Obesity: an emerging problem in Saudi Arabia. Analysis of data from the National Nutrition Survey.

To document the prevalence of obesity in Saudi Arabia, we used data from a cross-sectional study on 19,598 individuals in 2837 households. Body mass index, skinfold thickness and mid-arm circumference were measured. Prevalence of obesity ranged from 33.9% in Ha'il to 11.7% in Jizan. More women than men were obese, 23.6% compared to 14.2%. Prevalence of overweight was 30.7% for males and 28.4% for females. Obesity was present in all age groups. It is clear that changes must be made to the lifestyle of the Saudi population in order to reduce the prevalence of obesity.

Electrocardiographic abnormalities in patients with heat stroke.

Serial electrocardiograms were taken in 46 Hajj Pilgrims suffering from heat stroke immediately after cooling 12 and 24 h later. The collected data were analyzed and revealed that a statistically significant number of patients with heat stroke had sinus tachycardia (43 percent, p < 0.05), conduction defect (22 percent, p < 0.046), prolonged Q-T interval (61 percent, p < 0.007), diffuse nonspecific ST-T changes (26 percent, p < 0.036), and ST-T changes (localized to the ECG leads confirming to a territory of coronary artery) consistent with myocardial ischemia (21 percent, p < 0.02). Although adverse effects of heat stroke on the heart are multifactorial, the above data indicate that heat stroke predisposes to certain risk of myocardial ischemia and conduction disturbances. This may reflect the true cardiovascular status of these heat stroke victims.

Aneurysmal dilatation of the coronary arteries: diagnostic patterns and clinical significance.

In order to define the clinical features, clinical patterns and significance of aneurysmal dilatation of the coronary arteries, five cases are presented which were diagnosed by coronary angiography. Three cases presented with left ventricular dysfunction secondary to coronary arterial occlusive disease and the fourth patient presented with thromboembolic cerebrovascular disease. The fifth case presented with manifestations of acute myocardial infarction.

Prolapse of the mitral valve in hyperthyroid patients in Saudi Arabia.

Eighty-two patients (60 females and 22 males) who were under treatment for hyperthyroidism at the King Saud University affiliated hospitals in Riyadh, Saudi Arabia, were evaluated by M-mode and cross-sectional echocardiography for the presence of mitral valve prolapse. Sixty-seven patients (51 females and 16 males) had diffuse toxic goitre while 15 of them (9 females and 6 males) had nodular toxic goitre. The overall frequency of prolapse was 37.8% (31 of 82) and the frequency was similar for both sexes, being 38.3% in females and 36.3% in males. Prolapse was associated with both diffuse toxic goitre (overall frequency 35.8%) and nodular toxic goitre (overall frequency 46.6%); and the highest frequency was in females with nodular toxic goitre (55.5%). Out of the total of 31 patients with prolapse, early systolic and holosystolic prolapse were each present in 12 patients, while mid-to-late systolic prolapse was found in 7 patients. Cross-sectional echocardiography demonstrated prolapse in 16 cases, the M-mode was positive in 5 cases while the two methods confirmed it in 10 patients. The prevalence of prolapse of the mitral valve in otherwise healthy Saudi subjects has previously been found to be 12-15%. This study has confirmed a high frequency of prolapse in hyperthyroid patients and has demonstrated that sex, ethnic or racial origin and type of hyperthyroidism are not determinants of this association.

Haemostatic variables in patients with unstable angina.

To assess the contribution of thrombus formation in the pathogenesis of unstable angina, we employed the recently developed assays of small fragments which reflect the degree of activation of various components of the haemostatic system. Such haemostatic measurements were undertaken in patients with unstable angina (n = 47) from the time of their admission to the coronary care unit (CCU) at 8-h intervals in the first 24 h and then daily for a total of 5 days. The results obtained were compared with healthy control values. Patients exhibited lower ATIII, prolongation of the APTT and TT, but not PT or the reptilase time, which is a consequence of heparinization. There was significant elevation of fibrinogen, factor VIII:C, von Willebrand factor:antigen and von Willebrand factor:ristocetin cofactor throughout the study period. There was also evidence of thrombin generation as indicated by the elevated levels of fibrinopeptide A (FPA) and thrombin-antithrombin complexes. The platelet release proteins, beta-thromboglobulin (BTG) and platelet factor 4 (PF4), were markedly elevated in the first 2 days and dropped gradually thereafter. The fibrinolytic inhibitor, plasminogen activator inhibitor (PAI), levels were elevated throughout. Proteins C and S, plasminogen and alpha 2-antiplasmin remained unchanged. It was concluded that in patients with unstable angina, there is significant activation of the clotting system and inhibition of fibrinolysis which confirms the existence of a tendency towards thrombus formation in patients with unstable angina.

Endocarditis due to Actinobacillus actinomycetemcomitans.

A case of infective endocarditis in a 38-year-old Saudi male caused by Actinobacillus actinomycetemcomitans is reported. The patient was treated successfully with a combination of benzyl penicillin and gentamicin. Previously reported cases are reviewed.

Risk factors of coronary artery disease in different regions of Saudi Arabia.

A national nutrition survey was carried out in Saudi Arabia between 1989 and 1994. One objective was to investigate the prevalence of well established atherogenic risk factors among adults 18 years and older, namely obesity, hypercholesterolaemia, hypertriglyceridaemia, diabetes mellitus and high systolic and diastolic blood pressure. Obesity prevalence was positively correlated with all five coronary artery disease risk factors investigated. Variation among regions in relation to the prevalence of these risk factors was observed. Saudi Arabia's ecology has resulted in variation in the lifestyle and food consumption patterns of the people of the different regions, which might be a major underlying cause of the variation and high prevalence of coronary artery disease risk factors.

The prevalence of hypertension in different geographical regions of Saudi Arabia.

BACKGROUND: The results of the National Nutrition Survey of the people of the Kingdom of Saudi Arabia showed that the prevalence of arterial hypertension (BP >/= 160/95 mmHg) among the adult population is 5.3% and 7.3% for systolic and diastolic hypertension, respectively. The objective of this study, which is part of the Survey, was to investigate if the diversified ecological nature of the life of the people of the Kingdom has an effect on the prevalence of arterial hypertension in the adult population in the different geographical regions of the Kingdom. MATERIALS AND METHODS: The Survey was population-based, employing cluster sampling methods and household visits by health teams trained by the same investigators to avoid individual variations and ensure data validity. 2,556 families with 17,892 individuals of all ages were randomly selected from 12 areas according to the population distribution all over the Kingdom. The total number examined for BP with complete data amounted to 13,700 individuals, of whom 6,260 were adults (over 18 years of age). The WHO definition of arterial hypertension was used. Also used was the definition of 140/90 mmHg. RESULTS: Systolic blood pressure hypertension (SBPH) showed a statistically significant difference (P<0.001) among the regions. The highest prevalence was found in Farasan (8.9%) and the lowest was reported from Asir (2.2%). There was a higher prevalence among females compared to males in the 40-75 year age group in all regions, except in the highlands of Al Taif and Asir. However, the difference was not statistically significant, except in Makkah (25.9%, P<0.001) and Al Sharikia (22%, P<0.03). Diastolic blood pressure hypert ension (DBPH) prevalence increased with age in all regions, except in males of Farasan, Makkah, and in females of Asir. The difference in the prevalence between regions was statistically significant (P<0.001). The highest DBPH prevalence (sexes combined) was reported from Al Qassim (10.6%) and the lowest from Makkah (4.2%). Using the definition of hypertension as 140/90 mmHg, the highest SBPH prevalence was reported from Makkah (sexes combined) (27.9%), while the lowest was from Makkah and Asir (22% each). The prevalence of SBPH and DBPH was insignificantly higher among females than males in eight and seven of the 12 regions, respectively. CONCLUSION: There is a statistically significant difference in the prevalence of SBPH and DBPH in the different regions of the Kingdom (P<0.001). The prevalence pattern tends to be fairly similar to that found in the affluent societies in the Western countries.

Arterial hypertension in Saudi Arabia.

A cross-sectional population-based survey employing a cluster sampling method and household visits by trained health teams investigated hypertension prevalence in the Kingdom among 13,700 individuals of both sexes in all age groups. The World Health Organization (WHO) definition of hypertension of = 160/95 mmHg was used; it was found that 9.1% and 8.7% of the total sample investigated were systolic and diastolic hypertensives, respectively. However, 12.4% and 7.9% of children younger than 18 years were systolic and diastolic hypertensive. Among adults aged 18 years and above, 5.3% were systolic and 7.3% were diastolic hypertensives; 87.5% of systolic and 79.4% of diastolic hypertensives were aged 40 years and over. Females had statistically significant elevated systolic hypertension compared with males (P < 0.01). However, if blood pressure = 140/90 mmHg is used as a criterion for hypertension definition, the prevalence among the latter age groups would be 20.4% for systolic and 25.9% for diastolic hypertension. The prevalence of Isolated Systolic Hypertension (ISH), Isolated Diastolic Hypertension (IDH) and Systolic Diastolic Hypertension (SDH) among adults above 18 years was 1.8%, 3.8% and 3.5% respectively. ISH was higher among females compared with males (2% vs 1.4%), while IDH was higher among males than females (4.4% vs 3.4%). There is a need for tracking childhood hypertension, which could provide long-term analysis for risk of adult hypertension.

Clinical spectrum of skeletal abnormalities and mitral valve prolapse and their clinical implications.

Fifty-six patients were diagnosed to have mitral valve prolapse (MVP) syndrome by auscultatory criteria, confirmed by cross-sectional echocardiography. Complete physical examination and x-ray of the bony thorax revealed bony deformities which were subdivided into four main groups according to the predominant deformity. Shallow chest with pectus excavatum, straight back, kyphoscoliosis and elliptical chest in marfanoid patients were reported in the cases studied. It is concluded that musculoskeletal abnormalities have to be considered as nonauscultatory features of MVP. Therefore, any patient with musculoskeletal deformity has to be screened for MVP by cross-sectional echocardiography to prevent life-threatening complications.

Cardiac amyloidosis: Diagnostic features and clinical implications.

Seven patients with cardiac amyloidosis were referred to King Khaled University Hospital. All patients in this study developed congestive heart failure. They had a long duration of illness and thickened ventricular wall with marked abnormalities in the left ventricular filling, and normal systolic function. Diastolic function is suggested as a possible mechanism of congestive cardiac failure in the patients presented.

Prevalence of bicuspid aortic valve and mitral valve prolapse in a healthy Saudi population and the clinical implications of their association.

In this study, 103 Saudi males and 172 Saudi females were referred for medical check-up for employment purposes and/or as undergraduate students. Clinical evaluation of all participants included full cardiovascular examination, with the following investigations being performed: ECG, chest x-ray, and cross-sectional echocardiography. Bicuspid aortic valve was detected in three males and in four females, for a total percentage of 2.5%. Isolated mitral valve prolapse was detected in seven males (6.7%) and six females (3.5%). Association with mitral valve prolapse was reported in five males and seven females, with a total percentage of 4.3%. This association seems to have important etiological, medical and surgical implications.

Residency training in graduate medical education (nine-year view).

Assessment of the progress of residency training in graduate education after 9 years shows that the original goals established for various specialties are being effectively met. There are now 7 approved residency programmes for diplomas and 10 approved residency programmes for fellowships with 324 residents trained and in training, out of whom (32%) were females, and 222 (68%) were male residents. Student interest in these programmes has remained at a high level. Only 15 candidates (4.64%) had withdrawn from the residency training programmes. Heavy emphasis has been placed upon curriculum design, selection criteria of students and quality control mechanisms through residency committees in specialty departments and the residency board embracing residency coordinators. This paper outlines some concerns regarding the present status of various residencies and suggests some recommendations for future development of these programmes.