Assessment of low vitamin D among Saudi Arabians. Did we overshoot the runway?

To compare the performance of 3 commonly used 25-hydroxyvitamin D [25-OHD] assays among a sample of the Saudi population. This cross-sectional study was carried out between January 2011 and December 2012 at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. After informed consent, blood samples for measurement of 25-OHD level was extracted from 200 adults. The vitamin D level of each individual were determined using chemiluminescence immunoassay [CLIA], radio-immuno assay [RIA], and liquid chromatography-tandem mass spectrometry [LC-MS/MS] assay. Assays were also compared through commonly used cut-points for classification of vitamin D deficiency. Bias between assays was evaluated using Bland-Altman plots. The average age of patients was 45.7 +/- 16.1 years. A significant difference between the assays was found. The mean 25-OHD levels were highest for the LC-MS/MS [21.65 ng/mL, 95% CI 19.74-23.56], intermediate for RIA [16.607 ng/mL, 95% CI 14.87-18.32], and lowest for CLIA method [13.864 ng/mL, 95% CI 12.109-15.618]. Using 30 ng/mL as a cutoff value, only 6% was found to have normal levels of 25-OHD using CLIA, 9% using RIA, and 22% using LC-MS/MS. Levels of 25-OHD and the prevalence of vitamin D deficiency are dependent on the assay used. The reported high prevalence of hypovitaminosis D among the Saudi population can be partially explained by the use of assays that underestimate vitamin D levels

Effect of thrombolytic therapy on the incidence of early left ventricular infarct expansion in acute anterior myocardial infarction

To determine the incidence of early left ventricular infarct expansion within five days after first anterior ST-segment elevation myocardial infarction and the effect of early thrombolytic therapy on the incidence of early infarct expansion compared with late thrombolytic therapy. In a prospective study of 101 patients [75males and 26 females], with the first attack of acute anterior myocardial infarction, their ages ranged from 40-80 years [mean age: 61.07 +/- 10.78] who had been admitted to the Coronary Care Unit of Hawler Teaching Hospital for the period from July 2007 through to September 2009. Those who received alteplase 3-12 hours were labelled as group-II [52 patients]. The incidence of early left ventricular infarct expansion was diagnosed by 2D-echocardiography and was found to be 17.8%. Group I patients had a lower incidence of early left ventricular infarct expansion [8.16%] compared with group-II [26.92%; p=0.014]. Patients with early left ventricular infarct expansion had a higher frequency rate of left ventricular systolic dysfunction [94.44%] compared to patients without early left ventricular infarct expansion [8.43%; p<0.001]. There was a significant difference in the incidence of in-hospital mortality between the patients who developed early left ventricular infarct expansion [11.1%] compared with patients without early left ventricular infarct expansion [1.2%; p=0.025]. Early reperfusion therapy in acute anterior myocardial infarction can decrease the incidence of early left ventricular infarct expansion, preserve left ventricular systolic function and decrease in-hospital mortality

Influence of thrombolytic therapy on early and long term left ventricular systolic function in patients with ST-segment elevation myocardial infarction

Left ventricular systolic dysfunction complicating acute myocardial infarction are responsible for significant morbidity and mortality. This study to assess the effect of thrombolytic therapy on the left ventricular systolic function during the first week and a year after ST-elevation myocardial infarction. In a study of 56 patients with first ST-Segment elevation myocardial infarction [42 men and 14 women; age range, 42-89 years [mean, 61 +/- 10], who had been admitted to the Coronary Care Unit at Hawler Teaching Hospital from May 2008 to May 2009. study done to assess the left ventricular systolic function during the first week and first year after ST-elevation myocardial infarction. Twenty one patients received tissue plasminogen activator [Alteplase] 12 hour after the onset of symptoms labeled as group-I, the remaining patients [35], had no chance to receive thrombolytic therapy labeled as group II. In group I the mean ejection fraction improved significantly from 51.6 +/- 9.4 during the first week to 55.14 +/- 11, P=0.034, at first year after acute myocardial infarction, while in group II there was no significant difference of mean ejection fraction during the first week [45.97 +/- 12.2] and first year of acute myocardial infarction [46.1 +/- 13.2],P=0.5. Thrombolytic therapy has a beneficial effect on left ventricular systolic function detected by echocardiography at the end of the first year of ST-elevation myocardial infarction

Are We Missing Osteoporosis-Related Vertebral Fractures in Men?

STUDY DESIGN: Retrospective study. PURPOSE: To assess the prevalence of osteoporosis related spinal fractures among Saudi Arabian males. OVERVIEW OF LITERATURE: Vertebral fractures are the most common complication of osteoporosis and is the first sign in both sexes and only 25 to 30% of radiographically observed vertebral deformities are recognized. METHODS: We analyzed the chest radiographs of consecutive Saudi Arabian men > or = 50 years and who visited the emergency room of King Fahd University Hospital, Al Khobar, Saudi Arabia for a period of 12 months between November 1, 2007 and October 31, 2008. The site and type of fractures were classified as per the semi-quantitative technique. The other data retrieved from the medical records of patients included medications and clinical investigations for osteoporosis. RESULTS: Nine hundred seventy chest radiographs were performed during the study period and 876 radiographs could be analyzed. One hundred fifteen patients (13.1%) had 157 fractures. The mean age was 67.85 +/- 10.1 years. There was more than one fracture in 21 patients (18.2%). The majority of fractures (n = 102, 64.9%) were observed in thoracic spine. Seventy-one (45.2%) fractures were classified as mild, 54 (34.4%) were moderate and 32 (20.4%) were severe. For 26 (22.6%) patients, the report of the radiologist highlighted the fracture. CONCLUSIONS: Saudi Arabian males with osteoporosis continue to be missed despite the high prevalence osteoporosis leading to vertebral fractures. We believe it is important for physicians to identify vertebral fractures early and treat then appropriately before an extremity fracture occurs with high mortality.

effect of precordial st-segment depression in inferior st-segment elevation myocardial infarction on left ventricular systolic function: two-dimensional echocardiographic study

The importance of precordial ST-segment depression in patients with early inferior ST-segment elevation myocardial infarction remain unclear. Many studies have reported that patients with precordial ST-segment depression appear to have large infarctions. The objectives of this study was to evaluate the effect of precordial ST-segment depression in patients with early inferior ST-segment elevation myocardial infarction on the left ventricular systolic function and left ventricular regional wall abnormalities. Fifty eight patients with first inferior ST-segments elevation myocardial infarction [37 male, 21 femal] their ages ranged from 30-91 year, mean age 60.59 +/- 11.21 who underwent thrombolysis in the Coronary Care Unit of Erbil Teaching Hospital for the period from August 2008 to August 2009 were included in this study. Two-dimensional echocardiography was performed in the first week of acute inferior myocardial infarction. Patients were classified according to the absence [group 1, 30, 51.72%] or presence [group II, 28, 48.28%] of precordial ST- segment depression. Group-ll patients had a higher significant incidence of left ventricular systolic dysfunction [8, 28.57%] than group I [2, 6.67%], P=0.027 .despite thrombolytic therapy [alteplase]. Group-ll patients had higher significant incidence of left ventricular regional wall abnormalities [12, 42.9%] than group-l [3, 10%], P 0.00 .despite thrombolytic therapy [alteplase]. Early two-dimensional echocardiography is recommended for patients with inferior ST-segment elevation myocardial infarction associated with precordial ST-segment depression for the earliest detection of regional wall abnormalities and left ventricular systolic dysfunction

Osteoporosis-related vertebral fractures in postmenopausal women: prevalence in a Saudi Arabian sample

The study aimed to determine hospital-based prevalence of vertebral fractures in postmenopausal Saudi Arabian women. Chest radiographs from consecutive Saudi women over the age of 50 years visiting the emergency room at King Fahd Hospital of the University were evaluated. Of 785 radiographs analysed 159 [20.3%] patients had 198 vertebral fractures. The mean age of the women was 65.7 [SD 8.5] years. In only 37.8% of the radiographs with fractures was a vertebral fracture highlighted in the radiologist's report, and only 13.2% of the women with vertebral fractures were on antiresorptive therapy for osteoporosis

Genetic Markers for Idiopathic Scoliosis in Arab Population: A Pilot Study

STUDY DESIGN: Cross-sectional screening. PURPOSE: This study was conducted to determine if there is any association of the three microsatellite markers on chromosome 19p 13.3 in unrelated Saudi Arabian girls who were suffering with adolescent idiopathic scoliosis (AIS) and their healthy siblings. OVERVIEW OF LITERATURE: The genetic influence on the development of familial scoliosis has been previously described, but the genetic influence on AIS still remains unknown. Three microsatellite markers (D19S216, D19S894, and DS1034) of chromosome 19p 13.3 were reported to be significantly associated with familial scoliosis. This cross-sectional screening was carried out in AIS patients and their siblings. METHODS: For eleven Saudi Arabian girls who were treated for AIS and their 11 siblings, we performed a linkage analysis using parametric and nonparametric methods and using GENEHUNTER ver. 2.1. Multipoint linkage analysis was used to specify an autosomal dominant trait with a gene frequency of 0.01 at the genotypic and the allelic levels. One sided Fisher's exact tests were used in the analysis of the contingency tables for the D19S216, D19S894 and DS1034 markers. RESULTS: The analysis between the patient group and the healthy siblings showed that at the genotypic level there was a significant association of the markers and scoliosis (D19S894 [p=0.036], D19S216 [p=0.004], and DS1034 [p=0.013]). Yet at the allelic level, there was no statistically significant association of the markers between the AIS patients and their siblings. CONCLUSIONS: Our pilot study shows that there is a genetic influence between the AIS patients and the siblings. We believe large scale genetic screening is warranted for the patients with AIS to identify beyond any doubt the influence of these markers.

Clinical measurement of proprioceptive function after anterior cruciate ligament reconstruction

Proprioception is very important for the integrity and stability of the knee joint. Patients with anterior cruciate ligament [ACL] tear have a decline in proprioceptive functions of the injured knee. However, improvement of proprioceptive functions of the knee after ACL reconstruction is a subject of considerable debate. This study was conducted to evaluate the results of a simple clinical proprioception test developed by the author in patients with ACL reconstructed knees. This study was conducted in King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia, from January 1996 to June 2002. The proprioceptive function of the knee joint was studied in a group of ACL reconstructed patients [n=22] and compared them with a group of ACL deficient patients [n=32] and a group of healthy controls [n=30]. Proprioception was evaluated based on the performance in a simple clinical test. There was a significant difference in proprioceptive functions between the ACL deficient knees and the ACL reconstructed group [p<0.05], but there was no significant difference between the ACL reconstructed and the normal control group [p>0.05]. These findings indicate that proprioceptive deficits in ACL deficient knees, as measured clinically using the described test, might improve after ACL reconstruction