The present state of complementary medicine regulation in Saudi Arabia / 中西医结合学报

The prevalence of use of traditional and complementary medicine in the Saudi Arabia population has reached 75%. The most used therapies are religious healing, herbal medicine and cupping therapy. The National Center for Complementary and Alternative Medicine is the Saudi national reference for all activities regarding complementary medicine. This article briefly highlights the current state of complementary medicine regulation in Saudi Arabia.

Knowledge, attitude and practice of patients with type 2 diabetes mellitus towards complementary and alternative medicine / 中西医结合学报

<p><b>OBJECTIVE</b>The use of complementary and alternative medicine (CAM) is relatively common among patients with type 2 diabetes mellitus (T2DM) around the world. Like many other countries, Saudi Arabia has a high incidence of T2DM, and incorporates the use of CAM in its treatment. This study explores the knowledge, attitude and practice (KAP) of CAM therapies among patients with T2DM and explores the relationships between sociodemographics and the KAP of CAM modalities.</p><p><b>METHODS</b>This is a hospital-based, observational, cross-sectional study that selected 302 outpatients with T2DM, from Diabetic Center of King Salman bin Abdul-Aziz Hospital, in Riyadh city, in May 2014. Patients were interviewed using a predesigned questionnaire.</p><p><b>RESULTS</b>The mean age of patients was (51.6 ± 10.6) years and 43.4% of them were males. The prevalence of CAM practices was 30.5%; 30.39% of them used herbs, 20.58% used wet cupping and 17.64% used nutritional supplements and other therapies. The factors found to predict the use of CAM therapies among patients with T2DM were: age above 51 years, unemployment and the participants± knowledge about the effectiveness of CAM products.</p><p><b>CONCLUSION</b>This preliminary study estimated the prevalence of CAM use, revealed positive attitude towards CAM and found three significant predictors of CAM use among patients with T2DM, which is consistent with regional data. A community-based research with a larger sample that targets T2DM population is needed in Saudi Arabia.</p>

Comparison between ligasure vs. clamp-and-tie technique in total thyroidectomy for benign multilnodular goiter. A prospective randomized study

Introduction: LigcaSure [Valley Lab, CO, USA] is a bipolar diathermy system that seals vessels with reduced thermal spread. The device has been used successfully in abdominal surgery and has been introduced as a new method for haemostasis during thyroidectomy. This study compares the efficacy and advantages of LigaSure, when used for thyroidectomy in benign nodular thyroid disease, with the conventional clamp-and-tie technique

Methods: 60 patients underwent total thyroidectomy [30 with the conventional clamp-and-tie technique and 30 with LigaSure]. The main outcomes measured were age, sex, operating time, postoperative hypocalcaemia, recurrent laryngeal and nerve palsy, statistical analysis consisted of the chi-squared test and Student's t-test

Results: The mean operating time was significantly shorter in the LigaSure group [115.00 +/- 13.20 vs 88.83 +/- 11. 50 minutes; P=0.00]. Bleeding during surgery was significantly lower in the LigaSure group [118 +/- 15.33 ml vs. 69. 17:11:15 ml P=0.0]. There were no significant differences between the study groups in terms of postoperative hypo-parathyroidism or recurrent laryngeal nerve palsy

Conclusion: The LigciSure vessel sealer is a safe, effective alternative for thyroid surgery that reduces the overall operating time and operative blood loss, however, its higher cost is a significant limiting factor for its use in surgery

use of overnight pluse oximetry and phoniatrics parameters in the screening protocol of obstructive sleep apnea

Obstructive sleep apnea-hypopnea syndrome [OSAHS] is a major public health problem due to its high prevalence rate. Polysomnography is the current golden standard test for diagnosis of OSAHS. The studies with pulse oximetry reveal a high sensitivity and suggest that as a screening tool, these may exclude some patients with negative studies from further work-up for OSAHS. Acoustic analysis of snoring sounds would offer the advantage of a non-invasive technique that would be used to monitor normal sleep. The posterior vocal tract resonances [i.e. F1 and F2] of OSA patients would yield lower frequency values compared to non-OSA individuals. To determine the sensitivity and specificity of overnight oximetry and phoniatrics parameters in evaluation of OSAHS and to compare the results with those obtained from polysomnography [PSG] as the gold standard test. Twenty patients, were presented with presumptive clinical diagnosis of OSAHS, each patient was subjected to: Full history taking: including age, sex, complain and Epworth Sleepiness Scale [ESS]. Systemic examination: Including general examination and body mass index [BMI]. Standard ENT examination and fibroptic pharyngoscopy with Muller maneuver. Polysomnography was done using RESMED Apnea Link screening device. Other tests: Acoustic analysis of voice and acoustic analysis of snoring sounds using computerized speech lab [CSL]. Pulse oximetry: The overnight oximetry was analyzed using the Wrist Pulse Oximeter MD300W. Eighteen patients [90%] were found to have OSAHS and two patients [10%] were simple snorers. The sensitivity of overnight pulse oximetry for an apnea hypopnea index of >5, >15, and >30/h was 66.7%, 80%, and 100% respectively and the specificity was 50%. The formant frequencies of different vowels [i, u and a] in OSA patients and non-OSA snorers revealed that the mean F1 value for the vowel /i/ was significantly lowered in OSA patients. In addition, the mean F2 value of the vowel /i/ and /u/ was markedly lowered in OSA patients. There was significant increase in values of bandwidths [BW1 and BW2] for /i/ and /u/ vowels in OSA patients in comparison to non-OSA snorers. Acoustic analysis of snoring sounds revealed that; in the palatal snorers group, the average pitch was 105 +/- 8 Hz and in the tongue base snorers group the average pitch was 263 +/- 17 Hz; meanwhile the average pitch in the combined group was 160 +/- 14 Hz. The difference was highly significant between the 3 groups. However harmonic to noise ratio was increased in patients with tongue base obstruction. Polysomnography is the current golden standard test for diagnosis and evaluation of degree of OSA. Overnight pulse oximetry offers an inexpensive method of screening for and diagnosing OSAHS. Oximetry alone allowed confident recognition of moderate and severe cases of OSAHS. Acoustic analysis of snoring sounds and voice in patients with snoring and/or OSAHS is useful as a screening or supportive method with other investigations to diagnose the site of upper airway obstruction during sleep

Serum cystatin C in advanced liver cirrhosis and different stages of the hepatorenal syndrome

The hepatorenal syndrome [HRS] is classified into two types [HRS-2 and HRS-1] based on mild or high serum creatinine elevations. Although it has been identified as an early marker of renal dysfunction, data are lacking about cystatin C across the wide range of renal changes in end-stage liver disease. This study investigates serum cystatin C and creatinine in patients with advanced liver cirrhosis and classic HRS throughout its whole spectrum. Serum cystatin C immunonephelometric measurements were obtained from 65 Child-Pugh C patients: 32 with normal creatinine, 17 with HRS-2 and 16 with HRS-1. The glomerular filtration rate [GFR] was estimated according to modification of diet in renal disease [MDRD] and the Hoek formulae [creatinine- and cystatin C-based, respectively] with staging of renal dysfunction severity into an increasing order from 1 to 5. Early HRS was identified by the raised cystatin C in 56.3% of patients having normal creatinine. Cystatin C correlated significantly with creatinine in HRS-2 [r = 0.74; p < 0.001] and showed a significantly lower multiplication ratio [folds of rise] compared to creatinine in HRS-1 patients [p < 0.01]. There was no satisfactory agreement between MDRD and Hoek GFR staging [k = 0.29]. The 'early' HRS identified by a rise in cystatin C in cases with advanced cirrhosis was found to be common and can be added to the already classified two types, as type-3 HRS. Compared to creatinine, cystatin C provides no better information in HRS-2, and underestimates the renal deterioration in HRS-1. Further studies are required to determine the course of the early HRS

Self learning package versus traditional learningon communication skills of medical surgical nursing students

Nursing education is oriented toward equipping nursing students with knowledge and skills about communication through traditional and non-traditional learning. Self-learning package is a self contained learning activity that allows learners to progress at their own pace. was to evaluate the effect of self learning package versus traditional learning on communication skills, design and implementation a self- learning package and evaluate its effect on the students, communication skills. self- learning package will improve the communication skills.of the students nurses in the clinical areas than the traditional learning [Lecture]. the study was conducted in classroom and nursing skills laboratory at faculty of Nursing, Ain Shams University, as well as, Ain Shams University Hospitals. The total number of the students was 200 students-. They were divided into two equal groups, group A [100 students] was the lecture group and group B [100 students] was the self learning package group. Data were collected through questionnaire sheet about communication, observational checklists about communication, and student's opinionnaire sheet. Results of this study concluded that there were highly statistically significant differences among the students in group A [Lecture] as compared with the students in group B [Self-learning package] regarding knowledge, practice and student opinions. The students were more satisfied with using self-learning package than lecture in learning communication skills. The study concluded that self learning package improved the knowledge and skills of communication among student's nurses in the study group B than the study group A [traditional lecture]. The study recommended that educators must focus their efforts on developing a variety of strategies and learning alternatives so that each student can select those through which he/she can obtain the most productive learning strategies and non-traditional methods of teaching should be used in teaching the nursing students

Nutritional evaluation of some different formula using as a diet for lacto-vegetarian

Four types of formula were prepared from vegetable protein and milk products were evaluated using chemical score and biological methods. Forty adult male albino rats Sprague Dawley strain weighing 80-90gm were divided into five group's eight rats each. The first group was control fed casein diet at standard level, while the second group and the third fed formula containing [brand 1 and brand 2] respectively at 14% protein level while the forth and fifth groups of rats fed a formula containing [brand 3 and brand 4] respectively at the same level of protein. Food and water were provided ad libitum during 6 weeks of experiment after that all animals were sacrificed under ether anesthesia and blood sample were taken and organs were removed and washed in saline solution then dried and weighed. Serum were separated and subjected to biochemical analysis. The results revealed that chemical score was higher in the formula of [brand 4] while methionine was the first limiting amino acid in the all formula and control. The highest food intake and changes in body weight were found in the group of rats fed [brand 4]. No significant differences in hemoglobin and hematocrit values than control group; also total serum protein was not significant between groups, while serum albumin showed significantly higher [p<0.01] than control in group of rats received [brand 2 and brand 4] however no significant differences in globulin between all groups and control group. However serum urea and uric acid were significantly higher [p<0.01] than control in group of rats fed [brand 3]

Violence against women and the role of the governmental institutes to prevent it

1- The results show that about half of the ladies that had been married and in the reproductive age were subject to violence since they were 15 years old and that one of five ladies were subjected to violence during the last year of survey and their husbands are the main cause of this violence and with a less rate for mothers, fathers and brothers. 2- Body violence is considered the most spreading where one third of the ladies that had been married and were subject to body violence at least once from current marriage or the last, also 18% of the ladies were subject to violence during the last year of survey. 3- The result shows that about 18% of the ladies that had been married and subject to physically violence, also 10% of them had been subject to violence lately, 7% of the ladies stated that their husbands has forced them to have sex and that 4% of them were forced lately to it even. 4- The result shows that half of the ladies agreed that their husbands has all the reasons and right to hit his wife in any cause of this following: If she burnet the food, if she argued with him, if she went out without his permission, if she were careless to the kids or if she refused to have sex, also 17% of the ladies believe that there is a good reason for beating due to the five reasons above. 5- The percentage of acceptance of beating the ladies increases in the rural areas compared to the urban areas, especially ladies living in rural Upper Egypt. 6- Also, Women in the lowest wealth quintile were more than three times as likely to consider wife beating to be justified for at last one of the reasons as women in the highest wealth quintile [74%, 23% respectively]

Outcome of parathyroidectomy for primary hyperparathyroidism in Sohag university hospital in 5 years: retrospective study

Primary hyperparathyroidism [PHPT] is a common endocrine disease treated very effectively by surgery. It is the commonest cause of hypercalcaemia. The majority of cases are caused by adenoma [80% to 85%], whereas approximately 15% have diffuse hyperplasia of all four parathyroidglands. Rarely [1%], parathyroid carcinoma is the cause of hyperparathyroidism. Parathyroid diseases has not been investigated in our community before. This study had been conducted to analyze the outcome of surgical treatment of [PHPT], as regard the success rate, complications and recurrence. Between May 1999 and July 2004, 14 consecutive patients with [PHPT], who had been submitted to surgery in Sohag University Hospital were enrolled in this study. Analysis of clinical presentations, laboratory and imaging studies, surgical approach, intraoperative findings, and outcome assessment m terms of success rate, complications had been done. A total number of 14 patients diagnosed as PHPT, 10 were women and 4 were men. Their age ranged from 25-51 years, with a mean age of 41.2 +/- 6.9 years. Bone affection was the dominant presenting feature [79%]. All cases showed high level of serum calcium [mean 3.13 +/- 0.42 mmol/L] and parathormone hormone [mean 787.4 +/- 256.6 pg/mL]. Accuracy of ultratsound scanning of the neck was 71% in localization of parathyroid lesions, while that of CT and Sestamibi scan were 85% and 87.5% respectively. A single parathyroid adenoma was the commonest lesion [86%]. All patients, but two, had been followed up from 6 months to 18 months with a mean of 11 +/- 4 months. The success rate was achieved in all but one [92.9%], who had been found to be an ectopic parathyroid adenoma in the superior mediastinum. There was one case who died due to the morbid general medical condition. Postoperative temporary hypocalcaemia was observed in two cases. No permanent injury to RLN was reported in our cases. Parathyroid disease is not uncommon problem in our locality. Surgery of PHPT is a very successful operation with minimal morbidity. Early discovery of PHPT gives the best chance of cure and avoid disastrous complications of this disease

Transition from open to laparoscopic nissen fundoplication

We reviewed Nissen Fundoplication performed from January 2000 to January 2005, encompassing our transition from open to laparoscopic procedures. Records of 33 consecutive patients were reviewed. From year 2000 to 2005, all patients whom suffering from gastro esophageal reflux disease [GERD] and were in need for surgical interference were classified into two groups. First group operated upon by open fundoplication [n= 20]. Second group operated upon laparoscopically [n=13]. Mean operating time for laparoscopic cases was 143 +/- 20 minutes compared with 90 +/- 20 minutes for open cases [P<0.05]. Intraoperative complication rate was similar in both laparoscopic and open group [15%]. Length of hospitalization was shorter for patients who underwent laparoscopic surgery [2.2 days versus 7.2 for open procedures, P <0.05]. In follow-up, 80% of the laparoscopic group was asymptomatic compared with 70% of the open group. In patients who had the open procedure, 15% had wound complications. None of those treated laparoscopically had any complications at trocar insertion sites. Laparoscopic Nissen Fundoplication nowadys is the preferred approach and becomes the first surgical option in treating patients with GERD. It is effective as open fundoplication, safe, associated with a short hospital stay and early return to normal daily life activity

Upstream investment in health care: national and regional perspectives

Since the burden of disease has shifted towards non-communicable diseases and public health management, there is a greater need to direct resources to address risk factors of the diseases rather than the diseases themselves. The downstream agenda focused on treatment services and is still an important problem at the level of national health management. Much has been accomplished in preventive programs for infectious diseases in Saudi Arabia but a great deal more is needed to combat non-communicable diseases. While a national non-communicable diseases program is being established in the Kingdom, more advanced pilot projects of NCD can be started in the regions. A model for cardiovascular diseases in Qassim will be presented

Mid-term clinical and angiographic follow-up after percutaneous transluminal coronary angioplasty for treatment of coronary in-stent restenosis

With increasing incidence of stent deployment, the problem of ISR "the Achilles heel of stenting" is becoming increasingly prevalent and remains the major limitation of coronary catheter based interventions. Aim of the work: To evaluate the mid-term clinical outcome after PCI for treatment of different patterns of ISR and to make angiographic follow-up for patients with clinical restenosis. Thirty patients with ISR underwent successfi1 PC1 from September 2002 in Nasr City Insurance Hospital and were followed- up clinically and by exercise stress testing for six months after the procedure. Angiographic follow-up was done -for patients with recurrent symptoms [one patient] or with positive stress test results at follow up [one patient]. 80% of our patients underwent successful PCI using conventional balloon and in the remaining 20% cutting balloon was used. We found no difference between both for treatment of ISR at SLY months follow- up [P=0.66]. In the current study, only two patients [6.7%] had clinical and angiographic ISR. The remaining [93.3%] had a favorable clinical outcome. In conclusion: Repeat balloon angioplasty for the treatment of ISR is an easy and safe procedure with high procedural success, but its worthy to say that best management of ISR is not completely established. So, prevention of ISR at the outset should be the ultimate aim and in this issue drug-eluting stents [DES] may be an outstanding option

Thyroiditis: a disease with many faces

Background: Diagnosis of thymiditis is rather difficult since it can simulate any other thyroid disease. This study was conducted to determine the clinico-pathological features of thyroiditis and to evaluate the efficacy of the various modalities utilizedfor diagnosis of the disease

Patients and Methods: The study included 59 patients with the clinical diagnosis of thyroiditis. Ten patients had subacute thyroiditis SAT and 49 had chronic thyroiditis [CHT]. Investigations included serum levels of T3, T4 and TSH, anti-chromosomal antibodies [AMA], anti-thyroglobulin antibodies [ATGA], Ultrasonography for the thyroid gland and FNAC. Twenty-four patients improved by conservative treatment while 35 needed thyroidectomy where histopathology for the excised glands confirmed the diagnosis of thyroiditis

Result: The mean age of patients with SAT was significantly lower than that of those with CHT [2813 +/- 5.82 years vs. 44.1 +/- 8.36 years, respectively] [t: 5.62, p=0.002]. Seventy one percent of patients with CHT had concomitant autoimmune disease, and nine of the 10 patients with SAT had history of recent upper respiratory tract infection. There was an obvious tendon; towards hyperthyroidism associated with CHT and towards hyperthyroidism associated with SAT. Both AMA and ATGA were significantly higher in patients with CHT as compared to those with SAT [P<0.05]. Hypoechoic sonographic pattern of the goiters formed the majority in both groups [33/49 and 8/10 for CHT and SAT respectively] [X2=26.612, P<0.001] fNAC could diagnose 30 out of 49 cases of CHT with a sensitivity of 59.2% a specificity of 90%, a positive predictive value of 96.7% and a negative predictive value of 31%. It did not diagnose any of the ten SAT

Conclusions: Diagnosis of thyroiditis requires a high index of suspicion. A history of concomitant autoimmune disease could associate CHT. An upper respiratory tract infection nay well precede a SAT. CHT is associated with a significant rise of AMA and ATGA. Hypoechoic sonographic petten is found in a significant number of patients with thyroiditis. FNAC is specific yet insensitive test for the diagnosis of thyroiditis

association of helicobacter pylori infection with coronary artery disease: Fact or fiction?

Helicobacter pylori [H. pylori] infection is an important cause of peptic ulcer disease and other gastrointestinal disorders. Since its discovery, a number of extra-gastrointestinal diseases have been reported to be associated with H. pylori infection. Recently, several epidemiological and clinical studies suggested that H. pylori infection has been associated with an increased risk of developing coronary artery disease [CAD]. Evidence from animal studies showed that H. pylori plays an important role in the acute phase of myocardial infarction by causing platelet aggregation and inducing pro-coagulant activity in experimentally infected mice. However, results from human studies are conflicting in providing clear evidence for an association between H. pylori and CAD. Therefore, the aim of this article is to critically analyze the available evidence to prove or refute such an association

Antiarrhythmic efficacy of Montelukast, a selective leukotriene receptor antagonist, in guinea pigs

This study was conducted to demonstrate the potential antiarrhythmic activity, including the curative and prophylactic efficacy, of the selective leukotriene receptor antagonist Montelukast in guinea pigs. Arrhythmias were experimentally induced by either digoxin or epinephrine. The results obtained revealed that Montelukast [1 mg/kg b.w.] was capable of reversing both digoxin-induced and epinephrine-induced cardiac arrhythmias. Montelukast, used prophylactically in the same dose was also effective in preventing the different types of cardiac arrhythmias induced either by digoxin or epinephrine. In conclusion, the present study demonstrates that Mantelukast can be considered effective antiarrhythmic agent in epinephrine and digoxin induced arrhythmias, both curative and prophylactic

Dose titration for LVH regression in hypertensive rats: do antihypertensive classes differ?

Left ventricular hypertrophy [LVH] is a serious condition associated with development of coronary artery disease, cerebrovascular disease, heart failure and sudden cardiac death. This work was assigned to compare three antihypertensive drugs, namely ramipril, losartan and atenolol for a goal beyond blood pressure control i.e. reduction of LVH. LVH, induced in rats by fructose feeding for four weeks, was reduced significantly by the antihypertensive doses of the three drugs. Doubling the dose produced more significant LVH reduction with no more significant drop in blood pressure by ramipril and losartan, while atenolol produced no more significant LVH regression despite the more significant drop in blood pressure and bradycardia. It can be concluded that ramipril and losartan are more superior for LVH regression and more tolerable than atenolol since they have benefits beyond blood pressure control by blocking the rennin angiotensin system. So, we recommend dose titration of ramipril or losartan to the most maximum tolerable dose in hypertensive patients with LVH for reducing cardiovascular risks by regression of LVH

Serum and synovial neopterin, a marker for rheumatoid arthritis activity

Rheumatoid arthritis [RA] is a chronic inflammatory disease of unknown etiology characterized by an erosive proliferative synovitis. Since the etiology of RA remains obscure, rheumatoid disease activity can only be evaluated by indirect laboratory measures. Despite the intensive efforts to make the clinical assessment more objective by applying numerical grades and indices, a relevant, reliable and reproducible method to quantitate rheumatoid activity is still needed. The pathogenesis of RA is complex involving many cells and cytokines. Neopterin, a pyrazino-pyrimidine derivative from gua-nosine triphosphate, was found to be an excellent biochemical marker for the invivo activation state of cell-mediated immunity. The aim of the present work was to study the monocyte/macrophage activation in RA patients by measuring neopterin concentration in serum and synovial fluid to test the efficacy of this new biochemical parameter in reflecting rheumatoid disease activity. 47 RA patients and 25 controls were included in this study Neopterin as well as other routine laboratory investigations were performed on the serum and synovial fluid [when applicable]. The results of this work showed that serum neopterin is significantly higher in RA patients than normal controls. Both serum and synovial fluid neopterin correlated strongly with the activity of the disease. Serum levels increased significantly as the disease becomes more active. If has been concluded that neopterin measurement can be used as a parameter of rheumatoid disease activity