Evaluation of metabolic, antioxidant and anti-inflammatory effects of Garcinia kola on diabetic rats.

Garcinia kola (G. kola), is a plant characterized by its hypoglycemic properties. We recently reported our findings on the extracts of G. kola, in which we found that it prevented the loss of inflammation-sensible neuronal populations in streptozotocin (STZ)-induced rat models of type 1 diabetes mellitus (T1DM). In the present study we assessed the effect of G. kola bioactive compounds extracted successively with water, hexane, methylene chloride, ethyl acetate, and butanol. through analyzing biochemical markers of oxidative stress, inflammation, and metabolic function in STZ-induced diabetic animals. Animals made diabetic by a single injection with STZ (60 mg/kg, i.p.), were treated daily with either vehicle solution, insulin, or G. kola extracts and its fractions from the first to the 6th-week post-injection. Biochemical markers; glucose, insulin, C-peptide, neuron-specific enolase (NSE), creatinine kinase, glutathione peroxidase, malondialdehyde (MDA), resistin, soluble E-selectin (SE-Selectin), and C-reactive proteins (CRP) levels in the sera were determined in the study groups. A marked increase in blood glucose (209.26% of baseline value), and a decrease in body weight (-12.37%) were observed in diabetic control animals but not in animals treated with either insulin or G. kola extracts and its fractions. The sub-fraction F5, G. kola ethyl acetate had the highest bioactive activities, with a maintenance of blood sugar, malondialdehyde, C-peptide, E-selectin, C-reactive protein (CRP) and neuron-specific enolase (NSE) to levels and responses comparable to healthy non-diabetic vehicle group and the positive control diabetic insulin-treated group. Our findings suggest that G. kola may have a strong therapeutic potential against T1DM and its microvascular complications.

Perceived stress and associated factors among medical students.

BACKGROUND: Stress and its psychological manifestations are currently a major source of concern. Medical education poses challenging and potentially threatening demands for students throughout the world. OBJECTIVES: To determine the prevalence and factors associated with perceived stress in medical students in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia. MATERIALS AND METHODS: This was a cross-sectional study on all medical students of batches 9, 10, and 11, which constituted all the enrolled students. Data were collected using a questionnaire based on the Kessler10 psychological distress instrument with a total score ranging from 10 to 50 points in addition to some sociodemographic characteristics. Appropriate statistical test procedures were used to study the magnitude of stress and its risk factors. RESULTS: Mean stress score of the eighty participants was 26.03 ± 9.7. Students with severe stress constituted 33.8%, and 30% were well. Severe stress was significantly associated with female gender and junior level. Nervousness, feeling hopeless, feeling restless, and depressed were the most important factors affecting students' stress scores. Factor analysis revealed three hidden factors for stress in this group, namely, depression, nervousness, and age. CONCLUSION: Stress in medical students is prevalent and significantly associated with the female gender and the junior level. Implementation of coping programs is necessary.

Isolated Diastolic Hypertension among Adults in Saudi Arabia: Prevalence, Risk Factors, Predictors and Treatment. Results of a National Survey.

BACKGROUND: In the past, diastolic hypertension was the main criterion for treatment, but currently, systolic pressure is the main criterion because it was thought that Isolated Diastolic Hypertension (IDH) is not associated with complications. Studies later revealed that IDH carries significant risks. Quantifying the magnitude and risk factors of IDH in the community is essential for all intervention strategies. AIMS: This study aims to determine the prevalence, risk factors, predictors, treatment modalities and lifestyle practices of IDH adult patients in the Kingdom of Saudi Arabia (KSA). STUDY DESIGN: Cross-sectional study. METHODS: A community-based cross-sectional study using STEPwise approach among adults using a multistage, stratified, cluster random sample was carried out. Data were collected using questionnaires which included socio-demographics, blood pressure, biochemical, anthropometric measurements and lifestyle practices. Statistical analysis included calculating means and standard deviations, proportions, univariate and multiple logistic regression analysis. RESULTS: Of a total 4562 subjects, 180 (3.95%) suffered from IDH, which was significantly related to age, gender, employment, smoking, diabetes mellitus, obesity and hypercholesterolemia. More than 93% were using some form of treatment, with 77.2% on prescribed drugs, 63% using diet, and 23% using exercise. Significant predictors of IDH were retirement and hypercholesterolemia. CONCLUSION: IDH is associated with some sociodemographic characteristics and co-morbidity. Given the risk of cardiovascular disease associated with IDH, the findings of this study emphasize the need for diagnosing the disease in middle-aged persons focusing on the modifiable risk factors of IDH.

Impact of Interatrial Communication on Left Ventricle Performance in Patients with Significant Post-tricuspid Shunt.

Infants with post-tricuspid valve shunts (PTS) may benefit from interatrial communication (IAC). The effect of IAC on left ventricular (LV) performance in these patients was studied. IAC was documented prospectively in 55 patients with PTS. Clinical status, echocardiographic dimensions of LV, mitral inflow Doppler, tissue Doppler velocities and time intervals were measured. Creatinine kinase (CK), CKMB, troponin-I and NT pro-brain natriuretic peptide (NT pro-BNP) were measured. Patients were divided into four groups: (A) PTS but no IAC (n = 32); (B) PTS and IAC (n = 23); (C) VSD but no IAC (n = 16); and (D) VSD and IAC (n = 19). Group A had more frequent mitral regurgitation (p = 0.041), larger mitral annulus (1.80 vs. 1.30 cm, p < 0.0001) and larger LV systolic and diastolic dimensions (2.01 vs. 1.40 and 3.28 vs. 2.35 cm, p < 0.001) than group B. The E-wave deceleration time tended to be longer in group A (121.0 vs. 106.8 ms, p = 0.06). By tissue Doppler, group A had E'- and S-waves significantly taller (15.51 vs. 13.14 and 7.69 vs. 6.72 cm, p = 0.04 and p = 0.005, respectively) than group B. Also, NT pro-BNP was significantly higher in group A (1116.15 vs. 458.73 pg/ml, p = 0.028). Group C had significant larger mitral z-score values (1.2 vs. 0.01, p < 0.001), larger LV diameter z-score (p = 0.001) and higher NT pro-BNP level (1477.37 vs. 451.66 pg/ml, p = 0.001) than group D. There was no significant difference in the clinical status between the groups. In children with PTS, the presence of IAC could be beneficial. Their echocardiographic parameters and biomarker show better systolic and diastolic LV performance.

Anthropometric risk factors and predictors of hypertension among Saudi adult population - a national survey.

UNLABELLED: This cross-sectional study aimed at determining the anthropometric predictors of hypertension among adults in Saudi Arabia. Multi-stage stratified sampling was used to select 4758 adult participants. The average of three blood pressure measurements using an automatic sphygmomanometer was considered the real blood pressure. Anthropometric measurements and socio-demographics were obtained from participants. The overall prevalence of hypertension was 25.5%. Hypertension was significantly positively associated with selected anthropometric measurements. Selected anthropometric measures were significant predictors of systolic and diastolic blood pressures except for hip measurements. Waist for height ratio was a significant predictor for isolated diastolic hypertension and combined systolic and diastolic hypertension. Waist circumference was the significant predictor for isolated systolic hypertension. Body mass index was a significant predictor for the combined systolic diastolic type. Waist for Hip Ratio was not a significant predictor for any of the hypertension subtypes. CONCLUSION: Waist for height ratio is the most important predictor for blood pressure level and hypertension disease.

Comparative study of physical activity of hypertensives and normotensives: A cross-sectional study of adults in Saudi Arabia.

BACKGROUND: To formulate all intervention strategies for hypertension in the community, it is essential to quantify the magnitude of the disease and its risk factors. The patterns of physical activity have not been studied in terms of their being a risk factor or a predictor of hypertension in Saudi Arabia. MATERIALS AND METHODS: This was a community-based cross-sectional study using the STEP-wise approach of adults and a multistage, stratified, cluster random sample. Data were collected using a questionnaire which included sociodemographics, blood pressure, patterns, levels and duration of physical activity. RESULTS: Of a total of 4758, 1213 (25.5%) were hypertensives. Hypertension was significantly negatively associated with total levels and duration of physical activity in leisure, transport, and work. Significant predictors of hypertension included lower levels of work involving a moderate physical activity for 10 min, walking/cycling for 10 min continuously, and vigorous activity during leisure time. CONCLUSIONS: Hypertension is prevalent among adults; physical inactivity is a significant risk factor and predictor. Targeting this modifiable risk factor can help in prevention, early diagnosis, and control.

Association of tobacco products use and diabetes mellitus-results of a national survey among adults in saudi arabia.

OBJECTIVE: To compare the tobacco products use patterns of known diabetics and non diabetics. MATERIAL AND METHODS: A community-based cross-sectional study using STEPwise approach among adults using a multistage, stratified, cluster random sample. Data was collected using a questionnaire which included sociodemographics; tobacco products use habits, history of diabetes, biochemical and anthropometric measurements. RESULTS: Of the total of 4654 subjects who participated in the study, 1016 (21.8%) were ever smoked tobacco products users and 65 (1.4%) were ever smokeless tobacco products users. Known Diabetes prevalence was 15.3% (712 known diabetics). There were no significant differences in diabetic status and smokeless tobacco products use for both ever and current use. For smoked products diabetics are fewer in current smokers and more in ex smokers. Diabetics started smoking significantly older, smoked for longer duration and higher intensity than non diabetics. CONCLUSION: Diabetes appears to be associated with smoked but not smokeless tobacco products use.

Prevalence, Awareness, Treatment, and Control of Hypertension among Saudi Adult Population: A National Survey.

This cross-sectional study aimed at estimating prevalence, awareness, treatment, control, and predictors of hypertension among Saudi adult population. Multistage stratified sampling was used to select 4758 adult participants. Three blood pressure measurements using an automatic sphygmomanometer, sociodemographics, and antihypertensive modalities were obtained. The overall prevalence of hypertension was 25.5%. Only 44.7% of hypertensives were aware, 71.8% of them received pharmacotherapy, and only 37.0% were controlled. Awareness was significantly associated with gender, age, geographical location, occupation, and comorbidity. Applying drug treatment was significantly more among older patients, but control was significantly higher among younger patients and patients with higher level of physical activity. Significant predictors of hypertension included male gender, urbanization, low education, low physical activity, obesity, diabetes, and hypercholesterolemia. In conclusion prevalence is high, but awareness, treatment, and control levels are low indicating a need to develop a national program for prevention, early detection, and control of hypertension.

Prevalence and associated factors of cigarette smoking among medical students at King Fahad Medical City in Riyadh of Saudi Arabia.

OBJECTIVE: To determine the prevalence of smoking among medical students at the medical college at King Fahad Medical City in Riyadh, and assess the association between smoking and socio-demographical factors, smoking contacts, reasons for smoking and attempts to quit. MATERIALS AND METHODS: Cross-sectional survey in which anonymous, self-administered questionnaire was used to survey the cigarette smoking habits of the first- and second-year medical students in the Faculty of Medicine, King Fahad Medical City in June 2009. RESULTS: Overall 39.8 % of the investigated students (153) had smoked before, and 17.6% were current smokers. The mean age of initiating smoking was 15.8 (±3.3). There were significantly more males than females. The most important reasons for smoking were leisure, imitation of other people and a means of relieving psychological pressure. Reasons for not smoking were mostly health and religion-based. Smokers tended to have friends who smoked. CONCLUSION: Cigarettes smoking is highly prevalent among medical students in the Faculty of Medicine, King Fahad Medical City. Contact with smokers particularly friends are the major risk factors for the initiation of the habit. Health and religious considerations are important motives for not smoking, quitting or attempting to quit. These findings can be of help in designing future intervention strategies.

Pilgrims satisfaction with ambulatory health services in Makkah, 2008.

OBJECTIVE: The main objective of this study was to assess the level and correlates of patients' satisfaction with ambulatory health services provided for pilgrims during Hajj period in 2008. MATERIALS AND METHODS: This was a facility-based, cross-sectional study conducted in the Makkah region during the Hajj season in December 2008. A two-stage technique was used to select 500 patients from those who attended the ambulatory health services. One hundred subjects were selected by systematic random sampling (every fifth) from each of the five hospitals included in the study and asked to fill in a pilot-tested self-administered questionnaire. A total of 487 questionnaires were analyzed. Descriptive statistics and t-test, Mann Whitney test and ANOVA, or Kruskal-Wallis test was used as appropriate after checking for normality. Level of significance level was set to be <0.05 throughout the study. RESULTS: From 478 subjects analyzed, 390 (81.6%) were man, 345 (72.2%) were married, 28.9% had either intermediate or high secondary school education, and 2.4% were skilled laborers. The total satisfaction score for health facilities was 20.45 ± 4.03 of 25. The satisfaction scores were 20.15 ± 4.7 of 25 for patient satisfaction with physicians and 21.35 ± 4.5 for patient satisfaction with paramedical personnel. The overall satisfaction score was 61.5 ± 4.5 of 75 points. There were significant relations between total satisfaction of health facilities with education level and with occupation (P = 0.012, 0.001, respectively). The total satisfaction of patients with physicians was significant only with education level. The overall satisfaction score had a significant relation with occupation (P = 0.03), but a borderline relation with the education level (P = 0.056). CONCLUSION: Satisfaction with ambulatory Hajj health services is acceptable. Some physicians and waiting area services need special attention to improve satisfaction levels with ambulatory health in the subsequent Hajj seasons.

Gender differences in smoking behavior among adolescents in Saudi Arabia.

OBJECTIVE: To describe and assess gender differences in current cigarette smokers' according to certain variables including prevalence, access to tobacco, knowledge and attitude, environmental tobacco smoke, cessation of smoking, tobacco related advertisements, and education on tobacco in school among adolescents in grades 7-12 in Tabuk, Saudi Arabia. METHODS: A random sample of schools in Tabuk city was obtained using a 2-stage cluster, in April 2005. A total of 16 governmental schools were selected. Within the schools, 48 classes were selected, targeting grades was 7 to 12. An anonymous, self-administered questionnaire was used to select 1,505 participants, with 96% response rate. RESULTS: Out of 1,505 students, 22.3% (34% males, 11.1% females) were current cigarette smokers (students who had smoked on one or more days in the 30 days preceding the survey), and 5.8% (11.1% males, 0.7% females) were daily smokers. There were significant gender differences concerning source of cigarettes, usual place of smoke, intensity of smoking, knowledge on addiction of tobacco, exposure to education on tobacco, attitudes, and exposure to tobacco smoke in public places. While no significant gender differences were found with respect to age of initiation, knowledge of health hazards of tobacco, exposure to media, desire to quit, or exposure to tobacco smoke at home. CONCLUSION: For the suppression of the use of tobacco by adolescents in Saudi Arabia differential intervention strategies and policies in males and females are needed, such as reducing youth access to cigarettes-in addition to intensive school and community anti-tobacco programs.

Patients' perspective on factors affecting utilization of primary health care centers in Riyadh, Saudi Arabia.

OBJECTIVE: The aim of this study is to assess factors which the patients think can encourage, discourage or have no effect on utilization of Primary Health Care Centers (PHCCs) in Riyadh, Kingdom of Saudi Arabia. METHODS: Patients (n=540) attending the selected PHCCs in Riyadh were asked regarding their views on 21 (factors) items and whether they can encourage, discourage or has no effect on utilization of PHCCs services. Eight PHCCs were randomly selected according to the geographical location, 2 from each geographical zone. Seventy-five subjects were selected systematically, every 10th Saudi aged 15 years and above who visited the selected PHCCs during a one-month period (September 1998). The data was collected via a self administered pilot tested, internally consistent questionnaire which included patients' sociodemographic characteristics and their response to the 21 items rated as highly encouraging, encouraging, has no effect or discouraging utilization of offered health services. RESULTS: More than 60% of the patients were males, aged 15-39 years, 47% finished secondary school, 5.2% were illiterate, 58% of all patients were married, more than 60% were employees and approximately 60% have a monthly income of less than 4500 Saudi Riyals. Manpower factors particularly the physician, Arabic speaking health team and free service were the most encouraging factors, while overcrowding and geographical location of the PHCCs, particularly location near public services, were the least encouraging factors. Patients' gender, education and occupation were the most important and age was the least important patients' characteristics associated with utilization factors. CONCLUSION: An experienced physician, Moslem physicians and an Arabic speaking health team offering free service in PHCCs located near patients' homes can augment utilization of services.

Mothers' practices during pregnancy, lactation and care of their children in Riyadh, Saudi Arabia.

OBJECTIVE: To study mothers' practices during pregnancy, lactation and care during the first 2 years. METHODS: A cross section study was carried out in 5 Primary Health Care Centres (PHCC) in Riyadh, Kingdom of Saudi Arabia. Two hundred and fifty women (50 from each PHCC) who have children less than 2-years of age who visited the selected PHCCs during the study period were selected by systematic random sampling. Data was collected via a questionnaire which contained sociodemographic characteristics of the mother and their children and mothers' practices during pregnancy, lactation and the care of their children. RESULTS: Approximately 73% of the mothers breast fed their children initially but only 37.6% are currently breast feeding their children. The majority of the mothers started breast feeding during 1-8 hours after delivery, 63% added supplementary foods to their children at 4-8 months. The majority of mothers visited antenatal clinics during pregnancy, vaccinated their children and followed up their children in well baby clinics. Half of the mothers are currently using contraceptives and 19% are consuming less food during pregnancy. The mothers' educational level was the most important factor associated with mothers' practices. CONCLUSION: Some mothers' practices during pregnancy, lactation and child care needs corrective intervention.