Effect of parity on bone mineral density among postmenopausal Saudi Arabian women

Osteoporosis and osteopenia among postmenopausal Saudi Arabian women are common to the extent of over 60%. Pregnancy, multiparity and prolonged lactation are suggested as factors modifying negatively in the development of osteoporosis. Earlier reports from the institution indicated a beneficial role of multiparity in postmenopausal osteoporosis [PMO]. We conducted this study to measure the effect of parity on bone mineral density [BMD] measurement of lumbar spine and the upper femur. We conducted this prospective study at King Fahd Hospital of the University, College of Medicine, King Faisal University, Dammam, Saudi Arabia, between January 2002 and June 2003. This study analyzed 256 patients who attended orthopedic clinics. The data gathered was age, duration of menopause, number of children borne, height and weight for body mass index [BMI] calculation. We excluded women with secondary osteoporosis from the study. We entered the patients orthopedic complaints in the database. We carried out the BMD measurements using Hologic total body DEXA machine. We analyzed the data using SPSS package with significance at p<0.05 and confidence interval of 95%. For final analysis, we took into consideration an average of results of the lumbar spine and hip region. We analyzed the available data of 256 patients. We divided the patients into 2 groups; group A with >6 children and group B with women of <5 children. In group A, there were 116 women and 140 in group B. The mean age of patients in group A was 56.81 [50-65] years SD +/- 5.19 and in group B the mean age was 58.86 years [48-76] SD +/- 7.68. The average BMI in group A was 31.95 kg/m2 and in group B it was 29.14 kg/m2. The BMD of the lumbar spine of group A was 0.850g/cm2 [SD +/- 0.112] compared to group B of 0.699g/cm2 [SD +/- 0.141], p<0.005. The BMD of the hip region of group A was 0.836g/cm2 and that of group B patients was 0.716g/cm2 [p<0.01]. In women with <5 children, 25.5 had normal BMD as compared to 47 in women with >6 children, 25.4% were osteoporotic in group A and in group B 48%. As per the World Health Organization classification 56% in group A had an increased risk of fracture as compared to 77.5% in group B women. Our results indicate that women who had borne >6 children were less osteoporotic and of low fracture risk as compared to those women who had <5 children. The BMD of the women with >6 children was statistically higher than their counterparts, and they sustain this after prolonged lactation. We believe that increased parity protects women from osteoporosis and the severity of the disease, and it is our suggestion that women with <5 children and those nulliparous, who are at increased risk of developing osteoporosis should be investigated and treated accordingly

Birth associated trauma

To assess the incidence of birth-injuries seen at the King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia [KSA]. A retrospective analysis was carried out in 31028 consecutive deliveries between January 1986 and December 1996 at the King Fahd Hospital of the University, Al-Khobar, KSA. The study group was compared with a matched control group. There were 203 newborns with 208 injuries with an incidence of 6.70 per 1000 live births. The majority [55%] of the injuries was sustained during normal vaginal deliveries and the least were during cesarean section [5.2%]. The average gestational age was 39 weeks [25-44 weeks] in the study group and in the control group was 38.84 [21-44 weeks]. The birth weight in the study group was 3323 gms [780-6190] and the control group was 3015 gms [790-6015] p<0.01. The Apgar score in the study group was 7 and 9 at one and 5 minutes and in the control group was 8 and 9. There were 104 scalp injuries, 50 nerve injuries, 20 fractures [11 clavicle and 9 long bones] and 21 newborns had intracranial hemorrhage. This study demonstrates a variety of birth related trauma at the teaching institution with a lower overall incidence as compared to reports from the literature. The only significant factor was that birth weight was higher in the study group as compared to the control group [p <0.01]. It is recommended that every effort be required to further decrease the incidence of birth injuries

Comparison of ceftriaxone and cefuroxime for surgical prophylaxis in othopaedic practice

Aims: To assess the effect of a single dose of Ceftriaxone as compared to three doses Cefuroxime and its economic implications. Prospectively 60 consecutive patients [Group A] undergoing Orthopaedic surgery, were given a single dose of Ceftriaxone 1 gram intravenously, prophylactically 30 minutes preoperatively. In comparison the control group of 60 patients received Cefuroxime 1.5 gram preoperatively and 2 doses of 750 mg postoperatively [Group B]. The duration of the operation and they type of operation was recorded. Post operatively the patients were followed up for a year to find any infection related to the surgery. There were 17 males in Group A and 21 in Group B and the rest were females. The average age in the study group was 34.65 years [range 14-66 years] and in the control group the mean age was 35.5 year [range 16-80 years]. The duration of surgery was 112.2 minutes [35-210 minutes] in Group A and 108.5 minutes [40-200 minutes] in Group B, respectively. In the ceftriaxone group there was no postoperative wound infection as compared to the cefuroxime group in which three patient had infection [5%] which was clinically significant and the pValue was 0.24. One superficial and 2 deep infection. this study indicates that a single dose of 1 gram of ceftriaxone was more effective and economically better than the 3 doses of cefuroxime for prophlaxis in orthopaedic surgery. Moreover in the present climate of stringent hospital budgets, using ceftriaxone will save nursing time and cost per patient for prophylaxis in othopaedic surgery

Bone mineral density measurements of distal radius in Saudi Arabia females

A survey using Gammadensit x-ray bone mineralometer was conducted on 150 Saudi Arabian postmenopausal [PM] females and on another group of 150 females of menstruating age of around 30 years as the group with peak bone mass [PBM]. The minimum age in the PM group was 44 years and maximum was 71 years [mean 54.08 years], SD +/- 7.02, whereas for the PBM group, the mean age was 29.15 years [range 24 to 33]. The bone mineral density [BMD] for the PM group was 0.310 g/cm [2] minimum and the maximum was 0.546 g/cm [2] [mean 0.440 g/cm [2]]. In the PBM group, the mean BMD was 0.660 g/cm [2]. Compared to Western females, the PM group BMD was 21% lower and the Saudi PBM group was 29% higher than in Western females of the same age and sex. The BMD of rural Saudi females was 0.479 g/cm [2] as compared to 0.359 g/cm [2] in the urban population. In females who had borne more than 10 children, the BMD was 0.483 g/cm [2], and was 0.354 g/cm [2] in females who had fewer than five children. There was no statistical significance in rural versus urban and 10 children [P value was < 0.18 and < 0.13]. This study concludes that BMD of the PM Saudi females is lower than that of the Western females of the same age, making them more osteoporotic with a higher risk of osteoporotic-related fractures

dilemma of jumping syndrome

A retrospective review of 25 patients of Jumping Syndrome is presented. These females were admitted to King Fahd University Hospital, AI-Khobar between Ist January 1990 and 31st December 1992. The minimum age was 21 years and the maximum 40 years with a mean of 29.7 years. Thirteen of the 25 were Indonesian, 8 Sri Lankans and the remaining 4 Filipino nationals. they sustained 48 fractures and 1 dislocation the breakdown of which is; thoracolumbar spine 22, calcaneum 11, femur 3, tibia and fibula 3, radius and ulna 3, patella 2, pelvis 2, humerus 1, metatarsals 1 and 1 dislocated elbow respectively. Thirteen patients [52%] needed surgical intervention. the minimum hospital stay was 13 days and maximum 135 days with a mean of 56 days. There appears to be a rise in deliberate self harm and the new trend is by jumping from a height. This is causing a great socio-economic, medical care concern. We believe that our society as a whole must recognise this issue and attempts should be made to solve it sooner than later