Carfilzomib (CFZ), is a potent, selective second generation proteasome inhibitor, used for the treatment of multiple myeloma. The aim of the present study was to investigate the possible protective effect of apremilast (AP) on the CFZ -induced cardiotoxicity. Rats were randomly divided into four groups: Group 1, served as the control group, received normal saline. Group 2, served as the toxic group, received CFZ (4 mg/kg, intraperitoneally [i.p.]). Groups 3 and 4, served as treatment groups, and received CFZ with concomitant oral administration of AP in doses of 10 and 20 mg/kg/day, respectively. In the present study, administration of CFZ resulted in a significant increase in serum aspartate transaminase (AST), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase-MB (CK-MB), which were reversed by treatment with AP. CFZ resulted in a significant increase in heart malondialdehyde (MDA) contents and decrease in cardiac glutathione (GSH) level and catalase (CAT) enzyme activity which were significantly reversed by treatment with AP. Induction of cardiotoxicity by CFZ significantly increased caspase-3 enzyme activity which were reversed by treatment with AP. RT-PCR analysis revealed an increased mRNA expression of NF-κB, ERK and JNK which were reversed by treatment with AP in cardiac tissues. Western blot analysis revealed an increased expression of caspase-3 and NF-κB p65 and a decrease expression of inhibitory kappa B-alpha (Iκbα) with CFZ, which were reversed by treatment with AP. In conclusion, apremilast showed protective effect against CFZ-induced cardiotoxicity.

Proper completion of death certificates is of vital importance. This study assessed the accuracy of death certification at one major hospital in Riyadh, Saudi Arabia. We collected all certificates from 1997 to 2016 and scored them on the degree of accuracy. We found no errors of incompleteness or missed contributors to death. However, in all certificates (100%), cause of death was either incorrect or absent; 75% provided no cause of death. Further large-scale studies should be conducted in other hospitals to determine the exact prevalence of these serious errors.

Laparoscopic sleeve gastrectomy is a bariatric surgical procedure performed in patients with morbid obesity that provides the opportunity to review histopathological changes. The aim of this study was to characterize resected gastric specimens obtained from a Saudi patient population at a single center for a prospectively maintained database of laparoscopic sleeve gastrectomy cases. The histopathological findings from all patients undergoing laparoscopic sleeve gastrectomies at King Khalid University Hospital between 2010 and 2015 were retrospectively reviewed. Of the 602 cases reviewed, the majority (83.4% [n=502]) exhibited chronic gastritis, whereas 22.3% (n=134) involved Helicobacter pylori infections with active gastritis, 1% (n=6) had intestinal metaplasia, and one case (0.17%) revealed gastric adenocarcinoma. As the findings revealed conditions that are treatable, I highly recommend histological examinations of all sleeve gastrectomy specimens from a Saudi patient population.