The Prevalence and Risk Factors of Low Back Pain Among Office Workers in Saudi Arabia.

Background and objective Low back pain (LBP) is a significant and prevalent musculoskeletal disorder associated with the workplace that impacts individuals, families, communities, healthcare systems, and companies. Although LBP prevalence and risk factors have been studied in various professional categories in Saudi Arabia, there is no data on the prevalence of LBP among office workers and related risk factors. This study aimed to determine the prevalence of LBP among office workers in Saudi Arabia and identify major risk factors. Methodology This cross-sectional study was conducted among office workers in Saudi Arabia of both genders aged over 18 years living in five geographical regions: Central, Western, Southern, Eastern, or Northern. A self-administered questionnaire was distributed among office workers using an online survey. The questionnaire comprised sociodemographic characteristics, the prevalence of work-related LBP, and work-related characteristics. Results Among 604 office workers, 51.7% were males and 43.5% were aged between 18 and 30 years old. The prevalence of work-related LBP in this study was 59.9%. Independent risk factors for LBP include being overweight or obese, sleep disturbance, previous history of back trauma, increasing years of working in the office, changes made to workstation/work habits to reduce the risk of LBP, and frequent work stress. Protective risk factors for LBP include regular physical exercise and satisfaction with the current job. Conclusions LBP was widely prevalent among office workers in Saudi Arabia. Office workers with elevated body mass index (BMI) who had a previous history of back trauma and had sleep disturbance or work stress in the past month were at significant risk for LBP. Occupational health and safety programs are vital for building ergonomically safe working conditions, and regular physical exercise promotion could alleviate the risk of LBP at work.

X-ray and theoretical investigation of (Z)-3-(adamantan-1-yl)-1-(phenyl or 3-chlorophenyl)-S-(4-bromobenzyl)isothioureas: an exploration involving weak non-covalent interactions, chemotherapeutic activities and QM/MM binding energy.

A detailed exploration of crystal packing of two adamantane-isothiourea hybrid derivatives along with a known closely related structure has been performed to delineate the effect of halogen substituents and the role of weak intermolecular interactions in their supramolecular architectures. The adamantane-isothiourea hybrid derivatives used in the present study are (Z)-3-(Adamantan-1-yl)-S-(4-bromobenzyl)-1-phenylisothiourea (1), C24H27BrN2S and (Z)-3-(Adamantan-1-yl)-S-(4-bromobenzyl)-1-(3-chlorophenyl)isothiourea (2), C24H26BrClN2S, characterized by X-ray crystallography. The X-ray structures revealed that the molecular conformation of 1 and 2 are different and stabilized by intramolecular C-H···N interactions. In addition, a short intramolecular H···H contact is formed in 2. The Hirshfeld surface analysis was used to delineate the nature of different intermolecular interactions and their contributions toward crystal packing. The quantitative analysis of strengths of molecular dimers existed in 1 and 2 has been performed using the PIXEL method. The electrostatic potential map clearly revealed nature and strength of σ-holes at Br and Cl atoms. The topological analysis was used to characterize the nature and the strength of various intermolecular interactions including the type I Br···Br contact. Interestingly, all the H-H bonding observed in 1 and 2 show closed-shell in nature. Further, an in-vitro antimicrobial activity studies suggest that the title compounds exhibited potent antibacterial activity against all the tested Gram-positive bacterial strains and Gram-negative Escherichia coli. Compound 2 showed marked anti-proliferative activity against MCF-7 and HeLa cell lines.Communicated by Ramaswamy H. Sarma.

The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea.

The objective of this article is to review the role of the dentist in the early diagnosis of pediatric obstructive sleep apnea (OSA) and to provide an in-depth review of the best evidence-based practices available to treat and/or to refer these patients for intervention. MATERIAL AND METHODS: A narrative review was performed using indexed data bases (PubMed, Medline, EMBASE, OVID, Scopus and Cochrane) up to year 2020, and approximately 1000 articles were reviewed. The articles included were those with the best information provided. RESULTS: Detailed review of the literature suggests that the role of the dentist has been redefined owing to their expertise in the orofacial region. Every patient consulting a dental practice is not merely a dental patient; he/she also requires a comprehensive medical review. The role of the dentist is pivotal in pediatric patients once diagnosed with OSA; as the patients grow, growth modification can be achieved, and future management will be easier. Initiating dental treatments during growth can benefit patients two-fold, saving them from malocclusion, and intervening in orofacial structural growth can help to avoid cumbersome treatments, such as CPAP and various surgeries. Proper diagnosis and management of systemic illnesses can prevent compromised quality of life, delays in treatment, morbidity and, in some cases, mortality.

Different cellulosic polymers for synthesizing silver nanoparticles with antioxidant and antibacterial activities.

The use of cellulosic polymers as efficient reducing, coating agents, and stabilizers in the formulation of silver nanoparticles (AgNPs) with antioxidant and antibacterial activity was investigated. AgNPs were synthesized using different cellulosic polymers, polyethylene glycol, and without polymers using tri-sodium citrate, for comparison. The yield, morphology, size, charge, in vitro release of silver ion, and physical stability of the resulting AgNPs were evaluated. Their antioxidant activity was measured as a scavenging percentage compared with ascorbic acid, while their antibacterial activity was evaluated against different strains of bacteria. The amount of AgNPs inside bacterial cells was quantified using an ICP-OES spectrometer, and morphological examination of the bacteria was performed after AgNPs internalization. Cellulosic polymers generated physically stable AgNPs without any aggregation, which remained physically stable for 3 months at 25.0 ± 0.5 and 4.0 ± 0.5 °C. AgNPs formulated using ethylcellulose (EC) and hydroxypropyl methylcellulose (HPMC) had significant (p ≤ 0.05; ANOVA/Tukey) antibacterial activities and lower values of MIC compared to methylcellulose (MC), PEG, and AgNPs without a polymeric stabilizer. Significantly (p ≤ 0.05; ANOVA/Tukey) more AgNPs-EC and AgNPs-HPMC were internalized in Escherichia coli cells compared to other formulations. Thus, cellulosic polymers show promise as polymers for the formulation of AgNPs with antioxidant and antibacterial activities.

Knowledge about COVID-19 and beliefs about and use of herbal products during the COVID-19 pandemic: A cross-sectional study in Saudi Arabia.

The lack of treatment options for COVID-19 has raised many concerns among populations worldwide, which has led to many attempts to find alternative options to prevent the transmission of the disease or to alleviate the progression of the infection, including focusing more on preventive measures (to prevent transmission to other individuals) and the use of natural products and herbal extracts to increase immunity and decrease the probability of getting infected. This study explored the knowledge of the population of the Kingdom of Saudi Arabia (KSA) about COVID-19 preventive measures and their belief about the consumption of herbal products for the prevention of COVID-19 infection. A total of 5,258 individuals participated in this study. Participants' knowledge about the appropriate COVID-19 preventive measures in terms of handwashing procedures, self-quarantine and social distancing was moderate, with a mean score of 5.5 (SD: 1.7) out of 10 (representing around 55.0% of the total score). About 22.1% (n = 1,161) of the participants reported that they have used herbal products or nutritional supplements during the pandemic period, to protect themselves from the disease. Social media and the Internet (39.4%, n = 372) were the main motivators for the participants to try herbal products. Vitamin C was the most commonly used food supplement to increase immunity and reduces the chance of contracting COVID-19. Our study demonstrated that the general population in Saudi Arabia has a moderate level of knowledge about COVID-19 transmission and preventive measures. A considerable proportion of the population reported the use of herbal products or food supplements in order to protect themselves from the disease. Policymakers are suggested to provide further educational campaigns that increase population knowledge about the disease transmission routes and preventive measures. In addition, the use of herbal products should be evidence-based to ensure patient safety.

The risk of polyomavirus BK-associated hemorrhagic cystitis after allogeneic hematopoietic SCT is associated with myeloablative conditioning, CMV viremia and severe acute GVHD.

Hemorrhagic cystitis (HC) is a common complication after allogeneic hematopoietic SCT (allo-HSCT). Several risk factors have been suggested including BU-containing myeloablative conditioning, unrelated donors and GVHD, but these have not been consistently reported. We conducted a retrospective study including 339 allo-HSCT recipients between 2009 and 2012. Of 339 patients, 79 (23.3%) developed HC with 2-year cumulative incidence of 24.0% (95% confidence interval, 19.4-28.9). The median onset time was 45 days (range, 16-430) after allo-HSCT. Sixty-two patients (84%) out of 74 evaluated for urine BK virus PCR testing showed a positive result (mean 2.0 × 10(10) copies of DNA per mL). In univariate analysis, myeloablative conditioning, HLA-mismatched donor, CMV viremia and acute GVHD (aGVHD) grade 3-4 were significantly associated with the risk of HC. Multivariate analysis confirmed all associating factors identified in univariate analysis except for HLA-mismatched donor: myeloablative conditioning (hazard ratio (HR) 2.63, P=0.003), CMV viremia (HR 1.88, P=0.014) and aGVHD grade 3-4 (HR 1.71, P=0.029). HC did not affect OS or non-relapse mortality. Symptomatic HC is a frequent complication following allo-HSCT, with a 2-year cumulative incidence of 24.0%. Three clinical factors associated with HC were identified including myeloablative conditioning, CMV viremia and severe aGVHD.

Risk stratification of organ-specific GVHD can be improved by single-nucleotide polymorphism-based risk models.

We aimed to develop a risk model, based on single-nucleotide polymorphism (SNP) markers associated with an increased risk of organ-specific GVHD in 394 transplant pairs. A total of 259 SNPs were genotyped in 53 genes and evaluated for their associated risk of organ-specific GVHD. Risk models were generated using both clinical factors and genetic SNP markers. Patients were stratified by quartiles according to their risk scores and then categorized into three groups (low, intermediate and high risk) according to this model. We compared the risk of overall and organ-specific GVHD amongst these groups. Several SNP markers in the cytokine-, apoptosis-, TGF-ß- and PDGF-mediated pathways were identified as correlative markers of acute and chronic GVHD. Each organ-specific GVHD shared some common biologic pathway such as cytokine, TGF-ß- or PDGF-mediated pathways. However, we also identified different SNP markers that correlated with increased risk of organ-specific GVHD (for example, FCGR2A SNP for oral GVHD, and FAS and TGFB1 SNP for lung GVHD). The incorporation of genetic risk factors into the clinical factors risk model improved stratification power for organ-specific GVHD. The SNP-based approach was suggested to improve risk stratification of organ-specific GVHD.

Total, insoluble and soluble dietary fiber contents of selected Kuwaiti composite dishes.

Total dietary fiber (TDF), insoluble dietary fiber (IDF) and soluble dietary fiber (SDF) contents of 37 composite dishes commonly consumed in the State of Kuwait were determined by the AOAC enzymatic-gravimetric method of Prosky et al. Levels (g/100 g) of SDF ranged over 0.3-0.5 in fish-based dishes, 0.3-2.6 in meat-based dishes, 0.1-1.4 in rice dishes, 3.2-4.6 in vegetable dishes, 0.3-0.7 in soup dishes, 0 in dairy dishes, 0.7-0.8 in sandwiches, and 0.1-5.0 in sweet dishes. IDF levels ranged over 1.1-1.8 in fish-based, 0.9-3.2 in meat-based, 0.6-2.7 in rice, 2.1-4.0 in vegetables, 0.6-3.4 in soup, 0 in dairy, 0.2-0.3 in sandwiches, and 0.2-11.6 in sweets. TDF values ranged over 1.4-2.3 in fish-based, 1.2-3.7 in meat-based, 0.3-4.1 in rice, 3.2-4.6 in vegetables, 0.9-3.8 in soup, 0 in dairy, 0.7-0.8 in sandwiches and 0.3-15.4 in sweets. This work attempts to provide new data on TDF, IDF and SDF of selected commonly consumed Kuwaiti composite dishes.

The level and determinants of diabetes knowledge in Kuwaiti adults with type 2 diabetes.

AIM: To investigate the level of diabetes knowledge in a population with type 2 diabetes (T2D) and a high prevalence of illiteracy, to identify the main gaps in the knowledge and to study the determinants of the knowledge score. METHODS: This cross-sectional survey involved 24 diabetes clinics and Kuwaiti adults with T2D (n=5114), and used the Michigan Diabetes Knowledge Test. RESULTS: The participants' mean age (+/-S.D.) was 55.6+/-10.4 years; 68.2% were women, 45.0% were illiterate, 52.2% reported a family income equivalent to 1200 to 2400 euros per month and only 28.6% performed glucose monitoring. Mean+/-S.D. HbA(1c) was 8.76+/-2.3%. Their mean score for the total knowledge test was 58.9%. Knowledge deficits were apparent in the questions related to diet and self-care. Participants who were older, and with lower educational levels, limited family income, negative family history of diabetes or were smokers had significantly lower knowledge scores. The scores were also lower in those who had shorter disease duration and fewer complications, were taking insulin, had less frequent insulin injections, performed less glucose monitoring and had lower HbA(1c) levels. Education, family income, glucose monitoring and presence of complications were independent determinants of the knowledge score. CONCLUSION: Knowledge of diabetes in a T2D population with a high prevalence of illiteracy was poor. Limited family income and lack of self-care are other predictors of knowledge deficits. Efforts need to be focused on educational programmes with strategies to assist T2D patients of limited education and income to manage their disease more effectively.

Case report: Thromboembolic and septic complications of migrated cyanoacrylate injected for bleeding gastric varices.

Endoscopic injection of N-butyl-2-cyanoacrylate combined with radio-opaque lipiodol is widely used to achieve haemostasis in bleeding gastric varices. We present a case of migration of injected cyanoacrylate, thrombus formation and subsequent septic embolisation.

Comparison of BMI-for-age in adolescent girls in 3 countries of the Eastern Mediterranean Region.

International comparisons of adolescent overweight and obesity are hampered by the lack of a single agreed measurement reference. We compared 3 BMI-for-age references on samples of adolescent girls from Egypt, Kuwait and Lebanon. Overweight and obesity was highest in Kuwait and lowest in Lebanon. Performance of the 3 standards differed only slightly although one was particularly applicable in country-to-country comparisons.

Comparison of BMI-for-age in adolescent girls in 3 countries of the Eastern Mediterranean Region

International comparisons of adolescent overweight and obesity are hampered by the lack of a single agreed measurement reference. We compared 3 BMI- for- age references on samples of adolescent girls from Egypt, Kuwait and Lebanon. Overweight and obesity was highest in Kuwait and lowest in Lebanon. Performance of the 3 standards differed only slightly although one was particularly applicable in country- to- country comparisons

Perceived effectiveness and side effects of intermaxillary fixation for diet control.

Weight loss is one of the major side effects associated with intermaxillary fixation (IMF) following orthognathic surgery or jaw fractures. The aim of this study was to retrospectively interview patients treated with intermaxillary fixation for diet control (IMFDC) to collect base-line information regarding: (1) perceived effectiveness, patients' compliance and patients' satisfaction with the treatment; (2) the frequency of side effects associated with IMFDC. The results show that IMFDC significantly reduced weight by a mean of 6.8 kg during treatment, and a mean of 4.1 kg at a minimum of 1 month following IMFDC removal (P<0.0001). Only 32.5% of the patients complied with the planned period of IMFDC treatment while 70% were satisfied with the treatment results. The most common side effects were speech problems and oral-facial pain with a prevalence of 52.5 and 32.5%, respectively. IMFDC treatment is not effective for long-term weight reduction and may only be used for a very short period of time to initiate weight loss. Exercise and/or special diet programs are healthier and better means to treat obesity and maintain weight loss.

Inhibition of telomerase is related to the life span and tumorigenicity of human prostate cancer cells.

PURPOSE: Telomerase, the enzyme that catalyzes the elongation of telomeres, is illegitimately activated in the majority of cancers, including that of the prostate, where it may greatly extend the life span of malignant cells. The inhibition of telomerase by molecular intervention has been shown to lead eventually to cell death in several tumor or in vitro immortalized cell lines and in 1 case prevent tumor growth in vivo. Therefore, we tested whether a similar strategy may be used to limit the tumorigenic potential of late stage prostate cancer cells. MATERIALS AND METHODS: PC-3, LNCaP and DU-145 human prostate cancer cells were infected with a retrovirus encoding a dominant-negative version of the catalytic subunit of telomerase (DN-hTERT). Subclones or polyclonal populations were assayed for DN-hTERT expression, telomerase activity, telomere length, cell life span and in most cases tumorigenicity in nude mice. RESULTS: DN-hTERT expression levels directly correlated with cell life span and tumorigenic growth. PC-3 cells expressing high levels of DN-hTERT died rapidly and failed to form tumors in nude mice, whereas cells expressing the lowest levels proliferated the longest and generated tumors that later spontaneously regressed. Similarly the inhibition of telomerase activity in LNCaP cells was greater than in DU-145 cells and correspondingly LNCaP cells had a shorter life span. CONCLUSIONS: DN-hTERT expression limits the life span and tumorigenic potential of human prostate cancer cells, although the onset of these effects appears to be dictated by the expression level of DN-hTERT. Therefore, telomerase represents an attractive target for potentially managing prostate cancer. Nevertheless, effective means of inhibiting the enzyme may be required for a therapeutically useful outcome.

Left ventricular papillary fibroelastoma. An unusual cause of cerebral emboli.

We describe the case of a 63-year-old woman with a cardioembolic neurologic deficit secondary to papillary fibroelastoma, a rare intracardiac tumor. Diagnosis was made by use of 2-dimensional and transesophageal echocardiography. The tumor was surgically resected, and the patient had an uneventful recovery. In this report, we discuss the embolic potential of papillary fibroelastoma and the appropriate diagnostic and surgical approaches for patients with this rare disorder.

Results of percutaneous transluminal coronary angioplasty by multiple, relatively low frequency operators: 1986-1987 experience.

The initial results of percutaneous transluminal coronary angioplasty (PTCA) in this institution were described previously and were comparable with national statistics despite the comparatively small number of cases performed by individual physicians. Two years later, the number and complexity of cases have increased significantly. In the present study, the experience of 3 physicians (group 1) who performed greater than 100 PTCAs (143 +/- 35, mean +/- standard deviation) was compared with that of 14 physicians (group 2) who performed less than 100 PTCAs (25 +/- 16) during a recent 12-month period. Group 1 and group 2 performed 430 and 351 PTCAs, with a 91 and 84% success rate, respectively (p less than 0.01). Group 1 and group 2 attempted dilatation of 595 and 444 narrowings with an 85 and 81% success rate, respectively (p less than 0.025). The differences reflect outcomes with "complex lesions," with which group 1 had a higher success rate than group 2 (81 vs 69%, p less than 0.05) and a lower complication rate (3.1 vs 7.5%, difference not significant). Outcomes with "simple lesions" were similar for the 2 groups (93 vs 90%). As a result, the conclusions of the previous study should be modified. The present data suggest that while low frequency operators can perform PTCA of "simple lesions" with quite satisfactory results in the setting of an institution in which large numbers of PTCAs are performed and in which an expert team is available for support, outcomes with "complex lesions" are likely to be better in more experienced hands.