Outcome of pregnancy in Saudi women with sickle cell disease attending the Tertiary Care University Hospital in eastern province of Saudi Arabia

Sickle cell disease (SCD) is a chronic genetic hematological disorder with multiorgan involvement and is associated with complications during the pregnancy. This is a well-known disorder in Saudi Arabia, but no study has reported its outcomes in pregnant Saudi females of the Eastern region. This study was carried out to compare the fetomaternal outcome in patients with SCD with those without SCD. This was a retrospective cohort study done in the Eastern Province of Saudi Arabia in a tertiary care, teaching hospital, by retrieving the data through the code ICD-9 for SCD, the control group was also selected with comparable characteristics. A total of 302 SCD pregnant patients were included for comparison with 600 pregnant women without SCD as control, during the period of Jan 1, 2008 to December 31, 2018. After the data retrieval, percentages of complications were calculated between the study and control groups. Fischer‘s exact test and t-test were used for statistical analysis by using SPSS version 22. The results showed higher complication rates in pregnancies of patients with SCD. Hypertensive disorders (13.3%), abruptio placenta (1.6%), intrauterine growth restriction (19.2%), thromboembolism (6.6%) and stroke (2.6%) were all higher in SCD as compared to the control group .The complications of SCD itself including anemia (89.4%), acute chest syndrome (13.2%) and sickle cell crisis (39.2%) were also increased during the pregnancy. Both still birth (3.3%) and neonatal intensive care unit admission (1.6%) were also higher in SCD. SCD during the pregnancy is a high-risk situation and can lead to many fetomaternal complications; however, preconceptional counselling, early booking, a careful monitoring during pregnancy and multidisciplinary management approach can prevent potential adverse outcome in this regard.La maladie drépanocytaire (MD) est une anomalie hématologique génétique chronique impliquant plusieurs organes et qui est associée à des complications au cours de la grossesse. Il s'agit d'un trouble bien connu en Arabie Saoudite, mais aucune étude n'a rapporté ses résultats chez les femmes saoudiennes enceintes de l'est du pays. Cette étude a été réalisée dans le but de comparer les résultats foeto maternels chez les patientes atteintes de MD avec ceux ne souffrant pas de MD. Il s'agissait d'une étude de cohorte rétrospective réalisée dans un hôpital universitaire de soins tertiaires de la province orientale de l'Arabie saoudite. Les données ont été extraites du code ICD-9 pour MD. Le groupe témoin a également été sélectionné avec des caractéristiques comparables. Au total, 302 patientes atteintes de MD et enceintes ont été incluses pour la comparaison avec 600 femmes enceintes mais non atteintes servant comme témoin, entre le 1er janvier 2008 et le 31 décembre 2018. Après la récupération des données, les pourcentages de complications ont été calculés entre les groupes d'étude et de témoin. Le test exact et le test t de Fischer ont été utilisés pour l‘analyse statistique à l‘aide de la version 22 de SPSS. Les résultats ont montré des taux de complication plus élevés lors de la grossesse chez les patientes atteintes de MD. Les troubles hypertensifs (13.3%), une rupture du placenta (1.6%), une restriction de croissance intra-utérine (19.2%), une thrombo-embolie (6.6%) et un accident vasculaire cérébral (2.6%) étaient tous plus élevés chez patientes atteintes par rapport au groupe témoin. Les complications de MD ellemême y compris l‘anémie (89.4 %), le syndrome thoracique aigu (13.2%) et la crise de drépanocytose (39.2%) ont également augmenté au cours de la grossesse. Les taux d‘admission dans une unité de soins intensifs néonatals (1.6%) et de mortinatalité (3.3%) étaient également plus élevés chez les patients atteints de MD. La MD pendant la grossesse est une situation à haut risque et peut entraîner de nombreuses complications foeto-maternelles; Cependant, les conseils d‘avant-conception, les réservations précoces, une surveillance attentive pendant la grossesse et une approche de gestion multidisciplinaire, peuvent empêcher des résultats défavorables potentiels à cet égard.Keywords: Fetomaternal outcome, Maternal Complications, Vaso-occlusive crisis, Venous thromboembolismAfr J Reprod Health 2019; 23[3]: 42-48)

The Effect of Ursolic Acid and Hyperinsulinemia on the Liver and Kidney Function of Alloxan-Induced Diabetic Male Rabbits

The study aimed to examine the effect of extracted and standard ursolic acid in addition to hyperinsulinemia compared to vitamin B complex on the liver and kidney function of alloxan-induced diabetic male rabbits. The liver and kidney functions were determined and analyzed by one–way of a NOVA at variance software at a P-Value of 0.05. The result showed a significant decrease in aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and uric acid values in the groups treated with standard and extraction ursolic acid(UA) compared to the diabetic group. The rabbit group that was treated with vitamin B complex recorded a significant decrease in the three liver enzymes, uric acid, and creatinine values than the diabetic group. In addition, the rabbit group that was treated with hyperinsulinemia recorded a significant increase in aspartate aminotransferase (AST) and creatinine values than the diabetic rabbit group. While the histological results in the groups treated with standard and extraction ursolic acid had a clear ameliorative effect in liver and kidney function tests better than hyperinsulinemia, also vitamin B complex caused some good effects

Significance of immunohistochemistry in accurate characterization of malignant tumors

Background: To determine in a large series of surgical biopsies the role and significance of immunohistochemistry in the adequate and accurate characterization of malignant tumors. Methods: A retrospective study of 20,000 consecutive surgical biopsies reported in the Section of Histopathology, AKU in 2003. Data was obtained by retrieving the filed surgical biopsy reports in the section. Results And Conclusions: Out of the 20,000 biopsies, 6534 (32.67%) were neoplastic. 4726 neoplasms (72.33%) were malignant, and 1808 (27.67%) were benign. Immunohistochemistry was performed on 29.49% of malignant tumors, and 4.97% of benign tumors. Immunos were performed on only 2.82% of routine squamous cell carcinomas and adenocarcinomas of various organs, and in only 1.9% of infiltrating breast carcinomas, the commonest malignant tumors in females. In contrast, immunos were performed on 97.12% of non-Hodgkin\u27s lymphomas, 97.94% of Hodgkin\u27s lymphomas, 98.09% of malignant spindle cell neoplasms, 87.96% of small round blue cell tumors of childhood, 87.30% of neuroendocrine neoplasms, and 84.37% cases of malignant melanomas. In addition, immunos were performed on all cases of malignant undifferentiated neoplasms and were able to resolve the issue in over 89% of such cases. Immunos were also performed on 54.74% of metastatic tumors. Lymph nodes were the commonest organs on which immunos were performed i.e. 96.50% of lymph node tumors, followed by CNS and renal neoplasms with 33.01% and 25.92% respectively

Daily harvested energy of cadmium telluride thin Film photovoltaic

The power generated by solar photovoltaic (PV) is highly affected by the weather environment. Thin-Film solar module of cadmium telluride (CdTe) is one of the Semi-transparent PV (STPV) that can be employed in a wide application range as a means to sunlight permeability while supplying solar electrical energy with some shading which also preferable in hot areas. The system behavior and the forecast of a STPV harvested energy requires an accurate and reliable discribtion for the power pattern rate during the day time. This research presents a real-time daily measurements for CdTe PV modules that serve the system design, prediction, and modeling. Multilayer and single installation categories are configured to be experimentally tested at different weather conditions (temperature and irradiance). The measurements were conducted at UPM University, Serdang, Malaysia, where a 6 different modules are expreinced. A wireless monitoring system with high sampling frequency employed for this purose. The results show an efficiency of 2.51 as a maximum in cloudy day conditions, while the harvested daily energy show that a multi-layer configuration may only be effective when the transparency is high. This new generation of PV module is similar to that for Silicon-based PV but it has threshold value to start power generating and promises for efficient sustainable building materials

Depression, sleeping pattern, and suicidal ideation among medical students in Bangladesh: a cross-sectional pilot study

© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Background: Depression is a major morbidity and the most common mental disorder among the medical students in medical schools globally. Undergraduate students suffer stress more due to their academic curriculum than the students of other faculties. In low-resource settings like Bangladesh, there is a dearth in research on the mental health of undergraduate medical students. This pilot study was conducted to add to the existing limited evidence by reporting the prevalence of depression and describing sleeping pattern and suicidal tendencies among medical students. Relevantly, we have investigated the overall mental health status among the medical students in Bangladesh. Methods: This cross-sectional study was conducted in two medical colleges of Dhaka between July 2013 and December 2013, among 221 Bangladeshi medical students from first to fifth year. By the convenience sampling technique, data were collected by a pretested, structured, self-administered questionnaire and analysis was done by SPSS version 18.0. Depression was assessed by the validated Patient Health Questionnaire-9 (PHQ-9) tool among the respondents. Goldberg’s General Health Questionnaire (GHQ-28) was used for assessing overall mental health status. Results: Depression was found in 38.9% of participants, with 3.6%, 14.5%, and 20.8% being severe, moderate, and mild depression, respectively. 17.6% of medical students had suicidal tendency or attempted suicide at least once after attending medical school. The sleeping hours were inadequate and altered after starting this stressful academic course. 33.5% of medical students had poor mental health status. There was a statistically significant association between poor mental health status in the age group less than 22 years old and initial academic study year (1st to 3rd of MBBS). Conclusion: The findings are suggestive of a higher prevalence of depression among early-year medical students and marginal predominance in males. Suicidal tendency is also higher. This calls for further investigation with situation analysis, qualitative explorations, and surveys to explore the burden of such disorders in Bangladesh

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely