Pregnant women’s use and attitude toward herbal,vitamin, and mineral supplements in an academic tertiary care center,Riyadh, Saudi Arabia

Background

Herbal medicine has been widely utilized by pregnant women despite the limited available evidence regarding the safety and efficacy of that practice. The current available studies, from different countries, estimated that the use of herbal medicine during pregnancy range from 7% up to 96%. The aim of this study is to determine the prevalence, attitude, source of information, and reasoning behind the use of herbal medicine among pregnant women in Saudia Arabia.

Case Report: 49, XXXXY syndrome and high myopia

49, XXXXY karyotype syndrome has been thought of as a variant of Klinefelter's syndrome. It has an incidence of between 1/85 000 to 1/100 000 live births. Typical clinical features include coarse faces, skeletal abnormalities, hypogenitalism and severe learning difficulties. Common ocular features include hypertelorism, epicanthic folds and up-slanting palpebral apertures. Here we report a case of high myopia and its successful correction leading to a positive personality change in one such patient. We advocate full ophthalmic examination, under anaesthesia if necessary, and a trial of refractive correction, even in children thought unlikely to tolerate such.     

Quality of life among epileptic patients in Qassim Region,KSA

Objectives:To explore the influence of epilepsy on quality of life (QoL) among people with epilepsy in Saudi Arabia, and its association with sociodemographic and clinical characteristic aspects in the Qassim region.Methods:A cross-sectional multi-centered study done in the Qassim region from June 2018 to May 2019. A self-administered questionnaire was provided to 216 participants who attended the neurology clinic. We used a validated Arabic version of the QoL in Epilepsy (QOLIE-31) to measure the QoL.Results:The mean of the overall QOLIE-31 score was 64.23 ± 17.8. we found that employment status had a significant influence on the overall score (p<0.001) and all other QOL domains (rho ranged from -.136 for energy fatigue to -.193 for social function) Patients with focal seizures were significantly higher in emotional wellbeing (rho=-.159), seizure worry (rho=-.226), cognitive function (rho=-.166) and overall score (p=0.010) than patients with the generalized type. Monotherapy patients have higher scores in total (p<0.001) and all subscales except seizure worry and emotional wellbeing than those on polytherapy.Conclusion:Employment status, type of seizure, and AED number are the most important factors affecting Saudi patient’s QoL.

Many studies in multiple countries have tested quality of life (QoL) in epilepsy, and have highlighted areas of common concern. It has been shown that among Arabian people, epileptic patients are generally more susceptible to having higher levels of anxiety and depression.1 In Kenya, researchers have compared QoL between persons with epilepsy (PWE) and healthy people who have the same environment, social relationship, and living circumstances. These authors found that low education level, unemployment rate, unskilled employment, and low income were higher in PWE compared to their non-epileptic accompanying people.2 Despite the high prevalence rate in Saudi Arabia (6.54 per 1000),3 there has been limited research about the impact of QoL in epileptic patients. To better identify the factors that influence Saudi epilepsy patients, here we explore the influence of epilepsy on QoL among Saudi epileptic patients.     

Preparation and characterization of co-processed starch/MCC/chitin hydrophilic polymers onto magnesium silicate

It was aimed to investigate the compressibility, compactibility, powder flow and tablet disintegration of a new excipient comprising magnesium (Mg) silicate co-processed (5%–85% w/w) onto chitin, microcrystalline cellulose (MCC) and starch as the hydrophilic polymers of interest. Initially, the mechanism of tablet disintegration was studied by measuring water infiltration rate, moisture sorption, swelling capacity and hydration ability. Moreover, the powders compression behavior was carried out by applying Kawakita model of compression analysis in addition to porosity and radial tensile strength measurements. In vitro drug release of compacts made of 400?mg ibuprofen and 300?mg of the hydrophilic polymers containing 30% w/w Mg silicate co-precipitate was investigated in phosphate buffer (pH 7.8). This work demonstrated that the incorporation of Mg silicate to the hydrophilic polymers lead to the improvement of powder flowability, compactibility, stability (with regard to storage conditions), compacts crushing strength, and disintegration time in addition to faster drug release. The overall findings are practically advantageous in the context of finding a low cost and multifunctional co-processed excipient of natural origins.     

Routine Trans-Abdominal Ultrasonography Before Laparoscopic Sleeve Gastrectomy: the Findings

Although some bariatric guidelines reserve pre-operative trans-abdominal ultrasonography screening for symptomatic patients and those with elevated liver enzymes, there has yet to exist a general consensus regarding this issue. Some centers still employ its use as a vital step in the workup of the bariatric patient. This study aims to observe the prevalent findings on routine pre-operative trans-abdominal ultrasonography when used as a screening tool prior to laparoscopic sleeve gastrectomy (LSG). All patients undergoing LSG were screened pre-operatively with trans-abdominal ultrasonography. A retrospective study was done of the pre-operative ultrasonography results of patients who underwent LSG at Amiri Hospital from 2008 to 2012. A total of 747 patients were included in the study, with a median age of 36 (15–68). Five hundred ninety (79.0 %) patients were females while 157 (21.0 %) were males, with an overall median body mass index (BMI) of 45 (30–90). Two hundred forty patients (32.1 %) had normal pre-operative ultrasonography results, 83 (11.1 %) were found to have gallstones, 427 (57.2 %) had fatty liver, and 55 (7.4 %) had other pathologies. There was no statistically significant association between BMI and gallstones (p?=?0.545) and BMI and fatty liver (p?=?0.418). Trans-abdominal ultrasonography screening prior to LSG revealed a wide range of findings but does not add significant information to the pre-operative workup of patients undergoing the procedure and should be reserved for indicated patients.     

Laser Assisted Double-Layer Endoscopic Repair of Laryngeal Clefts: Our Experience in 11 Cases

Laryngeal cleft is a rare congenital malformation of the respiratory tract leading to a high level of morbidity and mortality, recently being diagnosed with increased frequency. Management throughout the years included medical and surgical. The open surgical technique is more commonly used although it has higher risk and need longer post-operative care. Recently surgical endoscopic repair was introduced using different techniques. To evaluate the clinical features of infants and children presenting with laryngeal clefts, and review endoscopic management modality especially the technique and results of repair using double-layer (2 layers) technique. Outlining our experience with the surgical technique, complications arising from surgery as well as surgical outcome by evaluating the decannulation rate and cessation of the assisted feeding by the end of treatment. Retrospective case series study. Review of infant and children seen in our clinic with the diagnosis of laryngeal cleft from January 2012 till June 2014., and treated by CO₂ laser assisted double-layer endoscopic closure. The presenting symptoms, patient demographics, diagnostic procedure, cleft type, surgical outcome and complications all were evaluated. We revised the case notes of 34 patients with a workable diagnosis of Laryngeal cleft. A total of 11 patients met our criteria and were included in the study. Clefts typing was according to modified Benjamin–Ingles classification, type 1 (n = 9) and type 2 (n = 2). All clefts were closed endoscopically by CO₂ laser incision of the mucosa and two-layer endoscopic closure of the cleft without postoperative intubation or tracheotomy. They accepted oral feeding within 5 postoperative days (range 3–11 days). 5 out of 6 patients (83.3%) successfully stopped nasogastric feeding and 1 out of 2 patients successfully weaned from nasal cannula. One patient deceased few months after surgery due to other medical problems. Two patients needed redo after burst of the upper cleft stitches immediately after repair by iatrogenic cause during suctioning. The repair was stable in all patients during the second look 6 weeks after surgery with no recurrence or fistula formed. There were no clinically significant observed complications with this technique. After a mean follow up of 24 months, all children have a good voice, have no sign of residual aspiration, and less hospital admissions. Laryngeal cleft should be suspected in children presenting with recurrent pneumonia and difficulties during feeding. Endoscopic repair is a successful and safe technique for treating laryngeal clefts, and has short post-operative recovery without postoperative intubation or tracheotomy. Using the double-layer technique appeared to be promising but needs more comparative studies in the future.