Ribonanza: deep learning of RNA structure through dual crowdsourcing.

Prediction of RNA structure from sequence remains an unsolved problem, and progress has been slowed by a paucity of experimental data. Here, we present Ribonanza, a dataset of chemical mapping measurements on two million diverse RNA sequences collected through Eterna and other crowdsourced initiatives. Ribonanza measurements enabled solicitation, training, and prospective evaluation of diverse deep neural networks through a Kaggle challenge, followed by distillation into a single, self-contained model called RibonanzaNet. When fine tuned on auxiliary datasets, RibonanzaNet achieves state-of-the-art performance in modeling experimental sequence dropout, RNA hydrolytic degradation, and RNA secondary structure, with implications for modeling RNA tertiary structure.

A nephrologist dream of peritoneal dialysis catheter with zero migration: A multicenter prospective study.

INTRODUCTION: PD catheter tip migration is a common complication and a significant cause of catheter malfunction. In this perspective, we present our experience with a new catheter and a new technique that involves the use of a new triple cuff PD catheter and a low entry site in an attempt to prevent PD catheter migration. METHODS: A total of 503 incident PD patients have been studied in more than one PD center over a period of 5 years. RESULTS: During the 5-year follow up we recorded zero percent catheter migration. Other technical complications were poor drainage in 3.4%, omental wrap in 2.8%, early leakage in 3.4%, and catheter replacement in 2.4%. By the end of the study, the one-year PD catheter survival was 97.6%. CONCLUSION: Our new triple cuff PD catheter and our low-entry approach seem to be effective in preventing PD catheter migration and minimizing other mechanical complications.

[Anti-IL-5 in severe asthma associated with eosinophilic granulomatosis with polyangiitis. Real-life study]. / Anti-IL-5 dans l'asthme sévère associé à une granulomatose éosinophilique avec polyangéite. Étude en vie réelle.

INTRODUCTION: Eosinophilic granulomatosis with polyangiitis (EGPA) is a form of necrotizing vasculitis affecting small vessels and typically characterized by severe glucocorticoid (GC)-dependent eosinophilic asthma. While mepolizumab, which is indicated at a dose of 100mg/4weeks in severe eosinophilic asthma, has been shown to be an effective treatment for EGPA-related asthma at a dose of 300mg/4weeks, it was only recently approved at this dose. METHODS: This retrospective, single-center, observational study was conducted to investigate over a 5-year period (2014-2019) the effect of mepolizumab 100mg/4weeks at 12months in patients with EGPA and glucocorticoid-dependant severe asthma. Response to treatment was defined as reduction in daily dose of oral corticosteroids to at most 5mg/day or reduction in annual exacerbation by at least 50%. RESULTS: Thirty patients were included, of whom twenty-three were treated (two were not fully evaluable). Among the 21 evaluable treated patients, 13 (62%) had responded at 12months. At baseline, non-responders had lower FEV1 levels and lower blood eosinophil levels than responders. CONCLUSIONS: Mepolizumab at a "severe asthma" dose (100mg/4weeks) is effective in treatment of GC-dependent severe asthma in most patients with EGPA.

Homocysteine as a predictor and prognostic marker of atherosclerotic cardiovascular disease: a systematic review and meta-analysis.

OBJECTIVE: Hyperhomocysteinemia is a well-known marker that is associated with an increased risk of atherosclerosis due to its toxic effect on endothelial cells. This, in turn, leads to cardiovascular injury and increases morbidity. Different studies have shown alterations in the levels of homocysteine with respect to multiple disease states. Whether this non-traditional marker is associated with cardiovascular injury or not is subject to conflicting results. The purpose of this systematic review is to evaluate the role of homocysteine in the formation of atherosclerotic cardiovascular disease in young adults and children. MATERIALS AND METHODS: This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). A search was done using specific keywords, including "homocysteine", "coronary artery disease", and "atherosclerosis", amongst several others, from the databases of PubMed, COCHRANE, and EBSCO. The data items included the diseased sample population along with the intervention used, or investigations carried out and the findings of the studies. Finally, 35 eligible studies were included. RESULTS: Young patients with atherosclerotic cardiovascular disease were more likely to have elevated levels of homocysteine compared to elderly patients. Elevated levels of homocysteine have been observed with several genetic, nutritional deficiencies, and autoimmune states such as rheumatoid arthritis. On the other hand, decreased levels of homocysteine have been observed after certain intervention treatments, such as oral contraceptive pills, L-thyroxine, and even the adoption of certain diets. In the majority of studies, whenever homocysteine levels were higher than normal, this was reflected by an increased carotid intima-media thickness. CONCLUSIONS: Homocysteine has a high correlation with atherosclerotic cardiovascular disease in young and overweight patients. In addition, the relationship of homocysteine with smoking, genetic polymorphism, specific hormonal and renal disorders, nutritional deficiencies (vitamin B12 and folic acid), and the use of specific medicines are among the other recurring findings. Given that many of these studies focus only on women, the relationship between homocysteine and atherosclerotic cardiovascular diseases in males is still unclear. Whether males are more prone to hyperhomocysteinemia needs to be assessed. Still, precise processes underlying variations in homocysteine in relation to all influencing factors are unclear and need further studies.

Decreased plasma myonectin levels in female patients with type 2 diabetes mellitus and its correlation with lipid and glycemic parameters.

OBJECTIVE: Myonectin is a novel myokine which has significant implications on diabetes. This study aimed to investigate plasma myonectin levels in patients with type 2 diabetes mellitus (T2DM), and their correlation with body composition, lipid and glycemic parameters. PATIENTS AND METHODS: The study participants included 40 diabetic and 33 non-diabetic healthy adult Saudi females matched for their BMI and age. Body composition was assessed by bioelectrical impedance analysis. Fasting blood samples were used to investigate plasma myonectin levels by ELISA, along with lipid and glycemic parameters. RESULTS: We found that plasma myonectin levels were significantly decreased in diabetic patients (40.90±4.13 ng/ml, p<0.05) compared to non-diabetic participants (59.58±4.41). Diabetic patients with poor glycemic parameters had significantly decreased myonectin levels (35.18±4.03 ng/ml p<0.05) compared to non-diabetic healthy subjects. There was no significant difference in myonectin levels between diabetic patients with good glycemic control (55.76±8.09 ng/ml p>0.05) and non-diabetic healthy participants. Pearson correlation analysis indicated a significant negative correlation with fasting blood sugar (R=-0.366, p=0.001), HbA1c (R=-0.406, p<0.0001), triglycerides (R=-0.264, p=0.024), insulin (R=-0.278, p=0.017), and HOMA-IR (R=-0.409, p<0.0001). CONCLUSIONS: Our findings highlight an important aspect of myonectin in the pathophysiology of T2DM. They also show that myonectin has the potential to be a useful biomarker and therapeutic target in T2DM.

Role of Nuclear Morphometry in the Cytologic Evaluation of Benign and Malignant Thyroid Lesions.

Thyroid lesions are very common problem in Bangladesh. To categorize the type of lesion, FNAC is a reliable, minimally invasive and cost-effective diagnostic modality. In routine cytology, precise categorization into benign and malignant is highly subjective. So, additional methods are needed to improve the accuracy of cytological diagnosis. Computerized semi-automatic nuclear morphometry is an objective and reproducible tool for quantitative evaluation of nuclear features which may help to differentiate between benign and malignant thyroid lesions in cytology. Objective of the study was to apply morphometry with regard to nuclear size parameters, shape parameters and nuclear chromasia with derivation of suitable cutoff values to differentiate benign and malignant lesions of thyroid gland. This cross-sectional study was done in total 55 cases at the Department of Pathology, Bangabandhu Sheikh Mujib Medical University, Bangladesh from March 2018 to February 2020. Morphometry was done on images containing diagnostic cells captured from cytological smears with open source ImageJ morphometric software. In this study, all the nuclear size parameters and one nuclear shape parameter was found significant in differentiating benign and malignant lesions. No significant difference was observed in analysis of chromasia parameter. The cut-off values derived between all benign and malignant lesions for mean value of nuclear area, maximum feret diameter, perimeter and aspect ratio were 40.20µm², 8.46µm, 6.68µm, 28.28µm and 1.35 respectively with sensitivity of 86%, 95%, 81%, 90% and specificity of 97%, 93%, 97% and 97% respectively. The Nuclear morphometry may be used as an adjunctive tool to routine thyroid cytology.

Relationship of serum inducible and endothelial nitric oxide synthase with exercise in healthy adult males and patients with type 2 diabetes mellitus.

OBJECTIVE: The importance of physical activities in the control of diabetes mellitus disorder is well known but its correlation with endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) in diabetic patients needs to be assessed. The aim of the study is to examine inducible and endothelial nitric oxide synthase in healthy adult male patients with type 2 diabetes mellitus (T2DM) in relation to exercise. PATIENTS AND METHODS: This is a cross-sectional study that has been performed in the Department of Physiology, King Saud University, Riyadh, Saudi Arabia. Subjects were divided into Group 1: control (n=79), and Group 2: T2DM (n=85). Each group was subdivided into three subcategories: sedentary, moderate activity, and active subjects. Serum nitric oxide (NO), iNOS, eNOS, high sensitivity C-reactive protein (hs-CRP), nitrates, and nitrites, were compared between different groups. RESULTS: We observed significant differences in iNOS in diabetic patients compared to the control [29.1 (2.8) vs. 22.4 (1.4), p=0.050] with a significant decrease in eNOS when compared to the control group [79.5 (4.8) vs. 101.8 (5.7), p=0.003]. In the control group, eNOS showed significant differences (increase) between subgroups; sedentary, moderate, and active control subjects [77.4 (9.2), 114.7 (9.3), and 105.6 (9.5), p=0.026]. It also showed insignificant differences between subgroups in iNOS [23.4 (2.5), 24.2 (2.2), and 20.4 (2.4), p=0.520]. In addition, hsCRP showed a decrease with exercise but with no statistically significant difference between the groups [4.0 (0.5), 3.3 (0.3), and 2.9 (0.4), p=0.271]. In the diabetic patients' group, a significant difference (decrease) between subgroups in iNOS [43.5 (4.8), 20.8 (3.9), and 19.8 (4.6), p<0.001] and hsCRP [5.7 (0.5), 3.8 (0.4), and 3.6 (0.5), p=0.006] was detected. In addition, eNOS showed a decrease with exercise but with no statistically significant difference between groups [82.9 (7.8), 74.6 (7.9), and 81.7 (10.2), p=0.741]. CONCLUSIONS: Patients with T2DM have shown significantly low eNOS and high iNOS levels. Furthermore, regular exercise can significantly decrease iNOS in patients with T2DM. Therefore, the importance of exercise for diabetic patients has to be emphasized to prevent long-term complications related to diabetes mellitus.

Identification of Variants and Mutational Analyses of Cardiac Myosin-binding Protein C (MYBPC3) Gene of Adult Bangladeshi Patients with Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is the most prevalent genetic hereditary cardiomyopathy characterized by sudden cardiac death. Mutations in the MYBPC3 gene are often the most prevalent genetic abnormality in HCM with a prevalence ranging from 20.0 to 42.0%. The mutation spectrum is available for different countries, but such studies are lacking in the Asian population including Bangladeshi patients. A cross-sectional descriptive study was conducted for mutation analysis of the whole MYBPC3 gene on a cohort of 75 HCM Bengali Bangladeshi probands through Next Generation Sequencing at the Genetic Research Lab of Bangabandhu Sheikh Mujib Medical University from 2016 to 2019. The structural and functional impact of the mutations was further analyzed by in silico process. We analyzed the data and found 103 variants in 102 locations in the MYBPC3 gene. Variants were identified in both the coding region and the non-coding region. We found one possibly novel variant in the MYBPC3 gene. The findings of this research will help to develop a genetic database of HCM which will help in the early diagnosis and proper management of HCM patients in Bangladesh. One pathogenic splice donor variant (47356592 C >T) was found in the intronic region. Among the variants in the coding region, one missense mutation was pathogenic (NP₋000247.2: p.Asp770Asn) which was found in seven patients and another one is of conflicting interpretations of pathogenicity (NP₋000247.2: p.Ser217Gly) which was found in two patients. We have identified one in-frame deletion (NP₋000247.2: p.Ala433del) that is possible a novel variant responsible for the development of HCM.

A Case of Congenital Coronary Ostial Stenosis with Systemic Lupus Erythematosus.

Congenital coronary ostial stenosis or atresia (COSA) is a spectrum of rare developmental conditions with different pathophysiologic mechanisms and clinical implications. Although COSA includes various entities, these entities have two features in common. First the defect is congenital, although it may progress during pre-natal and post natal life. Second the developmental defect may cause ostial or proximal coronary obstruction (that is stenosis or atresia). Coronary ostial stenosis or atresia affects the left coronary (L-COSA) more frequently than it does the right coronary artery. Systemic Lupus Erythematosus (SLE) is not an uncommon disease in young female, but combination of congenital coronary ostial stenosis with systemic lupus erythematosus make the case very rarer. Here we presented A 17 years old girl got admitted to Bangabandhu Sheikh Mujib Medical University, Bangladesh for evaluation of on and off chest pain of CCS-III to CCS-IV for 1 day on 17 September 2019.

Predictive value of arm circumference (AC) and arm muscle circumference (AMC) with cardiovascular risk in healthy and diabetic males.

OBJECTIVE: The predictive value of body simplified indices needs to be evaluated properly for cardiovascular risk. This study aimed to assess and compare the relative relationship of arm circumference (AC), arm muscle circumference (AMC), body mass index (BMI), and waist-hip ratio (WHR) with Ultra-Sensitive C-Reactive Protein (US-CRP) in healthy male subjects and with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: We performed the study at the department of Physiology, College of Medicine & King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. It was a cross-sectional study with 93 healthy male subjects and 112 type 2 diabetic male patients who underwent body composition analysis by BIA and fasting venous blood samples were collected. US-CRP and body composition were determined for all subjects. RESULTS: US-CRP is correlated positively with AC (0.378) and BMI (0.394) more than AMC (0.282) and WHR (0.253) which have lower correlation both in control and DM group. BCM has the lowest correlation with US-CRP (0.105). The association between US-CRP and AC, AMC, Body Fat Percent (BFP), and body fat mass (BFM) are statistically significant except for BFP in DM group. In control group, AC is noticed to be a better predictor for US-CRP, with area under curve (AUC) 64.2% (p=0.019), WHR with AUC 72.6% (p<0.001), and BMI with AUC 65.4% (p=0.011) but AMC is not a good predictor in control group with AUC 57.5% (p=0.213). In DM group, AC is noticed to be a better predictor for US-CRP, with AUC 71.5% (p<0.001), WHR with AUC 67.4% (p=0.004), BMI with AUC 70.9% (p=0.001), and AMC with AUC 65.2% (p=0.011). CONCLUSIONS: Simplified muscle mass body indices like AC and AMC have significant predictive value for assessing cardiovascular risk in both healthy population and patients with T2DM. Therefore, AC could be used as a future predictor for cardiovascular disease in healthy and DM patients. Further investigations are needed to confirm its applicability.

Knowledge, attitude and practices of schoolteachers toward epilepsy and students with epilepsy.

OBJECTIVE: This study aimed to estimate and evaluate teachers' knowledge, attitudes, and practices toward students with epilepsy and to determine the association between selected demographic factors. SUBJECTS AND METHODS: This cross-sectional study was approved by the ethical committee of King Saud University, Riyadh, Saudi Arabia. The study was conducted at the department of physiology, King Saud University, from October 2020 until October 2021. The data was collected through anonymous online self-administered 44-item questionnaires. The sampling technique used was Snowball sampling from ten randomly selected schools in Riyadh. RESULTS: The total sample size was 456 participants. The mean age of the respondents was 41.5 ± 8.52, and a male to female ratio of 1.4:1. The mean years of experience of the respondents is 16.14 ± 8.85. Almost all teachers knew that epilepsy is a neurological disorder (97.8%). However, females were more likely to know the cause of epilepsy (p=0.003). The majority of public-school teachers (80.2%) thought that epileptic students have normal intelligence (p=0.004). A considerable proportion of public-school teachers (82.8%) do not mind having a student with epilepsy in their classes (p=0.012). The vast majority of schoolteachers (95.4%) have not had any training on how to deal with an epileptic student during a seizure. CONCLUSIONS: This study shows that schoolteachers have very good knowledge about epilepsy but poor practice towards it. Well-directed training programs are needed to qualify teachers in providing first aid to epileptic students during seizures.

Health hazards related to using masks and/or personal protective equipment among physicians working in public hospitals in Dhaka: A cross-sectional study.

BACKGROUND: Wearing masks or personal protective equipment (PPE) has become an integral part of the occupational life of physicians due to the coronavirus disease 2019 (COVID-19) pandemic. Most physicians have been developing various health hazards related to the use of different protective gears. This study aimed to determine the burden and spectrum of various health hazards associated with using masks or PPE and their associated risk factors. METHODS: This cross-sectional survey was conducted in Dhaka Medical College from March 01-May 30, 2021, among physicians from different public hospitals in Dhaka, Bangladesh. We analyzed the responses of 506 physicians who completed case record forms through Google forms or hard copies. FINDINGS: The mean (SD) age of the respondents was 35.4 [7.7], and 69.4% were men. Approximately 40% were using full PPE, and 55% were using N-95 masks. A total of 489 (96.6%) patients experienced at least one health hazard. The reported severe health hazards were syncope, severe dyspnea, severe chest pain, and anaphylaxis. Headache, dizziness, mood irritation, chest pain, excessive sweating, panic attack, and permanent facial disfigurement were the minor health hazards reported. Extended periods of work in the COVID-19-unit, reuse of masks, diabetes, obesity, and mental stress were risk factors for dyspnea. The risk factors for headaches were female sex, diabetes, and previous primary headaches. Furthermore, female sex and reusing masks for an extended period (> 6 h) were risk factors for facial disfigurement. The risk factors for excessive sweating were female sex and additional evening office practice for an extended period. CONCLUSIONS: Healthcare workers experienced several occupational hazards after using masks and PPE. Therefore, an appropriate policy is required to reduce such risks.

Serum inducible and endothelial nitric oxide synthase in coronary artery disease patients with Type 2 Diabetes mellitus.

OBJECTIVE: Coronary artery disease (CAD) is a well-known cause of morbidity and mortality in type 2 diabetes mellitus (T2DM). The role of endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) in T2DM patients in relation to CAD is not well understood. We examined serum inducible and endothelial nitric oxide synthase activities in patients with T2DM in relation to the presence of coronary artery disease. PATIENTS AND METHODS: The present study was conducted in the Department of Physiology, King Saud University, Riyadh, Saudi Arabia. Subjects were grouped into control (Group A, n=87), T2DM without CAD (Group B, n=70), and T2DM patients with CAD (Group C, n=49). The selection of T2DM subjects was according to the American Diabetes Association (ADA). Serum iNOS, eNOS, hsCRP, nitrates and nitrites along with lipid profile were compared between different groups. Spearman's correlation and ROC analysis were also performed. RESULTS: Serum eNOS levels were significantly high in the control group (112.38±47.16 U/ml) than in DM without CAD (81.43±49.91 U/ml) and DM with CAD (84.80±43.32 U/ml, p<.001). Serum iNOS levels were significantly higher in DM with CAD (42.87±28.83 U/ml) compared to both control (22.08±11.77 U/ml) and DM without CAD (16.24±12.30 U/ml, p<.001). Additionally, the differences in nitrite and NO were not significant between the three groups (34.06±24.75, 33.02±21.50, 38.83±24.34 uM, p = .384), and (56.51±36.78, 49.89±28.83 vs. 55.77±30.34 uM, p=.416) respectively. ROC curve analysis revealed a sensitivity and specificity of 73.5% and 68.6% of iNOS level at a cutoff point of 21.1 U/ml to predict CAD in T2DM patients. The ROC analysis for iNOS, eNOS, and hs-CRP were .782 (p<.001), .574 (p=.170), and .726 (p<.001), respectively. CONCLUSIONS: Patients with T2DM have significantly higher levels of serum iNOS and lower levels of eNOS. However, iNOS levels were significantly higher in T2DM patients with concomitant CAD. Moreover, iNOS activity positively correlated with glycemic control and hsCRP. Therefore, iNOS could be an emerging future marker for CAD in T2DM patients and its antagonists could be useful in the management of these patients.

Online patient portal-based management of medication renewal and refill pickup in ambulatory care settings: A retrospective utilization study at tertiary care hospital in Saudi Arabia.

BACKGROUND: The prescription pickup and renewal process in ambulatory care settings requires numerous steps, such as making an appointment with a physician to renew prescriptions and direct pharmacy visits to pick up medications. This process can be difficult or cumbersome for some patients; however, digital health-associated patient portals can reduce the burden on both patients and healthcare professionals. METHODS: A retrospective study was conducted in an ambulatory care setting of Johns Hopkins Aramco Healthcare. We analyzed the utilization pattern of MyChart for medication renewal and refill pickup services for ambulatory care patients of all specialties from October 1, 2018, to September 30, 2020. The data were extracted electronically from the Epic-Hyperspace EHR system, and the effects of factors such as year of access and COVID-19 on MyChart utilization were analyzed. RESULTS: A total of 125,538 patients were registered using MyChart. In the first and second year of this study, MyChart was utilized by 44,063 (8.7%) and 59,622 (13.6%) patients, respectively, for medication pickup. Additionally, in these two years, 92,997 (21.6%) and 156,020 (38.9%) medication refills were requested through MyChart (with no direct pharmacy visit) and collected from different pickup locations, respectively. In two years, there were 363,159 medications sent to physicians for renewal through Epic-MyChart, of which 347,244 (95.6%) were approved and 15,915 (4.4%) were denied. A significant increasing (p less than 0.05) trend in utilization, medication requests, and renewal requests using the MyChart were observed over a period of 24 months and during quarantine due to COVID-19. Although there was a decrease in physicians denying renewal request, these were not significantly affected by time or COVID-19. CONCLUSION: The high and consistent utilization of the patient portal MyChart indicates its broad acceptance, significantly minimizing the barriers to medication pickup and renewal processes in ambulatory care settings. The year of access and COVID-19 were significantly associated with an increasing trend in MyChart utilization. With increased utilization and higher acceptability, the internet-based patient portal MyChart continues to hold great potential for providing quality healthcare services by increasing access and making patients decision-makers in their healthcare.

Validation of Various Prediction Scores for Cardiac Surgery-Associated Acute Kidney Injury.

Background and objectives: Following cardiac surgery, acute kidney injury (AKI) is a well-known complication that increases morbidity and mortality. This study was carried out to determine the factors associated with acute kidney injury and to assess the predictive value of three predictive scores for the development of AKI post-cardiac surgery in the Saudi community. Methods: In this retrospective study, the medical records of patients aged 18 years and above who underwent cardiac surgery on cardiopulmonary bypass (CPB) at Saud Albabtin Cardiac Center between January 2018 and March 2021 were reviewed. The first stage of both Kidney Disease Improving Global Outcomes (KDIGO) criteria and the risk, injury, failure, loss, end-stage (RIFLE) criteria were used to define AKI. The predicting value for acute kidney injury following cardiac surgery (AKICS score) and Renal replacement therapy for acute kidney injury (RRT-AKI) (Cleveland score, and SRI) were evaluated by area under receiver operating characteristic curve (AUROC) for the discrimination and Hosmer-Lemeshow test for the calibration. Results: Among the 329 patients evaluated, the total postoperative incidence of acute kidney injury was 26.4%. Moreover, the incidence of RRT-AKI was 2.1%. Using multivariate logistic analysis, the factors independently associated with AKI were CABG on pump-beating heart, presence of chronic kidney disease, pre-operative anemia, prolonged bypass time, and post-operative exposure to inotropes or vasopressors. For the prediction of CSA-AKI, the discrimination of AKICS (AUROC = 0.689) was poor, while the calibration (x2 = 9.380, P = 0.311) was fair. For RRT-AKI prediction, the discrimination of Cleveland score (AUROC = 0.717) was fair while the discrimination of SRI (AUROC = 0. 681) was poor. On the other hand, the calibration for both of them was fair (Cleveland score x2 = 3.339, P = 0.342; SRI x2 = 7.326, P = 0.120). Conclusion: In this single-center study, SRI score demonstrated a reasonably good prediction of RRT-AKI incidence. However, further researches are required to investigate the perioperative factors in order to create a unique risk score model that may be used in a population with widespread comorbidities.

Knowledge attitude and practices of university students to Vitamin D and Vitamin D supplements during times of low sun exposure and post lockdown.

OBJECTIVE: Vitamin D deficiency is prevalent in Saudi Arabia. Inability to get sun exposure greatly influences Vitamin D levels. Getting enough Vitamin D during childhood and young adulthood can prevent possible future diseases. We aim to estimate the level of knowledge of Saudi University students about Vitamin D and Vitamin D supplements, to correlate it with their attitudes and practices to sun exposure and Vitamin D supplements and to compare between males and females. MATERIALS AND METHODS: This is an epidemiological cross-sectional KAP study conducted at King Saud University in Riyadh. A stratified random sampling technique was used where students were randomly selected from 3 colleges and stratified to males and females. N= 767 students completed the online survey used to assess the knowledge, attitudes, and practices of the students. RESULTS: We found that the level of knowledge of university students was moderate to low (mean equivalent to 40%) whereas females had better knowledge. Also, their practices are not sufficient to maintain healthy Vitamin D levels as only 8.2% stay in the sun for more than an hour during weekdays. Only 10.2% of students take regular Vitamin D supplements, where females are the more likely users. 99.1% of students stay indoors during work. CONCLUSIONS: The knowledge about Vitamin D is low among university students but slightly higher in females and medical students. Almost all participants work indoors and most of them wear a mask whenever going out. Few students take regular Vitamin D supplements. Females agreed more they have Vitamin D deficiency and take supplements more than males.

Reduced pulmonary functions and respiratory muscle strength in Type 2 diabetes mellitus and its association with glycemic control.

OBJECTIVE: Diabetes mellitus is one of the main devastating causes of mortality and morbidity due to its detrimental complications. We aimed to evaluate the pulmonary functions and respiratory muscle strength in relationship with glycemic control and gender in type 2 Diabetes Mellitus (T2DM). MATERIALS AND METHODS: This cross-sectional study was performed at King Saud University and King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from June 2107 to June 2019. We evaluated pulmonary functions, respiratory muscle strength, body composition and glycemic control in T2DM (n=110) and control group (n=119). Gender differences were also evaluated in T2DM. RESULTS: Subjects with T2DM have significantly decreased forced vital capacity (FVC) (3.6±0.7 vs 3.3±0.9, p = 0.012), forced expiratory volume in first second (FEV1) (3.3±2.2 vs 2.7±0.6, p = 0.019), peak expiratory flow (PEF) (127.4±210.9 vs. 49.2±133.6, p = 0.003), FEF25-75 (3.6±1.3 vs. 3.1±1.1, p-value = 0.025), and maximum inspiratory pressure (MIP) (99.3±26.9 vs. 87.4±19.3, p=0.001). However, no significant difference between control and diabetes was found in maximum expiratory pressure (MEP) (132.5±34.9 vs 126.2±30.0, p = 0.202). Significant reduction in FVC (male=3.7±0.8 vs female = 3.0±0.7 p = 0.000), FEV1 (3.3±1.9 vs 2.6±0.5 p = 0.000), FEF25-75 (3.6 ± 1.3 vs 2.9 ± 1.0 with p-value = 0.000), MIP (96.9±23.1 vs 87.5±27.1 with p = 0.017), and MEP (134.0±32.2 vs. 120.1±33.5 with p = .011) were observed in females compared to males in T2DM subjects. CONCLUSIONS: Decline in the pulmonary function and inspiratory muscle strength are associated with poor glycemic control in T2DM. Moreover, there are significant differences between male and female in lung parameters and inspiratory as well as expiratory muscles strength. The exact pathophysiological mechanism to explain this association requires further investigations.

Implementation of pharmacist-led tele medication management clinic in ambulatory care settings: A patient-centered care model in COVID-19 Era.

Over the past 20 years, owing to rapid advances in technological innovation, namely in telecommunication and telemedicine, healthcare institutions have integrated clinical practices with cutting-edge telecommunication technology to enhance access to patient care, improve continuity of clinical care, and ensure patient safety. Johns Hopkins Aramco Healthcare (JHAH) is a gold-certified tertiary care institution, and it is an excellent center for patient-centered care. In response to the Coronavirus 2019 (COVID-19) pandemic, it has adopted various telecommunication technologies to provide patient-care services. This article describes the integration of telecommunication technology, such as telephone and video consultation, with a pharmacist-led medication management clinic (MMC) to provide person-centered patient care services at JHAH. The JHAH pharmacy services were found to be essential in establishing face-to-face outcome-oriented pharmacist-led medication management services for patients requiring chronic ambulatory care. The established tele-MMC services enhanced patient engagement and treatment compliance, and the integration process and its challenges were assessed. Especially during this COVID-19 pandemic, the pharmacist-led tele-MMC services were beneficial to chronic disease patients and ensured the continuity of care, maintenance of up-to-date lab tests, management of polypharmacy, minimization of the use of unwanted medications and medication synchronization. Further, the pharmacist-led tele-MMC services provided comprehensive patient counseling, which included the use of visual aids. This new integrated model provides an example for other healthcare organizations to adopt and implement the program in ambulatory care settings, to better ensure the continuity of quality healthcare, especially for elderly patients and those with chronic diseases.