Phytochemical Screening, In Vitro and In Silico Studies of Volatile Compounds from Petroselinum crispum (Mill) Leaves Grown in Saudi Arabia

The herbal plant Petroselinum crispum (P. crispum) (Mill) is commonly available around the world. In this study, the leaves of the herbal plant P. crispum were collected from the central region of Al-Kharj, Saudi Arabia, to explore their in vitro pharmacological activity. Essential oil from the leaves of P. crispum was isolated using the hydrodistillation method. The composition of P. crispum essential oil (PCEO) was determined using Gas chromatography-mass spectrometry (GC-MS). A total of 67 components were identified, representing approximately 96.02% of the total volatile composi-tion. Myristicin was identified as the principal constituent (41.45%). The in vitro biological activity was assessed to evaluate the antioxidant, antimicrobial, and anti-inflammatory potential of PCEO. PCEO showed the highest antimicrobial activity against Candida albicans and Staphylococcus aureus among all the evaluated microbial species. In vitro anti-inflammatory evaluation using albumin and trypsin assays showed the excellent anti-inflammatory potential of PCEO compared to the standard drugs. An in silico study of the primary PCEO compound was conducted using online tools such as PASS, Swiss ADME, and Molecular docking. In silico PASS prediction results supported our in vitro findings. Swiss ADME revealed the drug likeness and safety properties of the major metabolites present in PCEO. Molecular docking results were obtained by studying the interaction of Myristicin with an antifungal (PDB: 1IYL and 3LD6), antibacterial (PDB: 1AJ6 and 1JIJ), antioxidant (PDB: 3NM8 and 1HD2), and anti-inflammatory (3N8Y and 3LN1) receptors supported the in vitro results. Therefore, PCEO or Myristicin might be valuable for developing anti-inflammatory and antimicrobial drugs

Barriers and Facilitators to Children Wearing a Sports Mouthguard: A Systematic Review

A systematic review on the identification of the barriers and facilitators of wearing a sports mouthguard among children. For this, A systematic search was done from different databases following PRISMA guidelines. The six different databases including (Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Embase, Embase Classic, Web of Science, and Scopus) were searched, including the search terms related to the topic. 1470 records were identified, 36 studies were included in this systematic review. The data was collected using a modified data extraction form. The barriers and facilitators found were put into five sociological levels of influence based on the Theoretical Domains Framework domains (individual, interpersonal, organisational, community, and public policy). The Newcastle-Ottawa Scale was used to measure the risk of bias in the included studies. The discovered barriers and facilitators were classified into seven TDF domains, including knowledge, beliefs about consequences, intentions, memory, attention and decision process, environmental context and resources, social influence, and emotions

Dose optimization of β-lactams antibiotics in pediatrics and adults:A systematic review

Background: β-lactams remain the cornerstone of the empirical therapy to treat various bacterial infections. This systematic review aimed to analyze the data describing the dosing regimen of β-lactams. Methods: Systematic scientific and grey literature was performed in accordance with Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The studies were retrieved and screened on the basis of pre-defined exclusion and inclusion criteria. The cohort studies, randomized controlled trials (RCT) and case reports that reported the dosing schedule of β-lactams are included in this study. Results: A total of 52 studies met the inclusion criteria, of which 40 were cohort studies, 2 were case reports and 10 were RCTs. The majority of the studies (34/52) studied the pharmacokinetic (PK) parameters of a drug. A total of 20 studies proposed dosing schedule in pediatrics while 32 studies proposed dosing regimen among adults. Piperacillin (12/52) and Meropenem (11/52) were the most commonly used β-lactams used in hospitalized patients. As per available evidence, continuous infusion is considered as the most appropriate mode of administration to optimize the safety and efficacy of the treatment and improve the clinical outcomes. Conclusion: Appropriate antibiotic therapy is challenging due to pathophysiological changes among different age groups. The optimization of pharmacokinetic/pharmacodynamic parameters is useful to support alternative dosing regimens such as an increase in dosing interval, continuous infusion, and increased bolus doses

Assessment and Management of Scabies in Primary Care Settings

Scabies is an overlooked tropical illness that yet has significant worldwide effects and lasting health repercussions. The condition is caused by the mite Sarcoptes scabei var. hominis, which is a parasitic organism that dwells on the outer layer of the human skin. Scabies is prevalent in impoverished neighborhoods as a result of the high population density in locations such as nursing homes, correctional facilities, and among homeless and displaced children. Nevertheless, modern nations are also prone to scabies infestations, particularly in cases of institutional outbreaks or mini epidemics occurring after conflict or natural calamities. Scabies diagnosis can be aided by both invasive and noninvasive techniques. This paper reviews assessment diagnosis, and management of scabies in primary health care settings

Association Between Lipid Profile and Diabetic Foot Ulcer

Diabetic foot ulcer is a serious disabling consequence of Diabetes Mellitus. They are characterized by the breakdown of skin and underlying tissues in the feet, and are a major cause of lower limb amputations. Various risk factors have been identified for the development of diabetic foot ulcers, including poor glycemic control, peripheral neuropathy, peripheral arterial disease, and impaired wound healing. it is considered that the lipid profile is one of many factors that contribute to the formation and progression of diabetic foot ulcers. To stratify the incidence of diabetic foot ulcers (DFUs), biomarkers are required. The aim of this review is to assess the relationship between the risk of DFU and lipid profile in diabetic patients

The Importance of Preventive Medicine in Family Practice: A Review of Current Guidelines and Recommendations

Prevention is seen as a critical topic in family practice. Primordial prevention, primary prevention, secondary prevention, tertiary prevention, and quaternary prevention are all part of this strategy to disease prevention. To avoid the formation and development of risk factors, primary prevention focuses on addressing the fundamental causes and social determinants of disease. Primary prevention is the practice of preventing illnesses before they arise via the use of treatments such as immunizations and health education. Secondary prevention focuses on illness identification and intervention as early as possible to avoid disease development. Tertiary prevention addresses illness outcomes by restoring health and offering rehabilitation. Finally, quaternary prevention seeks to safeguard patients against needless medical treatments and the harm caused by over-medicating. Risks frequently rise in tandem with frailty and comorbidities. In contrast, advantages frequently drop as life expectancy increases. Preventive management strategies should consider the patient's viewpoint and be mutually agreed upon. Healthcare providers must prioritize the deployment of preventive care services, even when clinical treatments are required, in order to overcome preventive care hurdles. Healthcare practitioners may play a critical role in illness prevention and contribute to family well-being by investing in preventive care and executing these measures

Threat of antimicrobial resistance among pilgrims with infectious diseases during Hajj : lessons learnt from COVID-19 pandemic

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of anti-microbials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness, and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj

Assessing disparities in medical students’ knowledge and attitude about monkeypox: a cross-sectional study of 27 countries across three continents

Background and aimsThe recent monkeypox (Mpox) outbreak confirmed by the World Health Organization (WHO) underscores the importance of evaluating the knowledge and attitude of medical students toward emerging diseases, given their potential roles as healthcare professionals and sources of public information during outbreaks. This study aimed to assess medical students’ knowledge and attitude about Mpox and to identify factors affecting their level of knowledge and attitude in low-income and high-income countries.MethodsA cross-sectional study was conducted on 11,919 medical students from 27 countries. A newly-developed validated questionnaire was used to collect data on knowledge (14 items), attitude (12 items), and baseline criteria. The relationship between a range of factors with knowledge and attitude was studied using univariate and multivariate analyses.Results46% of the study participants were males; 10.7% were in their sixth year; 54.6% knew about smallpox; 84% received the coronavirus disease 2019 (COVID-19) vaccine; and 12.5% had training on Mpox. 55.3% had good knowledge of Mpox and 51.7% had a positive attitude towards it. Medical students in their third, fifth, or sixth year high- income countries who obtained information on Mpox from friends, research articles, social media and scientific websites were positive predictors for good knowledge. Conversely, being male or coming from high-income countries showed a negative relation with good knowledge about Mpox. Additionally, a positive attitude was directly influenced by residing in urban areas, being in the fifth year of medical education, having knowledge about smallpox and a history of receiving the coronavirus disease 2019 (COVID-19) vaccine. Receiving information about Mpox from social media or scientific websites and possessing good knowledge about Mpox were also predictors of a positive attitude. On the other hand, being male, employed, or receiving a training program about Mpox were inversely predicting positive attitude about Mpox.ConclusionThere were differences in knowledge and attitude towards Mpox between medical students in low and high-income countries, emphasizing the need for incorporating epidemiology of re-emerging diseases like Mpox into the medical curriculum to improve disease prevention and control

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Assessment of central pain mechanisms: generating knowledge and resources for translation into clinical practice

Background: Musculoskeletal (MSK) disorders are the second most common cause of disability. Persistent MSK pain has been associated with altered central pain mechanisms (CPMs), particularly somatosensory abnormalities. In research, a range of objective tools, such as quantitative sensory testing (QST) procedures are used to measure somatosensory abnormalities. QST procedures have a potential use in clinical practice for recognizing somatosensory abnormalities associated with pain. However, the knowledge in psychometric properties and the clinical utility of these test procedures in clinical practice remains unclear. Aim: The aim of this thesis was to synthesize knowledge and resources on the assessment of CPMs for translation into musculoskeletal physiotherapy clinical practice. Methods: Using the Knowledge to Action (KTA) model, a series of steps were undertaken to accomplish the aim of the thesis. Three systematic reviews were conducted to review the literature on psychometric properties (PMPs) of test procedures utilized to identify altered CPMs in individuals with MSK pain, including peripheral joint pain (PJP), neck pain, and back pain. This was followed by an online survey of New Zealand physiotherapists to collect information on current clinical practice related to the assessment of CPMs. The next step was a content analysis of YouTube™ and Google™ videos related to testing procedures, which demonstrated adequate PMPs. Finally, a focus group study was conducted to explore physiotherapists’ perceptions on the features of the identified videos with the aim of identifying better quality resources that can be used for educational medium for upskilling clinicians. Results: The level of evidence for PMPs varied across various test procedures in different types of MSK pain. The following test procedures have adequate PMPs for assessment of CPMs: the hand-held pressure algometer in individuals with chronic knee OA; the digital hand-held algometer and the neurometer CPT/C in individuals with chronic neck pain; the electronic pressure algometer, cross friction algometry, and conditioned pain modulation in individuals with back pain. The survey indicated that the majority of physiotherapists were assessing central sensitization (CS), but objective assessment of CPMs is not a part of routine clinical practice. In addition, physiotherapists reported lack of knowledge and training, limited clinical time, and unavailability of the testing equipment were the most common cited barriers for using QST procedures in clinical practice. The content analysis of YouTube™ and Google™ videos identified only two videos, which received better quality scores based on the primary criteria of the developed 17-item checklist. However, the qualitative study reported that physiotherapists viewed both videos were simple and lacked information that is necessary to reproduce the test procedure (i.e. algometer). Physiotherapists stated that poor technical quality and lack of professionalism in the videos lessened their credibility. Conclusion: This thesis identified the level of evidence of PMPs for different test procedures, such as algometer for the assessment of CPMs. However, such procedures were not a part of routine clinical practice. YouTube™ and Google™ videos related to testing procedures lacked essential content and technical quality to be used as educational resources. Therefore, physiotherapists recommended incorporating additional information on CS, standardization of test application and the position of the test subject. Additionally, future videos should have higher technical quality and professionalism to increase their trustworthiness