Disordered Eating Behaviors and Insulin Restriction in Saudi Adolescents and Young Adults with Type 1 Diabetes.

Background and Objectives: The prevalence of disordered eating behaviors (DEBs) in type 1 diabetes (T1D) has been studied globally; however, data from Saudi Arabia and Arab-speaking countries are scarce. This study aimed to measure the prevalence of DEBs and associated clinical characteristics in adolescents and young adults with T1D, and the impact of DEBs on glycemic parameters. Materials and Methods: A total of 265 adolescents and young adults with T1D (aged 12-25 years) were recruited randomly from the registry at the Jazan Endocrinology and Diabetes Center, Saudi Arabia. Participants completed the Diabetes Eating Problem Survey-Revised (DEPS-R) questionnaire. Other measures included hemoglobin A1c (HbA1c) in addition to sociodemographic, anthropometric, and clinical data. Results: The prevalence of DEBs among T1D was 27.2%. Females (32.5%) had a higher proportion of DEBs than males (18.6%) (p = 0.01). About 27% of the participants reported insulin restriction. A history of hospital admission in the previous 6 months due to DKA and frequent hypoglycemia was more frequently reported in T1D participants with DEBs compared to those without (p = 0.03). Participants with DEBs had higher HbA1c and higher BMI compared to those without DEBs. Conclusions: Adolescents and young adults with T1D with disordered eating and insulin restriction have higher glycated hemoglobin, and are at higher risk of DKA. Routine screening for DEBs should be an essential element in diabetes care, especially among highly vulnerable groups.

The severity and clinical characteristics of COVID-19 among patients with type 2 diabetes mellitus in Jazan, Saudi Arabia.

BACKGROUND: The objectives of the current study were to assess the severity and clinical characteristics of coronavirus disease 2019 (COVID-19) among Saudi adults with type 2 diabetes mellitus (T2DM) in Jazan region, Saudi Arabia. METHODS: This retrospective cohort study included 412 patients with COVID-19 selected randomly from the Health Electronic Surveillance Network system, which contains the primary data on COVID-19 infections in Jazan. RESULTS: COVID-19 disease duration was significantly longer in patients with T2DM (mean = 10.7 days) compared with those without T2DM (mean = 8.3 days) (P = .01). Six (7%) patients experienced an increase in blood glucose concentrations and had to escalate their total daily insulin dose accordingly. Median fasting and random blood glucose levels increased after infection with COVID-19 (pre-COVID median = 119 and 172 mg/dL, respectively; post-COVID median = 148 and 216 mg/dL, respectively) (P = .02). The total insulin dose pre-COVID (median = 42 units/d) increased after infection with COVID-19 (median = 58 units/d) (P = .01). Most patients with T2DM had clinical COVID-19 symptoms (91%) and the remainder (9%) were asymptomatic. A large proportion (80%) of T2DM patients with mild COVID-19 symptoms self-isolated at home. COVID-19 patients with T2DM (11%) who had an oxygen saturation of ≤ 90% and admitted to the intensive care unit were higher than those without T2DM (5%) (P =  < .001). COVID-19 patients with T2DM (9%) had higher mortality rate than COVID-19 patients without T2DM (1%) (P =  < .001). CONCLUSION: COVID-19 patients with T2DM were associated with a higher risk of admission to the intensive care unit and mortality than COVID-19 patients without T2DM.

Clinical characteristics and outcomes of post-COVID-19 pulmonary fibrosis: A case-control study.

ABSTRACT: The development of pulmonary fibrosis is a rare complication of the novel coronavirus disease 2019 (COVID-19). Limited information is available in the literature about that, and the present study aimed to address this gap.This case-control study included 64 patients with post-COVID-19 pulmonary fibrosis who were hospitalized for COVID-19.The percentage of patients aged ≥65 years (44%) who demised was higher than those who survived (25%). Male patients (62%) had higher mortality than female patients (37%). The most frequently reported clinical symptoms were shortness of breath (98%), cough (91%), and fever (70%). Most COVID-19 patients with pulmonary fibrosis (81%) were admitted to an intensive care unit (ICU), and 63% required mechanical ventilation. Bilateral lung infiltrates (94%), "ground glass" opacity (91%), "honeycomb" lung (25%), and pulmonary consolidation (9%) were commonly identified in COVID-19 patients with pulmonary fibrosis who survived. The findings for computed tomography and dyspnea scale were significantly higher in severe cases admitted to the ICU who required mechanical ventilation. A higher computerized tomography score also correlated significantly with a longer duration of stay in hospital and a higher degree of dyspnea. Half of the COVID-19 patients with pulmonary fibrosis (50%) who survived required oxygen therapy, and those with "honeycomb" lung required long-term oxygen therapy to a far greater extent than others. Cox regression revealed that smoking and asthma were significantly associated with ICU admission and the risk of mortality.Post-COVID-19 pulmonary fibrosis is a severe complication that leads to permanent lung damage or death.

Clinical characteristics and ABO blood groups in COVID-19 patients, Saudi Arabia.

ABSTRACT: This study assessed the proportion of ABO blood groups and clinical characteristics among Saudi patients with coronavirus disease 2019 (COVID-19) in Jazan, Saudi Arabia.This retrospective cohort study included 404 Saudi adults with COVID-19, confirmed by the real-time reverse transcription-polymerase chain reaction. The participants were selected randomly between July 1, 2020, and July 31, 2020, from the Health Electronic Surveillance Network system, which contains the primary data on COVID-19 infections in Jazan.Blood type O (62.4%) represented the highest proportion in COVID-19 Saudi patients followed by the other blood groups which distributed as follows: blood type A (25.5%), blood type B (10.1%), and blood type AB (2%). Men, and people aged 18-44 years, represented the higher percentage than women and those of a younger age. The majority of the patients with COVID-19 had clinical symptoms (88.4%), and the remainder (11.6%) were asymptomatic. Ninety four percent of the patients had mild COVID-19 symptoms and self-isolated at home. Only 6.4% of the cases were severe and admitted to hospital. There was no significant association between a specific ABO blood group and COVID-19 clinical symptoms (P = .950), incubation period (P = .780), disease duration (P = .430), and disease severity (P = .340). Old age and diabetes were the significant predictors of COVID-19 severity and hospital admission (P = .010).Blood group O represented the highest proportion of COVID-19 Saudi patients as it is the most common blood group in Saudi individuals in Jazan. However, no specific blood group was associated with COVID-19 severity and hospital admission. Old age and diabetes mellitus were shown to be significant predictors of severe COVID-19 and hospital admission.

Epidemiological and Clinical Characteristics of Deceased COVID-19 Patients.

OBJECTIVE: Fatalities due to coronavirus disease 2019 (COVID-19) continue to increase, and information on the epidemiological and clinical characteristics of deceased patients who were hospitalized with COVID-19 is limited in the Arab region. The current study aimed to address this gap. METHODS: Three hundred and four Saudi patients in Jazan Region, Saudi Arabia, who died after being hospitalized with COVID-19 between July 1, 2020, and December 31, 2020, were analyzed in this retrospective cohort study. RESULTS: A greater proportion of male patients (59%), compared to female patients (41%), died due to COVID-19. Just over half (55%) of the deaths due to COVID-19 affected patients aged ≥65 years. More than two-thirds of the deceased COVID-19 patients had diabetes (70%) and hypertension (69%); other comorbidities were obesity (30%), heart disease (30%), and chronic kidney disease (14%). Dyspnea (91%), cough (80%), and fever (70%) were the most frequently reported clinical symptoms. Eighty-five per cent of COVID-19 deaths occurred in patients admitted to the intensive care unit (ICU), and 90% of the patients required mechanical ventilation. Typically, lymphopenia, and neutrophilia were observed on admission and 24 hours prior to death. Creatinine and serum ferritin levels and erythrocyte sedimentation rate and D-dimer plasma levels increased significantly following infection with COVID-19. Lung infiltrates and pulmonary opacity (83%) were the most common findings on chest X-ray. Respiratory failure (70%) and acute respiratory distress syndrome (52%) were the leading complications to death. Logistic and Cox regression revealed that a higher age, smoking, high creatinine and aspartate transaminase levels, and respiratory failure were significantly associated with the risk of mortality during the early stay in hospitals. CONCLUSION: The proportion of comorbidities was high in deceased patients who were hospitalized with COVID-19 in Jazan region, Saudi Arabia. A higher age, smoking, and respiratory failure were significant predictors of mortality during the early stay in hospitals.

Co-morbidity and blood group type risk in coronavirus disease 2019 patients: A case-control study.

OBJECTIVE: The objective of the study was to assess mortality risk associated with co-morbidities and blood group type in coronavirus disease 2019 (COVID-19) patients in Jazan, Saudi Arabia. METHODS: This case-control study enrolled 323 Saudi adults with COVID-19, confirmed by real-time reverse transcription-polymerase chain reaction. The participants were selected randomly between August 31, 2020, and July 1, 2020, from the Health Electronic Surveillance Network system, which contains the primary data on COVID-19 infections in Jazan, Saudi Arabia. The sample included 108 patients who died due to COVID-19 disease and 215 controls who recovered from it (1:2 ratio). The chi-square test, independent samples t-test, and logistic regression were used to perform the statistical analysis. RESULTS: Mortality was higher in older age patients with COVID-19 (mean = 65.4 years, standard deviation [SD] = 15.6) compared to recovered patients (mean = 39.5 years, SD = 14.8) (p<0.001) with a moderate effect size (eta squared = 0.06). Diabetes mellitus (odds ratio [OR] = 9.4), hypertension (OR = 8.6), cardiovascular disease (OR = 7.4), chronic kidney disease (OR = 3.3), and obesity (OR = 2.0) were significantly associated with death due to COVID-19. Using logistic regression analysis, older age and diabetes mellitus were the primary independent predictors of COVID-19 mortality. However, there was no significant association between a specific ABO blood group and mortality risk (P = 0.07). CONCLUSION: Older age and the presence of co-morbidities, especially diabetes mellitus, increased the risk of death in patients with COVID-19. Establishing the causality of death in patients with COVID-19 should be a key aim of future studies.

Renovascular Mistaken as Essential Hypertension due to Giant Hepatic Hydatid: A Rare Treatable Entity.

Renovascular hypertension is an unusual but treatable cause of refractory hypertension that is infrequently caused by external compression of the renal vasculature by a giant hydatid cyst, a parasitic infection, caused by Echinococcus granulosus in its larval stage which is endemic in many parts of the world including Saudi Arabia. The disease can produce a cyst in almost every part of the body with the liver and lungs being the most frequently targeted organs producing a variety of symptoms depending upon the site and size of the cyst. We report a case of giant hepatic hydatid cyst with the possibility of renovascular hypertension due to mass effect as evident by dramatic drop of the blood pressure to its normotensive state postoperatively.