Frequency and Knowledge of Analgesics Self-Use and Their Adverse Effects in the Eastern Province of Saudi Arabia.

Background Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used over-the-counter (OTC) medications, both locally in Saudi Arabia (SA) and globally. They are widely available and can be easily obtained; however, the potential health risks of these drugs are well-documented. This study aimed to measure the frequency of analgesics' self-use and assess the general population's knowledge of their adverse effects. Methodology This is a descriptive, cross-sectional study that was conducted through an online self-administered questionnaire. It targeted adults who are non-healthcare professionals living in the eastern province of SA. Results The sample consisted of 345 participants, of which 196 (56.8%) were male and 149 (43.2%) were female. The most self-used medication was paracetamol at 91%, followed by ibuprofen at 38.8%. Although the prevalence of self-use was high, a low frequency of repeated use was evident, as 49.3% of the participants rarely used them and 19.4% used them only every few months. There was a significant association between the female gender, lower levels of education, and a higher frequency of repeated use of analgesics. About 54.5% of the participants recognized three side effects or fewer, while 90 (26.1%) of them showed knowledge about four to six side effects. Conclusions Considering that paracetamol and NSAIDs are easily procurable OTC, the knowledge of the general population about their harmful adverse effects needs to be enhanced, specifically that of the most vulnerable patient groups.

Prevalence and Severity of Dry Eye Disease Symptoms Among Diabetics: A Nationwide Survey.

INTRODUCTION: Diabetes mellitus (DM) microvascular complications can impair corneal sensitivity and lacrimal gland functioning, leading to dry eye disease (DED). Hence, this study aimed to measure the prevalence and severity of DED symptoms, and the related risk factors, among the Saudi diabetic population. METHODS: This is a retrospective, cross-sectional, survey-based study which targeted Saudi adults (20 years and older) previously diagnosed with type 1 or type 2 DM. It was conducted in eight primary healthcare centers (PCHs) scattered around eight different provinces of Saudi Arabia (SA). The prevalence and severity of DED were measured by the Ocular Surface Disease Index (OSDI). RESULTS: The total study population was 389 subjects, of which 182 (46.8%) were males and 207 (53.2%) were females. The overall prevalence of DED was 51.7%. Among those, 20.3% of patients had mild dryness, 11.1% had moderate dryness, and 20.3% had severe dryness. Glycosylated hemoglobin (HbA1c) levels of 6.5% or higher proved to be an independent risk factor for the development of DED symptoms, 3.6-folds higher for HbA1c levels of 6.5% to 9% (AOR=3.573; p=0.001), and 2.3-folds higher for HbA1c levels higher than 9% (AOR=2.293; p=0.013). The long duration of diabetes did not show a significant association with manifesting DED symptoms (p=0.263). CONCLUSION: Half of the diabetic population complained of DED symptoms, compared to one-third of the previously studied general Saudi population. Patients with mild to moderate HbA1c elevation were more likely to report DED symptoms than those with severe elevation, which could be related to impaired corneal sensation. Therefore, a routine ophthalmological examination is recommended.

The Influence of Rumen-Protected Choline and α-tocopherol Supplementation on Early Lactating Dairy Cows Metabolism.

It is well documented that choline is known as one of the essential ingredients of phospholipids. Choline acts as a determinative element for appropriate cell membrane functions. On the other hand α-tocopherol (Vit E) is a fat-soluble vitamin. This vitamin acts as a strong antioxidant in the living body's defense system against oxidative stress. Lipid peroxidation in peripartum and early lactating cows is significantly increased while the level of serum Vit E is decreases dramatically. These concomitant physiological changes demonstrate a higher level of oxidative stress subsequently leads to serious health issues in dairy cows. Therefore, the present research was designed to investigate the following items in dairy cattle: 1) evaluation of the possible changes in serum protein fractions, and 2) comparing the oxidative status of orally RPC and vitamin E supplementation in dairy cows in early lactation period. In the current study 30 early lactating primiparous and multiparous Holstein cows (body condition score (BCS)=2.51 ± 0.10) were used beginning five weeks postpartum. All the animals were randomly divided in to three groups (n=10) (number of lactation=2.61). The animals were randomly assigned to receive one of the following treatments. Group 1 served as control group were not received any supplement. The second group was supplemented with 90 g/d of RPC (Reashre Choline, Balchem, USA). The third group was administrated 4400 IU/d vitamin E (Roche, Vitamins Ltd; Switzerland). In the current study, serum protein electrophoresis showed four main fractions as follows: albumin, α-globulin, ß-globulin, and γ-globulin. The recorded data showed that the percentages of albumin and γ-globulin fractions were higher in treated groups compared to the control group. In the animals supplementing with RPC and vitamin E the percentages of serum albumin increased to the value of 37. 70±1.63 and 38.21±1.28 respectively compare to the control group (34.69±1.21), which were significant (P<0.05).

A critical evaluation of microRNA biomarkers in non-neoplastic disease.

BACKGROUND: MicroRNAs (miRNAs) are small (∼22-nt), stable RNAs that critically modulate post-transcriptional gene regulation. MicroRNAs can be found in the blood as components of serum, plasma and peripheral blood mononuclear cells (PBMCs). Many microRNAs have been reported to be specific biomarkers in a variety of non-neoplastic diseases. To date, no one has globally evaluated these proposed clinical biomarkers for general quality or disease specificity. We hypothesized that the cellular source of circulating microRNAs should correlate with cells involved in specific non-neoplastic disease processes. Appropriate cell expression data would inform on the quality and usefulness of each microRNA as a biomarker for specific diseases. We further hypothesized a useful clinical microRNA biomarker would have specificity to a single disease. METHODS AND FINDINGS: We identified 416 microRNA biomarkers, of which 192 were unique, in 104 publications covering 57 diseases. One hundred and thirty-nine microRNAs (33%) represented biologically plausible biomarkers, corresponding to non-ubiquitous microRNAs expressed in disease-appropriate cell types. However, at a global level, many of these microRNAs were reported as "specific" biomarkers for two or more unrelated diseases with 6 microRNAs (miR-21, miR-16, miR-146a, miR-155, miR-126 and miR-223) being reported as biomarkers for 9 or more distinct diseases. Other biomarkers corresponded to common patterns of cellular injury, such as the liver-specific microRNA, miR-122, which was elevated in a disparate set of diseases that injure the liver primarily or secondarily including hepatitis B, hepatitis C, sepsis, and myocardial infarction. CONCLUSIONS: Only a subset of reported blood-based microRNA biomarkers have specificity for a particular disease. The remainder of the reported non-neoplastic biomarkers are either biologically implausible, non-specific, or uninterpretable due to limitations of our current understanding of microRNA expression.

Association of comorbid depression, anxiety, and stress disorders with Type 2 diabetes in Bahrain, a country with a very high prevalence of Type 2 diabetes.

This study examined the association of depression, anxiety, and stress with Type 2 diabetes (T2DM) in Bahrain, an island-country with a very high prevalence of T2DM. This was a cross-sectional study involving administering Depression Anxiety Stress Scales (DASS)-21 structured depression, anxiety, and stress scale to 143 T2DM patients and 132 healthy controls. Higher proportion of T2DM patients were found in the mild-moderate and severe- extremely severe depression (p=0.002), anxiety (p<0.001), and stress (p<0.001) groups. Chronic disease and disease duration were significantly associated with the 3 disturbances, while employment status was associated with anxiety and depression. Logistic regression analysis showed that anxiety, depression, and stress were associated with T2DM after adjusting for all variables, while age was the only significant variable associated with stress. These results suggest a positive contribution of T2DM to increased depressive and/or anxiety and/or stress disorders among the patients examined, thereby recommending counseling for T2DM patients.

Diurnal and seasonal variations of the UV cut-off wavelength and most erythemally effective wavelength of solar spectra.

BACKGROUND: Biologically effective solar ultraviolet radiation is defined as the product of the intensity of the solar spectrum and the erythema action spectrum at each wavelength. In this way we may arrive at the weighted effectiveness of each wavelength of solar radiation to produce a sunburn reaction. There have been many measurements of the variation of the solar spectrum with the time of the day and the time of the year, but questions remain as to the variation of the quality of the spectrum and the contribution of the shortest wavelengths of solar terrestrial radiation. The purpose of the present study was to determine the variation of the biologically effective solar spectrum with the time of the day and the time of the year and to determine the variation of the shortest wavelength that contributes to the sunburn reaction with the time of the day and the time of the year. METHODS: Spectroradiometric measurements were made at ground level over the period of one year (1988-1989) and at different times of the day at latitude 29.5 degrees north. The measured spectral irradiance was multiplied wavelength by wavelength by the erythema action spectra. RESULTS: We determined that the biologically effective solar spectrum remains essentially the same over the times of the day that sunburn may be experienced. The maximally effective wavelength of biologically effective solar radiation was determined to be 308 nm. The cut-off wavelength for biologically effective solar radiation (defined as the wavelength at which the biologically effective solar radiation is at 1% of its maximum) varied from 291 to 295 nm over the time of the year and from 292 to 296 nm over the day. CONCLUSION: For all practical purposes the biologically effective spectrum of solar ultraviolet radiation may be considered to remain constant over the period when sunburn may occur and the minimal wavelength of sunlight that contributes to sunburn is in the range of 291-296 nm.

Erythema and melanogenesis action spectra in heavily pigmented individuals as compared to fair-skinned Caucasians.

The protective role of epidermal melanin pigmentation against chronic exposure to ultraviolet radiation is widely accepted, although its photoprotective effect against acute exposure is less certain. In this study, the action spectra of erythema and melanogenesis in heavily pigmented individuals (skin type V) were determined at 295, 305, 315, and 365 nm, and compared with those of skin types I and II. When the erythema and melanogenesis action spectra for skin type V were normalized to 295 nm, they were identical to the corresponding action spectra for fair-skinned individuals, indicating that the photoprotection of epidermal melanin pigmentation is essentially independent of wavelength. The ratio of values for the minimum erythema dose (MED) between skin type V and skin types I and II was 2.29, which is close to the ratio of pigment in these skin types, as measured by diffuse reflectance spectroscopy in the visible range. The minimum immediate pigment darkening dose (IPD) and the minimum melanogenic dose (MMD) at 365 nm, and the MED and MMD at 315 nm were the same for all skin types, while the variation of MED for every skin type was maximum at 305 and 365 nm. The results provide circumstantial evidence that erythema and melanogenesis have the same mechanism at short-wavelength UVB (295 and 305 nm), and different mechanisms in UVA (365 nm). Furthermore, the 24 h MED at 305 nm appears to be a sensitive indicator of skin type.

Development of cutaneous tolerance to ultraviolet B during ultraviolet B phototherapy for psoriasis.

During a schedule of multiple exposures to ultraviolet B radiation (UVB, 280-320 nm), skin develops a reduced sensitivity, variously called tolerance, photoadaptation, accommodation or acclimatization. In this study we have investigated the development of tolerance in the normal skin of a group of psoriatic patients during the course of UVB therapy. Tolerance was assessed by phototests carried out on non-lesional skin as frequently as possible throughout the treatment. Maximum tolerance was developed by the group of individuals most sensitive to UVB, which was twice that of the least sensitive group. The minimal perceptible erythema dose (MPE) increased rapidly in the first 2 weeks (220% per week) and reached a plateau by the eighth week of 800% above the baseline MPE dose. For the more sensitive patients there was a further increase in sensitivity (decrease in MPE dose) after the ninth week of continuous treatment. Tolerance to UVB also involves pigmentation in the first few weeks, but in these patients there was no evidence of hyperpigmentation by the end of treatment. While epidermal hyperplasia is most likely to play a leading role in the development of tolerance to UV, there is no reason to expect this protection to decrease under conditions of continuous exposure. Thus, accommodation to ultraviolet radiation (UVR) is not a monotonically increasing process but appears to alter the accepted reactions of human skin to UVR.

Minimum erythema dose determination in individuals of skin type V and VI with diffuse reflectance spectroscopy.

Erythema induced by ultraviolet B radiation (UVB) or PUVA (psoralen+UVA) was measured by diffuse reflectance spectroscopy (DRS) and laser Doppler flowmetry (LD) on patients receiving UV phototherapy and on healthy volunteers of skin type V and VI. The height of the 577 nm absorbance peak of oxyhemoglobin was taken as a measure of erythema intensity. DRS spectra from skin sites exposed to a series of doses were similar in shape. The dose necessary to produce a 0.05 difference in absorbance between 577 nm and 630 nm was determined to be a good indicator of minimal erythema dose (MED) in UVB. DRS measurements proved very reliable in the determination of MED or minimum phototoxic dose) of deeply pigmented subjects. In individuals with skin types V or VI, DRS detects and provides a measure for UVB and PUVA erythema and distinguishes it from melanin pigment, even when the erythema is not obvious. LD measurements lose sensitivity with increasing pigmentation and fail altogether in highly pigmented skin (types V and VI). Diffuse reflectance spectroscopic techniques also make possible the detection of sub-visual threshold reactions. DRS improved the accuracy of MED and MPD determination and the objective standardization of phototesting procedures irrespective of the subject's pigment level.

Changing the risk spectrum of injury and the performance of sunscreen products throughout the day.

Sunscreen products are tested normally against a defined solar simulator spectrum that, in ultraviolet (UVB), closely resembles the noontime spectral composition of summer sunlight. Although such a spectrum may define the product for use in the most adverse sunlight conditions, little attention has been given to how such products perform against other natural sunlight spectra. Outdoor clinical trials suggest that indoor testing of sunscreens may overestimate the performance of many products. In this study we compared the predicted efficacy of specific products to a variety of natural sunlight spectra taken at different solar angles and under different atmospheric conditions. We found that a standard product always provides less protection for a natural sunlight spectrum than its label value would suggest. The deviation from the labeled value is the greatest when the sun is low in the sky, i.e., close to the horizon. The deviation is due to the changing ratio of UVA to UVB radiation in natural sunlight. The deviation can be as large as a factor of 2.0.

In vitro and in vivo ultraviolet-induced alterations of oxy- and deoxyhemoglobin.

Ultraviolet (UV) radiation was found to convert oxyhemoglobin and deoxyhemoglobin stoichiometrically into methemoglobin and a met-like product, respectively. The peak conversion efficiency for oxyhemoglobin occurred at 285 nm and decreased by a factor of 100 by 315 nm. The peak conversion efficiency for deoxyhemoglobin occurred at 290 nm and decreased by a factor of 30 by 320 nm. The transformation of oxyhemoglobin to methemoglobin was also documented in intact erythrocytes using UV-B radiation. Finally, similar transformations were found to occur in human skin with UV-B exposure but not on all volunteers tested. These results imply that methemoglobin will be formed in vivo on solar exposure and provide evidence that UV-B photons reach the blood vessels.

Quantitative assessment of UV-induced pigmentation and erythema.

In this paper we present methods that we have developed to measure pigmentation in human skin. This involves the measurement of diffuse reflection spectra from human skin in vivo and referencing them to either totally depigmented skin, or the skin of the same individual if we are measuring variations in pigmentation. Changes in the pigmentary system brought about by UV radiation can be measured for each individual. Absolute measurements lead to estimates of the melanin concentration in the skin, while differential measurements lead to estimates of the quantity of additional or reduced pigment content of some skin lesions. The same instrumentation has been successfully used to assess UV-induced erythema as well as other vascular changes. The determination of the minimum detectable erythema dose can be performed even in the darkest-skinned subjects without loss of sensitivity as in the case of laser Doppler instruments. It has been shown that what is perceived by the eye as erythema is a very complex phenomenon, encompassing a large number of vascular reactions that can be studied in detail through diffuse reflection spectroscopy. Some of the possible responses are presented, as well as the contributing chromophores that have been identified so far.

Absorption mechanisms of human melanin in the visible, 400-720 nm.

In this paper we propose that human melanin absorbs visible radiation through two distinct mechanisms: one that is in effect over the entire visible range and is linear in wavelength, and a second one that is evident at wavelengths in the range 400-500 nm and is exponential in frequency. These mechanisms are apparent in all human diffuse reflectance spectra that we have collected. We show that the absorber is the same in all human volunteer skin samples. By studying the diffuse reflection spectra of DOPA-melanin in solution and DOPA-melanin in powder form, we find that we can correlate the absorption mechanisms, one with melanin in solution (a low molecular weight form) and the other with melanin in powder (a high molecular weight form). Therefore, we propose that melanin exists in two distinct states. This model is of biologic significance, as it provides a reasonable interpretation for the diffuse reflection spectra obtained from delayed pigment (UVB-induced) and immediate pigment (UVA-induced). Delayed pigment appears as an increase of both forms of melanin (neomelanogenesis), whereas immediate pigment appears as an increase in the higher molecular weight form with a commensurate decrease in the lower molecular weight form: the two mechanisms change independently of each other. Finally, we show that we can distinguish spectroscopically between the delayed pigment and the immediate pigment.

Spectroscopic characteristics of human melanin in vivo.

In this paper we present the absorption characteristics of human melanin in the visible range of wavelengths and specifically in the range 620-720 nm. The spectroscopy of melanin is studied by measuring remittance spectra of normal skin and vitiligo-involved skin of volunteers-patients. It is assumed that the spectral differences between adjacent areas of normally pigmented skin, and to some degree amelanotic skin, can only be due to the variations of the melanin filter. The ratio of the remittance spectrum of the vitiligo-involved skin with the spectrum of the normal skin in the range 620-720 nm can be fitted with a straight line for all the volunteers. A very strong correlation is obtained between the intercept and the slope for all the volunteers, which leads us to conclude that it is indeed melanin that we are measuring in all the volunteers and that it is the same substance spectroscopically for all the volunteers.