Association of Awake Bruxism with Khat, Coffee, Tobacco, and Stress among Jazan University Students

Objective. The objective is to assess the prevalence of bruxism among the university students and to check its association with their khat chewing habit. Materials and Methods. A cross-sectional descriptive study is designed using cluster random sampling. Pretested questionnaire was administered by a trained interviewer to assess awake bruxism and the use of variables like khat, coffee, tobacco, and stress. Chi-square test at 5% significance was used for assessing the association. Logistic regression was also performed after adjusting for covariates. Results. A high response rate (95%) was obtained as the distribution and collection of questionnaire was within an hour interval. 85% (63%, males; 22%, females) experienced an episode of bruxism at least one time in the past six months. Regression analysis revealed an association of stress (P=0.00; OR = 5.902, 95% CI 2.614–13.325) and khat use (P=0.05; OR = 1.629, 95% CI 0.360–7.368) with bruxism. Interestingly, it is observed that the one who chew khat experienced 3.56 times (95% CI; 2.62–11.22) less pain when compared to the nonusers. Conclusion. This study is the first of its kind to assess the association of bruxism with khat chewing. High amount of stress and khat use can be considered as important risk indicators for awake bruxism

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Czynniki ryzyka daremnej tracheostomii: analiza bazy danych NIS

INTRODUCTION: Respiratory insufficiency and failure are leading causes of ICU admissions. Advances in medical technology allow prolonging of survival in critical illnesses. Hence, more tracheostomies are being performed. However, we are limited in predicting who may actually benefit. Our goal was to determine prognostic indicators of early mortality after tracheostomy in order to avoid futile procedures. MATERIAL AND METHODS: We performed a retrospective cohort study utilizing the National Inpatient Sample (NIS) database on all adults who underwent tracheostomy between 2005 and 2015. We defined futile tracheostomy as death within 30 days post tracheostomy during the same hospital admission. Univariate and multivariate testing were performed on the weighted dataset. Odds ratios (OR) were calculated with multivariate logistic regression testing. RESULTS: 851,020 cases met the inclusion criteria. Rate of futility was 12.4% (n=105,658). Total hospitalization cost was greater in the futile group as compared to non-futile group. On Multivariate testing, male gender, age greater than 65, 3 Elixhauser mortality index categories, Asian/Pacific Islander and other race, self-pay and no charge insurance, septicemia and mechanical ventilation greater than 96 hours were independent risk factors to predict futility. Among these, septicemia was the greatest risk for futility (OR 2.32), followed by Elixhauser mortality index >10 (OR 1.954), and Elixhauser mortality index between 3 and 10 (OR 1.468). CONCLUSIONS: Between 2005 and 2015, 12.4% of tracheostomies could be considered futile. Targeted efforts are needed to decrease the number of unnecessary procedures in the critically ill. We should consider the identified risk factors to share more informed discussions with patients and families to set better long-term expectations and realistic goals for care.WSTĘP: Zapaść krążeniowa i niewydolność oddechowa są głównymi przyczynami przyjęć na OIT. Postęp technolgii w medycynie pozwala na przedłużenie życia w stanach krytycznych. W związki z tym wykonuje się więcej zabiegów tracheostomii. Jednak istnieją ograniczenia w określeniu kto powinien być faktycznie poddany zabiegowi. Celem autorów było określenie prognostycznych wskaźników wczesnej śmiertelności po tracheostomii, aby uniknąć daremnych zabiegów. MATERIAŁ I METODY: Przeprowadzono retrospektywne badanie kohortowe z wykorzystaniem National Inpatient Sample (NIS) - bazy danych osób dorosłych, którzy przeszli tracheostomię w latach 2005–2015. Daremną tracheostomię określilono jako śmierć w ciągu 30 dni po tracheostomii podczas tego samego przyjęcia do szpitala. Testy jednowymiarowe i wielowymiarowe były przeprowadzane na ważonym zbiorze danych. Ilorazy szans (OR) obliczono za pomocą wieloczynnikowych testów regresji logistycznej. WYNIKI: 851,020 przypadków spełniło kryteria włączenia. Wskaźnik daremności wyniósł 12.4% (n = 105,658). Całkowity koszt hospitalizacji był większy w grupie daremnej w porównaniu z grupą nie-daremną. W testach wielowymiarowych, płeć męska, wiek powyżej 65, trzy kategorie wskaźnika śmiertelności Elixhausera, rasy azjatyckie / wyspiarskie i inne rasy, samodzielne i bezpłatne ubezpieczenie, posocznica i wentylacja mechaniczna dłuższa niż 96 godzin były niezależnymi czynnikami ryzyka, które wskazywały na daremność. Pośród tych przypadków posocznica była największym ryzykiem daremności (OR 2.32), a następnie wskaźnik śmiertelności Elixhausera > 10 (OR 1.954), oraz Wskaźnik śmiertelności Elixhausera między 3 a 10 (OR 1.468). WNIOSKI: W latach 2005-2015 12.4% tracheostomii można uznać za daremne. Ukierunkowane wysiłki są potrzebne do zmniejszenia liczby niepotrzebnych zabiegów u osób w stanie krytycznym. Powinniśmy wziąć pod uwagę zidentyfikowane czynniki ryzyka, aby dzielić się bardziej świadomymi dyskusjami z pacjentami i rodzinami w celu ustalenia lepszych i realistycznych długoterminowych oczekiwań opieki

Association of Awake Bruxism with Khat, Coffee, Tobacco, and Stress among Jazan University Students

Objective. The objective is to assess the prevalence of bruxism among the university students and to check its association with their khat chewing habit. Materials and Methods. A cross-sectional descriptive study is designed using cluster random sampling. Pretested questionnaire was administered by a trained interviewer to assess awake bruxism and the use of variables like khat, coffee, tobacco, and stress. Chi-square test at 5% significance was used for assessing the association. Logistic regression was also performed after adjusting for covariates. Results. A high response rate (95%) was obtained as the distribution and collection of questionnaire was within an hour interval. 85% (63%, males; 22%, females) experienced an episode of bruxism at least one time in the past six months. Regression analysis revealed an association of stress (P=0.00; OR = 5.902, 95% CI 2.614–13.325) and khat use (P=0.05; OR = 1.629, 95% CI 0.360–7.368) with bruxism. Interestingly, it is observed that the one who chew khat experienced 3.56 times (95% CI; 2.62–11.22) less pain when compared to the nonusers. Conclusion. This study is the first of its kind to assess the association of bruxism with khat chewing. High amount of stress and khat use can be considered as important risk indicators for awake bruxism

Social anxiety disorder and its impact in undergraduate students at Jazan University, Saudi Arabia

Although social anxiety disorder (SAD) is a common mental disorder, it is often under diagnosed and under treated. The aim of this study is to assess the prevalence, severity, disability, and quality of life towards SAD among students of Jazan University, Saudi Arabia. A cross-sectional study was conducted among a stratified sample of 500 undergraduate students to identify the prevalence of SAD, its correlates, related disability, and its impact on the quality life. All participants completed the Social Phobia Inventory, Leibowitz Social Anxiety Scale, Sheehan Disability Scale, and the WHO Quality of Life – BREF questionnaire. Of 476 students, 25.8% were screened positive for SAD. About 47.2% of the students had mild symptoms, 42.3% had moderate to marked symptoms, and 10.5% had severe to very severe symptoms of SAD. Students who resulted positive for SAD reported significant disabilities in work, social, and family areas, and this has adversely affected their quality of life as compared to those who screened negative for SAD. Students reported several clinical manifestations that affected their functioning and social life. Acting, performing or giving a talk in front of an audience was the most commonly feared situation. Blushing in front of people was the most commonly avoided situation. Since the present study showed a marked prevalence of SAD among students, increased disability, and impaired quality of life, rigorous efforts are needed for early recognition and treatment of SAD

Prevalence of insomnia and relationship with depression, anxiety and stress among Jazan University students: A cross-sectional study

Insomnia, a common sleep disorder, is a public health concern, as it can lead to physical and mental exhaustion. The objective of this study was to determine the prevalence of insomnia and the common associated risk factors among students at Jazan University, in the Jazan region of southwestern Saudi Arabia. An observational cross-sectional study was conducted among a sample of 712 students. A pre-designed, structured questionnaire was used to collect the relevant information pertaining to the study variables. The overall prevalence of insomnia in the study was 19.3%. There was no significant difference in prevalence between males and females (p-value = 0.5). Participants from health colleges had greater prevalence of insomnia than those from art and Islamic colleges and science colleges (p-value = 0.03). Symptoms of depression, anxiety, and stress were significant risk factors for insomnia (p-value = 0.005, 0.000, 0.000, respectively). Insomnia is widely prevalent among Jazan University students. Symptoms of depression, anxiety, and stress, together with a noisy environment around the sleeping area, are important correlates. Screening for mental illnesses among university students is highly recommended

Antiviral and Antifungal of Ulva fasciata Extract: HPLC Analysis of Polyphenolic Compounds

The increasing usage of chemical control agents, as well as fungicides to manage plant diseases, causes human and environmental health problems. Macroalgae represent a reservoir for a tremendous variety of secondary metabolites that display a wide range of biological activities. However, their anti-phytopathogenic properties are still being studied. The current study was conducted to investigate whether or not the macroalgae Ulva fasciata extract exhibits antifungal and antiviral activities. In this regard, the organic extracts of U. fasciata were tested for their capabilities against tobacco mosaic virus (TMV) and three molecularly identified fungal isolates, Fusarium verticillioides, Alternaria tenuissima, and Botrytis cinerea with accession numbers OP363619, OP363620, and OP363621, respectively. Among the three tested extract concentrations, 100 µg/mL had the best biological activity against B. cinerea and TMV, with 69.26%and 81.25% inhibition rates, respectively. The HPLC analysis of chemical profiling of the extract showed the presence of a number of phenolic and flavonoid compounds widely known to display many biological activities. In this line, the 4-Hydroxybenzoic acid was the highest phenolic compound (12.3 µg/mL) present in the extract, followed by ferulic acid (9.05 µg/mL). The 7-hydroxyflavone (12.45 µg/mL) was the highest flavonoid in the organic extract of U. faciata followed by rutin, which recorded a concentration of 7.62 µg/ mL. The results of this study show that the U. fasciata extract has antiviral and antifungal properties, which makes it a possible source of natural antimicrobial agents

Antifungal, Antiviral, and HPLC Analysis of Phenolic and Flavonoid Compounds of <i>Amphiroa anceps</i> Extract

The increasing use of chemical control agents and pesticides to prevent plant disease has resulted in several human and environmental health problems. Seaweeds, e.g., Amphiroa anceps extracts, have significant antimicrobial activities against different human pathogens. However, their anti-phytopathogenic activities are still being investigated. In the present investigation, three fungal isolates were isolated from root rot and grey mold symptomatic strawberry plants and were molecularly identified by ITS primers to Fusarium culmorum, Rhizoctonia solani, and Botrytis cinerea with accession numbers MN398396, MN398398, and MN398400, respectively. In addition, the organic extract of the red alga Amphiroa anceps was assessed for its antifungal activity against the three identified fungal isolates and tobacco mosaic virus (TMV) infection. At 100 µg/mL, the A. anceps extract had the best biological activity against R. solani, B. cinerea, and TMV infection, with inhibition rates of 66.67%, 40.61%, and 81.5%, respectively. Contrarily, the A. anceps extract exhibited lower activity against F. culmorum, causing inhibition in the fungal mycelia by only 4.4% at the same concentration. The extract’s HPLC analysis revealed the presence of numerous phenolic compounds, including ellagic acid and gallic acid, which had the highest concentrations of 19.05 and 18.36 µg/mL, respectively. In this line, the phytochemical analysis also showed the presence of flavonoids, with the highest concentration recorded for catechin at 12.45 µg/mL. The obtained results revealed for the first time the effect of the A. anceps extract against the plant fungal and viral pathogens, making the seaweed extract a promising source for natural antimicrobial agents