Relationship of the Arabic version of the asthma control test with ventilatory function tests and levels of exhaled nitric oxide in adult asthmatics

To determine the relationship between the asthma control test [ACT] score using the Arabic version, fractional exhaled nitric oxide [FENO], and lung functions, and to derive the cutoff points for the ACT score with the American Thoracic Society recommended FENO standard levels of inflammation control. We recruited 59 adult asthmatics out of which 53 subjects completed the study between July 2011 and June 2012 at King Saud University, Riyadh, Saudi Arabia. The FENO levels were measured by NIOX MINO[R] [Aerocrine AB, Solna, Sweden], and ventilatory functions were recorded by standard techniques. The FENO values were significantly higher in patients with an ACT score <20 [65.5 +/- 35.4] compared with those patients with an ACT score >/= 20 [27.4 +/- 10.5, p<0.001]. Among the well-controlled group based on the ACT score criteria, 6 [25%] cases had high FENO levels, while among the poorly controlled group, 23 [79.3%] cases had high FENO levels [odds ratio: 11.5; p<0.0001; confidence interval: 3.16-41.72]. There was a significant negative correlation between FENO and ACT score [r=-0.581, p<0.0001]. At the international cutoff point of 20, the sensitivity was 95.2, and the specificity was 68.8. The receiver operating curve [ROC] showed that maximum sensitivity and specificity were observed at an ACT score cut off point of 19 [sensitivity: 90.5, and specificity: 81.2]. The FENO levels correlate negatively with ACT scores however, the relationship between FENO and lung function is not significant. A significant relationship between ACT score and FENO levels indicate that there is an ongoing inflammatory state in patients with poor asthma control

Epidemiology of skin cancer

The aim of the study is to find out the skin cancer distribution, level of risk and histopathological typing. Retrospective cancer registry-based study. Cancer Research Unit, Basrah Medical College. The study was performed from 2005 to 2009. Four hundred fifty-seven new cases were registered during five years. Eighty-three cases were not inhabitants of Basrah governorate and were excluded from statistical analysis. Therefore, the sample used in the study is 374 [81.8%]. Skin cancer accounts for 4.7% of all new cancer cases registered from 2005 to 2009. The mean age of skin cancer cases was 54.8+18.4 years. The risk increased with advancing age in both sexes in terms of relative frequency and in age specific incidence. Skin cancer has a major share among total cancer cases in Basrah. Further analytical epidemiological study to identify the determinants of local patterns is advised.

Pediatrician knowledge, perception, and experience on child abuse and neglect in Saudi Arabia

The objective of this study was to assess the knowledge, perception, and professional experience of pediatricians in Saudi Arabia regarding child abuse and neglect. Descriptive study during a one day pediatric conference held on King King Abdulaziz University Hospital, a tertiary care teaching hospital in western Saudi Arabia. The study targeted 198 attendees who were invited from different healthcare sectors in the country. The overall knowledge of participants about some important aspects of child abuse and negligence was adequate, ranging between 82% and 91%. However, their knowledge about reporting cases of child abuse and neglect was quite deficient, ranging between 66% and 79%. As for "professional experience about child abuse and negligence," it showed considerable variation between participants ranging between 43% and 82%, in which pediatricians who received their medical education in Saudi Arabia scored statistically significantly higher, while pediatricians who received their medical education in Western countries scored higher in all other aspects of the study. Currently, the knowledge and clinical experience on the subject of child abuse and neglect in Saudi Arabia is enough to adopt a comprehensive strategy for the prevention and interventions of child maltreatment at all levels. Pediatricians are expected to play a key role by leading and facilitating this process

Evaluation of ketorolac tromethamine as anti-inflammatory drug for topical applications in treatment of knee osteoarthritis

The non-steroidal anti-inflmmatory drugs [NSAIDs] are used as a classic treatment for painful rheumatic disorders of the knee such as osteoarthritis and rheumatoid arthritis. Ketorolac tromethamine [KT] is considered as a member of NSAIDs. It is a non-selective cycloxygenase COX inhibitor that is used in treatment of musculoskeletal and joint disorders. Because KT appears to be associated with a higher incidence of adverse effects mainly irritation to the stomach, change in kidney and liver functions, its use is restricted for the treatment of patients for whom other NSAIDs have been ineffective. The main problems associated with the frequent administration of KT could be overcome by alternative routes of administration. This could be achieved by avoiding the contact between the drug and the stomach through formulating the drug in topical formulations and this was the aim of this work. Seventy osteoarthritis patients were selected and were classified into three groups, KT group [24 patients], piroxicam group [23 patients] and placebo group [23 patients]. Efficacy assessments were done by using the Western Ontario and McMasters Individual Osteoarthritis Index [WOMAC-OA] and the WOMAC Composite Index [WOMAC-CI] for pain, stiffness, and physical functions. Tolerability assessments were done by recording any adverse effects at each visit. All adverse effects or unexpected events were recorded in the case record forms. During the study, 8 patients were lost to follow up 2 from piroxicam group, 3 from KT group and 3 from placebo group. The obtained results indicated that, there was no significant difference in efficacy between KT gel and piroxicam gel [p>0.05] in treatment symptoms of osteoarthritis patients. While there was significant difference between either KT gel or piroxicam gel and placebo gel [p<0.05]. No adverse effects were recorded in all groups within the duration of study except two patients in of KT group and one patient in placebo group showed mild skin irritation [erythema]. The clinical evaluation revealed that, therapy with topical KT in carbopol 934 gel was successful to a great extent and produced high efficacy and safety in improving patients symptoms of osteoarthritis of the knee

Serum resistin levels in patients with type 2 Diabetes Mellitus and its relationship with body composition

To assess the relationships of resistin concentrations with body mass index [BMI], body fat mass, lean body mass, and body protein mass in patients with type 2 diabetes mellitus [DM]. This cross-sectional study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia from April 2008 to March 2011. A total of 229 subjects were selected for the study. Body composition was assessed by bioelectrical impedance analyzer. Parameters recorded included BMI, waist hip ratio [WHR], total body water, fat, protein, and lean body masses. Blood samples were analyzed for glucose, glycosylated hemoglobin [HbA1c], and resistin levels. We found that BMI, WHR, fasting blood glucose, HbA1c, and resistin levels were significantly higher in diabetics compared to non-diabetic healthy individuals. Fat mass was significantly higher in diabetic patients compared with controls, while the difference for muscle mass and lean body mass was non-significant. A significant positive correlation was observed between plasma levels of resistin and fat mass in patients with DM [r=0.2824, p=0.0030]. Type 2 DM patients have significantly higher resistin levels that are positively correlated with body fat mass supporting the evidence that resistin plays an important role in the pathogenesis of obesity and insulin resistance.

study on preference and practices of women regarding place of delivery

This was a cross-sectional study in Basra, and involved 353 women who had recently given birth drawn from health care institutions. The main objective was to determine the factors that helped determine the women's choice of place of delivery: hospital or home. Only 16.1% delivered at home, while 83.9% delivered in hospital. The main reasons for choosing hospital delivery were safety and security [96.6% of the women], better hygiene [66.6%] and because of medical advice [63.2%]. The main reasons for the choice of home delivery were social support and privacy [98.2%]. The women were consistent in their choice of delivery place across different pregnancies [previous, present and future]

Reference range values of fractional exhaled nitric oxide in healthy Arab adult males

To determine the reference values of the fraction of exhaled nitric oxide [FENO] among healthy, non-smoking male adults and its correlation with age, height, weight, and body mass index [BMI]. This cross-sectional study was conducted at the Departments of Physiology and Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, from September 2007 to August 2008 on healthy non-atopic, non-smoking male Saudi subjects. The FENO was measured online using the single-breath technique according to recent guidelines of the American Thoracic Society [ATS]. We studied 121 subjects with a mean age of 31.00 +/- 12.24 years, BMI of 27.23 +/- 6.64, and FEV1/FVC 85% [81-92%]. The FENO ranged between 7.66 parts per billion [ppb] and 46.6 ppb [mean 22.79 +/- 8.13], with >84% of subjects recording levels <30 ppb and >95% with levels <40 ppb. The FENO negatively correlated with body weight [r=0.3888, p=0.001] and BMI [r=0.238, p=0.009]. No correlation was observed between FENO, FEV1/FVC ratio, age, and height. The reference values of FENO for non-smoking, non-atopic male Saudi adults fall between 7.66 and 46.6 ppb [mean 22.79 +/- 8.13], similar to other populations. The FENO negatively correlates with body weight and BMI

Exhaled nitric oxide in stable chronic obstructive pulmonary disease

The objective of the study was to test the hypothesis that fraction of exhaled nitric oxide [FENO] is elevated in nonsmoking subjects with stable chronic obstructive pulmonary disease [COPD] and compare it with the results in patients with asthma and a control population. Cross-sectional study. Pulmonology Clinic at a University Hospital. Twenty five control subjects, 25 steroid naive asthmatics and 14 COPD patients were studied. All the patients were nonsmokers and stable at the time of the study. All subjects completed a questionnaire and underwent spirometry. Exhaled nitric oxide was measured online by chemiluminescence, using single-breath technique. All the study subjects were males. Subjects with stable COPD had significantly higher values of FENO than controls [56.54 +/- 28.01 vs 22.00 +/- 6.69; P =0.0001] but lower than the subjects with asthma [56.54 +/- 28.01 vs 84.78 +/- 39.32 P = 0.0285].The FENO values in COPD subjects were inversely related to the FEV[1]/FVC ratio. There was a significant overlap between the FENO values in COPD and the control subjects. There is a significant elevation in FENO in patients with stable COPD, but the elevation is less than in asthmatic subjects. Its value in clinical practice may be limited by the significant overlap with control subjects

F-ratio, a surrogate marker of carpal tunnel syndrome

To explore the correlation of F-ratio and F-wave minimal latency [FWML] in carpal tunnel syndrome [CTS]. This retrospective study was conducted from January 2006 to January 2007 at the clinical physiology lab, King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia. Motor and sensory nerve conduction studies, FMW latencies of median and ulnar nerves, and F-ratio were carried out in 54 CTS patients and 30 controls. Out of 54 CTS patients, there were 14 were males [26%], and 40 females [74%], CTS was bilateral in 32 [59%], and unilateral in 22 [41%] patients. Fifty-one patients [94.4%] had involvement of the right hand, 28 patients [51.8%] had dyslipidemia and 20 patients [37%] had hypertension. The FWML [ms] in the right median nerve was 25.46 +/- 2.2, and 25.79 +/- 1.7 in the right ulnar nerve in the control group [p = 0.5224], while it was 29.1 +/- 3.35 in the right median nerve and 26.46 +/- 4.35 in the right ulnar nerve in patients with CTS [p = 0.0008]. A similar statistically significant increase in the median nerve latency was observed in the left hand. A statistically significant reduction in the F-ratio was found consistently in all patients with CTS in both the hands [p = 0.0001]. The present study reveals prolongation of FWML in the median nerve, and a statistically significant reduction of F-ratio in all CTS patients. A significant inverse correlation was found between FWML and F-ratio in CTS patients. Both FWML and F-ratio support the diagnosis of CTS

Lipoprotein [a] is a feature of the presence, diffuseness, and severity of coronary artery disease in Saudi population

To study lipoprotein[a] [Lp[a]] levels in Saudi patients with angiographically defined coronary artery disease and to see its relationship with its severity and diffuseness. This cross sectional study was carried out at King Khalid University Hospital, Riyadh, Saudi Arabia in 2006-2007. One hundred and forty-seven individuals with coronary artery disease [CAD] and 49 healthy individuals matched for age and body mass index were studied. Among CAD patients, 133 underwent angiography. Blood samples were analyzed for total cholesterol [TC], triglycerides [TG], low density lipoprotein [LDL] and high density lipoprotein [HDL] and Lp[a]. Coronary artery disease patients had higher Lp[a] levels than controls [25.78 +/- 25.09mg/dl versus 14.57 +/- 11.81 mg/dl, p=0.0030]. Patients without stenosis [10.97 +/- 8.06mg/dl] and one vessel involvement [19.67 +/- 17.33mg/dl] had significantly lower levels of Lp[a] compared to double [31.88 +/- 32.17mg/dl] and triple [29.70 +/- 28.12mg/dl] vessel disease. Lipoprotein[a] levels correlated significantly with coronary vessel score [r = 0.234, p = 0.033] and Gensini score [r = 0.256, p = 0.02]. Smoking [odds ratio [OR]: 1.86; 95% confidence interval [CI]: 1.020-2.510; p=0.04], TG levels [OR: 2.04; 95% CI: 1.251-4.932; p = 0.03] and Lp[a] levels [OR: 1.56; 95% CI: 1.033-3.687; p = 0.025] significantly predicted CAD severity. High risk levels of Lp[a] >/= 30 mg/dL were present in 66.7% of CAD patients. Lipoprotein[a] levels are significantly higher in Saudi patients with CAD compared to healthy individuals, and are associated with more severe and diffuse blockage of the coronary vessels

Liposomes as an ocular delivery system for fluconazole: in-vivo study

The purpose of this study was to formulate topically effective controlled release ophthalmic fluconazole liposomal formulations using the reverse-phase evaporation technique. Soya bean phosphatidylcholine [PC] and cholesterol [Ch] in specific weight ratios were used. Selected formulations were tested for their in-vivo ocular antifungal effect. These included the neutral, the positively [using stearyl amine] and the negatively [using dicetyl phosphate] charged liposomes. A reproducible model of Candida keratitis in rabbits was performed and the effects of the prepared liposomes were better than a solution of fluconazole. The order of fluconazole liposomal formulations according to the time to achieve complete healing is arranged in a descending order: negatively charged liposomes > positively charged liposomes > neutral liposomes [7:4] > neutral liposomes [5:5] > fluconazole solution. The frequency of instillation was decreased; also, the time of ulcer healing was decreased. It was concluded that the use of liposomes as a drug delivery system could contribute to the enhancement of the effect of fluconazole in the eye

Liposomes as an ocular delivery system of fluconazole: in-vitro studies

The purpose of this study was to formulate topically effective controlled release ophthalmic fluconazole liposomal formulations. Reverse-phase evaporation technique was used for the preparation of fluconazole liposomes consisting of phosphatidylcholine [PC] from soyabean and cholesterol [Ch] in weight ratios of [9:1], [7:2], [7:3], [7:4], [6:4], [7:6] and [5:5] with or without stearylamine [SA] or dicetyl phosphate [DP] as positive and negative charge inducers, respectively. The prepared liposomes were evaluated for their in-vitro release. The release mechanism was found to follow Higuchi and first order kinetics. Increasing cholesterol weight ratio in the prepared liposomal formulations progressively decreased the release of fluconazole from the vesicles. The positively charged liposomes showed slower rate of drug release compared to neutral ones. Negatively charged liposomes showed slight increase in the release rate and extent of fluconazole from the liposomal formulations 5:5:0.25 and 5:5:0.5; in comparison with neutral ones. Further increase in the amount of dicetyl phosphate 5:5:1 resulted in a significant decrease in the release rate. Four fluconazole liposome eye drops were prepared. Physical stability study including, visual appearance, particle size and amount of drug leakage from liposome eye drops were studied. Approximately 82.82%, 76.55%, and 70.90% of fluconazole was retained in negative, positive and neutral liposomal ocular formulations up to a period of 24 weeks at 5°C

Fluconazole-loaded liposomes for ocular delivery: characterization and antifungal activity

Fluconazole loaded liposomes were prepared using reverse phase evaporation technique for ocular delivery of the drug. Characterization of fluconazole liposomes including; particle size and physical morphology were studied. The effects of different variables [cholesterol weight ratio and charge type] on the loading efficiency of liposomes as well as particle size were determined. Inclusion of cholesterol in liposomal formulations improved the encapsulation of fluconazole into liposomes at certain Phosphatidylcholine: Cholesterol [PC: Ch] weight ratios further increase in cholesterol content resulted in a decrease in the encapsulation percent of the drug. A significant increase in the encapsulation at ratio 7:3 was noticed. At ratio 7:6, the encapsulation significantly decreased. Incorporation of stearylamine [SA] into liposomes decreased the loading efficiency of fluconazole at ratio [PC: Ch: SA] 5: 5: 0.25 followed by insignificant increase in the entrapment of the drug into liposomes at ratio 5: 5: 0.5. On the other hand, addition of dicetyl phosphate [DP] into liposomes resulted in a significant increase in fluconazole encapsulation into liposomes at all tested [PC: Ch: DP] ratios. The loading efficiency of the neutral liposomes was found to be in between those of positively and negatively charged liposomes. The particle size studies showed that, increasing cholesterol amount, led to an increase in the particle size. While increasing stearylamine and dicetyl phosphate led to decrease in the particle size of liposomes. An in-vitro study was done to know the effect of fluconazole loaded liposomes on different fungi isolated from eye

Exhaled nitric oxide: An emerging marker of inflammation in respiratory diseases

Fractional exhaled nitric oxide [FENO] is a recently introduced non invasive marker to measure inflammation and oxidative stress in the lung. The numerous roles of NO in respiratory pathophysiology have been extensively reviewed. There is contradictory evidence regarding the exact function of NO in lung diseases. In pathological states, the enzyme inducible NO synthase generates extraordinarily high concentrations of NO when the body faces an inflammatory response by attracting macrophages that generate NO and hence NO participate in host defense against specific organisms. Fractional exhaled nitric oxide measurements have been useful in asthma, chronic obstructive pulmonary disease, cystic fibrosis, and bronchiectasis. The technique used to measure FENO is well standardized, requires the same amount of time that spirometry takes, and is feasible to be performed in young children. Measuring FENO has added another dimension to the determination of adverse respiratory effects because it allows detection of inflammatory responses in the absence of functional impairments. This review provides an insight into measurement methods, physiological factors affecting FENO, interpretation of results and diseases related to changes in FENO levels. This will help physicians in diagnosing and monitoring their treatments for different respiratory diseases

Assessment of lipid profile in Saudi type 2 diabetic and non-diabetic periodontal patients

To study the extent of periodontal disease in diabetic and non-diabetic periodontitis patients, and to investigate the relationship of dyslipidemia and periodontal disease, in diabetic and non-diabetic periodontitis patients. This is a cross-sectional study at the Department of Preventive Dental Sciences College of Dentistry and Department of Physiology College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, from February 2003 to June 2004. A total of 90 patients was recruited, and divided into 3 equal groups of 30 subjects, with age and gender matched, and divided as follows: group 1 healthy group: periodontally and systemically healthy subjects, group 2 periodontitis group: chronic periodontitis patients with no systemic disease, group 3 diabetic group: chronic periodontitis patients with type 2 diabetes mellitus. Plaque index, bleeding on probing, probing pocket depth PPD, and clinical attachment level CAL were measured at the time of initial examination. The glycated hemoglobin, total cholesterol, low density lipoprotein LDL, triglyceride, high density lipoprotein were also measured. Periodontal parameters PPD and CAL were of significantly higher value in the diabetic patients, when compared to the periodontitis patients p<0.05. The total cholesterol, LDL, and triglyceride were also found to be significantly higher among the periodontitis patients than the healthy subjects p<0.05. This study indicated that type 2 diabetic patients had a higher risk to develop advanced periodontal disease than the non-diabetic subjects. It also highlighted the association of dyslipidemia in periodontitis patients

Cancer mortality in Basrah

This study aimed at determining the burden of cancer as a cause of death in Basrah over three selected years; namely 1989, 1997 and 2005. All death registries in Basrah city, Districts and sub districts were used as sources of information for data compiling. Every death recorded in the three years was checked for cause of death and all cases for which any type of cancer written as the cause of death were identified. Data related to age, sex, place of residence, type of cancer, place where death was certified and year of death were obtained. In addition, the numbers of total deaths due to all causes in each year were also recorded. The results indicate a total of 297 deaths in 1989, 499 deaths in 1997 and 649 deaths in 2005 could be attributed to cancer. Regarding sex distribution of deaths, slightly more deaths occurred in males [53.8%] than in females [46.2%] with significant rise of cancer in females in 2005. Cancer as a cause of death represents about 5% of all deaths with some degree of increase in 1997 and 2005 as compared to 1989, but no major change in the cancer specific death rates among different years. Geographically, the distribution shows significant but not substantial variation with years. The mean age of dead persons was similar in the three years. The leading cancer deaths were those of lung, urinary bladder, blood, breast, lymphomas and CNS. The overall risk of death is not much different in different years except for a slight increase in 1997 and 2005 in comparison to 1989. Most cancers show stable or slightly fluctuating level of risk of death with time. Slight rise in the risk of death may be noticed in cancers of CNS, blood [leukemia], Bones, lymphomas and Colon-rectum. The researchers suggest that the stable level of mortality could reflect some improvement in treatment based on early diagnosis of many cancers. A study covering at least ten years is highly recommended to establish more sound time trend in cancer mortality

effects of diving on pulmonary function

Diving as an occupation has its specific healtli problems. Respiratory system is one of the systems that can be affected by environmental changes associated ivith diving as increased hydrostatic pressure, increased breathing gas density, and increased partial pressure of gases e.g. oxygen and carbon dioxide. To determine the effects of diving on pulmonary function and the extent of this problem among Iraqi divers. One hundred and twenty divers tvitli 240 non-divers military personnel were interviewed according to special questionnaire and spirometry ivas performed for each of them. The values of all studied pulmonary function tests were found to be lower in divers as compared with non-divers [FEV[1], FVC, FEV[1]%, F[50], F[25], MVV and MEF] with highly significant differences, except FET which was significantly higher in divers than in non-divers. These changes gave the features of obstructive airway disease. Divers are at risk of some pulmonary function changes. The pattern of these changes is consistent with small airways obstruction and they could be related mostly to their diving activities. Other factors cannot be excluded. Further studies on such occupational group are recommended

Clinical characteristics and responsiveness to treatment in Lennox-Gastaut syndrome. Aretrospective Hospital Audit

To describe the clinical profile of Lennox-Gastaut syndrome [LGS] patients and to assess the best antiepileptic drug combination. Patient files of all children diagnosed with LGS at King Abdul-Aziz University [KAUH], Jeddah, Kingdom of Saudi Arabia between January 2000 to January 2005 were retrieved and analyzed. Details on clinical data, and disease related variables were collected. Treatment trial, last drug combination, maintenance dosage, seizure frequency, and duration before and after treatment, and the overall effect in reducing seizures were recorded. Fifty-four patients were identified with a male:female ratio of 2.4:1 with age range of 10 months-14 years. A history of febrile convulsion was found in 11 [20%] patients, history of infantile spasm was found in 14 patients [26%], mental retardation in 52 patients [96%], and hypotonia in 13 patients [24%]. All patients had abnormal EEG that meets the diagnostic criteria. Brain CT scan was abnormal in 32 [65%] patients. Brain MRI was abnormal in 17 [23%] patients. Neuroradiological abnormalities varied from non-specific atrophy to hippocampal sclerosis and calcification. Metabolic screening carried out for 11 patients [20%] was normal. All patients were on a 3-drug combination at some stage of their disease. The most frequent combination was sodium valproate and lamotrigine. Intravenous immunoglobulin was used in 2 patients with temporary improvement; ketogenic diet was tried in one patient, which did not add much to fit control. The severe nature and intractability of LGS emphasize the need for active and efficacious treatment, which can improve the prognosis as a whole. Different combinations of new anticonvulsants could achieve significant seizure control and could modify the quality of life for these patients. Each patient needs to be considered individually, taking into account the potential benefit of each therapy weighed against the risk of adverse effects