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Thrombophilia, where multiple genetic and acquired risk factors interact synergistically, are associated with thrombosis and pregnancy-related complications. Despite being studied profusely, an inconsistent association exists between thrombophilia and pregnancy complications. Between 2018 and 2020, ninety-three women with pregnancy complications were enrolled in the study. Twenty-five healthy pregnant women without pregnancy complications reported to the same hospital were also recruited as controls. Blood samples were tested for homocysteine, coagulation studies, and molecular diagnosis included FVL, PTH and MTHFR genes amplified using PCR strip assay (Vienna Lab Diagnostics, Austria). Other thrombophilia screening, including testing for AT, PC, and LA, were done by chromogenic assays (Dade Diagnostica, Munich, Germany). Homocysteine level was determined by fluorescence polarization immunoassay technology (Axsym, Abbot company, Germany). Overall, 29.03% of women with pregnancy complications had thrombophilia relative to 16% in the control group. However, the difference between the case and control groups did not reach a significant level (p=0.1175). Additionally, combined thrombophilia was more prevalent among cases (10.75%) than in the control group (4%). However, the difference did not reach statistical significance (p=0.1046). Our study demonstrated that the frequency of thrombophilia among healthy women was 16%, and among women with pregnancy-related complications, 29%. Relative to control, all measured thrombophilia markers were more frequent in women with pregnancy-related complications except for LA. Including all the studies on the Saudi population in a meta-analysis study could reveal more information about thrombophilia and pregnancy-related complications in our population.

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Retroperitoneal schwannoma is a rare benign tumor of the peripheral nerve Schwann sheath. We, herein, report the case of a 74-year-old woman who presented with vague abdominal pain. Computed tomography imaging revealed a retroperitoneal mass that is medial to the right kidney. The patient underwent robotic excision of the tumor with the pathology revealing schwannoma. We report this case due to the scarcity of this disease entity, especially at this location and to emphasize the indication and value of robotic technology in different pathological processes retroperitoneally.

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OBJECTIVE: This study sought to evaluate the safety of induction of labour with prostaglandin E2 (PGE2) gel in grand multiparous (GMP) women and to compare the labour outcome of GMP women who have undergone one previous Caesarean section (CS) with that of GMP women who never had a previous CS. METHODS: This prospective cohort study (Canadian Task Force Classification II-2) evaluated induction of labour with 1 mg of PGE2 gel in 96 GMP women with one previous CS (study group) and in 104 GMP women without previous CS (control group). RESULTS: One uterine rupture occurred in the study group (1%), and another occurred in the control group (0.9%). Additional oxytocin was used in seven patients (7.3%) in the study group and in 28 others (26.9%) in the control group (P = 0.002). Both uterine ruptures occurred with oxytocin augmentation. One case of uterine scar dehiscence was found in the study group. There was no significant difference between the study group and the control group regarding the rate of vaginal delivery (74 [77.1%] vs. 78 [75%]) or the rate of CS (21 [21.9%] vs. 24 [23.1%]), respectively. There was no significant difference between the groups in 5-minute Apgar scores ≤7. There was no neonatal death in either group. CONCLUSION: A low dose (1.0 mg) of PGE2 gel for induction of labour in GMP women with one previous CS is appropriate and appears to be safe for both mother and baby. Augmentation by oxytocin should be used judiciously.

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OBJECTIVE: To study the prevalence of osteopenia and osteoporosis in healthy Saudi women, a community-based screening was carried out. METHODS: Three thousand and two hundred sixty-nine women in the young women in peak bone mass (PBM) age group and 3131 in the postmenopausal age (PMA) group were screened using Achilles Insight (GE, USA). Subjects included in the study were healthy and residents of eastern province. The screening was conducted between January 2006 and December 2007. The study took place in King Fahd University Hospital, Al-Khobar, Kingdom of Saudi Arabia. RESULTS: In the PBM age group, 2090 (63.9%) were normal, 791 (24.2%) were osteopenic and 388 (11.9%) were osteoporotic. Osteopenia was more common in single urban women compared to those who were married and living in rural areas (p<0.01 and p<0.001). Women with college education had significantly normal bone mass than women with less than high school education (p<0.01). In the PMA, 948 (30.3%) were osteopenic and 720 (23%) were osteoporotic. Osteopenic was more common in women in urban areas as compared to industrial and the rural areas (p<0.01). Those women whose education was less than primary had significantly more osteoporosis when compared to women with college education (p<0.001). CONCLUSION: In the PBM, 11.9% were osteoporotic and in PMA group 23% were osteoporotic. Factors that influenced the risk for osteopenia and osteoporosis included level of education, number of children, and place of living.

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OBJECTIVE: Osteoporosis and osteopenia among postmenopausal Saudi Arabian women are common to the extent of over 60%. Pregnancy, multiparity and prolonged lactation are suggested as factors modifying negatively in the development of osteoporosis. Earlier reports from the institution indicated a beneficial role of multiparity in postmenopausal osteoporosis (PMO). We conducted this study to measure the effect of parity on bone mineral density (BMD) measurement of lumbar spine and the upper femur. METHODS: We conducted this prospective study at King Fahd Hospital of the University, College of Medicine, King Faisal University, Dammam, Saudi Arabia, between January 2002 and June 2003. This study analyzed 256 patients who attended orthopedic clinics. The data gathered was age, duration of menopause, number of children borne, height and weight for body mass index (BMI) calculation. We excluded women with secondary osteoporosis from the study. We entered the patients orthopedic complaints in the database. We carried out the BMD measurements using Hologic total body DEXA machine. We analyzed the data using SPSS package with significance at p<0.05 and confidence interval of 95%. For final analysis, we took into consideration an average of results of the lumbar spine and hip region. RESULTS: We analyzed the available data of 256 patients. We divided the patients into 2 groups; group A with >6 children and group B with women of <5 children. In group A, there were 116 women and 140 in group B. The mean age of patients in group A was 56.81 (50-65) years SD +/- 5.19 and in group B the mean age was 58.86 years (48-76) SD +/- 7.68. The average BMI in group A was 31.95 kg/m2 and in group B it was 29.14 kg/m2. The BMD of the lumbar spine of group A was 0.850 g/cm2 (SD+/-0.112) compared to group B of 0.699 g/cm2 (SD+/-0.141), p<0.005. The BMD of the hip region of group A was 0.836 g/cm2 and that of group B patients was 0.716g/cm2 (p<0.01). In women with <5 children, 25.5 had normal BMD as compared to 47 in women with >6 children, 25.4% were osteoporotic in group A and in group B 48%. As per the World Health Organization classification 56% in group A had an increased risk of fracture as compared to 77.5% in group B women. CONCLUSION: Our results indicate that women who had borne >6 children were less osteoporotic and of low fracture risk as compared to those women who had <5 children. The BMD of the women with >6 children was statistically higher than their counterparts, and they sustain this after prolonged lactation. We believe that increased parity protects women from osteoporosis and the severity of the disease, and it is our suggestion that women with <5 children and those nulliparous, who are at increased risk of developing osteoporosis should be investigated and treated accordingly.

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OBJECTIVE: To assess the incidence of birth-injuries seen at the King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia (KSA). METHODS: A retrospective analysis was carried out in 31,028 consecutive deliveries between January 1986 and December 1996 at the King Fahd Hospital of the University, Al-Khobar, KSA. The study group was compared with a matched control group. RESULTS: There were 203 newborns with 208 injuries with an incidence of 6.70 per 1,000 live births. The majority (55%) of the injuries was sustained during normal vaginal deliveries and the least were during cesarean section (5.2%). The average gestational age was 39 weeks (25-44 weeks) in the study group and in the control group was 38.84 (21-44 weeks). The birth weight in the study group was 3323 gms (780-6190) and the control group was 3015 gms (790-6,015) p<0.01. The Apgar score in the study group was 7 and 9 at one and 5 minutes and in the control group was 8 and 9. There were 104 scalp injuries, 50 nerve injuries, 20 fractures (11 clavicle and 9 long bones) and 21 newborns had intracranial hemorrhage. CONCLUSION: This study demonstrates a variety of birth related trauma at the teaching institution with a lower overall incidence as compared to reports from the literature. The only significant factor was that birth weight was higher in the study group as compared to the control group (p <0.01). It is recommended that every effort be required to further decrease the incidence of birth injuries.

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OBJECTIVE: The aim of this study was to throw light on the incidence of pre-eclampsia (PE) in women attending for care and delivery at a hospital in Saudi Arabia, and analyze the maternal risk factors and outcome of mothers and neonates in pregnancies complicated by PE. METHODS: This retrospective study involved almost all women (n = 27,787) who delivered at King Fahad Hospital of the University in a 10-year period (1992-2001). The maternal records were reviewed for age, parity, gestational age, mode of delivery, antenatal care, onset of PE, severity of proteinuria, and the frequency of antenatal and intrapartum complications. The neonatal records were reviewed for perinatal outcome including birth weight, frequency of stillbirths, and neonatal deaths. RESULTS: Among the study cohort of pregnancies, 685 women, i.e. 2.47%, were diagnosed as having PE among whom a high proportion (42.0%) were nulliparous women. Similarly, PE was encountered at a high percentage (40.0%) in women at the extreme of their reproductive age (< 20 and >40 years), and more women with PE delivered prematurely (30.2%) as compared to healthy controls (13.5%). Spontaneous vaginal deliveries were less frequent in women with PE (69.2%) as compared with healthy controls (86.2%). Instrumental deliveries, with spontaneous labor, amounted to 15.9% in women with PE, but they comprised only 2.9% in healthy women. The deliveries were more likely to be induced (22.8%) or be performed by cesarean section (14.9%) in women with PE than in healthy controls (6.8% and 9.6%). Placental abruption was the most common maternal complication (12.6%) in women with PE, followed by oligouria (7.9%), coagulopathy (6.0%), and renal failure (4.1%). The perinatal outcome of pregnancies with PE shows that stillbirths (2.34%) and early neonatal deaths (1.02%) comprised an overall mortality rate of 33.6 per 1,000. More stillbirths and neonatal deaths showed a tendency to be associated with the severe form of PE (diastolic BP > or =120), as compared with the mild form (diastolic BP 90-110). Stillbirths and neonatal deaths appear to be associated with women who had no or irregular antenatal care and whose proteinuria amounted to or exceeded 3 g per 24 h, when delivery occurred at 28th gestational week or less, and when the birth-weight of the neonates was between 500 and 1,000 g. CONCLUSION: We document a hospital-based incidence rate of PE of 2.47%, with a high proportion of PE cases occurring among nulliparous women and those at the extreme ends of the reproductive age. More maternal and neonatal complications were encountered in women with PE when the PE was severe, when the pregnancy had to be terminated early, when there was no regular antenatal care, the birth-weight was low, or the proteinuria was severe.

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OBJECTIVE: The aim of this paper is to give an overview of the conservative treatment of idiopathic detrusor instability in elderly women. It describes the clinical and urodynamic features of the over-active bladder and the role of physiotherapy as well as the various physiotherapeutic techniques in the management of this condition. METHODS: This is a prospective, uncontrolled clinical trial in which 20 older women aged 55-75 years participated for 8 weeks duration. The study was started on April 2000 at King Fahad Hospital of the University, Kingdom of Saudi Arabia. Therapeutic modalities including bladder training, pelvic floor exercise and electrical stimulation were applied for all subjects. RESULTS: The first desire to void, maximum capacity, flow rate and voiding intervals was increased in its mean at the end of the study period (P<0.0001), while the means of residual volume and frequency of micturation had significantly decreased at the end of the study (P< 0.0001). CONCLUSION: The study shows that correctly taught pelvic floor exercise, combined with bladder training, electrical stimulation and restriction of fluids' intake are effective treatment modalities for the idiopathic detrusor instability in elderly women.

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This paper documents the evolution of the Medical Laboratory Technology (MLT) program established in 1989 (1408/1409 H) at the College of Medicine and Medical Sciences, King Faisal University. The rationale, objectives, the general outline of the program as well as methods of instruction and evaluation are discussed. The internship period and future plans are also addressed. Two hundred and seventy (270) students had been enrolled in the program since its inception until September 2000. Ten batches (138 graduates) have already successfully graduated. One hundred and fifteen (83.3%) graduated technologists are employed in the different health sectors and educational institutions in the Kingdom.

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BACKGROUND: Despite the dearth of allied health professionals in the Kingdom of Saudi Arabia (KSA), the demand for them has increased. Like any other geographic location, KSA, has its own pattern of diseases. Therefore, the curriculum of the health professionals should be appropriately designed to meet the health needs of hospitals and clinics. OBJECTIVES: To demonstrate that changes in the curriculum of Allied (Applied) Health Sciences in KSA are necessary, and how these changes should be implemented. This paper also recommends that these changes must: (1) be based on the current needs of the community, (2) satisfy the health requirements of the Saudi community as well as the realities of its health practices. The Allied Health Colleges must: (1) undertake a long-term review of the curriculum, (2) ensure that the curriculum reform is continuous, (3) target faculty development, (4) target student evaluation.

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OBJECTIVE: To determine the course and outcome of pregnancy in 54 persistently HIV-1-seronegative pregnant commercial sex workers (prostitutes). STUDY DESIGN: Five hundred twenty-three initially HIV-1-seronegative prostitutes in Manipur, India, were studied between 1990 and 1999. Two hundred forty (46%) women seroconverted to HIV-1 during the study period. HIV-1 polymerase chain reaction with env, nef and vif gene primers was done on 98 persistently seronegative sex workers, who remained seronegative after three years of follow-up. Fifty-four of these women became pregnant (study group). The course and outcome of pregnancy were studied prospectively in 54 persistently HIV-1-seronegative women and compared with those in matched HIV-1-seronegative women from the general population coming for routine antenatal checkups. RESULTS: In the 54 seronegative women (study group) who became pregnant, there were 52 singleton, term vaginal deliveries and two emergency cesarean sections for fetal distress. All 54 infants had negative viral cultures for HIV-1 at birth. The women remained seronegative throughout pregnancy, as did the control group. All 54 infants were breast-fed and remained well. CONCLUSION: A small proportion of highly exposed individuals may have natural protective immunity to HIV, may be resistant to HIV-1 and may have successful outcomes of pregnancy.

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