Search

Nagham Sheblaq,1 Amal Al Najjar2 1Oncology Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 2Security Force Hospital, Riyadh, Saudi ArabiaCorrespondence: Nagham SheblaqThe Ministry of National Guard Health Affairs, 14611 Ar rimayah, KSA-Riyadh, Kingdom of Saudi ArabiaTel +966553014124Email Naghamramzi1@gmail.comBackground: The fraction of patients participating in clinical research studies has been relatively low and declined further in recent years, and many barriers are facing healthcare providers in conducting such studies. Our aim in this study is to identify common barriers facing our healthcare providers to conduct clinical trials in those patients in the MENA region.Methods: A qualitative study was carried out between July 2014 and April 2015 where the semistructured survey was conducted using Survey Monkey software to all healthcare providers who work in seven different domain areas (physicians, pharmacists, nurses, clinical research associates, clinical research coordinators, auditors, and IRB members and data entry clerks).Results: Of 329 responders from 7 specialties, the majority [183 (55.62%)] were males and 193 (58.66%) from Saudi Arabia. Physicians and pharmacists represent the majority [155 (47.11%) and 76 (23.10%)] of the total group, respectively, and the least were nurses and auditors [5 (1.52%) in each]. The highest rate barrier reported by physicians and pharmacists was inadequate training in clinical research implementation [76 (23.1%)], while clinical research coordinator reported the same barrier in 18 (5.5%). Clinical research associates reported a lack of incentive and credit for research work in 17 (5.2%). Reviewers reported a lack of leadership support and lack of financial grant support [5 (1.5%)] for both. The top reported strength points were having an opportunity for professional development [96 (29.2)] and being in an academic institution [97 (29.5)]. Of the total participants, 200 (60.79) of the participants suggested the need for more training on research methodology.Conclusion: This study demonstrated the barriers that face healthcare providers in the MENA region. Because of the inadequate training in clinical research implementation and the lack of designed system operating procedures for the research process, we should address to facilitate clinical research in the region.Keywords: clinical research in Arabic countries, barriers to participating, attitude, conducting research studies

Abstract Crithmum maritimum (sea fennel), is a halophytic plant species found globally in coastal environments. This study is the first investigation into the chemical composition and biological activities of C. maritimum growing wildly in Jebel Akhdar, Libya. Gas Chromatography-Mass Spectrometry (GC-MS) analysis was utilized to identify and profile the plant’s volatile components; it resulted in the identification of twenty-four components, representing 99.17% of the total peaks in the GC-MS chromatogram. The analysis revealed that thymyl methyl ether, γ-terpinene, and ledene oxide, were the major volatile constituents of the plant at relative percentage levels of 56.86, 16.17, and 4.32%, respectively. The analysis also indicated substantial variations in the volatile composition of C. maritimum Libyan species compared to those from various geographic regions. The plant’s volatile oil quality was evaluated by investigating its in vitro antioxidant activity and the oil’s ability to inhibit acetylcholinesterase (AChE) and tyrosinase enzymes. The oil markedly scavenged the free radicals and reduced the ferric ions in the DPPH and FRAP assays at levels of 34.30 ± 0.10 and 38.90 ± 0.51 Trolox equivalents, respectively. The plant’s volatile oil has substantially reduced the AChE at the IC50 value of 34.43 ± 0.25 compared to its effect against tyrosinase (IC50 12.449 ± 0.68). The in silico approach was used to highlight the mechanisms underlying the enzyme inhibitory effect of the plant volatile oil. The stigmastene and γ-santonin demonstrate stronger binding affinity towards AChE and tyrosinase compared to the co-crystalized controls, donepezil and tropolone. The study provides significant information for the environmental changes effect on the volatile constituents of C. maritimum and highlights the plant’s importance within the scope of its antioxidant and enzyme inhibition activities.

Abstract Ephedra alata Decne is a medicinal plant widely used in traditional medicine for the management of bronchial asthma and cancer. Phytochemical analysis and biological activities, including antioxidant and anticancer effects, were investigated in the current work as new findings for the plant E. alata, a species growing wildly in the marsh and saline environments of the central area of Saudi Arabia. The Ultra Pressure Liquid Chromatography coupled with Electron spray ionization-Quadropole-Time of flight (UPLC-ESI-Q-TOF) system was used for the phytochemical analysis of the plant constituents. In addition, Polyphenolic profiling including the total phenolic (TPC) and flavonoid (TFC) contents of the plant extracts were measured. Phenolic acids were found at the highest relative percentages among all the identified compounds and were measured at 66.07 mg GAE (Gallic acid equivalent). The UPLC analysis of the E. alata extract indicated the presence of chlorogenic acid, syringic acid, caffeic acid, vanillic acid, rosmarinic acid, umbelliferone, isorhoifolin, and apigenin at the highest relative percentages. Mineral analysis indicated that the microelement content of E. alata was relatively low, except for magnesium (Mg). In vitro antioxidant assays revealed the ability of the plant to scavenge DPPH free radicals, reduced molybdenum ions, and ferrous at levels of 14.63, 19.97, and 27.78 mg Trolox equivalents, respectively. The extract induced transition metal chelation at 31.36 mg EDTA equivalents. The extract induced cytotoxic effects against MDA-231 and A549 cell lines at IC50 levels of 25.31 and 39.81 µg/mL, respectively. The plant extract inhibited the colonization and migration of cancer cells as part of its potential anticancer effects. In addition, major E. alata constituents like isorhoifolin, chlorogenic acid, apigenin, and rosmarinic acid exhibited the lowest binding energy to the CAIX enzyme at − 8.41, − 6.64, − 6.32, and − 6.26 kcal/mol, respectively, compared to the binding energy (− 7.72 kcal/mol) of the co-crystallized ligand (Y0R). The docking results further supported the selection of the CAIX enzyme as a standard predictive therapeutic target, since it exhibited significant binding interactions with the major constituents of the plant.

Glucokinase (GK) activators are promising candidates for type 2 diabetes treatment. This study utilized structure-based pharmacophore modeling and QSAR analysis to identify novel activators. Virtual screening of a 250,000-compound library yielded eight new candidates with significant in vitro activity (over 50% activation at 25 µg/mL) and diverse structures. Molecular dynamics simulations revealed a potential mechanism involving a transient loop flip in the GK allosteric site, aligning with known activator behavior. The leading candidate, NSC12516, displayed superior hydrogen bonding with key residues (compared to known activator MRK501) and potentially stronger binding affinity due to favorable energetics. These findings clear the way for developing potent and selective GK activators for type 2 diabetes.

Background: Kombucha is a fermented tea with a distinct sweet and sour taste. It is believed to offer several health benefits, including improved digestion, enhanced immune system, detoxification, and potential anticancer activity, which is thought to be linked to its unique chemical constituents formed during fermentation. Purpose: This article explores how the fermentation process affects the chemical constituents of Kombucha and their potential anticancer activity. Methods: Data was obtained from the Publish or Perish application with the keywords Kombucha, fermented Kombucha, Kombucha on cancer. Then the article is analysed. A total of 97 research articles were retrieved after applying inclusion and exclusion criteria Results: Based on the report, the composition and quantity of chemical constituents in Kombucha are significantly affected by factors such as the fermentation substrate, temperature, and duration. These variables can be optimized to generate novel compounds and enhance the yield of existing ones. The chemical constituents of Kombucha inhibit the proliferation of cancer cells by targeting specific proteins involved in carcinogenesis, such as HIF-1α, VEGF, IL-8, COX-2, as well as caspases-3, -8, and -9, PARP, Bax, Bcl-2, p53, p21, MMP-2, MMP-9 and β-actin. However, comprehending the precise mechanisms governing the interactions between distinct chemical constituents within Kombucha and cancer cells is pivotal for thoroughly grasping its anticancer properties. Conclusion: Kombucha contains chemical constituents that play a role in inhibiting cancer cells. Some of these chemical compounds are glucuronic acid, gluconic acid, d-saccharic acid 1,4-lactone (DSL), acetic acid, ascorbic acid, succinic acid, dimethyl 2-(2‑hydroxy-2-methoxypropylidine) malonate and vitexin with protein carcinogenic protein targets HIF-1α, VEGF, IL-8, COX-2, as well as caspases-3, -8, and -9, PARP, Bax, Bcl-2, p53, p21, MMP-2, MMP-9 and β-actin

In this study, we investigate into the simulation of sheet metal hydroforming for crafting the cap of the axle-hub of a tip trailer within our manufacturing facility. This cap serves a crucial role in safeguarding wheel bearings from the detrimental effects of dust, sand, and dirt. The motivation for this work arises from the challenges encountered during the fixation of a conventional dust cap, which often falls off when subjected to pressure or threading, particularly when the tractor is in motion. The innovative approach pursued in this research involves the utilization of lightweight aluminum sheet metal for cap production, owing to its facile formability. The cap design incorporates four evenly distributed holes around its circumference and secures to the flange using screws. Prior to the manufacturing phase, a simulation of the cap-forming process was conducted using ANSYS Model 15, a computer-aided engineering program. The necessary models were crafted in CATIA, a computer-aided design program, streamlining the entire process to enhance efficiency, reduce costs, and minimize manpower requirements. The simulation encompassed three different thicknesses (1 mm, 2 mm, and 3 mm) for two distinct aluminum alloys, namely 1100 and 5652. The objective was to discern the optimal alloy for the forming process. Essential mechanical properties, including ultimate tensile strength, modulus of elasticity, and yield stress, were input into the ANSYS program to accurately reflect the materials' behavior during forming. The outcomes of our investigation revealed that aluminum alloy 5652 outperformed 1100 in terms of formability. The former exhibited a forming pressure of 300.2 MPa, while the latter required 298.3 MPa for the same forming depth (40 mm) across all three thickness variations. Additionally, the study demonstrated that 5652 is not only more efficient but also safer and more resilient than 1100.

The chisel plow is the most common plow due to its ease of operation. It goes deep into the soil to a relatively large depth. It also does not leave large clumps on the soil surface after plowing, as it breaks and loosens the soil without turning it. In this paper, three types of chisel plow tine designs (shovel, reversible, and pointed) were used for simulation to show which design is better. The plow was made in a state company of the automotive industry and equipment /mechanical factory. The input data of the simulation is based on real data field performance parameters which are moisture and soil resistance. CATIA Software was used to design the frame and tine that was used in this research, the simulation method (Finite Element Method) is done using ANSYS 2020. The material added to the tine plow has been unity for the three types. Also, the boundary conditions for the three models were fixed, namely fixing the tine plow stand and applying the load. In this study, three kinds of agricultural chisel plow tine are used in the analysis for designing stress, strain, and deformation. The simulation results showed the shovel tine is safer than the other two types.

Objectives. Post exposure prophylaxis (PEP) with the hepatitis B vaccine (HBVac) in combination with HBV immunoglobulins (HBIG) significantly minimizes the odds of vertical transmission of HBV to newborn infants. In this retrospective study, we aimed to evaluate the compliance and efficacy of PEP in a tertiary care center in Saudi Arabia. Methods. Infants were tested with HBV serological markers at 7 months of age to assess their PEP protection rate. Results. Out of 13,125 mothers who delivered in KAMC, 105 (0.8%) mothers were found to have HBsAg positive, with a prevalence of 8 per 1000 live births. All infants (n = 100) completed their PEP as per protocol before discharge from the hospital (2 days after delivery). Among infants (n = 59; 56.2%) who were tested at 7 months of age, all (100%) were found to be negative for HBV. Conclusion. PEP achieved 100% efficacy among infants who complied with the study protocol at 7 months of follow-up. The prevalence of hepatitis B among pregnant women was 8 per 1000 live births.

The ATP-dependent molecular chaperone, Hsp90, is crucial for the activity of hundreds of client proteins. Several of Hsp90 clients are involved in cancer cell growth and proliferation. Thus, numerous Hsp90 inhibitors have been developed to target Hsp90′s ATPase activity in cancer cells. CCT018159 is a pyrazole-based compound that successfully inhibited Hsp90 oncogenic activity by binding deeply to the ATP binding pocket in the Hsp90 N-terminal domain (N-Hsp90). In the present study, we utilized the CCT018159 structure to identify new potential Hsp90 inhibitors using a set of in-silico approaches. The ZINC database was virtually screened for CCT018159 analogs using the SwissSimilarity webpage. Ten molecules were selected for further investigation based on their drug-likeness, pharmacokinetics, and physiochemical properties. The molecular docking simulation analysis revealed that these ZINC compounds have Ligand Binding Energies (LBEs) ranging from −8.61 to −9.73 Kcal/mol, which reflects a high binding affinity compared to CCT018159 (LBE of −6.31 Kcal/mol). These compounds exhibited diverse interactions, including critical hydrogen bonds and hydrophobic contacts with crucial residues like Asn51, Ala55, and Leu107. Further optimization targeting unique interactions (e.g., ZINC000008973382 with Asp93, Met98, and Thr184) and exploiting the versatile Lys58 could lead to novel, potent anticancer agents targeting Hsp90.

This study examines the sustainability of livestock farming in Jordan’s arid regions, focusing on smallholder Awassi sheep and Baladi goat farming. It assesses breeders, economic factors, herd productivity, and sustainability, evaluating the vitality of these breeds by examining reproductive success through birth and survival rates. In 2021–2022, a total of 53 traditional Awassi sheep and Baladi goat farms in Northern Jordan’s Mafraq Governorate were surveyed using a comprehensive questionnaire to gather data on breeders’ information, farm economics, and herd indicators. Dry seasons in arid lands are tough on sheep and goats, with limited fodder and water availability harming their health and reproductive capacity. While wet seasons bring relief, they can also introduce diseases. Special care for these animals throughout the year is crucial to maintain healthy herds in arid regions. Linear models were employed to analyze sample data, with variance and correlation tests used to explore relationships among variables. Additionally, chi-squared analysis was utilized to assess the impact of male replacement plans on these herds. The main outcomes of this study reveal that breeder indicators pose challenges to the sustainability and growth of Awassi sheep and Baladi goat farming. Conversely, economic indicators suggest a blend of financial stability alongside obstacles related to profitability and resource ownership. Breeder age emerges as a significant factor in livestock herd management, influenced by elements such as experience, resource availability, and adherence to traditional practices. Experience notably influences breeders’ decisions regarding male insemination replacements, likely due to acquired skills. Crop cultivation is shown to reduce fodder costs, thereby enhancing profitability for each young animal sold and consequently increasing the breeders’ returns. Winter conditions elevate animal mortality rates due to cold stress, while other animals within herds contribute to increased kid mortality by facilitating disease transmission. Breeder experience significantly impacts lamb survival, underscoring its importance in ensuring proper care. Increasing ewe proportions within herds enhances lamb production and lowers lamb mortality rates. Effective ram management and yearling lamb sales further contribute to herd health and productivity. A higher proportion of goats within a herd positively correlates with the number of young yearlings sold but inversely affects breeding males and overall kid numbers, indicating a delicate balance that influences herd productivity and mortality rates. Sheep (92.5%) and goat herds (90.6%) demonstrate reproductive success, indicative of superior long-term vitality. While sheep excel in birth rates, survival, and sales, they exhibit lower ewe and lambing percentages. Goat farming demonstrates high birth rates, sales, and overall success but requires particular attention to ensuring kid survival, especially during the winter months. Improving the characteristics of the Awassi sheep and Baladi goat flocks is crucial for ensuring sustainability, achievable through proper care practices in dry lands. In conclusion, despite the challenges, there are promising opportunities to enhance sheep and goat farming in Jordan. Effective management, informed by the breeders’ experience and economics, is crucial. Empowering small-scale herders and implementing targeted interventions, like winter mortality solutions and selective breeding, is vital for sustainable growth.

Fibroblast growth-factor receptor (FGFR) is a potential target for cancer therapy. We synthesised a novel series of FGFR1 inhibitors bearing quinoline, quinoxalin and isoquinoline using a synthetic strategy employing a one pot reaction, yielding 2-hydroxy-1H-indene-1,3(2H)-dione. Structural elucidation via IR, NMR and HRMS analyses is complemented by a proposed mechanistic pathway. All newly-synthesised compounds were evaluated in vitro for their inhibitory activities against FGFR-1. The most potent derivatives were 9a, 9b, 9c and 7b with IC50 = 5.7, 3.3, 4.1 and 3.1 μM, respectively, supported by molecular docking studies which probed the binding interactions of these compounds within the active site of the kinase.

Abstract Probiotics are a mixture of beneficial live bacteria and/or yeasts that naturally exist in our bodies. Recently, numerous studies have focused on the immunostimulatory effects of single-species or killed multi-species probiotic conditioned mediums on macrophages. This study investigates the immunostimulatory effect of commercially available active, multi-species probiotic conditioned medium (CM) on RAW264.7 murine macrophages. The probiotic CM was prepared by culturing the commercially available probiotic in a cell-culture medium overnight at 37 °C, followed by centrifugation and filter-sterilization to be tested on macrophages. The immunostimulatory effect of different dilution percentages (50%, 75%, 100%) of CM was examined using the MTT assay, proinflammatory cytokine (tumor necrosis factor TNF-alpha) production in macrophages, migration, and phagocytosis assays. For all the examined CM ratios, the percentages of cell viability were > 80%. Regarding the migration scratch, TNF-alpha and phagocytosis assays, CM demonstrated a concentration-dependent immunostimulatory effect. However, the undiluted CM (100%) showed a significant (p-value

Background Ingrown toenail is a common condition that results in chronic pain, recurrent infections, and difficulty in performing daily activities. Our aim is to compare two surgical methods for the treatment of ingrown toenails: wedge resection with curetting versus wedge resection curetting followed by electrocauterization of the nail bed.

Botox treatment has become a popular method for reducing facial lines and wrinkles and rejuvenating the signs of aging. However, like any procedure, Botox can lead to temporary and minor complications. In the presence of certain systemic diseases such as diabetes mellitus, it is essential to take additional precautionary measures that should not be ignored, as it could turn into a life-threatening situation which may need to surgical intervention. Therefore, the key to success lies in ensuring that the procedure is carried out by skilled professionals, conducting a comprehensive medical history assessment, despite the simplicity of the procedure. Thus, we present a case of A 52-year-old diabetic woman came with a severe facial phlegmon persisting for 7 days and mentioned a previous Botox treatment 8 days ago. Drainage of the phlegmon was performed under general anesthesia using an intraoral vestibular approach.

Extramedullary plasmacytoma is a rare localized plasma cell neoplasm typically found in soft tissues outside the bone marrow. Predominantly occurring in the head and neck region, particularly in the sinonasal and nasopharyngeal areas, it presents a diagnostic challenge due to its uncommon nature. Herein, we report a 38-year-old female patient with Down’s syndrome with a 2-year complaint of intermittent dysphonia, hoarseness, and progressive respiratory distress, including dyspnea, fatigue, and biphasic stridor. Examination via flexible laryngoscopy revealed a white lesion, prompting direct microscopic laryngeal surgery to excise a 1x1 cm mass. Histological findings confirmed the diagnosis as solitary extramedullary plasmacytoma. Notably, this represented the first documented case of laryngeal solitary extramedullary plasmacytoma in a patient with Down’s syndrome. This case underscores the importance of considering tumor development in the larynx among individuals with Down’s syndrome, highlighting the necessity for tailored management strategies to address such occurrences effectively. Increasing awareness of this association can aid in early detection and appropriate treatment of tumors in this population.

Introduction: Single-station N2 (ssN2) versus multi-station N2 has been used as a selection criterion for treatment recommendations between surgical versus non-surgical multimodality treatment in stage III-N2 NSCLC. We hypothesized that clinical staging would be susceptible to upstaging on pathologic staging and, therefore, challenge this practice. Methods: A retrospective study of prospectively collected routine clinical data for patients with stage III-N2 NSCLC that had completed computed tomography (CT), positron emission tomography (PET), and staging endobronchial ultrasound (EBUS) and had been confirmed clinical stage III-ssN2 at multidisciplinary team discussion and went on to complete surgical resection as the first treatment to provide pathologic staging. The study was completed in two cohorts (A) across a single cancer alliance in England (Greater Manchester) January 1, 2015 to December 31, 2018 and (B) across five United Kingdom centers to validate the findings in part A January 1, 2016 to December 31, 2020. Results: A total of 115 patients met the inclusion criteria across cohort A (56 patients) and cohort B (59 patients) across 15 United Kingdom hospitals. The proportion of cases in which clinical stage III-ssN2 was upstaged to pathologic stage III-multi-station N2 was 34% (19 of 56) in cohort A, 32% in cohort B (19 of 59), and 33% across the combined study cohort (38 of 115). Most patients had a single radiologically abnormal lymph node on CT and PET (88%, 105 of 115). In the majority, the reasons for missed N2 disease on staging EBUS were due to inaccessible (stations 5, 6, 8, 9) N2 nodes at EBUS (34%, 13 of 38) and accessible lymph nodes not sampled during staging EBUS as not meeting sampling threshold (40%, 15 of 38) rather than false-negative sampling during EBUS (26%, 10 of 38). Conclusions: During multidisciplinary team discussions, clinicians must be aware that one-third of patients with stage III-ssN2 on the basis of CT, PET, and staging EBUS do not truly have ssN2 and this questions the use of this criterion to define treatment recommendations.

IntroductionThe Newborn Hearing Screening (NHS) program was officially launched in Jordan in 2021. Since its inception, no studies have examined the effectiveness of the program. This study seeks to assess the effectiveness and outcomes of the NHS program in Jordan.MethodsA retrospective cross-sectional study was conducted to investigate the program coverage rate, referral rate, loss to follow-up rate and the hearing status of newborns who successfully completed the necessary diagnostic assessment. Live births in all hospitals administered by the Ministry of Health (MoH) in Jordan from July 2021 to November 2023 were included.ResultsOut of 25,825 newborns delivered, 99.4% (25,682) were screened. A referral rate of 0.7% (189) was recorded. Approximately 61.9% of those referred (n = 117) had normal hearing, while 31.7% (60 infants) were diagnosed with hearing loss. The prevalence of congenital hearing loss was 0.14%, and the mean age for identifying hearing loss was 11 months.DiscussionThe current status of the NHS program in Jordan is promising. The program has achieved most benchmarks recommended by the Joint Committee on Infant Hearing (JCIH), demonstrating encouraging outcomes. There is a need to investigate and address the factors causing delays in the identification of hearing loss in Jordan.

Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of death in the United States and is expected to be ranked second in the next 10 years due to poor prognosis and a rising incidence. Distant metastatic PDAC is associated with the worst prognosis among the different phases of PDAC. The diagnostic options for PDAC are convenient and available for staging, tumor response evaluation, and management of resectable or borderline resectable PDAC. However, imaging is crucial in PDAC diagnosis, monitoring, resectability appraisal, and response evaluation. The advancement of medical technologies is evolving, hence the use of imaging in PDAC treatment options has grown as well as the utilization of ctDNA as a tumor marker. Treatment options for metastatic PDAC are minimal with the primary goal of therapy limited to symptom relief or palliation, especially in patients with low functional capacity at the point of diagnosis. Molecular profiling has shown promising potential solutions that would push the treatment boundaries for patients with PDAC. In this review, we will discuss the latest updates from evidence-based guidelines regarding diagnosis, therapy response evaluation, prognosis, and surveillance, as well as illustrating novel therapies that have been recently investigated for PDAC, in addition to discussing the molecular profiling advances in PDAC.