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Background. The safety and efficacy of combination tablets of metformin plus sulfonylurea or plus dipeptidyl peptidase-4 inhibitors have not been studied previously. This study aimed to compare the efficacy and safety of Gliconorm versus Sitavia plus among patients with type 2 diabetes mellitus who fast Ramadan. Methods. This was an open-label study conducted from 1 May 2018 till 1 July 2018. People with type 2 diabetes mellitus who were drug-naive or on metformin only, with HbA1c < 10 % were included. The participants were divided into two groups. The first group was given Gliconorm (glibenclamide 5 mg + metformin 1000 mg), while the second group was given Sitavia plus (sitagliptin 50 mg + metformin 1000 mg) imme-diately after Iftar. Glycated hemoglobin (HbA1c) was measured before and after Ramadan. Several home recordings of blood glucose were collected. In addition, patients were asked to report any hypoglycemic or severe hyperglycemic episodes. Results. A total of 34 participants (18 women) (19 in the first group and 15 in the second group) were involved the study. The mean age was 49.6 ± 9.3 years. HbA1c reduced from 8.7 % (72 mmol/mol) to 7.6 % (60 mmol/mol) and from 8.7% (72 mmol/mol) to 7.7 % (61 mmol/mol) in the first and second group, respectively (p < 0.0001). Only one patient in the first group experienced one episode of hypoglycemia and hyperglycemia. Conclusion. Both medications seem to be safe and effective during Ramadan fasting.

Scleroderma renal crisis is a life-threatening condition. It usually starts with a sudden onset of severe hypertension, followed by renal failure, hypertensive encephalopathy, congestive heart failure, and/or microangiopathic hemolytic anemia. Renal ischemia, hyperplasia of the juxtaglomerular apparatus, activation of the renin-angiotensin-aldosterone system (RAAS), and an increase in blood pressure are caused by decreased blood flow caused by structural changes in the blood vessels as well as renal vasospasm ("Raynaud's phenomenon"). This overview discusses the evaluation, diagnosis, and treatment of scleroderma renal crisis, emphasizing the importance of early detection of disease, strong correlation of corticosteroids intake and the disease incidence, and best approach of such cases.

Background: Thyroid function tests are mandatory in clinical practice because symptoms and signs are not reliable to discriminate between various types of thyroid disease. Aim: The aim of this study was to determine assay-specific reference range for serum free T4, total T4, total T3 and TSH among healthy non-pregnant adult cohort for Roche® platforms in Basrah (Southern Iraq) from single laboratory in a tertiary center using indirect approach of the available data. Methods: A Cross sectional study for non-pregnant adults 19 years and above. Sera were analyzed by using cobs e411 for thyroid functions tests. Results: Total enrolled persons were 10,078. The 95% reference intervals for TSH were 0.20-6.50 μIU/mL, which increased with age though not linear, for free T4 were 0.8-1.70 ng/dL, for total T4 were 3.78-15.33 μg/dL, and for total T3 were 0.80-2.50 ng/mL. Colcusion: Cobs e411(Roche® analytical platform) analyzer reference range for thyroid function cannot be applied for Iraqi population .

Objective: To evaluate histologically the deposition of iron in the epiphyseal cartilage of offspring’s of dams given iron supplementation during pregnancy and lactation in rat model. Study Design: Laboratory based experimental study. Place and Duration of Study: Department of Anatomy, Army Medical College, Rawalpindi and National Institute of Health (NIH) Islamabad, from Mar to Nov 2016. Methodology: In this study, 16 female and 4 male adult rats were chosen for breading. After confirmation of pregnancy, pregnant rats were separated in two groups. One group was given oral iron supplementation for four weeks till delivery and half of the pups fed by mothers who were given iron during lactation. The other group was kept on normal lab diet. Deposition of iron in the epiphyseal cartilage of newborn rats after four weeks was evaluated histologically in pups. Results: Iron deposition was maximum in group C i.e. 1.30 ± 0.48; in group B it was 0.20 ± 0.44. Statistically significant iron deposition (p

Background: The role of paraoxonase 1 enzyme (PON1) and its single nucleotide polymorphisms (SNPs) in children with nephrotic syndrome (NS) has been reported previously in different ethnic and racial groups with divergent results. The human PON1 gene contains two coding region polymorphisms leading to two different PON1 isoforms. Objectives: The aim of the present study was to find out the association between the PON1 (Q192R and L55M) polymorphisms and their relation with serum PON1 activity as well as lipid profile tests (total cholesterol, TC; triglycerides, TG; high-density lipoprotein cholesterol, HDL-c; and low-density lipoprotein cholesterol, LDL-c) in children with NS. Methods: This study included a total of 80 participants (40 with NS in the age group of 2-14 years and 40 age and sex-matched healthy controls). The PON1 enzyme activity and lipid profile tests were measured in serum samples of all included participants. The PON1 genotype was determined by PCR-restriction enzyme fragment length polymorphism (PCR-RFLP) for both PON1 alleles (192 and 55) SNPs. Results: Our findings showed that the mean levels of lipid profile tests (TC, TG, LDL-c) were significantly increased in patients when compared with healthy controls (p

Background: The most common glomerular disorder in children is nephrotic syndrome, associated with high morbidity despite notable advances in its treatment. Many of the nephrotic syndrome complications, including the increased risk of atherosclerosis and thromboembolism, can be linked to dysregulated lipid metabolism and dyslipidemia. Paraoxonase enzyme is responsible for the most of the antioxidant properties of HDL, thus preventing the formation of atherogenic ox-LDL molecules, and lecithin cholesterol acyltransferase is intimately involved in HDL maturation and is a key component of the reverse cholesterol transport pathway, which removes excess cholesterol molecules from the peripheral tissues to the liver for excretion. Objectives: The present study aimed to investigate the serum activities of paraoxonase-1 (PON-1) and lecithin cholesterol acyltransferase (LCAT) in children with nephrotic syndrome in an active phase (as newly diagnosed or old cases with acute relapse). Also, to study any correlation exists between paraoxonase-1 activity and lipid profile. Methods: This study consists of group 1 with 40 cases of nephrotic syndrome in the age group of (2-14 years) and group 2 with 40 age and sex-matched healthy controls. Lipid profile and paraoxonase activity, lecithin cholesterol acyltransferase activities were measured in both groups’ serum samples. Results: Statistical analysis of student’s t-test showed that the mean levels of total cholesterol, triglycerides, LDL were significantly increased in group 1 when compared to Group 2 (p

Background Patients and clinicians can choose from several treatment options to address acute pain from non-low back, musculoskeletal injuries. Purpose To assess the comparative effectiveness of outpatient treatments for acute pain from non-low back, musculoskeletal injuries by performing a network meta-analysis of randomized clinical trials (RCTs). Data sources MEDLINE, EMBASE, CINAHL, PEDro (Physiotherapy Evidence Database), and Cochrane Central Register of Controlled Trials to 2 January 2020. Study selection Pairs of reviewers independently identified interventional RCTs that enrolled patients presenting with pain of up to 4 weeks' duration from non-low back, musculoskeletal injuries. Data extraction Pairs of reviewers independently extracted data. Certainty of evidence was evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Data synthesis The 207 eligible studies included 32 959 participants and evaluated 45 therapies. Ninety-nine trials (48%) enrolled populations with diverse musculoskeletal injuries, 59 (29%) included patients with sprains, 13 (6%) with whiplash, and 11 (5%) with muscle strains; the remaining trials included various injuries ranging from nonsurgical fractures to contusions. Topical nonsteroidal anti-inflammatory agents (NSAIDs) proved to have the greatest net benefit, followed by oral NSAIDs and acetaminophen with or without diclofenac. Effects of these agents on pain were modest (around 1 cm on a 10-cm visual analogue scale, approximating the minimal important difference). Regarding opioids, compared with placebo, acetaminophen plus an opioid improved intermediate pain (1 to 7 days) but not immediate pain (≤2 hours), tramadol was ineffective, and opioids increased the risk for gastrointestinal and neurologic harms (all moderate-certainty evidence). Limitations Only English-language studies were included. The number of head-to-head comparisons was limited. Conclusion Topical NSAIDs, followed by oral NSAIDs and acetaminophen with or without diclofenac, showed the most convincing and attractive benefit-harm ratio for patients with acute pain from non-low back, musculoskeletal injuries. No opioid achieved benefit greater than that of NSAIDs, and opioids caused the most harms. Primary funding source National Safety Council. (PROSPERO: CRD42018094412).

An rare pandemic of viral pneumonia occurs in December 2019 in Wuhan, China, which is now recognized internationally as Corona Virus Disease 2019 (COVID-19), the etiological agent classified as Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). According to the World Health Organization (WHO), it has so far expanded to more than 213 countries/territories worldwide. Our study aims to find the viral peptides of SARS-COV-2 by peptide mass fingerprinting (PMF) in order to predict its novel structure and find an inhibitor for each viral peptide. For this reason, we calculated the mass of amino acid sequences translated from the SARS-CoV2 whole genome and identify the peptides that may be a target for inhibition. Molecular peptide docking with Moringa oleifera, phytochemicals (aqueous and ethanolic) leaf extracts of flavonoids (3.56 ± 0.03), (3.83 ± 0.02), anthraquinone (11.68 ± 0.04), (10.86 ± 0.06) and hydroxychloroquine present therapy of COVID-19 in Pakistan for comparative study. Results indicate that 15 peptides of SARS-CoV2 have been identified from PMF, which is then used as a selective inhibitor. The maximum energy obtained from AutoDock Vina for hydroxychloroquine is –5.1 kcal/mol, kaempferol (flavonoid) is –6.2 kcal/mol, and for anthraquinone –6 kcal/mol. Visualization of docking complex, important effects are observed regarding the binding of peptides to drug compounds. In conclusion, it is proposed that these compounds are effective antiviral agents against COVID-19 and can be used in clinical trials. Communicated by Ramaswamy H. Sarma

Age-associated pharmacological and physiological changes increase the susceptibly of elderly populations to the occurrence of adverse events attributed to the use of potentially inappropriate medications (PIMs). The purpose of this study was to evaluate the prevalence of PIMs and associated risk factors among elderly cardiac outpatients. A descriptive, non-experimental, cross-sectional study was conducted at the outpatient department of a tertiary-care hospital in Islamabad, Pakistan from June to September 2018. Eligible patients were those aged ≥ 65 years with one or more cardiovascular condition taking one or more prescribed drugs. Patients were interviewed to collect patient-related information using a structured questionnaire. Beers criteria 2015 and the Barthel index were used to assess PIMs and performance in activities of daily living (ADL), respectively. Of the 386 elderly cardiac patients who were interviewed, 260 (67.4%) were exposed to at least one PIM based on Beers criteria 2015. The most commonly prescribed PIMs were hydrochlorothiazide (21.5%), furosemide (17.1%), omeprazole (13.7%), and orphenadrine (6.7%). Based on logistic regression analysis, the strongest predictors of PIM use were excessive polypharmacy (i.e. use of ≥ 10 medications) (odds ratio [OR] 18.83; p = 0.005), comorbidity (OR 1.80; p = 0.046), and dependence in performing ADL (OR 2.52; p = 0.012). The use of PIMs is common in elderly cardiac patients and significantly associated with dependence in performing ADL. Strict compliance to guideline recommendations is necessary to improve the quality of medication use.

This study aimed to assess the toxicity and severity of zinc oxide nanoparticle (ZnO-NPs) in the tissues of gills. Therefore, carp fish (Cyprinus carpio) were subjected to sub-lethal concentration of (ZnO-NPs) 9mg/l for periods of (7, 14, 21, 28, 35, 42) days that led to a histopathological and ultrastructural alteration in gills tissue. Microscopic examination showed the occurrence of bleeding and the pyramidal form (clump shape) of the epithelial cells lining the secondary gill filament after the lapse of 7 and 14 days after the treatment, and hyperplasia in mucus cells with hypertrophy of pillar cells at 28 days of treatment. At day 42, the lesions were characterized by basement thickening in the secondary gill filament with edema and vacuolar degeneration of pillar cells. While ultrastructural examination showed the presence of cloudy swelling of chloride cells and condensation of micro organelles at seven days of exposure increased with increasing duration of exposure and, therefore, at day 14 of exposure to the (ZnO-NPs). The electron microscope examination showed a thickening of blood vessels wall, hyperplasia of mucous cells with vacuolar degeneration of chloride cells. Ultra-structural changes in gills tissue of fish that exposed to N-ZnO for 42 days revealed microvilli and adhesion of micro ridge with degeneration of epithelial cells lining the secondary gill filaments. In conclusion, ZnO-NPs are toxic in a concentration of 9mg/l in a common carp (Cyprinus carpio), that lead to histopathological and ultra-structure alteration in gills and there was a positive relationship between the severity of lesions and time of exposure (7, 14, 21, 28,35 and42) days.

We submit an unusual presentation of spontaneous atrial fibrillation in a young fit active-duty U.S. military African-American male without evidence of structural heart disease. His atrial fibrillation was refractory to several ablation treatments over the course of 3 years. Subsequently he was diagnosed with extracardiac sarcoidosis and fluorodeoxyglucose-positron emission tomography (FDG-PET) scan identified bi-atrial hypermetabolic lesions, concerning for cardiac sarcoidosis. Given the low incidence of atrial fibrillation in patients < 45 years-of-age, this case report aims to underscore consideration of cardiac sarcoidosis as a subclinical contributor towards developing atrial fibrillation in the appropriate patient population. Broadly more investigations are needed to explore the role of cardiac sarcoidosis with atrial involvement and the likelihood of developing atrial arrhythmias.

Rheumatoid arthritis (RA) is a chronic autoimmune disease of unknown etiology with much higher prevalence in world's population. RA is initially associated with inflammation of joints and cartilages that ultimately leads to their destruction thus requiring a therapeutic intervention. The available conventional therapeutic strategies for RA are not satisfactory because of the associated side effects such as toxicity, delayed action, and dependence. Therefore, a carrier system is required that should deliver the drug to the target site with minimal side effects. In this connection, nanocarrier systems are of prime importance because of the associated benefits such as their nano-scaled size, targeted drug delivery, and reduced toxicity that can improve the patient's compliance. Moreover, in the past few decades, nano-particulate-based drug delivery approaches that have been investigated for the treatment of RA include ceramics, polymers, and hydrogels. Among these nanocarrier systems, ceramics like hydroxyapatite have gathered striking attention due to their bioactive, biocompatible, and bio-conductive characteristics. Nano-sized hydroxyapatite (HA) permeates the bone tissues and serves as a source of calcium phosphates required for bone repairing that are damaged during disease process. The aim of this review article is to highlight the potential use of HA as nanocarrier for anti-rheumatic drugs as well its possible effect on bone remodeling.

Pre-axial polydactyly (PPD) is characterized by well-developed non-functional 1st digit (thumb) duplication in hands and/or feet. It is mostly inherited in autosomal dominant manner. In the present study, two families of Pakistani origin, demonstrating unilateral PPD type A, have been characterized at clinical and genetic levels. Whole-exome sequencing (WES) revealed a nonsense mutation (c.84C > A, p.Tyr28*) in the STKLD1, located on chromosome 9q34.2, in affected individuals of both the families. Our findings report the first direct involvement of the STKLD1 in the digit development and highlight the importance of inclusion of this gene for screening individuals presenting non-syndromic recessive PPD.

Inflammatory bowel disease (IBD) is the inflammation of the gastrointestinal tract (GIT) affecting the colon and ileum in particular. Increasing IBD prevalence worldwide is alarming, and needs to be resolved. Due to the limited therapeutic efficacy, accompanying adverse effects, dependence, and pharmacokinetics issues of the available therapy, IBD patients have compromised quality of life. Meanwhile, conventional drug delivery systems (DDS) for IBD face many obstacles en-route to the colon, such as physiological and pathophysiological barriers, genetic variability, disease severity, and nutrition status. Therefore, the pH-dependent nanocarrier DDS is a recent advancement that fulfills the need for a more tolerable and effective remedy for IBD. It facilitates localized and targeted action, eliminating systemic adverse effects and unnecessary flushing of the drug from the inflamed colon tissues. The integration of a pH-sensitive polymer as a nanocarrier provides protection in drug transport to the lower region of the GIT. In this review, we will briefly explain IBD pathophysiology, the pros and cons of pH-dependent conventional DDS, and highlight a novel pH-dependent nanocarrier system for treating the disease.

Background: Ectopic pregnancy one of the life threatening condition, that can’t be prevented but canmanaged safely. Rationale: rolling out of surgical intervention to medical management is hope of all, eventhough surgeon. Aim of the study: to compare between the expectant and surgical management of tubalectopic pregnancy. Patients and Methods: Single blinded, controlled and interventional study conductedin Bint Al-Huda teaching hospital in Thi-Qar-Iraq, extended all over the 2019 since January till last weekof December . Totally (74) patients enrolled in the study, all of them were complained from tubal ectopicpregnancy, questionnaire, B-HCG, Trans- vaginal US were the main tools of follow up, Results: The targetpatients for our study was 116, 34 of them were excluded, 16 was with positive fetal heart, 20 were hadhemoperitonium extend beyond the pelvis at the time of presentation and 8 patients were patients refusefallow up (expected management). Most of them(40%) were older than 34 years, followed by (32.5%) within age of 32.5%, while the youngest age group occupying minimal proportion (27%), According to ?-HCGconcentration most of them (58%) were with

Objectives: 5-Flourouracil (5-FU), a chemotherapeutic drug, is linked with severe deteriorating effects on intestine leading to mucositis. Further, Glycyrrhizic acid is a renown herbal medicine with combined mucoprotective, antioxidant and anti-inflammatory actions, however associated with pharmacokinetics limitations. Owing to its remarkable therapeutic action in inflammatory bowel disease inside the polymeric nanocarriers, we have tried to explore its activity against 5-FU led intestinal mucositis. Polymeric nanocarriers proved to be efficient drug delivery vehicles for long-term remedy against inflammatory diseases, however, yet not explored for 5-FU induced mucositis. Therefore, the study aimed to produce Glycyrrhizic acid loaded poly lactic-co-glycolic acid (GA-PLGA) nanoparticles to evaluate its protective and therapeutic effects on intestinal mucosa against 5-FU mediated mucositis. Methods: For the said purpose, GA-PLGA nanoparticles were prepared using modified double emulsion method, physicochemically characterized and tested for invitro drug release. Thereafter, mucositis was induced by 5-FU (50 mg/kg; IP) administration to the mice for the first three days (day 0, 1, 2) and orally treated with GA-PLGA nanoparticles till seventh day (day 0-6). Results: GA-PLGA nanoparticles significantly reduced mucositis severity as manifested through recovered body weight, diarrhea score, distress, and anorexia. Further, 5-FU induced intestinal histopathological damage, altered villi-crypt length, low goblet cell count, elevated pro-inflammatory mediators and suppressed antioxidant enzymes were reversed by GA-PLGA nanoparticles’ sustained release therapeutic action. Conclusion: Morphological, behavioral, histological, and biochemical results suggested that GA-PLGA nanoparticles found to be efficient, biocompatible, targeted, sustained release drug delivery nano-vehicle for enhanced mucoprotective, anti-inflammatory and antioxidant effects in ameliorating 5-FU intestine mucositis.

5-Fluorouracil (5-FU), a chemotherapeutic drug, has severe deteriorating effects on the intestine, leading to mucositis. Glycyrrhizic acid is a compound derived from a common herbal plant Glycyrrhiza glabra, with mucoprotective, antioxidant and anti-inflammatory actions, however, associated with poor pharmacokinetics. Owing to the remarkable therapeutic action of glycyrrhizic acid-loaded polymeric nanocarriers in inflammatory bowel disease, we explored their activity against 5-FU-induced intestinal mucositis in mice. Polymeric nanocarriers have proven to be efficient drug delivery vehicles for the long-term treatment of inflammatory diseases, but have not yet been explored for 5-FU-induced mucositis. Therefore, this study aimed to produce glycyrrhizic acid-loaded polylactic-co-glycolic acid (GA-PLGA) nanoparticles to evaluate their protective and therapeutic effects in a 5-FU-induced mucositis model. GA-PLGA nanoparticles were prepared using a modified double emulsion method, physicochemically characterized, and tested for in vitro drug release. Thereafter, mucositis was induced by 5-FU (50 mg/kg; IP) administration to the mice for the first 3 days (day 0, 1, 2), and mice were treated orally with GA-PLGA nanoparticles for 7 days (day 0–6). GA-PLGA nanoparticles significantly reduced mucositis severity measured by body weight, diarrhea score, distress, and anorexia. Further, 5-FU induced intestinal histopathological damage, altered villi-crypt length, reduced goblet cell count, elevated pro-inflammatory mediators, and suppressed antioxidant enzymes, all of which were reversed by GA-PLGA nanoparticles. Morphological, behavioral, histological, and biochemical results suggested that GA-PLGA nanoparticles were efficient, biocompatible, targeted, and sustained release drug delivery nano-vehicle for enhanced mucoprotective, anti-inflammatory, and antioxidant effects in 5-FU-induced intestinal mucositis.

Background and aim: Modern treatment strategies for inflammatory bowel disease (IBD) are postulated to change the natural disease course. Inception cohort studies are the gold standard for investigating such changes. We have initiated a new population-based inception cohort study; Inflammatory bowel disease in South Eastern Norway III (IBSEN III). In this article, we describe the study protocol and baseline characteristics of the cohort. Methods: IBSEN III is an ongoing, population-based observational inception cohort study with prospective follow-up. Adult and pediatric patients with suspected IBD in the South-Eastern Health Region of Norway (catchment area of 2.95 million inhabitants in 2017), during the 3-year period from 2017 to 2019, were eligible for inclusion. Comprehensive clinical, biochemical, endoscopic, demographic, and patient-reported data were collected at the time of diagnosis and throughout standardized follow-up. For a portion of the patients, extensive biological material was biobanked. Results: The study included 2168 patients, of whom 1779 were diagnosed with IBD (Crohn's disease: 626, ulcerative colitis: 1082, IBD unclassified: 71). In 124 patients, there were subtle findings indicative of, but not diagnostic for, IBD. The remaining 265 patients were classified as symptomatic non-IBD controls. Conclusion: We have included patients in a comprehensive population-based IBD cohort from a catchment population of 2.95 million, and a unique biobank with materials from newly diagnosed and treatment-naïve IBD patients and symptomatic non-IBD controls. We believe this cohort will add important knowledge about IBD in the years to come.

International audience; Aim: To fabricate and evaluate curcumin-loaded transfersomes (Cur-TF) for the targeted delivery and enhanced therapeutic efficacy of curcumin for the treatment of rheumatoid arthritis (RA). Methods: Modified thin-film hydration method was used to prepare Cur-TF which were then embedded into carbopol-934 gel. They were further evaluated through in vitro techniques and in an in vivo arthritis model. Results: Cur-TF had optimal particle size, spherical morphology, high encapsulation efficiency and sustained drug release profiles. The Cur-TF gel had better in vitro skin penetration than plain curcumin. In vivo findings demonstrated improved clinical, histological and x-ray scores and reduced pro-inflammatory cytokines through NF-κβ inhibition. Conclusion: Cur-TF gel delivered curcumin to the arthritic dermal tissue through a topical route and demonstrated promising therapeutic efficacy by significantly alleviating complete Freud's adjuvant (CFA)-induced arthritis.

Background Premixed insulin and basal insulin plus short-acting insulin regimens may be of value for treating individuals with type 2 diabetes (T2DM) who are fasting during Ramadan due to simplicity and better compliance. The objective of this study was to compare the effectiveness of human premixed insulin to basal plus short-acting insulin regimens in the management of fasting individuals with T2DM during Ramadan. Methods We conducted a prospective observational study in Basrah (southern Iraq) on 30 individuals with T2DM who fast during Ramadan. The enrolled patients were assigned into two groups at random: one group received a human premixed insulin regimen, the other received a basal plus short-acting insulin regimen. A baseline clinical and biochemical analysis was gathered for all patients at recruitment two weeks before fasting and within four weeks after the end of fasting. Patients were assessed twice during fasting month for insulin dose adjustment and documentation for any hyperglycemia or hypoglycemia. Results Fourteen patients were assigned to the premixed group, and 16 patients were assigned to the basal plus short-acting insulin group. The mean patient age was 53 ± 8 years, and the mean T2DM duration was 9.3 ± 4.2 years. The two groups were matched by age, body mass index, and glycated hemoglobin (HbA1c). There was no significant difference between the initial and final mean HbA1c in both groups. However, there was more non-significant HbA1c reduction in the premixed group as compared to the basal plus short-acting insulin group. The number of hypoglycemic events and weight changes among the two groups was not significant. Conclusions Both human premixed and basal plus short-acting insulin regimens are equally useful for glycemic control for patients with T2DM who choose to fast in observance of the month-long holiday of Ramadan.

Background Acute lung injury (ALI) together with acute respiratory distress syndrome (ARDS) are associated with high rate of mortality and morbidity in patients. In the current study, the anti-inflammatory effects of continentalic acid (CNT) in LPS-induced acute lung injury model was explored. Methods The acute lung injury model was established by administering LPS (5 mg/kg) intraperitonealy. Following LPS administration, the survival rate, temperature changes and lung Wet/Dry ratio were assessed. The antioxidants (GSH, GST, Catalase and SOD) and oxidative stress markers (MDA, NO, MPO) were evaluated in all the treated groups. Similarly, the cytokines such as IL-1β, IL-6 and TNF-α were analyzed using ELISA assay. The histological changes were determined using H and E staining, while Nrf2 and iNOS level were determined using immunohistochemistry analysis. The molecular docking analysis was performed to assess the pharmacokinetics parameters and interaction of the CNT with various protein targets. Results The results showed that CNT dose dependently (10, 50 and 100 mg/kg) reduced mortality rate, body temperature and lungs Wet/Dry ratio. CNT post-treatment significantly inhibited LPS-induced production of pro-inflammatory cytokines such as IL-1β, IL-6 and TNF-α. The CNT post-treatment markedly improved the hematological parameters, while significantly reduced the MPO (indicator of the neutrophilic infiltration) activity compared to the LPS treated group. Furthermore, the CNT (100 mg/kg) post-administration remarkably inhibited the lung Wet/Dry ratio. The CNT (100 mg/kg) treated group showed marked reduction in the oxidative stress markers such as malonaldehyde (MDA) and Nitric oxide (NO) concentration, while induced the level of the anti-oxidant enzymes such as GST, GSH, Catalase and SOD. Similarly, the CNT markedly reduced the iNOS expression level, while induced the Nrf2 protein expression. Additionally, the molecular docking study showed significant binding interaction with the Nrf2, p65, Keap1, HO-1, IL-1β, IL-6, TNF-α and COX-2, while exhibited excellent physicochemical properties. Conclusion The CNT showed marked protection against the LPS-induced lung injury and improved the behavioral, biochemical and histological parameters. Furthermore, the CNT showed significant interaction with several protein targets and exhibited better physicochemical properties.

BackgroundDiabetes mellitus is a chronic disease characterized by hyperglycemia that may occur due to genetic, environmental or lifestyle factors. Natural remedies have been used to treat diabetes since long and many antidiabetic compounds of varied efficacies have been isolated from medicinal plants.Rhazya strictahas been used for decades for the treatment of diabetes mellitus and associated ailments. Considering the folkloric use ofR. strictaagainst diabetes, it was aimed to investigate the effectiveness of its root extracts against diabetes through in vitro assays and in vivo studies using animal model along with phytochemical profiling through GCMS.MethodsVarious fractions ofRhazya strictaobtained through column chromatography were evaluated for a variety of assays including α-glucosidase, Dipeptidyl peptidase-IV (DPP-IV), β-secretase and Glucagon-like peptide-1 (GLP-1) secretion studies. For the in vivo studies the alloxan-induced diabetic mice were treated with root extracts and blood glucose levels, HbA1C, and other biochemical markers along with the histological study of the liver were done. The phytochemical identification was performed using an Agilent 7890B GC coupled to a 7010 Triple Quadrupole (MS/MS) system. GraphPad Prism software version 5.01 was used for statistical analysis.ResultsMajority of the extract fractions showed excellent results against diabetes by inhibiting enzymes DPP-IV (Up to 61%) and β-secretase (Up to 83%) with IC50s979 μg/ml and 169 μg/ml respectively with increase in the GLP1 secretion. The results of in vivo studies indicated a marked reduction in blood glucose and HbA1c levels along with positive effects on other parameters like lipid profile, liver functions and renal functions of extract-treated mice as compared to control. The histological examination of the liver demonstrated hepatoprotective effects against diabetes led changes and various classes of phytochemicals were also identified through GCMS in different fractions.ConclusionThe results revealed strong antidiabetic activity ofR. strictaroot with the potential to protect body organs against diabetic changes. Moreover, a variety of phytochemicals has also been identified through GCMS that might be responsible for the antidiabetic potential ofRhazya strictaroot.Graphical abstract

In the current study, the N-benzylidene-4-((2-hydroxynaphthalene-1-yl) diazenyl) hydrazides (NCHDH and NTHDH) were evaluated against the Carrageenan- and CFA-induced models. During the preliminary investigation, the NCHDH and NTHDH treatment showed marked anti-inflammatory and analgesic activity against the Carrageenan-induced acute model. Once the anti-inflammatory activity was established against acute Carrageenan model, the NCHDH and NTHDH were evaluated against the chronic CFA-induced arthritis model. The NCHDH and NTHDH treatment markedly attenuated the inflammatory and analgesic parameters compared to CFA-treated group. Furthermore, the increase in the oxidative stress and attenuation of antioxidant enzymes has been reported following CFA administration. However, NCHDH and NTHDH treatment significantly induced the antioxidants and attenuated the oxidative stress markers. The CFA administration showed marked tailing of DNA; however, the NCHDH- and NTHDH-treated group preserved DNA integrity. Furthermore, the histological studies showed marked alteration in the CFA-treated group; however, the NCHDH and NTHDH treatment markedly improved the histological features. The Western blot, immunohistology, and ELISA assay revealed marked increase in the Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), Jun N-terminal Kinase (JNK), TNF-α, and COX-2 levels; however, the NCHDH and NTHDH attenuated their expressions significantly. Similarly, the NCHDH and NTHDH significantly induced the mRNA expression levels of heat shock proteins. The computational analysis showed significant binding interaction with various protein targets via multiple hydrogens, and hydrophobic bonds. The in vivo pharmacokinetic study was also performed to assess the various pharmacokinetic parameters. In conclusion, the NCHDH and NTHDH treatment showed significant anti-arthritic activity against Carrageenan and CFA models.

The pandemic coronavirus disease 2019 (COVID‐19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2), has affected millions of people worldwide. To date, there are no proven effective therapies for this virus. Efforts made to develop antiviral strategies for the treatment of COVID‐19 are underway. Respiratory viral infections, such as influenza, predispose patients to co‐infections and these lead to increased disease severity and mortality. Numerous types of antibiotics such as azithromycin have been employed for the prevention and treatment of bacterial co‐infection and secondary bacterial infections in patients with a viral respiratory infection (e.g., SARS‐CoV‐2). Although antibiotics do not directly affect SARS‐CoV‐2, viral respiratory infections often result in bacterial pneumonia. It is possible that some patients die from bacterial co‐infection rather than virus itself. To date, a considerable number of bacterial strains have been resistant to various antibiotics such as azithromycin, and the overuse could render those or other antibiotics even less effective. Therefore, bacterial co‐infection and secondary bacterial infection are considered critical risk factors for the severity and mortality rates of COVID‐19. Also, the antibiotic‐resistant as a result of overusing must be considered. In this review, we will summarize the bacterial co‐infection and secondary bacterial infection in some featured respiratory viral infections, especially COVID‐19.

Background: Data on thyroid disease epidemiology in the Middle East are scanty and anecdotal. This study aimed to assess the pattern of thyroid disease seen in Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah,Southern Iraq. Methods Retrospective observational study of database retrieval from the FDEMC a tertiary care Center in Basrah for the period of September 2008 to January 2019. Included all adults non pregnant 18 years or older. Results Total enrolled patients 17878; of them 4174(23.3%) men and 13705(76.7 %) women. There were 2229(12.5%) patients with hypothyroidism (83.0% women), with subclinical hypothyroidism observed in 364 out of 2229 with hypothyroidism(16.3%). We found 1087 (6.1%) patients with hyperthyroidism (67.7% women) and subclinical hyperthyroidism observed in 92 of 1087 hyperthyroidism (8.4%). Thyroid nodularity was seen in 944 (5.2%) patients (807 women in 85.5%). Thyroidectomy was done in 776(4.3%). Differentiated thyroid cancer was seen in 77 (0.4%). Conclusion: Hypothyroidism was double that of hyperthyroidism. Cross-sectional community-based study can give more information on the epidemiology of thyroid disease in Iraq.Iodine status needed studded in the future. Keywords: Hyperthyroidism, hypothyroidism,autoimmune thyroid disease, Iraq.

Live attenuated Brucella melitensis Rev.1 strain is currently used in Iraq against caprine and ovine brucellosis. Vaccination with Rev.1 may lead to the adverse effects of strain persistence in the vaccinated animals and its occasionally spread horizontally. Moreover, in some countries it was shown that the vaccine strain caused human infection, demonstrating the zoonotic hazards of its virulence. Thirty Sheep milk samples and 30 Goat milk samples were taken from animals given a positive result with rose Bengal test. Also 12 Vaginal swabs from aborted ewes and 20 Vaginal swabs from aborted goats were taken in period didn't exceed 10 days after the abortion. At the same time, 50 blood samples taken from patients with Malta fever. The samples cultured on trypton soya broth and then sub-cultured on Brucella Basel agar. Biochemical test, PCR-RELP, and DNA sequencing were used to distinguish Vaccine Rev.1 strain from field strains. Out of 92 samples from goats and sheep, Brucella isolated from 43 (46.7%) case. The results revealed that vaginal discharges are better than milk samples for isolation of the Brucella. In human, the bacteria isolated from 11 (22%) of Malta fever patients. PCR-RELP and DNA sequencing revealed that Rev.1 strain isolated from 8 (21%) animals and 1 (11.1%) of human patients. © 2020, Research Journal of Pharmacy and Technology. All rights reserved.

Objectives: To find risk factors to diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) patients. Methods: A four years cross sectional study involving 386 patients with T2DM conducted at the diabetes clinic in Al-Hindeya General Hospital, Karbala, Iraq. Interviews were done for the participants focused on sociodemographic factors and included general examination with laboratory screening for fasting blood glucose (FBG), glycated haemoglobin (HbA1c), and serum lipids. The participants underwent ophthalmological testing including visual acuity, slit lamp examination, and optical coherence tomography. The patients were divided into retinopathy and non-retinopathy groups involving 109 and 277 patients, respectively. Both groups were screened for risk factors including age, gender, duration of disease, body mass index (BMI), treatment modality, HbA1c, and dyslipidemia. Results: The study included 109 patients (62 females, 47 males) with retinopathy and 277 patients (149 females, 128 males) control. Mean age for retinopathy and control groups were 54.76± 7.63 and 54.15± 9.20 years, respectively. Mean duration of disease for retinopathy and control groups were 12.79± 5.91 and 8.51± 5.16 years, respectively. Longer duration of disease and poor glycemic control showed positive association with DR with a P-value of 0.0001 and 0.033, respectively. Gender, BMI, age, treatment modality, and dyslipidemia showed negative association with DR. Conclusions: In our study DR significantly associated with longer duration of disease and poor glycemic control while the relation was insignificant for gender, BMI, age, treatment modality, and dyslipidemia. Keywords: Type 2 diabetes mellitus, Diabetic retinopathy, glycated hemoglobin, risk factor for retinopathy. DOI : 10.7176/JHMN/70-08 Publication date: January 31 st 2020

Background Alzheimer’s disease (AD) is a primary cause of dementia in ageing population affecting more than 35 million people around the globe. It is a chronic neurodegenerative disease caused by defected folding and aggregation of amyloid beta (Aβ) protein. Aβ is formed by the cleavage of membrane embedded amyloid precursor protein (APP) by using enzyme ‘transmembrane aspartyl protease, β-secretase’. Inhibition of β-secretase is a viable strategy to prevent neurotoxicity in AD. Another strategy in the treatment of AD is inhibition of acetylcholinesterase. This inhibition reduces the degradation of acetylcholine and temporarily restores the cholinergic function of neurons and improves cognitive function. Monoamine oxidase and higher glutamate levels are also found to be linked with Aβ peptide related oxidative stress. Oxidative stress leads to reduced activity of glutamate synthase resulting in significantly higher level of glutamate in brain. The aim of this study is to perform in silico screening of a virtual library of biaryl scaffold containing compounds potentially used for the treatment of AD. Screening was done against the primary targets of AD therapeutics, acetylcholinesterase, β-secretase (BACE1), Monoamine oxidases (MAO) and N-Methyl-D-aspartate (NMDA) receptor. Compounds were screened for their inhibitory potential by employing molecular docking approach using AutoDock vina. Binding energy scores were embodied in the heatmap to display varies strengths of interactions of the ligands targeting AD. Results Several ligands showed notable interaction with at least two targets, but the strong interaction with all the targets is shown by very few ligands. The pharmacokinetics of the interacting ligands was also predicted. The interacting ligands have good drug-likeness and brain availability essential for drugs with intracranial targets. Conclusion These results suggest that biaryl scaffold may be pliable to drug development for neuroprotection in AD and that the synthesis of further analogues to optimize these properties should be considered. Electronic supplementary material The online version of this article (10.1186/s12868-018-0472-6) contains supplementary material, which is available to authorized users.

Background: Thalassemias are a group of heterogeneous genetic disorders, in which the rate of production of hemoglobin is partially or completely suppressed due to reduced rate of synthesis of α or β- chain Objectives: to estimate the prevalence of Hepatitis C infection among B thalassemia patients attending Ibn-AL-Baladi center of blood diseases in AL-Sader city, in AL-Resafa Quarter of Baghdad and to determine the possible risk factors. Type of the study: Cross- sectional study. Methods: A cross sectional study conducted on B Thalassemia patients attending the blood diseases center in Ibn-AL-Baladi hospital during the period from 1st of July till the 31st of December 2015. Results: All of 400 eligible patients, who were recruited to be included in this study, were accepted to participate in the study giving an overall response rate 100%. The prevalence rate of Hepatitis C according to anti HCV antibody test among the study group was 26%. Conclusions: we conclude that about quarter of Iraqi thalassemic patients visiting the thalassemia center in Ibn-AL-Baladi hospital have HCV infection

The aim of the present study was to evaluate the knowledge, attitude, and practice of breast cancer screening methods among female patients attending five primary healthcare centers in Najran, Saudi Arabia. A cross-sectional survey was conducted on 500 female patients, and a direct interview questionnaire was used to collect data. Our results indicated a low knowledge about breast cancer, breast self-examination, mammogram and clinical breast examination was 54.4%, 56%, 90.4%, and 83.8%, respectively. Nineteen percent of patients demonstrated a high knowledge of breast self-examination. Breast self-examination was performed by 35% of patients, whereas 15% of patients received mammograms and 19.8% clinical breast examinations. The most common barrier for screening methods of breast cancer was that patients were unaware of half of the screening methods. A total of 20.6% of women did not perform breast self-examinations because they were not well trained, and 26.4% of women did not receive clinical breast examinations because there was no female doctor available. The main source of information among the women patients was social media (52.4%), whereas 8.8% received information through their healthcare provider. In summary, the majority of women demonstrated poor knowledge about breast cancer and screening methods. Additional effort should be put forth through women’s healthcare providers to increase the awareness of breast cancer screening. That means we need to continue emphasizing the importance of primary healthcare for early detection of breast cancer in the early stages. Electronic supplementary material The online version of this article (10.1007/s13187-018-1423-8) contains supplementary material, which is available to authorized users.

Background In the present study, the poncirin which is flavonoid-7-o-glycosides (isolated from the Poncirus trifoliata) in nature was evaluated against the Carbon tetra chloride (CCL4)-induced liver injury. The poncirin have been reported for various anti-inflammatory, analgesic activity etc. Based on the previous studies it was anticipated that the poncirin will ameliorate CCL4-induced liver injury. Methods The CCL4-induced acute and chronic liver injury model (albino BALB/c mice) was used. Following the induction of the liver injury various parameters such as food and water intake, body weight and weight to dry ratio changes were assessed. Furthermore, various hematological, biochemical parameters and histological studies such as hemotoxylin and eosin (H and E) staining were performed. The poncirin treatment was also evaluated against the pro-inflammatory cytokines such as interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) using enzyme link immunosorbant assay (ELISA). The Swiss Target prediction software was used to investigate interaction of the poncirin on the various hepatic enzymes. Results The poncirin treatment markedly improved the behavioral parameters such as food and water intake. The liver weight variation was attenuated and total body was improved markedly. The hematological and biochemical parameters were significantly improved compared to the CCL4 treated groups. The anti-oxidants were induced, while oxidative stress markers were reduced promisingly. The H and E staining showed that poncirin treatment significantly improved the histology of liver compared to the CCL4 treated group. Furthermore, the poncirin treatment also evidently decreased the inflammatory mediators. Conclusions The poncirin treatment showed marked improvement in behavioral, biochemical and histological parameters following CCL4-induced liver injury. Additionally, the poncirin treatment also markedly improved the antioxidant enzymes, attenuated the oxidative stress markers and inflammatory cytokines.

Background: Diabetes mellitus has an effect on the peripheral nerves. Such effect may start as asymptomatic peripheral neuropathy. Objectives: To assess the role of electrodiagnostic study in the diagnosis of patients with different types of diabetic peripheral neuropathy (DPN) and evaluate the usefulness of it in early detecting diabetic peripheral neuropathy in asymptomatic patients and to correlate the findings of nerve conduction study in patients with asymptomatic diabetic peripheral neuropathy with various risk factors. Subjects and Methods: subjects were allocated into three groups: 50 normal (non-diabetics apparently healthy subjects without peripheral neuropathy), 50 asymptomatic DPN patients and 50 symptomatic DPN patients. Clinical questionnaire, blood sugar, neurological examination and nerve conduction studies were performed for each subject. Results: This study showed that the prevalence of positive nerve conduction studies was 58% in asymptomatic diabetic patients, 100% for symptomatic diabetic patients and negative for control. The positive nerve conduction study findings in asymptomatic diabetic patients involved sensory more than motor fibers and the lower limbs nerves were affected more than that of the upper limbs. The most commonly involved nerve is the sural nerve sensory fiber which was more prevalent in old age patients (87.5%), patients with longer duration of diabetes (81.8%), over weight (71.4%), patient taking only oral antihyperglycemic drugs (76.9%) and in diabetic patients with poor glycemic control (84.2%) (86.3%) in fasting blood glucose (FBG) and HbA1c respectively. Using the logistic regression, only oral antihyperglycemic drugs (without insulin) and poor control HbA1c were significant predictors of abnormal nerve conduction. Conclusion: Even in asymptomatic patients, nerve conduction studies show diffuse changes, in a predictable pattern. Electrophysiological finding correlate with age, duration of disease, glycosylated hemoglobin levels, fasting blood glucose, type of the treatment if only oral antidiabetic and body mass index.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease where the body's immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs. Objective: to assess knowledge toward Systemic Lupus Erythematosus (SLE) among Students of King Faisal University. Subjects and Methods: this is a cross-sectional study enrolling 161 students atKing Faisal University to fill a survey on SLE awareness. The study targeted students of computer science, engineering, science and education colleges. The data was analyzed using SPSS software version 20. Results: the study reported that 98 students (60.9%) have no idea about SLE. The majority of respondent did not have clear idea regarding diagnostic, treatment and complications of disease. 55.9% respondent had idea that SLE is more prevalent among men. However, this disorder is reported more prevalent in women. Conclusion: this cross-sectional survey indicates that the students have low awareness and some misconception regarding the SLE. Therefore, the awareness programs are needed to increase the awareness about SLE, as these campaigns have proved that public awareness might be helpful to manage and control disease and associated complications.

Background: Weight gain is one of the most important hypothyroidism-related concerns among patients with hypothyroidism. However, not as expected, thyroxine replacement does not necessarily result in body weight (BWT) reduction among those patients. The study aimed to assess the patterns of BWT changes through time in patients with hypothyroidism. Method: A retrospective database study from Faiha Specialized Diabetes, Endocrine, and Metabolism Center. A total of 346 adult patients with hypothyroidism, 192 newly diagnosed and 154 known, who had 1 visit every 3 months, 5 visits per one year. From those patients, 116 new and 69 known had completd 9 visits per two years. Each visit involved thyroid-stimulating hormone (TSH) and BWT measurements. Patients with chronic liver or renal disease, diabetes mellitus, thyroid cancer, or other malignancies, pregnancy, and on steroid or hormonal therapies were excluded. The patients were further subdivided based on average TSH levels into controlled (TSH≤4.2 μIU/mL) and uncontrolled TSH>4.2 μIU/mL. Repeated measures ANOVA with a Greenhouse-Geisser correction and Post hoc tests using the Bonferroni correction were used to evaluate BWT changes through the study. Results: Both newly diagnosed and known hypothyroidism, over one and two years, in patients with average TSH>4.2 μIU/mL, BWT increased significantly through visits. For newly diagnosed over one year, (F(2.41, 321.60) = 3.28, p = 0.03), and mean BWT increase = 1.4 ± 0.38 kg from 3rd to 12th month visits, (p = 0.004). For newly diagnosed over two years, (F(3.10, 263.89) = 9.08, P < 0.0005), mean BWT increase = 3.02 ± 0.77 kg from 3rd to 24th month visits, (p = 0.007). And for known hypothyroidism over one year, (F(2.56, 187.47) = 7.11, p = 0.0003), mean BWT increase = 1.97 ± 0.64 kg at 12th month visit, and over two years, (F(2.35, 77.56) = 4.67, P = 0.009), mean BWT increase = 3.78 ± 1.26 kg at 24th month visit. While in all other patients with average TSH≤4.2 μIU/mL, the BWT changed non-significantly through visits. For newly diagnosed patients over one year and two years (p = 0.10, 0.34 respectively), and known patients over one year and two years (p = 0.47, 0.34 respectively). Conclusion: In contrary to what is believed, adequate treatment with thyroxine does not associate with weight reduction. Instead, either the patient kept on the same weight or continued to gain more weight.

Background Genodermatoses represent genetic anomalies of skin tissues including hair follicles, sebaceous glands, eccrine glands, nails, and teeth. Ten consanguineous families segregating various genodermatosis phenotypes were investigated in the present study. Methods Homozygosity mapping, exome, and Sanger sequencing were employed to search for the disease-causing variants in the 10 families. Results Exome sequencing identified seven homozygous sequence variants in different families, including: c.27delT in FERMT1; c.836delA in ABHD5; c.2453C>T in ERCC5; c.5314C>T in COL7A1; c.1630C>T in ALOXE3; c.502C>T in PPOX; and c.10G>T in ALDH3A2. Sanger sequencing revealed three homozygous variants: c.1718 + 2A>G in FERMT1; c.10459A>T in FLG; and c.92delT in the KRT14 genes as the underlying genetic cause of skin phenotypes. Conclusion This study supports the use of exome sequencing as a powerful, efficient tool for identifying genes that underlie rare monogenic skin disorders.

Background: Stone size is a key factor in the determination of the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery. Aim of the Study: to assess and compare the efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones greater than 2 cm versus percutaneous nephrolithotomy (PCNL). Patients and methods: A retrospective analysis was carried out for a total of 118 patients, of which 46 patients underwent RIRS while 72 patients underwent PCNL between May 2013 and May 2017. Results: The mean duration of operation was 96.39±41.11 min in the RIRS group and 69.51±19.3 min in the PCNL group (p

This paper reviews Crigler-Najjar Syndrome as a rare fatality affecting individuals in the early years of life. It’s rare incidence, mis-diagnosis and severe complications resulting in death at the early age has cause difficulty in determining its exact frequency in general population. This syndrome, is described by the accumulation of un-conjugated bilirubin in the body due to the inheritance of defects UGT1A1 genes. This anomaly disrupts the bilirubin mechanism at a greater extent. The high level of bilirubin in the body manifests itself in terms of specific signs and symptoms among which jaundice is most common and well-known. Therefore, treatment is primarily directed towards decreasing accumulation of un-conjugated bilirubin in the body. Aspects of liver transplant can be seen as permanent treatment plan at risk to benefit ratio.

Background: screening for prostate cancer (PCa) is surrounded by controversies regarding the benefits, risks and uncertainties of undergoing the screening. Current practices of prostate cancer involve measuring the level of PSA and digital rectal examination. This study aimed to measure the knowledge and awareness of undergoing a prostate cancer screening and the available treatment options amongst the participants. Method: a questionnaire-based quantitative cross-sectional study which focuses on determining the knowledge of prostate cancer screening and management in a hospital in Riyadh. Results: three hundred and twenty-three participants filled the surveys (100% males), more than 80% of all ages had heard about prostate cancer and that it is a disease of the male. A higher level of education is significantly associated with the level of awareness (P-value

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease where the body's immune system attacks its own healthy tissue. It can affect many organs such as skin, joints, brain, kidneys and other organs. Objectives: to evaluate the knowledge toward Systemic Lupus Erythematosus (SLE) among citizens in Al-Dammam city. Methods: a questionnaire-based quantitative cross-sectional study which focuses on determining the knowledge of Systemic lupus erythematosus in Al-Dammam city. Results: 240 participants filled the surveys, 130 participants (54%) have no idea about SLE. The majority of respondents had no clear idea regarding treatment and complications of the disease. 32% respondents had idea that SLE is more prevalent among females. In fact, this disorder is reported more prevalent in women. Conclusion: this study indicated that the public have low awareness with some misconception regarding the SLE. The awareness campaigns are needed to increase the awareness about SLE which will be helpful to educate the public about its symptoms and methods of treatments.

This study was designed to assess the achievement of a glycated hemoglobin (HbA1c) target in Iraqi type 2 diabetes mellitus (T2DM) patients via retrospective analysis of a tertiary care database over a 9-year period.A total of 12,869 patients with T2DM with mean (SEM) age: 51.4(0.1) years, and 54.4% were females registered into Faiha Specialized Diabetes, Endocrine and Metabolism Center(FDEMC) database between August 2008 and July 2017 were included in this retrospective study. Data were recorded for each patient during routine follow-up visits performed at the center every 3-12 months.Patients were under oral antidiabetic drugs (OAD; 45.8%) or insulin+ OAD (54.2%) therapy. Hypertension was evident in 42.0% of patients, while dyslipidemia was noted in 70.5%. Glycemic control (HbA1c7%) was achieved by 13.8% of patients. Multivariate analysis revealed55 years of age, female gender,3 years duration of diabetes, HbA1c10% at the first visit, presence of dyslipidemia, and insulin treatment as significant determinants of an increased risk of poor glycemic control. BMI25 kg/mUsing data from the largest cohort of T2DM patients from Iraq to date, this tertiary care database analysis over a 9-year period indicated poor glycemic control. Younger patient age, female gender, longer disease duration, initially high HbA1c levels, dyslipidemia, insulin treatment, overweight and obesity, and lack of hypertension were associated with an increased risk of poor glycemic control in Iraqi T2DM patients.

Aim: To fabricate and evaluate the therapeutic efficacy of glycyrrhizic acid (GA)-loaded pH-sensitive nanoformulations that specifically target and combat mucosal inflammation of the colon. Methods: GA-loaded Eudragit® S100/poly-(lactic-co-glycolic acid) nanoparticles were developed through modified double-emulsion evaporation coupled with solvent evaporation coating techniques and analyzed for physicochemical characteristics, surface chemistry, release kinetics, site-retention and therapeutic effectiveness. Results: Nanoparticles have a particle size of approximately 200 nm, high encapsulation efficiency, desired surface chemistry with pH-dependent and sustained drug release behavior following the Gompertz kinetic model. In vivo retention and therapeutic effectiveness in the inflamed colon tissues were confirmed by macroscopic and microscopic indices, cytokine analysis and antioxidant assays. Conclusion: GA-loaded Eudragit S100/poly-(lactic-co-glycolic acid) nanoparticles could efficiently deliver GA to the colon and ameliorate the mucosal inflammation for a prolonged duration.

5-Fluorouracil (5-FU)-induced intestinal mucositis (IM) is one of the most common oncological problem. It involves serious clinical consequences such as diarrhea, erythematous lesions of mucosa, and eventually development of ulcers accompanied by severe pain. The aim of the present study was to demonstrate the mucoprotective effects of Saikosaponin-A in 5-FU-induced intestinal mucositis in mice. Mucositis was induced in BALB/c mice by intraperitoneal injection of 5-FU (50 mg/kg/day) for three consecutive days and IM was assessed by both behavioral and histochemical analysis. While, Saikosaponin-A (1, 5, 10 mg/kg/day) was administered 1 h before 5-FU injection for consecutive seven days. Pre-treatment of Saikosaponin-A significantly ameliorated the severity of mucositis reflected as food intake, body weight loss, severity of diarrhea and mortality rate in a dose depended manner as compared to mice treated with 5-FU. Moreover, histopathological analysis furthered reinforced the mucoprotective potential of Saikosaponin-A against 5-FU-induced intestinal abnormalities referred as villus atrophy, mitotic crypt stem cells damage, inflammatory cells infiltration, vacuolization and edema. Furthermore, Saikosaponin-A administration strongly inhibited pro-inflammatory mediators (TNF-α, COX-2, IL-1β and IL-6) and apoptotic markers (p-JNK, Casp-3). Saikosaponin-A pre-treatment significantly reduced the production of nitric oxide (NO) in intestinal tissue, inhibited acetic acid-induced Evans blue vascular permeability. The Siaikosaponin-A treatment markedly enhanced the anti-oxidants enzymes (Nrf2, HO-1, SOD, GSH, GST and Catalase), while decreased the oxidative stress markers i.e. Malonaldehde (MDA). Hence, these data suggest that Saikosaponin-A maybe a potential candidate for the treatment of chemotherapy-induced intestinal mucositis.

Woodhouse Sakati syndrome (WSS, MIM 241080) is a rare autosomal recessive genetic condition characterized by alopecia, hypogonadism, hearing impairment, diabetes mellitus, learning disabilities and extrapydamidal manifestations. Sequence variants in the gene DCAF17, encoding nucleolar substrate receptor, were identified as the underlying cause of inherited WSS. Considerable phenotypic heterogeneity exists in WSS with regard to severity, organs involvement and age of onset, both in inter-familial and intra-familial cases. In this study, the genetic characterization of a consanguineous pedigree showing mild features of WSS was performed, followed by structural analysis of truncated protein. Exome sequencing identified a novel single base deletion variant (c.270delA; K90Nfs8*) in third exon of the gene DCAF17 (RefSeq; NM_025000), resulting in a truncated protein. Structural analysis of truncated DCAF17 revealed absence of amino acid residues crucial for interaction with DDB1. Taken together, the data confirmed the single base pair deletion as the underlying cause of this second report of WSS from Pakistan. This signifies the vital yet unexplored role of DCAF17 both in development and maintenance of adult tissues homeostasis.

Multiple sclerosis (MS) is a destructive autoimmune neuroinflammatory and neurodegenerative disorder of the central nervous system (CNS) with unknown etiology and mechanism of pathogenesis. Pathogens, especially human herpes viruses, have been suggested as environmental factors of the MS and other neuroinflammatory disorders. This study aimed to determine the prevalence of HHV-6 antibody response in MS patients and investigate the levels of pro/anti-inflammatory cytokine and chemokines in MS patients in comparison with healthy subjects. Two hundred sixty-three patients with clinically defined MS (140 females and 123 males), along with 263 healthy subjects (140 females and 123 males), were recruited for this study. After the analysis of HHV-6 seropositivity/seronegativity, the levels of some pro/anti-inflammatory cytokines, including TNF-α, IFN-γ, IL-1β, IL-6, and IL-12 as well as two chemokines, namely CCL-2 and CCL-5 were determined by the enzyme-linked immunosorbent assay (ELISA) method in HHV-6 seropositive/seronegative MS patients and healthy subjects. Our results showed that the serum concentrations of TNF-α, IFN-γ, IL-1β, IL-6, and CCL-5 elevated in HHV-6 seropositive compared with seronegative MS patients (P .05). Moreover, the levels of IL-12, IL-10, and CCL-2 levels were significantly lower in seropositive MS patients when compared with seronegative MS patients (P .05). Also, our results revealed that the mean values of the expanded disability status scale (EDSS) were significantly higher in HHV-6 seropositive versus seronegative MS patients (P .05). In conclusion, we proposed that HHV-6 infection may play a role in MS pathogenesis by changing cytokine signaling in MS patients that may lead to peripheral inflammation.