New Emirates Medical Journal - Volume 5, Issue 1, 2024

Olanzapine is an atypical antipsychotic drug for treating bipolar disorders and Schizophrenia. Regardless of being used as a common antipsychotic drug, there are reports of hepatic abnormalities caused by using Olanzapine. Silymarin and Vitamin C have been shown to have hepatoprotective effects.

The purpose of the present study was to study the hepatotoxic effects of Olanzapine and the hepatoprotective role of Silymarin and Vitamin C on the Liver of Albino rats.

The study was conducted on 24 albino rats. The animals were randomly divided into four groups of six rats each: Group A consisted of six rats and served as the control group; Group B consisted of six rats who received orally 4mg/kg of Olanzapine daily; Group C consisted of six rats who received 4mg/kg of Olanzapine plus 200mg/kg of Silymarin daily and Group D consisted of six rats which received orally 4mg/kg of Olanzapine plus 15mg/kg of Vitamin C daily. The animals were sacrificed in two sittings at four and eight weeks, and tissues were processed by routine histopathological technique. The liver enzymes (AST, ALP, ALT) were calculated and analyzed statistically using one-way ANOVA.

It was found that the liver of rats treated with Olanzapine showed sinusoidal dilatation, sinusoidal congestion, central venous congestion, central venous dilatation, cellular infiltration, and portal triaditis. The liver enzymes (AST, ALP, ALT) were markedly raised in the drug-treated rats, showing Olanzapine as a hepatotoxic agent. On the other hand, Silymarin and Vitamin C) both proved to show an excellent hepatoprotective effect.

Olanzapine administration causes histopathological and biochemical abnormalities in the liver. Vitamin C and Silymarin are both potent hepatoprotective agents against Olanzapine-induced hepatic toxicity.

Cardiomyopathies are a broad range of cardiac illnesses defined by mechanical and/or electrical dysfunction and abnormal ventricular hypertrophy or dilatation. Cardiomyopathies are classified into two categories: either primarily related to myocardial disease or secondary to other systemic or organ disorders, including the thyroid gland. Thyroid hormones have been linked to a wide range of significant effects on the cardiovascular system.

We experienced a case of a 37-year-old male who presented with symptoms of heart failure and was discovered to have dilated cardiomyopathy. The echocardiography study revealed significant left ventricular global hypokinesia and severely depressed left ventricular systolic function. The laboratory testing confirms the presence of severe normocytic, normochromic anemia with severe hypothyroidism.

The present case illustrates that hypothyroidism should be addressed systematically by healthcare providers when dilated cardiomyopathy is identified, and thyroid function testing should be regularly performed.

The Enhanced Recovery After Surgery (ERAS) program is a multidisciplinary approach aimed at minimizing postoperative complications, shortening hospital stays, and improving clinical outcomes. The current study assesses the knowledge, attitudes, and practices (KAP) of nurses and anesthesia technicians regarding the ERAS program, which is essential for evaluating their understanding and readiness to implement the program, as well as identifying factors influencing the successful adoption of ERAS in clinical practice.

The cross-sectional study involved nurses and anesthesia technicians with at least two months of experience at the University Medical Center in Ho Chi Minh City, Vietnam. A validated questionnaire assessed their KAP regarding the ERAS program. Data were collected via electronic surveys during ERAS group meetings and analyzed with Stata 16.0. The Wilcoxon and Kruskal-Wallis tests compared qualitative variables, while Spearman regression identified relationships between quantitative variables.

Among the 193 nurses and anesthesia technicians, knowledge and attitude scores towards the ERAS program were highly rated, with mean scores of 7.66 ± 1.46 and 40.10 ± 5.24, respectively. Their mean practice score was 6.51 ± 1.26. Age, work experience, and educational level significantly influenced the participant's knowledge, attitudes, and practices. Additionally, there was a positive correlation between attitude and practice (p < 0.001).

This study shows that nurses and anesthesia technicians possess the knowledge and a positive attitude toward the ERAS program; however, their practices remain limited. These results highlight the importance of continuous training and professional development to enhance the effectiveness of ERAS implementation in clinical practice.

Helicobacter pylori (H. pylori) is the most prevalent chronic bacterial infection in humans. Limited research has been conducted both internationally and locally to evaluate the general community’s collective understanding of H. pylori infection, its diagnosis, and its management.

This study aims to evaluate the level of understanding of H. pylori infection, its diagnosis, and management among the general population residing in the western region of Saudi Arabia.

The study employed a cross-sectional online survey method to gather data from a sample of 1,025 of the general population. Four major cities were selected for this study: Makkah, Madinah, Jeddah, and Taif. The knowledge scores were classified into three categories: low, fair, and good.

63.5% of participants had a fair knowledge of H. pylori infection. A statistically significant difference was observed between regions, with a P value of 0.022. Furthermore, there was a strong correlation between the respondents' degree of knowledge and age (p < 0.001), education level (p < 0.001), number of family members at home (p < 000.1), monthly income (p < 0.001), and previous exposure to H. pylori infection (p < 000.1).

Most participants know about H. pylori However, its transmission, link with stomach cancer, diagnosis, and treatment are had low level of knowledge. Several additional educational and policy interventions are recommended to enhance public knowledge of H. pylori To address the identified gaps in understanding, targeted educational campaigns should be developed.

Intestinal malrotation in adults is more common in chronic, insidious patterns, reported to be around 88% in the literature, with features ranging from intermittent abdominal pain and vomiting to food intolerance, malabsorption, and motility disorders. This clinical spectrum can be debilitating for the patient in terms of morbidity and mortality, especially in the context of acute presentation in the background of chronic features.

We present a 26-year-old male with a history of over 10 hospital admissions since childhood with intermittent abdominal pain and vomiting labeled as cyclic vomiting syndrome. He was in distress regarding the chronicity of his symptoms and presented with an acute abdomen due to acute small bowel intestinal obstruction. He underwent diagnostic laparoscopy and reduction of internal hernia followed by exploratory laparotomy and division of Ladd’s band and realignment of bowel. Postoperatively, he recovered and recuperated well.

Intestinal malrotation should be in the routine differential diagnosis of acute abdomen, especially with the history of nonspecific abdominal symptomatology, so that diagnosis can be made early to prevent morbidity and mortality in this age group.

This study focuses on the mental health and resilience of migrant students at RAK Medical and Health Sciences University (RAKMHSU) in the UAE, who often face unique challenges such as cultural adjustment, language barriers, and separation from family and friends.

This study aimed to evaluate the resilience levels of RAKMHSU's migrant students, identify their challenges, and provide evidence-based recommendations to enhance their mental health and resilience.

A total of 206 university students who migrated participated in the study. The study analyzed the resilience-mental health relationship using the Positive Mental Health Scale and the Brief Resilience Scale.

The study found that most students, 92.23%, had normal levels of resilience. A smaller proportion, 1.46%, exhibited high resilience. The mental health assessment revealed that 84.95% of students had high positive mental health scores. Furthermore, the study found a significant positive correlation (r = 0.188, p = 0.007) between mental health and resilience scores.

Migrant students face academic and migratory challenges. However, the student body at RAKMHSU exhibits high levels of mental health resilience. Tailored support programs can strengthen this resilience for better mental health and academic outcomes in the multicultural educational setting.

To evaluate the suitability of commercially available glucometers in the UAE in terms of accurate and reliable blood glucose measurements.

Portable glucometers are employed for measuring blood glucose levels, offering distinct advantages such as providing instant results and being user-friendly when compared to laboratory reference analyzers. However, certain molecules, such as those found in medications, can interfere with the accuracy of glucometer readings.

To evaluate the precision and interference in the presence of maltose and vitamin C of three glucometers commercially available in the UAE.

We utilized plasma samples to conduct two types of experiments: a precision experiment and an interference experiment. We compared the precision of three glucometer brands available in the United Arab Emirates [Accu-Chek Instant^TM, One Touch Select Plus Flex^TM, and Trister GlucoScan^TM] in the presence or not of various interfering molecules, such as Maltose and Ascorbic Acid (Vitamin C).

Accu-Chek Instant^TM demonstrated the highest precision among the glucometers tested, with a coefficient of variation of less than 5% for all measured glucose values. In contrast, OneTouch Select Plus Flex^TM and Trister Glucoscan^TM exhibited higher variability in precision, with coefficients of variation of 11.4% and 11%, respectively. Accu-Chek Instant^TM consistently performed well in terms of bias and precision in the presence of interferences, and does not display glucose readings above 50mg/dL of Vitamin C. Notably, Ascorbic acid induced a greater bias compared to Maltose for all three glucometers.

The performance of the glucometer is affected by its testing methodology. Accu-Chek Instant^TM shows improved precision and is able to detect the presence of Vitamin C. When it comes to Maltose interference, it results in a higher bias change but lower variability, which can be addressed by applying a correction factor.

Mobile health interventions showcase effectiveness for improving treatment adherence among Latent TB Infection (LTBI) patients. However, there is a paucity of evidence regarding their acceptability and usability. This study aimed to assess the initial acceptability and usability of a mobile health application that has been designed to ensure treatment adherence in LTBI patients.

A descriptive study was conducted to assess the acceptability and usability of a mobile health application, “My Treatment Friend”. A total of 82 LTBI patients were selected, and access to the application was given to them. This application provides support to LTBI patients in reporting daily medication and side effects. The basic demographic characteristics of the participants were collected through a Google form-based questionnaire. The acceptability and usability of the application were assessed using the likert scale questionnaire and SUS tool, with samples of n=44 and n=20 participants, respectively.

LTBI patients found the mobile application acceptable and feasible, with an SUS score of 73, which comes under Grade B as per the SUS score sheet. The majority believed that the app was very simple to use and easy to understand. However, there is a requirement to add more features that can enhance the acceptability and usability of the application.

The study showed the importance and usefulness of mobile applications to assist LTBI patients in finishing their prescribed treatment courses of action. Additionally, it highlights how crucial it is to build future applications using user-centered design. User-centered design may play an important role in designing mobile applications and ensuring effective engagement and satisfaction among users.

A significant risk factor for cardiovascular disease, hypertension, affects more than a billion people globally. Numerous non-pharmacological methods work well to lower blood pressure. The objective of this study was to assess the short-term effect of green tea supplementation on blood pressure among people with hypertension.

This community-based randomized controlled trial was conducted among people with hypertension recruited using a purposive sampling technique from the village of Lakhnaur, Mohali, Punjab, India. Sixty patients were randomly assigned to receive either supplementation with green tea beverage (one cup/day) or no intervention. The primary outcome measure was systolic and diastolic blood pressure. Blood pressure was measured at the baseline and 15 days after the intervention using a standard calibrated digital sphygmomanometer.

Post-intervention, the decrease in the mean systolic blood pressure was significantly greater (p <0.01) in the experimental group (129.83±6.497) than in the control group (135.0±6.433).

Green tea supplementation significantly lowered the systolic blood pressure among study participants. Green tea may be included as part of a lifestyle intervention to manage and control systolic blood pressure in hypertensive patients.

BFUHS/2K22/p-TH/12888 8/12/22.

The coverage of immunization amongst adults in India remains low; a lack of nationally endorsed guidelines and implementation policies is a contributing factor. There is a paucity of tools available to assess knowledge, attitude, and practices (KAP) regarding adult immunization. Hence, we attempted to develop a KAP questionnaire to evaluate the existing expertise regarding adult immunization among medicine and infectious diseases resident doctors in an apex medical institute in India.

A two-stage scheme for the development and validation of the questionnaire was followed. The first step involved an exhaustive literature review, focused group discussion, and in-depth interviews. The prepared draft was reviewed by experts in the field of infectious diseases and adult immunization across the domains of necessity, relevance, and clarity. ‘Item-level content validity indices’ (I-CVI) and ‘Scale-level content validity indices’ (S-CVI) were then calculated. Brennan and Prediger's AC (Agreement Coefficient) and Gwet’s AC (Agreement Coefficient) were used to establish inter-rater agreement on the obtained expert reviews.

A 57-item KAP questionnaire was developed and was reviewed by a total of 11 experts. The questionnaire had satisfactory I-CVI (>0.6 for all the items) and S-CVI Ave (>0.9 for each of the domains). The questionnaire had a strong inter-rater agreement as assessed by both Brennan and Prediger AC (> 0.6, p<0.001) and Gwet’s AC (>0.8, p<0.001).

The developed tool was scientifically validated following a staged process. We propose that this questionnaire can hence be used to evaluate the knowledge, attitude, and practices regarding adult immunization amongst medical practitioners across medical colleges and hospitals in India. This may be instrumental in developing programmatic interventions and major policy changes to enhance the practice of adult immunization amongst healthcare providers.

This study aimed to evaluate the effect of ameliorated insulin injection site rotation on the incidence of Lipohypertrophy (LH) and glycemic control in patients with diabetes.

A quasi-experimental design involving a pretest-posttest with a control group was utilized at the medical outpatients’ clinic of Sohag University Hospital. The participants were divided into two groups (30 in the study group and 30 in the control group). Two instruments were utilized to collect the data, i.e., a sociodemographic and clinical data sheet and a lipohypertrophy assessment sheet.

The majority have been found to suffer from type I DM with an insulin injection duration from one to less than 6 months. A significant reduction has been noticed in the lipohypertrophy incidence and grade during the 6-month assessment compared to the pre-intervention assessment.

A marked reduction in the incidence of LH and improved glycemic control have been noted in the study group, indicating the clinical significance of the anti-clockwise insulin site rotation technique.

Overweight and obesity are growing problems worldwide, along with a decrease in physical activity. This trend is also seen in the United Arab Emirates, including insufficient exercise among university students. This study aimed to evaluate the physical activity level, weight categories, and fat distribution among female college students and determine the correlations and associations between these factors and demographic factors.

A cross-sectional study was conducted among 204 female undergraduate health profession students recruited through a convenience sampling technique. Data were collected using anthropometric measurements and a self-administered International Physical Activity Questionnaire (IPAQ). The relationships between weight categories (Body Mass Index, BMI), fat distribution (Waist-to-Hip Ratio, WHR), and levels of physical activity, as well as the relationship between BMI and WHR, were analyzed using the PSPP statistical program.

The mean age of the students was 20.5 ± 1.9 years, with an average BMI of 25.4 ± 6.6 kg/m². About 60.3% of the students were moderately active. Physical activity levels were significantly associated with BMI categories (P= 0.008). BMI and WHR categories were also significantly associated (P= 0.012). There was a strong association between students' perceived physical activity levels and their actual activity, as measured by the IPAQ short form (P= 0.001). No significant relationships were found between physical activity, anthropometrics, and demographic characteristics.

Female college students demonstrated moderate levels of physical activity, and a negative correlation was detected between their physical activity levels and weight categories. None of the studied demographics showed a correlation or association.

Normal circadian blood pressure response includes a nocturnal fall in BP by 10 to 20% of the average daytime BP. Many diseases, including diabetes mellitus, alter these normal circadian BP changes. DM, through its long-term microvascular and macrovascular complications, such as autonomic neuropathy, affects BP dipping patterns by decreasing dipping (non-dipper), exaggerating dipping (nocturnal hypotension), or causing an actual increase in BP (reverse dipping). These altered dipping patterns are likely to be more common in those with long-standing hyperglycemia, poor glycemic control, and concurrent renal dysfunction. Abnormal dipping patterns (non-dipping and reverse dipping) are associated with increased target organ damage and cardiovascular risk among diabetic patients. The BP variation and dipping patterns are best studied using ambulatory blood pressure monitoring. This study has compared BP dipping patterns in patients with T2DM and healthy controls and evaluated their correlation with the duration of diabetes, glycemic status, and renal status by employing Ambulatory Blood Pressure Monitoring (ABPM).

50 patients with T2DM for more than 5 years have been compared with 50 normal subjects (controls) for alteration in the circadian BP pattern and its relationship with the patients’ duration of diabetes, glycemic status, and renal status.

This study has revealed statistically significant findings concerning abnormal dipping patterns (non-dipping and reverse dipping) between diabetic and non-diabetic patients (56% vs. 24%, p-value=0.001), between the duration of diabetes for more than 10 years and 5-10 years (77.8% vs. 43.8%, P=0.02), between higher HbA1c of more than 9% and 7-9% (34.5% vs. 4.8%, P=0.0001), between patients with proteinuria and those without proteinuria (p=0.045), and between patients with microalbuminuria and those with no microalbuminuria (87.5% vs. 41.2%, p=0.002).

Compared to normal subjects, most patients with T2DM had an abnormal BP dipping pattern. The duration of DM, poor glycemic control, and renal dysfunction (proteinuria and microalbuminuria) were positively correlated with nocturnal BP dipping pattern abnormalities.

An adverse drug reaction is defined as “an appreciably harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product, which warrants prevention or specific treatment, alteration of the dosage regimen, or withdrawal of the product, as it predicts hazard from future administration.”

Currently used to report such responses, the International Classification of Diseases will soon incorporate WHO's Adverse Reaction Terminology. A medication's bad effects can fall into one of six types, each having its own mnemonic: withdrawal, therapeutic failure, dose-and time-related, non-dose-related, weird, increased withdrawal, and withdrawal overall (time-related). Factors such as timing, illness pattern, investigation findings, and retesting the medicine could be useful in pinpointing the reason for a suspected adverse drug reaction. Management includes treating the effects of the medication specifically as well as, if feasible, stopping it altogether.

Reporting suspected adverse medication reactions is important. Monitoring techniques are able to identify responses and establish connections. There is many software that is used to report and monitor adverse drug reaction responses. Various Pharmacovigilance companies use AI technology to utilize this method to record signals, communicate, and solve new issues in order to limit or avoid harm because of large data size.

Osteoporosis is a bone condition that disrupts bone structure, reduces its strength, and increases the risk of fractures. While osteoporosis is commonly recognized as a disorder affecting the elderly, it can also develop in younger adults and be accompanied by other disorders. Screening individuals and diagnosing those at higher risk of osteoporosis early may significantly reduce the likelihood of complications and associated costs.

Serum biochemical factors are rather easily measured and accessible, making them valuable as predictive indicators for the prognosis and early diagnosis of osteoporosis. However, there is not enough evidence about possible relationships between these factors and osteoporosis in different bones.

In this descriptive cross-sectional study, we analyzed osteoporotic indices, including bone marrow density (BMD), T-score, Z-score, and standardized BMD, in a large population of individuals at risk of osteoporosis. We then investigated potential relationships between biochemical values and osteoporosis indices in the evaluated subjects. The collected data were analyzed using the Kruskal-Wallis test and Spearman correlation coefficient methods.

A total of 1104 patients were enrolled, with 87.7% being female and 12.3% male. The mean age of the patients was 56.48 ± 11.62 ( ± SE) years. Among them, 251 patients had normal bone density, while 556 patients had osteopenia, and 270 patients had osteoporosis. The Kruskal-Wallis analysis demonstrated that serum levels of Calcium (p=0.014), Phosphorus (p =0.002), and Vitamin D3 (p =0.045) were positively associated with the risk of osteoporosis, whereas serum albumin (p =0.005) and Alkaline phosphatase (p =0.002) levels were negatively associated. Additionally, the Spearman correlation coefficient showed a negative association between hemoglobin levels and BMD in both the spine (p =0.046) and femur (p =0.049).

Serum levels of biochemical factors may serve as primary predictive markers for the early diagnosis of individuals at higher risk of osteoporosis and bone fractures. In addition to factors involved in calcium homeostasis, serum levels of albumin and hemoglobin are also associated with BMD scores and the development of osteoporosis.

The study sought to quantify the frequency and categorize the types of prescribing errors occurring in outpatient settings while evaluating the efficacy of pharmacist interventions in mitigating such errors.

This study was a cross-sectional, retrospective interventional study conducted over a one-year period from September 1, 2017, to August 31, 2018, at the outpatient departments of one government and one private tertiary care hospital in Hyderabad, Pakistan. A total of 2,552 outpatient prescriptions were randomly collected and evaluated by the researchers to identify prescribing errors, using the British National Formulary (BNF) as a reference guide. The study rigorously adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, ensuring comprehensive reporting, transparency in methodology, analysis, and interpretation of the observational research findings.

The collected data were analyzed using chi-square tests in SPSS version 25 to assess statistical significance. Among the 2,552 outpatient prescriptions examined, 12,501 (40.4%) prescribing errors were identified. The error rate was higher in the government hospital (6,672; 42.8%) compared to the private hospital (5,829; 38.0%). The most prevalent errors occurred during the subscription stage (2,302; 45.1%), with 1,245 (48.1%) and 1,057 (42.0%) errors in the government and private hospitals, respectively. This was followed by errors in the inscription (3,447; 45.0%), superscription (5,156; 40.4%), and transcription (1,596; 31.3%) stages. Common interventions during the subscription stage addressed incomplete patient information (age, weight, etc.), missing consultant signatures, and stamps. For the inscription stage, frequent interventions involved incorrect drug doses and strengths.Typical interventions for the subscription and inscription stages included adding missing therapy durations and usage instructions, respectively. Pharmacist interventions were accepted at a higher rate in private hospitals (3,669; 62.9%) compared to government hospitals (3,675; 55.1%), with a total of 7,344 (58.7%) interventions accepted.

The study revealed a high prevalence of prescribing errors across all stages of the outpatient prescription process, with the subscription stage being the most error-prone. The findings highlight the critical role of pharmacist-led prescription interventions in mitigating prescribing errors, thereby enhancing prescribing practices, optimizing therapeutic outcomes, and safeguarding patient safety.

Type 2 diabetes is a heterogeneous disease characterized by high blood glucose levels. Its prevalence is increasing as a result of lifestyle, related genes expression, and insufficient insulin signaling. The activation or inhibition of some proteins in the insulin signaling pathway play a vital role in glucose uptake into the cells and in maintaining serum glucose homeostasis. Phosphoinositide-3-kinase (PI3K), 3-phosphoinositide-dependent protein kinase-1 (PDK1), Protein kinase B [PKB, also known as the serine and threonine kinase (AKT)], and Rac family small GTPase 1 (RAC1) are key proteins that play important roles in the liberation of Glucose Transported-4 (GLUT4) vesicle, and consequently the uptake of glucose in response to the insulin signal of hyperglycemia.

In this study, we have focused on the route of targeting insulin signaling proteins for decreasing insulin resistance by targeting the four proteins, PI3K, PDK1, AKT, and RAC1, using in silico studies.

Docking experiments, using AutoDock algorithms, were performed to predict the activity of eight recently purified derivatives of Gundelia tournefortii (GT) and Ocimum basilicum (4-hydroxybenzoic acid, beta-amyrin, beta-sitosterol, chlorogenic acid, lupeol, lupeol-trifluoroacetate, myo-inositol, and stigmasterol) on the insulin signaling proteins. The SwissADME website was used to predict ADMEtox properties for the eight derivatives of the above-mentioned medicinal plants.

Most of the Gundelia tournefortii and Ocimum basilicum derivatives have shown variable levels of activation, mainly on the PDK1 and AKT pathways, and to a much lesser extent on the PI3K and RAC1 pathways.

The results have indicated that Gundelia tournefortii and Ocimum basilicum derivatives can be potent anti-diabetic drugs, namely in targeting PDK1 and AKT pathways.

Valvular heart diseases are some of the most common causes of cardiovascular morbidity and mortality worldwide. The mitral valve is estimated to be the cause of 15% of deaths in heart valve disease. Mitral valve dysfunction can be treated with a variety of operative options, one of which is mitral valve replacement. Although it is less desirable than repair, in some situations, it is the only viable option. Thus, we conducted this systematic review to help guide future risk assessment for mitral valve replacement patients and help in the construction of pre-operative risk assessment tools.

This is a systematic review of original articles discussing the topic of predictors of mortality for patients undergoing mitral valve replacement surgery. A systematic search was conducted via independent researchers across a number of databases, starting with PubMed databases utilizing its MeSH database, followed by a complementary search through Google Scholar.

In total, 27 original articles were included in a collective cohort of 145005 patients. Older age was the most commonly cited variable as a mortality predictor, followed by decreased left ventricular ejection fraction. EuroSCORE is a well-known scoring system that predicts in-hospital mortality following major cardiac surgeries. It was found that it overestimated mortality greatly, while another study found that the revised EuroSCORE II system was a better predictor of mortality. Overall, we note that both versions usually overestimate mortality.

There seems to be an overall agreement over several factors, including older age, decreased ejection fraction, and the expertise of the surgeon and the institution on being clear predictors of postoperative mortality. There is also an obvious need for new tools to better predict mortality rates preoperatively, as the currently used scores often result in greatly inaccurate predictions.

A lack of proper anti-malarial medication use can lead to drug resistance, failed therapy, and even death. It is unclear how widespread the use of fake anti-malarial medications is in India. Better malaria treatment and the execution of regulatory initiatives to improve anti-malarial drug quality necessitate regional research into the quality of available anti-malarial pharmaceuticals. This study aimed to look into the quality of anti-malarial drugs in regions of India where malaria is common. Conclusions about the prevalence of substandard anti-malarial medications in Indian communities can be drawn from the findings.

Samples of anti-malarial pills were bought from stores in five different Indian areas. One hundred and fifty anti-malarial drug samples were gathered. Using a GPHF minilab lab kit, the quality of the following samples was determined: chloroquine (n=50), artemether lumefantrine (n=50), artesunate sulphadoxine-pyrimethamine (n=14), and primaquine (n=31).

This research confirmed that 98% of the tablets disintegrated properly in a minilab disintegration test. As a result, when compared to both the full set of standards and 80% of the samples, 99% of the samples passed the preliminary qualitative TLC test. Only 4% of samples (those with insufficient amounts of the active medicinal component) failed the quantitative HPLC test.

Anti-malarial medicine counterfeiting has been found to be quite uncommon in India compared to other countries. However, further research is needed, such as post-marketing surveillance, to ensure that effective anti-malarials are distributed to the public.

The normal anatomy of the coronary arteries consists of the right coronary artery and the left main coronary artery, which originate from the right and left sinuses of Valsalva in the aortic root separately. In general, congenital anomalies of the coronary artery are uncommon in adults. The ectopic origin of a coronary artery from the pulmonary trunk is part of a group of infrequent coronary artery anomalies. The Anomalous origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) is thought to be an extremely rare congenital coronary artery anomaly. Most of our knowledge and experience about this congenital coronary malformation is derived from published case reports and series.

We have, herein, reported the case of a 68-year-old male who was discovered to have ARCAPA after he presented to our center with chest pain. The patient underwent multiple invasive and non-invasive diagnostic imaging modalities, including an echocardiogram, a coronary angiogram, a multislice-gated coronary computed tomographic angiogram, and stress perfusion cardiovascular magnetic resonance imaging. The clinical decision was to continue with conservative non-surgical management along with close follow-up.

The ARCAPA anomaly is considered to be one of the rare congenital coronary artery variances that can be discovered in late adulthood as a patient may remain asymptomatic for many decades.

Identifying the preferred learning modalities of students is crucial for a comprehensive understanding of the content of the study, and this can be achieved by employing the VARK inventory developed by Neil D. Fleming. The preferred learning modality of students significantly influences their learning outcomes.

This study aimed to identify the preferred learning modalities among health professional students.

Using a cross-sectional survey study design, we surveyed a consecutive sample of 351 students from three health professional programs: Nursing, Medical, and Pharmacy. After obtaining institutional board approval, a standardized self-administered VARK inventory (Visual, Aural, Read/write, Kinaesthetic), version 7.8, was employed. VARK scores were computed for each respondent and sent to the publisher for interpretation and categorization of learning preferences. Data were analyzed using SPSS version 28.0 and 29.0.

The findings revealed that 35.9% of participants were between 18-20 years old and identified as unimodal learners, with 19.09% preferring kinaesthetic learning. In the bimodal and trimodal categories, 5.98% exhibited preferences for AK (Aural, Kinaesthetic) and VAK (Visual, Aural, and Kinaesthetic). Only seventy students (19.9%) preferred multimodal learning patterns. Notably, all the college students were identified as unimodal learners.

Understanding these diverse learning preferences empowers students to employ appropriate learning methods, enhancing their overall learning experience. Faculty members can leverage this data to tailor teaching styles, thereby optimizing the learning environment. Further research across different universities can contribute to broader knowledge and informed strategies that promote effective learning processes.

Nowadays, the resistance to available antibiotics could be mentioned as a global threat to public health. The aim of this preliminary study was to conduct a retrospective survey associated with the prevalence of Nosocomial Infections (NIs) and the pattern of microbial resistance in a tertiary care referral hospital (Alzahra), Isfahan, Iran.

The data between the years 2016 to 2022 were extracted from the official database of hospital NI records. The microbiological culture results, represented by non-repetitive specimens, were further analyzed for pathogens and the pattern of antibiotic resistance. Then antibiotic susceptibility testing was done using standard methods of disk diffusion or Phoenix M50. The recorded variables have been presented as mean ± standard deviation, prevalence, and percentage. Data were analyzed using SPSS version 20.

For a duration of 5.5 years, the period prevalence of NIs was recorded as 2%, with more than 50% associated with ventilator-associated events and urinary tract infections. Klebsiella pneumonia, Acinetobacter baumannii, and Staphylococcus were the main pathogens. Further study of specimens from the year 2022 (n= 898) confirmed the most isolated bacteria as Klebsiella pneumonia (n = 290, 32%), Acinetobacter baumannii (n= 206, 23%), Enterococcus (faecium-fecalis n=125, 14%), Escherichia coli (n = 116, 13%), Staphylococcus aureus (n = 95, 11%), and Pseudomonas aeruginosa (n = 66, 7%). Resistance (R%) in Isfahan versus the whole country was confirmed for Klebsiella pneumonia (third or fourth generation of cephalosporins: R = 80.9 vs. 82%), fluoroquinolones (R = 76.6 vs. 73%), beta-lactamase inhibitors (R = 75 vs. 79%), carbapenems (R = 65.7 vs. 66%), and so on, respectively.

There has been reported an increase in the proportion of isolates resistant to cephalosporins, fluoroquinolones, and others. The variety of latent pathogens resistant to frequently administered antibiotics highlights the significance of continued and homogenous antimicrobial evidence-based pharmacotherapy investigations in Isfahan, Iran. Further studies in this direction are recommended.

Sickle cell anemia (SCA) poses significant metabolic challenges in affected individuals, yet the relationship between resting metabolic rate (RMR) and disease severity remains underexplored, particularly in Sudanese pediatric populations.

The aim of this study is to investigate the RMR and its correlation with disease severity scores and treatment with hydroxyurea in Sudanese patients with sickle cell disease.

We conducted a case-control study on 100 individuals aged 3-18 years, with 50 having SCA and 50 forming the healthy control group. RMR was computed using the Harris-Benedict formula, the World Health Organization equation, and the Buchowski formula. Severity scores were determined using a SCA Scoring System.

The mean age for the control group (9.52 ± 4.35 y) was similar to that of the SCA group, whether receiving or not receiving hydroxyl-urea (9.44 ± 4.164 and 9.68 ± 4.534, respectively (p=0.980). The resting metabolic rate (RMR) in the case group was significantly lower compared to the control group when using the Harris-Benedict and WHO equations (p = 0.004 and 0.001, respectively). A notable difference in RMR was observed between the case group (using the Buchowski formula) and the control group (using the Harris-Benedict equation) (p = 0.006), but not with the WHO equation (p = 0.054). Treatment with hydroxyl-urea was significantly associated with low severity scores among the SCA patients (p< 0.001).

The elevated RMR levels among Sudanese SCA patients compared to healthy subjects can be shown when calculated with the Buchowski formula but not with the other standard equations designed for healthy individuals.

Non-resolving pneumonia after antibiotic treatment is encountered on quite a few occasions in clinical practice and is estimated to account for approximately 15 percent of inpatient pulmonary consultations and 8 percent of bronchoscopies. This is more frequently seen in intensive care/ ventilated patient-associated pneumonia compared to community-acquired pneumonia. Treatment failures are mostly due to infectious causes, and only 20% of the cases are due to noninfectious causes.

We present here an interesting case of non-resolving pneumonia. Our patient was a 58-year-old Middle Eastern descendant male who presented with a cough with excessive mucoid sputum for 6 months. Chest radiology showed patchy consolidation in the right lower lobe, which gradually progressed to multilobar consolidation over several months despite treatment with antibiotic antifungal and steroids. Extensive evaluation was done with laboratory microbiological studies and bronchoscopy, but it was negative for tuberculosis and malignancy. So, the patient underwent an open lung biopsy. Histopathology and immunohistochemical staining were suggestive of adenocarcinoma of the lung, predominant lepidic pattern, with papillary, acinar patterns, and foci of invasion.

This case is interesting because of its unique clinical presentation with bronchorrhea and progressive pneumonia. Also, it reveals the role of surgical lung biopsy in navigating cases of difficult non-resolving pneumonia.

In the year 2009, Remdesivir or Veklury was discovered by Gilead Sciences for the management of hepatitis C, Ebola and Marburg virus disease through injection into a vein and then a few years later, 22nd Oct 2020 (United States), the drug was recommended for the management of COVID-19 under a provisional guideline.

The aim of this systematic review was to address pharmacotherapy approaches associated with the efficacy and side effects of remdesivir for the treatment of viral infections.

This is a focused, in-depth consequent guide approach and literature search, with a methodical assessment associated with the terms “Remdesivir,” “ Remdesivir Bioavailability,” “Remdesivir and Disease,” “ Remdesivir and COVID-19” that was done through Pubmed, Scopus, and Web of Science from their inception to 29 Oct 2023.

101 studies included in silico, in-vivo, and in-vitro experiments to test remdesivir therapeutic efficacy were selected based on the current, knowledgeable, and high-quality topics of manuscripts. Regarding efficacy, in addition to COVID-19, remdesivir shows therapeutic efficacy in other virus infections, such as hepatitis C, Ebola, and Marburg. In patients with COVID-19, remdesivir shortens the time to recovery, lowering progression to mechanical ventilation and decreasing hospital resources. Combination with dexamethasone in selected patients who need minimal conventional oxygen but are at high risk of severe COVID-19 was reported beneficial. Combination with chloroquine or hydroxychloroquine may cause a decrease in the antiviral activity of remdesivir, but dexamatason reported minimal or no reduction in drug exposure. However, synergistic effects were reported in combination with favipiravir, but methotrexate toxicity needs to be evaluated. Significant improvement in 'patients' conditions was reported in combination with methylprednisolone pulse therapy. Infusion-related reactions such as nausea, elevated liver enzymes, sweating, and hypotension are the most common side effects.

Different studies showed that with remdesivir pharmacotherapy, in addition to significant improvement in the recovery rate in those with COVID-19, the risk of adverse effects was significantly lower than in the control groups. To verify efficacy and side effects, besides attentive consideration of kidney and liver function, further evidence-based pharmacotherapy studies of remdesivir seem advantageous.

Although most cases of choriocarcinoma are of gestational origin, rare cases of extrauterine origin (such as pulmonary) have been reported, which have a poor prognosis.

We present one such rare case involving a 35-year-old female patient who initially presented to the emergency department with hemothorax and was found to have primary lung choriocarcinoma after multiple biopsies. The patient was properly managed and discharged in a healthy condition. However, she subsequently returned to the hospital with an intracranial haemorrhage and, unfortunately, passed away despite all efforts.

Due to the life-threatening initial presentations of primary pulmonary choriocarcinoma, it is essential to conduct an intensive work-up and maintain close observation when a patient initially presents with such symptoms. Early diagnosis is crucial to initiate appropriate treatment and prevent further complications. Therefore, we aimed to discuss and establish an emergency medicine department-based diagnostic pathway to contribute to the early diagnosis of this deadly malignancy.

Dermatoglyphics is the study of dermal ridge configuration on the skin of the fingers and palms, which can be used to diagnose chromosomal disorders and individual identification. Stress is characterized by feeling overwhelmed with mental or emotional pressure and evokes a biological response when any intrinsic or extrinsic stimulus is applied. Stress can cause acute effects and disorders that can trigger structural changes like atrophy and decrement in weight in different brain parts with long-term effects on the nervous system.

In this cross-sectional study, fingerprints of 150 participants of Gulf Medical University with an equal number of students and faculty/ staff were obtained by fingerprint scanner. Participants were classified into low, moderate, and high-stress levels by questionnaire. Collected data were statistically analyzed to find any association between dermatoglyphics and perceived stress levels.

Radial Loop was found to have the highest frequency as a percentage in all three groups. Plain whorl was the pattern with the second-highest percentage of occurrences. A notable observation was the lack of plain arch and low frequency of accidental whorl in the high-stress group.

The findings contribute to our understanding of the potential of dermatoglyphics as an indicator of perceived stress, opening up avenues for further research in utilizing these patterns as a non-invasive tool for assessing stress levels.

The association between visceral obesity and insulin resistance establishes an alternative risk for the onset of type 2 diabetes mellitus. The infiltration of macrophages in the visceral fatty tissue and the unreliable generation of adipokines are associated with mechanisms directing the progress of insulin resistance.

The objective of the study was to observe the relationship between visceral fat-associated adipokines and biochemical variables in central obese type 2 diabetic patients.

This study included 100 central obese subjects (both genders) aged 30-60 years newly diagnosed with type 2 diabetes mellitus. Out of the 100 participants, 73 were male and 27 were female. Serum adipokines were analyzed using an enzyme-linked immunosorbent assay. Biochemical parameters were assessed using the Cobas^® 6000 analyzer, while HbA1c levels were determined through high-performance liquid chromatography.

The results showed a significant relationship (p < 0.05) between the adipokines and HbA1c, fasting, and postprandial blood glucose levels. The results indicated a significant association (p < 0.05) between the adipokines and lipid profile with varying degrees in central obese type 2 diabetic subjects.

The relationship between visceral fat-associated adipokines and metabolic variables may influence the metabolic pathways in central obese type 2 diabetic patients. The adipokines are strong predictors for the intensification of diabetic risk and can be used as a diagnostic tool for risk assessment in the central obese population.

It is known that attitudes towards the elderly are an important variable affecting healthcare services. Considering the increasing trends of the population over 65 years in countries, it is important to determine the attitudes of future healthcare workers towards the elderly and to prepare them to serve in the health sector with activities that will lead to positive changes. In this direction, it is important to determine the effect of personality traits of prospective healthcare workers on their attitudes toward the elderly.

The research was conducted using the “relational survey model”. The study was conducted with 581 prospective healthcare workers. Personal Information Form, Eysenck Personality Questionnaire, and Kogan's Scale of Attitudes towards the Elderly were used as data collection tools. Data were obtained and analyzed using the online data collection method.

According to the results of the study, it was found that the attitudes of students who were healthcare candidates for older adults were generally positive (= 63.46±13.42). While there was a positive yet moderate and statistically significant correlation between attitudes towards the elderly and scores on the Extraversion subscale (r= 0.634, p<0.01) and a negative yet moderate and statistically significant correlation with scores on the Neuroticism (r= -0.568, p<0.01) and Psychoticism (r= -0.602, p<0.01) subscales. The personality traits extraversion, neuroticism, and psychoticism explained 58.6% of the attitude towards the elderly. According to the regression results, extraversion (β= 0.358; p<0.001) positively affected attitudes towards the elderly, whereas neuroticism (β= -0.310; p<0.001) and psychoticism (β= -0.307; p<0.001) negatively affected attitudes towards the elderly.

Given the important role of healthcare professionals in improving the care and quality of life of the elderly, it is necessary to develop strategies to improve the attitudes of future healthcare professionals towards the elderly. Consideration of personality traits in determining these strategies may contribute to the development of effective and personalized approaches.

The relationship between ECG changes in dilated nonischemic cardiomyopathy and ejection fraction (EF) is complex and poorly understood. Thus, this study aimed to identify the most common patterns of ECG associated with dilated nonischemic cardiomyopathy and their relationship to EF.

A retrospective cross-sectional study was conducted between 2019 and 2022, including 100 consecutive patients with nonischemic dilated cardiomyopathy. ECG data were rate, axis, left (LBBB) and right bundle branch block (RBBB), first-degree heart block, premature ventricular contractions, depth of S wave in leads V1 and V2, length of R wave in leads V2 and V6, the ratio of R/S in the lead V4, left ventricular hypertrophy (LVH), maximum R wave length in leads I, II, and III, poor R wave progression, ST-segment elevation, and T wave inversion.

The most common ECG pattern associated with cardiomyopathy was T-wave inversion (47%). The EF was 23.9± 8.87% in patients with LBBB and 25.5± 8.07% in patients without LBBB (P= 0.361). In patients with T-wave inversion, the EF was 23.4± 8.21%, and it was 26.28± 8.35% in patients without T-wave inversion (P= 0.086). In patients with LVH, the EF was 23.89± 7.84%, and it was 25.5± 8.66% in patients without LVH (P= 0.354). A negative nonsignificant correlation existed between SV1, SV2, RV2, RV6, R/S V4, and maximum R in I, II, III, and EF.

The study showed that T-wave inversion was the most common pattern associated with dilated nonischemic cardiomyopathy. The study provided insight into the negative correlation between EF and SV1, SV2, RV2, RV6, R/S V4, and maximum R in I, II, and III, although it did not reach a significant level.

Acceptance of COVID-19 vaccination of medical personnel reduces the spread of infection the research aimed to evaluate healthcare professionals' attitudes toward vaccination by the health belief model.

A quantitative, cross-sectional research design was used for the study.

Most medical personnel agreed to get the COVID-19 vaccination (84%; n=384). Medical workers over 45 (90%) showed more readiness for vaccination. The main pushbacks against the vaccination included the development of a vaccine in a short period (n=56; 73.7%), fear of side effects (n=49; 64.5%), lack of reliable information about vaccination (n=35; 46.1%), negative information spread by the media (n=26, 34.2%). Recommendations by healthcare workers (63.9%), health authorities (73.1), media (70%), large number of people being vaccinated (72.6%), and provision of trustworthy information (71.3%) facilitate vaccination.

The high rate of COVID-19 vaccination among medical personnel shows that they have a high risk perception of infection. Among Health Belief Model components, cues to actions were most important in willingness to carry out vaccination. Recommendations of the WHO and scientists significantly influence the willingness to carry out vaccination. The regulatory responsibilities of the state and the public's trust in it play a crucial role in raising the population's awareness about the vaccine.

The study investigated the relationship between Determining the Factors Related to Maternal-Fetal Attachment in Pregnant Mothers with Maternal-Fetal Attachment.

Demographic policies in Iran emphasize population, fertility, and maternal health. Maternal-fetal attachment (MFA) is a term used to describe conditions that help the mother cope with the physiological changes during pregnancy. MFA contributes significantly to the future health of mother and child. Thus, it is essential to identify the nature of maternal-fetal attachment during pregnancy, when women need to prepare for and adapt to childbirth. The present study was conducted to determine the factors related to maternal-fetal attachment in pregnant mothers of Arak City.

The study investigated the relationship between obstetric-demographic factors, emotional intelligence, marital satisfaction, and domestic violence with maternal-fetal attachment.

The present cross-sectional study was conducted on 177 pregnant mothers with a gestational age of 37-40 who were referred to health centers in Arak, Iran, for pregnancy care in 2022. Five questionnaires, including an obstetric-demographic questionnaire, Cranley's Standard Mother-Fetal Attachment Scale, Schutte Self-Report Emotional Intelligence Test, ENRICH marital satisfaction scale, and HITS domestic violence questionnaire, were used to measure the factors related to maternal-fetal attachment. Data were analyzed using SPSS21 software and descriptive and analytical statistics, including frequency distribution, Pearson correlation, t-test, Chi-square, Analysis of variance (ANOVA), and Multiple Logistic Regression model.

The mean of age women and age of husbands was 29.07± 5.88 years and 32.93± 5.28 years, respectively. The mean maternal-fetal attachment score was 88.12± 15.76. The mean of the emotional intelligence, the marital satisfaction and, the domestic violence was 4.71± 2.81, 121.88± 17.30, 37.86± 7.25, 6.54± 3.35, respectively. The interval between the current and the previous pregnancy had a range of 1-7 years and a mean of 4.71± 2.8 years.

There was a positive significant correlation between the maternal-fetal attachment score and the interval between the current and the previous pregnancy (r=0.22, p=0.02),

There was a positive significant correlation between the maternal-fetal attachment score and the emotional intelligence (r=0.31, p=0.001) the marital satisfaction (r=0.25, P=0.001). There was a negative significant correlation between the maternal-fetal attachment score and the domestic violence (r=-0.26, p=0.001

Identifying attachment-related factors helps the health staff carry out the necessary training and preventive measures to increase maternal-fetal attachment, especially in high-risk parents who need more care.

Aphasia, also known as language impairment, is a condition that affects the ability to express and understand language, as well as the ability to communicate. Crossed Aphasia in Dextral (CAD) is defined as aphasia after a right hemispheric stroke. Usually, aphasia is caused by a left-sided stroke in right-handed individuals. The prevalence of crossed aphasia in right-handed individuals is 0.38% to 3%. CAD is diagnosed when the following factors are present: aphasia, right-handed patient, no family h/o left-handedness, the structural integrity of the left hemisphere, and absence of brain damage in childhood. Another entity, Global Aphasia Without Hemiparesis (GAWH), is a rare stroke syndrome presenting with global aphasia without any weakness and occurs in the lesion of the left-sided peri-sylvian region.

A 56-year-old female with a known case of severe mitral stenosis with chronic AF on warfarin and not on regular medications was brought to our hospital as she had not communicated for the past day. On initial examination, the patient was conscious, globally aphasic, with left facial lag and no weakness of limbs. Her initial Computed Tomography (CT) brain scan was normal. She was not thrombolysed as she was out of the window. Brain Magnetic Resonance Imaging (MRI) showed right frontal, temporal, and parietal infarct in middle cerebral artery territory. She was treated conservatively with full-dose anticoagulation and, upon discharge, was started on oral anticoagulants. At the time of discharge, the patient was able to understand a few commands and was having echolalia with non-fluent speech. She was reviewed again at 3 months, and she had a full recovery of her speech.

CAD is a rare stroke syndrome with low prevalence. Even though all subtypes of aphasic syndromes are seen in CAD, Broca's aphasia is the common subtype, and men are affected commonly. Most patients also present with apraxia and visuospatial neglect. Our patient had all the criteria for the diagnosis of CAD and also had GAWH and showed rapid recovery. The cause of the disease in this patient was considered to be two different lesions involving language areas due to an embolism in her heart.

This case has been presented for its rarity due to the occurrence of both CAD and GAWH in the same patient in a right-sided infarct.

The WHO Emergency Committee advocates preventive strategies for COVID-19 management, emphasising vaccines as highly effective but acknowledging their limitations. Chloroquine and hydroxychloroquine, initially effective against COVID-19, were discontinued due to severe side effects. Further clinical trials are imperative to establish the safety and efficacy of new antiviral agents, some of which may have harmful effects on human development.

The shortcomings of various conventional treatments have prompted urgent efforts to discover safe, natural compounds that may be useful in combating COVID-19. This study aims to review research that has investigated the potential of traditional phytotherapies used by different populations for the prevention and symptomatic treatment of COVID-19 infection.

This paper reviewed scientific studies published through searching on search engines such as PubMed, Scopus, Google Scholar, ScienceDirect and Elsevier from May until October 2023.

The preventive and anti-COVID-19 attributes of Traditional Chinese Medicine, Ayurvedic formulations and African medicinal plants have been substantiated in research. In Nepal, recommendations endorse the utilisation of medicinal plants for herbal teas and homemade sanitizers. Zingiber officinale, Curcuma longa L. and Curcuma xanthorriza Roxb., along with Camellia sinensis are crucial Indonesian medicinal plants with potential for treating COVID-19. Z. officinale was predominantly chosen for relieving coughs and sore throats associated with COVID-19 in Saudi Arabia.

The immunomodulatory properties of medicinal plants, which may prove useful in combating COVID-19, have been verified via elevation of the level of peripheral WBCs, IgM, IgG; inhibition of leukotrienes and prostaglandins, maintenance of the integrity of intestinal mucosal barrier and regulation of HMGB1. The antiviral effects of herbs, including the inhibition of viral DNA and RNA replication, down-regulation of oxidative stress, and the impediment of SARS-CoV-2 access to vascular endothelial cells, suggest their potential to facilitate earlier recovery from COVID-19 infection.

Advancing scientific research in phytotherapy promises the possibility of novel approaches for effectively managing future infectious diseases and pandemics.

Vancomycin, used to treat severe gram-positive infections, can induce acute kidney injury. Some evidence introduced Interleukin-18 (IL-18) as an inflammatory mediator of ischemic damage to many organs and urinary IL-18 as a diagnostic biomarker of acute tubular necrosis.

The current study aimed to evaluate the urinary level of IL-18 after vancomycin therapy.

This cross-sectional study was conducted on patients under treatment with vancomycin selected from those referred to Dr. Sheikh Hospital, Mashhad, Iran, from 2018-2019. Urinary IL-18 was measured based on nanograms per milliliter using a human IL-18 enzyme-linked immunosorbent assay kit about this cytokine before vancomycin administration and then two days later. All the analyses were performed in SPSS software (version 25), and a P-value less than 0.05 was considered statistically significant.

A total of 36 patients with a mean age of 40.06±36.67 months were included in the study. The mean scores of IL-18 before and after taking vancomycin were 1453.00±555.01 and 1713.00±660.98, respectively. The IL-18 was significantly lower before vancomycin consumption than the level reported after 48 h (P<0.05).

The present study highlighted a higher level of urinary IL-18 after vancomycin treatment, which may indicate kidney injuries. Therefore, it may be considered a potential biomarker of acute tubular necrosis in patients under vancomycin therapy.

Over the last half-century, the treatment and management of autoimmune rheumatic diseases have progressively improved, particularly with the contribution of immunobiological or biological therapies known as disease-modifying antirheumatic drugs. Although these agents have been generally efficient in the management of rheumatoid arthritis (RA), some patients experience limited efficacy and non-responsiveness to treatment. In addition, they may cause adverse clinical effects, further aggravating the disease.

Despite advancements in biological therapies, significant clinical needs persist. This review aims to discuss novel treatments, guiding future guidelines and drug discoveries for rheumatoid arthritis.

This review follows the 2020 PRISMA statement, utilising PubMed and Google Scholar for literature search and emphasizing recent meta-analyses on the safety and efficacy of targeted immunobiological medications.

Small molecule inhibitors, whether utilised independently or in conjunction with Methotrexate, have been shown to contribute to effective disease management and have the potential for better adherence to the American College of Rheumatology criteria. Tocilizumab therapy demonstrates a significant reduction in disease activity and improves rates of disease remission when combined with Methotrexate. Investigations of mesenchymal stromal cell therapies have had promising outcomes, improving both cartilage quality (as evaluated by Macroscopic Cartilage Repair Assessment) and joint tenderness and swelling in clinical joint counts. Intra-articular administration of tolerogenic dendritic cells has displayed a capacity to alleviate pain, as measured by Visual Analog Scale scores, and enhance the Disease Activity Score across 28 joints. Resveratrol capsules supplemented with allopathic therapy show potential in reducing TNF-α and interleukin-6 serum levels.

More investigations and their analysis will improve patient outcomes and reduce adverse effects and the costs involved in developing and obtaining immunobiological drugs. Moreover, assessing the safety and efficacy of anti-RA properties of the bioactive compounds could offer less toxic and more cost-effective natural treatment options.