Pharmacological Effects of Gemfibrozil on Some Isolated Smooth Muscle
Preparations Of Experimental Animals
Fatma Sabry El Makkawy, Azza Mohammed Ezzo,
Enass Abd El-Aty Ouda and Azza El-Said Mahmoud Al-Kassas
Department of Pharmacology,
Faculty of Medicine (Girls), Al-Azhar University
Gemfibrozil is a member of fibrates (gemfibrozil, fenofibrate, ceprofibrate, and benzafibrate)
which is employed for treatment of dyslipidemia particularly hypertriglyceridemiae through its action on
peroxisome proliflator activated receptors (PPAR-). Objective: The aim of this work was to study the site of
action and pharmacololgical effects of different doses of gemfibrozil on some isolated smooth muscles
preparations of experimental animals. Materials and Methods: The experiments were conducted on isolated
jejunum of rabbits, isolated spiral tracheal and urinary bladder strips of guinea pigs. Results: I- On isolated rabbit
jejunum, gemfibrozil produced a dose-dependent reduction on the amplitude of jejunal contractions. The
inhibitory effect of gemfibrozil was not abolished after complete blockade of alpha and beta adrenergic
receptors, while it was completely abolished after inhibition of nitric oxide synthase by N-methyl L-arginine. On
the other hand the stimulatory effects of nicotine small dose, acetylcholine, calcium gluconate, histamine and
serotonin were not abolished after administration of gemfibrozil. II- On isolated tracheal spiral strips of ginea
pigs, gemfibrozil produced a dose- dependent relaxation on the basal tone and a dose-dependent reduction on the
amplitude of acetylcholine-induced tracheal contractions of the tracheal strips. The inhibitory effect of
gemfibrozil was completely abolished after inhibition of nitric oxide synthase by N-methyl L-arginine.
Gemfibrozil completely abolished also serotonin-induced contraction, while it has no effect on histamine or
calcium-induced tracheal contractions. III- On isolated urinary bladder strips of guinea pigs, gemfibrozil
produced a dose-dependent reduction on the amplitude of urinary bladder contractions. The inhibitory effect of
gemfibrozil was not abolished after complete blockade of beta adrenergic receptors, while it was completely
abolished after inhibition of nitric oxide synthase by N-methyl L-arginine. On the other hand the stimulatory
effects of acetylcholine and serotonin were not abolished after administration of gemfibrozil. Conclusion:
Gemfibrozil (antidyslipidemic, PPAR- agonist) reduced jejunal and urinary bladder contractions and has a
relaxant effect on tracheal basal tone. So it has a beneficial effect in obstructive airway diseases and cases of
urgency and frequency of micturation and urinary incontinence. However, it may be used cauciously in cases of
,GIT disturbances as constipation and prostatic hypertrophy.
Key words: Gemfibrozil, isolated smooth muscle, jejumum of rabbits, tracheal strip, and urinary
bladder strips of guinea pigs.


Gemfibrozil (member of fibrates) is
direct smooth muscle relaxant effect through
PPAR- agonist which improves lipid profiles
inhibition of duodenal and urinary bladder
particulary very low density lipoprotein and high
contractions7. This is in agreement with the
density lipoprotein in patients with dyslipidemia
study of Nijkamp et al. reported that
gemfibrozil has a relaxant effect on the tracheal
basal tone Generally, the mechanism of the
receptors (PPARs) are steroid receptors that
inhibitory effect of gemfibrozil on different
exhibit broad tissue expression pattern 3, 4. They
smooth muscles is still unclear. So this work
regulate the expression of a wide array of genes
aimes to study the effect of gemfibrozil on
that are involved in fatty acids uptake and
some isolated smooth muscles of jejunum,
trachea and urinary bladder, and its possible
function5. The intensive studies of PPARs have
mechanism of action8.
revealed their importance in both normal

physiology and pathology of various tissues6.
Phelps and Peuler reported that fibrates has
Gemfibrozil was supplied in the form of

tablets which were film coated Each tablet
Received: 10/11/2016 DOI : 10.12816/0034628
Accepted: 12/12/2016

Full Paper (vol.66 paper# 1)

c:\work\Jor\vol66_2 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 18- 27

A Critique of Proposed Strategies for Tackling Female Obesity in Egypt
Raouf Alebshehy1, Josephine Ohas2
1Egyptian Ministry of Health,2Kenyan Ministry of Health
Corresponding author: Raouf Alebshehy, +201221253003,

obesity is a huge health problem in Egypt. Its prevalence is the double among Egyptian
females as compared to males. It is estimated that 75% of females over the age of thirty are
overweight or obese. However, 95% of Egyptian females are not taking any measures to control their
weight; additionally there is no national program to address the problem. Methods: following specific
appraisal criteria, this research article provides a critical appraisal of strategies that could help in
addressing the problem of obesity among females. This article includes an appraisal of interventions
of promoting healthy lifestyle changes; healthy diet and physical activity. It also provides an appraisal
of using social media, primary healthcare clinics, and pharmacies as delivery strategies of the
proposed interventions. Findings: the research article reveals the feasibility of the proposed strategies
based on the criteria of effectiveness, cost-effectiveness, organizational feasibility, and gender
Keywords: female obesity, interventions, delivery strategies

article provides an appraisal of interventions
During the last 25 years, Egypt underwent a
process of epidemiologic transition with a

remarkable increase of non-communicable
delivery strategies within the remit of Egyptian
diseases (1), leading to 60% prevalence of
Ministry of Health to tackle obesity in Egypt's
obesity and overweight among Egyptians (2). A
particular issue in Egypt is that prevalence of

obesity is more than double among females as
compared to males (3-5).
This research article is based on secondary data.
It is estimated that 75% of Egyptian females,
It provides an appraisal of proposed
over the age of 30, are overweight or obese (6).
interventions, and delivery strategies. The
Egyptian adult females' obesity (BMI 30
capacity of Egyptian Ministry of Health and its
kg/m²) and severe obesity (BMI 35 kg/m²)
Department of Preventive Medicine was
rose from the twelfth and the tenth highest in
considered in choosing these strategies.
the world in 1975 to the seventh and the sixth
Potential strategies should be judged based on
highest in 2014 respectively (7). Diet-related
evidence to determine their level of potential
chronic diseases have increased in parallel with
success (12), and analysing strategies, following
obesity, for instance, cardiovascular diseases'
specific criteria, helps to avoid making false
females annual mortality rose from 5% to 39%,
assumptions or poor decisions (13). Therefore,
from 1961 to 1985 (8). Moreover, 95% of
the proposed strategies were appraised by
Egyptian females are not taking any measures
following four appraisal criteria. These criteria
to change their weight (9).
are defined according to Walley and Wright (13),
Management of obesity is one of the main
Brown (14), and Swinburn et al. (12).
approaches for achieving United Nations' third
Effectiveness: The degree to which an
sustainable development goal, which aims to
intervention can lead to desired outcomes (12,14).
ensure healthy lives for all at all ages (10), and
In this context, it is the effectiveness of an
obesity tops the World Health Organization's
intervention in tackling obesity.
public health agenda as the major preventable
Cost-effectiveness: The balance between
risk factor for many non-communicable
financial costs of an intervention and its ability
diseases (11). However, based on the author's
to achieve required effects (14).
knowledge and after searching key health
Organizational feasibility: The ability to
databases; PubMed, Global health, Medline,
implement an intervention with the existing
Popline, and Web of science databases, there is
structure (13). The structure includes the existing
no national program to tackle adult females'
resources of facilities, and manpower.
obesity in Egypt. Therefore, this research
Received: 24/10/2016 DOI : 10.12816/0034629
Accepted: 30/10/2016

Full Paper (vol.66 paper# 2)

c:\work\Jor\vol66_3 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 28- 39

A Molecular and Microscopically Studies of Calicophoron Microbothrium
Alaa Abdel-Aziz Mohamed Samn
Zoology Department, Faculty of Science (Boys),Al-Azhar University, Cairo, Egypt,

Background: Paramphistomiasis is a parasitic disease of livestock animals and humans, which causes
heavy economic black lashes especially in countries with advanced animal industry
Aim of Study: the current study aimed to add more information about Calicophoron microbothrium
(C. microbothrium) and clarify its biological role and how its miracidia infecte the molluscan
intermediate host. In addition, a brief description to Bullins truncates; the morphological, structural and
chronological characteristics of the various intermolluscan stages of the parasite are studied in detail.
Moreover, the present work showed the effective role of physical parameters (light, temperature,
salinity and gas-phase (aerobic versus anaerobic)) on egg development and hatching and the biological
activities of cercaria and metacercaria. Beside these routine techniques, PCR also was used as more
advanced and accurate diagnostic technique based on the detection of nucleic acid. Where, 34 larvae
and adult worms of Calicophoron microbothrium were isolated from naturally infected buffaloes. The
results of the present study will facilitate the identification of this despise secular group of digeneans
although its bad effect not only affect animal industry but also human health. Furthermore, the current
research clears the weak points in its life cycle to aperient settling this parasite.
Keywords: Calicophoron microbothrium, Bullins truncates, paramphistome, biology, histology, Mas­
PCR technique.

host with its ability of widespread, surviving for
Paramphistomes are spreading worldwide,
several months and shedding numerous
especially in the warmer regions such as:

Australia, Africa and India, and mainly infect
cercariae, and then so dangerous threaten to the
cattle, goats and sheep. In addition, there are
domestic animals (3).
certain species of paramphistomes that infect

The paramphistomes are conical or
human it has medical importance beside their
cylindrical digenean with thick bodies. They are
economic one. Calicophoron microbothrium
distinguished from other flukes by the
(Paramphistomum microbothrium) is one of
possession of a posteriorly located acetabulum.
two of these parasites in Egypt as reported by
The most familiar species are parasites of
Ashour (1); the other species was Calicophoron
domesticated livestock. It has been considered,
gregarius. They were the most important flukes
for a long time, that paramphistomes are
identified in domestic Egyptian ruminants.
completely non-injurious to their vertebrate

This C. microbothrium has a life cycle
hosts, but this view has been challenged by
similar to that of the gastrointestinal trematodes.
many authors (4-7). Where, an acute infection of
Where, the adult flukes reside in the host's
calves and sheep had been caused by the
rumen and reticulum; their eggs are passed
immature conical flukes in the small intestine,
through host's faeces. When eggs reach water
particularly in advanced cattle raising regions
the miracidia hatch within 12-16 days and
causing elevation of mortality rate in sheep
penetrate suitable intermediate host. The
about 30% as reported by Chauhan et al. (8) and
parasite has a number of generations of rediae
21%-37.4% in cattle by Pande (9). In addition,
before the production of free swimming
Katlyar and Varsheney (10) recorded an
cercariae that are changed to metacercariae after
average percentage morbidity and mortality
encysting on water plants; these plants become
41.24% and 57.62% in sheep and 68.59% and
the source of the ruminant food causing the
75.53% in goats respectively. Moreover, Horak
infection and beginning a new cycle (2).
(6) recorded a loss of 11.4 kg of sheep's weight
Seriously, these parasites may survive up to
within 52 days and 27.3 kg in bovines after 140
years, so that they become a virtually constant
days, while an uninfected bovine gained 50.9 kg
during the same period.
generations. As a result to that, the intermediate
The clinical signs of acute paramphistomiasis in
sheep, goats and cattle have been represented by
Received:121/0/2016 DOI: 10.12816/0034630

Full Paper (vol.66 paper# 3)

c:\work\Jor\vol66_4 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 40- 45
Comparative Study on Copper, Zinc, Magnesium and Iron in Hydatid
Cyst Fluid (Supernatant and Residue) in Sheep and Camel in Egypt
1Fayez Muhammad Shaldoum, 2Wafaa Fayez Ahmed,
3Hanan Taher Hamza and 1Mohammed Sedik Shahin
1 Department of Zoology, Faculty of Science for Boys, Al-Azhar University, Cairo,2Department of
Environmental and Biological Sciences, Faculty of Home Economic, Al-Azhar University,
Tanta,3Department of Zoology, Faculty of Science for Girls, Al-Azhar University, Cairo, Egypt.
Corresponding Author: Fayez Muhammad Shaldoum, Faculty of Science for Buys, Al-Azhar
University, Cairo, Egypt. E-mail:


Aim: this study included comparative biochemical composition of micro-minerals, including Cu, Zn,
Mg and Fe in hydatid cyst fluid (supernatant and residue) from liver of infected sheep and lung of
infected camels. Materials and Methods: Organs with hydatid cysts were collected from El-Basateen
abattoirs, Cairo, Egypt, during the period from Nov. 2014 to Dec. 2015. Flame ionization by Atomic
absorption spectroscopy was used for measuring the micro-minerals concentration. Results: the current
study showed: significant difference in Mg, Cu and Fe micro-minerals between cyst' supernatant (S Sh)
and residue (R Sh) of infected sheep (p<0.001, p<0.05); significant difference in only Cu micro-mineral
between S Sh and cyst residue (R C) of camels (p<0.001); significant difference in both Fe and Zn
micro-mineral between cyst supernatant of infected camels (S C) and S Sh (p<0.05); significant
difference in both Mg and Fe between R Sh and R C (p<0.01); significant difference in Mg, Fe and Zn
between R Sh and S C (p<0.01, p<0.001) and significant difference in Fe and Zn between S C and R C
(p<0.001, p<0.01). Cu was the highest while Mg was the lowest concentration of all tested minerals in
both S Sh and S C but Fe was the highest and Zn was the lowest concentration of all tested minerals in
both R Sh and R C. Conclusions: in the current work, the parasite that was located in both sheep and
camel is characterized by having high levels of Copper in the cyst fluid and of iron in the scolecies.
Binding a scolecidal drug with either copper or iron may enhance its efficacy.
Keywords: copper, zinc, magnesium, iron, hydatid cyst, sheep, camel, Egypt.


Echinococcosis, also called hydatid disease
body including liver (70%), lung (22%), and
(Hydatidosis), is a zoonotic disease caused by
other organs such as heart, brain, kidney,
spleen, muscle, skeletal system, skin as well as
Echinococcosis affects humans and other
many parts of the body (8%)3 .There are
mammals, such as sheep, dogs, rodents and
essential and vital elements in the cyst fluid that
camels. Hydatidosis causes harmful, slowly
are very important in the biology of parasite.
enlarged cysts in the liver, lungs, and other
The composition of cyst content may differ in
organs that often grow unnoticed and neglected
various area and strains. The composition of
for years1. The annual economic losses from
hydatid cyst fluid is nearly 90%, the same as
host serum. The various electrolyte, enzymes,
approximately four billion US dollars on a
proteins, lipids, vitamins and hydrocarbons
global scale. These losses are due to disability
were seen in hydatid cyst fluid4.
and costs of treatment of infected humans as
The relationship between parasite and host is
well as animal production losses due to death of
very important. Understanding how parasites
infected animals, condemnation of internal
can grow in the body and what the requirements
organs of slaughtered life stock, reduction in
of parasites are, can be useful in understanding
carcass weight, decrease in milk production,
the ways for prevention of the parasite.
fecundity and other production-based losses.
Mazzocco5 and Von brand et al.6 identified the
Therefore, considering the importance of a
various electrolytes in hydatid cyst fluid.
problem, the World Health Organization and
McManus and Smyth7 detected large amounts
of hydrocarbon molecules such as glycogen and
echinococcosis in the list of the diseases which
polysaccharides in hydatid cyst fluid. Other
are the subject to radical eradication2. The cyst
researchers also detected urea and uric acid;
can implant in various and all organs of the
total protein and nucleic acid; globulin like host,

lipids compounds such as phospholipid
Received: 01/10/2016 DOI : 10.12816/0034631
Accepted: 08/10/2016

Full Paper (vol.66 paper# 4)

c:\work\Jor\vol66_5 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 46- 51

Evaluation of Ledipasvir plus Sofosbuvir for Treatment of
Compensated and Decompensated HCV Cirrhotic Patients
Shabaan Salah Al-Azhari, Mohamed Salem Negm, Mostafa Mostafa Kamel El-Awdy and
Al-Shazly Gaber Mohamed Galal
Tropical Medicine Department, Al-Azhar Faculty of Medicine

:unlike human immunodeficiency virus (HIV) and hepatitis B virus (HBV), hepatitis C virus
(HCV) infection is a curable disease. Current direct acting antiviral agent (DAA) targets are focused on HCV
NS3/4A protein (protease), NS5B protein (polymerase) and NS5A protein. The first generation of DAAs
includes boceprevir and telaprevir, which are protease inhibitors and were approved for clinical use in 2011.
The cure rate for genotype 1 patients increased from 45% to 70% when boceprevir or telaprevir was added to
standard PEG-IFN/ribavirin. More effective and less toxic second generation DAAs supplanted these drugs
by 2013. The second generation of DAAs includes sofosbuvir, simeprevir and fixed combination medicines
containing ledipasvir plus sofosbuvir and Viekira Pak. These drugs increase cure rates to over 90% without
the need for interferon and effectively treat all HCV genotypes. With these drugs the "cure HCV" goal has
become a reality. The aim of this study was to assess of ledipasvir plus sofosbuvir as treatment of HCV
infection in patients with advanced liver disease including cirrhotic patients with child B and C.
Patients and methods:in this prospective study, seventy five HCV PCR positive patients were classified into
three groups according to child score. Each group included twenty five patients. All patients received
ledipasvir plus sofosbuvir for six months.
For all patients thorough medical history, clinical examination, kidney function tests, liver function tests,
complete blood count, pelvi-abdominal ultrasound, HCVantibodies, hepatitis C viral RNA, quantitative,
HbsAg, alpha fetoprotein as baseline screening. HCV PCR done for all patients at end of treatment and three
months later to detect sustained virological response (SVR12). Patients with combined HCV and HBV
infection, hepatic or extrahepatic malignancies and late child C were excluded.

Results: showed that no statistical significant difference were detected in patients of group A as regard
liver function tests before and after treatment and SVR12 achieved by 96%. Patients of group B showed
significant statistical difference as regard liver function tests before and after treatment with SVR12
achieved by 88%. In patients of group C there were significant statistical difference in liver function tests
with SVR12 achieved by 80%. Also there were clinical improvement in patients of group B and C after end
of treatment.
Conclusion:it could be concluded that there will be a dramatic improvement in HCV therapy followed the
introduction of oral medicines that directly inhibiting the replication cycle of HCV. The combination pill
contains a fixed-dose of ledipasvir 90 mg and sofosbuvir 400 mg, two direct-acting antiviral agents against
HCV. Ledipasvir is an inhibitor of the NS5A protein, which is required for HCV replication. Sofosbuvir
inhibits the HCV NS5B RNA-dependent RNA polymerase, which is also required for viral replication.
Sofosbuvir is a nucleotide prodrug that undergoes intracellular metabolism to form a pharmacologically
active triphosphate that can incorporate into the HCV RNA. Ledipasvir plus sofosbuvir can be used safely in
treatment of compensated and decompensated post hepatitis C liver cirrhosis. SVR12 can be achieved by
96% in patients with early cirrhosis (child A), 88% in patients with child B cirrhosis and 80% in patients
with child C with subsequent improvement in liver functions.
Keywords: -Ledipasvir plus sofosbvir, Advanced liver disease, HCV infection, Direct acting antivirals.

drug use, poorly sterilized medical equipment, and
Hepatitis C is an infectious disease affecting
transfusions. An estimated 150­200 million people
primarily the liver, caused by the hepatitis C virus
worldwide are infected with hepatitis C. The
(HCV). The virus persists in the liver in about 85%
prevalence of hepatitis C virus (HCV) infection in
of infected patients (1). HCV is spread primarily by
Egypt is the highest in the world(2). The HCV
blood-to-blood contact associated with intravenous
genome contains a single large open reading frame
DOI: 10.12816/0034632

Full Paper (vol.66 paper# 5)

c:\work\Jor\vol66_6 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 52- 56
Correlation between Dyslipidiemia and The Severity of
Coronary Artery Disease Using SYNTAX Scoring System
Mostafa M. Abdelrazik, Ezz El Din El Sawy, Ahmed M. Fahmy, Fouad Rafik.
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

: the relationship between hyperlipidiemia and an increased risk of coronary heart disease
has been well documented and has served as a motivating factor for research into lipoproteins structure,
function and metabolism. Many epidemiological studies have revealed that chronically elevated lipid and
cholesterol levels are associated with an increased incidence of atherosclerosis. Dyslipidemia together
with hypertension and diabetes is major modifiable risk factors for atherosclerotic disease and the
subsequent development of cardiovascular events. Dyslipidemia is known to be an independent predictor
for cardiovascular events, other risk factors including family history, hypertension, tobacco use, age, sex
and diabetes also have been found to be associated with an increased risk of coronary artery disease
(CAD). This cross-sectional study was aimed to investigate the association of Dyslipidemia as an
atherosclerosis predictor and its relationship to the severity of CAD using SYNTAX score. Patients and
the current study included 535 patients who presented during 2015 with chest pain to Dar Al
Fouad Hospital, experiencing symptoms of CAD or evidence of CAD by noninvasive testing were
enrolled, a fasting blood sample was extracted and assessed for lipids profile. Patients underwent
coronary angiography either using femoral or radial approach, and the resulting angiographic study was
used to calculate the SYNTAX score of each patient. Patients were divided in to two group i.e. CAD and
Non-CAD group. The CAD group was further divided into three sub-groups according to the SYNTAX
score into low risk, intermediate risk and high risk group. Results: in this study, triglycerides, total
cholesterol and LDL-C levels were positively associated with sever CAD and higher number of diseased
vessels. Higher HCL-C levels were also found in subjects with normal coronaries. Conclusion: there was
no significant proportionate, linear relation between the SYNTAX score and the levels of triglycerides,
total cholesterol or LDL-C
Key words: Atherosclerosis, SYNTAX Score, Dyslipidemia, CAD, Non-CAD.


Atherosclerosis is a disease of large and medium
Triglycerides (TG) rich lipoproteins, which
sized arteries such as the carotid and coronary
originate both in the intestines and liver, are
arteries, and arteries of the lower extremities. It is
considered as atherogenic factor(4). The aim of
characterised by focal lesions of one of the
this study was to evaluate, in judging the severity
following types: fatty streak, fibrous plaque, or
of CAD, the association between the levels of
complicated lesions. A great number of
lipid profile parameters as a biomarker.
hypotheses have been published about the
Patients and methods:
pathogenesis of atherosclerosis, such as the lipid
A cross-sectional study was conducted on 535
hypothesis, thrombogenic hypothesis, and the
patients who underwent coronary angiography
endothelial cell injury hypothesis. Many
between January 2015 and December 2015 at
epidemiological studies have revealed that
Dar Al Fouad Hospital. The study was approved
chronically elevated lipid and
by Al Azhar University and Dar Al Fouad
cholesterol levels are associated with an
Hospital. Informed consent was taken from
increased incidence of atherosclerosi(1).
patients. The patients' demographic profiles,
The presence of Lp(a) ( a sub molecule of LDL)
socioeconomic status, personal habits, and
has emerged as a powerful
disease risk factors histories were recorded.
genetic risk factor for coronary artery disease
Blood pressure (BP) was measured before the
(CAD) raising the question of Dyslipidema and
patients were sent to the catheterisation
its relation to CAD(2). Lipoprotein (a) (lpa) is a
laboratory. Patients with a history of chest pain,
complex molecule of low-density lipoprotein
angina, ST-elevation acute coronary syndrome,
(LDL) to
non ST- elevation acute coronary syndrome and
glycoprotein, apolipoprotein (a) [Apo(a)], is
stable angina were included. All patients received
covalently linked via disulfide bonds. Based on
long-term treatment with angiotensin-converting-
its structure, Lp(a) has both atherogenic and
enzyme (ACE) inhibitors, calcium (Ca)
prothrombotic properties (3)
antagonists, or - and -adrenergic blocking
Received:2/10/2016 DOI: 10.12816/0034633

Full Paper (vol.66 paper# 6)

c:\work\Jor\vol66_7 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 57- 65

Assessing Awareness about Diabetes Mellitus among Attendees of Primary
Health Care Centers, Makkah, Saudi Arabia
Yasser Mohammed Shukri Alwan, Ibrahim S Alayed, Mohammed Hassan Albarakati,
Mohammed Abdulaziz Alaryni, Ghufran Abdulrahman Abu Kashaba,
Amina Saad Alkateeb, Salma Walid Mohammed Adham
Interns, Umm Al-Qura University, Makkah, Saudi Arabia
Correspondence author:Yasser Mohammed Shukri Alwan,Interns, Umm Al-Qura University,
Makkah, Saudi Arabia,Mobile: 00966564947766

diabetes is well studied in Saudi Arabia; however, there seems to be little research in the
area of awareness, education and health care delivery.
Objectives: to assess the awareness about diabetes mellitus among attendees of primary health care
centers, Makkah, Saudi Arabia.
Subjects and Methods: a cross-sectional study was conducted among a representative random sample of
adult attendees of primary health care centers (diabetic and non-diabetics), Makkah Al-Mokkaramah, the
kingdom of Saudi Arabia during the study period (1-31 November, 2016). An Arabic self-administered
questionnaire was used for data collection. It includes 31 questions with sections of demographic data,
community awareness regarding diabetes definition, risk factors, signs and symptoms, and complications
community awareness regarding diabetes prevention.
Results: the study included 662 adult patients. Approximately one-third of them (32.2%) aged 60 years
or more. Females represent 51.1% of them. More than one-fifth of them (21%) were university graduated
whereas 6.3% were illiterates. Prevalence of diabetes among the participants was 33.7% and majority of
them (97.9%) had family history of diabetes. The most frequent sources were mass media (57.4%), health
sector (29.9%) and educational sector (10.6%). Overall sufficient awareness regarding diabetes mellitus
was reported among majority of the participants (91.2%). Among studied factors, only marital status and
income were significantly associated with sufficient awareness.
Conclusion: population in Makkah AL-Mokkaramah has enough knowledge of the general knowledge of
diabetes regarding risk factors, symptoms, etc. However, they are not very well aware of the diabetes
associated secondary complications.
Keywords: Awareness, Diabetes mellitus, complications, Saudi Arabia


Type 2 diabetes mellitus (DM) is a
have a special genetic predisposition to develop
worldwide public health concern of great
type 2 diabetes, which is exaggerated by a rise in
impact. According to the World Health
obesity rates, a high rate of consanguinity and
Organization, there will be an increase in the
the presence of other factors such as the insulin
population with type 2 diabetes from 55 million
resistance syndrome (2).
in 2000 to 83 million in 2030 in developed
Diabetes is well studied in Saudi Arabia;
countries and from 30 million in 2000, to 80
however, there seems to be little research in the
million in 2030 (1).
area of awareness, education and health care
In the Kingdom of Saudi Arabia, in
delivery (2).
parallel with other parts of the world, diabetes

Diabetes complications are common
mellitus is an emerging major public health
among Saudi patients; retinopathy prevalence
problem. This pandemic has accompanied the
was 31% after more than10-years of diabetes,
adoption of a modern lifestyle, with a resultant
neuropathy prevalence was reported as high as
increase in rates of obesity and other chronic
82% and despite that data on diabetic
nephropathy in Saudi are scarce, diabetes
Additionally, the Saudi population seems to
Received: 13/12/2016 DOI : 10.12816/0034634
Accepted: 20/12/2016

Full Paper (vol.66 paper# 7)

Journal Name The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 66- 73

Amphibians as Bioindicators of the Health of Some Wetlands in Ethiopia
Samy Saber1, Wondwosen Tito2, Rashad Said3 ,
Seyoum Mengistou2 and Abdulaziz Alqahtani4
1Department of Zoology, Faculty of Science, Al-Azhar University, Cairo, Egypt
2College of Natural Sciences, Addis Ababa University, Ethiopia
3Department of Zoology, Faculty of Science, Al-Azhar University, Assiut, Egypt
4Department of Biology, Faculty of Science and arts, University of Bisha, Bisha, SaudiArabia
Corresponding author: Samy Saber, Prof. of fauna and animal ecology, Department of Zoology, Faculty of
Science, Al-Azhar University, Cairo, 00201006995630
Background: Ethiopia has a variety of wetlands which provide enormous socio-economic and
environmental values. Most of these wetlands are under severe pressure and degradation. Maintaining
the health of wetlands is recognized as crucial for protecting biodiversity, ecosystem function, and
human health. In order to properly protect and conserve wetlands, it is essential to collect baseline data
and establish monitoring programs which can detect change in the health of the wetland over time. One
common method for monitoring includes using bioindicators as amphibians.
Materials and Methods: the current study was conducted to assess the health in two areas in Ethiopia,
Abijata - Shalla Lakes and Awash National Parks using amphibians as bio-indicators and to predict any
changes on the natural environments and resources in the study area.
Results: in Abijata area, less species richness, lower total population index and higher fluctuating
asymmetry were observed compared to the second area (Hot spring area) which means that it is more
Keywords: Diversity, Developmental instability, Malformation, Abijata-Shalla, Awash.

Wetlands not only benefit people by
wetland over time. One common method for
supporting a host of ecological and hydrological
monitoring includes using bioindicators as
functions (e.g. water supply, water purification,
proxies (e.g. Amphibians). Ecological indicators
flood control), but that they are also critical for
can have many purposes, including being used
the conservation of biological diversity1. In spite
to assess the condition of the environment or
of their great importance, wetlands continue to
monitor trends in condition over time 7,8.
decline globally, both in area and in quality2,
Amphibians are widely considered to be useful
he provided the most recent and comprehensive
as indicator species 9,10,11,12.
picture of historical wetland losses. In his study
Globally; many amphibian populations
of 189 wetland assessments, he estimated that
and species have decreased or disappeared in
wetland losses in the 20th century were 64-71%,
the last few decades 13. Environmental impact
and for some regions, notably Asia, even higher
was suggested to be one of the causative factors
2. Ethiopia owns different types of wetlands
of amphibian declines 14. Anurans, frogs and
which provide enormous socioeconomic and
toads are probably one of the most sensitive
environmental values3. They are vital in
animals in the world and react very rapidly to
attracting tourists and providing ground for
substantial changes in their environments. They
cultural ceremonies4. Despite all those and
also form vital parts of the ecosystems they
other values, Ethiopian wetlands are under
belong to. That is why they are considered "an
severe pressure and degradation. The health
indicator species" the species that "indicate" the
of the wetlands is continuously decreasing from
state of the health of their ecosystems.
time to time that in doubt their existence in the
On the other hand, Fluctuating
near future 5,6. Maintaining the health of
asymmetry FA is a measure of the degree to
wetlands is recognized as crucial for protecting
which structures that are bilaterally symmetrical
biodiversity, ecosystem function, and human
depart from perfect symmetry 15. A failure of
health. In order to properly protect and
developmental regulation was suggested to
conserve wetlands, it is essential to collect
increase with levels of environmental stress.
baseline data and establish monitoring programs
Fluctuating asymmetry has been put forward as
which can detect change in the health of the
a biomarker of stress 1, 12,16,17,18.
Received: 03/11/2016 DOI : 10.12816/0034635
Accepted: 13/11/2016

Full Paper (vol.66 paper# 8)

c:\work\Jor\vol66_9 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 74- 8
Predictors of Diabetes Mellitus Type 2 Control
Abdullah Talal Almalki and Faisel Ahmed Albalawi
Residents (service), King Khalid hospital, Ministry of Health,
Tabuk, Kingdom of Saudi Arabia
Corresponding author: Abdullah Talal Almalki, Residents (service), King Khalid hospital,
Ministry of Health, Tabuk, Kingdom of Saudi Arabia, Mobile: 00966547100142

successful treatment of patients with type 2 diabetes mellitus (DM) is achieved by having a
HbA1C of<7%.
Objectives: to determine the factors that affect successful control of diabetes mellitus type 2 at Diabetic
centre, King Khalid hospital, Ministry of Health, Tabuk, KSA.
Subjects and Methods: a cross-sectional study was carried out at Diabetic centre, King Khalid hospital,
Ministry of Health, Tabuk, KSA. A representative sample of adult diabetes mellitus type 2 patients (18-60
years) both sexes, who attend diabetic center clinics during month of November 2016 were included.
Self-administer questionnaire was used for data collection. Last HBA1c level was addressed.
Results: almost one-third of the participants (n=342), aged between 41 and 50 years (35.1%) whereas
11.4% aged over 50 years. Male patients represent 65.8% of them. The duration of diabetes was more
than 10 years in 45.6%. Diabetic complications were reported by 26% of diabetic patients. Regarding
diabetes therapy, a combination of oral hypoglycemic and insulin was reported by 21.1% of them while
insulin alone and oral hypoglycemic alone were reported by 42.1% and 36.8% of the participants,
respectively. It is evident that DM was controlled among only 32.5% of the diabetic patients (HBA1C
was less than 7%) while it was uncontrolled among almost two-thirds of them (67.5%). Logistic
regression analysis revealed that patients aged between 41 and 50 years were at lower risk compared to
those aged 20-30 years (OR=0.13, p=0.008). Females were less likely compared to males to have
uncontrolled diabetes (OR=0.25, p=0.007). Patients having more than three children were at higher risk
for uncontrolled diabetes opposed to those without children (OR=11.19, p=0.003). Patients having
income ranged between 10001 and 15000 were more protective than whose income was 5000 SR/month
to develop uncontrolled diabetes (OR=0.22, p=0.007). Patients without diabetic complications were less
likely to have uncontrolled diabetes compared to those with complications (OR=0.24, p=0.004). Patients
treated with either insulin alone or a combination of insulin and oral hypoglycemic (OHGs) were at
higher risk for uncontrolled diabetes compared to those treated with OHGs alone (OR=3.51 and 3.07,
p=0.007 and 0.027. respectively). Patient who never compliant with diabetic diet were more prone to
uncontrolled diabetes (OR=15.09, p<0.001).
Conclusion: the study revealed relatively high prevalence of poor glycemic control as expressed by
HbA1c7%. There is a strong need for public education programs and for promoting public awareness
about control of blood glucose level in Saudi Arabia.
Keywords: Diabetes type 2, control, HBA1c, predictors


Proper management of type 2 diabetes
A new strategy for managing patients
depends mainly on a combination of life style
with type 2 DM should address the accompanied
modification, controlling of cardiovascular risk
risk factors and morbidities of obesity,
factors, and keeping normal level of blood
hypertension, and dyslipidemia with equal or
glucose1. Intensive blood glucose lowering as
occasionally even greater aggressiveness than for
compared to standard blood glucose lowering
hyperglycemia. Using of anti-diabetic agents that
was not associated with reducing mortality.
may address cardiovascular risk factors should be
Successful treatment of patients with type 2
considered more strongly in treatment algorithms,
diabetes mellitus (DM) is achieved by having a
although no drug therapy is likely to be
glycated hemoglobin (HbA1C) of < 7%2.
Received: 16/10/2016 DOI : 10.12816/0034636
Accepted: 22/10/2016

Full Paper (vol.66 paper# 9)

c:\work\Jor\vol66_10 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 81-90

Intersexual Variation in Tail Length, Venom Composition, Toxicity, and
Anticancer Activity of Cerastes cerastes (Viperidae)
Moustafa Sarhan1, Ahmed Mostafa1, Serag Eldin Elbehiry3,

Abdelbaset M. A. Abd el Reheem1 and Samy A. Saber2
1 Zoology Department, Faculty of Science, Al Azhar University, Assiut,2Zoology Department, Faculty of
Science, Al Azhar University, Cairo, 3The Egyptian Holding Company for Biological Products and
Vaccin (VACSERA), Cairo, Egypt

The medically important desert-horned or Egyptian sand viper (Cerastes cerastes) is one of
the most familiar snakes of the great deserts of North Africa and the Middle East. It is a poisonous and
widely distributed snake in Africa and inhabits the sandy deserts of Egypt. Male and female specimens of
C. cerastes have been compared from different aspects. Results: Morphologically, tail length relative to
snout-vent length was compared. Males significantly showed longer tails than do females. From the
venom aspect, males showed a significant (p<0.005) higher concentration of protein in the venom
(133mg/ml) compared to females (106 mg/ml). Female venom was significantly more toxic than male,
with a median lethal dose (LD50) in mice of 0.6g venom protein/gm body weight whereas LD50 for
males was 0.7 g/gm. Protein analyses by means of electrophoretic technique revealed differences in
venom composition between males and females. We have detected individual variability and highlighted
sex-specific protein similarities and differences among snake venoms. SDS-polyacrylamide gel
electrophoresis showed protein bands of 42 and 39 kDa specific to male venoms while bands of 46 and 44
kDa are specific to female venoms. Moreover, we evaluated the antitumor efficacy of male and female
snake venoms in liver (HEPG-2), breast (MCF-7), colon (HTC-116) and normal cell lines and IC50 was
calculated. Interestingly, both male and female venoms had anti proliferative effects on the tumor cell
lines with different potency. Female venom had a higher cytotoxicity against colon cells (IC50=0.006
µg/ml) than male venom (IC50= 0.019µg /ml). In contrast, male venom had a higher cytotoxicity against
breast cells (IC50=0.005 µg/ml) than female venom (IC50=0.024µg /ml). These results indicate that males
and females of C. cerastes produce venoms with different composition and activity, which may have
epidemiological implications.
Keywords: Cerastes cerastes, venom composition, toxicity, anticancer activity, intersexual variation.


Venom variation is important to basic venom
Snake venoms are complex mixtures of hundreds
research to consider such variation for the choice
of proteins and peptides that function to

immobilize or to kill the prey as well as to assist
of snake donors that are used for venom
in the digestion of the prey [1, 2]. The toxic effects
production. Venom variation is also important to
of snake venoms are complex because their
the management of snake envenomation in the
different components have various actions. These
selection of snake donors for antivenom
components may concert with other venom
production and subsequently the selection of
toxins in a synergistic way to boost their
anti-sera for therapeutic use [6, 14]. Moreover,
activities [2, 3]. Venom variability has long been
venom variation at different levels is also an
investigated and it is a documented phenomenon
important issue of studies on the evolutionary
[4, 5]. It occurs at several levels including
aspects of venomous snakes. At the level of
intersubspecies and intraspecies variation [6].
contribution to the venom composition is
Moreover, venom composition may be
important but the effects contributed by
influenced by the geographical and habitat of the
environmental conditions, age and feeding habits
snake origin [6-9]. Intraspecific venom variation
also influence the venom protein picture
occurs between individual specimens, and also in
exhibited by each specimen [15]. Studies of
individual specimens, due to seasonal variation
[10], diet [11], age [12], and sexual dimorphism[13].
intraspecific variation in venom is genetically
Received: 24/2/2017 DOI : 10.12816/0034637
Accepted: 29/2/2017

Full Paper (vol.66 paper# 10)

c:\work\Jor\vol66_11 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 90-93
Copro-Antigen versus Classical Microscopy as Diagnostic Tool for
Giardia Lamblia Infection in Egyptian Patients
Samir A. Shahat¹, Ahmed M. Sallam¹, Hesham M. Gad², Mohammed H. Abdallah¹
¹ Department of Parasitology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
² Department of Biochemistry, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt

: Giardia lamblia, a flagellate protozoa, is a one of the most common causes of non-viral
(parasitic) diarrheal illness in humans. Laboratory diagnosis mainly consists of direct microscopic
examination of stool specimen for trophozoites and cysts. However, due to intermittent fecal excretion of
the parasite, the patient may be misdiagnosed, continue excreting the parasite and infecting others.
Therefore, other methods of diagnosis should be looked for, which overcome the drawbacks of
microscopy when used alone for diagnosis. The present study aimed to evaluate the efficacy of copro-
antigen detection by ELISA test in comparison to direct microscopy in the diagnosis of G. lamblia in
stool specimens from patients with diarrhea and other gastrointestinal symptoms.
Patients and methods: stool samples were collected form 250 child included in the present study (150
symptomatic and 100 apparently healthy as a control group) aged between 1-10 years old, and subjected
for direct microscopic examination and ELISA test for copro-antigen detection.
Results: out of 250 stool samples, 53 specimens (21.2%) were positive for Giardia by direct microscopy,
while 68 specimens (27.2%) were positive by ELISA test.
Conclusion: ELISA test for copro-antigen detection in stool samples is a rapid and effective method with
high sensitivity and specificity for diagnosis of giardiasis in stool specimens even when the parasitic
count is low, thus reducing the chances of missing even in the asymptomatic cases.
Keywords: Direct microscopy, Giardia lamblia, RIDASCREEN Giardia (ELISA) test.


Giardia lamblia (also known as Giardia
microscopic examination of stool samples.
intestinalis, Giardia duodenalis and Lamblia
Multiple, successive fecal samples should be
intestinalis), a flagellate protozoa, is one of the
taken and examined over a period of 1-2 weeks
most common pathogenic gastrointestinal
because of the intermittent nature of cyst
parasites infecting humans 1. It has a global
excretion 9, 10. Special techniques like
distribution affecting about 280 million cases
concentration by formalin ethyl acetate
yearly (mainly children aged between 1-3 years
centrifugation or by zinc sulfate floatation and
old) in both developing and developed countries
special staining like trichrome staining can also
2. In recognition of the burden of disease caused
be used in conjugation with microscopy. The
by the parasite, the WHO has included giardiasis
main drawback of this method is that it is time
in the list of neglected diseases since 2004 3.
consuming and depends on the skill of an
Cysts are transmitted through the fecal­oral
experienced laboratory personnel. Also, the
route due to consumption of contaminated food
parasite may be hidden by bile pigments and not
or water 4.
visualized 11.
Clinical manifestations of giardiasis usually
Immunological diagnosis can also be done
appear 1-2 weeks after infection and may range
based on detection of anti-Giardia antibodies in
from asymptomatic carrier state to acute
the serum, but cross reaction and poor
fulminating diarrhea or chronic persistent
correlation between positive anti-Giardia
antibody titers and the presence of active
malabsorption and weight loss 5, 6. It may cause
Giardia infection can occur 12. This problem has
chronic post-infectious complications, including
been overcome by direct detection of G. lamblia
irritable bowel syndrome, via mechanisms that
antigen in stool (Copro-antigen diagnosis) 13.
remain obscure 7, 8.
Diagnosis of giardiasis is frequently based
(including ELISAs) have been used and have
on detection of trophozoites or cysts by
achieved specificities of (87-100%) and
Received: 12/11/2016 DOI : 10.12816/0034638
Accepted: 20/11/2016

Full Paper (vol.66 paper# 11)

c:\work\Jor\vol66_12 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 94-102

Study Factors Affecting Academic Achievement among Female
Students at Ibn Sina National College
Esraa Ahmed Aalshareef1, Zina Abdulkareem Alzahidy1, Marwa Thani Hawsawi1, Mohamed
Salem Basalama1, Ayat Ibrahim Al-Thobaiti3, Shuruq Hassan Alzahrani3, Tamer Hassan
Baghdadi2, Hamza Ahmed Awad2, Afnan Hameed Breek Alsulami3, Faisal Hamdan Aljuhine1,
Abdullah Ibrahim Alkhraiji2, Amina Saad AlKhateeb1, Yasser Mohammed Shukri Alwan3, Eyaad
Talat Ghallab2, Abdulaziz Ahmed Albalawi4, Mohammed Ammar A Almoabadi5 , Yasmeen Megad
Al-Ghamdi5, Wedad Ahmed Alharbi5, Malak Khalid Alshammari5, Lina Emad NourAldien1

1 Ibn Sina National College, 2 Battarje Medical College For Scince And Technology, 3 Umm Al-Qura University,
4 King Saud Bin Abdulaziz university For Health Sciences, and 5 King Abdulaziz University for Health Sciences

A good social environment is a key strategy to improve the level of education and
achievement in medical college students. However, survey data from Jeddah, Saudi Arabia have indicated
that a large number of medical students are affected negatively by their social status. This article
comparatively explores the impact of four main factors: Social class/Background, Students Personality,
Health Status, and Psychological health on their achievement. Data were collected as part of a program of
qualitative and quantitative research investigating the prevalence of bad environment effect on the
psychological level of the students.
Objectives: To study the four main factors Social class/Background, Students Personality, Health
Status, and Psychological health affecting academic achievement among Female Students at Ibn Sina
National College.
Methods: The study was conducted among 1315 female students attending colleges of Ibn Sina-Jeddah-
Saudi Arabia between 1st of April ­ 31th of May 2016. An open-ended questionnaire was developed to
cover the objectives.
Conclusion: After assessment of the factors and variables across the targeted sites about the academic
achievement were often conclude that overall achievement were very good regardless the factor.
Keywords: social factors; increase academic achievement


Students are the most essential asset for any

educational institute; therefore many empirical
achievement (4). A meta-analysis of personality-
studies are carried out to explore factors affecting
academic performance relationships, based on
college students academic achievement and
the Five-Factor Model (FFM), with cumulative
performance, yet the challenge remains that
sample sizes ranging to over 70,000 revealed that
measuring of academic performance of students
academic performance was found to correlate
can be influenced by a variety of factors such as
Social class/Background; A college education
conscientiousness, and openness. Academic level
was seen as a means of escape and a pathway
(primary, secondary, or tertiary), average age of
toward social mobility in colonial times and the
participant, and the interaction between academic
early 19th century for low-SES (Socio Economic
Status) students (1), a sentiment that became
correlations with academic performance (5).
ingrained in the American dream (2).Moreover,
There is a debate as to which personality traits
Parent educational status is considered one of the
are typical of students in medical studies as
most important aspects of Socio Economic Status
compared to students in other academic majors
(SES) because it is typically established at an
(6). and which specific personality traits predict
early age and tends to remain the same over time
medical student performance in the pre-clinical
years (7).
Second factor is Students' Personality Traits
and Academic Performance; Educators,
Achievement; Health status can be affected by
researchers, and psychologists have been
many factors such as Nutrition (8-9). Disabilities
constantly searching for parsimonious set of
(10), and Chronic Illness (11).
variables that predicts patterns of students
Fourth factors Psychological health; Medical
behaviors and their relationship to academic
students experience depression, burnout, and
Received: 15/10/2016 DOI : 10.12816/0034639
Accepted: 21/10/2016

Full Paper (vol.66 paper# 12)

c:\work\Jor\vol66_13 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 103-114

Knowledge, Attitudes and Practice of Nurses in Renal Dialysis Units
Regarding Infection Control in Abha City ­ Saudi Arabia, 2015
Adel Saeed Al Qahtani1 and Metrek Ali Almetrek2
1Community Medicine Unit, Department of Family & Community Medicine, College of
Medicine, King Saud University, 2Department of Family & Community Medicine, College of
Medicine, King Khalid University, Kingdom of Saudi Arabia
Correspondence to: Dr. Metrek Ali Almetrek- Department of Family & Community Medicine, College of
Medicine, King Khalid University, Kingdom of Saudi Arabia-Mobile: 00966542206098

patients on hemodialysis are at risk of nosocomial infections especially Hepatitis C
Virus (HCV) and Hepatitis B Virus (HBV). Nurses' adherence to infection control procedures is
instrumental to control the transmission of the virus among patients. The identification of gaps in
knowledge, attitudes and practices (KAP) of nurses aims at tailoring related training programs.
the study was conducted to determine the knowledge, attitudes and practices of nurses working
in dialysis units regarding standard recommendations of infection control.
a cross-sectional study was conducted between December 2014 and January 2015 targeting
all nurses in three dialyses units affiliated to the Ministry of Health in Abha city. Data was collected
using a self-administered questionnaire to assess nurses' KAP and an observation checklist to report on
the environmental aspects.
Results: one hundred and nine nurses were included with a response rate of 94.78%. Most of them
were Saudi nationals (62.39%) and holding a diploma (78.90%). The percentage score was
60.18+17.51 for knowledge, 85.59+8.09 for attitudes and 92.11+7.98 for practice. Nurses' practice was
high despite the deficiency in knowledge. Gaps in practice were identified including not always
adherent to hand washing (15% to 18%), use of eyewear when blood splash is likely (31.19%),
simultaneous care for positive and negative patients (24.77%), passing needles from hand to hand
(29.36%) and recapping needles after use (25.69%). Multivariate linear regression analysis revealed
that attitudes towards infection control, attempt to access infection control guidelines, on job training
and being non-Saudi independently predicted higher practice scores.
Conclusion: nurses' knowledge is deficient but their performance is significantly related to their
attitudes. Nurses tend to be adherent to certain infection control practices than the others. Training in
infection control should address the gaps in performance with emphasize on creating favorable attitude.
Keywords: Hepatitis C Virus, knowledge, attitude, practices, nurses, renal dialysis


Chronic kidney disease (CKD) refers to
centers in Riyadh, Saudi Arabia, showed that
either an irreversible decline in renal functions
5.7% of participants are affected by CKD. The
or a decrease in glomerular filtration rate (GFR)
incidence and the prevalence of ESRD has
of less than 60 mL/min/1.73 m2over a period of
increased in last two decade by 15-20 fold in
time 3months or more 1. CKD ranges from
Saudi Arabia; the prevalence of ESRD is 753
simple micro albuminuria marked by the
per million populations with an annual
leakage of excessive protein to the urine due to
incidence of 172 per million populations 6.
damage of kidney tissueswith 5 distinct stages
Renal replacement therapy (RRT) in
toend with end stage renal disease (ESRD) 2.
the form of renal transplant or renal dialysis is
ESRD is considered a growing
deemed essential for survival for patients with
worldwide public health problem 3. The
ESRD. Renal transplant is the most cost
growing problem of ESRD is attributed to
effective approach that ensures a better quality
ageing of the population and the increase in the
of life yet not always available or affordable.
rates of diabetic nephropathy, ischemic
Accordingly, renal dialysis is currently the most
nephropathy and other comorbid conditions 3, 4.
commonly adopted method 2, 3.
The systematic reviews of 44 studies
As of 2013, the number of the dialysis
conducted in 2012 by Hassanienet al.3
units in Saudi Arabia were 184 units affiliated
concluded that the incidence of ESRD is
to the Ministry of Health (MoH) (65%),
increasing in countries of Gulf Cooperation
governmental sectors other than the Ministry of
Council (GCC). A pilot study conducted by
health (12%) and private sector (23%) with a
Alsuwauda et al. 5 in 2008 in commercial
total of 5,086 dialysis machines serving 18,160
Received: 18/10/2016 DOI : 10.12816/0034640
Accepted: 23/10/2016

Full Paper (vol.66 paper# 13)

c:\work\Jor\vol66_14 The Egyptian Journal of Hospital Medicine (2017) Vol. 66, Page 115-122

Role of Liver and Cardiac Enzymes as Markers of Parasite Load
and Recovery after Treatment in Experimental Murine Toxocariasis
Salwa A Shams El-Din
Microbiology and Parasitology Department-Faculty of Medicine-King Abdulaziz University-KSA

Toxocara is mainly a parasite of animals. The disease is caused mainly due to accidental
ingestion of Toxocara canis embryonated eggs and to a lesser extent T.cati eggs. Till now, there is no
marker of severity of infection or treatment in toxocariasis.
Aim of the study: The current work aimed at studying the role of liver enzyme aspartate
transaminase (AST) and cardiac enzyme creatine kinase-MB isoenzyme (CK-MB) as markers of severity
infection and treatment of toxocariasis in correspondence to serum immunoglobulin with study of
histological cardiac effects of toxocariasis.
Materials and Methods: Laboratory mice were divided into groups infected with different doses of
Toxocara eggs. Sera were collected from each group before and after treatment for measurement of AST
and CK-MB, as well as ELISA for anti-Toxocara immunoglobulin IgG. T test, ANOVA test and Pearson
correlation tests were used to assess the results.
Results: CK-MB was elevated significantly with infection and reduced significantly after treatment. The
serum level of CK-MB also correlated significantly and positively with parasite load.
Conclusion: CK-MB can be used together with anti-Toxocara IgG in diagnosis and CK-MB can be a good
markers of treatment and parasite load in toxocariasis.
Key words: Toxocara- IgG- Liver enzymes-cardiac enzymes.
Running Title: Monitoring therapy of toxocariasis by liver and cardiac enzymes.
Conflict of interest: the author declares no conflict of interest.


Toxocara is mainly a parasite of animals. The
45.2 % in all samples of Medical Center
zoonotic infection with Toxocara is called
Laboratory, Ho Chi Minh City, Vietnam in 2012
toxocariasis 1. The disease is caused mainly due to
10. The recorded prevalence in rural areas in
Zagazig district, Sharkyia Governorate, Egypt,
embryonated eggs and to a lesser extent T.cati
was 2.2 % for Toxocara and it was the most
eggs 2. Larvae are liberated in upper part of small
prevalent helminthes among school children 11.
intestine and penetrate intestinal wall reaching
Clinically, patient complains of fever; larvae in
blood vessels and settle in different body organs 3.
tissues cause fever, hepatomegaly, respiratory,
T. canis sero-prevalence was 12.1%, by ELISA
cardiac or nervous disorders termed as visceral
and this sero-prevalence was confirmed by
larva migrans (VLM). When the disease is
Western Blot (14.5%) in the Estonian Population 4.
confined to the eye it is called ocular larva
Out of 238 patients with uveitis of unknown
migrans 3. Overt toxocariasis may go undiagnosed
etiology, 71 (29.8%) were diagnosed with ocular
as diagnostic tests may be expensive, difficult and
toxocariasis, and 80 (33.6%) had positive ELISA
cannot be carried out in health centers 12. The
results for serum anti-Toxocara IgG in Korea5.
cardiac manifestations of the disease may be
Twenty-two percent of pregnant women were
myocarditis, Loeffler's endocarditis or even
found to have anti-Toxocara IgG antibodies in
cardiac temponades 13.The importance of cardiac
pregnant women in Brazil 6. T. canis prevalence
manifestation and its relevance had been
was 14.5 % in Caribbean countries 7. The sero-
increasing recently 14.
prevalence of anti-T.canis IgG antibodies was
The disease is usually treated with anti-parasitic
14.9% in the research laboratories workers in
mebendazole and nitazoxanide 16.
against Toxocara spp. is high in rural population
Liver disease is often reflected by biochemical
in Gabon with prevalence for Toxocara spp.
abnormalities of 1 of the 2 different hepatic
59.9% 9. Sero- prevalence of toxocariasis was
systems or of liver function. Although tests that
Received: 18/11/2016 DOI : 10.12816/0034641
Accepted: 26/11/2016

Full Paper (vol.66 paper# 14)

c:\work\Jor\vol66_15 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 123-126

Dendritic Cells in Hepatitis C Virus Infection
Mona Mohamed Rafik, Nahla Mohamed Zakaria,
Hala Ghareeb, Mohamed, Nesrine Aly Mohamed, Ghada Maged Mohsen
Clinical pathology department, Ain Shams University.

The global prevalence of chronic hepatitis C is estimated at 2.8%. There is markedly higher
prevalence in the Middle East about 14.7% in Egypt. Dendritic cells (DCs) are one of the major Antigen
presenting cells in the body. They bridge innate and adaptive immunity and impact priming of HCV-
specific immune responses. The current study was aimed to investigate the DC activation status, and their
role in interaction with natural killer (NK) cells utilizing different setups with healthy NK and HCV+ DC,
HCV+ NK and healthy DC, healthy DC and healthy NK and finally HCV+ NK and HCV+ DC in the
presence of HCV peptides and a ratio of 5 NK: 1DC.
Results: DC-NK interaction in chronic HCV infection is mainly affected by the affection of DCs by HCV
leading to a maturation defect (decreased expression of HLA DR, CD 86 and CD 83). Healthy NK cells
were able to stimulate the maturation of DCs particularly with core peptide whereas NS3-4 had no effect.
When DCs were healthy, all peptides were able to produce significant maturation of DCs even when co-
cultured with HCV+ NK cells. Co-cultured HCV+ NK cells and HCV+ DCs showed significantly higher
apoptosis of both cells. This could be attributed to the immature moDCs more with chronic HCV
infection due to the fact that immature DCs typically under express HLA-class I molecules that would
protect from NK-mediated lysis.
Conclusion: Cross-talk between DCs and NK cells plays an important role in the induction of both the
innate and adaptive immune systems. HCV infection was found to impair the maturation of DCs. Thus
consequently affecting its antigen presentation and T cell allostimulatory capacity and rendering them
more liable to NK mediated lysis which could explain the persistence of infection and chronicity.
Keywords: dendritic cells and natural killer crosstalk, dendritic cells and natural killer cells in HCV,
dendritic cells and natural killer cells co-culture.


DCs also play a crucial role in the activation of
Despite extensive investigation, there is no
natural killer (NK) cells representing important
general consensus regarding the effects of HCV
effectors in the innate immune defense against
on DC function. The numbers comprising both
viruses. There is a bidirectional crosstalk between
the pDC and mDC subsets circulating in the
human DCs and NK cells where DCs enhance
peripheral blood were found to be reduced
CD69 expression, proliferation, interferon
substantially in chronic HCV infected patients.
(INF) and cytotoxic activity of NK cells.
Contradictory data indicate that functions of
Reciprocally NK cells either enhance the
pDCs and mDCs are either intact or impaired and
maturation of DCs or markedly augment their
phenotypically immature in patients with chronic
capacity to produce proinflammatory cytokines
hepatitis C (5).
and to stimulate T-cell responses (1), or it could

enhance immature DCs apoptosis, depending on
the activation status of both players (2). NK cells
Two groups of blood bags were selected from the
can also kill immature DCs. Thus, NK cells
blood bank according to: history taking, the
regulate DC homeostasis (3). The NK cell
presence of HCV antibodies by ELISA and HCV
activating receptor NKp30 appears to play a
central role in DC maturation or apoptosis
1- Twenty Blood bags from HCV Infected
induced by NK cells (4).
donors (double positive PCR and ELISA HCV

antibody) (Group I).

Received: 20/10/2016 DOI : 10.12816/0034642
Accepted: 28/10/2016

Full Paper (vol.66 paper# 15)

c:\work\Jor\vol66_16 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 127-139

The Synergetic Effect of Alternative Medicine with Acyclovir in the
Treatment and Control of Herpes Labialis; HSV1
Kouka Abdelwahab Saadeldin, Mohammad Mustafa Aljafar,
Abdulwahab Abdullah Alghamdi, Morshed Ali Alsawidan,Ali Hassan Almalki,
Fahad Sulaiman Alateeq, Abdulaziz Abdulsalam Alsudairi
Faculty of Medicine, Imam Abdulrahman AlFaisal University, Dammam, Saudi Arabia

herpes simplex is a common viral infection of the skin or mucous membranes. The lesions
caused by this infection are often painful, burning, or pruritic, and tend to recur in most patients. Short
term treatment with acyclovir can accelerate the healing of an acute outbreak, and continuous acyclovir
therapy is often prescribed for people with frequent recurrences. While this drug can reduce the
recurrence rate by 60-90 percent, it can also cause a wide array of side effects, including renal failure,
hepatitis, and anaphylaxis. Safe and effective alternatives are therefore needed. Aim of the Study: is to
examine and provide evidence on the potent effect of alternative medicine in Herpes treatment and
recurrence prevention. Patients and methods: 60 Patients were divided into 3 major groups according to
the severity of the infection with 7 subgroups split according to the treatment protocol.
among 60 patients with varies severity, recurrence of outbreaks was significantly reduced when
a combined therapy was used while 0-10 percent outbreak recurrence rate was observed for a year when
alternative therapy was used alone for mild cases.
there is evidence that certain dietary modifications and the use of alternative medicine can
be significantly useful for treating active Herpes simplex lesions and preventing recurrences.
Keywords: HSV1, Herpes Labialis, Alternative medicine, Acyclovir.

Herpes virus is an infectious DNA virus
primary infection and reactivation. Moreover,
belonging to Herpesviridae family that causes
HSV results in a lifelong infection by establishing
latent and lytic infections in a wide range of
latency in the host sensory neurons and
animals and humans. There are 8 herpesvirus
replicating in epithelial cells during primary
types known to infect humans: herpes simplex
infection and reactivation (3)
viruses 1 and 2 (HSV-1 and HSV-2,
Unlike many herpes viruses, HSV has low
aka. HHV1 and HHV2), varicella-zoster virus
species specificity and a wide host range. It has
(VZV, which may also be called by
the unparalleled ability to infect human and
its ICTV name, HHV-3),
nonhuman cells alike (4). The reason behind this
(EBV or HHV-4), human cytomegalovirus
successful story of infection is an accumulation
(HCMV or HHV-5), human herpesvirus 6A and
of multiple supporting factors include:
6B (HHV-6A and HHV-6B), human herpesvirus
- Possessing several multifunctional HSV
7 (HHV-7), and Kaposi's sarcoma-associated
glycoproteins to which corresponds an array
herpesvirus (KSHV, also known as HHV-8)(1).
of HSV entry receptors in the human body and
Human herpes viruses may cause infections of
evidence suggests even more unidentified
the central nervous system during primary
HSV receptors.
infection or following reactivation from a latent
- Multiple entry modes. HSV has the ability to
state. Especially in immunosuppressed patients,
enter into host cells by direct fusion with the
the infection can take a life-threatening course,
plasma membrane,or via endocytic pathways.
and therefore early diagnosis of herpesvirus-
The latter can be pH dependent or
associated neurological diseases should have high
priority (2).
- Multiple spread strategies of HSVs, including:
Herpes simplex viruses (HSV) are part of the
transmission of free virions, movement of
alpha herpes virus subfamily of herpes viruses.
HSV along filopodia-like cellular membrane
There are two types of HSV: type-1 (HSV-1) and
protrusions (surfing) towards the cell body,
type-2 (HSV-2). These viruses are neurotropic
and lateral cell-to-cell spread.
capable of infecting the nervous system and
The virus is spread and transmitted among
causing neurological diseases. Moreover, Herpes
humans through physical contact and commonly
viridae family; HSV results in a lifelong infection
causes localized mucocutaneous lesions [2]. Oral
by establishing latency in the host sensory
and ocular lesions are primarily caused by HSV-1
neurons and replicating in epithelial cells during
and genital lesions by HSV-2. However, HSV-2
Received: 11/11/2016 DOI : 10.12816/0034643
Accepted: 21/12/2016

Full Paper (vol.66 paper# 16)

c:\work\Jor\vol66_17 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 140-145
Surgical Fixation Compared with Conservative Treatment of Flail Chest Injuries
Gamal Abdel-Shafy Farag* and Mohammed Seddiq Al-Awadi
Cardiothoracic Department, Al-Azhar Faculty of Medicine
*Corresponding author: Gamal Abdel-Shafy Farag, e-mail:

although the surgical treatment of flail chest has been practiced for many decades, it is still
controversial. Aim: to compare between conservative treatment and surgical management intervention for
flail chest. Patients and Methods: The present research is a prospective study; included 71 patients with
flail chest, admitted at Al-Azhar University hospital, New Dameitta. The patients were divided into 2
groups according to the treatment they received; 33 patients in surgical fixation group and 38 in
conservative management group. The basic patients' clinical characteristics, associated comorbidities,
detailed intervention, laboratory investigations, and outcome were obtained. The outcome included total
ventilator days, length of stay (LOS) in the intensive care unit (ICU), rate of pulmonary complications,
postoperative pain, development of chronic pain, and mortality. Results: patients in surgical group had
statistically significant low APACHE II score after two weeks postadmission (7.48±1.17 vs. 9.36±1.02) and
higher postoperative FEV1 (1.62±0.06 vs. 1.41±0.02). Duration of mechanical ventilation was significantly
shorter in surgical group (5.25±1.76 vs. 11.81±2.57 days). Total duration of ICU stay was significantly
shorter in surgical group (6.12±1.55 vs. 13.86±2.40 days). No chest deformity was reported in surgical
group compared to 34.2% in conservative group; and the respiratory complications were significantly lower
in surgical group (30.3% vs. 73.3%). At 6 months, no significant difference between surgical and
conservative groups as regard to performing usual activity (18.2% vs. 15.8%) or return to job (45.5% vs.
34.2%). However, the chronic pain was significantly low in surgical group (21.1% vs. 36.8%). No mortality
was reported. Conclusion: surgical internal fixation was found to be superior to conservative treatment for
flail chest.
Keywords: Flail chest; fracture rib; surgery, conservative treatment; internal fixation.


For surgical stabilization of rib fractures,
Fractures of multiple ribs are a common
a number of new osteosynthetic implants
and associated with severe pain. When these
designed specifically had been developed in
fractures occur, a greater work of breathing is
recent years (6, 7). There are previous studies,
needed, that can lead to respiratory failure,
which advocated stabilization of rib fractures by
especially when the underlying lung parenchyma
such implants; as they had been shown that
is injured. This is the case in unstable thoracic
surgical stabilization of rib fractures could be
cage injuries or "flail chest", which defined as
associated with decreased respiratory movement
three or more adjacent ribs each fractured in more
restriction (8,9). Also, it may decrease the need of
than one location (1). Flail chest can result in
intensive care and mechanical ventilation with
paradoxical chest movements and require
decreased complications, improved lung function
ventilator support (2). In addition, flail chest is one
and reduction of overall cost (10,11,12). The correct
of the most severe and complex forms of chest
treatment approach of flail chest is still
trauma. It is usually associated mortality of up to
controversial (13). In addition, since there is a lack
33% (3). In addition to acute morbidities, flail
of knowledge about the operation indications and
chest also leads to chronic pain and disabilities (4).
benefits from surgery and the new technologies,
Conservative management of flail chest
physicians surgery awareness are extremely low
(analgesics and ventilator support) has been the
(14). Further, there is a lack of prospective studies
conventional treatment for flail chest. However, it
with a long-term follow-up concerning lung
function, mobility and pain (2).
immobilization, which leads to complications,
Fagevik et al. (15) in a study of 24
such as pulmonary infections, long-term
patients with multiple rib fractures, who had
disability and chronic pain (5).
undergone stabilizing surgery, found that 50%
still had pain after three months and 35% after six

Received:11/12/2016 accepted:16/11/2016 DOI: 10.12816/0034644

Full Paper (vol.66 paper# 17)

c:\work\Jor\vol66_18 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 146-151

Assessment of Knowledge, Attitude and Practice toward Down
Syndrome in Jeddah City, Saudi Arabia 2016
Yousef Ehab Jan, Murad Mahmood Binjahlan , Abdulrahman Ghazi Alqurashi ,
Ghayda ghazi Alqurashi, Mohammed Ahmed Zirari , Feher Mohammed Alturkistani ,
Mohannad Talal Tolah ,Almoutazbillah Abdurahman Khedrawi ,Khaled Majdi Tawlah ,
Azhar Abdulrahman Kurban, Rami Khalil Garah ,Ayman Sayed Abouhamda ,Abdulghani
Abdulaziz Alzamzami ,Hatim Ahmed Olithah Alshotairy ,Saeed Ahmed Alzahrani ,
Hanan Abdullah Alamri ,Marwa Thani Hawasawi, Zina Abdulkareem Al Zahidy,
Esraa Ahmed Alshareef
Faculty of Pediatrics, King Abdulaziz Hospital, Jeddah, Saudi Arabia


Background: Down syndrome (DS) is a chromosomal disorder that results in intellectual disability and
growth problems. The worldwide incidence of this syndrome is 1 in 1000 births and increases
exponentially with the maternal age. People with DS usually have reduced life expectancy and suffer
from mental retardation, heart problems, Alzheimer's disease among other complications. However, the
severity of the disease differs from patient to patient. Perceptions of the disease and the public attitudes
towards people with Down syndrome are very important in the inclusion of these people in the
community and the supporting families. Objectives: to assess the level of awareness, attitude and
practice toward Down syndrome in Jeddah city to identify barriers. Methods: a cross-sectional
analytical questionnaire-based study among the general population of Jeddah city.
Results: a total of 360 subjects answered the questionnaires. The mean age was 36 years, it ranged
from 16 to 70, with 45.2% females and 43.7% male respondents. Of these, 67% had attended college,
5% had a postgraduate degree, 23.5% had completed high school, and 3.1% had basic school. The
majority of participants had a high level of monthly income (38%). The majority of subjects included
in the research were (59.6%) married and (51.3%) were unemployed.
Most subjects (338) had poor knowledge about Down syndrome and there was no association between
the knowledge and demographics of participants except for education at the higher levels of education,
the more significant association with good knowledge.
Conclusion: The results of the present study reveal that the knowledge about the Down syndrome was
poor among the studied population. Also, education significantly impacts the knowledge of Down
syndrome, thus there is a need for providing the population and patients with the necessary information
to improve their Down syndrome awareness.
Key words: Down syndrome; awareness spreading.


Down syndrome (DS) is a chromosomal
Other studies that included different groups of
disorder that results in intellectual disability and
people has found that the United States
growth problems [1]. The worldwide incidence of
communities still hold negative opinions
this syndrome is 1 in 1000 births and increases
towards people with DS [5]. Another study found
exponentially with the maternal age. People
that European communities also still hold
with DS usually have reduced life expectancy
negative attitudes towards people with Down
and suffer from mental retardation, heart
syndrome [6].
problems, Alzheimer's disease among other
Our study was designed to examine health
complications. However, the severity of the
beliefs and the assessment level of awareness
disease differs from patient to patient [2].
toward Down syndrome among the population
Perceptions of the disease and the public
in Jeddah city, Saudi Arabia and apply the
attitudes towards people with Down syndrome
health belief model to determine barriers.
are very important in the inclusion of these
people in the community and the supporting
Down syndrome (DS) is a chromosomal
families [3], and early interventions can improve
disorder that results in intellectual disability and
their quality of lives [4]. Several surveys have
growth problems [1]. The worldwide incidence of
been carried out to explore the understanding
this syndrome is 1 in 1000 births and increases
and the attitudes of people towards people with
exponentially with the maternal age. People
DS and their inclusion in the community.
with DS usually have reduced life expectancy
Received: 19/10/2016 DOI : 10.12816/0034645
Accepted: 24/10/2016

Full Paper (vol.66 paper# 18)

c:\work\Jor\vol66_19 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 152-155
Autoimmune Hepatitis in Children: A Case Report
Youssef Ali Alqahtani, [1] Saleh M. Alqahtani, [1]Jaber Ahmed Alfaifi, [2]
Abdullah Abdulaziz Alghamdi, [2] Omar Mohammad Alrufaidy [2]
[1] Department of Child Health, King Khalid University, Abha, Kingdom of Saudi Arabia, [2]
Pediatricians, Ministry of Health, KSA
Corresponding author: Dr. Youssef Ali Mohamad Alqahtani, Demonstrator in child health department, King
Khalid University, Abha, Kingdom of Saudi Arabia,
e-mail:,Mobile: +966554736556

Autoimmune hepatitis (AIH) is considered rare, and it is even rarer in the pediatric
population. AIH in the pediatric population is categorized into type 1 and 2, which are differentiated by
their autoantibody profiles.
Case report: 5 years old Saudi boy presented with history of jaundice, fever and dark urine for 5 days
with previous similar history at the age of 3 years. Examination revealed that he was conscious, looks
pale and jaundiced but not in respiratory distress and well hydrated. Abdominal examination showed
hepatosplenomegaly. Anti-nuclear antibodies (ANA), antismooth muscle antibodies and anti-
neutrophilantibodies were positive whereas anti platelet antibodies and anti-mitochondrial antibodies
were negative. Hepatitis serology was negative. Magnetic resonant cholangiopancreatogram (MRCP)
showed diffuse periportal edema, likely related to liver cirrhosis. Liver biopsy was suggesting end stage
biliary cirrhosis. Diagnosis was end stage cirrhosis with biliary features secondary to autoimmune
process. The patient was treated with prednisolone, ursodeoxycholic acid, Vitamin K, omeprazol and iron.
He was discharged and listed on the liver transplant clinic.
Conclusion: This case report highlights and alerts physicians that AIH should always be considered in
paediatric patients presenting with chronic liver disease.
Keywords: Autoimmune hepatitis, childhood, IgG, Saudi Arabia


Case Report
Autoimmune hepatitis (AIH) is a
A 5 years old Saudi boy presented with
progressive chronic inflammatory process
fever, yellowish discoloration of skin and sclera
manifested by the presence of interphase
for 5 days. This child was well till the age of 3
hepatitis, plasma cell infiltrations and rosette
years when he developed jaundice and fever for
formations on histology, the presence of
2 weeks. At that time his family had sought
circulating non-organ-specific autoantibodies
and hypergammaglobulinemia of unknown
investigated there but no clear diagnosis has
been reached, and they advised the family to go
AIH is generally uncommon and is even
to a higher center. After that symptoms
less common among the pediatric population.
improved gradually but, he continued to be
The profiles of AIH in the pediatric population
mildly jaundiced over the last year. This time he
are similar to those in adults, the only difference
presented to emergency department (ED) with
being that the disease tends to be more severe in
jaundice, on and off fever of 39C associated
the former(2,3).Approximately 30% of patients,
sometimes with chills and dark color urine.
usually younger patients, will have an acute
These symptoms were progressive for 5 days.
presentation mimicking acute viral hepatitis.(4)
There was no abdominal pain, distention,
It is particularly aggressive in children
vomiting or diarrhea and no change in stool
color. Also, there was no associated skin rash,
immunosuppressive treatment is promptly
bruises or pruritis. The patient did not report any
started. (5)
joint or bone pain. No history of contact with
jaundiced patient, or raw milk ingestion. The
Received: 20/12/2016 DOI : 10.12816/0034646
Accepted: 27/12/2016

Full Paper (vol.66 paper# 19)

c:\work\Jor\vol66_20 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 156-158

INITIAL PRESENTATION: A Case Report and Literature Review
Abdulaziz Al-Dhubaib, Saqqer Al-Mulhim, Mohammed Al-Ghamdi,
Zeead Al-Ghamdi, Atef Elhag
Department of Surgery, King Fahad University Hospital, University of Dammam.

: Purple glove syndrome (PGS) is a rare complication of intravenous phenytoin use that
typically presents with pain, edema, and discoloration at the injection site that spreads to the distal limb.
Case Presentation: A 25-year-old female patient presented to Kind Fahad University hospital's
emergency department (ER) following a seizure episode, on admission to the hospital she was found to
have profound tonic-clonic seizures, flexed limbs, uprolling eyes and frothy secretion from her mouth. The
patient received IV fluid 0.9 NS and diazepam 5 mg IV injection followed by Phenytoin 1g was IV
administrated on 100cc NS over 3 hours with a dose of 50 mg IV/min, and was admitted to the medicine
service. Soon, the patient felt pain, swelling, Erythema and abnormal movement from the site of the IV
cannula over the left forearm while Phenytoin was being injected, however no purple discoloration was
detected and the patient was diagnosed with purple Glove syndrome (PGS). Accordingly, Phenytoin was
held and replaced by carbamazepine for Seizure control, Brain MRI and EEG were ordered
simultaneously. Patient symptoms were alleviated 2 days later and was ready for discharge. Follow-up
visits were scheduled until the patient was fully recovered and aware of the implications of Phenytoin on
her case.
Conclusion: Since PGS is a rare complication of IV phenytoin therapy, it's not common to link the clinical
symptoms of PGS to Phenytoin adverse reactions at the first prognosis especially when discoloration -
which is a profound symptom of PGS -is missing. The risk of PGS for this patient may have been abated
at the very early stage by decreasing the phenytoin infusion rate from 50 mg/min to less than 25 mg/min.
Keywords: Phenytoin, PGS, seizures, extravasation, adverse reactions.


One of the most poorly understood and
extravasation. This has raised the question as to
potentially serious local complications of
whether phenytoin itself, irrespective of route of
intravenous phenytoin administration is the
administration, may induce PGS in patients due
purple glove syndrome, which is characterized by
to phenytoin doses and serum levels that are
progressive limb edema, discoloration, and pain.
higher than recommended therapeutic doses or
In the only reported systematic study of this
levels. (4)
syndrome at the time (1998) had the incidence of
The presence of thrombi in the early-stage lesion
purple glove syndrome was 5.9% (nine of 152) in
of PGS also suggests that thrombosis plays a role
patients receiving intravenous phenytoin (1).
in the initial pathogenesis of this condition. (5)
Phenytoin is an anticonvulsant licensed for the
In this study, the authors prospectively concluded
that LCR is common in routine hospital practice,
(grandmal) seizures and complex partial
but are generally mild and benign.
(psychomotor, temporal lobe) seizures (2).It is also

approved by the United States Federal Drug
Authority for the prevention and treatment of
A 25 years old female - who was accompanied
seizures occurring during or after neurosurgery (3).
by her sister and wasn't known to have any
A more recent study ­ in 2000- a case of PGS
previous medical illness -was presented to ER
was reported following oral administration of
with a tonic-clonic seizures, flexed limbs,
phenytoin which provides supporting evidence
uprolling eyes and frothy secretion from her
that PGS may occur with or without phenytoin
mouth. It was discovered later on that she had

similar episode one month ago.
Received: 12/09/2016 DOI : 10.12816/0034647
Accepted: 19/09/2016

Full Paper (vol.66 paper# 20)

c:\work\Jor\vol66_21 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 159-165

A Call for Spreading Awareness among Parents and Gynecologists on the Danger
of Genital Herpes on Neonates - Department of Medicine and Dermatology- King
Abdulaziz Hospital and Oncology Center, Jeddah, Saudi Arabia

Nawaf Abdullah Alroqaiba1, Khalid Mohammad Althomali2, Ekram Ibrahim Saeed3, Ibrahim
Mahmoud Alhaj3, Maha Nageeb Alkatheri3, Razan Isam Alrifaie3, Abrar Sheikh Faisal Al
Aidarous3, Nejoud Bassam Rabie4, Reham Abdulrahman Abdullah4, Elaf Abdul Qader
Bahanshel3, Abdulwahab Mohammed Binhuwail4, Fawaz Obadan Alzamil5
1 King Saud Bin Abdulaziz University, 2Carol Davila university of medicine and pharmacy, 3 Battarjee Medical College, 4
Ibn Sina National College, 5 King Abdulaziz university

genital Herpes infection is caused by HSV 1 and HSV2 Virus. It causes distressing
symptoms in a significant number of adolescents and adults with over 40 million people sufferers from
recurrent HSV genital ulcer disease causes significant disease globally and it is potentially fatal when
transmitted to neonates and most maternal infections with risk of transmission are asymptomatic.
Aim of the Study: highlighting the crucial rule of parents education and awareness on the prevention
and management of HSV in neonates (NHSV).
Patients and methods:
112 females and 34 males HSV2 seropositive patients were assigned to fill a
questionnaire on their awareness about HSV2 infection and symptoms and its effect on potential
neonates. In parallel, there was a questionnaire for the assigned gynecologists to assess the counseling
process of the mothers about the history of previous infection. Data was compared to the patients
medical chart and past delivery of defected and treated neonates.
Patients whom were aware with the dangerous effect of the infection of virus had no
mortality in their neonatal and had the good treatment for them.
Conclusion: Couple educational and Awareness campaigns on genital Herpes infection have become a
compelling need in order to avoid neonates mortality and help in designing preventive measures for
neonates morbidity.
Keywords: Genital Herpes, HSV2, NHSV, Acyclovir, Neonates morbidity, pregnant women.


400 million people at increased risk of genital
Herpes genitalis is one of the most
ulcer disease, HIV acquisition, and transmission
common sexually transmitted diseases (1).
Historically, Herpes infection routes of

transmission have been narrowed down to either
HSV-2 to partners or neonates. These estimates
sexual contact for HSV-2 infection, or oral-to-
highlight the critical need for
oral contact for HSV-1 infection causing oro-
development of vaccines, microbicides, and
labial herpes. However, there is an emerging
other new HSV prevention strategies (6).
trend of increasing genital HSV-1 infection
The incidence of herpes simplex virus
among young people in many settings (2).
(HSV) infection has been increasing steadily in
Although type-specific serological tests can
recent decades, and concerns about perinatal
measure the presence of HSV-1 antibodies, they
HSV infection are growing among women of
are unable to determine the site of infection (3).
reproductive age because of the risk of
However, recurrences due to genital HSV-1
transmission of the virus to their babies during
infection are much less frequent than with
genital HSV-2 infection (4), and globally most
consequences to the fetus(7) . It is potentially
symptomatic genital herpes is due to HSV-2(5).
fatal when transmitted to neonates, and causes
According to 2012 statistical study, there were
distressing symptoms in a substantial number of
417 million people aged 15­49 years (range:
adolescents and adults with over 40 million
274­678 million) living with HSV-2 infection
people sufferers from recurrent HSV genital
world-wide (11.3% global prevalence), of
ulcer disease.
whom 267 million were women. The global
Maternal genital HSV cases may be classified
burden of HSV-2 infection is large, leaving over
as follows (8):
Received: 17/12/2016 DOI : 10.12816/0034648
Accepted: 24/12/2016

Full Paper (vol.66 paper# 21)

c:\work\Jor\vol66_22 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 166-169

Prevalence of Internal Hernia Post Laparoscopic Surgery
Wail Omar AlGorashi1 , Zina Abdulkareem Al Zahidy1 , Amal Mohamed Sharton2,
Sara Abdullah Turki2 , Aisha Omar Aljiffry1, Alaa Khalid Al-jehani2, Rasis Khalid Saber2,
Dina Alamin Gaber2, Asmaa Yaseen Nassir1, Rahaf Tarik Dashash2 ,Wadha Saad Almohamdi1,
Bayan Hamdan AlGhamdi1, Ahmed Zaki Alaidaroos2, Fahad Noraldeen Kahilah1
1 Ibn Sina National College, 2 Battarjee Medical College

Laparoscopic approach for colorectal resections is now very popular. Internal small bowel
herniation (SBH) through a mesenteric defect has been recorded especially if the mesentery is not
repaired. Although it's rare, it is a severe complication. Lack of postoperative adhesions is one advantage
of minimally invasive surgery but it's also responsible for a higher incidence of internal hernias. These
patients often present with intermittent abdominal pain or small bowel obstruction with completely
normal contrast radiographs. Laparoscopic surgery is a minimally invasive approach with good treatment
outcomes and is currently the standard surgery for colorectal cancer in Saudi Arabia.
Objective: the aim of our study was to evaluate the incidence and outcome of internal hernias after
laparoscopic procedure in King Abdul-Aziz Hospital & Oncology Center.
Patients and methods: a total of 372 patients underwent laparoscopic colon resection surgery for colon
cancer during the study period from August 2015 to October 2016 in King Abdul-Aziz Hospital &
oncology center. Results: our result found that internal hernia was reported 48 times.
Keywords: Internal hernias; closed colon cancer resection surgery.

Laparoscopic surgery for colon cancer
During the study period from August 2015
resection complications is very different to those
to October 2016, 372 patients underwent
in open surgery [1].On the other hand
laparoscopic colon resection surgery for colon
laparoscopic operation has minimal invasion and
cancer in King Abdul-Aziz Hospital &
minimal scars that benefits the patients [2].Intra-
Oncology Center. The vast majority were
abdominal adhesions are also markedly reduced
primary laparoscopic colon cancer resection
following laparoscopic surgery. Some of the side
procedures. Patient were informed about the
effects that can presented from laparoscopic
procedure and signed on a written consent.
procedure such as peritonitis and internal
Some hernias were found incidentally during
herniation [3, 4, 5]. The major cause of the internal
exploring for the pathologies and some
herniation is the mesenteric defect because it
patients were found to have a mesenteric
doesn't repair completely in laparoscopic surgery
defect without herniation of bowel. Patients
as it does in open surgery [6,7,8]. Lately
who had the hernia were presented with
laparoscopic surgery has become more popular
and more performed than open surgery. In both
obstruction. We have evaluated the patients
laparoscopic and open surgeries the mesenteric
according to their signs and symptoms at
will be closed .However, numerous reports
presentation. Patients who presented with clear
indicate that mesenteric defects are often not
signs of herniation and intestinal obstruction
closed during laparoscopic surgery [6].We have
were offered to have re operation to repair the
reported a lot case of an internal hernia
hernia and close the mesenteric defect. Patients
projecting through a mesenteric defect following
who presented with intermittent abdominal
laparoscopic resection of the colon. Ironically,
pain with no signs of obstruction underwent
the advent of laparoscopic surgery has increased
further investigations such as contrast for
the incidence of this problem, but also has
upper GI , Computed tomography (CT) scan ,
simplified the diagnosis and treatment of these
Ultrasonography and Endoscopy . We also had
to do exploration for all those with un- clear

symptom and for those with post-surgery
Received: / /2016 DOI : 10.12816/0034649
Accepted: / /2016

Full Paper (vol.66 paper# 22)

c:\work\Jor\vol66_23 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 170-187
Trends and Determinants of Contraceptive Use among Young
(15-24 Year) Married Women: A Secondary Analysis Based on
the 2008 and 2014 Egypt Demographic and Health Surveys
Essam A. El-Moselhy1*, Farag M. Moftah2, Manal M. Darwish2,

and Alyaa H. Abo-Rahma1
Department of Public Health and Community Medicine
Faculty of Medicine, 1Al-Azhar and 2Assiut University
*Corresponding author: Dr. Essam A. El-Moselhy, Prof. and Head of Public Health and Community Medicine,
Faculty of Medicine, Al-Azhar University, e-mail: and

Background: young females in Egypt still face a number of challenges regarding their reproductive
health (RH) despite efforts to enhance it. Importance of young womens reproductive choices arises
from the concept that early childbearing can impair their health and their productive participation in
community. Aim: the paper aimed to explore the key determinant of the contraceptive (CC) use
amongst young married females in Egypt using the 2008 and 2014 Egypt Demographic and Health
Survey (EDHS) with a comprehensive look at the CC use changes occurred in the study period 2008-
2014. Subjects and Methods: data from the 2008 and 2014 EDHS were secondary analyzed. Variables
were selected to assess their effect on CC use. Multivariable regression analyses were performed. Odds
ratio was computed. Results: overall contraceptive prevalence (CP) decreased from 53.7% in 2008 to
51.2% in 2014. Traditional methods were responsible for this decrease. Younger age, being from rural
Upper Egypt, husband desire for more children, no visit to health facility were the most important risk
factors for not using any CC method among Egyptian young married females in 2008. Added to these
factors; low women autonomy, no exposure to family planning message, in the poster and women
justifying husband violence in 2014. However, region lost its significance as a determinant in 2014.
: our results discovered the determinants that modulate the CC use behavior among
Egyptian young married females.
Key Words: Contraceptive use, Trend, Determinants, young married females, Egypt Demographic
Health Survey.

major socio-economic factors favor adolescent
According to the United Nations [1], 64.0%
childbearing in Egypt [6].
of married or in partner-relationship females in
Despite CP in Egypt increased rapidly in
the reproductive age worldwide were using
the 1980s, to reach 60.0% in 2003,but since
some form of contraception. However, contra-
2003, CC use rate didn't changes ignificantly
ceptive prevalence (CP) was much lower in the
contrasted the expectation, swing between
least developed countries.
59.0% and 60.0% [7].
In Egypt, one in five people is between the
Political events in Egypt since January
ages of 15 and 24 with a total number of 16
2011 revolution added further challenges to
million in 2012. Preparing these young people
Egypt in the aspects of maternal health [4]. The
for the time when sexuality and reproduction
socio-political transition decreased access to
are central, is necessary [2].
family planning (FP) services and added
The 1994 International Conference on
barriers to high-quality public health services
Population Development was held in Egypt;
where the concept of reproductive health (RH)
The reproductive choices taken by young
was laid [3]. Egypt demographic data show that
females have a great effect on their health,
many reproductive outcomes get better between
education, and work prospects [9].
1990 and 2013; Egypt decreased its maternal
This paper is an attempt to examine the
mortality ratio from 120/100,000 in 1990 to
determinants regulates contraceptive (CC) use
45/100, 0000 in 2013 [4].
among Egyptian young married women. Also, it
Adolescent fertility is still high leading to
aims to discover CC changes and trends in
higher levels of maternal mortality [4] and low
Egypt. Also, it aims to guide reproductive
birth weight infant [5]. Low educational level of
health (RH) program planners and policy-
women and poor economic status constitute the
makers to implement RH programs that will
Received: 11/12//2016 DOI : 10.12816/0034650
Accepted: 18 /12 /2016

Full Paper (vol.66 paper# 23)

c:\work\Jor\vol66_24 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 188-192

Seroprevalence and Potential Root Cause of Toxoplasmosis in Primary
Children; A Study Conducted at King Abdulaziz Hospital
Eman Hassan Alharbi1, Logeen Khalid Yamani1, Aisha Esam Taiyeb1, Saad
Mahmoud Tobaigi1, Mawaddah Mohammed Zawawi2, Alhassan Mohamed Shahrour3,
Rawan Abdullah Alsaedi1, Saleh Abdulaziz Alghamdi1, Reem Ahmed Alshareef1,
Ekram Ibrahim Saeed1, Sara Abdulelah Alqurashi4, Zainab Ahmed Aljubarah4
1 Battarjee Medical College, 2 Umm Al-Qura University, October 6 University, 4 Ibn Sina National College

Toxoplasmosis is a zoonosis with a high prevalence throughout the world. Toxoplasma
gondii infection is frequently asymptomatic. Primary school children are particularly vulnerable to
toxoplasmosis due to their habits of playing in water, soil, eating various raw foods, or contact with
pets, including dogs, cats, and birds and hence they are an ideal target group to investigate T.
prevalence. Data collected from this age group can thus be used to assess whether T.
threatens the health of school-aged children, and also as a reference for evaluating the need for
community interventions. The aim of this study was to determine the prevalence rate of anti-
toxoplasmosis IgG and IgM in Primary School children and to detect agents that increase prevalence of
the disease.
Materials and methods: 328 primary children (219 females and 109 males) were screened for T.
gondii antibodies with ELISA along with a questionnaire conducted to all children and
parents/guardians to obtain data for relevant eating and social habits. Among the risk factors tested,
including contact with cats and soil, consumption of raw meat and vegetables, and drinking unboiled
Results: the seroprevalence of anti-Toxoplasma IgG & IgM was found to be 12 % (40 out of 328) and
2.4 % (8 out of 328), respectively while combined anti Toxoplasma IgG & IgM antibodies were found
in 1.5 % of the children (5 out of 328). Infection acquisition rate was directly proportional to age and it
was of interest that the most significant risk factor was not the petting of cats but the ingestion of raw
meat. The seroprevalence of T. gondii IgG & IgM by ELISA among primary children in this region of
Saudi Arabia is considerable with few identifiable significant risk factors reported.
Conclusion: effective measures should be taken to prevent and control T. gondii infection in primary
school children, the results of this study showed that in order to increase awareness of the disease in the
community especially for girls and their parents on common root causes such as raw meat and
vegetable is necessary. Policy makers also need to initiate prevention and control programs to not only
primary children but also pregnant women and immunocompromised patients in particular because they
are more severely affected by T. gondii infection.
Keywords: primary school children, Toxoplasma gondii, Seroprevalence, Saudi Arabia.


become infected from food or water
Toxoplasmosis refers to a symptomatic
contaminated with oocysts. Eating of unwashed
infection by Toxoplasma gondii, a widely

distributed protozoan that usually causes an
raw vegetables or fruits or ingestion of water
asymptomatic infection in the healthy host.
contaminated with oocysts , have been identified
Pediatric toxoplasmosis can be acute or chronic
as important risk factors (3,4).
and congenital or postnatally acquired (1)
Human infection occurs from ingesting food
.Sporozoites (oocysts) result from the parasite's
contaminated with oocysts or poorly cooked
sexual cycle, which takes place in the epithelial
cells of the cat intestine. Infected cats excrete
experimental attempts to transmit tachyzoites by
oocysts in large numbers (up to 10 million cysts
arthropods were negative, cockroaches and flies
during a single day) with excretion occurring for
are believed to be able to transport oocysts to
up to 2 weeks following infection. Once shed,
water and food. Because parasitemia can persist
the oocyst sporulates in 1 to 5 days, becoming
up to a year in healthy persons, blood
infective and may remain infective for more than
transfusion is a potential source of infection (5).
1 year in unfrozen, moist soil (2).Humans can
Once the individual is infected, the organism
persists as tissue cysts for life. The degree of
Received: 25 /12 /2016 DOI : 10.12816/0034651
Accepted: 30 /12 /2016

Full Paper (vol.66 paper# 24)

c:\work\Jor\vol66_25 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 193-197
Assessment of Knowledge, Attitude and Practice toward Acne
Vulgaris among Community in Jeddah City, 2016
Abdulrahman M Albahlool, Hatim Ahmed Alshotairy, Reham Abdulrahman A Abdullah ,
Bayan Fouad Mogharbel ,Sultan tariq S fageeha , Ameen Mohammed Malky, Manahel Abdulsattar
Qurban , Lamiaa Saleh alzahrani ,Ahmed Abdulaziz Ali Haider ,Ghufran abdullah albakri ,
Abdullah Jamal A Ahmad , Smaher Abdullah Bahawi , Jihad Abdullah Banda, Awatef Ayed M
Alshammari , Abdallah Alomar , Kholood Mohmad Jafarali Khan, Reham Hamed ALSaidlani ,
Khalid Mohamad Gormallh Al-ghamdi , Jabir Abdulrahman K Alzidi
Faculty of Dermatology, King Fahad Hospital, Jeddah Saudi Arabia.


acne vulgaris is the most common skin condition seen by the dermatologists. It is a chronic
inflammatory disease of pilosebaceous unit characterized by seborrhea, comedones, papules, pustules,
nodules, cysts and in some cases scars and keloids, which persist for rest of the life.
Objectives: the present work aimed at evaluating the level of awareness, Attitude And Practice toward acne
vulgaris in Jeddah city . Methods: a cross sectional analytical questionnaire based study was carried out
among the general population in Jeddah city. This study started in the year (2016) and composed of 461
subjects. The mean age of citizens was 28,82. To assess citizens' demographic factors and beliefs about
acne vulgaris, consenting citizens completed an anonymous online questionnaire. The data was entered and
analyzed using SPSS version 20. Results: The sample is consisted of 65,8% women and 34,2% men.
Among the respondents 7,7% reported suffering from acne vulgaris and 13,6% confirmed having a history
of acne vulgaris illness in their family. The results of the study showed that 153 (34,8%) subjects had weak
knowledge related to the disease, 260 (59,1%) subjects had average level of knowledge while only 27
(6,1%) subjects had good knowledge regarding acne vulgaris. There was a statistical significant association
between gender, educational level and the level of awareness about acne vulgaris.
Conclusion: acne vulgaris is a disease that is potentially controllable but that cannot be cured. Education
still be important overall the treatment of the patients.
Keywords: acne ,prophylactic measures ;treatment plan.


Acne vulgaris is the most common skin condition
acne, there is lack of information on the
seen by the dermatologists[1,2].It is a chronic
knowledge and understanding by the patients
inflammatory disease of pilosebaceous unit
about acne especially from this part of the world.
characterized by seborrhea, comedones, papules,
A review of recent literature shows that acne
pustules, nodules, cysts and in some cases scars
sufferers are not well informed about the causes
and keloids, which persist for rest of the life[3,4].
and the modalities to alleviate its severity[10-11-12]
There is general recognition that there are many
.Acne is not a trivial disease, the physical, social
factors in the etiology of acne vulgaris [5]. Causes
and psychological morbidity associated with the
could be attributed to both genetic and
disease can be profound and the quality of life in
environmental factors. There is familial
sufferers can be severely impaired.[13-14]Our Study
predisposition of severe forms of acne that support
Was Designed To Examine Health Beliefs And
a genetic component. Acne usually occurs around
Assessment Level OF Awareness Toward acne
puberty but it may start late in the thirties and
vulgaris among Population In Saudi Arabia,
forties (in adulthood) [6, 7, 8]. It takes several years
Jeddah city And Applies The Health Belief Model
before spontaneous remission [6]. Prognosis of the
To Determine Barriers.
disease is usually good but, as a chronic disease,

relapses even during treatment could occur. It can
remit spontaneously[9] . Although substantial
There is general recognition that there are many
literature is present on basic science, clinical
factors in the etiology of acne vulgaris. Causes
features, psychosocial impact and treatment of
could be attributed to both genetic and
Received: 15 /12 /2016 DOI : 10.12816/0034652
Accepted:23 /12 /2016

Full Paper (vol.66 paper# 25)

c:\work\Jor\vol66_26 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 198-201

Postoperative Recurrence of Huge Hydatid Cyct

Bilal aljefri and Shahd Abdulaziz Almalki

Al Hada Armed Forces Hospital


hydatid disease (Echinococcus granulosus), is a parasite disease infestation in humans
most commonly occurs in the liver. It has high recurrence rate. Surgery remains the mainstay of
treatment for HD and aims to eliminate the parasite, promoting the rapid disappearance of any residual
cavity and preventing complications and recurrence . Case study:our patient is a case of recurrent
huge hydatid cyst which infested in the liver of 39-year-old female, medically free, in 2009 she
underwent evacuation of hydatid cyst with partial removal of the cyst wall. 7 years later (2016) she
presented to ER with abdominal mass increasing in size with time, associated with dull, aching pain
and vomiting, with jaundice and itching, there was no fever, no change in bowel habit, no change in
urine and stool color. A full investigation done, abdominal CT showed large oval shaped
intraperitoneal cystic lesion with a diameter about 20 cm * 15 cm. The patient received anti-parasitic
medications for 2 weeks before the operation. The operation of complete cyst excision (cystectomy)
was done. We recommend a total or partial pericystectomy as the most appropriate procedure for the
management of primary hydatid cyst and also for recurrent hydatid cyst with pre- and post-operative
courses of anti-parasitic drugs should be considered which helped in reducing the intraoperative
spillage of viable cysts and to decrease the recurrence rate post-operatively, and the patient has to
avoid the risk factors and transmission ways of the parasite.
Keywords: Hydatid cyst, echinococcosis


No history of cough or contact with
Hydatid disease (Echinococcus granulosus) is
T.B patient.
endemic in the Middle East as well as other
No history of contact with hepatitis
parts of the world, including India, Africa,
South America, New Zealand, Australia,
Other systemic review unremarkable
Turkey and Southern Europe1-3. Infestation by
PMH medically free
hydatid disease in humans most commonly
Family history no similar episode, no DM,
occurs in the liver (55--70%) followed by the
no HTN.etc.
lung (18--35%). Surgical management is the
Social married house wife with 4 kids, live in
basic treatment for hydatid disease. Overall, the
south region of Saudi Arabia (sharorah) low
recurrence rate appears to be high (4.6%­
income, they own sheep farm which the wife
22.0%). Both host and parasite factors
usually take care of them.
Certain technical
On examination the patient was conscious,
problems increase the chance of inadvertent
oriented, underweight, not in distress no
operative rupture and spillage of cyst contents.
jaundice, vitally stable.
The purpose of this study was to report our
Abdominal examination revealed subcostal
results in the management of recurrent hydatid
scar with upper midline extension, soft lax
abdomen with huge intra-abdominal swelling

measures 20*12cm .
Case Report
All labs work were within normal range.
39 years old female patient with PSH of
CT done at 8/7/2013 showed large oval shaped
evacuation of hydatid cyct with partial removal
intraperitoneal cystic lesion measuring about
of the cyst wall on 2009.
20cm * 15cm, pushing the liver and the
The patient presented to ER complains of
stomach laterally and is in contact with the
abdominal mass at epigastric region with
pancreas, pushing the abdominal wall
gradual increase in size for 9 months' duration,
anteriorly. this lesion showing no vegetation,
associated with dull aching pain and vomiting,
loculation or enhancement after contrast
with no fever, no bleeding, no change in bowel
injection. This is highly suggestive of hydatid
habit, no change in urine or stool color. there is
history of loss of weight, jaundice and itching.

Received: 23 / 12 /2016 DOI : 10.12816/0034653
Accepted: 29 /12 /2016

Full Paper (vol.66 paper# 26)

c:\work\Jor\vol66_27 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 202-214

Review Article: Risk Factors for Non-communicable Diseases in Libya
Nura N. Altajori1 and Yousef M. Elshrek2
Clinical Biochemistry Department, Medical University, Benghazi, Libya 1, and
Food Science Department, Faculty of Agriculture, University of Tripoli, Libya 2

This review article highlights the current situation of some non-communicable diseases in Libya and
factors contributing to its prevalence such as obesity, diabetes, cardiovascular diseases (CVD), high blood
pressure and cancer. Obesity is a global epidemic resulting in major morbidity and premature death.
Between 26-41% among adult Libyan women and 11­21 % among adult Libyan men (about 64% of
Libyan adults are either overweight or obese), obesity progressively increasing with age, and two times
more common among Libyan women than men. Hypertension is a common co-morbidity of diabetes,
affecting 20-60% of people with diabetes. Hypertension is also a major risk factor for CVD as well as
microvascular complications such as retinopathy and nephropathy. About 68.4% of Libyan males and
48.4 % of Libyan females who suffer from high blood pressure are under treatment. The average rate of
those who suffer from diabetes mellitus among Libyans reached between 11 ­ 23.3 % for both sexes. The
main causes of death are cardiovascular diseases (43%), cancer (14%), chronic respiratory diseases (4%),
diabetes (5%), other Non-communicable diseases (NCDs) (12%), communicable maternal perinatal and
nutritional conditions (10%), and road traffic injuries (12%). The prevalence of risk factors for non-
communicable diseases has risen as a result of changing lifestyles. More than 30% of the adult male
population smokes regularly. Approximately, 1.2 percent of the population is blind, mainly due to
cataract. Trachoma remains endemic in some pockets in the country. Road traffic crashes, which result in
6 deaths per day and even higher figures for disability, account for a significant burden of disease.
Keywords: Libya, Non-communicable diseases, obesity, diabetes, cancer, blood pressure.


The prevalence and incidence of non-
instrument and a methodology adapted to
communicable diseases in Libya have increased
Libya's resource setting. Therefore, the purpose
dramatically over the past 30 years.
of this paper is to review the current situation of
Cardiovascular diseases, hypertension, diabetes,
some non-communicable diseases in Libya, and
cancer beside that traffic accidents, contributed
factors contributing to its prevalence.
significantly to morbidity and mortality, and
Obesity in Libya
have put a considerable strain on the country's
Obesity is a global epidemic resulting in major
health expenditure. The prevalence of risk
morbidity and premature deaths. Cases of
factors for non-communicable diseases has risen
obesity and overweight are increasing in Libya
as a result of changing lifestyles. The main
as well as all over the world, with genetic and
causes of deaths are cardiovascular diseases,
environmental factors playing a contributory
cancer, road traffic injuries and diabetes
(Country Cooperation Strategy for World Health
energy/high fat foods, fast food consumption,
Organization (WHO) and Libya (1,2). In an effort
television watching, "super-sized" portions, etc.
to tackle this problem, the Ministry of Health,
must play an important role in the obesity
with the support of WHO, has adopted the WHO
epidemic and habitual diet is one of many
stepwise approach to non-communicable disease
environmental factors that potentially contribute
risk factor surveillance. The WHO stepwise
to the inter-individual differences in body fat
approach is a simple standardized method for
mass. Differences in habitual dietary intake are
collecting, analyzing and disseminating data in
also partly determined by differences in genes
countries. The stepwise survey was successfully
influencing smell and taste preferences (3).
conducted in 2009 using a standard survey
Table (1) shows that the mean BMI (kg/m2) in

Libyan adults (aged between 24 ­ 65 years) is
Received: 22 /12 /2016 DOI : 10.12816/0034654
Accepted: 26 /12 /2016

Full Paper (vol.66 paper# 27)

c:\work\Jor\vol66_28 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 215-220
A Meta-Analysis Study on Intraoperative Awareness with
Recall and Need for Proper Guidelines
Mohamed Ibrahim, Yousef Ehab Yousefjan, Ibrahim Saeed bin Sadan Alzahrani,
Fisal Mahmood B Torkostani, Abdullah Ali Baawadh, Abdullah Alawi .H. Alattas, Badr Fouad
Mogharbel, Nada MohiedinSabbagh, Meshari A Alkhaleefa, Abdulrahman S Alhumaid, Abdulaziz
Khalid Bakhaider, Abdulrahman Mubarak Al-Ahmari, Adel Mohammed Saeed Alhashim,
Abdu Ibrahim A Alsayed, Mohammed Fayez Mohammed Alshehri, Jabir Abdulrahman K Alzaidi,
Ahmed Abdulaziz Ali Haider and Sulaiman Abdullah Binbadi
Department of Anesthesia, King Abdulaziz University Hospital, Jeddah, Saudi Arabia

The main objective of the article is to provide the necessary awareness on decision making in order to
support better patient care. The awareness is through advisory technique with more emphasis on practical
application. The article has analysis of the opinions from experts on synthesis. More so, there is provision
of better ways to clinical data feasibility, open forum consultations and surveys from experts on anesthesia.
The main emphasize of the article is decision making in improvement of the patient care. Although
advisories are important, the aim should always be decision making and the article focuses on practice in
order to improve medical knowledge. The article gives an outline on additional measures to be taken to
improve the medical practice according to Anesthesiology. The article emphasizes the advisory from the
anesthesiologists and all the supporting physicians. In addition, there is also provision of advisory to
individuals who administer general anesthesia. Review of the article on Metal-Analysis study has identified
many characteristics of patients who have been associated with the risk of little awareness. The review has
explained the procedures to be followed when dealing with situations of higher risks on intraoperative
awareness. The anesthetic techniques on intraoperative awareness are also included in the preoperative
Keywords: intraoperative awareness,

A Meta-Analysis Study Review
Intraoperative awareness from surgical

operations with general anesthesia is rare as

explained by most anesthesiologists and patients.
analgesia, hormonal suppression, and motor
However, the surgery has undesirable and adverse
reactions during the stressful surgical proceeding.
implication on the patient due to the resulting pain.
Despite the initiative to inhibit the effects of pain,
Such a consideration demonstrates the possible
intraoperative memory associated awareness
consequences of poor techniques in anesthesia,
occurs when a patient is capable of processing
failure of equipment, or inadequate monitoring.
information and produces an accurate response to
The associated risks could lead to the development
stimuli. Such a move is depicted by the various
of traumas, cardiopulmonary bypasses and
phases of interoperation that are independent. For
obstetric intercurrences that are side effects of the
instance, the declarative memory appears when the
process of intraoperative awareness. Meanwhile,
patient can recall events and experiences during
the involuntary experience and memory of the
the administration of the medication (1). As well,
surgical events are often devastating to a patient,
procedural memory takes effect when the victim is
which remains an area of interest for the study.
unable to express the facts verbally, though post-
Intraoperative awareness with an explicit recall of
operative behaviors manifest the changes during
the episodes of the procedure is significant in
the anesthesia. In such regard, psychological tests
achieving patient safety, monitoring standards and
are recommended for the detection of the
search for conscious correlation (1).
The medical use of anesthesia is purposely
performances (2).
for inducing unconsciousness in a patient through
Consequently, the wakefulness state
drug administration. However, the provision is
appears in intraoperative awareness where one can
Received: 26 / 12 /2016 DOI : 10.12816/0034655
Accepted: 30 /12 /2016

Full Paper (vol.66 paper# 28)

c:\work\Jor\vol66_29 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 221-226

Interval Appendectomy Operative vs. Non-Operative Management of
Appendicitis in Saudi Arabia
Ayman Abouhamda, Yousef Jan, Majid Alturkstani, Fouad Alsaadi, Rami Garah, Sara
Alaqel, Fawaz Al Thobaiti, Abdullah Ali Alshamrani, Hamdan Alaamri, Majed Al
Hotelah, Danya Yousef Bakhsh, Ahmed Haider
General Surgery, King Abdulaziz University


The goal of this review is to analyze the perfect mechanism for managing acute appendicitis.
Both surgical and non-operative approaches are in contention as the best remedies for the appendix
complications. To draw a better comparative analysis, the strengths and weaknesses of each proposed
mechanism are analyzed. In the Kingdom of Saudi Arabia (KSA), both immediate and interval surgical
procedure remain debatable as best remedies for acute appendicitis. To determine the suitability of both
immediate and interval appendectomy against non-operative management in KSA, vast literature is
analyzed to portray the strengths of each medical maneuver.
Background: The primary objective of appendicitis management is to ensure early diagnosis and
prevent operative management, which is risky and costly [1]. However, this goal has remained elusive due
to delayed diagnosis, a characteristic that is prevalent for most people. In an analysis concerning the
changing trends of appendicitis management over the past 30 years, surgery is not the only remedy for
appendicitis patients [2]. Some individuals, as exhibited by numerous studies, have been able to recover
without the need for surgical procedures, currently conceptualized as appendectomy. However,
concentrating on the analysis by a number of scholars, it becomes evident that some delayed attention to
symptoms, mainly due to patient's ignorance, makes appendectomy inevitable. As such, the most
common cause of abdominal surgical emergency is appendicitis [3]. Narrowing down to the ground
situation in America, not much difference is exhibited. Appendectomy remains the most significant tool at
the physicians disposal when faced with relatable appendicitis dilemmas. By the time patients seek
medical attention, it is already late, an aspect that motivates physicians to put into use prompt surgical
The growing attention to appendicitis management is proportional to its prevalence rate.
Appendicitis accounts for approximately 40,000 hospital admissions each year in England [2]. Similarly,
early studies performed by English medical scholars indicated that close to 150 people from England and
Wales die from acute appendicitis [4]. The prevalence rate of appendix complications is approximately
seven to eight percent of the global population. Regardless of the advanced diagnostic and surgical
technology, morbidity of the complication is 10%, and the mortality rate is between 1% and 5%. Despite
its high prevalence, acute appendicitis is decreasing the in the US and the European region while
proportionally increasing in the developing countries, mainly due to changing lifestyles
[5,6,7].Consequently, a histopathological study on KSA in 2015 revealed that diagnosis rate of acute
appendicitis was 52% while acute suppurative, acute gangrenous appendicitis and acute perforated
appendicitis remained at 28%, 12.5% and 2% respectively [8]. However, it is important to acknowledge
that the study was limited to one geographical area, but scientifically, the figures represent a consistent
pattern. Significantly, the prevalence rate of subhepatic acute appendicitis accounted for 0.054% of Saudi
Arabia's hospital population [9]. With much research being carried on the best way of handling
appendicitis, this next segment of the review covers a summary of current research's perception
concerning the effective medical procedure (operative vs. non-operative). The summary section is not
conclusive but rather shows a sample of analyses approaching the best way of handling appendix
complications in the general population.
Methods:A review of the literature was made using the most common electronic sources including:
electronic database, EMBASE, MEDLINE search using
Keywords: Appenedectomy interval, Appendicitis, Appendiceal mass, Phlegmon and Saudi Arabia.
The major outcomes gained were related with the different approaches associated with appendicitis
Received: 26/12/2016 DOI : 10.12816/0034656
Accepted: 30/12/2016

Full Paper (vol.66 paper# 29)

c:\work\Jor\vol66_30 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 227-233

Systematic Review and Evidence Based Guidance on the Surgical Antibiotic
Guidelines Adherence
Hani Helal Khader Alhassani ,Khalid Mohamad Gormallh Al-Ghamdi ,Ahmad Hameed Allehaiby ,Moataz
Abdulhalim Mohammed, Maram Adnan Rawah ,Saleh Jamaan Alzahrani, Alyaa Mohammed Rafie A
Banjar ,Sarah Musaed Alluheibi ,Abdullah Mohammed Sindi ,Hassan Omar Qahwaji ,Sara Abdo Saif
,Raghad Abdulrahman Rasheed ,Ali Hussein Mohammed Alasmri ,Badr Fouad Mogharbel ,Sulafah Sameer
Abduljawad ,Rayan Tareq Jameel Alrefai, Sultana Sameer Saeedi
Faculty of general surgery, King Abdulaziz hospital, Jeddah, Saudi Arabia
antibiotic administration is an essential element for any surgical operation success, even if
a prior infection was not detected. This is due to the fact that antimicrobial agents do not only act as
therapy to treat preexisting infection but also as a prophylaxis which is given preoperatively to reduce the
incidence of surgical site infection and as an adjunct to operative treatment which is given in the setting of
operative management of infections such as secondary peritonitis or necrotizing fasciitis. Prophylactic
antibiotics are also used as primary therapy when operation is not performed, such as for cellulitis, or
postoperative pneumonia which indicates the significance of surgical antibiotic prophylaxis and the great
importance of adhering to the right treatment protocol and guidelines.
Aim of the Study: a systematic review was performed to evaluate the adherence to clinical guidelines for
surgical antibiotic prophylaxis. Methods: of which fifteen studies were retrieved that fulfilled most of the
inclusion requirements of being randomized controlled clinical trials.
952 articles were retrieved from database, of which 15 studies were selected for selected for
synthesis. 5 outcome of interest were identified, on top of which were the administration of antibiotic at
the correct time and adequate discontinuation of antibiotic which ranged from 0.3% to 100%.

Conclusion: the assessed studies addressed a gap in the adherence to guidelines for surgical antibiotic
prophylaxis and more rigor approaches to leverage the guidelines.
Keywords: Surgical site infection, SSI, Prophylaxis, Antibiotic, Systematic review, Guideline adherence.


Surgical site infections (SSIs) are a common
does not overwhelm the host natural defenses,
cause of healthcare-associated infection. The
causing infection (7).The adequate use of
United States Centers for Disease Control and
perioperative antibiotic prophylaxis can reduce
Prevention (CDC) has developed criteria that
the rate of SSI in up to 50%(8).
define surgical site infection as infection related
Efforts have been undertaken to
to an operative procedure that occurs at or near
establish guidelines for the appropriate use of
the surgical incision within 30 or 90 days of the
antibiotic prophylaxis. These guidelines are
procedure, depending on the type of procedure
designed to provide professionals with a
performed (1). SSIs are often localized to the
standardized approach to rational, safe and
incision site but can also extend into deeper
effective use of antimicrobial agents for the
adjacent structures.
prevention of SSI, and their content is based on
SSIs are the most common and costliest
current available clinical evidence, besides
healthcare-associated infections (3,4). Among
emerging issues(9).
surgical patients, SSIs account for 38 percent of
Although the principles of antimicrobial
nosocomial infections. It is estimated that SSIs
prophylaxis in surgery are clearly established
develop in 2 to 5 percent of the more than 30
and several guidelines have been published, the
million patients undergoing surgical procedures
implementation of these guidelines has been
each year (i.e., 1 in 24 patients who undergo
impaired by multiple factors (10). Some possible
inpatient surgery in the United States has a
reasons include the difficulty encountered by
postoperative SSI) (5,6).
professionals to update their knowledge, their
Antibiotic prophylaxis is aimed to
dependence on habits originated in clinical
reduce the incidence of SSI by preventing the
practice rather than in evidence, the lack of
development of infection caused by organisms
policies, and failures in the implementation of
that colonize or contaminate the surgical site.
norms and institutional guidelines(11).
The main target of antibiotic prophylaxis is the
In view of the aforementioned, the
wound. Antibiotics are administered to the
present review aimed to assess the adherence to
patient to reduce the bacterial load, so that it
guidelines for surgical antibiotic prophylaxis,
Received:22 /12 /2016 DOI : 10.12816/0034657
Accepted: 29 /12 /2016

Full Paper (vol.66 paper# 30)

c:\work\Jor\vol66_31 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 234-236
Clinical Utility of PCA3 Assay in Patients with Suspicious Prostate Cancer
AbdelSattar N A, Seif AM, ELHadidi EA, Mohamed N R,
Abu El Naga MA and Abdelhakam AD
Department of Clinical and Chemical Pathology, Faculty of Medicine, Ainshams University.

this study evaluated the clinical utility of the PCA3 assay in guiding initial biopsy decisions in
prostate cancer. Subjects and Methods: this study was conducted on fifty patients selected from the Urology
Department at Ain Shams University Hospitals and scheduled for prostate biopsy after digital rectal examination
first catch urine was collected. PCA3 scores were determined using RT-PCR and compared to biopsy outcome.
The diagnostic accuracy of PCA3 was compared to total prostate specific antigen and %free prostate specific
antigen.Results: the best cutoff for PCA3 was 4.6 folds (RQ). This cutoff had a diagnostic sensitivity of 94.7%,
specificity 95% and area under the curve (AUC) was 0.978. Total PSA at the cutoff 10 ng/mL had a
diagnostic sensitivity 68%, specificity 70% and AUC was 0.766. At cut off 19%, f/t PSA ratio had a
diagnostic sensitivity 38%, diagnostic specificity 90 %, and AUC was 0.529.
Conclusions: the PCA3 assay can aid in guiding biopsy decisions. It is superior to total prostate specific antigen
and %free prostate specific antigen in predicting initial biopsy outcome, and may be indicative of prostate cancer
Keywords: Prostate cancer, PCA3, PSA, BPH.

Prostate cancer is the second leading cause of
cancer-related deaths exceeded only by lung cancer
This study was conducted on fifty patients
among men world-wide (1).. In Egypt, the estimated
selected from the Urology Department at Ain
incidence was 2358 cases and the yearly
Shams University Hospitals and scheduled for
estimated deaths were 1513(2).
prostate biopsy because of an elevated total PSA
Current screening techniques are based on
level and/or a suspicious DRE. According to the
measurement of serum prostate specific antigen
results of the TRUS guided biopsy, patients were
(PSA) levels and digital rectal examination
subdivided into the following subgroups:
(DRE). A decisive diagnosis of prostate cancer
A. Subgroup I: Men with Positive Biopsy for
(PCa) is based on trans-rectal ultrasound (TRUS)
Prostate Cancer (n =26):
guided prostate biopsies (3). Serum PSA has
This group included twenty six patients with a
several controversies have arisen about its use,
median age of 67 years who were diagnosed with
mainly related to its low specificity.This low
prostate cancer (PCa) as confirmed by TRUS
diagnostic specificity translates to numerous false
guided biopsy. Tumor stage and Gleason scores
positive results and many unnecessary biopsies in
were assessed.
patients who are suspected to have prostate
B. Subgroup II: Men with Negative Biopsy for
cancer and this invasive procedure carries a risk
Prostate Cancer (n = 24):
of infection and hemorrhage(4).
This group included twenty four patients
PCA3 is a non-coding messenger RNA, formerly
with a median age of 66 years who were negative
known as Differential Display clone 3 (DD3), is
for PCa as confirmed by TRUS guided
expressed 66­100 times more in prostate cancer
biopsy.They were diagnosed as BPH, prostatitis
cells than in normal prostate tissue. It is also
or BPH with Prostatis, and pre-neoplastic lesions
highly expressed in prostate cancer tissue
as atypical acinar proliferation.
compared to benign tissue. Several studies have
shown a 140 times greater expression of PCA3 in
Urine and blood samples were collected prior to
cancer cells than in Benign Prostatic
the initial biopsy.The first 20­30 mL of voided
Hypertrophy (BPH), which is not a characteristic
urine was collected from each patient, after an
of PSA(5).
extended DRE. Whole urine specimens were

labelled and immediately cooled on ice followed
by centrifugation 700Xg for 10 minutes, urine
Our aim was to evaluate the clinical utility of
sediments were obtained and stored at -70°C to
PCA3 assay in diagnosis of prostate cancer and
be used for further PCA3 RNA extraction. 3 mL
to investigate its role in guiding initial biopsy
of venous blood were withdrawn from each
participant in the study under complete aseptic
conditions in serum separator clot activator
Received: 16 /6 /2016 DOI : 10.12816/0034658
Accepted:23 /6 /2016

Full Paper (vol.66 paper# 31)

PSYCHOSOCIAL IMPACTS AND QUALITY OF LIFE AMONG ADULT PATIENTS WITH POSORIASIS The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 237-247

Psychosocial Impact and Quality of Life among Adult Egyptian Patients
with Psoriatic Arthritis
Essam A. El-Moselhy1*, Sabah A. Hagrass2, Abd-Elnaser S. Mohammed1,
Throwt M. Abd-Alrhman3, Aly A. Alnabawy4, Ahmed Mosalam5
Departments of Community Medicine1, Community Health Nursing2, Orthopedics3,
Psychiatry4, and Physical Medicine, Rheumatology & Rehabilitation5
Faculty of Medicine, Al-Azhar University, Egypt,
„Faculty of Nursing, Zagazig University, Egypt

*Corresponding Author: Essam A. El-Moselhy, Professor and Head of the Department of Public Health and
Community Medicine, Faculty of Medicine, Al-Azhar University, Egypt. E-mail: and

: psoriatic arthritis (PsA) is a chronic, inflammatory, progressive joint disease. It has much
psychosocial impact and affects quality of life (QOL) of the patients. Aim of the study: to determine the
psychosocial impact of PsA on the patients and to define QOL of them. Patients and Methods: the
study was conducted on 50 PsA patients, 68 psoriasis (Ps) patients, and 100 controls. A case-control,
clinic-based study design was used in this research. An interviewing form and Middle Sex Hospital
Questionnaire were used to survey the characteristics of the patients and controls. Severity of PsA was
determined clinically. Also, the medical outcomes study 36-item short form (SF-36) was used to assess
impact of the disease on the patient's QOL. Results: most (92.0%) of PsA patients had psychiatric
symptoms. The disease had interfered with most of patients' personal feelings and relationships, daily
activities, school/work, and leisure/sport. Majority (88.0%) of the patients had stigma feeling. Also,
40.0% and 60.0% of PsA patients had severe and mild forms, respectively. The differences between two
forms of PsA regarding interference with school/work and presence of suicidal ideation were significant.
The difference regarding presence of familial psychological stress was significant. The highly affected
SF-36 domain scores were general health and physical limitation. The eight mean domain scores were
significantly lower among PsA patients than controls. The mean domain scores of physical functioning,
physical limitation, social functioning, emotional limitation, and mental health were significantly lower
among patients with severe PsA than those with mild PsA. The eight mean domain scores were
significantly lower among PsA patients than those with only Ps. Conclusions: the physical and
psychosocial aspects of PsA may interact and influence one another. So, PsA has a great effect on the
patients' QOL; disrupting physical and psychosocial aspects, and interfering with daily activities,
school/work, and leisure/sport. QOL scores were significantly lower among PsA than only Ps patients.
Keywords: Psoriatic arthritis, Adults, Impacts, Psychosocial, Familial, Medical care, QOL.

have PsA [5]. However, PsA may be more
Psoriatic arthritis (PsA) is a chronic,
common than previously described [6].
Anxiety is more common in patients with
(arthropathy), which is heterogeneous in
chronic diseases than in those without [7].
presentation and clinical course, and mostly
Detecting and treating anxiety is an integral part
associated with psoriasis (Ps) [1,2]. The
of the management, leading to better quality of
prevalence of PsA in patients with Ps ranges
life (QOL) and less use of resources [8]. So, PsA
from 6.0% to 39.0% [3,4]. So, for most PsA
patients are susceptible to distress from their
patients, the disease encompasses not only joint
condition [9]. Also, PsA imposes a considerable
burden but also skin burden [1]. The overall
economic and QOL burden to patients and
prevalence of PsA in the US ranges from 101-
society. Although the burden of Ps has been
250/100,000 people; with an annual incidence
described extensively, the burden of illness
of 6.6/100,000 people [3]. Estimates cleared that
associated with PsA has not been as well
~750,000 people in the US are living with PsA.
quantified [10]. Average direct costs ranged from
It is believed that many cases remain mis-
$4,008 in Hungary to $5,646 in the US. The
diagnosed or undiagnosed [1]. According to the
primary driver of direct costs is hospitalizations,
NPF survey, 31.4% and 46.4% of the patients
about 60.0% [11,12]. Total indirect costs
with moderate and severe Ps, respectively
associated with PsA and account for 52.0%-
Received: / /2016 DOI : 10.12816/0034659
Accepted: / /2016

Full Paper (vol.66 paper# 32)

c:\work\Jor\vol66_33 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 248-256

Meta-analysis of Fluids and Electrolytes Balance in Postoperative Patients
Samaher Soud Alraddadi, Sarah Fouad Nabrawi, Osama Noorullah Khojah, Tariq Abdulrahman Elessawi,
Adian Abdulrahman Wahhas, Hadeel Mohmmed Alsanamah, Hawra Al-Eirani, Salah Mahmoud Alabbasi,
Rayan Ali Karbouji, Fahd Osama Saadi, Asma Mohammad Alismail, Jafar Mhmoud Albagshi, Faisal
Abdullah Alterazi, Sara TagAldin Alamin Yousof, Rawan Khaled Ahmed, Abdulrhman Taj Uddin Alsawas,
Meaad Mohammed Baatya, Jafar Saleh Alaesh
King Abdulaziz University Hospital, Jeddah, Saudi Arabia


The primary objective of this research was to systematize the existing studies done on the
commonly used intravenous (IV) fluids, electrolytes and trace elements in the fluid replacement
postoperative procedure. This particular meta-analysis was done in place of the traditional use of
literature review, and for this reason, this research paper has compared opinions from various existing
studies done by different scholars on synthesis. Also, this analysis has explored the best-identified
guidelines that should be applied to postoperative patients. Although this analysis would give various
advisories on the type of fluids and electrolytes used for replacement in postoperative patients, the
primary emphasis would be to highlight the advantages and disadvantages of each identified replacement
fluid. This also included the surgical and anesthetic techniques that should apply in the best practice
guideline used, when dealing with postoperative patients.
Keyword: Postoperative, replacement fluid, electrolytes, anaesthesiologist, Intravenous fluids


Since there is a substantial variation in
anesthesiologists, surgeons and scholars, the
the electrolyte composition of the intracellular
postoperative fluid replacement process has a
and extracellular fluids (ECF) in a normal and
direct relation to fluid and electrolyte
healthy person, it is crucial to identify that
abnormalities. Based on the patient's
sodium is the most useful element in ECF while
electrolyte and body fluid status, different types
potassium, on the other hand, predominates in
of fluid replacement therapies are applied in
the Intracellular fluid. With the knowledge of
addition to the maintenance therapy so as to
these body fluids and electrolyte composition,
compensate for any form of preoperative and
surgeons, nurses and caregivers can identify the
common fluid replacement type, electrolyte and
postoperative patients may require the fluid
trace element replacement type to administer in
replacement therapy due to other reasons such
the postoperative therapy (3).
as ongoing gastrointestinal fluid loss, the stress

response to surgery or any other bodily fluid
According to a 2007 SAFE Study
Ideally, in the postoperative process,
intravenous (IV) fluids that are primarily used in
the standard maintenance fluid requirements,
postoperative fluid replacement are those that
which give guidance to the fluid and electrolyte
are within the group of volume expanders (4).
replacement, will vary depending on various
Therefore, in most cases, fluid replacement in
factors on the patient. Some of these aspects are
postoperative patients is provided either in the
the patient's body weight, body surface area,
form of colloids and crystalloids which, due to
gender and age. Despite the fact that any
their nature and composition, are known to have
possible abnormalities in the patient's
varying advantages and disadvantages when
hemodynamic milieu will have been identified
administered to different postoperative patients.
and corrected before or during the surgical
Thus, taking an overview of four prospective
process, a postoperative calculation of the
and retrospective research available on
patient's fluid requirement is done 2. This
replacement fluids and postoperative patient
calculation is made prior to the fluid
care, this research paper focuses on two aspects;
replacement therapy, so as to make a distinction
the commonly used replacement fluids with
between the fluid and electrolyte volume
both their advantages and disadvantages and the
required to maintain the body's normal
most appropriate guideline to use when dealing
functions and the significant amount that is
with postoperative patients.
needed to replace possible abnormal losses.

Received: 11 / 12 /2016 DOI : 10.12816/0034660
Accepted: 18 /12 /2016

Full Paper (vol.66 paper# 33)

c:\work\Jor\vol66_34 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 257- 260
Prevalence of Tuberculosis among HIV Patients in Jeddah, Saudi
Ela Lutfallah Alturkistani1, Wed Ahmed M Alayyafi2, Haya Abdulrahman Alnafisah1, Abdullah
Hussain Khan3, Areej Abdulaziz Alwaheed4, Esra Hassan Alzein4, Amal Mohamed Sharton1,
Waseem Morshed Qaq5, Ibrahim Hussain Muzaffar6, Ahmed Mohammed Al Dawood2, Essam
Abdulkhalig Felemban7, Mohammed Hisham Ojaimi2
1 Battarjee Medical College, 2 Ibn Sina National College, 3 Al Noor Specialist Hospital,
4 Since And Technology University In Jordan, 5 Bayan Clinic, 6 Um Alqura University,
7 King Saud Bin Abdulaziz University

Tuberculosis (TB) is the commonest infection that has been reported in HIV/AIDS patients in developing
countries. This cross sectional study has been conducted in the chest clinic, King Abdulaziz Hospital and
Oncology Center to evaluate the prevalence of TB among these patients in Saudi Arabia.
Methods: across sectional survey has been conducted in the City of Jeddah, Chest Department, King
Abdul-Aziz Hospital and Oncology Center of total 172 HIV positive patients.
Conclusion: we have found that the majority of HIV/AIDS patients had tuberculosis and the rest of them
had a high susceptibility to get it. Radiograph has also TB findings .TB can occur at any stage of CD4+T
cells depletion.
Keywords: Tuberculosis , HIV ,Patients , Saudi Arabia


Tuberculosis (TB) is the commonest
occur in persons infected with HIV11. Also the
opportunistic infection and the number one
risk of progressing from latent to active TB is
cause of death in HIV patients in developing

countries, and accounts for about 40% of all
estimated to be between 26 and 31 times greater
manifestations seen in HIV patients 1. About
in people living with HIV than among those
25% to 65% of patients with HIV/AIDS have
without HIV infection12. This also means that
tuberculosis of any organ and tuberculosis
they may become infectious and pass TB on to
accounts for about 13% of all HIV related deaths
someone else, more quickly than would
[2, 3, 4, 5, 6].
otherwise happen. Overall it is considered that
prevalence has declined by more than 20%
the lifetime risk for HIV negative people of
worldwide, the rates in Africa have tripled since
progressing from latent to active TB is about 5-
1990 in countries with high HIV prevalence and
10%, whereas for HIV positive people this same
are still rising across the continent at 3­4% per
figure is the annual risk13. In 2014 there were 9.6
year7. Between 2015 and 2016, a 20% increase
million new cases of TB, of which 1.2 million
of tuberculosis cases was reported in countries
were among people living with HIV12.
severely affected by HIV/AIDS in Saudi Arabia

The major high risk groups included
Study setting: the study was conducted in the
heterosexually promiscuous, intravenous drug
City of Jeddah, Chest Department at King
abusers and blood donors9. But, there is very
Abdul-Aziz Hospital and Oncology Center.
little information on HIV seropositivity among
Study design: a cross-sectional study of among
tuberculosis patients in India. It has been
Saudi patients.
suggested that tuberculosis and gastro-intestinal
Variables: The dependent variable in this study
diseases might increase in seropositive
were obtained from total 172 HIV positive
individuals and vice versa10. Tuberculosis often
patients who were attended at antiretroviral
appears before other opportunistic infections
therapy (ART) clinic, having < 350/l CD4
Received: 27 / 12 /2016 DOI : 10.12816/0034661
Accepted: 30 / 12 /2016

Full Paper (vol.66 paper# 34)

c:\work\Jor\vol66_35 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 261- 268

A Critical Review on the Relation and Impact of
Bruxism and Prosthetic Treatment
1Haitham Ehab Y Jan, 1Hamza Abdulkareem Al Zahidy, 1Rahaf Essam O Yousef, 1Ranad
Abdulkareem K Alghamdi, 1Abrar Aqeel A Jefri , 1Lamis Khalid M Albakri , 1Wejdan Ibrahim
Alzahrani, 1Ghayda Saud S Mandili, 1Ameera Khalid M Alrasheed , 2Mohammed Khalid Y.
Alzamzami, 3Sawsan Badr Eshaq,
1Ibn Sina National College, 2 King Fahad General Hospital, 3 battarjee college, Saudi Arabia

Bruxism is defined as the medical term for clenching and grinding of teeth. Its one of
the most common parafunctional habit, occurring both during sleep "Eccentric Bruxism" and wakefulness
"Centric Bruxism". Bruxism can result in tooth wear and damage, jaw disorders, headaches and dental
restoration damage.
Bruxism is usually a subconscious reflex that is often not recognized by the patient. As a consequence, one
of the most difficult aspects of this treatable problem is convincing the patient of this disorder. The early
diagnosis and management can prevent the breakdown of the dentition and pain in the orofacial region.
Although various treatment modalities are present, the successful management of bruxism lies in the
precise diagnosis and isolation of the etiology.
Aim of the Study: raw conclusions about the existence of a possible relationship between the two, and its
clinical relevance. Study selection: dental literature in bibliographic database like PubMed/Medline was
searched for the terms ,,bruxism and ,,prosthetic treatment, relevant studies were critically reviewed were
conducted using, as well as combinations of these and related terms.
there is no known treatment to stop bruxism, including prosthetic treatment. The role of bruxism
is considered as a major cause in the tooth wear process and as informed by the present critical review, the
relationship between bruxism and prosthetic treatment is one that relates mainly to the effect of the former
on the latter
Bruxism may be included among the risk factors, and is associated with increased mechanical
and/or technical complications in prosthodontic rehabilitation, although it seems not to affect implant
survival. When prosthetic intervention is indicated in a patient with bruxism, efforts should be made to
reduce the effects of likely heavy occlusal loading on all the components that contribute to prosthetic
structural integrity. Failure to do so may indicate earlier failure than is the norm.
Keywords: Bruxism, Sleep bruxism, Awake bruxism, Current concepts in bruxism, Review of bruxism.


Bruxism, which can be considered an umbrella
'Sleep Bruxism' (SB). Awake bruxism is linked to
term for clenching and grinding of the teeth, is
the commonest of the many parafunctional
stress caused by familial responsibility or work
activities of the masticatory system. Opinions on
pressure. Sleep Bruxism is an oromandibular
the cause of bruxism are numerous and widely
behaviour that is defined as a stereotyped
varying. Current reviews indicate that the
movement disorder occurring during sleep and
etiology is not fully known but that it is probably
(3). characterized by tooth grinding and/or
multifactorial (1).
clenching. Sleep bruxism was recently classified
Bruxism can occur during wakefulness or during
as sleep related movement disorder according to
sleep. The American Academy of Sleeping
recent classification of Sleep Disorders(3).
Disorders proposed the terms Sleep and Awake
Prevalence rate of Awake and Sleep Bruxism is
Bruxism. Bruxism during daytime is commonly a
about 20% and 8­16% respectively in adult
semi-voluntary 'clenching' activity and is also
known as 'Awake Bruxism' (AB) or Diurnal
predominantly among females while no gender
Bruxism (DB) (2). Bruxism during sleep either
difference is seen for sleep bruxism (5). Onset of
during daytime or during night is termed as
Sleep Bruxism is about 1 year of age soon after
Received: 15 / 12 /2016 DOI : 10.12816/0034662
Accepted: 20 / 12 /2016

Full Paper (vol.66 paper# 35)

c:\work\Jor\vol66_36 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 269- 278

A Systematic Review and Meta-Analysis for Surgical Techniques Intended to
Alleviate Post-Operative Adhesions Following Abdominal and Pelvic Surgery
Ahmad Hameed Allehaiby, Asal Suweid Abduallh Aldosari, Mohammed Anwar Alalwani, Rayan Ali
Karbouji, Esra Hassan Alzain, Khaled Mohammad Al Basheiti, Sulafah Sameer Abduljawad, Areej
Abdulaziz Alwaheed, Salah Mahmoud Salah Alabbasi, Bayan Abdulkarim F Kharsan, Hassan
Ibrahim Alasmari, Abdullah Ghazzai G Alotaibi, Anwar Khalid Boudal, Ethar Ahmad Boudal,
Waseem Morshed Qaq
King Abdulaziz Hospital, Jeddah, Saudi Arabia.


Background: postoperative peritoneal adhesions are common and frequent complication following
abdominal and Pelvic Surgery. Adhesions can lead to bowel obstructions and infertility in women (when
they develop around the reproductive organs), chronic pain which consequently results in reducing the
quality of life for patients, level of energy, productivity, and increase the risk, complexity and chance of
complications in subsequent surgeries .Main objective of this review is to study the implication of using
the good surgical techniques` in the prevention of postoperative adhesions.
Methods: the present review included randomized controlled trials (RCTs) that investigated the different
surgical technique impact on adhesion-related outcomes were identified through search in Pubmed,
CENTRAL and Embase. Identified endpoints were: clinical outcomes and incidence of adhesions. The
primary Identification of papers and data extraction were performed by independent researchers.
Results: out of 1709 studies, there were only 21 papers eligible for a systematic review and included in
the meta-analysis and qualitative assessment. None of the techniques that were compared significantly
reduced the incidence of adhesive small bowel obstruction. In a small low-quality trial, the pregnancy
rate increased after subserous fixation of suture knots. However, the incidence of adhesions was lower
after laparoscopic compared with open surgery [relative risk (RR) 0.14; 95% confidence interval (CI):
0.03­0.61] and when the peritoneum was not closed (RR 0.36; 95% CI: 0.21­0.63).
Conclusion: None of the specific techniques that were compared reduced the two main adhesion-related
clinical outcomes, small bowel obstruction and infertility. The meta-analysis provides some evidence for
the surgical principle that using less invasive techniques, introducing less foreign bodies or causing less
ischemia reduces the extent and severity of adhesions.
Keywords: adhesions, bowel obstruction, laparoscopy, pelvic surgery, infertility.


Adhesions are defined as abnormal fibrous
pelvic surgery. Notable among its potential
connection between 2 anatomically different
sequelae are infertility (3) with increased risk of
Adhesions may appear as thin sheets of tissue
subsequently conceive, (4) abdominal and pelvic
similar to plastic wrap or as thick fibrous bands.
pain, (5) bowel obstruction, (6) and difficult repeat
The tissue develops when the body's repair
(7) . In
mechanisms respond to any tissue disturbance,
abdominopelvic adhesions may interfere with
such as surgery, infection, trauma, or radiation.
Although adhesions can occur anywhere, the
chemotherapy in patients with abdominal or
most common locations are within the stomach,
pelvic cancer (8).
the pelvis, and the heart (1).
The risk for adhesion-related complication is
It is estimated that 93% to 100% of patients who
highest following colorectal surgery and surgery
undergo transperitoneal surgery will develop
of the ovaries, with a 10-year risk of readmission
postoperative adhesions.5 The extent of
directly related to adhesions as high as 8.8 and
adhesion formation varies from one patient to
7.5%, respectively (9). It`s quite difficult to
another and is most dependent on the type and
completely eliminate the root causes and factors
magnitude of surgery performed, as well as
that contribute to the formation of adhesions
whether any postoperative complications
such as:
o Trauma: Surgery is trauma, and the body
Post-operative adhesion has proved to be a
may form adhesions as a defense against that
scourge after peritoneal injury in abdominal and
trauma as a normal part of the healing process.
Received: 25 / 12 /2016 DOI : 10.12816/0034663
Accepted: 30 / 12 /2016

Full Paper (vol.66 paper# 36)

c:\work\Jor\vol66_37 The Egyptian Journal of Hospital Medicine (Jan. 2017) Vol. 66, Page 279- 284
A Critical Review on Risks versus Benefits of Bariatric Surgery
1Rawan Abdulkarim Agala, 2Sajjad Madan Almusaiad, 3Abdullah Mohammad Alsufi, 4 Zamil Jamil
Alyamani Aldhiafah, 5Abdullah Hussain Muzaffar, 6 Saeed Saad Al Ghamdi , 7 Abdulaziz Gazy
Alosaimi , 7Ahmed Ali Al Sheikhi , 5Amr Waheeb Ergsous , 8Eyad Saleem J. Alharbi, 8Yousef
Mohammad Howssawi , 8Abdulaziz Kaki Alsamti, 1 Rawan Abdulrahim Alaeq
1Battarjee Medical College, 2 Aldammam Medical complex, 3Heraa General Hospital,
4Primary Healthcare Center, 5Um Alqura University, 6Hamdrd University, 7 Ibn Sina National College,
8King Faisal Hospital-Makkah

bariatric surgery refers to a series of weight loss procedures that an obese individual can
have in order to reduce their food intake, therefore causing them to lose weight.
Obese patients lose more weight with bariatric surgery than with medical weight-loss treatment. The
laparoscopic Roux-en-Y gastric bypass procedure results in more short-term weight loss than
laparoscopic adjustable gastric banding, but the latter has fewer postoperative complications and a
lower mortality rate; long-term comparative data are currently lacking. The decision regarding which
procedure to perform should be based on individual patient and surgeon factors
Aim and Intervention of the study: to review the history of bariatric surgery in order to compare the
different bariatric operations, to list the current indications for these procedures, to evaluate the
outcomes, and to consider the risks.
Position: a critical review of controlled randomized studies has provided evidence that bariatric surgery
produces durable weight loss exceeding 100 lb (46 kg), full and long-term remission of type 2 diabetes
in over 80% with salutary effects on the other comorbidities as well with significant reductions in all-
cause mortality.
Conclusion: bariatric surgery is the therapy of choice for patients with severe obesity.
Keywords: Obesity, Bariatric surgery, bypass, Diabetes.


Bariatric surgery is currently the only
kg/m2 or more with coexistence of significant
modality that provides a significant, sustained
weight loss for morbidly obese patients, with
The prevalence of severe obesity seems to be
increasing at an even higher rate than moderate
comorbidities, This article delineates the current
degrees of obesity (4). Bariatric surgery, also
types of bariatric surgery, their respective
known as weight-loss surgery or obesity surgery,
outcomes, and their impact on obesity-related
is widely accepted as the only known effective
medical comorbidities.
treatment for severe obesity. This procedure was
Bariatric Surgery as Treatment for Severe
introduced in the 1950s and involves surgical
manipulation of the gastrointestinal tract to
The health implications of obesity include
induce long-term weight loss in severely obese
increased risk for coronary artery disease,
individuals. Bariatric surgery has been shown to
hypertension, hyperlipidemia, type 2 diabetes
substantially improve or resolve many common
mellitus, sleep apnea, stroke, arthritis of the
obesity-related comorbid conditions, including
weight-bearing joints, and increased prevalence
type II diabetes, hypertension, sleep apnea, and
of selected types of cancer. Obesity contributes
dyslipidemia. A recent report with 10-year
to approximately 300,000 premature deaths each
outcome data from the observational Swedish
year as a result of health-related complications
Obese Subjects (SOS) study showed marked
(1). The risk for developing these medical
benefits in patients treated surgically compared
comorbidities is directly proportional to the
with matched control subjects treated medically,
degree of obesity (2). Additionally, the relative
including recovery from diabetes, lipid
risk for death increases substantially with
abnormalities, sleep apnea, and quality of life(5) .
increasing BMI, particularly for individuals who
Several studies have also shown that bariatric
have BMI of 35 kg/m2 or more (3) . Thus, severe
surgery improves long-term survival (6).
obesity is somewhat arbitrarily
Mechanisms for Diabetes Remission
defined as a BMI of 35 kg/m2 or more, and
Type 2 diabetes mellitus has long been and
morbid obesity is defined as a BMI of 40
continues to be a significant source of morbidity
Received: 23 / 12 /2016 DOI : 10.12816/0034664
Accepted: 30 / 12 /2016

Full Paper (vol.66 paper# 37)