Investigating the Interrelationships Between Obesity, Academic Achievement, Physical Activity, and Social Support Among Jazan University Students.

Background: In developing and developed countries, the prevalence of overweight and obesity has grown. The college phase is a critical period during which healthy behaviors are learned through lifestyle and social environment. College students are prone to increased stress, negatively affecting their daily activities and academic performance. Objective: The general study objective was to investigate the prevalence of obesity among Jazan University students. Methods: This observational cross-sectional study used a pre-tested self-administered anonymous electronic questionnaire to evaluate the prevalence of obesity among 474 Jazan University students and its association with academic performance, physical activity, and social support. Data were analyzed using the Statistical Package for the Social Sciences, and associations between variables were assessed using the chi-square test. Results: Approximately 21% and 9.2% of the male and female students were obese, respectively, and the prevalence of obesity significantly differed between them. The use of one or more tobacco products was significantly associated with the prevalence of obesity (P < 0.001); the prevalence of obesity was substantially higher among the tobacco product users than among the non-users (35.3% vs. 14.4%). The presence of a morbidity was also significantly associated with the prevalence of obesity (P = 0.007); the prevalence of obesity was significantly higher among the students with at least one comorbidity than among the medically free students (28.8% vs. 14.9%). Conversely, obesity was not associated with academic performance and depression. Specifically, the grade point average was not affected across the academic years (P = 0.085 and P = 0.308, respectively). Conclusion: Obesity is significantly associated with male sex and the use of one or more tobacco products. This finding warrants the need for strategic and multidisciplinary plans at all levels to encourage healthy behaviors among college students, including an active, healthy lifestyle.

Patients' perception towards digital health services in Saudi Arabia: A cross-sectional study.

The COVID-19 pandemic has highlighted the importance of the widespread use of digital health services (DHS). Despite evidence of the benefits of DHS, there are many barriers to their adaptation worldwide. This study aimed to measure the effectiveness of DHS from the patient perspective. A cross-sectional study was conducted in the Jazan region of Saudi Arabia from December 2022 to March 2023. Of the 323 participants who completed the online questionnaire, 63.5% were female, and 55.4% of participants found that DHS was satisfactory. 34% of the participants preferred DHS via telephone calls and 40.2% found that DHS was comparable to direct regular services in building trust between patients and doctors. A total of 79.2% agreed that DHS could reduce unnecessary outpatient visits and 70.9% agreed that it could be used effectively to follow patients with chronic diseases. DHS was found to be cost-effective in 76.8%. Digital healthcare has the potential to significantly improve health care outcomes and effectiveness in Saudi Arabia. Therefore, the use of a DHS for monitoring and dispensing care would be advantageous. However, difficulties such as lack of time or a packed schedule have prevented patients in Saudi Arabia from using telemedicine.

Effectiveness of Blood Glucose Time in Range to Reduce Risk of Blood Glucose Extrusion and Improve Blood Glucose Metrics in Type 1 Diabetic Patients.

BACKGROUND: With evolving diabetes technology, continuous glucose monitoring (CGM) and time in range have been advanced as critical measurements to assess complications. They have shown improvement in A1C levels and decreased episodes of blood glucose extrusion. AIMS: This study aimed to assess the awareness and utilization of blood glucose time in range and its effectiveness in reducing the risk of blood glucose extrusion and improving blood glucose metrics among patients with type 1 diabetes mellitus. METHODS: A retrospective study included 342 patients who met the inclusion criteria and were using the CGM, aiming for a TIR of 70% daily. Glycemic control was followed using TIR data, blood glucose extrusion frequency (including hyperglycemia and hypoglycemia events), active sensor time, average blood glucose, and glucose management indicator (GMI) levels. RESULTS: A total of 342 individuals participated in this study, the majority of whom were below 18 years of age (62.3%). The hypoglycemic frequency was significantly increased compared to the baseline, and most participants experienced hypoglycemia events (p = 0.0001). The incidences increased over time, with 90.9% and 93% having hypoglycemia at 60 and 90 days (p = 0.0001), respectively. The active scan and sensor time were not followed, which led to the blood glucose target not being achieved, with no improvement throughout the study. Consequently, no improvement occurred in glycemic control. CONCLUSION: CGM technology has been promising and proven effective in improving glycemic. However, our study did not show these benefits as expected, which could be explained by the underutilization and improper use of the CGM.

Assessment of Knowledge and Perception of Sodium-Glucose Co-transporter 2 (SGLT-2) Inhibitors prescription Among Physicians in Saudi Arabia.

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors are a new class of medications that have been proven to improve both glycemic control and cardio-renal outcomes. The knowledge, attitude, and perception toward their prescriptions in Jazan, Saudi Arabia, are still unknown. OBJECTIVE: The study aimed to measure the level of knowledge and attitude toward sodium-glucose cotransporter 2 inhibitors prescription among physicians in the Jazan region, Saudi Arabia. METHODS: Data analysis was performed using Statistical Package for the Social Sciences, SPSS 23rd version. Frequency and percentages were used to display categorical variables. Minimum, maximum, mean, and standard deviation were used to test numerical variables. Independent t-test and ANOVA test were both utilized to test the factors associated with knowledge and attitude toward the use of SGLT-2 inhibitors. RESULTS: A total of 65 participants were included in the study. 26.2% had a low knowledge level, 30.8% had a moderate knowledge level, and 43.1% had a high knowledge level of sodium-glucose cotransporter 2 inhibitors. 9.2% had a low attitude level, 43.1% had a moderate attitude level, and 47.7% had a high attitude level toward sodium-glucose cotransporter 2 inhibitors. Age, professional status, years of experience, and specialty were significantly associated with attitude but not with the knowledge of sodium-glucose cotransporter 2 inhibitors prescription. CONCLUSION: While the study cohort scored high in the knowledge and attitude domains of the survey, a large proportion failed to answer very essential questions in type 2 diabetes management. An educational awareness program needs to be carried out to strengthen the physicians' knowledge of SGLT2 inhibitors prescription.

Footcare knowledge and practice among diabetic patients attending primary health care centers in Jazan region, Saudi Arabia.

Background: Diabetic foot is one of the significant complications of diabetes mellitus, associated with a high risk of morbidity and mortality. Patients' knowledge of, and willingness to practice, good footcare are essential and may decrease these risks. This study was conducted to assess adult diabetic patients' knowledge of footcare and willingness to put their knowledge into practice. Method: A cross-sectional observational study was conducted on adult diabetic patients in the central area of the Jazan Region using patients' responses to a questionnaire. Descriptive statistics were calculated for study variables, and the Pearson chi-squared test was used to compare categorical data. Results: A total of 410 diabetic patients were included in this study. The mean age of the participants was 56.7 years. The mean duration of their diabetes mellitus (DM) to date was 9.2 years, and 63% had complications of diabetes. For the questionnaire, 56% of the patients gave incorrect responses to the knowledge of the footcare section and 81% to the willingness to practice footcare section. Highly educated patients have better knowledge and practice of diabetic footcare than those who are less educated (77% vs. 23%, p < 0.05), (37% vs. 20%, p < 0.05), respectively. A statistically significant difference exists between patients with good and poor knowledge scores. Conclusion: This study demonstrates that the knowledge and practice of footcare among DM patients are poor. Therefore, appropriate patient information programs are needed to increase patients' understanding of their illness and how to manage it.

Health-related Quality of Life among Type 2 Diabetes Patients in Southern Province of Saudi Arabia using WHOQOL-BREF: A Cross-section Study.

BACKGROUND: Quality of life has become a more important health outcome with advancements in medical therapies and disease management, leading to better lives for people in general, particularly those living with chronic diseases. Diabetes has a direct impact on the physical, psychological, and social aspects of personal health. This study aimed to determine healthrelated quality of life (HRQOL) and its predictors in patients with type 2 diabetes. METHODS: A cross-sectional study was carried out on 420 patients with type 2 diabetes who presented to primary healthcare centers in Samtah Town, Saudi Arabia, from March 2017 to February 2018. The HRQOL of the study participants was determined using the World Health Organization Quality of Life-BREF. Multi-level linear regression was employed to ascertain the factors associated with HRQOL among patients with type 2 diabetes. RESULTS: Female sex was significantly associated with higher HbA1c, anxiety, depression, and stress scores and a lower HRQL in the physical, psychological, and environmental health subscales than males (P<0.001). All subscales of HRQOL were significantly lower in the > 50 years age group. When compared to those with low levels of education (illiterate, primary, or elementary school), patients with secondary and bachelor's degrees had significantly higher HRQOL in all subscales (P<0.001). In addition, there were significant differences in glycemic control and HRQL with a longer duration of diabetes, the presence of one or more diabetes complications, and the presence of comorbid hypertension (P<0.001). However, no significant differences in the Depression Anxiety and Stress Scale (DASS) index were observed with a longer duration of diabetes and the presence of comorbid hypertension. Patients with diabetes on combined therapy and healthy diet and exercise showed significantly higher HRQOL on physical functioning (P<0.001). CONCLUSION: Type 2 diabetes was significantly associated with impaired health-related quality of life and mental health among study participants. Females appeared to have worse quality of life and mental health than males. Age, duration of diabetes, comorbid hypertension, diabetes complications, and level of education were significantly associated with lower HRQOL and mental health scores. Healthy diet and exercise, when combined with hypoglycemic and insulin therapy, were found to improve HRQOL and mental health among patients with diabetes. Scales based on a broad definition of health, such as the WHOQOL-BREF, are appropriate for use in primary care settings and can enhance patient management and care.

The Association between SARS-CoV-2 Infection and Diabetic Ketoacidosis in Patients with New-Onset Diabetes: A Retrospective Study from a Diabetic Center in Saudi Arabia.

BACKGROUND: Various reports described new-onset diabetes during or after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with no previous history of diabetes or glucocorticoid use. Further, SARS-CoV-2 could increase the risk of diabetes, including diabetic ketoacidosis (DKA). However, data on the relationship between new-onset diabetes and COVID-19 are still limited in our region. Thus, we aimed in this study to evaluate the association between new-onset diabetes and DKA in patients with COVID-19. METHODS: A retrospective, cross-sectional study was conducted at a diabetic center in Jazan province, Saudi Arabia, between 2020 and 2021. Demographic data, COVID-19 status, and DKA incidence were collected and verified manually from diabetic patients' medical records. Data were analyzed using a t-test and chi-square test. RESULTS: We included 54 diabetic patients diagnosed during the COVID-19 pandemic, with a median age of 17 years. The majority of patients were females (57.4%). About 38.8% were diagnosed with COVID-19, and 16.6% reported having DKA. About 33.3% of the patients who experienced DKA reported being COVID-19-positive. However, only 6% of patients who denied contracting SARS-CoV-2 developed DKA (p-value = 0.020). CONCLUSIONS: Patients with newly diagnosed diabetes due to COVID-19 seem at a higher risk of developing DKA. Further epidemiological and molecular studies are required for a better understanding of the correlation between DKA in patients with diabetes and COVID-19.

Admission Grades as Predictors of Medical Students' Academic Performance: A Cross-Sectional Study from Saudi Arabia.

Background: Admission to medical school is competitive, and different countries use various tests in addition to high school grades to minimize selection bias. A few studies have been conducted to evaluate the usefulness of these tests as predictors for students' academic performance. In this article, we aimed to assess factors that influenced students' grades in medical school. Methods: A cross-sectional study included all students who graduated from the Faculty of Medicine at Jazan University between 2018 and 2020. Scores of the included participants were extracted from the registry of Jazan University, and additional questions about study habits were completed by the included students. Descriptive, univariate, and multivariate analyses were performed for the factors that impacted academic performance. Results: There were 331 included candidates, and the majority of them were female (53%). About 60% of the participants were medical residents at the time of the study, and 40% were interns. Univariate and multivariate analyses indicated that grades in high school and the pre-requisite tests were positively associated with students' academic performance. Further, studying more than two hours per day was positively correlated with better grades in medical school. Conclusion: Scores of the admission tests can serve as predictors for student performance in medical school. National studies are deemed essential to evaluate additional admission tests for medical school, an action that would minimize selection bias.

Knowledge and Attitude Toward Organ Donation Among the Adult Population in Jazan, Saudi Arabia.

Background Organ transplantation is recognized as a life-saving procedure for patients with potentially terminal illnesses. However, the population's awareness of organ donation and related issues is variable throughout the world. Objectives The study purposes to evaluate the knowledge and attitude toward organ donation among the adult population in the Jazan region, Saudi Arabia. Methods We conducted a cross-sectional questionnaire-based study on the general population in Jazan using the convenient sampling method. The questionnaire was composed of 21 items distributed over demographic characteristics, knowledge, and attitude domains. The knowledge and attitude domain levels were categorized into low, moderate, and high based on the scoring of its items. The data had been analyzed using SPSS software version 23 (IBM Corp., Armonk, NY). Frequency and percentages were used to display categorical variables. Mean and standard deviation was used to present numerical variables. The independent t-test and analysis of variance (ANOVA) test were both used to test for factors associated with knowledge score and attitude score toward organ donation. Results A total of 1019 participants were included in the study. The majority were between the ages of 18 and 30 years and 3.4% of them were older than 50 years. Eighty percent of participants had a university level of education or higher and 48% were students. This survey showed that 493 (48.4%) had a moderate knowledge level of organ donation (total score between 50% and 75%) with younger age, being a student, and residence status associated with a higher level of knowledge while gender and the education levels were not. Five hundred one (49.2%) of the participants reported being in agreement with organ donation and 56 (5.5%) of them reported disagreement. Most of the participants exhibited a low positive attitude toward organ donation, with 592 (58.1%) of the participants (a total score less than 50%) (score of 4 and less). Young age and being a student were the factors associated with a positive attitude while gender, education levels, residence status, and monthly status were having no significant associations with the positive attitude toward organ donation. Conclusion This study concluded that study participants had a moderate level of knowledge and a low positive attitude toward organ donation. The advocacy in promoting organ donation should be increased through the use of appropriate mediums to change the attitudes and enhance the willingness of people.

Baseline Characteristics Associated With Sodium-Glucose Cotransporter Inhibitor Prescriptions in Type 2 Diabetic Patients in Jazan, Saudi Arabia.

BACKGROUND: Sodium-glucose cotransporter inhibitors are promising medications for improving cardiovascular outcomes in diabetic and non-diabetic patients. The baseline characteristics associated with its prescription in Jazan, Saudi Arabia, are still lacking. OBJECTIVES: This study aims to determine the baseline characteristics associated with its prescription among type 2 diabetic patients in the Jazan region. METHODS: A retrospective cohort study of adult patients with type 2 diabetes mellitus (T2DM) in Jazan region, Saudi Arabia, who received a prescription of sodium-glucose cotransporter 2 inhibitors (SGLT2i) from June 2016 to December 2021 was conducted. Categorical baseline characteristics are reported as frequencies, and proportion and continuous variables are reported as means (SD). The crude odds and adjusted ratio (OR) (95% CI) for SGLT2i prescription were then calculated using univariate and multivariate logistic regression analysis. RESULTS: A total of 370 patients who satisfied the inclusion criteria were included in this study. There were 133 patients (36%) who had been prescribed SGLT2i over a median follow-up of five years. Characteristics associated with the prescription were female gender (adjusted odds ratio [aOR]: 2.2, 95% Cl: 1.3-3.9), endocrinologist doctors (aOR: 2.4, 95% Cl: 1.3-4.5), patients who had visited the center four times or more (aOR: 10.9, 95% Cl: 4.6-25.9), patients who have evidence of DM retinopathy (aOR: 9.7, 95% Cl: 2.9-31.7), or patients who are morbidly obese (aOR: 4.1, 95% Cl: 1.1-14.8). CONCLUSION: The sodium-glucose cotransporter inhibitors are under-prescribed among type 2 diabetic patients in the Jazan region despite their availability. Further studies are warranted to address the potential barriers to prescriptions among different medical specialties.

Kidney Transplant Recipient with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Secondary to COVID-19 Pneumonia: A Case Report.

BACKGROUND: Currently, COVID-19 is becoming one of the most common causes of viral pneumonia worldwide. In the medical literature, very few case reports describe the association between COVID-19 and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in kidney transplant patients. METHODS: A 74-year-old immunocompromised man post-kidney transplant presented with nonspecific symptoms consisting of fatigue, malaise, and anorexia. He was also found to have hyponatremia in the context of pulmonary insults. SIADH in the setting of COVID-19 pneumonia was diagnosed after exclusion of other causes of hyponatremia. He was treated for COVID-19 pneumonia with antiviral therapy, secondary bacterial infection prophylaxis, dexamethasone and ventilatory support in addition to modification of antirejection medications. RESULTS: The patient has improved and his serum sodium normalized with management of primary insult. CONCLUSIONS: SIADH should be suspected in transplant patients with COVID-19 pneumonia once they develops hyponatremia. The decision of intravenous fluid administration should be taken carefully in these settings.

Early versus Delayed Strategies for Renal Replacement Therapy Initiation in Adult Patients with Severe Acute Kidney Injury Complicating Septic Shock: A Systematic Review and Meta-analysis.

Sepsis-associated acute kidney injury (AKI) is a frequent complication in hospitalized patients and is associated with significant morbidity and mortality. Renal replacement therapy (RRT) is used to manage AKI. The optimal timing of starting RRT in patients with AKI is still uncertain. This study is aimed to assess the effect of different timing strategies of RRT (early vs. standard) on mortality and dependence on dialysis in severe AKI complicating septic shock. A systematic review was conducted using the Ovid Medline database, trial registries, and manual searches of key journals from January 2000 to October 2020. Appropriate outcomes were pooled and analyzed via a meta-analysis. Only randomized controlled trials (RCTs) were included to compare between the early vs. delayed strategies of RRT. The inverse generic method was used, and the data were pooled using random effects. Five studies were included in this review, with 4329 participants. Overall, most domains were assessed as low-risk or with some concerns about the risk of bias. Compared with standard therapy, early initiation probably results in little or no difference regarding death, and may also result in no or little difference in independence on dialysis. The early strategy may result in a slight increase in adverse events. Compared with the standard strategy, earlier RRT initiation may slightly reduce the length of hospital stay. Further RCTs are needed to define the optimal timing of RRT initiation in this population.

Impact of COVID-19 on Patients with Diabetes Standard of Care in the Jazan Region, Saudi Arabia.

Background: COVID-19 patients with DM have increased mortality and severity of the disease. Although telemedicine helps to minimize the impact of COVID-19 on the DM standard of care, it is increasingly evident that COVID-19 has a significant impact on DM standards of care, especially in areas where telemedicine is not available. Objective: The study aimed to assess the impact of COVID-19 on patients with diabetes standard of care in the Jazan region, Saudi Arabia. Methods: A cross-sectional study using an online pretested questionnaire targeted adult diabetic patients living in the Jazan region between December 2021 to March 2022. The participants were selected through a random sampling method. They completed self-administered questionnaires that included demographic variables. Results: A total of 258 study subjects participated in this study. In comparison to DM standards of care before and during COVID-19, there was no clinically significant difference in medication compliance, blood glucose checking, or experiencing blood glucose extrusion. However, with the spread of the corona pandemic and the closure of clinics, the percentage of those who have difficulty controlling blood sugar levels has increased to 22%, despite the availability of telemedicine. Conclusion: DM standards of care have not been affected and were not statistically significant, which could be explained by the rapid adoption of telemedicine during the lockdown. However, as corona spread participants had difficulty controlling blood sugar levels. This indicates that governmental multidisciplinary work limits the COVID-19 impact; however, further work is still needed to ensure that DM care is not compromised.

Incidence of Direct Oral Anticoagulant Prescriptions in Kidney Transplant Recipients in Ontario, Canada.

BACKGROUND: Kidney transplant recipients (KTRs) are routinely excluded from direct oral anticoagulant (DOAC) trials. Given the lack of safety and efficacy data in this population, we examined real-world prescribing practices of DOACs in KTRs. METHODS: We conducted a retrospective cohort study using linked administrative data sets in Ontario, Canada. All adult KTRs (n = 5580) from June 23, 2009, to March 31, 2017, were included. The primary outcomes were the first prescription for a DOAC or warfarin. Patients were censored on graft failure, death, or end of follow-up. RESULTS: The mean age was 55 (SD, 14) years; 63% were male, and 65% had received a deceased donor kidney. Over a median follow-up of 5.5 and 4.7 years, 224 KTRs (4.0%) and 824 KTRs (14.8%) were prescribed DOACs and warfarin, respectively. The rates of DOAC and warfarin prescriptions were 8.1 and 32.6 per 1000 person-years, respectively. Older age, receipt of a kidney transplant in more recent years, and higher baseline estimated glomerular filtration rate were associated with DOAC prescription compared with warfarin. Patients with multiple comorbidities and a history of deep venous thromboembolism had a lower risk of DOAC prescription compared with warfarin. When examined by era, the incidence rate of both DOAC and warfarin prescriptions increased significantly over time. CONCLUSIONS: Despite limited safety and efficacy data, DOACs are prescribed to KTRs. However, warfarin still remains more commonly prescribed in this selected patient population. Anticoagulant prescriptions overall are on the rise in KTRs. Further study is needed to determine the safety and efficacy of DOACs in KTRs.