Type 2 diabetes mellitus (T2DM) increases the risk of coronary thrombosis and both conditions are associated with altered fibrin clot properties. However, the influence of T2DM on fibrin clot properties in patients with coronary artery disease (CAD) remains unclear. We aimed to investigate the influence of T2DM on fibrin clot properties in patients with CAD. Fibrin clot structure and fibrinolysis were investigated in 581 CAD patients (148 with T2DM) using turbidimetric assays, confocal and scanning electron microscopy. Clots made from plasma and plasma-purified fibrinogen were studied, and plasma levels of inflammatory markers were analysed. T2DM patients had increased clot maximum absorbance compared with non-diabetic patients (0.36 ± 0.1 vs 0.33 ± 0.1 au; p=0.01), displayed longer lysis time (804 [618;1002] vs 750 [624;906] seconds; p=0.03) and showed more compact fibrin structure assessed by confocal and electron microscopy. Fibrinogen levels were elevated in T2DM (p< 0.001), but clots made from purified fibrinogen showed no differences in fibrin properties in the two populations. Adjusting for fibrinogen levels, T2DM was associated with C-reactive protein and complement C3 plasma levels, with the former correlating with clot maximum absorbance (r=0.24, p< 0.0001) and the latter with lysis time (r=0.30, p< 0.0001). Independent of fibrinogen levels, females had more compact clots with prolonged lysis time compared with males (all p-values< 0.001). In conclusion, T2DM is associated with prothrombotic changes in fibrin clot properties in patients with CAD. This is related to quantitative rather than qualitative changes in fibrinogen with a possible role for inflammatory proteins.

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Background The enhanced thrombotic milieu in diabetes contributes to increased risk of vascular events. Aspirin, a key antiplatelet agent, has inconsistent effects on outcomes in diabetes and the best dosing regimen remains unclear. This work investigated effects of aspirin dose and interaction with glycaemia on both the cellular and protein components of thrombosis. Methods A total of 48 participants with type 1 diabetes and 48 healthy controls were randomised to receive aspirin 75 or 300 mg once-daily (OD) in an open-label crossover study. Light transmittance aggregometry and fibrin clot studies were performed before and at the end of each treatment period. Results Aspirin demonstrated reduced inhibition of collagen-induced platelet aggregation (PA) in participants with diabetes compared with controls, although the higher dose showed better efficacy. Higher aspirin dose facilitated clot lysis in controls but not individuals with diabetes. Collagen-induced PA correlated with glycaemic control, those in the top HbA1c tertile having a lesser inhibitory effect of aspirin. Threshold analysis suggested HbA1c levels of > 65 mmol/mol and > 70 mmol/mol were associated with poor aspirin response to 75 and 300 mg daily doses, respectively. Higher HbA1c was also associated with longer fibrin clot lysis time. Conclusions Patients with diabetes respond differently to the antiplatelet and profibrinolytic effects of aspirin compared with controls. In particular, those with elevated HbA1c have reduced inhibition of PA with aspirin. Our findings indicate that reducing glucose levels improves the anti-thrombotic action of aspirin in diabetes, which may have future clinical implications. Trial registration EudraCT, 2008-007875-26, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2008-007875-26.

The vaccination campaign against COVID-19 is an essential public health strategy to reach herd immunity, eradicate diseases, and prevent a pandemic. This study aimed to investigate the acceptance rate of the COVID-19 vaccine among people in Riyadh, Saudi Arabia. This cross-sectional study was conducted in the Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Out of the 922 participants involved, 294 (31.9%) were male and 628 (68.1%) were female, with a mean age of 30–49 years. A bilingual, self-administered, computer-based questionnaire was designed and distributed through social media platforms. In total, 900 participants (97.6%) showed a high acceptance rate of the vaccine. The vaccine acceptance rate was higher among people aged 60 years and above than in other age groups (p = 0.008) and single individuals compared to other groups (p = 0.003). The results reveal a relatively high acceptance level of the COVID-19 vaccine among study participants. Importantly, regression analysis results show that female gender and elderly participants are more likely to accept the COVID-19 vaccine than their counterparts. Moreover, the main factor that influenced the participants’ perception of the COVID-19 vaccine was the proper timely scientific recommendations.

Background: One of the well-known and indisputable facts; is that sleep is an essential physiological necessity. Representing one-third of the average human lifetime, it is considered a behavioural and physiological component of human physiology. This study was conducted to measure the association between sleep quality, stress, and academic performance among pre-clinical and clinical medical students. Methods: A cross-sectional study was conducted on undergraduate medical students at King Saud University, and a computer-based questionnaire was used in interviewing students. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), stress was assessed using the Kessler psychological distress scale (K10), and academic performance using grade point average (GPA). Results: Among the studied subjects, 76.9% of the participants reported poor sleep quality, and 63.3% reported a high level of stress. Poor sleep quality was significantly associated with elevated mental stress levels (P &lt; 0.001). In addition, the multivariable stepwise binary logistic regression showed that poor sleep quality and stress were significantly associated with students&apos; academic performance. Conclusion: Poor sleep quality was highly associated with stress. Furthermore, both poor sleep quality and stress were significantly associated with students&apos; academic performance. Poor sleep quality and high stress were more prevalent amongst clinical medical students; lastly, virtual learning improved students&apos; stress and sleep quality.

Background and Objectives: Folic acid (FA) is a necessary ingredient for numerous bodily activities including pregnancy. Because of this, women should have knowledge and awareness of the health benefits of FA supplementation. Thus, we aimed to investigate the level of knowledge on the importance of FA and determine associated factors for knowledge among female college students at King Saud University in Riyadh, Saudi Arabia. Material and Methods: We conducted a cross-sectional study using a questionnaire between January 2020 and February 2021 among female college students aged 17 to 26 years old. The questionnaire adapted with permission from Alnaami et al. included questions on the demographic profile of the participants as well as questions related to their knowledge and awareness of FA, FA supplementation, the importance of supplementation and their sources of knowledge of FA. Results: A total of 437 female undergraduate students participated in the study, 285 (65.2%) of whom were from the non-health colleges and 152 (34.8%) from the health colleges. The majority of participants were between ages 17 and 21 years old (n = 361, 82.6%). Half of the respondents were in their 3rd and 4th year of study (n = 122, 50.8%), 138 respondents (31.6%) were married, and 111 of these married women (80.4%) had children. There were 266 respondents (61.0%) who had heard and had knowledge of FA, 241 (55.3%) knew of FA timing of intake, 243 (55.7%) of FA duration of intake and 362 (83.0%) knew of the diseases prevented by FA supplementation. Linear regression analysis showed that being in the health college (B = 1.464, t = 11.37, p < 0.001, 95% CI = 1.211, 1.717) and a higher educational year level (B = 0.139, t = 2.442, p = 0.015, 95% CI = 0.027, 0.251) were the significant predictors of knowledge of FA. Conclusions: Knowledge of FA and FA supplementation was low at 61% considering that our study population were college students. Being enrolled in a health college and in a higher educational year level were significant positive correlates of higher knowledge of FA and FA supplementation. Despite this, there exists a gap of information regarding FA and FA supplementation particularly among single women and college educated women in the early years of their college life as well as those in non-health colleges.

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