Vitamin D and Hypoxia-Inducible Factor (HIF-1α) Serum Levels as Markers for Progression of Nephropathy in Type 2 Diabetic Patients.

BACKGROUND: Vitamin D is a locally acting hormone, which plays a major role in skeletal health. Previous studies reported an important role of vitamin D in modulation of inflammatory response. We aimed to investigate the role of vitamin D deficiency and hypoxia-inducible factor (HIF-1α) as markers for the progression of diabetic nephropathy in Saudi patients with type 2 diabetes mellitus (T2DM). METHODS: We included 174 Saudi patients with T2DM in addition to 60 healthy control subjects. Patients were classified according to urinary Albumin to Creatinine Ratio (ACR) into three groups: Group AI: ACR < 30 µg/mg, Group AII: ACR levels of 30 - 300 µg/mg and Group AIII: ACR > 300 µg/mg. We estimated fasting blood glucose, HbA1c, lipid profile, serum creatinine, hemoglobin concentration (Hb), estimated glomerular filtration rate (eGFR), urine albumin/creatinine ratio, serum 25 hydroxyvitamin D, calcium, parathyroid hormone (PTH), tumor necrosis factor (TNF-α), C- reactive protein (CRP), and hypoxia-inducible factor (HIF-1α). RESULTS: There was a significant difference among studied groups regarding serum levels of vitamin D, calcium, PTH, TNF-α, CRP, and HIF-1α levels. The level of vitamin D was lower in diabetic patients in comparison to the controls and was significantly related to the severity of renal nephropathy as indicated by the level of albumin in urine. Moreover, vitamin D levels showed significant negative correlation with the inflammatory markers: TNF-α, CRP, and HIF-1α levels. CONCLUSIONS: Vitamin D deficiency and elevated HIF-1α serum levels showed a significant correlation to progression of nephropathy in Saudi patients with T2DM.

Association of Vitamin D Deficiency, Dyslipidemia, and Obesity with the Incidence of Coronary Artery Diseases in Type 2 Diabetic Saudi Patients.

BACKGROUND: Diabetes mellitus type 2 (T2DM) is a chronic metabolic disease associated with vascular complications. We aimed to evaluate the relationship of vitamin D deficiency, dyslipidemia, and obesity with the incidence of coronary artery disease in type 2 diabetes mellitus. METHODS: The study included 200 Saudi adult subjects, aged 40 - 60 years, of both genders, attending King Abdulaziz Specialist Hospital in Taif city. Subjects were divided into four groups; 50 subjects each: Control group, type 2 diabetic, type 2 diabetic with coronary artery disease, and type 2 diabetic obese patients having body mass index (BMI) ≥ 30 kg/m2. Serum vitamin D (25-OH-D), fasting blood glucose (FBG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), and glycosylated hemoglobin (HbA1c) levels were estimated. RESULTS: Serum vitamin D and HDL-C in the three diabetic patient groups were significantly decreased (p < 0.001) compared to the control group. Among patient groups, the levels in the diabetic coronary and diabetic obese patients were significantly decreased as compared to the diabetic patient group (p < 0.001). FBG levels, HbA1c%, TC, TG, LDL-C levels, and BMI in all diabetic patient groups were significantly higher (p < 0.001) in comparison to control. Significant negative correlations were observed between serum vitamin D and FBG, HbA1c%, TC, TG, LDL-C levels, and BMI whereas positive correlations with HDL-C in all diabetic patient groups. CONCLUSIONS: The deficiency status of 25-OH-D is associated with dyslipidemia in type 2 Saudi diabetic patients, specifically those complicated with obesity and coronary artery diseases.

Seroprevalence of IgM and IgG Against SARS-CoV-2 after Two Doses of Pfizer-BioNTech COVID-19 Vaccine in Women with Breast Cancer.

BACKGROUND: This study evaluates the seroprevalence of immunoglobulin M (IgM) and G (IgG) antibodies against SARS-CoV-2 after two doses of Pfizer-BioNTech COVID-19 vaccination from women with breast cancer in Jazan city Kingdom of Saudi Arabia, antibody detections were performed one month and three months after the administration of the second dose. METHODS: Overall, 103 breast cancer patients were included. Individuals who had had two doses of Pfizer-BioNTech vaccine, patients who were earlier diagnosed with COVID-19 infection, had not finalized immunization plan, or who received the second dose recently were excluded from the study. The antibodies detection test was run according to the manufacturer's directions of Viva Diag™ SARS-CoV-2 IgM/IgG Rapid Test (COVID-19 IgM/IgG Rapid Test). RESULTS: This study included 62 (60.2%) and 41 (39.8%) patients with invasive ductal carcinoma and invasive lobular carcinoma, respectively. The age, median and interquartile range (IQR) was 54.0 (26) years. Regarding reactivity of antibodies, after one month IgM antibody showed 64 (62.1%) positive and 39 (37.9%) negative while IgG antibody showed positive results in all patients. After three months IgM antibody showed 44 (42.7%) positive and 59 (57.3%) negative, while IgG showed 87 (84.5%) positive and 16 (15.5%) negative. There were significant differences in the IgM and IgG seropositivity. There were 19.3% patients with ductal carcinoma who were positive and then turned negative versus 17.7% who were positive and then turned negative, respectively (p < 0.001). There were significant differences in IgM antibody positivity among different age groups. CONCLUSIONS: Our results recommend the importance of screening for an antibody response for breast cancer patient after immunization in order to reveal persons who need early and late extra enhancing vaccine dose. Upcoming studies recommended to estimate different methods that raise cancer patients' immune response.

Cross-cultural adaptation and validation of the Arabic version of oxford ankle foot questionnaire for children.

PURPOSE: The purpose of this study was to translate and cross-culturally adapt the original English version of the Oxford Ankle Foot Questionnaire (OxAFQ-c) into the Arabic language, and to evaluate its psychometric properties among Arabic speaking children aged from 5 to 16 years in Saudi Arabia. MATERIALS AND METHODS: An Arabic OxAFQ-c for children was developed according to established guidelines (ISPOR). The Arabic OxAFQ-c version was completed by eighty-seven patients with foot and ankle problems and their caregivers. Construct validity of the Arabic OxAFQ-c was also examined. RESULTS: The reliability analysis of OxAFQ-Ar exhibited good internal consistency in both children's and parent's versions for all domains (α = 0.80-0.89) and excellent test-retest reliability in both versions for all domains. (ICC = 0.87-0.94). A moderate correlation between the OxAFQ-Ar and PedsQL 4.0 was observed indicating moderate construct validity. CONCLUSIONS: The OxAFQ-c was successfully translated and cross-cultural adapted into the Arabic language. The OxAFQ-Ar is a valid, reliable and useful quality of life questionnaire for evaluating children's ankle foot problems.IMPLICATION OF REHABILITATION OF OxAFQ-c ARABIC VERSIONThe Arabic version of the OxAFQ-c is an acceptable, clear and comprehensible outcome measure.The Arabic version of the OxAFQ-c demonstrated evidence supporting its internal consistency, test-retest reliability and construct validity as a measure to evaluate foot and ankle pathologies in patients aged 5-16 years.The Arabic OxAFQ-c has very good internal consistency, test-retest reliability, and acceptable measurement error with no floor and ceiling effects.The Arabic version of the OxAFQ-c can be used in daily clinical practice and in research studies to assess children aged from 5 to 16 years in Arabic speakers with ankle-foot conditions.

Self-Reported Moderate-to-Vigorous Physical Activity: Its Association with Health-Related Quality of Life in a Large Cohort of People with Chronic Diseases.

The aim of this study was to investigate the dose-response relationship between physical activity and health-related quality of life (HRQoL) in a large population-based sample of people with chronic disease. We analysed the data of 29,271 adults (15,315 women) who were diagnosed with chronic diseases and participated in the Welsh Health Survey (Wales, UK; data collection 2011-2015). Participants were classified, based on their weekly minutes of moderate-to-vigorous physical activity (MVPA), into four groups as follows: inactive (no MVPA), insufficiently active (<150 min/week), sufficiently active (≥150-<300), and very active (≥300). The main outcome was HRQoL measured via the Short-Form 36 Health Survey (SF-36). This study found a curvilinear association between MVPA and HRQoL and a dose-response relationship for the perception of general health and vitality domains. Compared to inactive participants, those who were very active had higher HRQoL scores (coefficient = 12.54; 95% confidence interval [CI] 11.39-13.70), followed by sufficiently active (coefficient = 11.70; 95% CI 10.91-12.49) and insufficiently active (coefficient = 9.83; 95% CI 9.15-10.51) participants. The fully adjusted regression model showed curvilinear associations between MVPA and the domains of SF-36. Future research should find ways to motivate people with chronic diseases to engage in physical activity. The evidence to support regular exercise in individuals with chronic diseases in all age groups is strong and compelling, and patients should be encouraged to regularly devote more time to physical activity in order to improve their health and well-being.

Effect of Application of Repeated Downhill Walking Bouts on Ankle Isokinetic Parameters in Children with Obesity.

BACKGROUND: Obesity among children became of high concern. Obesity can affect many health aspects including muscular strength. Downhill walking is a useful intervention to enhance muscular strength, especially in older adults. OBJECTIVE: The current study's purpose was to investigate the effect of repeated bouts of downhill walking on ankle isokinetic parameters in children with obesity. METHODS: 32 obese male children aged from 8 to 12 years engaged in the study. The children were divided into two groups: the level walking group (LWG) (n = 16) and the downhill walking group (DWG) (n = 16). Participants in both groups walked 20 minutes on the treadmill, two sessions per week for 6 weeks, with a speed of 5 km/h, and the treadmill slope used for the DWG was set at -20%. Isokinetic dynamometry (Cybex 6000) was used to analyze the normalized eccentric and concentric torque of both ankle dorsiflexors and plantar flexors of the dominant leg in all participants. RESULTS: The normalized peak torques for eccentric plantar flexion, concentric plantar flexion, eccentric dorsiflexion, and concentric dorsiflexion significantly increased by 38.66%, 23.87%, 38.58%, and 15.51%, respectively, after repeated bouts of downhill walking. Level walking resulted in nonsignificant improvement in the muscular torques. CONCLUSION: Downhill walking is a beneficial intervention in improving ankle muscular torques of obese children.

Association of Vitamin D Deficiency and Vitamin D Receptor Genetic Variants With Coronary Artery Disease in Type 2 Diabetic Saudi Patients.

BACKGROUND/AIM: Vitamin D deficiency accelerates the onset of type 2 diabetes mellitus (T2DM). Polymorphisms in the vitamin D receptor (VDR) have been linked to coronary artery disease (CAD). This study aimed to evaluate the association of vitamin D deficiency and VDR polymorphism with CAD in T2DM. PATIENTS AND METHODS: A total of 150 adult male and female subjects, aged from 40 to 60 years, were divided into three groups, each with 50 subjects; control group, T2DM, and T2DM with CAD. Fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), HDL-C, LDL-C, glycosylated hemoglobin (HbA1c), and 25-hydroxyvitamin D (25-OH D) were assessed. VDR genotypes (BsmI, Taq1 and FOK1) were investigated by polymerase chain reaction fragment length polymorphism. RESULTS: There was a significant negative correlation between serum 25-OH D and FBG, TC, TG, and LDL-C levels, and a positive correlation with HDL-C levels in all diabetic patient groups. The risk of CAD was markedly higher in the group of T2DM with CAD in comparison to the control (p<0.0001) and the T2DM group. Regarding Taq1, there was also a significantly higher risk of CAD in Tt+tt genotypes and t allele in the T2DM with CAD group compared to control (p<0.001, 0.031 respectively). In addition, 25-OH D concentrations and the prevalence of VDR polymorphisms (BsmI, Taq1) were correlated with the risk of CAD. CONCLUSION: Deficiency of vitamin D and the prevalence of VDR polymorphisms (BsmI, Taq1) can serve as important markers for CAD.

Effect of Application of Treadmill Training on Metabolic Control and Vitamin D Level in Saudi Patients with Type 2 Diabetes Mellitus.

BACKGROUND: Diabetes mellitus type 2 and vitamin D deficiency are both prevalent in the Saudi Arabia. Vitamin D deficiency treatment with supplements carries a risk of intoxication. AIM: The present study is aimed at elucidating the effect of exercise on modulation of metabolic status and vitamin D level in patients with type 2 diabetes mellitus (T2DM). METHODS: A sum of 110 type 2 diabetic patients were voluntarily enrolled for the present investigation by dividing them into two separate groups (55 individuals for each group), the diabetic study group and diabetic control group. The diabetic study group was engaged in the training program using treadmill exercise. Laboratory parameters were monitored before and after the training program. RESULTS: There were significant elevation in the diabetic study group compared to diabetic control group regarding postexercise vitamin D level, high-density lipoprotein (HDL) (p value ≤ 0.001, 0.045; respectively). In addition, triglycerides, low-density lipoprotein (LDL), glycosylated hemoglobin (HbA1C), and homeostatic model assessment-insulin resistance (HOMA-IR) were significantly decreased (p value < 0.001 for all mentioned parameters). Moreover, there were significant higher level in postexercise parameters as compared to preexercise level in the diabetic study group. CONCLUSION: The exercise training program improved the metabolic control and vitamin D level after three months of intervention.

Effects of Plyometric Exercises versus Flatfoot Corrective Exercises on Postural Control and Foot Posture in Obese Children with a Flexible Flatfoot.

BACKGROUND: Obesity contributes to the acquired flatfoot deformity which in turn impairs balance. AIM: The purpose of the current study was to compare the effect of plyometric exercises with flatfoot corrective exercises on balance, foot posture, and functional mobility in obese children with a flexible flatfoot. METHODS: Forty-seven children participated in the study. Their age ranged from 7 to 11 years. Participants were randomly divided into 3 groups: experimental group I (EGI), experimental group II (EGII), and the control group (CG). The EGI received plyometric exercises and the EGII received corrective exercises, 2 sessions weekly for 10 weeks. The control group did not perform any planned physical activities. The Prokin system was used to assess balance, the timed up and go test (TUG) was used to assess functional mobility, and the navicular drop test (NDT) was used to assess foot posture. RESULTS: EGI showed significant improvement in all balance parameters, foot posture, and TUG. EGII showed improvement in the ellipse area and perimeter in addition to foot posture and TUG. CONCLUSION: Plyometric exercises and foot correction exercises had a positive effect on foot posture, balance, and functional mobility in obese children with flatfeet.

Effect of Application of Different Exercise Intensities on Vitamin D and Parathormone in Children with Down's Syndrome.

BACKGROUND: Children with Down's syndrome are more liable to vitamin D deficiency. Treating this deficiency with supplements is associated with the risk of intoxication. AIM: The study is aimed at comparing the effect of two exercise intensities on the modulation of vitamin D and parathormone levels in children with DS. METHODS: Forty-four DS male children aged from 8 to 12 years participated in the study. They were assigned randomly into two equal groups. Group I received high-intensity treadmill aerobic exercises, and group II received moderate-intensity T-AE, three times per week for three months. The blood samples were collected from both groups before the intervention, after one month of intervention, then after three months of intervention to assess serum 25(OH)D and PTH levels. RESULTS: Repeated measure MANOVA revealed that the high-intensity T-AE induced a significant increase in 25(OH)D after one month and after three months while it significantly decreased PTH only after three months. Moderate-intensity T-AE had a nonsignificant effect on both hormones. CONCLUSION: The current study concluded that the high-intensity T-AE improved both vitamin D and parathormone serum levels after three months of intervention.

Impact of the 2019 Coronavirus Disease Pandemic on Health-Related Quality of Life and Psychological Status: The Role of Physical Activity.

This study investigated the impact of the 2019 coronavirus disease (COVID-19) pandemic on health-related quality of life (HRQoL) and psychological status among Saudi adults, and whether physical activity modifies this association. The participants were 518 adults aged ≥18 years (67.4% men). Using an online survey, data regarding demographic information, the impact of COVID-19 (assessed by the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5), HRQoL (Short Form-8), psychological distress (Depression, Anxiety and Stress Scale), and physical activity behavior (International Physical Activity Questionnaire-Short Form) were collected. The results demonstrate that adults reporting moderate or high levels of impact of COVID-19 had a lower HRQoL and higher psychological distress than adults reporting a low impact. HRQoL was higher for adults reporting any level impact (low, moderate, or high) of COVID-19 when they participated in recommended levels of physical activity (≥600 metabolic equivalent (MET)-min/week of total physical activity). Psychological distress was lower for adults reporting a high level of impact when they participated in recommended physical activity. Moderate or high levels of impact of COVID-19 were associated with a significantly lower HRQoL and higher psychological distress than the low impact of COVID-19. However, these associations were moderated by the recommended levels of physical activity.