The retina’s intricate interplay of forces and structures, with a focus on the retinal pigment epithelium (RPE) and photoreceptors, is essential for retinal health and function. Among these forces, electrostatic forces play a crucial role, working alongside van der Waals forces and oncotic pressure to maintain the retina’s attachment to the RPE and ensure the integrity of the blood-retina barrier (BRB). The composition of the interphotoreceptor matrix (IPM), influenced by molecules like Retbindin secreted by rod photoreceptors, further modulates these forces, affecting processes like visual pigment regeneration and metabolite exchange. In the context of retinal tissue engineering and new technologies for support and cells-based treatments, electrostatic forces are harnessed to optimize nutrient supply to transplanted RPE cells by reducing pore size in electrospun polymer membranes. Scaffold-based strategies for retinal repair also utilize electrostatic, hydrophobic, van der Waals, and hydrogen bonding forces to enhance cell adhesion and growth, mimicking the basement membrane. Understanding the complex dynamics of these forces in retinal-RPE interactions holds promise for innovative treatments for retinal disorders, emphasizing the intricate balance between electrostatic forces, van der Waals forces, oncotic pressure, and more. These insights open exciting avenues for research and therapeutic interventions in ophthalmology. Additionally, van der Waals forces are explored in the context of cell adhesion, and their potential role in retinal health is discussed, particularly in relation to melanin’s protective properties against blue light-induced damage. Tissue engineering approaches, both scaffold-free and scaffold-based, are discussed, highlighting the importance of physical surface treatments and adhesive forces in preserving engineered RPE tissue. Overall, this abstract provides a comprehensive overview of the multifaceted role of electrostatic and other forces in retinal biology and their implications for future research and clinical applications in ophthalmology.

Ophthalmology is a crucial aspect of primary care, often featuring prominently in both general practice and emergency settings. With over 2 billion individuals worldwide affected by visual impairment, proficiency in basic ophthalmology is essential for general practitioners and emergency physicians. A cross-sectional study was conducted involving 624 medical students from six universities in Jordan. Data were collected using a questionnaire assessing knowledge, diagnostic abilities, and treatment skills in ophthalmology, alongside demographic information and student satisfaction with their ophthalmology rotations. Statistical analyses were performed using SPSS to identify significant associations between variables, with a p-value of less than 0.05 considered statistically significant. Informed consent was obtained from all participants. The majority of participants (44.6

There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. 1874 patients from 159 centres across 52 countries were included. 78.3

Introduction: Primary pleural hydatid cysts (PPHCs) are a rare clinical condition caused by the larval stage of the parasite Echinococcus granulosus. They occur in <1 % of all hydatid cysts in the body and can cause serious complications such as pneumothorax, pleural effusion, and mediastinal shift. Presentation of case: We report a rare case of a 28 -year -old female who was initially misdiagnosed and ignored her pneumothorax for several months, resulting in progressive dyspnea and chest pain. After performing radiological images, a primary pleural hydatid cyst was suspected. She was surgically treated and the cyst was removed by our doctors and the patient improved without any significant complications. Discussion: PPHCs are a challenging diagnosis due to their nonspecific symptoms and low prevalence. They can mimic other pleural diseases such as tuberculosis, empyema, or malignancy. The diagnosis of PPHCs requires a high index of suspicion and a combination of imaging, serology, and histopathology. The treatment of choice is surgical removal of the cyst, along with perioperative anthelmintic therapy to prevent recurrence and anaphylaxis. Conclusion: PPHCs are a rare but potentially life -threatening condition that requires early diagnosis and management. Clinicians should be aware of this entity and include it in the differential diagnosis of pleural diseases, especially in developing countries. Surgical treatment is effective and safe, and can improve the quality of life of patients with PPHCs.

Key Clinical Message This case highlights the need for further research to explore a potential link between systemic sclerosis and fistula development, and the importance of raising awareness among clinicians about this possibility for timely appropriate management. Abstract The primary diagnosis in this case is systemic sclerosis (scleroderma) in a 47‐year‐old female patient with various clinical manifestations, including vesicovaginal and vesicorectal fistulas. The medical interventions and diagnostic workup involved an electrocardiogram, cardiac echocardiogram, pulmonary function tests, beta blockers, aspirin, inhaled corticosteroids, albuterol, endoscopy, biopsy, treatment for Helicobacter pylori infection, fluconazole for candida esophagitis, endoscopic dilation for achalasia, anticholinergic therapy for mixed urinary incontinence, gabapentin for neuropathic symptoms, analgesia for knee pain, and psychiatric treatment with selective serotonin reuptake inhibitors. The outcomes described in the case report include the diagnosis of systemic sclerosis, the identification of vesicovaginal and vesicorectal fistulas, the patient's medical history and symptoms over the years, and various treatments and management strategies.

Background: Endoscopic surgery is now increasingly taking the place of open surgery in urology. Traditionally, endourological procedures are classified as clean-contaminated because the genitourinary tract is colonized by micro-flora, even in the case of sterile urine. The aim of this study was to determine whether a difference occurs in the infection rate after short endourological procedures using standard scrubbing and partial scrubbing techniques before the operations. Patients and Methods: This was a retrospective analysis of 397 patients who underwent a short endourological procedure, with all procedure durations lasting <30 min. Patients were divided into a first group who underwent operations using a full-scrub technique and a second group who underwent operations using a partial-scrub technique. All patients were followed up for the occurrence of urinary tract infections (UTIs). Both groups were compared for age, gender, and post-operative development of UTIs. Values of p < 0.05 were considered statistically significant. Results: Of the 397 patients, 200 and 197 underwent their procedures using the full-scrub and partial-scrub techniques, respectively. Females and males accounted for 142 (35.8%) and 255 (64.2%) patients, respectively. Only 18 (4.5%) patients developed documented UTIs and antibiotics were prescribed. Of the 18 patients diagnosed with post-operative UTIs, 10 (55.5%) had undergone partial-scrub operations and 8 (45.5%) had undergone full-scrub operations (p = 0.638). Conclusion: Our findings did not indicate any significant relationship between the risk of developing UTI after a short endourological procedure and the scrub technique used before the operation (partial or full scrub).

Abstract Background Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes according to GASTRODATA Registry for elective gastric cancer surgery patients and identify risk factors. Method We conducted an international prospective study on ≥18 years patients undergoing elective surgery for gastric cancer with curative intent from 01 April 2022 to 30 September 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression was used to identify variables associated to 90-day outcome. Results 380 collaborators from 47 countries submitted data on 1538 patients. Mean age was 64.2 years and 58.5% were males. 90-day morbidity rate was 38.2% (n=587) and mortality rate was 2.9% (n=45). Pre-operative higher CCI or ASA score, pre-operative weight loss >10%, and surgical determinants such as type of gastric resection, positive specimen margin, number of harvested lymph nodes, longer surgery duration and post operative pathological IV staging (p value<0.05) were identified as predictors of postoperative severe complications and mortality. Conclusion Elective gastric cancer surgery has a 90-day morbidity of 38.2% and 90-day mortality of 2.9%, globally. This study identified several factors associated with higher morbidity and exemplified the importance of a unified language on surgical morbidity, pre-habilitation and ongoing audits to enhance patient outcomes.

BackgroundNo robust data are available on the safety of primary bariatric and metabolic surgery (BMS) alone compared to primary BMS combined with other procedures.ObjectivesThe objective of this study is to collect a 30-day mortality and morbidity of primary BMS combined with cholecystectomy, ventral hernia repair, or hiatal hernia repair.SettingThis is as an international, multicenter, prospective, and observational audit of patients undergoing primary BMS combined with one or more additional procedures.MethodsThe audit took place from January 1 to June 30, 2022. A descriptive analysis was conducted. A propensity score matching analysis compared the BLEND study patients with those from the GENEVA cohort to obtain objective evaluation between combined procedures and primary BMS alone.ResultsA total of 75 centers submitted data on 1036 patients. Sleeve gastrectomy was the most commonly primary BMS (N = 653, 63%), and hiatal hernia repair was the most commonly concomitant procedure (N = 447, 43.1%). RYGB accounted for the highest percentage (20.6%) of a 30-day morbidity, followed by SG (10.5%). More than one combined procedures had the highest morbidities among all combinations (17.1%). Out of overall 134 complications, 129 (96.2%) were Clavien-Dindo I-III, and 4 were CD V. Patients who underwent a primary bariatric surgery combined with another procedure had a pronounced increase in a 30-day complication rate compared with patients who underwent only BMS (12.7% vs. 7.1%).ConclusionCombining BMS with another procedure increases the risk of complications, but most are minor and require no further treatment. Combined procedures with primary BMS is a viable option to consider in selected patients following multi-disciplinary discussion.

Background: Hepatitis B infection is a potentially fatal liver illness caused by the hepatitis B virus (HBV). In recent years, the Centres for Disease Control have recognised pharmacists as immunisation providers and potential educators for patients and their families on the importance of vaccination and the best drug use. This study aimed to evaluate Jordanian pharmacy students’ knowledge, attitudes, and practices towards HBV infection. Methods: A cross-sectional study was conducted among 626 Jordanian pharmacy students to assess their knowledge, attitudes, and practices. Results: Of the 626 respondents, 19.8% were males and 81% were females. Students were mostly knowledgeable about disease transmission, and a substantial percentage were aware of the importance of vaccination in preventing it. Females, fifth-year students, and those who encountered infected patients have shown significantly better knowledge of HBV. Conclusion: Knowledge, attitudes, and practices towards HBV infection among pharmacy students in Jordan are unsatisfactory. More effort should be made to raise awareness among future pharmacy students and explore other factors associated with these low levels of awareness.

One of the most common health concerns disturbing people within working years globally is diabetes mellitus (DM). One well-known consequence of DM is vascular damage, which can manifest as macro- and microangiopathy affecting the ocular retina. Therefore, Diabetic macular edema (DME) is a major sight-threatening complication of diabetic retinopathy (DR) worldwide. It is the most prevalent cause of significant vision impairment in diabetic patients. Long-term vision loss can be avoided by following early DME treatment guidelines in everyday life. Hence, there are various therapeutic approaches for DME management. Currently, the first-line treatment for DME is anti-VEGF family drugs, such as ranibizumab, brolucizumab, bevacizumab, and aflibercept. Nevertheless, relapses of the disease, inadequate response, and resistance during anti-VEGF therapy are still seen because of the intricate pathophysiological foundation of the disease. Consequently, there is an excellent requirement for therapeutic approaches to advance and become better at controlling diseases more satisfactorily and require fewer treatments overall. We conducted a thorough literature search in the current review to present a comprehensive overview of the primary data about the current DME therapeutic agents. We also covered the novel advances in DME management and probable future treatments being investigated and developed. This review recommended that Large clinical trials should afford sufficient evidence to support these innovative treatment modalities.

Introduction:Renal cell carcinoma (RCC) is a type of urological malignancy that affects approximately 2% of the global population. Imaging modalities, especially computed tomography (CT) scanning, play a critical role in diagnosing RCC. In this study, we investigated whether there is a relationship between tumour grade of clear cell RCC and HU values of renal lesions on CT scan performed before operation.Materials and Methods:We conducted a retrospective analysis of 123 patients who underwent radical or partial (open or laparoscopic) nephrectomy for clear cell RCC between January 2017 and January 2021. Post-operation histopathological grades were recorded according to World Health Organization (WHO)/International Society of Urological Pathology (ISUP) 2016 grading system and divided into low grade (includes grade 1 and 2) and high grade (grade 3 and 4), and their links to age, sex, smoking habits, tumour size, and HUs of renal lesions were evaluated.Results:The mean age of the patients studied was 63.02 years old. About 56.9% of the patients were low grade (grade 1 or grade 2), while 43.1% were high grade (grade 3 or 4). The mean tumour size was 6.31 cm. There were no significant differences in tumour grade according to age, sex, or smoking habits. We found a significant relation between tumour grade and HU in the pre-contrast and nephrogenic phases, with p values of 0.001 and 0.037, respectively. On the other hand, there was no significant relation linking the tumour grade to the difference in HU between these phases, where there was a p value of 0.641.Conclusion:HU in the pre-contrast and nephrogenic phases in addition to tumour size on CT scan have a significant relation to clear cell RCC grade.

Gastric volvulus and wandering spleen are two rare and uncommon conditions. Gastric volvulus is characterized by the rotation of the stomach around itself, causing a closed obstruction. It was first described in the 19th century and is classified according to the axis, etiology, or chronicity. A wandering spleen is defined by the absence of one or all of the splenic ligaments, which occurs either for congenital or acquired reasons. An enlarged spleen may contribute to the wandering spleen and, in turn, lead to gastric volvulus and infarction of the stomach, requiring emergency surgical intervention. In this report, we present a case of a 19-year-old female who presented to the emergency department with severe abdominal pain and epigastric distension. After performing the necessary investigations, she was diagnosed with a wandering spleen and acute gastric volvulus. An immediate laparotomy was performed and both the spleen and the stomach were resected to save the patient’s life at the right time.

On 11 March 2020, the World Health Organization (WHO) declared the novel SARS-CoV-2 virus responsible for causing COVID-19, a global pandemic. The virus primarily targets the respiratory system but can also affect other systems, notably causing hematological pathologies. Anemia, a common hematologic disorder, is characterized by the reduced oxygen-carrying capacity of red blood cells. The existing literature has a suspected link between anemia and severe COVID-19 cases. Researchers are currently investigating the long-term complications of COVID-19 in anemic patients, as these complications may play a crucial role in predicting patient prognosis. Anemic individuals are at a higher risk of experiencing severe COVID-19 infections due to several contributing pathophysiological mechanisms, including thrombotic, hemorrhagic, and autoimmune etiologies. The primary effect of these mechanisms is a decrease in circulating hemoglobin levels, reducing oxygen availability for cells. This exacerbates the hypoxia caused by COVID-19-induced acute respiratory distress syndrome (ARDS). This review offers a comprehensive overview of the evidence regarding the long-term complications of COVID-19 in anemic patients.

Background: The end of smallpox in 1980 and the subsequent stopping of vaccination against smallpox was followed by the emergence of monkeypox (mpox), a viral disease of animal origin, meaning that it is transmitted from animal to human. The symptoms of mpox are similar to smallpox, except that they are less severe in terms of clinical features. In the case of public health, the mpox virus is one of the most important orthopoxviruses (such as variola, cowpox, and vaccinia) that come from the family Poxviridae. Mpox occurs mostly in central Africa and sometimes in tropical rainforests or some urban areas. Also, there are threats other than COVID-19, that must be addressed and prevented from spreading, as there has been an outbreak of mpox cases since May 7, 2022, throughout the USA, Europe, Australia, and part of Africa. Objectives: In this review, we will discuss mpox between the past, the present and during the COVID-19 pandemic. Also, it offers an updated summary of the taxonomy, etiology, transmission, and epidemiology of mpox illness. In addition, the current review aims to highlight the importance of emerging pandemics in the same era such as mpox and COVID-19.Methods: A literature search was done for the study using online sources like PubMed and Google Scholar. Publications in English were included. Data for study variables were extracted. After the duplicate articles were eliminated, full-text screening was performed on the papers' titles and abstracts.Results: The evaluation included a series documenting mpox virus outbreaks, and both prospective and retrospectiveinvestigations. Conclusions: monkeypox is a viral disease caused by the monkeypox virus (MPXV), which is primarily found in central and western Africa. The disease is transmitted from animals to humans and presents symptoms similar to those of smallpox, including fever, headache, muscle aches, and a rash. Monkeypox can lead to complications such as secondary integument infection, bronchopneumonia, sepsis, and encephalitis, as well as corneal infection that can result in blindness. There is no specific clinically proven treatment for mon-keypox, and treatment is primarily supportive. However, antiviral drugs and vaccines are available for cross -protection against the virus, and strict infection control measures and vaccination of close contacts of af-fected individuals can help prevent and control outbreaks.(c) 2023 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/ 4.0/)

Background: Ivor lewis oesophagectomy (ILO) for oesophageal cancer (OC) is associated with high morbidity with an anastomotic leak (AL) rate of upto 30% been quoted in literature.This can lead to return to intensive care, delayed recovery and mortality.Several techniques have been developed in an attempt to reduce this risk such as, hand sewn technique, circular anastomosis and side to side linear stapled anastomosis (LSA).Recent meta-analysis suggested reduced AL with LSA.We demonstrate our technique for a totally robotic side to side LSA performed for distal OC.Methods: We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and surgical description.74 year old male patient with a BMI of 30 and performance status of 1, underwent robotic ILO for a Siewert type 1 T2N1 distal oesophageal adenocarcinoma after neo-adjuvant chemotherapy.Preoperatively staging investigations included endoscopy, endoscopic ultrasound, computerised tomography (CT) and positron emission tomography (PET).Fitness was assessed using cardio-pulmonary exercise testing (CPET).Results: Patient was on the high dependency unit as per our routine practice for less than 24 hours and was transferred to our monitored ward bed.Enhanced recovery after surgery (ERAS) protocol was followed.There were no complications and patient was discharged in 8 days following ILO.Conclusions: We demonstrate our technique using side to side LSA for robotic ILO.

Chlorine gas is a hazardous substance that can cause severe health effects when inhaled or exposed to the skin. It is an odorless, colorless gas in many industrial and manufacturing settings and conflict areas. While exposure to chlorine gas is generally limited to the workplace and public areas, there are instances in which people may be exposed to high levels of chlorine gas for a short period of time due to spills, mishaps on the road or railroads, or other tragedies. In addition to the general health effects of chlorine gas, this essay will focus on the effects of chlorine gas on the eyes. The eyes are particularly sensitive to chlorine gas, and exposure can cause various symptoms, ranging from mild irritation to severe damage. Symptoms of chlorine gas exposure to the eyes include redness, burning, tearing, and blurred vision. In more serious cases, exposure to chlorine gas can cause permanent damage to the eyes, including corneal ulcers, scarring, and blindness. It is important to be aware of the signs and symptoms of chlorine gas exposure and the potential long-term effects to take the necessary steps to protect oneself. In addition to the potential health effects, it is important to understand the properties of chlorine gas. Chlorine gas is heavier than air and tends to settle in low-lying areas. It is highly reactive and can react with other substances to form hazardous compounds. As such, it is important to be aware of the potential for chlorine gas to react with other environmental substances and accumulate in certain areas. Finally, it is important to understand the background of chlorine gas use in various conflict areas. Chlorine gas has been used as a chemical weapon for centuries, and its use in modern warfare has been documented in various conflicts. As such, it is important to be aware of the potential for chlorine gas to be used in war zones and to take the necessary precautions to protect oneself. In conclusion, chlorine gas is a hazardous substance that can cause severe health effects when inhaled or exposed to the skin. The eyes are particularly sensitive to chlorine gas, and exposure can cause various symptoms, ranging from mild irritation to severe damage. It is important to be aware of the signs and symptoms of chlorine gas exposure and the potential long-term effects to take the necessary steps to protect oneself. Additionally, it is important to understand chlorine gas's properties and its background use in various conflict areas.

In female mammals, the development and regulation of the reproductive system and non-reproductive system are significantly influenced by estrogens (oestrogens). In addition, lipid metabolism is another physiological role of estrogens. Estrogens act through different types of receptors to introduce signals to the target cell by affecting many estrogen response elements. Breast cancer is considered mostly a hormone-dependent disease. Approximately 70% of breast cancers express progesterone receptors and/or estrogen receptors, and they are a good marker for cancer prognosis. This review will discuss estrogen metabolism and the interaction of estrogen metabolites with breast cancer. The carcinogenic role of estrogen is discussed in light of both conventional and atypical cancers susceptible to hormones, such as prostate, endometrial, and lung cancer, as we examine how estrogen contributes to the formation and activation of breast cancer. In addition, this review will discuss other factors that can be associated with estrogen-driven breast cancer.

This case reports an 89-year-old male who presented with sepsis, disseminated intravascular coagulopathy, acute kidney injury, and upper GI bleeding to the emergency department. He was admitted to the ICU, where he was managed for septic shock, diabetic ketoacidosis, and coagulopathy then sent home on medications with an improved status.

Face masks, along with other preventive measures, can help slow the spread of COVID-19. Despite the positive effect of the mask in combating the virus, it has some negative effects on the human body that must be followed up on and reduced. In this study, we discuss the impact of wearing face masks on the eye and the common issues associated with using them. The literature search was conducted using electronic databases such as PubMed and Google Scholar. Only articles published in English were included. A total of 39 relevant articles were deemed eligible. After the duplicate articles were removed, the titles and abstracts of 20 papers underwent full-text screening. The review comprised both prospective and retrospective investigations, case reports, and a series of reporting ocular symptoms following the use of face masks. The COVID-19 pandemic affected ophthalmology practices in managing patients. New factors must be considered, especially when dealing with anti-VEGF injections, such as the risk of endophthalmitis, tests and symptoms of patients with glaucoma, and the emerging symptoms associated with the COVID-19 vaccination. The use of face masks and breathing aids seemed to influence the tear film.

COVID-19 is caused by a novel coronavirus (2019-nCoV), which was declared as a pandemic after it emerged in China 2019. A vast international effort has been conducted to prevent and treat COVID-19 due to its high transmissibility and severe morbidity and mortality rates, particularly in individuals with chronic co-morbidities. In addition, polymorphic variants increased the need for proper vaccination to overcome the infectivity of new variants that are emerging across the globe. Many treatment options have been proposed and more than 25 vaccines are in various stages of development; however, the infection peaks are oscillating periodically, which raises a significant question about the effectiveness of the prevention measures and the persistence of this pandemic disease. In this review, we are exploring the most recent knowledge and advances in the treatment and vaccination options as well as the new emerging variants of 2019-nCoV and the possible mitigation of one of the most aggressive pandemics in the last centuries.