Ovulation induction by metformin among obese versus non-obese women with polycystic ovary syndrome

Objectives: There is some evidence that the efficacy of metformin as an ovulation stimulation agent depends on the body mass index (BMI) of the treated anovulatory women with polycystic ovary syndrome (PCOS). The aim of this study was to examine the likelihood of successful ovulation among obese (BMI ⩾30 kg/m2) versus non-obese (BMI <30 kg/m2) women with PCOS. Methods: A total of 243 medical charts of women with PCOS who visited King Khaled University Hospital (KKUH) in Riyadh, Saudi Arabia, between 2006 and 2012 were reviewed. Patients’ sociodemographic, laboratory, and medical data were collected. Descriptive statistics and multiple logistic regression analyses were performed to compare the patients’ baseline data and successful ovulation among the obese and non-obese anovulatory women with PCOS, respectively. Results: One hundred and nine women with PCOS who were prescribed metformin for ⩾3 months were included in the study. Almost 60% of the women who were included in the study were obese. The likelihood of ovulation among obese women with PCOS was 77.9% (odds ratio = 0.221, 95% CI 0.052–0.947, P = 0.042) less than that in their non-obese counterparts. Conclusion: The findings of this study suggest that metformin is more effective as an ovulation stimulation agent when administered to non-obese women with PCOS. Lifestyle modifications such as diet and exercise should be emphasized upon as an integral part of any treatment plan for PCOS

Relationship between health literacy and body mass index among Arab women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) puts patients at higher risk for obesity and diabetes. Poor health literacy is also associated with these conditions. Notably, weight loss is associated with improved ovulation and pregnancy rates for women with PCOS. In this study the association between health literacy and body mass index (BMI) among women with PCOS was examined. Methods: The health literacy of women with PCOS was measured using the Arabic version of the single item literacy screener (SILS) at a university medical center. Sociodemographic and medical information was collected by interviewing the participants and reviewing their medical records, respectively. The relationship between health literacy and BMI was assessed by multiple logistic regression analysis. Results: Health literacy was assessed in 127 women with PCOS from September 2015 to February 2016. Only 16.54% of participants had limited health literacy. The mean BMI for all participants was 30.57 (kg/m2), and the mean age was 27.40 years. Further, most of the participants (74%) had a high school diploma or a higher degree. Almost 56% of the participants were taking metformin, and 11.81% had hypothyroidism. After controlling for age, education, hypothyroidism diagnosis, and the use of metformin, participants with high BMI were 10% less likely to have a good health literacy level (OR = 0.904; 95% CI = 0.829–0.987; P = 0.0238). Conclusion: Improving the health literacy of patients with PCOS may have a positive impact on their BMI and eventually lead to favorable health outcomes

Orthopedic Surgeons’ Views of Hyaluronic Acid Formulations in the Management of Knee Osteoarthritis: A Questionnaire-Based Cross-Sectional Study

Background and Objectives: Multiple hyaluronic acid (HA) products were approved and marketed to manage osteoarthritis (OA). Although these products are widely prescribed by orthopedic surgeons to manage OA, especially knee OA, the therapeutic value of these products is highly uncertain. Few studies with significant limitations in their designs have indicated positive outcomes among OA patients treated with HA; however, their results were inconclusive. Thus, we aimed to explore the therapeutic value of different HA products in alleviating knee OA pain and improving patients’ physical function from the orthopedic surgeons’ perspective. Materials and Methods: This was a questionnaire-based cross-sectional study in which practicing orthopedic surgeons in two countries (e.g., Saudi Arabia and Jordan) were invited to participate. The 10-item, newly developed questionnaire inquired about the respondents’ sociodemographic characteristics (e.g., age, gender, country, years of experience), and their opinions regarding the efficacy of HA products in the management of OA (e.g., efficacy in improving mobility and alleviating pain). Results: Out of the 200 orthopedic surgeons who were invited to participate, 122 (61%) filled out the questionnaire. Most of the respondents were from Saudi Arabia (58%), aged 35 to 55 years (68%), had at least 10 years of experience (69%), and male (98%). About 80% of the respondents reported prescribing HA, such as Hyalgan®, Orthovisc®, Hyalubrix®, and Crespine Gel®. About 66% of the respondents believed that HA was moderately to highly effective in managing knee OA, and 34% believed that HA was either ineffective or mildly effective. Pain at the site of injection (44.3%) and rash or local skin reactions (22.1%) were the most commonly reported adverse events. Conclusions: The variations in the formulation of different HA brands (e.g., molecular weight and cross-linking) did not seem to offer any therapeutic advantage. HA might have value in the management of knee OA; however, its value is highly uncertain and necessitates more well-designed studies to further examine its therapeutic value

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population