Where traditional drug discovery meets modern technology in the quest for new drugs

Identifying novel compounds or improving bioavailability of drugs requires extensive screening, in vitro and in vivo testing and subsequent commercialisation. Traditional methods can be labour intensive and time-consuming. Use of modern technologies can reduce these challenges and is best achieved through collaboration with researchers specialising in different research fields. The range of research activities carried out in our lab is outlined and demonstrates the diversity of techniques used in our drug discovery programme

The Effect of Altering the Mechanical Loading Environment on the Expression of Bone Regenerating Molecules in Cases of Distraction Osteogenesis

Distraction osteogenesis (DO) is a surgical technique where gradual and controlled separation of two bony fragments following an osteotomy leads to the induction of new bone formation in the distracted gap. DO is used for limb lengthening, correction of bony deformities, and the replacement of bone loss secondary to infection, trauma, and tumors. Although DO gives satisfactory results in most cases, one major drawback of this technique is the prolonged period of time the external fixator has to be kept on until the newly formed bone consolidates thus leading to numerous complications. Numerous attempts at accelerating bone formation during DO have been reported. One specific approach is manipulation of the mechanical environment during DO by applying changes in the standard protocol of distraction. Attempts at changing this mechanical environment led to mixed results. Increasing the rate or applying acute distraction, led to poor bone formation in the distracted zone. On the other hand, the addition of compressive forces (such as weight bearing, alternating distraction with compression or by over-lengthening, and then shortening) has been reported to increase bone formation. It still remains unclear why these alterations may lead to changes in bone formation. While the cellular and molecular changes occurring during the standard DO protocol, specifically increased expression of transforming growth factor-beta 1, platelet-derived growth factor, insulin-like growth factor, basic fibroblast growth factor, vascular endothelial growth factor, and bone morphogenic proteins have been extensively investigated, the literature is sparse on the changes occurring when this protocol is altered. It is the purpose of this article to review the pertinent literature on the changes in the expression of various proteins and molecules as a result of changes in the mechanical loading technique in DO and try to define potential future research directions

Delivering natural products and biotherapeutics to improve drug efficacy

Due to the increasing problem of drug resistance, new and improved medicines are required. Natural products and biotherapeutics offer a vast resource for new drugs; however, challenges, including the cost and time taken for traditional drug discovery processes and the subsequent lack of investment from the pharmaceutical industry, are associated with these areas. New techniques are producing compounds with appropriate activity at a faster rate. While the formulation of these combined with drug-delivery systems offers a promising approach for expanding the drug developments available to modern medicine. Here, various classes of drug-delivery systems are described and the advantages they bring to small molecule and biotherapeutic targeting are highlighted. This is an attractive approach to the pharmaceutical industry and the rising trend in research in this area is examined in brief

Use of the Corail stem for revision total hip arthroplasty: Evaluation of clinical outcomes and cost

© 2019 Joule Inc. or its licensors. Background: With the growing number of total hip arthroplasty (THA) procedures performed, revision surgery is also proportionately increasing, resulting in greater health care expenditures. The purpose of this study was to assess clinical outcomes and cost when using a collared, fully hydroxyapatite-coated primary femoral stem for revision THA compared to commonly used revision femoral stems. Methods: We retrospectively identifed patients who underwent revision THA with a primary stem between 2011 and 2016 and matched them on demographic variables and reason for revision to a similar cohort who underwent revision THA. We extracted operative data and information on in-hospital resource use from the patients\u27 charts to calculate average cost per procedure. Patient-reported outcomes were recorded preoperatively and 1 year postoperatively. Results: We included 20 patients in our analysis, of whom 10 received a primary stem and 10, a typical revision stem. There were no signifcant between-group differences in mean Western Ontario and McMaster Universities Osteoarthritis Index score, Harris Hip Score, 12-Item Short Form Health Survey (SF-12) Mental Composite Scale score or Physical Composite Scale score at 1 year. Operative time was signifcantly shorter and total cost was signifcantly lower (mean difference -3707.64, 95% confdence interval -5532.85 to -1882.43) with a primary stem than with other revision femoral stems. Conclusion: We found similar clinical outcomes and signifcant institutional cost savings with a primary femoral stem in revision THA. This suggests a role for a primary femoral stem such as a collared, fully hydroxyapatite-coated stem for revision THA

Virtopsy Controversies and Knowledge Gaps in the Middle-East and the Role of Virtopsy During the Present COVID-19 Pandemic

The present review will discuss gaps in the current state of knowledge about virtopsy in the Middle East and its practical application during the covid-19 Pandemic. Published literature in different journals with strict inclusion and exclusion criteria was extensively reviewed using PubMed search engine to elucidate applications and implications of the virtual autopsy. The present review is based upon literature survey covering a period of 17 months (June 2019 – October 2021) using the key words “Forensic Science, Virtopsy, Middle East, Radiology, Post-Mortem, Covid-19, Covid-19 pandemic”. Studies using virtopsy in the Middle East are minimal and confined to four countries: Israel (56%) followed by Turkey (27%), Iran (9%) and UAE (5%). In terms of radiological modalities applied in virtopsy in the Middle East, computerized tomography (CT) was used the most (52%), followed by X-ray (38%), ultrasound (5%) and MRI (5%). The application of virtopsy in the postmortem investigations during the current Covid-19 pandemic was documented in four reports originating from a total of 32 corona-associated deaths. Of these 32 deceased, virtopsy alone was used in 19 deceased, while 13 deceased cases were examined by traditional autopsy combined with virtopsy. The mean age of the deceased was 68 (33-94) years. There were 69% males and 31% females. In combination with traditional autopsy, virtopsy can be very effective in identifying the cause, mode, and the state of health a person was in before he died. However, virtopsy alone is shown to be less sensitive than traditional autopsy and, therefore, requires further research to replace traditional autopsy. It is hoped that the present paper will elucidate further the practical significance of virtopsy in the Middle East

Effect of the extent of release for knee balancing on post-operative limb coronal alignment after primary total knee arthroplasty

© 2020 Alzahrani et al. Introduction: Outcomes and longevity of total knee arthroplasty (TKA) depend mainly on restoring knee function, through precise bony resection and appropriate soft tissue balancing. The current literature lacks evidence regarding the degree of radiographic change after intra-operative knee balancing. The purpose of our study was to assess the degree of change in coronal lower extremity alignment by comparing pre-operative to post-operative full-length radiographs (FLR) after quantifying the degree of intra-operative knee balancing and corre-late patient-reported outcomes to the extent of balancing required. Patients and Methods: One hundred and fifty-four patients undergoing primary TKA for varus knee osteoarthritis were included in the study. The performed soft tissue releases and bony adjustments to obtain a balanced TKA intra-operatively were prospectively documen-ted and were grouped into minimal, moderate and extensive release groups. Hip-knee-ankle angle (HKA), anatomical femoral-tibial angle (FTA), condylar hip angle (CH), medial proximal tibial angle (MPTA) and condylar plateau angle (CPA) were measured on full-length radiographs both pre-operatively and post-operatively. Frequencies of the soft tissue releases and bony resections in addition to descriptive statistics of the measured angles on the radiographs were recorded. In addition, patient-reported outcome scores (PROMs) were compared between the grouped patients. Results: Of those that were included in the study, 66 knees (42.9%) required minimal release to adequately balance the knee, while 70 (45.5%) required moderate release and 18 (11.7%) required extensive release. No statistically significant differences were found in change of alignment between the groups for all the measured angles. In addition, no difference in PROMs was seen between the groups both pre-and post-operatively. Conclusion: Although we found no association between post-operative coronal alignment of a TKA and the degree of soft tissue release and bony resection, this likely represents the fact that a balanced TKA is dynamic and not dependent on change of single radiographic parameters. Patient-reported outcomes were not impacted by the extent of releases

Role of Plastic Surgery in Management of Cleft Lip

Plastic surgery is a very tiny subspecialty of surgery, having roots that date back over three millennia to India. In the US, there are about 6900 plastic surgeons in active practice, and there are about 230 residency spots available annually. Plastic surgery is perhaps one of the most diversified medical specialties, despite its tiny size. The most common congenital anomalies to occur repeatedly impacting the orofacial area are cleft lip and palate. It can happen on its own, in different combinations, or in addition to other congenital abnormalities, including congenital cardiac conditions. For a patient with an orofacial cleft malformation to be functionally and aesthetically well, treatment must be started at the appropriate age. Care for a newborn with a cleft lip and palate must be coordinated and supplied by several different specialists for the infant to be managed successfully. This study\u27s objective was to look into if plastic surgery has a crucial role in treating cleft lip, hence enhancing the quality of life for those who are born with this disease. Correcting cleft lip defects both aesthetically and functionally is mostly dependent on plastic surgery

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