Serum uric acid as a sensitive concordant marker with lupus nephritis and new onset of renal damage: a prospective cohort study.

OBJECTIVE: The objectives of this study are to assess serum different uric acid levels among systemic lupus erythematosus patients with or without active lupus nephritis in comparison to healthy controls and to study the relation of baseline uric acid levels to the development of new-onset renal damage in lupus nephritis. METHODS: This is a case-control study followed by a prospective cohort of systemic lupus erythematosus (SLE) patients. Three groups were included; all were having normal kidney function, 25 SLE patients with recently diagnosed active lupus nephritis (LN), 26 SLE patients without LN, and 38 healthy controls. Serum uric acid (SUA)and serum creatinine were done for all groups; for SLE patients, 24-h protein in the urine, urinalysis, C3, C4 levels, anti-DNA, anti-ENA antibodies, SLE Disease Activity Index (SLEDAI), and SLICC/ACR damage index (SDI) evaluation were also calculated. Follow-up was done with clinical and laboratory assessment including SUA, with SLEDAI and SDI evaluation. RESULTS: Serum uric acid was significantly higher in SLE patients with active LN than the other two groups (p < 0.05), a cutoff value of serum uric acid associated with lupus nephritis onset was 0.41 mmol/L with a sensitivity of 58% and specificity of 100%, however, C3 and C4 showed very low sensitivity and specificity. During follow-up, all patients with LN with baseline serum uric acid ≥ 0.52 mmol/L were associated with new-onset renal damage within 43 months. CONCLUSIONS: High-serum uric acid levels showed a significant association with lupus nephritis onset and new onset of renal damage. Key Points • Serum uric acid is a cheap, rapid, and popular test available in most of the worldwide laboratories; its higher levels showed a significant association with lupus nephritis onset and new onset of renal damage • The current work is the largest study done on lupus nephritis with strict control to the confound risk factors that are associated with the increase of the uric acid levels; moreover, it is the first study to assess such relation in Saudi population • Uric acid could have a role in the pathogenesis of lupus nephritis patients and consequent renal damage.

Community-based screening for pre-hypertension among military active duty personnel.

OBJECTIVE: To determine the prevalence of both pre-hypertension and hypertension, and risk factors associated with the newly diagnosed Saudi military active duty personnel. METHODS: A community-based cross-sectional screening of 1238 Saudi military active duty service personnel was conducted during the period from September to December 2007 at the military units of Taif region, western Saudi Arabia. Screening tools included self-administrated questionnaire, general physical examination, anthropometric measurements, and assessment of blood pressure. RESULTS: All participants were Saudi males. Their age ranged from +/-7.02. By applying the Joint National Committee on prevention, detection, evaluation, and treatment of high hypertension criteria, 214 (17.3%) were considered pre-hypertensive. Multivariate logistic regression analysis showed that obesity as measured by body mass index [odds ratio (OR)=2.71, confidence interval (CI): 1.39-5.28], positive family history (OR=1.46, CI: 1.03-2.06), ever smoking (OR=1.45, CI: 1.05-2.02), and increased waist circumference (OR=1.04, CI: 1.02-1.06) were the significant predictors of hypertension among military active duty personnel. CONCLUSION: Pre-hypertension is a common hidden problem and it predicts the development of frank hypertension. Findings of the current study support the recommendation of lifestyle modification for pre-hypertension patients. However, further prospective studies are required to determine the role of pharmacotherapy in pre-hypertension.

Does the use of radiofrequency ultrasonic dissector in tonsillectomy have a beneficial effect over the use of laser?

OBJECTIVE: To compare the intra- and post- operative morbidities on the use of radiofrequency ultrasonic dissector (US) with the use of laser during tonsillectomy in the same patients. METHODS: A randomized comparative study was implemented where all patients underwent tonsillectomy at Al-Hada Armed Forces Hospital, Taif, and Aouhod Hospital, Al-Madinah, Kingdom of Saudi Arabia during the period January 2000 to December 2005 were recruited for the study. Radiofrequency US was used in one side, and laser was used in the other side of the same patient. Intra- and post- operative blood losses, and duration of the operation, in addition to postoperative pain score were recorded. RESULTS: Five hundred and twenty-eight patients were recruited for the study. The mean operation duration was significantly shorter in the US group as compared to the laser group (p<0.01). Intraoperative blood loss was significantly lesser in the US group (p<0.001). Post-operative pain score was significantly lower among US subjects (p<0.001). No significant difference in postoperative hemorrhage was detected between the compared groups. CONCLUSION: The use of US in tonsillectomy showed a beneficial effect on intraoperative blood loss, duration of the operation, as well as, postoperative pain over the use of laser.

Association of glycosylated haemoglobin level and diabetes mellitus duration with the severity of coronary artery disease.

Diabetes mellitus (DM) is known to cause microvascular and possibly macrovascular complications. This study was performed to find the association between glycosylated haemoglobin (HbA1C) level and the severity of coronary artery disease. One hundred and ten consecutive patients admitted to hospital with acute myocardial infarction were studied. Seventy-eight patients (70.9%) had DM, 73 (93.58%) had HbA1C > 7%, 52 (47.3%) were hypertensive, 19 (17.3%) had a history of smoking and 37 (33.6%) had raised cholesterol. Coronary angiography was carried out in 87 (79.1%) patients and the severity of disease was assessed using the Gensini score. The mean Gensini score was 53.36+/-36.94 and the mean HbA1C was 8.4+/-2.39%. There was a significant association between Gensini score and DM (p=0.003) and between Gensini score and hypertension (p=0.018). HbA1C (r=0.427, p=0.001) and duration of DM (r=0.362, p=0.004) had a positive linear correlation with the Gensini score. Multiple regression analysis showed HbA1C to be an independent factor that influenced the Gensini score (p=0.021).

Exercise capacity of Saudi with symptoms suggestive of cardiovascular disease in a military hospital in Western Saudi Arabia.

OBJECTIVE: To analyze the results of exercise tolerance test (ETT) of Saudi women and assess their exercise capacity. METHODS: A hospital based retrospective cohort analysis was carried out on all Saudi women referred to the Cardiology Department for ETT from February 2005 to June 2007. They underwent symptom limited treadmill test according to the standard Bruce protocol with exercise electrocardiogram monitoring. RESULTS: One hundred and seventy-six women were included in the study. Fifty-one (31.9%) patients did not achieve target heart rate. The mean age +/- SD was 48.3 +/- 9.3 years. There was no association of age, diabetes mellitus, hypertension, positive family history of ischemic heart disease (IHD) and hyperlipidemia to achieve target heart rate (p>0.05). Exercise time was influenced by diabetes mellitus (p=0.054) and hyperlipidemia (p=0.044). The mean exercise time +/-SD was 5.15 +/- 2.63 minutes and the mean exercise capacity +/-SD was 6.29+/-2.52. metabolic equivalent. Sensitivity was 36.4% (95% CI 29.3-44.6), specificity 92.3% (95% CI 80.5-96.8), positive predictive value 26.7% (95% CI 21.3-31.4), negative predictive value 95.4% (95% CI 90.9-98.3), likelihood ratio for positive result was 4.7 (95% CI 3.1-6.2) and likelihood ratio for negative result was 0.69 (95% CI 0.48-0.81). CONCLUSION: Exercise capacity of Saudi women is less when compared to similar studies in women from other regions. Exercise tolerance test can be used to rule out presence of IHD in Saudi women, but value of a positive test is less likely to predict the presence of IHD.

Pattern of disability among patients attending Taif Rehabilitation Center, Saudi Arabia.

PURPOSE: Despite the growing awareness of the community about the economic, psychological and medical impact of disability, limited research has been carried out to determine the pattern of disabilities in Saudi Arabia. METHODS: This is a cross-sectional study of hospital records of patients who were admitted to Armed Forces Rehabilitation Center, Taif, Saudi Arabia, during the period from 1999-2005. A total of 850 patient records were reviewed. Data were collected on age, sex, nationality, data of admission and discharge and type of disability. Univariate and multivariate logistic regression analyses were performed to determine predictors of long stay at the hospital. RESULTS: Trauma as an etiology of disability was more common than non-traumatic incidents among male and middle age patients (16-45 years). Traumatic accidents mostly result in quadriplegia (72.8%). Male, single, less than 45 years old, patients with traumatic accidents and patients with paralytic types of disability were significantly more likely to stay longer at the hospital (>or=6 months). CONCLUSIONS: The home care program should be expanded to minimize duration of stay at the rehabilitation centers with lower cost as well as health education of the public would help in encouraging disabled patients to adapt to daily life activities.

Non-Hodgkin's lymphomas in Alexandria, Egypt; incidence rates and trend study (1995-2004).

During the past decades, the incidence of the most common non-Hodgkin's lymphomas has increased dramatically worldwide. In Egypt, it is the fifth most common cancer in both the sexes. The purpose of this study is to study the problem of non-Hodgkin's lymphomas in Alexandria, Egypt: incidence rates and trend. The method employed was record reviewing for estimation of the annual incidence rates of non-Hodgkin's lymphoma and their trends. The general incidence rate of non-Hodgkin's lymphoma was 5.90 in 1995 and reached 8.99 in 2004, with a peak (9.40) in the year 2002. The male incidence of non-Hodgkin's lymphoma demonstrated an obvious rise from 1995 to 1998, with a slowing from 1999 to 2002, followed by another evident rise from 2003. Women showed an increase in non-Hodgkin's lymphoma incidence rates from 1995 to 2000, then a decline afterwards, till 2004. As regards the population from 15 to 60 years old, there was a rise through the period from 1994 to 1999, then a drop from 2000 to 2004. In the elderly group, the incidence rate was doubled during the 10 years (from 13.36/100 000 in 1995 to 26.65 in 2004). The incidence of non-Hodgkin's lymphoma increased steadily from 1995 to 2004 in Alexandria, particularly in the elderly population. The importance of developing additional strategies for screening and prevention of non-Hodgkin's lymphoma, in this group, on the basis of epidemiological evidences is warranted.

Insomnia symptoms and their correlates among the elderly in geriatric homes in Alexandria, Egypt.

The prevalence of sleep complaints increases steadily with age. Studies investigating insomnia among elderly people living in geriatric homes, especially among Egyptians, are scarce. This study aimed to determine the prevalence of insomnia symptoms among the elderly living in geriatric homes in Alexandria and their correlates. A cross-sectional survey of a representative sample of elderly population of geriatric homes in Alexandria was implemented. A total of 177 persons aged 60 years or older participated. Difficulty initiating sleep was reported by 65% of the participants. Approximately half of them had difficulty maintaining their sleep (50.8%) or had non-restful sleep (51.4%). Short sleep was reported by 43.5% of the participants, while early morning awakening was reported by 28.2%. Advanced age (> or = 75 years) was significantly associated with increased risk for early morning awakening, non-restful sleep and short sleep. Women had approximately a fourfold risk of non-restful sleep as opposed to men. Short stay in geriatric homes (<1 year) was associated with 2.5-fold increased risk of non-restful sleep. Unmarried status was strongly and positively related to difficulty to maintain sleep and non-restful sleep. Depressive status was significantly associated with an increased risk of difficulty to maintain sleep and decreased risk of early morning awakening. Conclusively, the present study showed that insomnia symptoms are highly prevalent among the elderly living in geriatric homes. It also revealed that although age, gender, and other socio-demographic factors are correlated with insomnia symptoms, other factors are highly important. Health care providers should take these factors in consideration when dealing with elderly patients who complain of insomnia.

Prevalence, symptomatology, and risk factors for depression among high school students in Saudi Arabia.

OBJECTIVE: To assess the prevalence and pattern of depression in a secondary school sample of Saudi Arabia adolescents. METHODS: Four hundred and ninety secondary school students, comprising 306 males (62.4%) and 184 females (37.6%), in the age group 16-20, were surveyed from January to May, 2005 in Taif, Saudi Arabia, using the Arabic Beck`s Depression Inventory (BDI) by a team consisting of a psychiatrist and psychologist. RESULTS: The prevalence of depression according to the Beck Depression Inventory (CBDI) (cut-off point: 19) was 110 (22.4%) for moderate (19-29), 36 (7.3%) for severe (30-40), and 18 (3.7%) as very severe (>40) in this study group, with a clear predominance of prevalence of depression in girls than in boys (1.5 times). Multivariate logistic regression analysis demonstrated that the most significant risk factors involved were: gender, birth order, history of psychiatric illness, history of relative loss, and familial history of chronic diseases. Factor analysis revealed that self-criticalness, agitation, and loss of energy had the highest scores in the total sample. In the male subgroup, loss of energy, self-criticalness, punishment feeling, and agitation had the highest score while in the female subgroup, self-criticalness, agitation, and crying had the highest scores. CONCLUSION: Our findings provide gender differences in the prevalence and presentation of depressive symptoms. The experience of stressful life events increases the risk of depression. Assessment using screening is recommended. The increased risk for the onset of depression in adolescents reinforces the importance of early recognition and intervention.

Anemia and nutritional status of schoolchildren living at Saudi high altitude area.

OBJECTIVE: To estimate the prevalence and possible risk factors for anemia and abnormal anthropometric measurements among schoolchildren in Al-Hada Area, Taif, Kingdom of Saudi Arabia. METHODS: We conducted the study between January and April, 2005 at Al-Hada area. A nested case-control study was conducted to estimate risk factors for anemia and abnormal anthropometric measurements. RESULTS: From 5 schools, 513 students were recruited. The mean hemoglobin concentration was 13.4+/-0.9 g/dL, while the prevalence of anemia was 11.6% and 15.5% based on hemoglobin and hematocrit values. At the same time, underweight affected 14.2% of the students, and stunting affected 12.2%. Moreover, 9.8% of the students were obese and 13.8% suffered from wasting. Most of the victims of anemia and erroneous anthropometric measurements were females, except for wasting which was more prevalent among males. CONCLUSION: Anemia is highly prevalent among these schoolchildren, which is seriously affecting the growth of 6-14 year-old children. Similarly, malnutrition seems to be a significant health problem among those children as estimated by anthropometric measurements, where all forms of abnormal body measurements affected at least 9.8% of the studied group. An in-depth investigation of the etiological factors of iron deficiency and malnutrition is urgently needed, and suitable nutrition-education and iron supplementation programs are recommended.

Surveillance of nosocomial infections at a Saudi Arabian military hospital for a one-year period.

UNLABELLED: The objectives of the current study are to define how many and what kind of nosocomial infections are occurring, what are the causative microbes and what kind of drugs can be used in treatment of infection at Al-Hada Armed Forces Hospital, Taif, Saudi Arabia during the year 2004. A prospective study was implemented for all cases admitted at Al-Hada Armed Forces Hospital during the period 1(st) January, 2004 till 31(st) December, 2004 and which developed infection. Determination of nosocomial infections was performed using standardized CDC criteria. A total of 1382 patients had developed infection during hospital admission and were included in the study. Of them, 668 (48.3%) had nosocomial infection and 714 (51.7%) had community-acquired infection. Among those who developed nosocomial infections, 216 (32.3%), 172 (25.7%) and 124 (18.6%) had respiratory tract (RTI), urinary tract (UTI) and blood stream infections (BSI) respectively. Surgical site infection (SSI) was reported in 86 cases (12.9%). The overall nosocomial infection rate along the study period was 4.98 per 100 discharged patients. Gram-positive organisms were reported in 31.8%. MRSA (Methicillin-resistant S. aureus) was the commonest (10.2%), followed by coagulase negative staphylococci (8.5%) and MSSA (Methicillin-susceptible S. aureus, 7.4%). While Gram-negative organisms were reported in 66.2%, E. coli was the commonest (22.3%), followed by Pseudomonas aeruginosa (17.6%) and Klebsiella pneumoniae (9.9%). Acinetobacter spp. and MRSA were highly sensitive to Imipenem (88.6%) and Vancomycin (98.5%) respectively. E. coli were highly sensitive to most of the antimicrobial agents except ampicillin (26.6%). CONCLUSIONS: Pneumonia, urinary tract infections, and blood stream infections made up the great majority of nosocomial infections. There is a need for further risk assessment associated with main types of infection.

Epidemiologic study of nosocomial urinary tract infections in Saudi military hospitals.

A case-control study of patients with and without confirmed UTI was performed to identify risk factors for nosocomial UTI. Duration of hospitalization, unit of admission, history of diabetes mellitus or debilitating diseases, and duration and number of urinary catheters were independently associated with increased risk of nosocomial UTIs.

Nosocomial urinary tract infection. Risk factors, rates and trends.

OBJECTIVE: This report aims at both estimation of the rates of overall nosocomial and urinary tract infection (UTI) and their linear trends as well as studying the potential risk factors of patients admitted to Al-Hada, Rehab and Prince Sultan military hospitals and developed nosocomial UTIs (NUTIs). METHODS: A case-control study on 206 discharged patients with confirmed UTI and 618 controls without UTI was carried out between August 2001 through to July 2003 to study risk factors for nosocomial UTI as well as hospital records during the period (1998-2002) were reviewed for calculation of the overall annual nosocomial infection and nosocomial UTI rates. RESULTS: Multiple logistic regression analysis showed that duration of hospital stay, unit of admission, history of diabetes mellitus or debilitating diseases, and duration and number of urinary catheters were independently associated with increased risk of NUTIs. The mean incidence rate of overall nosocomial infection along the study period (1998-2002) was 2.82, while the mean incidence rate of UTI nosocomial infection was 0.85 per 100 discharged patients. Urinary tract infection represents approximately 31.7% of overall nosocomial infection throughout the study period. CONCLUSION: Urinary tract infections comprise approximately one third of nosocomial infections. The results, thus, indicated that to reduce the incidence of UTI nosocomial infection, it was important to take factors that can be managed into consideration. Therefore, the involved persons should pay more attention and set practical and effective guidelines for the hospital.

Emotional and behavioral problems among male Saudi schoolchildren and adolescents.

OBJECTIVE: Determination of the prevalence rate of emotional or behavioral problems, or both, among male Saudi schoolchildren and identifying the possible risk factors behind these problems. METHODS: The study was conducted from March-May, 2003 and included all male schoolchildren of Al-Abnae schools specialized for the sons of the employees of the Saudi Ministry of Defense (military and civilians) in Taif Governorate, Kingdom of Saudi Arabia (total number 1416 students). It was conducted through 2 phases: A screening phase (using the Child Behavior Checklist "Parent`s form") for all schoolchildren and adolescents included in the study through a cross-sectional approach to assess their emotional and behavioral problems, and a case-control phase to study risk factors. RESULTS: Among the 1313 male schoolchildren that participated in the study, 109 (8.3%) were emotionally or behaviorally disturbed students. Among studied sociodemographic variables, only educational level (intermediate versus primary) and mother`s occupation (working versus non working) was associated with a higher risk of developing emotional or behavioral disturbance. Unwanted pregnancy (odds ratio [OR]=4.77, confidence interval [CI] 3.68-5.86), history of meningitis (OR=7.50, CI 5.12-9.88), history of accidents (OR=4.07, CI 2.87-5.26) and those with history of bronchial asthma (OR=2.96, CI 2.16-3.76) had an increased risk of emotional or behavioral disturbance. CONCLUSION: The prevalence rate of behavioral and emotional disturbance according to parent`s reports is lower than that reported in other countries. Several risk factors including child, familial, and environmental risk factors play an important role in the genesis of emotional and behavioral problems in schoolchildren. Mental health problems can be recognized and treated; caring families and communities working together can help.