The current discovery that the gut microbiome, which contains roughly 100 trillion microbes, affects health and disease has catalyzed a boom in multidisciplinary research efforts focused on understanding this relationship. Also, it is commonly demonstrated that the gut and the CNS are closely related in a bidirectional pathway. A balanced gut microbiome is essential for regular brain activities and emotional responses. On the other hand, the CNS regulates the majority of GI physiology. Any disruption in this bidirectional pathway led to a progression of health problems in both directions, neurological and gastrointestinal diseases. In this review, we hope to shed light on the complicated connections of the microbiome-gut-brain axis and the critical roles of gut microbiome in the early development of the brain in order to get a deeper knowledge of microbiome-mediated pathological conditions and management options through rebalancing of gut microbiome.

DPP4 (Dipeptidyl-peptidase 4) a versatile protease, emerges as a prominent player in soluble and membrane-bound forms. Its heightened expression has been intimately linked to the initiation and severity of diverse autoimmune diseases, spanning rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis (SSc), inflammatory bowel disease, autoimmune diabetes, and even SARS-CoV-2 infection. Operating as a co-stimulator of T cell activity, DPP4 propels T cell proliferation by binding adenosine deaminase (ADA), thereby augmenting the breakdown of adenosine—an influential inhibitor of T cell proliferation. However, the discovery of a wide range of DPP4 inhibitors has shown promise in alleviating these diseases’ signs, symptoms, and severity. The available DPP4 inhibitors have demonstrated significant effectiveness in blocking DPP4 activity. Based on the characterization of their binding mechanisms, three distinct groups of DPP4 inhibitors have been identified: saxagliptin, alogliptin, and sitagliptin, each representing a different class. Elevated levels of angiotensin-converting enzyme 2 (ACE2) expression are associated with producing various coronavirus peptidases. With its anti-inflammatory properties, Sitagliptin may assist COVID-19 patients in preventing and managing cytokine storms. This comprehensive review delves into the burgeoning realm of DPP4 inhibitors as therapeutic interventions for diverse autoimmune diseases. With a discerning focus on their efficacy, the investigation sheds light on their remarkable capacity to alleviate the burdensome signs and symptoms intricately linked to these conditions.

Background: Antenatal care (ANC) is the care women receive during pregnancy before birth and represents a cornerstone of maternal and child health. Previously, Saudi women faced various barriers to practicing ANC, including challenges related to transportation, low maternal education, poor communication with healthcare centers, and incorrect maternal beliefs. In line with Saudi Vision 2030, this multicenter cross-sectional study aimed to investigate the timing of ANC contact, coverage of service utilization in public hospitals among Saudi mothers, sociodemographic factors and antenatal health care utilization, and beliefs about prenatal vitamins, and supplement use among pregnant Saudi women. Methods: Data was collected from 1230 pregnant women across 11 Ministry of Health (MOH) facilities. The study assessed the timing of ANC initiation, beliefs about prenatal vitamins, and the use of folic acid, calcium, and iron during pregnancy. Chi-square tests were employed to analyze associations between variables. Results: The findings revealed that 14.55% of participants initiated ANC within the first 8 weeks of pregnancy, with 85.44% starting later. However, the majority 88.78% received prenatal care during pregnancy, regardless of the timing of ANC initiation. Beliefs about prenatal vitamins varied, with 20.08% agreeing that prenatal vitamins were only indicated for malnourished mothers, 72.35% disagreeing, and 7.56% uncertain. Moreover, 51.30% believed ANC should begin before pregnancy, 29.83% after pregnancy confirmation, and 13.57% during the first trimester, with no significant correlation between beliefs and ANC timing. Regarding prenatal care, 95.20% would recommend starting prenatal care with every pregnancy, regardless of the timing of their own ANC initiation. Conclusion: This study offers a comprehensive analysis of factors impacting late ANC contact and inadequate ANC contacts among pregnant Saudi women. These findings contribute to the broader understanding of ANC practices among Saudi women and underscore the importance of considering various determinants for tailored interventions and health education programs.

Purpose: Older persons are frequently prescribed several medications; therefore, inappropriate medication prescriptions are common. Prescribing potentially inappropriate medications (PIMs) poses a serious risk and hence, we aimed to assess the PIMs in older patients in Tabuk, using the 2023 Beers criteria. Patients and Methods: A retrospective cross-sectional study was carried out, including older persons ≥ 65 years of age admitted in two government hospitals from June 2022 to May 2023, and prescribed with five or more medications. PIMs were assessed using the 2023 Beers criteria. Descriptive analysis was performed for the categorical and continuous variables. Logistic regression was used to assess the influence of age, gender, number of medications and comorbidities on PIMs using SPSS version 27. Results: The study included 420 patients. The mean age of the participants was 75.52 ± 8.70 years (range, 65– 105 years). There was a slightly higher proportion of females (52%). The prevalence of PIMs was 81.43%, where 35.41% were prescribed one PIM, 26.48% were prescribed two PIMs, and 17.32% were prescribed three PIMs. The proportion of medications considered potentially inappropriate among older patients was 70.11%, and proton pump inhibitors were the most commonly prescribed medication (52.99%). The proportion of medications to be used with caution was 19.55%, with diuretics being the most frequently administered medication (91.43%). Gender and comorbidity did not influence PIMs, but age and number of medications significantly influenced the likelihood of PIMs. Conclusion: PIMs are prevalent among older people and are significantly associated with age and multiple medications. Caution should be exercised while prescribing medications to older persons. Frequent audits should be performed to assess PIMs, and clinicians should be informed of the same to avoid serious outcomes associated with PIMs. Interventions designed to reduce PIM need to be initiated.

Background: Knee osteoarthritis (KOA) is one of the most common conditions resulting in disability, particularly in the elderly population. Osteoarthritis (OA) is the most common articular disease and the leading cause of chronic disability in the developed world.Objective: This study was carried out to evaluate knee pain in the Asir region of Saudi Arabia. An analytical cross-sectional survey design was adopted in the Asir region from April 2023 to August 2023 to assess the knee pain of the adult population using an anonymous online questionnaire.Results: Of 1234, 332 were men (26.90) and 902 were women (73.09). WOMAC index score category 55.34% (n = 683) of the subjects had a low risk (score <60), 28.68% (n = 354) had a moderate risk (score 60–80), and 15.96% (n = 197) had a high risk (score ≥81) for KOA. According to clinical criteria, 79.33% (n = 979) of the study subjects had OA. Age group, gender 2.17 (1. 67–2.82) [OR 2.17; 95% CI 1.67–2.82), family history of OA [OR 0.47; 95% CI 0.37–0.62], diabetes [OR 2.78; 95% CI 2.17–3.56], hypertension [OR 0.35; 95% CI 0.26–0.45] were significantly associated with the percentage of the WOMAC index score using the Chi-square test analysis (P<0.05). Therefore, the WOMAC index showed higher diagnostic precision with a statistically significant association [OR 9.31 CI 6.90–12.81] with a P< 0.0001.Conclusion: KOA is more common in older, obese people who have reached the age of 50 in the Asir region, and it is more prevalent in women. Alarms the need for appropriate awareness programs for better disease prevention and health outcomes for the benefit of the community through general public health programs.