Introduction: Warts, benign skin growths caused by various human papillomavirus strains, are categorized as genital and non-genital. Non-genital warts often lack noticeable symptoms but can lead to psychological distress due to factors like embarrassment. Traditional treatments, including physical and chemical methods, show limitations, prompting the exploration of novel approaches like intralesional immunotherapy. The clinical challenge lies in selecting the most effective modality. Objective: In our study, we used the network meta-analysis (NMA) as a statistical tool to explore the most effective intralesional immunotherapy interventions. Methods: Comprehensive searches of Web of Science, PubMed, Cochrane, and Scopus databases were conducted until December 2023. Eligible studies were analyzed for outcomes presented as risk ratios (RRs) with 95% confidence intervals (CI). Treatments were ranked using the P-score in an NMA performed with R software. Results: We included 68 RCTs in our study. For complete response, needling showed a significant difference compared to Candida albicans antigen (RR= 0.13, 95% CI [0.02; 0.99]) and Mw (RR= 0.12, 95% CI [0.02; 0.94]). In overall response, both bleomycin and furosemide with digoxin were significant compared to autoimplantation (RR= 0.46, 95% CI [0.24; 0.88]) and (RR= 0.40, 95% CI [0.18; 0.91]) respectively. Similarly, both were significant compared to cryotherapy (RR= 0.45, 95% CI [0.27; 0.76]) and (RR= 0.40, 95% CI [0.19; 0.82]) respectively. Conclusion: This NMA indicates needling, furosemide with digoxin, and PBP antigen stimulants as effective for non-genital warts, surpassing traditional treatments in complete and overall response. Direct comparisons in future research are warranted to confirm their superiority.
Abstract Background Usually, old age brings a poor quality of life due to illness and frailty. To prolong their lives and ensure their survival, all elderly patients with chronic diseases must adhere to their medications. In our study, we investigate medication adherence for elderly patients and its impact on the general health of the patient. Methods We implemented a cross-sectional survey‐based study with four sections in April 2022 in Saudi Arabia. Data about the participants’ demographic characteristics, the Morisky Medication Adherence Scale, Patient Activation Measure (PAM) 13, and EQ-5D-5 L. Results A total of 421 patients participated in this study, their mean age was 60.4 years, and most of them were males. Most of our population is living independently 87.9%. The vast majority of people have a low adherence record in the Morisky Medication Adherence Scale (8-MMAS) classes (score = < 6). Moreover, the average PAM13 score is 51.93 (Level2) indicating a low level of confidence and sufficient knowledge to take action. Our analysis showed a significant correlation between socioeconomic status and medication adherence. Also, there was an association between housing status and medication adherence. On the other hand, we found no correlation between medication adherence and quality of life (QOL) by EQ-5D-5 L. Conclusion Medication adherence is directly affected by living arrangements, as patients who live with a caretaker who can remind them to take their medications at the appropriate times have better medication adherence than those who live alone. Medication adherence was also significantly influenced by socioeconomic status, perhaps as a result of psychological effects and the belief of the lower-salaried population that they would be unable to afford the additional money required to cure any comorbidities that arose as a result of the disease. On the other hand, we did not find any correlation between medication adherence and quality of life. Finally, awareness of the necessity of adherence to medication for the elderly is essential.
Epigenetics is the study of nucleotide modifications that are heritable and act as regulatory mechanisms without changing the nucleotide sequence of the genome. Exogenous cues such as environment, lifestyle, nutrition, stress, and psychological factors affect epigenetic mechanisms. This mechanism is in concordance with the genetic information that plays an important role during prenatal and postnatal life of an individual. Recent epigenetic studies have revealed the potential of epigenetics in elucidating the mechanisms of different diseases. In this review, we discuss basic epigenetic mechanisms and their roles in health and disease. In addition, reported aberrations in epigenetic regulation for some common human diseases are described. Finally, we address some epigenetic approaches that have shown potential for targeted treatment of diseases.علم التخَلُّق هو دراسة التعديلات النوكليوتيدية المورَّثة التي تعمل كآلية تنظيمية دون تغيير التسلسل النيوكليوتيدي للجينوم. تؤثر إشارات خارجية مثل البيئة، ونمط الحياة، والتغذية، والإجهاد والعوامل النفسية على آليات التخَلُّق. وتتوافق هذه الآلية مع المعلومات الجينية التي تلعب دورا مهما في حياة الفرد قبل الولادة وبعدها. لقد كشفت الدراسات الأخيرة في علم التخَلُّق إمكانات علم التخَلُّق في توضيح آليات أمراض مختلفة لم يتم فهمها سابقا بشكل كامل.ناقشنا في هذا الاستعراض آليات التخَلُّق الأساسية ودورها في الصحة والمرض. إضافة إلى ذلك فقد تم وصف الانحرافات في التنظيم التخلُّقي التي تم تسجيلها لبعض الأمراض البشرية الشائعة. وأخيرا، تتناول الورقة بعض الأساليب في علم التخَلُّق، التي تكمن بها القدرة على العلاج الموجَّه للأمراض.
Abstract Purpose The study aimed to test the validity and reliability of the Arabic version of the sedentary behavior questionnaire (SBQ). Methods A total of 624 university students (273 males; 351 females, mean age = 20.8 years) were recruited from Taibah University, Madinah, Saudi Arabia. For criterion and constructive validity ( n = 352), the Arabic SBQ was compared with total sitting time from the International Physical Activity Questionnaire-short form (IPAQ-SF) and the International Physical Activity Questionnaire-long form (IPAQ-LF). For concurrent validity, the English and Arabic SBQ versions were given concurrently to bilingual university students ( n = 122) once. For test–retest reliability, the Arabic SBQ was given twice to participants ( n = 150) at a one-week interval. Results Sitting time of IPAQ-SF (7 th question: sitting time on weekdays) and IPAQ-LF (21 st question: sitting time on weekdays and 22 nd question: sitting time on weekends) correlated significantly with total sitting time/week of the Arabic SBQ ( r = 0.29, p = 0.003; r = 0.14, p = 0.02, respectively). Motorized transportation measured with the IPAQ-LF correlated significantly with time spent driving in a car, bus, or train from the Arabic SBQ on weekdays and weekends ( r = 0.53, p < 0.001; r = 0.44 p < 0.001, respectively). The total sitting time of the Arabic SBQ was inversely correlated with BMI ( r = -0.18, p = 0.001). The correlations between the Arabic and the English SBQ versions ranged from 0.25–0.96; p < 0.001 on weekdays and 0.50–0.90; p < 0.001 on weekends. Moderate to good reliability was also found between test and retest for all SBQ items and total score during weekdays (0.72 to 0.8), and weekends (0.64 to 0.87), with exception of the 7 th item "play musical instrument", ICC = 0.46). Mean difference of test–retest of the Arabic SBQ was not significantly different from zero for the total sitting time of the Arabic SBQ (t = -0.715, P = 0.476). Conclusion The Arabic SBQ had satisfactory levels of reliability, with total sitting time of the Arabic SBQ correlating significantly with sitting times derived from IPAQ-SF, IPAQ-LF, and the English SBQ versions. Hence, the Arabic SBQ can be used as a tool to measure sedentary behavior among adult Arabs aged between 18 to 30 years old in future epidemiologic and clinical practice.
Objective: We examine obese and non-obese patients with respect to Helicobacter pylori (H. pylori) positive-infection (HPPI) and associated factors, specifically body mass index (BMI). Methods: This study took place in the Department of Endoscopy of a central hospital in the Najran region of Saudi Arabia (SA). A total of 340 obese Saudi patients (BMI ≥ 30 kg/m²) who had undergone diagnostic upper endoscopy before sleeve gastrectomy, were compared with 340 age and gender-matched control patients (BMI < 30 kg/m²) who had undergone diagnostic upper endoscopy for other reasons. Data collected included diagnosis of HPPI. Descriptive and multivariable binary logistic regression was conducted. Results: Mean patient age was 31.22 ± 8.10 years, and 65% were males. The total prevalence of HPPI was 58% (95% CI = 54⁻61%) with obese patients presenting significantly more HPPI than non-obese patients (66% vs. 50%, OR = 1.98, 95% CI = 1.45⁻2.70, p < 0.0005). Age and gender did not associate significantly with HPPI (p = 0.659, 0.200, respectively) and increases in BMI associated significantly with increases in HPPI (p < 0.0005). BMI remained a significant factor in HPPI when modelled with both age and gender (OR = 1.022, 95% CI = 1.01⁻1.03, p < 0.0005). Conclusions: Within the limitations of this study, the significance of HPPI in obese Saudi patients residing in the Najran region in SA was demonstrated alongside the significance role of BMI in HPPI.
Introduction: Muslims abstain from eating and drinking from dawn to dusk during Ramadan. We aim to evaluate the fasting experience of people with type 1 diabetes (PwT1D) and identify predictors of successful fasting and attaining glycemic targets during Ramadan. Methods: We included the 149 PwT1D who attempted to fast during Ramadan 2022, were seen in our Endocrine clinics during the month preceding Ramadan, and were using a continuous glucose monitor (CGM). They were categorized, based on their treatment modality, into 3 groups: a) Hybrid closed loop (HCL) pump (n=39); b) Open loop pump (n=12); and c) Multiple daily injections (MDI) (n=98). CGM Reports for Ramadan and the month preceding Ramadan and self-administered surveys about fasting experience were evaluated. Predictors for attaining the “double target” of: a) breaking fast ≤2 days and b) maintaining glucose time in range (TIR) ≥70% during Ramadan were analyzed using uni- and multi-variable logistic regression. Results: The “double target” of a) breaking fast ≤2 days and b) maintaining TIR≥70% during Ramadan was attained by 21.5% of PwT1D. Users of the HCL therapy, compared to the open loop and MDI users, had a significantly lower glycemia risk index (GRI), glucose management indicator (GMI), time below range (TBR), time above range (TAR), and average glucose during Ramadan (all p<0.05). Those with health insurance and better “pre-Ramadan” glycemic control (i.e. lower GRI, TAR, and coefficient of variation and higher TIR) were more likely to attain the “double target” during Ramadan. Users of the HCL pumps were more likely to attain the “double target” compared to the users of MDI + CGM [OR (95% CI): 25.47 (4.72, 137.49)] after adjusting for age, sex, educational level, employment status, insurance status, and diabetes duration. Conclusion: Using HCL pump therapy and having better pre-Ramadan CGM metrics predict attainment of the double target of fasting most of days and having TIR ≥70% during Ramadan among PwT1D. Disclosure M.Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. S.Alharthi: None. S.Albunyan: Employee; ProMedEx, Medtronic. N.Alzaman: None. D.C.Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc. A.M.Alguwaihes: Consultant; Eli Lilly and Company, Research Support; AstraZeneca, Novo Nordisk, Speaker's Bureau; Novo Nordisk, Sanofi.
Background: Chronic kidney disease (CKD) is defined as abnormalities of kidney structure and/or function persisting for a minimum of three months. Methods: An online cross-sectional study was conducted in the Kingdom of Saudi Arabia (KSA) between June and August 2022 to assess the knowledge, attitudes, practices, and barriers among family, internal medicine, and general physicians related to CKD screening, diagnosis, and management. Results: A total of 427 physicians were included in the study. The majority exhibited a strong grasp of the accurate definition of CKD (83%) and recognized common risk factors, such as diabetes (99%), drugs (95%), and hypertension (98%). Two-thirds of physicians were aware of the five stages of CKD and identified estimated glomerular filtration rate (eGFR) and creatinine clearance as the most suitable markers for kidney function. Physicians also displayed knowledge of CKD-related complications. However, a noticeable gap between knowledge and practice was evident. Only one-third of participants reported screening their patients every year, primarily using serum creatinine (92.5%) and eGFR (97%) for diagnosis, while only 16% recognized that stage 4 CKD is the appropriate time to refer patients to nephrologists. In terms of barriers, the majority of physicians reported encountering low barriers to CKD management, but general practitioners working in primary healthcare centers experienced significantly higher levels of barriers. Conclusion: Most participants in our study possess a good level of knowledge and positive attitudes towards CKD diagnosis and management. Nevertheless, a discrepancy between knowledge and practical application, particularly in terms of over-screening and early referral, highlights the need for educational efforts to improve physician practice in KSA. These findings underscore the importance of addressing this gap to promote effective CKD management.
Transient hypocalcemia after thyroidectomy is not uncommon and the risk increases with the extent of neck surgery. We report a case of severe and prolonged hypocalcemia after total thyroidectomy complicated by thoracic duct injury. Hypoparathyroidism and thoracic duct injury are potential complications following total thyroidectomy with extensive lymph node dissection. This case suggested that having both conditions may complicate treatment of hypoparathyroid-induced hypocalcemia by way of losses of calcium and vitamin D in the chyle leak.This report highlights chyle leak as an uncommon cause of prolonged hypocalcemia in patients who have undergone extensive neck surgery.Chyle has an electrolyte concentration similar to that of plasma.Medical treatment options for a chyle leak include fat-free oral diet or parenteral nutrition without oral intake, pharmacological treatment (primarily octreotide).
Coronavirus disease (COVID-19) has forced the urgent lockdown of schools and colleges worldwide. To ensure the continuity of education a shift from traditional teaching to e-learning was required. This study aims to identify factors that affect students' satisfaction and continued intention towards e-learning. A questionnaire was distributed to medical and dental students (second to sixth year) from different universities in Saudi Arabia. The study synthesizes the expectation-confirmation theory (ECT) and the theory of planned behavior (TPB) to predict students' satisfaction and intention to continue using e-learning using a validated self-administered questionnaire. We used the structural equation model to analyze the results and assess the study's hypotheses. A total of 870 completed questionnaires were received (67% response rate). The results showed that students were at a moderate level of satisfaction (median = 3.5). According to the ECT, both perceived usefulness and confirmation significantly influenced students' satisfaction (β = −.69 and β = .82, respectively). Satisfaction was the strongest predictor of students' continued intention (β = 1.95). Among the TPB constructs, perceived behavioral control (β = .51), attitudes (β = .39), and subjective norms (β = .36) had a significant positive influence on their intention to use e-learning. The results suggest efforts to increase students' satisfaction and intention with e-learning should be directed to adopting easy and useful e-learning platforms. In addition, training and motivating students to continue e-learning and increasing their confidence to ensure the effective and efficient use of such teaching modalities.
