Potential health risks of maternal phthalate exposure during the first trimester - The Saudi Early Autism and Environment Study (SEAES).

Phthalates are the most ubiquitous contaminants that we are exposed to daily due to their wide use as plasticizers in various consumer products. A few studies have suggested that in utero exposure to phthalates can disturb fetal growth and development in humans, because phthalates can interfere with endocrine function. We collected spot urine samples from 291 pregnant women in their first trimester (9.8 ± 2.3 gestational weeks) recruited in an ongoing prospective cohort study in Saudi Arabia. A second urine sample was collected within 1-7 d after enrollment. The aims of this study were to: (1) assess the extent of exposure to phthalates during the first trimester and (2) estimate the risk from single and cumulative exposures to phthalates. Most phthalate metabolites' urinary levels were high, several-fold higher than those reported in relevant studies from other countries. The highest median levels of monoethyl phthalate, mono-n-butyl phthalate (MnBP), mono-iso-butyl phthalate (MiBP), and mono-(2-ethylhexyl) phthalate (MEHP) in µg/l (µg/g creatinine) were 245.62 (197.23), 114.26 (99.45), 39.59 (34.02), and 23.51 (19.92), respectively. The MEHP levels were highest among three di (2-ethylhexyl) phthalate (DEHP) metabolites. %MEHP4, the ratio of MEHP to four di (2-ethylhexyl) phthalate metabolites (∑4DEHP), was 44%, indicating interindividual differences in metabolism and excretion. The hazard quotient (HQ) of individual phthalates estimated based on the reference dose (RfD) of the U.S. Environmental Protection Agency indicated that 58% (volume-based) and 37% (creatinine-based) of the women were at risk of exposure to ∑4DEHP (HQ > 1). Based on the tolerable daily intake (TDI) from the European Food Safety Authority, 35/12% (volume-/creatinine-based data) of the women were at risk of exposure to two dibutyl phthalate (∑DBP) metabolites (MiBP and MnBP). The cumulative risk was assessed using the hazard index (HI), the sum of HQs of all phthalates. The percentages of women (volume-/creatinine-based data) at health risks with an HI > 1 were 64/40% and 42/22% based on RfD and TDI, respectively. In view of these indices for assessing risk, our results for the anti-androgenic effects of exposing pregnant women to ∑4DEHP and ∑DBP early during pregnancy are alarming.

An Evaluation of Mentorship for Hospital Residents in Saudi Arabia: A Qualitative study using Semi-structured Interviews.

Background: In this study, we explore how doctors in training perceive mentorship and leadership and whether they believed that mentoring influences the development of leadership skills. The study also addressed whether certain leadership styles lend themselves better to mentoring. Methods: A qualitative research method was employed in this study and ethical approval was granted by the Research Ethics Committee (REC) at King Faisal Specialist Hospital and Research Centre (KFSH&RC), after which twelve hospital residents were recruited using purposive sampling. Semi-structured interviews were conducted by the authors and thematic data analysis was performed. Results: Three themes emerged and were later refined, using Braun and Clarke's 2006 thematic analysis method:1. Purpose of mentorship, with sub themes: a. Expectations, b. Perception of mentorship as supervision, and c. The role of mentorship, including informal mentoring in leadership development2. Role of mentorship in leadership development.3. Perceptions of a leader, with sub-themes: a. The leader as a manager, b. The leader as a role model, and c. The merits of different leadership styles. Discussion: Most of the residents (doctors in training) viewed mentorship in a positive way. However, when the mentor was perceived more as a supervisor, the usefulness of mentoring was less clear. However, they found that informal mentoring would contribute to leadership skills and would inspire them to become leaders themselves. They were likely to be influenced positively when they saw the leader as a role model, rather than a manager.

The risk of cancer in primary care patients with thrombocytosis: A retrospective observational study within a family medicine setting in Saudi Arabia.

Background: An elevated platelet count, or thrombocytosis, is a risk factor for cancer. This study will highlight the importance of primary health care providers' awareness of the potential for malignancy in patients with thrombocytosis. Aim: To evaluate the prevalence of cancer among patients aged above 40 years with elevated platelet counts. Objectives: The purpose of the study was to analyze the prevalence of cancer among patients aged above 40 years at King Faisal Specialist Hospital and Research Centre (KFSHRC) who had thrombocytosis and a platelet count above 450 × 109/L. A secondary objective was to examine whether primary care physicians were prompt in initiating investigation of these patients. This study's findings will help primary care physicians thoroughly investigate thrombocytosis and develop guidelines that can be applied in primary care settings. Materials and Methods: This study was an observational cohort study. The data used originated from the family medicine patient Records at KFSHRC. The data were collected from electronic records by searching all the patient consultations and laboratory results that were available. Results: In total, 338 patients aged above 40 years had a platelet count above 450 × 109/L. Of these patients, 68 were men (20%) and 270 were women (80%). Cancer was diagnosed within two years of thrombocytosis in 7.8% of patients (n = 26), of whom 8 were men and 18 were women. Conclusion: It is necessary to enhance primary health care professionals' awareness of the need to investigate the prevalence of cancer in patients with thrombocytosis.

Transient osteoporosis of the hip.

Transient osteoporosis of the hip is an uncommon cause of hip pain, mostly affecting healthy middle-aged men and also women in the third trimester of pregnancy. We present a case of transient osteoporosis of the hip in a 33-year-old non-pregnant female patient. This case highlights the importance of considering a diagnosis of transient osteoporosis of the hip in patients who present with hip pain.

Attitudes and perceptions towards HPV vaccination among young women in Saudi Arabia.

BACKGROUND: Rising incidence of human papillomavirus (HPV) infection and cervical cancer can be reduced by effective vaccination. Saudi Food and Drug Administration approved prophylactic HPV vaccine in 2010 for females of 11-26 years. OBJECTIVES: To determine the awareness of HPV infection, its health sequel and the attitude and barriers to the acceptance of HPV vaccine by young women in Saudi Arabia. Dynamics influencing the decision of patients and parents regarding vaccination were assessed to foster effective and strategically focused interventions. MATERIALS AND METHODS: All patients of Family Medicine department, King Faisal Specialist Hospital and Research Center, Riyadh were invited to participate in this study from January 2012 to June 2014. A culturally sensitive and specially designed questionnaire was administered using an interview-based model to assess the knowledge, perception, and associated sociodemographic factors of HPV. RESULTS: A total of 325 patients participated as per the inclusion criteria: 87.4% were Saudis, 53.5% had university or higher education and 65.2% were adolescents (age 11-19 years). The questionnaire was answered by participants (50.8%) or guardians (49.2%). About 34.5% of the population was aware of HPV infection, and 27.4% were aware of its relation with cervical cancer. However, awareness of the HPV vaccine, perception of its prevention of cervical cancer and other HPV-related disease was relatively low (32.3%), Saudis (29.9%) versus non-Saudis (48.8%) (P = 0.016). More guardians (41.2%) were aware of the HPV vaccine and its impact than participants (27.9%) (P = 0.01). Higher educational background (43.1%) increased the knowledge of HPV compared to less than high school education (24.5%) (odds ratio: 2.33; 95% confidence interval: 1.44-3.76). Nearly 64.3% of participants agreed, and 35.7% refused to receive the HPV vaccine. CONCLUSION: Knowledge and perception of HPV infection as an sexually transmitted infections and its vaccine was significantly low in this cohort of patients. Higher age and educational levels directly correlated with increased knowledge of HPV infection and its complications. It is recommended that awareness should be raised, and access to HPV vaccination increased to help reduce the health care burden of HPV sequelae in the Kingdom.

Management of vaginal penetration phobia in Arab women: a retrospective study.

BACKGROUND AND OBJECTIVES: Vaginal penetration phobia is a common and distressing problem world.wide. It interferes with vaginal penetrative sexual relations, and leads to unconsummated marriage (UCM). This problem may be heightened in Arab women, due to cultural taboos about pain and bleeding, that may be associated with the first coital experience after marriage. Data about this problem is scarce in Arab societies. The aim of this study was to evaluate the response of these women and their husbands to an individualized, psychotherapeutic assessment and treatment to resolve this problem. DESIGN AND SETTINGS: Retrospective descriptive in a general gynecology community setting over a 6-year period. METHODS: The study involved a retrospective sequential cohort of 100 Arab couples with UCM due to the woman's VPP. They were evaluated by a female gynecologist in out patient clinics. Data was collected through chart review, and telephone interviews. Final analysis was performed on 100 Arab couples, who satisfied the inclusion criteria. They were followed up to assess their response to an individualized, structured treatment protocol. The treatment combined sex education with systematic desensitization, targeting fear and anxiety as.sociated with vaginal penetration. RESULTS: A total of 96% of the studied group had a successful outcome after an average of 4 sessions. Penetrative intercourse was reported by the tolerance of these women; further pregnancy was achieved in 77.8 % of the infertile couples. CONCLUSION: Insufficient knowledge of sexual intercourse is a major contributor to the development of VPP in the sampled population. It appears that they respond well to an individualized, structured treatment protocol as described by Hawten 1985 (regardless of other risk factors associated with vaginismus).