Functional assessment of septo(rhino)plasty revision surgery.

INTRODUCTION: Functional septo(rhino)plasty incurs a 17-25% rate of revision for persistent symptoms. OBJECTIVES: The main study objective was to assess functional results before and after surgical revision. The secondary objective was to describe the shortcomings or excesses of the prior surgeries, with a-posteriori comparison of efficacy for the surgical techniques requiring revision. MATERIAL AND METHODS: A single-center retrospective study included functional salvage septo(rhino)plasties. Data comprised epidemiology, intraoperative anatomic abnormalities indicative of prior surgery, operative correction maneuvers, and pre- and post-intervention NOSE and RhinoQoL scores and satisfaction on VAS. RESULTS: Eighty-two patients were included. Anatomic abnormalities comprised deviated posterior septum (81.7%) and chondroethmoidal junction (58.5%), valve stenosis (54.9%), and obstructive boney spur or crest (46.3%). Prior surgeries comprised 33 submucosal resections, 29 septorhinoplasties, 14 Cottle septoplasties and 5 Killian procedures. Complete septoplasty was performed in 80% of cases, with associated maneuvers in 15%. All scores showed improvement taking the whole population together (P<10-5), but on subgroup analysis improvement concerned only revision of septorhinoplasty (P<10-4) and of submucosal resection (P<10-3), while 17% of patients showed no change in scores. CONCLUSION: Functional nasoseptal salvage surgery enables most patients to recover respiratory comfort, with the exception of a few cases despite a perfectly straight nasal septum.

Optimizing anterior laryngeal exposure during direct suspension laryngoscopy in adults.

An analysis of the literature on laryngeal exposure during direct suspension laryngoscopy in adults summarized the resources available to improve visualization, specifically at the anterior commissure.

The efficacy of metformin as adjuvant to chemotherapy on IGF levels in non-diabetic female patients with progressive and non-progressive metastatic breast cancer.

OBJECTIVE: Some studies have shown that metformin inhibits the proliferation of breast cancer (BC) cells via multiple ways. One of these mechanisms is through the indirect control of the IGF-route mediated via the activation of the AMPK-LKB1 pathway in the liver, which leads to a decrease in blood glucose and insulin levels. The objective of this study was to investigate the effects of metformin as adjuvant to chemotherapy on IGF levels in female patients with progressive and non-progressive metastatic BC. PATIENTS AND METHODS: In this trial, 107 women receiving chemotherapy for metastatic breast cancer (MBC) were divided into two groups: the metformin group received 500 mg of metformin twice daily, whereas the control group did not receive any metformin. All patients received chemotherapy according to the South Egypt Cancer Institute's (SECI) established regimen. The level of IGF-1 was determined in the blood at the initiation of therapy (baseline) and at six months post treatment. RESULTS: No substantial differences were noted regarding IGF-1 levels in both groups at baseline (IGF-1 average level was 40.74 ± 36.16 vs. 32.06 ± 20.00 in the metformin and the placebo group, respectively, p = 0.462). While after six months, the mean IGF-1 level was 37.62 ± 31.35 vs. 39.12 ± 2 5.93 in the metformin and placebo groups, respectively, (p = 0.170). CONCLUSIONS: Metformin as an adjuvant to chemotherapy in MBC patients had no significant effect on reducing IGF-l levels which promotes the inhibition of the proliferation of BC cells in MBC patients.

Retrospective validation of the postnatal Growth and Retinopathy of Prematurity (G-ROP) criteria in a developing country.

Background: The characteristics of premature infants vary from country to country rendering it challenging to apply retinopathy of prematurity (ROP) screening algorithm globally. The screening criteria for postnatal growth and ROP (G-ROP) for preterm infants are known to be beneficial, but it is not clear whether these criteria can be used universally. Aim: The aim of this study is to validate the accuracy of the G-ROP criteria in screening preterm infants in Saudi Arabia. Subjects and Methods: This single-center retrospective study included 300 premature infants (mean gestational age [GA], 28.72 ± 2.2 weeks; range, 21-36 weeks) at a referral center who were screened for ROP between 2015 and 2021. The inclusion criteria were the availability of data on ROP outcome and body weight up until day 40 after birth. The G-ROP 1 and G-ROP 2 models were examined for their ability and accuracy in identifying infants with any stage ROP and treatable ROP. Results: The G-ROP 1 and G-ROP 2 models identified 233 and 255 infants for screening, respectively. The sensitivity of G-ROP 1 and G-ROP 2 for detecting treated ROP was 96.7% and 100%, respectively, and the specificity for detecting treatable ROP was 24.4% and 16.7%, respectively. Incorporation of the G-ROP 2 model, which did not miss any infant with type 1 ROP, would have reduced the number of screened infants by 15%. Conclusion: G-ROP 2 was more sensitive than G-ROP 1 for identifying infants who required treatment and could potentially reduce the burden of ROP screening.

Gastrointestinal manifestations of COVID-19: An updated systematic review.

Lack of knowledge about the type and prevalence of gastrointestinal symptoms as a clinical manifestation is one of the reasons for delayed diagnosis and treatment of COVID-19 patients. This review study aimed to systematically review the type and prevalence of gastrointestinal symptoms in COVID-19 patients. To study the gastrointestinal manifestations of COVID-19, we used the 06- PRISMA registered in the CAMARADES-NC3Rs Preclinical Systematic Review and Meta-Analysis Facility (SyRF) database. PubMed, Embase, Web of Science, Google Scholar, and Scopus databases were searched for publications on the gastrointestinal manifestations of COVID-19 with no publication time frame. Articles were found using the following terms and search strategy: ["COVID-19, Coronavirus, 2019-nCoV, Clinical SymptomsGastrointestinal or gastric or intestinal manifestations"]. Out of 27652 papers, 35 papers on a total of 6730 COVID-19 patients up to 2022 met the inclusion criteria. Remarkably, most articles (28 papers, 77.8%) were from China (77.8%). The most common gastrointestinal manifestations were nausea or vomiting (13.1%), diarrhea (11.05%), anorexia (8.7%), and abdominal pain (2.4%), respectively. The findings of the present review revealed that contrary to what was initially assumed in the COVID-19 outbreak, this infection does not manifest only as respiratory symptoms but also as gastrointestinal symptoms. Therefore, clinicians and gastroenterologists must be alert to these unusual cases and fecal-oral transmission during the COVID-19 pandemic and implement preventive strategies.

An in silico analysis of the impact of POLE mutations on cladribine docking.

OBJECTIVE: Polymerase ε exonuclease (POLE) is an enzyme involved in DNA replication and may be an attractive therapeutic target in various cancers. Here we sought to model the impact of specific POLE mutations on protein function. Due to the lack of a crystal structure, the tertiary structures of the wild type and four common mutants were modeled using I-Tasser server. MATERIALS AND METHODS: Molecular docking and dynamic simulation studies were performed, and the structure and function of the mutants analyzed through residue conservation analysis and protein folding energy changes. RESULTS: All mutants of POLE gene had favorable binding affinities compared with their wild type of counterpart. The P286R variant, but not the other variants, disrupted cladribine binding to the protein. Similarly, dynamics studies revealed instability of the P286R mutant, while V411L, L424V, and L424F appeared to favor cladribine binding. CONCLUSIONS: Since P286R is a hotspot mutation in endometrioid carcinomas, patients with this variant may not respond to cladribine. Population-based pharmacogenomics studies will be required to validate our results.

Motivational factors influencing undergraduate medical students' willingness to volunteer during an infectious disease pandemic in Saudi Arabia, a cross-sectional study.

OBJECTIVE: Healthcare outbreaks, especially infectious disease pandemics, often stretch the healthcare systems to its limits. Healthcare systems have no option other than being supported by the participation of young and motivated healthcare providers (HCPs) in their undergraduate medical studies during their prevention and control internship program during the outbreak. Understanding key motivation factors influencing HCPs are vital to ensure their effective participation in such situations. SUBJECTS AND METHODS: A cross-sectional study was conducted on 410 undergraduate medical students at Qassim University in Saudi Arabia with the aim to describe the motivation factors that affect their willingness to volunteer during a pandemic. An online survey questionnaire was conducted. RESULTS: 410 participants of which 239 (58.29%) were female, 108 (26.34%) were in their third academic year and 129 (31.46%) were between 21-22 years of age. More than 70% of participants showed willingness to volunteer during a pandemic. Their willingness to volunteer was motivated by distance of workplace to home, availability of transportation, being vaccinated, access to health care for self and family if affected, and provision of specialized training. CONCLUSIONS: Healthcare administrators and policy makers need to address these factors effectively to ensure the availability of skilled and motivated healthcare providers during a pandemic.

GC-MS and in vitro antibacterial potential of Cinnamomum camphora essential oil against some clinical antibiotic-resistant bacterial isolates.

OBJECTIVE: Antibiotic resistance is increasing alarmingly in all parts of the world. Cinnamomum camphora (Linn.) Presl (C. camphora) is one of the earliest herbal remedies still in use today in traditional medicine. This study aimed to analyze the component of C. camphora grown widely in Saudi Arabia (Qassim region) using GC-MS. Also, this study evaluates the in vitro antibacterial properties of C. camphora against certain clinical bacteria obtained from hospitals, including multi-drug resistant pathogens. MATERIALS AND METHODS: Leaves of C. camphora tree were collected and essential oil was extracted for this study. The extract was subjected to GC-MS analysis. Eight clinical antibiotic-resistant pathogens were used in this study for the following assays: antibiotics susceptibility assay, determination of minimum inhibitory concentration (MIC), determination of minimum bactericidal concentration (MBC) and MIC index (MBC/MIC). RESULTS: The results show that the main components of the essential oil (EO) from the leaves of C. camphora were Eucalyptol. The EO had good antibacterial activity against eight clinical antibiotic-resistant pathogens, namely, Pseudomonas aeruginosa, Acinetobacter baumannii (two strains), Klebsiella pneumonia (two strains), Escherichia coli (one strain), Staphylococcus aureus (two strains). CONCLUSIONS: These findings may lead to a more complete knowledge of this aromatic plant's antibacterial action against antibiotic-resistant pathogens (in vitro).

Factors influencing the vancomycin trough level in patients admitted at King Fahad Specialist Hospital, Qassim, KSA.

OBJECTIVE: Although vancomycin is an effective antibiotic against methicillin-resistant Staphylococcus aureus, its usage is often associated with nephrotoxicity which necessitates optimization of the vancomycin dose to be both precise and appropriate. To achieve this, the importance of therapeutic drug monitoring arises, and serum trough vancomycin concentrations are the most accurate and practical method for monitoring vancomycin effectiveness and even risk of nephrotoxicity. This study evaluated the influences on the trough levels of vancomycin given to admitted patients at King Fahad Specialist Hospital (KFSH). PATIENTS AND METHODS: This cross-sectional hospital-based study has been conducted at KFSH among 197 patients, of which 53.3% were male and 46.7% were female. They received intravenous vancomycin at intermittent dose of 30 mg/kg/day with no clinical or laboratory renal impairment. The serum was drawn trough concentrations within 15 to 45 minutes before the fourth vancomycin dose. RESULTS: One-way ANOVA test showed a significantly higher trough level of vancomycin among females, patients older than 50 years, and CCU and CSICU admitted patients (p-value < 0.05). Spearman correlation test also showed significant correlation with the serum vancomycin trough levels, site of infection (Rho=0.406, p=0.009), age (Rho=0.341, p=0.044) and patients' admission (Rho=0.321, p=0.041). CONCLUSIONS: Even at body adjusted dosing, vancomycin serum trough levels varied among patients with significant variations of age, gender, site of infection and type of admission, especially CCU and CSICU, which raises the concept of dose individualization, age and gender considerations especially among critically ill patients.

Frequency of ocular manifestations in multiple sclerosis patients admitted in tertiary care hospital in Saudi Arabia.

OBJECTIVE: Multiple Sclerosis (MS) is one of the most destructive demyelinating diseases of the nervous system, and it manifests through broad involvement of the visual system. The present study was aimed to evaluate the frequency of ocular symptoms among MS patients admitted to the Kingdom Hospital in Saudi Arabia PATIENTS AND METHODS: This is a cross-sectional study aiming at investigating the prevalence of eye disease among MS patients referred to Hawtat Sudair Hospital, Zulfi General Hospital, Majmaah General Hospital, and Kingdom Hospital in Riyadh (Saudi Arabia) from January 2020 to December 2020. The sample size was made of 100 MS patients including 50 males and 50 females, all presented with eye disorders. The data were analyzed with SPSS 25, Chi-square test, and descriptive statistics. RESULTS: The examined patients included 100 patients with MS symptoms aged 35 years, ranging from 20 to 70 years. The results showed a considerable lack of sharpness of vision among patients (80%), and the rate of double vision was reported to be about 49% among them which was the most prevalent vision problem from the onset of the disease until the examination time. CONCLUSIONS: The achieved data from this study demonstrated that multiple sclerosis could cause eye diseases. Initial recognition of this syndrome provides the possibility of having an appropriate evaluation of patients to clinicians. Moreover, after the prevalence of MS, other ocular symptoms may occur consequently.

Gastrointestinal manifestations of COVID-19: An updated systematic review

@#Lack of knowledge about the type and prevalence of gastrointestinal symptoms as a clinical manifestation is one of the reasons for delayed diagnosis and treatment of COVID-19 patients. This review study aimed to systematically review the type and prevalence of gastrointestinal symptoms in COVID-19 patients. To study the gastrointestinal manifestations of COVID-19, we used the 06- PRISMA registered in the CAMARADES-NC3Rs Preclinical Systematic Review and Meta-Analysis Facility (SyRF) database. PubMed, Embase, Web of Science, Google Scholar, and Scopus databases were searched for publications on the gastrointestinal manifestations of COVID-19 with no publication time frame. Articles were found using the following terms and search strategy: [“COVID-19, Coronavirus, 2019-nCoV, Clinical SymptomsGastrointestinal or gastric or intestinal manifestations”]. Out of 27652 papers, 35 papers on a total of 6730 COVID-19 patients up to 2022 met the inclusion criteria. Remarkably, most articles (28 papers, 77.8%) were from China (77.8%). The most common gastrointestinal manifestations were nausea or vomiting (13.1%), diarrhea (11.05%), anorexia (8.7%), and abdominal pain (2.4%), respectively. The findings of the present review revealed that contrary to what was initially assumed in the COVID-19 outbreak, this infection does not manifest only as respiratory symptoms but also as gastrointestinal symptoms. Therefore, clinicians and gastroenterologists must be alert to these unusual cases and fecal–oral transmission during the COVID-19 pandemic and implement preventive strategies.

Comparison of MALDI-TOF mass spectrometry with phenotypic methods for identification and characterization of Staphylococcus aureus causing mastitis.

The emergence of methicillin-resistant Staphylococcus aureus (MRSA) infection is one of the greatest threats to both animal and human health. Our investigation was aimed to identify and differentiate between MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) recovered from mastitic milk using MALDI-TOF mass spectrometry compared with phenotypic methods and studying their susceptibility to various antibiotics. Four hundred milk samples from mastitic animals (cows, sheep, goats, and dromedary camels) were investigated. Phenotypic identification of S. aureus was made through MASTASAPH Latex test, STAPH ID 32, and Vitek 2 system. The proteomic characterization of S. aureus was done by MBT. The Kirby Bauer method was accomplished to detect the resistance of S. aureus strains to antibiotics. The results of the MASTASAPH Latex test, revealed that 54 (46%) were recognized as S. aureus. All S. aureus isolates were identified by MBT with a score of more or equal 2.00. Several peaks were identified in the mass of 4590 Da, 4863 Da, and 4938 Da for MSSA and in the mass of 2636 Da and 3009 Da for MRSA. The MSP dendrogram demonstrated that the S. aureus isolates were classified into one group with a distance level of less or equal 400. The percentage of S. aureus resistance against carbenicillin, erythromycin and kanamycin was 94.4%, 38.88%, and 33.33%, respectively. In conclusion, S. aureus bacteria are among the key triggers for mastitis in Saudi Arabia. MBT is reported to be not only the rapid tool to identify S. aureus but also able to discriminate MRSA from MSSA.

Dental anxiety, child-oral health related quality of life and self- esteem in children and adolescents: a systematic review and meta-analysis.

AIM: To identify the directions, strength and associations between dental anxiety, COHRQoL and self-esteem in children and adolescents. BASIC RESEARCH DESIGN: PRISMA guidelines were followed and the review registered (PROSPERO CRD42019140037). MEDLINE, Cochrane Library, Scopus, Science Direct, CINAHL, Joanna Briggs Institute (JBI), Grey Literature Report, and British Library EThOS using MeSH terms and keywords were searched. Three reviewers examined the abstracts of all articles, excluded duplicates and those not meeting inclusion criteria. All full-text papers were read by all reviewers. Meta-analysis association data including Pearson's or Spearman's correlation coefficient were extracted and effect sizes estimated. RESULTS: Twelve papers met the inclusion criteria, 7 assessed the relationship between child dental anxiety and COHRQoL; four between COHRQoL and self-esteem and one between child dental anxiety and self-esteem. Significant relationships were found between COHRQoL and the other child-related outcomes measures. An inverse relationship was shown for dental anxiety and COHRQoL. The meta-analysis found small associations between child dental anxiety and COHRQoL and moderate associations between COHRQoL and self-esteem. High heterogeneity between COHRQoL and self-esteem was noted. The association between child dental anxiety and self-esteem was limited. No source reported associations between all three variables. CONCLUSION: The studies were of varying quality and the degree of heterogeneity meant that only limited conclusions were possible. There is a need for high-quality evidence to underpin intervention designs to promote COHRQoL and self-esteem to reduce child dental anxiety.

Mode of bond failure between 3D-printed denture teeth and printed resin base material: effect of fabrication technique and dynamic loading. An in-vitro study.

PURPOSE: To evaluate the failure load of 3D-printed denture resin material and teeth before and after dynamic loading. MATERIALS AND METHODS: A total of 40 specimens were fabricated following ISO/TS 19736 and were divided into two equal groups. In the test group, the cylindrical base and denture teeth were 3D printed separately and then luted together. In the control group, the specimens were fabricated from conventional heat-cured polymethyl methacrylate (PMMA) and commercially available denture teeth using the compression-molding technique. Ten specimens from each group were subjected to dynamic load of 50 N for 250,000 cycles in a chewing simulator. All specimens were subjected to static load of 50 N using Instron machine with a crosshead speed of 1 mm/minute until fracture. The fractured surfaces were analyzed using field emission scanning electron microscopy. The failure loads were calculated and compared using analysis of variance (P < .05). RESULTS: All specimens survived the loading, undergoing 250,000 cycles without fracture. The mean failure load was influenced by fabrication technique and was significantly higher for the 3D-printed test group (P = .028). 3D-printed teeth showed a mixed mode of fracture, whereas in the control group, the specimens showed cohesive fracture within the teeth. CONCLUSION: The fabrication technique has an influence on the mode of failure between acrylic teeth and resin base material. Cohesive failure in teeth was predominant in the conventional group, suggesting possibly higher bond strength between the teeth and resin base in this group. The observed failure modes reveal that both fabrication techniques exhibited satisfactory bond strength. Chewing simulation did not significantly influence the bond strength of any of the tested groups.

Assessment of quality and safety in rhinologic day surgery.

OBJECTIVES: To assess and compare the safety and quality of the management of sinonasal surgery (all procedures) between day-case and traditional admission. MATERIAL AND METHODS: A 2-year retrospective study included all patients undergoing functional septonasal surgery, ethmoidectomy, middle antrostomy, frontal sinusotomy or endoscopic sphenoidotomy, as day-surgery on inpatient admission. Demographic, operative, pre- and post-operative anesthetic data, complications, and rates of emergency consultation and readmission within 30 days were collected and compared between out- and in-patients. RESULTS: Nine hundred and nine patients were included: 569 functional septonasal surgeries, 180 ethmoidectomies, 101 middle meatotomies, 40 Draf procedures and 19 sphenoidotomies; respectively 60%, 21%, 54%, 20% and 37% were performed in the day-surgery unit. There were no significant differences in number of emergency consultations or readmissions between the out- and in-patient groups. There were more complications in in-patients (P<0.0001) (4.9% anticoagulant and 12% antiplatelet treatments, 18% obstructive sleep apnea-hypopnea syndromes). The conversion rate to conventional admission was 4.6%. Antiplatelet treatment or postoperative nasal packing were not significant risk factors for complications or readmission. CONCLUSION: Outpatient sinonasal surgery does not seem to incur extra risk for the patient or surgeon when eligibility criteria are met.

Comparison of MALDI-TOF mass spectrometry with phenotypic methods for identification and characterization of Staphylococcus aureus causing mastitis

@#The emergence of methicillin-resistant Staphylococcus aureus (MRSA) infection is one of the greatest threats to both animal and human health. Our investigation was aimed to identify and differentiate between MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) recovered from mastitic milk using MALDI-TOF mass spectrometry compared with phenotypic methods and studying their susceptibility to various antibiotics. Four hundred milk samples from mastitic animals (cows, sheep, goats, and dromedary camels) were investigated. Phenotypic identification of S. aureus was made through MASTASAPH Latex test, STAPH ID 32, and Vitek 2 system. The proteomic characterization of S. aureus was done by MBT. The Kirby Bauer method was accomplished to detect the resistance of S. aureus strains to antibiotics. The results of the MASTASAPH Latex test, revealed that 54 (46%) were recognized as S. aureus. All S. aureus isolates were identified by MBT with a score of more or equal 2.00. Several peaks were identified in the mass of 4590 Da, 4863 Da, and 4938 Da for MSSA and in the mass of 2636 Da and 3009 Da for MRSA. The MSP dendrogram demonstrated that the S. aureus isolates were classified into one group with a distance level of less or equal 400. The percentage of S. aureus resistance against carbenicillin, erythromycin and kanamycin was 94.4%, 38.88%, and 33.33%, respectively. In conclusion, S. aureus bacteria are among the key triggers for mastitis in Saudi Arabia. MBT is reported to be not only the rapid tool to identify S. aureus but also able to discriminate MRSA from MSSA.

The influenza virus, SARS-CoV-2, and the airways: Clarification for the otorhinolaryngologist.

The influenza virus and SARS-CoV-2 cause trivial upper and severe lower respiratory infections (Influenza virus 290,000 to 650,000 deaths/year). These viruses come into contact with the airways either by direct projection, by secondary inhalation of airborne droplets, or by handling (fomites). The objective of this article is to clarify the mechanisms of production and penetration of droplets of secretions emitted during all expiratory phenomena likely to transport these viruses and come into contact with the respiratory mucosa. The droplets>5µm follow the laws of ballistics, those<5µm follow Brownian motion and remain suspended in the air. The aerosols of droplets are very heterogeneous whether the subject is healthy or sick. During an infectious period, not all droplets contain viral RNA. If these RNAs are detectable around patients, on surfaces, and in the ambient air at variable distances according to the studies (from 0.5m to beyond the patient's room), this is without prejudice to the infectious nature (viability) of the virus and the minimum infectious dose. There is a time lag between the patient's infectious period and that of RNA detection for both viruses. Subsequently, the inhaled particles must meet the laws of fluid dynamics (filtration) to settle in the respiratory tree. All of this partly explains the contagiousness and the clinical expression of these two viruses from the olfactory cleft to the alveoli.

Melioidosis: Case reports of confirmed Burkholderia pseudomallei in Saudi Arabia.

Melioidosis is an infectious disease of tropical climates. The disease is caused by the bacterium Burkholderia pseudomallei. Most cases are diagnosed in southeast Asia and northern Australia. Some imported cases diagnosed in returning tourists, soldiers, and immigrants from endemic areas. It caught much attention since the Centers for Disease Control and Prevention (CDC) designated B. pseudomallei as an agent for biological warfare and terrorism. We describe two cases of a 26-year-old Saudi woman who had fulminant sepsis soon after returning from Thailand & a 48-year-old woman with a long history of fever. B. pseudomallei was isolated from both patients blood cultures, and they had different consequences. A confirmed case of melioidosis was not reported before in Saudi Arabia.

Lower vitamin D levels in Saudi pregnant women are associated with higher risk of developing GDM.

BACKGROUND: Gestational diabetes mellitus (GDM) has serious consequences such as increased risks of preeclampsia, macrosomia and cesarean delivery. Even though the mechanistic basis of GDM has not been completely understood, several risk factors have been identified and one of these is vitamin D. However, the link between vitamin D deficiency and development of GDM is yet to be proven with certainty. METHODS: This study aimed to investigate the link between the incidence of GDM and serum vitamin D level in pregnant women of Saudi Arabia. 515 Saudi women (ages 18-46) in their 24-28th week of pregnancy, visiting various hospitals of Riyadh, participated in this study. Serum vitamin D and various biochemical and anthropometric parameters were determined in the first trimester and the recruits were screened for GDM by OGTT according to IADPSG criteria in their 2nd trimester. The association between vitamin D deficiency and development of GDM was calculated based on odds ratio of the incidence of GDM among vitamin D deficient and normal women. RESULTS: In this study cohort of 515 pregnant women, in the first trimester vitamin D deficiency (< 50 nmol/l) was detected in 425 (82.5%). On their 2nd visit (2nd trimester), 116 (27.7%) were diagnosed with GDM out of 419 with OGTT, according to IADPSG criteria. GDM risk was significantly higher among vitamin D deficient than non-deficient women (Odds Ratio: 2.87; Confidence Interval: 1.32-6.25; P = 0.008) even after adjusting for season, sun exposure and vitamin D intake (OR: 2.9; CI: 1.07-7.89). Of the various anthropometric and biochemical parameters, the GDM women differed significantly from non-GDM women with respect to serum levels of triglycerides (in mmol/l) (1.3 ± 0.6; 1.5 ± 0.6, p = 0.018) and fasting glucose (in mmol/l) [4.7 (4.3-5.2); 5.1 (4.6-5.6), p < 0.01]. Also, fasting glucose level in the 2nd trimester correlated inversely to serum vitamin D level determined during the 1st trimester (r = - 0.121; p = 0.014). CONCLUSIONS: Results of our study reveal a significantly higher risk of development of GDM among pregnant women having deficient vitamin D status.

The saudi clinical practice guideline for the management of overweight and obesity in adults

OBJECTIVE: To assist healthcare providers in evidence-based clinical decision-making for the management of overweight and obese adults in Saudi Arabia. METHODS: The Ministry of Health, Riyadh, Kingdom of Saudi Arabia assembled an expert Saudi panel to produce this clinical practice guideline in 2015. In collaboration with the methodological working group from McMaster University, Hamilton, Canada, using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, which describes both the strength of recommendation and the quality of evidence. RESULTS: After identifying 11 questions, corresponding recommendations were agreed upon as guidance for the management of overweight and obese adults. These included strong recommendations in support of lifestyle interventions rather than usual care alone, individualized counseling interventions rather than generic educational pamphlets, physical activity rather than no physical activity, and physical activity in addition to diet rather than diet alone. Metformin and orlistat were suggested as conditional recommendations for the management of overweight and obesity in adults. Bariatric surgery was recommended, conditionally, for the management of obese adults (body mass index of ≥40 or ≥35 kg/m2 with comorbidities). CONCLUSIONS: The current guideline includes recommendation for the non-pharmacological, pharmacological, and surgical management of overweight and obese adults. In addition, the panel recommends conducting research priorities regarding lifestyle interventions and economic analysis of drug therapy within the Saudi context, as well as long term benefits and harms of bariatric surgery.