Decoding molecular mechanisms:brain aging and Alzheimer's disease

The complex morphological,anatomical,physiological,and chemical mechanisms within the aging brain have been the hot topic of research for centuries.The aging process alters the brain structure that affects functions and cognitions,but the worsening of such processes contributes to the pathogenesis of neurodegenerative disorders,such as Alzheimer's disease.Beyond these observable,mild morphological shifts,significant functional modifications in neurotransmission and neuronal activity critically influence the aging brain.Understanding these changes is important for maintaining cognitive health,especially given the increasing prevalence of age-related conditions that affect cognition.This review aims to explore the age-induced changes in brain plasticity and molecular processes,differentiating normal aging from the pathogenesis of Alzheimer's disease,thereby providing insights into predicting the risk of dementia,particularly Alzheimer's disease.

Medical management of urolithiasis: Great efforts and limited progress

Objective:To provide a comprehensive review on the existing literature on medical management of urolithiasis.Methods:A thorough literature review was performed using Medline,PubMed/PMC,Embase,and the Cochrane Database of Systematic Reviews up to December 2022 to identify publications on the medical management of urolithiasis.Studies that assessed dietary and pharmacologic management of urolithiasis were reviewed;studies on medical expulsive therapy were not included in this review.Results:Medical management of urolithiasis ranges from the prophylactic management of kidney stone disease to dissolution therapies.While most treatment concepts have been long established,large randomized controlled trials are scarce.Dietary modification and increased fluid intake remain cornerstones in the conservative management of urolithiasis.A major limitation for medical management of urolithiasis is poor patient compliance.Conclusion:Medical management of urolithiasis is more important in patients with recurrent urolithiasis and patients with metabolic abnormalities putting them at higher risk of developing stones.Although medical management can be effective in limiting stone recurrence,medical interventions often fail due to poor compliance.

Adenoma of the Nipple, Mimicking Paget’s Disease of the Breast: Report of a Case

Nipple adenoma is a rare benign condition that simulates malignancy. A 37-year-old woman presented with unilateral bloody nipple discharge for 1-year duration followed by severe nipple erosion. As biopsy revealed nipple adenoma and therefore, complete local excision was done. The final histopathology showed florid papillomatosis which was adequately excised. Nipple adenoma although rare entity this should be included in the differential diagnosis of any nipple erosion such as carcinoma and Paget’s disease of the breast specially when associated with bloody discharge in premenopausal women.

The Impact of Nurses Recognition, and Empowerment Related to Nurses Job Satisfaction at KFSH-D

Introduction: Nurses’ job satisfaction is referring to the level to which people feel that they are able to have an influence on their workplace. Nurse leaders should use a variety of empowerment strategies that are important to nurses’ job satisfaction. Meanwhile, meaningful recognition for nurses is considered a powerful tool to enhance nurses’ sense of self-efficacy especially facing an emotional challenge that may affect their wellbeing. Aim: The aim of the studies is to analyze the importance of nurses’ recognition, and empowerment towards nurses’ job satisfaction at KFSH-D. Method: This study takes the form of a quantitative research methodology, and descriptive-analytical technique. A questionnaire used to gather data from registered nurses employed at King Fahad Specialist Hospital-Dammam (KFSH-D) about the structural empowerment and nurses’ recognition program impact on their job satisfaction. Following the collection of data, the descriptive statistic used to describe the personal characteristics of the respondents, while inferential statistics used to determine the statistical relationship existing between independent variable job satisfaction and the structural empowerment and nurses’ recognition program among the registered nurses at KFSH-D as dependent variables. Recommendation: The researcher only focuses on the in-patient units, future studies, are recommended to focus on every dimension and category level of units. Apart from that, when looking into job satisfaction and empowerment, to be more specific, the researcher could investigate another dimension by comparing age, and clinical working experience which may provide a depth of understanding of the contribution perception of structural empowerment. Conclusion: The findings of the studies reveal recognition and empowerment are assets to make nurses stay and increase their level of job satisfaction and task assignments.

Controversy of hand-assisted laparoscopic colorectal surgery

Laparoscopically assisted colorectal procedures are time-consuming and technically demanding and hence have a long steep learning curve. In the technical demand, surgeons need to handle a long mobile organ, the colon, and have to operate on multiple abdominal quadrants, most of the time with the need to secure multiple mesenteric vessels. Therefore, a new surgical innovation called hand-assisted laparoscopic surgery (HALS) was introduced in the mid 1990s as a useful alternative to totally laparoscopic procedures. This hybrid operation allows the surgeon to introduce the non-dominant hand into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum. A hand in the abdomen can restore the tactile sensation which is usually lacking in laparoscopic procedures. It also improves the eye-to-hand coordination, allows the hand to be used for blunt dissection or retraction and also permits rapid control of unexpected bleeding. All of those factors can contribute tremendously to reducing the operative time. Moreover, this procedure is also considered as a hybrid procedure that combines the advantages of both minimally invasive and conventional open surgery. Nevertheless, the exact role of HALS in colorectal surgery has not been well defined during the advanced totally laparoscopic procedures. This article reviews the current status of hand-assisted laparoscopic colorectal surgery as a minimally invasive procedure in the era of laparoscopic surgery.

Traumatic pancreatic fistula with sinistral portal hypertension:Surgical management

Combined ductal and vascular injuries are awesome complications of pancreatic injury.We report on a 29-year-old male unrestrained driver who sustained a blunt abdominal injury from the steering wheel in a high velocity head-on car collision.He developed a pancreatic fistula,portosplenic venous thrombosis and sinistral portal hypertension as a result of complete duct disruption at the pancreatic neck.We describe a safe surgical strategy of spleen-preserving distal pancreatectomy after failed medical and endoscopic management.

Appendiceal mass:Is interval appendicectomy “something of the past” ?

The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis.There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted,there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms.On the other hand,the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate.It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Moreover,it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration.If emergency LA is to become the standard of care for appendiceal mass,I.A will certainly become 'something' of the past.

Transcranial magnetic stimulation in animal models of neurodegeneration

Brain stimulation techniques offer powerful means of modulating the physiology of specific neural structures. In recent years, non-invasive brain stimulation techniques, such as transcranial magnetic stimulation(TMS) and transcranial direct current stimulation, have emerged as therapeutic tools for neurology and neuroscience. However, the possible repercussions of these techniques remain unclear, and there are few reports on the incisive recovery mechanisms through brain stimulation. Although several studies have recommended the use of non-invasive brain stimulation in clinical neuroscience, with a special emphasis on TMS, the suggested mechanisms of action have not been confirmed directly at the neural level. Insights into the neural mechanisms of non-invasive brain stimulation would unveil the strategies necessary to enhance the safety and efficacy of this progressive approach. Therefore, animal studies investigating the mechanisms of TMSinduced recovery at the neural level are crucial for the elaboration of non-invasive brain stimulation. Translational research done using animal models has several advantages and is able to investigate knowledge gaps by directly targeting neuronal levels. In this review, we have discussed the role of TMS in different animal models, the impact of animal studies on various disease states, and the findings regarding brain function of animal models after TMS in pharmacology research.

Migration of a biliary stent causing duodenal perforation and biliary peritonitis

Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.

Role of ERCP in the era of laparoscopic cholecystectomy for the evaluation of choledocholithiasis in sickle cell anemia

AIM:To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis in patients with sickle cell anemia (SCA) in the era of laparoscopic cholecystectomy (LC). METHODS:Two hundred and twenty four patients (144 male,80 female; mean age,22.4 years; range,5-70 years) with SCA underwent ERCP as part of their evaluation for cholestatic jaundice (CJ). The indications for ERCP were:CJ only in 97,CJ and dilated bile ducts on ultrasound in 103,and CJ and common bile duct (CBD) stones on ultrasound in 42. RESULTS:In total,CBD stones were found in 88 (39.3%) patients and there was evidence of recent stone passage in 16. Fifteen were post-LC patients. These had endoscopic sphincterotomy and stone extraction. The remaining 73 had endoscopic sphincterotomy and stone extraction followed by LC without an intraoperative cholangiogram.CONCLUSION:In patients with SCA and cholelithiasis,ERCP is valuable whether preoperative or postoperative,and in none was there a need to perform intraoperative cholangiography. Sequential endoscopic sphincterotomy and stone extraction followed by LC is beneficial in these patients. Endoscopic sphincterotomy may also prove to be useful in these patients as it may prevent the future development of biliary sludge and bile duct stones.

Sickle cell cholangiopathy:An endoscopic retrograde cholangiopancreatography evaluation

AIM:To evaluate the role of endoscopic retrograde cholangiopancreatography(ERCP) in patients with sickle cell disease(SCD) .METHODS:Two hundred and twenty four SCD patients with cholestatic jaundice(CJ) had ERCP.The indications for ERCP were based on clinical and biochemical evidence of CJ and ultrasound findings.RESULTS:Two hundred and forty ERCPs were performed.The indications for ERCP were:CJ only in 79,CJ and dilated bile ducts without stones in 103,and CJ and bile duct stones in 42.For those with CJ only,ERCP was normal in 42(53.2%) ,and 13(16.5%) had dilated bile ducts without an obstructive cause.In the remaining 22,there were bile duct stones with or without dilation.For those with CJ,dilated bile ducts and no stones,ERCP was normal in 17(16.5%) ,and 28(27.2%) had dilated bile ducts without an obstructive cause.In the remaining 58,there were bile ducts stones with or without dilation.For those with CJ and bile duct stones,ERCP was normal in two(4.8%) ,and 14(33.3%) had dilated bile ducts without an obstructive cause.In the remaining 26,there were bile duct stones with or without dilatation.CONCLUSION:Considering the high frequency of biliary sludge and bile duct stones in SCD,endoscopic sphincterotomy might prove helpful in these patients.

Body Mass Index and Breast Cancer Risk: A Retrospective Multi-Institutional Analysis in Saudi Arabia

Background: The purpose of this study was to evaluate the association between the body mass index (BMI) of breast cancer patients and non-cancer females of the Eastern Province of Saudi Arabia. Methods: The weight, height and age was obtained from the patient records of 706 newly diagnosed breast cancer patients and of 20,872 non-cancer female patients who consulted the two largest hospitals in the Eastern Province of Saudi Arabia between 2006 and 2012. Factorial analysis of variance (ANOVA) was used to assess the association between the BMI, age and breast cancer status. Results: The mean BMI of the non-cancer females was 29.4 and the percentage of obese patients of the different age groups ranged from 23.9% to 66.5%. The BMI increased significantly with age. The ANOVA revealed that breast cancer patients older than 50 years had a significantly lower BMI compared to their non-cancer counterparts (p = 0.01). Conclusion: Our data confirm the high BMI of the Saudi Arabian female population. The reason for our finding of a lower BMI of postmenopausal breast cancer patients compared to their non-cancer counterparts is unclear. Future studies are warranted to assess the impact of possible confounding factors on the association between obesity and breast cancer risk. An interesting factor to investigate in future studies would particularly be the use of the anti-diabetic and cancer-protective drug metformin considering that diabetes mellitus is endemic in Saudi Arabia with a prevalence of 30%.

Updated bone mineral density status in Saudi patients with inflammatory bowel disease

BACKGROUND Little is known about inflammatory bowel disease(IBD)burden and its impact on bone mineral density(BMD)among adult patients in Saudi Arabia.To the best of our knowledge,our study is the only study to give an update about this health problem in adult Saudi patients with IBD.IBD is a great risk factor for reduced BMD due to its associated chronic inflammation,malabsorption,weight loss and medication side effects.Consequently,screening for reduced BMD among patients with IBD is of utmost importance to curb and control anticipated morbidity and mortality among those patients.AIM To assess the relationship between IBD and BMD in a sample of adult Saudi patients with IBD.METHODS Ninety adult patients with IBD-62 Crohn’s disease(CD)and 28 ulcerative colitis(UC)-were recruited from King Fahad Specialist Hospital gastroenterology clinics in Buraidah,Al-Qassim.All enrolled patients were interviewed for their demographic information and for IBD-and BMD-related clinical data.All patients had the necessary laboratory markers and dual-energy x-ray absorptiometry scans to evaluate their BMD status.Patients were divided into two groups(CD and UC)to explore their clinical characteristics and possible risk factors for reduced BMD.RESULTS The CD group was significantly more prone to osteopenia and osteoporosis compared to the UC group;44%of the CD patients had normal BMD,19%had osteopenia,and 37%had osteoporosis,while 78%of the UC patients had normal BMD,7%had osteopenia,and 25%had osteoporosis(P value<0.05).In the CD group,the lowest t-score showed a statistically significant correlation with body mass index(BMI)(r=0.45,P<0.001),lumbar z-score(r=0.77,P<0.05)and femur z-score(r=0.85,P<0.05).In the UC group,the lowest t-score showed only statistically significant correlation with the lumbar z-score(r=0.82,P<0.05)and femur z-score(r=0.80,P<0.05).The ROC-curve showed that low BMI could predict the lowest t-score in the CD group with the best cut-off value at≤23.43(m/kg2);area under the curve was 0.73(95%CI:0.59–0.84),with a sensitivity of 77%,and a specificity of 63%.CONCLUSION Saudi patients with IBD still have an increased risk of reduced BMD,more in CD patients.Low BMI is a significant risk factor for reduced BMD in CD patients.

Fractured tracheostomy tube obturator: A rare cause of respiratory distress in a tracheostomized patient

Foreign body aspiration is a worldwide health problem which often results in life threatening complications. Tracheostomy tube fracture resulting in airway obstruction is a serious condition which has been reported in the medical literature. We report a rare case of a tracheostomy obturator fractured and lodged in tracheobronchial tree in a patient who presented with acute respiratory distress. Rigid or flexible bronchoscopy is frequently necessary for the diagnosis as well as the treatment. In adults, removal of the foreign body can be attempted during a diagnostic examination with a fiberoptic bronchoscope under lignocaine local infiltration with sedation, which may help to avoid any further invasive procedures. Flexible bronchoscopy should always be considered in foreign body aspiration. A periodic review of the techniques of tracheostomy care, including timely check-ups for signs of wear and tear, can possibly eliminate such avoidable late complications.

Anesthetic challenges in ventilating patients with tracheal diverticulum: Case reports and review of literature

The spectrum of disorders involving the tracheobronchial tree is diverse and tracheal diverticulum is an extremely rare entity accounting for 1%-2% of cases. Tracheal diverticulum is mainly asymptomatic and discovered incidentally either on radiological examination or at autopsy. We hereby report two cases of tracheal diverticulum with hoarseness in one case and dysphagia in the second case, where intubation was difficult in both cases. However, laryngeal mask airway was inserted successfully in case one and endotracheal intubation using a smaller size intubation tube in case two.

Efficacy and safety of non-vitamin K antagonist oral anticoagulants post-kidney transplantation

BACKGROUND Novel oral anticoagulants(NOACs)were developed as alternatives to vitamin K antagonists,primarily warfarin,as they do not require routine monitoring and have limited drug-drug and drug-food interactions.However,the efficacy and safety of these agents in kidney transplantation are not well studied.AIM To assess the profile and safety of NOACs for patients who had kidney transplantation,and to provide recommendations and guidelines on therapeutic strategies in these patients.METHODS This was a retrospective study carried out among adult patients who were actively on the following NOACs(apixaban,rivaroxaban or dabigatran)in our renal transplantation program from December 2015 to December 2016.The patients were identified primarily through electronic medical record system(patient data linkage).Data on the clinical and laboratory profile of the patients were retrieved and analyzed with SPSS 22.0.RESULTS Complete data on 42 renal transplant patients were retrieved:59.5%males,90.5%were whites and 66.7%were older than 60 years old.The mean duration since renal transplantation of the patients was 8.8±7.4 years.The most common risk factors for the development of end-stage renal disease in the subjects were hypertension(19.0%),polycystic kidney disease(19.0%),followed by diabetic nephropathy(16.7%)and chronic glomerulonephritis(16.7%).The main indications for NOACs use in the cohort were atrial fibrillation in 25 patients(59.5%)and venous thromboembolism in 10 patients(23.8%).Overall,29 patients(69%)were treated with apixaban,10 patients(23.8%)with rivaroxaban and 3 patients(7.14%)with dabigatran.No(0%)thromboembolic events were observed during the one-year period,but 3(7.1%)bleeding events occurred in the cohort consisting of 1 patient treated with rivaroxaban 15 mg daily and 2 patients who received apixaban 2.5 mg twice daily.There were no significant changes in serum tacrolimus level three days after the initiation of NOACs among patients treated with tacrolimus(pre-and post-NOACs tacrolimus levels were 7.2516 and 7.8867 ng/m L,P=0.55,respectively).Also,after one-year of treatment with NOACs there were no significant changes in the pre-and post-NOACs serum creatinine level(P=0.772)and estimated glomerular filtration rates(P=0.232).CONCLUSION No thromboembolic events or significant changes in renal profile were observed in our cohort of kidney transplant recipients who were treated with NOACs for at least a year.However,a few bleeding events were observed.This calls for further well-planned randomized controlled trials to assess the efficacy and safety of NOACs among renal transplant recipients.

Safety of pegylated interferon and ribavirin therapy for chronic hepatitis C in patients with sickle cell anemia

AIM:To evaluate the safety and efficacy of combined pegylated interferon and ribavirin for the treatment of chronic hepatitis C(HCV)in patients with sickle cell anemia(SCA). METHODS:Fifty-two patients with SCA and HCV were treated over a period of 7 years from June 2002 to July 2009.Their medical records were reviewed for:age at treatment,sex,body mass index,Hb level at the start of therapy and on follow-up,hemoglobin electrophoresis,liver function tests,G6PD level,LDH, bilirubin,HCV-RNA viral load,HCV genotype,liver biopsy,duration of treatment,and side effects.All were treated with pegylated interferon and a standard dose of ribavirin.The treatment was continued for 24 wk for those with genotype 2 and 3 and for 48 wk for those with genotype 1 and 4. RESULTS:Fifty-two patients(30 females and 22 males) were treated.Their mean age was 29.5 years(range 15-54 years).HCV genotype was determined in 48 and 15 had liver biopsy.Their mean pre-treatment HCV-RNA viral load was 986330 IU/mL(range 12762-3329282 IU/mL).The liver biopsy showed gradeⅠin 6 and gradeⅡin 9 and stageⅠin 13 and stageⅡin 2.Only 8 were receiving hydroxyurea at the time of treatment.All tolerated the treatment well and none experienced a decrease in their Hb which required blood transfusion pre,during or after therapy.There were no hematological side effects attributable to ribavirin at the usual recommended dose.Thirty-seven(71.2%)achieved SVR at 6 mo after the end of treatment.The remaining 15 were non-responders.Two of them showed an ETR but had a relapse.The remaining 13 had a relatively significant HCV-RNA viral load with a mean HCV-RNA viral load of 1829741.2 IU/mL(900000-3329282 IU/mL) and eight of them had HCV genotype 1,four had HCV genotype 4,and one had HCV genotype 5. CONCLUSION:Patients with SCA and HCV can be treated with pegylated interferon and ribavirin at the usual recommended dose.This is even so in those who are not receiving hydroxyurea.The treatment is safe and effective and the response rate is comparable to those without SCA.

Clinical Demographic Patterns of Type 1 Diabetes in Saudi Children in Tabuk City, 2000-2010

We aimed to identify the variation in the clinical background of children diagnosed with type 1 diabetes mellitus (T1DM) at King Salman Military Hospital (KSMH), Tabuk City, Kingdom of Saudi Arabia, from 2000 to 2010. Methods: This retrospective observational study was based on the clinical records of pediatric diabetes outpatients at KSMH. All children aged Results: Of 313 patients recruited, female patients were predominant (p = 0.002). The mean age of onset was 6.46 years (standard deviation, 3.02). One-third of the newly diagnosed patients were overweight (35.5%). Diabetic ketoacidosis (DKA) was the presenting feature in 38.0% of patients, wherein female patients and those aged 0 - 3 years exhibited the highest likelihood of developing DKA (odds ratio, 1.7 and 2.9, respectively). Moreover, underweight children had a greater DKA incidence than healthy, overweight, or obese children (p = 0.02). Conclusion: This study provides additional data on T1DM in the population of the Kingdom of Saudi Arabia. In particular, we found a female predominance at presentation as well as 2 peaks for age at onset. Moreover, the BMI was lower in younger age groups overall, but was greater in older boys. Furthermore, the DKA rates were high in younger children. Thus, our data confirm the presence of variable clinical patterns in the Kingdom of Saudi Arabia, which requires further epidemiological analysis using national registry data.

Management of nonalcoholic fatty liver disease in the Middle East

The prevalence of nonalcoholic fatty liver disease(NAFLD)in the Middle East is increasing in parallel to an increase in the prevalence of associated risk factors such as obesity,metabolic syndrome,and type 2 diabetes mellitus.About 20%to 30%of the patients progress to develop nonalcoholic steatohepatitis(NASH),a histological subtype of NAFLD,with features of hepatocyte injury such as hepatocyte ballooning.NASH can progress to fibrosis,cirrhosis,and even hepatocellular carcinoma.NAFLD thus causes a substantial burden on healthcare systems and it is imperative that appropriate strategies are discussed at a regional level to facilitate effective management tailored to the needs of the region.To fulfil this unmet need,expert gastroenterologists,hepatologists,and endocrinologists from the region came together in three advisory board meetings that were conducted in Saudi Arabia,United Arab Emirates,and Kuwait,to discuss current local challenges in NAFLD screening and diagnosis,and the different available management options.The experts discussed the disease burden of NAFLD/NASH in the Middle East;screening,diagnosis,and referral patterns in NAFLD;and available treatment options for NAFLD and NASH.This paper summarizes the discussions and opinion of the expert panel on the management of NAFLD/NASH and also presents an extensive literature review on the topic.

LBP–Bilateral Based Feature Fusion for Breast Cancer Diagnosis

Since reporting cases of breast cancer are on the rise all over the world.Especially in regions such as Pakistan,Saudi Arabia,and the United States.Efficient methods for the early detection and diagnosis of breast cancer are needed.The usual diagnosis procedures followed by physicians has been updated with modern diagnostic approaches that include computer-aided support for better accuracy.Machine learning based practices has increased the accuracy and efficiency of medical diagnosis,which has helped save lives of many patients.There is much research in the field of medical imaging diagnostics that can be applied to the variety of data such as magnetic resonance images(MRIs),mammograms,X-rays,ultrasounds,and histopathological images,but magnetic resonance(MR)and mammogram imaging have proved to present the promising results.The proposed paper has presented the results of classification algorithms over Breast Cancer(BC)mammograms from a novel dataset taken from hospitals in the Qassim health cluster of Saudi Arabia.This paper has developed a novel approach called the novel spectral extraction algorithm(NSEA)that uses feature extraction and fusion by using local binary pattern(LBP)and bilateral algorithms,as well as a support vector machine(SVM)as a classifier.The NSEA with the SVM classifier demonstrated a promising accuracy of 94%and an elapsed time of 0.68 milliseconds,which were significantly better results than those of comparative experiments from classifiers named Naïve Bayes,logistic regression,K-Nearest Neighbor(KNN),Gaussian Discriminant Analysis(GDA),AdaBoost and Extreme Learning Machine(ELM).ELM produced the comparative accuracy of 94%however has a lower elapsed time of 1.35 as compared to SVM.Adaboost has produced a fairly well accuracy of 82%,KNN has a low accuracy of 66%.However Logistic Regression,GDA and Naïve Bayes have produced the lowest accuracies of 47%,43%and 42%.