Factors Associated With the Uptake of Cervical Cancer Screening Among Family Medicine Physicians, Compared With Women of the Community in Riyadh, Saudi Arabia.

BACKGROUND: Cervical cancer is the ninth diagnosed cancer among Saudi women. The majority of cervical cancer cases occur in women who did not undergo screening. However, the screening rates in several countries, including Saudi Arabia, remain suboptimal. It is important to identify the factors associated with the uptake of screening and predictors of screening in order to increase the uptake rate. AIM: To determine the factors associated with the uptake of cervical cancer screening among family medicine physicians (FMPs), compared with women of the community. METHODS: This was a cross-sectional study conducted in the central region (Riyadh), Kingdom of Saudi Arabia from February 2021 for 12 months on female physicians and women of the community. An electronic questionnaire was used to investigate the demographics of women and variables related to the uptake of screening. RESULTS: A total of 126 FMP and 127 women from the community were included. The factors affecting screening among FMP included age (P=0.013), health insurance (P=0.002), availability of Pap smear (P˂0.001), and physician encouragement (P˂0.001). The factors affecting the screening of community women included the availability of Pap smears (P˂0.001) and physician encouragement (P˂0.001). Multivariate analysis revealed that physician encouragement of Pap smear was a significant predictor of screening among FMP (OR=8.26, P˂0.001) and community women (OR=6.67, P˂0.001). The perceived benefit was the only predictor for screening among FMP (OR=0.75, P=0.004). CONCLUSION: The uptake of cervical cancer screening was higher in the community women. The factors linked to the uptake differed among the two groups, but the support of doctors played a significant role in the likelihood of uptake, regardless of the group of women. It is recommended to enhance the guidance of medical personnel in recommending screening during clinic visits for the specific target group. Additionally, there should be increased education on the significance of screening and efforts to educate the community about cervical cancer and screening.

Chemical composition of the essential oils of two Citrus species and their biological activities.

Essential oils obtained by hydrodistillation of the fruit rinds of Citrus jambhiri Lush. (Rough lemon) and C. pyriformis Hassk (Ponderosa lemon) were analyzed by capillary gas chromatography (GLC/FID) and gas chromatography-mass spectrometry (GLC/MS). A total of 94 compounds were unambiguously identified from the oils and the (hexane/ether) extracts of the rind and juices representing 98.55% and 97.98% of the total oil composition. The main component of both oils was D-limonene (92.48% and 75.56% respectively). The antioxidant, anti-inflammatory, antitrypanosomal, antimicrobial and cytotoxic activities of the essential oils were evaluated. Whereas Citrus jambhiri and C. pyriformis have antioxidant activity with IC50 +/- SD 37.69 +/- 0.21 mg/ml and 28.91 +/- 0.09 mg/ml, respectively. Ascorbic acid a known potential inhibitor for DPPH free radical an commonly used antioxidant showed an antioxidant activity with an IC50 value of 16.32 +/- 0.161 g/mI. Both oils inhibited the activity of 5-lipoxygenase (5-LOX) with an IC50 of 40 +/- 1.63 and 38 +/- 0.82 microg/ml, respectively, and could be considered as interesting candidates for antiinflammatory agents. The essential oils of both species showed substantial antimicrobial activity against all tested Gram positive bacteria and yeasts. The essential oil of C. pyriformis showed higher cytotoxic activity against tested cell lines than that of C. jambhiri. The IC50 values were 374.36 +/- 43.95 microg/ml and 588.06 +/- 27.12 microg/ml in case of HepG2 cells and 213.87 +/- 18.50 microg/ml and 512.45 +/- 61.46 microg/ml in case of MIA-PaCa-2 cells, respectively.

Gastric intramucosal acidosis in patients with chronic kidney failure.

BACKGROUND: Patients with chronic kidney failure have an increased incidence of gastrointestinal complications, particularly bleeding from the stomach. Diminished mucosal blood flow is thought to be an important etiologic factor for such bleeding. METHODS: Eleven patients with kidney failure on maintenance dialysis underwent placement of a gastric tonometer for the determination of gastric intramucosal pH (pHi) before and during dialysis. The arterial pH (pHa), calculated pHi, and pHa-pHi differences were compared with the results in a control group of seven normal volunteers. RESULTS: The patients with chronic kidney failure had a mean (+/- SD) pHa (7.36 +/- 0.04) similar to that found in seven control subjects (7.37 +/- 0.04). However, the gastric mucosal pH in the patients on dialysis (7.20 +/- 0.17) was lower than in the seven control subjects (7.38 +/- 0.06) (p < 0.01). A gastric mucosal pH thought to be predictive of either bleeding from stress ulceration (pHi < 7.32) or mucosal ischemia (pHi-pHa difference > 0.13) was found in nine (82%) of the patients with kidney failure and in only one (14%) of the control subjects (p < 0.001). CONCLUSIONS: This new preliminary finding suggests that the high incidence of gastric bleeding in chronic kidney failure may be related to mucosal ischemia.

Factors underlying abnormal zinc metabolism in uremia.

Zinc balance studies were completed in ten hemodialyzed adult uremic patients and five normal controls to determine the cause of abnormal zinc metabolism in uremia. Subjects were fed standard hospital foods providing nutrients in amounts recommended for adult stable hemodialyzed patients. The amount of zinc in the diet was kept constant at 10 mg per day. After one week of stabilization, blood, urine, used dialysate (in patients on dialysis days) and stool samples were collected daily for the next two weeks. In comparison to controls, patients had lower plasma zinc levels (mean +/- SD, 112 +/- 10 vs. 82 +/- 12 micrograms/dl, P less than 0.01), lower urinary zinc excretion (560 +/- 120 vs. 40 +/- 20 mg/24 hrs, P less than 0.001) and higher fecal zinc losses (8.1 +/- 0.7 vs. 10.2 +/- 0.6 mg/24 hrs, P less than 0.01). Dialytic zinc losses were minimal (26 +/- 4 micrograms/treatment). During the study period, patients were in a negative zinc balance while normal controls maintained a positive zinc balance on 10 mg dietary zinc intake. These results demonstrate that augmented fecal zinc excretion in the presence of hypozincemia contributes to the negative zinc balance in hemodialyzed uremic patients.

Taste acuity and zinc metabolism in captopril-treated hypertensive male patients.

Hypogeusia is a reported side effect of captopril. Linkage of hypogeusia to zinc deficiency has been suggested. We objectively assessed taste acuity using Henkin's three-drop stimulus technique and measured plasma zinc (PZn) level and urinary zinc excretion in 31 hypertensive patients. Of these, 11 were long-term, high-dose captopril recipients (more than 6 months, 266 +/- 34 mg/day), six were short-term captopril recipients (less than 6 months, 104 +/- 40 mg/daily dose), and the remaining 14 served as noncaptopril controls. Compared to controls, the long-term captopril group had significantly higher taste detection and recognition thresholds, lower PZn (91 +/- 3 vs. 100 +/- 3 micrograms/dl, P less than 0.05) and higher urinary zinc excretion (1017 +/- 89 vs. 609 +/- 76 micrograms/day, P less than 0.005). The short-term captopril group did not differ significantly from the noncaptopril group except for higher taste-recognition thresholds for NaCl and sucrose (P less than 0.05). Discontinuing captopril improved taste acuity and almost normalized zinc parameters in two patients on long-term captopril. These results suggest that abnormalities of taste are commonly associated with captopril therapy and may be related to changes in zinc metabolism. This is especially true in patients on long-term, high-dose captopril therapy.

Zinc tolerance test in uremia: effect of calcitriol supplementation.

The effect of 1,25(OH)2D3 on zinc absorption was indirectly determined in hemodialysis patients using the oral zinc tolerance test. The increment in plasma zinc and the area under the curve following an oral zinc load of 25 mg were studied in seven patients, before and after 6 weeks of therapy with 1 microgram/day of 1,25(OH)2D3 [Rocaltrol(R)]. Before therapy, fasting plasma zinc, 2 hour plasma zinc, and the area under the curve (AUC) were subnormal (hemodialysis patients vs normals: 96 +/- 2 vs 105 +/- 3 micrograms/dl, p less than 0.05, 161 +/- 8 vs 222 +/- 16 micrograms/dl, p less than 0.025, and 188 +/- 25 vs 302 +/- 33 micrograms hr/dl, p less than 0.025, respectively). Following Rocaltrol, serum calcium level increased (8.9 +/- .12 to 9.8 +/- .4 mg/dl, p less than 0.05), parathyroid hormone levels decreased (20.4 +/- 8.9 to 13.6 +/- 7.2 ng/ml, p less than 0.05), but there was no significant change in fasting plasma zinc, 2 hour plasma zinc, or AUC (89 +/- 3 micrograms/dl, 149 micrograms/dl, and 176 +/- 18 micrograms hr/dl, respectively). These results suggest that short-term 1,25(OH)2D3 therapy had no significant impact on zinc absorption or plasma zinc level in uremics.

Elevated plasma copper in chronic renal failure.

Hypercupremia has been described in patients undergoing chronic dialysis. To further characterize dialysis-associated hypercupremia, we studied plasma copper (PCu) and ceruloplasmin (Cp) in patients on hemodialysis (n = 20) and peritoneal dialysis (n = 25), in uremic patients (n = 10) not yet on dialysis, and in normal age-matched control subjects (n = 20). PCu was significantly elevated in all three patients groups (mean +/- SD) (20.6 +/- 4.1, 19.8 +/- 4.6, 19.8 +/- 4.9 mumol/L, respectively) vs control subjects (16.5 +/- 2.7 mumol/L). However, Cp levels were not significantly different among the four study groups (330 +/- 60, 320 +/- 70, 370 +/- 100, and 360 +/- 90 mg/L, respectively). Calculated nonceruloplasmin copper was significantly higher in all uremic groups. The measurement of chelatable Cu confirmed the presence of significantly higher extractable Cu in hemodialysis (2.7 +/- 0.6 mumol/L) and peritoneal dialysis patients (2.4 +/- 0.5 mumol/L) than control subjects (1.5 +/- 0.3 mumol/L). Cu is elevated in uremia regardless of dialysis status and this elevation is not accounted for by an increase in plasma ceruloplasmin.

Zinc tolerance test in uremia. Effect of ferrous sulfate and aluminum hydroxide.

The effects of ferrous sulfate and aluminum hydroxide on the oral zinc tolerance test after administration of 25 mg of elemental zinc as sulfate were studied in six hemodialysis patients and six normal controls. Fasting plasma zinc levels, the 2-hour plasma zinc peak, and the area under the plasma zinc curve were significantly lower in patients compared with values in controls (plasma zinc, 92 +/- 4 compared with 108 +/- 3 micrograms/dL, p less than 0.025; 2-hour plasma zinc peak, 159 +/- 8 compared with 228 +/- 17 micrograms/dL, p less than 0.025; and area under the curve, 193 +/- 41 compared with 316 +/- 39 micrograms h/dL, p less than 0.025). Ferrous sulfate (300 mg orally), when administered along with zinc sulfate, decreased the area under the curve significantly (in patients by 28%, in controls by 40%) in comparison with the results obtained when zinc sulfate was given alone. When 30 mL of aluminum hydroxide was administered orally with zinc sulfate, the area under the curve decreased by 60% in controls and 75% in patients (p less than 0.005). These results confirm the presence of diminished zinc absorption in patients with renal failure and show that ferrous sulfate and aluminum hydroxide, which worsen this defect, also impair zinc absorption in normal subjects.

Cautopyreiophagia. Cause of life-threatening hyperkalemia in a patient undergoing hemodialysis.

A male patient undergoing hemodialysis in whom the cause of severe hyperkalemia (more than 8 mmol/liter) was found to be an unusual pica is described. His pica consisted of ingestion of burnt match heads (cautopyreiophagia). The potassium content of his daily consumption of burnt matches added 80 mmol to his 45 mmol dietary potassium intake. Hypogeusia and hypozincemia were documented. Oral zinc supplementation (zinc sulfate 220 mg per day for 10 weeks) normalized his plasma zinc level and taste acuity. He abandoned his pica and his plasma potassium level dropped significantly to 5.5 to 6 mmol/liter. It is suggested that inquiry about pica should be part of the dietary history in patients with renal failure.

Effect of renal transplantation on zinc metabolism and taste acuity in uremia. A prospective study.

The effect of successful renal transplantation on zinc metabolism and taste acuity was determined prospectively in 15 adult uremic patients. Before transplantation all patients had subnormal concentrations of zinc in plasma and hair, as well as abnormal taste detection and recognition thresholds for sodium (salty), sucrose (sweet), hydrochloric acid (sour), and urea (bitter). Following renal transplantation, abnormalities of taste acuity and zinc metabolism persisted and were accompanied by increased urinary zinc excretion in all patients. Normalization of zinc concentration in plasma and hair as well as taste acuity did not occur until one year after transplantation and was associated with a concomitant decrease in urinary zinc excretion. The plasma zinc levels and daily urinary zinc excretion were inversely related (r = 0.62, P less than .001) in all patients with normal allograft function. None of the zinc parameters was significantly related to azathioprine or corticosteroid dosage. The results of this study suggest that zinc deficiency and taste abnormalities of uremia persist up to one year posttransplant and may be related to increased urinary zinc losses. The mechanisms underlying post-transplant hyperzincuria as well as clinical significance of zinc deficiency following transplantation remain to be determined.

Hypoxemia during hemodialysis using acetate versus bicarbonate dialysate.

To evaluate the extent and cause(s) of dialysis-related hypoxemia, we studied 10 patients, 7 days apart using acetate (AC) and bicarbonate dialysate (HCO3). We measured arterial blood gases, WBC, minute ventilation (VE) and inspired and expired gas concentrations and calculated the respiratory quotient (R) and the alveolar-arterial oxygen difference (A-a)DO2 before and during hemodialysis. 8 patients developed hypoxemia. Arterial PO2 (PaO2) dropped similarly at 30 min from 93 +/- 5 to 78 +/- 6 (p less than 0.05) and 89 +/- 4 to 79 +/- 5 mm Hg (p less than 0.05) with AC and HCO3, respectively. R and VE decreased during AC (p less than 0.05). (A-a)DO2 increased at 30 min and correlated with the drop in PaO2 during both AC (r = 0.68, p less than 0.025) and HCO3 (r = 0.76, p less than 0.025). The fall in PaO2 also correlated with the fall in WBC count for both AC and HCO3 (r = 0.63, p less than 0.005). The increase in arterial pH during HCO3 (up to 7.45 +/- 0.01) was significantly greater than that during AC (up to 7.42 +/- 0.01) (p less than 0.025), and coincided with a relative decrease in VE. We conclude that (1) HCO3 does not prevent hypoxemia, and (2) hypoventilation V/Q abnormalities and increase in arterial pH, contribute variably to dialysis related hypoxemia depending on the type of dialysate and the time during dialysis.

Zinc metabolism and taste acuity in renal transplant recipients.

To determine the effect of renal transplantation on taste acuity and zinc metabolism, we tested 43 patients with functioning allografts for 2.5 to 96 months. They were tested for taste by the 3-drop stimulus technique. In 30 of them, we determined zinc levels in plasma, hair, and urine. Subnormal plasma and hair zinc, as well as hyperzincuria, was present in all of the 15 patients less than 12 months posttransplant. In contrast, 10 patients who were more than 12 months posttransplant had plasma zinc levels, hair zinc, and urinary zinc excretions in the normal range. Zinc concentrations in plasma and hair of 5 patients who were more than 12 months posttransplant with renal failure, were subnormal and were similar to those in hemodialysis patients. Similarly, taste detection and recognition thresholds for sodium chloride, sucrose, urea, and hydrochloric acid were normal only in patients more than 12 months posttransplant with normal renal function. Plasma zinc, hair zinc, and urinary zinc were not related to prednisone or azathioprine dosage. These results suggest that abnormalities of zinc and taste persist up to 12 months posttransplant and may be related to increased urinary zinc losses.

Renal handling of zinc: effect of cysteine infusion.

Zinc clearance studies in anesthetized dogs were performed during hydropenia, mannitol infusion, and infusion of mannitol plus ZnSO4, ZnCL2, or cysteine. Mannitol expansion caused no significant change in Zn clearance. ZnSO4 infusion increased filtered Zn 13-fold without changing clearance. Zn excretion increased only sixfold, indicating increased net Zn reabsorption. Cysteine infusion increased urinary Zn excretion 86-fold, indicating net tubular Zn secretion, some of which derived from nonplasma sources. Stop-flow studies localized Zn reabsorption to the distal nephron during infusion of mannitol and mannitol plus ZnSO4 or ZnCl2. Net Zn secretion was shown to occur in the proximal tubule during cysteine infusion with reversal of the distal reabsorption pattern seen during ZnSO4 and ZnCl2 infusion. Despite increased urinary Zn excretion during ZnSO4 infusion, calcium excretion was unaltered. During cysteine infusion dissociation of tubular handling of CA2+ and Zn occurred in both the proximal and distal tubule. These experiments demonstrate that the nephron under these experimental conditions is capable of both proximal secretion and distal reabsorption of Zn.

Phenytoin, renal function and renin release.

Phenytoin (DPH), a widely used anticonvulsant, has been shown to effect membrane transport in a wide variety of tissues. After injection, DPH is known to accumulate in high concentration in the kidney, however the renal effects of this drug have not been investigated. Therefore, these studies were designed to elucidate the effect of DPH on renal function and renin release. Dogs were anesthetized and had renal venous, aortic, brachial and ureteral catheters placed. During each of three successive experimental clearance periods, either saline, propylene glycol vehicle (V) or V + DPH (0.18 mg/kg/min) was infused via a 23-gauge needle in the left renal artery. In five dogs (Group I), the sequences of infusion was saline, (V) and (V). Five animals (Group II) differed only in that V was infused during all three periods. Seven animals (Group III) underwent sequential infusions of V, V + DPH, and V. Infusion of V alone resulted in a significant increase in systemic blood pressure from 120 to 135 mm Hg (P < .05). Significant increases after V infusion were found in urine volume (0.45 to 0.87 ml/min) (P < .05) and osmolar clearance (1.23 to 1.83 ml/min). Infusion of DPH produced a 22% increase in renal blood flow from 238 to 291 ml/min (P < .05) and a fall in renal vascular resistance from 0.51 to 0.41 mm Hg/ml/min (P < .05). Significant increases were also seen in urine volume from 0.87 to 1.58 ml/min (P < .05), urine sodium excretion (157 to 269 microEq/min) (P < .05) and osmolar clearance (1.54 to 2.62 ml/min) (P < .05). Renal renin secretion rate was unchanged in Group I and II animals but DPH infusion resulted in a 7-fold increase in renin secretion from 21 to 151 ng A-I/hr x min (P < .05). We conclude that intrarenal arterial infusion of DPH results in renal vasodilation, diuresis and natriuresis. Furthermore, this agent also stimulates renin release which may be the result of its effect on membrane transport.