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Background: Prehypertension (PHT) is a cardiovascular health risk defined by blood pressure (BP). Arterial stiffness (AS) provides beyond brachial BP inference on vascular ageing and pulse wave analysis (PWA) can measure it non-invasively.We compared association between AS and PHT using age and gender matched case-controls. Methods: This is a sub analysis of previous PWA studies of hypertensives and non-hypertensives. Using oscillometric PWA by Mobil-o-Graph (IEM, Stolberg, Germany), parameters of AS (augmentation pressure and index, reflection magnitude, aortic pulse wave velocity, pulse pressure amplification), brachial hemodynamics (BH), and central hemodynamics (CH; aortic BP, cardiac output related parameters, stroke work) were derived. Age and gender matched case controls were compared as: 1) Nonhypertensives with BP at prehypertensive level (PHT) versus normotensives (NT) (n = 217 each), 2) Under treatment hypertensives with BP at prehypertensive level (PHT-T) versus untreated, nonhypertensives with BP at prehypertensive level (PHT-UT) (n = 74 each). Results: PHTs had higher AS, BH and CH than NTs, with statistical significance for all but few parameters. PHT-T had comparable BH but higher AS, CH than PHT-UT with significance for few parameters. Conclusion: Pulse wave analysis derived arterial stiffness is associated with prehypertension compared to normal, after age and gender matching. In hypertensives, arterial stiffness is significantly higher despite being treated to prehypertension level as compared to control. It hints arterial stiffness to be better parameter than brachial BP to study prehypertension.

ObjectiveThis study aims to assess the knowledge and perceptions of the public toward migraine in Saudi Arabia.MethodsThis cross-sectional survey assessed the knowledge and perceptions of migraine among Saudi Arabian individuals. The study was conducted over three months in 2023 (1st of June 2023 to 31st of August 2023) using a prevalidated online questionnaire divided into four sections.ResultsA total of 1,975 adults aged between 18 and 64 completed the web-based survey. Of these, over half were male (n = 1,268; 64.2%). The main causes of migraine identified by the participants were genetic disease (n = 540, 27.3%), followed by physical disease (n = 341, 17.3%), head trauma (n = 274, 13.9%), and psychiatric disease (n = 157, 7.9%). The main symptoms identified by the participants were photophobia (21%), followed by inability to control urine (14.1%), vomiting and nausea (13.8%), and vision loss (8.3%). The majority of the participants in this study had a good knowledge of migraines, while 49% had poor knowledge. The migraine knowledge score was significantly associated with the participants' gender (p = 0.002), age (p = 0.0001), educational level (p = 0.001), employment status (p = 0.001), monthly income (p = 0.0001), region (p = 0.0001), and history of migraine (p = 0.0001).ConclusionAlthough one-third of the participants exhibiting good knowledge, deficiencies existed in certain clinical aspects, emphasizing the need for targeted educational interventions to enhance public awareness and understanding of migraines.

Maryam Sherwani,1,* Lubna Vohra,1,* Danish Ali,1,* Rufina Soomro,2 Syed Adnan,1 Romana Idrees3 1Department of Surgery, Aga Khan University, Karachi, Pakistan; 2Department of Surgery, Liaquat National Hospital, Karachi, Pakistan; 3Department of Pathology, Aga Khan University, Karachi, Pakistan*These authors contributed equally to this workCorrespondence: Lubna Vohra, Aga Khan University Hospital, Karachi Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan, Tel +92 21 34930051, Fax +92 21 3493 4294, Email lubna.vohra@aku.eduPurpose: To describe the clinicopathological features, and subtypes of metaplastic breast cancer (MpBC) in Pakistan and further to understand its response to treatment, including region-specific survival outcomes.Patients and Methods: This retrospective cohort study was conducted at two private tertiary care hospitals in Karachi, Pakistan. Our selection criteria included a total of 215 patients who were diagnosed with MpBC at an age older than 18 years from 1994 to 2021. Data regarding clinicopathological features, staging, receptor status, treatment modalities, recurrence, and survival was obtained. Death was scored as an event, and patients who were alive were censored at the time of the last follow-up.Results: The incidence of MpBC at our study centers is 3.21%. The median age of diagnosis was 50 years (range 22 to 80 years) and most patients presented at Stages II (45.1%) and III (44.2%). Among patients who received neoadjuvant chemotherapy, 31.7% achieved complete pathological response. The 3-year survival of those who received neoadjuvant chemotherapy was 96%. During our study, 19.1% of patients died and the median survival duration was 9 years 7 months 9 days. Survival of patients was significantly lower in patients who had metastasis (p-value = 0.042) and those who had tumor recurrence (p-value = 0.001).Conclusion: Metaplastic breast cancer is an extremely rare variant of breast cancer with features that exist as a spectrum. Our study demonstrated considerable success with the use of neoadjuvant chemotherapy. The pathological complete response achieved in our study is one of the highest ever reported. Our success, though limited, warrants further research in the use of neoadjuvant chemotherapy in MpBC.Keywords: neoadjuvant therapy, triple negative, squamoid, overall survival

BackgroundPrevious studies have highlighted instances where pharmacists lacked knowledge regarding women’s health issues related to epilepsy.ObjectivesTo assess UAE community pharmacists’ knowledge, toward women’s issues in epilepsy.Methodsa cross-sectional research method was employed. A team of seven pharmacy students in their final year visited a randomly selected sample of community pharmacies in the UAE and face-to-face interviews were conducted with the pharmacists using a structured questionnaire. The questionnaire includes two parts; Eight questions designed to elicit data about the demographics of the study participants and 12 questions eliciting insights into the participants’ knowledge of women’s issues in epilepsy.ResultsA total of 412 community pharmacist were recruited in the study. The overall level of knowledge about women’s issues in epilepsy was good and the average knowledge score was 81% with a 95% confidence interval (CI) [79.1, 82.7%]. The results of multivariate analysis showed higher knowledge scores in chain pharmacies (OR 1.37; 95% CI 1.12–1.67), Chief pharmacists (OR 1.44; 95% CI 1.01–2.06), Pharmacists in charge (OR 3.46; 95% CI 2.7–4.45), pharmacists with 1–5 Years of experience (OR 2.87; 95% CI 1.71–4.82), pharmacists with 6–10 Years (OR 2.63; 95% CI 1.58–4.38), pharmacists with >10 years (OR 3.13; 95% CI 2.03–4.83), graduation form regional universities (OR 1.37; 95% CI 1.12–1.67), graduation form international universities (OR 1.73; 95% CI 1.36–2.20) and receiving a training on epilepsy (OR 1.36; 95% CI 1.12–1.67).ConclusionWhile the findings reveal an overall promising level of knowledge among community pharmacists regarding the issues faced by women with epilepsy, pinpointing which clinical and demographic factors have the most significant impact on this knowledge would permit the implementation of tailored educational interventions. Workshops and modules targeting the issues faced by women with epilepsy would further raise the knowledge and competence among community pharmacists in this area, ensuring better pharmaceutical care for this population.

Bariatric surgery has significantly increased globally as an effective treatment for severe obesity. Nutritional deficits are common among candidates for bariatric surgery, and follow-up of nutritional status is critically needed for post-surgery healthcare management. This observational prospective study was conducted at King Khalid University Hospital in Riyadh. Samples were collected pre- and post-laparoscopic sleeve gastrectomy (LSG), with the visit intervals divided into four visits: pre-surgery (0M), 3 months (3M), 6 months (6M) and 12 months (12M). Food intake and eating patterns significantly changed during the first year (P < 0·001). The mean energy intake at 3M post-surgery was 738·3 kcal, significantly lower than the pre-surgery energy intake of 2059 kcal. Then, it increased gradually at 6M and 12M to reach 1069 kcal (P < 0·00). The intake of Fe, vitamin B12 and vitamin D was below the dietary reference intake recommendations, as indicated by the 24-hour dietary recall. The prevalence of 25 (OH) vitamin D deficiency improved significantly from pre- to post-surgery (P < 0·001). Vitamin B12 deficiency was less reported pre-LSG and improved steadily towards a sufficient post-surgery status. However, 35·7 % of participants were deficient in Fe status, with 28·6% being female at higher levels than males. While protein supplementation decreased significantly over the 12M follow-up, the use of vitamin supplements dramatically increased at 3 and 6M before declining at 12M. Fe and vitamin B12 were the most popular supplements after vitamin D. This study confirms the necessity for individualised dietary plans and close monitoring of candidates' nutritional status before and after bariatric surgery. [ABSTRACT FROM AUTHOR]

The importance of each person's healthcare should be viewed as fundamental in the modern world due to the rise in various health issues. A decrease in the proportion of doctors is caused by an increase in the number of cases. The diagnosis is consequently delayed, or some patients are overlooked. As a result, people become more reliant on doctors for checkups. In order to retain each patient's digital identification, in light of all these worries, health and medical care systems have begun to connect and interact with the internet of things (IoT). Many health disorders in the healthcare system go undiagnosed resulting from a shortage of doctors and other medical experts, as well as a lack of access to healthcare services. These IoT-based healthcare options, on the other hand, have made it possible for patients and medical professionals to continuously track and analyze patient data. In this study, IoT for healthcare systems is discussed. These included applications, structures, and potential design snags and issues. It has been demonstrated that these systems could be very beneficial to people, especially during the (Covid-19) pandemic's global isolation and the growing challenges in treating patients intelligently. This paper also presents a survey study on the use of IoT in smart healthcare, its applicability, the future directions for its development, and a review of past researchers' applications.

Tumors in the middle ear rarely have an adenomatous nature. Adenomatous tumors can manifest as neuroendocrine adenoma, endocrine adenoma and middle ear adenoma (or temporal bone adenoma). They may represent the same tumors at different stages of glandular and neuroendocrine differentiation. Middle ear adenoma refers to rare tumors. The tumor can clinically manifest itself with nonspecific symptoms, which makes timely diagnosis difficult. According to computed tomography and magnetic resonance imaging, a soft-tissue tumor with clear boundaries usually is detected in the middle ear, without destructive changes and spreading beyond the middle ear. Usually no difference between adenoma and other middle ear tumors, which makes differential diagnosis difficult. The final diagnosis is usually made according to the histological examination. Surgery is the main method of treatment of middle ear adenoma, the purpose of which is radical resection of tumor.

Introduction: Mathematics is one of the most important academic subjects in school. However, it is one of the most difficult subjects, and both students and teachers face difficulties in this subject. Teachers have difficulty engaging students in learning the subject. Rarely has the concept of engagement been researched in the Middle East region, in general, and in Oman in particular. Similarly, the concept of self-efficacy has been minimally investigated. The purpose of this study is to test the construct validity of: self-efficacy, engagement, and anxiety in mathematics. Once constructs are validated, models of relations among constructs were developed and tested. Method: A multi stage cluster sample (n=900: 420 females; 480 males) was selected from two Omani school directorates. The sample was selected from grades 6, 8 and 10 in Muscat and Aldhahira. Three measures were administered to intact classes. Results: The results revealed reasonable construct validity for each construct. Structural equation models indicated that self-efficacy significantly predicted engagement. Neither self-efficacy nor engagement was able to predict anxiety. Discussion and Conclusion: The implication of our results is that for programs and initiatives to promote engagement in mathematics, students should develop confidence in learning mathematics. Also, any program should assess students math anxiety and focus more on students with low to medium math anxiety since students in this category of math anxiety produce negative correlations between math anxiety and self-efficacy and between math anxiety and engagement in mathematics.

Fragrances are among the most common ingredients in cosmetics products. Importantly, exposure to fragrances on a daily basis might pose a health risk, leading to serious effects, such as contact dermatitis or contact eczema. Annex III of the European Union Directive on Cosmetic Products and Gulf Cooperation Council standardization organization (GSO) introduced restrictions for 26 allergens, with their concentrations exceeding 0.001% and 0.01% in leave-on products and rinse-off products, respectively. In the current study, we aimed to expand the scope of the analytical method (EN16274, 2012) to include a broader range of matrices. The optimized method was validated by examining a statistical approach, including selectivity, linearity, accuracy, precision, and measurement of uncertainty. Successfully, the validated data demonstrated acceptable limits according to validation protocols, with linearity showing satisfactory regression of r > 0.995. During method performance assessment, samples were extracted using ultrasound-assisted extraction to extract allergens that yielded relatively high recoveries. Studies on matrices spiked with allergens at different levels showed insignificant bias as an average of 0.07 µg/g. Method performance was assessed by analyzing 140 cosmetics samples, including perfumes, deodorants, aftershave, baby wet wipes, shampoos, lotions, and lip care products. The new optimized analytical method is believed to be a valuable analytical tool to be used in surveillance studies covering a wide range of cosmetic matrices.

Background: Effective medication management, disposal, and donation are vital for public health and environmental sustainability. Improper handling of medications can lead to drug misuse, accidental poisoning, and environmental damage. This study examines current practices and challenges in Saudi Arabia, identifying opportunities for improvement. Method: A cross-sectional survey conducted in October and November 2023 targeted the general population in Saudi Arabia. This study employed convenience sampling to explore medication usage, storage, disposal practices, and awareness of donation procedures. Data were analyzed through both descriptive and inferential statistical methods. Results: This study involved 430 respondents. Of these, 73.0% held a university degree, yet 66.3% were unaware of drug donation programs, and 84.2% lacked knowledge about proper medication disposal. Despite this, 71.4% believed that drug donation programs positively impact healthcare, and 87.9% saw them as reducing drug waste and environmental pollution. However, 48.1% expressed concerns about the potential misuse of donated medicines. Awareness and knowledge were significantly higher among participants aged 30 and above. Conclusions: The findings highlight the need for enhanced public awareness, clear medication disposal guidelines, and ethically governed donation practices in Saudi Arabia. These measures can improve healthcare outcomes, protect the environment, and support global health and sustainability goals. [ABSTRACT FROM AUTHOR]

The incidence of hospital- and community-acquired infections has been dramatically increased worldwide. Accordingly, hands hygiene and the use of disinfectants have been increased leading to the expansion in hand sanitizers production to meet public demand. This study was conducted to assess the efficiency of common disinfectants in the market of Riyadh, Saudi Arabia in inhibiting the microbial growth during the time of Coronavirus disease 2019 (COVID-19) pandemic. Five bacterial strains of commonly hospital-acquired infections (Pseudomonas aeruginosa, Escherichia coli, Salmonella enteritidis, Staphylococcus aureus, and Enterococcus faecalis) (ATCC reference strains and clinical isolates) were examined for their susceptibility against 18 disinfectants collected from the Saudi market. The tested 18 disinfectants were broadly clustered into different groups based on their active chemical composition as following: 12 products contained alcohol, 2 products had chlorhexidine, 3 products contained mixed concentration of alcohol/chlorhexidine and 1 product had a mixture of chlorhexidine/Hexamidine/Chlorocresol. By measuring the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC), our results revealed that all the 18 disinfectants have reduced the microbial growth of all the tested strains. Generally, the MICs and the MBCs for the clinical strains are higher than those of the reference strains. Taken together, our findings showed that all tested products have high disinfectants’ killing rate against microbes of different origins, which suggest the high quality of these disinfectants and the good surveillance practice by the local authorities in Saudi Arabia.