Post COVID-19 Vaccination-Associated Neurological Complications

PURPOSE

Neurological sequelae after COVID-19 vaccination are rare. We investigated the possible pathogenesis behind the development of neurological complications within a short period after Saudi residents received a COVID-19 vaccine.

PATIENTS AND METHODS

We evaluated 18 patients who recently received a COVID-19 vaccine (Comirnaty and Vaxzevria vaccines) and presented with neurological complications to the Saudi German Hospitals in Jeddah, Saudi Arabia. Neurologists assessed the patients' clinical presentation, radiological investigations, and laboratory findings.

RESULTS

Three patients who received the first dose of the Vaxzevria vaccine experienced severe cerebral venous thrombosis, two of them were complicated by intracranial hemorrhage. Their laboratory investigations showed very high d-dimers and severe thrombocytopenia, which have been linked to higher mortality and poor outcome. Ischemic stroke occurred in eight cases (44.4%) with a predominance in older male patients. Three patients presented with seizures, two had optic neuritis. Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS) occurred in two male patients following vaccination with Comirnaty.

CONCLUSION

Neurological complications after COVID-19 vaccinations are very rare, and only a few cases have been reported worldwide. The shared pathophysiological basis between COVID-19 viral infection and COVID-19 vaccines stands behind the very rare neurological complications resulting from the hypercoagulable state triggered by the general inflammatory condition. We suspect some differences in the pathogenesis of ischemic stroke caused by COVID-19 infection and COVID-19 vaccines, which render COVID-19 vaccine-associated ischemic stroke more responsive to treatment. To date, no definitive association between the vaccine and GBS has been proven by any strong evidence, but it has recently been added as a very rare side effect of the Janssen COVID-19 vaccine. No possible links of Miller Fisher syndrome to COVID-19 vaccines have been reported before the one reported in this study.

Type 2 diabetes control and complications and their relation to serum magnesium level

INTRODUCTION

Type 2 diabetes (T2D) is a growing health problem nationally and worldwide. Magnesium is an important mineral that is essential for a wide range of metabolic reactions. Here, our primary goal was to determine the prevalence of hypomagnesemia and its relationship to glycemic control, cardiovascular markers, and T2D-related complications.

MATERIAL AND METHODS

A cross-sectional study was performed from September 2015 to March 2017 including adult patients with T2D who attended the Endocrine and Diabetes Center, Taif, Saudi Arabia. Those with known hypomagnesemia, patients with type 1 diabetes, gestational diabetes, patients with end-stage renal disease, and those on magnesium supplementations were excluded. Those with a serum magnesium level < 0.7 mmol/l were considered to have hypomagnesemia. Otherwise, patients were considered to have a normal serum Mg level.

RESULTS

A total of 285 patients with a mean age of 59.4 ±12.7 years were enrolled. The majority of patients were female, with long-standing T2D, with a mean body mass index in the obesity category, and most of them had comorbid conditions. Twenty-eight percent of the screened T2D patients had hypomagnesemia and this group were more likely to have a bachelor degree (p = 0.034), to be on metformin, statin, and glargine insulin (all p < 0.05), have worse glycemic control (p < 0.05), and a higher pulse rate (p = 0.039), but were less likely to be on diet control (p = 0.034) when compared to those with a normal Mg level.

CONCLUSIONS

Almost one-third of the screened T2D patients have hypomagnesemia. Hypomagnesemia was associated with the treatment modalities, worse glycemic control, and with peripheral artery disease.

Chloroquine and hydroxychloroquine inhibitors for COVID-19 sialic acid cellular receptor: Structure, hirshfeld atomic charge analysis and solvent effect

COVID-19, the pandemic disease recently discovered in Wuhan (China), severely spread and affected both social and economic activity all over the world. Attempts to find an effective vaccine are challenging, time-consuming though interminable. Hence, re-proposing effective drugs is reliable and effective alternative. Taking into account the genome similarity of COVID-19 with SARS-CoV, drugs with safety profiles could be fast solution. Clinical trials encouraged the use of Chloroquine and Hydroxychloroquine for COVID-19 inhibition. One of the possible inhibition pathways is the competitive binding with the angiotension-converting enzyme-2 (ACE-2), in particular with the cellular Sialic acid (Neu5Ac). Here, we investigate the possible binding mechanism of ClQ and ClQOH with sialic acid both in the gas phase and in water using density functional theory (DFT). We investigated the binding of the neutral, monoprotonated and diprotonated ClQs and ClQOHs to sialic acid to simulate the pH effect on the cellular receptor binding. DFT results reveals that monoprotonated ClQ⁺ and ClQOH⁺, which account for more than 66% in the solution, possess high reactivity and binding towards sialic acid. The Neu5Ac-ClQ and the analogues Neu5Ac-ClQOH adducts were stabilized in water than in the gas phase. The molecular complexes stabilize by strong hydrogen bonding and π - π stacking forces. In addition, proton-transfer in Neu5Ac-ClQOH⁺ provides more stabilizing power and cellular recognition binding forces. These results shed light on possible recognition mechanism and help future breakthroughs for COVID-19 inhibitors.

Thyroid Dysfunction in Patients Admitted in Cardiac Care Unit: Prevalence, Characteristic and Hospitalization Outcomes

Introduction

Cardiovascular disease is one of the main causes of hospital admission and mortality, and thyroid dysfunction increases the risk of developing acute or exacerbation of chronic cardiac conditions. The aim of this study is to investigate the prevalence of thyroid hormone abnormality among patients in the cardiac care unit (CCU) patients and its relation to admission diagnosis, clinical, biochemical data, and hospital-related outcomes.

Methods

We conducted a retrospective cohort observational that included adult patients who were admitted to the CCU. We excluded those with known thyroid dysfunction and those who received amiodarone or IV contrast.

Results

A total of 374 patients with a mean age of 62.7+14.7 years old were included. Ischemic changes were observed in 70.6% of the patients based on the admission diagnosis. In comparison to the non-ischemic group, the ischemic group was more likely to be male (P=0.010), to be active/former smokers (P=0.011), to have diabetes (P=0.009), to have diastolic dysfunction (P=<0.001), to have undergone thrombolysis (P=<0.001), and to have been referred to a tertiary center (P=<0.001). Euthyroidism was observed in 57.8% of the patients based on the thyroid function test at admission. Compared to patients with thyroid dysfunction, those with Euthyroidism were more likely to be active/former smokers (P=0.002), to have lower heart rates (P=0.018), to not have chronic kidney disease (P=0.016), to not have heart failure (P=0.006), to have lower thyroid-stimulating hormone (TSH) levels (P=<0.001), and to have lower tricuspid regurgitation (P=0.042).

Conclusion

Thyroid dysfunction is common among patients admitted to the CCU. Non-significant positive correlations between TSH and hospitalization length, tertiary center referral, 30-day readmission, and in-hospital mortality when adjusting for potential confounders.

In the peripheral blood mononuclear cells (PBMCs) of HCV infected patients the expression of STAT1 and IRF-1 is downregulated while that of caspase-3 upregulated

Several peripheral blood mononuclear cell (PBMC) defects have been linked with hepatitis C virus (HCV) infection, including alterations in cytokine secretion and increased cell death. This study was performed to investigate the expression levels of signal transducer and activator of transcription 1 (STAT1), interferon regulatory factor 1 (IRF-1), and caspase 3 in PBMCs of patients infected with HCV. STAT1, IRF-1, and caspase 3 expression levels were compared in PBMCs from 19 untreated (naïve) HCV+ patients, 8 treated (sustained responder [SR]) HCV patients, and 20 HCV- healthy controls. Moreover, PBMCs from naïve HCV+ patients and SR-HCV patients were also evaluated for HCV RNA expression. The expression levels of STAT-1 and IRF-1 were significantly downregulated in PBMCs from naïve HCV+ patients (P  Keywords: PBMC; hepatitis C virus; STAT1; IRF-1; caspase-3.

A National Survey of Self-Prescription of Beta-Blockers and Their Relation to Undiscovered Anxiety Among Medical and Pharmacological Students in Saudi Arabia

BACKGROUND

The development of beta-blocker (BB) medications is considered one of the most critical milestones of drug research. Several trials showed possible anti-anxiety effects of BBs. Our primary goal is to investigate the prevalence of anxiety disorder and the use of BBs as anxiolytic without medical prescription among medical and pharmacological students in Saudi Arabia.

METHODS

A cross-sectional study was conducted at multiple universities in Saudi Arabia. Students were given a questionnaire containing 44 questions that included demographic data, school location, BB usage behavior, GPA status before and after using BBs, and a GAD-7 anxiety screening questionnaire.

RESULTS

A total of 3326 mainly female senior students participated in the study with a mean age of 21.9±1.7 years. According to the GAD-7 score, half of the sampled students did not meet criteria indicative of anxiety disorder, and one-third were considered to have mild anxiety with a significant positive correlation between the BB usage and the GAD-7 score. A total of 6.4% of the sample reported usage of BBs. Therapeutics and Internal Medicine were the most common subjects for which BBs were used. When compared to pharmacy students, medical students were more likely to be male, smokers, diagnosed with psychiatric illness, having a higher mean GAD-7 score, report BB usage, and correctly identified common and serious BB side effects.

CONCLUSION

The inappropriate use of BB drugs without medical advice might have short- and long-term effects, and those may be more vulnerable to have psychological issues in the future. Our findings shed light on the need to identify students who are taking BBs as being at high risk of underlying anxiety disorders.

Scintigraphy evaluation of hyperthyroidism and its correlation with clinical and biochemical profiles

Objective

Hyperthyroidism is the excessive synthesis of thyroid hormones. Thyroid uptake scans and ultrasonography provide an accurate diagnosis of hyperthyroidism, especially when thyroid receptor antibody (TRAb) measurement is not readily available. This study explored the prevalence of various hyperthyroidism causes using retrospective scintigraphy results and evaluated their relationship with clinical, biochemical, and sonographic imaging parameters from patients who underwent ^99mTc-pertechnetate thyroid scans between 2016 and 2019 in Taif, Saudi Arabia, where literature is insufficient. Furthermore, the inappropriate use of thyroid scanning in different thyroid diseases was evaluated.

Results

The study enrolled 207 patients (mean age: 42.5 ± 14.7 years). The mean free T4, T3, antithyroid peroxidase antibody, antithyroglobulin antibody, C-reactive protein, and erythrocyte sedimentation rate levels were high. Graves’ disease was the most common diagnosis. Compared to toxic solitary/multinodular goiter, patients with Graves’ disease were usually younger, used carbimazole during both the uptake and the scan, had an enlarged thyroid gland, and had higher FT4 and FT3 levels. Inappropriate thyroid uptake and scan use was reported in approximately 10% of patients, and 25% of the patients used carbimazole during the uptake and scan. Thus, better patient education is needed to avoid misinterpreting the scan results.

The Prevalence of Obesity among School Students and its Relation to Dietary and Physical Habits

BACKGROUND: Recent studies suggest that unhealthy food practices and lack of exercise are the main cause of the progressive increase in the obesity prevalence. AIM: We aim to assess the prevalence of obesity among school students and its relationship to dietary and physical habits. METHODS: A cross-sectional study from 18 intermediate and high schools located in Taif, Saudi Arabia, between April 2014 and June 2015. We excluded any student with a psychological disease or chronic diseases. We calculated the body mass index (BMI) of students by measuring their height and weight. Dietary, physical, sleep habits, and socioeconomic status were assessed. RESULTS: A total of 2943 students participated with a mean age of 15.4 ± 1.7 years. The majority of these were boys and attending government schools with a mean BMI 22.7 ± 8.6 kg/m2. Overall, 13.6% were overweight and 12.8% were obese. One-third of students report a sedentary lifestyle. Compared to girls, boys were more likely to have lower BMI (p < 0.001), be overweight (p < 0.001), exercise for >300 min/week (p < 0.001), own electronic devices other than smartphone (p < 0.001), use the electronic devices <3 h/day (p = 0.007), eat their meals with their family (p < 0.001), eat fruits and vegetables daily (p < 0.05), exercise for >300 min/week (p < 0.001), and walk to and from school at least once weekly (p < 0.001). CONCLUSION: A quarter of the students were either overweight or obese. Girls were more likely to be obese with less favorable socioeconomic, media consumption, dietary, and physical profiles.

Diabetics Retinopathy Knowledge and Awareness Assessment among the Type 2 Diabetics

INTRODUCTION

Diabetic retinopathy (DR) is a leading cause of blindness worldwide. In Saudi Arabia and other Arab countries, several studies estimated the prevalence of DR ranging from 30 - 40%.

AIM

To assess the DR knowledge and its association with diabetes control among Type 2 diabetic patients.

METHODS

A cross-sectional study of patients with Type II diabetes (T2D) who had a routine visit to the endocrine clinic to assess the DR knowledge and its relation to the glycemic control. We used a questionnaire that was used in previously published studies, and the reliability was assessed using the alpha Cronbach coefficient. Patients who answered correctly > 60% were considered to have good knowledge about DR.

RESULTS

Total of 253 patients participated, 43.4% has diabetes > 10 years and 30.7% have it for 5 - 10 years, 36.4% did college degree or higher, 40.8% considered having low income. 37.7% of participants were not screened for the DR in the past year. 28.4% of participants think that seeing optometrist is enough for DR diagnosis. Diabetics with good knowledge who have T2D > 10 years were 46.3% compared to 38.6% (p = 0.04). Diabetics with good knowledge have mean A1c of 8.55 vs. 8.59 (p = 0.32), mean BMI 30.4 vs. 30.2 (p = 0.46), mean diastolic pressure was 77.12% vs. 79.48% (p = 0.03).

CONCLUSION

Almost two-thirds of screened T2D were considered to have good knowledge about DR. The good knowledge group tends to have a longer duration of T2D, more likely to have a college degree, and tend to have non -significantly better A1c control.

Diabetes-Related Distress Assessment among Type 2 Diabetes Patients

BACKGROUND AND OBJECTIVES

Diabetes is one of the most common chronic diseases; it is a debilitating and hard to live with. Diabetes-related distress (DRD) refers to the emotional and behavioral changes caused by diabetes. Our study aims to assess the prevalence of DRD among type 2 diabetes (T2D) patients using Diabetes Distress Scale-17 items (DDS-17) and its relation to complications and treatment modalities.

METHODS

A cross-sectional study of adult T2D patients with follow-up visits at the Diabetes and Endocrinology Center in Taif, Saudi Arabia, between January and July 2017. We excluded patients with other forms of diabetes, untreated hypothyroidism, and psychiatric illness. The total score of DDS-17 was calculated by summing the 17 items' results and then dividing the total by 17. If the total score was >2, then it was considered as clinically significant results (moderate distress), but if it is ≥3, then it is classified as a high distress.

RESULTS

A total of 509 T2D patients with a mean age of 58 ± 14 years were included. The majority of participants were male, married, not college educated, and reported a sedentary lifestyle. We found 25% of the screened T2D patients have moderate to high DRD. Regarding the DRD components, emotional distress was the most prevalent followed by physician-related distress. HabA1c was significantly higher in those with high combined distress and high emotional distress compared to those with mild/moderate distress (p = 0.015 and 0.030, resp.).

CONCLUSION

Our study shows that DRD is a medically relevant issue that clinicians need to address. Despite observing a low prevalence of DRD compared to other studies, we found significant correlations between DRD scores and HabA1c, triglyceride levels, BMI, T2D duration, and interval between visits.

The Association Between Body Mass Index and Dental Caries: Cross-Sectional Study

Background

Obesity is a growing health-related problem worldwide. Both obesity and dental caries are important health issues with multifactorial aspects. Some studies have shown an association between body mass index (BMI) and caries in childhood/adolescence but limited data about such an association are available in adults. The primary goal of this study was to assess the prevalence of dental caries and its relationship to BMI.

Methods

We conducted a cross-sectional study at Taif University Outpatient Clinic, for adults who had a visit to the dental clinic. Baseline characteristics were obtained by the participating physician. The decayed, missing, and filled teeth (DMFT) index was used to determine the prevalence of dental caries. Information about healthy eating, smoking, exercise, sleep patterns, media consumption, and brushing habits were collected.

Results

A total of 385 patients were enrolled with a mean age of 28.39 years, 72.8% were male, mean DMFT index score was 6.55, and 85.5% reported brushing their teeth at least once daily. Of the participants, 55.3% were either overweight or obese, and 42.2% demonstrated a high prevalence of dental caries with no significant difference in BMI when compared to the low dental caries group.

Conclusions

A high prevalence of overweight/obesity and dental caries was observed among the participants. After controlling for potential confounders like smoking and brushing habits, significant positive correlation between BMI and DMFT was observed.

Gender differences in osteoporosis screening: retrospective analysis

INTRODUCTION

Osteoporosis is a common disease affecting 20 % of all men. It accounts for more than 1.5 million fractures yearly in the USA. Up to 20 % of patients who sustain hip fractures die within the first 12 months from related complications. The Endocrine Society recommends screening all men 70 years or older regardless of risk factors. There are little data comparing gender-specific osteoporosis screening rates. The aim of the study is to identify any gender difference in osteoporosis screening.

METHODS

We conducted a retrospective study to determine the screening rates for osteoporosis in males and females in our Division of Internal Medicine, university-based outpatient clinic (UBC). Males aged 70–75 years and females aged 65–70 years with a primary care physician (PCP) at our UBC, who have had at least one routine health maintenance exam (HME) since 2002, were included.

RESULTS

A total of 8,262 patients who met the age criteria were identified: 3,255 (39.4 %) males and 5,007 (60.6 %) females. Of the 3,255 male patients, 342 patients had their PCP at our UBC and had at least one HME; of those, 63 patients had DXA performed for an osteoporosis screening rate of 18.4 %. Of the 5,007 female patients, 668 patients had their PCP at our UBC and had at least one HME; of those, 402 patients had DXA performed for an osteoporosis screening rate of 60 %.

CONCLUSION

Males are screened less frequently although they have a comparable prevalence of osteoporosis.