In-silico and in-vitro studies revealed alpha-amyrin as a potent pnhibitor of TLR2 for the therapeutics of bacterial infection and sepsis.

This study employed a multifaceted approach to investigate the inhibitory potential of alpha-amyrin against TLR2, a key player in bacterial infection and sepsis. A high-resolution TLR2 model was constructed using Swiss-MODEL, exhibiting excellent quality with 100% sequence identity and coverage. Cavity detection revealed five significant cavities on TLR2. Molecular docking identifies alpha-amyrin as a potent inhibitor, displaying a strong binding affinity of -8.6 kcal/mol. Comprehensive analyses, including ADMET predictions, PASS analysis, and SwissTargetPrediction, affirm alpha-amyrin's drug-like properties and diverse biological activities. Cytotoxicity assays on HEK-293 cells confirm its safety, and fluorescence-based inhibition assays provide empirical evidence of its inhibitory potency on TLR2 enzymatic activity. Further validations in HUVECs show a significant decrease in TLR2 mRNA expression (p<0.01) and activity (p<0.05) upon alpha-amyrin treatment. In conclusion, this integrative study positions alpha-amyrin as a promising therapeutic candidate for TLR2 inhibition, emphasizing its potential in combating bacterial infections with safety and efficacy.

Leflunomide-induced cardiac injury in adult male mice and bioinformatic approach identifying Nrf2/NF-κb signaling interplay.

Leflunomide (LFND) is an immunosuppressive and immunomodulatory disease-modifying antirheumatic drug (DMARD) that was approved for treating rheumatoid arthritis. LFND-induced cardiotoxicity was not fully investigated since its approval. We investigated the cardiac injury in male mice and identified the role of nuclear factor erythroid 2-related factor 2/nuclear factor-κ B (Nrf2/NF-κB) signaling. Male albino mice were assigned into five groups as control, vehicle, and LFND (2.5, 5, and 10 mg/kg). We investigated cardiac enzymes, histopathology, and the mRNA expression of Nrf2, NF-κB, BAX, and tumor necrosis factor-α (TNF-α). The bioinformatic study identified the interaction between LFND and Nrf2/NF-κB signaling; this was confirmed by amelioration in mRNA expression (0.5- to 0.34-fold decrease in Nrf2 and 2.6- to 4.61-fold increases in NF-κB genes) and increased (1.76- and 2.625-fold) serum creatine kinase (CK) and 1.38- and 2.33-fold increases in creatine kinase-MB (CK-MB). Histopathological results confirmed the dose-dependent effects of LFND on cardiac muscle structure in the form of cytoplasmic, nuclear, and vascular changes in addition to increased collagen deposits and apoptosis which were increased compared to controls especially with LFND 10 mg/kg. The current study elicits the dose-dependent cardiac injury induced by LFND administration and highlights, for the first time, dysregulation in Nrf2/NF-κB signaling.

Comparing the Efficacy of Local Corticosteroid Injection, Platelet-Rich Plasma, and Extracorporeal Shockwave Therapy in the Treatment of Pes Anserine Bursitis: A Prospective, Randomized, Comparative Study.

Background: Pes anserine bursitis (PAB) is one of the most common causes of painful knee syndromes. This study aimed at examining the efficacy of local corticosteroid injection, platelet-rich plasma (PRP) injection, and extracorporeal shock wave therapy (ESWT) as different modalities to alleviate pain and enhance function in patients with pes anserine bursitis (PAB). Methods: A prospective, randomized, comparative study was conducted on 180 patients diagnosed with chronic PAB. They were equally divided into three groups as follows: Group I received a local corticosteroid injection of 40 mg of methylprednisolone acetate/1 ml; Group II received a PRP injection; and in Group III, ESWT was used. Outcome measures included the visual analog scale (VAS), Western Ontario and McMaster Universities (WOMAC) pain score, WOMAC physical function score, and Ritchie articular index (RAI) for tenderness, which were recorded at the baseline, after 1 week, and after 8 weeks. Results: Before the application of procedures, there was a statistically significant increase in the WOMAC pain score in the local corticosteroid group compared to the PRP group and the ESWT group (P < 0.001). After the application of procedures, there was a statistically significant improvement in the 1-week and 8-week WOMAC pain score, WOMAC physical function score, and VAS in the local corticosteroid group in comparison to the PRP group and the ESWT group. (P < 0.001). Moreover, RAI for tenderness shows statistically significant improvement at 8 weeks in the local corticosteroid groups compared to the PRP groups (P < 0.001) and ESWT groups (P < 0.001). Similarly, a statistically significant difference was found between the PRP and ESWT groups (P=0.023). Conclusion: Our data suggest that in patients with PAB, local corticosteroid injection is more efficient than PRP injection and ESWT for reducing pain and enhancing function.

Phenotype and Genotype of Saudi Pediatric Patients With Neurofibromatosis Type 1: A Seven-Year Multicenter Experience From Saudi Arabia.

Background Neurofibromatosis type 1 (NF1) is a complex disorder. Genetics and environment might be attributed as the leading cause of NF1, which is characterized by multisystemic involvement. We aim to elaborate on Saudi children's NF1 phenotypes and genotypes. Methods This study was conducted in the Ministry of National Guard Health Affairs (MNGHA), Saudi Arabia including three tertiary hospitals, using a retrospective cohort method. Electronic charts were reviewed to extract the variables. All Saudi pediatric patients aged less than 18 with NF1 were included. Consecutive sampling was used due to the limited number of patients. Results The study included 160 patients (81 males) with an average age of 8.08 years. Also, 33 (20.6%) patients had cutaneous neurofibroma while 31 (19.4%) patients had plexiform neurofibromas. Iris lisch nodules were seen in 33.75%. Optic pathway glioma was seen in 29 (18%) cases while non-optic pathway glioma was seen in 27 (17%) cases. Skeletal abnormalities were seen in 27 (17%) of cases. A first-degree relative with NF1 was seen in 83 (52%) of cases. Epilepsy was the presenting feature of 27 (17%) cases. Cognitive impairment was found in 15 (9.4%) patients. Genetic mutation was seen in 82/100 cases, the rest were negative. The types of mutations were as follows: nonsense 30 (36.6%); missense 20 (24.4%); splicing site mutation 12 (14.6%); frameshift 10 (12.2%); microdeletion 7 (8.5%); and whole gene deletion 3 (3.75%) patients. No phenotype-genotype correlation was seen. Conclusion In this cohort of Saudi pediatric patients with NF1, optic pathway glioma and other brain tumors were prevalent. The most common mutation is the nonsense mutation.

Prevalence and Risk Factors of Osteoporosis in Saudi End-Stage Renal Disease Patients on Hemodialysis.

Background: Osteoporosis is characterized by a decrease in bone mineral density, thereby increasing the risk of pathological fractures. It is a common complication of chronic kidney disease. However, there is limited local data on the prevalence of osteoporosis in end-stage renal disease. Objective: The current study evaluated the epidemiology of osteoporosis in end-stage rental disease patients at a Saudi Arabian tertiary care center. Methods: This cross-sectional retrospective study was conducted using data obtained between 1 January 2016 and 31 December 2019 at the Dialysis Center at King Abdulaziz Medical City, Riyadh, Saudi Arabia. End-stage rental disease patients who were aged ≥50 years and underwent hemodialysis for at least 1 year were included, while those with documented metabolic bone disease and absence of bone mineral density data were excluded. Results: Sixty-four end-stage rental disease patients undergoing hemodialysis met the inclusion criteria. The patients underwent bone mineral density measurement at the discretion of the treating physician. The mean patients' age was 73 ± 11.5 years and 76% were women. The overall prevalence of osteoporosis was 37.5%, and it was similarly distributed among women and men (38.8% and 33.3%, respectively). Nine of the 15 male patients (60%) and 24 of the 49 female patients (49%) had fractures. Twenty-five (39%) patients used glucocorticoids. Osteoporosis was most commonly identified in the femoral neck (26.2%), followed by proximal femur (19.4%), and lumbar spine (18.8%). A high rate of osteoporosis was significantly associated with older age and being underweight. Conclusion: A high rate of low bone mineral density was demonstrated in end-stage renal disease patients. The femoral neck was the most common osteoporosis site in this patient population, and advanced age and underweight were possible risk factors for low bone mass.

A Pattern of Lipid Profile Among Saudi Adults With Type 1 Diabetes Mellitus in a Tertiary Hospital: A Retrospective Study.

OBJECTIVE: Dyslipidemia is prevalent in adults living with type 1 diabetes, and it can worsen the presentation of microvascular complications such as retinopathy. This study aims to identify the pattern coupled with the frequency of dyslipidemia in diabetic adults who followed up at different clinics in King Abdulaziz Medical City, Riyadh, and evaluate the associations with demographic and clinical characteristics. METHODS: A cross-sectional, retrospective chart review study of 514 adults with type 1 diabetes was conducted in a tertiary health care facility in the central region of Saudi Arabia. Demographics were retrieved by using the implemented electronic medical records. Fasting lipid profile, glycated hemoglobin (HbA1c), and thyroid-stimulating hormone (TSH) levels were checked for all subjects. RESULTS: Five hundred and fourteen (514) subjects aged 18-65 years were studied (mean age: 26.1 ± 7.1 years). There were 318 (62%) females in the sample, and their mean age was significantly different from the mean age of males (p = 0.01). The mean duration of having diabetes was 12.8 ± 6.9 years. The prevalence of lipid abnormalities included abnormal low-density lipoprotein (LDL) (70%), hypercholesterolemia (23%), abnormal high-density lipoprotein (HDL) (8%), and hypertriglyceridemia (5%). Abnormal HDL was significantly higher in males than in females (p=<0.001). There were no statistically significant differences in the prevalence of other lipid abnormalities between the two genders and the age group < or ≥ 25 years. There was no statistically significant difference in the mean of the tested lipids levels between the two genders. One hundred and forty-three (143) (27.8%) patients had more than one abnormal lipid condition. A statistically significant difference was observed in the mean HbA1c between males and females (p=0.001). Otherwise, there was no significant association of lipid abnormalities with gender, age, diabetes duration, and weight. CONCLUSION: The most prevalent lipid abnormality was high LDL cholesterol. Nearly a third of the tested individuals had more than one lipid abnormality. Furthermore, poor glycemic control was linked to abnormal lipid profiles. Consequently, local programs must aim to screen and intervene early to delay and prevent future severe vascular complications related to non-treated dyslipidemia.

Anticipation of Relapse and Acute Graft-Versus-Host Disease after Allogeneic Peripheral Blood Stem Cell Transplantation: The Fundamental Role of Antigen-Presenting (Dendritic) Cells.

Background: Dendritic cells (DCs) are antigen-presenting cells. In humans two distinct lineages of DCs exist: DC1 and DC2. Efforts to explore the role of DCs in acute graft-versus-host disease (aGVHD) after allogeneic peripheral blood stem-cell transplantation (PBSCT) are gaining traction. However, further research is needed to identify particular lineages and their values in terms of developing an evidence-based aGVHD- or relapse-prevention strategy. We monitored DC counts and subsets in PBSC grafts while harvesting stem cells in recipients to elucidate their value in anticipating disease relapse or aGVHD. Methods: We enrolled 29 participants. Using fluorescence-activated cell sorting, total counts/kg of CD34+, DCs, and DC subsets were analyzed in 29 PBSC-graft components using CMRF44, CD11c, and CD4 monoclonal antibodies (MoAbs). Results: In the 29 grafts, we detected a significant positive correlation (P<0.01) between DCs and both DC1 and DC2. Significantly higher counts (P<0.01) of DCs and DC1 in those who had developed aGVHD (nine cases) were also observed. Relapsed cases (two) were also associated with higher counts of DCs and DC2. A significant positive correlation (P<0.05), was recorded between DCs and DC1 counts and the day of myeloid engraftment, while this was not detected on the day of platelet engraftment. Myeloid engraftment transpired earlier in patients without aGVHD. Increased DC-graft numbers, particularly DC1 measured by CD11c Moabs, were associated with aGVHD. Recipients of higher numbers of CD4bright DCs had an increased risk of relapse after allogeneic PBSCT. Conclusion: This study analyzed DCs in PBSC grafts, using novel specific MoAbs and flow cytometry. Our data showed that higher donor DC1 counts were linked to the incidence of aGVHD and DC2 with relapse. We propose a fundamental role for DC-graft monitoring in anticipating aGVHD and disease relapse.

Phenotypic Changes of Trichinella Spiralis Treated By Commiphora Molmol,Lepidium Sativum, and Albendazole: in Vitro Study.

Trichinellosis is a nematode-causing disease distinguished by its continuous transmission in the carnivores and omnivores. Despite effective eradication of the enteral forms, conventional drugs fail to eliminate the migrating and muscle ones. Over the past years, researchers intensified the work on herbal medicines as alternatives or aids to albendazole, the reference drug. This research hypothesizes that the therapeutic agent absorption route could be an evidence-based carrier molecule or auxiliary drug to albendazole. Accordingly, this in vitro study was designed to investigate mainly the phenotypic changes induced by a mono-treatment of albendazole, Lipidium sativum (garden cress), and Commiphora molmol (myrrh). Incredibly, no data were reported on the morphological alterations of T. spiralis larvae treated by any of these drugs. The experimental design tested various concentrations (25, 50, 100, and 200 µg/ml) of each herbal medicine for the lethal effects on the parasite forms for a day (1, 12, and 24h). The data showed that the highest significant mortality rate of the parasite forms was in favor of the concentration 200 µg/ml of both plant extracts in a time-dependent manner. Therefore, albendazole at 200 µg/ml dose was tested in parallel, and all experimental groups were compared to non-treated muscle larvae and worms. Albendazole-treated worms accounted for the least significant (p<0.001) survival rate (2 %), followed by myrrh (5 %), and the adverse was valid for the survival rate of the muscle larvae at that time. None of the larvae/worms was alive after 24 hours of incubation with the 200µg/ml of either treatment. The scanning electron microscope investigation of the experimental groups provided a shred of evidence for different routes of taking up the candidate drugs by the parasite. In conclusion, the results of the previous work in vivo and current in vitro study recommend myrrh over garden cress as a complementary agent of albendazole.

The Prediction of Malignancy Risk in Thyroid Nodules Classified as Bethesda System Category III (AUS/FLUS) and the Role of Ultrasound Finding for Prediction of Malignancy Risk.

Objective To predict the risk of malignancy in category III of the Bethesda System for Reporting Thyroid Cytopathology "Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS)" at King Abdulaziz Medical City, Riyadh, Saudi Arabia. It also intends to determine other possible contributing predictors of malignancy in thyroid nodules such as age, sex, and ultrasound (US) findings. Method This retrospectively designed study included 187 patients (mean age, 43.9 ± 14.1 years) with thyroid nodules, which were diagnosed as AUS/FLUS and all patients included had total thyroidectomy or lobectomy between January 2013 and December 2018 at King Abdulaziz Medical City in Riyadh, Saudi Arabia. The electronic medical records, US images, and final cytopathology and histopathology reports were reviewed and analyzed. Result The overall incidence of AUS/FLUS was (46.5%). Multivariate analysis of US features revealed that malignancy was significantly associated with nodules with irregular margins, microcalcification, multiple numbers (P < 0.001), and hypoechogenicity (P 0.04). Conclusion Despite the high rate of malignancy of nodules AUS/FLUS, it is still consistent with previously reported studies. The highly suspicious ultrasound features (irregular margins, microcalcification, multiple nodules, and hypoechogenicity) could be helpful in the diagnosis of thyroid cancer.

Macrophage activation syndrome triggered by systemic lupus erythematosus flare: successful treatment with a combination of dexamethasone sodium phosphate, intravenous immunoglobulin, and cyclosporine: a case report.

BACKGROUND: Macrophage activation syndrome is classified as a secondary form of hemophagocytic lymphohistiocytosis. It is a hyperinflammatory complication observed to be comorbid with a variety of autoimmune diseases, including adult-onset Still's disease and systemic juvenile idiopathic arthritis. Macrophage activation syndrome is less commonly detected in adult patients with systemic lupus erythematosus, which, if untreated, can be fatal, though determining the optimum treatment strategy is still a challenge. CASE PRESENTATION: Herein, we report a case of macrophage activation syndrome in a 33-year-old Egyptian female as an unusual complication of a systemic lupus erythematosus flare in adult patients. Our patient was initially treated with a combination of intravenous methylprednisolone pulse therapy and intravenous immunoglobulin therapy, which was followed by a course of oral prednisolone and oral cyclosporine with little response. Switching from oral prednisone to intravenous dexamethasone sodium phosphate showed a more favorable clinical and biochemical response. CONCLUSION: Macrophage activation syndrome is less commonly detected in adult patients with systemic lupus erythematosus. Our case demonstrates that dexamethasone sodium phosphate can be a successful alternative treatment for patients with systemic lupus erythematosus complicated by macrophage activation syndrome in whom the response to pulse methylprednisolone was inadequate to manage their illness, proving to be remarkably effective in a relatively short time frame.

Percutaneous endoscopic gastrostomy in children: A single center experience in Saudi Arabia.

OBJECTIVES: To evaluate the demographic data and complications in children who had undergone percutaneous endoscopic gastrostomy (PEG) over 9 years period. METHODS: The demographic data, complications, length of hospital admission related to PEG insertion and follow-up findings of 39 patients who had undergone percutaneous endoscopic gastrostomy using the standard pull-through technique between 2011 and 2020 were examined. The study took place at the Gastroenterology Division, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia RESULTS: The most common indications of feeding with a gastrostomy tube include neurological diseases (n=30, 76.9%), followed by metabolic disorders (n=3, 7.69%), chronic diarrhea (n=2, 5.1%), chronic kidney diseases (n=2, 5.1%), cystic fibrosis (n=1, 2.56%), feeding aversion fibrosis (n=1, 2.56%). Out of the 39 patients, 20 (51%) did not have any complications. However, minor complication are expected. Most common complications included local infection (n=14, 35.89%) followed by granulation tissue (n=6, 15.38%), "buried bumper syndrome" developed in one. CONCLUSION: Percutaneous endoscopic gastrostomy tube is the desirable method for patients who are unable to feed orally, feeding is not adequate for demands, has special feeding requirements, or swallowing dysfunction. The technique has become more widespread because of its simplicity, safety, and low cost. Major complications are rare. The procedure is safe and effective and could be carried out by pediatric gastroenterologists after training.

Coronavirus disease 2019 pandemic stress and its effects on irritable bowel syndrome patients in Saudi Arabia.

ABSTRACT: Coronavirus disease 2019 (COVID-19 pandemic has affected the psychological health of people, causing a higher level of stress. Stress can exaggerate the symptoms of irritable bowel syndrome (IBS).To assess the effect of the COVID-19 pandemic stress on patients with IBS in Saudi Arabia.A descriptive cross-sectional approach was used, which targeted accessible subjects with IBS from different regions of Saudi Arabia. Data were collected from participants using a structured electronic questionnaire, which captured the participants' socio-demographic data, medical history, IBS clinical data, self-reported stress due to COVID-19, and its effect on IBS symptoms.A total of 1255 IBS patients completed the questionnaire. About 63.4% of them reported stress due to the pandemic. The most frequently reported causes of stress were fear of infection occurring in the family, followed by fear of self-infection (43.5%), and death due to COVID-19 infection (17.2%). Most of the stressed participants (56.6%) reported that stress usually exaggerated IBS symptoms. Almost 22% of them consulted a physician for stress aggravation of the symptoms, 18.1% used sedatives due to stress, 9.2% modified IBS medications due to the stress, and 75.5% of the participants reported impaired daily activities due to symptoms exacerbation. Coexisting chronic morbidities and inability to differentiate between COVID-19 gastrointestinal symptoms and IBS symptoms were significantly associated with COVID-19 related stress (P = .039 and .001, respectively).Two-thirds of IBS patients were stressed during the first few months of COVID-19 pandemic. Patients unable to differentiate between COVID-19 gastrointestinal tract symptoms and IBS symptoms, and patients suffering from chronic morbidities were more vulnerable. Pandemic stress exacerbated patients' symptoms and impacted their activities of daily life.

Current Practices and Existing Gaps of Continuing Medical Education among Resident Physicians in Abha City, Saudi Arabia.

BACKGROUND: Continuing medical education (CME) is an everlasting process throughout the physician's working life. It helps to deliver better services for the patients. OBJECTIVES: To explore CME among resident physicians in Abha City; their current practices, their opinions, and barriers faced. METHODS: A cross-sectional study was conducted among resident physicians at the Ministry of Health hospitals in Abha City using a validated self-administered questionnaire. It included personal characteristics, current CME practices, satisfaction with CME, and barriers to attendance. RESULTS: The present study included 300 residents from 15 training specialties. Their reported CME activities during the previous year were lectures and seminars (79.7%) followed by conferences (43.7%), case presentations (39.7%), workshops (34.0%), group discussion (29/7%), and journal clubs (27.3%). Astonishingly enough, very few (8%) attended online electronic CME activities. There were significant differences in CME satisfaction scores by different training specialties. Regarding residents' perceptions of the effectiveness of different CME activities (conferences/symposia, workshops/courses, and interdepartmental activities) the results showed that workshops and courses were significantly the most effective method compared to the other two methods in retention of knowledge, improving attitudes, improving clinical skills, improving managerial skills, and in improving practice behaviors. Barriers reported were being busy, lack of interest, high cost, and lack of suitable providers. CONCLUSION: Based on the findings of this study, it is recommended that online learning be promoted as a CME format for trainees. There should be support of residents and clinicians through the provision of protected time for their CME activities outside their daily clinical commitments.

Risk factors of colorectal cancer among Saudi Population: Case-control study.

BACKGROUND: Colorectal cancer (CRC) incidence and related mortalities have been steadily increasing in KSA over the past 20 years. CRC in the Kingdom of Saudi Arabia (KSA) population presents in younger ages and in more advanced disease states as compared to other countries. This study was aimed to determine factors (demographic, habitual, environmental, nutritional, and genetic) associated with CRC in Riyadh, KSA. MATERIALS AND METHODS: A matched case-control study conducted in the major hospitals in Riyadh (King Khalid university Hospital, King Faisal Specialist Hospital, Riyadh Military Hospital, Security Force Hospital, King Fahd Medical City). Here most of CRC cases are managed. The cases (n = 121) group included all recently diagnosed and pathologically confirmed Saudi cases of CRC identified during the period 1st of January 2017 till 31st of December 2018 who agreed to participate and fulfilled the inclusion criteria. A similar number of controls attending the study settings were selected consecutively from the clinics where cases were managed and matched on a 1:1 basis with cases based on age (+/-3 years) and gender. Data were collected using a structured questionnaire. Conditional logistic regression models were fitted to determine factors associated with risk of CRC. RESULT: This study included similar number of males and females in both groups: males 69 (57%) and females 52 (43%) in each group (Chi-square test P = 1.0). The mean (S.D) age in the cases group was 53.6 (S.D = 12.9) and 53.3 (S.D = 12.9) in the controls group (Student test P = 0.86). In the final multivariate conditional logistic regression model, variables independently associated with risk of colorectal cancer were body mass index (OR = 0.93; 95% CI 0.87-0.98; P = 0.011) employment status (inverse relation: OR = 0.33; 95% CI 0.14-0.77; P = 0.010), colon polyps (OR = 4.09; 95% CI 1.06-15.82; P = 0.041), and constipation (OR = 4.98; 95% CI 1.91-15.99; P = 0.001). CONCLUSION: Factors associated with CRC in the major referral hospitals in KSA were colon polyps, chronic constipation, and unemployment. These factors should be considered when screening for patients at risk for CRC.

Sleep hygiene, sleep-related problems, and their relations with quality of life in a primary-care population in southwest Saudi Arabia.

BACKGROUND: Little is recognized about factors affecting poor sleep hygiene and relations of sleep problems with the quality of life among adults. AIMS: To evaluate sleep hygiene, explore its associated factors, assess the prevalence of excessive daytime sleepiness (EDS) and insomnia, and their relations with sleep hygiene. Besides, correlate sleep problems with life quality. METHODS: A representative sample of primary healthcare population was surveyed using questionnaires comprising sociodemographic characters, personal lifestyles, validated Arabic versions of Epworth sleepiness scales, Athens insomnia scale, short-form health survey questionnaire (SF-12), and developed Arabic sleep hygiene index (SHI). RESULTS: A total of 401 adults participated in the study. The average SHI score was 17.25 ± 7.33. Poorer sleep hygiene was significantly detected in younger age, unmarried, unemployed, smokers, and energy drinks consumers (P < 0.05). Positive significant correlations were correlated with cellphone and video-gaming duration. About 56.61% and 39.90% of participants suffered insomnia symptoms and EDS, respectively. Significant poorer SHI was detected among insomnia and EDS sufferers. Negative significant correlations were observed between scores of both components of SF-12 and EDS, insomnia, and SHI. CONCLUSION: Significant negative associations were detected between SHI, EDS, insomnia, and both components of life quality. The role of sleep hygiene education programs in the promotion of sleep and quality of life need to be considered.

Molecular Mechanisms Contributing Bacterial Infections to the Incidence of Various Types of Cancer.

Cancer causes a major health concern worldwide due to high incidence and mortality rates. To accomplish this purpose, the Scopus, PubMed, and Web of Science databases were searched using the keywords bacteria and cancer. Most of published research addressed several different factors that induced cancer, such as toxins, medications, smoking, and obesity. Nonetheless, few studies are dealing with cancer induction via bacterial infection. In addition, mechanisms of cancer induction via bacterial infections are not well understood. Therefore, in this review, we will shed light on different bacteria that induced cancer via different molecular mechanisms. Among the bacterial infection that induced cancer, Helicobacter pylori was the first recognized bacteria which caused gastric cancer and might be also linked to extragastric cancer in humans. H. pylori has been associated with adenocarcinoma in the distal stomach by its ability to cause severe inflammations. It has been found that inflammations induced cancer via different mechanisms including induction of cell proliferation and production of high levels of free radicals. Recently, free radicals were found to induce and cause various types of cancer. Salmonella typhi has been found to be associated with gallbladder carcinoma (GBC). Also, intercellular infection of lungs with Chlamydia pneumoniae was found to contribute as one of the ethological factors of lung cancer. Moreover, infection of the urinary tract with Staphylococcus aureus, Klebsiella spp., and Proteus mirabilis has been found to cause bladder cancer. These microorganisms produce a high level of N-nitrosamines which are metabolically activated leading to the generation of alkylating agents that damage DNA and other macromolecules. It is concluded that a certain bacterium is linked with induction of a specific type of cancer via different molecular and biochemical mechanisms as discussed in the text in details. This infection could potentially affect human health in different ways. In addition, it is important to know the possible factors involved in cancer induction for better treatment of cancer patients.

Modeling of the Transmission of Coronaviruses, Measles Virus, Influenza Virus, Mycobacterium tuberculosis, and Legionella pneumophila in Dental Clinics.

Dental health care workers are in close contact to their patients and are therefore at higher risk for contracting airborne infectious diseases. The transmission rates of airborne pathogens from patient to dental health care workers are unknown. With the outbreaks of infectious diseases, such as seasonal influenza, occasional outbreaks of measles and tuberculosis, and the current pandemic of the coronavirus disease COVID-19, it is important to estimate the risks for dental health care workers. Therefore, the transmission probability of these airborne infectious diseases was estimated via mathematical modeling. The transmission probability was modeled for Mycobacterium tuberculosis, Legionella pneumophila, measles virus, influenza virus, and coronaviruses per a modified version of the Wells-Riley equation. This equation incorporated the indoor air quality by using carbon dioxide as a proxy and added the respiratory protection rate from medical face masks and N95 respirators. Scenario-specific analyses, uncertainty analyses, and sensitivity analyses were run to produce probability rates. A high transmission probability was characterized by high patient infectiousness, the absence of respiratory protection, and poor indoor air quality. The highest transmission probabilities were estimated for measles virus (100%), coronaviruses (99.4%), influenza virus (89.4%), and M. tuberculosis (84.0%). The low-risk scenario leads to transmission probabilities of 4.5% for measles virus and 0% for the other pathogens. From the sensitivity analysis, it shows that the transmission probability is strongly driven by indoor air quality, followed by patient infectiousness, and the least by respiratory protection from medical face mask use. Airborne infection transmission of pathogens such as measles virus and coronaviruses is likely to occur in the dental practice. The risk magnitude, however, is highly dependent on specific conditions in each dental clinic. Improved indoor air quality by ventilation, which reduces carbon dioxide, is the most important factor that will either strongly increase or decrease the probability of the transmission of a pathogen.

Effect of Hypovitaminosis D on Lipid Profile in Hypothyroid Patients in Saudi Arabia.

BACKGROUND: Hypothyroidism is believed to be associated with dyslipidemia and is considered a risk factor for the development of atherosclerotic cardiovascular diseases (ASCVD). Vitamin D, due to its steroid hormone action, retains cell function and controls the metabolism of lipids. Therefore, the present study was carried out to show the association of the risk factors of ASCVD and deficiency of thyroid hormones and vitamin D levels since no previous studies have been performed on Saudi patients before. Methodology. A retrospective cohort study was carried out on 400 hypothyroid patients. Medical records of those patients were followed up and were classified as normal and hypothyroid patients according to their thyroid-stimulating hormone levels. TSH, vitamin D, and lipid profiles were determined using the ELISA technique. RESULT: Total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels were significantly higher in hypothyroid patients than those in the normal group. We have found a significant correlation between TSH levels and the risk factors of ASCVD (total cholesterol, triglycerides, and LDL-C). Moreover, a significant correlation between vitamin D levels and the risk factors of ASCVD (total cholesterol, triglycerides, and LDL-C) has been found. In addition, there is a correlation between deficiency of Vit D and low-TSH levels (95% CI 1.092-4.05) indicating a higher risk for the development of ASCVD among those patients. CONCLUSION: Hypothyroid and vitamin D-deficient patients must be screened regularly at an early stage to predict and also to prevent cardiovascular diseases. Moreover, an adequate supply of vitamin D and TH should be given to those patients to prevent cardiovascular diseases at an early stage.

Kinetic study of transesterification using particle swarm optimization method.

In the present work, an optimization method called Particle Swarm Optimization (PSO) was applied to study the kinetics of alkali-catalyzed rapeseed oil transesterification, using methanol, in a batch process. The validation of the PSO program was realized using numerical and experimental data from literature. The PSO method resulted in a 4 times lower error compared to classic methods used in the domain, which showed its efficiency and strength. After validation, an experimental study was led on the transesterification of rapeseed oil and methanol in a batch process using KOH as catalyst (1wt/wt %) with a methanol:oil molar ratio of 6:1 at 45 °C, 55 °C and 65 °C respectively. Then, PSO was used in order to determine the reaction rate constants ( k j m ) of the reversible 3-steps of transesterification mechanism as well as the kinetic parameters (activation energy Ea and pre-exponential factor A). Then, the kinetic model was used in order to investigate the effects of methanol: oil molar ratio variation (3:1, 4:1, 5:1, 6:1, 8:1, 12:1) on rate constants, yield and conversion rate at 65 °C. The results of the simulation showed a perfect agreement with experimental results.