Fawzia Habib

Serum paraoxonase 1 activity and oxidant/antioxidant status in Saudi women with polycystic ovary syndrome

Oxidative stress is considered to be implicated in the pathophysiology of polycystic ovary syndrome (PCOS). This study was designed to evaluate the paraoxonase 1 (PON1) activity and oxidant/antioxidant status in Saudi women with PCOS and its contribution to the risk of atherosclerosis. Lipid profile, hormonal parameters, serum PON1 activity and oxidant (malondialdehyde)/antioxidant (total antioxidant capacity (TAC) levels were analyzed in 35 patients with PCOS and 30 healthy controls using a spectrophotometric method; correlation analysis was made between these variables. Insulin resistance was calculated by homeostasis model assessment (HOMA-IR). Women with PCOS had significantly higher fasting insulin, HOMA-IR and LH levels than controls. Lipid profiles and free androgen index (FAI) were significantly higher in women with PCOS when compared with controls. Serum PON1 activity was lower in the PCOS group (161.2+/-6.1U/l vs. 217.6+/-9.3U/l, p<0.001) compared with controls, whereas malondialdehyde levels were higher in the PCOS group (4.26+/-0.18nmol/ml vs. 1.37+/-0.12nmol/ml, p<0.001) compared with controls. Total antioxidant capacity was lower in the PCOS group (0.88+/-0.10mmolTrolox/l vs. 1.63+/-0.17mmolTrolox/l, p<0.001) compared with controls. In PCOS group, serum PON1 was positively correlated with HDL-C (r=0.425, p<0.05) and TAC (r=0.582, p<0.01) but inversely correlated with HOMA-R (r=-0.54, p<0.01), testosterone (r=-0.672, p<0.01), FAI (r=-0.546, p<0.01) and malondialdehyde (r=-0.610, p<0.01). In conclusion, our data indicate that PON1 activity and antioxidant status were significantly decreased in Saudi women with PCOS. Lower serum PON1 activity might contribute to the increased susceptibility for the development of atherosclerosis risk in Saudi women with PCOS. Therefore, measurement of serum PON1 activity may be of value in assessment of women at higher risk for development of atherosclerosis risk in PCOS. However, further studies with larger sample size are needed to verify these results, and to assess the efficacy of antioxidant therapy on these patients.

Learning styles of medical students at Taibah University: Trends and implications.

Background: Understanding the learning styles of medical students can drive the institutions to adapt instructional materials to enhance students’ learning of knowledge and skills. This study explored the learning styles of undergraduate medical students, comparing gender variations in terms of their significant preferences. Materials and Methods: A cross-sectional observational study was performed in 2012-2013, incorporating 1st-5th year undergraduate medical students of Taibah University. The instrument used was a Learning Style Questionnaire, with four learning styles (activist, reflector, theorist and pragmatist) and 40 items. Results: Of 450 students, 384 responded (response rate; 85%). No single learning style predominated; 96 (25%) reflectors, 78 (20%) theorists, 68 (17%) pragmatists, and 37 (9%) activists. Combined reflector and theorist was the predominant dual learning style in 27 (7%) students. Among genders, theorist style had a significant result (P = 0.071) indicating that theorists varied among genders due to their different opinions. Learning style preferences of theorists and pragmatists also showed a significant result (P = 0.000 each), depicting that both genders had unique preferences. Males had fewer variations of preferences, when compared with females who showed a significant difference of opinions (P < 0.05). Conclusion: The students in the study preferred diverse learning styles, which were unevenly distributed, reflectors being the most common and activists as the least common. The results reflect the need to promote self-directed learning and modifications of instructional strategies, with expectant tilt in the students’ learning styles towards activists and pragmatists.

Reassessment of the undergraduate educational environment in College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia.

Background: We reassessed the perception of all undergraduate students in Taibah medical college regarding the educational environment during the academic year 2010–2011 and compared it with the assessment carried out three years earlier in order to identify the change over time from previous assessment. Method: In the present prospective study, the validated 50-item Dundee Ready Education Environment Measure (DREEM) inventory was collected from medical students of basic phase (n = 302) and clinical phase (n = 222) and compared the scores of students’ responses with those of previous assessment 3years earlier. Results: In the year 2007/2008 DREEM inventory scored 109.1/200 and scored 120.70/200 (p ≤ 0.0001) in the year 2010/2011. There was an interesting inclination of female students towards a more positively perceived learning environment as compared to male students (26/48 versus 24/48, p < 0.03). There were statistically significant differences in all domain components of DREEM between the academic years 2007/2008 and 2010/2011. Conclusions: DREEM helped pinpoint areas of change in students’ perception regarding many aspects of the educational environment. It also helped to identify areas that are still in need of improvement by the colleges administration and staff. DREEM inventory can be used to monitor change over time in the educational environment.

Serum levels of adrenomedullin and inflammatory cytokines in women with term idiopathic intrauterine growth restriction

This study aimed to determine the concentrations of adrenomedullin (AM), tumour necrosis factor (TNF)-α and interleukin (IL)-6 in maternal circulation of full-term idiopathic intrauterine growth restriction (IUGR) in relation to appropriate-for-gestational-age (AGA) and the possible correlation of AM to these cytokines. A case–control study included 50 idiopathic IUGR mothers and 25 AGA, who were evaluated regarding their serum levels of AM, TNF-α and IL-6. We found that women with idiopathic IUGR have significantly higher serum levels of AM, TNF-α and IL-6 (p = 0.008; 0.016; 0.029, respectively) and the level of AM was significantly correlated to serum level of TNF-α (r = 0.417, p = 0.003) but not significantly correlated to IL-6 compared with the AGA group. In conclusion, the significant increase of AM, TNF-α and IL-6 in the idiopathic IUGR group might contribute to the uteroplacental haemodynamic alterations and can serve as a useful biochemical marker. Significant correlation between AM and TNF-α could hypothesise the existence of a complex interaction between AM and this inflammatory cytokine.

Immunohistochemical expression of oestrogen and progesterone receptors during experimental acute and chronic murine Schistosomiasis mansoni

INTRODUCTION The responsibility of Schistosoma mansoni in female infertility is still controversial. This study was conducted to evaluate the effect of acute and chronic schistosomiasis mansoni infection on the endometrium using immunohistochemical analysis of uterine hormone receptor expression. METHODS Twenty-four nonpregnant swiss albino mice were divided into three groups: control, noninfected; acute; and chronic Schistosoma mansoni infection. Histological sections of uterine specimens were examined by light microscope with an image analyzing system to detect structural histological, estrogen receptor (ER) and progesterone receptor (PR) expression in the endometrium. RESULTS No secretory phase was detected in the endometrium in acute and chronic Schistosoma infection. Hormone receptor expression (ER and PR) showed statistically significant differences among the groups (p< 0.05), with significant low ER hormone expression in chronic infection, compared to control proliferative, control secretory and acute infection cases, and statistically significant high PR expression in both acute and chronic infection cases compared to the control secretory cases (p< 0.05). CONCLUSIONS Schistosomiasis mansoni seems to have an important impact on the hormone expression of affected women. Further studies to explore the mechanism of such changes are recommended.

Mycotic VulvoVaginitis: Epidemiology, Pathogenesis and Profile of Antifungal Agents

Abstract Objective VulvoVaginitis is the most common gynecological problem affecting millions of women world wide. At some point in their life time, nearly 75% of all women experience an attack of Candida Vulvovaginitis. Little is known about the prevalence of different causes of Vulvovaginitis and risk factors for this entity in Saudi Arabia. This survey was conducted to study the etiologic agents associated with mycotic Vulvovaginitis and review some predisposing factors correlated with this type of infection in Al-Madina Al-Munawarah, Saudi Arabia. Methods High vaginal swabs (HVS) specimens were collected from 1000 patients attending gynecological out patients clinics of two general hospitals in Al-Madinah Al-Munawarah. Specimens were cultured on specific medium for yeasts and identification of the positive isolates was carried out using” API” kit. Antifungal sensitivity pattern of the isolates was tested out using” Candifast” kit. Proteolytic enzyme activity of the isolates was also detected. Results Three hundred and forty nine positive cases of yeast infection out of 1000 diagnosed cases representing 34.9% were recorded in this study. These positive cases were classified on the basis of the risk factor as; diabetic (28.9%); pregnant, (32.1%); pregnant and diabetic (7.5%); Menopause (5.5%); oral contraceptive users (10.6%); post hysterectomy (1.4%) and no observed factor in 14% of the cases. Twenty one different species belonging to 7 genera were recovered in this study. The genus Candida was the most common (93.4%) and included 14 different species. Candida albicans was the highest in prevalence (51.3%). The non-Candida species were Saccharomyces cervisiae (2.9%); Rhodotorula rubra (1.1%); R. minuta (0.9%) Debaryomyces hansenii (0.6%); Trichosporon mucoides (0.6%); Cryptococcus neoformans (0.3%) and Picm’a ohmeri (0.3%). Most of the Candida species were sensitive towards nystatin, amphoterian B and fluconazole and resistant to other azole drugs. Saccharomyces cervisiae and Debaryomyces hansenii were sensitive to almost all the tested antifungal drugs.The rest of the species were variable in their pattern. Proteolytic activity of C. albicans reached its maximum value after 72 hours. Neutral proteases was the highest at pH 6.5 followed by alkaline proteases at pH 8.2 and the least amount was acid protease at pH 3.5. Conclusion The results of this survey which is the first study done in this region threw some light on the prevalence, etiology, sensitivity profile of the etiologic agents and the risk factors of Vulvovaginitis in Al-Madina Al-Munawarah Saudi Arabia. Awareness towards the increase incidence of Vulvovaginits needs more attention to be paid for fungal infection and antifungal sensitivity.

Medical students perception of test anxiety triggered by different assessment modalities

Abstract Objectives: Test anxiety is well known among medical students. However, little is known about test anxiety produced by different components of exam individually. This study aimed to stratify varying levels of test anxiety provoked by each exam modality and to explore the students perceptions about confounding factors. Methods: A self-administered questionnaire was administered to medical students. The instrument contained four main themes; lifestyle, psychological and specific factors of information needs, learning styles, and perceived difficulty level of each assessment tool. Results: A highest test anxiety score of 5 was ranked for “not scheduling available time” and “insufficient exercise” by 28.8 and 28.3% students, respectively. For “irrational thoughts about exam” and “fear to fail”, a highest test anxiety score of 5 was scored by 28.8 and 25.7% students, respectively. The highest total anxiety score of 1255 was recorded for long case exam, followed by 975 for examiner-based objective structured clinical examination. Excessive course load and course not well covered by faculty were thought to be the main confounding factors. Conclusions: The examiner-based assessment modalities induced high test anxiety. Faculty is urged to cover core contents within stipulated time and to rigorously reform and update existing curricula to prepare relevant course material.

Factors associated with different symptom domains among postmenopausal Saudi women in Riyadh, Saudi Arabia

Objective: To determine factors associated with different symptom domains among postmenopausal Saudi women in Riyadh, Saudi Arabia. Methods: In a cross-sectional study, interviews were conducted with 542 postmenopausal Saudi women, comprising sociodemographic history, social support, and the Menopause-specific Quality of Life questionnaire. Results: The mean age of participants was 58 (±7.0) years, and the mean age at menopause was 49 (±4.7) years. We found that 41% (n = 224), 14.4% (n = 78), 57% (n = 307), and 12.7% (n = 69) of women reported severe/moderate impact of vasomotor, psychosocial, physical, and sexual symptoms, respectively. Multivariate logistic regression revealed that lacking emotional support was associated with severe/moderate vasomotor (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.1, 2.3), psychosocial (aOR 2.0, 95% CI 1.2, 3.4), and physical (aOR 1.7, 95% CI 1.2, 2.6) symptoms. Lack of tangible social support was associated with severe/moderate sexual symptoms (aOR 1.9, 95% CI 1.0, 3.4). In addition, women who worked (aOR 1.8, 95% CI 1.1, 3.2), were obese (aOR 2.0, 95% CI 1.0, 4.1), lived in rented accommodations (aOR 3.9, 95% CI 1.2, 13.1), or had a retired spouse (aOR 1.6, 95% CI 1.0, 2.4) had higher odds for moderate/severe menopausal symptoms. Conclusions: Establishing educational and counseling programs for postmenopausal women, their spouses, and other family members could improve social support and hence quality of life of postmenopausal women. Effective preventive strategies to deal with modifiable risk factors, such as obesity and work stress, should also be implemented.

Morbidity and Mortality in Anemia

A growing body of research suggests that anemia is independently associated with morbidity and mortality in the general population as well as in patients with chronic diseases where the prevalence of anemia is high (1-4). Anemia prognosis depends on the underlying cause of the anemia. However, the severity of the anemia, its etiology, and the rapidity with which it develops can each play a significant role in the prognosis. Similarly, the age of the patient and the existence of other co-morbid conditions influence outcome. Higher mortality rates are almost always observed in patients with anemia. Many studies (511) identified anemia as an independent factor impacting mortality and provided the evidence that management of anemia, independent of other risk factors, improves mortality rates. In one study (3), independent of the underlying disease, anemia was associated with increased mortality in chronic kidney disease, congestive heart failure and acute myocardial infarction patients; increased morbidity in chronic kidney disease, congestive heart failure and cancer radiotherapy patients; and decreased quality of life in chronic kidney disease and cancer patients. In addition to its impact upon mortality, anemia also significantly influences morbidity. Multiple studies support this assertion especially in patients with chronic kidney disease and heart failure (12-17).

Obstetricians' perception of medico-legal problems in Al Madinah Al Munawarah Kingdom of Saudi Arabia

Abstract Objectives Obstetrics is a specialty that is widely perceived to be associated with a high risk of litigation. Most of the potential problems in obstetrics usually result from the lack of competence, which may harm pregnant women and their fetus. Obstetrics litigation leads the way in being the most litigation prone medical specialty in Saudi Arabia. In an attempt to improve the defining standards of quality, this study illustrates the medico-legal obstetrics claims in Al Madinah Al Munawarah region –Kingdom of Saudi Arabia, the consequences and the psychological morbidity among obstetricians. Methods A cross-sectional survey was conducted in Al Madina Al Munawara involving 90 obstetricians regarding their views about obstetrics litigation, using a piloted and well structured questionnaire. Results The response rate was 88.8%. The majority of the surveyed obstetricians were female 62.5%. 38% were below 40 and 39.4% had 21–30 year of experience. Most of the participants agreed that birth asphyxia was the commonest cause of obstetrics litigation 62% and about 53% of were exposed to legal medical organization, while 54% were exposed to Supreme Court, resulting in either financial compensation (59%) or claim dismissal (40%). Most of the participating obstetricians suffered from depression (83%) and 90% of the female participants developed family problems and about 15% of the participants thought of changing their career. Conclusion Attention to safety issues and effective risk management system should help to reduce medico-legal claims in obstetrics.