Patient journey for hypertension and dyslipidemia in Saudi Arabia: highlighting the evidence gaps.

BACKGROUND: In recent years, Saudi Arabia has witnessed staggering rates of hypertension and dyslipidemia-related cardiovascular (CV) deaths, overburdening the healthcare ecosystem of the country. Appropriate public health interventions can be devised through quantitative mapping of evidence. Identification of potential data gaps can prioritize future research needs and develop a 'best-fit' framework for patient-centric management of hypertension and dyslipidemia. METHODS: This review quantified data gaps in the prevalence and key epidemiological touchpoints of the patient journey including awareness, screening, diagnosis, treatment, adherence, and control in patients with hypertension and dyslipidemia in Saudi Arabia. Studies published in English between January 2010 and December 2021 were identified through a structured search on MEDLINE, Embase, BIOSIS, and PubMed databases. An unstructured search on public and government websites, including Saudi Ministry of Health, without date limits was carried out to fill data gaps. After exclusion of studies based on predefined criteria, a total of 14 studies on hypertension and 12 studies and one anecdotal evidence for dyslipidemia were included in the final analyses. RESULTS: The prevalence of hypertension was reported to be 14.0%-41.8% while that for dyslipidemia was 12.5%-62.0%. The screening rate for hypertension was 100.0% as revealed by the nationwide surveys. Among hypertensive patients, only 27.6%-61.1% patients were aware of their condition, 42.2% patients underwent diagnosis, 27.9%-78.9% patients received antihypertensive treatment, 22.5% patients adhered to treatment medication, while blood pressure (BP) control was achieved in 27.0%-45.0% patients. Likewise, among patients with dyslipidemia, 10.5%-47.3% patients were aware of their condition, 34.6% patients were screened, and 17.8% underwent diagnosis. Although high treatment rates ranging from 40.0%-94.0% were reported, medication adherence recorded was 45.0%-77.4% among the treated patients. The overall low control rates ranged from 28.0%-41.5%. CONCLUSIONS: The study findings highlight evidence gaps along key touchpoints of patient journey. Reinforcing the efforts for high-quality evidence-based research at a national level may pave a path for better resource utilization and provide guidance to practice and amend health policies for patients, healthcare practitioners (HCPs), and healthcare policy makers for better patient outcomes in Saudi Arabia.

Relation between Helicobacter pylori infection and severe pre-eclampsia complicated by intrauterine growth restriction in a rural area in Egypt.

The purpose of this study was to evaluate the association of Helicobacter pylori (HP) infection with severe pre-eclampsia (PE) complicated by intrauterine growth restriction using rapid stool antigen test in a rural area in Egypt. Maternal stool samples were collected from 50 pregnant women diagnosed with PE-associated intrauterine growth restriction (IUGR) and from 50 women with healthy pregnancies (control) between 34 and 38 weeks of gestation. HP stool antigen (HPSA) was measured using a monoclonal antibody test, which is an immuno-chromatographic assay that uses antibody-coated colloidal gold. A significantly higher percentage of HPSA positive women were found among PE cases complicated by IUGR (76%) compared to healthy pregnancies (32%) (p < .0001). However, in the PE/IUGR group, neonatal weight was not significantly lower in HPSA positive patients compared to HPSA negative patients (p = .08). This led to our conclusion that Helicobacter pylori infection has a possible role in the etiopathogenesis of PE with IUGR with no evident effect on its severity.

Value of first-trimester serum lipid profile in early prediction of preeclampsia and its severity: A prospective cohort study.

STUDY OBJECTIVE: The purpose of this study was to evaluate the association of first-trimester serum lipid profile with preeclampsia (PE) and if so, its association with the severity of the disease. STUDY: Prospective cohort study. PATIENT AND METHODS: A total of 251 pregnant women participated in this study in their first trimester. Maternal blood samples were collected between 4 and 12 weeks of gestation. Fasting serum triglycerides (TGs), total cholesterol (TC), HDL-cholesterol, and low-density lipoprotein cholesterol (LDL-C) were drawn and measured by ELISA. From the cohort, 26 women developed PE (16 mild and 10 severe) and 174 remained normotensive and used as control subjects. RESULTS: There was a significant rise in fasting serum TGs, TC, and LDL-C and a significant decrease in HDL-C in women who developed PE than in those who remained normotensive and more significantly evident in severe preeclamptic cases compared to mild cases of PE (p < 0.05). CONCLUSION: Early pregnancy dyslipidemia, particularly hypertriglyceridemia and hypercholesterolemia, may help in predicting women who later develop PE and may help in prediction of its severity.

Religious and cultural legitimacy of bioethics: lessons from Islamic bioethics.

Islamic religious norms are important for Islamic bioethical deliberations. In Muslim societies religious and cultural norms are sometimes confused but only the former are considered inviolable. I argue that respect for Islamic religious norms is essential for the legitimacy of bioethical standards in the Muslim context. I attribute the legitimating power of these norms, in addition to their purely religious and spiritual underpinnings, to their moral, legal, and communal dimensions. Although diversity within the Islamic ethical tradition defies any reductionist or essentialist reconstruction, legitimacy is secured mainly by approximation of Islamic ethical ideals believed to be inherent in the scriptural texts, rather than by the adoption of particular dogmatic or creedal views. With these characteristics, Islamic (bio) ethics may provide useful insights for comparative ethics and global bioethics.