Medicine Papers & Publications

Metronidazole-induced neurotoxicity is a rising challenge in managing susceptible infections. The mechanisms involved in metronidazole-induced neurotoxicity are not fully unraveled. This study aimed to explore the effect of metronidazole on iron homeostasis in SH-SY5Y neuroblastoma cells. Confluent SH-SY5Y neuroblastoma cells were treated with different concentrations of 1.0, 10, 25, 50, 100, and 250 µM of metronidazole only or in combination with 20 µM iron. DMSO or culture media was used as control. Viability and ferritin assays were conducted on the treated cells. The treatments were for 24 hours, 48 hours, and 72 hours, respectively. In the viability assay, doses of metronidazole reduced the viability of SH-SY5Y neuroblastoma cells in a time and concentration-dependent manner. After 24-hour treatment, 250 µM metronidazole significantly reduced cell viability while 50 µM, 100 µM and 250 µM metronidazole reduced considerably viability only after 48-hour and 72-hour compared with control. Different doses of metronidazole 50 µM, 100 µM, and 250 µM in 20 µM iron reduced viability in a time-dependent manner in all the test periods. Metronidazole also induced a time- and concentration-dependent increase (p<0.05) in cellular iron uptake in the 48-hour and 72-hour treated cells in concentrations above 25 µM metronidazole. It is concluded that metronidazole induces a time and concentration-dependent iron overload and consequent cell death in SH-SY5Y neuroblastoma cells and this may contribute to the mechanism of metronidazole-induced neurotoxicity.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Administering medication to children at home presents substantial challenges for caregivers. Errors in dosage, timing, or administration method could be harmful. A key contributor to such errors is inadequate knowledge of pediatric medication. The objective of this study was to explore how parents in Libya administer oral medications to their children and the self-care therapies they use for them. A cross-sectional study was conducted using an online self-designed questionnaire consisting of yes/no and multiple-response questions. The sample size was 523 parents with valid questionnaires. Inclusion criteria were being a parent of children aged six months to 10 years and consent to participate. The data were analyzed by the Chi-square test was employed to examine associations between demographic characteristics and parental behaviors and techniques of medication administration. One-third of parents used inappropriate tools to administer liquid medications to their children. When children resisted medication, 49.3% of parents insisted on administering it, 10.7% mixed it with milk or other drink, 5.2% mixed it with food, and 9.2% dissolved solid forms in water or another drink. Additionally, 9.4% of parents admitted to giving doses higher than prescribed, trying to achieve rapid recovery. Furthermore, 82.0% of the parents engaged in self-medication of children, mostly with antipyretics (86.4%) but also with antibiotics (2.5%). We concluded that knowledge of the correct practices for administering oral medication to children was inadequate. It is suggested to develop educational programs for parents on correct practices.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

The global endeavor to develop and deploy COVID-19 vaccines has underscored both significant scientific progress and enduring disparities in worldwide access. This analysis examines regional vaccine distribution patterns across World Health Organization (WHO) regions—Africa, the Americas, Eastern Mediterranean, Europe, and Western Pacific—revealing substantial variations in vaccine types and manufacturer contributions. Data indicate that the Americas and Europe demonstrate a broad vaccine portfolio, with prominent contributions from major international pharmaceutical companies alongside regionally developed vaccines. Conversely, African, Eastern Mediterranean, and Western Pacific regions show considerable reliance on vaccines from Asian (notably China and India) and Russian manufacturers, in addition to Western products. This distribution highlights the influence of geographical proximity to manufacturing centers, regional alliances, and local production capabilities (e.g., CIGB and Finlay in the Americas, COVIran Barakat in the Eastern Mediterranean, and various Chinese products in the Western Pacific) on vaccine availability. Predominant vaccines by country count include Pfizer-BioNTech's Comirnaty, AstraZeneca's Vaxzevria, Janssen's Ad26.COV2-S, Moderna's Spikevax, Beijing CNBG's BBIBP-CorV, and SII's Covishield. The observed regional variations in vaccine types and supply chains carry implications for comparative effectiveness research, the understanding of differential immune responses, and the evaluation of pandemic control strategies. Furthermore, inconsistencies in global data reporting and product nomenclature present challenges for comprehensive analysis. The findings emphasize the importance of diversified supply chains, the growing role of regional manufacturing in enhancing global health security, and the need for standardized global data for a more profound understanding of vaccine equity and efficacy to inform future pandemic responses.

Mostafa Eissa

Epithelial cells, lining the skin and internal organs, play a crucial role as protective barriers and regulators of substance transport. Traditionally, these cells were not considered to employ electrical signaling for communication. However, recent investigations have unveiled that epithelial cells generate slow electrical signals, termed the "silent scream," in response to injury, thus challenging conventional views of intercellular communication. A recent experimental investigation provided compelling evidence for this phenomenon, demonstrating the ability of these cells to transmit electrical signals over considerable distances within the epithelium. The research utilized microelectrode array chips to precisely detect subtle electrical events in keratinocytes and Madin-Darby Canine Kidney (MDCK) cells, revealing spiking activity characterized by slow propagation speeds, distinct from the rapid action potentials of neurons. The mechanisms underlying this novel signaling are explored, focusing on the involvement of mechanosensitive ion channels, calcium signaling, and Adenosine triphosphate (ATP) release. Calcium ions, well-established intracellular messengers, appear to play a central role in this biological phenomenon. Integrating this newly discovered communication mode into the existing understanding of skin cell biology reveals a more intricate picture of how skin senses and responds to its environment. The implications of this finding extend to various facets of skin physiology and pathology, including wound healing, inflammation, and skin aging. In wound healing, where endogenous electric fields guide cell migration and promote repair, this unique type of electrical signaling potentially plays a crucial part. Furthermore, aberrant electrical signaling might contribute to chronic inflammatory conditions, and age-related changes in this signaling could underlie the functional decline observed in aged skin. The potential for other environmental stressors to trigger the epithelial-generated electric signals also warrants investigation. The exploration concludes by discussing potential technological applications, such as bioelectric sensors and enhanced wound healing therapies, and future research directions aimed at further elucidating the molecular mechanisms and functional roles of this non-excitable cell electrophysiology.

Mostafa Eissa

Introduction: Mental health disparities are deeply entrenched within the fabric of societal inequalities, shaped by structural factors that perpetuate intergenerational cycles of disadvantage. Addressing these disparities is crucial for promoting social justice and improving public health outcomes. Aim: This paper aims to synthesize high-quality evidence to elucidate the causal relationships between social determinants and mental health outcomes. It prioritizes pervasive social determinants that influence major mental disorders across the life course and outlines preventive strategies to mitigate these effects. Methodology: A comprehensive literature review was conducted, focusing on publications from the Global North from 2014 to 2024, to explore the influence of social determinants on mental health. Keywords such as "social determinants," "mental health outcomes," "preventive strategies," and "vulnerable populations" guided the search across databases like PubMed and Google Scholar. Results: The review highlights significant associations between mental health and social determinants such as socioeconomic status, racial and ethnic marginalization, and exposure to adverse environments. It underscores the heightened vulnerability of marginalized groups, including refugees, LGBTQ+ individuals, and those living in poverty. The paper introduces a preventive framework to guide primary prevention efforts and reviews both primary and secondary strategies to improve mental health equity. Conclusion: Strategic interventions aimed at the root social causes of mental health disparities can substantially enhance public mental health. This paper provides seven strategic recommendations focused on social justice, offering a roadmap for researchers, policymakers, and public health professionals to address these pressing issues.

Dr K C Yadav

Recent reports showed an association between bariatric surgery and the development of acute pancreatitis. This report presents a case of acute pancreatitis following a laparoscopic sleeve gastrectomy (LSG) in a 24-year-old Indian female patient, who presented to the Emergency Department at Hamad General Hospital, Qatar, with severe epigastric pain and persistent vomiting 13 days after LSG. She was diagnosed with acute pancreatitis based on a high level of lipase greater than three times the upper limit of normal, and a computed tomography scan of the abdomen, which was consistent with acute pancreatitis. The patient was treated conservatively with a significant improvement in her symptoms and laboratory tests throughout her admission and consequently was discharged.

Karishma

Iatrogenic splenic infarction is a rare clinical entity that can result from various abdominal surgical and invasive procedures. We report a case of iatrogenic splenic infarction in a 29-year-old female who presented with hemoptysis and was found to have pulmonary sequestration. During the embolization of the anomalous artery supplying the pulmonary sequestration, she developed severe pain and was found to have a splenic infarction, caused by a part of the coil that dislodged during the procedure. The patient showed good response to conservative management and was discharged in good condition.

Karishma

A 33-year-old young male patient with a history of uncontrolled hypertension was referred to my clinic due to a 2-week fever, generalized body aches, shortness of breath, and easy fatigue. Clinical examination showed a toxic dyspneic patient, but conscious and well-oriented. His blood pressure was 170/100 mm Hg, pulse 90 beat/min, respiratory rate 15/min, and the temperature was 38.6°C. Cardiac examination showed a harsh systolic murmur at the mitral area radiating to the axilla. Abdomen examination revealed moderate splenomegaly and mild hepatomegaly. The rest of the examination was unremarkable.

Karishma

A 22-year-old Indonesian woman was admitted through the emergency department with a 10-day history of  fever associated with chills. Other medical history was unremarkable. On examination, she appeared ill; BP 95/60 mmHg, pulse 105/min, and temperature 39.5°C. Abdominal examination showed splenomegaly; examination of the heart, lungs, and nervous system was unremarkable.

Karishma

Medical science has grown tremendously at a rapid rate over the recent past. This is especially true in the fields of diagnostics and therapeutics encompassing various diseases of all the systems of the human body including psychosomatic disorders. During the past three to four decades, precision in diagnostics has enormously improved due to invention of multiple imaging modalities such as computerized tomography (CT) scan, magnetic resonance imaging (MRI) scan, positron emission tomography scan, ultrasound scanguided studies, CT-guided diagnostic procedures, Doppler studies, arteriography, CT angiography, advanced needle biopsy procedures, histochemistry studies, tumor marker studies, as well as in the ongoing improvements in all diagnostic and therapeutic branches. The surgical advancements due to increasing use of key-hole surgery using scopes such as arthroscope, laparoscope, colonoscope, and bronchoscope have revolutionized the surgical treatments and made surgery safer, less time-consuming, less costly, and less risky with reduced post-operative morbidity. Cardiac catheterization, percutaneous cardiac angiography, angioplasty, and vascular surgery have made the procedures/ surgeries related to the heart and major vessels, much simpler, faster, and safer minimizing the need for big infrastructures or large operative teams.

Karishma

Celiac disease (CeD) is a complex disorder characterized by gastrointestinal (GI) symptoms as well as extraintestinal manifestations, sometimes difficult to diagnose. Commonly referred to as a childhood disease, adult CeD is a well-known entity that should be included in the differential diagnosis of chronic diarrhea or malabsorption syndrome. The pathogenesis involves a genetically mediated autoimmune pathway. In individuals with genetic susceptibility, the mucosa of the small intestine is damaged in response to foods containing gluten. The clinical presentation is variable and ranges from typical GI symptoms to extra-intestinal and systemic manifestations. Clinical improvement and restoration of the intestinal mucosa occur simply by eliminating gluten from the diet. We reported a case of CeD in a young man after 6 years of iron deficiency anemia (IDA), without asserting a clear etiology during this time. In our country, the search for CeD in patients with IDA is usually forgotten and we hereby put it in the spotlight.

Karishma

This is a non-inclusive collection of my published articles.

Mostafa Eissa

The concept of inherited memories, where experiences from one generation can influence the traits and behaviors of subsequent generations, has long captivated scientific curiosity. Recent advancements in epigenetics have provided compelling evidence for the potential mechanisms underlying this phenomenon. This focused brief review article outlines the current state of knowledge on inherited memories, examining the transgenerational effects observed in animal models, the epigenetic mechanisms involved, and the environmental influences that shape these heritable traits. Additionally, Highlights about emerging areas of inquiry were explored, including the cross-generational transmission of social behaviors, the evolutionary implications of inherited memories, and the ethical considerations surrounding research in humans. Thus, a unique perspective could be deduced from this rapidly evolving field and accordingly, further research could be stimulated into the implication of inherited memories.

Mostafa Eissa

Background: Cannabis sativa has garnered significant attention due to its complex phytochemistry and diverse pharmacological properties. Given the rising interest in medicinal cannabis, understanding its physicochemical properties is crucial for drug development, quality control, and abuse prevention. This study aimed to analyze its phytoconstituents, with a focus on the isolation and profiling of cannabinoids. Methods: Fresh C. sativa leaves were macerated in ethanol to obtain a crude extract, which underwent phytochemical screening to detect alkaloids, flavonoids, cardiac glycosides, terpenes, steroids, and resins. Thin-layer chromatography (TLC) was performed using a n-hexane/diethyl ether (8:2) ratio as the mobile phase to separate cannabinoids, with visualization under UV light. Column chromatography further purified the extract, and subsequent TLC confirmed cannabinoid-rich fractions. Hydrogen peroxide-modified TLC was employed to assess oxidation effects on cannabinoid stability. Results: Phytochemical screening confirmed the presence of alkaloids, flavonoids, terpenes, and resins, while saponins and tannins were absent. TLC analysis revealed distinct Rf values for tetrahydrocannabinol (THC = 0.94) and cannabidiol (CBD = 0.90), with color differentiation indicating successful separation and a more polar nature of CBD. Column chromatography yielded enriched fractions, validated by TLC. Hydrogen peroxide exposure altered Rf values of 0.78 to 0.8, suggesting oxidative degradation. The study identified THC and CBD as dominant markers, alongside minor cannabinoids, reinforcing C. sativa’s complex chemical profile. These findings give clues to further research into standardized extraction protocols and stability testing to optimize medicinal applications of the plant and its phytoconstituents. Conclusions: This study highlights the efficacy of TLC and column chromatography for cannabinoid isolation and profiling. The presence of THC, CBD, and other bioactive compounds underscores C. sativa’s dual therapeutic and psychoactive potential.

Karishma

Background: Preanalytical variability due to anticoagulant choice remains inadequately characterized in resource-limited tropical settings like Yemen, where environmental stressors exacerbate challenges. This study aimed to compare the stability and cost-effectiveness of K₂EDTA and K₃EDTA anticoagulants for complete blood count testing under simulated Yemeni conditions. Methods: Prospective study of 100 healthy adult male volunteers in Ad’Dla Governorate, Yemen (January–March 2025). Paired samples in K₂EDTA/K₃EDTA tubes were analyzed at baseline (T0) and after 6-hour storage at 22 ± 2°C (T6). Statistical analysis included Bonferroni-corrected repeated-measures ANOVA and paired t-tests. Results: Fresh samples showed high inter-anticoagulant concordance (ICC > 0.90). After 6-hour storage, K₂EDTA exhibited significant Mean Corpuscular Volume (MCV) reduction (Δ = −2.33 fL, p < 0 xss=removed xss=removed xss=removed> 2 hours), while K₃EDTA is preferable for immediate analysis. These findings provide preliminary guidance for hematology testing in Yemeni laboratories and similar tropical settings, pending validation in diverse populations and extreme conditions.

Karishma

Background: Previously, Ocimum sanctum (Lamiaceae), commonly known as holy basil, has been noted for its anti-ulcer properties, primarily attributed to its oil and leaf extracts. However, the anti-ulcer activity of an ethanolic extract derived from the whole plant has not been reported. This study aimed to evaluate the antiulcer effect of the ethanolic extract of O. sanctum whole plant (OSWP) in an experimental ulcer model. Methods: The study, conducted at PCSIR Labs Complex in Karachi in August 2024, was approved by the Ethical Use of Experimental Animals Committee (IEC/OSWP-05). This study investigates the anti-ulcer activity of an ethanolic extract of OSWP in a rat model of ethanol-induced gastric mucosal damage at 200, 300, and 400 mg/kg body weight, with ranitidine (50 mg/kg) used as a positive control. Outcome measures included ulcer index (UI), percentage protection, and gastric pH. Results: The ethanolic extract of OSWP demonstrated dose-dependent gastroprotective effects. At 200, 300, and 400 mg/kg, the UIs were 9.49 ± 2.40, 4.55 ± 1.44, and 2.5 ±2.25, respectively, with corresponding protection ranging from 48.9% to 86.54% for the 200 to 400 mg/kg doses (p < 0.05). Gastric pH increased from 5.6 to 7.6. In comparison, ranitidine (50 mg/kg) resulted in a UI of 4.0 ± 0.88, 78.47% protection (p < 0.05), and a pH of 7.0. Conclusions: The study demonstrates the dose-dependent anti-ulcer activity in the ethanolic extract of OSWP, which may be further developed as a potential anti-ulcer agent. A graphical presentation of the whole experimental process is shown in Figure 1.

Karishma

Background: Percutaneous coronary intervention (PCI) has remained one of the greatest treatment modalities of the spectrum of atherosclerotic coronary artery disease over the past few years due to its high efficacy and minimal invasiveness. The most common cause of stent failure is stenting under-expansion, which complicates PCI. Thus, it is tremendously important to perform PCI relying on the precise measurement of the size of the coronary artery obtained with the help of intracoronary imaging. There is limited data on the size of coronary arteries as measured by intravascular ultrasound (IVUS) in India and specifically in southern India. This study, conducted between January 2022 and March 2023, aimed to estimate the coronary artery dimensions, which can serve as a guide to PCI when intracoronary imaging is not available Methods: A sample size of 165 patients with proven coronary artery disease undergoing IVUSguided PCI during acute or chronic coronary syndrome were recruited, and coronary arterydimensions were measured in this research work. The mean arterial size and predictors of the arteries were reviewed. Results: A total of 165 patients with 590 coronary artery segments were recruited: the mean left main (LM), external elastic membrane (EEM) diameter, and cross-sectional area (CSA) were 4.92 ± 0.41 mm and 17.83 ± 2.88 mm2 proximal left anterior descending (LAD) artery, 3.75 ± 0.32 mm and 13.74 ± 2.45 mm2 the mid-LAD 3.42 + 0.28 mm and 10.65 + 2.08 mm2 the distal LAD 2.94 + 0.31 mm and 7.98 + 2.07 mm2 the proximal left circumflex artery (LCX) 3.62 ± 0.32 mm and 11.67 ± 2.36mm2, the distal LCX 2.91 ± 0. 33 mm and 8.98 ± 2.22mm2 the proximal right coronary artery (RCA) 4.17 ± 0.41 mm and 14.82 ± 2.78 mm2 the mid-RCA 3.85 ± 0.36 mm and 12.94 ± 2.44 mm2, the distal RCA 3.43 ± 0.30 mm and 11.08 ± 2.05 mm2, respectively. The predictor of most epicardial coronary arteries is body surface area (BSA) with positive linear correlation. Conclusions: Measurements of the coronary arteries obtained were comparable to the previous data on coronary artery size of Southeast Asia and Caucasian populations using IVUS. BSA is an independent predictor for the majority of epicardial coronary arteries with a positive linear relationship. Male gender and hypertension also positively correlate with larger coronary artery dimensions, while dyslipidemia leads to smaller coronary artery sizes. Neither diabetes nor smoking influences coronary artery size in the current study. Finally, the quantification of the size of the coronary artery will help the clinician to have a reference dimension in instances where there is no intravascular imaging available.

Karishma

To the editor, On April 24, 2025, the World Health Organization (WHO) issued an urgent call to reinvigorate global action to end malaria, releasing updated guidelines that reflect both progress and persisting challenges in combating this deadly disease. [1] This renewed guidance arrives at a critical juncture: global malaria cases have plateaued, progress is faltering, and health systems in endemic regions face increasing strain from drug resistance, climate change, and funding shortfalls.

Karishma