Shoeb Qureshi

Preventive effects of phytoestrogens against postmenopausal osteoporosis as compared to the available therapeutic choices: An overview

Estrogen deficiency is a major risk factor for osteoporosis in postmenopausal women. Although hormone replacement therapy (HRT) has been rampantly used to recompense for the bone loss, but the procedure is coupled with severe adverse effects. Hence, there is a boost in the production of newer synthetic products to ward off the effects of menopause-related osteoporosis. As of today, there are several prescription products available for the treatment of postmenopause osteoporosis; most of these are estrogenic agents and combination products. Nevertheless, in view of the lack of effect and/or toxicity of these products, majority of the postmenopausal women are now fascinated by highly publicized natural products. This is an offshoot of the generalized consensus that these products are more effective and free from any adverse effects. Recently, certain plant-derived natural products, mostly phytoestrogens (isoflavones, lignans, coumestanes, stilbenes, flavonoids) and many more novel estrogen-like compounds in plants have been immensely used to prevent menopause-related depletion in bone mineral density (BMD). Although, a number of papers are published on menopause-related general symptoms, sexual dysfunction, cardiovascular diseases, Alzheimers disease, diabetes, colon, and breast cancers, there is paucity of literature on the accompanying osteoporosis and its treatment. In view of the controversies on synthetic hormones and drugs and drift of a major population of patients toward natural drugs, it was found worthwhile to investigate if these drugs are suitable to be used in the treatment of postmenopausal osteoporosis. Preparation of this paper is an attempt to review the (a) epidemiology of postmenopausal osteoporosis, (b) treatment modalities of postmenopausal osteoporosis by hormones and synthetic drugs and the associated drawbacks and adverse effects, and (c) prevention and treatment of postmenopausal osteoporosis by phytoestrogens, their drawbacks and toxicity. It is apparent that both the categories of treatment are useful and both have adverse effects, but the plant products are nonscientific and hence are not advised to be used till more studies are undertaken to ensure that the benefits clearly outweigh the risk, in addition to recognition by Food and Drug Administration.

Utility of cytokine, adhesion molecule and acute phase proteins in early diagnosis of neonatal sepsis

Background and Aim: Neonatal infection, including bacterial sepsis, is a major health care issue with an annual global mortality in excess of one million lives. Therefore, this study aimed to evaluate the potential diagnostic value of C-reactive protein (CRP), E-selectin, procalcitonin (PCT), interleukins-6 (IL-6), and tumor necrosis factor-α (TNF-α) both independently and in combination for the diagnosis of neonatal sepsis in its earliest stages. Materials and Methods: A total of 320 subjects were included in this study. A prospective cross-sectional study was conducted among neonates admitted to Neonatal Intensive Care Unit at King Abdulaziz Medical City, Riyadh, KSA during January 2013 to August 2015, the study based on three study groups categorized according to clinical symptoms and blood culture result. Study groups include healthy control neonates (n = 80), clinical sepsis (CS) group (n = 80) with clinical signs of sepsis but their blood culture was negative, and sepsis group with clinical signs of sepsis and their blood culture was positive. Results: The study observed significant difference in plasma levels of CRP, IL-6, TNF-α, E-selectin, and PCT in patients group when compared with control group (P < 0.001). Furthermore, the levels are significantly different between patient groups including CS and neonatal sepsis group. Moreover, result observed significant difference in CRP and IL-6 in early onset sepsis (EOS) when compared with late onset sepsis (LOS) neonates (P < 0.001 and 0.01), respectively, while there were no significant difference in TNF-α, E-selectin, and PCT between EOS and LOS (P = 0.44, 0.27 and 0.24), respectively. Regarding biomarkers accuracy, the result showed that CRP has the best diagnostic accuracy with cutoff value of 3.6 ng/ml (sensitivity 78% and specificity of 70%). The best combination is shown with CRP and IL-6 in which sensitivity increased to 89% and specificity to 79%. Conclusion: It was concluded that infected new-born babies have a higher E-selectin, PCT, IL-6, TNF-α, and CRP compared with the neonates with CS and control. IL-6, TNF-α, and CRP should be measured in combination for mare diagnostic accuracy in neonatal sepsis. Likewise, PCT should be investigated as a part of sepsis screening for all suspected neonates.

Relation between glycosylated hemoglobin and lipid and thyroid hormone among patients with type 2 diabetes mellitus at King Abdulaziz Medical City, Riyadh

Background: The main objectives of this study were to: (1) Evaluate the levels of thyroid hormones and glycosylated hemoglobin (HbA1c) among patients, (2) correlate between thyroid hormones and HbA1c and different types of lipids and HbA1c among diabetic patients. Materials and Methods: A retrospective chart review study was conducted at Department of Clinical Chemistry, King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia, during the period from August 2014 to December 2014, including 100 male and female patients diagnosed with diabetes mellitus (DM) type 2 and excluding patients with DM type 1. These patients were admitted to the hospital in 2013. Biochemical laboratory results were retrieved from biochemistry laboratory database while age and sex of patients were retrieved from patient files. Statistical analysis was performed using SPSS software conducting frequency analysis and correlation test. Results: The result showed increased mean levels of HbA1c (8.4%) and normal level of thyroid stimulating hormone (TSH) (4.5 mlU/L) and T4 (14.1 pmol/L). The results also showed a weak positive correlation between HbA1c and TSH (r = 0.212, P = 0.034) and insignificant correlation with thyroxin T4 (r = −0.018, P = 0.855). There was a weak positive correlation between HbA1c and total cholesterol and low density lipoprotein (r = 0.258, P = 0.001), (r = 0.297, P = 0.003), respectively. Conclusion: It is concluded that increased blood glucose could trigger anterior pituitary gland to increase secretion of TSH, whereas there was no direct correlation between increased glycemic index and the rate of thyroxine secretion. Furthermore, it is concluded that there is an association between blood glucose and some lipid markers.

Determination of the serum levels of troponin I and creatinine among Sudanese type 2 diabetes mellitus patients

Background: Diabetes mellitus (DM) is a significant risk factor for developing cardiac diseases. Hence, we compare the serum levels of cardiac troponin I (CTnI) among type 2 diabetic and healthy patients. We additionally correlated CTnI and creatinine levels with duration of disease. Materials and Methods: A cross-sectional study was conducted at Department of Clinical Chemistry, Sudan University of Sciences and Technology, Khartoum, Sudan, from February 2008 to February 2011. 200 patients diagnosed with DM type 2 from Jabir Abulizz Diabetes Centre in Khartoum state, Sudan, and 100 healthy volunteers were included in this study. Blood samples were collected from both groups, and the serum levels of CTnI, creatinine, fasting plasma glucose and glycosylated hemoglobin (HbA1c) levels were measured. Results: Significant increase in serum levels of CTnI, glucose, HbA1c, and creatinine was observed in diabetic patients compared to healthy controls. In addition, the significant increase in CTnI and creatinine levels was observed among diabetic patients with ischemic heart disease or hypertension when compared with those without ischemic heart disease or hypertension. Further a strong positive correlation was observed between the duration of diabetes and the serum levels of CTnI and creatinine (r = 0.84, P > 0.01) and (r = 0.72, P > 0.01), respectively. Conclusion: The higher levels of CTnI and creatinine may be indicative of progressive cardiovascular disease and nephropathy among diabetic patients.

Assessment of microalbuminuria and albumin creatinine ratio in patients with type 2 diabetes mellitus

Aim: We aimed to evaluate the levels of urine microalbumin, urine albumin creatinine ratio, plasma creatinine and glycosylated hemoglobin (HbA1c) among type 2 diabetic patients and assessed the correlation between microalbuminuria and plasma creatinine levels. Materials and Methods: A retrospective chart review study was conducted at Department of Clinical Chemistry, King Abdulaziz Medical City in Riyadh, Saudi Arabia, during August to December 2014. The study included 100 male and female patients diagnosed with type 2 diabetes mellitus (DM) and excluding patients with type 1 DM. Medical history and biochemical laboratory data were obtained from medical records and from biochemistry laboratory database. Results: Increase in mean level of plasma creatinine (138 μmol/L), urine microalbuminuria (240 mg/L), albumin creatinine ratio (82) and HbA1c (8.7%) was observed among type 2 DM patients. Moderate positive correlation was observed between microalbuminuria and urine albumin creatinine ratio (r = 0.509 P = 0.0006) and between urine albumin creatinine ratio and plasma creatinine (r = 0.553 P = 0.017). Conclusion: We concluded that type 2 DM patients who are at risk of developing renal impairment must be regularly monitored for microalbuminuria, urine albumin creatinine ratio, and HbA1c levels.

Rare Occurrence of Two Cases of CongenitalSyngnathia at Osmania General Hospital, Hyderabad,India: A Case Report

Congenital craniofacial defect encompass 20% of congenital birth defects [1]. The defects of the fusion can present in a severity from single mucosal band (synechiae) to complete bony fusion (Syngnathia) [2]. Congenital maxilla-mandibular syngnathia, (fusion of the jaws), is a rare condition that has a broad spectrum of presentations [3]. The constrained opening of the mouth can lead to difficulties with feeding, swallowing, and respiration resulting in failure to thrive [4]. Early recognition and treatment is necessary for proper growth and development. Congenital bony fusion of the mandible and maxilla without any other oral incongruities is a very rare condition [5]. Numerous cases with other anomalies like cleft lip, cleft palate, aglossia have been described. Syngnathia can also occur with syndromes (Vander Woude, popliteal pterygium) and other congenital anomalies such as those which involve central nervous system, that cause mental retardation or the cardiac system, which manifest as the outcome of patent ductus arteriosus and tetralogy [6]; or the skeletal system, which include hemi vertebrae and fused ribs, feet syndactyly, and hand brachydactyly. Cases may also have associated anomalies affecting the endocrinal systems, including type I diabetes mellitus, hypothyroidism, and the reproductive system anamolies, such as micropenis or hypospadias. In cases of bilateral fusion between both jaws, the craniofacial structure anomalies are rarely observed. In 1997, Dawson et al. [5] classified syngnathia into type 1 (simple syngnathia), bony fusion between mandible and maxilla or the zygoma in the absence of other congenital anomalies in the head and neck; and type 2 (complex syngnathia), syngnathia occurring with other congenital anomalies in the head and neck. Furthermore, the type 2 syngnathia was further classified as type 2a syngnathia (syngnathia with aglossia) and type 2b syngnathia (syngnathia with agenesis or hypoplasia of the proximal mandible) [7].

Etiology of Neonatal Morbidity and Mortality inSaudi Arabia – A Mini Review

A new born baby is specially called a neonate in the first four weeks after birth. After a month, the baby is no longer considered a neonate. The neonates are exposed to a host of intrinsic and extrinsic conditions, which make the life vulnerable to either developing permanent deformities and morbidity or discontinuation of survival. There are many conditions including; necrotizing enterocolities, pregnancy with sickle cell anemia, antenatal prevalence of congenital anomalies, different types of congenital diaphragmatic hernia, eclampsia and pre-eclampsia, autosomal recessive disorder ((Sanjad-Sakati syndrome), Infectious diseases, hydrocephalus in neonates, bacterial sepsis in Neonatal Intensive Care Unit (NICU), caesarean sections, transferring unstable and critically ill neonates to and from the operating room to wards. Materials and Methods: To accomplish the target on morbidity and mortality in neonates, peer-reviewed English language articles published during the last 35 years (1980 to 2015), were selected from Pub Med, Pub Med Central, Science Direct, Up-to-date, Med Line, comprehensive databases, Cochrane library, and the Internet (Google, Yahoo). Conclusion: This brief review includes explicit descriptions of the difficulties faced by the NICUs is written with a view to introduce the subject and make a broader outlook with a detailed review paper in future.

Frequency distribution of sickle cell anemia, sickle cell trait and sickle/beta-thalassemia among anemic patients in Saudi Arabia

Background: Notwithstanding, the growing incidence of sickle cell hemoglobinopathies (SCH) such as sickle cell anemia (SCA) or sickle cell disease, sickle/beta-thalassemia; the exact prevalence remains obscure in Saudi Arabia. Hence, this study is an attempt to determine the frequency of SCA and sickle cell trait (SCT) among all anemic patients with SCH treated at the King Abdul-Aziz Medical City (KAMC), Riyadh, Saudi Arabia. Furthermore, the hemoglobin (Hb) S and other Hb patterns (Hb AS and Hb F) were also estimated in SCA and SCT patients. Materials and Methods: Results of Hb capillary electrophoresis performed on all patients with SCH from January 2011 to December 2013 were evaluated retrospectively. Results: Of a total of 3332 patient data analyzed, 307 were anemic patients (58% males and 42% females) with SCH. The sickling test showed all the patients to be positive. Hb electrophoresis revealed the incidence of 96.7%, 3.3%, and 0% of the patients suffered from SCA, SCT and sickle/beta-thalassemia, respectively. Patients with SCA had a higher level of Hb F and showed no crisis when compared with other SCA patients who had lower or no Hb F levels. Conclusion: SCA is relatively frequent among males (56.4%) than females out of all patients with SCH. The SCA incidence was more common (48.5%) among children, frequency of SCT among adult age group was 1.6%, while sickle/beta-thalassemia was 0%.

Effects of passive smoking on students at College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh

Background: Despite the recent campaigns to eliminate smoking, the rates are still increasing world-wide. Exposure to passive smoking (PS) is associated with morbidity and mortality from awful diseases. Although many college students smoke, little is known about their exposure to PS, common places and sources of exposures in Saudi Arabia. Aim: The aim of the following study is to identify prevalence and magnitude of PS among college students, exposure time, locations, sources of exposure, investigate the effects and make recommendations. Materials and Methods: A cross-sectional study was performed to identify factors associated with PS exposure among students of College of Applied Medical Sciences, Riyadh. Results: Out of 61 students included in the study, 91.8% were found exposed to PS. Exposure in Hospitality venues (Estirah) was the most common followed by other areas. Among the sources of exposure, the highest was among friends and the least were parents and guests. The frequency of highest exposure per month was >15 times and the lowest was 10-15 times. Levels of annoyance varied between 18% and 37.7%, respectively. Since the values obtained for different markers in the pulmonary function test are more than the predicted values, the observed spirometry is normal. The percent oxygen saturation in hemoglobin and blood pressure of PS were in normal range. Conclusion: Since the properties of mainstream smoke and environmental tobacco smoke are quite different, risk extrapolation from active to PS is uncertain, especially during a short period. Nevertheless, it can be deteriorating during a longer duration, hence; the administrators, policy makers and tobacco control advocates may endorse policies to restrict smoking in shared areas, particularly working environment.

Determination of the most common morphological patterns of anemia among Saudi anemic patients attending King Abdul-aziz Medical City-Riyadh

Background: Anemia is a medical condition in which the red blood cells (RBCs) count and hemoglobin (Hb) are less than the normal range. The main causes of anemia are a decrease in RBCs, their destruction and decrease of Hb synthesis. A useful method for diagnosis and classification of anemias is based on the morphological appearance of RBCs on an ideal stained blood smear. The main terms used in such classification are normocytic normochromic, microcytic hypochromic and macrocytic anemia. Aim: The aim of this study is to determine the most common morphological pattern of anemia in Saudi anemic patients who were admitted at King Abdul-aziz Medical City-Riyadh. Materials and Methods : Retrospectively we evaluated the results of complete blood count (CBC) and peripheral blood picture (PBP) of all anemic patients attending during the year 2013 (from 1 st January to 31 st December). Results: Participants in this study included 150 patients (13 infants, 27 children, 12 youths, 52 adults and 46 old). The gender distribution showed 70 males and 80 females. The results of CBC and PBP showed that 113 (75.3%), 36 (24%) and 1 (0.7%) of the patients had normocytic normochromic, microcytic hypochromic and macrocytic pattern of anemia respectively. Conclusion: The normocytic normochromic pattern of anemia is highly frequent among this sample of Saudi patients while the macrocytic pattern of anemia is the lowest. According to gender groups microcytic hypochromic pattern of anemia is more common among females; malnutrition, increase of blood loss due to pregnancy or menstruation, and lack of iron absorption are the main causes, while the normocytic normochromic is highly frequent among males, which are mainly due to blood loss or chronic diseases.