Haematological, lipid profile and other biochemical parameters in normal and hypertensive subjects among the population of the eastern province of Saudi Arabia.

OBJECTIVE: To determine the lipid profile complete blood count and other biochemical parameters in normotensive and hypertensive individuals. DESIGN: Cross-sectional population-based epidemiological household survey. SETTING: Population sample of the Eastern Province of Saudi Arabia. RESULTS: Hypertensive individuals had significantly higher mean levels of glucose, Tc, LDL-c, HDL-c, triglycerides and HBAIc, compared to normotensive individuals while there were no significant difference in the mean levels of Apo AI and Apo B. Within the same group there were variations in the levels of certain parameters between male and female. While the mean levels of haemoglobin, WBC and platelets were significantly higher in the hypertensive group compared to normotensive, there were no significant differences between these two groups in the levels of RBC, MCV, HCT, MCH and MCHC. However, the mean levels haemoglobin, RBC count and HCT were significantly higher in male compared to female within the same group with no significant difference in levels of WBC, MCV, MCH and MCHC. Furthermore, the mean concentration of platelets was significantly higher in females compared to male within the same group. Hypertensive individuals had significantly higher serum sodium, chloride and calcium levels but a significantly lower potassium level when compared to normotensive with no siginificant differences between male and female within the same group. CONCLUSION: The lipid and electrolyte profile of hypertensive individuals differ from that of normotensive individuals in this population. This study has contributed towards establishing the normal values for a number of parameters involved in the aetiology of cardiovascular diseases in the population of Eastern province.

Emergence of methicillin-resistant Staphylococcus aureus as a community pathogen.

Methicillin-Resistant Staphylococcus aureus (MRSA) infection is an established nosocomial pathogen, with hospital-based outbreaks occurring worldwide. An increase in MRSA infections without risk factors has been recently documented in several reports. A prospective study was conducted over a 36-month period to determine the prevalence and risk factors for community-acquired MRSA infection at King Fahad Hospital of the University Al-Khobar, Saudi Arabia. Patients hospitalized within the previous 12 months or transfers from hospitals or nursing homes were excluded. The number of patients with community-acquired MRSA disease increased from a single patient in 1998 to fifteen patients in the year 2000 and the percentage of community-acquired MRSA/total number of MRSA increased from 5% to 33%. Fifteen (75%) of 20 patients with community-acquired MRSA infection had no discernible characteristics of MRSA infections. Skin and soft tissue infections were the predominant presentation. Most MRSA isolates (95%) were susceptible to multiple antibiotics. Our data suggest that MRSA is an emerging community pathogen. Hospital infection control strategies will have to be redefined and community approaches developed to reduce transmission.

The changing sensitivity of Helicobacter pylori to metronidazole.

The objective was to determine over two periods, seven years apart, the sensitivity of H. pylori isolates to metronidazole, tetracycline and erythromycin. The study periods were 1987/88 and 1995/96 and the population consisted of 133 patients undergoing upper gastrointestinal endoscopy for peptic ulcer disease in KFHU. The sensitivity of H. pylori isolates from their biopsy specimens was tested to three antibiotics using the disc diffusion method. In 1987/88, 62%, 97.0% and 98.6% of isolates were sensitive to metronidazole, erythromycin and tetracycline respectively. The corresponding sensitivities in 1995/96 were 14.5, 93.5% and 100% respectively. In 1987/88 there was no difference in the metronidazole resistant H. pylori isolates from men and women (38.2% vs 37.5%) but in 1995/96 slightly more women than men had metronidazole resistant isolates (89% vs 82.9%). The resistance of H. pylori to metronidazole increased over time. In order to improve outcome of treatment, sensitivity of H. pylori isolates needs to be determined for each patient. The recommended triple therapy requires to be modified if the prevailing sensitivity pattern of H pylori in our environment is taken into account.

Stroke register: experience from the eastern province of Saudi Arabia.

A stroke registry was established in the Eastern Province of Saudi Arabia with an estimated population of 750,000 inhabitants of whom 545,000 are Saudi citizens. The register started in July 1989 and ended in July 1993. The Gulf war led to its interruption from August 1990 to August 1991. Four hundred eighty-eight cases (314 males, 174 females) of first-ever strokes affecting Saudi nationals were registered over the 3-year period. The crude incidence rate for first-ever strokes was 29.8/100,000/year (95% CI: 25.2-34.3/100,000 year). When standardized to the 1976 US population, it rose up to 125.8/100,000/year. Ischemic strokes (69%) predominated as in other studies but subarachnoid hemorrhage (SAH) was extremely rare (1.4%). The important risk factors were: systemic hypertension (38%), diabetes mellitus (37%), heart disease (27%), smoking (19%) and family history of stroke (14%). Previous transient ischemic attacks (3%) and carotid bruits (1%) were uncommon. The 30-day case fatality rate was 15%. The study showed that the age-adjusted stroke incidence rate for Saudis in this region is lower than the rates reported in developed countries but within the range reported worldwide. The pattern of stroke in Saudi Arabia is not different from that reported in other communities with the exception of the low incidence of SAH. The risk factors are similar to findings in other studies except for the high frequency of diabetes mellitus in our cases. The lower mortality rate was probably due to the younger age of the population and the availability of free medical services for management of cases.

Drug induced rhabdomyolysis: case report.

Rhabdomyolysis results from skeletal muscle injury leading to the release of intracellular contents into blood and urine. Its diverse aetiology includes severe exercise, muscle trauma or ischaemia, metabolic disorders, infections and exposure to drugs and toxins. Known risk factors include heredity disorders of glycogen and lipid metabolism as well as a history of substance abuse. A case of rhabdomyolysis associated with exposure to opiates and benzodiazepines is described and the pathogenesis and treatment are reviewed. The rhabdomyolysis was complicated by acute renal failure; the patient fully recovered. It is suggested that rhabdomyolysis should be borne in mind in patients presenting with altered mental status, or fluid and electrolyte abnormalities, in particular, if they also give a history of substance abuse.

A double-blind, randomized, placebo-controlled trial of cisapride in Saudi Arabs with functional dyspepsia.

BACKGROUND: Trials on functional dyspepsia (FD) have been performed mostly in Western populations. We evaluated the effect of cisapride in Saudi Arabs with FD. METHODS: In a double-blind, randomized, placebo-controlled trial patients were treated with cisapride three times daily or matching placebo and assessed at 2 and 4 weeks. RESULTS: Cisapride (n = 44) was significantly superior to placebo (n = 45) in improving heartburn, postprandial bloating, epigastric pain, early satiety, epigastric burning, and nausea. The global response to treatment was excellent or good in 86.7% and 26.7% of the cisapride and placebo groups, respectively. Treatment was judged more effective than the previous therapy in 86.4% and 33.3% of those receiving cisapride and placebo, respectively. There were no adverse drug effects. CONCLUSIONS: Cisapride is an effective and well-tolerated treatment for FD in Saudi Arabs. Pharmacogenetic factors are unlikely to play any role in its effects.

Clinical presentation of spontaneous primary hypothyroidism in adults.

In a retrospective study of 309 cases of hypothyroidism seen at King Fahd Hospital of the University (KFHU), Al-Khobar, 124 (90 Saudis and 34 non-Saudis) adult patients with spontaneous primary hypothyroidism satisfied the inclusion criteria for detailed analysis. Their male:female ratios for Saudis and non-Saudis were 1:4.6 and 1:3.9 respectively. The majority were diagnosed in their third and fourth decades. The prevalence of previously undiagnosed spontaneous and biochemically overt primary hypothyroidism in Saudis was 5.2/1000 females and 0.94/1000 males. FT4I was normal in 43 (35%) and low in 81 (65%). FT4I correlated with cold intolerance, constipation, dry skin, hoarseness, delayed reflex relaxation, and coarse and cold skin. In rank order, presenting symptoms in those with low FT4I were tiredness (56%), cold intolerance (38%), constipation, weight gain, menstrual disturbance - especially amenorrhea - (36% each), dry skin (35%), hoarseness (31%); signs were coarse skin (53%), delayed reflex relaxation (32%), cold skin and goiter (24% each). The above clinical findings may help physicians in the early detection of primary hypothyroidism. Population-based studies are necessary to provide more data on this disease in this country.

A randomized, double-blind, clinical trial of topical clotrimazole versus miconazole for treatment of cutaneous leishmaniasis in the eastern province of Saudi Arabia.

The parenteral treatment currently available for cutaneous leishmaniasis (CL) is painful and potentially exposes patients to serious side effects. Thus, effective, topical therapy would be valuable. We assessed the efficacy of topical 1% clotrimazole and 2% miconazole creams in relation to early healing of lesions in CL in a randomized, double-blind clinical trial in 54 patients with 151 lesions treated for 30 consecutive days. Response to treatment was assessed at two weeks and 30 days and classified as fully healed, size reduced, no change, and size increased or worse. Of 89 lesions treated with clotrimazole, 14 (15.7%) healed fully, 42 (47.2%) were reduced in size, 20 (22.5%) showed no change, and 13 (14.6%) got worse. Correspondingly, in the 62 lesions treated with miconazole, none healed fully, 22 (35.5%) were reduced in size, 16 (25.8%) showed no change, and 24 (38.7%) got worse. The differences were statistically significant (P < 0.001). No side effects were observed. It is concluded that clotrimazole was the more effective of the two imidazoline compounds and is recommended as initial treatment for simple lesions.

Pattern of pleural effusion in Eastern Province of Saudi Arabia: a prospective study.

In order to establish the clinical pattern and aetiology of pleural effusion in adults in the eastern province of Saudi Arabia, all patients aged 18 years and above presenting with clinical and radiological evidence of pleural effusion, between 1st December 1987 and 30th November 1991, at three participating hospitals, were prospectively studied. Of the 201 (145 male, and 56 female) patients recruited, 102 (51%) were Saudis; their mean age was 43.4 +/- 17.8 years. Pleural effusion was more common on the right side (56%) than the left (32%). In rank order, the most common diagnoses were tuberculosis (37%), neoplasm (18%), parapneumonia (14%), and congestive cardiac failure (14%). There were a variety of other causes. The aetiology was indeterminate in only 3 (1.5%) patients. Patients with tuberculosis (75 patients) were relatively young (mean age 33.4 years) and 50 (67%) of them were expatriates, mainly from the Indian subcontinent and Yemen. Of the diagnostic procedures, the most useful were histological examination and culture of pleural biopsy. The contribution of culture and cytology of pleural fluid to diagnosis was rather small. It is concluded that the clinical pattern and aetiology of pleural effusion observed in this study are similar to those of the developing countries, although they seem to have been influenced by the large migrant labour force in the country.

Tuberculous pleural effusion in the eastern province of Saudi Arabia.

The incidence and clinical pattern of tuberculous pleural effusion (TPE) and the contribution of individual laboratory procedures in the diagnosis of TPE were assessed in a five year prospective study. Two hundred and fifty-three patients presenting in three participating hospitals with pleural effusion (PE) were assessed clinically and had various laboratory investigations. Eighty-nine (35.2%) of them, including 73 (82%) men and 31 (34.8%) Saudis had TPE. Their mean age +/- SD was 33.4 +/- 11.2 years. Main symptoms in rank order were cough (80%), fever (75%), shortness of breath (64%), chest pain (61%), anorexia and weight loss (47%). PPD was positive in 82 (92%) patients. Positive culture or histological evidence of tuberculosis (TB) was observed in pleural biopsy (68.5%), pleural fluid (10%) and sputum (2%). Pleural fluid microscopy was positive in only one patient, chest radiological features of TB in 3 (3.4%). Six months anti-TB therapy resulted in complete recovery in 86 patients. It is concluded that in this community TPE constitutes over a third of all the causes of PE. The relatively young age of patients reflects the age structure of the indigenous population as well as immigrant workers. PPD, histology and culture of pleural biopsy were the most useful diagnostic tools while pleural fluid and sputum microscopy were unhelpful. The 6-months anti-TB therapy was excellent.

The effect of supplemental oxygen in sedated and unsedated patients undergoing upper gastrointestinal endoscopy.

A total of 212 patients undergoing elective upper gastrointestinal endoscopy were prospectively studied. They were randomly assigned to one of four treatment groups: (I) sedation with no supplemental oxygen; (II) no sedation and no oxygen supplementation; (III) sedation and supplemental oxygen; and (IV) no sedation but supplemental oxygen. Oxygen desaturation occurred in all the groups except group IV and was worsened by sedation. Supplemental oxygen corrected the desaturation in the sedated patients and minimized the associated haemodynamic changes. The duration of the endoscopy procedure was shortest in patients who were sedated and given supplemental oxygen. It can be concluded that during conscious sedation for upper gastro-intestinal endoscopy, supplemental oxygen should be given and continued during the postendoscopy period to prevent oxygen desaturation.

Subacute toxicity of pentavalent antimony compounds in rats.

A subacute toxicity study of pentavalent antimony (Sb) compounds, sodium stibogluconate (SSG) and meglumine antimoniate (MA) was carried out in rats. Three groups of 10 rats each were treated with saline (control group), 300 mg Sb kg-1 d-1 or 900 mg Sb kg-1 d-1 of SSG for 30 d. A parallel study of similar type was conducted for MA. Compared with controls, drug-treated rats showed an impairment of feeding habits and retardation of weight gain (P less than 0.01) during the treatment period. In both SSG- and MA-treated rats there was a dose-related reduction in haemoglobin concentration (P less than 0.001), and hematocrit (P less than 0.001). Red cell count was reduced in SSG-treated rats only. Both drugs, however, significantly raised the white cell count (P less than 0.05). These changes were more pronounced with SSG them with MA. There was no change in MCV, MCH and MCHC. SSG, 900 mg Sb kg-1 d-1, significantly raised AST (P less than 0.005), ALT (P less than 0.01) and alkaline phosphatase activity (P less than 0.01). SSG-treated rats also had raised BUN (P less than 0.01) and creatinine (P less than 0.001), but no significant change in bilirubin levels. MA significantly raised AST (P less than 0.01), ALT (P less than 0.01), BUN (P less than 0.001) and serum creatinine levels (P less than 0.001), but had no appreciable effect on bilirubin and alkaline phosphatase levels. Both SSG and MA decreased blood glucose levels (P less than 0.01) and induced proteinuria.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of topical ketoconazole in cutaneous leishmaniasis.

The efficacy of topical ketoconazole in cutaneous leishmaniasis (CL) caused by L. major was assessed in an open trial. Ten patients with twenty two lesions of CL, confirmed by smear/or biopsy, were recruited into the study. Of the twenty two lesions treated, three increased in size and lesion characteristics worsened, ten showed no change but in nine there was some improvement in lesion characteristics. No lesion healed completely. No side effects were reported in nine. Topically applied ketoconazole is safe but does not significantly alter the course of CL. The differences in the results of systematically administered and topically applied ketoconazole may be due to differences in the pharmacokinetics of the drug when it is administered by different routes.

Obesity in a primary health care centre: A retrospective study.

In a retrospective study, the heights and weights of 1072 Saudis (477 men and 595 women), aged 18 to 74 years, were studied to determine the prevalence of obesity in Saudi patients attending the primary health care center of King Fahd Hospital of the University, Al-Khobar, in the Eastern Province of Saudi Arabia. Of the total group, 51.5% (95% confidence interval, 46.5 to 56.0) of the men and 65.4% (95% confidence interval, 61.5 to 69.2) of the women were considered obese, using as the criterion a body mass index (wt/ht(2)) of greater than 25 kg/m(2). Significantly more women were obese than men. An active detection program and campaign against obesity must be mounted in the community, and this should include advice on diet and the better education of patients with regard to obesity and its complications.

A clinical study of stroke.

The records of 99 Saudis (68 males and 31 females) admitted to the King Fahd Hospital of the University (KFHU) over a two-year period were reviewed. There was a male to female ratio of 2.2:1. Eighty-five (86%) patients were above 44 years old. All the patients under 44 years old were males. The major predisposing factors identified were hypertension (65%), diabetes mellitus (36%), cardiac disease (20%) and cigarette smoking (29%). The combination of hypertension and diabetes mellitus seemed to carry a higher risk especially in women. Motor dysfunction, encountered in 95 (96%) patients was the dominant clinical feature, and presented mainly as hemiparesis (83 out of 95). Impaired level of consciousness at presentation carried a poor prognosis particularly in the elderly.

The population attributable risk of hypertension from heavy alcohol consumption.

The association between alcohol consumption and hypertension was studied in 11,899 men aged 40-55 years. The prevalence of hypertension among heavy drinkers was significantly higher than among those who did not drink heavily. Heavy drinking was defined as consumption of five or more drinks daily or four or more drinks daily. A total of 136 persons fulfilled the five drinks or more per day definition and 230, the four drinks daily definition. The population-attributable risk of hypertension contributed by heavy drinking, depending on the diagnostic criteria used to define each endpoint, varied from 3 to 12 percent. There is reason to suspect that the contribution of alcohol to hypertension in the general population may be somewhat higher at the present time than in the late 1950s when the study was conducted. Moderation of alcohol consumption, in addition to weight reduction and salt restriction, is another important nonpharmacological means to control hypertension.

The profile of the African smoker: the Ghana smoking studies.

PIP: The prevalence of cigarette smoking in Ghana was assessed by examining the data on smoking from 2 World Health Organization sponsored studies of blood pressure and cardiovascular disease. The 2 studies were the Civil Servants Hypertension Project, which surveyed a sample of approximately 20% of all civil servants and included 486 male and 202 female respondents, and the Mamprobi Survey, which sampled the general population and included 3745 respondents, aged 14-64 years. Additional data from 2 other studies was also examined. Overall, the studies found that the proportion of smokers in Ghana was small and that most of those who smoked were not heavy smokers. The smoking prevalence rate among civil servants was 32% for males and 5.9% for females. Among the respondents in the Mamprobi Survey, the respective rates were 24% and 0.8%. For those aged 15-19 years, the prevalence rates in the 2 studies ranged from 4.6%-7.8% for males and was 0.0% for females. In another recent study of 2493 respondents from the general population, the proportion of smokers was only 15.1%. The proportion of smokers was similar among those who earned low and high salaries. In the Civil Servants Study the mean number of cigaretters smoked/day among the civil servants was 7 for the males and 4.7 for the females. In the Mamprobi Survey, the respective mean numbers were 8.4 and 3.0. Among civil servants, professional and administratie personnel smoked an average of 12 cigarettes/day while lower salaried workers smoked an average of 7 cigarettes/day. Only 3.7% of all the smokers in the 2 studies combined smoked 20 or more cigarettes/day. All of the studies indicate that 97%-99% of those who smoked/used cigarettes. Among civil servants, 91% of the smokers and 60% of the nonsmokers used alcohol. The studies indicate that the typical smoker in Ghana is an urban male, between 20-29 years of age, who began smoking as an adolescent. He is just as likely to belong to a high income group as a low income group; however, if he belongs to the former group, he is more likely to smoke more than the average number of cigarettes/day. Available information on smoking should be used to launch a public health campaign to reduce smoking in Ghana. At the present time, only a minority of the population smokes, few individuals are heavy smokers, and teachers and educators are showing considerable interest in combating smoking. Currently, educated and professional groups have a relatively high proportion of smokers. If these groups can be motivated to stop smoking, they might serve as effective role models for other segments of the population. Factors which may increase the smoking problem in Ghana are the growing number of young people who smoke and the ambivalence of the government toward smoking. Voluntary organizations and health professionals should assume more active roles in educating the public about the hazards of smoking.^ieng