Search

Background The treatment of osteoarticular infections in pediatric patients with sickle cell disease (SCD) is a challenging task for the practitioner. The aim of this study is to evaluate cefixime for the treatment of osteoarticular infections in pediatric SCD patients by retrospective design. Methods This study was done in the pediatric hospital of King Saud Medical City, Riyadh, Saudi Arabia. The data was obtained from medical records of patients aged 1-16 years admitted between January 2019 to December 2020, diagnosed with SCD and received cefixime for the treatment of OI. A descriptive study for pediatric patients admitted between January 2019 to December 2020 diagnosed with sickle cell disease and diagnosed with osteoarticular infection. All patients were treated with cefixime. Medians and interquartile ranges (IQRs) were used for the descriptive analysis. Results A total of 260 patients were screened, and 51 cases [osteomyelitis (OM), n = 43, and septic arthritis (SA), n = 8] met the inclusion criteria. The median age of OM patients was 7 years, with males making up 67.4% of the cohort. The median length of IV antibiotics and hospital stays were 10 days and 11 days, respectively. The median total duration of antibiotic use was 37 and 25 days for OM and SA, respectively. The treatment success rate was 88% in OM cases and 100% in SA patients. Readmission was noted in 39.5% of the OM patients, while only 25% of the SA patients were recorded for reinfection. Conclusion The study's findings revealed that Cefixime is a viable oral alternative for treating osteoarticular infection in pediatric SCD patients. Nonetheless, a prospective investigation is required to corroborate the findings of this study.

Type 2 diabetes mellitus (T2DM) is a chronic disease with ever-increasing prevalence worldwide. In our study, we evaluated the prevalence of the risk of developing T2DM in Saudi Arabia and investigated associations between that risk and various sociodemographic characteristics. To those ends, a web-based cross-sectional survey of Saudi nationals without diabetes, all enrolled using snowball sampling, was conducted from January 2021 to January 2022. The risk of developing T2DM was evaluated using a validated risk assessment questionnaire (ARABRISK), and associations of high ARABRISK scores and sociodemographic variables were explored in multivariable logistic regression modeling. Of the 4559 participants, 88.1% were 18 to 39 years old, and 67.2% held a college or university degree. High ARABRISK scores were observed in 7.5% of the sample. Residing in a midsize city versus a large city was associated with a lower ARABRISK risk score (p = 0.007), as were having private instead of governmental insurance (p = 0.005), and being unemployed versus employed (p < 0.001). By contrast, being married (p < 0.001), divorced or widowed (p < 0.001), and/or retired (p < 0.001) were each associated with a higher ARABRISK score. A large representative study is needed to calculate the risk of T2DM among Saudi nationals.

Background: COVID-19 is newly emerging infectious disease that spread globally at unpredictable and unique pattern to the extent that the World Health Organization announced COVID-19 as a pandemic in the first couple months of 2020. This study aims to describe clinical and demographic features of COVID-19 patients and the influence of various risk factors on the severity of disease. Methods: This research is a retrospective study based on Saudi Arabia's ministry of health's Covid-19 data. The analysis relies on data of all COVID-19 patients recorded in Riyadh between 1st, March 2020 and 30th, July 2020. Statistical analyses were performed to investigate the effect of demographic characteristic, clinical presentation, and comorbidities on infection severity. Results: A total number of 1026 COVID-19 patients were identified based on the demographic data as follows: 709 cases (69% of cases) were males and 559 cases (54% of cases) were Saudi. Most of patients were diagnosed with mild signs and symptoms 697 (68% of cases), while 164 patient (16% of cases) demonstrated moderate signs and symptoms, and 103 cases (10%) were severe and 62 (6%) had critical febrile illness. Fever, cough, sore throat, and shortness of breath were the most common symptoms among patients with COVID-19. Among studied comorbidities in COVID-19 patients, diabetes mellitus and hypertension were the most prevalent. The results from the bivariate logistic regression analysis revealed that older age, diabetes mellitus, asthma, smoking, and fever are associated with severe or critically ill cases. Conclusion: The findings of this study show that old age, fever, and comorbidities involving diabetes mellitus, asthma, and smoking were significantly associated with infection severity. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background & Objectives: Cigarette smoke is associated with several diseased states including defects in reproductive behavior. Salvadora persica (S. persica) known as the toothbrush plant is reported to possess several pharmacological properties including antidepressants and anxiolytics. The present research was done to determine the libido-protective effect of S. persica in chronic cigarette smoke-exposed rats. Materials and Methods: The decoction of freshly dried roots of S. persica (50, 100, and 200 mg/kg, oral) was administered to the chronic-cigarette smoke-exposed adult rats. The parameters related to libido were recorded using a close-camera circuit (CCTV). Serum corticosterone and testosterone levels were estimated. Further, the phytochemical constituents were identified in the decoction. The data obtained were analyzed using one-way analysis of variance and significance was considered at p

Background The uncertainty about COVID-19 outcomes in angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) users continues with contradictory findings. This study aimed to determine the effect of ACEI/ARB use in patients with severe COVID-19. Methods This retrospective cohort study was done in two Saudi public specialty hospitals designated as COVID-19 referral facilities. We included 354 patients with a confirmed diagnosis of COVID-19 between April and June 2020, of which 146 were ACEI/ARB users and 208 were non-ACEI/ARB users. Controlling for confounders, we conducted multivariate logistic regression and sensitivity analyses using propensity score matching (PSM) and Inverse propensity score weighting (IPSW) for high-risk patient subsets. Results Compared to non-ACEI/ARB users, ACEI/ARB users had an eight-fold higher risk of developing critical or severe COVID-19 (OR = 8.25, 95%CI = 3.32–20.53); a nearly 7-fold higher risk of intensive care unit (ICU) admission (OR = 6.76, 95%CI = 2.88–15.89) and a nearly 5-fold higher risk of requiring noninvasive ventilation (OR = 4.77,95%CI = 2.15–10.55). Patients with diabetes, hypertension, and/or renal disease had a five-fold higher risk of severe COVID-19 disease (OR = 5.40,95%CI = 2.0−14.54]. These results were confirmed in the PSM and IPSW analyses. Conclusion In general, but especially among patients with hypertension, diabetes, and/or renal disease, ACEI/ARB use is associated with a significantly higher risk of severe or critical COVID-19 disease, and ICU care.

Background & objectives Rosuvastatin calcium (RC) is a potent and competitive synthetic inhibitor of HMG-CoA reductase used for the treatment of dyslipidemia. Guggulipid obtained from Commiphora mukul is used in the treatment of a wide variety of diseases such as atherosclerosis, hypercholesterolemia, rheumatism, and obesity. The present study evaluates the pharmacokinetic and pharmacodynamic interactions between RC and the standardized guggulipid extract in rats. Materials and methods The guggulipid extract was standardized for the presence of guggulsterones. The pharmacokinetic interaction was determined after a single dose administration of RC alone or in combination with the guggulipid extract or after multiple-dose administration of RC alone or RC along with the guggulipid extract for 14 days. To determine the pharmacodynamic interaction, RC and guggulipid extract were administered to hyperlipidemic rats for 14 days. The level of significance was determined using unpaired student’s t-test, one way ANOVA, the post-ANOVA Tukey test. Results Standardization of guggulipid extract showed it contains 7.5%w/w of guggulsterones. Guggulipid extract increased the bioavailability of RC in both single-dose and multiple-dose studies. Guggulipid extract reduced the rate of absorption (Ka) of RC but showed an increase in maximum serum concentration (Cmax). An in-vitro study using isolated rat intestine revealed that guggulipid extract decreased the rate of absorption of RC in the intestinal lumen. The hypolipidemic activity of RC was augmented by the guggulipid extract in hyperlipidemic rats. Interpretation & conclusion Therefore it is concluded that guggulipid extract increases the bioavailability of RC by delaying its Ka and augments its hypolipidemic action. However, it is recommended that a combination of RC with guggulipid extract should be used only after an adverse effect(s) of this combination are determined.

Background & objectives Natural dietary supplements are progressively getting famous to supplant synthetic substances particularly in chronic morbidities. The aim of this study was to evaluate the anti-obesity potential of almond on the normal, Cafeteria, and Atherogenic diets. Materials and methods Parameters such as change in body weight, body temperature, lipid profile, organ weights, and fat pad weights were assessed. Central Nervous System related studies (Despair Swim test and Elevated Plus maze test) were also performed to comprehend the effect of the diets, and almond on the brain. All of the experimental animals were randomly assigned to one of three diet categoriesregular, cafeteria, or atherogenic, and fed those diets for 40 days. Each diet had the control group, standard drug group and three almond groups (low dose: 50; medium dose: 100 and high dose: 200 mg/kg body weight). Body weight was recorded every alternate day. On 40th day, body temperature was measured. On day 41, lipid parameters, organ weights, fat pad weights and the CNS parameters were evaluated. ANOVA followed by Duncans Multiple Range Test were used for statistical analysis. Results Treatment of animals with either a low or high dose of almond as well as a standard herb prevented a rise in body weight significantly (p = 0.01) in all three diet groups. When a regular diet was replaced with a cafeteria and atherogenic diet, the serum levels of triglycerides and LDL increased significantly, while HDL levels decreased significantly. Overall, almond preparation reduced lipid parameters, organ weights, fat-pad weights, and stabilized CNS parameters substantially. Interpretation & conclusion The almond high dose was the most effective of all the almond preparations. Our study suggests that chronic administration of almond independently reduces the body weight in experimental animals.

Background and objectives Pharmaceutical sterile wastes are not only environmental hazard but an economical loss. There are many strategies employed in various parts of the world for minimizing the parenteral admixture returns in hospitals, however, they are not practiced in Saudi Arabia. Therefore, this study was done to assess the impact of a) intravenous (IV) pharmacy round and b) twice daily batching, as reduction strategies on the number of IV admixture returns and the associated cost of medication wastage. Method This study was conducted at the central IV room of the in-patient pharmacy unit at King Fahad Medical City, Riyadh, Saudi Arabia for general intensive care unit (ICU) IV returns. Phase 1 of the study was intended to measure the baseline parameters, while the Phase 2 and 3 were measured with the application of IV pharmacy round plan, and twice-daily batching strategies, respectively. Comparison of IV returns were done in each of the phases and economical loss was calculated. Results Out of number of IV admixtures prepared and supplied to ICU during a month, 4.85% of the items were deemed wasted during baseline phase with as estimated cost of IV wasted items to be 2,128.02 USD. In the IV pharmacy round and twice-daily batching strategies, the percentage of the wasted items decreased to 4.27% and 3.73%, respectively. Moreover, there is 13.84% and 42. 48% reduction in the estimated cost in the wasted items in, pharmacy round and twice-daily batching strategies, respectively, compared to baseline phase. Conclusion Implementation of interventions caused reduction in total recycled, wasted items and the associated cost of medication wastage of sterile pharmaceutical preparations. Twice daily batching strategy has better effect in decreasing the IV returns and its associated cost.

This study aimed to evaluate the effectiveness of tocilizumab in mechanically ventilated patients with coronavirus disease 2019 (COVID-19). This retrospective multicenter study included adults (≥18 years) diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time polymerase chain reaction (RT-PCR) from nasopharyngeal swab, and requiring invasive mechanical ventilation during admission. Survival analyses with inverse propensity score treatment weighting (IPTW) and propensity score matching (PSM) were conducted. To account for immortal bias, we used Cox proportional modeling with time-dependent covariance. Competing risk analysis was performed for the extubation endpoint. A total of 556 (tocilizumab = 193, control = 363) patients were included. Males constituted the majority of the participants (69.2% in tocilizumab arm,74.1% in control arm). Tocilizumab was not associated with a reduction in mortality with hazard ratio [(HR) = 0.82,95% confidence interval (95%CI): 0.62–1.10] in the Inverse propensity score weighting (IPTW) analysis and (HR = 0.86,95% CI: 0.64–1.16) in the PSM analysis. However, tocilizumab was associated with an increased rate of extubation (33.6%) compared to the control arm (11.9%); subdistributional hazards (SHR) = 3.1, 95% CI: 1.86–5.16). Although tocilizumab was not found to be effective in reducing mortality, extubation rate while on mechanical ventilation was higher among tocilizumab treated group.

Background & Objectives As intestinal failure (IF) inhibits the digestive system from absorbing nutrients, total parenteral nutrition (TPN) is required to provide all of a person's nutritional demands. In children with malabsorptive conditions like IF, iron deficiency anemia (IDA) is common. This study used a quasi-experimental approach to assess the efficacy and safety of oral iron therapy in treating IDA in TPN-dependent children with IF. Materials and Methods Sixteen pediatric patients with an ongoing history of IF, TPN dependency, and iron deficiency anemia were enrolled and given an oral iron syrup dose of ferric hydroxide polymaltose complex (6 mg/kg/day in 2–3 separate doses of elemental iron) after receiving ethical approval and parental consent. Blood tests were done to measure serum iron, ferritin, complete iron-binding capacity [TIBC], transferrin saturation [TSAT], and hemoglobin (Hb) level at the time of inclusion (T0), 14 (T14), and 30 days after treatment (T30). Results The mean age was 7.13 (±1.99) and female were 12 (75%). No remarkable change in Hb level was noted in the first and second subsequent follow-ups, notwithstanding, the normal estimation of the serum ferritin level significantly increased during the first follow-up (on fourteenth day) which further enhanced by second follow-up (30th day). The aggregate of the total iron binding capacity (TIBC) declined during the course of oral iron therapy with a reduction in transferrin saturation. Interpretation & Conclusion The data suggest that oral iron therapy is unsuccessful in the treatment of IDA in children with IF. There is no substantial improvement in hemoglobin level or iron profile aside from serum ferritin. In order to avoid using parenteral iron in IF patients, an additional supportive system is needed to aid in the integration of oral iron therapy.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contains spike proteins that assist the virus in entering host cells. In the absence of a specific intervention, efforts are afoot throughout the world to find an effective treatment for SARS-CoV-2. Through innovative techniques, monoclonal antibodies (MAbs) are being designed and developed to block a particular pathway of SARS-CoV-2 infection. More than 100 patent applications describing the development of MAbs and their application against SARS-CoV-2 have been registered. Most of them target the receptor binding protein so that the interaction between virus and host cell can be prevented. A few monoclonal antibodies are also being patented for the diagnosis of SARS-CoV-2. Some of them, like Regeneron® have already received emergency use authorization. These protein molecules are currently preferred for high-risk patients such as those over 65 years old with compromised immunity and those with metabolic disorders such as obesity. Being highly specific in action, monoclonal antibodies offer one of the most appropriate interventions for both the prevention and treatment of SARS-CoV-2. Technological advancement has helped in producing highly efficacious MAbs. However, these agents are known to induce immunogenic and non-immunogenic reactions. More research and testing are required to establish the suitability of administering MAbs to all patients at risk of developing a severe illness. This patent study is focused on MAbs as a therapeutic option for treating COVID-19, as well as their invention, patenting information, and key characteristics.

The COVID-19 infection caused by the new SARS-CoV-2 virus has been linked to a broad spectrum of symptoms, from a mild cough to life-threatening pneumonia. As we learn more about this unusual COVID-19 epidemic, new issues are emerging and being reported daily. Mucormycosis, also known as zygomycosis or phycomycosis, causes severe fungal illness to individuals with a weakened immune system. It is a devastating fungal infection, and the most frequent kind is the rhino cerebral type. As a devastating second wave of COVID-19 sweeps India, doctors report several instances involving a strange illness—sometimes known as the “black fungus”—among returning and recovered COVID-19 patients. This paper analyzes the existing statistical data to address the severity of prevalence and further notes the nano-based diagnostic parameters, clinical presentations, its connection with other conditions like diabetes, hypertension, and GI disorders, and the importance of anti-fungal therapy in treating the same. Anti-fungal therapies, as well as surgical interventions, are currently used for the treatment of the disease. Proper and timely diagnosis is necessary, along with the reduction in the spread of COVID-19. From the review, it was found that timely pharmacologic interventions and early diagnosis by using a nano-based diagnostic kit can help control the disease. Additionally, this paper provides novel information about the nanotechnology approaches such as fungal detection biosensors, nucleic acids-based testing, point-of-care tests, and galactomannans detection, in the diagnosis of mucormycosis, and thereby reinforces the need for further research on the topic.

Coronavirus disease-19 (COVID-19) is a highly contagious infection that mainly affects the respiratory system of patients. To date, more than 10 million people have been affected by this virus, and Saudi Arabia has also reported over 210 million cases. At present, there is no established treatment for COVID-19. Vaccination is one of the ways to defeat the pandemic. Recent reports have indicated rare but serious adverse events after vaccination, causing an anxious response from the general public worldwide. Therefore, this study was aimed at evaluating the knowledge, attitude, and perception of the COVID-19 vaccine among the Saudi population. This study is a cross-sectional, web-based online survey conducted using a snowball sampling technique. A self-administered questionnaire prepared in Arabic and English was used to collect feedback from the general population on their knowledge, attitudes, and perceptions about the COVID-19 vaccine. Participants (n = 2022) from different regions of the country replied to the questions. The responses to the questions were recorded on a spreadsheet and analyzed using the SPSS software. Statistical analysis was performed using one-way ANOVA and non-parametric tests to draw conclusions about the results. Multivariate stepwise regression analysis was performed to determine the association between the knowledge, attitude, and perception scores and the demographic variables. p &lt, 0.05 was used to indicate the significance of the data. The data from the study indicated that most of the participants were males (81%), between 18 and 59 years of age (85.9%), Saudi nationals (98.3%), and possessed graduation or above as a qualification (62.9%). The results suggest that a major portion of respondents have satisfactory knowledge (76%), a positive attitude (72.4%), and perception (71.3%) towards the use of COVID-19 vaccines. Their responses can be categorized as between ‘good’ and ‘fair’. However, 30–40% of respondents lacked information about COVID-19 vaccination availability for under 18-year-olds as well as for pregnant women, in addition to the lack of knowledge about the serious unreported adverse reactions and long-term protection offered by the vaccine against coronavirus. The correlation analysis between the variables (p &gt, 0.05) indicated that the response to the KAP domains has no direct relationship. The survey results suggest that most of the Saudi population has sound knowledge and a positive attitude and perception. Since the COVID-19 vaccines have been approved for use in pregnancy and above 12-year-old children by health authorities, the lack of information shown by a significant percentage of participants requires strategies to update this information. Awareness programs targeting all sections of the population must be continued to provide all the updates, including vaccinations for pregnant women and children.

Magnetic resonance imaging (MRI) is extensively used for the diagnostic purposes. Patients who undergo MRI usually spend 30 to 45 minutes in a magnetically confined, loud environment. Therefore, in order to obtain high-quality diagnostic images, the majority of children and agitated adults need anaesthesia or sedation to remain calm and in position. The success of sedation for MRIs has typically been evaluated based on both the safety of the procedure and its efficacy. It can be challenging to keep the patient's respiration and hemodynamic steady while achieving the profound sedation level required to stop them from moving. The purpose of this research is to review the available information about drug selection for sedation in MRI. For painless diagnostic MRI, a single sedative or anaesthetic drug without analgesia is safer than a cocktail of several sedatives. Various commonly used drugs for sedation are dexmedetomidine, ketamine, chloral hydrate, midazolam, pentobarbital among others. Each drug has its own efficacy and safety profile along with certain side effects. It is critically important for the physician to choose the sedative drug appropriately. Drugs used for sedative purposes should have some definite characteristics including quick onset of action, wide therapeutic window, predictable duration among certain others. Dexmedetomidine, which preserves respiratory drive, and propofol, which has a high effectiveness and quick recovery, are currently chosen for children having an ambulatory MRI. Also, the combination of these drugs is used to sedate patients. Research in future can significantly contribute to defining elaborated criteria for selection of drugs since the available literature is scarce and limited mainly to paediatric population studies.

The World Health Organization (WHO) announced COVID-19, a novel coronavirus outbreak, as a pandemic in 2020. In the month of February 2020, the disease began to spread through the Middle East. The first case of COVID-19 in the Kingdom of Saudi Arabia was identified in March 2020, and it is now one of the region’s most affected countries. Analyzing the disease’s propagation pattern may aid in the development of pandemic-fighting strategies. This study aims to analyze the trend of COVID-19’s spread, its recovery, and mortality in the Kingdom of Saudi Arabia (KSA). Two to three major cities from the 13 provinces of the country were chosen, and the rate of infection recovery was recorded from the first month until the number of confirmed cases showed a decline. The data published on the official Ministry of Health website were recorded on an Excel sheet, graphically represented as figures to indicate the pattern of spread. According to the study’s findings, COVID-19 positive cases were discovered in the majority of provinces as early as March 2020. The province of Makkah had the largest number of COVID-19 positive cases (30.7%), followed by Riyadh (23%). The province of Al Jowf had the lowest number of COVID-19 cases (0.3%). Tabuk province had the highest rate of recovery (97.8%), followed by the Northern Border Province (96.7%). Makkah province had the highest mortality rate (2.6%), followed by Al Jawf province (2.4%). The peak case–fatality ratio was recorded in August and September. The highest number of tests to detect the COVID-19 was performed in the month of July, and the highest percentage of positive cases was detected in June (19.55%). All the provinces from the month of September 2020 showed a progressive decline in the number of confirmed COVID-19 cases. According to this study, COVID-19 infection was found in the majority of Saudi Arabian provinces in March 2020, with a peak in June–July 2020. Considering the climatic and demographic characteristics of the region, specific modalities need to be adopted in collaboration with international guidelines to defeat the COVID-19 pandemic.

Background & objectives: Dodonaea viscosa is one of the natural medications utilized in Saudi Arabia for treatment of several diseases and disorders. Prior investigations have revealed its anti-inflammatory and antioxidant properties. In the present study, the chloroform and methanolic extracts of Dodonaea viscosa were formulated as ointments using the emulsifying base and its wound healing property was determined in animal models. Materials and methods: The dried leaves of Dodonaea viscosa was macerated in methanol and chloroform solvents to obtain respective solvent extracts. Both the extracts were subjected for phytochemical investigation. A 10% w/w herbal ointment of the extracts were formulated and their physicochemical properties; color and odor, loss on drying, pH, and spreadability were evaluated. Further, both the formulations were tested for stability studies. The wound healing activity of individual herbal formulations were studied in Sprague Dawley rats using incision and excision wound models. The application of ointment was done topically once every day up to the end of the healing of the wound. The epithelization period in the excision wound model and tensile strength in the incision wound model were assessed to determine the wound-healing effects. Results: Methanolic and chloroform extracts of Dodonaea viscosa leaves have flavonoids and saponins in addition to other phytochemicals. All the evaluated physicochemical properties of both the formulations were within ideal cutoff points and they remained stable. In comparison with control and base groups, methanolic extract formulation took significantly (p

Background & Objectives In late December 2019, an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS COV-2) occurred in the city of Wuhan, the capital of the Hubei province in the central part of the People’s Republic of China ( Ren et al., 2020 ). In Saudi Arabia, the first case of COVID-19 was reported in March 2, 2020. In March 8, 2020, the Saudi authorities adopted the lockdown strategy to contain the disease. The aim of this study was to determine the effectiveness of the various phases of the lockdown strategy in Saudi Arabia and its impact on the basic reproductive number (R0) of the COVID-19 outbreak. Material and Methods The timeline of the COVID-19 outbreak in Saudi Arabia was divided into three-time intervals. Google Mobility Community Reports (2020) was used to estimate the changes in community mobility during the various phases of the lockdown. The basic reproductive number (R0) of the COVID-19 outbreak was calculated daily using the Susceptible, Infected and Recovered (SIR) model based on the Saudi Ministry of Health (MOH) daily reports. This is a standard system to determine the spread of the virus on the basis of infection rate, quarantine rate as well as confirmation rate. The mean values of the calculated R0 during each interval were compared using one-way ANOVA test. Results There was no statistically significant difference between the mean values of the different phases of the lockdown (P > 0.05). Moreover, mean R0 value of the second interval was 0.09 higher than the initial interval with free community mobility. Furthermore, the mean R0 values of the third interval with the full lockdown was 0.28 higher than the initial interval. Conclusion Early implementation of lockdown strategy combined with other social distancing strategies help in containing infectious outbreaks in their early phases. Continuous assessment of such strategies’ effectiveness provides decision makers with precious information needed to justify their application when considering their economic impact.

Cytogenetic analysis is essential to determine the effect of mutagens and antimutagens on genetic material. This study was done to evaluate the protective effect of root bark extract of Morus alba (M. alba) against cyclophosphamide induced somatic and germinal cell damage in male rats. The ethanolic extract of M. alba (0.25, 0.5 and 1 g/kg, 2 weeks) was evaluated against cyclophosphamide (75 mg/kg, single dose) induced nuclear damage. The sampling was done after 48 h of the clastogen treatment. The somatic and germinal nuclear damage was studied by bone marrow micronucleus and sperm analysis, respectively. Serum superoxide and catalase levels were estimated to determine the antioxidant status in each group. The results were analyzed statistically to find the significant variation. The administration of M. alba for 2 weeks suppressed dose-dependently the changes induced by cyclophosphamide. M. alba (0.5 g/kg) decreased the frequency of micronucleated erythrocyte, sperm shape abnormality and enhanced the sperm count, sperm motility and polychromatic-normochromatic erythrocytes ratio significantly (p &lt, 0.05) in comparison with the cyclophosphamide treated group. The highest tested dose of M. alba (1 g/kg) produced more prominent suppression (p &lt, 0.01) in the cyclophosphamide-induced somatic and germinal cell defects. The results also showed significant (p &lt, 0.05) improvement in the serum antioxidant enzymes levels with M. alba when compared with the challenge group. The lower dose of M. alba extract (0.25 g/kg) prevented the CP-induced changes but was found to be statistically insignificant. Therefore, antimutagenic potential of the high dose of the extract of M. alba is possibly due to its antioxidant nature. The ability of the M. alba extract to prevent the nuclear damage could play an important role in overcoming several mutational defects that are associated with anticancer chemotherapy.

Background: The use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) is controversial for treating COVID-19 patients. We aimed to estimate pooled risks of mortality, disease severity, and hospitalization associated with ACEI/ARB use and stratify them by country and country clusters. Methods: We conducted a search in various databases through 4 July 2020 and then applied random-effects models to estimate pooled risks (ORp) across stratifications by country cluster. Clusters were chosen to reflect outbreak times (China followed by Korea/Italy, others subsequently) and mobility restrictions (China and Denmark/France/Spain with stricter lockdowns than the UK/US). Results: Overall analysis showed no increase in mortality, however, a statistical increase in mortality was seen in the US/UK cluster with ORp = 1.28 [95% CI = 1.04, 1.56] and a decrease in China with ORp = 0.65 [95% CI = 0.43, 0.96] and France with OR = 0.31 [95% CI = 0.14, 0.69]. Severity and hospitalization were not statistically significant in the analysis, however, several associations were seen in specific countries but not in country clusters. Conclusion: The country-cluster meta-analysis provided a reasonable explanation for COVID-19 mortality among ACEI/ARB users. The analysis did not explain differences in severity and suggested the involvement of other factors. Hospitalization findings among ACEI/ARB users may be considered informative as they may have been subjected to clinical decisions and hospital-bed availability.

Introduction Favipiravir is a repurposed drug to treat coronavirus 2019 (COVID-19). Due to a lack of available real-world data, we assessed its effectiveness and safety in moderately to critically ill COVID-19 patients. Methods This retrospective study was conducted in two public/specialty hospitals in Saudi Arabia. We included patients ≥18 years) admitted April–August 2020 with confirmed SARS-CoV-2 diagnosed by real-time polymerase chain reaction (RT-PCR) from nasopharyngeal swab. Patients received either favipiravir (1800 mg or 1600 mg twice daily loading dose, followed by 800 mg or 600 mg twice daily) or supportive-care treatment. Patients were excluded if they were outside the study period, classified as having a mild form of the disease per WHO criteria, or had an incomplete patient file. Kaplan–Meier (KM) models were used to estimate median time to discharge. Discharge ratios, progression to mechanical ventilation, and mortality outcomes were estimated across the severity spectrum using Cox proportional-hazards models. As a sensitivity analysis, we performed propensity score-matching (PSM) analysis. Results Overall, median time to discharge was 10 days (95%CI = 9–10) in the favipiravir arm versus 15 days (95%CI = 14–16) in the supportive-care arm. The accelerated discharge benefit was seen across the COVID-19 spectrum of severity. The adjusted discharge ratio was 1.96 (95%CI = 1.56–2.46). Progression to mechanical ventilation was slower with favipiravir (HRadj = 0.10, 95%CI = 0.04–0.29). There was no significant effect on mortality (HRadj = 1.56, 95%CI = 0.73–3.36). There was a statistically non-significant trend toward worse outcomes in the critical category (HRadj = 2.80, 95%CI = 0.99–7.89). Age was an independent risk factor for mortality in mechanically ventilated patients. PSM analyses confirmed these findings. Conclusion Favipiravir was associated with clinical benefits, including accelerated discharge rate and less progression to mechanical ventilation; however, no overall mortality benefits were seen across the severity spectrum.

Background: The uncertainty about COVID-19 outcomes in angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) users continues with contradictory findings. The aim of this study was to determine the effect of ACEI/ARB use in patients with severe COVID-19. Methods: This retrospective cohort study was done in two Saudi public specialty hospitals designated as COVID-19 referral facilities. We included 354 patients with confirmed diagnosis of COVID-19 between April and June 2020, of which 146 were ACEI/ARB users and 208 were non-ACEI/ARB users. Controlling for confounders, we conducted a multivariate logistic regression and a sensitivity analyses using propensity score matching (PSM) and Inverse propensity score weighting (IPSW) for high risk patient subsets. Results: Compared to non-ACEI/ARB users, ACEI/ARB users had an eight-fold higher risk of developing critical or severe COVID-19 (OR=8.25, 95%CI=3.32-20.53); a nearly 7-fold higher risk of intensive care unit (ICU) admission (OR=6.76, 95%CI=2.88-15.89) and a nearly 5-fold higher risk of requiring noninvasive ventilation (OR=4.77,95%CI=2.15-10.55). Patients with diabetes, hypertension, and/or renal disease had a five-fold higher risk of severe COVID-19 disease (OR=5.40,95%CI=2.0-14.54]. These results were confirmed in the PSM and IPSW analyses. Conclusion: In general, but especially among patients with hypertension, diabetes, and/or renal disease, ACEI/ARB use is associated with a significantly higher risk of severe or critical COVID-19 disease, and ICU care.

The influence of the COVID-19 pandemic is unprecedented on physical and mental health. This study aimed to determine the impact of the COVID-19 event on mental health among Saudi Arabian females of Riyadh by a cross-sectional study design. The samples of the study were recruited using convenience and snowball sampling methods. The questionnaire is composed of items related to sociodemographic profile, general mental status, negative attitude scale, impact of event (COVID-19 pandemic) scale (R) and negative health impact. The data obtained were analyzed using multivariate regression analysis. Out of the 797 samples (34.58 &plusmn, 12.89 years), 457 (57.34%) belonged to an age group of &ge, 25 years. The average BMI of the participants was 26.73 (kg/m2). Significantly (p = 0.000), a large proportion of the participants were overweight and unemployed. Age group (&gt, 25 years) have more odds for abnormal mental status (OR, 1.592), development of negative attitudes (OR, 1.986), the intense impact of COVID-19 events (OR, 1.444) and susceptibility to attain negative health impacts (OR, 1.574). High body weight is another risk factor for altered mental status, negative attitude and developing impact of COVID-19 quickly. Overall, the COVID-19 pandemic was directly associated with stress (53%), anxiety (63%) and depression (44%) in our sample population. There is an urgent need for psychological counseling for the distressed population.

Although rare, brucellosis is endemic in the Kingdom of Saudi Arabia (KSA). In the case presented here, a neonate was born at 29 weeks gestation with severe respiratory depression, pyrexia; hypotension and an elevated white blood cell count. Her mother was a 19-year-old pregnant woman who developed premature rupture of the membranes and went into labour early. Sepsis was suspected and so the neonate received dobutamine and empiric ampicillin/gentamicin. The mother reported visiting a farm during her pregnancy and so congenital brucellosis was considered a possibility. Blood cultures were positive for Gram-negative coccobacilli and serology confirmed the presence of Brucella abortus and B. meltiness. Antibiotic treatment was changed to rifampin/gentamicin/ciprofloxacin but on day 17 the baby deteriorated and gentamicin was discontinued and meropenem was added. The neonate gradually improved; meropenem was discontinued on day 24 and the baby was discharged from hospital on day 38.

The carrot plant (Daucus carota) and its components are traditionally reported for the management of gastric ulcers. This study was performed to evaluate the role of carrot when administered concurrently with a conventional antiulcer treatment, pantoprazole, in alleviating gastric and duodenal ulcers in female experimental animals. The study involved standard animal models to determine the ulcer preventive effect using pylorus ligation, ethanol, and stress induced acute gastric ulcer models and duodenal ulcer models involving cysteamine. Acetic acid-induced chronic gastric ulcer and indomethacin-induced gastric ulcer models were used to evaluate the ulcer healing effect. Carrot fruit (500 mg/kg) and its co-administration with pantoprazole produced significant protection in an ethanol- and stress-induced acute gastric ulcer and cysteamine-induced duodenal ulcer. The healing of the acetic acid-induced chronic gastric ulcer was also augmented with this combination. Both total proteins and mucin contents were significantly increased in indomethacin-induced gastric ulcers. Similarly, in pylorus ligation, the pepsin content of gastric juice, total acidity, and free acidity were reduced. Overall, both ulcer preventive effects and ulcer healing properties of the pantoprazole were significantly enhanced in animals who received the co-administration of carrot fruit (500 mg/kg).

The carrot plant (Daucus carota) and its components are traditionally reported for the management of gastric ulcers. This study was performed to evaluate the role of carrot when administered concurrently with a conventional antiulcer treatment, pantoprazole, in alleviating gastric and duodenal ulcers in female experimental animals. The study involved standard animal models to determine the ulcer preventive effect using pylorus ligation, ethanol, and stress induced acute gastric ulcer models and duodenal ulcer models involving cysteamine. Acetic acid-induced chronic gastric ulcer and indomethacin-induced gastric ulcer models were used to evaluate the ulcer healing effect. Carrot fruit (500 mg/kg) and its co-administration with pantoprazole produced significant protection in an ethanol- and stress-induced acute gastric ulcer and cysteamine-induced duodenal ulcer. The healing of the acetic acid-induced chronic gastric ulcer was also augmented with this combination. Both total proteins and mucin contents were significantly increased in indomethacin-induced gastric ulcers. Similarly, in pylorus ligation, the pepsin content of gastric juice, total acidity, and free acidity were reduced. Overall, both ulcer preventive effects and ulcer healing properties of the pantoprazole were significantly enhanced in animals who received the co-administration of carrot fruit (500 mg/kg).

The uncertainty about COVID-19 outcomes in angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) users continues with contradictory findings. The aim of this study was to determine the effect of ACEI/ARB use in patients with severe COVID-19. This retrospective cohort study done in two Saudi public specialty hospitals designated as COVID-19 referral facilities. We included 354 patients with confirmed diagnosis of COVID-19 between April and June 2020, of which 146 were ACEI/ARB users and 208 were non-ACEI/ARB users. Controlling for confounders, we conducted a multivariate logistic regression and a sensitivity analysis using propensity score matched (PSM) patients. Compared to non-ACEI/ARB users, ACEI/ARB users had an eight-fold higher risk of developing critical or severe COVID-19 (OR=8.25, 95%CI=3.32-20.53); a nearly 7-fold higher risk of intensive care unit (ICU) admission (OR=6.76, 95%CI=2.88-15.89) and a nearly 5-fold higher risk of requiring noninvasive ventilation (OR=4.77,95%CI=2.15-10.55). Patients with diabetes, hypertension, and/or renal disease had a five-fold higher risk of severe COVID-19 disease (OR=5.40,95%CI=2.0-14.54]. These results were confirmed in the PSM analysis. In general, but especially among patients with hypertension, diabetes, and/or renal disease, ACEI/ARB use is associated with a significantly higher risk of severe or critical COVID-19 disease, and ICU care.

Objectives The surge in the prevalence of childhood obesity has drawn attention to its impact on executive and cognitive functions. The adverse correlation between an increase in body weight and a fall in brain health is well reported in the literature. The study was done to examine the relationship between obesity and memory function in female school children in Riyadh, Saudi Arabia. Methods The participants of this study (8 to 12 years) were recruited from schools in Riyadh. The memory function test was done using a digit span memory model and a recall test was conducted using the lecture-recall technique. The data obtained was subjected to descriptive analysis and the impact of obesity on memory was interpreted using multiple and stepwise linear regression analysis (SPSS-IBM 23). Results A total of 611 female school children (average age, 10.3±1.1 years) were included in this study. Around 57% of them were in the healthy weight category. The percentage of failures for students in the memory function test and the recall test were 15% and 11%, respectively. It is noted that with every increase in the BMI category (from underweight, healthy weight, overweight and obese), there was a decrease in working memory scores. The least decreased prediction of the score was found in the working memory food category. Tahfeez had a positive impact on working memory. In four of the five tests, an increase in age by one year had a positive impact, except for the recall test. Similarly, a change in school had a negative impact on recall tests. Conclusion Overall, a greater level of memory function deficit was noted in obese children. Also, obese children tend to remember food items more accurately, and there is a positive role for memorizing practice in functional memory.

Background: High prevalence of obesity was reported in Saudi Arabia since decades. Bariatric surgery is considered as the most common effective and permanent method for treatment of obesity and decreasing the long-term mortality and morbidity worldwide. In addition, bariatric surgery is one of the most common elective gastrointestinal procedure done nowadays. Objectives: To evaluate the level of awareness and attitude towards bariatric surgery among Saudis. Methods: A questionnaire based on cross-sectional study self-administrator was distributed among 450 Saudi participants between the periods November 2018- December 2018. The questionnaire was based on 3 aspects including subject’s demographics, perception about obesity and knowledge about Bariatric surgery. Results: Overweight and obesity were found to be high among Saudi population. The most common causes for obesity were bad life style habits and genetic factors. There was a good knowledge about obesity but moderate knowledge about bariatric surgery as majority of participants believe that lack of physical activities is a risk factor for obesity (63.8%) and Majority of participants chose that bad life style habits could cause obesity (71.1%). Conclusion: The knowledge of participants regarding the obesity and its risk factors were high but the knowledge about Bariatric surgeries were low-moderate. These results indicated that efficient public awareness campaigns about obesity and Bariatric surgeries are needed to fill the gap and to increase the level of awareness toward obesity and its complications. Keywords: Obesity, awareness, perception, Bariatric Surgery, KSA, Saudi Arabia

The global incidence of breast cancer among men is steadily growing. Despite this, compared to female breast cancer patients, there are very few studies on biomarkers in male breast cancer patients. A cross-sectional case control study was carried out to determine the serum levels of melatonin, ghrelin, dopamine, serotonin, epinephrine, and GABA in male breast cancer. All the recruited patients were obese, old, and had recently been diagnosed with the disease. They had not received any treatment for the cancer until the time of the study. Melatonin and epinephrine serum levels were significantly higher in breast cancer patients compared to their age-matched controls, whereas ghrelin, dopamine, GABA, and serotonin serum levels were lower in patients compared to the control group. The serum levels of most of the studied biomarkers in male breast cancer patients were similar to those observed in female breast cancer patients, except for serum melatonin levels.

In several parts of the world, Boswellia sacra Fluck. is one of the most commonly used herbs for the treatment of arthritis. Its usage should be validated in light of recent findings of haematotoxicity. This study was aimed to determine the effect of chronic administration of standardized methanolic extract of frankincense on blood cell count in experimental animals. Using high-performance liquid chromatography, the active constituents of B. sacra extract; boswellic acids were analyzed. The effect of three different doses of the extract (250, 500, and 1000 mg/kg) on different blood cells and associated parameters was investigated. The behavior, food, and water consumption of the rats were recorded. Boswellic acids were present in varying amounts with α-boswellic acid and β-boswellic acid present in more amounts compared to other boswellic acids in the extract. All three doses tested had no effect on the animals’ behavior, food consumption, or weight gain. The administration of a low (500 mg/kg) and high (1000 mg/kg) dose of the extract resulted in a non-dose dependent reduction in MCH ( p

This study sought to investigate the cardioprotective potency and interaction of muskmelon (Cucumis melo) with enalapril (ENA) against myocardial damage caused by acute and chronic isoprenaline (ISO) treatments in rats. In the acute model, 150 mg/kg (s.c) of ISO was administered for two consecutive days at the end of pretreatment with either ENA, muskmelon, or both in their respective groups. ISO was introduced into the chronic therapy of ENA/muskmelon/ENA + muskmelon groups during the last 10 days at 3 mg/kg. Muskmelon was tested at three doses (100, 200, and 500 mg/kg, p.o., 30 days), and one normal dose of ENA (10 mg/kg) was used. Blood samples were taken at the end of treatment, and the animals were sacrificed. Biochemical markers such as LDH and CK-MB, as well as antioxidant (superoxide dismutase (SOD) and catalases) and thiobarbituric acid reactive species (TBARS) were measured in both serum and heart tissue homogenate (HTH). To confirm the biochemical findings, histological slides of heart tissue were prepared. ISO administration induced an elevation in the amount of TBARS, which was increased in all groups in which it was administered. Prior treatment with muskmelon and ENA in animals resulted in a rise in biomarker activity in homogenated heart tissue and a decrease in serum. In terms of alleviating the abnormal conditions caused by ISO, the group given a high dose of muskmelon and combined therapy had the best outcomes. The activities of SOD and catalase were substantially higher in the treated classes. Histological findings showing the cytoprotective actions of the high dose of muskmelon and ENA have confirmed the biochemical outcomes of both models. It is therefore concluded that the high dose of muskmelon (500 mg/kg) has a promising cardioprotective potential that is improved more efficiently in the acute injury model in the presence of ENA.

[This corrects the article DOI: 10.1371/journal.pone.0265042.]., (Copyright: © 2023 Alanazi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)