Saad Al Shohaib

Measures of Religiosity

The measurement of religiosity and spirituality is increasingly common in the social and behavioral sciences, as well as within medicine and the medical and psychological sciences. However, attempting to measure and quantify such vague, nebulous, and seemingly subjective concepts has caused havoc among investigators. We define here the construct of religiosity and discuss general approaches to measurement. We then describe seven dimension-specific and three multidimensional scales, most developed within Christian populations. We also describe five religion-specific measures to assess Jewish, Muslim, Hindu, Buddhist, and New Age faith traditions. Finally, recommendations are made on the best measures of religiosity to use depending on the purpose of the research, the religious composition of the population, and the space available in the questionnaire. The chapter is rounded out with a brief description of measures of spirituality.

Tuberculosis in Active Dialysis Patients in Jeddah

The incidence of tuberculosis in The Kingdom of Saudi Arabia remains high. The objective of this study is to determine the prevalence of Tuberculosis among haemodialysis patients, since they are highly susceptible to this infection. A retrospective study, over a 5-year period, was carried out in the Renal Units of two large hospitals in Jeddah. Diagnosis was established by Ziehl Neelsen microscopy and culture of specimens on Lowenstein-Jensen media, radiological and histological examinations. Tuberculosis was diagnosed in 17 of 210 patients on hemodialysis. Pulmonary tuberculosis was present in 10 cases and tuberculous lymphadenitis in 8 cases. One patient had both pulmonary and lymph node involvement while another one had both pulmonary and peritoneal tuberculosis. Mycobacterium tuberculosis was diagnosed in sputum in 5 cases, by lymph node histopathology in 5 cases, and combined radiological and clinical evidence in the remaining patients. The Mantoux test was positive in 9 (60%) cases. Eight patients were diabetics (47%) and there appears to be some association of tuberculosis with diabetes in patients on dialysis. Treatment with first-line anti-tuberculosis agents was continued for 6–18 months. Fourteen (82%) patients were completely cured while 3 showed clinical improvement only. The study showed that successful therapy of tuberculosis in this group of dialysis patients could be achieved but high index of suspicion is required to recognize the unusual presentation in this group of patients so that early diagnosis can be achieved and prompt treatment instituted. Diabetic patients presenting for dialysis, in areas with high endemicity for tuberculosis, chemoprophylaxis with anti-tuberculosis agents should be considered.

Differences and Similarities

One of the most important chapters in this book is Chap. 5. Here we lay out the differences and similarities between Muslims and Christians in what they believe, practice, and value. For over a thousand years, Muslims and Christians have focused on the differences between their belief systems, which have been used to justify wars and atrocities on both sides. Yes, there are differences, and some pretty major ones at that. However, what is usually neglected are the striking similarities between the two belief systems, the overlap in religious practices, and the almost identical religious values regarding the sanctity of life, the family, and many behaviors likely to affect health. Here we unapologetically lay out the differences and the similarities in as objective and rigorous way as possible, relying on the sacred writings in the Qur’an and the Bible for guidance. These differences and similarities are likely key to understanding how religion affects individual and community health in both traditions.

Religious involvement and tobacco use in mainland China: a preliminary study.

BackgroundCigarette smoking causes serious health, economic, and social problems throughout the world. Religious involvement is known to be an important predictor of health behaviors and substance use. The present study examines the correlation between religious involvements and tobacco use, and explores connections between religiosity and tobacco use in Muslims and non-Muslims in Western China.MethodsData were examined from a representative sample of 2,770 community-dwelling adults in the province of Ningxia located in Western China. Self-report smoking, past smoking, religious attendance and the importance of religious in daily life were measured. The WHO Composite International Diagnostic Interview was used to diagnose tobacco use disorders. Three separate logistic regression models were used to examine correlations between religious involvement and smoking status.ResultsIn the overall sample, religious attendance was inversely associated with current smoking (p < 0.001), as was importance of religion (p < 0.05). Current smoking was also less common in those categorized as high on religious involvement. No association, however, was found between religious involvement and either past smoking or tobacco use disorders. In Muslims, both religion attendance and high religiosity were inversely associated with current smoking (p < 0.001), although no association was found in non-Muslims.ConclusionsReligious involvement is inversely related to current smoking in Western China, although this association depends on religious affiliation.

Increased Risk of Hypertension, Proteinuria and Preeclampsia in Pregnant Saudi Females with IgA Nephropathy

Background. IgA nephropathy is fairly prevalent in Saudi Arabia. In this paper we examine the natural history of pregnancies and their impact on renal function in Saudi females affected by this condition. Methods. We followed a series of 12 patients, documented to have IgA nephritis by kidney biopsy, during their gestation. We monitored their blood pressure, serum creatinine, creatinine clearance, 24-hour protein before conception and at the third trimester of pregnancy. We also documented any maternal or fetal complications. Results. All patients had well-controlled blood pressure, normal renal function, and proteinuria of less than one gram per day prior to conception. During pregnancy, all patients (100%) developed hypertension-requiring treatment and three of them (25%) developed preeclampsia. One patient (8.3%) had hemolysis, elevated liver enzymes, and, low platelets syndrome. All patients had worsening of their proteinuria during pregnancy from 535.2 (101.4) to 2179.2 (636.6) mg/24 h (p < 0.01) with a decrease in creatinine clearance from 88.6 (7.6) mls/min to 77.4 (5.9) mls/min (p < 0.05). No fetal complications were observed. Conclusion. We conclude that pregnancies in patients, even with mild IgA nephritis, require close observation as there is an increased incidence of worsening hypertension and preeclampsia.

Simvastatin-induced rhabdomyolysis and acute renal injury.

Simvastatin is one of the most commonly prescribed CoA reductase inhibitors. The safety profile of this drug has been widely discussed in the medical and consumer advocacy communities. Like other statins, simvastatin can cause a serious and potentially life-threatening complication: rhabdomyolysis. We describe a case of simvastatin-induced rhabdomyolysis complicated by acute renal failure requiring urgent hemodialysis. The relative safety of simvastatin compared to other HMG-CoA reductase inhibitors and the conditions that can potentiate its toxicity are discussed. The clinical features of rhabdomyolysis, and subsequent acute renal failure, and their treatment modalities are presented.

Erythropoietin Therapy in a Pregnant Post-Renal Transplant Patient

Erythropoietin (EPO) is a glycoprotein hormone produced principally by the kidney and is the major stimulus for erythropoiesis. Recombinant human EPO has now been biosynthesized and is available for clinical use, particularly in patients with renal failure. EPO has been reported to be effective in treating anaemia due to chronic renal failure. It has been used in pregnancy to correct anaemia following renal transplantation with graft dysfunction. We report here the case of a post-renal transplant patient who became pregnant and developed severe anaemia which was not related to iron, B12, or folate deficiency. Her anaemia was successfully treated with EPO with no evidence of rejection or significant graft dysfunction following therapy. She tolerated EPO very well, and there was a successful outcome of the pregnancy. This case has encouraged us to conclude that EPO has a useful role in the treatment of anaemia in pregnant women following renal transplantation.

Religion and Negative Emotions in Muslims

This chapter is the first in a series of five chapters dealing with research on religiosity and health within Muslim populations, where we also compare the health of Muslims with the health of members of other religious group (Christians in particular). The topics parallel those presented in the last chapter for research in Christians. Chapter 7 begins by reviewing qualitative and quantitative studies on the role that Islamic beliefs and practices play in coping with stress and loss. We then systematically and exhaustively review studies on religious involvement and depression, suicide, physician-assisted suicide, anxiety, psychosis, alcohol use/abuse, and illicit drug use/abuse. These findings are summarized in tables so that the reader can quickly scan the results of our review. The findings will be eye-opening for many readers, both Muslim and Christian.

Hemolytic-Uremic Syndrome Superimposed on Chronic Lupus Nephritis

Accessible online at: www.karger.com/journals/nef Dear Sir, Hemolytic-uremic syndrome (HUS) is an acute syndrome characterized by the presence of thrombocytopenia, microangiopathic hemolytic anemia, and renal failure [1]. There are various causes of HUS, including Escherichia coli 0157:H7, viral infections, drugs (ciclosporin, FK506, mitomycin), pregnancy, malignant hypertension and systemic lupus erythematosus (SLE) [2–4]. Coombs-positive autoimmune hemolytic anemia can occur in SLE and usually responds well to high-dose steroids [5]. Here we describe a case of HUS superimposed on chronic renal failure in a young lady with SLE. It was very important that HUS was correctly diagnosed in this case, since the therapy required is different [4]. Autoimmune hemolytic anemia can occur superimposed on lupus nephritis, and it can be difficult to differentiate this picture from that of HUS [5]. An 18-year-old Saudi female, known to have lupus nephritis for the last 5 years, presented first with nephrotic syndrome. A kidney biopsy was done, and the patient was found to have class IV lupus nephritis (diffuse proliferative glomerulonephritis) with little chronic changes. She also had interstitial disease, but no interstitial fibrosis. She was treated with high-dose steroids and received monthly cyclophosphamide 1 g for 6 months, then every 3 months for an additional 18 months. Initially she did well, particularly her edema and proteinuria improved. However, her creatinine level started to increase and reached 300 Ìmol/l over the last 3 years. We wanted to repeat a biopsy to reassess her renal disease again, but she was not willing to do that. Two months later she presented to the emergency room with severe dyspnea, orthopnea, and ankle edema. On examination, she looked pale, anxious, and dyspneic, with a blood pressure of 160/100 mm Hg. Cardiovascular examination revealed increased jugular venous pressure, decreased air entry, a third heart sound, and fine basal crepitation. Laboratory investigations showed the following: hemoglobin 6.5 (baseline 10.0) g/ dl, platelets 61 ! 103/Ìl, and white blood cells 8.5 ! 103/Ìl. Blood films showed fragmented red cells and evidence of intravascular hemolysis. Urea was 45 mmol/l, creatinine 650 Ìmol/l, Na 131 mmol/l, K+ 5.3 mmol/l, HCO3 20 mmol/l, lactate dehydrogenase 920 U/l, reticulocytes increased, Coombs’ test negative, bilirubin 30 mmol/l, aspartate aminotransferase 90 U/l, alanine aminotransferase 79 U/l, antinuclear antibody negative, and complement normal. A diagnosis of microangiopathic hemolytic anemia, on top of chronic lupus nephritis, was made. The patient was treated with daily plasmapheresis for 10 days and diuretics. She showed remarkable improvement by the 7th day of plasmapheresis. She had no evidence of hemolysis on blood film, platelets increased to 130 ! 103/Ìl, and her hemoglobin stabilized at 8 g/dl. Her renal function improved, and her creatinine concentration was stable at 350 Ìmol/l. We think, this case was unusual, since it is rare for HUS to occur on top of lupus nephritis. We also feel that it is extremely important not to miss this diagnosis. Exacerbation of lupus nephritis can be accompanied by autoimmune hemolytic anemia that usually responds to high-dose steroids [5]. On the other hand, microangiopathic hemolytic anemia would require plasmapheresis [4]. We feel it is very important to recognize this entity, since early treatment would change the outcome. This diagnosis can be easily missed because of the similarity of symptoms.

Applications in Clinical Practice

Many of the research findings described in the previous chapters have direct application to the care of Muslim patients in health settings. This chapter focuses on clinical applications that could be implemented immediately based on what we know about relationships between religion and health in Muslims. Nevertheless, religion is a sensitive and personal topic for many people, and doctors and other health professionals have been reluctant to address it due to a lack of training and general discomfort with the subject. In this chapter we discuss reasons why health professionals in Islamic societies should consider integrating spirituality into patient care. We describe sensitive and sensible ways of identifying spiritual needs and addressing them as part of whole person healthcare. As this movement to address patients’ spiritual needs has grown in the West, much has been learned from the successes and mistakes that have occurred there. Topics reviewed in this chapter include taking a spiritual history, documenting information from the spiritual history, orchestrating resources to meet spiritual needs, referring patients with complex spiritual needs to chaplains, supporting spiritual beliefs of patients, and considering simple spiritual interventions in select cases. We also discuss the limits of what health professionals can do in this area and the boundaries that should not be crossed.