Ibrahim Al Alwan

Objective: This study aimed to assess the prevalence, diagnostic accuracy, and inpatient management of pediatric weight abnormalities at a tertiary children's hospital in Riyadh, Saudi Arabia, using a retrospective cohort design. Methods: The study analyzed medical records of pediatric inpatients aged 2–14 years admitted to King Abdullah Specialized Children's Hospital (KASCH) in 2023. Data collected included anthropometrics, dietary history, physical activity, diagnostic workup, and treatment plans. Overweight and obesity were classified using BMI percentiles, while FTT was identified via weight-for-age and growth percentile criteria. Descriptive statistics were used to analyze diagnostic accuracy and factors influencing missed diagnoses. Results: Of 7,771 admissions, 760 patients (9.6%) had weight abnormalities: 60.3% with FTT, 24.2% obese, and 15.5% overweight. FTT was more accurately diagnosed (38%) than obesity (28%) or overweight (13%). Documentation of dietary intake was detailed in only 9.6% of cases; physical activity and screen time were universally undocumented. Obese children more frequently underwent metabolic testing and were referred to endocrinology, while FTT patients often received high-calorie formulas and follow-up with dietitians. Logistic regression revealed age group and dietary history documentation were significantly associated with diagnostic accuracy (p < 0.05). Conclusion: The study highlights underdiagnosis of overweight and obesity, suboptimal documentation practices, and inconsistent inpatient management of pediatric weight disorders. Despite standard anthropometric measurements, weight abnormalities are often overlooked during acute hospital care. FTT receives comparatively more clinical attention, while overweight and obesity remain underrecognized.

Background: Type 2 diabetes (T2D) is a growing health concern among adolescents, driven by rising obesity rates. Early identification of prediabetes, particularly impaired fasting glucose (IFG), can guide interventions to reduce long‐term risks. Despite the global burden of diabetes, limited data exist on Saudi adolescents, a population experiencing high rates of obesity. Objective: To determine the prevalence and associated factors for IFG in a representative sample of Saudi adolescents. Methods: We conducted a cross‐sectional analysis on a subgroup of participants from the national Jeeluna study (2011–2012), which sampled adolescents aged 10–19 years from all 13 regions of Saudi Arabia. Anthropometric measurements, fasting plasma glucose levels, and lifestyle data were collected. Dysglycemia (IFG or diabetes) was defined using American Diabetes Association (ADA) criteria. A logistic regression analysis was conducted to identify factors associated with dysglycemia. Results: The study included 5,421 participants (50.8% females; mean ± SD age was 15.9 ± 1.8 years). Prevalence of dysglycemia was 4.8% (IFG: 4.1%; diabetes: 0.7%). Dysglycemia was more prevalent in obese adolescents (8.2%) compared to overweight (4.8%) and nonobese/nonoverweight peers (4.1%), p < 0.0001. Regional differences were noted with the highest prevalence in Mecca (6.1%). Compared with nondysglycemic patients, those who were dysglycemic had higher proportion of individuals consuming fast food meals per week ( p = 0.03), body mass index (BMI) ( p < 0.0001), tri‐ponderal mass (TMI) ( p < 0.001), waist‐to‐height ratio ( p = 0.001) and systolic BP ( p < 0.001) and lower triglycerides ( p < 0.0001). Factors independently associated with dysglycemia included systolic BP (OR = 1.03; 95% CI 1.01–1.04, p < 0.0001), triglyceride levels (OR = 1.60; 95% CI 1.27–2.00, p < 0.0001) and geographical region (Mecca OR = 1.54, 95% CI 1.07–196, Riyadh OR = 0.61,95% CI 0.42–0.89, p < 0.001, compared with other regions combinedly). Conclusion: Our study highlights the prevalence of dysglycemia (4.8%) among Saudi adolescents, particularly in those with obesity. Risk factors included higher BMI and increased fast food consumption. Notably, regional differences were observed, with Mecca reporting the highest prevalence. Our findings underscore the need for targeted interventions in obesity, focusing on promoting healthy lifestyles and early screening for T2D in this vulnerable population.

Background: Managing severe insulin resistance (IR) is challenging, necessitating a multifaceted approach, including dietary restriction, exercise, and pharmacotherapy. This paper will detail our utilization of dapagliflozin in a series of cases involving patients with severe IR of various etiology and inadequate glycemic control. Case Studies: We describe six cases of extreme IR with distinct clinical diagnoses: four with Rabson–Mendenhall syndrome (RMS), one with IR type 1A, and a patient with type 1 diabetes mellitus (T1DM) and severe subcutaneous (SC) IR. These cases exhibit the observable characteristics of IR, characterized by an inability to effectively manage blood glucose (BG) with a standard treatment plan. Every case had a remarkable response to dapagliflozin. Subsequent assessment demonstrated improved HgbA1C, fasting glucose, insulin, and C‐peptide concentrations. Furthermore, several cases demonstrated improvement in the clinical manifestations of IR following the administration of dapagliflozin, while others showed a reduction in the frequency of diabetic ketoacidosis (DKA). There were no documented adverse reactions with the use of dapagliflozin for a duration of 2–4 years in these patients. Conclusion: Dapagliflozin appeared both safe and effective as a standalone treatment or when used alongside other antidiabetes medications such as insulin in a case series of children with T1DM and severe IR or IR syndromes (IRS).

Background: Congenital Adrenal Hyperplasia (CAH) is a chronic disease that requires lifelong treatment. Patients may face stigmatization, which may affect their quality of life (QoL). Therefore, we assessed the clinical characteristics and QoL of patients with CAH in the Middle East.Methods: This case-control study included patients with CAH aged >5 years from two tertiary centers (2020–2021). The patients were matched to a healthy control group and were then divided into pediatric and adult groups. Data were collected from their electronic medical records. Additionally, the EQ-5D-5L QoL questionnaire was completed by both the patients and control group to assess five domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression).Results: The study included 248 patients with CAH (females: 58.8%), with a family history of the condition (57.3%) and/or parental consanguinity (68.1%). The most frequently reported gene defect was CYP21A2, while the most commonly reported symptoms/signs were ambiguous genitalia and obesity. Almost all female patients had received corrective surgery. The questionnaire response rate was 86.3% (n=214/248). The CAH patient group’s mean total QoL score was 85.2 compared with 99.8 in the control. Further, CAH patients had lower QoL scores in all domains compared to those in the control group (p ≤ 0.0001–0.0023). The pain/discomfort and anxiety/depression domains were affected significantly more than the other domains were, with 47.7% and 44.4% participants, respectively, p<0.0001. Additionally, obesity was found to be a predictor of reduced mobility following a logistic regression analysis (p ≤ 0.04, OR (0.18-0.98)).Conclusion: Patients with CAH reported lower QoL overall, particularly in the pain/discomfort and anxiety/depression domains. Based on this, we recommend the early involvement of psychologists in a multidisciplinary team approach, pre-marital screening, and the implementation of awareness programs for people diagnosed with CAH in communities with high consanguineous mating.

Objective. Puberty has a significant contribution to the final height. Therefore, it is crucial to understand the normal variations in the onset and tempo of puberty in a specific population. In this study, we aimed to provide normative data on the timing of puberty and late pubertal height (LPH) in Saudi schoolboys in Riyadh. Methods. This is a cross-sectional field study (20112013) including Saudi schoolboys (grades 112; aged 6 to 19 years). Schools were chosen to represent the population from urban and rural areas in the Riyadh region. Pubertal maturity staging for gonads was assessed by measuring testicular size using a Prader orchidometer and assessing the Tanner staging of pubic hair. The marginal mean age was calculated using regression analysis. Results. We recruited 1086 schoolboys. The estimated mean age of pubertal onset at G2 was 11.8 (95 CI 11.6012.0) years, for gonadal development at G3 was 13.2 (95 CI 12.913.5), G4=15.0 (95 CI 14.715.2), and G5=16.1 (95 CI 15.916.3) years, and for pubic hair stage 2 (PH2) was 12.6 (95 CI 12.412.9) years. The estimated time from G2/PH2 to G5/PH5 was 4.3 and 3.9years, respectively. At the onset of puberty, the mean height was 144.7cm and it reached 167.8cm at G5 with a pubertal height gain of 23.1cm. Conclusion. Our data present the norms of the timing of puberty and LPH in Saudi schoolboys. Saudi adolescent males are shorter than some European and American comparatives mainly due to shortness during childhood. However, they could have shorter LPH than Turkish, Greek, Thai, and Japanese due to a less pubertal height gain.

Vitamin D intoxication (VDI) usually develops due to inappropriate use of vitamin D in high doses by the families of infants with complaints suggestive of vitamin D deficiency such as delayed teething, knock knees, or delayed walking. We present here an experience of treating an infant with asymptomatic VDI that had a prolonged course of recovery and a sustainable level of vitamin D over a follow-up period of 2.5 years. In our patient, vitamin D started to drop steadily after a month of stopping vitamin D supplements but not to a normal level. It reached an acceptable level only after six months. This case emphasizes the importance of educating parents about the empirical use of vitamin D over the counter, assessing the baseline level of serum vitamin D level prior to initiation of treatment and highlights the value of verifying additional dietary sources of vitamin D or oral supplements in patients history.

Our research shows that the newborns of vitamin D–deficient mothers have higher serum alkaline phosphatase (ALP) activity compared with those of vitamin D–non-deficient mothers, which is likely related to increased bone turnover rather than just being a marker for bone formation. This has a potential negative impact on fetal bone development and subsequent skeletal growth.

Poor patients have greater morbidity and die up to 10 years earlier than patients who have higher socio-economic status. These findings are often attributed to differences in life-style between groups. The present study aimed at investigating the extent to which physicians contribute to the effect by providing relative poorer care, resulting in relative neglect in terms of time spent with a poor patient and more inaccurate diagnoses. A randomised experiment with 45 internal medicine residents. Doctors diagnosed 12 written clinical vignettes that were exactly the same except for the description of the patients’ socio-economic status. Each participant diagnosed four of the vignettes in a poor-patient version, four in a rich-patient version, and four in a version that did not contain socio-economic markers, in a balanced within-subjects incomplete block design. Main measurements were: diagnostic accuracy scores and time spent on diagnosis. Mean diagnostic accuracy scores (range 0–1) did not significantly differ among the conditions of the experiment (for poor patients: 0.48; for rich patients: 0.52; for patients without socio-economic markers: 0.54; p > 0.05). While confronted with patients not presenting with socio-economic background information, the participants spent significantly less time-to-diagnosis ((for poor patients: 168 s; for rich patients: 176 s; for patients without socio-economic markers: 151 s; p < 0.01), however due to the fact that the former vignettes were shorter. There is no reason to believe that physicians are prejudiced against poor patients and therefore treat them differently from rich patients or patients without discernible socio-economic background.

To estimate age at menarche and to assess trends in menarcheal age among Saudi women. A prospective longitudinal study was conducted among healthy prepubertal female school children and adolescents from September 2006 to July 2012 in Riyadh, Kingdom of Saudi Arabia. Study participants were invited from diverse socioeconomic backgrounds. Tanner stage, height, weight, body mass index, and socioeconomic parameters including parent's level of education were collected. Age at menarche was compared with maternal age at menarche. The study included 265 girls and mothers. Mean±standard deviation (SD) age at menarche for girls was 13.08 ± 1.1 years, and their distribution category across the ≤10 years was 4 (1.5%), 11-14 years was 239 (90.2%), and ≥15 years was 22 (8.3%) girls. Anthropometric measurements, mother's level of education, and family income were not statistically significant determining factors associated with age at menarche. Mean ± SD age at menarche for mothers was 13.67 ± 1.4 years, and their distribution category across the ≤10 years was 7 (2.6%), 11-14 years was 172 (64.9%), and ≥15 years was 86 (32.5%). Girls attained menarche at younger age compared with their mothers (p less than 0.0001). A downward secular trend in age of menarche was observed (Cuzick test for trend = 0.049). Saudi girls attain menarcheal age earlier than their mothers, reflecting a downward secular trend in menarcheal age.

Turner syndrome (TS) is a common genetic disorder caused by abnormalities of the X chromosome. We aimed to describe the phenotypic characteristics of TS patients and evaluate their association with presenting clinical characteristics and time at diagnosis. We studied females diagnosed with TS at King Abdul Aziz Medical City (KAMC), Riyadh between 1983 and 2010. Patients were classified based upon karyotype into females with classical monosomy 45,X (group A) and females with other X chromosome abnormalities (mosaic 45,X/46,XX, Xqisochromosomes, Xp or Xq deletion) (group B). Clinical features of the two groups were analyzed. Of the 52 patients included in the study, 16(30.8%) were diagnosed with classical monosomy 45,X and the rest with other X chromosome abnormalities. Only 19(36.5%) patients were diagnosed in infancy and the remaining during childhood or later (odds ratio (OR) = 4.5,95%CI 1.27-15.90, p=0.02). Short stature was universal in group A versus 77.8% in group B. All patients in group A had primary amenorrhea compared with 63.2% of those in group B (P = 0.04); the rest of group B had secondary amenorrhea. Cardiovascular abnormalities were higher in group A (OR=3.50, 95%CI 0.99-12.29, p-value =0.05). Renal defects and recurrent otitis media were similar in both groups. This study suggests that karyotype variations might affect the phenotype of TS; however, it may not reliably predict the clinical presentation. Chromosomal analysis for all suspected cases of TS should be promptly done at childhood in order to design an appropriate management plan early in life.