c:\work\Jor\vol696_1 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2552-2556

Knowledge, Attitude and Practices towards Otitis Media in Saudi
Arabia Community
Linah Khalid Qasim1, Yara Saleh Bayunus 1,Fatimah Ali Alzubaidi 1,
Sabra Hasan ALyami 1, Naif Khalil Ibrahim AlOsaimi 2
1- Faculty of Medicine, Umm Al-Qura University, 2- King Saud Bin Abdulaziz University for Health Sciences.

otitis media (OM) and its complications resulted in high prevalence of hearing loss and
increasing the rates of health care visits with special regard to the developing countries.
Aim of the work: this study aimed to evaluate the knowledge, attitude and practice (KAP) toward otitis
media among adult teachers in Kingdom of Saudi Arabia (KSA).
Patients and Methods: this is a cross sectional questionnaire based study and it was conducted among a
random sample of teachers in KSA from March to June 2017. All the teachers were inter viewed in their
schools during the break period and answered the questionnaire that was comprised of four objects
including the socio-demographics of subjects, knowledge, attitude and practice pattern of participants
toward otitis media.
Results: the overall knowledge about the risk factors, disease prevention and serous type was improper.
Also, a poor level of attitude and practice pattern was found among most of the subjects. The overall KAP
of the teachers was poor among 58.8%, while 41.2% showed adequate KAP about Otitis media. The good
KAP showed a significant association with higher economic level, while other variables showed no
association with KAP including age, gender and cigarette smoking.
Conclusion: the suboptimal knowledge about otitis media would result in poor attitude and practice pattern
which increased the prevalence and complications of otitis media. The economic level was associated with
OM, thus it was considered a vital factor in prevention of otitis media.
Keywords: knowledge, attitude, practice, otitis media (OM), KSA.


The ear is responsible for hearing and

equilibrium maintenance thus any disorders in the
communicable diseases in the region (9). Also,
structure as well as function may result in
aging process, hypertrophy in adults, head and
progressive hearing impairment and decreasing
neck tumors could result in OM among adults (10,
the quality of life (1, 2).
11).Although the prevalence of OM among adults
Otitis media (OM) is defined as a disease
is less prevalent than children and most of OM
of the middle ear associated with a group of
studies concerned with OM in children. This study
multifaceted inflammatory and communicable
aimed to detect the KAP toward otitis media
conditions. The OM and its complications resulted
among Saudi adult population.
in high prevalence of hearing loss and increasing

the rates of health care visits with special regard to
the developing countries (3, 4).
An ethical approval was obtained from the
OM has different types including acute
Faculty of Medicine and primary schools included
that is a self-limited disease with low mortality
in the present study, then this cross sectional
rates , but associated with high morbidity
questionnaire based study was conducted among a
especially among children and the chronic type is
random sample of teachers in KSA from March to
the most common cause for hearing loss, delay in
June 2017.
speech and academic performance(5-7).
Thirty primary schools were divided as 15
The prevalence of OM was reported to be
primary schools for girls and 15 primary schools
2-4% in Africa, Southeast of Asia and the
for boys distributed allover KSA that were
countries located in the western pacific region,
randomly chosen by multi-stratified randomized
while it was less than 2% in Europe and Northern
America (8).
Then, a representative sample of 831
The risk factors for OM were
female and male teachers was interviewed during
malnutrition, family history, smoking, low
the study period.
economic studies. High prevalence of lung and
Received:4 / 9 /2017 DOI : 10.12816/0042229
Accepted: 13 /9 /2017

Full Paper (vol.696 paper# 1)

c:\work\Jor\vol696_2 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2557-2561

Assessment of Knowledge toward Complications of Diabetic Septic
Foot among Diabetics Patients in Saudi Arabia
Rashed Fahad Alhabshan 1, Meshari Sulaiman Bin Huwaymil1,Omar Ahmed Alsaqabi1,
Abdulrahman Nasser Alzaid1, Abdulhakeem Ibraheem Almasoud2
1-Mohammad Bin Saud Islamic University,2-Jeddah University

diabetic foot ulcer is a major health problem around the world with a high morbidity and
mortality rates. The good knowledge and practice pattern could decrease the diabetic foot ulcer
Objectives: this study aimed to evaluate knowledge of the diabetic patients regarding the complications of
diabetic foot ulcer in Saudi Arabia (KSA).
Patients and Methods: this is a cross sectional community based study conducted from March 2017 to
July 2017 among 920 diabetic patients. The subjects were interviewed in the shopping malls, pharmacies
and coffee shops and asked to fill out a pre-tested questionnaire about the knowledge of complications.
Results: the duration of diabetes was more than 10 years among 65% of them. About 40.9% of subjects
were using oral hypoglycemic agents, 57.8% were using insulin for management of diabetes. The most
common diabetic complication was retinopathy, while the most common foot ulcer complication was foot
numbness and stiffness. The level of knowledge was good among most of subjects (77%), while 23% had
insufficient knowledge regarding the diabetic foot ulcer. The good awareness was significantly associated
with higher educational levels.
Conclusion: the level of awareness about complications of diabetic foot was sufficient among most of
Saudi subjects. But, there was an urgent need for raising the awareness and identifying the risk factors,
educating the patients through increasing the patients and doctors relationship. The knowledge alone was
not sufficient for assessing the practice pattern thus major studies must be conducted to assess the
knowledge, attitude and practice pattern among Saudi subjects.
Keywords: knowledge, diabetes mellitus, diabetic foot care.


Diabetes mellitus (DM) is a main disease that
patients with poor awareness and practice pattern
affects most of populations around the world and
(12). The education of diabetic patients could
its prevalence was supposed to be increased by
prevent foot complications and facilitate healing
year 2030 to 366 million by 2030 (1). The situation
process (13, 14).This study aimed to assess the
in KSA is similar to other parts of the world as
Knowledge of Saudi diabetic patients regarding
about 20.5% of Saudi adult subjects suffer from
the complications of diabetic foot ulcer in Saudi
diabetes as estimated by the International Diabetes
Arabia, 2017.
Federation (IDF) (2). Also, the present study

showed that more than 25% of adult populations
were suffering from diabetes and this rate was
Study design
supposed to be doubled (3). Diabetic foot also
This is a cross-sectional study conducted from
represented a major health problem of high
March 2017-July 2017 among 920 diabetic
mortality and morbidity rates (4). Also, diabetic
patients. The subjects were interviewed in the
foot prevalence was 8-17% among diabetic
shopping malls, pharmacies and coffee shops and
patients with higher rates of amputations caused
asked to fill out a pre-tested questionnaire about
by diabetes than other causes including foot ulcers
the knowledge of diabetic foot complications.
and non-traumatic causes (5, 6). The foot
Study population and sample size:
complications that related to diabetes could be
After considering the size of adult population in
preventable through appropriate control of blood
KSA, a random sample of 920 adult Saudi subjects
sugar with proper medications and enhancing the
were enrolled in the study using the web calculator
good lifestyle habits thus decreasing the risks of
(15)with a margin of error of 5%, and confidence
microvascular complications (7-9). Also, routine
interval of 95%.
foot examination and using good footwear would
Study tools

prevent diabetic foot ulcer and prevent the
The questionnaire was collected from previous
expected complications (10, 11). Major foot
studies and revised by 3 experts in chronic disease
complications were present among diabetic
Received:3 / 9 /2017 DOI : 10.12816/0042230
Accepted: 12 /9 /2017

Full Paper (vol.696 paper# 2)

Toxicity of Sodium Fluoride in Liver of Albino Rat and the Beneficial Effect of Calcium in Reversing Fluoride Toxicity The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2562-2582
Toxicity of Sodium Fluoride in Liver of Albino Rat and the Beneficial
Effect of Calcium in Reversing Fluoride Toxicity: Histological,
Ultrastructural and Immunohistochemical Studies
Amal Seliman Sewelam
Department of Anatomy and Embryology, Faculty of Medicine, Zagazig University
E-mail: ali121212121213@yahoo.com, Phone: 00201155789552

fluoride (F) is an essential element for human being from health point of view. Its intake in
high doses caused toxic effects on various organs. The liver is a target organ for F toxicity. Using natural
supplements is a modern approach in treatment.
Aim of the Study:
this study aimed to investigate the effect of sodium fluoride (NaF) on liver tissue in adult
male albino rats and also to determine whether calcium(Ca) co-treatment has an ameliorative role in reversing
F toxicity or not.
Material and Methods: eighteen adult albino male rats were categorized into three groups (each of six
animals): Group I (Control): were given distilled water and fed balanced diet, Group II (NaF treated): were
given NaF at a dose of 30 mg /kg/day and Group III (NaF and Ca treated): were received NaF (similar previous
dose) and 20 mg /kg/day calcium chloride (Cacl). After six weeks, under anesthesia, the livers were rapidly
delivered, dissected out carefully, prepared and examined by light and electron microscopy, biochemical,
immunohistochemical, morphometeric studies.
the results showed that F induced severe histopathological changes in the liver tissue, significantly
increased apoptosis and hepatic marker enzymes as compared to the control group. The histopathological
changes induced by NaF included hepatocytic vacuolization, pyknosis and necrosis, vascular dilatation and
congestion, Kupffer cell proliferation and periportal inflammatory cell infiltration. The ultra structural changes
of hepatocytes included nuclear disorganization (Being heterochromatic, pyknotic nuclei or disintegrated
chromatin), vague mitochondria ridges , fragmentation of the rough endoplasmic reticulum, dispersed
ribosomes, disruption of hepatocytes microvilli, ill defined space of Disse , Kupffer cell activation and bile
canalicular dilatation. Co-treatment with Ca failed to improve liver tissue damages induced by NaF treatment.
Conclusion: results of this study suggested that NaF treatment caused severe damages to liver tissue. Ca co-
administration failed to reset NaF induced hepatotoxicity.
Keywords: fluoride, liver, calcium, apoptosis, Caspase-3.

histological and biochemical parameters are very
Fluoride (F) is very widely distributed in the
important to detect toxicity of chemicals.
natural environment and is extensively used among
Subsequently, the liver is specifically liable to F
industry, agriculture as well as medicine (1). It is an
toxicity (14). Serum ALT, AST, ALK are known to be
essential trace element for human body and is a
important markers to investigate the health of an
normal constituent of soft tissues, body fluids, teeth
animal species. ALT and AST are present in the
and bones (2). F sources are either natural or artificial
mitochondria and cytoplasm respectively mainly in
and include fluoridated foodstuffs, insecticides,
the liver. They are also located in striated and cardiac
ground water, toothpaste, drugs, vapors released from
muscles and have a vital role in protein metabolism.
industries using fluoride containing compounds and
High serum levels of these enzymes have been used
dentifrices (3). Moderate levels of F intake promote
as an indicator of tissue damage (15). Previous studies
bone development and are useful for caries
have suggested that excessive F intake can induce
prevention. However ingestion or inhalation of high
oxidative stress and subsequently apoptosis (2,16,10) .
F doses causes adverse effects on human and animal
Caspases are present in cells as inactive zymogens
health (4,5). F toxicity targets not only the bone and
and undergo a series of catalytic activation at the
teeth (6), but also soft tissues including kidney (7),
beginning of apoptosis (17). Therefore, the activity of-
brain (8) and blood (9). It has a toxicity on cells, genes
caspase-3 could be checked to detect apoptosis.
and immune system and can induce lesions in the
Marked improvement of F cytotoxicity when co-
peripheral blood, kidney, spleen and intestine (10) and
administered with a combination of carnosin,
in the mouse spleen and kidney (11,12,13). Being very
vitamin E and methionine has been shown(18) and
active organ, the liver is involved in metabolism and
when given in combination with each of quercetin,
elimination of toxic substances from the body. It's
black tea extract , gallic acids and ferulic (19,20,14,21 )
Received: 1 /9 /2017 DOI : 10.12816/0042231
Accepted:11 /9 /2017

Full Paper (vol.696 paper# 3)

c:\work\Jor\vol696_4 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2583-2588

Compliance with Antihypertensive Medication in Family Practice
Yazeed Ahmed Asiri1, Saeed Abdulrahim Alamoodi2, Rayan Abdulbasit Marzuqi2,
Albatool Adel Alwesaibi3, Mohammed Sheker Al-Kalif3, Mohammed Salman Almutairi4,
Abdullah Abdulqader Azouz2, Mohammad Abdulhakim Almatar5, Munirah Maneef Alshammari6,
Sukaynah Adnan S Alsaigh3, Dareen Hussain Alhendi7
1 Rijal Almaa PHC, 2 King Abdulaziz University, 3 Imam Abdulrahman Bin Faisal University,
4 Imam Mohammad Ibn Saud University, 5 King Saud Medical City,
6 King Fahad Medical Military Hospital, 7 Taibah University
Corresponding Author: Yazeed Ahmed Asiri ­ yazasiri@gmail.com - 0542042444

Noncompliance to treatment in chronic diseases such as hypertension is a very common
phenomenon, owing to its chronic nature, lack of obvious symptoms, affordability, doctor-patient relationship,
unawareness of complication, and forgetfulness. This noncompliance negatively affects disease course and
increases risk of morbidity and mortality. Methodology: We conducted this review using a comprehensive
search of MEDLINE, PubMed, and EMBASE, January 1999, through March 2017. The following search terms
were used: drug compliance, hypertension medication compliance, antihypertensive drug compliance, factors
affecting compliance, medication compliance. Aim: Our aim in carrying out this study was to understand the
status of medication compliance among hypertensive patients, studying the factors that affect it, and exploring
ways to improve compliance.Conclusion: We have noticed in the review that there is direct correlation between
noncompliance and lack of proper doctor-patient relationship, patient education, and patients belief about
disease and treatment. Improvement on such factor can benefit the patients in great amount regarding blood
pressure control and in preventing morbidity and mortality. More studies to analyze the lack of compliance
must take place in Saudi Arabia, and stricter guidelines of doctor-patient- relationship must be reinforced.
Keywords: hypertension medication compliance, antihypertensive drug compliance, factors affecting
compliance, medication compliance


Hypertension or high blood pressure is described as
having insistent, raised systolic blood pressure of
noninterventionism of the patient in scheming his or
140 mmHg or more or diastolic blood pressure of 90
her management plan, deficiency of patient
mmHg or more. Uncured or sub-optimally treated
education, adverse effects of drugs, length of
hypertension might lead to increased danger of
therapy, amount of behavioral change essential, and
morbidity and mortality because of cardiovascular,
unintended noncompliance most importantly due to
renal diseases, or cerebrovascular. Hypertension
forgetfulness. Other proposed factors inducing
disturbs close to a billion individuals globally [1].
patient compliance are beliefs about the cause of an
Noncompliance with antihypertensive prescriptions
illness and control over an illness [3]. Studies have
causes many people to undergo from hypertension-
shown that an individuals interpretation of the cause
related morbidity and death. These along with other
of an illness or symptom and perceived control
costs of noncompliance can lead to direct and
regarding chronic conditions may affect their
indirect financial burden to patients. Direct costs can
decision to seek medical care, take preventive
describe cost of extra prescriptions, preventable
actions toward the illness, and adhere with medical
emergency room visits, hospitalizations, and added
advice. This suggests that a patients belief of the
doctor visits. An indirect cost may include lost
cause of an illness or control over the illness may
productivity. Therefore, to avoid these hostile health
influence adaptation, specifically compliance to
and economic results, steps need to be taken to
prescribed medication regimens. Thus, it is vital to
reduce the frequency of noncompliance [2].
study the relationship among illness attribution and
Causes for noncompliance in hypertensive
treatment compliance. In this study, we will focus on
patients are numerous and multifaceted. Factors
causes of non-compliance and find out how to make
linked with noncompliance are the price of
it better [4].
Received: 7 / 9 /2017 DOI : 10.12816/0042232
Accepted: 16 /9 /2017

Full Paper (vol.696 paper# 4)

c:\work\Jor\vol696_5 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2589-2595

Pathogenesis, Treatment and Impact on Quality of Life in Psoriasis
Lujain Hamza Arafsha1, Alhassan Abdulhameed Alyami2, Dina Anwar Aljaber3,
Ruba Abdulqader Alrehaili4, Reem Farhan Alanazi3, Hawraa Ali Alaliwi5,
Jenan Abdulfatah Alfehaid6, Ibtihal Abdulrahman Malawi7, Abdulaziz Khalid Maddah8, Ashwaq Y.
Asiri9, Bayan sultan Al jobran9, Ibrahim Mahmoud Alhaj10
1 Umm Alqura University, 2 Royal College Of Surgeons In Ireland, 3 Northern Border University,
4 Taiba University, 5 King Saud University-Riyadh, 6 Imam Abdulrahman Bin Faisal University,
7 Umm Al-Qura University, 8 Ibn Sina National College, 9 King Khalid University , 10 Batterjee Medical College
Corresponding Author: Lujain Hamza Arafsha - Lujain.arafsha@hotmail.com - 0566067900

psoriasis is a papulo-squamous disease with different morphology, severity, distribution and
course of disease. The aim of the treatment was to reduce disease activity to a level that permits an acceptable
quality of life with negligible toxicity from the treatment itself. About 25% of patients experience major
psychological distress due to the disease. Its long duration along with comorbidities have a negative impact on
quality of life. Aim of the work: we tried to understand the types, pathogenesis and management of psoriasis,
and also try to understand its effect on the quality of life. Methodology: we conducted this review using a
comprehensive search of MEDLINE, PubMed and EMBASE from January 1994 to March 2017. The following
search terms were used: psoriasis, psoriasis classification, psoriasis management, quality of life in psoriasis
patients. Aim of the work: we tried to understand the types, pathogenesis, and management of psoriasis, and
also try to understand its effect on the quality of life. Conclusion: due to the chronic course, and its noticeable
visibility on skin, many patients suffer from major social and psychological ill effects. In majority of the time the
health care providers fail to recognize or treat such comorbidities. Healthcare providers must be educated to offer
ways to tackle such issues in the management plan for better results
Keywords: psoriasis, pathogenesis of psoriasis, management of psoriasis, impact on quality of life in psoriatic

annular pattern and may look a lot like a map,
Psoriasis is a papulo-squamous disease with
therefore the term geographic tongue [2].
different morphology, severity, distribution, and

course of disease. Differential diagnosis other
Although psoriasis normally does not disturb
papulo-squamous diseases that must be considered
survival, it undoubtedly has various major negative
include tinea infections, lichen planus and pityriasis
effects on patients, evident by a substantial
rosea. The lesions of psoriasis are different from
disadvantage to quality of life. Due to the chronic
these other types and are characteristically very well
and incurable nature of psoriasis, its accompanying
circumscribed, round, red papules, or plaques with a
morbidity is weighty. About one in four patients
grey or dry silvery-white scale. At the same time, the
experience and note chief psychological distress and
lesions are classically scattered symmetrically on the
the degree to which they feel socially stigmatized
scalp, knees, elbows, body folds and lumbosacral
and left out is massive. Unfortunately, doctors,
area [1]. Psoriasis may also grow at the location of
including dermatologists, and other medical staff
precious trauma or injury. This phenomenon is
usually fail to analyze the magnitude of this
known as Koebner's phenomenon. Progressive or
disability [3]. Therefore, we attempted to understand
uncontrolled psoriasis can end up as a generalized
the types, pathogenesis, and management of
exfoliative erythroderma. Nail may be involved,
psoriasis, and also try to understand its effect on the
predominantly if case of psoriatic arthritis.
quality of life.
Sporadically psoriasis may cause lesion in the oral

mucosa or the tongue. The dorsal surface of the
tongue may have gyrate red patches, sharply
Data Sources and Search terms
circumscribed with a white yellow border. The
We conducted this review using a comprehensive
patches can grow and spread, can have a discrete
search of MEDLINE, PubMed and EMBASE, from
January 1992 to March 2017. The following search
Received:21 /8 /2017 DOI : 10.12816/0042233
Accepted: 30 /8 /2017

Full Paper (vol.696 paper# 5)

c:\work\Jor\vol696_6 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2596-2600
Comparison between Placental Site Injection of Vasopressin and Bilateral
Internal Iliac Artery Ligation to Reduce Blood Loss during Cesarean
Section for Placenta Praevia, A Randomized Controlled Trial
Omar, KA and Galal, M
Obstetrics and Gynecology Department, AL-Azhar Faculty of Medicine (Damietta)
Corresponding author: Mohammad Galal, email:mohammed.30028@yahoo.com

placenta praevia is an obstetric complication in which the placenta is inserted partially or
completely in the lower uterine segment, A significant proportion of these cases is associated with life
threatening hemorrhage during delivery, often by caesarean section in the vast majority of cases, many
procedures introduced to overcome this problems, none of them is completely successful.
Aim of the work: this study aimed to compare between local vasopressin injection in the placental bed and
bilateral internal iliac artery ligation on the blood loss during caesarean section for placenta praevia.
Patients and Methods:
this a randomized-controlled prospective trial included 60 pregnant women with a
diagnosis of placenta praevia, they were categorized into 3 equal groups according to methods to control
blood loss during cesarean section for placenta praevia. Group 1 included 20 pregnant women who
underwent vasopressin injection at placental site. Group 2 included 20 pregnant women who underwent
bilateral internal iliac artery ligation. Group 3 included 20 pregnant women who underwent caesarean
section without internal iliac artery ligation or local injection of vasopressin (The control group), comparison
between groups were done and statistically analyzed.
Results: there were statistical significant differences between the intervention and the control groups as
regard estimated blood loss, P value was <0.001; group 3(Control) had more amounts of blood loss, there
were no statistical significant differences between group 1 and group 2 as regard estimated blood loss, P
value was > 0.05 . Comparison between group1 and group 2 showed that internal iliac artery ligation was
significantly associated with prolonged operative time than vasopressin injection(P value was <0.001).
Conclusion and Recommendation: local injection of vasopressin at placental site seemed to be a promising
modality for reducing blood loss during cesarean delivery for placenta praevia and was associated with
similar reduction of blood loss and less operative time when compared with internal iliac artery ligation, may
be done first before trying internal iliac artery ligation and needs no experience.
Keywords: Vasopressin, Bilateral Internal Iliac Artery Ligation, CesareanSection, Placenta Praevia.


Placenta praevia (pp) is a potential life
boundary established by the Nitabuch fibrinoid
threatening pregnancy complication that may cause
layer. If invasion extends into the myometrium, the
various clinical situations, serious adverse
term placenta increta is used; placental invasion
beyond the uterine serosa (at times involving the
haemorrhage, massive transfusions and need for
bladder or other pelvic organs and vessels) is
extension of surgical procedure leading to injury of
termed placenta percreta (5). Cesarean delivery is
the adjacent organs like bladder or bowel ,mainly
essential in nearly all cases of placenta previa and
due to the abnormal invasion of the placenta(1).
the amount of blood loss during surgery is
Placenta praevia is an obstetric complication in
significantly higher than in cases of normal
which the placenta is inserted partially or
placental presentation, also the rate of blood
completely in the lower uterine segment (2). Major
transfusion was also significantly increased (6).
placenta praevia is recognized by the presence of
Different conventional approaches had been used
an abnormal placenta overlying the internal
to stop hemorrhage, including continuous uterine
cervical os and it is considered as one of the most
massage, uterine packing, and uterotonic agents,
anxious adverse maternal and fetal-neonatal
including oxytocin, prostaglandin and ergometrine.
complications in obstetrics(3).The incidence of
However, in patients with placenta praevia ,
placenta praevia has been recently increased over
hemorrhage from the placental implantation site
the past few decades, correlating with the elevated
may continue after placental delivery because the
caesarean section rate(4).One of the most serious
lower uterine segment has poorer contraction than
complications of placenta previa is the
the uterine body(6).There were multiple modalities
development of placenta accreta. This condition
that have been evolved to minimize blood loss
involves trophoblastic invasion beyond the normal
during CS, which had directed towards reducing
Received: 1 / 9 /2017 DOI : 10.12816/0042234
Accepted: 11 / 9/2017

Full Paper (vol.696 paper# 6)

c:\work\Jor\vol696_7 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2601-2606

A Single Large Dose of Tranexamic Acid before Vaginal
Delivery: Is It Beneficial?
Ahmed Abd Elhamid, Ashraf Hamdy, Sileem Ahmed Sileem
Department of Obstetrics and Gynaecology, Faculty of Medicine,Al-Azhar University, Asuit , Egypt
*Corresponding author: Ahmed Abd Elhamid, E-mail: drahmedhamid1977@yahoo.com

many factors are attributed in the management of postpartum hemorrhage after vaginal delivery
to assess the efficacy and safety of a single large dose of intravenous tranexamic acid in reducing
postpartum blood loss after vaginal delivery.
Subjects and Methods: this is a multicentric prospective randomized double blind placebo controlled trial.
240 pregnant women were randomized to receive either 60 mg/kg of TA (n=120) or placebo (n=120)
intravenously in the second stage of labour. Postpartum blood loss was collected and measured accurately from
placental delivery to 2 hours postpartum and adverse effects of were observed.
Results: the mean estimated postpartum blood loss was significantly lower in women treated with tranexamic
acid compared to women in the placebo group (241.5 ± 82.7 versus 322.8 ± 127.4, respectively; p < 0.001),
and the proportion of women in the tranexamic acid group who had an estimated blood loss 500 mL was
significantly lower than in the placebo group ( 5 [4.2%] versus 18 [15%], relative risk [RR]=0.30; 95%
confidence interval [CI] 0.11 to 0.78; P<0.05). Maternal and neonatal outcomes did not differ significantly
between both groups.
A single large dose of tranexamic acid administrated intravenously before vaginal delivery
significantly reduces the amount of postpartum blood loss and contributes to prevention of PPH. Adverse
effects were only mild and transient. Thus, tranexamic acid can be used safely and effectively to reduce
bleeding after vaginal delivery.
Keywords: tranexamic acid, postpartum hemorrhage, vaginal delivery.

PPH is commonly defined as blood loss of 500
Postpartum haemorrhage (PPH) stills the most
ml after vaginal delivery of a baby, or 1000 ml
common cause of maternal mortality worldwide,
after caesarean section. However, these thresholds
accounting for about 300,000 deaths every year, and
do not take into account pre-existing health status,
most of deaths occur in the immediate postpartum
and blood loss of as little as 200 mL can be life-
period. PPH causes morbidity related to anaemia,
threatening for a woman with severe anaemia or
blood transfusion and haemorrhage related
cardiac disease and the problem is more hazardous
ischaemic complications. Haemostatic abnormalities
in the developing countries [6]. Therefore, measures
have long been considered consequences of
aiming to reduce postpartum blood loss have
uncontrolled bleeding (1, 2) .
positive effects in reducing bleeding related maternal
PPH also contributes to hospital morbidity
morbidity and contributing the global commitment
because patients may require a blood transfusion,
to the Millennium Development Goal (MDG) of
which can transmit blood borne viral infections.
reducing maternal deaths by three-quarters by the
Approximately 1% of women with spontaneous
year 2015, a commitment that requires a reduction of
vaginal deliveries receive a blood transfusion, but
the maternal mortality ratio by 5.5% each year.
the rate increases to about 5% for women with
Several measures for minimizing bleeding as well as
instrumental deliveries or caesarean sections [3].
preventing PPH are available, but further advances
Direct causes of PPH are mainly uterine atony,
in this field are important, especially the
trauma to the birth canal, coagulopathy and retained
identification of safe, easy to use, and cost-effective
placenta [2, 4]. PPH is poorly predictable,
regimes. Tranexamic acid (TA) merits evaluation to
underestimated when diagnosed clinically and not
assess whether it meets these criteria. TA was
deserving of early specific treatment. Accordingly,
chosen because it has been demonstrated to be a
detailed guidelines have been issued for optimal use
potent antifibrinolytic agent in elective surgical
of obstetric interventions and uterotonic drugs [5].
patients and because it is the most often used

antifibrinolytic agent worldwide. TA has the
Received: 8 / 8 /2017 DOI : 10.12816/0042235
Accepted:17 /8 /2017

Full Paper (vol.696 paper# 7)

c:\work\Jor\vol696_8 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2607-2613

Epidemiology of Sports-Related Injuries among
Athletes in Jeddah, Saudi Arabia
Mohammad Sameer A. Shobian *, Amre Hamdi, Wael Hassan S. Bakhamees,
Bashair Mahmoud Magadmi
Department of Orthopedic, King Abdulaziz University
* Corresponding author: Jeddah, Saudi Arabia, Email: dr.shobain@gmail.com, Mobile: +966542206064

Practicing sports regularly has a known positive impact on the well-being of individuals; however, it
exposes individuals to sports-related injuries. To date, scarce epidemiological studies are available about the
prevalence of sports-related injuries in Saudi Arabia. Objectives: The aim of this study was to determine the
prevalence of sports injuries among basketball and soccer players in Jeddah, and to compare the number and the
severity of sports-related injuries between different types of sports. Patients and Methods: It was a cross-
sectional study conducted on 1054 participants aged between 10 and 60 years with sports-related injuries. Data
were collected via personal interview or online surveys and analyzed using SPSS. Results: Males constituted
79.9% of participants. The median age of the sample was 24.8±7.8. 50% of injuries were related to soccer, 34%
to basketball, and only 2% to swimming. Recreational practice constituted 78.9% of injuries, whereas 12.9%
were professional and 8.5% were collegiate practitioners. About 38% were injured three­four times. Practicing
for 2­4 hours weekly had the highest risk of injury, 62%, while the lowest rate was among practitioners for 11­
14 hours weekly. 49% got injured outdoors. Ankle, knee, and hands and fingers injuries constituted 40%, 46%,
and 27%, respectively. Twisting was the mechanism of injury in 56%. Over 50% needed rest for 1­4 weeks
only. Conclusions: Soccer was the most common sport associated with injury. Recreational practice, few
weekly hours, and outdoor practice had the highest risks. Twisting, ankle sprains, and ligamentous injuries were
the most prevalent.
Keywords: Sports injury, prevalence, severity.


Practicing sports regularly, when viewed from
Rationale: Studies about the epidemiology of sports-
different aspects, has a known positive impact on the
related injuries in basketball and soccer and other
well-being of individuals, even though athletes
sports (incidence prevalence) in the Middle East and
practicing those sports still have the risk of
Saudi Arabia are scarce, and those we found were
developing sports-related injuries which may affect
lacking in quality.
their health in a negative way or even lead to severe
complications (1,2).
1. To determine the prevalence of sports injuries
Sport injuries are defined by Engebretsen et
among basketball and soccer players in Jeddah,
al. (3) as "any damage of the tissues of the body that
Saudi Arabia, focusing on knee, ankle, upper
occurs as a result of sport or exercise" Recent studies
extremities, and face injuries.
have found that athletes sustain 4 million sports-
2. To compare the number and the severity of sports-
related injuries annually and require approximately
related injuries between different types of sports.
2.6 million emergency room visits at a cost of nearly

$2 billion (3-5). Therefore, a standard protocol for
screening and monitoring those injuries must be
This was a cross-sectional study at King
performed, in the addition of a reliable management
Abdulaziz University Hospital, Jeddah, Saudi
plan for preventing advanced complications; in order
Arabia. The study was done in the Western Province,
to reach this, assessment of the incidence, extent, and
Makkah Region at Jeddah city.
severity of sport injuries must be done. Up to this
Saudi Arabia's population, according to the
date, there are still no available epidemiological
last census, is estimated to be 30,770,375 people.
studies to facilitate measuring sports-related injuries
in Saudi Arabia. Consequently, this study aims at
measuring the incidence, extent, and severity of
64years:4.5%;65years and over:3.2%. Median age:
sports-related injuries in Jeddah, Saudi Arabia.
Received: 11/08/2017 DOI : 10.12816/0042236
Accepted: 20/08/2017

Full Paper (vol.696 paper# 8)

c:\work\Jor\vol696_9 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2614-2617

Prevalence of Type 2 Diabetes Mellitus and Hypertension in
Overweight and Obese People in Riyadh City, KSA 2017

Hind Fahad Alqubali1, Khalid Awd Albalawi1, Abdulmajeed Eidhah Alswat2,
Abdulaziz Abdullah Aljebreen 2, Khalid Essa Alotaibi 2,Haneen Saad Aljehani 3,
Reyouf Abdulsalam Almughamsi 3, Alaa Mohammad Hussain4,Hamidah Fawzi Albiek5
1-Tabuk University,2-Imam Muhammad Ibn Saud Islamic University,3-King Abdulaziz University,
4-Umm Al-Qura University,5-pavol Jozef Safarik University

Background: overweight and obesity are well known risk factors for high morbidity and mortality rates and are
associated with chronic diseases including hypertension and diabetes.
Objectives: evaluating the prevalence of hypertension (HTN) and diabetes mellitus type II (DMT2) in
overweight and obese adult Saudi population. Methods: a cross sectional community based study was
undertaken among 549 of overweight and obese Saudi subjects in Riyadh region, Kingdom of Saudi Arabia
(KSA).All enrolled volunteers were subjected to the following clinical history taking, calculating BMI,
diagnosis of HTN and measurement blood pressure.
Results: the age of the subjects was 20-35 years old in 23.9%, 48.2% were 36-50 years old and 27.9% were
older than 50 years old. About 55%of respondents were females and 45% were males. 60.8% of subjects were
overweight and 39.2% were obese. The HTN and DM prevalence were found to be significantly higher among
obese subjects than overweight group.
Conclusion: the results indicated that obese subjects were at increased risk of hypertension and diabetes. Also,
obese females were more susceptible to DM and HTN than men.
Hypertension, Diabetes mellitus, Obesity, Overweight, Riyadh.


Obesity is defined as the imbalance between
metabolic disorders, female gender, old age,
the intake of energy and the energy expenditure (1, 2).
economic status and drug abuse (11).
Obesity is a global disease and a complex condition

that impacts the physical and psychological health of
Aim of the study
humans (3). Also, the WHO defines obesity as major
The study aimed at evaluating the
accumulation of excessive fat in the body. A body
prevalence of hypertension (HTN) and diabetes
mass index (BMI) of 25 kg/m2is defined as
mellitus type II (DMT2) in overweight and obese
adult Saudi population.
The negative health impacts of the obesity

includes encountering the economic growth and
representing a burden on the society and health - Study design
facilities (5, 6). Obesity may also result in enhancing
A cross sectional community based study was
chronic non-communicable diseases including
undertaken on a random sample of overweight and
diabetes, hypertension (HTN), breathing disorders,
Saudi subjects from February to June
osteoporosis and certain types of cancers (7, 8).
2017 in Riyadh region, Kingdom of Saudi Arabia
In Saudi Arabia, obesity is related to various
chronic diseases thus many studies are focusing on - Sample size and population:
this issue for controlling the high prevalence in our
Out of a random sample of 870 adult Saudi
society. The nature of diet, activity, cultural
population, only549 were enrolled in the present
behaviors and education are linked to high incidence
study, they were diagnosed to be overweight and
of obesity among Saudi population (9) with a
obese according to their body mass index (BMI) in
frequency of 285 among males and 44% among
Saudi population (12). The inclusion criteria were
females (10).
being older than 20 years old, BMI more than 23
Complex disorders could induce obesity
Kg/m2 for overweight and more than 25 for obese
including endocrine diseases, genetic factors,
Received: 13/08/2017 DOI : 10.12816/0042237
Accepted: 23/08/2017

Full Paper (vol.696 paper# 9)

c:\work\Jor\vol696_10 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2618-2626
Breastfeeding Practice in Arar, Northern Saudi Arabia
Murtadha Mohammed A BinAbd1*, Mishael Maki A AlDawood1, Khulud Awad S Altarfawi2,
Zahra Mohamed A Al Muwais1, Aqeela Mowsa J Al-Redwan1, Eiman Saeed I Alajyan1,
Fatimah Falah M Aldajani1, Mohammed Riyadh A AlAbbad1, Hassan Ali Y Al Dehneen1,
Abdullah Ahmed AlSaileek3, Nedal Mohammed AlHababi1, Aqeel Ghassan A AlHashem1,
Ali Mohammed H AlHijab1, Hussain Abdulsamad Aljeshi1
1Imam Abdulrahman bin Faisal University, Dammam, 2Primary Health Care Center, Arar,
3Alfaisal University, Riyadh, KSA
*Corresponding author: Murtadha Mohammed A BinAbd, E-mail: mbinabd2@gmail.com, Phone: +966549372200

Human milk meets all the nutritional requirements of infants for the first 6 months of life,
and it is associated with a lower incidence of diarrhea than partial or artificial feeding. The infant should
be exclusively breastfed for at least 4 months of life and if possible for 6 months, as recommended by
Aim of the Study: was to assess the breastfeeding practice for children under 24 months in Arar city, as
well as its relation to some sociodemographic and nutrition related variables.
Participants and methods:
A cross-sectional study was carried out in Arar city, mothers were selected
from the attendees of 6 randomly selected primary health care centers in the city. They were interviewed
and filled in a questionnaire that included the key questions.
Results: 11.8% of infants received exclusive breastfeeding, 39.7% received a mix of both breast and
artificial feeding while 48.5% depended only on artificial feeding. More than 50% of the studied infants
were males, 70% of the mothers weren't working. No significant relationship between type of child feeding
and child age, sex, mother education, mother's working status, father's work or mother age group (P
>0.05). About 2 thirds of children who had mixed feeding suffered from repeated gastroenteritis, delayed
teething, standing and walking.
Conclusion: In accordance with the obvious deficiency of exclusive breastfeeding in Arar city which is
located in Northern Saudi Arabia, we highly recommend that programs promoting exclusive breastfeeding
in the first 6 months of age must be conducted to increase mothers' awareness of the exclusive
breastfeeding duration is recommended.
Keywords: Breastfeeding; Artificial feeding; Exclusive breastfeeding; Breastfeeding Practice; Arar,
Northern Saudi Arabia


Breast milk is the foremost nutrition for
diabetes (8,9), while early use of complementary
healthy infants, as it contains all of the essential
feeding affects the child growth and increases the
nutrient that have short and long term benefits for
risk of mortality from diarrheal disease (10,11).
infants (1,2). The World Health Organization
Eastern Mediterranean Regional Office
(WHO) has strongly endorsed not only the
of WHO report showed that over 60% of early
feeding of all infants exclusively with breast milk
breastfeeding mothers continue to breastfeed until
for the first 6 months of their lives (3), but also
12 month in the Middle East and North Africa
the continuity of breastfeeding until 2 years of
(MENA) countries (12). Despite these high rates,
age in addition to nutritionally adequate
the previous report was less than 40% of infants
complementary foods (4,2). About 38% of infant
under six months were being exclusivity
feed only on breast milk during first 6 month (5).
breastfed (12). The report from Dop and
In United State, about 75% of women began
Benbouzid showed that rate of exclusive
breastfeeding and only 13% of them get it until
breastfeeding at four months has reached 24% in
the age of 6 month (6).
Middle East region. Nevertheless, The Global
On an annual basis, about 820,000
Data Bank on infant and young child feeding
children under the age of five could have their
included low rates from the MENA region. These
lives saved by increasing breastfeeding (7).
low rates have been observed in countries like
Feeding on breast milk in the first 6 month
Algeria, Sudan and Egypt (13).
promotes the healthy growth and development of
Taking Australian data from 2004 to
infant, and reduces the likelihood of infant with
2005 as an example, although a high initiation
rate of 92% was found for exclusive
Received: 22/08/2017 Accepted: 1/09/2017 Doi: 10.12816/0042238

Full Paper (vol.696 paper# 10)

c:\work\Jor\vol696_11 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2627-2631

Poly Cystic Ovarian Syndrome and Vit D Correlation with
Fertility: Review Article
Marah Mohammed Alzaidi1, Hassan Hamza A Almir2, Afraa Qasim Ibrahim Khormi3,
Yassmeen Mohammed Alltaleb4, Zahra Mohamed A Al Muwais2, Rehab Abdul Rahman Alsaleh5,
Nora Faisal Alsaud4, Lama Mohammed Alomar6, Lara Saleh Alkuhaimi4, Fatimah Radi Slais7,
Alhanouf Abdullah Alyahya6, Reema Adnan Shabkah8, Abdulrahman Hassan Khormi9, Reyhana Safi5
Department of Obstetrics and Gynecology
1Taif University, Taif, 2Imam Abdulrahman bin Faisal university, Dammam, 3Jazan University, Jazan,
4Alfaisal University, Riyadh, 5Ibn Sina National College, Jeddah, 6 Almaarefa College for Science and
Technology, Riyadh, 7Al Amal complex for Mental Health, Dammam, 8 King Abdulaziz University, Jeddah,
9 King Fahd Central Hospital, Jazan, Saudi Arabia
Corresponding Author: Marah Mohammed Alzaidi, email: dr.mara7-alzaidi@hotmail.com, mobile:+966564999166

Over the past few decades, vitamin D was proposed to be highly influential on female fertility and
reproductive health. Its role was extensively studied and evaluated specifically in females with polycystic
ovarian syndrome. Objectives: the aim of this research was to study the correlation between vitamin D and
fertility in general, and in polycystic ovarian syndrome-associated infertility in particular. Methods: we
searched Cochrane Library and PubMed for articles addressing the impact and role of vitamin D in fertility
issues in females with polycystic ovary disease. Specifically-related topics were carefully reviewed and
analyzed to summarize their conclusive results. Results and Discussion: Vitamin D was lower in females with
PCOS and vitamin D administration had increased its level, improved metabolic disturbance and shortened
inter-menstrual intervals in those patients. Patients with high vitamin D levels had a better success rate of in-
fertilization. However, it did not affect the time to pregnancy in PCOS women. Conclusion: Vitamin D
is beneficial for improving metabolic as well as reproductive functions in women with PCOS. It is also
essential for successful in-vitro fertilization, and it is probably protective against endometriosis. However,
results from different studies are contradictory, and still there is no solid evidence that there is a cause-effect
relationship between vitamin D and fertility.
Keywords: Polycystic ovary, PCO, Vitamin D, Fertility.


Vitamin D is one of the fat-soluble vitamins
complex; excessive pituitary gland secretion of
that can be exogenously taken, via certain types of
luteinizing hormone (LH) that subsequently
food, or endogenously formed, through skin
stimulate ovarian thecal cells for overproduction of
exposure to ultraviolet sun rays. The main well-
androgens is one of the common proposed
established role of vitamin D is related to calcium
mechanisms(3). PCOS is closely correlated with
metabolism, mineralization, and bone health.
obesity, insulin resistance, and hyperinsulinemia
However, it was found that it is also implicated in
which may augment the gonadotropin hormonal
the pathogenesis and risk amplification in certain
effect on ovaries(4).
medical diseases. Vitamin D deficiency or
Study rationale and objectives:
disturbed metabolism is encountered in many

Many researches had proposed a role
disorders such as cancer, autoimmune, infectious,
of vitamin D in polycystic ovarian syndrome
endocrinal, as well as cardiovascular diseases(1).
management, and eventually various studies had
Polycystic ovarian syndrome, on the other
intensively focused on this point of research. The
side, is one of the most common endocrinopathies,
aim of this research article was to review the
it affects 6-10% of females in the reproductive age
literature studies addressing the correlation between
worldwide. Patients with polycystic ovarian
vitamin D and fertility in general, and Vitamin D in
PCOS-associated fertility in particular.
irregularities and signs of hyperandrogenism(1).
Infertility, diabetes, obesity, and metabolic
To achieve the review article objective, we
syndrome are not uncommon among those
conducted a systematic search of medical database,
patients(2). The pathophysiology of PCOS is
Received: 8/09/2017 DOI : 10.12816/0042239
Accepted: 17/09/2017

Full Paper (vol.696 paper# 11)

c:\work\Jor\vol696_12 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2632-2639

The Prevalence and Risk Factors of Postoperative Complications between
Open and Lab cholecystectomy among Al-Madinah citizens,
Kingdom of Saudi Arabia, 2017
Mohammed Rashwan(1) , Sara Mahrous(1), Akram Alandijani(1), Hussam Atallah(1),
Ghassan Alsisi(2)
(1)College of Medicine, Taibah University, Medinah, (2) King Fahd hospital, Medinah, Saudi Arabia

Gallstone disease is common, and it is asymptomatic, patients may need an operative.
Laparoscopic cholecystectomy becomes the choice for symptomatic gallstone disease intervention; open
surgery was replaced by Laparoscopic cholecystectomy in the cholecystolithiasis treatment, open surgery
has different complications. Laparoscopic cholecystectomy has several advantages over open surgery, but
it has several complications also.
To investigate the prevalence and risk factors of postoperative complications of open and lab
cholecystectomy in AL-Madinahcitizen.
This retrospective cross-section study included 205 patients from king Fahad hospital in Al-
Madinah AL-Munwwarah. A questionnaire was conducted on the participant by interview to investigate
different variables.
The percent of a female was 73.7%, and percent of a male was 26.3%, the bleeding complication
represented 19.5%, infection was 3.9%, biliary leakage was 3.9%, and wound infection was 1.5%. The
mean duration of recovery was 3.56 days while the mean duration for returning back to work was 12.37
days. Lap operation had less duration for recovery than an open operation.
Bleeding was the most common complication among patients, lap group patients
experienced complications less than the open group. Male gender, age, obesity, the emergency of
operation, diabetes mellitus, hypertension, thyroid and heart disease were not risked factors for
LC, Open surgery, Gallbladder operations.

shorter operative time, low cost[12], less
Gallstone disease is common, and it is
impairment of vital functions and rapid return to
asymptomatic between one and four percent of
normal activity and work[13] .
patients with gallstones, patients may need an
Although LC is the first option of treatment,
operative intervention [1].Acute cholecystitis,
there is a higher risk of intra-operative injury
cholangitis, acute pancreatitis and obstructive
during laparoscopic cholecystectomy when
jaundice can result from untreated gallstones
compared to open Cholecystectomy [14,15] .
[1].Open surgery has been replaced by
Also, cystic duct leak is a serious
laparoscopic cholecystectomy (LC) in the
complication of LC, it is an infrequent
cholecystolithiasis treatment [2], LC became the
complication and it can be reduced by replacing
choice for symptomatic gallstone disease [3-7].
simple clips by locking clips [16] .Also, the
LC was first performed in 1985 [8]. Almost 70-
conversion from LC to open surgery and
80% of cholecystectomies are performed
occurrence of morbidity and mortality may
laparoscopically, while 20-30% is still done by
occur due to the presence and severity of
open cholecystectomy often performed in
inflammation[17,18],male gender[19-23] , advancing
cardiopulmonary compromised patients, elderly
patient's age[6] and greater body weight[19,24].
patients and patients with complicated gallstones

where the laparoscopic procedure is not feasible
Review of literature
[9].Now, LC is considered the gold standard for
There were several studies [25,26] ,
the treatment of benign gallbladder disease [9,10].
demonstrated that LC was a safe and efficient

treatment strategy for acute cholecystitis than
open cholecystectomy. Risks of laparoscopic
several advantages over open surgery for
cholecystectomy included bile duct injury,
cholecystolithiasis [11], it permits the patients to
which acts as a severe potentially life-
get the advantages of minimally invasive surgery
threatening complication of LC .It was reported
[2] , shorter hospital stay, reduced post-operative
that the incidence of bile duct injuries ranged
pain, decreased morbidity and mortality rates [11],
from 0.5% to 1.4% [27] , another study [28] ,
Received: 27/08/2017 DOI: 10.12816/0042240
Accepted: 6/09/2017

Full Paper (vol.696 paper# 12)

c:\work\Jor\vol696_13 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2640-2646

Schizophrenia: Etiology, Pathophysiology and Management - A Review
Bayan Zaid Fatani1, Razanabdullah Aldawod2, Fatimah Abdulwahab Alhawaj2, Sajedaali Alsadah3,
Fatimah Radi Slais3, Eman Nasser Alyaseen4, Abdulaziz Sami Ghamri1, Jumanaahmad Banjar1,
Yahya Alhussain Qassaim6
1 Um AlQura University, 2 Imam Abdulrahman Bin Fasial University, 3 Alamal Complex for
Mental Health, 4 Alamal Complex for Mental Health, 5 Ibn Sina National College, 6 Royal College of
Surgeons in Ireland,
Corresponding Author: Bayan Zaid Fatani­email: Bayan.z.f@gmail.com- mobile:0599433733

Diagnosis of schizophrenia is largely a clinical assessment of a group of signs and symptoms.
There are various factors that can be a cause or a risk factor for creating this disorder; some preventable and
some non-preventable. The treatment options are diverse and are continuously being studied in order to
enhance results and minimize adverse effect of various forms of therapy.
Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE, January 1987, through March 2017. The following search terms were used: schizophrenia,
etiology of schizophrenia, pathophysiology, clinical features, and treatment of schizophrenia
Aim: Our aim in this study was to understand the etiology, pathophysiology, and study various lines and
advancement in management of schizophrenia. Conclusion: In the recent years, many treatment options are
emerging where newer drugs and their combination with or without non-pharmacological therapy have
shown promising results. More studies must be done to implement advanced regimens for treatment of
Keywords: schizophrenia, genetic cause of schizophrenia, pharmacologic management of schizophrenia


may show no symptoms at all. A psychotic
The fundamental features of Schizophrenia are:
episode is described by patient-specific symptoms
1. Positive symptoms which include delusions

and hallucinations, also called the psychotic
and signs (known as psychotic features) that
symptoms where there is a loss of contact with
mirror the false reality formed in the patient's
awareness. The first episode of psychosis typically
2. Negative symptoms which includes in specific
happens in late adolescence or early adulthood but
impaired motivation, drop in spontaneous speech,
is often headed by a prodromal phase known as at
risk mental state.
3. Cognitive weakening.
Additionally in some examples premorbid
The positive symptoms have a tendency to
impairments in social functioning and/ or
relapse and remit, although some patients feel
cognition go back several years. Still, in other
residual prolonged psychotic symptoms. The
examples onset is abrupt in formerly well-
negative and cognitive symptoms have a tendency
functioning individuals[2].
to be chronic and are related to long-term effects
Substance-abuse disorders happen most
on societal function. Cognitive signs are the up-to-
frequently amongst these patients; such disorders
date classification in schizophrenia. These
can involve a range of substances, which includes
symptoms are not specific and therefore, they
should be severe enough for the others to notice
tobacco. Anxiety, obsessive-compulsive disorder,
them. Cognitive symptoms comprise disorganized
depression, and panic are also noticeable in
speech, attention, and thought, eventually
patients with schizophrenia and may worsen the
symptoms of their disorder. Such patients also
have an overall lack of mindfulness of their
Among additional abnormal (schizoid)
disease. This mindset has been associated to great
actions, social withdrawal usually leads a person's
rates of non-adherence, poor psychosocial
first psychotic episode; nevertheless, some patients
Received: 16/09/2017 DOI: 10.12816/0042241
Accepted: 25/09/2017

Full Paper (vol.696 paper# 13)

c:\work\Jor\vol696_14 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2647-2651

The Effectiveness of Gamma Knife Surgery in the Treatment of
Trigeminal Neuralgia: A Systematic Review
Ali Mansour Taher Sumayli1, Saad Khalid Saleh Boqursain2, Ahmed Abdalmuhssen
Alnuwaiser 2, Abdulrahman Abdullah Ali Sari1, Rahaf Abdalaziz Odah Albaqawi3,
Khalid Mohammed Yahya Mania1, Albaraa Abdullah Mohammed Najmi1,
Ahmed Ali Ahmed Jaafari1, Mohammad Ali Mousa Daghriri1
1Faculty of Medicine, Jazan University,2 Faculty of Medicine, King Faisal University, 3Faculty of
Medicine, Hail University

Introduction: Gamma knife surgery is one of the stereotactic surgery which recently used in the
treatment of trigeminal neuralgia due to its minimally invasive nature. The short-term effectiveness of
gamma knife surgery in a reduction of pain episodes among patients with trigeminal neuralgia are
reported by several studies. However, few studies elaborated the long-term effectiveness of gamma knife
This review aimed at evaluating the effectiveness of gamma knife surgery by reviewing of
pain relief rates and recurrence rates reported by the included studies.
: The electronic search was conducted in Medline, EmBase and Science direct databases using
the key words of (Gamma knife surgery AND trigeminal neuralgia). The search of the literature, after
exclusion of irrelevant, duplicated and review studies revealed 8 studies met the inclusion criteria. The
data extraction conducted using data extraction sheet regarding characteristics such as duration of
symptoms, number of trigeminal divisions involved, lack of sensation or surgery before surgery,
anatomical results in the operation, the rate of pain relief and pain recurrence rate.
Results: The history of surgery and medications before gamma knife radio surgery was assessed by
included studies. It was found that only one study used gamma knife surgery as their first treatment of
choice with no prior surgery. The pain relief rate ranged from 73.8% to 96% while pain recurrence rate,
which reported in four included studies ranged from 2% to 26.3%.
: The gamma knife surgery was not the first surgical choice of treatment in most of the
studies. The reported pain relief rates associated with this new technique were generally high while pain
recurrence rates were low. As the worst reported scenario found about a quarter of patients complained of
pain recurrence following gamma knife surgery.
Keywords: Gamma knife; Trigeminal neuralgia; Neurosurgery; Pain management.


Trigeminal neuralgia is a characteristic pain
stereotactic surgery which recently used in the
syndrome which presents clinically with sharp
treatment of trigeminal neuralgia (TN) due to its
severe electrical-shock like pain episodes
minimally invasive nature (5). Although GKS has
distributed according to the divisions of the
an immediate high success rate, there are still
trigeminal nerve (1). Treatment of trigeminal
some patients in whom GKS fails to provide
neuralgia is mainly pharmacological with
pain relief. Additionally, about 50% of patients
antiepileptic or antidepressant drugs to reduce
may develop recurrent refractory pain within 3-5
pain episodes (2). Invasive surgical treatment is
years of follow-up (6).
only used in refractory trigeminal neuralgia
Gamma Knife Surgery is a four-step
when medications are no longer effective. The
neurosurgery procedure including the treatment
micro-vascular decompression and thrombotic
planning, the application of the stereotactic
ablation surgery have been the interventions of
frame to the patient's head, the acquisition of
choice for surgical treatment of trigeminal
holographic images, and radiation exposure (7).
neuralgia (3).
The system allows the stereoscopic acquisition
Stereotactic radio surgery is a new way to
of images from MRI, cerebral angiography,
treat well-defined targets in the brain, causing
positron emission tomography and computed
the destruction of cells, blockage of blood
tomography. Applications for GKS include
vessels or certain functional changes. It is one of
treatment of benign and malignant tumors well
the fastest growing fields of neurosurgery (4).
defined from the head, cerebral vascular
Gamma knife surgery (GKS) is one of the
malformations and treatment of certain pain
Received: 10/09/2017 DOI: 10.12816/0042242
Accepted: 19/09/2017

Full Paper (vol.696 paper# 14)

c:\work\Jor\vol696_15 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2652-2657

Association between Dementia and Diabetes Mellitus: A Systematic Review
Mohammad Ali Mousa Daghriri1, Hanan Mothaqab Mashi1, Yasser Mossa Daghriri1, Maryam
Ismail Jaran1, Ali Mohammed Naser Alhazmi1, Ahmad Ali Mohajer1, Wejdan Ali Merzzen
Mobasher2, Jnadi Mohammed Jaber Madkhali1, Ali Mansour Taher Sumayli1
1Faculty of Medicine, Jazan University, 2Faculty of Medicine, King Khalid University

The association between diabetes mellitus and dementia is not well-established such that
found between diabetes mellitus and vascular diseases. This article aimed at reviewing the longitudinal
prospective studies which evaluated the association between diabetes mellitus and incidence of dementia
among different age groups of patients.
An electronic search was performed by Google Scholar, PubMed, and Sciencedirect to identify
all relevant articles. The number of eligible articles based on titles and abstracts were 21 eligible articles.
After that, the irrelevant, duplicated and other reviews studies were excluded based on, which resulted in
the exclusion of 13 irrelevant articles. Finally, 7 articles were included in this review. The data collected
about mean age of the population, type and duration of diabetes, the strength of association and the
statistical significance.
The strength of association between dementia and diabetes mellitus varied in the included
studies, the reported ratios varied from a relative risk of 1.2 to a 4.77. Regarding the statistical significance
of these associations, all the studied articles revealed significant associations with P values less than 0.05.
This review supported the evidence of the association between diabetes mellitus and
occurrence of dementia depending on the findings of the recent epidemiological studies.
Dementia; Diabetes Mellitus; Alzheimer; Cognitive.


Diabetes mellitus is a metabolic disease
higher risk of dementia. Another longitudinal
that associated with an absolute or relative
study reported a strong relationship between
shortage in insulin secretion (1). It is a growing
diabetes mellitus and dementia related to the
public health problem with recent projections of
incidence of stroke with lower risk in Whites than
an increase in international prevalence from 2.8%
in Blacks (9). A study reported twofold elevated
in 2000 to 4.4% in 2030 (2). Dementia is the
risk of dementia among patients with diabetes
severe deterioration of cognitive functions which
mellitus (10). The reported cognitive decrements
is usually associated with old age when about a
including verbal, memory, and information
third of people above 85 years old could be
processing ability.
affected (3). Similarly, the occurrence of diabetes
However, the limited psychometric screening
mellitus increases with age to reach 15%
and inaccurate cognitive function tests reduced
prevalence among people above 80 years old (3).
the confidence on the findings of these studies.
The vascular diseases have been found
This article aimed at reviewing the longitudinal
responsible for adverse health effects such as
prospective studies which evaluated the
cognitive impairment and dementia. However,
association between diabetes mellitus and
diabetes mellitus has not similar well-established
incidence of dementia among different age groups
associations. Many studies, after adjustment of
of patients.
age effect, found that diabetes mellitus is an

independent predictor for the incidence of
dementia and impairment of cognitive functions
Keywords and search strategy
(4-6). However, these studies used cross-sectional
The keywords and search strategy used in
designs that characterized by an absence of the
this review were showed in the summary of
temporal relationship which should be initiated
search findings (table 1). All steps of the
between the risk factor (diabetes mellitus) and
systematic review (identification, screening,
outcome (dementia).
eligibility, inclusion) were conducted in this
The longitudinal approaches are more
appropriate to study the presence and magnitude

of such association (7). In a longitudinal study
Eligibility Criteria
conducted by Whitmer et al. (8). Patients with a
All articles published in English language
history of major hypoglycemic shocks were at a
and published in the last decade (since 2006) were
Received: 11/09/2017 DOI: 10.12816/0042243
Accepted: 20/09/2017

Full Paper (vol.696 paper# 15)

Microsoft Word - Final paperUse of social media and other electronic media in health education and health promotion - Copy.docx The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2658-2662
Use of Social Media and Other Electronic Media in Health
Education and Health Promotion (Pilot Study)
Abdullah S Alshammari, Hotoon S Alshammari
College of Medicine, AlMaarefa College, College of Medicine
Imam Muhammad Ibn Saud Islamic University

social media is becoming progressively used for improving health literacy and health
this study aimed to find out the magnitude of use of social media among people of Saudi
Arabia and how far they were used to send health education messages.
this study was a cross sectional study was conducted on convenient sample of participants using
survey monkey software. The collected surveys over one month were entered into PC computer using SPSS
software. Results: it was found that the majority of participants used one sort of social media or another.
Also it was found that Instagram, WhatsApp and SMS were the most preferred media. There were age and
gender differences. More than 50% of the participants received health promotion messages and they
thought that it was a good idea.
Methods: A Cross sectional study was conducted on convenient sample of participants using survey
monkey software. The collected surveys over one month were entered into pc computer using SPSS
software. Results: it was found that the majority of participants uses one sort of social media or another.
Also it was found that Instagram, WhatsApp and SMS were the most preferred media. There were age and
gender differences. More than 50% of the participants received health promotion messages and they
thought it was a good idea.
Conclusion: it's a good opportunity to use these preferred social media to send health education messages
to the target population.
Keywords: Electronic Media, Social Media, Health Education, Health Promotion.


Since the introduction of social network sites
affected by Type 2 Diabetes Mellitus in 2004 (3).
such as Facebook, Twitter, YouTube between
Almost 10 years later, this number is expected
1997 and 2006, they have attracted millions of
to have increased significantly. The burden of the
users with a wide range of interests all over the
disease raises great social and economic concerns.
world. They were integrated into their daily
So far, type 2 Diabetes Mellitus burdens the Saudi
practices. Most sites of those help diverse
economy with a total of over $0.87 billion (4).
audiences connect based on shared interests and
Hypertension is extremely grievous disease,
activities (1). They introduce substantial changes to
which is rapidly becoming one of the most
common chronic diseases internationally as well
communities, and individuals. Social media differ
as locally in Saudi Arabia. A highly reliable study
from traditional media in many ways, including
emphasizes that the prevalence of hypertension
quality; frequency, usability, immediacy, and
among adults in our community reach up to 30%
permanence. There are many effects that stem
from internet usage.
The World health organization (WHO)
catastrophic, and death is probable as it is a
estimates that more than 347 million people are
leading cause for coronary heart disease, stroke,
affected by diabetes worldwide and expects the
Kidney diseases and many others. High
disease to become the 7th cause of death by 2030.
percentage of undiagnosed cases in KSA reaches
In the year 2010 alone, over 3.4 million people
up to 27%, which is an alarming sign.
died because of complications related to high
Furthermore, neglecting by many diagnosed, as
fasting blood glucose (2). In Saudi Arabia, studies
treatment requires the outmost perseverance, can
have shown that 23.7% of the population was
and will aggravate the problem (6).
Received: 21/09/2017 DOI: 10.12816/0042244
Accepted: 30/09/2017

Full Paper (vol.696 paper# 16)

c:\work\Jor\vol696_17 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2663-2666

Glasgow Coma Scale in Anticipation of Sepsis and Septic Shock: Review Article
Mohammed Saeed M Alalawi1, Hussain Abdullah M Aljabran2, Abdullah Mohammed Alkhamri3,
Abdulrahman Mohammed Alwahbi4, Zahra Ibrahim AlQarrash2, Hussain Abdulillah M Iraqi5,
Mohammed Saleh M Alonazi6, Abdulaziz Raja Najim Alotaibi7, Majed Ali Mohammed Alahmari6, Ahmed
Abdalmuhssen A Alnuwaiser8, Feras Khalid A. Mimarji5, Abdullah Atallah Al-Enezi9, Naif Ahmed A
Alabbad10, Alaa Hassan Alhayki2, Mashail Hashim H Farran11
Department of Emergency Medicine
1Anak General Hospital, Anak, Saudi Arabia, 2Imam Abdulrahman bin Faisal University, Dammam,
Saudi Arabia, 3 King Saud University, Riyadh, Saudi Arabia, 4Qassim University, Qassim, Saudi Arabia,
5 Jeddah University, Jeddah, Saudi Arabia, 6Imam Muhammad ibn Saud Islamic University,
Riyadh, Saudi Arabia, 7Taif University, Taif, Saudi Arabia, 8 King Faisal University,
Hofuf, Saudi Arabia, 9Majmaah University, Al Majmaah, Saudi Arabia, 10University of Warmia and
Mazury in Olsztyn, Olsztyn, Poland, 11Ibn Sina National College, Jeddah, Saudi Arabia
Corresponding Author: Mohammed Saeed M Alalawi, Email: mohd.s.alawi@gmail.com Mobile: +966598157904

Evaluation of level of consciousness has become essential for anticipation of sepsis and septic shock. Both
the Sequential Organ Failure Assessment (SOFA) score and the quick SOFA score utilize the Glasgow Coma
Score (GCS) for screening of sepsis. Objectives: the aim of this review is to determine and study the role of
Glasgow coma score in anticipation of sepsis and septic shock. Methods: To achieve this aim, we have searched
online database, namely PubMed and Cochrane Library for studies and review articles assessing the significance
of assessment of Glasgow Coma Scale (GCS) for anticipating sepsis or septic shock. Thirteen appropriately-
related studies were selected for review. Results: Disturbed sensorium was found to be a sensitive early indicator
for sepsis, thus GCS is used for assessment of both the Sequential Organ Failure Assessment (SOFA) and quick
SOFA scores qSOFA scores. Lower GCS scores were associated with high mortality rates. Discussion:
Encephalopathy is an early sign of sepsis and septic shock. Glasgow Coma score (GCS) was a good indicator of
neurological dysfunction evaluated by the SOFA and qSOFA scores. The use of GCS was also a predictor of
mortality in patients with sepsis. Some researchers, however, reported that GCS was not the best tool for
measuring brain dysfunction in sepsis. Conclusions: Glasgow coma score can anticipate sepsis and septic shock,
and predict the outcome of sepsis.
Keywords: Glasgow Coma score, Sepsis, Septic shock.


Sepsis in a major health problem and an
sepsis. Because there is no gold standard test for
important cause of mortality in intensive care units
diagnosis of sepsis, researchers focused on
(ICUs) worldwide. It is estimated that about 300 every
developing, as well as evaluating the efficacy of, tools
100 population in the United states develop severe
that can anticipate sepsis among hospitalized patients
sepsis(1). Septic shock is a significant cause of
with likelihood of infection(4). The currently used tool
mortality with a mortality rate reaching up to 50%(1).
for screening of sepsis is the Sequential Organ Failure
In spite of the continuous efforts to put solid criteria
Assessment (SOFA) score(5). The development of this
for early diagnosis of sepsis, physicians still find a
score was based on the new definition of sepsis as
challenge to accurately identify patients with sepsis in
"life-threatening organ dysfunction caused by a
wards and/or emergency departments. In the past, the
deregulated host response to infection"(6). Eventually,
systemic inflammatory response syndrome(SIRS)
sepsis can be diagnosed when a patient scores two or
diagnostic criteria was used to detect sepsis in
more points on the SOFA score. SOFA score is based
different clinical situations(2). The previous consensus
on evaluation of the function of six systems, namely
definitions of sepsis(Sepsis-2) required the presence
the respiratory, neurological, cardiovascular, hepatic,
of infection, along with at least two criteria for SIRS,
renal, and coagulation systems. Because it is time-
as well as organ failure for diagnosis of sepsis(2,3).
consuming, the task force developed a shorter easily-
However, recent researchers claimed that these
applicable score for detection of sepsis, the quick
criteria were neither sensitive nor specific, and had
SOFA score or qSOFA(7).The qSOFA score indicates
hindered the accurate detection and identification of
that sepsis is very likely if the patient has any 2 of the
Received: 12/09/2017 DOI: 10.12816/0042245
Accepted: 21/09/2017

Full Paper (vol.696 paper# 17)

c:\work\Jor\vol696_18 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2667-2674
Evaluation of Choroidal Thickness in Diabetic Macular Edema
Using Spectral-Domain Optical Coherence Tomography Enhanced
Depth Imaging Mode
Mona Mohamad Aly
Ophthalmology Department, Faculty of Medicine, Al-Azhar University

to evaluate the choroidal thickness (CH-T) and the central macular thickness (CMT) in eyes with
diabetic macular edema (DME) and to detect if CH-T varies according to the type of DME.
Patients and methods: One hundred forty two eyes of 96 patients were enrolled in the study. Eyes of
diabetic patients with non-proliferative diabetic retinopathy (NPDR) with/without DME were evaluated.
Eyes of normal subjects with no ocular or systemic diseases were included as a control group. The CMT
and the underlying choroidal thickness were estimated using enhanced depth imaging mode of spectral-
domain optical coherence tomography (EDI SD-OCT). CH-T thickness was measured at the subfoveal area
and at an interval of 500 m up to 1500 m from the center of the fovea (nasal, temporal, superior and
inferior). In eyes with DME, the type of DME was detected.
Results: DME included cystoid DME (19 eyes), diffuse DME (27 eyes), and DME with serous retinal
detachment (SRD) (23 eyes). 33 eyes with NPDR without DME and 40 non diabetic normal eyes were
examined. Estimation of the choroidal thickness was performed and the subfoveal CH-T was thickest in the
control group and significantly decreased in the diabetic groups especially with DME. The sub-foveal CH-T
was 326±25.75 m in the control group, 256.27±30.5 m in NPDR without DME group, 210±23.96 m in
Cystoid DME group, 215.5±27.0 m Diffuse DME group and 195.2±23.9 m in DME with SRD group.
The CMT was 238.75 ± 14.7 m, 260.85 ± 24 m, 530± 120.5 m, 420.8± 101.6 m and 506.60± 131.87
m in the control group, NPDR without DME group, Cystoid DME, Diffuse DME and DME with SRD
groups respectively. There was a statistically insignificant negative correlation between the subfoveal
choroidal thickness and the CMT.
Conclusion; there is an overall decrease in the CH-T in patients with NPDR and this thinning become more
pronounced with the presence of diabetic macular edema.
Keywords: diabetic macular edema, choroidal thickness, enhanced depth imaging, spectral-domain optical
coherence tomography


There is a growing interest in the role of the
with diabetic retinopathy worldwide. Although
alterations in retinal vasculature resulting in
Abnormalities of the choroidal integrity have been
compromise of the blood-retinal barrier have been
associated with the pathogenesis of several retinal
demonstrated to have a critical role in the
diseases, such as age-related macular degeneration,
pathophysiology of the disease, changes in the
central serous chorioretinopathy and diabetic
choroidal vasculature may also have a contributing
maculopathy [1]. The choroidal vasculature,
role [4]. The choroidal vasculature may play a
especially the choriocapillaris, is critical for
potential role in modulating disease severity by
maintenance of the neurosensory retina because it
affecting the hydrostatic or osmotic pressures that
supplies the outer retina with nutrition and oxygen.
determine the absorption rate of intraretinal fluid [5].
It is most important in the foveal avascular zone [2].
Decreased blood flow in the choriocapillaris may
The role of the choroid is increasingly gaining
cause retinal tissue hypoxia and subsequent
attention as a key factor in diabetic eye disease.
increased expression of vascular endothelial growth
There is histopathologic evidence that diabetes
factor (VEGF), which is one of the mechanisms
implicated in the pathogenesis of DME [6].
arteriosclerosis, choriocapillaris degeneration, and
Prior to the advent of optical coherence
neovascularization [3]. Diabetic macular edema
tomography (OCT), clinical evaluation of the
(DME) is a leading cause of blindness in patients
Received: 17/08/2017 DOI: 10.12816/0042246
Accepted: 27/08/2017

Full Paper (vol.696 paper# 18)

c:\work\Jor\vol696_19 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2675-2679

Assessment of Knowledge Attitude and Practice of Epistaxis in Saudi
Khaled Saleh Almulhim, Ibrahim Abdulhakim Al Sheikh Mubarak,
Marwan Abdul Rahman Al-Shaikh Hussain, Mohammed Sami Alhaddad,
Nasser Khalid Alotaibi, Khalid A. Alyahya
King Faisal University

epistaxis is acute hemorrhage from the nasopharynx or the nose. Epistaxis is a common
otorhinolaryngology, and it ranges from mild to a severe, life-threatening rhinological emergency. First
aid is performed to reduce mortality and morbidity of the emergency case until obtaining medical support.
The aim of the work:
this study aimed to assess knowledge, attitude, and practice of first aid measures in
Saudi population regarding epistaxis.
Patients and Methods:
The present study included 1114 Saudi participants using a semi-modified
questionnaire. The data was collected using excel sheet and analysis of data was performed by using
There were 751 (67.4%) of participants knew about epistaxis management, while 363 (32.6%)
didn't know. The mean score ± SD of KAP was 8.25±1.9, the correlation between KAP with gender (P
value=0.001), marital status (P value=0.02) and education (P value=0.004) was significant.
knowledge of participants about epistaxis management was moderate, sex, marital status and
education significantly affected KAP score.
epistaxis, epistaxis first aids, KAP of epistaxis.


6% of individuals were admitted to medical
Epistaxis is defined as the acute bleeding
treatment to control the hemorrhage, while 60% of
from the nasal cavity, nasopharynx or the nose (1).
them had at least one episode of epistaxis
Bleeding from the nasal septum is responsible
throughout their lifetime and it was mentioned
for the majority of epistaxis cases (2). Epistaxis is a
that males were more prone to experience
common otorhinolaryngology emergency in ear,
epistaxis than females (9). Epistaxis is common
nose, and throat (ENT) and accident and
among young adults and children, while it is rare
emergency departments (3,4).
among neonates, in the sixth decade it reaches its
It acts as a significant workload in
peak (10). The vast majority of patients that
accident and emergency and otolaryngology
exposed to epistaxis can settle with standard first
departments; it usually causes anxiety for both
aid measures. However, some epistaxis episodes
patients and clinicians (1). It ranges from mild
required hospital admission (11). First aid is the
bleeding to severe, life-threatening rhinological
emergency treatment of injury or illness to
emergency which acts as a challenge to an
prevent deterioration of condition and to decrease
otolaryngologist (5), where it may continue for
pain until professional medical help reaches (12), to
more than an hour (6).
reduce mortality and morbidity of the emergency

case (13) especially in persistent bleeding cases (14).
The nasal bleeding caused by either systemic
This study aimed to assess the knowledge,
or local factor, the systemic factors involved
attitude, and practice of epistaxis first aid
coagulopathy, blood disorders, the use of
measures in the Saudi population.
anticoagulant and arterial high blood pressure,

while the local factors included upper airway
infections, nasal allergies, the introduction of
Subjects and study design
foreign bodies into the nasal cavity, trauma and
This study included 1114 Saudi participants;
septal perforation (7). The incidence of epistaxis
the study was conducted in the period from June
was reported to range from 10% to 60 % of
2017 to September 2017. This study was
individuals (8).
performed using semi modified questionnaire to

assess demographics, knowledge, attitude, and
Received:15 /09/2017 DOI: 10.12816/0042247
Accepted: 24 /09/2017

Full Paper (vol.696 paper# 19)

c:\work\Jor\vol696_20 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2680-2684
A Review of Knowledge, Attitude and Prevalence of Flu Vaccination
and Its Effect among Elderly
Sarah Musaed Alluheibi1, Ahmad Hameed Allehaiby2, Thekra Ali Aseeri3, Abdullah Saeed A
Alqahtani4, Jawaher Awaad Althumali5, Omamah Abdu Abudaia6, Rawabi Samah Alanezi7,
Amor Abdullah Al Mehdar4, Fatimah Hussain Abu Qurain8, Basem Abdullah Alghamdi9,
Faisal Ahmad A Alokasi4, Saeed Ali S Aldamkh10, Duaa Khalid M Alalawi8,
Abdulrahman Mohammed Aleidan11, Moatasem Mohammed Modhish12
Department of Family Medicine
1 Primary Health Care, Mecca, 2Primary Health Care, Jeddah , 3Umm al-Qura University, Mecca,
4 Ministry of Interior, Riyadh, 5 Taif University, Taif, 6Asir Hospital, Abha, 7 Hail University, Hail, Saudi
Arabia,8Medical University of Warsaw, Poland, 9 Najran University Hospital, Najran, Saudi Arabia.
10Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia.
11 King Saud University, Riyadh, Saudi Arabia. 12 Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.
Corresponding Author: Sarah Musaed Alluheibi, email: sara.alluheibi@gmail.com .,mobile: +966555007759

Elderly individuals are very vulnerable to influenza infection, and more prone to influenza-related
morbidity and mortality. However, the prevalence of elderly persons receiving influenza vaccine remains low.
Many factors have been proposed as the cause beyond this low prevalence, with knowledge and
misconceptions about the vaccine on the top of the list. Objectives: the aim of this review is to assess the
knowledge, attitude, and prevalence of flu vaccine and its effect among elderly. Methods: To achieve this
aim, online database search was conducted to review articles stating knowledge, attitude, and incidence of flu
vaccine and its effects among elderly. PubMed was searched for appropriately-related studies that address the
studied parameters. PubMed search yielded 19 results, we quickly inspected the abstracts of these results to
select those with most relevant data. Of 19 articles, 8 were chosen for review. Results: The prevalence of
influenza vaccine ranged from 58% to 73%. Inadequate or lack of knowledge about the vaccine were common
in over half of the elderly patients not receiving vaccine. The vast majority (>90%) of those received the
vaccine did so after a clear recommendation by their physicians. Discussion: Inadequate knowledge and false
beliefs about the influenza vaccines were the main cause of low vaccination rate among elderly. Physicians
advice and health education were the most potent influencer on raising the prevalence of elderly
Keywords: Flu vaccine, elderly, prevalence, knowledge, attitude, effect.


Elderly are very vulnerable to influenza
individuals above the age of 6 months as long as
infection. They constitute the vast majority of
they do not have a contraindication(6). However,
less than two-thirds of elderly individuals receive
mortality(1,2). Through influenza vaccine was
influenza vaccine(7). Seeking vaccination is
found to provide up to 100% protection to the
thought to be affected by many factors including
vaccinated young adult, this level is much less
the general knowledge and misperception about
among individuals 65 years. However, it
the efficacy, side effects, benefits or harms of the
provided a considerable protection against
vaccine, and previous experience(8­10).
morbidity and mortality of the disease(3).
Study rationale and objectives: This
Researchers stated that influenza vaccine had
research aimed at reviewing the literature to
significantly decreased hospital admission and
explore the prevalence of influenza vaccine among
deaths among elderly patients(4,5). The 2016­2017
the elderly in different countries, and at assessing
recommendations of the Advisory Committee on
the impact of knowledge on elderly vaccination
Immunization Practices (ACIP) recommend the
and the attitude towards it.
use of seasonal influenza vaccines to all

Received:17 /09/2017 DOI: 10.12816/0042248
Accepted: 26 /09/2017

Full Paper (vol.696 paper# 20)

c:\work\Jor\vol696_21 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2685-2689

Assessment of Knowledge and Attitude and Practice of Parents
towards Epilepsy among Children in Jeddah City
Maha Abdullah Al.Zubaidi1, Njood Mohammad Alsudairy1, Bayan Abdu Alzubaidi1,
RawanNashaat Joharji1, Samah Mohammed AlQurashi2, KhairyaAbdulrahman Alsadi1,
Areej Ahmad Abulela1
1-Ibn Sina National College,2-Umm Alqura University

Background: one of the most common neurological disorders among pediatrics is epilepsy. The lack of
knowledge about epilepsy would influence the life of affected children.
Objectives: considering the knowledge, attitude and practice (KAP) regarding epilepsy among children in
Jeddah City, Kingdom of Saudi Arabia (KSA).
Methods: this wasa cross sectional community survey design that was conducted from June to August
2017 on 930 adult Saudi parents. A pre-tested questionnaire was distributed among Saudi parents. The
questionnaire included the demographics of included subjects and the source of their information, the
knowledge, attitude and practice pattern. Results: all of the parents were heard before about epilepsy, but
most of them had poor knowledge regarding the cause of the disease, the nature of epilepsy as
neurological, but not mental disease and the surgical treatment of epilepsy. The majority of respondents
had negative attitudes toward the ability of epileptic children to had normal life. The level of practice was
inadequate among most of parents as most of them did not know how to deal with epileptic children with
seizures and most of them would avoid dealing with epileptic children. The KAP was inadequate among
78.2% of parents and was good among 21.8% of them.
most of Saudi parents had poor knowledge regarding the epilepsy that resulted in poor
attitude and practice misconceptions. The adequate education about epilepsy would increase the incidence
of disease management.
knowledge, attitude, practice, epilepsy, Saudi parents, Jeddah City, 2017.


among parents would result in positive attitude
Epilepsy is a common neurological
and practices toward their children thus lead to
condition that associated with recurrent seizures

and about4-8 cases from 1000 children suffered
proper management of epilepsy and decreasing
from epilepsyin the developing countries (1,
the complications among children (11-13). The
2). Also, the results from Arab countries showed
present study aimed at assess the knowledge,
high prevalence rates prevalence rates of 230
attitude and practice (KAP) of Saudi parents
cases per 105 in Libya, 650/105 in Saudi Arabia
toward epilepsy.
(3).The seizures are a temporary distress in the

cerebral function and cortical nerve cell activity
that results from irregular paroxysms. The
Study design
paroxysms would suddenly increase the improper
This was a crosssectional community
discharge from the cerebral neurons causing loss
survey design that was conducted at Jeddah City,
Saudi Arabia, from June to August 2017.
disturbance, psychic conditions or many be
complex of these symptoms (4, 5). The epileptic
Study population and sample size
patients may also suffer from stress, depression
This study included 930 subjects who
and psychosis (6, 7).The majority of epilepsy cases
were randomly chosen using multiple stratified
are idiopathic, but some other causes may induce
random sampling technique. The inclusion criteria
epilepsy including stroke, tumor of the brain,
were adult male or female parents, they had at
alcohol or drug abuse as well as brain injury (8-10).
least one child. The participants were interviewed
Genetic mutations also play a vital role in
in community pharmacies and private clinics
progression of epilepsy (8).There is a lack of
distributed in different parts of Jeddah City.
knowledge among community population about
Study tools

the epilepsy in KSA which was shown in different
The tool used in this study was a pre tested
studies. The proper awareness about epilepsy
questionnaire that was based on other studies
conducted in different parts of KSA among Saudi
Received: 20 /09/2017 DOI: 10.12816/0042249
Accepted: 29 /09/2017

Full Paper (vol.696 paper# 21)

c:\work\Jor\vol696_22 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2690-2693

Assessment of Community Knowledge toward Joint
Replacement Therapy in Jeddah City
Mohammed Hamad Al-Rumaih1, Basim Khalid AlHarthi2, Atif Abdullah Althobaiti2,
Khalid Ahmad Alghamdi2, Adel Abdulkareem Alhabili3, Rayan Abadel A Alsofyani2,
Hammad Abdulmughni Alshaikh3, Jaber Hathloul Muslim Alshammari4,
Anas Mustafa Makhdoum5, Abdulmalek Abdulrahman Aljulaihim6.
1-Imam Mohammed Ibn Saud Islamic University,2-Taif University,3-Cairo University,4-Hail University,
5-Taibah University,6-King Saud Bin Abdulaziz University for Health Sciences

the joint replacement surgery is a great advance in the orthopedic medicine with a longlife
promise of knee or hip reconstructive surgery which may exceeds 20 years old.
Objectives: this study aimed to evaluate the knowledge of community Saudi adults regarding the joint
replacement surgery in Jeddah City, Saudi Arabia (KSA), 2017.
Methods: this was across sectional community based survey and it was conducted from May to August
2017 in Jeddah city among 670 adult Saudi subjects who were interviewed at shopping malls and
community pharmacies. All the respondents answered a self-administrated questionnaire that considered
the knowledge of respondents toward joint replacement therapy.
Results: all the subjects heard before the term joint replacement therapy and the major source of
information was from friends and relatives. Only nine subjects (1.3%) have undergone hip or knee
replacement surgery. The level of awareness about joint replacement surgery was adequate in only 30.9%
of subjects and insufficient among 69.1% of subjects. The higher level of awareness was significantly
associated with old age. Conclusion: the level of awareness was inadequate among most of Saudi
participants about the causes and effects of the joint replacement surgery. There is urgent need for public
education about the joint replacement surgery to address the concerns and advantages of the surgery
through media, internet and health educational campaigns.
Keywords: knowledge, joint replacement surgery, Jeddah, 2017


The joint replacement surgery is a great
surveyed the complications and quality of life in
advance in the orthopedic medicine during the
Jeddah City(10), while another study assessed the
last five decades. The long life of knee or hip
patient's attitude toward the surgery (11).
reconstructive surgery may exceeds 20 years old
The knowledge and understanding of the
(1). The complications of some surgeries were
causes and biological aspects concerning the joint
associated with complications related to wear,
replacement therapy are important factors for
infection, chronic pain, improper implantation
improving the pain and physical activity (12).
and stiffness. Also, the rates of replacements are

dramatically increasing even among young (2-4).
Osteoarthritis and rheumatoid arthritisare
This study aimed to evaluate the knowledge
rated as the most common complication among
of community Saudi adults regarding the joint
elderly that would result in physical disability and
replacement surgery in Jeddah City, Saudi Arabia
higher rates of joint replacement (5). The surgery
(KSA), 2017.
had resulted in higher success rates in about 90%,

relieving the pain and improving the function of
osteoarthritis patients (6, 7). In Kingdom of Saudi
Study design
Arabia, the number of replacement surgeries is
This was a Cross-sectional community based
low in comparison with Western Countries. Also,
survey that was conducted from May to August
no national, long term studies or regional studies
2017 in Jeddah city.
were found in the literature regarding the
Study population and sample size:
outcomes, personal characteristics and quality of
A total of 670 adult subjects were included in this
life after joint replacement surgery.Some few
study after taking into consideration the number
studies in KSA were conducted to assess the rates
of adult population in Jeddah City using the web
of knee replacement surgery (8, 9); only one study
calculator with 5% error margin and 95%

confidence interval (13). The enrolled subjects

Received:21 /09/2017 Accepted: 30 /09/2017 DOI: 10.12816/0042250

Full Paper (vol.696 paper# 22)

c:\work\Jor\vol696_23 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2694-2697

Role of Prophylactic Thyroid Neck Dissection in Papillary
Thyroid Cancer
Hisham Sameer Alhathloul1, Mohammed Ahmed Almasabi2,
Abdulghani Mohammad Lodhi3, Atheer Majed Alghamdi4
1-King Faisal Unilversity,2-King Khalid University, 3-King Abdulaziz University,4-Almaarefa Colleges for
Science and Technology

the utility and efficacy of prophylactic central neck dissection with total thyroidectomy for
treatment of differentiated thyroid cancers has been debated in the literature over the past few decades.
Proponents of prophylactic central neck dissection support its routine use with the notion that it reduces local
recurrence, increases accuracy in TNM staging and reduces surgical morbidity associated with reoperation.
Conversely, those against the use of routine prophylactic central neck dissection argue there was no clear
evidence which showed a reduction in recurrence or added benefit to survival, while the procedure increased
the risk for complications and morbidity. This article discussed the role of prophylactic central neck dissection
in the setting of thyroid cancer and reviewed recently published literatures to evaluate efficacy and safety of
this procedure.The papillary thyroid carcinoma (PTC) is the most common disorder with favorable prognosis
around the world. PTC has 90% survival rate, but the most important challenge was the lymph node metastases
that would result in disease recurrence. There is a debate about the utility of prophylactic central neck
dissection in the area of PTC. The available studies for performing PCND showed a difficulty in predicting its
outcomes, but PCND could provide potential reduction in the recurrence rates and risks of performing another
surgery in the neck. This review discussed the PCND advantages compared to its long term outcomes and
Keywords: papillary thyroid carcinoma (PTC), prophylactic central neck dissection (pCND), metastases,
lymph node.


Differentiated thyroid cancer (DTC) is a major
because of there is a lack in the studies concerning
and most popular endocrine malignancy with a high
this issue (6, 13).
prevalence among other types of cancers around the
Also, the American Thyroid Association (ATA)
world (1). The papillary thyroid carcinoma (PTC)
Guidelines for DTC patients recommended the
represents about 85% of thyroid cancers and bout
addition of prophylactic central-compartment neck
35% of PTC patients had macrometastatic cervical
dissection (PCND) in PTC patients with clinically
lymph node metastases(2, 3).
uncomplicated central neck lymph nodes (cN0) or
Other studies showed an average of 60 % of PTC
clinically complicated lateral neck nodes (cN1b)(14).
patients developed cervical lymph node metastases

in the central compartment (4-6). In spite high
Definition of central Neck Dissection (CND)
mortality rates of cancer, the 5-10 years survival
Till now there is an inconsistent definition of
rate of PTC patients was above 90% (7).
what CND is and what itcontains (15, 16).The ATA
Total thyroidectomy (TT) surgery was the main
described the central compartment as a lymph node
corner stone in treatment of PTC, but about 15% of
compartment bounded from the superior part by the
patients underwent total thyroidectomy would
hyoid bone, from the inferior part by the
develop nodular recurrence, thus nodal metastases
innominate artery and from the lateral part by the
is an ideal prognostic factor for disease recurrence
common carotid arteries(15, 16).
(8, 9).
Also, it is bounded from the anterior and
The addition of prophylactic central neck
posterior parts by the superficial and deep layer of
dissection to the total thyroidectomy is a treatment
the deep cervical fascia. Also, as for the nodal
of choice for preventing neck metastases and
groups, it included the pre- and para-tracheal, as
recurrence of nodules (10-12). But this is still a debate
well as prelaryngeal lymph node basin (17, 18).
in DTC patients with clinically node-negative

Received: 19 /09/2017 DOI: 10.12816/0042251
Accepted: 28 /09/2017

Full Paper (vol.696 paper# 23)

c:\work\Jor\vol696_24 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2698-2702

Detection of Fluoroquinolones Resistance in Enterobacteriaceae and
Pseudomonas species Using Molecular Techniques
Amal Said Morsey Abdelmegeed, Hadia Hussein Bassim, Samia Abdou Girgis,
Sally Mohamed Saber, Dalia Hosni AbdelHamid and Ramy Mohamed Mahmoud
Department of Clinical Pathology, Faculty of Medicine- Ain Shams University
Corresponding author: Amaal Said, email: moon_14_ma@hotmail.com

: quinolone resistance is traditionally mediated by chromosomal mutations mutation of DNA
gyrase and/or topoisomerase IV or by the mutation of genes regulating the expression of efflux pumps, until
PMQR was described in a clinical isolate of Klebsiella pneumoniae in 1998. PMQR genes generally confer
low-level resistance, with their MICs falling below Clinical and Laboratory Standards Institute (CLSI)
breakpoints for intermediate resistance; therefore, their contribution to quinolone resistance can be masked in
strains also harboring QRDR mutations in gyrA and parC. However, their clinical significance stems from the
fact that they greatly facilitate the selection of more highly quinolone-resistant strains. Although the PMQR
mechanism only confers low-level resistance to FQs, its association with the occurrence of mutations in QRDR
can lead to clinically relevant resistance levels. These PMQR determinants are increasingly being identified
worldwide in clinical isolates of Enterobacteriaceae and Pseudomonas spp. Aim of the work: this study aimed
to identify different mechanisms of fluoroquinolones resistance and determine fluoroquinolones resistance
pattern among the studied isolates. Material and methods: this study was carried on 100 non duplicate
clinically relevant Enterobacteriaceae and Pseudomonas spp. recovered from clinical specimens referred to
Central Microbiology Laboratory, Ain Shams University Hospital for routine culture and sensitivity, aiming to
1) Determine the occurrence of plasmid-mediated fluoroquinolones resistance (PMQR) determinants by
multiplex PCR and chromosomal mutations by PCR-RFLP among Enterobacteriaceae and Pseudomonas spp.
in clinical specimens. 2) Identify different mechanisms of Fluoroquinolones resistance. 3) Determine
Fluoroquinolones resistance pattern among the studied isolates. Results: in this study we found that 77% of
FQs resistant isolates were positive to one or more plasmids, oqxAB was highest recovered PMQR among
Klebsiella. 78% were positive for gyrA mutations, gyrA gene mutations were higher in Pseudomonas, Asp-
87mutation was 56/78(72%) higher than Ser-83 mutation 38/78 (49%) isolates.
Keywords: Fluoroquinolones, Enterobacteriaceae, Pseudomonas, Molecular Techniques.


Quinolones are a family of synthetic broad
aminoglycoside-modifying enzyme (4). Although
spectrum antimicrobial drugs, they have been
chromosomal QRDR mutations in topoisomerases
widely used for the treatment of several community
play an important role in conferring a high level of
and hospital acquired infections, in the food
quinolone resistance, some of researchers believed
processing industry and in the agricultural field (1).
that PMQR may contribute to an increase in
Resistance has been reported with increasing
quinolone resistance in clinical isolates of
frequency in clinical isolates of Enterobacteriaceae
Enterobacteriaceae (5).
(2). The targeting of either DNA gyrase or
The level of resistance of Enterobacteria and
topoisomerase IV varies with bacterial species and
Pseudomonas aeruginosa to fluoroquinolone is
specific fluoroquinolone; however, as a broad
alarming and significantly increasing in Europe
generalization, the key target in gram-negative
bacteria is DNA gyrase, whereas in gram-positive
Considerably high fluoroquinolone resistance
among E. coli, Klebsiella pneumoniae and
preferentially targeted (3). Plasmid-mediated
Pseudomonas aeruginosa was reported by the
quinolone resistance (PMQR) genes are alternative
European Centre for Disease Prevention and
mediators of quinolone resistance or reduced
Control (ECDC) in Slovakia reached 41.9%, 70.6%
susceptibility, they encode DNA gyrase protection
and 58.7%, respectively. Assuming that such a high
proteins, efflux pumps and a variant of a common
rate of fluoroquinolone resistance may be
Received:2 /09/2017 DOI: 10.12816/0042252
Accepted: 11 /09/2017

Full Paper (vol.696 paper# 24)

c:\work\Jor\vol696_25 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2703-2710

Awareness about Causes and Risk Factors of Cataract among
General Population of Albaha City
Abdulrahman H.A. Alghamdi, Ali M.A. Alamri, Raed A.M. Alzahrani, Abdulrahman A.M.
Alghamdi, Saeed Y.S. Alghamdi, Fahad A.A. Dokhaikh, Osama H.A. Alhabi, Fares A.M. Alzahrani
Faculty of Medicine, Albaha University, Albaha, KSA
cataract is the most common age-related eye disease and the most treatable cause of visual
impairment and blindness in adults.
Aim of the work: this study aimed to assess the knowledge of Saudi population in Albaha city about
cataract and its risk factors. Methods: this was a cross-sectional study that included a representative
sample of 756 adults of the Saudi population in this region. Participants answered self-administered
questionnaires consisting of items assessing the knowledge about cataract.
Results: nearly half of the studed sample (50.5%) misunderstood cataract as a white membrane growing
over the eye, while only 222 (29.4%) realized it as an increase in eye lens opacity. Moreover, this study
revealed clearly deficient knowledge in the studied population about risk factors of cataract. High percent
of participants (84%) did not know that incidence of cataract increases with positive family history.
Likewise, there was a shortage of knowledge about the relationship of malnutrition, dehydration,
hypertension and ultraviolet rays and the development of cataract. Fortunately, considerable numbers
considered cataract as an age related disease and recognized that diabetes mellitus is a major precipitating
factor to cataract. Conclusion: Saudi population in Albaha city had poor knowledge towards cataract and
its risk factors. Hence, great efforts should be made to increase the knowledge and awareness of the
general public about this disease.
Keywords: cataract, Saudi population, survey, risk factors.


Cataract is any opacification of the lens
still the single most important risk factor for
of the eye, which may lead to increased light
cataract (4). Risk factors that have been associated
scattering. Lens opacities may result from protein
with cataract also included educational status (5),
phase separation, protein aggregation or
smoking (6), diabetes (7), sunlight exposure (8),
disturbance of the regular alignment or packing
body mass index (9) and drug use (10).
of the fiber cells. Sometimes increased coloration
Although cataract is often considered to be an
and subsequently decreased light transmission is
unavoidable consequence of aging, recent studies
found in cataracts with nuclear opacities (1).
of the risk factors associated with human cataract
Early-onset cataracts are responsible for a
identified some interventions that may prevent
relatively small percentage of visual disability,
cataract or slow its progression.
but age-related cataracts contribute to the
Despite being the leading cause of treatable
majority of all blindness worldwide. Cataracts
blindness, the lack of awareness about the disease
remain the leading cause of blindness in middle-
and its treatment is still a major hurdle in
and low-income countries. Approximately 90%
decreasing the blindness due to cataract in the
of visually impaired people live in developing
developing countries especially in the rural areas.
countries and most of all visual impairments can
Hence, we conducted a survey among general
be prevented or cured (2).
population in Albaha City to assess their level of
Cataract is one of the most expensive eye
awareness about cataract causes and risk factors.
diseases requiring care. Identification of its risk
Our specific objectives were to evaluate the
factors may help to arrange preventive and
degree of awareness about cataract causes and
treatment strategies in order to minimize the
risk factors; to measure people practices related
economic and public health burden of this disease
to the care, prevention and management of
(3). Cataract is a multifactorial disease that could
cataract and to increase the level of knowledge
have a genetic, socio-demographic, behavioral or
about cataract causes and risk factors among
environmental basis. Although it is likely that
people living in Albaha city, Saudi Arabia.
these factors interact with each other and age is

Received:21 /09/2017 DOI: 10.12816/0042253
Accepted: 30 /09/2017

Full Paper (vol.696 paper# 25)

c:\work\Jor\vol696_26 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2711-2721

Postnatal Developmental Changes of The Kidneys of The Albino Rat
Emtethal M. El-Bestawy, Ashraf S. Hegab, Reda A. Abdel Hamid and Amal S. Sewelam
Department of Anatomy and Embryology, Faculty of Medicine, Zagazig University
Corresponding author: Amal S. Sewelam, email: ali121212121213@yahoo.com, Phone: 00201155789552

Being a highly immature organ at birth, the rat kidney is morphologically as fetal when
compared with humans. Events that occur during fetal development might determine adult renal diseases.
Aim of work: This study aimed to characterize the postnatal developmental changes of the kidneys in albino
rats using light microscope from postnatal day (PND) 2 until PND 70. This may give references to
pathologists when evaluating juvenile toxicology studies.
Materials and Methods: Ten healthy pregnant albino rats were used in this study. Twenty-five of their
offsprings were obtained and divided according to age into five groups of 5 pups each. Group A: studied at
PND 2. Group B: studied at PND 10. Group C: studied at PND 20. Group D: studied at PND 30. Group E:
studied at PND 70. Kidneys were removed, processed for light microscopic study and 5 m thick paraffin
sections were obtained and stained with hematoxylin and eosin stain.
Results: Light microscopic examination of the renal cortex at PND 2 revealed subcapsular nephrogenic zone
contained immature renal developmental stages, juxtamedullary zone contained formed glomeruli with
medullary rays between the two zones. The renal cortex acquired maturation centrifugally with the
superficial nephrons was the last to mature by PND 20. The papilla was the most mature region of the kidney
and at PND2; it had the structural composition of the inner stripe of outer medulla. The papillary maturation
involved a process of tubular elongation and increase in the interstitium until reaching adult structure by
PND 20. At PND 2, the medulla was the most immature zone being formed of islets of tubular structures
among abundant interstitium with high degree of undifferentiation. Its maturation involved tubular
elongation and decrease of the interstitium with the outer medulla was the last to mature as late as PND 30.
Consequently, the medulla remained immature for a relatively long postnatal period, in comparison to the
other kidney regions.
Conclusion: It was concluded that, rat kidney is immature at birth and kidney sub regions mature at different
rates during postnatal development. The papilla was the first to mature (PND 20) followed by the cortex
(PND 20) and finally the medulla (PND 30).
Keywords: postnatal development, kidney, rat.


The mammalian kidney is a highly vital organ that
the mature adult kidneys present certain
eliminates nitrogenous waste, maintains blood
susceptibilities to toxic injury. As renal tubular
volume, composition and pressure and keeps bone
transport capacities vary with maturation also, the
density (1). Its development includes three excretory
degree of nephrotoxicity may vary with maturation
organs, the pronephros, the mesonephros which are
(3). Nephrons number is highly dependent on
transitory and the metanephros (2) which is
factors that regulate ureteric bud (UB) growth and
permanent. Development of the metanephros is a
nephrogenesis during development (4). Metanephric
two stage processes, the first involves inductive
development begins at 5th week gestation in
interaction between ureteric bud and metanephric
human and at 10.5 days postcoitum in mouse when
mesenchyme and the second involves nephron
the ureteric bud protrudes from the distal portion of
development. Renal functional capability begins
the mesonephric duct (5). This process of
early with formation of fetal nephron and becomes
metanephrogenesis is completed in humans in
rapid after birth until reaching adult levels. The
utero before 36th week of gestation, while in mice
morphologic and physiologic characteristics that
and rats it is completed at about 7-10 days
differentiate the fetal and newborn kidneys from
postnatal (6).

Received:16 /09/2017 DOI: 10.12816/0042254
Accepted: 25 /09/2017

Full Paper (vol.696 paper# 26)

c:\work\Jor\vol696_27 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2722-2729

Articular Cartilage Mapping through Novel Advances in
MRI Techniques
Mahmoud Eldoukali Ali Zreaba, Mohamed Amin Nassef, Amgad Samy Abdel Rahman
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University

Magnetic resonance imaging (MRI) has emerged as a useful tool for clinicians and scientists
to assess the health of cartilage and other soft tissues. Conventional MRI provides sufficient tissue contrast
to detect morphological changes in cartilage where radiography cannot. However, changes in cartilage
physiology prior to morphological changes cannot be visualized or measured with conventional MRI. The
recent advances in MR sequences together with the implementation of higher resolution MRI due to high-
field MR systems as well as sophisticated coil technology have overcome existing limitations and led to
promising in vivo approaches in morphological and biochemical MRI of cartilage. Recently, quantitative
MRI techniques such as T2, T2*, dGEMRIC (delayed gadolinium-enhanced MRI of cartilage), sodium
imaging ((23)Na), chemical exchange saturation transfer (CEST), diffusion weighted imaging (DWI) and
T1rho mapping have been shown to be sensitive to biochemical changes in cartilage. Advanced magnetic
resonance (MR) sequences for cartilage evaluation are focused on the assessment of articular cartilage
biochemical composition, more specifically to the collagen and glycosaminoglycan content.
Aim of the Study: The aim of this work is to emphasize the role of new advances of magnetic resonance
imaging in diagnosis of cartilage disease.
Conclusion: MRI provides a powerful solution for noninvasive imaging. Improvements have been made in
morphologic imaging of cartilage in terms of contrast, resolution, and acquisition time. These
improvements allow detailed maps of the cartilage surface to be developed that can be used to quantify both
thickness and volume.
Keywords: MRI of cartilage, cartilage mapping, glycosaminoglycan, T2, T2*, dGEMRIC (delayed
gadolinium-enhanced MRI of cartilage, MR sequences.


Magnetic resonance imaging (MRI) has
tissue. It is generally accepted that a combination
emerged as a useful tool for clinicians and
of sequences is necessary for comprehensive
scientists to assess the health of cartilage and
other soft tissues. Conventional MRI provides
Essential requirements for evaluation of hyaline
sufficient tissue contrast to detect morphological
cartilage include high in plane and through plane
changes in cartilage where radiography cannot.
resolution and optimal SNR and CNR, thereby
However, changes in cartilage physiology prior
avoiding partial volume artifacts and allowing
to morphological changes cannot be visualized
differentiation from surrounding fluid and
or measured with conventional MRI (1).
tissues. To this end, utilization of high field
The recent advances in MR sequences together
strength scanners and dedicated coilsis strongly
with the implementation of higher resolution
advised (3).
MRI due to high field MR systems as well as
Significant advances have been made in
sophisticated coil technology have overcome
characterizing, quantifying, and standardizing
existing limitations and led to promising in vivo
the specific morphological as well as
approaches in morphological and biochemical
biochemical changes in patients with cartilage
MRI of cartilage (2).
pathologies. Besides the exact evaluation of the
Since the introduction of MRI evaluation of
cartilage defect, respectively, the cartilage
joints, there has been a quest for MRI sequences
degeneration, also the specific therapeutical
that optimize articular cartilage evaluation. Over
approaches, can be assessed in best possible
time, increased signal to noise ratio (SNR),
fashion noninvasively (2).
contrast to noise ratio (CNR) and acquisition
As structural cartilage damage is preceded by
speeds have become available, along with coil
biochemical alterations such as proteoglycan
and scanner improvements. Despite this, there is
loss, or changes in the collagen matrix, there is a
currently no single specific sequence that allows
substantial interest in detecting such changes in
for one stop shopping evaluation of this complex
the course of cartilage disease/injury or after

cartilage repair (4). Recently, quantitative MRI
Received:2 /09/2017 DOI: 10.12816/0042255
Accepted: 11 /09/2017

Full Paper (vol.696 paper# 27)

c:\work\Jor\vol696_28 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2730-2735
Congestive Heart Failure in Patients with Chronic Kidney Disease on Dialysis
Saud Mohammed Saeed Alshahrani1, Saeed Abdulrahman Saleh Alghamdi1,
Ali Saeed Kadasah1, Mohammed Saeed Kadsah2, Shubayli Hassan Hayazi Alshehri1,
Sultan Khalid Saeed Kadasah1, Mohammed Abdullah Mohammed Alqarni1,
Mohammed Sharaf Saad Alshahrani1, Abdullah Mohammed Hassan Alsuayri1
1 King Khalid University, 2 Misr University for Science and Technology
Corresponding Author: Saud Mohammed Saeed Alshahrani - s.semran@hotmail.com - 009665529991886

chronic kidney disease can lead to end stage renal disease which would require the patient to be
on dialysis. Kidney diseases predispose patients to many complications, such as cardiovascular,
hematological, endocrinological, and others. For a patient who is on dialysis, the damaging processes on the
cardiovascular system resulting in congestive heart failure are accelerated, making it the biggest cause of
mortality. Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed,
and EMBASE, January 2001, through February 2017. The following search terms were used: chronic kidney
disease, end stage renal disease, congestive heart failure, indications of dialysis, hemodialysis, complications
of dialysis, congestive heart failure in dialysis patients. Aim: in this review, we aim to evaluate the incidence,
prevalence, pathogenesis, and outcome of congestive heart failure in a patient who is on dialysis due to
chronic kidney disease. Conclusion: Congestive heart failure and chronic kidney disease patients on dialysis
have a very bad prognosis of only three years, and there has been no improvement in prognosis from over
twenty years. More studies and researches must be conducted in this topic in order to come up with better
Keywords: Chronic kidney disease, congestive heart failure, heart failure on dialysis, pathophysiology of
congestive heart failure with chronic kidney disease.


Chronic kidney disease (CKD) is a word
are irrespective of the cause of the CKD or the
that covers all degrees of declined renal function.
presence or absence of other comorbidities [3].
The guidelines have defined CKD as a decreased
The typical life expectancy of a patient on
glomerular filtration rate (GFR) of less than 60
hemodialysis is less than 3 years, and unfortunately,
mL/min/1.73 m2 for a minimum of 3 months
hasn't changed in over 20 years (2). CKD is
despite of the primary etiology. Kidney disease is
associated with an increased risk of developing
the 9th leading cause of death in the United States of
cardiovascular disease, chronic renal failure,
America. CKD is classified as stages form 1 to 5
hypertension, anemia, protein loss, platelet
based on the decreasing amount of GFR, where
dysfunction, fatigue, and overall decreased quality
stage 5 is the worst with a GFR <15 mL/min/1.73
of life. Cardiovascular disease remains the greatest
m2, or those requiring dialysis [1]. End stage renal
cause of mortality in patients with ESRD, and it
disease (ESRD) is described as a condition of
accounts for 53% of all deaths with a known cause
individuals with CKD, who necessitate renal
in dialysis patients. It is assessed that up to 36% of
replacement therapy. There are two types of renal
all people with ESRD already have congestive heart
replacement therapy, which are dialysis or
failure (CHF) at the beginning of dialysis, while
transplant. ESRD is the most dreaded complication
another 25% of dialysis patients progress to de-
of CKD [2]. Indications for renal replacement
novo CHF. The yearly incidence of such
therapy comprise presence of any of the following:
occurrence is 7% (4). The patho-biological processes
that reinforce the severity and advancement of
intractable volume overload, encephalopathy,
cardiovascular disease in CKD include hastened
pericarditis, failure to thrive and malnutrition,
atherosclerosis and constant reduction in the
peripheral neuropathy, intractable gastrointestinal
function of left ventricular (LV) as the renal
symptoms, and in asymptomatic patients with a
function declines, and when that patient is on
GFR of 5-9 mL/min/1.73 m˛. The listed conditions
hemodialysis, these processes are accelerated [3].
Received: /08/2017 DOI: 10.12816/0042256
Accepted: /08/2017

Full Paper (vol.696 paper# 28)

c:\work\Jor\vol696_29 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2736-2742

Emergency Management of Stroke
Nedaa Mohammed A. Alromail1, Mahmoud Shehab Halawani2, Imtinan
Abdulrahman Malawi2, Jumanah Sahal Malibari3, Abdulrahman Mubarak
Almutairi4, Abdullah Abdulziz Alsaib5, Bejad Nasha AL-Osaimi6, Asmaa Idris Ali2,
Faisal Abdulrahman Althobaiti6, Lamma Abdulmohsen A Alghiryafi3
1 King Saud University, 2 Batterjee Medical College for Sciences and Technology, 3 Umm Alqura
University, 4 Majmaah University, 5 King Abdulaziz University, 6 Taif University
Corresponding Author: Nedaa Mohammed A Alromaili ,email:Alromailinedaa@gmail.com,mobile:b0599306646

A stroke takes place when the blood supply to the brain is interrupted or there is bleeding in the brain.
Within a short time, brain cells starts to die. It is critical to seek emergency care at the first sign of a stroke.
Early treatment saves many lives and decreases the effects of stroke. If brain cells die or are damaged as a
consequence of a stroke, symptoms take place in the parts of the body that these brain cells control.
Examples of stroke symptoms comprised sudden weakness, paralysis or numbness of the face, arms, or legs
(paralysis is an inability to move), trouble speaking or understanding speech and trouble seeing. A stroke is
a serious medical condition that requires emergency care and may cause lasting brain damage, long-term
disability or even death.
Keywords: stroke, thrombolytic therapy, emergency management, ischemic stroke, prevention.


Acute ischemic stroke (AIS) is described by
anticipated to triple, to $184.1 billion, with most of
the sudden loss of blood flow to an area of the
the anticipated increment in costs emerging from
brain, normally in a vascular territory, causing in a
those 65 to 79 years old [5]. Ischemic and
corresponding loss of neurologic function.
hemorrhagic stroke can't be dependably separated
Additionally, earlier it was called cerebrovascular
on the premise of clinical examination discoveries
accident (CVA) or stroke syndrome, stroke is a
alone. Advance assessment, particularly with
nonspecific condition of brain damage with
tomography [CT] scanning or magnetic resonance
pathophysiologic reasons [1]. Strokes can be
imaging [MRI]) is necessary.
distributed into 2 types: hemorrhagic or ischemic.

Acute ischemic stroke is caused by thrombotic or
embolic occlusion of a cerebral artery.
· Data Sources and Search terms
Hemorrhagic stroke is less mutual than ischemic
We conducted this review using a comprehensive
stroke (i.e., stroke initiated by thrombosis or
search of MEDLINE, PubMed, EMBASE,
embolism), epidemiologic investigations showed
Cochrane Database of Systematic Reviews and
that only 8-18% of strokes were hemorrhagic [2].
Cochrane Central Register of Controlled Trials
On the other hand, hemorrhagic stroke is allied
from January 1, 1980, through August 31, 2017.
with higher mortality rates than in case of
· Data Extraction
ischemic stroke [3].
Two reviewers independently reviewed studies,
Patients with hemorrhagic stroke may show
abstracted data and resolved disagreements by
focal neurologic shortages like those of ischemic
consensus. Studies were evaluated for quality. A
stroke, but have a tendency to be sicker than are
review protocol was followed throughout.
patients with ischemic stroke. Nevertheless,
The study was approved by the Ethics Board of
patients with intracerebral bleeding probably had
King Saud University.
headache, nausea and vomiting, seizures, altered

mental status and marked hypertension. About
Signs and symptoms
800,000 individuals endure strokes every year in
Patients with intracerebral bleeds are more
the United States. Nearly, 82-92% of these strokes
likely than those with ischemic stroke to have
were ischemic. Stroke is the fifth driving reason
headache, altered mental status, seizures, nausea
for grown-up death and incapacity, bringing about
and vomiting, and/or marked hypertension. Even
$72 billion in yearly cost [4]. Between 2012 and
so, none of these findings reliably distinguished
2030, add up to coordinate therapeutic stroke-
between hemorrhagic and ischemic stroke [6-8].
related expenses are
Received:21 /09/2017 DOI: 10.12816/0042257
Accepted: 30 /09/2017

Full Paper (vol.696 paper# 29)

c:\work\Jor\vol696_30 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (6), Page 2743-2749
Diagnosis and Management of Thyrotoxicosis
Awatif Ahmed Althubyani1, Alaa Jamal Akbar2, Mohammed Mahmoud Alenezy2,
Abdulilah Ateeq Alsolami2, Saleha Ahmed Aleid3, Saud Abdullah Naser Alasmi1,
Al Qahtany. Faisal Hani M3, Yazeed Waleed O Alfadl1, Mohammed Taha A Alnoor1,
Manar Ibrahim Y Sangoura1, Waleed Eid Alraddadi1, Afnan Shukri A Sharourou4
1- Ibn Sina National College, 2- King Abdulaziz University ,
3- Imam Abdulrhman Bin Faisal University, 4- Royal College of Surgeons in Ireland
Corresponding Author: Awatif Ahmed Althubyani - Tofe3636@hotmail.com - 0553348289

thyrotoxicosis is a hypermetabolic state due to excessive amounts of thyroid hormone in the
circulation. There are several causes and the worst presentation is a thyroid storm, which is an endocrinal
emergency. Clinically, thyrotoxicosis can present vaguely leading to misdiagnosis and mismanagement.
Aim of the work:
this study aimed to understand the clinical presentation of thyrotoxicosis, its diagnosis and
ways of management.
Methodology: we conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE from January 1987 to March 2017.
Conclusion: due to its vague presentation, thyrotoxicosis can be misdiagnosed and managed wrongly, leading
to life threatening condition called thyroid storm. Health care physicians must keep a high degree of suspicion
in order to provide prompt therapeutic measures to avoid complications as well as death of patient.
Keywords: thyrotoxicosis, diagnosis of thyrotoxicosis, thyroid storm, management of thyroid storm, anti-
thyroid drugs, thyroidectomy


Hyperthyroidism is defined more than normal
including delirium, anorexia, atrial fibrillation,
production of thyroid hormone by the thyroid gland
congestive heart failure (CHF), osteoporosis,
and release into circulation which results in
thromboembolism, muscle weakness, altered mental
excessively high levels in serum. This out of
status and even death. People at higher risk for
proportion amount of hormone leads to a speeded
serious complication included pregnant women,
up metabolic state. The common causes are diffuse
elderly and children. It is vital that the emergency
toxic goiter also known as Grave's disease, toxic
medicine provider keeps a high clinical suspicion
multinodular goiter and toxic adenoma [1].
for thyrotoxicosis in patients with a cluster of
Thyrotoxicosis, on the other hand, refers to an
apparently unrelated symptoms. Thyroid storm
acute hypermetabolic state that gives rise to an
needs to be recognized rapidly and managed
excessive amounts of serum thyroid hormone, but
aggressively in order to avoid multi-organ failure
also consists of extrathyroidal sources of thyroid
and death [1].
hormone for instance exogenous intake or release of

preformed stored hormone from the glands. A
frequent cause of thyrotoxicosis is thyroiditis which
· Data sources and search terms
is inflammation of the thyroid gland leading to
We conducted this review using a comprehensive
release of the stored hormone.
search of MEDLINE, PubMed and EMBASE, from
Clinically, thyrotoxicosis presentation can vary
January 1987 to March 2017. The following search
from asymptomatic to a life threatening thyroid
terms were used: hyperthyroidism, thyrotoxicosis,
storm. Thyroid storm is an absolute endocrine
diagnosis of thyrotoxicosis, thyroid storm,
emergency. Its diagnosis is derived from history,
management of thyroid storm, anti-thyroid drugs
signs,symptoms and laboratory findings [2].

Thyroid hormone impacts every organ system
· Data Extraction
and therefore, can result in a mixture of complaints
Two reviewers have independently reviewed the
that are challenging to recognize. Moreover, if
studies, abstracted data and disagreements were
undiagnosed, it can result into serious complications
resolved by consensus. Studies were evaluated for

Received: 21/09/2017 DOI: 10.12816/0042258
Accepted: 30/09/2017

Full Paper (vol.696 paper# 30)