Estrogen Receptor Alpha (ESR1) Gene Polymorphisms in Pre-eclamptic Saudi Patients.

OBJECTIVES: Pre-eclampsia causes maternal mortality worldwide. Estrogen receptor alpha (ESR1) gene polymorphisms were responsible for cardiovascular diseases. This case control study was conducted to investigate whether 2 polymorphic genes of ESR1 are associated with pre-eclampsia among Saudi women in Madina city, Saudi Arabia. METHODS: Blood samples from 97 pre-eclamptic and 94 healthy pregnant women were analyzed using restriction fragment length polymorphism-polymerase chain reaction method. All the subjects were recruited randomly from outpatient clinics of Madina Maternity Children Hospital (MMCH), Madina, Saudi Arabia, between Dec. 2012 and Jan. 2014. RESULTS: There was no association between pre-eclampsia and PvuII and XbaI ESR1 gene polymorphisms individually. TT/AA and TT/AG genotype combination existed significantly in pre-eclamptic patients compared to control. The frequency of PvuII and XbaI combined TT/AA genotypes between pre-eclamptic women was 36.1% vs 9.6%, however, frequency of PvuII and XbaI combined TT/AG genotypes between pre-eclamptic women was 3.1% vs 17%, compared to control. The homozygous T-A haplotype carriers showed high pre-eclampsia risk, independent of pregnancy, BMI and smoking status (adjusted odds ratio (OR): 3.26, 95% confidence interval (CI):1.71-9.21). The heterozygous T-A haplotype carriers did not differ from that of non-carriers (adjusted OR: 1.12, 95% CI: 0.47-2.75). No association was observed between pre-eclampsia and T-G, C-G and C-A haplotype of PvuII and XbaIESR1 gene polymorphisms. CONCLUSIONS: T-A haplotype of homozygous associated with pre eclampsia not heterozygous carriers of ESR 1 PvuII and XbaI gene polymorphisms elicited high risk of pre-eclampsia. GG genotype of XbaI polymorphism decreased pre-eclampsia risk. Further studies using larger sample size are recommended to investigate the ESR 1 gene polymorphisms associated with pre-eclampsia.

Indwelling bladder catheterisation as part of intraoperative and postoperative care for caesarean section.

BACKGROUND: Caesarean section (CS) is the most common obstetric surgical procedure, with more than one-third of pregnant women having lower-segment CS. Bladder evacuation is carried out as a preoperative procedure prior to CS. Emerging evidence suggests that omitting the use of urinary catheters during and after CS could reduce the associated increased risk of urinary tract infections (UTIs), catheter-associated pain/discomfort to the woman, and could lead to earlier ambulation and a shorter stay in hospital. OBJECTIVES: To assess the effectiveness and safety of indwelling bladder catheterisation for intraoperative and postoperative care in women undergoing CS. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2013) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing indwelling bladder catheter versus no catheter or bladder drainage in women undergoing CS (planned or emergency), regardless of the type of anaesthesia used. Quasi-randomised trials, cluster-randomised trials were not eligible for inclusion. Studies presented as abstracts were eligible for inclusion providing there was sufficient information to assess the study design and outcomes. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility and trial quality, and extracted data. Data were checked for accuracy. MAIN RESULTS: The search retrieved 16 studies (from 17 reports). Ten studies were excluded and one study is awaiting assessment. We included five studies involving 1065 women (1090 recruited). The five included studies were at moderate risk of bias.Data relating to one of our primary outcomes (UTI) was reported in four studies but did not meet our definition of UTI (as prespecified in our protocol). The included studies did not report on our other primary outcome - intraoperative bladder injury (this outcome was not prespecified in our protocol). Two secondary outcomes were not reported in the included studies: need for postoperative analgesia and women's satisfaction. The included studies did provide limited data relating to this review's secondary outcomes. Indwelling bladder catheter versus no catheter - three studies (840 women) Indwelling bladder catheterisation was associated with a reduced incidence of bladder distension (non-prespecified outcome) at the end of the operation (risk ratio (RR) 0.02, 95% confidence interval (CI) 0.00 to 0.35; one study, 420 women) and fewer cases of retention of urine (RR 0.06, 95% CI 0.01 to 0.47; two studies, 420 women) or need for catheterisation (RR 0.03, 95% CI 0.01 to 0.16; three studies 840 participants). In contrast, indwelling bladder catheterisation was associated with a longer time to first voiding (mean difference (MD) 16.81 hours, 95% CI 16.32 to 17.30; one study, 420 women) and more pain or discomfort due to catheterisation (and/or at first voiding) (average RR 10.47, 95% CI 4.71 to 23.25, two studies, 420 women) although high levels of heterogeneity were observed. Similarly, compared to women in the 'no catheter' group, indwelling bladder catheterisation was associated with a longer time to ambulation (MD 4.34 hours, 95% CI 1.37 to 7.31, three studies, 840 women) and a longer stay in hospital (MD 0.62 days, 95% CI 0.15 to 1.10, three studies, 840 women). However, high levels of heterogeneity were observed for these two outcomes and the results should be interpreted with caution.There was no difference in postpartum haemorrhage (PPH) due to uterine atony. There was also no difference in the incidence of UTI (as defined by trialists) between the indwelling bladder catheterisation and no catheterisation groups (two studies, 570 women). However, high levels of heterogeneity were observed for this non-prespecified outcome and results should be considered in this context. Indwelling bladder catheter versus bladder drainage - two studies (225 women)Two studies (225 women) compared the use of an indwelling bladder catheter versus bladder drainage. There was no difference between groups in terms of retention of urine following CS, length of hospital stay or the non-prespecified outcome of UTI (as defined by the trialist).There is some evidence (from one small study involving 50 women), that the need for catheterisation was reduced in the group of women with an indwelling bladder catheter (RR 0.04, 95% CI 0.00 to 0.70) compared to women in the bladder drainage group. Evidence from another small study (involving 175 women) suggests that women who had an indwelling bladder catheter had a longer time to ambulation (MD 0.90, 95% CI 0.25 to 1.55) compared to women who received bladder drainage. AUTHORS' CONCLUSIONS: This review includes limited evidence from five RCTs of moderate quality. The review's primary outcomes (bladder injury during operation and UTI), were either not reported or reported in a way not suitable for our analysis. The evidence in this review is based on some secondary outcomes, with heterogeneity present in some of the analyses. There is insufficient evidence to assess the routine use of indwelling bladder catheters in women undergoing CS. There is a need for more rigorous RCTs, with adequate sample sizes, standardised criteria for the diagnosis of UTI and other common outcomes.

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 1(st)-5(th) 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.

Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium.

OBJECTIVES: The goal of this study was to define the diagnostic value of hysteroscopy in evaluating uterine cavity compared to endometrial biopsy in women presenting with postmenopausal bleeding and thick endometrial mucosa with particular attention to endometrial hyperplasia and carcinoma. METHODS: Eighty-three consecutive women presenting with postmenopausal bleeding and endometrial thickness of 5 mm or more measured by transvaginal ultrasound (TVU) were enrolled in a prospective study between May 2008 and July 2010. They underwent diagnostic hysteroscopy and endometrial biopsy. Hysteroscopic data was compared with the final diagnosis established by histological examination. RESULTS: The women's mean age was 61.2 ± 5.2 years (range 44-80). The most frequent endometrial lesion was endometrial polyps (31.1%). Hyperplastic endometrium was confirmed in 23 (27.8%), only 13 cases were suspected by the hysteroscope. Out of the 14 (16.9%) proven cases of endometrial cancer, only half of the cases were suspected. In benign endometrial lesions, the sensitivity of the hysteroscopic view was 94.7%, specificity was 97.8%, positive (PPV) and negative (NPV) predictive values were 97.3 and 95.7%, respectively. On the other hand, hysteroscopy demonstrated an overall sensitivity, specificity, PPV, and NPV of 56.5, 91.6, 72.2, and 84.6%, respectively, in endometrial hyperplasia, whereas the same parameters for endometrial cancer were 50, 94.2, 63.6, and 90.2%. CONCLUSION: Hysteroscopy can be used as the first line diagnostic tool for evaluating the benign endometrial lesions, such as endometrial polyp and submucosal myoma, nonetheless hysteroscopy has poor validity for excluding endometrial hyperplasia and cancer in women presenting with the postmenopausal bleeding and thick endometrium.

Enhanced expression of vascular endothelial growth factor and increased microvascular density in women with endometrial hyperplasia: a possible relationship with uterine natural killer cells.

This case-control study aimed to investigate the expression of natural killer cells (NKCs) and the integrated optical density (IOD) of vascular endothelial growth factor (VEGF) and to quantify microvascular density (MVD) in endometrial biopsies from women with endometrial hyperplasia (EH) relative to normal subjects. Histological data from four groups were analyzed. The study population included 30 women with simple EH without atypia, 25 patients with complex EH without atypia, 25 with complex EH with atypia and 25 healthy women with non-hyperplastic endometrium (control group). Paraffin sections were immunostained with antibodies against CD56, VEGF-A and CD34 using an Avidin-Biotin-Peroxidase technique. The evaluation of NKC density and IOD of VEGF expression and measurement of MVD were performed using light microscopy examination and image analysis techniques. Increased numbers of NKCs were documented in cases of complex EH with atypia compared with the other groups (p<0.001). The number of NKCs was lower in cases of hyperplasia without atypia compared with the controls, but the difference was not significant. The IOD of VEGF-A and MVD increased significantly with progression from the non-hyperplastic endometrium through the three groups of EH (p<0.001). We observed a significant correlation between the MVD and the IOD of VEGF-A in the studied groups (r=0.434; p<0.001). Additionally, NKCs density was correlated significantly with IOD of VEGF-A (r=0.661; p<0.001) and with the MVD (r=0.473; p<0.001). These results suggest that NKC-count, IOD of VEGF and endometrial MVD are all related to the histological changes of the endometrium and that endometrial hyperplasia exhibits distinct immunological backgrounds in the context of NKC infiltration and VEGF production.

Results of delivery in umbilical cord prolapse.

OBJECTIVE: To review the peripartum clinical course of patients whose pregnancies were complicated by umbilical cord prolapse and to evaluate its impact on neonatal outcome. METHODS: All cases of cord prolapse managed in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 1990-2000 were identified. There were 111 patients identified among 55,789 deliveries. Each maternal and fetal chart was reviewed for parity, age, gestational age, fetal presentation, status of membranes, time from diagnosis to delivery, mode of delivery, baby weight, Apgar scores and cord blood hydrogen ion concentration (PH). The data collected was analyzed using Gold Stat Software Package, and statistical significance was established by using analysis of variance and Chi-square. RESULTS: The incidence of cord prolapse was found to be one in 503 cases (1.99 per thousand deliveries) in our study. Seventy-two (64.9%) of the fetuses were in vertex presentation and 39 (35.1%) were non-vertex, including breech and transverse presentations. Ninety one point nine percent were singletons and 8% were twins. At the time of diagnosis in 15 (13.5%) membranes were artificially ruptured and in 96 (86.5%), they were spontaneously ruptured. The cervix was fully dilated in 10% and minimally dilated in 100 (90%). Regarding mode of delivery, 7 (6.5%) were vaginal deliveries and 104 (93.5%) were cesarean sections. The interval from diagnosis to delivery ranged from 10 minutes to >20 minutes. Six (5.4%) of the babies were delivered in 10 minutes, 49 (44.1%) in 20 minutes and 56 (50.5%) in more than 20 minutes. Apgar score was less than 7 in 44 (39.6%) of the babies at one minute and in 5 (4.5%) of the babies at 5 minutes. Cord PH was less than 7 in 2 (1.8%) cases and more than 7 in 109 (98.2%). Forty-one (36.9%) of the babies were admitted in neonatal intensive care unit. There was no perinatal mortality in our study group. CONCLUSION: In our review, we found that cord prolapse is not associated with higher rates of perinatal mortality or morbidity and our study supports clinical management of cord prolapse by cesarean section. The interval from diagnosis to delivery may not be the only determinant of neonatal outcome.

Prediction of low birth weight infants from ultrasound measurement of placental diameter and placental thickness.

BACKGROUND: The aim of the study was to help to predict low birth weight infants by measuring placental diameter and thickness. SUBJECTS AND METHODS: A prospective study was conducted of 70 consecutive singleton pregnancies to evaluate placental diameter and thickness by ultrasonographic measurement at 36 weeks gestation. The individual data were fitted to a logistic regression analysis. RESULTS: A "warning limit" of a placental diameter of 18 cm and placental thickness of 2 cm at 36 weeks gestation were calculated to predict low birth weight infants. CONCLUSION: Ultrasonographic placental diameter and thickness measurements appears to be of prognostic value in identifying the subsequent occurrence of fetal growth retardation.

Placental growth factor and soluble Fms-like tyrosine kinase 1 in diabetic pregnancy: A possible relation to distal villous immaturity.

This study aimed to describe the prevalence of chorionic distal villous immaturity (DVI) in overt diabetic/gestational diabetic (OD/GD) women compared with normoglycemic ones and to analyze the relation of DVI index (DVII) to placental growth factor (PlGF) and soluble Fms-like tyrosine kinase 1 (sFlt-1). Three groups were studied; normoglycemics (n=21), OD (n=17) and GD (n=20). Maternal blood samples were evaluated regarding serum levels of PlGF and sFlt-1. Immunohistochemical methodologies were employed in term placentae of all subjects to assess DVII and area% of PlGF and sFlt-1 immunostaining. We found that mean Hemoglobin A1c (HbA1c) is 5.22±0.15 in normoglycemics, 6.2±0.3 in OD, and 5.70±0.23 in GD with significant differences between groups (p=0.012). DVII was significantly higher in OD (66.6±4.7) and GD (72.4±4.5) compared to controls (11.6±2.5; p=0.000). Healthy women have significantly lower levels of PlGF (86.6±14.5) compared to OD (166.6±22.4, p=0.000) and GD (150.3±23.97, p=0.000) and their placentae expressed a significantly lower area% of PlGF (6.5±0.8) compared to OD (14.8±1.0, p=0.000) and GD (18.8±1.3, p=0.000). Also, normoglycemic women have significantly lower levels of sFlt-1 (108.9±12.1) compared to OD (226.5±18.6, p=0.000) or GD (197.2±16.8, p=0.000) and their placentae expressed a significantly lower area% of sFlt-1 (3.2±0.3) compared to OD (15.4±1.7, p=0.000) and GD (16.9±1.2, p=0.000). There was significant correlation between DVII and both serum level and area% of PlGF and sFlt-1 expression in the 3 groups. This study provided a new score for evaluating DVI in normal and diabetic placentae and suggested a role for PlGF and sFlt-1 in regulation of DVI in diabetic pregnancies.

Expression pattern of tumor necrosis factor alpha in placentae of idiopathic fetal growth restriction.

Tumor Necrosis Factor-Alpha (TNF-α) is one of the proinflammatory cytokines that provokes a variety of biological effects on the placenta. The increased placental exposure to TNF-α have induced impaired fetal development in experimental animals, but no data are available on the expression and localization of TNF-α in human placenta of idiopathic fetal growth restriction (FGR). The aim of this study was to characterize the immunohistochemical expression and localization of TNF-α in idiopathic FGR placentae in comparison with those of appropriate for gestational age (AGA) fetuses. 75 human placentae were collected between April, 2010 and March, 2011; 50 placentae were collected from pregnancies associated with idiopathic FGR and 25 placentae from AGA pregnancies. Histological and Immunohistochemical methodologies were employed in formalin fixed paraffin-embedded sections from the placentae of all subjects. Area percent of TNF-α immunostaining was evaluated using image analysis technique. In both AGA and idiopathic FGR placentae, cytoplasmic TNF-α was localized in the decidual and chorionic trophoblasts and in the endothelium of decidual and chorionic vessels. Trophoblast giant cells (TGC) in the decidua and chorionic villi of AGA specimens show deficient or negative TNF-α immunoexpression while those of idiopathic FGR show positive immunostaining. The mean area percent of TNF-α staining was greater in idiopathic FGR placentae (5.93 ± 0.69) compared to AGA ones (3.28 ± 0.41) (p = 0.001). Enhanced placental expression and specific cellular localization and of TNF-α are expected to contribute to impaired fetal development in idiopathic FGR and the TGCs are proposed to be an obvious source of this cytokine in such cases.

Structural analysis of human placental stem and terminal villi from normal and idiopathic growth restricted pregnancies.

Studying in detail different histomorphological and pathological findings in placental stem and terminal villi of appropriate for gestational age (AGA) and idiopathic intrauterine growth restricted (IUGR) fetuses, then analyzing their correlation to the neonatal birth weight and to the some morphological features of the placenta. Fifty full-term human placentae of idiopathic IUGR and 25 of AGA pregnancies were processed for haematoxylin and eosin staining and evaluated by light microscope aided with Image Analyzer. The mean number of stem villous arteries, and the mean number of terminal villous capillaries per field are significantly lower in idiopathic IUGR group (4.63 ± 0.46, 47.09 ± 4.44, respectively) than in AGA group (12.36 ± 0.61, 73.35 ± 5.13, respectively) (p = 0.001). Both AGA and idiopathic IUGR placentae share the presence of many pathological features: (1) narrowing of stem villous arteries appears in 38 (76 %) of IUGR cases and in 9 (36 %) of AGA cases with significant difference between groups (p = 0.001); (2) cellular infiltration (villitis) of the stem villi is significantly higher in IUGR cases [24 (48 %)] than in AGA cases [2 (8 %)] (p = 0.001). The study shows significant correlation between the birth weight and different pathologic features in the stem villi as arterial number (r = 0.494; p = 0.000), arterial narrowing (r = 0.283, p = 0.004), degenerative changes (r = 0.331, p = 0.001) and villitis (r = 0.275, p = 0.005). There is also significant correlation between neonatal birth weight and terminal villous capillary number (r = 0.281, p = 0.001) but no significant correlation is found between the birth weight and terminal villous fibrotic changes (r = -0.098, p = 0.318). Histomorphological and pathological changes in the stem villi could explore the cause of idiopathic IUGR. Stem villous arterial number, arterial narrowing, degeneration and villitis could be underlying mechanisms. Further researches on the hormonal and cytokine level should be undertaken to demonstrate the precipitating factors of these changes and the possible preventing measures.

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.

Cardiovascular disease markers in women with polycystic ovary syndrome with emphasis on asymmetric dimethylarginine and homocysteine.

BACKGROUND AND OBJECTIVES: Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Little is known about cardiovascular risk factors in patients with PCOS. We investigated plasma markers of cardiovascular disease in Saudi women with PCOS, with an emphasis on asymmetric dimethylarginine (ADMA) and total homocysteine (tHcy). PATIENTS AND METHODS: Fifty Saudi women with PCOS diagnosed by the Rotterdam criteria (mean age [SD] 30.2 [3.0] years) and 40 controls without PCOS (mean age 29.3 [2.5] years) had measyrements taken of clinical, metabolic, and hormonal parameters, including plasma ADMA, tHcy, lipoprotein (a) ([Lp(a)], and serum high sensitivity C-reactive protein (hs-CRP), nitric oxid, and fibrinogen. Insulin resistance was calculated by the homeostasis model assessment (HOMA-IR). RESULTS: Women with PCOS had significantly higher fasting insulin, HOMA-IR, and luteinizing hormone (LH) levels than healthy controls (P P P CONCLUSION: Our study revealed that Saudi women with PCOS had a significantly different levels of plasma markers of cardiovascular disease compared with normal controls. Therefore, clinicians who manage women with PCOS should follow up on these markers to reduce the risk of cardiovascular disease.

Evaluation of periodontal status among saudi females with gestational diabetes and its relation to glucose and lipid homeostasis in ohud hospital, Al madina Al-munwarrah.

OBJECTIVES: Due to the lack of pregnant based oral health studies in our country, we conducted this study to evaluate periodontal status among females with gestational diabetes in Ohud Hospital, Al Madinah Al-Munwarrah and to assess its effect on insulin sensitivity and lipid metabolism. METHODS: This cross-sectional descriptive study was conducted from January 2008 till June 2008. The sample includes 250 Saudi females, 100 were pregnant with gestational diabetes (GDM), and 100 were pregnant without GDM and 50 were normal non pregnant females. The study cases were matched age and body mass index. All the participants were subjected to history taking, physical examination and assessment of their periodontal status. Laboratory tests include fasting blood sugar, insulin levels, Homeostasis Model Assessment Insulin Resistance (HOMA-IR) test and serum lipids. Serum levels of inflammatory markers (CRP, ESR, IL-1ß, and TNF-α) also measured. The periodontal health status was assessed using the Community Periodontal Index of Treatment Needs (CPITN). RESULTS: Severe periodontal diseases were elicited in 37% of the pregnant females with GDM, 29% of the pregnant females without GDM and 14% of non pregnant normal control group. Females with GDM showed higher systolic and diastolic blood pressure, fasting insulin, HOMA-IR, serum lipids and serum inflammatory markers levels than the other groups. Serum fasting insulin levels, HOMA-IR, triglyceride levels, and serum inflammatory markers were higher in females with severe periodontal diseases. Females with recurrent GDM were found to have higher Body Mass Index (BMI), severe periodontal diseases, as well as higher HOMA-IR, than those presented for first time with GDM. Females with GDM; also shows significant positive correlation between CPITN scoring and patient age, HOMA-IR and inflammatory markers. CONCLUSIONS: The prevalence of periodontal disease is high among pregnant females especially those with GDM. Periodontal disease had important deleterious effects on carbohydrates and lipids metabolism. Strategies are needed to improve dental health care and to reduce periodontal diseases among pregnant females.

Incidence of post cesarean section wound infection in a tertiary hospital, Riyadh, Saudi Arabia.

OBJECTIVE: To measure the rate of wound infection after cesarean section and assess risk factors for such infection. METHODS: A prospective surveillance was conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, during the period January 2000 through to December 2000. This included a total of 754 cesarean sections. The following risk factors, which were studied included, age, parity, gravida, gestational age, antenatal care, type of cesarean section emergency or elective, previous history of cesarean section, duration of operation, rank of surgeon, use of antibiotics, wound infection, complications and length of stay in the hospital. Post discharge surveillance was carried out 5-10 days later to check for wound infection. RESULTS: The overall wound infection rate was 4.5% (95% confidence interval [CI], 3-6%). In the multivariate analysis, the independent risks factors for wound infection were age of the mother less than 20 years (Odds ratio (OR) = 12.13: 95% CI 1.43-118.50: P = 0.039), the duration of surgery, more than one and a half hour (OR = 23.9: 95% CI 10.36-55.78: P = < .001) and medical complications namely diabetes mellitus (OR = 2.28: 95% CI 1.01-5.05: P = 0.03). There was a statistical significant relationship between wound infection and length of stay (P < 0.001). CONCLUSION: A protocol for prophylactic antibiotics is needed, in addition to a new strategy to reduce the nosocomial infection, in order to decrease the incidence of wound infection after cesarean section.