Dr Mohammed Mahmoud Youssif

“Global warming” or “climate change” is caused by rising fossil fuel emissions, harming the environment and agriculture. Immediate solutions for sustainable growth are needed. Diesel engines, although efficient and durable, produce more pollutants than gasoline engines and are widely used in power-intensive applications. Reducing these pollutants is essential for environmental and public health, achievable through new technology. The article reviews methods for cleaning diesel exhaust, noting that emission after-treatment devices lose efficiency over time, affecting engine performance. Emphasizing durability, it highlights maintaining high purification standards to meet regulatory and environmental goals. The costs of diesel exhaust purification units vary based on technology complexity, material quality, and application scale. Advanced systems like selective catalytic reduction (SCR) and diesel particulate filters (DPF) require significant investments to ensure efficiency and durability. Installation costs, particularly for retrofitting, can be substantial, and ongoing maintenance and replacement parts add to long-term expenses. Despite these high initial and operational costs, these units are essential for complying with environmental regulations and reducing health risks from diesel emissions. Economic burdens can be alleviated through government incentives and subsidies that promote cleaner technologies.

Eosinophilic esophagitis (EoE) is a type 2 inflammatory esophageal disease that presents in adults as dysphagia and food impaction. EoE is characterized by a predominance of T helper 2 cells among the T cell population. Environmental agents, including food antigens and aeroallergens, trigger EoE. EoE exhibits immunoglobulin E- (IgE-) and non-IgE-mediated allergic responses to these environmental allergens. Local antigen-specific IgE can also trigger mast cell degranulation, thereby worsening EoE. Individuals with atopic dermatitis, asthma, IgE-mediated food allergy, or allergic rhinitis are at a higher risk of developing EoE. EoE treatment aims to achieve clinical improvement, endoscopic mucosal healing, and reduction in or resolution of histological inflammation. However, attaining and maintaining "deep remission" with conventional treatments can be challenging, underscoring the need for targeted therapies. This expert opinion focuses on the latest global recommendations for using novel therapies to improve outcomes in patients with EoE. It also highlights current practices in the Greater Gulf region to manage EoE, identify challenges, and address future educational gaps.

Eosinophilic esophagitis (EoE) is a type 2 inflammatory esophageal disease that presents in adults as dysphagia and food impaction. EoE is characterized by a predominance of T helper 2 cells among the T cell population. Environmental agents, including food antigens and aeroallergens, trigger EoE. EoE exhibits immunoglobulin E- (IgE-) and non-IgE-mediated allergic responses to these environmental allergens. Local antigen-specific IgE can also trigger mast cell degranulation, thereby worsening EoE. Individuals with atopic dermatitis, asthma, IgE-mediated food allergy, or allergic rhinitis are at a higher risk of developing EoE. EoE treatment aims to achieve clinical improvement, endoscopic mucosal healing, and reduction in or resolution of histological inflammation. However, attaining and maintaining "deep remission" with conventional treatments can be challenging, underscoring the need for targeted therapies. This expert opinion focuses on the latest global recommendations for using novel therapies to improve outcomes in patients with EoE. It also highlights current practices in the Greater Gulf region to manage EoE, identify challenges, and address future educational gaps.

Background The world is witnessing tremendous development in the field of new digital tools, including artificial intelligence (AI), in all sectors, including the health and medical sectors. However, educational and training opportunities in the field of artificial intelligence remain nascent and limited. Hence, this study aims to assess the awareness, attitudes, and knowledge of artificial intelligence among students of health specialties in Saudi universities and to assess whether artificial intelligence is viewed as a beneficial innovation or a potential threat to healthcare roles. Methods This cross-sectional study included 498 male and female students from various health colleges at different Saudi universities. The participants completed an online questionnaire adapted from previous studies to assess their awareness, attitudes, and knowledge of artificial intelligence. Descriptive statistics and chi-square analyses were conducted to explore the associations between variables related to artificial intelligence and other factors. Results Most students showed a high level of awareness of artificial intelligence, with social media being identified as their main source of information about artificial intelligence. While students’ attitudes towards AI were generally positive, for example, 89.2% of the students believed that AI would be crucial to the future of healthcare, 76.7% supported AI education, and 78.3% were keen to increase their knowledge of AI. In terms of assessing students’ knowledge of AI, the study revealed that the participating students had moderate knowledge of AI principles and skills, with significant gaps in understanding specific AI capabilities and functions. Conclusions While healthcare students in Saudi Arabia demonstrate strong awareness and positive attitudes towards AI, there are significant gaps in practical knowledge. These findings underscore the need for tailored educational strategies to better integrate AI into curricula, thus preparing future healthcare professionals to effectively leverage AI.

Background: Non-coding RNAs (ncRNAs), including miR-7 and ciRS-7, are implicated in many autoimmune diseases, but their roles in rheumatoid arthritis (RA) stay largely unexplored. Aim of the work: To assess miR-7 and ciRS-7 as diagnostic biomarkers for RA by comparing their expression patterns in patients vs. controls and correlating their profiles with anti-cyclic citrullinated peptide (anti-CCP) levels and clinical findings. Patients and methods: Forty-five patients and 45 controls were enrolled. Enzyme-linked immunosorbent assay (ELISA) was performed to assess plasma anti-CCP levels, and reverse transcription polymerase chain reaction (RT-PCR) was conducted to determine miR-7 and ciRS-7 expression levels. Results: All cases were female with a mean age of 39.6 ± 10.2 years. Cases exhibited significantly lower levels of miR-7 expression than control (median, 0.51 vs. 1.03; p < 0.001), while a significant elevation in ciRS-7 was observed in cases (median, 4.29 vs. 0.93; p < 0.001). Neither miR-7 nor ciRS-7 showed a significant correlation with anti-CCP levels. Meanwhile, miR-7 and ciRS-7 levels significantly correlated with the duration of RA (rs = 0.32, p = 0.03; rs = 0.4, p = 0.01, respectively), while the anti-CCP levels demonstrated a significant negative correlation with disease duration (rs= −0.33, p = 0.03). miR-7 and ciRS-7 significantly distinguish cases from controls at cut-off values of < 0.81 and > 1.7, respectively (AUC = 0.98 and 0.99; p < 0.001), and their combination achieved 100 % diagnostic accuracy, with an AUC of 1 (p < 0.001). Conclusions: miR-7 and ciRS-7 have an inverse relationship, suggesting that ciRS-7 could modulate miR-7 regulatory functions. Both miR-7 and ciRS-7 could be used as diagnostic biomarkers for RA, and their combination could improve RA prediction.

BACKGROUND: Milk is an important dietary source for a healthy and balanced diet, owing to its rich content of proteins, fats, sugars, vitamins, and minerals. Due to the importance of milk macronutrient content for consumers' preferences, a multiplex metabolomics-based approach using Fourier-transform infrared spectroscopy (FTIR) and gas chromatography-mass spectrometry (GC-MS) fingerprinting platforms was employed for the characterization of metabolites in different types of buffalo (BM), cow (CM), goat (GM), and camel (LM) milk.

METHODS: GC-MS and FTIR coupled to chemometric tools (multivariate data analysis) were employed for the discriminative qualitative and quantitative analysis of BM, LM, CM, and GM milk, targeting their primary metabolites. A side-by-side comparative assessment of the performance of both the FTIR and GC-MS methods was implemented in the light of green analytical chemistry principle (GAC) and white analytical chemistry principles (WAC) using the 12 green analytical chemistry principles (12 GAC), analytical greenness metric approach (AGREE), national environmental methods index (NEMI), eco-scale assessment (ESA) and complementary green analytical procedure index (ComplexGAPI), and the red green blue (RGB) 12 algorithms.

RESULTS: The milk types were qualitatively identified by visual inspection of their characteristic FTIR spectra as a fingerprint for each milk type. Quantitatively, GC-MS revealed the presence of 87 peaks belonging to alcohols, amino acids/nitrogenous compounds, fatty acids, organic acids, sterols, sugars, and vitamins. Sugars, mainly lactose, appeared as the major component in all milk types. The highest lactose content was detected in CM 1.07-fold higher than LM making LM a potential alternative for lactose intolerance. Both BM and CM were found to contain the highest organic acid content 5.2-fold higher than that in LM, accounting for their acidity (sourness), while the lowest level was found in LM. On the other hand, LM had the highest vitamins content compared to other milks. Lastly, FTIR outperformed GC-MS in terms of greenness and whiteness, suggesting its utilization as an alternative to traditional chromatographic techniques such as GC-MS.

The Far-Red Impaired Response 1 (FAR1) plant transcription factor plays an essential role in plant development, the transduction of light signals, and stress regulation. The FAR1 gene family has been studied in many plant species. However, no research has been conducted on the FAR1 gene family in finger millet. This study identified 42 EcFAR1 genes within the finger millet. Based on evolutionary analysis, the EcFAR1 genes were divided into five subgroups. Through MEME analysis, it was found that EcFAR1 genes within the same sub-group had conserved motifs. Light and stress-responsive elements were identified in the promotor regions of EcFAR1 genes, indicating their role in abiotic stress. Cellular localization analysis revealed the organelle-specific expression of EcFAR1 genes. Multiple miRNA target sites were identified in EcFAR1, which suggested the significance of FAR1 genes in the finger millet gene regulation. EcFAR1-15, EcFAR1-25, and EcFAR1-31 were significantly upregulated during expression analysis under salt stress. This study provides valuable insights into the functions of FAR1 genes in finger millet development and abiotic stress, which can be used as possible genetic targets to grow stress-resistant cultivars of finger millet.

Summary Introduction Restoration of surgical capacity is essential to post-COVID-19 recovery. This study explored the use and safety of anaesthesia options for inguinal hernia surgery, a common tracer condition, to describe current global practice and highlight opportunities to build the capacity of health systems. Methods This is a secondary analysis of an international prospective cohort study of consecutive patients who underwent elective inguinal hernia surgery. We used a consensus process to define generalisable outcomes to measure patient selection, utilisation of hospital capacity and peri-operative safety in patients who received locoregional, spinal or general anaesthesia for their surgery. Results In total, 16,554 patients from 83 countries were included. Locoregional anaesthesia was performed in 1536 (9.2%) of patients, compared with 9165 (55.4%) who had general and 55,853 (35.4%) who had spinal anaesthesia. Patient selection outcomes were comparable across anaesthesia groups. As a measure of hospital capacity, adjusted day-case rates were higher for locoregional anaesthesia (OR 6.62, 95%CI 5.13?8.54, p?<?0.001) but not for spinal anaesthesia (OR 0.97, 95%CI 0.84?1.12, p?=?0.68) compared with general anaesthesia. Complications were lower in patients who underwent locoregional anaesthesia (OR?=?0.67, 95%CI 0.52?0.87, p?=?0.001) but not for spinal anaesthesia (OR?=?0.90, 95%CI 0.77?1.05, p?=?0.167) compared with general anaesthesia after risk adjustment. Discussion This study has filled knowledge gaps of anaesthesia practice in common surgeries across the world. Locoregional and spinal anaesthesia could be adopted as safe options to increase surgical volume when there is limited access to general anaesthesia.

ABSTRACT Introduction Cancer is one of the most expensive global health challenges and surgery is needed in most cases. This study aimed to describe out-of-pocket payments for cancer surgery across country income groups. Methods This was a preplanned secondary analysis from an international prospective cohort study of consecutive patients undergoing cancer surgery in October 2020. Out-of-pocket payments (OOPP) to cover most of the cost of cancer surgery were compared across country income groups. Other funding sources were also described as follows: public funds, insurance, or others. A logistic regression model was used to identify variables independently associated with OOPP in low- and middle-income countries. Results There were 24,498 patients included from 1332 hospitals from 108 countries. Overall, 6.4% (1571/24,498) had OOPP to cover most of the cost of their cancer surgery. OOPP rates varied across country income groups: 0.5% (89/16,680) in HICs, 5.7% (272/4784) in UMICs, 38.6% (1008/2614) in LMICs, and 48.1% (202/429) in LICs. Besides the country income, male sex (OR 1.16, 95% CI 1.02?1.32, and p = 0.024) and elective surgery (OR 1.31, 1.04?1.67, and p = 0.022) were associated with OOPP for cancer surgery. Discussion Patients accessing cancer surgery in LMICs are at an increased risk of catastrophic expenditure. Governments should prevent this by developing health insurance plans that cover elective cancer surgery, possibly involving diverse stakeholders. The interpretation of gender-related risks demands deeper understanding of the ability to pay out-of-pocket and access care.

Headache disorders, especially migraines and tension-type headaches (TTHs), are major global public health concerns, as shown by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We provide updated global estimates of prevalence and years lived with disability (YLDs) from 1990 to 2021 across 204 countries and territories and forecasts through 2050. In 2021, there are 2.0 billion people with TTH and 1.2 billion with migraine. Although TTH is more prevalent, migraine causes higher disability. While crude prevalence and YLDs increased, age-standardized rates remained stable and are projected to continue this trend due to population growth. There is a disproportionately higher burden in women aged 30-44 and countries with higher Socio-demographic Index and Healthcare Access and Quality Index. Despite this, migraines remain underrecognized in health policies and funding. This study emphasizes the urgent need to prioritize headache disorders in global health agendas.

IMPORTANCE: Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure.OBJECTIVE: To estimate the worldwide burden of SAH.
DESIGN, SETTING, AND PARTICIPANTS: Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021.
EXPOSURES: SAH and 14 modifiable risk factors.
MAIN OUTCOMES AND MEASURES: Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor-specific population attributable fractions (PAFs).
RESULTS: In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100 000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF] = 51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF = 14.4%; 95% UI, 12.4%-16.5%) had the highest attribution.
CONCLUSIONS AND RELEVANCE: Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.

This study aimed to evaluate the health status of rabbits with Sarcoptes scabiei (S. scabiei) lesions scores. From August 2022 to August 2023, 200 domestic rabbits were thoroughly inspected for the presence of mange in their bodies. Lesion scores were recorded; moreover, sera were collected for biochemical analysis, along with infested skin and spleen samples from the infested animals. The clinical skin lesions were present around the head, ears, neck, trunk, feet, and genitalia, which determined the lesion score. The skin lesion scores on the external ear margins, head, nose, and toes were indexed for 5 scores. Infested and un-infested control rabbits were divided into two groups of 10 each according to lesion score, and blood samples were collected from the ear vein for five milliliters of blood. Serum nitric oxide (NOx) and Major histocompatibility class I (MHC-I) were evaluated. The affected rabbits suffered from malnutrition and emaciation. There were also indications of scratching, itching, fur loss, hyperemia, and thickening of the skin with crust formation. The mite specimens in our study were identified as S. scabiei based on the ITS2 gene sequence submitted to GenBank (Accession No. PQ130162). The results of the phylogenetic analysis based on the ITS2 were performed using MEGA 7 software. Serum nitric oxide was evaluated according to the lesion scores; a score of 0 was negative healthy, and then the serum nitric oxide levels were elevated in accordance with the increase in the severity of the diseases as indicated by the lesion scores. There were measurable quantities of major histocompatibility class (MHC)-I mRNA that was examined in each group lesion score, either in the skin or the spleen. The spleen expression profile was higher in all groups than in the skin. With increasing of the score lesion the transcript levels increase.

Hippobosca equina, a common ectoparasite of horses, poses a significant challenge to equine health worldwide. This study provides a molecular characterization of H. equina and examines its impact on host immune responses and oxidative stress. Genetic analysis of samples from various regions revealed notable homogeneity, indicating limited genetic variation among populations. Phylogenetic analysis demonstrated close genetic relationships among sequences from Egypt, France, Kazakhstan and Portugal, while also showing comparable but more distant identities to sequences from China, Denmark, Finland and other countries. Infested horses exhibited elevated levels of pro‐inflammatory cytokines, including IL‐6, TNF‐α and IFN‐γ, relative to uninfested control horses, indicating a strong immune response to the parasite. Additionally, there was a significant increase in oxidative stress markers, including malondialdehyde, catalase, glutathione peroxidase and nitric oxide, indicating substantial cellular damage. These findings highlight the dual impact of H. equina infestations on horse health, prompting both immune activation and oxidative stress. This study emphasizes the importance of targeted pest management strategies that consider the genetic uniformity of parasites and host physiological responses. By providing valuable insights into the complex host–parasite interactions between H. equina and equine hosts, this research enhances our understanding of equine ectoparasites and suggests potential avenues for improving horse health and welfare. Molecular analysis confirmed the identity and phylogenetic placement of Hippobosca equina from equine hosts. Infestation led to significant alterations in immune‐regulating cytokine expression in horses. Increased oxidative stress biomarkers revealed systemic physiological impact of H. equina infestation.