Prevalence and Factors Associated With Poor Sleep Quality Among Visitors of Primary Healthcare Centers in Al-Ahsa, Kingdom of Saudi Arabia: An Analytical Cross-Sectional Study.

Introduction Poor sleep quality can predict poor health and is associated with mortality risk. Many factors are associated with sleep quality such as gender, health, education, socioeconomic status, and stress. The objective of this study was to estimate the magnitude of poor sleep quality among visitors of Primary Healthcare Centers (PHCCs) in Al-Ahsa and to identify factors associated with poor sleep quality. Methods This is an analytical cross-sectional study. A multistage cluster sampling technique was used to recruit 461 visitors to PHCCs in Al-Ahsa Governorate in the Eastern Province of Saudi Arabia. A structured questionnaire was administered through face-to-face interviews. The questionnaire includes demographics, a validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI), the Arabic version of the International Physical Activity Questionnaire (IPAQ), the Arabic version of the Patient Health Questionnaire-2 (PHQ-2), the Arabic version of the Generalized Anxiety Disorder-2 (GAD-2), the Arabic version of Perceived Stress Scale-10 (PSS-10), and a translated Mobile Related Sleep Risk Factors (MRSRF). Univariate analysis was performed using the Mann-Whitney U test for continuous data, the chi-square test (χ²) or Fishers's exact test (as appropriate) for categorical data, and logistic regression for multivariable analysis. A P-value of less than or equal to 0.05 was considered significant. Results The study included 433 participants, with 72.5% of them being poor sleepers (PSQI global score of over 5). The highest percentage of poor sleepers was found among those aged 18 - 28 years (81.7%), with no significant difference between genders (p = 0.676). The study's multivariable logistic regression analysis revealed that poor sleep is associated with smoking four hours before bedtime (OR = 2.9, CI = 1.2 - 6.7), consuming caffeine (drinks or pills) three hours before sleep (OR = 2.3, CI = 1.23 - 4.12) or immediately before bedtime (OR = 3.2, CI = 1.02 - 9.9), using mobile phones right before bedtime (OR = 2.6, CI = 1.5 - 4.5), having anxiety (OR = 5.8, CI = 1.3 - 26.2), and depression symptoms (OR = 6.5, CI = 2.9 - 14.5), among other risk factors. Conclusion The prevalence of poor sleep quality in our sample was notably high at 72.5%. Many factors are strongly associated with poor sleep quality including experiencing symptoms of anxiety and depression. Longitudinal studies are needed to explore this crucial health issue further. Healthcare providers in Al-Ahsa should pay particular attention while assessing patients who suffer from sleep disturbance by screening them for depression and anxiety and raising public awareness of the importance of good quality sleep and the factors that affect it.

Physical education teachers' attitudes toward inclusion of students with disabilities in Saudi Arabia.

The attitudes of physical education (PE) teachers toward inclusion are critical to the successful provision of inclusive teaching for students with disabilities. Therefore, the purpose of this study was to investigate the attitudes of Saudi Arabian PE teachers toward the inclusion of students with disabilities in PE classes and the effect of sociodemographic variables (e.g., gender and length of teaching experience) on their attitudes toward inclusion. A total of 1,314 PE teachers (M age = 41.09, SD = 9.40, females = 42.8%) completed the Arabic version of the Sentiments, Attitudes, and Concerns about Inclusive Education-Revised Scale (SACIE-R). Analyses found that, in general, PE teachers had moderately positive attitudes toward the inclusion of students with disabilities in PE lessons. A significant difference was found between the two genders in their attitudes toward inclusion. Specifically, female PE teachers demonstrated more positive attitudes toward inclusion than males. Multiple linear regression analysis, meanwhile, showed that the length of teaching experience and the experience of teaching a student with a disability were significant predictors of participants' attitudes toward inclusion. Our findings highlighted the importance of reconsidering the quality of PE teachers' experiences and interactions with students with disabilities as a means to improving their attitudes, which in turn would translate into successful inclusion.

Absence of K13 gene mutations among artesunate/sulfadoxine-pyrimethamine treatment failures of Sudanese Plasmodium falciparum isolates from Damazin, southeast Sudan.

BACKGROUND: The emergence of resistant parasites to artemisinin poses a threat to malaria treatment. The study aimed to investigate K13 gene mutations in Plasmodium falciparum artesunate (AS)/sulfadoxine-pyrimethamine (SP) efficacy study in Sudan. METHODS: A total of 31 (14 failures and 17 adequate clinical and parasitological response [ACPR]) pretreatment dried blood samples from patients with uncomplicated P. falciparum malaria treated with AS/SP were examined. Nested polymerase chain reaction (PCR) and DNA sequencing of the K13 gene was performed. RESULTS: PCR products were obtained from 30 (96.8%) samples and sequencing was successful in 28 (90.3%). No mutation of the K13 gene was recorded in the treatment failure group. A single mutation (C>T; A621V) in one ACPR patient sample was detected. CONCLUSION: There is no evidence of K13 mutation among AS/SP treatment failure patients. A single mutation of the K13 gene not linked to treatment failure has been detected.

Impact of 5 fluorouracil chemotherapy on gut inflammation, functional parameters, and gut microbiota.

Emerging evidence suggests that gut microbiota may influence the response to chemotherapy. We sought to characterize the effects of 5 fluorouracil (5FU) chemotherapy on colon inflammation and functional measures in colorectal cancer (CRC) and to further determine whether gut microbiota can influence this response. 50 C57BL/6 were randomized into four groups; Control + Vehicle (n = 10), Control + 5FU (n = 10), AOM/DSS + Vehicle (n = 15), and AOM/DSS + 5FU (n = 15). CRC was induced chemically by a single 10 mg/kg injection of azoxymethane (AOM) followed by two cycles (2% and 1%) of dextran sodium sulfate (DSS). Mice were then treated with 3 cycles of vehicle or 5FU (cycle 1: 40 mg/kg, cycle 2 + 3: 20 mg/kg). Functional tests (grip strength and run-to-fatigue) were performed prior to 5FU treatment (baseline) and at the completion of the second cycle of 5FU. Following the third 5FU cycle, mice were euthanized and the colon was evaluated for expression of inflammatory genes using RT-qPCR and stool samples were profiled using 16S rRNA sequencing. A second experiment used fecal microbiota transplantation from 5FU treated mice to control mice (n = 10-15/group) to determine whether 5FU associated changes in the microbiota could influence functional measures and colon inflammation. 5FU reduced grip strength (p < 0.05) and caused a trending decrease in run-to-fatigue performance in cancer mice (p = 0.06). Select intestinal inflammatory genes were significantly elevated with 5FU treatment and this was further exacerbated with cancer (p < 0.05). Microbiota analysis revealed increased dissimilarity and alterations in bacterial taxonomy in 5FU and AOM/DSS-treated mice (p < 0.05). Fecal transplant from 5FU treated mice reduced functional performance (p < 0.05) and altered select colon inflammatory markers (p < 0.05). This study provides evidence of an effect of 5FU on inflammatory responses and functional measures in a mouse model of CRC and suggests that gut microbes may play a role in some, but not all, 5FU related perturbations.

G protein beta3 subunit 825T allele and its potential association with obesity in hypertensive individuals.

OBJECTIVE: The 825T allele of the G protein beta3 subunit is associated with hypertension in Caucasians. To generate a novel hypothesis regarding the underlying mechanisms, we examined for a potential association of the 825T allele with obesity in hypertension. PATIENTS AND METHODS: We genotyped 197 hypertensive individuals (104 men, 93 women; mean age 54 years) recruited from the general population in the Heidelberg (Germany) area. Data acquisition included age at first diagnosis of hypertension, body weight and height, actual treated blood pressure values, and history of stroke and/or myocardial infarction (cardiovascular events). RESULTS: The 825T allele was significantly (P = 0.02) associated with body mass index (BMI), mean values being 28.6+/-4.1, 27.0+/-3.1, and 26.1+/-3.8 kg/m2 for TT, TC, and CC respectively, which persisted after correction for sex and age. The 825T allele frequency was 23.8, 31.4 and 40.0% in individuals with normal weight (BMI <24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI >29.9 kg/m2), respectively. Odds ratio for obesity versus normal weight was 3.9 [95% confidence interval (CI) 1.1-14.3; P = 0.03] for TT/CC and 1.8 (95% CI 0.7-4.6; P = 0.18) for TC/CC. BMI and age, but not genotype were significantly correlated with cardiovascular events as determined by logistic regression analysis. CONCLUSIONS: The findings suggest an association between obesity and the 825T allele, a genetic marker for enhanced G protein reactivity, in hypertensive individuals.

Unique fatty acid composition of normal cartilage: discovery of high levels of n-9 eicosatrienoic acid and low levels of n-6 polyunsaturated fatty acids.

We report here the finding that normal, young cartilages, in distinction from all other tissues examined, have unusually high levels of n-9 eicosatrienoic (20:3 cis-delta 5,8,11) acid and low levels of n-6 polyunsaturated fatty acids (n-6 PUFA). This pattern is identical to that found in tissues of animals subjected to prolonged depletion of nutritionally essential n-6 polyunsaturated fatty acids (EFA). This apparent deficiency is consistently observed in cartilage of all species so far studied (young chicken, fetal calf, newborn pig, rabbit, and human), even though levels of n-6 PUFA in blood and all other tissues is normal. The n-9 20:3 acid is particularly abundant in phosphatidylethanolamine, phosphatidylinositol, and the free fatty acid fractions from the young cartilage. Several factors appear to contribute to the reduction in n-6 PUFA and the appearance of high levels of the n-9 20:3 acid in cartilage: 1) limited access to nutritional sources of EFA due to the impermeability and avascularity of cartilage, 2) rapid metabolism of n-6 PUFA to prostanoids by chondrocytes, and 3) a unique fatty acid metabolism by cartilage. Evidence is presented that each of these factors contributes. Previously, EFA deficiency has been shown to greatly suppress the inflammatory response of leukocytes and rejection of tissues transplanted into allogeneic recipients. Because eicosanoids, which are derived from EFA, have been implicated in the inflammatory responses associated with arthritic disease, reduction of n-6 PUFA and accumulation of the n-9 20:3 acid in cartilage may be important for maintaining normal cartilage structure.

Reaction of ascorbate with lysine and protein under autoxidizing conditions: formation of N epsilon-(carboxymethyl)lysine by reaction between lysine and products of autoxidation of ascorbate.

N epsilon-(Carboxymethyl)lysine (CML) has been identified as a product of oxidation of glucose adducts to protein in vitro and has been detected in human tissue proteins and urine [Ahmed, M. U., Thorpe, S. R., & Baynes, J. W. (1986) J. Biol. Chem. 261, 4889-4894; Dunn, J. A., Patrick, J. S., Thorpe, S. R., & Baynes, J. W. (1989) Biochemistry 28, 9464-9468]. In the present study we show that CML is also formed in reactions between ascorbate and lysine residues in model compounds and protein in vitro. The formation of CML from ascorbate and lysine proceeds spontaneously at physiological pH and temperature under air. Kinetic studies indicate that oxidation of ascorbic acid to dehydroascorbate is required. Threose and N epsilon-threuloselysine, the Amadori adduct of threose to lysine, were identified in the ascorbate reaction mixtures, suggesting that CML was formed by oxidative cleavage of N epsilon-threuloselysine. Support for this mechanism was obtained by identifying CML as a product of reaction between threose and lysine and by analysis of the relative rates of formation of threuloselysine and CML in reactions of ascorbate or threose with lysine. The detection of CML as a product of reaction of ascorbate and threose with lysine suggests that other sugars, in addition to glucose, may be sources of CML in proteins in vivo. The proposed mechanism for formation of CML from ascorbate is an example of autoxidative glycosylation of protein and suggests that CML may also be an indicator of autoxidative glycosylation of proteins in vivo.

Oxidative degradation of glucose adducts to protein. Formation of 3-(N epsilon-lysino)-lactic acid from model compounds and glycated proteins.

The chemistry of Maillard or browning reactions of glycated proteins is being studied in model systems in vitro in order to characterize potential reaction pathways and products in biological systems. In previous work with the Amadori rearrangement product N alpha-formyl-N epsilon-fructoselysine (fFL), an analog of glycated lysine residues in proteins, we showed that fFL was oxidatively cleaved between C-2 and C-3 of the carbohydrate chain to yield N epsilon-carboxymethyllysine (CML) and D-erythronic acid. We then detected CML in proteins glycated in vitro, as well as in human lens proteins and collagen in vivo (Ahmed, M. U., Thorpe, S. R., and Baynes, J. W. (1986) J. Biol. Chem. 261, 4889-4894). This work provided an explanation for the origin of CML in human urine and evidence for non-browning pathways of the Maillard reaction in vivo. In this report we describe the identification of a second set of products resulting from oxidative cleavage of fFL between C-3 and C-4 of the sugar chain, i.e. 3-(N epsilon-lysino)-lactic acid (LL) and D-glyceric acid. The formation of LL from fFL was increased at slightly acid pH, representing about 30% of the yield of CML at pH 6.4, compared with 4% at pH 7.4 in phosphate buffer. By gas chromatography-mass spectroscopy, LL was detected in proteins glycated in vitro and then identified as a natural product in human lens proteins and urine. Our results indicate that oxidative degradation of Amadori adducts to proteins occurs in vivo, leading to formation and excretion of CML and LL. These non-browning pathways for reaction of Amadori compounds may be physiologically relevant mechanisms for averting potentially damaging consequences of the Maillard reaction.

Capillary gas chromatography-mass spectrometry of carbohydrate components of legionellae and other bacteria.

Capillary gas chromatography using fused-silica columns followed by electron impact or chemical ionization mass spectrometry was used to profile and identify neutral and amino sugars present in several legionellae and other bacteria. A modified alditol acetate derivatization method was employed to produce volatile carbohydrate derivatives. Muramic acid, a component of bacterial peptidoglycan, was detected in all legionellae examined. Heptose, a component of bacterial lipopolysaccharide, was identified in Escherichia coli organisms and in several purified Gram-negative bacterial lipopolysaccharides but not in the legionellae examined. Two amino dideoxyhexoses were found to be present in several of the Legionellae examined. The potential of gas chromatography-mass spectrometry for the direct chemical characterization of microorganisms is discussed.

Capillary gas chromatographic analysis of carbohydrates of Legionella pneumophila and other members of the family Legionellaceae.

Legionella pneumophila, the causative agent of Legionnaires disease, and related organisms have previously been characterized primarily by conventional bacteriological methods, DNA-DNA hybridization, antigenic analysis, and fatty acid analysis. By capillary gas chromatographic analysis for carbohydrates, we have shown that muramic acid and glucosamine, characteristic markers of bacterial cell walls, were present in samples of L. pneumophila and a group of legionella-like organisms. Some bacterial samples contained two unusual isomeric aminodideoxyhexoses (X1 and X2). L. pneumophila was characterized by the absence of fucose and the presence of the peak X1. Tatlockia micdadei (Legionella micdadei) was distinguishable by the presence of large amounts of rhamnose and fucose and by the absence of X1 and X2. Fluoribacter strains were much more variable in their carbohydrate composition. These data suggest that, in addition to other reported techniques, carbohydrate profiling by capillary gas chromatography can be a valuable diagnostic method in reference microbiology laboratories for differentiating members of the family Legionellaceae.