The aim of this study was to examine the feasibility and effectiveness of telemedicine care provi... more The aim of this study was to examine the feasibility and effectiveness of telemedicine care provided to osteoporotic patients in Saudi Arabia. Our results show that this service was effective and feasible, and patients had a good rate of satisfaction with it. Purpose To investigate the efficacy and feasibility of telemedicine care in osteoporotic patients during the COVID-19 lockdown period in Saudi Arabia compared to in-person patients, as well as their satisfaction with this service. Methods This observational retrospective study was conducted between March 2021 and September 2021 in King Saud University Medical City, Saudi Arabia. A survey was used to compare patients attending telemedicine clinics with in-person patients in terms of access and adherence to medications, occurrence of new fractures, and overall satisfaction with this service. Results 195 patients attended the telemedicine clinic, while 63 attended the in-person clinic. Exercise frequency was similar in both groups, although exercise intensity was greater in the in-person group. 25(OH)D levels were stable in both groups. The availability and delay of supply of osteoporosis medications were not statistically different between both groups while adherence to treatment did not differ significantly between the two groups. The majority of patients in the telemedicine group were satisfied. Conclusions Telemedicine care was feasible and effective in managing osteoporotic patients during the COVID-19 epidemic. Such service could be considered in the future for managing disabled patients and those living in remote areas.
Metabolic syndrome (MetS) is a serious health condition that is becoming extremely threatening in... more Metabolic syndrome (MetS) is a serious health condition that is becoming extremely threatening in Saudi Arabia. The link between vitamin D receptor (VDR) gene polymorphisms and maternal MetS has been observed in several ethnic groups, but is yet to be clarified in the Arabian population. This study aims to investigate the relationship between the FokI VDR genotype and the risk of MetS and its components in pregnant Saudi women. A cross-sectional study was conducted using 368 pregnant Saudi women on first trimester screened for MetS (44 with MetS and 324 without MetS). Measurements included anthropometrics, glycemic and lipid profile and 25(OH)D. TaqMan genotyping assay was used to determine Fokl VDR genotype of participants. Vitamin D deficiency (25(OH)D <50nmol/l) was seen in 85% of the participants. An estimated 12% of participants had MetS. In the MetS group, the FokI VDR genotyping frequencies for FF, Ff, and ff genotypes were 50%, 36.4% and 13.6%, respectively. In controls, ...
Introduction: This study aimed to investigate the association between components of metabolic syn... more Introduction: This study aimed to investigate the association between components of metabolic syndrome (MetS) at first trimester and development of Gestational diabetes mellitus (GDM) in 498 Saudi pregnant women. Materials and Methods: Biochemical and anthropometric parameters were determined at the first trimester and MetS components were defined. Participants were screened for GDM at follow up according to International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. The main outcome measures were development of GDM and GDM risk vs. MetS components at first trimester. Results: One hundred twenty three (24.7%) were diagnosed with GDM according to IADPSG criteria. GDM risk was significantly higher for participants with hypertriglyceridemia at 1st trimester even after adjusting for age, BMI and parity (OR: 1.82; CI: 1.1-3.7, p = 0.04). Furthermore, the odds of hyperglycemia at 1st trimester was significantly higher in GDM than in non-GDM participants even after adjustments (OR: 2.13, 95% CI: 1.1 to 4.3, p = 0.038). The receiver operating characteristic (ROC) for predicting GDM revealed an area under the curve (AUC) of 0.69 (95% CI: 0.64 to 0.74, p < 0.001) and 0.71 (95% CI: 0.65 to 0.77, p < 0.001) for first-trimester hyperglycemia and hypertriglyceridemia respectively. Conclusions: The incidence of GDM in Saudi pregnant women was strongly associated with hyperglycemia and hypertriglyceridemia at first trimester. These findings are of clinical importance, as an assessment of MetS in early pregnancy can identify women at higher risk of developing GDM.
Data regarding the prevalence and predictors of vitamin D deficiency during early pregnancy are l... more Data regarding the prevalence and predictors of vitamin D deficiency during early pregnancy are limited. This study aims to fill this gap. A total of 578 Saudi women in their 1 trimester of pregnancy were recruited between January 2014 and December 2015 from three tertiary care antenatal clinics in Riyadh, Saudi Arabia. Information collected includes socio-economic, anthropometric, and biochemical data, including serum vitamin D (25(OH)D) levels, intake of calcium and vitamin D, physical activity, and sun exposure indices. Pregnant women with 25(OH)D levels <50 nmol/L were considered vitamin D deficient. The majority of participants ( = 468 (81%)) were vitamin D deficient. High levels of indoor activity, whole body clothing, multiparity, total cholesterol/HDL ratio(>3.5), low HDL-cholesterol, and living in West Riyadh were significant independent predictors for vitamin D deficiency, with odds ratios (ORs) (95% confidence interval) of 25.4 (5.5–117.3), 17.8 (2.3–138...
Objective A summary of recommendations is given within the Gulf Cooperation Council (GCC) setting... more Objective A summary of recommendations is given within the Gulf Cooperation Council (GCC) setting on the assessment and management of vitamin D deficiency in the region. Methods An assembly of 11 regional experts gathered to formulate an all-inclusive approach to vitamin D deficiency within GCC. Results and Conclusion Several gaps were identified before regional guidelines could be developed. These include adequacy and standardization of vitamin D testing, frequency of repeated testing and reference ranges, distinguishing prevention from the treatment of vitamin D
Background: Vitamin D deficiency is a common nutritional issue and dietary supplementation in the... more Background: Vitamin D deficiency is a common nutritional issue and dietary supplementation in the general population, including pregnant women, is generally advised. Appropriately high levels of vitamin D are expected to play a role in containing the glycemic and atherogenic profiles observed in pregnancy. However, the relation between vitamin D status and the lipid metabolic profile in Saudi women, who are known to suffer from chronic vitamin D deficiency and high incidence of obesity and type II DM, during the course of pregnancy is not known. Methods: In this study, we analyzed the relation between serum vitamin D level and various serum metabolic markers among Saudi women (n = 515) in their first trimester of pregnancy (11.2 ± 3.4 weeks). Coefficients of Pearson correlation and Spearman rank correlation were calculated for Gaussian and non-Gaussian variables, respectively. Serum vitamin D status was defined as (in nmol/L): deficient (<25), insufficient (25–50); sufficient (50...
Background: Vitamin D deficiency is a global public health problem. The published literature on v... more Background: Vitamin D deficiency is a global public health problem. The published literature on vitamin D deficiency is limited among Arab pregnant women and its association with different metabolic markers. Objective: To determine the prevalence of vitamin D deficiency in Arab pregnant women and neonates and its association with various biomarker profiles. Methods: This is a multicenter study taken from a large prospective project in Riyadh, the capital city of Saudi Arabia. Maternal biochemical levels were measured routinely. Maternal and neonatal 25(OH)D levels were assessed using a chemiluminescence immunoassay. A total of 1,097 pregnant women >16 years old with gestational ages <24 weeks were recruited from different tertiary hospitals in Riyadh between February 2011 and June 2012. Results: Almost 85% of pregnant subjects had 25(OH)D level <50 nmol/L. Vitamin D deficiency among neonates was 88%. Maternal 25(OH)D was significantly associated with neonatal 25(OH)D (r = 0...
To provide clinicians with an update on the diagnosis of celiac disease (CD) and to make recommen... more To provide clinicians with an update on the diagnosis of celiac disease (CD) and to make recommendations on the indications to screen for CD in patients presenting with low bone mineral density (BMD) or fragility fractures. A multidisciplinary task force developed clinically relevant questions related to the diagnosis of CD as the basis for a literature search of the MEDLINE, EMBASE, and CENTRAL databases (January 2000 to January 2009) using the key words celiac disease, osteoporosis, osteopenia, low bone mass, and fracture. The existing literature consists of level I and II studies. The estimated prevalence of asymptomatic CD is 2% to 3% in individuals with low BMD. Routine screening for CD is not justified in patients with low BMD. However, targeted screening for CD is recommended for patients who have T-scores of -1.0 or less at the spine or hip, or a history of fragility fractures in association with any CD-related symptoms or conditions; family history of CD; or low urinary cal...
This study was conducted to examine the prevalence, mode of presentation and management of primar... more This study was conducted to examine the prevalence, mode of presentation and management of primary hyperparathyroidism in one of the major hospitals in Saudi Arabia. This was a retrospective analysis of 24 cases of primary hyperparathyroidism, comprising 21 females and three males, who were seen at King Khalid University Hospital over a period of 16 years from 1982 until December 1997. The prevalence of the disease was estimated to be 11.34 per 100,000 hospital population. The majority of the patients presented with musculoskeletal complaints (62%-67%) and/or renal complications (58%). Hypercalcemia was seen in 92% of the cases. Serum PTH was available for 21 patients and 20 had significantly elevated levels. Fifty percent of the patients had features of hyperparathyroid bone disease on plain x-ray, while 79% showed osteopenia of the femoral neck on dual x-ray absorptiometry, and almost all the patients had lumbar osteopenia. Fifty percent of the patients had features of metabolic bone disease on bone scan. Thalliumtechnetium subtraction studies proved to be the most reliable tool, with 83% sensitivity, followed by ultrasound scan of the neck, with a sensitivity of 55%. CT scan of the neck was attempted in only seven patients (29%), with a sensitivity of 86%. Twenty-one patients (87.5%) underwent surgical exploration and removal of the parathyroid adenoma. Single parathyroid adenoma was identified in 85% of the cases, 5% had multiple adenomas, and 5% had hyperplasia of the parathyroid gland. Our results showed that primary hyperparathyroidism is not a rare disease in Saudi Arabia. It has a tendency for late presentation with complications. We believe that routine screening for calcium and early identification of such cases are warranted to reduce the morbidity of this easily treatable disorder.
The HAIR-AN syndrome, which consists of hyperandrogenism (HA), insulin resistance (IR) and acanth... more The HAIR-AN syndrome, which consists of hyperandrogenism (HA), insulin resistance (IR) and acanthosis nigricans (AN), is an underdiagnosed endocrinopathy. 2 Hyperandrogenic women are seen frequently in clinical practice, the challenge being to identify a cause and source of the problem. Many such patients are classified, after thorough investigations, as polycystic ovary syndrome (PCOS). The problem with this identification is that the PCOS encompasses a wide range of clinical and laboratory presentations and, therefore, classification into subgroups may help in understanding the process and thereby targeting the management in a more appropriate way. The HAIR-AN syndrome is an example of a unique entity with a specific molecular basis. It was thought to be a rare syndrome, but recent experience suggests that as many as 5% of hyperandrogenic women have this syndrome. Here we report a classical case of HAIR-AN which had an unfortunate outcome because of initial misdiagnosis.
Mediterranean Journal of Nutrition and Metabolism, 2011
In recent years, the role of Vitamin D in extraskeletal tissue has been strongly emphasized. The ... more In recent years, the role of Vitamin D in extraskeletal tissue has been strongly emphasized. The importance of optimizing Vitamin D levels in patients with chronic diseases and for risk reduction of many of those diseases including certain types of cancer is being increasingly recognized. Knowledge of the rapidly emerging, therapeutic and preventive utilities of Vitamin D is suboptimal among the health care providers (HPs). HPs do not regularly evaluate or optimize Vitamin D levels in patients. This study was conducted to explore the awareness, knowledge and attitude of HPs towards the current therapeutic and preventive roles of Vitamin D. A survey of HPs was conducted during the preregistration for a Vitamin D Symposium conducted
The aim of this study was to examine the feasibility and effectiveness of telemedicine care provi... more The aim of this study was to examine the feasibility and effectiveness of telemedicine care provided to osteoporotic patients in Saudi Arabia. Our results show that this service was effective and feasible, and patients had a good rate of satisfaction with it. Purpose To investigate the efficacy and feasibility of telemedicine care in osteoporotic patients during the COVID-19 lockdown period in Saudi Arabia compared to in-person patients, as well as their satisfaction with this service. Methods This observational retrospective study was conducted between March 2021 and September 2021 in King Saud University Medical City, Saudi Arabia. A survey was used to compare patients attending telemedicine clinics with in-person patients in terms of access and adherence to medications, occurrence of new fractures, and overall satisfaction with this service. Results 195 patients attended the telemedicine clinic, while 63 attended the in-person clinic. Exercise frequency was similar in both groups, although exercise intensity was greater in the in-person group. 25(OH)D levels were stable in both groups. The availability and delay of supply of osteoporosis medications were not statistically different between both groups while adherence to treatment did not differ significantly between the two groups. The majority of patients in the telemedicine group were satisfied. Conclusions Telemedicine care was feasible and effective in managing osteoporotic patients during the COVID-19 epidemic. Such service could be considered in the future for managing disabled patients and those living in remote areas.
Metabolic syndrome (MetS) is a serious health condition that is becoming extremely threatening in... more Metabolic syndrome (MetS) is a serious health condition that is becoming extremely threatening in Saudi Arabia. The link between vitamin D receptor (VDR) gene polymorphisms and maternal MetS has been observed in several ethnic groups, but is yet to be clarified in the Arabian population. This study aims to investigate the relationship between the FokI VDR genotype and the risk of MetS and its components in pregnant Saudi women. A cross-sectional study was conducted using 368 pregnant Saudi women on first trimester screened for MetS (44 with MetS and 324 without MetS). Measurements included anthropometrics, glycemic and lipid profile and 25(OH)D. TaqMan genotyping assay was used to determine Fokl VDR genotype of participants. Vitamin D deficiency (25(OH)D <50nmol/l) was seen in 85% of the participants. An estimated 12% of participants had MetS. In the MetS group, the FokI VDR genotyping frequencies for FF, Ff, and ff genotypes were 50%, 36.4% and 13.6%, respectively. In controls, ...
Introduction: This study aimed to investigate the association between components of metabolic syn... more Introduction: This study aimed to investigate the association between components of metabolic syndrome (MetS) at first trimester and development of Gestational diabetes mellitus (GDM) in 498 Saudi pregnant women. Materials and Methods: Biochemical and anthropometric parameters were determined at the first trimester and MetS components were defined. Participants were screened for GDM at follow up according to International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. The main outcome measures were development of GDM and GDM risk vs. MetS components at first trimester. Results: One hundred twenty three (24.7%) were diagnosed with GDM according to IADPSG criteria. GDM risk was significantly higher for participants with hypertriglyceridemia at 1st trimester even after adjusting for age, BMI and parity (OR: 1.82; CI: 1.1-3.7, p = 0.04). Furthermore, the odds of hyperglycemia at 1st trimester was significantly higher in GDM than in non-GDM participants even after adjustments (OR: 2.13, 95% CI: 1.1 to 4.3, p = 0.038). The receiver operating characteristic (ROC) for predicting GDM revealed an area under the curve (AUC) of 0.69 (95% CI: 0.64 to 0.74, p < 0.001) and 0.71 (95% CI: 0.65 to 0.77, p < 0.001) for first-trimester hyperglycemia and hypertriglyceridemia respectively. Conclusions: The incidence of GDM in Saudi pregnant women was strongly associated with hyperglycemia and hypertriglyceridemia at first trimester. These findings are of clinical importance, as an assessment of MetS in early pregnancy can identify women at higher risk of developing GDM.
Data regarding the prevalence and predictors of vitamin D deficiency during early pregnancy are l... more Data regarding the prevalence and predictors of vitamin D deficiency during early pregnancy are limited. This study aims to fill this gap. A total of 578 Saudi women in their 1 trimester of pregnancy were recruited between January 2014 and December 2015 from three tertiary care antenatal clinics in Riyadh, Saudi Arabia. Information collected includes socio-economic, anthropometric, and biochemical data, including serum vitamin D (25(OH)D) levels, intake of calcium and vitamin D, physical activity, and sun exposure indices. Pregnant women with 25(OH)D levels <50 nmol/L were considered vitamin D deficient. The majority of participants ( = 468 (81%)) were vitamin D deficient. High levels of indoor activity, whole body clothing, multiparity, total cholesterol/HDL ratio(>3.5), low HDL-cholesterol, and living in West Riyadh were significant independent predictors for vitamin D deficiency, with odds ratios (ORs) (95% confidence interval) of 25.4 (5.5–117.3), 17.8 (2.3–138...
Objective A summary of recommendations is given within the Gulf Cooperation Council (GCC) setting... more Objective A summary of recommendations is given within the Gulf Cooperation Council (GCC) setting on the assessment and management of vitamin D deficiency in the region. Methods An assembly of 11 regional experts gathered to formulate an all-inclusive approach to vitamin D deficiency within GCC. Results and Conclusion Several gaps were identified before regional guidelines could be developed. These include adequacy and standardization of vitamin D testing, frequency of repeated testing and reference ranges, distinguishing prevention from the treatment of vitamin D
Background: Vitamin D deficiency is a common nutritional issue and dietary supplementation in the... more Background: Vitamin D deficiency is a common nutritional issue and dietary supplementation in the general population, including pregnant women, is generally advised. Appropriately high levels of vitamin D are expected to play a role in containing the glycemic and atherogenic profiles observed in pregnancy. However, the relation between vitamin D status and the lipid metabolic profile in Saudi women, who are known to suffer from chronic vitamin D deficiency and high incidence of obesity and type II DM, during the course of pregnancy is not known. Methods: In this study, we analyzed the relation between serum vitamin D level and various serum metabolic markers among Saudi women (n = 515) in their first trimester of pregnancy (11.2 ± 3.4 weeks). Coefficients of Pearson correlation and Spearman rank correlation were calculated for Gaussian and non-Gaussian variables, respectively. Serum vitamin D status was defined as (in nmol/L): deficient (<25), insufficient (25–50); sufficient (50...
Background: Vitamin D deficiency is a global public health problem. The published literature on v... more Background: Vitamin D deficiency is a global public health problem. The published literature on vitamin D deficiency is limited among Arab pregnant women and its association with different metabolic markers. Objective: To determine the prevalence of vitamin D deficiency in Arab pregnant women and neonates and its association with various biomarker profiles. Methods: This is a multicenter study taken from a large prospective project in Riyadh, the capital city of Saudi Arabia. Maternal biochemical levels were measured routinely. Maternal and neonatal 25(OH)D levels were assessed using a chemiluminescence immunoassay. A total of 1,097 pregnant women >16 years old with gestational ages <24 weeks were recruited from different tertiary hospitals in Riyadh between February 2011 and June 2012. Results: Almost 85% of pregnant subjects had 25(OH)D level <50 nmol/L. Vitamin D deficiency among neonates was 88%. Maternal 25(OH)D was significantly associated with neonatal 25(OH)D (r = 0...
To provide clinicians with an update on the diagnosis of celiac disease (CD) and to make recommen... more To provide clinicians with an update on the diagnosis of celiac disease (CD) and to make recommendations on the indications to screen for CD in patients presenting with low bone mineral density (BMD) or fragility fractures. A multidisciplinary task force developed clinically relevant questions related to the diagnosis of CD as the basis for a literature search of the MEDLINE, EMBASE, and CENTRAL databases (January 2000 to January 2009) using the key words celiac disease, osteoporosis, osteopenia, low bone mass, and fracture. The existing literature consists of level I and II studies. The estimated prevalence of asymptomatic CD is 2% to 3% in individuals with low BMD. Routine screening for CD is not justified in patients with low BMD. However, targeted screening for CD is recommended for patients who have T-scores of -1.0 or less at the spine or hip, or a history of fragility fractures in association with any CD-related symptoms or conditions; family history of CD; or low urinary cal...
This study was conducted to examine the prevalence, mode of presentation and management of primar... more This study was conducted to examine the prevalence, mode of presentation and management of primary hyperparathyroidism in one of the major hospitals in Saudi Arabia. This was a retrospective analysis of 24 cases of primary hyperparathyroidism, comprising 21 females and three males, who were seen at King Khalid University Hospital over a period of 16 years from 1982 until December 1997. The prevalence of the disease was estimated to be 11.34 per 100,000 hospital population. The majority of the patients presented with musculoskeletal complaints (62%-67%) and/or renal complications (58%). Hypercalcemia was seen in 92% of the cases. Serum PTH was available for 21 patients and 20 had significantly elevated levels. Fifty percent of the patients had features of hyperparathyroid bone disease on plain x-ray, while 79% showed osteopenia of the femoral neck on dual x-ray absorptiometry, and almost all the patients had lumbar osteopenia. Fifty percent of the patients had features of metabolic bone disease on bone scan. Thalliumtechnetium subtraction studies proved to be the most reliable tool, with 83% sensitivity, followed by ultrasound scan of the neck, with a sensitivity of 55%. CT scan of the neck was attempted in only seven patients (29%), with a sensitivity of 86%. Twenty-one patients (87.5%) underwent surgical exploration and removal of the parathyroid adenoma. Single parathyroid adenoma was identified in 85% of the cases, 5% had multiple adenomas, and 5% had hyperplasia of the parathyroid gland. Our results showed that primary hyperparathyroidism is not a rare disease in Saudi Arabia. It has a tendency for late presentation with complications. We believe that routine screening for calcium and early identification of such cases are warranted to reduce the morbidity of this easily treatable disorder.
The HAIR-AN syndrome, which consists of hyperandrogenism (HA), insulin resistance (IR) and acanth... more The HAIR-AN syndrome, which consists of hyperandrogenism (HA), insulin resistance (IR) and acanthosis nigricans (AN), is an underdiagnosed endocrinopathy. 2 Hyperandrogenic women are seen frequently in clinical practice, the challenge being to identify a cause and source of the problem. Many such patients are classified, after thorough investigations, as polycystic ovary syndrome (PCOS). The problem with this identification is that the PCOS encompasses a wide range of clinical and laboratory presentations and, therefore, classification into subgroups may help in understanding the process and thereby targeting the management in a more appropriate way. The HAIR-AN syndrome is an example of a unique entity with a specific molecular basis. It was thought to be a rare syndrome, but recent experience suggests that as many as 5% of hyperandrogenic women have this syndrome. Here we report a classical case of HAIR-AN which had an unfortunate outcome because of initial misdiagnosis.
Mediterranean Journal of Nutrition and Metabolism, 2011
In recent years, the role of Vitamin D in extraskeletal tissue has been strongly emphasized. The ... more In recent years, the role of Vitamin D in extraskeletal tissue has been strongly emphasized. The importance of optimizing Vitamin D levels in patients with chronic diseases and for risk reduction of many of those diseases including certain types of cancer is being increasingly recognized. Knowledge of the rapidly emerging, therapeutic and preventive utilities of Vitamin D is suboptimal among the health care providers (HPs). HPs do not regularly evaluate or optimize Vitamin D levels in patients. This study was conducted to explore the awareness, knowledge and attitude of HPs towards the current therapeutic and preventive roles of Vitamin D. A survey of HPs was conducted during the preregistration for a Vitamin D Symposium conducted
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