Cronobacter sakazakii is associated with severe and often fatal cases of infant meningitis and necrotizing enterocolitis. The form of meningitis differs from that due to Neisseria meningitidis and Streptococcus spp., in that it is highly invasive and destructive towards human brain cells. However, there is relatively little understanding of the cytopathogenic interaction of C. sakazakii with host cells which results in stimulation of an inflammatory immune response. The production of Cronobacter outer membrane vesicles (OMV) and their potential pathogenic functions have not yet been elucidated. This study is the first to show that C. sakazakii produce OMV, which may play a role in the activation of cytopathogenic and host cell responses on human intestinal epithelial cells. Cronobacter sakazakii strain 767 was used which had been isolated from a fatal outbreak of neonatal meningitis and necrotizing enterocolitis. Cronobacter sakazakii OMV were internalized by Caco-2 cells, increased cell proliferation and stimulated the host's innate proinflammatory response without inducing overt toxicity. A total of 18 OMV-associated proteins were identified by mass spectrometry and their potential pathogenicity roles were evaluated. Collectively, these data indicate that C. sakazakii OMV could play a role in pathogenesis by delivering bacterial toxins into host epithelial cells, driving proliferative and proinflammatory responses.

Background. Only few studies have investigated the prevalence and risk factors of headaches among the Saudi population. The study aimed to estimate the prevalence of headache and to explore its associated risk factors Al-Kharj, Saudi Arabia. Methods. The multistage sampling technique was used to enroll 1200 population-based participants who were asked to complete a self-administered questionnaire about headaches, demographics, and several other parameters such as smoking status and different chronic and psychological illnesses. The chi-square test and multivariate logistic regression analysis were used to test the association. Results. The overall prevalence of headaches in this study was 3%. The multiple logistic regression analysis showed that females were more likely to have headaches than males (odds ratio (OR) 0.735, 95% confidence interval (CI) = 0.612–1.341; P = 0.024 ). Being a current smoker was also significantly associated with higher “odds” of having headache (OR = 1.319, 95% CI = 0.932–2.462; P = 0.037 ). Participants who were overweight had a significantly higher risk of headache (OR = 1.631, 95% CI = 1.48–1.854; P = 0.037 ). Nonmarried people were significantly more likely to have headache pain, compared to married individuals (OR = 0.875, 95% CI = 0.646–2.317; P = 0.047 ). Conclusion. The prevalence of headaches was 3%, and four significant associated factors were identified: females, nonmarried, smoking, and overweight. The temporality of the relationship between these factors and headache cannot be confirmed in this cross-sectional study; so future longitudinal studies are needed to confirm these potential causal relationships.

BackgroundPsychological distress/morbidity is amongst the primary reason for the cause of pain at multiple sites, its progression, and recovery. Though still not very clear if physical pain in the neck or the back may predict psychological morbidities or not. Thus, we investigated the association between combined neck or back pain and psychological distress/morbidity.MethodsA cross-sectional study was conducted in Al-Kharj, Saudi Arabia, including 1,003 individuals. The questionnaire comprised of General Health Questionnaire-12 (GHQ-12) and some questions about neck and back pain. Data analysis was done using statistical software SPSS version 26.0.ResultsThe results of the multivariate analysis revealed a significant positive association between neck/back pain status and total GHQ score (unstandardized Beta = 2.442, P ≤ 0.0001). Having neck/back pain had almost a 2.5 times greater risk of psychological distress/morbidity. Further, females were more likely to have a higher risk of psychological distress/morbidity (unstandardized Beta = 1.334, P = 0.007) than males while adjusting for sociodemographic and clinical characteristics.ConclusionThe combination of neck and back pain was significantly associated with the Saudi population’s psychological problems. Therefore, the Saudi government needs to devise high-risk strategies and allocate adequate resources to the cause so that at-risk people can be shielded from the adverse complications arising from this condition in the long run.

AbstractDietary inorganic nitrate has been shown to lower blood pressure (BP) and improve endothelial function(1). The main sources of dietary nitrate are vegetables (root and green leafy varieties) as well as drinking water but data available on dietary analysis software on nitrate levels in vegetables and vegetable-based foods is very limited. To date, very few studies have investigated the relationship between the level of consumption of dietary nitrate on BP and other cardiovascular disease (CVD) risk factors in a representative UK population. The aim of the study was to address this knowledge gap using data from the National Diet and Nutrition Survey (NDNS) years 1–8, a cross-sectional study conducted in 3339 men and women aged 19–64 y between 2008/09–2011/12. A comprehensive database was first developed to evaluate the nitrate and nitrite levels in vegetables, cured meats and composite dishes to more accurately estimate the dietary nitrate intakes of the NDNS participants. The population was then classified into quartiles of daily nitrate intake, with quartile 1 (Q1: 26–106 mg/d) and quartile 4 (Q4: 183–559 mg/d) representing diets with the lowest and highest intakes, respectively. ANCOVA analysis was performed to determine the relationship between the level of daily nitrate intake with available data on biomarkers of CVD risk (including BP (systolic, diastolic and pulse pressure), lipid profile, (total, high-density lipoprotein and low-density lipoprotein (LDL-C) cholesterol), C-reactive protein, anthropometric measures (body mass index and waist to hip ratio) and glycaemic control (glucose and glycated haemoglobin). There were significant differences in systolic (P-trend = 0.008) and diastolic (P-trend = 0.025) BP across increasing quartiles of dietary nitrate intake, with BP significantly lower in Q3 than all other quartiles. Pulse pressure (calculated as systolic–diastolic BP) was also found to be significantly different across quartiles (P-trend = 0.001), with diets of participants in Q3 and Q4 being associated with significantly lower pulse pressures than those in Q1 (P-Q1 vs. Q3 = 0.005, P-Q1 vs. Q4 = 0.007). All of the other CVD risk markers were not different between quartile groups. Our preliminary results suggest that the level of dietary nitrate intake may be significantly associated with BP, a key independent CVD risk factor. There is an urgent need to more accurately estimate the dietary nitrate intake in the UK population and to determine whether the source of dietary nitrate (vegetables vs cured meats) impacts on the significant relationship with BP.

Objective Since 2010, simulation-based learning has become increasingly popular as a well-recognized method of learning used by medical undergraduates in clinical settings. However, the relatively new concept of simulation-based peer-assisted learning has not yet been widely accepted, so it has not been well documented. Therefore, this study evaluated the perceived advantages of simulation-based peer-assisted learning among health professions students and interns and their acceptance of this new concept of learning from a student-instructor. Methods This was a pilot study conducted with 11 students in various health profession fields at Princess Nourah bint Abdulrahman University (PNU). The students were given a comprehensive lecture on simulation scenario development and were assigned to four separate interdisciplinary teams for a practical session on simulation scenario writing. Then, they each completed a questionnaire seeking their opinion concerning their experience and concept understanding. Results The results confirmed the advantages of interprofessional simulation-based peer-assisted learning as it helped in understanding the process as perceived by the study participants. All students expressed their willingness and enthusiasm to use simulation as a technique for peer-assisted learning. Conclusion The study affirms the importance of developing student teachers’ teaching skills at an institutional level. The future implementation of simulation-based peer-assisted learning is dependent on the students’ awareness of the concept. By exploring a new dimension of medical education, the student teachers could expand their horizon of exposure to holistic case management and interactive learning and equip themselves with practical communication skills to excel in a real-world setting.