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This study evaluated the protective effect of kaempferol, a natural flavonoid, against cadmium chloride (CdCl2)-induced liver damage and examined the possible anti-inflammatory and antioxidant mechanisms of protection. Adult male rats were divided into 4 groups (each of 8 rats) as control, kaempferol (50 mg/kg/day orally), CdCl2 (15 ppm/day), and CdCl2 (15 ppm/day) + kaempferol (50 mg/kg/day). All treatments were given for 30 days. With no effect on attenuating the reduced food intake, kaempferol significantly increased body weight and lowered serum levels of liver injury markers including bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase 1 (γ-GTT1) in the CdCl2-treated rats. It also restored normal liver architectures, prevented hepatocyte, loss, and swelling and reduced inflammatory cell infiltration. These effects were associated with a reduction in mitochondrial permeability transition pore, as well as in the expression of cytochrome-c and cleaved caspase-3, markers of mitochondrial damage, and intrinsic cell death. In both the control positive and CdCl2-treated rats, kaempferol significantly lowered the hepatic levels of reactive oxygen species, malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), Interleukine-6 (IL-6), and the nuclear activity and localization of NF-κB p65. Besides, kaempferol significantly increased the hepatic total and nuclear levels of the nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1, as well as levels of superoxide dismutase (SOD) and reduced glutathione (GSH) but reduced the cytoplasmic protein levels of keap1. In conclusion, the protective effect of kaempferol against CdCl2-induced hepatic damage is mediated by antioxidant and anti-inflammatory effects driven by upregulating Nrf2/HO-1 axis and suppressing the NF-κB p65 and keap1.

Samah Labban,1,2 Fahad S Alshehri,3 Maher Kurdi,4 Yasser Alatawi,5 Badrah S Alghamdi6,7 1Department of Physiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Physiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 3Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 4Department of Pathology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia; 5Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia; 6Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 7Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Badrah S AlghamdiDepartment of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaTel +966 56 776 4144Email basalghamdi@kau.edu.saIntroduction: Alzheimer’s disease (AD) is a neurodegenerative disease that has become a leading cause of death in recent years. Impairments in spatial learning and memory are an important clinical feature of AD. Melatonin (MLT), the main product secreted by the pineal gland, showed multiple antioxidant, anti-inflammatory, and neuroprotective properties.Purpose: The present study aimed to explore the possible prophylactic effects of MLT against spatial memory deficits in a sporadic mouse model of AD induced by D-galactose and aluminium chloride (AlCl3).Methods: Four groups of mice (n = 10 per group) were prepared: control, AD (the D-galactose and AlCl3 AD model group), AD+MLT (AD mice treated with 80 mg/kg MLT), and AD+DON (AD mice treated with 3 mg/kg donepezil). We then used the object location and Y-maze tests to assess spatial memory in the four groups. Gene expression levels of brain-derived neurotrophic factor (Bdnf) and cAMP-responsive element-binding protein (Creb1) were measured using real-time polymerase chain reaction.Results: We found that MLT improved spatial memory in the sporadic AD mice. MLT ameliorated Creb1 gene expression and significantly increased Bdnf gene expression in the hippocampus of AD model mice compared with the AD group.Conclusion: MLT could have a substantial potential to alleviate memory impairment in sporadic AD if introduced at early stages.Keywords: melatonin, Alzheimer’s disease, spatial memory, CREB, BDNF

There has been an increase in cases of drug addiction and prescription drug abuse worldwide. Recently, pregabalin abuse has been a focus for many healthcare agencies, as highlighted by epidemiological studies. We previously evaluated the possibility of pregabalin abuse using the conditioned place preference (CPP) paradigm. We observed that a 60 mg/kg dose could induce CPP in mice and that pregabalin-rewarding properties were mediated through glutamate neurotransmission. Notably, the dopaminergic reward circuitry is also known to play a crucial role in medication-seeking behavior. Therefore, this study aimed to explore the possible involvement of dopaminergic receptor-1 in pregabalin-induced CPP. Mice were randomly allocated to receive saline or the dopamine-1 receptor antagonist SKF-83566 (0.03 mg/kg, intraperitoneal). After 30 min, the mice received either saline or pregabalin (60 mg/kg) during the conditioning phase. Among the control groups that received saline or SKF-83566, the time spent in the two conditioning chambers was not significantly altered. However, among the pregabalin-treated group, there was a marked increase in the time spent in the drug-paired chamber compared to the time spent in the vehicle-paired chamber. Notably, blocking dopamine-1 receptors with SKF-83566 completely prevented pregabalin-induced place preference, thus demonstrating the engagement of the dopaminergic system in pregabalin-induced reward-related behavior.

Lobna A Saleh,1– 3 Farooq M Almutairi,2,4 Wejdan K Alorabi,1 Bashayr A Alkuhayli,1 Shaden S Alzaidi,1 Shahad B Alzahrani,1 Futun A Aljumayi,1 Maram H Abduljabbar,1 Ayidh S Alharthi,1 Mashhour A Alsufyani,1 Mohammed H Alhazmi,1 Abdulbari A Althobaiti,1 Fahad N Almutairi,1 Fahad S Alshehri,5 Ebtehal Altowairqi,1 Yusuf S Althobaiti1,2,6 1Department of Pharmacology and Toxicology, College of Pharmacy, Taif University, Taif, 21944, Saudi Arabia; 2Addiction and Neuroscience Research Unit, College of Pharmacy, Taif University, Taif, Saudi Arabia; 3Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 4Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, University of Hafar Al-Batin, Hafar Al-Batin, Saudi Arabia; 5Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 6General Administration for Precursors and Laboratories, General Directorate of Narcotics Control, Ministry of Interior, Riyadh, Saudi ArabiaCorrespondence: Yusuf S AlthobaitiDepartment of Pharmacology and Toxicology, College of Pharmacy, Taif University, Health Science Campus, P.O. Box 11099, Airport Road, Al Haweiah, Taif, 21944, Saudi ArabiaTel +966 545736200Email ys.althobaiti@tu.edu.saPurpose: Depression is one of the most common psychological disorders. The nutritional etiology of the depression proposes that vitamin D may play a significant role in the pathogenesis of depression. Further, vitamin D deficiency has been found to aggravate depression in animals. Therefore, vitamin D treatment might be a potential therapeutic aid in depression management. This study aimed to explore the antidepressant effects of vitamin D in a Bacillus Calmette-Guerin (BCG)-induced depression model.Methods: Thirty-six mice were randomly assigned to short-term and long-term experimental groups. In each group, mice were randomly subcategorized into three subgroups: 1. control (received vehicle), 2. BCG (received BCG [107 CFU/mouse]), and 3. BCG + vitamin D (received vitamin D [60.000 IU/kg] before BCG [107 CFU/mouse] inoculation). After completion of the two experimental periods (3 days for the short-term group and 2 weeks for the long-term group), the mice underwent three behavioral tests: locomotor activity, the forced swimming test (FST), and the tail suspension test (TST).Results: Locomotor activity did not significantly differ among the subgroups in either the long-term or short-term groups. In the short-term group, the total immobility time on the FST was decreased in the vitamin D-treated group compared to the BCG group. However, in the TST, no significant difference was found between the vitamin D-treated group and the BCG group. In the long-term group, the immobility time on the FST was decreased in the vitamin D-treated group compared to the BCG group. Similarly, the total immobility time on the TST was also significantly lower in the vitamin D-treated mice than in the BCG-treated mice.Conclusion: Vitamin D is useful in the management of depressive behavior. The potential role of vitamin D in the etiology of depression should be investigated in future work.Keywords: depression, natural supplements, tail suspension test, forced swimming test

This study examined the protective effect of Kaempferol against streptozotocin-induced diabetic nephropathy (DN) in rats and studies the underlying mechanisms. Rats were divided into 4 groups as control, control + Kaempferol, STZ, and STZ + Kaempferol. All treatments were conducted for 8 weeks daily after the induction of diabetes. Kaempferol prevented STZ-induced weight and food loss and attenuated renal damage and the alterations in all biochemical related parameters. Concomitantly, Kaempferol reduced renal levels of TNF-α and IL-6, cleaved caspase-3, p38, and Bax, suppressing JNK phosphorylation and NF-κB p65 transactivation, and upregulation of Bcl-2. In both control and STZ-diabetic rats, Kaempferol reduced fasting glucose levels, increased fasting insulin levels and HOMA-β, reduced the levels of ROS and MDA, stimulated SOD and GSH levels, and increased the expression of Nrf2 and HO-1. In conclusion, Kaempferol prevents STZ-induced diabetic nephropathy, mainly, by antioxidant potential, mediated by the upregulation of the Nrf-2/HO-1 axis.

Aim: The primary aim of this study was to standardize the correlated effective dosage of the antidiabetic drug empagliflozin (EMPA) and the antipsychotic drug olanzapine (Ola). Background: Atypical antipsychotics are associated with BWG and metabolic disturbances for which many approaches have been used to minimize these issues, including antidiabetic drugs. The antidiabetic drugs have been quite effective in reversing BWG induced by the administration of antipsychotic drugs in patients who have psychosis, schizophrenia and bipolar disorder. Objective: The objective of this study was to standardize the correlated effective dosage of EMPA and Ola. Methods: The study was carried out for 28 days to represent the chronic effect of Ola on female Wistar rats. Rats were divided into three groups based on the dose they received: control (vehicle), Ola-4 and Ola-8 (4 and 8 mg/kg/OD, respectively), and EMPA-10 and EMPA-20 (10 and 20 mg/kg/OD, respectively). Results: Both doses of Ola produced a significant increase in the percentage of BWG, however, Ola-4 produced a higher BWG. Also, both the doses of EMPA were able to reverse the effect of Ola-induced BWG; however, EMPA-20 produced a higher reversal in BWG and normalized the rat's body weight. Conclusion: We conclude that Ola-4 and EMPA-20 were the most effective dosage for experimental purposes in female Wistar rats. The findings of this study standardized the effective correlated dosage of olanzapine and empagliflozin in female Wistar rats that will help understand the underlying molecular and behavioral mechanisms.

Background Paediatric rhinosinusitis is mostly different than that in adults. More frequently, children presented with cough, bad breath, crankiness, low energy, and swelling around the eyes, besides a thick yellow-green nasal or post-nasal discharge. About 5- 13% of childhood viral upper respiratory tract infections may advance to acute rhinosinusitis, with some of them developing a chronic condition. Aim To assess prevalence and clinical presentation of sinusitis in the paediatric age group in Aseer, Saudi Arabia. Methodology A retrospective record-based study was conducted in Abha Maternity and Children Hospital in Abha city, Saudi Arabia between January 2015 and January 2018. All medical records during the study period for children whose from to 15 years old attended the hospital and diagnosed as having sinusitis were included. Results The study included 100 children with complete files whose ages ranged from less than 1 year to up to 13 years old with a mean age of 5.3 4.2 years. Nearly 51% of the children aged 4 years or less and male were 53 (53%). Past history for chronic rhinosinusitis (CRS) was positive among 30 children. Regarding clinical presentations of rhinosinusitis (RS) as reported by the children caregivers, fever was the most reported complaint (50%) followed by red eye (44%), ringing nose (42%), cough (41%) and headache (36%). Mucous culture was positive among 58 cases. The most isolated pathogens were streptococcus pneumoniae (45.6%), Haemophilis influenza (24.6%). Conclusions In conclusion, the study revealed that CRS is a common disease in children at different ages, especially, maxillary and frontal sinuses. In most of the cases, medical treatment is highly appreciated; though, surgical intervention may be needed in a small percentage.

Introduction: Femoral neck fractures (FNFs) in young adults are relatively uncommon emergency that requires early diagnosis and management possible to prevents joint complications. Case Report: A 24-year-old male presented with a right hip pain for 3 months after a heavy physical exercise during military training. The imaging exhibited a transcervical FNF with displacement and a potential of avascular necrosis (AVN). The patient was managed by Open reduction and internal fixation through surgical hip dislocation (SHD) and bone grafting from the right iliac bone. The patient returned to his full military services 14 weeks following the surgery and was followed for 3 years without any symptomatic or functional problems. Conclusion: SHD could be one of the surgical options hired in the management of late presentations of FNFs in young adults with high suspicion of AVN. Keywords: Femoral neck fracture, open reduction and internal fixation, surgical hip dislocation.

Substance abuse is a chronic, relapsing disorder characterized by compulsive drug use regardless of negative consequences. Incremental increases in pregabalin abuse have been observed in Saudi Arabia and throughout the world. In previous studies, the potential for pregabalin abuse with escalating doses of the drug (30, 60, 90, and 120 mg/kg) were investigated in male mice. Notably, researchers have argued that women may exhibit a greater tendency to consume drugs without a prescription to alleviate stress and depression. Moreover, female subjects are more prone to impulsivity in drug intake or abuse than their male counterparts. Therefore, in the present study, we compared the potential for pregabalin abuse between male and female mice using a conditioned place preference paradigm. Male and female BALB/c mice were divided into four groups based on the pregabalin dose administered (30, 60, 90, or 120 mg/kg, intraperitoneal). Preference scores were then calculated and compared between male and female mice in each dosage group. Interestingly, preference scores were significantly higher in female mice than in male mice at dosages of 30 and 120 mg/kg. These findings indicate that female mice may be more prone to pregabalin abuse and tolerance than male mice. These results might be helpful to the healthcare providers and policymakers to consider these sex differences in choosing therapeutic plans and consider alternatives to the misused prescription medications.

Background: Tonsillectomy is one of the most frequently applied and oldest surgical procedures in otorhinolaryngology. Various surgical techniques are used to perform this operation including traditional and cauterization techniques. Objectives: To assess morbidity and efficacy and compare objectively the techniques in tonsillectomy, i.e., traditional technique and cauterization technique. This study compares the traditional and cauterization tonsillectomy techniques in view of their advantages and complications. Methods: This is a retrospective study and comparative study, conducted during the period from January 2017 to March 2018 from the patients attending to Alnamas General Hospital, Aseer Region, Saudi Arabia. The questionnaire was designed to compare the traditional and cauterization tonsillectomy. Fifty patients underwent traditional technique and fifty patients underwent cauterization method. The data analyzed using SPSS V.16.0 (SPSS Inc; Chicago, IL, USA). Results: A total of 100 patients, 62 males and 38 females, aged 8 to 16 years were included in the study. A total of 100 patients were enrolled in the study. Traditional and cauterization tonsillectomy were performed. 50 (27 male and 23 female) patients, whose ages ranged from 9 to 16 years old underwent the traditional tonsillectomy, 50 (35 male and 15 female) patients whose ages ranged from 8 to 16 years underwent cauterization. The two groups were similar for demographic parameters. The difference between mean operative times of the two methods was statistically significant. Postoperative bleeding is significantly higher in the traditional technique compared to cauterization method. Postoperative pain is significantly less in cauterization method. Only a few patients experienced fever, bleeding, and other complications related to anesthesia. The bleeding severity is significantly lower in the cauterization technique. Postoperative pain was less in cauterization technique on day 1 and day 5. Postoperative pain was from mild to severe. Conclusion: This study revealed significantly less postoperative complications in traditional tonsillectomy in comparison with the cauterization method. Healing time was significantly faster in cauterization technique than in traditional method.

Inertial sensors can detect between-limb asymmetries in shank angular velocity (SAV) during loading response of walking in individuals with ACL reconstruction (ACLR), which may be indicative of abnormal knee joint loading. However, it is unknown whether these SAV asymmetries would exist up to 6 months post-ACLR and how they differ from SAV asymmetries in uninjured healthy subjects.To investigate whether patients with ACLR show significant and meaningful between-limb SAV asymmetries during walking and walking fast at 4 and 6 months post-surgery and to determine whether limb asymmetries are related across gait tasks and time.Fifteen individuals with ACLR participated in this prospective study. Testing occurred in clinical settings. Participants were instructed to walk and walk fast while wearing one inertial sensor on each shank. The average of sagittal plane SAV peaks during loading response of gait was calculated bilaterally. The smallest meaningful between-limb difference for SAV was calculated from uninjured healthy subjects (n = 16) to define the limit of meaningful SAV asymmetries in patients with ACLR.At 4 and 6 months post-ACLR, the involved limb had significantly smaller peak SAV during walking (P.01, d = 0.69-0.85) and walking fast (P.005, d = 1.03-1.07) compared to the uninvolved limb. A significant main effect of gait task on SAV asymmetries was found (P = .006, ηIndividuals with ACLR presented with significant and meaningful SAV asymmetries during walking and walking fast at 4 and 6 months post-surgery. Greater limb SAV asymmetries persisted across gait tasks and time, with greater asymmetry was observed at a faster walking speed. Thus, inertial sensors are feasible to be used in clinical settings to identify SAV asymmetry during gait post-ACLR.

Purpose Morphine is the predominantly used drug for postoperative and cancer pain management. However, the abuse potential of morphine is the primary disadvantage of using opioids in pain management. Melatonin is a neurohormone synthesized in the pineal gland and is involved in circadian rhythms in mammals, as well as other physiological functions. Melatonin provenly attenuates alcohol‐seeking and relapse behaviors in rats. Therefore, we aimed to investigate the involvement of the melatonergic system in attenuating morphine dependence. Materials and methods Male Wistar rats were divided into three groups: control, morphine, and morphine + melatonin. Animals were habituated for 3 days, and the initial preference was evaluated. Following the initial preference, the control group received the vehicle and was placed for a 45‐min session in the assigned chamber every day, alternating between the two chambers, for 8 days. The morphine group received a morphine injection (5 mg/kg, IP) and was placed for a 45‐min session in the white chamber, for a total of four sessions. The morphine + melatonin group received the morphine injection (5 mg/kg, IP) for a total of four sessions over an 8‐day period. In the posttest session, the control and morphine groups received a vehicle injection 30 min before placement in the conditioned place preference (CPP). The morphine + melatonin group received a single injection of melatonin (50 mg/kg, IP) 30 min before the preference test. Results Statistical analysis revealed that repeated administration of morphine for four sessions produced a significant increase in the CPP score in the morphine group compared to the control group. However, a single melatonin injection administered 30 min before the posttest attenuated morphine‐seeking behavior and reduced morphine‐induced place preference. Conclusion These findings provide novel evidence for the role of the melatonergic system as a potential target in modulating morphine‐seeking behavior., These findings provide novel evidence for the role of the melatonergic system as a potential target in modulating morphine‐seeking behavior.

Opioid addiction remains a widespread issue despite continuous attempts by the FDA to help maintain abstinence. Melatonin is a neurohormone considered to be involved only in the neuroendocrine and reproductive systems; however, recent reports have demonstrated its potential to attenuate drug addiction and dependence. Cumulative studies have suggested that melatonin can attenuate the rewarding effects of several drugs of abuse, including opioids. This study aimed to investigate the effect of melatonin (50 mg/kg) on morphine (5 mg/kg) to produce place preference. We also investigated the effect of melatonin and morphine on the expression of GLT-1, BDNF, NF-κB, and CREB within the nucleus accumbens. Male Wistar rats were divided into control, morphine, melatonin, and the morphine + melatonin groups. The study involved a two-phase habituation phase from day 1 to day 3 and an acquisition phase from day 5 to day 14. The conditioned place preference (CPP) score, distance traveled, resting time, ambulatory count, and total activity count were measured for all animals. Rats that received morphine showed a significant increase in CPP score compared to those in the control group. Morphine treatment reduced the mRNA expression of GLT-1, BDNF, and CREB and increased that of NF-κB. However, melatonin treatment administered 30 min before morphine treatment attenuated morphine place preference and reversed GLT-1, BDNF, NF-κB, and CREB expression levels. In conclusion, the study results indicate, for the first time, the new potential targets of melatonin in modulating morphine-induced CPP.

The fifth metatarsal base avulsion fracture (i.e., Pseudo-Jones fracture) is one of the most common foot fractures. The management of pseudo-Jones fractures could be carried out surgically or conservatively. This systematic review and meta-analysis aimed to provide an update about the efficacy of orthotic removable support compared to short-leg casting for individuals with pseudo-Jones fracture.We searched Embase, Medline, and Cochrane Central register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) that compared the clinical outcomes of orthotic removable support and short-leg cast for adult individuals with a fifth metatarsal base avulsion fracture. We used 95% as a confidence level and P0.05 as a threshold. The standardized mean difference (SMD) was used for the continuous outcomes, and the risk ratio (RR) was used for the dichotomous outcomes.A total of 6 RCTs incorporating 403 individuals out were deemed eligible. There was no significant difference between orthotic removable support and short-leg casting regarding AOFAS score (standardized mean difference (SMD)= 0.31, 95% CI -0.17 to 0.8), pain on VAS score (SMD= -0.08, 95% CI -0.39 to 0.22), VAS-FA score (SMD= 0.22, 95% CI -0.19 to 0.62) EQ-5D VAS score, and non-union rate (RR=0.37, 95% CI 0.05 to 2.74).The current meta-analysis reveals that there is no difference between orthotic removable support and short-leg casting for the conservative management of individuals sustaining pseudo-Jones fracture.

The assessment of greenness of analytical protocols is of great importance now to preserve the environment. Some studies have analyzed either only the neurotransmitters, dopamine, serotonin, glutamate, and gamma-aminobutyric acid (GABA), together or with other neurotransmitters and biomarkers. However, these methods have not been investigated for their greenness and were not compared with each other to find the optimum one. Therefore, this study aims to compare seven published chromatographic methods that analyzed the four neurotransmitters and their mixtures using the National Environmental Method Index, Analytical Eco-Scale Assessment (ESA), and Green Analytical Procedure Index (GAPI). As these methods cover both qualitative and quantitative aspects, they offer better transparency. Overall, GAPI showed maximum greenness throughout the analysis. Method 6 was proven to be the method of choice for analyzing the mixture, owing to its greenness, according to NEMI, ESA, and GAPI. Additionally, method 6 has a wide scope of application (13 components can be analyzed), high sensitivity (low LOQ values), and fast analysis (low retention times, especially for glutamate and GABA).

Background Post-traumatic stress disorder (PTSD) is a global problem. According to its definition, it is a disorder that occurs with some people who have undergone or witnessed a shocking, terrifying, or hazardous event, and the coronavirus disease (COVID-19) with its consequent threats and fear meets the definition of a traumatic event. The main aim of this study is to determine PTSD in healthcare workers (HCWs) who survived COVID-19 in Jeddah, Saudi Arabia. Subjects and methods Through an analytical cross-sectional study, HCWs working in Jeddah city with a minimum of seven days since their first positive COVID-19 result were included in this study. They were screened using the 'PTSD checklist for The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)' (PCL-5), which is a 20-item self-report measure that assesses the presence and severity of PTSD symptoms. Results Out of all respondents (n=404), there was slight dominance of females (54.0%) over males (46.0%), and an almost equal distribution of Saudis (51.2%) and non-Saudis (48.8%); their mean age accounted for 36.9±8.7 years. PTSD was detected in 14.9%; the prevalence was significantly higher in those who had chronic diseases (23.7%), especially diabetics (30.8%) and obesity (41.2%), HCWs whose job necessitates exposure to positive cases (18.8%), and those who were isolated in hospitals while being ill. All the above values were statistically significant (p

Glomangiomas are rare and benign hamartomas that commonly occur in the upper extremities. It is not typical for benign glomangiomas to be larger than one centimeter in size, and they usually present as a faint, blue-red subungual papule associated with a triad of symptoms of paroxysmal pain, pain with cold exposure, and tenderness to touch. We herein report a case of a 72-year-old man with multiple comorbidities presented to our clinic as a case of right-hand middle finger swelling for the past five years. Initially, it was not painful. However, the pain became more noticeable when he lowers his hand, and it was relieved when he kept it elevated. There were no skin changes around it with minimal tenderness over the swelling. Hand MRI demonstrated a well-defined small lobulated nodule at the radial aspect of the middle finger, at the level of the middle phalanx with no invasion to an adjacent structure. Surgical excision was done and the patient was diagnosed by histopathology to have glomangioma. Glomangiomas, also known as glomus tumors, are rare and benign hamartomas that commonly occur in the upper extremities. The hand is the most common site for glomus tumors, particularly the subungual area, the lateral aspect of the digits, and the palms. Female patients are the most common to present with subungual glomangioma. Multiple papers reported different presentations, and due to the rarity of the conditions and overlapping in clinical and imaging characteristics with other conditions, it was challenging to diagnose. Such atypical cases must be approached with high clinical suspicion and proper imaging and investigations so as to not delay diagnosis and management.

Atypical antipsychotic drugs are commonly associated with undesirable side effects including body weight gain (BWG) and metabolic deficits. Many pharmacological interventions have been tested in an attempt to minimize or prevent these side effects. Preliminary evidence suggests that antidiabetic drugs may be effective in attenuating antipsychotic-induced BWG. In the current study, we examined the effect of an antidiabetic drug empagliflozin (EMPA) on BWG induced by anatypical antipsychotic drug olanzapine (Ola) in female and male Wistar rats. Rats were divided into six groups based on the dose they received: group 1 (female control), group 2 (female EMPA, 20 mg/kg; IG), group 3 (female Ola, 4 mg/kg; IP), group 4 (female Ola, 4 mg/kg; IP + EMPA, 20 mg/kg; IG), group 5 (male control), and group 6 (male Ola, 4 mg/kg; IP). Ola induced sustained increase in BWG. The subsequent treatment of Group 3 and 4 with EMPA attenuated the Ola-induced BWG in female Wistar rats. In terms of the gender difference between female and male Wistar rats, the male control group 5 gained more weight throughout the study as compared to the female control group 1. Similarly, the male Ola group 6 gained more weight throughout the study as compared to the female Ola group 3. However, Ola did not cause any weight difference between male rats treated with Ola in comparison with male control group, thus showing a significant gender difference regarding body weight between male and female Wistar rats regardless of Ola administration. In addition, the present findings showed that EMPA effectively attenuates the Ola induced BWG in female Wistar rats. These novel findings should help to better understand the underlying molecular and behavioral mechanisms contributing to the observed increase in body weight after treatment with Ola and other atypical antipsychotic drugs across male and female rats.

Objectives Behaviour management strategies involving pharmacological or non-pharmacological interventions during dental procedures should be considered to attain safe and successful treatment outcomes. This study compared the frequencies of use and the completeness of treatment with these interventions. Methods A total of 1725 dental records of patients up to 18 years old, who were treated in the King Abdulaziz Medical City in Jeddah City from October 2018 to June 2019, were used in this retrospective, cross-sectional study. Inferential analysis, Chi-square test, Kruskal–Wallis test, and regression model were used in the data analysis. Results About two-thirds of the patients were treated with attendant non-pharmacological interventions, while one-third, with pharmacological interventions. The application of General Anesthesia (GA) was the most frequently used intervention. Restorative procedures and extractions were done in higher frequencies with pharmacological interventions. Treatments with space maintainers and orthodontic appliances were carried out in higher frequencies with non-pharmacological strategies. The choice of intervention was significantly influenced by the systemic conditions of the patients. Patients treated with non-pharmacological intervention comprised the dominant type of patients, because they required treatments with less pain. Those treated with GA needed restorative treatments and extractions, or treatments that involve pain, but these treatments had higher frequencies of being completed. Conclusions The treatments with pharmacological intervention through GA have higher frequencies of being completed, compared to those with non-pharmacological interventions. Factors, such as age, potential to complete the treatment, and the type of dental treatment applied, influence the choice of treatment intervention.

Aim The aim of the study was to evaluate the knowledge, attitude, and practice toward prostate cancer and its screening methods among patients attending primary care facilities in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. Materials and methods A cross-sectional survey was conducted on a random sample of 385 men. The questionnaire was distributed using a non-random sampling method (convenience sampling) that included 13 questions that assess the knowledge, attitude, and practice of adult male patients toward prostate cancer and its screening methods. The questions were divided into three general questions that test the knowledge, four questions that analyze patients' opinions (attitude), and six questions on how patients are practicing screening methods with questions three and six being dependent on the answers to the questions that come before them. Results Around 64% of the participants had adequate knowledge about prostate cancer. Respondents with higher socioeconomic status demonstrated a higher level of knowledge about prostate cancer than the other groups. Regarding the attitude, more than 70% of the respondents believed that it is very important to screen for prostate cancer. About 23% of the participants had done some form of prostate screening test either prostate-specific antigen (PSA) or digital rectal exam (DRE); most of them were men older than 50 years. Conclusions The majority of the respondents to our survey demonstrated high general knowledge about prostate cancer. However, practice toward prostate screening methods was significantly low regardless of the positive attitude on the importance of screening. More data should be obtained to investigate the potential multifactorial reasons for such a low practice.

BACKGROUND: Protein kinase R (PKR) can suppress various types of solid tumors by inducing cellular oxidative stress and apoptosis. Likewise, Slaidorside, a plant flavonoid, was shown to have anti-tumorigenesis in many solid tumors. OBJECTIVE: This study evaluated anti-tumorigenesis of Salidroside in HT29 colorectal cancer and investigated if the underlying mechanism involves activation of PKR. METHODS: Control or PKR deficient cells were cultured in DMEM media treated with 100 μM Salidroside and cell survival, apoptosis, and other biochemical-related markers were evaluated. RESULTS: Salidroside significantly reduced cell survival and proliferation and increased the release of lactate dehydrogenase (LDH) and levels of single-stranded DNA (ssDNA). It also increased the protein levels of caspases 3 and 8. Concomitantly, Salidroside increased the protein level and activity of PKR and increased the expression of its downstream targets, p-eIF2α (Ser51), p53 MAPK, and p53. On the contrary, it inhibited the nuclear activation of STAT-3 and NF-κB p65. In PKR deficient cells, the partial effects of Salidroside on cell survival, proliferation, and apoptotic markers were observed coincided with no effects on the expression of eIF-2α, and JNK, p53, p38 MAPK, and caspase 8 but with a significant decrease in the nuclear activities of STAT3 and NF-κB. CONCLUSION: Salidroside suppresses the tumorigenesis of HT29 CRC by increasing activation of eIF-2α and JNK and upregulation of p53, p38 MAPK, and caspase-8 through upregulating and activation of PKR. However, the tumor suppressor effect of Salidroside requires also inhibition of STAT3 and NF-κB in a PKR-independent mechanism.

Badrah S Alghamdi,1,2,* Yasser Alatawi,3,* Fahad S Alshehri,4 Haythum O Tayeb,5 Frank I Tarazi6 1Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2Pre-Clinical Research Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia; 4Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 5Division of Neurology, Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 6Department of Psychiatry and Neuroscience Program, Harvard Medical School and McLean Hospital, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Badrah S Alghamdi Tel +966 567764144Email basalghamdi@kau.edu.saPurpose: Coronavirus disease 2019 (COVID-19) has evolved into a worldwide pandemic and continues to escalate exponentially in many countries across the globe. Recently, higher rates of psychological distress have been reported in several countries during the pandemic. Accordingly, the study aim was to investigate the relationship between public mental health and immune status during the COVID-19 pandemic.Methods: Participants of this cross-sectional study were 2252 national and foreign residents of Saudi Arabia. We used a web-based self-rated questionnaire to measure the association between psychological distress (Depression, Anxiety and Stress Scales [DASS-21]) and immune status (Immune Status Questionnaire [ISQ]) during the COVID-19 pandemic. We also investigated predictors of reduced immune status using binary logistic regression analyses.Results: Data from 1721 respondents showed that 17.5% of participants scored below the immune status cutoff (ISQ ˂ 6). Mean (± standard deviation) depression, anxiety, and stress scores in the reduced immune status group (ISQ ˂ 6) indicated moderate depression, anxiety, and stress (19.1 ± 11.4; 15.0 ± 9.6; 21.8 ± 11.2, respectively) and were significantly higher than scores in the normal immune status group (ISQ ≥ 6) (8.6 ± 9.1, P ˂ 0.0001; 5.0 ± 6.7, P ˂ 0.0001; 9.3 ± 9.3, P ˂ 0.0001, respectively). The regression analysis showed that age, anxiety, and stress were the only factors that significantly predicted the presence of reduced immune status.Conclusion: There is an association between mental health problems during the COVID-19 pandemic and immune response in the public, especially in elderly people.Keywords: mental health, COVID-19, immune status, Immune Status Questionnaire, psychological distress

Cadmium (Cd) is associated with non-alcoholic fatty liver disease (NAFLD). The hepatic activation of p53/miR-43a-induced suppression of SIRT1/FXR axis plays a significant role in the development of NAFLD. In this study, we have investigated CdCl2-induced NAFLD in rats involves activation of miR34a/SIRT1/FXR axis. Adult male rats were divided into 4 groups (n-8/each) as a control, CdCl2 (10 mg/l), CdCl2 + miR-34a antagomir (inhibitor), and CdCl2 + SRT1720 (a SIRT1 activator) for 8 weeks, daily. With no effect on fasting glucose and insulin levels, CdCl2 significantly reduced rats' final body, fat pads, and liver weights, and food intake. Concomitantly, it increased the circulatory levels of liver markers (ALT, AST, and γ-GTT), increased the serum and hepatic levels of total cholesterol and triglycerides coincided with increased hepatic lipid accumulation. Besides, it increased the mRNA and protein levels of SREBP1, SREBP2, FAS, and HMGCOA reductase but reduced mRNA levels of PPARα, CPT1, and CPT2. Interestingly, CdCl2 also increased mRNA levels of miR34 without altering mRNA levels of SIRT1 but with a significant reduction in protein levels of SIRT1. These effects were associated with increased total protein levels of p53 and acetylated protein of p53, and FXR. Of note, suppressing miR-34a with a specific anatomic or activating SIRT1 by SRT1720 completely prevented all these effects and reduced hepatic fat accumulations in the livers of rats. In conclusion, CdCl2 induced NAFLD by increasing the transcription of miR-34a which in turn downregulates SIRT1 at the translational level.

Background: Coronavirus disease 19 is a pandemic affecting millions worldwide. Since February 2020, new cases are reported in Saudi Arabia, and regulations have been imposed to control the spread of the disease and raise awareness. This study aimed to assess the knowledge and attitudes of the Kingdom’s residents toward coronavirus disease 19 during the early stages of the pandemic. Method: A cross-sectional study of 2071 participants who were recruited from various cities in Saudi Arabia. An online questionnaire was shared through social media, which contained questions about demographic data, general knowledge of coronavirus disease 19, and participants’ attitudes. Results: The mean age of the study population was 34 ± 12.4 years. Most of the participants agreed that coronavirus disease 19 is a pandemic and is more serious than seasonal influenza. More than 90% believed that handwashing and social distancing are effective in preventing disease transmission. No significant results were observed when comparing the knowledge of high-risk participants and the normal population. More than half of the cohort were strictly compliant with curfew regulations, handwashing, and face mask. Around 80% of the population is following coronavirus disease 19 news and information through official authorities’ press releases. Conclusion: The Kingdom of Saudi Arabia residents showed decent knowledge of coronavirus disease 19. Nevertheless, some information needs emphasizing and proper education. Frequent communication between healthcare authorities and the public is highly recommended.

Yasser Alatawi,1 Fahad S Alshehri,2 Abdullah A Alhifany,3 Adnan Alharbi,3 Badrah S Alghamdi4 1Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia; 2Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 4Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Fahad S AlshehriDepartment of Pharmacology and Toxicology, College of Pharmacy, Umm Al‑Qura University, Al‑Abidiyya, Makkah 21955, Kingdom of Saudi ArabiaTel +966 542166571Email fsshehri@uqu.edu.saPurpose: This study aimed to investigate the prevalence of and factors associated with posttraumatic stress disorder (PTSD) during the COVID-19 pandemic in Saudi Arabia.Materials and Methods: This was a cross-sectional online survey that targeted adults over the age of 18 residing in Saudi Arabia. The data collection began June 1, 2020 and continued for four weeks. The Posttraumatic Stress Disorder Checklist-Specific, the Brief Illness Perception Questionnaire version BIP-Q5, and a 9-item health literacy measure were used.Results: There were 1249 participants, of which 62.21% were under the age of 34. The prevalence of PTSD was 19.5% among all participants. The results showed that both the perception of threat (OR =1.17, 95% CI = 1.13− 1.19) and health literacy (OR =0.97, 95% CI = 0.95− 0.99) were associated with PTSD symptoms.Conclusion: This study highlights important findings that the level of an individual’s perception of threat and health literacy is associated with symptoms of PTSD. Thus, an understanding of these constructs in the target population will enable the development of better measures designed to reduce the psychological impact of the COVID-19 pandemic.Keywords: COVID-19, Saudi Arabia, posttraumatic stress disorder, perception, health literacy

Background Physically active individuals are susceptible to sports injuries, one of which is anterior cruciate ligament (ACL) injury. ACL injury can be managed conservatively or by surgical reconstruction. Returning to sport (RTS) after ACL injury is one of the main goals of ACL reconstruction (ACLR). However, rates of return vary and can be affected by several factors. The objectives of this study were to estimate the rate of return and to identify the factors that might affect RTS after ACLR. Methods This was a cross-sectional study, including individuals who had an ACLR. Participants were sent an online survey included questions about their injury, sport participation, International Knee Documentation Committee form (IKDC), and the Tampa Scale for Kinesiophobia (TSK-11). Participants who had their surgery in the period between January 2011 to December 2018 and participated in sports regularly were included. Descriptive statistics were performed. Chi-square and student t-tests were performed to explore the differences between participants who returned and the ones that did not. Results A total of 93 participants were included. The majority (69.9%) were playing soccer before the injury. Though more than half (61.3%) returned to sports, only 29% participated at the same level before the injury. Fear of reinjury was the most frequent reason for delaying or not returning (30%), followed by pain (29). Significantly better IKDC (p=0.002) and TSK-11 (p

Background The coronavirus diseases of 2019 (COVID-19) pandemic was classified as one of the worst pandemics in the 21st century. Its rapid transmission, unpredicted mortality rate, and the uncertainty surrounding its transmission method have evoked additional fear and anxiety. Nonetheless, to the best of our knowledge, no prior study has explored PTSD prevalence three months after the start of the quarantine procedures in Saudi Arabia nor has examined PTSD prevalence by three different methods. Objective This observational cross-sectional study aimed to identify the prevalence, severity, and influencing factors of PTSD in different regions of Saudi Arabia three months after the onset of the quarantine procedures related to the COVID-19 pandemic. Methods Through the month of June 2020, 1374 people (49.05% men and 50.95% women) completed a 35-item, 10-minute online. The prevalence of PTSD was measured using PCL-S (specific for COVID-19) that assesses the 17 symptoms of PTSD. Resilience was measured using 2-items Arabic version of the Connor-Davidson Resilience Scale 2 (CD-RISC 2). Results We calculated the prevalence by three methods, namely, PTSD cut-off score, criteria, and combined, and the prevalence was 22.63%, 24.8%, and 19.6%, respectively. Female participants showed higher prevalence than male. As well, participants who were either tested positive or suspected of having been infected with COVID-19 showed higher PTSD prevalence. Higher resilience was associated with lower PTSD prevalence. Conclusions This was the first study to report PTSD prevalence by three differential methods three months after the onset of the quarantine procedures related to the COVID-19 pandemic in Saudi Arabia. We observed a significant impact of the COVID-19 pandemic in the Saudi population; therefore, great attention should be performed in implementing new procedures that deal with the highlighted risk factors, especially in vulnerable groups, to overcome the psychological impact of the COVID-19 pandemic.

Objectives: To systematically review the literature and to summarize all evidence related to the diagnosis and management of patulous eustachian tube. Methods: The present study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Overall, 59 articles were retrieved and included in the analysis. Studies investigating treatments enrolled 1279 patients collectively, with follow-up duration varying from few days and up to 2 years. Eight studies reported medical treatments with intranasal saline instillation as the most frequently studied option. Other studies reported various surgical treatments varying from simple tympanostomy to invasive procedures targeting the orifice of the ET or the anatomical features surrounding it. In addition, 10 studies including 367 subjects investigated different diagnostic methods. Conclusion: Currently, there is a wide spectrum of diagnostic and therapeutic interventions with minimal clinical efficacy, a persistent lack of systematic guidelines, and several gaps in previous research endeavours. PROSPERO REG. NO. CRD: 1644000

Gilteritinib is primarily metabolized via cytochrome P450 (CYP). Therefore, concomitant administration of strong CYP3A4 inducers or inhibitors is not recommended. We evaluated the incidence of gilteritinib-related adverse events (AEs) in 47 patients who received gilteritinib with or without antifungal triazoles which are known inhibitors of CYP3A4. Reasons for coadministration were antifungal prophylaxis or treatment of suspected or confirmed fungal diseases. Gilteritinib-related AEs were similar in the gilteritinib-triazole group compared to the gilteritinib without triazole group (75 % vs. 55.5 %, P = 0.23). Additionally, severity of AEs, gilteritinib dose reductions (15 % vs. 14.8 %) or discontinuation due to AEs (10 % vs. 22.2 %), and 90-day mortality (35 % vs. 11.1 %) were similar in both groups. Thus, concomitant gilteritinib and triazole therapy is feasible and is not associated with clinically meaningful increase in gilteritinib-related AEs.

Introduction: Intraosseous mandibular haemangiomas are rare benign tumors.To this date there is no general consensus regarding their treatment. Observation: The authors present a case of a 56-year-old patient with swelling of the basilar left edge, without any other associated symptom. Radiolucent images with a well-defined honeycomb structure supports the vascular injury found using dental orthopantomography and cone beam computed tomography. Dynamic magnetic resonance angiography (MRA) showed mild intense intralesional vascularity and a biopsy confirmed the diagnosis of mandibular cavernous haemangioma. Clinical and radiological active surveillance were carried out. The size of the lesion had regressed by more than half in one year and there was no more palpable lump. Discussion: The most commonly approved treatment approach of haemangioma is selective embolization followed by complete surgical resection, which may be complicated by bleeding. From the follow-up of this case it seems that an active clinical and radiological surveillance can be proposed in the management of intraosseous mandibular haemangioma with few persistent symptoms and a low risk of complication, these may even regress with time.

Alcohol dependence is associated with deficits in glutamate uptake and impairment of glutamate homeostasis in different brain reward regions. Glutamate transporter subtype 1 (GLT-1), cystine-glutamate exchanger (xCT) and glutamate/aspartate transporter (GLAST) are one of the key players in regulating extracellular glutamate concentration in the brain. Parenteral treatment with ceftriaxone, β-lactam antibiotic, has been reported to attenuate ethanol consumption and reinstatement to cocaine-seeking behavior, in part, by restoring the expression of GLT-1 and xCT in mesocorticolimbic brain regions in rats. In this study, we focused to test Augmentin (amoxicillin/clavulanate), which can be administered orally to subjects. Therefore, we examined the effects of orally administered Augmentin on ethanol intake as well as GLT-1, xCT and GLAST expression in male alcohol-preferring (P) rats. We found that orally administered Augmentin significantly attenuated ethanol consumption in P rats as compared to the vehicle-treated group. Importantly, the attenuation in ethanol consumption was associated with a significant upregulation of GLT-1 and xCT expression in nucleus accumbens (NAc) and prefrontal cortex (PFC). There was no effect of orally administered Augmentin on GLAST expression in either NAc or PFC. These findings present strong evidence that oral administration of Augmentin can be used as an alternative to parenteral treatment.

Alzheimer’s disease (AD) is the foremost cause of dementia among other neurodegenerative diseases, leading to memory loss and cognitive deficits. AD has gained extensive attention in research for exploring possible interventions. One promising field is natural substances and compounds that could provide a wide range of neuroprotection against AD. This study aimed to investigate the possible effects of melatonin (MEL) and resveratrol (RES) in improving memory deficits in a sporadic mouse model of AD. Memory deficit was induced using AlCl3 and d-galactose for generating an AD mouse model. Mice were randomly distributed into five groups (n = 13): control, AD, AD + MEL (AD mice treated with 80 mg/kg of MEL), AD + RES (AD mice treated with 40 mg/kg of RES), and AD + Combination)AD mice that received 80 mg/kg MEL and 40 mg/kg RES). A novel object recognition task (NORT) and passive avoidance task (PAT) were used for assessing memory. Moreover, acetylcholinesterase (AChE) level, brain-derived neurotrophic factor (BDNF), and cAMP-response element binding (CREB) protein expression were measured in the prefrontal cortex tissue. Our results showed that MEL significantly improved memory deficits in both the NORT and PAT of the AD model, while RES improved the PAT only in the AD model. Co-treatment with MEL and RES exerted beneficial additive effects on recognition memory impairment in the AD mouse model. Moreover, our results demonstrated that both MEL and RES enhanced the cholinergic system and BDNF and CREB signaling pathways in the prefrontal cortex in an AD mouse model.

Alcohol withdrawal syndrome (AWS) is a medical emergency situation which appears after abrupt cessation of ethanol intake. Decreased GABA-A function and increased glutamate function are known to exist in the AWS. However, the involvement of glutamate transporters in the context of AWS requires further investigation. In this study, we used a model of ethanol withdrawal involving abrupt cessation of binge ethanol administration (4 g/kg/gavage three times a day for three days) using male alcohol-preferring (P) rats. After 48 hours of withdrawal, P rats were re-exposed to voluntary ethanol intake. The amount of ethanol consumed was measured during post-withdrawal phase. In addition, the expression of GLT-1, GLAST and xCT were determined in both medial prefrontal cortex (mPFC) and nucleus accumbens (NAc). We also measured glutamine synthetase (GS) activity, and the tissue content of glutamate, glutamine, dopamine and serotonin in both mPFC and NAc. We found that binge ethanol withdrawal escalated post-withdrawal ethanol intake, which was associated with downregulation of GLT-1 expression in both mPFC and NAc. The expression of GLAST and xCT were unchanged in the ethanol-withdrawal (EW) group compared to control group. Tissue content of glutamate was significantly lower in both mPFC and NAc, whereas tissue content of glutamine was higher in mPFC but unchanged in NAc in the EW group compared to control group. The GS activity was unchanged in both mPFC and NAc. The tissue content of DA was significantly lower in both mPFC and NAc, whereas tissue content of serotonin was unchanged in both mPFC and NAc. These findings provide important information of the critical role of GLT-1 in context of AWS.

Purpose: There is limited data available on the short-term effect of intravitreal aflibercept injection on intraocular pressure (IOP) for diabetic macular edema (DME). We performed a prospective, observational clinical study to evaluate short-term IOP changes after aflibercept injection in eyes with DME. Methods: Patients with diabetes mellitus type II and associated DME were recruited at King Abdulaziz Medical City, Saudi Arabia, between December 2015 and October 2016. All eyes were injected with 2 mg(0.05ml) of intravitreal aflibercept. Inclusion criteria were patients with DME, patients eligible for aflibercept injection, patients aged 18 years or more. Exclusion criteria were patients with a history of anti-VEGF injection, argon laser photocoagulation, glaucoma, antiglaucoma medications, uveitis, or steroid. We measured IOP using Tono-Pen (Tono-Pen XL, Reichert Inc., Depew, NY, USA) immediately before injection, at 5, 15, 30, 45, 60 min and 1 day after injection. We compared short-term IOP changes before and after aflibercept injections using paired t-test for statistical analysis. Results: A total of 14 eyes from 14 DME patients (7 female and 7 male) with a mean age of 62.43±10.68 years fulfilled the inclusion criteria. Our findings showed that the mean IOP readings recorded before injection, at 5, 15, 30, 45, 60 min and 1 day after injection were 19.71±1.90, 32.07±13.68 mmHg (p=0.005), 23.43±6.38 mmHg(p=0.043), 20.86±5.07 mmHg(p=0.476),19.50±3.11 mmHg(p=0.803),19.21±3.17 mmHg(p=0.583) and 17.71±1.59(p= 0.011) respectively. Comparing the mean IOP before and after intravitreal aflibercept injection, it was significantly higher at 5 and 15 min after injection. However, the mean IOP returned to normal pre-injection level at 60 min (p=0.583). Three eyes (21.43%) had persistent increased IOP one day after intravitreal aflibercept injection. Comparing pre and post injection mean IOP at 5, 15 min and 1 day in terms of gender effect, the mean IOP changes were not statistically significant (p=0.591, 0.473, 0.345; respectively). Conclusions: Our study confirmed that intravitreal aflibercept injection is safe with respect to short-term IOP changes in patients with DME. A significant short-term rise of IOP occurred within 15 minutes after injection then it returned to normal in most patients. The effect of gender on the mean IOP before and after aflibercept injection was not statistically significant. Keywords: Aflibercept, intraocular pressure, intravitreal injection.