Effects of combined aerobic and resistance training on glycemic control, blood pressure, inflammation, cardiorespiratory fitness and quality of life in patients with type 2 diabetes and overweight/obesity: a systematic review and meta-analysis.

Background: Structured aerobic or resistance training alone seems to be a beneficial tool for improving glucose homeostasis, chronic systemic inflammation, resting cardiovascular function, and mental health in people with obesity and type 2 diabetes mellitus (T2DM). The aim of the present study was to synthesize the available data on the effectiveness of combined aerobic and resistance training (CART) on glycemic control, blood pressure, inflammation, cardiorespiratory fitness (CRF), and quality of life (QoL) in overweight and obese individuals with T2DM. Methods: A database search was carried out in PubMed, Web of Science, Scopus, Science Direct, Cochrane Library, and Google Scholar from inception up to May 2023. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the reliability of evidence. A random-effects model was used, and data were analyzed using standardized mean differences and 95% confidence intervals. The study protocol was registered in the International Prospective Register of Systematic Reviews (ID: CRD42022355612). Results: A total of 21,612 studies were retrieved; 20 studies were included, and data were extracted from 1,192 participants (mean age: 57 ± 7 years) who met the eligibility criteria. CART demonstrated significant improvements in body mass index, glycated hemoglobin, systolic and diastolic blood pressure, C-reactive protein, tumor necrosis factor-alpha, interleukin-6, CRF, and QoL compared to ST. These findings highlight the significance of exercise interventions such as CART as essential elements within comprehensive diabetes management strategies, ultimately enhancing overall health outcomes in individuals with T2DM and overweight/obesity.No differences were found in resting heart rate between CART and ST. An uncertain risk of bias and poor quality of evidence were found among the eligible studies. Conclusion: These outcomes show clear evidence considering the positive role of CART in inducing beneficial changes in various cardiometabolic and mental health-related indicators in patients with T2DM and concurrent overweight/obesity. More studies with robust methodological design are warranted to examine the dose-response relationship, training parameters configuration, and mechanisms behind these positive adaptations.

Home-based circuit training improves blood lipid profile, liver function, musculoskeletal fitness, and health-related quality of life in overweight/obese older adult patients with knee osteoarthritis and type 2 diabetes: a randomized controlled trial during the COVID-19 pandemic.

BACKGROUND: There is strong evidence showing the association between obesity, type 2 diabetes mellitus (T2DM), and knee pain resulting from osteoarthritis. Regular exercise has been reported as a foundational piece of the preventive therapy puzzle for knee osteoarthritis (KOA) patients. Nonetheless, evidence-based exercise protocols for people with comorbidities, such as obesity, T2DM, and KOA are limited. Therefore, the present trial aimed to assess the effectiveness of a 12-week home-based circuit training (HBCT) protocol on various indices related to cardiometabolic health, musculoskeletal fitness, and health-related quality of life (HRQoL) among overweight/obese older adult patients with KOA and T2DM during the COVID-19 lockdown. METHODS: This is a randomized controlled trial study registered at the National Medical Research Register (ID: RSCH ID-21-01180-KGTNMRR ID-21-02367-FUM) and obtained approval on December 9, 2021. Seventy overweight or obese patients with KOA and T2DM (62.2 ± 6.1 years; 56% female) were randomly assigned to the intervention group (n = 35, HBCT) or the no-exercise control group (n = 35, CON). HBCT performed a 12-week progressive protocol (seven exercises; 15-30 repetitions per exercise, 1 min passive rest between exercises; 2-4 rounds per session; 20-60 min total session duration). Blood samples were collected, and assays were performed to assess the lipid profile, liver function, and fasting blood glucose (FBG). In addition, the 30-s Chair Stand Test (30CST) was used to evaluate lower body muscular strength and endurance while the Timed Up and Go (TUG) test was used to evaluate lower limb function, mobility, and the risk of falls for all the participants. HRQoL was assessed using the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL). All the assessments were conducted at pre-, mid-, and post-training stages during the application or practice of the exercise protocol, rather than during the training sessions themselves. RESULTS: HBCT significantly reduced total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), aminotransferase, alanine aminotransferase, FBG and knee pain (p < 0.05). Furthermore, HBCT induced meaningful increases in high-density lipoprotein (HDL-C), lower body muscular strength, endurance, function, mobility, and HRQoL in overweight/obese older adults with T2DM and KOA (p < 0.05). CONCLUSION: The present outcomes recommend that an injury-free HBCT program may improve various indicators related to cardiometabolic health, musculoskeletal fitness, and HRQoL in elderly with overweight/obesity, T2DM and KOA. These findings offer valuable insights for clinicians and practitioners seeking evidence-based exercise interventions tailored for patients managing substantial metabolic and musculoskeletal health challenges in clinical practice.

Omicron variants of SARS-CoV-2: Epidemiological and clinical insights from a tertiary care center in Saudi Arabia.

BACKGROUND: The actual burden of the Omicron variants remains unclear. Therefore, this study aims to analyze the epidemiological and clinical features of Omicron-infected patients and investigate factors influencing hospital admission. METHODS: This retrospective single-center study included individuals with positive SARS-CoV-2 infection, specifically the Omicron variants (XBB, EG or JN), identified through real-time reverse-transcriptase polymerase chain reaction assays from January 2022 to December 2023. RESULTS: A total of 305 Omicron-infected patients were included; (53.11 %) were females and (46.89 %) were males, with a median age of 39 years [interquartile range (IQR): 30, 53]. Underlying diseases, including endocrine/metabolic disorders (22.30 %), hypertension (12.79 %), chronic respiratory disease (10.49 %), and malignancy (9.18 %) were prevalent, while (40.98 %) were medically free. The XBB variant was predominant (73.11 %), followed by JN (20.33 %), and EG variant (6.56 %). The seasonality analysis demonstrates XBB variants' domination in 2022, with a surge to 40 cases in December. The trend continued in 2023, peaking at 76 XBB cases in March. May 2023 reported 38 XBB cases and the emergence of 17 EG instances. Notably, in December, only one XBB case was reported, and 62 instances emerged with the JN variant. Overall, 233 out of 305 cases were reported during flu season (September to March) (76.39 %). Moreover, hospitalization occurred in (16.39 %), with a (1.31 %) mortality rate (all deaths in the JN variant). Multivariable analysis confirmed renal disease, chronic respiratory disease, endocrine/metabolism issues, and polymicrobial infection as positive predictors of hospitalization (p < 0.05). While COVID-19 vaccination significantly reduced hospitalization odds (Odds Ratio: 0.20, p = 0.001). CONCLUSIONS: These findings contribute valuable insights into Omicron epidemiology and factors influencing hospitalization. The dynamic fluctuations in Omicron variants, particularly XBB, EG, and JN, over 2022 and 2023, with JN emerging as the dominant circulating variant globally, underscore the need for continuous vigilance and urgency for updated vaccine formulations.

The prevalence of sedentary behavior among university students in Saudi Arabia.

BACKGROUND: A considerable body of research has demonstrated that reducing sitting time benefits health. Therefore, the current study aimed to explore the prevalence of sedentary behavior (SB) and its patterns. METHODS: A total of 6975 university students (49.1% female) were chosen randomly to participate in a face-to-face interview. The original English version of the sedentary behavior questionnaire (SBQ) was previously translated into Arabic. Then, the validated Arabic version of the SBQ was used to assess SB. The Arabic SBQ included 9 types of SB (watching television, playing computer/video games, sitting while listening to music, sitting and talking on the phone, doing paperwork or office work, sitting and reading, playing a musical instrument, doing arts and crafts, and sitting and driving/riding in a car, bus or train) on weekdays and weekends. RESULTS: SBQ indicated that the total time of SB was considerably high (478.75 ± 256.60 and 535.86 ± 316.53 (min/day) during weekdays and weekends, respectively). On average, participants spent the most time during the day doing office/paperwork (item number 4) during weekdays (112.47 ± 111.11 min/day) and weekends (122.05 ± 113.49 min/day), followed by sitting time in transportation (item number 9) during weekdays (78.95 ± 83.25 min/day) and weekends (92.84 ± 100.19 min/day). The average total sitting time of the SBQ was 495.09 ± 247.38 (min/day) and 58.4% of the participants reported a high amount of sitting time (≥ 7 hours/day). Independent t-test showed significant differences (P ≤ 0.05) between males and females in all types of SB except with doing office/paperwork (item number 4). The results also showed that male students have a longer daily sitting time (521.73 ± 236.53 min/day) than females (467.38 ± 255.28 min/day). Finally, 64.1% of the males reported a high amount of sitting time (≥ 7 hours/day) compared to females (52.3%). CONCLUSION: In conclusion, the total mean length of SB in minutes per day for male and female university students was considerably high. About 58% of the population appeared to spend ≥7 h/day sedentary. Male university students are likelier to sit longer than female students. Our findings also indicated that SB and physical activity interventions are needed to raise awareness of the importance of adopting an active lifestyle and reducing sitting time.

Effect of nanoparticle size on their distribution and retention in chronic inflammation sites.

Nanomedicines are increasingly researched and used for the treatment of chronic inflammatory diseases. Herein, the effect of the size of nanoparticles on their distribution and retention in chronic inflammatory sites, as compared to healthy tissues, was studied in a mouse model with chronic inflammation in one of the hind footpads. Using PEGylated gold nanoparticles of 2, 10, 100, and 200 nm, we found that although the smaller nanoparticles of 2 and 10 nm showed greater distribution and slower clearance in the inflamed footpad than the relatively larger nanoparticles of 100 and 200 nm, the larger nanoparticles of 100 and 200 nm were more selectively distributed in the inflamed hind footpad than in the healthy hind footpad in the same mouse. Based on these findings, we prepared protein nanoparticles of 100-200 nm with albumin, IgG antibody, or anti-TNF-α monoclonal antibody (mAb). The nanoparticles can release proteins in response to high redox activity and/or low pH, conditions seen in chronic inflammation sites. We then showed that upon intravenous injection, those stimuli-responsive protein nanoparticles distributed more selectively in the inflamed footpad than free proteins and remained longer in the inflamed footpad than similar protein nanoparticles that are not sensitive to high redox activity or low pH. These findings support the feasibility of increasing the selectivity of nanomedicines and protein therapeutics to chronic inflammation sites and prolonging their retention at the sites by innovative nanoparticle engineering.

Validity and reliability of the Arabic sedentary behavior questionnaire among university students aged between 18-30 years old.

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 (7th question: sitting time on weekdays) and IPAQ-LF (21st question: sitting time on weekdays and 22nd 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 7th 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.

Maternal awareness to the timing of allergenic food introduction in Saudi infants: A cross-sectional study.

BACKGROUND: Current guidelines recommend the introduction of allergenic foods as early as 4-6 months of age to decrease the risk of food allergy. However, caregivers' knowledge about such practices and adherence to them is ambiguous. OBJECTIVES: The purpose of this study was to evaluate the timing of introduction of potentially allergenic foods into children's diet and the level of maternal awareness about and degree of compliance with current recommendations. MATERIALS AND METHODS: We conducted a cross-sectional study from May 2019 to January 2020 at Imam Mohammad Ibn Saud Islamic University Medical Center, Riyadh, Saudi Arabia. Data were collected through questionnaire-based surveys, and a total of 405 mothers were enrolled in the study. The eligibility criteria included mothers of children between the ages of 12 and 36 months. RESULTS: Most mothers in this study had initiated allergenic foods, and the average time of introduction was 9.84 ± 3.16 months for eggs, 14.6 ± 5.78 months for peanuts, and 13.6 ± 5.37 months for fish. Around one-quarter (n = 102, 25.2%) of the children were identified as being in the high-risk group. Most mothers did not know or disagreed that the timing of introducing allergenic foods might help in preventing food allergy, but there was no difference between the risk groups (33.8% and 26.2%, respectively). Moreover, only 18.6% and 13.2% of the high- and low-risk groups, respectively, received correct information from their health care providers (P = .004). Mothers with only one child were less likely to start eggs at an early age (odds ratio [OR] = 0.5 and P = .005). Furthermore, children at a high risk of food allergy were two times more likely to start eggs at an earlier age (OR = 2.12 and P = .003). CONCLUSION: In this study, the allergenic food feeding practices being followed for infants and young children were found to be suboptimal. Parental education level and the number of siblings were identified as potential barriers to the implementation of and adherence to recent guidelines. There is a need for corrective measures to ensure safe and appropriate feeding practices in the Saudi community.

Safety Concerns of Nasal Corticosteroids Usage in Patients With Allergic Rhinitis.

Background Intranasal corticosteroids (INCSs) are the first-line treatment for patients with moderate to severe conditions of allergic rhinitis (AR) as per current guidelines. However, patients' knowledge and practice towards the safety of such medications remains ambiguous. Therefore, this study was undertaken to identify the awareness of and knowledge about the safety of nasal corticosteroid usage in patients with allergic rhinitis as well as their adherence to taking the medication. Materials and methods We conducted a cross-sectional study from June to September 2020 at Imam Mohammad Ibn Saud Islamic University Medical Center, Riyadh, Kingdom of Saudi Arabia. Data were collected through questionnaire-based surveys, and a total of 375 patients were enrolled in the study. The eligibility criteria included all adult patients diagnosed with allergic rhinitis. Results Most of the patients had used intranasal corticosteroids. However, only two-fifths of patients stated these medications were effective and only 27% thought they were safe to use. More than half of the patients expressed concerns about using intranasal corticosteroids; however, there was no difference among the patients when asked if their concerns made them discontinue their medication. The majority of patients (73.3%) did not receive appropriate advice on how to use intranasal corticosteroids, but most were compliant with the therapy regardless of their uncertainty about the medication's safety (71.5%). Most patients reported a benefit of using intranasal corticosteroids (71.5%). Half of the patients (53.9%) reported being aware of a special technique for how to use a nasal spray, but the nonsmokers were more knowledgeable about the techniques than the smokers (p = 0.007). Conclusion The patients' knowledge about, adherence to, and perceptions of intranasal corticosteroid use were found to be suboptimal. Patients' age, gender, socioeconomic status, education level, and smoking status were recognized as potential barriers to a positive perception of and adherence to the treatment plan. Corrective measures are needed to ensure better health outcomes.

Parental Knowledge of Children's Developmental Milestones in Riyadh, Saudi Arabia.

OBJECTIVE: Parental recognition of children's developmental milestones has been correlated with more effective childcare strategies and overall better outcomes for children. However, the knowledge that parents have about children's development remains uncertain which reflects serious concerns about children's health in Saudi Arabia. Therefore, this study was undertaken to identify parents' knowledge levels about children's developmental milestones and the information sources they rely on for this knowledge. Study Design. We recruited 1471 parents aged ≥18 with at least one child under 14 and living in Riyadh to participate in an online survey between July of 2019 and January of 2020. RESULTS: Most respondents showed a poor level of knowledge (80.0%) in all of four domains. However, mothers had more acceptable levels of knowledge (21.0%) than fathers (10.0%) (p ≤ 0.01). There was a significant association between knowledge and age at first child's birth; respondents who had their first child between 39 and 50 had the highest levels of knowledge (37.5%; p ≤ 0.01). In the four domains of development, parents were found to have the most knowledge about physical development (52.3%), followed by cognitive development (21.6%), social development (21.5%), and emotional development (21.2%). Only a few parents (5%) claimed to always rely on their healthcare professionals for information. CONCLUSION: There is a lack of appropriate knowledge about developmental milestones among parents, which reflects serious concerns about children's health in Saudi Arabia. Healthcare institutions and pediatricians currently play a minimal role in health education. Effective health education programs and strategies should be implemented to improve child development outcomes in the community.

Multiple Sclerosis Patients in Saudi Arabia: Prevalence of Depression and its Extent of Severity.

Background Multiple sclerosis (MS) is a serious chronic autoimmune disorder of the central nervous system of unknown etiology. MS-related depression is a common mood disorder recognized within the medical community. However, their association is ambiguous, underdiagnosed, undertreated and less reported. Objectives The study aimed to estimate the point prevalence and severity of depression among multiple sclerosis patients in Saudi Arabia. Materials and methods We conducted an observational cross-sectional study among multiple sclerosis patients in Riyadh region, Saudi Arabia. Patients filled demographic data and Patient Health Questionnaire-9 (PHQ-9) to determine depression. Those who did not meet the age, disease duration, and regular follow-up eligibility criteria were excluded from the study. Results We enrolled 238 MS patients in the study, male patients represented 39.1% (n = 93) while females accounted for 60.9% (n = 145) (male:female ratio 0.64). The mean age of the study population was 32.07 ± 7.93 years. The mean duration of the disease was 7.06 ± 4.7 years. We determined that 89.9% (n = 214) of the patients showed mild to severe depression symptoms (55.46% of the females, and 34.4% of the males; p = 0.474). We further found that 37.39% (n = 89) and 65.13% (n = 155) of the depressed patients were unemployed (p = 0.039) and were non-smokers (p = 0.097) respectively. Furthermore, depression severity is significantly associated with education (p = 0.005). Conclusion High levels of depression symptoms were found among MS patients in Saudi Arabia. The relationship between MS and psychiatric conditions exists despite the uncertainty of its pathogenesis. Further longitudinal studies should be carried out to obtain more valid outcomes. Neurologists treating MS patients can play a role in studies related to the condition by investigating depressive symptoms actively and providing the data.

Perceptions On Reciprocal Peer Teaching Among Medical Students As Learners And As Tutors.

OBJECTIVES: The College of Medicine at Imam University has incorporated reciprocal peer-teaching into the curriculum in the form of peer-led seminars. The aim was to evaluate this program and ascertain student perceptions. METHODS: A cross-sectional survey of medical students attached to the Internal Medicine I and II courses was conducted in 2018. The questionnaire evaluated perceptions about the peer-teaching program, tutors' knowledge, skills and attitudes, both from a student and a tutor perspective. RESULTS: Based on a 63% response rate from a total of 410 students, 34.5% of learners agreed that peer-tutoring was the most effective method of clinical teaching and 30.3% disagreed. More students reported that peer-led seminars did not prepare them for their exams (38.4%) compared to those who reported it did (27.9%). More than 40% of participants reported the tutors were approachable, created a welcoming learning environment and provided targeted information. From a tutor perspective, more than 70% of participants reported that they developed personally and professionally, improved their collaborative, communication, tutoring and presentation skills and confidence. Female students reported they benefited more as tutors compared to male students. CONCLUSION: Students regard obligatory reciprocal peer-teaching in the form of peer-led seminars as similar to faculty teaching and an overwhelming majority report that they benefit both personally and professionally from leading seminars. As doctors are expected to teach and train younger generations, medical schools should prepare all students for such roles. A system that provides an opportunity for every student to become a peer-teacher can fulfil this need.

Effect of the Ratio of Betamethasone to TNF-α siRNA Coencapsulated in Solid Lipid Nanoparticles on the Acute Proinflammatory Activity of the Nanoparticles.

There is evidence that encapsulating glucocorticoids into nucleic acid-containing nanoparticles reduces the inflammatory toxicities of the nanoparticles. Herein, using betamethasone acetate (BA), a glucocorticoid, and a solid lipid nanoparticle formulation of siRNA, we confirmed that coencapsulating BA into the siRNA solid lipid nanoparticles significantly reduced the proinflammatory activity of the siRNA nanoparticles in a mouse model. Using TNF-α siRNA, we then showed that the BA and TNF-α siRNA coencapsulated into the solid lipid nanoparticles acted as a dual anti-inflammatory and synergistically reduced TNF-α release by mouse macrophages in culture following stimulation with lipopolysaccharide, as compared to solid lipid nanoparticles encapsulated with TNF-α siRNA or BA alone. Importantly, upon studying the effect of the ratio of BA and TNF-α siRNA on the proinflammatory activity of the resultant nanoparticles, we identified that BA and TNF-α siRNA coencapsulated solid lipid nanoparticles prepared with a BA to TNF-α siRNA weight ratio of 2:1 induced the lowest proinflammatory cytokine production by macrophages in culture. This result was in comparison to nanoparticles prepared with BA to TNF-α siRNA ratios both higher and lower than 2:1 (i.e., 4:1, 1:1, and 0.5:1) and is likely due to differences in molecular interactions among the various components in the BA and TNF-α-siRNA coencapsulated solid lipid nanoparticles at these ratios. Encapsulating glucocorticoids into siRNA-nanoparticles represents a viable strategy to reduce the proinflammatory activity of the nanoparticles; however, the ratio of the glucocorticoid to siRNA in the nanoparticles requires optimization.

Effects of Acute Eccentric Exercise on Appetite-Related Hormones and Food Preferences in Men.

Eccentric exercise has been suggested to improve muscle atrophy, muscle function, and insulin sensitivity. The aim of this study was to examine the effect of acute eccentric exercise on appetite-related hormones, food preferences, and food intake. Fourteen moderately active men were recruited to participate in this study (age 24.2 ± 5.5 years; BMI 23.4 ± 3.3 kg/m2; VO2max 48.9 ± 3.1 ml/kg/min). Three different conditions were implemented; no exercise, flat running "inclination 0" and downhill running "inclination -12%." Appetite-related hormones, subjective appetite sensations, food preference and reward, and ad libitum food intake were measured at pre-, immediately post-, and 24 h post exercise. There were no significant median changes in total ghrelin or pancreatic peptide concentrations between conditions. There were also no median differences in subjective appetite ratings or energy intake between conditions, but the median change in explicit liking of sweet versus savory foods differed significantly between pre-exercise and 24 h post exercise (p = .013). Post-hoc analysis observed a significant difference in the pre-exercise to 24 h post exercise change between front running and downhill running (p = .023), and indicated greater liking of savory foods over sweet foods in downhill running than front running. However, no further differences were seen between conditions for the remaining food preference parameters, suggesting there were no systematic trends in these data. In conclusion, there was no effect of front and downhill running on eating behavior as compared to a nonexercise control condition, but these data need to be replicated in a larger and more heterogeneous sample.

Diabetic patients in Saudi Arabia: The evaluation of glycemic control measures based on emergency department utilization and the percentages of adherence to the recommended follow-ups for microvascular complications.

OBJECTIVES: To determine the association between emergency department (ED) visits, glycemic control and the quality of preventive diabetes care among diabetic patients in a Saudi community. Methods: This study was an observational, cross-sectional study that collected data through interview-based surveys between February and April 2017. Data were collected from 530 diabetic patients in the diabetes clinics at King Saud Medical City, the tertiary center of Riyadh, Kingdom of Saudi Arabia.  Results: This study found statistically significant relationships (p less than 0.05) between ED visits and patient age, the glycated hemoglobin (HbA1c) and education level. Emergency department visits increased by 43% for each unit of increase in HbA1c (odds ratio [OR]=1.43, 95% confidence interval (CI)=1.26-1.62). Graduating from high school decreased the odds of visiting the ED by 43% (OR=0.57, 95% CI=0.34-0.94). Most of the participants were not followed for possible microvascular complications; the majority did not visit nephrology (96.2%), ophthalmology (78.3%) and neurology (97.9%) clinics within the 12 months prior to the interviews. Conclusion: Emergency department visits can indicate poor glycemic control in diabetic patients. Additionally, the current practices of preventive diabetes care in Saudi Arabia are not sufficient, according to the diabetic standards of care recommended by the American Diabetes Association.

Problem-based learning: medical students' perception toward their educational environment at Al-Imam Mohammad Ibn Saud Islamic University.

BACKGROUND: Problem-based learning (PBL) is a student-centered innovating instructional approach in which students define their learning objectives by using triggers from the problem case or scenario. OBJECTIVES: To assess undergraduate medical students' perception toward PBL sessions and to compare their perceptions among different sex and grade point average (GPA) in the college of medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia. MATERIALS AND METHODS: We conducted a cross-sectional study based on a self-administered anonymous online questionnaire during the first semester of the 2017-2018 academic year in IMSIU. The data were collected from male and female students of the second and third year, as well as male students of the fourth year. RESULTS: Out of 259 students, 152 (58.7%) completed the questionnaire. The students' perception toward PBL was more positive than negative. Most of the students reported that PBL sessions increased their knowledge of basic sciences (P=0.03). Furthermore, most students agreed that PBL provided a better integration between basic and clinical sciences which differed significantly between the different GPA groups (P=0.02). Nevertheless, only 28.3% of the students agreed that the teaching staff is well prepared to run the sessions with significant statistical difference among different GPA groups (P=0.02). Moreover, only 26.3% of the students reported that there was proper student training before starting the PBL sessions with no significant difference. Additionally, only 34.2% and 28.9% of the students felt that they learn better and gain more knowledge thorough PBL than lectures respectively, with no significant difference. CONCLUSION: This study showed that tutors should be trained to guide the process of PBL effectively to achieve its goals. Moreover, students should be securely introduced to PBL and experience the development of their clinical reasoning through PBL. Further improvements are needed to provide students with an effective favorable learning environment and to take the students recommendations into consideration.

Intranasal immunization with aluminum salt-adjuvanted dry powder vaccine.

Intranasal vaccination using dry powder vaccine formulation represents an attractive, non-invasive vaccination modality with better storage stability and added protection at the mucosal surfaces. Herein we report that it is feasible to induce specific mucosal and systemic antibody responses by intranasal immunization with a dry powder vaccine adjuvanted with an insoluble aluminum salt. The dry powder vaccine was prepared by thin-film freeze-drying of a model antigen, ovalbumin, adsorbed on aluminum (oxy)hydroxide as an adjuvant. Special emphasis was placed on the characterization of the dry powder vaccine formulation that can be realistically used in humans by a nasal dry powder delivery device. The vaccine powder was found to have "passable" to "good" flow properties, and the vaccine was uniformly distributed in the dry powder. An in vitro nasal deposition study using nasal casts of adult humans showed that around 90% of the powder was deposited in the nasal cavity. Intranasal immunization of rats with the dry powder vaccine elicited a specific serum antibody response as well as specific IgA responses in the nose and lung secretions of the rats. This study demonstrates the generation of systemic and mucosal immune responses by intranasal immunization using a dry powder vaccine adjuvanted with an aluminum salt.

Lipid nanoparticles with minimum burst release of TNF-α siRNA show strong activity against rheumatoid arthritis unresponsive to methotrexate.

TNF-α siRNA has shown promising therapeutic benefits in animal models of rheumatoid arthritis. However, there continues to be a need for siRNA delivery systems that have high siRNA encapsulation efficiency and minimum burst release of TNF-α siRNA, and can target inflamed tissues after intravenous administration. Herein we report a novel acid-sensitive sheddable PEGylated solid-lipid nanoparticle formulation of TNF-α-siRNA, AS-TNF-α-siRNA-SLNs, prepared by incorporating lipophilized TNF-α-siRNA into solid-lipid nanoparticles composed of biocompatible lipids such as lecithin and cholesterol. The nanoparticles are approximately 120 nm in diameter, have a high siRNA encapsulation efficiency (>90%) and a minimum burst release of siRNA (<5%), and increase the deilvery of the siRNA in chronic inflammation sites in mouse models, including in a mouse model with collagen-induced arthritis. Importantly, in a mouse model of collagen antibody-induced arthritis that does not respond to methotrexate therapy, intravenous injection of the AS-TNF-α-siRNA-SLNs significantly reduced paw thickness, bone loss, and histopathological scores. These findings highlight the potential of using this novel siRNA nanoparticle formulation to effectively treat arthritis, potentially in patients who do not respond adequately to methotrexate.

Acid-Sensitive Sheddable PEGylated, Mannose-Modified Nanoparticles Increase the Delivery of Betamethasone to Chronic Inflammation Sites in a Mouse Model.

Inflammation is implicated in a host of chronic illnesses. Within these inflamed tissues, the pH of the microenvironment is decreased and immune cells, particularly macrophages, infiltrate the area. Additionally, the vascular integrity of these sites is altered with increased fenestrations between endothelial cells. These distinctive properties may be exploited to enhance targeted delivery of anti-inflammatory therapies. Using a mouse model of chronic inflammation, we previously showed that acid-sensitive sheddable PEGylation increases the distribution and retention of nanoparticles in chronic inflammation sites. Here we demonstrated that surface modification of the acid-sensitive sheddable PEGylated nanoparticles with mannose, a ligand to mannose receptors present in chronic inflammation sites, significantly increases the targeted delivery of the nanoparticles to these areas. Furthermore, we showed that the acid-sensitive sheddable PEGylated, mannose-modified nanoparticles are able to significantly increase the delivery of betamethasone-21-acetate (BA), a model anti-inflammatory compound, to chronic inflammation sites as compared to free BA. These results highlight the ability to engineer formulations to target chronic inflammation sites by exploiting the microenvironment of these regions.

Interleaved neuromuscular electrical stimulation reduces muscle fatigue.

INTRODUCTION: Neuromuscular electrical stimulation (NMES) can be delivered over a muscle belly (mNMES) or nerve trunk (nNMES). Both methods generate contractions that fatigue rapidly due, in part, to non-physiologically high motor unit (MU) discharge frequencies. In this study we introduce interleaved NMES (iNMES), whereby stimulus pulses are alternated between mNMES and nNMES. iNMES was developed to recruit different MU populations with every other stimulus pulse, with a goal of reducing discharge frequencies and muscle fatigue. METHODS: Torque and electromyography were recorded during fatigue protocols (12 min, 240 contractions) delivered using mNMES, nNMES, and iNMES. RESULTS: Torque declined significantly 3 min into iNMES and 1 min into both mNMES and nNMES. Torque decreased by 39% during iNMES and by 67% and 58% during mNMES and nNMES, respectively. CONCLUSIONS: iNMES resulted in less muscle fatigue than mNMES and nNMES. Delivering NMES in ways that reduce MU discharge frequencies holds promise for reducing muscle fatigue during NMES-based rehabilitation. Muscle Nerve, 2016 Muscle Nerve 55: 179-189, 2017.

Acid-Sensitive Sheddable PEGylated PLGA Nanoparticles Increase the Delivery of TNF-α siRNA in Chronic Inflammation Sites.

There has been growing interest in utilizing small interfering RNA (siRNA) specific to pro-inflammatory cytokines, such as tumor necrosis factor-α ( TNF-α), in chronic inflammation therapy. However, delivery systems that can increase the distribution of the siRNA in chronic inflammation sites after intravenous administration are needed. Herein we report that innovative functionalization of the surface of siRNA-incorporated poly (lactic-co-glycolic) acid (PLGA) nanoparticles significantly increases the delivery of the siRNA in the chronic inflammation sites in a mouse model. The TNF-α siRNA incorporated PLGA nanoparticles were prepared by the standard double emulsion method, but using stearoyl-hydrazone-polyethylene glycol 2000, a unique acid-sensitive surface active agent, as the emulsifying agent, which renders (i) the nanoparticles PEGylated and (ii) the PEGylation sheddable in low pH environment such as that in chronic inflammation sites. In a mouse model of lipopolysaccharide-induced chronic inflammation, the acid-sensitive sheddable PEGylated PLGA nanoparticles showed significantly higher accumulation or distribution in chronic inflammation sites than PLGA nanoparticles prepared with an acid-insensitive emulsifying agent (i.e., stearoyl-amide-polyethylene glycol 2000) and significantly increased the distribution of the TNF-α siRNA incorporated into the nanoparticles in inflamed mouse foot.