Measures of health-related quality of life in PCOS women: a cross sectional study from Saudi Arabia.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is the most common endocrine-gynecologic disorder affecting women of childbearing age. It has a wide range of clinical manifestations, including menstrual irregularity, infertility, hirsutism, acne, and obesity. Studies have confirmed that PCOS can significantly reduce a patient's health-related quality of life (HRQoL). The pathophysiology of PCOS is poorly understood, but it is believed to be caused by the interaction of several factors. Moreover, there is a lack of information about HRQoL among PCOS women in Saudi Arabia. This study aims to assess the HRQoL of PCOS patients by using the Arabic Version of the Polycystic Ovarian Syndrome Health-Related Quality of life Questionnaire (AR-PCOSQ) in Riyadh city. SUBJECTS AND METHODS: A descriptive cross-sectional study was conducted on 281 women in Riyadh city using the translated questionnaire (AR-PCOSQ) to explore PCOS quality of life among Saudi females. The eligibility criteria were Saudi female who had been diagnosed with PCOS, living in Riyadh city, aged 18 and above, and willing to participate. The sample size was estimated using the 10-events-per variable rule for prediction models (REF). Informed consent was taken from all participants and a Google Form was used to create the survey and collect data. RESULTS: The higher score represents poor QOL. However, the analysis revealed that higher scores of the weight-related QOL had the greatest impact on patients' quality of life in older age groups, including women aged 26 to 35 (beta = 0.143, 95% CI, 0.023 to 0.304, p-value = 0.046) and women aged > 35 (beta = 0.229, 95% CI, 0.039 to 0.428, p = 0.011). Other domains of QOL, such as emotions, body hair, infertility, and menstrual problems, were not significantly predicted by any of the women's demographic characteristics. CONCLUSIONS: The findings revealed that PCOS-related conditions such as weight problems, menstrual irregularity, and infertility were associated with a reduction in quality of life.

Health-related quality of life in Welsh adults: psychometric properties of the SF-36v2 and normative data.

OBJECTIVES: The use of normative data has become well-accepted and a common strategy to interpret individual's health outcome scores, which can help in making decisions. The objectives of this study were to obtain population normative data for the domains and component summaries of the 36-item SF-36® Health Survey (SF-36), and to evaluate its reliability and construct validity. METHODS: This study was conducted using population-based data from the Welsh Health Survey (WHS; 2011-2015). This study used version 2 of the SF-36 (SF-36v2® Health Survey). The descriptive statistics and normative data for the eight domains and two summaries, physical component summary (PCS) and mental component summary (MCS), were calculated. Reliability assessment used internal consistency methods and construct validity assessment used known group comparisons and item-scale correlations. STUDY DESIGN AND SAMPLE: We performed a secondary analyses of data from the Welsh Health Survey (WHS). RESULTS: This study included 74,578 participants aged 16 years or older (53.6% were women). Participants aged 16-24 years scored higher on SF-36 scale than older groups on all domains. The SF-36 profiles by age group demonstrated lower scores for older age groups, with the most pronounced differences shown on the physical-related scales. Across the age groups, men had higher PCS and MCS scores than women. All SF-36 domains and PCS and MCS achieved a good to excellent internal consistency reliability exceeding 0.7. The scales demonstrated construct validity by showing associations with a range of factors known to be related to health. CONCLUSIONS: This study provides SF-36 normative data for Wales based on a representative data and confirms the construct validity and reliability of the SF-36.

Evaluation of Eltrombopag in Thrombocytopenia Post Hematopoietic Cell Transplantation: Rertrospective Observational Trial.

BACKGROUND: Thrombocytopenia remains a life-threatening late complication of HCT with an incidence of 5-20%. Currently, there is no approved drug for the treatment of persistent thrombocytopenia post HCT and platelet transfusion is the maintain stay of treatment. Eltrombopag is approved for the treatment of thrombocytopenia associated with different diseases, however; data on eltrombopag treatment post HCT are limited. METHODS: This is a retrospective cohort study evaluating the effect of eltrombopag on platelet recovery in patients with persistent thrombocytopenia post HCT. The primary endpoint was platelet recovery to ≥ 20,000/µL for 7 consecutive days without transfusion support after starting eltrombopag. Secondary endpoint was platelet recovery to ≥ 50,000/µL for 7 consecutive days. RESULTS: Twenty-one patients were included. Twelve (75%) of 16 patients became independent from platelet transfusions. Median time from starting eltrombopag to last transfusion was 60 days (range, 9-226 days). Ten (63%) of 16 transfusion dependent patients with platelet count < 20,000/µL achieved the primary endpoint. Seven (33%) patients of 21 included had successful platelet recovery (ie, ≥50,000/µL without transfusion support) and the median time to platelet recovery in patients who achieved it was 32 days (range, 13-265 days). Ten patients (48%) were able to successfully discontinue eltrombopag without recurrence of thrombocytopenia. CONCLUSION: Our findings demonstrated that eltrombopag appears to have a clinically significant impact on platelet recovery in persistent thrombocytopenic patients post HCT.

Toward establishing telepsychology guideline. Turning the challenges of COVID-19 into opportunity.

INTRODUCTION: The COVID-19 pandemic has obstructed the classical practices of psychological assessment and intervention via face-to-face interaction. Patients and all health professionals have been forced to isolate and become innovative to continue receiving and providing exceptional healthcare services while minimizing the risk of exposure to, or transmission of, COVID-19. AIM: This document is proposed initially as a guide to the extraordinary implementation of telepsychology in the context of the COVID-19 pandemic and to extend its implementation to use fundamentally as the main guideline for telepsychology services in Saudi Arabia and other Arabic communities. METHOD: A professional task force representing different areas of professional psychology reviewed, summarized, and documented methods, policies, procedures, and other resources to ensure that the recommendations and evidence reviews were valid and consistent with best practices. RESULTS: The practice of telepsychology involves the consideration of legal and professional requirements. This paper provides a guideline and recommendations for procedural changes that are necessary to address psychological services as we transition to telepsychology, as well as elucidates and demonstrates practical telepsychology frameworks, procedures, and proper recommendations for the provision of services during COVID-19. It adds a focused examination and discussion related to factors that could influence the telemedicine guideline, such as culture, religion, legal matters, and how clinical psychologists could expand their telepsychology practice during COVID-19 and after, seeking to produce broadly applicable guidelines for the practice of telepsychology. Professional steps in practical telemedicine were illustrated in tables and examples. CONCLUSION: Telepsychology is not a luxury or a temporary response. Rather, it should be considered part of a proactive governance model to secure a continuity of mental health care services. Arabic communities could benefit from this guideline to telepsychology as an essential protocol for providing mental health services during and after the COVID-19 pandemic.

INTRODUCTION: La pandémie COVID-19 fait obstacle aux pratiques classiques d'évaluation et d'intervention psychologiques par le biais d'une interaction en face à face. Les patients et tous les professionnels de la santé ont été contraints de s'isoler et d'innover pour continuer à recevoir et à fournir des services de santé exceptionnels tout en minimisant le risque d'exposition à la COVID-19 ou de transmission de cette maladie. OBJECTIF: Ce document se propose dans un premier temps comme un guide pour la mise en œuvre extraordinaire de la télépsychologie dans le contexte de la pandémie COVID-19 et ensuite pour étendre sa mise en œuvre afin de l'utiliser comme principale ligne directrice pour les services de télépsychologie en Arabie Saoudite et dans d'autres communautés arabes. MÉTHODE: Un groupe de travail professionnel représentant différents domaines de la psychologie professionnelle a examiné, résumé et documenté les méthodes, politiques, procédures et autres ressources afin de s'assurer que les recommandations et les examens des preuves étaient valides et conformes aux meilleures pratiques. RÉSULTATS: La pratique de la télépsychologie implique la prise en compte des exigences légales et professionnelles. Ce document fournit une ligne directrice et des recommandations pour les changements de procédure qui sont nécessaires pour traiter les services psychologiques lors de la transition vers la télépsychologie, ainsi qu'il élucide et démontre les cadres pratiques de la télépsychologie, les procédures et les recommandations appropriées pour la fourniture de services pendant la COVID-19. Il ajoute un examen et une discussion ciblés liés aux facteurs qui pourraient influencer la directive sur la télémédecine, tels que la culture, la religion, les questions juridiques, et la façon dont les psychologues cliniques pourraient étendre leur pratique de la télépsychologie pendant COVID-19 et après, en cherchant à produire des directives largement applicables pour la pratique de la télépsychologie. Les étapes professionnelles de la télémédecine pratique ont été illustrées dans des tableaux et des exemples. CONCLUSION: La télépsychologie n'est pas un luxe ni une réponse temporaire. Elle doit plutôt être considérée comme faisant partie d'un modèle de gouvernance proactive visant à assurer la continuité des services de soins de santé mentale. Les communautés arabes pourraient tirer profit de cette directive sur la télépsychologie en tant que protocole essentiel pour la fourniture de services de santé mentale pendant et après la pandémie COVID-19.

The role of dietary nitrate and the oral microbiome on blood pressure and vascular tone.

There is increasing evidence for the health benefits of dietary nitrates including lowering blood pressure and enhancing cardiovascular health. Although commensal oral bacteria play an important role in converting dietary nitrate to nitrite, very little is known about the potential role of these bacteria in blood pressure regulation and maintenance of vascular tone. The main purpose of this review is to present the current evidence on the involvement of the oral microbiome in mediating the beneficial effects of dietary nitrate on vascular function and to identify sources of inter-individual differences in bacterial composition. A systematic approach was used to identify the relevant articles published on PubMed and Web of Science in English from January 1950 until September 2019 examining the effects of dietary nitrate on oral microbiome composition and association with blood pressure and vascular tone. To date, only a limited number of studies have been conducted, with nine in human subjects and three in animals focusing mainly on blood pressure. In general, elimination of oral bacteria with use of a chlorhexidine-based antiseptic mouthwash reduced the conversion of nitrate to nitrite and was accompanied in some studies by an increase in blood pressure in normotensive subjects. In conclusion, our findings suggest that oral bacteria may play an important role in mediating the beneficial effects of nitrate-rich foods on blood pressure. Further human intervention studies assessing the potential effects of dietary nitrate on oral bacteria composition and relationship to real-time measures of vascular function are needed, particularly in individuals with hypertension and those at risk of developing CVD.

Intracranial hypertension secondary to high dose cytosine arabinoside - A case study.

We report a rare case of intracranial hypertension following high dose cytosine arabinoside (HiDAC) in a 20-year-old man, with precursor B-cell acute lymphoblastic leukemia (ALL). A five drug induction protocol for ALL was initiated; post induction consolidation was with HiDAC (3 g/m2 IV every 12 h on days 1, 3 and 5). Post consolidation, cytogenetic remission was attained and he received an intensification and maintenance regimen for ALL, for a period of approximately 24 months. Four months following the completion of his treatment, the patient relapsed within the central nervous system (CNS). Intravenous salvage chemotherapy was initiated using a combination of fludarabine 30 mg/m2, followed by cytarabine 2 g/m2 4 h later on days 1 through 5 (FA). On day # 23 of FA, he developed a severe headache. A gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed increased intracranial pressure. On day # 25, ophthalmology examination suggested bilateral papilledema. He was started on acetazolamide 250 mg twice daily. He had spontaneous resolution of his symptoms. The patient had no recurrence of papilledema or any other neurological symptoms. Intracranial hypertension secondary to HiDAC, is an exceedingly rare complication and is not regularly associated as a common side effect of cytarabine administration. Prompt action in diagnosing and treating intracranial hypertension will save the patient from consequences, such as loss of vision, that are prevalent in this condition.

Prophylaxis and treatment of venous thromboembolism in patients with cancer: the Saudi clinical practice guideline

BACKGROUND AND OBJECTIVES: Venous thromboembolism (VTE) is commonly encountered in the daily clinical practice. Cancer is an important VTE risk factor. Proper thromboprophylaxis is key to prevent VTE in patients with cancer, and proper treatment is essential to reduce VTE complications and adverse events associated with the therapy. DESIGN AND SETTINGS: As a result of an initiative of the Ministry of Health of Saudi Arabia, an expert panel led by the Saudi Association for Venous Thrombo-Embolism (a subsidiary of the Saudi Thoracic Society) and the Saudi Scientific Hematology Society with the methodological support of the McMaster University working group produced this clinical practice guideline to assist health care providers in evidence-based clinical decision-making for VTE prophylaxis and treatment in patients with cancer. METHODS: Six questions related to thromboprophylaxis and antithrombotic therapy were identified and the corresponding recommendations were made following the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. RESULTS: Question 1. Should heparin versus no heparin be used in outpatients with cancer who have no other therapeutic or prophylactic indication for anticoagulation? RECOMMENDATION: For outpatients with cancer, the Saudi Expert Panel suggests against routine thromboprophylaxis with heparin (weak recommendation; moderate quality evidence).Question 2. Should oral anticoagulation versus no oral anticoagulation be used in outpatients with cancer who have no other therapeutic or prophylactic indication for anticoagulation? RECOMMENDATION: For outpatients with cancer, the Saudi Expert Panel recommends against thromboprophylaxis with oral anticoagulation (strong recommendation; moderate quality evidence).Question 3. Should parenteral anticoagulation versus no anticoagulation be used in patients with cancer and central venous catheters? RECOMMENDATION: For outpatients with cancer and central venous catheters, the Saudi Expert Panel suggests thromboprophylaxis with parenteral anticoagulation (weak recommendation; moderate quality evidence).Question 4. Should oral anticoagulation versus no anticoagulation be used in patients with cancer and central venous catheters? RECOMMENDATION: For outpatients with cancer and central venous catheters, the Saudi Expert Panel suggests against thromboprophylaxis with oral anticoagulation (weak recommendation; low quality evidence).Question 5. Should low-molecular-weight heparin versus unfractionated heparin be used in patients with cancer being initiated on treatment for venous thromboembolism? RECOMMENDATION: In patients with cancer being initiated on treatment for venous thromboembolism, the Saudi Expert Panel suggests low-molecular-weight heparin over intravenous unfractionated heparin (weak; very low quality evidence).Question 6. Should heparin versus oral anticoagulation be used in patients with cancer requiring long-term treatment of VTE? RECOMMENDATION: In patients with metastatic cancer requiring long-term treatment of VTE, the Saudi Expert Panel recommends low-molecular-weight heparin (LMWH) over vitamin K antagonists (VKAs) (strong recommendation; moderate quality evidence). In patients with non-metastatic cancer requiring long-term treatment of venous thromboembolism, the Saudi Expert Panel suggests LMWH over VKA (weak recommendation; moderate quality evidence).

Sister chromatid exchanges and sperm abnormalities produced by antidepressant drug fluoxetine in mouse treated in vivo.

OBJECTIVES: The aim of this investigation was to determine the capacity of serotonin reuptake inhibitor (SSRI) antidepressant drug fluoxetine (FLX) to induce genotoxic damage in somatic and germ cells. METHODS: For this study, sister-chromatid exchanges (SCE's) in bone marrow cells and sperm abnormalities assays in male mice were used. The animals were organized in four groups constituted by five mice. They were orally administered with the test substance as follows: a negative control group; three groups treated with FLX (2.6, 7.8 and 13.0 mg/kg b.wt.) for 5 consecutive days. Animals were sacrificed 24h after the last treatment for analysis SCE's and left for 35 days from the first treatment for analysis sperm-shape abnormalities. RESULTS: The results showed that the drug was SCE and sperm abnormalities inducer. The response of this compound was dose-dependent, and showed that the highest tested dose increased about two times SCE and four times the sperm abnormalities control level. The cellular proliferation kinetics was not affected by the chemical, and the mitotic indexes were slightly diminished with the highest dose. The percentage of sperm count and sperm motility decreased (p < 0.01) with increased the dose of treatment. CONCLUSIONS: These results indicate an in vivo genotoxic potential for the antidepressant drug FLX.