Suppression of type 2 diabetes mellitus-induced aortic ultrastructural alterations in rats by insulin: an association of vascular injury biomarkers.

Diabetes represents a major public health problem and an estimated 70% of people with diabetes die of cardiovascular complications. The protective effect of insulin treatment against ultrastructural damage to the tunica intima and tunica media of the aorta induced by type 2 diabetes mellitus (T2DM) has not been investigated before using transmission electron microscopy (TEM). Therefore, we induced T2DM in rats using high fat diet and streptozotocin (50 mg/kg) and administered insulin daily by i.v injection for 8 weeks to the treatment group. Whereas, the T2DM control group were left untreated for the duration of the experiment. A comparison was also made between the effect of insulin on aortic tissue and the blood level of biomarkers of vascular injury, inflammation, and oxidative stress. T2DM induced profound ultrastructural damage to the aortic endothelium and vascular smooth muscle cells, which were substantially protected with insulin. Furthermore, insulin returned blood sugar to a control level and significantly (p < .05) inhibited diabetic up-regulation of endothelial and leukocyte intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein 1 (VCAM-1), endothelial cell adhesion molecules, P-selectin and E-selectin, tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and malondialdehyde (MDA). Furthermore, insulin augmented the blood level of the anti-oxidant enzyme superoxide dismutase (SOD). We conclude that in a rat model of T2DM, insulin treatment substantially reduces aortic injury secondary to T2DM for a period of 8 weeks, possibly due to the inhibition of hyperglycemia, vascular activation, inflammation, and oxidative stress.

Effects of Weight Reduction After Sleeve Gastrectomy on Metabolic Variables in Saudi Obese Subjects in Aseer Province of Kingdom of Saudi Arabia.

OBJECTIVES: The objectives of this study were to investigate the occurrence of oxidative stress, status of protective antioxidants enzymes, inflammatory biomarkers, and some metabolic health variables in the blood and to compare the results between those of the normal controls and obese patients submitted to sleeve gastrectomy-induced weight loss over a 1-year follow-up period. MATERIALS AND METHODS: A prospective study was conducted in Aseer Central Hospital and Abha Private Hospital in the Kingdom of Saudi Arabia from January 2012 to January 2013 on 50 normal (BMI = 22-25 kg/m2) control subjects and 50 obese (BMI = 45-50 kg/m2) patients. A subset of 20 men and 80 women patients, aged 20-45 years, was included. The systemic blood cell counts were determined by Beckman Coulter UniCel analyzer. The occurrence of oxidative stress, the status of antioxidant enzyme system in the blood, levels of serum hepatic enzymes, cardiovascular risk factors, and serum sodium, potassium, copper, and zinc levels were determined by spectrophotometric procedures. The concentration of TSH and T4 were analyzed by Siemens Immunoassay System. RESULTS: Group 1 (Obese: preoperative) This group compared with the normal controls exhibited significant (p < 0.05) increase in inflammatory biomarkers, a significant (p < 0.05) rise in hepatic enzymes, a significant (p < 0.05) decrease in serum total bilirubin. Concentration of serum total cholesterol (TC), triacylglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose(FBG) were significantly (p < 0.05) increased, but HDL cholesterol (HDL-C) was significantly depleted (p < 0.05). Serum urea and creatinine contents were significantly (p < 0.05) decreased. Serum copper and zinc levels were significantly (p < 0.05) increased. Group 2: Sleeve Gastrectomy Surgery (Obese: postoperative) This group compared with the obese group, preoperatively, demonstrated a profound reduction in body weight (-32%) as well as in BMI (-29%). Serum malondialdehyde, a stress index, was significantly (p < 0.001) inhibited and conversely, activities of antioxidant enzymes: superoxide dismutase(Cu-Zn SOD), glutathione peroxidase (GPx), glutathione-S-transferase (GST), glucose-6-phosphate dehydrogenase (G6PDH), and vitamin C, were remarkably (p < 0.001) increased. Furthermore, remarkable improvements in deranged metabolic variables approaching normality were discernible. Inflammatory biomarkers in the blood and hepatic enzymes in serum were significantly (p < 0.001) decreased. Levels of TC, TG, LDL-C, FBG, and HDL-C in serum exhibited significant (p < 0.05) reductions, a reversal toward normality. Serum albumin and total bilirubin concentrations were significantly increased (p < 0.001). Serum sodium, potassium, copper, zinc, and TSH levels were significantly (p < 0.001) decreased. CONCLUSIONS: Obesity is a chronic disease of multifactorial origin and resulted in perturbations of whole body metabolism in this study. It is thus likely that this imbalance was associated with an inhibition in protective antioxidants and occurrence of oxidative stress. The staging concept of sleeve gastrectomy is a safe and effective approach with remarkable efficacy in sustaining weight loss and bringing back normal metabolism of variables in tissues over a 1-year follow-up period.

Heart Failure Models: Traditional and Novel Therapy.

Cardiovascular disease (CVD) is among the most major causes of morbidity and mortality worldwide. Great progress has been made in the management of CVD which has been influenced by the use of experimental animal models. These models provided information at cellular and molecular levels and allowed the development of treatment strategies. CVD models have been developed in many species, including large animals (e.g. pigs and dogs) and small animals (e.g. rats and mice). Although, no model can solely reproduce clinical HF, simulations of heart failure (HF) are available to experimentally tackle certain queries not easily resolved in humans. Induced HF may also be produced experimentally through myocardial infarction (MI), pressure loading, or volume loading. Volume loading is useful to look at hormone and electrolyte disturbances, while pressure loading models is helpful to study ventricular hypertrophy, cellular imbalance and vascular changes in HF. Coronary heart disease is assessed in MI animal models. In this review we describe various experimental models used to study the pathophysiology of HF.

Differentiated mesenchymal stem cells ameliorate cardiovascular complications in diabetic rats.

Cardiovascular manifestations are one of the major complications of type 1 diabetes mellitus (T1DM) and supersede the slow progression of DM in most cases as the leading cause of mortality. There have been many studies and trials in regenerating the functional ß-cells of islets from mesenchymal stem cells (MSCs) with varied success. The effect of MSCs ex vivo differentiated to mimic functional insulin-secreting ß-cells of islets and their impact on restoration of diabetic complications and transplantation via systemic delivery have not been well studied. In the current study, bone marrow MSCs differentiated to insulin-secreting ß-cells are used to treat STZ-induced diabetic rats. The post-homing effects of the differentiated MSCs (dMSCs) were endogenous with definite reversal of diabetic parameters. Consequently, the altered cardiac functions like heart beat rate, left ventricular performance, contractility index and physiological body weight gain due to hyperglycemia were amelorated into normacy. The primary onset cardiac perfomance and the endothelial activation were well evidenced by high fibrinogen levels and systolic blood pressure (SBP) being reversed on the treatment by dMSCs. Further high basal [Ca(2+)]c in isolated endothelial cells and thereby increased ROS confirmed the endothelial activation. The levels of pro-apoptotic makers p53 and Bax were highly expressed in the diabetic groups indicating oxidative stress through ROS induced by high cytosolic calcium skewing the cells towards apoptosis. The expression of the anti-apoptotic marker Bcl-2 was observed to be low in the diabetic group further augmenting the stress state of endothelial cells (ECs) in T1DM. Restoration of [Ca(2+)]c chelates ROS and the subsequent reversal of pro- and anti-apoptotic markers after the successful treatment of dMSCs proved that endogenous reconstitution of insulin secretion improves diabetic-induced cardiac manifestations.

Production of recombinant streptokinase from Streptococcus pyogenes isolate and its potential for thrombolytic therapy.

OBJECTIVES: To produce an effective recombinant streptokinase (rSK) from pathogenic Streptococcus pyogenes isolate in yeast, and evaluate its potential for thrombolytic therapy. METHODS: This study was conducted from November 2012 to December 2013 at King Khalid University, Abha, Kingdom of Saudi Arabia (KSA). Throat swabs collected from 45 pharyngitis patients in Asser Central Hospital, Abha, KSA were used to isolate Streptococcus pyogenes. The bacterial DNA was used for amplification of the streptokinase gene (1200 bp). The gene was cloned and in vitro transcribed in an eukaryotic expression vector that was transformed into yeast Pichia pastoris SMD1168, and the rSK protein was purified and tested for its thrombolytic activity. RESULTS: The Streptococcus pyogenes strain was isolated and its DNA nucleotide sequence revealed similarity to other Streptococcus pyogenes in the Gene bank. Sequencing of the amplified gene based on DNA nucleotide sequence revealed a SK gene closely related to other SK genes in the Gene bank. However, based on deduced amino acids sequence, the gene formed a separate cluster different from clusters formed by other examined genes, suggesting a new bacterial isolate and accordingly a new gene. The purified protein showed 82% clot lysis compared to a commercial SK (81%) at an enzyme concentration of 2000 U/ml. CONCLUSION: The present yeast rSK showed similar thrombolytic activity in vitro as that of a commercial SK, suggesting its potential for thrombolytic therapy and large scale production. 

Increased systemic low-grade inflammation in high altitude native rats mediated by adrenergic receptors.

OBJECTIVE: To compare the serum levels of inflammatory mediators in high altitude (HA) native rats, and to search for the possible underlying mechanism(s). METHODS: The study was carried out between January and April 2013. Fifty male rats from the same genetic pool were bred at either a HA or low altitude (LA) area. The study was carried out in 2 stages. In the first stage, serum levels of inflammatory markers, adhesive molecules, lipid profiles, catecholamines, magnesium (Mg+2), and lipid peroxidation were compared between theses 2 groups. In the second stages, inflammatory response and lipid peroxidation were analyzed in HA native rats after treatment with either alpha (Prazosin) or beta (propranolol) adrenergic blockage. RESULTS: The HA native rats showed significant increases in the serum levels of inflammatory cytokines, lipid profiles, as well as a significant increase in the urinary norepinephrine with a concomitant decrease in the serum levels of Mg+2 and increased lipid peroxidation. Blockage of the beta and alpha adrenergic receptors of the HA rats caused partial or complete decreases in both inflammatory and oxidative stress mediators. CONCLUSION: Living under HA conditions results in an increased systemic inflammatory reaction; an effect that is mediated through the sympathetic nervous system mainly via alpha-adrenergic receptors and could be attributed to low Mg+2 levels.

Ricin poisoning causing death after ingestion of herbal medicine.

Ricin intoxication is a fatal and an uncommon medical condition. We report a case of ricin poisoning in a 42-year-old Saudi male patient who ingested a herbal medicine mixture containing ricin bean powder, after which he presented with gastrointestinal symptoms followed by gastrointestinal bleeding and hypotension. The patient then passed into a state of shock with respiratory failure followed by cardiac arrest and death. Public health awareness of self-prescribed herbal medications is necessary.

Diagnostic importance of platelet parameters in patients with acute coronary syndrome admitted to a tertiary care hospital in southwest region, Saudi Arabia.

OBJECTIVE: Identifying risk factors for acute coronary syndrome (ACS) is important for both diagnostic and prognostic purposes. Abnormal platelet parameters, mainly platelet count (PC), mean platelet volume (MPV) and platelet distribution width (PDW) are thought to be among these risk factors. In this study, the associations between PC, MPV and PDW and ACS were investigated in patients admitted to the tertiary care hospital in the south west region of Saudi Arabia. MATERIALS AND METHODS: A retrospective cohort of 212 patients with the diagnosis of ACS admitted to Aseer Central Hospital during the period extending from February 1, 2008 to October 31, 2008 were included. The control group consisted of 49 matched subjects who were admitted for chest pain investigation and subsequently found to be non-cardiac chest pain after performing relevant investigations. Blood samples were taken at the time of admission for platelet parameters. Statistical analysis was made using SPSS software and P-values were considered significant if <0.05. RESULTS: A total of 212 patients with acute coronary syndrome (80 patients with MI and 132 patients with UA) and 49 matched controls were studied. The PC was not statistically different among the three groups (283.3 ± 94.8 × 10(9) L(-1) for MI cases, 262 ± 60.8 × 10(9) L(-1) for UA cases and 275.8 ± 58.9 × 10(9) L(-1) for controls). The MPV was significantly larger in MI cases compared to controls (8.99 ± 1.5 fl vs. 8.38 ± 0.51 fl, respectively, P < 0.009), similarly, the MPV was significantly larger in UA cases compared to controls (9.23 ± 1.19 fl vs. 8.38 ± 0.51 fl, respectively, P < 0.001). The PDW was significantly higher in MI cases compared to controls (15.88 ± 1.5 fl vs. 11.96 ± 1.8 fl, respectively, P < 0.001), similarly, the PDW as also significantly larger in UA cases compared to controls (18.1 ± 18 fl vs. 11.96 ± 1.8 fl, respectively, P < 0.019). CONCLUSION: Platelet parameters mainly MPV and PDW are readily available and relatively simple and inexpensive laboratory tests which we detected to be significantly raised in patients who have suffered an acute coronary syndrome compared with controls.

Clinical and Therapeutic Profiles of Heart Failure Patients admitted to a Tertiary Hospital, Aseer Region, Saudi Arabia.

OBJECTIVES: This study aimed to investigate the clinical and therapeutic profiles of heart failure (HF) cases admitted to Aseer Central Hospital (ACH), Saudi Arabia. METHODS: A retrospective cohort of 300 consecutive patients admitted with the diagnosis of HF to ACH from 1 June 2007 to 31 May 2009 were included in the study. Data on demographic variables, aetiologic factors, risk factors, and therapeutic profiles of patients with HF were collected and analysed. RESULTS: The patients' mean age was 67.4 ± 13.7 years and 68.7% of them were male. The commonest aetiologies for HF were ischaemic heart disease (IHD) and hypertension in 38.3% and 33.3% of patients, respectively. A total of 61.3% of patients were diabetics. Other risk factors for HF included renal failure in 9.7%, atrial fibrillation in 13%, and anaemia in 48.3% of patients. Echocardiography was performed in 98.7% of cases: the average ejection fraction (EF) was 33% ± 17. Angiotensin converting enzyme inhibitors (ACEI) or angiotensin 2 receptor blockers were used in 68.3% of cases, ß-blockers in 51.6% of cases and digoxin in 28.3% of cases. CONCLUSION: The major causes of HF in our study were IHD and hypertension. Diabetes and anaemia were common risk factors. The cohort constituted an intermediate HF risk group (ejection fraction (EF) 33%). Important therapeutic agents like angiotensin converting enzyme inhibitor I, ß-blockers and digoxin were underutilised. Fostering such therapy in practice will lead to a better outcome in the management of HF patients. Anaemia was a significant risk factor in our HF patients and should be managed properly.

Effect of gender difference in management of heart failure patients in aseer, saudi arabia.

BACKGROUND: Heart failure (HF) is a common medical problem with a high impact on public health. Evidence of gender difference in management of HF is scarce. We conducted a retrospective study to evaluate the presence of gender difference in management of HF patients admitted to the tertiary care hospital in the Aseer region/Saudi Arabia. PATIENTS AND METHODS: A chart review was conducted at Aseer Central Hospital (ACH) on consecutive patients admitted with the primary diagnosis of HF between Jun 2007 and May 2009. Data were collected on clinical and management profiles and analyzed for the presence of gender difference in HF management. RESULTS: A total of 206 male patients and 94 female patients with HF were reviewed. Ischemic and dilated cardiomyopathy etiologies were significantly higher in male patients (42.7 vs. 28.7%, P < 0.021) and (13.1% vs. 3.2%, P < 0.008), respectively. Renal failure and atrial fibrillation were significantly higher in female patients with HF (20.2 vs., 5.3% P < 0.001) and (20.2 vs. 10.2%, P < 0.018), respectively. Smoking was significantly higher in male patients (11.7 vs. 0%, P < 0.001). Echocardiography was performed equally for both genders and ejection fraction was significantly higher in female patients (38.2 ± 16.9% vs. 30.4 ± 16.6%, P < 0.001). Beta-blockers were prescribed significantly less to female patients (36.2 vs. 57.8%, P < 0.001), while ACE inhibitors and digoxin were prescribed significantly less to male patients (64.1 vs.75.5%, P < 0.049) and (24.8 vs. 36.2%, P < 0.042), respectively. CONCLUSION: Gender differences were detected in clinical presentation and management of HF. Female patients with HF had less ischemic etiology and smoking, but more atrial fibrillation and renal dysfunction. Female patients were under-treated by Beta-blockers while male patients were under-treated by ACE inhibitors and digoxin. Both genders were investigated equally, and female patients had a better ejection fraction.

Immunochemical studies on catechol-estrogen modified plasmid: possible role in rheumatoid arthritis.

INTRODUCTION: Increased concentrations of estrogen metabolites (catecholestrogens) have been found in rheumatoid arthritis (RA) but the exact patho-etiology remains elusive. METHODS: The binding of antibodies from the sera of RA patients and control subjects to native and modified DNA was studied by direct binding and inhibition ELISA, quantitative precipitin titration. Experimentally induced antibodies were also checked to detect oxidative lesions in the DNA as well as for the estimation of 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels in different fluids of RA. RESULTS: Anti-DNA IgG from RA sera, exhibited increased recognition of modified DNA than native DNA (nDNA; P < 0.001). The relative affinity of anti-DNA antibodies for modified and nDNA was in the order of 1.85 × 10(-7), 1.23 × 10(-7), and 1.2 × 10(-6). Samples of DNA from RA patients showed a significant inhibition in the induced antibody activity in comparison to DNA isolates from controls (P < 0.001). The concentration of 8-OHdG evaluated by induced antibody in RA patients was found to be significantly higher than controls ((P < 0.0001, P < 0.01, P < 0.05). CONCLUSION: High binding of modified DNA with the IgG from RA patient might explain possible antigenic role of 4-OHE(2)-modified DNA in the production of anti-DNA antibodies. In addition, the induced antibodies have been shown to represent an alternative immunochemical probe to detect oxidative lesions in DNA as well as for the estimation of 8-OHdG levels in different body fluid of RA patients, which may be used as marker in the diagnosis of the disease.

Clinical and microbiological profiles of infective endocarditis in a tertiary hospital in Aseer region, Saudi Arabia.

OBJECTIVES: We aimed to evaluate demographic data, underlying cardiac abnormalities, clinical profile, microbiological features, treatments and complications of infective endocarditis (IE) in a tertiary hospital in Aseer region, Saudi Arabia. METHODS: A retrospective study of all cases with the diagnosis of definite endocarditis according to modified Duke Criteria admitted to ACH between May 2002 and April 2007. Data were reviewed on demographic and clinical data, underlying cardiac disease, microbiological findings, treatments and complications of IE. RESULTS: The study included 44 patients (28 males and 16 females; mean age 31.1 ± 16 years; range 13-65 years). Infective endocarditis developed on a native valve in 31 (70.5%), a mechanical prosthetic valve in 10 (22.7%), mitral valve prolapse in 2 (4.5%) and ventricular septal defect in 1 (2.3%). Rheumatic heart disease in 31 cases (70.5%) was the most common preexisting valvular abnormality in native valve endocarditis. The mitral valve was the most commonly affected valve 28 (63.6%). Fever occurred in 40 (90.9%) of the cases. Electrocardiography was abnormal in 34 cases (77.3%). Trans-thoracic and/or trans-esophageal echocardiography showed a vegetation in 22 (50%). Staphylococci in 10 cases (22.7%) and Streptococci in 8 cases (18%) were the most common causative agents and cultures were negative in 20 cases (45.5%). Twenty-two patients (50%) underwent surgical treatment. Congestive heart failure occurred in 16 (36.4%) cases, atrial fibrillation in 6 (13.6%) cases, and cerebrovascular accidents in 4 (9%) cases. CONCLUSION: Our data reflects the clinical and microbiological profiles of IE in a tertiary hospital in Aseer region, Saudi Arabia.

Gender differences in clinical presentation and management of patients with acute coronary syndrome in Southwest of Saudi Arabia.

OBJECTIVE: Gender differences in the clinical presentation and management of patients with acute coronary syndrome (ACS) have been reported in different parts of the world with contradicting results. We aimed at investigating the presence of gender bias in patients admitted with ACS to Aseer Central Hospital (ACH). METHODS: A retrospective cohort of all consecutive patients admitted to ACH with the diagnosis of ACS, during the period between the 1st of June 2007 and the 31st of May 2009 was studied. Data on demographic and clinical profiles, management and outcomes of ACS patients were collected and compared for both genders. RESULTS: The present study included 148 females and 397 males. Females were significantly older than males (62.9 ± 14.2 vs. 60 ± 13.4, respectively, P < 0.03), were less likely ever to have smoked (0.7% vs. 26.2%, respectively, P < 0.001), less likely to have had a history of hyperlipidemia (10.8% vs. 22.2%, respectively, P < 0.003) or family history of ischemic heart disease (10.1% vs. 18.9%, respectively, P < 0.014). Female patients presented more with atypical presentation (42.6% vs. 28.9%, respectively, P < 0.003), more with unstable angina (72.3% vs. 50.4%, respectively, P < 0.001), and less with ST-elevation myocardial infarction (18.9% vs. 40.8%, respectively, P < 0.001). Furthermore, they had significantly lower levels of hemoglobin compared to males (12.9 ± 2.3 vs. 14.5 ± 2.2 g/L, respectively, P < 0.001), and higher levels of high density lipoprotein (1.1 ± 0.4 vs. 0.98 ± 0.4 mmol/L, respectively, P < 0.008). Left ventricular ejection fraction was significantly higher in female patients compared to males (50.9 ± 14 vs. 45.8 ± 14, respectively, P < 0.003). Coronary angiography showed a higher rate of normal findings (29.3% vs. 8.9%, respectively, P < 0.001) and less severe disease (46.7% vs. 60.3%, respectively, P < 0.027) in women, however, they were less likely to undergo invasive revascularization procedures (31% vs. 42.8%, respectively, P < 0.013). No significant differences were found between both sexes regarding in-hospital mortality or re-infarction rates. CONCLUSION: We documented gender differences in both clinical presentation as well as management of patients admitted with ACS to ACH. However, there were no significant differences between both genders regarding the clinical in-hospital outcomes. Emphasis should be made to avoid such bias in the future.

The underutilization of adjunctive pharmacotherapy in treating acute coronary syndrome patients admitted to a tertiary care hospital in southwest region, saudi arabia.

BACKGROUND: Acute coronary syndrome (ACS) is the most prevalent cardiac disorder. Adjunctive pharmacotherapy has proved to be safe and effective in treating patients with this syndrome. Underutilization of such pharmacotherapy was reported in different studies. OBJECTIVES: In this study, we evaluated the underutilization of these pharmacotherapies on patients admitted to Aseer Central Hospital (ACH) with ACS, find out factors that may predict utilization of these therapies, and determine the effect of such pattern of drug utilization on survival at discharge. MATERIALS AND METHODS: A retrospective cohort of 562 patients admitted with the diagnosis of ACS to ACH during the period from March 2007 to February 2009 was studied. RESULTS: ß-blockers (B-blocker) and angiotensin-converting enzyme inhibitors (ACEI) were used in only 69 and 59% of cases, respectively. Aspirin, clopidogrel, and statin were used in 98.4, 82.6, and 89.3% of cases, respectively. The presence of diabetes predicts the use of ACE inhibitors, whereas the diagnosis of unstable angina and ST-elevation myocardial infarction predict the use of statin. Survival rate at discharge was 95.6%. Use of statin and aspirin improved survival. CONCLUSION: Certain adjunctive pharmacotherapies were underutilized in ACS patients in Southwest region, Saudi Arabia, specifically ß-blockers and ACEI. Standard of care should be revised and updated, aiming to improve adherence to guidelines of management of patients with ACS.

Knowledge about coronary artery disease among patients admitted to Aseer Central Hospital with acute coronary syndrome.

BACKGROUND: Coronary Artery Disease is a major killer worldwide. Level of education about this important health problem is unknown in our local population. METHODS: A pre-tested questionnaire was used to identify the level of education about CAD in all consecutive patients admitted to Aseer Central Hospital with the diagnosis of Acute coronary syndrome for the period (Jan. 2000 - Feb. 2001). RESULTS: We found the level of knowledge in the majority of patients was poor, the older and the less educated patients had a lower level of knowledge. The patients showed improved level of knowledge during their stay in the hospital. CONCLUSION: Our cardiac patients have poor knowledge about their disease and improvement on this level of education is needed.

Perception of Canadian training programs by Saudi resident trainees.

BACKGROUND: The aim of the study was to determine how Saudi medical trainees in Canada perceive their training programs with regards to educational, ethnic and socio-cultural issues, and if different factors such as the chosen field of training, place or level of training make any difference to this perception. SUBJECTS AND METHODS: All Saudi residents in training programs in Canada in the 1996/1997 academic year were surveyed using a written anonymous self-administered questionnaire, evaluating educational, ethnic and socio-cultural aspects of various training programs. RESULTS: The response rate was 72.5% (185/255). Most of the respondents were in the fourth year of training. Overall, the level of stress was rated as tolerable in 154 (83%), and 179 respondents (96.8%) described the educational aspects of their program positively. Furthermore, 154 (83%) of the respondents agreed that they were treated fairly in the distribution of job functions with regards to Canadian residents, and 133 (72%) did not face any major difficulty in practicing their religion. The sites of training, type of specialty and the level of training made significant impact on the perceived educational, social, religious and administrative aspects of training. CONCLUSION: The majority of Saudi medical trainees in Canada perceived the educational aspects of their training as a positive experience. Major problems faced were mainly related to administrative matters and to some extent, social adjustment. Issues that affect the training process need to be tackled by the concerned authorities to ensure the success of the training programs.