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Cross-Sectional Studies, Health Knowledge, Attitudes, Practice, Humans, Parents, Patient Acceptance of Health Care, Vaccination, Social Media, and Vaccines

Vaccination has had tremendous impact on human health. The tendency to hesitate or delay vaccination has been increasing, which has contributed to outbreaks of vaccine-preventable diseases. This cross-sectional study aimed to investigate the prevalence of childhood vaccine hesitancy and social media misconceptions in vaccine refusal among randomly selected parents from October 2019 through March 2020 in the outpatient clinics of King Khalid University Hospital, Riyadh, Saudi Arabia. The data were collected using a three-part questionnaire: the socio-demographic and economic questions, the Parents' Attitudes about Childhood Vaccines (PACV) survey, and questions concerning social media use. Based on the PACV survey tool, 37 parents (11%) scored a value > 50 and were suggested as hesitant (8% hesitant and 3% very hesitant). Overall, 288 parents (89%) scored < 50, hence deemed to not be hesitant about childhood vaccination. There was no significant association between high educational level or social media exposure with vaccine hesitancy. The most commonly used social media platform was Twitter (40%). In conclusion, we report a low prevalence of vaccine hesitancy about childhood vaccination among parents, with no significant impact of education level or social media on vaccine hesitancy. Further studies are required to replicate these findings in other regions and cities to generalize these observations for Saudi Arabia.

diabetes, leptin, nanofibers, taurine, Pharmacy and materia medica, and RS1-441

Diabetes poses a high risk for debilitating complications in neural tissues, regulating glucose uptake through insulin-dependent and predominantly insulin-independent pathways. Supramolecular nanostructures provide a flexible strategy for combinatorial regulation of glycemia. Here, we compare the effects of free insulin to insulin bound to positively charged nanofibers comprised of self-assembling amino acid compounds (AACs) with an antioxidant-modified side chain moiety (AAC2) in both in vitro and in vivo models of type 1 diabetes. Free AAC2, free human insulin (hINS) and AAC2-bound-human insulin (AAC2-hINS) were tested in streptozotocin (STZ)-induced mouse model of type 1 diabetes. AAC2-hINS acted as a complex and exhibited different properties compared to free AAC2 or hINS. Mice treated with the AAC2-hINS complex were devoid of hypoglycemic episodes, had improved levels of insulin in circulation and in the brain, and increased expression of neurotransmitter taurine transporter, Slc6a6. Consequently, treatment with AAC2-hINS markedly advanced both physical and cognitive performance in mice with STZ-induced and genetic type 1 diabetes compared to treatments with free AAC2 or hINS. This study demonstrates that the flexible nanofiber AAC2 can serve as a therapeutic platform for the combinatorial treatment of diabetes and its complications.

Foreign bodies, Respiratory tract, Bronchoscopy, Tracheostomy, Case report, Otorhinolaryngology, and RF1-547

Aspiration of foreign body into the airway is a common emergency in pediatric population and has high risk of morbidity and mortality. Clinical presentation of foreign body aspiration varies between children. Some children may present to emergency department with acute life-threatening presentations that require immediate intervention, while others might have long term coarse of symptoms that were misdiagnosed and mistreated for long time. Variation of clinical presentations based on location of dislodged foreign body in the airway tree and size of the aspirated foreign body. Large impacted foreign body creates extra challenge and possible complications during attempt of retrieval via endoscopy alone. We report a case of large aspirated foreign body that had multiple failed attempts of endoscopic removal, and eventually retrieved using combined endoscopic and open approach without tracheostomy. This technique is safe and efficient in cases that failed conventional endoscopy due to large foreign body size.

With the emergence of Western posthuman understandings, new materialism, artificial intelligence (AI), and the growing acknowledgment of Indigenous epistemologies, an ongoing rethinking of existing assumptions and meanings about creativity is needed. The intersection of new technologies and philosophical stances that upend human-centered views of reality suggests that creativity is not an exclusively "human" activity. This opens new possibilities and assemblages for conceiving of creativity, but not without tensions. In this article, we connect multiple threads, to reimagine creativity in light of posthuman understandings and the possibilities for creative emergence beyond the Anthropocene. Creativity is implicated as emerging beyond non-human spaces, such as through digitality and AI or sources in the natural world. This unseats many understandings of creativity as positioned in Euro-Western literature. We offer four areas of concern for interrogating tensions in this area, aiming to open new possibilities for practice, research, and (re)conceptualization beyond Western understandings. [ABSTRACT FROM AUTHOR]

Arabs, Government, Humans, Lebanon epidemiology, Pandemics, Personal Satisfaction, SARS-CoV-2, and COVID-19 epidemiology

Background: Public acceptance of governmental measures are key to controlling the spread of infectious diseases. The COVID-19 pandemic has placed a significant burden on healthcare systems for high-income countries as well as low- and middle-income countries (LMICs). The ability of LMICs to respond to the challenge of the COVID-19 pandemic has been limited and may have affected the impact of governmental strategies to control the spread of COVID-19. This study aimed to evaluate and compare public opinion on the governmental COVID-19 response of high and LMICs in the Middle East and benchmark it to international countries.
Methods: An online, self-administered questionnaire was distributed among different Middle Eastern Arab countries. Participants' demographics and level of satisfaction with governmental responses to COVID-19 were analyzed and reported. Scores were benchmarked against 19 international values.
Results: A total of 7395 responses were included. Bahrain scored highest for satisfaction with the governmental response with 38.29 ± 2.93 on a scale of 40, followed by the Kingdom of Saudi Arabia (37.13 ± 3.27), United Arab Emirates (36.56 ± 3.44), Kuwait (35.74 ± 4.85), Jordan (23.08 ± 6.41), and Lebanon (15.39 ± 5.28). Participants' country of residence was a significant predictor of the satisfaction score (P < 0.001), and participants who suffered income reduction due to the pandemic, had a history of SARS-CoV-2 infection, and held higher educational degrees had significantly lower satisfaction scores (P < 0.001). When benchmarked with other international publics, countries from the Gulf Cooperation Council had the highest satisfaction level, Jordan had an average score, and Lebanon had one of the lowest satisfaction scores.
Conclusion: The political crisis in Lebanon merged with the existing corruption were associated with the lowest public satisfaction score whereas the economical instability of Jordan placed the country just before the lowest position. On the other hand, the solid economy plus good planning and public trust in the government placed the other countries of the Gulf Cooperation Council on top of the scale. Further investigation is necessary to find out how the governments of other low-income countries may have handled the situation wisely and gained the trust of their publics. This may help convey a clearer picture to Arab governments that have suffered during the pandemic.
(© 2022. The Author(s).)

Vascular fibrosis (VF) is one of the most significant pathologies related to blood vessel dysfunction. VF results in an impairment of vascular tone due to an increase in extracellular matrix proteins (ECM) and vascular smooth muscle synthesis within the vessel wall, thus increasing vascular stiffness and reducing lumen diameter. VF is both caused by and exacerbates numerous vascular diseases including diabetes, atherosclerosis and in particular, hypertension, which accounts for 13% of deaths globally (WHO World Health Report, 2002). Multiple studies have investigated various therapeutic approaches to interfere with VF, but to date this condition remains untreated, thus novel approaches to target fibrosis development and progression are urgently required. Our lab identified the transcription factor scleraxis as a novel master regulator of cellular phenotype conversion. We demonstrated that scleraxis is sufficient to induce fibroblast to myofibroblast phenotype conversion, a critical step in the development of fibrosis in many tissue types. Scleraxis also induces Epithelial to Mesenchymal Transition (EMT) and cell migration as part of development and cell differentiation. Some studies have shown that mechanical stretch in tendons increases expression of scleraxis, while additional studies reported that stretch in rabbit aorta induces the vascular smooth muscle proliferative phenotype. Our preliminary data has revealed that scleraxis is expressed in VSMCs in the arterial wall, and we have found elevated scleraxis expression in high pressure versus low pressure regions of vessels. We thus hypothesize that scleraxis is sufficient and necessary to induce vascular fibrosis. Our data shows that scleraxis overexpression increases thickness of the aortic vascular wall in scleraxis overexpression mice, via histological sections, thus contributing to the progression of vascular fibrosis. In vitro studies show that scleraxis overexpression in Human Aortic Smooth Muscle Cells (HAOSMC) induces their proliferation and migration using different assays (CCk8/Edu+ proliferation assay, Transwell migration assay, gene expression assays). Scleraxis overexpression also induces hypertrophy of HAOSMC shown via immunostaining. This suggests that scleraxis overexpression induces VSMC plasticity from contractile to synthetic-proliferative phenotype, thus inducing VSMC hyperplasia. New & Noteworthy: Our findings indicate that scleraxis plays a role in VSMC plasticity via scleraxis- mediated transcriptional regulation of VSMC proliferation and migration. This work has potential relevance to many related diseases that feature VSMC activation, including atherosclerosis and restenosis.
(© FASEB.)

Adolescent, Humans, Longitudinal Studies, Risk, Prodromal Symptoms, and Psychotic Disorders diagnosis

Having a first-degree relative with a psychotic disorder increases an individual's risk for developing psychosis to 10% compared to 1% in the general population. The impact of being at family high-risk for psychosis (FHR) has been examined in samples of youth who are at clinical high-risk for psychosis (CHR). The second North American Prodrome Longitudinal Study (NAPLS-2) identified very few clinical differences between CHR individuals with and without FHR. This paper aims to confirm these results in a new CHR sample, NAPLS-3. The NAPLS-3 sample consisted of 703 CHR participants, of whom 82 were at FHR (CHR+FHR), and 621 were not (CHR+FHRneg). The Family Interview for Genetic Studies was used to determine the presence of a first-degree relative with a psychotic disorder. The groups were compared on social and role functioning, positive and negative symptoms, IQ, cannabis use, and trauma. At baseline, the CHR+FHR group reported a statistically significant increased severity of positive and negative symptoms, lower IQ scores, and increased reports of trauma, psychological and physical abuse. There were no differences in transition rates between the two groups. This study supports some of the already reported differences in trauma, physical and psychological abuse between CHR individuals with and without FHR.
(Copyright © 2022. Published by Elsevier B.V.)

IBV infection may lead to reduced egg production and poor egg quality in layer flocks. The DMV/1639 strain was recently identified as one of the most dominant IBV variants isolated from Canadian layer flocks with egg production problems. The current study aimed to investigate the immunopathogenesis of the Canadian DMV/1639 strain in laying chickens. Specific-pathogen-free (SPF) layers were infected at the peak of lay (29 weeks; n = 10) with an uninfected control group (n = 10). Egg production in the infected group dropped to 40% by the fifth day post-infection (dpi). Five birds from the infected and the control groups were euthanized at 5 and 10 dpi. Ovarian regression and shortened oviduct with marked histopathological changes were observed in the infected group at 10 dpi. An increase in the IBV viral load in reproductive tissues was accompanied by a significant recruitment (p < 0.05) of KUL01+ macrophages and CD4 + and CD8 + T cell subsets at 10 dpi. Additionally, anti-IBV antibody response was detected in serum and locally in the reproductive tract washes of the infected group. Overall, our findings contribute to the understanding of the pathogenicity of the Canadian DMV/1639 strain and the subsequent host responses in the reproductive tract of chickens.
(Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Attitude, Female, Humans, Mental Health, Social Stigma, Islam psychology, and Mental Health Services

Background: The underutilization of mental health services is a recognized problem for the growing number of Muslims living in the West. Despite their unique mental health risk factors and the pivotal role they play in determining mental health discourse in their families and in society, Muslim women in particular have not received sufficient study.
Aim: To help remedy this research gap, we examined factors that may impact the rejection attitudes of Muslim women toward professional mental health care using the first psychometrically validated scale of its kind; the M-PAMH (Muslims' Perceptions and Attitudes to Mental Health).
Methods: A total of 1,222 Muslim women responded to questions about their cultural and religious beliefs about mental health, stigma associated with mental health, and familiarity with formal mental health services in an anonymous online survey.
Results: Hierarchical multiple regression analysis revealed that higher religious and cultural beliefs, higher societal stigma, and lower familiarity with professional mental health services were associated with greater rejection attitudes toward professional mental healthcare. The final model was statistically significant, F (5, 1,216) = 73.778; p  < .001, and explained 23% of the variance in rejection attitudes with stigma accounting for the most (12.3%) variance, followed by cultural and religious mental health beliefs (6%), and familiarity with mental health services (2.7%).
Conclusions: Findings suggest that although the examined factors contributed significantly to the model, they may not be sufficient in the explanation of Muslim women's rejection attitudes toward mental health services. Future research may explore additional variables, as well as predictive profiles for Muslim women's perceptions and attitudes of mental health based on a combination of these factors.

Government, Perception, Middle East, Arab countries, COVID-19, Level of satisfaction, Public aspects of medicine, and RA1-1270

Abstract Background Public acceptance of governmental measures are key to controlling the spread of infectious diseases. The COVID-19 pandemic has placed a significant burden on healthcare systems for high-income countries as well as low- and middle-income countries (LMICs). The ability of LMICs to respond to the challenge of the COVID-19 pandemic has been limited and may have affected the impact of governmental strategies to control the spread of COVID-19. This study aimed to evaluate and compare public opinion on the governmental COVID-19 response of high and LMICs in the Middle East and benchmark it to international countries. Methods An online, self-administered questionnaire was distributed among different Middle Eastern Arab countries. Participants’ demographics and level of satisfaction with governmental responses to COVID-19 were analyzed and reported. Scores were benchmarked against 19 international values. Results A total of 7395 responses were included. Bahrain scored highest for satisfaction with the governmental response with 38.29 ± 2.93 on a scale of 40, followed by the Kingdom of Saudi Arabia (37.13 ± 3.27), United Arab Emirates (36.56 ± 3.44), Kuwait (35.74 ± 4.85), Jordan (23.08 ± 6.41), and Lebanon (15.39 ± 5.28). Participants’ country of residence was a significant predictor of the satisfaction score (P

Fibrosis is an energy-intensive process requiring the activation of fibroblasts to myofibroblasts, resulting in the increased synthesis of extracellular matrix proteins. Little is known about the transcriptional control of energy metabolism in cardiac fibroblast activation, but glutaminolysis has been implicated in liver and lung fibrosis. Here we explored how pro-fibrotic TGFβ and its effector scleraxis, which drive cardiac fibroblast activation, regulate genes involved in glutaminolysis, particularly the rate-limiting enzyme glutaminase (GLS1). The GLS1 inhibitor CB-839 attenuated TGFβ-induced fibroblast activation. Cardiac fibroblast activation to myofibroblasts by scleraxis overexpression increased glutaminolysis gene expression, including GLS1, while cardiac fibroblasts from scleraxis-null mice showed reduced expression. TGFβ induced GLS1 expression and increased intracellular glutamine and glutamate levels, indicative of increased glutaminolysis, but in scleraxis knockout cells, these measures were attenuated, and the response to TGFβ was lost. The knockdown of scleraxis in activated cardiac fibroblasts reduced GLS1 expression by 75%. Scleraxis transactivated the human GLS1 promoter in luciferase reporter assays, and this effect was dependent on a key scleraxis-binding E-box motif. These results implicate scleraxis-mediated GLS1 expression as a key regulator of glutaminolysis in cardiac fibroblast activation, and blocking scleraxis in this process may provide a means of starving fibroblasts of the energy required for fibrosis.

Adult, Aged, Data Analysis, Female, Humans, Male, Middle Aged, Basal Ganglia Hemorrhage diagnosis, Basal Ganglia Hemorrhage epidemiology, Basal Ganglia Hemorrhage therapy, Hypertension complications, Hypertension diagnosis, and Hypertension epidemiology

Background: Spontaneous simultaneous bilateral basal ganglia hemorrhage (SSBBGH) is an extremely rare condition with only a few published case reports and series. However, there is no systematic review that has been published yet.
Objective: The study aims to conduct a systematic review on spontaneous simultaneous bilateral basal ganglion bleeding and a descriptive statistical analysis of collected data on epidemiology, clinical features, etiology, therapeutic approach and prognosis. This review aims to be a clinical reference for busy clinicians when they are faced with such a rare condition.
Methodology: This review has been carried out in accordance with recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
Results: Review of 60 cases showed that SSBBGH affected predominantly male patients (70%) with an average age of 50.8 ± 15.33 years and the male-to-female ratio was 2.5:1. The female patients tend to be older with an average age of 54.22 ± 16.67 years. Location of SSBBGHwas more common in the putamen (90% vs 10% non-putaminal). SSBBGH posed a significant mortality rate (33.33%). Among patients who survived, only 40.6% (13/32 report) have had favorable outcomes (mRS ≤2) and the remaining 59.4% (19/32) ended up with poor functional status (mRS ≥3-5). The most common implicated etiologies were hypertension followed by alcohol intoxication.
Conclusion: SSBBGH is a rare clinical entity with significant morbidity and mortality. Systemic approach can lead to early recognition of etiology and prompt treatment. Hypertension and the putamen are the most common etiology and location of SSBBGH, respectively. History of hypertension and age can help narrow differential diagnosis and limit unnecessary testing or intervention.
(© 2022 Alhashim et al.)

Introduction: The onset of the COVID-19 pandemic resulted in governments implementing new regulations to divert healthcare resources, which in return led to the postponement of elective and semi-elective surgical procedures. Henceforth, many surgeons and surgeons in training reported feeling redundant, which ultimately resulted in psychological distress. This study aims to assess the psychological impact resulting from the COVID-19 pandemic and outline the effect it had on surgical training.
Methods: The following study is a cross-sectional study conducted in Kuwait. Data was collected by distributing a questionnaire to surgeons and surgeons in training electronically. The survey included questions aimed at assessing both the effect of the pandemic on surgical training and the psychological impact it had on surgeons, assessing the latter using the DASS-21 screening tool.
Results: The response rate for the following study was 52%, with the majority being junior male surgeons. The majority of surgeons in training reported postponement of their scheduled academic teaching sessions and pre-assigned surgical rotations, 78.9% and 65.8% respectively. In terms of the psychological impact of the pandemic, the majority of the participants reported an element of depression and stress, 61.2% and 55%, respectively, while approximately half, 48.1%, had symptoms associated with anxiety.
Conclusion: The COVID-19 pandemic had a negative effect on the psychological well-being of a significant proportion of surgeons and associated surgical training programs.
(The Author(s). Published by S. Karger AG, Basel.)