Circulating microRNAs as potential biomarkers of physical activity in geriatric patients with HCV.

BACKGROUND: Circulating microRNAs have been implicated in a diverse array of biological and pathological phenomena. Their potential utility as noninvasive biomarkers for screening and diagnosing various diseases has been proposed. OBJECTIVE: This study aimed to explore the potential role of the miRNAs miR-122 and miR-486 as molecular biomarkers in the pathogenesis of hepatitis C virus (HCV) infection. Thus, miR-122 and miR-486 were detected in the serum of HCV patients and healthy controls. Moreover, the potential correlations of miR-122 and miR-486 with viral complications, such as physical activity, pain, muscle fatigue, and HCV infection, were identified. METHODS: A total of 150 subjects aged 30 to 66 years were included in this study. The patients were classified as patients with chronic hepatitis C virus (CHC) (n = 110) or healthy controls (n = 40). Real-time polymerase chain reaction (PCR) analyses were performed to determine miR-122 and miR-486 expression. Physical activity (PA), pain score, HCV genotyping, viral overload, aspartate transaminase (AST), alanine transaminase (ALT), lactic acid dehydrogenase (LDH), creatine kinase (CK), and antioxidant status were also estimated by using prevalidated questionnaires, PCR, and spectrophotometric analyses. RESULTS: Compared with those in normal controls, significant increases in the serum levels of miR-122 and miR-486 were reported in patients with CHC. In physically active CHC patients, there was a significant correlation between the expression of miRNAs and increased alanine transaminase (ALT), aspartate transaminase (AST), fibrosis scores, and inflammation activity, but no association was reported for hepatitis C virus (HCV) RNA or viral load. Additionally, significant decreases in LDH, CK, GSSG, and pain scores and increases in TAC, GSH, and the GSH/GSSG ratio were reported. Moreover, the expression of miR-122 and miR-486 was positively correlated with changes in body mass index (BMI) and liver fibrosis stage, as well as negatively correlated with sex, PA, TAC, GSH, GSSG, and the GSH/GSSG ratio. CONCLUSION: MiR-122 and miR-486 expression levels were strongly correlated with physical activity, pain perception, and muscle fatigue biomarkers in HCV-infected patients. These miRNA levels were associated with elevated AST, ALT, fibrosis scores, LDH, CK, and antioxidant status, thus suggesting their potential as biomarkers for disease severity and oxidative stress. However, no correlation was observed with viral load or HCV-RNA expression, thus implying that these miRNAs may impact disease progression and symptoms through host factors, rather than directly affecting viral replication. In summary, the results demonstrated that molecular studies of miR-22 and miR-468 and their associations with PA, pain, adiposity, sex differences, and muscle fatigue, as well as routine biomarkers, could be useful as prognostic nanoninvasive biomarkers, thus providing novel therapeutic targets for CHC infection.

Effects of extracorporeal shockwave therapy versus ultrasonic therapy and deep friction massage in the management of lateral epicondylitis: a randomized clinical trial.

The study's goal was to compare and evaluate the benefits of deep friction massage and ultrasonic therapy (US) vs extracorporeal shockwave therapy (ESWT) for people with lateral epicondylitis. This double-blind, parallel-arm randomized clinical trial was conducted after ethical approval on a sample of 80 subjects with lateral epicondylitis. Participants were enrolled based on predefined eligibility criteria. They were randomly allocated to groups A and B. Group A received ESWT, while Group B received the US combined with deep friction massage. Data was collected using the Numeric Pain Rating Score (NPRS) and Patient-rated tennis elbow evaluation questionnaire (PRTEE) at baseline, at 3rd, and at 7th week of treatment. On the basis of the normality of the data, a non-parametric test was applied to evaluate between-group and within-group differences. P value ≤ 0.05 was considered significant. There was a significant difference between groups (p < 0.001). Comparisons of PRTEE scores at 3rd week and 7th week of intervention were found significant for both groups (p < 0.001). While considering between-group comparisons based on percentile scores of PRTEE at baseline, 3rd and 7th week of intervention, in group A Median (IQR) at the baseline was 24.00 (5.00), at 3rd week, 10.00 (5.00) and 7th week was 1.50 (2.50) and in group B Median (IQR) at the baseline was 25.00 (4.00), at 3rd week 19.50 (4.50) and at 7th week was 11.50 (2.50). The results were significant in both groups (p = 0.000), but between-group analysis revealed that ESWT is more effective in patients with lateral epicondylitis.

Effectiveness of extracorporeal shock wave therapy on functional ability in grade IV knee osteoarthritis - a randomized controlled trial.

Extracorporeal shockwave therapy (ESWT) is a non-invasive physical therapy intervention that has emerged in the recent past to address the upswing of osteoarthritis (OA). However, insufficient evidence is present to prove the efficacy of ESWT on grade IV knee osteoarthritis (KOA). The present study aimed to examine the effects of ESWT on functional ability in patients suffering from grade IV KOA. Thirty volunteers aged 45-60 years with grade IV primary KOA diagnosed by an orthopaedic surgeon based on the Kellgren-Lawrence score participated in the study. The participants were equally and randomly divided into two groups (i.e. experimental and control), with 15 participants in each group. The participants in the control group performed conventional physiotherapy (CPT) that included ultrasound therapy, isometric quadriceps, SLR and isometric hip adductor strengthening exercises. The participants in the experimental group received ESWT in addition to CPT. Lower extremity functional scale (LEFS) score was measured before and after the four weeks of intervention. In both groups, a statistically significant (p = 0.001) improvement in LEFS was observed. In the experimental groups, it improved by 81.92% and in the control groups by 48.15%. A statistically significant (p < 0.001) difference was observed in LEFS post-intervention values between both groups. As demonstrated by our trial results, the addition of ESWT to the CPT program will yield beneficial results in ameliorating the functional disability in patients with primary KOA (grade IV). Further studies are needed to confirm and apply these findings to a larger cohort.

The effects of previous abdominal surgery and the utilisation of modified access techniques on the operative difficulty and outcomes of laparoscopic cholecystectomy and bile duct exploration.

BACKGROUND: Early reports suggested that previous abdominal surgery was a relative contraindication to laparoscopic cholecystectomy (LC) on account of difficulty and potential access complications. This study analyses different types/systems of previous surgery and locations of scars and how they affect access difficulties. As modified access techniques to minimise risk of complications are under-reported the study details and evaluates them. METHOD: Prospectively collected data from consecutive LC and common bile duct explorations (LCBDE) performed by a single surgeon over 30 years was analysed. Previous abdominal surgery was documented and peri-operative outcomes were compared with patients who had no previous surgery using Chi-squared analysis. RESULTS: Of 5916 LC and LCBDE, 1846 patients (31.2%) had previous abdominal surgery. The median age was 60 years. Those with previous surgery required more frequent duodenal (RR 1.07; p = 0.023), hepatic flexure (RR 1.11; p = 0.043) and distal adhesiolysis (RR 3.57; p < 0.001) and had more access related bowel injuries (0.4% vs. 0.0%; p < 0.001). Previous upper gastrointestinal and biliary surgery had the highest rates of adhesiolysis (76.3%), difficult cystic pedicles (58.8%), fundus-first approach (7.2%), difficulty grades (64.9% Grades 3-5) and utilisation of abdominal drains (71.1%). Previous open surgery resulted in longer operative time compared to previous laparoscopic procedures (65vs.55 min; p < 0.001), increased difficulty of pedicle dissection (42.4% vs. 36.0%; p < 0.05) and required more duodenal, hepatic flexure and distant adhesiolysis (p < 0.05) and fundus-first dissection (4% vs 2%; p < 0.05). Epigastric and supraumbilical access and access through umbilical and other hernias were used in 163 patients (8.8%) with no bowel complications. CONCLUSION: The risks of access and adhesiolysis in patients with previous abdominal scars undergoing biliary surgery are dependent on the nature of previous surgery. Previous open, upper gastrointestinal and biliary surgery carried the most significant risks. Modified access techniques can be adopted to safely mitigate these risks.

Prevalence of peripheral neuropathy, amputation, and quality of life in patients with diabetes mellitus.

Peripheral neuropathy and amputation are common complications of diabetes mellitus (DM) that significantly impact the quality of life of the affected individuals. This study aims to investigate the prevalence of peripheral neuropathy, the level of amputation, and the quality of life in patients with DM. This cross-sectional study was conducted after approval of the synopsis involving 225 diagnosed patients with DM on pre-defined eligibility criteria, selected from public sector OPDs, specialized diabetes centres, and centres manufacturing orthotics and prosthetics. Data were collected through interviews, observations, and the administration of the Michigan Neuropathy Screening Instrument and the Asian Diabetes Quality of Life Questionnaire. The level of amputation was recorded for each participant. Data was entered into SPSS, and results were synthesized. Pearson correlation is applied to find an association between gender and the quality of life of the participants, while P ≤ 0.05 will be considered significant. The prevalence of peripheral neuropathy in a sample of 225, based on a self-administered questionnaire, was (44.4%), and in terms of foot examination was (51.1%). As people progressed in age, the prevalence increased to 20.0% in patients above 60 years and 8.9% in ≤ 35 years of age. The majority of participants (56.0%) have had DM for less than five years. Females were 57.8% of the study population, while 97.8% of participants had type II DM. Below-knee amputation of the right limb was observed in 22(9.8%) of the participants. The QoL was poor in the majority of the participants (96.9%) patients with DM (P = 0.638 and T = -0.471). This cross-sectional study highlights a high prevalence of peripheral neuropathy and amputation and poor QoL in patients with diabetic mellitus.

Postprandial Antioxidative Response to Ingestion of Formulated Date- and Fruit-Based Nutritional Bars by Healthy Individuals.

Nutritional bars (NBs) are gaining popularity among healthy and athletic individuals, but postprandial antioxidative response has not been investigated. Therefore, the current study examined the postprandial alterations in total phenolic content (TPC), total antioxidant capacity (T-AOC), malondialdehyde (MDA), and Superoxide dismutase (SOD) in the plasma of healthy individuals after the ingestion of 140 g (510 Kcal) from formulated date-based bars (DBBs) or fruit-based bars (FBBs). Firstly, the free and bound phenolic contents (PCs) were determined to be 10.15 and 12.98 and 6.19 and 3.57 mg GAE g-1, respectively. FBBs were significantly higher in free PC than DBBs, while DBBs were considerably higher in bound PC than FBBs. Secondly, twenty participants with age, height, weight, body mass index (BMI), fat mass, and fat-free mass averages of 21.4 years, 170.0 cm, 66.3 kg, 22.9 kg m2, 14.5, and 29.2 kg, respectively, were subjected to metabolic experiments (ISRCTN19386758). Ingestion of 140 g of FBB or DBB resulted in 288.50 or 302.14 µg TPC mL-1 blood, respectively. Postprandial TPC content increased with time progression and peaked after 120 min. T-AOC contents averaged 22.63 and 23.61 U mL-1 before ingestion of FBBs or DBBs, respectively. The T-AOC content increased significantly 120 and 180 min after ingestion of DBBs, while no significant change was noted after consuming FBBs. A significant decrease in MDA content was observed 180 min after consuming DBBs, while no significant change was noted after consuming FBBs. SOD concentrations ranged from 193.99 to 201.07 U L-1 in FBBs and DBBs, respectively. No considerable response was noted up to 3 h after ingestion of FBBs. On the contrary, a significant response was found 120 min after consuming DBBs. Pearson's correlation coefficient indicated a highly significant positive correlation coefficient (p < 0.01) between T-AOC and either MDA or SOD, as well as between MDA and SOD. The principal component analysis demonstrated a strong and positive relationship between SOD and TPC at 60 and 120 min after DBB ingestion. In conclusion, the relative changes in postprandial responses in T-AOC and MDA did not significantly (p > 0.05) differ between DBBs and FBBs, except for TPC (p = 0.04, paired t-test) and SOD (p = 0.003, paired t-test). Further studies with an extended experimental time are needed to confirm the current findings.

Comparison of effects of Otago exercise program vs gaze stability exercise on balance and fear of fall in older adults: A randomized trial.

BACKGROUND: Fall occurrences and the associated risk of injury are debilitating and major health concerns in the older population. Several interventions have been investigated and implemented to address the needs of balance impairments and to reduce the increased risk of falls. This study aimed to compare the effectiveness of the Otago exercise program (OEP) and gaze stability exercises (GSE) on balance and the risk of falls in older adults residing at an old age home facility. METHODS: Thirty elderly participants were equally and randomly divided into 2 groups: Group OEP received the OEP, and group GSE received GSE for 8 weeks (thrice a week). In addition, both groups also performed core muscle-strengthening exercises. The outcome measures were the Berg balance scale (BBS) and the Fall efficacy scale-International (FES-I). RESULTS: The interventions resulted in significant improvements (P < .001) in both outcome measures in both groups. The mean pretest BBS scores of groups OEP and GSE increased from 40.4 and 39.2 to the mean post-test scores of 48 and 45.2, respectively. Similarly, the mean pretest FES-I scores of groups OEP and GSE also improved from 39.47 and 40.4 to the mean post-test scores of 32.73 and 36.07. The between-group comparison showed greater improvement (P < .05) in OEP group in both variables. CONCLUSIONS: OEP and GSE were found to be beneficial rehabilitation programs in improving balance and fear of falls in healthy older adults. However, the OEP was found to be a more effective intervention and may allow better balance and fall prevention improvements. TRIAL REGISTRATION: The study has been registered in clinicaltrials.gov (ID: NCT05781776; on 23/03/2023).

Modulation of Angiotensin II-Induced Cellular Hypertrophy by Cannflavin-C: Unveiling the Impact on Cytochrome P450 1B1 and Arachidonic Acid Metabolites.

This research aimed to clarify the impacts of cannflavin-C on angiotensin II (Ang II)-induced cardiac hypertrophy and their potential role in modulating cytochrome P450 1B1 (CYP1B1) and arachidonic acid (AA) metabolites. Currently there is no evidence to suggest that cannflavin-C, a prenylated flavonoid, has any significant effects on the heart or cardiac hypertrophy. The metabolism of arachidonic acid (AA) into midchain hydroxyeicosatetraenoic acids (HETEs), facilitated by CYP1B1 enzyme, plays a role in the development of cardiac hypertrophy, which is marked by enlarged cardiac cells. Adult human ventricular cardiomyocyte (AC16) cell line was cultured and exposed to cannflavin-C in the presence and absence of Ang II. The assessment of mRNA expression pertaining to cardiac hypertrophic markers and cytochromes P450 (P450s) was conducted via real-time polymerase chain reaction (PCR), whereas the quantification of P450 protein levels was carried out through western blot analysis. Ang II induced hypertrophic markers myosin heavy chain (ß/α-MHC), atrial natriuretic peptide (ANP), and brain natriuretic peptide (BNP) and increased cell surface area, whereas cannflavin-C mitigated these effects. Gene and protein expression analysis revealed that cannflavin-C downregulated CYP1B1 gene expression, protein level, and enzyme activity assessed by 7-methoxyresorufin O-deethylase (MROD). Arachidonic acid metabolites analysis, using liquid chromatography-tandem mass spectrometry (LC-MS/MS), demonstrated that Ang II increased midchain (R/S)-HETE concentrations, which were attenuated by cannflavin-C. This study provides novel insights into the potential of cannflavin-C in modulating arachidonic acid metabolites and attenuating Ang II-induced cardiac hypertrophy, highlighting the importance of this compound as potential therapeutic agents for cardiac hypertrophy. SIGNIFICANCE STATEMENT: This study demonstrates that cannflavin-C offers protection against cellular hypertrophy induced by angiotensin II. The significance of this research lies in its novel discovery, which elucidates a mechanistic pathway involving the inhibition of CYP1B1 by cannflavin-C. This discovery opens up new avenues for leveraging this compound in the treatment of heart failure.

Assessing the Influence of Intermittent Alcohol Access on Acrylamide-Induced Neuronal Toxicity in an Experimental Rat Model.

Tobacco and alcohol have been identified as health risk behaviors associated with significant unfavorable health consequences, ranking within the list of the top ten causes of mortality and disability-adjusted life years (DALY). The combustion of tobacco leads to the formation of acrylamide (ACR), which is well known for its neurotoxic effects. Similarly, alcohol consumption has also been widely recognized for its neurotoxic effects. Both substances can affect neurons and neuroglia cells through various pathways. This study sought to examine the impacts of co-administration of ACR and intermittent-access ethanol (IAE) consumption over a period of one month. The experimental group received 20 mg/kg of ACR, administered orally, along with IAE of 20% ethanol sessions lasting 24 h, three times per week. The cognitive outcomes were assessed utilizing the elevated plus maze (EPM), which was employed as a means of assessing the capability to learn and remember, the novel object recognition (NOR) test, which was employed to assess recognition memory, and the Y-maze, which was used to explore a new environment and navigate. Additionally, ELISA assays were performed to examine underlying mechanisms, including markers associated with inflammation (NF-κB, PGE2, and TNF-α), apoptosis (Bcl2, Bax, and Caspase-3), and oxidative stress (MDA, catalase, and GSH). These markers were assessed in the brain homogenate as part of the investigation. Furthermore, a histopathological study was conducted. The findings indicated that NF-κB levels increased significantly in the combination of ACR and IAE groups (ACR + IAE) compared to either the ACR-alone or IAE-alone groups. However, parallel changes were observed in TNF-α, PGE2, Bax, Bcl-2, Caspase-3, GSH, and CAT levels when comparing the ACR + IAE group to the ACR-alone group. Comparable alterations were noted between the ACR + IAE treatment and IAE-alone groups in TNF-α, Bcl-2, MDA, GSH, and CAT levels. Moreover, the histopathological analysis revealed significant changes between the ACR + IAE and the ACR- or IAE-alone groups. Regarding memory parameters assessed using tests including EPM, NOR, and Y-maze, considerable changes were observed across all treatment groups as opposed to the control. Surprisingly, there were no notable differences in the NOR and Y-maze tasks between the alone and combination treatment. Further study is necessary to explore the long-term alteration of co-administering ACR and IAE on behavior, memory, and neurotoxicity-related mechanisms, in order to elucidate their combined effects more clearly.

Assessing muscle energy technique and foam roller self-myofascial release for low back pain management in two-wheeler riders.

Pain in the lower back is a major concern in today's era due to prolonged sitting in two-wheeler riders, mainly due to hamstring tightness. It also creates physical disability and impairment in activities of daily living. The study aimed to compare the efficacy of muscle energy technique (MET) and self-myofascial release (SMFR) using the foam roller on hamstring flexibility, dynamic balance, and physical disability amongst two-wheeler riders with chronic low back pain (LBP). Participants were randomized into two intervention groups, MET and SMFR using the envelope method, with each group having 20 participants. Hamstring flexibility and range of motion for knee extension and the lower back were assessed using the active knee extension test (AKE-L and AKE-R) and sit and reach test (SRT), while the dynamic balance was assessed by the star excursion balance test (SEBT) and physical disability by Roland-Morris Disability Questionnaire, (RMDQ). Measurements were taken at baseline and after 4 weeks of intervention. This study demonstrated that both SMFR using a foam roller and MET are effective in enhancing hamstring muscle flexibility, (SRT-F(1, 38) = 299.5, p < 0.001; AKE-R-F(1, 38) = 99.53, p < 0.001; AKE-L-F(1, 38) = 89.67, p < 0.001). Additionally, these techniques significantly improved dynamic balance in various directions, including anterior (ANT), anteromedial (AMED), medial (MED), posteromedial (PMED), posterior (POST), posterolateral (PLAT), lateral (LAT), and anterolateral (ALAT) directions (p < 0.01). Furthermore, there was a significant reduction in physical disability (RMDQ-F(1, 38) = 1307, p < 0.001), among two-wheeler riders suffering from chronic LBP. Compared to MET, SMFR using foam rollers was found to be more effective in enhancing hamstring flexibility, improving balance, and decreasing disability level on the RMDQ after 4 weeks.

The patient safety curriculum: An interventional study on the effectiveness of patient safety education for Jordanian nursing students.

INTRODUCTION: The purpose of the study was to assess the effectiveness of the World Health Organization's (WHO) patient safety curriculum (PSC) in improving the patient safety education for nursing students in Jordanian higher education programmes. METHODS: An interventional design adopting a pre-test and post-test was used. A questionnaire survey was administered to 373 nursing students before and after the curriculum. Students were asked to complete pre-test and post-test questionnaires on self-awareness of patient safety. RESULTS: Students had moderate knowledge of factors that influence patient safety and scored as the highest, (mean 3.45, SD 0.94). The greatest improvement was in the role of the health organisation in error reporting (the mean difference was 0.97, P = 0.001). Taking into consideration the essential measurements, the results obtained after the post-test regarding the two patient safety topics showed a significant increase after completing the training, demonstrating that the patient safety course was effective. CONCLUSION: The study highlights the importance of developing a curriculum in nursing schools that incorporates patient safety education. The WHO PSC guide can be a great start in this domain.

Alteration of Hepatic Cytochrome P450 Expression and Arachidonic Acid Metabolism by Arsenic Trioxide (ATO) in C57BL/6 Mice.

The success of arsenic trioxide (ATO) in acute promyelocytic leukemia has driven a plethora studies to investigate its efficacy in other malignancies. However, the inherent toxicity of ATO limits the expansion of its clinical applications. Such toxicity may be linked to ATO-induced metabolic derangements of endogenous substrates. Therefore, the primary objective of this study was to investigate the effect of ATO on the hepatic formation of arachidonic acid (AA) metabolites, hydroxyeicosatetraenoic acids (HETEs), as well as their most notable producing machinery, cytochrome P450 (CYP) enzymes. For this purpose, C57BL/6 mice were intraperitoneally injected with 8 mg/kg ATO for 6 and 24 h. Total RNA was extracted from harvested liver tissues for qPCR analysis of target genes. Hepatic microsomal proteins underwent incubation with AA, followed by identification/quantification of the produced HETEs. ATO downregulated Cyp2e1, while induced Cyp2j9 and most of Cyp4a and Cyp4f, and this has resulted in a significant increase in 17(S)-HETE and 18(R)-HETE, while significantly decreased 18(S)-HETE. Additionally, ATO induced Cyp4a10, Cyp4a14, Cyp4f13, Cyp4f16, and Cyp4f18, resulting in a significant elevation in 20-HETE formation. In conclusion, ATO altered hepatic AA metabolites formation through modulating the underlying network of CYP enzymes. Modifying the homeostatic production of bioactive AA metabolites, such as HETEs, may entail toxic events that can, at least partly, explain ATO-induced hepatotoxicity. Such modification can also compromise the overall body tolerability to ATO treatment in cancer patients.

Visible light assisted photooxidative facile degradation of azo dyes in water using a green method.

In this study, the methyl orange (MO) dye has been degraded after screening several azo dyes due to its effective results and being toxic and carcinogenic to aquatic life and humans. An environmentally friendly, economical, and green method for water purification was used in this study using the photooxidative method. Several organic acids were screened for oxidative applications against various azo dyes but due to better results, methyl orange was selected for the whole study. Ascorbic acid, also known as vitamin C, was found to be best for photodegradation due to its high oxidative activity among various organic acids utilized. A newly developed photoreactor box has been used to conduct the photooxidation process. To evaluate the degradation efficiency of AsA, photooxidative activity was monitored periodically. When the dose of AsA was used at a contact time of 180 minutes, degradation efficiency was 96%. The analysis of degraded products was performed using HPLC and GC-MS. The nucleophilicity of HOMO-LUMO and MEPs was confirmed using density functional theory. For the optimization of the process, central composite design (CCD) in Response Surface Methodology (RSM) was utilized.

Does the health information system in Jordan support equity to improve health outcomes? Assessment and recommendations.

BACKGROUND: This study is based on extensive evidence-based assessments. The aim of this paper is to evaluate how well Jordan's health information system (HIS) incorporates social determinants of health inequity (SDHI) and to propose suggestions for future actions. METHODS: An extensive evidence-based assessment was performed. A meta-synthesis of the inclusion of the SDHI in the HIS in Jordan was conducted. After searching and shortlisting, 23 papers were analyzed using Atlas.ti 9.0 employing thematic analysis technique. RESULTS: The HIS in Jordan is quite comprehensive, comprising numerous data sources, various types of information, and data from multiple producers and managers. Nevertheless, the HIS confronts several obstacles and fails to ensure the timely and secure publication of available data. The assessment of the inclusion of the SDHI in the HIS showed that the HIS allows for the measurement of progress in relation to social policies and actions but has a very limited database for supporting the inclusion of health inequity measures. One reason for the difficulty in identifying fairness is that certain crucial information necessary for this task cannot be obtained through the available institutional HIS or population survey tools. Additionally, relevant modules for fairness may be missing from population surveys, possibly due to a failure to fully utilize the capabilities of the institutional HIS. CONCLUSION: There are opportunities to make use of Jordan's dedication to fairness and its already established strong HIS. Some social determinants of health exist in the HIS, but much more data, information, and effort are needed to integrate the SDHI into the Jordanian HIS. A proposal from a regional initiative has put forward a comprehensive set of indicators for integrating SDHI into HIS, which could aid in achieving health equity in Jordan.

The utility of Hibiscus sabdariffa L. to prepare metal oxides NPs for clinical application on osteoporosis supported by theoretical study.

Green synthesis of metal oxides as a treatment for bone diseases is still exploring. Herein, MgO and Fe2O3 NPs were prepared from the extract of Hibiscus sabdariffa L. to study their effect on vit D3, Ca+2, and alkaline phosphatase enzyme ALP associated with osteoporosis. Computational chemistry was utilized to gain insight into the possible interactions. These oxides were characterized by X-ray diffraction, SEM, FTIR, and AFM. Results revealed that green synthesis of MgO and Fe2O3 NPs was successful with abundant. MgO NPs were in vitro applied on osteoporosis patients (n = 35) and showed a significant elevation of vit D3 and Ca+2 (0.0001 > p < 0.001) levels, compared to healthy volunteers (n = 25). Thus, Hibiscus sabdariffa L. is a good candidate to prepare MgO NPs, with a promising enhancing effect on vit D3 and Ca+2 in osteoporosis. In addition, interactions of Fe2O3 and MgO NPs with ALP were determined by molecular docking study.

Lithium-Associated Hypothyroidism in a Specialized Lithium Clinic at a Tertiary Care Hospital in Riyadh, Saudi Arabia: A Retrospective Study.

Hypothyroidism is a common side effect of lithium use and is associated with a slower response to treatment and poorer long-term remission in patients with bipolar disorder. No studies have examined the prevalence of lithium-associated hypothyroidism or its associated factors in Saudi Arabia. We aimed to estimate the prevalence of lithium-associated hypothyroidism among psychiatric patients in a specialized lithium clinic at a tertiary care hospital in Saudi Arabia and to examine the possible risk factors for its development. This retrospective observational study included 117 participants. The prevalence of secondary hypothyroidism was 15%. The median duration between the start of lithium therapy and the first abnormal thyroid test result was 341 days. The multiple logistic regression showed that none of the studied variables, namely, sex, current age, age of lithium initiation, continuity on lithium, lithium level (≤0.5 mmol/L or >0.5 mmol/L), and prescription of as-needed medications, was significantly associated with secondary hypothyroidism. Our study also shed light on the possible clinical significance of baseline TSH levels in developing hypothyroidism secondary to lithium. Further multicenter studies with larger sample sizes are warranted to examine the generalizability of these results.

Exploring the Mediating Role of Sleep Deficit-Related Functional Status in Subacute Stroke Survivors.

Background: Understanding post-stroke fatigue (PSF) and its associated factors is crucial for effective therapy and rehabilitation. This study aimed to assess the mediating role of the excessive daytime sleepiness-related functional status (SFS) on the relationship between sleep and the severity of fatigue in subacute stroke survivors. Methods: Subacute stroke survivors (n = 50; male = 38; female = 12), completed a cross-sectional study involving the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the insomnia severity index (ISI), the functional outcome of the sleep questionnaire (FOSQ), and the fatigue severity scale (FSS). Results: The SFS mediated the association between the severity of fatigue and sleep problems. The PSQI and FOSQ (b = -0.37, p < 0.001), and the FOSQ and FSS were correlated (b = -0.18, p < 0.05), with a significant indirect effect of the PSQI on the FSS. The ISI correlated with the FOSQ (b = -0.20, p < 0.001), with significant direct (b = 0.15, p < 0.001), as well as indirect, effects of the ISI on the FSS. The ESS correlated with the FOSQ (b = -0.23, p < 0.001), with a significant indirect effect of the ESS on the FSS. Conclusions: In subacute stroke survivors, fatigue and sleep are linked. Increased understanding of sleep-PSF may help in exploring new targets for supplement therapy.

Patients' Expectations in Emergency Department at King Abdulaziz University Hospital: A Cross-Sectional Survey-Based Study.

BACKGROUND: Emergency departments (EDs) are vital to the timely and necessary care that a significant percentage of patients get. Emergency medicine places a high priority on quality, and to deliver patient-centered care, it is crucial to first investigate patient expectations from ER visits. METHODOLOGY: This is a cross-sectional study of all visits to the King Abdulaziz University Hospital Emergency Department in Jeddah. The study included adult patients who visited the emergency department and were willing to complete a survey and participate in an interview. Data was collected through face-to-face questionnaires. Patient's expectations during their visit to the emergency department were correlated to different parameters using univariate and bivariate analysis. RESULTS: The study included 291 patients. The majority of patients believed that their medical condition required admission to the hospital and agreed that it would be easier to receive treatment if admitted to the hospital. Results showed that 65.6% (n=191) of patients reported that the most serious patients should be seen first, and 65.3% (n=190) reported that a doctor should determine the seriousness of their health problem upon arrival. There was no significant difference found between age groups in relation to other items of expectations. CONCLUSION: It is clear that a sizable percentage of patients place a high value on seeing the most urgent cases first and having a doctor assess each patient's condition when they arrive. Our results show that, in order to guarantee the best patient happiness and care, healthcare practitioners must meet patients' expectations and modify their strategies accordingly.

Green Organo-Photooxidative Method for the Degradation of Methylene Blue Dye.

This study used an organophoto-oxidative material to degrade the toxic azo dye, methylene blue (MB), due to its hazardous effects on aquatic life and humans. MB is traditionally degraded using metal-based catalysts, resulting in high costs. Several organic acids were screened for organo-photooxidative applications against various azo dyes, and ascorbic acid (AA), also known as vitamin C, was found to be best for degradation due to its high photooxidative activity. It is an eco-friendly, edible, and efficient photooxidative material. A photocatalytic box has been developed for the study of organo-photooxidative activity. It was found that when AA was added, degradation efficiency increased from 42 to 95% within 240 min. Different characterization techniques, such as HPLC and GC-MS, were used after degradation for the structural elucidation of degraded products. DFT study was done for the investigation of the mechanistic study behind the degradation process. A statistical tool, RSM, was used for the optimization of parameters (concentration of dye, catalyst, and time). This study develops sustainable and effective solutions for wastewater treatment.