Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study.

BACKGROUND: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. METHOD: We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS:  1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS: This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.

Psychobiological regulation of plasma and saliva GDF15 dynamics in health and mitochondrial diseases.

GDF15 (growth differentiation factor 15) is a marker of cellular energetic stress linked to physical-mental illness, aging, and mortality. However, questions remain about its dynamic properties and measurability in human biofluids other than blood. Here, we examine the natural dynamics and psychobiological regulation of plasma and saliva GDF15 in four human studies representing 4,749 samples from 188 individuals. We show that GDF15 protein is detectable in saliva (8% of plasma concentration), likely produced by salivary glands secretory duct cells. Using a brief laboratory socio-evaluative stressor paradigm, we find that psychosocial stress increases plasma (+3.5-5.9%) and saliva GDF15 (+43%) with distinct kinetics, within minutes. Moreover, saliva GDF15 exhibits a robust awakening response, declining by ~40-89% within 30-45 minutes from its peak level at the time of waking up. Clinically, individuals with genetic mitochondrial OxPhos diseases show elevated baseline plasma and saliva GDF15, and post-stress GDF15 levels in both biofluids correlate with multi-system disease severity, exercise intolerance, and the subjective experience of fatigue. Taken together, our data establish that saliva GDF15 is dynamic, sensitive to psychological states, a clinically relevant endocrine marker of mitochondrial diseases. These findings also point to a shared psychobiological pathway integrating metabolic and mental stress.

Iron slag/activated carbon-electrokinetic system with anolyte recycling for single and mixture heavy metals remediation.

The electrokinetic process has been proposed for in-situ soil remediation to minimize excavation work and exposure to hazardous materials. The precipitation of heavy metals in alkaline pH near the cathode is still challenging. Reactive filter media and enhancement agents have been used in electrokinetics to enhance the removal of heavy metals. This study investigated coupling industrial iron slag waste and iron slag-activated carbon reactive filter media with electrokinetic for a single and mixture of heavy metals treatment. Instead of using acid enhancement agents, the anolyte solution was recycled to neutralize the alkaline front at the cathode, reducing the operation cost and chemical use. Experiments were conducted for 2 and 3 weeks at 20 mA electric current. Copper removal increased from 3.11 % to 23 % when iron slag reactive filter media was coupled with electrokinetic. Copper removal increased to 70.14 % in the electrokinetic experiment with iron slag-activated carbon reactive filter media. The copper removal increased to 89.21 % when the anolyte solution was recycled to the cathode compartment. Copper removal reached 93.45 % when the reactive filter media-electrokinetic process with anolyte recirculation was extended to 3 weeks. The reactive filter media- an electrokinetic process with anolyte recycling was evaluated for removing copper, nickel, and zinc mixture, and results revealed 81.1 % copper removal, 89.04 % nickel removal, and 92.31 % zinc removal in a 3-week experiment. The greater nickel and zinc removal is attributed to their higher solubility than copper. The results demonstrated the cost-effectiveness and efficiency of the electrokinetic with iron slag-activated carbon reactive filter media with anolyte recirculation for soil remediation from heavy metals.

Evaluation of Cellular Changes and Immunohistochemistry Expression of p53 and p16 in the Oral Mucosa Among Saudi Smokers.

BACKGROUND: Smoking is a well-known risk factor for various health problems, including oral cancer. P16 and P53 proteins are involved in cell cycle regulation and proliferation, and their expression levels can provide insights into cellular health. OBJECTIVE: This study aims to evaluate the cellular changes and immunohistochemistry expression of p53 and p16 in the oral mucosa among Saudi smokers. METHOD: In a cross-sectional study obtained by scraping the buccal mucosa, 1000 samples were collected from 2022 to 2023. All of the study's participants were Saudi citizens of both genders. Seven hundred cigarette smokers and 300 nonsmokers made up the controls, using two sampling techniques: initially purposive and then snowball sampling. The materials were subjected to immunohistochemical analysis for P16 and P53 protein overexpression. The samples were scored based on the percentage of positively stained cells and staining intensity. The data were analyzed using SPSS, and categorical variables were identified as frequencies and percentages using the chi-squared test; a value of (P<0.05) was considered significant. RESULT: Cigarette smokers demonstrate significantly higher rates of cytological inflammation, reverse cytological infection, atypia, and binucleated/multinucleated cells compared to nonsmokers, with an overall abnormal result rate of 46% versus 18.7%, respectively (P=0.024). The study found higher P53 and P16 expression among smokers (7.14% and 2.14%, respectively) compared to nonsmokers (0.1% and 0.33%) (P=0.038). No significant differences were observed in P53/P16 expression across age groups (P=0.72) or between male and female participants (P=0.25). CONCLUSION: These findings highlight the detrimental effects of smoking on cellular health and reinforce the importance of smoking cessation in reducing the risk of developing cytological abnormalities and associated diseases. These results highlight the association of smoking with increased biomarker expression, emphasizing its relevance in understanding oral health risks.

Parents' Knowledge, Attitudes, and Practices Regarding Baby Walkers, Baby Car Seats, Oral Health, and Child Screen Time in Saudi Arabia: A Cross-Sectional Study.

Background Awareness of age-appropriate milestones and developmental stages is crucial for parents to identify any potential delays or concerns early on and seek appropriate interventions. This study aimed to assess the knowledge, attitudes, and practices of caregivers in Saudi Arabia regarding baby walkers, baby car seats, early dental visits, and screen time for young children. Methods A cross-sectional survey was conducted among parents in Saudi Arabia using a structured questionnaire. A convenience and snowball sampling method was employed to recruit participants from various regions of the country. The questionnaire aimed to assess parents' knowledge regarding the recommended use of baby walkers and baby car seats, their awareness of the importance of early dental visits, and their understanding of appropriate screen time guidelines. Additionally, the survey explored parents' practices toward these recommendations. Descriptive statistics were used to analyze the data, and associations between variables were examined using the chi-squared test. Results A total of 1318 participants were included. The analysis revealed that the majority of the participants (n=1066,81.3%) use a baby walker, while only (n=292,22.3%) consider that they should never be used. Overall, (n=388,29.6%) of the participants never used a car seat for their infants or children. In terms of early childhood dental visits, approximately (n=518,39.5%) of the participants reported actually taking their child to the dentist within the recommended timeframe. Regarding screen time for children, (n=148,11.3%) of the participants reported that their children spend >5 hours daily in front of the screen.  Conclusions Raising parents' awareness about recent childcare recommendations and safe practices is crucial for promoting optimal child development, preventing health problems, facilitating evidence-based decision-making, reducing risks, enhancing parental confidence and empowerment, and nurturing positive parent-child relationships.

Determining the appropriate natural fibers for intelligent green wearable devices made from biomaterials via multi-attribute decision making model.

Intelligent and green wearable technology becomes essential for new modern societies. This work introduces a multi criteria decision making model to properly assess and compare relative desired criteria for selecting the most suitable constituents for green body wearable bio-products made from bio-based materials. It aims to enhance the sustainability of intelligent green wearable devices by providing support in the selection process of lightweight, eco-friendly materials suitable for personal body wearable bio-products made of natural fiber composites to improve qualities that may help in better monitoring human vital signs and thereby address the health care concern. The relative intrinsic characteristic and merits of various natural fibers were utilized to compare and evaluate their relative performance in bio-composites. The model considered several evaluation factors like mechanical performance including tensile strength and modulus of elasticity, comfortability including size and weight, availability, fiber orientation, cellulose content, and cost. Results have demonstrated different priorities of the considered natural fibers relative to each evaluation factor. However, the model was capable of properly evaluating and ranking the best fibers relative to the whole conflicting evaluation criteria simultaneously. The closeness of priorities in several cases emphasizes upon using such decision making models to be able to judge the relative merits of natural fibers for such applications. It can also help designers to avoid bias during determining the best alternatives considering several conflicting evaluation criteria.

Addressing Signal Drift and Screening for Detection of Biomarkers with Carbon Nanotube Transistors.

Electrical biosensors, including transistor-based devices (i.e., BioFETs), have the potential to offer versatile biomarker detection in a simple, low-cost, scalable, and point-of-care manner. Semiconducting carbon nanotubes (CNTs) are among the most explored nanomaterial candidates for BioFETs due to their high electrical sensitivity and compatibility with diverse fabrication approaches. However, when operating in solutions at biologically relevant ionic strengths, CNT-based BioFETs suffer from debilitating levels of signal drift and charge screening, which are often unaccounted for or sidestepped (but not addressed) by testing in diluted solutions. In this work, we present an ultrasensitive CNT-based BioFET called the D4-TFT, an immunoassay with an electrical readout, which overcomes charge screening and drift-related limitations of BioFETs. In high ionic strength solution (1X PBS), the D4-TFT repeatedly and stably detects subfemtomolar biomarker concentrations in a point-of-care form factor by increasing the sensing distance in solution (Debye length) and mitigating signal drift effects. Debye length screening and biofouling effects are overcome using a poly(ethylene glycol)-like polymer brush interface (POEGMA) above the device into which antibodies are printed. Simultaneous testing of a control device having no antibodies printed over the CNT channel confirms successful detection of the target biomarker via an on-current shift caused by antibody sandwich formation. Drift in the target signal is mitigated by a combination of: (1) maximizing sensitivity by appropriate passivation alongside the polymer brush coating; (2) using a stable electrical testing configuration; and (3) enforcing a rigorous testing methodology that relies on infrequent DC sweeps rather than static or AC measurements. These improvements are realized in a relatively simple device using printed CNTs and antibodies for a low-cost, versatile platform for the ongoing pursuit of point-of-care BioFETs.

Peri-ocular proliferative apocrine hidrocystoma (cystadenoma): A clinicopathological case series.

INTRODUCTION: Apocrine cystadenomas are rare, benign tumors that might arise in the periocular region from glands of Moll. They characteristically demonstrate proliferative features on histopathological examination, which differentiate them from simple hidrocystomas. PRESENTATION OF CASES: We retrospectively identified 4 consecutive cases of apocrine cystadenomas in male patients with a mean age of 48.5 years (range 20-62). One of the cases was a recurrent lesion. The Preoperative clinical diagnosis was mostly hidrocystoma. All patients agreed on complete surgical excision of their cystic lesions. Histopathological review of the excised cysts confirmed the diagnosis of apocrine cystadenoma based on the presence of proliferative features with no atypia or infiltrative behavior. Cases are summarized in Table 1 and the histopathological appearance is demonstrated in the included figure. DISCUSSION: Apocrine cystadenoma is rare. It occurs in the areas of skin with hair follicles, such as the axilla, neck, and trunk, and may be mistaken for other skin lesions, such as nevi or syringomas. In the eyelid region, they are commonly missed and frequently diagnosed as simple hidrocystoma due to the presence of bluish hue such as in our series. Recurrence is rare but was found in one of our patients at initial presentation. Our series included unique locations of this lesion in the medial canthus in one patient and near the eyelid tarsus in another. CONCLUSION: Ophthalmologist should be aware of the rare occurrence of this lesion in the periocular region. Further studies to explain the etiology of such proliferative nature in apocrine cysts would be interesting.

Chronic Insufficient Sleep in Women Impairs Insulin Sensitivity Independent of Adiposity Changes: Results of a Randomized Trial.

OBJECTIVE: Insufficient sleep is associated with type 2 diabetes, yet the causal impact of chronic insufficient sleep on glucose metabolism in women is unknown. We investigated whether prolonged mild sleep restriction (SR), resembling real-world short sleep, impairs glucose metabolism in women. RESEARCH DESIGN AND METHODS: Women (aged 20-75 years) without cardiometabolic diseases and with actigraphy-confirmed habitual total sleep time (TST) of 7-9 h/night were recruited to participate in this randomized, crossover study with two 6-week phases: maintenance of adequate sleep (AS) and 1.5 h/night SR. Outcomes included plasma glucose and insulin levels, HOMA of insulin resistance (HOMA-IR) values based on fasting blood samples, as well as total area under the curve for glucose and insulin, the Matsuda index, and the disposition index from an oral glucose tolerance test. RESULTS: Our sample included 38 women (n = 11 postmenopausal women). Values are reported with ±SEM. Linear models adjusted for baseline outcome values demonstrated that TST was reduced by 1.34 ± 0.04 h/night with SR versus AS (P < 0.0001). Fasting insulin (ß = 6.8 ± 2.8 pmol/L; P = 0.016) and HOMA-IR (ß = 0.30 ± 0.12; P = 0.016) values were increased with SR versus AS, with effects on HOMA-IR more pronounced in postmenopausal women compared with premenopausal women (ß = 0.45 ± 0.25 vs. ß = 0.27 ± 0.13, respectively; P for interaction = 0.042). Change in adiposity did not mediate the effects of SR on glucose metabolism or change results in the full sample when included as a covariate. CONCLUSIONS: Curtailing sleep duration to 6.2 h/night, reflecting the median sleep duration of U.S. adults with short sleep, for 6 weeks impairs insulin sensitivity, independent of adiposity. Findings highlight insufficient sleep as a modifiable risk factor for insulin resistance in women to be targeted in diabetes prevention efforts.

The Indications of Tonsillectomy Among Pediatric Patients: Our Nine-Year Retrospective Review.

INTRODUCTION:  Tonsillectomy is a surgical procedure that involves removing the tonsils, often performed alongside adenoidectomy. Dating back to ancient times, it improves quality of life and can be life-saving when done for appropriate reasons. Common indications in children include recurrent tonsillitis and sleep-disordered breathing (SDB). Evidence suggests it reduces how often and how severe sore throats are in highly affected children. Symptoms such as lymphadenopathy, tonsillar pus, fever, or signs of streptococcal infection should be present for diagnosis of tonsillitis. Polysomnography (PSG) is essential to diagnose obstructive sleep apnea (OSA) and confirm airway obstruction. AIM: Our aim in this study is to determine the reasons for tonsillectomy in Taif, Saudi Arabia, since it is not well established before in this city. METHODS:  A nine-year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy performed in a tertiary hospital. Data was analyzed using SPSS (IBM Corp., Armonk, NY, USA). RESULTS:  The research study involved analyzing data from 361 participants. Among the participants, 16.9% (n = 61) underwent tonsillectomy alone, while the majority (83.1%; n = 300) underwent tonsillectomy in combination with other procedures. The most common combined procedure was adenotonsillectomy (71.7%; n = 259). Additionally, adenotonsillectomy and insertion of grommets in other combinations was observed and was equal to 11.4% (n = 41) of the total percentage of our sample. The primary indications for tonsillectomy alone were chronic tonsillitis (42.6%; n = 26) and recurrent tonsillitis (49.2%; n = 30).  Conclusion: This research study provides valuable information on the types of procedures performed and the indications for surgery in pediatric patients. The results highlight the prevalence of chronic and recurrent tonsillitis and adenotonsillitis as primary indications for tonsillectomy, either alone or in combination with other procedures. These findings contribute to our understanding of the clinical decision-making process and can aid healthcare professionals in providing optimal care for pediatric patients with tonsillar and adenotonsillar pathologies.

The Incidence of Acute Peritonitis Secondary to Different Sites of Viscus Perforation.

Objective The incidence of peritonitis secondary to viscus perforation will be examined to determine the most common sites of perforation and associated comorbidities. Methods This is a retrospective observational study based on data collected from the King Fahad Hospital of the University (KFUH). This research targeted patients who had viscus organ perforation and the relation of peritonitis secondary to it. The sample was taken from patients under the care of the General Surgery Department from the first of Feb 2016 to the 12th of Sep 2022. The final sample consisted of 450 patients. The method of diagnosis of peritonitis was mainly clinical, and the surgical approach was either through an exploratory laparotomy or a diagnostic laparoscopy. Incidental findings of viscus organ perforation were noted in addition to certain postoperative complications (e.g., adhesions) and hospital stay. Results Analysis of the results showed a significant relation (p<0.001) between viscus organ perforation and peritonitis. The most common comorbidities associated with secondary peritonitis were hypertension (12, 24.5%), diabetes mellitus (10, 20.4%), any abdominal mass (3, 6.1%), and inflammatory bowel disease (1, 2%). However, a chi-square analysis has shown no significant association between peritonitis and the targeted associated comorbidities. Conclusion Perforation of the small intestine carries the biggest association with peritonitis incidence, in addition to comorbidities such as hypertension and diabetes mellitus. Further study to establish the value of these factors might contribute to decreasing the morbidity and mortality of secondary peritonitis.

Paradoxical Effects of Prolonged Insufficient Sleep on Lipid Profile: A Pooled Analysis of 2 Randomized Trials.

Background Insufficient sleep is associated with increased cardiovascular disease risk, but causality is unclear. We investigated the impact of prolonged mild sleep restriction (SR) on lipid and inflammatory profiles. Methods and Results Seventy-eight participants (56 women [12 postmenopausal]; age, 34.3±12.5 years; body mass index, 25.8±3.5 kg/m2) with habitual sleep duration 7 to 9 h/night (adequate sleep [AS]) underwent two 6-week conditions in a randomized crossover design: AS versus SR (AS-1.5 h/night). Total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, and inflammatory markers (CRP [C-reactive protein], interleukin 6, and tumor necrosis factor-α) were assessed. Linear models tested effects of SR on outcomes in the full sample and by sex+menopausal status (premenopausal versus postmenopausal women+men). In the full sample, SR increased high-density lipoprotein cholesterol compared with AS (ß=1.2±0.5 mg/dL; P=0.03). Sex+menopausal status influenced the effects of SR on change in total cholesterol (P-interaction=0.04), LDL-C (P-interaction=0.03), and interleukin 6 (P-interaction=0.07). Total cholesterol and LDL-C decreased in SR versus AS in premenopausal women (total cholesterol: ß=-4.2±1.9 mg/dL; P=0.03; LDL-C: ß=-6.3±2.0 mg/dL; P=0.002). Given paradoxical effects of SR on cholesterol concentrations, we explored associations between changes in inflammation and end point lipids under each condition. Increases in interleukin 6 and tumor necrosis factor-α during SR tended to relate to lower LDL-C in premenopausal women (interleukin 6: ß=-5.3±2.6 mg/dL; P=0.051; tumor necrosis factor-α: ß=-32.8±14.2 mg/dL; P=0.027). Conclusions Among healthy adults, prolonged insufficient sleep does not increase atherogenic lipids. However, increased inflammation in SR tends to predict lower LDL-C in premenopausal women, resembling the "lipid paradox" in which low cholesterol associates with increased cardiovascular disease risk in proinflammatory conditions. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02835261, NCT02960776.

Iron slag permeable reactive barrier for PFOA removal by the electrokinetic process.

The efficacy of the Standalone Electrokinetic (EK) process in soil PFAS removal is negligible, primarily due to the intersecting mechanisms of electromigration and electroosmosis transportation. Consequently, the redistribution of PFAS across the soil matrix occurs, hampering effective remediation efforts. Permeable reactive barrier (PRB) has been used to capture contaminants and extract them at the end of the EK process. This study conducted laboratory-scale tests to evaluate the feasibility of the iron slag PRB enhanced-EK process in conjunction with Sodium Cholate (NaC) biosurfactant as a cost-effective and sustainable method for removing PFOA from the soil. A 2 cm iron slag-based PRB with a pH of 9.5, obtained from the steel-making industry, was strategically embedded in the middle of the EK reactors to capture PFOA within the soil. The main component of the slag, iron oxide, exhibited significant adsorption capacity for PFOA contamination. The laboratory-scale tests were conducted over two weeks, revealing a PFOA removal rate of more than 79% in the slag/activated carbon PRB-EK test with NaC enhancement and 70% PFOA removal in the slag/activated carbon PRB-EK without NaC. By extending the duration of the slag/AC PRB-EK test with NaC enhancement to three weeks, the PFOA removal rate increased to 94.09%, with the slag/AC PRB capturing over 87% of the initial PFOA concentration of 10 mg/L. The specific energy required for soil decontamination by the EK process was determined to be 0.15 kWh/kg. The outcomes of this study confirm the feasibility of utilizing iron slag waste in the EK process to capture PFOA contaminants, offering a sustainable approach to soil decontamination. Combining iron slag PRB and NaC biosurfactant provides a cost-effective and environmentally friendly method for efficient PFOA removal from soil.

Molecular characterization of patients with chronic hepatitis C virus infection in Jordan: implications on response to direct-acting antiviral therapy.

OBJECTIVES: To investigate the molecular characteristics of Hepatitis C Virus (HCV) detected in patients with chronic HCV infection in Jordan. METHODS: The study included 48 Jordanian treatment-naïve patients with active chronic HCV recruited from seven governorates. HCV genotype and the resistance-associated substitutions (RAS) profile were investigated by next-generation sequencing of the NS5B, NS5A, and NS3 regions of HCV. RESULTS: "Unusual genotype 4 subtypes" were detected in four (8.3%) patients (4n-n = 1, 4o-n = 2, 4v-n = 1); one patient (2.1%) was co-infected by genotypes 1b+4a. Overall prevalence of NS5A RASs was 38.3% (3% cutoff); genotype 4a showed the highest NS5A RAS prevalence (n = 11, 55.0%). Overall prevalence of NS3 RASs was 21.8% (7/32), all genotype 1a-infected patients. CONCLUSIONS: We report, for the first time in Jordanian patients with chronic HCV infection, the detection of unusual genotype 4 subtypes 4n, 4o, and 4v. Baseline RASs in NS5A are frequent, with complex RASs patterns in some of the unusual subtypes. Our data support the need for sequencing surveillance programs in sub-Saharan Africa, Asia, and the Middle East and North African region to monitor response to treatment in these subtypes and to facilitate the World Health Organization's 2030 elimination strategy.

A Cytological Study of Oral Human Papillomavirus (HPV) Infection Among Electronic Cigarette Smokers in Al-Madinah Al-Munawara.

Objective This study aims to determine how electronic cigarette (e-cigarette) use contributes to the spread of the human papillomavirus (HPV) and to assess the potential cellular proliferative activity it may produce. Methodology In Madinah, a case-control study was conducted between October 2022 and March 2023. Two oral cytologic smear samples were collected from each of the 500 volunteers; 250 consumers of electronic cigarettes and 250 non-smokers each provided two samples. To detect cytological changes and HPV infection, these samples were stained using Papanicolaou and immunocytochemical techniques. Results Twelve (4.8%) of the electronic cigarettes exhibited cytological atypia, while only one (0.4%) of the nonsmokers' group did. Infection with the human papillomavirus (HPV) was detected in eight (3.2%) of the e-cigarette users, but it was only found in two (0.8%) of the nonsmokers (P ≤ 0.05). Conclusion Electronic cigarette smoking increases the likelihood of contracting HPV and developing cytological atypia, both of which, if left untreated, can contribute to the development of precancerous and cancerous lesions in the mouth.

Changes in eating patterns in response to chronic insufficient sleep and their associations with diet quality: a randomized trial.

STUDY OBJECTIVES: Insufficient sleep leads to overconsumption, but the factors contributing to this effect are poorly understood. Therefore, we assessed the influence of prolonged curtailment of sleep on free-living eating patterns linked with overconsumption and explored associations of these eating patterns with diet quality under different sleep conditions. METHODS: Sixty-five adults (47 females) participated in outpatient randomized crossover studies with two 6-week conditions: adequate sleep (7-9 h/night) and sleep restriction (-1.5 h/night relative to screening). Food records were collected over 3 nonconsecutive days, from which we ascertained data on eating frequency, midpoint, and window and intakes of energy and nutrients. Linear mixed models were used to assess the impact of sleep condition on change in eating pattern (sleep × week interaction) and the relation between eating patterns and dietary intakes (sleep × eating pattern interaction). RESULTS: Sleep condition impacted the change in eating frequency across weeks, with eating frequency increasing in sleep restriction relative to adequate sleep (ß = 0.3 ± 0.1; P = .046). Across conditions, eating more frequently tended to relate to higher energy intakes (ß = 60.5 ± 34.6; P = .082). Sleep also influenced the relation of variability in eating midpoint with intakes of saturated fat (ß = 6.0 ± 2.1; P = .005), polyunsaturated fat (ß = -3.9 ± 2.0; P = .051), and added sugar (ß = 17.3 ± 6.2; P = .006), with greater midpoint variability associated with more adverse changes in these diet quality components in sleep restriction vs adequate sleep. CONCLUSIONS: Chronic short sleep increases eating frequency and adversely influences associations of variability in meal timing with components of diet quality. These findings help to explain how short sleep leads to overconsumption and obesity. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Impact of Sleep Restriction in Women; URL: https://clinicaltrials.gov/ct2/show/NCT02835261; Identifier: NCT02835261 and Name: Impact of Sleep Restriction on Performance in Adults; URL: https://clinicaltrials.gov/ct2/show/NCT02960776; Identifier: NCT02960776. CITATION: Barragán R, Zuraikat FM, Tam V, RoyChoudhury A, St-Onge M-P. Changes in eating patterns in response to chronic insufficient sleep and their associations with diet quality: a randomized trial. J Clin Sleep Med. 2023;19(11):1867-1875.

Obstacles and Satisfaction to Balance Between Family Life and Medical Career Among Saudi Women Doctors.

BACKGROUND:  Besides their medical career obligations, female physicians traditionally have assumed responsibility for raising families and maintaining the household. Finding an acceptable balance between their career and family life is challenging. OBJECTIVE:  The study aimed to discover the obstacles and the relationship between the barriers/factors with the satisfaction in balancing career and family life. METHODOLOGY:  A cross-sectional study that analyzed data from Saudi female physicians. The study included 165 female physicians from the six Ministry of Health hospitals in Al-Madinah Al-Munawarah; 65 were specialists and consultants, and 100 were general practitioners and residents. The data were collected from October until the end of November 2022 through a semi-structured, self-administered questionnaire gathered by convenience sampling. The data were collected and analyzed with SAS software. RESULTS:  The study's main findings include a satisfaction rate in balancing career and family life among the studied female physicians, which was low at 15.7%. In comparison, female physicians unsatisfied with such balancing were 38.2%. The effect of family responsibilities on career choice was nearly equal, where 50.3% of the studied female physicians affected them. There was a statistically significant difference regarding the satisfaction in balancing career with family life by their specialty; female surgeons and gyn/obs physicians found a higher percentage of unsatisfaction, whereas, among family medicine physicians, the least rate of unsatisfaction was found (P-value < 0.01). At 80% of the studied physicians suggested providing childcare centers as the main solution to their difficulties and obstacles; also, 46.5% suggested taking more days off of maternity leave. Transportation difficulties, however, represented the lowest type of difficulty, 12.7%. CONCLUSION:  The present study has revealed several obstacles facing female physicians that negatively impact relationships with their families.

The multifactorial role of vanillin in amelioration of aluminium chloride and D-galactose induced Alzheimer's disease in mice.

The onset and progression of Alzheimer's disease (AD) are influenced by a variety of factors. These include oxidative stress, overexpression of acetylcholinesterase (AChE), depletion of acetylcholine levels, increased beta-secretase mediated conversion of Amyloid Precursor Protein (APP) to Amyloid Beta (Abeta), accumulation of Abeta oligomers, decrease in Brain Derived Neurotrophic factor (BDNF) and accelerated neuronal apoptosis due to elevated levels of caspase-3. The currently available therapeutic approaches are inadequate in affecting these pathological processes except maybe the overexpression of AChE (AChE inhibitors like donepezil, rivastigmine). There is an urgent need to develop disease modifying pharmacotherapeutic interventions which have appreciable safety and cost effectiveness. From previously reported in vitro studies and a preliminary assessment of neuroprotective effect in scopolamine induced dementia-like cognitive impairment in mice, vanillin has been used as the compound of interest in the present study. Vanillin, a phytoconstituent, has been used in humans, safely, in the form of a flavouring agent for various foods, beverages, and cosmetics. Owing to its chemical nature i.e. being a phenolic aldehyde, it has an additional antioxidant property that is congruent to the desirable characteristics that are sought in a suitable novel anti-AD agent. In our study, vanillin proved to have a nootropic effect in healthy Swiss albino mice as well as an ameliorative effect in aluminium chloride and D-galactose induced AD model in mice. Apart from tackling oxidative stress, vanillin was found to reduce the levels of AChE, beta secretase, caspase-3, enhance degradation of Abeta plaques and elevate the levels of BDNF, in cortical and hippocampal regions. Vanillin is a promising candidate for being incorporated into the search for safe and effective anti-AD molecules. However, further research might be needed to warrant its application clinically.