Predictors of the unfavorable outcomes in acute ischemic stroke patients treated with alteplase, a multi-center randomized trial.

Worldwide, stroke is a leading cause of long-term disability in adults. Alteplase is the only approved treatment for acute ischemic stroke (AIS) and results in an improvement in a third of treated patients. We evaluated the post-stroke unfavourable outcome predictors in alteplase-treated patients from Egypt and Saudi Arabia. We assessed the effect of different risk factors on AIS outcomes after alteplase in Egypt and Saudi Arabia. Our study included 592 AIS alteplase-treated patients. The relationship between risk factors, clinical presentation, and imaging features was evaluated to predict factors associated with poor outcomes. An mRS score of three or more was used to define poor outcomes. Poor outcome was seen in 136 patients (23%), and Patients with unfavourable effects had significantly higher admission hyperglycaemia, a higher percentage of diabetes mellitus, cardioembolic stroke, and a lower percentage of small vessel stroke. Patients with higher baseline NIHSS score (OR 1.39; 95% CI 1.12-1.71; P = 0.003), admission hyperglycaemia (OR 13.12; 95% CI 3.37-51.1; P < 0.001), and post-alteplase intracerebral haemorrhage (OR 7.41; 95% CI 1.69-32.43; P = 0.008) independently predicted unfavourable outcomes at three months. In AIS patients treated with alteplase, similar to reports from other regions, in patients from Egypt and Saudi Arabia also reveal that higher NIHSS, higher serum blood sugar, and post-alteplase intracerebral haemorrhage were the predictors of unfavourable outcomes three months after ischemic stroke.Trial registration: (clinicaltrials.gov NCT06058884), retrospectively registered on 28/09/2023.

The prevalence of sedentary behavior among university students in Saudi Arabia.

BACKGROUND: A considerable body of research has demonstrated that reducing sitting time benefits health. Therefore, the current study aimed to explore the prevalence of sedentary behavior (SB) and its patterns. METHODS: A total of 6975 university students (49.1% female) were chosen randomly to participate in a face-to-face interview. The original English version of the sedentary behavior questionnaire (SBQ) was previously translated into Arabic. Then, the validated Arabic version of the SBQ was used to assess SB. The Arabic SBQ included 9 types of SB (watching television, playing computer/video games, sitting while listening to music, sitting and talking on the phone, doing paperwork or office work, sitting and reading, playing a musical instrument, doing arts and crafts, and sitting and driving/riding in a car, bus or train) on weekdays and weekends. RESULTS: SBQ indicated that the total time of SB was considerably high (478.75 ± 256.60 and 535.86 ± 316.53 (min/day) during weekdays and weekends, respectively). On average, participants spent the most time during the day doing office/paperwork (item number 4) during weekdays (112.47 ± 111.11 min/day) and weekends (122.05 ± 113.49 min/day), followed by sitting time in transportation (item number 9) during weekdays (78.95 ± 83.25 min/day) and weekends (92.84 ± 100.19 min/day). The average total sitting time of the SBQ was 495.09 ± 247.38 (min/day) and 58.4% of the participants reported a high amount of sitting time (≥ 7 hours/day). Independent t-test showed significant differences (P ≤ 0.05) between males and females in all types of SB except with doing office/paperwork (item number 4). The results also showed that male students have a longer daily sitting time (521.73 ± 236.53 min/day) than females (467.38 ± 255.28 min/day). Finally, 64.1% of the males reported a high amount of sitting time (≥ 7 hours/day) compared to females (52.3%). CONCLUSION: In conclusion, the total mean length of SB in minutes per day for male and female university students was considerably high. About 58% of the population appeared to spend ≥7 h/day sedentary. Male university students are likelier to sit longer than female students. Our findings also indicated that SB and physical activity interventions are needed to raise awareness of the importance of adopting an active lifestyle and reducing sitting time.

Determinants of Z-Score of Bone Mineral Density among Premenopausal Saudi Females in Different Age Groups: A Cross Sectional Study.

This is a comparative multicenter cross-sectional study that evaluated the potential determinants of Z-scores among premenopausal Saudi women before and after the age of peak bone density. The Study concluded that for better BMD among premenopausal women, attention should be paid to early physical activity and healthy nutrition, especially vitamin D, during the childbearing period. OBJECTIVE: To explore the potential determinants of Z-scores among premenopausal Saudi females in different age groups before and after the expected age of peak bone density (PBD). METHODS: This multicenter comparative cross-sectional study was conducted in Madinah and Jeddah, Saudi Arabia, between August 2021 and March 2022. We recruited 886 premenopausal females (605 (68.3%) below and 281 (31.7%) at or above the age of 30). The structured pre-coded Arabic questionnaire included sociodemographic data, a BMD questionnaire, menstrual history, an Arab Teen Lifestyle Study questionnaire, and food frequency data. Metabolic Equivalents (METs) were calculated from physical activity. Analysis of serum PTH, 25(OH) vitamin D (VD) was performed with chemiluminescent immunoassay. BMD was measured with a calcaneal qualitative ultrasound. RESULTS: Most women had age-matched Z-scores, with very few (24 (2.7%)) being non-age-matched with no identified secondary causes. Significant Z-score determinants before PBD were BMI (OR: 0.167, p = 0.003) and total METs (OR: 0.160, p < 0.005). After the age of PBD, significant predictors were parity (OR: 0.340, p = 0.042), history of vitamin D deficiency (OR: 0.352, p = 0.048), and BMI (OR: 0.497, p = 0.019). CONCLUSIONS: Early determinants of Z-scores among premenopausal women were the nutritional status and physical activity. After the age of PBD, parity and vitamin D status offer additional determinants. For better BMD, attention should be paid to early physical activity and healthy nutrition, especially for vitamin D, with intensification of efforts during the childbearing period.

Developing a COVID-19 Mortality Prediction (CoMPred) Indicator for ICU Diabetic Patients Treated with Tocilizumab in Saudi Arabia: A Proof-of-Concept Study.

Since the beginning of the COVID-19 pandemic, efforts have been made to underline its discourse and identify factors contributing to its severe forms. Clinically, many physicians depended on subjective criteria to determine its severe forms, which varied significantly between practices. However, they did not rely on objective laboratory findings. This study aimed to present a novel and objective laboratory-based indicator to predict mortality among COVID-19 patients. The study included 249 COVID-19 patients who were admitted to the ICU, of which 80 did not survive. The COVID-19 Mortality Prediction (CoMPred) indicator was developed by including the age and the following lab investigations: neutrophil-to-lymphocyte ratio (NLR), D-Dimer, PT, aPTT, ESR, CRP, and urea levels. A CoMPred score of 7.5 or higher carries a sensitivity of 81.10% in predicting mortality, i.e., a patient with a CoMPred score of 7.5 or higher has an 81.10% chance of dying. The CoMPred indicator score directly correlates with mortality, i.e., the higher the score, the higher the possibility of the patient dying. In conclusion, the CoMPred indicator is an objective tool that is affordable and widely available, will assist physicians, and limit the burden on clinical decisions on an unpredicted course of COVID-19 in patients.

The Association Between Bone Remodeling Markers, genes polymorphisms with Incidence of Osteopenia Among Young Saudi Female.

Osteopenia and osteoporosis, are prevalent skeletal systemic conditions, cause weaker bones and an increased risk of fragility fractures. This work is aimed to evaluate the relation between bone-remolding markers and genotypes of four single nucleotide polymorphisms in young Saudi females (rs2297480 of farnesyl diphosphate synthase (FDPS), rs3736228 of Low-density lipoprotein receptor-related protein 5 (LRP5), rs1234612 of sclerostin (SOST), and rs9934438 of Vitamin K epoxide reductase complex subunit 1  (VKORC1) ). For this purpose, 750 premenopausal females aged 18 to 40 years old, either university students, postgraduates, or university employees were recruited and divided into three groups according to bone mineral density BMD (g/cm2) divided by T score into osteoporosis (n = 12), osteopenia (n = 147), and normal (n = 591). Serum SOST, BALP, calcium, phosphate, ALP, albumin, beta-CTXs and human VDR levels were determined. TaqMan SNP Genotyping assays were used to genotype four polymorphisms using real-time PCR (applied biosystem). Results showed that BALP, CTX-1 and SOST were significantly higher in the osteoporosis and osteopenia groups than in the normal group. Bone mineral density readings were considerably lower in females with the GG genotype in FDPS rs2297480 and TT genotype in LRP5 rs3736228, which increase the risk for osteopenia by 3. 6-fold and 3. 06-fold than control respectively. Also, females with the TT genotype in LRP5 rs3736228 have decreased average values for Bone Mineral Density. In conclusion, the GG genotype of FDPS rs2297480 and the TT genotype of LRP5 rs3736228 was shown to be strongly associated with osteopenia in young Saudi females with low bone mineral density and SOST levels.

Association Between Vitamin D Level and Z-Score Changes of Bone Density in College-Age Saudi Girls: A Cross-Sectional Study.

Objective: Vitamin D (VD) deficiency is a worldwide health problem. VD plays a crucial role in calcium homeostasis, phosphorus metabolism and bone health. Still much remain to understand the effect of VD deficiency on bone mass. This study aimed to evaluate the relationship between VD levels and bone mass density (BMD) among college-age Saudi females. Methods: In a cross-sectional study, 460 females with a median age of 21 years, were enrolled, completed a comprehensive, structured questionnaire which was validated by experienced endocrinologist, a dietician, and a statistician. Body mass indexes (BMI) were calculated, and BMD was estimated through quantitative ultrasound to ankle. Serum VD, calcium, phosphate, parathyroid hormone, and alkaline phosphatase were measured using chemiluminescent immunoassay technique. Results: VD deficiency reached up to 83.3% (66.9% insufficiency and 16.4% deficiency). Lower than normal BMD was detected in 18.3% of subjects, with only 1.1% having a non-age-matched high risk for osteoporosis. The significant independent predictors of Z-score were age of menarche, menstrual irregularities, dairy products consumption, physical activity, BMI, alkaline phosphatase, and history of previous VD supplementation. Conclusion: VD deficiency and low BMD are highly prevalent among college-age Saudi females. Low BMD is not linked to serum level of VD but to its previous use as a supplementation. Early lifestyle changes, attention to gynecological problems, and prevention of VD deficiency are all needed to support BMD among these girls.

Diabetic Patients' Perspective About New Technologies Used in Managing Diabetes Mellitus in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND:  Diabetes technologies are hardware, devices, and software that are used by people with diabetes to manage their condition, from lifestyle interventions to the monitoring of blood glucose levels. The development of these technologies is advancing, but their use in Saudi Arabia is under-researched. OBJECTIVES:  To appraise the awareness of using new technological options in managing patients with diabetes and to assess the patients' satisfaction while using them. METHOD:  This was an e-questionnaire-based cross-sectional study. The targeted population of the study was patients with diabetes in Saudi Arabia. A total of 452 respondents participated in a survey in the period between 2020 and 2021. The collected data were analyzed using descriptive statistical methods and Chi-squared tests. RESULTS:  Some 69% of participants were aware of the new technologies used in managing diabetes. There were discrepancies between the awareness and the use of new technologies. Several causes of non-use were identified; the main cause was high cost, as reported by more than half of non-users (53.2%). Other causes included non-availability and difficulty of use. Mobile health applications had the highest use rate (13.5%) among new technologies; patients reported using them mostly for blood glucose monitoring, physical activity, and nutritional programs. Patients' satisfaction was higher for modern technologies than for conventional methods. CONCLUSION:  The results indicate that awareness of the new technologies used in managing diabetes was higher than their use. Moreover, the use of modern technologies improved the satisfaction of patients.

Student perception of the educational environment in regular and bridging nursing programs in Saudi Arabia using the Dundee Ready Educational Environment Measure.

BACKGROUND: Taibah University offers regular nursing (RNP) and nursing bridging (NBP) bachelor programs. We evaluated student perception of the learning environment as one means of quality assurance. OBJECTIVES: To assess nursing student perception of their educational environment, to compare the perceptions of regular and bridging students, and to compare the perceptions of students in the old and new curricula. DESIGN: Cross-sectional survey. SETTING: College of Nursing at Taibah University, Madinah, Saudi Arabia. PATIENTS AND METHODS: The Dundee Ready Educational Environment Measure (DREEM) instrument was distributed to over 714 nursing students to assess perception of the educational environment. Independent samples t test and Pearson's chi square were used to compare the programs and curricula. MAIN OUTCOME MEASURE: The DREEM inventory score. RESULTS: Of 714 students, 271 (38%) were RNP students and 443 (62%) were NBP students. The mean (standard deviation) DREEM score was 111 (25). No significant differences were observed between the programs except for the domain "academic self-perceptions" being higher in RNP students (P < .001). Higher mean DREEM scores were observed among students studying the new curriculum in the RNP (P < .001) and NBP (P > .05). CONCLUSION: Nursing students generally perceived their learning environment as more positive than negative. Regular students were more positive than bridging students. Students who experienced the new curriculum were more positive towards learning. LIMITATIONS: The cross-sectional design and unequal gender and study level distributions may limit generalizability of the results. Longitudinal, large-scale studies with more even distributions of participant characteristics are needed.

Vitamin D and extra-skeletal health: causality or consequence.

Vitamin D deficiency /insufficiency is widely recognized as a global health problem that is likely to be involved in pathogenesis or progression of many acute and chronic health disorders. Its relation to skeletal health has been clearly demonstrated and thoroughly examined. This review aims to highlight the continuous debate about the relation between vitamin D and extra-skeletal health and whether it is a causality or just an association. Overall, the available evidence does not meet the criteria for establishing cause-and-effect relationships because of the limitations of observational studies to corroborate the causality due to many potential confounders. Moreover, the causal relationship couldn't be established in randomized studies or in many meta-analyses. This may reflect the fact that vitamin D level reduction is just a biomarker of ill health. The inflammatory processes involved in the disease occurrence and the functional limitations of the diseases would have a role in reducing serum 25-hydroxy vitamin D "25 (OH) D" level, which would explain why low vitamin D is reported in a wide range of disorders. This may underscore the possibility of harm instead of benefit of vitamin D supplementation when its exact role is not fully established, thus many guidelines and interest groups are still hesitant toward recommending replacement in extra-skeletal disease. Future directions entails the need for a large well-designed randomized control trials (RCTs) to resolve the active debate on the benefits of vitamin D replacement for extra-skeletal disease, and not only that, future studies should establish specific, clinically relevant effects of vitamin D repletion, provide cut-values for optimal serum levels of 25 (OH) D, and appropriate doses for non-skeletal health benefits.

The Saudi clinical practice guideline for the management of overweight and obesity in adults.

OBJECTIVE: To assist healthcare providers in evidence-based clinical decision-making for the management of overweight and obese adults in Saudi Arabia. METHODS: The Ministry of Health, Riyadh, Kingdom of Saudi Arabia assembled an expert Saudi panel to produce this clinical practice guideline in 2015. In collaboration with the methodological working group from McMaster University, Hamilton, Canada, using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, which describes both the strength of recommendation and the quality of evidence  RESULTS: After identifying 11 questions, corresponding recommendations were agreed upon as guidance for the management of overweight and obese adults. These included strong recommendations in support of lifestyle interventions rather than usual care alone, individualized counseling interventions rather than generic educational pamphlets, physical activity rather than no physical activity, and physical activity in addition to diet rather than diet alone. Metformin and orlistat were suggested as conditional recommendations for the management of overweight and obesity in adults. Bariatric surgery was recommended, conditionally, for the management of obese adults (body mass index of ≥40 or ≥35 kg/m2 with comorbidities).  CONCLUSIONS: The current guideline includes recommendation for the non-pharmacological, pharmacological, and surgical management of overweight and obese adults. In addition, the panel recommends conducting research priorities regarding lifestyle interventions and economic analysis of drug therapy within the Saudi context, as well as long term benefits and harms of bariatric surgery.

Body weight reduction and metformin: Roles in polycystic ovary syndrome.

BACKGROUND AND OBJECTIVES: Polycystic ovary syndrome (PCOS) is a common problem in women at fertile age. A prospective study was conducted to clarify the pathophysiological responses during an application of insulin sensitizer, metformin and weight reduction therapy at the Gynecology Center in Ohud hospital, in AL-Madinah AL-Munawarah, Kingdom of Saudi Arabia. METHODOLOGY: Twenty healthy women served as controls and 180 PCOS women divided into three groups participated in the study. First group was treated with Clomid citrate 100mg/day from the 2nd day of menses to the 6th day plus gonadotrophin from day three to the 13th. Group II was treated as group I plus 850mg metformin twice a day and group III was treated as group I plus weight reduction. Clinical symptoms, menstrual pattern, hirsutism, blood glucose, body mass index, waist-to-hip ratio, insulin, hormonal, and lipid profiles were assessed pre- and post treatment. Insulin resistance was calculated. RESULTS: PCOS women had significantly higher values than the healthy women in most of the measurements. Metformin and weight reduction therapy resulted in a significant decrease in the fasting insulin, glucose/insulin ratio and HOMA-IR. Metformin and weight reduction therapy resulted in a significant decrease in the lipid parameters, testosterone, LH/FSH ratio, SHBG, and prolactin levels. HOMA-IR was significantly higher in women with PCOS. HOMA-IR was positively correlated with testosterone, estradiol, TG, total cholesterol and LDL-cholesterol parameters, and negatively correlated with HDL-cholesterol and FSH levels. CONCLUSION: Metformin therapy and weight reduction had favorable influences on the basic metabolic and hormonal profiles in women with PCOS and that metformin and lifestyle modification (weight reduction via diet restriction or exercise) resulted in a significantly greater weight loss than hormonal therapy alone. Metformin and weight reduction therapy decreased also hyperandrogenism and insulin resistance.

Nutritional and health status of medical students at a university in Northwestern Saudi Arabia.

OBJECTIVE: To assess the nutrition and health status, nutrients intake, and physical activity among Saudi medical students. METHODS: A cross-sectional survey using a questionnaire, anthropometric measurements, and laboratory assessments was conducted from January to May 2011 on 194 randomly selected Saudi medical students at Taibah University, Madinah, Kingdom of Saudi Arabia. The adequacy of nutrient intake was compared with the recommended daily intake (RDI) per the National Research Council. RESULTS: Caloric intake was derived from carbohydrates (72.1%), fats (19.4%) and proteins (8.4%). Proteins and fats were obtained from a greater number of animal sources than of plant sources (5.3% versus 3.2% for proteins and 11.6% versus 7.8% for fats). There were low percentages of RDI of fibers (8.5%), most vitamins especially vitamin D (14.2%), and minerals (potassium (31.3%), zinc (40.7%), magnesium (24.5%), and calcium (47%). Overall, 34.5% of the students were overweight, and 10.3% were obese. Dyslipidemia was diagnosed in 24.7%, and 56.2% had high high-sensitivity C-reactive protein (hs-CRP). There was a positive correlation between the median caloric intake and both the BMI (r=0.42, p=0.00) and hs-CRP (r=0.3, p=0.001). Inactivity was prevalent among the students (64.4%). CONCLUSION: This study showed deficiencies in several essential nutrients among medical students, and the prevalence of overweight status, obesity, and inactivity were relatively high. These results indicate the need to improve nutrition and promote healthy lifestyles among the medical students.

Assessment of coronary heart diseases in diabetics in al-Madinah al-Munawarah.

BACKGROUND: Coronary heart disease is highly prevalent and a major cause of morbidity and mortality in diabetic patients. The aim of this study was to assess the major risk factors and their predictor score for coronary heart diseases in diabetic patients. METHODS: The present study was conducted in al-Madinah, Kingdom of Saudi Arabia. Using a cross-sectional case control study, 262 outpatient diabetics and 264 matched control subjects were examined for the risk factors and risk predictor scores for ischemic heart disease. The mean age of the patient and control groups was 49.61 ± 12.93 years and 48.39 ± 11.60 years, respectively. RESULTS: Diabetic patients had significantly higher positive family history of diabetes, but no significant difference regarding their family history of hypertension. There was a significantly higher body mass index (33.67 kg/m(2)), glycosylated hemoglobin (7.26%), significantly higher cholesterol, low-density lipoprotein, and triglyceride in diabetics compared to control. Diabetic patients had higher risk for developing coronary heart disease with a mean risk score of 6.07 while the control subject risk score was -6.81. However, females showed significantly higher risk for coronary heart diseases than did males. CONCLUSION: Our study replicates the known fact of higher risk in diabetes, but higher risk of coronary heart disease in female diabetics compared with male diabetics.

Life-threatening hyponatremia following a low-iodine diet: a case report and review of all reported cases.

OBJECTIVE: To report a case of life-threatening hyponatremia as a complication of a 4-week long low-iodine diet and highlight the risk factors for this complication by reviewing all previously reported cases. METHODS: The clinical and biochemical data from the study patient are presented and the pertinent literature is reviewed. A risk analysis for this complication is highlighted. RESULTS: A 66-year-old Vietnamese woman had a total thyroidectomy and bilateral neck lymph node dissection for papillary thyroid carcinoma. A whole body radioiodine scan demonstrated 2 foci of activity in the anterior neck. The patient received recombinant human thyrotropin (rhTSH) and was admitted for radioiodine therapy. She had strictly adhered to a low-iodine diet for 4 weeks in preparation for ablation. The patient was on a thiazide diuretic for her hypertension, which was discontinued on admission. On admission, the patient started feeling light-headed, dizzy, and nauseated. Blood tests revealed a critical serum sodium concentration of 107 mEq/L. Further investigations confirmed hypotonic hyponatremia, which had developed despite being euthyroid after receiving rhTSH. The patient was managed accordingly and made a full recovery. CONCLUSIONS: This case, in addition to the reviewed cases, emphasizes the importance of preventing and managing this rare but relatively dangerous complication. Based on an analysis of the reviewed cases, the risk factors for developing this complication are a prolonged low-iodine diet, the elimination of salt from the diet, and the use of thiazide diuretics. All patients in the reported cases were older than 65 years of age.