Genetic Influence in Developmental Dysplasia of the Hip in Saudi Arabian Children Due to GDF5 Polymorphism.

Developmental dysplasia of the hip (DDH) is quite common among Saudi Arabian babies. With an objective to assess the presence of SNP rs143383 and the alleles in the GDF5 gene among patients with DDH, parents, and unaffected siblings, we undertook this case-controlled study. We collected and analyzed for a functional single nucleotide polymorphism (SNP) in the 5'-untranslated region of the GDF5 gene (rs143383), 473 blood samples, (100 patients, 200 parents, 73 siblings and 100 healthy controls. We determined the association between the patients' genotype and their fathers', mothers' and siblings' genotype through Chi-square analysis. The majority of those screened possessed the TC genotype, and 61.8% of patients and their fathers had the TT genotype. There was no association between patients' and fathers' genotype, P value < 0.332, 95% CI (0.328-0.346), and between patients' and mothers', P < 0.006, 95% CI (0.004-0.007). When considering DDH patients' and the control group's genotypes, the odds ratios of TT versus other combined (0.641 > 1) and CC versus other combined (0.474 < 1) revealed that the TT genotype has higher risk of developing DDH compared with the CC genotype. The 95 percent confidence interval of TT versus other combined and CC versus other combined is 0.932-2.891 and 0.208-1.078, respectively. For patients' and fathers' genotypes, the odds ratios of TT versus other combined (1.275 > 1) and CC versus other combined (0.815 < 1) indicate that the TT genotype has higher risk of exhibiting DDH compared to the CC genotype. For patients' and siblings' genotypes, the odds ratios of TT versus other combined (1.669) and CC versus other combined (1.048) specify that the TT genotype possesses higher risk of developing DDH compared with the CC genotype. Our study shows that there exists a relationship between GDF5 (SNP rs143383) and DDH in our population. Second, we found for the first time that the genotype TT and the T allele were overly expressed in the patients and the fathers. More studies on the confirmation of this genetic marker for DDH are called for.

The role of growth factor Sadat-Habdan mesenchymal stimulating peptide in healing of burn wounds.

BACKGROUND: Burns occur in everyday life and cause morbidity and mortality due to delayed healing. Many agents were tried to accelerate healing of burns. The aim of this study was to assess for the first time Sadat-Habdan mesenchymal stimulating peptide (SHMSP) known angiogenesis factor in healing of experimentally created burns in rats. METHODS: Forty male rats weighing (200-250 g) were randomly divided into 2 groups of 20 each. Under general anesthesia, reproducible, deep, partial-thickness, thermal burn injury was created by 1-cm aluminum template on the dorsal aspect of the body of each animal by heating the template at 80 °C for 10 seconds. Alternate rats were assigned to 1 of the 2 groups to minimize the difference of timing of the burn. Sadat-Habdan mesenchymal stimulating peptide 10 mg was applied on daily burn area, covered with a nonabsorbent dressing. All animals were kept in similar standard laboratory conditions. Its application continued 14 days as described by the inventors, and burned areas were photographed. On day 15, blood was collected from the animals for serum albumin levels, and the animals were killed, then the entire burn areas were excised for biopsy for general morphology and histopathology. RESULTS: There were no deaths among groups. The majority of the animals showed good to excellent healing compared with the control group. Clinical pictures revealed better healing in the SHMSP-treated group. Quantitative and qualitative analyses of images revealed significant contraction of burned areas. Image analysis showed that improved healing in the form of exaggerated fibroplasia in 19 of 20 in the study group and 11 of 20 in the control group. Regeneration of the panniculous muscle layer was observed in 19 of 20 of the study group and 5 of 20 of the control group. The mean vessel index in the study group was 53.18 ± 4.74 mm(2) and in the control group 23.7 ± 6.37 mm(2) (P < 0.001; confidence interval, 25.88-33.04), whereas the mean of vessel area density was 24.76 ± 7.35 versus 8.68 ± 4.04 mm(2) (P < 0.001; confidence interval, 12.28-19.88) in the control group. Histopathologic analysis by hematoxylin-eosin stain, CD31, and factor VIII stains showed significant angiogenesis in the quantity and quality of the new blood vessels in the study group compared with the control group. CONCLUSIONS: Sadat-Habdan mesenchymal stimulating peptide has potential of early healing of experimentally produced burns in rats. Healing was effective and better in the study group compared with the control group, in qualitative and quantitative measures.

An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population.

BACKGROUND AND OBJECTIVES: Osteoporosis is common in Saudi Arabia and the burden of management in an aging population will increase in coming decades. There is still no national policy nor consensus on screening for this silent disease. The objective of this analysis was to determine from the published data the prevalence of osteopenia and osteoporosis in Saudi Arabians, the prevalence of secondary osteoporosis, and the prevalence of osteoporosis-related fractures (ORF). We also sought to determine the best age to begin and best modality for screening. METHODS: Data Sources were MEDLINE (1966 to May 2011), EMBASE (1991 to May 2011), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (1952 to May 2011), and the Science Citation Index (1966 to May 2011), published data from the Saudi Medical Journal (1985-2011) and Annals of Saudi Medicine (1985-2011). We selected English-language articles with at least 100 Saudi individuals. Two authors independently reviewed articles and abstracted data. RESULTS: The authors identified 36 potentially relevant articles, of which 24 met the inclusion criteria. Of 5160 healthy women 50 to 79 years of age (mean, SD: 56.8 [2.7]), 36.6% (6.6%) were osteopenic and 34.0% (8.5%) were osteoporotic. In three studies on males (n=822), the prevalence of osteopenia was 46.3% and osteoporosis 30.7%. Males had a significantly higher frequency of osteopenia in comparison to females (P= < .001 95% CI < -0.0333), The mean age of the patients with secondary osteoporosis was 37.4 (13.5, 18-57) years, with the osteoporosis in 46.4% and osteopenia in 34.1%. In 5 studies of ORF, the incidence of vertebral fractures was between 20%-24%. CONCLUSION: The currently available literature on Saudi Arabian population suggests that the ideal age for screening for low bone mass among the Saudi population should be earlier (55 years) than the >=65 years in Western countries. Both quatitative ultrasound and dual-energy x-ray absorptiometry could be used for screening. The relatively small number of studies on Saudi Arabians and the different machines used for diagnosis limited the authors ability make conclusions with surety.

Efficacy of EZStep in the management of plantar fasciitis: a prospective, randomized study.

Plantar fasciitis is one of the most common causes of heel pain. Despite extensive efforts foot surgeons continue to debate the best modality of treatment. Analgesics, shoe inserts, stretching exercises, steroid injection, night splints, and extracorporeal shock wave therapy have proved effective in one group but fail in others. This study evaluated the efficacy of EZStep, a new foot brace for the management of plantar fasciitis. A total of 198 patients were randomized in 2 groups; group 1 (study group) received nonsteroidal anti-inflammatory drugs (NSAIDs; 4-6 weeks) and EZStep whereas group 2 (control group) received either NSAID and physiotherapy alone (2A) or NSAID, physiotherapy, and local steroid injection (2B). None of the patients received over-the-counter insoles or strapping of plantar arch to avoid any bias in randomization. Evaluations included measurement of weight and height, visual analog scale (VAS) for pain, and Short-Form McGill Pain Questionnaire (SFMPQ). After 8 weeks, patients were reevaluated, and assessment for the VAS and SFMPQ with treatment outcome was performed. Patients with VAS scores ≤3 were considered as excellent, ≥4 as good, and ≥7 as poor. The posttreatment evaluation showed that VAS scores were in the range from 2.97 ± 1.06 to 7.64 ± 2.9 (2A), P = .001, 95% confidence interval (CI) <-4.104; for 2B P = .001, CI <-2.44, and SFMPQ was 21.7 ± 4.5 and 69.2 ± 5.8 (group 2A; P = .001, 95% CI <-46.44). Compared with group 2B the SFMPQ was 66.5 ± 4.3 (P = .001, 95% CI <-30.720). In group 1 as per VAS, 86 (73.5%) were evaluated as excellent, 15 (12.8%) as good, and 16 (13.6%) as poor. Our study shows that the regular use of EZStep with short course of NSAIDs (4-6 weeks) was effective in ameliorating symptoms in more than 85% of patients suffering from plantar fasciitis.

Bone mass measurement using quantitative ultrasound in healthy Saudi women. A cross-sectional screening.

OBJECTIVE: To study the prevalence of osteopenia and osteoporosis in healthy Saudi women, a community-based screening was carried out. METHODS: Three thousand and two hundred sixty-nine women in the young women in peak bone mass (PBM) age group and 3131 in the postmenopausal age (PMA) group were screened using Achilles Insight (GE, USA). Subjects included in the study were healthy and residents of eastern province. The screening was conducted between January 2006 and December 2007. The study took place in King Fahd University Hospital, Al-Khobar, Kingdom of Saudi Arabia. RESULTS: In the PBM age group, 2090 (63.9%) were normal, 791 (24.2%) were osteopenic and 388 (11.9%) were osteoporotic. Osteopenia was more common in single urban women compared to those who were married and living in rural areas (p<0.01 and p<0.001). Women with college education had significantly normal bone mass than women with less than high school education (p<0.01). In the PMA, 948 (30.3%) were osteopenic and 720 (23%) were osteoporotic. Osteopenic was more common in women in urban areas as compared to industrial and the rural areas (p<0.01). Those women whose education was less than primary had significantly more osteoporosis when compared to women with college education (p<0.001). CONCLUSION: In the PBM, 11.9% were osteoporotic and in PMA group 23% were osteoporotic. Factors that influenced the risk for osteopenia and osteoporosis included level of education, number of children, and place of living.

Are orthopedic surgeons prone to burnout?

OBJECTIVE: Burnout syndrome (BOS) is a state of physical, and emotional or mental exhaustion, depersonalization, and low personal accomplishment. Health care givers are most prone to suffer from BOS. There are no studies to date on BOS among trained orthopedic, and trauma surgeons. The objective of this study, was to assess the prevalence of BOS among the orthopedic surgeons in the Eastern province of Saudi Arabia. METHODS: This study was conducted among the orthopedic surgeons of the Eastern province of Saudi Arabia between September 2003 and October 2004. One hundred and two questionnaires of the Maslach Burnout Inventory (MBI) were sent to the qualified orthopedic surgeons with a self-addressed stamped envelope, from the Department of Orthopedic Surgery, King Fahd Hospital of the University, Al-Khobar. Three factors of MBI, which were assessed, were emotional exhaustion, depersonalization, and personal accomplishment. The data were entered in the database, and analyzed using Statistical Package for Social Science. RESULTS: Sixty-nine (67.6%) of the orthopedic surgeons completed the questionnaire. The average age was 45.72 +/- 6.82 (33-57) years. Thirty-five (50.7%) were found to be in a state of emotional exhaustion, 59.4% depersonalized, and 17% had low state of personal accomplishment. Doctors working in the government hospitals fared better than those in the private sector. CONCLUSION: Burnout syndrome is common among orthopedic surgeons working in the Eastern province Saudi Arabia. It is emphasized that awareness of the problem should be highlighted; programs need to be put in place to reduce the prevalence of burnout syndrome.

Bone mineral density among postmenopausal Saudi women.

OBJECTIVE: Osteoporosis is reported to be common among postmenopausal Saudi women. The reported incidence varies between 50-60%. Different machines were used to reach these conclusions. At present it is believed that dual energy x-ray absorptiometry (DEXA) is the most accurate method to diagnose osteoporosis. This study was conducted to measure bone mineral density (BMD) measurement of lumbar spine and the upper femur of Saudi postmenopausal women attending orthopedic clinic with unrelated complaints. METHODS: This study comprises of 256 patients attending orthopedic clinics at the King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia between January 2002 and June 2003. The data gathered was age, duration of menopause, height and weight for body mass index (BMI) calculation. Women with secondary osteoporosis were excluded from the study. Patients' orthopedic complaints were also recorded in the database. Bone mineral density measurements were carried out using Hologic total body DEXA machine. The data were analyzed using SPSS package. RESULTS: The data of 256 patients was available for analysis. The average age of patients screened was 57.62 years (49-76) SD +/- 6.71. The BMI was 21.3-42.9 Kg/m2 (SD +/- 5.34). The BMD of the lumbar spine was 0.785 gm/cm2 (0.527-1.023) SD +/-0.142 and that of the hip region was 0.764 gm/cm2 (0. 500-1.069) SD +/- 0.149. As per the WHO classification 59 women (23%) were classified as normal with T score of -0.82, 78 (30.5%) as osteopenic with T score -2.5 and 119 (46.7%) as osteoporosis with T score -3.58. When the BMD of the hip was analyzed 62 (24.2%) were normal T score -1.0, 81 (31.6%) as osteopenic, T score -2.5 and 113 (44.1%) as osteoporotic, with a T score of -3.1. On the basis of analysis of the lumbar spine 190 (74.2%) had increased risk of fracture as compared to the analysis of hip 59% were at increased risk of fracture. CONCLUSION: Our results indicate that postmenopausal Saudi women suffer from osteoporosis and osteopenia higher than those from other parts of the country. Necessary steps are needed so as to avoid osteoporosis and its complications which could end up in epidemic proportions.