c:\work\Jor\vol697_1 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2750-2753

Sleeping Disorders among Medical Students in Saudi Arabia; in Relation to
Anti-Insomnia Medications
Muath S. AlQahtani, Talal M. Alkhaldi, Abdullah Mutib Al-Sultan, Abdulelah S. Bin Shihah,
Ahmed Saad Aleid, Ziyad Khater Alzahrani, Khalid Hisham Alfaryan
College of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU)
Riyadh, Saudi Arabia

due to their demanding lifestyle, sleep deprivation is common amongst the medical students.
A study, which followed 1,007 young adults at a health maintenance organization for 3.5 years, found that a
history of insomnia predicted new-onset depression, also other psychiatric disorders. Another study showed
that sleeping disorders and insomnia are negatively associated with academic performance in medical
students in Saudi Arabia. The relationship between sleeping disorders among medical students in Saudi
Arabia; about anti-insomnia medications is insufficiently addressed in the literature. This study aimed to
assess the relationship between sleep habits and sleep duration with academic performance in the medical
students. Objectives: this study aimed to determine sleep pattern disorders among medical students, as well
as, the use of anti-insomnia medications and alsoto define the relation regarding the academic performance
among the sample medical students in Saudi Arabia.
this is a cross-sectional study which was conducted among the medical students at three
different medical schools, Riyadh, Saudi Arabia from May 2014 to December 2014.. A self-administrated
randomized questionnaire was developed and designed in the Arabic language in the form of multiple
choices and short answers, concerning age, gender, educational level, grade point average GPA, financial
status, total sleep hours per day, mid-day naps duration, quality and latency of sleep and using of anti-
insomnia medications. Epworth Sleepiness Scale (ESS) was also involved in the questionnaire. Results: out
of 276 received questionnaires, 237 questionnaires were completed. Out of those 237 subjects, 92 subjects
were female students (38.7%), and 145 were male students (60.9%). The mean age was 22 ±2.37.
Regarding GPA, 122 participants got below average GPA, 28 participants got average GPA, 62 participants
got an average GPA, while 25 participants got an excellent GPA (51.3%, 11.8%, 26.1%,10.5%
respectively). 127 of the participants were used medications to help them to sleep, and 9.7% used it
occasionally, whereas 110 of the participants did not use any medication. Out of 127 participants who used
the medications, 92.5% of them agreed that medications they took were helpful and effective.Conclusion:
this study showed a significant relationship between the use of anti-insomnia medications and the academic
performance of medical students, further committee and education should be established by the universities
and faculties to enhance the student's awareness to the issue of the chronic use of anti-insomnia
medications at first and to apply a perfectly healthy environment with less stress and condensed classes and
Keywords: sleep, sleeping disorders, anti-insomnia, Saudi Arabia.


Sleep is an essential part of a human being's
quantity, trouble getting to sleep and trouble
life. An average person spends about 7 - 9 hours
maintaining sleep (1).
per day sleeping. Sleeping is crucial for promoting
A general consensus has developed from
efficient thinking and daily physical performance.
population-based studies that approximately 30%
Sleeping disorders are defined as problems with
of a variety of adult samples drawn from different
sleeping, including trouble falling or staying
countries reported one or more of the symptoms of
asleep, decreased sleeping , sleeping at the wrong
insomnia: difficulty initiating sleep, difficulty
times, too much sleep or abnormal behaviors
maintaining sleep, waking up too early and in some
during sleep. Insomnia is a broad term used to
cases, nonrestorative or poor quality of sleep (2). A
describe a wide range of complaints relating to
study, which followed 1,007 young adults at a
disorders of sleep. For many people, insomnia is a
health maintenance organization for 3.5 years,
subjective complaint of dissatisfaction with sleep,
found that a history of insomnia at baseline not
including decreased sleep quality, decreased sleep
only predicted new-onset depression, but also other

Received: 18/09/2017 DOI: 10.12816/0042561
Accepted: 27/09/2017

Full Paper (vol.697 paper# 1)

c:\work\Jor\vol697_2 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7) , Page 2754-2770
Influence of Age on Aluminum-Induced Hepatotoxicity in the Male Albino Rat
Soheir Ibrahim Saleh, Ashraf Ramzy Youssef, Shereen Adel Saad and Mona Nabil Mohamed
Human Anatomy and Embryology Department, Faculty of Medicine, Ain Shams University
Corresponding author: Mona Elgendy, email: monaelgendy503@gmail.com

aluminum is the third most common element in the earth's crust and is about 8% of its total
mineral components. It is widely used in antacid drugs, food additives and tooth pastes. Moreover, it is added
to the drinking water for purification purposes. It is also the metal of choice in making several household
cookware and storage utensils despite its toxic effects.
Aim of the work:
this study aimed to describe the histological changes which occurred in liver of rats
exposed to aluminum and also to clarify whether those changes were related to the age of the experimental
animals or not.
Material and methods: 32 male albino rats were used in this study, 16 adults and they were weighing
150-180 gm and 16 senile and they were weighing 400-450 gm. Group I: was consisted of 16 adult male rats.
This group was categorized into two equal subgroups; subgroup IA and subgroup IB. Group II: was consisted
of 16 senile male rats. This group was categorized into two equal subgroups; subgroup IIA and sub group IIB.
Subgroups IA and IIA were served as control and received distilled water. Subgroups IB and IIB received
aluminum chloride in a dose of 475 mg/kg body weight by gastric gavage once daily for three weeks. At the
end of the experiment, liver specimens were collected, processed for paraffin blocks and semithin sections and
examined by light microscope.
Results: liver sections obtained from adult rats received aluminum chloride showed disrupted and
discontinuous liver capsule, disorganized hepatic architecture, affection of the hepatocytes especially those
under the liver capsule which had small darkly stained nuclei and dilated, distorted and slightly congested
central veins. Most of the blood sinusoids appeared either narrow and obliterated or congested. The portal
triads showed vascular congestion and dilatation, proliferation of the bile ducts with slight increase in the
collagen deposition around the portal triads. Sporadic positive PAS reaction within the cytoplasm of the
hepatocytes was also noticed in liver sections stained with PAS stain. Semithin sections stained with toluidine
blue showed well circumscribed vacuoles of different sizes inside and outside the hepatocytes. On the other
hand, liver sections obtained from senile rats received aluminum chloride showed the same previous changes
that occurred in the adult group, but they were exaggerated and there were additional changes such as the
presence of irregular homogenous materials and tiny vacuoles in the cytoplasm of most of the hepatocytes.
Conclusion: oral administration of aluminum chloride in rats resulted in degenerations in the liver and
that was conclusive of toxic hepatitis. These changes were exaggerated among the senile rats which proved
that senile rats are more susceptible to the hepatoxicity induced by aluminum. Therefore, it is advised to create
awareness among people especially the senile ones about the hazards of extensive use of aluminum.
Keywords: effect, liver, aluminum, toxic hepatitis


Aluminum is the third most common
effect (5). Previous studies showed that aluminum
element in the earth's crust and is about 8% of its
may cause several neurodegenerative diseases, such
total mineral components (1). It is widely used in
as Parkinson's disease, Alzheimer's disease,
antacid drugs, food additives and tooth pastes (2).
amyotrophic lateral sclerosis, Guam-Parkinson's
Moreover, it is added to the drinking water for
dementia and dialysis encephalopathy (6-9).
purification purposes (3). Aluminum remains the
On the other hand, the liver is a pivot
metal of choice in making several household
organ and it is one of the target organs of aluminum
cookware and storage utensils despite its toxic
burden because it is involved in the detoxification
effects (4). Although small amounts of aluminum are
and the metabolism of toxic metals. Most of other
absorbed via the gastrointestinal tract, oral intake
studies on aluminum hepatotoxicity have been
represents the route with the highest toxicological
based on biochemical analysis (10). Elevation of liver
Received: 23/08/2017 DOI: 10.12816/0042562
Accepted: 2/09/2017

Full Paper (vol.697 paper# 2)

c:\work\Jor\vol697_3 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7) , Page 2771-2776

Causes and Management of Postoperative Fever
Talal Hamid Alfallaj1, Rakan Abdullah Mohammed Aljaafary2, Nouf Ali Alqahtani3,
Khloud Abdulrahman Altowirqi3, Fatmah Ibrahim Alabdullah4, Sara Faisal Bagdood3,
Ali Mohammed Alibrahim5, Asaad Saleh Radwan2, Hassan Mohammed Barnawi6,
Zainab Redaa Alghanim4, Aqeel Ghassan Alhashim4, Eyaad Talat Ghallab7
1 Dow University Of Health Sciences, 2 King Abdulaziz University, 3 Ibn Sina National College,
4 Imam Abdulrahman Bin Faisal University, 5 Tainjin Medical University ­ China,
6 Taibah University, 7 King Abdullah Medical Complex Jeddah
Corresponding Author: Talal Hamid Alfallaj - Alfallaj_Talal@Hotmail.Com - 054 933 1199

Postoperative fever presents a frequent and at times, thorny issue for the clinician. Whereas fever is
frequently a normal phenomenon in the prompt post-surgical period, massive amounts of resources are used
each day in the quest of more unfavorable diagnoses. The occurrence of a postoperative fever is not always
suggestive of an infectious process. Mild temperature rise might be transient in nature and can emerge from
the body's reaction to tissue damage. Fevers that present from two to more than seven days after a surgical
procedure can be caused by other physiological reactions. Perioperative nurses can target nursing
assessments according to the postoperative day on which the fever presents.
Keywords: Fever, Postoperative, Body Temperature, Management, Fever Timing.


Fever is common amid postoperative patients;
defined as postoperative. Fever was allied with a
so that postoperative fever is a known term in the
significantly higher severity of illness (by
literature even though the fact that the syndrome
APACHE II score), but not among those with
has not been well characterized. Furthermore,
"postoperative fever." Fever itself was not
postoperative fever is broadly believed to be
associated with increased mortality, although
benign and frequently ascribed to non-infectious
prolonged fever (>5 days, usually due to infection)
causes [1, 2]. It is assessed that 27-45% of patients
was associated thusly. In contrast, early
in intensive care units (ICUs) are febrile at some
postoperative fever ensues in fewer than 15% of
point [3,4]. Several examinations show that the
non-critically ill patients [10]. The causes of
cause of fever in the ICU is similarly likely to be
postoperative fever require better definition [2].
infectious or non-infectious [5, 6]. Among surgical
There are several potential causes, including the
patients, fever is more likely because of infection
pro-inflammatory response to tissue injury and
as the time interval following surgery increases.
surgical stress, the infection that required surgical
Normal body temperature includes an extensive
treatment among emergency surgery patients,
variety of values, but for practical purposes a
occult community-acquired infection, and surgical
fever has been defined as 38.3oC (100.4o F) and
site infections. Potential non-infectious causes
above in ICU patients and may be defined as such
include tissue ischemia/infarction, hematoma,
in surgical patients [5, 7]. In the first 48 hours of
the postoperative period a fever is nearly always
controversially, atelectasis. Patients may have
non-infectious in origin. The inflammatory
more than one cause of fever, and infectious and
mechanisms accountable for postoperative fever
non-infectious causes may co-exist. Among
have been the subject of a number of studies.
patients with purely infectious causes of fever,
Tissue damages alone results in the disruption of
multiple infections may co-exist [10]. The
phospholipids from the cell membrane, leading to
evaluation of fever can be protracted and costly [11]
a cascade of prostaglandins and cytokines which
due to the low yield of many diagnostic tests, and
ultimately lead to a body temperature elevation [8].
eventually, in as many as 30% of cases [9], the
Nevertheless, fever that continues beyond 96
cause of postoperative fever may never be found.
hours normally warrants further attention.
Nevertheless, fever is one clinical indicator of
In a prospective observational study of 93
the pro-inflammatory state identified as systemic
ICU patients, nearly 70% of whom had
inflammatory response syndrome [12], which does
experienced elective surgery, a temperature
not have benign significances for surgical patients,
elevation to at least 38.4°C was present in 65
particularly when persistent or fully manifest.
cases (70%), more than half of which were simply
Talmor et al. [13] studied 2,300 consecutive
Received: 21/09/2017 DOI: 10.12816/0042563
Accepted: 30/09/2017

Full Paper (vol.697 paper# 3)

c:\work\Jor\vol697_4 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2777-2782
Ultrasound and Computed Tomography in Abdominal and Pelvic Diagnoses
Ibrahim Abdullah Abdulrazaq Albakri1, Refah Saad Al-Qahtani2, Maher Ghazi Alsharif2, Hadil
Mohammed Alenezi3, Ghaida Mohammad Ahmad2, Ahmed Sulaiman Aljuhani2, Salman Ali Alaliwi4,
Abdullah Mohammed A. Alqarni5, Abdullah Ali Alkhalifa6, Doaa Yousif Alamri7, Mohammed Abobakr
Hassan Balkheir8, Fatimah Abduladhim Alabudib9
1 -Najran University, 2- King Abdulaziz Hospital, 3- Northern Border University,
4 -Arabian Gulf University, 5- King Khalid University, 6- Ministry Of Health, 7 -Taiba University,
8- Albaha University, 9 -Imam Abdulrahman Bin Faisal University
Corresponding Author: Ibrahim Abdullah Abdulrazaq Albakri , email: e_al.bakry@windowslive.com, Tel: 00966539390353

the major imaging modalities used in diagnosis of pelvic and abdominal conditions ranged from
X-ray, ultrasonography, computed tomography and many more. In each different kind of disorder; a different
modality is preferred based on the nature of disease, the patient and the hospital where the management is
provided. Some conditions require more than one source of imaging. Aim of the work: this study aimed to
discuss various abdominal and pelvic pathologies separately to explore the preferred type of imaging modality.
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: ultrasound versus CT, acute
abdomen imaging, abdominal radiology and pelvic pain diagnosis
Conclusion: various disorders and conditions required different modality of imaging and a health care
provider must be well informed of the benefits and risks and be able to weigh in order to make use of the most
appropriate imaging technique.
Keywords: ultrasound, computed tomography, acute abdomen, pelvic pain, gynecologic emergency, radiology


Conventional radiography has been substituted
theoretical risk of cancer.
by ultrasound (US), computed tomography (CT),
With an estimated 2% of future cancers being
and sometimes magnetic resonance imaging (MRI),
triggered just by CT scans; clinicians need to decide
in the evaluation of acute abdomen.
methods to reduce this exposure. The second issue
Although CT is the choice of investigation for
is that the scanners are costly and not accessible in
the right and left lower quadrant and diffused
all medical practice environments, predominantly in
abdominal pain, US remain the choice of
developing countries. Lastly, in certain cases,
investigation in case of right upper quadrant pain.
administration of oral and/or rectal contrast is
Ultrasound, CT and MRI all have various
favored, leading to lengthy emergency department
advantages and disadvantages over each other and
(ED) length of stay and when intravenous (IV)
each has its roles, which may not often
contrast is administered, there is a hazard of allergic
interchangeable. The risks of ionizing radiation with
reaction and nephrotoxicity [2].
CT must always be considered, predominantly in
Ultrasound has the major benefit of safety due
young and pregnant patients.
to no ionizing radiation, cost, accessibility and it can
A non-ionizing alternative such as US or MRI
be repeated as often as required. However, it is
should be chosen in those cases if feasible and if it
considered as more operator-dependent than the
is likely to produce as much diagnostic information.
other techniques. MRI also does not use ionizing
Nevertheless, if justified by understanding the
potential benefit outweighing the risk, CT must be
contraindications such as metallic medical devices
performed and the patient can be reassured about
like pacemakers and claustrophobia.
the possible future risks [1]. Despite its greater
It is also comparatively expensive and access is
sensitivity, there are at least three difficulties with
limited, especially to general practitioners. We
abdominal CT. The first is that the investigation
discussed several abdominal and pelvic pathologies
involves exposing the patient to ionizing radiation,
separately to explore the preferred type of imaging
which carries a distinguished, nonetheless
modality [1].
Received: 22/08/2017 DOI: 10.12816/0042564
Accepted: 01/09/2017

Full Paper (vol.697 paper# 4)

c:\work\Jor\vol697_5 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2783-2787

Effect of Artificial Sweets on Neurologic Disorders
Ali Malik Alahmed 1, Mohammad Ehsan M Shokri 2, Faris Ali Nasser Ayidh 3, Amer Baraki
Alotaibi 4, Tarnim Muhsen Alghamdi 5, Faisal Barrak H Alziyadi 6, Abdulsalam S. Alluhaydan 7,
Nora Faisal Alsaud 8, Abdulwahab Malawi S Alshahrani 3, Osama Abdulaziz M Gasem 9,
Abdulrhman Ebrahim A. Mughallis 10, Albayyali,Tariq Hassan H 11
1- University Of Dammam( Imam Abdulrahman Bin Faisal University),2- King Abdulaziz University
Hospital,3- King Khalid University,4- King Abdullah Hospital-Bisha,5- King Abdulaziz Hospital,
6- Klakh PHC,7- King Saud Medical City-Riyadh,8- Alfaisal University, 9- King Abdulaziz University,
10- Jazan General Hospital,11- Aljouf University

Sugar- and artificially-sweetened beverage consumption have been connected to cardio
metabolic hazard factors, which rise the danger of cerebrovascular illness and dementia.
Purpose: We studied whether sugar or artificially sweetened beverage intake was related with the
prospective dangers of incident stroke or dementia. Materials and methods: We studied 361 members aged
more than 45 years for incident stroke (mean age 61 [SD, 10] years; 163 men) and 185 participants aged >60
years for incident dementia (mean age 68 [SD, 7] years; 85 men). Beverage consumption was computed
using a food-frequency questionnaire at cohort studies. We quantified latest consumption at investigation 7
and cumulative intake by averaging across examinations. Surveillance for incident events commenced at
examination 7 and continued for 5 years. We observed 12 cases of incident stroke (10 ischemic) and 10 cases
of incident dementia (8 consistent with Alzheimer's disease). Results: After modifications for age, gender,
education (for analysis of dementia), caloric consumption, diet feature, physical activity, and smoking,
higher recent and higher cumulative consumption of artificially sweetened soft drinks were related with an
increased risk of ischemic stroke, all-cause dementia, and Alzheimer's disease dementia. When comparing
day-to-day aggregate consumption to 0 per week (reference), the risk ratios were 2.87 (95% confidence
interval, 1.24­6.89) for ischemic stroke and 2.91 (95% confidence interval, 1.15­6.99) for Alzheimer's
disease. Sugar-sweetened beverages were not associated with stroke or dementia. Conclusions: Artificially
sweetened soft drink consumption was allied with a higher risk of stroke and dementia.
Keywords: Artificial Sweets, Soft Drinks, Dementia, Stroke, Sugar.

dementia, mild cognitive impairment, or other
Sugar-sweetened beverages are linked with
significant neurological disease at baseline and
cardio metabolic illnesses [1,2], which can increase
those less than 60 years. These age cutoffs are
the danger of stroke and dementia [3,4]. Limited
consistent with our prior work in this area. There
prior findings recommend that sugar and
were 361 and 185 participants available for
artificially sweetened beverages are both linked
analysis of occurrence stroke and new-onset
with an improved risk of occurrence stroke [5], even
dementia, respectively. Participants completed the
though contradictory findings have been reported
[6]. To our knowledge, studies are yet to examine
questionnaire (FFQ) at examination cycles 2. The
the relations between sugary beverage intake and
FFQ provides a validated measure of dietary intake
the risk of occurrence dementia. Therefore, we
over the past 12 months [7]. Participants replied
studied whether sugar or artificially sweetened soft
according to how frequently they consumed 1
drinks were linked with the 5-year risks of
glass, bottle, or can of each sugary beverage item,
occurrence stroke and dementia. We furthermore
on average, across the previous year. The FFQ
studied total sugary beverages, which combined
included 3 items on sugar-sweetened soft drink, 4
sugar-sweetened soft drinks with noncarbonated
items on fruit juice, 1 item on noncarbonated
high sugar beverages, for instance, fruit juices and
sugar-sweetened fruit drinks, and 3 items on
fruit drinks.
artificially sweetened soft drinks. Each item was
scored according to 9 responses spanning from
We estimated the 5-year risk of both incident
never or <1 per month to 6+ per day. Intake of soft
stroke and dementia beginning from the 4th
drinks using the FFQ has been validated against
examination cycle. For the study of stroke in
dietary records (correlation coefficients of 0.81 for
relation to beverage intake, we excluded people
Coke/ Pepsi) and is reliable when re-administered
with prevalent stroke or other significant
after 12 months (correlation coefficients of 0.85 for
neurological disease at baseline and those less than
Coke/Pepsi) [8,9]. We combined FFQ items to create
45 years. For investigating the occurrence of
variables reflecting consumption of total sugary
dementia, we excluded people with prevalent
beverages (combining sugar-sweetened soft drinks,
Received: 21/09/2017 DOI: 10.12816/0042565
Accepted: 30/09/2017

Full Paper (vol.697 paper# 5)

c:\work\Jor\vol697_6 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2788-2794
Visits to Emergency Departments for Gynecologic Disorders in KSA
Sadeem Adnan Alqusair 1, Khalid Ibrahim S Albulushi 1, Lujain Nizar Malaka 2, Rakan
Alhussin alsharif 3, Ali Ibrahim Ali Alsalbi 4, Yousef Abdulrahman O Aloufi 1, Mohannad
Mohamed Eissa Abousaadah 1, Ziyad Adnan Turkistani 2, Samer Sameer Y miski 5, Mohammed
Yaanallah Mohammed Al Ghamdi 6, Mohammad Hesham A Sindi 7, Daniah Samir S Allali 1
1 King Abdulaziz University, 2 Umm-Alqura University, 3 Primary Care Center, 4 Taibah University,
5 Ibn Sina National College, 6 Al Baha University, 7 King Saud University

Abnormal uterine bleeding (AUB) influences 20­30% of women sooner or later in their
regenerative years and regularly cause women to look for urgent or emergent care.
Purpose: To describe the population of women seeking urgent medical attention for abnormal uterine
bleeding (AUB), in terms of symptoms, medical history, and clinical examination findings; and to
determine characteristics associated with anaemia in this population.
Materials and Methods: We implemented a retrospective cohort study of patients comprehended in
King Abdulaziz Hospital Emergency Room for abnormal uterine bleeding from November 2016 to
May 2017 (n=126). Data collected included demographic factors, laboratory and radiologic findings,
clinical history, and physical examination findings. We calculated pervasiveness ratios for moderate
to severe anaemia (defined as haemoglobin less than 10 g/dL) and sensitivity and specificity of
clinical characteristics for recognizing women with anaemia.
Results: The median age of patients was 33 years (range 14­68 years). Nearly half (47.6%) had a
concurrent medical condition which could affect their treatment options and 15 had moderate to
severe anaemia. The only factors related with moderate to severe anaemia were having both
tachycardia and hypotension; duration of bleeding more than 7 days: and haemoglobin of less than 10
g/dL in the previous year.
Conclusions: A substantial proportion of patients looking for urgent medical care for abnormal
uterine bleeding had potential contraindications for the mainstays of treatment. Clinical symptoms and
bleeding history were poorly predictive for moderate to severe anaemia in this population of women.
Keywords: Anaemia, Abnormal Uterine Bleeding, Emergency Facility, Acute Uterine Bleeding.

made to assess and compare the efficacy, side
effects and
influences 20­30% of women sooner or later in

their regenerative years and regularly cause
safety of these treatments. Safety of treatment is
women to look for urgent or emergent care [1­4].
exceptionally reliant on patients' medical
Dysfunctional uterine bleeding can have a
history; while treating patients with AUB,
substantial financial and quality-of-life burden
clinicians should ponder co-morbid medical
[5]. Some women looking for emergent care will
conditions, for example, cigarette smoking,
have acute uterine bleeding; bleeding that
cardiovascular disease, cancer history, and
requires prompt treatment to diminish the danger
thromboembolic disease as these conditions
of anaemia that might require blood transfusion
could be contraindications to few of the medical
or surgical intervention [6, 7].
treatments [8, 9].
In the clinical setting, seriousness of
The nonappearance or presence of
bleeding, nonappearance or presence of
significant anaemia in women with AUB is a
vital criterion to support determines the urgency
of the condition and the suitable treatment. In
normally dictate administration. Hormonal
the emergency room setting, laboratory services
treatments used for women with acute uterine
for instant haemoglobin valuation are readily
bleeding incorporate progesterone, estrogen, and
accessible. Nevertheless, not all patients with
estrogen and progesterone combinations (in the
acute uterine bleeding present to emergency
form of oral contraceptive pills). Despite the fact
administrations. When administering for these
that these treatments are normally utilized as a
patients in the emergency departments setting,
part of clinical practice, little research has been
either face to face or via phone, clinicians are
presented with the difficult choice of who to
Received:21 /09/2017 DOI: 10.12816/0042566
Accepted: 30 /09/2017

Full Paper (vol.697 paper# 6)

c:\work\Jor\vol697_7 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2795-2797

Rectal Atresia with Congenital Rectovaginal Fistula: A Rare Variant of
Anorectal Malformations
Ali H. Al-Ameer, Ilhama Jafarli, Abdulwahab S. Al-Jubab
Pediatric Surgery Department, King Fahad Medical City, Riyadh, Saudi Arabia.
Corresponding Author: Ali H. Al-Ameer, E-mail: al-ameer.ali.92@live.com

: rectal atresia is a rare variant of anorectal malformations. The presence of fistulous
communication between the rectum and the urogenital system in case of rectal atresia is even rarer to
occur. Aim of the work: this article aimed to describe a case of rectal atresia in a female infant associated
with proximal and distal congenital rectovaginal fistula. Results: the clinical, radiological findings and
the surgical management were discussed . Conclusion: the case demonstrated the possibility to find a
rectovaginal fistula in rectal atresia, and the possibility of recurrence after surgical intervention.
Keywords: anorectal malformations, rectal atresia, rectovaginal fistula.


Anorectal rectal malformations are wide
opening with no stool coming out. Lower
spectrum of birth defects mean abnormal
gastrointestinal (GI) study showed short, blind
development of the anus and rectum with an
ended anal canal, which was not connected to
incidence rate of 2.0-2.5 per 10,000 live births
the rectum, urinary tract or vagina [Figure 1].
(1). Rectal atresia is one of the rare variant of
Computed tomography (CT) scan with contrast
showed dilated, blind-ended rectum and leak of
Wingspread classification; its incidence rate is
the contrast material to the vagina, which was
1-2% of all anorectal anomalies with male
suggestive of the presence of rectovaginal fistula
predominance. Blind ended rectum without any
[Figure 2].

developed anal canal and sphincter were usually
found in such variety (2,3). So, we studied a case
of rectal atresia associated with proximal and
distal congenital rectovaginal fistula.

A 10-months-old baby girl of primigravida
mother with type I diabetes mellitus born full
term with weight of 2.8 kilograms referred to
our hospital at age of three weeks with history of
passing stool from vaginal opening and double
outlet left ventricle. Examination showed soft,
lax abdomen and normally placed anal opening.
Calibrating the anal canal with a catheter

revealed resistance about 2 cm from the anal
Figure 1: contrast material in the anal canal

does not pass to the rectum

Received:21 /09/2017 DOI: 10.12816/0042567
Accepted:30 /09/2017

Full Paper (vol.697 paper# 7)

c:\work\Jor\vol697_8 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2798-2803
Breast Cancer Staging and The Role of Radiology
Salha Mofareh Ghazwani 1, Maram Adnan Rawah 2, Jaber Mohammed Zarbah 3,
Abdulrahman Saleh Amoudi 4, Fatimah Hassan Alyahya 5, Abdulrahman Ahmed H Aman 6, Raed
Fuad Ahmad Abuazzah 7, Omar Talal M Tallab 1, Amirah Ali Alshammari 8, Alaa Jamal A Akbar 9,
Abdulrahman Abdulaziz Alharbi 10, Fatimah Nasser Alsaad 8, Amor Abdullah Al Mehdar 11
1- King Khalid University,2- Jeddah Eye Hospital,3- Najran University, 4- Madina Maternity and
Children Hospital (MMCH),5- King Abdulaziz University in Jeddah, 6- Batterjee Medical
College, 7- Taibah University, 8- Imam Abdulrahman Bin Faisal Hospital, 9- Ajyad Emergency
Hospital, Makkah, 10- Umm Al-Qura University,11- Ministry of Health

To Compare tomosynthesis to mammography, ultrasound, MRI, and histology for the detection
and staging of BI-RADS 4­5 anomalies, as a function of breast composition, histology, size, and lesion
Materials and methods: 25 patients underwent tomosynthesis, MRI, mammography, and ultrasound. The
diagnostic accuracy of the different examinations was compared.
Results: The sensitivities for detection were as follows: 92.7% for MRI, 80.5% for ultrasound, 75.6% for
tomosynthesis, and 61% for mammography. Tomosynthesis improves the sensitivity of mammography (P
= 0.0001), but not the specificity. The detection of multifocality and multicentricity was improved, but not
significantly. Tomosynthesis identified more lesions than mammography in 10% of cases and improved
lesion staging irrespective of the density, but was still inferior to MRI. The detection of ductal neoplasia
was superior with tomosynthesis Compared to mammography (P = 0.016), but this was not the case with
lobular cancer. The visualization of masses was improved with tomosynthesis (P = 0.00012), but not with
microcalcifications. Tomosynthesis was capable of differentiating lesions of all sizes, but the smaller
lesions were easier to see. Lesion sizes measured with tomosynthesis, excluding the spicules, concurred
with histological dimensions. Spicules lead to an overestimation of the size.
Conclusion: In our series, tomosynthesis found more lesions than mammography in 10% of patients,
resulting in an adaption of the surgical plan.
Keywords: Breast, Tomosynthesis, Multifocality, Staging.


Worldwide, breast cancer is the most
Ideal staging, to define the size of the tumor
frequently diagnosed life-threatening cancer in
and the presence of extra lesions, is
women and the leading cause of cancer death
indispensable for suitable surgery with healthy
among women [1]. Because of early detection,
margins. Multicentricity (two or more lesions in
intervention, and postoperative treatment, breast
different quadrants), multifocality (more than
two lesions in the same quadrant), or
Mammography is the preferred screening
contralateral disease may require more extensive
examination for breast cancer. It is widely
breast surgery[5,6]. Ignorance of additional
available, well-tolerated and inexpensive.
lesions affects relapse and survival rates, but the
Randomized controlled trials have demonstrated
literature is not consensual [7]. To detect these
a mortality benefit for women from 40 to 74
multiple lesions, mammography has a sensitivity
years old. Some studies have shown that
of less than 50% [8-11], and mammary MRI of
mammography might be mainly helpful for
94­99% [12-15]. Tomosynthesis, a new procedure
women who are 80 years of age and older [2, 3].
in 3D breast imaging, obtains reconstructed
The earliest sign of breast cancer can be an
volume data, the data is reconstructed
abnormality depicted on a mammogram, before
secondarily in mammary slices from many
it can be felt by the woman or by her physician.
radiographs achieved from different angles of
When breast cancer has grown to the point
view (-25° to +25° for Siemens®). It
where physical signs and symptoms appear, the
theoretically improves the sensitivity of
patient feels a breast lump (regularly painless).
detection by permitting enhanced delimitation of
The improved prognosis for breast cancers is
the lesion margins, and the specificity by
partly linked to advances in treatment [4].

superimposition [16].
Received: 21/09/2017 DOI: 10.12816/0042568
Accepted: 30/09/2017

Full Paper (vol.697 paper# 8)

c:\work\Jor\vol697_9 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2804-2808

Post-Operative Anticipation of Outcome after Cholecystectomy
Hussam Muidh Althagafi 1, Faisal Saleh Alghamdi 1, Mohammad Mustafa S Alali 2, Linah Khalid
Qasim 3, Yara Saleh Bayunus 3, Abdullatif Mohammed Alomair 4, Feras Fouad Sarouji 5, Abdullah
Sulaiman A Alboseer 6, Ghadeer Isa Abdali Isa Ebrahim Aldaaysi 7, Bader Saad Alkhathami 8,
Mohammed Humayyed Mohammed Alotaibi 9, Yousef Abdulrahman O Aloufi1
1-King Abdulaziz University 2- Imam Abdulrahman Bin Faisal University 3- Umm Alqura University,
4- King Faisal University 5- KSH, 6- Qassim University, 7- Rak Medical and Health Sciences University,
8- King Khaled University 9- King Abdulaziz Specialist Hospital

A substantial group of patients with gallstone disease experience negative outcome after
surgical removal of the gallbladder (cholecystectomy). Early identification of these patients is important.
Purpose: The purpose of the study was to recognize predictors (trait anxiety and clinical symptoms) of
negative symptomatic outcomes at 5 weeks after cholecystectomy.
Materials and Methods: Consecutive patients (n=66), 18­60 years, with symptomatic gallstone disease,
completed symptom checklists and the state-trait anxiety inventory preoperatively and at 6 weeks after
cholecystectomy. Results: High trait anxiety was the only predictor of persistence of biliary symptoms at 6
weeks after cholecystectomy (OR=6.79). Conclusion: In addition to clinical symptoms, high trait anxiety
is a predictor of negative symptomatic outcome at 6 weeks after cholecystectomy. Trait anxiety should be
evaluated to aim at a patient-tailored approach in gallstone disease.
Keywords: Cholecystectomy, Symptomatic gallstone disease, Trait anxiety.


Whereas it is true that no operation has been
Deprived post-cholecystectomy result is
more profoundly affected by the advent of
allied with clinical factors, for example,
laparoscopy than cholecystectomy has, it is
heightened pain sensitivity, high comorbidity, a
equally true that no procedure has been more
long history of complaints (biliary pain,
instrumental in ushering in the laparoscopic age
symptoms, attacks), the use of psychotropic
medication, and preoperative dyspeptic symptoms
Laparoscopic cholecystectomy has rapidly
[9-13]. Stable personality behaviours, such as
become the procedure of choice for routine
neuroticism and introversion [14, 15]; similarly have
gallbladder removal and is currently the most
a negative influence on long and short-term
commonly performed major abdominal procedure
results, for example, medication use and pain.
in Western countries [1].
Trait anxiety is a dimensional feature of
A National Institutes of Health consensus
personality connected to neuroticism [16]. Trait
statement in 1992 stated that laparoscopic
anxiety is defined as a relatively stable individual
cholecystectomy provides a safe and effective
variance in the tendency to respond with
treatment for most patients with symptomatic
intensified anxiety to threatening situations [17].
gallstones and has become the treatment of choice
The influence of trait anxiety on post-
for many patients [2].
cholecystectomy recovery is inarticulate [18, 19], as
This procedure has more or less ended
studies examined small populations [14, 18] and
attempts at non-invasive management of
focussed on the first 5 days after cholecystectomy
gallstones. Surgical removal of the gallbladder
only. Evidence of the influence of trait anxiety on
(cholecystectomy) is the regular procedure in case
post-cholecystectomy result is flawed as studies
of symptomatic gallstone disease. Positive results
used different procedures and result variables, and
are stated after cholecystectomy, for example,
controlled for different pre-operative and
relief of biliary pain (74­96%), a decrease of
postoperative factors. We assumed that high trait
lower abdominal pain (66­91%), and less
anxiety is a risk factor of negative post-
dyspepsia (46­89%) [3, 4]. In contrast, a substantial
cholecystectomy result, next to clinical risk
group of patients report unacceptable outcomes
factors. Clinical experience teaches that the
after cholecystectomy, for example, the
majority of patients report a relief of symptoms
persistence and improvement of new symptoms
and return to work at 6 weeks after discharge [20].
and pain [5-8]. Early recognition of these patients is
Consequently, we investigated the impact of high
critical to improve clinical decision making.
trait anxiety on a symptomatic outcome at 6
weeks after discharge.
Received: 21/09/2017 DOI: 10.12816/0042569
Accepted: 30/09/2017

Full Paper (vol.697 paper# 9)

c:\work\Jor\vol697_10 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2809-2813

Features of Menopause and Menopausal Age among Saudi Women
Amor Abdullah Al Mehdar 1, Hariri,Mohammad Zaki O 2,Fay Ali F Alotaibi 3,Turki Ali Abdullah
AL Alyani 4,Naseem Ahmad M Matary 5,Mohammed Atiah Ahmed Bakri 6,Jaman Hassan AlQahtani 7,
Sultan Essa Alsalami 8, Alharbi, Abrar Ahmed A 9, Hussam Muidh Althagafi 3, Samirah Nasser A
Majrshi 10, Laila Mossa Mahdi 11, Faisal Saleh Alghamdi 3, Munirah Abdulrahman H Sattam 3
1- GP Ministry of Health, 2- PHC, Makkah, 3- King Abdulaziz University, 4- Abha Psychiatric Hospital,
5- King Khalid University (KKU), 6- Abu - Arish Al-Janoubi Primary Health Care, 7- King Dahad
Armed Forces Hospital, 8- Maternity & Children's Hospital in Jeddah, 9- Western Al-Azizia Primary
Health Care Center, 10- Primary Health Care in Al-Jumum- Makkah, 11- Aseer Central Hospital

Menopause is the estimated end of reproductive life. Having a positive attitude towards it has
been shown to outcome in a positive experience, whereas a negative attitude is connected with negative
experiences and symptoms. Conventionally, women regularly abstain from sex after menopause.
Purpose: The study aimed to determine the level of awareness and perceptions about the menopause and sex
in perimenopausal women attending a general outpatient clinic.
Methods: Women over 40 years were enlisted from the Family Medicine Department of King Abdulaziz
Hospital, excluding those who were menopausal. Data analyses were done with chi-square test (P<0.05).
The study was done according to the ethical board of Umm Al Qura university.
Results: Most (151; 85.8%) of the 176 surveyed participants were aware of the menopause. Only 36.1%
anticipated associated symptoms. About half (55.68%) were indifferent to menopause onset, while 23.3%
had a positive attitude and 21.11% had a negative attitude, respectively. Younger women were less likely to
have a positive attitude to the menopause (P=0.04). There were negative cultural beliefs towards sex. Sexual
activity was low and declined with age (P<0.001). Many women would like treatment to improve their
sexual activity.
Conclusion: Most participants had a favourable disposition towards the menopause, though sexual
relationships suffer. Counselling and treatment should be offered.
Keywords: Menopause, Sexual Relationships, Counselling, Treatment.

them with the menopause. During the
Menopause marks the end of the natural
menopausal transition, physiologic changes in
reproductive capacity of a woman. The clinical
responsiveness to gonadotropins and their
diagnosis is made retrospectively after twelve
secretions occur, with wide variations in hormone
months of amenorrhoea[1, 2]. Hormonal changes
levels. Women often experience a range of
and clinical symptoms occur over a period
symptoms such as Hot flashes or flushes, Weight
leading up to and immediately following
gain and bloating, Mood changes, Depression,
menopause; this period is frequently termed the
Insomnia, Mastodynia, Headache, and Irregular
climacteric or perimenopause but is increasingly
menses[6].Previous workers have determined that
referred to as the menopausal transition. For
having a positive attitude towards the menopause
numerous women, it is a welcome relief from
is often linked with having a positive experience
menses and removes the risk of pregnancy [3, 4],
with menopause, and having a negative attitude
while for others, in whom pregnancy is still
was linked with negative experiences and
desired, menopause is not welcome. Many
symptoms [7].
women are conscious that their menstrual periods
Evaluating perception of menopause allows
will cease sooner or later, but anecdotal
us to assess knowledge gaps and can guide health
indication in our clinical settings displays that
talks and counselling. When women have better
they are generally not aware of the other changes
knowledge of what to expect, they are more
and symptoms that accompany menopause. This
probable to understand and be accepting of their
makes them stressed and confused when they
symptoms. Moreover, if they are conscious that
start to agonize from these. Women might think
administration options are obtainable, they can
that these symptoms are warning signs of
similarly be more likely to pursue health care if
sickness[5]. This is made worse as these
needed. First-line healthcare providers such as
symptoms regularly arise before the end of
family physicians are in a position to empower
menses, so victims do not willingly associate
women through appropriate counselling and

education that is geared towards improving
Received:21 /09/2017 DOI: 10.12816/0042570
Accepted:30 /09/2017

Full Paper (vol.697 paper# 10)

c:\work\Jor\vol697_11 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2814-2818

Assessment of Patients with Beta-thalassemia
Ahmad Hameed Allehaiby 1, Sarah Musaed Alluheibi 2, Sarah Mohammed Alnassar 3,
Mansor Ahmed Bayydih 4, Mohammad Mabrook S Almohammadi 5, Layla Mohammed
Alnashry 6, Abdulrahim Abdullatif Alomair 7, Mazen Mosfer A Alzahrani 8, Rawan Ezzi

Abufaia 9, Riyad Mohammed Alhajji 10, Meshal Fahad M Alshamrani 11,
Omar Hasan Abdullah Badahman 11, Haitham Musaad A Aloraini 12
1- Primary Health Care, Jeddah, 2- Primary Health Care, Mecca, 3- Obhur PHC, 4- Sabya PHC, 5- Elixir
Medical Center, 6- University of Tabuk, 7- King Faisal University, 8- Al-Azizyah Maternity& Children
Hospital Jeddah, 9- Asfan PHC, 10- Alomran Center, 11- King Abdulaziz University, 12- Almaarefa College

Thalassemia major has become a public health problem worldwide, mainly in developing
and poor countries, while the role of educating the family and community has not been considered enough
in patients' care. Purpose: This study was done to examine the impact of partnership care model on mental
health of patients with beta-thalassemia major. Materials and Methods: This experimental study, with
pretest and posttest design, was performed on patients with beta-thalassemia major in Jeddah city. 40
patients with beta-thalassemia major were assigned randomly into two groups of intervention (20 patients)
and control (n=20) groups. Mental health of the participants was measured using the standard questionnaire
before and after intervention in both groups. The intervention was applied to the intervention group for 6
months, based on the partnership care model. Results: There were significant differences between the
scores of mental health and its subscales between the two groups after the intervention (< 0.05).
Conclusions: The findings of the study revealed the efficacy and usefulness of partnership care model on
mental health of patients with beta-thalassemia major; thus, implementation of this model is suggested for
the improvement of mental health of patients with beta-thalassemia major.
Keywords: Beta-thalassemia, mental health, DeferoxamineMesylate.


Thalassemia is a public health problem
5 times a week [6]. Complex medical care and life
worldwide, mainly in developing countries [1].
long unpleasant clinical self-management regimen
According to the World Health Organization
have adverse effects on mental function and mood
report, more than 15 million people suffer from
of patients and their families [7, 8].
thalassemia worldwide [2] and annually about 56
Studies have presented that these patients
thousand children are born with it in the world [3].
suffer from psychological issues, such as anxiety
This disease is a major problem, not only for
and depression, and might be easily hurt by these
patients and their families, but also for public
problems [8]. Another important point is that this
health system in any country, bearing in mind the
disease affects the patients' health and causes
care and treatment costs; containing regular
physical disorder, growth retardation, and late
infusions of DeferoxamineMesylate (desferal),
puberty [9] which affects their self-conscious and
recurrent hospitalization, and other medical
will eventually rise the patient's anxiety and
procedures [4, 5]. The aim of the treatment is to
negatively affect their lives [10].
preserve hemoglobin levels at at least 10g/dL in
both genders. The blood volume for transfusion
thalassemia major are not treated due to absence of
was calculated based on the patient's hemoglobin
public consciousness and inaccessibility of drugs
(10­15mL/kg). Treatment with chelators starts
and experience mood disorders, including despair,
after the first 10­20 blood transfusions or when
isolation, depression, hostility, sadness, anxiety,
blood Ferritin level reaches more than 1000ng/mL
fear of death, lack of self-esteem, and anger [11].
[10]. Intravenous chelators are routinely used in
Alternatively, complications of this ailment
chelation therapy. Oral or combined chelator's
increment with age and make the patient more
therapy is used when the patient is unable to
tired [12]. This issue will disrupt the self-care and
tolerate the intravenous chelators or when
psychomental status and interrupt the treatment
sufficient intravenous chelators are not obtainable.
procedure. Nurses are on the front lines of
Deferoxamine is injected subcutaneously using an
providing care to the patients and witnessing the
injection pump at a rate of 20­60mg/kg of body
patients' problems. They need to know about the
weight usually over 8- to 12-hour period, and 3 to
patient's psychomental status in order to provide

the most appropriate care plan. In addition, the
Received:21 /09/2017 DOI: 10.12816/0042571
Accepted:30 /09/2017

Full Paper (vol.697 paper# 11)

c:\work\Jor\vol697_12 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2819-2823

Retained Bandage Contact Lens for More Than Two Years in One
Eyed Patient: A Case Report
Shorooq A Alenzi 1, Abdulrahman F. AlBloushi 2
1. Taibah University, College of Medicine, Medina, Kingdom of Saudi Arabia,
2.King Saud University, Department of Ophthalmology, Riyadh, Kingdom of Saudi Arabia

Aim of the work:
this study aimed to report a case of a bandage contact lens (BCL) retained for two years and
six months in its primary position, which was associated with distinct clinical appearance over the patient's only
Seeing Eye.
Patient and methods: a 70-year-old one-eyed female patient with a history of systemic hypertension and poor
vision in the left eye due to an old trauma was presented with right eye spontaneous corneal perforation and
leak. The patient was treated with cyanoacrylate corneal glue along with a bandage contact lens (BCL). For the
unknown reasons, the patient did not come for a follow-up medical care and presented after two years and six
months with the retention of the BCL in its original position. Results: the retained BCL developed an atypical
clinical appearance in the form of granular deposits along the edges made of mixed epithelium and mucous
deposition. We hypothesize that this deposition occurred as an adaptive mechanism and aided in BCL
stabilization and prevention of serious contact lens-related complications.
Conclusions and Importance: to our knowledge, long-term in-place retention of BCL with distinct clinical
appearance has not been characterized before. Despite the long period of retention, the lens did not migrate to
the local vicinity and presented any serious complications. This report highlights the importance of appropriate
patient education and counselling to ensure their compliance, thereby preventing any unfavourable future
Keywords: bandage contact lens, retained, case report.


Contact lenses have been associated with
hypoxia [12, 13] , loss of epithelial layers integrity [12]
optical, medical or even cosmetic enhancement and
and corneal vascularization [14, 15] . These
visual aid in order to correct myopic conditions,
complications are significantly associated with time
hyperopia, ophthalmic diseases and refractive error
duration of contact lens use [15]. Few cases related
[1, 2]. Contact lenses can also be used as an ocular
to retain contact lenses have been previously
therapeutic system in some diseases like glaucoma
published that presented complications like mass,
and severe infection as a drug delivery system [3, 4].
cyst and/or chalazion [17- 24].
Likewise, bandage contact lenses present
In this report, we documented a case of an
themselves as a versatile form of soft contact lenses
elderly one-eyed female patient who retained her
that are widely used to promote healing of the
bandage contact lens (BCL) for more than two
corneal epithelial defect such as after refractive
years and presented in the clinic with a peripheral
surgery or trauma. These lenses protect the corneal
contact lens epithelization and mucous deposition.
surface from any mechanical trauma and aid in
The layer of epithelium and mucus deposited at the
reducing any associated pain [1, 2, 5, 6]. Commonly
periphery of the lens was speculated to be a natural
associated complications are corneal epithelial
defence mechanism that may have aided in
defects, microbial or sterile keratitis, corneal
preventing long-term serious contact lens-related
epithelial edema, giant papillary conjunctivitis and
blurred vision due to mucus deposition [7-10].
The study was done according to the ethical
Accordingly, several ocular surface changes can
board of King Abdulaziz university.
occur due to extensive contact lens usage without

proper care. These include transient appearance of
black lines between the endothelial cells that

A 70-year-old uneducated female
disappear once lenses are removed [11] , alteration of
patient with systemic hypertension on medication
corneal curvature, corneal thinning due to chronic
was referred from rural area to the emergency room
Received: 23/08/2017 DOI: 10.12816/0042572
Accepted: 02/09/2017

Full Paper (vol.697 paper# 12)

Type of article: Original The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2824-2833

Exposure of Early Adolescent Girls to Genital Mutilation\Cutting:
"Secondary Analysis of Survey of Young People in Egypt"
Maha Sayeda, Ghada S. T. Al-Attarb, Omaima Elgibalyb
aDirectorate of Health Affairs, Assiut, Egypt, bDepartment of Public Health & Community Medicine,
Faculty of Medicine, Assiut University, Assiut, Egypt
*Corresponding author: Maha Sayed, Directorate of Health Affairs, Assiut, Egypt, e-mail:dr_mahasayed87@hotmail.com

Background: female genital mutilation/cuutting (FGM/C) is one of the main social problems affecting
adolescent girls in Egypt. FGM/C has many health hazards affecting adolescents later in their lives.
Researches related to FGM/C in Egypt focused mainly on prevalence and causes of FGM/C among women.
However, there was little attention in exploring this problem among early adolescent girls. Aim: the
objectives of this study included determining the prevalence and correlates of FGM/C among early
adolescents in Egypt. Subjects and Methods: a secondary analysis of a nationally representative stratified
multistage cluster sample using early adolescent girls using Survey of Young People in Egypt (SYPE) data
2009. Descriptive analysis was done using univariate & bivariate analysis to identify prevalence of FGM/C
in Egypt among early adolescents and associated factors. Correlates of FGM/C were identified using logistic
regression analysis with 95% confidence interval and P <0.05 as a significant level. Software used was SPSS
version 20. Results: nearly two thirds of 10­14 years old girls in Egypt were exposed to FGM/C.FGM/C
was carried on the majority of them by medical personnel (70.7%) at home or at private medical facilities.
Older age, living in rural areas, and belonging to lowest wealth quintile were the main predictors of FGM\C
exposure. Conclusions: FGM/C is still a major threat to early adolescent girls in Egypt especially by
medical personnel among rural and poor families. Emphasizing strict legal sanctions against physicians
performing the procedures as well as against responsible parents is very crucial in Egypt.
Keywords: FGM/C, prevalence, correlates, early adolescent girls, secondary analysis of SYPE.


The World Health Organization (WHO)
age group (males and females) aged 10-29.
The current study sample included 2012
(FGM/C) as "all procedures that involve partial or
adolescent girls aged 10 ­ 14 years belonged to
total removal of the external female genitalia, or
2012 households.
other injury to the female genital organs for non-
Data management: Two main files of data were
medical reasons". WHO estimated that more than
used; the household file and the individual data
200 million girls and women had been cut in 30
files. In the individual data file; eligible study
countries in Africa, the Middle East and Asia[1].
participants were identified and selected while all
In Egypt 92% of ever-married women had been
other data related to other age groups in the
circumcised. The highest prevalence was in the
original SYPE survey were dropped. Then
Rural Upper Egypt (75%)[2]. FGM/C exposure
merging of the new individual file and the
may lead to extreme pain, excessive bleeding,
household file was done to relate the individual
recurrent urinary and vaginal infections, infertility,
data of each participant to the household data. The
difficult labour, psychological impact and
merging was done through the following
abnormalities in the female sexual function[3-5].
identification variable: (INDSW-1). Population
Eighty two percent 82% of circumcised daughters
weights were applied prior to the analysis using
were done by trained medical personnel while it
the weight variable: (eligw_adj_expan).
was 38% among ever married women[2].
Variables: The dependent variable was exposure
This study aimed at identifying the prevalence
to FGM/C among early adolescent girls aged 10 to
and the correlates of exposure to FGM/C among
14 years. The question used was: Are you
early adolescents in Egypt.
circumcised? A dichotomous variable was

constructed with the value of 1 to represent "Yes"
if the adolescent girl was circumcised and 0 if
This study is a secondary analysis using Survey
adolescent girl said "No". Adolescent girls who
of Young People in Egypt (SYPE) data 2009. The
"refuse to answer" were excluded from the
SYPE sample is a nationally representative,
analysis of FGM/C exposure.
stratified, multi-stage cluster sample. Out of the
Independent and other variables included: Lists
11,372 households included in the SYPE samples,
of independent variables related to FGM/C were
a total number of 20,200 young people were in the
identified based on the literature review and the
Received: 23/08/2017 DOI: 10.12816/0042573
Accepted: 02/09/2017

Full Paper (vol.697 paper# 13)

c:\work\Jor\vol697_14 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2834-2838
The Influence of Diverse Irrigation Protocols on Resin Sealer
Bond Strength to Dentin
Reham Abdulkhaleq Felemban1, Shaimaa Gamal Tagrida1, Ayshah Abdullah Alshehri1,
Reem Abdullmuhsen Alshraim1, Amal Mohammed alanaze1 , Maha Salem baaboud2 , Turki Bakheet
Alfuhigi3 , Mohammed Musayyab Alruwaili3 , Lujain Ahmed Mohammed alghrairy4
1Alfarabi Collage for Dentistry and Nursing (Jeddah), 2Batterjee Medical Collage for Sciences and Technology,
3October 6 University(Egypt), 4Hail Umiversity

The purpose of this study was to assess. The influence of diverse irrigation protocols on resin sealer
bond strength to dentin.
Materials and Methods:
A sum of 36 single-established andibular premolar teeth were utilized. Root channel
forming strategies were applied with ProTaper rotary instruments (Dentsply Maillefer) up to measure F4. The
prepared models were then arbitrarily collected into 3 groups (n=12). For each group, an ultrasonic tip (measure
15, 0.02 taper) which was additionally covered with an epoxy resin based sealer and put 2 mm shorter than the
working length. The sealer was then actuated for 10 s. A push-out test was utilized to gauge the bond strength
between the root canal dentine and the sealer. Kruskal-Wallis test was used to assess the push-out bond strength
of epoxy based sealer (P=0.05). The failure mode information were statistically examined utilizing Pearson's chi
square test (P=0.05). Results: Kruskal-Wallis test showed that there were statistically insignificant difference
between the push out bond strength values of 3 mm (p=0.149) and 6 mm (P=0.052) , for group one and two,
while there was a statistically significant difference with the push out bond strength value of 9 mm (P=0.029).
Pearson's chi square test showed statistically significant differences for the failure types among the groups.
Several epoxy resin based sealers actuated ultrasonically demonstrated comparative bond strength in
oval formed root canals. Apical areas for all groups have higher push out bond strength standards than middle and
coronal segments.
Epoxy resin-based sealers, Ultrasound, Bond strength, Root canal filling.


Even though predictable clinical outcomes have
bonding and/or fracture of the core and post can
been stated with the utilization of nonbonding root
occur [11]. Successful bonding minimizes the wedging
canal sealers [1, 2], there has been a constant search for
effect of the post within the root canal and requires
less dentine removal to accommodate a shorter and
instantaneously to canal wall dentin along with
thinner post; in addition, it leads to lower
filling materials [3­5]. Before the start of
susceptibility to tooth fracture [12].
contemporary methacrylate resin­based sealers that
The sealing of a root canal structure totally keeps
are exactly designed for endodontic application [6, 7],
the colonization and re -infection of the oral
there had been sporadic efforts on the utilization of
pathogens in the root canal and periapical tissues;
low viscosity resin composites and dentin bonding
accordingly, this technique may give a long haul
agents, such as, sealers for root filling materials and
effective endodontic management [13, 14]. Gutta-
with favorable in vitro outcomes [8, 9].
percha can't stick to the dentinal surface so sealer
The preservation of fiber posts in root canals is
application is needed. The actuation of root canal
reliant on adhesion amid the resin cement and the
sealers may probably sustenance their penetration
dentine, in addition to the adhesion amid the resin
inside dentinal tubules, giving an expansion in the
cement and the posts. On the other hand, the
sealability and antibacterial impacts [15]. Numerous
adhesion amid the resin cement and the dentine is
scientists have examined different irrigation methods
deliberated to be the weak point in luting a fiber post
and ultrasonic frameworks to expand the push-out
[10].Even though bonding amid the post and the root
bond strength of sealers [16-18].
canal dentine plays a pivotal role in the long-term
Epoxy pitch based sealers have phenomenal
success of a restoration, ensuring reliable bonding
physical properties, for example, longer setting time,
between the post and the composite core is also
low dissolvability, high stream rate, low volumetric
necessary. If the bonding of that interface is poor, de-
polymerization reduction, and interfacial adjustment
Received: 21/09/2017 DOI: 10.12816/0042574
Accepted: 30/09/2017

Full Paper (vol.697 paper# 14)

Low back pain is a world wide health problem ,it's a common form of musculoskeletal disorder [1,2] The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2839-2845

Low Back Pain in Population of Arar City, Northern
Saudi Arabia: an Epidemiological Study

Muhammad Sari Z Alanzi1, Ali Ghannam Ali Almuhawwis1, Nagah Mohamed Abo el-Fetoh2, Fahad Ali A
Alsahli1, Muhammad Abdullah M Almalki1, Tarki Moubarak A Alenezi1, Fadi Mohammad M Alruwaili1,
Almhnd Talal Alenezi1, Mohammed Amer M Alanazey1, Abdulrahman F S Alenezi1

1Faculty of Medicine, Northern Border University, 2 Family and Community Medicine Department, Faculty of
Medicine, Northern Border University, Arar, KSA.

Low back pain (LBP) is a nonspecific condition of acute or chronic pain in or near the
lumbosacral spines. It can be caused by inflammatory, degenerative, neoplastic, gynecologic, traumatic,
metabolic, or other disorders. The aim of the study was to determine the prevalence and risk factors of low
back pain. To show also its symptoms and treatment trials among general population of Arar, Kingdom of
Saudi Arabia. Methods: A cross-sectional community based study was carried out on population of Arar
city, Northern Saudi Arabia, during the period from 1 January to 30 July 2017. Systematic random sampling
technique was followed. Data was collected by personal interview, using pre designed questionnaire which
include questions designed to fulfill the study objectives. Results: Among 501 studied individual. The
prevalence of low back pain was 23.8%, 57% of them were females (P=0.02) and 30% had family history of
low back pain. However 91% of cases doesn't need vigorous effort in their work. Of the cases 90%
doesn't seek medical care for treatment. Disk problems were found in 6.7% of cases, soft tissue problems in
9.3% and in 84% of cases the cause was not diagnosed. About quarter (25.2%) get medical treatment but
only 16.8% improved. While 19.3% get physiotherapy and most of them (18.2%) improved. No ases get
surgical treatment. Conclusion and Recommendations: There was a high prevalence of LBP among Arar
population (23.8%). Many risk factors were identified that would necessitate multidisciplinary involvement.
Disk problemswere found in 6.7% of cases, soft tissue problems in 9.3% and in 80% of cases the cause was
not diagnosed. We recommend that educational programs on prevention and coping strategies for
musculoskeletal disorders are mandatory to reduce the rate of work-related musculoskeletal disorders.
Keywords: Saudi Arabia, low back pain, prevalence, Arar, Epidemiological Study


years, and It's starts to appear at the age of 30 and
Low back pain is a world wide health
reach to it's highest range at the age 45-60 years [6].
problem. It is a common form of musculoskeletal
Although it was found that low back pain affects
disorders [1]. It was defined as pain or muscle
men and women in the same range, UK reported
tension below the costal margin and above the
that the affected women are slightly higher than
inferior gluteal fold, with or without leg pain. In
men [7]. Low back pain problem induce affects on
Saudi Arabia after 6 month of study, it was found
the economic state of the country. It was reported
that above 50% of affected population suffer from
in united states that the costs of these condition
neuropathic pain. Studies in USA found that above
exceed 100 billion dollars per year [8]. It also
60% of general population suffer from low back
affects people's employment because they suffer
pain at some point in their life time [2]. Studies
from social, physical and mental disturbance, this
showed different prevalence rates. Point
disturbance appears in the form of loss of physical
prevalence ranged from12% to 33%. First
function, deteriorated general health, irritability,
prevalence ranged from 22% to 65% and life time
anxiety and depression [9,10].
prevalence from 11% to 84% [3,4].
In USA, back pain is the most common
All these studies can't be compared due to
cause of activity limitation in people younger than
the different questions involved in each study. And
45 years, and in United Kingdom back pain is
each study was carried on different population.
considered the common cause of absence from
Low back pain was not limited on old people only,
work as it represents 12.5% of all sick days [11].
but it was a common problem in adolescents as
Till present time the main cause of low back pain
about 39% of them suffered from this problem and
couldn't be found. But few studies showed that
12-80% of them were student [5]. Brittan study has
there is a relation between low back pain in
reported that the number of people affected by low
individuals and their life style, physical activity
back pain increased from 36,4% to 44% in 10
and smoking [13]. There is a relation between
Received:21 /09/2017 DOI: 10.12816/0042575
Accepted:30 /09/2017

Full Paper (vol.697 paper# 15)

c:\work\Jor\vol697_16 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2846-2851

Seizures; A Pediatrics Emergency in Maternity and Children's Hospital,
Arar, Northern Saudi Arabia
Omar Tabaan Alenezi1, Yusef Muhana Alenezi2, Nagah Mohamed Abo el-Fetoh2, Aledeilah,
Rawan Deham I3, Basel Waleed Khurfan4, Badar Abdulrahman Almuhaya5,
Abdullah Tban Alanazi1, Raghad Aladham Alanazi1
1 Faculty of Medicine, Northern Border University, 2 Family and Community Medicine Department,
Faculty of Medicine, Northern Border University, 3 Primary Health Care Center, Arar, 4 Surgery
Department, Specialized Medical Center, 5 Faculty of Medicine, Alfaisal University, Riyadh, KSA.

seizures are the most common neurologic emergency in pediatrics and can be terrifying for
patients and families. Aim of the work: this study aimed to determine the etiologies and sex distribution
of seizure in children admitted to Emergency Department of Maternity and Children's Hospital in Arar
city, Northern Saudi Arabia, during the period from 1 January to 30 July 2017. Methods: this was a
descriptive hospital-based study conducted in the Department of Pediatrics Emergency, Maternal and
Child Hospital of Arar City during the period from 1 January to 30 July 2017. All the children below 12
years of age who were hospitalized at emergency department were enrolled in this study. The final
diagnosis of seizure was made by a pediatric neurologist. The age, sex, type of seizure, associated fever,
history of head trauma and other variables related to seizure in pediatric group were reviewed from the
medical records. Results: a total of 158 children with diagnosis of seizures were included in this study.
The proportion of male to female was about 2:1 as the percentage of males was 65.8% of patients. All
patients up to 12 years were included with a mean age of 26.3±15.8 months. Less than quarter (16.5%) of
the patients had focal seizures, while 83.5% had generalized seizures. Family history of seizures disorders
were noted in only 15.2% patients. A previous history of seizure was mentioned in 19% patients. Febrile
seizure was the most common etiology (72.2% of patients). Epilepsy in 17.7% and vaccine-associated
seizure in 5.1% of the patients. Hypoglycemia, intracranial hemorrhage, encephalitis and hyponatremia
were reported 2(1.3%) for each of them. Conclusion and recommendations: as this is the first study
conducted in Arar maternity and children's hospital to differentiate of the etiology of seizure in children
attending the emergency department. Indeed, we suggested other researchers to follow the patients to
show the repetitions of seizure and the prognosis in them especially those with dangerous etiologies as
epilepsy, diabetes, encephalitis and intracranial hemorrhage. Fever coexistence, seizure type, physical and
neurological examinations and history of head injury and measurement of serum blood sugar level may
provide important information for primary emergency physicians when evaluating children with attack of

damage or death. Furthermore, in the
Seizures are common conditions attending
management of children with seizure, it is very
the emergency departments so they are
importance to investigate the etiologic profile of
distressing to the physicians and staff. There is
associated morbidity and mortality with seizures,
Febrile seizures are the most common type
and it should not be considered as routine cases
of childhood seizures, occurring in 2 to 5 percent
(1).Seizures occur in about 4-10% of children and
of children six months to five years of age (5).
constitute 1% of all emergency department visits
Although febrile seizure has a good prognosis,
(2). The most common etiologies of attacks of
the presence of fever and seizure together is also
seizures in children included infection with fever,
seen in bacterial meningitis which may have bad
developmental and neurological problems,
outcomes (6). Due to different etiologies, first
traumatic head injuries and metabolic disorders
attack of a non-febrile seizure often has a great
(3).Important conditions of patients who present to
diagnostic challenge to physicians and staff.
the emergency department included those with
Sever electrolyte imbalance, as hypocalcaemia or
non generalized seizures, and those with status
hyponatremia and hypoglycemia were found to
epilepticus(1).While, some types of seizure as
be the etiology of seizure in less than 1% of
simple febrile seizures are not dangerous and
children (7).In a study conducted in Taiwan by
self-limited in nature (4), others can cause brain
Chen et al. on patients with first attack of
Received:21 /09/2017 DOI: 10.12816/0042576
Accepted:30 /09/2017

Full Paper (vol.697 paper# 16)

c:\work\Jor\vol697_17 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2852-2855

A study of Tinea Capitis in Children
Moatasem Mohammed Modhish 1, Manal Muneer Ibraheem Al-Assiri 2, Ahmed Mohammed
Yahya Althui 3, Amr Mohammad K Alhazmi 3, Amjad Obeid Saad Alghamdi 3, Yassmeen
Mohammed Alltaleb 4, Razaz Abdulaziz AlAssiri 5, Lara Saleh A Alkuhaimi 4, Ahmed Abdulaziz
AlAssiri 2, Neda Manea Hussein Alsadi 2, Alasmari Buoshra Saeed 3, Lina Hassan T Bugis 6
1- 6 October University GP (Dr.Suliman Faqeeh Hospital), 2- Ibn Sina National College , 3- King Khaled
University , 4- Alfaisal University ,5- Prince Sultan Military Medical City , 6- Umm AlQura University

Tinea capitis is a superficial fungal infection that predominantly affects the pediatric
population. The etiological factors vary from area to area, and the exact occurrence remains obscure. The
clinicoepidemiological and mycological aspects of this dermatophytosis were studied in King Abdulaziz
Hospital. Purpose: To determine the clinicoepidemiological aspects and mycological findings of
dermatophytes involved in tinea capitis cases. Subjects and Methods: KOH examination, Wood's lamp
examination, and fungal culture were performed in 50 clinically diagnosed cases of tinea capitis with patients'
age up to 13 years over a period of 8 months. The epidemiological factors associated with the disease were
also evaluated. Results: Tinea capitis was predominant in the 3­6 and 6­9 years age groups with a male
preponderance. Grey patch tinea capitis was the most common variant. KOH positivity was 74%, and
Trichophyton tonsurans was the most common fungal isolate. Conclusion: Tinea capitis is a very common
fungal infection in our setting. Early detection and diagnosis is mandatory to prevent its spread in the
community as well as the development of scarring alopecia in the affected individual.
Dermatophytes, tinea capitis, Trichophyton tonsurans.

small number of cases also encountered in adults
Tinea capitis is a disease caused by
superficial fungal infection of the skin of the
Etiologically, in tinea capitis, wide
scalp, eyebrows, and eyelashes, with a
differences have been seen in different
propensity for attacking hair shafts and follicles.
geographic areas. Changes similarly happen in
The disease is deliberated to be a form of
the etiology in a given area over a period of time
[7]. Even the clinical pattern differs from place to
Numerous synonyms are used, comprising
place. Hygiene, immune status of the host,
ringworm of the scalp and tinea tonsurans. The
standard of living, use of different antimycotic
incidence of tinea capitis is increasing all over
agents, genetic constitution, climate, immigration
the world [1]. Dermatophytes are fungi that
patterns, and resistance to different drugs in
commonly infect the keratinous tissues of
different districts, , and dermatophyte related
humans and some lower animals. The superficial
factors could all play some role in governing the
layers of the epidermis, mainly the stratum
predominant causative species. Tinea capitis is
corneum, and the keratin rich appendages, for
predominantly a disease of preadolescent
example, the hair and nails of the living host, are
children. Typical age of onset is between 5 and
invaded by these dermatophytes, where they
10 years [8]. Tinea capitis accounts for up to 92.5%
ultimately proliferate and multiply [2]. It is a
of dermatophytoses in children younger than 10
common scalp infection realized in children from
years. The disease is rare in adults, although
developing countries, regularly causing changing
occasionally, it may be found in elderly patients.
degrees of hair loss [3,4].
This study was designed to get an insight into the
Clinical presentation of tinea capitis differs
pattern of tinea capitis and the likely causative
dermatophyte strains.

inflammatory disease with scaly erythematous
lesions and hair loss or alopecia that may
The current study was carried out in the
progress to severely inflamed deep abscesses
outpatient department of dermatology over a
termed kerion, with the potential for scarring and
period of 8 months from November 2016 to July
permanent alopecia. The type of disease elicited
2017, after taking clearance from the institutional
depends on interaction between the host and the
ethical committee. It was a prospective cross-
etiologic agents. Unlike other dermatophytosis
sectional study in which 50 clinically diagnosed
that have no age predilection, tinea capitis is
cases of tinea capitis in children up to 13 years of
primarily seen in the pediatric population, with a
age go to the outpatient department were
Received:21 /09/2017 DOI: 10.12816/0042577
Accepted: 30 /09/2017

Full Paper (vol.697 paper# 17)

c:\work\Jor\vol697_18 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2856-2859

Drug Prescription in Ophthalmology
Maram Adnan Rawah 1, Mohammed Mahmoud Alkhayri 2, Mashail Ali Alomari 2, Raed Khalid
ALmalki 3, Fatimah Hassan Alyahya 4, Fay Ali F Alotaibi 4, Lama Hassan M Meriky 4, Sarah Saeed
Alawami 4, Mohannad Ali S Alomari 5, Razan Mohammad Naseem Jan 6, Alyaa Mohammedrafie
Banjar 1, Humoud Mansour H AlKhalaf 7
1- Jeddah Eye Hospital , 2- King Khalid University (KKU) , 3- King Abdulaziz Medical City , Riyadh , 4-
King Abdulaziz University , Jeddah , 5- GP at Najran University Hospital , 6- Umm Al-Qura university ,
7- Royal College of Surgeons in Ireland

Drug prescription studies provide a pharmacoeconomic basis for making evidence-based
health-care decisions. In ophthalmology practice, rational prescribing shows a vital role in decreasing the
ocular disease burden.
Purpose: The purpose of the study was to inspect the drug consumption pattern in ophthalmology
department of King Abdulaziz hospital in KSA.
Materials and Methods:
A prospective, cross-sectional study was conducted for a period of 3 months.
The prescriptions for all consecutive patients attending the ophthalmology outpatient department for the
first time (first time encounter) were incorporated and reviewed using a pre-designed form to record
information from the ophthalmology outpatient department prescription cards of each patient. Data
analysis was carried out using the descriptive statistical methods: frequencies, mean, percentage, and
standard deviation.
A total of 500 prescriptions were considered with the average number of drugs per prescription
being 2.2 (0.8). The most common disorders diagnosed were eyelid diseases (31.6%) followed by foreign
body in the eye (23,2%), conjunctivitis (20,8%), glaucoma, conrneal ulcer, squint, and others. Drugs were
prescribed in different dosage forms with eye drops being the most common (62.9%) followed by
ointment (20.5%), capsule (8.6%), and tablets (8.0%) of all dosage forms. The frequency of drug
management and period of treatment was recorded in 94% and 76% of all prescriptions respectively.
Drugs were predominantly prescribed in brand name rather than generic name.
The current study showed certain lacunae in the prescribing practices of the
ophthalmologists of the institute as showed by low generic prescribing, insufficient information about
frequency of management and period of treatment in many prescriptions. This can be addressed over
appropriate sensitization of clinicians in the art of rational prescribing.
drug consumption, ophthalmology, outpatient department.


Drug consumption has been defined as the
Network for The Rational Use of Drugs have
applied themselves to evolve standard drug
utilization of drugs in a society with superior
utilization indicators [2]. In ophthalmology
emphasis on the subsequent medical and social
practice, rational prescribing has a crucial role in
consequences [1-3]. They provide a sound
decreasing the ocular disease burden of the
pharmacoeconomic basis for making better
health-care decisions. The existing variations in
Drug therapy is a major component of
the drug prescribing pattern, concerns over
patient care administration in health care settings.
adverse drug reactions and escalation in the
Prescribers and consumers are submerged with a
pricing of drugs have increased the significance
massive array of pharmaceutical products with
of drug utilization studies [4]. A periodic
innumerable brand names, obtainable regularly
checking of drug utilization pattern has become
at an unaffordable cost [5]. Irrational and
essential for supporting rational use of drugs by
inappropriate use of drugs in health care system
increasing the therapeutic effectiveness and the
observed internationally is a main concern [1, 6, 7].
cost-effectiveness whereas declining incidence
To address the increasing microbial resistance,
of untoward adverse effects. To promote rational
physicians willingly accept and extensively
utilization of drugs in developing nations,
utilize newly developed expensive and broad
international organizations like the World Health
spectrum antibiotics which further add to
Organization (WHO) and the International
increase rates of antimicrobial resistance and

health care costs [8].
Received:21 /09/2017 DOI: 10.12816/0042578
Accepted:30 /09/2017

Full Paper (vol.697 paper# 18)

c:\work\Jor\vol697_19 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2860-2864

Neurosurgery for Cerebral Aneurysm
Setah Rashd AlShammari 1, Hawazen Atef Kamal 2, Amal Abdullah Al-Buqaisi 3, Hussam Muidh
Althagafi 4, Maria Khalifah Alhamed 5, Saber Mutlaq Baseem 6, Mohammed Ahmed alfaqih 7,
Mohammed Saad Alkhathami 8, Abdulrhman Saleh Dairi 9, Abdullah Mohammed ALdayri 10,

Abdullah Ali Junayd 9, Talal Hamid Al Fallaj 11, Wed Bashier Alshora 12
1 - Ibn Sina National College,2 - Batterjje Medical College ,3 - University of Hail,4 - King Abdulaziz
University,5 - King Faisal University,6 - Aljouf University,7 - SQGH, 8 - KAAH, 9 - Umm Al-Qura
University,10- Majmaah University,11- Dow University of Health Sciences,
12- Faculty of Medicine, Cairo University

Management of small aneurysms regularly poses a therapeutic problem and surgical
treatment or coiling can be considered as therapeutic choices. In the current study, we reviewed our
series of ruptured small cerebral aneurysm preserved surgically.
Materials and Methods:
A total of 53 consecutive patients with ruptured small aneurysm were
surgically treated between November 2014 and November 2016. Data were retrospectively collected.
Procedure-related death and complications were systematically reviewed. Clinical outcomes were
evaluated utilizing the Modified Ranking Scale. Neuroradiological follow-up was performed to evaluate
aneurysmal occlusion and recanalization rate.
The mean aneurysm size was 2 mm ± 0.7 mm. All the patients were operated and the aneurysm
clipped. Clinical outcomes were as expected on the basis of the presenting Hunt and Hess grade.
Generally, major and minor neurological deficit related to clipping were 5% and 3%, respectively. At the
time of discharge, 85% of the patients presented with a favorable outcome, while 15% had poor clinical
outcome. Aneurysm occlusion was achieved in all the cases. Neither recanalization nor re-aneurysmal
rupture was observed in the clinical follow-up.
Aneurysms, 3 mm in diameter or smaller, represent a therapeutic challenge. Given the
proven role of microsurgery in small aneurysms and the perceived challenges with endovascular therapy,
surgical clipping still can be considered an effective treatment modality in this setting.
Neuroradiology, Intracranial Aneurysm, Treatment Outcome, Retrospective Studies.


Subarachnoid hemorrhage (SAH) from
operative rupture (IOR), cerebral ischemia
rupture of an intracranial aneurysm is a
prompted by brief clasp situating or of parent
distressing occasion. Data from population-
vessel impediment, and cerebrum harm
based studies suggest that the incidence rates of
identified with intraoperative retractors use [9-11].
cerebral aneurysm vary considerably from 6 to
Little aneurysms represent 6% of all
16/100,000 [1, 2]. The overall mortality rates
ruptured intracranial aneurysms [12] and their
from 32% to 67% with 10­20% of patients with
long-term dependence due to brain injury [3, 4].
International Study of Unruptured Intracranial
Twelve percent of patients influenced by
aneurismal subarachnoid hemorrhage die before
asymptomatic aneurysms <7 mm in width in the
therapeutic treatment and 25% die within 24
foremost course have a negligible provability of
hours. A further 40­60% mortality rate happens
break. Most as of late, the Unruptured Cerebral
within a month [5]. Result relies upon a heap of
Aneurysm Study (UCAS) generated outcomes
like the ISUIA [14]. On the other hand, a few
seriousness of the underlying occasion, re-
bleeding, perioperative therapeutic treatment,
examinations, revealing a higher level of little
and the planning and specialized achievement of
aneurysms among their case arrangement of
aneurysm treatment. Treatment of burst cerebral
ruptured intracranial aneurysms [15-17]. This
aneurysm is the essential worry in all patients
demonstrates an inconsistency between the
after subarachnoid hemorrhage. Up to now,
ISUIA and UCAS information and the extent of
surgical treatment is identified with a death rate
cracked aneurysms found in routine clinical
of 2% and around 10% morbidity rate [6 - 8].
practice. In spite of the fact that the
Main complications identified with surgery are
International Subarachnoid Aneurysm Trial
draining event some time recently, after, or
(ISAT) demonstrated a result advantage with
amid surgical cutting because of an intra-
endovascular curling contrasted with surgical
Received:21 /09/2017 DOI: 10.12816/0042579
Accepted: 30 /09/2017

Full Paper (vol.697 paper# 19)

c:\work\Jor\vol697_20 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2865-2870

Awareness about Anesthesia amid General Populace
Lulwah Abdulaziz Alturaifi 1, Abdulelah Ibraheem Alhatlan 2 , Mohammed Yaanallah M Al-Ghamdi
3, Haitham Abdullah Almejally 4, Mustafa Hussain H Alshawaf 2, Hussien Ali S Aljaziri 2,
Ali Adel M Alamer 2, Ghassan Ali J Alqahtani 5, Afnan Khalid Alotaibi 6, Abdullah Hejji A
Almaihan 2, Yasmin Mohamed O Sharton 7, Abrar Mansour A Alhazmi 6
1- King Khaleed Hospital in Hail , 2- King Faisal University , 3- Albaha University , 4- King Faisal
Hospital,Makkah , 5- Aseer Central Hospital , 6- King Abdulaziz University ,
7- King Abdulaziz University Hospital

The public consciousness towards anesthesiologist and anesthesia is limited even in urban
population. Our cross-sectional analysis highlights this lack of public awareness and discusses possible
remedies to overcome these limitations.
Materials and Methods:
Surgical outpatient department was screened for 6 months period in King Abdulaziz
Hospital. A questionnaire divided into three parts (awareness about anesthesiologist, consent, present surgical
experience) was filled out for each patient. The patients on the basis of their answers were classified as aware
or unaware, furthermore, source of patient data was analyzed.
Even with an exceptionally low threshold, only 44.86% of population could be categorized as aware,
and commonest source of their information was not anesthesiologist but surgeon (56%). 89.7% patients were
not aware of contents of pre-operative consent they had signed and further, only 21.4% were aware of
anesthesia-related issues. Pain was reported as the most mutual pre-operative fear and post-operative patient
concern. 40.2% patients due to lack of pre-operative counseling were not able to recognize the type of
anesthesia and thought they had received both general anesthesia and spinal anesthesia. Finally, after
explaining the role of anesthesia for surgery, 98.1% patients presented desire to meet the anesthesiologist
before if they were to be operated in future.
The awareness about anesthesia is particularly low likely due to low knowledge rates and lack of
pre-operative counseling by anesthesiologist. Both patient and anesthesiologist should understand the
significance of consent, as it is not only a legal binding but can eliminate pre-operative factitious fears of
patients and can improve patient satisfaction towards surgery.
Anesthesia, public awareness, pre-operative counseling, anesthesiologist.


General anesthesia is the state produced
It is not unusual for an anesthesiologist in
when a patient receives medications for amnesia,
KSA to face questions like, is anesthesia a separate
analgesia, muscle paralysis, and sedation. An
medical science?, The weight of research is not
anesthetized patient can be thought of as being in a
only to improve safe anesthesia methods yet in
controlled, reversible state of unconsciousness.
addition to produce public awareness about
Anesthesia enables a patient to tolerate surgical
anesthesia and the part of an anesthesiologist.
procedures that would otherwise inflict unbearable
Maternal and child health programs have improved
pain, potentiate extreme physiologic exacerbations,
the public knowledge about option of painless
and result in unpleasant memories [1].
labor; though, these programs have added very
General anesthesia uses intravenous and
little to public knowledge about the primary role of
inhaled agents to allow adequate surgical access to
anesthesia and the anesthesiologist.
the operative site. A point worth noting is that
To quantify anesthesia awareness, we
general anesthesia may not always be the best
conducted a survey in general surgery outpatient
choice; depending on a patient's clinical
department (OPD) in a World Health Organization
presentation, local or regional anesthesia may be
approved health center. The study targeted not only
more appropriate [2, 3]. The worry of awareness
to evaluate the patient perspective on anesthesia
under anesthesia has always challenged numerous
but also to determine awareness about the involved
anesthesiologists and has incited tremendous
anesthesiologist. By this study, we were likewise
research. Be that as it may, awareness about
able to highlight the importance of launching
anesthesia is still good in spite of the branch
developing and growing a century back.
programs, as these programs were found to have
Anesthesiology is a fundamental branch of
significant positive impact on population
medicine; though, public awareness about
awareness about labor analgesia. The outcome
anesthesiology appears to be dull beyond big cities.
besides evaluating our current public perspective
Received:21 /09/2017 DOI: 10.12816/0042580
Accepted: 30 /09/2017

Full Paper (vol.697 paper# 20)

c:\work\Jor\vol697_21 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2871-2875
Interaction between Proton Pump Inhibitors and Antiplatelet Therapy
Fawaz Tawhari1, Mohammed Kariri1, Yahya Addarbi1, Ibrahim Tawhari2
1-Jazan University College of Pharmacy, 2-University of Utah Health Care

proton pump inhibitors are agents that inhibit the final step in gastric acid formation. They are
available in oral forms or intravenous forms. Proton pump inhibitors can be used in case of gastric ulcer.
Antiplatelet therapy is a medication that acts as cardiovascular therapy as it is used in platelet inhibition. Some
antiplatelet agents may case ulcer and proton pump inhibitors may become necessary for ulcer treatment, the
use of this combination may cause adverse effects for patients.
Aim of the work:
this study aimed to investigate the interaction between proton pump inhibitors and
antiplatelet therapy. Materials and methods: we used the internet to obtain articles about this subject, we used
Google scholar, Pub Med and Research Gate to find the articles.
we obtained 44 articles, only 11 were included and we excluded 31 articles as they have either
irrelevant title or content.
interaction between proton pump inhibitors and antiplatelet therapy was conflicted. The data
available were from randomized studies or trials, patients inclusion criteria, methods and outcome differ
between the various studies, also the clinical data were limited.
PPIS, antiplatelet therapy, aspirine, clopidogrel.


Proton pump inhibitors (PPIs) are common
of PPIs consists of substituted pyridine ring and
medication that used in primary care sittings for the
substituted benzimidazole ring, they are connected
treatment of acid-peptic diseases (1). PPI was found
together by methylsulfinyl chain (6).
to be effectively reduced the gastrointestinal

bleeding risk in the patients who require dual
Proton pumps inhibitors, types and uses
antiplatelet therapy (DAPT) (2).It was recommended
PPIs are available in an oral formulation such
in guidelines to use PPI in high-risk patients
requiring antiplatelet therapy as a prophylactic (3) ,
esomeprazole and lansoprazole. Intravenous PPIs
but there was a concern about possible adverse
also are available for those who are unable to
effects as a result of drug interaction between PPI
administrate tablets or capsules (5). PPIs are
and antiplatelet (4). Potential pharmacological
administrated in the form of capsule with delayed
interaction between these agents was supported by
release gelatin which contains enteric-coated
early preclinical data, however clinical data were
granules (lansoprazole and omeprazole) or tablets
limited (4).
with delayed-release (pantoprazole and prazole) (7-

11). Using of intravenous PPIs included conditions
related to acid (gastroeosophageal reflux disease),
In this review, we used the internet to search
hypersecretory states (Zollinger-Ellison syndrome)
for articles related to the present subject. Key words
and patients who were unable to take oral form (5).
such as proton pump inhibitors, interactions of PPIs,
Also, they can be administrated in other cases such
antiplatelet therapy and interaction of antiplatelet
as stress related to mucosal bleeding, prevention of
therapy. We found 44 articles, 33 of them were
acid aspiration syndrome and peptic ulcer bleeding
excluded as they were of irrelevant title or content
and 11 were included. The included articles were
Action of Proton pump inhibitors:
published between 2002 and 2017.
All PPIs have short plasma half-life, but they have
The study was approved by the Ethics Board of
long duration of action as they have a unique
Jazan University.
mechanism of action (1). PPIs are prodrugs that

require acidic environment to become protonated
and convert to the active form (15). As PPIs are
Proton pump inhibitors; definition:
lipophilic weak bases, they cross the parietal cell
PPIs are highly selective potent inhibitors for
membrane and then enter the acidic parietal cell
H+, K+ adenosine triphosphate (ATPase) enzyme,
canaliculus (1). These acidic conditions make PPIs
this enzyme catalyzes the final step in the secretion
protonated, so they produce the activated form of
of the gastric acid (5). The basic chemical structure
sulphonamide of the drug that covalently bind to
Received: 21 /09/2017 DOI: 10.12816/0042581
Accepted: 30 /09/2017

Full Paper (vol.697 paper# 21)

c:\work\Jor\vol697_22 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2876-2889

Protective Role of Acacia Nilotica Extracs And Silymarin against
Mutagenic and Hepatic Injuries Induced by 2-Butoxyethanol in Male Mice
Zeinab E.M. Hanafy1, Ahkam M. El-Gendy1, Alaa A. Zaky2,
Ahmed M. Mansour2 and Nada Mostafa
1-Zoology Department, Faculty of Science, Al­Azhar University (Girls),
2- Faculty of Pharmacy, Al­Azhar University
2-Butoxyethanol (2-BE) is a clear colorless liquid that smells like ether. It is used as a solvent in spray
lacquers, varnishes, varnish removers, herbicides, liquid soaps, cosmetics, industrial and household cleaners,
and dry-cleaning compounds. 2-BE causes cellular damage via formation of reactive oxygen species. Acacia
(A.nilotica) leaf extract exhibited significant antimutagenic and DNA-protective effects against
oxidative damage due to the presence of alkaloids, volatile essential oils, phenols and phenolic glycosides; it is
considered an excellent free radical scavenging antioxidant owing to the high number of hydroxyl groups.
Silymarin (SIL) is a standardized mixture of antioxidant flavonolignans (silybin and silibinin).
Silybum marianum (Milk thistle) family Asteraceae is an ancient medicinal plant from which SIL is
extracted. It is a free radical scavenger and a membrane stabilizer that prevents lipid peroxidation. In the
present study, we investigated the effects of extracts of A.nilotica leaves and SIL on the toxicity of 2-BE.
Materials and Methods: 2-BE was given orally to male albino mice for 28 days at dose (450l/kg b.wt). A.
leaf extract (25 mg/kg b.wt) was dissolved in water and was administered orally for 14 days prior to 28
days treatment of 2-BE and during the 28 days. Also SIL (20 mg/kg b.wt) was administered orally for 14 days
prior to 28 days treatment of 2BE and during the 28 days.
Result: In the present work, genotoxic effects were induced by 2-BE through oral administration, and the
protective effect of A. nilotica and SIL are studied. 2-BE induced a significant increase in the structural as well
as numerical chromosomal aberrations. The frequency of chromosomal aberrations showed significant
decrease when mice treated with A. nilotica extract and SIL. Also, there were significant increases in
micronuclei. A. nilotica extract and SIL administration significant decreases micronuclei induced by 2-BE.
However 2-BE induced a significant decrease in mitotic index. Administration of both A. nilotica extract and
SIL significant increase mitotic index in mice treated with 2-BE. Exposure of mice to 2-BE caused significant
changes in the hematological paramters as well as significant increases in the activities of serum
enzymes alanine aminotransferases (ALAT), aspartate aminotransferases (ASAT) and alkaline phosphatase
(ALP). Also, 2-BE induced a significant decrease in the content of liver reduced glutathione (GSH), however,
induced a significant increase in the level of hepatic lipid peroxidation end product (MDA) of male mice. Co-
administration of both A. nilotica extract and SIL to 2-BE-intoxicated mice ameliorated the above-mentioned
parameters. Conclusion: 2-BE induced mutagenic and liver injury in male mice. A.nilotica and SIL are found
to reduce the percentage of chromosomal aberration and micronuclei cells as they are a powerful antioxidant,
they are able to scavenger reactive oxygen species (free radicals) formed by 2-BE in the cells, these free
radicals damage DNA and hence cause defects in the chromosomes. A. nilotica extract and SIL could be used
as a protective agent against mutagenic and hepatic injuries resulting from 2-BE. The protective action of SIL
is more effective than A. nilotica.
Keywords: 2-Butoxyethanol, Acacia nilotica leaves extracts, Silymarin, Chromosome aberration,
Micronucleus, hematological parameters, liver functions and oxidative stress.

BE causes cellular damage via formation of reactive
2-Butoxyethanol is glycol ether with the
oxygen species (ROS). ROS are believed to cause
molecular formula: C6H14O2.It is a volatile organic
lipid peroxidation resulting in damage to biological
compound (VOC) and is not known to occur as a
membranes3. Herbal extracts with their proven
natural product but is emitted into the atmosphere
potential and less side effects in therapeutics has
due to its use as solvent, mainly during surface
replaced the synthetically derived drugs in modern
coating and cleaning activities1. Human exposure to
allopathic medication system4. Acacia species
2-BE can occur through skin contact, inhalation, or
(Mimosaceae) are rich in phenolics and have strong
ingestion2. There are several studies reporting that 2-
antioxidant activities 5. Acacia nilotica (L.) Willd
Received:12 /09/2017 DOI: 10.12816/0042582
Accepted: 23 /09/2017

Full Paper (vol.697 paper# 22)

c:\work\Jor\vol697_23 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2890-2896
Urinary Incontinence in Healthy Saudi Women
Dayili Abdulmajeed Ahmed Y, Sahhari Mohammed Abdulrahman Mohammed,
Radwan Ismail Mohammed I, Alazmi Salim Ahmed H, Refaei Naif Abdulmajeed A, Ibraheem
Nasser Mansour Shammakhi,Ali Ahmed Atiah Ruwayni,Mujeeb Alrhman Idaros Madkoor,
Hatim Ali Asiri Halawi,Mousa Sulaiman Ghazwani

Jazan University

urinary incontinence is a distressing common medical disease in which patient cannot
control leakage of urine. The prevalence of urinary incontinence differs between countries and between
different studies. The risk factors for urinary incontinence including increasing age, chronic cough,
medical co-morbidity, childbirth, obesity, depression, smoking, gender and previous hysterectomy.
Aim of the work: this study aimed to assess the prevalence of urinary incontinence in Saudi females and
its associated risk factors.
this was a cross-section study based on a survey on the internet, it included 400 female
participants with a minimum age of 30 years old.
the prevalence of urinary incontinence was 44.25%, 66.3% of them were in age of 50 years and
above. 43.5% of participants were obese, 19.5% were post-menopausal, 6.25% performed hysterectomy,
37.5 % had parity more than 3 times, 33% had depression and 35.5% had diabetes.
prevalence of urinary incontinence was moderate. The most common risk factors for
urinary incontinence were older age, menopause and high parity.
urinary incontinence, urinary incontinence prevalence, urinary incontinence in females,
Saudi Arabia.

exercising, sexual activity, traveling, shopping
Urinary incontinence (UI) is an involuntary
and it causes emotional disorders such as
leakage of urine (1); it is a distressing common
depression (3).
medical disease, (2). Almost, over 200 million

individuals in the world had UI with more
It was demonstrated that women with UI
prevalence in females (3). Several studies from
symptoms tend to experience depression, feel
European population and North America reported
more humiliated and have higher anxiety levels
a prevalence of 8.5% to 58% (4-6). In a Saudi study
than women without UI symptoms (14).
(7), the prevalence of UI between females who
The aim of the present study was to estimate
attended PHCCs in Jeddah was 41.4%. Others
the prevalence of UI between Saudi women and
mentioned that UI was experienced by more than
investigate some of UI risk factors.
30% of adult females (8).

UI prevalence is increasing with increasing
age, childbirth, medical co-morbidity and obesity
This study was a cross-sectional survey-
of females (9).
based study, it included 400 female participants
Gender, previous hysterectomy, pregnancy,
whose age not less than 30 years, there were 53
chronic cough, depression smoking, genetics and
participants were excluded as their age were less
menopause are the other risk factors (9-11). It was
than 30years old. A survey via the internet was
reported that the UI in females is most common
established to investigate the demographics,
between the advanced age women and those with
chronic diseases and urine incontinence of
multi-parity (4). Also, it was reported that one-
females. The study was conducted in the period
third of females were suffered from stress
from August 2017 to September 2017. Data were
incontinence after 5 years of their vaginal
analyzed by using Statistical Package for Social
delivery (12). In a cross-sectional study on 400
Studies (SPSS 22; IBM Corp, New York, NY,
menopausal women (13) it was found that obesity
USA). Categorical variables were expressed as
was a risk factor for UI. UI results in limitation in
percentages. Chi-square test was used for
the daily activities, loss of self-esteem and
categorical variables. P-value <0.05 was
decrease in the quality of life (7)as it limits
considered statistically significant.
Received:9 /09/2017 DOI: 10.12816/0042583
Accepted: 18 /09/2017

Full Paper (vol.697 paper# 23)

c:\work\Jor\vol697_24 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2897-2905

Role of Magnetic Resonance Imaging in Evaluation of Anterior
Cruciate Ligament Injuries
Randa H. Abdullah (1), Rasha T. Khattab (1), Ahmed R. Ahmed (2),
Raghad Mohammed Hatif (1)
(1) Department of Radio-diagnosis, (2) Department of Orthopaedic Surgery
Faculty of Medicine - Ain Shams University
Magnetic resonance imaging (MRI) is used more commonly in evaluation of knee trauma
compared to other modalities. It is an excellent diagnostic tool that may help clinicians in the evaluation of
injuries to menisci and ligaments, osseous structures, articular surfaces, and tendon, it plays an important
role in clinical decision-making.
Aim of the Work: The aim of the study was to determine the role of magnetic resonance imaging (MRI) in
the assessment of injuries related to anterior cruciate ligament compared to arthroscopy.
Patients and Methods: This study included (20) ACL injury patients referred to the Radiology Department
from the Orthopedics outpatient clinic department, Al-Demerdash Hospital, Faculty of Medicine, Ain Shams
University from December of 2016 to August of 2017. Results: eighteen (90%) male and 2 (10%) female
patients were enrolled in this study. We found that sensitivity, specificity, PPV, NPV and accuracy were
(90%, 70%, 71.4% 100%, 80 %) respectively in partial ACL injury. And the sensitivity, specificity, PPV,
NPV and accuracy in complete ACL injury were (78.4%, 100%, 100%, 71.4%, 82 %) respectively. And the
sensitivity, specificity, NPV, PPV and accuracy of medial meniscal tear were 99.8 %, 91.7%, 92.3%, 100%,
94% respectively and the sensitivity, specificity, NPV, PPV of lateral meniscal tear were 95.4%, 97.3%,
99%,100%, 98% respectively. Conclusion: MRI is now commonly used before diagnostic arthroscopy in
most settings as an effective screening tool with most patients because it is faster, non-invasive and does not
involve morbidity associated with arthroscopy. MRI findings before arthroscopy help in the management of
meniscal and ligament injuries, ultimately improving patient outcome.
magnetic resonance image, anterior cruciate ligamgent injuries, arthroscopy.


The knee is a major weight bearing joint
articles detected high sensitivity and specificity of
that provides mobility and stability during physical
MRI in assessment of knee joint injuries (4).
activity as well as balance while standing.

Traumatic knee injuries are frequently encountered
both in general practice and in the hospital setting.
The aim of the study was to determine the role
These injuries are often caused by sports activities
of magnetic resonance imaging (MRI) in the
and may lead to severe pain and disability (1). The
assessment of injuries related to anterior cruciate
anterior cruciate ligament (ACL) is a dense fibrous
ligament compared to arthroscopy.
band composed of collagen fibrils. It is

approximately 3.5-3.8 cm long and 1 cm in
transverse diameter. the ligament originates from

the posteromedial aspect of the lateral femoral
This study Included (20) patients referred to
condyle in the intercondylar notch. It courses
the Radiology Department from the Orthopedics
through the notch in an anterior, inferior, and
outpatient clinic department, Al-Demerdash
medial direction (2). Magnetic resonance imaging
Hospital, Faculty of Medicine, Ain Shams
(MRI) is used more commonly in the assessment of
University from December of 2016 to August of
knee trauma comparing to other modalities as it is
2017. The patients presented with suspected ACL
an excellent diagnostic tool that may help
injury. All patients were submitted to history
clinicians in the evaluation of injuries to menisci
taking and clinical provisional diagnosis and each
and ligaments, osseous structures, articular
patient exposed to MRI examination followed by
surfaces, and tendon. Moreover, it plays an
important role in clinical decision-making (3).

Arthroscopy considered the gold standard
Inclusion criteria
for diagnosis of Anterior Cruciate Ligament and
Inclusion criteria are suspicious injury of ACL
Meniscal injuries yet, MRI considered an
(tear) and meniscal injuries.
alternative to diagnostic arthroscopy as many

Received: 3 /09/2017 DOI: 10.12816/0042584
Accepted:12 /09/2017

Full Paper (vol.697 paper# 24)

c:\work\Jor\vol697_25 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2906-2909

Assessment of Knowledge and Attitude of Nurses towards Ionizing
Radiation During Radiography in Jeddah City, 2017
Mohammed Ali Alzubaidi1, Huda Hamad al Mutairi2, Soliman Mohammed Alakel3,
Hani Ahmed Saleh Al Abdullah4, Ibrahim Abdullah Albakri5, Saleh Fahad Abdullah Alqahtani6
1-Umm AlQura university,2-Qassim university, 3-King Abdulaziz University,4-King Faisal University,
5-Najran University, 6-King Khalid University
The nurses working in radiation wards need to have an adequate knowledge about the risks and
preventive measures of radiation exposure to protect themselves from health hazards of radiation as well as
giving the patient the correct information about radiation exposure practices. Adiography in Jeddah city,
Kingdom of Saudi Arabia (KSA). Methods: A cross sectional study was assessed among 300 nurses in Jeddah
city from June 2017 to August 2017. All the nurses were interviewed then filled up a questionnaire sheet. The
questionnaire included 3 parts and the first part comprised questions about the demographics of included
subjects, the second and third parts included questions about the knowledge and attitude of nurses toward
radiation. Results: The majority of nurses (65%) had adequate knowledge regarding the ionizing radiation risk
factors and protective measures and about 35% had poor knowledge. The level of nurse's attitude was good
among 79% and poor among 21% toward ionizing radiation. The level of knowledge was significantly
associated with the level of educational degree and magnitude of practical years of experience. Conclusion:
the nurses' radiation protection knowledge and attitude were good among most of nurses. However, there is a
need for other educational safety programs to increase the knowledge of the rest of nurses.
Keywords: Knowledge, Attitude, Radiation, Nurses; Radiology, KSA.


of awareness about radiation risks is very
The medical imaging is a powerful tool for
dangerous to health thus , this study was
diagnosis of many diseases using Ionizing
conducted to assess the knowledge and attitude of
radiation. Many studies focused on the hazards of
nurses towards Ionizing Radiation during
industrial radiation and the risks of medical
Radiography in Jeddah city, Kingdom of Saudi
radiation exposure were underestimated as several
Arabia (KSA).
studies have revealed a need for radiological

examination in most of patients for disease
diagnosis and confirmation (1, 2). The benefits of
- Study design
medical diagnostic interventions are major but
This is a cross sectional study that was assessed
have some potential risks that can't be ignored(3, 4).
among a sample of nurses in Jeddah city from June
The radiation has various medical hazards which
2017 to August 2017.
increases with the increasing dose level and the
- Study setting and population
exposure time to radiation (5). The major potential
effects of radiations are induction of cancer,
governmental and private hospitals in Jeddah City
cataracts, fertility and blood dyscrasias (6).
and included 300 nurses.
Decreasing the exposure time and dose a
- Study tools
well as increasing the distance from the source
A self-administrated questionnaire was
could protect patients and occupational health
designed and validated after reviewing the
workers. The nurses usually present at the
previous studies. The questionnaire was revised by
radiology wards and theatre as they offer the health
3 experts then a pilot study was conducted in 3
care for patients during and after radiological
different random hospitals on 20 nurses for
investigations (7). Also, nurse's responsibilities
validating the questionnaire then was translated
include preparing the equipment used in
into simple Arabic. The questionnaire included 3
radiological procedure and help patients till
parts. The first part comprised questions about the
finishing the procedure (8, 9).
demographics of included subjects, the second and
The nurses working in radiation wards need
third parts included questions about the knowledge
to have an adequate knowledge about the risks and
and attitude of nurses toward radiation. The study
preventive measures of radiation exposure to
was done after approval of ethical board of
protect themselves from health hazards of radiation
King Abdulaziz university.
as well as giving the patient the correct information
Statistical analysis: Statistical analysis was
about radiation exposure practices(10, 11). The lack
performed by using software SPSS (version 22).
Received:21 /09/2017 DOI: 10.12816/0042590
Accepted: 30 /09/2017

Full Paper (vol.697 paper# 25)

c:\work\Jor\vol697_26 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2910-2917

Effect of Social Media Network on Social Relations and Academic
Achievement Among Medical Students
Ali Mohammad Ali Aljabry, Ahmed Ali Ahmed Jaafari, Mohammed Abdullah Mohammed
Salawi, Fahad Abdoh Taher Majrabi, Nagi Mohammed Ahmed Hazzazi, Ahmed Hadi A Khormi,
Mohammad Ali Mousa Daghriri, Abdulaziz Mohammed Abdullah Alfaqih, Mohmmed
Ahmad Mohmmed Al-harobi, Saud Abdulaziz Musa Alqahtani
Jazan University
Corresponding Author: Ali Aljabry <a_aljabry@hotmail.com>

Social networks influence the lives of individuals and communities. They have several
advantages; however, they have many disadvantages including its adverse effect on social life and
academic performance of students. They are reasons for time-consuming, individuals can even addict
these sites.
Aim of the work: this study aimed to determine impact of social media on academic performance and
social relationships as well as factors associated with social media and pattern of using social media.
This was an observational cross-sectional study which was conducted in Jazan University; it
included 205 (45.1%) male students and 250 (54.9%) female medical students. A questionnaire was
used to perform this study. SPSS was used to analyze data.
Results: The present results showed that the most common used sites were facebook (53%), 65.9% of
students used social networks for more than three years, 58.5% used these sites for 2 to 4 hours. Gender
was a significant factor regarding using Facebook and WhatsApp (P-value=0.001, 0.004 respectively),
the only significance was found between the different academic years was regarding WhatsApp (P-
value=0.001) which was commonly used by fourth-year students (46.1%). Both numbers of hours and
using social media during lectures influenced study level (P-value=0.01, 0.021 respectively).
Conclusion: The most common social site used was Face book and the social media affected the
academic performance of students negatively. Social media has both positive and negative effect on
social relations.
Keywords: social media, academic performance, social media effects.


Social media was defined as "internet-
There are advantages of social media
based applications that allow the creation and
such as convenient access to information, fast
change of content which is user-generated" [1].
and efficient communication with other people,
Social media involves a group of applications
promoting tool for businesses and collaborative
and websites that enable users to share their
environment [8]. Social media also has different
ideas, feelings, different contents, experiences
roles in education [9].
and communicate with other users [2]. There was
Social media also has several disadvantages
a rapid expansion of social media which lead to
including personal data leakage, time wasting
dramatic alteration in the world; this rapid
and recruitment for jobs [10], causing anxiety,
increase can be attributed to several factors such
depression, sleep problems and addiction to
as easy of accessibility and use, availability of
social media which affects and interferes with
mobile phones and tablets [3].
performing daily missions[11].

The most popular social media include
Also, these sites can make fundamental
changes in social relations and social life [6]. A
messenger, skype, Viber, Instagram and we-chat
study had investigated the effect of using social
[4]. Facebook is the most popular social media in
media on the academic performance of students
the world with 1.65 billion users and the age
[10]. Social media sites have effects on the lives of
group of 20-29 years represented 30% of total
students and their academic achievement as well
users [4], however in Saudi Arabia twitters users
as the duration of their studies [12,13]. A study
are higher [5]. Many students consider using
from Pakistan revealed that the use of social
social media sites as a component of their lives
media affected negatively on lives and education
[6]. It was found in one study that 90% of college
of teenagers and children [14].
individuals were facebook users [7].
Received:21 /09/2017 DOI:
Accepted: 30 /09/2017

Full Paper (vol.697 paper# 26)

c:\work\Jor\vol697_27 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2918-2929
Lifestyle of Medical students at Qassim University
Tameem A Alhomaid1, Majed Wadi1, Mohannad M Almanea1, Abdulrahman T AlTurki1,
Bakr F Alharbi1, Muhannad M Aldubaykhi1, Layla M Alnashry2, Bander A Alharbi1,
Rakan M Alahmad1, Sulaiman S Alharbi1, Fahad O Alharbi1
1Qassim University, 2Tabuk University

Background: Healthy lifestyle is an important element for success, especially for Medical students. It includes
lots of items such as physical activity, diet, and sleep which we believe that these three items are the major for a
healthy lifestyle. The aim of this study is to evaluate healthy and non-healthy behaviors including physical
activity, diet and time devoted to sleep, leisure, stress, and smoking of medical students in Qassim region.
Methodology: A cross-sectional study was targeted medical students at Qassim region in different cities
(Buraydah and Unizah). A self-administered questionnaire was used. It included a domain for physical activity,
time devoted for sleep, leisure, and smoking. Results: Around 714 medical students participated in this study,
467 (55.3%) males and 247 (44.7%) females. Regarding physical activity, it was found that one-third of the
students excise 1-3 times per week. Regarding diet, 31% of students were always eating there breakfast. But,
81.8% were consuming fast food 1 to 6 times weekly. Furthermore, half of the students devoted 4-6 hours only
for sleep during school days and during the weekend they sleep 7-9 hours. Time spent on a cell phone,
computer, and surfing Internet (for leisure) was more than 4 hours for 32.5% during the week and it increases at
the weekend to 51.9%. Conclusions: Lifestyle of the majority of the students were: did not sleep enough, did
not exercise, consumed fast food, and spent much time in usage of a cellphone, which are common habits
among medical students of both genders. These habitats had a significant impact on their overall satisfaction of
life and may affect their academic performance and general health.


Lifestyle is one of many elements of success,
students' academic achievement. Habits in any group
especially for medical students. The concept of
of people will result positively, which are the healthy
lifestyle is "someone's way of living; the things that a
habits, or negatively, leading to lifestyle disorders (3).
person or a particular group of people usually do" (1).
Medically, sedentary lifestyle that can be associated
A lot of items play an important role in deciding
with the increased prevalence of dyslipidemia,
whether the lifestyle is healthy or non-healthy.
obesity, and cardiovascular diseases (4). Well-being
Physical activity, diet and time devoted to sleep are
lifestyle results in good health in the long term (5). A
the three major ones which the research is focusing
cross-sectional study was done on male and female
medical students at the college of the medicine
experience big changes in different aspects of their
University of Dammam during the academic years:
lives, starting with being responsible for driving their
1st, 3rd, and 6th year, 562 students have been
own way to progress step by step towards having a
participated, during the first semester of the
good job and eventually a great career. on the other
hand, maintaining a trustful base of relationships
participated in this study. Another study involved
which will lead to increase the level of social
604 students from different 4 universities in
activities, and in the same time keeping an eye for
Wroclaw, Poland (6). There were different parameters
their financial situation balancing a low income
to be measured among students: physical activity,
usually with an expensive HEALTHY lifestyle
needs, these changes can be stressful if time
consumption, and drug using (3-6).
management and self-discipline falls down and
Physical activity means: it is "the
usually lots of disorders start to affect lifestyle as a
performance of physical exertion for improvement of
result, varying from bad eating habits to drug
health or correction of physical deformity". Diet
addiction which will lead to low academic
defined as "the customary allowance of food and
drink took by any person from day to day,
Lifestyle among medical students could be
particularly one especially planned to meet specific
affected by stress, as well as, stress could affect
requirements of the individual, and including or
Received:21 /09/2017 DOI: 10.12816/0042586
Accepted: 30 /09/2017

Full Paper (vol.697 paper# 27)

c:\work\Jor\vol697_28 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2930-2934

Senile Cataract in Arar, Northern Saudi Arabia: Hospital Based Study
Wafa Mohammed Falah Alanazi1, Najah Salah F Alanazi1, Hanan Khalid Alotaibi1, Fatimah Fahad
Altaleb1, Aseel Menwer Alanazi1, Arwa Nughaymish Alanazi1, Yusef Muhana Alenezi2
1 Faculty of Medicine, Northern Border University, Arar, 2 Family and Community Medicine Department,
Faculty of Medicine, Northern Border University, Arar, KSA.

Senile cataract is an age-related, vision-impairing disease characterized by gradual
progressive thickening of the lens of the eye. It is the world's leading cause of treatable blindness.
The objective of this study was to identify the percentage and determinants of Senile Cataract in Arar,
Northern Saudi Arabia. Methods: The current study is a hospital based conducted in Arar Cental
Hospital, for the period from 1/3/ 2016 to 30/9/2017. All elderly patients referred to or admitted to the
hospital ocular department and who were clinically suspected to have Cataract were included in the study
after obtaining an informed consent from them. Exclusion criteria included patients who refused to
participate in the study. Data was collected through face to face interview and filling a questionnaire which
included questions about age, sex of participants, signs and symptoms of cataract and it's complications,
presence of comorbidities. Results: The study included 134 cases, 95.5% of the studied cases had
Cataract, of them 53.9% were males and 46.1% females, 53.1% aged between 50-60. One third of the
cases had cataract for less than one year, 37.5% for -2 years. Fifty five (43%) reported foggy vision, 17.2%
see halos around the light, 15.6% reported problems in seeing bright colors, 12.5% problems with night
vision and 11.7% reported fad in colors and 0.6% had complete blindness. Twenty nine (22.7%) of the
cases had DM, 17.2% were obese, 16.4% had hypertension, 6.2% had IHD and 28.1% were smokers. Only
49.2% had cataract operation but succeeded in 28.9% of them. Conclusions: We found senile cataract in
95.5% of the studied old aged participants, there was high rates of no operated cataract in older people in
North Saudi Arabia. Males had higher rates of cataract, and 0.6% had complete blindness.
Keywords: Senile Cataract, determinants, Arar, Northern Saudi Arabia.


Senile Cataract is an ocular morbidity of
improved quality of life [7]. Globally, cataracts
aging. It is the leading cause of blindness [1].
cause moderate to severe disability in 53.8
Senile cataract is defined as the opacity of the
million during 2004, 52.2 million of whom are in
lens of the eye or its capsule, with no obvious
low and middle income countries [8].
cause, occurring in people over the age of 50
Cataracts affect nearly 22 million Americans
years [2]. The opacity is due to protein aggregates
age 40 and older. By age 80, more than half of all
that are formed for unknown reasons. Protein
Americans have cataracts. Direct medical costs
aggregates may be located in various parts of the
for cataract treatment are estimated at $6.8 billion
lens structure, which constitute the types of
annually [9].
cataract: nuclear, cortical and posterior sub-
In the eastern Mediterranean region, cataracts
capsular [3],
are responsible for over 51% of blindness.
The composition of the lens opacity is
Access to eye care in many countries in this
not known but structural modifications of
region is limited [10]. The leading cause of
crystallins (the proteins maintaining the
diminished vision in developing countries is
transparency of the lens) are suspected to be
cataract, in the Fayum, Egypt, study the
involved and catalyzed by oxidative stress [4, 5].
prevalence of cataract was 10.6% with more
There are some risk factors that facilitate
prevalence in females (5.9%) than males (4.7%)
the age dependent opacification, including family
history, diabetes, smoking and solar exposure [6].
Other study in Egypt, conducted in four
Prevention includes wearing sunglasses and not
village among residents aged 40 years, Mousa
smoking. Early on the symptoms may be
et al. [12] reported, the prevalence of cataract was
improved with glasses. If this does not help,
22.9% (higher in women, with significant
surgery to remove the cloudy lens and replace it
with an artificial lens is the only effective
The objective of this study was to identify
treatment. Surgery is needed only if the cataracts
the percentage and determinants of Senile
are causing problems and generally results in an
Cataract in Arar, Northern Saudi Arabia.
Received:21 /09/2017 DOI: 10.12816/0042587
Accepted: 30 /09/2017

Full Paper (vol.697 paper# 28)

c:\work\Jor\vol697_29 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2935-2938

Knowledge of Community Population in Al Ahsaa about The
Outcomes of ACL Injury,2017
Ali S Al-Sultan1, Mahdi Y AlYousef1, Hassan A Al Wtayyan1, Mustafa A Bo Khamseen1,
Mohammed Nasser alrasasi2
1-King Faisal University, 2-Imam Abdulrhman Bin Faisal University

Background: The injury of the anterior cruciate ligament (ACL) is a common injury of the knee which
needs an accurate medical management for avoidance of the complications. However, knowledge about the
risk factors and effects of ACL are limited in Kingdom of Saudi Arabia (KSA).
Objectives: Assessing the knowledge of Saudi subjects about the effects of anterior cruciate ligament
(ACL) injury on daily activities in Al Ahsaa City, Kingdom of Saudi Arabia (KSA).
Methods: A cross sectional study that included 700 Saudi subjects who were randomly chosen from June ­
August 2017. The volunteers were interviewed in shopping malls and filled out a questionnaire sheet that
included information about their demographics and questions associated with ACL risk factors and
outcomes. Results: About 6% of subjects declared suffering from ACL injuries. The knowledge of
respondents toward ACL injury definition, risk factors, symptoms, treatment and complications were
inadequate among 71.3% of subjects. The good knowledge was significantly associated with the older age
and male gender while the education level showed no association with knowledge score.
Conclusion: There was
a lack of knowledge about ACL injuries among Saudi participants that need
efficient educational campaigns for increasing the awareness about the etiology, risk factors, treatment and
complications of ACL injuries.
Key words:
Anterior Cruciate Ligament (ACL), Knowledge, Risk Factors, Outcomes, Al Ahsaa.


The injury of the anterior cruciate
The study aimed at assessing the
ligament (ACL) is a common injury of the knee
knowledge of Saudi subjects about the effects of
which needs an accurate medical management for
anterior cruciate ligament (ACL) injury on daily
avoidance of the complications (1, 2). The
activities in AL Ahsaa City, KSA.
appropriate medical diagnosis is associated with

the knowledge about the risk factors, mechanism
of injury as well as physical and radiological

symptoms. After surgical, reconstruction or
- Study design
physical therapy, the patient will regain the
A cross sectional study was used during the
function and stability of the knee (3).
period of June-August 2017 in Al Ahsaa,
The injury of the anterior cruciate
Kingdom of Saudi Arabia (KSA).
ligament (ACL) has several mechanisms as
- Sample size and population:
collisions from accidents or fall and sport field (4,
The study included 700 subjects who were
5). The most common types of ACL tears (70%)
randomly chosen from Saudi subjects from both
occur with non-contact during sports also hitting
genders using a multistage sampling method. The
the lateral knee will result in ACL injury (6, 7).
included subjects were interviewed in different
The ACL injury is the main risk factor
shopping malls in Al Ahsaa region.
for Knee instability with secondary disorders in
Study tools
the intra- and peri-articular structures of the knee
A questionnaire sheet was designed after
and cause degeneration of the articular structures
reviewing the literature review and studies
. Also, ACL is associated with the injury of the
conducted in different parts of the world. The
meniscal especially among young and trainees,
questionnaire included 3 parts. The first part
also among 50% of these injuries may be
included questions about the age, gender and
complicated to knee osteoarthritis (9, 10).
educational level. The second part associated with
ACL injury has a poor healing capacity
the prevalence of ACL injuries among the
due to anatomical, biological and biomechanical
community and the third part included questions
factors and could be complicated with persistent
related to the risk factors and the effects of ACL
instability of the knee with pulling the ligaments
stumps apart thus affecting the quality of life (11,

Received: 21 /09/2017 DOI: 10.12816/0042588
Accepted: 30/09/2017

Full Paper (vol.697 paper# 29)

c:\work\Jor\vol697_30 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (7), Page 2939-2943
Assessment of Knowledge and Attitude and Practice of
Parents about Immunization in Jeddah City, 2017
Ahmed Abdullah Saleh Alenazi1, Reem Ahmed Alshareef2, Fatimah Abduladhim Alabudib3,
Yomna Majed Alsayagh3, Ayah Jawad H Almuqarrab4
1-Ibn sina National college, 2-Batterjee medical college,
3-Imam Abdulrahman bin Faisal University, 4-King Khalid University
Immunization has shown a major preventive aspects of infectious diseases, disability and death.
Objectives: Assessing the Knowledge, attitude and practice (KAP) of Saudi parents in Jeddah City regarding
the immunization programs for children, Saudi Arabia (KSA), 2017.
Methods: It is a cross sectional survey study that was carried among 600 different Saudi parents form different
parts of Jeddah City for 3 months from May to July 2017. The parents completed a questionnaire that contains
4 different parts about the demographics, knowledge, attitude and practice of parents toward immunization.
Results: The included parents have shown a high level of awareness about vaccination regarding the
preventive measures and importance of vaccination which resulted in positive attitudes and practice pattern
among most of them. The overall KAP was good among most of parents (87.2%). The higher KAP level was
significantly associated with female gender, higher educational degree and having higher number of children.
Conclusion: Most of Saudi parents had good KAP toward immunization which was associated with female
gender and higher educational degrees. However, educational programs are still needed to increase the parents'
knowledge and practice especially among illiterate and less educated parents living in rural areas.
Keywords: Knowledge, Attitude, Practice (KAP), Immunization, Vaccination, Parents, Children, KSA, 2017.


During the last few decades, the burden of the
and practice pattern of parents toward vaccination
infectious diseases has been reduced though
from the first day of birth could provide early
immunization. Also, immunization has shown major
prevention from many communicable diseases,
aspects of disease, disability and death prevention.
disabilities as well as other causes of death (10, 11).
The most common vaccine preventable diseases are

Rubella, measles, diphtheria, Tetanus, pertussis and
Polio (1, 2). Giving the child the appropriate vaccine
This study aimed at assessing the Knowledge,
would significantly decrease the costs of disease
attitude and practice (KAP) of Saudi parents in
treatment and rates of disease thus enhance a good
Jeddah City regarding the immunization programs
quality of life for children(3).
for children as well as defining the correlation
The WHO estimated a reduction in the death
between KAP and parent's demographics.
rate from infectious diseases between 2 and 3

million each year (4). The main vaccines for children
in Saudi Arabia are scheduled from birth to 6 years
Study design
old by the Saudi Ministry of Health to protect
It is a cross sectional survey study that was
children from the diseases that could be prevented
carried out in 600 houses that were randomly
through immunization (5).
chosen using stratified sampling technique from the
Despite the major efforts of health authorities to
east, west, north and south parts of Jeddah City for 3
keep KSA free of Diphtheria, Pertussis, Tetanus,
months from May to the end of July.
polio and measles, many physicians face major
Study population
obstacles from the parents about the safety,
The study included 600 different parents having
efficiency and the necessity of regular childhood
at least one child. The participants have been
vaccines (6). Most of parents in KSA believed that
interviewed in their own houses.
vaccines can cause autism and disabilities (7).
Study tools

Also, in a global report issued by the CDC, it
This survey included an interview with the
was stated that the general attitude of parents was
parents and were asked to complete a questionnaire.
negative among most of them toward childhood
The questionnaire was collected and tested after
vaccination programs (8). Moreover, some parents
searching the available search engines including
thought that polio immunization will decrease the
Pubmed, Google scholar, science direct,..etc. using
fertility rate thus the parents attitude plays important
the key words including Knowledge, attitude,
role in vaccination process as they are the decision
makers for their children (9). The knowledge, attitude
vaccination. The data of the questionnaire were
Received: 2 /09/2017 DOI: 10.12816/0042589
Accepted: 12/09/2017

Full Paper (vol.697 paper# 30)