Acute exposure to Catha edulis depresses contractility and induces myocardial infarction in spontaneously contracting, isolated rabbit's heart.

Khat chewing is a recreational habit known to pose major socio-economic and medical problems in countries of Southern Arabia and the Horn of Africa. Among other adverse health effects, khat chewing has been associated with an increased risk of myocardial infarction (MI) in heavy consumers. This study was carried out to examine the direct effects of Catha edulis extract on contractility of spontaneously contracting, isolated rabbit heart and to investigate its mechanism of action. Isolated six rabbit's hearts attached to a Langendorff apparatus were perfused with extract at a constant flow rate and continuously bubbled with a 95% O2/5% CO2 gas mixture. Each heart served as its own control, as responses were recorded before and after administration of C. edulis extract. Varying concentrations of extract (50, 100 and 250 mg/ml) were loaded in the perfusate, their effects recorded and effluent fluid collected for assay of cardiac enzymes. Histological examination of the cardiac tissue was performed at the end of perfusion with 250 mg/ml extract. This study revealed that acute exposure to C. edulis extract exerted negative inotropic and chronotropic effects on isolated hearts. The extract also had a vasoconstrictor effect on coronary vessels, independent of α1 adrenergic receptor stimulation. Histological examination of hearts perfused with 250 mg/ml C. edulis extract revealed the presence of histological changes unique to myocardial infarction, a finding consistent with observed increased levels of cardiac enzymes in perfusates. Thus, we have demonstrated experimentally a direct cardiac depressant- and MI inducing effects of C. edulis extract. These results are consistent with the earlier reported deleterious effects of khat on cardiovascular function among khat chewers.

Adherence of primary health care physicians to hypertension management guidelines in the Aseer region of Saudi Arabia.

Although there has been significant progress in the management of hypertension, rates for control of this chronic disease in the Kingdom of Saudi Arabia (KSA) has been shown to be very low. This study was aimed to assess the knowledge of primary health care (PHC) physicians and the extent of their adherence to the recommendations of clinical practice guidelines concerning care of hypertensive patients. The assessment was made in the Aseer region of KSA using a modified version of the World Health Organization "Physician Inquiry Questionnaire." Only 5.6% of the participants measured blood pressure (BP) with the patient in sitting and other postures. Variable sphygmomanometer cuff sizes for different patients were used by 56.5% of the participants, while 74.8% correctly recorded the diastolic BP at Koratkoff sound, phase- 5. Among non- diabetics, the correct diagnosis of systolic and diastolic hypertension was reported by 76.7% and 81.4% respectively, of the PHC physicians. Among diabetics, the correct diagnosis of systolic and diastolic hypertension was reported by 36% and 17.1% of the PHC physicians, respectively. Most physicians inquired about cardiovascular risk factors. Several important items of patients' clinical examination were not completely covered by physicians, e.g., fundus examination (75.2%). PHC physicians missed a few investigations and laboratory tests, e.g., ECG (87.9%), serum creatinine (88.2%) and lipid profile (89.8%). Less than one- fifth of the physicians correctly chose the thiazide diuretics as the preferred initial anti- hypertensive agent (19.9%). Almost two- thirds of the physicians (65.2%) emphasized the importance of BP self- measurement, 89.8% encouraged patients to use a reminder system while 96.3% motivated patients for BP control. Measures for lifestyle modification included weight reduction (98.8%), sodium restriction (97.5%), physical exercise (96.3%) and behavioral improvement (87.6%). Our study suggests that continuing medical education and training courses on guidelines for hypertension management should be arranged for PHC physicians in Aseer.

Prevalence of Depression, Anxiety and Stress as Measured by the Depression, Anxiety, and Stress Scale (DASS-42) among Secondary School Girls in Abha, Saudi Arabia.

OBJECTIVES: To determine the prevalence of symptoms of depression, anxiety and stress among secondary school girls. METHODS: A cross- sectional study was carried out on secondary school girls in Abha city, Aseer Region, Saudi Arabia, using the Arabic version of the Depression, Anxiety, and Stress Scale (DASS-42). RESULTS: Of 545 female students recruited in this study, 73.4% had the symptoms of at least one of the three studied disorders; 50.1% had at least two disorders. The prevalence of symptoms of depression, anxiety and stress was 41.5 %, 66.2% and 52.5% respectively. The majority of symptoms were mild to moderate in severity. The scores for depression, anxiety, and stress were positively and significantly correlated. No significant association was found between the girls' sociodemographic characteristics and the scores of the three studied disorders. CONCLUSION: One of the most important aspects of a primary care physician's care of females is to screen for and treat common mental disorders.

Quality of referral letters to Abha Psychiatric Hospital, Asir region, Kingdom of Saudi Arabia.

OBJECTIVE: This study aims to explore the quality of referral letters from different health institutions to Abha Psychiatric Hospital, the only psychiatric center in Asir region, Kingdom of Saudi Arabia. METHODS: In this descriptive study, a total of 582 consecutive referral letters to Abha Psychiatric Hospital, during the first half of 1998, were evaluated for the components that are supposed to be found in the consentient referral letter to a psychiatric service. Each letter quality was indicated as good or poor according to the used scale. RESULTS: Thirty-six percent of the referral letters were poor. The clinical information relating to the psychiatric history was significantly poor compared to other clinical information (p<0.05). Asir Central Hospital (tertiary level) referral letters were better in quality than those of secondary hospitals (p<0.001). Referral letters with diagnosis or impression of legal concern showed a better quality compared to others (p<0.001). CONCLUSION: The quality of clinical information relating to the psychiatric history in the referral letters to psychiatric service, needs to be improved to ensure better patient care and more appropriate use of resources.