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Purpose Adrenalectomy for pheochromocytoma (PHEO) presents a significant challenge due to the high incidence of early hospital readmission (ER). This study evaluated the incidence and risk factors of ER for PHEO within 30 days of adrenalectomy. Methods A retrospective analysis of 346 patients > 18 years with unilateral PHEO who underwent adrenalectomy between September 2012 and September 2024. The patients were categorised into ER ( n  = 49) and no ER ( n  = 297) groups. Logistic regression analyses were performed to predict risk factors for ER. Results The most common causes of ER were postoperative maintained hypotension (42.9%), bleeding (6.1%), ileus (24.5%), wound infection (4.1%), hyperkalemia (8.2%), pneumonia (2%), intra-abdominal abscess (2%), acute MI (4.1%), and colonic injury (6.1%). Most postoperative complications were Clavien-Dindo grade II ( n  = 40, 81.6%). Two perioperative deaths (4%) occurred in the ER group. Logistic regression showed that low body mass index (OR 0.849, 95% CI, 0.748–0.964; p  = 0.012), tumor size < 5 cm (OR 0.096, 95% CI, 0.030–0.310; p  < 0.001), and low ASA (OR 0.435, 95% CI, 0.249–0.761; p  = 0.003) were associated with risk reduction for ER while malignancy (OR 5.302, 95% CI, 1.214–23.164; p  = 0.027), open approach(OR 12.247, 95% CI, 5.227–28.694; p  < 0.001), and intraoperative complications (OR 19.149, 95% CI, 7.091–51.710; p  < 0.001) were associated with risk increase of ER. Conclusion Postoperatively maintained hypotension and ileus were the most common causes of ER. Low body mass index, tumour size < 5 cm, and low ASA were risk reductions for ER, while malignancy, open approach, and intraoperative complications were the independent risk increase factors.

Purpose There is no consensus on the standard approach for trans-sphincteric perianal fistulas (TPAF) in the elderly population. The most commonly used sphincter-saving procedures are ligation of the inter-sphincteric fistula tract (LIFT) and mucosal advancement flap (MAF). We aimed to evaluate the incidence and risk factors for recurrence and incontinence in elderly patients with TPAF using both approaches. Methods This retrospective study included 257 patients who underwent LIFT (136 patients) or MAF (121 patients) for de novo and cryptoglandular TPAF between July 2018 and July 2021. Recurrent fistulas were clinically and radiologically detected using MRI. Postoperative incontinence was evaluated using the Wexner score and anorectal manometry. Logistic regression analysis was used to detect the risks of recurrence and incontinence. Results The median ages of the patients were 68 (64, 74) and 68 (65, 74) years in the LIFT and MAF groups, respectively. Higher recurrence rates were observed after LIFT (17 (12.5%)) than after MAF (13 (10.7%)), but the difference was not statistically significant ( P  = 0.662). Postoperative incontinence was observed in 18 patients (13.2%) and seven patients (5.8%) in the LIFT and MAF groups, respectively ( P  = 0.044). The predictors for fistula recurrence were smoking (OR, 75.52; 95% CI, 1.02 to 5611.35; P  = 0.049), length of tract (OR, 17.3; 95% CI, 1.49 to 201.13; P  = 0.023), and CD classification (OR, 7.08; 95% CI, 1.51 to 33.14; P  = 0.013). A low Charlson comorbidity index score (≤ 5) (OR, 0.68; 95% CI, 0.47 to 0.99; P  = 0.046) and high postoperative mean squeeze anal pressure (OR, 0.97; 95% CI, 0.95 to 0.99; P  = 0.001) were significant factors associated with reduced risk of incontinence. In particular, LIFT was associated with a significantly higher risk of incontinence than MAF (OR, 2.089; 95% CI, 1.006 to 4.33; P  = 0.04). Conclusions The healing rates of MAF and LIFT procedures did not differ significantly; however, continence was significantly better after MAF. MAF should be added to the guidelines as a good option for the treatment of TPAF in elderly patients. Trial registration The study was registered as a clinical trial www.clinicaltrials.gov (NCT06616662).

Selenium nanoparticles (SeNPs) synthesized using Dahlia pinnata L tuber extract exhibit significant antimicrobial, antidiabetic, and anti-inflammatory properties. This study describes the green synthesis of SeNPs using D. pinnata L. tuber extract, a sustainable approach that leverages plant-based compounds. Green synthesis was confirmed via UV-Vis spectroscopy (280 nm peak), XRD trigonal crystal structure with planes (100), (101), (110), (111), and (201), and TEM (spherical particles, 17.37 nm average size). FTIR revealed functional groups (C–H, C = O, Se–Se), while HPLC identified gallic acid (1070.58 µg/g) and chlorogenic acid (903.87 µg/g). In antimicrobial studies, SeNPs demonstrated strong efficacy against 70 Escherichia coli isolates from laboratory samples of diabetic patients. For 15 multidrug-resistant (MDR, 21.4%) isolates, SeNPs had MICs of 25–50 µg/ml (mean: 35 ± 12 µg/ml) and MBCs of 50–100 µg/ml (mean: 76.6 ± 26 µg/ml). Non-MDR isolates (78.6%) were more sensitive, with MICs of 10–25 µg/ml (mean: 15 ± 4.5 µg/ml) and MBCs of 25–50 µg/ml (mean: 35 ± 12 µg/ml), outperforming selenium precursors and vancomycin. SeNPs also showed antidiabetic potential through α-amylase inhibition (IC 50  = 50.32 µg/ml) and α-glucosidase inhibition (IC 50  = 31.55 µg/ml), though less effective than acarbose (IC 50  = 5.85 µg/ml and 3.93 µg/ml, respectively). In anti-inflammatory assays, SeNPs achieved dose-dependent hemolysis inhibition, with 96.0% inhibition at 1000 µg/ml and an IC 50 of 11.53 µg/ml, compared to indomethacin’s IC 50 of 4.51 µg/ml. These findings demonstrate the promising in vitro bioactivities of SeNPs synthesized from D. pinnata L. tuber extract and support their potential for further preclinical investigation.

Biochar represents carbon rich material product obtained from pyrolyzing biomass and has been postulated to enhance soil health and agricultural productivity. This study examined the effect of amending the soil with biochar on yield as well as the physical and chemical properties of Valencia oranges. A control (no biochar) (T1), biochar applied at 2.0 (T2), 4.0 (T3), and 6.0 (T4) kg/tree/year were among the treatments used in a field experiment. Results showed that, when compared to control, biochar significantly ( p  < 0.05) increased leaf nutrient content in terms of N, P, K, and total chlorophyll content of leaves. The effect was strongest at the highest application rate of 6 kg/tree/year (T4). Biochar treatments also enhanced physical properties of fruit; the most marked improvements again being observed in T4. Yield was observed to increase progressively with increased biochar application rates. In the first year, yield increases over control were 52.9% in T2, 69.0% in T3, and 73.3% in T4. For T2, T3, and T4, the corresponding increases in the second season were 47.7%, 59.9%, and 67.9%. Biochar application also improved fruit chemical properties. Therefore, it was demonstrated that biochar could be utilized as a significant soil amendment to enhance Valencia orange production by increasing the soil’s nutrient availability, increasing leaf chlorophyll content, fruit physical attributes, and ultimately fruit yield. In conclusion an application rate of biochar at the rate of 6 kg/tree/year is recommended for fulfilling the productivity of Valencia orange orchards.

Familial hypercholesterolemia (FH) is a common autosomal dominant disorder that can result in premature atherosclerotic cardiovascular disease (ASCVD). Limited data are available worldwide about the prevalence and management of FH. Here, we aimed to estimate the prevalence and management of patients with FH in five Arabian Gulf countries (Saudi Arabia, Oman, United Arab Emirates, Kuwait, and Bahrain). The multicentre, multinational Gulf FH registry included adults ([greater than or equal to]18 years old) recruited from outpatient clinics in 14 tertiary-care centres across five Arabian Gulf countries over the last five years. The Gulf FH registry had four phases: 1- screening, 2- classification based on the Dutch Lipid Clinic Network, 3- genetic testing, and 4- follow-up. Among 34,366 screened patient records, 3713 patients had suspected FH (mean age: 49±15 years; 52% women) and 306 patients had definite or probable FH. Thus, the estimated FH prevalence was 0.9% (1:112). Treatments included high-intensity statin therapy (34%), ezetimibe (10%), and proprotein convertase subtilisin/kexin type 9 inhibitors (0.4%). Targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol were achieved by 12% and 30%, respectively, of patients at high ASCVD risk, and by 3% and 6%, respectively, of patients at very high ASCVD risk (p <0.001; for both comparisons). This snap-shot study was the first to show the high estimated prevalence of FH in the Arabian Gulf region (about 3-fold the estimated prevalence worldwide), and is a \"call-to-action\" for further confirmation in future population studies. The small proportions of patients that achieved target LDL-C values implied that health care policies need to implement nation-wide screening, raise FH awareness, and improve management strategies for FH.

The current study estimated the in vitro anti-inflammatory activity and in vivo anti-arthritic activities of the aqueous ethanolic extract of Ximenia caffra ( X. caffra ) seeds extract. It was hypothesized that X. caffra seeds extract, rich in phytochemicals that could modulate inflammatory pathways and protect joint tissues in an antigen-induced arthritis rat model. The chemical composition of X. caffra seeds extract was examined using liquid chromatography high-resolution mass spectrometry (LC-HRMS). Ximenia caffra seeds extract showed promising in vitro anti-inflammatory activity with an IC 50  = 26.01 ± 0.85 µg/ml. To evaluate in vivo efficacy, antigen-induced arthritis was established in rats using Complete Freund’s Adjuvant (CFA), followed by subcutaneous administration of X. caffra extract at doses of 26, 50, and 100 mg/kg body weight, alongside a standard drug control [Methotrexate (MTX), 0.3 mg/kg] in separate groups of animals. Anti-arthritic effects were assessed by measuring joint diameter, arthritic score, body weight, and through histopathological and ultrastructural analyses of joint and muscle tissues as well as osteoclast assessment, cytokine analyses, renal and kidney functions. The optimal dose (26 mg/kg) significantly alleviated arthritis symptoms, restoring joint and muscle morphology toward normal architecture. Ex vivo osteoclast evaluation and flow cytometric apoptosis analysis indicated that X. caffra extract promoted cellular recovery and reduced inflammatory damage. Furthermore, cytokine profiling demonstrated that treatment with X. caffra shifted pro-inflammatory mediators (IL-1β, IL-6, IL-17, IFN-γ) toward an anti-inflammatory balance by elevating IL-4 and regulating IgG1a/IgG2a ratios. Collectively, these results support the hypothesis that X. caffra seeds extract had potent anti-inflammatory and anti-arthritic effects by modulating immune responses and preserving joint integrity, suggesting its potential as a natural therapeutic alternative for rheumatoid arthritis management after further validation.

Purpose: Unplanned hospital readmission forms costly, but preventable burdens on healthcare system. This study was designed to evaluate cardiovascular-related readmission rate after discharge of acute coronary syndrome (ACS) patients and its relationship with medication adherence at a university hospital, Saudi Arabia. Methods: A total of 370 consecutive patients presenting with ACS were involved. The inclusion criteria were clinical and coronary angiography diagnostic data of ACS. Exclusion criteria included heart valve disease, myocarditis, hepatic disease, and history of acute infection during the previous two weeks. Patients were divided into index admission group (n = 291) and unplanned readmission group (n = 79). Readmission and medication adherence rates were evaluated during 1-30, 31-180, 181-365, and 366-548 days post-ACS discharge. Medication adherence was estimated with a (yes/no) questionnaire. Results: The overall readmission rate was 21.4%; individual rates were 30.4%, 38.0%, 27.8%, and 3.8% and the overall medication adherence rate was 62.03%, while individual rates were 54.2%, 70.0%, 63.6%, and 33.3% during the four periods, respectively. There were strong correlations between medication non-adherence and readmission rates. Heart failure, ST-elevated myocardial infarction, unstable angina, cerebrovascular accident, and arrhythmia represented the top causes. Body mass index was higher in readmission group. There were significant correlations between smoking, hypertension, cerebrovascular accident, ischemic heart disease, previous stent, instent restenosis, and LDL-cholesterol as predictor factors and readmission rate. Conclusion: The cardiovascular-related unplanned readmission rate post-ACS discharge was 21.4%, and medication non-adherence rate was 37.97%. There were strong correlations between them in the time frames from 1-month to 1.5-year post-discharge. The individual rates decreased by time, but the first month showed lower rates than the following 5 months and this indicated the role of factors other than medication non-adherence in readmission. The rates are generally consistent with the international levels but utilizing technology can further improve medication adherence and reduce readmission rates. Keywords: medication adherence, readmission rate, acute coronary syndrome, Saudi Arabia

Background Asthma is a chronic respiratory disease characterized by airway inflammation, leading to varying degrees of respiratory difficulties. Effective disease management depends on consistent medication adherence, which remains a significant challenge in Saudi Arabia. Objective This study aims to assess the level of adherence to asthma medications among patients in Al-Ahsa, Saudi Arabia, and identify factors contributing to non-adherence. Methods A cross-sectional study was conducted between may and July 2024, targeting asthma patients aged 18 years and older in Al-Ahsa. Participants were selected using a stratified random sampling technique from various geographic stria. Data were collected through structured phone interviews utilizing a validated questionnaire designed to assess adherence to medication refills. Descriptive statistics, chi-square tests, and multivariable logistic regression were used to identify factors associated with medication non-adherence. Results Only 39.3% of participants were adherent to their prescribed asthma medications, while 60.7% were non-adherent. Common reasons for non-adherence included stopping medications when feeling better (36.9%) and stopping medication due to side effects (20.4%). Female gender ( p =  0.021), higher income ( p =  0.034), being married ( p =  0.049), urban residence ( p =  0.001), and receiving medication support ( p <  0.001) were significantly associated with higher adherence. Multivariable regression showed that younger age (OR = 0.97; 95% CI: 0.95–0.98), male gender (OR = 1.76; 95% CI: 1.16–2.69), lower income (OR = 0.85; 95% CI: 0.75–0.97), and lack of medication support (OR = 0.06; 95% CI: 0.04–0.10) were independently associated with non-adherence. Conclusion Medication non-adherence is prevalent among asthma patients in Al-Ahsa and is influenced by demographic, socioeconomic, and healthcare-related factors. Interventions targeting support systems, education, and access may enhance adherence and improve asthma outcomes in this population.

There is an accelerating need for interprofessional education (IPE) in the Public Health field, as healthcare providers become diverse and multi-disciplinary. Public Health students with health education concentration at Qatar University are required to join training sessions in IPE before the start of their field experience, where students are placed in a variety of community-based and clinical settings including, but not limited to, primary healthcare. The goal of this qualitative research study is to understand health education students' experience in interprofessional care during their field experience in a primary healthcare setting and to highlight the successes and challenges. Participants were third-year health education students (N = 22) enrolled in the Public Health program at Qatar University who obtained their experiential learning in three different primary health care centers. Students' weekly reports reflecting on primary interprofessional care were included in the analysis for the purpose of this study. Following constant comparative techniques, thematic analysis was conducted on health education students' reports. Interprofessional care was witnessed and practiced by students in teamwork and collaboration for the benefit of the patient, communication among health care professionals and referral process and patient flow. Health education students understood their role in interprofessional care in the fields of behavior change, and patient education and empowerment. However, professionals and patients were not recognizing health educators' role and were not familiar with their contributions to interprofessional care in primary healthcare. Students suggested delivering interprofessional education for health care providers to enhance collaborative teamwork and promote knowledge about the evolving health education field among healthcare providers in Qatar. In addition, they recommended orienting their training supervisors about the goal of IPE-based practice in a primary healthcare setting. Interprofessional care was observed and practiced by health education students through collaborative teamwork, communication among health care professionals and management of patient flow. However, they faced challenges during their practice-based IPE. The findings can be tailored towards planning for interprofessional education workshops to boost collaboration progress among health care providers including health educators and supporting professionals interested to implement practice-based IPE in their placement curriculums.

Objectives To evaluate the impact of passive ultrasonic irrigation on the micro-tensile bond strength of two different self-etch adhesive systems, including a universal one-step adhesive and a two-step adhesive system, to pulp chamber dentine compared to conventional syringe irrigation. Methods Twenty-four extracted human mandibular first molar teeth were chosen according to strict criteria and mounted in epoxy resin blocks. Subsequently, the pulp chambers were exposed using an Isomet cutting machine. The specimens were numbered and assigned to four groups (6 teeth each) based on the canal irrigation method and the adhesive system used as follows: Conventional syringe irrigation in which a universal one-step self-etch adhesive system was applied (CSIU), conventional syringe irrigation in which a two-step self-etch adhesive system was used (CSIT), passive ultrasonic irrigation in which a universal one-step self-etch adhesive system was utilized (PUIU), and passive ultrasonic irrigation in which a two-step self-etch adhesive system was employed (PUIT). Following placement of the final restoration and submission to simultaneous thermo-mechanical cycling (artificial aging) equivalent to 6-month intra-oral aging, the teeth were sectioned and dentine/restoration beams were prepared. The micro-tensile bond strength was evaluated and the failure mode was defined, with a confirmatory evaluation of the dentine-resin interface using a scanning electron microscope. Statistical analysis was conducted using one-way ANOVA and Tukey’s post hoc tests to compare irrigation regimens for each adhesive technique independently, while failure modes of each adhesive system were represented as the frequency for each irrigation method. The significance level was set at 5%, with a confidence interval (CI) of 95%. Results The micro-tensile bond strength of composite resin restorations to pulp chamber dentine was reduced significantly with ultrasonic irrigation with more unfavorable failure modes compared to syringe irrigation ( P  < 0.0001), irrespective of the type of adhesive system used. The means of the micro-tensile strength for teeth treated with the two-step adhesive system were 26.1055 ± 4.7611 MPa and 16.0079 ± 3.7665 MPa for CSIT and PUIT, respectively. For teeth treated with the universal adhesive system, the mean for CSIU (20.1818 ± 3.8500 MPa) was significantly higher than that of PUIU (11.2090 ± 2.9928 MPa). The micro-tensile bond strength was significantly greater with the two-step adhesive system compared to the universal adhesive, regardless of the irrigation method ( p  < 0.05). An adhesive layer with varying thickness was noted in all groups, displaying distinct morphological features. Conclusions Within the limitations of the present laboratory investigation, ultrasonic irrigation may negatively affect the bond between composite resin restorations and pulp chamber dentine compared to conventional syringe irrigation. The two-step self-etch adhesive tended to achieve a stronger bond to pulp chamber dentine than the universal one-step self-etch adhesive. Clinical relevance While ultrasonic irrigation would be essential for effective root canal debridement and disinfection, it is imperative for clinicians to consider its potential adverse effects. This method may considerably impact the bond strength of composite resin restorations to the pulp chamber dentine, particularly when compared to conventional syringe irrigation. In root canal-treated teeth, a two-step self-etch adhesive system might be more effective in maximizing the bond strength to pulp chamber dentine than a universal adhesive system. However, these findings were concluded under the conditions of the present study and must be interpreted cautiously. Further research is recommended to validate these results and fully understand the clinical ramifications of ultrasonic irrigation on adhesive performance in different dental situations. Clinical trial number Non-applicable. Conducting the current experiment was limited to the approval of the local Research Ethics Committee at the Faculty of Dentistry, Minia University, Egypt (Committee No. 106, Registration No. 910, Date: April 30, 2024).