Quercetin (QUE) is a primary polyphenol in the flavonoid family. It is categorized as one of the six subclasses of flavonoid compounds. As an abundant form of flavonoid molecules, quercetins are ubiquitously distributed in various dietary plants, including apples, berries, onions, bananas, tomatoes, and grapes. Furthermore, it is affordably marketed in the form of dietary supplement tablets. QUE is relatively lipophilic with low solubility in the water. Withal, QUE glucoside is more water soluble than the aglycone, and its absorption is limited to sodium-dependent glucose transporter-1 (SGLT-1); however, glucose transporter-2 (GLUT-2)-dependent absorption is also a significant contributor. Following absorption, QUE undergoes extensive metabolism in the liver, generating numerous metabolites. Data on the bioavailability of QUE differ substantially depending on the methods used for measuring QUE level. Pharmacokinetic interactions of QUE and its metabolites on cytochrome P450 enzymes have been studied extensively, but the results among the studies were inconsistent, such as weak inhibition toward CYP3A4 and no inhibition of CYP2D6 activity. Additionally, inhibition affects ATP- (adenosine triphosphate) binding cassette (ABC). Based on the pharmacokinetics profile, QUE has variable bioavailability based on the polymorphism of intestinal enzymes and transporters.

Introduction: Neonatal sepsis (NS) is a major healthcare burden in Gulf Cooperation Council (GCC) countries, with a prevalence higher than the global average. Microbial drug resistance has major implications for mortality and morbidity from NS. Objective: To synthesize data regarding the patterns of causative bacteria of NS in the GCC and their antimicrobial susceptibility profiles. Methods: Following the exploration of four electronic databases, i.e., EBSCOhost, ProQuest, PubMed/MEDLINE, and ScienceDirect, eligible studies were identified (i.e., published between 2013 and 2023 and reported bacterial profile and/or antimicrobial susceptibility patterns). The outcomes included the pooled prevalence of bacteria and their susceptibility patterns. Proportion meta-analysis was performed for each outcome of interest. Results: Fifteen studies were eligible (total positive cases = 2,473). Coagulase-negative Staphylococci (CoNS) (28.1%) were the most common gram-positive causative pathogen, followed by group B Streptococcus (GBS) (16.2%) and Staphylococcus aureus (9.9%); for gram-negative, Escherichia coli (12.7%) and Klebsiella species (11.4%) were most common. The susceptibility rates of these bacteria to first-line antibiotics were high; gram-positive bacteria had the highest susceptibility to ampicillin (72.8–98%), and gram-negative bacteria was most susceptible to amikacin (94.6–98%). Additionally, both gram-positive (67–77%) and negative (87–93%) bacteria exhibited high susceptibility to gentamicin. Conclusion: The most common pathogens among NS patients were gram-positive. The pathogens, irrespective of stain test, were susceptible to the current antibiotic therapy. We recommend the judicious use of empirical antibiotic therapy to prevent the growing risk of antimicrobial resistance.

Fetus-in-fetu (FIF) is a rare embryological anomaly in which an encysted fetiform mass develops within the infant or adult host body. It mainly occurs intraabdominal. There are embryo-pathogenetic debates over whether it belongs to the spectrum of highly differentiated teratomas or is a parasitic twinning from a monozygotic monochorionic diamniotic pregnancy. The presence of vertebral segments and an encapsulating cyst can reliably distinguish FIF from teratoma. The diagnosis may be initially made by imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI), and a confirmatory diagnosis made by histopathology of the excised mass. Our center experienced a case of a male neonate presented after emergency cesarean delivery at 40-week gestation with the suspicion of an intraabdominal mass identified antenatally. Antenatal ultrasonography at 34 weeks gestation suggested the presence of an intraabdominal cystic mass measuring 6.5 cm with a hyperechoic focus. A follow-up MRI performed after the delivery showed a well-defined mass with the cystic formation in the left abdominal region with a centrally located fetiform structure. Vertebral bodies and long limb bones were visualized. The diagnosis of FIF was initially made preoperatively by the characteristic findings of imaging studies. Laparotomy was scheduled on day 6, revealing a large encysted mass with fetiform content. FIF should be considered a possible differential diagnosis of neonatal encysted fetiform mass. Routine antenatal imaging permits more frequent antenatal detection with earlier workup and management.

Bushra Mohandes, Fatma Elsayed Ahmed Bayoumi, Aisha Abdulkarim AllahDiwaya, Maryam Salah Falah, Leen Hesham Alhamd, Razan Abid Alsawadi, Yipeng Sun, Aidi Ma, Idris Sula, Muhammad Candragupta Jihwaprani. J Pharmacopuncture 2024;27:177-89. https://doi.org/10.3831/KPI.2024.27.3.177

The risks and benefits of bedaquiline (BDQ) for treatment of drug‐resistant tuberculosis (DR‐TB) have not been firmly established. We aimed to assess the safety and efficacy of BDQ‐containing regimens for the treatment of DR‐TB as evidenced in available randomized controlled trials (RCTs). In this systematic review and meta‐analysis, five databases (i.e., ClinicalTrials.gov, Cochrane CENTRAL, PubMed, ScienceDirect, and SinoMed) were searched. RCTs among DR‐TB patients that had a control arm were eligible. The safety endpoints were all‐cause mortality and serious adverse effects (SAEs). Efficacy outcomes were sputum culture conversion rate at 8–12 weeks and 24–26 weeks, treatment success, and time to culture conversion. A total of 476 records were screened; 18 met the eligibility criteria. The pooled analysis included 2520 participants (55.8% received BDQ‐containing regimens, n = 1408). Pooled safety outcomes showed no significant reduction in all‐cause mortality (relative risk [RR] [95%confidence interval (CI)] = 0.94 [0.41–2.20]) or SAEs (RR [95%CI] = 0.91 [0.67–1.23]) in the BDQ‐regimen group. Pooled efficacy outcomes showed significantly superior culture conversion rates at 8–12 weeks (RR [95%CI] = 1.35 [1.10–1.65]) and 24–26 weeks (RR [95%CI] = 1.25 [1.15–1.36]), more treatment success (RR [95%CI] = 1.30 [1.17–1.44]), and a 17‐day reduction in the time to culture conversion (standardized mean difference [SMD] [95%CI] = −17.46 [−34.82 to −0.11]) in the BDQ‐regimen group (reference: non‐BDQ regimen). Overall, BDQ regimens showed significant treatment effect against DR‐TB but did not reduce mortality or SAEs.