The Relation Between Osteoporosis and Bone Fractures and Health-Related Quality of Life in Post-menopausal Saudi Women in the Jazan Region: A Cross-Sectional Study.

INTRODUCTION: Osteoporosis is a significant health concern, often leading to fragility fractures and severely impacting the quality of life in post-menopausal women. Studies evaluating the effects of osteoporosis and resultant fractures on health-related quality of life (HRQoL) in Saudi women are lacking. This study aimed to assess the relationship between osteoporosis and fracture and physical, psychological, social, and environmental HRQoL domains in post-menopausal Saudi women. METHODS: In this cross-sectional study conducted in Jazan, Saudi Arabia, 158 post-menopausal Saudi women completed HRQoL surveys using the validated Arabic WHOQOL-BREF questionnaire. Data on socioeconomics, comorbidities, and fracture history were gathered. Descriptive statistics delineated sample characteristics. Analysis of variance (ANOVA) and post-hoc tests identified differences in HRQoL across socioeconomic and clinical categories. Multivariate regression analyses determined factors independently related to HRQoL. RESULTS: Of 158 women surveyed, 39% had a history of osteoporotic fracture. Foot (35%), hand (31%), and vertebral (10%) fractures were the most frequent. Women over 70 had significantly lower physical HRQoL than those aged 45-55 (p<0.001). Unemployed and lower-income women showed poorer HRQoL across domains (p<0.01). Vertebral and hand fractures were negatively related to physical and psychological health (p<0.05). Chronic diseases like hypertension and rheumatoid arthritis reduced HRQoL (p<0.01). In regression analyses, older age, vertebral fracture, physical inactivity, long-term hormone therapy, and unemployment emerged as determinants of poorer HRQoL (p<0.05). CONCLUSION: Osteoporosis and resultant fragility fractures, especially in vertebral and hand bones, led to substantial impairments in physical, social, psychological, and environmental HRQoL in Saudi women. Modifiable risk factors like physical inactivity and long-term hormone use also affected HRQoL. Targeted screening and multidomain interventions for disadvantaged women with osteoporosis are warranted to improve functioning and quality of life.

Zerumbone reduces TLR2 stimulation-induced M1 macrophage polarization pattern via upregulation of Nrf-2 expression in murine macrophages.

Hyperuricemia contributes significantly to gout arthritis pathogenesis, which promotes urate crystal deposition in the joints and activates joint-resident macrophages and circulating monocytes to initiate a state of inflammatory arthritis. In the joint, macrophages have an immune defense role where the presence of urate crystals results in the inflammatory mediators secretion, inflammatory cells recruitment to the joint, and shift macrophage population toward M1 pro-inflammatory phenotypes. Current treatment modalities of gout arthritis have side effects that limit their use in the elderly. A novel treatment that targets macrophage polarization to re-establish homeostasis may initiate a drug discovery program of novel disease-modifying agents for gout. Zerumbone (Zer) is a sesquiterpenoid bioactive compound found in the rhizome of Zingiberaceae family and possesses anti-inflammatory, antioxidant, and anti-proliferative activity. Our study hypothesized that soluble uric acid (sUA) and Pam3CSK4 (TLR2 agonist) reduce the anti-inflammatory function of murine M2 bone marrow-derived macrophages and change the expression of M2 genetic markers toward M1 phenotypes. We observed that priming of M2 macrophages with sUA and Pam3CSK4 significantly decreased M2 specific markers expression, e.g., Arg-1, Ym-1, and Fizz-1, enhanced mRNA expression of IL-1ß, TNF-α, CXCL2, and iNOS and increased oxidative stress in M2 macrophages, as exhibited by a reduction in Nrf2 expression. We also aimed to study the impact of Zer on reducing the pro-inflammatory effect of sUA in TLR2-stimulated M2 macrophages. We noticed that Zer treatment significantly reduced L-1ß and TNF-α production following Pam3CSK4 + sUA treatment on M2 macrophages. Furthermore, Zer reduced the caspase-1 activity without altering cytosolic NLRP3 content in challenged M2 BMDMs. We also observed that Zer significantly enhanced M2-associated marker's expression, e.g., Arg-1, Ym-1, and Fizz-1, and augmented Nrf-2 and other antioxidant proteins, including HMOX1 and srxn1expression following Pam3CSK4 + sUA treatment. We draw the conclusion that Zer is a potentially effective anti-inflammatory treatment for gout arthritis linked to hyperuricemia.

A Case of a Young Military Officer with Bilateral Simultaneous Femoral Neck Stress Fracture.

Stress fractures of the femoral neck are rare in young adults and usually happen when the bone is repeatedly put under a lot of stress or because of a bone disease. The incidence of stress fractures is a major health concern for soldiers. Most often, stress fractures affect the metatarsals and tibias, while injuries to the femoral neck are less common. Exertional groin or anterior thigh discomfort that develops gradually over time is often vague and subtle; therefore, a high index of clinical suspicion is indicated. In most cases, the first radiographs will be normal. In order to properly diagnose a stress fracture in the femur, a CT scan is very helpful. Because most femoral neck fractures are not displaced when patients present with them, a diagnosis is often delayed. In conclusion, new military soldiers feeling hip pain should have a thorough medical evaluation to establish an early diagnosis and prevent any consequences.

Septic Arthritis of the Knee in Children.

Septic arthritis of the knee is the most common form of septic arthritis in children and can lead to irreversible damage to the joint. Staphylococcus aureus is the primary pathogen associated with septic arthritis, although other causative pathogens may be isolate in children with specific risk factors. The diagnosis of knee septic arthritis is based on comprehensive evaluation, including the patient's medical history, physical examination, blood tests, and arthrocentesis. Empirical treatment typically involves anti-staphylococcal penicillin or a first-generation cephalosporin, although modifications may be made based on local resistance patterns and clinical culture data. Surgical debridement, either through open surgery or arthroscopy, involving extensive debridement of the joint, is effective in eliminating the infection. In most cases, additional surgical intervention is not necessary.

Osseous Metastases in Thyroid Cancer: Unveiling Risk Factors, Disease Outcomes, and Treatment Impact.

Bone is the second most common site of metastasis in patients with thyroid cancer (TC) and dramatically impacts overall survival and quality of life with no definitive cure, yet there is no extensive study of the demographic and clinical risk factors in the recent literature. Data regarding 120,754 TC patients with bone metastasis were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were used to identify the risk factors of bone metastasis occurring in various histologies of TC. Cox regression was performed to analyze the influence of bone metastasis on overall survival. Hazard ratios were computed to analyze the association between bone metastasis and the primary outcomes. Of the 120,754 records collected from the SEER database from 2000 to 2019, 976 (0.8%) presented with bone metastasis, with occurrence being the greatest in patients of age ≥ 55 years (OR = 5.63, 95%CI = 4.72-6.71), males (OR = 2.60, 95%CI = 2.27-2.97), Blacks (OR = 2.38, 95%CI = 1.95-2.9) and Asian or Pacific Islanders (OR = 1.90, 95%CI = 1.58-2.27), and single marital status. TC patients presenting with bone metastasis (HR = 2.78, 95%CI = 2.34-3.3) or concurrent bone and brain metastases (HR = 1.62, 95%CI = 1.03-2.55) had a higher mortality risk. Older age, gender, race, and single marital status were associated with bone metastasis and poorer prognosis in TC patients at initial diagnosis. Understanding such risk factors can potentially assist clinicians in making early diagnoses and personalized treatment plans, as well as researchers in developing more therapeutic protocols.

Thymoquinone Ameliorates Carfilzomib-Induced Renal Impairment by Modulating Oxidative Stress Markers, Inflammatory/Apoptotic Mediators, and Augmenting Nrf2 in Rats.

Chemotherapy-induced kidney damage is an emerging problem that restricts cancer treatment effectiveness. The proteasome inhibitor carfilzomib (CFZ) is primarily used to treat multiple myeloma and has been associated with severe renal injury in humans. CFZ-induced nephrotoxicity remains an unmet medical need, and there is an urgent need to find and develop a nephroprotective and antioxidant therapy for this condition. Thymoquinone (TQ) is a bioactive compound that has been isolated from Nigella sativa seeds. It has a wide range of pharmacological properties. Therefore, this experimental design aimed to study the effectiveness of TQ against CFZ-induced renal toxicity in rats. The first group of rats was a normal control (CNT); the second group received CFZ (4 mg/kg b.w.); the third and fourth groups received TQ (10 and 20 mg/kg b.w.) 2 h before receiving CFZ; the fifth group received only TQ (20 mg/kg b.w.). This experiment was conducted for 16 days, and at the end of the experiment, blood samples and kidney tissue were collected for biochemical assays. The results indicated that administration of CFZ significantly enhanced serum marker levels such as BUN, creatinine, and uric acid in the CFZ group. Similarly, it was also noticed that CFZ administration induced oxidative stress by reducing antioxidants (GSH) and antioxidant enzymes (CAT and SOD) and increasing lipid peroxidation. CFZ treatment also enhanced the expression of IL-1ß, IL-6, and TNF-α production. Moreover, CFZ increased caspase-3 concentrations and reduced Nrf2 expression in the CFZ-administered group. However, treatment with 10 and 20 mg/kg TQ significantly decreased serum markers and increased antioxidant enzymes. TQ treatment considerably reduced IL-1ß, IL-6, TNF-α, and caspase-3 concentrations. Overall, this biochemical estimation was also supported by histopathological outcomes. This study revealed that TQ administration significantly mitigated the negative effects of CFZ treatment on Nrf2 expression. Thus, it indicates that TQ may have utility as a potential drug to prevent CFZ-induced nephrotoxicity in the future.

In Rats, Whole and Refined Grains Decrease Bone Mineral Density and Content through Modulating Osteoprotegerin and Receptor Activator of Nuclear Factor Kappa B.

Wheat is a staple grain in most parts of the world and is also frequently used in livestock feed. The current study looked at the impact of a wheat grain diet on bone turnover markers. Thirty male rats (n = 10) were separated into three groups of ten. The rats in Group 1 were fed a chow diet, while the rats in Group 2 were provided whole grains. The rats in Group 3 were fed refined grains. Each rat's bone mineral content (BMC) and bone mineral density (BMD) were measured after 12 weeks in the tibia of the right hind limb. We also looked at the amounts of bone turnover indicators in the blood. TRAP-5b (Tartrate-resistant acid Phosphatase 5b), NTx (N-telopeptide of type I collagen), DPD (deoxypyridinoline), alkaline phosphatase (ALP), and osteocalcin (OC), as well as the levels of Receptor Activator of Nuclear Factor Kappa B (RANK) and osteoprotegerin (OPG). Rats fed whole and refined grains showed lower BMC and BMD (p < 0.05) than the control group rats. The grain diet resulted in lower OPG, OC, and ALP levels than the chow-fed rats, as well as significantly higher (p < 0.05) levels of RANK, DPD, TRAB 5b, and NTx. In a rat model, an exclusive whole or refined grain diet lowered bone turnover and mass.

Cross-sectional community-based study in Saudi Arabian population with inclusion of behavioral studies of osteoporosis patients.

Purpose: Osteoporosis is especially prevalent in the older population and in women. Fractures lead to many health complications, placing an enormous burden on the health system. Improved knowledge will encourage healthy practices that prevent osteoporosis and help community members avoid unhealthy lifestyles and habits. The goal of this study was to evaluate the knowledge, attitudes, and practices relating to osteoporosis among male and female students of the Jazan community. Methods: The Jazan region has 13 governorates and a population of more than 1.5 million. For this study, 440 participants were selected from seven different governorates, and the osteoporosis knowledge assessment tool (OKAT) was used together with five background variables and some questions on attitude and practice. A Chi-squared test was implemented to identify any significant relationships between the background variables and the knowledge and practice scores. A P value of less than 0.05 was considered significant. Results: Of the 440 participants, 53% were men and 47% women. Thirty-three percent of them held government jobs, 73% had completed university, and 50% had a monthly income of less than 5,000 riyals. Regarding the risk factors for osteoporosis, 62 (14%) smoked, 37 (8.4%) used steroids, 184 (41.8%) had a family history of osteoporosis, and 393 (89.3%) had not attended an education campaign on osteoporosis. The highest number of correct answers in the OKAT was to the question "osteoporosis increases the risk of fractures" (423, 96.1%), and the lowest number of correct answers was to the question "osteoporosis is more common in men" (60, 13.6%). Regarding protective behaviors against osteoporosis, namely physical activity, daily intake of dairy products, attending an education campaign, and background characteristics, attending an education campaign was statistically significant, with a P value of 0.003, but marital status, education level, body mass index (BMI), and occupation were not statistically significant. For the risk factors, sex was statistically significant, along with the daily soft drink intake and smoking but not with the use of steroids. Other background characteristics, such as education level and BMI, were not statistically significant as osteoporosis risk factors. Conclusions: The participants' level of knowledge was high, and the risk factors for osteoporosis were still present together with a low level of achievement for protective measures. It is highly recommended that education campaigns be implemented to increase knowledge and encourage improved attitudes and practices.

A Rat Model of Rheumatoid Arthritis: TDZD-8 is Associated with the Protection Against the Induction of the Synovium Knee Joint IL-17A/GSK3β/ROS/α-SMA Axis of Fibrosis

SUMMARY: Rheumatoid arthritis (RA) that affects the synovial knee joint causes swelling of the synovial membrane and tissue damage. Interleukin-17A (IL-17A) and the enzyme glycogen synthase kinase-3β (GSK3β) are involved in the pathogenesis of RA. The link between IL-17A, GSK3β, the oxidative stress, and the profibrogenic marker alpha-smooth muscle actin (α-SMA) with and without TDZD-8, GSK3β inhibitor has not been studied before. Consequently, active immunization of rats was performed to induce RA after three weeks using collagen type II (COII) injections. The treated group received daily injection of 1 mg/kg TDZD-8 for 21 days following the immunization protocol (COII+TDZD-8). Blood and synovium tissue samples were harvested at the end of the experiment. RA development was confirmed as corroborated by a substantial increase in blood levels of the highly specific autoantibody for RA, anti-citrullinated protein antibody as well as augmentation of reactive oxidative species (ROS) levels measured as lipid peroxidation. RA induction also increased synovium tissue levels of IL-17A and the profibrogenic marker, α-SMA. All these parameters seemed to be significantly (p<0.0001) ameliorated by TDZD-8. Additionally, a significant correlation between IL-17A, ROS, and α-SMA and biomarkers of RA was observed. Thus, knee joint synovium RA induction augmented IL-17A/GSK3β/ROS/α-SMA axis mediated arthritis in a rat model of RA, which was inhibited by TDZD-8.

La artritis reumatoide (AR) que afecta la articulación sinovial de la rodilla provoca inflamación de la membrana sinovial y daño tisular. La interleucina-17A (IL-17A) y la enzima glucógeno sintasa quinasa-3β (GSK3β) están involucradas en la patogenia de la AR. No se ha estudiadol vínculo entre IL-17A, GSK3β, el estrés oxidativo y el marcador profibrogénico actina de músculo liso alfa (α-SMA) con y sin inhibidor de TDZD-8, GSK3β. En consecuencia, se realizó una inmunización activa de ratas para inducir la AR después de tres semanas usando inyecciones de colágeno tipo II (COII). El grupo tratado recibió una inyección diaria de 1 µg/ kg de TDZD-8 durante 21 días siguiendo el protocolo de inmunización (COII+TDZD-8). Se recogieron muestras de sangre y tejido sinovial al final del experimento. El desarrollo de AR se confirmó como lo corroboró el aumento sustancial en los niveles sanguíneos del autoanticuerpo altamente específico para AR, el anticuerpo antiproteína citrulinada, así como el aumento de los niveles de especies oxidativas reactivas (ROS) medidos como peroxidación lipídica. La inducción de AR también aumentó los niveles de tejido sinovial de IL-17A y el marcador profibrogénico, α-SMA. Todos estos parámetros parecían mejorar significativamente (p<0,0001) con TDZD-8. Además, se observó una correlación significativa entre IL- 17A, ROS y α-SMA y biomarcadores de AR. Por lo tanto, la inducción de AR en la sinovial de la articulación de la rodilla aumentó la artritis mediada por el eje IL-17A/GSK3β/ROS/α-SMA en un modelo de rata de AR, que fue inhibida por TDZD-8.

A rat model of rheumatoid arthritis: TDZD-8 is associated with the protection against the induction of the synovium knee joint IL-17A/GSK3beta/ROS/alpha-SMA axis of fibrosis / Un modelo de rata de artritis reumatoide: TDZD-8 está asociado con la protección contra la inducción del eje de fibrosis de la articulación sinovial de la rodilla IL-17A/GSK3ß/ROS/α-SMA

SUMMARY: Rheumatoid arthritis (RA) that affects the synovial knee joint causes swelling of the synovial membrane and tissue damage. Interleukin-17A (IL-17A) and the enzyme glycogen synthase kinase-3β (GSK3β) are involved in the pathogenesis of RA. The link between IL-17A, GSK3β, the oxidative stress, and the profibrogenic marker alpha-smooth muscle actin (α-SMA) with and without TDZD-8, GSK3β inhibitor has not been studied before. Consequently, active immunization of rats was performed to induce RA after three weeks using collagen type II (COII) injections. The treated group received daily injection of 1 mg/kg TDZD-8 for 21 days following the immunization protocol (COII+TDZD-8). Blood and synovium tissue samples were harvested at the end of the experiment. RA development was confirmed as corroborated by a substantial increase in blood levels of the highly specific autoantibody for RA, anti-citrullinated protein antibody as well as augmentation of reactive oxidative species (ROS) levels measured as lipid peroxidation. RA induction also increased synovium tissue levels of IL-17A and the profibrogenic marker, α-SMA. All these parameters seemed to be significantly (p<0.0001) ameliorated by TDZD-8. Additionally, a significant correlation between IL-17A, ROS, and α-SMA and biomarkers of RA was observed. Thus, knee joint synovium RA induction augmented IL-17A/GSK3β/ROS/α-SMA axis mediated arthritis in a rat model of RA, which was inhibited by TDZD-8.

La artritis reumatoide (AR) que afecta la articulación sinovial de la rodilla provoca inflamación de la membrana sinovial y daño tisular. La interleucina-17A (IL-17A) y la enzima glucógeno sintasa quinasa-3β (GSK3β) están involucradas en la patogenia de la AR. No se ha estudiadol vínculo entre IL-17A, GSK3β, el estrés oxidativo y el marcador profibrogénico actina de músculo liso alfa (α-SMA) con y sin inhibidor de TDZD-8, GSK3β. En consecuencia, se realizó una inmunización activa de ratas para inducir la AR después de tres semanas usando inyecciones de colágeno tipo II (COII). El grupo tratado recibió una inyección diaria de 1 µg/ kg de TDZD-8 durante 21 días siguiendo el protocolo de inmunización (COII+TDZD-8). Se recogieron muestras de sangre y tejido sinovial al final del experimento. El desarrollo de AR se confirmó como lo corroboró el aumento sustancial en los niveles sanguíneos del autoanticuerpo altamente específico para AR, el anticuerpo antiproteína citrulinada, así como el aumento de los niveles de especies oxidativas reactivas (ROS) medidos como peroxidación lipídica. La inducción de AR también aumentó los niveles de tejido sinovial de IL-17A y el marcador profibrogénico, α-SMA. Todos estos parámetros parecían mejorar significativamente (p<0,0001) con TDZD-8. Además, se observó una correlación significativa entre IL- 17A, ROS y α-SMA y biomarcadores de AR. Por lo tanto, la inducción de AR en la sinovial de la articulación de la rodilla aumentó la artritis mediada por el eje IL-17A/GSK3β/ROS/α-SMA en un modelo de rata de AR, que fue inhibida por TDZD-8.

Analysis of MIR27A (rs11671784) Variant Association with Systemic Lupus Erythematous.

Multiple microRNAs (miRs) are associated with systemic autoimmune disease susceptibility/phenotype, including systemic lupus erythematosus (SLE). With this work, we aimed to unravel the association of the miR-27a gene (MIR27A) rs11671784G/A variant with SLE risk/severity. One-hundred sixty-three adult patients with SLE and matched controls were included. A TaqMan allelic discrimination assay was applied for MIR27A genotyping. Logistic regression models were run to test the association with SLE susceptibility/risk. Genotyping of 326 participants revealed that the heterozygote form was the most common genotype among the study cohort, accounting for 72% of the population (n = 234), while A/A and G/G represented 15% (n = 49) and 13% (n = 43), respectively. Similarly, the most prevalent genotype among cases was the A/G genotype, which was present in approximately 93.3% of cases (n = 152). In contrast, only eight and three patients had A/A and G/G genotypes, respectively. The MIR27A rs11671784 variant conferred protection against the development of SLE in several genetic models, including heterozygous (G/A vs. A/A; OR = 0.10, 95% CI = 0.05-0.23), dominant (G/A + G/G vs. AA; OR = 0.15, 95% CI = 0.07-0.34), and overdominant (G/A vs. A/A + G/G; OR = 0.07, 95% CI = 0.04-0.14) models. However, the G/G genotype was associated with increased SLE risk in the recessive model (G/G vs. A/A+ G/G; OR = 17.34, 95% CI = 5.24-57.38). Furthermore, the variant showed significant associations with musculoskeletal and mucocutaneous manifestations in the patient cohort (p = 0.035 and 0.009, respectively) and platelet and white blood cell counts (p = 0.034 and 0.049, respectively). In conclusion, the MIR27A rs11671784 variant showed a potentially significant association with SLE susceptibility/risk in the studied population. Larger-scale studies on multiethnic populations are recommended to verify the results.

Prevalence of Patellofemoral Pain and Knee Pain in the General Population of Saudi Arabia.

Background Patellofemoral pain (PFP) is a common cause of knee pain. This condition can restrict daily activities by trying to avoid activities that aggravate their pain. This study aimed to determine the prevalence of PFP and knee pain and its associated factors among Saudi young adults. Methods A descriptive cross-sectional study was conducted in Saudi Arabia. A validated translated Arabic questionnaire was used. Data was collected through an online self-administered questionnaire. Saudi young adults of both genders aged between (18 to 40 years) were included. The mean ±SD was described for continuous variables, whereas categorical variables were reported using frequencies and percentages. The chi-square test was used for descriptive analysis. Results A total of 1558 subjects were enrolled in the current study. About 663 (42.6%) were males and 895 (57.4%) were females. Of the total participants, 718 (46%) were within the age group of 18 to 25. The overall prevalence of PFP among the current study participant was found to be 30.3%. The prevalence of PFP among males was found to be 31.4% and the prevalence of PFP among females was found to be 29.5%. The overall prevalence of knee pain among study participants was found to be 13.2% as 205 of the participants reported knee pain. The prevalence of knee pain among males was found to be 14% and the prevalence of knee pain among females was found to be 12.3%. The multivariate analysis included the following variables: age, gender, and marital status. The following factors predicted higher rate of PFP: being 18 to 25 years old (p-value < 0.001, odds ratio = 1), being 26 to 35 years old (p-value = 0.001, odds ratio = 1.689). Conclusion The prevalence of PFP and knee pains was found to be relatively high in Saudi Arabia. Age less than 40 years old was found to be associated with a higher prevalence of PFP and knee pain when compared to other age groups.

The Prevalence and Risk Factors of Plantar Fasciitis Amongst the Population of Jazan.

Background Plantar fasciitis develops as a consequence of irritation of the plantar fascia, which is responsible for supporting the arches and absorbing shock. Multiple factors can contribute to plantar fasciitis, but the most common factor is overuse stress. The classical presentation is a sharp pain that is felt at the plantar aponeurosis (near the area of its insertion on the medial process of the calcaneal tuberosity), and it is possible to find a heel spur (osteophyte) in some cases. Most treatments for plantar fasciitis are ineffective and unsatisfactory for patients. Objective To estimate the prevalence and assess risk factors for plantar fasciitis among the population of the Jazan region. Methods A cross-sectional online survey was conducted on the population of the Jazan region. An online Google form questionnaire was prepared and distributed to the study population. Data was then entered and analyzed using IBM SPSS (Statistical Package for the Social Sciences) Statistics, version 21.0. Results A total of 695 participants were enrolled in the study. Out of that, 350 (50.4%) of the participants were males, while 345 (49.6%) were females. About the age of the participants, 507 (72.9%) were younger than 40 years of age. Participants with hypertension were 43 (6.2%), and 37 (5.3%) participants had diabetes. In terms of occupation, 120 (17.3%) worked in healthcare, 187 (26.9%) taught, and 43 (6.2%) served in the military. A great quantity of standing or walking was necessary for the jobs for 127 people (18.3%), while moderate amounts were recorded for 273 people (39.3%). The most commonly reported lower limb conditions were: pes planus (low arches) in 26 (3.7%) participants; and weakness of the gastrocnemius, soleus, and intrinsic foot muscles. The most commonly reported exercises were walking for 499 (71.8%) participants and jogging for 97 (14%) participants. The prevalence of plantar fasciitis was found to be 37% of the participants. Regarding the Foot and Ankle Outcome Score (FAOS) survey, the mean symptoms subscale score was 57.81 + 11.28, the mean pain subscale score was 72.87±20.84, the mean daily living subscale score was 72.73 ± 22.25, the mean sports and recreation subscale score was 76.83 ± 23.06, and the mean quality of life subscale score was 70.23 ± 25.17. Multivariate logistic regression was done and the following factors predicted a higher rate of plantar fasciitis: being 40 to 55 years old (p < 0.001, odds ratio = 2.15), being 56 to 65 years old (p = 0.037, odds ratio = 3.58), being obese (p = 0.031, odds ratio = 2.16), having weakness of the gastrocnemius, soleus, and the intrinsic foot muscles (p = 0.003, odds ratio = 7.39), jobs requiring a great amount of time standing or walking (p < 0.001, odds ratio = 3.17), and jobs requiring a moderate amount of time standing or walking (p = 0.012, odds ratio = 1.83). Being male predicted a lower rate of plantar fasciitis (p < 0.001, odds ratio = 0.52). Conclusion Plantar fasciitis is a prevalent and disabling condition with considerable effects on quality of life. Jobs that require long hours of walking or standing were associated with an increased risk of developing plantar fasciitis. Middle age, prolonged exercise, and gastrocnemius muscle tightness were also associated with plantar fasciitis. Efforts should be directed towards health education of the population regarding the risk factors and management of plantar fasciitis.

Prevalence of Bullying and Its Association With Health-Related Quality of Life Among Adolescents in Jazan: A Cross-Sectional Study.

BACKGROUND AND AIM: Bullying is one of the most significant problems that has emerged across the world. It has negative effects on physical, psychological, and social health, especially among adolescents. No previous studies have been conducted in the Jazan region of Saudi Arabia to investigate the association between bullying and health-related quality of life (HRQOL). The study aimed to estimate the prevalence of bullying and its association with HRQOL among adolescents in Jazan. METHODS: A cross-sectional study was conducted among 461 adolescents in the Jazan region, Saudi Arabia. They were selected from nine schools by a convenient type of sampling, using snowball technique. HRQOL was tested using the Arabic version of KIDSCREEN-27. Data were collected using a web survey and analyzed by the Statistical Package for Social Sciences (SPSS) version 24 (Armonk, NY: IBM Corp.). RESULTS: The study revealed that 35.3% of all participants were labeled as victims. Victimization was more common among boys (17.78%) than girls (17.57%) (P = 0.001). Most of the victims were bullied verbally (75.6%), and most of them were bullied by friends (57.67%). Regarding sex differences, cyberbullying was more prevalent among girls (18.04%) than among boys (9.82%) (P = 0.01). Bullying was more common in elementary schools (39.5%) than in others. Associations were found between bullying and all aspects of HRQOL that were evaluated (P<0.0001). CONCLUSIONS: Bullying prevalence is high among adolescents of the Jazan region and is associated with a poorer quality of life. This requires more attention from families and sectors of education, health, and social services.

The Prevalence of and Factors Associated With Neck Pain Among Jazan Adult Population.

Background Neck pain is considered one of the main musculoskeletal conditions affecting the population worldwide. However, it is difficult to identify the precise causes of pain. Objective This study aimed to estimate the prevalence of neck pain and its associated factors in the adult population and surrounding districts. Methods This cross-sectional study was conducted in Jazan city and the surrounding districts of the Kingdom of Saudi Arabia. A total of 443 adults of both sexes participated in an online questionnaire designed to determine the prevalence of neck pain and the significance of the relationship between neck pain and specific risk factors. The collected data included the participants' characteristics (personal, socioeconomic, demographic, and work-related aspects). Results Neck pain was highly prevalent among adults in Jazan city and the surrounding districts, as 347 of 443 participants (78.3%) experienced neck pain, while 96 (21.7%) did not suffer from neck pain. There was a significant relationship between the most common physical positions while using electronic devices and reading and the prevalence of neck pain (p = 0.015). The most common position accompanied by neck pain was the sitting position compared to the positions of lying, walking, or standing (79.7% vs. 67.9%, 60%, and 0%, respectively). No significant association was observed between the prevalence of neck pain and sex, age, monthly income, place of residence, smoking, or the number of hours spent on electronic devices or reading. Conclusion This study revealed a high prevalence of neck pain among adults in Jazan, Saudi Arabia, and a remarkable association with people who spend many hours daily using electronic devices, reading, performing work, sitting for a long time, and with lack of exercise.

Morphine Deteriorates Cisplatin-Induced Cardiotoxicity in Rats and Induces Dose-Dependent Cisplatin Chemoresistance in MCF-7 Human Breast Cancer Cells.

Morphine (MOR) is a strong analgesic that is often used in treatment of severe pains during cancer treatment, and thus might be concomitantly used with anticancer drugs as cisplatin (CP). The aim of the current study was to investigate the mechanisms by which MOR can affect CP-induced cardiotoxicity and to explore effects of MOR on the cytotoxic efficacy of CP. MOR (10 mg/kg/day i.p.) was administered to rats for 10 days, with or without 7.5 mg/kg CP single i.p. dose at day 5 of the experiment. In addition, MOR and/or CP were administered to MCF-7 cells to test their cytotoxicity. Compared to control, CP caused cardiotoxic effects manifested by significant increase in serum enzymatic markers; creatine kinase-MB and lactate dehydrogenase, with histopathological cardiac damage. In addition, CP caused cardiac oxidative stress, manifested by significant increased tissue lipid peroxidation product; malondialdehyde and nitric oxide, with significant decrease in tissue antioxidants as reduced glutathione, superoxide dismutase and catalase compared to control. Furthermore, CP significantly increased tissue proinflammatory cytokines; TNF-α and IL-6, as well as upregulated the apoptotic marker; caspase 3 compared to control. MOR/CP combination significantly deteriorated all tested parameters compared to CP alone. In MCF-7 breast cancer cells, administration of MOR in concentrations of 0.1, 1, 10 or 30 µM concomitantly with 1 or 10 µM CP caused dose-dependent reduction in CP-induced cytotoxicity in vitro. In conclusion, MOR administration might deteriorate CP-induced cardiotoxicity during cancer chemotherapy through oxidant, pro-inflammatory and apoptotic mechanisms, and might reduce CP chemotherapeutic efficacy.

Osteoporosis knowledge, attitudes, and practices among female Princess Nourah University students in Riyadh, Saudi Arabia.

BACKGROUND AND OBJECTIVE: Osteoporosis is characterized by decreased normal bone density. More than 8.9 million fractures worldwide annually are caused by osteoporosis; these fractures are a significant cause of morbidity and mortality. Evidence suggests that the modification of several lifestyle habits could assist in lowering the incidence of osteoporosis. However, limited studies have been conducted in Saudi Arabia to assess the knowledge, attitudes, and lifestyles associated with osteoporosis among college-age females. This study aimed to provide evidence to assist in the development of effective strategies against osteoporosis. MATERIALS AND METHODS: This cross-sectional study was conducted at Princess Nourah Bint Abdul Rahman University (PNU), in February 2018; a self-administered questionnaire was used. The different components of the questionnaire assessed knowledge, attitudes, and lifestyles with regard to osteoporosis. The participants were divided into groups on the basis of their age as follows: juniors, 17-20 years of age; seniors, 21-25 years of age. RESULTS: Of the 250 included participants, 122 (49%) and 128 (51%) were seniors and juniors respectively. Only 16% of all participants achieved a good score on the knowledge questionnaire; in particular, knowledge regarding osteoporosis risk factors was inadequate. Media was the only source of information of the included participants. Only 49% of participants believed that osteoporosis is a serious disease. Overall, only 32% and 27% of juniors and seniors are consumed sufficient dairy products, and 13% and 11% of juniors and seniors engaged in physical exercise, respectively. CONCLUSION: Osteoporosis misconceptions were extremely prevalent among PNU students, as was poor knowledge and lifestyle habits regarding osteoporosis. Information regarding osteoporosis presented through the media needs to be revised and simplified. Concerned institutions should combine their efforts eventually practice. Information about osteoporosis presented through media need to be revised, simplified, and implement a national program to improve osteoporosis awareness and prevention.

Interactions of Analgesics with Cisplatin: Modulation of Anticancer Efficacy and Potential Organ Toxicity.

Cisplatin (CDDP), one of the most eminent cancer chemotherapeutic agents, has been successfully used to treat more than half of all known cancers worldwide. Despite its effectiveness, CDDP might cause severe toxic adverse effects on multiple body organs during cancer chemotherapy, including the kidneys, heart, liver, gastrointestinal tract, and auditory system, as well as peripheral nerves causing severely painful neuropathy. The latter, among other pains patients feel during chemotherapy, is an indication for the use of analgesics during treatment with CDDP. Different types of analgesics, such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDS), and narcotic analgesics, could be used according to the severity of pain. Administered analgesics might modulate CDDP's efficacy as an anticancer drug. NSAIDS, on one hand, might have cytotoxic effects on their own and few of them can potentiate CDDP's anticancer effects via inhibiting the CDDP-induced cyclooxygenase (COX) enzyme, or through COX-independent mechanisms. On the other hand, some narcotic analgesics might ameliorate CDDP's anti-neoplastic effects, causing chemotherapy to fail. Concerning safety, some analgesics share the same adverse effects on normal tissues as CDDP, augmenting its potentially hazardous effects on organ impairment. This article offers an overview of the reported literature on the interactions between analgesics and CDDP, paying special attention to possible mechanisms that modulate CDDP's cytotoxic efficacy and potential adverse reactions.

Tutors and self-assessment of medical students' performance in pre-clinical problem-based learning tutorial sessions.

This article was migrated. The article was marked as recommended. Background: It is currently acknowledged that developing the skills in self-assessment is imperative for the continuing learning of every physician. Objective : This study aimed to assess students' performance in tutorial sessions in a hybrid problem-based learning (PBL) curriculum conducted during the pre-clinical years through self-and tutors assessment. Methods : Sixty nine first year and eighty second year students of the Bachelor of Medicine and Bachelor of Surgery (MBBS) Program at the Princess NourahBint Abdulrahman  University  participated in the study. Both self-and tutors assessment of students performance within the PBL tutorial setting was conducted using a validated questionnaire developed by Valle et al., (1999). Mean ratings between self-and tutors assessments were compared using paired t-test. Association between self and tutors  assessments  and PBL written exam scores was analyzed using Pearson correlation coefficients. Results: Results revealed a significant difference between self and tutors assessment for first year medical students under scoring their own performance than the tutors' with a total mean score of  79.99 (± 25.87) and 98.02 (± 8.71) respectively ( P=0.001).Tutors assessment correlated poorly with self-assessment (r=0.344). No correlation between self-assessment and exam scores was observed but a strong correlation  (r=0.726 & P=0.045) was shown for tutor assessment and exam scores. In contrast to the first year group, the total score showed no significant difference between self- and tutors assessment in second year students. There was strong correlation between tutor and self-assessment (r=0.722& P=0.041) as well as between tutor assessment and exam scores (r=0.806 & P=0.030 ) but not with self-assessment and exam scores. Conclusion: This study has presented reservations with regards to the use of self-assessment scores as part of the overall student grade in PBL.