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As part of Saudi Vision 2030, the country's healthcare system is undergoing a significant makeover, with accessibility and effectiveness serving as the benchmarks for measuring patient care quality. This study's goal was to ascertain the degree of patient satisfaction with the medical care and services received in Riyadh's tertiary care facilities. The PSQ-18 (Patient Satisfaction Questionnaire-18), a standardized validated questionnaire including areas of “overall satisfaction,” “technical quality,” “interpersonal aspect,” “communication,” “financial aspect,” “time spent with the doctor,” and “accessibility and convenience,” was used in this cross-sectional study on 384 patients of two tertiary care facilities in Riyadh, Saudi Arabia, over a 6-month period. The degree to which sociodemographic characteristics and components of patient satisfaction are correlated was assessed using binary and multiple regression analysis. When the P-value was < 0.05, the results were considered significant and were presented as adjusted odds ratios (AOR). To ascertain how each PSQ-18 subscale affected other subscales, a Pearson Correlation analysis was conducted. The overall degree of satisfaction with all 18 items was 73.77%. The financial component received a rating of 81% compared to 77% for general satisfaction. Technical quality (75%) was followed by accessibility and convenience (73.5%), communication (73%), and interpersonal elements (72%). At 68%, the time spent in the doctor's domain received the lowest rating. The odds of satisfaction were increased by 3.87 times, 3.45 times, and 3.36 times among those who are employed, qualified by university education, and married compared to unemployed (P-value = 0.018), less qualified (P-value = 0.015) and singles (P-value = 0.026), respectively. The younger age group also made 1.78 times more of a difference in higher satisfaction ratings. The general satisfaction domain showed a positive association with other areas. Participants who were satisfied with the communication and accessibility and convenience domains of healthcare providers were the only ones who were typically satisfied with the domain of doctor time spent. The study's findings could act as a benchmark for Saudi Arabia's healthcare services as well as a starting point for quality assurance procedures.

Triple-negative breast cancer is a unique subtype among breast cancers. Management includes a neoadjuvant chemotherapy regimen. Psychiatric complications of the regimen have not been reported before. We present a case of acute psychosis after the second cycle of chemotherapy in a 42-year-old woman with triple-negative breast cancer. The patient presented with sudden irritability, agitation, disorganization in speech and behavior, and paranoia involving her coworkers conspiring against her and causing her trouble with the law for 4 days. She was in her usual state of health until after her second cycle of chemotherapy. This was the first presentation of psychotic symptoms in her life. She was conscious and oriented. There were no neurologic deficits. She denied any change in her mood and any features of hallucinations. She was uncooperative, restless, had flight of ideas, and persecutory delusions. The remainder of the examination was normal. An autoimmune process, nervous system infection, or psychosis secondary to the chemotherapy were suspected. Serum electrolytes and other biochemical parameters were normal. Imaging of the brain showed no signs of acute brain insults or intracranial metastasis. Cerebrospinal fluid analysis and culture showed no abnormality or growth. The work-up revealed that neurologic, infectious, or autoimmune causes of her psychotic symptoms were less likely. Thus, a diagnosis of psychosis secondary to chemotherapy was considered. Treatment was with paliperidone, risperidone, clonazepam, and sertraline. Over the course of treatment, she showed substantial improvement and completed all of the chemotherapy sessions without adverse effects. In summary, we report a case of a patient whose initial chemotherapy course was complicated by psychosis. Since the neurotoxic and psychiatric effects of chemotherapeutics are not yet sufficiently elucidated, our case emphasizes that early signs of behavioral changes in patients receiving chemotherapy should trigger comprehensive psychiatric evaluation and monitoring of the patient’s mental state.

May Bin-Jumah,1 Sadaf Jamal Gilani,2 Mohammed Asadullah Jahangir,3 Ameeduzzafar Zafar,4 Sultan Alshehri,5,6 Mohd Yasir,7 Chandra Kala,8 Mohamad Taleuzzaman,8 Syed Sarim Imam5 1Biology Department, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 2Department of Basic Health Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 3Department of Pharmaceutics, Nibha Institute of Pharmaceutical Sciences, Rajgir, Nalanda 803116, Bihar, India; 4Department of Pharmaceutics, College of Pharmacy, Jouf University, Sakaka, Aljouf, Saudi Arabia; 5Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 6College of Pharmacy, Almaarefa University, Riyadh, Saudi Arabia; 7Department of Pharmacy, College of Health Science, Arsi University, Asella, Ethiopia; 8Faculty of Pharmacy, Maulana Azad University, Jodhpur 342802, Rajasthan, IndiaCorrespondence: Sadaf Jamal GilaniDepartment of Basic Health Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi ArabiaEmail gilanisadaf@gmail.comSyed Sarim ImamDepartment of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaEmail sarimimam@gmail.comPurpose: The topically administered drugs through conventional delivery systems have low bioavailability. Henceforth, the present study was designed to prepare and optimize clarithromycin (CTM)-loaded chitosan nanoparticles (CHNPs) to demonstrate the efficacy against microorganisms.Methods: Clarithromycin-loaded chitosan nanoparticles (CTM-CHNPs) were prepared by ionotropic gelation method. The formulation was optimized by box-Behnken design using the formulation variables like CH (A), STPP concentration (B), and stirring speed (C). Their effects were evaluated on the independent variables like particle size (Y1) and entrapment efficiency (Y2). Further, CTM-CHNPs were evaluated for physicochemical parameters, in-vitro drug release, ex-vivo permeation, bioadhesive study, corneal hydration, histopathology, HET-CAM, and antibacterial study.Results: The optimized formulation (CTM-CHNPopt) showed the low particle size (152± 5 nm), which is desirable for ocular delivery. It also showed high encapsulation (70.05%), zeta potential (+35.2 mV), and was found in a spherical shape. The drug release study revealed a sustained drug release profile (82.98± 3.5% in 12 hours) with Korsmeyer peppas kinetic (R2=0.996) release model. It showed a 2.7-fold higher corneal permeation than CTM-solution. CHNPs did not exhibit any sign of damage to excised goat cornea, which is confirmed by hydration, histopathology, and HET-CAM test. It exhibited significant (P< 0.05) higher antibacterial susceptibility than CTM-solution.Conclusion: The finding of the study concluded that CTM-CHNPs can be used for effective management of bacterial conjunctivitis by increasing the precorneal residence time.Keywords: clarithromycin, chitosan, optimization, nanoparticles, HET-CAM, antimicrobial assessment

Bader B Alsulays,1 Md Khalid Anwer,1 Gamal A Soliman,2,3 Sultan M Alshehri,4 El-Sayed Khafagy1,5 1Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; 2Department of Pharmacology, College of Veterinary Medicine, Cairo University, Cairo 12211, Egypt; 3Department of Pharmacology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia; 4Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 5Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Suez Canal University, Ismailia 415-22, EgyptCorrespondence: El-Sayed KhafagyDepartment of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, PO Box 173, AlKharj 11942, Saudi ArabiaTel +966 533564286Fax +966 115886001Email e.khafagy@psau.edu.saPurpose: This study evaluated the stereoisomeric effect of L- and D-penetratin—cell-penetrating peptides (CPPs)—incorporated insulin-loaded solid lipid nanoparticles (INS-SLNs) on the bioavailability (BA) of oral insulin (INS).Methods: Insulin-loaded solid nanoparticles, L-penetratin-INS-SLNs (LP-INS-SLNs), and D-penetratin-INS-SLNs (DP-INS-SLNs) were formulated by double emulsification. The developed SLNs were evaluated for particle size, zeta potential (ZP), and drug encapsulation and subjected to differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), and evaluated for stability against enzymatic degradation in rat intestinal fluid. Finally, the SLNs were administered to rats to evaluate the BA of INS-SLNs that contained L- and D-penetratin.Results: The mean particle size, PDI, and ZP values of INS-SLNs, LP-INS-SLNs, and DP-INS-SLNs ranged from 618.5 to 973.0 nm, 0.227 to 0.734, and −17.0 to −23.7 mV, respectively. The encapsulation efficiency (%EE) and drug loading (%DL) of INS-SLNs, LP-INS-SLNs, and DP-INS-SLNs ranged from 59.03% to 67.42% and from 1.62% to 1.82%, respectively. Differential scanning calorimetry and FTIR analyses indicated that INS was successfully encapsulated in SLNs. Enzymatic degradation of DP-INS-SLNs was slower in intestinal fluid, and the half-life (t1/2) was significantly prolonged, compared to all other SLNs. The pharmacological availability (PA) and BA of orally administered LP-INS-SLNs, which were the most effective SLNs, were 13.1% and 15.7% relative to s.c. administration, respectively.Conclusion: Penetratin stereochemistry significantly impacted oral BA of INS-SLNs, which are promising carriers for oral INS administration.Keywords: cell-penetrating peptides, penetratin, stereochemistry, solid lipid nanoparticles, enzymatic degradation, oral insulin bioavailability

A Thesis Submitted to the Faculty of Graduate Studies and Research In Partial Fulfillment of the Requirements For the Degree of Doctor of Philosophy in Engineering, University of Regina. xvii, 340 p. Extreme Programming (XP) is one of the most successful methods in software development. It offers a set of practices designed to work together in order to provide value to the customer. The XP process emphasizes simplicity, feedback, and encouragement among team members. During the XP lifecycle, developers and customers regularly encounter situations in which they need to make decisions or evaluate factors that will affect the development process and team productivity. The Analytic Hierarchy Process (AHP) can analyze complex decisions and help accomplish XP values and fulfill team needs. This research describes a framework for the application of AHP to XP to resolve conflict and evaluate influential factors by structuring the decision making process. AHP seems promising for use in XP for the effective resolution of conflict and the achievement of effective decisions during the software development process. In this research, more than 10 areas related to XP practices that could benefit from the AHP technique are elaborated upon. Planning game, simple design, metaphor, pair programming, refactoring, and testing are some XP practices whose quality depends on decisions, and thus are ideally suited for AHP. First, in the planning game, two areas were investigated: prioritizing the user stories and ranking the prioritization techniques. Second, AHP explored two areas in the XP simple design practice: selecting the best simple design tool for the XP team and prioritizing the CRC cards as a common simple design tool. Third, in the pair programming practice, AHP was used for two purposes: selecting the best matching pairs and deciding if the pairs should have the same characteristics or be different. Fourth, in the practice of refactoring, AHP was used to rank the refactoring techniques based on the internal and external quality attributes. Fifth, the AHP was applied to help make decisions about the level of automated testing and ranking the software release indicators. The AHP is a structure technique based on mathematical models that analyzes various tangible and intangible attributes in order to accomplish a specific goal. It has been applied in numerous fields and many engineering applications. The AHP provides a framework that structures decision problems in order to provide mathematical judgments built on knowledge and experience. AHP has been very useful in software development, where complex decisions occur routinely, and especially useful for unstructured or light processes, like agile processes. The overall results show that in the XP environment, AHP received positive feedback from all participants in terms of the quality of the decisions, team performance and communication, and user satisfaction. A Thesis Submitted to the Faculty of Graduate Studies and Research In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy *, University of Regina. *, * p. Student yes