Effects of ankle angular position and standing surface on postural control of upright stance

The purpose of the study was to investigate the effects of ankle angular position and standing surface type on static upright balance. Ten young adults stood on a force platform or on a firm wedge that induced 15° of either dorsiflexion or plantarflexion. In addition, a piece of foam was placed on top of the force platform and on the wedge. The center of pressure distance and velocity in the anteroposterior and mediolateral directions were calculated. Significantly larger magnitudes in most of the investigated variables were seen while standing with ankles in the dorsiflexion when compared with standing with the ankle joints in a natural position (p \u3c .05). Plantarflexion increased the center of pressure anteroposterior velocity by 87% when compared with a natural stance (p \u3c .05). Standing on the foam surfaces resulted in increases in all of the center of pressure measures by an average of 38% in all of the ankle conditions

Dietary knowledge among adults with type 2 diabetes - Kingdom of Saudi Arabia

Dietary management is considered as a major step in assessing a patient’s knowledge related to nutritional aspects, treatment, and complications of diabetes. Diabetes patients frequently face difficulty in identifying the recommended diet, including its quality and quantity. In the Kingdom of Saudi Arabia (KSA), sedentary lifestyle, along with food choices and portion sizes, have increased considerably and this has resulted in the soaring risk of diabetes. In addition, there is paucity of literature focusing on the Dietary Knowledge (DK) of type 2 diabetics in KSA. The study aimed to assess and evaluate the DK of type 2 diabetics. An analytical cross-sectional study was conducted among 350 type 2 diabetics using a valid and reliable self-prepared questionnaire comprising of 21 questions. Results showed that type 2 diabetics had an overall poor DK (28.57%). Sub-group analysis further revealed that diabetes patients had poor knowledge related to the consumption of carbohydrates and food choices, whereas they had good knowledge related to lipids and fats, proteins and food types. The role of diet in controlling of diabetes is considered imperative, but still, diabetes patients are unaware how they should approach this issue. The patient empowerment approach can be used to counsel patients with a poor DK. Primary care physicians and dietitians should work together and carry out individualized, tailored and patient-centered dietary education sessions

Expanding the allelic spectrum of ELOVL4‐related autosomal recessive neuro‐ichthyosis

Background Very long-chain fatty acids (VLCFAs) composed of more than 20 carbon atoms are essential in the biosynthesis of cell membranes in the brain, skin, and retina. VLCFAs are elongated beyond 28 carbon atoms by ELOVL4 enzyme. Variants in ELOVL4 are associated with three Mendelian disorders: autosomal dominant (AD) Stargardt-like macular dystrophy type 3, AD spinocerebellar ataxia, and autosomal recessive disorder congenital ichthyosis, spastic quadriplegia and impaired intellectual development (ISQMR). Only seven subjects from five unrelated families with ISQMR have been described, all of which have biallelic single-nucleotide variants. Methods We performed clinical exome sequencing on probands from four unrelated families with neuro-ichthyosis. Results We identified three novel homozygous ELOVL4 variants. Two of the families originated from the same Saudi tribe and had the exact homozygous exonic deletion in ELOVL4, while the third and fourth probands had two different novel homozygous missense variants. Seven out of the eight affected subjects had profound developmental delay, epilepsy, axial hypotonia, peripheral hypertonia, and ichthyosis. Delayed myelination and corpus callosum hypoplasia were seen in two of five subjects with brain magnetic rosonance imaging and cerebral atrophy in three. Conclusion Our study expands the allelic spectrum of ELOVL4-related ISQMR. The detection of the same exonic deletion in two unrelated Saudi family from same tribe suggests a tribal founder mutation

Effect of Ankle Joint Angular Position on Postural Control of Upright Stance

People frequently perform activities of daily living that require maintaining the upright balance over inclined surfaces with altered ankle joints position. Such postures might affect the postural control and lead to increased incident of falls. The aim of the thesis was to evaluate the postural control in static and dynamic tasks when standing over inclined surfaces inducing ankle joints dorsiflexion and plantarflexion. The static task (Chapter two) involved a quiet standing with dorsiflexed and plantarflexed ankles. Ten young adults stood on a force platform or on a firm 15° inclined wedge that induced either dorsiflexion or plantarflexion. A piece of foam was placed on top of the force platform and on the wedge. The center of pressure (COP) distance and velocity in the anteroposterior (AP) and mediolateral (ML) directions were calculated. Significantly larger magnitudes in most of the investigated variables were seen while standing with ankles in the dorsiflexion when compared to standing naturally (p<0.05). Plantarflexion increased the COP velocity in the anteroposterior direction (COPAP) when compared to a natural stance. Standing on the foam surfaces resulted in increases in all of the COP measures in all of the ankle conditions. The dynamic task (Chapter three) involved standing with dorsiflexed and plantarflexed ankles and performing bilateral arm movements. Another group of 10 young adults were asked to stand erect on the fore platform and on the 15 inclined wedge inducing either ankle joints dorsiflexion or plantarflexion and perform a self-paced discrete bilateral shoulder flexion. The muscles activity was acquired using adhesive EMG electrodes attached to the bellies of the major postural muscles. The analysis of muscles activity performed prior to performing the arm movement in the anticipatory postural adjustments phase (APAs) and after the arm movement in the compensatory postural adjustments phase (CPAs). The coactivation (C) and reciprocal activation (R) indexes were calculated for the ventral and dorsal muscles in the trunk, leg and shank segments in the APA and CPA phases. The COPAP displacement was acquired from the force platform signals. The study outcomes showed a modification of shank muscles activity across the experimental conditions in the APAs and CPAs. Noticeably, the dorsiflexion standing was associated with an inhibition in the tibialis anterior muscle and activation in the gastrocnemius muscle. The C index was significantly larger than R index in all the body segments in the natural and plantarflexion standing. The COPAP displacement was similar across the experimental conditions. The outcomes of the thesis could provide a basis for future research studying the effect of prolonged standing over inclined surfaces on the control of vertical posture. Furthermore, future research could include a sample population with diminished balance ability as elderly and people with neurological condition

Case report: Wolman disease in four-month infant, with pathogenic variant G87V in the Jazan region, Saudi Arabia

Background: Wolman disease (WD) severe lysosomal acid lipase is a rare, autosomal recessive lysosomal storage disease caused by the absence or deficiency of lysosomal acid lipase enzyme. This deficiency leads to the accumulation of cholesterol esters and triglycerides in multiple organs of the body. Jazan Region is the second smallest region of Saudi Arabia. It stretches 300 km (190 mi) along the southern Red Sea coast, just north of Yemen. It covers an area of 11,671 km² and has a population of 1,567,547 at the 2017 census. The region has the highest population density in the Kingdom and a high consanguinity marriage rate. Case Presentation: We report a rare case of WD, misdiagnosed by a surgeon to be pyloric stenosis, treated for a while as renal tubular acidosis, found to have typical WD presentation of malabsorption, hepatosplenomegaly, and adrenal calcification. Conclusion: This case report is the first report that described the existence of WD in the Jazan region up to date. [JBCGenetics 2019; 2(2.000): 139-142

The Synergistic Protective Effect of γ-Oryzanol (OZ) and N-Acetylcysteine (NAC) against Experimentally Induced NAFLD in Rats Entails Hypoglycemic, Antioxidant, and PPARα Stimulatory Effects

This study estimated that the combined effect of γ-Oryzanol and N-acetylcysteine (NAC) against high-fat diet (HFD)-induced non-alcoholic fatty liver disease (NAFLD) in rats also estimated some of their mechanisms of action. Adult male rats were divided into seven groups (n = 8 each) as control, control + NAC, control + γ-Oryzanol, HFD, HFD + NAC, HFD + γ-Oryzanol, and HFD + NAC + γ-Oryzanol. NAC was administered orally at a final concentration of 200 mg/kg, whereas γ-Oryzanol was added to diets at a concentration of 0.16. All treatments were conducted for 17 weeks and daily. Both NAC and γ-Oryzanol were able to reduce final body weights, fat weights, fasting glucose, fasting insulin, serum, and serum levels of liver function enzymes as well as the inflammatory markers such as tumor necrosis factor-α (TNF-α), interleukine-6 (IL-6), and leptin in HFD-fed rats. They also improved hepatic structure and glucose tolerance, increased adiponectin levels, and reduced serum and hepatic levels of triglycerides (TGs) and cholesterol (CHOL) in these rats. These effects were concomitant with a reduction in the hepatic levels of lipid peroxides (MDA) and serum levels of LDL-C, but also with an increment in the hepatic levels of superoxide dismutase (SOD) and glutathione (GSH). Interestingly, only treatment with γ-Oryzanol stimulated the mRNA levels of proliferator-activated receptor alpha (PPARα) and carnitine palmitoyltransferase 1 (CPT1) in the liver and white adipose tissue (WAT) of rats. Of note, the combination therapy of both drugs resulted in maximum effects and restored almost normal liver structure and basal levels of all the above-mentioned metabolic parameters. In conclusion, a combination therapy of γ-Oryzanol and NAC is an effective therapy to treat NAFLD, which can act via several mechanisms on the liver and adipose tissue

Dietary attitude of adults with type 2 diabetes mellitus in the Kingdom of Saudi Arabia: A cross-sectional study

Background and objectives: There is a paucity of literature on the dietary attitude (DA) of patients with type 2 diabetes in the Kingdom of Saudi Arabia (KSA). Although the prevalence of diabetes mellitus (DM) is high in Gulf countries, there remains a lack of understanding of the importance of dietary behavior in diabetes management among patients. Understanding the behavior of patients with diabetes towards the disease requires knowledge of their DA. Therefore, this study aimed to assess and evaluate the DA of type 2 diabetes patients, and it is the first of its kind in the KSA. Material and Methods: An analytical cross-sectional study was conducted among 350 patients with type 2 diabetes. A self-administered DA questionnaire was used to collect the data. Psychometric properties of the questionnaire were assessed by face validity, content validity, exploratory factor analysis, and internal consistency reliability. The data were collected using a systematic random sampling technique. Results: The overall DA of the patients was inappropriate (p = 0.014). Patients had an inappropriate DA towards food selection (p = 0.003), healthy choices (p = 0.005), food restraint (p < 0.001), health impact (p < 0.001), and food categorization (p = 0.033). A poor DA was also observed in relation to the consumption of red meat (p <0.001), rice (p < 0.001), soup and sauces (p = 0.040), dairy products (p = 0.015), and junk food (p < 0.001). Conclusions: It is highly recommended that patients with diabetes receive counseling with an empowerment approach, as this can bring about changes in their dietary behavior, which is deeply rooted in their daily routine. Healthcare providers should also be well-informed about patients’ attitudes and beliefs towards diabetes to design tailored educational and salutary programs for this specific community. Diabetes self-management educational programs should also be provided on a regular basis with a special emphasis on diet and its related components

Assessment of Primary Care Physicians’ Expertise of Common Dermatological Conditions in the Jouf Region, Saudi Arabia: A Mixed Methods Study

Primary care physicians (PCPs) are the first line of defense for the management of common dermatological conditions (DCs). This study aimed to assess how dermatological diseases are identified, managed, and referred to in primary healthcare centers (PHCs). This was a mixed methods study comprising a cross-sectional survey and semi-structured interviews recruited through PHCs across the Jouf region of Saudi Arabia. Sixty-one PCPs completed the data, and eight participants were interviewed. A survey based on a sample of 22 photographs of common DCs in the Kingdom was administered to the participants to answer questions about the correct diagnosis, appropriate management, referral strategy, and encounter rate. In our sampled population, the mean overall knowledge level on a scale of 10 was 7.08 (±1.3). Among participants that had good to acceptable scores, 51 (83.6%) were in the overall knowledge parameter, 46 (75.4%) in the diagnosis parameter, and 49 (80.3%) in the management parameter. PCPs with five years or more of experience were found to have significantly higher overall knowledge and management scores. Most of our PCPs demonstrated sufficient knowledge of common DCs and had good to acceptable scores in all parameters. However, educational and regulatory aspects of PCPs’ clinical management were identified. Focused training, provision of workshops, and improving medical school curricula regarding common DCs are recommended