rehabilitation facilities for disabled older people. OBJECTIVE: To determine the current physiotherapy and occupational therapy provision to UK nursing homes. SAMPLE: Four hundred private nursing homes in England, Scotland and Wales were selected by stratified proportional random sampling and surveyed by postal questionnaire. RESULTS: The response rate for the effective sample was 346/355 (97%). Only 10% of residents were in current receipt of physiotherapy, mostly through private physiotherapists employed by the nursing homes. Occupational therapy was being provided to only 3.3% of residents. CONCLUSION: Older people in nursing homes in the UK currently receive little physiotherapy and occupational therapy input and are particularly isolated from National Health Service (NHS) services.

The effects of lipid extraction on the immunomodulatory activity of Malassezia species in vitro.

Malassezia spp. are believed to be the causative agents of pityriasis versicolor and are strongly implicated in seborrhoeic dermatitis. The yeast also forms part of the normal human cutaneous microflora. We have previously shown that when Malassezia yeast cells are incubated with human peripheral blood mononuclear cells (PBMCs), they are capable of reducing the levels of pro-inflammatory cytokines produced. In order to test the hypothesis that this immunoevasive phenomenon may be related to the unusually high level of lipid in the Malassezia yeast cell wall, we have compared the immunomodulatory capacity of normal and lipid-depleted yeast cells. Stationary phase yeast cells of Malassezia sympodialis, M. globosa and M. restricta were treated with chloroform/methanol to extract the surface lipids. The lipid-depleted and non-depleted yeast cells were then co-cultured with human PBMCs from three different human donors at a ratio of 20 yeasts per leukocyte for 24 h. The levels of interleukin (IL)-1beta, IL-6 and tumour necrosis factor (TNF)-alpha were then determined by enzyme-linked immunosorbent assay (ELISA). The results demonstrated that extraction of lipid reversed the yeast cell capacity to reduce the levels of pro-inflammatory cytokines. The levels of IL-1beta, IL-6 and TNF-alpha produced in response to lipid-extracted Malassezia of all three species were either no different from or significantly greater (P < 0.05; ANOVA) than the constitutive control levels. These results suggest that the lipid microfibrillar layer of Malassezia may prevent the yeast cells from inducing inflammation and provide an explanation for the normal commensal status of the organism on human skin. The hypothesis that the lipid layer is absent or altered in seborrhoeic dermatitis may provide an explanation for the inflammatory nature of this dermatosis.

Meningioma with rhabdoid transformation.

A 29-year-old man was operated on for an intracranial tumour with the gross features of a meningioma. Histology showed features of a rhabdoid tumour. The tumour recurred in 1997, 17 months after the first operation, and was re-excised and showed identical histology. Meningiomas with rhabdoid change are very rare. The clinicopathologic features are presented and the differential diagnoses discussed.

An unusual tumour metastasis to the cervix.

INTRODUCTION: The vast majority of tumours in the cervix are either primary carcinomas or direct extension of primary tumours from nearby sites such as the endometrium, myometrium, rectum and bladder. Patients usually present with abnormal bleeding, pain and dyspareunia. A smaller number of patients are asymptomatic and their tumours can be diagnosed early by PAP smears. CLINICAL PICTURE: We present an unusual case of an elderly lady with breast cancer that had metastasized to the cervix 4 years after primary treatment of the breast malignancy. Although the appearance of the cervix was "normal looking", it was firm and indurated on palpation. PATHOLOGY: A definite diagnosis of metastatic infiltration could only be made by colposcopic biopsy. Early PAP smears had shown some abnormal cells suggestive of metastatic lobular carcinoma but were not conclusive of metastasis from breast carcinoma. Subsequent bone scans and CT scans of the abdomen revealed metastatic lesions in the skull, spine, left femoral shaft and liver.