Evaluating the Synergistic Potency of Essential Oils and Antibiotics Against Klebsiella pneumoniae BLSE Strains.

Klebsiella pneumoniae producing extended-spectrum ß-lactamases (ESBL) continues to pose huge therapeutic challenges in the treatment of infections, primarily urinary infections, due to its multidrug resistance to antibiotics. Therefore, there is a need for research on this topic to investigate ways to reduce the spread of antibiotic resistance, identify novel therapeutic approaches to treat these infections and gain a better understanding of the mechanisms of resistance. In this context, this study aimed to analyze the chemical composition of essential oils (EOs) of Thymus algeriensis, Syzygium aromaticum, and Eucalyptus globulus and assess their activity against K. pneumoniae ESBL strains, as well as the interaction type between these EOs and antibiotics used for the treatment of K. pneumoniae ESBL infections. The composition of the EOs was determined by gas chromatography-mass spectrometry (GC-MS). The activity of EOs was tested using the disc diffusion and liquid microdilution methods. The type of interaction between EOs and antibiotics was studied using the agar disk diffusion and chessboard methods. The analysis of the EO of T. algeriensis showed that the main compounds were thymol (23.14%), linalool (18.44%), and p-cymene (16.17%). The main constituents of EO of E. globulus were eucalyptol (54.29%), α-pinene (17.32%), aromadendrene (7.02%), and pinocarveol (6.32%). As for the EO of S. aromaticum, the major constituents were eugenol (80.46%) and eugenol acetate (16.23%). Results of the activity tests showed that all three EOs were active against the tested strains, with inhibition diameters ranging from 7.39±0.44mm to 32.4±1.05mm and minimum inhibitory concentrations (MICs) varying from 2 to 441.5±5.66 mg/ml. A synergistic interaction was obtained between amoxicillin-clavulanic acid and T. algeriensis EO against two strains of K. pneumoniae ESBL. These results demonstrate the potential of our EOs to inhibit multi-resistant pathogenic ESBL strains, as well as their synergistic interaction with antibiotics used in therapy, which could be an alternative to the use of antibiotics alone in treatment to fight against these multi-resistant pathogenic bacteria.

Impact of a Turbulent Ocean Surface on Laser Beam Propagation.

The roughness of the ocean surface significantly impacts air-to-sea imaging, oceanographic monitoring, and optical communication. Most current and previous methods for addressing this roughness and its impact on optical propagation are either entirely statistical or theoretical, or are 'mixed methods' based on a combination of statistical models and parametric-based physical models. In this paper, we performed experiments in a 50-foot-wave tank on wind-generated waves, in which we varied the wind speed to measure how the surface waves affect the laser beam propagation and develop a geometrical optical model to measure and analyze the refraction angle and slope angle of the laser beam under various environmental conditions. The study results show that the laser beam deviations/distortions and laser beam footprint size are strongly related to wind speed and laser beam incidence angle.

Simulations of vehicular optical wireless communication systems and comparisons with DSRC systems.

Optical wireless communication (OWC) has been proposed as a complementary technique to radio frequency (RF) communications for vehicular applications. OWC systems can be categorized into two types based on the transmitters: the first one is the light-emitting diode (LED)-based OWC system, and the second is the laser diode (LD)-based OWC system. Simulations of both types of OWC systems are presented in this paper. To simulate the OWC systems precisely, outdoor experiments of OWC systems have been done and the measurements of background noise are applied in the simulations. In terms of the LED-based OWC system, the impulse responses are obtained by an improved ray tracing algorithm. To reduce the computational complexity, visibility graphs are applied in the improved ray tracing algorithm. Compared with the brute force algorithm, our improved algorithm is able to reduce the computational complexity from O(n3) to O(n2log⁡(n)), where n is the number of mobile terminals. In LD-based OWC systems, the performance and stability are highly dependent on the tracking system in vehicular applications. Therefore, this paper also analyzes the requirements of tracking accuracy in LD-based OWC systems. Finally, the simulated LED-based OWC system is compared with the dedicated short-range communication (DSRC) system under different traffic densities. Our experimental and simulation results have demonstrated that OWC can be a complementary technique for DSRC under conditions of high traffic density.

Modeling of fenuron pesticide adsorption on CNTs for mechanistic insight and removal in water.

Inexpensive multi-walled carbon nanotubes (MCNTs) were prepared with 10-40 nm particle sizes and 9.0 m2g-1 surface area. Fenuron pesticide was removed in water using these CNTs with 100.0 µgL-1 concentration, 60 min contact time, 2.0 g L-1 dose, 7.0 pH, and 25 °C. 90% removal of fenuron pesticide was achieved. Adsorption data obeyed Tempkin, Freundlich, Langmuir and Dubinin-Radushkevich models. The standard free energies values of fenuron pesticide adsorption were -11.89, -11.59, -11.55 kJ mol-1. The values of enthalpy and entropy were -9.12 kJmol-1 and -26.61 × 10-3 kJ mol-1 K. The negative values of free energy showed speedy adsorption of fenuron pesticide on CNTs. The supramolecular mechanism of fenuron adsorption onto CNTs was fixed by simulation studies and the binding energy and binding affinity of fenuron with CNTs were - 6.5 kcal mol-1 and 5.85 × 104 M-1, respectively. There were one π-σ, seven π-π stacked, one π-π T-shaped, and three π-alkyl type of hydrophobic interactions between fenuron and carbon nanotube. These results clearly indicated the physical nature of the adsorption. The method is speedy, cost-effective, efficient and repeatable. Therefore, the established adsorption method is appropriate for adsorption of fenuron pesticide in waters.

Propagation of partially coherent beams with convex-shaped spatial coherence modulation in vertical turbulent links.

The convex partially coherent beam (CPCB) is a special type of nonuniformly correlated beam with a convex-shaped complex degree of coherence (DoC) distributions. Previously our research has illustrated the potential of CPCBs with super-Gaussian DoCs in free-space optical communications (FSOC), mainly manifested as self-focusing which can be transferred into extra scintillation reduction and SNR gain. In this study, the effects of the DoC transition slopes are analyzed and more details about the turbulence propagation of CPCBs with super-Gaussian shaped DoC are revealed. By means of wave optics simulation, the longitudinal intensity evolution of the CPCB is explored, showing that the DoC slope has a profound influence on the self-focusing features such as the focusing plane and the peak intensity. Aperture scintillation and mean SNR at the receiver end of some short-range vertical turbulent links are numerically computed. The obtained results show that, with CPCBs, an ~2 dB SNR gain can be achieved as compared to conventional Gaussian Schell-modal (GSM) beams. However, CPCBs are preferred only in shorter links, which is found to be relevant to the power-in-the-bucket of the receiving aperture. Furthermore, the impacts of the ratio of the source coherence time to the detector integration time are investigated, implying that the CPCB is less susceptible than the GSM. We have also examined the off-axis scintillation of the CPCB. Due to its convex-shaped DoC, the CPCB has significantly reduced off-axis scintillation, which can be beneficial in the presence of pointing errors.

Enantio-selective molecular dynamics of (±)-o,p-DDT uptake and degradation in water-sediment system.

Enantio-selective molecular dynamics of (±)-o,p-DDT uptake and degradation in water-sediment system is described. Both uptake and degradation processes of (-)-o,p-DDT were slightly higher than (+)-o,p-DDT enantiomer. The optimized parameters for uptake were 7.0µgL-1 concentration of o,p-DDT, 60min contact time, 5.0pH, 6.0gL-1 amount of reverine sediment and 25°C temperature. The maximum degradation of both (-)- and (+)-o,p-DDT was obtained with 16 days, 0.4µgL-1 concentration of o,p-DDT, pH 7 and 35°C temperature. Both uptake and degraded process followed first order rate reaction. Thermodynamic parameters indicated exothermic nature of uptake and degradation processes. Both uptake and degradation were slightly higher for (-)-enantiomer in comparison to (+)-enantiomer of o,p-DDT. It was concluded that both uptake and degradation processes are responsible for the removal of o,p-DDT from nature but uptake plays a crucial role. The percentage degradations of (-)- and (+)-o,p-DDT were 30.1 and 29.5, respectively. This study may be useful to manage o,p-DDT contamination of our earth's ecosystem.

Nano-capillary electrophoresis for environmental analysis.

Many analytical techniques have been used to monitor environmental pollutants. But most techniques are not capable to detect pollutants at nanogram levels. Hence, under such conditions, absence of pollutants is often assumed, whereas pollutants are in fact present at low but undetectable concentrations. Detection at low levels may be done by nano-capillary electrophoresis, also named microchip electrophoresis. Here, we review the analysis of pollutants by nano-capillary electrophoresis. We present instrumentations, applications, optimizations and separation mechanisms. We discuss the analysis of metal ions, pesticides, polycyclic aromatic hydrocarbons, explosives, viruses, bacteria and other contaminants. Detectors include ultraviolet-visible, fluorescent, conductivity, atomic absorption spectroscopy, refractive index, atomic fluorescence spectrometry, atomic emission spectroscopy, inductively coupled plasma, inductively coupled plasma-mass spectrometry, mass spectrometry, time-of-flight mass spectrometry and nuclear magnetic resonance. Detection limits ranged from nanogram to picogram levels.

Detection and quantification of the opioid tramadol in urine using surface enhanced Raman scattering.

There is an on going requirement for the detection and quantification of illicit substances. This is in particular the case for law enforcement where portable screening methods are needed and there has been recent interest in breath tests for a range of narcotics. In this study we first developed surface enhanced Raman scattering (SERS) for the detection of tramadol in water and establish robust and reproducible methods based on silver hydroxylamine colloid. We used 0.5 M NaCl as the aggregating agent, with the pH ∼ 7.0 and SERS data were collected immediately (i.e., the analyte association and colloid aggregation times were zero). The limit of detection was rather high and calculated to be 5 × 10(-4) M which would not be practical in the field. Undeterred we continued with spiking tramadol in artificial urine and found that no aggregating agent or modification of pH was necessary. Indeed aggregation occurred spontaneously due to the complexity of the medium which is rich in multiple salts, which are commonly used for SERS. We estimated the limit of detection in artificial urine to be 2.5 × 10(-6) M which is equivalent to 657.5 ng mL(-1) and very close to the levels typically found in individuals who use tramadol for pain relief. We believe this opens up opportunities for testing SERS in real world samples and this will be an area of future study.

Application of surface enhanced Raman scattering to the solution based detection of a popular legal high, 5,6-methylenedioxy-2-aminoindane (MDAI).

The ever increasing numbers and users of designer drugs means that analytical techniques have to evolve constantly to facilitate their identification and detection. We report that surface enhanced Raman scattering (SERS) offers a relatively fast and inexpensive method for the detection of MDAI at low concentrations. Careful optimisation of the silver sol, and salt concentrations was undertaken to ensure the SERS analysis was both reproducible and sensitive. The optimised system demonstrated acceptable peak variations of less than 15% RSD and resulted in a detection limit of just 8 ppm (5.4 × 10(-5) M).

Simultaneous multiplexed quantification of caffeine and its major metabolites theobromine and paraxanthine using surface-enhanced Raman scattering.

Accurate quantitative measurement of drugs and their metabolites is important as this can be used to establish long-term abuse of illicit materials as well as establish accurate drug dosing for legal therapeutics. However, the levels of drugs and xenometabolites found in human body fluids necessitate methods that are highly sensitive as well as reproducible with the potential for portability. Raman spectroscopy does offer excellent reproducibility, portability and chemical specificity, but unfortunately, the Raman effect is generally too weak unless it is enhanced. We therefore developed surface-enhanced Raman scattering (SERS) and combined it with the powerful machine learning technique of artificial neural networks to enable rapid quantification of caffeine and its two major metabolites theobromine and paraxanthine. We established a three-way mixture analysis from 10(-5) to 10(-7) mol/dm(3), and excellent predictions were generated for all three analytes in tertiary mixtures. The range we selected reflects the levels found in human body fluids, and the typical errors for our portable SERS analysis were 1.7 × 10(-6) mol/dm(3) for caffeine, 8.8 × 10(-7) mol/dm(3) for theobromine and 9.6 × 10(-7) mol/dm(3) for paraxanthine. We believe this demonstrates the exciting prospect of using SERS for the quantitative analysis of multiple analytes simultaneously without recourse to lengthy and time-consuming chromatography, a method that often has to be combined with mass spectrometry.

Attitude of Saudi Arabian adults towards consanguineous marriage.

BACKGROUND: Research on the attitudes of Saudi adults towards consanguinity is scarce. The study aimed to explore the attitudes towards consanguinity and its associations with socio-demographic characteristics in a sample of Saudi adults. METHODS: A cross-sectional study was conducted using a self-administered questionnaire. A total of 386 outpatient waiting-area attendees at King Abdul-Aziz Medical City-Riyadh were included. Participants were asked about their socio-demographic characteristics, attitude towards consanguinity and the reasons behind this. RESULTS: The positive attitude towards consanguinity among the study respondents was 48.1% with 95% confidence interval (42.91-53.33%). Social and traditional culture (59.9%) were found to be the predominant reasons for favoring consanguinity in Saudi Arabia. Evidence against a positive attitude towards consanguinity was noted in respondents who received medical information about consanguinity versus those who had not received medical information (42.3% vs. 57%, p-value = 0.008). According to the multivariate logistic model, the odds of a positive attitude towards consanguinity were 2 times higher for males (adjusted odds ratio [aOR]: 2.2; 95% CI: 1.147, 4.290) and 4.1 times higher in respondents in consanguineous marriages (aOR: 4.1; 95% CI: 2.350, 7.156). The odds of a positive attitude towards consanguinity were 50% less in respondents who received health information on consanguinity compared to those who had not received health information about consanguinity (aOR: 0.50; 95% CI: 0.253, 0.863). CONCLUSION: One in every two Saudi adults favors consanguinity however, Saudi men and women differ in their attitudes towards consanguinity. Receiving health information on consanguinity was associated with a negative attitude towards this practice.

Simultaneous multiplexed quantification of nicotine and its metabolites using surface enhanced Raman scattering.

The detection and quantification of xenobiotics and their metabolites in man is important for drug dosing, therapy and for substance abuse monitoring where longer-lived metabolic products from illicit materials can be assayed after the drug of abuse has been cleared from the system. Raman spectroscopy offers unique specificity for molecular characterization and this usually weak signal can be significantly enhanced using surface enhanced Raman scattering (SERS). We report here the novel development of SERS with chemometrics for the simultaneous analysis of the drug nicotine and its major xenometabolites cotinine and trans-3'-hydroxycotinine. Initial experiments optimized the SERS conditions and we found that when these three determinands were analysed individually that the maximum SERS signals were found at three different pH. These were pH 3 for nicotine and pH 10 and 11 for cotinine and trans-3'-hydroxycotinine, respectively. Tertiary mixtures containing nicotine, cotinine and trans-3'-hydroxycotinine were generated in the concentration range 10(-7)-10(-5) M and SERS spectra were collected at all three pH values. Chemometric analysis using kernel-partial least squares (K-PLS) and artificial neural networks (ANNs) were conducted and these models were validated using bootstrap resampling. All three analytes were accurately quantified with typical root mean squared error of prediction on the test set data being 5-9%; nicotine was most accurately predicted followed by cotinine and then trans-3'-hydroxycotinine. We believe that SERS is a powerful approach for the simultaneous analysis of multiple determinands without recourse to lengthy chromatography, as demonstrated here for the xenobiotic nicotine and its two major xenometabolites.

Perceptions and Factors That Influence the Choice of Pathology as a Career Among Medical Students in Saudi Arabia.

Introduction Pathologists play a pivotal role in diagnosing diseases and improving patient care. Nonetheless, research indicates that a mere fraction of medical school graduates opt for a career in pathology, ranging from 1% to 3%. Diverse factors influence students' perceptions of pathology, encompassing lifestyle, patient interaction, and income. Aim The aim of this study was to assess the perceptions and factors that influence students' selection of pathology as a career in Saudi Arabia. Methodology A cross-sectional, self-administered electronic questionnaire was distributed among students from various regions of Saudi Arabia. The questionnaire encompassed both quantitative and qualitative data. To ensure statistical rigor, a confidence level of 95%, response distribution of 10%, and margin of error of 5% were applied. Accordingly, the recommended sample size of 150 participants was determined. Data analysis was performed using IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY), with the chi-square test applied at a significance level of P < 0.05. Results Among the 664 participating students, 130 (19.6%) indicated an interest in pathology, of whom only 19 (2.9%) regarded it as their primary choice. No statistically significant difference was found between the male and female students or between the students in foundational and clinical years. Conclusions The female students generally held a more favorable perception of pathology, acknowledging its clinical significance and role in diagnosis, prognosis, and patient management. The absence of nocturnal calls emerged as the most encouraging factor, while limited patient interaction emerged as the primary deterrent in choosing pathology.

Attitudes and Stigma Toward Seeking Psychological Help Among the General Population of Makkah, Saudi Arabia.

Background and objective Depression and anxiety are among the most common mental health conditions globally, and, according to the World Health Organization (WHO), roughly 25% of people worldwide suffer from them. Serious mental diseases can cause a great deal of suffering and incapacity, lowering people's quality of life. Stigma and unfavorable attitudes toward mental illness often discourage people from seeking psychological assistance and achieving recovery from mental problems. This observational cross-sectional study aimed to investigate the attitudes of the general population of Makkah, Saudi Arabia, toward seeking psychological help, and to determine the degree to which stigma prevents individuals from seeking help. Methods An online, self-administered survey was distributed via social media platforms among the general population of Makkah between September and December 2023. Males and females over the age of 18 years living in Makkah were included. The exclusion criteria were participants who declined to participate in the study or those who were below 18 years of age. Results A total of 495 eligible participants completed the study survey. Of them, 378 (76.4%) were female, and most (390, 78.8%) were Saudi Arabian nationals. A total of 341 (68.9%) participants had symptoms of anxiety, and 319 (64.4%) had symptoms of depression. Regarding unfavorable attitudes, the scores were significantly higher among participants over 40 years of age (1.81 ± 0.46; p<0.05) and those with relatively low levels of education (1.93 ± 0.65; p<0.05). As for stigma, the scores were significantly higher among male participants (2.38 ± 0.83; p<0.05) and those with low levels of education (2.54 ± 0.8; p<0.05). Conclusion A significant negative correlation between participants' attitudes toward seeking psychological help and stigma was observed. However, in contrast, the psychological symptom scores did not significantly correlate with the participants' attitudes. Stigma scores showed significant positive correlations with depression and overall symptom scores. This research showed that stigma has a significant impact on attitudes toward help-seeking.

Productivity Index Prediction for Single-Lateral and Multilateral Oil Horizontal Wells Using Machine Learning Techniques.

Horizontal wells are geometrically shaped differently and projected to different flow regimes than vertical wells. Therefore, the existing laws that govern flow and productivity in vertical wells are not applicable to horizontal wells directly. The objective of this paper is to develop machine learning models that predict well productivity index using several reservoir and well inputs. Six models were developed using the actual well rate data from several wells divided into single-lateral wells, multilateral wells, and a combination of single-lateral and multilateral wells. The models are generated using artificial neural networks and fuzzy logic. The inputs used to create the models are the typical inputs used in the correlations and are well-known for any well under production. The results of the established ML models were excellent as suggested by an error analysis performed, reflecting the models to be robust. The error analysis showed high correlation coefficient values (between 0.94 and 0.95) supported by a low estimation error for four models out of six. The added value of this study is the developed general and accurate PI estimation model that overcomes many limitations of several widely used correlations in the industry and can be utilized for single-lateral or multilateral wells.

Landscape degradation in the Jazan coastal desert: Understanding the impact of human activities.

This study examines the landscape degradation of the Jazan coastal desert in Saudi Arabia and explores strategies to balance tourism development and environmental preservation. The Coastal Scenery Evaluation System (CSES) was utilized to assess the scenic quality of 42 coastal sites, revealing that most sites fell into Classes III, IV, and V. Factors such as coastal erosion, hard structures, urbanization, marine wrack, litter, sewage, and beach driving had a negative impact on the scenic quality of the coastal sites. To enhance the landscape of the Jazan coastline, it is important for the Kingdom of Saudi Arabia (KSA) to give primacy to approaches to the management of coastal scenery that maintain an equilibrium between promoting tourism and safeguarding the environment. These strategies should focus on preserving, enhancing, and restoring coastal scenic characteristics and incorporate the protection and restoration of ecosystems and habitats, sustainable use of resources, natural and cultural heritage conservation, a balance between protection and development, legal and institutional support, identification and assessment of scenic values, stakeholder involvement, resource provision for effective management, and promotion of research and evaluation. Successful implementation of these strategies will lead to increased tourist arrivals and a much-improved coastal management system in the Jazan coastline and other coasts in the Kingdom of Saudi Arabia experiencing similar development pressures.

Urinary coproporphyrins as a diagnostic biomarker of Dubin-Johnson syndrome in neonates: A diagnostic pathway is proposed.

Background: Dubin-Johnson syndrome (DJS) presents during the neonatal period with a phenotype that overlaps with a broad list of causes of neonatal cholestasis (NC), which makes the identification of DJS challenging for clinicians. We conducted a case-controlled study to investigate the utility of urinary coproporphyrins (UCP) I% as a potential diagnostic biomarker. Methods: We reviewed our database of 533 cases of NC and identified 28 neonates with disease-causing variants in ATP-binding cassette-subfamily C member 2 (ABCC2) gene "Cases" (Study period 2008-2019). Another 20 neonates with cholestasis due to non-DJS diagnoses were included as "controls." Both groups underwent UCP analysis to measure CP isomer I percentage (%). Results: Serum alanine aminotransferase (ALT) levels were within the normal range in 26 patients (92%) and mildly elevated in 2 patients. ALT levels were significantly lower in neonates with DJS than in NC from other causes (P < 0.001). The use of normal serum ALT levels to predict DJS among neonates with cholestasis had a sensitivity of 93%, specificity 90%, positive predictive value (PPV) 34%, and negative predictive value (NPV) 99.5%. The median UCPI% was significantly higher in DJS patients [88%, interquartile range (IQR) 1-IQR3, 84.2%-92.7%] than in NC from other causes [67%, (IQR1-IQR3, 61%-71.5%; Confidence interval 0.18-0.28; P< 0.001)]. The use of UCPI% >80% to predict DJS had a sensitivity, specificity, PPV, and NPV of 100%. Conclusion: Based on the results from our study, we propose sequencing of the ABCC2 gene in neonates with normal ALT, presence of cholestasis and UCP1% >80%.

Prevalence of Obesity among Children and Adolescents in Saudi Arabia: A Multicenter Population-Based Study.

Background: Childhood obesity has increased in Saudi Arabia over the past few decades. However, a representative burden of obesity remains unclear, as most studies had relied on small samples and/or used international growth references, which may have resulted in over-or underestimations of prevalence. Objective: The study aimed to determine the prevalence of obesity among children and adolescents in Saudi Arabia using the Saudi growth chart. Methods: This population-based retrospective study included children and adolescents aged 2-19 years who visited any facility within the National Guard Health System (5 hospitals and 24 primary care centers) across Saudi Arabia between 2016 and 2021. The Saudi growth reference for children and adolescents was used for classification. Those with body mass index ≥95th percentile were considered as obese and ≥85th to <95th percentile as overweight. Chi-square tests were used to compare frequencies across groups. Results: A total of 351,195 children and adolescents were included, of which 337,316 (96%) were Saudis. Overall, about one-fifth of the population was overweight (11.2%) or obese (9.4%). The prevalence of obesity was highest among children aged 2-6 years (12.3%), and it was higher among boys (10.4%) than girls (8.3%). In terms of region, the prevalence of obesity among Saudis was highest in the Central and Eastern regions (9.9% for both). Conclusion: The findings highlight an urgent need for national interventions to focus on the upstream determinants of childhood obesity and to improve healthy options for children and adolescents in terms of food and physical activities.

Assessment of the Prevalence and Level of Awareness of Medication Overuse Headache Among the General Population in Makkah City, Saudi Arabia.

BACKGROUND: Medication overuse headache (MOH) is a secondary headache condition caused by consistently using more medication than necessary to treat headache symptoms. MOH is defined as a headache that occurs for 15 or more days per month in a patient with a pre-existing primary headache, and it develops as a result of regular overuse of symptomatic headache medication for more than three months. Patients with headaches often use simple pain medication for 15 or more days per month (e.g., non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol) and 10 or more days per month of opioids, triptans, and combination analgesics, but when there is no relief from these medications, the headache progression can lead to a cycle of consuming more medication with increased pain, which can lead to MOH. OBJECTIVE: This study aimed to assess the prevalence and awareness of MOH among the general population of Makkah, Saudi Arabia. METHODS: A cross-sectional study was conducted between December 2022 and March 2023 using a self-administered online questionnaire disseminated through social media. Data were collected from females and males 18 years of age and older living in Makkah, Saudi Arabia. RESULTS: Overall, 715 individuals completed the questionnaire, 497 of whom were female (69.5%). The average age of the participants was 32.9 years (±13.3 years). The prevalence of MOH among those who reported having experienced headaches throughout their lifetimes was estimated to be 4.5%. Only 134 people (18.7%) were determined to be aware of MOH. CONCLUSION: This study demonstrated that the general population of Makkah has a high prevalence of MOH and low levels of MOH awareness.

Environmental tobacco smoke exposure and non-syndromic orofacial cleft: Systematic review and meta-analysis.

INTRODUCTION: Environmental tobacco smoke (ETS) is associated with several congenital anomalies, including non-syndromic orofacial clefts (NSOFCs). This systematic review aimed to update the literature on the association between ETS and NSOFCs. METHODS: Four databases were searched up to March 2022, and studies that evaluated the association between ETS and NSOFCs were selected. Two authors selected the studies, extracted the data, and evaluated the risk of bias. Comparing the association of maternal exposure to ETS and active parental smoking with NSOFCs allowed for the creation of pooled effect estimates for the included studies. RESULTS: Twenty-six studies were deemed eligible for this review, of which 14 were reported in a previous systematic review. Twenty five were case-control studies, and one was a cohort study. In total, these studies included 2142 NSOFC cases compared to 118129 controls. All meta-analyses showed an association between ETS and the risk of having a child with NSOFC, based on the cleft phenotype, risk of bias, and year of publication, with a pooled increased odds ratio of 1.80 (95% CI: 1.51-2.15). These studies had a marked heterogeneity, which decreased upon subgrouping based on the recent year of publication and the risk of bias. CONCLUSIONS: ETS exposure was associated with more than a 1.5-fold increase in the risk of having a child with NSOFC, showing a higher odds ratio than paternal and maternal active smoking. TRIAL REGISTRATION: The study is registered on the International Prospective Register of Systematic Reviews database # CRD42021272909.