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Aims/Background Previous research has shown that smoking tobacco is associated with changes or differences in brain volume and cortical thickness, resulting in a smaller brain volume and decreased cortical thickness in smokers compared with non-smokers. However, the effects of smokeless tobacco on brain volume and cortical thickness remain unclear. This study aimed to investigate whether the use of shammah, a nicotine-containing smokeless tobacco popular in Middle Eastern countries, is associated with differences in brain volume and thickness compared with non-users and to assess the influence of shammah quantity and type on these effects. Methods Male shammah users (aged 20 to 47 years, n = 30) and non-users (n = 39) underwent 1.5T magnetic resonance imaging (MRI) scans, and cortical brain volumes and thicknesses were measured using FreeSurfer. Results Significant differences were found in the volume of the right pallidum ( p = 0.02), total pallidum ( p = 0.02), total ventricle ( p = 0.02), middle posterior corpus callosum ( p = 0.04), and brainstem ( p = 0.02) between shammah users and non-users. Furthermore, yellow shammah users exhibited smaller volumes in the right lateral ventricle ( p = 0.02), total lateral ventricle ( p = 0.03), and right putamen ( p = 0.02) compared with users of other types of shammah. Regarding cortical thickness, significant differences were observed in the right medial orbito-frontal thickness ( p = 0.03), left rostral middle frontal thickness ( p = 0.03), and right rostral anterior cingulate thickness ( p = 0.04). Conclusion These findings shed light on the potential neurobiological effects of shammah use, particularly the yellow shammah, and highlighting the need for further research to fully understand its implications for brain structure and function.

Background and Aim: Aluminum (AL) is commonly found in food, drinking, air, and soil and it can be a serious contaminant in varying amounts. Therefore, this study investigated the biochemical and histological hazardous reactions to aluminum chloride (AlCl 3 ) and the efficiency of the methanol extract of Delonix regia aerial parts with gum Arabic ( GA ) as anti-toxic therapies to return to a natural state after AlCl 3 exposure., Materials and Methods: A total of 20 male Wistar rats were randomly divided into four equal groups. (i) CG: Served as a control group. (ii) AlCl 3 : Rats were exposed to 80 mg/kg/body weight (BW) AlCl 3 . (iii) AlCl 3 + D. regia/GA : rats were administered AlCl 3 + 100 mg/kg B.W. with 15% BW of D. regia and GA, respectively. (iv) D. regia/GA : Rats were administered 100 mg/kg B.W. with 15% BW D. regia and GA , respectively. The experimental treatment was administered for 30 days. On the 30 th day, blood biochemical parameters were assessed, and specimens from the liver and kidney were collected and stored in a neutral buffer with 10% formalin until immediate histopathological examination after euthanasia., Results: This study revealed a significant increase in white blood cells and platelets after AlCl 3 exposure compared with CG, while there was a decrease in red blood cells, hemoglobin, hematocrit, and mean corpuscular volume. Treatment with D. regia/GA improved lymphocytes, monocytes, eosinophils, and basophils. Furthermore, the animals exposed to AlCl 3 showed a significant increase in aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase compared with CG, whereas AlCl 3 + D. regia/GA treatment improved these activities. In addition, the rats exposed to AlCl 3 had significantly increased glucose, lipase, amylase, triglyceride, cholesterol, high-density lipoprotein, and low-density lipoprotein levels, and D. regia/GA treatment significantly improved these levels compared with AlCl 3 . This study reported no significant differences in Ca and Na concentrations among groups, but rats exposed to AlCl 3 had elevated K, Cl, and Mg levels, whereas D. regia/GA treatment improved these levels., Conclusion: The co-administration of the methanolic extract of D. regia with GA can protect against AlCl 3 toxicity., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Al-Doaiss, et al.)

Urinary tract infection is a common medical condition encountered in outpatient clinics and emergency departments. Recurrence of urinary tract infections is common. The recurrence can arise from behavioral, mechanical, and physiological factors. Urachal anomalies are very rare congenital clinical entities. We present the case of a 41-year-old woman who presented to the emergency department with dysuria, frequency, urgency, and incontinence. There was no history of fever or flank pain. Physical examination revealed no abnormalities. Initial laboratory markers were within the normal range. However, urinalysis findings showed numerous white blood cells and positive leukocyte esterase and nitrite. While these findings are suggestive of acute simple cystitis, the patient had a concerning history of recurrent urinary tract infections. The urology team advised performing an abdominal computed tomography scan to rule out any structural abnormalities. The patient underwent a computed tomography scan, which demonstrated the presence of a fluid-filled structure arising from the dome of the bladder and extending superiorly toward the umbilicus, representing a vesicourachal diverticulum. The patient underwent surgical resection after antibiotic therapy. The vesicourachal diverticulum is a very rare type of urinary tract anomalies. The case highlights the importance of considering congenital urachal anomalies in patients with recurrent urinary tract infections. A computed tomography scan can make the diagnosis of such anomalies with high accuracy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Alqarni et al.)

Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness and pulmonary manifestations are the typical presentations of the disease. However, it became evident that the COVID-19 is not limited to the respiratory system. Specifically, gastrointestinal involvement in patients with COVID-19 is very common, particularly in patients with a critical illness. We present a case of a 52-year-old man who was diagnosed as having severe COVID-19 pneumonia and underwent endotracheal intubation and mechanical ventilation. The patient remained in the intensive care unit for seven days. Following his recovery, he started to experience generalized abdominal pain. The pain did not resolve with conservative measures. A computed tomography scan of the abdomen demonstrated small bowel loops clustered with a surrounding thin membrane. Such findings conferred the diagnosis of sclerosing encapsulating peritonitis. The patient was prepared for laparoscopic surgery. Resection of the membrane was performed without any injury to the encapsulated bowel. Analysis of peritoneal fluid by reverse transcription-polymerase chain reaction (RT-PCR) was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient had an uneventful recovery. Sclerosing encapsulating peritonitis is a very rare condition associated with COVID-19 pneumonia. The present case is the first reported case to document the presence of the SARS-CoV-2 virus in the peritoneal fluid in a patient with sclerosing encapsulating peritonitis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Mofti et al.)