Parental perception of nocturnal enuresis in a local region of Saudi Arabia.

Nocturnal enuresis (NE) has been associated with neurodevelopmental disorders such as autism spectrum disorder, attention deficit or hyperactivity disorder, and intellectual disability. This study aimed to assess parents' perception of NE in children in the eastern region of Saudi Arabia. We conducted a cross-sectional study from May to August 2023, including parents aged ≥18 years living in the area. We administered an online questionnaire to assess parents' knowledge and attitudes toward NE and its treatment. A total of 616 parents completed the questionnaire, 71.4% of which were women, 35% were aged between 25 and 35 years, 75% were married, 65% had a university degree, and 49% had three or more children. In total, 70% demonstrated a good overall knowledge about NE and its treatment, and nearly 60% had a positive attitude toward the condition. Univariate and multivariate ordinal logistic regression analyses revealed that female sex, a higher level of education, and having more than one child were associated with a higher score regarding attitude toward treatment. The level of education and the number of children were predictors of knowledge and a positive attitude toward NE in children.

Beliefs, practices, perceptions and motivations of healthcare professionals on medication deprescribing during end-of-life care: A systematic review.

AIM: Conduct a systematic review to investigate current beliefs, practices, perceptions, and motivations towards deprescribing practices from the healthcare professional perspective in older adults residing in long term care facilities with cardiometabolic conditions, using a narrative approach. METHODS: Studies were identified using a literature search of MEDLINE, CINAHL and Web of Science from inception to June 2023 Two reviewers (EH and AA) independently extracted data from each selected study using a standardised self-developed data extraction proforma. Studies reviewed included cross-sectional and observational studies. Data was extracted on baseline characteristics, motivations and beliefs and was discussed using a narrative approach. RESULTS: Eight studies were identified for inclusion. Deprescribing approaches included complete withdrawal, dose reduction, or switching to an alternative medication, for at least one preventive medication. Most healthcare professionals were willing to initiate deprescribing strategies and stated the importance of such interventions, however many felt inexperienced and lacked the required knowledge to feel comfortable doing so. CONCLUSION: Deprescribing is a key strategy when managing older people with cardiometabolic and multiple long term conditions (MLTC). Overall, HCPs including specialists, were happy to explore deprescribing strategies if provided with the relevant training and development to do so. Barriers that still exist include communication and consultation skills, a lack of evidence-based guidance and trust based policies, and a lack of MDT communications and involvement. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022335106.

Non-pharmacological interventions to improve cardiovascular risk factors in people with diabetic foot disease: A systematic review and meta-analysis.

Cardiovascular disease (CVD) risk in those with diabetic foot disease is very high. Non-pharmacological interventions may improve this risk, though no previous evidence synthesis has been completed. This systematic review aimed to investigate the impact of non-pharmacological interventions on CVD risk factors in diabetic ulcer disease. Multiple databases and trials registers were searched from inception to December 6th 2023. We included reports of randomised controlled trials investigating the impact of non-pharmacological interventions on cardiovascular risk in those with type 1 or type 2 diabetes and current or previous diabetic foot disease. Twenty studies were included. Extracted data included: study design and setting; participant sociodemographic factors; and change in cardiovascular risk factors. Data were synthesised using random effects meta-analyses and narrative syntheses. Interventions included nutritional supplementation, collaborative care, hyperbaric oxygen therapy, patient education, nurse-led intervention, self-management, family support, relaxation and exercise, over a median duration of 12 weeks. Significant post-intervention changes were observed in fasting plasma glucose, serum insulin levels, insulin sensitivity and resistance, glycated haemoglobin, triglycerides, total cholesterol, low-density lipoprotein-cholesterol and C-reactive protein. No effects were detected in very low- or high-density lipoprotein-cholesterol or body mass index. Non-pharmacological interventions show promise in improving CVD risk in diabetic foot disease.

The Impact of Androgenic Alopecia on the Quality of Life of Male Individuals: A Cross-Sectional Study.

Background Hair plays a significant role in physical appearance and hair loss can profoundly affect self-esteem and mental health. Studies show that people with clinically obvious and undetectable hair loss may have dramatically decreased quality of life (QoL). This study investigated the impact of androgenic alopecia on the quality of life of male individuals in the Eastern Province of Saudi Arabia and their willingness to seek treatment. Methods In the eastern province of Saudi Arabia, a cross-sectional study was carried out among men identified with androgenic alopecia (AGA). A self-administered survey was disseminated among the patients through social media sites. The questionnaire includes fundamental demographic factors including age, place of residence, level of education, the severity of androgenic alopecia, treatment method, and Skindex-29 to assess the patient's quality of life. Results Four hundred-two male patients out of 717 participants were selected, and 158 (39.3%) were aged between 20 to 29 years old. Satisfaction with treatment medication was reported by 24 (19.5%) out of those who underwent treatment (n=123). Less effectiveness was the most common reason for treatment dissatisfaction (81, 81.8%). The overall mean Skindex-29 score was 23.2 (SD 19.6) out of 100 points. Younger age, suffering hair loss for a shorter duration, undergoing alopecia treatment, being diagnosed with alopecia by a medical doctor, and having a moderate level of AGA were the factors that greatly affected the patient's QoL. Conclusion Consistent with the literature, this study showed that AGA significantly impaired patients' QoL. Among QoL domains, the symptoms domain had a greater effect on patients than the emotions or functional domains. Younger males who were suffering recently from hair loss and were diagnosed with AGA by the medical doctor demonstrated greater QoL impairment than the rest of the patients. A multicenter study may result in a better representation of the impact of QoL in patients with AGA.

Knowledge and Attitudes Regarding Clinical Trial Participation: A Cross-Sectional Study in the Eastern Province, Saudi Arabia.

Objective This study aims to assess the knowledge and attitudes toward clinical trial (CT) participation among the adult population in the Eastern Province of Saudi Arabia. Material and methods This cross-sectional study was conducted among the population of the Eastern Province of Saudi Arabia. A self-administered questionnaire was distributed among the general population using an online survey. Results A total of 334 participants completed the questionnaire. Participants' ages ranged from 18 to 65 years, with a mean age of 31.2 ± 13.9 years, 56.6% of whom were males, 42.2% were employed, 29.6% were students, and 23.1% were unemployed. Surprisingly, only a small percentage of respondents (7.5%) were requested to participate in a randomized controlled trial (RCT), of which the majority did partake. Additionally, 25.4% of participants believe CTs are used to evaluate new drugs; others believe that CTs are used to understand diseases and human behavior. The data show that most participants believe that CTs improve patient care, welfare, and society. Also, participants were more likely to take part if they were aware of the study's purpose and findings and were given more time to consider their options. Conclusion Participants believed that the biggest obstacle was a lack of knowledge of CTs. It is crucial to educate patients more about CTs. Multimodal strategies such as improved patient-provider communication and online information for trial information sharing may be effective in boosting knowledge and CT recruitment.

Self-Medication Practices During the COVID-19 Pandemic Among the Adult Population in the Eastern Region of the Kingdom of Saudi Arabia.

BACKGROUND: Self-medication is vital to public health because it has an impact on people's health and the current healthcare system, both positively and negatively. During public health catastrophes like the COVID-19 disease, this is particularly true. AIM: This study aimed to examine the behavioral response of the community with regard to self-medication during the COVID-19 pandemic in the eastern region of the Kingdom of Saudi Arabia. METHODS: During the COVID-19 outbreak from March to September 2020, a cross-sectional online survey of 398 participants using structured questionnaires was conducted to observe knowledge, prevalence, patterns, and sources of self-medication among the respondents in the eastern region of the Kingdom of Saudi Arabia. RESULTS: The percentage of respondents who had heard about self-medication was 50.5%, and those who practiced self-medication during COVID-19 were 43.7% of the respondents. Regarding knowledge, 60.3% had a low overall knowledge level versus 39.7% who had a high knowledge level. Most of those who practiced self-medication took medication based on their own decision (34.4%). The most frequently used drugs during the outbreak were analgesics (43.5%) and vitamins (24.9%). Only 1% of participants reported using anti-malaria drugs (hydroxychloroquine). The most common reasons for self-medication practices were having a mild illness (30.4%), followed by fear of infection (26.6%). The symptoms for which the respondents took self-medication were headache (29.6%), cough (26.6%), and fever (24.6%). CONCLUSION: Our investigation showed a low level of knowledge about self-medication and a considerable level of self-medication practices. Therefore, self-medication may be minimized with ongoing awareness-raising and sensitization.

Corrigendum to "The prevalence and long-term health effects of long Covid among hospitalised and non-hospitalised populations: a systematic review and meta-analysis".

[This corrects the article DOI: 10.1016/j.eclinm.2022.101762.].

Impact of novel glucose-lowering therapies on physical function in people with type 2 diabetes: A systematic review and meta-analysis of randomised placebo-controlled trials.

AIMS: We investigated evidence from randomised, placebo-controlled trials of novel glucose-lowering therapies; sodium-glucose co-transporter-2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP4i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), on physical function in people with type 2 diabetes (T2D). METHODS: PubMed, Medline, Embase and Cochrane library were searched from 1 April 2005 to 20 January 2022. The primary outcome was change in physical function in groups receiving a novel glucose-lowering therapy versus placebo at the trial end-point. RESULTS: Eleven studies met our criteria including nine for GLP-1RA and one each for SGLT2i and DPP4i. Eight studies included a self-reported measure of physical function, seven with GLP-1RA. Pooled meta-analysis showed an improvement of 0.12 (0.07, 017) points in favour of novel glucose-lowering therapies, mainly GLP-1RA. These findings were consistent when assessed individually for commonly used subjective assessments of physical function; namely the Short-Form 36 item-questionnaire (SF-36; all investigating GLP-1RA) and the Impact of Weight on Quality of Life-Lite (IWQOL-LITE; all, except one, exploring GLP-1RA) with estimated treatment differences (ETDs) of 0.86 (0.28, 1.45) and 3.72 (2.30, 5.15) respectively in favour of novel GLTs. For objective measures of physical function (VO2max and 6-minute walk test (6MWT)) no significant between-group differences between the intervention and the placebo were found. CONCLUSIONS: GLP-1RAs showed improvements in self-reported outcomes of physical function. However, there is limited evidence to draw definitive conclusions especially because of lack of studies exploring the impact of SGLT2i and DPP4i on physical function. There is a need for dedicated trials to establish the association between novel agents and physical function.

The effects of weight-lowering pharmacotherapies on physical activity, function and fitness: A systematic review and meta-analysis of randomized controlled trials.

Weight-lowering pharmacotherapies provide an option for weight management; however, their effects on physical activity, function, and cardiorespiratory fitness are not fully understood. We conducted a systematic review and meta-analysis of randomized controlled trials to investigate the effect of licensed weight loss pharmacotherapies on physical activity, physical function, and cardiorespiratory fitness in individuals with obesity. Fourteen trials met our prespecified inclusion criteria: Five investigated liraglutide, four semaglutide, three naltrexone/bupropion, and two phentermine/topiramate. All 14 trials included a self-reported measure of physical function, with the pooled findings suggesting an improvement favoring the pharmacotherapy intervention groups (SMD: 0.27; 95% CI: 0.22 to 0.32) and effects generally consistent across different therapies. Results were also consistent when stratified by the two most commonly used measures: The Short-Form 36-Item Questionnaire (SF-36) (0.24; 0.17 to 0.32) and the Impact of Weight on Quality Of Life-Lite (IWQOL-Lite) (0.29; 0.23 to 0.35). Meta-regression confirmed a significant association between pharmacotherapy induced weight loss and improved physical function for IWQOL-Lite (p = 0.003). None of the studies reported a physical activity outcome, and only one study reported objectively measured cardiorespiratory fitness. Improvements in self-reported physical function were observed with weight loss therapy, but the effect on physical activity or objectively measured physical function and fitness could not be determined.

Physical activity and risk of chronic kidney disease: systematic review and meta-analysis of 12 cohort studies involving 1,281,727 participants.

The role of regular physical activity in preventing vascular and non-vascular disease is well established. Chronic kidney disease (CKD) is a major cause of global morbidity and mortality and largely preventable, but it is uncertain if regular physical activity can reduce the risk of CKD. Using a systematic review and meta-analysis of published observational cohort studies in the general population, we sought to assess the association between physical activity and CKD risk. Relevant studies with at least one-year of follow-up were sought from inception until 02 May 2022 in MEDLINE, Embase, Web of Science, and manual search of relevant articles. Relative risks (RRs) with 95% confidence intervals (CIs) for the maximum versus the minimal amount of physical activity groups were pooled using random effects meta-analysis. The quality of the evidence was evaluated using the GRADE tool. A total of 12 observational cohort studies comprising 1,281,727 participants and 66,217 CKD events were eligible for the analysis. The pooled multivariable-adjusted RR (95% CI) of CKD comparing the most versus the least physically active groups was 0.91 (0.85-0.97). The association was consistent across several study level subgroups. Exclusion of any single study at a time from the meta-analysis did not change the direction or significance of the association. There was no evidence of small study effects among contributing studies. The GRADE quality of the evidence was low. In the general population, individuals who are most physically active have a lowered risk of CKD compared to those who are not or least physically active. CRD42022327640.

The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis.

Background: The aim of this study was to systematically synthesise the global evidence on the prevalence of persistent symptoms in a general post COVID-19 population. Methods: A systematic literature search was conducted using multiple electronic databases (MEDLINE and The Cochrane Library, Scopus, CINAHL, and medRxiv) until January 2022. Studies with at least 100 people with confirmed or self-reported COVID-19 symptoms at ≥28 days following infection onset were included. Patient-reported outcome measures and clinical investigations were both assessed. Results were analysed descriptively, and meta-analyses were conducted to derive prevalence estimates. This study was pre-registered (PROSPERO-ID: CRD42021238247). Findings: 194 studies totalling 735,006 participants were included, with five studies conducted in those <18 years of age. Most studies were conducted in Europe (n = 106) or Asia (n = 49), and the time to follow-up ranged from ≥28 days to 387 days. 122 studies reported data on hospitalised patients, 18 on non-hospitalised, and 54 on hospitalised and non-hospitalised combined (mixed). On average, at least 45% of COVID-19 survivors, regardless of hospitalisation status, went on to experience at least one unresolved symptom (mean follow-up 126 days). Fatigue was frequently reported across hospitalised (28.4%; 95% CI 24.7%-32.5%), non-hospitalised (34.8%; 95% CI 17.6%-57.2%), and mixed (25.2%; 95% CI 17.7%-34.6%) cohorts. Amongst the hospitalised cohort, abnormal CT patterns/x-rays were frequently reported (45.3%; 95% CI 35.3%-55.7%), alongside ground glass opacification (41.1%; 95% CI 25.7%-58.5%), and impaired diffusion capacity for carbon monoxide (31.7%; 95% CI 25.8%-3.2%). Interpretation: Our work shows that 45% of COVID-19 survivors, regardless of hospitalisation status, were experiencing a range of unresolved symptoms at ∼ 4 months. Current understanding is limited by heterogeneous study design, follow-up durations, and measurement methods. Definition of subtypes of Long Covid is unclear, subsequently hampering effective treatment/management strategies. Funding: No funding.

Evaluation of quality of diabetic foot examination on YouTube.

INTRODUCTION: Foot ulcers and amputations are common conditions in people with diabetes and can considerably impact quality of life, necessitate a lengthy hospital stay and increase mortality. Preventative foot care and examination can prevent or delay ulceration, and individuals may seek information from publicly available social media resources such as YouTube. Therefore, the purpose of this study is to evaluate the educational quality and reliability of publicly available YouTube videos on diabetes foot examinations. METHOD: A YouTube search for "diabetic foot examination" was conducted, and the first 100 relevant English videos focused on examining the diabetic foot were included for evaluation. The Journal of the American Medical Association (JAMA) standards were used to measure video reliability. The Global Quality Score (GQS) and the Diabetes UK Annual Foot Check (DUK-C) checklist were used to assess video educational quality. Differences in JAMA, GQS, and DUK-C ratings were analysed after videos were sorted by topic and source. RESULTS: The mean number of views per video was 101,311.9 ± 348,383.6, and the mean video power index was 41.6 ± 170.0. The most common upload source was from physicians (28%) and, the most popular material category was diabetes foot examination (58 videos). In terms of video reliability, 36% of videos scored 0. According to the GQS standards, only 5% of the videos are of excellent quality, while 34% are of poor quality, with 24 videos scoring between 0 and 1 on the DUK-C scale. CONCLUSION: While foot care examination videos have a substantial audience, the majority are considered low in quality and reliability. Videos on comprehensive diabetic foot examination should be accessed on reputable sources that guarantee standardisations of video quality and take into account the simplification of information transmission in order to reach lay audiences.

Use of Complementary and Alternative Medicines (CAMs) Among Diabetic Patients in Al Ahsa, Saudi Arabia: A Cross-Sectional Study.

Background: Complementary and Alternative Medicine (CAM) is a popular practice among Saudis. CAM refers to drugs and medical procedures that doctors do not typically employ. Objective: The study's goal was to determine the prevalence of CAM and the most prevalent form used among patients with diabetes in Al Ahsa, Saudi Arabia. Methods: This cross-sectional study enrolled individuals with diabetes mellitus (DM) in Al Ahsa, Saudi Arabia. Online questionnaires were employed between March to July 2023 to collect data on sociodemographic characteristics, information about diabetes, knowledge and use of CAM, and the different types of herbal supplements used. Results: Of the 386 patients, 54.1% were males, 45.9% were aged between 46 and 60 years old, and 45.9% had heard of CAM. The most popular CAM treatment for diabetes was biologically based, and the most common reason for using CAM was its accessibility (27.1%). The majority (82.1%) of diabetic patients reported using CAM as a treatment. Independent predictors of CAM use were diabetes complications, having heard of CAM, and social media. Conclusion: CAM use has a high prevalence in the treatment of diabetes. Independent predictors of CAM use were a shorter disease duration, diabetes complications, having heard of CAM, and social media. To avoid negative and unnecessary side effects, patients must be informed about CAM use.

Prevalence, frequency, and disability of migraine headaches and tension headaches among the general population in the Eastern Region of Saudi Arabia.

A tension-type headache (TTH) is a recurrent headache that is mild to moderate in intensity, unlike migraine (MH), which is accompanied by crippling effects of nausea, vomiting, photophobia, or phonophobia. TTH is more frequent than migraine, but it is less likely to cause severe pain and physical dysfunction. TTHs account for more lost workdays due to their prevalence. The study aimed to evaluate the prevalence, frequency, and disability of MHs and TTHs among the general population in the Eastern Region of Saudi Arabia. A cross-sectional study was employed using a validated questionnaire. The questionnaire implemented the HARDSHIP algorithm to diagnose MH and TTH and questions to correlate their prevalence to socio-demographic data, measurement of the level of disability, headache management, and treatment effectiveness using the chi-square test. The study reviewed 877 subjects (46.6% males vs. 53.4% females). 52.9% of the participants experienced headaches during the previous three months, and 35.6% experienced headaches recently. The most common type of headache was a probable MH (32.1%), followed by a TTH (26.9%), probable TTH (19.5%), and MH (15%). It was reported that some disability was attributed to 47% of MHs and 26% of TTHs. The most commonly used headache medication was paracetamol (53.5%). This study revealed that TTH and MH are common illnesses in Saudi Arabia's Eastern Region. TTH and MH are correlated with significant individual and social burdens, particularly for MH. Headache sufferers mostly manage their headaches using conventional over-the-counter methods.

Patient's Perspective on Factors Affecting Health-Seeking Behavior in Al-Ahsa, Saudi Arabia.

 Background There are different determinants of health-seeking behaviors. Studying health-seeking behaviors and their factors help governments use the existing health resources properly for a potent healthcare system. This study aimed to evaluate the factors influencing health-seeking behavior in Al-Ahsa. Methods The study is a questionnaire-based observational cross-sectional study of the factors influencing health-seeking behaviors in the general population of the Al-Ahsa governorate. A non-probability convenience sampling technique was used to acquire the sample. The study followed all ethical considerations and received approval from King Faisal University. Results A total sample of 481 participants completed the study questionnaire. 21.2% of people visited the health centers for medical checkups despite having no symptoms, while 29.1% admitted to avoiding the health centers despite knowing they needed medical attention. Additionally, the majority of patients prefer government-run health facilities (58.6%), while 41.4% prefer the commercial sector. When experiencing any health complaints, precisely 70.7 % of women go to a medical facility, compared to 61.8% of men (P=.038). In addition to that, 68.5% of participants with intermediate economic status visit healthcare centers for any symptoms compared to 50% of others with high financial status (P=.049). Specifically, 73.3% of participants diagnosed with a disease or chronic diseases visited healthcare centers for clinical symptoms compared to 64.3% of others without (P=.049). Conclusion This study identified that most participants with chronic diseases seek medical care for any symptom, and the participants with an intermediate economic status are more likely to go to a governmental primary healthcare center for any symptoms. The findings of this research provide insights for the government and policymakers to create effective strategies and manage the existing resources in Al-Ahsa.

The effects of technology use on children's physical activity: a cross-sectional study in the Eastern province of Saudi Arabia.

Recently, a considerable amount of literature has been concerned with the impact of screen time on physical activity. Furthermore, recent evidence reveals that children under 14 spend an average of 23 hours each week looking at screens, including watching TV and DVDs, playing video games, or using a computer or mobile device. This study aimed to determine the relationship between technology use and physical activity. 277 parents completed an online questionnaire in this cross-sectional investigation. The questionnaire comprised 44 closed-ended questions divided into three sections: demographics, the impact of technology on children, and the Children's Physical Activity Questionnaire (CPAQ). 88 (31.8%) of children reported up to 5 hours of screen time per day, while 189 (68.2%) reported 6 hours or more. According to the CPAQ, 131 (47.3%) children had a low level of physical activity, 96 (34.7%) had a moderate level, and 50 (18.1%) had a high level. There was a strong relationship between parental age and child screen time, with 24.9% of children with screen time greater than 6 hours having parents aged 35-40 years, compared to 28.4% of children with screen time less than 5 hours having parents aged 25-30 years. Inadequate physical activity in children was linked to the number of siblings, ownership of electronic devices, and screen time. Physical activity should be increased through lifestyle changes that the entire family can implement.

Prevalence and Associated Risk Factors of Childhood Obesity in the Eastern Province of Saudi Arabia.

Introduction Overweight and obesity are defined as excessive fat accumulation that poses a risk to well-being. In children, a BMI of the 85th percentile to less than the 95th percentile is considered overweight, and the 95th percentile or greater is considered obese. Aim This study aimed to measure the prevalence of childhood obesity in a population of six to 16 years of age and its associated risk factors. Participants and methods This is a cross-sectional study conducted among children aged between six and 16 years old who live in the Eastern province of Saudi Arabia. The data collector in each school distributed envelopes containing an informed consent form and a survey to collect data on the demographics and socioeconomic status to all students. All students whose parents signed the informed consent would undergo measurement of growth parameters which ultimately determined the BMI. Results Six hundred eighty-eight children agreed to participate. The prevalence of overweight and obesity was 15.3% (overweight 10.2%, obese 5.1%). Children who eat four or more meals per day were 29.5% while only 10% were regularly exercising for more than two hours a day. Independent risk factors of obesity and overweight were eating four or more meals per day. Spending more than an hour a day on physical activity was a protective factor against being overweight and obese. Conclusion Increased daily food consumption was the most frequent risk factor for obesity. Physical activity was the protective factor against obesity in children and adolescents. Further intervention measures must be implemented to reduce the prevalence of overweight and obesity. A healthy lifestyle based on effective dietary education and physical activity promotion is required to prevent overweight and obesity among youth.

Effectiveness and Safety of Ayurvedic Medicines in Type 2 Diabetes Mellitus Management: A Systematic Review and Meta-Analysis.

Introduction: Many Ayurvedic medicines have the potential for managing type 2 diabetes mellitus (T2DM), with previous systematic reviews demonstrating effectiveness and safety for specific Ayurvedic medicines. However, many of the reviews need updating and none provide a comprehensive summary of all the Ayurvedic medicines evaluated for managing T2DM. Objective: The objective of this systematic review was to evaluate and synthesize evidence on the effectiveness and safety of Ayurvedic medicines for managing T2DM. Inclusion criteria: Published and unpublished RCTs assessing the effectiveness and safety of Ayurvedic medicines for managing T2DM in adults. Methods: The JBI systematic review methodology was followed. A comprehensive search of sources (including 18 electronic databases) from inception to 16 January 2021 was made. No language restrictions were applied. Data synthesis was conducted using narrative synthesis and random effects meta-analyses, where appropriate. Pooled results are reported as mean differences (MD) with 95% confidence intervals (CI). Results: Out of 32,519 records identified from the searches, 219 articles were included in the systematic review representing 199 RCTs (21,191 participants) of 98 Ayurvedic medicines. Overall, in the studies reviewed the methodology was not adequately reported, resulting in poorer methodological quality scoring. Glycated hemoglobin (HbA1c) was reduced using Aegle marmelos (L.) Corrêa (MD -1.6%; 95% CI -3 to -0.3), Boswellia serrata Roxb. (-0.5; -0.7 to -0.4), Gynostemma pentaphyllum (Thunb.) Makino (-1; -1.5 to -0.6), Momordica charantia L. (-0.3; -0.4 to -0.1), Nigella sativa L. (-0.4; -0.6 to -0.1), Plantago ovata Forssk. (-0.9; -1.4 to -0.3), Tinospora cordifolia (Willd.) Hook.f. and Thomson (-0.5; -0.6 to -0.5), Trigonella foenum-graecum L. (-0.6; -0.9 to -0.4), and Urtica dioica L. (-1.3; -2.4 to -0.2) compared to control. Similarly, fasting blood glucose (FBG) was reduced by 4-56 mg/dl for a range of Ayurvedic medicines. Very few studies assessed health-related quality of life (HRQoL). Adverse events were not reported in many studies, and if reported, these were mostly none to mild and predominately related to the gastrointestinal tract. Conclusion: The current evidence suggests the benefit of a range of Ayurvedic medicines in improving glycemic control in T2DM patients. Given the limitations of the available evidence and to strengthen the evidence base, high-quality RCTs should be conducted and reported.

Perceived barriers and facilitators of physical activity among Saudi Arabian females living in the East Midlands.

Objective: This study was conducted to explore the potential barriers to and facilitators of physical activity in Saudi Arabian females living in the East Midlands region of the United Kingdom. Methods: A qualitative study was conducted with Saudi Arabian females currently living in the East Midlands, along with the completion of International Physical Activity Questionnaires (IPAQs). The Semi-structured interviews were digitally recorded, transcribed, and analysed using a narrative thematic approach; IPAQ data were descriptively analysed. A total of 12 interviews were conducted. Five refined themes and 19 sub-themes were identified. Results: The results of this research showed that attractive climate, availability of open spaces, easy gymnasium accessibility, low cost, independent student lifestyles, food habits, efficient transportation, and UK culture serve as facilitators, while reduced availability of individual women-only gyms, non-engaging fitness instructors and reduced attention to different age groups serve as barriers to physical activity for Saudi Arabian females in the East Midlands. Conclusions: Although the results concerned Saudi Arabian females in the East Midlands, the participants' perspectives showed that more appropriate action could be taken to raise awareness of the advantages of being active among females in general. Drawing on a service delivery model based on the stages of change and including relevant stakeholders in developing and implementing effective interventions, strategies and policies must be developed to promote the participation of Saudi Arabian females and female expats from other countries in physical activity in the UK.

Cardiovascular and renal outcomes of initial combination therapy with glucose-lowering agents versus a stepwise approach in newly diagnosed or treatment-naïve type 2 diabetes: A systematic review and meta-analysis.

AIM: To evaluate the efficacy and safety of the initial combination therapy versus a stepwise approach in newly diagnosed type 2 diabetes (T2D) by conducting a systematic review and meta-analysis of observational cohort studies and randomized controlled trials (RCTs). METHODS: Studies were identified from MEDLINE, Embase, the Cochrane Library, and through search of bibliographies to January 2022. Study-specific risk ratios (RRs) and mean differences with 95% confidence intervals (CIs) were pooled. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: Eight articles including four unique RCTs (n = 5527 participants) and one observational cohort study (n = 200) that compared initial combination therapy versus stepwise therapy were included. The RR for myocardial infarction comparing initial combination therapy versus stepwise therapy was 1.21 (95% CI 0.74-2.00). Initial combination therapy reduced levels of fasting plasma glucose and glycated haemoglobin: mean differences -0.97 mmol/L (95% CI -1.41, -0.53) and -24.92 mmol/mol (95% CI -25.67, -24.27), respectively. Initial combination therapy versus stepwise therapy reduced lipid levels, blood pressure and intima media thickness, with no differences in body composition variables, neuropathy, retinopathy or adverse events. Single-study results showed that initial combination therapy reduced creatinine levels and urine albumin excretion rate. The quality of the evidence ranged from moderate to very low. CONCLUSIONS: Except for improving cardiometabolic and glycaemic variables, a limited number of studies characterized by small sample sizes show that initial combination therapy for newly diagnosed T2D may be similar in efficacy and safety to stepwise therapy with respect to cardio-renal outcomes. There is a lack of sufficient evidence to recommend initial combination therapy with glucose-lowering agents in newly diagnosed T2D with the aim of preventing cardio-renal outcomes. Definitive RCTs are warranted.