Dermatological Lesions of Cholesterol Embolization Syndrome and Kaposi Sarcoma Mimic Primary Systemic Vasculitis: Case Report Study

Primary systemic vasculitis can present with a wide spectrum of manifestations ranging from systemic non-specific features such as fever, malaise, arthralgia, and myalgia to specific organ damage. We describe two cases of cholesterol embolization syndrome and Kaposi sarcoma mimicking primary systemic vasculitis, both of which were characterized by features such as livedo reticularis, blue toe syndrome, a brown, purpuric skin rash, and positive p-ANCA associated with Kaposi sarcoma. Establishing the right diagnosis was challenging, and thus we aim in this study to highlight the possible ways to distinguish them from primary systemic vasculitis. Keywords: Dermatological lesions, Cholesterol embolization syndrome, Kaposi sarcoma, vasculitis mimic

Analysis of Gabapentinoids Abuse-Reports in the Middle East and North Africa Region Utilizing the Food and Drug Administration Adverse Event Reporting System

Objectives: The purpose of this study was to identify abuse-related post-marketing reports associated with gabapentinoids use in the Middle East and North Africa (MENA) region countries. Methods: A retrospective cross-sectional analysis of abuse-related adverse drug event (ADE) reports from the Middle East and North Africa (MENA) region. It was performed using the Food and Drug Administration Adverse Event Reporting System (FAERS) database from January 2008 through June 2020. Abuserelated ADE reports for gabapentin and pregabalin were extracted from the FAERS database. Descriptive statistics were performed, and the proportional reporting ratio (PRR) was calculated to detect disproportional attribution of abuse-related ADEs for gabapentin versus pregabalin. Results: We identified 559 all-cause ADE reports for gabapentinoids, including 205 (36.7%) abuse-related ADE reports reported to FAERS in the period of analysis. FAERS included 139 (67.8%) pregabalin and 66 (32.2%) gabapentin abuse-related ADE reports. Among MENA region countries, Turkey (55, 39.6%) and Saudi Arabia (34, 23.7%) had the highest number of abuse-related ADE reports for pregabalin. The most pregabalin abuse-related ADE reports involved adult male patients. The PRR of pregabalin versus gabapentin abuse-related ADE reports was 1.11, indicating that the number of abuse-related events was higher for pregabalin compared to gabapentin. Conclusion: Over 200 cases of abuserelated gabapentinoids events were reported to FEARS from the MENA region in the study period. Further studies should assess risk factors and potential programs to reduce gabapentinoids abuse

Biophysical, Biochemical, and Molecular Docking Investigations of Anti-Glycating, Antioxidant, and Protein Structural Stability Potential of Garlic.

Garlic has been reported to inhibit protein glycation, a process that underlies several disease processes, including chronic complications of diabetes mellitus. Biophysical, biochemical, and molecular docking investigations were conducted to assess anti-glycating, antioxidant, and protein structural protection activities of garlic. Results from spectral (UV and fluorescence) and circular dichroism (CD) analysis helped ascertain protein conformation and secondary structure protection against glycation to a significant extent. Further, garlic showed heat-induced protein denaturation inhibition activity (52.17%). It also inhibited glycation, advanced glycation end products (AGEs) formation as well as lent human serum albumin (HSA) protein structural stability, as revealed by reduction in browning intensity (65.23%), decrease in protein aggregation index (67.77%), and overall reduction in cross amyloid structure formation (33.26%) compared with positive controls (100%). The significant antioxidant nature of garlic was revealed by FRAP assay (58.23%) and DPPH assay (66.18%). Using molecular docking analysis, some of the important garlic metabolites were investigated for their interactions with the HSA molecule. Molecular docking analysis showed quercetin, a phenolic compound present in garlic, appears to be the most promising inhibitor of glucose interaction with the HSA molecule. Our findings show that garlic can prevent oxidative stress and glycation-induced biomolecular damage and that it can potentially be used in the treatment of several health conditions, including diabetes and other inflammatory diseases

The association between linagliptin and acute pancreatitis: A review

BackgroundLinagliptin is a Dipeptidyl Peptidase inhibitor (DPP-4i) with rare hypoglycaemic episodes and no need for renal adjustment. However, acute pancreatic is a major concern.AimsThe current review aimed to assess the relationship between linagliptin and acute pancreatitis.Methods A systematic electronic search was conducted in PubMed, MEDLINE, and the first hundred articles of Google Scholar for relevant articles. All human studies published during the period from 2006 to October 2019 were eligible. Studies on animals, experimental studies, and reviews were excluded. The search terms linagliptin, acute pancreatitis, chronic pancreatitis, and DPP-4i with protean AND or OR were used One hundred and thirty-two articles were retrieved and only six met the inclusion and exclusion criteria. The author's name, country of origin, date of publication, type of study, number of patients, and the duration were reported.Results There were 132 studies (thirty-two in Pub Med and MEDLINE and the first hundred articles in Google Scholar), out of fourteen full texts reviewed, only six studies were eligible. Three were meta-analyses (showed no association of linagliptin with acute pancreatitis, a pooled analysis of 22 randomized controlled trials supported the above observation, while a recent randomized controlled trial concluded acute pancreatitis in 0.3 per cent in linagliptin arm vs. 0.1 per cent placebo of which 2/9 were fatal. The last study was a case report at a high risk of acute pancreatitis due to multiple gallstones and diuretics use.ConclusionAcute pancreatitis was not higher among linagliptin users. Physicians need to take the benefits of this weight and cardiovascular risk-neutral drug with no need for renal adjustment

Prevalence, Recognition, And Management Of Mental Disorders In Primary Care

According to latest figures, 50% of individuals will have a minimum of one mental health issue in their lifetime, with at least 25% experiencing a mental condition in the previous year. primary care doctors are overwhelmingly responsible for recognition, evaluation, therapy, and referral, with at least one-third of their consultations containing a direct and obvious mental aspect Primary care physicians are the foundation of the majority of medical care programs that involve recognizing, diagnosing, treating, and referring patients to specialists for every kind of diseases, whether physical, mental, or both. Over the last two decades, there has been a greater emphasis on this position, notably in the treatment of mental problems in primary care

Population pharmacokinetics of vancomycin in very low birth weight neonates

IntroductionVancomycin dosing in very low birth weight (VLBW) neonates is challenging. Compared with the general neonatal population, VLBW neonates are less likely to achieve the vancomycin therapeutic targets. Current dosing recommendations are based on studies of the general neonatal population, as only a very limited number of studies have evaluated vancomycin pharmacokinetics in VLBW neonates. The main aim of this study was to develop a vancomycin population pharmacokinetic model to optimize vancomycin dosing in VLBW neonates.MethodsThis multicenter study was conducted at six major hospitals in Saudi Arabia. The study included VLBW neonates who received vancomycin and had at least one vancomycin serum trough concentration measurement at a steady state. We developed a pharmacokinetic model and performed Monte Carlo simulations to develop an optimized dosing regimen for VLBW infants. We evaluated two different targets: AUC0–24 of 400–600 or 400–800 µg. h/mL. We also estimated the probability of trough concentrations >15 and 20 µg/mL.ResultsIn total, we included 236 neonates, 162 in the training dataset, and 74 in the validation dataset. A one-compartment model was used, and the distribution volume was significantly associated only with weight, whereas clearance was significantly associated with weight, postmenstrual age (PMA), and serum creatinine (Scr).DiscussionWe developed dosing regimens for VLBW neonates, considering the probability of achieving vancomycin therapeutic targets, as well as different toxicity thresholds. The dosing regimens were classified according to PMA and Scr. These dosing regimens can be used to optimize the initial dose of vancomycin in VLBW neonates

The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section

BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available

Detecting the Second Mesiobuccal Canal in Maxillary Molars in a Saudi Arabian Population: A Micro-CT Study

The aim of this study was to determine MB2 canal detectability in maxillary first and second molars obtained from a Saudi population using micro-CT. Maxillary first (n=35) and second (n=30) molars were scanned with micro-CT technology. The number of canals was recorded, and in case of having more than one canal, the level of extracanal detection was analyzed. The presence of extracanal was categorized based on the level they were first detected. Among the maxillary first molars, 28 (80%) and six (17%) teeth had two and three MB canals, respectively. Among the maxillary second molars, 24 (80%) and four (13%) teeth had two and three MB canals, respectively. The MB2 canal was detected at the chamber floor in 70% and 61% of the maxillary first and second molars, respectively. At 1 mm depth, the MB2 canal was found in 15% and 18% of the maxillary first and second molars, respectively. At 2 mm depth, the MB2 canal was found in 3% and 18% of the maxillary first and second molars, respectively. The remaining teeth had the MB2 canal at levels deeper than 2 mm. The MB2 canal was detected in 97% and 93%% of maxillary first and second molars, respectively. Among them, the MB2 canal could be immediately detected in 70% and 61% of the maxillary first and second molars, respectively, once the pulp chamber is exposed. However, the rest of the MB2 were observed at deeper levels in the root and this requires troughing preparation in the chamber floor

Power Management in Islanded Microgrids Using Multi-Agent Systems

This paper presents a power management strategy for islanded microgrids. The proposed strategy utilizes the MultiAgent System (MAS) to perform the required tasks. The strategy is divided into two stages. The first stage is an operational planning stage which aims to optimize the operation of the microgrid in the islanded mode. This is achieved by performing Optimal Power Flow (OPF) periodically in the grid connected mode using a central agent. Once the islanded mode is detected, the results of the OPF are used to balance the operation of the microgrid. Several distributed agents along with the central agent aim to further fine tune the set points obtained from the OPF based on the actual operating conditions of the microgrid. To demonstrate the effectiveness of the proposed strategy, four scenarios are simulated and presented