c:\work\Jor\vol695_1 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2373-2377

Overview of Complications and Management Approaches of
Unilateral Ureteral Obstruction
Ibrahim Abdullah Abalhassan*, Mohammed Saud Bin Shibrayn,
Othman Mohammed Almousa1, Moaz Hassan Alharbi.
Prince Sattam Bin Abdulaziz University
*Corresponding author: Ibrahim Abdullah Abalhassan,Email: ibabalhassan@gmail.com,Phone Number:


Unilateral ureteral obstruction (UUO) is a popular speculative version of renal injury, associated
with kidney drop. Throughout the time of UUO, nephron damage is started by a boosted intratubular
hydrostatic pressure and also secondary ischemia. In the course of the disease, even more, general arbitrators
of kidney injury are invited.
Objective: Primary goal of this review was to highlight the complications following the Unilateral ureteral
obstruction (UUO) and obstructive uropathy in general, as well as to discuss the therapeutic strategies for
this urological condition.
Material and method: We review the Published literature concerning unilateral ureteral obstruction (UUO)
up to August, 2017. Search was conducted using electronic databases; Medline, and Embase. Search strategy
through mentioned databases was performed using medical subject headings (MeSH) as following,
"obstructive uropathy", "obstructive nephropathy", "Unilateral ureteral obstruction", "UUO". Furthermore,
bibliographic of the articles were manually searched for having more relevant studies. Restriction to our
search was applied to only English language published studies.
Conclusion: Speculative UUO is an animal version of the human condition, which duplicates not only
human-ureteral-tract-obstruction-induced kidney injury, it is largely held that CKD happens consequently of
the procedure of damaging fibrosis. UUO is a well-described model of renal fibrosis and the mood of CKD
occurrence while UUO persisting. Additionally, several crucial procedures in the pathogenesis of AKI as
well as CKD, such as tubular cell injury, interstitial inflammation and fibrosis. Management approaches of
UUO can be through several steps; first the diagnostic management which will indicate the need of the
following two steps of treatment; whether pharmacological, as rapamycin substantially undermined kidney
interstitial damages in a UUO-induced rat version of renal fibrosis, suggesting that rapamycin could have the
possibility to postpone the progression of the transformation of renal mesenchymal and kidney fibrosis of
surgical treatment.
Keywords: obstructive uropathy, obstructive nephropathy, Unilateral ureteral obstruction, renal injury,
chronic kidney disease.

After UUO, both kidney blood flow (RBF) and
Unilateral ureteral obstruction (UUO) is a
glomerular filtering price (GFR) decrease, as well
popular speculative version of renal injury,
as the reductions are irreversible without
associated with kidney failure, discomfort or fever
intervention. If UUO is managed within a specific
is a urological emergency need of punctual
duration, both RBF and GFR rise 3. Prognosis,
assessment and therapy 1. Present treatment
quality of life and complications are important
methods including pharmacological treatment, and
variables to be considered with UUO. Ureteral
decompression by a cystoscopically insertion of
stents as well as percutaneous nephrostomy tubes
ureteral stent or percutaneous nephrostomy (PCN)
have similar complication prices in the
tube. UUO is well-described version of renal
administration of malignant extrinsic ureteral
fibrosis and thus is considered a version of chronic
compression 4.
kidney disease (CKD) 2. Popular changes in UUO
Renal fibrosis is considered the last usual
consist of declines in renal feature and also
pathway for the majority of kinds of dynamic
increased fibrosis, tubular apoptosis, as well as
kidney diseases as well as entails glomerular
cellular spreading leading to renal failure later on
sclerosis and/or interstitial fibrosis triggered by
Received: 5 / 8 /2017 DOI : 10.12816/0041679
Accepted: 14 /8 /2017

Full Paper (vol.695 paper# 1)

c:\work\Jor\vol695_2 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2378-2383

A Review of the Pathogenesis of Pediatric Asthma and the Effect of Leukotriene
Modifiers in Pediatric Asthma Management
Ola Abdullah Al-Nemer1, Haneen Jameel Alshareef2, Afnan Abdullah Aljehani2, Abrar Mohammed
noor Gashgari3, Bayan Ali Alqarni4, Abdullah Abdulaziz Bin Jariyd5, Fahad ObaidAlshammari6,
Muayad Mahmood Anbar Serri5, Raed Mohammad noor Alsamadani7, Rayan Ibrahim Sayyal7
1 Princess Nourah Bint Abdulrahman University, 2 Umm Al-Qura University, 3 Batterjee Medical
Collage, 4 Ibn Sina National College, 5 Al Imam Muhammad Ibn Saud Islamic University, 6 Imam
Abdulrahman Bin Faisal University, 7 King Abdulaziz University
Corresponding Author: Ola Abdullah Al-Nemer- Dr.Olaal-Nemer@Hotmail.Com ­ 00966508099998

Asthma is the most common chronic illness that affects children. It is described by chronic
airway inflammation, remodeling of the airway wall, and airway hyper-responsiveness to non-specific spasms
in response to stimuli causing a reversible airflow obstruction. Leukotrienes are one of the primary chemical
mediators of inflammation in asthmatic airway, therefore leukotriene modifiers are an important class of drug
for treating asthma. Methodology: We conducted this review using a comprehensive search of MEDLINE,
PubMed, and EMBASE, January 1981, through February 2017. The following search terms were used: asthma
pathophysiology, chemokines, leukotriene, leukotriene modifiers, Montelukast in asthma management

Aim: our aim was to understand in depth the pathophysiology of pediatric asthma, and to study the effect of
leukotriene modifiers in asthma management. Conclusion: For management of pediatric asthma, the
leukotriene modifiers play a key role. New studies have shown that they could help in reducing dose and
dependency on inhaled corticosteroid for maintenance, and decrease the need of systemic steroids in
exacerbation. Leukotriene modifiers can have a positive impact on future asthma management and requires
more studies to be done in this subject.
Keywords: pediatric asthma, asthma pathophysiology, leukotriene modifiers for asthma management


Pediatric asthma is a disorder in children
during asthma attacks, chest tightness, and dyspnea
characterized by recurrent airway obstruction, airway
after physical activity. The symptoms happen
inflammation, and bronchial hyper-responsiveness.
episodically, and may occur at night too. Asthma is
Asthma is the most common chronic illness that
diagnosed with the presence of symptoms and
affects children, which roughly is seen in 8.5% of
pulmonary function test. Demonstration of airways
children in the United States. Asthma is more
obstruction and its reversibility (which is indicated
prevalent in males in early years of life, but more
by increase of more than 12% and 200 ml increase in
commonly seen in females in adolescence. The
FEV1) after inhaling a bronchodilator is
global death rate from asthma is around 0.7 per
recommended to confirm the clinical diagnosis[3].
100000 children[1].It is also one of the most common

causes of a large number of school absences, thus
impairing a child's academic and social achievement.

Asthma can be classified as allergic (extrinsic) or
· Data Sources and Search terms
non-allergic (intrinsic) based on the type of trigger.
We conducted this review using a comprehensive
Common triggers that cause extrinsic asthma are
search of MEDLINE, PubMed, and EMBASE,
plant pollen, fur, dust mites, cigarettes smoke both
January 1981, through February 2017. The following
active and passive, food substances, certain
search terms were used:
chemicals, perfumes, and fumes. Triggers that may
· Data Extraction
induce an intrinsic asthma are released from within
Two reviewers have independently reviewed the
the body mostly due to viral or bacterial infection.
studies, abstracted data, and disagreements were
Physical or emotional stress can also cause one to
resolved by consensus. Studies were evaluated for
have asthma symptoms[2]. Coughing and wheezing
quality and a review protocol was followed
are the most common symptoms children present
throughout.The study was done after approval of
with. Other symptoms are sudden shortness of breath
ethical board of King Abdulaziz University.
Received: 15 /8 /2017 DOI : 10.12816/0041680
Accepted: 24 / 8 /2017

Full Paper (vol.695 paper# 2)

c:\work\Jor\vol695_3 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2384-2388

Prevalence and Risk Factors for Gallstones among
Population in Riyadh City, KSA 2017
Youssef Ahmed Alishi1, Faris Ahmad Howaish1, Fahad Abdulrahman Alhamdan1,
Ahmed Abdullah Almalki2, Salman Assal Alqahtani3, Saif Abdullah Alharthi4,
Ahmed Saleh Alanazi5, Abdullah Hadi Saaty Alsuroji6
1-Imam Mohammad Bin Saud Islamic University, 2-Southeast University,3- University of Jeddah,
4-Taif University,5-Tabuk university, 6- King Abdulaziz University

Background: The most common risk factors for gallstones formations are old age, female gender, obesity and
diabetes mellitus. However, information about the prevalence and significant risk factors in Kingdom of Saudi
Arabia (KSA) are limited. Objectives: Evaluating the prevalence and risk factors of gallstone disease among
Saudi population in Riyadh, Kingdom of Saudi Arabia (KSA). Methods: A cross sectional study that included
500 subjects adult Saudi population who were randomly chosen from February ­June 2017. The volunteers were
subjected to clinical evaluation, laboratory investigations and ultrasound examination. Results: The overall
prevalence of gallstone disease was 8.6%. The older age, female gender, physical activities and obesity are key
factors in the gallstones progression. Also, diabetes, liver enzymes and the lipid profile were modifiable risk
factors for gallstones. Conclusion: The risk factors for gallstones formation are old age, female gender, physical
activities and obesity were key factors in the gallstones progression.
Key words:
Gallstones, prevalence, Risk Factors.


gallstone from the period of February 2017 to June
Gall stones are the most common risk
2017 in Riyadh, Kingdom of Saudi Arabia (KSA).
factor for admission to emergency room that
- Sample size and population:
impose a significant worldwide health issue and
The included subjects were chosen using a
economic burden (1). It is defined as aggregation of
multistage sampling method where 50 subjects
solid material as bile acids, cholesterol and
aged 30 years old were randomly enrolled in the
pigmented materials in the biliary tract parts(2-4).
study from 100 shopping malls in Riyadh region
The well-known risk factors for gallstones
and 500 subjects participated. Non Saudi subjects
are advanced age, female gender, obesity and
and subjects who undergone cholecystectomy were
inactivity (5-7). Also, high levels of serum lipids and
excluded from the study.
high glucose levels are associated with gallstone
Each participant was interviewed alone and asked
disease (8). In addition, the risk disease occurrence
to fill out a reliable questionnaire that was based on
increases with getting older in both genders (9, 10)
the study of Bilal et al.(17).
and a more significant prevalence among females

than males (11, 12).
Study tools
Data suggest that physical activity,
1- A predesigned questionnaire that included the age,
modifying life style, decreasing weight gain and
gender, education level, Body mass index (BMI)
avoiding spicy and fried foods would result in
and physical activity.
prevention of gallstones prevalence (13-16). However,
- All enrolled volunteers were asked to visit the out-
scarce data are present in KSA regarding the
patient clinic where they were subjected to the
prevalence and risk factors of gallstone formation.

- A venous blood sample was taken from each
participant for assessing the random blood sugar
The study aimed at assessing the
level, liver function tests and serum lipids.
prevalence and risk factors for gallstone formation
- Abdominal Ultrasonography: abdominal ultrasound
disease among adult Saudi population in Riyadh.
(US) was performed for all volunteers by two
experienced sonologists with an experience of at
least 5 years. The radiological evidence of gallstone
- Study design
The study was based on a cross sectional study for
was done using scanner that has a 3.5-MHz
assessing the prevalence and risk factors for
transducer (Philips Medical Systems, Inc., Bothell,
Received:16 / 8 /2017 DOI : 10.12816/0041681
Accepted:25 /8 /2017

Full Paper (vol.695 paper# 3)

Introduction The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2389-2399

Assessment of Sub-Endometrial Blood Flow and Endometrial
Leukemia Inhibitory Factor as a Marker for Endometrial
Receptivity in Women with Unexplained Infertility
Hazem A. El-Zenneni1, Rowaa A. Moustafa1, Magda N. Nasr Eldeen2,
Amr Ahmed Riad1, Ibrahim S. El-Shazly1
Departments of Obstetrics & Gynecology 1 and Pathology 2,Faculty of Medicine - Ain Shams University
*Corresponding author: Ibrahim S. El-Shazly, Tel: 01200520500, Email: dr.ibrahim.elshazly@gmail.com

Background: Infertility is customarily defined as the inability to conceive after 1 year of regular unprotected
intercourse. The infertility evaluation is typically initiated after 1 year of trying to conceive, but in couples
with advanced female age (> 35 years), most practitioners initiate diagnostic evaluation after an inability to
conceive for 6 months. Aim of the Work: To assess endometrial receptivity in women with unexplained
infertility using sub-endometrial vascular flow resistant index and endometrial leukemia inhibitory factor
(LIF). Patients and Methods: This clinical controlled trial was conducted at Ain Shams University
Maternity Hospital during the period from August 2014 to September 2017 on 140 patients divided into two
equal groups: Group I (study group): women with unexplained infertility defined as inability to conceive
inspite of regular marital life for at least 12 months. Group II (control group): matched women with
infertility due to tubal factor, recruited from outpatient gynecology or infertility clinic at Ain Shams
University Maternity Hospital. Results: A cutoff value for LIF staining score of 1 predicted unexplained
infertility with a sensitivity of 73.33% and specificity of 70.67%; whereas a cutoff of > 0.71 for
subendometrial blood flow RI predicted unexplained infertility with a sensitivity of 70.67% and specificity
of 86.67%. A cutoff of 10 mm for endometrial thickness had the highest sensitivity of 100%, but lacked
specificity (only 16%). Conclusion: Leukemia inhibitory factor may be a predictor for unreceptive
endometrium in cases of unexplained infertility. Subendometrial blood flow RI and endometrial thickness
may be used rather than LIF IHC (due to its invasive nature)for the prediction of endometrial factor status in
cases of unexplained infertility because of the statistically significant negative correlation between the above
parameters. Recommendations: Further studies are needed to evaluate the predictive value of the multiple
logistic model including (endometrial thickness, subendometrial blood flow color Doppler and LIF IHC
score and even other proposed cytokines as VEGF, IL6 and integrins) in unexplained infertility.
sub-endometrial blood flow, endometrial leukemia, inhibitory factor, endometrial receptivity,
unexplained infertility.

(i.e., that the couple has unexplained infertility) is
Unexplained infertility refers to the
approximately 15% to 30% (3).
absence of a definable cause for a couple's failure
In the absence of a correctable
to achieve pregnancy after 12 months of
abnormality, the therapy for unexplained
attempting conception despite a thorough
infertility is, by default, empiric. Proposed
evaluation, or after six months in women 35 and
older (1).
insemination (IUI), ovulation induction with
Unexplained infertility affects 15% of
oral or injectable medications, combination of
couples. Infertility rates are influenced by a
IUI with ovulation induction, and assisted
woman's age. Although the rate is approximately
reproductive technologies (ART) (3).
10% at 30 years of age, it can be as high as 40%
Embryo implantation represents the most
by the time a woman reaches 40 years of age (2).
critical step of the reproductive process in many
Diagnosis of unexplained infertility
species. It consists of a unique biological
includes a semen analysis, assessment of
phenomenon, by which the blastocyst becomes
ovulation, a hysterosalpingogram, and if
intimately connected to the maternal endometrial
indicated, tests for ovarian reserve and
surface (4).
laparoscopy. When the results of a standard
The endometrium is normally a non-
infertility evaluation are normal, practitioners
receptive environment for an embryo, except
assign a diagnosis of unexplained infertility.
during implantation window. Implantation
Although estimates vary, the likelihood that all
window is a period during which the
such test results for an infertile couple are normal
endometrium is optimally receptive to implanting

blastocyst. Implantation of the human embryo

may occur only during a regulated "implantation
Received:7/8/2017 accepted:16/8/2017 DOI: 10.12816/0041682

Full Paper (vol.695 paper# 4)

c:\work\Jor\vol695_5 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2400-2404

Bariatric Surgery to Treat Obesity Among Adults
Nazer Raef Waleed M 1 , Yazid Ali M Algadhi 2 , Saeed Awdah Assiri 3 , Mashail Ali Alomari 2 ,
Osama Talaat Khouj 4 , Meaad Yassin Albakestani 1 , Doha Taha Abafallata 1 , Muath Abdullah
Aloufi 5 , Mosab Abed F Alsobhi 6 , Nahlah ali alsubhi 7 , Nasser Mubarak S Alshahrani 2 ,
Mohammed Sadan M. Alzahrani 8 , Eman Ahmad H. Alabdrabalrasol 9 ,
Sajedah Hassan Almshikhess 10 , Turki Rashid A Alsudairi 11
1- Batterjee Medical College, 2-King Khalid University, 3-Al-Baha University, 4-King Abdul Aziz
University Hospital, 5-University of Tabuk,6-King Abdulaziz University, 7-Ibn Sina National College, 8-
Alsulimaniah Phcc-Jeddah's East General Hospital, 9- Imam Abdulrahman Bin Faisal University, 10- Umm
Alqura University, 11- King Faisal University

Bariatric surgery is one of the few effective treatments for morbid obesity, yet little
information about weight outcomes after surgery in this demographic are available. We determined the
effectiveness of bariatric surgery in reducing weight and body mass index (BMI) in adults.
Materials and Methods: Adults from 18 to 30 years old who had undertaken gastric bypass or adjustable
gastric band surgery between May 2013 and November 2016 and who had complete follow-up data available
were included in the present analysis. Mean weight and BMI before and one year after surgery were
Results: Among 35 adults, Mean BMI and weight, and z-scores and percentile transformations were all
significantly lower after surgery for the entire sample (P < 0.001). Gastric bypass surgery presented
significantly better weight loss outcomes for all anthropometric measures versus adjustable gastric band
surgery (P < 0.05). No perioperative complications were reported. Two patients who stopped taking
supplements as prescribed experienced iron-deficiency anaemia within the year following surgery.
Our results show that bariatric surgery can markedly reduce weight among a predominantly
adult patients sample, and gastric bypass procedure in particular. These findings indicate that bariatric
surgery has the potential to be safe and effective in substantially reducing weight in a group of adults who
are at particularly high risk for obesity-related health consequences.
Overweight, Treatment, Bariatric Surgery, Metabolic Syndrome, Adults.

been shown to be an excellent indicator of
Obesity is a major health problem worldwide
abdominal fat mass. A circumference of greater
and has reached an epidemic proportion in the
than 88 cm (35 in.) in women or more than 102 cm
society. Indication continues to accumulate that
(40 in.) in men strongly correlates with an increased
obesity is a major risk factor for many diseases and
risk of obesity-related disease.
is related with significant morbidity and mortality.
Obesity is a complex, multifactorial chronic
The Centres for Disease Control and Prevention
disease influenced by the interaction of several
(CDC) lately described that the pervasiveness of
factors, such as genetic, endocrine, metabolic,
childhood obesity has become stable over the past
environmental (social and cultural), behavioural,
few years, while it remains high among all age, sex,
and psychological components. The basic
and ethnic groups. However, an estimated 12% of
mechanism involves energy intake that exceeds
all US children amongst 2 and 19 years old fall in
energy output. Youthful start obesity has several
the category of morbid obesity (a body mass index
short and long-term health related concerns,
[BMI] 97th percentile for age and gender).
comprising dyslipidaemia, hypertension, glucose
Furthermore, noteworthy differences in obesity
intolerance, and insulin resistance, which include
pervasiveness by race/ethnicity were distinguished.
the metabolic syndrome [2, 3]. Consecutively, these
The authors similarly found that there was a
conditions are risk elements for type 2 diabetes and
substantial increase in BMI between adult's ages 12
cardiovascular disease in both childhood and adults
through 19 years from 1999­2000 to 2009­2010 [1].
[4, 5, 6]. Infancy overweight has also been connected
Considering other factors (e.g., total muscle mass,
with orthopaedic complications [7], non-alcoholic
waist circumference) besides the BMI may be
fatty liver disease [8], polycystic ovarian syndrome
important. Such as, an extremely muscular
[9], in addition to anxiety and depression [10]. The
individual may have an elevated BMI without being
majority of these health problems similarly have a
considered overweight. Waist circumference has
tendency to continue into adulthood [5, 6]. Ethnic
Received:10 / 8 /2017 DOI : 10.12816/0041683
Accepted: 19 / 8 /2017

Full Paper (vol.695 paper# 5)

c:\work\Jor\vol695_6 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2405-2411
Assessment of Knowledge, Attitude and Practice Regarding Antibiotics
Misuse among the Public in Saudi Arabia
Almutairi Masaad Awadh1, Alharthi Khuwilid Raja2, Alshehri Ibrahim Mahdi3*,
Alasiri Abdullah Khalid4

Departments of clinical pharmacy, 1-Almahd General Hospital, Medina,2- King Abdullah Hospital,
Bishah,3-Rabigh General Hospital, Jeddah,4- Medina General Hospital, Medina
*Corresponding author: Alshehri Ibrahim Mahdi, Mobile No.+966546161543 E-Mail: Ialshehri2010@gmail.com

The misuse of antibiotics could result in a public health problem including the high prevalence
of antibiotic resistance.
Objectives: Assessing the knowledge, attitude and practice (KAP) regarding the antibiotics misuse in
Kingdom of Saudi Arabia (KSA).
Methods: A cross-sectional questionnaire based study was conducted at AL-Mahd General Hospital, Saudi
Arabia, Ministry of Health, from February to June 2017 among 721 adult Saudi subjects.
Results: The most common source of knowledge about antibiotics among participants was a physician
(50.8%) followed by internet in 25.9%. About 50.3% of subjects used antibiotics more than 5 times per year
and 65.6% of participants have recently used antibiotics. Insufficient knowledge was found among 59.6% of
respondents and most of the subjects declared negative attitude and poor practice pattern. The good
knowledge was associated with being young, female and higher educational degree.
Conclusion: The level of knowledge was insufficient and resulted in inappropriate attitude and practice
pattern in KSA. The lower educational degree, young age and female gender were significant contributors to
sufficient knowledge about antibiotic use.
Keywords: Knowledge, Attitude, Practice, Antibiotic use, Misuse.


Although the high prevalence of bacterial
thus reducing the undesirable effects of antibiotic
resistance to antibiotics, they are chief treatments
misuse (14-18). The present study aimed at assessing
that used for bacterial infections (1-3). This high
the KAP of Saudi adult subjects toward the use of
prevalence could be attributed to the drug abuse
and overuse that would result in antimicrobial

resistance which in turn threaten the antibiotics
efficiency, longer and severe episodes of
Study design
diseases(4, 5). Also, the drug misuse would increase
A cross-sectional questionnaire based
the costs of treatments, morbidity and mortality
study was conducted at AL-Mahd General
rates (6).
Hospital in Al-Madinah Al-Monawara, Saudi
The misuse of antibiotics could be due to
Arabia, Ministry of Health, from February to June
less knowledge of prescribers, the demand of the
patients, weak spreading awareness among
Study population and sample size:
patients through physicians and negative attitude
After taking into consideration the
and practice pattern(7-9). The utilization of
population size of the hospital during the last 4
antibiotic control methods are important factors
months, the sample size was calculated using
that involves interactions between health
website calculator (19)with a response rate of 50%
and a confidence interval 95% then the sample
populations (10, 11).
size was calculated as 753 subjects from which
In the middle East Counties including
721 respondents completed the full questionnaire.
Saudi Arabia, receiving antibiotics is easy and
The inclusion criteria were Saudi subjects aged 16
considered as over the counter drug and there are
years old or more and could read and write in
no restrictions on using such medications and
Arabic language.
could be bought without a prescription (12, 13).
Study tools:

Many studies were conducted addressing
A systemic search was done using Pubmed,
the knowledge, attitude and practice of Saudi
Scopus, Research gate, Google Scholar and other
population toward antibiotic use in order to
search engines by the following keywords:
enhance the general awareness of the population
antibiotics, antimicrobials (AMS), antibiotic
Received: 17 / 8 /2017 DOI : 10.12816/0041684
Accepted: 26/ 8 /2017

Full Paper (vol.695 paper# 6)

c:\work\Jor\vol695_7 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2412-2416

Prevalence of Social Phobia among Medical Students in Saudi Arabia
Adnan Khalifah Alkhalifah1 ,Najeeb Saleh Alsalameh2, Majed Ali Alhomaidhy,
Nabiel abdulaziz alrwies 4
1Qassim University, College of Medicine, 2Alamal Mental Hospital, Riyad,3Prince Sultan Military
Medical City, Riyadh , 4Alamal Mental Hospital, Alqassim, KSA
Corresponding author: Najeeb alsalameh,email: najib1427@hotmail.com

Social phobia is the second most common type of anxiety disorders. It is A persistent fear
of one or more social or performance situations in which the person is exposed to unfamiliar people or to
possible scrutiny by others. The individual fears that he or she will act in a way (or show
anxiety symptoms) that will be embarrassing and humiliating. The symptoms of social phobia including
nausea, slurred speech and palpitations. It can negatively affect the activity of the person. Persons with
social phobia have a negative effect on social relationships and impairments in work performance. Social
phobia prevalence varies between different countries and cultures.
To estimate the prevalence of social phobia among medical students in Saudi Arabia.
This study was conducted by using SPIN structured questionnaire and it included 1447 of
medical students from different educational years. The questionnaire involved 17 questions, the total
score referred to the different severity of the disease that ranged from no disease to very severe.
The female percent was 61.7% and male percent was 38.3%. Students from the 7th medical year
represented the large majority of participants 25.4%. The mean score of social phobia was 37.95 ±14.17.
The prevalence of mild grade of social phobia was 29%, moderate represented 24.3%, sever grade
represented 19.1% and very severe represented 19.8%, higher percent of females 20.3% suffered very
sever social phobia than males (19%). There was a significant difference regarding different social phobia
grades and the medical years of students (P-value=0.004).
There was a mild prevalence of social phobia between medical students with no significant
difference between males and females regarding different grades of social phobia.
Keywords: Social phobia, Medical students, SAD in KSA.


Social phobia is also known as Social
Savari found a significant negative
Anxiety Disorder (SAD) [1], it is a type of anxiety
correlation between social competence and social
[2] and it is the second most common type of
phobia [7]. Social phobia also was found to be
anxiety disorders [1]. It is A persistent fear of one
associated with mood disorders [8], bipolar
or more social or performance situations in which
disorder [9] and social isolation [10]. The risk of
the person is exposed to unfamiliar people or to
developing a major depressive disorder can be
possible scrutiny by others. The individual fears
increased by social phobia [4]. The early diagnosis
that he or she will act in a way (or show
can reduce symptoms of this disease and
anxiety symptoms) that will be embarrassing and
decrease its adverse events as well as prevent its
humiliating, it can influence the daily activity of
complications [2].
the individual[3] .
The prevalence of social phobia varies
The somatic symptoms of social phobia
between different countries and cultures [2]. Social
including excessive sweating, slurred speech,
phobia prevalence in western countries accounts
palpitations, blushing, tremor and nausea [2].
for 7-13% [11] other percents were reported in
Individuals who suffer social phobia have a
other countries, it was reported to be relevant at a
significantly lower quality of life, negative
rate of 10 % in India [12] and 11.7% in Saudi
impact on social relationships and impairments in
Arabia [13].
work performance [5]also they have lower self-
The prevalence of social phobia was
esteem than those who don't have social phobia
evaluated between King Khalid University
[6]. Many of those who had this disorder may lose
Medical Students and it was found to be 60 % [4].
their educational and occupational opportunities
A study from Malaysia on medical students
and they may stay at home for long period of
showed that 56% of medical students had
time [2].
s of


phobia [14]. Higher percent
Received: 8 / 8 /2017 DOI : 10.12816/0041685
Accepted: 7/ 8 /2017

Full Paper (vol.695 paper# 7)

c:\work\Jor\vol695_8 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2417-2420

Assessment of Knowledge, Attitudes and Practices Regarding
Pulmonary Tuberculosis among Community in Riyadh City, 2017
Meshari Sulaiman Bin Huwaymil, Mohammed Abdulaziz Alkhalifah, Meshari Abdullah Alfaris
Omar Ahmed Alsaqabi , Rashed Fahad Alhabshan, Abdulrahman Nasser Alzaid
Medical students at Mohammad Bin Saud Islamic University

The control of TB could achieved with a high level of knowledge regarding managing the risk
factors and high risk groups.
Objectives: Assess the knowledge of community population toward tuberculosis (TB) in Riyadh, Saudi
Arabia (KSA).
Methods: A community based-cross sectional descriptive study was conducted among 675 adult Saudi
population at the several malls of Riyadh city, Saudi Arabia during the period from February to May 2017.All
respondents filled out a validated questionnaire for assessing the subject's demographic and knowledge about
Results: The general knowledge about TB was high among 88.7% of subjects and the source of knowledge
was health professionals in 35.1% followed by TV in 32.9% and internet among 32%. A poor knowledge was
found among 55.9% and good knowledge was shown among 44.1% of respondents. The good knowledge was
significantly associated with young age and working at medical jobs.
Most of participants had misconceptions about tuberculosis. Also, the control programs for TB
in KSA need more understanding for enhancement of TB control and improve medical awareness among
population in KSA as well as increasing protection measures against the infection with TB.
Keywords: Knowledge, Attitude, Practice, Pulmonary Tuberculosis (TB), Riyadh.


Tuberculosis (TB) is a major worldwide

health disease especially in African countries and
South East Asia (1, 2). About 1% of population get
The present study aimed at assessing the
infected by TB every year and in 2014, the
knowledge, attitude and health practice of Saudi
incidence of active cases was recorded in 9.6
subjects regarding pulmonary tuberculosis.
million cases from which 1.5 million died (3). Also,

in some parts of Africa, 80% of people had
positive Tuberculin test and 5-10% were found in
Study design
United States (4).
A community based-cross sectional
The situation in Saudi Arabia is moderate
descriptive study was conducted at the several
that is like most of developing counties. The WHO
malls of Riyadh city, Saudi Arabia during the
stated about 18/100,000 population get infected by
period from February to May 2017.
TB yearly (5).

Study population and sample size
The most common risk factors for TB
The Riyadh region was stratified into four
among Saudi populations are male gender and
quarters including East, West, South and North
older age but the high incidence among female
then 3 malls from each part were randomly
gender was associated with non-Saudi subjects (6).
selected in the study using a stratified random
The transmission of TB from one person
sampling technique. A total of 675 of adult
to another through the air that contains TB
participants were enrolled in the present study.
microbes from the cough, speak and sneeze of
The inclusion criteria were adult Saudi subjects
active lung TB people while people with the latent
older than 20 years and can read and write.
form don't transmit the disease into air (7-9).
Study tools:

The control of TB could be achieved with
A systemic search was done using multiple
a high level of knowledge regarding managing the
search engines as Pubmed, science direct for
risk factors and high risk groups (10, 11), however
conducting a reliable questionnaire. The
the studies concerned the KAP of Saudi
questionnaire was validated and reviewed by 3
population toward TB are Scarce.
supervisors then was translated into Arabic
Received:18 / 8 /2017 DOI : 10.12816/0041686
Accepted: 27 / 8 /2017

Full Paper (vol.695 paper# 8)

c:\work\Jor\vol695_9 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2421-2425
Assessment of Knowledge, Attitudes and Practices Regarding
Pulmonary Tuberculosis among Saudi Arabia Community in 2017
Arwa Abdullah Aseeri1, Raghad Abdulaziz Turkestani2 , Mohammed Ali Alamri1,Ghadah
Abdulrahman Algabr3, Saif Abdulrahman Alobaysi4, ZohairRadi Alghazal5,Asma Mohammed
Alghamdi2, Wala'a Ali Abdulmotaali1, Maram Ali Almane1,Sultan Hassan Asiri1
1-King Khalid University, 2-Ibn Sina National Collage, 3-Pavol Jozef Safárik University,
4-Taif University, 5-University of Dammam

Despite the improvements in the health care education of management in KSA, the
prevalence of tuberculosis remains alarming. Objectives: Evaluation of the knowledge, attitude and
practice among Saudi population regarding pulmonary tuberculosis (TB) in Kingdom of Saudi Arabia
(KSA). Methods: A multi-center community cross sectional study was assessed among random sample of
2056 adult Saudi subjects from different regions in KSA. All participants filled out a questionnaire that
included questions about demographics, awareness, attitude and practice about pulmonary tuberculosis.
Results: Most of participants (76.8%) had general knowledge about TB disease and only 23.2% haven't
heard about TB before. The majority of Saudi adult (74.9%) have inadequate knowledge about TB and only
25.1% have good knowledge regarding TB. The attitude of respondents about TB was negative among most
of them while most of participants had a good practice level but it needs to be increased. There was a
significant association between young age and high educational degree with good knowledge about TB.
Conclusion: KAP of Saudi population toward TB seems to be facing some challenges in the Kingdom of
Saudi Arabia. The awareness, attitude and practice need to be significantly evaluated in different studies to
improve control policies for reducing the disease incidence in our society. The prevention of TB and
management are based on good knowledge and education of Saudi population thus the health authorities
should intensify efforts and arranging specific educational programs about the disease and the consequences
of spreading infection among large sector of the population . Also, means of discovery, medication should
receive special attention by the governmental medical authorities.
Keywords: Knowledge, Attitude, Practice, Pulmonary Tuberculosis (TB), general population, KSA


population regarding pulmonary tuberculosis (TB)
Tuberculosis (TB) is an air borne disease
in Kingdom of Saudi Arabia (KSA).
which represents a chief public health hazard on the
general population around the world (1). It is caused
Study design
A cross sectional community survey study
Mycobacterium tuberculosis is usually the
was conducted at several parts of Saudi Arabia
causative agent (2). The prevalence of TB was
during the period from March to June 2017.
estimated according to the WHO to be increased as
Study population and sample size
about 20.000 subjects are infected and 5000 died
The Kingdom of Saudi Arabia is divided
from the disease every day (3).The situation in KSA
into 13 regions then each region was stratified into
showed that the prevalence of TB was decreased
4 quarters (East, North, West and South) then 2
but still alarming and the successful achievement in
large malls were randomly chosen from each part
this regard was due to the implantation of the
using a stratified random sampling technique. Then
National TB Control Program (NTP) for more
a total of 104 malls were included in the study
than3 decades (4). However, there is a lack in the
where 2056 Saudi educated adult subjects are
studies regarding the prevalence of TB in KSA. present.
The latest incidence of TB in the Riyadh region was
Study tools

8.5% while it was 23.1% in Hail for Saudi
An eligible questionnaire was translated into
subjects(5).Also, the prevalence rate among Saudis
Arabic language then distributed among the
ranged between 8.6 and 12.2 for every 100,000
respondents. The questionnaire included 2 tools :
subjects (6). The education was a chief constituent of
the first tool considered the subject's demographics
TB control thus assessing the knowledge of Saudi
and the second part included questions about the
subjects and implanting public awareness programs
knowledge, attitude and practice regarding the
could improve the elimination of TB in KSA (7, 8).
pulmonary TB disease.
Ethical approval
The study was conducted to evaluate the
Ethical approval was given by the review board of
knowledge, attitude and practice among Saudi
King Khalid University for conducting the study.
Received: 19/ 08 /2017 DOI : 10.12816/0041687
Accepted: 28/ 08/2017

Full Paper (vol.695 paper# 9)

c:\work\Jor\vol695_10 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2426-2432

Diagnostic Procedures for Cardiac Arrhythmias, MI or Hypertension
Omar Hussain Alghamdi, Hatim Owaidh Alamri, Hassan Abdulrahman Eissa, Abdulaziz Saeed
Alzhrani, Abdulaziz Saud Alghamdi, Safwan Abdulaziz Hamouh, Abdulraouf Muhammad Altaleb,
Mohammed Abdullah Almalki, Abdallah Mohamed Cheick, Mohammed Ibrahim Alrimawi
King Abdulaziz University, Jeddah, Saudi Arabia

The goal of this study was to highlight the diagnostic methods and approaches toward most
devastating cardiac disorders which are cardiac arrhythmias, MI and hypertensive.
Methods: We searched thorough electronic databases as, MEDLINE, EMBASE using the following terms
individually and/or in combination: Cardiac arrhythmias`, myocardial infarction (MI)`, hypertension`,
ventricular arrhythmias` and diagnosis`, to look for the most important and relevant articles concerning
with the diagnostic approaches of hypertension, MI, and arrhythmias in general.
Some ideal cardiac biochemical markers need to have not only high level of sensitivity but
additionally high specificity to coronary infarction. The creatine kinase-MB, a reasonably certain cardiac
marker, could be elevated in situations other than acute myocardial infarction. The ECG continues to be a
cornerstone in the diagnosis of MI as well as need to be regularly duplicated, particularly if the first ECG is
not analysis of MI. The diagnosing high blood pressure consist of 24-h ambulatory blood pressure
monitoring (ABPM) as well as self-home) BP surveillance (SBPM) as optional methods for determining
hypertensive patients. None of the current standards have actually yet consisted of ABPM or SBPM as
essential devices for detecting hypertension, preferring instead to depend on standard workplace analyses
tape-recorded by mercury sphygmomanometry.
Keywords: Cardiovascular Disease, Tachycardia, Atrial Fibrillation, Sudden Cardiac Death.


Hypertension is an epidemiologically
years increases to 9% in adults older than 80
considerable illness with a prevalence of about
years [4, 5].
15-20% [1]. Hypertension has actually been
Myocardial infarction (MI) is a term used for
recognized as the principal and most common
an event of cardiovascular disease which is due to
risk factor responsible for death and disability of
the formation of plaques in the interior walls of
the arteries resulting in lowered blood circulation
Undoubtedly, hypertension results in heart
to the heart and injuring heart muscles because of
failure, coronary artery illness, stroke, peripheral
lack of oxygen supply [6]. Arrhythmias are
artery disease, and chronic renal failure. The
frequently present in patients with acute MI, the
existence and the intricacy of both ventricular and
signs of MI are chest discomfort, which travels to
supraventricular arrhythmias have been shown to
the left arm or left the side of the neck, shortness
affect the morbidity, mortality and the lifestyle of
of breath, sweating, queasiness, throwing up,
hypertensive patients [2, 3]. Concomitant cardiac
irregular heart pounding, stress and anxiety,
arrhythmias are commonly seen in patients with
fatigue, and other elements [6]. Nearly 64 % of
high blood pressure, although the mechanism of
people who have MI do not experience chest
this association is uncertain. The contribution of
discomfort which is called" silent" MI [7]. The
hypertension to the development of ventricular
electrocardiogram (ECG) identifies the MI by
and atrial arrhythmias is unrecognized and
electrical signals in the heart and damage to the
therefore undertreated. These arrhythmias have a
blood supply to the heart muscle. The typical
large spectrum, varying from supraventricular
blood tests are troponin and creatine kinase (CK-
early beats to atrial fibrillation (AF) and from
MB) [7].
ventricular early complexes to ventricular
The goal of this study was to highlight the
tachycardia or abrupt cardiac death [4]. The
diagnostic methods and approaches toward most
occurrence of AF increases with age; an
devastating cardiac disorders which are cardiac
occurrence of 0.1% in adults younger than 55
arrhythmias, MI and hypertensive.
Received: 19/ 08 /2017 DOI : 10.12816/0041688
Accepted: 28/ 08/2017

Full Paper (vol.695 paper# 10)

c:\work\Jor\vol695_11 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2433-2437

Factors Influencing Time to CT in ER for Patients with Suspected
Subarachnoid Hemorrhage
Abdulaziz Saeed Balubaid, Ahmed Khalid Alzahrani, Omar Hussain Alghamdi,
Hatim Owaidh Alamri, Hassan Abdulrahman Eissa, Abdulaziz Saeed Alzhrani, Abdulaziz Saud
Alghamdi, Safwan Abdulaziz Hamouh, Mohammed Abdullah Almalki, Khalid Yahya Alzahrani
King Abdul-Aziz University, Jeddah, Saudi Arabia
IN our present review, the main goal was to determine the factors that influence the time of CT in
diagnosis of SAH in emergency department, since the ED physicians are the first who are approaches to the
patients, awareness and attitude of those physicians are very important for the benefit of SAH patients.
We conducted a comprehensive search using following databases; PUBMED, EMBASE, SCOPUS
of studies that involving data on the roles and time of CT in diagnosis of subarachnoid hemorrhage (SAH) in
ED patients with acute headache, published in English language up to 2017.
CT within 6 hours might be considered enough to rule out SAH in the following circumstances: a
neurologically regular patient, a thunderclap headache presentation, a clear time of beginning, and a modern-
day CT scan carried out within 6 hours of beginning read by a going to radiologist. Time from headache
beginning to imaging is reasonably associated with favorable imaging for SAH. Postpone to health center
presentation represent the biggest portion of time to imaging, especially those without SAH. These findings
recommend restricted opportunity to minimize lumbar puncture rates merely by accelerating in-hospital
processes when imaging hold-ups are under 2 hours, as diagnostic yield of imaging decreases beyond the 6-hour
imaging window from headache beginning.


A headache is a typical presenting problem to
by arteriovenous malformations, various other
the Emergency Department (ED) [1]. While the
vascular sores, tumors, as well as various other less
majority of migraines are self-limiting, the
common problems [6, 7].
possibility of spontaneous subarachnoid hemorrhage
In the evaluation of acute stroke disorder,
(SAH) is an essential diagnostic consideration in
neuroimaging plays a crucial role in establishing
patients presenting with an abrupt, serious
patient care. Noncontrast CT (NCCT) stays the first-
frustration. These abrupt beginning headaches
line imaging strategy for setting apart ischemic as
include the traditional "thunderclap headache" that
well as hemorrhagic stroke as well as recognizing
instantaneously comes to a head at migraine
various other etiologies for altered neurologic status,
beginning, along with headaches that get to the
such as an intracranial mass [8]. In a stroke, NCCT is
topmost extent within seconds to one hour of
used to leave out acute hemorrhage and also huge
beginning [2]. Sudden beginning headaches consist of
locations of clearly infarcted cells and to select
a wide range of possible diagnoses, including SAH,
patients for thrombolysis [9, 10]. The addition of cross-
benign post-coital headache, exertional headache,
sectional CT angiography and also perfusion
imaging can further enhance discovery of infarct,
hemorrhage, hypophyseal apoplexy, sphenoid
could recognize candidates that will have the best
sinusitis, sinus apoplexy, cough-related, vascular
practical result after thrombolysis, as well as may
dissection, analytical vasospasm, and also migraine
further broaden the moment window for
headache frustrations [3, 4]. A migraine and other a lot
intravascular treatment [11, 12].
more benign headaches imitate SAH and also are
In our present review, the main goal was to
estimated to be at least 50-times a lot more usual
determine the factors that influence the time of CT
compared to SAH [5]. Although the injury is the
in the diagnosis of SAH in the emergency
leading source of SAH, ruptured intracranial
department, since the ED physicians are the first
aneurysms account for 80% of non-traumatic
who are the first to receive the patients, awareness,
instances [4, 5]. Of the staying 20%, half are caused
and attitude of those physicians are very important
by non-aneurysmal venous "perimesencephalic"
for the benefit of SAH patients.
hemorrhages. The various other 10% are triggered

Received:24 / 8 /2017 DOI : 10.12816/0041689
Accepted: 3 /9 /2017

Full Paper (vol.695 paper# 11)

c:\work\Jor\vol695_12 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2438-2441

Use of Smartphones, ipads, Laptops and Desktops as A Risk Factor for
Non-Specific Neck Pain among Undergraduate University Students
Meshari Musaad Almalki, Saad Saleh Algarni, Bader Hulayyil Almansouri,
Mohammad Abdullah Aldowsari
College of Medicine and Medical Science - Taif University, Taif, Ibn Sina National College for Medical
Studies, Jeddah, College of Medicine and Medical Science - Taif University, Taif, college of medicine and
medical science - Al-Imam Mohammad Ibn Saud Islamic University, Riyadh

Purpose: This study aimed at determining the association between non-specific neck pain and the use of
smart phones, iPads, laptops, and computers by university students.
Neck pain is frequently common among adults and contributes significantly to the demand for
medical services and the economic burden of absence from work. Population-based studies indicated a
prevalence of neck pain between 12 and 34% with an elevated prevalence of the symptoms among users of
portable electrical devices. Prolonged use of computers, smartphones and other electronic devices is very
common among university students.
: This is a cross-sectional study included 355 undergraduate students from King Abdulaziz
University. The data were collected though interviewing using a structured questionnaire to investigate the
frequency of neck pain in relation to the types of devices used by the students.
Methods: Students had pain or numbness in the neck according to the frequency of reported pain episodes;
pain or numbness in the neck responded by saying very often, often, quite often, sometimes and never. The
question of assessment of neck pain was `Have you had an ache; pain or numbness in the neck during the
last 12 months?'.
The comparisons were made between respondents according to the gender variable, type of
devices used in the study and types of devices used for entertainment. The chi-square test was used to detect
the significant differences between categories. In this study, a P-value less than 0.05 was assumed to be
statistically significant (1).
: The vast majority of the students were electronic devices users 98%, of them, 92% of used both
smartphones and iPads for entertainment, while 32% used these devices for purpose of study.
Approximately 64% of the students never complained of neck pain, while 8.2% suffered from neck pain
either often or very often. The findings of this study showed significant associations between neck pain and
risk factors such as gender, type of devices used for entertainment, and type of devices used for study.
About 44% of female students reported the occurrence of neck pain in comparison with only 29% of male
students. Regarding the type of devices used for entertainment, 26.3% of students used smartphone and
iPad for entertainment, while only 16% of students used desktops and laptops for this purpose. On another
side, 45.2% of the students used smartphone and iPads for study, while about 26% of them used desktops
and laptops to study.
Conclusions: Most of the university students use electronic devices usually for leisure activities. About a
third of the students complained of neck pain symptoms which showed significant associations with female
gender and use of small portable devices, smartphone and iPads, either for study or leisure purposes.
Keywords: Neck pain, Smartphones, iPads, Laptops, Students, University.


Neck pain causes a great personal discomfort
factors can be work-related or non-work-related,
due to disability, pain, reducing work productivity
and they can be divided roughly into 3 categories
and poor quality of life (1,2). Neck pain is
physical, psychosocial, and individual risk factors
frequently common among adults and contributes
(4). The physical factors can be explained by the
significantly to the demand for medical services
and the economic burden of absence from work
musculoskeletal skeleton. Frequently, neck
due to illness. Population-based studies indicated a
muscles can be strained from bad positioning
prevalence of between 12 and 34% (3).
either it's hunching over the workbench or leaning
Neck pain is assumed to be a multifactorial
over the computers and smartphone devices (5).
condition, and therefore there are several risk
Causes of neck pain could be ranged, from
factors contributing to its development. Risk
recurrent movement strain to discrete spine
Received:27 / 7 /2017 DOI : 10.12816/0041690
Accepted: 6/ 8/2017

Full Paper (vol.695 paper# 12)

c:\work\Jor\vol695_13 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2442-2447
Increasing of PCOs among Young Females
Koloud Ateeq Alharbi1, Mohammed Meshal AlShathri2, Sajidah Alah Alshnqyta3, Safaa Mahmood
Al-Hasani4, Mazin Ali Aaad Almosa5, Abdulrahman Mohammed Aljowair2, Osama Mohammed
Alkhalifah6, Lina Emad Nouraldien1, Abdulrahman Omar Mansy7, Hadeel Lowthan Alshammari8
1 Ibn Sina National College For Medical Studies, Jeddah, Saudi Arabia, 2 Prince Sattam Bin Abdulaziz
University, Al-Kharj, Saudi Arabia, 3 Taibah University, Al Madinah Al Munawarah , Saudi Arabia,
4 Batterjee Medical College For Science And Technology, Jeddah, Saudi Arabia, 5 King Khalid University,
Abha, Saudi Arabia, 6 Mansoura University, Mansoura , Egypt, 7 Taif University, Altaif, Saudi Arabia,
8 Immam Abdulrahman Bin Faisal University, Al Dammam, Saudi Arabia
Corresponding Author: Koloud ateeq alharbi - Khulod_alharbi@hotmail.com ­ 0508771942

Polycystic ovary syndrome (PCOS) is a typical heterogeneous endocrine disorder characterized by
irregular menses, polycystic ovaries, and hyperandrogenism. The pervasiveness of PCOS differs relying upon
which criteria are utilized to make the diagnosis. Clinical manifestations incorporate oligomenorrhea or
amenorrhea, hirsutism, and normally infertility. Risk factors for PCOS in adult women incorporates type I
diabetes, type II diabetes, and gestational diabetes. Insulin resistance influences 50%­70% of women with
PCOS prompting various comorbidities containing metabolic syndrome, dyslipidemia, diabetes, glucose
intolerance, and hypertension. Studies demonstrate that women with PCOS will probably have expanded
coronary artery calcium scores and increased carotid intima-media thickness. Mental health disorders
comprising anxiety, depression, binge eating disorder and bipolar disorder similarly occur more often in
women with PCOS. Weight loss advances menstrual irregularities, symptoms of androgen excess, and
infertility. Management of clinical manifestations of PCOS comprises oral contraceptives for menstrual
irregularities and hirsutism. Spironolactone and finasteride are used to treat symptoms of androgen excess.
Treatment options for infertility include clomiphene, gonadotropins, laparoscopic ovarian drilling, and
assisted reproductive technology. Appropriate diagnosis and administration of PCOS is crucial to address
patient concerns yet additionally to anticipate future metabolic, endocrine, psychiatric, and cardiovascular
Keywords: Polycystic ovary syndrome, diagnosis, treatment, Surgical Intervention.


The main features of polycystic ovarian
they were capable of conceive. As a result, a
syndrome (PCOS) comprise anovulation, menstrual
primary ovarian defect was supposed to be the main
dysfunction, and signs of hyperandrogenism [1].
culprit, and the disorder came to be identified as
While the exact etiopathophysiology of this
polycystic ovarian disease [5].
condition is uncertain, polycystic ovarian syndrome
Patients with polycystic ovarian syndrome
may outcome from abnormal function of the
(PCOS) have irregularities in the metabolism of
hypothalamic-pituitary-ovarian (HPO) axis. A key
estrogen and androgens and in the control of
characteristic of PCOS is unsuitable gonadotropin
androgen creation.
secretion, which is more probable a result of, afore
High serum concentrations of androgenic
a cause of, ovarian dysfunction. Furthermore, one
hormones, as testosterone, androstenedione, and
of the most consistent biochemical features of
dehydroepiandrosterone sulfate (DHEA-S), might
polycystic ovarian syndrome is a raised plasma
be experienced in these patients. Though, singular
testosterone level [2]. Hyperandrogenism, a clinical
variety is impressive, and a specific patient may
assurance of PCOS, can cause inhibition of
have usual androgen levels. Polycystic ovarian
follicular development, micro-cysts in the ovaries,
syndrome is additionally connected with peripheral
anovulation, and menstrual changes.
insulin resistance and hyperinsulinemia, and
Stein and Leventhal were the first to distinguish a
obesity intensifies the degree of both abnormalities.
relationship between the presence of polycystic
Insulin resistance in PCOS can be optional to a post
ovaries and signs of hirsutism and amenorrhea
binding deficiency in insulin receptor signalling
(e.g., oligomenorrhea, obesity) [4]. After women
pathways, and elevated insulin levels can have
gonadotropin augmenting consequences for ovarian
experienced successful wedge resection of the
task. Hyperinsulinemia might likewise bring about
ovaries, their menstrual cycles became steady, and
concealment of the hepatic generation of sex
Received: 25 / 8 /2017 DOI : 10.12816/0041691
Accepted: 4 /9 /2017

Full Paper (vol.695 paper# 13)

c:\work\Jor\vol695_14 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2448-2454

Treatment of Adult Patients with Short-Bowel Syndrome
Muayyad Abdullah Abualjadayel1, Mansour Ali Shaiban2, Norah Abdulaziz Alhatim3,
Mohammed Riyadh A Alabbad4, Anas Salah Almiro5, Fatmah Ibrahim Alrawaji3,
Alaa Eid Aljohani6, Ali Abdulazeem Habeeb7, Mohammed Sunaytan Al Otaibi8,
Nedal Mohammed Alhababi4
1- Umm Alqura University, 2- Jazan University, 3- Al Maarefa Colleges, 4- Imam Abdulrahman
Bin Faisal University, 5 -University of Science and Technology, 6- Ohud Hospital ­ Almedina
Almonwra, 7- Imam Abdulrahman Bin Faisal University, 8- Security Forces Hospital
Corresponding author: Muayyad Abdullah Abualjadayel - King21monstar@hotmail.com - 0546993163

: extensive resection of the intestinal tract regularly results in insufficient digestion and
absorption of nutrients, a condition identified as short bowel syndrome. This condition requests a devoted
multidisciplinary collaboration to overcome the morbidity and mortality in these patients. With progresses
in serious care management, an increased number of patients survive the prompt morbidity of massive
intestinal resection present with short bowel syndrome. Some treatments, including parenteral nutrition and
surgical methods to reconstruct bowel have been utilized in these patients. Dietary methods,
pharmacotherapy and convenient surgical interventions have all added to the enhanced result in these
patients. Nevertheless, increasing experience and promising outcomes of intestinal transplantation had
added a new aspect to the administration of short bowel syndrome.
Keywords: intestinal, extensive, malabsorption, short bowel syndrome, total parenteral nutrition.


Short-bowel syndrome is a disorder clinically
Numerous operative or intrusive procedures
defined by steatorrhea, malabsorption, diarrhea,
and treatments have been considered and applied
malnutrition, fluid and electrolyte disturbances.
to the treatment of short-bowel syndrome. This
The final mutual etiologic factor in all causes of
incorporates the creation of central venous access
short-bowel syndrome is the functional or
for delivery of total parenteral nutrition (TPN),
anatomic loss of extensive segments of small
non-transplantation abdominal operations and
intestine so that absorptive capacity is severely
intestinal transplantation. TPN was produced
compromised. Even though resection of only the
effectively by Dudrick et al. [4]. Their paper
colon normally does not outcome in short-bowel
included research facility in a canine model and
syndrome, the condition's incidence may be a
clinical outcomes in 30 grown-up patients with an
serious factor in the treatment of patients who lose
assortment of gastrointestinal (GI) diseases
substantial amounts of the small intestine [1, 2].
extending from achalasia, horrendous pancreatitis

to territorial enteritis. The creature display
Great small intestinal resection compromises
unmistakably exhibited viability.
digestive and absorptive procedures. Satisfactory
digestion and absorption can't happen and
intravenously outperformed their littermate
accurate nutritional status can't be preserved
controls in weight pick up and were equivalent as
without supportive care. Currently, the most
far as action level, skeletal development and other
mutual causes of short-bowel syndrome in adults
formative points of interest. In the clinical arm of
contain Crohn disease [3], radiation enteritis,
the examination [4], 30 subjects accepting TPN
trauma, mesenteric vascular accidents and
could accomplish positive nitrogen adjust, look
recurrent intestinal obstruction. In the pediatric
after weight, mend wounds and close fistulae.
Wilmore and Dudrick [5] detailed positive
enterocolitis and intestinal volvulus are the most
nitrogen adjust, development and advancement in
well-known etiologic factors. Different conditions
a baby conceived with diffusely atretic little inside
related with short-bowel syndrome incorporate
who was bolstered totally parenterally.
congenital short small bowel, gastroschisis and
After these early achievements, the new
meconium peritonitis.
technique was brought into the clinical standard,

and signs for its utilization had extended
Received:26 /8 /2017 DOI : 10.12816/0041692
Accepted: 5 /9 /2017

Full Paper (vol.695 paper# 14)

c:\work\Jor\vol695_15 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2455-2458
Prognosis of Unfractioned Heparin versus Low Molecular Weight
Heparin in Pumlonary Embolism: Review Article
Abdullah Obaid Binobaid1, Maan Ahmed Alsaaid2, Ibrahim Ali I. Alasseri3, Mohammed
Balgaith H. Albareqi4, Kawther Abdulroof Alabbas5, Meryem Safi6, Ali Mohammed A. Alasmari7,
Yousef Mohammed Alhazmi8, Haider Issa Alaqaili9, Fatema Salman Hasan Salman Khalaf10,
Nareman Suliman Shamlan11, Bashayer Ateya Al-Harthy12, Mohannad Abdulrazzaq Alalwan13,
Mahdi Hussain Aljawad13, Adel Mushref Ali Alharban14
Department of Internal Medicine
1Alfaisal University, Riyadh, Saudi Arabia. 2Arabian Gulf University, Manama, Bahrain. 3Majardah General
Hospital, Abha, Saudi Arabia. 4Primary Health Care, Al-Birk, Saudi Arabia. 5Al Maarefa Colleges, Riyadh,
Saudi Arabia. 6Ibn Sina National College, Jeddah, Saudi Arabia. 7King Fahd Military Medical Complex,
Dammam, Saudi Arabia. 8Al Amal Mental Health Complex, Jeddah, Saudi Arabia. 9Dammam Medical
Complex, Dammam, Saudi Arabia. 10October 6th University, Cairo, Egypt. 11Batterjee Medical College,
Jeddah, Saudi Arabia. 12Taif University, Taif, Saudi Arabia. 13Imam Abdulrahman bin Faisal university,
Dammam, Saudi Arabia. 14Primary Health Care, Abha, Saudi Arabia.
Corresponding Author: Abdullah Obaid Binobaid, Alfaisal University, email: abinobaid@alfaisal.edu,
mobile: +966546667356
Anticoagulation is the mainstay treatment of pulmonary embolism. Using low molecular weight heparin versus
unfractionated heparin remains a matter of debate. Objectives: the aim of this review is to study the prognosis of
using low molecular weight versus unfractionated heparin in treatment of pulmonary embolism. Methods: PubMed
and Cochrane library were searched for articles comparing the efficacy of low molecular weight heparin and
unfractionated heparin in management of pulmonary embolism. Ten related results were selected for review. Results:
Literatures studies indicated that low molecular weight heparin was effective in therapeutic treatment of acute sub-
massive and massive pulmonary embolism. It was as effective as intravenous unfractionated heparin. It was not
associated with higher risk of major, minor bleeding, or thrombocytopenia. Low molecular weight heparin was as
effective as unfractionated heparin in prophylaxis of deep venous sinus thrombosis as well as pulmonary embolism.
Discussion: Low-molecular-weight heparin seemed to be as effective safe as intravenous unfractionated heparin for
the treatment as well as prophylaxis of pulmonary embolism. It was also safe with no major bleeding risk or higher
risk of thrombocytopenia. Conclusion: Both low molecular weight and unfractionated heparin had similar efficacy
and safety in management of PE.
Keywords: Pulmonary embolism, low molecular weight heparin, unfractionated heparin, outcome.

Study rationale and objectives: To date,
Anticoagulation is the mainstay treatment of
clear-cut data are unavailable about the superiority
pulmonary embolism. It had significantly decreased
of any of the two available types of heparin in
the pulmonary embolism-related mortality(1).
prevention and management of pulmonary
Recently, two forms of heparin are available for
embolism. Data from different studies are
treating pulmonary embolism; low molecular weight
conflicting. Thus, this review was conducted to
heparin (LMWH) and unfractionated heparin (UFH).
review different literature articles about the effect
Unfractionated heparin had long been used for
and prognosis of both medications.
therapeutic management of pulmonary embolism.
However, with the introduction of low molecular
For achieving this aim, PubMed and Cochrane
weight heparin in 1980, the role of unfractionated
library were searched for articles comparing the
heparin in deep venous thrombosis (DVT) and
efficacy of low molecular weight heparin and
pulmonary embolism (PE) began to diminish(2). Low
unfractionated heparin in management of pulmonary
molecular weight heparin was proved to be superior
embolism. Ten related results were selected for
to unfractionated heparin in prevention of deep
review. Studies evaluating the efficacy of both
agents on prophylactic as well as therapeutic
unfractionated heparin is still widely used in
management of pulmonary embolism were
treatment of pulmonary embolism(4).
reviewed. Of various search results, ten of them
Received: 13 / 8 /2017 DOI : 10.12816/0041693
Accepted: 22 /8 /2017

Full Paper (vol.695 paper# 15)

c:\work\Jor\vol695_16 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2459-2462
Effect of Nicu Admission on Development and Nutrition in
Early Childhood Years
Saleh Abdulrahim S Alnajim1, Moatasem Mohammed Modhish2, Razan Hussain J Alzahrani3,
Abdullah Ibrahim Almulhim4, Ahmad Hasan Mubarak Alkathiry5, Manal Mubarak Alqahtani1,
Ahmed Saleh S Alobaisy6, Abdulaziz Mohammed A Al Mulhim7, Ateeq Ali Al Ateeq8,
Sarah Obaidallah Abdullah Alshuaibi9, Adel Saeed Eid Alghamdi10, Waleed Khalid M Alqurashi5,
Tahani Nassir A Bahkely11, Abdulaziz Faisal W Alrubayyi12
1Imam Abdulrahman bin Faisal university, Dammam, Saudi Arabia. 2Soliman Fakeeh Hospital, Jeddah,
Saudi Arabia. 3King Khalid University, Abha, Saudi Arabia. 4King Faisal University, Hofuf, Saudi Arabia.
5King Abdulaziz University, Jeddah, Saudi Arabia. 6King Salman Hospital, Riyadh, Saudi Arabia.
7King Fahad Hospital, Al-Hasa, Saudi Arabia. 8Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi
Arabia. 9Ibn Sina National College, Jeddah, Saudi Arabia. 10Al Baha University, Al Baha, Saudi Arabia.
11Jazan University, Jazan, Saudi Arabia. 12Aljouf University, Aljouf, Saudi Arabia
Corresponding Author: Saleh Abdulrahim S Alnajim, Imam Abdulrahman bin Faisal university,
email: albrofesor1@hotmail.com , Mobile: +966592265555

Admission rate to neonatal intensive care units (NICU) was considerably increased over the past few decades.
Short-term outcomes had been enhanced, and mortality rates had decreased. However, the impact of advanced
neonatal care interventions on long-term outcome of infants was not thoroughly reviewed. Objectives: the aim
of this review is to investigate the effect of NICU admission on long-term developmental and nutritional
outcomes in early childhood years. Methods: Medical database, particularly Medline and Cochrane Library were
searched for studies, researches, and review articles about the long-term outcome of neonates who were admitted
at neonatal intensive care unit, particularly from the nutritional and developmental perspectives. Results: Overall
impact of NICU admission on long-term outcome is generally related to the etiological indication of admission;
Hypoglycemia, tetanus, low birth weight, and prematurity had a negative impact on childhood development.
Adequate nutrition and rapid growth velocity in NICU improved nutritional and physical development.
Discussion: Long-term outcome of neonatal intensive care unit admission depends to a large degree on the
etiology of admission. Adequate nutritional support at neonatal intensive care units had improved developmental
and nutritional outcome of preterm and very preterm infants. Term and late term infants admitted at NICUs were
not significantly different from their counterparts who were not admitted at NICUs on long-term outcomes.
Conclusions: Admission at NICU is not an independent risk factor for poor nutritional or developmental
outcome at early childhood years, but the etiological indication of NICU admission was more predicting. Early
nutrition for low birth weight babies improved nutritional development.
Keywords: Neonatal intensive care, development, nutrition, long-term.


Rates of neonatal admission to neonatal intensive
admission(1). Over the last few years, various
care units (NICUs) had shown a notable increase
advances had been applied to optimize neonatal
during the last few decades(1). Wade Harrison and
intensive care. Ventilator techniques, improved
David Goodman(1) in their retrospective study on
parenteral nutrition, novel surgical interventions
17896048 newborns admitted to NICUs during the
antibiotics, steroids, and surfactant therapy are
period from 2005 to 2012, reported that the
examples of the advances that resulted in a
admission rate to neonatal intensive care units
considerable reduction in neonatal mortality rates(2).
increased from 64/1000 live birth in 2005 to 77.9
However, the enhanced survival of cerebral palsy
live births in 2012 (P<0.001). Admission rates had
neonates, hypoxic-ischemic encephalopathy cases,
increased for normal weight, low-birth weight, as
and other serious neonatal disorder might have
well as low birth weight infants. More specifically, a
increased the long term negative motor and
notable increase was reported in the percentage of
developmental outcomes(3­5). Study rationale and
normal weight neonates requiring intensive care unit
objectives: Meticulous monitoring of long-term
Received:27 / 8 /2017 DOI : 10.12816/0041694
Accepted: 6/9 /2017

Full Paper (vol.695 paper# 16)

c:\work\Jor\vol695_17 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2463-2468

Prevalence and Risk Factors of Chronic Sinusitis among
People in Jazan Region' KSA
Mohammed Ali Homood , Saud Mohammed Alkhayrat, Khalid Mousa Kulaybi,
Ahmad Ali Mohajer, Abdullah Sagheer Majrashi, Ali Abdullah Salawi, Ali Yahya Darbi,
Mustafa Abdullah Alnuman, Nehad Khalaf Khawaji
College of Medicine, Jazan University

Chronic Sinusitis results from the impairment of paranasal sinus ventilation. Symptoms of
chronic sinusitis include facial pressure, fullness or pain, nasal obstruction, headache, clear or mucopurulent
nasal discharge and hyposmia or anosmia. Risk factors of chronic sinusitis involve smoking, allergy, septal
deviation, aspirin sensitivity and bronchial asthma.
To determine the prevalence of chronic sinusitis and it's related risk factor as well as correlation
with demographics. Methods: The present study included 867 participants using Monkey survey for
investigation which included 20 questions.
Results: There were 25.3% of participants had chronic sinusitis, 26.4% of the males and 22.4% of females
suffer from the disease. Chronic sinusitis was more prevailed among young, the younger aged participants
in addition to those living in rural area. Chronic sinusitis was less prevalent in married persons and those
working in a medical job. Presence of any type of allergy was a risk factor for chronic sinusitis.
Conclusion: Chronic sinusitis and allergy consider as risk factors for chronic sinusitis.
Chronic Sinusitis (CS), CS in KSA, Risk factors for CS, Allergy.


The paranasal sinuses involve the maxillary,
Diagnosis of chronic sinusitis is based on the
frontal, sphenoidal and ethmoidal sinuses, which
presence of two symptoms from a variety of
develop as diverticula from the nasal mucosa, they
symptoms which last for 12 consecutive weeks,
are rudimentary at birth, and then expand during
symptoms including facial pressure, fullness or
the eruption of permanent teeth and at puberty
pain, nasal obstruction, headache, clear or
[1].Sinusitis which is also known as rhino sinusitis
mucopurulent nasal discharge and hyposmia or
is an inflammation of the lining membranes of one
anosmia [8]. The previous symptoms are not
or more of the sinuses [2].Several inflammation
specific, so physical examination is required and
causes lead to sinusitis, chronic inflammation
in certain situation diagnosis by using enhanced
which leads to chronic disease, pathophysiology
CT is recommended [8]. Chronic Sinusitis is a big
which causes obstruction of the sinus cavity and
health problem worldwide that affects almost 15%
subsequent infection leads to acute sinusitis [3].
of humans [2], the prevalence rate was reported to
Sinusitis is characterized by Sub-acute symptoms
be in the range of 6 % to 27.1 % [2, 9-12].In the USA
that last for 4 to 8 weeks, acute symptoms which
the prevalence rate of chronic rhinosinusitis was
last for less than 4 weeks and chronic symptoms
12% [13] and in Europe, it was 10.9% [9]. In Saudi
that last for longer than 8 weeks [4]. There are
Arabia, the prevalence of chronic rhinosinusitis is
several factors that contribute to the chronicity of
in the eastern province [7], an increase in the
sinusitis including ostial blockage, mucus
prevalence in Saudi Arabia has been noted [14]. In
recirculation and osteitis [5].
one study in Saudi Arabia, it was found that half
Chronic Sinusitis (CS) is caused by drainage
of the participants had infected with chronic
disorders and the impairment of paranasal sinus
sinusitis [7]. Chronic sinusitis is related to
ventilation which caused by a blockage of the
bronchial asthma, analgesic intolerance and nasal
ostiomeatal complex in the middle nasal meatus
polyposis [15,16], almost 20% of chronic sinusitis
[6]. Symptoms of chronic sinusitis persist for more
patients have nasal polyposis [17].
than 90 days, either with or without acute
Chronic sinusitis is associated with serious
exacerbations [3]. A chronic disease which is
medical treatment costs, reduced workplace
defined as an inflammation of paranasal sinuses
productivity [12, 18] and a substantially impaired
and nose which lasts for 12 weeks or longer [7].
quality of life [19].This disease is common in all
Received: 29 / 8 /2017 DOI : 10.12816/0041695
Accepted:8 / 9/2017

Full Paper (vol.695 paper# 17)

c:\work\Jor\vol695_18 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2469-2475

Relation between Iron Deficiency and Susceptibility to Bacterial
Fahad Abdullah R Alqeaid, Abdullah Khalid A Dakhel
Qassim College of Medicine, Qassim - Alrass city

Iron deficiency (ID) is a common deficit of the particular nutrient in the body and the top-ranking cause of
anemia worldwide. It is a common cause of morbidity and accounts for 50% of anemia cases in the world.
Symptoms of iron deficiency are subtle and nonspecific including severe anemia, fatigue, diminished work,
gastrointestinal disturbances, associated with the impaired natural type of immunity and the cell-mediated type of
immunity. Therefore, differentiating the term iron deficiency and the other term infection is essential. The
process by which the microbes acquires iron supplement and the respectful virulence can be identified by the
application of the different type of host mechanisms and also different microbial mechanisms, thus interfering
with these respective mechanisms is likely to create the future therapy forms for the bacterial diseases that are
infectious. In this review article, we summarized the mechanism of iron metabolism in the body, the
characteristics of iron deficiency anemia, symptoms, epidemiology and etiology, host mechanism during
bacterial infection, and the susceptibility to bacterial invasion in case of iron deficiency anemia.
Keywords: anemia; iron deficiency anemia, bacterial infection, iron, immunity.

absorbed being is dependent on the sufficiency of

Iron is considered to be the second most
iron stores. Human iron metabolism is remarkably
type of metal that is considered to be abundant in
efficient, as only 0.5 ­ 1 mg of the approximately
the crust of the earth, it's a substantial element for
4 ­ 5 g of the total amount of iron that is present in
most living organisms and the one responsible for
the body iron is lost on a daily basis (3). In the
the maintenance of their health. Iron can be
individuals who are considered to be healthy,
regarded to be a vital component of several body
almost all the iron that is lost is taken into the
functions, primarily hemoglobin synthesis and
plasma where it is bound to transferrin, and thus,
transport of oxygen throughout the body. It is
limiting the catalysis of free radical production of
found in several different enzymes involved in
iron. This facilitates the process of iron
maintaining cell integrity, such as catalases,
transportation to the cells of interest. The delivery
peroxidases, and oxygenases. Proportionally
process of the iron that is loaded with transferrin
higher iron concentrations are located in the basal
to the cells of interest where it is accomplished by
ganglia of the human brain than in liver. In
the respective endocytosis that is receptor-
breastfeeding infants, brain parts, particularly the
mediated. The ferric type of iron that is released
microglia, continue to develop, and therefore iron
from the transferrin is then reduced into the
is vital for developing cognitive functions at this
endosome using the ferrireductase STEAP3 where
stage of life (1, 2).
it is also transported in a subsequent manner to the

cytoplasm using the DMT1 (3).
It from this location that we realize that
In the body, iron is distributed into two
the fate of iron mainly relies on the cellular
compartments. The first is a functional
requirements. One application of Iron it can be
compartment formed of a number of compounds,
used for the heme biosynthesis, whereby heme is
including hemoglobin, myoglobin, transferrin and
regarded as the tetrapyrrole-type of a molecule
enzymes, and all of which require iron as a
that serves both as the prosthetic group consisting
cofactor or a prosthetic (ion or haem) group. The
of the metalloenzymes, also serving as the oxygen-
second is the storage compartment, formed of the
the binding moiety that is meant for hemoglobin.
ferritin and the hemosiderin, which constitute the
In the same case, iron is capable of being
body's mineral reserves (2).
incorporated to
The absorption of iron takes place at the
the clusters of iron-sulfur, which are the redox
proximal duodenum, with the amount of the iron
cofactors that are mainly applied for the
Received:20 / 8 /2017
DOI : 10.12816/0041696
Accepted: 29/8 /2017

Full Paper (vol.695 paper# 18)

c:\work\Jor\vol695_19 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2476-2479

Knowledge and Attitude of Foot Care Among Diabetics in
Prevention of Amputation in Saudi Arabia
Mohammed Sulaiman Alrashed1, Sufana Amer Al Otaibi2, Abdulrahman Mohammed G Habib3,
Khadijah Ali Saiys4, Hanan Mohammed Alghamdi5, Hind Ahmed Nassar Alnassar2, Harith Own
Alsahfy2, Afnan Mohammed M Khan6, Hesham Faisal Alsaati7, Ahmed Soud Muhammad Alzayed8,
Ahmed Sami Ali Alhussain9, Mohammed Sami Mohammed Alhaddad9, Ali Ameer Hassan
Almohammedsaleh9, Abdullah Mohammed Ali Alhamdi10, Humaidan Hamoud Almalki11
Department of General Surgery
1Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia. 2Imam Abdulrahman bin Faisal
university, Dammam, Saudi Arabia. 3Sulaiman Al Rajhi Colleges, Al Bukayriyah, Saudi Arabia. 4Umm al-
Qura University, Mecca, Saudi Arabia. 5Ibn Sina National College, Jeddah, Saudi Arabia. 6University of
Science and Technology, Sana'a, Yemen. 7Alfaisal University, Riyadh, Saudi Arabia. 8University of Hail,
Hail, Saudi Arabia. 9King Faisal University, Hofuf, Saudi Arabia.10Al Baha University, Al Baha, Saudi Arabia.
11Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
Corresponding Author: Mohammed Sulaiman Alrashed, Imam Muhammad ibn Saud Islamic University,
Riyadh, Saudi Arabia. Email: msalrashed@hotmail.com , Mobile: +966543959515

Diabetes mellitus is a prevalent endocrinal disorder in Saudi Arabia. Diabetic foot ulceration occurs in
about one fifth of diabetics, and significantly increase the risk of gangrene and amputation. Early and proper
foot care is essential to prevent such deleterious complication. Objectives: the aim of this review is to study
the knowledge and attitude about foot care among diabetics in Saudi Arabia and its impact on prevention of
amputation. Methods: To achieve this aim, online database was searched for articles reporting knowledge
and/or attitude of Saudi patients about foot care. Results yielded from this search were quickly inspected, the
titles and abstract were quickly read to select related studies. Results: Up to one fifth of diabetic patients had
poor knowledge about their foot care, and in spite of regular checkups, they lacked awareness of signs and
symptoms of diabetic foot infection. However, when educational programs were implemented, complications
rate has significantly declined. Discussion: Previous literature studies indicated that Saudi diabetic patients
had moderate to poor knowledge about their illness in general. Most of them are not adequately educated about
the complications of their illness, and how to deal with them. However, when engaged in systematic
educational programs, they were highly responsive and compliant and their new adopted attitude and
knowledge about the illness decreased their amputation as well as other complications rate.
Keywords: Diabetic foot, diabetes, amputation, knowledge, attitude.

subsequently amputation. The most common of
Diabetes mellites is a prevalent endocrinal
which are diabetic peripheral neuropathy, vascular
disorder among Saudi Arabia, affecting up to 30%
insufficiency, mechanical factors, uncontrolled
of the population(1). It has deleterious effects on
diabetes and trauma(3,6­9).
organs and systems including the feet. Ulceration
In Saudi Arabia, a retrospective cohort study
of feet and lower limbs occur in about 15% of
conducted on 62,681 diabetic patients indicated
diabetic patients(2). These ulcerations make diabetic
that prevalence of diabetic foot complications was
patients at 15 to 40-fold higher risk of gangrene
3.3%. Foot ulcers, gangrene and amputation
and amputation(3). In spite of the continuous efforts
occurred in only 2.05%, 0.19% and 1.06%,
aimed at prevention, there was a notable increase
respectively. Risk factors reported to increase the
in amputation rate over the last decade in the
rate of complications among the studied population
United States (3). Amputation has a significant
were male gender, duration of diabetes (10 years),
negative impact on survival, the five-year survival
uncontrolled diabetes, insulin use, peripheral
rate reported after amputation hovered around
vascular, coronary artery disease or cerebro-
50%(4,5). Many risk factors have been established to
vascular disease, diabetic neuropathy, diabetic
increase the risk of diabetic foot to ulceration and
retinopathy, smoking and hypertension(10). The
Received: 12 / 8 /2017 DOI : 10.12816/0041697
Accepted:21 /8 /2017

Full Paper (vol.695 paper# 19)

c:\work\Jor\vol695_20 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2480-2485
Open Appendectomy versus Laparoscopic Appendectomy in Adults
Abdullah Eid Ayyadah Alahmadi 1, Ali Mohammed Fayez AlShehri2,
Fatemah Nasser Al Rebh3, Areej Mohammed Al-Amri1, Abdullah Mohammed ALdayri4,
Raid Naysh Alghamdi5, Qais Saad Alrashidi5, Abdullah Suliman Alwehibi6,
Ali Mohammed Ali Al-Mousa7, Abdulla Abduljaleel Alkhalifa7
1 Taibah University, 2 King Khalid University, 3 Umm Al_Qura University,
4 Majmaah University, 5 King Saud Bin Abdulaziz University for Health Sciences Riyadh,
6 Qassim University, 7 King Faisal University
Corresponding Author: Abdullah Eid Ayyadah Alahmadi - Near12009@hotmail.com ­ 0567790806

As of late, the occurrence of appendicitis has notably diminished. However, appendicitis stays one of the
more common surgical emergencies, and appendectomy stays the treatment of non-complicated appendicitis.
Acute appendicitis (AA), a typical intra-abdominal surgical pathology, obliges a comprehensive
understanding of its presentation, assessment, diagnosis, and overall operative administration. There are two
types of surgery to remove the appendix. The standard technique is an open appendectomy and laparoscopic
appendectomy. As with other laparoscopic surgical procedures, the literature defines decreased pain, earlier
resumption of diet, and decreased length of hospital stay for laparoscopic appendectomy versus the
equivalent open procedure. Nevertheless, this should be accurately considered in the light of the present
condition of the open procedure, which already causes minimal risk and is related with an extremely short
hospital stay and a low complication rate. Further disadvantages of laparoscopy incorporate increased cost
and longer operating times. We conducted this review using a comprehensive search of MEDLINE,
PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of
Controlled Trials from January 1, 1988, through July 28, 2017.
Keywords: Open appendectomy, Laparoscopic appendectomy, Appendicitis.


Acute appendicitis (AA), a typical intra-
Expanding evidence proposes that in numerous
patients with uncomplicated acute AA, antibiotic
comprehensive understanding of its presentation,
treatment might be as effective as surgical
assessment, diagnosis, and overall operative
treatment [2, 3].
administration. There are two types of surgery to
Concisely, the pathophysiology and progressive
remove the appendix. The standard technique is an
timeline of AA are ascribed to the following:

appendectomy. Concisely, the pathophysiology and Bacterial invasion
progressive timeline of AA are ascribed to luminal Luminal obstruction causing distention
obstruction, causing distention, bacterial invasion, Ineffective venous and lymphatic drainage
ineffective venous and lymphatic drainage, and Perforation with associated leakage of contents into
lastly, perforation with related leakage of contents
the peritoneal cavity. The operative method to deal
into the peritoneal cavity.
with AA comprises of appendectomy (surgical
The presentation, assessment, and diagnosis
expulsion of the vermiform appendix); be that as it
of AA are extremely inconsistent; many factors
may, the decision between an open and a
attribute to these inconsistencies. The classic
laparoscopic operation keeps on being argued in the
history consists of anorexia and periumbilical pain,
medical literature [4, 5]. The right-lower-quadrant
after that nausea, vomiting, and right-lower-
entry point of open appendectomy has persevered
quadrant pain, in addition to leucocytosis [1].
basically unaltered since it was spearheaded by
Physical examination and history ought to provide
McBurney in the nineteenth century [6]. The
sufficient clinical information to diagnose AA, with
utilization of laparoscopy in the surgical
the utilization of imaging modalities as adjuncts in
administration of AA was first portrayed in 1983,
the valuation.
and there is progressing pattern toward expanded
Treatment comprises of giving aggressive
utilization of this approach [7]. Likewise with other
intravenous liquid resuscitation and antibiotics,
laparoscopic surgical techniques, the literature
putting the patient on nil per os (NPO) status,
depicts diminished pain, before resumption of
giving pain control, and getting a general surgical
eating routine, and diminished length of hospital
counsel for authoritative operative administration.
stay remain for laparoscopic appendectomy versus
Received:1 / 9 /2017 DOI : 10.12816/0041698
Accepted: 10 /9 /2017

Full Paper (vol.695 paper# 20)

c:\work\Jor\vol695_21 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2486-2492

Antibiotics Used in Gastrointestinal Surgery Prophylaxis and
Treatment of Postoperative Infection
Mohammed Seror Bawahal1, Habib Khalifah Al-Radhi2, Adel Awadh Alghurais3, , Bashayer Fahad
Alzohayan3, Ayat Adel Almusally4, Abdullah Yousef Alfulaij5, Saud Abdulaziz Obaid Alsammani5,
Mahmoud Fareed Qutub5, Mohammed Abdulrahman Alshaikh6, Ziyad Saud Rasheed Slmjlad7
1king abdullah hospital Bishah, 2- King Faisal University, 3- King Khalid University, 4 -Imam Abdulrahman
Bin Faisal University, 5 - King Saud Bin Abdulaziz University For Health Sciences, 6 King Abdulaziz
University, 7- King Saud Medical City
Corresponding Author: Mohammed Seror Bawahal,email: bawhal_01@yahoo.com - 0534473326

Aim of the work:
surgical site infections are the second most common cause of hospital acquired infections
and happens in 10%­30% of all patients undertaking gastrointestinal surgery. They are more likely to be
admitted in critical care unit and have five times higher mortality than those patients without surgical site
infections. Prophylactic use of antimicrobials and other preparations before surgery have shown significant
reduction in infectious complication. After surgery the treatment of postoperative bacterial or fungal infections
comprises cause control, antimicrobial cure, supportive and adjunctive approaches with the help of various
types of antimicrobials. Methodology: we conducted this review using a comprehensive search of MEDLINE,
PubMed, and EMBASE, from February 1986 to April 2017. The following search terms were used:
perioperative surgical complications, post-operative infection after gastrointestinal surgery, antibiotics used in
gastrointestinal surgery, MRSA in gastrointestinal surgery. This study aimed to explore the prevalence,
prophylaxis and management of perioperative gastrointestinal infections and study about the types of antibiotics
used for such management. Conclusion: better ways of post-operative management of infections must be
studied such that the recommend use of antibiotics have full or specific coverage of pathogens and have
minimal adverse effects
Keywords: perioperative gastrointestinal infection, management of surgical infection, surgical prophylaxis
antibiotics, surgical antimicrobial.


Surgical site infections are the second most
gastrointestinal tract due to diverticular disease and
common cause of hospital acquired infections and
cancer. Gut ischemia because of arterial embolism,
happens in 10%­30% of all patients undertaking
thrombosis, or vascular disease lead to peritonitis,
gastrointestinal surgery. They are more likely to be
primarily in elderly patients. The treatment of
admitted in critical care unit and have five times
postoperative bacterial or fungal infections
higher mortality than those patients without surgical
comprises of cause control, antimicrobial cure,
site infections [1].
supportive and adjunctive approaches with the help
Prophylactic use of antimicrobials and other
of various types of antimicrobials. In this study, we
preparation before surgery have shown significant
explored the various prophylactic and post-
reduction in infectious complication. The essential
operative antibiotics that can be used to reduce
spectrum for coverage in gastrointestinal surgery is
morbidity and mortality in gastrointestinal surgery
decided by the flora found within the patient's large
intestine. This is a mixture of both anaerobic and

aerobic bacteria along with than introduction of
bacteria from the patient's skin or the operating
· Data Sources and Search terms
room, so antibiotic choices that protect against both
We conducted this review using a comprehensive
anaerobic and aerobic bacteria showed the best
search of MEDLINE, PubMed and EMBASE from
results [2].
February 1986 to April 2017. The following search
Common reasons of intra-abdominal infections
terms were used:
after surgery in patients who stay in intensive care
· Data Extraction
units are perforations of the upper gastrointestinal
Two reviewers have independently reviewed
tract due to ulcer disease, or in case of the lower
the studies, abstracted data and disagreements were
Received: 2 / 9/2017 DOI : 10.12816/0041699
Accepted: 11 / 9/2017

Full Paper (vol.695 paper# 21)

c:\work\Jor\vol695_22 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2493-2496

The Dangerous Effects of Excessive Use of Antibiotics among
Community in Saudi Arabia
Manal Hassan Alharbi1, Amro Yahya Khormi2, Areej Misfer Albisher1, Maram Mubarak
Barkoot3, Badeah Ayesh Alsofyani4, Fatmah Mohammed Althabet3, Reyouf Abdulsalam
Almughamsi5, Reham Awdah Albalwi6, Sahab Mohammed Alsari3, Haneen Saad Aljehani5
1-Alfaisal University,2-Arabian Gulf University,3-King Khalid University,
4-Taif University, 5-King Abdulaziz University, 6-Tabuk University

antibiotic misuse is a common problem around the world with special regard to developing
countries. It could result in increased rate of infections and admission to hospitals, high treatment costs as well as
increased mortality rates.
Aim of the work: this study aimed to assess the general knowledge of community population in Saudi Arabia
(KSA) regarding the adverse effects of antibiotics overuse.
Patients and methods: this was a cross-sectional descriptive study conducted among 1700 Saudi adults from the
period of February to June 2017. Respondents were interviewed and filled out a questionnaire that consisted of 3
parts the: first parts considered their demographics, the other parts regards the use of antibiotics and knowledge
about their adverse effects.
Results: the pattern of antibiotic use showed that 76.8% have recently used antibiotics. The major source of
antibiotic use was pharmacist (46.5%) followed by physician (23.9%). About 71.7% used antibiotics for cold and
cough and 61.8% used antibiotics for viral diseases. The level of knowledge toward excessive use of antibiotics
was in adequate among 61% of respondents and was good among 39% of them. A significant correlation was
detected between young age and good knowledge.
Conclusion: there was a lack in the public knowledge regarding the adverse effects of antibiotic overuse among
Saudi subjects. Educational programs may be performed to fill up the awareness gaps and enhance the knowledge
thus decreasing the costs paid by health authorities to manage the adverse effects of antibiotics overuse.
KSA, Knowledge, adverse effects, antibiotic overuse.


The use of antibiotics has been extended
using the stratified random sampling technique. The
during the last decades and resulted in increasing the
inclusion criteria were age above 20 years, Saudi
life expectancy and treatment of most of
subjects and able to read and write in Arabic.
communicable diseases. Use of antibiotics has shifted

from communicable to non-communicable diseases (1,
Study tools: after reviewing the available literature, a
2). Also, antibiotic resistance have emerged from the
excessive and improper use of antibiotics that led to
distributed among the participants who were
antibiotic resistance around the world (3, 4). In
interviewed by the researchers in different sites
addition, the misuse of antibiotics was associated
including supermarkets, community pharmacies and
with failure in the treatment, high morbidity and
shopping malls. The questionnaire consisted of 3
mortality rates as well as higher rates of hospital
parts: the first part considered their demographics, the
admission and stay (5, 6).
other parts regards the use of antibiotics and
Moreover, overuse of antibiotics has been
knowledge about its adverse effects. The validity of
emerged in decreasing the beneficial gut
the questionnaire was enhanced after carrying out a
microorganisms as well as disturbing its function and
pilot study that among 40 participants then the final
composition which affects the health (7, 8). This study
version was corrected according to the subject's
aimed to assess the general knowledge of community
population in Saudi Arabia (KSA) regarding the
Ethical approval
adverse effects of antibiotics overuse.
An informed consent was obtained from the

respondents before participating in the study.

This was a cross-sectional study that conducted in
Statistical analysis
Saudi Arabia during the period of February to June
The obtained data were carried out using
2017. A sample of 1700 Saudi participants from
Statistical Package for Social Sciences (SPSS,
different parts of KSA was enrolled in this study
Received:28 /8 /2017 DOI : 10.12816/0041700
Accepted: 7 /9 /2017

Full Paper (vol.695 paper# 22)

c:\work\Jor\vol695_23 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2497-2501
Prostaglandin E1 before Elective Caesarean Section to Reduce Transient
Tachypnea of the Newborn (TTN): A Randomized Control Trial
Noha H. Rabea1, Noha A.S. Sakna1, Marwa S. Sayed1, Hossam H. Ahmed2
Obstetrics and Gynecology Department, Faculty of Medicine1,2
Ain Shams University1, Cairo University2
Aim of the study:
this study aimed to determine the role of prostaglandin E1 on the reduction of the
neonatal respiratory morbidity specially (TTN). Study Design: this is a parallel, randomized placebo
controlled trial, comparing the use of Misoprostol (Prostaglandin E1) use in the form of Misoprostol E1
vaginal tablets with nonmedicated similar vaginal tablet (placebo) to decrease the neonatal respiratory
distress specially (TTN). Results: this study included 300 cases with gestational age range between 38
weeks to less than 39 weeks the included cases were classified into 2 groups: study group included 150 case
were given PG E1 control group included 150 case were given placebo. Conclusion: we found one positive
cases for TTN in study group, and 3 positive cases for TTN in the control group results we got were
insignificant. So, we suggested taking more large sample in the future studies.
Keywords: prostaglandins cesarean section respiratory morbidity transient tachypnea of newborn.


Neonatal respiratory distress occur more in

preterm newborn than term newborn and whether
Police Hospital- Nasr City and it started from
born vaginally or through caesarean section, but in
November 2016 to July 2017.
a higher percentage after elective caesarean than
Trial Design
after normal vaginal delivery (1). Transient
Parallel, randomized placebo controlled trial,
tachypnea of the newborn (TTN) occurred due to
comparing the use of Misoprostol (Prostaglandin
delayed resorption of pulmonary fluid, as a result of
E1) use in the form of Misoprostol E1 vaginal
tablets with non medicated similar vaginal tablet
surge (2). Catecholamines can stimulate pulmonary
(placebo) to decrease the neonatal respiratory
fluid reabsorption through acting upon beta-
distress specially (TTN).
adrenergic receptors in foetal lung which present

more late in gestation, and thus enable the secretion
Eligibility Criteria
of surfactant (3). This surge of catecholamines can Inclusion criteria
be provoked through prostaglandins given before Age: 18 years or more.
caesarean section to pregnant females (4) as those Term pregnancy (38 - < 39 weeks).
who are born vaginally are found to be adapted Pregnant women planned for elective transverse
metabolically through a higher catecholamine level
lower segment caesarean section with an
at birth (4). So, prostaglandins may be given about
indication. A written informed consent signed by
one hour before an elective caesarean section after
the participating women.
excluding the presence of contraindication to their Exclusion criteria
use to decrease the neonatal respiratory distress (5). Women with history of significant cardiac disease,
In a previous similar prospective study of 36
D.M, eclampsia, pre eclampsia, epilepsy, severe
women scheduled for an elective caesarean section
asthma, severe allergic condition, vascular disease,
beyond 38weeks (4) 18 women received intravaginal
renal or hepatic disease.
prostaglanadin E2 tablets and 18 received placebo, Women with contraindication to prostaglandins as
there was one neonatal respiratory distress case in
the control group which was reported as transient
prostaglandins or specifically for Misoprostol.
tachypnea of the newborn with similar Apgar score Psychological problem or mental disease that
at one and five minutes and no need to mechanical
renders the patient not able to understand the
ventilation nor side effects related to treatment in
nature, scope, and sequences of the study.
either group, so no difference in respiratory Pregnancies
outcome was reported.
malformation/s or chromosomal aberration.

Study Setting
The population in this study was consisted of a
This study was conducted in Ain Shams
sample of pregnant women between 38 - < 39
University Maternity Hospital (ASUMH) and
weeks gestation scheduled for elective caesarean
Received:12 /8 /2017 DOI : 10.12816/0041701
Accepted: 21 /8 /2017

Full Paper (vol.695 paper# 23)

c:\work\Jor\vol695_24 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2502-2511

Cyanoacrylate Glue Mesh Fixation versus Suture Mesh Fixation in
Open Inguinal Hernia Repair
Mohammed Salah- Eldin Shehata, Mohammed Elkordy, Mohammed
Abd-Elaal Nafe, Ahmed Farag Mohammed Radwan
Department of General Surgery, Faculty of Medicine, Al Azhar University
Corresponding author, Ahmed Farag Mohammed Radwan, i : doctor.lion@yahoo.com

Aim of the work: surgical sealants (adhesives) have been widely used in surgery to prevent air leaks (from
holes in diseased soft tissues such as lung), liquid leaks (including hemostasis, as for oozing) and as
adhesives (to bond two separate tissues, but very rarely). They have many advantages over traditional
techniques (i.e., sutures and staples) such as reducing both operative time and physical load on patients.
Sutures have been most extensively used for wound closure, though they have shortcomings such as the
highly skilled procedures involved, the long time required for wound closure, and the postoperative removal
of non-bioabsorbable Sutures.
Methods: forty male patients with primary unilateral groin hernia were randomized to undergo open hernia
repair with suture fixation (Group B) or cyanoacrylate glue fixation of the mesh (Group A). Primary
outcome was early and late postoperative pain. Secondary endpoints were use of painkillers after 24 hours,
morbidity rate and recurrence rate.
Results: early postoperative pain and pain between 48 hours and 1 month after surgery were significantly
lower in Group A. Only two patients had chronic pain and both were in Group B. Clinical recurrences were
two, both in Group B.
Conclusion: cyanoacrylate seemed to be a simple, original, reasonable, feasible, reproducible technique and
competitive alternative to the standard tissue-penetrating mesh fixation devices in open inguinal hernioplasty.
It is accompanied by a reduction in chronic inguinal pain, with no increase in the early recurrence rate.
Keywords: inguinal hernia, hernia repair, cyanoacrylate glue, mesh fixation.


Surgical sealants (adhesives) have been
that may be mixed with lipiodol, oily contrast
widely used in surgery to prevent air leaks (from
agent, before injection. Mixing cyanoacrylate
holes in diseased soft tissues such as lung), liquid
glues with lipiodol slows the rate of solidification,
leaks (including hemostasis, as for oozing) and as
it can be used in gastric varices, esophageal
adhesives (to bond two separate tissues, but very
varices, nonvariceal hemostasis as treatment of
rarely). They have many advantages over
bleeding peptic ulcers and fistulae (3).
traditional techniques (i.e., sutures and staples)

such as reducing both operative time and physical
load on patients. Sutures have been most
This was a prospective study which was done in
extensively used for wound closure, though they
Department of Surgery, Sayed Galal Hospital, Al-
have shortcomings such as the highly skilled
Azhar University in the period from December
procedures involved, the long time required for
2016 to June 2017. It included 40 patients, 20
wound closure, and the postoperative removal of
cases was used cyanoacrylate glue mesh fixation
non-bioabsorbable sutures(1).
in open inguinal hernia repair and 20 cases was
The surgical suture, both when realized with
used suture mesh fixation in open inguinal hernia
the traditional threads and with the most modern
repair after approval by the medical director and
mechanical staplers, r pr s nts th "c ssic"
the local ethical committee of the hospital.
method for wound repair. However, all surgeons
Age :the age of patients ranged from 18 to 70
sometimes have to deal with wounds hard to
recover because, due to stretching and ischemic
Inclusion criteria

events of variable extent, complications such as
Adults with primary unilateral groin hernia
hematomas, granulomata, dehiscences and fistulae
suitable for elective open mesh repair were
may occur, impairing the tissue healing (2).
involved in this study and gave informed consent.
Cyanoacrylates are a class of synthetic glues that
Exclusion criteria
rapidly solidify on contact with weak bases, such
Bilateral and/or recurrent hernia, femoral
as water and blood. Cyanoacrylate glue is a liquid
hernia, emergency presentation, chronic steroid
Received: 24 / 8 /2017 DOI : 10.12816/0041702
Accepted:3 /9 /2017

Full Paper (vol.695 paper# 24)

c:\work\Jor\vol695_25 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2512-2515
Toxic Effect of Some Heavy Metals (Cadmium and Lead) on
Thyroid Function
Magdi Mohammed Sherif (1), Yousuf Solyman Mohammed(1), Hendawy Abd El-Moaty Zedan (2),
Mohammed Abd El-hamid Kheder (3), Ahmed Hassan Abd EL-Salam Mohammed(1)
(1) Department of Forensic Medicine and Clinical Toxicology, (2)Department of Internal Medicine,
Al-Azhar University, (3)Department of Clinical Pathology, Al-Azhar University, Egypt.
Corresponding Author: Ahmed Hassan Abd EL-Salam Mohammed, Phone Number: 01004982858,
Email: drahmedaltantewy@gmail.com

Aim of the work:
this study aimed at exploring the effects of lead and cadmium on the thyroid function of
workers of welding operation are exposed to welding fumes containing various toxic metals. Subjects and
the level of blood lead and cadmium was measured by atomic absorption spectro-photometry.
Thyroid stimulating hormone, free thyroxin, free triiodothyronine in serum were estimated by enzyme
Results: the workers with higher level of blood lead level (BLL) (30­60) ug/dl showed high thyroid-
stimulating hormone level (0.50-9)uIU/ml andno changes in free thyroxine and free triiodothyronine. No
changes in free thyroxine, free triiodothyronine and Thyroid-stimulating hormone level in relation to
increase in cadmium level. Conclusion: we concluded that higher level of blood lead may cause
certain damage to thyroid function leading to subclinical hypothyroidism.
We concluded no relation between cadmium level and thyroid hormones. The smokers have
higher cadmium level (0.59-9.6)ug/L.


Lead is one of the most commonly used
heavy metals and it has wide applications
since ancient times. However, it is also one of
and no consensus has been reached regarding
the most detrimental pollutants in the
the effect of lead and cadmium on thyroid
industrial environment in many countries.
physiology. The purpose of this study was to
Occupational and environmental exposures to
investigate the potential effects of lead and
lead continues to be among the most
cadmium on thyroid function by comparing
significant public health problems (1). Lead
thyroid parameters in lead and cadmium
can have adverse effects on many organ
occupational workers to those in healthy
systems, and various effects of lead on
thyroid functions have been reported in

the past 50 years (2).

The present study included one hundred
Cadmium (Cd2+) is a heavy metal that is
adult male between 18-49 years old,eighty of them
produced due to pollution from several
were occupationally exposed to lead and cadmium
sources. Occupational exposure can result
during welding operation in kafr El-Sheikh
governorateand twenty person as control group.
Age of the study subjects was in the range of 18-
49 years old. The study subjects were classified
electroplating. Also, exposure results from
according to the blood level of lead and cadmium
the profound use of consumer products such
into 3 groups:
as nickel/ Cd2+ batteries, pigments, and

plastics. Cadmium toxicity is associated with
Lead groups

Group1: it consisted of 20 normal healthy
leukemia, as well as cancers of the lung,
men with blood lead level range from (0 ­
kidney, urinary bladder, pancreas, breast, and
12.5) ug/dL.
prostate(3).Some studies recorded the effect of
Group2: it composed of 40 subjects with
cadmium on thyroid gland(4).
blood lead level range from (13­30) ug/dL.

Group3: it included 40 subjects with blood

lead level range from (30­60) ug/dL.
Received:25 / 8 /2017 DOI: 10.12816/0041703
Accepted: 4 /9 /2017

Full Paper (vol.695 paper# 25)

c:\work\Jor\vol695_26 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2516-2524

Risk Factors and Management of Venous Thromboembolic Diseases in
Donor of Living Donor Liver Transplant
Mohamed M. Bahaa El Din(1), Kamal M. Kamal(1), Mohamed I. Mohamed(2), Ahmed G. Salem(1)
1- Department of General Surgery, 2- Vascular Surgery Department,
Faculty of Medicine ­ Ain Shams University
Correspondign author: Ahmed G. Salem, Mobile number: 01003349688; Email: a_g147@hotmail.com

liver transplantation surgically replaces a failing or diseased liver with one that is normal and
healthy. At this time, transplantation is the only cure for liver insufficiency or liver failure because no device or
machine reliably performs all of the functions of the liver. Aim of the Work: this study aimed to highlight risk
factors of the venous thromboembolism in donors of living donor liver transplant and its management.
Patients and Methods: this study included 40 patients who underwent hepatectomy for living donor liver
transplant. All patients were evaluated extensively, including history and physical examination and specialty
consultations when indicated. All patients did haematological studies to detect the risk factors of thromboembolic
disease. Results: in patients with manifestations of venous thromboembolism 2 donors have single risk factor for
venous thromboembolism and 4 donors have double risk factors. Conclusion: presence of multiple risk factors for
venous thromboembolism led to increase in its incidence, so during preoperative assessment of the donors, if they
have multiple risk factors for thrombosis some precautions should be taken to avoid venous thrombosis.
Recommendations: preoperative precautions include heamatological consultations for the donors and prophylaxis
dose of anticoagulant. Intra operative precautions included pneumatic calf pressure, elastic stocking. Finally
postoperative precautions should be continued , these donors should take therapeutic doses of anticoagulants and
follow up by lower limb venous duplex.
Keywords: venous thromboembolic disease, living donor liver transplant.


Liver transplantation or hepatic transplantation is
mental, and psychosocial problems that affect the
the replacement of a diseased liver with some or all
quality of life and psychological outcomes of living
of a healthy liver from another person (Allograft).
donors after transplantation. Therefore, it is important
The most commonly used technique was
to precisely evaluate the surgical complications, liver
phototropic transplantation, in which the native liver
dysfunction and quality of life of living donors after
was removed and replaced by the donor organ in the
operation. Initially, the work-up included endoscopic
same anatomic location as the original liver. Liver
retrograde cholangiography; this has since been
transplantation is a viable treatment option for end-
replaced by Cholangio MRI (4).
stage liver disease and acute liver failure (1).
One of the complication for living donor
Liver transplantation is now performed at
liver transplant is venous thromboembolism. the risk
over one hundred centers in the US, as well as
factors for venous thromboembolismmay congenital
numerous centres in Europe and elsewhere. One-
or aquired congenital risk factors included
year patient survival was 80-85% and outcomes
deficiencies or defects in natural anticoagulants,
continue to improve, although liver transplantation
such as antithrombin, protein C and protein S and
remains a formidable procedure with frequent
genetic polymorphisms such as prothrombin
complicatio.For adult-to-adult living donor liver
G20210A and cleavage-resistant forms of factor V.
transplantation, we have preferred the right lobe
Acquired risk factors included antiphospholipid
(Segment V, VI, VII and VIII) (2).
antibodies, detected as lupus anticoagulants and/or
Donor evaluation is one of the most
anticardiolipin antibodies and/or anti-beta-2-
important aspects of adult-to-adult living donor liver
glycoprotein-I antibodies. High levels of clotting
transplantation. The evaluation process should reveal
factors, dysfibrinogenemia, hyperhomocysteinemia,
any conditions that may predispose the healthy donor
prolonged immobilization, increasing age, surgery,
to any intra and post-operative complications
trauma, cancer, obesity, poor nutrition, pregnancy,
including hemorrhage, bile leakage due to bile track
oral contraceptives and hormone replacement
truma or even death. Almost all donors experience
therapy (5).
short-term liver dysfunction and routine blood count
One of the risk for venous thromboembolism
abnormalities (3). Although laboratory test results may was factor v leiden. Factor v leiden is a genetic
guide surgery and identify complications earlier, disorder characterized by a poor anticoagulant response
some complications may lead to physical,
to activated protein c and an increased risk for venous

thromboembolism. Deep venous thrombosis and
Received: 22 / 8 /2017 Accepted: 1 /9 /2017 DOI: 10.12816/0041704

Full Paper (vol.695 paper# 26)

c:\work\Jor\vol695_27 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2525-2532

Color Stability Evaluation of Different Provisional Materials
Immersed in Beverages
Omar Alghamdi*, Ahmad Alebdi , Haneef Sherfudhin
College of Dentistry, King Saud University, Riyadh, Saudi Arabia
*Corresponding author: Omar Alghamdi, email: omar-141018@hotmail.com
The aim of the study is to evaluate the surface topography (Polished vs. Non-polished) and
color stability of different provisional materials: 1) Bis-acryl Composite (System C&B ­
IvoclairVivadent); 2) Bis-acryl Composite (ProTemp IV ­ 3M ESPE); 3) Bis-acryl Composite (Success
CD ­ Promedica); 4) Polymethyl Methacrylate (Trim II ­ Bosworth); and 5) Light-cure Polymethyl
Methacrylate (UniFast TRAD ­ GC Europe) immersed in commonly used beverages.
Material and Methods: The color change value of each specimen after immersion in different beverages
i.e. 1) Coffee with artificial saliva; 2) Tea with artificial saliva; 3) Cola with artificial saliva; 4) Apple juice
with artificial saliva; and 5) Saline with artificial saliva was measure using spectrophotometer with CIE
LAB system before and after immersion at 2 days, 1, 2 weeks, and 1 month.
Results: ProTemp IV was found to be the most color stabile material, followed by System C&B, Success
CD, Trim II, and UniFast TRAD respectively. It was found that coffee had the most staining ability,
followed by tea, cola, and apple juice. Conclusion: Bis-acryl composites showed the highest color stability
values (ProTemp IV, System C&B, and Success CD), followed by Polymethyl Methacrylate (Trim II),
then light cured polymethyl methacrylate (UniFast TRAD). Polishing decreases the color changing values
of the provisional materials. Coffee had the most color changing effect.
Keywords: Provisional Material, Color Stability, Spectophotometer.


A provisional restoration is an integral part of
shade guide but the reliability and repeatability is
successful treatment for fixed prosthesis as they
source of error. Multiple devices can used to
protect the prepared abutment teeth, while the
measure color difference (delta E) through one of
final prosthesis is being fabricated. They provide
two different systems; Munsell color system and
pulpal protection, maintain periodontal health,
occlusal relationship and tooth position of the
abutment tooth and also help in deciding the
Spectrophotometer is one of the devices which
shade, shape and contour of the final restoration,
measure L*, a* and b* by CIE-Lab system which
especially in cases of long term anterior
is recommended from American Dental
temporization (1). Provisional restoration can be
Association (4,5). L* measures the value through
made from different materials. these materials are
black and white scale, a* measures the red or
green chroma and b* measures the yellow or blue
chroma (6). The E can be measure through
methacrylate, urethane methacrylate, bis-acryl,
difference between two objective values:
and microfilled resin (2). The mode of setting for
= (L2 + 2 + 2)0.5
each materials is different, it can be polymerized

chemically, using light cure, or both. (3) There are
Discoloration of provisional materials for
multiple factors that are considered when making
fixed prosthodontics may result in patient
the restoration, when it is done in the anterior
dissatisfaction and additional expenses for the
area, the most important factor is the esthetic (1).
replacement. This is particularly problematic
Three techniques can be used in fabrication of
when provisional restorations are subjected to
provisional restoration. It can be fabricated
colorants during lengthy treatment. Hence, color
directly, indirectly, or indirect-direct technique (3).
stability is a significant criterion in the selection
In esthetically critical areas, the provisional
of a particular provisional material for use in
restoration must not only provide an initial shade
esthetically critical area (1). The aim of the study is
match, but also must maintain its esthetic
to evaluate the surface topography and color
appearance over the period of service. (1)
stability of different provisional materials
Perceptible color change of the provisional
immersed in commonly used beverages.
restorative material may compromise the
The study was approved by the Ethics Board
of King Saud University.
Evaluation of color can be assessed manually by
Received:30 /8 /2017 DOI : 10.12816/0041705
Accepted: 9 /9 /2017

Full Paper (vol.695 paper# 27)

c:\work\Jor\vol695_28 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2533-2541
Relation of Tumor Necrosis Factor-Alpha with Insulin Resistance in
Rheumatoid Arthritis Patients
Dahlia A. M. Hussein, Samah A. El Bakry, Noran O. El-Azizi, Neama L. Mohamed,
Tarek Y. S. El Batrawy
Internal Medicine and Rheumatology and Clinical Pathology Departments,
Faculty of Medicine- Ain Shams University
Corresponding author: Tarek El Batrawy, email:dr_elbatrawy@yahoo.com
: rheumatoid arthritis (RA) is a chronic inflammatory arthropathic with multiorgan
involvement. Increased prevalence of insulin resistance (IR) has been observed in patients with RA. High-
grade systemic inflammation is implicated in the development of IR in these patients. Tumor necrosis factor-
alpha (TNF-) is a potent proinflammatory cytokine that plays a role in initiation and progression of
inflammation and the mechanisms associated with accelerated atherosclerosis in RA. Aim of the work: this
study aimed to investigate the relation between TNF- and IR in RA patients and its relation to disease
activity. Patients and methods: 40 RA patients were included as the patient group and 40 healthy subjects
as the control group. Both groups were subjected to full history, clinical examination including body mass
index (BMI) and lab investigation, fasting blood glucose, fasting insulin and TNF-. Results: the sex
distribution was the same in patients and the control groups, 82.5% females and 17.5% males. The disease
activity (DAS score) was 4.57 ± 1.35. TNF- median was 240 with IQR 190-510. RA patients had
significantly higher serum TNF- than controls (p value = 0.001). BMI and Waist Circumference among RA
patients and controls showed no significant difference. TNF- has significantly positive correlations with
fasting serum insulin, HOMA-IR and disease activity in RA patient group (p value < 0.001).
Conclusion: serum TNF- level was significantly higher in RA patients than the control groups with
positive correlation in fasting serum insulin, HOMA score and disease activity.
Keywords: rheumatoid arthritis (RA), TNF-, HOMA-IR, insulin resistance (IR).

following ACR 1987 revised criteria (5) as the
RA is chronic inflammatory, immune
patient group and 40 healthy subjects as the
mediated disease with prevalence of 0.5-1% in the
control group. Patients were selected from
developed countries. In RA, chronic synovial
outpatient clinic and inpatient Rheumatology
inflammation and hyperplasia drive articular
Department of Ain Shams University Hospitals
destruction and bone erosion, leading to functional
and informed written consent taken from all
decline and disability (1). Disease hallmarks are
subjects approved by ethical committee of Ain
synovial inflammation, progressive bone erosion,
Shams University. Both groups were subjected to
joint destruction and subsequent weakness of
full history taking, clinical examination included
surrounding tissues and muscles. Systemic
body mass index (BMI) and lab investigation;
manifestations also occur. Presentations ranged
fasting blood glucose (FBG), fasting serum insulin
from mild to severe, although the typical patient
and TNF-. RA patients only were subjected to
had a progressive course leading to functional
full rheumatological examination, assessment of
limitations (2).TNF is a pleiotropic cytokine that is
disease activity using Disease Activity Score 28,
transcriptionally activated in response to a variety
erythrocyte sedimentation rate (DAS28-ESR) (6)
of stimuli during inflammation, infection and
and other lab investigations (Complete blood
stress. Excessive TNF activity contributes to the
count (CBC), ESR, serum C-reactive protein
complex pathogenesis of RA, associated with pro-
(CRP), rheumatoid factor (RF), aspartate
inflammatory cascade that includes production of
transaminase (AST), alanine transaminase (ALT)
IL-1 and IL-6 and drives tissue destruction (3).
and serum creatinine). CBC performed on 5 parts
Increased prevalence of IR has been observed in
differential automated cell counter; Sysmex
Hematology Autoanalyzer (©2012 Sysmex
inflammation was implicated in the development of
America, Inc.), CRP level using dimension clinical
IR in these patients(4). This study aimed to
investigate the relation between TNF- and IR in
Diagnostic Products GmbH, Malburg, Germany)
RA patients and its relation to disease activity.
based on particle enhanced turbidimetric
immunoassay technique (Cut off value 3.0 mg/L),
This study was a cross sectional patient
ESR by using Westergren's method. AST, ALT,
control study; it involved 40 RA patients
FBG and S-creatinine were done using AU 680
chemistry autoanalyzer, (Beckman Instruments.,
Received: 20 /8 /2017 DOI : 10.12816/0041706
Accepted: 29 /8 /2017

Full Paper (vol.695 paper# 28)

c:\work\Jor\vol695_29 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2542-2545
Hypertonic Saline Infusion Minimizes Bacterial Translocation and
Degenerative Changes in Liver of Shocked Rats
1Nouf Salem Mashyut ALjuaid , 2 Abeer Nasser M ALghalbi
1Faculty of Science , 2Faculty of Medicine , Taif University ,Kingdom of Saudi Arabia (KSA)
Corresponding author: Nouf Salem Mashyut ALjuaid,Email: noof-salim@hotmail.com,mobile:00966554800982

Background: The hypertonic saline (HTS) solutions have recently gained widespread acceptance in
control of shock.
Aim of the work: The aim of this work is to study the use of hypertonic saline with the resuscitation fluids
in rats with induced hemorrhagic shock to evaluate the impact of this solution on the extent of early
bacterial translocation, blood pressure, and histopathological liver changes.
Materials and methods: sixty phenobarbital anesthetized rats were involved in this study where they were
allowed to bleed. Arterial pressure was maintained below 50 mm Hg for 30 minutes. They were
randomized into 2 groups, each of 30 rats. Resuscitation in group I was done by using Lactated Ringer's
(LR) solution (60 ml/Kg) and in group II HTS 7.5% in a dose of 4 ml /kg body weight was added to
Lactated Ringer's (LR) solution (60 ml/Kg). Regular monitoring of blood pressure was done and blood
samples were withdrawn 1, 30, and 90 minutes and 6 hours after commencement of the resuscitation and
sent for blood culture for both aerobic and anaerobic growths. After 24 hours the liver was resected and
sent for histological examination. Results: The mean arterial blood pressure in group I before resuscitation
was found to be about 48±11 mm Hg and it was raised to a mean of 90±8 mm Hg after 2 hours of
resuscitation with LR alone. In group II, the mean arterial blood pressure was found to be 49±5 mm Hg
and it was efficiently controlled by HTS with LR and 2 hours after commencement of resuscitation it was
elevated to 114±10 mm Hg. The blood cultures were positive in 3.3% of the rats of group II and in 40% of
rats of group I. Escherichia coli were the most commonly isolated organism. Histopathological findings
showed inflammatory process and early severe hepatocyte degeneration of the liver of group I rats and
these changes were absent or minimal in group II.
hypertonic saline was found to be effective for decreasing the rate of early bacterial
translocation to blood and also for more efficient restoring of the mean arterial pressure in rats with
induced hemorrhagic shock; in addition, HTS infusion minimizes the inflammatory and degenerative
process in liver.
Keywords: Hypertonic saline, hepatocytes, bacterial translocation, rats.

The gastrointestinal tract has been considered
of nitric oxide and super oxide with intestinal
to be a potential source of sepsis from the
bacterial translocation that may occur after shock,
replacement alone seems to be not the only factor
burns, and other major injuries (1). Bacterial
to prevent this process (6-12). Uncontrolled
translocation (BT) occurs when the bacteria
hemorrhagic shock is associated with host
and/or their cell wall components pass across the
responses related to inflammation and apoptotic
intestinal wall to the mesenteric lymph nodes and
process and liver clearly plays an important role
in turn to peripheral blood (2). Factors which have
in metabolic processes following shock(13).
been shown to predispose to BT include reduced
Investigators have shown that crystalloids
splanchnic blood flow, intestinal mucosal
represent an effective and inexpensive means to
damage, immune deficiency, parental nutrition,
restore intravascular volume and offer a survival
antibiotic therapy, and bacterial overgrowth (3).
advantage over colloids in the resuscitation of
The route of entry of these bacterial products and
traumatic hemorrhagic shock (7, 9). More recently,
other non- bacterial soluble factors into the
small volume resuscitation with 4 mL of 7.5% Na
systemic circulation is the mesenteric lymphatic
Cl per kilogram of body weight of hypertonic
and not the portal vein (4). Three basic
saline (HTS) has been proposed to be very
mechanisms have been proposed to promote BT,
effective in the treatment of hemorrhagic shock (5-
which, include; intestinal mucosal injury by
9). The aim of this work is to study the use of
hypo-perfusion, decreased intracellular killing of
hypertonic saline (HTS) with the resuscitation
bacteria and decrease of intracellular generation
fluids in rats with induced hemorrhagic shock to
Received:6 / 9 /2017 DOI : 10.12816/0041707
Accepted:15 /9 /2017

Full Paper (vol.695 paper# 29)

c:\work\Jor\vol695_30 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (5), Page 2546-2551

The Effect of Mineral Trioxide Aggregate and Other Endodontic
Materials in Contact with Osteoblast-Like Cell
Abrar Aqeel Aljefri(1),Wejdan Ibrahim Y Alzahrani(1), Rahaf Abdullah Albakri(1),
Rahaf Essam O Yousef(1), RAnad Abdulkareem Alghamdi(1), Ahmed Zaki A Nawawi(2),
Raghdan Adel A Hafiz(2), Ibrahem Turki Almaktoom(3)
1Ibnsina National college,2Modern Sciences and Arts University (MSA),3King Abdulaziz university
Corresponding author: Abrar Aqeel Aljefri,email:abrar.aljefri@gmail.com

The objective of the study was to compare the effect of mineral trioxide aggregate and other
endodontic materials in contact with osteoblast-like cell over a time period of 20 days.
Materials and methods: Human PDL cells and osteoblasts were gathered, cultured and permitted to
standardized protocols. The cell populations were characterized with the conforming surface markers
following standardized processes. The specimens were produced with special concern to constant
dimensions and volume in the different groups. Cell attachment and proliferation were assessed
morphologically after Richardson staining and cell count was performed after 1d, 7d, 14d and 21d. All
trials were done in triplets. The outcomes were statistically analyzed using the ANOVA- and Tukey-test
Results: Morphological examination showed good proliferation and cell attachment in both cements. A
remarkable outcome was the prepared increasing and parallel alignment of the PDL cells in connection
with MTA and particularly Biodentine. From 7d forward Biodentine indicated the highest quantity of
PDL cells (p<0.05). Biodentine and MTA caused in a significantly greater cell density in osteoblast and
PDL cell culture. The other groups presented a lower PDL cell density from 7d and a lower osteoblast cell
density from 14d when matched to control and cement samples (p<0.05).
Conclusions: MTA and Biodentine showed a good biocompatibility in contact with the human
osteoblasts and cells of the periodontal ligament. Regarding cell survival and proliferation particularly of
PDL cells Biodentine showed good results and can be considered as a well-tolerated bioactive endodontic
Keywords: Composite resin, Mineral Trioxide Aggregate, Biodentine, Periodontal ligament cells,

perforation of the root canal system might
It is assessed that over 24 million endodontic
arise or a root-end surgery might be required.
procedures are implemented on an annual basis,
Both procedures cause in communication of the
with up to 5.5% of those procedures including
pulp chamber or the root canal system with the
endodontic apical surgery, perforation repair, and
periodontium. For the best prognosis, these
apexification treatment [1]. Endodontic surgery is
contact areas should be restored and sealed.
performed to resolve inflammatory processes that
Therefore, purpose of such filling is to obturate
cannot be effectively treated by conventional
the root-end or a perforation cavity and to avoid
methods, which might be as a result of complex
micro leakage. A suitable filling material should
canal and/or apical anatomy and external
be biocompatible; ensure a long-term three-
inflammatory processes [2]. Surgical procedures
dimensional sealing of all margins, preferably by
can similarly be specified for the resolution of
a molecular bonding to the dentinal walls; be
procedural misadventures, to include root
bacteriostatic, or not encourage bacterial growth;
perforation that may occur either through canal
stable; insoluble; non-absorbable; not moisture-
instrumentation or post-space preparation [2,3].
sensitive; easy to prepare and place; radiopaque
Surgical treatment regularly includes the
and bioactive and induce regeneration of the
placement of a material designed to seal the root
periodontal ligament and bone [4-7].
canal contents from the periradicular tissues and
However, for an effective endodontic treatment
repair root defects [2]. Comprehensibly, this
a high quality apical root canal filling or
material should demonstrate the ability to form a
perforation repair is necessary. Earlier, several
seal with dental tissues while similarly exhibiting
diverse materials similar to amalgam, glass
biocompatible behavior with the periodontal
ionomer cement, reinforced zinc oxide eugenol
tissues [3]. Throughout endodontic treatment a
cements (IRM, Super-EBA), and composite resin
Received:5 / 9 /2017 DOI : 10.12816/0041708
Accepted: 14 / 9/2017

Full Paper (vol.695 paper# 30)