Association between insulin resistance and abnormal menstrual cycle in Saudi females with polycystic ovary syndrome.

Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder experienced by women of reproductive age and is marked by insulin resistance (IR) and menstrual cycle abnormalities. In this study, we set out to assess how the level of menstrual abnormalities relates to the degree of IR in women with PCOS. Methods: The participants in this study were 93 women diagnosed with PCOS and 100 controls with regular vaginal bleeding. Data was collected through blood samples, physical examinations, and medical histories. The primary outcome measures were body mass index (BMI), fasting glucose, fasting insulin, homeostatic model assessment for IR (HOMA-IR), and hormonal parameters. Results: Values for BMI and HOMA-IR were higher in PCOS cases than in controls [(28.6 ± 1.9 vs. 23.7 ± 2.3) and (2.29 ± 2.87 vs. 1.48 ± 1.02), respectively]. Oligomenorrhea was documented in 79.4% of women with PCOS, with the others experienced vaginal bleeding intervals under 45 days. The greater the menstrual irregularity, the higher the levels of luteinizing hormone/follicle-stimulating hormone and testosterone. Among the PCOS group, those with vaginal bleeding intervals of above 90 days had a higher HOMA-IR values (2.46 ± 2.77), after adjustments for age and BMI, than the participants who went<45 days between periods (2.01 ± 2.14) and those whose interval was 45-90 days (2.09 ± 2.43). Conclusions: Most of the participants with PCOS had obvious oligomenorrhea of at least 6 weeks between episodes of vaginal bleeding and had significantly higher insulin resistance than did the controls. This suggests that insulin resistance in PCOS cases may be predicted by the presence of clinically overt menstrual dysfunction.

Volumetric bone mineral density and serum 25-hydroxyvitamin D status in the UK dwelling Arab, Caucasian, and South Asian women.

Objectives: Little is known about ethnic differences in bone geometry, nor their association with 25-hydroxyvitamin D (25(OH)D), especially among ethnicities living in the same country. The purpose of this preliminary study was to investigate differences in bone geometry at the radius and tibia, as well as in 25(OH)D status, between Arab (A), South Asian (SA), and Caucasian (C) premenopausal women residing in the UK. The potential association between 25(OH)D concentration and indices of bone geometry was also assessed. Methods: Fifty-seven healthy premenopausal women (17 A, 18 SA, and 22 C), ranging in age from 18 to 51 years, underwent assessment of their volumetric bone mineral density and 25(OH)D concentration. Ethnic differences were assessed using ANOVA. Spearman's rho was used to analyze associations between 25(OH)D and pQCT bone variables. Results: At the 4% radius, Arab women had a lower BMC, as well as a smaller total bone area and trabecular area than did Caucasian women. At the 4% tibia, Arab women had a lower total vBMD than did South Asian women. Serum 25(OH)D among Arab (36.5(22.4SD)) and South Asian (31.4 (16.8SD)) women was significantly lower than in Caucasian women (81.9(20.0SD)) (P < 0.05). There were no statistically significant correlations between 25(OH)D and pQCT bone variables in any ethnic group. Conclusions: This study suggests a possible need for attention to bone health in premenopausal Arab women as well as improvement in Vitamin D status in Arab and South Asian populations.

Estimating blood loss during cesarean delivery: A comparison of methods.

Objectives: Obstetrical hemorrhage contributes significantly to maternal morbidity and mortality. Assessment of blood loss while undergoing cesarean sections (CS) is essential in lowering the morbidity and mortality, however this amount is commonly underestimated by the surgeon and probably the anesthetist too. Methods: This study addresses this issue by comparing three separate ways of assessing blood loss during cesarean sections. For each of 97 full-term pregnant women undergoing elective CS, blood loss was measured by the following: visual estimation by both the obstetrician and the anesthetist, weighing surgical pads pre operatively and post operatively and by calculations (multiplying the difference of pre-operative and postoperative hemoglobin values by the patient's estimated blood volume). Results: The results of this study indicated that the lowest estimated value for blood loss came from visual estimation, while the highest value came from the mathematical formula. Anesthetists were more accurate in their visual estimation of blood loss than were obstetricians. Conclusion: This study found the amount of blood loss during CS to be overestimated by the mathematical calculation and underestimated by obstetricians. However, the estimate given by anesthetists was close to that obtained by weighing pads. This underscores the need for more accurate methods of blood loss estimation in cesarean sections to be adopted.

Acceptance of trial of labor after cesarean (Tolac) among obstetricians in the Western Region of Saudi Arabia: A cross-sectional study.

BACKGROUND: Babies to women eligible for trial of labor after a cesarean (TOLAC) are sometimes delivered by cesarean section (CS). To obtain clinicians' attitudes and beliefs about TOLAC, this study was designed to investigate the views of clinicians when advising TOLAC-eligible pregnant women about TOLAC, and to explore their reasons in favor of or against TOLAC. METHODS: Interviews were carried out individually (face-to-face) with clinicians using a specially designed questionnaire to collect data from obstetricians in the Western Region of Saudi. Regression analysis was used as appropriate. RESULTS: Among the 183 obstetricians included in the current study, approximately 79.2% were against offering TOLAC. However, most of the physicians (89.1%) were in favor of offering TOLAC to patients who had had a successful vaginal birth after CS. significant associations were found between physicians' opposition to TOLAC and medical and most non-medical factors. CONCLUSION: Clinicians should recognize that the critical role they play in the delivery decision-making process and in boosting women's confidence in TOLAC may be key to increasing the rate of TOLAC.

Hyperemesis Gravidarum in First-Trimester Pregnant Saudi Women: Is Helicobacter pylori a Risk Factor?

INTRODUCTION: Hyperemesis gravidarum (HG) is a serious complication of pregnancy involving nausea and vomiting which affects all facets of the lives of many women. Helicobacter pylori infection has been linked to HG in some regions of the world. However, the prevalence of H. pylori in Saudi Arabian pregnant women and its link to HG has not been the subject of previous research. Detecting and treating H. pylori infection in women early in their pregnancies may lower the likelihood of adverse maternal outcomes. This study aims to assess the connection between the pathogenesis of HG and H. pylori infection in this population. METHODS: Forty-five pregnant women with HG were recruited from the outpatient clinic for antenatal care in the Gynecology and Obstetrics Department at King Abdulaziz University Hospital. Forty-five pregnant women without HG were matched as controls. Both groups underwent testing for the H. pylori antigen in stool samples. RESULTS: A statistically significant difference (P < 0.05) was observed between the cases and controls in terms of the occurrence of H. pylori. Thirty-eight women in the HG group (84.4%) tested positive for H. pylori, while the same was true of only 20 of the controls (44.4%). The mean level of blood hemoglobin in positive cases was significantly lower than that in negative cases (9.56 ± 1.29 vs. 11.90 ± 1.18 g/dl, P = 0.012). CONCLUSION: H. pylori may play a contributing role in the presence of HG in the study population. It may be included with other investigations of HG, especially with cases that do not respond to conventional management and continue into the second trimester. Women with H. pylori were also more likely to suffer from anemia compared to those without the infection. For this reason, those working with pregnant women should pay close attention to those infected with H. pylori. Additional large case-control studies are necessary to better understand the part H. pylori plays and the pathogenesis of HG.

Relationship of Vitamin D-Deficient Diet and Irisin, and Their Impact on Energy Homeostasis in Rats.

BACKGROUND AND OBJECTIVE: Previous studies have identified the role of irisin and vitamin D in energy homeostasis. However, the effect of irisin and vitamin D on energy regulation has not been thoroughly investigated. Therefore, in this study, the effects of a vitamin D-deficient diet and irisin on total energy expenditure (TEE), food intake, and blood metabolites were investigated in rats. METHODS: Sixteen healthy weaned male albino rats were randomly divided into two groups: a group fed a normal balanced growth diet (group A: n = 8) and a group fed a normocalcemic diet that is vitamin D deficient with limited ultraviolet (UV) light exposure (group B, n = 8). After 6 weeks, the volumes of respiratory gases were measured by open-circuit indirect calorimetry. Serum irisin, 25-OHVD3, calcium, insulin, and glucose levels were measured using ELISA. The respiratory quotient (RQ), energy expenditure, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were calculated. RESULTS: Rats with hypovitaminosis D were hypoirisinemic. Food intake, RQ (to the range of using endogenous fat), and glucose levels reduced significantly, while insulin levels increased. Body weight and TEE were non-significant changed. Additionally, irisin was strongly and positively correlated with body weight under normal conditions (r = 0.905, p < 0.01), and a moderate negative correlation in group B (r = -0.429, p < 0.05). TEE and irisin showed no significant correlation. CONCLUSION: This study demonstrated that the early changes in energy homeostasis and irisin levels during states of hypovitaminosis D are affected by long-term consumption of a vitamin D-deficient diet with limited UV exposure.

Perceptions of an integrated curriculum among dental students in a public university in Saudi Arabia.

BACKGROUND: Being aware of the limits of traditional discipline-based education, the Faculty of Dentistry at King Abdulaziz University (KAU) tasked basic medical science faculty members with developing a new integrated curriculum for undergraduate dental students to be applied in the 2014/2015 academic year. OBJECTIVE: To determine the students' perceptions of the restructured curriculum and elicit student suggestions for improvement. METHODS: A questionnaire was distributed to all first-year dental undergraduate students (n=192) enrolled in the academic year of 2014/2015. The questionnaire was written in English and included standard questions designed to determine student satisfaction toward the restructured curriculum. The different variables in the study were analyzed with descriptive statistics and the significance level was measured by SPSS version 16, using the descriptive statistics and Chi-square test. RESULTS: At the end of the first year, a large majority of students rated their overall experience with the course as good or excellent and agreed that the connection between basic and clinical sciences was made clear in the dental relevance sessions. In general, students' experience with the instructors was positive. However, although most students felt that assessment methods were fair and reflected the curriculum, the overall success rate was lower than that of the previous academic year (2013/2014) (P=0.002), when the traditional-discipline based curriculum was still in place. CONCLUSION: Having completed the first step of the restructuring of the first-year basic science dental curriculum, our plan for the next phase in the curriculum integration process is to increase inter-course and inter-topic integration and supplement the delivery of the course material with more clinical case scenarios.