Knowledge and attitude of breastfeeding among women in Al-Madina Al-Munawwarah, Saudi Arabia, 2017

Background: breastfeeding is considered to be beneficial for both babies and mothers

Objective: this study aimed to assess the knowledge and attitude of breastfeeding among women in Al-Madina Al-Munawwarah, Saudi Arabia

Methods: this was an analyticalcross-sectional study and it was carried out in Al- Madina, Kingdom of Saudi Arabia during the year 2017. Data were collected by electronic self-administered semi-structured questionnaire

Results: data were collected from 388 female. The majority of the respondents were above 36 years old [48.2%]. More than half of our respondents 225 [58.0%] were unemployed and 277 [71.4%] had a college-level education or higher. 138 [35.6%] of the women were exclusively feeding their baby by breastfeeding, while the majority of the respondents 220 [56.7%] chose a mix of both breast and formula feeding. The percentage of women who received hospital education regarding breastfeeding was equal to the women who had not received the hospital education 194 [50.0%]. 175 [45.1%] of the respondents reported that health problem is the most reason that preventing them from breastfeeding their babies. Mothers believed that breastfeeding helped them by preventing breast and ovarian cancer 308 [79.4%] and the majority of the respondents 334 [86.1%] believed that breastfeeding improved the immunity and protect from different illness

Conclusion: in spite of the low percentage of exclusive breastfeeding, all the mothers were certain about the importance of breastfeeding to them and to their babies. There is a significant opportunity to improve awareness among women regarding the importance of exclusive breastfeeding

Effects of topiramate administration on placenta of rat

Background: Topiramate was classified as pregnancy category D, which means that it possesses a potential risk to the fetus. An increasing evidence points to the risk of development of cleft lip and/or cleft palate [oral clefts] in infants born due to Topamax [topiramate] during pregnancy

Objective: To evaluate the effects of the therapeutic doses of topiramate on the placental structure

Design: An Experimental Animal Study

Setting: Teratology Laboratory, Anatomy Department, CMMS, Arabian Gulf University

Method: Pregnant rats were treated with oral topiramate at doses of 50 and l00mg/Kg body weight. On day 20, the pregnant rats were sacrificed, and the placentae were collected and processed for histological evaluation

Result: Degenerative changes in all three layers of the placenta [decidual, basal and labyrinthine] were observed. In the decidual layer, deposition of fibrous and hyaline materials were found in the cells, in addition to vacuolization and hemorrhages. In the basal layer, the trophoblast cells [giant, basophilic and glycogen cells] showed vacuolization, cytolysis and cyst formation. In the labyrinthine layer, there was an increased fibrinoid material and fetal mesenchyme. In addition, degeneration of cells and congestion of blood vessels were evident

Conclusion: The deleterious effects of the therapeutic doses of topiramate on the placental structure may play a role in its teratogenicity. These placental changes are not dose dependent

[Effect of water extract of Costus Indian or sea-qust on pathogenic fungi for the respiratory system in human to exhibit the miracle scientific in the Sunah]

The plant extracts are one of methods which use them since antiquity in alternative medicine and still until now. This extracts are developing by the progress of science and technology where some materials extracted from plants, to be effective against disease-causing microorganisms, because they contain essential oils and essences, alkaloids, flavonoids, triterpenes and organic acids .In addition that materials are used to make many pharmaceutical drugs. This study aims to identify the effect of water extracts for Costus Indian and sea-Qust on some fungi and yeast pathogens for the respiratory system of humans and to demonstrate the scientific in prophet's Sunah where the prophet [PBUH] said [Cupping and marine Costus are the best of your remedies] and also he said [Use this Indian wood, because it contains seven types of cures, among them a cure for pleurisy]. That importance which appeared in the prophet's guidance for treating to Costus is revealed by this study, especially as the water extracts are shown highly effective against Aspergilus niger, A. fluvus and Candida albicans tested, it exhibit this effect in all the extracts treatment, cold or hot when used for private high concentrations of them. As a result, the extract of sea-Qust on a hot treatment is demonstrated an effective on the fungus A. niger, and the Costus cold for both types of Costus was a highly effective from a hot treatment for A. flavus. Also, the growth rate of Candida albicans have been affected by all treatments of Costus extract

Functional capacity in patients with coronary artery bypass grafting surgery after cardiac rehabilitation program

To evaluate the effect of cardiac rehabilitation program on cardiac function and functional capacity in patients with coronary artery bypass grafting surgery. Forty patients with CABG were included. Thirty patients served as group I and ten patients as group II [control group]. Group I patients were enrolled in cardiac rehabilitation program for 12 weeks. All patients were subjected to: functional classification scaling, exercise stress test at the start and at 12 weeks [to detect the metabolic energy times and functional capacity of patients] and echocardiography at the start and at 12 weeks to evaluate the cardiac function. There was no significant difference between patients and controls at the start as regard exercise stress test, left ventricular ejection fraction and functional class. At 12 weeks: the exercise stress test results showed a significant increase in exercise duration, METs and VO2 max in group I in comparison to group II, and in group I at 12 weeks in comparison to its initial results. The echocardiography results showed a highly significant difference of LVEF between group I and group II at 12 weeks and in group I at 12 weeks in comparison to the start. Early return to work, at 12 weeks, was noticed in 14 out of 16 male patients [87%] in group I, and two out of five male patients [40%] in group II. Cardiac rehabilitation is an important component of the current interdisciplinary approach to the management of the patients with various presentations of coronary heart disease

Correlation of patellar alignment with pain and function in knee osteoarthritis

To find out the correlation of patellar alignment with pain and function in knee osteoarthritis [KOA]. Sixty [KOA] patients were subjects for clinical assessment; body mass index, psychometric assessment using Center of Epidemiologic Studies Depression Scale [CES-D]. We assessed knee pain and function using the Western Ontario and McMaster Universities [WOMAC] index. CBC, ESR, serum uric acid and urine analysis were performed. Postero-anterior plain x-rays in weight bearing were done for radiological grading of [KOA] using Kellgren-Lawrence score. Magnetic resonance image [MRI] was done in a sagital plane to measure patellar length [PL] and trochlear length [TL]. Patellar length ratio [PLR] was calculated by dividing PL by TL. MRI in a transverse plane was used to measure trochlear indices [depth SA, inclination LTI and angle TA] and patellar indices [LPTA and BO]. PLR and LTI increased significantly with WOMAC pain, not so with TA or SA. There was an increase of LPTA and a decrease of BO with WOMAC pain but not to a significant level. There was a tendency of LTI to increase with WOMAC function. PLR increased with WOMAC function but not to a statistical level. TA, SA, LPTA and BO showed no significant change with WOMAC function. PF arthritis should be considered as an entity separate from tibio-femoral arthritis. There was an association between patellar alignment with knee pain and function. Therefore, procedures to improve patellar biomechanics to correct articular damage may be beneficial to alleviate pain

Effect of botulinum toxin type-A on traumatic spinal cord injury spasticity

To evaluate the effect of botulinum toxin type A on spasticity in spinal cord injured patients and their functional outcome. Forty spastic patients due to traumatic spinal cord injury were studied. Initial assessment included general and neurological examination, ASIA classification, motor power, spasticity grading and functional assessment at the start, at 3 and 6 months. All patients received conventional physiotherapy rehabilitation on daily basis for 3 months then three times weekly for another 3 months. Thirty patients [group I] received botulinum toxin type A in the spastic muscles, dose according to body weight. Ten patients [group II] did not receive botulinum toxin. There 'was no significant difference between groups I and II as regard ADL on the 3 assessments. FIM was significantly lower in group 2 at 3 and 6 months. Clonus score showed a significant higher score of grade 3 and 4 only at 6 months in group II. Spasm frequency scale showed a significant higher rate of scale 3 and 4 in group II at 3 and 6 months. Global pain scale showed no significant difference between groups I and II at any occasion. Adductor tone scale showed a significant higher rate of scale 3 and 4 in group II at 3 and 6 months. Modified Ashworth scale showed a significant higher rate of scale 3 and 4 in group II at 3 and 6 months. Botulinum toxin has a reducing effect on spasticity in spinal cord injured patients, consequently improving their functional outcome

Serum interleukin-16 level in systemic lupus erythematosus

To detect serum interleukin-16 level in patients with systemic lupus erythematosus and to find out its correlation with disease activity. The study included 30 female patients with systemic lupus erythematosus. 20 apparently healthy females with matched age represent the control group. All patients subjected to full history taking, thorough clinical assessment of disease activity using SLE Disease Activity Index [SLEDAI] serum level of IL-16 mere examined using an enzyme-linked immunosorbent assay [ELISA]. Serum level of interleukin-16 [IL-16] was significantly increased in patients with systemic lupus erythematosus compared to controls and there was a significant positive correlation between IL-16 levels and disease activity assessed by the SLEDAI score. Circulating IL-16 levels are high in SLE patients and are correlated with the disease activity so serum level of IL-16 can be used as a useful indicator of SLE disease activity

Plasma osteopontin concentration in lupus nephritis

To measure plasma concentration of osteopontin and to correlate these levels with clinical, laboratory, disease activity and histopathological parameters in SLE patients. This study was performed on 20 SLE patients and 10 normal control subjects. Plasma osteopontin concentrations were measured by ELISA technique for both patients and control groups. All patients underwent renal biopsies within 3 months of onset of proteinuria or hematuria. There was a highly significant difference between patients and control groups as regards plasma osteopontin concentration [p<0.001]. There was a significant positive correlation between osteopontin and SLEDAI [p<0.001] and activity index of renal biopsies [p<0.05]. Also there was a highly significant differences as regard osteopontin plasma concentration between patients with and without renal affection [p<0.001]. Osteopontin has been shown at least partly to account for SLE nephritis probably through predominance of Th[1]-type response in both peripheral and renal tissue. Further investigation of this mechanism in lupus nephritis may allow the design of new therapeutic strategies of lupus nephritis such as manipulation of Th[1]/Th[2] and down-regulation of Th[1]-response

Thermal tactile Vs. Neuromuscular electric stimulation in the rehabilitation of stroke-induced dysphagia

To study the effect of neuromuscular electric stimulation on the swallow functional score in stroke patients having dysphagia and compare the effect of neuromuscular and thermal tactile stimulation on its rehabilitation. Fifty patients with dysphagia due to stroke were included. They were divided into two equal groups according to the rehabilitation programs they received. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. Group II received tactile thermal stimulation on the anterior faucial arch one hour daily for 12 weeks. Swallow functional score for dysphagia assessment using the modified barium swallow [MBS] was done for both groups, at the start and at 4 weeks, 8 weeks and 12 weeks. No statistically significant difference was detected between Groups I and II as regards the swallowing score at the start, 4 weeks and 8 weeks [p>0.05]. But there was a statistically significant higher score at 12 weeks [p<0.05]. There was a statistically significant higher change in the score from the start till 12 weeks in Group I as compared to Group II [p<0.05]. Also, there was a higher dysphagia score with hemispherical lesions over the 12 weeks of rehabilitation program in Group I [p<0.05] which was seen only in patients having chest problems in Group II [p<0.05]. The electrical stimulation has the advantage of being Non-invasive and actively assisting swallowing. Thus it can be used as an alternative treatment for dysphagia. It also helps in the restoration of the normal swallowing mechanism and decreases the incidence of the subsequent complications of dysphagia. To use neuromuscular electric stimulation of the neck muscles instead of thermal tactile stimulation in rehabilitation of dysphagia secondary to stroke. Further studies are needed to detect its long term effect on dysphagia rehabilitation

Prevalence of macrovascular disease in systemic sclerosis

To detect the prevalence of macrovascular disease in systemic sclerosis. Thirty patients with systemic sclerosis and ten normal controls matched in age and sex were included in the study. All subjects were screened for atherosclerosis risk factors and non-invasive vascular assessment as carotid duplex scanning and measurement of ankle brachial blood pressure index. There was no significant difference in risk factors as cigarette smoking, systolic, diastolic blood pressure, cholesterol, triglycerides and glucose levels between patients and controls groups. Twenty three out of 30 patients [76.7%] had carotid artery disease compared to [30%] of normal controls with a highly significant difference. Macrovascular disease is a common finding in systemic sclerosis. Early identification allows early intervention and treatment with better control of high rate of cardiovascular mortality

Correlation between serum matrix metalloproteinase-9 in SLE patients with neuropsychiatric manifestations and brain magnetic resonance imaging abnormalities

Neuropsychiatric manifestations of systemic lupus erythromatosus [SLE] are common and its pathogenesis is still unclear but recent neuroimaging studies in SLE attributed it to vasculitic processes which results in cerebral ischemia. Matrix metelloproteinase-9 [MMP9] has a central role in ischemic damage of the brain, it disrupts the blood brain barrier [BBB] and it also induces a high breakdown capacity in arteriolar basement membrane leading to cerebral edema and secondary hemorrhage. Also it participates in the degradation of myelin basic protein which is a major component of both central and peripheral nervous system. This study was performed to evaluate the possible association between serum MMP9 and neuropsychiatric manifestation with cerebral MRI abnormalities in patients with SLE. Serum MMP9 levels were determined in forty patients with systemic lupus erythromatosus and twenty apparently healthy controls who underwent clinical examination, neurological examination and neuropsychological testing. Cerebral MRI scans with T[1] and T[2] weighted lesions were performed for all subjects. In addition, immunological assay and routine investigations were performed. SLE patients with neuropsychiatric manifestations [NP-SLE] had significantly higher serum MMP9 concentrations than patients without neuropsychiatric manifestations [NNP-SLE], and those with cognitive deficits had significantly higher concentrations of serum MMP9. Furthermore MMP9 levels were significantly higher in patients with T[1] and T[2] weighted lesions in cerebral MRI in NP-SLE. Elevated levels of serum MMP9 in patients with SLE may reflect neuropsychiatric involvement particularly cognitive dysfunction and MRI results favor the association between serum MMP9 levels and ischemic changes with increased risk of cerebral ischemic events in SLE patients

Assessment of fatigue in ankylosing spondylitis patients: clinical and self-reported measures

Pain, stiffness, functional impairment, range of motion and quality of life are the main conventional domains used in studies evaluating ankylosing spondylitis [AS]. However, fatigue has been reported as the major complaint of AS patients. To evaluate fatigue as a potential independent domain in comparison to the conventional ones and to evaluate the sensitivity to change after non-steroidal anti-inflammatory drug [NSAID] therapy. Twenty patients were selected as having painful AS [modified New York criteria 1984]. The following variables were recorded at baseline and after six weeks of NSAID therapy: pain [VAS], function [Bath Ankylosing Spondylitis Functional Index], patient's global assessment [VAS], inflammation [night pain], morning stiffness, metrology [Schober test, finger-to-floor] and fatigue using 0-100 VAS scale. Analysis consisted of the prevalence of fatigue [VAS value of at least 50mm] and the sensitivity to change, by calculating the standardized response mean [mean change / S.D. change] [SRM] between before and after NSAID therapy. Fatigue was considered important in 14 patients [out of 20: 70%]. The information provided by pain, function and global assessment explained only 44% of the variability of the variable "fatigue" [similar analyses considering "pain" on the one hand and "function" on the other hand as the dependent variables showed an R value of 34 and 60%, respectively]. The NSAID treatment effect [SRM] was higher for the variables "pain" and "function" [0.76 and 0.71 respectively] than for "fatigue" [0.34]. This study strongly suggests that fatigue should be considered as an independent domain to be systematically evaluated in AS patients and that conventional therapy such as NSAIDs have a lower effect on fatigue than on pain or functional impairment

Relation of antimyeloperoxidase antibody t o rheumatoid arthritis disease pattern

Objective: To determine the presence of antimyloperoxidase [anti-MPO] in rheumatoid arthritis patients in order to assess its relation to disease pattern

Methodology: Serum antimyeloperoxidase antibodies were assessed with Enzyme Linked Immunosorbent Assay [ELISA] in 25 rheumatoid arthritis patients and 10 controls

Results: Anti-MPO was found in 60% of patients and 10% of controls with a high statistical difference between the patients and control groups [p > 0. 001]. Also there was a highly significant difference between the patients and controls regarding ESR [p < 0.001] and serum creatinine [p< 0.05]. There was no correlation between the mean anti-MPO and activity sore, duration of morning stuffiness and number of affected joints [p> 0.05]. There was a positive correlation between serum creatinine duration of RA, ESR and disease severity with mean of Anti-MPO among cases [p<0.01]

Conclusion: The use of Anti-MPO helps in the assessment of RA disease activity and help in the assessment of disease severity and prediction of renal affection. It cannot be used to predict the onset of RA but can be used as an indicator of long standing RA disease

Evaluation of hand function in patients on long term hemodialysis and its correlation to the parameters of dialysis

Hemodialysis is associated with deposition of beta-2-microglobulin [beta-2m] in musculoskeletal structures, leading to the syndrome of dialysis related amyloidosis and impairment of hand function. The detection of amyloidosis in several patients on long-term dialysis came as a surprise. The subsequent identification of beta-2m as the main component of dialysis related amyloidosis demonstrated that we were faced with a new, specific complication of long-term renal replacement therapy. To assess the hand function in a cross section of patients undergoing hemodialysis and to correlate it to dialysis duration, efficiency, nutritional status, and other parameters of dialysis. The study comprised two groups: Group A included thirty-nine patients [16 females, 23 males] with end stage renal disease receiving maintenance hemodialysis. Their mean age was 49 +/- 11 years; their mean duration of hemodialysis was 37 +/- 31.8 months. Dialysis efficacy was calculated with the formula of single pool Kt/V. Group B included 20 normal healthy volunteers [8 females and 12 males] as a control group; their mean age was 45 +/- 15 years. All patients and controls were tested as regards kidney functions, hemoglobin, albumin, and parathyroid hormone. Then, the hand function was evaluated with the JAMAR handgrip test [JA Preston Corp, Ontario, Canada] for the dominant and non-dominant hands. beta-2m was significantly elevated in group A in comparison to control group B [34.7 +/- 14.14 versus 3.9 +/- 2.1mg/dl] [p<0.001]. JAMAR hand function test was significantly decreased in patients as compared to controls [25.01 +/- 8.7 versus 42.8 +/- 8.9] [p<0.001]. In group A, 25 out of 39 patients [64%] had abnormal performance of hand function tests used. This percentage was 85% [17 out of 20 patients] for ages above 55 years, while it was 36% [8 out of 19 patients] for ages below 55 years. The JAMAR handgrip test of the dominant hand was highly significant correlated to serum beta-2m levels [r=-0.42, p =0.007], to hemodialysis duration [r=-0.6, p <0.001], and to serum albumin concentration [r=0.57, p <0.01]. While beta-2m positively correlated with hemodialysis duration [r=0.9, p<0.001], it negatively correlated to both parathormone [r=-3.19 p<0.04] and albumin r=-0.55 p<0.001. Hand dysfunction is a common association with long standing chronic dialysis therapy. Hand function negatively correlated to beta-2m, hemodialysis duration. Age and hemodialysis duration were important risk factors for hand dysfunction. We recommend the use of hand function test for the early detection of dialysis related amyloidosis as well as in the serial monitoring of patients on dialysis, especially in patients who are on hemodialysis for at least 5 years and for patients who start dialysis after 55 years of age. This will help to shift those affected patients for using high-flux biocompatible membranes in conjunction with ultra-pure dialysis fluid

Level of serum transforming growth factor-beta1 in different rheumatological disorders

To detect the serum level of transforming growth factor- beta[1] [TGF- beta[1]] in Beh‡et disease, systemic lupus erythromatosis [SLE] and rheumatoid arthritis [RA]. Also, to compare them with healthy controls, to determine the relationship between TGF- beta[1], and other parameters of disease activity. The study was performed on 50 subjects. Ten patients had Beh‡et disease, 14 had SLE, 16 had RA besides 10 healthy controls. At the time of the study, all patients had clinically active disease and were subjected to detailed clinical assessment and laboratory investigations. None of them were using immunosuppressive drugs. Steroids were discontinued 30 days before blood samples were collected. Estimation of serum TGF- beta[1] was done using TGF- beta[1] Elisa kit. There was a statistically significant decrease in the mean level of TGF- beta[1] in our SLE group, while there was a statistically significant increase in our RA group. On the other hand, there wasn't any statistically significant difference in our Beh‡et group as compared with the control group [mean 72.5 +/- 9.6, 139.3 +/- 23.8, 105.0 +/- 4.7, 102.0 +/- 8.5, p<0.05, p>0.05 respectively]. Neither sex nor the presence of oral or genital ulcers, eye affection, or superficial or deep phlebitis showed any significant difference in Beh‡et patients with or without those manifestations [p>0.05]. The mean serum level of TGF- beta[1] showed a negative significant correlation with disease duration in the Beh‡et group [r: -0.65, p<0.05]. In the SLE group, a significant difference in the mean level of TGF- beta[1] was detected only in patients having CNS manifestations, Raynauds phenomenon or oral ulcers [p<0.05]. Also, there was a negative correlation between the ESR and TGF- beta[1] [r: -0.93, p<0.05]. In the RA group, patients having positive rheumatoid nodules showed a significant difference in level of TGF- beta[1] [p<0.05]. Both the disease activity index and the ESR showed a positive significant correlation with level of TGF- beta[1], while both the disease duration and total leucocytic count showed a negative one [r: 0.59, r: 0.72, - 0.55, -0.85 respectively, p<0.05]. Our results suggest that the serum level of TGF- beta[1] could play a role in the immunologic defect of different rheumatological disorders

Observational study on patients suffering of Raynaud's phenomenon

We examined Raynaud's phenomenon in systemic sclerosis [SSc], systemic lupus erythematosus [SLE] and rheumatoid arthritis [RA] to determine its relation to the clinical and laboratory data of different rheumatic diseases. Thirty-six patients were included in our study 18 of them with and 18 without Raynaud's phenomenon. There was a significant difference between both groups as regards clinical data of cerebritis, nephritis and systolic blood pressure where such were higher in the Raynaud's positive group than Raynaud's negative group. These findings can be explained on the patho-physiological basis of the disease itself. We can get either affection of the kidney [nephritis] or vasculitis presenting by cerebritis or due to the circulating endothelin substance

Ultrasonographic assessment of the quadriceps muscle in elderly women

Anthropometrical and qualitative ultrasonographic assessment of the quadriceps muscle [vastus lateralis] in thirty elderly women was done before and after a physical training program to develop muscle strength for eighteen weeks. Statistical comparison in different assessment parameters showed that there was no statistical significant difference [p > 0.05] in body weight, thigh girth and cross sectional area of the quadriceps before and after the physical training program. But there was a statistical significant difference [p < 0.05] as regards thigh subcutaneous fat and muscle thickness