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

Frequency of low bone mineral density in Saudi patients with inflammatory bowel disease

Metabolic bone disease is common in patients with inflammatory bowel disease [IBD]. Our aim was to determine the frequency of bone loss among Saudi patients with IBD and possible contributing risk factors. We retrospectively reviewed Saudi patients with IBD, between 18 and 70 years of age, who had bone mass density [BMD] determined by dual-energy X-ray absorptiometry scanning at one of three hospitals in the Kingdom of Saudi Arabia from 2001 to 2008. Case notes and BMDs results were carefully reviewed for demographic and clinical data. Low bone mass, osteopenia, and osteoporosis were defined according to the WHO guidelines. Predictive factors for BMD were analyzed using group comparisons and stepwise regression analyses. Ninety-five patients were included; 46% had Crohn's disease [CD] and 54% had ulcerative colitis [UC]. The average age was 30.9 +/- 11.6 years. Using T-scores, the frequency of osteopenia was 44.2, and the frequency of osteoporosis was 30.5% at both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our results revealed a positive correlation between the Z-score in both the lumbar spine and the proximal femur and body mass index [BMI] [P=0.042 and P=0.018, respectively]. On regression analysis BMI, age, and calcium supplementation were found to be the most important dependent predictors of BMD. Saudi patients with IBD are at an increased risk of low BMD and the frequency of decreased BMD in Saudi patients with CD and UC were similar. BMI and age were the most important independent predictors of low BMD

status of Vitamin D in medical students in the preclerkship years of a Saudi medical school

The prevalence of vitamin D deficiency has recently been recognized in different parts of the world, even affecting healthy populations. The deficiency of vitamin D can lead to rickets in children and osteomalacia in adults. Few studies have been done to evaluate the status of vitamin D in the medical community. The objective of this study was to evaluate the prevalence of low levels of vitamin D in healthy Saudi medical students. A cross-sectional study was carried out in November 2009 on male and female students in the preclerkship years of medical school at the King Faisal University, Dammam. Data on age, consumption of dairy products and seafood, and exposure to sunlight were collected. The body mass index was calculated. Approximately, 15 ml of blood was extracted for the measurement of serum calcium, serum albumin, serum phosphorus, alkaline phosphatase, fasting parathyroid hormone, and vitamin D levels. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D < 50 nmol/l. Comparison between groups was done for statistical significance using an unpaired t-test. Significance was set at P < 0.05 using 95% CI for all comparisons. The data from 95 male and 103 female students were analyzed. The mean age for all students was 19.54 years. In 100% of the students, the vitamin D level was low. The prevalence of vitamin D deficiency in all students was 96.0% [92.64% in males and 99.03% in females], while the remaining 4% had vitamin D insufficiency. The mean 25-hydroxy vitamin D level was 26.83 +/- 12.60 nmol/l in males and 16.03 +/- 8.28 nmol/l in females [P-value = 0.0001]. Males had a statistically significant higher body mass index as well as consumption of dairy products, while the consumption of seafood was significantly higher in females. There was no difference between the two groups in terms of exposure to the sun. Vitamin D deficiency was highly prevalent among medical students included in this study. An urgent action has to be taken in order to prevent adverse consequences of low vitamin D in the young, otherwise healthy populations

Favorable impact of Nigella sativa seeds on lipid profile in type 2 diabetic patients

The atherogenic pattern of dyslipidemia associated with type 2 diabetes mellitus [DM] has been increasingly discussed. We have recently reported a hypoglycemic effect of Nigella sativa [NS] seeds in patients with type 2 DM. In this study we sought to assess the impact of NS seeds on lipid profile in type 2 diabetic patients. A total of 94 patients with type 2 DM were recruited and divided into 3 dose groups. Capsules containing NS were administered orally in a dose of 1, 2, and 3 g/day for 12 weeks. All patients were subjected to measurement of total cholesterol [TC], triglycerides [TG], low-CJ density lipoprotein cholesterol [LDL-c], and high-density lipoprotein cholesterol [HDL-c] before treatment and 4, 8, and 12 weeks thereafter. Patients receiving 1 g/day NS seeds for 12 weeks [group 1] showed I nonsignificant changes in all the parameters except for a significant increase in HDL-c after 4 weeks of treatment. However, patients ingested 2 g/day NS displayed a significant decline in TC, TG, and LDL-c, and CD a significant elevation in HDL-c/LDL-c, compared with their baseline data and to group 1 patients. Increasing

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.

Influence of vitamin D levels on bone mineral density and osteoporosis

The effects of vitamin D on bone mass remain to be understood. This study was conducted with the objective of evaluating the influence of 25-hydroxyvitamin D [25OHD] levels on bone mineral density [BMD] among Saudi nationals. Cross-sectional study carried out at university hospital from 1 February 2008 to 31 May 2008. Healthy Saudi men and women in the peak bone mass [PBM] age group and those aged >50 years were recruited from the outpatient department of King Fahd University Hospital, Al Khobar, Saudi Arabia, between February 1, 2008, and May 31, 2008. Patient age and sex were documented, and body mass index was calculated. Hematological, biochemical, and serum 25OHD tests were performed. BMD was determined by dual-energy x-ray absorptiometry of the upper femur and lumbar spine. Patients were divided into three groups, based on their 25OHD level. Data from 400 patients were analyzed. Among individuals with a normal 25OHD level, 50% of women and 7% of men in the PBM age group and 26.4% of women and 49.2% of men aged >50 years had low bone mass. In patients with 25OHD insufficiency, 84.2% of women and 88.9% of men in the PBM age group and 83.3% of women and 80% of men aged >50 years had low bone mass. Results for patients with 25OHD deficiency revealed that none of the men and women in the PBM age group or >50 years old had normal BMD. Significant positive correlations between 25OHD level and BMD and significant negative correlations with parathyroid hormone were shown in most of the groups. This study showed that the vitamin D level significantly influences BMD reading among Saudi individuals. Evaluation and treatment of hypovitaminosis D should be considered during management of low bone mass

Simulation-based medical teaching and learning

One of the most important steps in curriculum development is the introduction of simulation- based medical teaching and learning. Simulation is a generic term that refers to an artificial representation of a real world process to achieve educational goals through experiential learning. Simulation based medical education is defined as any educational activity that utilizes simulation aides to replicate clinical scenarios. Although medical simulation is relatively new, simulation has been used for a long time in other high risk professions such as aviation. Medical simulation allows the acquisition of clinical skills through deliberate practice rather than an apprentice style of learning. Simulation tools serve as an alternative to real patients. A trainee can make mistakes and learn from them without the fear of harming the patient. There are different types and classification of simulators and their cost vary according to the degree of their resemblance to the reality, or 'fidelity'. Simulation- based learning is expensive. However, it is cost-effective if utilized properly. Medical simulation has been found to enhance clinical competence at the undergraduate and postgraduate levels. It has also been found to have many advantages that can improve patient safety and reduce health care costs through the improvement of the medical provider's competencies. The objective of this narrative review article is to highlight the importance of simulation as a new teaching method in undergraduate and postgraduate education

Bone mass measurement using quantitative ultrasound in healthy Saudi women. A cross-sectional screening

To study the prevalence of osteopenia and osteoporosis in healthy Saudi women, a community-based screening was carried out. Three thousand and two hundred sixty-nine women in the young women in peak bone mass [PBM] age group and 3131 in the postmenopausal age [PMA] group were screened using Achilles Insight [GE, USA]. Subjects included in the study were healthy and residents of eastern province. The screening was conducted between January 2006 and December 2007. The study took place in King Fahd University Hospital, Al-Khobar, Kingdom of Saudi Arabia. In the PBM age group, 2090 [63.9%] were normal, 791 [24.2%] were osteopenic and 388 [11.9%] were osteoporotic. Osteopenia was more common in single urban women compared to those who were married and living in rural areas [p<0.01 and p<0.001]. Women with college education had significantly normal bone mass than women with less than high school education [p<0.01]. In the PMA, 948 [30.3%] were osteopenic and 720 [23%] were osteoporotic. Osteopenic was more common in women in urban areas as compared to industrial and the rural areas [p<0.01]. Those women whose education was less than primary had significantly more osteoporosis when compared to women with college education [p<0.001]. In the PBM, 11.9% were osteoporotic and in PMA group 23% were osteoporotic. Factors that influenced the risk for osteopenia and osteoporosis included level of education, number of children, and place of living

there a relationship between body mass index and serum vitamin D levels?

To evaluate the relationship between vitamin D level and body mass index [BMI] among Saudi Arabian citizens. Four hundred healthy individuals aged >/= 25 years [200 males and 200 females] were included in this cross-sectional study. Subjects were recruited in the period between 1st February 2008 and 31st May 2008 from the medical staff and employees of King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia, and from patients attending the endocrinology, orthopedic, and infertility clinics at the same hospital. Clinical evaluation was carried out, and BMI was calculated. Serum 25 hydroxy vitamin D [25OHD], in addition to serum parathyroid hormone levels and calcium chemistry were measured for all subjects. The mean age was 46.5 +/- 14.6 years for males, and 42.6 +/- 15.9 years for females [p=0.01]. Mean BMI was similar in both genders, and the difference in the level of serum 25OHD just reached statistical significance [p=0.04]. Male subjects with vitamin D deficiency were found to be older [p=0.03], and with higher BMI [p=0.01] compared to males with normal 25OHD. Although female subjects with hypovitaminosis D were also older than subjects with normal vitamin D level [p=0.01], BMI was significantly lower in females with vitamin D deficiency [p=0.001]. Obese males are at higher risk of having low 25OHD levels, while obesity in females appears to be protective against vitamin D deficiency in the population studied. We believe that obese male and thin female patients should be appropriately investigated, and treated for vitamin D deficiency

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

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. 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. 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. 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

25-Hydroxyvitamin D levels among healthy Saudi Arabian women

To assess the serum level of 25 hydroxyvitamin D 25OHD among healthy Saudi Arabian women living in the eastern province. A cross-sectional randomized study was conducted between February 1st 2008 and May 31st 2008 at the King Fahd University Hospital, Al-Khobar, Kingdom of Saudi Arabia in 200 Saudi women between 25-35 years group 1 and women of >/= 50 years group 2. Clinical examination, laboratory tests, a complete blood picture, serum calcium, phosphorous, alkaline phosphatase, parathormone, and the serum levels of 25OHD levels were carried out. Data on lifestyle, dietary, and demographic questionnaires were collected. Vitamin D was defined as deficient with serum level < 50 nmol/L, insufficient between 52-72 nmol/L, and normal as 75nmol/L. In group 1, 70% of women had normal 25OHD, and in women of group 2, 45% had normal levels of 25OHD. Alkaline phosphatase and parathormone levels were significantly higher in women with low vitamin D levels. Sun exposure and consumption of dairy products were minimal. Vitamin D deficiency among healthy young Saudi women of 25-35 years was 30% and 55% in women of >/= 50 years. This study indicates that hypovitaminosis D is common in young and postmenopausal women. Efforts are require to augment and encouraged women for adequate exposure to sunlight and increased intake of fortified vitamin D products to maintain skeletal health

Familial hypomagnesemia with hypercalciuria and nephrocalcinosis in 2 sisters

Familial hypomagnesemia with hypercalciuria and nephrocalcinosis FHHNC is a rare autosomal recessive tubular disorder characterized by excessive renal magnesium and calcium wasting, eventually, progressing to renal failure. It has been recently attributed to a mutation in the Claudin 16 CLDN 16 gene of the Paracellin-1 PCLN-1 tight junction protein. Herein, we report 2 sisters with FHHNC. Both sisters presented at an early stage with hypomagnesemia and hypocalcemia. The first patient was initially mislabeled and treated as a case of hypoparathyroidism, while the second patient was diagnosed retrospectively after the diagnosis of her sister. The 2 patients developed end stage renal disease

Influence of androgens on bone mass in young women with sickle cell anemia

To evaluate the relationship between the gender hormonal levels and bone mineral density in premenopausal women suffering with sickle cell disease. A cross-sectional study including consecutive female adult patients with sickle cell anemia attending the outpatient hematology/orthopaedic clinics, or admitted to King Fahd University Hospital, Al-Khobar, Saudi Arabia, between August 2006 and June 2007. Patient's age was documented, and body mass index was calculated. Blood was drawn for complete blood picture, biochemistry, and hormonal profile including total estradiol E2 and total testosterone Te. Bone mineral density BMD was measured for all patients using dual energy x-ray absorptiometry scan at the hip and lumbar spine. We analyzed the data of 51 patients with an average age of 26 +/- 3.1 years. Patients were divided into 2 groups group A and group B. Group A had normal BMD and group B with low BMD. Thirty-one [60.8%] were in group A and 20 [39.2%] were in group B. The E2 level was not statistically different between the 2 groups, while Te level was significantly lower in women with low BMD 38 +/- 11.8 versus 22.3 +/- 11.7 ng/dl, p<0.001. Our study indicates that in premenopausal female patients with sickle cell anemia, testosterone may play a role in the preservation of bone mass

Medicine and clinical skills laboratories

The main objective of the medical curriculum is to provide medical students with knowledge, skills and attitudes required for their practice. A decade ago, the UK Medical Council issued a report called [Tomorrow 's Doctors][1] which called for the reduction in the factual content of the medical course with the promotion of problem-based and self-dedicated learning. This report was the basis for a move toward an extensive reform of the medical and nursing curricula. The new reformed curricula enhanced the integrated medical teaching and emphasized the teaching and learning of clinical skills. However, there were still concerns about the standards and appropriateness of the skills of new medical graduates[2]. The changes in the teaching and learning methods, the radical changes in the health care delivery the rapid growth of technology challenged the traditional way of clinical skills development and led to the emergence of clinical skills laboratories [CSLs] in the medical education of many medical and nursing schools. With the proliferation of the CSLs, it is important to evaluate and introduce the reader to their applications, bearing in mind the paucity of information on this subject particularly over the last couple of years. This article is based on literature review