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Bandar Alosaimi,1 Deema I Fallatah,2 Samar Abd ElHafeez,3 Marina Saleeb,4 Huda M Alshanbari,5 Maaweya Awadalla,1 Mamoun Ahram,6 Mohammad Adnan Khalil7 1Research Center, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia; 2Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; 3Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt; 4MARS Global, Covent Garden, London, UK; 5Department of Mathematical Sciences, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 6Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Amman, Jordan; 7Department of Basic Medical Sciences, Faculty of Medicine, Aqaba Medical Sciences University, Aqaba, JordanCorrespondence: Bandar Alosaimi; Mohammad Adnan Khalil, Email balosaimi@kfmc.med.sa; mohdkhalilphd@gmail.comIntroduction: In Saudi Arabia, the HPV vaccine is administered to young females through school-based immunization programs; however, the program’s efficacy depends on parental consent, with physicians acting as primary determinants in parental decision-making regarding HPV vaccination.Methods: In this cross-sectional study, we recruited 128 physicians and assessed their knowledge and attitudes toward cervical cancer, HPV, and the HPV vaccine, and unraveled predictors of HPV vaccine acceptability and factors that would influence recommending the vaccine.Results: Although the major factor that influenced recommending the vaccine negatively was the fear of vaccine side effects, a positive influence of the physician’s personal reading (91%), recommendations from colleagues (88%), and government directives (87%) provided reassurance and increased confidence in recommending the vaccine. Longer clinical experience and institutional awareness were found to be a predictors of favorable recommendation of HPV vaccination. Physicians in vaccine-related medical specialty with more than 4 years of experience were 5 to 6 times more likely to have positive attitude and better knowledge regarding HPV and HPV vaccination. A notable finding was that participants who reported knowing a woman suffering from cervical cancer had more positive attitudes compared to those who did not.Discussion: This study identified physicians’ personal reading, peer recommendations, and government directives as factors affecting the physicians’ decision to recommend HPV vaccine, and found that longer clinical experience and institutional awareness were predictors influencing physicians to recommend the vaccine. It also emphasizes on the influence of healthcare providers in promoting the HPV vaccination and the need for designing interventions targeting specific demographic and professional groups that would be more effective in improving better knowledge and promoting positive attitudes towards these critical public health issues.Keywords: HPV vaccine, cervical cancer, human papillomavirus, factors, physicians, knowledge, attitudes

Ayman Mubarak,1 Mahfoudh Alqoufail,1 Saeedah Almutairi,1 Bahauddeen Alrfaei,2 Abdulaziz Almotairi,3 Ibrahim Aziz,1 Taghreed N Almanaa,1 Mostafa A Abdel-Maksoud,1 Mohamed A Farrag,1 Allolo D Aldreiwish,4 Maaweya E Awadalla,5 Bandar Alosaimi,5 Wael Alturaiki4 1Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia; 2Stem Cells Unit, Department of Cellular Therapy, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Science, MNGHA, Riyadh, Saudi Arabia; 3College of Medicine, Almaarefa University, Riyadh, Saudi Arabia; 4Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia; 5Research Center, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi ArabiaCorrespondence: Wael Alturaiki, Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia, Email w.alturaiki@mu.edu.saPurpose: Thymic stromal lymphopoietin (TSLP) is a proinflammatory cytokine produced by epithelial cells that is involved in the activation of allergic disorders. To date, no study has examined TSLP induction during Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Herein, we aimed to study the effects of the recombinant spike protein of MERS-CoV on TSLP production. Additionally, the effects of recombinant human TSLP (rhTSLP) on B cell survival and antibody production were investigated.Patients and Methods: B cells were separated using the Human B Cell Enrichment Kit, and B cell survival was measured using the WST-1 Assay Kit. Enzyme-linked immunosorbent assay (ELISA) was used to measure TSLP levels in the sera of both MERS-CoV-infected (n=4; median age, 53 years) and healthy individuals (n=5; median age, 35 years).Results: We showed that the group of infected patients had significantly higher levels of TSLP than healthy controls (37.6 pg/mL vs 19.8 pg/mL, &ast;p< 0.05). The levels of TSLP in A549 cells were remarkably increased after 48 h of stimulation with recombinant full-length spike protein (rSP) (32.2 pg/mL, p=0.01). B cell survival was greatly enhanced by rhTSLP alone or in combination with rSP (0.02 vs 0.046, and 0.045; &ast;&ast;p< 0.01, respectively). Our data also showed a significant synergistic effect of rhTSLP and rSP on the augmented response of IgG antibodies against the spike protein of MERS-CoV compared with unstimulated cells (0.156 vs 0.22; &ast;p< 0.05).Conclusion: TSLP production is induced in vivo after MERS-CoV infection and in vitro after treatment with the rSP of MERS-CoV, which has a significant effect on the survival of B cells. Our data suggest that TSLP can be used as a strong mucosal adjuvant for vaccine development against MERS-CoV infection. However, further investigation is required to study the functional role of TSLP in MERS-CoV infection.Keywords: MERS-CoV, TSLP, recombinants spike protein, B cells

Abstract Introduction Stress-induced (Takotsubo) cardiomyopathy is a rare form of cardiomyopathy which presents in a manner similar to that of acute coronary syndrome. This sometimes leads to unnecessary thrombolysis therapy. The pathogenesis of this disease is still poorly understood. We believe that reporting all cases of Takotsubo cardiomyopathy will contribute to a better understanding of this disease. Here, we report a patient who, in the absence of any recent stressful events in her life, developed the disease after a session of dancing. Case presentation A 69-year-old Caucasian woman presented with features suggestive of acute coronary syndrome shortly after a session of dancing. Echocardiography and a coronary angiogram showed typical features of Takotsubo cardiomyopathy and our patient was treated accordingly. Eight weeks later, her condition resolved completely and the results of echocardiography were totally normal. Conclusions Takotsubo cardiomyopathy, though transient, is a rare and serious condition. Although it is commonly precipitated by stressful life events, these are not necessarily present. Our patient was enjoying one of her hobbies (that is, dancing) when she developed the disease. This case has particular interest in medicine, especially for the specialties of cardiology and emergency medicine. We hope that it will add more information to the literature about this rare condition.

This article develops the existence theory for sequential fractional differential equations involving Caputo fractional derivative of order 1 < α ∀ 2 with nonlocal integral boundary conditions. An example is given to demonstrate application of our results. [ABSTRACT FROM AUTHOR]