Association between handgrip strength and metabolic syndrome in relation to gender and adiposity among middle aged and older Saudi populations

AIM

This cross-sectional study investigated the association between metabolic syndrome (MetS) and handgrip strength (HGS) with respect to sex and adiposity in Saudi men (n = 287) and women (n = 268).

MATERIAL AND METHODS

Anthropometry, body composition, HGS, and blood biochemistry were measured. The average age of the study population was 57.65 ± 9.3 years (men = 55.1 ± 9.3 years, women = 60.4 ± 9.3 years). We report that HGS/body mass index (BMI), HGS/weight, and HGS/fat (%) were significantly higher in controls than in patients with MetS in men but not in women. According to the ROC analysis, relative HGS (RHGS) was higher than HGS alone in the association with MetS, which was significant for men (p < 0.01). At lower quartiles of HGS, the probability of MetS was higher in women, and the same was found in men in the lower quartiles of HGS/%Fat. Multinomial regression revealed significant associations between age and adiposity and MetS in men and HGS in women. Additionally, the linear regression of age, HGS, and weight exhibited significant associations between HGS with WC in both sexes.

CONCLUSION

A higher risk of MetS in the lower quartiles of HGS was found in women, and adiposity moderated the relationship between HGS and MetS in men.

Estimation of Sarcopenia Indices in Women from Saudi Arabia in Relation to Menopause and Obesity: Cross-Sectional Comparative Study

Sarcopenia prevalence depends on the definition, and ethnicity must be considered when setting reference values. However, there is no specific cut-off for sarcopenia in Saudi women. Accordingly, we aimed to establish a cut-off value for sarcopenia in Saudi women. We determined the prevalence of sarcopenia in terms of low handgrip strength (HGS) in postmenopausal women using the EWGSOP2 value, redefined a specific cut-off for low HGS derived from Saudi premenopausal women, re-determined the prevalence of low HGS using the new cut-off, and analyzed the proportion of low HGS in women with obesity compared to those without obesity. Following EWGSOP2 guidelines, we defined probable sarcopenia and set new HGS values. We assessed HGS and body composition in 134 pre/postmenopausal women. Probable sarcopenia prevalence was calculated using EWGSOP2's HGS of 16 kg and new cut-offs from young premenopausal women without obesity. HGS 10 and 8 kg cut-offs were calculated from premenopausal Saudi women's mean -2 SDs and mean -2.5 SDs. Using the HGS 16 kg cut-off, sarcopenia prevalence was 44% in postmenopausal and 33.89% in premenopausal women. Applying the new HGS 10 kg and 8 kg cut-offs, the prevalence was 9.33% and 4%, respectively, in postmenopausal and 5% and 3.40%, respectively, in premenopausal women. Women with obesity had a higher proportion of low HGS across all cut-offs. We suggest that EWGSOP2 cut-offs may not be adaptable for Saudi women. Considering body composition differences between Saudis and Caucasians, our proposed HGS cut-offs appear more relevant.

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.

Comparison of depression, anxiety, and stress between public and private university medical students

Context

Depression, anxiety, and stress are common among medical students because of hectic and heavy studies.

Aim

This study was carried out to determine the magnitude of the Depression, Anxiety, and Stress Scale (DASS) among undergraduate medical students and its relationship with its causative factors in public and private universities.

Setting and Design

The study tool was DASS (Depression, Anxiety, Stress Scale-21) which was distributed through the Department of Physiology, College of Medicine, King Saud University, adopting a multistage cluster sampling method for an observational study design.

Subjects and Data

Data from undergraduate medical students (N = 337) was collected from public and private medical colleges in Saudi Arabia.

Statistical Analysis

Independent t-tests and analysis of covariance were applied to analyze the data.

Results

There was a significant difference in depression with a higher mean score in private versus public medical students (8.38±5.93 vs 6.34±5.46, p=0.001), anxiety (9.49±5.12 vs 7.91±5.00, p=0.005), and stress (9.11±5.11 vs 7.93±5.02, p=0.035). There was a significant difference in the level of anxiety between second- and third-years students (p =0.01).

Conclusion

Private medical university students have significantly higher depression, anxiety, and stress levels compared to public universities. More studies are needed to explore the causes of this psychological impact.

High prevalence of lack of knowledge and unhealthy lifestyle practices regarding premature coronary artery disease and its risk factors among the Saudi population

OBJECTIVE

Literature regarding coronary artery disease (CAD) and awareness of its risk factors is available in Saudi Arabia (SA). However, it is lacking with respect to premature coronary artery disease (PCAD). Therefore, it is necessary to evaluate the lack of knowledge of this underrepresented critical issue and to devise a well-constructed strategy for PCAD. This study aimed to assess the knowledge of PCAD and its risk factors in SA.

METHODS

A cross-sectional questionnaire-based study was performed in the Department of Physiology, College of Medicine, King Saud University (KSU), Riyadh, SA between July 01, 2022, and October 25, 2022. A validated proforma was sent to the Saudi population. The sample size was 1046 participants.

RESULTS

Proforma results indicated that 46.1% (n = 484) of participants believed that CAD could occur in people under the age of 45, whereas 18.6% (n = 196) did not believe, and 34.8% (n = 366) did not know. There was a highly statistically significant association present between sex and the belief that CAD can affect people who are under the age of 45 (p < 0.001), with 355 (73.3%) females believing that CAD can affect people below the age of 45 compared to 129 (26.7%) males. The results also showed a highly statistically significant relationship between educational status and the belief that CAD can affect people who are under the age of 45 (bachelor's degree, 392 participants, representing 81.1%; p < 0.001). Furthermore, having employment was notably positively associated with that belief (p = 0.049) as was having a health specialty (p < 0.001). In addition, 62.3% (n = 655) of participants were not aware of their lipid profile, 49.1% (n = 516) preferred using vehicles to get to nearby places, 70.1% (n = 737) did not undergo regular medical checkups, 36.3% (n = 382) took medications without consultations, 55.9% (n = 588) did not exercise weekly, 69.5% (n = 112) were E-cigarette smokers, and 77.5% (n = 810) consumed fast food weekly.

CONCLUSIONS

Individuals from SA have an evident lack of public knowledge and poor lifestyle practices regarding PCAD, which demonstrates the need for health authorities to take a more targeted and attentive approach toward PCAD awareness. In addition, extensive media involvement is required to highlight the severity of PCAD and its risk factors in the population.

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.

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.

Heart Rate Variability and Chronotype in Young Adult Men

Whether morning heart rate variability (HRV) predicts the magnitude of its circadian variation in the absence of disease or is influenced by chronotype is unclear. We aimed to quantify associations between (1) morning HRV and its diurnal change, and (2) morning HRV and a Morningness−Eveningness Questionnaire (MEQ)-derived chronotype. Resting electrocardiograms were obtained in the morning and evening on separate days in a counterbalanced order to determine the mean RR interval, root mean square of successive differences (RMSSD), and standard deviation of normal-to-normal RR intervals (SDNN) in 23 healthy men (24.6 ± 3.4 yrs; body mass index: 25.3 ± 2.8 kg/m2). The MEQ was completed during the first laboratory visit. Morning RMSSD and SDNN were significantly higher (Ps < 0.05) than evening values. Morning RMSSD and SDNN were associated with their absolute (Ps < 0.0001), and relative diurnal changes (Ps < 0.01). No associations were observed between HRV parameters and the MEQ chronotypes (Ps > 0.09). Morning HRV was a stronger determinant of its evening change than chronotype. Greater diurnal variation in HRV was dependent on higher morning values. Strategies to improve basal HRV may therefore support healthier cardio-autonomic circadian profiles in healthy young men.

Comparison of mobile phone usage and physical activity on glycemic status, body composition & lifestyle in male Saudi mobile phone users

Background

&Objectives: This study aimed to compare the effects of mobile phone usage and physical activity on HbA1c, body composition, and lifestyle among male Saudi Arabian mobile phone users.

Methods

The study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia from July 2020 to July 2021. The study sample consisted of 203 non-smoker male Saudi participants aged from 20 to 60 years who used mobile phones. Personal information was obtained through interviews using a proforma. The participants were divided into three groups according to their daily mobile phone usage: Group (1): less than 2 h, Group (2): 2–3 h, and Group (3): more than 3 h, and according to their physical activities: Group (1): sedentary, Group (2): average, and Group (3): athletes. Glycated Hemoglobin (HbA1c), Bioelectrical Impedance Analysis (BIA), and (SF) 36- items survey was performed.

Results

The mean age of 203 Saudi male adult participants was 28.0 ± 10.4 years. Mobile phone usage in the less than 2 h group was (33.5%), between 2-3 h (22.7%), and more than 3 h (43.8%) respectively. The mean age of Group (3), who used mobile phones for more than 3 h, was the lowest (23.9 ± 5.7). The results showed that HbA1C levels were almost equal in all three groups (5.8 ± 0.4, 5.7 ± 0.4, and 5.7 ± 0.3 respectively). In addition, emotional well-being and social functioning showed insignificant decreases in the more than 3 h group compared to other groups of mobile phone usage (69.3 ± 15.7, 70.9 ± 15.5, 65.2 ± 16.0, p = .091 and 82.9 ± 201, 81.2 ± 18.7, 77.6 ± 21.6, p = .267) respectively. No effect was detected between groups regarding various body compositions. Regarding physical activity classifications: the sedentary group constituted (36%) of the sample, whereas the average and athlete groups represented (53.7%) and (10.3%) of the total sample respectively. There was a significant decrease in BMI (29.6 ± 7.8, 25.3 ± 5.1,24.7 ± 5.6, p = .000), fat mass (24.7 ± 15.0, 17.1 ± 9.1, 15.3 ± 10.6, p = .000), and free fat mass (64.0 ± 10.2, 56.8 ± 8.7, 57.5 ± 8.0, p = .000) in the average and the athletic groups compared to the sedentary group. No significant difference was found in HbA1c between physical activity groups (5.8 ± 0.4, 5.7 ± 0.4, 5.7 ± 0.4, p = .218).

Conclusions

Mobile phone usage does not affect HbA1c and body composition parameters. Furthermore, we found the youngers used mobile phones longer than others. Insignificant decrease in emotional well-being and social functioning parameters of the style of life due to long mobile phone usage which needs more attention.

Incense Burning Indoor Pollution: Impact on the prevalence of prediabetes and Type-2 Diabetes Mellitus

Objectives:

Incense burning is a well-known practice in Asian and Middle Eastern cultures for ceremonial and religious purposes. The excessive use of incense burning has become a critical environmental health concern. The incense sellers are more exposed to incense allied air pollution. This study examines the association between prediabetes and type 2 diabetes mellitus (T2DM) in incense sellers.

Methods:

This cross-sectional prevalence study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia” during the period July 2019 to January 2020. After medical history and examinations had been performed, a total of 265 non-smoking volunteers male incense sellers were selected. American Diabetes Association (ADA) criteria were followed, people with “HbA1c less than 5.7% were considered normal; HbA1c 5.7%-6.4% were pre-diabetics, and HbA1c > 6.4% were considered people with diabetes”. In shops, the incense sellers were exposed to incense-related pollution for 8 hours daily, seven days a week. The mean age for the participants was 25±5.5 years, and body mass index was 19±2.8 (kg/m)2.

Results:

In incense sellers, the pre-diabetic was 125 (47.2%), and diabetes was 75 (28.3%). However, 65 (24.5 %) incense sellers were without prediabetes and diabetes. There was an increase in HbA1c levels with increasing working exposure to incense shops.

Conclusions:

The prevalence of pre-diabetic and type-2 diabetes was increased in incense sellers. The prevalence of pre-diabetic and type-2 diabetes was further increased with the increasing working duration of incense sellers. The study findings call for safe practice and avoiding indoor burning incense. It is suggested that well-ventilated areas with proper masks for the workers may reduce the incense-related pollution effects.

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.

The relationship between fatigue severity and mild cognitive impairment in Saudi patients with type 2 diabetes mellitus

Type 2 Diabetes Mellitus (T2DM) is a major health issue in Saudi Arabia, with a prevalence of 23.7% in 2015. Several factors contribute to the occurrence of Mild Cognitive Impairment (MCI) and its progression to Alzheimer's disease in patients with T2DM. This study assesses MCI and fatigue severity and their relationship in patients with T2DM. Out of the 160 Saudi adults interviewed at the King Khalid University Hospital in Riyadh from October 2019 till March 2020, 80 were known cases of T2DM while the rest were non-diabetic individuals. The Montreal Cognitive Assessment (MoCA) test, Mini Mental State Exam (MMSE) and Fatigue Severity Score (FSS) were used to evaluate MCI and fatigue severity, respectively. According to the MoCA scale, 68.7% diabetic individuals as against 42.5% from the non-diabetic group had MCI. While the FSS showed that 40% of the diabetic group vs 26.3% of the non-diabetic were fatigued. In conclusion, patients with T2DM are at a higher risk of developing MCI. Keywords: Type 2 diabetes mellitus, Mild cognitive impairment, Fatigue, Mini mental state exam, Montreal Cognitive Assessment, Saudi Arabia.

Relationship of Plasma Gremlin 1 Levels with Body Adiposity and Glycemic Control in Saudi Female Type 2 Diabetes Patients

OBJECTIVE

Gremlin 1 is a novel adipokine that plays an important role in obesity and type 2 diabetes mellitus (T2DM). In the current study, we aimed to evaluate plasma levels of Gremlin 1 in diabetic and non-diabetic Saudi adult females and its correlation with body composition, glycemic control and lipid profile.

METHODS

A case-control study was conducted among 41 T2DM and 31 non-diabetic adult age matched females (controls). All patients underwent body composition by bioelectrical impedance analysis, with a commercially available body analyzer. Fasting venous samples were analyzed for glycemic markers and lipids, while plasma Gremlin 1 was measured by ELISA. The results were compared between the two groups and correlated with other anthropometric and adiposity parameters.

RESULTS

Gremlin 1 levels were elevated in T2DM patients (345 ± 26 ng/mL) when compared to control subjects (272 ± 16 ng/mL, p < 0.05). Diabetic patients having poor glycemic control had significantly higher Gremlin 1 levels (382 ± 34 ng/mL) compared to patients with good glycemic control (291 ± 37 ng/mL, p < 0.05). Pearson correlation analysis revealed a positive correlation of Gremlin 1 with fat mass (r = 0.246, p = 0.012), HbA1C (r = 0.262, p = 0.008) and HOMA-IR index (r = 0.321, p = 0.001).

CONCLUSION

Our study demonstrates an important role of Gremlin 1 in glycemic control and body adiposity in the pathophysiology of obesity and T2DM. Gremlin 1 may emerge as a promising biomarker and therapeutic target in obesity and T2DM.

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.

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.

Auditory brainstem response: An overview of neurophysiological implications and clinical applications -A Narrative Review

Evoked Potentials are electrical potentials that occur in a group of neurons in response to stimulation of a sensory organ which can be recorded by surface electrodes. Testing evoked potentials is useful in assessing the integrity of neuronal pathways both at sensory and motor levels of neural control. Early auditory evoked potentials include cochlear and brainstem auditory-evoked potentials, popularly known as electrocochleogram, and auditory brainstem response. Evoked potential audiometry is a neurophysiogical test to assess auditory pathway function in response to auditory stimuli. Auditory brainstem response mainly assesses brainstem functions and integrity. These evoked potentials are widely used for assessment of the cochlear functions, auditory nerve and the brainstem. Most common indications for auditory evoked potentials include routine newborn hearing screening for auditory pathway deficits, detecting retrocochlear pathologies, intraoperative and intensive care monitoring, frequency-related measurement of auditory sensitivity and for diagnosing some demyelinating disorders in initial stages. The current narrative review was planned to highlight auditory brainstem response recording's basic principles, uses and methods of interpretation in health and disease phases.

Circulating Adiponectin and Resistin Levels Are Associated with Adiposity Indices and Physical Fitness in Healthy Adult Males

BACKGROUND The aim of this study was to assess the correlation of physical fitness scores (PFS) with serum adiponectin, resistin, and adiponectin/resistin ratio (AR ratio) in relation to body adiposity indices in healthy adult males. MATERIAL AND METHODS This cross-sectional study was conducted at the Clinical Physiology Unit, Physiology Department, King Saud University Medical City, King Saud University, Riyadh, from March 2017 to April 2018. We included 125 healthy adult males. Serum samples were obtained after overnight fasting. Analysis was performed for fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), basal insulin, lipid profile, resistin, and adiponectin. Bioimpedance analysis (BIA) was used to assess body composition. Based on ideal body composition, PFS were computed as previously published for all subjects and compared with serum markers. RESULTS There was a positive correlation of adiponectin with PFS (r=.218, p=0.015) and an inverse correlation with obesity degree (OD), OD (r=-.239, p=0.001), body mass index (BMI) (r=-.244, p=0.001), and waist/hip ratio (WHR) WHR (r=-.296, p=0.001). Moreover, it was correlated negatively with basal insulin (r=-.211, p=0.009) and homeostatic insulin resistance model (HOMA-IR) HOMA-IR (r=-.221, p=0.013). Resistin was correlated negatively with PFS (r=-.203, p=0.023), while its correlation with OD, BMI, WHR, and HOMA-IR was not significant. AR ratio was positively correlated with PFS (r=.286, p=0.001) and negatively with OD (r=-.210, p=0.019), BMI (r=-.222, p=0.013), WHR (r=-.308, p=0.001) and basal insulin (r=-.237, p=0.008). In linear regression analysis, the relationship of PFS was significant with adiponectin (r=.218, p=0.015), resistin (r=-.203, p=0.023) and AR ratio (r=.286, p=0.001). ROC curve analysis showed that individually the values of adiponectin and resistin were not significantly correlated with PFS, but they were significant with the combined AR ratio with AUC 64.6% (p=0.029). CONCLUSIONS Serum adiponectin was positively correlated and resistin was negatively correlated with physical fitness scores based on healthy body composition with low proportion of body adiposity and a higher proportion of fat-free mass. However, the combined effect of adiponectin/resistin ratio is an even better predictor of physical fitness. Moreover, the adiponectin/resistin ratio is even more highly associated with physical fitness than adiponectin or resistin alone.

Circulating Adiponectin and Resistin Levels Are Associated with Adiposity Indices and Physical Fitness in Healthy Adult Males

Background

The aim of this study was to assess the correlation of physical fitness scores (PFS) with serum adiponectin, resistin, and adiponectin/resistin ratio (AR ratio) in relation to body adiposity indices in healthy adult males.

Material/Methods

This cross-sectional study was conducted at the Clinical Physiology Unit, Physiology Department, King Saud University Medical City, King Saud University, Riyadh, from March 2017 to April 2018. We included 125 healthy adult males. Serum samples were obtained after overnight fasting. Analysis was performed for fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), basal insulin, lipid profile, resistin, and adiponectin. Bioimpedance analysis (BIA) was used to assess body composition. Based on ideal body composition, PFS were computed as previously published for all subjects and compared with serum markers.

Results

There was a positive correlation of adiponectin with PFS (r=.218, p=0.015) and an inverse correlation with obesity degree (OD), OD (r=−.239, p=0.001), body mass index (BMI) (r=−.244, p=0.001), and waist/hip ratio (WHR) WHR (r=−.296, p=0.001). Moreover, it was correlated negatively with basal insulin (r=−.211, p=0.009) and homeostatic insulin resistance model (HOMA-IR) HOMA-IR (r=−.221, p=0.013). Resistin was correlated negatively with PFS (r=−.203, p=0.023), while its correlation with OD, BMI, WHR, and HOMA-IR was not significant. AR ratio was positively correlated with PFS (r=.286, p=0.001) and negatively with OD (r=−.210, p=0.019), BMI (r=−.222, p=0.013), WHR (r=−.308, p=0.001) and basal insulin (r=−.237, p=0.008). In linear regression analysis, the relationship of PFS was significant with adiponectin (r=.218, p=0.015), resistin (r=−.203, p=0.023) and AR ratio (r=.286, p=0.001). ROC curve analysis showed that individually the values of adiponectin and resistin were not significantly correlated with PFS, but they were significant with the combined AR ratio with AUC 64.6% (p=0.029).

Conclusions

Serum adiponectin was positively correlated and resistin was negatively correlated with physical fitness scores based on healthy body composition with low proportion of body adiposity and a higher proportion of fat-free mass. However, the combined effect of adiponectin/resistin ratio is an even better predictor of physical fitness. Moreover, the adiponectin/resistin ratio is even more highly associated with physical fitness than adiponectin or resistin alone.

The battle against the COVID-19 pandemic- a perspective from Saudi Arabia

COVID-19 has emerged as the world's biggest challenge that has not only threatened human lives but also had an immense impact on the economy, safety and religious practices. The situation has worsened due to the lack of proper guidelines for fighting the sudden unexpected outbreaks. The world was not prepared for this situation. Muslims make up the largest religious group in the world, and Saudi Arabia is the center of religious life for Muslims. The eye of the Muslim world is turned toward the measures and reforms that the Saudi state is implementing during this pandemic, including strict curfews and quarantines with heavy fines and punishments for violations. This review highlights some important steps the Saudi government is taking and their impact on controlling the COVID-19 outbreak.

Thyroid "claw sign" a useful diagnostic marker in the outsized lesions of isthmus: A large colloid cyst

Thyroid isthmus lesions are generally small sized and can be solid or cystic. Discerning isthmic origin of a large nodule, especially if purely cystic, can become a diagnostic challenge because of thin thyroid tissue in it. We report a case of a 68-year-old male patient who had 6 weeks history of non- inflammatory central neck swelling associated with recent dysphagia, for which he underwent ultrasound and computed tomography (CT) scan examinations. Colloid nodules usually do not require further attention. Despite being commonest and benign thyroid nodules, they may require treatment if causing pressure symptoms. Its imaging characteristics can be variable, but they usually exhibit comet tail artifacts on ultrasound. In equivocal cases, claw sign on CT scan is diagnostic to confirm the site. Radiologists have a principle role to rule out other differentials of cystic neck lesions by careful examination of imaging features. In our case, CT scan allowed to rule out primary differential of thyroglossal cyst and guided clinicians for specific management plan.

The relationship between type 2 diabetes mellitus with cognitive functions

Background

Type 2 diabetes mellitus (T2DM) has been associated with impairment of cognitive functions. Since the majority of patients with diabetes in the Saudi population are between the ages of 40 and 69 years, it is crucial to ascertain whether the control of blood glucose level negatively correlates with the level of cognitive function scores similar to the way it correlates in those who are not controlling their blood glucose level with medications.

Aims

To assess cognitive functions in patients with T2DM and examine the effect of glycemic control on cognitive functions impairment in Saudi adults with T2DM.

Methods and material

Seventy-nine patients with T2DM underwent cognitive assessment testing using the Cambridge neuropsychological test automated battery (CANTAB), Mini-Mental State Examination (MMSE), and Fatigue severity scale. Their cognitive function scores were then correlated with their blood glucose levels, duration of diabetes, and levels of education. Poor glycemic control was defined as glycated hemoglobin levels more than 7.5. We excluded patients with depression or neurocognitive disorders as well as those over 75 years of age.

Results

Attention switching task (AST) total latency (P = 0.003), AST congruent score (P = 0.002), AST incongruent score (P = 0.003), AST block 3 (p = 0.004), and AST Block 7 (p = 0.006) were significantly higher in poorly-controlled DM. The intra-extra dimensional set shift (IED) total errors were significantly higher in poorly-controlled patients (p = 0.023). The difference in IED stages completed (p = 0.716) and spatial span (SSP) (p = 0.782) were not significant between the two groups. The mini-mental state exam (p = 0.336) and the fatigue severity scale (P = 0.167) did not show any statistical significance between good and poor control of T2DM. There was a significant positive correlation between the duration of T2DM and AST latencies for AST total latency, AST congruent score, and AST incongruent score.

Conclusions

Patients with T2DM have a statistically significant association between their cognitive functions and their glycemic control. Patients with uncontrolled T2DM showed decreased cognitive scores. Moreover, worsened cognitive scores were associated with longer disease duration.

Association between physical activity patterns and sarcopenia in Arab men

Objective

In this study, we aimed to examine the association between physical activity patterns and sarcopenia in Arab men.

Methods

This cross-sectional study included 363 men (47.7 ± 15.4 years). We analyzed appendicular lean mass (ALM), handgrip strength test, and physical activity levels. ALM divided by height (meters) squared was calculated (ALM/Ht 2 ), and participants with −1 and −2 standard deviations below the sex-specific mean for Saudi young adults were considered to have sarcopenia class I and class II, respectively. Independent t-tests, analysis of variance, and Mann–Whitney U tests were performed to determine mean and median differences.

Results

We observed a significant difference between participants with and without sarcopenia in moderate-to-vigorous physical activity (MVPA); the correlation between ALM/H2 and MVPA was borderline significant. With a 1-hour/week increase in MVPA, ALM/Ht 2 increased by 0.30 kg/m2. Total and ALM, handgrip strength, and MVPA were significantly lower in participants age >60 years; fat mass and waist circumference were unchanged as compared with middle-aged participants.

Conclusions

We identified an association between time spent in recreational MVPA and lean muscle mass among Arab men. Future studies should examine the role of MVPA training programs on muscle mass and strength in older men.

Healthcare workers' knowledge and attitudes towards COVID-19 in Saudi Arabia

OBJECTIVE

The world is facing a devastating challenge in the COVID-19 (coronavirus disease 19) outbreak.  Healthcare workers (HCWs) provide the first line of defense against any disease outbreak. Thus, the present study is designed to assess HCWs' attitudes towards, knowledge of, and awareness of COVID-19.

MATERIALS AND METHODS

A cross-sectional observational study was conducted using an online survey on social media; the participants were 597 adults. The study was conducted from March to April 2020. The questionnaire was randomly administered on Arabic-language social media applications; the 26-item survey assessed knowledge levels, attitudes, and practices.

RESULTS

The analysis includes 597 complete responses from HCWs; participants included physicians, nurses, medical students, and pharmacists. Most participants were females aged 18 to 25 years. Most participants agreed that the virus can spread via direct and indirect contact. Most participants indicated that they wash their hands; avoid touching their eyes, nose, or mouth; and avoid crowded places to protect themselves against infection. Most indicated that a bat was the original source of the virus. Most participating HCWs indicated that the symptoms of COVID-19 include fever, cough, and shortness of breath. Most of the participants also indicated that there is no specific treatment for patients infected with COVID-19.

CONCLUSIONS

The findings of this work can support the design of effective measures to prevent and control COVID-19 infections during the pandemic. The results also highlight where improvement is needed to HCWs' knowledge of and attitudes towards COVID-19; the findings also highlight the best healthcare practices regarding this illness.

Relationship of asthma control test scores with pulmonary function tests, quality of life and adiposity in asthmatic children

OBJECTIVE

This study aimed at assessing asthma control test (ACT score), quality of life (QOL), and pulmonary functions in asthmatic children, and to see the correlations between ACT score, QOL, and pulmonary functions.

PATIENTS AND METHODS

This cross-sectional study was conducted at the departments of pediatrics and physiology, College of Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. A total of 109 (53 asthmatics and 56 controls) children (aged 6 to 13 years) of both genders were studied. All subjects underwent clinical evaluation, 36-Item Short Form Survey (SF-36) for QOL, Spirometry, and cognitive assessment through mini mental state examination (MMSE).

RESULTS

QOL showed significantly lower scores in asthmatic compared to non-asthmatic children. The higher social functioning [SF] (p=0.0012) and less role limitation due to physical health [RLPH] (non-asthmatic patients had had higher physical functioning [PF] (p=0.0001), less energy/fatigue [EF] (p=0.0008=0.0068). On the opposite side, no significant difference was found regarding role limitations due to emotional problems [RLEP] (p=0.0644) and Emotional well-being [EW] (p=0.0758) between the two groups. A significant positive correlation was seen between QOL items and ACT score in PF (r=.535, p<0.01), less RLPH (r=.593, p<0.01), less FE (r=.379, p<0.01), higher EW (r=.310, p<0.05), and higher SF (r=.495, p<0.01). No significant correlation was found between body mass index (BMI) and lung functions in children with asthma. Interestingly, a positive correlation was found in asthmatic children between BMI and MMSE scores (r=.298, p=0.030).

CONCLUSIONS

Our study concluded that QOL in asthmatic patients was significantly lower than healthy subjects in terms of patient's physical functioning and social life. However, the emotional aspects of QOL were not significantly affected in asthmatic children.

The association of smart mobile phone usage with cognitive function impairment in Saudi adult population

Background & Objectives:

Excessive use of mobile phones has raised a great concern about adverse health effects on human health. The present study’s aim was to investigate the association of the usage of smartphones with cognitive function impairment in the Saudi adult population.

Methods:

The present cross-sectional study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia during September 2019 to January 2020. A total of 251 Saudi adults who were using mobile phones were recruited, and knowledge, attitude and practices were assessed by interview using a predesigned proforma. The Montreal Cognitive Assessment (MOCA) tool was employed to assess the cognitive functions, comparison was made between daily mobile phone usage group and their correlated Montreal Cognitive Score (MOCA).

Results:

The mean age for 251 Saudi adult participants was 32.43 ± 12.8 years. More than 80% of the participants used their mobile phone for more than two hours daily. About 61% of the participants were not aware of the side effect of the radiation generated from mobile phone. The participants showed a decrease in MOCA score with increased daily mobile phone usage (MOCA=26.8 for <1 hour daily usage, 26.1 for 1-2 hours, and 24.6 for >2 hours with P< 0.05). In addition, participants showed decreased MOCA score by keeping their mobile phone near their pillow while sleeping; MOCA=24.35 for near pillow groups and >25.5 for the groups that placed their mobile phone away from the pillow.

Conclusions:

Excessive use of mobile phones can cause cognitive function impairment. Strict policies must be implemented to control the use of smartphones in order to minimize the effects on mobile phone radiation on cognition. The media has to be on the forefront in educating the public about the proper usage of mobile phones.

Radiological diagnostic dilemma in a child with small aggressive facial mass, time to increase the differentials: an inflammatory myofibroblastic tumour

A 5-year-old girl with left facial swelling in the medial maxillary region close to the nasal ala was brought by her parents to our head and neck clinic. They have visited other doctors for similar presentation in the last 6 months, which started as redness and swelling, with occasional epiphora. The redness resolved after medical treatment, with slight regression of swelling, although it did not disappear. CT and MRI showed a locally aggressive, small enhancing soft tissue mass involving the left anteromedial maxillary wall, the nasal bone and the orbital floor. The mass involved the bony course of the nasolacrimal duct, which was the aetiology of the epiphora. The head and neck team performed an incisional biopsy through a sublabial approach. Concurrently, a nasolacrimal duct stent was inserted by an ophthalmologist. Histopathology was consistent with inflammatory myofibroblastic tumour with positive stains for CD68, CD163 and anaplastic lymphoma kinase-1. The tumour was excised and presently the patient is on periodic follow-up with head and neck and ophthalmology clinics.

Suitability of Ultra-Short-Term Heart Rate Variability in Military Trainees

We aimed to (a) evaluate the agreement between ultra-short-term and criterion resting heart rate variability (HRV) measures in military trainees, and (b) compare associations between HRV recording lengths and body composition. HRV recordings were performed for 10 min in 27 military male students. Mean RR interval, the root-mean square of successive differences (RMSSD), RMSSD:RR interval ratio, standard deviation of normal-to-normal RR intervals (SDNN), and SDNN:RR interval ratio were determined from the last 5 min of the 10-min recording and considered the criterion. Parameters were also recorded in successive 1-min epochs from the 5-min stabilization period. No differences were observed between criterion values and any of the 1-min epochs (p > 0.05). Effect sizes ranged from -0.36-0.35. Intra-class correlations ranged from 0.83-0.99. Limits of agreement ranged from 38.3-78.4 ms for RR interval, 18.8-30.0 ms for RMSSD, 1.9-3.1 for RMSSD:RR, 24.1-31.4 ms for SDNN, and 2.5-3.0 for SDNN:RR. Body fat% was associated (p < 0.05) with all HRV parameters at varying time segments. A 1-min HRV recording preceded by a 1-min stabilization period seems to be a suitable alternative to criterion measures. Ultra-short procedures may facilitate routine HRV tracking in tactical populations for status-monitoring purposes.

Associations of Physical Activity and Sedentary Time with Metabolic Syndrome in Saudi Adult Males

Purpose

The association between objectively measured sedentary behavior and physical activity with metabolic syndrome (MetS) has been rarely investigated in Saudi Arabia. The purpose of the current study was to examine the association of objectively measured sedentary, light physical activity (LPA), and moderate-vigorous physical activity (MVPA) with MetS among Saudi adult males.

Materials and Methods

The study participants were 103 males from Riyadh, Saudi Arabia (mean age = 54.9 ± 10.6 years). Metabolic syndrome was defined based on having three or more of cardiometabolic risk factors. Triaxial accelerometers were used to measure the time spent on sedentary and physical activities across 7 days. A minimum four days with ≥10 hours of wearing time per day were considered a valid data. Binary logistics regression models were performed to examine the association of sedentary and physical activity levels with MetS vs no MetS. Model 1 was unadjusted, models 2, 3, and 4 were mutually controlled for sedentary, light, and MVPA intensities.

Results

About 38% of males in the present study were classified as having MetS as demonstrated by a significant (p<0.05) decrease in high-density lipoprotein cholesterol (HDL-C) and a significant (p<0.05) increase in body weight, body mass index (BMI), waist circumference (WC), systolic blood pressure, glucose, and triglycerides compared to those without MetS. In addition, low levels of LPA (less than 6.3 hours per day) were significantly associated with the risk of having MetS, independent of sedentary and MVPA (odds ratio (OR) 4.26-6.96). The results showed that the associations between sedentary tertiles and MetS were not statistically significant. Levels of MVPA were also not significantly associated with an increased risk of developing MetS in all models.

Conclusion

This study showed that low levels of LPA were significantly associated with the risk of having MetS in Saudi males from Riyadh city, independent of MVPA and sedentary time. The results suggest that future intervention studies should assess the positive effect of increasing levels of LPA in reducing the risk of developing MetS in males.

Predictive Value of Markers of Adiposity in Carpal Tunnel Syndrome: A Clinical and Electrophysiological Evaluation

OBJECTIVE

To determine the association of total and segmental body composition adiposity indices with electrophysiological indicators of CTS.

STUDY DESIGN

Observational cross-sectional study.

PLACE AND DURATION OF STUDY

Departments of Medicine and Clinical Physiology at King Saud University Medical City, King Saud University, Riyadh from August 2018 to December 2019.

METHODOLOGY

Total and segmental body composition analyses were performed by a bio-impedance body composition analyser. All the patients were grouped according to body mass index [BMI], total body fat % [TBF%], total fat mass [TFM], arm fat % [AF%], arm fat mass [AFM], and visceral fat rating [VFR] scores. Nerve conduction studies (NCS) were performed according to the standard protocols.

RESULTS

CTS clinical severity score and CTS by NCS correlated significantly with BMI, TBF%, TFM, VFR, AF% and AFM. In ROC analysis, it was revealed that adiposity indices including BMI, TFM, VFR and AFM were significant predictors of abnormal NCS with area under the curve (AUC) of 0.824, 0.795, 0.795, and 0.803, respectively. VFR was a significant independent predictor of CTS severity (β coefficient=0.613, p<0.001) and delayed median nerve latency (β coefficient=0.317, p=0.017).

CONCLUSION

Total and segmental body composition adiposity indicators are significantly associated with clinical severity of CTS and electrophysiological markers; especially, visceral adiposity. Large scale studies are required to explore the true predictive value of body composition in CTS. Key Words: Body mass index, Body composition, Adipose tissue, Body fat distribution, Carpal tunnel syndrome, Nerve conduction, Median nerve entrapment, Visceral fat, Bioelectrical impedance, ROC analysis.

Reference Ranges and Determinant Factors for Fractional Exhaled Nitric Oxide in a Healthy Saudi Adult Population

BACKGROUND Fractional exhaled nitric oxide (FENO) has emerged as a promising marker in respiratory research. The aim of this study was to determine the reference range values of FENO for healthy Saudi adults and the factors associated with FENO levels. MATERIAL AND METHODS This cross-sectional study was conducted at the Department of Physiology, King Saud University, Riyadh, Saudi Arabia, from January 2016 to August 2017. A total of 429 healthy Saudi adults were initially recruited. The final selection included 412 participants, consisting of 307 men and 105 women. FENO measurements were performed according to the current recommendations of the American Thoracic Society. RESULTS We observed that the FENO levels of women were significantly lower than those of men (18.6 vs. 21.3, P=0.009). In women, the measured FENO ranged from 5.7 ppb to 42 ppb, and in men from 5.0 ppb to 55.0 ppb. The mean FENO level in the entire study population was 20.6, with a range of 5.0 ppb to 55.0 ppb. The difference became non-significant when we calculated the FENO after adjusting for body surface area by different percentile distributions. Multiple linear regression analysis showed that body surface area and weight were significant predictors of FENO levels. CONCLUSIONS In this study, FENO levels were significantly affected by demographic variables. Therefore, it is important to consider the factors influencing FENO values to make a valid clinical interpretation.

Utility of Spirometry Values for Evaluating Tracheal Stenosis Patients Before and After Balloon Dilation

OBJECTIVES

Tracheal stenosis is defined as a narrowing of the airway distal to the lower edge of the cricoid cartilage. It is initially diagnosed based on clinical presentation and then confirmed using direct laryngobronchoscopy. Other adjunctive diagnostic methods, including spirometry, have been proposed. This study aimed to evaluate the relationship between tracheal stenosis severity and pre- and post-balloon dilatation spirometry parameters in order to assess for significant changes in spirometry values and to evaluate for the effects of stenosis-associated factors on post-dilation spirometry values, including vertical length and grade of the stenosis, as well as the role of wound-modifying agents.

METHODS

This retrospective study included adults (>18 years of age) with isolated tracheal stenosis who underwent endoscopic balloon dilations at King Saud University Medical City from June 2015 to May 2019, with detailed documentation of operative findings and valid spirometry measurements pre- and post-balloon dilation. Basic demographic data and operative note details, including information about the percentage of tracheal stenosis, distance of tracheal stenosis from vocal cords, vertical length of stenotic segment, and use of wound-modifying agents (topical mitomycin C or triamcinolone injections), were extracted.

RESULTS

Fourteen patients with spirometry measurements obtained on 50 occasions (25 pre-balloon dilation and 25 post-balloon dilation) were included. Each 1-unit increase in the vertical length of the stenosis showed a statistically significant negative relationship (-1.47 L/s) with pre-balloon dilation peak expiratory flow (PEF; P = .034). Post-balloon dilation spirometric values showed statistically significant improvements for most variables.

CONCLUSIONS

The vertical length of an isolated tracheal stenosis can be predicted before surgical interventions using PEF values and may be a significant indicator of anticipated post-balloon dilation surgical success. Our study suggested that spirometry is a very useful technique for evaluating patients with tracheal stenosis due to its noninvasiveness, cost-effectiveness, with a good clinical value.

Neurological Sequelae in Youngest Adult Behcet's Disease Patient on Infliximab

Neuro-Behcet's disease is a rare neurological complication of Behcet's disease presenting between second and fourth decades of life. The etiology of Behcet's disease is still unknown but genetic predisposition has been described to play a role. The disease is reported more in males than females. Neurological involvement could cause brain parenchymal, vascular or meningeal changes with other distinct systemic symptoms, which may include orogenital ulcers, uveitis and skin lesions. Parenchymal neuro-Behcet's disease has a poor prognosis. MRI aids in diagnosing and differentiating it from other entities. Treatment includes anti-inflammatory drugs and immunotherapeutics. Our case is the youngest adult reported so far and is an unusual presentation of neuro-Behcet's disease, as the patient was already in remission and on infliximab infusion. Key Words: Neuro-Behcet's, MRI, Infliximab.

Assessment of fatigue severity and neurocognitive functions in the real setting of Ramadan in patients with type 2 diabetes mellitus

OBJECTIVES

Type 2 diabetes mellitus (T2DM) is linked with a risk of dementia and decline in neurocognitive function. The current observational case-control study was conducted to evaluate the effect of fasting during Ramadan on cognitive functions and fatigue severity in T2DM patients using the Cambridge Neuropsychological Test Automated Battery (CANTAB).

METHODS

This research was conducted at King Saud University Medical city, on 82 subjects including 43 control and 39 T2DM patients of both genders. The standardized Fatigue Severity Scale (FSS) and tests from CANTAB, including the Motor Screening Task (MOT), Spatial Span (SSP) and Intra-Extra Dimensional Set Shift (IED) were recorded during 3rd week and 2-3 weeks after Ramadan under controlled environmental conditions. Neurocognitive functions were recorded through CANTAB.

RESULTS

IED errors (24.43 vs 50.73, p = 0.007), MOT mean and median latency (1466.32 vs 1120.27, p = 0.002) were significantly higher in T2DM than controls. IED stages completed (7.43 vs 8.69, p = 0.003) and SSP Span length were significantly lower in T2DM than controls (4.13 vs 4.82, p = 0.059). The significant differences between T2DM patients and controls persisted in the post. T2DM patients made more errors and completed less IED stages than did the controls, indicating that a worsened flexibility of attention relative to controls. Moreover, T2DM patients exhibited longer latencies in MOT, indicating poor motor performance. A comparison of performances by T2DM patients on FSS and CANTAB during and after Ramadan showed that fasting substantially increased fatigue scales, motor performance, and working-memory capacity.

CONCLUSIONS

Patients with T2DM have impaired cognitive functions including poor motor performance, low flexibility of attention, and poor working memory capacity compared to healthy control subjects during and also in post Ramadan period. However, there is no clear statistical evidence that the cognitive functions (except for SSP SL scores) and fatigue severity of T2DM subjects differ between Ramadan and after Ramadan in both T2DM and controls.

Sarcopenia Coexisting with High Adiposity Exacerbates Insulin Resistance and Dyslipidemia in Saudi Adult Men

OBJECTIVE

The associations between sarcopenia, adiposity indices and metabolic dysregulation still remain controversial. We aimed to assess and compare insulin resistance and metabolic profile in sarcopenic and non-sarcopenic obese Saudi adult men.

METHODS

This cross sectional study was conducted at the College of Sports Sciences, King Saud University, Riyadh. We recruited 312 Saudi adult male individuals and 288 were finally selected for the study. Body composition analysis and hand grip strength (HGS) were estimated by bioimpedance analysis (BIA) and dynamometer in all subjects, respectively. Fasting blood samples were collected for glucose (FBG), basal insulin (BI) and lipid profile. The subjects were divided into three groups based on the body composition parameters, appendicular lean mass (ALM) and body fat percentage (BF%), into non-obese (NonOb) [Normal ALM+<25 BF%], obese without sarcopenia (ObNonS) [Normal ALM+>25 BF%] and obese with sarcopenia (ObS) [Low ALM+>25 BF%].

RESULTS

Obese subjects had significantly higher BI, HOMA-IR and HOMA-β compared to non-obese. Moreover, comparison between two obese groups revealed that both BI and HOMA-IR levels were higher in ObS subjects compared to ObNonS individuals revealing that sarcopenia exacerbates the insulin resistance profile. There was a significant trend of higher resistance and lower sensitivity from non-obese to obesity with sarcopenia. Total cholesterol (TC) and triglycerides (TG) were significantly higher and high density lipoprotein cholesterol (HDL-C) was significantly lower in sarcopenic obese subjects compared to non-sarcopenic obese individuals. The worsening effects were more significant at cutoff point of 7.46 on insulin indices and lipid profile showing that sarcopenia associated with obesity exacerbates the dyslipidemia.

CONCLUSION

Our study shows that obesity associated with sarcopenia exhibits significantly greater insulin resistance and dyslipidemia than sarcopenia or obesity per se. Therefore, sarcopenic obesity might be an independent risk factor for metabolic disease progression.

Unique clinical spectrum with distinguishing diagnostic features in Vogt-Koyanagi-Harada syndrome

A 36-year-old ulcerative colitis male patient on treatment for 7 years was referred to dermatology with resistant alopecia universalis and hypopigmented patches on limbs for 5 months. During this time he also reported to ophthalmology with acute bilateral decreased vision for 5 days. His examination revealed hyperaemic discs, multifocal retinal detachments and choroidal granulomas. Taking into account the revised diagnostic criteria, atypical course of disease in the form of early cutaneous presentation followed by ophthalmic manifestations was attributed to Vogt-Koyanagi-Harada syndrome (VKHS) which was supported by relevant investigations including ophthalmic imaging, MRI and nerve conduction studies. Subclinical nerve conduction abnormalities and white matter demyelination were also seen for the first time in a patient of VKHS. Appropriate treatment was required to prevent visual complications; therefore, systemic corticosteroids with steroid sparing immunosuppressive drug therapy showed significant improvement in vision on follow-up. Cutaneous manifestations were resilient to the entire regimen.

Impact of radiological diagnostics in the survivor of disseminated Fournier gangrene patient with septic pulmonary embolism

A 51-year-old diabetic man diagnosed with prostatic abscess underwent its drainage twice. Following surgery he developed fever and right-sided painless visual loss due to endophthalmitis. To rule out its endogenous source CT scan was done which showed multisystem aetiology and complications. His pelvic CT and CT cystogram revealed postsurgical urethral injury along with urinary extravasation, perineal and pelvic soft tissues air densities with fat stranding ascribed to Fournier gangrene, air in distended urinary bladder due to emphysematous cystitis and right common iliac vein air containing septic thrombus. CT chest spotted bilateral multiple septic pulmonary emboli. These radiological findings were promptly handled by uro-surgical team followed by alliance with other relevant departments. With hasty surgical drainage/debridement, urological restoration of urinary obstruction, aggressive broad spectrum antibiotics, anticoagulation and radiological follow-ups the patient withstood multisystem lethal complications and come up with excellent outcome except evisceration.

Predictive value of high sensitivity C-reactive protein on progression to heart failure occurring after the first myocardial infarction

Background: High sensitivity C-reactive protein (hsCRP) predicts myocardial dysfunction after acute coronary syndromes. We aimed to study the association of hsCRP estimation at first acute myocardial infarction (AMI) with myocardial dysfunction and heart failure.

Methods: This research was carried out at the Department of Physiology and Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. In this prospective study, 227 patients were studied. hsCRP levels were estimated when patients came to the emergency department at AMI, 7 days post AMI, and at 12 weeks of follow up after AMI. The outcome was change in myocardial functions, especially heart failure, 12 months after the attack.

Results: Based on a cutoff mean value of hsCRP levels at admission (10.05±12.68 mg/L), patients were grouped into high and low C-reactive protein (CRP.) The ejection fraction was significantly lower at follow up in the high CRP group (37.29±12.97) compared to the low CRP group (43.85±11.77, p<0.0198). hsCRP had significant inverse correlation with left ventricular ejection fraction (r=−0.283, p<0.01). About 38.1% patients showed heart failure, with 23.6% in the high CRP group and 14.5% in the low CRP group (OR 2.4, p=0.028). Receiver operating characteristic curve analysis showed that CRP levels at AMI had a specificity of 79% and sensitivity of 83% to predict heart failure.

Conclusion: A high hsCRP level measured at first AMI predicts myocardial dysfunction and heart failure. It is suggested that hsCRP plays an important role in the development of heart failure after myocardial infarction.

Effect of transcranial direct current stimulation on the number of smoked cigarettes in tobacco smokers

BACKGROUND

Recent studies reported that transcranial direct current stimulation (tDCS) applied over the dorsolateral prefrontal cortex (DLPFC) reduced craving and cigarette smoking. We aimed to evaluate whether 3 sessions of tDCS over the DLPFC modulate cigarette smoking which is a critical factor in tobacco smokers.

METHODS

In a double-blinded, sham-controlled, parallel experimental study, 22 participants who wished to quit smoking received tDCS with the cathodal over the right DLPFC and anodal over the left DLPFC based on the 10-20 EEG international system (F4, F3) at an intensity of 1.5 mA for 20 minutes during three consecutive days. For sham stimulation, the electrodes placement was the same as for the active stimulation.

RESULTS

For the short time interval (8 days after the end of the tDCS regimen), the number of smoked cigarettes was reduced similarly in the active and sham groups (p < 0.001). Also, at the long time-interval (4 months after the end of the tDCS regimen) as compared to pre-tDCS, there was no significant difference in the number of smoked cigarettes in the active (p = 0.806) or the sham (p = 0.573) groups. Overall, there were no statistically significant differences between the active and sham tDCS groups on cigarette smoking.

CONCLUSION

These findings suggested that 3 sessions of tDCS over the right and left DLPFC may reduce number of smoked cigarettes for short-time period but might not be significantly more effective than sham to decrease cigarette smoking.

Cardiovascular Risk and Neurocognitive Assessment in Young Adults and Their Relationship to Body Adiposity

BACKGROUND We assessed body composition, adiposity, cardiovascular risk, and cognitive functions in healthy young adult females and investigated the possible correlation between neurocognitive decline, adiposity, and cardiovascular risk markers. MATERIAL AND METHODS This cross-sectional study was conducted on 83 healthy, young adult, Saudi women (age 19-23 years). Subjects were classified into group (A) with 19 non-obese subjects and negative family history (FH) of cardiovascular diseases (CVD), group (B) with 38 non-obese subjects with a positive FH of CVD, and group (C) with 18 obese subjects with positive FH of CVD. Body composition was analyzed by bioelectrical impedance analysis. Cognitive functions were evaluated using the Cambridge Neuropsychological Automated Battery (CANTAB). The blood samples were tested for lipoprotein(a) [Lp(a)] and high-sensitivity C-reactive Protein (hs-CRP). RESULTS There was significantly prolonged Attention-Switching Task (AST) latency in obese subjects with negative family history of CVD (p=0.014) and those with positive family history of CVD (p=0.026) compared to controls, but the difference in AST Percent Correct Trials, Intra-Extra Dimensional Set Shift (IED) Total Errors, and Simple Reaction Time (SRT) was not significant. Simple response time had a weak but significant inverse correlation with BMI (r=-0.227, p<0.05). BMI was correlated positively with Lp(a) and hs-CRP, while BF% was correlated with hs-CRP only. No correlation was observed between the CANTAB tests, Lp(a), and hs-CRP. CONCLUSIONS Cardiovascular risk increases with higher adiposity and the presence of a positive family history of cardiovascular disease. Neurocognitive function may decline with higher adiposity; however, no relationship was observed between neurocognitive functions and cardiovascular risk markers.

Physical Fitness and Its Relationship to Plasma Leptin, Leptin Soluble Receptor, and Free Leptin Index in a Saudi Population: A Comparison Between Diabetic and Non-Diabetic Individuals

Background

Low physical activity is considered to be a risk factor for type 2 diabetes mellitus (T2DM). One theory suggest that leptin resistance is involved in the pathophysiology of impaired glucose metabolism. In this study we aimed to assess the correlation of physical fitness scores (PFS) with serum total leptin (TL), serum leptin soluble receptor (LSR), and free leptin index (FLI) in a group of Saudi patients with T2DM.

Material/Methods

This cross-sectional study involved 115 subjects: 52 healthy control subjects and 63 patients with T2DM. All subjects underwent body composition analysis. Blood samples were analyzed for fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), serum total leptin (TL), and serum leptin soluble receptor (LSR). Based on ideal body composition and our previous studies, physical fitness scores (PFS) were recorded for each subject.

Results

In patients with T2DM, levels of LSR were positively correlated with PFS (r=0.281, p=0.025), while the levels of TL (r=−0.425, p=0.001) and FLI (r=−0.439, p=0.001) were negatively correlated with PFS. In control subjects, TL and FLI levels were negatively correlated (r=−0.612, p=0.001and r=−0.543, p=0.001 respectively) with PFS. In linear regression analysis, after adjustment for age and BMI, TL and FLI were independent predictors of PFS.

Conclusions

Serum TL and FLI were negatively correlated while LSR was positively correlated with PFS in patients with T2DM. Therefore, they may be important biomarkers for predicting the outcomes of physical fitness and exercise programs.

Role of Endocannabinoids on Neuroinflammation in Autism Spectrum Disorder Prevention

Autism Spectrum Disorder (ASD) disease has become a mounting socio-economical alarm around the world. Neuroinflammtion had been shown in postmortem brain specimens from ASD patients. The Endocannabinoids System (ES) consists of a family of locally produced, short-lived, endogenous, phospholipid-derived agonists (endocannabinoids) that control energy balance and body composition. The growing number of medical benefits of ES, such as their ability to regulate processes like neuroinflammation, neurogenesis and memory, raise the question of their potential role as a preventive treatment of ASD. To test this hypothesis, basic and clinical studies allow us a thorough investigation of the role of ES in the pathogenesis of ASD. This hypothesis will help to understand the mechanism of ES and its role in ASD.

Relationship of serum novel adipokine chemerin levels with body composition, insulin resistance, dyslipidemia and diabesity in Saudi women

OBJECTIVE

Chemerin is believed to be a mediator for the adipose tissue inflammation that occurs in obesity. The present study compared chemerin levels between healthy and type 2 diabetic women matched for age and body composition. We also aimed to assess the relationship of serum chemerin levels with body composition, insulin resistance, dyslipidemia, and diabesity.

PATIENTS AND METHODS

This observational case-control study was conducted at the Departments of Physiology and Medicine, Saud University Riyadh, Saudi Arabia, from September 2013 to April 2014. A total of 100 subjects were recruited, including 51 adult diabetic females, and a control group consisting of 49 healthy females. Finally, 80 subjects were selected as per inclusion criteria. In the finally selected group, 45 of were type 2 diabetics and 35 were healthy subjects matched for age, body mass index (BMI) and body composition with age ranging between 30-65 years. Body composition analysis was estimated using bioelectrical impendence analyzer. Fasting venous blood samples were analyzed for glycemic markers, lipids, and chemerin. Insulin resistance and sensitivity indices were calculated by HOMA-IR and QUICKI using standard formulas.

RESULTS

The two groups were matched for age, BMI, body fat percentage (BF%), basal metabolic rate (BMR), truncal fat and waist hip ratio (WHR). Serum chemerin levels were higher in diabetics than controls (p=0.001). Systolic blood pressure, weight, fat mass and visceral fat were found to be significantly higher in diabetics when compared to controls. Fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL), triglycerides (TG), insulin and HOMA-IR were significantly higher in diabetics compared to controls. While QUICKI and HDL were significantly lower in diabetics compared to controls. Chemerin levels correlated positively with age (r=0.300, p=0.007), waist hip ratio (r=0.250, p=0.026), weight (r=0.270, p=0.016), BMI (r=0.334, p=0.003), BF% (r=0.325, p=0.003), fat mass (r=0.250, p=0.026), visceral fat (r=0.356, p=0.001), truncal fat mass (r=0.245, p=0.030), truncal fat % (r=0.249, p=0.027), serum basal insulin levels (r=0.354, p=0.001) and HOMA IR (0.275, p=0.015), while it correlated inversely with QUICKI (r=-0.283*, p=0.012). In multiple linear regression analysis age (r=0.236, p=0.023), BF% (r=0.265, p=0.014) and basal insulin levels (r=0.265, p=0.014) were independent predictors of chemerin.

CONCLUSIONS

Serum chemerin levels are elevated in patients with type 2 DM compared to healthy control subjects and are positively correlated with adiposity and Insulin resistance in patients with type 2 DM.

Effect of Smoking on Cognitive Functioning in Young Saudi Adults

BACKGROUND Smoking is the predominant form of tobacco consumption and is growing worldwide, particularly in the younger generation in the Middle-East. We aimed to determine the effects of tobacco smoking on cognitive functions among young Saudi adults. MATERIAL AND METHODS We recruited a group of cigarette smokers (N=22) and a group of controls (non-smokers) (N=30) from apparently healthy male volunteers aged 18-29 years. Cognitive function was assessed by using the Cambridge Neuropsychological Automated Battery (CANTAB). The cognitive functions outcome variables were the response time (attention-switching task [AST]), and the percentage of correct response (pattern recognition memory [PRM] task). Clinical, demographic, blood markers (brain-derived neurotrophic factor (BDNF) and apolipoprotein E) were assessed between groups. RESULTS The 2 groups were matched for age and educational status. In comparison to the control group, smokers showed significant cognitive impairments in AST-Latency (p=0.001), AST-Congruent (p=0.001), and AST-Incongruent condition (p=0.001). There was not significant difference in BDNF APOE serum level between the 2 groups. CONCLUSIONS These results indicate that attention and alertness were significantly impaired in smokers compared to non-smokers.

Post-Traumatic Bilateral Facial Paralysis Associated with Temporal Bone Fracture

Bilateral traumatic facial paralysis is a very rare clinical condition. Loss of taste sensation, associated with bilateral traumatic paralysis, is even rarer and has not been well described in the literature. In this report, a 23-year old male, who developed bilateral facial paralysis with loss of taste sensation and hearing impairment, following a motor vehicle accident, is presented. He had initially presented with unconsciousness for about 2 hours after he sustained closed head injury after a motor vehicle accident. Initial Computed Tomography (CT) scans revealed a small epidural hematoma, right temporal bone fracture and air densities around the basal cistern. On the 4th day after trauma, he was noted to have incomplete closure of both eyes and was feeling difficulty with chewing and drooling of saliva. Electrodiagnostic testing confirmed the diagnosis of bilateral facial paralysis-House-Brackmann (HB) grade V. Electroneuronography (ENoG) showed degeneration of 90% nerve fibres bilaterally. The high-resolution CT scans showed bilateral temporal bone fractures. At 3 months of follow-up, the patient had partial recovery of facial nerve function bilaterally and improvement in HB classification to grade III and ENoG of 60% was observed.