Osteoporosis: Is the prevalence increasing in Saudi Arabia.

Background and Objective: The objective of this analysis is to report from a teaching hospital in eastern Saudi Arabia hospital based prevalence of osteopenia and osteoporosis. Methods: This is a retrospective study of all patients who underwent dual-energy X-ray absorptiometry (DXA) scan between January 1, and December 31, 2018, at King Fahd Hospital of the University at Alkhobar, Saudi Arabia. Demographic data of patients, which included age, sex, diabetes mellitus status based on fasting blood sugar, hemoglobin A1C, Vitamin D level, parathormone level, and T score of the neck of femur and lumbar spine was extracted from the Quadrumed patient care system. The data was entered into database and analyzed. Results: Three hundred and one patients had a DXA scan for the year 2018, a jump of 27.2% of requests to diagnose osteoporosis. There were 55 (18.27%) were male and rest females (246). The average age for males was 65.2 ± 10.5 and females 62.9 ± 9.4 years. Using T score of the lumbar spine, 63.6% were osteoporotic in males and 52.8% in females. Conclusions: The hospital-based study shows that the prevalence of osteoporosis has significantly increased in men to 63.6%, while in postmenopausal women to 58.4%, this is high compared to the earlier reports.

Résumé Contexte et objectif: L'objectif de cette analyse est de faire rapport d'un hôpital d'enseignement dans l'hôpital de l'Arabie Saoudite est basé Prévalence de l'ostéopénie et de l'ostéoporose. Méthodes: Il s'agit d'une étude rétrospective de tous les patients atteints de rayons X à double énergie Absorptiométrie (DXA) Numérisation entre le 1er janvier et le 31 décembre 2018, à l'hôpital roi Fahd de l'Université d'Alkhobar, en Arabie saoudite. Données démographiques des patients, qui comprenaient l'âge, le sexe, le diabète suit des Mellitus basé sur la glycémie à jeun, l'hémoglobine A1C, la vitamine D Le niveau de niveau, de la parathormone et du score T du col du fémur et de la colonne lombaire a été extrait du système de soins quadrumé des patients. le Les données ont été entrées dans la base de données et analysées. Résultats: Trois cent et un patients avaient une analyse DXA pour l'année 2018, un saut de 27,2% des demandes de diagnostiquer l'ostéoporose. Il y avait 55 (18,27%) étaient des femmes et des femmes de repos (246). L'âge moyen des hommes était de 65,2 ± 10,5 et les femelles 62,9 ± 9,4 ans. En utilisant la score T de la colonne lombaire, 63,6% étaient ostéoporotes chez les hommes et 52,8% chez les femmes. Conclusions: le L'étude à l'hôpital montre que la prévalence de l'ostéoporose a considérablement augmenté chez les hommes à 63,6%, tandis que dans les femmes ménopausées À 58,4%, cela est élevé par rapport aux rapports précédents. Mots-clés: ostéopénie, ostéoporose, prévalence, Arabie Saoudite, Vitamine D.

Efficacy of autologous bone marrow derived Mesenchymal stem cells (MSCs), osteoblasts and osteoblasts derived exosome in the reversal of ovariectomy (OVX) induced osteoporosis in rabbit model.

Background: A recent study showed that OVX-induced osteoporosis was reversed after injection of osteoblasts cultured from the bone marrow in rats. The present study evaluated the effect of injecting MSCs, osteoblasts, and exosomes isolated from osteoblasts for the treatment of osteoporosis in the rabbit model. Methods: Osteoporosis was created in 40 rabbits by performing ovareictomy at 6 months of age, and 1 mg/kg body weight of methyl prednisolone sodium succinate was injected daily for 8 weeks. Animals were fed twice daily and were given water ad libitum. MSCs and osteoblasts were grown from the bone marrow as per the methodology described earlier. From osteoblasts, exosomes were extracted. After the 15th day, MSCs (Group 2), osteoblasts (Group 3), and exosomes (Group 4) were injected into 5 animals each, and 0.5 ml of normal saline were injected into the control group (Group 1). After 12 weeks (11 months of age), all the animals were euthanized. The whole femur and the lumbar vertebrae 3-5 were dissected out and were subjected to radiological assessment using high-resolution peripheral quantitative computerized tomography (HRpQCT). All parameters of the bone volume, trabecular number, thickness, and spacing were assessed using SPSS (Statistical Package for the Social Sciences), version 21.0, Chicago, Illinois. A p value of <0.05 was considered Statistically significant with a confidence interval (CI) of 95%. Results: Structural indices of the osteoblasts-injected animals were significantly better than the control group for the distal femur. The most significant improvement was seen in the osteoblasts, MSCs, and exosomes group in that order. The p value of all parameters was <0.0001 in the osteoblasts group, whereas the total and bone volume had a lower p value in the MSCs group. In the osteoblasts group, the positive changes were similar in the distal femur and lumbar vertebrae, but with MSCs and exosomes, the changes were more pronounced in the vertebral spine than the distal femur. Conclusions: This study shows that autologous bone marrow-derived osteoblasts have the robust influence of reversing OVX-induced osteoporosis in rabbits.

Time out: should vitamin D dosing be based on patient's body mass index (BMI): a prospective controlled study.

The recommended daily dose of vitamin D is 2000 IU was found to be insufficient in many patients. The objective of the present study is to find whether the daily dose of vitamin D should be based on BMI. Two hundred and thirty patients with an established vitamin D deficiency (serum level of 25 Hydroxy vitamin D3 (25OHD3) of ≤20 ng/ml) and patients with BMI ≥30 kg/m2 were included in the study. Demographic data, comorbidities and BMI were recorded. Pre-treatment and post-treatment serum 25OHD3, calcium, phosphorus and parathyroid hormone (PTH) were tested at 0-, 3- and 6-month periods. Patients were treated with a standard dose of 50 000 IU of vitamin D weekly and 600/1200 mg of calcium a day. Once their level of 25OHD3 reached ≥30 ng/ml, patients were randomised into two groups. Group A received a standard recommended maintenance dose of 2000 IU daily and Group B patients received 125 IU/kg/m2 of vitamin D3. The data were entered in the database and analysed. The mean age of Group A was 50⋅74 ± 7⋅64 years compared to 52⋅32 ± 7⋅21 years in Group B. In both groups, pre-treatment vitamin D level was ≤15 ng/ml and increased to 34⋅6 ± 2⋅6 and 33⋅7 ± 2⋅4 ng/ml at the end of 3 months treatment with a dose 50 000 IU of vitamin D3 and calcium 600/1200 mg once a day for group A and group B, respectively. At 6 months, patients in Group A 25OHD3 level was 22⋅8 ± 3⋅80 and in Group B was 34⋅0 ± 1⋅85 ng/ml (P < 0⋅001). This preliminary study suggests that obese patients need higher dosage of vitamin D than the recommended dose. It is prudent that the dosage should be based on the BMI to maintain normal levels for a healthy musculoskeletal system.

Spinal cord injury regeneration using autologous bone marrow-derived neurocytes and rat embryonic stem cells: A comparative study in rats.

BACKGROUND: Spinal cord injury (SCI) is an important cause of traumatic paralysis and is mainly due to motor vehicle accidents. However, there is no definite treatment for spinal cord damage. AIM: To assess the outcome of rat embryonic stem cells (rESC) and autologous bone marrow-derived neurocytes (ABMDN) treatment in iatrogenic SCI created in rats, and to compare the efficacy of the two different cell types. METHODS: The study comprised 45 male Wistar rats weighing between 250 and 300 g, which were divided into three groups, the control, rESC and ABMDN groups. The anesthetized animals underwent exposure of the thoracic 8th to lumbar 1st vertebrae. A T10-thoracic 12th vertebrae laminectomy was performed to expose the spinal cord. A drop-weight injury using a 10 g weight from a height of 25 cm onto the exposed spinal cord was conducted. The wound was closed in layers. The urinary bladder was manually evacuated twice daily and after each evacuation Ringer lactate 5 mL/100 g was administered, twice daily after each bladder evacuation for the first 7 postoperative days. On the 10th day, the rats underwent nerve conduction studies and behavioral assessment [Basso, Beattie, Brenham (BBB)] to confirm paraplegia. Rat embryonic stem cells, ABMDN and saline were injected on the 10th day. The animals were euthanized after 8 wk and the spinal cord was isolated, removed and placed in 2% formalin for histopathological analysis to assess the healing of neural tissues at the axonal level. RESULTS: All the animals tolerated the procedure well. The BBB scale scoring showed that at the end of the first week no recovery was observed in the groups. Post-injection, there was a strong and significant improvement in rats receiving rESC and ABMDN as compared to the control group based on the BBB scale, and the Train-of-four-Watch SX acceleromyography device exhibited statistically significant (P < 0.0001) regeneration of neural tissue after SCI. Histological evaluation of the spinal cord showed maximum vacuolization and least gliosis in the control group compared to the rESC and ABMDN treated animals. In the ABMDN group, limited vacuolization and more prominent gliosis were observed in all specimens as compared to the control and rESC groups. CONCLUSION: This study provided strong evidence to support that transplantation of rESC and ABMDN can improve functional recovery after iatrogenic SCI. The transplanted cells showed a beneficial therapeutic effect when compared to the control group.

Maintenance Dose of Vitamin D: How Much Is Enough?

BACKGROUND: It is still unclear the ideal vitamin D dosage once the deficiency and insufficiency is treated. Once deficiency was corrected we prospectively treated patients with 2,000 IU of vitamin D3 to check whether this dosage is enough to keep them above the 30 ng/mL of 25-hydroxy-vitamin D (25[OH]D). METHODS: One hundred and thirty-five Saudi Arabian men and women treatment naïve for the vitamin D deficiency and insufficiency were part of this study. History and clinical examination were done to rule out any metabolic bone disease. Weight and height was taken to calculate the body mass index (BMI). Patients who were vitamin D deficient (≥30 ng/mL), a standard treatment of 50,000 IU of vitamin D3 weekly for 3 months, a blood test for the vitamin D levels at the end of 3 months, maintenance dose of 2,000 IU of vitamin D3 for 3 months and a third blood sample after 3 months. RESULTS: The data for 128 patients was available for analysis. The average age was 44.95±12.97 years with the mean BMI of 29.60±2.59 kg/m2. The baseline 25(OH)D level was 13.16±3.30 ng/mL. The increase in the level of 25(OH)D on 50,000 IU weekly was significant from 13.16±3.3 ng/mL to 36.97±4.67 ng/mL (P<0.001) and then 2,000 IU daily for next 3 months, the level of 25(OH)D dropped top 20.38±5.42 ng/mL (P<0.001). CONCLUSIONS: Our study indicates that the maintenance dose of 2,000 IU of vitamin D is not enough for patients to keep the 25(OH)D levels above 30 ng/mL.

Hysteroscopy as an investigation tool in recurrent implantation failure in vitro fertilization.

OBJECTIVES: To evaluate the use of hysteroscopy in the assessment of uterine pathologies in infertile women with repeated implantation failure (RIF) after in vitro fertilization (IVF) and determine whether removal of such pathologies increased pregnancy rates in women with RIF. METHODS: This prospective study was conducted at King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia, between January 2010 and December 2015. The inclusion criteria were women who underwent IVF treatment cycles and ended in more than 2 RIF, and women who underwent hysterosalpingography (HSG). Hysteroscopies were performed, findings were recorded, and the clinical pregnancy rates were compared and assessed in patients with and without uterine cavity abnormality. All hysteroscopic procedures were performed by a single consultant. RESULTS: Hysteroscopies were performed on 266 women who  had at least 2 RIF. The average duration of infertility was 7.2±3.1 years. In 162 patients (60.9%), a hysteroscopy did not find any abnormality of the uterine cavity. In 104 patients (39.1%) there were one or more abnormal hysteroscopic findings. Hysterosalpingography was able to detect only 54 abnormalities (51.9%). The pregnancy rate was significantly higher in patients who were treated by a hysteroscopy for a detected uterine abnormality (39.4%). CONCLUSION: A hysteroscopy was able to detect intrauterine pathologies which were missed by other investigative modalities. We believe patients with a history of RIF should undergo hysteroscopic examination before any further cycles are considered.

Anxiety and depression during pregnancy in women attending clinics in a University Hospital in Eastern province of Saudi Arabia: prevalence and associated factors.

BACKGROUND: Anxiety and depression during the antenatal period is a growing problem with major effects on the mother, the developing fetus, and the neonate. OBJECTIVES: To assess the prevalence of anxiety and depression during pregnancy in women attending the hospital for antenatal care and assess the associated factors. METHODS: This is a prospective cohort study conducted in the University Hospital of Imam Abdulrahman Bin Faisal University. Anxiety was evaluated using State Trait Anxiety Inventory. Depression was assessed using Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Complete data were available for 575 women. The mean EPDS score was 10.5 (SD 5.5). The prevalence of depression was 26.8%. The mean state-anxiety score was 38.4 (SD 11.4) and mean trait-anxiety score was 38.2 (SD 9.5). The prevalence of anxiety using state-anxiety scale was 23.6%, while using the trait scale it was 23.9%. The risk is higher among unemployed women with history of miscarriage and unplanned pregnancy. CONCLUSION: Anxiety and depression are common during pregnancy.

Vitamin D deficiency in Saudi Arabians: A reality or simply hype: A meta-analysis (2008-2015).

BACKGROUND AND OBJECTIVE: The objective of this systematic review was to determine from published data the prevalence of Vitamin D deficiency in the Saudi population. METHODS: An extensive and meticulous search was conducted for studies published in MEDLINE, EMBASE the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (2008-2015), and the Science Citation Index published data from the Annals of Saudi Medicine and Saudi Medical Journal with the key words: Vitamin D deficiency, insufficiency, and Saudi Arabians. The inclusion criterion was studies published during 2008 to 2015, and studies involving healthy individuals between the age of 18 and 80 years. Binary random- effect model was used to estimate pooled Vitamin D deficiency. Prevalence rates along with overall estimate were presented by forest plot. Heterogeneity test was used to assess the significance of heterogeneity among studies. RESULTS: The authors identified 26 potentially relevant articles, 16 of which met the inclusion criteria. A total of 20,787 patients were analyzed. Sixty-two percent (12,959) were females, and the rest were males. The overall Vitamin D deficiency was 63.5% (95% CI: 53.3, 73.7). CONCLUSIONS: The currently available literature on the Saudi Arabian population suggests that the Vitamin D deficiency is around 60% and not 100% as indicated in some studies. The relatively small number of studies on the population and the different modes of diagnostic methodology used make the issue of correct figures of Vitamin D deficiency contentious.

Dehydroepiandrosterone supplementation in women undergoing assisted reproductive technology with poor ovarian response. A prospective case-control study.

Objective The effects of dehydroepiandrosterone (DHEA) supplementation in Saudi Arabian women with poor ovarian response (POR) is presently unknown. The present study aimed to assess the benefits of DHEA supplementation in women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Methods This was a prospective case-control study involving 62 women who were diagnosed with POR and underwent IVF/ICSI between January 2012 and June 2016. The positive influence of DHEA in 34 women, compared with 28 women without supplementation, was defined as improvements in the number of oocytes retrieved, the fertilization rate, the number of grade I embryos generated and the pregnancy rate. Results Both groups were evenly matched for age, body mass index and laboratory test parameters. There were statistically significant differences between the groups with and without DHEA supplementation for oocyte yield (6.35 ± 2.41 versus 3.98 ± 3.2), Grade I embryos generated (55% versus 30%), positive pregnancy rate (21/34 versus 10/28), and live birth rate (18/34 versus 4/28). Conclusion DHEA supplementation in women with POR had a positive effect on hormonal profiles, the quality of the endometrium, the number of oocytes retrieved, the quality of embryos, and the pregnancy and live birth rates.

Bone Marrow-derived Osteoblasts in the Management of Ovariectomy induced Osteoporosis in Rats.

Background: The objective of this study is to assess if infusion of osteoblasts can temporarily reverse osteoporosis in rats. Methods: Osteoporosis was induced in 20 female Sprague-Dawley rats by performing ovariectomy (OVX) that was carried out at 4 weeks of age. At 3 months a biopsy of the iliac crest was made to assess the bone quality and the same site bone marrow was harvested. From the bone marrow aspirate, MSCs were separated. Osteoblasts were then generated and were characterized using Alizarin red staining. Osteoblasts were injected in the tail vein of 10 rats. Two weeks after the injection of osteoblasts, a second biopsy was done. Animals were euthanized after 8 weeks of osteoblasts infusion by overdose of ketamine mixed with xylazine. The whole femurs and lumbar spine were dissected and the specimens were stored in 2% formalin. The specimens were analyzed using HRpQCT (High-resolution peripheral quantitative computerized tomography (µCT 100, SCANCO Medical AG, Brüttisellen, Switzerland). Results: In all the 10 animals from which bone aspiration was performed, osteoblasts were cultured and transplanted. Analysis showed that there was significant bone formation at bone sites of distal femur and lumbar spine (<0.001), with increased number of trabeculae and thickness (P<0.001). Further analysis revealed that there was robust bone formation in the animals that had osteoblasts injection. Conclusions: This preliminary study indicates that osteoblasts infusion can lead to new bone formation in osteoporosis induced by ovariectomy in rats.

Genetic influence on circulating vitamin D among Saudi Arabians.

OBJECTIVES:  To examine the effect of most common studied single nucleotide polymorphisms (SNP) on serum 25-hydroxyvitamin D (25OHD) levels in Saudi Arabian population.  METHOD: A cross-sectional observational study was carried out between July 2014 and October 2015, at King Fahd Hospital of the University (KFHU), Al-Khobar, Kingdom of Saudi Arabia. After informed consent, blood samples from 283 subjects living in the Eastern province were collected for 25-OHD measurement and genetic analysis of SNPs in vitamin D receptor (VDR) [rs2228570 and rs1544410], Cytochrome, P450 family 2 (CYP2R1) [rs10741657 and rs1993116], and Group-specific components (GC) [rs2282679 and rs4588].  RESULTS: Vitamin D deficiency was found in 87.6% and insufficiency in 7.7%. The percentages of the different alleles of the 6 SNPs tested ranged between 0-62.5%. There was significant difference between the AA, AG, and GG alleles of VDR rs2228570. The carries of GG allele was associated with increased risks of vitamin D insufficiency (p less than 0.002) and deficiency (p less than or equal to 0.005). The CYP2R1 rs10741657 gene showed that AG and GG allele carriers had significant risk of vitamin D deficiency. AG allele (normal versus Insufficiency p less than 0.02 and normal versus deficiency p less than 0.08) and GG allele normal versus deficiency (p less than 0.002) and insufficiency versus deficiency (p less than 0.001). For group-specific components (GC rs4588), there was only significant difference between the normal and deficiency for the AC allele (p less than 0.0001). CONCLUSION: The presence of GG allele of the SNP rs2228570 of VDR gene, SNPs rs4588 of GC gene and CYP2R1 rs10741657 gene was associated with vitamin D deficiency.

A 5-year analysis of semen parameters in Saudi Arabian men attending infertility clinics.

OBJECTIVE: To evaluate semen parameters in infertile Saudi Arabian men. METHODS: In this retrospective study, semen analysis and other clinical data were extracted from medical records of men attending an infertility clinic. Patients were stratified according to smoking status and presence or absence of varicocele. RESULTS: The study included 425 patients. Nonsmokers (n = 322) had significantly higher serum testosterone and sperm motility than smokers (n = 194). Serum testosterone, semen volume, motility, morphology, sperm/ejaculation and sperm count were significantly higher in patients without varicocele (n = 328) than in those with varicocele (n = 188). CONCLUSIONS: In this study, smoking and the presence of varicocele had negative effects on semen parameters in infertile men.

Uterine and Tubal Abnormalities in Infertile Saudi Arabian Women: A Teaching Hospital Experience.

BACKGROUND AND OBJECTIVE: Hysterosalpingography (HSG) is commonly used in the evaluation of the subfertile and infertile women. This study was undertaken to assimilate the findings observed during HSG in Saudi Arabian infertile patients and to find the most common pathology identified by the HSG. PATIENTS AND METHODS: A retrospective analysis was conducted of subfertile and infertile patients who had undergone HSG between June 2007 and May 2012. Patients' demographic data were collected from the medical records of the King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The data included age, years of marriage, menstrual history either regular or irregular, primary/secondary infertility, hormonal profile, previous infection or pelvic surgery, and diagnostic laparoscopy. Radiographic reports of HSG were collected from the IPAC system and analyzed for fimbrial findings, tubal patency, and cervical and uterine cavitary pathology. The data were entered in the database and analyzed using a t-test to compare means between the age, type of infertility, different pathologies and for all the parameters assessed. All tests were performed using Statistical Package for the Social Sciences, version 14.0, Chicago, Illinois, USA. A P < 0.05 was considered statistically significant with a confidence interval of 95%. RESULTS: Data from the medical records of 117 patients with an average age of 32.59 ± 5.48 years were analyzed. Of this total, 48 (41%) had been diagnosed as having primary infertility. In 95 (81.2%) patients, there was an abnormality in the fallopian tubes and in 27 (23%) patients, there was an abnormality in the uterus. Patients with primary infertility were significantly younger (29.7 ± 5.6 vs. 34.58 ± 4.75; P < 0.001), and tubal and uterine pathology was more common (P < 0.08 and 0.01). CONCLUSIONS: Our review indicates that the most common pathology found through HSG in women presenting with infertility is tubal blockage.

Parathyroid Glands response to Low Vitamin D levels in Healthy Adults: A Cross-Sectional Study.

OBJECTIVE: To assess the correlation of serum parathyroid hormone (PTH) and vitamin D (25-OHD) levels based on different assays for measuring 25-OHD in healthy Saudi Arabians living along the east coast. PATIENTS AND METHODS: A cross-sectional study was conducted in 200 patients (150 women and 50 men aged between 18-69 years) between January 2011 and December 2012, attending outpatient clinic at King Fahd Hospital of the University, Al Khobar. The first 200 patients seen without vitamin D supplementation at clinic were enrolled in the study. Serum calcium, phosphorous, alkaline phosphatase, parathormone, and 25-OHD tests were performed. 25-OHD was assessed using:chemiluminescence immunoassay (CLIA)radioimmunoassay (RIA) using Wallac 1470 Gamma CounterHPLC -LC.MS (high performance liquid chromatography-liquid chromatography with mass spectrometry. The data was collected, entered into a database and analysed using SPSS, Inc., version 14. RESULTS: The mean age was 45.8±15.8 (18-74) years, and calcium level was 2.27±0.15 mmol/l. (range 2.125 to 2.62 mmol/l). Alkaline phosphatase was 88.91±35.94 (34-302) IU, parathormone 6.7±3.06 (1.35-21.2) (1.3-6.8 pmol/l). Of the participants, 188 were either vitamin D insufficient or deficient as measured by CLIA 11.85±6.14 (2-29.6), and 91 (48.4%) of them had secondary hyperparathyroidism 9.48±4.55 pc/l. Those with normal CLIA-measured 25-OHD levels had normal PTH levels. Of those with insufficiency, 4/21 (19%) had raised PTH levels; and of those with deficiency, 81/166 (48.79%) had raised levels, whereas with HPLC-LC.MS, 156 were shown to be insufficient and 97 deficient (with PTH level of 7.41±4.2). Thirteen of 41 patients (31.7%) with insufficiency were shown, by HPLC-LC.MS, to have raised PTH. All patients with vitamin D deficiency as diagnosed by HPLC-LC.MS had secondary hyperparathyroidism. CONCLUSIONS: The above results suggest that the method of measurement strongly influences vitamin D levels and that previous reports suggesting no association between vitamin D deficiency and secondary hyperparathyroidism should be viewed with caution.

Fertility after oophorectomy due to torsion.

OBJECTIVES: To investigate the prevalence of infertility in patients who underwent salpingo-oophorectomy due to adnexal torsion (AT). METHODS: All adult women admitted to the Teaching Institution of the University of Dammam, Dammam, Saudi Arabia who underwent surgery due to AT between January 2001 and 2010 were included. Complete data was collected from the time of admission to the follow up. The data was entered into the database and analyzed. RESULTS: The data of 26 patients was available for analysis. The mean age (±standard deviation) at presentation was 22.19±4.4 years, and average age at follow up was 34.81±5.75 years. The average delay in presentation was 37.76±47 hours, and the surgery was performed at 45.07±48.57 hours. The right side was involved in 13 (53.8%) of the cases. Fourteen (53.9%) women presented with infertility. Eleven (78.57%) were treated for infertility, and 5 (45.5%) conceived. Patients who were younger at the time of torsion fared better with regard to pregnancy (p<0.03, 95% confidence interval:-6.85; <0.58). CONCLUSION: Patients who undergo salpingo-oophorectomy for AT have an increased risk of infertility and should be warned of this impending complication.

Effect of smoking on reproductive hormones and semen parameters of infertile Saudi Arabians.

OBJECTIVE: The purpose of this retrospective study is to look into the effect of smoking on semen and hormonal profile of Saudi Arabians attending infertility clinics. MATERIALS AND METHODS: Medical record numbers of patients who attended infertility clinics and who underwent full assessment were identified rom Quadramed system and out-patient log books between January 2010 and December 2012. The standard protocol of the patients include full history, age, number of years of marriage personal habits of smoking, alcohol consumption, primary or secondary infertility. Standard laboratory tests which were performed, included, complete blood picture, random blood sugar, testosterone, follicle stimulation hormone, luteinizing hormone, prolactin level and semen analysis; volume, count, progressive motility and morphology. The data was entered in the database and analyzed. RESULTS: During the study period, 279 patients attended and infertility clinic and only 258 gave the sample for analysis. The average age of patients in the smoking group was 34.23 ± 7.66 and in the nonsmokers 34.07 ± 7.92 years. Primary infertility was more common in smokers versus nonsmokers P < 0.001 confidence interval (CI)< -44.0705, total serum testosterone level was lower 383.8 ± 239.5 versus 422.5 ± 139.2 ng/dL (0.009 CI< -9.9415), serum prolactin level was higher 18.68 ± 13.28 versus 12.85 ± 12.34 ng/mL (0.001 CI < 8.3794). The average volume of the semen among the smokers was 2.8 ± 1.35 mL and in nonsmokers it was 3.08 ± 0.76 mL (P < 0.008 CI< -0.123). The mean progressive motility in smokers was 31.5 ± 23.1 compared to nonsmokers 40.05 ± 25.43% (0.002 CI< -3.2962) and total sperm count was 119.52 ± 114.12 and 139.71 ± 104.82 million/mL (0.07 CI < 1.4657). CONCLUSIONS: This study shows that the effect of smoking is dramatic reduction in the hormonal levels and semen parameters. It is recommended that smoking men undergoing fertility treatment should stop smoking to increase their chances of having offspring.

A review of 33 years (1980-2013) of data indicating a rise in ectopic pregnancy in Saudi Arabia.

OBJECTIVE: To assess the trend in ectopic pregnancy (EP) at a single center in Saudi Arabia and to compare the data with those from the rest of Saudi Arabia. METHODS: In a retrospective study, data were analyzed from patients admitted to King Fahd Hospital of the University, Al Khobar, Saudi Arabia, with a diagnosis of EP between January 2011 and December 2013. The prevalence of EP was calculated as a percentage of the number of live births during the study period. A 30-year review of publications on EP in Saudi Arabia was done via search engines. RESULTS: During the study period, there were 58 EPs among 3818 deliveries, giving an overall incidence of 1.5% at the study center; the incidence of EP in the rest of the country during this period was 0.5%. Between 2002 and 2004, the country's incidence was 0.6% as compared with 1% at the study center. CONCLUSION: The incidence of EP in Saudi Arabia has increased in the past few decades.

Assessment of low vitamin D among Saudi Arabians. Did we overshoot the runway?

OBJECTIVES: To compare the performance of 3 commonly used 25-hydroxyvitamin D (25-OHD) assays among a sample of the Saudi population. METHODS: This cross-sectional study was carried out between January 2011 and December 2012 at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. After informed consent, blood samples for measurement of 25-OHD level was extracted from 200 adults. The vitamin D levels of each individual were determined using chemiluminescence immunoassay (CLIA), radio-immuno assay (RIA), and liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. Assays were also compared through commonly used cut-points for classification of vitamin D deficiency. Bias between assays was evaluated using Bland-Altman plots. RESULTS: The average age of patients was 45.7+/-16.1 years. A significant difference between the assays was found. The mean 25-OHD levels were highest for the LC-MS/MS (21.65 ng/mL, 95% CI 19.74-23.56), intermediate for RIA (16.607 ng/mL, 95% CI 14.87-18.32), and lowest for CLIA method (13.864 ng/mL, 95% CI 12.109-15.618). Using 30 ng/mL as a cutoff value, only 6% was found to have normal levels of 25-OHD using CLIA, 9% using RIA, and 22% using LC-MS/MS. CONCLUSION: Levels of 25-OHD and the prevalence of vitamin D deficiency are dependent on the assay used. The reported high prevalence of hypovitaminosis D among the Saudi population can be partially explained by the use of assays that underestimate vitamin D levels.

Reproductive and gynaecological issues in Saudi women with end stage renal disease.

Women with End Stage Renal Disease (ESRD) have hormonal imbalance leading to gynaecological and reproductive disturbances. The objective of this study was to see the reproductive and gynaecological problems associated with ESRD. Forty Saudi Arabian women with a diagnosis of ESRD for a period of 60 months were interviewed at the dialysis unit of King Fahd University Hospital, Al Khobar.The average age was 51.5 +/- 17.1 years with a range of 19-90 years. Eighteen (45%) were premenopausal with a mean age of 36.5 +/- 11.1 years. Diabetes mellitus and Hypertension was the cause of ESRD in 29 (72.5%). Out of 18 menstruating women 11(61.1%) had irregular periods. Only 2 had children after ESRD was diagnosed. Thirty-three (82.5%) women did not have their regular mammograms and 25 (73.5%) had no pap smears. Our study shows that majority of women with ESRD have gynaecological and reproductive issues which are being neglected.

Topical delivery of vitamin d3: a randomized controlled pilot study.

BACKGROUND AND OBJECTIVE: The purpose of the present study is to explore the assessment if the transdermal delivery of vitamin D is feasible. METHODS: In 50 female Medical students, this study was conducted. Age, weight and height was taken, a detailed history and clinical examination was performed. Blood was drawn for 25 Hydroxy Vitamin D3 (25OHD) level. Two women had >30 ng/mL of 25OHD and was excluded from the study. The participants were divided into two groups of 24 in each arm. All participants equivocally agreed not to change their dietary habits and life style till the study was over. The study group of women were asked to apply; Top-D (Aloe Vera based- Vitamin D3) (Patency Pending) was developed at King Fahd Hospital of the University, AlKhobar with each gram of the Top-D cream delivering 5000 IU of vitamin D3. The second group used 1 gram of Aloe vera gel. The participants had no knowledge to which group they belong. A second blood sample was taken at the end of 3 months and the data was analyzed. RESULTS: The data of 48 women was available for analysis. The average age was 22.58 ± 1.95 years. The mean pre-treatment 25OHD in the study group was 12.05 ng/Ml ± 6.54 and post-treatment was 37.95 ng/mL ± 6.43 (P=0.001, CI<28.582 ). In control group pre-treatment 25OHD was 11.4 ng/mL ± 3.97 and post-treatment was 10.58ng/mL ± 3.03. CONCLUSIONS: This randomized control study shows that vitamin D3 can safely be delivered through the dermal route. This route could be exploited in treating vitamin D deficiency.