Efficacy of Zinc Fortified and Fermented Wheat Flour (EZAFFAW): A randomized controlled trial protocol.

BACKGROUND: Zinc deficiency poses significant health risks, particularly in low-income settings. This study aims to evaluate the impact of agronomically zinc biofortified (fermented and non-fermented) and post-harvest wheat flour flatbread on zinc status and metabolic health in adolescents and adult women in rural Pakistan. METHODS: A four-arm triple-blind randomized controlled trial will be conducted in a rural district of Pakistan. Participants (adolescents aged 10-19 and adult women aged 20-40) will be assigned to receive fermented or unfermented high zinc agronomically biofortified wheat flour flatbread, post-harvest zinc-fortified wheat flour flatbread, or low zinc conventional whole wheat flour flatbread. The meal would be served once a day, six days a week for six months. The study aims to enroll 1000 participants and will be analyzed based on the intention-to-treat principle. The trial is registered with number NCT06092515. OUTCOMES: Primary outcomes will include serum zinc concentration and metabolic markers, while secondary outcomes include anthropometric measurements, blood pressure, and dietary intake. CONCLUSION: This trial will provide valuable insights into the efficacy of agronomically zinc biofortified wheat flour in improving zinc status and metabolic health. Findings may inform public health strategies to combat zinc deficiency in resource-limited settings.

Diet, lifestyle factors, comorbidities, and hepatocellular carcinoma risk in a middle eastern country: a case-control study.

BACKGROUND: Hepatocellular Carcinoma (HCC) can be classified as one of the most common malignancies worldwide. There is scarcity of the published data on the risk factors for HCC in the Gulf Cooperation Council countries specifically Kuwait. Therefore, this case-control study sought to examine the risk factors associated with HCC in Kuwait. METHODS: Fifty-three histopathologically confirmed HCC cases were recruited from the Kuwait Cancer Control Center Registry. One hundred ninety-six controls (1:4 ratio) were selected from medical and/ or surgical outpatient's clinics at all six public hospitals of Kuwait. A structured questionnaire was used to collect the data both from cases and controls through face-to-face interviews. A multivariable logistic regression model was fitted to the case-control data. Adjusted odds ratios (ORadj) and their 95% confidence intervals (CI) were computed using the parameters' estimates of the final model and used for interpretation of the model. RESULTS: The HCC cases compared with the controls were 41.6 times more likely to have had the history of non-alcoholic fatty liver disease (NAFLD) (ORadj = 41.6; 95% CI: 8.9-193.5; p < 0.001). The cases compared with the controls were more likely to have reported the history of heavy alcohol drinking (ORadj = 14.2; 95% CI: 1.2-173.4; p = 0.038). Furthermore, compared with the controls, the HCC cases tended to frequently consume milk and/or milk substitutes (≥ 3 glass/ week) (ORadj = 7.2; 95% CI: 1.2-43.4). Conversely however, there was a significant protective effect if the participants reportedly have had regularly used olive oil in their routine diet as a source of fat (ORadj = 0.17; 95% CI: 0.04-0.80) or regularly used non-steroid anti-inflammatory drugs (NSAIDs) (ORadj = 0.20; 95% CI: 0.05-0.71). CONCLUSIONS: This study showed that heavy alcohol consumption, NAFLD history, and excessive consumption of milk/ milk substitutes were associated with a significantly increased HCC risk. Conversely however, regular use of olive oil in the diet as a source of fat or regular use of NSAIDs had a significantly protective effect against HCC risk. Adapting healthy dietary habits and preventing/ treating NAFLD may minimize the HCC risk. Future research with a larger sample size may contemplate validating the results of this study and unraveling additional risk factors contributing to HCC risk. The resultant data may help design and implement evidence-based educational programs for the prevention of HCC in this and other similar settings.

Lactic Acid Fermentation Ameliorates Intrinsic Toxicants in Brassica campestris L. Leaves Harvested at Different Growth Stages.

Brassica campestris (syn. Brassica rapa) is often known as mustard and is grown worldwide owing to its health-promoting characteristics associated with the presence of nutrients and phytochemicals. Along with the nutritional components, B. campestris also contains anti-nutrients (phytates, oxalates, tannins, alkaloids, saponins) that can cause adverse severe health effects to consumers, including rashes, nausea, headaches, bloating and nutritional deficiencies. In the present study, heating (blanching) and fermentation (Lactiplantibacillus plantarum) treatments were applied to reduce the load of the anti-nutrients of B. campestris leaves harvested at three different growth stages: the first stage (fourth week), the second stage (sixth week) and the third stage (eighth week). Results revealed that fermentation treatment using Lp. plantarum increases the ash (5.4 to 6%), protein (9 to 10.4%) and fiber (9.6 to 10.7%) contents, whereas moisture (0.91 to 0.82%), fat (9.9 to 9.1%) and carbohydrate (64.5 to 64.2%) contents decreased among B. campestris samples, and the trend was similar for all three stages. Blanching and fermentation lead to the reduction in phytates (46, 42%), saponins (34, 49%), tannins (1, 10%), oxalates (15, 7%) and alkaloids (10, 6%), separately as compared to raw samples of B. campestris leaves. In contrast, fermentation had no considerable effect on phytochemical contents (total phenolic and total flavonoids) and antioxidant potential (DPPH and FRAP). The action of blanching followed by fermentation caused more decline in the aforementioned toxicants load as compared to blanching or fermentation alone. Structural modifications in blanching and the biochemical conversions in fermentation lead to enhanced stability of nutrients and antioxidant potential. Taken together, these findings suggest blanching followed by fermentation treatments as a reliable, cost-effective and safer approach to curtail the anti-nutrient load without affecting the proximate composition, phytochemical attributes and antioxidant activity.

Antenatal Depression and its Associated Factors: Findings from Kuwait Birth Cohort Study.

BACKGROUND: Pregnant and postpartum women are at high risk of depression due to hormonal and biological changes. Antenatal depression is understudied compared to postpartum depression and its predictors remain highly controversial. AIM: To estimate the prevalence of depressive symptoms during pregnancy and investigate factors associated with this condition including vitamin D, folate and Vitamin B12 among participants in the Kuwait Birth Study. METHODS: Data collection occurred as part of the Kuwait Birth Cohort Study in which pregnant women were recruited in the second and third trimester during antenatal care visits. Data on antenatal depression were collected using the Edinburgh Postnatal Depression Scale (EPDS), considering a score of ≥ 13 as an indicator of depression. Logistic regression was used to investigate factors associated with depressive symptoms in pregnant women. RESULTS: Of 1108 participants in the Kuwait Birth Cohort study, 1070(96.6%) completed the EPDS. The prevalence of depressive symptoms was 21.03%(95%CI:18.62-23.59%) and 17.85%(95%CI:15.60-20.28%) as indicated by an EPDS ≥ 13 and EPDS ≥ 14 respectively. In the multivariable analysis, passive smoking at home, experiencing stressful life events during pregnancy, and a lower level of vitamin B12 were identified as predisposing factors. Conversely, having desire for the pregnancy and consumption of fruits and vegetables were inversely associated with depressive symptoms. CONCLUSION: Approximately, one fifth of pregnant women had depressive symptoms indicating the need to implement screening program for depression in pregnant women, a measure not systematically implemented in Kuwait. Specifically, screening efforts should focus on pregnant women with unintended pregnancies, exposure to passive smoking at home, and recent stressful live events.

Correction: Abbas et al. Bioactive Compounds, Antioxidant, Anti-Inflammatory, Anti-Cancer, and Toxicity Assessment of Tribulus terrestris-In Vitro and In Vivo Studies. Antioxidants 2022, 11, 1160.

In the original publication [...].

Fabrication of Multifunctional Tents Using Canvas Fabric.

Herein, this study was compiled to investigate a suitable solution for the fabrication and development of the multifunctional defense tent from previously reported research. The military always needs to protect their soldiers and equipment from detection. The advancement of infrared detection technology emphasizes the significance of infrared camouflage materials, reducing thermal emissions for various applications. Objects emit infrared radiation detectable by devices, making military targets easily identifiable. Infrared camouflage mitigates detection by lowering an object's infrared radiation, achieved by methods such as reducing surface temperature, which is crucial in designing military tents with infrared (IR) camouflage, considering water repellency and antibacterial features. Water repellency, as well as antimicrobial properties, in army tents is also important as they have to survive in different situations. All these problems should be addressed with the required properties; therefore, the authors try to introduce a new method from which multifunctional tents can be produced through economical, multifunctional, and sustainable materials that have IR protection, water repellency, ultraviolet (UV) protection, air filtration and permeability, and antimicrobial properties. There is still no tent that performs multiple functions at a time, even those functions that do not correlate with each other such as water repellency, IR protection, antimicrobial, and air permeability. So, a multifunctional tent could be the solution to all these problems having all the properties discussed above. In this study based on the literature review, authors concluded a method for the required tent for canvas fabric coated with zinc sulfide (ZnS), graphene oxide (GO), and zinc oxide (ZnO), or these materials should be incorporated in fiber formation because fiber composition has more impact. These multifunctional tents will be very beneficial due to their multifunctions like weather resistance, durability, and long life. These would help the army in their missions by concealing their soldiers and equipment from detection by cameras and providing filtered air inside the tent in case of gases or explosions. The proposed method will help to fulfill the stated and implied needs of customers.

Prevalence of and factors associated with multimorbidity among adults in Kuwait.

BACKGROUND: This cross-sectional study aimed to assess the prevalence of morbidity i.e., one morbidity and multimorbidity (≥ 2 morbid conditions) among adults in Kuwait and to examine the sociodemographic and lifestyle factors associated with morbidity as a multinomial outcome in the study population. METHODS: The data were collected from January 26, 2021, to February 3, 2021, using an electronic questionnaire, which was distributed on social media platforms. The consent form was attached with the questionnaire and the participants were requested to sign the consent form before completing the questionnaire. The prevalences (%) of each morbidity and multimorbidity were computed. Multivariable polychotomous logistic regression analysis was used to evaluate the association between the demographic and lifestyle factors with morbidity as a multinomial outcome. RESULTS: Of 3572 respondents included, 89% were Kuwaiti, 78.3% females and 66% were 21- 40 years old. The prevalence of multimorbidity and one morbidity respectively was 27.4% and 29.7%. The prevalence of multimorbidity with two, three, four or five ill-health conditions were 14.3%, 7.4%, 3.5%, and 1.2%, respectively. A higher prevalence of multimorbidity was among respondents over 60 years of age (71%) and Kuwaiti nationals (28.9%). The final multivariable polychotomous logistic regression model revealed that age, sex, nativity, sedentary lifestyle, smoking, and alcohol drinking were significantly (p < 0.05) associated with multimorbidity. However, age and alcohol drinking were significant (p < 0.05) predictors of one morbidity. CONCLUSION: This study provides evidence that multimorbidity is more prevalent among the elderly, females, and Kuwaiti nationals. Sedentary behaviour, smoking and alcohol consumption were significantly and independently associated with multimorbidity. These findings highlight the burden of multimorbidity and should be considered in the development of future prevention programs.

Physicochemical, Rheological and Sensory Evaluation of Herbal Bread Containing Turmeric, Ginger, and Black Cumin Powder.

The diversity in the global food market is expanding as thousands of new products enter the business every year, among which nutraceutical and functional foods hold important positions. The present research work aimed at the nutritional evaluation of three medicinal herbs, i.e., turmeric (Curcuma longa L.), ginger (Zingiber officinale), and black cumin (Nigella sativa). A bread formulation was enriched with the individual/combined supplementation (1-3%) of these herbs. Later, the bread was analyzed for nutritional, rheological, textural, and sensorial characteristics. The results revealed that the herbs improved the nutritional composition of bread, especially ash and fiber, as the maximum ash and fiber contents were noticed in T15 (2.0% dried powder of each plant) with values of 1.64 ± 0.04% and 4.63 ± 0.16%, respectively. The results regarding the rheological behavior showed minor variations in the rheological traits and a slight increase in dough development time up to 4.50 ± 0.20 min in T10 from 2.80 ± 0.13 min in T0. The sensorial attributes also indicated their marked suitability as external and internal characteristics were least affected by the addition of the herbs. Although some parameters like the crust and crumb colors were affected by the addition of black cumin, showing values of 6.25 ± 0.52 and 4.44 ± 0.19, respectively, in T15, and aroma characteristics were affected by the addition of ginger, supplementation with a combination of herbs at lower doses mitigated the adverse effects of other herbs. Moreover, shelf-life extension, especially with the addition of turmeric powder, was the hallmark of this research. This study concluded that medicinal herbs can be incorporated into baked products to improve the nutritional and sensorial attributes of functional herbal bread.

Exposure to household secondhand tobacco smoke and the odds of developing atopic dermatitis among adolescents: A causal mediation analysis.

INTRODUCTION: Exposure to household secondhand tobacco smoke (SHS) among adolescents has been shown to be associated with atopic dermatitis, and affects disproportionality females. However, the mechanisms underlying this link are uncertain. This study sought to identify modifiable factors that mediate the relationship between household SHS exposure and atopic dermatitis among adolescents. METHODS: During October 2015, a cross-sectional study was conducted using the ISAAC questionnaire for data collection from adolescents enrolled in nine high schools of Hawalli - one of the six governorates of Kuwait. Data were collected on sociodemographic characteristics, self-reported tobacco smoking among adolescents, household SHS exposure (≥1 smokers at home vs none), self-reported asthma and atopic dermatitis. For causal mediation analysis an inverse odds-weighting approach was used. RESULTS: Of 746 participants, 74.8% were Kuwaiti, 50.1% were female, 12.4% were regular daily smokers and 54.1% had household SHS exposure, which was more common among Kuwaiti (79.6%) than non-Kuwaiti (20.4%) adolescents. The prevalences of self-reported asthma and atopic dermatitis were 20.6% and 14.9%, respectively. After adjusting for the pre-exposure covariates (i.e. sex and nativity), household SHS exposure had a significant (p=0.043) total effect, non-significant (p=0.133) natural direct effect, and marginally insignificant (p=0.058) natural indirect effect, which were jointly mediated by asthma status and adolescent's self-reported smoking status, with a proportion of mediated risk to atopic dermatitis of 29.6%. CONCLUSIONS: Asthma and self-tobacco smoking among adolescents not only directly affected but also mediated household SHS exposure effect on atopic dermatitis risk. Voluntarily adopting a smoke-free home rule may minimize household SHS exposure, reduce the odds of developing asthma, and deter the initiation of tobacco smoking among adolescents. Such an effort will likely mitigate the atopic dermatitis risk among adolescents in this and other similar settings. If implemented, future studies may contemplate evaluating the impact of such intervention.

Glycosaminoglycans and collagen fibril distribution at various depths of the corneal stroma of normal and CXL treated rats.

Corneal collagen cross-linking (CXL) is widely used to treat keratoconus and ecstatic corneal disorders. The present studies were carried out to investigate the distribution of glycosaminoglycans (GAGs) and collagen fibril (CF) at different depths of the normal and CXL treated corneal stroma of four week old rats 7 days after standard CXL application. Ten Wistar rats' corneas were used for the study. The epithelium of the cornea from the left eye of each rat was removed and treated with standard CXL application using riboflavin and Ultraviolet-A (UVA) (3 mW/cm2 for 30 min). The cornea from the right eye was used as the control cornea. The cornea was removed from the eye and processed for transmission electron microscopy. A bottom mounted Quemesa camera was used to capture digital images and these images were analysed using iTEM software. In the control cornea, the GAGs area size was not significantly different in the anterior, middle, and posterior stroma. In the CXL treated rats the GAGs area size gradually increased from the anterior to the posterior stroma whereas the spacing between the GAGs gradually decreased. There were very large GAGs present in the posterior stroma of the CXL treated rats. When comparing the control and CXL cornea, the GAGs area in the CXL cornea was significantly higher and inter-GAGs-spacing was smaller than in the control cornea. In the control cornea, the collagen fibrils diameter was higher in the anterior stroma and lowest in the posterior stroma. In the CXL treated cornea, the CF diameter and the interfibrillar spacing gradually decreased from the anterior to the posterior stroma. On comparison between the control and the CXL treated cornea, the interfibrillar spacing was significantly smaller in the CXL treated cornea than the control cornea in the anterior, middle, and posterior stroma but there was no difference in the diameter. The CXL treatment significantly increased the GAGs area and decreased the inter-GAGs-spacing, and inter-CF-spacing. This could be due to the gradual decline in the availability of riboflavin, UVA, and oxygen in the middle and posterior stroma. Further studies are required to investigate the role of keratan sulphate and chondroitin sulphate by using monoclonal antibodies with immunogold technique.

Comparative effectiveness of manual intermittent cervical longitudinal mobilization versus pain modalities in cervical radiculopathy: A double blinded randomized controlled study.

BACKGROUND: Cervical radiculopathy is a common condition encountered in clinical practice and is characterized by compression or irritation of the nerve roots in the cervical spine. OBJECTIVE: To compare the effectiveness of manual intermittent cervical longitudinal mobilization (mICLM) and therapeutic modalities in managing acute, sub-acute and chronic radiculopathy pain. METHODS: This was a multicenter, double-blinded, randomized controlled trial. Individuals with radiculopathies were randomized into interventional; (IG, n= 18) receiving mICLM and control group; (CG, n= 17), receiving Microwave Diathermy (MWD) and transcutaneous electrical nerve stimulation (TENS) at the cervico-dorsal area daily for two weeks. The neck pain disability index (NPDI), numeric pain rating scale (NPRS), and global rating of change score (GRoC) were used as outcome measures. Statistical analysis was conducted using SPSS version 23.0. RESULTS: Both mICLM and MWD with TENS were equally effective in reducing the pain and disability in either group. However, it was noted that mICLM had a better impact on acute, sub-acute and chronic cases of radiculopathy pain comparatively. Mean age was 42.3 (SD =± 10.9) years. 54.3% were between the age group of 40-60 years out of which 51.4% were male and 48.6% were female. 51.4% were in IG and 48.6% were in CG. The mean comparison of NPAD and NPRS within groups was significant with p< 0.01*. Post treatment mean comparison of NPAD outcomes in IG and CG remain significant with p= 0.004* and p< 0.01* respectively. The post NPAD and NPRS between IG and CG were found statistically insignificant with p= 0.75 and p= 0.57 respectively. CONCLUSION: mICLM and therapeutic modalities showed similar outcomes in managing radiculopathy pain. The study highlights the need for further research to understand the effectiveness of these interventions in larger patient populations.

Neonatal Hearing Screening Programme And Challenges Faced By The Developing Country: A Tertiary Care Hospital Experience.

OBJECTIVE: To screen new-borns to diagnose any hearing impairment early. METHODS: The prospective, cross-sectionalstudy was conducted at the Department of Otorhinolaryngology, Head and Neck Surgery Liaquat National Hospital, Karachi, from November 1, 2020, to April 30, 2021, and new- borns of either gender aged >12h born via spontaneous vaginal delivery, induced labour, and Caesarean section. A predesigned questionnaire was used to collect detailed case history, including gestational age, duration of labour, and other prenatal, natal, and postnatal risk factors. Otoacoustic emission test was performed, and infants referred twice were scheduled for complete diagnostic evaluation and brainstem evoked response audiometry. Data was analysed using SPSS 23. RESULTS: Of the 267 neonates, 249(93.3%) passed the first screening. Of the remaining 18(6.7%) neonates, 8(44.4%) passed the second screening, while 10(55.5%) were asked to come for a follow-up after three weeks. Of them, 3(30%) returned for check-up, while 7(70%) did not show up. CONCLUSIONS: Neonatal risk factors associated with hearing loss need to be identified, and a comprehensive hearing screening programme is required for neonates.

Effect of Growth Stages and Lactic Acid Fermentation on Anti-Nutrients and Nutritional Attributes of Spinach (Spinacia oleracea).

Spinach (Spinacia oleracea) is a winter-season green, leafy vegetable grown all over the world, belonging to the family Amaranthus, sub-family Chenopodiaceae. Spinach is a low-caloric food and an enormous source of micronutrients, e.g., calcium, folates, zinc, retinol, iron, ascorbic acid and magnesium. Contrarily, it also contains a variety of anti-nutritional factors, e.g., alkaloids, phytates, saponins, oxalates, tannins and many other natural toxicants which may hinder nutrient-absorption. This study was aimed at investigating the effect of fermentation on improving the nutrient-delivering potential of spinach and mitigating its burden of antinutrients and toxicants at three growth stages: the 1st growth stage as baby leaves, the 2nd growth stage at the coarse stage, and the 3rd growth stage at maturation. The results revealed the significant (p < 0.05) effect of fermentation on increasing the protein and fiber content of spinach powder from 2.53 to 3.53% and 19.33 to 22.03%, respectively, and on reducing total carbohydrate content from 52.92 to 40.52%; the effect was consistent in all three growth stages. A significant decline in alkaloids (6.45 to 2.20 mg/100 g), oxalates (0.07 mg/100 g to 0.02 mg/100 g), phytates (1.97 to 0.43 mg/100 g) and glucosinolates (201 to 10.50 µmol/g) was observed as a result of fermentation using Lactiplantibacillus plantarum. Fermentation had no impact on total phenolic content and the antioxidant potential of spinach, as evaluated using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and ferric-reducing antioxidant power (FRAP) assays. This study proposes fermentation as a safer bioprocess for improving the nutrient-delivering potential of spinach, and suggests processed powders made from spinach as a cost-effective complement to existing plant proteins.

The Comparative Effect of Lactic Acid Fermentation and Germination on the Levels of Neurotoxin, Anti-Nutrients, and Nutritional Attributes of Sweet Blue Pea (Lathyrus sativus L.).

Grass pea (Lathyrus sativus L.), an indigenous legume of the subcontinental region, is a promising source of protein and other nutrients of health significance. Contrarily, a high amount of ß-N-oxalyl-l-α,ß-diaminopropionic acid (ß-ODAP) and other anti-nutrients limits its wider acceptability as healthier substitute to protein of animal and plant origin. This study was aimed at investigating the effect of different processing techniques, viz. soaking, boiling, germination, and fermentation, to improve the nutrient-delivering potential of grass pea lentil and to mitigate its anti-nutrient and toxicant burden. The results presented the significant (p < 0.05) effect of germination on increasing the protein and fiber content of L. sativus from 22.6 to 30.7% and 15.1 to 19.4%, respectively. Likewise, germination reduced the total carbohydrate content of the grass pea from 59.1 to 46%. The highest rate of reduction in phytic acid (91%) and ß-ODAP (37%) were observed in germinated grass pea powder, whereas fermentation anticipated an 89% reduction in tannin content. The lactic acid fermentation of grass pea increased the concentration of calcium, iron, and zinc from 4020 to 5100 mg/100 g, 3.97 to 4.35 mg/100 g, and 3.52 to 4.97 mg/100 g, respectively. The results suggest that fermentation and germination significantly (p < 0.05) improve the concentration of essential amino acids including threonine, leucine, histidine, tryptophan, and lysine in L. sativus powder. This study proposes lactic acid fermentation and germination as safer techniques to improve the nutrient-delivering potential of L. sativus and suggests processed powders of the legume as a cost-effective alternative to existing plant proteins.

Impact of the first Gulf war on multiple sclerosis risk in Kuwait: a quasi-experimental study.

OBJECTIVE: It has been reasoned that stressful life events tend to alter immune function thereby increasing the susceptibility to autoimmune diseases including multiple sclerosis (MS). Using the database of Kuwait National MS Registry, this quasi-experimental study assessed the impact of the first Gulf War (Iraqi invasion of Kuwait in 1990) on MS risk in Kuwait. METHODS: MS incidence data from 1980 to 2019 were obtained from the Kuwait National MS Registry. Annual age-standardized incidence rates (ASIRs) (per 105 person-years) were computed using the World Standard Population as a reference. Interrupted time series analysis with the option of autoregressive order (1) was used to evaluate the impact of the first Gulf War on MS risk by treating 1990 as an intervention year. RESULTS: Estimated baseline annual ASIR (per 105 person-years) was 0.38 (95% CI: -1.02, 1.78; p = 0.587). MS ASIRs (per 105 person-years) tended to increase significantly every year prior to 1990 by 0.45 (ASIR per 105 person-years = 0.45; 95% CI: 0.15, 0.76; p = 0.005). During the first year of the first Gulf War, there seemed to be a non-significant increase (step change) in ASIRs (per 105 person-years) of MS (ASIR per 105 person-years = 0.85; 95% CI: - 5.16, 6.86; p = 0.775) followed by a non-significant increase in the annual trend in MS ASIRs per 105 person-years (relative to the preintervention trend i.e., the difference between the pre-first Gulf War versus the post-first Gulf War trends) by 0.65 (ASIR per 105 person-years = 0.65; 95% CI: - 0.22, 1.52; p = 0.138). However, a postestimation measure of the post-first Gulf War trend was statistically significant (ASIR per 105 person-years = 1.10; 95% CI: 0.40, 1.80; p = 0.003), which implies that the post-first Gulf War trend in the annual ASIRs (per 105 person-years) inclined to be the same as was the pre-first Gulf War (i.e., counterfactual of the pre-first Gulf War trend in annual ASIRs (per 105 person-years) as if no first Gulf War took place).The Durbin-Watson test statistic (d = 1.89) showed almost non-significant autocorrelations across the time series observations on ASIRs (per 105 person-years). CONCLUSIONS: This study suggests that the first Gulf War was not significantly associated with the increasing trend in MS risk at population level in Kuwait neither with any short-term change nor with secular trend. Future studies may consider confirming the role of conflict-related stress or other stressful life events in potential exacerbation of MS risk along with unraveling biologically plausible mechanistic pathways.

Disparities in oesophageal cancer risk by age, sex, and nativity in Kuwait:1980-2019.

BACKGROUND: This cross-sectional cohort study assessed the inequalities in oesophageal carcinoma risk by age, sex and nativity in Kuwait: 1980-2019. METHODS: Using oesophageal cancer incidence data from the Kuwait National Cancer Registry, relevant Kuwaiti population data and World Standard Population as a reference, age-standardized incidence rates (ASIR) (per 100,000 person-years) overall and by subcohorts were computed. The incident oesophageal cancer cases count was overdispersed with excessive structural zeros, therefore, it was analyzed using multivariable zero-inflated negative binomial (ZINB) model. RESULTS: Overall ASIR of oesophageal cancer was 10.51 (95% CI:  6.62-14.41). The multivariable ZINB model showed that compared with the younger age category (< 30 years), the individuals in higher age groups showed a significant (p < 0.001) increasing tendency to develop the oesophageal cancer.  Furthermore, compared with the non-Kuwaiti residents, the Kuwaiti nationals were significantly (p < 0.001) more likely to develop oesophageal cancer during the study period. Moreover, compared with 1980-84 period, ASIRs steadily and significantly  (p < 0.005) declined in subsequent periods till 2015-19. CONCLUSIONS: A high incidence of oesophageal cancer was recorded in Kuwait, which consistently declined from 1980 to 2019. Older adults (aged ≥ 60 years) and, Kuwaiti nationals were at high risk of oesophageal cancer. Focused educational intervention may minimize oesophageal cancer incidence in high-risk groups in this and other similar settings. Future studies may contemplate to evaluate such an intervention.

Deficiency of the RNA-binding protein ELAVL1/HuR leads to the failure of endogenous and exogenous neuroprotection of retinal ganglion cells.

Introduction: ELAVL1/HuR is a keystone regulator of gene expression at the posttranscriptional level, including stress response and homeostasis maintenance. The aim of this study was to evaluate the impact of hur silencing on the age-related degeneration of retinal ganglion cells (RGC), which potentially describes the efficiency of endogenous neuroprotection mechanisms, as well as to assess the exogenous neuroprotection capacity of hur-silenced RGC in the rat glaucoma model. Methods: The study consisted of in vitro and in vivo approaches. In vitro, we used rat B-35 cells to investigate, whether AAV-shRNA-HuR delivery affects survival and oxidative stress markers under temperature and excitotoxic insults. In vivo approach consisted of two different settings. In first one, 35 eight-week-old rats received intravitreal injection of AAV-shRNA-HuR or AAV-shRNA scramble control. Animals underwent electroretinography tests and were sacrificed 2, 4 or 6 months after injection. Retinas and optic nerves were collected and processed for immunostainings, electron microscopy and stereology. For the second approach, animals received similar gene constructs. To induce chronic glaucoma, 8 weeks after AAV injection, unilateral episcleral vein cauterization was performed. Animals from each group received intravitreal injection of metallothionein II. Animals underwent electroretinography tests and were sacrificed 8 weeks later. Retinas and optic nerves were collected and processed for immunostainings, electron microscopy and stereology. Results: Silencing of hur induced apoptosis and increased oxidative stress markers in B-35 cells. Additionally, shRNA treatment impaired the cellular stress response to temperature and excitotoxic insults. In vivo, RGC count was decreased by 39% in shRNA-HuR group 6 months after injection, when compared to shRNA scramble control group. In neuroprotection study, the average loss of RGCs was 35% in animals with glaucoma treated with metallothionein and shRNA-HuR and 11.4% in animals with glaucoma treated with metallothionein and the scramble control shRNA. An alteration in HuR cellular content resulted in diminished photopic negative responses in the electroretinogram. Conclusions: Based on our findings, we conclude that HuR is essential for the survival and efficient neuroprotection of RGC and that the induced alteration in HuR content accelerates both the age-related and glaucoma-induced decline in RGC number and function, further confirming HuR's key role in maintaining cell homeostasis and its possible involvement in the pathogenesis of glaucoma.

Combined antidiabetic potential of camel milk yogurt with Cinnamomum verum and Stevia rebaudiana by using rodent modelling.

This study aimed to evaluate anti-diabetic potential of functional camel milk yogurt enriched with Cinnamomum verum and Stevia rebaudiana that not only mask its peculiar flavour rather have an antidiabetic effect as well. Sixty-three pathogen free STZ-induced albino Wistar rats were categorized into 7 groups on the basis of treatments. From each treatment group three animals were dissected periodically at 0, 7 and 21 days of study to determine the effect of all treatments on physicochemical parameters, serum glucose, serum chemistry and haematology. The study revealed that the mean blood glucose level in the untreated control group was within normal range (100-108 mg/dl) while there was noticeable decrease in mean blood glucose level of all the treated groups during three weeks' trial. Decline in blood glucose level (46%) was higher in animal group containing functional camel milk yogurt (T4) at 3rd week of trial as compared to other treatments.

Mechanistic insights of Cucumis melo L. seeds for gastrointestinal muscle spasms through calcium signaling pathway-related gene regulation networks in WGCNA and in vitro, in vivo studies.

BACKGROUND: In addition to the nutritional benefits of Cucumis melo L., herbalists in Pakistan and India employ seeds to treat various ailments. This study aimed to determine the regulatory role of C. melo seeds in calcium-mediated smooth muscle contraction. METHODS: We identified and quantified the phytochemicals of C. melo with LC ESI-MS/MS and HPLC, then conducted in vitro and in vivo tests to confirm the involvement in smooth muscle relaxation. Then, diarrhea-predominant irritable bowel syndrome gene datasets from NCBI GEO were acquired, DEGs and WGCNA followed by functional enrichment analysis. Next, molecular docking of key genes was performed. RESULTS: The quantification of C. melo seeds revealed concentrations of rutin, kaempferol, and quercetin were 702.38 µg/g, 686.29 µg/g, and 658.41 µg/g, respectively. In vitro experiments revealed that C. melo seeds had a dose-dependent relaxant effect for potassium chloride (80 mM)-induced spastic contraction and exhibited calcium antagonistic response in calcium dose-response curves. In in vivo studies, Cm.EtOH exhibited antidiarrheal, antiperistaltic, and antisecretory effects. The functional enrichment of WGCNA and DEGs IBS-associated pathogenic genes, including those involved in calcium-mediated signaling, MAPK cascade, and inflammatory responses. MAPK1 and PIK3CG were identified as key genes with greater binding affinity with rutin, quercitrin, and kaempferol in molecular docking. CONCLUSIONS: The bronchodilator and antidiarrheal effects of C. melo were produced by altering the regulatory genes of calcium-mediated smooth contraction.

Effect of Thermal and Non-Thermal Processing on Nutritional, Functional, Safety Characteristics and Sensory Quality of White Cabbage Powder.

This study was aimed to improve nutritional, functional and consumer safety aspects of cabbage powder (CP). White cabbage (Brassica oleracea var. capitata f. alba) was dehydrated to CP following microwave heating, blanching, alkali or acid washing treatments. The results for nutrients and mineral composition of raw and processed CP elucidated raw CP to exhibit significantly (p < 0.05) higher amounts of protein (12.2%), dietary fiber (25.2%), Na (52 mg/100 g), Ca (355 mg/100 g), K (286 mg/100 g), Fe (14 mg/100 g) and Zn (32 mg/100 g). Among different processing techniques, microwave treatment resulted in a higher rate of reduction for alkaloids, oxalates, tannins and phytates contents, i.e., 77%, 85%, 85%, and 86%, respectively. Likewise, microwave treatment was found more effective in reducing residual levels of neonicotinoids, pyrethroids, organophosphates including imidacloprid, cypermethrin, bifenthrin, chlorpyrifos and deltamethrin in cabbage in the range of 0.98−0.12 ppm, 1.22−0.23 ppm, 1.03−0.15 ppm, 1.97−0.43 ppm, and 2.12−0.36 ppm, respectively. CP supplementation at the rate of 5% in unleavened flatbreads was observed to maintain textural and sensory attributes of the product. The results suggest microwave heating as a cost-effective technique to reduce toxicants load in cabbage powder. Further, ~5% supplementation of CP in wheat flour may also improve nutritional and functional properties of the baked goods.