Obesity: an emerging problem in Saudi Arabia. Analysis of data from the National Nutrition Survey.

To document the prevalence of obesity in Saudi Arabia, we used data from a cross-sectional study on 19,598 individuals in 2837 households. Body mass index, skinfold thickness and mid-arm circumference were measured. Prevalence of obesity ranged from 33.9% in Ha'il to 11.7% in Jizan. More women than men were obese, 23.6% compared to 14.2%. Prevalence of overweight was 30.7% for males and 28.4% for females. Obesity was present in all age groups. It is clear that changes must be made to the lifestyle of the Saudi population in order to reduce the prevalence of obesity.

Obesity: an emerging problem in Saudi Arabia. Analysis of data from the National Nutrition Survey

To document the prevalence of obesity in Saudi Arabia, we used data from a study on 19 598 individuals in 2837 households. Body mass index, skinfold thickness cross-sectional and mid- arm circumference were measured. Prevalence of obesity ranged from 33.9% in Ha'il to 11.7% in Jizan. More women than men were obese, 23.6% compared to 14.2%. Prevalence of overweight was 30.7% for males and 28.4% for females. Obesity was present in all age groups. It is clear that changes must be made to the lifestyle of the Saudi population in order to reduce the prevalence of obesity

Behaviour and time-course of sleep disordered breathing in patients with acute coronary syndromes.

To our knowledge, no study has examined the persistence of sleep disordered breathing in acute coronary syndrome (ACS) patients. We examined the time course of SDB in ACS patients by assessing them within days of the acute event and again after 6 months. Consecutive patients with ACS were asked to voluntarily participate in the study. Patients underwent an overnight polysomnography (PSG) approximately 3 days after the acute event. Patients with an apnea hypopnea index (AHI) > 10/h then underwent another PSG after they were stable (approximately 6 months). Fifty patients were studied. First PSG showed an AHI was 23.1 +/- 3.6/h. A second PSG was performed 6.1 +/- 0.3 months later on 21 patients and showed an AHI > 10/h in the first assessment. The AHI and the obstructive apnea index did not change over the 6 months. However, the central apnea index all was lower at the second assessment.

Risk factors of coronary artery disease in different regions of Saudi Arabia.

A national nutrition survey was carried out in Saudi Arabia between 1989 and 1994. One objective was to investigate the prevalence of well established atherogenic risk factors among adults 18 years and older, namely obesity, hypercholesterolaemia, hypertriglyceridaemia, diabetes mellitus and high systolic and diastolic blood pressure. Obesity prevalence was positively correlated with all five coronary artery disease risk factors investigated. Variation among regions in relation to the prevalence of these risk factors was observed. Saudi Arabia's ecology has resulted in variation in the lifestyle and food consumption patterns of the people of the different regions, which might be a major underlying cause of the variation and high prevalence of coronary artery disease risk factors.

Risk factors of coronary artery disease in different regions of Saudi Arabia

A national nutrition survey was carried out in Saudi Arabia between 1989 and 1994. One objective was to investigate the prevalence of well established atherogenic risk factors among adults 18 years and older, namely obesity, hypercholesterolaemia, hypertriglyceridaemia, diabetes mellitus and high systolic and diastolic blood pressure. Obesity prevalence was positively correlated with all five coronary artery disease risk factors investigated. Variation among regions in relation to the prevalence of these risk factors was observed. Saudi Arabia's ecology has resulted in variation in the lifestyle and food consumption patterns of the people of the different regions, which might be a major underlying cause of the variation and high prevalence of coronary artery disease risk factors

The prevalence of hypertension in different geographical regions of Saudi Arabia.

BACKGROUND: The results of the National Nutrition Survey of the people of the Kingdom of Saudi Arabia showed that the prevalence of arterial hypertension (BP >/= 160/95 mmHg) among the adult population is 5.3% and 7.3% for systolic and diastolic hypertension, respectively. The objective of this study, which is part of the Survey, was to investigate if the diversified ecological nature of the life of the people of the Kingdom has an effect on the prevalence of arterial hypertension in the adult population in the different geographical regions of the Kingdom. MATERIALS AND METHODS: The Survey was population-based, employing cluster sampling methods and household visits by health teams trained by the same investigators to avoid individual variations and ensure data validity. 2,556 families with 17,892 individuals of all ages were randomly selected from 12 areas according to the population distribution all over the Kingdom. The total number examined for BP with complete data amounted to 13,700 individuals, of whom 6,260 were adults (over 18 years of age). The WHO definition of arterial hypertension was used. Also used was the definition of 140/90 mmHg. RESULTS: Systolic blood pressure hypertension (SBPH) showed a statistically significant difference (P<0.001) among the regions. The highest prevalence was found in Farasan (8.9%) and the lowest was reported from Asir (2.2%). There was a higher prevalence among females compared to males in the 40-75 year age group in all regions, except in the highlands of Al Taif and Asir. However, the difference was not statistically significant, except in Makkah (25.9%, P<0.001) and Al Sharikia (22%, P<0.03). Diastolic blood pressure hypert ension (DBPH) prevalence increased with age in all regions, except in males of Farasan, Makkah, and in females of Asir. The difference in the prevalence between regions was statistically significant (P<0.001). The highest DBPH prevalence (sexes combined) was reported from Al Qassim (10.6%) and the lowest from Makkah (4.2%). Using the definition of hypertension as 140/90 mmHg, the highest SBPH prevalence was reported from Makkah (sexes combined) (27.9%), while the lowest was from Makkah and Asir (22% each). The prevalence of SBPH and DBPH was insignificantly higher among females than males in eight and seven of the 12 regions, respectively. CONCLUSION: There is a statistically significant difference in the prevalence of SBPH and DBPH in the different regions of the Kingdom (P<0.001). The prevalence pattern tends to be fairly similar to that found in the affluent societies in the Western countries.

Arterial hypertension in Saudi Arabia.

A cross-sectional population-based survey employing a cluster sampling method and household visits by trained health teams investigated hypertension prevalence in the Kingdom among 13,700 individuals of both sexes in all age groups. The World Health Organization (WHO) definition of hypertension of = 160/95 mmHg was used; it was found that 9.1% and 8.7% of the total sample investigated were systolic and diastolic hypertensives, respectively. However, 12.4% and 7.9% of children younger than 18 years were systolic and diastolic hypertensive. Among adults aged 18 years and above, 5.3% were systolic and 7.3% were diastolic hypertensives; 87.5% of systolic and 79.4% of diastolic hypertensives were aged 40 years and over. Females had statistically significant elevated systolic hypertension compared with males (P < 0.01). However, if blood pressure = 140/90 mmHg is used as a criterion for hypertension definition, the prevalence among the latter age groups would be 20.4% for systolic and 25.9% for diastolic hypertension. The prevalence of Isolated Systolic Hypertension (ISH), Isolated Diastolic Hypertension (IDH) and Systolic Diastolic Hypertension (SDH) among adults above 18 years was 1.8%, 3.8% and 3.5% respectively. ISH was higher among females compared with males (2% vs 1.4%), while IDH was higher among males than females (4.4% vs 3.4%). There is a need for tracking childhood hypertension, which could provide long-term analysis for risk of adult hypertension.

Cardiac amyloidosis: Diagnostic features and clinical implications.

Seven patients with cardiac amyloidosis were referred to King Khaled University Hospital. All patients in this study developed congestive heart failure. They had a long duration of illness and thickened ventricular wall with marked abnormalities in the left ventricular filling, and normal systolic function. Diastolic function is suggested as a possible mechanism of congestive cardiac failure in the patients presented.

Prevalence of bicuspid aortic valve and mitral valve prolapse in a healthy Saudi population and the clinical implications of their association.

In this study, 103 Saudi males and 172 Saudi females were referred for medical check-up for employment purposes and/or as undergraduate students. Clinical evaluation of all participants included full cardiovascular examination, with the following investigations being performed: ECG, chest x-ray, and cross-sectional echocardiography. Bicuspid aortic valve was detected in three males and in four females, for a total percentage of 2.5%. Isolated mitral valve prolapse was detected in seven males (6.7%) and six females (3.5%). Association with mitral valve prolapse was reported in five males and seven females, with a total percentage of 4.3%. This association seems to have important etiological, medical and surgical implications.

Clinical spectrum of skeletal abnormalities and mitral valve prolapse and their clinical implications.

Fifty-six patients were diagnosed to have mitral valve prolapse (MVP) syndrome by auscultatory criteria, confirmed by cross-sectional echocardiography. Complete physical examination and x-ray of the bony thorax revealed bony deformities which were subdivided into four main groups according to the predominant deformity. Shallow chest with pectus excavatum, straight back, kyphoscoliosis and elliptical chest in marfanoid patients were reported in the cases studied. It is concluded that musculoskeletal abnormalities have to be considered as nonauscultatory features of MVP. Therefore, any patient with musculoskeletal deformity has to be screened for MVP by cross-sectional echocardiography to prevent life-threatening complications.

Horizontal versus vertical transmission of human immunodeficiency virus type 1 (HIV-1). Experience from southwestern Saudi Arabia.

Twenty-five confirmed cases of human immunodeficiency virus type 1 (HIV-1) infection due to blood transfusion have been documented at King Fahad Hospital (KFH) in Al-Baha, southwestern Saudi Arabia since 1986, but complete follow-up was only possible on 19 of these cases and their contacts. Seventeen cases were diagnosed as having acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) after admission to the hospital due to the deterioration of their health status. Two cases were found to be anti-HIV-1 positive on routine screening for blood donation. This cluster of HIV-1 infected patients through blood transfusion allowed us to study the efficiency of sexual transmission of HIV-1 infection between spouses, the rate of perinatal transmission of HIV-1 infection, and to see whether intrafamilial transmission is a possible route of spread of the virus. Firstly, the present results confirm our earlier observation that transmission of HIV-1 infection was more efficient from the infected husband to his wife(s) in contrast to the inefficient transmission of the infection from the infected wife to her husband. Secondly, by the age of 16 months, all nine newborns to HIV-1 infected mothers became HIV-1 infected. This highlights the importance of medical advice to those mothers regarding conception and/or breast-feeding, particularly as breast-feeding up to 2 years is not an uncommon practice among Saudi women. Finally, none of the household contacts of the 19 cases was infected until now, indicating that intrafamilial spread of HIV-1 did not occur among the population studied.

PIP: In June 1986, screening for anti-HIV using enzyme immunoassay (EIA) started on all donated blood at King Fahad Hospital (KFH) in Al-Baha, southwestern Saudi Arabia. In December 1988, an HIV clinic was established at KFH and 25 adult cases were identified as HIV-1 positive who had a history of blood transfusion between 1982 and 1986. Follow-up was only possible in 19 of these cases and their contacts. When a person was found to be anti-HIV-1 positive, all family members were called for HIV testing. Contacts of HIV-1 positive patients were followed-up on a monthly basis, and those who were anti-HIV-1 positive were started on zidovudine therapy. Serum testing for anti-HIV and for HIV-Ag was done by enzyme-linked immunosorbent assays (ELISA) and confirmed by Western blot. The majority of cases were diagnosed as having AIDS (10/19) or ARC (5/19) after admission to the hospital. All AIDS cases died within 2 months after diagnosis, while those with ARC died within 1-2 years after the diagnosis. Two of the cases (cases 1 and 2) were found anti-HIV-1 positive on routine screening for blood donation, and 3 cases (cases 11, 17 and 18) were detected when their respective children were admitted and diagnosed as having AIDS. In case 6, as in case 7, the husband infected both wives. All children born before the mother had the blood transfusion and hence the infection were anti-HIV-1 negative and were still negative after 3-7 years of follow-up. In contrast, all 9 children born to HIV-1-positive mothers became infected. Although some of the infants had no evidence of infection up to 9 months of age or more, all became anti-HIV-1 positive and HIV-Ag positive by 16 months of age. These children had no blood transfusion during the 16 months period.

Haemostatic variables in patients with unstable angina.

To assess the contribution of thrombus formation in the pathogenesis of unstable angina, we employed the recently developed assays of small fragments which reflect the degree of activation of various components of the haemostatic system. Such haemostatic measurements were undertaken in patients with unstable angina (n = 47) from the time of their admission to the coronary care unit (CCU) at 8-h intervals in the first 24 h and then daily for a total of 5 days. The results obtained were compared with healthy control values. Patients exhibited lower ATIII, prolongation of the APTT and TT, but not PT or the reptilase time, which is a consequence of heparinization. There was significant elevation of fibrinogen, factor VIII:C, von Willebrand factor:antigen and von Willebrand factor:ristocetin cofactor throughout the study period. There was also evidence of thrombin generation as indicated by the elevated levels of fibrinopeptide A (FPA) and thrombin-antithrombin complexes. The platelet release proteins, beta-thromboglobulin (BTG) and platelet factor 4 (PF4), were markedly elevated in the first 2 days and dropped gradually thereafter. The fibrinolytic inhibitor, plasminogen activator inhibitor (PAI), levels were elevated throughout. Proteins C and S, plasminogen and alpha 2-antiplasmin remained unchanged. It was concluded that in patients with unstable angina, there is significant activation of the clotting system and inhibition of fibrinolysis which confirms the existence of a tendency towards thrombus formation in patients with unstable angina.

Residency training in graduate medical education (nine-year view).

Assessment of the progress of residency training in graduate education after 9 years shows that the original goals established for various specialties are being effectively met. There are now 7 approved residency programmes for diplomas and 10 approved residency programmes for fellowships with 324 residents trained and in training, out of whom (32%) were females, and 222 (68%) were male residents. Student interest in these programmes has remained at a high level. Only 15 candidates (4.64%) had withdrawn from the residency training programmes. Heavy emphasis has been placed upon curriculum design, selection criteria of students and quality control mechanisms through residency committees in specialty departments and the residency board embracing residency coordinators. This paper outlines some concerns regarding the present status of various residencies and suggests some recommendations for future development of these programmes.

Electrocardiographic abnormalities in patients with heat stroke.

Serial electrocardiograms were taken in 46 Hajj Pilgrims suffering from heat stroke immediately after cooling 12 and 24 h later. The collected data were analyzed and revealed that a statistically significant number of patients with heat stroke had sinus tachycardia (43 percent, p < 0.05), conduction defect (22 percent, p < 0.046), prolonged Q-T interval (61 percent, p < 0.007), diffuse nonspecific ST-T changes (26 percent, p < 0.036), and ST-T changes (localized to the ECG leads confirming to a territory of coronary artery) consistent with myocardial ischemia (21 percent, p < 0.02). Although adverse effects of heat stroke on the heart are multifactorial, the above data indicate that heat stroke predisposes to certain risk of myocardial ischemia and conduction disturbances. This may reflect the true cardiovascular status of these heat stroke victims.

Relationship of atrial fibrillation to significant pericardial effusion in valve-replacement patients.

Rhythm change was observed in 21 of 242 (8.7%) patients during the first four weeks of open heart surgery (OHS). In the valve-replacement group of 148 patients the rhythm change was found to be associated with significant pericardial effusion (PE). Seven patients had rhythm changes during the first three days of OHS unrelated to PE. Two patients who were in atrial fibrillation (AF) developed fast ventricular rate and twelve patients showed rhythm change from sinus to supraventricular tachyarrhythmia (AF in ten and supraventricular tachycardia in two) and all these fourteen patients had significant PE. With pericardiocentesis or open drainage or withdrawal of anticoagulation, AF reverted to sinus rhythm in nine patients and five patients remained in AF but with a slow ventricular rate. Significant PE was related to a high anticoagulation ratio. We conclude from this study that within the first four weeks of OHS, high anticoagulation ratio contributes to the development of significant PE, and tachyarrhythmia (particularly AF) is a forerunner of significant PE or cardiac tamponade: the aim of management should be to rule out or show evidence of significant PE once tachyarrhythmia develops, and if significant PE is present then the pressure in the pericardial cavity should be reduced.