Women health in Saudi Arabia: a review of non-communicable diseases and their risk factors

This is a review of the changing pattern of chronic diseases among women in the Kingdom of Saudi Arabia [KSA]. Data from national surveys conducted in KSA, whose results were published between 1996 and 2011 were used. The results showed that over a period of ten years the prevalence of obesity increased in Saudi women from 23.6% to 44.0% and in men from 14.2% to 26.2%; self-reported physical inactivity worsened in both women [from 84.7% to 98.1%] and men [from 43.3% to 93.9%]; prevalence of smoking in women increased [from 0.9% to 7.6%], while it declined in men [from 21.0% to 18.7%]. The prevalence of metabolic syndrome was significantly greater in women than men [42.0% versus 37.2%; p < 0.01]. In conclusion, Saudi women are potentially at a greater risk than a decade ago to develop cardiovascular diseases and diabetes mellitus, with a notable increase in obesity compared to men

Treatment of Graves' hyperthyroidism - prognostic factors for outcome

To determine whether clinical and biochemical features of Graves' disease at presentation predict response to medical and radioiodine treatment. We carried out a retrospective 10-year study of 194 consecutive Saudi subjects with Graves' disease who were treated with antithyroid drugs, radioiodine therapy, or both, between January 1995 and December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. At diagnosis, the mean age was 32 +/- 0.9 years. Only 26% of patients had successful outcome after a course of antithyroid medication. None of the clinical or biochemical factors were associated with a favorable outcome of antithyroid treatment. One dose of radioiodine [13-15 mCi [481-555 MBq]] cured hyperthyroidism in 83% of patients. Presence of ophthalmopathy at presentation was shown to be a significant contributing factor to failure to respond to a single dose of radioiodine [odds ratio, 6.4; 95% CI, 1.51-24.4; p<0.01]. Failure of radioiodine treatment was also associated with higher serum free T3 concentration at presentation [p=0.003]. In patients with Graves' hyperthyroidism, radioiodine treatment is associated with higher success rate than antithyroid drugs. A dose of 13-15 mCi [481-555 MBq] seems to be practical and effective, and should be considered as first line therapy. Patients with high free T3 concentration and, those with ophthalmopathy at presentation were more likely to fail radioiodine treatment. A higher dose of radioiodine may be advisable in such patients

Bone mineral density and bone scintigraphy in adult Saudi female patients with osteomalacia

This prospective study was conducted to demonstrate the role of bone mineral density [BMD] and bone scan in the management of adult Saudi female patients with established diagnosis of osteomalacia. Bone scan using Tc99m methylene diphosphonate [MDP] and BMD of the lumbar spine and femoral neck using dual x-ray absorptiometry [DXA] were performed at the time of diagnosis 6 months and one year after therapy in 96 Saudi female patients attending the metabolic bone disease clinic at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January 1997 through to June 1999, aged between 20 and 73-years [mean 42 years]. Alkaline phosphatase, calcium and inorganic phosphorus were measured for all patients before and after treatment. 25 Hydroxy Vitamin D was only measured with the first BMD measurements. The bone profile showed typical biochemical abnormalities of osteomalacia. The bone scan showed feature of "superscan" in all patients and "pseudofractures" in 43 patients. Bone mineral density measurements were compared with that of normal Saudi subjects matched for age and sex. The BMD was significantly low at diagnosis and showed significant improvement after therapy. The improvement of bone density in response to therapy was more evident in lumbar spine than in femoral neck bone. Our results showed that BMD in adult Saudi female patients with osteomalacia was markedly affected probably due to specific constitutional and environmental factors [inadequate exercise, lack of sun exposure and lack of intake of milk and dairy products]. In addition, lumbar BMD and serum calcium appeared to be better markers to monitor therapy. Bone scan helped in demonstrating disease activity, the presence of pseudofractures

Primary hyperparathyroidism and pregnancy

The coexistence of primary hyper-parathyroidism and pregnancy is very rare worldwide. It carries serious complications to the mother and fetus, therefore, early diagnosis and management is of paramount importance. Over a period of 16 years from 1982-1997, 24 patients with primary hyperparathyroidism were identified from the central diagnostic index data base of King Khalid University Hospital. Out of these, only 3 women with primary hyperparathyroidism complicating pregnancy were identified. All 3 women were in the fourth decade. Two of them had coexisting vitamin D deficiency with initially normal serum calcium and were misdiagnosed as cases of osteomalacia while the third had very high serum calcium on first presentation. A single parathyroid adenoma was identified in all 3 patients with 2 undergoing surgical removal of the adenoma. The third patient unfortunately had an abortion. The babies of the first 2 patients were born healthy with no complications. Primary hyperparathyridism, even though rare in pregnancy, carries risks to the mother and fetus and therefore early screening for asymptomatic hyper-parathyroidism in all women of childbearing age and in the early antenatal period of pregnant women is recommended

Primary hyperparathyroidism: King Khaled University Hospital experience

This study was conducted to examine the prevalence, mode of presentation and management of primary hyperparathyroidism in one of the major hospitals in Saudi Arabia. Patients and This was a retrospective analysis of 24 cases of primary hyperparathyroidism, comprising 21 females and three males, who were seen at King Khalid University Hospital over a period of 16 years from 1982 until December 1997. The prevalence of the disease was estimated to be 11.34 per 100,000 hospital population. The majority of the patients presented with musculoskeletal complaints [62%-67%] and/or renal complications [58%]. Hypercalcemia was seen in 92% of the cases. Serum PTH was available for 21 patients and 20 had significantly elevated levels. Fifty% of the patients had features of hyperparathyroid bone disease on plain x-ray, while 79% showed osteopenia of the femoral neck on dual x-ray absorptiometry, and almost all the patients had lumbar osteopenia. Fifty% of the patients had features of metabolic bone disease on bone scan. Thalliumtechnetium subtraction studies proved to be the most reliable tool, with 83% sensitivity, followed by ultrasound scan of the neck, with a sensitivity of 55%. CT scan of the neck was attempted in only seven patients [29%], with a sensitivity of 86%. Twenty-one patients [87.5%] underwent surgical exploration and removal of the parathyroid adenoma. Single parathyroid adenoma was identified in 85% of the cases, 5% had multiple adenomas, and 5% had hyperplasia of the parathyroid gland. Our results showed that primary hyperparathyroidism is not a rare disease in Saudi Arabia. It has a tendency for late presentation with complications. We believe that routine screening for calcium and early identification of such cases are warranted to reduce the morbidity of this easily treatable disorder