Dietary, Psychological and Lifestyle Factors Associated with Premenstrual Symptoms

Purpose

To measure the associations of diet, psycological distress, and lifestyle factors with premenstrual symptoms (PMSx) in women in Riyadh, Saudi Arabia.

Patients and Methods

An interview-based, cross-sectional study was conducted on 1831 women aged 18-50 years seen in primary healthcare centers and teaching institutes in Riyadh from December 2015 to June 2016. Question topics included sociodemographics, physical activity, smoking, and dietary habits information. PMSx were assessed using a symptom checklist with 6 domains: anxiety/mood changes; abdominal/back/joint pain; increased appetite/weight gain, breast pain/tenderness, severe headache, and ≥3 PMS symptoms (any). Multivariable logistic regression analyses were conducted to provide adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with each PMSx domain.

Results

Except for breast pain, drinking >5 cups of Arabic coffee was associated with increased odds of anxiety/mood [aOR 2.44 (95% CI 1.44, 4.12)], pain [1.83 (1.13, 2.98)], appetite/weight gain [1.66 (1.10, 2.50)], headache [1.57 (1.00, 2.56)] and ≥3 symptoms [1.50 (1.07, 2.11)]. A significant association was noted between sugar intake and anxiety/mood symptoms [1.53 (1.07, 2.19)] and abdominal/back pain symptoms [1.84 (1.17, 2.88)]. Increased severity of psychological distress was associated with all symptom domains: anxiety/mood [2.75 (1.92, 3.94)]; pain [1.45 (0.92, 2.28)]; appetite/weight gain [2.01 (1.53, 2.65)]; breast pain [2.19 (1.68, 2.88)]; headache [1.86 (1.37, 2.54)] and ≥3 symptoms [3.52 (2.49, 4.95)]. Low physical activity was significantly associated with odds of breast pain symptoms [1.29 (1.04, 1.59)]. Smokers were 3.41 (1.19, 9.77) times as likely to report any ≥3 symptoms compared to nonsmokers.

Conclusion

Several potentially modifiable factors, such as diet and stress, were positively associated with PMSx. Thus, we suggest that increasing women's awareness of healthy lifestyles, particularly diet and stress reduction, may help to reduce the occurrence of premenstrual symptoms.

Size optimization of carfilzomib nanocrystals for systemic delivery to solid tumors

Carfilzomib (CFZ) is a second-generation proteasome inhibitor effective in blood cancer therapy. However, CFZ has shown limited efficacy in solid tumor therapy due to the short half-life and poor tumor distribution. Albumin-coated nanocrystal (NC) formulation was shown to improve the circulation stability of CFZ, but its antitumor efficacy remained suboptimal. We hypothesize that NC size reduction is critical to the formulation safety and efficacy as the small size would decrease the distribution in the reticuloendothelial system (RES) and selectively increase the uptake by tumor cells. We controlled the size of CFZ-NCs by varying the production parameters in the crystallization-in-medium method and compared the size-reduced CFZ-NCs (z-average of 168 nm, NC₁₆₈) with a larger counterpart (z-average of 325 nm, NC₃₂₅) as well as the commercial CFZ formulation (CFZ-CD). Both CFZ-NCs showed similar or higher cytotoxicity than CFZ-CD against breast cancer cells. NC₁₆₈ showed greater uptake by cancer cells, less uptake by macrophages and lower immune cell toxicity than NC₃₂₅ or CFZ-CD. NC₁₆₈, but not NC₃₂₅, showed a similar safety profile to CFZ-CD in vivo. The biodistribution and antitumor efficacy of CFZ-NCs in mice were also size-dependent. NC₁₆₈ showed greater antitumor efficacy and tumor accumulation but lower RES accumulation than NC₃₂₅ in 4T1 breast cancer model. These results support that NC formulation with an optimal particle size can improve the therapeutic efficacy of CFZ in solid tumors.

C47. Heparin Induced Thrombocytopenia (HIT) Associated with Multiple Deep Vein Thrombosis (DVT) and Intracardiac Thrombus Who Underwent Vena Cava Filter Prior to Surgical Thrombus Evacuation : a Case Report

Background

Heparin-induced thrombocytopenia (HIT) is a serious adverse drug reaction that increases patient’s risk of developing venous or arterial thromboembolism, which maybe life-threatening. The frequency varies from 0.5% to 5%, depending on population studies. This condition will worsen especially in patients with deep vein thrombosis.

Case

A 52 years old woman was reported swelling and decreased saturation of the lower extremities, with a history of Heparin therapy for 5 days before being referred to Haji Adam Malik Hospital Medan. Platelet count on admission day was 225.000/µl but dropped into 64.000/µl in the 7th post heparin treatment day. Doppler examination showed multiple thrombosis in deep femoral vein and and sign of stenosis peripheral artery. Echocardiography showed intracardiac thrombus without sign of acute pulmonary embolism. Two days after discontinuation of heparin, the platelet still tend to be low but in the next days, its count increases to within normal range. Due to the high risk of embolism, it was decided to place a vena cava filter prior to surgery for thrombus evacuation.

Discussion

This case demonstrates several interesting aspects of HIT, including thrombotic complication, limitation tools to support diagnosis of HIT, how to prepare this patient into surgical management, and the last is placing a IVCF prior to surgical thrombus evacuation and thrombectomy to reduce the risk of thromboemboli before surgical treatment. This is the first time procedure in Medan for placing a vena cava filter in a DVT patients who have contraindication to heparin administration.

C47. Heparin Induced Thrombocytopenia (HIT) Associated with Multiple Deep Vein Thrombosis (DVT) and Intracardiac Thrombus Who Underwent Vena Cava Filter Prior to Surgical Thrombus Evacuation : a Case Report

Background

Heparin-induced thrombocytopenia (HIT) is a serious adverse drug reaction that increases patient’s risk of developing venous or arterial thromboembolism, which maybe life-threatening. The frequency varies from 0.5% to 5%, depending on population studies. This condition will worsen especially in patients with deep vein thrombosis.

Case

A 52 years old woman was reported swelling and decreased saturation of the lower extremities, with a history of Heparin therapy for 5 days before being referred to Haji Adam Malik Hospital Medan. Platelet count on admission day was 225.000/µl but dropped into 64.000/µl in the 7th post heparin treatment day. Doppler examination showed multiple thrombosis in deep femoral vein and and sign of stenosis peripheral artery. Echocardiography showed intracardiac thrombus without sign of acute pulmonary embolism. Two days after discontinuation of heparin, the platelet still tend to be low but in the next days, its count increases to within normal range. Due to the high risk of embolism, it was decided to place a vena cava filter prior to surgery for thrombus evacuation.

Discussion

This case demonstrates several interesting aspects of HIT, including thrombotic complication, limitation tools to support diagnosis of HIT, how to prepare this patient into surgical management, and the last is placing a IVCF prior to surgical thrombus evacuation and thrombectomy to reduce the risk of thromboemboli before surgical treatment. This is the first time procedure in Medan for placing a vena cava filter in a DVT patients who have contraindication to heparin administration.

Scalable Production of Ambient Stable Hybrid Bismuth-Based Materials: AACVD of Phenethylammonium Bismuth Iodide Films*

Large homogeneous and adherent coatings of phenethylammonium bismuth iodide were produced using the cost-effective and scalable aerosol-assisted chemical vapor deposition (AACVD) methodology. The film morphology was found to depend on the deposition conditions and substrates, resulting in different optical properties to those reported from their spin-coated counterparts. Optoelectronic characterization revealed band bending effects occurring between the hybrid material and semiconducting substrates (TiO2 and FTO) due to heterojunction formation, and the optical bandgap of the hybrid material was calculated from UV-visible and PL spectrometry to be 2.05 eV. Maximum values for hydrophobicity and crystallographic preferential orientation were observed for films deposited on FTO/glass substrates, closely followed by values from films deposited on TiO2 /glass substrates.

Thiel-embalmed porcine placenta: A valid and reusable microsurgical practice model

BACKGROUND

Simulation models are increasingly important for skill acquisition during microsurgery training. Prosthetics, living and non-living biological models have been proposed in the literature in the optics of recreating real-life scenarios in a controlled environment. This study aims to validate and prove the reusability of a novel non-living biological model: the porcine placenta.

METHODS

A prospective comparative study was carried out to assess face and content validities of the proposed model, as well as the reusability and quality of the Thiel-embalming method. Participants were asked answer a questionnaire for each anastomosis they performed on porcine placental vessels of ≤2mm (small) and 2-4mm (large). Scores were classified according to different subgroups, either small or large vessels and first or second sessions. Reliability analysis of the questionnaire was carried out using Cronbach's α, to ensure an α>0.7. Median scores for each question were analyzed using boxplots and compared amongst each subgroup using a non-parametric independent Mann-Whitney U test.

RESULTS

With nine participants, the Cronbach's α for each category of question was 0.867, 0.778, 0.720 and 0.593. Statistical differences were found between responses of small and large vessels on 5/10 questions, where large vessels reported higher validity. No statistical differences were found between scores of the first and second sessions.

CONCLUSION

By evaluating face and content validity, the Thiel-embalmed porcine placenta has proven its suitability as a microsurgery model, especially for vessels of larger caliber. Qualities that distinguish this model is its reliable reusability, its low cost-effectiveness, and its ethical acceptability.

Ovarian Cancer in Morocco: Diagnosis and Outcome

Background: Ovarian cancer is the fifth most common cancer and the fourth leading cause of cancer death among women in northern Africa, with an estimated 5050 new cancer cases and 3509 deaths from cancer in 2012 ( GLOBOCAN 2012 ). Aim: This study was conducted to determine the epidemiologic characteristics of ovarian cancer in Morocco. Methods: This is a descriptive retrospective study of ovarian cancer cases, diagnosed and treated at Al Azhar Oncology Center in Rabat between 2005 and 2015. Results: There were 164 new cases of ovarian cancer diagnosed at Al Azhar Oncology Center, accounting for 3.5% of all cancers affecting women reported during 2005-2015. During this period, ovarian cancer was the third most common cancer and the third leading cause of cancer death after breast and cervical cancer among women. The average age at diagnosis of ovarian cancer was 52.5 ± 13.3 years (range 18-81 years). The risk of developing the disease is associated with age, 91.1% of cases were diagnosed in women aged 35 years and older, with 70.2% of new ovarian cancer cases occurring among those aged 35-64 years. A 43-year-old woman was diagnosed with metastatic disease. Among all detected cases, 18 (11%) died during the study period, accounting for 6.6% of all female cancer deaths. Conclusion: Ovarian cancer is a preventable disease, and a significant decrease in incidence and mortality can be expected as a result of population-based screening programs, which rely on regular preventive examinations to search for precancerous changes and to prevent the development of malignant tumors.

Prostate Cancer in Morocco: The Epidemiological Evidence

Background: Prostate cancer is one of the most common types of cancer in men. It is the fourth most common cancer and the fourth leading cause of cancer death among men after liver, lung and bladder cancer in northern Africa, with an estimated 7548 new cancer cases and 5000 deaths from cancer in 2012, the most recent year for which international estimates are available ( GLOBOCAN 2012 ). Aim: The aim of this study is to determine the prevalence and the epidemiologic characteristics of prostate cancer in Morocco. Methods: This is a descriptive retrospective analysis of prostate cancer cases, diagnosed and treated at Al Azhar Oncology Center in Rabat between 2005 and 2015. Results: During the period of study, there were 644 new cases diagnosed with prostate cancer at Al Azhar Oncology Center, accounting for 20% of all new cases of cancer in men reported during this period. The average age of the patients at diagnosis was 68.1 ± 9.6 years (range 8-97 years). The risk of developing prostate cancer is associated with advancing age, 97.7% of cases were diagnosed in men aged 50 years and older, with 85.1% of new cancer cases occurring among those aged 55-79 years. Among all detected cases, 6.5% were diagnosed with metastatic disease and 4.8% died during the study period. Conclusion: Prostate cancer is the second leading cause of death from cancer in elderly men. Early detection to improve prostate cancer outcome and survival remains the cornerstone of prostate cancer control.

Medical students' perception of test anxiety triggered by different assessment modalities

OBJECTIVES

Test anxiety is well known among medical students. However, little is known about test anxiety produced by different components of exam individually. This study aimed to stratify varying levels of test anxiety provoked by each exam modality and to explore the students perceptions about confounding factors.

METHODS

A self-administered questionnaire was administered to medical students. The instrument contained four main themes; lifestyle, psychological and specific factors of information needs, learning styles, and perceived difficulty level of each assessment tool.

RESULTS

A highest test anxiety score of 5 was ranked for "not scheduling available time" and "insufficient exercise" by 28.8 and 28.3% students, respectively. For "irrational thoughts about exam" and "fear to fail", a highest test anxiety score of 5 was scored by 28.8 and 25.7% students, respectively. The highest total anxiety score of 1255 was recorded for long case exam, followed by 975 for examiner-based objective structured clinical examination. Excessive course load and course not well covered by faculty were thought to be the main confounding factors.

CONCLUSIONS

The examiner-based assessment modalities induced high test anxiety. Faculty is urged to cover core contents within stipulated time and to rigorously reform and update existing curricula to prepare relevant course material.

From The Mine to Cancer Therapy: Natural and Biodegradable Theranostic Silicon Nanocarriers from Diatoms for Sustained Delivery of Chemotherapeutics

Drug delivery using synthetic nanoparticles including porous silicon has been extensively used to overcome the limitations of chemotherapy. However, their synthesis has many challenges such as lack of scalability, high cost, and the use of toxic materials with concerning environmental impact. Nanoscale materials obtained from natural resources are an attractive option to address some of these disadvantages. In this paper, a new mesoporous biodegradable silicon nanoparticle (SiNP) drug carrier obtained from natural diatom silica mineral available from the mining industry is presented. Diatom silica structures are mechanically fragmented and converted into SiNPs by simple and scalable magnesiothermic reduction process. Results show that SiNPs have many desirable properties including high surface area, high drug loading capacity, strong luminescence, biodegradability, and no cytotoxicity. The in-vitro release results from SiNPs loaded with anticancer drugs (doxorubicin) demonstrate a pH-dependent and sustained drug release with enhanced cytotoxicity against cancer cells. The cells study using doxorubicin loaded SiNPs shows a significantly enhanced cytotoxicity against cancer cells compared with free drug, suggesting their considerable potential as theranostic nanocarriers for chemotherapy. Their low-cost manufacturing using abundant natural materials and outstanding chemotherapeutic performance has made them as a promising alternative to synthetic nanoparticles for drug delivery applications.

Probing the structural and magnetic properties of a new family of centrosymmetric dinuclear lanthanide complexes

A series of centrosymmetric dinuclear lanthanide complexes, including Gd^III (1), Dy^​III (2), Ho^​III (3), Er^​III (4) and Yb^III (5), have been synthesized and studied for the effects of lanthanide contraction on their magnetic properties.

Terminal solvent effects on the anisotropy barriers of Dy2 systems

A family of three dinuclear dysprosium complexes, all of which exhibit single-molecule magnet behaviour under zero applied dc fields, have exemplified that terminally bonded solvent molecules can drastically impact slow magnetic relaxation properties.

Prevalence and factors associated with low bone mineral density in Saudi women: a community based survey

Background

Low bone mineral density (BMD) is a public health issue in Saudi Arabia. This study measured the prevalence and factors associated with low BMD in Saudi women in Riyadh, Saudi Arabia.

Methods

A cross sectional study using two stage cluster sampling technique was conducted in Riyadh, 2009. Thirty clusters, each comprising of 300 houses were randomly chosen and from each cluster 38–40 households were selected to identify 1150 women of >40 years. Women were invited to primary health care center for filling of self-administered questionnaire (n = 1069) comprising of sociodemographic, health, diet and physical activity variables. 1008 women underwent screening for low BMD using the quantitative ultrasound technique. 535 (53%) women with positive screening test were referred to King Khalid Hospital for Dual X-ray Energy absorptiometry (DXA).

Results

362 women underwent DXA and 212 (39.6%) were screened low BMD either at lumbar spine or femur neck. Mean age of women was 55.26(±8.84) years. Multivariate logistic analysis found; being aged 61 to 70 years (OR 2.75, 95% CI: 1.32-1.48), no literacy (OR 2.97, 95% CI:1.44 - 6.12) or primary education (OR 4.12, 95% CI:2.05-8.29), history of fractures (OR 2.20, 95% CI:1.03- 4.69) and not drinking laban(diluted yogurt) (OR 2.81, 95% CI:1.47- 5.37) significantly associated with low BMD.

Conclusions

Women with low level of education, who do not drink laban and had history of fractures were at high risk of low BMD.

Reassessment of the undergraduate educational environment in College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia

BACKGROUND

We reassessed the perception of all undergraduate students in Taibah medical college regarding the educational environment during the academic year 2010-2011 and compared it with the assessment carried out three years earlier in order to identify the change over time from previous assessment.

METHOD

In the present prospective study, the validated 50-item Dundee Ready Education Environment Measure (DREEM) inventory was collected from medical students of basic phase (n = 302) and clinical phase (n = 222) and compared the scores of students' responses with those of previous assessment 3 years earlier.

RESULTS

In the year 2007/2008 DREEM inventory scored 109.1/200 and scored 120.70/200 (p ≤ 0.0001) in the year 2010/2011. There was an interesting inclination of female students towards a more positively perceived learning environment as compared to male students (26/48 versus 24/48, p < 0.03). There were statistically significant differences in all domain components of DREEM between the academic years 2007/2008 and 2010/2011.

CONCLUSIONS

DREEM helped pinpoint areas of change in students' perception regarding many aspects of the educational environment. It also helped to identify areas that are still in need of improvement by the college's administration and staff. DREEM inventory can be used to monitor change over time in the educational environment.

Haemostatic and cytokine changes in gestational diabetes mellitus

BACKGROUND

Limited data indicate the existence of a hypercoagulable state and the possible involvement of pro-inflammatory cytokines in the pathogenesis of gestational diabetes mellitus (GDM).

AIM

To characterise the coagulation inhibitor and cytokine profiles in women with GDM.

METHODS

Two groups of women in the third trimester of pregnancy were studied: GDM (n = 150) and controls: women with normal pregnancy (n = 100); GDM in their first post-delivery day (n = 52). LABORATORY ASSAYS: Plasma fibrinogen, antithrombin (AT), protein C, total and free protein S, interleukins-2, 6 and 8 (IL-2, 6, 8).

RESULTS

During pregnancy, the only significant alterations noted were higher levels of body mass index, fibrinogen and total protein S in women with GDM when compared to normal pregnancy. In the post-delivery group, there was further elevation in the levels of plasma fibrinogen and significant drop in the level of total protein S, protein C and AT. Significant elevation of IL-2 and IL-6 levels was recorded only in post-delivery group.

CONCLUSION

In GDM, the only indicator of a tendency towards hypercoagulability is the higher fibrinogen levels as compared to normal pregnancy. This feature along with the higher body mass index and presumed associated insulin resistance suggests that GDM may be a mild form of the metabolic syndrome. The lack of significant change in the levels of pro-inflammatory cytokines do not support the existence of an inflammatory state in GDM.

Antenatal care in primary health care centres in Medina, Saudi Arabia, 2009: a cross-sectional study

This study evaluated antenatal care (ANC) services for pregnant women attending primary health care centres in Medina city, Saudi Arabia in 2009. A cross-sectional survey collected data on ANC tasks performed at visits by 394 pregnant women attending 7 clinics. ANC was assessed in 3 domains: clinical assessment (at the initial visit and return visit), health promotion and care provision. The mean duration of initial visits was 10.3 (SD 2.3) minutes and of return visits was 9.1 (SD 1.1) minutes. Overall performance on ANC tasks was fair. The significant predictors of ANC performance of tasks were: size of population served per centre; presence of more than 1 physician carrying out ANC at the centre; physician's age, mother tongue, nationality and qualifications; and woman's education and employment status. Having more physicians available for ANC in primary care centres could improve the standard of care.