AB1568-PARE LIVED EXPERIENCES OF POSTMENOPAUSAL OMANI WOMEN WITH OSTEOPOROSIS

Background

Osteoporosis is a globally significant clinical public health problem associated with age-related fractures [1,2]. Most research on the impact of the disease has been based on quantitative survey data. There are relatively few qualitative studies exploring women’s lived experience with osteoporosis. Furthermore, most data are from Western countries, with no data from the Middle East. Direct access to lived experiences is a powerful tool for gaining insights into a disease [3]. This study aimed to determine the lived experience of postmenopausal Omani women with osteoporosis.

Objectives

This study sought to answer three questions:

1.What does living with osteoporosis mean for postmenopausal Omani women?

2.How does culture impact the lives of postmenopausal Omani women with osteoporosis?

3.How do postmenopausal Omani women with osteoporosis perceive the support and care provided by healthcare professionals?

Methods

An interpretive phenomenology design was used with a purposive sample of 15 postmenopausal Omani women with osteoporosis and fragility fractures from primary and secondary care facilities in Muscat, Oman. Audio recorded, semi-structured, one-on-one interviews were held by Zoom and telephone; Crist and Tanner’s framework was used to analyze data and identify key themes.

Results

The mean age of the participants was 63 years. Five (33.3%) reported a previous fracture. Just over half (53%) were illiterate; three (20%) had studied in college. Key themes related to their lived experience emerged from the data analysis: culture and religion; health care professionals’ attitudes; and services and treatment regimen. The subjects’ social and cultural lives were negatively impacted by osteoporosis and fragility fractures, which prevented some from attending celebrations such as close family marriages and religious gatherings. Participants played significant care-giving roles as wives, mothers and grandmothers but many were unable to perform many household chores, such as cooking, due to the osteoporosis and fractures. They perceived healthcare professionals through the professionals’ communication styles and information they provided. Participants satisfied with their doctor’s communication style described it as humanistic, with humour added, noting they provide health information and understand patients’ needs. Those not satisfied indicated their doctors had poor communication styles, showed insufficient interest in them, and asked few questions during their appointments. Professionals at in-patient clinics were perceived as more caring and empathetic than those at out-patient clinics. Treatment abroad was preferred by these women, though some were highly satisfied with their treatment from Omani hospitals. Beliefs about and usage of traditional herbal remedies for the management of fragility fractures differed between educated and non-educated women.

Conclusion

This study explored postmenopausal Omani women’s experiences of living with osteoporosis and fragility fractures including the impact of the disease on social and cultural life. It contributes also to our understanding of the experience of the disease in non-western settings.

References

[1]Barake M, El Eid R, Chakhtoura M, Meho L, Mahmoud T, Atieh J, et al. Osteoporotic hip and vertebral fractures in the Arab region: a systematic review. Osteoporosis International [Internet]. 2021. Available from: https://doi.org/10.1007/s00198-021-05937-z

[2]Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International. 2013; 24:23-57.

[3]McIntosh I, Wright, S. Exploring what the notion of ‘lived experience’ offers for social policy analyses. J Soc Policy. 2018;48(3):449-67.

Disclosure of Interests

None declared

Downregulation of endothelial transient receptor potential vanilloid type 4 channel underlines impaired endothelial nitric oxide-mediated relaxation in the mesenteric arteries of hypertensive rats

The endothelium contributes to the maintenance of vasodilator tone by releasing endothelium-derived relaxing factors, including nitric oxide (NO). In hypertension, endothelial nitric oxide synthase (eNOS) produces less NO and could be one of the contributing factors to the increased peripheral vascular resistance. Agonist-induced Ca(2+) entry is essential for the activation of eNOS. The transient receptor potential vanilloid type 4 (TRPV4) channel, a Ca(2+)-permeant cation channel, is expressed in the endothelial cells and involved in the regulation of vascular tone. The present study aimed to investigate the role of TRPV4 channel in endothelium-dependent NO-mediated relaxation of the resistance artery in hypertensive rats. Using a wire myograph, relaxation response to the TRPV4 activator, 4alpha-phorbol-12,13-didecanoate (4alphaPDD) was assessed in mesenteric arteries obtained from Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHRs). Compared to WKY, SHR demonstrated a significantly attenuated 4alphaPDD-induced endothelium-dependent NO-mediated relaxation. Immunohistochemical analysis revealed positive staining for TRPV4 in the endothelium of mesenteric artery sections in both WKY and SHR. Furthermore, TRPV4 mRNA and protein expressions in SHR were significantly lower than their expression levels in WKY rats. We conclude that 4alphaPDD-induced endothelium-dependent NO-mediated vasorelaxation is reduced in SHR and downregulation of TRPV4 could be one of the contributing mechanisms.

Frequency of TLR4 (1063A/G and 1363C/T) polymorphisms in healthy and HIV-infected Omani individuals and their relationship to viral load and T cell count

Toll-like receptors (TLRs) are essential elements of the innate immune response to different infections including the infection with human immunodeficiency virus (HIV). Single nucleotide polymorphisms (SNPs) in TLRs such as TLR4 1063A/G and 1363C/T have been found to be associated with changes in CD4 count, viral load (VL), and disease progression during HIV infection. However, the association of these SNPs with the pathogenesis during HIV infection is controversial. We investigated the frequency of TLR4 1063A/G and 1363C/T SNPs in 168 Omani donors [68 HIV-infected patients (>3% of Omani HIV-infected patients) and 100 healthy controls] and the association of these SNPs with the VL, CD8 and CD4 counts, and the immune recovery after cART as observed by CD4 T cell increase. SNPs were analyzed after the amplification of the regions that contain them by polymerase chain reaction (PCR) and sequencing of the PCR products. The TLR4 1063GG genotype was detected in the HIV-infected group only. No association was found between the studied SNPs and the average VL during 1 year of infection, the average CD4 and CD8 count during 1 year of viremia, the nadir CD4 count, the CD4 count when the patient reached VL < 50 copies/mL due to cART, and the ratio of the CD4 count 3 and 6 months after reaching VL < 50 copies/mL after cART to the last CD4 count before reaching VL < 50 copies/mL. Our study suggests that TLR4 (1063A/G and 1363C/T) SNPs have no association with the VL or the CD4 and CD8 counts during HIV infection.

Association of single-nucleotide polymorphisms in TLR7 (Gln11Leu) and TLR9 (1635A/G) with a higher CD4T cell count during HIV infection

BACKGROUND

Toll-like receptors (TLRs) are essential elements of the innate immune response to different infections including HIV-1 infection. The single-nucleotide polymorphisms (SNPs) in TLRs have been associated with CD4T cell count and HIV disease progression. The TLR7 (Gln11Leu) SNP was shown to be associated with a rapid decline of CD4T cell count. A relation between TLR9 (1635A/G) SNP and CD4T cells count in HIV-infected patients is suggested, although the outcome associated with this SNP is still controversial.

OBJECTIVES

To determine the relation of the TLR7 (Gln11Leu) and TLR9 (1635A/G) SNPs with the damage to the immune system during HIV infection as reflected by the average CD4T cell count.

METHODS

A total of 63 HIV-infected patients and 100 healthy individuals (controls) were enrolled in this study. The above named SNPs were analyzed after amplification of the regions that potentially contain the SNPs by polymerase chain reaction (PCR) and sequencing of the PCR products. The frequency of these SNPs and their relation with the CD4T cell count were investigated.

RESULTS

The TLR7 (AA) genotype 'Gln' had a trend toward being associated with a CD4T cell count >400cells/μl after controlling viremia via HAART. Additionally, the TLR9 1635 (GG) genotype was associated with a low average CD4T cell count and the TLR9 1635 (AG) genotype was significantly related to a higher average CD4T cell count during the viremic period in HIV-infected patients.

CONCLUSION

The results of this longitudinal study supports the presence of an association between the TLR9 (1635A/G) genotype and the CD4T cell count, which helps clarifying the controversial results regarding this association. It also suggests that the CD4T cell count during the viremic period might be linked to the combination of both TLR7 (Gln11Leu) and TLR9 (1635A/G) genotypes. These results may help predicting the damage to the immune system, and thus impacting the planning for novel anti-HIV strategies.