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   2016| May-August  | Volume 23 | Issue 2  
    Online since April 21, 2016

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Ramadan fasting is not usually associated with the risk of cardiovascular events: A systematic review and meta-analysis
Tanvir C Turin, Salim Ahmed, Nusrat S Shommu, Arfan R Afzal, Mohammad Al Mamun, Mahdi Qasqas, Nahid Rumana, Marcus Vaska, Noureddine Berka
May-August 2016, 23(2):73-81
DOI:10.4103/2230-8229.181006  PMID:27186152
Over one billion Muslims worldwide fast during the month of Ramadan. Ramadan fasting brings about some changes in the daily lives of practicing Muslims, especially in their diet and sleep patterns, which are associated with the risk of cardiovascular diseases. Over the years, many original studies have made the effort to identify the possible impact of the Ramadan fast on cardiovascular diseases. This systematic review and meta-analysis is an attempt to present the summary of key findings from those articles and an appraisal of selected literature. A systematic search using keywords of “;Ramadan fasting” and “;cardiovascular diseases” was conducted in primary research article and gray-literature repositories, in combination with hand searching and snow balling. Fifteen studies were finally selected for data extraction on the outcomes of stroke, myocardial infarction, and congestive heart failure. The analysis revealed that the incidence of cardiovascular events during the Ramadan fast was similar to the nonfasting period. Ramadan fast is not associated with any change in incidence of acute cardiovascular disease.
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Preconception care in Saudi women with diabetes mellitus
Amal Y Madanat, Eman A Sheshah
May-August 2016, 23(2):109-114
DOI:10.4103/2230-8229.181012  PMID:27186158
Background: The rate of preexisting diabetes mellitus (DM) in Saudi Arabia is one of the highest in the world. The role of preconception care (PCC) is well-established as a means of improving pregnancy outcomes in DM. Objectives: To assess the rate of preconception counseling, the level of PCC knowledge, and the rate of unplanned pregnancies in Saudi women with DM. Materials and Methods: A cross-sectional study was conducted among 355 Saudi women aged 18–49 years with self-reported DM. The study questionnaire contained variables about the provision of preconception counseling, knowledge of PCC facts, and the number of unplanned pregnancies after developing DM. The level of PCC knowledge was evaluated using a modified Likert scale. Statistical Package for Social Sciences 20 was used for statistical analysis. Descriptive statistics, mean and standard deviation, and percentages were calculated; t-test was used for statistical significance. Results: About one-third of the participants had received preconception counseling after being diagnosed with DM. Counseling on PCC for older and married participants was significantly less. Of the 355 participants, 42.8% had little or no PCC knowledge. All pregnancies that occurred after developing DM were unplanned. Conclusions: The rate of preconception counseling, the level of PCC knowledge in the studied Saudi women with DM is suboptimal, and none of the pregnancies that occurred after developing DM was planned. The study highlights the need for PCC programs that target all Saudi women of child-bearing age with DM, and their families starting at the age of puberty and at diagnosis of type 2DM, to optimize women's health and improve pregnancy outcomes.
  10 2,980 379
Can the management of blood sugar levels in gestational diabetes mellitus cases be an indicator of maternal and fetal outcomes? The results of a prospective cohort study from India
Rajesh Jain, Sanjeev Davey, Anuradha Davey, Santosh K Raghav, Jai V Singh
May-August 2016, 23(2):94-99
DOI:10.4103/2230-8229.181002  PMID:27186155
Background: Gestational diabetes mellitus (GDM) is emerging as an important public health problem in India owing to its increasing prevalence since the last decade. The issue addressed in the study was whether the management of blood sugar levels in GDM cases can predict maternal and fetal outcomes. Materials and Methods: A prospective cohort study was done for 1 year from October 1, 2013, to September 31, 2014, at 652 diabetic screening units as a part of the Gestational Diabetes Prevention and Control Project approved by the Indian Government in the district of Kanpur, state of Uttar Pradesh. A total of 57,108 pregnant women were screened during their 24–28th weeks of pregnancy by impaired oral glucose test. All types of maternal and perinatal outcomes were followed up in both GDM and non-GDM categories in the 2nd year (2013–2014) after blood sugar levels were controlled. Results: It was seen that for all kinds of maternal and fetal outcomes, the differences between GDM cases and non-GDM cases were highly significant (P < 0.0001, relative risk >1 in every case). Moreover, perinatal mortality also increased significantly from 5.7% to 8.9% when blood sugar levels increased from 199 mg/dl and above. Perinatal and maternal outcomes in GDM cases were also significantly related to the control of blood sugar levels (P < 0.0001). Conclusion: Blood sugar levels can be an indicator of maternal and perinatal morbidity and mortality in GDM cases, provided unified diagnostic criteria are used by Indian laboratories. However, to get an accurate picture on this issue, all factors need further study.
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Esophageal eosinophilia in secondary adrenal insufficiency
Chetana Sen, Krishnarpan Chatterjee
May-August 2016, 23(2):120-121
DOI:10.4103/2230-8229.181005  PMID:27186162
  2 1,651 167
Proportion and determinants of tuberculosis among human immunodeficiency virus-positive patients attending the antiretroviral therapy center attached to a Medical College in South India
Vandana Hiregoudar, Bellara Raghavendra, Aravind Karinagannavar, Wahid Khan, Sneha Kamble, Timmalapur G Goud
May-August 2016, 23(2):88-93
DOI:10.4103/2230-8229.181009  PMID:27186154
Background: The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic has caused a re-emergence of tuberculosis (TB). In persons infected with both HIV and TB, the lifetime risk of developing TB disease is 50–70% compared to 10% in HIV-negative individuals. India has world's 3rd highest HIV burden and is also one of the countries endemic for TB, so the country faces a dual epidemic of HIV and TB. Objectives: To find out the proportion and determinants of TB in HIV-positive subjects. Subjects and Methods: This study was undertaken at the ART center from June 01, 2012, to May 31, 2013. HIV-positive subjects aged above 15 years who had been on antiretroviral therapy (ART) for more than 6 months were included in the study. Nonprobability purposive sampling was adopted. A predesigned semi-structured questionnaire was used to obtain data. Results: A total of 536 HIV-positive people were interviewed, 58.8% of whom were males, 79.1% were Hindu, 61.0% had up to high school education, and 57% were unskilled laborers. About 63% were married, 40% were from the upper lower class, and 60% were from urban areas. For the majority (89.1%), the probable mode of transmission of HIV was by the heterosexual route. TB co-infection was present in 38.4% subjects. The most common form of TB was extra-pulmonary in subjects on antituberculous treatment (47.3%) and among old cases (57.6%). On bivariate analysis, 136 (42.4%) married subjects and those from rural areas were more commonly affected by TB compared to subjects who were unmarried and from urban areas with odds ratio (OR): 1.555, confidence interval (CI): 1.077–2.246 and OR: 1.523, CI: 1.061–2.185, respectively. The proportion of TB was high among subjects who lived in overcrowded houses 130 (44.2%), and who had a habit of alcohol use compared to others with OR: 1.731, CI: 1.734–2.179 and OR: 1.524, CI: 1.045–2.223, respectively. Logistic regression analysis showed that TB among people living with HIV/AIDS was highest in persons living in overcrowded houses (OR: 1.706, CI: 1.185–2.458) and those who consumed alcohol (OR: 1.605, CI: 1.090–2.362). Conclusions: Demographic factors like male gender, middle age, living in the rural areas, consumption of alcohol, and living in overcrowded houses were found with a higher proportion of TB. The use of highly active ART appeared to progressively decrease but did not completely eliminate the risk of TB.
  2 2,422 343
The association between physical activity and overweight and obesity in a population of children at high and low altitudes in Southwestern Saudi Arabia
Humeda S Ahmed, Mohammed E.M. Khalid, Osama M Osman, Mansour A Ballal, Fahaid H Al-Hashem
May-August 2016, 23(2):82-87
DOI:10.4103/2230-8229.181011  PMID:27186153
Objective: To assess the relationship between overweight and obesity and physical activity in Saudi children born and permanently domiciled at high and low altitudes in Southwestern Saudi Arabia. Subjects and Methods: A cross-sectional study of 145 healthy Saudi children aged 10–15 years who were born and lived permanently at high altitude (3000–3100 m) and 154 healthy Saudi children of comparable age who were born and lived permanently at a relatively low altitude (500 m) was conducted. For each subject selected, body weight and body height were measured using an Avery beam weighing scale and a stadiometer, respectively. Body mass index (BMI) was calculated using the equation BMI = (weight [kg]/height [m2]). Physical activity scores were determined using International Physical Activity Questionnaire-Short Form-A. Resting radial pulse rate (beat/minutes) was determined clinically. Results: Physical activity was significantly and inversely associated with overweight and obesity in boys at both high (χ2 = 15.8, P< 0.001) and low (χ2 = 14.7, P< 0.001) altitudes, but there was no clear trend for girls at either altitude. The lack of association between physical activity and overweight and obesity in girls was attributed to the low and homogeneous level of physical activity. Conclusion: Physical activity should be encouraged as a strategy for weight reduction in the overweight and the obese and the prevention of overweight and obesity in Saudi children at high and low altitudes.
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The unexpected truth about dates and hypoglycemia
Mohammed I Yasawy
May-August 2016, 23(2):115-118
DOI:10.4103/2230-8229.181008  PMID:27186159
Background: Dates are a concentrated source of essential nutrients, vitamins, minerals, and carbohydrates (CHOs), which are necessary for the maintenance of optimum health. Most of the CHOs in dates come from sugars including glucose and fructose. Dates are commonly consumed in Saudi Arabia, particularly at the time of breaking the fast to provide instant energy and maintain blood sugar level. However, dates may cause hypoglycemia in a rare condition named as heredity fructose intolerance (HFI), and a few families have been to see us with a history of that nature. This is to report the preliminary results of an on-going study of a group of patients who get symptoms of hypoglycemia following the ingestion of dates and have suffered for years without an accurate diagnosis. Methodology: This report is based on three patients, from the same family, living in a date growing region of the Kingdom of Saudi Arabia (KSA). The patients had been to several medical centers without getting any definite answers or diagnosis until they were referred to the Gastroenterology Clinic of King Fahd Hospital of the University, Al-Khobar, KSA. The data were obtained by careful history and laboratory investigations, and a final diagnosis of HFI made on fructose intolerance test (FIT). Results: The patients reported that they had avoided eating dates because of various symptoms, such as bloating, nausea, and even hypoglycemia when larger amounts were consumed. Their other symptoms included sleepiness, sweating, and shivering. After full examinations and necessary laboratory tests based on the above symptoms, FIT was performed and the patients were diagnosed with HFI. They were referred to a dietitian who advised a fructose-free diet. They felt well and were free of symptoms. Conclusion: HFI may remain undiagnosed until adulthood and may lead to disastrous complications and even death. The diagnosis can only be suspected after a careful dietary history is taken supported by FIT. This can prevent serious complications. Restricting dietary fructose may give relief from symptoms in a high proportion of patients with this disorder.
  1 2,500 296
Erratum: Control of type 2 diabetes in King Abdulaziz Housing City (Iskan) population, Saudi Arabia

May-August 2016, 23(2):122-122
DOI:10.4103/2230-8229.179381  PMID:27186163
  - 1,622 173
Vitamin D for infants
Manas P Roy
May-August 2016, 23(2):119-119
DOI:10.4103/2230-8229.181003  PMID:27186160
  - 1,533 197
Author's Reply
Afrah I Babli, Kasim M AlDawood, Ammar H Khamis
May-August 2016, 23(2):119-120
  - 1,388 172
Gender inequality in acute coronary syndrome patients at Omdurman Teaching Hospital, Sudan
Hyder O Mirghani, Mohammed A Elnour, Akasha M Taha, Abdulateef S Elbadawi
May-August 2016, 23(2):100-104
DOI:10.4103/2230-8229.181007  PMID:27186156
Background: Gender differences among patients with the acute coronary syndrome is still being debated, no research has been done on gender inequality among coronary syndrome patients in Sudan. Objectives: To study gender differences in presentation, management, and outcomes of acute coronary syndrome in Sudan. Subjects and Methods: This cross-sectional descriptive longitudinal study was conducted in Omdurman Teaching Hospital between July 2014 and August 2015. Patients were invited to sign a written informed consent form, were interviewed and examined by a physician, and then followed during their hospital stay. Information collected includes coronary risk factors, vital signs, echocardiography findings, arrhythmias, heart failure, cardiogenic shock, and death. The Ethical Committee of Omdurman Teaching Hospital approved the research. Results: A total of 197 consecutive acute coronary syndrome patients were included, 43.1% were females. A significant statistical difference was evident between males and females regarding the type of acute coronary syndrome, its presentation, and time of presentation to the hospital, smoking, and receipt of thrombolysis (P < 0.05). No differences were found with regard to age, hypertension, diabetes, family history of myocardial infarction, percutaneous coronary intervention, and in-hospital acute coronary complications (P > 0.05). Conclusion: Women were less likely to receive thrombolytic therapy, present with chest pain, and diagnosed with ST-segment elevation myocardial infarction. No gender differences were found in acute coronary syndrome risk factors apart from smoking, which was more common in males, and there were no differences between males and females as regards in-hospital complications.
  - 2,479 297
Seroprevalence of erythrovirus B19 in Saudi pregnant women
Ayman K Johargy
May-August 2016, 23(2):105-108
DOI:10.4103/2230-8229.181010  PMID:27186157
Background: Erythrovirus B19 infection is associated with clinical symptoms that range from mild to severe. The common clinical presentation of B19 virus (B19V) infection is erythema infectiosum, arthropathy, aplastic crisis, and fetal infection. Infection in seronegative pregnant women can lead to fetal hydrops. Objectives: To determine the seroprevalence of immunoglobulin G (IgG) to erythrovirus B19 in Saudi pregnant women in the cities of Makkah and Jeddah in Saudi Arabia. Materials and Methods: A total of 364 blood (serum) samples were tested for erythrovirus B19-specific-IgG antibody in Saudi pregnant women in the cities of Makkah and Jeddah in Saudi Arabia. Results: Erythrovirus B19-specific-IgG antibodies were detected in 182/364 (50%) of Saudi pregnant women of different age groups. Conclusion: This study indicated that B19V is clearly circulating in the community in a way that is similar to what is found in most nontemperate countries.
  - 2,121 218


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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010