A systematic review and meta-analysis of heart rate variability in COPD

Background: Chronic obstructive pulmonary disease (COPD) is associated with disruption in autonomic nervous control of the heart rhythm. We present here quantitative evidence of the reduction in HRV measures as well as the challenges to clinical application of HRV in COPD clinics. Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we search in June 2022 Medline and Embase databases for studies reporting HRV in COPD patients using relevant medical subject headings (MeSH) terms. The quality of included studies was assessed using the modified version of the Newcastle–Ottawa Scale (NOS). Descriptive data were extracted, while standardized mean difference was computed for changes in HRV due to COPD. Leave-one-out sensitivity test was performed to assess exaggerated effect size and funnel plots to assess publication bias. Results: The databases search yielded 512 studies, of which we included 27 that met the inclusion criteria. The majority of the studies (73%) had a low risk of bias and included a total of 839 COPD patients. Although there were high between-studies heterogeneity, HRV time and frequency domains were significantly reduced in COPD patients compared with controls. Sensitivity test showed no exaggerated effect sizes and the funnel plot showed general low publication bias. Conclusion: COPD is associated with autonomic nervous dysfunction as measured by HRV. Both sympathetic and parasympathetic cardiac modulation were decreased, but there is still a predominance of sympathetic activity. There is high variability in the HRV measurement methodology, which affects clinical applicability

SPARC 2018 Internationalisation and collaboration : Salford postgraduate annual research conference book of abstracts

Welcome to the Book of Abstracts for the 2018 SPARC conference. This year we not only celebrate the work of our PGRs but also the launch of our Doctoral School, which makes this year’s conference extra special. Once again we have received a tremendous contribution from our postgraduate research community; with over 100 presenters, the conference truly showcases a vibrant PGR community at Salford. These abstracts provide a taster of the research strengths of their works, and provide delegates with a reference point for networking and initiating critical debate. With such wide-ranging topics being showcased, we encourage you to take up this great opportunity to engage with researchers working in different subject areas from your own. To meet global challenges, high impact research inevitably requires interdisciplinary collaboration. This is recognised by all major research funders. Therefore engaging with the work of others and forging collaborations across subject areas is an essential skill for the next generation of researchers

Phytochemical fingerprint and biological activities of three Malaysian Ficus Deltoidea Cultivars

Background: Ficus deltoidea(Moraceae), is a Malay Traditional Medicine locally known as Mas Cotek. Three varieties (angustifolia, deltoidea and kunslerii) has been indictincty used. Aims We here aim to better understand their chemistry and bioactivities to inform future scientific and agronomic research. Methods: We extracted and analyzed (HPTLC and HPLC-UV) samples from these varieties. The in vitro screening included the scavenging of DPPH and NO radicals, activity upon tyrosinase and cytotoxicity against three human prostate cancer cells (PC3, DU145 and LNCaP)using the sulforhodamine B proliferation assay and the MTT mitochondrial viability assay. Results : We show that vitexin, orientin and isoorientin may act as intraspecific and interorgan phytomarkers The biological activities of the extracts point out to the antioxidant value of extracts from the deltoidea and kunslerii varieties whilst the inhibition of tyrosinase is only present in the root extract of the var. deltoidea which is also endowed with cytotoxic activity against prostate cancer cells. Conclusion: We suggest that the three Malaysian Ficus deltoideabotanical varieties (angustifolia, deltoideaand kunslerii) can be considered chemovars. The most active extract was from the roots of var. deltoids that show antioxidant, antimelanogenic and cytotoxic potential

Multiple Long-Term Conditions and Disability are Independently Associated with Higher Risk of Fall Among Community Adults: a Cross-Sectional Study

Aqeel M Alenazi,1 Norah A Alhwoaimel,1 Bader A Alqahtani,1 Mohammed M Alshehri,2 Ahmed S Alhowimel,1 Kamlesh Khunti,3 Mohammed S Alghamdi4 1Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; 2Department of Physical Therapy, Jazan University, Jazan, Saudi Arabia; 3Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK; 4Department of Medical Rehabilitation Sciences, Umm Al-Qura University, Makkah, Saudi ArabiaCorrespondence: Aqeel M Alenazi, Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alt-Kharj, 11942, Saudi Arabia, Tel +966115886354, Email [email protected]; [email protected]: Previous studies have suggested an association between falls and the presence of Multiple Long-Term Conditions (MLTC) or disabilities. However, there is limited understanding of how these factors independently or collectively contribute to the risk of falls and fear of falling among community-dwelling adults.Objective: This study examined the independent association between MLTC and the presence of disability with the risk of falls among community adults.Methods: A cross-sectional study included 324 adults (age ≥ 50). Demographic and clinical data included age, sex, body mass index (BMI), MLTC (≥ two chronic diseases) risk of fall (ie, history of fall in the previous 12-months, number of falls, and recurrent falls). The Barthel Index and Falls Efficacy Scale-International (FES-I) were used to assess disability and fear of fall, respectively.Results: MLTC (Odds Ratio (OR) 2.50, 95% Confidence Interval (CI) [1.26, 4.95], p=0.009), and disability (OR 1.71, 95% CI [1.04, 2.79], p = 0.034) were independently associated with history of falls. MLTC (Incidence Rate Ratio (IRR) 2.87, 95% CI [1.93, 4.29], p < 0.001) and disability (IRR 1.86 95% CI [1.46, 2.36], p < 0.001) were independently associated with an increased number of falls. MLTC (OR 4.50, 95% CI [1.78, 11.36], p = 0.001) and disability (OR 2.82, 95% CI [1.58, 5.05], p < 0.001) were independently associated with recurrent falls. MLTC (B = 6.45, p < 0.001) and disability (B = 3.05, p = 0.025) were independently associated with increased fear of falling.Conclusion: This study indicated that both MLTC and disability are independently associated with falls, number of falls and fear of falling in this population.Keywords: falling, disabilities, impairments, functional limitations, multiple chronic diseases, multimorbidity, Saud

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Bromocriptine for Idiopathic Intracranial Hypertension: A Retrospective Multicenter Cohort Study

Mahmoud M Morsy,1,&ast; Ahmed Y Azzam,1,&ast; Mohammed Tarek Mirdad,2 Alsaleem Mohammed Abadi,3 Saif Aboud M Alqahtani,4 Hana J Abukhadijah,5 Osman Elamin,6 Mohamed D Morsy,7 David J Altschul8,9 1October 6 University Hospital, October 6 University, Giza, Egypt; 2College of Medicine, King Khalid University, Abha, Saudi Arabia; 3Family and Community Medicine Department, College of Medicine, King Khalid University, Abha, Saudi Arabia; 4Internal Medicine Department, College of Medicine, King Khalid University, Abha, Saudi Arabia; 5Medical Research Center, Hamad Medical Corporation, Doha, Qatar; 6Department of Jordan Hospital Neurosurgery, Amman, Jordan; 7Department of Clinical Physiology, College of Medicine, King Khalid University, Abha, Saudi Arabia; 8Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; 9Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA&ast;These authors contributed equally to this workCorrespondence: David J Altschul, Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10467, USA, Email [email protected]: Idiopathic Intracranial Hypertension (IIH) is a disorder characterized by elevated intracranial pressure without an identifiable cause, commonly affecting young obese women. Current treatment strategies, including weight loss, acetazolamide, and surgical interventions, have limitations due to side effects, adherence challenges, and potential complications. Bromocriptine, a dopamine D2 receptor agonist, has emerged as a potential novel therapy due to its metabolic effects. This study aims to evaluate the safety and efficacy of bromocriptine in IIH management through a retrospective cohort analysis.Methods: A retrospective analysis was conducted, focusing on patients with IIH. Propensity score matching was applied to balance baseline characteristics, including age, sex, race, and BMI, between the bromocriptine and control groups. Key outcome measures, papilledema, headache severity, refractory IIH status, and acetazolamide dose dependency, were assessed at multiple follow-up intervals.Results: The bromocriptine group demonstrated significant improvement in papilledema and headache severity over 24 months, with early effects observed at one month. There was a marked reduction in refractory IIH (30.66% lower incidence at 24 months, p< 0.0001) and reduced dependency on acetazolamide from three months onward (p=0.0246). The safety profile was favorable, with comparable adverse event rates to controls, although allergic skin reactions were noted in the bromocriptine group.Conclusion: Bromocriptine shows promise as an effective and safe therapeutic option for IIH, with sustained improvement in clinical parameters and reduced reliance on conventional treatment. Future randomized controlled trials are needed to confirm these findings and explore optimal dosing strategies.Keywords: idiopathic intracranial hypertension, pseudotumor cerebri, intracranial pressure, bromocriptine, dopamin

The Burden of Obesity in Saudi Arabia: A Real-World Cost-of-Illness Study

Mouaddh Abdulmalik Nagi,1,2 Ziyad Saeed Almalki,3,&ast; Montarat Thavorncharoensap,4,5,&ast; Sermsiri Sangroongruangsri,4 Saowalak Turongkaravee,4 Usa Chaikledkaew,4,5 Abdulhadi M Alqahtani,6 Lamis S AlSharif,6 Ibrahim A Alsubaihi,7 Abdulaziz I Alzarea,8 Mohammed M Alsultan9 1Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; 2Department of Pharmacy, Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen; 3Department of Clinical Pharmacy, Prince Sattam bin Abdulaziz University, Riyadh - Al-Kharj, Saudi Arabia; 4Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; 5Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand; 6Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia; 7Department of Clinical Trials Support and Development, Saudi National Institute of Health, Riyadh, Saudi Arabia; 8Department of Clinical Pharmacy, Al-Jouf University College of Pharmacy, Sakaka, Saudi Arabia; 9Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Ziyad Saeed Almalki, Department of Clinical Pharmacy, Prince Sattam bin Abdulaziz University, P.O. Box: 173, Riyadh - Al-Kharj, 11942, Saudi Arabia, Email [email protected] Montarat Thavorncharoensap, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand, Email [email protected]: The rising prevalence of obesity in the Kingdom of Saudi Arabia (KSA) poses a significant public health challenge. Estimates of the economic cost of obesity are crucial for prioritizing healthcare interventions, guiding policy choices, and justifying budget allocations aimed at reducing obesity prevalence. This study aimed to estimate the cost of obesity in the KSA in 2022.Methods: A prevalence-based cost-of-illness approach was used to determine the cost of obesity. This analysis encompasses 29 diseases, namely obesity and twenty-eight diseases attributable to obesity. Both direct and indirect costs were considered. The annual cost of treatment for each obesity-attributable disease was obtained from the hospital records of one tertiary hospital in the KSA. Data on direct non-medical costs were obtained from the patient survey. The human capital approach was used to estimate the indirect costs of morbidity and mortality.Results: The total economic burden of obesity (2022 values) was estimated at US&dollar;116.85 billion from a societal perspective and US&dollar;109.67 billion from a healthcare system perspective. From a societal perspective, the total direct medical cost accounted for the largest portion of the total cost (94%). In terms of direct medical costs, the cost of treating diseases attributable to obesity was substantially greater than the cost of treating obesity itself. According to the sensitivity analysis, the total cost ranged from 3.4% of the country’s Gross domestic product (GDP) when the unit cost of treatment was reduced by 74% to 9.5% of the country’s GDP when the prevalence of obesity and its comorbidities was reduced by 5%.Conclusion: Obesity imposes a substantial economic burden on the healthcare system and society in the KSA. Interventions aimed at promoting healthier lifestyles to reduce the prevalence and incidence of obesity and its comorbidities are highly warranted to alleviate the impact of obesity in the country.Keywords: body mass index, cost-of-illness, economic burden, obesity, Saudi Arabi

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Evaluation of Radiant Power of the Light Curing Units Used in Clinics at Governmental and Privates Dental Faculties

Sami Abdulsalam Ali Hasan,1 Ibrahim Zaid Al-Shami,1 Mohsen Ali Al-Hamzi,1 Ghadeer Saleh Alwadai,2 Nada Ahmad Alamoudi,2 Saleh Ali Alqahtani,2 Arwa Daghrery,3 Wafa H Alaajam,4,5 Mansoor Shariff,6 Hussain Mohammed Kinani,7 Mohammed M Al Moaleem8 1Department of Conservative Dentistry, Faculty of Dentistry, Sana’a University, Sanaa, Yemen; 2Department: Restorative Dental Science, College of Dentistry, King Khalid University, Abha, Saudi Arabia; 3Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, 45142, Saudi Arabia; 4Department of Restorative Dental Science, College of Dentistry, King Khalid University, Abha, Saudi Arabia; 5Department of Restorative Dentistry, Faculty of Dentistry, Sana’a University, Sana’a, Yemen; 6Prosthetic Department, College of Dentistry, King Khalid University, Abha, 62529, Saudi Arabia; 7Ministry of Health, Sabya General Hospital, Department of Dentistry, Jazan, Saudi Arabia; 8Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, 45142, Saudi ArabiaCorrespondence: Mohammed M Al Moaleem, Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, 45142, Saudi Arabia, Email [email protected]:  To evaluate the radiant power of the light cure units (LCUs) in relation to their type, radiant exitance, number of years in clinical use, and condition of LCUs tips in governmental and public clinics in Dental Faculties in Sana’a City.Materials and Methods: LCUs were collected from different colleges at Sanaa City, Yemen, then LCU data as type, clinical age ( 850 mW/cm², labeled as inadequate, marginal, and adequate radiant exitances, respectively. A Woodpecker radiometer was used with a mode lasting of 20 seconds was used with each LCU. Descriptive statistics of the different parameters were evaluated with SPSS version 25. One-way ANOVA and Mann–Whitney tests were performed to determine the mean difference between the groups with a significance value of ˂ 0.05 was considered.Results: Two hundred twenty-three LCUs were surveyed, and the majority were Light–emitting diode (LED). Forty-nine (21.9%), 117 (52.4%), 57 (25.6%) recorded lesser than, 400– 850, and more than 850 mW/cm², respectively. Radiant exitances of < year-old units were found to be higher than those of units used for ˃ 5 years with significant differences (p=0.001). The ANOVA test showed significant differences between the radiant exitance with clinical age and LCU tip conditions and a strong correlation p ˃ 0.050.Conclusion: LED curing lights were the most used in the tested Dental Faculties. More than half of the used LCU offered sufficient radiant exitance. Clinical age, the presence or absence of composite buildups, and damage to curing tips showed significantly affect radiant exitance values.Keywords: dental light cure, radiant exitance, contaminated tip, radiomete

Cost-Effectiveness Analysis of Ofatumumab versus Teriflunomide for Relapsing-Remitting Multiple Sclerosis: A 10-Year Markov Model

Ziyad Saeed Almalki,1 Mashael Mafleh Alshammari,2 Saja H Almazrou,2 Ohud Abd Alhadi Alqahtani,3 Maryam Riyadh Alkhayat,3 Shahad Fahad Alnemari,3 Haya Showky Mukhemair,3 Sara Mohamaad Alkredeas,3 Abdulrahman A Alsuhibani,4 Bushra Yousif Asiri,3 Tala Nouraldin Alalawi,3 Abdullah K Alahmari,1 Fahad Obaid Alotaibi5 1Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia; 2Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 3Collage of Pharmacy, Almaarefa University, Riyadh, Saudi Arabia; 4Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia; 5Forensic Medical Services Center, Ministry of Health, Riyadh, Saudi ArabiaCorrespondence: Ziyad Saeed Almalki, Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia, Tel +966-11 588 7315, Email [email protected] and Objectives: Ofatumumab, a fully human anti-CD20 monoclonal antibody, is a promising disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS). This study investigates its cost-effectiveness compared to teriflunomide from the perspective of Saudi healthcare payers. This comparison is crucial for informing treatment strategies and resource allocation in Saudi Arabia, where RRMS poses a significant healthcare burden and access to newer DMTs is evolving.Patients and Methods: A Markov model was constructed to evaluate the long-term cost-effectiveness of ofatumumab compared to teriflunomide for treating RRMS in Saudi Arabia. This model simulates disease progression over 10 years, a timeframe chosen for its clinical relevance and consistency with similar studies. To reflect the Saudi patient population, the model uses a hypothetical cohort with characteristics mirroring those in the ASCLEPIOS I/II clinical trials. The model incorporates transition probabilities between disease states, primarily derived from the British Columbia MS (BCMS) database and further refined using data from the ASCLEPIOS trials. To ensure relevance to the Saudi context, local data sources were utilized, including drug costs from the Saudi Food and Drug Authority (SFDA) and health state costs from published local studies. Clinical expert input was incorporated to validate model assumptions.The primary outcome measure was the incremental cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were conducted to assess the robustness of the model findings.Results: Compared to teriflunomide, ofatumumab yielded incremental cost-effectiveness ratios (ICERs) of &dollar;46,188 per QALY over the 10-year period. Ofatumumab demonstrated a greater impact on reducing disability progression, particularly in the early stages of the disease. At a willingness-to-pay (WTP) threshold of &dollar;99,120 per QALY, ofatumumab demonstrated a 99.14% probability of cost-effectiveness in probabilistic sensitivity analyses.Conclusion: This cost-effectiveness analysis demonstrates that ofatumumab is a cost-effective treatment for RRMS in Saudi Arabia, with an ICER below the WTP. Policymakers should consider including ofatumumab in national formularies and prioritize its use in early-stage RRMS to maximize patient benefit and cost-effectiveness.Keywords: cost-effectiveness analysis, ofatumumab, teriflunomide, relapsing-remitting multiple sclerosis, expanded disability status scale, ASCLEPIOS clinical trials, Saudi Arabia, disease-modifying therap