Menstrual Changes Following COVID-19 Vaccination: A Cross-Sectional Study.

Background and Objectives: Menstrual changes, including altered cycle length and bleeding patterns, have been reported following COVID-19 vaccination. This study aimed to determine the prevalence and types of menstrual changes occurring after COVID-19 vaccination among female students and staff at a university in Saudi Arabia. Materials and Methods: A cross-sectional study was conducted among women aged 18-39 years who received at least one dose of a COVID-19 vaccine. Eligible participants, including university students and staff, were recruited between May 2022 and November 2022. Participants completed a questionnaire detailing their sociodemographic characteristics, general medical and reproductive history, and menstrual characteristics before and after vaccination. The prevalence of various menstrual changes (cycle length, bleeding days, flow, and mid-cycle spotting) was calculated. The demographic factors associated with menstrual changes were analyzed using chi-squared tests. Results: The 472 included participants had a mean age of 20.9 years, and 95.3% were unmarried. Changes in menstrual cycle characteristics after COVID-19 vaccination were reported by 54.7% of respondents overall. The most common change was in cycle length, followed by the number of menstruation days and bleeding flow. Menstrual changes were not associated with age, BMI, occupation, marital status, or medical history. Changes in intermenstrual bleeding were more frequently reported after the third dose of the Pfizer vaccine compared to the Moderna vaccine (p = 0.014). Conclusions: More than half of the recruited female students and staff reported menstrual changes following COVID-19 vaccination, with altered cycle length being the most common. The potential underlying mechanisms and implications of these menstrual alterations require further investigation. These findings provide evidence of the menstrual side effects of COVID-19 vaccines among women in Saudi Arabia.

Hippocampal Malrotation Presenting With Treatment-Resistant Insomnia: A Case Report.

A frequent complaint in medical settings is insomnia. Chronic insomnia is defined as the occurrence of sleep disturbance symptoms for a period of three months, three times per week, and in conjunction with at least one daytime symptom. In the case study, a young man with a documented seizure disorder underwent a thorough evaluation for chronic sleeplessness. Electroencephalograms, sleep investigations, and drug reviews were unsuccessful in determining the cause. Nonetheless, it was found that there was bilateral hippocampal malrotation. This link is distinct and hasn't been mentioned as a possible cause before.

Effect of Ramadan Fasting on Blood Glucose Level in Pregnant Women with Gestational and Type 2 Diabetes.

Background: Pregnant women with diabetes are strongly advised against Ramadan fasting and have religious exemption, but a large proportion still choose to fast. Unfortunately, there is little information about glycemic control in these patients. This study aims to determine the fasting and postprandial blood glucose levels and to predict the risk factors for hypoglycemia in pregnant women with type 2 diabetes mellitus (DM) and gestational DM (GDM) who fast during Ramadan. Methods: A prospective cohort research was conducted at a single tertiary hospital between 2021 and 2023 on 70 pregnant women with GDM (n = 53) and type 2 DM (n = 17) in their second and third trimester. Their fasting and postprandial blood glucose levels during Ramadan were compared to those of the previous month, and hypoglycemia was defined as blood glucose levels less than 60 mg/dl. Binary regression was used to predict the risk variables for hypoglycemia. Results: The GDM and type 2 DM groups were similar in terms of age, parity, number of fasting days, and number of daily fasting hours. Only 26.9% of the women who were permitted to fast were given special instructions for Ramadan fasting. Dietary intervention was more common in the GDM group, whereas insulin and metformin treatment were more common in the type 2 DM group. The fasting glucose level decreased significantly after Ramadan fasting in both groups, from 92.5 (17.4) mg/dl to 90 (17.13) mg/dl (p = 0.033). However, there were a significantly higher number of hypoglycemia events in the type 2 DM group. Further, type 2 DM was identified as a risk factor for hypoglycemia (OR = 6.23; 95% CI = 1.04-37.54; P = 0.046. Conclusion: The present findings indicate that Ramadan fasting may improve fasting glucose control. In addition, type 2 DM was identified as a risk factor for hypoglycemia.

Correlation between Subclinical Hypothyroidism and Metabolic Syndrome: A Retrospective Study.

Background: Several studies worldwide have studied the correlation between subclinical hypothyroidism (SCH), and metabolic syndrome (MetS), but have reported inconsistent findings. Objectives: To assess the correlation between SCH and MetS in a population from Saudi Arabia. Methods: This retrospective study was conducted at King Abdulaziz University Hospital and analyzed all thyroid function tests conducted between January 1, 2019, to December 31, 2021. A predesigned checklist was used to collect data about patients' characteristics such as age, gender, nationality, TSH, FT4 level, and MetS components. Results: A total of 41,519 thyroid function tests were conducted during the study period. From this, 1303 (3.1%) patients were found to have SCH, with the majority being females (74.4%). The prevalence did not differ according to gender but increased to 3.5% among those aged >60 years. MetS components between mildly and markedly elevated TSH were significant for total cholesterol (P < 0.001) and high-density lipoprotein cholesterol (P < 0.05). Male patients with SCH were at a higher risk of developing diabetes (P < 0.001) and hypertension (P < 0.02), than female patients with SCH. After adjusting for age, in the multiple stepwise linear regression analysis, a significant association was found between TSH levels and ALT (odds ratio: 0.77) and SBP (odds ratio: 0.35). Conclusion: The study demonstrated that the prevalence of SCH is similar between both genders but increases with age. MetS components were abnormal in patients aged >50 years and in males with SCH. SCH and MetS components were found to be correlated, and thus monitoring these variables in patients with SCH is advisable.

Complications and risk factors of early-onset versus late-onset gestational diabetes mellitus: A cohort study from Saudi Arabia.

OBJECTIVES: To contribute to this discussion by comparing the complications associated with early-diagnosed versus (vs.) late-diagnosed gestational diabetes mellitus (GDM) for mothers and infants in order to provide baseline data that might guide future changes in the current recommendations for screening. METHODS: The study compares the risk factors and complications for early- vs. late-diagnosed GDM in a cohort from Saudi Arabia. Prenatal, perinatal, postpartum, and neonatal variables were compared between the early vs. late-diagnosed GDM groups using information gathered from the patient's hospital records. RESULTS: Significant predictors of early-diagnosed GDM included pregestational BMI and GDM history. Additionally, early diagnosis of GDM was linked to a higher incidence of pre-eclampsia and intrauterine fetal death. Women with early-diagnosed GDM also required more glycemic control interventions, like administering insulin and metformin and controlling their diet. The fetal birth weight and postpartum BMI were significantly higher in the early onset GDM group. The need for insulin and pre-eclampsia were significant factors linked to an early diagnosis of GDM, according to a logistic regression analysis. CONCLUSION: Therefore, the current findings emphasize the need for early screening in pregnant women with high pregestational BMI and a history of GDM and show that those with early-onset GDM more likely to need insulin therapy and be at a higher risk of developing pre-eclampsia.

Obesity prevalence, physical activity, and dietary practices among adults in Saudi Arabia.

Introduction: The current study evaluated obesity prevalence, physical activity, and dietary practices among Saudi adults in the Makkah region of the Kingdom of Saudi Arabia (KSA). The current survey was accomplished between November 2021 and March 2022. Method: A validated questionnaire, Arab Teens Lifestyle Study (ATLS), was used to evaluate all participants' physical activities, sedentary behaviors, and nutritional habits in addition to demographic data. Result: A total of 2,115 people [1,238 (58.5%) women and 877 (41.5%) men] participated in this survey. Being overweight was prevalent in 32.8% of the population (41% of men and 28.9% of women), obesity was prevalent in 23% of the population (males 23.1% and females 24.2%). Obese people consumed more soft drinks, and overweight people did not consume enough vegetables (fresh/cooked). Obese people consumed fast food (e.g., burgers, sausage, pizza, or Arabic shawarma) over three times each week. The mean (SD) number of days of practice walking was 2.51 (2.05) vs. 1.3 (1.87) (p < 0.001) for lean and obese individuals, respectively. In addition, individuals with normal BMI had more days of jogging, moderate and high-intensity exercise, dancing, and strength training than those with obesity. The odds of being obese increased with age (OR: 1.07; p < 0.001), in males (OR: 2.16; p < 0.001), in participants earning <5,000 SR/month (1.3 thousand $) and 10-15 thousand SR/month (1.34-2.66 thousand $) (OR: 2.36; P = 0.01). Obesity was inversely associated with moderate-intensity exercise (OR: 0.802; p = 0.009), and regular walking (OR: 0.685; CI: 0.624-0.752; p < 0.001). Discussion: Overweight and obesity were prevalent in 32.8% and 23% of the population, respectively. Sociodemographic factors associated with obesity. Focused intervention strategies are needed to overcome the obesity issue.

Obesity and Its Associations with Gender, Smoking, Consumption of Sugary Drinks, and Hour of Sleep Among King Abdulaziz University Students in Saudi Arabia.

Background: This study investigated the prevalence of obesity among university students in Saudi Arabia's western region, as well as its association with gender, smoking, consumption of sugary drinks, and hours of sleep. Methods: A cross-sectional study recruited a simple random sample of students from King Abdulaziz University (KAU) in Saudi Arabia's western region. In this study, the Arab Teens Lifestyle (ATLS) questionnaire was used. The survey was conducted between April and June 2022. Results: In total, 659 students participated (313 males [37.3%] and 437 females [66.2%]). One-fourth of the students, 158 (24%), were overweight, and 83 (12.7%) were obese. Male participants were overweight or obese by a rate of 32.6% and 19.4%, respectively. Female overweight and obese rates were 16.2% and 6.6%, respectively. Moreover, obesity/overweight rates were 43.6% in the urban area and 36.9% in the rural area (P=0.03). A total of 370 participants (56.14%) slept less than 8 hours per day, 185 (28.1%) spent more than five hours per day watching television or using the internet, and 303 (46%) ate breakfast on a regular basis. Obesity/overweight was more common in smokers than in nonsmokers (59.7% vs 32.8%, P=0.01). The prevalence of obesity was lower among those who walked three days or more per week (28.1% vs 44.1%; P=0.01) and ran/jogged outside or on a treadmill three days or more per week (29.5% vs 39.8%; P=0.03) than among those who ran/jogged less than three days per week. Student obesity was independently predicted by being male (P=0.01), drinking more sugary drinks (P=0.01), smoking (P=0.03), and sleeping for fewer hours (P=0.03). Conclusion: Obesity was more prevalent in male students, with a prevalence of 24%. Male gender, consumption of more sugary beverages, smoking, and sleeping for fewer hours were all independent predictors of obesity among university students.

Interplay Between Sociodemographic Variables, Physical Activity, Sleep, Dietary Habits, and Immune Health Status: A Cross-Sectional Study From Saudi Arabia's Western Province.

BACKGROUND: In addition to developing effective therapeutic approaches, the maintenance of health also constitutes lifestyle and behavioral aspects related to being more resilient in the event of future illness. Reduced immune health has been linked to reports of more frequent and severe infections as well as a variety of non-communicable diseases, both of which may eventually place a significant burden on the healthcare system. Several lifestyles and behaviors can influence immune health, both positively and negatively. Accordingly, this study aimed to evaluate the immune health status and investigate its relationship with widely practiced lifestyle behaviors that are thought to affect immunological functioning. DESIGN AND METHOD: Saudi Arabian citizens and international residents of the Western Province were invited to participate in this cross-sectional web-based survey through an online advertisement. The integrated questionnaire on lifestyle (Arab Teens Lifestyle Study) and immune health status (Immune Status Questionnaire (ISQ)) was completed in November 2022 by 1230 participants. Descriptive analysis, Mann-Whitney U test, chi-square, or Fisher's exact test was utilized to investigate the relationships between study variables and immune health status groups. Spearman's or Pearson's correlation coefficients were used to determine correlations between the overall ISQ scores and study variables. RESULTS: Of the 925 study participants, 34.7% scored below 6 on the ISQ. Of the respondents, 50% had a body mass index of 25 or higher, and 46.3% reported sleeping less than four hours each night. Of the participants, 62-82% did not engage in any form of physical activity. The associations between the ISQ score and weight (p = 0.006), total sleep time per night (p = 0.001), duration of household activities (p < 0.001), and smoking status (p = 0.001) were statistically significant. CONCLUSIONS: According to the data presented here, reduced immune health as measured by ISQ < 6 was prevalent among residents of Saudi Arabia's Western Province and correlated significantly with obesity, sleep duration, and smoking status. Various measures to mitigate the negative impact of an unhealthy lifestyle on public health and to reverse the observed poor immune health and their economic consequences are highly required.

Cardiac myxoma presenting with multisystem involvement.

A cardiac myxoma is a rare tumor that could be incidental or present with common symptoms due to embolization. A minority of cases are attributed to carney complex, a rare inherited disease. A 73-year-old Asian male presented with acute left-side weakness, slurred speech, gait imbalance, and subacute constitutional symptoms. Left atrial myxoma was discovered by computed tomography and confirmed by echocardiography. Brain imaging revealed pituitary macroadenoma with subarachnoid and intraventricular hemorrages. The hormonal profile confirmed pituitary apoplexy, for which hormone replacement was initiated. Workup also revealed multiple endocrine tumors and excluded infection and malignancy. Myxoma resection could not be carried out, due to the patient's rapid clinical deterioration and death.Furthermore, the presence of cardiac myxoma, non-functioning pituitary macroadenomas, and pituitary apoplexy is extremely rare and rarely documented in the literature. Therefore, we emphasize clinical awareness of rare conditions with atypical presentations to improve outcomes.

A pragmatic randomized controlled trial comparing pathway-based versus usual care in community-acquired acute kidney injury.

Clinical pathways have shown conflicting evidence in improvement of several patient-centered outcomes across different clinical settings. However, the effectiveness of clinical pathway in management of acute kidney injury (AKI) has not been reported. Therefore, we aimed to assess the length of hospital stay (LOS) and patient-centered outcomes in community acquired AKI and compared pathway care (PC) versus usual care (UC). The CHAMP-Path AKI Trial is a pragmatic, parallel, single-blind randomized controlled trial. Physicians were randomized to provide either UC or PC. Patients were randomized through a computer-generated sequence. Allocation was concealed. Patients presenting to the emergency department with AKI and hemodynamic stability, who were over 14 years with a serum creatinine greater than 1.5 times the baseline were eligible. Patients with chronic kidney disease stages 4 or 5, kidney transplantation recipients, those admitted with obstructive uropathy, suspected glomerular or interstitial disease, and pregnant women were excluded. Thirty-eight patients were enrolled from March 2012 to December 2013. The primary outcome was LOS. Secondary outcomes included: 30-day readmission, in-hospital mortality, determinants of LOS, and patient-centered outcomes. Eighteen patients were randomized to PC, and 20 to UC. Baseline characteristics were comparable in both groups. Using an intention-to-treat analysis, the median LOS was 4.96 [interquartile range (IQR) 6.57] and 4.80 days (IQR 6.84) for PC and UC, respectively (P = 0.770). Of the five readmissions, none were for AKI. No in-hospital mortality was reported. The CHAMP-Path AKI pragmatic trial demonstrated that PC was not different than UC in reducing LOS. There was no difference in 30-day re- admission, in-hospital mortality, and patient-centered outcomes.

Knowledge and Awareness of Colorectal Cancer among Undergraduate Students at King Abdulaziz University, Jeddah, Saudi Arabia: a Survey-Based Study.

BACKGROUND: This study explored the knowledge and awareness about colorectal cancer (CRC) among undergraduate students of one of the leading universities in Saudi Arabia, along with the mode of information access. MATERIALS AND METHODS: The present cross-sectional study was conducted at the King Abdulaziz University, Jeddah, Saudi Arabia, among students of different faculties. The study questionnaire, containing 28 items, was adapted from surveys identified in the relevant literature. The CRC awareness questionnaire consisted of an awareness section (early CRC signs and symptoms, and risk factors) and a knowledge section. The data were analyzed using the SPSS version 21.0. RESULTS: A total of 525 undergraduate students participated in the study. The majority were females (63.0%) and approximately half (56.8%) were medical students. The majority of the students (82.3%) were aware of CRC, and 68% thought that CRC is a preventable disease. Regarding colorectal cancer screening tests, only one-third of students (33%) had actual knowledge, while the majority of the students (77.0%) thought that there are tests which help in early detection. Only 4% of the participants had a family history of CRC. The majority of the participants (84%) thought that CRC is a disease that can be cured. Almost 50-60% participants had good awareness level regarding risk factors, and signs and symptoms. Regarding knowledge, participant responses varied for family history (52%), age (59%), chronic infection of the colon (72%), obesity and lack of exercise (66%). More than one-third of the students had received information material regarding CRC from their curriculum followed by social media (20.4%), and nearly 40% from other sources such as TV, hospital and mass media. Female participants had significantly better awareness in a few questions regarding CRC awareness as compared to their male counterparts. There was a significant difference observed between medical and non-medical students (<0.001) in overall score of awareness and knowledge about CRC while no significant difference found in gender-wise comparison. CONCLUSIONS: Knowledge and awareness of students about CRC were not up to the mark. Medical students and female students had better knowledge in a few areas, but the overall situation is dismal.