Antibiotic are the molecules that science discover and applied for treatment of infectious disease The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 2944-2947

Study of Antibiotic Use in a Tertiary Care Hospital in Tabuk City,
Northern West, Saudi Arabia
Amjad Saud Mhrb Alrowili1
1Pharmacist at King Salman Hospital for Armed Forces in Tabuk city, Northern West,
Kingdom of Saudi Arabia

Background: Inappropriate use of antibiotics is known as an important risk factor in the development of
antibiotic resistance, which increases the morbidity and mortality. We aimed to determine the prevalence and
characteristics of antibiotic use in a Tertiary Care Hospital in Tabuk city, Northern Saudi Arabia.
Methods: A cross sectional study was conducted in a Tertiary Care Hospital in Tabuk city, during October
2017. Results: A total of 120 participants, 107 of them had antibiotics in their prescriptions with antibiotic
use prevalence 89.2%. Most of patients were males (62.6%) and children and adolescents (0-19 years)
constituted 4.8%. The most attended department was internal medicine (32.7%). 21 diseases were identified,
upper respiratory tract infection (URTI), followed by urinary tract infection (UTI) 8.4%. Among the
antibiotics, ampicillin, cephalosporin and metronidazole were the most prescribed antibiotics as each of them
was found in 16.8% of cases, followed by quinolones in 12.1% and macrolides in 11.2%. In addition
Augmentin (9.3%), aminoglycosides (7.5%) and chloramphenicol (1.9%). Regarding the combined therapy,
31.8% of patients received combination of two antibiotics, 4.7% received three antibiotics and only one
antibiotic was prescribed in 68% of patients. The most common route of administration was the oral tablets in
48.6% and syrup in 14% of patients. Conclusion and recommendations: The prevalence of antibiotic use in
Tabuk Tertiary Care hospitals was very high (89.2%) which could be a risk factor for the development of
antibiotic resistance. We advocate public health measures targeting healthcare providers on the use and
misuse of antibiotics.
Key words: Prevalence, Antibiotics, Tertiary Care hospital, Tabuk, Northern Saudi Arabia.


Antibiotic are the molecules that science
more than two thirds of critically ill patients are on
discover and applied for treatment of infectious
antimicrobials at any one time [7].
disease. Antibiotic are perceived as strong,
Improper use of antibiotic which lead to
efficient drug and it plays an important role in
bacterial resistance can occur due to misbehavior
decreasing certain forms of bacterial diseases,
of patient in taking it. Clinical study indicate that
infectious diseases and it's complications and
under dosing may lead to promote drug resistance
treatment. So it decreases morbidity and mortality
during therapy [8].
rate in individuals which occur due to infectious
Physician prescribe a broad spectrum
disease [1].
antibiotics which are recent and expensive that
Inappropriate antimicrobial drug use is
make pressure which accelerate gain of resistance
associated with adverse events in hospitalized
factor [9].
patients and contributes to the emergence and
It is found that there is a monitoring system
spread of resistant pathogens. Targeting effective
found in developed countries that monitor any
interventions to improve antimicrobial use in the
appearance of bacterial resistance to antibiotic and
acute care setting requires understanding hospital
it was found in United State that 75% of the
prescribing practices [2].
patient has bacterial resistance [10].
The disappearance of certain forms of serious
Bacterial resistance can spread easily in
bacterial diseases, the decrease of common
hospitals so we should control improper use of
infectious disease complications, the treatment of
infectious diseases are largely attributed to
The objectives of the current study was to
antibiotic [3].
determine the prevalence and characteristics of
Excessive and/or inappropriate use of
antibiotic use in a Tertiary Care Hospital in Tabuk
antibiotics brought the development and expansion
city, Northern Saudi Arabia.
of bacterial resistance to these products [4].

Antibiotic resistance reduces the effectiveness and
treatment options and increases the morbidity and
This was a cross-sectional study conducted in
mortality risks [5,6].
a Tertiary Care Hospital in Tabuk city, Northern
Antimicrobials are prescribed in up to a third
Saudi Arabia. Our study was conducted in a period
of hospital inpatients, often inappropriately and
from 1 to 31 October 2017.
Received: 1 /09/2017 DOI: 10.12816/0042831
Accepted: 11/09/2017

Full Paper (vol.698 paper# 1)

Assisted Otoendoscopy in Treatment of The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 2948-2954

MR Imaging Features of Chemotherapeutic Neurotoxicity in Cancer Patient
Salwa Taha Ahmed Ismail, Mohammad Sobhi Hassan, Ahmed Mohamed Bassiouny,
Ayda Aly Youssef, Amr Mostafa Elkatatny, Dina Mahmoud Al Najjar
Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Dina Alnajjar, email:

Aim of the work
: this study aimed to display the role of imaging by MRI in early detection and accurate
diagnosis of chemotherapeutic neurotoxicity in neoplastic patients under chemotherapy.
Patients and methods:
this study included 50 cases of different cancers with CNS radiological manifestations.
It included any cancer patient, regarding the age, sex and primary cancer and received any type of
chemotherapy. The entire patients were evaluated by CEMRI technique, MR venography as well as diffusion
weighted MRI.
Results: our result showed different forms of neurotoxicity that occur in cancer patients due to the effect of
chemotherapy such as posterior reversible encephalopathy syndrome and cerebral venous sinus thrombosis.
Conclusion: all survivors of cancer patients should have lifelong follow-up, preferably with magnetic
resonance imaging which provided greater anatomic detail and early detection of any abnormality.
Keywords: PRES, CVST, MTX neurotoxicity, MRI & Diffusion MRI.

damage to the CNS white matter, termed
The breadth of chemotherapeutic agents is
leukoencephaloapthy (LEP). On MR imaging, the
vast and adverse effects are unfortunately
hallmark of LEP is T2 hyper-intensities typically
common. Distinguishing disease pathology from
located in the periventricular white matter,
the adverse chemotherapeutic effects remains
particularly in the centrum semiovale (6).
challenging (1).
Cerebral venous sinus thrombosis (CVST)
Chemotherapeutic agents cause both
is a feature of Aspariginase-related thrombosis.
central and peripheral neurotoxicity. Central
MRV is now the method of choice for diagnosis of
neurotoxic side effects of chemotherapy are the
CVST (1).
main reason to limit the dose of chemotherapy in

many patients, despite the protective role of the
blood­brain barrier (BBB) (2).
This prospective study was carried out on 50
Cancer patients may experience a wide
patients 38 males and 12 females, their age ranged
range of neurological symptoms due to
from 2 to 61 years. Patients were selected from
chemotherapy. The development of these harmful
Radiology Department in National Cancer
effects may have an acute, sub-acute, or delayed
Institute (NCI) - Cairo University in the period
course, and may be reversible or (partially)
from December 2015 to April 2017. They were
irreversible (2). Seizures, focal symptoms like
presented with neurological complains such as
aphasia or hemiparesis, and cortical blindness may
headache, nausea, emesis, lethargy, blurred vision,
occur as isolated symptoms (3).
aphasia, hemiparesis, paresis or convulsions.
Magnetic resonance imaging (MRI) is a

MRI Technique
leukoencephalopathy (4).
All patients were subjected to the
One of the most common MR finding
features of neurotoxicity post chemotherapy is
Conventional contrast enhanced MRI
encephalopathy syndrome in which there is
1.5 Tesla units were used (Achieva, Philips
vasogenic edema within the occipital and parietal
Medical System, Best and The Nether Lands).
regions (~95% of cases), The edema is usually
The used protocol basically was consisted
symmetrical (5).
Methotrexate is often implicated as the major
Axial T1WI (450 / 12 ms) TR/TE spin echo.
cause of acute neurotoxicity, in which there is
Axial T2WI (4540 / 96 ms) TR/TE spin echo.

Axial FALIR (9000 / 116/ 2500 ms)
Received: 7 /09/2017 DOI: 10.12816/0042833
Accepted: 16/09/2017

Full Paper (vol.698 paper# 2)

c:\work\Jor\vol698_3 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 2955-2959
The Prevalence of Middle Ear Disease in The Adult Population
1Talal Saad Almutairi,1Husam Khalid Algayed,1Fawaz Mohammed Alharbi,2 Hadil Mohammed
Alenezi ,3 Oqab Mohsen AlMutairi,4 Read Alzahrani, 5Abdullah Fahad Al qudhybi
1Imam Muhammad Ibn Saud Islamic University,2Northern Borders University,
3 Almaarefa Colleges for Science and Technology,4King Salman Hospital Riyadh,
5King Saud Bin Abdulaziz University for Health Sciences

otitis media (OM) also known as middle ear disease is an inflammation of the middle ear cleft,
where infection leads to the effusion of fluids into the middle ear. In developing countries, otitis media is the
main cause of hearing impairment. There are several factors that enhance the presence of otitis media,
including genetic, environmental and demographic.
Aim of the study:
this study aimed to investigate the prevalence and risk factors of otitis media in adults.
this study included 117 participants and it based on an online survey, the survey was divided into
two parts. The data were collected in excel sheet and analyzed by SPSS.
Results: the prevalence rate of OM was 40.2%, there were significance differences between health
individuals and OM patients regarding chronic diseases (P value=0.01) and allergy (P value=0.001).
Conclusion: the prevalence of OM was low, chronic disease and allergy were risk factors for OM.
OM, OM prevalence, OM in adults.


Otitis media (OM) or middle ear disease
between the different population, ethnic groups
(MED) is a common ear condition of childhood if
and countries (13).
this condition still untreated the more severe and
The prevalence of OM ranges from 1.3% to
chronic MED condition will develop (1). Otitis
31.3%, CSOM prevalence rate ranged from 4% to
media is defined as inflammation in the middle
33.3% and ASOM ranged from 2.3% to 20% (13,15).
ear cleft, the effusion of fluids into the middle ear
In Indian study (7) it was found that the prevalence
occurs as a result of an infection which in turn
of OM was 35.8% for participants with age less
may be associated with either absence or presence
than 15 years. Studies from US and Finland
of tympanic membrane perforation (2,3). Infections
expected increase in the OM incidence (16,17) this
in the upper respiratory tract play an important
may be attributed to the change in the
role in the middle ear disease etiology (4). Both
environmental and host risk factors for developing
children and adults have experience about long-
OM (8).
term of morbidity with different degrees of
There are several factors that enhance the
hearing loss; this can result from the presence of
vulnerability of OM; these factors include
fluid in the middle ear (5,6). OM is the main cause
environmental, demographic, genetic and other
of hearing impairment in developing countries
health-related factors such as allergy, asthma, cleft
(7).The clinical spectrum of OM may extend from
palate, adenoid hypertrophy, infections and
benign and self-limiting condition to prolonged
eustachian tube dysfunction (18-20).
condition. However, it may reach complicated
The environmental risk factors include seasons
disease (8). The duration and etiology of OM lead
of the year, day care, home care, exposure to other
to sequelae of several disorders such as chronic
suppurative otitis media (CSOM), otitis media
socioeconomic status, whereas the host-related
with effusion (OME) and acute suppurative otitis
risk factors including age, gender, race, change in
media (ASOM) (9,10).
host defense and prenatal factors (8). There is
CSOM is a persistent otorrhea over three
scarcity in the epidemiological studies for the
weeks with a permanent perforation of tympanic
middle ear inflammatory conditions in Saudi
membrane leading to middle ear inflammation or
Arabia (21,13) so this study aimed to investigate the
hearing loss (11). ASOM is the acute form of OM
prevalence of middle ear disease in the adult
in which presence of fluid in the middle ear and
population and its associated risk factors.
inflammation involves irritability, fever or otalgia

symptoms (11). As OM is a common condition in
children, it is prevalence rate reaches 90% in
Study design
children of less than two years old. However, it
This study was conducted in the period
may occur in adults (8,12). OM prevalence differs
between September 2017 to October 2017, it was
Received: 1/09/2017 DOI: 10.12816/0042834
Accepted: 11/09/2017

Full Paper (vol.698 paper# 3)

c:\work\Jor\vol698_4 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 2960-2974

Study for The Relationship between Lupus Nephritis and
Anti-C1q Antibodies
Ashraf Abdel-Maged Donia 1, Ahmed Ibrahim Amin 2 and Sameh Soliman Dawoud Mohamed 3
1. Urology and Nephrology department, National Institute of Urology and Nephrology, 2.Biochemistry
department, Faculty of Science, Cairo University,3.Desert Research Center, Cairo, Egypt.
Corresponding Author: Sameh Soliman,, Desert Research Center, Cairo, Egypt.


Background: lupus nephritis (LN) is an inflammation of the kidney caused by systemic lupus
erythematosus (SLE), a disease by the immune system.
Anti-C1q antibodies have been found in many different systemic autoimmune diseases, they are strongly
linked to immune complex disorder most prominently SLE and severe rheumatoid arthritis and have been
suggested to be closely associated with lupus nephritis (LN).
Generally anti-dsDNA antibodies have been acknowledged as an important tool in the diagnosis of SLE,
however their predictive value as to the activity of the disease remains controversial, on the contrary anti-C1q
antibodies appear to have a clear-cut relationship with renal complications of SLE not only have they been
shown to play a pathogenic role in the development of lupus nephritis but also their serum levels correlate
with the presence of active proliferation lupus nephritis.
Aim of the study: this study aimed to investigate association between serum titer of anti-C1q antibody
and disease manifestation of SLE. Methodology: the study was carried out in three different groups: healthy
group, rheumatoid arthritis group and lupus nephritis group. All groups were subjected to determination of
anti-C1q antibody, blood urea nitrogen (BUN) and serum creatinine.
Results: there was no significant difference in BUN levels between the normal and rheumatoid arthritis
groups in contrast there was a highly significant difference in BUN between the normal and lupus groups
also, between the rheumatoid arthritis and lupus nephritis groups (p0.001). No significant difference was
detected in serum creatinine levels between the normal and rheumatoid arthritis groups in there was a highly
significant difference in serum creatinine between the normal and lupus groups and also between the
rheumatoid arthritis and lupus nephritis groups (p0.001). No significant difference was realized in serum
anti-C1q antibodies levels between the normal and rheumatoid arthritis groups in contrast there was a highly
significant difference in serum anti-C1q antibodies between the normal and lupus groups and also between
rheumatoid arthritis and lupus nephritis groups (p0.001). In the control group and rheumatoid arthritis
groups, only BUN showed a highly significant positive correlation with serum creatinine concentration
(r=0.906, r=0.404) and (P0.001, P0.05) respectively, while in lupus nephritis group, BUN showed a highly
positive correlation with serum creatinine concentration (r=0.773, P0.001) also serum creatinine
concentration showed a positive concentration with serum anti-C1q antibody (r=0.513, P0.05).
Conclusion: the present study suggested that anti-C1q antibody might be a new parameter for the
development of lupus nephritis since the increased of anti-ds DNA antibody and hypocomplementemia (C3
and C4) are serological markers of SLE activity, but they are not enough to identify which organ may be
affected, while anti-C1q antibody either alone or in combination with other serological markers could give
information of the diagnosis of a renal flare with 100% sensitivity and specificity.
Keywords: lupus nephritis, systemic lupus erythematosus, anti-ds DNA antibody, anti-C1q antibody,
rheumatoid arthritis.


One of the most complex, beautifully
this, human kidneys have a highly developed,
engineered organs of the human body is the
superbly refined anatomy and physiology. Some
Kidneys, that perform several essential tasks
patients with kidney involvement may show rapid
including the excretion of waste products, the
progression to renal failure, while others may enter
maintenance of homeostatic balance in the body
complete and stable remission after adequate
and the release of important hormones. To achieve
therapy. More difficult to manage are the large
Received: 5/09/2017 DOI: 10.12816/0042836
Accepted: 14/09/2017

Full Paper (vol.698 paper# 4)

c:\work\Jor\vol698_5 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 2975-2980

Causes and Treatment of Tonsillitis
Nuha Saad H Alasmari 1, Ryan Omar M Bamashmous 2, Rakan Mohammed Ahmed Alshuwaykan 3,
Majed Ali Mohammed Alahmari4, Rawan Mahdi Almubarak 5 , Amjad Awdah Mohammed
Alshahrani 6 , Saad Ahmed Alqarni 2 , Abdulrahman Saleh Alhadlag 7 , Faisal Ali A Alotaibi 8 ,
Abdulaziz Suleman Abdulaziz Alassiri9, Ahmed Abdu Hassan Alnaji9, Saleem Othman Rafi Alamri 10
1- Ibn Sina National College, 2- King Abdulaziz University, 3- Tabuk University, 4- Imam Muhammad
Bin Saud University, 5- Imam Abdulrahman Bin Faisal University, 6- King Khalid University,
7- Sulaiman Al Rajhi Colleges, 8- Taif University, 9- Tabuk University, 10- Ohud Hospital Almadinah

Sore throats can have a range of causes. Common cold viruses are usually to blame. In rarer cases, sore
throats are caused by an infection of the tonsils (tonsillitis). This infection is often bacterial, or sometimes
viral. But it isn't easy to tell what kind of germs are responsible for the infection. Children and teenagers are
much more susceptible to tonsillitis than adults are. Tonsillitis is inflammation of the pharyngeal tonsils.
The inflammation usually extends to the adenoid and the lingual tonsils; therefore, the term pharyngitis may
also be used. Most cases of bacterial tonsillitis are caused by group A beta-hemolytic Streptococcus
pyogenes (GABHS). Tonsillitis of viral origin is usually treated with supportive care. We describe the
anatomic features and the immunologic function of the palatine tonsils, including a detailed discussion of
history and physical examination findings, treatment, and possible complications of acute tonsillitis.
Establishing an accurate diagnosis and initiating appropriate treatment are key components of managing this
common pathologic process.
Keywords: Tonsillitis, Pharyngeal tonsils, GABHS infection.

consequently, the term pharyngitis might similarly
Tonsillitis is inflammation of the pharyngeal
be used [3]. Pharyngotonsillitis and adenotonsillitis
tonsils. The inflammation usually extends to the

adenoid and the lingual tonsils; therefore, the term
are considered comparable for the purposes of this
pharyngitis may also be used. Most cases of
article. Lingual tonsillitis states to isolated
bacterial tonsillitis are caused by group A beta-
inflammation of the lymphoid tissue at the tongue
hemolytic Streptococcus pyogenes (GABHS). In
base. A "carrier state" is defined by a positive
the first century AD, Celsus described
pharyngeal culture of group A beta hemolytic
tonsillectomy performed with sharp tools and
Streptococcus pyogenes (GABHS), without
followed by rinses with vinegar and other
evidence of an antistreptococcal immunologic
medicinals. Since that time, physicians have been
Tonsillitis most frequently occurs in children;
Tonsillitis gained further care as a medical concern
nevertheless, the condition infrequently occurs in
in the late 19th century.
children younger than 2 years. Tonsillitis caused
The consideration of quinsy in the differential
by Streptococcus species normally occurs in
diagnosis of George Washington's death and the
children aged 5-15 years, although viral tonsillitis
discussion of tonsillitis in Kean's Domestic
is more common in younger children. Peritonsillar
Medical Lectures, a home medical companion
abscess (PTA) usually happens in teens or young
book published in the late 19th century, reflect the
adults but might present earlier. Pharyngitis
rise of tonsillitis as a medical concern [1].
accompanies many upper respiratory tract
Understanding the disease procedure and
infections. Amid 2.5% and 10.9% of children
administration of this common illness remain
might be defined as carriers. In one study, the
significant today. This article summarizes the
mean prevalence of carrier status of schoolchildren
current management of tonsillitis and highlights
for group A Streptococcus, a cause of tonsillitis,
recent advances of this condition and its variations:
was 15.9% [4, 5]. Consistent with Herzon et al,
acute tonsillitis (Fig 1), recurrent tonsillitis, and
children account for almost one third of
chronic tonsillitis and peritonsillar abscess (PTA)
peritonsillar abscess episodes [6]. Klug found
seasonal and/or age-based variations in the
Tonsillitis is an inflammation of the
occurrence and cause of PTA. Among his
pharyngeal tonsils. The inflammation regularly
conclusions, he stated that the occurrence of PTA
lengthens to the adenoid and the lingual tonsils;
increased throughout childhood, peaking in
teenagers and then progressively falling until old
Received: 03/00/2017 DOI: 10.12816/0042838
Accepted: 13/00/2017

Full Paper (vol.698 paper# 5)

c:\work\Jor\vol698_6 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 2981-2985

A Study to Evaluate KM/Propofol versus KM Alone for
Procedural Sedation in Children
Abdulrahman Fayez Kinsara 1 , Ahmad Abdulaziz M. Almehmadi 2 , Turki Jafar
Abdulmajid 3, Motaz Ashoor 4 , Qusai Abdullah Al Saqabi 5 , Rakan Abdulrahman Alrzoq 6 ,
Badr Wadee S Abulhamail 7 , Randa Fahad Almatrafi 8 , Basim Salman w Almazrui 9 ,
Basem Abdullah Alghamdi 10 , Fawaz Sulaiman Ayed Alshammari 11
1- King Faisal Hospital Makkah , 2- Ibn Sina National College , 3- Al Immam Abdulrahman Al Faisal
Hospital , 4- King Abdulalziz General Hospital Jeddah Radiology Department 5- Al Jouf University ,
6- Imam University , 7- King Abdulaziz University Hospital , 8- Al-Noor Specialty Hospital ,
9- GP in Aseer Hospital , 10- GP - Najran University Hospital , 11- University of Hail

The co-administration of ketamine and propofol (CoKP) is thought to maximize the beneficial
profile of each medication, while minimizing the respective adverse effects of each medication.
Objective: Our objective was to compare adverse events between ketamine monotherapy (KM) and CoKP
for procedural sedation and analgesia (PSA) in a pediatric emergency department (ED).
Methods: This was a prospective, randomized, single-blinded, controlled trial of KM vs. CoKP in patients
between 3 and 21 years of age. The attending physician administered either ketamine 1 mg/kg i.v. or
ketamine 0.5 mg/kg and propofol 0.5 mg/kg i.v. The physician could administer up to three additional doses
of ketamine (0.5 mg/kg/dose) or ketamine/propofol (0.25 mg/kg/dose of each). Adverse events (e.g.,
respiratory events, cardiovascular events, unpleasant emergence reactions) were recorded. Secondary
outcomes included efficacy, recovery time, and satisfaction scores.
Results: Thirty-two patients were randomized to KM and 29 patients were randomized to CoKP. There was
no difference in adverse events or type of adverse event, except nausea was more common in the KM group.
Efficacy of PSA was higher in the KM group (99%) compared to the CoKP group (90%). Median recovery
time was the same.
Conclusions: We found no significant differences in adverse events between the KM and CoKP groups.
While CoKP is a reasonable choice for pediatric PSA, our study did not demonstrate an advantage of this
combination over KM.
Keywords: Ketamine, Propofol, Procedural Sedation.


Pediatric procedural sedation and analgesia
effects. Disadvantages comprise bradycardia, dose-
(PSA) is a frequent incidence in the emergency
dependent hypotension, pain with injection, and
department (ED) setting. The aims of procedural
respiratory depression. Furthermore, propofol does
sedation and analgesia contain adequate sedation,
not provide analgesia.
analgesia, and amnesia to permit for successful
Ketamine and propofol managed together have
procedural completion, whereas diminishing
been used effectively in a variability of settings,
comprising cardiovascular, dermatologic, and
cardiopulmonary function. For years, ketamine
interventional radiological procedures in children
monotherapy (KM) has been the primary
[3-7]. The co-administration of ketamine and
pharmacologic agent utilized for reasonable to deep
propofol (CoKP) is expected to maximize the
pediatric PSA. Numerous studies support the
beneficial profile of each medication, while
utilization of KM for sedation, amnesia, and
diminishing their respective adverse effects. When
analgesia on children experiencing painful
used in combination, reduced doses of each
processes in the emergency department setting [1,2].
medication are managed, making a more stable
Ketamine can correspondingly be managed
hemodynamic and respiratory profile. This
intramuscularly if intravenous access is not
combination may reduce recovery time and
obtainable. Ketamine monotherapy (KM) has been
frequency of emergence reactions, vomiting, and
validated as safe and effective, even though
the pain of propofol injection [8]. Our objective was
unwanted side effects, such as emergence
to compare adverse events between KM and CoKP
phenomenon, laryngospasm, and vomiting, are well
for PSA in a pediatric emergency department.
documented [1,2]. Propofol is a sedative-hypnotic
agent extensively utilized for procedural sedation.
extensively utilized for procedural sedation. The
The benefits of propofol comprise rapid onset,
benefits of propofol contain rapid onset, rapid and
quick and predictable recovery time, and antiemetic
predictable recovery time, and antiemetic effects.
Received: 6/09/2017 DOI: 10.12816/0042839
Accepted: 16/09/2017

Full Paper (vol.698 paper# 6)

c:\work\Jor\vol698_7 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 2986-2991

Meta-Analysis for The Treatment of Helicobacter Pylori
Bader Abdulrahman Alageel 1 , Rayyan Abdullah S. Alyahya 2 ,
Hanan Abdullah A Alrashedi 3 , Lamma Abdulmohsen A Alghiryafi 4 ,
Elham Hamid Alfallaj 3 , Ahmed Ibrahim Ahmed AlJuraysan 5 , Waleed Khalid M Alqurashi 6 ,
Ismail Hassan H Almakrami 6 , Adel Ahmed S Almuzaini 6 , Azzam Khalid A Laskar 6 ,
Sultan Khalid A Abdullah 6 , Ibrahim Ahmed M Alnashri 6
1- King Saud,Medical City-Riyadh, 2- Al Imam, 3- Almaarefa College for Science and
Technology, 4- University of Um Alqura , 5- King Faisal University , 6- King Abdul Aziz

Purpose: To assess whether Helicobacter pylori (H. pylori) eradication therapy benefits patients with
functional dyspepsia (FD). Methods: Randomized controlled trials (RCTs) examining the efficacy and
safety of H. pylori eradication therapy for patients with functional dyspepsia published in English (till
November 2016) were recognized by searching PubMed, EMBASE, and The Cochrane Library.
Pooled estimates were measured using the fixed or random effect model. Overall effect was expressed
as a pooled risk ratio (RR) or a standard mean difference (SMD). All data were analyzed with Review
Manager 5.3 and Stata 12.0.
This analysis involved 15 RCTs with a total of 3567 patients with FD. These studies were
used to assess the benefits of H. pylori eradication therapy for symptom improvement; the pooled RR
was 1.26 (95%CI: 1.10-1.40, P < 0.0001). H. pylori eradication therapy demonstrated symptom
improvement during long-term follow-up at 1 year (RR = 1.27; 95%CI: 1.13-1.41, P < 0.0001) but
not during short-term follow-up at < 1 year (RR = 1.26; 95%CI: 0.83-1.92, P = 0.27). Four studies
showed no benefit of H. pylori eradication therapy on quality of life with an SMD of -0.01 (95%CI: -
0.09 to 0.07, P = 0.74). Four studies demonstrated that H. pylori eradication therapy reduced the
development of peptic ulcer disease compared to no eradication therapy (RR = 0.34; 95%CI: 0.17-0.67,
P = 0.002). Three studies showed that H. pylori eradication therapy increased the likelihood of
treatment-related side effects compared to no eradication therapy (RR = 1.87; 95%CI: 1.08-3.47, P =
0.02). Ten studies demonstrated that patients who received H. pylori eradication therapy were more
likely to obtain histologic resolution of chronic gastritis compared to those who did not receive
eradication therapy (RR = 7.05; 95%CI: 3.59-13.74, P < 0.00001).
The decision to eradicate H. pylori in patients with functional dyspepsia requires
individual assessment.
Peptic ulceration, functional dyspepsia, Helicobacter pylori eradication, symptom
improvement, quality of life.

helicobacter pylori eradication treatment in
Functional dyspepsia (FD) is a mutual
functional dyspepsia are unpredictable in
gastrointestinal disorder and affects as many as

earlier published randomized trials and meta-
epigastric pain, and early satiation without
Previous meta-analyses largely focused on
organic causes, functional dyspepsia undesirably
influences the patient's quality of life.
eradication therapy; their findings (whether or
Functional dyspepsia is diagnosed by Rome III
not to eradicate) were not consistent due to
criteria, which are symptom-based criteria [2].
variable study designs and follow-up durations [7,
Even though the pathophysiology is not well
8]. One meta-analysis conducted by Moayyedi et
al [9] provided an economic assessment and
dysfunction [3], visceral hypersensitivity [4], and
recommended that H. pylori eradication therapy
psychological disturbance [5] may play a role in
is the most cost-effective treatment technique.
the pathogenesis of functional dyspepsia.
We carried out this meta-analysis not only to
Helicobacter pylori (H. pylori) infection is more
assess benefits of H. pylori eradication therapy
common in patients with dyspepsia (OR = 2.3;
for symptom relief, but also to argue the effects
95%CI: 1.9-2.7) in comparison to healthy
on the quality of life, adverse events, and the risk
controls [6]. Nonetheless, the effects of
of subsequent peptic ulcer disease.
Received: 3/09/2017 DOI: 10.12816/0042844
Accepted: 13/09/2017

Full Paper (vol.698 paper# 7)

c:\work\Jor\vol698_8 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 2992-2996

Griseofulvin vs. Terbinafine in the Treatment of Tinea Capitis
Humoud Mansour AlKhalaf 1, Adnan Meteb Mohamed Almezani 2, Youssef Mohammad Almodhaibri
3, Mustafa Mohamed Ali Almusallami 4, Jumanh Khalid Attiah 5, Abdulaziz Mohammed Alsahli 6,
Maha Fahad Alluqmani 5, Fatimah Mohammed Saeedi 5, Ali Hassan Jaber Alzahrani 7, Ibrahim
Abdullah Al Taha 8, Somaya Khalid Alsharif 9, Fatema Hassan A. ALAjwad 10, Nawal Hatem
Herzallah 1
1- Royal college of surgeons in Ireland, 2- Hail university , College of Medicine , 3- Qassim University , 4- Hera
General Hospital , 5- ibn sina national college , 6- King Abdulaziz university , 7- King Abdulaziz university-Rabigh
branch , 8- Oyun City Hospital , 9- Umm Al-Qura University , 10- Imam abdulrahman bin faisal university

Two oral antifungal agents, griseofulvin and terbinafine, have regulatory approval but it is
unknown whether one has superior overall efficacy. Genus-specific differences in efficacy are believed to
exist for the two agents. It is not clear at what doses and durations of treatment these differences apply.
: The purposes of this meta-analysis were to determine whether a statistically significant difference
in efficacy exists between these agents at a given dose and duration of each in tinea capitis infections overall
and to determine whether a genus-specific difference in efficacy exists for these two treatments at a given
dose and duration of each. We performed a literature search for clinically and methodologically similar
randomized controlled trials comparing 8 weeks of griseofulvin (6.25­12.5 mg/kg/day) to 4 weeks of
terbinafine (3.125­6.25 mg/kg/day) in the treatment of tinea capitis. A meta-analysis was performed using
the Mantel­Haenszel method and random effects model; results were expressed as odds ratios with 95%.
Results: Meta-analysis of randomized controlled trials did not show a significant difference in the overall
efficacy of the two drugs at the doses specified, but specific efficacy differences were observed based on the
infectious species. For tinea capitis caused by Microsporumspp., griseofulvin is superior (p = 0.04), whereas
terbinafine is superior for Trichophyton spp. infection (p = 0.04).
Conclusion:Our results support species-specific differences in treatment efficacy between griseofulvin and
terbinafine and provide a clinical context in which this knowledge may be applied.
Keywords: Griseofulvin, Terbinafine, Tinea Capitis.

Meta-analyses of these trials have consequently
Tinea capitis is a fungal infection of the hair
been performed in a challenge to synthesize the
and scalp with worldwide distribution, affecting
obtainable data into a clear conclusion (6, 7). These
commonly prepubertal children. It is caused by the
analyses have accordingly far failed to detect a
statistically significant difference between the two
Microsporum. The mid-20th century saw a shift in
drugs, generally, while latest reviews presented
main genus from Microsporum to Trichophyton
that terbinafine is more effective for Trichophyton
following the introduction of griseofulvin and the
spp. and griseofulvin for Microsporum spp. (8,
availability of the Wood's lamp for diagnosing
9).Previous meta-analyses have assembled the
Microsporum infections (1). After its introduction
outcomes from all available randomized controlled
in 1958, griseofulvin became the treatment of
trials (RCTs) in an effort to boost statistical power.
select for tinea capitis and remained popular for
This forces the combining of data from studies that
decades. Terbinafine was first introduced to the
might be clinically and methodologically diverse.
U.S. market as a treatment for onychomycosis in
Study characteristics can impact efficacy results,
the 1990s and subsequently gained popularity as
so combining data in this manner might avoid
an off-label treatment for tinea capitis. Lately a
detection of a real difference in efficacy.
new formulation of the drug (oral granules) has
This method can similarly be problematic if a
gained marketing approval for tinea capitis in the
difference is detected between the two treatment
United States. Griseofulvin and terbinafine have
groups. The heterogeneity in the treatment
been shown to be safe and efficacious in the
procedures could make it difficult to define which
treatment of tinea capitis, but whether one of these
dose and period is the most effective of the
agents has superior overall efficacy is unresolved.
combined treatments. It can moreover be
A number of clinical trials comparing
problematic because there might be a hierarchy of
griseofulvin and terbinafine have been published,
response in which certain doses and periods might
yielding mixed outcomes as to superiority (2-7).
not conform to the combined efficacy measures.
At certain doses and durations of treatment, for
Received: 3/09/2017 DOI: 10.12816/0042845
Accepted: 13/09/2017

Full Paper (vol.698 paper# 8)

c:\work\Jor\vol698_9 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 2997-3002

Anemia of Chronic Disease
Ayman Ali Alhboob1, Khuludyahyam.Khati2, SAMAHER Sahal Malibari3, Bariahyahya Drain4,
Faisal Abdulmohsen Alhusayni5, Wafa Abdullah Alshamrani6, Abdullah Mohammad Almarzooq7,
Nouf Mohammed Al Mutairi8, Duaamunir Alsafwani9, Ziyadwaleed Iskander4, Waleed Eid Alraddadi4,
Roqayya Mohammad Alhayyani10, Aqeelasaad Alshubini11, Amal Ali Faheem4
1 Taiz University, 2Batterjee Medical College for Sciences and Technology, 3 Umm Alqura University,
4 Ibn Sina National College for Health Sciences, 5 King Saud Bin Abdulaziz University for Health Sciences,6
King Fahad Medical Military Hospital, 7 Imam Abdulrahman Bin Faisal University,
8 King Fahad Medical Military Complex in Dahran, 9 Arabian Gulf University,
10 King Khalid University, 11Warsaw Medical University
Corresponding Author: Ayman Ali Alhboob -, 055 943 0747

Anemia of chronic disease has a widespread impact on patients with chronic disorders such as
chronic inflammation, infection, malignancy etc. The pathophysiology behind it is largely due to involvement of
hepcidin levels which are high as a result of the underlying chronic disorder, but negatively affects iron
metabolism and erythropoiesis. Aim of the work: We tried to understand the pathogenesis, impact, diagnosis, and
management of anemia due to chronic diseases. Methodology: We conducted this review using a comprehensive
search of MEDLINE, PubMed and EMBASE from January 2001 to March 2017. The following search terms were
used: anemia of chronic disease, anemia of inflammation, types of anemia, management of chronic anemia
Conclusion: Since absolute treatment for the underlying chronic conditions are not available, various other
modalities aimed at treating the anemia are developing. They include conventional and novel therapies. More
researches must be done in order to manage the condition by treating the underlying cause, or for finding therapies
with least side effects.
Keywords: anemia of chronic disease, anemia of inflammation, types of anemia, management of chronic anemia.


The anemia of chronic disease (ACD)
CRIT study of anemia and blood transfusion for
describes the impaired production of red blood cells
the critically ill, which was an observational cohort
associated with chronic inflammatory states, which
study of 4892 patients in intensive care units across
includes cancer, autoimmune diseases, or chronic
the United States of America, average hemoglobin
infection. Recent data show that anemia can also
levels in these patients reduced over a 30-day period
arise in the setting of severe, acute inflammation,
regardless of the administration of blood
which includes critical illness, or in case of milder
transfusions. Additionally, a base hemoglobin <9
but persistent inflammatory states that occur with
g/dL was an autonomous predictor of increased
aging, obesity, and kidney failure. Therefore, the
mortality and length of hospital stay. In another
name "anemia of inflammation" is more suitable
recent study of 191 consecutive hospitalized senior
compared to that of chronic disease. The National
patients with anemia, 70% of them were noted to
Health and Nutrition Examination Study (NHANES
have anemia of chronic disease. 16% of the patients
III) indicated that 1 million Americans older than
suffering from anemia of chronic disease had
sixty-five years of age exhibit anemia due to
simultaneous chronic renal failure. 71% of the
inflammation. In NHANES III, anemia of
patients ease was noted to have an acute infection,
inflammation was referred to low serum iron level
12% of them had cancer, and 16% of the patients had
(<10.74 M or <60 g/dL) without findings of low
a chronic inflammation mostly including pressure
iron stores, that is, transferrin saturation >15%, along
ulcer, or a chronic autoimmune inflammatory
with serum ferritin >12 ng/mL, or an erythrocyte
protoporphyrin concentration >1.24 M. Other

features of anemia of inflammation comprise in
appropriately low levels of erythropoietin and high
Data Sources and Search terms
counts of inflammatory markers, for example C-
We conducted this review using a comprehensive
reactive protein[1]. The anemia of inflammation is
search of MEDLINE, PubMed and EMBASE, from
predominantly common in hospitalized patients. In
January 2001 to March 2017. The following search
Received: 21/09/2017 DOI: 10.12816/0042846
Accepted: 30/09/2017

Full Paper (vol.698 paper# 9)

c:\work\Jor\vol698_10 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3003-3010

Posterior Pericardial Drainage in Patients with Heart Surgery
Yazid Ali M Algadhi 1 , Abdullah Mohammed Ibrahim Mosa 1 , Ibrahim MohammedMahdi Khayyat
2 , Mohammed Baqer Al Khalaf 3 , Mohammad Noor Qadrouh 4 , Badr Fouad H Mogharbel 3 , Raed
Saleh G Alanazi 5 , Alsuhaymi Zuhair Hamdan A 6 , Khalid Saeed Ahmed Alghamdi 7 , Mojahid
Ibrahim H Ghazi 8 , Tamanni Muhsen M. Alghamdi 9 , Afnan Hedian M Alsofyani 10
1- King Khalid University , 2- King Saud University , 3- King Faisal University , 4- Maastricht University
, 5- Qassim University , 6- Mikhwah General Hospital , 7- Al Baha University , 8- University Of Jeddah ,
9- King Abdulaziz Hospital , 10- Taif University

Aim of the Study:
To assess the merits and demerits of posterior pericardial drainage in patients undergoing heart surgery.
Materials and Methods: A systematic review and meta-analysis of observational studies and randomized
controlled trials was conducted. We searched for relevant trials in the Cochrane Library, MEDLINE (from
1980), Embase from 1970 the Transfusion Evidence Library from 1980, and ongoing trial databases; all
searches current to 30 September 2017.
Results: The search yielded Sixteen randomized controlled trials which included 2755 patients. Results
revealed that Posterior pericardial drainage was associated with a significant 90% reduction of the odds of
cardiac tamponade versus the control group: (OR 95% confidence interval) 0.13; P < 0.001. The ORs of death
or cardiac arrest were significantly decreased by approximately 50% in the posterior pericardial drainage group
compared to controls: OR (95% CI): 0.47, P = .028; I2 = 0%
Conclusion: Posterior pericardial drainage has been reported in the literature to significantly reduce the
prevalence of early pericardial effusion as well as cardiac tamponade. A significant enhanced survival rate was
recorded postcardiac surgery.
Keywords: posterior pericardiotomy; systematic review, atrial fibrillation; cardiac tamponade; coronary artery
bypass grafting, pericardial effusion.


Pericardial effusion is a common
pericardial disease and concurrent HIV infection
finding in clinical practice either as incidental
may have an important promoting role) (4), the
finding or manifestation of a systemic or cardiac
disease. The spectrum of pericardial effusions
centercompared to secondary and general
ranges from mild asymptomatic effusions to cardiac
hospitals), and the availability of specific
tamponade. Moreover, pericardial effusion may
accumulate slowly or suddenly(1).
rheumatology, and oncology). Furthermore, since
Pericardial effusion is very common after cardiac
postoperative PE or pericardial tamponade (PT)
surgery. Despite the high incidence of effusion, the
may present without prominent clinical signs and
clinical approach to this problem remains
findings, there is a potential risk for life-threatening
controversial. Once pericardial effusion is
events. The delayed presentation of PE or PT may
documented, serial echocardiographic studies are
arise several days to weeks after the operation. In
frequently performed, at considerable expense(2).
these clinical situations, early diagnosis would aid
Unfortunately, there are few epidemiological data
in the early treatment(5).
on the incidence and prevalence of such effusions
Pericardial drainage procedures can be
in the clinical setting. In Maria Vittoria hospital, an
performed for diagnostic or therapeutic purposes
urban general hospital in Torino and an Italian
(patients with cardiac tamponade). In patients
referral center for pericardial diseases, the mean
without hemodynamic compromise the diagnostic
annual incidence and prevalence of pericardial
yield of pericardial fluid or pericardial tissue is very
effusion have been, respectively, 3 and 9% in a 6-
low(6). Patients with echocardiographic collapses
year experience of the echo laboratory (2000­05)
rarely require pericardial drainage for therapeutic
(3). Such data mainly depend on the epidemiological
purposes during the initial admission. Therefore,
background (especially developed vs. developing
pericardial drainage procedures are not justified on
country, where tuberculosis is a leading cause of
a routine basis in patients without hemodynamic
Received: 3/09/2017 DOI: 10.12816/0042846
Accepted: 13/09/2017

Full Paper (vol.698 paper# 10)

c:\work\Jor\vol698_11 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3011-3015
The Occurrence of Hip Fractures among Old Patients in KSA
Bader Saad Alkhathami 1, Hussam Ahmed Mohammed Alghamdi 2 , Motaz Ashoor 3 , Mohammad
Ahmed Abdulkarim 4 , Abdulrahman Anis Kh. Khan 5, Mohammed Abdullah Mohammed Alrobie 6,
Khalid Mohammed A. Alhazzazi 7 , Abdullah Adel Alomair 4 , Mohammed Ammar A Almoabadi 8 ,
Alaa Adel Shabekni 9 , Rayan Othman M Alsadiqi 10
1- King Khalid University, 2- Albaha University, 3- King Abdulaziz General Hospital Jeddah Radiology
Department, 4- Service Resident Ortho, Prince Sultan Medical Military Hospital Riyadh,
5- King Abdulaziz General Hospital Jeddah, 6- Qassim University, 7- King Saud Bin Abdulaziz
University for Health Sciences, 8- Massachusetts General Hospital, 9- Ibn Sina College,
10- Al-Imam Mohammed bin Saud Islamic University
Associated with the increase in the aging population, there is an increase in the occurrence
of hip fractures worldwide. Result following such fractures is influenced by age of the patient.
Purpose: This study purposes to evaluate the incidence and early outcome of hip fractures, comparing
between different age groups.
Materials and Methods: Data of hip fractures collected over a period of five years was analyzed. Patients
were divided into three groups, group A (patients under the age of 64), group B (patients between 65 and
84 years of age), and group C (patients over the age of 85).
Results: Of the 588 patients included in the study, there were 45 patients in group A, 351 patients in group
B and 192 patients in group C. There was a female preponderance across all age groups, and this increased
as age advanced (p < 0.0001). A significantly larger number of older patients lived alone and needed aids
to walk before the injury (p < 0.0001). There was no significant difference in the type of fracture across the
three groups (p = 0.13). A higher proportion of the elderly with intracapsular fractures were treated by
replacement arthroplasty. Older patients who had internal fixation of intracapsular fractures had a better
walking ability at 4 months. The overall deterioration in mobility was greater in older patients (p < 0.0001).
Mortality was higher in older patients.
Conclusions: Hip fractures are more common among females irrespective of age group. Older patients
have a higher mortality and a greater deterioration of walking ability after such injuries. Internal fixation of
intracapsular fractures have demonstrated satisfactory early outcome in the immediate period. This might
be attributed to retention of native bone, better proprioception and shorter operation time.
Keywords: Intracapsular Fractures, Elderly Patients, Hip Fractures.


Hip fractures in the population above 65 years
Notwithstanding from the higher frequency,
of age over the second half of the 20th century and
hip fractures in the geriatric population are a
at the beginning of the 21st century are becoming
significant problem due to the possible onset of
emerging problems for health care systems
severe and in some cases dramatic complications
worldwide. These types of fractures are so far the
and consequences. These types of fractures are
most frequent cause of hospitalization after a fall
responsible for increased mortality, up to 33% in
in the elderly population and treatment is highly
the first year after the fracture [11,12]. It is important
expensive [1]. Throughout the world it is predicted
to underline that mortality in the elderly above 65
that the total number of hip fractures will increase
years of age is three times higher for those with
from 1.26 million in 1990 to 2.6 million by the
hip fractures during the first year from the time of
year 2025 and to 4.5 million by the year 2050
fracture, than for those without hip fractures [13].
[2].With the life time threat for a woman of
The purpose of this study was to evaluate the
sustaining a hip fracture being more than that for
effect of age on the incidence, fracture pattern,
increasing a breast carcinoma [3, 4], this fracture
management and outcome of hip fractures in
has extended a vital place in terms of monitoring
different age groups.
preventive and therapeutic measures for

osteoporosis and falls. Earlier studies have stated a
higher mortality attributable to the fracture with
We analyzed data on hip fractures collected
greater decrease in life expectancy in the younger
prospectively over a period of five years at King
age group and males compared to patients in the
Abdulaziz Hospital, KSA. Demographic details,
older age group and females [5, 6]. The pattern of
pre- operative, intra operative and post-operative
hip fracture [7-9] and the risk of social deterioration
details of these patients were collected. Patients
[10] are primarily determined by the age of the
were followed up for up to 4 months following the
fracture. For the purpose of the study we divided
Received: 3/9/2017 DOI: 10.12816/0042848
Accepted: 13/9/2017

Full Paper (vol.698 paper# 11)

c:\work\Jor\vol698_12 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3016-3020

Natural History and Surgical Management of Oral Malignant Melanoma
Rahmah Hameed Al Salman 1 , Mohammed Essam Fageha 2 , Khalid Abdulrahman S Alghamdi 3 ,
Suzan Sulaiman hamad Shamlan 4 , Yara Tareq Mohammed Talab 4 , Alaa Omar D Almalki 3 , Wajdi
Mohammed Bardisi 5 , Khaled Hamad M Albaradi 6 , Majid Gais Faisal Alsharif 7
1- Alfarabi College , 2- Al-Farabi College for Nursing and Dentistry , 3- Jordan university of Science and
technology , 4- 5th years general dentist on batterjee medical college , 5- umm al-qura university faculty of
dentistry , 6- Intern in KAU , 7- Batterjee medical college

Pigmented entities are relatively common in the oral mucosa and arise from intrinsic and extrinsic sources.
Conditions such as melanotic macules, nevi, smoker's melanosis, amalgam and graphite tattoos, racial
pigmentation, and vascular blood-related pigments occur with some frequency. Addison disease, Peutz-
Jeghers syndrome, and Laugier-Hunziker syndrome also appear in perioral and oral locations as pigmented
macules. Detailed knowledge of melanoma at the molecular level allows the development of new treatment
alternatives and to design effective new drugs. Addison disease presents as adrenal cortical hypofunction
along with splotchy or generalized bronzing of the mucosa and skin. Peutz-Jeghers syndrome has periorificial
freckling along with hamartomatous intestinal polyps, and, as a differential diagnosis, Laugier-Hunziker
syndrome presents with macular mucocutaneous hyperpigmentation and melanonychia with no known
systemic disease association. We conducted this review using a comprehensive search of MEDLINE,
PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled
Trials from January 1, 1970, through February 28, 2017.
Keywords: Malignant Melanoma, Oral Mucosa, Immunotherapy.

Pigmented entities are relatively common in the
oral mucosa and arise from intrinsic and extrinsic
melanonychia with no known systemic disease
sources. Conditions such as melanotic macules,
association. Oral pigmentations may range from
nevi, smoker's melanosis, amalgam and graphite
light brown to blue-black, red, or purple. The color
tattoos, racial pigmentation, and vascular blood-
depends on the source of the pigment and the depth
related pigments occur with some frequency. The
of the pigment from which the color is derived.
incidence of melanoma is increasing worldwide.
Melanin is brown, yet it imparts a blue, green, or
Melanomas represent 3% of all skin cancers but
brown color to the eye.
65% of skin cancer death [1]. Melanoma is currently
This effect is due to the depth and density of
the fifth and sixth most common solid malignancy
the pigmented cells (or melanin granule dispersion)
diagnosed in men and women, respectively [2]. The
and the physical properties of light absorption and
rates of melanoma have been rising for at least 30
reflection described by the Tyndall light
years [3]. Although melanoma is no longer
phenomenon or effect. Oral conditions with
considered just `one disease', pathologists will
increased melanin pigmentation are common;
continue to have important role in identifying and
though, melanocytic hyperplasias or hamartomas
describing tumor subtypes [4].
are rare. Clinicians should visually examine the
More detailed understanding of melanoma
oral cavity, obtain good clinical histories, and be
allows the development of new specific treatment
willing to perform a biopsy on any pigmented
alternatives, which are targeted at specific
condition that is not readily explainable or
receptors or the genes of tumor cells. Addison
diagnosed. Patients with oral malignant melanoma
disease, Peutz-Jeghers syndrome, and Laugier-
regularly recall having an existing oral
Hunziker syndrome also appear in perioral and oral
pigmentation month to years before diagnosis, and
locations as pigmented macules. Addison disease
the condition may even have elicited prior
presents as adrenal cortical hypofunction along
comment from examining physicians and dentists
with splotchy or generalized bronzing of the
(or healthcare providers, when considering the
mucosa and skin. Peutz-Jeghers syndrome has
periorificial freckling along with hamartomatous
In contrast to the incidence of cutaneous
intestinal polyps, and, as a differential diagnosis,
melanoma, which continues to rise, the incidence
Laugier-Hunziker syndrome presents with macular
of oral melanoma has remained stable for more
Received: 3/9/2017 DOI: 10.12816/0042849
Accepted: 13/9/2017

Full Paper (vol.698 paper# 12)

Comparative Study of C - Reactive Protein Levels in Relation to Adequacy of Children with End-Stage Renal Disease on Maintenance Hemodialysis The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3021-3028
Assisted Arthrscopic Microfracture Treatment of
Osteochondral Lesions of The Knee
Ahmed El-Badawy Shaheen, Amr Saber El-Sayed and Sameh Selim Mankoula
Department of Trauma and Orthopedic Surgery, Menofia University Hospital
Corresponding author: Sameh Selim Mankoula ,

: chondral injuries in the knee are a common source of pain and morbidity. Treatment of
symptomatic chondral defects is challenging due to the limited healing capacity of articular cartilage.
Microfracture is the most common surgical technique used to treat chondral defects in the knee and utilizes
marrow stimulation to generate a fibrocartilage repair. Microfracture has demonstrated good short-term
postoperative outcomes. Long-term outcomes following microfracture are variable, with loss of improvement
attributed to the poor mechanical qualities of the fibrous repair tissue.
Aim of the work: this prospective study with a 12 months follow-up was conducted to determine the efficacy
of microfracture in the postoperative follow-up. We prospectively followed up these patients preoperatively
and postopertively, clinically and radiologically. The final diagnosis was confirmed during arthroscopy.
Patients and Methods: thirty symptomatic patients with articular cartilage defects of the knee were treated
with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum
follow-up of twelve months with a combination of validated outcome scores, subjective clinical rating and
cartilage-sensitive magnetic resonance imaging.
Results: at the time of the latest follow-up, knee function was rated good to excellent for twenty patients
(60%), fair for four patients (13%) and poor for eight (26%). A lower body-mass index correlated with higher
scores for the activities of daily living, with the worst results for patients with a body-mass index of >30
kg/m2. Significant improvement in the activities of daily living score was more frequent with a preoperative
duration of symptoms of less than twelve months (p < 0.05). Magnetic resonance imaging in 15 knees
demonstrated good healing in tissue fill of eight patients (54%), moderate fill in four (29%) and poor fill in
three patients (17%). The fill grade was correlated with the knee function scores. All knees with good fill
demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and
decreasing functional scores after twelve months. Conclusions: microfracture healing of articular cartilage
lesions in the knee results in significant functional improvement at a minimum follow-up of one year. The best
short-term results were observed with good fill grade, low body-mass index and a short duration of
preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade
was associated with limited short-term durability.
Keywords: microfracture (MF), oesteochondral defect (OCD), articular cartilage, knee, arthroscopic and


An osteochondral defect (OD) is a lesion
with or without bone marrow stimulation,
involving the articular cartilage and its subchondral
autologous chondrocyte implantation, allograft
bone. If only cartilage is involved in the pathology,
the term chondral defect is used. Many synonyms
are used, including osteochondritis dissecans,
advancements in some of these options, arthroscopic
transchondral fracture, flake fracture, talar dome
fracture, osteochondral fracture, osteochondral
stimulation is still the best currently available
lesion and osteochondral defect (1).
treatment (3). The microfracture technique often is
Full-thickness articular cartilage defects only have
considered the golden standard therapy for the
limited regenerative potential. Thus, spontaneous
treatment of cartilage defects. The first results and
healing is unlikely. Untreated full-thickness cartilage
the technique were published in 1994.The
lesions are usually associated with significant pain
microfracture procedure was originally designed for
and swelling. Moreover, patients have an increased
patients with post traumatic lesions of the knee that
risk of subsequent osteoarthritis which is a major
have progressed to full thickness chondral defects.
cause of disability and represents a significant
Unstable cartilage that overlies the subchondral bone
socioeconomic burden (2). Various treatment options
also is an indication for microfracture as well as
exist including nonoperative treatment, debridement
degenerative changes in the knee joint with proper
Received: 23/08/2017 DOI: 10.12816/0042850
Accepted: 2/09/2017

Full Paper (vol.698 paper# 13)

c:\work\Jor\vol698_14 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3029-3035
Role of Chest Ultrasonography in Pleural Diseases
Hanan M. AbuZeid, Mohamed S. Ghazy, Ahmed H. Soliman, Alyaa A. Abdulrahman
Department of Radiology, Faculty of Medicine, Ain Shams University
Corresponding author:

lung ultrasound is a part of the diagnostic armamentarium in Resuscitation and Recovery
Units with an enormous potential due to its advantages capacity to diagnose more precisely than
conventional radiology, earlier diagnosis, convenience due to being able to perform at the bedside,
possibility of being performed by one person, absence of ionizing radiation and due to its dynamic character.
Aim of the Work: this study aimed to assess the impact of chest ultrasonography in detecting,
differentiation and management of the different pleural diseases. Patients and Methods: this prospective
study included 50 patients who were presented with suspected clinical and/or radiological evidence of
pleural disease in the Chest Department of Demerdash Hospital, during the period between November 2014
and June 2017. Patients with pleural diseases with lung involvement were excluded. Results: US was more
statistically significantly sensitive and specific in the detection of pleural effusion compared to chest
radiography. A sensitivity of 0.92 for US examination against 0.74 for chest radiography in detection of
pleural thickening was noted. There were no statistically significant differences between the sensitivity and
specificity of chest US and chest CT in detection of different pleural pathologies. Conclusion: US is an
efficient and suitable method for the evaluation of different pleural diseases in critically ill patients in the
RICU. US is mostly sensitive and specific in diagnosing pleural effusions. US-guided diagnostic and
therapeutic pleural interventions are successful in achieving their goal with favorable outcomes and minimal
complications. Recommendations: US accessibility was difficult for some patients because of tissue edema,
subcutaneous emphysema and obesity. Thus further studies are needed in order to generalize these results.
Keywords: chest ultrasonography, pleural diseases, lung, resuscitation.


Lung ultrasound has become part of the
image guided drainage (5). Pleural ultrasonography
diagnostic armamentarium in Resuscitation and
(PU) is more sensitive than chest radiograph (CXR)
Recovery Units with an enormous potential due to
for diagnosing pneumothorax and could be useful
its advantages capacity to diagnose more precisely
for detecting resolution of pneumothorax after
than conventional radiology, earlier diagnosis,
drainage (6). In ultrasound, pleural tumors are well-
convenience due to being able to perform at the
defined, hypoechoic or echogenic solid nodular
bedside, possibility of being performed by one
lesions located in the parietal or visceral pleura.
person, absence of ionizing radiation and due to
Primary neoplasms of the pleura are rare except for
its dynamic character, is capable of transforming
benign and malignant mesothelioma. Metastatic
into physiological processes that were once static
pleural tumors or mesothelioma can appear as
images (1).
polypoid pleural nodules or sheet like pleural
Pleural effusions and hematomas can be
thickening combined with pleural effusion
sometimes, differentiation between pleural fibrosis
of ultrasound,
and pleural tumor is difficult by US. A US-guided
the pleural surface can be accessed by sonography
core needle biopsy is very helpful for pathologic
(2). Ultrasound has a higher accuracy in detecting
diagnosis of pleural tumors (7).
pleural effusion in comparison with bedside chest
In addition, ultrasound allows identification of
X-rays (93% vs. 47%). In fact, chest X-rays can
adjacent structures: chest wall, hemidiaphragm
detect the presence of pleural effusion in patients
(over the liver or spleen) and visceral pleural
in the orthostatic position only if the volume of
surface. This is important, especially in the case of
the effusion is at least 200 mL, whereas
an invasive procedure, in order to avoid organ injury
ultrasound can detect effusions as small as 20 mL
(3). Pleural aspiration, biopsy and drainage are all

proven to be safer and more efficacious using
image guidance (4). Although small, freely flowing
This study aimed to assess the impact of
parapneumonic effusions can be drained by
chest ultrasonography in detecting, differentiation
and management of different pleural diseases by
parapneumonic effusions or empyemas require
Received: 6/09/2017 DOI: 10.12816/0042851
Accepted: 15/09/2017

Full Paper (vol.698 paper# 14)

Relation of Breast Milk Adiponectin Level to Infant Growth The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3036-3041
Relation of Breast Milk Adiponectin Level to Infant Growth
Ahmed M Hamdy1, Yasmin G. Algendy1, Menat Allah Shaaban2,
Adel M El Shalabi2
1Department of Pediatrics, Faculty of Medicine - Ain Shams University
2Department of Clinical and Chemical Pathology, Faculty of Medicine - Ain Shams University

Studies on the physiology of breastfeeding revealed the presence of the adipokines as
adiponectin in mothers' milk. In full-term neonates, during the first few days of life, serum and plasma
adiponectin levels correlate positively with birth weight and length, neonatal adiposity. While, circulating
adiponectin levels correlate negatively with the degree of adiposity in children aged between 5 and 10 years.
Patient and Methods: In the current cross sectional study patients and their mother were recruited from out
patient clinic in Ain Shams Hospital. Questionnaire was done for maternal age, maternal diseases, gestational
age, mode of delivery, infant sex and type of feeding. Also in this study maternal body mass index and infant
anthropometry were calculated and breast milk adiponectin levels were measured at 1st week, one month and at
six months. Results: Maternal body mass index ranges from (19-29). Infant weight z-score ranges were (-1.77-
1.84), (-1.76-1.9) and (-2.02-1.62) at one week, one month and six months respectively. Infant length z-score
ranges were (-1.45-2.72), (1.43-3.01) and (-1.61-1.54) at one week, one month and six months respectively.
Breast milk adiponectin ranges were (12.8-38.4 ng/dl), (8.8-30.8 ng/dl) and (5.5-25 ng/dl) at one week, one
month and six months respectively.
Conclusion: The results of the present study confirm that human milk adiponectin was significantly associated
with lower infant WAZ score at one month, with high significant association with lower infant WAZ score at
six month. However, not associated with infant weight at baseline.
Keywords: Adipocyte complement-related protein 30 - Adiponectin - Breast milk- Body mass index .

Breast-feeding is recommended as the

optimal source of nutrition for infants to support
All newborns were included in the study during
normal growth and development as well as long-
the first week of life and were subjected to the
term health (1).While breast-feeding generally
reduces the risk of weight gain and the development
History taking: Birth date, Gestational age.
of obesity, high formula protein content has been
Mode of delivery, Sex: male female. Detailed
shown to induce early weight gain as well as later
maternal history including: maternal chronic diseases
obesity (2).Low serum levels of adiponectin are
as hypertension, diabetes mellitus, bronchial asthma,
associated with obesity, type2diabetes, dyslipidemia
rheumatic heart disease, infections, renal or thyroid
and cardiovascular diseases (3).
diseases and intake of drugs of medical importance.
Higher adiponectin concentrations in human
Clinical examination: All newborns were
milk are associated with significantly lower weight
subjected to medical examination including chest,
and leaner body proportionality over the first 6
cardiac, abdominal, neurological examination aiming at
months of life in breastfed infants. Also, it may
detection of any congenital anomalies so that they
contribute toward the low risk of obesity and
would be excluded from the study at this point.
inflammatory disorders when infants are breastfed
Anthropometric measurements including body
weight (BW), body length (BL)and maternal body

mass index (MBMI) were performed at the 1st week,
after one month and at six months to follow up
The aim of the present study was to detect
growth and calculated as follows:
the relation between mother adiposity and
Weight was measured to the nearest 10 g by
adiponectin level in breast milk and their effect on
using a standard digital scale in kilograms, length
infants growth.
was measured in supine position (Crown-Heel

length) in meters and maternal body mass index was
Weight (in kilograms)
Inclusion criteria: Fullterm healthy

(length) 2 (
in meters)
neonates. Exclusively breast fed. Exclusion
Prematurity. Congenital malformations.
The study was approved by the Ethics
Sepsis. NICU admission.
Board of Ain Shams University.

Received: 23/08/2017 DOI: 10.12816/0042852
Accepted: 2/09/2017

Full Paper (vol.698 paper# 15)

c:\work\Jor\vol698_16 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3042-3049

The Effect of Time Management on Academic Performance among
Students of Jazan University
Wasan Siddiq Yahya Alsalem1, Lujain Abduh Alamodi1, Aisha Taher Mohammed Hazazi2,
Amal Mousa Shibah3, Shagra Abdullah Jabri1, Zainab Ali Albosruor4
1-Medical Intern, Faculty of Medicine, Jazan University, Jazan, 2- Radiology Resident, Faculty Of Medicine,
King Fahad Central Hospital, Jazan, 3- Faculty of Medicine, Jazan University, Jazan, 4- Alfaisaliah Primary
Health Care, Al Ahsa, Saudi Arabia.
Corresponding author: Wasan Siddiq Yahya Alsalem1. email:

Many students could not manage their times efficiently before being students in college since
they did not have any challenges or difficulties in high school. However, the case changed completely when
they are attending college. Being a student in college means that the responsibility is bigger and the courses are
more difficult than what they were in high school.
The research aimed to determine the relationship between the time management skills and academic
performance of students, to assess time management and practice among students, to determine patterns of time
management among Jazan University students. In addition to determine whether student participation in extra-
curricular activities and social media correlates to his or her cumulative grade point average (CGPA).
Method: The study design is a cross-sectional study of the effect of time management on academic
performance. Conducted it in Jazan University for medical and non-medical students.
Results: The study conducted on 491 participants of female (53.80%) and male (46.20%) students. The Applied
Medical Science students (24.20%) stated that they just consumed their time to complete homework, while
Faculty of Science students (9.40%) reported that they rarely have time to do. We find that 44.2% of male and
65% of female never participate in student club, while 43.50% of male and 15.60% of female always do sports
and 12.90% of male and 4.20% of female always planning for these activities.
Conclusion: Students who had opportunities to practice time management skills revield better academic
performance in addition to the differences in the time management level between students according to faculty,
gender and curriculum.
Keywords: Time management, Cross-sectional study, CGPA, Extra-curricular activities, Jazan University


Time management plays a vital role in improving
control their time spent. It was also found that
student's academic performance. Every student
students who reported using goal-oriented time
should have time management ability which
management had a higher overall GPA [2]. A cross-
includes setting goals and priorities, using time
sectional study in United States University
management mechanism. The basic problems or
concluded that the amount of time spent studying
constraints related to time management are similar,
positively related to the amount of class meeting
spending hours on social networking sites, no
time, however, the ratio is 0.75 hours of study time
proper schedule, organization, guidance, targets,
for every one hour of class time [3]. In (1996) a study
missions, objectives or vision and social
examined 293 first-year students of psychology on a
British version of an American time-management
College students may become overwhelmed with
scale where students were divided into three age
feelings that there is not enough time to complete all
groups the first was traditional-entry students - aged
their work adequately. It is even more crucial for
less than 21 years, the second was borderline mature
medical students who have one of the most time-
students and the third was older mature students
consuming majors. This will serve as a guide for
more than 25 years. The results indicated that
students to effectively manage their time and study
female students, in general, reported significantly
by full capacity. Time management is a group of
greater time-management skills than males and
practices, skills, tools, and systems that work
older mature students significantly had better time-
together to help improving the quality of life [1].
management skills than did the other groups [4].
Worldwide, students that practiced both planning
Another previous study with a sample size of 165
and positive time attitudes found that they had much
students completed a questionnaire in Flinders
more time to complete their tasks because they
University, Australia in 1990 revealed that a cross-
Received: 4/09/2017 DOI: 10.12816/0042853
Accepted: 14/09/2017

Full Paper (vol.698 paper# 16)

c:\work\Jor\vol698_17 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3050-3053

Predictors of Length of Stay, Complications and Patient's Satisfaction after
Fawaz Mohammed Alharbi1, Talal Saad Almutairi 1, Husam Khalid Algayed1, Mohammed Saleh
Alaskar1, Omar Ahmad Alkhayari1, Muath Khalid Abaalkhail2, Abdulilah Mokhtar Alshenghiti 3

1 Imam Muhammad Ibn Saud Islamic University, 2 Almaarefa Colleges for Science And Technology,
3 King Salman Hospital Riyadh
appendicitis is the inflammation of appendix which requires appendectomy for treatment.
Appendectomy involves the surgical removal of the appendix. Early diagnosis and early appendectomy
performing results in a good outcome of the surgery. The traditional strategy was an open surgery, while the
modern one is laparoscopic appendectomy. However both have complications. Aim of the work: this study
aimed to investigate the predictors of length stay, complications and patient satisfaction after performing an
appendectomy. Methods: this study based on a simple online survey which composed of 2 parts. The data
were collected using an excel sheet and analyzing data were performed using SPSS. Results: complication
after surgery included presence of abscess which represented 88.7%, suffering from complications which
represented 69.3% and wound infection which represented 5.7%. The range of hospital stay was 1 to 10
days with a mean± SD of 3.9± 2.4 days. 39.6% of participants had good satisfaction, 35.8% had very good
satisfaction, 15.1% and 9.4% had a fair and bad level of satisfaction. Males had mean± SD of hospital stay
= 4.69 days, while females had mean± SD 2.9 days. Mean ± SD of hospital stay for patients with chronic
diseases was 5.14±2.34, while for those without chronic diseases it was 3.56±2.31. Conclusion: the most
common complication for appendectomy was abscess after the operation, individuals reported good level of
satisfaction. Male gender had chronic disease were associated with longer hospital stay.
appendectomy, complications of appendectomy, survey about appendectomy.

studies [17-19]. However, the risk for development
Appendicitis is the inflammation of
of intra-abdominal abscess and superficial wound
vermiform appendix [2], it is considered as one of
infection cannot be neglected [20]. The period after
the most frequent surgical emergencies which
appendectomy is a social problem, where
require appendectomy [2] with a lifetime risk
hospitalization process may involve physical
estimated to be 5 and 20% [3]. Appendectomy is
injury and emotional stress, also for the surgical
the treatment for appendicitis by surgical removal
recovery of patients it is important to interpret
of the appendix [4]; it is non elective operation
daily activities [21]. The early diagnosis of patients
which performed by general surgeons [5-7].


Studies reported a constant level of the
appendectomy before perforation lead to good
incidence of both acute appendicitis and
outcome [22,23]. A study [24] revealed that
appendectomy [8,9], while other studies from
western countries [10-12] showed that there was a
appendicitis had a higher risk of death (4% vs.
decrease in the incidence. Open appendectomy
0.7%) and higher complications (24.9% vs.
was introduced in 1887 by George Thomas Martin
12.7%) than those who performed appendectomy
and in 1889 by Charles McBurney. Laparoscopic
for appendicitis without peritonitis. A multi-
appendectomy was described in 1983 by Kurt
professional approach is necessary for patients
Semm and it is now performed for the majority of
after performing the appendectomy [21], where
cases[13]. Laparoscopic appendectomy is over the
patients may complain pain after surgery. Hence,
traditional open surgery [14]. Open appendectomy
health professionals should intervene to prevent
has several complications including; adhesions,
pain-induced noxious effects [25]. There was a
bowel obstruction, wound infection, intra-
study [21] reported that all patients performed
abdominal abscess and pulmonary complications
appendectomy suffered from post-operative pain
from general anesthesia [15].The mortality and
and 21.9% of cases suffered from moderate pain.
morbidity rates of open appendectomy were 0.3%
Emergency surgery represented a challenge to the
and 11% respectively [16]. Advantages of
patient, where the admission of the patient was
laparoscopic appendectomy such as rapid
unplanned and the journey of the patient in the
postoperative recovery, shorter hospital stay and
hospital can be complicated [25], appendectomy is
better pain control were reported by several
an emergency surgery, so patient faces this

challenge in this operation. Improving patient
Received: 5/09/2017 DOI: 10.12816/0042854
Accepted: 15/09/2017

Full Paper (vol.698 paper# 17)

c:\work\Jor\vol698_18 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3054-3057
Prevalence of Dyslipidemia in Obese Patients in Saudi Arabia
Husam Khalid Algayed1, Fawaz Mohammed Alharbi1, Talal Saad Almutairi1, Mohammed Saleh
Alaskar1, Ahmad Fawzi Rammal2, Mohanned Mohammed Alrahili3
1Imam Muhammad Ibn Saud Islamic University,2 King Saud University,
3 King Saud Bin Abdulaziz University for Health Sciences
Dyslipidemia is defined as defect or over production of lipoprotein, it is a consequence of
obesity. Dyslipidemia can result in several complications and diseases including stroke, cardiovascular
diseases and arthrosclerosis. The prevalence of both obesity and dyslipidemia are increasing as a result of
change in dietary content and change in life styles.
To investigate the prevalence of dyslipidemia in obese patients.
The study included 150 participants who were divided into 2 groups; the obese group and non-
obese group. Total cholesterol, LDL, HDL and triglycerides were estimated for all individuals.
There were 90 obese person and 60 non-obese individuals. The mean± SD of TC for non-obese
participants and obese was 191±12.7 mg/dl and 234.5±14.2 mg/dl respectively (P-value=0.04), while for
LDL was 97.2± 5.4 mg/dl for non-obese and 166± 7.3 mg/dl for obese (P-value=0.02). Triglycerides mean ±
SD for non-obese was 117.7±5.3 mg/dl and for obese was 160.7±12.4 mg/dl (P-value=0.012), regarding
HDL mean± SD was 117.7± 7.2 mg/dl for non-obese and 160.8± 12.6 mg/dl for obese individuals (P-
The prevalence of dyslipidemia was high in obese patients and the most common type was
Dyslipidemia, types of dyslipidemia, dyslipidemia prevalence.


Dyslipidemia is the disruption of lipids. Most
Arabia and other gulf countries reported that the
dyslipidemia is hyperlipidemia which is low levels
incidence of overweight and obesity was 13-50%
of high density lipoprotein (HDL) in blood or the
[24-29]. In the present study we aimed to estimate the
increase in the plasma level of triglycerides (TGs),
prevalence of different types of dyslipidemia in
cholesterol or both [1]. Dyslipidemia develops
obese patients and to compare the prevalence
rapidly with changes in lifestyle changes [2] .The
between obese and non-obese persons.
prevalence in dyslipidemia increases all over the

world and it became a worldwide public health
problem, the prevalence varies between different
The present study included 200 individuals, 50
nations according to cultural, socioeconomic and
were excluded as they were suffering either
ethnic characteristics [2].
thyroid or renal disease, also some of excluded
In Saudi Arabia, dyslipidemia became
persons were on steroid therapy, smokers and
apparent because of the dietary, sociodemographic
alcoholic consumers, postmenopausal women also
and lifestyle changes through the recent decades
excluded. 150 participants were included, they
[3]. Worldwide, the prevalence of dyslipidemia was
were divided into 2 groups; the obese group which
ranged from 2.7% to 51.9% [4-9], while it was
included 90 individuals and a non-obese group
reported to range from 20% to 44 % in Saudi study
which included 60 individuals.
[10]. Dyslipidemia is one of the major risk factors
The study was conducted in Dr.Abdulrahman
for several chronic non-communicable diseases
Faisal Hospital. Routine physical examination was
which results in critical morbidity and mortality
performed for all patients, Total cholesterol, LDL,
[10]. Dyslipidemia is responsible for the
HDL and triglycerides were measured for all
development of stroke [11,12], type 2 diabetes [13,14],
atherosclerosis [15,16] and cardiovascular diseases
The study was approved by the Ethics Board of
[17,18]. Obesity act as an independent risk factor for
Imam Muhammad ibn Saud Islamic University.
dyslipidemia[19]. Obesity is measured by body

mass index (BMI) [19], obesity is defined as BMI
Statistical analysis
equal 30kg/m2 [20]. Obesity is a chronic complex
Statistical analysis was done using SPSS 16.0
condition which is
statistical software package. Results were
associated with morbidity and mortality and is
presented as mean and standard deviation for
prevalent worldwide [21-23]. Several studies in Saudi
quantitative data, while frequencies and percent
Received: 10/09/2017 DOI: 10.12816/0042855
Accepted: 20/09/2017

Full Paper (vol.698 paper# 18)

c:\work\Jor\vol698_19 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3058-3065

Barriers that Impede Primary Health Care Physicians from Screening
Women for Domestic Violence at Makkah ALmukarramah City
Jumanah Ahmed Alsaedi, 1Wagih GamalEldin Elbarrany,
2Waad Ahmed AL Majnon,1Afnan Abdullatif Al-Namankany 1
1 Umm AlQura University, Makkah, 2Department of Anatomy, Faculty of Medicine,
Umm AlQura University, Makkah, Saudi Arabia
Correspondence author: Wagih GamalEldin Elbarrany, e-mail:,Mobile: 00966593649963

Nowadays, violence against women represents a major public health concern despite the
efforts to raise awareness about it at the local and the global level. Doctors have a crucial role to play in
detecting violence against women but they are confronted to many barriers.
Objective: To identify the barriers that impede physicians from screening women for domestic violence.
Subjects and methods: A cross-sectional study was conducted using a questionnaire to collect data from 62
primary health care physicians at Makah Almukarramah city.
Results: More than a half of the physicians, working at primary health centers at Makkah and who
participated in our survey, dealt with a case of a women abused by her partner. Many participants agreed
that there were barriers that impeded them from screening violence like insufficient training, feeling of
embarrassment, shame of asking question about abuse and fear of revenge by the husband or relatives.
Conclusion: Implementing training program with intervention could help in managing and preventing
violence against women.
Keywords: Violence, Women, Screening: physicians, barriers.


Violence against women is a worldwide
illnesses, chronic pain syndromes, depression,
problem; The Declaration on the Elimination of
posttraumatic stress disorder, and substance abuse
Violence against Women, adopted by the United
disorders. Furthermore, compared with women
Nations General Assembly in 1993, defines
with no history of abuse, abused women have
violence against women as "any act of gender-
higher levels of health care use [11,12].
based violence that results in, or is likely to result
Physicians have a crucial role to play in
in, physical, sexual, or psychological harm or
detecting violence against women who, often
suffering to women, including threats of such acts,
through shame or denial, prefer to hide it. The
coercion or arbitrary deprivation of liberty, whether
proportion of physician who declares cases of
occurring in public or private life" [1]. On 2006, a
intimate partner violence remains insufficient in
multicounty study showed that the prevalence of
comparison to the prevalence of those cases. Many
violence against women ranges from 15 to 71% [2,
explanation was advanced as barriers to screening
3]. On 2013, an international analysis conduct by
women abuse, like the absence of guidelines on
WHO over 80 countries, found that worldwide,
how to manage the victim of violence, the
almost one third (30%) of all women who have
workload of health professional and other barriers
been in a relationship have experienced physical
related to the examiner [13,14]. Thus, the purpose of
and/or sexual violence by their intimate partner. In
this study was to identify barriers of screening for
the Arab world, according to literature, the
domestic violence against women in the primary
prevalence of women who reported being subject
health care (PHC) centers in Makkah city.
to violence ranges from 20 to 87% [4-9].

Violence against women can have a
multitude of devastating consequences for their
A Cross-Sectional Study was conducted
health and well-being in the short and long term
among general practitioners and family medicine
[10]. The immediate physical and psychological
physicians in the primary health care centers of
consequences that affect the abused woman may be
Makkah City. An adapted questionnaire was used
accompanied by deterioration in her overall quality
for data collection. The questionnaire consisted of
of life throughout her life. This is in addition to the
two sections. The first section is the socio-
broader social costs associated with the delivery
demographic characteristics, including age, sex,
and maintenance of health care. Abused women
nationality, marital status, educational qualification
often experience somatic and stress-related
and current job and number of years at work.
Received: 07/09/2017 DOI: 10.12816/0042856
Accepted: 17/09/2017

Full Paper (vol.698 paper# 19)

c:\work\Jor\vol698_20 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3066-3076

Knowledge and Attitude of Basic Life Support among Medical Students at
King Abdul-Aziz University
Yousef Zaki Khedher, Lana Shawwa, Ahmed Abdullah Alamri,
Muhannad Mohammed Farraj, Mohamed Emad Bayoumi
King Abdul-Aziz University Jeddah-Saudi Arabia
Address for Correspondence: Ahmed Abdullah Alamri. Phone number: +966583595762,

Aim of the work:
basic life support (BLS) refers to the skills that require few tools to save lives of the
victims of cardiac or respiratory arrests. All healthcare providers are required to master these skills in
order to maximize the care to those who experience such emergencies. This study aimed to assess the
knowledge and attitude toward BLS in King Abdul-Aziz University among 3rd to 6th year medical
Methods: this is a retrospective cross-sectional study conducted in King Abdul-Aziz University, College
of Medicine in Jeddah-Saudi Arabia among the medical students, from June to October 2016 lasting for a
period of 4 months. Data were gathered by using electronic Google forms questionnaires that were
distributed to 3rd, 4th, 5th and 6th years medical students. Data analysis was done by using SPSS version 17
in July 2017
Results: 370 medical students at King Abdul-Aziz University (KAU) were participated to evaluate their
knowledge and attitude toward Basic Life Support (BLS). 190 of the students were male students. 43%
and 38.5% of female and male students scored all the right answers respectively. Both the total mean of
correct answers of knowledge and attitude toward BLS were 40% for both variables. Students who had
BLS courses other than the mandatory ones scored 41.5% of the correct answers, while the students who
had only mandatory BLS courses scored 39% of the correct answers.
Conclusions: among KAU medical students, the data showed poor essential knowledge toward BLS.
Overall attitude towards BLS was negative. However, the data also showed slight improvement when
students had BLS courses other than the mandatory ones. Therefore, more focus may be placed for
strengthening BLS skills. In addition, it is recommended to have an annual BLS simulation for all
medical students to consolidate their skills and knowledge. We also recommend adding active learning to
all medical students.
basic life support, students, knowledge, attitude, Saudi Arabia


Coronary artery disease (CAD) is the most
BLS skills are not only mean for the
common cause of sudden cardiac arrest and it is
healthcare providers in fact anyone in the
a major cause of death in both USA and Europe
community can learn simply by attending BLS
[1, 2] . According to WHO in 2014, 46% of
courses [3].
overall mortality were due to CAD in Saudi
When the heart stops pumping oxygenated blood
Arabia. Basic life support (BLS) refers to the
especially to the high metabolic vital organs
skills that almost require no or few tools to save
such as brain, irreversible damage may occur
lives of the victims of cardiac or respiratory
and therefore CPR works the work of the heart
by compressing the chest to allow blood flow to
BLS included Cardiopulmonary Resuscitation
the brain and heart muscles and lungs by giving
(CPR), using an automated external defibrillator
the patient positive-pressure ventilation until
(AED) and clearing an obstructed airway by
advanced medical treatment takes over.
foreign body for people of all ages. All
With an excellent BLS skills and CPR done,
healthcare providers are required to master these
minimum damage to the tissues can occur and
skills in order to maximize the care to those who
the patients' survival rate highly increases,
experience such emergencies.
therefore mastering the CPR is a must especially
Received: 08/09/2017 DOI: 10.12816/0042857
Accepted: 18/09/2017

Full Paper (vol.698 paper# 20)

c:\work\Jor\vol698_21 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3077-3082

Knowledge and Perception on Surgical and Invasive Procedure Protocols among Final
Year Medical Students and Interns in A University Affiliated Hospital in Jeddah
Adel D. Almaymuni, Abdullah A. Alamri, Majed N. Alnefaie, Hatim A. Al-Abbadi
Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

medical students and interns are exposed to training programs in the hospitals to enhance their
knowledge, skills and attitudes in the different clinical situations. Their training should offer an opportunity to
be aware of the safety protocols in each medical department so as to prevent the possibility of errors.
Objective: this study aimed to determine the level of knowledge and perception of final year medical students
and medical interns on surgical and invasive procedure protocols in a university affiliated hospital in Jeddah,
Saudi Arabia. Methods: this was a questionnaire was administered to final year medical students and interns of
King Abdulaziz University Hospital in Jeddah City, Saudi Arabia. The questionnaire consisted of two sections:
demographic profile in addition to knowledge and perception on surgical and invasive procedure protocols. A
total of 264 participants answered the researcher-administered questionnaire.
Results: these results showed that there was a lack of knowledge on surgical and invasive protocols of the
participants with a mean score of 65.68%, which represented their agreement to the 2009 World Health
Organization guidelines for safe surgery. There was a significant association between the level of confidence of
the participants and their ages and year levels (p-value <.05), but not with gender. All demographic factors
investigated were significantly associated with participants belief on the importance of having knowledge on
surgical and invasive protocols (p-value <.05). Conclusion: the results of this study call academic institutions to
revisit their curriculum and training programs specifically on the area of surgery.
Keywords: knowledge, perception, surgical, invasive protocols, survey.


Medical students and interns add to the
The World Health Organization (WHO)
workforce of health care institutions in Saudi Arabia.
Guidelines for Safe Surgery reported that in 2004
They are the future medical practitioners who will
data from 56 countries showed an annual volume of
take charge of responding to the challenges of
major surgery estimated to be 187-281 million
healthcare. They are continuously exposed to special
operations, or approximate one operation for every
training programs in the hospitals to enhance their
25 human beings alive. While, the rates of death and
knowledge, skills and attitudes in the different
complication were difficult to compare since data
clinical situations. Their training offers an important
were so diverse, industrialized countries reported a
opportunity for personal development and career
complication rate of 3-22% of inpatient surgical
planning (9). As they are dealing with crucial health
procedures, and death rate of 0.4-0.8% (1-4). It was
scenarios; it is expected that they have full
further reported that nearly half the adverse events
knowledge of the safety protocols in each medical
were preventable. In developing countries, death rate
departments as a part of their pre-clinical
was associated with major surgery seemed to be as
competencies so as to significantly reduce the
high as 5 to 10%. Mortality associated with
possibility of errors. Despite the diligent efforts of
anesthesia was reported to be 1 in 150 in Saharan
the researchers to look for studies similar in nature
Africa. Infections and postoperative complications
in Saudi Arabia or in Middle East Region, efforts
were of equal significance (1,5,6,7,8).
were futile. Hence, the need to conduct this
Recognizing the substantial public health harm
investigation was more than just a requirement but a
due to inadequate patient safety, WHO through the
necessity. Establishing the level of knowledge
World Health Assembly was urging countries to
among the target population could impact all the
strengthen the safety of healthcare and monitoring
components of the medical education especially on
systems. Hence, in 2009 they published the
the development and relevance of the current
protocols for surgery and invasive procedures (1). curriculum in improving the knowledge and
However, since its release, there were evidently
competencies of the would-be physicians. Results of
scarce studies on assessing the knowledge, attitude
this study may serve as a baseline data to launch a
and compliance of healthcare practitioners regarding
large scale investigation throughout the Kingdom to
these guidelines.
impact modalities of education and clinical
Received: 08/09/2017 DOI: 10.12816/0042858
Accepted: 18/09/2017

Full Paper (vol.698 paper# 21)

c:\work\Jor\vol698_22 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3083-3091

Comparative Evaluation of Antioxidant and Hepatoprotective Effects of Three
Olive Leave Species Cultivated in Aljouf Region, Saudi Arabia
Ismail H. Osman1,2 and Ahmed A. Tantawy1,3
1- Department of Clinical Lab Sciences, Al Jouf University, Sakaka, Saudi Arabia 2- Biochemistry
Department, Bahri University, Khartoum, Sudan, 3-Pathology Department,
Faculty of Veterinary Medicine, Benha, University, Egypt
Corresponding author: Ismail Osman, email:

Aim of the work
: the purpose of this study was to evaluate the antioxidant, anti-inflammatory and
hepatoprotective effects of extract from 3 olive leave cultivars; K18, Nibali and Sorani growing in Aljouf
region, Saudi Arabia.
Methods: all plants were extracted with 80% methanol and the extracts were used to determine the total
phenolic content, the total flavonoid content, the DPPH radical and anti-lipid peroxidation scavenging
activities. In vivo hepatoprotective effect of these olive leaves extracts (OLEs) was evaluated in rabbit
intoxicated with CCl4. Expression of iNOS, caspase-3, TNF- and IL-1 along with the histopathological
findings of the examined liver were recorded to evaluate the extent of hepatoprotective of each extract.
Results: methanolic extracts of all plants exhibited DPPH and peroxyl radicals scavenging activity that
was well correlated with their total phenolic and flavonoid contents. The phenolic, flavonoid contents,
DPPH, and peroxyl scavenging activities were in the following orders: Nibali K18 Sorani. Pretreatment
with OLE (400 mg/kg) along with CCl4 was significantly alleviated liver damage as indicated by
improvement of the microscopic picture of liver and reduced hepatic iNOS, caspase-3, TNF-and IL-1
expression compared to CCl4 intoxicated group. However, the hepatoprotective effects of Nibali and K18
OLEs were more prominent compared to those exerted by Sorani OLE.
Conclusion: all OLEs had potent anti-inflammatory, antioxidant and antiapoptotic activities that preserved
hepatic cells against CCl4-induced hepatic damage through attenuation of pro-inflammatory cytokines,
oxidative stress and apoptotic pathways, however, these activities were probably species dependent.

inflammatory and antioxidant effects than olive
Liver is a critical body organ that has many
oil (8,9). Olive tree leaves contain similar
biological functions. Removal and inactivation of
polyphenols as those found in extra-virgin olive
toxic substances and drugs is the primary
oil or the fruit itself, but at a much higher
function of the liver. Hepatotoxicity is liver
concentration (7). Therefore, olive leaves are
damage exerted by a direct toxic effect of some
considered as a rich source for biologically active
chemicals and overloads of drugs, a reactive
phenolic compounds and have superior
metabolite or an immunologically-mediated
antioxidant activity, anti-inflammatory power
response (1-3). The hepatic toxicity also attributed
and radical scavenging effects (10-13). These
to the changes in oxidative stress and alteration
bioactive properties of the olive leaves have
in acute phase proteins (4). Up until now, drug
formed a base for their beneficial health effects
development and research still unable to
such as anti-hypertensive (14), cardioprotective
establish a reliable hepatoprotective drug. So,
(15), hypoglycemic (16) and hypo-cholesterolemic
many studies were carried out on different
agents (17), In addition, several flavonoids,
natural sources including medicinal plants to
namely luteolin and apigenin, which have
evaluate their hepatic protective efficacies (4-6).
revealed anticancer activities were also detected
Medicinal plants are considered as a low-cost
only in olive leaves extract and were not detected
source of unique constituents, which could be
in the oil from the fruit (18-20).
used broadly for the development of new drugs
Therefore, the current study was designed to
for treatment of different hepatic disorders.
compare the potential antioxidant, anti-
Among these medicinal plants, olive leaves
inflammatory and hepatoprotective effects of
which are a valuable one which has been widely
methanol extracts obtained from three species of
used in traditional remedies in European and
olive leaves (Nibali, K18, and Sorani) cultivated
Mediterranean countries (7). Several studies
in Saudi Arabia. This comparison was based on
reported that extra-virgin olive oil has higher
in vitro properties of these extracts as well as the
phenolic content provided potential anti-
Received: 09/09/2017 DOI: 10.12816/0042859
Accepted: 19/09/2017

Full Paper (vol.698 paper# 22)

c:\work\Jor\vol698_23 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3092-3103

Review on Liver Cirrhosis Complications and Treatment
Haider Issa Alaqaili 1, Ahmed Ibrahim AlJuraysan 2 , Razan Mansour A Hawsawi 3 , Fadia
Abdulelah Abuzaid 4 , Muath Abdullah Alharbi 5 , Abdulrhman Ebrahim A. Mughallis 6 , Yazeed
Abdullah H Alsubhi 7 , Mohammed Rraiy A Asiri 8 , Abdullah Saleh S Alamer 9 , Abdullah
Mohammed S Azab 7 , Abdullah Javed Khaleel 7 , Hanan Khalil Ibrahim Al-Rajeh 10
1- Dammam Medical Complex, 2- King Faisal University, 3- King sau-Hs , 4- King Abdulaziz
University,Medicine-Basic Medical Sciences-Anatomy,Research Assistant King Fahad Medical
Research Center , 5- Medical University of Lodz , 6- Jazan General Hospital , 7- King Abdulaziz
University ,8- Sharg Almjaredah PHCC , 9- Qassim University , 10- King Fahad Hospital

cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and
conditions, such as hepatitis and chronic alcoholism. The liver carries out several necessary functions, including
detoxifying harmful substances in your body, cleaning your blood and making vital nutrients. Cirrhosis occurs in
response to damage to your liver. Each time your liver is injured, it tries to repair itself. In the process, scar tissue
forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function.
Objective of the Study: review and evaluate the best practices in diagnosis, complications and management of
cirrhosis, and novel clinical and scientific developments.
Methods: electronic search in the scientific database from 1966 to 2017­ (Medline, Embase, the Cochrane
Library as well as NHS center websites were searched for English Publications obtained from both reprint
requests and by searching the database. Data extracted included authors, country, year of publication, age and sex
of patients, epidemiology, geographical distribution, pathophysiology, risk factors, clinical manifestations,
investigations and types of surgical treatment.
Results: there is sufficient body of evidence suggesting that cirrhosis is a pathological diagnosis with no
laboratory cutoff values for the diagnosis of cirrhosis.
However, it can still be diagnosed clinically, by history, physical examination laboratory analyses and ancillary
testing such as ultrasonography. Early diagnosis has proven to give relevantly better case management results
while late detection can only hardly manage the symptoms accompanied with cirrhosis.
Conclusion: Screening for chronic liver disease is a key factor for early detection of signs for liver damage,
which can be performed inexpensively and easily with clinical history-taking, measurement of transaminase
concentrations, upper abdominal ultrasonography, and transient elastography (where available). Abnormal
findings should prompt specific diagnostic testing to determine the etiology of the underlying disease. In most
patients, the dynamic process of progressive fibrosis, which could ultimately lead to cirrhosis, can be interrupted
by the timely recognition of the risk, followed by appropriate treatment.
Keywords: cirrhosis, progressive liver disease, ascites, chronic disease.


Cirrhosis results from different mechanisms of
One-year mortality in cirrhosis varies widely,
liver injury that lead to necroinflammation and
from 1% to 57%, depending on the occurrence of
fibrogenesis; histologically it is characterized by
clinical decompensating events (2). Histopathologists
diffuse nodular regeneration surrounded by dense
have proposed that the histological term cirrhosis
fibrotic septa with subsequent parenchymal
should be substituted by advanced liver disease, to
extinction and collapse of liver structures, together
underline the dynamic processes and variable
causing pronounced distortion of hepatic vascular
prognosis of the disorder (3). Moreover, fibrosis,
architecture (1). This distortion results in increased
even in the cirrhotic range, regresses with specific
resistance to portal blood flow and hence in portal
therapy if available, such as antiviral treatment for
hypertension and in hepatic synthetic dysfunction.
chronic hepatitis B or C (4).
Clinically, cirrhosis has been regarded as an end-
Cirrhosis isn't curable, but it's treatable. Doctors
stage disease that invariably leads to death, unless
have two main goals in treating this disease: stop the
liver transplantation is done, and the only preventive
damage to your liver, and prevent complications.
strategies have been screening for esophageal
Alcohol abuse, hepatitis, and fatty liver disease are
varices and hepatocellular carcinoma.
some of the main causes. Your doctor will
Received: 09/09/2017 DOI: 10.12816/0042860
Accepted: 19/09/2017

Full Paper (vol.698 paper# 23)

c:\work\Jor\vol698_24 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3104-3107

Systemic Lupus Erythematosus Presenting with Fulminant
Autoimmune Hemolytic Anemia
Hanan Mothaqab Mashi, Ahmed Ali Jaafari, Zainab Ahmad Jafari,
Nourah Ali Homaily, Ahmed Shamakhi
King Fahad Central Hospital


We describe a female patient 9-year- old girl with Systemic Lupus Erythematosus (SLE) who developed
a fulminant autoimmune hemolytic anemia (AIHA) as an isolated symptom of her underlying disease. On
admission, laboratory investigations were conducted and revealed high ESR 150 mm\h, severe anemia Hb
was 3.4 g/dl with reticulocytosis 9%, low platelet count 74 \ 10^3\uL and positive direct Coombs tests.
Upon further examinations, a diagnosis of SLE complicated by AIHA was reached, and
methylprednisolone IVIG therapy was prescribed, and remission was approached.
Keywords: systemic lupus erythematosus, children, Coombs test, mixed-type, autoimmune hemolytic
anemia, reticulocytosis.


SLE is a chronic autoimmune disease with a

highly variable
clinical course.
Table 1: Immunological laboratory parameters
systemic inflammation which affects multiple
at admission
organs (American College of Rheumatology
The diagnosis of SLE can be achieved using
the revised criteria of the American College of
Rheumatology (ACR) which includes: Malar
rash, Hematologic disorders, Discoid rash,
Renal disorders, Arthritis, Serositis, Oral ulcers,
H IU\ml
ate 27 ­ 35
Immunologic Disorders, Neurologic disorders,
Photosensitivity and the Antinuclear antibody
>= 35
which is diagnostic per se.
The pediatric-onset SLE (pSLE) is usually
associated with a higher disease severity than
the adult-onset SLE [1].
>= 20
AIHA is the most common hematological
disorder in pediatric SLE [2]. In some cases, it
nuclear Ab >200.0
develops throughout the disease course, while in
>= 20
other cases it might be the first manifested
symptom. The warm antibody AIHA (warm

AIHA) is detected in the majority of cases [3].
There are reports of adult-onset SLE cases who
developed AIHA secondary to the SLE with the
Positive 1:
hep2 640
involvement of not only warm antibodies but
< 1 ; 40
also cold antibodies, known as the mixed-type

AIHA (mixed AIHA). The clinical course of
e pattern
this mixed type is not entirely understood. Also,

it is scarce in children [3].
The study was done after approval of the

ethical board of King Fahad King Fahad

Central Hospital.


Received: 09/09/2017 DOI: 10.12816/0042861
Accepted: 19/09/2017

Full Paper (vol.698 paper# 24)

c:\work\Jor\vol698_25 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3108-3114

The Effect of Cigarettes on Acute Pancreatitis Among Patients in Saudi Arabia
Amirah Abduallah M Alzahrani 1, Hariri, Mohammad Zaki O 2, Nahlah Ali Alsubhi 3, Mohammed
Fayez Mohammed Alshehri 4, Helal Jarallah Alharthi 5, Muhannad Fahad W Alsahli 6, Faisal Menwer
Alqurashi 7, Badr Saad Dhawi Alghamdi 8 , Sabah Abdulrahman Khozam 4 , Ali Ibrahim Ali Alsalbi 9 ,
Ahmad Ibrahim M Albridi 4 , Albayyali, Tariq Hassan H 10 , Modhi Saleh Ibrahim Alburaidi 11
1- King Abualziz Hospital, 2- Public Health Center, Makkah, 3- Ibn Sina National College, 4- King Khalid
University,5- University of Warmia and Mazury, Poland, 6- Al Imam Abdulrahman Alfaisal Hospital in
Riyadh, 7- Umm Alqura University, 8- Buljurashi Psychiatric Hospital, 9- Taibah University,
10- Al-Jouf University, 11- Qassim University


Background and purpose: Questions remain unclear about the association of smoking status and the
development of acute pancreatitis (AP). We performed a meta-analysis of observational studies to explore this
association. Materials and Methods: A computerized literature search was performed in MEDLINE and
EMBASE through October 15, 2016. We also searched the reference lists of pertinent articles. We used a rand
om-effects model to calculate the summary relative risks (SRRs) and their corresponding 95% confidence
intervals (CIs).
Results: A total of 8 observational studies (4 case control and 4 prospective cohort/nested case control
studies) were identified. Compared with never smokers, the summary RR estimates were 1.49 (95% CI, 1.29-
1.78) for ever smokers, 1.69 (95% CI, 1.42-2.21) for current smokers, and 1.19 (95% CI, 1.11-1.52) for
former smokers. Smoking is found to be a potential risk factor for alcohol use, idiopathic factors and drugs
related AP, but not for gallstone related AP, in the ever and current smokers. A dose response effect of
tobacco use on the risk was ascertained: current smokers had a 40% (95% CI, 30%-50%) increased risk of AP
for every additional 10 cigarettes per day.
Conclusion: The current analysis suggests that smokers have an elevated risk of AP development. Further
studies, however, are warranted before definitive conclusions can be drawn.
pancreatitis, cigarettes, smoking, meta-analysis.


The occurrence of acute pancreatitis (AP) has
When we were arranging this manuscript, we
increased worldwide in latest years [1, 2]. Most
have taken into consideration studies which
incidences of AP are self-limiting and mild,
reported AP
necessitating only a short hospitalization [3];
related to alcohol use [8], antihypertensive
nevertheless, nearly 20% of acute pancreatitis
medications [9, 15], endoscopic retrograde
patients will progress to a life-threatening
cholangiopancreatography pancreatitis (ERCP) [10],
condition with local and extra-pancreatic
or reported only of persons who had ever smoked
complications categorized by the early progress of
(ever-smokers) [11] and other factors. The aim of
multi-organ failure [4].
the current study was to examine the important

epidemiological observations linking tobacco
In the overall population, 80-90% of AP cases
smoking to acute pancreatitis development.
happen due to either gallstone disease or alcohol

abuse [5]. Numerous other risk factors as well have
been suggested, containing high levels of
This meta-analysis was carried out following
the meta-analysis of observational studies in
hypercalcemia, drugs, and a high body mass index
epidemiology (MOOSE) guidelines [16]. Two
(BMI) or obesity [6].
independent reviewers carried out a computerized

literature search in MEDLINE (from January 1,
The role of smoking in the threat of pancreatic
1965) and EMBASE (from January 1, 1974), up to
cancer and chronic pancreatitis has been clarified
15 October, 2016.
[7], though, its role in the threat of acute

pancreatitis has not been established. Some earlier
We searched the relevant studies, additional
studies that have examined the association
studies were retrieved by hand searching reference
between smoking status and risk of acute
lists of original studies and review articles on this
pancreatitis have yielded inconsistent results [8-15].
topic. Only articles written in English were

Received: 09/09/2017 DOI: 10.12816/0042862
Accepted: 19/09/2017

Full Paper (vol.698 paper# 25)

c:\work\Jor\vol698_26 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3115-3122

Accuracy of Diagnosis of Distal Radial Fractures by Ultrasound
Ahmad Saladdin Sultan, Muddather Abdul Aziz, Yakdhan Z. Alsaleem
Mosul Teaching Hospital, Emergency Medicine Department, Mosul, Iraq
Corresponding author: Ahmad Saladdin <
although distal radial fracture account up to 20% of all fractures, it forms the most
common fracture in upper extremities. Distal radial fracture has six types the most common one is Colle's
fracture. The gold standard for diagnosis of distal radial fracture is conventional radiograph. Despite
using ultrasound in tendon rupture, localizing foreign bodies, ultrasound started to be used for diagnosing
bone fracture especially distal radius. Aim of the work: this study aimed to detect the accuracy of
ultrasound in the diagnosis of distal radial fracture. Patients and methods: this was a selective
prospective case series study in the Emergency Department, Al-Jumhoori Teaching Hospital,78 patients
were included in this study, their age ranged between 6-45 years with mean age 17.1. 59 were males and
19 females. Duration of the study was one year (January2013 - January 2014). Results: by analyzing data
of 78 patients for distal radial fracture ultrasound and comparing the results with the gold standard
conventional radiograph we found that sensitivity of ultrasound in detecting fracture was 95.5%,
specificity 100%, accuracy 96.15%, positive predictive value 100% and negative predictive value 80%.
Conclusion: results of the current work demonstrated that ultrasound can be considered as a promising
alternative to routine radiograph in diagnosis of the distal radial fractures and the horizon still open for
further studies of use of ultrasound in diagnosis of other types of fractures.
Keywords: distal radial fractures, ultrasound, musculoskeletal ultrasound.


Anatomy of radius bone
crumpling or a splintering of the cortex, more often
The radius is the lateral bone of the fore arm, and
the break is complete and the bone fragments are
is homologous with the tibia of the lower limb.
displaced. If the overlying skin remains intact it is
Radius along with ulna connect elbow to forearm.
a closed (or simple) fracture; if the skin or one of
Radius has a head, a lower end and a shaft (1).
the body cavities is breached it is an open (or
Distal end of Radius
compound) fracture, liable contamination and
The distal end tends to be turned slightly
infection (3).
forwards, has somewhat triangular form. Its distal
Clinical Features
carpal articular surface is concave from backwards
Individuals with high activity levels appear
and slightly from side to side; it is divided into two
to be at greater risk for fractures (4) . This group
facets by a slight antero-posterior ridge(2).
includes children and athletes participating in
The anterior border is prominent and turned
contact sports. It is also common in senile people
forwards , it is rough at its edge serves for the
Symptoms of fractures usually begin with pain that
attachment of the anterior part of the capsule of the
increases with attempted movement or use of the
border is
area and swelling at the involved site (5). The skin
rounded and tubercular and it is grooved by many
in the area may be pale and an obvious deformity
tendons (2).The styloid process lies to the lateral
may be present. In more severe cases, there may be
side of the distal end and broads at its base, it
a loss of pulse below the fracture site, such as in
becomes narrow and pointed distally where by its
the extremities, accompanied by numbness,
medial cartilage-covered surface it forms the
tingling, or paralysis below the fracture (6).An open
summit of the distal triangular articular area. On
or compound fracture is often accompanied by
the medial side of the distal extremity the ulnar
bleeding or bruising (7). Pain, bruising and swelling
notch is placed for the reception of the head of the
is a common symptom, but they do not distinguish
ulna(2). It is concave before backwards and plane
a fracture from a soft tissue injury. Deformity was
proximo-distally. It forms a rectangular edge, by
much more suggestive (3).
its inferior margins, which separates it from the
distal carpal surface (2).
Diagnosis begins immediately with an
individual's own observation of symptoms (6).
Medical history and physical exam by a physician
Fracture is a break in structural continuity
often reveals the presence of a fracture. X- ray of
of the bone. It may be no more than a crack, a
the injured area is the most common test used to

determine the presence of a bone fracture. X- ray

series performed at least two views of the area to
Received: 10/09/2017 DOI: 10.12816/0042863
Accepted: 20/09/2017

Full Paper (vol.698 paper# 26)

c:\work\Jor\vol698_27 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3123-3133

3D Ultrasonography Compared with Magnetic Resonance
Imaging for the Diagnosis of Adenomyosis
Ahmed M. Hashad, Nashwa E. Hassan, Ahmed E. Elbohoty,
Ibrahim M. Ibrahim, Omnia B. Bakr
Obstetrics and Gynecology Department, Faculty of Medicine, Ain-Shams University
Corresponding author: Omnia B. Bakr, email:, Mobile, 01205566692

Background: Adenomyosis is a common benign gynecological affecting premenopausal woman, in which
there is increased overgrowth of the endometrium with invasion of the underlying myometrium. The precise
pathogenesis of adenomyosis remains unknown with many theories being proposed that consider it to be a
pathology that initially affects the endomyometrial junctional zone (JZ). Aim of the Work: The study aims
to compare 3D transvaginal ultrasound with MRI in diagnosing adenomyosis in comparison with the gold
standard histopathology. Patients and Methods: This cross-sectional study was carried out on 77 patients
who were recruited from women presenting to the outpatient clinic at Ain Shams University Maternity
Hospital planned to undergo hysterectomy (abdominal, vaginal or laparoscopic assisted hysterectomy) for
adenomyosis according to the inclusion/ exclusion criteria. Results: Out of 77 patients included in the study,
67(87%) were +ve for adenomyosis by 3D TVUS, confirmed in 46(59.74%) by histopathology, while
52(67.53%) were +ve by MRI, confirmed in 39(50.64%) by histopathology.3D transvaginal US was able to
diagnose adenomyosis in 67(87%) patients and fibroid in 23(29.9%) patients, while MRI was able to
diagnose adenomyosis in 52(67.5%) and fibroid in 36 (46.8%). Conclusion: our study results indicated that,
3D transvaginal ultrasound is highly accurate as MRI in diagnosing adenomyosis and leiomyoma as a
preoperative diagnostic tool. Recommendations: As the 3D ultrasonography is more available, cheaper, less
time consuming and easier technique, it is recommended to be used in every day clinical practice, helping the
clinicians to reach an accurate diagnosis, select an appropriate treatment, and individualize management for
each patient to reach the best outcome therapeutic rates.
Keywords: ultrasonography, magnetic resonance imaging, adenomyosis.


Adenomyosis refers to a disorder in which
(especially T2-weighted images) offers the highest
endometrial glands and stroma are present within the
uterine musculature (uterine adenomyomatosis) (1).
adenomyosis (9). In a review of 23 articles, the
It is a condition that causes heavy
sensitivity and specificity of MRI for diagnosing
adenomyosis was 77% and 89%, as compared with
(dysmenorrhea), chronic pelvic pain, subfertility and
72% and 81% for ultrasound (8). For 2D-TVS and
infertility, in which the uterus gets larger than
3D-TVS, respectively, the overall accuracy for
normal too (2,3). Its incidence is estimated to be
diagnosis of adenomyosis was 83% and 89%, the
25% to 35% in women undergoing hysterectomy
sensitivity was 75% and 91%, the specificity was
because of benign gynecologic conditions,
90% and 88%, the positive predictive value was
although in some studies, it has been reported to
86% and 85% and the negative predictive value was
be as high as 70% (4). Approximately 50 percent of
82% and 92% (10,11). Although it is more expensive
affected women have co-existent fibroids (5).
than ultrasonography, MRI can be employed in
The diagnosis of adenomyosis is still a
cases with indeterminate sonographic results for
challenging problem, until recently; the criterion
adenomyosis. Thin-section, high-resolution MRI
standard for a definitive diagnosis of adenomyosis
scans obtained with a pelvic multicoil array are
was histopathologic analysis of hysterectomy
optimal for diagnosing adenomyosis. The uterine
specimens (6). The only proven treatment for
zonal anatomy is best seen on T2-weighted images
adenomyosis is surgery to remove the uterus,
(12). On sonograms, the most common appearance
called a hysterectomy (7). However, a recent meta-
of adenomyosis is areas of decreased echogenicity or
analysis has demonstrated that both US and MRI
heterogeneity in the myometrium, including
may enable accurate non-invasive diagnosis (8).
irregular, myometrial, cystic spaces predominantly
Magnetic resonance imaging (MRI) seems
involving the posterior uterine wall; an enlarged
to be a highly accurate tool in the preoperative
uterus with a widened posterior wall; an eccentric
endometrial cavity; and decreased uterine
combination of transvaginal ultrasound and MRI
Received: 10/09/2017 DOI: 10.12816/0042864
Accepted: 20/09/2017

Full Paper (vol.698 paper# 27)

c:\work\Jor\vol698_28 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3134-3143
Correlation between Vitamin D Deficiency and Depression
Afnan Hedian Alsofyani 1, Abeer Mohammed M Alharbi 2 , Arwa Bader N Alanazi 3 ,
Khaled Abdul Aziz Alasous 4 , Rawan Ahmad Ageeli 5 , Amirah Abduallah M ALZahrani 6 ,
Moatez Khalaf Almofarreh 7 , Reham Awdah Albalwi 8 , Samirah Nasser A Majrshi 9 ,
Muhannad Fahad W Alsahli 10 , Ayat Essam Shaban 11 , Ghaida Mohammad Ahmad 12
1- Taif University, 2- Alfaisal University, 3- Northern Border University, 4- Sattam Bin Abdulaziz
University, 5- Jazan University, 6- King Abdullaziz Hospital , 7- Aljouf University , 8- Tabuk University ,
9- Primary Health Care Al-Jumum- Makkah , 10- Al Imam Abdulrahman Al Faisal Hospital in Riyadh ,
11- Al Nahda Primary Health Care Center, Jeddah , 12- East Jeddah Hospital

Aim of the Study:
To conduct a systematic review and meta-analysis of prospective cohort studies of the
association of vitamin D deficiency with onset of depression in non- depressed individuals.
Methods: A systematic review of the electronically searched publications of the scientific literature. We
searched the Cochrane Hepato Biliary Group Controlled Trials Register, Cochrane Central Register of
Controlled Trials in The Cochrane Library, MEDLINE (1946 to 2017), EMBASE (1974 to 2017), and Science
Citation Index Expanded (1900 to 2017). Initially all randomized clinical trials which studied the correlation
of Vitamin D with depression were included, articles were then selectively screened according to the eligibility
criteria. Results: the search yielded 11 studies, A meta-analysis of all studies without flaws demonstrated a
statistically significant improvement in depression with Vitamin D supplements (+0.72 CI +0.28, +1.31).
Nevertheless, studies with biological flaws were mainly inconclusive
Conclusion: Our analyses are consistent with the hypothesis that Vitamin D supplementation (800 I.U. daily)
was supported in the management of depression.
Keywords: Depression, biological plausibility, meta-analysis, systematic review, 25OHD, Vitamin D


Vitamin D is a unique secosteroid hormone
which means that vitamin D is acting in some way
formed mainly by photosynthesis, so an indoor
in the brain. These receptors are found in the areas
lifestyle and sun-avoidance leads to deficiency
of the brain that are linked to the development of
(25OHD <50 nmol/L) (1). Vitamin D deficiency is
depression. For this reason, vitamin D has been
now a global public health problem affecting a
linked with depression and with other mental health
billion people worldwide (2). Even in sunny
problems (6).
Australia, deficiency affects one third of the
On a separate note, depression is a biological
population (3), with much higher rates observed in
disease, like multiple sclerosis, it has a strong
migrant populations (4). There has been an increase
genetic characteristic. Depression can be triggered
in the prevalence of Vitamin D deficiency and a
by a number of different things. Sometimes there is
ten-fold increase in spending on supplements in the
one main trigger, such as the death of a loved one,
US over the last decade (5).
but there are a number of different factors that may
Vitamin D plays a vital role in bone health and
play a part (7). Although the factors leading to
researchers are now discovering that vitamin D may
depression differs between individuals, the most
play a role in many other areas of health as well.
common triggers include: Physical illness, family
Vitamin D receptors have been found in many parts
history of depression, major life changes, early life
of the brain (6). Receptors are found on the surface
experiences or genetic predisposition and regular
of a cell where they receive chemical signals. By
heavy drinking (7). Depression affects 350 million
attaching themselves to a receptor, these chemical
people worldwide, it is the leading cause of
signals direct a cell to do something, for example to
disability and the fourth-leading cause of the global
act in a certain way, or to divide or die. Some of the
disease burden (8).
receptors in the brain are receptors for vitamin D,
Epidemiological evidence shows that vitamin

D deficiency is associated with an 8%­14%
Received: 11/09/2017 DOI: 10.12816/0042865
Accepted: 21/09/2017

Full Paper (vol.698 paper# 28)

c:\work\Jor\vol698_29 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3144-3153

Postnatal Corticosteroids to Treat or Prevent Bronchopulmonary
Dysplasia in Preterm Infants
Alsuhaymi Zuhair Hamdan A 1, Zamil Mufleh Al-Wahbi 2 , Abdulmohsen Abdulkarim Alanazi 3 ,
Zayed mohammed Z Al Almathlma 4 , Samar Osama Mohamed Mahmoud Kassem 5 , Faisal Ali A
Alotaibi 6 , Ghadi abdullah Aljehani 7 , Mushari Aber F Alonazi 8 , Abdulrahman Sulaiman I
Alshudokhi 9 , Alanoud Thamer Al Drasouny 10 , Fatimah Fayiz Alghanim 11 , Toqa Eissa Aljowaid 7
1- Mikhwah General Hospital, 2- Khamis Mushait Maternity & Children Hospital (KMMCH), 3- King
Abdullah Bin Abdulaziz University Hospital, 4- Mohayil General Hospital , 5- Umm Al Qura University ,
6- Taif University , 7- Ibn Sina College , 8- Aljouf University , 9- Alfaisal University , 10- Almaarefa
Colleges For Science And Technology , 11- Imam Abdulrahman Bin Faisal University

Background: The lungs of particularly newborn are fragile and can be easily damaged. With injury, scarring
may follow which is translated into difficult breathing and increased oxygen needs, a condition called
bronchopulmonary dysplasia (BPD) or Chronic Lung Disease (CLD). Since inflammation plays an important
role in the pathogenesis of CLD, corticosteroids, especially dexamethasone, have been extensively used to
avert or treat CLD. Thus, several studies suggest that systemic corticosteroids decrease the duration of
ventilator dependence.
Aim of the Study: investigate the beneficial and harmful effects of the use of steroid in the prevention and
treatment of BPD.
Methods: A systematic review and meta-analysis of observational studies and randomized controlled trials
was conducted. A review of the scientific literature. Pubmed, Embase and Central were searched to identify
randomized controlled trials that investigated postnatal corticosteroids treatment for BPD were the primary
endpoints. Identification of papers and data extraction were performed by two independent researchers. We
searched for relevant trials in the Cochrane Library, MEDLINE (from 1955), Embase (from 1970), the
Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to September
2017.Results: The search yielded seven RCTs which enrolled a total of 1862 participants eligible for inclusion
in the present review. There were significant beneficial outcomes such as lower rates of failure to extubate and
decreased risks of chronic lung disease at both 28 days (RR 0.84, 95% CI 0.83 to 0.87) and 36 weeks'
postmenstrual age (RR 0.77, 95% CI 0.72 to 0.84), death or chronic lung disease at 28 days (RR 0.9, 95% CI
0.85 to 0.96) and 36 weeks' postmenstrual age (RR 0.91, 95% CI 0.87 to 0.96). Nevertheless, there were no
significant differences in the rates of neonatal mortality (RR= 1.06, 95% CI 0.93, 1.26), periventricular
leukomalacia (RR 1.16, 95% CI 0.9 to 1.46), necrotizing enterocolitis or pulmonary haemorrhage (RR 1.21,
95% CI 0.83 to 1.62). In contrast, gastrointestinal bleeding (RR 2.13, 95% CI 1.41 to 2.84) and intestinal
perforation (RR 1.77, 95% CI 1.46 to 2.1) were imperative adverse effects. Moreover, many adverse
neurological effects were found at follow-up examinations, including developmental delay (RR 1.72, 95% CI
1.4 to 2.05) and cerebral palsy (RR 1.56, 95% CI 1.03 to 2.1). Additionally, the rates of the combined
outcomes of death or cerebral palsy (1.92, 95% CI 1.18 to 2.67), or of death or major neurosensory disability
(RR 1.25, 95% CI 0.98 to 1.53), were not significantly increased. In subgroup analyses by type of
corticosteroid, most of the advantageous and disadvantageous effects were related chiefly to dexamethasone
whilst hydrocortisone had slight effect on any of the outcomes except for an increase in intestinal perforation
and a borderline reduction in patent ductus arteriosus. The overall risk for bias was low as all were RCTs using
robust methods.
Conclusion: despite the fact that early corticosteroid treatment can have beneficial outcome for BPD
management through facilitation of extubation and decreasing the risk of chronic lung disease and patent
ductus arteriosus, it ,on the other hand, results in short-term adverse effects including gastrointestinal bleeding,
intestinal perforation, hyperglycaemia, hypertension, hypertrophic cardiomyopathy and growth failure.
Clinicians should carefully assess the risks of a short course of glucocorticoid therapy to mitigate BPD for
premature neonates such that an individualized decision should be made in conjunction with the infant's

Received: 11/09/2017 DOI: 10.12816/0042866
Accepted: 21/09/2017

Full Paper (vol.698 paper# 29)

c:\work\Jor\vol698_30 The Egyptian Journal of Hospital Medicine (October 2017) Vol. 69 (8), Page 3154-3159

Coexistence of Hypertension and Diabetes Mellitus in Elderly
Population of Arar City, Northern Saudi Arabia
Thamer Owaid Alanazi 1, Yusef Muhana Alenezi 2, Mohammed Ibrahim Omar Alalawi
3, Abdullah Mohammed Alshehri 4, Essam Abdullah Alghamdi 5, Assaf Nahar J Alsulami
6, Abdullah Khaled J Alzahrani 7, Bandar Ali Mohammed Albarqi 8,
Saleh Saad T Alotaibi 7, Alanazi Ahmed Owaid Z 9, Alharthi Saleh Furayhan O 4,
Abdullah Hameed Alghanmi 10, Sultan Hassan Y Asiri 11
1 King Fahad Medical City, Al-Dahrran, 2 Family and Community Medicine Department, Faculty of
Medicine, Northern Border University, Arar, 3 Internal Medicine Department, King Khalid University,
Abha, KSA, 4 Faculty of Medicine, University of Debrecen, Debrecen, Hungary, 5 General Surgery
Department, Umm Alqura university, 6 Military Hospital, Al Madina, KSA, 7 Faculty of Medicine,Taif
University, Taif, 8 Military Hospital, Khamis Mushait, 9 Medical Student, Faculty of Medicine, NBU,
Arar, KSA, 10 King Fahad Military Hospital, Jeddah, 11 King Khalid University, Abha,

: Type 2 diabetes (DM) mellitus and Hypertension (HT) are among the most common
chronic non-communicable diseases affecting at a higher prevalence in the older age group. The
presence of hypertension in diabetic patients substantially increases the risks of coronary heart disease,
stroke, nephropathy and retinopathy. The objective of this study is to determine the prevalence rate and
risk factor associated with co-existence of hypertension and diabetes mellitus in elderly population in
Arar city, Northern Saudi Arabia. Methods: A cross sectional study, included 181 elderly attending
seven randomly selected primary healthcare centers in Arar city during the period from 1st January to
30th June 2017. Participants selected using a systemic random sampling procedure as we take every
second elderly attending the PHC during the study period. Data collected by means of personal interview
using a predesigned questionnaire covering the required items. Results: The prevalence of coexistence
of diabetes and hypertension was 16.6% while coexistence of diabetes, hypertension and obesity were
found in 9.9%. Two-thirds (66.66%) of cases of coexisting diabetes and hypertension were females (P
value>0.05). The relation between coexisting diabetes and hypertension with smoking status was
significant (P value<0.05) while the relation with BMI was non-significant (P value>0.05).
Conclusion: Coexistence of diabetes and hypertension were found in 16.6% of elderly population of
Arar, Northern KSA. This association leads to several cardiovascular complications, so it is mandatory
to adopt more strategies for the control of DM and HT in Arar elderly population by appropriate
Coexistence of diabetes and hypertension; elderly population; Arar; Northern Saudi Arabia.


Type 2 diabetes (DM) mellitus and
demand immediate attention and thus remain
Hypertension (HT) are among the most common
undiagnosed at onset and even when diagnosed
chronic non-communicable diseases affecting
is often ignored by persons afflicted by it [3].
both developed and developing countries and
Studies indicate that the prevalence of DM
occur at a higher prevalence in the older age
ranges from 7 to 14% in the population aged 30
group and result from both genetic and
to 69 years old [5]. The presence of hypertension
environmental factors [1]. HT is considered to
in diabetic patients substantially increases the
be one of the most common causes of morbidity
risks of coronary heart disease, stroke,
and mortality affecting mankind [2]. It is a
nephropathy and retinopathy. When HT coexists
multifactorial clinical condition called a
with DM, the risk of CVD is increased by 75%,
syndrome and characterized by the presence of
which further contributes to the overall
high tension levels, associated with metabolic
morbidity and mortality of already high risk
and hormone changes and with trophic
population [4]. Epidemiologic studies provide
phenomena [6]. HT is a common health problem
evidence for co-existence of hypertension and
in developed countries and a major risk factor
diabetes and possibly point towards a common
for CVD. DM is a disease of insidious onset and
genetic and environmental factor promoting both
the symptoms, when they eventually appear, do
diabetes and hypertension [7].
Received: 11/09/2017 DOI: 10.12816/0042867
Accepted: 21/09/2017

Full Paper (vol.698 paper# 30)