The Correlation Between Vitamin D Levels and the Glycemic Marker HbA1c and Lipid Profile in Patients With Type 2 Diabetes Mellitus: A Study at the King Saud Medical City, Riyadh.

Background and objective Vitamin D, a fat-soluble vitamin also called the sunshine vitamin, is produced in plants, and animals when exposed to sunlight. It plays a crucial role in musculoskeletal development, immune system regulation, and glucose metabolism, thereby reducing the risk of diabetes. This study aimed to investigate the association of vitamin D levels with glycemic control markers [glycated hemoglobin (HbA1c)] and lipid profile, as well as sociodemographic factors and comorbidities. Methodology A cross-sectional study was conducted at the King Saud Medical City in Riyadh, Saudi Arabia, among adult diabetic patients aged 20 years and above. The sociodemographic characteristics, vitamin D levels, HbA1c, and lipid profiles of 472 participants were studied. Data were analyzed using SPSS Statistics version 27 (IBM Corp., Armonk, NY). Results The majority of the participants were women (n=296, 62.7%); the mean age of the cohort was 56.5 ±13.13 years. Most participants were Saudi nationals (n=361, 76.5%). Lab tests revealed vitamin D deficiency (71.41 ±36.88 nmol/l) and elevated HbA1c (9.49 ±9.85%) in the cohort. Low-density lipoprotein (LDL) cholesterol levels were higher than normal (2.71 ±4.26 mmol/l), while high-density lipoprotein (HDL) was slightly lower (1.23 ±0.39 mmol/l). Bivariate correlations showed weak negative and positive associations between vitamin D and HbA1c (r=-0.093, p<0.05) and HDL (r=0.114, p<0.05), respectively. HbA1c correlated positively with triglycerides (r=0.168, p<0.01). Conclusions We found an association between deficiency of vitamin D and levels of HbA1c and lipid profile in type 2 diabetes patients. The association was marked by low vitamin D levels and characterized by high HbA1c, LDL cholesterol, and lipid profile. Elevated HbA1c, LDL cholesterol, and triglyceride levels suggested vitamin D's role in lipid homeostasis. Variations in biomarker levels across sociodemographic factors highlight the need for personalized interventions for diabetes prevention and management.

Dermatologists' and Rheumatologists' Adherence to the Latest Recommendations for Screening of Hydroxychloroquine Retinopathy in Saudi Arabia: A Cross-Sectional Study.

INTRODUCTION:  Hydroxychloroquine (HCQ) is used to manage the symptoms of inflammatory rheumatic and dermatologic disorders. However, HCQ retinopathy is a serious side effect because even after the drug is discontinued, irreversible vision loss may occur and may continue to progress. According to the American Academy of Ophthalmology (AAO), the recent recommendation for HCQ dosing is ≤5 mg/kg of real body weight, with baseline ophthalmologic screening during the first year of HCQ treatment and yearly screening after five years of continuous use of HCQ medication, unless the patient is at high risk or symptoms have developed. Nonetheless, this study aims to assess dermatologists' and rheumatologists' adherence in Saudi Arabia to the 2016 AAO HCQ retinal toxicity guidelines. METHODS:  A questionnaire-based cross-sectional study was conducted on dermatologists and rheumatologists in Saudi Arabia. It was conducted between August and September 2022 and questionnaires were sent to dermatologists and rheumatologists via their professional emails or accounts. RESULTS: The collected sample consisted of 635 participants; males and females represented 54% and 46%, respectively; 47.6% were consultants; 50.1% were rheumatologists; and 49.9% were dermatologists. Approximately 28.2% of the participants reported treating one to three patients with HCQ in the previous year. Only 45.4% of the respondents stated that the ideal recommended HCQ dose for reducing the risk of retinopathy is "≤ 5 mg/kg of the real body weight." More than 50% of the respondents stated that systemic lupus erythematosus was the most common disease for which they used HCQ. Additionally, 36.5% of the physicians screened patients during the first year of HCQ treatment. We found significant associations between practice levels and specialty practice-related questions with a p-value of less than 0.05, except for the specialty practice-related question, "What is the most common disease for which you use HCQ?" with a p-value of 0.074. Also, we found significant associations between all demographic variables and screening-related variables with a p-value of less than 0.05, with two exceptions: no significant associations were found between specialty area and the screening-related question, "Do you recommend screening tests for all patients starting treatment with HCQ?" at p = 0.270, and gender and the screening-related question, "When would you recommend screening tests for a patient without risk?" at p = 0.142. CONCLUSIONS:  Dermatologists and rheumatologists in Saudi Arabia have shown poor adherence to the most recent AAO recommendations. Educating physicians and patients about the AAO guidelines is needed for HCQ to be used in a way that is both effective and safe.

Retraction: Lipoma of the Pancreas: A Rare Incidental Tumor.

[This retracts the article DOI: 10.7759/cureus.20122.].

Long-Term Outcomes of COVID-19 Otolaryngology Symptoms in Saudi Arabia.

OBJECTIVES: The objectives of the study are to measure the prevalence of the most common symptoms and different long-term otorhinolaryngology manifestations among COVID-19-positive patients in Saudi Arabia. METHODS: This is a cross-sectional study. Data were collected using a Google form questionnaire sent to the study sample. The data were entered and then analyzed using SPSS version 25.0 (IBM Corp, Armonk, NY). RESULTS: A total of 13,530 COVID-19-positive adult patients were enrolled in the current study. The most reported initial symptom was fever (53.3%) followed by headache (49.3%), sore throat (48.9%), nasal congestion, rhinorrhea (42.1%), and loss of smell and/or loss of taste (37.8%). Regarding the continuation of the symptoms, vertigo was mentioned by 5852 (43.3%) followed by fever (16.1%) and blocked ear sensation (15.6%). CONCLUSION: The most commonly reported initial symptom was fever followed by headache. Interestingly, vertigo is a frequent long-term complication after a COVID-19 infection. Other otology-related symptoms include hearing loss and ear blockage, while rhinology and upper airway-related symptoms were less frequent in the long term after the acute phase of the infection.

Nutcracker Phenomenon: A Rare Incidental Finding.

The nutcracker phenomenon, or left renal vein (LRV) entrapment syndrome, occurs when there is compression of the LRV, mostly between the abdominal aorta and the superior mesenteric artery. Patients with nutcracker syndrome (NCS) may present with various symptoms, with the most common being hematuria, left flank pain, varicocele in males, proteinuria, and anemia. Our 22-year-old male patient presented with abdominal pain without hematuria. Insidiously, we made the diagnosis of NCS with this unusual presentation. Some studies have proposed a relationship between rapid weight loss in a short period of time and the appearance of NCS. We recommend that healthcare providers suspect NCS in patients who present with abrupt severe abdominal discomfort, particularly in situations that coincide with rapid weight loss for an unknown reason.

Lipoma of the Pancreas: A Rare Incidental Tumor.

Recent studies have shown a significant increase in the utilization of computed tomography (CT) scans in the emergency department for a broad spectrum of conditions. This had a significant impact on the identification of patients with serious pathologies in a timely manner. However, the overutilization of computed tomography scans leads to increased identification of incidental findings. For example, pancreatic lesions are not uncommon findings that can be identified in imaging studies performed for other indications. Here, we report the case of a 55-year-old male with a history of urinary stone disease who presented with right flank pain and dysuria. The urinalysis findings revealed numerous red blood cells and leukocytes. Non-contrast computed tomography scan of the abdomen was performed to detect urinary stones, but no hyperdense stones were noted, suggesting the possibility of spontaneous passage of the stone. However, a lesion in the pancreatic tail was observed. This exhibited fat attenuation with no solid component in the pancreatic tail representing a pancreatic lipoma. No surgical intervention was made considering the benign nature of the incidentally detected tumor. Pancreatic lipoma is a very rare benign mesenchymal tumor of the pancreas. Recognition of the classic radiological feature of pancreatic lipoma is essential to avoid unnecessary investigation and procedures.