Age related changes in the bone microstructure in patients with femoral neck fractures.

BACKGROUND: The risk of femoral neck fracture progressively increases with age. However, the reasons behind this consistent increase in the fracture risk can't be completely justified by the decrease in the bone mineral density. The objective of this study was to analyze the correlation between various bone structural features and age. STUDY DESIGN & METHODS: A total of 29 consecutive patients who suffered an intracapsular hip fracture and underwent joint replacement surgery between May 2012 and March 2013 were included in this study. A 2 cm × 1 cm Ø cylindrical trabecular bone sample was collected from the femoral heads and preserved in formaldehyde. Bone mineral density (BMD), microarchitecture, organic content and crystallography were analyzed using a Dual-energy X-ray absorptiometry scan, micro-CT scan, and high resolution magic-angle-spinning-nuclear magnetic resonance (MAS-NMR), respectively. Statistical correlations were made using Spearman´s or Pearson´s correlation tests depending on the distribution of the continuous variables. RESULTS: The mean patient age was 79.83 ± 9.31 years. A moderate negative correlation was observed between age and the hydrogen content in bone (1H), which is an indirect estimate to quantify the organic matrix (r = -0.512, p = 0.005). No correlations were observed between BMD, trabecular number, trabecular thickness, phosphorous content, apatite crystal size, and age (r = 0.06, p = 0.755; r = -0.008, p = 0.967; r = -0.046, p = 0.812; r = -0.152, p = 0.430, respectively). A weak positive correlation was observed between Charlson´s comorbidity index (CCI) and c-axis of the hydroxiapatite (HA) crystals (r = -0.400, p = 0.035). CONCLUSION: The femoral head relative protein content progressively decreases with age. BMD was not correlated with other structural bone parameters and age. Patients with higher comorbidity scores had larger HA crystals. The present results suggest that the progressive increase in the hip fracture risk in elderly patients could be partially explained by the lower bone protein content in this age group.

Chronotherapy of Non-Steroidal Anti-Inflammatory Drugs May Enhance Postoperative Recovery.

Postoperative pain relief is crucial for full recovery. With the ongoing opioid epidemic and the insufficient effect of acetaminophen on severe pain; non-steroidal anti-inflammatory drugs (NSAIDs) are heavily used to alleviate this pain. However, NSAIDs are known to inhibit postoperative healing of connective tissues by inhibiting prostaglandin signaling. Pain intensity, inflammatory mediators associated with wound healing and the pharmacological action of NSAIDs vary throughout the day due to the circadian rhythm regulated by the clock genes. According to this rhythm, most of wound healing mediators and connective tissue formation occurs during the resting phase, while pain, inflammation and tissue resorption occur during the active period of the day. Here we show, in a murine tibia fracture surgical model, that NSAIDs are most effective in managing postoperative pain, healing and recovery when drug administration is limited to the active phase of the circadian rhythm. Limiting NSAID treatment to the active phase of the circadian rhythm resulted in overexpression of circadian clock genes, such as Period 2 (Per2) at the healing callus, and increased serum levels of anti-inflammatory cytokines interleukin-13 (IL-13), interleukin-4 (IL-4) and vascular endothelial growth factor. By contrast, NSAID administration during the resting phase resulted in severe bone healing impairment.

HLA DRB1*130101-DQB1*060101 haplotype is associated with acute chest syndrome in sickle cell anemia patients.

We investigated the association of human leukocyte antigens (HLA) class II alleles and haplotypes with the pathogenesis of acute chest syndrome (ACS) in 186 sickle cell anemia (SCA) patients, of whom 58 had documented ACS (new pulmonary infiltrate, fever, and other associated clinical events) and 128 with a negative history of ACS, serving as controls. HLA DRB1* and -DQB1* genotyping was performed by polymerase chain reaction-sequence-specific priming. Of the DRB1* and DQB1* alleles analyzed, only DRB1*130101 (Pc < 0.001) was positively associated with ACS. DRB1*130101-DQB1*060101 haplotype was more prevalent among ACS patients (P = 0.018), thus conferring disease susceptibility. Specific HLA alleles and haplotypes may influence ACS risk in SCA patients, and specific HLA genotypes may be useful markers for identifying high-risk SCA ACS patients.

Evidence for HLA class II susceptible and protective haplotypes for osteomyelitis in pediatric patients with sickle cell anemia.

We investigated the association of human leukocyte antigen (HLA) class II alleles and haplotypes with the pathogenesis of sickle cell anemia (SCA) osteomyelitis. SCA patients comprised 42 patients with osteomyelitis and 150 patients without osteomyelitis; HLA-DRB1* and HLA-DQB1* genotyping was performed by polymerase chain reaction-sequence-specific priming (SSP). DRB1*100101 (P value corrected for the number of different alleles tested, Pc=0.003) was positively associated with osteomyelitis. At the haplotype level, DRB1*100101-DQB1*050101 (Pc=0.001) was more prevalent among patients, while DRB1*030101-DQB1*0201 (Pc=0.020) and DRB1*040101-DQB1*0302 (Pc=0.039) were more prevalent among SCA controls, thereby conferring disease susceptibility or protection to these haplotypes, respectively. These results show that specific HLA haplotypes influence SCA osteomyelitis risk and that specific HLA types may serve as markers for identifying SCA patients at high risk for osteomyelitis.

Some correlates of dieting behavior in Saudi schoolgirls.

OBJECTIVES: The study examines the correlates of dieting behavior among Saudi schoolgirls. METHODS: Stratified cluster sampling was used to select female students from Grades 7 to 11 in Riyadh, Saudi Arabia. Subjects completed a sociodemographic data sheet and the Eating Disorders Inventory (EDI); their heights and weights were measured by a trained nurse. The total sample size was 1,271 students with a response rate of 92.76%. RESULTS: 15.9% scored positively on the EDI-Drive for Thinness subscale. Body mass index, speaking a Western language, and having lived in a Western country were the most significant personal factors associated with dieting behavior. Small family size and higher parental education and better occupation were significant family factors associated with dieting. DISCUSSION: Results reflect some culture-specific findings that are explained in cultural terms.

Prevalence and correlates of depression among Saudi elderly.

OBJECTIVES: To assess the prevalence of depression and associated factors in elderly people in Saudi Arabia. METHOD: A cross-sectional national survey of the elderly population of Saudi Arabia was conducted between January 1994 and December 1995. A stratified two-stage sampling technique was used to select the study subjects. In the first stage, a random sample of primary health care centres (PHCs) was selected in each of the five administrative regions of the country. The family health records (FHR) of each selected PHC were reviewed and a list of the elderly (60 years and over) was compiled. In the second stage, a sample of the subjects was selected from the FHR and contacted for a personal interview. The subjects' physical, social and environmental health status were assessed by an interview during which a structured questionnaire was completed. The Geriatric Depression Scale (GDS) was used to screen for depression. Other items of information in the questionnaire included subjects' sociodemographic characteristics, activities of daily living (ADL), laboratory and radiological investigations. RESULTS: The total number of elderly subjects included in this study was 7970. Their mean age+/-standard deviations was 68.8+/-7.7 (male 69.1+/-.7.7; and female 67.7+/-7.5) years. Depressive symptoms were reported in 3110 (39%) of the subjects, and 8.4% were in the severe depressive symptoms score group. Personal characteristics that correlated strongly with depression were poor education (p=0.001), unemployment (p=0.001), divorced or widowed status (p=0.001), old age and being a female (p=0.001). Living in a remote rural area with poor housing arrangements and limited accessibility within the house and poor interior conditions were also significantly associated with high depressive symptoms (p=0.001). Limited privacy, such as having a particular room specified for the elderly, was associated with more depressive symptoms than sharing a room with another person (p=0. 001). Lower incomes inadequate for personal needs as well as depending on charity or other relatives were associated with more cases of depression (p=0.001). The proportion of cases of depression correlated positively with the number of medical diagnoses and medications received (p=0.001). Significant depression was associated with loss of a close relative, living alone and limited participation in recreational activities. Perception of poor health and dependence on others for daily activities were associated with more depressive symptoms (p=0.001). Also health problems, especially faecal or urinary incontinence, were associated with more depressive symptoms (p=0.001). CONCLUSION: Depressive symptoms are common among Saudi elderly. Detection and management rates were low. Primary care teams could help these patients if properly trained. A simple instrument such as the Geriatric Depression Scale is useful and easily administered.

The Arabic self-reporting questionnaire (SRQ) as a psychiatric screening instrument in medical patients.

BACKGROUND: The self-reporting questionnaire was originally developed by the WHO in order to screen for psychiatic disorders. To assess the validity of the Arabic self-reporting questionnaire (SRQ) as a screening instrument for psychiatric morbidity in a sample of Saudi medical patients. METHODS: All patients referred for endoscopy underwent a semi-structured interview, and were then asked to fill out the SRQ. One hundred and sixty-six males and 126 females were included in the study. RESULTS: Sixty percent of the subjects were identified by the SRQ as psychiatric cases, compared to 48.6% identified using the psychiatric interview. A cut-off point between six and seven, was found to yield a sensitivity of 93%, a specificity of 70%, and a misclassification rate of 19%. Females had more psychiatric morbidity than males. CONCLUSION: The validity indices and receiver operating characteristic (ROC) analysis support the usefulness of the SRQ as a cost-effective screening instrument for psychiatric morbidity in a two-stage large population research.

Training primary health care physicians in Saudi Arabia to recognize psychiatric illness.

In order to evaluate the effect of training primary health care (PHC) physicians to recognize mental disorders, an intervention randomized controlled trial was conducted. Three categories of PHC physicians were selected: the index group (n = 12 doctors), control group 1 (n = 12) and control group 2 (n = 4). For 1 week randomly selected patients from all trial centres were asked to complete the General Health Questionnaire (GHQ-28), and the three groups of doctors were asked to identify the presence of and rate the severity of any mental disorder in these patients. The same process was repeated for all three groups after a 6-month training course which was provided for the index group only. The doctors' ability to detect mental disorders was measured by calculating Spearman's correlation coefficient between their severity rating and the GHQ scores of their patients. Training produced a noticeable improvement in the diagnostic accuracy of the index group, whereas there was minimal improvement in control group 1 and deterioration in control group 2. Recommendations to improve the ability of PHC physicians to detect mental disorders are discussed.

Validity of the Arabic version of the Eating Attitude Test.

OBJECTIVES: To assess the validity of the Eating Attitude Test (EAT-26) in Arabic as a screening instrument in nonclinical populations. METHODS: A representative sample of Grade 7-12 female students in Riyadh, Saudi Arabia, was selected randomly but proportional to various social classes. The girls were independently assessed by the EAT-26 and a structured clinical interview. RESULTS: One hundred twenty-nine subjects were included. Twenty-five were identified by EAT-26 as having abnormal eating attitudes. One case was identified as anorexia nervosa by the interview and no cases of bulimia were found. DISCUSSION: EAT-26 was found to be highly sensitive and reasonably specific. Like some other studies in non-Western populations, it yielded a high false positive rate and a low positive predictive value. Because of its low cost and practicality, EAT-26 might be a useful tool in screening large populations for eating disorders.

Validity of the Arabic version of the eating disorders inventory (EDI).

BACKGROUND: We aimed to validate the Eating Disorders Inventory (EDI) in Arabic. METHODS: Subjects were chosen randomly from female school students. Only healthy Saudi students were included. They were asked to fill the EDI and undergo a semi-structured interview by a psychiatrist who was unaware of the EDI scores. Of 146 students approached 12 did not meet our criteria and were excluded; 16 other students were excluded for incomplete responses. RESULTS: The difference between the two diagnostic methods in the proportion of caseness was statistically significantly (P < 0.0001). The scores on Perfectionism, Maturity Fears and Interoceptive Awareness were significantly higher in the Saudi students compared with Canadians (P < 0.05). CONCLUSIONS: The EDI-DT subscale has a sensitivity of 100% and a specificity of 85%. Despite its low positive predictive value of 5%, it may be useful for screening large non-clinical groups for eating disorders.

Transcultural attitude towards being overweight in patients attending health centers, Riyadh, Saudi Arabia.

OBJECTIVE: To assess differences in body weights among various nationalities living in Riyadh and find out the effect of sociodemographic characteristics of participants on their attitudes towards body weight. METHODS: In May and June of 1992, 4144 health center patients of various nationalities in Riyadh were surveyed about their attitudes towards the overweight. A survey of attitudes of 4144 health center participants of various nationalities in Riyadh towards the overweight were conducted during May-June 1992. Fifteen health centers representing the five arbitrarily divided sections of Riyadh (North, South, East, West, and Central) participated in the study. Every third patient was included if he or she satisfied the criteria. Participants were asked to complete a questionnaire and to have their height and weight recorded. The body mass index (BMI) was calculated for all patients and their opinions about their weights were compared with the BMI. RESULTS: Obesity was more common among other Arabs (43.8%) and Saudis (36.4%) than Indians (27.6%) and Westerners (30.1%). Female subjects were more obese than their male counterparts in all nationalities. The body weights increased with age, fewer physical activities, low levels of education, and marital status. All these differences were statistically significant. When comparing positive predictive value of the opinion of the participants with their BMI, it was found that the Indians (87.2%) were less likely to be correct when they judge their degree of overweight than Saudis (92.2%), Westerners (92.8%), and other Arabs (95.4%). However, positive predictive values varied with the participants sociodemographic characteristics. CONCLUSION: The findings in the present study of higher proportion of patients with obesity in the study group stresses the importance of promoting programs aimed at preventing or reducing obesity in the community.