Impact of Clinical Pharmacist Running Anticoagulation Clinic in Saudi Arabia.

Despite the effectiveness of warfarin in extended anticoagulation, its narrow therapeutic index requires frequent dose adjustments and careful patient monitoring. Thus, we aimed to evaluate the outcomes of clinical pharmacists' intervention in warfarin therapy management in terms of International Normalized Ratio (INR) control, reduction of bleeding, and hospitalization in a tertiary care hospital. An observational retrospective cohort study was conducted on 96 patients taking warfarin therapy in a clinical pharmacist-led anticoagulation clinic. We observed that 39.6% of patients required dose adjustments at their first and second visits. However, dose adjustments during the third, fourth, and fifth weeks were required at 31.1%, 20.8%, and 4.2%, respectively, to achieve INR levels. We also observed that 36.46% of the patients attained the target INR at baseline, which was increased over the first week to the fifth week to 57.29%, 61.46%, 61.46%, 68.75%, and 85.42%, respectively. No one reported the ADR between the third and fifth weeks. Based on our findings, the study strongly suggests that pharmacists' interventions can improve the health-related quality of life of patients undergoing warfarin therapy. Thus, competent pharmacy personnel must be a priority in both usual patient care and critical care among primary care networks.

Primary ovarian insufficiency and myasthenia gravis.

Myasthenia gravis (MG) is an autoimmune disease. In some patients, Primary Ovarian Insufficiency (POI) is considered to be an autoimmune condition. Their coexistence is rare and suggests autoimmune perturbation. We describe a patient who was determined to have POI at 17 years of age and who developed MG 20 years later.

Honey and diabetes mellitus: Obstacles and challenges - Road to be repaired.

BACKGROUND AND OBJECTIVE: Since ancient times, honey has been used due to its nutritional and therapeutic value. The role of honey has been acknowledged in the scientific literature however, its use has been controversially discussed and has not been well accepted in modern medicine especially for diabetic patients. This study aimed to investigate the role of honey in diabetic patients. METHODS: In this study, we identified 107 research articles from data based search engines including "PubMed", "ISI-Web of Science", "Embase" and "Google Scholar". The research papers were selected by using the primary key-terms including "Honey", "Honey bee" and "Diabetes Mellitus". The research documents in which "Honey" and "Diabetes Mellitus" were debated are included. After screening, we reviewed 66 papers and finally we selected 35 studies which met the inclusion criteria and the remaining documents were excluded. RESULTS: This study investigated the preclinical, clinical, human and animal model studies on honey and diabetes mellitus and found that honey decreases the fasting serum glucose, increases the sting C-peptide and 2-h postprandial C-peptide. Although, there is a dearth of data and literature also contrary discussed the use of honey in diabetic patients. CONCLUSION: Honey decreases the fasting serum glucose, increases fasting C-peptide and 2-h postprandial C-peptide. Honey had low glycemic index and peak incremental index in diabetic patients. The use of honey in diabetic patients still has obstacles and challenges and needs more large sample sized, multi-center clinical controlled studies to reach better conclusions.

Association of ABO and Rh blood groups with breast cancer.

OBJECTIVES: The aim of this study was to determine the association of "ABO" and "Rhesus" blood groups with incidence of breast cancer. METHODS: In this study, we identified 70 research documents from data based search engines including "PubMed", "ISI-Web of Knowledge", "Embase" and "Google Scholar". The research papers were selected by using the primary key-terms including "ABO blood type", "Rhesus" blood type and "breast cancer". The research documents in which "ABO" and "Rhesus" blood types and breast cancer was debated were included. After screening, we reviewed 32 papers and finally we selected 25 research papers which met the inclusion criteria and remaining documents were excluded. RESULTS: Blood group "A" has high incidence of breast cancer (45.88%), blood group "O" has (31.69%); "B" (16.16%) and blood group "AB" has (6.27%) incidence of breast cancer. Blood group "A" has highest and blood group "AB" has least association with breast cancer. Furthermore, "Rhesus +ve" blood group has high incidence of breast cancer (88.31%) and "Rhesus -ve" blood group has least association with breast cancer (11.68%). CONCLUSION: Blood group "A" and "Rhesus +ve" have high risk of breast cancer, while blood type "AB" and "Rhesus -ve" are at low peril of breast cancer. Physicians should carefully monitor the females with blood group "A" and "Rh +ve" as these females are more prone to develop breast cancer. To reduce breast cancer incidence and its burden, preventive and screening programs for breast cancer especially in young women are highly recommended.

Exome sequencing reveals MCM8 mutation underlies ovarian failure and chromosomal instability.

Premature ovarian failure (POF) is a genetically and phenotypically heterogeneous disorder that includes individuals with manifestations ranging from primary amenorrhea to loss of menstrual function prior to age 40. POF presents as hypergonadotropic hypogonadism and can be part of a syndrome or occur in isolation. Here, we studied 3 sisters with primary amenorrhea, hypothyroidism, and hypergonadotropic hypogonadism. The sisters were born to parents who are first cousins. SNP analysis and whole-exome sequencing revealed the presence of a pathogenic variant of the minichromosome maintenance 8 gene (MCM8, c.446C>G; p.P149R) located within a region of homozygosity that was present in the affected daughters but not in their unaffected sisters. Because MCM8 participates in homologous recombination and dsDNA break repair, we tested fibroblasts from the affected sisters for hypersensitivity to chromosomal breaks. Compared with fibroblasts from unaffected daughters, chromosomal break repair was deficient in fibroblasts from the affected individuals, likely due to inhibited recruitment of MCM8 p.P149R to sites of DNA damage. Our study identifies an autosomal recessive disorder caused by an MCM8 mutation that manifests with endocrine dysfunction and genomic instability.

Accurate diagnosis as a prognostic factor in intrauterine insemination treatment of infertile saudi patients.

BACKGROUND: The study meant to define the prognostic factors that help in prescribing intrauterine insemination (IUI) for infertility treatment which remains an area of continuous improvements. METHODS: The diagnostic indications of a cohort of IUI-treated patients and their corresponding pregnancy rates (PRs) were randomly and prospectively studied among Saudi cohort of 303 patients for a period of 20 months. The indications of IUI cases were statistically analyzed for those eligible patients over a period of twenty months (January 2010 till August 2011), and the PR that corresponded to each group was investigated as well. P-value less than 0.05 was considered significant. RESULTS: The highest PR, 18.87%, of the polycystic ovarian syndrome (PCOS)-only diagnosed patients, was significantly higher than the average PR of all other indications combined, 7.22%, (p = 0.011, compared to all other groups combined). The second highest PR, 14.0%, of the tubal factor (TF)-only indication, was double the PR average of all other indications combined, though it did not reach significance. However, PCOS and TF accompanied by other indications caused the PR to drop to 5.88% and 5.56%, respectively. However, a group of some hormonal-imbalance based indications had the least PR (0.0% to 2.70%). Those indications were elevated serum FSH, hyperprolactinemia, hypogonadotrophy, hypothyroidism and endometriosis. The rest of the indications had an average PR (8.33% to 11.11%). CONCLUSION: There is a reasonable chance of conception after IUI treatment for female factor infertility except in cases with sever hormonal imbalance. The PCOS cases having the best success chances.

Age, body mass index, and number of previous trials: are they prognosticators of intra-uterine-insemination for infertility treatment?

BACKGROUND: To examine whether pregnancy rate (PR) of intrauterine insemination (IUI) is related to certain demographic factors, such as age and body mass index (BMI), along with number of IUI cycles performed, a set of infertile Saudi women. MATERIALS AND METHODS: During this prospective study (a 24-month period), 301 Saudi women with infertility underwent IUI in our infertility clinic. We investigated whether PR is correlated with patient age and BMI, and the number of IUI trials, in order to determine if they could be used as prognosticators of pregnancy success. RESULTS: The highest PR was 14.89% for ages 19-25 and the lowest PR was 4.16% for ages 41-45, indicating no statistically significant difference among PR in all age groups (p value of 0.225). Also, in terms of BMI, the highest PR was 13.04% for BMI ≥35 and the lowest was 7.84% for BMI of <25 to 18.5, indicating no significant difference among different BMI groups (p value of 0.788). One-cycle treatment, as expected, was more successful (PR=12.84%) than 2-cycle treatment (PR=5.75%), however, 3-5-cycles treatment still showed encouraging results (PR=17.24%); but the difference did not reach statistical significance (p value=0.167). CONCLUSION: PR after IUI treatment remained approximately 10% from 19 to 40 years of age and declined after 40. Although no significant difference was observed among different age groups, earlier treatment is still recommended. There was a positive but not statistically significant correlation between PR and patient's BMI indicating that BMI is not a determining factor. There was also no correlation between PR and number of IUI trials. Patients can thus try as many times as they want before moving on to in vitro fertilization (IVF) treatment.

Advanced reproductive age and fertility: no. 269, November 2011.

OBJECTIVE: To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies (ART) and provide recommendations for their management,and to review investigations in the assessment of ovarian aging. OPTIONS: This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility. OUTCOMES: The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility. EVIDENCE: Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in June 2010, using appropriate key words (ovarian aging, ovarian reserve, advanced maternal age, advanced paternal age, ART). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated into the guideline to December 2010. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table). BENEFITS, HARMS, AND COSTS: Primary and specialist health care providers and women will be better informed about ovarian aging and the age-related decline in natural fertility and about options for assisted reproductive technology.

Thrombosis of subclavian and internal jugular veins following severe ovarian hyperstimulation syndrome: a case report.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is a serious, albeit rare, complication of fertility treatment. In its severe form, it may be life-threatening. Increased vascular permeability with hemoconcentration is the hallmark of the syndrome. Vascular thromboembolism is a significant potential complication. CASE: A previously healthy 26-year-old nulligravid woman developed severe OHSS following an in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycle. She required hospitalization for treatment comprising IV fluid replacement, albumin infusion, paracentesis, and prophylactic heparin. She presented two days after discharge from hospital with left arm edema and neck pain. Subclavian and internal jugular vein thrombosis was diagnosed. CONCLUSION: OHSS is a serious complication of treatment for ovulation induction and is a significant risk factor for vascular thrombosis. Patients remain at risk even if given prophylactic heparin. The clinical presentation of OHSS may be unusual and late, indicating the importance of vigilance on the part of all physicians caring for patients who have undergone fertility treatment.