Showing papers in "Saudi Medical Journal in 2009"

History of diabetes mellitus.

Abstract: Clinical features similar to diabetes mellitus were described 3000 years ago by the ancient Egyptians. The term "diabetes" was first coined by Araetus of Cappodocia (81-133AD). Later, the word mellitus (honey sweet) was added by Thomas Willis (Britain) in 1675 after rediscovering the sweetness of urine and blood of patients (first noticed by the ancient Indians). It was only in 1776 that Dobson (Britain) firstly confirmed the presence of excess sugar in urine and blood as a cause of their sweetness. In modern time, the history of diabetes coincided with the emergence of experimental medicine. An important milestone in the history of diabetes is the establishment of the role of the liver in glycogenesis, and the concept that diabetes is due to excess glucose production Claude Bernard (France) in 1857. The role of the pancreas in pathogenesis of diabetes was discovered by Mering and Minkowski (Austria) 1889. Later, this discovery constituted the basis of insulin isolation and clinical use by Banting and Best (Canada) in 1921. Trials to prepare an orally administrated hypoglycemic agent ended successfully by first marketing of tolbutamide and carbutamide in 1955. This report will also discuss the history of dietary management and acute and chronic complications of diabetes.

Smoking in Saudi Arabia.

Abstract: This article reviewed the literature on the epidemiology, consumption, trade, control, prevention, and treatment of tobacco smoking in Saudi Arabia. The prevalence of current smoking in Saudi Arabia ranges from 2.4-52.3% (median = 17.5%). Among school students, the prevalence of current smoking ranges from 12-29.8% (median = 16.5%), among university students from 2.4-37% (median = 13.5%), and among adults from 11.6-52.3% (median = 22.6%). In elderly people, the prevalence of current smoking is 25%. The prevalence of smoking in males ranges from 13-38% (median = 26.5%), while in females it ranges from 1-16% (median = 9%). To conclude, smoking is prevalent in the Saudi population at different age groups. The prevalence of current smoking is much higher in males than in females at different ages. More research is needed in the area of prevention and treatment of smoking.

Effect of dexmedetomidine added to spinal bupivacaine for urological procedures.

Abstract: OBJECTIVES To determine the effect of adding dexmedetomidine to bupivacaine for neuraxial anesthesia. METHODS Sixty-six patients were studied between April and May 2008 in the University of Jordan, Amman Jordan. They were randomly assigned into 3 groups, each receiving spinal bupivacaine 12.5mg combined with normal saline (group N) Dexmedetomidine 5 microg (group D5), or dexmedetomidine 10 microg (group D10). The onset times to reach T10 sensory and Bromage 3 motor block, and the regression times to reach S1 sensory level and Bromage 0 motor scale, were recorded. RESULTS The mean time of sensory block to reach the T10 dermatome was 4.7 +/- 2.0 minutes in D10 group, 6.3 +/- 2.7 minutes in D5, and 9.5 +/- 3.0 minutes in group N. The mean time to reach Bromage 3 scale was 10.4 +/- 3.4 minutes in group D10, 13.0+/-3.4 minutes in D5, and 18.0 +/- 3.3 minutes in group N. The regression time to reach S1 dermatome was 338.9 +/- 44.8 minutes in group D10, 277.1 +/- 23.2 minutes in D5, and 165.5 +/- 32.9 minutes in group N. The regression to Bromage 0 was 302.9 +/- 36.7 minutes in D10, 246.4 +/- 25.7 minutes in D5, and 140.1 +/- 32.3 minutes in group N. Onset and regression of sensory and motor block were highly significant (N vesus D5, N versus D10, and D5 versus D10, p<0.001). CONCLUSIONS Dexmedetomidine has a dose dependant effect on the onset and regression of sensory and motor block when used as an adjuvant to bupivacaine in spinal anesthesia.

Prevalence of symptoms and risk of sleep apnea in middle-aged Saudi women in primary care.

Abstract: OBJECTIVES The prevalence of obstructive sleep apnea OSA has not been assessed in Saudi Arabia. We aimed to assess the prevalence of individuals who were at risk of OSA in a sample of middle-aged Saudi males, using the Berlin questionnaire at primary care settings. METHODS The study was conducted at King Khalid University and King Fahd National Guard primary health care clinics in Riyadh, Kingdom of Saudi Arabia between December 2005 and March 2006. Berlin Questionnaire was administered by trained medical students to consecutive Saudi male patients in the age group 30-65 years attending the primary health care clinics, after explaining the procedure of the study. Based on the data collected and defined criteria, patients were stratified into high risk and low risk according to responses. RESULTS Five hundred and seventy-eight middle-aged Saudi males with a mean age of 45.02 +/- 9.3 year were surveyed in this study. Snoring was present in 52.3%, and breathing pauses more than once per week was noticed in 11.3%. Based on the Berlin questionnaire stratification for risk of OSA, 33.3% were considered as high risk patients for OSA. The occurrence of daytime tiredness >once/week was reported by 35.5%. The prevalence of snoring and risk for OSA is similar to that reported in the US. CONCLUSIONS In primary care setting, one in 3 middle-aged Saudi males is at risk for OSA.

Attitudes, knowledge, and practices in relation to cervical cancer and its screening among women in Saudi Arabia.

Abstract: OBJECTIVES To assess the knowledge, attitude, and practices related to cervical cancer screening, and its underlying etiology and preventive measures among women living in the Kingdom of Saudi Arabia. METHODS Six hundred self-administered questionnaires were distributed to randomly selected women from different groups in the general population of Jeddah, Kingdom of Saudi Arabia. These questionnaires were sent out to school teachers, relative, friends, as well as, through direct interview of patients visiting the outpatient clinic while awaiting for their appointments at the King Abdul-Aziz University Hospital from January to March 2008. There were 500 respondents (83.3%). RESULTS The knowledge of the human papilloma virus (HPV) as an etiological agent for cervical cancer was expressed by 72 (14.4%), and the HPV vaccine by 49 (9.8%) of the respondents. Whereas, 338 (67.6%) of the respondents were aware of the Pap smear, however, only 84 (16.8%) had undergone the test. The main reason for not having a Pap smear was the lack of awareness. CONCLUSIONS The awareness on cervical cancer among women in Saudi Arabia is far behind that in the developed countries. There is a need to educate and promote awareness of cervical cancer in this population.

Current practice in the management of patients with type 2 diabetes mellitus in Saudi Arabia.

Abstract: OBJECTIVES To gather data on current practices in the management of patients with type 2 diabetes mellitus (T2DM) in Saudi Arabia and to evaluate the degree of compliance with international guidelines. METHODS This paper represents the results of the Saudi Arabia T2DM data collected at the cross-sectional part of Wave 2006 of the International Diabetes Management Practices Study (IDMPS). Data were collected on a case report form from 28 health centers all over the Kingdom of Saudi Arabia, in the period between 01/12/2006 and 30/12/2006. It included demographic and socioeconomic profile in addition to diabetes management and metabolic control. RESULTS Three hundred and fifty-three Saudi T2DM diabetic patients were studied. The mean age was 51.61+/-10.84 years; average duration of diabetes was 8.25+/-6.49 years; 63-86% had never been screened for diabetes complications or cardiovascular risk factors during the previous year. Of all patients with T2DM, 7% were treated with insulin alone, 28% with oral glucose lowering drug (OGLD) + insulin and 64% with OGLD alone. The average last hemoglobin A1c (HbA1c) was 8.20+/-1.89% and among all patients, only 27% had reached the target HbA1c of <7% while 42% of patients had been considered as reached glycemic control by physicians. Sixteen percent attained the target blood pressure of <130/80, and 65% had lipid profile above the optimal level. CONCLUSIONS The majority of patients did not attain the recommended target glycemic level. This indicates the presence of a gap between recommendations of the international guidelines and the actual practices.

A balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery.

Abstract: OBJECTIVES To evaluate the effect of adding dexmedetomidine to a balanced anesthetic technique on postoperative nausea and vomiting after laparoscopic gynecological surgeries. METHODS A prospective double-blind randomized study was designed at Jordan University Hospital, Amman, Jordan between December 2008 and February 2009. Eighty-one female patients in their child-bearing age (17-48 years); American Society of Anesthesiologists (ASA) clinical status I, who were scheduled for elective diagnostic laparoscopic surgeries under general anesthesia were divided into 2 groups. Group D (n=42) received dexmedetomidine infusion, while group P (n=39) received 0.9% sodium chloride infusion along with the balanced anesthesia. The incidence of early (up to 24 hours) postoperative nausea, vomiting, nausea and vomiting, and the need for postoperative rescue anti-emetic medications were recorded. RESULTS The total incidence of postoperative nausea and vomiting decreased significantly in group D; 13 out of 42 patients (31%), compared to group P; 23 out of 39 patients (59%), vomiting alone did not significantly change, the incidence of postoperative nausea, and the use of rescue anti-emetic medications were significantly different. A significant drop in overall consumption of fentanyl and sevoflurane was also noted in group D. CONCLUSIONS Combining dexmedetomidine to other anesthetic agents, results in more balanced anesthesia and a significant drop in the incidence of postoperative nausea and vomiting after laparoscopic gynecological surgeries.

Vitamin D deficiency in Saudi patients with systemic lupus erythematosus.

Abstract: OBJECTIVES To determine vitamin D status among Saudi patients with systemic lupus erythematosus (SLE) versus matched control group METHODS Hospital-based cohorts of 165 SLE patients and 214 SLE-free volunteers were recruited at King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia between January 2006 and June 2008 Serum levels of 25-hydroxyvitamin D [25(OH)D] were measured Vitamin D sufficiency is defined as a serum level of 25(OH)D >75 nmol/L (>30 ng/ml) A level ranging between >50 to 20 to <30 ng/ml) is considered as vitamin D insufficiency, whereas <50 nmol/L (<20 ng/ml) as vitamin D deficiency Both deficiency and insufficiency are considered to comprise vitamin D inadequacy RESULTS The prevalence of SLE patients with 25(OH) D inadequacy and deficiency was higher than in the control group: 988 versus 55%, 897 versus 20% (p<00001) Only 2 (12%) SLE patients had adequate levels of 25(OH)D compared to 96 (45%) of control group (p<00001) The mean serum levels (nmol/L) of 25(OH)D in SLE patients with vitamin D inadequacy and deficiency in comparison to the control group were 223 +/- 136 versus 445 +/- 175 (p<00001) and 191 +/- 95 versus 229 +/- 67 (p=00152) No significant differences were evident in female and male patients with SLE with respect to the mean serum levels of 25(OH)D and prevalence of its deficiency CONCLUSIONS Vitamin D inadequacy is highly prevalent in Saudi patients with SLE Vitamin D supplementation and its evaluation in the treatment of SLE should be considered

Prognostic factors in adult granulosa cell tumor of the ovary.

Abstract: OBJECTIVES To determine the clinicopathologic prognostic factors in adult granulosa cell tumors (GCTs) of the ovary. METHODS This retrospective study was carried out over a period of 10 years (1995-2005) in the Gynecology Department of Shengjing Hospital, China Medical University, Shenyang, China. Forty-six patients with GCT were enrolled in this study. Demographic data, pathologic findings, treatments, and survival time were reviewed and analyzed for prognostic significance. RESULTS It was found that International Federation of Gynecology and Obstetrics (FIGO) stage (p=0.0003), presence of nuclear atypia (p=0.036), and increased mitoses (p=0.002) were the 3 factors that impacted significantly on survival. Age, residual tumor disease, parity, and size of the tumor had no significant effect on survival. The only factor associated with risk of recurrence was rupture of the tumor (p=0.038). Patients who received chemotherapy had a better median disease-free survival than those who did not (105 versus 78 months), however, this did not reach statistical significance (p=0.080). CONCLUSIONS The FIGO stage, nuclear atypia, and increased mitoses are the statistically significant prognostic factors, and may be used for selecting patients for adjuvant therapy. A prolonged follow-up is necessary due to risk of recurrences, late, and exceptional for the adult ovarian GCT, especially when the tumor ruptured before, or at operation.

Idiopathic granulomatous mastitis.

Abstract: OBJECTIVES To discuss the clinical and radiological features and treatment approaches in 14 patients diagnosed with idiopathic granulomatous mastitis (GM). METHODS We retrospectively evaluated the clinical features, radiological findings, and treatment approaches in 14 patients with idiopathic GM in the General Surgery Department, Gulhane School of Medicine, Ankara, Turkey between April 2000 and June 2006. RESULTS The mean age of the patients was 34.5 years (range 27-41 years). The complaints at admission were a mass in the breast in 7 (50%) patients, an abscess and a mass in 6 (42.8%), and a skin fistula in one (7.2%). Granulomatous mastitis was unilateral in all subjects (on the right in 5 patients and on the left in 9). All of the patients underwent ultrasonographic evaluation. Mammography was performed in 8 and magnetic resonance imaging in 5 patients. Seven patients (50%) were suspected to have breast carcinoma according to radiological findings. We performed large excision in 11, incisional biopsy plus abscess drainage in one, and incisional biopsy plus abscess drainage plus medical treatment (prednisolone, methotrexate) in 2 patients. Due to the development of abscess after 9 months, drainage and large excision were also performed in one patient who received medical treatment. CONCLUSIONS Idiopathic GM is a disease that generally affects young women of reproductive age and may be mistaken for breast carcinoma in clinical and radiological evaluations. The gold standard for the diagnosis is histopathologic evaluation.

Bibliometric analyses of biomedical research outputs in Lebanon and the United Arab Emirates (1988-2007).

Abstract: OBJECTIVES We assessed the role of bibliometric methods in representing quantitative and qualitative differences in biomedical research outputs in Lebanon and the United Arab Emirates (UAE). METHODS Data on biomedical research productivity for years 1988-2007 were obtained from PubMed then imported into a specifically designed local database system and normalized to the population size for each country. RESULTS Data reveal a continuous increase in research production in Lebanon, whereas a plateau phase is observed in the UAE between 1998 and 2007. In Lebanon, most of the citations originated from the capital city of Beirut, mainly the American University of Beirut. Detailed analysis of biomedical research objectives in Lebanon indicate a focus on internal medicine, anesthesiology, surgery, transplantation, medical genetics, pediatrics, obstetrics, neoplasms, and pain management. In the UAE, most of the biomedical publications originate from Al-Ain University. Detailed analysis of biomedical research objectives in the UAE indicate developed interest in pediatrics, obstetrics, clinical dysmorphologies, transplantation, dermatology, diabetes, and consanguinity. CONCLUSIONS Biomedical research outputs quickly recovered in Lebanon following a long war (1974-1992) mainly supported by uninterrupted activities in private higher education institutes. In the UAE, the plateau phase for biomedical research output size could be due to the limitation of most of the research in the country to Al-Ain University. This situation may only improve when other institutes offering biomedical programs engage also in research activities.

Correlation between serum 25 hydroxy vitamin D3 and laboratory risk markers of cardiovascular diseases in type 2 diabetic patients.

Abstract: OBJECTIVES To determine the association between vitamin D deficiency and cardiovascular risk markers among diabetic patients. METHODS This was a cross-sectional study conducted in Ghaem Hospital, Mashhad, Iran, from December 2007 to March 2008 in 119 type 2 diabetic patients. Coronary, cerebrovascular, and peripheral vascular diseases were confirmed. Blood biochemical parameters including laboratory risk markers of cardiovascular disease were determined. Serum 25 hydoxy (OH) D was measured during winter. The correlation between vitamin D deficiency and cardiovascular prevalence, and also laboratory variables was determined. RESULTS The mean age of patients was 55.3 +/- 11.2 years. The mean 25(OH) D concentration was 32.4 +/- 21.6 ng/ml. The prevalence of hypovitaminous D was 26.1% among the diabetic patients. The difference with the control group was not significant (p=0.12). Overall, 36 (30.3%) patients were positive for coronary vascular disease (CVD). The correlation between hypovitaminous D and CVD was not significant (p=0.11). Patients with vitamin D deficiency had significant differences in body mass index (p=0.003), metabolic syndrome (p=0.05), high sensitive C-reactive protein (p=0.009), microalbuminuria (p=0.04), and glumerular filtration rate (p=0.02), compared to patients with sufficient vitamin D. The fasting blood sugar, glycosylated hemoglobin, lipid profiles, homocysteine, uric acid, and insulin resistance were not related to vitamin D deficiency. CONCLUSIONS There is an association between hypovitaminous D and inflammatory markers that contributed to CVD, so vitamin D may be important in maintaining cardiovascular health.

Distribution of ABO blood groups and rhesus factor in Southwest Saudi Arabia.

Abstract: OBJECTIVES To document the distribution of the ABO and rhesus (Rh) blood groups in a random sample of Saudi students from the King Khalid University, Abha, Kingdom of Saudi Arabia, and to compare our results from that of other studies in the Kingdom and elsewhere. METHODS The subjects included in this study were 944 males from the southwest region of Saudi Arabia including Aseer, Jizan, and Najran regions. The ABO blood groups and Rh factor from 944 Saudi males were determined. The frequency of ABO blood groups and Rh status were calculated separately. This study was carried out at King Khalid University, Abha, Kingdom of Saudi Arabia, from January to March 2008, and the ethical approval was obtained from the Research Ethical Committee, College of Science, King Khalid University. RESULTS The frequencies of ABO groups showed 56.8% for group O, 33.4% group A, 6% group B and 3.8% group AB trend. Only 7.2% of them were found to be Rh-negative. CONCLUSIONS The frequencies of ABO and Rh phenotypes in the southwest population of Saudi Arabia are similar to those reported in most areas of the Arabian Gulf region.

Berberine and total base from rhizoma coptis chinensis attenuate brain injury in an aluminum-induced rat model of neurodegenerative disease.

Abstract: OBJECTIVES To investigate the protective effects of the total base from rhizoma coptis chinensis (CTB) and berberine (Ber) on neurodegeneration induced by aluminum overload in rats. METHODS The study took place in the Department of Pharmacology, Chongqing Medical University, Chongqing, China, between February 2005 and May 2007. Wistar rats were divided into control group, model group, Ber-treated group, CTB (55 mg/kg and 110 mg/kg)-treated group, and nimodipine-treated group (n=20). A rat brain damage model was established via intragastric administration of 400 mg/kg element aluminum once a day, 5 days a week for 12 weeks. The CTB, Ber, and nimodipine were intragastrically administered 4 hours after each aluminum administration for 12 weeks. The morphological changes of the neurons of the rat hippocampus and the changes of rat learning and memory functions were observed. The superoxide dismutase (SOD), choline acetyltransferase (ChAT), acetylcholinesterase (AchE), and monoamine oxidase-B (MAO-B) activities and malondialdehyde (MDA) content, as well as the MAO-B expression in the rat brain were examined. RESULTS The CTB, Ber, and nimodipine significantly improved the learning and memory ability impairment and hippocampal neuronal death. The CTB, Ber, and nimodipine also significantly blunted the decrease of SOD and ChAT activities, and the increase of MDA content, AchE activities, and MAO-B expressions and activity in the aluminum-overload rats. CONCLUSIONS The CTB and Ber have protective effects on neurodegeneration induced by aluminum overload. The CTB (110 mg/kg) has more powerful neuroprotection than Ber.

Molecular characterization of methicillin-resistant Staphylococcus aureus recovered from outpatient clinics in Riyadh, Saudi Arabia.

Abstract: OBJECTIVES To examine the recovered strains phenotypically, by conventional methods and genotypically by polymerase chain reaction (PCR), for direct detection of Staphylococcus aureus (S. aureus) 16S ribosomal Ribonucleic Acid (rRNA) gene (which serves as an internal control) and mecA gene. Secondly, introduce multiplex PCR targeting at the same time S. aureus 16S rRNA, Panton-Valentine Leucocidin (PVL), and staphylococcal cassette chromosome mec (SCCmec) type IV. METHODS Thirty-seven strains of S. aureus collected in 2007 from outpatient clinics in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, were tested in the College of Pharmacy phenotypically by conventional methods and genotypically by PCR for direct detection of S. aureus 16S rRNA and mecA genes. All the 37 strains, were tested also by multiplex PCR targeting at the same time S. aureus 16S rRNA, PVL, and (SCCmec) type IV. RESULTS Polymerase chain reaction detected all the 37 bacteriologically positive S. aureus (100%) and the mecA gene in all strains phenotypically resistant to methicillin (100%), at the same time it detected the mecA gene in 2 strains phenotypically sensitive to methicillin. Only 3 strains (8.1%) recovered from skin and soft tissue infections were positive for PVL and SCCmec type IV. CONCLUSIONS The PCR assay can be used for rapid detection of S. aureus and mecA gene. At the same time the multiplex PCR assay explained in this study is a rapid, sensitive, and reliable test for direct detection of community-acquired methicillin-resistant S. aureus.

Dexmedetomidine as a substitute for remifentanil in ambulatory gynecologic laparoscopic surgery.

Abstract: OBJECTIVES To compare dexmedetomidine with remifentanil in desflurane based ambulatory gynecologic laparoscopic surgery, in respect to its effects on orientation, discharge time, nausea-vomiting, and postoperative analgesic need. METHODS Sixty 20-40 year old ASA I-II patients undergoing gynecologic laparoscopic surgery were randomized into 2 groups. This study was performed in the operating theaters of the Hacettepe University Faculty of Medicine, Hacettepe, Turkey in 2004 as a prospective, randomized, and double blinded study. The remifentanil group (group R), and dexmedetomidine group (group D) received a bolus of 1 microg/kg over 10 minutes, followed by 0.2 microg/kg/minute peroperative infusion of remifentanil, and 0.4 microg/kg/hour of dexmedetomidine. Hemodynamic parameters, time to extubation, and to orientation to person, place, and date, postoperative nausea, vomiting, pain, analgesic requirement at home, and satisfaction with anesthesia were recorded. RESULTS Demographic, hemodynamic data, postoperative pain scores, and discharge time were similar in both groups. Time to extubation, to orientation to person, to place and date were shorter in group R. Postoperative nausea, vomiting, and analgesic requirements at home were less in group D. CONCLUSIONS This study demonstrated that dexmedetomidine infusion causes a relatively slow recovery with reduced postoperative nausea, vomiting, and analgesic requirements, and similar hemodynamics compared to remifentanil in ambulatory laparoscopic surgeries. It may be an alternative to remifentanil in ambulatory anesthesia.

The effect of dietary supplementation of Nigella sativa L. on serum lipid profile in rats.

Abstract: OBJECTIVES To investigate the effect of oral treatment of Wistar albino rats with different doses of Nigella sativa L (NS) powdered seeds on the levels of serum lipids METHODS This study was performed in the Medical Science Application and Research Center of Dicle University, Diyarbakir, Turkey, from February 2003 to December 2008 A total of 75 Wistar albino male rats, 60 of them with NS supplementation and 15 animals acting as controls, were included in the study The NS groups were divided into 4 main groups of 15 each Four doses of NS were used (100, 200, 400, and 600 mg/kg/day) Each dose group was further divided into 3 duration subgroups of 5 rats each, the feeding of NS seeds continued for one, 2, and 4 weeks Control animals were divided into 3 main groups of 5 rats each The rats were sacrificed at one, 2, and 4 weeks after feeding Lipid parameters were measured RESULTS Rats treated with the 400mg dose for one week's duration showed a significant increase in high-density lipoprotein-cholesterol levels There was a significant decrease in low density lipoprotein-cholesterol levels after one week for 400 and 600 mg doses, and all doses after 2 weeks and 4 weeks for 200 and 600 mg doses when compared to control groups There was a significant decrease in very low-density lipoprotein-cholesterol levels after one week for 200, 400, and 600 mg doses, and all doses for 2 and 4 weeks A 400 mg dose for 2 weeks, and all doses for 4 weeks caused a significant decrease in triglyceride levels There was a significant decrease of total cholesterol levels in all doses after 4 weeks of NS feeding CONCLUSIONS These results indicate that NS may ameliorate the alteration in the lipid levels caused by diseases or toxic agents

Comparison of preoperative computerized tomography scan imaging of temporal bone with the intra-operative findings in patients undergoing mastoidectomy.

Abstract: OBJECTIVES To compare the consistency rates of pre- and intra-operative radiological findings in patients with chronic suppurative otitis media (CSOM). METHODS In a cross-sectional study, 80 patients with CSOM underwent pre-operative CT scanning and we compared the results with intra-operative clinical findings during mastoidectomy from 2000-2004 in the Otology Department, Amiralmomenin Hospital of Guilan Medical University, Rasht, Iran. Sensitivity, specificity, positive and negative predictive value of CT scan in tympanic and mastoid cholesteatoma, ossicular chain erosion, tegmen tympani erosion, dehiscence of facial canal, lateral semicircular canal (LSCC) fistula were assessed. Then, correlation between radiological findings and intra-operative findings were calculated. RESULTS The mean age of the patients was 27.9 +/- 16.3 years. Mostly were males (n=57 [71.3%]). Correlation of preoperative radiological images with intra-operative clinical findings were moderate to good on tympanic cholesteatoma, mastoid cholesteatoma and ossicular chain erosion, but weak and insignificant in cases of tegmen tympani erosion, facial canal dehiscence and LSCC fistulae. CONCLUSIONS Preoperative CT scan may be helpful in decision-making for surgery in cases of cholesteatoma and ossicular erosion. Despite of limitations radiological scanning is a useful adjunct to management of CSOM.

Uninvestigated dyspepsia and its related factors in an Iranian community

Abstract: OBJECTIVES To determine the prevalence and determinants of uninvestigated dyspepsia in the Iranian population. METHODS A cross-sectional study conducted in Tehran province from May 2006 to December 2007, included 18,180 adult persons selected randomly. The study took place at Shahid Beheshti University, MC, Tehran, Iran. A questionnaire was completed in 2 steps. In the first part, personal characteristics and 11 gastrointestinal symptoms were inserted. Those who reported at least one of these 11 symptoms were referred for the second interview, which consisted of questions on different gastrointestinal disorders based on Rome III criteria, including uninvestigated dyspepsia. RESULTS The prevalence rate of uninvestigated dyspepsia was 8.5% (10.9% in women and 6.4% in men). Among the subjects diagnosed with dyspepsia, bothersome postprandial fullness was the most common symptom (41.5%). Uninvestigated dyspepsia was more common in low educated and widowed participants. Approximately 41.4% of patients had a history of depression, and 66.1% had self report of stress. The prevalence of functional irritable bowel syndrome in patients with uninvestigated dyspepsia was 8.3% and gastroesophageal reflux disease was 64.9%. CONCLUSIONS Uninvestigated dyspepsia has a less common prevalence in the general Iranian population than developed countries. Women, older, obese, widowed, and low education subjects are more likely to suffer from dyspepsia.

Quality of life in people with epilepsy and their family caregivers. An Arab experience using the short version of the World Health Organization quality of life instrument.

Abstract: OBJECTIVES To assess the subjective quality of life (QOL) of Sudanese epilepsy patients with generalized tonic clonic seizures and their family caregivers, compared with the general population, and previous Sudanese data for chronic conditions, and to examine the predictors of QOL. METHODS This cross-sectional study using the World Health Organization's 26-item QOL instrument, was carried out from December 2005 to December 2006, on consecutive government hospital Neurology Clinic attendees and their family caregivers, who fulfilled the study's inclusion criteria, in the cities of Khartoum, Wad Medani, and Atbara, Sudan. RESULTS There were 276 patients (56.5% male; mean age 29.5 years). Patients' QOL scores were significantly lower (physical health domain [57.1%], psychological [60.1%], social relations [58.4%], environment [50.6%], and general facet [60.8%]), than the control group. They scored lower than the WHO 23-country patients for social relations and environment domains, and had lower environment domain scores than Sudanese diabetes patients. Caregivers had significantly higher scores (57.4 -73.7%) than patients and control group. Patients' higher QOL was associated with marriage, education, employment, no side effects and caregiver occupation. Caregivers had lower QOL if they were female, patients' own children, and less educated. The predictors of QOL included caregiver's proxy rating of the patient's QOL and drug side effects. CONCLUSIONS Poor QOL in epilepsy reflects social underachievement, and calls for programs to remedy their psychosocial circumstance, and improve service provisions. Vulnerable caregivers need to be identified for assistance, to enhance their role.

Prevalence and clinical characteristics of tori and jaw exostoses in a teaching hospital in Jordan.

Abstract: OBJECTIVES To determine the prevalence and clinical characteristics of oral bony outgrowths (OBOs); torus palatinus (TP), torus mandibularis (TM), and exostoses in Jordanian dental patients. METHODS This cross-sectional study was conducted between November 1 and December 31, 2008 at the University of Jordan Hospital, Amman, Jordan. Clinical examinations of 618 patients (354 men and 264 women), 10-82 years of age, were conducted to determine the presence of OBOs. RESULTS There were 239 subjects (38.7%) who had OBOs. Nearly one-third (34.6%) had TP, TM, or both. The prevalence rates were 25.7% for TM, 15.4% for TP, and 14.4% for exostoses. The OBOs were mostly noted in patients in their fifth decade of life, with attrition, clenching, or bruxism. Women had more TP, but gender differences were not statistically significant in cases of TM and exostoses. Most TP were large in size (71.6%), spindle (41.1%), or flat (40%) in shape, and located at the premolar-molar region (45.3%). The TM were mostly medium to large in size (84.9%), bilateral (81.1%), composed of single node (69.2%), and located at the premolar region (65.4%). Of the studied subjects, 7.1% had mandibular buccal exostosis, 10% had maxillary buccal, and 2.4% had palatal exostoses. Statistically significant associations were noticed between the concurrent existence of OBOs. CONCLUSIONS A relatively high prevalence of OBOs was noted, and this should be taken into consideration when planning periodontal surgery and prosthodontic treatment.

The healing effects of Teucrium polium in the repair of indomethacin-induced gastric ulcer in rats.

Abstract: OBJECTIVES To determine the healing effect of Teucrium polium (T. polium) in indomethacin-induced gastric ulcer in rats. METHODS In the fall of 2007, 250 Sprague-Dawley rats provided by the Shiraz University Laboratory Animal Center were divided into 4 equal groups including control (70 rats), and 3 experimental groups (60 rats each), and each group received different doses of T. polium. Ten rats were used to study the induction of gastric ulcer by indomethacin (25 mg/kg/stat). After 24 hours, their stomachs were evaluated for any mucosal ulcer. The T. polium extract was administered orally, 24 hours after indomethacin administration. In the experimental group, 10 animals were sacrificed after 24, 48, and 72 hours, after administration of T. polium, and at one, 2, and 4 weeks, and in the control group identically after the administration of distilled water. RESULTS In rats treated with indomethacin, multiple ulcers were evident. After 4 weeks of treatment with T. polium, more re-epithelialization, proliferation, mucosal hyperplasia, migration of the gastric epithelial cells, and decrease in inflammatory cells were observed. The T. polium reduced the ulcer indices by >50% after one week, >80% after 2 weeks, and >90% after 4 weeks. CONCLUSIONS The healing effect of T. polium may be due to antioxidant activity along with the ability to modulate the mucin secretion, prostaglandin synthesis, and epidermal growth factor receptor expression. These results along with the non-toxicity properties of T. polium suggests it as a promising anti-ulcer compound.

Frequency and antimicrobial susceptibility of gram-negative bacteria isolated from 2 hospitals in Makkah, Saudi Arabia.

Abstract: OBJECTIVES To estimate the prevalence and antibiotic susceptibility of the gram-negative bacteria isolated from 2 hospitals in Makkah. METHODS This study was undertaken in 2 main tertiary care hospitals namely; Al-Noor Specialist Hospital, and Hera Hospital in Makkah, Kingdom of Saudi Arabia from October 2005 to March 2006. A total of 1137 gram-negative bacteria were identified in non-duplicate clinical specimens obtained from 965 patients of various body sites infections. Demographic data, identity of microorganisms, and antimicrobial susceptibilities were obtained from medical and laboratory records. RESULTS The most prevalent gram-negative bacteria were Escherichia coli (31.6%), and Pseudomonas aeruginosa (31.2%), followed by Acinetobacter baumannii (10.8%), Klebsiella pneumoniae (8.3%), Klebsiella sp. (6.2%), Haemophilus influenzae (3.7%), Proteus sp. (3.3%), and Enterobacter sp. (1.9%). Results demonstrated that gram-negative bacteria have a high rate of resistance to commonly used antibiotics. Furthermore, multi-drug resistance was also common in this study. CONCLUSIONS Our data showed a high rate of resistance among gram-negative pathogens in comparison with other countries in the world. The implementation of monitoring programs is an important part of the prevention strategy against the development of antibiotic resistance in hospitals.

Secondary malignancies in ovarian dermoid cyst.

Abstract: OBJECTIVES To review our local experience with mature cystic ovarian teratoma, and describe our treatment modality regarding this uncommon condition. METHODS The databases of the Sydney Gynecologic Oncology Group at Royal Prince Alfred and Liverpool Hospital, Sydney, Australia, were reviewed from 1987 to 2007. A retrospective chart review, and analysis of patient's data were conducted. RESULTS Eleven cases of ovarian dermoid cyst with secondary malignancy were identified. Six out of eleven (54.5%) of the cases were carcinoid tumor, 4/11 (36%) squamous cell cancer, and one case (9%) transitional cell carcinoma. The median age of cases was 47 years (range of 28-74). Stage I-II was recorded in 8/11 (73%) of the cases, while stage III-IV was found in 3/11 (27%). The initial treatment ranged from unilateral cystectomy to hysterectomy, and bilateral salpingo-oophorectomy, and debulking surgery. All patients with stage I disease showed more than 5 years survival (100%). The survival for late staged disease (III-IV) ranged from 2.5 months to 18 months with an average of 8 months. CONCLUSIONS Carcinoid tumor is the most common malignancy noticed. Survival is related mainly to tumor stage, and optimal debulking procedure. However, further studies are needed to study the effect of other factors on survival.

Association between thyroid hormones, insulin resistance, and metabolic syndrome

Abstract: OBJECTIVES To determine the association between thyroid hormones, insulin resistance, and metabolic syndrome in euthyroid women. METHODS Forty-five women with no past medical history were studied in this cross-sectional study at the Department of Endocrinology, Medwin Hospitals, Hyderabad, India, from August 2008 to September 2008. The body fat was estimated using bio-impedance method, and fasting blood sample was analyzed for total triiodothyronine (T3), total thyroxine (T4), thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), lipid profile, insulin, and glucose. RESULTS The mean age of the participants was 32.6 +/= 9.6 years with a body mass index (BMI) of 29.9 +/= 3.8 kg/m2. Evidence of homeostasis model assessment index for insulin resistance (HOMA-IR) more than 3 was seen in 34 (75%) and metabolic syndrome in 29 (64%) participants. Total T3 showed a positive correlation with triglycerides, low density lipoprotein- cholesterol (LDL-C), total cholesterol, insulin, HOMA-IR and negatively with body fat. Thyroid-stimulating hormone correlated positively with BMI, insulin, HOMA-IR, LDL-C and negatively with HDL-cholesterol (p<0.05). Free triiodothyronine correlated positively with waist circumference and T4 did not correlate with metabolic syndrome parameters. CONCLUSIONS Our preliminary data show an association between thyroid hormones and some components specific of the metabolic syndrome in euthyroid women. Total triiodothyronine and TSH correlated more with variables of metabolic syndrome than FT3 and T4.

The effects of resveratrol and tannic acid on apoptosis in colon adenocarcinoma cell line.

Abstract: OBJECTIVES To investigate the effects of resveratrol and tannic acid on apoptosis, and Bcl-2 homologous antagonist/killer (Bak) and fas associated death domain (FADD) proteins in the CaCo-2 cell line. METHODS In the present study, resveratrol and tannic acid were administrated in the CaCo-2 cell line at doses of 25, 50, and 100 microM. The CaCo-2 cells were grown and cultured in the Medical Biology Department, Eskisehir Osmangazi University, Eskisehir, Turkey in 2007. The effects of these agents on apoptotic index were determined by Apop Taq peroxidase kit and their effects on the ratios of Bak and FADD proteins by the immunohistochemical staining method at 24, 48, and 72 hours. Stained and non-stained cells in 30 separate areas of the 3 separate chamber slides, prepared for each group, were counted. The percentage of apoptosis, and Bak and FADD proteins was calculated with the control. Mean +/- standard error values were calculated for the 3 experiments. RESULTS Apoptotic index, Bak protein percentage ratio, and FADD protein percentage ratio values in all groups that received tannic acid and resveratrol increased when compared within the groups. This increase was found to be time and dose independent in all parameters. CONCLUSIONS Cells undergo apoptosis in 2 pathways (mitochondrial and death receptor) in resveratrol and tannic acid induced CaCo-2 cells.

Airway allergy and skin reactivity to aeroallergens in Riyadh.

Abstract: OBJECTIVES To determine the pattern of skin prick test reactivity to aeroallergens in patients with asthma and rhinitis (airway allergy) residing in Riyadh region. METHODS This is a retrospective cross sectional study based on data analysis of skin prick test results of individuals with clinical diagnosis of airway allergy.Allergy skin prick test result data of 139 Saudi nationals from Riyadh region tested at King Khalid University Hospital between January 2003 and March 2004 was analyzed retrospectively. This group comprised of 53% females and 47% males, with a mean age of 27 +/- 12 years. A set of aeroallergens extracts for both indoor and outdoor allergens including fungal spores was used to test the patients. RESULTS Seventy-five percent (105) of patients reacted to one or more allergen extracts. The most frequently reacting indoor allergen was house dust mite (77.8%) followed by the cat (33.6%) and cockroach (19.2%). Among the outdoor allergens Prosopis juliflora was tested positive in 72.1%, Bermuda grass in 53.8%, Chenopodium album in 47.1%, Rye grass in 36.5% and Salsola kali in 36.5%. A significant proportion of patients were also found reacting to Moulds (18.2%) and Aspergillus fumigatus (18.2%) extracts. CONCLUSIONS Sensitivity to one or more aeroallergens was common in patients, indicating high level of aeroallergen sensitization in patients with airway allergy residing in Riyadh region.

Effectiveness of Ankaferd blood stopper in the topical control of active bleeding due to cutaneous-subcutaneous incisions.

Abstract: OBJECTIVES To assess the effectiveness of Ankaferd blood stopper (ABS) in the topical control of bleeding due to cutaneous/subcutaneous incisions. METHODS We included in this study, 69 patients with cancer that were admitted for port insertion to the Emergency Department of Gaziantep University Hospital, Gaziantep, Turkey, between May and July 2008. We used the wet compress form of ABS in 37 patients (group I), and regular dry sterile sponges in 32 patients (group II), to stop the bleeding that occurs during the clinically indicated vascular port insertion in patients with cancer. The success rate in terms of bleeding control, time needed to stop the bleeding, recurrence of bleeding, and complications were recorded. RESULTS A total of 69 patients were included in this study. The average time needed to stop the bleeding was 32.97 +/- 29.9 seconds for group I, and 123.75 +/- 47.5 seconds for group II. Bleeding restarted in 24% in group I, and in 50% in group II. Among the patients in group I, 13.5% developed localized redness, and 8.1% minor swelling, while 8.1% reported local pain at the wound site; in 5.4% of the patients, the sutures at the wound site opened. The same parameters were recorded for group II; 9.4% for localized redness, 0.0% for minor swelling, 6.2% reported local pain, and the sutures at the wound site opened in 3.2% (p=0.592). CONCLUSIONS The Ankaferd blood stopper was proven to stop local bleeding in a shorter time, with a lower recurrence rate in comparison with the sterile sponge.

Effects of trace elements on albumin and lipoprotein glycation in diabetic retinopathy.

Abstract: OBJECTIVES To test the effect of some trace elements, on protein and lipoprotein glycosylation and their impact on the severity of diabetic retinopathy. METHODS A case control study was conducted in 42 diabetic patients (14 without retinopathy [DC]; 14 with non-proliferative diabetic retinopathy [NPDR]; 14 with proliferative diabetic retinopathy [PDR]) at Ebin Al-Haitham Specialized Hospital, Baghdad, Iraq for Ocular Diseases from February to December 2008. In addition to 20 age and gender matched healthy controls (NC). The glycation of albumin, alpha-, pre beta-, and beta-lipoproteins was measured by agarose gel electrophoresis. Serum levels of cadmium (Cd), selenium (Se), chromium (Cr), zinc (Zn), and copper (Cu) were analyzed by flameless atomic absorption spectrophotometer. RESULTS There was significant elevation in the mean serum glycated beta-lipoprotein in DC (p<0.05) and a near significant increase (p=0.06) in the means of both glycated albumin and pre beta-lipoproteins among the PDR and NPDR groups. Moreover, a significant reductions in serum means of Cd (p<0.05) and Zn/Cu ratios (p<0.001) were recorded in all diabetic retinopaths as compared to DC. The Cd level rises with the increase in duration of diabetes (p<0.001) and hyperglycemia (p<0.025) whereas, the serum Cr values decreases with the progression of diabetes (p<0.025). CONCLUSIONS Both glycation and oxidative processes are involved in the development of diabetic retinopathy, and changes in the concentration of Cd, Se, Cr, Zn, and Cu have some impact on the disease progression.