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Mahmoud M Habibullah,1,2 Syam Mohan,3,4 Nabeel Kashan Syed,5 Hafiz A Makeen,5 Qazi Mohammad Sajid Jamal,6 Hani Alothaid,7 Farkad Bantun,8 Alaa Alhazmi,1,2 Ali Hakamy,2,9 Yahia A Kaabi,1 Ghalia Samlan,10 Mohtashim Lohani,11 Neelaveni Thangavel,12 Mohamed Ahmed Al-Kasim5 1Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2SMIRES for Consultation in Specialized Medical Laboratories, Jazan University, Jazan, Saudi Arabia; 3Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia; 4School of Health Science, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India; 5Pharmacy Practice Research Unit, Department of Clinical Pharmacy, Faculty of Pharmacy, Jazan University, Jazan, Saudi Arabia; 6Department of Health Informatics, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah, Saudi Arabia; 7Department of Basic Sciences, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia; 8Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 9Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 10Department of Food Science and Nutrition, College of Food and Agriculture Sciences, King Saud University, Riyadh, Saudi Arabia; 11Emergency Medical Services Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 12Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jazan University, Jazan, Saudi ArabiaCorrespondence: Mahmoud M Habibullah, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Al Maarefah Road, Jazan, Saudi Arabia, Tel +966 556644205, Email mhabibullah@jazanu.edu.saIntroduction: Numerous drugs with potent toxicity against cancer cells are available for treating malignancies, but therapeutic efficacies are limited due to their inefficient tumor targeting and deleterious effects on non-cancerous tissue. Therefore, two improvements are mandatory for improved chemotherapy 1) novel delivery techniques that can target cancer cells to deliver anticancer drugs and 2) methods to specifically enhance drug efficacy within tumors. The loading of inert drug carriers with anticancer agents and peptides which are able to bind (target) tumor-related proteins to enhance tumor drug accumulation and local cytotoxicity is a most promising approach.Objective: To evaluate the anticancer efficacy of Chitosan nanoparticles loaded with human growth hormone hGH fragment 176– 191 peptide plus the clinical chemotherapeutic doxorubicin in comparison with Chitosan loaded with doxorubicin alone.Methods: Two sets of in silico experiments were performed using molecular docking simulations to determine the influence of hGH fragment 176– 191 peptide on the anticancer efficacy of doxorubicin 1) the binding affinities of hGH fragment 176– 191 peptide to the breast cancer receptors, 2) the effects of hGH fragment 176– 191 peptide binding on doxorubicin binding to these same receptors. Further, the influence of hGH fragment 176– 191 peptide on the anticancer efficacy of doxorubicin was validated using viability assay in Human MCF-7 breast cancer cells.Results: In silico analysis suggested that addition of the hGH fragment to doxorubicin-loaded Chitosan nanoparticles can enhance doxorubicin binding to multiple breast cancer protein targets, while photon correlation spectroscopy revealed that the synthesized dual-loaded Chitosan nanoparticles possess clinically favorable particle size, polydispersity index, as well as zeta potential.Conclusion: These dual-loaded Chitosan nanoparticles demonstrated greater anti-proliferative activity against a breast cancer cell line (MCF-7) than doxorubicin-loaded Chitosan. This dual-loading strategy may enhance the anticancer potency of doxorubicin and reduce the clinical side effects associated with non-target tissue exposure.Keywords: anticancer potency, nanoparticles, cytotoxicity, docking analysis

Mahmoud M Habibullah,1,2 Ali Hakamy,3 Abdullah S Mansor,1 Ibrahim Mohammed Atti,4 Abbas Ali Jaber Alwadani,4 Yahia A Kaabi1,2 1Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Medical Research Center, Jazan University, Jazan, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 4Department of Laboratory and Blood Bank, Prince Mohammed bin Nasser Hospital, Ministry of Health, Jazan, Saudi ArabiaCorrespondence: Mahmoud M Habibullah, Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia, Tel +966556644205, Email mhabibullah@jazanu.edu.saIntroduction: Autoimmune hypothyroidism (AHT) is a widespread disease that disproportionately affects women over men. It is characterized by the presence of autoantibodies that lead to the dysfunction of the thyroid gland. The exact cause of this process is unknown; however, some factors, such as genetic factors, may be to blame. The uncoupling protein 2 (UCP2) gene encodes uncoupling protein 2, which has been linked to several pathogeneses; however, the link between UCP2-866 G/A polymorphism and AHT has yet to be investigated. Thus, we investigate the potential relationship between UCP2-866 G/A polymorphism and AHT.Methods: A total of 158 subjects participated in this study, they were either control or AHT patient, and genotyping was performed using a polymerase chain reaction.Results: The frequencies of UCP2-866 G/G, G/A, and A/A in the control subject were 34%, 51%, and 15%, respectively, whereas these frequencies in the AHT were 43%, 46%, and 10%.Conclusion: The study concludes a significant relationship between UCP2-866 G/A polymorphism and AHT, with a carrier subject of the – 866 A allele being 3 times more likely to suffer from AHT than wild-type carriers in the study population.Keywords: autoimmune hypothyroidism, AHT, uncoupling protein 2, UCP2-866, Hashimoto׳s thyroiditis

Background: Effectiveness and safety of Resistance Training in treating various Cerebrovascular Disease diagnoses have drawn attention in recent years. Patients suffering with coronary artery disease should be offered individually tailored Resistance Training in their exercise regimen. Resistance Training was developed to help individuals with their functional status, mobility, physical performance, and muscle strength. Objective: The objective of this review was to collect, summarize and present information on the state of science focusing on usefulness, viability, safety and efficacy of Resistance Training in treating coronary artery disease and enhancing the aerobic capacity and improving overall health-related quality of life. Methods: The review is prepared in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Searches were conducted in Cochrane Library, PubMed/MEDLINE, PEDro and Scopus database. PEDro scale was used for methodological quality assessment of included studies. Two independent reviewers determined the inclusion criteria of studies by classifying interventions based on core components, outcome measures, diagnostic population and rated the quality of evidence and strength of recommendations using GRADE criteria. Results: Total 13 studies with 1025 patients were included for the detailed analysis. Findings emphasize the importance of assessing effectiveness and safety of Resistance Training in individuals with coronary artery disease. Patient specific designed exercise programs as Resistance Training targets at enhancing patients’ exercise tolerance, improves hemodynamic response and muscular strength with reduction in body fat composition. Conclusion: Resistance Training is an effective exercise that should be incorporated to counteract the loss of muscle strength, muscle mass, and physiological vulnerability, as well as to combat the associated debilitating effects on physical functioning, mobility and overall independence and Quality of Life during rehabilitation of patients with coronary artery disease.

Vitamin D has a pivotal role in maintaining healthy bones and in the modulation of multiple physiologic processes. Vitamin D deficiency has become a global burden that affects all members of society. This study aimed to investigate the prevalence and correlation of vitamin D deficiency with hematological and biochemical parameters in young adult college students. Hundred and fourteen students (77 men and 37 women) were recruited.The socio-demographic and clinicopathologic features of the students were evaluated using a pre-tested and validated questionnaire, and samples were collected for complete blood count (CBC), vitamin D, calcium, parathyroid hormone, and phosphorus measurements.Vitamin D deficiency was more prevalent in men (53.2%) than in women (48.7%). Calcium and parathyroid hormone levels were within the normal range, and 26% and 22% of male and female participants, respectively, had low phosphorus levels. Vitamin D showed a positive correlation with calcium in men (r=0.3927;Vitamin D deficiency is very prevalent among college students, therefore health education and public awareness campaigns on the consequences of vitamin D deficiency on health and well-being are required.

Background Pneumocystis pneumonia (PCP) is a fatal infectious disease caused by Pneumocystis jirovecii (PJP). The major factor relevant to morbidity and mortality seems to be the host inflammatory reaction. The objective of this study was to evaluate the role of IL-2, IL-4, IL-10, and IL-13 cytokine mRNA expression among suspected P. jirovecii infection. Methods This was a cross-sectional analytical study undertaken in Aseer region, Saudi Arabia. One hundred suspected PCP cases and 100 healthy controls were included in the study. Basic clinical manifestations, radiological findings, microbiological and immunological findings were extracted from the hospital records from January 2019 to August 2019, Pneumocystis detection was done by immune-fluorescent staining (IFAT, Gomorimethanamine silver staining (GMSS), Giemsa staining, Toluidine blue O (TBO), and Pneumocystis RT-PCR. Results Increased more than 5 fold, 3 fold, 4 fold, and 7 fold of IL-2, IL-4, IL-10, and IL-13 mRNA expression were observed in PCP cases compared to controls. Higher expression of IL-2 mRNA was connected with crept, wheezing and chest X-ray findings like central perihilar infiltrate, patchy infiltrate, consolidation, hilar lymphadenopathy, pneumothorax, pleural effusion which showed higher expression compared to counterpart (pp=0.002), dyspnea (p=0.003), crept (p=0.01), and chest X-ray findings (p Conclusion Confirmed cases of P. jirovecii showed higher IL-2, IL-4, IL-10, and IL-13 mRNA expression comparatively to negative cases. Increased expression of cytokines may be indicative of infection severity and could help in patients’ management.

Known for its high nutritional and medicinal value, okra (Abelmoschus esculentus) is commonly used for replacing plasma and expanding blood volume in humans. It is a major economic crop cultivated in tropical and subtropical regions worldwide. The present study aimed to investigate and evaluate the nutritional properties and prospective applications of the consumable parts of okra. The total ash content (mineral content), carbohydrate, crude fiber, fat, protein, and moisture fractions of okra pod aqueous extract were determined. The results show that okra aqueous extract contained 84.670–87.650% moisture, 1.514–1.197% ash, 7.857–8.261% carbohydrate, 2.367–3.410% crude protein, and 6.781–8.314% crude fiber. Okra was determined to have high nutritional value, with γ-tocopherol and α-tocopherol contents about 2.67 mg/100 g and 1.62 mg/100 g, respectively. High-performance liquid chromatography (HPLC) was performed to determine the sugars present in okra aqueous extract. The water-soluble polysaccharide content was 10.22–16.45 g/100 g. The tested aqueous extract was a rich source of total phenolic compounds in gallic acid equivalents (288.2–3426.2 mg/100 g), chlorophyll a (3.53 mg/100), chlorophyll b (2.43 mg/100), and carotenoids (1.3 mg/100 g). The detected minerals were Ca, Mg, Cu, Zn, Fe, K, Na, and Mn. Atomic absorption spectrometry analysis of these ashed minerals was performed. In addition to the nutritional benefits, okra pods exhibited antimicrobial, anticancer, and antioxidant properties. The aqueous extract was found to be potentially active against bacterial strains of Staphylococcus aureus (MIC value = 21.8 mg/mL), Escherichia coli (MIC value = 18.7 mg/mL), Bacillus cereus (MIC value = 20.7 mg/mL), and Klebsiella pneumoniae (MIC value = 20.2 mg/mL). Okra aqueous extract exhibited inhibitory activity against α-amylase (IC50 = 120 µg/mL) and α-glucosidase (IC50 = 115 µg/mL). The okra extract exhibited high anticancer activity, concentration-dependent and with an IC50 value of about 158.3 mg/mL. The results indicated that okra pods have nutritional and medicinal properties and, hence, can be used as a functional food and broad-spectrum nutraceutical supplement.

Abdullah A Mobarki,1 Gasim Dobie,1 Muhammad Saboor,1,2 Aymen M Madkhali,1 Mohammad S Akhter,1 Ali Hakamy,3 Adel Humran,4 Yousof Hamali,5 Denise E Jackson,6 Hassan A Hamali1 1Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia; 2Medical Research Center, Jazan University, Gizan, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia; 4Respiratory Care Department, King Fahad Central Hospital, Gizan, Saudi Arabia; 5Radiodiagnostics and Medical Imaging Department, Prince Sultan Medical City, Riyadh, Saudi Arabia; 6Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology (RMIT) University, Bundoora, VIC, AustraliaCorrespondence: Hassan A HamaliDepartment of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, P.O. Box 1906, Gizan, 45142, Saudi ArabiaTel +966581155585Email hhamali@jazanu.edu.saObjective: The aims of the current study were to evaluate the importance of MPR and NLR as prognostic markers in ICU-admitted COVID-19 patients and to investigate the impact of COVID-19 on hematological and coagulation parameters in patients from Jazan region of Saudi Arabia.Methods: This retrospective study was conducted between October 2020 and January 2021 at King Fahad Central Hospital, Jazan region. Medical files, which included the results of complete blood count (CBC), calculated mean platelet volume to platelet count ratio (MPR) and neutrophils-to-lymphocytes ratio (NLR) parameters, coagulation profile and D-dimer test, of 96 (64 male and 32 female) COVID-19-infected patients admitted to the intensive care unit were reviewed. Associations between the test results and COVID-19 infection outcomes (discharged [DC] or passed away [PA]) were measured.Results: The results of the current study demonstrate overall significant differences in CBC parameters between PA group as compared to DC group (P < 0.05). The PA group had a significantly elevated MPR (10.15± 12.16 vs 4.04± 1.5; P < 0.01) and NLR (18.29± 19.82 vs 7.35± 9.68; P < 0.01) as compared to the DC group, suggesting an association between these parameters and mortality. Odds ratios analysis also showed that adjustment for demographic variables and comorbidities did not weaken the observed association.Conclusion: Elevated MPR and NLR are associated with poor prognosis in COVID-19 patients and could be useful as therapy management indicators.Keywords: COVID-19, NLR, MPR, ICU, CBC, mortality

Asthma affects a large number of people worldwide and is characterized by chronic allergic airway inflammation. Anatabine is a natural alkaloid that is structurally similar to nicotine and found in the Solanaceae family of plants, with anti-inflammatory properties. Consequently, this study aimed to evaluate the potential therapeutic effect of anatabine against asthma.Ovalbumin was used to induce asthma in rats. Two asthmatic groups were treated with low and high doses of anatabine.Asthmatic animals experienced increased total leukocyte count and inflammatory cytokines in bronchoalveolar lavage fluid (BALF), bronchitis, and bronchopneumonia associated with mast cell infiltration. Additionally, inducible nitric oxide synthase immunostaining was observed, with decreased pulmonary antioxidant capacity and enzymes and decreased Nrf2 and HO-1 gene expression while increased NFκB-P65 expression. Interestingly, asthmatic animals treated with anatabine at both doses showed dose-dependently decreased inflammatory cells and cytokine levels within BALF reduced inflammation in the airways through decreased mast cell infiltration within lung tissues and increased antioxidant enzymes and Nrf2 and Ho-1 expression levels.Our results highlight the potential beneficial effect of anatabine against asthma through anti-inflammatory and antioxidant mechanisms. Therefore, anatabine is a promising candidate for pulmonary asthma treatment.

Ali Hakamy,1,2 Tricia M McKeever,2 Michael C Steiner,3 C Michael Roberts,4 Sally J Singh,3 Charlotte E Bolton1 1Nottingham Respiratory Research Unit, NIHR Nottingham Biomedical Research Centre, 2Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, 3Leicester Respiratory Biomedical Research Unit, Institute for Lung Health, University Hospitals of Leicester NHS Trust, Leicester, 4Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK Abstract: Our aim was to evaluate the use and impact of the practice walk test on enrolment, completion, and clinical functional response to pulmonary rehabilitation (PR) using the 2015 UK National Chronic Obstructive Pulmonary Disease (COPD) Pulmonary Rehabilitation audit data. Patients were assessed according to whether a baseline practice walk test was performed or not. Study outcomes included use of the practice walk test, baseline and change in incremental shuttle walk test distance (ISWD) or 6-minute walk test distance (6MWD), and enrolment to and completion of PR program. Of 7,355 patients, only 1,666 (22.6%) had a baseline practice test. At baseline, the practice walk test group walked further as compared to the no practice walk test group: ISWD, 17.9m [95% confidence interval (CI) 8.2–27.5m] and 6MWD, 34.8m (95% CI 24.7–44.9m). The practice walk test group were 2.2 times (95% CI 1.8–2.6) more likely to enroll and 17% (95% CI 1.03–1.34) more likely to complete PR. Although the change in ISWD and 6MWD with PR was lower in the practice walk test group, they walked further at discharge assessment. Only 22.6% of the patients in the 2015 National PR audit had a practice walk test at assessment. Those who did had better enrolment, completion, and better baseline walking distance, from which the prescription is set. Keywords: pulmonary rehabilitation, COPD, functional performance test, functional exercise test

A matched cohort study was conducted to determine the incidence of falls in patients following a diagnosis of COPD using a UK primary care database. 44 400 patients with COPD and 175 545 non-COPD subjects were identified. The incidence rate of fall per 1000 person-years in patients with COPD was higher (44.9; 95% CI 44.1 to 45.8) compared with non-COPD subjects (24.1; 95% CI 23.8 to 24.5) (P

Objectives: To evaluate the impact of pulmonary rehabilitation on survival and fall (including balance) in patients with chronic obstructive pulmonary disease (COPD) at stability. Design: Systematic Review. Methods: OVID, MEDLINE, EMBASE, and Cochrane Collaboration Library were searched for literature dating from January 1980 up to November 2014 as well as an update in October 2015. Two reviewers screened titles, abstracts and full text records, extracted data and assessed studies for risk of bias; any disagreements were resolved by a third member of the team, and consensus was always sought. Results: Initial searches yielded 3216 records but after review, only 7 studies were included and no studies focused solely on falls. Two cohort studies found some positive benefits of pulmonary rehabilitation on balance but the results were inconsistent across the studies. Regarding survival, two randomised controlled trials were conducted; one study showed significant survival benefit at 1 year while the other one showed non-significant survival benefit at 3 years. Neither were adequately powered and in both, survival was a secondary outcome. Conclusions: There was only limited inconclusive evidence to show that pulmonary rehabilitation has a significant beneficial effect on balance or survival.

BACKGROUND: Pulmonary Rehabilitation (PR) is recommended for patients with COPD who are functionally limited with an MRC score of three or worse. OBJECTIVE: To examine the demographic and clinical parameters of patients with COPD in relation to PR; using The Health Information Network (THIN) primary care database in UK from 1 January 2004 to 31 December 2011. METHOD: We identified patients with COPD and divided them into two groups depend on if they have recorded PR or not. RESULT: Recording of PR increases gradually since 2004 across the UK; of the 27,388 patients; only 2,964 patients (10.8%) have recorded PR on at least one occasion. Those who had PR were more likely to be younger at diagnosis, higher socio-economic status, worse MRC score, a current smoker, and have a higher level of comorbidity; however gender was not associated with a recording of PR. Furthermore, of those patients with MRC score of three or worse recorded at any point of time, only 18.6% had a recording of PR on at least one occasion. CONCLUSION: Despite the effectiveness of PR for COPD; it is not recorded for the majority of patients with COPD.

The aim of this study is to conduct a systematic review of published studies that evaluate the impact of pulmonary rehabilitation (PR) on survival and fall (including balance) in patients with chronic obstructive pulmonary disease at stability. OVID, Medline, EMBASE, and Cochrane collaboration library were searched for literature dating from January 1980 up to November 2014 as well as an update in October 2015. Two reviewers screened titles, abstracts and full text records, extracted data, and assessed studies for risk of bias; any disagreements were resolved by a third member of the team, and consensus was always sought. Initial searches yielded 3216 records but after review only seven studies were included and there were no studies focused solely on falls. Two cohort studies found some positive benefits of PR on balance, but the results were inconsistent across the studies. Regarding survival, two randomized controlled trials were conducted; one study showed significant survival benefit at 1 year, while the other one showed nonsignificant survival benefit at 3 years. Neither were adequately powered and in both, survival was a secondary outcome. There was only limited inconclusive evidence to show that PR has a significant beneficial effect on balance or survival.

Current public policy does not reflect health risk awareness associated with hookah smoking. Although, cigarette smoking has gained considerable attention accompanied by public restrictions, hookah smoking continues to increase as an unrestricted, socially acceptable means of recreation. This study identified novel biomarkers altered by hookah smoking compared to cigarette smoking using exhaled breath condensate collected from nonsmokers, hookah smokers and cigarette smokers pre and post smoking. Both cigarette and hookah smokershad higher levels of inflammatory mediators suggestive of inflammasome activation as well as altered expression of miR-217 and miR-17, which are known to regulate inflammasome activation and promote oncogenesis. Toassess current public knowledge of risk factors and behaviors associated with hookah smoking, and if knowledge of hookah dangers would influence smoking behaviors, the experimental data were integrated into a survey emphasizing cancer risk associated with hookah smoking. Survey results indicated that 70% of study participants were encouraged to abstain from hookah smoking after gaining knowledge of cancer risk associated with hookah. The identification of behaviors associated with hookah smoking and novel biomarkers of health risk may influenceits public health regulation and facilitate community health education.

Pulmonary rehabilitation is recommended for patients with COPD to improve physical function, breathlessness and quality of life. Using The Health Information Network (THIN) primary care database in UK, we compared the demographic and clinical parameters of patients with COPD in relation to coding of pulmonary rehabilitation, and to investigate whether there is a survival benefit from pulmonary rehabilitation. We identified patients with COPD, diagnosed from 2004 and extracted information on demographics, pulmonary rehabilitation and clinical parameters using the relevant Read codes. Thirty six thousand one hundred and eighty nine patients diagnosed with COPD were included with a mean (SD) age of 67 (11) years, 53% were male and only 9.8% had a code related to either being assessed, referred, or completing pulmonary rehabilitation ever. Younger age at diagnosis, better socioeconomic status, worse dyspnoea score, current smoking, and higher comorbidities level are more likely to have a record of pulmonary rehabilitation. Of those with a recorded MRC of 3 or worse, only 2057 (21%) had a code of pulmonary rehabilitation. Survival analysis revealed that patients with coding for pulmonary rehabilitation were 22% (95% CI 0.69–0.88) less likely to die than those who had no coding. In UK THIN records, a substantial proportion of eligible patients with COPD have not had a coded pulmonary rehabilitation record. Survival was improved in those with PR record but coding for other COPD treatments were also better in this group. GP practices need to improve the coding for PR to highlight any unmet need locally., Chronic lung disease: Rolling out the rehab Analysis of recent UK data suggests that more patients with chronic lung disease could benefit from lung rehabilitation programmes. During pulmonary rehabilitation (PR), patients with chronic obstructive pulmonary disease (COPD) work with specialists to learn exercises and optimise breathing techniques. The programmes are recommended under current guidelines, particularly for patients with a high breathlessness score. Despite this, when Charlotte Bolton and co-workers at the University of Nottingham analysed 36,189 patient primary care records gathered since 2004, they found only 9.8% of COPD patients had ever had a coded record of being assessed, referred for, or undertaken PR. Those patients who completed PR were 22% less likely to die that those who didn’t, although appeared they had also received better overall COPD care. Current smokers, those suffering from co-morbidities and younger patients were more likely to receive PR than other patient groups.