Repair of an Isolated Sternal Head Tear of the Myotendinous Junction of the Pectoralis Major Using Knotless Suture Anchors: Case Report and Literature Review.

Although considered a relatively uncommon sports injury, publications on pectoralis major (PM) injuries have increased in the last couple of decades. Knowledge of the complex anatomy of the PM muscle is important in diagnosing, understanding the complexity of the injury, and determining the suitable modality of management of these injuries. Despite the increase in publications, there is no consensus on the superiority of any proposed surgical management. We present a case of a recreational body builder who presented to our clinics with a rare pattern of isolated musculotendinous junction of the lower fibers of the PM muscle and proposed a new technique of surgical management of such injuries using knotless suture anchors and running locked suture pattern in different directions. We then conducted a comprehensive review of literature of these injuries and presented a review on the pathophysiology, the various patterns of these injuries, and the available described modalities of surgical management. Understanding the complex anatomy of the PM, the various pattens of injury, and the aid of an MRI read by an expert musculoskeletal radiologist is crucial before managing these injuries. We believe that acute surgical repair of musculotendinous junction injuries using running Krackow/Brunnell locked configuration and the use of knotless suture and anchors will provide adequate and practicable surgical repair of these injuries.

Garlic Extract Promotes Pancreatic Islet Neogenesis Through α-to-ß-Cell Transdifferentiation and Normalizes Glucose Homeostasis in Diabetic Rats.

SCOPE: Garlic extract (GE) has been shown to ameliorate hyperglycemia in diabetic rats (DRs) by increasing insulin production. However, the mechanism through which it exerts its effects remains unclear. Here, it investigates the molecular process and the origin of regenerating ß-cell in rats with streptozotocin (STZ)-induced diabetes in response to GE. METHODS AND RESULTS: In this study, quantitative RT-PCR (qRT-PCR), western blotting, and immunohistochemical analysis are carried out after pancreas isolation. These findings show that 1 week of GE treatment increases the expression of the endocrine progenitor cell markers Neurogenin3 (Neurog3), pancreatic and duodenal homeobox 1 (Pdx1), neurogenic differentiation factor 1 (Neurod1), paired box proteins (Pax)4, V-maf musculoaponeurotic fibrosarcoma oncogene homolog B (Mafb), and NK homeobox factors (Nkx)6-1 in STZ-induced DRs. Continuation with GE treatment for 8 weeks causes the expression of the mature ß-cell markers insulin(Ins)2, urocortin3 (Ucn3), and glucose transporter 2 (Glut2) to peak. Comprehensive examination of the islet through immunohistochemical analysis reveals the presence of a heterogeneous cell population including INS+/GLUT2- and INS+/GLUT2+ ß-cell subpopulations with few bihormonal INS+/GCG+ cells after 4 weeks. By week 8, islet architecture is reestablished, and glucose-stimulated insulin secretion was restored through the upregulation of Ucn3. CONCLUSION: GE induces ß-cell neogenesis in DRs and restores islet architecture. The newly formed mature ß-like cells could have originated through the differentiation of endocrine progenitor cells as well as α- to ß-cell transdifferentiation.

Giant Cell Tumor With Secondary Aneurysmal Bone Cyst in the Left Distal Humerus: A Case Report.

Giant cell tumor (GCT) is a common benign aggressive tumor that mostly occurs in the proximal tibia, distal radius, and distal femur but is rarely seen in the distal region of the humerus. It originally presents between the ages of 30 and 50 with suddenly occurring pain. Treatment is generally curettage adjuvant treatment if necessary and reconstruction if required. In our case report, we present the clinical and radiological findings, diagnosis, and management of a 33-year-old female patient with a giant cell tumor (GCT) accompanied by a secondary aneurysmal bone cyst (ABC) in the left distal humerus, where the patient experienced pain for many years without significant history of trauma. Upon clinical examination, the patient displayed tenderness over the medial side of the elbow but no noted swelling, redness, or hotness. She had a painless full range of motion, with an intact distal neurovascular examination. Imaging concluded GCT with secondary ABC. A biopsy confirmed the diagnosis, ruling out metastatic lesions. The patient underwent surgical intervention, with plate fixation, which yielded excellent outcomes.

Among Other Tissues, Short-Term Garlic Oral Treatment Incrementally Improves Indicants of Only Pancreatic Islets of Langerhans Histology and Insulin mRNA Transcription and Synthesis in Diabetic Rats.

BACKGROUND: The source, mRNA transcription, and synthesis of insulin in the pancreas, in addition to the bile duct and liver, in streptozotocin (STZ)-induced diabetic rats (DR) in response to garlic oral treatment are not yet clear. OBJECTIVE: This study investigated the accumulative effects of continued garlic oral treatment on changes in the pancreas, bile duct, and liver with regards to: 1-Insulin mRNA transcription, synthesis, and concentration in relation to changes in serum insulin (SI); 2-Insulinogenic cells insulin intensity and distribution, proliferation, and morphology. METHOD: Fasting blood glucose (FBG) and insulin concentration in serum and pancreas (PI) and sources and mRNA transcription in the pancreas, bile duct, and liver in normal rats given normal saline (NR-NS) and DR given either NS (DR-NS) or garlic extract (DR-GE) before and after 1, 4, and 8 weeks of oral treatment were examined. RESULTS: Compared to NR-NS, DR-NS showed a significant increase in FBG and reductions in SI and PI and deterioration in islets histology, associated pancreatic insulin numerical intensities, and mRNA transcription. However, compared to DR-NS, the targeted biochemical, histological, and genetic variables of DR-GE were significantly and incrementally improved as garlic treatment continued. Insulin or its indicators were not detected either in the bile duct or the liver in DR-GE. CONCLUSIONS: 8 weeks of garlic oral treatment is enough to incrementally restore only pancreatic islets of Langerhans insulin intensity and insulinogenic cells proliferation, morphology, and distribution. These indices were associated with enhanced pancreatic insulin mRNA transcription and synthesis. Eight weeks of garlic treatment were not enough to stimulate insulinogenesis in either the bile duct or the liver.

Complicated Management of Left-Sided Loculated Empyema Secondary to Streptococcus intermedius and Prevotella in a 53-Year-Old Male.

We present the case of a 53-year-old male with complicated left-sided parapneumonic effusion due to Streptococcus intermedius and Prevotella buccae. Management required video-assisted thoracoscopic surgery and partial decortication of the left lung. Complications during the hospital stay were extensive, including sepsis, acute hypoxic respiratory failure, alcohol withdrawal, and transient ischemic attack.

HPLC/UV approach method for the first simultaneous estimation of molnupiravir and ertapenem as a binary mixture in human plasma and dosage form as a regimen for COVID-19 treatments.

COVID-19 is a serious virus that can have a lot of effects, one of which is a secondary bacterial infection that can be more life-threatening and even lethal than the initial viral infection. Hence a fast and sensitive HPLC/UV method was developed and validated for the first estimation of a binary mixture of molnupiravir (MOL) and ertapenem (ERT) as a co-administrated medicine for the management of COVID-19 in pharmaceutical dosage forms, and human plasma samples. The drug combination was separated within 5 min via RP-ODS column using isocratic elution with a mobile phase of 0.05 M phosphate buffer (pH 3.5): acetonitrile with a 76: 24% ratio v/v. The presented method provided a linear response ranging from 0.03 to 17.0 and 0.05-20 µg mL-1 with LOD values of 0.009 and 0.008 µg mL-1 for MOL and ERT respectively. The good separation and high sensitivity of the HPLC method provide the determination of the cited drugs in human plasma without matrix interference with a percent of recovery ranging from 94.97 ± 2.05 to 98.44 ± 1.92. Based on the results, this method could be utilized to monitor cited drugs in quality control and therapeutic laboratories.

Awareness and acceptance of teleclinic services during COVID-19 in the general population in Riyadh: Cross-sectional study.

BACKGROUND: The first COVID-19 case in Saudi Arabia was reported on March 2, 2020. The Saudi government introduced the "937" service number as one of the telemedicine services for COVID-19 information. Telemedicine uses telecommunication and information technologies in the medical field to deliver healthcare services and improve patients' health status. This study aims to estimate the frequency of teleclinics usage during COVID-19, assess awareness of teleclinics, and assess acceptance of teleclinics during COVID-19 in the Saudi population. MATERIALS AND METHODS: The cross-sectional study used a convenient sample encompassing the 1,583 Saudi and non-Saudi adult population of Riyadh, Saudi Arabia, and was conducted online between August 2020 and April 2021. A self-administrated online questionnaire was distributed to all participants and data were collected on sociodemographics, knowledge of use of teleclinics, and its acceptance. Analysis of quantitative data by t-test and association of qualitative variables by Chi-square test was conducted. Regression analysis was performed on the significant values of univariate analysis. Data were analyzed by SPSS 25. RESULTS: Most (92.5%) participants were female and had a university education (65.9%). The main reason for using teleclinic was experiencing a new complaint (27.3%), next, for medications refill (13.2%), with COVID-19-related issues being the least common reason for using teleclinic (8.2%). The result shows that 77.1% of participants had a good level of acceptance of teleclinic. The regression analysis showed that number of teleclinics utilization, as an advantage it is more convenient, and recommending this service to someone else was significantly associated with acceptance of teleclinics in future. CONCLUSION: As per the findings, the experience of using teleclinic positively impacts the level of acceptance of teleclinic among the population. The adoption of telemedicine for healthcare delivery during the COVID-19 pandemic helped limit the spread of the infection and reduce the risk of exposure to COVID-19 for both patients and healthcare providers. In the future, telemedicine can be used as an alternative to minor complaints and follow-up checkups. In this way, the burden of healthcare system can also be overcome.

A Ganglion Cyst in the Anterior Cruciate Ligament of a 13-Year-Old Boy.

Intra-articular ganglion cysts of the knee are a rare occurrence in pediatric patients, particularly involving the anterior cruciate ligament (ACL). Only a handful of case reports have been documented in the medical literature, highlighting the rarity of this condition. Patients with intra-articular cysts often experience knee discomfort and mechanical symptoms like locking of the knee. We present the case of a 13-year-old boy who had a unilateral intra-articular ganglion cyst of the ACL in his left knee. To diagnose and treat the cyst, we conducted radiographs and MRIs, and arthroscopic drainage was performed, resulting in a successful cyst decompression. Our case report provides an overview of the pathogenesis, diagnostic methods, treatment options, and complications of treatment for intra-articular cysts of the ACL. It highlights the rarity of this condition in pediatric patients and underscores the importance of prompt diagnosis and appropriate management.

Hematological reference values of horses in Western Libya and their relationship to breed, age, and management.

Background: Hematological evaluation is an important step for health assessment in equine medicine. Besides biochemical tests, that evaluation could be pivotal for diagnosis, prognosis, and treatment monitoring. In Libya, the horse population has drastically increased in the last years, and hitherto, no report addressed the reference hematological values for the existing equine breeds. Aim: This study aimed to establish the reference for hematological indices of traditional equestrian and stud-farm equine breeds in Western Libya in regard to some variables such as individual characteristics, management system, and rearing purpose. Methods: Blood samples of 167 horses of Arabian, Thoroughbred, and local breeds were collected from an area covering a large part of Western Libya and complete blood counts of the samples were performed using a hematological auto-analyzer. The collected data were statistically analyzed using the Statistical Package for Social Science software. Results: Hematological reference indices were generated for the aforementioned equine breeds in Western Libya. The equine hematological profile was variable according to some individual and management factors. In addition, the significant effects of those factors were usually restricted to erythrocyte- and platelets (PLTs)-related indices. In terms of breed influence, Thoroughbreds had significantly lower erythrocyte counts of red blood cells (RBCs) compared to local horses (p = 0.04), and Arabian horses showed significantly higher PLT counts compared to Thoroughbreds and local horses; p = 0.00 and p = 0.03, respectively. Moreover, significantly lower values of hemoglobin (HGB), hematocrit (HCT), mean cell volume (MCV), and PLT counts were noticed in young horses vis-à-vis significantly higher values of HCT, mean corpuscular hemoglobin concentration and red cell distribution width in females. In regard to exercise, racing horses varied significantly from nonracing horses in monocyte percentage (p = 0.04), RBC (p = 0.00), HGB (p = 0.00), HCT (p = 0.00), MCV (p = 0.00), and mean corpuscular hemoglobin (MCH) (p = 0.00). Diet supplementation also influenced the equine erythrocyte-related indices, as horses offered supplemented diet had significantly higher RBC (p = 0.00), HGB (p = 0.00), HCT (p = 0.00), MCV (p = 0.00), and MCH (p = 0.00), comparing to those served nonsupplemented diet. Conclusion: This study provided the first reference values of the equine hematological profile in Western Libya. In addition, the age, breed, exercise, and diet supplementation had variable impacts on hematological equine indices.

The epidemiology and characteristics of patients with diabetes with or without NASH: a systematic review.

Introduction: NASH or "Non-alcoholic Steatohepatitis" is related to non-alcoholic fatty liver disease (NAFLD). The simultaneous occurrence of NASH and type 2 diabetes is common. However, only a limited number of studies have focused on the characteristics of patients with diabetes with or without NASH. Objectives: This systematic review summarises epidemiological evidence related to the prevalence and characteristics of NASH in patients with diabetes. Methods: Different electronic databases PubMed, Scopus, and Google Scholar were searched for the published articles. Original studies conducted in patients with diabetes published in English were included in this review. Results: Thirteen studies were eligible for inclusion in this review. In patients with diabetes, increased BMI, overweight/obesity, increased HbA1c, increased serum cholesterol, and elevated liver enzyme levels have been strongly linked with NASH. Other significant characteristics include increasing age, being female, race(white), low HDL, metformin use, increased ferritin, and increased albumin levels. The prevalence of NASH ranged from 12% to 93.8%, the highest percentage was found in studies in Romania (87.1), and lowest in studies in India (12.5). Conclusion: The incidence of NASH increases with age. Gender differences as a risk factor for NASH still need to be fully understood. This systematic review provides insight and strong indication to all patients with diabetes to visit hepatologists and screen for fatty liver disease. If steatosis is found on baseline ultrasound, a liver biopsy should be performed for timely management. At present, no NAFLD/NASH-specific medication on the market helps in treating the disease. New development of the drugs and ongoing research is important for the cure and treatment of NASH, with specific attention being provided to involve populations at high-risk.

Testicular torsion as the initial presentation of testicular tuberculosis.

Testicular tuberculosis (TB) is a rare disease, and it tends to mimic other testicular diseases which are more common. We highlight the case of a 37-year-old male who presented to the emergency department with testicular torsion. Further investigations revealed evidence of TB.

Expression Profiling of Pdx1, Ngn3, and MafA in the Liver and Pancreas of Recovering Streptozotocin-Induced Diabetic Rats.

Studies in animal diabetic models have demonstrated the possibility of islet regeneration through treatment with natural extracts, such as Allium sativum (garlic). This study aimed to investigate the effect of garlic extract (GE) on the expression of three genes (Ngn3, Pdx1, and MafA) in the pancreas and liver of diabetic rats. Thirty-two rats were divided into two groups, streptozotocin (STZ)-induced diabetic rats (n = 16) and healthy rats (n = 16). Both groups were subdivided into GE-treated (n = 8), and those administered 0.9% normal saline (NS) (n = 8) for 1 week (n = 4) and 8 weeks (n = 4). In the pancreas of diabetic rats treated with GE for 1 week, all three genes, Ngn3, Pdx1, and MafA, were significantly upregulated (p ≤ 0.01, p ≤ 0.05, and p ≤ 0.001, respectively) when compared to diabetic rats treated with NS only. However, after eight weeks of GE treatment, the expression of all three genes decreased as blood insulin increased. In the liver, only Pdx1 expression significantly (p ≤ 0.05) increased after 8 weeks. The significant expression of Ngn3, Pdx1, and MafA in the pancreas by week 1 may have induced the maturation of juvenile ß-cells, which escaped the effects of STZ and caused an increase in serum insulin.

Incidental detection of paranasal sinuses abnormalities on CT imaging of the head in Saudi adult population.

The paranasal sinuses are hollowed, air-filled cavities surrounding the nasal cavity. Many pathological processes affect the sinuses, but inflammatory conditions are the commonest, even in asymptomatic patients who undergo head imaging for other indications showing one or more abnormalities of the sinuses. Our research aims to determine the prevalence of incidental paranasal sinuses abnormalities seen among patients who undergo head CT scanning. In addition, it provides baseline information for further investigations required. The study was designed to evaluate all patients who underwent head CT scanning for any reason unrelated to paranasal sinuses abnormalities. 1849 cases were selected and retrospectively analyzed from the elective and emergency CT in the last nine months, from August 2020 to April 2021. In order to meet the inclusion criteria, indications for imaging must not be sinus-related. The study was conducted on 1849 cases who had undergone head CT scans for pathology, 1204 (65%) were male and 645 (35%) were female. Abnormalities of the sinuses were found in about 617 (33%) of all patients, with a higher rate in males (22.23%) than females (11.14%). In addition, these abnormalities were found in younger patients at a higher rate than in middle and old ages 19.74%, 7.19%, and 6.44%, respectively. Our findings revealed that the prevalence of paranasal sinuses abnormalities in asymptomatic Saudi patients was high (33%). Most of the affected sinuses were the maxillary. The male patients were more affected than females in all findings.

Depression, anxiety, and stress symptoms among Jordanian midwives: A hospital-based study.

OBJECTIVE: To investigate the prevalence of depression, anxiety, and stress symptoms in Jordanian midwives and identify associated factors. DESIGN: Setting and participants: This descriptive, cross-sectional study was conducted with a sample of 321 registered midwives from 18 public hospitals in Jordan that provide antepartum, intrapartum, postpartum care, and family planning services. The survey included the Depression, Anxiety, and Stress Scale (DASS-21) and demographic and professional data forms. FINDINGS: High rates of depression (76.2%); anxiety (85.3%) and stress (66.8%) symptoms were reported among midwives in Jordan. Midwives aged between 22 - 30 years reported more depression, anxiety, and stress symptoms than midwives in the other age groups. Married midwives had higher depression symptoms than single midwives. Midwives with < 10 years in practice had higher depression, anxiety, and stress symptoms compared to midwives with ≥ 10 years in practice. Midwives providing care for > 10 women per shift had higher anxiety and stress symptoms than midwives caring for five or less women per shift. Midwives who rotated between shifts had higher depression and stress symptoms than midwives who did not rotate. CONCLUSIONS: Rates of depression, anxiety, and stress symptoms reported by Jordanian midwives were higher than rates reported by midwives in other countries. The high rates of distress highlight the urgent need for national strategies to support the emotional wellbeing and retention of midwives within Jordanian settings.

Psychological Wellbeing of Diabetic Individuals, Prediabetics, and Non-diabetics: A Population-Based Study in Saudi Arabia.

Background: The increased burden of diabetes affects the quality of life, including psychosocial problems. The study aims to compare the psychological well-being of individuals who are prediabetic, diabetic, or non-diabetic. Methods: A cross-sectional exploratory study was conducted from January to June 2016 (n = 1,019) in Al Kharj, Saudi Arabia. After consent and questionnaires were filled out, trained staff took blood samples followed by anthropometry. Chi-squared tests, one-way ANOVA, and multiple linear regression analyses were conducted to examine the association between diabetes classes defined by HbA1c cut-off levels set by the American Diabetes Association (three categories), individual items, and total score in general health questionnaire (GHQ). An ROC curve was plotted for the total GHQ-12 score against HbA1c. Findings: The mean GHQ score for psychological distress was significantly higher (F = 6.569, P = 0.038) in the diabetics (mean = 14.7) and the prediabetics (12.4) than in the non-diabetics (10.71). Four out of six positive GHQ items and three out of six negative GHQ items significantly differed among the three classes of diabetes. The adjusted multivariate analysis revealed that people with diabetes were most likely to report psychological distress compared to non-diabetics (unstandardized beta = 2.414; P = 0.037). The AUC examining the relationship between HBA1c and GHQ scores showed a moderate but statistically insignificant sensitivity/specificity of 0.643 (P = 0.23). Conclusion: This study demonstrates that psychological wellbeing is substantially poorer among diabetic or prediabetic individuals than non-diabetic individuals. Future longitudinal studies are required to examine a plausible causal relationship between diabetes/prediabetes and psychological distress.

Combined' Neck/Back Pain and Psychological Distress/Morbidity Among the Saudi Population: A Cross-Sectional Study.

Background: Psychological distress/morbidity is amongst the primary reason for the cause of pain at multiple sites, its progression, and recovery. Though still not very clear if physical pain in the neck or the back may predict psychological morbidities or not. Thus, we investigated the association between combined neck or back pain and psychological distress/morbidity. Methods: A cross-sectional study was conducted in Al-Kharj, Saudi Arabia, including 1,003 individuals. The questionnaire comprised of General Health Questionnaire-12 (GHQ-12) and some questions about neck and back pain. Data analysis was done using statistical software SPSS version 26.0. Results: The results of the multivariate analysis revealed a significant positive association between neck/back pain status and total GHQ score (unstandardized Beta = 2.442, P ≤ 0.0001). Having neck/back pain had almost a 2.5 times greater risk of psychological distress/morbidity. Further, females were more likely to have a higher risk of psychological distress/morbidity (unstandardized Beta = 1.334, P = 0.007) than males while adjusting for sociodemographic and clinical characteristics. Conclusion: The combination of neck and back pain was significantly associated with the Saudi population's psychological problems. Therefore, the Saudi government needs to devise high-risk strategies and allocate adequate resources to the cause so that at-risk people can be shielded from the adverse complications arising from this condition in the long run.

Comparing and Optimizing RNA Extraction from the Pancreas of Diabetic and Healthy Rats for Gene Expression Analyses.

Advanced differential gene expression analysis requires high-quality RNA. However, isolating intact pancreatic RNA is challenging due to abundant pancreatic ribonucleases, which limits efficient downstream gene expression analysis. RNAlater treatment reduces endogenous ribonucleases effects through either pre-organ excision via organ mass or bile duct direct injection or organ mass injection post-isolation. We compared RNA extraction protocols to establish a reproducible and effective pancreatic RNA extraction method to obtain high RNA integrity number (RIN) values from healthy and streptozotocin (STZ)-induced diabetic rats for gene expression analyses. Different methods were tested focusing on RNase activity inhibition using RNAlater (Qiagen) pre-harvest of the pancreatic tissue, and extracted RNA quality and concentration were analyzed using NanoDrop spectrophotometer, Agilent Bioanalyzer, and RT-PCR. Inclusion of several pre- and post-excision modifications in the RNeasy Mini Kit (Qiagen) protocol resulted in RIN values more than two-fold higher compared to those using the standard protocol. Additionally, RT-PCR amplification of the housekeeping gene, ß-actin, revealed no differences in extracted RNA quality from healthy and STZ-induced diabetic rats. We compared and developed a more effective and reproducible pancreatic RNA extraction method from healthy and diabetic rats, which resulted in RNA of superior quality and integrity and is suitable for complex molecular investigations.

Health related quality of life and perceived social support in French and Lebanese MS patients: A comparative study.

BACKGROUND: The perception of diagnosis announcement, the social support and the coping strategies seem to be determining factors for the quality of life of multiple sclerosis (MS) patients, with possible transcultural variations. This study explores these psychosocial dimensions in Lebanese and French MS patients. METHODS: For this cross-sectional multi-center study, 8 questionnaires were used to assess quality of life, family support, coping strategies, mood, fatigue, stress, and hopelessness in MS patients. 7 were translated into Arabic and then back translated into French. These were administered to a group of Lebanese MS patients and compared to an MS sample from France. The data was collected for both populations and analyzed. RESULTS: A total of 107 patients were included, 46 Lebanese and 61 French. The majority of MS patients were young females with a high level of education, relapsing remitting form of MS and a low level of disability. Both populations exhibited comparable quality of life and answers on the questionnaires regarding mood disorders, hopelessness, and perceived stress. However, the French patients had significantly more fatigue. Perceived social support given by family was considered greater in the French group compared to the Lebanese one. Also, maladaptive coping strategies (such as self-distraction, denial, behavioral disengagement, substance use, self-blame, venting) were used more frequently by the French population compared to the Lebanese, and this correlated with higher anxiety scores. Diagnosis communication was overall brief, informative, and satisfying in both populations. CONCLUSION: This study highlighted transcultural differences between French and Lebanese MS patients mainly in social support and coping strategies.

Prevalence and characteristics of multivitamin-multimineral (MVMM) use among Saudi populations in Riyadh, Saudi Arabia: A cross-sectional study.

ABSTRACT: Use of multivitamin multimineral (MVMM) preparations is prevalent and growing worldwide, contributing to major health expenditure. Minimal literature on prevalence and characteristics of MVMM use is available from Saudi Arabia.The study was conducted to determine the prevalence and characteristics of MVMM use among Saudi population in Riyadh, Saudi Arabia.A cross-sectional study was conducted at 6 shopping malls located in the different regions of Riyadh city for 6 months from February 01, 2019, to July 31, 2019. A well-structured English questionnaire was developed, translated into Arabic language, and validated by the experts. A pertinent inclusion and exclusion criteria were established. After having informed consent to be included in the study, the printed copies of the questionnaire were distributed among the participants using a convenient sampling technique. The data were collected and analyzed using SPSS version 24. Descriptive statistics were presented as numbers, percentages, means, and standard deviations. A P value of ≤.05 and 95% confidence intervals were used to report the statistical significance.Out of 1200 surveys distributed, 1105 were returned by the participants (response rate 92%). Prevalence of MVMM supplements use turned out to be 47%. The study revealed statistically significant association between MVMM use and gender, marital status, education, regular exercise, smoking, following special diet, and eating fruits and vegetables (P ≤ .05). Majority of the participants used MVMM on daily basis (57.9%), and hospital prescriptions (57.9%) were the most common reason of MVMM use. Majority of the participants used MVMM for diet supplements (32.2%), health promotion (29.4%), and treatment of disease (16%).The MVMM use is prevalent in Saudi population, warranting sound regulatory policies for their judicial use and increase awareness about the benefits and side effects of dietary supplements.

Vanillin attenuates thioacetamide-induced renal assault by direct and indirect mediation of the TGFß, ERK and Smad signalling pathways in rats.

Inflammation and fibrosis are two pathological features of chronic kidney disease (CKD). Renal fibrosis is considered to be one of the most important conditions, as it may be the result of excessive extracellular matrix protein production and deposition, or prolonged exposure to nephrotoxic substances or drugs. Unfortunately, no suitable therapies or medications are currently available to prevent renal fibrosis. We conducted this study for the evaluation of the protective potential of vanillin by reversing TAA (250 mg/kg TAA for 6 weeks) induced renal injury in rats. The concentrations of the proteins tumour necrosis factor alpha (TNFα), interleukin-6 (IL-6), extracellular signal regulated kinase 1/2 (Erk1/2), and transforming growth factor beta-1 (TGF-ß1) in kidney tissues were assessed using ELISA. Kidney Injury Molecule-1 (KIM-1) and mothers against decapentaplegic homologue 2, 3 (SMAD 2, 3) expressions were evaluated using real time PCR. We also estimated the expression of α-smooth muscle actin (α-SMA) using immunohistochemistry. Treatment with vanillin (100 mg/kg) significantly ameliorated kidney Injury and improved the kidney function. Vanillin treatment also significantly decreased the malondialdehyde (MDA) content, and elevated glutathione peroxidase (GPx) and catalase (CAT) activities in kidney tissues. Vanillin also reduced α-SMA renal expression and TNFα, IL-6, TGF-ß1, and Erk1/2 renal levels. Vanillin significantly decreased the expression of the genes encoding KIM-1 and SMAD 2, 3 and ameliorated histological abnormalities in kidney architecture. Our molecular docking findings showed that vanillin has a good binding mode inside TGF-ß type I receptors (ALK5) biding site.