Prevalence of menstrual irregularities after coronavirus disease 2019 vaccination: A cross-sectional study in the Eastern Province, Saudi Arabia.

BACKGROUND: Reports indicate that there are menstrual cycle disturbances following coronavirus disease 2019 (COVID-19) vaccination. The present study explored the prevalence of menstrual irregularities after COVID-19 vaccination and the association of menstrual irregularities with vaccine type, doses, immediate adverse effects, history of COVID-19 infection, and its severity. MATERIALS AND METHODS: For this cross-sectional study, 406 women of reproductive age completed an online survey about the postvaccine changes in their menstruation (cycle duration, bleeding days, and bleeding amount), COVID-19 vaccine history (doses, type of vaccine, and immediate adverse effects), history of COVID-19 infection, and its severity. Data was analyzed using SPSS; descriptive statistics were computed and Chi-square test, and binary logistic regression analysis were performed. RESULTS: Of the total 406 women, 45% reported postvaccine changes in their menstrual cycle. The most common menstrual change was increased dysmenorrhea (68%), followed by an increase in the length of the cycle (52%). There was a significant association between postvaccine menstrual changes and the age, marital status, and family history of menstrual irregularities. No association was observed between postvaccine menstrual changes and COVID-19 vaccine-and COVID-19 infection-related variables. As per the best-fit model of our predictors, the odds of having postvaccine menstrual changes were 0.41 times less in "single" women (confidence interval [CI] = 0.26-0.27; P < 0.001) and 1.714 times greater in women who had a "family history of menstrual irregularities" (CI = 1.092-2.690; P = 0.02), respectively. CONCLUSION: A substantial number of women complained of postvaccine menstrual changes regardless of their age, type of COVID-19 vaccine, doses, immediate adverse effects, and COVID-19 infection history/severity. Being "single" decreased the probability, whereas having a family history of menstrual irregularities increased the probability significantly of having postvaccine menstrual changes.

Short sleep duration is a novel independent risk factor for overweight and obesity.

OBJECTIVES: To investigate the association between sleep duration (SD) and body mass index (BMI) in young adults. METHODS: This cross-sectional study was carried out between January and September 2022, and the participants were 1724 health sciences students aged 16-22 years, from Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Measurement of height and weight was carried out and BMI was calculated by the formula=weight in kg/height in m2. Based on SD, subjects were divided into 3 groups: short SD: <7 hours/24 hours; normal SD: 7-9 hours/24 hours; and increased SD: >9 hours/24 hours. RESULTS: The participants' mean age was 19±3.2 years. Short sleepers had significantly higher BMI (24.2 kg/m2, p<0.001) relative to normal (23.03 kg/m2) and long sleepers (23.2 kg/m2, p=0.041). In addition, short sleep duration (SSD) was associated with overweight (OW) and obesity (OB) (p=0.01). Moreover, multivariate logistic regression analysis found SSD to be an independent risk factor for OW and OB, as it retained its significance (p=0.049) even after adjusting for the major confounding factors of BMI (namely, decreased physical activity and increased food intake). Moreover, it emerged that SSD could lead to 1.47 times higher odds ratio of OW and OB. CONCLUSION: Participants with a SSD had significantly higher BMI than normal and long sleepers. Short sleep duration is an independent risk factor for increased BMI, which potentially leads to 1.47 times increased odds ratio of having OW and OB.

The Effectiveness of Nigella sativa and Ginger as Appetite Suppressants: An Experimental Study on Healthy Wistar Rats.

Background: Obesity is a global pandemic that is associated with high morbidity and mortality. Natural herbs are commonly used for weight reduction and appetite suppression. Therefore, we aim to investigate the role and mechanism of Nigella sativa (NS) and ginger on weight reduction and appetite regulation. Methods: This experimental study was performed at Imam Abdulrahman Bin Faisal University. Twenty-five female rats were distributed into 5 groups: NS (oral 1000mg/kg), Ginger (500 mg/kg), NS-ginger (both interventions), a positive control (intraperitoneal 50 µg/kg Liraglutide), and a negative control. Each intervention was given for 9 weeks. Food intake and body weight were assessed weekly. Serum lipid profile and peptides involved in appetite control (cholecystokinin (CCK), glucagon-like peptide 1(GLP-1), gastric inhibitory polypeptide (GIP), ghrelin, peptide YY, and orexin) were assayed at the end of the experiment. Results: None of the interventions showed a statistically significant difference regarding food consumption or weight gain (p > 0.05). However, the three interventions significantly reduced total cholesterol (TC), NS and NS-ginger significantly increased HDL, NS increased ghrelin and ginger increased orexin. Conclusion: The present dose and duration of NS, ginger, or in combination did not demonstrate a significant change in body weight or food consumption in comparison to the negative or positive controls. However, NS or ginger has improved the lipid profile by reducing TC and increasing HDL. In addition, NS or ginger can influence some of the peptides involved in appetite regulation such as the increase in ghrelin induced by NS and the reduction of orexin induced by ginger. We believe that these latter effects are novel and might indicate a promising effect of these natural products on appetite regulation.

Body mass index, eating habits, and various lifestyle changes in young adults during the two years of the coronavirus disease 2019 (COVID-19) pandemic.

BACKGROUND: The aim of this study was to find out the perceived impact of 2 years of coronavirus disease 2019 (COVID-19) pandemic on various lifestyle behaviors (LSBs) and changes and their effect on body mass index (BMI) of young Saudi adults. MATERIALS AND METHODS: This was a descriptive exploratory study conducted in January 2022 on 1724 students (aged 16-21 years) from multiple colleges of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. The main tools of the study were: BMI and an online 30-item LSB and changes structured questionnaire, which assessed LSB and perceived changes, 1 month immediately preceding and 2 years after the COVID-19 outbreak. RESULTS: Our study results showed that 48% of the subjects gained weight after the pandemic. Screen time (ST) increased from 6.8 h before pandemic to 9.2 h/24 h after pandemic outbreak (P < 0.0001). However, no significant association was observed between excessive ST and increased BMI. A significant decrease in physical activity was seen after the outbreak (P < 0.001), which was positively but insignificantly associated with increased BMI (P = 0.3). A significant increase in the frequency of food intake was observed; 18.7% of the subjects reported taking ≥ 4 meals/day before the epidemic compared to 32.1% during the pandemic (P = 0.001). Decreased intake of homemade food, increased intake of junk food, and increased number of the meals/day were significantly related with increased BMI (P < 0.05). The strongest risk factor for increased BMI after the outbreak of the pandemic was ≥4 meals/day (OR=1.6; P = 0.048). CONCLUSION: After 2 years of the pandemic, 48% of the young adults perceived they had gained weight, which was strongly associated with self-reported increase in the number of meals/day (≥4). These observations could aid the development of nutritional recommendations to maintain the health of young adults during and after the COVID-19 pandemic.

Whole-Exome Sequencing Reveals Migraine-Associated Novel Functional Variants in Arab Ancestry Females: A Pilot Study.

Migraine, as the seventh most disabling neurological disease with 26.9% prevalence in Saudi females, lacks studies on identifying associated genes and pathways with migraines in the Arab population. This case control study aims to identify the migraine-associated novel genes and risk variants. More than 1900 Arab ancestry young female college students were screened: 103 fulfilled the ICHD-3 criteria for migraine and 20 cases confirmed in the neurology clinic were included for the study with age-matched healthy controls. DNA from blood samples were subjected to paired-end whole-exome sequencing. After quality control, 3365343 missense, frameshift, missense splice region variants and insertion-deletion (indels) polymorphisms were tested for association with migraine. Significant variants were validated using Sanger sequencing. A total of 17 (p-value 9.091 × 10-05) functional variants in 12 genes (RETNLB, SCAI, ADH4, ESPL1, CPT2, FLG, PPP4R1, SERPINB5, ZNF66, ETAA1, EXO1 and CPA6) were associated with higher migraine risk, including a stop-gained frameshift (-13-14*SX) variant in the gene RETNLB (rs5851607; p-value 3.446 × 10-06). Gene analysis revealed that half of the significant novel migraine risk genes were expressed in the temporal lobe (p-value 0.0058) of the cerebral cortex. This is the first study exploring the migraine risk of 17 functional variants in 12 genes among Saudi female migraineurs of Arab ancestry using whole-exome sequencing. Half of the significant genes were expressed in the temporal lobe, which expands migraine pathophysiology and early identification using biomarkers for research possibilities on personalised genetics.

Post-Acute Effect of SARS-CoV-2 Infection on the Cardiac Autonomic Function.

Background: Recent studies reported a long-lasting effect of COVID-19 infection that extends beyond the active disease and disrupts various body systems besides the respiratory system. The current study aims to investigate the post-acute effect of SARS-CoV-2 infection on cardiovascular autonomic activity, reactivity and sensitivity in patients who had the infection at least 3 months before. Methods: This was a comparative cross-sectional observational study. Fifty-nine subjects were allocated into two groups, controls (n=31), who had no history of positive COVID-19 infection, and the post-COVID patients (n=28) who were recruited 3 to 8 months after testing positive for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR). Baseline cardiovascular autonomic activity was evaluated through recording of baseline heart rate variability (HRV), autonomic reactivity was determined through standard cardiovascular autonomic reflex tests (CART), and cardiac autonomic sensitivity was assessed through cardiac baroreceptor sensitivity (cBRS). Results: Higher incidence of orthostatic hypotension was observed in post-COVID patients compared to controls (39.3% and 3.2%, respectively, p <0.001). Additionally, significantly reduced handgrip test, and heart rate response to head-up tilt was illustrated in the post-COVID group (p <0.001). About 85.7% of post-COVID participants had at least one abnormal cardiovascular reflex test (CART) compared to the control group (p <0.001). Although HRV parameters (TP, LF, HF, SDRR, RMSSD, pRR50), and the cBRS were numerically lower in the post-COVID-19 group, this did not reach the level of significance. Conclusion: The results of the present study are suggestive of altered cardiovascular reactivity in post-acute COVID patients and demand further investigation and longer term follow up.

The Effect of Various Patterns of Personal Listening Devices on Hearing Among University Students in Saudi Arabia.

Background: The long-term use of earphones at high volume levels is a major risk factor for noise-induced hearing loss. Aim: To compare the hearing of university students who use personal listening devices (PLDs) at extremes (upper & lower quartiles) with respect to a) Duration of use/day b) The number of years since use c) Volume level. Methods: This cross-sectional study was conducted in the Department of Physiology, College of Medicine, at Imam Abdulrahman bin Faisal University (IAU), from September 2021 to April 2022. An online survey was distributed among IAU medical students on the subjects' patterns of earphone use. Forty participants volunteered to participate in the hearing tests: Pure Tone Audiometry (PTA), Tympanometry, and Transient Evoked Otoacoustic Emission (TEOAEs) at the ENT clinic of the King Fahd Hospital of the University (KFHU). Results: The pure tone audiometry and TEOAE showed no significant differences in the hearing thresholds/levels of participants in upper quartiles vs lower quartiles of both ears, in any of the PLD use pattern categories. However, in the TEOAE two observation were detected: a) Significantly lower amplitude in the upper quartile of the category "duration of PLD use/day" at a frequency of 1.0 kHz in the left ear (p-value 0.04) b) Significantly lower amplitude in the upper quartile of the category "volume of PLD use" at a frequency of 1.0 kHz in the left ear (p-value 0.03). Conclusion: The present findings suggest that hearing threshold/level and cochlear outer hair cells' functions do not differ significantly in the participants belonging to the upper and lower quartiles of PLD use pattern (volume level, duration of use/day, and the number of years since use).

Association Between Time Spent on Electronic Devices and Body Mass Index in Young Adults.

Objective: To evaluate the association between time spent on electronic devices (TSED) and body mass index in young adults. Methods: This cross-sectional study was conducted from June to December 2021 on 1877 students (aged 18-22 yrs) from multiple health Colleges of Imam Abdulrahman Bin Faisal University. The main tools of the study were 1) Body mass index (BMI) and an online questionnaire. The subjects were categorized into 3 main groups based on their TSED: 1) Low TSED < 2 hours/day, 2) Medium TSED= 3 to 5 hours/day, 3) Excessive TSED ≥ 6 hours /day. Based on BMI, subjects were categorized into three main groups: Normal and underweight (BMI ≤ 24.9), overweight (BMI > 25-29.9), and obese (BMI > 30). Results: Participants' average age was 20 ± 2 years. The average BMI was 23.5 k/m2. The % of students falling into the categories of normal weight, overweight, and obesity was 69.2%, 19.05%, and 11.7% respectively. The average TSED of study participants was 8.2 ± 3.45 hrs /24 hours. 71.15% of participants indicated a TSED of ≥6 hrs/24 hours and 23.71% reported a TSED of 3-5 hrs/24 hours. Only 3.15% of participants reported TSED of ≤2 hrs/24 hours. Although a rise in the mean BMI was observed with an increase in the TSED, but this difference was not statistically significant. The pairwise wise comparison also failed to demonstrate any difference in BMI between different categories of TSED. Furthermore, no significant positive correlation was found between increased BMI and excessive TSED (P = 0.37). Conclusion: A high percentage of young adults (31.2%) were overweight or obese, but excessive TSED was not significantly associated with increased BMI in this study population. Further studies are recommended to identify the effects of other factors in causing increased BMI in young adults.

Variations of Ghrelin and Obestatin Hormones During the Menstrual Cycle of Women of Different BMIs.

Introduction: The cyclical changes of hormones during the menstrual cycle are responsible not only for reproductive function but also have other effects on dietary intake and appetite. The current study aimed to investigate the variations of appetite-related hormones (ghrelin and obestatin) during the menstrual cycle and their association with adipokines, estrogen, and BMI. Methods: Fifty-six regularly menstruating female students were grouped into normal weight (BMI ≤24.9; n = 26), and overweight/obese subjects (BMI ≥25; n = 30). Serum ghrelin, obestatin, leptin, adiponectin, and estrogen levels were measured during the early follicular, preovulatory, and luteal phases of the menstrual cycle using the ELISA technique. Results: There were insignificant differences in the levels of serum ghrelin, obestatin, and ghrelin/obestatin ratio across menstrual cycle phases in the whole cohort as well as in each group separately (p > 0.05). Serum ghrelin was significantly less in OW-OB as compared to the NW group (p = 0.005), whereas the average serum obestatin did not show any significant differences between the two groups. No significant correlation was seen between ghrelin and obestatin with the adipokines and estradiol. Conclusion: Significant low level of ghrelin was observed in obese group during the follicular phase. This finding may provide new insights into the altered ghrelin patterns in OW-OB individuals, as a cause or a consequence of obesity and related menstrual disorders.

Factors Affecting Health Care Professionals' Adherence to COVID-19 Precautionary Measures.

Objective: COVID-19 is a public health emergency of international concern. There is still no definitive cure for this highly transmittable illness. Immunization and breaking the chain of infection is the only successful approach to mitigate its spread. Our study explored the adherence to COVID-19 preventive measures and its associating factors among Health Care Professionals (HCPs) working in Saudi Arabia. Methods: For this cross-sectional study, an online survey was conducted from December 01, 2020, to March 31, 2021, among 978 HCPs in Saudi Arabia. The self-administered questionnaire consisted of demographic information, COVID-19 preventive behaviors, knowledge, attitude, fear, and risk. Mann-Whitney U-test, Kruskal-Wallis one-way analysis, Spearman correlation, and binary logistic regression tests were used in data analysis. Results: Most of the HCPs were Saudi nationals (86.9%), females (63.1%), age group 20-29 years (42.3%), Middle Eastern ethnicity (82.5%), and working in the government sector (80.8%). A 52.2% of the participants were compliant with COVID-19 preventive behavior. The most and the least compliant preventive behaviors were "wearing masks" (88.8% compliance) and "keeping social distancing" (60.7% compliance). Preventive behavior was significantly higher in HCPs having a) more knowledge of COVID-19 (U=104849; p 0.001); b) positive attitude (U=84402; p 0.001); c) higher fear (U=103138; p less than 0.001) and d) nursing profession (p 0.01). COVID-19 knowledge (p<0.001), attitude (p<0.001), and fear (p<0.001) contributed significantly to the prediction of preventive behavior compliance. A unit increase in COVID-19 knowledge, attitude, and fear scores raised the odds of being compliant with preventive behavior by factors of 2.34, 1.87, and 1.53 respectively. Conclusion: About half of the study participants were compliant with COVID-19 preventive behavior. Preventive behavior is significantly higher among HCPs having more knowledge of COVID-19, more fear, a positive attitude, and the "nursing" profession. Having more knowledge, a positive attitude, and more fear of COVID-19 may increase the likelihood of being compliant with preventive behavior.

A Pilot Mitochondrial Genome-Wide Association on Migraine Among Saudi Arabians.

Background: Mitochondrial DNA (mtDNA) mutations have been reported in multiple neurological diseases and helped to explain the pathophysiology of these diseases. Similarly, variations in mtDNA might exist in migraine and can explain the effect of low ATP production in the neurons on the initiation of migraine attack. Therefore, in the current study we aim to explore the association of mtDNA mutations on migraine in the Saudi population. Subjects and Methods: Over 1950 young Saudi female students were screened for migraine, among that a total of 103 satisfied the ICHD-3 criteria. However,  20 migraine cases confirmed in the neurology clinic and gave consent to participate in the study. Another 20 age-matched healthy controls were also recruited. Mitochondrial sequence variations were filtered from exome sequencing using NCBI GenBank Reference Sequence: NC_012920.1 and analysed using MITOMAP. Genes with significant single nucleotide polymorphisms (SNPs) were investigated by the gene functional classification tool DAVID and functional enrichment analysis of protein-protein interaction networks through STRING 11.5 for the most significant associated genes. Results: Genome wide analysis of the mitochondrial sequence variations between the patients with migraine and control revealed the association of 30 SNPs (p < 0.05) in the mitochondrial genome. The highest significance (p = 0.001033) was observed in a coding SNP (rs1603225278) in the CYTB gene and rs386829281 in the region of origin of replication. Twenty-four significant SNPs were in the coding region of nine (ND5, ND4, COX2, COX1, ND3, CYTB, COX3, ND2 and ND1) genes. Conclusion: This is the first study to demonstrate the association of mtDNA variations with migraine in the Saudi population. The current findings will help to highlight the significance of mtDNA mutations to migraine pathophysiology and will serve as a reference data for larger national and international studies.

The Psychological Impact of COVID-19 on Residents of Saudi Arabia.

Purpose: This study aimed to determine the stress levels and identify various factors responsible for causing high-stress scores during the COVID-19 pandemic in the Saudi population. Patients and Methods: This cross-sectional study was conducted at Imam Abdulrahman Bin Faisal University, Dammam, from June 2020 until December 2020 on 4052 respondents from the Eastern province of Saudi Arabia. An online survey was used to collect information about various stress factors. The psychological impact of COVID-19 was measured by using the COVID-19 impact event scale (COVID-19 IES), whereas general stress levels were assessed by K10 Kessler Psychological Distress Scale (K10). Results: The psychological impact of the COVID-19 outbreak revealed that 35.4% of participants suffered from moderate or severe psychological impact (score>33); 19.7% had a mild psychological impact (scores24-32), whereas 44.9% reported minimal psychological impact (score <23). The factors significantly associated with higher stress scores and COVID-19 IES included male gender, low monthly income, having a private business, living in apartments/residential complexes, poor general health status, visit hospital/doctor in the past three months, presence of chronic disease, direct/indirect contact with someone diagnosed with/suspected to have COVID-19, contact with surfaces/tools infected with COVID-19, getting screened or quarantined for COVID-19, follow-up of the latest news about COVID-19 and knowledge of a greater number of people infected and died with COVID-19 (p < 0.05). In contrast, being an elementary school student, having 4-10 children, observing various protective measures, and staying home for 4-12 hours were associated with lower COVID-19 IES (p < 0.05). Conclusion: During the initial six months of the COVID-19 outbreak in Saudi Arabia, 35.4% participants suffered from moderate to the severe psychological impact. This study identified various factors responsible for high COVID-19 IES and K10 stress scores. These findings can help formulate psychological interventions for improving the stress scales in vulnerable groups during the COVID-19 pandemic.

Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine.

Migraine is a neurological ailment that is characterized by severe throbbing unilateral headache and associated with nausea, photophobia, phonophobia and vomiting. A full and clear mechanism of the pathogenesis of migraine, though studied extensively, has not been established yet. The current available information indicates an intracranial network activation that culminates in the sensitization of the trigemino-vascular system, release of inflammatory markers, and initiation of meningeal-like inflammatory reaction that is sensed as headache. Genetic factors might play a significant role in deciding an individual's susceptibility to migraine. Twin studies have revealed that a single gene polymorphism can lead to migraine in individuals with a monogenic migraine disorder. In this review, we describe recent advancements in the genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine. We also discuss the potential roles of genetic and abnormal factors, including some of the metabolic triggering factors that result in migraine attacks. This review will help to accumulate current knowledge about migraine and understanding of its pathophysiology, and provides up-to-date prevention strategies.

The Long-Term Impact of COVID-19 Pneumonia on the Pulmonary Function of Survivors.

BACKGROUND: The sequelae of COVID-19 pneumonia on pulmonary function and airways inflammation are still an area of active research. OBJECTIVE: This research aimed to explore the long-term impact of COVID-19 pneumonia on the lung function after three months from recovery. METHODS: Fifty subjects (age 18-60 years) were recruited and classified into two groups: the control group (30 subjects) and the post-COVID-19 pneumonia group (20 patients). Pulmonary function tests, spirometry, body plethysmography [lung volumes and airway resistance (Raw)], diffusion capacity for carbon monoxide (DLCO), and fractional exhaled nitric oxide (FeNO), were measured after at least 3 months post-recovery. RESULTS: Significant reduction in total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume (FEV1), FEV1/FEV, and diffusing capacity for carbon monoxide (DLCO) was observed in post-COVID-19 subjects compared to controls. Restrictive lung impairment was observed in 50% of post-COVID-19 cases (n = 10) compared to 20% in the control group (n = 6, P = 0.026). In addition, mild diffusion defect was detected in 35% (n = 7) of the post-COVID-19 group compared to 23.3% (n = 7) in the controls (P = 0.012). CONCLUSION: COVID-19 pneumonia has an impact on the lung functions in terms of restrictive lung impairment and mild diffusion defect after three months from recovery. Therefore, a long-term follow-up of the lung function in post-COVID-19 survivors is recommended.

Association between sex hormones and migraine in young Saudi females.

OBJECTIVES: To assess the sex hormone levels in young Saudi female migraineurs during a migraine attack and during pain-free periods and compare them with control subjects. METHODS: A case-control study involving 14 Saudi female migraineurs and 21 control subjects was conducted between December 2019 and March 2020. Demographic and disease history data were collected through participant interviews. Blood samples were drawn during the migraine attack and pain-free periods. RESULTS: Follicular (30.00±19.60; p<0.001) and luteal (39.79±11.45; p=0.037) estrogen levels were significantly higher in patients with non-menstrual related migraine (NMM), while luteal testosterone levels (1.10±0.31; p=0.023) were significantly higher in patients with menstrually related migraine (MM). Body mass index (BMI) was higher in patients with NMM (25.77±6.53; p=0.013), and it was found to be associated with follicular estrogen (p=0.016), progesterone (p=0.018), and pain intensity (p=0.042). Luteal estrogen level was significantly lower (13.96±7.88; p=0.036) in patients with luteal onset of attack. CONCLUSION: High estrogen levels were found to mediate NMM, their effect being more pronounced with increase in BMI; whereas low luteal estrogen levels mediated MM. Young females with MM might have high luteal testosterone levels, and a compensatory protective role could be surmised accordingly.

Diagnostic Accuracy of Serum Calcitonin Gene-Related Peptide and Apolipoprotein E in Migraine: A Preliminary Study.

BACKGROUND: A reliable, migraine-specific biomarker has not been identified so far. Calcitonin Gene-Related Peptide (CGRP) and Apolipoprotein E (ApoE) might serve as migraine biomarkers due to their roles in migraine pathophysiology. However, their diagnostic usefulness has not been explored yet. Present study explored the diagnostic accuracy of CGRP and ApoE in migraine. METHODS: A cross-sectional, case-control study was conducted from November 2019 to April 2020 at Physiology department of our university. Fourteen female migraine patients, 18-25 years old, with confirmed "Migraine" diagnosis by a neurologist, were recruited. Control group consisted of 14 age-matched healthy females with no personal/family history of migraine. Blood was drawn once from control subjects and twice from migraine patients (ictal and interictal phase). Serum CGRP and ApoE levels were assessed by ELISA. Statistical analysis involved paired t-test, one-way ANOVA, Receiver operating characteristic (ROC) curves and cross-tabs. RESULTS: ApoE (mg/dl) was higher significantly in interictal (1.90±0.50) and ictal (1.97±0.65) phases of migraine compared to control (1.07±0.26) (p ≤ 0.001). ROC curves for ApoE were significant in migraine ictal vs control (AUC= 0.91, AUC 95% CI: 0.78-1.0) and migraine interictal vs control (AUC=0.92, AUC 95% CI: 0.8-1.0) subjects. ROC curve for CGRP (pg/mL) was significant in migraine ictal vs control subjects only (AUC=0.79, AUC 95% CI: 0.6-0.97). CONCLUSION: Serum ApoE has "excellent" accuracy to diagnose migraine patients whether in ictal or interictal phase, from healthy subjects. ApoE levels of patients in these two phases of migraine are raised significantly than healthy subjects. CGRP has "fair" diagnostic accuracy to discriminate between migraine ictal phase and healthy subjects. Its levels do not differ significantly among migraine ictal, interictal phase and healthy controls.

Effectiveness of case-based teaching of cardiovascular physiology in clinical pharmacy students.

OBJECTIVE: This study aimed to formulate and implement a case-based cardiovascular physiology module for second year clinical pharmacy (CP) students. We also evaluated the students' feedback and compared the academic performance between a case-based teaching (CBT) group and a traditional didactic lectures (TDL) group. METHODS: This descriptive quantitative study was conducted on 181 students who were divided into two groups. Group 1 (77 students) underwent TDL and the same topics were delivered to Group 2 (94 students) through CBT. A written examination was conducted at the end of both modules. A validated questionnaire was used to obtain feedback from the CBT group regarding CBT and their assessment grades (response rate - 93.6%). RESULTS: Students' feedback about CBT was positive. The majority of students, 63 (72%), preferred learning and understanding through CBT, finding it an enjoyable experience. Participants stated that CBT stimulated critical thinking (67; 76%) and linked theory to practice (69, 78%). Furthermore, 70 (80%) preferred this type of teaching and assessment in the future and 70 (80%) agreed to include CBT in all preclinical subjects. Students feedback was supported by exam results: the mean percentage of exam scores in the CBT group was significantly higher in comparison to the TDL group (81.2% vs. 79%, p value <0.05). Further comparison within the CBT group revealed improved student performance in "case-based" as compared to "conventional" questions (82.75% vs. 80%, p value <0.05). CONCLUSION: Students greatly appreciated CBT, as it stimulated logical thinking and active participation in the class, resulting in improved performance in exams.

Prevalence of Migraine and its Relationship with Psychological Stress and Sleep Quality in Female University Students in Saudi Arabia.

PURPOSE: This study aimed to determine the prevalence of migraine in young female adults and to identify if a relationship exists between psychological stress or poor sleep quality and migraine. MATERIALS AND METHODS: This case control study was carried out at Imam Abdulrahman Bin Faisal University (IAU), Dammam, KSA from March 2019 to March 2020 on 1,990 female students (17- to 26-years-old). The study tools were Migraine Screening Questionnaire (MS-Q), International Headache Society (IHS) Criteria for Migraine, K10 Psychological Distress Instrument (K10) and Pittsburgh Sleep Quality Index (PSQI). RESULTS: A total of 103 out of 1,990 (5.17%) participants were identified to have migraine. Migraineurs compared to controls had significantly higher average stress scores; felt more tired, nervous, restless, could not sit still, felt that everything was an effort, and nothing cheered them up (p values; 0.008, 0.001, 0.02, 0.01, 0.004, 0.009, 0.02 respectively). Moreover, presence of migraine was significantly correlated with various stress parameters including "High K10 scores," "being tired," "being nervous," "restlessness," "inability to sit still," and "feeling that everything is an effort" (p values: 0.01, 0.002, 0.018, 0.01,0.005, 0.01,0.02). Regarding sleep quality and sleep parameters, no statistically significant difference was found between migraineurs and controls. No correlation was found between presence of migraine and poor sleep quality. CONCLUSIONS: The results of this study indicate that 5.17% of young females (17- to 26-years-old) suffer from migraine. It also concludes that poor sleep quality is not correlated with migraine, whereas high stress scores are significantly correlated with migraine in young female adults.

Effects of -3.7α Deletion and Sickle-Cell Trait on Ventilatory and Hemodynamic Responses to Maximum Exercise in Young Saudi Females.

INTRODUCTION: Hemoglobinopathies are common disorders in Saudi Arabia and have an impact on the general health of the affected individuals. The current study aimed to find out the effects of the presence of α 3.7 kb rightward deletion or sickle-cell trait (SCT) on ventilatory and hemodynamic parameters of maximum exercise testing in young Saudi women. METHODS: In a cross-sectional study, 75 randomly selected female students from different colleges were tested for VO2max using a COSMED system for maximum exercise testing. Blood parameters and globin genotyping were determined. RESULTS: Hemoglobin genetic studies revealed 28 of the students had 3.7 α-globin deletion only (-3.7α2/α1α2), five had SCT, and 42 had normal α-globin (α1α2/α1α2 and no HbS) and were considered the control group. Subjects with -3.7α2/α1α2 showed significantly lower VO2max and higher resting systolic blood pressure, while SCT carriers showed no difference in regard to ventilatory parameters, but had higher post-exercise systolic blood pressure than controls. CONCLUSION: It is concluded that individuals with 3.7 α-globin deletion might have lower fitness capacity, as demonstrated by lower VO2max, which might explain the general lower VO2max in the young women of this population. Furthermore, increments in resting systolic and posteexercise systolic blood pressure in 3.7 α-globin deletion and SCT, respectively, might indicate a future risk of cardiovascular diseases and require attention and extensive studies.