Ayoub Ali Alshaikh

Background/Objectives: Children and adolescents with type 1 diabetes mellitus (T1DM) may be particularly vulnerable to vitamin D deficiency; however, its association with glycemic control remains incompletely understood. This study aimed to determine the prevalence of vitamin D deficiency among children and adolescents with T1DM and to evaluate its relationship with glycemic control. Methods: This cross-sectional study enrolled individuals aged 1–18 years diagnosed with T1DM. Serum 25-hydroxyvitamin D concentrations were assessed, with deficiency defined as p < 0.001). A strong negative correlation was observed between HbA1c and 25-hydroxyvitamin D levels (Spearman’s ρ = −0.651, p < 0.001). Vitamin D insufficiency was significantly associated with poor glycemic control (aOR = 4.74, 95% CI: 2.48–9.32), while vitamin D deficiency was associated with substantially greater odds (aOR = 40.59, 95% CI: 15.55–129.23). The optimal cut-off for predicting poor control was 26.5 ng/mL, achieving a sensitivity of 75.5% and specificity of 82.2%. Decision curve analysis confirmed that the 25-hydroxyvitamin D model provided superior net benefit compared to treat-all and treat-none strategies across a threshold probability range of 32–85%. Conclusions: Vitamin D deficiency and insufficiency are highly prevalent among children and adolescents with T1DM. Lower 25-hydroxyvitamin D levels are independently associated with poorer glycemic control. Serum 25-hydroxyvitamin D demonstrates good diagnostic accuracy and potential clinical utility for risk stratification. Screening for 25-hydroxyvitamin D status and consideration of supplementation may serve as an adjunctive strategy to support metabolic management in this population.

Background: The impact of Type 1 Diabetes Mellitus (T1DM) on linear growth in children remains unclear, with conflicting evidence regarding the roles of glycemic control, disease duration, and nutritional factors. This study aimed to assess growth patterns and identify factors independently associated with short stature among Saudi school-age children and adolescents with T1DM, comparing them to a healthy control group. Methods: A retrospective cross-sectional study was conducted at an endocrinology clinic, including 250 patients with T1DM aged 5–18 years and 267 healthy controls. After propensity score matching, 231 patients were matched to 231 controls. Data were extracted from electronic medical records using a standardized form. Anthropometric measurements were converted to Z-scores and percentiles using validated Saudi growth charts. Short stature was defined as height below the third percentile for age and gender. Univariate and multivariable logistic regression analyses were performed to identify factors associated with short stature among T1DM participants. Results: The median age of the 250 T1DM participants was 13.0 [10.0–15.0] years, with a slight male predominance (58.0%). Of them, 6 (2.4%) children were tall, 30 (12.0% were short), and 214 (85.6%) were normal. A significantly higher proportion of short stature was observed in the T1DM group compared with the control group (6.1% vs. 1.7%; p = 0.016). Among T1DM participants, the proportion of short stature increased progressively with diabetes duration: 3.0% in new-onset disease, 14.9% in intermediate duration (2–5 years), and 25.0% in long-standing disease (>5 years) (p = 0.001). Age at onset of T1DM was also significantly associated with having short stature (p = 0.036). In multivariable analysis, intermediate duration (adjusted odds ratio [aOR] = 5.72, 95% CI (1.02–32.1); p = 0.047) and long-standing duration (aOR = 11.03, 95% CI: (1.09–111.45); p = 0.042) remained significant independent predictors of short stature. In contrast, glycemic control (HbA1c), vitamin D status, time in range, and treatment adherence were not significantly associated with short stature after adjustment. Conclusions: Children and adolescents with T1DM have significantly lower height percentiles and a higher prevalence of short stature compared to their controls. Diabetes duration is a strong, independent predictor of short stature in this population, with progressively higher risk as disease duration lengthens, regardless of glycemic control status. These findings underscore the necessity of systematic longitudinal growth monitoring, particularly in patients with disease duration exceeding five years, to enable early identification and intervention for those at highest risk of growth impairment.

Background: Euthyroid sick syndrome (ESS) is commonly diagnosed in children during acute metabolic stress such as diabetic ketoacidosis (DKA). Nevertheless, the association of ESS with clinical outcomes has not been fully established. This study aimed to address the association between ESS and duration of hospital stay among pediatric patients presenting with DKA. Methods: This retrospective cohort study included 176 children admitted with confirmed DKA. Baseline clinical, biochemical, and outcome data, including complications and time to discharge, were collected. Kaplan–Meier survival analysis and Cox proportional hazards regression models were used to assess factors associated with duration of hospital stay. Results: Children were classified based on thyroid function tests at admission into ESS (n = 112, 63.6%) and non-ESS (n = 64, 36.4%). Children with ESS were younger [median age 10.0 (6.5–13.5) years vs. 14.0 (11.5–16.0) years; p < 0.001], had lower median weight [31.0 (20.5–44.5) Kg vs. 40.5 (34.5–49.5) Kg; p < 0.001], had lower median BMI [18.0 (16.5–20.0) kg/m² vs. 19.0 (17.5–20.5) kg/m²; p = 0.007), and slightly lower mean pH at admission [7.1 ± 0.1 vs. 7.2 ± 0.1, p = 0.016]. Free T3 (2.4 (2.0–3.4) vs. 5.1 (4.2–5.5) pmol/L), Free T4 (12.0 (10.7–14.1) vs. 14.4 (14.0–16.2) pmol/L), and TSH 1.8 (1.1–2.9) vs. 2.7 (1.7– 3.2) mIU/L) were significantly lower in ESS patients (p < 0.001 for all). Impaired consciousness occurred exclusively in the ESS group (8.9% vs. 0%, p = 0.034). Median hospital stay was longer among ESS patients, with over a quarter hospitalized for ≥5 days (26.8% vs. 0%; p < 0.001). Kaplan–Meier analysis showed significantly prolonged hospitalization for ESS patients (log-rank p < 0.0001). Patients with ESS [hazard ratio (HR) = 0.31; 95% CI, 0.21–0.45; p < 0.001], pediatric intensive care unit admission [HR = 0.49; 95% CI, 0.29–0.83; p = 0.008], moderate DKA [HR = 0.51; 95% CI, 0.30–0.87; p = 0.014], and severe DKA [HR = 0.28; 95% CI, 0.14–0.57; p < 0.001] were associated with prolonged hospital stay. Conclusions: ESS is significantly associated with prolonged hospital stays in children with DKA. Early identification of ESS may help guide monitoring strategies and discharge planning.

Background: Euthyroid sick syndrome (ESS) is a common finding in critically ill patients, including children with diabetic ketoacidosis (DKA). However, its prevalence, specific hormonal patterns, and recovery in the pediatric population remain inadequately characterized. This study aimed to determine the prevalence of ESS in pediatric DKA, characterize its hormonal subtypes, and identify factors associated with short-term thyroid function recovery. Methods: A retrospective cohort study was conducted involving 182 pediatric patients (0–18 years) with type 1 diabetes mellitus admitted for DKA between January 2023 and June 2025. Thyroid function tests (TSH, FT4, FT3) were measured at presentations and two weeks after DKA resolution. ESS was defined using age-specific reference ranges. Results: The prevalence of ESS at DKA presentation was 61.5% (112/182). Two distinct hormonal phenotypes were identified: isolated low FT3 (n = 40, 35.7%) and combined low FT4 and FT3 (n = 72, 64.3%). Patients with the isolated low FT3 pattern were significantly younger (median 9.5 [3.50, 11.00] vs. 12.0 [8.50, 14.00] years, p = 0.004) and had milder hormonal derangement than the combined group. Normalization of FT4 was significantly lower in children with severe DKA compared with those with mild/moderate disease (50.0% vs. 84.8%, p = 0.002). FT3 normalization was also reduced in the severe group (20.0% vs. 42.4%), although this difference did not reach statistical significance (p = 0.078). After 2 weeks, all ESS patients (100%) had achieved normal levels of at least one thyroid hormone, with 38.4% reaching normalization of FT3 and 36.6% achieving normalization of all measured thyroid parameters. Age (adjusted odds ratio [aOR] = 2.08, 95% confidence interval (CI): 1.57–3.06, p < 0.001) and baseline FT4 level (aOR = 2.14, 95% CI: 1.51–3.32, p < 0.001) were positive predictors for complete recovery. Conclusion: ESS is highly prevalent in pediatric DKA, with distinct phenotypic patterns associated with age and the severity of acute illness, particularly the degree of acidosis. While transient in nature, complete biochemical recovery within two weeks is not universal. These findings underscore that thyroid function tests during acute DKA should be interpreted with caution to avoid misdiagnosis of primary thyroid disease, and they support the critical practice of follow-up testing after metabolic stabilization instead of immediate hormone replacement.

Background: Down syndrome (DS) is strongly associated with a high prevalence of thyroid dysfunction. International guidelines recommend regular screening to ensure early detection and management. This study aimed to determine the prevalence, spectrum, and management outcomes of thyroid dysfunction in children with DS in the Aseer region of Saudi Arabia. Methods: A retrospective cross-sectional study was conducted by reviewing the medical records of 106 children with DS from two major healthcare centers: Abha Maternity and Children Hospital and King Khalid University Medical Center. Data on demographics, clinical symptoms, thyroid function tests, autoimmune status, treatment, and follow-up patterns were collected and analyzed. Results: The prevalence of thyroid dysfunction was 52.8%. Subclinical hypothyroidism was the most common disorder (46.4%), followed by autoimmune hypothyroidism (30.4%). Patients with thyroid dysfunction had a significantly higher symptom burden, particularly in metabolic, dermatological, and gastrointestinal domains (p < 0.01). A strong family history of thyroid disease was a significant risk factor (adjusted odds ratio (aOR) = 4.57, 95% CI: 1.89–11.6, p < 0.001). While adherence to screening and follow-up was high (78.0% and 82.1%, respectively), a critical gap was identified in treatment optimization, with 74.4% of patients treated potentially requiring levothyroxine dose adjustment. Conclusions: Thyroid dysfunction is highly prevalent in the Southern Saudi children with DS, with subclinical hypothyroidism and autoimmune hypothyroidism being the most common types. Despite good screening adherence, there is a substantial need for improved treatment titration and long-term management to optimize patient outcomes in this population.

Diabetes mellitus (DM) has a systemic consequence, influencing many systems of the body, including metabolic functions. This study aimed to determine the prevalence of gastrointestinal complications among patients with type 2 DM in the Asser region of Saudi Arabia, identify sources of information, and investigate the association of these symptoms with disease duration and glycated hemoglobin. This cross-sectional study was conducted between November 13 and December 27, 2023. The questionnaire collected demographic data including age, sex, education, employment, income, and nationality, and 16 questions (5 points for each symptom) about the frequency of gastrointestinal symptoms in the past 3 months. The total score was 80, participants were categorized based on their total scores into 2 groups: those scoring 40 or below, and those scoring above 40. A total of 230 patients were included in this study, their median age was 32.0 (24.00) years, 60% were men, 63.9% were married, 38.7% earned between 5000 and 10,000 Saudi Riyal/month, 85.2% did not work in the medical field, 39.1% held university degrees, 54.8% did not have health insurance, 70.4% did not smoke, 35.7% worked in government jobs, 63% lived in urban areas, 95.2% were Saudi and 53.5% had only DM. More than half of the respondents, 57.4%, relied on doctors for information about DM. Dysmotility symptoms were common: dyspepsia affected 26.5% often and 5.7% always; early satiety impacted 24.3% often and 5.2% always; and bloating affected 28.3% often and 10.9% always. Constipation/diarrhea were a common complaint, with 23.5% of patients experiencing them often and an additional 4.8% reporting it always. Stool consistency also varied widely, with 21.7% experiencing lumpy or hardened stool. Health insurance status and having chronic diseases showed significant association with the severity of symptoms. Duration of diabetes and glycated hemoglobin were associated with the frequency of the symptoms. Gastrointestinal symptoms are common among diabetic patients in Aseer. The frequency of symptoms is associated with glycemic control, duration of diabetes, and health insurance status. These findings highlight the need for improved management and support for better gastrointestinal health in diabetes.

Foreign body aspiration (FBA) is a serious preventable pediatric health problem and one of the main causes of accidental death in children. Although unusual in adults, it is often overlooked as a cause of airway obstruction with serious consequences. This study assessed awareness and previous FBA experiences in the Asir community, Kingdom of Saudi Arabia. Using validated questionnaire, an annonymous online survey was conducted among 870 people aged 18 years and above. The questionnaire was used to collect data about the personal and sociodemographic characteristics of the respondents, as well as their experiences with FBA, and participants’ knowledge and perceived seriousness of FBA. The level of knowledge was deemed good if the score ranged between 60% and 100%, and bad if the score fell below 60%The level of knowledge was deemed good if the score ranged between 60% and 100%, and bad if the score fell below 60%. The majority of the participants (79.7%) were females, 48.1% were aged 18 to 30 years, 72.9% had university degree, 30.6% were students, 26.9% worked in the educational sector, 43.6% reported monthly income of P < .001). The findings of this study indicate an urgent need to raise community awareness of FBA. To reduce FBA morbidity and mortality, health education efforts in community and healthcare settings are required to educate people about the seriousness and importance of early diagnosis and management of the condition.

Patients with irritable bowel syndrome (IBS) experience not only a detrimental impact on their physical health but also a significant influence on their psychological well-being. This study aimed to assess the prevalence of IBS among university students, investigating the sociodemographic and lifestyle factors influencing its onset. Furthermore, it explored the potential impact of psychological factors such as depression, anxiety, and overall well-being on the prevalence of IBS. A cross-sectional analytical study was conducted at Saudi Arabian universities in November and December 2023. To collect data, an anonymous, validated, predesigned questionnaire was used. The diagnosis of IBS was carried out using the validated Arabic version of the Rome IV questionnaire. We used the Arabic version of the World Health Organization Well-being Index to assess the participants’ well-being. We used the Arabic version of the Hospital Anxiety and Depression Scale (HADS) to identify people who show clinically significant symptoms of anxiety and depression. Our study included a total of 379 university students, 46.7% were female 86.0% of participants resided in urban areas, and 7.2% had been previously diagnosed with IBS. The prevalence of IBS among participants was found to be 31.9%. We observed a significant association between marital status and IBS ( χ ² = 3.95, P = .047). Furthermore, the highest prevalence of IBS was observed among students majoring in literary and scientific disciplines ( χ ² = 0.952, P = .049). Individuals with IBS demonstrate a significantly higher prevalence of anxiety (71.90% vs 41.09%, P < .001) and depression (64.46% vs 42.64%, P < .001) compared to those without IBS. Furthermore, people with IBS had a slightly higher prevalence of poor well-being (38.84%) compared to those without IBS (33.72%), but this association was not statistically significant. In multivariate analysis, having a family history of IBS [OR = 1.75 (95% CI, 1.06–2.87), P = .029] having borderline anxiety [OR = 7.58, 95% CI (2.12–27.06), P = .012] and anxiety [OR = 16.07, 95% CI (4.57–56.52), P < .001], and depression [OR = 2.97, 95% CI (1.13–7.83), P = .010] were the main significant predictors of IBS among university students. The high prevalence of IBS among university students was associated with a family history of IBS as well as depression and anxiety. Increasing awareness, multidisciplinary support, and access to mental health services is required to ensure university students’ well-being.