c:\work\Jor\vol701_1 The Egyptian Journal of Hospital Medicine (January,2018) Vol. 70, Page 1-7

Knowledge, Beliefs and Practices of Parents towards Childhood
Vaccination in Najran City, Saudi Arabia
Atheer R. Alyami, Ghadi M. Alhashan, Iman A. Nasser, Sarah R. Alyami,
Norah H. Al Mardhamah, Maram H. Alyami, Ahlam Y.S. Alyami, Manar H. Alqahtani,
Batool M. Alwadei, Aljouharah M. Alanazi
Faculty of Medicine, Najran University, KSA
vaccinations play an important role in protecting children against life threatening infections.
During the past years, parents expressed concerns about the safety of routine vaccinations; resulting in non-
Objective: this study aimed to assess the attitudes, beliefs and behaviors of parents towards vaccinations and
the effects on vaccination practice in Najran region.
Methods: this is a cross sectional study was carried out by distributing questionnaire among the general
public in Najran City, Saudi Arabia. The questionnaire consisted of the following sections: demographic
profile, knowledge, beliefs, behaviors and open-ended questions regarding vaccination.
Results: 668 parents were participated in this study; out of them 61.8% reported compliance with the
vaccination schedule. Factors that were significantly associated with compliance included older age (p =
0.001), high education (p = 0.022) and better knowledge of the benefits of immunization. The main concerns
about vaccinations were fear of weakening the child's immunity and non-necessity of some vaccinations.
Causes that prevented compliance with vaccinations were lack of knowledge about their benefits (48.1%),
illness of the child at time of vaccination (13.5%), travel (9.6%) and fear of side effects (7.7%). Sources of
information that effectively changed parent's attitude included flyers (31.4%), social media (26.8%) and TV

Conclusion: most parents had an acceptable and good knowledge of the importance of vaccinations. However,
fears and misconceptions resulted in non-compliance of a substantial percentage of the responders. Educational
programs should address these causes of non-compliance and stress the importance of routine child
vaccinations to improve knowledge, beliefs and attitude of parents.
Keywords: vaccination, immunization, knowledge, attitude, questionnaire.


Childhood vaccinations play a pivotal role
Parent's knowledge and attitude affect to a
in protecting against life threatening infections.
great extent the immunization of their children.
However, in recent years, some parents began to
Previous studies have described the knowledge and
express concerns about the safety and efficacy of
attitude of parents in some regions of Saudi Arabia
routine vaccinations. These misconceptions can
including Al-Riyadh (2), Al-Taif (3) and Al-Madina
result in decreased rates of vaccination; with
(1). However, this subject was not studied in Najran
subsequent reappearance of vaccine-preventable
region. Therefore, this study aimed to assess the
diseases (1).
attitudes, beliefs, and behaviors of parents towards
In Saudi Arabia, the vaccination rate
vaccinations and the effects on vaccination practice
approaches nearly 100%, but some parents
in Najran region.
postpone the vaccination past their appointed time

in the schedule and do not appreciate the benefits of
immunization. In fact, the high vaccination
Ethical considerations
coverage in Saudi Arabia stems from the bylaws
This study design was approved by the
that mandate completion of the vaccination
institutional review board of the Faculty of
schedule before issuing birth certificates or
Medicine, Najran University. An informed consent
admitting children into school (2).
was obtained from each participant.

Received: 8 /10/2017 DOI: 10.12816/0042954
Accepted: 30/10/2017

Full Paper (vol.701 paper# 1)

c:\work\Jor\vol701_2 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 8-12

Evaluation and Comparison of Hepatic Enzymes in Different CKD Categories
Mashel Khalid Alhawish, Mohammad Saleh Alghoraibi, Rizqallah Abdullah Alzahrani,
Mazi Turki Alosaimy, Muath Khalid Abaalkhail, Mshari Abdulrahman Alabdulwahed,

Oqab M Almutairi Almaarefa,*Talal Saad Almutairi
Colleges for Science and Technology, *Imam Muhammad Ibn Saud Islamic University

Chronic Kidney Disease is a global public health issue, with increasing incidence. It consists
wide spectrum of renal conditions that lead to progressive decline in renal function and abnormal GFR. Liver
disorders are common among chronic kidney diseases. LFT's particularly play a vital role in the diagnosis and
monitoring CKD patients. Currently, eGFR considered being the most valuable parameter for diagnosing CKD.
But it has some limitations, it is not done routinely in apparently healthy people, secondly, GFR has different
normal values for different ethnic groups so the formulae for calculating eGFR being used in west might not be
applicable in eastern population and vice versa. Objectives: This study was carried out to compare hepatic
enzymes of patients with different stages of chronic kidney disease. Materials and methods: A total of 257
persons were recruited. Cases were divided into two subgroups based on the glomerular filtration rate (GFR).
Subgroup 1: 85 Cases had GFR <15, subgroup 2: 99 cases with GFR > 15 and Subgroup 3: 73 normal healthy
controls. The hepato-renal profile was done for all cases and controls.
Results: Hepatic transferases in the patients undergoing dialysis fell into the normal range. But the same
enzymes showed a marked elevation in the patients with chronic kidney disease having non-invasive treatment.
Alkaline phosphatase showed mark elevation for both groups A and B as compared to normal controls.
Keywords: Chronic kidney disease, liver function, hepatic enzymes, glomerular filtration rate, end stage renal


Chronic kidney disease is defined as kidney
the prevalence of chronic kidney disease among
damage for 3 months (measured in terms of
different population distributed on the basis of
structural or functional damage), presented with or
different socio-economic, educational and behavioral
without a change in glomerular filtration rate. These
derangements can be assessed by identifying the
The outcome in the patients with chronic
biochemical markers of kidney damage i.e. urea and
kidney disease is also not very promising. A major
creatinine(1). Chronic kidney disease is gradually
portion of the population suffering from chronic
becoming a global threat. According to the Global
kidney disease develops end stage renal failure,
burden of disease study, in 1990 CKD was ranked
insulin resistance, hypercholesterolemia, uremia and
27th in the list of major killers, but its rank drastically
encephalopathy(5). The number of diseases affected
gained momentum and rose to 18th in 2010 (2).
disability days is also increased. On the other hand,
In Kingdom of Saudi Arabia, the dynamics
the mortality rate due to multisystem organ failure
of chronic kidney disease are also changing very
(hepatic failure, stroke etc.) is also greatly
rapidly. Mortality due to CKD is 17.8 per 100,000
populations (3). Different studies were conducted in
Hepatic transferases and phosphatases are
the Kingdom to establish a prevalence of chronic
the markers of hepato-cellular inflammation and
kidney disease. The efforts were also made to
damage to the hepatocytes. The enzymes or
categorize chronic kidney disease in different stages
biomarkers follow a definite pattern of wax and wane
according to glomerular filtration rates using
in different diseases. In the patients with chronic
different formulas of eGFR including Cockcroft-
kidney disease, different studies showed the
Gault equations, MDRD-3(Modification of Diet in
tranferases and phosphatses with a specific pattern.
Renal Disease MDRD3 formula), and the CKD-EPI.
They fall on the lower limit of the normal range as
The results showed a prevalence of chronic kidney
compared to the normal population(7). The fall of this
disease which was 5.7 %, irrespective of the stage of
transferase is irrespective of the stage of kidney
kidney disease, there is no significant difference of
disease, dialysis or extent of hepatic or kidney
Received: 03 /10/2017 DOI: 10.12816/0042955
Accepted: 13/10/2017

Full Paper (vol.701 paper# 2)

c:\work\Jor\vol701_3 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 13-20

Pregnant Women Risk Perception of Medications and Natural
Products Use During Pregnancy in Alahsa, Saudi Arabia
Abdulrhman Mohammed Aljohera*, Mohammed Abdullah Alsaeeda,
Mohammed Abdulltife AlKhlfana, Aishah Wassil Almethena,
Monirah Abdullah Almukhaitaha, Humaira Zareena, Sayed Ibrahim Alia
a College of Medicine, King Faisal University, Alahsa, Saudi Arabia
*Corresponding author: Abdulrhman Mohammed Aljoher, Saudi Arabia,
Telephone +966549897688, aaljoher93@gmail.com

The use of medications during pregnancy has increased in the recent years. Some congenital
anomalies, birth defects, and miscarriages have been found to be preceded by some medications use during
pregnancy. The use of herbal medicines is not yet proved to be safe during pregnancy, since some herbs
showed increased risk of certain congenital malformations.
Aim: This study assesses the pregnant women perception, beliefs, and attitude toward medication and
natural products use and their influencers during pregnancy.
Methodology: This is a cross-sectional study targeting women in Alahsa, Saudi Arabia. More than 300
women have responded to a pretested questionnaire collecting their sociodemographic, perception and
attitude toward medication and natural product. The data were analyzed using SPSS Statistics under the
supervision of a statistician.
This study involved 184 participants, 29.2% of pregnant women avoided using prescribed
medications, 40.7% non-prescribed, and 33.3% natural products during pregnancy. Paracetamol was on the
top of the avoided medications, and herbals were on the top of the avoided natural products. The most
common reason for avoidance was fearing of its effect on fetus. More than half of the participants always
looked for the product safeness. Pain killers, antibiotics, cinnamon, and pineapple are the most commonly
believed products to be harmful during pregnancy. 1st trimester is believed to be the critical period in which
medications and herbals should be avoided.
Conclusion: Pregnant women should be educated more about unsafe products during pregnancy. Women's
beliefs about natural products need further exploration because of lack of evidence.
Keywords: Pregnancy, teratogenic, medication, herbals, congenital anomaly, birth defect.


In the last 30 years, the number of pregnant
mothers of infants with congenital anomalies
women who take medications has increased more
were using aspirin, antacids, dextroamphetamine,
than the double to reach a ratio of 9 out of 10
women use at least one medication during
pregnancy [1]. It is well known that the use of
sulphonamides,and nicotinamide [6]. NSAIDs
medications in pregnancy is required in some
were found to be associated with the increased
women especially for those who have certain
risk of miscarriage especially when they are used
medical conditions which require continuous
early in pregnancy or for long time [7]. Some
treatment, such as hypertension, diabetes mellitus
medications have also high risk for some birth
and asthma, otherwise their life would be in
defect such as hypospadias [8-11].
danger. Medications during pregnancy may also
On the other hand, we have a huge number of
be used for certain medical conditions that occurs
pregnant women in the developing countries who
because of the pregnancy [2]. The increase in the
use herbal medicine because they believe that
occurrence of chronic diseases in reproductive
these medicines are natural and safe [12,13]. In
age along with the advancement of maternal age
USA, the use of herbal medicine was estimated to
during pregnancy are 2 factors influencing the
be 17.9% [14]. According to the complementary
increase in the consumption of prescribed
and alternative drugs (CAD'S), the use of herbal
medications in pregnancy [3,4]. Medication use
medicines (preparations) is not always proved and
during pregnancy should be controlled under the
there is little data concerning the safety and the
supervision of physicians, as some of these
adverse consequences of their use during
substances may cross the placenta and affect the
pregnancy as well as the purities of these
growth of the fetus [5]. It has been reported that
preparations [15]. It is very important to know that

Accepted: 18 /09/2017

Full Paper (vol.701 paper# 3)

c:\work\Jor\vol701_4 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 21-28

Percutaneous Needle Aspiration Versus Catheter Drainage in
Treating Hepatic Abscess
Jawad Abdullah Ali Aldhafeeri 1, Haya Hussam N Alkahtani 2 , Ahmad Mohammed A Dakheel 3 ,
Abdulghani Mohammed M Lodhi 3 , Khaled Masoud Alghamdi 4 , Mohammed Abdullah M Asiri 5 ,
Mohammed Abdullah M Alzahrani 5 , Fatima Alawi S Alhebshi 5 , Abdulwahab Malawi S Alshahrani 6
, Ahmed Omer S Alamoudi 3 , Muatz Ahmed Khayat 3 , Sameer Ali Y Alaidarous 3
1- Najran University Hospital 1 , 2- Ibn Sina National College , 3- King Abdulaziz University , 4- Health
Control Centers in King Abdulaziz International Airport , 5- Taif University , 6- King Khalid University

Aim of the study:
was to investigate the effectiveness of Percutaneous Needle Aspiration in comparison to
continuous catheter drainage in the treatment of hepatic abscesses.
Methods: A review of the scientific literature (From 1980 to October 2017)
MEDLINE, EMBASE, SCOPUS, Current Contents, Cochrane Library, and Clinicaltrials.gov were searched
to identify randomized controlled trials that investigated thoroughly the Percutaneous Needle Aspiration
Versus Catheter Drainage in the treating of hepatic abscess and clearly met the inclusion criteria and the
study primary endpoints (success rate, total resolution and mortality). Identification of papers and data
extraction were performed by independent researchers.
Results: the search yielded six eligible RCTs covering 348 patients. The meta-analysis showed that
outcomes in patients treated with PCD were superior to those in patients treated with PNA in terms of
success rate (RR: 0.79, 95% CI=0.64­0.97; P = 0.04), days to achieve a 50% reduction in abscess cavity size
(SMD: -1.076, 95% CI 0.63­1.51; P < 0.00001) and overall clinical improvement (SMD: 0.71, 95% CI
0.35­1.09; P =0.0001). On the other hand, no significant difference was notable in the duration of
hospitalization (SMD: -0.15, 95% CI -2.03 to 1.72, P = 0.84) or procedure-related complications (RR: 0.48,
95% CI 0.13­2.58; P = 0.39).
The results of the present meta-analysis and systematic review indicated that PCD and PNA
can be less safe and less invasive methods for the treatment of hepatic abscesses yet PCD is suggested to be
more advantageous and superior to PNA.
Keywords: Catheter Drainage, LIVER ABSCESS, Percutaneous Needle Aspiration, Pyogenic abscess of liver


Liver is an important and vital organ of the
Also, secondary bacterial infection may
body. This organ is subjected to numerous
complicate 20% of amebic liver abscesses (4).
systemic infections viral, bacterial and parasitic
In such patients and in patients with pyogenic
and lies at the distal end of the portal circulation
liver abscesses, surgical drainage has been the
(1). Liver abscesses are infectious, space-
traditional mode of treatment (5). However,
occupying lesions in the liver; the two most
operative drainage is associated with significant
common abscesses being pyogenic and amoebic.
(10-47%) morbidity and mortality (6). In recent
Pyogenic Liver Abscess (PLA) is a rare but
years, imaging guided percutaneous drainage has
potentially lethal condition; its severity depends
been increasingly used to treat liver abscesses
on the source of the infection and the underlying
with reported success rates ranging from 70% to
condition of the patient. Amebic Liver Abscesses
100% (7). Although percutaneous placement of an
(ALA) are common in tropical regions mainly
indwelling catheter is the method most widely
where `Entamoeba histolytica' is endemic and is
preferred to drain liver abscesses, recent studies
more prevalent in individuals (mostly young
have shown therapeutic needle aspiration to be a
males) with suppressed cell mediated immunity
simpler, less costly, and equally effective mode
Liver abscesses, both amebic and pyogenic,
Although mortality is improved, it is still
continue to be an important cause of morbidity
high, making early diagnosis of HA exceedingly
and mortality in tropical countries. The primary
important to the clinical outcome. HA can be
mode of treatment of amebic liver abscess is
difficult to diagnose, and the symptomatology is
medical; however, as many as 15% of amebic
abscesses may be refractory to medical therapy (3).
nonspecific, and therefore, diagnosis relies largely

on imaging (9). Percutaneous drainage is now

considered the treatment of choice for most intra-
Received: 04/10/2017 DOI: 10.12816/0042957
Accepted: 12/10/2017

Full Paper (vol.701 paper# 4)

c:\work\Jor\vol701_5 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 29-32

Prevalence and Awareness of Refractive Errors among Aljouf
University Medical Students
Waleed Sultan Alruwaili1*, Mansour Sultan Alruwaili2,
Malak Khalid Alkuwaykibi3, Khalid A. Zaky4
1College of Medicine, Aljouf University,2King Abdulaziz Specialist Hospital, Ministry of Health,
3CM-AU and 4Department of Ophthalmology, CM-AU, Sakaka, Saudi Arabia.
*Corresponding author: E-mail: wldsltn@gmail.com. Mobile No: +966533501319

To evaluate the prevalence of refractive errors (REs) among medical students of Aljouf
Methods: A cross-sectional study was conducted anonymously on 278 students. A structured close-ended
questionnaire was distributed for data collection and checking awareness concerning REs amongst them in
the period between December 2016 and January 2017. All volunteering participants underwent ophthalmic
examination including autorefractometer examination (Topcon RM-8000B, Tokyo, Japan).
Results: The response rate was 72.3%. Mean age was 21.2 ± 1.45 years (range 19 - 25 years). 71.6% of
the participant in the study was males. Results from the autorefractometer showed that 83.1% of
participants suffered from REs. 74.129% were myopic, while 53.731% were astigmatic, and 47.264% had
combined astigmatism and myopia. Furthermore, hypermetropia prevalence was 3.483%. 80.6% of males,
while 89.5% of females suffered REs. However, there was no significant association between REs and
gender (P>0.05). Only about half of the students (48.8%) involved in the study were aware of REs, which
explains the notion that 51.5% of students enrolled were not using any kind of treatment for REs. Only
10.9% of students were engaged in regular follow up for eye care service.
Conclusion: The prevalence of REs among investigated students was 83.1%, which is one of the highest
rates reported. There has to be a concern for a regular checkup starting from early ages as a preventive
measure against REs through increasing knowledge, awareness and practice concerning REs particular for
medical students as future health care professionals.
Keywords: Refractive errors, Autorefractometer, Medical students, Awareness, myopia, astigmatism,
hypermetropia, Aljouf.

Visual impairment is one of the major worldwide
On the other side, European reports conducted on
health issues, where the uncorrected refractive
medical students in Denmark and Norway
errors (REs; myopia, hyperopia and astigmatism)
showed relatively lower prevalence rates of 50%
contributes 43% toward the problem that makes it
and 50.3%, respectively(9, 10).
the major cause of blindness(1). Several studies
Nationally in Saudi Arabia, a study held in Al-
reported an increasingly epidemic rate for myopia
Hassa that targeted primary school children
prevalence, especially in East Asia, and among
showed that 89.36% had defective vision. Of
populations of Chinese descent(2-4). However,
those, 13.7% had refractive errors. Myopia was
myopia have been found to achieve higher
the major REs reaching 65.7 %( 11). Generally,
intelligence test scores and higher educational
students have been reported to be at high risk for
levels than non-myopic(5). The correlation
myopia(12). Patients from Al-Jouf region
between myopia and high education levels was
examined in primary health care centers show
settled long time ago. In European cohort,
that leading cause of visual impairment was
Mirshahi et al showed that individuals with
refractive errors, with a rate of 36%(13). REs were
higher level of education are more likely to be
the second leading cause of visual impairment,
myopic(6). Medical students are exposed to high
estimating 24.7% among northern Saudi Arar
level of eye effort through their college life(7).
population(14). Low awareness of the problem is
A study of myopia conducted in Taiwan that
prevailing and hinders seeking for treatment. In
targeted medical students showed that myopic
Riyadh, a study conducted between the years
students constituted 90% of all students(7). In
2003 and 2004 found only 8% of the affected
Singapore, it was reported that the prevalence
persons were using eyeglasses for correction of
rate of myopia among medical students was 82%,
while that of astigmatism was more than 70%(8).
Received: 03/10/2017 DOI: 10.12816/0042958
Accepted: 13/10/2017

Full Paper (vol.701 paper# 5)

c:\work\Jor\vol701_6 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 33-38

Prehypertension and Hypertension in Medical Students of
Northern Border University in Arar, Saudi Arabia
Abdulrahman Mazki J Alanazi1, Yusef Muhana Alenezi2, Tariq Hulayyil Alanazi3,
Bader Arar Shadad Alruwaili3, Abdulaziz Mofareh Murid Alanazi3, Amjed Naeem Alrawili
3Eissa Zaedan M Alenezi 3, Abdulrahman Sulaiman Shadad Alanazi3, Abdulkarim Dhahawi H
Alruwaili3, Abdurhman Aiash Alrwaili3, Abdulhamid Mahmoud Alshaheen3,
Bader Khalid M Alruwaili3, Khalid Abdulrahman Dhafi Hussain3
1 Primary Health Care Center, Arar, 2 Family and Community Medicine Department, Faculty of Medicine,
Northern Border University, 3 Faculty of Medicine, Northern Border University.

Aim of the work
: hypertension is the commonest cardiovascular disorder. Prehypertension in adolescents
and young adults is a risk factor for developing hypertension in later years of life. The objective of this
study was to determine the prevalence rate and risk factor associated with prehypertension and hypertension
in the medical students of Northern Border University in Arar city, Saudi Arabia. Methods: this cross-
sectional study included 232 students. The study subjects were selected by systematic random sampling
method. This study included 232 medical students (136 male and 96 female). The study period was from 1
March to 31 May 2017. Students were given a predesigned and pretested questionnaire to collect the
relevant data. Results: Fifty (52.1%) of females and 58.8% of males were pre-hypertensive and 1.5% from
males were hypertensive. Family history of hypertension was positive in 66.7% of hypertensive or pre-
hypertensive students (P<0.05), 18.2% were obese (P<0.05), 9.1% of hypertensive or pre-hypertensive
students were diabetic (P>0.05), 31.8% were smokers (P>0.05), 10.6% were drug addicts (P>0.05), 18.2%
only performing muscular exercise (P>0.05), 62.1% consume >5g salt /day (P<0.05)and 40.9% of them
spent 2-5 hours in front of TV, Computer or mobile (P>0.05). Conclusion: in medical students of the
Northern Border University, 52.1% of females and 58.8% of males were pre-hypertensive and 1.5% of
males were hypertensive. Risk factors included obesity, family history, sedentary life and excess salt intake.
So health-care providers should recognize the increased risk of prehypertension and hypertension and
should seek to identify and manage the modifiable risk factors in those students.
Keywords: Prehypertension, Hypertension, Medical Students ,Northern Border , Arar,SA.


obesity and prehypertension. The mortality rate in
cardiovascular disorder and it is a major public
pre-hypertinsive adults is 50% higher than
health challenge to population in socio-economic
normotensive counterparts. Framingham stated
and epidemiological transition(1).The Seventh
that pre-hypertension is strongly associated with an
Report of the Joint National Committee on
increased risk of myocardial infarction and
Prevention, Detection, Evaluation and Treatment of
coronary artery diseases (5).Prehypertension tends to
High Blood Pressure (JNC7) defined hypertension
be unnoticed; However early identification of
as blood pressure >140/90 mmHg (2), when pre
prehypertension plays an important role in
hypertinson was defined as individuals with blood
identification of modifiable factors required for
pressure (BP) above optimal levels, but not clinical
prevention of cardiovascular problems (5).
hypertension, i.e., systolic BP (SBP) 120-139
Physicians across the globe are found to have
mmHg or diastolic BP (DBP) of 80-89 mmHg (3).
higher prevalence of metabolic syndrome than
Prehypertension in adolescents and young adults is
previously expected (2), so we aimed in this study to
a risk factor for developing hypertension in later
identify the prevalence of pre-hypertension,
years of life. These disorders are seen affecting the
hypertension and associated factors among
younger age groups and adolescents at an
adolescent medical students who were from similar
increasing rate. With growing urbanization, socio-
socioeconomic status, dietary habits, and lifestyle.
developmental and life style changes from
Many studies have been done around the world in
traditional to modern have led to physical
this area. Studies from India have given varied
inactivity, stress on technology, computers and
prevalence of prehypertension, ranging from 20%
alarming consumption of junk food and other
to 80% (6,7). Another studies determined the
modified dietary patterns characterized by
prevalence of cardiovascular risk factors among the
increased consumption of diets rich in fat, sugar
medical students elsewhere (8,9) have all shown high
and calories (4) has led to youth suffering from
prevalence of cardiovascular risk factors. Drug
Received: 03/10/2017 DOI: 10.12816/0042959
Accepted: 13/10/2017

Full Paper (vol.701 paper# 6)

c:\work\Jor\vol701_7 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 39-41
Outcome of Iris Fixation of Posterior Chamber Intraocular Lenses
Using Siepser Sliding Knot Technique
Abdulrahman A. Kaki1, Maan A. Al-Barry2, Ammar M. Al-Mahmood3, Ghada Y. Al-Binali4,
Ali Al Khairi5, Anoud F. Al Saati6, Samar A. Al-Swailem7, Sabah S. Jastaneiah8
[1] Department of ophthalmology Taibah University, Madinah, Kingdom of Saudi Arabia, [2] Department of
Ophthalmology, Anterior Segment division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi
Arabia, [3] Department of Ophthalmology, Bahrain Defense Force Hospital, Kingdom of Bahrain,
[4] Department of Ophthalmology, Riyadh Military Hospital, Kingdom of Saudi Arabia.
Corresponding Author: Abdulrahman A. Kaki1, Phone Number: 0501462209, E-mail: Abdulrahmanakaki@hotmail.com

Purpose: To report the outcomes and complications of iris-fixated posterior chamber intraocular lenses
(PCIOL) using Siepser sliding knot technique in suturing one or both haptics.
Methods: Retrospective, observational case study involving surgical placement of a foldable iris-sutured
PCIOL using the Siepser sliding knot technique. This study was carried out between September 2008 and
March 2010 and reviewed by seven anterior segment surgeons. Outcome measures included change in visual
acuity (VA) and complications.
Results: 30 eyes of 29 patients were included. 26 PCIOLs (86.7%) had the Siepser sliding knot technique fixed
on both haptics whereas 4 (13.3%) had the PCIOL knot was fixed over a single haptics. Mean age of patients at
the time of surgery was 50.5 years ± 24.5 (Range, 7 to 79 years). Preoperatively, the mean Snellen decimal
uncorrected VA (UCVA) was 0.158 ± 0.163 and the mean preoperative best-corrected VA (BCVA) was 0.249
± 0.195. Postoperatively, the mean Snellen decimal BCVA was 0.383 ± 0.232. 22 patients (73.3%)
showed improved BCVA following surgery. The mean follow up period was 6.9 months ± 5.5 (Range, 1 to 16
months). Complications included elevated intraocular pressure (IOP) (10%, n=3), transient diplopia (6.7%,
n=2), decompensated cornea (3.3%, n=1), wound leak (3.3%, n=1) and dislocated PCIOL (3.3%, n=1).
Conclusion: Iris-fixated PCIOL using Siepser sliding knot technique in suturing one or both haptics is a useful
and safe technique for PCIOL implantation in the event of a partial or complete absence of capsular support.
Keywords: Iris fixation, posterior chamber, intraocular lenses, Siepser sliding knot technique.


Posterior chamber intraocular lens (PCIOL)
iris-fixated PCIOL at our tertiary eye center
fixation in the absence of adequate capsular support
between September 2008 and March 2010 were
is required in cases of primary or secondary
reviewed. Our inclusion criteria included patients
implantation following rupture of the posterior
that had iris-fixated PCIOL using Siepser sliding
capsule or disinsertion of the zonules, or for re-
knot technique in suturing one or both haptics.
fixation of dislocated/subluxated PCIOLs. If
Those who had iris-fixated PCIOL using other
adequate capsular support exists, a PCIOL can be
techniques were excluded. Specific data collected
placed in the ciliary sulcus or over the remaining
included age, eye involved, preoperative and
capsule[1]. We report the visual outcomes and
postoperative uncorrected corrected visual acuity
complications following an iris-sutured foldable
(UCVA) and best corrected visual acuities
PCIOL implantation using the Siepser sliding knot
technique in fixing one or both haptics.
endothelial cell counts, associated systemic and

ocular illnesses, intra-operative and postoperative
complications, and associated surgical procedures.
The institutional review board at King Khaled
The Snellen visual acuities (VA) were converted to
Eye Specialist Hospital approved this study. A
decimal fraction for statistical analyses. For Snellen
computer-based search of inpatient records was
VA less than 20/400 (0.05), counting fingers (CF;
generated by cross-referencing coded discharge
0.025), hand motions (HM; 0.0125), light
information to obtain a list of eligible patients. The
perception (LP; 0.006), and no light perception
Medical records of all patients who underwent the
(NLP; 0.0) were used.
Received: 04/10/2017 DOI: 10.12816/0042960
Accepted: 14/10/2017

Full Paper (vol.701 paper# 7)

c:\work\Jor\vol701_8 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 42-49

High Altitude and Related Illnesses Awareness among
General Population in Albaha City
Saad A. Manakrwi, Thamer A.H. Alghamdi, Raed J.D. Alghamdi, Mohammed O.M. Alghamdi,
Omair M.S. Alghamdi, Ghazi S.A. Alghamdi, Abdullah I.S. Alghamdi
Faculty of Medicine, Albaha University, Albaha, KSA


Background: high altitude illness (HAI) refers to a number of acute syndromes that may take place in
individuals who are not acclimatized to high altitude, including acute mountain sickness, high altitude
pulmonary edema and high altitude cerebral edema. Awareness of the general population about the
manifestations and risk factors of high altitude illness may enhance the recognition of patients and ensure
adequate management of acute cases.
Objective: this study was carried out to assess the awareness of general population of Albaha city regarding
high altitude and related illnesses.
Methods: this questionnaire was distributed among the general public in Albaha city, Saudi Arabia. The
questionnaire consisted of two sections: section 1 included personal data and section 2 was concerned with
awareness and knowledge of people regarding high altitude illness. Only completed questionnaires without
missing data were statistically analyzed.
Results: a high frequency of the participants identified the risk factors contributing to HAI including
ascending too quickly, overexertion, dehydration and sleeping at high altitude. On the other hand,
participants had some false believes about the risk factors, the gravity of the illness and the lowest level of
altitude at which manifestations may develop. Only 30.1% identified the lowest altitude at which HAI can
occur. About one third of the subjects had symptoms of HAI in the form of difficulty in breathing,
exhaustion, headache, weakness and difficulty in sleeping.
Conclusion: overall, respondents were interested in learning more about high altitude sickness. Physicians
and the internet were the most attractive sources of information for this population.
high altitude illness, acute mountain sickness, survey, Saudi Arabia.


High altitude illness is a term used to describe a
hypertension, diabetes, and chronic obstructive
number of acute syndromes that may occur in
pulmonary disease do not affect the susceptibility
unacclimatized individuals at high altitude
to high altitude illness (3). Interactions between
including acute mountain sickness (AMS), high
genes and environment most likely explain this
altitude pulmonary edema (HAPE) and high
individual susceptibility or resistance to high
altitude cerebral edema (HACE) (1).
altitude illness, especially HAPE. Mortimer et al.
As altitude increases ambient pressure falls and
(7) reported a significant association between
this leads to a lowered partial pressure of ambient
HAPE and specific polymorphisms of the
oxygen and a decreased saturation of hemoglobin
endothelial nitric oxide synthase gene, the
as a result (2). High altitude begins at altitudes
angiotensin converting enzyme gene and the
around 2500 m, where arterial oxygen saturation
human leukocyte antigens-DR6 and DQ4.
falls to values lower than 90%. High altitude
High altitude exposure triggers physiologic
illness is usually mild and self-limiting, but rarely
responses for maintaining an adequate tissue
it may progress to more severe forms, which can
oxygenation (8). Subjects who adapted to these
be life threatening. Risk factors for developing
altitudes for many months or years may develop
high altitude illness include the rate of ascent, the
chronic mountain sickness, which is characterized
altitude reached, the altitude at which the
personlsleeps and individual susceptibility (3).
hypoventilation, fatigue, dyspnea, cyanosis,
Persons over 50 years of age were somewhat
clubbing of the fingers and leg edema (9).
less susceptible to AMS than younger persons,
High altitude induced changes in cardiac
whereas the incidence in children appears to be the
rhythm that may explain the higher rate of sudden
same as that in adults. Women seem less
cardiac death at high altitude (10). High altitude
susceptible to HAPE than men, but equally prone
residents have adaptive mechanisms to survive in
to AMS (4-6). Pregnancy and common preexisting
such hypoxic environment (11).
illnesses such as coronary artery disease,
These adaptive mechanisms, although generally

tolerated by most healthy subjects, may induce
Received: 13/08/2017 DOI: 10.12816/0042961
Accepted: 04/09/2017

Full Paper (vol.701 paper# 8)

c:\work\Jor\vol701_9 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 50-59

Awareness about Symptoms and Role of Diet in Renal Stones among
General Population of Albaha City
Saeed Y.S. Alghamdi, Ali M.A. Alamri, Raed A.M. Alzahrani, Abdulrahman H.A. Alghamdi,
Abdulaziz A.A. Alghamdi, Abdulrahman A.M. Alghamdi, Raad J.D. Alghamdi
Faculty of Medicine, Albaha University, Albaha, KSA
nephrolithiasis is an extremely common disorder in Saudi Arabia. Certain dietary changes and
practices can influence the development of renal stones.
Aim of the work: the aim of this study was to evaluate the awareness about the symptoms and proper diet of
renal stones among general population of Albaha city in Saudi Arabia.
Methods: a questionnaire was distributed among the general public in Albaha City, Saudi Arabia. The
questionnaire was consisted of two sections: section 1 included personal data and section 2 explored the
awareness and knowledge about the most common symptoms and complications of renal stones.
Results: 417 participants were recruited. Most of the respondents were females, aged between 34 to 49 years,
married and had high education. About one third of respondents had previous information about renal stones.
Nearly half the respondents recognized only one risk factor and only one identified all the eight factors listed
(0.2%). There was lack of knowledge about some symptoms and false beliefs about some foods (fish and sea
food, greens and spinach). Conclusion: some misconceptions were revealed about risk factors and symptoms of
renal stones. There was a lack of sufficient knowledge about the role of diet in medical management of renal
stones. Educational programs should focus on these points of defect in knowledge and attitude. We
recommended providing the health information concerning renal stone disease through the Internet (being the
source of information used by most participants) and ensuring the inclusion of these information in the routine
instructions and health education of patients.
Keywords: urolithiasis, symptoms, risk factors, knowledge, questionnaire.


Kidney stones are a very common urologic
correction of dietary habits and avoidance of
problem. Their incidence is rising, with an estimated
unfavourable environmental factors (if possible) are
global prevalence of 10%­15% (1). It is a recurrent
integral parts of the medical management of renal
condition and stone formers are much more likely to
stones (7).
have a further stone. Sometimes the condition passes
Public knowledge about renal stones can
asymptomatically; however, many patients had pain,
improve the patient's quality of life. Research
urinary tract infection, hematuria or impairment of
concerning the level of health knowledge in the
renal functions, which may require multiple hospital
general public is limited; few studies evaluated
admissions or multiple surgical procedures (2). In
knowledge and practice of medical practitioners in
Saudi Arabia, renal stone disease represented a
management of renal stones (8-10).
significant health problem, affecting a much higher
In general, higher level of knowledge would
percentage of Saudi people than in western countries
allow people to better comply and manage their own
(3-5). The high incidence and prevalence of renal
care, for example by avoiding nephrotoxic agents
stone disease in KSA can be attributed to the effect
and maintaining a healthy diet. Hence, we conducted
of a certain diet peculiar to the Gulf region and
this study on the general population of Albaha city
Middle East with decreased calcium intake and high
in Saudi Arabia to assess their awareness about renal
intake of animal protein (whether meat, fish or
stones regarding the symptoms and proper diet of
poultry) and oxalate; thus resulting in enteric
this disease and also, to explore their practices and
hyperoxaluria and an increased risk of calcium-
attitudes in relation to prevention and management
oxalate stone formation. Moreover, the lower urine
of renal stones.
volumes, due to the hot, dry climate, increased the

risk of stone formation (4). Fortunately, prevention of
recurrent calculi is feasible and easily obtainable (6).
Ethical considerations
Most stone formers respond to changes in dietary
This study design was approved by the
habits and environmental factors. Therefore,
institutional review board of the Faculty of
Received: 22/09/2017 DOI: 10.12816/0042983
Accepted: 11/10/2017

Full Paper (vol.701 paper# 9)

c:\work\Jor\vol701_10 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70(1), Page 60-64
Management of Adult Syphilis between Gynecology and Urology
Osama Mohammed Alkhalifah1, Mohammed Samy Tayb2, Salwa Metwally Aly Khalifa3, Maha Sultan
Alrajeh4, Afnan Mohammed Buhlaigah5, Ruzanah Abdulaziz Almarzugi6, Samaher Maher Bukhari7,
Fatma Mohammed Al-Shehab8, Mohammed Hasan Alsharif9, Mohannad Ali Alghamdi6, Nihal
Mubarak Mohamed Hussien10, Ahmad Abdulwhab Jaml Allil11, Fahad Abdullah Alhamdan11, Afnan
Mohammed Buhlaigah12, Muna Imad Hussein3, Noha Rihab Baeshen11.
1 Mansoura University, 2 University of 6th October, 3 Dr. Soliman Fakeeh Hospital, 4 Pavol Jozef Safárik
University, 5 University of Dammam, 6 King Abdulaziz University, 7 Batterjee Medical College,
8 Arabian Gulf University, 9 Umm Alqura University, 10 University of Bahri,
11 Ibn Sina National College, 12 Jubail General Hospital
Corresponding Author: Osama Mohammed Alkhalifah - Osamamk41@gmail.com - 0591029922
Syphilis is a sexually transmitted disease found only in humans, which is caused by a spirochete (Treponema
pallidum). It infects the genital area, lips, mouth, or anus of both men and women. Patients usually get syphilis
from sexual contact with someone who has it. It can also pass from mother to baby during pregnancy. The
early stage of syphilis usually causes a single, small, painless sore. Sometimes it causes swelling in nearby
lymph nodes. If you do not treat it, syphilis usually causes a non-itchy skin rash, often on your hands and feet.
Many people do not notice symptoms for years. Symptoms can go away and come back. The sores caused by
syphilis make it easier to get or give someone HIV during sex. If you are pregnant, syphilis can cause birth
defects, or you could lose your baby. In rare cases, syphilis causes serious health problems and even death.
Syphilis is easy to cure with antibiotics if you catch it early. Correct usage of latex condoms greatly reduces,
but does not completely eliminate, the risk of catching or spreading syphilis.
Keywords: Syphilis, Infectious Diseases, Prevention, Penicillin, Treponema pallidum.

reaction by sensitized T lymphocytes and
Syphilis is a sexually transmitted disease found
macrophages results in gummatous ulcerations and
only in humans, which is caused by a spirochete
necrosis. Antigens of T pallidum persuade host
(Treponema pallidum). Infection is categorized by a
production of treponemal antibodies and nonspecific
wide symptomatology, which makes the diagnosis
antibodies. Immunity to syphilis is incomplete. For
hard when based exclusively on the clinical picture
instance, host humoral and cellular immune
[1]. The infection continues to be a significant
responses might avert the formation of a primary
epidemiological problem [2, 3]. The World Health
lesion on consequent contaminations with T
Organization estimate that each year in the world
pallidum, but they are inadequate to clear the
there are about 11 million new cases [4]. Since the
organism. This can be because the outer sheath of
year2000 in most European countries and the North
the spirochete is lacking immunogenic molecules, or
America a steady increase in the occurrence of
it might be as a result of down-regulation of helper
syphilis has been witnessed [5]. Treponema pallidum
T cells of the TH1 class [7, 8].
is a fragile spiral bacterium 6-15 micrometers long
The study was done after approval of ethical
by 0.25 micrometers in diameter. Its small size
board of King Abdulaziz university.
makes it unseen on light microscopy; consequently,
Primary syphilis
it should be recognized by its distinctive undulating
Primary syphilis ensues 10-90 days after
movements on dark field microscopy. It can survive
interaction with a diseased individual. It manifests
only momentarily outside of the body; accordingly,
mostly on the glans penis in males and on the vulva
transmission nearly always necessitates direct
or cervix in females. 10 % of syphilitic lesions are
contact with the infectious lesion. Syphilis is
found on the fingers, anus, nipples, oropharynx,
regularly classified into 4 stages: primary,
tongue, or other extragenital sites. Regional
secondary, latent, and tertiary. It can be either
nontender lymphadenopathy follows incursion.
attained or congenital. Explicitly, it can be
Lesions (chancres) typically begin as solitary, firm,
transmitted either by intimate contact with
raised, red papules that can be numerous
infectious lesions (most common) or via blood
centimeters in diameter. The chancre erodes to
transfusion (if blood has been collected during early
produce an ulcerative crater within the papule, with
syphilis), and it could correspondingly be
slightly prominent edges around the central ulcer. It
transmitted transplacentally from a diseased mother
regularly heals within 4-8 weeks, with or without
to her fetus [6]. The syphilitic penetrate reflects a
treatment. Even though genital chancres are
delayed-type hypersensitivity reaction to T pallidum,
regularly solitary, they might be multiple in few
and in certain individuals with tertiary syphilis, this
Received: 01/10/2017 DOI: 10.12816/0042962
Accepted: 10/10/2017

Full Paper (vol.701 paper# 10)

c:\work\Jor\vol701_11 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 65-71

Prevalence of People That Using Multivitamins Supplementation &
Experiencing A Side Effect in Saudi Arabia
1Mohammed Ateih Awwad Alsofyani, 2Maryam Hussain Ali Al-Essa, 1Mohammed Abdullah Assiri,
3Bashaer Mahboub Alalwani, 4Afrah Abdulraheem Abuzeefa, 1Abdulrahman Talal Qasim,1Sara
Mohammed AlOsaimi, 1Anood Qalil Althubaiti, 1Dima Obeid Aldosari, 4Sayed Ibrahim Ali
1.Taif University, 2. Maternity and Children Hospital in Al-Ahsa ,3. Royal Commission Medical Center,
4. Armed Forces Hospital ­Alhada, King Faisal University


Introduction: multivitamins are normally used to treat vitamin deficiencies. They may cause constipation
and diarrhea. We are concerned to see the prevalence for using multivitamins supplementation & awareness
of their side effects among saudi people. Methods: we conducted a cross sectional study and data collected
by distributing an electronic questionnaire from 6/3 to 15/8/2017 and approved by the King Faisal University
in Alhass, SA. Both gender above 18 years were included and excluded people below them. Statistical
analyses were performed using SPSS. Results: this study was applied on 471persons from different areas of
Kingdom of Saudi Arabia. Most of them were female 67.5 %.the age of our studied group was above 18
years. Most of them was healthy, pre-university, from western area and used multivitamins for weight gain.
15.5% had harmful effect and 69.6% had vitamins or minerals deficiency (51.7% iron deficiency). 43.1%
used them with no prescription and 85% used as pill. 80.8% considers them are important to their health and
35.8% believe there is no difference between using vitamins with or without medical advice. 24.9% believe
they have no side effects and16.3% believe that they are sufficient for the variety and quantity of food.70.7%
believe that the amount of vitamins in the food is not sufficient for the daily body and 42.5% read about
vitamins from scientific books.
Conclusion: the majority of the participants were using vitamins according to medical advice and there is a
less percentage of people that experienced a side effect from using that supplementations.
Objectives: to determine the prevalence, reasons, source of information of multivitamins supplement uses,
and their side effects.
Keywords: multivitamins, Saudi Arabia.

conducted. The participants were interviewed and
Multivitamins are a combination of many
information was collected in a predesigned
different vitamins that are normally found in foods
structured questionnaire. The data was analyzed
and other natural sources. Multivitamins are used
and expressed as counts and percentages. Of the
to provide vitamins that are not taken in through
120 study participants, 66 were males and 54 were
the diet. Multivitamins are also used to treat
females. Results revealed that 68.33% (82) of the
vitamin deficiencies (lack of vitamins) caused by
illness, pregnancy, poor nutrition, digestive
supplements. Out of the users, 69.5% (57)
disorders, and many other conditions. Many
participants consumed on the advice of doctors,
multivitamin products contain minerals such as
18.2% (15) were self-prescribers while 12.1% (10)
calcium, iron, magnesium, potassium, and zinc(1).
relied on advice of family or friends. Among the
Multivitamins can be in the form of tablets,
users, 70.96% considered such supplements to be
helpful. Reasons quoted for self-medication use of
Constipation, diarrhea,
or upset
stomach may
multivitamins were multiple such as maintenance
occur. These effects are usually temporary and
of general health (55%), to allay weakness or
may disappear as your body adjusts to this
fatigue (20%), to improve appetite (15%) etc.
medication (3). Less serious side effects may
Majority of the participants were unaware
include: headache, or unusual or unpleasant taste
regarding the correct indications for multivitamin
in your mouth.
supplementation. Regarding knowledge about the
Minerals (especially taken in large doses) can
natural sources of these vitamins, as many as 76%
cause side effects such as tooth staining, increased
showed ignorance (5). Four hundred patients were
urination, stomach bleeding, uneven heart rate,
interviewed during the period from July to
confusion, and muscle weakness or limp feeling.
September 2008, at the out-patient clinics, Aga
Signs of an allergic reaction: hives, difficulty
Khan University Hospital, Karachi. A pre-tested
breathing, swelling of your face, lips, tongue, or
and structured questionnaire was used to collect
throat(4). A descriptive cross-sectional study on
information. It consisted of questions regarding
120 adult participants from the general public was
demographics, awareness of vitamin supplements
Received: 5/10/2017 DOI: 10.12816/0042963

Full Paper (vol.701 paper# 11)

c:\work\Jor\vol701_12 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 72-75

Emergency Contraception Types and Mechanism of Actions
Safaa Mahmood Al-Hasani
Batterjee Medical College for Science and Technology
Corresponding Author: Safaa Mahmood Al-Hasani ,email: AlHasaniSM@gmail.com ,mobile: 00966569003666

roughly 50% of pregnancy in the United States are unintended, and one of the reasons behind is
lack of knowledge among women about various methods of emergency contraception. They come in tablet
form, which is commonly known as the morning after pill, and coper intrauterine devices.
Aim of the work: In this study, our aim is to discuss various methods commonly used for emergency
contraception, and explore their availability and adverse effects. We will also find its application in obese and
breast-feeding women.
Methodology: we conducted this review using a comprehensive search of MEDLINE, PubMed and EMBASE
from January 2010 to March 2017. The following search terms were used: emergency contraception, morning
after pill, adverse effects of emergency contraception, obese women contraception
Conclusion: Proper education if provided by health care providers to their female patients regarding methods
of emergency contraception can lower rates of unintended pregnancies and elective abortions. Such awareness,
consultation, and prescription must be given to all women of reproductive age, regardless of marital status for
decreasing adverse outcomes of long term health of the woman and decrease rate of abortion.
Keywords: emergency contraception, morning after pill, plan-B, emergency contraception for obese women,
breast-feeding emergency contraception

Around 50% of pregnancies in the United States
· Data sources and search terms
are unplanned. Hence, it is important that women
We conducted this review using a comprehensive
have knowledge and access to a full range of
search of MEDLINE, PubMed and EMBASE, from
contraceptive methods, which includes most
January 2010 to March 2017. The following search
importantly emergency contraception (EC).
terms were used: emergency contraception, morning
EC is defined as the usage of any drug or method
after pill, adverse effects of emergency
after an unprotected sexual intercourse in order to
contraception, obese women contraception
prevent an unintended pregnancy. EC gives a
· Data extraction
second chance to stop pregnancy when
Two reviewers have independently reviewed the
contraception method has failed or in the case of
studies, abstracted data and disagreements were
unprotected intercourse. If properly used, EC holds
resolved by consensus. Studies were evaluated for
the potential to decrease the amount of induced
quality and a review protocol was followed
abortions [1].
throughout. This study was done after approval of
Major gynecologic, pediatric, and primary care
ethical board of King Abdulaziz University.
organizations suggest counseling women who are at

risk of unintended pregnancy about methods of EC.
Methods of EC
Currently, in the United States, four methods are
Table 1 [2] summarizes the different EC options
accessible, which includes the copper intrauterine
that are available in the United States. Women of
device (IUD) and 3 forms of oral methods:
reproductive age pursue contraceptive counseling
levonorgestrel (LNG) 1.5 mg (which is a progestin-
from different providers, which includes those in
only pill), the Yuzpe regimen (which is high-dose
primary health care and emergency medicine staff,
who need to be simple in prescribing oral EC and in
contraceptives), and ulipristal acetate (UPA) 30 mg
referring women who desire for a copper IUD in a
(which is a selective progestin receptor modulator).
timely method. Providers must educate patients
All EC options can be obtained and used within
about all forms of contraception, including EC, in
5 days of unprotected intercourse and display
scheduled routine health visits [3].
varying efficacy [2].
Received: 01/10/2017 DOI: 10.12816/0042964
Accepted: 10/10/2017

Full Paper (vol.701 paper# 12)

c:\work\Jor\vol701_13 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 76-81
Causes and Management of Asthma
Hassan Saleh Felemban, Abdullah Jameel Motahar, Nairooz Mohammed Alzamzami,
Weaam Alhusini Felemban, Abdulrahman Mustafa Adnan, Saud Saad Albishi,
Heba Hesham Nezamadeen, Mohammad Ahmed A Alrefaei, Faisal Abdullah Alzahrani
Umm Alqura University
Corresponding Author: Hassan Saleh Felemban - Dr.7assan.f@hotmail.com -0560002996

Asthma is defined as a chronic inflammatory disorder of the airways which manifests itself as
recurrent episodes of wheezing, breathlessness, chest tightness and cough. It is characterized by bronchial
hyper-responsiveness and variable airflow obstruction, that is often reversible either spontaneously or with
treatment. Other nonspecific symptoms in infants or young children may be a history of recurrent
bronchitis, bronchiolitis, or pneumonia; a persistent cough with colds; and/or recurrent croup or chest
rattling. For all but the most severely affected patients, the ultimate goal is to prevent symptoms, minimize
morbidity from acute episodes, and prevent functional and psychological morbidity to provide a healthy (or
near healthy) lifestyle appropriate to the age of child. 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 1st , 1994, through November 30th , 2017.
Keywords: Inflammatory Disorder, Asthma, Inhaled Corticosteroids.


Asthma is a chronic respiratory ailment that is
Asthmatic patients regularly experience
predominant worldwide. It is reflected as a major
acute exacerbations. These exacerbations are
reason of morbidity and a chief contributor to the
commonly triggered by allergens; comprising
high health care expenditure particularly in
animal dander ,pollens, dust mites, and mold; viral
developed nations [1]. There are two major
respiratory tract contaminations; irritants such as
pathological features in asthmatics' airways,
smoke and dust; cold air and exercise. The most
inflammation, and hyper- responsiveness. These
mutual cause of acute asthma exacerbation in both
features are consistent, but not entirely dependent
children and adults, but more in children, is viral
on each other [2]. Airway inflammatory changes
respiratory tract contaminations. Viruses might be
contain airway wall edema, expanded airway
accountable for up to 80% of wheezing episodes in
mucus secretions, inflammatory cellular infiltrates,
children and 50-75% of episodes in adults [5].
smooth muscle hypertrophy, epithelial cell
Many viruses may be the reason for exacerbation
damage, and submucosal fibrosis[3].
of asthma symptoms, the most vital and most
The cellular infiltrates are generally composed
mutual is rhinovirus[6]. Respiratory syncycial virus
and influenza virus similarly cause substantial
macrophages, basophils, and lymphocytes. The
proportion of exacerbations. Airway epithelial
ratio of these cells might widely differ between
cells play a main role in the pathology of virally
patients indicating asthma heterogeneity [4].
induced asthma exacerbation. In response to
Asthma is naturally divided into three central
infection they secret chemokines like interleukin-8
immune pathological phenotypes: Eosinophilic,
and CCL-5 that can attract inflammatory cells
comprising neutrophils and lymphocytes that can
eosinophilic phenotype is categorized by expanded
eosinophilic infiltration of the airways. Patients are
inflammation [7].
susceptible to be a topic, have asthma triggered by
exposure to allergens and tend to respond well to
corticosteroids. The neutrophilic phenotype is
sensitization and respiratory viral contaminations
characterized by increased neutrophilic infiltration
may synergize to cause asthma exacerbation[8].
of the airways. Patients are susceptible to have
Children who are atopic are more expected to have
severe, aggressive, and out of sorts controlled
virally induced wheezing and respiratory distress
asthma. They habitually do not react to
than non atopic children[9]. Bacteria like
corticosteroids along with the eosinophilic sort. In
Hemophilus influenze and Moraxella catarrhalis,
the paucigranulocytic phenotype, eosinophils,
have been lately shown to be allied with acute
andbronchial neutrophils are much lower [4].
wheezing episodes in children [10]. Their role and
Received: 02/10/2017 DOI: 10.12816/0042965
Accepted: 12/10/2017

Full Paper (vol.701 paper# 13)

c:\work\Jor\vol701_14 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 82-87

Atherosclerosis: Pathophysiology and Management
Al Qahtany , Faisal Hani M1, HawraAbdulkhaliq Al Shali1, Ahmed Abdulrahman Bayamin2,
Haifa Saeed Alzabien3, Ala'a Mohammed Alrehaili4, Hosam Monahe Z Aldalbahi5,
Hassan Mohammed AL Awadh6, Mohamed Magdi Yousif7, Khalid Abdulelah Alqurashi8,
Nouf Abdullah Aljehani9, Naif Mishkhas Alazwari9, Mishael Tariq Alghamdi3
1 Imam Abdulrahman Bin Faisal University, 2 Taif University, 3 Battarjee Medical College, 4 Taibah
University, 5 Prince Sattam Bin Abdulaziz University, 6 King Faisal University, 7 International University
of Africa, 8 King Saud Bin Abdulaziz University for Health Sciences, 9 King Abdulaziz University,
Corresponding Author: Al Qahtany , Faisal Hani M - mr.faisalhani@gmail.com - 0569288410


Background: Atherothrombotic cardiovascular disease is currently the leading cause of morbidity, mortality
and cost burden in the medical community. New studies have found atherosclerosis to be predominantly an
inflammatory reaction of vessel wall. Methodology: We conducted this review using a comprehensive
search of MEDLINE, PubMed, and EMBASE, January 1987, through February 2017. The following search
terms were used: Atherosclerosis, thrombotic heart diseases, hypertriglyceridemia, dyslipidemia, pathology
of atherosclerosis, treatment of atherosclerosis. Aim: In this review, we evaluated the pathogenesis, risk
factors and management of atherosclerosis.
Conclusion: More studies must be done to offer better management, even though massive success was
achieved in the past decades. Also healthy population must be encouraged to avoid risk factors that cause
such pathologies.
Keywords: hyper triglyceridemia, dyslipidemia, pathology of atherosclerosis, treatment of atherosclerosis

Atherosclerosis is described as a chronic
Data Sources and Search terms
inflammatory reaction of the wall of vessels in
We conducted this review using a comprehensive
response to dyslipidemia along with endothelial
search of MEDLINE, PubMed, and EMBASE,
distress including the inflammatory recruitment of
January 1987, through February 2017. The
leukocytes with the activation of local vascular
following search terms were used: Atherosclerosis,
cells. The chronic inflammation of arterial
thrombotic heart diseases, hypertriglyceridemia,
vascular wall is believed to cause multifocal
dyslipidemia, pathology of atherosclerosis,
plaque development.
treatment of atherosclerosis
Most plaques stay asymptomatic in a
Data Extraction
subclinical state, some become obstructive causing
Two reviewers have independently reviewed the
stable angina, but a few become thrombosis-prone
studies, abstracted data, and disagreements were
which are vulnerable and lead to atherothrombotic
resolved by consensus. Studies were evaluated for
events including acute myocardial infarction
quality and a review protocol was followed
(AMI), stroke and ischemia of lower limb[1].
Atherothrombotic cardiovascular disease (CVD)
The study was done after approval of ethical
is currently the leading cause of death and
board Imam Abdulrahman Bin Faisal
morbidity not only in rich countries but world-
wide and, therefore, has a large economic burden

and public health impact.Fortunately, the mortality
of atherothrombotic CVD has fallen dramatically
Hypercholesterolemia is noted as one of the chief
in the past several years, causing prolonged
triggers of atherosclerosis. The rise in plasma
survival with chronic disease, which in turn
cholesterol levels causes changes inpermeability
explains the reason why prevalence, burden, and
of arterial endothelial cells that allows the
costs of this disease has become high[2].
migration of lipids, particularly LDL-C particles,

inside the arterial wall. Circulating monocytes

stick to the endothelial cells that express adhesion
Received: 02/10/2017 DOI: 10.12816/0042966
Accepted: 12/10/2017

Full Paper (vol.701 paper# 14)

c:\work\Jor\vol701_15 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 88-91
Risk Factors of Chronic Renal Failure in Adult Patients at King Khalid
Hospital, Najran City, Saudi Arabia
Mohammed Dhafer Yahya Alzamanan, Abdullah Salem Mohammed Al Rayshan,
Abdullah Saleh Alyami
Najran University, Najran, Saudi Arabia

Background: chronic kidney disease (CKD) is defined as a reduced glomerular filtration rate, increased
urinary albumin excretion, or both and it is an increasing public health issue with prevalence estimated to be
8­16% worldwide. Objective: the risk factors for CKD are increasing in the Saudi population. Hence, this
descriptive study aimed to assess the files of the adult patients with chronic renal failure (CRF) at King
Khalid Hospital, Najran City, Saudi Arabia. It also identified the relationship of these common risk factors
such as hypertension, diabetes mellitus, polycystic kidney disease, certain infections, effects of nonsteroidal
anti-inflammatory drugs (NSAIDs) with CRF. Methods: a structured-type interview was conducted with
checklist with 50 samples from the patient's record using the non-probability sampling technique. Frequency
and percentage distributions were used to describe the incidence and the common risk factors associated with
CKD. Results: this study revealed that the most affected group of people with renal failure was from 41 to 50
years age group, which represented about 30% of all samples taken from King Khalid Hospital. Hypertensive
patients occurred to be highest in 90% of patients with CRF, while the patients with polycystic kidney disease
had low risk of renal failure with 20%. Diabetes mellitus was reported in about 70% of patients. Lifestyle,
diet and genetic factors are important factors in developing this disease and they are greatly associated with
chronic renal failure.
Keywords: risk factors; chronic kidney disease; renal failure; hypertension; diabetes mellitus; nonsteroidal
anti-inflammatory drugs.


Chronic kidney disease (CKD) is defined
diabetic nephropathy is higher in some Asian
as a reduced glomerular filtration rate, increased
groups than in whites. The age is of relevance;
urinary albumin excretion, or both, and it is an
CKD due to atherosclerotic renal vascular disease
increasing public health issue with prevalence
is much more common in the elderly than in the
estimated to be 8­16% worldwide (1). Chronic
young. Over 70% of all cases with CKD are due to
kidney disease refers to an irreversible
diabetes mellitus, hypertension and atherosclerosis
deterioration in renal function, which classically
(3). Locally, the risk factors for chronic kidney
develops over a period of years. Initially, it is
disease (CKD) are increasing in the Saudi
manifested only as a biochemical abnormality.
population. Consequently, the incidence and
Eventually, loss of the excretory, metabolic and
prevalence of ESRD have increased substantially
endocrine functions of the kidney leads to the
in Saudi Arabia over the past three decades. Many
clinical symptoms and signs of renal failure, which
reports have shown evidence of increasing
are referred to as uremia. When death is likely
prevalence of the most common causes of ESRD
without renal replacement therapy, it is called end-
in Saudi Arabia such as diabetes, and obesity-
stage renal disease/failure (ESRD or ESRF) (2).
conditions associated with many chronic diseases.
Wide geographical variations in the
Furthermore, the incidence and prevalence of renal
incidence of disorders causing CKD exist. The
replacement therapy (RRT) have been increasing
most common cause of glomerulonephritis in sub-
substantially in the last three decades. The
Saharan Africa is malaria. Schistosomiasis is a
majority of patients with ESRD are getting their
common cause of renal failure due to urinary tract
RRT in the form of haemodialysis (around 53.7%),
obstruction in parts of the Middle East, including
with 5.1% on peritoneal dialysis and with 41.2%
southern Iraq. The incidence of ESRF varies
renal graft. Around 70% of RRT is provided by
between racial groups. End-stage renal failure is
Ministry of Health free of charge (4). In Saudi
three to four times as common in black Africans in
Arabia, CKD is more prevalent in the highly
the UK and USA as it is in whites and
productive age group. The highest number of
hypertensive nephropathy is a much more frequent
people receiving dialysis treatment is found in the
cause of end-stage renal failure in this group. The
age group of 31 to 45 years. However, the
prevalence of diabetes mellitus and hence of
prevalence and incidence of the earlier stages of
Received: 02/10/2017 DOI: 10.12816/0042967
Accepted: 12/10/2017

Full Paper (vol.701 paper# 15)

c:\work\Jor\vol701_16 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 92-96

Effect of HCV Infection Versus HBV Infection on the Response to Erythropoietin
Therapy in The Treatment of Anemia in Prevalent Haemodialysis Patients
Mai Nabil Elnaggar, Waleed Ahmed Bichari, Hoyaida Elshinnawy
Nephrology Unit, Internal Medicine Department, Faculty of Medicine, Ain Shams University
Corresponding Author: Mai N Elnaggar, E-mail: mai_nabil84@yahoo.com
Background: Patients with end stage renal disease (ESRD) on dialytic support are usually anemic due to lack of
Erythropoietin (EPO) secretion from the kidney. There was a highly significant association of hemoglobin and
hematocrit with HCV infection. Patients with HCV infection were associated with higher hemoglobin and
hematocrit compared with non-infected patients. Aim of this work: was to study the effect of HBV versus HCV
infection on the response to erythropoietin therapy in the treatment of anemia in prevalent hemodialysis.
Subjects and methods: this study was conducted at Damanhour Fever Hospital hemodialysis unit including 60
patients under regular hemodialysis three sessions a weak and this phase extended from October 2015 till april
2016. Results indicated that hemodialysis patients with HCV and hemodialysis patients with HBV infection had
higher mean hemoglobin, than negative group but with no significant statistical difference. Conclusion: It could
be concluded that hemodialysis patients with HCV tend to have higher baseline hemoglobin (with no significant
statistical difference) and decreased need for EPO therapy while patients with HBV infection tend to have higher
baseline hemoglobin (with no significant statistical difference) and increased need for EPO therapy.
Keyword: Anemia, Erythropoitin , HCV ,HBV , Dialysis.


on chronic hemodialysis. The EPO resistance index
Anemia is a common clinical problem in
(ERI) has been considered useful to assess the EPO
patients with chronic kidney disease and is associated
resistance and can be easily calculated in the clinic
with increased morbidity and mortality. Anemia
(5). Virus infections namely hepatitis B (HBV) and C
affects 60% to 80% of patients with chronic kidney
(HCV) (4).
disease (CKD) and reduces their quality of life.
Some studies and case reports indicated
Treatment options are blood transfusion, epoietin alfa
attenuated anemia in HD patients with HCV
and darbepoetin alfa(1).
infection, and they previously considered this to be
Anemia of CKD is, in most patients,
related to increased erythropoietin production after
normocytic and normochromic and primarily caused
hepatic stimulation by chronic infection with
by depressed production of erythropoietin (EPO),
hepatitis virus (6).
oxidative stress and inflammation, erythropoiesis
Anti-HCV(+) HD patients had higher serum
inhibition and reduction in red blood cell survival(2).
EPO levels and required less EPO and iron
The other cause of anemia is deficiency of
replacement as compared to anti-HCV(-) patients.
iron. The dialysis patient is in a state of continuous
Because of the changes in iron metabolism, iron
iron loss from gastrointestinal bleeding, blood
treatment should be carefully administered in HD
drawing, and/or, most important with hemodialysis
patients with HCV (7).
(HD), the dialysis treatment itself (3).
The influence of hepatitis B (HBV) and
HD patients lose an average of 2 g of iron per
hepatitis C virus (HCV) infection on blood
year. Thus, iron deficiency will develop in virtually
hemoglobin (Hb) and serum erythropoietin (Epo) and
all dialysis patients receiving EPO unless
interleukin-6 (IL-6) concentrations was studied in
supplemental iron therapy is given orally or
some anemic patients on regular hemodialysis.
intravenously (3).
Serum immunoreactive Epo levels were significantly
It was shown, that the use of recombinant
higher in patients whose Hb values improved after
human erythropoietin (rHuEPO) in haemodialysed
infection than in patients with persisting anemia after
patients with chronic renal failure (CRF) stimulates
infection. Hb levels were maximal at the time of
erythropoesis (4).
serum alanine aminotransferase normalization. Red
The response to erythropoietin (EPO)
cell production increases as a result of elevated
treatment varies considerably in individual patients
Received: 02/10/2017 DOI: 10.12816/0042968
Accepted: 12/10/2017

Full Paper (vol.701 paper# 16)

c:\work\Jor\vol701_17 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 97-101

Medical Student's Knowledge of Ionizing Radiation and
Radiation Protection in Riyadh, Saudi Arabia
Tarik Anwar Rahmatullah*, Khalid Anwar Abo Alela, Khalid Saeed Alanazi
Almaarefa Colleges, Riyadh, Saudi Arabia
*Corresponding author: Tarik Anwar Rahmatullah, Email: Tarik_jhan@hotmail.com, Mobile number: +966534720065
This study aimed to assess the knowledge of medical students in ionizing radiation and to study the
effect of a 3-hour lecture in correcting their misconceptions.
Methods: a cohort study was conducted on medical students at Almaarefa Colleges, Riyadh, Kingdom of Saudi
Arabia during the academic year 2015-2016. A 7-question multiple choice test type questionnaires administered
before and after a 3-hour lecture was used to assess their knowledge. The data were collected from December
2015 to February 2016. The lecture was given to 333 (72%) participants, out of the total of 459 medical
students. It covered topics in ionizing radiation and radiation protection. The questionnaire was validated and
analyzed by 3 content experts. Results: of the 333 who attended the lecture, only 253 (76%) students
completed the pre- and post questionnaire and they were included in this study. The average student score
improved from 47-78% representing a gain of 31% in knowledge (p =0.01).
Conclusion: the results indicated that the medical student's knowledge regarding ionizing radiation and
radiation protection is inadequate. Additional lectures in radiation protection significantly improved their
knowledge of the topic and correct their current misunderstanding. This study had shown that even with one
dedicated lecture, students can learn and learn general principles regarding ionizing radiation.
Keywords: ionizing, non-ionizing ,radiation, students, lecture


Radiological investigations have been widely used
in patient management and these investigations
knowledge should already be developed at the
involved exposing the patients to either ionizing, or
undergraduate level [3-5]. Since 1989 and up to date,
non-ionizing radiation. The number of investigations
several studies were questioning medical student's
involving ionizing radiation has dramatically
knowledge related to ionizing radiation and more
increased in the past decade. It was estimated that CT
research has been conducted on the topic. Some of
examinations have increased in the USA by a factor
them found that student's knowledge of radiation
of 10 from 1980-2005[1]. In the USA, CT
safety is insufficient and hundreds of unnecessary
examinations account for 13% of all diagnostic
examinations are performed every year due to this
exposure, but it was estimated to be responsible for
lack of knowledge. They have emphasized that
more than 70% of the collective radiation dose
radiation protection should be mandatory and part of
delivered to patients [2]. Advancement in technology
the medical school curriculum [3-10].All these
has led to complex interventional radiological
disappointing results urged O'Sullivan et al. [11] to
procedures and nuclear medicine investigations.
investigate the effect of a curriculum in clinical
With these advancements, concerns regarding
radiology that included radiation protection. They
radiation dose to patients arise. Although most of
assessed the awareness of all medical students (from
these exposures were justified, not all of them were
years 1-5) of radiation exposure and studied the
clinically useful. Today, patients are more aware that
effect of clinical radiology curriculum on their
radiation can be harmful. During medical exposure
knowledge. They used a questionnaire that assessed
from examinations involving radiation, doctors are
radiation knowledge and radiology teaching. First
the main source of information. They have to be
year medical student on their first week of classes
prepared and aware of the risks, benefits and dose in
was used as a control group. Improvement in
order to provide an accurate explanation to their
knowledge was found year after year in comparison
patients. Doctor's justification of diagnostic imaging
with the control group. They concluded that those
requests depends on their experience and knowledge
who received radiology teaching (87%) performed
of radiation doses of these investigations. This has
better than those who did not. But, still only 60% of
been of concern among faculty members in charge of
the population knew that CT used ionizing radiation
Received: 02/10/2017 DOI: 10.12816/0042969
Accepted: 12/10/2017

Full Paper (vol.701 paper# 17)

c:\work\Jor\vol701_18 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 102-108
An Overview of the Most Common Enzyme Defect,
Glucose-6-Phosphate-Dehydrogenase Deficiency
Ibrahim Hussain Muzaffar1, Khaled Rashad Boundaqji2, Hazim Abdulkarim Khatib3,
Ruqayah Taqi Almozayin2, Mahmoud Shehab Halawani4, Abdulmalik Ghassan Ibrahim
Abumohssin3, Bayan Khalid Sabb Gul1, Mohibullah Noorunnabi khan2, Ayman Ali ALhboob5,
Faris Abdullah Alharbi6, Mona Eada Khalfe Mohmmad7
1- Umm Alqura University, 2- Ibn Sina National College, 3- King Abdulaziz University, 4- Batterjee Medical
College for Sciences and Technology, 5- Taiz University, 6- University of Gezira, 7- Al Furat University
Corresponding Author: Ibrahim hussain muzaffar - Dr.ibrahim.muzaffar@outlook.sa - 0547771242

Glucose-6-Phosphate-Dehydrogenase (G6PD) deficiency is the most common enzyme
deficiency globally and is more remarkable in certain parts of the world which had high malaria prevalence in
the past. It is an X-linked genetically inherited disorder, where the first presentation can be neonatal jaundice.
There are over 300 variants of this disorder based upon the genetics. Although the morbidity and mortality is
not very high, the deficiency can be more appropriately managed by proper preventive methods which include
screening and avoidance of trigger. Also prompt management of acute hemolysis can save a child from many
Methodology: we conducted this review using a comprehensive search of MEDLINE, PubMed, and
EMBASE from January 1987 to March 2017. The following search terms were used: G6PD deficiency,
prevalence of G6PD, genetics of G6PD deficiency, management and diagnosis of G6PD
Aim of the work: this study aimed to understand about the etiology, pathophysiology and study various lines
Conclusion: proper preventive and treatment methods can avoid negative effects on the child's quality of life
and reduce morbidity and mortality, therefore the child's care takers must be well informed.
Keywords: G6PD deficiency, prevalence of G6PD, genetics of G6PD deficiency, management and
prevention of G6PD, diagnosis of G6PD.


G6PD deficiency is a hereditary genetic
and Plasmodium falciparum malaria is widespread
defect, X-linked, caused by mutations in
gives us circumstantial proof that G6PD
the G6PDgene, creating protein variants with
deficiency offered resistance against malaria [2].
various degrees of enzyme activity, which are
Historically, a pathological disorder was
associated with an extensive range of clinical and
noticed after ingestion of fava beans (Vicia faba),
biochemical phenotypes. G6PD deficiency is the
later it was identified as G6PD deficiency. Several
most common enzyme deficiency worldwide
doctors in southern Italy and Sardinia, during the
affecting 400 million people across the globe and
beginning of the 20th century, described a clinical
one of the most common disorders addressed in
picture of what was called favism at that
the pediatric hematology department, especially in
time. However, since the response to fava bean
some parts of the world [1]. The highest
consumption was noted to be inconsistent,
occurrences are detected in Africa, Middle East,
common theories on the pathogenesis of favism
Asia and the Mediterranean region; owing to
were associated with allergy or toxic effects. Later
current migrations, nevertheless, the disorder is
in 1956, it was found that patients developing
also found in areas like North and South America
hemolytic anemia triggered by the antimalarial
and northern European countries. The most
drug primaquine showed a very low amount of
common clinical presentations are neonatal
G6PD activity in their red blood cells. A similar
jaundice and acute hemolytic anemia, which often,
trend was noted in Sardinia in patients with severe
is triggered by an exogenous agent in most
hemolytic anemia associated after consumption of
patients. The remarkable similarity between the
fava beans, or sometimes even inhalation of the
regions where G6PD deficiency is prevalent
plant's pollen. A low activity of G6PD enzyme in
Received: 02/10/2017 DOI: 10.12816/0042970
Accepted: 12/10/2017

Full Paper (vol.701 paper# 18)

c:\work\Jor\vol701_19 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70, Page 109-113

Correlation between Central Corneal Thickness and Degree of Myopia
Mostafa A, Mohamed M, Mohamed M.
Al Hussein University Hospital and Nour Al Hyaa Eye Hospital, Cairo.
Corresponding author: Momen Mohamed, email: momen5816@gmail.com

Aim of the work: this study aimed to determine the relationship between central corneal thickness (CCT) and
Methods: one hundred and eight (108) Egyptian subjects were included in this study. They were not
presenting with any eye disease and had never undergone eye surgery. The total number of subjects meeting
the inclusion criteria was 108 (216 eyes) 87 were myopes and 21 were emmetrope. They were categorized into
two main groups: myopic group (Group I) and the control group (Group II). The CCT was measured with the
Results: the present study comprised 59 males (54.6 %) and 49 females (45.4%). Their age ranged between 19
and 58 years. The mean CCT was 538.2 right eye and 536.3 left eye in group Ia, 522.3 right eye and 523.7 left
eye in group Ib, 542.0 right eye and 550.3 left eye in group Ic, and 529.0 right eye and 526.8 left eye in the
control group (Group II).
this clinical study showed that there was no difference in CCT between emmetropic and myopic
eyes. CCT did not correlate with the degree of myopia.
Keywords: central corneal thickness , myopia pachymetry.


The cornea is a transparent, a vascular tissue
Moreover, CCT is a measure of corneal rigidity
that measures 11­12 mm horizontally and 10­11
and consequently has an impact on the accuracy of
mm vertically. The cornea along with sclera forms
intraocular pressure measurement by applanation
the outermost coat of the eyeball, it is a complex
tonometry. A study had demonstrated that thicker
structure has a protective role; it is responsible for
corneas with greater rigidity may offer a greater
about three quarters of the optical power of the eye
resistance when subjected to applanation, resulting
(1).It contributes 74% or 43.25 diopters (D) of the
in artificially higher intraocular pressure readings
total 58.60 dioptric power of a normal human eye.
(4). In addition, with the development of corneal
Its refractive index is 1.376. The normal cornea is
refractive surgery procedures, CCT values are of
free of blood vessels. For its nutrition, the cornea
enormous importance during the preoperative
depends on glucose diffusing from the aqueous
evaluation of the patients as they influence the
humor and oxygen diffusing through the tear film.
decision whether or not to perform surgery, the
In addition, the peripheral cornea is supplied with
type of recommended procedure and rate of
oxygen from the limbal circulation. The cornea has
postoperative complications (5).Corneal pachymetry
one of the body's highest densities of nerve
is the process of measuring the thickness of the
endings and the sensitivity of the cornea is 100
cornea. It can be done by using contact methods
times that of the conjunctiva. The cornea is
such as ultrasound and confocal microscopy or
composed of six layers; which are epithelium,
non-contact methods such as optical biometry with
Bowman's layer, stroma, Dua's layer, Descemet's
a single Scheimpflug camera (such as the Oculus
membrane and endothelium (2).
Pentacam or Sirius), Dual Scheimpflug (eg,
The normal thickness of the cornea varies from
Galilei), coherence tomography (Visante, ivue, or
central to peripheral limbus and it is ranging from
others), or optical coherence pachymetry (with
0.7 to 0.9 mm at the limbus and from 0.49 mm to
orbscan) (3).
0.6 mm at the centre. Central corneal thickness
Myopia is a common refractive error especially
(CCT) is an important indicator of corneal health
in Asian countries undergoing rapid development.
status. As an estimate of the corneal barrier and
Myopia prevalence could be as high as 95% in
endothelial function, CCT is an essential tool in the
medical school students. Myopic changes of the
assessment and management of corneal disease (3).
eyes included elongated axial length, deeper
Received: 02/10/2017 DOI: 10.12816/0042971
Accepted: 12/10/2017

Full Paper (vol.701 paper# 19)

c:\work\Jor\vol701_20 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 114-117
Lab Diagnosed Anemia among Women in Alyamamah Hospital in
Riyadh, Saudi Arabia
Abdulmajeed Mohammed Alolayah1*, Hamad Zaal Assaf1, Youssef Fayez Horaib1, Leejin Saleh Bin
Kleib1, Ola Haidar Wahbi1, Mhd Salim Khatab1, Fatima Zeyaul Haque Siddiqui2, Eman Ahmed
Sharahili1, Mohamed Ismail Yassin1, Abdulrhman Fahad Almutairy1, Afnan Abdullah Alghamdi1,
Tarik Anwar Rahmatullah1, Bader Abdulaziz Alsehali1, Khalid Anwar Aboalela1, Feras Maeid
Sarhan1, Nada Anwar Aboalela1, Manal Abdullah Alshammari3, Beshayer Mohammed
Alshammari3, Marwah Ahmed Bin Garhom4, Nadia Mohammed Banafa5, Atheer Abdullah
1 Almaarefa Colleges, Riyadh, 2 Alfaisal University, Riyadh, 3 University of Hail, Riyadh,
4 Al Iman General Hospital, Riyadh, 5 Kingdom Hospital, Riyadh
*Corresponding Author: Abdulmajeed Mohammed Alolayah, E-mail: Mcst.555@gmail.com,
Mobile Number: +966566668807

anemia in pregnancy is a common problem. Easy diagnosis and treatment enhance focus on
anemia cases.
Aim and Objectives: to determine the common types and grades of anemia in a hospital lab in Riyadh and
to compare types of anemia among age and pregnancy status.
Method: cross-sectional study. Study area: a hematology-log in lab. Samples: convenience samples of 120
anemic ladies. Tool: questionnaires. Methods of data collection: CBC results.
Results: This study-addressing anemia among women in a lab in Riyadh involves 120 ladies. When they
were distributed as pregnant and non-pregnant women, 70% were pregnant. About 70% of the pregnant
and 39% of non-pregnant had iron deficiency anemia, this difference statistically significance (P= 0.0013).
Normocytic normochromic anemia was falling in 26% and 50% of the pregnant and non-pregnant ladies
respectively; this difference was statistically significant (P= 0.0112). About 94.5% of iron deficiency
anemias have low MCH. PCV was low in all cases of anemia.
Conclusion: Anemia in women of child bearing age are more commonly observed in study. Most common
type of anemia among cases was iron deficiency anemia. Iron deficiency anemia was the most common in
pregnant, while normochromic normocytic anemia was the most common in non-pregnant. MCV & MCH
were significant characteristics finding in iron deficiency anemia.
Keywords: Anemia, Iron, Women, Pregnant, Non-pregnant.

microcytic, hypochromic anemias suggest
CBC: Complete Blood Count; MCH: Mean

Corpuscular Hemoglobin; PCV: Packed Cell
disorders of hemoglobin synthesis (most often iron
Volume; MCV: Mean Corpuscular Volume; SCA:
deficiency), while macrocytic anemias suggest
Sickle Cell Anemia; MCHC: Mean Corpuscular
abnormalities in bone marrow erythroid precursor
Hemoglobin Concentration; IDA: Iron Deficiency
maturation; normochromic, normocytic anemias
have diverse etiologies (1).

Iron deficiency is the most common cause of
anemia in every country of the world. It is the
Anemia is a reduction in the total circulating
most common cause of a microcytic hypochromic
red blood cells (RBCs) mass below normal limits;
anemia, in which all three red cells indices (the
the consequences are reduced oxygen carrying
MCV, MCH, and MCHC - mean corpuscular
capacity and tissue hypoxia. Patients are pale,
weak, and easily fatigued. Anemia is formally
concentration, respectively) are reduced and the
diagnosed based on a reduction in hematocrit
blood film shows small (microcytic) and pale
(hypochromic) red cells. This appearance is caused
classification of anemias is usually based on the
by a defect in hemoglobin synthesis (2).
underlying mechanism; the specific of RBC

morphology (size, shape, and hemoglobinization)
The research aims to determine the common
can often provide etiologic clues. Those,
types and grades of anemia in a hospital lab in

Accepted: 16/10/2017

Full Paper (vol.701 paper# 20)

c:\work\Jor\vol701_21 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 118-123

Assessment of the Knowledge of Gastroesophageal Reflux Disease
among The Saudi Population of Altaif City
Neama M. Taha1, Mohammed Badr Sahaki2, Omar Moussa Darwish Maimsh3,
Abdullah Saad Safar Alghamdi3, Anas Hassan Saeed Alzahrani3, Marwan Mahmoud Mohammed
Aljohani3, Mohammed Mahmoud Mohammed Aljohani3, Abdullah Mady Sultan Alsubeay3,
Abdulghaffar Talal Halawani3.
1-Physiology Department, College of Medicine, 3Umm Al-Qura University, KSA 2- Batterjee Medical
College for Sciences and Technology, 3- King Abdulaziz University
Corresponding Author: Mohammed Badr Sahaki- Moe.badr87@gmail.com- 0560781958

gastroesophageal reflux disease (GERD) ranks as one of the most common gastrointestinal
disorders. Up to this date, no studies examined the level of health knowledge of Saudi population about GERD.
Aim of the study:
this study aimed to assess knowledge about GERD signs, symptoms and risk factors in Saudi
residents of Altaif City.
Methods: this minimal knowledge questionnaire that was distributed among the general public in Altaif City,
Saudi Arabia. The questionnaire consisted of two sections: section 1 included personal data and section 2
explored the awareness and knowledge about the most common symptoms and risk factors of GERD. Only
questionnaires without missing data were subjected to statistical analysis.
Results: respondents who answered all the questions correctly represented 7.4%, while those who answered all
wrongly were 1.5%. The mean proportion of minimal medical knowledge (MMK) score was 64.66%.
Respondents with higher education (p < 0.001), medical background (p = 0.004) and health knowledge derived
from books (p = 0.001) achieved the highest total scores. Sex, residence, marital status, and past/family history
of GERD seemed not to affect the mean MMK scores (p = 0.277, 0.234, 0.970, 0.873 and 0.085 respectively).
Conclusion: some symptoms (Globus sensation, dysphagia and odynophagia) and risk factors (Scleroderma
and asthma) for GERD remained unknown to nearly half the participants. We recommend providing health
information concerning GERD on the Internet or to prepare booklets to be distributed through the health care
Keywords: gastroesophageal reflux, symptoms, risk factors, knowledge questionnaire.


Esophageal diseases may present with impaired
serious complications, such as gastrointestinal
function or pain. The major esophageal symptoms
bleeding or Barrett's esophagus (4,3).
Genetic, lifestyle (including nutrition, alcohol
pain, dysphagia, odynophagia and globus sensation.
consumption, smoking, intake of NSAIDs, sleeping
The clinical history is the key for evaluation of
position) and dietary factors have been suggested to
esophageal symptoms. Important details included
play important roles in the development of GRED,
weight gain or loss, gastrointestinal bleeding, dietary
however the exact etiology is still unknown (5,6,7).
habits, smoking and alcohol consumption (1).
The clinical history is of great importance for
Gastroesophageal reflux disease (GERD) is one
the evaluation of esophageal symptoms and
of the most common chronic digestive disorders. It
eventually the management of the condition. It is
results from lower esophageal sphincter dysfunction
essential for patients with GERD to early recognize
and/or large hiatal hernia. The prevalence of GERD
the symptoms of the disease and seek medical
was reported to be as high as 20% in Western world
assistance. Hence, the purpose of this study was to
with much lower rate in Asia (2,3).
document knowledge about GERD signs, symptoms
Classical symptoms of GERD included
and risk factors in Saudi residents of Altaif City.
heartburn and regurgitation, which were the main

drive for patients to seek medical attention and the
target for diagnostic evaluation and treatment. The
Ethical considerations
current body of evidence showed that GERD may
This study design was approved by the institutional
significantly reduce the quality of life and lead to
review board of the Faculty of Medicine, Altaif
Received: 06/10/2017 DOI: 10.12816/0042973
Accepted: 16/10/2017

Full Paper (vol.701 paper# 21)

c:\work\Jor\vol701_22 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 124-126

Polycythemia Vera (PV) Complicated by Late Diagnosis of
Multiple Splenic Infarcts: A Case Report
Musab A Alsubaie1, Samer A Alamri1, Saleh H Alkhalid1
1College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi

Polycythemia vera (PV) is a chronic myeloproliferative tumor where bone marrow makes more red blood cells
and other bone marrow cells. Many patients initially are asymptomatic, however, other patients may develop
symptoms and complications of this disease later on. One of the PV complications is developing thrombosis in
different sites, one of these sites is splenic vessels causing splenic infarction. Here we are describing a JAK2
positive PV case who presented with vague abdominal pain and diagnosed by CT to have splenic infarction, and
was treated medically without going to surgical options. In conclusion, splenic infarction is a rare and unique
complication of PV. Early diagnosis is paramount to prevent complications and a team approach is highly
recommended for the best outcomes.
Key words: Polycythemia vera, Splenic infarction, Thrombosis


Polycythemia vera (PV) is a slow growing
was intolerant to hydroxyurea and was switched to
myeloproliferative tumor where bone marrow makes
Ruxolitinib 10 months prior to the presentation.
more red blood cells and other bone marrow cells,
On examination, she was afebrile and vitally
which in turn cause thickening of the blood and
stable. The abdomen was soft and lax with severe
thrombosis 1,2. Many patients initially are
epigastric tenderness. Her investigations revealed
asymptomatic, however, other patients may develop
hemoglobin of 7.3 gm/dl and hematocrit of 24.4%
symptoms of itching, headache, dizziness, minor
with low red blood cell count (3.7 x1012), other lab
bleeding or bruising, blurred vision, or shortness of
tests were within normal levels. Previous abdominal
breath 1. Complications of this disease arise from
ultrasound (US) done upon recent ER admission,
thickening of the blood and thrombosis, which is the
one month prior to the current visit, showed an
presenting symptom in 20% of the cases 3. Sites of
enlarged and heterogeneous spleen measuring 13.3
thrombosis found to involve both, arteries and veins
cm with patent splenic vein and artery.
4. One of these sites is the spleen where a single
The patient was given analgesia and pain improved.
focus of infarction or multiple foci can be
After that, she had intravenous contrast enhanced CT
developed. Here, we present a case of a patient with
of the abdomen and pelvis with arterial and venous
PV who had vague abdominal pain for about one
phases. CT demonstrated an increase in the caliber
month and found lately to have multiple splenic
of splenic and portal veins and its branches with no
enhancement representing acute thrombosis. Also,
The study was done after approval of ethical
there was superior mesenteric and left ovarian veins
board of King Saud bin Abdulaziz university.
thrombosis. In the spleen, there was multiple

peripheral wedge shaped subcapsular hypodensities
Case report
representing multiple splenic infarcts (Figure1).
A 75-year-old female, who is known to have DM
The patient was admitted as a case of multiple
and HTN presented to the emergency room (ER)
splenic infarctions and was started on heparin
with recurrent epigastric abdominal pain for one
infusion. Esophagogastrodudenoscopy (EGD) was
month that had increased in severity in the last few
done to rule out GI bleeding. It showed the
days prior to the presentation. The pain was
esophagus with large esophageal varices and
generalized all over the abdomen but increased in
esophagitis. The patient continued on heparin
central abdomen and was associated with melena for
infusion with therapeutic PTT, and planned to
one month. The patient is a known case of PV JAK2
continue for conservative management. Then, she
positive on Ruxolitinib 10 mg oral twice daily. She
was switched into enoxaparin in addition to warfarin

4 mg once daily and reached a therapeutic range of
Received: 02/10/2017 DOI: 10.12816/0042974
Accepted: 12/10/2017

Full Paper (vol.701 paper# 22)

c:\work\Jor\vol701_23 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 127-131

12 Months' Outcomes of Corneal Collagen Cross-Linking for
Keratoconus Patients in Saudi Arabia
Humoud Alkhalaf, Abdulrahman Alkhalaf
Royal College of Surgeons in Ireland, King Saud University
Corresponding author: Homoud Alkhalaf, E-mail: homoud92@gmail.com

keratoconus is a degenerative disorder of the eye in which structural changes within the cornea
becomes thin and accompanied by changes in its shape. Corneal collagen cross linking is one of the options to
treat keratoconic eye by using riboflavin drops and UV light.
Purpose: was to assess the safety and efficacy of corneal collagen cross-linking and to investigate the
refractive and topographic outcomes before and after the surgery.
Methods: this is a retrospective randomized study enrolling 77 patients with keratoconic eyes, we gathered the
data of refractive (Sphere and cylinder), keratometry (K1, K2), pachymetry readings before and up to 12
months after corneal collagen cross-linking procedure in Binrushd Ophthalmologic Clinic Centre.
Results: in this study, male to female ratio was 2.6:1. Age of patients ranged between 15-41 years old. Mean
outcomes at 1 year postoperatively were K2 (-0.89) Dipolar, K1 was -0.53) Dipolar. The thinnest area of the
cornea (Pachymetry) improved by a mean of 23 microns. In addition to that, the results showed a clinically
significant improvement in K-reading, pachymetry and refractive error in both males and females patients
regarding to the p value which reached 0.23.
Conclusion: corneal collagen cross-linking is a safe modality to treat keratoconic eye in delaying or
preventing the progression of the disease.
Keywords: Cornea, Collagen, Cross-Linking, keratoconic eyes.


Keratoconus is a noninflammatory, bilateral
progressive degeneration of cornea. It characterized
by protruding and thinning of the cornea, abnormal
astigmatism and progressive myopia.
Vision loss occurs because of the corneal apex
being displaced, thus creating irregular astigmatism
The most promising technology for treating
Keratoconus called collagen cross linking with
UVA [2].
The interest is rapidly growing in corneal
collagen cross-linking since the publication of the
first report by Spoerl et al. in 2003[3] which was
followed in 2004[4] with another article explaining
the ncreased resistance of cross-linked cornea
against enzymatic digestion .
The use of corneal collagen cross-linking helps
to strength the cornea by using riboflavin (Vitamin
B2) and a longer wavelength ultraviolet violet
In addition to that, corneal collagen cross-

Fig.1: shows cornea layers before cross-linking.
linking can delay or prevent corneal transplantation
Fig. 2: indicates increased cross-linking after
in patients with these conditions is of a great benefit.
treatment [5].
Received: 09/10/2017 DOI: 10.12816/0042975
Accepted: 19/10/2017

Full Paper (vol.701 paper# 23)

Introduction The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 132-139

Serum Galectin-3 Levels in Patients with Hepatocellular Carcinoma,
Liver Cirrhosis and Chronic Viral Hepatitis
Mohammed K. Zahra1, Taher E. Attia 2, Amira Y. Ahmad 1, Mai A. Othman 1
1- Department of Clinical Pathology,2- Department of Tropical Medicine and Infectious Diseases,
Faculty of Medicine, Tanta University
Corresponding author: Mai A. Othman, email: mai.abdelmabood@gmail.com
hepatocellular carcinoma (HCC) represents a global health problem. It is the fifth most
common solid tumor and the third cause of cancer-related mortality per year. In Egypt, it represents 75% of
malignant liver tumors. Early detection and diagnosis of these cases are required for successful treatments and
improved outcomes. Aim of the Work: this study aimed to detect serum galactin-3 levels in patients with
HCC, liver cirrhosis and chronic viral hepatitis (HBV, or HCV) patients. Patients and Methods: this
prospective study was conducted on a total of 60 patients, 20 of them with chronic viral hepatitis B or C, 20
with cirrhosis secondary to chronic viral hepatitis and 20 with HCC secondary to chronic viral hepatitis. It was
carried out at the Clinical Pathology Department, Tanta University Hospital. Results: the mean galectin3
levels were 15.5 ng/mL (±5.5) in HCC patients, 20.46 ng/mL (±7.56) in cirrhotic patients and 7.003 ng/mL
(±4.24) in chronic viral hepatitis group. There were statistical differences between HCC and cirrhotic patients
(P < 0.03), but they were lower in chronic hepatitis group statistically compared to cirrhosis and HCC (P <
0.001). Conclusion: serum galectin3 levels in patients with chronic HBV or HCV may guide us about
progression to cirrhosis or HCC and prognosis of the disease. In these patients, if galectin3 levels were found
to be high, serum alphafeto protein level and ultrasonographic examination could be repeated at more
frequent intervals. This may also guide us in terms of the treatment plan. Recommendations: it was
recommended to measure changes of galectin-3 in hepatitis carries. Measurement of galectin-3 in a large scale
of patients to explore its prognostic value.
Keywords: Galectin-3, HCC, Liver cirrhosis, Chronic viral hepatitis.


Hepatocellular carcinoma (HCC) represents
advanced stage and their prognosis remained very
a global health problem. It is the fifth most
dismal (9). Thus, early detection and diagnosis of
common solid tumor and the third cause of cancer-
hepatocellular carcinomas still present the best
related mortality per year (1).
chance for successful treatments and improved
In Egypt, HCC represents 75% of malignant
outcomes (10). Galectins are members of a newly
liver tumors. Liver cancer is the 5th most common
defined and growing family of the animal lectins.
cancer in both genders, the 6th in female it
Galectin3 is the most extensively studied.
represented 3.4% of cancers and 2nd in order in
Oncogenic and viral stimulation can change
males after cancer urinary bladder representing
galectin3 expression and galectin3 increases in
11.5% of all cancers. In 2010, liver cancer came in
several human tumors (11). Normal hepatocytes do
the 3rd order in both sexes (8.1%), 1st in males
not express galectin3, but this protein can be
(12.1%) and 5th in females (4%) (2).
present in HCC. A study revealed that galectin3
The etiology of HCC included major risk
expression in HCC was independent of whether
factors such as infection with hepatitis B or C virus
(HBV, HCV), alcohol abuse or dietary exposure to
the patient had prior HBV infection. It was found
aflatoxin (3). Regardless of the carcinogenic insult
that focal regenerating nodules of cirrhotic tissue
HCC usually develops in patients with cirrhosis
also express galectin3. A study showed that
due to chronic inflammation and advanced fibrosis
galectin3 expression was involved in the tumor
(4). Nonalcoholic steatohepatitis (NASH), a
progression and related to the tumor prognosis of
metabolic disorder resulting from insulin fibrosis
HCC (12).This study discussed the possible role of
and cirrhosis, is emerging as another important
galectin-3 in HCC. It highlighted the involvement
risk factor for HCC (5,6).
of galectin-3 in other pathological settings of the
During the past decade the management of
liver, where chronic viral hepatitis B or C and/or
HCC had significantly improved (7). However, only
cirrhosis take place.
about 10% to 20% of patients were currently
eligible for potentially curative therapies at the
This study aimed to detect serum galactin- 3
time of diagnosis (8), most of the patients with
levels in patients with HCC, liver cirrhosis and
hepatocellular carcinomas were diagnosed at an
chronic viral hepatitis (HBV, or HCV) patients.
Received:2/9/2017 DOI: 10.12816/0042976

Full Paper (vol.701 paper# 24)

Role of advanced MRI techniques The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 140-150

Role of Advanced MRI Techniques in Evaluating The
Response of Breast Cancer to Neoadjuvant Chemotherapy
Nancy A Mohamed, Lobna A Habeeb, Nivine A Chalabi
Department of Radio-diagnosis
Faculty of Medicine ­ Ain Shams University
Corresponding author: Nancy A Mohamed, Mobile: 01066588625; Email: drnancyahmed2014@gmail.com

Neoadjuvant chemotherapy (NAC) is the favored treatment of choice among locally
advanced breast cancer patients because it significantly increases the possibility of breast-conserving
surgery. However, for non-responders, an early prediction of response to NAC is essential. Magnetic
resonance imaging (MRI) of the breast is an adjunct diagnostic procedure to mammography and
ultrasound. Because of its high sensitivity and effectiveness in dense breast tissue, MRI can be a valuable
addition to the diagnostic work-up of a patient with breast abnormality or biopsy-proven cancer. Aim of
the Work:
To highlight the role of advanced MRI techniques in the prediction and follow up of the
response of breast cancer to neoadjuvant chemotherapy. Conclusion: Early change in tumor size measured
on MR images is a good predictor of final response after Neoadjuvant chemotherapy (NAC). However,
even if the cells respond to treatment, it takes some time for the tumor to shrink. Substantial research effort
has been spent on investigating whether other information provided by MR imaging may serve as earlier
response indicators than change in tumor size. Techniques that seem to be closest to clinical application,
due to their feasibility and the promising results, are the pharmacokinetic analysis of DCE-MRI (Dynamic
Contrast Enhanced- MRI), DW-MRI (Diffusion Weighted- MRI) and Spectroscopy.
Keywords: MRI, breast cancer, neoadjuvant chemotherapy.


Neoadjuvant chemotherapy (NAC) is the
favored treatment of choice among locally
multicenter trial with DCE MR imaging reported
advanced breast cancer patients because it
that tumor volume measurements were superior to
significantly increases the possibility of breast-
conserving surgery. However, for non-responders,
measurement in the prediction of pathologic
an early prediction of response to NAC is essential
complete response pCR after NAC (6). Another
(1). Magnetic resonance imaging (MRI) of the
study had previously reported that the initial MR
breast is an adjunct diagnostic procedure to
imaging tumor volume and its change after NAC
mammography and ultrasound. Because of its high
were predictive of recurrence-free survival in
sensitivity and effectiveness in dense breast tissue,
breast cancer patients (7). Prediction of response to
MRI can be a valuable addition to the diagnostic
neoadjuvant chemotherapy with DW MR imaging
work-up of a patient with breast abnormality or
might help physicians individualize treatments and
biopsy-proven cancer (2). Compared with clinical
avoid ineffective chemotherapy (8).
examination, ultrasonography and mammography,
Magnetic resonance imaging is the first
dynamic contrast enhanced magnetic resonance
breast imaging modality that not only allows
imaging (DCE-MRI) is considered the most
detailed visualization of the anatomy but also
accurate method for evaluating the extent of
advanced sequences (e.g., diffusion-weighted
residual breast tumor after NAC (3).
imaging or spectroscopy) are used, provides
DW MR imaging without contrast
functional information (9). There are innovative
medium may provide diagnostic ability equivalent
techniques that go one step beyond morphology
to that of contrast-enhanced MR imaging in
and are able to provide a better insight into tumor
detection of residual breast cancer after
biology. These techniques are increasingly
neoadjuvant chemotherapy (4). The advantage of
investigated in clinical trials, but are not yet
DW imaging to help visualize residual breast
widely used in clinical routine for breast MRI.
cancer without the need for contrast medium could
Techniques that seem to be closest to clinical
be advantageous in women with impaired renal
application, due to their feasibility and the
function (5).Dynamic contrast agent­enhanced
promising results, are the pharmacokinetic analysis
(DCE) magnetic resonance (MR) imaging can
of DCE-MRI (Dynamic Contrast Enhanced- MRI),
depict the distribution of a contrast agent within a
DW-MRI (Diffusion Weighted- MRI) and
tumor over time and noninvasively assess the
Spectroscopy (10).
Received: 06/10/2017 DOI: 10.12816/0042977
Accepted: 16/10/2017

Full Paper (vol.701 paper# 25)

c:\work\Jor\vol701_26 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 151-154
Cataracts Pathophysiology and Managements
Abdulrahman Zaid Alshamrani
King Abdulaziz University
Corresponding author: Abdulrahman Zaid Alshamrani - Lion_man_90@hotmail.com - 0500846834

Cataract is defined as the loss of lens transparency because of opacification of the lens. Age-
related cataract is the most prevalent type in adults, with the onset between age 45 to 50 years, while in
children hereditary and metabolic causes are most common.
Aim of the work: In this study, our aim was to discuss the epidemiology, pathophysiology, classification, risk
factors, symptoms, and management of cataracts.
Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed and EMBASE
from January 1981 to March 2017. The following search terms were used: cataracts, causes of cataract,
pathophysiology of cataract, management of cataract.
Conclusion: Cataract is one of the most common causes of blindness worldwide, and more prevalent in
developing countries. It is also the most curable cause of blindness which involves a simple surgical procedure.
Keywords: cataracts, causes of cataract, pathophysiology of cataract, management of cataract.


Cataract is defined as the loss of lens
This study was done after approval of
transparency because of opacification of the lens.
ethical board of King Abdulaziz University.
Based on the causes, cataracts can be classified into

age-related cataracts, pediatric cataracts, and
cataracts due to other causes. Age-related cataract is
WHO assessed that around 95 million people
the most prevalent type in adults, with the onset
are visually impaired because of cataracts in 2014.
between age 45 to 50 years, while in children
Numerous large-scale population-based studies have
hereditary and metabolic causes are most common.
described that the prevalence of cataract rises with
Cataracts occurs more frequently in low to medium
age, from 3·9% at age 55 to 64 years to around
92·6% at age over 80 years. Moreover, the presence
therefore more common in developing countries[1].
of cataracts is related with increased mortality, and
The assessment and management of cataract is
this association might be because of the relationship
rather simple where the lens is surgically replaced.
between cataracts and systemic conditions for
In this review, we discuss the epidemiology,
example type 2 diabetes mellitus or smoking[1].
The prevalence of cataracts in the past two
symptoms, and management of cataracts.
decades has been decreasing because rates of

cataract surgery have been increasing due to the
improved techniques. Nevertheless, cataracts
· Data Sources and Search terms
continue to be the leading cause of blindness in
We conducted this review using a comprehensive
search of MEDLINE, PubMed and EMBASE, from
responsible for 50% of blindness, while they are
January 1981 to March 2017. The following search
accountable for only 5% of blindness in developed
terms were used: cataracts, causes of cataract,
countries. It is imperative to device a set of policies
pathophysiology of cataract, management of
to improve the access of effective ophthalmic
facility and screening, and the quality of
· Data Extraction
management delivered in developing countries[2].
Two reviewers have independently reviewed
Cataract surgery continues to be one of the
the studies, abstracted data and disagreements were
most cost-effective treatments and the most
resolved by consensus. Studies were evaluated for
frequently used procedure in many countries. By
quality and a review protocol was followed
2020, over 30 million people yearly worldwide are
predicted to experience cataract surgery. The
Received: 04/10/2017 DOI: 10.12816/0042978
Accepted: 14/10/2017

Full Paper (vol.701 paper# 26)

A Retrospective Analysis of Epidemiology Prognostic Factor and Response The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 155-170

A Retrospective Analysis of Epidemiology Prognostic Factor and Response
of Treatment of Malignant Pleural Mesothelioma
Dalia A El-Khodary, Khaled K Elghoniemy, Wesam R EL Ghamry, Heba R Saleh
Department of Clinical Oncology and Nuclear Medicine
Faculty of Medicine - Ain Shams University
Corresponding author: Heba R. Saleh, Mobile: 01159303022; Email: dr.xivago87@gmail.com

malignant pleural mesothelioma (MPM) represents a common malignant disease. It is an
aggressive tumor arising from the mesothelial cells lining the pleura. There is an extremely poor prognosis and
a vast majority of MPM patients are diagnosed in an advanced stage. Rapid progression of the disease, no
effective therapeutic approach and resistance to chemotherapy and radiotherapy resulted in a median survival
time of less than 12 months. Aim of the Work: this study aimed to analyze the clinic pathological profile, the
various prognostic factors and treatment response of malignant mesothelioma patients in our center in terms of
overall survival and progression free survival. Patients and Methods: this retrospective was conducted on
Malignant Mesothelioma patients who presented to the Department of Clinical Oncology, Ain Shams
University from 1 January, 2011 to 31 December, 2014. Results: the mean age of the included patients were
61.04 years with male predominance 50.6% and female 49.1%. Occupational risk was documented in only
11.1% of included patients; most patients live in the industrial environment (67.9%) and the rest in non
industrial environment (32.1%). All patients had negative family history of cancer. All patients had negative
surgical history, 66.7% of patients had positive history of asbestos exposure. The commonest co morbidity
among the studied patients were HTN as it was accounted for 24.7% of the included patients followed by
diabetes mellitus in 16% of patients on the other hand, only 3.7% of patients had no co morbidity. Dyspnea
was the commonest symptoms (77.8%) among the included patients, followed by cough (33.3%) and chest
pain in 12.3%, the other symptoms with lower presentation included hemoptysis and anemia. P.S 1(28.4%)
was recorded among the included patients and 53.1% patients had P.S 2 while, rest of patients 18.5% had P.S
3. Patients were diagnosed by CT chest and pleural biopsy either US guided or CT guided, chest X ray,
thoracoscopic biopsy, FNAC and open pleural biopsy. The results also showed that the median PFS among the
included patients was 2 months. Median OAS was 6.1 months. Conclusion: best survival data in patients with
MPM were currently reported from groups using multimodality treatment including MCR achieved either by
EPP or extrapleural decortication for patients qualifying as far as tumor stage and functional reserve were
concerned. In general, several treatment combinations have been applied ranging from systemic (neo- or
adjuvant) to localized chemotherapy, neo- or adjuvant radiotherapy and others. Recommendations: The
choice of the surgical procedure should be tailored according to tumor stage, performance status, and
institutional experience. Morbidity and mortality of these treatment approaches have been reduced at
experienced centers indicating that this complex treatment should be performed at dedicated high volume
mesothelioma centers.
Keywords: epidemiology, malignant pleural mesothelioma.


Malignant pleural mesothelioma (MPM) is
A study performed in Clinical Oncology
considered to be a relatively rare tumor. In Great
Department, Ain Shams University showed that
Britain, the incidence in males was 3.4/100 000, in
304 patients were referred to the clinic between
France it was 2.3/100 000 and in the Netherlands it
January 2003 and December 2008, for further
was 3.2/100 000 (1). In Egypt, epidemiological data
management after being diagnosed with MPM.
on MPM incidence was not available since there
One hundred and ninety patients (62.5%) came
was no comprehensive national population-based
from endemic areas (Shoubra El Kheima, Helwan,
cancer registry. However, official statistics, as well
and El Hawamdia) and/or had a history of
as Egyptian National Cancer Institute (NCI) and
occupational asbestos exposure; the majority (101
Hospital based registries, showed that MPM
patients) came from Shoubra El Kheima. One
incidence in Egypt was rising markedly. The NCI
hundred and fifty-six patients (51.3%) had a
hospital-based registry showed an increase in the
history of smoking and the majority (128 patients)
relative frequency of MPM from 0.47% in 2001 to
were men (4).According to Ain Shams Clinical
1.3% in 2003 (2).In Egypt, according to NCI; Cairo
Oncology Department in 2015 malignant
University cancer registries pleural malignancy
mesothelioma constituted about 4.4%.
constituted 1.4% ranking 16th (3).
Occupational exposure to asbestos accounts for

Received: 17/9/2017 DOI: 10.12816/0042979
Accepted: 26/9/2017

Full Paper (vol.701 paper# 27)

c:\work\Jor\vol701_28 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 171-176

Patient Compliance in Laparoscopic Cholecystectomy versus
Open Cholecystectomy
Ahmed Bahjat A Alghamdi1, Zaid Ahmad M Alzahrani1, Majed Dakhel Almutairi2,
Naif Negikhan Alotaibi2, Omar AbdulAziz Yamani Alzahrani3
1 Ibn Sina National College for Medical Studies, 2 Qassim University, 3 King AbdulAziz University
Corresponding Author: Ahmed Bahjat A Alghamdi - Ahmedbahjat@hotmail.com - 0501122786

Gallbladder disease is one of the most mutual procedures done worldwide. Earlier, an open technique
was the regular procedure for cholecystectomy. This typically encompassed performing an intraoperative
cholangiogram, and individuals regularly had a two to six-day post-operative hospital stay. With the
introduction of laparoscopic surgery and the laparoscopic cholecystectomy in the early 1990s, the standards
for cholecystectomy have changed to a laparoscopic technique. This technique presented a 30% increase in
the overall performance of elective cholecystectomies. Nowadays, 92% of all cholecystectomies are
performed laparoscopically. There are numerous signs in performing open cholecystectomies, and this
procedure residues a significant part of training for the general surgery resident. Laparoscopic
cholecystectomy is indicated for the treatment of cholecystitis (acute/chronic), gallstone pancreatitis,
acalculous cholecystitis, biliary dyskinesia, symptomatic cholelithiasis, and gallbladder masses/polyps.
These indications are the same for an open cholecystectomy. Cases of gallbladder cancers are usually best
treated with open cholecystectomy.
Keywords: Gallbladder, Laparoscopic cholecystectomy, symptomatic gallstones, open cholecystectomy,
Cholecystitis, Choledocholithiasis.


Gallbladder disease is one of the most
into the strategy of decision for routine gallbladder
mutual procedures done worldwide. Earlier, an
removal and is at present the most usually
open technique was the regular procedure for
performed significant abdominal method in
cholecystectomy. This typically encompassed
Western nations [2].
performing an intraoperative cholangiogram, and
A National Institutes of Health agreement
individuals regularly had a two to six-day post-
statement in 1992 expressed that laparoscopic
[1]. Laparoscopic
cholecystectomy gives a secure and effective
cholecystectomy is a minimally invasive surgical
treatment for most patients with symptomatic
procedure for removal of a diseased gallbladder [2].
gallstones and has turned into the treatment of
Most open cholecystectomies performed to
decision for several patients [4]. This method has
deliver symptoms associated to biliary colic from
pretty much-finished endeavors at the noninvasive
cholelithiasis, to treat complications of gallstones
administration of gallstones.
(e.g., acute cholecystitis and biliary pancreatitis),
Laparoscopic cholecystectomy diminishes
or as incidental cholecystectomies performed
postoperative discomfort, reduces the requirement
during other open abdominal procedures.
for postoperative analgesia, reduces the hospital
Laparoscopic cholecystectomy is indicated for the
stay from 1 week to less than 24 hours, and returns
the patient to full movement inside 1 week
gallstone pancreatitis, acalculous cholecystitis,
biliary dyskinesia, symptomatic cholelithiasis, and
cholecystectomy). Laparoscopic cholecystectomy
gallbladder masses/polyps. These indications are
likewise gives enhanced cosmesis and enhanced
the same for an open cholecystectomy. Cases of
patient fulfillment as contrasted and open
gallbladder cancers are usually best treated with
cholecystectomy [5, 6]. Although direct operating
open cholecystectomy [3]. While the reality of the
room and recovery room costs are higher for
matter is that no operation has been more
laparoscopic cholecystectomy, the reduced length
significantly influenced by the appearance of
of hospital stay indicates to cost savings. Quicker
laparoscopy than cholecystectomy has, it is
return to typical activity can lead to indirect cost
similarly genuine that no method has been more
savings [7]. In lower-income countries, open
instrumental in introducing the laparoscopic age
cholecystectomy can be more cost-effective than
the laparoscopic comparable and can consequently
Laparoscopic cholecystectomy has quickly turned
be desired on that basis [8].

Received:21/9/2017 DOI:10.12816/0042980
Accepted: 30/9/2017

Full Paper (vol.701 paper# 28)

c:\work\Jor\vol701_29 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 177-180

Profile of Skin Biopsies and Skin Cancer Subtypes in Hail Region,
A Three Years Retrospective Study
Fouad Taiwilaa Alshammari, Saleh Muflih Alghaythi,
Mohammed Abdulrazaq Alharbi, Fawwaz Alshammrie
University of Hail
Corresponding Author: Fouad Taiwilaa Alshammari, , email: F-3033@hotmail.com, 0507214746

: to analyze the spectrum of skin lesions at our institute, and study the age, sex and anatomic
distribution pattern. We will also classify the lesions into major categories and determine the incidence of
each subcategory.
Materials and Methods: we carried a three and half year's retrospective study of skin biopsies which were
collected from King Khalid Hospital recording system in Hail region in a time period from January 2014 till
April 2017.Results: The highest percentage was in the age group 30-39 year (25.1%) with a male
preponderance of 52.8%. The head, neck and face were most frequently involved body parts (46.06%). Cysts
were the most common (32.3%) which included the sub-types epidermoid cyst, ganglion, dermoid cyst, pilar
cyst and brachial cleft cyst. Nevi (19.4%) including intradermal nevus, congenital nevus and blue nevus were
the second most common skin lesion. Correlation with the histopathologic diagnosis was positive in 94.9%
cases and negative in 5.1% cases.
Keywords: Biopsy, Histopathology, Dermatopathology, Skin lesions


The skin is the largest organ in the body,
published are based on clinical studies rather than
which functions as a protection for internal organs
histopathological ones.
against environmental insults and regulates
Skin cancer is the most prevalent malignancy
temperature. The skin is the most exposed organ to
among Caucasians. It accounts for approximately
sunlight and other forms environmental hazards (1).
20-30% of all malignancies in Caucasians and 1-
The management of skin diseases requires an
2% among those with colored skin (7). There are
accurate diagnosis, which in many instances
two subtypes of skin cancer: malignant melanoma,
constitutes a complex process (2). Skin biopsy is a
which is less common, but more aggressive; and
fundamental investigation in dermatology, where
non-melanoma type, a common, yet not so
histopathologic finding assists in determining
aggressive (8). According to Skin Cancer
disease pattern as well as morphological
Foundation Statistics, malignant melanoma is the
correlations (1). Skin biopsies are routinely
19th most common malignant in the world, with
undertaken in the outpatient dermatology setting as
nearly 232,000 new cases diagnosed in 2012 (2% of
a tool to diagnose benign tumors, malignant
the total) (8).
cancers, and inflammatory skin lesions. They are
Non melanoma skin cancer (NMSC) differs
the link that allows dermatologists and dermato-
according to geographic location across the globe.
pathologists to participate in the treatment of
Development of basal cell carcinoma (BCC) has
patients (3).Dermatologists often depend on skin
been attributed to prolonged, intense UV exposure,
biopsy for finalizing their diagnostic abilities (2).
occurring commonly after the fifth decade of life.
Skin diseases are common and may be the cause of
BCC is the most common skin cancer among
considerable morbidity, especially in elderly (1). The
Caucasians, Chinese and Japanese (9). Squamous
prevalence of skin diseases varies widely according
cell carcinoma (SCC) in heavily pigmented skin is
to various geographical regions and is affected by
often associated with scarring. A myriad of chronic
many factors such as environmental, genetic,
dermatoses have been associated with malignant
dietary, hygiene and others (2). There are a few
potential for development of SCC (10). Furthermore,
published reports on the pattern of skin disease in
exposure to sunlight is the major cause of NMSC.
general, (3-6) and most, if not all studies which are
The incidence of SCC increases more with age and

with growing sun exposure (11). There are only few
Received: 21/9/2017 DOI: 10.12816/0042981
Accepted: 30/9/2017

Full Paper (vol.701 paper# 29)

c:\work\Jor\vol701_30 The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (1), Page 181-186

Nonalcoholic Fatty Liver Disease (NAFLD)
Abrar Mohammed Noor Gashgari1, Khalid Mohamad Alhusainy2, Fahad Obaid Eid Alharbi3,
Al Qahtany Faisal Hani M4, Abdulaziz Mohammed Omer1, Abdulaziz Hamad Alali5,
Firas Ibrahim Moharaq6, Ziad Marwan Soufi1, Khaled Rashad Boundaqji7,
Rayyan Ibrahim Sayyal7, Hesham Mohammed Alsharif8
1 Baterjee Medical Collage, 2 Majmaah University, 3 Qassim University,
4 Imam Abdulrahman Bin Faisal University, 5 Imam Mohammed Bin Saud University,
6 Umm Al Qura University, 7 Ibn Sina National College, 8 Taif University
Corresponding Author: Abrar Mohammed Noor Gashgari ­ email: A.gashgari@ymail.com ­ Tel: +966500024025

Nonalcoholic fatty liver disease is the most frequent cause of liver disease across the world. Its
pathophysiology is considered multifaceted and is controlled by numerous mechanisms comprising
environmental, metabolic, genetic, and gut microbial factors. Diagnosis of nonalcoholic fatty liver disease poses
a challenge owing to its subtle and non-specific presentation.
we conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE
from January 1987 to March 2017. The following search terms were used: fatty liver disease, nonalcoholic liver
disease, chronic liver disease, diagnosis and management of liver pathology
Aim of the work: In this study we aimed to understand about the pathophysiology, diagnosis, management and
prognosis of nonalcoholic fatty liver disease.
Conclusion: More studies must be done to formulate a more definite and reliable diagnostic method. General
practitioners and specialists must be informed of the possible manifestation sings to keep higher degree of
suspicion. Once NAFLD is established, frequent follow-up and proper management can reduce complications
and improve prognosis.
Keywords: nonalcoholic fatty liver disease, chronic liver disease, liver disease in adults


Nonalcoholic fatty liver disease (NAFLD) is the
We conducted this review using a comprehensive
most frequent cause of liver disease globally with
search of MEDLINE, PubMed and EMBASE from
ranging from 25% to 45%, increasing in association
January 1987 to March 2017. The following search
with obesity and diabetes. Most recent estimates
terms were used: fatty liver disease, nonalcoholic
suggest that 68% of adults in US are overweight or
liver disease, chronic liver disease, diagnosis and
obese; from the expected prevalence of 75 to 100
management of liver pathology
million individuals in the United States are likely to
· Data extraction
have NAFLD [1]. NAFLD was first described in 1980
Two reviewers have independently reviewed the
and is classified into categories based on histology:
studies, abstracted data and disagreements were
(1) nonalcoholic fatty liver, which comprises patients
resolved by consensus. Studies were evaluated for
with isolated hepatic steatosis and patients with
quality and a review protocol was followed
steatosis along with mild and nonspecific
The study was done after approval of ethical
(2) nonalcoholic steatohepatitis, which varies from
board of King Abdulaziz University.
the former by the further presence of features of

hepatocellular injury which could occur with or
without fibrosis. Nonalcoholic steatohepatitis is
Nonalcoholic steatohepatitis is a multifaceted
defined as the progressive subtype of NAFLD;
disease that is controlled by numerous mechanisms
nevertheless, data suggested that hepatic steatosis
comprising environmental, metabolic, genetic, and
with inflammation has a distinct and more
gut microbial factors. Even though the presence of
progressive natural history than hepatic steatosis [2].
steatosis is necessary for nonalcoholic steatohepatitis,

the specific mechanisms that cause one patient to
grow nonalcoholic steatohepatitis and others to have
· Data Sources and search terms
isolated steatosis only are not well defined [2].
Received: 07/10/2017 DOI: 10.12816/0042982
Accepted: 17/10/2017

Full Paper (vol.701 paper# 30)