Insulin Resistance and Bone Metabolism Markers in Women with Polycystic Ovary Syndrome: A Cross-Sectional Study on Females from the Islamic University Medical Center.

Background and Objectives: polycystic ovarian syndrome (PCOS) prevails in females in the 18-40-year-old age group and varies from 5-20% depending on the demographic and diagnostic standards. It is unknown how long passes between the onset of a specific symptom and the appearance of the disease. The three most significant characteristics of PCOS include irregular menstruation, a polycystic ovarian shape found by pelvic ultrasound, and hyperandrogenism, which could possibly delay menarche. This study's objective was to assess insulin resistance and bone bio-markers' metabolism-involved characteristics of females with PCOS. Materials and Methods: We present a cross-sectional study carried out on 100 female patients suffering from PCOS and 100 healthy female subjects as a control living in Saudi Arabia in the Al-Madinah Al-Munawara Region between May 2021 and March 2022. The age of the studied groups ranges from 20-40 years, and patients were categorized into three groups; group I (control, n = 100), group IIa (overweight or obese females with PCOS, n = 70), and group IIb (non-obese females with PCOS, n = 30). The diagnosis of PCOS was carried out as per Rotterdam criteria as recommended for adolescent and adult subjects. All the groups were subjected to physical examination, and anthropometric measures, biochemical parameters, endocrine activity, and clinical parameters were determined. The data obtained were computerized and analyzed statistically using the SPSS program for range, mean, and standard deviation. ANOVA test with post hoc Tukey test was applied to assess the pattern and variation among the test and control groups. Results: In the present study, age, waist circumstances, systolic blood pressure, and diastolic blood pressure were reported enhanced in the PCOS over the control group. Additionally, anthropometric measures were reported slightly upregulated in group IIa over group IIb (p < 0.001). Biochemical parameters including glucose, insulin incidence, and lipids were reported higher in the PCOS over the control group, where group IIa showed slightly increased values compared to group IIb (p < 0.001). On the contrary, PTH, Ca+2, and 25(OH)D levels were reported lower in the PCOS over the control group. However, in the control groups, a slight variation was reported as higher in group IIa compared to group II. In the study, PTH and 25(OH)D were found associated with bone metabolism; a lower level of PTH and 25 (OH) D is linked with a decline in bone density. Conclusions: Lower serum levels of PINP and osteocalcin along with the 25(OH)D were associated with the PCOS compared to the control group, imposing a higher risk of the syndrome. On the contrary, an elevated level of NTx in groups IIa and IIb over the control group was associated with insulin resistance and bone metabolism.

Genotypes of Hepatitis C Virus and Efficacy of Direct-Acting Antiviral Drugs among Chronic Hepatitis C Patients in a Tertiary Care Hospital.

Hepatitis C virus (HCV) chronic infection is a major causative factor for several chronic liver diseases, including liver cirrhosis, liver cell failure, and hepatocellular carcinoma. The HCV has seven major genotypes. Genotype 4 is the most prevalent genotype in the Middle East, including Saudi Arabia, followed by genotype 1. The HCV genotype affects the response to different HCV treatments and the progression of liver disease. Currently, combinations of direct-acting antiviral drugs (DAAs) approved for the treatment of HCV achieve high cure rates with minimal adverse effects. Because real-world data from Saudi Arabia about the efficacy of DAAs are still limited, this study was conducted to assess the effectiveness of DAAs in treating patients with chronic hepatitis C and to identify the variables related to a sustained virologic response (SVR) in a real-world setting in Saudi Arabia. This prospective cohort study included 200 Saudi patients with chronic HCV who were 18 years of age or older and had been treated with DAAs at King Abdul-Aziz Specialized Hospital in Taif, Saudi Arabia, between September 2018 and March 2021. The response to treatment was assessed by whether or not an SVR had been achieved at week 12 post treatment (SVR12). An SVR12 was reached in 97.5% of patients. SVR12 rates were comparable for patients of different ages, between men and women, and between patients with and without cirrhosis. In addition, the SVR12 rates did not differ according to the infecting HCV genotype. In this study, the presence of cirrhosis and the patient's gender were independent predictors of who would not reach an SVR12 (known here as the non-SVR12 group) according to the results of univariate and multivariate binary logistic regression analyses based on the determinants of SVR12. In this population of patients with chronic HCV infection, all DAA regimens achieved very high SVR12 rates. The patients' gender and the presence of cirrhosis were independent factors of a poor response.

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.

Thyroid Function Assessment in Saudi Males with Metabolic Syndrome.

Background: Metabolic Syndrome (MetS) is a multifactor condition associated with cardiovascular risk. Thyroid hormones regulate MetS components via controlling energy homeostasis, lipids, and glucose metabolism. The risk ratio for MetS and related disorders changes between males and females. Aim and Objectives: Study aim to access thyroid functions in Saudi population with metabolic syndrome. Materials and Methods: The current study sought to evaluate the impact of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) in predicting the risk of MetS. A total of 200 (MetS 100 and control 100) Saudi Arabian males were enrolled for the study, and after applying eligibility criteria, the eligible study size was examined for the physical test (chest, abdominal, and general examination with stress on blood pressure measurement) and anthropometric parameters (bodyweight, body mass index, and waist circumference). Results: In the present study, the biochemical parameters, such as TSH, FT3, FT4, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), high-density lipoprotein (LDL), fasting glucose, and fasting insulin were measured in the study group, and statistical analysis was also performed. The results revealed that the MetS and control differ in terms of physical, anthropometric, and biochemical markers. The study showed that thyroid dysfunction (TD) and MetS are closely associated with the difference in physical, anthropometric, and metabolic characteristics. Conclusion: The result demonstrated hypothyroidism major risk factor due to TD in MetS. These findings provide a scientific basis for diagnosis and the management of TD, associated MetS, and cardiovascular disease (CVD).

Prevalence, toxin gene profile, genotypes and antibiotic susceptibility of Clostridium difficile in a tertiary care hospital in Taif, Saudi Arabia.

Purpose: Clostridium difficile (C. difficile) is an important causative agent of nosocomial diarrhoea and has become a major worldwide public health concern. The current study was conducted to determine the prevalence of C. difficile infection (CDI) amongst patients with nosocomial diarrhoea in a large tertiary care hospital in Taif, Saudi Arabia, and to define molecular characteristics and antimicrobial sensitivity profiles of C. difficile strains isolated from those patients. Materials and Methods: Stool specimens were collected from 456 patients and were cultured for C. difficile isolation. The isolates were subjected to multiplex polymerase chain reaction (PCR) for detecting genes encoding the toxins (toxin A, toxin B and binary toxin [CDT]), genotyping by PCR ribotyping method and antimicrobial sensitivity testing using E test strips. Results: Seventy-four C. difficile strains were recovered, of which 44 (59.5%) were A+B+CDT-, 14 (18.9%) were A-B+CDT-, 4 (5.4%) were A+B+CDT+ and 12 (16.2%) were A-B-CDT-. Toxigenic strains, and hence CDI, were detected in 13.6% of the patients (62/456). Fourteen different ribotypes were distinguished amongst bacterial isolates, of which ribotypes 002, 001, 017, 014 and 020 were the most prevalent (20.3%, 18.9%, 18.9%, 9.5% and 8.1%, respectively). Four isolates (5.4%) belonged to ribotype 027. All bacterial isolates showed sensitivity to metronidazole, vancomycin and piperacillin-tazobactam. The isolates exhibited resistance to linezolid (2.7%), chloramphenicol (5.4%), rifampicin (13.5%), tetracycline (21.6%), moxifloxacin (48.6%), clindamycin (54%) and imipenem (83.8%). Multiple drug resistance was observed in 56.8% of the isolates. Conclusion: Further larger studies are required for an accurate understanding of CDI epidemiology in Saudi Arabia.

Prevalence of Hepatitis C Virus Seropositivity and Its Impact on Coronary Artery Disease among Egyptian Patients Referred for Coronary Angiography.

Background. We tested the prevalence and impact of HCV seropositivity among Egyptian patients referred for coronary angiography. Subjects and Methods. This cross-sectional study was conducted in Zagazig University hospitals including 509 patients scheduled for elective coronary angiography between June 2013 and June 2014. By taking full history on admission, laboratory workup including HCV Ab, echocardiography study, and coronary angiography, we calculated the mean number of coronary artery lesions and the mean number of affected coronary artery vessels for all patients. The severity of the coronary lesions was estimated using the Gensini score. Results. HCV seropositive patients referred for coronary angiography were about 30.3% (which is greater than the prevalence of HCV seropositivity among general population in Egypt), patients proved to have CAD who are HCV antibody positive had more severe coronary lesions than in seronegative one (p < 0.05), and patients proved to have CAD who are HCV antibody positive had comparable prevalence of cardiovascular risk factors as seronegative patients except for diabetes and hypertension which are more prevalent in seronegative patients (p < 0.05). Conclusion. Prevalence of HCV antibody positive patients referred for coronary angiography was about 30.3%, and CAD patients who are HCV antibody positive had more severe coronary lesions and less prevalence of diabetes and hypertension than HCV antibody negative.

Impact of Admission Glycosylated Hemoglobin A1c on Angiographic Characteristics and Short Term Clinical Outcomes of Nondiabetic Patients with Acute ST-Segment Elevation Myocardial Infarction.

We aimed to assess the predictive value of admission HbA1c level in nondiabetic patients presented by acute STEMI, on outcome of PCI and short term outcome of adverse cardiac events. Methods. 60 nondiabetic patients were admitted to Cardiology Department, Zagazig University Hospital, with acute STMI: 27 patients with HbA1c levels of 4.5% to 6.4% (group 1), 17 patients with HbA1c levels of 6.5% to 8.5% (group 2), and 16 patients with HbA1c levels higher than 8.5% (group 3). Either invasive intervention was done at admission by (pPCI) or coronary angiography was done within month (3-28 days) from taking thrombolytic. Participants were followed up for 6 months. Results. There was significant difference among different groups of HbA1c as regards the number of diseased vessels, severity of CAD lesions (p value < 0.01), and TIMI flow grades (p value < 0.05). There was significant difference among different groups as regards the adverse cardiac events on short term follow-up period (p value < 0.05). Conclusion. The present study showed that admission higher HbA1c level in patients presented by acute STEMI is associated with more severe CAD, lower rate of complete revascularization, and higher incidence of adverse cardiac events.