Prevalence of Depression Among the Adult Population in Southwestern Saudi Arabia: A Cross-Sectional, Community-Based Study.

Background Depression is one of the most common mental disorders, which is increasing globally with higher prevalence among women. Many factors contribute to the etiology and risk factors for depression, including biological and psychosocial factors. This study aimed to assess the prevalence of depression among the adult population in Al-Qunfudah governorate, southwestern Saudi Arabia (SA). Methods A cross-sectional study was conducted on a sample of 1036 participants among adults in Al-Qunfudah governorate, southwestern SA, using a validated Arabic version of the Patient Health Questionnaire (PHQ-9) during the period from October 1st, 2022 to the end of December 2022. The PHQ-9 contains nine items, with a total score ranging from 0 to 27. A score of 1-4 represented minimal depression, while a score of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. The sample size was estimated to be 375 participants, by considering a margin of error of 5%, and a 95% confidence interval, calculated using Raosoft calculator (Raosoft Inc., Seattle, WA). Data collection was performed through an online survey of the PHQ-9 on a Google form and distributed using different social media platforms. The eligible participants' responses were kept confidential and analyzed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). p-values of <0.05 were considered statistically significant.  Results The study showed that the overall prevalence of depression among the 1036 adult study participants was 68.1%. Mild, moderate, moderate to severe, and severe depression was diagnosed among 28.2%, 21.9%, 12%, and 6% of the participants, respectively. Several factors were significantly associated with PHQ-9 diagnosed depression including being younger (p<0.0001), a female (p<0.0001), single (p<0.0001), a student (p<0.0001), and non-employed (p<0.0001) and having a lower educational level (p<0.0001). Conclusions There is a high prevalence rate of depression among the adult population of Al-Qunfudah governorate in southwestern SA, which highlights the need for interventions to address this issue, and to reduce the incidence of depression in the region among the high-risk groups.

Autonomic brain functioning and age-related health concerns.

The autonomic nervous system (ANS) regulates involuntary bodily functions such as blood pressure, heart rate, breathing, and digestion, in addition to controlling motivation and behavior. In older adults, the ANS is dysregulated, which changes the ability of the ANS to respond to physiological signals, regulate cardiovascular autonomic functionality, diminish gastric motility, and exacerbate sleep problems. For example, a decrease in heart rate variability, or the variation in the interval between heartbeats, is one of the most well-known alterations in the ANS associated with health issues, including cardiovascular diseases and cognitive decline. The inability to perform fundamental activities of daily living and compromising the physiological reactivity or motivational responses of older adults to moving toward or away from specific environmental stimuli are significant negative consequences of chronic and geriatric conditions that pose grave threats to autonomy, health, and well-being. The most updated research has investigated the associations between the action responsiveness of older adults and the maintenance of their physiological and physical health or the development of mental and physical health problems. Once autonomic dysfunction may significantly influence the development of different age-related diseases, including ischemic stroke, cardiovascular disease, and autoimmune diseases, this review aimed to assess the relationship between aging and autonomic functions. The review explored how motivational responses, physiological reactivity, cognitive processes, and lifelong developmental changes associated with aging impact the ANS and contribute to the emergence of health problems.

Herpetic Whitlow Associated With an Eating Disorder: A Case Report.

Herpetic whitlow is a localized cutaneous viral infection primarily affecting the fingers, caused by herpes simplex virus types 1 (HSV-1) or 2 (HSV-2). It can be recurrent due to behavioral factors associated with eating disorders, such as bulimia nervosa. We would like to introduce "Jehany Sign," suggesting the term for the association of bulimia nervosa with HSV infections. Here, we present the case of a 50-year-old pre-diabetic female with recurrent herpetic whitlow on her left index finger associated with self-induced vomiting and extreme concern about her weight and body shape. Skin examination showed an eroded group of vesicles on an erythematous base on her left finger. The diagnosis was established through history and clinical examination. Upon follow-up, the patient showed complete resolution in one week after receiving topical and systemic acyclovir, which led to a subsequent referral to a psychiatrist for further management regarding bulimia nervosa. This case highlights the importance of a multidisciplinary approach and the complicated connections between eating disorders and dermatological diseases. Recognizing these allows healthcare providers to deliver more comprehensive care, improve patient outcomes, and further study in this area.

Perspective of biopharmaceutics knowledge and practice of pharmacy personnel toward the effect of medication route and medical procedure on nullifying fasting.

Background: In Ramadan, most of the dosing schedules for the patients are changed, and to ensure patient compliance to medications and to healthy life among patients, appropriate guidelines and educations are needed. This can be achieved by pharmacy personnel in all clinical settings who are recognized as biopharmaceutical experts and integral educators of medications. Aims: This study aimed to identify the perspective knowledge of pharmacy personnel about effect of medication route and medical procedure on nullifying fasting in Ramadan and to determine the predictors of this knowledge. Methods: A cross-sectional study was conducted in Jordan during March-April 2022. An internet-based self-administrated questionnaire on knowledge, and views was distributed using social media groups to the pharmacy personnel among different geographical areas in Jordan. A descriptive and univariate analysis were performed. Binary logistic regression was conducted to determine the predictors of knowledge including all variables with p < 0.20 on univariate analysis. Results: A total of 1003 responses to the study questionnaire were collected and included in the analysis. The most common source that pharmacy personnel used to get information on medication intake and medical procedures during fasting in Ramadan was Fatwa (57.8%) followed by Islamic materials "books and brochures" (47.1%). The majority of respondents were knowledgeable about the effect of administration route of medication and medical procedures on nullifying fasting in Ramadan (greater than70%). The univariate analysis showed that more than half of respondents (56.1%) were considered knowledgeable, and the binary logistic regression analysis identified that both professional degree type and confidence of respondents to modify the patient's medication schedule as predictors for knowledge (OR = 1.791, 95% CI = 1.035-3.098, p = 0.037), (OR = 1.375, 95% CI = 1.04-1.817, p = 0.025), respectively. Conclusions: Most of pharmacy personnel in Jordan are knowledgeable in biopharmaceutics principles and practice toward effect of medication route and medical procedure on nullifying fasting, and the identified predictors for this knowledge, can provide an opportunity to improve safe and effective use of medications and medical procedures during the holy month of Ramadan.

Potential roles of NEDD4 and NEDD4L and their utility as therapeutic targets in high­incidence adult male cancers (Review).

The term 'cancer' refers to >100 disorders that progressively manifest over time and are characterized by uncontrolled cell division. Although malignant growth can occur in virtually any human tissue, the underlying mechanisms underlying all forms of cancer are consistent. The International Agency for Research on Cancer's annual GLOBOCAN 2020 report provided an update on the global cancer incidence and mortality. Excluding non-melanoma skin cancer, the report predicts that there will be 19.3 million new cancer cases and >10 million cancer-related fatalities in 2023. Lung, prostate, and colon cancers are the most prevalent and lethal cancers in males. It was recognized that post-translational modifications (PTMs) of proteins are necessary for almost all cellular biological processes, as well as in cancer development and metastasis to other bodily organs. Thus, PTMs have a considerable impact on how proteins behave. Various PTMs may have harmful roles by affecting the hallmarks of cancer, metabolism and the regulation of the tumor microenvironment. PTMs and genetic changes/mutations are essential in carcinogenesis and cancer development. A pivotal PTM mechanism is protein ubiquitination. Of note, the rate-limiting stage of the protein ubiquitination cascade is hypothesized to be E3-ligase-mediated ubiquitination. Numerous studies revealed that the neural precursor cell expressed developmentally downregulated protein 4 (NEDD4) E3 ligase is among the E3 ubiquitin ligases that have essential roles in cellular processes. It regulates protein degradation and substrate ubiquitination. In addition, it has been shown that NEDD4 primarily functions as an oncogene in various malignancies but can also act as a tumor suppressor in certain types of tumor. In the present review, the roles of NEDD4 as an anticancer protein in various high-incidence male malignancies and the significance of NEDD4 as a potential cancer therapeutic target are discussed. In addition, the targeting of NEDD4 as a therapeutic strategy for the treatment of human malignancies is explored.

The effects of statin therapy on brain tumors, particularly glioma: a review.

Brain tumors account for less than 2% of all malignancies. However, they are associated with the highest morbidity and mortality rates among all solid tumors. The most common malignant primary brain tumors are glioma or glioblastoma (GBM), which have a median survival time of about 14 months, often suffer from recurrence after a few months following treatment, and pose a therapeutic challenge. Despite recent therapeutic advances, the prognosis for glioma patients is poor when treated with modern therapies, including chemotherapy, surgery, radiation, or a combination of these. Therefore, discovering a new target to treat brain tumors, particularly glioma, might be advantageous in raising progression-free survival and overall survival (OS) rates. Statins, also known as competitive HMG-CoA reductase inhibitors, are effective medications for reducing cholesterol and cardiovascular risk. The use of statins prior to and during other cancer treatments appears to enhance patient outcomes according to preclinical studies. After surgical resection followed by concurrent radiation and treatment, OS for patients with GBM is only about a year. Statins have recently emerged as potential adjuvant medications for treating GBM due to their ability to inhibit cell growth, survival, migration, metastasis, inflammation, angiogenesis, and increase apoptosis in-vitro and in-vivo studies. Whether statins enhance clinical outcomes, such as patient survival in GBM, is still debatable. This study aimed to explore the effects of statin therapy in the context of cancer treatment, with a particular focus on GBM.

Isorhamnetin Reduces Glucose Level, Inflammation, and Oxidative Stress in High-Fat Diet/Streptozotocin Diabetic Mice Model.

Background: Isorhamnetin is a flavonoid that is found in medical plants. Several studies showed that isorhamnetin has anti-inflammatory and anti-obesity effects. This study aims to investigate the anti-diabetic effects of isorhamnetin in a high-fat diet and Streptozotocin-(HFD/STZ)-induced mice model of type 2 diabetes. Materials and Methods: Mice were fed with HFD followed by two consecutive low doses of STZ (40 mg/kg). HFD/STZ diabetic mice were treated orally with isorhamnetin (10 mg/kg) or (200 mg/kg) metformin for 10 days before sacrificing the mice and collecting plasma and soleus muscle for further analysis. Results: Isorhamnetin reduced the elevated levels of serum glucose compared to the vehicle control group (p < 0.001). Isorhamnetin abrogated the increase in serum insulin in the treated diabetic group compared to the vehicle control mice (p < 0.001). The homeostasis model assessment of insulin resistance (HOMA-IR) was decreased in diabetic mice treated with isorhamnetin compared to the vehicle controls. Fasting glucose level was significantly lower in diabetic mice treated with isorhamnetin during the intraperitoneal glucose tolerance test (IPGTT) (p < 0.001). The skeletal muscle protein contents of GLUT4 and p-AMPK-α were upregulated following treatment with isorhamnetin (p > 0.01). LDL, triglyceride, and cholesterol were reduced in diabetic mice treated with isorhamnetin compared to vehicle control (p < 0.001). Isorhamnetin reduced MDA, and IL-6 levels (p < 0.001), increased GSH levels (p < 0.001), and reduced GSSG levels (p < 0.05) in diabetic mice compared to vehicle control. Conclusions: Isorhamnetin ameliorates insulin resistance, oxidative stress, and inflammation. Isorhamnetin could represent a promising therapeutic agent to treat T2D.

Postoperative Candida Infection following Complex Periocular Reconstruction.

Postoperative candida infection is a rarely reported complication in cutaneous surgery, although it may develop more often in particular clinical settings. We present a 59-year-old woman with a well-controlled human immunodeficiency virus infection. She developed a bright red eruption with satellite pustules 2 weeks after excision of recurrent lentigo maligna melanoma of the left lower eyelid and periocular region. Due to defect size and complexity of the reconstruction (glabellar transposition flap, Hughes flap, composite graft from upper contralateral eyelid, and full-thickness skin graft from ipsilateral retroauricular region), she was placed on prophylactic oral amoxicillin-clavulanic acid and topical bacitracin and polymyxin. Immediate postoperative course was unremarkable, and sutures were removed after 7 days. Three days later, she developed bright red erythema and pustules within the surgical site and complained of burning. Empirically she was switched to topical gentamicin and oral ciprofloxacin, and later to linezolid, due to inadequate response. Wound culture grew Candida albicans sensitive to fluconazole and voriconazole. After oral fluconazole and topical clotrimazole initiation, the patient rapidly improved. The graft remained viable and apart from small partial dehiscence on the cheek, the healing was unremarkable. Apart from the case presentation, we also discuss different factors associated with postoperative candida infection, including immunocompromised status, surgical procedure location, and postoperative antibiotic use. Early recognition and treatment of postoperative candida infections are crucial to prevent delayed healing and associated morbidity.

Regulation of ABCG4 transporter expression by sterols and LXR ligands.

BACKGROUND: Oxysterols, which are derivatives of cholesterol produced by enzymic or non-enzymic pathways, are potent regulators of cellular lipid homeostasis. Sterol homeostasis in the brain is an important area of interest with regards to neurodegenerative conditions like Alzheimer's disease (AD). Brain cells including neurons and astrocytes express sterol transporters belonging to the ABC transporter family of proteins, including ABCA1, ABCG1 and ABCG4, and these transporters are considered of interest as therapeutic targets. Although regulation of ABCA1 and ABCG1 is well established, regulation of ABCG4 is still controversial, in particular whether the transporter is an Liver X receptor (LXR) target. ABCG4 is thought to transport cholesterol, oxysterols and cholesterol synthesis intermediates, and was recently found on the blood brain barrier (BBB), implicated in amyloid-beta export. In this study, we investigate the regulation of ABCG4 by oxysterols, cholesterol-synthesis intermediates and cholesterol itself. METHODS: ABC transporter expression was measured in neuroblastoma and gliablastoma cell lines and cells overexpressing ABCG4 in response to synthetic LXR ligands, oxysterols and cholesterol-synthesis intermediates. RESULTS: In contrast to previous reports, ABCG4 expression was induced by a synthetic LXR ligand in U87-MG astrocytes but not in neuroblastoma and BBB endothelial cell lines. In addition, ABCG4 protein was stabilized by cholesterol as was previously shown for ABCG1. ABCG4 protein was furthermore stabilized by cholesterol-synthesis intermediates, desmosterol, lathosterol and lanosterol. CONCLUSIONS: These results identify new aspects of the post-translational control of ABCG4 that warrant further exploration into the role of this transporter in the maintenance of sterol homeostasis in the brain.

Silicone spacer repair of medial rectus after iatrogenic orbit fracture.

A 51-year-old woman underwent endoscopic nasal polypectomy and ethmoidectomy with accidental entry into the right orbit causing enophthalmos and transection of the medial rectus muscle (MR). The repair of a fracture and of a damaged MR is technically challenging, particularly when large portions of bone and muscle are missing. We report a rare case of repair of the bony defect with an implant and reattachment of the MR with a silicone retina band, through a combined transcaruncular and transconjunctival approach. Postoperatively, the patient had residual enophthalmos and strabismus; further surgical options are discussed.

Periorbital physical urticaria in an anophthalmic patient with dermatographism.

Physical urticarias are a subset of chronic urticarias in which patients have urticaria induced by a variety of environmental stimuli, including pressure. A 50-year-old white woman with a history significant for dermatographism presented with recurrent swelling of the eyelids shortly after manipulation or removal of her custom-fit prosthesis. This swelling, which lasted for hours to days, responded to treatment with oral corticosteroids. This is an uncommon finding of a physical urticaria in the periorbital region.

Late-onset orbital hematoma secondary to alloplastic orbital implant mimicking transient ischemic attacks.

Alloplastic orbital implants are commonly used by surgeons in the repair of orbital wall defects. They are generally well tolerated, but they may cause late-onset complications. The authors present the case of a 65-year-old man with a history of left orbital floor fracture repair 25 years prior using a silicone orbital implant. He presented with a 1-year history of recurrent binocular vertical diplopia previously diagnosed as transient ischemic attacks. The patient subsequently presented with symptoms suggestive of orbital cellulitis, and after failure to respond to antibiotic therapy, he underwent surgical removal of the implant, revealing a large orbital hematoma. This case represents an unusual presentation of a known complication associated with orbital implant placement in a patient with previously diagnosed cerebrovascular disease as the cause of his neuroophthalmologic symptoms.

Wegener granulomatosis causing compressive optic neuropathy in a child.

Wegener granulomatosis is an uncommon illness in children that is known to cause myriad ophthalmic complications, but it is rarely a cause of compressive optic neuropathy. A 17-year-old Hispanic boy with Wegener granulomatosis developed unilateral loss of vision, pain, and proptosis of the left eye. CT findings revealed enlargement of bilateral lacrimal glands with compression of the left optic nerve. The patient was admitted for high-dose intravenous corticosteroids and daily oral cyclophosphamide treatment. The patient's vision, pain, and proptosis improved dramatically, and he is now stable on mycophenolate mofetil and prednisone.

Group A streptococcal necrotizing fasciitis of the eyelids and face managed with debridement and adjunctive intravenous immunoglobulin.

The authors describe a patient with right upper and lower eyelid necrosis combined with facial, neck, and chest edema and sepsis secondary to Group A streptococcal infection after minor trauma. This is an uncommon, life-threatening condition that was successfully treated with limited surgical debridement, antimicrobial therapy, and intravenous immunoglobulin. Oculoplastic surgeons should be aware of the indications and potential benefit of adjunctive intravenous immunoglobulin therapy for Group A Streptococcus-induced necrotizing fasciitis.

Lacrimal sac melanoma.

A 48-year-old woman presented with a 5-month history of unilateral epiphora and progressive growth of a left-sided medial canthus mass. CT revealed a nonenhancing soft tissue mass of the left lacrimal sac with widening and erosion of the nasolacrimal canal. The tumor was resected and pathologically confirmed to be malignant melanoma. Despite wide resection and adjuvant radiotherapy, the patient developed metastases to the chest wall. The patient currently is receiving combined immunotherapy and chemotherapy. The clinical course and treatment strategies are reviewed for this highly aggressive and rare neoplasm.

Bilateral eyelid edema and orbital cellulitis associated with Pott's puffy tumor.

Pott's puffy tumor is rarely associated with orbital cellulitis. We describe a pediatric patient with Pott's puffy tumor and right-sided orbital cellulitis. He underwent urgent surgical drainage of a glabellar subperiosteal abscess and completed a six week course of intravenous antibiotics with complete resolution of infection and no long-term sequelae. Close monitoring with imaging for intracranial spread and multidisciplinary surgical intervention are commonly recommended.

Lacrimal gland involvement in graft-versus-host disease: a murine model.

PURPOSE: To describe lacrimal gland involvement in a murine model of acute graft-versus-host disease (GVHD). METHODS: Histopathologic examination was performed on lacrimal glands of mice affected by GVHD at 1, 2, 4, and 6 weeks after allogeneic bone marrow transplantation (BMT). Histopathologic scoring, based on characteristic GVHD findings in human disease involved evaluation of periductal inflammation, apoptosis, ductal stasis, ductal debris, and fibrosis. CD3, CD4, CD8, CD20, and CD68 antibodies were used to stain leukocyte subsets in GVHD lacrimal gland infiltrates. Lacrimal glands from syngeneic BMT mice were used in control experiments. RESULTS: Patchy periductal inflammation and focal fibrosis were significantly elevated as early as 2 weeks after allogeneic BMT. Histopathologic scoring of lacrimal glands after allogeneic BMT was significantly different at 4 (P = 0.005) and 6 (P < 0.0001) weeks when compared with scores in syngeneic control mice. The leukocytes in lacrimal gland GVHD infiltrates were predominately CD3+ T lymphocytes, most of which were CD8+, with fewer CD4+ cells present. CONCLUSIONS: This study describes the first murine model of lacrimal gland GVHD with features that closely mimic those described in human disease and indicates that lacrimal involvement occurs in acute GVHD.

The remineralization of fluoride-treated bovine enamel surfaces.

Various etching methods are examined with respect to their ability to induce the surface nucleation and growth of fluorapatite from solutions of low, sustained supersaturation with respect to hydroxyapatite and fluorapatite. The constant composition kinetics method enables the rates of remineralization to be precisely determined, and the possibility of the direct growth of fluorapatite on calcium fluoride crystals in calcium phosphate solutions of low supersaturation has also been examined.

The mineralization of enamel surfaces. A constant composition kinetics study.

The in vitro remineralization of acid-etched enamel surfaces offers an attractive model for simulating carious lesion recalcification and the repair of teeth in the oral environment. In the present work the influence of the extent of etching with hydrochloric and phosphoric acids has been examined. The kinetics of growth of hydroxyapatite as an exclusive phase on the pretreated enamel surfaces has been studied by means of a constant solution composition procedure. This method enables studies to be made at low constant supersaturations so that the stoichiometry of the precipitating phase may be defined. The very small rates of mineralization with HAP were determined with a precision hitherto unattainable. In addition, the influence of fluoride ion in enhancing the remineralization of damaged enamel has been investigated.