Health rights knowledge among medical school students at King Abdulaziz University, Jeddah, Saudi Arabia.

BACKGROUND: Health care is a basic human right, and Saudi Arabia affirms these rights for all its citizens. OBJECTIVES: To assess the knowledge of medical students regarding health rights in Saudi Arabia. METHODS: This cross-sectional study was conducted at King Abdulaziz University (KAU) from September 2015 through November 2015. A questionnaire written in English collected demographic data and included questions about reproductive health care and health rights of women and patients with cancer, senility, or special needs. RESULTS: Of the 267 participants, 184 (68.9%) were female, and 252 (94.4%) were Saudi. Regarding consent, 87 (32.6%) and 113 (42.3%) participants believed a female patient required the consent of a male guardian to receive medical treatment or surgery, respectively, in Saudi Arabia, and only 106 (39.7%) knew that a female patient could provide consent for a caesarean section. Sixty-six (24.7%) believed that abortion is never allowed in Islam. Only 93 (34.8%) were aware that acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) patients had health rights, about half (144, 53.9%) knew that cancer patients have a right to full information, and most (181, 67.8%) believed that a patient had the right to withhold health information from his/her family. Approximately half were aware that cancer patients have the right to free medical treatment (138, 51.7%) or that health rights applied to special needs patients (137, 51.3%) and senile patients (122, 45.7%). CONCLUSIONS: The knowledge of KAU medical students regarding health rights of certain patient populations highlights the importance of health rights education in medical school.

The prevalence of sexual dysfunction in the female health care providers in Jeddah, Saudi Arabia.

The objective of this study was to determine the prevalence of sexual dysfunction in Saudi and non-Saudi female health care providers in Jeddah, Saudi Arabia. One -hundred twenty (60 Saudi and 60 non-Saudi) sexually active female health care professionals in Jeddah, Saudi Arabia, were anonymously surveyed using the English version of the female sexual function index questionnaire. The individual domain scores for pain, arousal, lubrication, orgasm, satisfaction, pain, and overall score for the Saudi and non-Saudi women were calculated and compared. The two groups were comparable in demographic characteristics. No statistically significant differences were found between Saudi and non-Saudi women in desire (P = .22) and arousal scores (P = .47). However, non-Saudi women had significantly higher lubrication (P < .001), orgasm (P = .015), satisfaction (P = .004), and pain scores (P = .015). The overall scores in Saudi and non-Saudi women were low (23.40 ± 4.50 compared with 26.18 ± 5.97), but non-Saudi women had a significantly higher overall score (P = .005). Taken together, sexual dysfunction is prevalent among Saudi and non-Saudi female health care providers, with Saudi women demonstrating lower scores in four sexual function domains and the overall score.

Patient satisfaction after laparoscopic total or supracervical hysterectomy.

BACKGROUND/AIMS: To evaluate patient satisfaction after laparoscopic supracervical (LASH) or total hysterectomy (TLH). METHODS: Retrospective study of patient satisfaction after LASH or TLH. RESULTS: We studied 40 cases of LASH and another 40 of TLH. The age of the patients, marital status, education level and employment status between the two groups were comparable. Both LASH and TLH results in improvement of general health and symptoms. However, there was no significant difference in patient satisfaction with surgery, in general health, body and self-images, and sexual satisfaction between the LASH and TLH group. Before surgery, patients in the TLH group experienced more pain with a sexual relationship than those in the LASH group. The difference became non-significant after surgery. There was no difference in urinary or gastrointestinal symptoms after either type of hysterectomy. CONCLUSIONS: Both LASH and TLH result in improvement of general health and symptoms. Body and self-images, sexual function, gastrointestinal and urinary functions after LASH or TLH are comparable.

New advances in ovulation induction.

PURPOSE OF REVIEW: To review recent advances in ovulation induction. RECENT FINDINGS: Aromatase inhibitors can replace clomiphene citrate as ovulation-inducing substances. The most widely used aromatase inhibitor for this purpose is letrozole and the optimal dose is 5 mg daily for 5 days. Compared to clomiphene citrate, it is associated with a thicker endometrium and a better pregnancy rate. It is as effective as gonadotropin but yet less expensive. The overall rates of congenital malformation among newborns conceived after infertility treatment with letrozole or clomiphene citrate are similar. When letrozole is combined with gonadotropin, it leads to lower gonadotropin requirements with pregnancy rates comparable to gonadotropin treatment alone. Another promising aromatase inhibitor is anastrazole. Recent evidence suggests that luteinizing hormone activity in human menopausal gonadotropin modifies follicular development so that fewer intermediate-sized follicles develop. Compared to the use of follicular stimulating hormone only, human menopausal gonadotropin is associated with less ovarian hyperstimulation. SUMMARY: Aromatase inhibitors are alternative drugs to clomiphene or gonadotropin for ovulation induction or superovulation.

Failure of uterine fibroid embolization.

OBJECTIVE: To assess the outcomes of patients who underwent uterine fibroid embolization (UFE) and to evaluate factors associated with failure of UFE. DESIGN: Retrospective study. SETTING: University teaching hospital. PATIENT(S): Two hundred thirty-three consecutive patients who underwent UFE from November 1997 to February 2004. INTERVENTION(S): Uterine fibroid embolizations were performed by three interventional radiologists using 355-500-mu polyvinyl alcohol particles. MAIN OUTCOME MEASURE(S): Hysterectomy rate, myomectomy rate, and repeat UFE rate. RESULT(S): With a mean follow-up of 13 months, a total of 22 patients underwent surgery after UFE (9.4%); 16 had hysterectomies (6.9%), and 6 had myomectomies (2.6%). This included 3 patients who underwent repeat UFE and subsequently required surgical intervention. The mean (+/- SEM) time interval between UFE and subsequent treatment was 12.5 +/- 2.0 months. Among patients who required surgery, 13 (59.1%) presented with recurrent menorrhagia, and 5 (22.7%) complained of persistent abdominal pain. Histopathologic examination revealed concomitant findings of adenomyosis in 25% of hysterectomy specimens. Patients who failed UFE were more likely to have had a previous myomectomy (13% vs. 2.4%) and significant reduction in the uterine size 6 months after UFE (57.1% vs. 25.2%). CONCLUSION(S): The overall failure rate of UFE is 9.4%. Failure is mainly due to persistent menorrhagia and abdominal pain. Shrinkage of the uterus after UFE does not necessarily correlate with long-term success of UFE.

Audit of morbidity and mortality rates of 1792 hysterectomies.

STUDY OBJECTIVE: To audit morbidity and mortality rates of laparoscopic, abdominal, and vaginal hysterectomy. DESIGN: Retrospective review of monthly morbidity and mortality rates (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: One thousand seven hundred ninety-two women who underwent hysterectomy for benign, nonobstetric indications at the Sir Mortimer B. Davis-Jewish General Hospital. INTERVENTIONS: Laparoscopic supracervical (LASH), vaginal (VH), and abdominal (AH) hysterectomies. MAIN OUTCOME MEASURES: Morbidity outcomes of different types of hysterectomy. Reoperation, admission to the intensive care unit, discordant diagnosis, and prolonged hospitalization also were evaluated. RESULTS: We studied 223 cases of LASH, 1349 AH, and 220 VH. The overall hysterectomy-related morbidity rate was 6.1%. The rate of morbidity was higher in the LASH group (9.4%) than in the AH group (5.2%, p <.01), but no significant difference was noted between AH and VH (8.6%). The incidence of intraoperative bowel injury was 0.4% in the LASH group (a trocar injury in a patient) and 0.3% in the AH group. Bladder injury was encountered in two patients in the LASH group (0.9%) and in another two in the AH group (0.1%). Ureteral injury occurred in a patient in the AH group (0.07%). There were no cases of intraoperative vascular injury. Vaginal hysterectomy was associated with more urinary retention and hematoma formation than the other two groups. Discordant diagnosis was noted in four cases (two missed endometrial cancer, atonic and distended bladder mistaken for an ovarian cyst, and pelvic tuberculosis). The conversion rate to laparotomy was 1.7% in the LASH group and 0.4% in the VH group, and the incidence of reoperation was 0.4% in the AH group. CONCLUSIONS: The overall hysterectomy-related morbidity rate in our series is 6.1%. Compared with other types of hysterectomy, more urinary retention and hematoma formation occur after VH. Laparoscopic supracervical hysterectomy is associated with a higher morbidity rate than AH; mainly because of conversion to laparotomy and blood transfusion.