Melatonin Induced Cold Tolerance in Plants: Physiological and Molecular Responses

Cold stress is one of the most limiting factors for plant growth and development. Cold stress adversely affects plant physiology, molecular and biochemical processes by determining oxidative stress, poor nutrient and water uptake, disorganization of cellular membranes and reduced photosynthetic efficiency. Therefore, to recover impaired plant functions under cold stress, the application of bio-stimulants can be considered a suitable approach. Melatonin (MT) is a critical bio-stimulant that has often shown to enhance plant performance under cold stress. Melatonin application improved plant growth and tolerance to cold stress by maintaining membrane integrity, plant water content, stomatal opening, photosynthetic efficiency, nutrient and water uptake, redox homeostasis, accumulation of osmolytes, hormones and secondary metabolites, and the scavenging of reactive oxygen species (ROS) through improved antioxidant activities and increase in expression of stress-responsive genes. Thus, it is essential to understand the mechanisms of MT induced cold tolerance and identify the diverse research gaps necessitating to be addressed in future research programs. This review discusses MT involvement in the control of various physiological and molecular responses for inducing cold tolerance. We also shed light on engineering MT biosynthesis for improving the cold tolerance in plants. Moreover, we highlighted areas where future research is needed to make MT a vital antioxidant conferring cold tolerance to plants

Early recognition and treatment of TC II deficiency: Case report

Transcobalamin (TC) is a carrier protein and it delivers vitamin B12 to the cellular TC receptor. TC II deficiency is a very rare disease and is life-threatening if left untreated. It is an Autosomal recessive disease and needs lifelong treatment. The clinical presentations are variable, started at early infancy, and sometimes mimic severe combined immunodeficiency or acute leukemia. It includes failure to thrive, diarrhea, anemia and or pancytopenia, hypotonia, developmental delay, and recurrent infection. Diagnosis of TC II deficiency is suspected based on clinical presentations with megaloblastic anemia, the elevation of plasma homocysteine, and urine methylmalonic acid level with a normal level of vitamin B12 and folate. Molecular analysis of the TCN 2 gene is needed for confirmation of the diagnosis. We present a case of 2 years old Saudi boy who was admitted to the hospital with a history of fever, recurrent chest infection, failure to thrive with diarrhea, and hypotonia, and his complete blood counts showed Pancytopenia. Though, normal vitamin B12 level and folate level, homocysteine, and urine methylmalonic acid lever were elevated. Peripheral smear and bone marrow aspiration and biopsy revealed Hypersegmented neutrophils and megaloblastic change.&nbsp

Regional Prevalence of Hemoglobin C Across Saudi Arabia: An Epidemiological Survey

Abstract Introduction HbC is a common structural hemoglobinopathy especially in West Africa. Prevalence and regional distribution of HbC in Saudi Arabia are widely undocumented. Patients with homozygous HbC disease may have mild hemolytic anemia whereas combination with hemoglobin S (HbS) leads to a clinically severe phenotype. Aim The current epidemiological study, considered the largest from Saudi Arabia, aimed to evaluate the regional prevalence of the HbC variant among the couples participating in the premarital screening program from 2011 to 2018. Methods Data from the PMSGC program were obtained for premarital screening and genetic counseling. The collected data were then entered into the SEHA platform, a centralized electronic repository for the 13 designated regions in Saudi Arabia. Hemoglobin electrophoresis samples are analyzed using either HPLC, capillary electrophoresis, or a combination of both methods to confirm the presence of abnormal hemoglobin bands. Results This study included 1,871,184 individuals from 2011 to 2018. Of those, 49.8% were males and 50.2% were females. 112,618 (6.0%) had an abnormal test. Total number of Hb C cases were 778 (0.04%). HbC trait (HbAC) was detected in 764 participants while homozygous HbC (HbCC) and combined heterozygous (HbSC) were found in 9 and 5 cases, respectively. The regions near the Red Sea have higher rates than the central and eastern regions. Conclusion HbC is a rare variant in Saudi Arabia with varying regional frequencies. HbC variant is more common in Mecca and Madina regions. The geographic area of HbC distribution differs from the areas with high prevalence of HbS, which explains why HbSC disease cases are overwhelmingly rare

Assessing the Reliability of Miller’s Classification and Cairo’s Classification in Classifying Gingival Recession Defects: A Comparison Study

Background and Objectives: Gingival recession results in adverse aesthetics and root sensitivity, and there is a need to treat and prevent its further progression. To overcome these problems, various advances have been made by clinicians in treating gingival recession based on the type of gingival recession. Miller’s classification has been used for a long time to classify the type of recession. However, certain limitations have been found with use of Miller’s classification such as a lack of clarity in the method for measuring soft and hard tissue loss in the interproximal area. Cairo classification was proposed to overcome limitations of Miller’s classification to classify gingival recession. Cairo’s classification is a treatment-oriented classification based on buccal and interproximal attachment loss. Therefore, the study was conducted to assess and compare the reliability of Miller’s and Cairo’s classifications in determining gingival recession. Material and methods: A total of 220 buccal gingival recession defects were included in the study based on the inclusion and exclusion criteria. Four examiners were included in the study. Two examiners classified the recession defects according to Miller’s classification and the other two examiners classified recession defects according to Cairo’s classification at baseline and at a 1-week interval. Statistical analysis was conducted using SPSS software version 25.0 using Cohen’s kappa correlation coefficient and Chi-square test statistics to determine the intra- and inter-rater agreement among the examiners for the two gingival recession classification systems. A p value of Results: The intra-rater agreement for Cairo’s classification was 0.86 and 0.82, whereas for Miller’s classification, it was found to be 0.68. The inter-rater reliability agreement for Cairo’s classification was 0.82 and 0.8, whereas for the Miller’s classification, it was 0.56 and 0.67. Conclusions: Within the limitations of the study, it was found that Cairo’s classification is clearer and more reliable than Miller’s classification in the assessment of gingival recession

Knowledge and Awareness of Adults towards Nocturnal Enuresis in Children among the Medina Population

Background: Nocturnal Enuresis (NE) is a common problem among children that is stressful for both the child and adults. There is a lack of adults’ knowledge and awareness of the NE condition. Objective: This study aimed to evaluate the adults’ knowledge and awareness of NE in Medina City, Saudi Arabia. Method: A cross-sectional observational study was conducted among adults in Medina through September and October 2023, using a questionnaire composed of socio-demographic characteristics and adults’ knowledge and awareness of NE. A statistical analysis was performed using SPSS software. Results: The study was conducted among 553 adults in Medina, with a mean (standard deviation [SD]) age of 37.69 (10.775). Most participants (94.8%) were Saudi nationals, of which 84.4% were females, 76.3% were married, and 97.1% were urban residents with university degrees (80.3%). The mean (SD) total score of knowledge and awareness was 4.69 (1.783) out of 9 and 6.49 (2.167) out of 12, respectively. Being female (p p = 0.002), and knowing about enuresis in children (p = 0.011) are significant factors affecting adults’ knowledge with higher scores than others. Conclusions: An inadequate knowledge and awareness level of NE in children was revealed among adults living in Medina City, Saudi Arabia. These results emphasize the need for targeted educational campaigns to enhance adults’ knowledge and awareness of enuresis

APPROACH TO HEADACHE IN THE ER

Introduction: Acute severe headache is always serious and demands care and usually patients present to to the emergency department (ED). There are many medications available, and many hazards to be avoided, both regarding the diagnosis and the management. It represents an agonizingly painful and disturbing event for the patients, families, as well as the medical team. Usually, these patients have done many methods with expert doctors to no benefit. Inpatient assessment and management could be helpful in some patients. The major diagnostic difficulties in diagnosing the cases of severe acute headache in the ED are misdiagnosis of primary headache syndromes and undiagnosed secondary causes of headache. Missing the correct diagnosis will decrease the chances of correct management. Red flags such as meningismus, fever, neurologic signs, and concurrent medical illnesses should raise the attention. Aim of work: In this review, we will discuss the most recent evidence regarding the recent approach to the emergency management of patients with headache. We will also discuss options for the management. Methodology: We did a systematic search for approach to headache in the emergency department using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). We only included full articles. Conclusions: Most cases of headache are evaluated in EDs have migraine, however some of them have other primary and secondary headache disorders that must be excluded. When this is performed, many medications are available to relief of headache, involving parenteral ketorolac, neuroleptic antiemetics, DHE, triptans, and magnesium sulfate. Opioids, while commonly employed, are generally less useful, and may lead to readmission to the ED. Even though most chronic headache problems could be treated in the outpatient setting, inpatient management can offer many benefits, especially in patients who are overusing medications. Intravenous DHE has good evidence for efficacy. Few commonly proposed managements plans for acute headache relief in the ED have been studied in that setting; similarly, most inpatient IV treatment protocols are not clearly established to be effective. Problems to further research include lack of funding and individual differences between refractory headache patients, making comparison studies difficult. Key words: Headache, emergency department, management

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population