Attitude and Behavior of Parents of Children With Sickle Cell Disease Toward the Disease: An Observational Study in Saudi Arabia.

BACKGROUND: Sickle cell disease (SCD) is a significant hematological disorder affecting populations worldwide, with a notable prevalence in certain regions of Saudi Arabia. Despite extensive screening programs, there is a critical need for improved public health education to enhance understanding and management of SCD. This study examines the relationship between the attitudes and behaviors of parents toward their children's disease and its management. METHODS: We conducted a cross-sectional observational study at the King Fahd Medical Research Center in Jeddah. This research encompassed children aged 5-16 years with SCD and their parents. Comprehensive questionnaires assessed sociodemographic data, attitudes toward SCD, and behavioral responses to the illness and treatment. RESULTS: The study included 66 parents, predominantly in the age range of 30-39 years and earning below 5000 Saudi Riyals, who exhibited varying attitudes towards SCD, with a majority questioning the availability of a cure and expressing caution towards new treatments. Despite a cautious approach to invasive treatments, parents relied on information from healthcare providers. Attitudes towards treatment showed significant differences based on gender and education level, with females and less-educated parents exhibiting more hesitancy towards new treatment and blood transfusions. CONCLUSION: The study indicates that while parents show a positive and proactive attitude toward SCD, there is hesitancy towards new and invasive treatments, reflecting the need for continued educational support. The results underscore the importance of tailored healthcare communication strategies to address the diverse needs of families affected by SCD.

Potential inflammatory targets in the integrative health care of patients with sickle cell disease.

Inflammation plays an integral role in the complications of sickle cell disease (SCD), which can lead to vaso-occlusive crisis and extreme pain. SCD is accompanied by numerous complications, including cardiovascular disease, cognitive decline and endothelial dysfunction, contributing to mortality. As disease severity increases with age, the present study aimed to assess if age is also correlated with a definite pattern of progression of the two inflammatory markers, high-sensitivity C-reactive protein (hsCRP) and total homocysteine (tHCY). The findings of the present study could lead to an improved understanding of the threshold levels of these inflammatory markers and timely interventions to delay complications. In an observational study, levels of hsCRP and tHCY were analyzed in 70 patients (35 male and 35 female patients) with SCD aged between 5 and 16 years. hsCRP levels were in the high-risk range in 64.29% (n=45) of all male and female patients. A sex-wise distribution showed that, of the 35 male patients, 74.28% (n=26) were in the high-risk range, and of the 35 female patients, 54.28% (n=19) were in the high-risk range. An age-wise distribution showed that of the 41 patients in the 5-10-years age group, 70.73% (n=29), were in the high-risk range. In comparison, of the 29 patients in the 11-16-years age group, 55.17% (n=16) were in the high-risk range. tHCY levels were observed to be in the normal range in 98.57% (n=69) of all children, as compared with 1.43% (n=1) in the high-risk range. Furthermore, a sex-wise distribution showed that female patients in the high-risk group of hsCRP had higher concentrations of tHCY as compared with the male patients in that risk group. An age-wise distribution of hsCRP concentration also showed that the risk of CVD in patients in the 11-16-years age group was higher with increased concentrations of tHCY. A weak negative correlation was observed between age and hsCRP concentrations (r-value=-0.280; P=0.026) and a weak positive correlation was detected between tHCY and age (r-value=0.259; P=0.036). In conclusion, the results of the present study indicated that higher levels of hsCRP could be a useful marker in children with SCD, and levels of tHCY may be an adjunct marker as the disease progresses with age.

Omega 3 fatty acids - Potential modulators for oxidative stress and inflammation in the management of sickle cell disease

Abstract Objective Sickle cell disease is characterized by clinical complications resulting in vaso-occlusive crisis with prominent attributes of oxidative stress, inflammation, and pain. Inflammation is an integral part of this disease which further exacerbates the pain during a crisis. Omega-3 fatty acids are known to possess anti-inflammatory and anti-aggregatory properties and assist in diminishing the slow physiological inactivation. Methods A pilot nutritional interventional study was conducted wherein forty-three children with sickle cell disease aged 5-16 years were supplemented with omega-3 fatty acids for a period of six months. Analysis of oxidative stress, as well as inflammatory parameters, was done pre and post-supplementation. Results Increased free oxygen radical transference values depicting free radical generation is enhanced in these patients along with a reduced antioxidant defense, as seen by decreased free oxygen radical defense values. Supplementation with omega-3 fatty acids for a period of six months significantly reduced the inflammatory marker homocysteine in all patients, whereas high sensitive C reactive protein was significantly reduced only in females of the age group 11-16years. Simultaneously a significant reduction in oxidative stress parameters with a concomitant increase of antioxidant defense was observed in all patients. Conclusion The authors' findings suggest the regulatory effects of omega-3 fatty acids as cellular activators in alleviating the complications due to sickle cell disease. Omega-3 fatty acids hold promise as future therapeutic candidates in patients with sickle cell disease.

Omega 3 fatty acids - Potential modulators for oxidative stress and inflammation in the management of sickle cell disease.

OBJECTIVE: Sickle cell disease is characterized by clinical complications resulting in vaso-occlusive crisis with prominent attributes of oxidative stress, inflammation, and pain. Inflammation is an integral part of this disease which further exacerbates the pain during a crisis. Omega-3 fatty acids are known to possess anti-inflammatory and anti-aggregatory properties and assist in diminishing the slow physiological inactivation. METHODS: A pilot nutritional interventional study was conducted wherein forty-three children with sickle cell disease aged 5-16 years were supplemented with omega-3 fatty acids for a period of six months. Analysis of oxidative stress, as well as inflammatory parameters, was done pre and post-supplementation. RESULTS: Increased free oxygen radical transference values depicting free radical generation is enhanced in these patients along with a reduced antioxidant defense, as seen by decreased free oxygen radical defense values. Supplementation with omega-3 fatty acids for a period of six months significantly reduced the inflammatory marker homocysteine in all patients, whereas high sensitive C reactive protein was significantly reduced only in females of the age group 11-16years. Simultaneously a significant reduction in oxidative stress parameters with a concomitant increase of antioxidant defense was observed in all patients. CONCLUSION: The authors' findings suggest the regulatory effects of omega-3 fatty acids as cellular activators in alleviating the complications due to sickle cell disease. Omega-3 fatty acids hold promise as future therapeutic candidates in patients with sickle cell disease.

Prevalence of Musculoskeletal Disorders and its Correlation to Physical Activity Among Health Specialty Students.

BACKGROUND: Musculoskeletal disorders is defined as a musculoskeletal strain reported by an individual. Physical activity prevents many disabling diseases and musculoskeletal disorders. Low level of physical activity is associated with a higher prevalence of musculoskeletal disorders. In Saudi Arabia and among medical students, lowest rates of physical activity were found. Our aim is to assess the prevalence of musculoskeletal disorders and its correlation to physical activity. METHODS: A cross-sectional study of 392 health specialty students in Taif University was carried out from January 1 to March 1, 2018, using a predesigned questionnaire, including demographic characteristics, an International Physical Activity Questionnaires-short form to assess the level of physical activity, and Standardized Nordic Questionnaires for the analysis of musculoskeletal symptoms. RESULTS: Our study found that 64.8% of the students had musculoskeletal disorders. The highest prevalence was among medical students; 48.4% of them were having musculoskeletal disorders (P < 0.05). The most frequent region was the lower back (33.4%). There is a significant association between the musculoskeletal disorders and the level of physical activity, with 42.9% of the students with a moderate level of physical activity having musculoskeletal disorders (P < 0.05). CONCLUSIONS: The prevalence of musculoskeletal disorders is higher among medical than pharmacy and health science students. Most of the affected students were having a moderate level of physical activity. Psychosocial stress seems to be a major contributor to musculoskeletal disorders, rather than physical activity level.

Comparative study of fatty-acid composition of table eggs from the Jeddah food market and effect of value addition in omega-3 bio-fortified eggs.

Health consciousness has increased the desire of people around the world to consume functional foods. Omega-3 essential fatty acids are one among these beneficial and important health supplements without which a general predisposition to degenerative and stress related disorders can occur. Saudi Arabia has shown an alarming increase in obesity (Al-Nozha et al., 2005), diabetes (Alqurashi et al., 2011), and cardiovascular disease (Al-Nozha et al., 2004) in the last few decades mainly due to nutritional transitions and lifestyle alterations (Amuna and Zotor, 2008). Lack of nutrient dense foods and the prevailing food related disorder of obesity (Popkin, 2001; Prentice, 2014) especially render egg as a choice food to be value-added for attaining nutritional security in Saudi Arabia and in effect reverse the increasing incidences of lifestyle diseases. Nutritional intervention through a commonly consumed food product would be an important step in improving the health of the people, and reducing health care costs. As eggs are a frequently consumed food item in Saudi Arabia, enriching them with omega-3 fatty acids would be an excellent way to alleviate the existing problems. A significant deposition of omega-3 fatty acids in the eggs was observed when the diet of hens was supplemented with omega-3 fatty acids from either flaxseed or fish oil source. Inadequacy of omega-3 fatty acids could thus be rectified by producing omega-3 enriched eggs from hens supplemented with flaxseed or fish oil source, and thus contribute toward better health choice of the consumer.

Precipitating factors and targeted therapies in combating the perils of sickle cell disease--- A special nutritional consideration.

Nutritional research in sickle cell disease has been the focus in recent times owing to not only specific nutritional deficiencies, but also the improvements associated with less painful episodes. Though hydroxyurea remains the drug of choice, certain adverse health effects on long term supplementation makes room for researches of different compounds. Macro and micro nutrient deficiencies, along with vitamins, play an important role in not only meeting the calorific needs, but also reducing clinical complications and growth abnormalities. Symptoms of hyper protein metabolism, increased cell turnover, increased cardiac output, and appetite suppression due to enhanced cytokine production, might give us leads for better understanding of the mechanisms involved. Different nutritional approaches comprising of traditional herbal therapies, antioxidants, flavonoids, vitamins, minerals etc., reducing oxidative stress and blood aggregation, have been tried out to increase the health potential. Nutritional therapies may also serve complementary to the newer therapies using ozone, hematopoietic stem cell transplantation, antifungal medications, erythropoietin etc. Herein we try to present a holistic picture of the different patho-physiological mechanisms, and nutritional strategies adopted.

Alzheimer's Disease and Autistic Spectrum Disorder: Is there any Association?

Autism spectrum disorder (ASD) and Alzheimer's disease (AD) are neurodevelopmental and neurodegenerative disorders respectively, with devastating effects not only on the individual but also the society. Collectively, a number of factors contribute to the expression of ASD and AD. It is of utmost curiosity that these disorders express at different stages of life and there is an involvement of certain susceptible genes. This genetic basis makes the background of common associations like memory deficits, cognition changes, demyelination, oxidative stress and inflammation, an integral part of both disorders. Modern technology resulting in genetically modified crops and increase in gadgets emitting electromagnetic frequencies have resulted in enhanced risks for neurological dysfunctions and disorders like ASD and AD. Subsequent advances in the psychological, pharmacological, biochemical and nutritional aspects of the disorders have resulted in the development of newer therapeutic approaches. The common clinical features like language impairment, executive functions, and motor problems have been discussed along with the patho-physiological changes, role of DNA methylation, myelin development, and heavy metals in the expression of these disorders. Psychopharmacological and nutritional approaches towards the reduction and management of risk factors have gained attention from the researchers in recent years. Current major therapies either target the inflammatory pathways or reduce cellular oxidative stress. This contribution focuses on the commonalities of the two disorders.

Unraveling the complex relationship triad between lipids, obesity, and inflammation.

Obesity today stands at the intersection between inflammation and metabolic disorders causing an aberration of immune activity, and resulting in increased risk for diabetes, atherosclerosis, fatty liver, and pulmonary inflammation to name a few. Increases in mortality and morbidity in obesity related inflammation have initiated studies to explore different lipid mediated molecular pathways of attempting resolution that uncover newer therapeutic opportunities of anti-inflammatory components. Majorly the thromboxanes, prostaglandins, leukotrienes, lipoxins, and so forth form the group of lipid mediators influencing inflammation. Of special mention are the omega-6 and omega-3 fatty acids that regulate inflammatory mediators of interest in hepatocytes and adipocytes via the cyclooxygenase and lipoxygenase pathways. They also exhibit profound effects on eicosanoid production. The inflammatory cyclooxygenase pathway arising from arachidonic acid is a critical step in the progression of inflammatory responses. New oxygenated products of omega-3 metabolism, namely, resolvins and protectins, behave as endogenous mediators exhibiting powerful anti-inflammatory and immune-regulatory actions via the peroxisome proliferator-activated receptors (PPARs) and G protein coupled receptors (GPCRs). In this review we attempt to discuss the complex pathways and links between obesity and inflammation particularly in relation to different lipid mediators.

Alcohol does not affect dark adaptation or luminance increment thresholds.

OBJECTIVE: It has been proposed that alcohol might induce within the retina a state akin to dark adaptation. However, the evidence to support this proposal is quite indirect. Another possibility is that alcohol might affect retinal gain control rather than sensitivity. To investigate these proposals psychophysically, we measured dark adaptation functions and increment thresholds with the increment threshold procedure in individuals with moderate blood alcohol concentrations (BACs). METHOD: Individuals were tested under both alcohol and no-alcohol conditions (BAC approximately .08%). In Experiment 1, thresholds for the detection of a parafoveal target were measured over a 25-minute period following a 3-minute bleach in six males. In Experiment 2, the cone dark adaptation function of four males was examined in more detail for a foveal target following bleaching at three different levels. In Experiment 3, we measured the thresholds of nine men for a small target superimposed on a background field that varied over 4 log units in luminance. RESULTS: We found no effects of alcohol on either the rod or the cone portion of the dark adaptation curve or on increment thresholds. CONCLUSIONS: Together, these data indicate that moderate alcohol ingestion does not affect the recovery of visual sensitivity in the dark nor does it affect gain control at the retinal level.

Alcohol slows interhemispheric transmission, increases the flash-lag effect, and prolongs masking: evidence for a slowing of neural processing and transmission.

While the alcohol literature is extensive, relatively little addresses the relationship between physiological effects and behavioural changes. Using the visual system as a model, we examined alcohol's influence on neural temporal processing as a potential means for alcohol's effects. We did this by using tasks that provided a measure of processing speed: Poffenberger paradigm, flash-lag, and backward masking. After moderate alcohol, participants showed longer interhemispheric transmission times, larger flash-lags, and prolonged masking. Our data are consistent with the view that alcohol slows neural processing, and provide support for a reduction in processing efficiency underlying alcohol-induced changes in temporal visual processing.

Effects of ethanol on anti-saccade task performance.

It has been shown that saccade-related neurons in the superior colliculus (SC) display an increased level of prestimulus activity and a higher stimulus-related burst in action potentials preceding direction errors in the anti-saccade task compared with correct anti-saccades. From this, it has been hypothesized that errors occur when the incoming visual signal in the SC passes a threshold and triggers a reflexive saccade. This hypothesis predicts that an attenuated visual signal will reduce the number of direction errors. Since ethanol has been shown to have a suppressive effect on cortical visual event-related potentials (ERPs), the purpose of the present study was to investigate the effects of moderate ethanol consumption on anti-saccade performance. Under both placebo and ethanol conditions, we recorded ERPs and measured eye movements in male subjects during the performance of an anti-saccade task in which the fixation point disappeared 200 ms prior to stimulus presentation. Compared with the placebo condition, we found in the ethanol condition: (1). a decrease in ERP amplitudes during the gap period and after stimulus presentation, (2). an increase in the latencies of anti-saccades, and (3). a decrease in the percentage of direction errors. These data demonstrate the effects of ethanol on anti-saccade task performance and provide further support for the hypothesis that errors in the anti-saccade task are triggered by the incoming visual signal.