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Background : This study explored the association between ApaI-TaqI Single Nucleotide Polymorphisms (SNPs) in a Vitamin D receptor (VDR) and the risk of Gestational Diabetes Mellitus (GDM) in Saudi women, along with the serum levels of vitamin D. Methods : Ninety women with GDM and 90 non-GDM women were enrolled, based on the inclusion and exclusion criteria for pregnant women enrolled in a single-center study. Blood samples were retrieved from 180 pregnant women using ethylenediaminetetraacetic acid (EDTA) tubes. Serum samples were used to measure the vitamin D, 25-hydroxyvitamin D (25(OH)D or calcidiol), and lipid profiles. Blood was used to measure the hemoglobin A1c levels and to isolate the DNA. The polymerase chain reaction (PCR) was performed for the ApaI (rs79785232), BsmI (rs1544410), FokI (rs2228570), and TaqI (rs731236) SNPs in the VDR gene using restriction fragment length polymorphism analysis. Validation was performed using Sanger sequencing. Statistical analyses were performed between the patients with and without GDM using various statistical software packages. Results : The Hardy-Weinberg equilibrium analysis was statistically significant ( p > 0.05). The ApaI, BsmI, and TaqI SNPs were associated with alleles, genotypes, and different genetic models ( p < 0.05). Vitamin D levels were associated with deficient levels ( p = 0.0002), as well as with a normal and overweight body mass index ( p = 0.0004). When vitamin D levels were measured with GDM covariates, the fasting plasma glucose (FPG) ( p = 0.0001), postprandial blood glucose (PPBG) ( p < 0.0001), oral glucose tolerance test (OGTT)-1 h ( p = 0.005), high-density lipoprotein ( p = 0.022), and low-density lipoprotein cholesterol (LDLc) ( p = 0.001) levels were significantly different. When similar vitamin D levels were measured for each genotype, we confirmed that the ApaI SNP was associated with sufficient levels ( p < 0.0001), whereas the BsmI, FokI, and TaqI ( p < 0.05) were associated with insufficient levels. The logistic regression model confirmed that the first hour of the OGTT ( p = 0.005) was strongly associated with GDM, whereas the analysis of variance confirmed that FPG and PPBG ( p < 0.05) were strongly associated with all the SNPs evaluated in the VDR gene. Additionally, the second hour of the OGTT ( p = 0.048) and LDLc ( p = 0.049) were associated with the ApaI and FokI SNP. Moreover, the first hour OGTT ( p = 0.045) and lipid profile parameters ( p < 0.05) were associated. Haplotype analysis revealed positive associations among the examined SNPs, which seemed compatible with the hypothesis that variants and combinations of multiple SNP genotypes enhance the risk of GDM in women. Haplotype analysis revealed that different combinations of alleles, such as AGCC, CATT, CGTC, AGTC, and CATT ( p < 0.05), were strongly associated. The linkage disequilibrium (LD) analysis showed a strong association with all combinations ( p < 0.05). Among the gene-gene interactions, all possible combinations showed a positive association ( p < 0.05). Conclusions : Low vitamin D levels were observed in women with GDM. The ApaI, BsmI, and TaqI SNPs were associated with genotype and allele frequencies ( p < 0.05). Vitamin D and the SNPs in the VDR gene were associated, according to the ANOVA, logistic regression, haplotype analysis, LD analysis, and the generalized multifactor dimensionality reduction model ( p < 0.05).

Background: Globally, it is estimated that approximately 537 million adults are living with diabetes. Of them, more than 90% have type 2 diabetes (T2DM). In 2023, a previous meta-analysis showed that the prevalence of T2DM among the general adult population in Saudi Arabia was 28%. This study was conducted to assess the risk of developing T2DM among the students at Hail University, Saudi Arabia., Methods: This cross-sectional study was conducted in 2022/2023 among a census sample of 740 students (both genders, aged 17-26 years) studying at nine colleges of Hail University, Saudi Arabia. The diabetes risk score was assessed using the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). Anthropometric measurements were measured and recorded using standard methods. Socio-demographic variables were also obtained with an interview-based questionnaire. Statistical analysis was performed using SPSS version 25., Results: A total of 740 students were included in the final analysis. Of them, 274 (37.0%) were male students and 466 (63.0%) were female students. The mean age of the study participants is 19.9 ± 1.6 years. The findings showed that 61.9% of the study participants were at intermediate and high risk of diabetes (59.7 and 2.2%, respectively). The majority 85.7% of male students were at intermediate risk of diabetes, and 5.8% were at high risk of diabetes. In total, 44.4% of female students were at intermediate risk of diabetes, and none of them were at high risk of diabetes. For the following variables (age, gender, college name, area of the university, academic years, weight, height, and BMI), the differences were statistically significant between different categories of diabetes risk scores ( P -values < 0.005)., Conclusion: More than half of the students at the Hail University of Saudi Arabia have an intermediate and high risk of T2DM. Male students are at a higher risk compared to female students. The high risk of T2DM among university students should be seriously considered., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Abd El-Razik Siam, Abdou Rizk and Mahmoud.)

Background: Screening is a cancer prevention measure for groups who are asymptomatic, and diagnosis is a medical test for groups who are symptomatic. The occupational privilege of health care providers (HCPs) is expected to play a positive role in cancer screening practices. Therefore, this study aimed to assess perceptions and personal attitudes of HCPs regarding their decision to screen for cancer in the Eastern Province of Saudi Arabia., Design: A cross-sectional multicenter survey study was conducted. A well-designed and validated questionnaire was distributed to the HCPs at three tertiary hospitals in the Eastern Province of Saudi Arabia., Results: Out of 900 health care providers who received the questionnaire, 372 completed it. Two-thirds, 247 (66.4%) of them were nurses and the rest were physicians and the mean age was 34.1 ± 7.1 years. Regardless of gender, profession, or age, the overall rate of belief in the importance of regular cancer screening was high; 91.4%. The number of participants who did not screen for colonoscopy was significantly higher than those who screened. The number of females in the age group of between 45 and 54 years who screened with mammography was significantly higher than non-screened. In a similar way, male HCPs above 54 years who got themselves screened for Prostate-Specific Antigen (PSA) were significantly higher than those who did not., Conclusions: Findings of the current research and existing evidence specifically for the Saudi community indicated a need to raise awareness, emphasizing the role of HCPs in motivating themselves, their families, and their patients to implement various cancer screening programs., (© 2022. The Author(s).)

Objective: To evaluate the Saudi campers' knowledge and the applied safety practices regarding carbon monoxide poisoning during camping activities., Methods: The cross-sectional questionnaire-based study was conducted from December 1, 2018, to February 1, 2019, in Riyadh, Saudi Arabia, and comprised young male campers from recreational camps in the northern parts of the city. Data was collected from the participants regarding socio-demographic characteristics, knowledge regarding carbon monoxide poisoning, the applied safety measures to prevent carbon monoxide poisoning and the dealing with carbon monoxide poisoning during camping activities. Data was analysed using SPSS 22., Results: There were 235 male subjects with mean age 24.47±1.139 years (range: 21-32 years). Of the total, 50(21.3%) participants had received civil defence education or training. Overall, 137(58.3%) participants had a good mean knowledge score, and 157(66.8%) participants had a good mean practice score for applying healthy measures in preventing and managing carbon monoxide poisoning. As a preventive measure against carbon monoxide poisoning, the use of carbon monoxide detectors was valued by 107(45.5%) participants. Having civil defence training, having a monthly income >10,000 Saudi Riyals, and having a good knowledge score were the elements that had significant association with the choice related to carbon monoxide detector usage., Conclusions: The campers had relatively high knowledge regarding carbon monoxide poisoning, but this knowledge was not fully translated into good health practice.

Objective: To investigate the effect of Timed Up and Go category on the Five Times Sit to Stand Test, and to determine the role of recreational status on Timed Up and Go rating., Methods: The descriptive, cross-sectional study was conducted between October 2018 and April 2019 at the College of Medical Rehabilitation Sciences, Taibah University, Madina, Saudi Arabia, and comprised community-ambulant retired overweight or obese subjects of either gender aged 60-69 years. Timed Up and Go, Five Times Sit to Stand Test and Single-Leg Stance Test were used to measure basic mobility, transitional skills and static balance respectively. Data was analysed using SPSS 23., Results: Of the 150 subjects, 108(72%) were males and 42(28%) were females. The overall mean age was 63.1}2.5 years and the mean body mass index was 29.6}3.8 kg/m2. There were 46(31.5%) subjects who were freely mobile, 60(41.1%) who were mostly independent and 40(27.4%) who had variable mobility. Also, 36(24%) subjects were recreationally active, while 114(76%) were recreationally inactive. The freely mobile subjects managed to finish the Five Times Sit to Stand Test in less time than the other groups (p<0.05). The recreationally active subjects took significantly less time to finish the Timed Up and Go test compared to the inactive. Besides, the males had longer Single-Leg Stance Test timing than females (p<0.05)., Conclusions: The elderly belonging to different Timed Up and Go mobility categories demonstrated variable Five Times Sit to Stand abilities, with the recreational mobility status significantly affecting the category.

Background: One of the most effective measures regarding improving women's health is to promote healthy lifestyle behaviors. This study aimed to investigate the relationship between health-promoting behaviors and sleep quality among a sample of Saudi menopausal women., Methods: A descriptive cross-sectional study was used to collect data from 410 Saudi postmenopausal women visiting primary healthcare care centers located in Sakaka, Jouf, Saudi Arabia, using the Menopause Rating Scale (MRS), Health-Promoting Lifestyle Profile II (HPLPII) and Pittsburgh Sleep Quality Index (PSQI)., Results: The mean age of the study participants was 52.60 ± 4.65 years, the study findings highlighted that among all the HPLP domains, the highest mean score was observed for spiritual growth (24.00 ± 6.60) whereas the lowest score was observed for physical activity (16.18 ± 1.8). Statistically significant negative relations between the total score of HPLP and sleep quality score and menopausal symptoms ( p < 0.001, p < 0.005), respectively. Total scores of lifestyle, health responsibility, and stress management were significant differences between participants with good and poor sleep quality. Being overweight/obese, physically inactive, having a chronic illness and poor sleep quality were predictors influencing health-promoting behavior., Conclusion: Health-Promoting Lifestyle Profile II was more obvious in the good sleeper in form of health responsibility and stress management. Being overweight and or obese, having a chronic illness, and having poor sleep quality were the significant factors influencing health-promoting behaviors. Designing and performing educational interventional plans are crucial to create motivation toward a healthy lifestyle and improve the quality of their sleep., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Abdelaziz, Elsharkawy and Mohamed.)

Objectives: To assess sleep quality and examine its relationship with menopausal symptoms among Saudi postmenopausal women., Methods: We carried out a cross-sectional study of 410 postmenopausal women, aged 50-60 years, visiting Prince Mutaib bin Abdulaziz Hospital, Maternity and Children Hospital, and primary health care clinics, Sakaka, Jouf, Saudi Arabia. The menopause rating scale (MRS) was used to assess menopause symptoms and severity, while the Pittsburgh sleep quality index (PSQI) was used to assess sleep quality., Results: The participants' age was 53.04±4.15 years, their mean age at natural menopause was 49.14±3.07, and the meantime since their menopause was 6.50±3.84 years. The PSQI total mean score was 6.10±4.17, classified into good versus poor sleepers; 65.4% scored ≤5, and 34.6% scored >5. The Mann-Whitney analysis revealed that somatic and urogenital symptoms, and total MRS score were associated with poor sleep quality ( p <0.001)., Conclusion: The study findings revealed that more than one-third of Saudi postmenopausal women had poor sleep quality., (Copyright: © Saudi Medical Journal.)

Resistant Gram-negative bacteria (GNB) constitute a severe threat to public health by becoming increasingly prevalent worldwide; they are challenging to treat and highly adaptive pathogens that develop resistance to antibiotics through several mechanisms with high morbidity and mortality rates. This study aimed to determine the incidence and outcome of children with GNB infections at a tertiary hospital in Jeddah, Saudi Arabia. A retrospective cohort study was done in 2019 on a total of 278 patients aged from one month to 16 years. Data were collected from patient medical records by using a data collection sheet without exclusion criteria. Among patients with GNB, more than half were males with 57.9% (161), while 42.1% (117) were females. However, the most GNB isolated were Staphylococcus in 31.7% (88) of the patient then Klebsiella in 18% (50). Organisms isolated from urine were 46.1% (117), which was the primary site of isolation, where blood was 26.6% (74). About 20.1% (56) were primarily diagnosed with sepsis. The length of stay was around one month or less, with more than half of patients 56.5% (157). The mortality rate was 9.4% (26/278). A patient between one and 5 years of age was the most age affected by multidrug-resistant (MDR) (11/16). No statistically significant differences were observed between the MDR and non-MDR patients with GNB infections concerning age, length of stay, and mortality rate. Conversely, there were statistically significant differences in primary diagnosis, isolated organisms, and site of isolation with MDR and non-MDR. Staphylococcus and Klebsiella were the most abundant GNB, and the mortality rate was 9.4%. However, additional studies in other settings with a larger sample size are needed to compare between different healthcare facilities.

Objective: To assess physicians' attitudes toward integrative medicine (IM), including prophetic medicine (PM), combining the best of modern medicine with the best of alternative and complementary medicine. Most physicians are unfamiliar with IM and PM and may thus be against them and it may communicate that to the public., Methods: Taibah University (Saudi Arabia) is the sole university in the Arab world with an educational medical course in IM and PM. We assessed IM scientific knowledge and students' feedback regarding course contents, course design, and teaching methods. A questionnaire was administered to medical students who attended the course., Results: A total 650 students (264 men, 386 women) participated in the study; 83% considered the IM (including PM) education beneficial. Among them, 49.6% (range, 60% to 100%) reported that they gained medical benefit from studying IM, and 74% expressed strong positive attitudes toward studying IM. Among participants, 65.8% agreed with the current course topics, without the need to add or delete any topics; 95% of students were satisfied with IM and PM education. Students' interest in the branches of IM included all IM subspecialties., Conclusion: IM and PM education should be globally generalized to all medical students, physicians, and health practitioners, particularly in Arabic universities.

Introduction: Tobacco is one of the leading preventable cause of death worldwide. Tobacco consumption among teenagers is a major public health problem, especially in developing countries. Younger smokers are more liable to smoking complications. The objectives were to evaluate the prevalence of smoking among male secondary school students in the Northern Borders region, KSA., Methods: A cross-sectional study was conducted in Arar city. Four schools were chosen randomly from 21 secondary schools. A total of 240 students responded to the pre-designed questionnaire. The questionnaire included questions on demographic factors, smoking behavior and knowledge about smoking hazards., Results: Prevalence of current smoking among male secondary school students is 40.8%. Cigarette smoking was the most common type (67.3%) followed by Shish smoking (22.4%). Few students (2.1%) reported other forms of smoking, example (Hashish). Of the studied group, 39.8% smoke on a daily basis with 29.6% of them smoke more than five cigarettes per day., Conclusion: Smoking is a prevalent habit among teenagers. Special concern should be directed to smoking cessation campaigns with behavioral, legal and economic interventions., Competing Interests: The authors declare no competing interests.

Background: The Kingdom of Saudi Arabia is seeking malaria eradication. Malaria transmission has been very low over the last few years. Discovered cases of Plasmodium falciparum infection are assigned a treatment protocol of artemisinin-based combination therapy, which consists of artesunate in addition to sulfadoxine-pyrimethamine rather than the traditional chloroquine, which has high resistance rates worldwide. This study aims to investigate the presence of different gene mutations concerning anti-malarial drug resistance (pfdhfr, pfdhps, pfmdr1, pfcrt, pfcytb, pfkelch13) to identify whether drug-resistant alleles are present in this area of the Kingdom and whether the country's treatment protocol is still suitable for Plasmodium bearing a resistance mutation [corrected]., Methods: Blood samples were collected from patients suffering from symptoms suggesting malaria coming to King Faisal Hospital, Taif, from February to August 2016. Diagnosis was performed by Giemsa-stained thin and thick blood films, rapid diagnostic test and PCR. Positive P. falciparum samples were further subjected to series of PCR amplification reactions targeting genes related with drug resistance (pfdhfr, pfdhps, pfmdr1, pfcrt, pfcytb, pfketch13)., Results: Twenty-six cases were positives, 13 infected with P. falciparum, of those, 4 cases were autochthonous, and 13 with Plasmodium vivax. The results of the gene mutation detection confirmed that there was no mutation related to resistance to artemisinin or atovaquone, on the other hand chloroquine resistance alleles were detected in 31% of samples. Moreover, point mutations in the pfdhfr and pfdhps genes, related resistance to antifolate drugs, were detected in all characterized samples., Conclusions: Haplotypes of P. falciparum in the western region of the Kingdom of Saudi Arabia exhibit high resistance against antifolate drugs. These results should be extensively discussed when planning to modify anti-malarial drug protocols in the future.

A qualitative study was carried out to explore the health status of people with diabetes during Ramadan. Fifteen patients participated in two focus group discussions. Most respondents reported lack of knowledge regarding their own conditions and do not follow the medical advice of not fasting during Ramadan. Barriers facing the patients seeking healthcare before and during Ramadan were the atmosphere, long distances to facilities, monthly appointments, and monthly prescribed medication. All respondents agreed on the importance of physical activity but their opinions varied on how to conduct it. Regarding the services, most respondents were unsatisfied due to the lack of health services provided in addition to the shortage of essential medication or laboratory investigations. Others blamed primary healthcare-center staff for the delay in laboratory investigation results and the unavailability of glycosylated hemoglobin (HbA1c). Respondents also claimed that self-check glucometer measurements are not as accurate as laboratory results. Doctors may be able to educate patients regarding the effects of fasting with diabetes whereas religious leaders may influence individuals to follow doctors' advice. Evaluation of the quality of healthcare services is necessary to identify defects in health services in order to ameliorate service quality, including availability of drugs and glucometers in pharmacies, and laboratory investigations, including HbA1c, to meet patient satisfaction., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed in children and represents approximately 25% of cancer diagnoses among those younger than 15 years of age., Materials and Methods: This study investigated alterations in the displacement loop (d-loop) region of mitochondrial DNA (mtDNA) as a risk factor and diagnostic biomarker for early detection and diagnosis of acute lymphoblastic leukemia. Using mtDNA from 23 subjects diagnosed with acute lymphoblastic leukemia, the first 450 bp of the d-loop region were amplified and successfully sequenced., Results: This revealed 132 mutations at 25 positions in this region, with a mean of 6 alterations per subject. The d-loop alterations in mtDNA in subjects were all identified as single nucleotide polymorphisms in a homoplasmic distribution pattern. Mutant alleles were observed in all subjects with individual frequency rates of up to 95%. Thirteen mutant alleles in the d-loop region of mtDNA occurred with a high frequency. Novel alleles and locations were also identified in the d-loop of mtDNA as follows: 89 G insertions (40%), 95 G insertions (13%), 182 C/T substitutions (5%), 308 C insertions (19%), and 311 C insertions (80%). The findings of this study need to be replicated to be confirmed., Conclusions: Further investigation of the relationship between mutations in mitochondrial d-loop genes and incidence of acute lymphoblastic leukemia is recommended.